Poor Intake Research Articles

Incidence and predictors of readmission following tonsillectomy in pediatric population

BackgroundTonsillectomy is one of the most common surgical procedures performed in the pediatric population. This study aims to estimate the incidence rate of readmission post tonsillectomy in pediatrics and identify the causes and predictors contributing to the readmission post-surgery. MethodsA retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at a tertiary hospital in 2019 and 2020. The study sample was divided into two groups based on readmission and were compared using the appropriate statistical tests. Significant variables (p-value≤0.05) were included in the logistic regression model to determine the predictors of readmission following tonsillectomy in these patients. ResultsThe readmission rate following tonsillectomy was 6.3 % (95 % confidence interval 5.1–7.9). The causes of readmission included poor oral intake followed by bleeding and vomiting, 55.6 %,49.4 %, and 13.6 %, respectively. In the multivariable logistic regression model, the only significant predictor of post-tonsillectomy readmission was the use of a single postoperative analgesia (OR: 57.27, P = 0.000). ConclusionThe readmission rate following tonsillectomy in this study was relatively high. The most common causes contributing to readmission post tonsillectomy were poor oral intake and hemorrhage. The study also revealed a significant association between the utilization of single postoperative analgesia and an increased likelihood of readmission.

Nutritional status, macronutrient and micronutrient intake in relation with dementia among older adults in Surabaya, Indonesia: a cross-sectional study

Background Older adults are prone to dementia due to poor nutrients intake and malnutrition. The purpose of this study was to determine the correlation between body mass index (BMI), macronutrient and micronutrient intake with dementia. Methods This was a cross-sectional study including 400 older adults randomly recruited from the study site. Dementia was measured using the mini-mental state exam questionnairefig while nutrient intake was retrieved from three non-consecutive days 24h food recall. Socio-economic data were retrieved from a structured questionnaire. Data was then analyzed statistically using chi-squared and ANOVA with Bonferonni correction. Results The result reveals that age, sex, present disease and socio-economic measures were correlated with dementia (p < 0.05). Post-hoc analysis found that there was a significant difference in BMI, daily intake of carbohydrate, saturated fat, and sodium intake between older adults with and without dementia. Conclusions This study offers an important insight to improve older adults’ daily intake related to BMI, carbohydrate, saturated fat, and sodium intake in minimizing the risk of dementia. More health promotion on older adults’ balanced diet should be encouraged to achieve better quality of life.

The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review.

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment. This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice. The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status. With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.

Nutrition optimisation of young tuberculosis patient with poor oral intake

ABSTRACT A 19-year-old female teenager, Chinese, admitted to medical ward on 30 April 2023 with the reason of admission of recurrent disseminated pulmonary tuberculosis (TB) and presented with fever (2/12), cough (3/7), loose stool (1/12), shortness of breath (6/12), lethargy (2/52) and poor oral intake. She had underlying diseases of hypochromic microcytic anemia anaemia 2° iron-deficiency anaemia and folate deficiency, severe hypoalbuminaemia, hospital-acquired pneumonia due to Pseudomonas infection and persistent fever despite being on anti-TB medication. In this case, the patient had already been referred to a dietitian, but a follow-up was needed as she had a loss of appetite and inadequate oral nutrition for a few days. Her calculated body mass index is 16.1 kg/m2 (underweight) and Subjective Global Assessment (SGA) was rated with Grade B (mild-moderate malnutrition) with a history of severe weight loss for the past 1 month. The biochemical data showed abnormal readings of renal profile, albumin and haemoglobin levels.

