Age Body Mass Index Research Articles

Association of parental eating styles and markers of food intake and nutritional status of Brazilian children

We analysed the relationships between maternal feeding styles and children’s eating and nutritional factors. A cross-sectional study was developed with 416 mothers linked to 130 public higher education institutions in all Brazilian states and their children aged 18 months to six years. A semi-structured online questionnaire was applied using the Google Forms tool, with questions about sociodemographic conditions, food consumption and anthropometry of the children. The children’s food consumption was assessed based on the Food Consumption Markers Form (SISVAN) for the age groups up to 24 months (n = 84) and over 24 months (n = 332), and the parental style in feeding, based on the Parental Feeding Styles Questionnaire (QEPA). The assessment of the child’s nutritional status was based on the weight and height data reported by the mother. The body mass index/age (BMI/Age) was calculated and classified into age-specific WHO curves. Descriptive analysis and univariate analyses were performed, in the Statistical Package for the Social Sciences (SPSS, version 26.0) programs (SPSS Inc., Chicago, IL). To test the association between categorical variables, the Chi-square test or Fisher’s exact test was used, and multiple logistic regression was used to estimate the independent association between the variables of interest, with an estimated odds ratio and 95% confidence interval. Statistical significance was adopted at 5%. Children under 24 months of age with authoritative mothers were 8.7 times more likely to consume ultra-processed foods and 5.3 times less likely to consume foods rich in vitamin A than those with indulgent mothers. Children over 24 months old with authoritative mothers were 2.5 times more likely to eat meals while watching television, 2.0 times more likely to consume sandwich cookies, candies and sweets, and 2.3 times less likely to have at least the three main meals of a day, compared to those with indulgent mothers. The chances of overweight children being born to authoritative mothers were two times greater compared to underweight children. Higher scores in the demandingness domain among responsive mothers increased the odds ratios of children eating unhealthy foods, using screens during meals, and proved to be a protective factor against low child weight.

Obesity and risk of hypertension in preadolescent urban school children: insights from Pakistan

BackgroundChildhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in urban Karachi, Pakistan.MethodsThis is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescents aged 6–11 years, attending two private schools conducted from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension.ResultsAnalysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension at followup (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) at follow up in the final model.ConclusionThis study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension or prehypertension at followup within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.

Association of handgrip strength with nutritional status and clinical outcomes in hospitalized pediatric patients

Background & aimsMalnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients. MethodsCohort study conducted with patients aged 6 to 18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 hours of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/I) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge. ResultsA total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR=0.63; 95%CI 0.23 - 1.77), prolonged hospital stay (OR=1.89; 95%CI 0.72 - 4.92) or readmission to hospital 3 months after hospital discharge (OR=1.82; 95%CI 0.67 - 4.93), in a model adjusted for the clinical condition. ConclusionReduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.

Improving the Nutritional Status of Socially Vulnerable Children in Manaus, Brazilian Amazon, through a Food Supplementation Programme.

Information on the effects of government nutrition programmes provided to socially vulnerable children to improve their nutritional status is scarce. We analysed the effectiveness of a nutritional programme, including food supplementation with infant formula, on the evolution of the weight and height of socially vulnerable children from Manaus in the Brazilian Amazon. This study included 7752 children aged 12-24 months admitted to the programme between 2017 and 2020. Weight and height measurements at admission and every three months thereafter were extracted from the programme database. Weight-for-age, weight-for-height, body mass index-for-age (BMI/A), and height-for-age z-scores were analysed using a multilevel linear regression model, which showed a statistically significant decrease in nutritional deficits toward nutritional recovery at follow-up. The programme's effectiveness was evaluated in 1617 children using a paired analysis comparing data from between 12 and 15 months of age at admission and follow-up after 6-9 months. Children admitted with wasting presented an increase in the BMI/A z-score, whereas children admitted with a risk of being overweight and obese had a statistically significant decrease in the BMI/A z-score. Children admitted with stunted growth also showed increased height-for-age z-scores. The nutrition programme was effective for children experiencing wasting and reducing excess weight.

