Height-for-age Z-score Research Articles

Антропометрические показатели и нутритивный статус детей с тяжелой формой атопического дерматита и пищевой аллергией

Objective. To assess the nutritional status and factors affecting it in children with severe atopic dermatitis (AD) and food allergy (FA). Patients and methods. This single-center, observational, cross-sectional, uncontrolled, retrospective study enrolled 315 children aged between 1 month and 17 years 11 months with severe AD and FA. Standard anthropometric parameters were measured and calculated, including WAZ (weight-for-age Z-score), HAZ (height-for-age Z-score), and BAZ (BMI-for-age Z-score). Patients’ medical histories were examined, and the levels of total IgE and specific IgE to food allergens, hemoglobin, ferritin, iron, and vitamin D were evaluated. Results. On average, anthr opometric parameters in the examined patients were below the reference values. Failure to thrive of mild degree was detected in 27.6% of children, moderate degree in 13.7%, and severe degree in 2,2%. The frequency of overweight and obesity was 9.5% and 3.8%, respectively. A correlation was found between HAZ and children’s age (r = 0.21, p = 0.015) and the number of excluded food groups (r = -1.66, p = 0.031), and between BAZ and the number of excluded food groups (r = -1.39, p = 0.019). HAZ (p = 0.014) and BAZ (p = 0.017) values were lower in children following a dairy-free diet than in children on other types of elimination diets. At the same time, BAZ was higher in children who did not strictly follow the diet than in those who did (p = 0.011). There was a correlation between BAZ and vitamin D levels (r = 0.29, p = 0.012). Formulas based on extensive hydrolyzed protein and free aminoacides reduced severity and frequency of failure to thrive in management children with CMPA. Conclusion. Children with severe AD and FA require careful planning of their diets to reduce the risk of failure to thrive. It is necessary to study the influence of dietary composition and eating behavior of patients on their nutritional status. Key words: children, atopic dermatitis, nutritional status, elimination diet, food allergy, physical development, vitamin D

Effect of school feeding program on the anthropometric and haemoglobin status of school children in Sidama region, Southern Ethiopia: a prospective study.

Ethiopia recently scaled up the implementation of a school feeding program (SFP) as a targeted intervention for protecting disadvantaged school children from hunger and food insecurity. However, the contribution of the program to advancing the nutritional status of children has not been adequately explored. We assessed the effect of SFP on the anthropometric and haemoglobin status of school children in Sidama Region, Southern Ethiopia. Our prospective cohort study compared the height-for-age z-score (HAZ), BMI-for-age z-score (BAZ) and haemoglobin concentration of SFP beneficiary (n 240) and non-beneficiary (n 240) children, 10-14 years of age. The children were recruited from 8 SFP implementing and 8 control schools using a multistage sampling procedure and were followed for an academic year. The SFP intervention and control schools were matched one-to-one based on agro ecological features and geographical proximity. Exposure, outcome and pertinent extraneous variables were collected through baseline and end-line surveys. Multilevel difference-in-differences (DID) analysis was used to measure the net effect on the outcomes of interest. In the multivariable DID model adjusted for potential confounders including maternal and paternal literacy, household monthly income, wealth index and household food insecurity, the SFP did not show significant effects on the haemoglobin concentration (β = 0⋅251, 95 % confidence interval (CI): -0⋅238, 0⋅739), BAZ (β = 0⋅121, 95 % CI: -0⋅163, 0⋅405) and HAZ (β = -0⋅291, 95 % CI: -0⋅640, 0⋅588) of children.

Effect of Mother's Nutritional Knowledge and Hygiene Practices on School-Going Adolescents Living in Dhaka City of Bangladesh.

