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Desai TS, Hulst JM, Bandsma R, Mehta S. Nutrition in pediatric end-stage liver disease. Curr Opin Clin Nutr Metab Care 2024; 27:492-498. [PMID: 39302271 DOI: 10.1097/mco.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to outline recent studies relating to nutritional status and outcomes in pediatric end-stage liver disease. MAIN FINDINGS Pediatric patients with chronic and end-stage liver disease are at high risk of malnutrition. Given additional growth demands in children and the inherent complications of chronic liver disease, achieving adequate nutrition in these patients remains a challenge. In addition, while guidelines on nutrition in chronic liver disease exist, global approaches and definitions of malnutrition vary. Recent literature has focused on sarcopenia and nutrition-related transplant outcomes, with some studies exploring nutritional assessment and management. Pediatric studies however continue to lag adult research, with limited prospective and interventional studies. SUMMARY Optimizing nutrition in pediatric end-stage liver disease remains a challenge, however understanding of the mechanisms and clinical manifestations of malnutrition in this population is improving. Despite these efforts, high quality studies to determine optimal nutrition strategies and interventions are lacking behind adult evidence and should be the focus of future research.
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Affiliation(s)
- Tejas S Desai
- The Hospital for Sick Children, Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition
- Department of Pediatrics
| | - Jessie M Hulst
- The Hospital for Sick Children, Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition
- Department of Pediatrics
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Robert Bandsma
- The Hospital for Sick Children, Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition
- Department of Pediatrics
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sagar Mehta
- The Hospital for Sick Children, Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition
- Department of Pediatrics
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Létourneau J, Bélanger V, Marchand V, Boctor DL, Rashid M, Avinashi V, Groleau V, Spahis S, Levy E, Marcil V. Post-discharge complications and hospital readmissions are associated with nutritional risk and malnutrition status in a cohort of Canadian pediatric patients. BMC Pediatr 2024; 24:469. [PMID: 39044205 PMCID: PMC11265476 DOI: 10.1186/s12887-024-04941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND This study constitutes a secondary analysis of a prospective cohort aiming to evaluate the potential correlation between nutritional risk and status at admission with the occurrence of post-discharge complications and hospital readmissions in children receiving care at high resource Centres. METHODS Data was collected from 5 Canadian tertiary pediatric Centers between 2012 and 2016. Nutritional risk and status were evaluated at hospital admission with validated tools (STRONGkids and Subjective Global Nutrition Assessment [SGNA]) and anthropometric measurements. Thirty days after discharge, occurrence of post-discharge complications and hospital readmission were documented. RESULTS A total of 360 participants were included in the study (median age, 6.1 years; median length of stay, 5 days). Following discharge, 24.1% experienced complications and 19.5% were readmitted to the hospital. The odds of experiencing complications were nearly tripled for participants with a high nutritional risk compared to a low risk (OR = 2.85; 95% CI [1.08-7.54]; P = 0.035) and those whose caregivers reported having a poor compared to a good appetite (OR = 2.96; 95% CI [1.59-5.50]; P < 0.001). According to SGNA, patients identified as malnourished had significantly higher odds of complications (OR, 1.92; 95% CI, 1.15-3.20; P = 0.013) and hospital readmission (OR, 1.95; 95% CI, 1.12-3.39; P = 0.017) than to those well-nourished. CONCLUSIONS This study showed that complications and readmission post-discharge are common, and these are more likely to occur in malnourished children compared to their well-nourished counterparts. Enhancing nutritional care during admission, at discharge and in the community may be an area for future outcome optimization.
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Affiliation(s)
- Joëlle Létourneau
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Véronique Bélanger
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marchand
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Dana L Boctor
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mohsin Rashid
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Vishal Avinashi
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Véronique Groleau
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Schohraya Spahis
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Emile Levy
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marcil
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada.
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Menon J, Shanmugam NP. Nutrition in Pediatric Liver Disease. Indian J Pediatr 2024; 91:366-373. [PMID: 38324201 DOI: 10.1007/s12098-024-05036-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
In liver disease, there is derangement of appetite, digestion, absorption, assimilation, storage and metabolism of both macro and micronutrients. These derangements have an impact on mortality and morbidity associated with liver diseases. In infants, breast feeds should not be stopped unless there are compelling reasons such as underlying metabolic problem. Parenteral nutrition should be considered only if, oral or nasogastric feeding is not possible. The effect of malnutrition on liver disease and impact of liver failure on nutrition is vicious and nutritional intervention has to be done at the earliest to break that vicious cycle. This chapter gives an overview of nutritional management in acute and chronic liver diseases in children and also its impact on specific clinical scenarios including liver transplantation.
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Affiliation(s)
- Jagadeesh Menon
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Naresh P Shanmugam
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
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Ong SH, Chen ST, Chee WSS. Validation of AND/ASPEN pediatric malnutrition diagnosis in children admitted to medical wards in two tertiary hospitals in Malaysia. Nutr Clin Pract 2023. [PMID: 36811458 DOI: 10.1002/ncp.10971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Identification and management of malnutrition among pediatric hospitalized patients is critical for improved clinical outcomes and recovery. This study investigated the use of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) pediatric malnutrition diagnosis in comparison with the Subjective Global Nutritional Assessment (SGNA) tool and single anthropometric indicators (weight, height, body mass index, and mid-upper arm circumference) among hospitalized children. METHODS A cross-sectional study was conducted among 260 children admitted to general medical wards. SGNA and anthropometric measurements were used as references. Kappa agreement, diagnostic values, and area under the curve (AUC) were analyzed to evaluate the diagnostic ability of the AND/ASPEN malnutrition diagnosis tool. Logistic binary regression was performed to determine the predictive ability of each malnutrition diagnosis tool on the length of hospital stay. RESULTS The AND/ASPEN diagnosis tool detected the highest malnutrition rate (41%) among the hospitalized children in comparison with the reference methods. This tool demonstrated fair specificity of 74% and sensitivity of 70% compared with the SGNA. It obtained a weak agreement in determining the presence of malnutrition by kappa (0.06-0.42) and receiver operating characteristic curve analysis (AUC = 0.54-0.72). The use of the AND/ASPEN tool obtained an odds ratio of 0.84 (95% CI, 0.44-1.61; P = 0.59) in predicting the length of hospital stay. CONCLUSIONS The AND/ASPEN malnutrition tool is an acceptable nutrition assessment tool for hospitalized children in general medical wards.
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Affiliation(s)
- Shu Hwa Ong
- Institute of Research Development and Innovation, International Medical University, Kuala Lumpur, Malaysia
| | - Seong Ting Chen
- Division of Nutrition and Dietetics, International Medical University, Kuala Lumpur, Malaysia
| | - Winnie Siew Swee Chee
- Division of Nutrition and Dietetics, International Medical University, Kuala Lumpur, Malaysia
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