Markers of chronic disease risk in term low birthweight Indian children aged 8-14 years.

Low birth weight (LBW) is a public health problem in India with consequences in the short and long term. It increases the risk of obesity and its related comorbidities including type 2 diabetes and cardiovascular disease (CVD) in later life. This study aimed to assess the risk markers of chronic disease in term born low birthweight Indian children aged 8-14 years. This was a cross-sectional follow-up of LBW children from DIViDS (Delhi Infant Vitamin D Supplementation) cohort and involved assessment of their anthropometric measurements, body composition, levels of adipokines and biomarkers of chronic diseases. Neighbourhood children born normal birth weight (NBW) (>2.5 kg) were enrolled for comparison. The study included 667 LBW and 87 NBW children. Height-for-age, body mass index for-age (BMIZ), fat-free mass index, and waist circumference of LBW children were lower than those of NBW children. LBW children could jump farther. LBW children who were now overweight had higher leptin, triglyceride and VLDL and lower HDL, compared to NBW children in the same BMIZ category. Currently underweight LBW children had higher adiponectin and lower leptin levels than the reference group. There were no differences between LBW and NBW children in visfatin, fasting glucose and insulin, hemoglobin A1c, triglyceride, low density lipoprotein or C-reactive protein. At 8-14 years few children were overweight and there were few differences in some risk markers of chronic disease between LBW and NBW children. Overweight, which was associated with some increased risk markers, may increase with age, thus timely counselling and monitoring of these LBW children will be important to mitigate these risks.

Pengukuran dan Penilaian Status Gizi Anak Sekolah Dasar Negeri 100 Kendari Menggunakan Indeks Massa Tubuh Menurut Umur

<p><em>The growth and development of school-age children are linked to their nutritional status. It is necessary to monitor the nutritional well-being of these children, as issues during this crucial period can have lasting effects on their future and impact the overall quality of human resources. This research was performed to measure and assess the nutritional status of elementary school children at State Elementary School 100 Kendari based on the Body Mass Index for Age (BMI/A). The participants were pre-adolescents aged between 10-12 years old at the fourth, fifth, and sixth grade totaling to 63 students. The anthropometric measurements of weight and height was used as the primary method for assessment. Nutritional status was determined through the BMI/A. The results indicate that in the fourth grade, 12 students (57%) were classified as underweight, 8 students (38%) as normal, and 1 student (5%) as overweight. Similarly, in the fifth grade, 10 students (48%) were under weight, 8 students (38%) were normal, and 3 students (14%) were overweight. In the sixth grade, 9 students (43%) were under weight, 9 students (43%) had a normal nutritional status, and 3 students (14%) were overweight. Regular monitoring of nutritional status is emphasized as a preventive measure against nutritional problems in school-age children. </em></p>

Changes of anthropometric indicators of lithuanian first-graders in 2008–2019 according to International Obesity Task Force (IOTF) and World Health Organization (WHO) definitions

IntroductionThe monitoring of children’s growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children’s anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period.MethodsThis study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year.ResultsThe mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008–2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl’s group with obesity aged 8 years according to IOTF cut-offs.ConclusionThe prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children’s growth tendencies.

Breast milk leptin concentrations and infant anthropometric indicators in SGA versus non-SGA breastfed infants born at term

