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Mignot M, Huguet H, Cambonie G, Guillaumont S, Vincenti M, Blanc J, Ovaert C, Picot MC, Karsenty C, Amedro P, Kollen L, Gavotto A. Risk factors for early occurrence of malnutrition in infants with severe congenital heart disease. Eur J Pediatr 2023; 182:1261-1269. [PMID: 36633658 DOI: 10.1007/s00431-023-04812-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
To identify the risk factors of early occurrence of malnutrition in infants with severe congenital heart disease (CHD) during their first year of life. Retrospective longitudinal multicenter study carried out from January 2014 to December 2020 in two tertiary care CHD centers. Four CHD hemodynamic groups were identified. Malnutrition was defined by a Waterlow score under 80% and/or underweight under -2 standard deviations. A total of 216 infants with a severe CHD, e.g., requiring cardiac surgery, cardiac catheterization, or hospitalization for heart failure during their first year of life, were included in the study. Malnutrition was observed among 43% of the cohort, with the highest prevalence in infants with increased pulmonary blood flow (71%) compared to the other hemodynamic groups (p < 0.001). In multivariate analysis, low birthweight (OR 0.62, 95% CI 0.44-0.89, p = 0.009), CHD with increased pulmonary blood flow (OR 4.80, 95% CI 1.42-16.20, p = 0.08), heart failure (OR 9.26, 95% CI 4.04-21.25, p < 0.001), and the number of hospitalizations (OR 1.35, 95% CI 1.08 l-1.69, p = 0.009) during the first year of life were associated with malnutrition (AUC 0.85, 95% CI 0.79-0.90). Conclusions: In infants with a severe CHD, early occurrence of malnutrition during the first year of life affected a high proportion of subjects. CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations were risk factors for malnutrition. Further studies are required to identify optimal nutritional support in this population. What is Known: • Malnutrition is a known morbidity and mortality factor in children with severe congenital heart disease. What is New: • Early occurrence of malnutrition during the first year of life in infant severe congenital heart disease (CHD) was high (43%). • CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations during the first year of life were risk factors for malnutrition.
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Affiliation(s)
- Margot Mignot
- Department of Pediatric Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
- Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, Montpellier, 34295, France
- Pathogenesis and Control of Chronic Infection, INSERM, UMR 1058, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Julie Blanc
- Pediatric and Congenital Cardiology Department, Timone Children Hospital, Aix-Marseille University, Marseille, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, Timone Children Hospital, Aix-Marseille University, Marseille, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
- Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Clement Karsenty
- Pediatric Cardiology Unit, Children Hospital, Toulouse Hospital, Toulouse, France
- Institut Des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, Toulouse, France
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - Laura Kollen
- Department of Pediatric Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, Montpellier, 34295, France.
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
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Lee C, Kim S, Kim J, Lim C, Jung M. Challenges of diet planning for children using artificial intelligence. Nutr Res Pract 2022; 16:801-812. [PMID: 36467765 PMCID: PMC9702545 DOI: 10.4162/nrp.2022.16.6.801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/13/2022] [Accepted: 03/23/2022] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES Diet planning in childcare centers is difficult because of the required knowledge of nutrition and development as well as the high design complexity associated with large numbers of food items. Artificial intelligence (AI) is expected to provide diet-planning solutions via automatic and effective application of professional knowledge, addressing the complexity of optimal diet design. This study presents the results of the evaluation of the utility of AI-generated diets for children and provides related implications. MATERIALS/METHODS We developed 2 AI solutions for children aged 3-5 yrs using a generative adversarial network (GAN) model and a reinforcement learning (RL) framework. After training these solutions to produce daily diet plans, experts evaluated the human- and AI-generated diets in 2 steps. RESULTS In the evaluation of adequacy of nutrition, where experts were provided only with nutrient information and no food names, the proportion of strong positive responses to RL-generated diets was higher than that of the human- and GAN-generated diets (P < 0.001). In contrast, in terms of diet composition, the experts' responses to human-designed diets were more positive when experts were provided with food name information (i.e., composition information). CONCLUSIONS To the best of our knowledge, this is the first study to demonstrate the development and evaluation of AI to support dietary planning for children. This study demonstrates the possibility of developing AI-assisted diet planning methods for children and highlights the importance of composition compliance in diet planning. Further integrative cooperation in the fields of nutrition, engineering, and medicine is needed to improve the suitability of our proposed AI solutions and benefit children's well-being by providing high-quality diet planning in terms of both compositional and nutritional criteria.