Evaluation of Real Time PCR Detection of the 47 kDa Gene for Reliable Diagnosis of Pediatric Scrub Typhus

Objective: Diagnosis of scrub typhus is difficult, because of its non-specific clinical features and a lack of reliable serological assays. This study assessed real time PCR detection of the 47 kDa gene along with routine IgM ELISA for confirmatory diagnosis of scrub typhus. Methods: This observational study was conducted between March 2021 and February 2023. Real time PCR detection of the 47 kDa gene was used as a diagnostic assay. Confirmed scrub typhus cases were defined by IgM ELISA and/or real time PCR positivity. Results: A total of 105 children (0–18 years of age) were enrolled, 30 (28.57%) of whom were confirmed to have scrub typhus, according to IgM ELISA and/or real time PCR positivity. The clinical symptoms of scrub typhus positive children included fever, diarrhea, abdominal pain, breathing difficulties, lymphadenopathy, rash, headache, edema, seizure, and poor intake. Good statistical correlations were observed among real time scrub positivity, high grade fever of 8.2 days’ duration, the presence of eschar and thrombocytopenia. Non-specific respiratory symptoms; cough, and cold were more severe in patients with scrub typhus. The real time PCR test showed good specificity in discriminating scrub typhus from enteric fever, a common pediatric disease. Conclusion: Detection of the 47 kDa gene with real time PCR has good sensitivity and specificity. The number of days between fever onset and sampling, as well as the administration of antibiotics before sampling, influence the performance of real-time PCR.

A 43 year old male with Jaundice

Malnutrition and liver cirrhosis go hand in hand due to poor metabolic and detoxifying capacity of liver. Due to impaired liver function, patient is anorexic, portal hypertensive, altered mental state, nausea, jaundice, ascitis. These symptoms associated with liver diseases are enough to lead to malnutrition by poor food intake, maldigestion, malabsorption and impaired detoxification process. Present case was a 43 year old male suffering diagnosed with D-CLD with jaundice, ascitis, hepatic encephalopathy with comorbidities of type 2 diabetes and hypothyroidism. He was grossly investigated for extent of liver function in terms of Child Turcotte Pugh and MELDna scores. Accordingly his medications were started. Simultaneously, the patient was assessed for his nutritional status, in which he was found moderately malnourished as evidenced by SGA rating B. Patient was motivated to improve food intake and given a lot of varieties in diet. Consequently his condition was improved drastically although permanent treatment was liver transplant for which workup has been started.

A real-world analysis of pharmacotherapy adherence and the factors influencing it in Serbia: a nationwide, population-based, cross-sectional study.

Monitoring the pharmacotherapy adherence in society is crucial for identifying occurance and causes of potential inadequate use of drugs and inform providers about the need for better customer counceling. It is necessary component of the strategic planning of the quality of healthcare services. This population- based study aimed to assess the medication intake adherence in the Republic of Serbia and the individual factors and health system variables influencing its pattern. We applied a cross-sectional approach to study medication intake adherence using a secondary analysis of the latest 2019 Serbian National Health Survey data. The statistical modeling of the pharmacotherapy adherence incorporated sociodemographic data, self-reported disease, and lifestyle behavior. In 2019, in the representative sample of 12,066 adults in Serbia, requiring prescribed medicine, 49.8% did comply with the prescribed drugs, and 50.2% do not. Participants who adhered to prescribed medication were significantly (p < 0.001) older (62.4 ± 14 years), predominantly female (55.3%), had secondary education (48.5%), resided in southern and eastern parts of Serbia (55.5%), and belonged to the lowest income quintile (21.4%). The participants most often take prescribed drugs for hypertension (64.1%) and lower back pain (30.5%), while around 20% take medication for coronary disease, diabetes mellitus, and high blood cholesterol. About 85-92% of participants with financial or general difficulties using prescribed medication. There is poor medication intake adherence to prescribed medication in Serbia. Gender, age, and region determine the adherence. Also, health-related and healthcare system-related factors impact the use of prescribed medication. Study findings can inform planning the counceling interventions in the target groups where improving medication adherence is necessary, as well as to enhance training of healthcare providers about pharmacotherapy adherence.

Undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia: A community-based study.