Leptin concentrations in breast milk can influence metabolic programming during the first months of life. Small for gestational age (SGA) newborns show a peculiar growth pattern after birth, which can lead to adulthood diseases. This study aims to assess an association between leptin concentration in mature breast milk and the infant anthropometric indicators of the SGA and the non-SGA groups, in addition, to comparing the hormone level between these groups. A longitudinal study was performed with mother-infant pairs. The maternal sociodemographic information was collected in the first 48 h postpartum. Breast milk was collected at one month postpartum and leptin concentrations were obtained by immunoassays. The infant anthropometric measurements were collected at three and six months postpartum and included weight, height (to body mass index-BMI calculated), triceps skinfold (TSF), and subscapular skinfold (SSF). The BMI for age (BMI/A), TSF, and SSF were calculated by Z-score indicators. Data from 67 mother-infant pairs (n = 16 SGA and n = 51 non-SGA) were analyzed. In univariate analyses, the breast milk of the SGA group had lower leptin concentrations than the non-SGA group (p = 0.006), however, after adjustment, there was no difference between groups (p = 0.181). In the SGA group, there was a significant association between leptin concentrations and lower SSF at six months in infants, after adjustment (p = 0.003). In the non-SGA group, the breast milk leptin was associated with lower BMI/A at three and six months in infants, after adjustment (p = 0.002 and p = 0.010, respectively). The association between breast milk leptin concentrations with SSF in the SGA group and BMI/A in the non-SGA group suggests that leptin may be a modulating factor in infant growth in the first months of life.

Nutritional status and inflammatory markers as survival predictors in pediatric central nervous system tumors

Central nervous system tumors (CNS) are the second most common malignancies in childhood. Inflammation and changes in nutritional status play an important role and can be used as prognostic markers. Thus, this study aimed to evaluate the predictive ability of nutritional status and inflammatory markers on overall survival (OS) of pediatric patients with CNS. In this retrospective cohort study, 103 patients were followed for 5 years. Clinical, anthropometric, and hematological data were collected. Body mass index for age (BMI/A), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) were calculated. OS curves were calculated using the Kaplan Meier method and evaluated using the Log-Rank test. The Cox proportional hazards model was performed to identify independent variables associated with prognostic factors, generating hazard ratios (HR) and 95% confidence intervals (CI). Nutritional status did not significantly affect OS. However, patients with NLR ≥2.18 and SIRI ≥1249.18 had significantly lower OS in 5 years. Only treatment and high NLR were identified as independent prognostic factors for worse OS. Treatment with exclusive radiotherapy or chemotherapy (HR: 16.22, 95% CI: 2.19-120.07) and NLR (HR: 1.94, 95% CI: 1.02-3.69) were identified as independent prognostic factors for worse OS at 5 years. High pretreatment NLR was shown to be an independent prognostic factor for OS in pediatric patients with CNS.

Perfil nutricional de crianças indígenas menores de cinco anos de idade no Alto Rio Solimões, Amazonas, Brasil (2013)

Abstract Objectives: to characterize the nutritional status of indigenous children underfive years of age living in rural communities in the Upper Solimões River region, inhabited by seven ethnic groups, based on data of december 2013. Methods: weight and height data extracted from SISVAN-I (Indigenous Food and Nutritional Surveillance System) forms filled in 2013 for 7,520 children (86.0% of the estimated children in this age group). The indices height-for-age (H/A), weight-for-age (W/A), weight-for-height(W/H), and body mass index-for-age (BMI/A) were calculated. Growth reference curves proposed by the World Health Organization were used to calculate z-scores. Results: the height-for-age (H/A) index presented the lowest mean z-score values, reaching -1.95 among children between 36 and 60 months. Mean z-score values for the weight-for-age (W/A) index also remained below zero. Mean z-score values for the indices weight-for-height (W/H) and body mass index-for-age (BMI/A) remained slightly above zero, reaching a maximum value of 0.5. Of all children, 45.7% presented low H/A, 9.6% presented low W/A, 4.5% presented low W/H, and 10.7% presented overweight based on BMI/A. Conclusion: our analysis show that in 2013 poor nutritional status persisted as an important health issue among these rural indigenous children.