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Affiliation(s)
- Changhun Lee
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Korea
| | - Soohyeok Kim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Korea
| | - Jayun Kim
- Kosin Innovative Smart Healthcare Research Center, Kosin University Gospel Hospital, Busan 49267, Korea
| | - Chiehyeon Lim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Korea
- Graduate School of Artificial Intelligence, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Korea
| | - Minyoung Jung
- Kosin Innovative Smart Healthcare Research Center, Kosin University Gospel Hospital, Busan 49267, Korea
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea
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Defining Normal Ranges of Skeletal Muscle Area and Skeletal Muscle Index in Children on CT Using an Automated Deep Learning Pipeline: Implications for Sarcopenia Diagnosis. AJR Am J Roentgenol 2022; 219:326-336. [PMID: 35234481 DOI: 10.2214/ajr.21.27239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Skeletal muscle area (SMA), representing skeletal muscle cross-sectional area at the L3 vertebral level, and skeletal muscle index (SMI), representing height-normalized SMA, can serve as markers of sarcopenia. Normal SMA and SMI values have been reported primarily in adults. Objective: To use an automated deep-learning (DL) pipeline for muscle segmentation on abdominal CT to define normative age- and sex-based values for pediatric muscle cross-sectional area, as a guide for diagnosis of sarcopenia in children. Methods: This retrospective study reviewed records of patients who underwent abdominal CT at Cincinnati Children's Hospital Medical Center from January 1, 2009 to January 3, 2019. Patients were excluded on the basis of age outside of the eligible range (2.00-18.99 years), body mass index (BMI) outside of 5% to 95% age-based percentiles using CDC and WHO growth charts), known medical condition, medication use, support devices, surgery, or missing axial images at L3 level. A previously validated automated DL pipeline (https://github.com/cchmc-dll/pediatric_sarcopenia_pipeline.git) was used to identify an axial slice at L3 and segment skeletal muscle, to generate SMA and SMI. Pearson correlation coefficients were computed. Quantile regression analysis was used to plot SMA and SMI as functions of age and sex and to determine age- and sex-based percentile values. Results: Of 8817 patients who underwent abdominal CT during the study period, 2168 (mean age, 11.5±45 years; 1125 females, 1043 males) met inclusion criteria. Mean BMI-for-age percentile based on CDC and WHO growth charts was 64.8±25.3% for females and 61.4±25.8% for males. SMA showed strong correlation with weight, height, age, and BMI for males (0.79-0.94) and females (0.75-0.90); SMI showed weak-to-moderate correlation with weight, height, age and BMI for males (0.25-0.57) and females (0.00-0.43). Normal SMA and SMI ranges for age and sex were expressed as curves and as a lookup table, identifying 54 males and 59 females with muscle measurements below the 5-percentile regression curve. Conclusion: By using an automated DL pipeline in a large sample of carefully selected children, normal ranges for SMA and SMI were calculated as functions of age and sex. Clinical Impact: The normative values should aid the diagnosis of sarcopenia in children.
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Woolfson JP, Perez M, Chavhan GB, Johara FT, Lurz E, Kamath BM, Ng VL. Sarcopenia in Children With End-Stage Liver Disease on the Transplant Waiting List. Liver Transpl 2021; 27:641-651. [PMID: 33460522 PMCID: PMC8248423 DOI: 10.1002/lt.25985] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
Sarcopenia predicts morbidity and mortality in adults with end-stage liver disease (ESLD) and is determined by total psoas muscle area (tPMA) measurement from computed tomography (CT) imaging. Recently developed pediatric age- and sex-specific tPMA growth curves provide the opportunity to ascertain prevalence and impact of sarcopenia in children awaiting liver transplantation (LT). This retrospective single-center study evaluated sarcopenia in children between 1 and 16 years with ESLD and a clinically indicated abdominal CT less than 3 months before first isolated LT. Sarcopenia was defined as tPMA z score less than -2 measured at the intervertebral L4-5 level. Patient demographic, biochemical, and outcome data were recorded. tPMA was compared with other measures of nutritional status using univariate and multivariate logistic analyses. Outcome measures included 1-year morbidity events and mortality after LT. CT images from 25 (64% female) children with median age of 5.50 (interquartile range [IQR], 3.75-11.33) years were reviewed. Ten children (40%) had a tPMA z score less than -2. Sarcopenia was associated with lower z scores for weight (odds ratio [OR], 0.38; P = 0.02), height (OR, 0.32; P = 0.03), and nutritional support before LT (OR, 12.93; P = 0.01). Sarcopenic children had a longer duration of pediatric intensive care unit (PICU) stay (3.50 [IQR, 3.00-6.00] versus 2.00 [IQR, 2.00-3.50] days; P = 0.03). Sarcopenia was prevalent in 40% of children with ESLD awaiting LT, and lower tPMA z score was associated with deficient anthropometrics and need for nutritional support before LT. Post-LT PICU duration was increased in children with sarcopenia, reflecting adverse outcomes associated with muscle loss. Further studies are needed to elucidate the underlying mechanisms of sarcopenia in children with ESLD.
