Mid-arm Circumference Research Articles

Effect of multidisciplinary medical nutrition therapy on the nutrition status of patients receiving peritoneal dialysis: A randomized controlled trial.

Malnutrition is a prevalent complication in patients undergoing peritoneal dialysis (PD). This study established a multidisciplinary team for medical nutrition therapy (MNT) to investigate the impact of this approach on enhancing the nutrition, anemic, and microinflammatory status of patients receiving PD. This randomized controlled trial study involved 81 patients undergoing PD (n = 41 in the intervention group, n = 40 in the control group). The intervention group received comprehensive MNT management, whereas the control group received standard nutrition care. The intervention spanned a 6-month period. Various nutrition parameters, markers of anemia, and microinflammatory indexes were assessed before the intervention, at 3 months, and at 6 months postintervention. Repeated-measures analysis of variance and the nonparametric Scheirer-Ray-Hare test were used for within-group and between-group comparisons. There were no statistically significant differences between the groups in terms of age, sex, duration of dialysis, primary disease, or baseline prenutrition inflammation data. At 6 months postintervention, the intervention group exhibited higher levels of serum albumin, blood calcium, serum iron, hemoglobin, total iron-binding capacity, body mass index, midarm circumference, triceps skinfold thickness, handgrip strength, and daily energy and protein intake compared with the control group (P < 0.05). Additionally, the intervention group demonstrated lower levels of subjective nutrition assessment value, C-reactive protein, and neutrophil-to-lymphocyte ratio than the control group (P < 0.05), with no statistically significant differences in other markers after interventions. Multidisciplinary MNT can ameliorate the nutrition status of patients receiving PD, decrease the incidence of malnutrition, and improve anemia and microinflammatory outcomes.

Nutritional Assessment of Children and Adolescents with Isolated Ventricular Septal Defects after Closure

Background: Children with congenital heart disease, including VSD, often start life with a normal birth weight. However, malnutrition and growth failure become apparent within the first few months. The energy intake and nutritional status of these children directly impact their growth, necessitating regular and meticulous follow- up from the moment of diagnosis, and extending for years after the defect has been corrected.The Aim: this study aimed to evaluate the nutritional status of children who have undergone surgical or interventional closure of isolated ventricular septal defects 6 to 12 months after closure.Methods: This study is a cross sectional observational included 50 patients were recruited form post cardiac interventional clinic (PCIC), Pediatric department Cairo university and October 6 university. All patients were subjected to Nutritional Assessment including objective and subjective global assessment, assessing length/height, weight, head circumference, BMI, skin fold thickness, and mid upper arm circumference. These parameters were plotted on WHO Z scores to detect malnutrition's type and degree. Nutritional Assessment by using the Subjective Global Assessment (SGA) form, that considers weight changes, food intake, functional status, and body composition, providing a holistic view of the child's nutritional health.Results: The mean age of the studied cases was 4.5 (±1.4 SD) with range (2.1-7.8) years, with 29 (58%) males. According to VSD size there were 8 (16%) moderate VSD and 42 (84%) large VSD. Membranous VSD was the most common type of VSD in 15 (30%). The mean age of VSD closure was 3.98y (±1.35 SD), according to method of closure. most of them were surgical 33 (66%) and 17 (34%) were interventional, The mean time interval between closure and assessment was 8 months (±2.14 SD). Among the studied cases according to subjective global assessment there were 8 (16%) A, 30 (60%) B and 12 (24%). Regarding weight for age on Z score 19 (38%) of the patients had moderate malnutrition lying bet (-2 to -3) and 1 patient (2%) had severe malnutrition less than (-3) on Zscore. Regarding MUAC 12 (24%) were moderately acute malnourished lying bet -2 to -3 and 10 (20%) were severely acute malnourished for age less than -3 on Z score. Regarding Ht for age on Z score 29 (58%) of the patients were above -2 on Z score while 42% were malnourished divided into 17 (34%) who suffers moderate stunting lies bet -2 to -3 on Z score and 4 (8%) had severe stunting for age less than -3.Conclusion: this study concludes that Malnutrition is still prevalent in patients after successful VSD closure and ongoing nutritional assessment is needed and SGA is a relevant tool in assessment of nutritional status of these children also Malnutrition in these patients is palpably multifactorial and not only due to the effect of VSD.