Association of nutritional status with clinical outcomes of critically ill pediatric patients with complex chronic conditions

There is a high prevalence of children with complex chronic conditions (CCCs) in pediatric intensive care units (PICUs). However, information on the nutritional status (NS) of this specific population is limited. This study aimed to evaluate the NS of critically ill pediatric patients with CCCs and to relate it to clinical outcomes. A retrospective cohort study of children admitted to a PICU over a 4-year period. We classified NS according to body mass index-for-age (BMI/A) and height-for-age (H/A) z-scores, using the World Health Organization (WHO) growth curves as a reference. We recorded the presence of CCC according to the definition proposed by Feudtner etal. Severity on admission was measured using the Pediatric Index of Mortality 2 (PIM2). We assessed the following outcomes: mortality, multiple organ dysfunction syndrome during PICU stay, and PICU length of stay (LOS). We included 1753 children in the study. Presence of CCC accounted for 49.8% (873) of the sample. Among children with CCCs, 61.7% (539) had appropriate weight, 19.8% (173) were underweight, and 18.4% (161) were overweight. H/A was considered inadequate in 32.2% (281) of patients with CCCs, a higher rate than in those without CCCs (25.3%; 132) (p<0.001). Regarding outcomes, underweight children had more organ dysfunctions and prolonged LOS. The association only remained for prolonged LOS when adjusting for confounders. Although underweight children had a higher PIM2-predicted risk of mortality, there was no significant difference in actual mortality between the three NS groups (p=0.200). The rates of nutritional inadequacies in patients with CCCs were high. Underweight was independently associated with prolonged LOS in children with CCC.

Linear growth of infants aged 0-6 months in breastfeeding mothers who consume Moringa oleifera leaf extract capsules: randomized controlled doubleblind design

The prevalence of stunting in children in Indonesia is still high. However, linear growth and infant growth rates are relatively rarely published. This study aimed to analyse the effect of linear growth and growth rate of infants aged 0-6 months exclusively breastfed on mothers who consumed Moringa leaf extract and Moringa leaf powder supplements. The design of this study was a randomized controlled Double-Blind Design. Subjects were divided into 35 intervention groups and 35 control groups. The intervention group was given Moringa extract capsules (3.2 g/day) and breastfeeding education, while the control group was given Moringa leaf powder capsules (3.2 g/day) and breastfeeding education for about 3 months. Infant growth was followed until the age of 6 months, the variables of infant growth were expressed in weight for age, body length for age and growth based on the nutritional status of the infant expressed in the Z score of weight for age (W/A), Z score of body length for age (BL/A), Z score of body weight for body length (BW/BL) and Z score of body mass index for age (BMI/A). Statistical analysis with paired T-test, Kolmogorov-Smirnov, and Exat Fisher Test. The results showed that the growth of body weight, body length, and BL/A were not different between the intervention group and the control group (p&gt;0.05). Especially for the Z score of BW/A, BW/BL, BMI/A found a difference between the intervention and control groups with a p-value &lt;0.05. The conclusion of the research is the growth rate of weight and length of infants aged 0-6 months were influenced by birth weight, infant morbidity, and exclusive breastfeeding status. The difference in the average deviation of the Z score value from the four anthropometric indices (BW/A, BW/BL, and BMI/A) roled in the administration of Moringa extract.

The association of cesarean section with overweight and neurodevelopment of Chinese children aged 1-5 months.

ObjectiveThe purpose of this survey was to explore the association of delivery mode with overweight and neurodevelopment of Chinese infants aged 1–5 months.Materials and methodsThis study was based on a cross-sectional survey. Data for this study were obtained from the Children’s Nutrition and Health System Survey in China which was conducted from 2019 to 2020. Characteristics of parents and children and the delivery mode were obtained using interview-administered questionnaires. Body mass index-for age z-score (BMI z) was calculated using World Health Organization (WHO) child growth standards. Children’s neurodevelopment was assessed by a trained child health care physician using the Child Psychological Development Scale. The association of delivery mode with infant overweight was analyzed using a multivariable logistic regression model. We conducted a multivariable linear regression model to explore the relationship between delivery modes with neurodevelopment.ResultsIn total, the present analysis included 1,347 children aged 1–5 months, 35.61% were born via cesarean section, of which 15.21% were overweight. After adjustment for infant characteristics and parental factors, the cesarean section was significantly related with the likehood of being overweight [OR = 1.95; 95% confidence interval (CI): 1.27 to 2.98]. Children born via cesarean section had a 3.41-point decrease in gross motor development (β = −3.41; 95% CI: −5.77 to −1.05), a 3.65-point decrease in fine motor development (β = −3.65; 95% CI: −6.03 to −1.28), and a 2.96-point in language development (β = −2.96; 95% CI: −5.20 to −0.73), a 1.65-point in total development (β = −1.65; 95% CI: −3.17 to −0.14) compared with those who were vaginal birth.ConclusionIn our study population, cesarean section was associated with overweight and neurodevelopment outcomes. The cesarean section might increase the likehood of infant overweight, and might decrease the developmental scores of gross motor, fine motor and language. Further studies should be conducted to verify the associations and explore the possible mechanisms.

