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Saxena R, Agrawal T, Saxen R, Pathak M, Nayak S, Jadhav AS, Rathod KJ, Sinha A. Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. Pediatr Surg Int 2024; 40:156. [PMID: 38871828 DOI: 10.1007/s00383-024-05736-7] [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] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
AIM To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. METHODOLOGY This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien-Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes. RESULTS There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A-67.2%, Group B-82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). CONCLUSION In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.
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Affiliation(s)
- Rahul Saxena
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India.
| | - Tripti Agrawal
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Rahul Saxen
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Manish Pathak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Shubhalaxmi Nayak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Avinash Sukdev Jadhav
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Kirtikumar J Rathod
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Arvind Sinha
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
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Rompca A, McCallister A, Cruse W, Webber EC, Vanderpool C. Education and documentation strategies to improve malnutrition diagnosis in hospitalized children: A quality improvement project. Nutr Clin Pract 2024; 39:696-701. [PMID: 37817534 DOI: 10.1002/ncp.11080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) published malnutrition guidelines in 2014. In 2015, our institution implemented a quality improvement project focused on malnutrition identification with the goal to improve the diagnosis of malnutrition in hospitalized children. METHODS Our project included three approaches: education, nutrition assessment, and documentation initiatives. Education initiatives focused on physicians at all levels of training. Nutrition screening was completed on all patients admitted to our institution. Registered dietitians (RDs) conducted nutrition assessments and identified and documented malnutrition based on AND/ASPEN guidelines. Documentation initiatives included development of automatic text and template changes to allow import of RD-assigned malnutrition diagnosis into physician documentation. We met with members of our clinical documentation integrity team regularly to review the results of these initiatives starting in 2016. RESULTS The total diagnosed cases of malnutrition increased from 208 cases in 2016 at the start of our monitoring to >800 cases per year in 2020-2022. Unspecified (no severity assigned) protein calorie malnutrition as a percentage of total malnutrition diagnoses decreased from 36.9% in 2016 to <10% since 2018. Children with severe malnutrition have remained the largest portion of children with a malnutrition diagnosis, with >40% of children with malnutrition diagnosed with severe malnutrition. CONCLUSION Our education and documentation initiatives have led to both improved diagnosis of malnutrition and accurate identification and documentation of malnutrition severity. These initiatives could be utilized to improve malnutrition diagnosis and documentation at other institutions caring for hospitalized children.
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Affiliation(s)
- Annemarie Rompca
- Division of Pediatric Gastroenterology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Anne McCallister
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Wendy Cruse
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Emily C Webber
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Division of Pediatric Hospital Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Charles Vanderpool
- Division of Pediatric Gastroenterology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
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Bellini SG, Johnson J, McDonald CM, Culhane S, Snell Y, Eggett D. Developing a nutrition screening tool for children with cystic fibrosis ages 0 to 2 years: Children with cystic fibrosis nutrition screening tool. J Cyst Fibros 2024; 23:532-537. [PMID: 37926667 DOI: 10.1016/j.jcf.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND For children with cystic fibrosis (CF), achieving and maintaining optimal growth by the age of 2 years is critical for future health outcomes. A standardized nutrition screening is needed to identify growth problems, enable timely interventions, and improve nutritional outcomes for children (0 to 2 years) with CF. The purpose of this study was to develop a nutrition screening tool for children (0 to 2 years) with CF to identify nutrition risk at every clinical encounter. METHODS A retrospective cross-sectional study was used to develop a nutrition screening tool to determine if nutrition interventions needed to change (at-risk) or continue (not at-risk). Retrospective data for pertinent nutrition factors were collected for 99 children attending an accredited CF clinic. The nutrition factors were compared to a dietitian assessment. A stepwise discriminant analysis determined weight-for-age (WFA) and weight-for-length (WFL) z-scores were significant. Then anthropometric data and corresponding dietitian assessment results were collected for children with CF attending two other accredited CF clinics (n = 29, n = 30). Discriminant analysis was used to determine sensitivity and specificity of the nutrition factors and to create a nutrition screening tool equation. RESULTS The nutrition screening model that included WFA z-score, LFA z-score, WFL z-score, and weight change velocity adequacy determined nutrition risk the best. The sensitivity was 89.7 %, specificity 83.2 %, NPV 93.3 %, and PPV 75.4 % for this model. CONCLUSION The nutrition screening tool equation developed in this study standardizes the process to identify children (0 to 2 years) with CF at nutrition risk. Further validation is needed.
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Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, S219 ESC, Provo, UT 84602, United States.
| | - Jessica Johnson
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, S219 ESC, Provo, UT 84602, United States; Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States
| | - Catherine M McDonald
- Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, United States
| | - Suzanne Culhane
- Texas Children's Hospital, 6621 Fannin St, M/C2-3521, Houston, TX 77030, United States
| | - Yungjing Snell
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, United States
| | - Dennis Eggett
- Department of Statistics, Brigham Young University, 2152 WVB, Provo, UT 84602, United States
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Huot JR, Livingston PD, Pin F, Thomas CR, Jamnick NA, Callaway CS, Bonetto A. Long-term Musculoskeletal Consequences of Chemotherapy in Pediatric Mice. FUNCTION 2024; 5:zqae011. [PMID: 38706958 PMCID: PMC11065107 DOI: 10.1093/function/zqae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/08/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024] Open
Abstract
Thanks to recent progress in cancer research, most children treated for cancer survive into adulthood. Nevertheless, the long-term consequences of anticancer agents are understudied, especially in the pediatric population. We and others have shown that routinely administered chemotherapeutics drive musculoskeletal alterations, which contribute to increased treatment-related toxicity and long-term morbidity. Yet, the nature and scope of these enduring musculoskeletal defects following anticancer treatments and whether they can potentially impact growth and quality of life in young individuals remain to be elucidated. Here, we aimed at investigating the persistent musculoskeletal consequences of chemotherapy in young (pediatric) mice. Four-week-old male mice were administered a combination of 5-FU, leucovorin, irinotecan (a.k.a., Folfiri) or the vehicle for up to 5 wk. At time of sacrifice, skeletal muscle, bones, and other tissues were collected, processed, and stored for further analyses. In another set of experiments, chemotherapy-treated mice were monitored for up to 4 wk after cessation of treatment. Overall, the growth rate was significantly slower in the chemotherapy-treated animals, resulting in diminished lean and fat mass, as well as significantly smaller skeletal muscles. Interestingly, 4 wk after cessation of the treatment, the animals exposed to chemotherapy showed persistent musculoskeletal defects, including muscle innervation deficits and abnormal mitochondrial homeostasis. Altogether, our data support that anticancer treatments may lead to long-lasting musculoskeletal complications in actively growing pediatric mice and support the need for further studies to determine the mechanisms responsible for these complications, so that new therapies to prevent or diminish chemotherapy-related toxicities can be identified.
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Affiliation(s)
- Joshua R Huot
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
- Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis, IN, 46202 USA
| | - Patrick D Livingston
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis, IN, 46202 USA
| | - Fabrizio Pin
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
- Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
| | - Connor R Thomas
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202 USA
| | - Nicholas A Jamnick
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045 USA
| | - Chandler S Callaway
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045 USA
| | - Andrea Bonetto
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045 USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045 USA
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Raina R, Suchan A, Soundararajan A, Brown AM, Davenport A, Shih WV, Nada A, Irving SY, Mannemuddhu SS, Vitale VS, Crugnale AS, Keller GL, Berry KG, Zieg J, Alhasan K, Guzzo I, Lussier NH, Yap HK, Bunchman TE, Sethi SK. Nutrition in critically ill children with acute kidney injury on continuous kidney replacement therapy: a 2023 executive summary. Nutrition 2024; 119:112272. [PMID: 38118382 DOI: 10.1016/j.nut.2023.112272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/04/2023] [Accepted: 10/21/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Nutrition plays a vital role in the outcome of critical illness in children, particularly those with acute kidney injury. Currently, there are no established guidelines for children with acute kidney injury treated with continuous kidney replacement therapy. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with acute kidney injury receiving continuous kidney replacement therapy. METHODS An electronic search using PubMed and an inclusive academic library search (including MEDLINE, Cochrane, and Embase databases) was conducted to find relevant English-language articles on nutrition therapy for children (<18 y of age) receiving continuous kidney replacement therapy. RESULTS The existing literature was reviewed by our work group, comprising pediatric nephrologists and experts in nutrition. The modified Delphi method was then used to develop a total of 45 clinical practice points. The best methods for nutritional assessment are discussed. Indirect calorimetry is the most reliable method of predicting resting energy expenditure in children on continuous kidney replacement therapy. Schofield equations can be used when indirect calorimetry is not available. The non-intentional calories contributed by continuous kidney replacement therapy should also be accounted for during caloric dosing. Protein supplementation should be increased to account for the proteins, peptides, and amino acids lost with continuous kidney replacement therapy. CONCLUSIONS Clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with acute kidney injury and on continuous kidney replacement therapy based on the existing literature and expert opinions of a multidisciplinary panel.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA; Akron Children's Hospital, Akron, Ohio, USA.
