Severe Childhood Malnutrition Research Articles

Long-term outcomes after severe childhood malnutrition in adolescents in Malawi (LOSCM): a prospective observational cohort study

Research on long-term outcomes of severe childhood malnutrition is scarce. Existing evidence suggests potential associations with cardiometabolic disease and impaired cognition. We aimed to assess outcomes in adolescents who were exposed to severe childhood malnutrition compared with peers not exposed to severe childhood malnutrition. In Long-term Outcomes after Severe Childhood Malnutrition (LOCSM), we followed up adolescents who had 15 years earlier received treatment for severe childhood malnutrition at Queen Elizabeth Central Hospital in Blantyre, Malawi. Adolescents with previous severe childhood malnutrition included in LOCSM had participated in an earlier follow-up study (ChroSAM) at 7 years after treatment for severe childhood malnutrition, where they were compared to siblings and age-matched children in the community without previous severe childhood malnutrition. We measured anthropometry, body composition, strength, glucose tolerance, cognition, behaviour, and mental health during follow-up visits between Sept 9, 2021, and July 22, 2022, comparing outcomes in adolescents exposed to previous severe childhood malnutrition with unexposed siblings and adolescents from the community assessed previously (for ChroSAM) and newly recruited during current follow-up. We used a linear regression model to adjust for age, sex, disability, HIV, and socioeconomic status. This study is registered with the International Standard Randomised Controlled Trial Number Registry (ISRCTN17238083). We followed up 168 previously malnourished adolescents (median age 17·1 years [IQR 16·5 to 18·0]), alongside 123 siblings (18·2 years [15·0 to 20·5]), and 89 community adolescents (17·1 years [16·3 to 18·1]). Since last measured 8 years previously, mean height-for-age Z (HAZ) scores had improved in previously malnourished adolescents (difference 0·33 [95% CI 0·20 to 0·46]) and siblings (0·32 [0·09 to 0·55]), but not in community adolescents (difference -0·01 [-0·24 to 0·23]). Previously malnourished adolescents had sustained lower HAZ scores compared with siblings (adjusted difference -0·32 [-0·58 to -0·05]) and community adolescents (-0·21 [-0·52 to 0·10]). The adjusted difference in hand-grip strength between previously malnourished adolescents and community adolescents was -2·0 kg (-4·2 to 0·3). For child behaviour checklist internalising symptom scores, the adjusted difference for previously malnourished adolescents was 2·8 (0·0 to 5·5) compared with siblings and 2·1 (-0·1 to 4·3) compared with community adolescents. No evidence of differences between previously malnourished adolescents and unexposed groups were found in any of the other variables measured. Catch-up growth into adolescence was modest compared with the rapid improvement seen in childhood, but provides optimism for ongoing recovery of height deficits. We found little evidence of heightened non-communicable disease risk in adolescents exposed to severe childhood malnutrition, although long-term health implications need to be monitored. Further investigation of associated home and environmental factors influencing long-term outcomes is needed to tailor preventive and treatment interventions. The Wellcome Trust.

Evaluation of The Integrated Protocol for The Management of Severe Malnutrition in Children at The National Hospital of Nouakchott-Mauritania

Malnutrition is a worldwide concern with worrisome outcomes that affect substantially the lifestyle of infants. The main aim is to investigate the efficacy of the IMSAM protocol over malnourished Mauritanian children during hospitalization. A cohort of 230 participants, including 126 boys and 104 girls collected from rural and urban areas with an average age of 15.52 ± 7.727 months were enrolled. The study is carried out in the Pediatric Service of the National Hospital Center of Nouakchott, Mauritania on children who have undergone the national protocol for the Integrated Management of Severe Acute Malnutrition (IMSAM). In addition, the medical and nutritional treatment, and body measurements were appreciated as well as the anthropometric parameters. The findings exhibit during nutritional-based intervention significant differences between the mean of weight during the pre- and post-intervention (P < 0.001). Moreover, through a regression test, we found a negatively predicted weight gain (P < 0.05) by the variables Z-score of weight to height (P / T) Edema after Nutritional Support and final health status. Last, but by no means least, the IMSAM-based intervention with rational management might make inroads into mitigating adverse outcomes of malnutrition through maximizing social skills.