Temporal variation in the incidence of overweight and abdominal obesity among adolescents in the city of Salvador, Bahia, Brazil

The scope of this study was to analyze the temporal variation in the incidence of overweight and abdominal obesity among adolescents from public schools in a capital in northeastern Brazil. It is a study including information from three cross-sectional surveys carried out in 2001, 2009 and 2017, with 2,496 students aged 10 to 18 years of both sexes living in the city of Salvador, Bahia. Overweight was assessed using the Body Mass Index for Age (BMI/A) and abdominal obesity was assessed using waist circumference and waist-to-height ratio. Pooled OLS (Ordinary Least Squares) regression, with constant effect, was used to assess the variation of anthropometric indicators over the period. The results of this study indicate that the prevalence of overweight increased by 103% and the indicators of abdominal obesity increased by 153% and 142%, respectively, in the period under analysis. The increase in the mean body mass index and waist-to-height ratio was greater among adolescents and in the mean BMI and waist circumference among those aged 14 to 18 years old. The conclusion reached was that there was a significant increase in the prevalence of overweight and abdominal obesity in the period 2001 to 2017 among adolescents in the city of Salvador.

Effect of a Short-Term Low Glycemic Index Dietary Intervention on Ad Libitum Food Intake, Diet Quality, and Subjective Appetite Ratings in Preschoolers

ObjectivesTo examine the effect of ad-libitum low-glycemic index (GI; high fiber) versus high-GI diet on energy intake, diet quality (Healthy Eating Index 2015 (HEI-2015)), self-reported feelings of hunger and fullness, liking of the foods, and physical activity (PA) in preschoolers.MethodsTwenty-five healthy preschoolers (aged 48 ± 7.3 mo, 47% females, 73% healthy weight) were recruited to participate in “day camps” of two low- and two high-GI (usual diet) days. Food and nutrient consumption, HEI-2015 scores, pre- and post-lunch hunger ratings, food liking, and PA were measured each day. Paired t-tests were used to compare treatment differences. Results were stratified into healthy (HW; <85% of BMI-for Age z-score of the CDC growth charts) and non-healthy weight (NHW; ≥85%) and compared within- (by diet) and between- (HW vs NHW) groups.ResultsGI and glycemic load (GL) were significantly lower on the low- versus high- GI diet (GI: 46.5 ± 3.3 vs 58.2 ± 5.1, GL: 24.9 ± 16.8 vs 47.4 ± 17.9, respectively; P < 0.01). Children consumed more total fiber while eating the low-GI diet (14.6 ± 8.8g vs 6.4 ± 2.6, P < 0.001), despite no difference between low- and high-GI diets in total energy (459.3 ± 230.6 vs 497.5 ± 173.9kcal, p< 0.001), carbohydrate (82.9 ± 45.1 vs 87.4 ± 30.9g, p = 0.55), fat (10.5 ± 5.2 vs 12.3 ± 5.7g, p = 0.07), and protein (14.4 ± 8.4 vs 12.0 ± 5.1, p = 0.05) intake, respectively. Mean HEI-2015 scores were higher on the low- versus high-GI diets (85.2 ± 11.6 and 59.4 ± 7.0, respectively; P < 0.001). There were no differences in hunger (p > 0.26), food liking (p > 0.01), or PA (p = 0.88) between diets. Fewer NHW children reported being “full” compared to HW children, (26% vs 52%, respectively, p = 0.03), yet both groups had similar energy intake (467.5 ± 155.0 and 482.1 ± 220.7kcal, respectively, p = 0.78).ConclusionsAn ad libitum low-GI diet provided better diet quality in preschoolers, with no difference in food liking. Although there was no effect on hunger, body mass may influence response to food intake and suggests eating in the absence of hunger observed in the overweight/obese children. Additional work is needed to better understand the effect of low-GI diets and fiber consumption on appetite regulation in preschoolers with overweight/obesity.Funding SourcesThis study was funded by the University of Virginia School of Education and Human Development Initiative Fund.