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Affiliation(s)
- Jessica P. Woolfson
- Division of Gastroenterology, Hepatology, and Nutritionthe Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Manuela Perez
- University of TorontoTorontoOntarioCanada
- Department of Diagnostic Imaging and Department of Medical Imagingthe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Govind B. Chavhan
- University of TorontoTorontoOntarioCanada
- Department of Diagnostic Imaging and Department of Medical Imagingthe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Fatema T. Johara
- Division of Gastroenterology, Hepatology, and Nutritionthe Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Eberhard Lurz
- Division of Gastroenterology, Hepatology, and Nutritionthe Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Binita M. Kamath
- Division of Gastroenterology, Hepatology, and Nutritionthe Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
- Transplant and Regenerative Medicine Centrethe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Vicky L. Ng
- Division of Gastroenterology, Hepatology, and Nutritionthe Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
- Transplant and Regenerative Medicine Centrethe Hospital for Sick ChildrenTorontoOntarioCanada
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5
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Lurz E, Patel H, Lebovic G, Quammie C, Woolfson JP, Perez M, Ricciuto A, Wales PW, Kamath BM, Chavhan GB, Jüni P, Ng VL. Paediatric reference values for total psoas muscle area. J Cachexia Sarcopenia Muscle 2020; 11:405-414. [PMID: 31920002 PMCID: PMC7113526 DOI: 10.1002/jcsm.12514] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sarcopenia, the unintentional loss of skeletal muscle mass, is associated with poor outcomes in adult patient populations. In adults, sarcopenia is often ascertained by cross-sectional imaging of the psoas muscle area (PMA). Although children with chronic medical illnesses may be at increased risk for muscle loss because of nutritional deficiencies, physical deconditioning, endocrine anomalies, and systemic inflammation, consistent quantitative definitions for sarcopenia in children are lacking. We aimed to generate paediatric reference values for PMA at two intervertebral lumbar levels, L3-4 and L4-5. METHODS In this cross-sectional study, we analysed abdominal computed tomography scans of consecutive children presenting to the emergency department. Participants were children 1-16 years who required abdominal cross-sectional imaging after paediatric trauma between January 1, 2005 and December 31, 2015 in a large Canadian quaternary care centre. Children with a documented chronic medical illness or an acute spinal trauma at presentation were excluded. Total PMA (tPMA) at levels L3-4 and L4-5 were measured in square millimetres (mm2 ) as the sum of left and right PMA. Age-specific and sex-specific tPMA percentile curves were modelled using quantile regression. RESULTS Computed tomography images from 779 children were included. Values of tPMA at L4-5 were significantly larger than at L3-4 at all ages, but their correlation was high for both girls (r = 0.95) and boys (r = 0.98). Amongst girls, tPMA 50th percentile values ranged from 365 to 2336 mm2 at L3-4 and from 447 to 2704 mm2 for L4-5. Amongst boys, 50th percentile values for tPMA ranged between 394 and 3050 mm2 at L3-4 and from 498 to 3513 mm2 at L4-5. Intraclass correlation coefficients were excellent at L3-4 (0.97, 95% CI 0.94 to 0.981) and L4-5 (0.99, 95% CI 0.986 to 0.995). Weight and tPMA were correlated, stratified by sex for boys (L3-4 r = 0.90; L4-5 r = 0.90) and for girls (L3-4 r = 0.87; L4-5 r = 0.87). An online application was subsequently developed to easily calculate age-specific and sex-specific z-scores and percentiles. CONCLUSIONS We provide novel paediatric age-specific and sex-specific growth curves for tPMA at intervertebral L3-4 and L4-5 levels for children between the ages of 1-16 years. Together with an online tool (https://ahrc-apps.shinyapps.io/sarcopenia/), these tPMA curves should serve as a reference enabling earlier identification and targeted intervention of sarcopenia in children with chronic medical conditions.