Severe malnutrition in children weakens immune response to infections

Severe malnutrition in children weakens immune response to infections

Spatial distribution and associated factors of severe malnutrition among under-five children in Ethiopia: further analysis of 2019 mini EDHS

BackgroundMalnutrition is both a significant cause and a result of poverty and deprivation. In developing nations, child malnutrition is still the main public health issue. Severe malnutrition affects every system of the body and leads to medical instability. The assessment of the burden of severe malnutrition is important for ready-to-use therapeutic foods and preparing therapy for these conditions. Therefore, this study aimed to assess the prevalence and spatial distribution of severe malnutrition and the factors associated with it.MethodsData from the 2019 Mini-EDHS (Ethiopian Demographic and Health Surveys) with stratified sampling techniques were used. The data were weighted using sample weight to restore the data's representativeness and provide accurate statistical estimations. A total of 5,006 weighted samples of children under the age of five were used to analyze the study. A multilevel binary logistic regression model was built, and a cutoff P-value of 0.05 was used. The wag staff normalized concentration index and curve as well as spatial analysis were used.ResultsThe prevalence of severe malnutrition practice among under five years children in Ethiopia was 14.89% (95%CI: 13.93%, 15.91%), and ranges from 4.58% in Addis Ababa to 25.81% in the Afar region. Women with secondary and above education status as compared to uneducated [AOR = 0.17; 95%CI;[0.06, 0.48], high community women's education as compared to low [AOR = 0.54; 95%CI; 0.36, 0.78], women from richest household as compared to poorest [AOR = 0.63; 95%CI; 0.26, 0.94] and living in Oromia region as compared to Tigray [AOR = 0.33: 95%CI; 0.15, 0.74] were preventive factors. Whereas children 24–59 months of age as compared to under six months [AOR = 1.62; 95%CI; 1.50, 1.75], and being multiple births as compared to single [AOR = 5.34; 95%CI; 1.36,2 1.01] have significant risk factors for severe malnutrition. There was a pro-poor distribution of severe malnutrition among under-five children in Ethiopia with a concentration index of -0.23 [95%CI: -0.27, -0.19]. Severe malnutrition has significant spatial variation over regions in the country where the entire Afar, Eastern Amhara, Southern, and eastern Tigray regions were severely affected (RR = 1.72, P-value < 0.01).Conclusion and recommendationsThe prevalence of severe malnutrition in Ethiopia is relatively high as compared to other studies and most of them were severe chronic malnutrition. Having an educated mother/caregiver, and living in a cluster with high community women's education were preventive factors for severe malnutrition in children. Whereas having an unmarried mother/caregiver, old age of the child, plurality of birth, and having double children in the family have a positive association with it. Moreover, it was disproportionately concentrated in poor households (pro-poor distribution).The spatial distribution of childhood severe malnutrition was not random. Regions like Tigray, Afar, Eastern parts of Amhara, and Somalia regions should be considered priority areas for nutritional interventions for reducing severe malnutrition. Equity-focused nutritional interventions could be needed to curb the wealth-related inequalities of childhood severe malnutrition.

Urinary Excretion of 5-L-Oxoproline (Pyroglutamic Acid) Is Increased during Recovery from Severe Childhood Malnutrition and Responds to Supplemental Glycine

We hypothesized that a limitation in the endogenous formation of glycine might constrain catch-up growth during recovery from severe childhood malnutrition. The urinary excretion of 5-L-oxoproline is increased when the glycine available for glutathione synthesis is limited. Urinary excretion of 5-L-oxoproline was measured throughout recovery in 12 children (aged 16 ± 6 mo) with severe malnutrition. Urinary 5-L-oxoproline was similar at admission and after recovery, but was increased significantly during rapid catch-up growth. There was a significant relationship between the rate of weight gain and 5-L-oxoproline excretion in urine. In nine children (aged 15 ± 5 mo), the effect of oral supplementation with glycine, [1.7 mmol/(kg·d) for 48 h] during rapid catch-up growth on 5-L-oxoprolinuria and blood glutathione concentration was determined. In seven of the nine children weight gain was less than 17 g/(kg·d) and following oral glycine supplements 5-L-oxoproline excretion was reduced up to 64% and blood glutathione concentration increased up to 100%. In the two children who were gaining weight at a rate >17 g/(kg·d), glycine supplementation was associated with a further increase in 5-L-oxoproline excretion and a decrease in blood glutathione. If 5-L-oxoproline is an index of the relative availability of glycine, then the data indicate that glycine may be limiting during rapid catch-up growth. This would have important implications for repletion of muscle and gain in height.