Adolescence which is a critical stage for growth and development is influenced by various issues along with maternal nutritional knowledge, control over their earnings, freedom of movement, and participation in household decision-making over child's health care. This study focused on assessing mothers' nutritional knowledge and hygiene practices and their effect on dietary diversity as well as the nutritional status of school-going adolescents of Dhaka city. A community-based cross-sectional study was conducted at 44 schools in Dhaka city. A total of 710 school-going adolescents aged 10-17 years were randomly selected and their mothers were interviewed for assessing their knowledge on nutrition and hygiene practices. One-way ANOVA and multivariate linear regression were used to examine the association between dietary diversity and the nutritional status of the adolescents with their mother's nutritional knowledge and hygiene practices. About one-third (35.8%) of the mothers maintained hygiene and sanitation satisfactorily. Although 53.1% of them had satisfactory general knowledge about a healthy diet, only 6.5% showed good knowledge of the nutritional value of food. The prevalence of stunting, thin, and overweight was 8, 4.6, and 5.8%, respectively. Fair hygiene practices were positively associated (P = 0.048) with height for age z-score. Maternal knowledge on the nutritional value of food was positively associated (P = 0.027) with the dietary diversity of the adolescents. Adequate nutritional knowledge and hygiene practices of the mothers have positive effects on children's dietary diversity and nutritional status. Providing nutrition education to mothers would ensure better nutritional status and improved dietary practices for their children.

Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia, 2009-2019.

Objective:This study aimed to assess Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia 2009–2019.Methods:Institutional-based retrospective cohort study was employed among 721 on antiretroviral therapy care seropositive children since 2009–2019. Data were entered using EpiData version 4.2 and exported to STATA (SE) R-14 version statistical software for further analysis. Beside, Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. Bivariable and multivariable Cox regression analyses were conducted to identify the predictors of mortality. Finally, variables with p-value less than 0.05 were considered significant predictors of mortality.Result:Overall, 721 (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. A median time of death was reported at 19.5 months (interquartile range = ±8.5). The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% confidence interval: 3.6–5.8). Severe stunting (height for age Z-score <−3) (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4), admission with septic shock (hazard ratio = 2.3, 95% confidence interval: 1.2–4.3, p < 0.008), CD4+ count below threshold (hazard ratio = 1.6, 95% confidence interval: 1.19–7.9), and World Health Organization Stages III and IV (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4) were at high risk of mortality.Conclusion:A high rate of SAM associated mortality rate within short median (±SD) time to death was reported as compared with previous finding in Ethiopia. Seropositive children presenting with CD4 counts being below a threshold, World Health Organization Stages III and IV, and being nutritionally stunted during antiretroviral therapy initiation were at high risk of early mortality.

Celiac Disease in Short Stature Pediatric Population Presenting to Endocrinology Clinics: A Cross-Sectional Study from a Tertiary Care Hospital in Karachi

Background: Among many reasons, short stature is one of them for referring children to paediatric endocrinology. The most frequent extra-intestinal symptom of celiac disease is short stature (SS). A very high probability of celiac disease is reported among children with SS for non-endocrinological reasons. Objective: To ascertain the frequency of celiac diseases among short-stature children presenting in endocrinology clinics in a tertiary care hospital. Methods: This descriptive cross-sectional study was performed in pediatric endocrinology clinics at the National Institute of Child Health for a six-month duration from February 2022 to July 2022. All short-stature children of any gender and age from 2 to 12 years were included in the study. Short stature was defined as height for age &lt; -2 standard deviation for the corresponding age and gender. Serological investigation including Immunoglobin A (IgA), anti-tissue-transglutaminase antibodies (TTG IgA) and TTG IgG test was done by ELISA (enzyme-linked immunosorbent assay) method for all of the patients recruited into the study. Results: A total of 149 children with short stature were studied. The mean age of children was 10.2 ± 3.1 years. The majority of patients were males 53.7%. Average height and height for age z-score were 104.8 ± 8.9 cm and -5.1 ± 1.9 respectively. Out of 149 children, only 6.7% had positive serology for celiac diseases. None of the patients' factors was significantly different among patients with and without celiac disease. Conclusion: The current investigation discovered that patients with low stature had a substantial frequency of celiac disease. It was discovered that none of the patients' demographics were linked to celiac disease. For prompt diagnosis and treatment of celiac disease, people with short height should undergo screening.