Phase angle is a useful predicting indicator for protein-energy wasting and cardiovascular risk among maintenance hemodialysis patients

Protein-energy wasting (PEW) is a major contributor to the high mortality among maintenance hemodialysis (MHD) patients. Cardiovascular disease (CVD) is the leading cause of death in dialysis patients, and PEW can significantly increase cardiovascular mortality in MHD patients. Previous studies have confirmed that PA may be a good objective indicator for determining the nutritional status and prognosis of MHD patients. Our study aimed to determine the predictive value of phase angle (PA) as detected by bioelectrical impedance analysis (BIA) on PEW and cardiovascular (CV) risk among MHD patients. Our retrospective observational study involved 161 adult patients with HD. The Cardiovascular risk score is a risk model based on the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). We established LASSO logistic regression analysis model to identify key parameters related to body composition that can predict PEW in MHD patients. The area under the curve (AUC) values for PA, appendicular skeletal muscle mass index (ASMI), body cell mass (BCM), and mid-arm circumference (MAC) in predicting PEW in male MHD patients were relatively large, with 0.708, 0.674, 0.663, and 0.735, respectively. The predicted PEW values of these parameters were slightly lower in female patients than in men. We incorporated PA, ASMI, BCM, and MAC into a model that predicted the incidence of PEW in maintenance hemodialysis patients using LASSO technology. We discovered that the model predicted a greater AUC of PEW occurrence than any single factor, 0.877 for men and 0.76 for women. The results of the univariate logistic regression analysis showed that the low PA tertile array group had a greater incidence of PEW than the high PA group (P < 0.001). Additionally, we also found that lower PA was associated with higher CV risk scores. The PA detected by bioelectrical impedance analysis could predict the risk of PEW and cardiovascular events among patients with MHD. When used in conjunction, PA, ASMI, BCM, and MAC have a high diagnostic efficacy for PEW in patients on maintenance hemodialysis.

Anthropometric weight estimation is less accurate than visual weight estimation in forensic postmortem cases in a Swiss population

When the time since death must be calculated forensic pathologists often consider a calculation based on the Henssge nomogram. This calculation requires an estimated body weight. Previous research has indicated that healthcare workers generally inaccurately guessed patients’ body weights. In recent years, weight estimation methods based on anthropometric parameters, such as mid-arm or waist circumference, have been shown to improve estimation accuracy. This study aimed to examine whether anthropometric weight estimation methods could improve weight estimation accuracy compared to visual estimation in forensic pathology.In 199 cases from a Swiss population, we measured the actual body weight, mid-arm circumference, waist circumference, and body height before autopsy. Additionally, two forensic pathologists visually estimated the body weight. We found mid-arm circumferences to correlate the strongest with actual body weight (Pearson ’sr 0.87, 95 % CI 0.83–0.90). However, all mid-arm circumference-based estimation methods performed worse than those previously described. A statistical bias between −12.3 % and −14.5 % indicated a systematic weight underestimation. Combined two-physician visual estimation performed significantly better than anthropometric measurements in our population but showed no difference from anthropometric estimation methods previously described in the literature. Further research is needed on novel body weight estimation methods that are currently not applicable for the global population.

Blood Pressure Cuff Sizes for Pregnant Women in the United States: Findings from the National Health and Nutrition Examination Survey.

The use of correctly-sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff. This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26cm), adult (>26 to ≤34cm), large (>34 to ≤44cm), and extra-large (XL) (>44cm). Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles. Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately-sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

Study of malnutrition in patients with idiopathic pulmonary fibrosis

Background Although the interest in Idiopathic Pulmonary Fibrosis (IPF) has increased in recent years due to the appearance of new therapies however the interest has focused on pulmonary involvement with little concern for systemic manifestations such as the nutritional status abnormalities. Thus, our study assessed the malnutrition prevalence in patients with IPF and the best indicators for the assessment of malnutrition among them. Patients and methods This work was conducted on 110 stable IPF patients who attended the outpatient clinic of Ain Shams University Hospitals from October 2020 to July 2021. Data about the detailed history and nutritional assessment was collected. Results 22.7% and 20.9% were malnourished according to the definition of fat-free mass index (FFMI) and body mass index (BMI), respectively. Most malnourished patients according to low FFMI were female; not using PPI was a significant independent predictors of malnutrition. There was a statistically significant relation between low FFMI and low serum albumin, hemoglobin, and oxygen saturation. Our findings also revealed that measuring BMI and being less than or equal to 22.1 kg/m2 and mid-arm circumference (MAC) less than or equal 28.5 cm is significantly related to low free fat mass index (malnutrition) and increases that risk by 31.63 folds. Conclusion Nearly one-quarter of IPF patients were malnourished and it was found that measuring BMI less than or equal to 22.1 kg/m2 together with MAC less than or equal to 28.5 cm can predict low FFMI and that can be used in our clinical approach.