| | - Andrew Suchan
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | | | - Ann-Marie Brown
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Children's Healthcare of Atlanta, Atlanta, Georgia, USA; ECU Health, Greenville, North Carolina, USA
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Weiwen V Shih
- Children's Hospital Colorado, University of Colorado, Section of Pediatric Nephrology, Aurora, Colorado, USA
| | - Arwa Nada
- Division of Pediatric Nephrology, Department of Pediatrics, Le Bonheur Children's Hospital and St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sai Sudha Mannemuddhu
- Division of Pediatric Nephrology, East Tennessee Children's Hospital, Knoxville, Tennessee, USA; Department of Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Aylin S Crugnale
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA
| | | | - Katarina G Berry
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jakub Zieg
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Khalid Alhasan
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Isabella Guzzo
- Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | | | - Hui Kim Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Timothy E Bunchman
- Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sidharth K Sethi
- Department of Pediatric Nephrology, Kidney Institute, Medanta-The Medicity, Gurgaon, India
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Raina R, Suchan A, Sethi SK, Soundararajan A, Vitale VS, Keller GL, Brown AM, Davenport A, Shih WV, Nada A, Irving SY, Mannemuddhu SS, Crugnale AS, Myneni A, Berry KG, Zieg J, Alhasan K, Guzzo I, Lussier NH, Yap HK, Bunchman TE. Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations. KIDNEY360 2024; 5:285-309. [PMID: 38112754 PMCID: PMC10914214 DOI: 10.34067/kid.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Nutrition plays a vital role in the outcome of critically ill children, particularly those with AKI. Currently, there are no established guidelines for children with AKI treated with continuous RRT (CRRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CRRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CRRT. METHODS PubMed, MEDLINE, Cochrane, and Embase databases were searched for articles related to the topic. Expertise of the authors and a consensus of the workgroup were additional sources of data in the article. Available articles on nutrition therapy in pediatric patients receiving CRRT through January 2023. RESULTS On the basis of the literature review, the current evidence base was examined by a panel of experts in pediatric nephrology and nutrition. The panel used the literature review as well as their expertise to formulate clinical practice points. The modified Delphi method was used to identify and refine clinical practice points. CONCLUSIONS Forty-four clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CRRT on the basis of the existing literature and expert opinions of a multidisciplinary panel.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio
- Akron Children's Hospital, Akron, Ohio
| | - Andrew Suchan
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Sidharth K. Sethi
- Department of Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, India
| | - Anvitha Soundararajan
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | | | | | - Ann-Marie Brown
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
- ECU Health, Greenville, North Carolina
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, United Kingdom
| | - Weiwen V. Shih
- Section of Pediatric Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Arwa Nada
- Department of Pediatrics, Division of Pediatric Nephrology, Le Bonheur Children's & St. Jude Children's Research Hospitals, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sharon Y. Irving
- Children's Hospital of Philadelphia, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Sai Sudha Mannemuddhu
- Division of Pediatric Nephrology, East Tennessee Children's Hospital, Knoxville, Tennessee
- Department of Medicine, University of Tennessee at Knoxville, Knoxville, Tennessee
| | - Aylin S. Crugnale
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Archana Myneni
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Katarina G. Berry
- Children's Hospital of Philadelphia, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Jakub Zieg
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Khalid Alhasan
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Isabella Guzzo
- Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | | | - Hui Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Timothy E. Bunchman
- Department of Pediatrics, Childrens Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
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Wong J, Densmore J, Hilbrands J, Elkadri A, Cabrera J, Noe J, Eickhoff J, Goday PS. Perioperative nutrition in the setting of pediatric inflammatory bowel disease. Nutr Clin Pract 2024; 39:184-192. [PMID: 37302062 DOI: 10.1002/ncp.11021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/10/2023] [Accepted: 04/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Optimization of nutrition prior to inflammatory bowel disease (IBD)-related surgery could improve outcomes. The aim of this study was to assess the perioperative nutrition status and management of children undergoing intestinal resection for treatment of their IBD. METHODS We identified all patients with IBD who underwent primary intestinal resection. We identified malnutrition using established criteria and methods of nutrition provision at various time points (preoperative outpatient evaluation, admission, and postoperative outpatient follow-up) for elective cases (who underwent their procedure at a scheduled admission) and urgent cases (who underwent an unplanned surgical intervention). We also recorded data on postsurgical complications. RESULTS A total of 84 patients were identified in this single-center study (male sex: 40%, mean age: 14.5 years, Crohn's disease: 65%). Thirty-four patients (40%) had some degree of malnutrition. Prevalence of malnutrition in the urgent and elective cohorts was similar (48% vs 36%; P = 0.37). Of these patients, 29 (34%) were noted to be on some type of nutrition supplementation prior to surgery. Postoperatively, BMI z scores increased (-0.61 vs -0.42; P = 0.0008), but the percentage of patients who were malnourished did not change from preoperative status (40% vs 40%; P = 0.10). Despite this, use of nutrition supplementation was only noted in 15 (17%) patients at postoperative follow-up. Complications were not associated with nutrition status. CONCLUSION Utilization of supplemental nutrition decreased postprocedure despite no change in malnutrition prevalence. These findings support the development of a pediatric-specific perioperative nutrition protocol in the setting of IBD-related surgery.
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Affiliation(s)
- Jonathan Wong
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - John Densmore
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julia Hilbrands
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Abdul Elkadri
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Jose Cabrera
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Josh Noe
- Department of Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Praveen S Goday
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
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Raiten DJ, Steiber AL, Dary O, Bremer AA. The Value of an Ecological Approach to Improve the Precision of Nutritional Assessment: Addressing Contributors and Implications of the "Multiple Burdens of Malnutrition". Nutrients 2024; 16:421. [PMID: 38337706 PMCID: PMC10857452 DOI: 10.3390/nu16030421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Globally, children are exposed to multiple health risks associated with diet and nutrition. Rather than simply being a condition of having too much or too little food, malnutrition is more a syndrome comprising multiple burdens of coexisting and reciprocal malnutrition, infection, or other conditions. Importantly, children with such syndromes (e.g., stunting and anemia, which are neither specific nor necessarily sensitive to nutritional status) are more likely to also have irreversible functional outcomes such as poor growth, impaired immune function, or cognitive delays. The global health community has identified nutrition-related targets (e.g., Sustainable Development Goals (SDGs) and World Health Organization (WHO) Global Nutrition Targets) that, for multiple reasons, are difficult to address. Moreover, as the complexity of the global health context increases with persistent pandemics of infectious diseases and the rising prevalence of noncommunicable diseases, there is a growing appreciation that conditions selected as nutrition/health targets indeed represent syndromes for which nutritional status serves as both an input and outcome. In recognition of the impact of these combined challenges and the role of the multiple manifestations of malnutrition, we suggest an approach to nutritional assessment that is intended to improve the precision of context-specific, equitable approaches to health promotion, disease prevention, and treatment.
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Affiliation(s)
- Daniel J. Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA;
| | | | - Omar Dary
- USAID, Bureau for Global Health, Division of Nutrition and Environmental Health, Washington, DC 20523, USA;
| | - Andrew A. Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA;
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Runco DV, DiMeglio LA, Vanderpool CP, Han Y, Daggy J, Kelley MM, Mikesell R, Zimmers TA. Growth differentiation factor 15 (GDF15) elevation in children with newly diagnosed cancer. Front Oncol 2023; 13:1295228. [PMID: 38146512 PMCID: PMC10749306 DOI: 10.3389/fonc.2023.1295228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Background Growth differentiation factor 15 (GDF15), an inflammatory marker and mediator of adult cancer cachexia, remains largely unexplored in children. GDF15 increases nausea, vomiting, and anorexia in cancer and contributes to malnutrition, with the potential to be a cachexia therapeutic target. No studies have examined GDF15 in children with newly diagnosed cancer. Our pilot study compares GDF15 in children with newly diagnosed cancer to age- and sex-matched controls and correlates levels with anthropometric measurements and quality of life (QOL). Methods Children with newly diagnosed cancer aged 2-21 years were enrolled with serum GDF15 ELISA, anthropometric measures [height, weight, and mid-upper arm circumference (MUAC)], and QOL assessments (using PedsQL™ Core and Gastrointestinal Modules), which were collected at baseline and repeated 3 months later. Serum GDF15 levels were obtained from age- and sex-matched controls for comparison. Results A total of 57 participants enrolled (N=30, cancer group; N=27, control group) with a median age of 8.8 years (IQR 5.6-15.9 years). The participants were primarily male (54.4%), white (82.5%), and non-Hispanic (82.5%). Cancer diagnoses included acute lymphoblastic leukemia (N=8), lymphoma (N=8), neuroblastoma (N=5), soft tissue tumors (N=4), acute myeloid leukemia (N=2), and single participants with brain, kidney, and bone tumors. Baseline GDF15 was higher in the cancer cohort compared to the control cohort (median=614.6pg/mL and 320.5pg/mL, respectively; p<0.001). When examining participants with evaluable baseline and 3-month follow-up GDF15 levels (N=18), GDF15 was not statistically different (median=657.1pg/mL and 675.3pg/mL, respectively; p=0.702). A total of 13 of the 30 participants and 21 caregivers completed the PedsQL™ Core and Gastrointestinal symptom modules. QOL scores did not differ significantly at 3-month follow-up compared to baseline, but diarrhea worsened (p=0.017). Median participant response for diarrhea at baseline was 92.9 (IQR=92.9-96.4; N=13), which was significantly better than the follow-up (median=78.6; IQR= 71.4-92.9; p=0.017). There were no correlations between change in height, weight, or MUAC and change in GDF15 levels (p=0.351, 0.920, and 0.269 respectively). Conclusion GDF15 was elevated in children with cancer at diagnosis compared to controls but did not correlate with anthropometric measurements or QOL. This pilot study will inform future prospective studies to better describe the natural history of GDF15 and its role in cachexia and as a potential therapeutic target.
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Affiliation(s)
- Daniel V. Runco
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Linda A. DiMeglio
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Charles P. Vanderpool
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yan Han
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joanne Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Mary M. Kelley
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Raya Mikesell
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Teresa A. Zimmers
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
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10
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Perlman M, Senger S, Verma S, Carey J, Faherty CS. A foundational approach to culture and analyze malnourished organoids. Gut Microbes 2023; 15:2248713. [PMID: 37724815 PMCID: PMC10512930 DOI: 10.1080/19490976.2023.2248713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
The gastrointestinal (GI) epithelium plays a major role in nutrient absorption, barrier formation, and innate immunity. The development of organoid-based methodology has significantly impacted the study of the GI epithelium, particularly in the fields of mucosal biology, immunity, and host-microbe interactions. Various effects on the GI epithelium, such as genetics and nutrition, impact patients and alter disease states. Thus, incorporating these effects into organoid-based models will facilitate a better understanding of disease progression and offer opportunities to evaluate therapeutic candidates. One condition that has a significant effect on the GI epithelium is malnutrition, and studying the mechanistic impacts of malnutrition would enhance our understanding of several pathologies. Therefore, the goal of this study was to begin to develop methodology to generate viable malnourished organoids with accessible techniques and resources that can be used for a wide array of mechanistic studies. By selectively limiting distinct macronutrient components of organoid media, we were able to successfully culture and evaluate malnourished organoids. Genetic and protein-based analyses were used to validate the approach and confirm the presence of known biomarkers of malnutrition. Additionally, as proof-of-concept, we utilized malnourished organoid-derived monolayers to evaluate the effect of malnourishment on barrier formation and the ability of the bacterial pathogen Shigella flexneri to infect the GI epithelium. This work serves as the basis for new and exciting techniques to alter the nutritional state of organoids and investigate the related impacts on the GI epithelium.