Chronic Intestinal Failure in Children: An International Multicenter Cross-Sectional Survey.

Background: The European Society for Clinical Nutrition and Metabolism database for chronic intestinal failure (CIF) was analyzed to investigate factors associated with nutritional status and the intravenous supplementation (IVS) dependency in children. Methods: Data collected: demographics, CIF mechanism, home parenteral nutrition program, z-scores of weight-for-age (WFA), length or height-for-age (LFA/HFA), and body mass index-for-age (BMI-FA). IVS dependency was calculated as the ratio of daily total IVS energy over estimated resting energy expenditure (%IVSE/REE). Results: Five hundred and fifty-eight patients were included, 57.2% of whom were male. CIF mechanisms at age 1–4 and 14–18 years, respectively: SBS 63.3%, 37.9%; dysmotility or mucosal disease: 36.7%, 62.1%. One-third had WFA and/or LFA/HFA z-scores < −2. One-third had %IVSE/REE > 125%. Multivariate analysis showed that mechanism of CIF was associated with WFA and/or LFA/HFA z-scores (negatively with mucosal disease) and %IVSE/REE (higher for dysmotility and lower in SBS with colon in continuity), while z-scores were negatively associated with %IVSE/REE. Conclusions: The main mechanism of CIF at young age was short bowel syndrome (SBS), whereas most patients facing adulthood had intestinal dysmotility or mucosal disease. One-third were underweight or stunted and had high IVS dependency. Considering that IVS dependency was associated with both CIF mechanisms and nutritional status, IVS dependency is suggested as a potential marker for CIF severity in children.

Nutritional status of children with heart disease at the Komfo Anokye Teaching Hospital, Ghana

Background Undernutrition is associated with forty-five percent of all deaths in children under-five years. Irrespective of the type of heart disease (HD), malnutrition remains a constant phenomenon in children with both congenital and acquired HD. To minimize the long-term effect of malnutrition in a cohort of patient who have very limited chance of surgical treatment even when indicated, their nutritional statuses must be assessed periodically, and rehabilitation instituted early. The objective of this study was to assess the nutritional status of children attending the Pediatric Heart Disease clinic of the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.&#x0D; MethodsA retrospective review of children up to fourteen years, enrolled into the Pediatric Heart Disease clinic with confirmed HD from November 2020 to June 2021 were systematically recruited. Their ages, weights, heights and mid-upper arm circumferences (MUAC) were measured by standardized methods to assess their nutritional status. Subsequently, their Weight-for-Height (WfH), Height-for-Age (HfA), Weight-for-Age (WfA), Body Mass Index-for-Age (BfA) and MUAC-for-Age (MfA) z-scores were determined based on the WHO Child Growth Standards (2006). Z-scores less than -2 standard deviations (SDs) or greater than +2SDs were considered abnormal. Data was collected and analyzed using Epidata and R statistical software respectively.&#x0D; ResultsA hundred and sixty-seven patient were recruited with 86 (51.5%) being females. The median age was 56 months (Range: 1 to 172). The mean z-score for the WfH was -1.21 (95%CI: -1.48 to -0.94), HfA -1.18 (95%CI: -1.44 to -0.93), WfA -1.81 (95%CI: -2.06 to -1.56), BfA -1.41 (95%CI: -1.61 to -1.21) and MfA -1.66 (95%CI: -1.87 to -1.46). None of the patients had a z-score greater than +2SD for all anthropometric methods determined. The percentage of children with z-scores less than -2SD for WfH was 20.5% (95%CI: 12.0 to 31.6), HfA 21.3% (95%CI: 14.4 to 29.6), WfA 41.5% (95%CI: 33.1 to 50.3), BfA 31.1% (95%CI: 23.1 to 40.2) and MfA 36.0% (95%CI: 28.6 to 44.0).&#x0D; ConclusionThere is a high prevalence of malnutrition, wasting and stunting among children attending the Pediatric Heart Disease clinic at KATH. Strategies should be put in place to improve their nutritional status, which in turn could improve surgical and long-term developmental outcome.