Height-adjusted calf circumference and mid-arm circumference better predict survival and nutrition status in patients with cancer

Height-adjusted calf circumference and mid-arm circumference better predict survival and nutrition status in patients with cancer

A study to determine a practical method for weight estimation of deceased persons

BackgroundBody weight is an important parameter for estimating the postmortem interval (PMI) at a crime scene. However, a challenge arises at crime scenes when a weight scale for measuring the total body weight is unavailable. Anthropometry-based models to estimate body weight have been developed in previous studies. This study aims to determine the accuracy of body weight estimations by practitioners, test the anthropometry-based models for applicability to deceased individuals, and examine a potential new method based on applying heel weight. MethodsA prospective study was conducted at the Isala Hospital in the Netherlands. During the study period, deceased people that were admitted to the hospital mortuary were included consecutively. The body weight of deceased persons estimated by practitioners was compared to the actual body weight. Anthropometric measurements were taken and used to perform eight sex dependant anthropometry-based models, with accuracy for the actual body weight calculated using RMSE values. A Pearson's correlation test was used to determine the correlation between heel weight and total body weight. ResultsDuring the study period, a total of 100 cases, 56 males and 44 females, were included. Overall, only 33.3 % of practitioners' estimations were within 5 % of the actual measured weight. The model based on abdominal and thigh circumference performed best for weight estimation in males and the models based on mid-arm circumference, abdominal circumference, calf circumference and, in one model, subscapular skinfold performed best in females. A Pearson's correlation test revealed a weak positive correlation between weight of the heel and total body weight (Pearson's correlation coefficient: 0.214). DiscussionEstimations of underweight or obese patients posed a challenge for weight estimation. Especially in these cases, study results showed that anthropometry-based models have potential for daily practice. However, additional research is required to assess the reliability of the best performing models before implementation in forensic casework. The correlation between the weight of the heel and body weight was low, therefore implementation of the current method is not recommended, and further research is required.

Myostatin as a Marker of Reduced Muscle Mass in Children and Adolescents with Chronic Liver Disease

Abstract Background Sarcopenia is defined as a decrease in muscle mass, and is a reliable marker of nutritional status of patients with chronic diseases. Multiple factors contribute to malnutrition in chronic liver disease (CLD), such as impaired absorption and/or digestion, increased metabolic demands, anorexia, and decreased oral intake. Changes due to liver cirrhosis are considered potential disruptors of the balance of protein anabolism and catabolism which is a characteristic feature of Sarcopenia. Aim of the Work to assess the muscle mass in CLD pediatric patients and evaluate myostatin as a biomarker of sarcopenia in CLD pediatric patients and its association with muscle mass. Patients and Methods The study was conducted at the hepatology and nutrition clinics, of Ain Shams Children`s Hospital. It included 42 (20 male and 22 female) CLD patients and 45(26 male and 19 female) healthy controls aging between 2 and 18 years during the period from August 2021 to January 2022. They were subjected to full history taking, clinical evaluation, anthropometric measurements including weight, height, mid upper arm circumference(MUAC) and body mass index(BMI), assessment of body composition and measurement of serum myostatin. Results The prevalence of malnutrition in the CLD patients was significantly higher than the controls with p value&amp;lt;0.001 and it was as follow: 50% had abnormal weight, 42.85%were stunted and 42.85% had abnormal BMI. Although the prevalence of malnutrition in the cases detected by MUAC (in age group 2-5years) was 33.33%, yet this was not statistically significant compared to healthy control with p value 0.329. As regards the lean muscle mass measured by body composition scale, we found that the prevalence of decreased lean muscle mass was 57.58% in the cases which was significantly higher than the controls with p value&amp;lt;0.001. Our study showed that CLD patients had significantly higher serum myostatin level with median of 757ng/mL and range of (450-825ng/mL) in comparison to median of 120ng/mL and range of (100-140ng/mL) in healthy controls. There was a negative but non-significant correlation between the serum myostatin and decreased lean muscle mass in the cases with p value 0.253 and r -0.205. Conclusion Malnutrition is prevalent in children with CLD and decreased lean muscle mass is significantly evident. Serum myostatin level is significantly higher in patients with CLD compared to healthy controls.

