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Marino LV, Paulson S, Ashton JJ, Weeks C, Young A, Pappachan JVP, Swann JR, Johnson MJ, Beattie RM. A scoping review: urinary markers of metabolic maturation in infants with CHD and the relationship to growth. Cardiol Young 2023; 33:1879-1888. [PMID: 36325968 DOI: 10.1017/s1047951122003262] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Growth failure in infants born with CHD is a persistent problem, even in those provided with adequate nutrition. OBJECTIVE To summarise the published data describing the change in urinary metabolites during metabolic maturation in infants with CHD and identify pathways amenable to therapeutic intervention. DESIGN Scoping review. ELIGIBILITY CRITERIA Studies using qualitative or quantitative methods to describe urinary metabolites pre- and post-cardiac surgery and the relationship with growth in infants with CHD. SOURCES OF EVIDENCE NICE Healthcare Databases website was used as a tool for multiple searches. RESULTS 347 records were identified, of which 37 were duplicates. Following the removal of duplicate records, 310 record abstracts and titles were screened for inclusion. The full texts of eight articles were reviewed for eligibility, of which only two related to infants with CHD. The studies included in the scoping review described urinary metabolites in 42 infants. A content analysis identified two overarching themes of metabolic variation predictive of neurodevelopmental abnormalities associated with anaerobic metabolism and metabolic signature associated with the impact on gut microbiota, inflammation, energy, and lipid digestion. CONCLUSION The results of this scoping review suggest that there are considerable gaps in our knowledge relating to metabolic maturation of infants with CHD, especially with respect to growth. Surgery is a key early life feature for CHD infants and has an impact on the developing biochemical phenotype with implications for metabolic pathways involved in immunomodulation, energy, gut microbial, and lipid metabolism. These early life fingerprints may predict those individuals at risk for neurodevelopmental abnormalities.
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Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust; Faculty of Health Science, University of Southampton, Southampton, UK
| | - Simone Paulson
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton, UK
| | - James J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Charlotte Weeks
- Paediatric Intensive Care Unit, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aneurin Young
- Department of Neonatal Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust and NIHR Southampton Biomedical Research Centre, UK
| | - John V P Pappachan
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Medicine, University of Southampton, Southampton, UK
| | - John R Swann
- Biomolecular Medicine, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark J Johnson
- Neonatal Medicine, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust; Faculty of Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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Macena MDL, Silva Júnior AED, Praxedes DRS, Leite FMDB, Silva Neto LGR, Pureza IRDOM, Florêncio TMDMT, Bueno NB. Association between phase angle and height-to-age index classifications of children under five years of age. Clin Nutr ESPEN 2021; 44:367-371. [PMID: 34330491 DOI: 10.1016/j.clnesp.2021.05.013] [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: 01/12/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS The phase angle (PA) has been used as an indicator of prognosis and nutritional status because it reflects the integrity of the individuals' cellular function. In contrast to the investigations that assessed acute malnutrition (weight deficit) and PA in children, studies that evaluated the relationship of this indicator with stunting (height deficit) are still scarce and inconclusive. Thus, we aim to investigate whether there are differences in PA according to the classifications of the height-for-age (H/A) index of children under five years of age. METHODS This is a cross-sectional study carried out in a nutritional recovery center, in households, and in a daycare center in Maceió-Alagoas, Brazil. Anthropometric data were collected, and resistance and reactance were obtained through the use of tetrapolar electrical bioimpedance, from children aged 2-5 years. The PA and the percentage of body fat were calculated. Children were divided into 3 groups: adequate H/A, at-risk of stunting and stunted. Analysis of covariance for the main outcome was performed using age, sex, and the body mass index-to-age as covariates, and the H/A classification as the exposure. RESULTS The mean children's PA in the adequate H/A group was 3.9° [95% CI 3.6-4.2], while in the group at-risk of stunting and stunted it was 4.5° [95% CI 4.3-4.7] and 4.6° [95% CI 4.4-4.8], respectively, showing statistical difference (p < 0.01). CONCLUSION In the present sample, stunted children have higher PA values than children with adequate H/A.
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Affiliation(s)
- Mateus de Lima Macena
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, 57072-970, Brazil.
| | | | | | | | | | | | | | - Nassib Bezerra Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, 57072-970, Brazil.
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Myatchin I, Abraham P, Malbrain MLNG. Bio-electrical impedance analysis in critically ill patients: are we ready for prime time? J Clin Monit Comput 2020; 34:401-410. [PMID: 31808061 PMCID: PMC7223384 DOI: 10.1007/s10877-019-00439-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ivan Myatchin
- Department Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium
- Department Anaesthesiology, Sint-Trudo Regional Hospital, Sint-Truiden, Belgium
| | - Paul Abraham
- Anaesthesiology and Critical Care Medicine Department, Hôpital Edouard-Herriot, Lyon Cedex 03, France
| | - Manu L N G Malbrain
- Department Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium.
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Elsene, Belgium.
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Marino LV, Harris A, Johnstone C, Friend A, Newell C, Miles EA, Lucas JS, Calder PC, Walker WT. Characterising the nutritional status of children with primary ciliary dyskinesia. Clin Nutr 2018; 38:2127-2135. [PMID: 30243504 DOI: 10.1016/j.clnu.2018.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/28/2018] [Accepted: 08/25/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a rare, heterogeneous genetic disorder where impaired mucociliary clearance is caused by dysfunctional motile cilia leading to bronchiectasis. There is limited evidence characterising the nutritional status of children with PCD, although lower body mass index (BMI) z-score has been associated with worse lung function (FEV1). METHODS All children (n = 43) with PCD, aged <16 years, from a single tertiary centre were prospectively enrolled. Information on clinical phenotype and nutritional status including bioelectrical impedance spectroscopy (BIS) phase-angle was collected. RESULTS There was a weak positive association between height-for-age z-score (HAZ) and FEV1 z-score (n = 28, r = 0.4, p = 0.049). Those with a low fat free mass index (<-2 z scores) had a lower BMI z score (-1.3 ± 1.2 vs. 0.8 ± 0.7, p = 0.0002). BIS phase angle identified more patients at nutritional risk than using moderate malnutrition cut-offs of either HAZ or BMI ≤ -2 z scores alone (21% vs. 4.6% vs. 6.9% respectively). PCD patients had a higher incidence of vitamin D insufficiency (<50 nmoL/L) (54%) and deficiency (<30 nmoL/L) (26%) than healthy children. CONCLUSIONS We have characterised the nutritional phenotype of a cohort of children with PCD. Monitoring vitamin D levels is important in PCD patients. There is a weak association between lung function and nutritional status, and measures of BIS phase-angle. The use of BIS phase-angle may allow for early identification of at risk children and may therefore be of benefit for nutritional assessments in the clinical setting. These findings will help inform a future nutritional intervention strategy in children with PCD.
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Affiliation(s)
- L V Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
| | - A Harris
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Johnstone
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Friend
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Newell
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - E A Miles
- Human Development & Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J S Lucas
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P C Calder
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Human Development & Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - W T Walker
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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