An exclusive breastfeeding period is a time when the infant's feeding depends on only breast milk. Inadequate maternal nutrition during this period could lead to insufficient infant feeding, which can further lead to childhood undernutrition and developmental restrictions. Evidently, the burden of maternal undernutrition was higher in resource-limited countries, including Ethiopia. This study aimed to assess the proportion of undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia. The study used a community-based cross-sectional design. The study was conducted among 442 nursing mothers from 10 to 30 June 2022. The participants were selected using multistage sampling techniques. An interviewer-administered structured questionnaire was used to collect information. Statistical software EpiData version 3.1 and SPSS version 20 were used for data entry and analysis, respectively. The factors associated with undernutrition were identified using a binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used to include the variable in the multivariable analysis, whereas p-value less than 0.05 was an odds ratio used to declare an independent association at a 95% confidence interval. The proportion of undernutrition among the participants was found to be 24.8% in the study area. Poor intake of extra meals (adjusted odds ratio = 2.104; 95% confidence interval: 1.208, 3.664), poor dietary diversity habits (adjusted odds ratio = 3.605; 95% confidence interval: 2.112, 6.153), a lack of nutrition information (adjusted odds ratio = 1.853; 95% confidence interval: 1.070, 3.212), and household food insecurity (adjusted odds ratio = 4.424; 95% confidence interval: 2.639, 7.417) were identified as factors enhancing undernutrition among exclusive breastfeeding mothers in the area. A quarter of exclusive breastfeeding mothers were undernourished in the area. Poor dietary diversity habits, poor intake of extra meals, a lack of nutrition information, and household food insecurity were found to be the factors determining undernutrition. Hence, it is important to reinforce nutrition intervention programs, including maternal nutrition education and counseling.

Gambaran Tingkat Pengetahuan Ibu Tentang Stunting Pada Balita Di Puskesmas Kota Manna Kabupaten Bengkulu Selatan

Globally, stunting remains one of the main nutritional problems in infants and children under five years old. Stunting is a condition in children marked by length or height for age and sex less than -2 SD based on the World Health Organization (WHO) growth curve, due to chronic malnutrition associated with low socioeconomic conditions, poor nutritional intake and maternal health, a history of recurrent illness, and/or inappropriate infant and young child feeding practices. The purpose of this study was to determine the level of knowledge of mothers about stunting in toddlers at the Puskesmas Kota Manna, South Bengkulu Regency. The method used in this research is quantitative research with descriptive research method. The population of this study were all mothers who had toddlers in the working area of the Puskesmas Kota Manna, South Bengkulu Regency in June 2023 with 20 samples selected using the random sampling method. The results of this study obtained the age of the majority of respondents aged in the range of 20-35 years as many as 18 people (90.0%), the minority aged&gt; 35 years as many as 2 people (10.0%). The majority of respondents' education is junior high school as many as 8 people (40.0%), the minority of SARJANA is 5 people (25.0%). The majority of respondents' occupations were housewives as many as 14 people (70.0%) and a minority of civil servants as many as 2 people (10.0%). the majority of respondents' knowledge was lacking, namely 9 people (45.0%) and a minority of sufficient knowledge as many as 7 people (35.0%). Based on the results of the study, the majority of mothers' knowledge about stunting in toddlers at the Puskesmas Kota Manna, South Bengkulu Regency in 2023 was less as many as 9 people (45.0%).

Gestational Malnutrition is Still the Skeleton in the Closet: Where Are the Malnutrition Risk Screening Criteria?

In 2020 there were 3,613,647 live births in the US. Fifty to 90% of those pregnancies were affected by nausea and vomiting of pregnancy (NVP) while the most severe NVP, known as hyperemesis gravidarum (HG) affected 1.5- 3.0% of those gravidas. In 2014 58,436 gravidas were hospitalized with HG. While hospital admissions for HG were down 42%, the number seen in Emergency departments rose by 27.7%. Although HG has been viewed as a positive predictor of a favorable pregnancy outcome, patients who also demonstrate weight loss and electrolyte disturbance may be a distinct entity and at greater risk for growth retardation and fetal anomalies. Poorly managed HG can result in compounded maternal injuries, increased rates of therapeutic abortions and suicide ideation, as well as a high rate of fetal loss. This study focuses on one of the most severe catastrophes originating from HG: Wernicke’s encephalopathy (WE) continues to be an under-recognized and often misunderstood disease in all populations. The acknowledged cause of WE is vitamin B1 or thiamin deficiency, a specific form of malnutrition. Unfortunately, this syndrome is most often recognized at autopsy, especially among non-alcoholics. One manifestation of WE is cognitive dysfunction which may explain the increase in suicidal ideation and/or elected terminations. The current mounting legislation of pregnancy termination limits will complicate the decision to abort for critically ill gravidas and their medical providers. However, antecedent events to WE are extremely poor nutritional intake leading to excessive weight loss and delayed nutritional interventions which can mitigate these situations.