Assessing the risk factors associated with nutritional status in patients with liver cirrhosis: A case-control study.

Cirrhosis is one of the most common clinical diseases in the world. The patient with cirrhosis has many complications, such as spontaneous peritonitis, hepatic encephalopathy. Malnutrition is one of the most common complications in patients with cirrhosis, and it is also a key factor affecting the prognosis of patients. However, the research on cirrhosis malnutrition is relatively scarce. This study aimed to explore the new factors of the liver cirrhosis with the nutritional status. A total of 370 patients with liver cirrhosis were admitted to the Fourth Affiliated Hospital of Harbin Medical University from January 2019 to January 2023 were selected. Patients were assigned to the malnourished group and normal group. The weight, height, mid arm circumference (MAC) and triceps skinfold thickness (TSF) of the two groups were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Furthermore, the Health Literacy Management Scale (HeLMS), biochemical indexes, incidence of complications, disease grade were also counted and the Royal Free Hospital-Nutrition Prioritization Tool were used to evaluate the nutritional status of the patient. A total of 370 patients was included in this study, including 177 malnutrition patients, accounting for 45.29%, and the scores and total scores of the patients in the malnutrition group were lower than those in the normal group. The measured values of Na+, Alb, PA, T-Bil, TC, TLC, Hb, and RBC were all lower than those of the normal group, and the difference was statistically significant. The overall complication rate of the patients in the malnourished group was 89.61%, and that of the normal group was 39.78%. Multifactorial logistic regression analysis was performed with nutritional level as the dependent variable (normal = 0, malnutrition = 1), and the above indicators of variability (Na+, Alb, PA, T-Bil, TC, PT, Hb, RBC, HG, and HeLMS scores) as the independent variables. The results showed that Na+, Hb were the influencing factors of nutritional level (P< 0.05). The incidence of malnutrition in cirrhotic patients included in this study was at a moderate level, and the nutritional literacy of these patients was low. In addition, the level of serum sodium, Hemoglobin can affect the nutritional level of patients with cirrhosis.

Association between complementary anthropometric measures and all-cause mortality risk in adults: NHANES 2011-2016.

Previous studies using a single obesity indicator cannot fully assess the association between body shape and mortality. We aimed to investigate the association between complementary anthropometric measures and all-cause mortality risk. We combined National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016 with mortality data up to December 31, 2019. After excluding individuals with cancer at baseline, 13,728 participants were included. Cox regression models and restricted cubic spline (RCS) analyses were used to explore the association between general obesity, central obesity, and peripheral fat indicators and all-cause mortality risk. A total of 743 deaths occurred over a median follow-up of 5.83 years. In multivariable-adjusted Cox models, each 10-cm increase in waist circumference (WC), each 0.1-unit increase in waist-to-height ratio (WHtR), and each 0.01-unit increase in A Body Shape Index (ABSI) were associated with 20% (HR = 1.20; 95% CI: 1.02-1.41), 119% (2.19; 1.70-2.83), and 5% (1.05; 1.03-1.08) increased all-cause mortality risk, respectively. Conversely, each 1-cm increment in mid-arm circumference (MAC) was associated with 13% (HR = 0.87; 95% CI: 0.83-0.92) decreased mortality risk. Compared with normal group (body mass index (BMI): 18.5- <25.0), underweight (HR = 1.97; 95% CI: 1.12-3.45) and grade 3 obesity (1.37; 1.04-1.81) were at higher mortality risk. However, after further adjustment for WC, the effect of grade 3 obesity disappeared, and the RCS analyses for BMI changed from a J-shaped (P < 0.05 for non-linearity test) to a negative association (P < 0.01). Underweight, grade 3 obesity, and central obesity were associated with an increased mortality risk, while peripheral fat was inversely associated with mortality.

Comprehensive analysis of nutritional parameters in patients with idiopathic achalasia: A prospective study in India.