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Affiliation(s)
- Meryl Perlman
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stefania Senger
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
| | - Smriti Verma
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - James Carey
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
| | - Christina S. Faherty
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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11
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Klein LJ, Abdullahi SU, Gambo S, Stallings VA, Acra S, Rodeghier M, DeBaun MR. Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries. Blood Adv 2023; 7:6923-6930. [PMID: 37756514 PMCID: PMC10685159 DOI: 10.1182/bloodadvances.2023009711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/25/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Previously, we demonstrated that older children with sickle cell anemia (SCA) living in Nigeria are at increased risk of death if they are underweight (weight-for-age z score < -1). We now conducted a cross-sectional study in low- and high-income settings to determine the risk factors for being underweight a in children aged 5 to 12 years with SCA. The children from low- and high-income settings were eligible participants for the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria (SPRING; N = 928) and the Silent Cerebral Infarct (SIT, North America/Europe; N = 1093) trials, respectively. The median age in the SPRING and SIT cohorts was 8.1 and 8.5 years, respectively (P < .001). A total of 87.9% (n = 816) of participants in the SPRING trial (low-income) met the study criteria for being underweight (weight-for-age z score < -1), and 22.7% (n = 211) for severely underweight (weight-for-age z score < -3), significantly higher than the SIT (high-income) cohort at 25.7% underweight (n = 281) and 0.7% severely underweight (n = 8; P < .001 for both comparisons). In the combined cohort, older age (odds ratio [OR], 1.24; P < .001) and lower hemoglobin level (OR, 0.67; P < .001) were associated with being underweight. Age and hemoglobin level remained statistically significant in separate models for the SPRING and SIT cohorts. Older age and lower hemoglobin levels in children aged 5 to 12 years with SCA are associated with being underweight in low- and high-income settings.
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Affiliation(s)
- Lauren Jane Klein
- D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
| | - Shehu Umar Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Sari Acra
- D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | - Michael R. DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
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12
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Drayton AK, Knight RM, Shepard H, Andersen AS, Shriver D. Looking Beyond the Growth Curve: A Retrospective Study on Nutrient Deficient Diets in Children with Severe Food Selectivity. JPGN REPORTS 2023; 4:e365. [PMID: 38034439 PMCID: PMC10684205 DOI: 10.1097/pg9.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/22/2023] [Indexed: 12/02/2023]
Abstract
Severe food selectivity places children at risk for nutrient deficiencies and long-term medical complications, if unaddressed. However, poor nutrition in highly selective eaters is often overlooked when considering other behavioral or medical concerns. Additionally, studies regarding food selectivity are sparse and limited to children with developmental delays. This study further investigates the nutritional deficiencies and growth characteristics of children with severe food selectivity to assist pediatricians in the earlier identification of patients for nutrition screening. A retrospective chart review was completed for 13 patients admitted to a pediatric feeding program solely for table-textured food selectivity. Nutrition and anthropometric data from the medical record were analyzed. All patients were determined to be following an age-appropriate growth curve but had multiple micronutrient deficiencies. Additionally, 6 children were typically developing outside of the feeding context. Results suggest that children with food selectivity may require more intensive and earlier nutrition screening beyond their growth patterns.
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Affiliation(s)
- Amy K Drayton
- From the Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
| | - Rachel M Knight
- From the Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
| | - Heather Shepard
- Ambulatory Care Services Department of Clinical Nutrition, Harris Health System, Houston, TX
| | | | - Daniel Shriver
- From the Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
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13
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Ning XL, Shao M. Analysis of prognostic factors in patients with emergency sepsis. World J Clin Cases 2023; 11:5903-5909. [PMID: 37727482 PMCID: PMC10506019 DOI: 10.12998/wjcc.v11.i25.5903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Emergency sepsis is a common and serious infectious disease, and its prognosis is influenced by a number of factors. AIM To analyse the factors influencing the prognosis of patients with emergency sepsis in order to provide a basis for individualised patient treatment and care. By retrospectively analysing the clinical data collected, we conducted a comprehensive analysis of factors such as age, gender, underlying disease, etiology and site of infection, inflammatory indicators, multi-organ failure, cardiovascular function, therapeutic measures, immune status and severity of infection. METHODS Data collection: Clinical data were collected from patients diagnosed with acute sepsis, including basic information, laboratory findings, medical history and treatment options. Variable selection: Variables associated with prognosis were selected, including age, gender, underlying disease, etiology and site of infection, inflammatory indicators, multi-organ failure, cardiovascular function, treatment measures, immune status and severity of infection. Data analysis: The data collected are analysed using appropriate statistical methods such as multiple regression analysis and survival analysis. The impact of each factor on prognosis was assessed according to prognostic indicators, such as survival, length of stay and complication rates. RESULTS Descriptive statistics: Descriptive statistics were performed on the data collected from the patients, including their basic characteristics and clinical presentation. CONCLUSION Type 2 diabetes mellitus were independent factors affecting the prognosis of patients with sepsis.
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Affiliation(s)
- Xian-Li Ning
- Department of Emergency, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230031, Anhui Province, China
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14
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Yohana S, Indriyanti R, Suryanti N, Rahayuwati L, Juniarti N, Setiawan AS. Caries Experience among Children with History of Neonatal Stunting. Eur J Dent 2023; 17:687-692. [PMID: 36075267 PMCID: PMC10569887 DOI: 10.1055/s-0042-1750775] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Children with neonatal growth retardation (defined as birth length <48cm) are at risk for chronic malnutrition that begins before birth and continues into infancy. Stunting can adversely affect a child's growth and development, including oral health itself, and especially the experience of dental caries. This study analyzed the dental caries experience in children with neonatal growth retardation. MATERIALS AND METHODS: This was a baseline and 1-year follow-up analysis of a cohort of stunted children in a potential stunting site in Bandung City. Annual data collection included interviews with mothers and dental and anthropometric examinations of children. Descriptive analysis was performed in SPSS. STATISTICAL ANALYSIS Data were recorded on paper forms and manually entered into a Microsoft Excel spreadsheet for later analysis using IBM SPSS (version 23.0). After assessment, descriptive statistics was generated prior to bivariate analysis. RESULTS Fifty-five children met the inclusion criteria and participated in the 1-year study. Decay, missing, filling teeth (Dmft) was in the intermediate category (4.13) at baseline and fell into the high category (5.16) at 1-year follow-up, although the increase in caries remained in the low category. CONCLUSION Dysplastic children with a history of neonatal developmental delay experience dental caries beginning in the first year of life and may become more severe later in life.
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Affiliation(s)
- Siska Yohana
- Dentist Education Program, Faculty of Dentistry, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Ratna Indriyanti
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Netty Suryanti
- Department of Community Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Laili Rahayuwati
- Department of Community Nursing, Faculty of Nursing, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Neti Juniarti
- Department of Community Nursing, Faculty of Nursing, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Arlette S. Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Jawa Barat, Indonesia
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15
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Güngör Ş, Doğan A. Diaphragm thickness by ultrasound in pediatric patients with primary malnutrition. Eur J Pediatr 2023:10.1007/s00431-023-05024-x. [PMID: 37178359 PMCID: PMC10182341 DOI: 10.1007/s00431-023-05024-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Skeletal muscle atrophy is known to be a marker for nutritional deficiency. The diaphragm is both a skeletal muscle and a respiratory muscle. There is not enough data in the literature about the change in diaphragm thickness (DT) in children with malnutrition. We think that malnutrition may have negative effects on diaphragm thickness. Therefore, in this study, we aimed to compare the diaphragm thicknesses of pediatric patients with primary malnutrition and a healthy control group. The DT of pediatric patients diagnosed with primary malnutrition by a pediatric gastroenterologist was prospectively evaluated by a radiology specialist by ultrasonography (USG). The obtained data were statistically compared with the data of the healthy control group. There was no statistically significant difference between the groups in terms of age and gender (p = 0.244, p = 0.494). We found that right and left diaphragm thicknesses were significantly thinner in the malnourished group than in the healthy control group (p = 0.001, p = 0.009, respectively). We found that right and left diaphragm thicknesses were thinner in those with moderate and severe malnutrition compared to the normal group (p < 0.001, p = 0.003, respectively). We found a significant weak positive correlation between weight and height Z score and right and left diaphragm thickness (respectively, r: 0.297, p < 0.001; r: 0.301, p < 0.001). Conclusion: Malnutrition is a disease that affects all systems. Our study shows that the DT is thinner in patients with malnutrition. What is Known: •Malnutrition causes skeletal muscle atrophy. What is New: •Diaphragm muscle thickness decreases in malnutrition. •There is a significant positive correlation between diaphragm muscle thickness and height, weight and BMI z scores.
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Affiliation(s)
- Şükrü Güngör
- Department of Pediatric Gastroenterology, School of Medicine, Kahramanmaras Sütcü İmam University, Kahramanmaras, Turkey
| | - Adil Doğan
- Department of Radiology, School of Medicine, Kahramanmaras Sütcü İmam University, 46010, Kahramanmaras, Turkey.
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16
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Zheng Y, Mostamand S. Nutrition in children with exocrine pancreatic insufficiency. Front Pediatr 2023; 11:943649. [PMID: 37215591 PMCID: PMC10196508 DOI: 10.3389/fped.2023.943649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Exocrine pancreatic insufficiency (EPI) is a condition defined as pancreatic loss of exocrine function, including decreased digestive enzymes and bicarbonate secretion, which leads to maldigestion and malabsorption of nutrients. It is a common complication in many pancreatic disorders. If left undiagnosed, EPI can cause poor digestion of food, chronic diarrhea, severe malnutrition and related complications. Nutritional status and fat-soluble vitamins should be carefully assessed and monitored in patients with EPI. Early diagnosis of EPI is clinically important for appropriate nutritional support and initiating pancreatic enzyme replacement therapy (PERT) which could significantly improve patient outcomes. The evaluation of nutritional status and related unique management in children with EPI will be discussed in this review.