Nutritional status of children with epilepsy, attending the Pediatric Neurology Clinic of University of Nigeria Teaching Hospital, Enugu

Background: Malnutrition is a direct or underlying cause of 45% of all deaths of under-five children in Nigeria. Nigeria has one of the highest burden of malnourished children in the world. Certain vulnerable groups such as children with chronic diseases are often neglected in nutritional studies. Objective: This study sought to determine the prevalence of malnutrition among children with epilepsy, attending the Neurology Clinic of the University of Nigeria Teaching Hospital. Materials and Methods: This was a descriptive cross-sectional study. Study participants were epileptic children aged 6 months to 18 years. Socio-economic status was determined using the Oyedeji classification. Weight and height were measured using standard protocols. The weight for height, body mass index for age, and height for age z-scores were calculated using the WHO Anthro and Anthro Plus software. Data were analyzed using SPSS version 20.0, and significant p-values were set at less than 0.05. Results: One hundred and twenty children with epilepsy aged 6 months to 18 years who met the inclusion criteria were included in the study. Seventy-eight (65%) were males; (male: female ratio = 1: 0.5). The overall prevalence of wasting, stunting, overweight, and obesity were 5.8%, 9.2%, 10.8%, and 5.8%, respectively. There were no statistically significant differences between various forms of malnutrition and the gender, age group, and socio-economic status of study participants (p > 0.05). Conclusion: Overweight was the most common form of malnutrition, followed by stunting among the epileptic children. There is need for regular anthropometric monitoring of children with drug-naive epilepsy with targeted interventions to correct malnutrition in them during the course of epilepsy management.

Recovery of children following hospitalisation for complicated severe acute malnutrition

Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52‐weeks posthospitalization. Multivariable Fine‐Gray subdistribution hazard models, with death and loss to follow‐up as competing risks, were used to identify factors associated with hospital readmission; negative binomial regression to assess time to hospitalisation and ordinal logistic regression to model factors associated with nutritional recovery. A total of 649 children (53% male, median age 18.2 months) were discharged to continue community nutritional rehabilitation. All‐cause hospital readmission was 15.4% (95% CI 12.7, 18.6) over 52 weeks. Independent risk factors for time to readmission were cerebral palsy (adjusted subhazard ratio (aSHR): 2.96, 95% CI 1.56, 5.61) and nonoedematous SAM (aSHR: 1.64, 95%CI 1.03, 2.64). Unit increases in height‐for‐age Z‐score (HAZ) (aSHR: 0.82, 95% CI 0.71, 0.95) and enrolment in Zambia (aSHR: 0.52, 95% CI 0.28, 0.97) were associated with reduced subhazard of time to readmission. Young age, SAM at discharge, nonoedematous SAM and cerebral palsy were associated with poor nutritional recovery throughout follow‐up. Collectively, nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low HAZ are independent risk factors for readmission and poor nutritional recovery following complicated SAM. Children with these high‐risk features should be prioritised for additional convalescent care to improve long‐term outcomes.

Predictor of Obese Mothers and Stunted Children in the Same Roof: A Population-Based Study in the Urban Poor Setting Indonesia.

Stunting leads to the poor cognitive development, increases the risk of child mortality, and elevates the risk of non-communicable diseases. This study aimed to determine the magnitude of double burden of malnutrition (DBM) in the urban poor setting in Indonesia and investigate its predictors. This was a cross-sectional study involving 436 mothers proportionally chosen from 16 integrated health posts in Surabaya, Indonesia. The households were categorized into the two groups based on the body mass index (BMI) of mother and the height-for-age z-score (HAZ) of child; households without DBM and household with DBM. Energy, carbohydrate, protein, and fat intake were obtained using 24-h food recall and socioeconomic status was measured using a structured questionnaire. Data on socioeconomic status were educational level of mother and occupation, household income, and food expenditure. The prevalence of household with DBM was 27.5%; 12.4% pair stunted children and normal weight mother; 45.6% pair of overweight/obese mother and normal height children. The logistic regression analysis showed significant differences in the education level and occupation of mother, protein intake of the children, and fat intake of the mother between households with and without DBM. This study offers an important insight to improve the knowledge of mother related to the protein intake of children to reduce stunting risk and fat intake of mother to prevent over-nutrition.