Achalasia cardia, a primary motility disorder of the esophagus, poses significant malnutrition risks. This study aims at comprehensively assessing the nutritional status in untreated achalasia patients, contrasting it with functional gastrointestinal disorders (FGIDs) cases and impact of per-oral endoscopic myotomy (POEM) on nutrition at one-year. We conducted a prospective study, including consecutive achalasia cases, from December 2021 to April 2022 at a tertiary care centre. Biochemical parameters, anthropometry, subjective global assessment (SGA) and malnutrition universal screening tool were used for nutritional assessment. Cases diagnosed with FGIDs served as controls. As many as118 cases (41.2 ± 13.9years, 61% males) with achalasia and 200 controls (43.4 ± 11.9years, 69% males) were included in the study. Sub-types of achalasia included type I (16.9%), II (76.3%) and III (6.8%). Overall, 38.1% and 6.8% cases were moderately and severely malnourished, respectively. As compared to controls, cases with achalasia had lower pre-albumin (19.4 vs. 25.2; p = 0.001), serum calcium (p = 0.012), vitamin D (p = 0.001), serum iron (p = 0.001), triceps fold thickness (p = 0.002) and hand-grip strength (p = 0.001). On univariate analysis, type-I achalasia, body mass index, % weight loss, lower esophageal sphincter pressures and Eckardt scores were predictors of malnourishment (SGA). On multivariate analysis, type of achalasia, mid arm circumference and low body mass index were significant predictors of malnourishment in cases with achalasia. There was significant improvement in the nutritional status after POEM at one-year follow-up. Achalasia patients demonstrate a notably higher risk of malnutrition compared to individuals with FGIDs. Nutritional status significantly improves after POEM. (NCT05161923).

The Risk of Malnutrition and Sarcopenia in Elderly People Living with HIV during the COVID-19 Pandemic.

Malnutrition is a risk factor of sarcopenia in the elderly. During the COVID-19 pandemic, limited transportation and supply chain disruptions restricted access to nutritious foods. We assessed the nutritional status and sarcopenia risk in older people living with HIV (PLWH) on combination antiretroviral therapy in Thailand. This study was a hospital-based cohort among virally suppressed older PLWH who came for routine HIV clinic visits. The mini nutritional assessment (MNA), body composition analysis and 5-time chair stand test (CST) were performed to assess the nutritional status, muscle mass and physical performance, respectively. A total of 177 PLWH were enrolled (57.60% male). The median age was 58 years (IQR 55-62 years). Thirty-five participants (19.8%) were at risk of developing sarcopenia, and 28.2% had abnormal nutritional status. Muscle mass correlated positively with nutritional scores (r = 0.355, p < 0.001) but negatively with 5-time CST duration (r = -0.173, p = 0.021). In the multivariate model, muscle mass was associated with age, sex, mid-arm circumference, calf circumference and 5-time CST duration. In a well-viral-suppressed older Asian PLWH cohort, given the positive correlation between nutritional status and muscle mass, the nutritional status of older PLWH should be routinely evaluated and monitored.

Sodium Bicarbonate Treatment and Clinical Outcomes in Chronic Kidney Disease with Metabolic Acidosis: A Meta-Analysis.

In patients with chronic kidney disease (CKD), impaired kidney acid excretion leads to the onset of metabolic acidosis (MA). However, the evidence is not yet conclusive regarding the effects of sodium bicarbonate in treating CKD with MA. Databases with PubMed, Embase, and the Cochrane Library were used to search for randomized controlled trials from the inception until November 11, 2023 to identify randomized controlled trials investigating the effect of sodium bicarbonate in participants with CKD and MA. The primary outcome was the change in estimated glomerular filtration rate (eGFR). Secondary outcomes included hospitalization rates, change in systolic blood pressure (SBP), all-cause mortality, and mid-arm muscle circumference (MAMC). A random-effects model was applied for analysis, and subgroup, sensitivity analyses were also performed. Fourteen RCTs comprising 2,037 patients demonstrated that sodium bicarbonate supplementation significantly improved eGFR (standardized mean difference [SMD]: 0.33, 95% CI: 0.03 to 0.63, P = 0.03). The group receiving sodium bicarbonate had a lower hospitalization rate (odds ratio: 0.37, 95% CI: 0.25 to 0.55, P < 0.001). Higher MAMC was observed with sodium bicarbonate treatment compared with those without (SMD:0.23, 95% CI: 0.08 to 0.38, P = 0.003, I2 < 0.001). However, higher risk of elevated SBP was found with sodium bicarbonate treatment (SMD:0.10, 95% CI: 0.01 to 0.20, P = 0.03). No significant difference in all-cause mortality was noted. In patients with CKD and MA, sodium bicarbonate supplementation may provide potential benefits in preventing the deterioration of kidney function and increasing muscle mass. However, treatment may be associated with higher blood pressure. Due to the risk of bias stemming from the absence of double-blinded designs and inconsistencies in control group definitions across the studies, further research is crucial to verify these findings.