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Affiliation(s)
- Yuhua Zheng
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Shikib Mostamand
- Gastroenterology, Hepatology, and Nutrition, Stanford Children’s Health & Stanford University School of Medicine, Palo Alto, CA, United States
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17
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The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position on the Role of the Registered Dietitian Nutritionist in the Care of the Pediatric Patient With Chronic Gastrointestinal Diseases. J Pediatr Gastroenterol Nutr 2023; 76:390-399. [PMID: 36580920 DOI: 10.1097/mpg.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The optimization of nutrition is essential for the growth and development of all children, including those with gastrointestinal (GI) conditions that can variably affect nutrient intake, absorption, or metabolism. Registered Dietitian Nutritionists (RDNs) are essential partners in delivering high quality care for pediatric GI disorders, but limited evidence is available to support the role of the RDN in the care of these patients. This position paper outlines the evidence supporting the role of the RDN in the management of chronic pediatric GI issues in both inpatient and outpatient settings. Gaps in the literature, opportunities for future research, and barriers to RDN access are discussed.
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18
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Carvalho-Salemi J, Phillips W, Wong Vega M, Swanson J, Becker PJ, Salemi JL. Malnutrition among Hospitalized Children in the United States: A 2012-2019 Update of Annual Trends. J Acad Nutr Diet 2023; 123:109-116. [PMID: 35659540 DOI: 10.1016/j.jand.2022.05.021] [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: 04/25/2018] [Revised: 05/24/2022] [Accepted: 12/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce. OBJECTIVE The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis. DESIGN Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample. PARTICIPANTS/SETTING Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years. MAIN OUTCOME MEASURE CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes. STATISTICAL ANALYSES Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression. RESULTS CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient. CONCLUSIONS Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals.
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Affiliation(s)
| | | | | | - Justin Swanson
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, Florida
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19
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A Low-Diet Diversity Score Is Associated With Increased Risk of Growth Failure Among Children. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Franke J, Bishop C, Runco DV. Malnutrition screening and treatment in pediatric oncology: a scoping review. BMC Nutr 2022; 8:150. [PMID: 36550508 PMCID: PMC9773580 DOI: 10.1186/s40795-022-00643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition and cachexia during pediatric cancer treatment worsen toxicity and quality-of-life. Clinical practice varies with lack of standard malnutrition definition and nutrition interventions. This scoping review highlights available malnutrition screening and intervention data in childhood cancer and the need for standardizing assessment and treatment. METHODS Ovid Medline, CINAHL, and Cochrane Library were searched for studies containing malnutrition as the primary outcome with anthropometric, radiographic, or biochemical measurements. Secondary outcomes included validated nutritional assessment or screening tools. Two authors reviewed full manuscripts for inclusion. Narrative analysis was chosen over statistical analysis due to study heterogeneity. RESULTS The search yielded 234 articles and 17 articles identified from reference searching. Nine met inclusion criteria with six nutritional intervention studies (examining appetite stimulants, nutrition supplementation, and proactive feeding tubes) and three nutritional screening studies (algorithms or nutrition support teams) each with variable measures and outcomes. Both laboratory evaluations (albumin, prealbumin, total protein) and body measurement (weight loss, mid-upper arm circumference) were used. Studies demonstrated improved weight, without difference between formula or appetite stimulant used. Screening studies yielded mixed results on preventing weight loss, weight gain, and survival. CONCLUSION Our review demonstrated a paucity of evidence for malnutrition screening and intervention in pediatric cancer treatment. While a variety of malnutrition outcomes, interventions, and screening tools exist, nutritional interventions increased weight and decreased complications. Screening tools decreased malnutrition risk and may improve weight gain. Potential age- and disease-specific nutritional benefits and toxicities also exist, further highlighting the benefit of standardizing malnutrition definitions, screening, and interventions.
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Affiliation(s)
- Jessica Franke
- grid.421123.70000 0004 0413 3417Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN 46222 USA
| | - Chris Bishop
- grid.421123.70000 0004 0413 3417Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN 46222 USA
| | - Daniel V. Runco
- grid.257413.60000 0001 2287 3919Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, ROC Suite 4340, Indianapolis, IN 46202 USA ,grid.414923.90000 0000 9682 4709Department of Pediatrics, Division of Hematology/Oncology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN USA
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21
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Runco DV, Zimmers TA, Bonetto A. The urgent need to improve childhood cancer cachexia. Trends Cancer 2022; 8:976-979. [PMID: 35931609 PMCID: PMC10029855 DOI: 10.1016/j.trecan.2022.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
Clinical care and research around cancer cachexia in children is lacking. Cachexia increases treatment-related toxicity and long-term morbidity and potentially affects mortality. We highlight the urgent need for specific focus on childhood cancer cachexia and discuss potential solutions to inform cachexia therapeutics for children.
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Affiliation(s)
- Daniel V Runco
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, IN, USA; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Teresa A Zimmers
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA; Richard L Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Andrea Bonetto
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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22
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Low serum 25-hydroxyvitamin D (vitamin D) level among children with ventricular septal defect: how big is the risk for pulmonary hypertension? Cardiol Young 2022; 32:1984-1988. [PMID: 35067256 DOI: 10.1017/s1047951122000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Ventricular septal defect is the most common CHD, leading to pulmonary hypertension. Significantly lower 25-hydroxyvitamin D level was reported in children with CHD compared with healthy controls. The current study aimed to investigate the correlation between 25-hydroxyvitamin D level and pulmonary hypertension in children with ventricular septal defect. METHODS A cross-sectional study was conducted on ventricular septal defect paediatric patients from January to June, 2019. Serum 25-hydroxyvitamin D was measured using electrochemiluminescence. Pulmonary hypertension was defined as mean pulmonary artery systolic pressure > 20 mmHg for children >3 months of age at sea level, measured by Doppler echocardiography. RESULTS From forty-four subjects, the majority of the subjects were female (56.8%) with normal nutritional status and perimembranous ventricular septal defect. Bivariate analysis showed that 25-hydroxyvitamin D level was associated with pulmonary hypertension (p < 0.01), type and size of ventricular septal defect (p = 0.02), and heart failure (p < 0.01). Higher 25-hydroxyvitamin D level was correlated with better nutritional status (p = 0.04, r = 0.26), and lower 25-hydroxyvitamin D level was correlated with the occurence of perimembranous ventricular septal defect (p = 0.01, r = -0.39), larger defect size (p < 0.01, r = -0.70), history of pneumonia (p = 0.02, r = -0.31), and heart failure (p < 0.01, r = -0.64). Subjects with 25-hydroxyvitamin D deficiency had prevalence ratio of 24.0 times for pulmonary hypertension. Higher pulmonary artery pressure was correlated to the occurence perimembranous ventricular septal defect (p = 0.01, r = 0.47), larger defect size (p < 0.01, r = 0.78), history of pneumonia (p = 0.01, r = 0.38), and heart failure (p < 0.01, r = 0.75). CONCLUSION Children with ventricular septal defect who had low 25-hydroxyvitamin D level posed a higher risk of having pulmonary hypertension.
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Ezzat MA, Albassam EM, Aldajani EA, Alaskar RA, Devol EB. Implementation of new indicators of pediatric malnutrition and comparison to previous indicators. Int J Pediatr Adolesc Med 2022; 9:216-224. [PMID: 36937329 PMCID: PMC10019954 DOI: 10.1016/j.ijpam.2022.12.003] [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: 10/17/2022] [Revised: 12/11/2022] [Accepted: 12/27/2022] [Indexed: 01/08/2023]
Abstract
Background Early identification of childhood malnutrition is imperative to improve overall health outcomes, and more importantly, to start early intervention to decrease the risk of future complications. This study aimed to evaluate new malnutrition Z-score growth indicators for detecting pediatric malnutrition and degrees of severity and compare their accuracy with that of growth chart centiles. Patients and Methods This retrospective study included 475 pediatric patients from several pediatric nutrition clinics for six months. The participant's weight, height, age, and growth parameters were recorded using both traditional growth charts (centiles) and updated malnutrition indicators (z-scores). The percentage and degree of malnutrition using centiles and Z-scores were compared. Results In children aged <2 years, the percentage of malnutrition was 4.7% higher when measured using new malnutrition indicators (weight-for-length Z-score) compared with (weight-for-length centiles). Our results also showed 9.6% higher number of malnourished children >2 years of age when BMI-for-age Z-score was used compared to weight-for-height centiles while there were 15.8% higher malnourished children when BMI-for-age Z-score was compared to BMI-for-age centiles for the same group. We found a significant difference (X2 = 202.548, P=<.0001) between the degree of malnutrition in children aged >2 years using BMI-for-age Z-score (normal vs. malnourished) and the degree of malnutrition using BMI centiles (normal vs. malnourished). Approximately 34% of the children classified as normal using centiles were classified as malnourished using Z-scores. Comparing the degrees of Malnutrition, approximately 23% (45 of 196) of children classified as normal based on centiles were classified as having mild malnutrition when Z-scores were used, and 42% (80 of 192) of children who were classified as having mild malnutrition based on centiles were classified as having moderate malnutrition when Z-scores were used. Conclusions In our study, a higher percentage of children showed malnutrition when assessed using the Z-score (BMI-for-age for children >2 years/weight-for-length for children <2 years of age) than the centiles growth chart.