To Compare the Effects of Post-tonsillectomy Intra-operative Infiltration of Ropivacaine Versus Bupivacaine in Tonsillar Fossa.

Tonsillectomy is one of the most common surgical procedures practiced in Otorhinolaryngology. A significant obstacle for the speedy and smooth recovery is early post- operative pain. Pain leads to negative outcomes such as poor intake, tachycardia, anxiety, delayed wound healing and insomnia. Aim to assess and compare the effect of post-incisional infiltration of 0.75% Ropivacaine v/s 0.5% Bupivacaine on post tonsillectomy pain, the on start of oral intake and stay in hospital and to investigate any complications that can arise due to infiltration of the said drugs. 60 Patients above the age of 5years were posted for tonsillectomy or adenotonsillectomy under general anesthesia. Patients were blinded about the group in which they will be enrolled. Group A received Inj. ropivacaine (0.75%) 2ml and Group B: received Inj. Bupivacaine (0.50%) 2ml in each fossa. After surgery, no analgesics were given & patients were observed for the intensity of post-operative pain in the immediate post-operative period, at 2, 4, 6, 12, 24, 48h and further if not discharged using VISUAL ANALOGUE SCORE (VAS) and VERBAL RATING SCALE(VRS). Post-operative pain assessment was done using VAS and VRS at 2nd, 4th, 6th, 12th, 24th and 48th hour which was found to be lower in Group 'A'. Patients in Group 'A' also started their oral intake sooner, had lesser hospitalization days than group 'B' patients. Longer time for Rescue analgesic and reduced total dose of analgesic required was seen in Group A compared to Group B. This comparative study on Post-incisional infiltration of 2ml 0.75% Ropivacaine v/s 2ml 0.5% Bupivacaine has shown that Ropivacaine is a more effective drug in reducing post-operative pain in comparison to Bupivacaine, proven statistically.

Preventing malaria in pregnancy: knowledge and practices of pregnant women in an urban hospital in Kumasi, Ghana

Background: Malaria in pregnancy (MiP) is a public health concern in Ghana. The current national control program seeks to have 85% of pregnant women sleeping under insecticide treated nets (ITNs). It also seeks to achieve 100% intake of at least 2 doses of Sulfadoxine-Pyrimethamine (SP). In order to achieve these aims, it is important that pregnant women have good knowledge of malaria and subscribe to good preventive practices. This cross-sectional study sought to evaluate the knowledge and practices on malaria prevention among pregnant women in an urban setting of Ghana. Methods: This was a hospital-based study which involved 185 pregnant women visiting an urban hospital for antenatal care in Kumasi, Ghana. Data was collected via structured interviewer administered questionnaires. Univariate and bivariate analyses were conducted to assess the participants’ knowledge and practices on malaria prevention. Results: The women demonstrated good knowledge of MiP, with 76% of them having an excellent knowledge score. Familiarity with ITNs (99.5%) was higher than IPTp-SP (86.5%). There was a statistically significant association between tertiary education and high total knowledge score (X2 =31.912, df = 18, p = 0.023). ITN usage was poor (55.1%), with common challenges being difficulty in hanging nets, nets being deemed too hot, and unpleasant smell of the nets. 66.5% of the women had taken at least 2 SP doses. Conclusion: Although there was good knowledge, ITN use and SP coverage were below national targets. More studies should be conducted to explore the factors underlying poor ITN use and SP intake.

Time trends of 16 modifiable risk factors on the burden of major cancers among the Chinese population.