The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta-analysis.

This systematic review and meta‐analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer‐reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies' biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random‐effects models. Eighty studies were included in this review: Fifty‐one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi‐experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z‐scores (HAZ), 23 (29%) measured weight for height z‐scores (WHZ), 27 (34%) measured weight for age z‐scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention's effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35–2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17–0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004–0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02–0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions.

The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months.

The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.

Growth patterns by sex and age among under-5 children from 87 low-income and middle-income countries

IntroductionAlthough boys tend to be more affected by linear growth faltering than girls, little is known about sex differences across distinct age groups. We aimed to compare sex differences in...

Environmental metal exposure and growth to 10 years of age in a longitudinal mother–child cohort in rural Bangladesh

• Life-long Cd exposure was associated to lower WAZ at 10y, especially in boys. • Maternal Cd exposure was linked to diminished growth during childhood. • Concurrent Pb exposure was associated with lower WAZ and HAZ at 10y in boys. • Effect estimates were small, but of relevance in vulnerable populations. Early-life exposure to arsenic (As), cadmium (Cd), and lead (Pb) has been linked to smaller birth and early childhood anthropometry, but little is known beyond the first years in life. To evaluate the impact of gestational and childhood exposures to As, Cd, and Pb on growth up to 10 years of age. We studied 1530 mother–child dyads from a nested sub-cohort of the MINIMat trial in rural Matlab, Bangladesh. Metal concentrations in maternal erythrocytes during pregnancy and in children’s urine at 10y were measured by inductively coupled plasma mass spectroscopy. Child height and weight were measured at 19 occasions from birth until 10y and converted to height-for-age Z-scores (HAZ) and weight-for-age Z-scores (WAZ). Associations between log 2 -transformed metal concentrations and growth parameters were assessed with multivariable-adjusted regression models. Children’s concurrent urinary Cd (median 0.24 µg/L), reflecting long-term exposure, was inversely associated with WAZ (B: −0.072; 95% confidence interval (CI): −0.12, −0.020; p = 0.007), and possibly HAZ (B: −0.046; 95% CI: −0.096, 0.0014; p = 0.057), at 10y. The association with WAZ was stronger in boys than in girls. Maternal erythrocyte Cd (median 0.90 µg/kg) during pregnancy was inversely associated with WAZ during childhood only in boys (B: −0.071, 95% CI: −0.14, −0.0047, p = 0.036). Concurrent urinary Pb (median 1.6 µg/L) was inversely associated with WAZ (B: −0.084; 95% CI: −0.16, −0.0085; p = 0.029) and HAZ (B: −0.087; 95% CI: −0.15, −0.021; p = 0.010) in boys, but not in girls. Neither gestational nor childhood As exposure (median maternal erythrocyte As 4.3 µg/kg and children’s urinary As 57 µg/L) was associated with growth up to 10y. While all effect estimates were small, environmental exposure to Cd and Pb is common and impaired growth is of public health concern, especially for children already at risk of reduced growth due to malnutrition. Gender differences in susceptibility need further investigation.

Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate.