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Affiliation(s)
- Mai Adnan Ezzat
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Corresponding author. Nutrition Department, King Faisal Specialist Hospital and Research Center, Saudi Arabia.
| | - Ebtsam Mohmmed Albassam
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Eman Abdullah Aldajani
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raneem Abdulaziz Alaskar
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Edward Bentz Devol
- King Faisal Specialist Hospital and Research Centre, Department of Biostatistics, Riyadh, Saudi Arabia
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Fauziah N, Aviani JK, Agrianfanny YN, Fatimah SN. Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review. Trop Med Infect Dis 2022; 7:371. [PMID: 36422922 PMCID: PMC9697828 DOI: 10.3390/tropicalmed7110371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 09/01/2023] Open
Abstract
Intestinal parasitic infections are common infectious diseases causing many health problems and impaired growth and physical development.. Children under five years old are the most vulnerable to infections, due to their immature immunity and feeding and exploratory behaviours. This systematic review aimed to assess the relationship between intestinal parasitic infections and undernutrition among children under 5 years old. Fifteen studies met the inclusion and exclusion criteria and were classified as high-quality studies. Twelve parasites were reported, including Ascaris lumbricoides, Cryptosporodium spp., Entamoeba histolytica, Enterobius vermicularis, Giardia lamblia, hookworm, Hymenolepis nana, Strongyloides sterocalis, Taenia spp. and Trichuris trichuria. Ascariasis is the most reported infection, with a prevalence ranging from 10.77% in Ethiopia to 57.14% in Malaysia, and is correlated with stunting (OR 2.17 (95% CI 1.14, 4.13), p = 0.02). Giardiasis is the second most reported infection, with a prevalence ranging from 4.43% in Ethiopia to 66.33% in the Central African Republic, and is related to an increased risk of stunting (OR 2.34 (95% CI 1.07, 5.10), p = 0.03)), wasting (OR 2.90 (95% CI 1.12, 7.49, p = 0.03)), and being underweight (OR 1.53 (95% CI 1.02, 2.29, p = 0.04)). The third and fourth most prevalent infections are T. trichiura and hookworm infections. Intestinal parasitic infections can occur very early in life and cause significant growth retardation. It is important to understand the prevalence and effects of infection based on the parasite species in order to implement therapeutic interventions and prevention controls.
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Affiliation(s)
- Nisa Fauziah
- Division of Parasitology, Department of Basic Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Jenifer Kiem Aviani
- Department of Biotechnology, School of Life Science and Technology, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Yukan Niko Agrianfanny
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Siti Nur Fatimah
- Division of Clinical Nutrition, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
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25
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Carter L, Hulst JM, Afzal N, Jeejeebhoy K, Brunet-Wood K. Update to the pediatric Subjective Global Nutritional Assessment (SGNA). Nutr Clin Pract 2022; 37:1448-1457. [PMID: 35594373 DOI: 10.1002/ncp.10859] [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: 11/22/2021] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 11/12/2022] Open
Abstract
Lack of a standardized method of identifying and defining pediatric malnutrition has led to an inability to fully understand the prevalence of and impact that malnutrition has on pediatric patients and the healthcare system. The Subjective Global Nutritional Assessment (SGNA) is an assessment tool meant to determine presence and severity of malnutrition in pediatric populations. However, the anthropometric section of the tool contains some out-dated parameters. This has limited its clinical practicality. The aim of this paper is to propose updates to the anthropometrics section of the SGNA. A retrospective analysis of 153 SGNA's performed on children aged 1 month to 16 years was completed, comparing the original SGNA results to SGNA results incorporating updated anthropometric parameters for percentiles and ideal body weight. The category of length/height for age was updated to include z score cutoffs rather than percentiles, and ideal body weight was updated to z scores for weight for length or body mass index (BMI). Two serial growth questions were updated in wording only, to reflect z score trends. The results of the analysis showed these updates would have changed the rankings of eight patients (5%) for length/height for age, and 20 patients (13%) for ideal body weight to weight for length or BMI. Adjustments to these questions did not impact the overall SGNA rating. This study shows updates to the SGNA are not expected to have a significant impact on the validity of the tool and has the potential to improve its applicability to current day practice.
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Affiliation(s)
- Laura Carter
- Alberta Health Services, Nutrition Services, Edmonton, Alberta, Canada
| | - Jessie M Hulst
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Canadian Malnutrition Task Force, Edmonton, Alberta, Canada
| | - Nooran Afzal
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Development and Validation of a New Screening Tool with Non-Invasive Indicators for Assessment of Malnutrition Risk in Hospitalised Children. CHILDREN 2022; 9:children9050731. [PMID: 35626908 PMCID: PMC9140013 DOI: 10.3390/children9050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
There is no evidence of the most effective nutritional screening tool for hospitalized children. The present study aimed to develop a quick, simple, and valid screening tool for identifying malnutrition risk of hospital admission with non-invasive indicators. A cross-sectional study was conducted. Children`s nutritional baseline using a questionnaire, subjective malnutritional risk, and Subjective Global Nutritional Assessment were assessed on admission. Concurrent validity was assessed using American Society for Parenteral and Enteral Nutrition (ASPEN)and Academy of Nutrition and Dietetics assessment and Subjective Global Nutritional Assessment tool. A new screening tool Simple Pediatric Nutritional risk Screening tool (SPENS) was developed, and sensitivity, specificity and reliability were evaluated. A total of 180 children aged from 1 month to 18 years were included (142 in the development phase and 38 in the validation phase). SPENS consist of four variables and shows almost perfect agreement with subjective malnutritional risk assessment (κ = 0.837) with high sensitivity and specificity (93.3% and 91.3% respectively). Compared with Subjective Global Nutritional Assessment and ASPEN and Academy of Nutrition and Dietetics assessment, SPENS had sensitivity 92.9% and 86.7%, a specificity of 87.5% and 87.0%, and an overall agreement of 0.78 and 0.728, respectively. Due to the fast, simple, easy, and practical to use, screening the SPENS can be performed by nurses, physicians, and dieticians.
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27
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Horsley M, Pathak S, Morales D, Lorts A, Mouzaki M. Nutritional Outcomes of Patients with Pediatric and Congenital Heart Disease Requiring Ventricular Assist Device. JPEN J Parenter Enteral Nutr 2022; 46:1553-1558. [DOI: 10.1002/jpen.2351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - David Morales
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery
- Division of Cardiology
| | - Angela Lorts
- Department of Clinical Pediatrics
- Division of Cardiology
| | - Marialena Mouzaki
- Department of Clinical Pediatrics
- Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine
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28
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Amevor AA, Yodoshi T, Trout AT, Dillman JR, Singh R, Jarvis R, Fei L, Liu C, Taylor A, Miethke A, Mouzaki M. Sarcopenia is highly prevalent in children with autoimmune liver diseases and is linked to visceral fat and parent-perceived general health. Liver Int 2022; 42:394-401. [PMID: 34817929 PMCID: PMC9453636 DOI: 10.1111/liv.15108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with autoimmune hepatitis (AIH) and primary or autoimmune sclerosing cholangitis are at nutritional risk; their body composition and has not been extensively studied. We aimed to describe their body composition and identify clinical links. METHODS Using magnetic resonance imaging (MRI), two reviewers segmented total psoas muscle area (tPMSA), visceral fat area (VFA) and subcutaneous fat area (mm2 ) and measured visceral and subcutaneous thickness (mm). Clinical, laboratory and quality of life (QoL; using PedsQL) data were collected. Sarcopenia was defined as tPMSA ≤5th percentile. Analysis of variance, Wilcoxon rank test and multivariable modelling were performed. A paediatric cohort with non-alcoholic fatty liver disease (NAFLD) was used as a comparator following propensity score matching. RESULTS Fifty-eight patients with autoimmune liver disease (AILD) (33 [57%] with AIH) were included: median age 16 years (interquartile range [IQR]: 13-18), 33 (57%) male. Median time from diagnosis to MRI was 15 months (IQR: 2-39 months). Two patients (3%) had a BMIz indicative of mild malnutrition. tPMSA was measurable in 52 subjects (90%). Of those, 25 (48%) had sarcopenia. Sarcopenic patients had a lower blood urea nitrogen compared to non-sarcopenic (median [IQR]: 9.5 [8.0, 12.0] vs 11 [10, 14] mg/dL; P = .023). There was no difference in corticosteroid use between groups. The VFA of sarcopenic patients was higher (3156 [2064, 7492]) vs 2084 [688, 3092]) mm2 ; P = .005). Patient-reported QoL negatively associated with VFA and general health negatively associated with VFA. Compared with NAFLD, the odds ratio for sarcopenia with AILD was 14.5 (95% confidence interval: 2.3-90.7). CONCLUSION In autoimmune liver diseases, sarcopenia is highly prevalent, associated with increased visceral fat and QoL.
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Affiliation(s)
- Antoinette A. Amevor
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Toshifumi Yodoshi
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Radiology, University of Cinncinati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R. Dillman
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Radiology, University of Cinncinati College of Medicine, Cincinnati, Ohio, USA
| | - Ruchi Singh
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ryan Jarvis
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amy Taylor
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexander Miethke
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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29
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Runco DV, Stanek JR, Yeager ND, Belsky JA. Malnutrition identification and management variability: An administrative database study of children with solid tumors. JPEN J Parenter Enteral Nutr 2022; 46:1559-1567. [PMID: 35040171 PMCID: PMC9544103 DOI: 10.1002/jpen.2329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
Background Malnutrition during cancer treatment increases treatment‐related morbidity and mortality. Our study better characterizes variability in malnutrition identification and treatment by examining nutrition‐related diagnoses and support for children with central nervous system (CNS) and non‐CNS solid tumors during therapy. We examined diagnosis of malnutrition, use of tube feeding or parenteral nutrition (PN), and appetite stimulants. Methods We retrospectively reviewed 0 to 21‐year‐old patients in the Pediatric Health Information System from 2015 to 2019. Patients were classified as having (1) billed malnutrition diagnosis, (2) malnutrition diagnosis or using PN and enteral nutrition (“functional malnutrition”), and (3) any previous criteria or prescribed appetite stimulants (“possible malnutrition”), as well as associated risk factors. Results Among 13,375 unique patients, CNS tumors were most common (24.4%). Overall, 26.5% of patients had malnutrition diagnoses, 45.4% met functional malnutrition criteria, and 56.0% had possible malnutrition. Patients with adrenal tumors had highest billed, functional, and possible malnutrition (36.6%, 64.1%, and 69.4%, respectively) followed by CNS tumors (29.1%, 52.4%, and 64.1%). Patients with adrenal tumors had highest rates of PN use (47.4%) and those with CNS tumors had the highest tube feeding use (26.8%). Hospital admissions with malnutrition had a longer hospital length of stay (LOS) (6 vs 3 days, P < 0.0001), more emergency department admissions (24.4% vs 21.8%, P < 0.0001), and more opioid use (58.6% vs 41.4%, P < 0.0001). Conclusions Variability in malnutrition diagnoses hinders clinical care and nutrition research in pediatric oncology. Improving disease‐specific recognition and treatment of malnutrition can target nutrition support, ensure appropriate reimbursement, and potentially improve outcomes for children with solid tumors.