The cancer burden in China is increasing. We aimed to assess the time trends in the prevalence of 16 modifiable risk factors involved in lifestyle, diet, infection, and air pollution between 1997 and 2025 based on the China Health and Nutrition Survey, the Global Burden of Disease website, and publically available studies. The population attributable fraction (PAF) and its 95% uncertainty interval (UI) from 2007 to 2035 were calculated to quantify the attributable cancer burden in major 12 anatomic sites using the comparative risk assessment method, considering a 10-year lag effect. As a result, 1,559,476 cancer cases (PAF = 54.1%, 95% UI: 36.8%-65.8%) from the 12 anatomic sites were attributable to these modifiable risk factors in 2007, with lung, liver, and gastric cancer raging the top three. It was predicted that by 2035, the attributable cancer cases would reach 1,680,098 (PAF = 44.2%, 95% UI: 29.1%-55.5%), with the top three of lung, liver, and colorectal cancer. Smoking, physical inactivity, insufficient fruit consumption, HBV infection, and Helicobacter pylori infection were the most attributable risk factors in 2007, contributing to 480,352, 233,684, 215,009, 214,455, and 187,305 associated cancer cases, respectively. In 2035, the leading factors for cancer would be smoking, physical inactivity, insufficient fruit intake, HPV infection, and HBV infection, resulting in 427,445, 424,327, 185,144, 156,535, and 154,368 cancer cases, respectively. Intervention strategies should be swiftly established and dynamically altered in response to risk factors like smoking, physical inactivity, poor fruit intake, and infectious factors that may cause a high cancer burden in the Chinese population.

Optimasi Model Algoritma Klasifikasi menggunakan Metode Bagging pada Stunting Balita

Stunting is a serious problem for the health of toddlers, who experience malnutrition during their development. Poor nutritional intake or a lack of knowledge about nutrition can be a factor in stunting. This study aims to optimize the stunting classification algorithm in toddlers using the K-Nearest Neighbor algorithm, Support Vector Machine, and Naïve Bayes by using bagging optimization. This study uses toddler data totaling 10,000 records, 7 attributes, and 2 classes taken from Krobokan Health Center, Semarang City. Based on the findings of this study, the Bagging Method shows excellent performance with 89.77% accuracy, 95.57% precision, 85.45% recall, and a 90.27% F1-score. This shows great potential for improving the model's ability to classify data with a high degree of accuracy, completeness, and balance. The SVM model has a high recall of 80.59%, while the Naïve Bayes model gets an F1-score of 71.84%, indicating that Naïve Bayes has a good balance between precision and recall. Overall, the Bagging Model is the best choice, with far superior performance compared to other models. Based on the results obtained, the Bagging Method can predict stunting data accurately, showing a very good level of truth in stunting prediction efforts.

Feeding Characteristics in Children With Food Allergies: A Scoping Review.

Food allergy (FA) affects approximately 8% of children and may be immunoglobulin E (IgE)-mediated or non-IgE-mediated. It is recognized clinically that children with both subtypes of FA may present with features of pediatric feeding disorder (PFD); however, there is currently a limited detail of presenting characteristics. The objective of this study was to synthesize the current evidence regarding the feeding characteristics of children with FA, with a focus on the feeding skills and psychosocial domains of PFD. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Papers published between 2001 and 2022 describing feeding characteristics in the feeding skills and psychosocial domains in children with FA/history of FA were included. Papers that focused solely on characteristics from the medical or nutritional domains were excluded. Descriptive information regarding demographics, methodology, allergy profile and history, and the characteristics of PFD observed was extracted using a preconceived data extraction form. Overall, 40 papers contained descriptions of feeding characteristics of children with non-IgE-mediated FA (n = 22) and IgE-mediated FA (n = 11), while four were nonspecific. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were the most frequently reported, regardless of FA subtype. Less information was reported regarding feeding skills, although slowness in eating, immature diet, and delays in oral sensory-motor skills were described. Children with FA/history of FA may present with a range of characteristics that map across the feeding skill and psychosocial domains of PFD. Systematic research is needed to fully describe the feeding characteristics of children with FA. https://doi.org/10.23641/asha.24562732.