Patients with cleft lip and/or palate (CLP) are at increased risk of malnutrition. Acute and chronic malnutrition have been associated with elevated risk of postsurgical wound complications, adding morbidity and cost to patients and their families. To study the association between demographic factors, including insurance type, race, and median neighborhood income (MNI), and malnutrition in patients with CLP. Retrospective cohort study. Retrospective review was performed in patients undergoing their first cleft-related surgery at a large tertiary pediatric hospital from 2006 to 2018. Demographic data, weight and height at surgery, type of insurance, race, and primary residential address were collected. Geocoded information on MNI was generated using patient address. World Health Organization Z-scores for weight-for-age (WFA) and height-for-age (HFA) were used as proxies for acute and chronic malnutrition, respectively. Linear regression models were generated to analyze the relationship of insurance type, race, and MNI on WFA and HFA Z-scores. About 313 patients met inclusion criteria. Increasing MNI predicted increasing WFA Z-score (0.05 increase in WFA per $1,000 increase, P=.047) as well as HFA Z-score (0.09 increase in HFA per $1,000 increase, P=.011). The effect of MNI was not independently modified by race for either WFA (P=.841) nor HFA (P=.404). Race and insurance type did not predict WFA or HFA. Lower MNI is a significant independent risk factor for acute and chronic malnutrition in children with CLP. Combined with previous investigation linking malnutrition to surgical outcomes in this population, this offers a target area for intervention to improve patient outcomes. 3 Laryngoscope, 132:1482-1486, 2022.

Realising the potential human development returns to investing in early and maternal nutrition: The importance of identifying and addressing constraints over the life course.

The benefits of interventions which improve early nutrition are well recognised. These benefits, however, only accrue to the extent that later life circumstances allow. Consequently, in adverse contexts many of the benefits will never be realised, particularly for the most vulnerable, exacerbating inequality. Returns to investment in early nutrition could be improved if we identified contextual factors constraining their realisation and interventions to weaken these. We estimate cost and impact of scaling 10 nutrition interventions for a cohort of South African children born in 2021. We estimate associated declines in malnutrition and mortality, and improvements in years of schooling and future earnings. To examine the role of context over the life-course we estimate benefits with and without additional improvements in school quality and employment opportunities by socio-economic quintile. Scale up reduces national stunting (height for age < = -2SD) rates among children at 24 months by 3.18 percentage points, implying an increase in mean height for age z-score (HAZ) of 0.10, and 53,000 years of additional schooling. Quintile 1 (the poorest) displays the largest decline in stunting, and largest increase in mean HAZ. Estimated total cost of increasing coverage of the interventions for the cohort is US$90 million. The present value of the additional years of schooling is estimated at close to US$2 billion. Cost-benefit ratios suggest the highest return occurs in quintile 5 (1:23). Reducing inequality in school quality closes the gap between quintile 5 and the lower quintiles. If school quality and labour force participation were equal the highest returns are in quintile 1(1:31). An enabling environment is key to maximising human development returns from investing in early nutrition, and to avoid exacerbating existing inequality. Therefore, particularly for children in adverse conditions, it is essential to identify and implement complementary interventions over the life course.

Preoperative nutritional status effects postoperative outcome in patients undergoing surgery for congenital heart disease

ObjectiveThe aim of this study was to evaluate the relationship between preoperative nutritional status and the postoperative clinical outcomes of cardiac surgery performed in children with congenital heart disease (CHD). MethodsThis was a prospective observational study conducted between March 2019–2020, which included 80 patients with CHD. Preoperative nutritional status of the patients was determined by weight-for-age z-score (WAZ), height-for-age z-score (HAZ), serum albumin level, serum prealbumin level. Preoperative myocardial stress was evaluated by serum brain natriuretic peptide (BNP). Vasoactive-Inotropic Score (VIS) measurements were performed pre- and postoperatively. ResultsMalnutrition was present in 15.0% according to HAZ (<−2) and 23.8% according to WAZ (<−2). VIS scores improved significantly after surgical treatment. Albumin decrease was found to be an independent risk factor for the increase in VIS score at 48hours. There was a negative correlation between prealbumin level and the duration of mechanical ventilation (MV), and also between WAZ and duration of stay in ICU. Increase in cardiopulmonary bypass duration was found to be an independent factor for baseline and 48th hour VIS scores. Duration of aortic cross-clamp was found to positively correlate with duration of MV and VIS scores. BNP levels were positively correlated with MV duration, ICU stay, and 24th and 48th hour VIS scores. A positive correlation was found between RACHS-1 level and the duration of MV and 24th hour VIS score. ConclusionIncreased nutritional deficiency was found to negatively affect postoperative clinical parameters in children undergoing surgical treatment for CHD.