Sociocultural Determinants of Nutritional Status Among Children Under Five Years of Age: An Ethnographic Study From Gujarat.

BackgroundThe magnitude of child malnutrition, including severe child malnutrition, is high in India, and Gujarat has a higher prevalence of child malnutrition. Prior studies have employed anthropometric measures to identify the prevalence and associated factors of children’s undernutrition. The present study explored community-level determinants of malnutrition among malnourished and well-nourished children in Devbhumi Dwarka district of Gujarat State, India.MethodsA qualitative research employing focused ethnographic methodologies was used. In-depth observations of 60 families in a home food environment were carried out. Each child was observed at their respective homes for three consecutive days. Data were analyzed using thematic analysis techniques.ResultsThe study revealed that lack of knowledge on malnutrition, inadequate feeding practices, poor socioeconomic status, insufficient hygiene and sanitation practices, lack of food variety, use of health facilities, and birth complications were the major community-based determinants of malnutrition.ConclusionThe study identified community-level determinants of malnutrition among children under five years in the Devbhumi Dwarka district. To tackle the immediate and underlying causes of malnutrition, interventions are urgently needed to create community awareness about malnutrition as a disease and optimal infant and young child feeding (IYCF) practices using behavior change communication strategies.

Current scenario of ocular morbidity in severe acute childhood malnutrition in central part of India

The study aimed to assess the prevalence of ocular involvement in children 6 months to 5 years attending tertiary care centre with Severe Acute Malnutrition and to detect the associated risk factors for ocular morbidity in severe acute malnutrition.: This hospital based observational study was carried out at Gandhi Medical College, during the study period of 2 years on children diagnosed with SAM belonging to 6 months to 5 years of age. Detailed history was obtained and physical, systemic and ocular examination was done. : A total of 100 severe acute malnourished children were included. Prevalence of ocular involvement in severe acute malnourished children was 72%. Conjunctival pallor was observed in 71.5% eyes and retinal hemorrhages were most common posterior segment finding. Vitamin A deficiency signs were observed in 17 eyes (8.5%). Higher birth order and number of sibling was significantly associated with higher incidence of ocular manifestations (p&amp;#60;0.05). However, other variables showed no significant association between other variables and ocular manifestations (p&amp;#62;0.05). Training should be given to health workers at the primary health care level and health centers on counseling mothers on feeding, growth monitoring, the preventable eye blinding diseases and hygiene during the vaccination sessions and early referral of children with eye signs to hospitals. Also education of couple regarding proper nutrition of mother and child should be encouraged and couples should be insisted to have not more than two children.

Clinical Profile and Effects of Ductal Size on Anthropometry of Children with Patent Ductus Arteriosus (PDA)

Background&#x0D; It is not known at which size a congenital Patent ductus arteriosus (PDA) in children becomes associated with a resultant severe malnutrition in children. Furthermore, the effect of ductal size on anthropometry of children with PDA is yet to be determined.&#x0D; Objectives&#x0D; This study was aimed to asses if the ductal size had any effect on anthropometry of children with PDA and at which size evidence of severe malnutrition ensues&#x0D; Methods&#x0D; This was a five-year observational cross-sectional study of children who presented at three tertiary institutions with PDA.&#x0D; Results&#x0D; There was a negative non-significant correlation between the size of PDA and the weight of patients, (Pearson correlation coefficient = -0.1, p = 0.7). There was also a negative non-significant correlation between the size of PDA and patient’s height/length, (correlation coefficient = -0.1, p = 0.5).&#x0D; The association between the size of PDA and the severity of malnutrition revealed greater proportion of 35.3% (6/17) for wasting and stunting in patients who had large PDA sizes of &gt;7mm, when compared with fewer proportions in those with PDA sizes of 3- 6mm (26.1% (6/23) and those with tiny PDA of &lt;3mm (33.3% (10/30); (χ2 = 10.21, p = 0.8).&#x0D; There was a positive correlation between ductal size and nutritional status of patients, and severe malnutrition ensued from ductal size of 3.2mm; with ETA square of 0.072.&#x0D; The majority of children with PDA presented with severe forms of malnutrition (wasting and stunting).&#x0D; Conclusion: Severe malnutrition ensues when ductal size is 3.2mm. The size of PDA has no effect on weight and height of children with PDA.