Association of a Combination of Sarcopenia and Type 2 Diabetes with Blood Parameters, Nutrient Intake, and Physical Activity: A Nationwide Population-Based Study

This study aimed to investigate the association of sarcopenia and type 2 diabetes (T2D) with blood parameters, nutrient intake, and physical activity in older Korean adults. We divided 2952 participants into four groups: sarcopenic diabetes (SD), sarcopenia alone (S), diabetes alone (D), and non-sarcopenia and non-diabetes (NSND). Sarcopenia was defined by the appendicular skeletal muscle mass index, and T2D by fasting glucose levels or ongoing treatment. Blood samples were collected after an 8-h fast. Nutrient intake was assessed using a 24-h recall; physical activity was evaluated using a questionnaire. Compared with those in the other groups, the men in the S and SD groups showed significantly lower hemoglobin and hematocrit levels; vitamin D levels in men and parathyroid hormone levels in women were significantly lower in the SD group. Total energy, protein, and carbohydrate intakes were significantly lower in the SD and S groups than those in the D and NSND groups. Physical inactivity was significantly more common in the SD group (men: odds ratio, 1.61; women: odds ratio, 2.37) than in the NSND group. A combination of sarcopenia and diabetes as well as sarcopenia alone was associated with low levels of blood parameters, poor nutrient intake, and low physical activity.

Causes of Iron Deficiency Anemia in Children Less Than 12 Years Old at Cooper University Hospital and Their Response to Intravenous Iron Replacement

Title of project: Causes of iron deficiency anemia in children less than 12 years old at Cooper University Hospital and their response to intravenous iron Background: Iron deficiency anemia (IDA) is the most common type of anemia in children. Even among industrialized countries like the US, IDA affects many children. Serious adverse outcomes can occur in children with IDA including, cognitive and motor neurodevelopmental delays which may be irreversible. While poor oral intake tends to be the focus of screening and preventative measures, additional causes of IDA include malabsorption from gastrointestinal abnormalities, medications that decrease iron absorption, parasitosis, genitourinary loss, and blood loss. Menorrhagia is a common cause of IDA among adolescents. The average age of menarche for adolescent girls is 12.43 years. Therefore, on data evaluation for the cause of IDA among patients aged 1-21, menstrual bleeding was overrepresented. Objective: This sub-analysis of a single center retrospective chart review analyzed the causes of IDA among children less than 12 years of age at Cooper University Hospital and their response to intravenous iron treatment. Methods: Data on all patients 1-12 years old who received intravenous iron infusions at Cooper University Hospital for IDA between 2016 and 2021 was analyzed. Descriptive statistics on the etiology of IDA and paired t-tests comparing pre-infusion hematologic parameters (hemoglobin, RDW, RBC, MCV, iron, ferritin, TIBC, percent saturation) to post-infusion values were conducted. Results: From the 150 patients included in the original study, 26 patients were 12 years of age or younger. The causes of IDA among these patients included inadequate dietary intake (65.4%), inflammatory bowel disease (15.4%), menorrhagia (15.4%) and one patient with factor II deficiency (3.8%). These patients required between one to eleven infusions to return to normal lab values. When comparing pre-infusion to post-final infusion lab values, there was significant improvement in all values (ferritin, iron, hemoglobin, MCV and RBCs) except total iron binding capacity, RDW and percent saturation. Discussion: Inadequate dietary intake was the most common cause of IDA in children less that 12 years old treated at Cooper University Hospital. Other causes included inflammatory bowel disease, menorrhagia and factor II deficiency. In contrast, the most common cause of IDA in children 12 and older was menorrhagia. Childhood food insecurity has been linked to IDA among low-income patients in the United States. Despite food assistance programs and adequate dietary education, patients continue to remain iron deficient. The current first-line therapy at Cooper University Hospital is oral iron supplementation. However, many patients fail the oral iron trial due to non-adherence, children spitting up or refusing to take the medication, and gastrointestinal side effects. Many pediatric patients in our clinic population are on NJ state insurance which requires a failed oral iron therapy trial prior to qualifying for coverage of intravenous iron. Yet, in a previous retrospective study completed in our clinic, intravenous iron has proven to be effective and safe, with fewer side effects and better adherence. For many patients, especially infants and toddlers, intravenous iron may provide a quicker cure for IDA, preventing irreversible neurodevelopmental delays. We propose that treatment with oral iron and intravenous iron should both be considered for first-line therapies and should be a shared decision between parents and providers.