Early high-energy feeding in infants following cardiac surgery: a randomized controlled trial.

BackgroundEffective nutrition programs are beneficial for nutritional recovery in infants. Few studies have focused on the effect of early high-energy feeding after open heart surgery. This study sought to assess the effects of early high-energy feeding in infants after congenital heart surgery.MethodsPatients at a tertiary pediatric cardiology center who underwent open heart surgery between July 2016 and July 2018 were recruited and randomly allocated to 1 of the following 2 groups: (I) the intervention group (postoperative early high-energy feeding; n=124); and (II) the control group (no intervention; n=120).The primary endpoints of average energy delivery and growth Z-scores [i.e., weight-for-height Z-score (WHZ), weight-for-age Z-score (WAZ), and height-for-age Z-score (HAZ)] were recorded preoperatively, during the intensive care unit (ICU) stay, at discharge, and at 1 and 3 months postoperatively. The secondary endpoints of malnutrition recovery, ventilator support time, infection rate, and cardiac ICU (CICU) stay were also recorded.ResultsA total of 244 infants were included in the study. There were no significant differences in the baseline features between the 2 groups. The intervention group received higher calories on average than the control group (44.5 vs. 34.7; P<0.001). At discharge from the ICU, the WHZ (−2.29 vs. −2.76; P<0.001) and WAZ (−3.08 vs. −3.43; P=0.005) of patients in the intervention group were higher than those of patients in the control group. Ventilator support time (P=0.004), CICU stay (P=0.045), and infection rate (P=0.001) were significantly lower in the intervention group than the control group. At 3 months post-surgery, the intervention group exhibited a higher malnutrition recovery rate than the control group (19.4% vs. 6.5%; P=0.002).ConclusionsThe administration of early high-energy feeding to infants after congenital heart surgery is associated with improved growth, reduced CICU stay, decreased ventilator support time, and reduced postoperative infection rates.Trial RegistrationClinicalTrials NCT04609358.

Insulin Growth Factor-1 in Egyptian Children with Juvenile Idiopathic Arthritis: Correlation with Growth Pattern and Disease Activity

Background: Juvenile idiopathic arthritis (JIA) is a systemic, chronic, inflammatory disease that affects patients under 18 years. Interactions between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and the immune system are complex. Many studies found that chronic inflammation suppresses GH/IGF-1 axis. Objective: To assess if there is correlation between the serum level of IGF-1 and the growth pattern in children with JIA in Egypt, and to evaluate the correlation between the serum level of IGF-1 and disease activity among these patients. Patients and Method: The study was a case control study which included 80 patients with JIA and 40 normal children as a control. Their ages ranged from 5-15 years. All patients were subjected to full history taking from their care givers, clinical examination, growth assessment, and laboratory measurement of serum IGF-1 level, CRP, ESR, and CBC. Results: There was a statistically significant decrease in serum level of IGF-1 among patients with JIA. There was a statistically significant positive correlation between serum level of IGF-1 with height, weight and BMI. There was a statistically significant difference between patients and controls regarding Height-for-Age-Z-Score (HAZ), 35% of patients had short stature. There was a statistically significant decrease in weight and BMI, 90% of patients were underweight. There was no statistically significant correlation between serum level of IGF-1 and the disease activity. Conclusion: There was a statistically significant positive correlation between IGF-1 with height, weight and BMI. Short stature and underweight were common among JIA patients. There was no significant correlation between serum level of IGF-1 and the disease activity among JIA patients.