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Affiliation(s)
- Daniel V Runco
- Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Joseph R Stanek
- Division of Pediatric Hematology/Oncology/Bone and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH.,Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas D Yeager
- Division of Pediatric Hematology/Oncology/Bone and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Jennifer A Belsky
- Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology
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30
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Seremet Kurklu N, Geyin F, Ceylan L, Korkut Genc D, Kamarli Altun H, Karacil Ermumcu MS. Comparison of three different nutrition screening tools for pediatric inpatients. Nutr Clin Pract 2022; 37:698-704. [PMID: 34981863 DOI: 10.1002/ncp.10828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Early detection of children at risk of developing malnutrition during hospitalization prevents the development of complications. This study aims to determine the malnutrition risk of pediatric inpatients by using three different nutrition screening tools and to evaluate the reliability/sensitivity of the screening tools. METHODS This cross-sectional study included 176 children who were 1-16 years of age and were admitted to the pediatrics service of a second-line hospital. Body weight and height were used to evaluate the nutrition status of children. Age- and sex-specific z-score values for height for age (HFA), weight for age (WFA), and body mass index for age (BFA) were indicators of malnutrition. The Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Yorkhill Malnutrition Score (PYMS), and Pediatric Nutrition Screening Tool (PNST) were used under the responsibility of pediatricians and dietitians to evaluate the risk of malnutrition in children. RESULTS At admission, according to the HFA, BFA, and WFA SD scores (SDSs), the incidence of malnutrition in children was 8.5%, 14.8%, and 6.3%, respectively. Three screening tools determined that WFA SDSs were significantly higher in children without malnutrition risk than in those at risk of malnutrition (P < 0.05). PYMS revealed a relatively higher sensitivity of 90.9% and 84.6% for WFA and BFA, respectively, and PNST revealed a relatively higher sensitivity of 88.9% for HFA. CONCLUSIONS PYMS and PNST are suitable for use in malnutrition risk assessment in pediatric inpatients because of the screening tools' high sensitivity.
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Affiliation(s)
- Nilgun Seremet Kurklu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | | | - Latife Ceylan
- Dr. Latife Ceylan Private Pediatric Office, Antalya, Turkey
| | - Deniz Korkut Genc
- Department of Nutrition and Dietetics, Antalya Kepez State Hospital, Antalya, Turkey
| | - Hulya Kamarli Altun
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
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31
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Castro JDS, Santos CAD, Rosa CDOB, Firmino HH, Ribeiro AQ. STRONGkids nutrition screening tool in pediatrics: An analysis of cutoff points in Brazil. Nutr Clin Pract 2021; 37:1225-1232. [PMID: 34897796 DOI: 10.1002/ncp.10807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Studies have indicated the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) as a method of pediatric nutrition screening with good validity in the hospital setting. However, we need to analyze whether the cutoff values originally proposed are suitable for use in Brazil. METHODS A cross-sectional study was performed in patients admitted to the pediatric ward of a public hospital. STRONGkids was used to assess nutrition risk (low risk, 0 points; moderate risk, 1-3 points; and high risk, 4-5 points). The indexes weight/height or body mass index/age were used to indicate acute malnutrition, and length or height/age was used to indicate chronic malnutrition. Receiver operating characteristic curves were constructed and the areas under the curve were calculated, with respective 95% confidence intervals, to assess the ability of STRONGkids to predict malnutrition and longer hospital stay. RESULTS The study included 599 patients, with a median age of 2.6 years. The frequency of nutrition risk (medium or high) was 83.6%. In comparison with anthropometric indexes, STRONGkids was the only scoring system with the discriminatory capacity to identify patients with longer hospital stays. The comparative analysis of the means of hospital stay according to STRONGkids showed that patients with a score equal to 3 behaved similarly to those classified as high nutrition risk (4-5 points). CONCLUSIONS Considering the best cutoff point to predict prolonged hospitalization, STRONGkids used in Brazil should consider patients with 3 points as having high nutrition risk, as well those scoring 4 and 5.
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Affiliation(s)
- Joice da Silva Castro
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | | | | | - Heloísa Helena Firmino
- Multidisciplinary Nutritional Therapy Team, São Sebastião Hospital, Viçosa, Minas Gerais, Brazil
| | - Andréia Queiroz Ribeiro
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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32
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Goday PS, Lewis JD, Sang CJ, George DE, McGoogan KE, Safta AM, Seth A, Krekel C. Energy- and protein-enriched formula improves weight gain in infants with malnutrition due to cardiac and non-cardiac etiologies. JPEN J Parenter Enteral Nutr 2021; 46:1270-1282. [PMID: 34822187 PMCID: PMC9540590 DOI: 10.1002/jpen.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background We aimed to assess safety, tolerability, and improvement in weight gain with an energy‐ and protein‐enriched formula (EPEF) in infants with poor growth. Methods Infants aged 1–8 months with poor growth received EPEF for 16 weeks. Our primary objective was improvement in weight as measured by change in weight‐for‐age z‐score (WAZ) and weight gain velocity (grams per day) ≥ median for age. Secondary objectives included improvement in other anthropometric z‐scores, formula tolerance, and safety. Results Twenty‐six patients with poor growth due to congenital heart disease (n = 15), other organic causes (n = 9), and nonorganic causes (n = 2) completed the study per protocol. Mean daily energy intake was 123 ± 32 kilocalories per kilogram of body weight, with >90% of energy coming from EPEF. Weight gain velocity exceeded the median for 83% (20 of 24) and 67% (16 of 24) of infants at ≥1 time point and for the overall study period, respectively. Mean ± SD WAZ improved from −2.92 ± 1.04 at baseline to −2.01 ± 1.12 at 16 weeks (P = 0.0001). Z‐scores for weight‐for‐length and head circumference (P = 0.0001) and for length‐for‐age (P = 0.003) improved significantly at 16 weeks. Compared with baseline, stool consistency was different at 2, 4, and 16 weeks (P < 0.05). There were no significant differences in vomiting, fussiness, or daily number of stools while there was a decrease or no change in spit‐up, flatulence, crying, or gassiness. Conclusion EPEF is safe, well tolerated, and improves weight gain in infants with poor growth.
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Affiliation(s)
- Praveen S Goday
- Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffery D Lewis
- Children's Center for Digestive Health Care, LLC, Atlanta, Georgia, USA
| | - Charlie J Sang
- Pediatric Cardiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Donald E George
- Division of Pediatric Gastroenterology and Nutrition, Nemours Children's Specialty Care, Jacksonville, Florida, USA
| | - Katherine E McGoogan
- Division of Pediatric Gastroenterology and Nutrition, Nemours Children's Specialty Care, Jacksonville, Florida, USA
| | - Anca M Safta
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anand Seth
- SK Patent Associates, LLC, Dublin, Ohio, USA
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Oral Nutritional Supplementation Improves Growth in Children at Malnutrition Risk and with Picky Eating Behaviors. Nutrients 2021; 13:nu13103590. [PMID: 34684591 PMCID: PMC8538528 DOI: 10.3390/nu13103590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (<5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery; oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were >24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC; ONS2 + DC; and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p < 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p < 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.
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34
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Cañedo G, Palomino Pérez LM, Puerta Macfarland LA, Ruano Dominguez D, Cañedo-Villaroya E, Garcia Alcolea B, Madero López L, Pedrón-Giner C. Validity and Reliability of a Nutritional Screening Tool (SCAN) in Children Newly Diagnosed with Cancer. Nutr Cancer 2021; 74:1754-1765. [PMID: 34490807 DOI: 10.1080/01635581.2021.1970782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
No standardized approach towards nutritional screening and assessment of pediatric oncology patients has been established. The nutrition screening tool for childhood cancer (SCAN) has been previously published as an effective screening method. This is an observational cross-sectional study to assess the validity and reliability of the SCAN tool, compare it to the detection of undernutrition using standard measures of assessment, and determine the overall prevalence of malnutrition and micronutrients alterations in our cohort. We included children newly diagnosed with cancer in a pediatric tertiary hospital in Madrid, Spain from August 2018 to May 2019. The following measurements were performed: SCAN questionnaire, anthropometric measurements, nutritional markers in blood, and micronutrient levels. A total of 49 patients were included. 22 patients (45%) were at risk of malnutrition according to the SCAN questionnaire. Four patients (8%) could be diagnosed with moderate undernutrition. These undernourished patients were distributed homogeneously among at-risk and not at-risk populations identified by the SCAN tool. Several micronutrient deficiencies were identified. We conclude that the SCAN questionnaire is an easy-to-use tool for everyday clinical practice. By not including anthropometric measurements it misses patients considered to be malnourished. Future data might help clarify if it is an effective tool in predicting a higher nutritional risk during the entire treatment course.
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Affiliation(s)
- Gustavo Cañedo
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Laura María Palomino Pérez
- Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - David Ruano Dominguez
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elvira Cañedo-Villaroya
- Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beatriz Garcia Alcolea
- Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Madero López
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Consuelo Pedrón-Giner
- Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Zhang Z, Li F, Hannon BA, Hustead DS, Aw MM, Liu Z, Chuah KA, Low YL, Huynh DTT. Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13093036. [PMID: 34578914 PMCID: PMC8468927 DOI: 10.3390/nu13093036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).