Evaluation of Vitamin (A) Deficiency among Critically Ill Children with Sepsis

Abstract Background Vitamin A is an immunomodulatory, and its deficiency may cause impaired immune function, which are found in sepsis. There is a biological rationale that vitamin A deficiency (VAD) may be a contributing factor related to poor clinical outcomes in patients with sepsis. Aim of the Work to assess the prevalence of vitamin A deficiency in critically ill children with sepsis and its association with clinical outcomes. Patients and Methods This cross-sectional study included 40 critically ill children with sepsis who were admitted to the paediatric intensive care unit. The control group consisted of 40 age- and sex-matched approximate-health children from outpatient clinic. For the measurement of serum vitamin A status, blood samples were taken from all patients within the first 24 hours of admission. The vitamin A status of the sepsis and control groups were compared. Univariate and multivariate approaches were used to assess the link between vitamin A deficiency and sepsis. Results The study enrolled 40 children with sepsis and 40 matched healthy children so there was no statistically significant difference between controls and patients among age and sex, with median age 4 (2 – 12) months for both groups with male predominance (60.0%). Regarding body measures there was a high statistically significant lower values among patients group than controls group for z score of weight, height/length, body mass index (BMI) and mid arm circumference (MAC) of the studied subjects, that indicated increased malnutrition prevalence among septic children than control group. In the present study, by comparing VAD between patients and controls, there was high statistically significant difference as all septic patients (100%) had VAD and the VAD among healthy control was found in 30% of them. We also found that patients with septic shock, patients who were nothing per os (NPO), patients on ventilators and died patients were more deficient in vitamin A level than other patients compared with them (high statistically significant difference), illustrated that VAD may be had a role in sepsis related morbidity and mortality. There was a positive correlation between vitamin A and BMI z score and MAC while there was a negative correlation with prism 3 and prism 4.ROC curve for assessment of vitamin A as a predictor of sepsis, found that at cut off value ≤9 μg/dl, the Sensitivity, Specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100% for each. Conclusion low level of vitamin A, lower than or equal to 9 μg/dl was associated with sepsis, septic shock, and higher PRISM score. Vitamin A deficiency may be a marker of morbidity and mortality in critically ill children with sepsis.

Radiological Assessment of Hand and Wrist Bones in Malnourished Children

Abstract Background Protein energy malnutrition (PEM) is still an important health problem that is responsible for childhood morbidity and mortality leading to permanent impairment of physical and mental growth. Objective This study is designed to assess the appearance of ossification centers of lower end of radius and ulna, carpals, metacarpals and phalanges in normal children and malnourished children then comparing between them, to detect early changes in bone growth in malnourished children. Subjects and Methods This case-control cross-sectional study included 45 malnourished children and 45 age and sex matched controls whose ages ranged between 6 months and 5 years. The patients were recruited from Pediatric Nutrition Clinic of Ain Shams University. All children (malnourished and control) were examined for anthropometric parameters (weight, height, body mass index (BMI) and mid upper arm circumference (MUAC)), investigated for serum calcium, phosphorus, alkaline phosphates and had a plain X-ray done on left hand and wrist (posteroanterior (P-A) view), the X-ray was analyzed by using A Digital Atlas of Skeletal Maturity. Results The plain X-ray hand and wrist showed delayed appearance of ossification centers in malnourished infants and children (97.8% had delayed bone age) when compared to controls (25.5% had delayed bone age) which was statistically highly significant with P-value &amp;lt; 0.01. Signs of vitamin D deficiency rickets together with serum calcium, phosphorus and alkaline phosphatase were statistically significantly lower in the cases when compared to the controls with P-value &amp;lt; 0.01. The statistical measurements of mean ± SD regarding weight of case group and control group was (9.05 ± 2.48, 13.54 ± 3.81) with P-value &amp;lt; 0.01 which is highly significant, regarding length or height was (79.51 ± 12.78, 88.94 ± 15.02) with P-value &amp;lt; 0.01 which is highly significant, regarding MUAC was (11.38 ± 1.91, 16.02 ± 1.26) with P-value &amp;lt; 0.01 which is highly significant. Conclusion X-ray hand and wrist for malnourished infants and children showed delayed appearance of ossification centers when compared to matched controls.