Hierarchy of Associations Between BMI-for-Agez-Scores, Growth and Family Social Status Among Urban Bengali Girls of Siliguri Town, West Bengal: A St. Nicolas House Analysis

The present study assesses the association of different socio-economic variables with children’s BMI-for-age z-scores (BAZ) and influence of children’s height on BAZ, a proxy index of nutritional status. The study was undertaken among 322 girls belonging to the Bengali Hindu Caste Population (BHCP) aged 5–13 years. These girls were the students of two schools located in Siliguri town of West Bengal, India. The prevalence of short stature, underweight and overweight was assessed using the World Health Organization’s ( WHO, 2007 , Growth Reference Data for 5–19 years) references. The statistical analyses used were St. Nicolas House Analysis (SNHA), analysis of variance (ANOVA), linear and logistic regression. The prevalence of underweight, overweight and obesity was 19.3%, 17.8% and 5.9%, respectively. The prevalence of short stature (−2.0 HAZ) was 8.7%. The range of BAZ was from −5.69 to 4.15. The variation of BAZ explained by height-for-age z-scores (HAZ) was 11.4%. The BAZ was observed to be associated with mothers’ occupation as revealed by 2% variation through SNHA analysis. The present study observed the usefulness of SNHA for non-parametric data with unequal sub-sample or categories. However, SNHA was not devised to assess the direction and magnitude of variables of interest. The finding of the present study supports the use of BAZ as a proxy adiposity measure among the overweight/obese populations and populations with normal growth in height. The study further supports the recommendations that mother empowerment can help improve nutritional status of a girl child.

Weight-for-Height Z-score Gain during Inpatient Treatment and Subsequent Linear Growth during Outpatient Treatment of Young Children with Severe Acute Malnutrition: A Prospective Study from Uganda.

ABSTRACTBackgroundLinear catch-up growth after treatment of severe acute malnutrition (SAM) is low, and little is known about the association between ponderal and subsequent linear growth.ObjectiveThe study assessed the association of weight-for-height z-score (WHZ) gain with subsequent linear growth during SAM treatment and examined its modifiers.MethodsThis was a prospective study, nested in a trial (ISRCTN16454889), among 6–59-mo-old children treated for SAM in Uganda. Weight, total length (TL), and knee-heel length (KHL) were measured at admission, weekly during inpatient therapeutic care (ITC), at discharge, and fortnightly during outpatient therapeutic care (OTC) for 8 wk. Linear regression was used to assess the association between WHZ gain during ITC and linear growth during OTC.ResultsOf 400 children, 327 were discharged to OTC and 290 were followed up for 8 wk. Mean WHZ gains were 0.45 in ITC and 1.24 in OTC, whereas mean height-for-age z-score (HAZ) declined by 0.41 during ITC and increased by 0.14 during OTC. WHZ gain during ITC was positively associated with HAZ, TL, and KHL gains during OTC [regression coefficients (β) (95% CI): 0.12 (0.09, 0.15) z-score; 3.1 (2.4, 3.8) mm and 0.5 (0.1, 0.7) mm, respectively]. The regression coefficients were highest for the middle tertile of WHZ gain with respect to HAZ and TL. Admission diarrhea and low plasma citrulline reduced the association between WHZ gain during ITC and HAZ and TL gain during OTC (P < 0.001). In contrast, pneumonia (P = 0.051) and elevated plasma C-reactive protein (P < 0.001) increased the association with TL gain, but reduced the association with KHL gain (P < 0.001).ConclusionsAmong children admitted with SAM, considerable WHZ gain during ITC was followed by very modest linear catch-up growth during OTC, with no indication of a WHZ gain threshold, above which linear growth was higher. To optimize linear growth in these children, early treatment of infections and conditions affecting the gut may be necessary.

Associations between women's empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data.

Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women's empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women's empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women's empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy-numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <-2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women's empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy-numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women's empowerment was associated with socioemotional, literacy-numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. Women's empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women's empowerment as a potential strategy.