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Affiliation(s)
- Zhiying Zhang
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Fei Li
- Abbott Nutrition China Research and Development Center, Building 14, No. 1036 Tianlin Road, Shanghai 200233, China;
| | - Bridget A. Hannon
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Deborah S. Hustead
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Marion M. Aw
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
| | - Zhongyuan Liu
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Khun Aik Chuah
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Yen Ling Low
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Dieu T. T. Huynh
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
- Correspondence: ; Tel.: +65-8322-9798
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Wang L, Yin C, Zhang M, Mao H, Hao H, Hu X, Xue W. A randomized controlled trial on the effect of dietary guidance on the treatment of Henoch-Schonlein purpura in children. J Investig Med 2021; 69:1464-1472. [PMID: 34362779 DOI: 10.1136/jim-2021-001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/03/2022]
Abstract
The amino acid-based formulae were extensively added to diet of children for the treatment of Henoch-Schonlein purpura (HSP), and the nutrition and growth situation of children were evaluated after giving new dietary intervention. Patients were randomly divided into restricted diet group (n=30) and dietary guidance group (n=30). Besides, 30 cases with bronchiolitis who had normal diet were selected as the control group. The dietary questionnaire was designed to record the types and intakes of various foods taken by children every day, and the intake levels of nutrients were analyzed. Physical examination, biochemical analysis of blood and urine routine were carried out to evaluate the effect of dietary guidance on their growth and development. The results showed that restricted diet group had lower levels of nutrient intake and the actual/recommended percentage. However, overall nutrient intake level of the dietary guidance group was higher, basically equal to the recommended intake level. Besides, the actual intake and actual/recommended percentage of nutrients of dietary guidance group were significantly higher than those of restricted diet group (p<0.05). Dietary guidance can improve nutrients and protein intake of children with HSP, and reduce the relapse of rash and incidence of complications.
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Affiliation(s)
- Li Wang
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chunyan Yin
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Meizhen Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hua Mao
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huixiang Hao
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoting Hu
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wanli Xue
- Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Zhu Y, Ye H, Feng Y, Pan L, Fu H, Liu Y, Fei J, Hong L. Assessment of nutritional status in paediatric outpatients using bioelectrical impedance analysis and anthropometric z-scores. J Paediatr Child Health 2021; 57:1274-1280. [PMID: 33749969 PMCID: PMC8451919 DOI: 10.1111/jpc.15450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate paediatric outpatients' nutritional status using bioelectrical impedance analysis and anthropometric z-scores. METHODS A retrospective data analysis of tertiary paediatric hospital outpatients from 2017 to 2019 was conducted. Patients were categorised into three groups (non-illness, illness and simple obesity) according to clinical diagnoses. The nutritional status was evaluated using anthropometric and bioelectrical impedance analysis. In addition, body composition measurements of patients in three subgroups of the illness group and age- and gender-matched healthy controls were compared. RESULTS A total of 2015 paediatric outpatients were enrolled. According to body mass index z-scores, undernutrition prevalence among participants was 14.0% (non-illness group, 21.3%; illness group, 11.4%). Body composition measurements indicated that 41.6% of participants had a low fat-free mass index, and the proportions of participants with a low fat-free mass index in the non-illness, illness and simple obesity groups were 48.4, 47.0 and 10.7%, respectively. Compared with healthy controls, the haematology and oncology subgroup had a significantly lower fat-free mass index and fat mass index; the nephrology and rheumatology subgroup had significantly lower height-for-age z-scores but higher fat mass index; and the gastroenterology subgroups had lower fat mass index, fat-free mass index and body mass index z-scores. CONCLUSIONS The results suggested the low fat-free mass index prevalence was greater than the low body mass index z-score prevalence among paediatric outpatients, and body composition parameters varied across different illnesses. Body composition analysis is recommended in nutrition clinics for accurate paediatric outpatient nutritional assessment, thereby providing timely individualised nutritional interventions.
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Affiliation(s)
- Yuan Zhu
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hong Ye
- Department of PaediatricFujian Province Children's Hospital, Fujian Provincial Maternity and Children's Hospital, Fujian Medical UniversityFujianChina
| | - Yi Feng
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Li‐ya Pan
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huan‐huan Fu
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yun‐man Liu
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jun Fei
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Li Hong
- Department of Clinical NutritionShanghai Children's Medical Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
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Webb CM, Morales ML, Lopez M, Baca-Turpo B, Arque E, White AC, Cabada MM. Stunting in pre-school and school-age children in the Peruvian highlands and its association with Fasciola infection and demographic factors. PLoS Negl Trop Dis 2021; 15:e0009519. [PMID: 34153050 PMCID: PMC8248620 DOI: 10.1371/journal.pntd.0009519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/01/2021] [Accepted: 05/30/2021] [Indexed: 11/18/2022] Open
Abstract
Fascioliasis is a zoonotic trematode infection that is endemic in the highlands of Peru. Chronic fascioliasis can be asymptomatic and remain undiagnosed for years. Chronic malnutrition in children, as manifested by stunting, leads to delayed cognitive development and lost productivity. We hypothesized that fascioliasis is among the factors associated with stunting in children from endemic areas. We conducted a cross-sectional study among children attending pre-school and school in 26 communities in the Anta province in the Cusco region of Peru. We conducted interviews to collect information on demographic, socioeconomic, and medical history. Blood was collected and tested for complete cell count and FAS2 ELISA for Fasciola antibodies. Three stool samples per participant were tested for parasites by Kato-Katz and Lumbreras rapid sedimentation methods. Chronic fascioliasis was determined by the presence of ova in stool. Children's height, weight, and age were recorded and used to calculate height for age Z scores (HAZ). Three thousand children participated in the study. Nine percent (264) of children had at least one positive test for Fasciola infection, 6% (164) had chronic fascioliasis, and 3% (102) had only positive antibody tests. The median HAZ was -1.41 (IQR: -2.03 to -0.81) and was similar in males and females. Twenty six percent (776) of children had stunting with HAZ < -2. Children with chronic fascioliasis had a lower median HAZ than children without Fasciola (-1.54 vs. -1.4, p = 0.014). History of treatment for malnutrition, history of treatment for anemia, having other helminths in stool, lower socioeconomic score, living at a higher elevation, and fewer years of schooling of both parents were associated with a lower HAZ score. In a multiple regression analysis, older age and a lower socioeconomic score were associated with a lower HAZ score. While fascioliasis and other helminths were associated with lower HAZ, they were not independent of the socioeconomic score.
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Affiliation(s)
- Camille M. Webb
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Maria Luisa Morales
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Martha Lopez
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Benicia Baca-Turpo
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Eulogia Arque
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - A. Clinton White
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Miguel M. Cabada
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- Alexander von Humboldt Tropical Medicine Institute, Department of Medicine, Universidad Peruana Cayetano Heredia, Cusco, Peru
- UPCH–UTMB Collaborative Research Center—Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
- * E-mail:
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Abstract
OBJECTIVES Spinal muscular atrophy (SMA) is a genetic motor neuron disorder characterized by progressive muscle atrophy. Our aims were to evaluate the impact of nutritional intervention and nusinersen therapy on the nutritional status of SMA patients. STUDY DESIGN This prospective study included all children and young adults (<24 years of age) with SMA who attended our multidisciplinary SMA clinic, during January 2017-July 2019. We documented demographic, clinical, anthropometric, and nutritional data at baseline and follow-up. A nutritional intervention was implemented according to standards of the 2018 Consensus Statement of SMA Management. RESULTS The cohort included 51 SMA patients with a median age of 7.2 (interquartile range 2.1-15.3) years. Among them, 24 (47%) were SMA type 1, 16 (31.4%) SMA type 2, and 11 (21.6%) SMA type 3 patients. At baseline, 28 (54.9%) patients presented with malnutrition, 20 (71.4%) of whom with severe malnutrition. A decline in the frequency of severe malnutrition of SMA type 1 patients was observed at follow-up. The body mass index of patients who started nusinersen therapy after the nutritional intervention increased significantly compared with patients that started nusinersen therapy before the nutritional intervention (P = 0.042). There was also a significant increase in total energy and protein consumption in the former group (P = 0.043). CONCLUSIONS Malnutrition is frequent among children with SMA, and the nutritional status of patients that started nusinersen therapy after implementation of a nutritional intervention underwent a more significant improvement. The importance of combining adequate nutritional management with disease-modifying treatment is highlighted.
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Nelms CL, Shaw V, Greenbaum LA, Anderson C, Desloovere A, Haffner D, Oosterveld MJS, Paglialonga F, Polderman N, Qizalbash L, Rees L, Renken-Terhaerdt J, Tuokkola J, Vande Walle J, Shroff R, Warady BA. Assessment of nutritional status in children with kidney diseases-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2021; 36:995-1010. [PMID: 33319327 PMCID: PMC7910229 DOI: 10.1007/s00467-020-04852-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/03/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
In children with kidney diseases, an assessment of the child's growth and nutritional status is important to guide the dietary prescription. No single metric can comprehensively describe the nutrition status; therefore, a series of indices and tools are required for evaluation. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. Herein, we present CPRs for nutritional assessment, including measurement of anthropometric and biochemical parameters and evaluation of dietary intake. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Audit and research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.
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Affiliation(s)
| | - Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, London, WC1N 3JH, UK
- University of Plymouth, Plymouth, UK
| | - Larry A Greenbaum
- Emory University, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Dieter Haffner
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Michiel J S Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Lesley Rees
- University College London Great Ormond Street Hospital Institute of Child Health, London, WC1N 3JH, UK
| | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, WC1N 3JH, UK.
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Tekin M, Simsek A, Bilak S, Konca C, Almis H, Bilen A. Evaluation Using Spectral-Domain Optical Coherence Tomography of the Effects of Malnutrition on Ocular Parameters in Pediatric Patients. Optom Vis Sci 2021; 97:154-161. [PMID: 32168237 DOI: 10.1097/opx.0000000000001490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE We determined decreases in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in all quadrants. Our findings show that the choroid and RNFL are affected before the emergence of ocular symptoms in malnourished children. PURPOSE We aimed to determine whether the RNFL, a component of the neuronal structure, and the choroid, supplying the retina, are affected in children with malnutrition using spectral-domain optical coherence tomography. METHODS One hundred twenty-six malnourished patients without ocular symptoms, aged between 5 and 10 years, and 116 healthy children were included in the study. Age, sex, weight-for-age (WFA) z score, height-for-age z score, body mass index-for-age z score, and spectral-domain optical coherence tomography data were recorded. RESULTS Average RNFL thickness was 96.5 μm (82.0 to 128.0 μm) in the malnutrition group and 111.0 μm (95.0 to 128.0 μm) in the control group (P < .001). Retinal nerve fiber layer thickness was statistically significantly lower in all quadrants in malnourished patients compared with the control group. Median choroidal thickness in the foveal center was 304.0 μm (250.0 to 375.0 μm) in the malnutrition group and 345.0 μm (280.0 to 403.0 μm) in the control group (P < .001). Choroidal thickness in all quadrants was also statistically significantly lower in malnourished patients. Positive correlation was determined between average RNFL thicknesses and WFA z score. Average RNFL thickness decreased as WFA z score decreased (r = 0.730 and P < .001). Positive correlation was also observed between choroidal thickness in the foveal center and WFA z score. Foveal center choroidal thickness decreased in line with WFA z score (r = 0.786 and P < .001). CONCLUSIONS Our results show that the retinal nerve fiber layer and choroidal thickness decreased in malnourished children without clinically reported ocular symptoms. A decreased retinal nerve fiber layer and choroidal thickness may be an important clue to the prevention of retinal pathologies that may develop at later ages if the malnutrition is not addressed.