Comparison of three different nutrition screening tools for pediatric inpatients

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. 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. 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. PYMS and PNST are suitable for use in malnutrition risk assessment in pediatric inpatients because of the screening tools' high sensitivity.

Risk factors for insufficient weight and height gain in children with congenital heart disease followed up at a nutrition outpatient clinic.

Objective:To describe weight and height evolution and to identify risk factors for insufficient anthropometric growth in children with congenital heart disease.Methods:Historical cohort study including 131 children with congenital heart disease, followed up at a nutrition outpatient clinic. The anthropometric indices over time (initial score, after 12 and 24 months of follow-up) were analyzed using generalized estimating equations. The outcome was ‘insufficient weight-height gain’, defined as an increase of ≤0.5 in the z-score of weight-for-age (W/A), height-for-age (H/A) or body mass index-for-age (BMI/A) after 12 months of follow-up. Multiple logistic regression models were applied to identify risk and confounding factors.Results:The z-scores of W/A (p<0.001) and BMI/A (p<0.001) improved after 12 months, as well as the three indexes after 24 months (p<0.001). At the end of this period, 55.7% of the patients did not achieve an increase of >0.5 in the Z score of W/A; 77.1%, of H/A; and 45.8%, of BMI/A. A follow-up of less than five appointments was associated with insufficient gain in W/A (OR 7.78; 95%CI 3.04–19.88), H/A (OR 10.79; 95%CI 2.22–52.45) and BMI/A (OR 2.54; 95%CI 1.12–5.75). Not having undergone cardiac surgery and being aged ≥12 months were factors associated with insufficient W/A gain (OR 3.95; 95%CI 1.38–11.29/OR 3.60; 95%CI 1.33–9.72) and BMI/A (OR 2.81; 95%CI 1.08–7.28/OR 3.39; 95%CI 1.34–8.56). Low income was associated with insufficient H/A gain (OR 4.11; 95%CI 1.25–13.46).Conclusions:Being aged less than or 12 months, the lowest number of appointments, absence of surgical treatment and low family income were risk factors for insufficient weight and height gain in children with congenital heart disease.

Nutritional deviations in children: comparative analysis of data from the food and nutrition surveillance system and those obtained by anthropometrists.

ABSTRACTObjective:To compare the prevalence rates of nutritional deviations in children under five years of age according to data from the Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional — SISVAN) and those obtained by trained anthropometrists.Methods:This is a descriptive cross-sectional study based on data from 10 municipalities and 2 sources: i) SISVAN Web (secondary database) and ii) an investigation that evaluated the implementation of food and nutrition actions in the Family Health Strategy in the state of Paraíba (primary database), with 24,137 and 897 individuals, respectively. Proportions of overweight — according to weight/age (W/A), weight/height (W/H), and body mass index/age (BMI/A) — and stunting — according to the height/age (H/A) index — based on classifications of SISVAN Web and those obtained by trained anthropometrists were compared using the two-proportion Z-test.Results:Frequencies of overweight, according to W/A (10.0 vs. 7.8%), W/H (17.2 vs. 14.3%), and BMI/A (18.1 vs. 14.4%), as well as stunting (12.3 vs. 8.6%), were higher on data from SISVAN Web than on those obtained by trained anthropometrists, and the differences were significant.Conclusions:The findings point to distortions in the nutritional classification of children under five years of age monitored by SISVAN Web.