Improving nutrition care and diet intake for hospitalised older people at risk of malnutrition through a nurse-driven mealtime assistance bundle.

Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition. This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition. This project adopted a pre-post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) questionnaire were performed before and after implementation. There were fewer older adults with poor intake in the post-implementation group than the pre-implementation group. Among those at risk of malnutrition, older adults in the post-implementation group had higher average intake of all provided meals as well as the protein-dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge-Attitude subscale and Practice subscale of the M-KAP questionnaire. Integrating a nurse-driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care. Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food-promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed.

Euglycemic Diabetic Ketoacidosis: Experience with 44 Patients and Comparison to Hyperglycemic Diabetic Ketoacidosis.

Euglycemic diabetic ketoacidosis (DKA) (glucose <250milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period. This is a retrospective review of adult emergency department patients in DKA at an academic medical center. Patients were included if they were >18years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (<250milligrams per deciliter [mg/dL]) vs hyperglycemic (≥250mg/dL) cohorts by presenting glucose. We extracted and analyzed patient demographics, resource utilization, and safety outcomes. Etiologies of euglycemia were obtained by manual chart review. For comparisons between groups we used independent-group t-tests for continuous variables and chi-squared tests for binary variables, with alpha 0.05. We identified 629 patients with DKA: 44 euglycemic and 585 hyperglycemic. Euglycemic patients had milder DKA on presentation (higher pH and bicarbonate, lower anion gap; P < 0.05) and lower initial glucose (195 vs 561mg/dL, P < 0.001) and potassium (4.3 vs 5.3mmol/L, P < 0.001). Etiologies of euglycemia were insulin use prior to arrival (57%), poor oral intake with baseline insulin use (29%), and SGLT2 inhibitor use (14%). Mean time on insulin infusion was shorter for those with euglycemic DKA: 13.5 vs 19.4 hours, P = 0.003. Mean times to first bicarbonate >18mmol/L and first long-acting insulin were similar. Incidence of hypoglycemia (<70mg/dL) while on insulin infusion was significantly higher for those with euglycemic DKA (18.2 vs 4.8%, P = 0.02); incidence of hypokalemia (<3.3mmol/L) was 27.3 vs 19.1% (P = 0.23). Compared to hyperglycemic DKA patients managed in the same protocolized fashion, euglycemic DKA patients were on insulin infusions 5.9 hours less, yet experienced hypoglycemia over three times more frequently. Future work can investigate treatment strategies for euglycemic DKA to minimize adverse events, especially iatrogenic hypoglycemia.

No food for thought-How important is breakfast to the health, educational attainment and wellbeing of school-aged children and young people?

There have been reports from teachers of pupils in the United Kingdom arriving at school hungry. Poor nutritional intake during childhood can increase the risk of developing both short- and long-term health problems. Breakfast consumption has been associated with several outcomes including better diet quality and healthier weight status. Nevertheless, skipping breakfast is a frequent behaviour in young people, particularly adolescents, and those from lower socio-economic groups, who are less likely to meet dietary recommendations and nutritional targets. The aim of this narrative review is to explore the contribution of breakfast consumption at home or at school and the impact of breakfast skipping on nutrient intakes in school-aged children (aged 4-18 years), and their effect on weight and cardiometabolic health. We will also summarise evidence for a link with cognitive function and educational attainment. A broadly positive effect of breakfast intake on diet quality, weight status and school-related outcomes was found in the literature, although inconsistencies in findings and methodological limitations within the evidence base are notable. Further research is warranted to better understand impact of breakfast intake and school breakfast provision on longer-term learning, educational attainment and health outcomes. This also needs to consider the cost benefit, type of breakfast and any unintended consequences such as encouraging multiple breakfasts. Breakfast consumption could improve the nutritional intakes of the most vulnerable young people and may help to address inequalities in educational outcomes at least in the short term.