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Affiliation(s)
| | - Ali Simsek
- Department of Ophthalmology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Semsettin Bilak
- Department of Ophthalmology, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Capan Konca
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Habip Almis
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Abdurrahman Bilen
- Department of Ophthalmology, School of Medicine, Adiyaman University, Adiyaman, Turkey
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Kilinc AA, Beser OF, Ugur EP, Cokugras FC, Cokugras H. The effects of nutritional status and intervention on pulmonary functions in pediatric cystic fibrosis patients. Pediatr Int 2021; 63:316-322. [PMID: 32745357 DOI: 10.1111/ped.14417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) causes malabsorption of nutrients that exacerbate pulmonary problems. Nutritional interventions can improve pulmonary functions. We aimed to evaluate the effects of nutritional intervention in CF patients with malnutrition, and to determine if there is a correlation between nutritional status and pulmonary functions. METHODS The study included 143 CF patients (67 females) with a mean 2 year follow-up time. Patients' sociodemographic data, presenting symptoms and history were recorded. Height-for-age, weight-for-age, weight-for-length/height (WFL/H), and body mass index (BMI) were calculated in all patients. Patients were grouped as well nourished, mild malnutrition, moderate malnutrition, and severe malnutrition. These four groups were compared in terms of pulmonary function test results, lung infections, and the hospitalization rate. RESULTS Among the patients with a WFL/H or BMI z-scores that decreased, the frequency of lung infection was 74.1% and the hospitalization rate was 40.7%, versus 34% and 12.3%, respectively among the patients with a WFL/H or BMI z-scores that increased. The difference was significant (P = 0.02 and P = 0.01, respectively). The difference in bacterial lung infections differed significantly between the four nutritional status groups (P = 0.002). Patients in the well-nourished group had significantly higher pulmonary function test scores than the other groups. The forced expiratory volume in the first second differed significantly between the patients with and without an increase in the WFL/H or BMI z-scores (P = 0.001). CONCLUSIONS The appropriate nutritional intervention to pediatric CF patients with malnutrition, decrease the frequency of lung infections, and improve respiratory function.
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Affiliation(s)
- Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Omer Faruk Beser
- Department of Pediatrics Gastroenterology, Cerrahpasa Faculty of Medicine, İstanbul University- Cerrahpasa, İstanbul, Turkey
| | - Ebru Pelin Ugur
- Department of Nutrition and Dietetics, Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Fugen Cullu Cokugras
- Department of Pediatrics Gastroenterology, Cerrahpasa Faculty of Medicine, İstanbul University- Cerrahpasa, İstanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
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Measuring malnutrition and its impact on pediatric surgery outcomes: A NSQIP-P analysis. J Pediatr Surg 2021; 56:439-445. [PMID: 33190812 DOI: 10.1016/j.jpedsurg.2020.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/17/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a limited understanding of the impact of pediatric malnutrition indicators on post-operative outcomes. MATERIALS AND METHODS All pediatric surgical patients captured in the ACS NSQIP-Pediatric database from 2016 to 2018 were included. Multivariable logistic regression was used to estimate odds of 30-day post-operative infection by malnutrition definition (stunted, wasted, requiring nutritional support, pre-operative hypoalbuminemia). RESULTS Among pediatric surgery patients (n = 282,056), 19% of patients met one definition of malnutrition, 6% met two, 1% met 3, and <0.1% met all 4. After adjustment, requiring nutritional support (OR 1.47, 95% CI 1.36-1.60), stunting (OR 1.17, 95% CI 1.10-1.25), and hypoalbuminemia (OR 1.17 95% CI 1.04-1.32) were associated with increased odds of post-operative infection while wasting was not. Requiring nutritional support was associated in an increase of 10.17 days (95% CI 9.89-10.44) in time from admission to surgery. CONCLUSIONS The metric used to define malnutrition changed the association with post-operative outcomes. Nutritional supplementation, stunting, and hypoalbuminemia were associated with poorer postoperative outcomes. These findings have implications for pre-operative patient level counseling, accurate risk stratification, surgical planning, and patient optimization in pediatric surgery. LEVEL OF EVIDENCE III.
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Murray RD, Kerr KW, Brunton C, Williams JA, DeWitt T, Wulf KL. A First Step Towards Eliminating Malnutrition: A Proposal for Universal Nutrition Screening in Pediatric Practice. NUTRITION AND DIETARY SUPPLEMENTS 2021. [DOI: 10.2147/nds.s287981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Bunker S, Pandey J. Educational Case: Understanding Kwashiorkor and Marasmus: Disease Mechanisms and Pathologic Consequences. Acad Pathol 2021; 8:23742895211037027. [PMID: 34458565 PMCID: PMC8392804 DOI: 10.1177/23742895211037027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/20/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Affiliation(s)
- Sarah Bunker
- Central Michigan University College of Medicine, East Campus Drive, Mount Pleasant, MI, USA
| | - Jyotsna Pandey
- Central Michigan University College of Medicine, East Campus Drive, Mount Pleasant, MI, USA
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Phillips W, Becker PJ, Wong Vega M, Smith E, Konek S, Bailer J, Carvalho-Salemi J. Comprehensive Application of the Malnutrition Quality Improvement Initiative (MQII) Toolkit to Pediatric Malnutrition Care. J Acad Nutr Diet 2020; 121:1021-1034. [PMID: 33187924 DOI: 10.1016/j.jand.2020.08.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 01/04/2023]
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Abstract
Objective: Stunting (height-for-age < −2 sd) is one of the forms of undernutrition and is frequent among children of low- and middle-income countries. But stunting perse is not a synonym of undernutrition. We investigated association between body height and indicators of energetic undernutrition at three critical thresholds for thinness used in public health: (1) BMI SDS < −2; (2) mid-upper arm circumference divided by height (MUAC (mm) × 10/height (cm) < 1·36) and (3) mean skinfold thickness (SF) < 7 mm and to question the reliability of thresholds as indicators of undernutrition. Design: Cross-sectional study; breakpoint analysis. Setting: Rural and urban regions of Indonesia and Guatemala – different socio-economic status (SES). Participants: 1716 Indonesian children (6·0–13·2 years) and 3838 Guatemalan children (4·0–18·9 years) with up to 50 % stunted children. Results: When separating the regression of BMI, MUAC or SF, on height into distinguishable segments (breakpoint analysis), we failed to detect relevant associations between height, and BMI, MUAC or SF, even in the thinnest and shortest children. For BMI and SF, the breakpoint analysis either failed to reach statistical significance or distinguished at breakpoints above critical thresholds. For MUAC, the breakpoint analysis yielded negative associations between MUAC/h and height in thin individuals. Only in high SES Guatemalan children, SF and height appeared mildly associated with R2 = 0·017. Conclusions: Currently used lower thresholds of height-for-age (stunting) do not show relevant associations with anthropometric indicators of energetic undernutrition. We recommend using the catch-up growth spurt during early re-feeding instead as immediate and sensitive indicator of past undernourishment. We discuss the primacy of education and social-economic-political-emotional circumstances as responsible factors for stunting.
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Standards der ernährungsmedizinischen Versorgung in der ambulanten und stationären Pädiatrie durch spezialisierte Einrichtungen der Kinder- und Jugendmedizin. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bellini SG, Becker PJ, Carney LN, Green Corkins K, Medico T, Van Poots HA. Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics. Nutr Clin Pract 2020; 35:1080-1086. [DOI: 10.1002/ncp.10495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department Brigham Young University Provo Utah USA
| | - Patricia J. Becker
- Dayton Children's Hospital Medical Center Dayton Ohio USA
- Owner KidsRD.com/PediatricMalnutrition.com Dayton Ohio USA
| | | | - Kelly Green Corkins
- Le Bonheur Children's Hospital Department of Nutrition Therapy Memphis Tennessee USA
| | - Tegan Medico
- Morrison Healthcare/University of Virginia Health System Charlottesville Virginia USA
- University of Virginia–School of Continuing and Professional Studies Charlottesville Virginia USA
- Piedmont Valley Community College–Division of Business, Mathematics & Technologies Charlottesville Virginia USA
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Utilization of Current Diagnostic Indicators to Characterize Pediatric Undernutrition among US Children. Nutrients 2020; 12:nu12051409. [PMID: 32422888 PMCID: PMC7285203 DOI: 10.3390/nu12051409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to estimate the prevalence of pediatric undernutrition in the US general population using the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus statement on identification of pediatric malnutrition (undernutrition). National Health and Nutrition Examination Survey (NHANES) data for years 2005–2014 was analyzed for children ages 1–13 years (n = 13,950) with valid anthropometric data. The prevalence of undernutrition was assessed through z-scores for weight-for-height, body mass index (BMI)-for-age, height-for-age, and mid-upper-arm circumference-for-age generated from the 2000 Centers for Disease Control and Prevention growth charts. Children were stratified into: no undernutrition, mild undernutrition, and moderate or severe undernutrition. Descriptive statistics were used to identify the prevalence of undernutrition. Differences in Z-scores across growth chart metrics were compared across undernutrition categories using analysis of variance. The total prevalence of pediatric undernutrition in this sample was 0.4% (severe undernutrition), 2.0% (moderate undernutrition), and 10.9% (mild undernutrition) for all ages. Z-scores differed significantly across all levels of undernutrition for all anthropometrics, showing poorer mean growth metrics in those with undernutrition. Pediatric undernutrition is a prevalent condition that transcends the prior focus on <5th percentile of growth curves and impacts children across different demographic categories.
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