Identifying Severe Malnutrition in Children with an Expert System

Expert system is a computer program which is designed for modelling the ability of problem solving as it is an expert (human expert). The expert system method used is the forward chaining method which is the inference method that is doing logical reasoning from the problem to its solution. The aim of this research is to design and develop an expert system that is able to identify the severe malnutrition on children from the age of 0 - 5 years old. The knowledge is derived from the question askedto a nutrition expert. The data are taken from the questions asked to the user and when all of the questions has been answered, then the goal will be appeared which shows the nutrition status. This system application will enable the user to diagnose the nutrition/disease that affects children and get the solution. This system can be used by any kind of user due to the easy access. This system is also put the important information about the severe malnutrition and the recent news of children’s health so it will add more knowledge for the parents about the importance of severe malnutrition’s prevention.

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

IntroductionChild malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the...

Application of Early Enteral Nutrition in Critically Ill Children

Objective: The objective is to investigate the incidence of moderate and severe malnutrition in children in intensive care units, and to analyze the safety and clinical efficacy of early enteral nutrition therapy in critically ill children. Methods: A total of 80 children hospitalized in the pediatric care unit meeting the inclusion criteria were selected and general data were collected, including 48 in the early enteral nutrition (EEN) group and 32 in the late EN group. The two groups were compared in the incidence of moderate to severe malnutrition, feeding tolerance, length of stay in ICU, total length of stay, changes in blood routine and biochemical indicators. Results: After 1 week in ICU, the feeding tolerance of the treatment group was better than that of the control group (P 0.01). After 1 week of treatment in ICU, serum prealbumin in treatment group was significantly higher than that in control group (P albumin was not significantly higher (P > 0.05). The rate of moderate to severe malnutrition at discharge was lower in the treatment group than at admission to the ICU (17 cases vs. 20 cases, 35.4% vs. 41.7%), but higher in the control group (19 cases vs. 16 cases, 59.4% vs. 50.0%). Conclusion: Malnutrition is prevalent in children treated in pediatric intensive care units. Early enteral nutrition therapy for critically ill children is safe and effective, that can significantly improve the nutritional status of critically ill children, reduce inflammatory response, and shorten the hospital stay.

Childhood Malnutrition and Association of Lean Mass with Metabolome and Hormone Profile in Later Life.

This study aimed to determine the associations of targeted metabolomics and hormone profiles data with lean mass index (LMI), which were estimated using bioelectrical impedance, in survivors of child severe malnutrition (SM) (n = 69) and controls (n = 77) in Malawi 7 years after being treated. Linear associations between individual metabolite or hormone and LMI were determined, including their interaction with nutrition status 7 years prior. Path analysis was performed to determine structural associations. Lastly, predictive models for LMI were developed using the metabolome and hormone profile by elastic net regularized regression (EN). Metabolites including several lipids, amino acids, and hormones were individually associated (p < 0.05 after false discovery rate correction) with LMI. However, plasma FGF21 (Control: β = −0.02, p = 0.59; Case: β = −0.14, p < 0.001) and tryptophan (Control: β = 0.15, p = 0.26; Case: β = 0.70, p < 0.001) were associated with LMI among cases but not among controls (both interaction p-values < 0.01). Moreover, path analysis revealed that tryptophan mediates the association between child SM and LMI. EN revealed that most predictors of LMI differed between groups, further indicating altered metabolic mechanisms driving lean mass accretion among SM survivors later in life.

Socio-demographic risk factors for severe malnutrition in children aged under five among various birth cohorts in Bangladesh.