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Affiliation(s)
- Eberhard Lurz
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, von Haunersches Kinderspital, LMU, Munich, Germany
| | - Hiten Patel
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Gerald Lebovic
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Claudia Quammie
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessica P Woolfson
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Manuela Perez
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Ricciuto
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paul W Wales
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Ooi PH, Thompson-Hodgetts S, Pritchard-Wiart L, Gilmour SM, Mager DR. Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children? JPEN J Parenter Enteral Nutr 2019; 44:407-418. [PMID: 31328301 DOI: 10.1002/jpen.1681] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/13/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malnutrition is a common complication in children with chronic diseases. Sarcopenia is one component of malnutrition, characterized by reduced skeletal muscle mass (SMM) and muscle function. The presence of sarcopenia is associated with adverse outcomes in children. Although there is growing research interest in sarcopenia, no review has been done on this novel concept in pediatrics. The purpose of this review was to explore current evidence in sarcopenia with and without obesity and to evaluate the knowledge gaps in the assessment of childhood sarcopenia. METHODS A total of 12 articles retrieved from PubMed or Web of Science databases were included. RESULTS Limited studies have elucidated sarcopenia in pediatrics. Challenges in sarcopenia assessment include heterogeneity in definition and absence of standardized body composition methods used to measure SMM and muscle function tests. There is a lack of age-specific and gender-specific normative data for SMM, particularly in young children and infants. None of the studies incorporated muscle function assessment, causing potential bias and misclassification of sarcopenia. The research in childhood sarcopenia is also hampered by low study quality, limited number of outcomes-based research, and lack of longitudinal data. CONCLUSION Consensus needs to be reached in methodological approaches in sarcopenia diagnosis, body composition measurements, and age-appropriate muscle function tests in pediatrics. Careful considerations on growth, neurocognitive status, and factors influencing development in various clinical populations are warranted. Early identification of sarcopenia is crucial to enable targeted treatment and prevention to be carried out across the pediatric clinical populations.
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Affiliation(s)
- Poh Hwa Ooi
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susan M Gilmour
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Division of Pediatric Gastroenterology & Nutrition/Transplant Services, The Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Diana R Mager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Pitman RT, Mui M, Michelson PH, Manary MJ. Ready-to-Use Supplemental Food for Nutritional Supplementation in Cystic Fibrosis. Curr Dev Nutr 2019; 3:nzz016. [PMID: 31011716 PMCID: PMC6468303 DOI: 10.1093/cdn/nzz016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/15/2019] [Accepted: 03/11/2019] [Indexed: 01/23/2023] Open
Abstract
Undernutrition is common in cystic fibrosis (CF) and is correlated with long-term outcomes, yet current nutritional interventions have not demonstrated consistent improvements in energy intake, and subsequently, growth. Development of novel nutritional interventions to increase energy intake is essential to improve clinical outcomes of individuals with CF. Ready-to-use supplemental food (RUSF) is a modifiable, inexpensive, palatable, safe, and nutrient-dense food for treatment or prevention of acute malnutrition in developing countries. Utilizing a linear-programming tool we identified 6 RUSF formulations with sufficient nutrient density (495 kcal/100 g), protein, and fat for children with CF. Palatability was established by a taste-trial and affirmed by a 2-wk tolerability assessment that demonstrated consistent consumption and tolerance of the RUSF. Although preliminary, this study demonstrates the potential for developing RUSF as a nutritional supplement for increasing energy intake in children with CF.
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Affiliation(s)
- Ryan T Pitman
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Melody Mui
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Peter H Michelson
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Mark J Manary
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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Abstract
As a result of new medications and therapeutic approaches, most children with rheumatic diseases are no longer at risk for growth failure which results from chronic inflammation and prolonged corticosteroid treatment. However, obesity, poor nutrition, and insufficient exercise are still problems which increase risks for poor bone, cardiovascular, and general health. Diet should be monitored and modified as appropriate; supplemental calcium and Vitamin D should be provided. Obesity and poor physical fitness can be ameliorated by an exercise program that should become part of a more healthy lifestyle.
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Affiliation(s)
- Sharon Bout-Tabaku
- Department of Pediatric Medicine, Sidra Medicine, Qatar Foundation, OPC, Level 2, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar.
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