Malnutrition among Egyptian hemodialysis patients: prevalence and risk factors

Background Malnutrition commonly affects hemodialysis (HD) patients. Malnourished HD patients have increased morbidity and mortality. We aimed to assess the prevalence and risk factors of malnutrition among Egyptian hemodialysis patients. Material and methods This is a cross-sectional study carried out on ESRD patients with regular HD. All participants were subjected to detailed history taking and complete physical examination. Assessment of nutritional status was done using subjective global assessment (SGA). Anthropometric measures included mid-arm circumference (MAC), triceps skin fold (TSF), and body mass index (BMI) assessment. Results One hundred thirty patients with a mean age of 55.2 ± 12.6 years, completed the study. The mean duration of HD was 4.51 ± 3.68 years. The mean SGA was 12.1 ± 3.9. Malnutrition was present in 34 (26.2%) patients [mild to moderate (23.8%), severe (2.4%)]. Patients had a mean BMI of 25.69 ± 4.5 kg/m2, a mean MAC of 25.9 ± 4.9 cm, and a mean TSF of 18.1 ± 8.9 mm. There was a significant negative correlation between malnutrition and mid arm circumference and serum Na with P value of 0.003 and 0.012, respectively. Patients with malnutrition had a significantly longer duration on HD (P=0.004), lower Kt/V (P=0.040), lower serum albumin (P=0.007), lower BMI (P=0.002), less MAC (P=0.002), less TSF (P=0.002). Conclusions Malnutrition is common in HD patients with a significant inverse correlation with mid arm circumference and serum Na. Malnourished patients had a longer duration on HD, lowered serum albumin, BMI, dialysis adequacy and anthropometric measures.

A Cohort Study to Evaluate the Effect of Nutritional Intervention on Severe Acute Malnutrition Children Admitted to A Nutritional Rehabilitation Centre in A Tertiary Care Hospital in Central Gujarat, India

Background: Undernutrition is one of the most concerning health and development issues in India as well as in the world. Nutritional rehabilitation centres (NRC) were started by Government of India to control severe acute malnutrition. The aim is to assess the effect of nutrition interventional measures for severe acute malnutrition (SAM) children admitted at NRC through selected anthropometric indicators. Methodology: A hospital-based prospective cohort study was conducted at NRC of SSG Hospital, Vadodara, Gujarat from April to September 2022, all children of 6-60 months of age admitted during this period were observed during their stay with three follow-ups after discharge at 15 days interval. The data was entered in Microsoft Excel and was analysed using Medcalc Software. Results: A total of 76 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and 3 follow-ups (ANOVA=141, p&lt;0.001); difference of mid upper arm circumference (MUAC) (ANOVA=84.2, p&lt;0.001) and difference of height (ANOVA=43.3. p&lt;0.001) at admission, discharge and follow-up were also statistically significant. Conclusions: NRCs have had a positive impact on the selected anthropometric indicators of severe malnourished children but lag behind proper follow-up visits.

The predictive value of GLIM criteria on clinical outcomes and responses to nutritional support in patients with neurocritical illnesses

Neurocritically ill patients frequently exhibit coma, gastroparesis, and intense catabolism, leading to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition was created to achieve a consistent malnutrition diagnosis across diverse populations. This study aimed to validate the concurrent and predictive validity of GLIM criteria in patients with neurocritical illnesses. A total of 135 participants were followed from admission to the neurocritical unit (NCU) until discharge. Comparing GLIM criteria to the Subjective Global Assessment (SGA), sensitivity was 0.95 and specificity was 0.69. Predictive validity of GLIM criteria was assessed using a composite adverse clinical outcome, comprising mortality and various major complications. Adjusted hazard ratios for moderate and severe malnutrition were 2.86 (95% CI 1.45–5.67) and 3.88 (95% CI 1.51–9.94), respectively. Changes in indicators of nutritional status, including skeletal muscle mass and abdominal fat mass, within 7 days of admission were obtained for 61 participants to validate the predictive capability of the GLIM criteria for the patients’ response of standardized nutritional support. The GLIM criteria have a statistically significant predictive validity on changes in rectus femoris muscle thickness and midarm muscle circumference. In conclusion, the GLIM criteria demonstrate high sensitivity for diagnosing malnutrition in neurocritically ill patients and exhibit good predictive validity.

Improving Pediatric Hypertension Screening in an Academic Primary Care Setting.

Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.