Tackling malnutrition is a major health priority for a developing country like Bangladesh. This study explored the differences in prevalence of having only one form, and multiple forms, of severe malnutrition (stunting, wasting and underweight) among under-5 children in Bangladesh, and aimed to identify the important factors affecting these. Data were extracted from the Bangladesh Demographic Health Surveys conducted in 2007, 2011 and 2014. The outcome measures were 'only one form' and 'multiple forms' of severe malnutrition in children aged under 5 years. A Chi-squared test was performed to find the association of outcome variables with selected socio-demographic factors and logistic regression models were applied to identify risk factors. A total of 19,874 children aged under 5 years were included in the analysis. The overall proportion with one form of severe child malnutrition was approximately 12%, and the proportion with multiple forms was 8%. Age, mother's education, father's occupation, mother currently working, watching television, source of water, solid waste used in cooking, intimate partner violence (IPV), wealth index, urban/rural place of residence and birth cohort were found to be significant factors for both having only one and having multiple forms of severe child malnutrition. Children with an uneducated mother of poor socioeconomic class had a higher risk of severe malnutrition. Children of fathers with a professional occupation were at lower risk of having multiple forms of severe malnutrition. The proportions of children aged under 5 years with one or multiple forms of severe malnutrition were shown to be high in Bangladesh. The prevention of malnutrition in the country should be seen as a significant public health issue and given top priority.

Malnutrition And Disability: Evaluating Factors Influencing Severe Malnutrition In Children With Cerebral Palsy In Lusaka, Zambia

The aim of this study was to identify the main risk factors associated with severe malnutrition in children with CP. An unmatched case control study was used to compare 33 children with CP presenting with severe malnutrition (WAZ ≤ -3 SD) against 66 non malnourished CP children (WAZ ≥ -2SD) at the University Teaching Hospital in Lusaka. Risk factors for severe malnutrition in children with CP were determined with bivariate and multiple logistic regression. A p-value of &lt; 0.05 was considered significant at 95% confidence interval. After adjusting for other variables , factors that remained statistically significant (p-value &lt; 0.05) included the following: use of unflushed pit latrine toilet (p=0.0119); bilateral CP (p=0.0054); GMFCS level 4 or 5 (p=0.0001); history of illness in the past six months (p=0.0241); swallowing difficulties (p=0.0006); tonic bite (p= 0.0011no weight gain in the past 2 to 3 months (p=0.0001); dependent on feeding (p=0.0061); feeds only on semisolids or liquids (p=0.0231); taking more than 30 minutes feeding (p=0.0381); fed for ≤ 3 times/day (0.0025); child opening bowels after 3 or more days (0.0057); caregiver concerned about child’s feeding difficulties (p=0.0076); not likely to be fed Irish potatoes (p=0.0008) and Fish (p=0.0001). The risk factors identified in the current study are related to the child’s severity and feeding difficulties including caregiver caring practices.

World Health Organization's Growth Reference Overestimates the Prevalence of Severe Malnutrition in Children with Sickle Cell Anemia in Africa.

Anthropometric indices are widely used to assess the health and nutritional status of children. We tested the hypothesis that the 2007 World Health Organization (WHO) reference for assessment of malnutrition in children with sickle cell anemia (SCA) overestimates the prevalence of severe malnutrition when compared to a previously constructed SCA-specific reference. We applied the WHO and SCA-specific references to children with SCA aged 5–12 years living in northern Nigeria (Primary Prevention of Stroke in Children with SCA in sub-Saharan Africa (SPRING) trial) to determine the difference in prevalence of severe malnutrition defined as body mass index (BMI) Z-score <−3 and whether severe malnutrition was associated with lower mean hemoglobin levels or abnormal transcranial Doppler measurements (>200 cm/s). A total of 799 children were included in the final analysis (median age 8.2 years (interquartile range (IQR) 6.4–10.4)). The application of the WHO reference resulted in lower mean BMI than the SCA-specific reference (−2.3 versus −1.2; p < 0.001, respectively). The use of the WHO reference when compared to the SCA-specific reference population also resulted in a higher prevalence of severe malnutrition (28.6% vs. 6.4%; p < 0.001). The WHO reference significantly overestimates the prevalence of severe malnutrition in children with SCA when compared to an SCA-specific reference. Regardless of the reference population, severe malnutrition was not associated with lower mean hemoglobin levels or abnormal transcranial Doppler (TCD) measurements.

Оцінювання нутрітивного статусу у дітей з гострою дихальною недостатністю: проспективне обсерваційне когортне дослідження

Оцінювання нутрітивного статусу у дітей з гострою дихальною недостатністю: проспективне обсерваційне когортне дослідження

Edematous severe acute malnutrition is characterized by hypomethylation of DNA

Edematous severe acute childhood malnutrition (edematous SAM or ESAM), which includes kwashiorkor, presents with more overt multi-organ dysfunction than non-edematous SAM (NESAM). Reduced concentrations and methyl-flux of methionine in 1-carbon metabolism have been reported in acute, but not recovered, ESAM, suggesting downstream DNA methylation changes could be relevant to differences in SAM pathogenesis. Here, we assess genome-wide DNA methylation in buccal cells of 309 SAM children using the 450 K microarray. Relative to NESAM, ESAM is characterized by multiple significantly hypomethylated loci, which is not observed among SAM-recovered adults. Gene expression and methylation show both positive and negative correlation, suggesting a complex transcriptional response to SAM. Hypomethylated loci link to disorders of nutrition and metabolism, including fatty liver and diabetes, and appear to be influenced by genetic variation. Our epigenetic findings provide a potential molecular link to reported aberrant 1-carbon metabolism in ESAM and support consideration of methyl-group supplementation in ESAM.

ACUTE MALNUTRITION

Objective: To determine the frequency of low mid upper arm circumference(MUAC) of children with acute malnutrition. Patients and methods: This study was conducted inthe department of paediatrics at Liaquat University Hospital Hyderabad from 01-06-2012 to 30-11-2012. All the children with features of malnutrition, of either gender were recruited andevaluated for their mid upper arm circumference which was measured through plastic measuringtape. Result: During six month study period, total 135 children with acute malnutrition werestudied for their mid upper arm circumference (MUAC), of which 95(70%) were males and40(30%) were females. The mean age ±SD of overall population was 30.24±10.57 month whilethe mean age of male children was 32.88±11.76 and the female child was 31.62±10.97 months.Regarding the MUAC, was low in 93(68.9%) children with acute malnutrition. The mean age ±SDof child with low MUAC was 28.99±12.52 while the mean ±age of male and female child with lowMUAC was 27.63±10.73 and 29.85±11.64 respectively. The mean MUAC in children of acutemalnutrition with low MUAC was 8.85±3.93 while it was 8.66±3.96 and 8.93±3.31 in male andfemale child with low MUAC respectively. Conclusions: The present study suggested that MUACis appropriate and good tool for identifying severe malnutrition in children.

Assessment of nutritional status of rural children (2-5 years) in Udaipur district

The nutritional status of 80 children (2-5years) in udaipur district was studied. Personal interviews consisting, 24 hour dietary recall of children was used. Amount of nutrients obtained per day from food consumed was calculated and compared with RDA for Indian children. Anthropometric measurements including weight and height were used to identify the physical condition of children. Waterlow’s, Gomez’s classification BMI-for-age determined the extent of mal-nutrition in children and were compared with IAP standards. The height, weight and BMI of all respondents were significantly (p<0.05) lower than the reference value. As per Waterlow’s and Gomez’s classification, only 11.25 per cent of the children were normal. 87.5 per cent of the children were wasted and 41.25 per cent severely malnourished. Food consumption patterns indicated that except fat, diet consumed lacked all major and minor nutrients required for growth of children. Nutritional inadequacies, poverty, lack of infrastructure and poor education of mother resulted in severe mal-nutrition in children. This condition needs careful consideration. Steps like nutritional interventions and women education programmes organized along with governmental and non-governmental groups can help in improving this condition.

The Growing IDPs in the Country and Impact on Childhood Malnutrition: Averting a Future Generation with Stunted Growth and Knowledge

Al least 80,000 people are forcefully displaced from their homes every 24 hour across the globe while in Nigeria the total number of IDPs in 2018 stands at 2.1 million. Among the major challenges facing the IDPs in camps scattered across the country is severe childhood malnutrition. This could lead to poor physical, mental and psychological development of children leading to the breeding of a large segment of children with stunted growth and associated compromised number recall, conceptual thinking, general cognition, and attention deficit which could manifest prominently in adult life. All efforts should therefore be intensified to meet adequate nutritional needs of all children in IDPs camps to ensure a healthy physical and mental future generation.