Weight Z-score Research Articles

Associations between Maternal and Infantile Factors and Neonatal Growth Metrics: A Large-scale, Retrospective Study

Objective: The primary aim of this large-scale, retrospective study was to identify the maternal and infantile factors influencing neonatal growth metrics within the 1st month of life. Materials and Methods: Data were collated from the Sina Electronic Health System between 2015 and 2018. The study employed the World Health Organization (WHO) Z-score system for categorizing neonatal growth and utilized logistic regression models to explore associations between maternal and infant characteristics and neonatal growth metrics. Results: The study comprised 137,548 neonates, with a slight male predominance (51%). An overwhelming 98% of infants were breastfed. The logistic regression analysis revealed male gender as a significant predictor for higher weight-for-age Z-score (WAZ) (odds ratio [OR] = 1.268, P < 0.001), height-for-age Z-score (HAZ) (OR = 1.316, P < 0.001), and weight-for-height Z-score (WHZ) scores (OR = 1.137, P = 0.015). In addition, vaginal delivery was strongly associated with higher WAZ (OR = 1.176, P < 0.001), HAZ (OR = 2.109, P < 0.001), and WHZ scores (OR = 1.176, P = 0.003). The influence of breastfeeding was particularly noteworthy, with significant associations with higher WAZ (OR = 1.934, P < 0.001), HAZ (OR = 5.435, P < 0.001), and WHZ scores (OR = 1.558, P = 0.008). Conclusions: Our robust analysis substantiates the significant influence of male gender, vaginal delivery, and breastfeeding on neonatal growth metrics, as evidenced by elevated WAZ, HAZ, and WHZ scores. The findings provide a compelling argument for the promotion of natural birthing methods and breastfeeding, and they highlight the role of gender in neonatal growth outcomes during the initial month of life.

Aplicação do índice de alimentação de lactentes e crianças pequenas e avaliação de sua relação com o estado nutricional de crianças de 6 a 24 meses

ABSTRACT Objective To evaluate the complementary feeding practices of mothers in infant and child nutrition using Infant and Young Child Feeding Indicator and Infant and Child Feeding Index and to determine their relationship with nutritional status. Methods Study data were collected through an online questionnaire administered to 141 parents on healthy 6-24 month infants/children. Complementary feeding practices for infants/children were evaluated in line with the Infant and Child Feeding Index and Infant and Young Child Feeding Indicator. In the evaluation of growth, weight for age z-scores, length for age z-scores, and weight for length z-scores of infants/children were calculated with the World Health Organization Anthro program. Results 74.5% of 141 infants and children (71 boys, 70 girls) evaluated in the study are breastfed. The prevalence of stunting, wasted, and underweight was determined as 6.4%, 0.7%, and 4.3%, respectively. When evaluated using Infant and Young Child Feeding Indicator, it was determined that 82.3% of children met the minimum meal frequency, 80.9% met the minimum dietary diversity, and 67.4% met the minimum acceptable diet. Regarding Infant and Child Feeding Index evaluations of the children, while there was no difference between 9-11 and 12-24 month age groups, the mean Infant and Child Feeding Index score in the 6-8 month group was significantly lower than the other age groups (p=0.000). The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were found to be high in most infants/children. No clear relationship was found between stunting and minimum acceptable diet, minimum dietary diversity or minimum meal frequency, which are indicators of both Infant and Child Feeding Index scores and World Health Organization, Infant and Young Child Feeding Indicator. Conclusion The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were high in most infants/children. In addition, the high rates of MMF, minimum dietary diversity, and minimum acceptable diet coverage in evaluating infants/children in terms of World Health Organization indicators show that they have appropriate complementary feeding practices. However, study found no clear relationship between stunting and minimum acceptable diet, minimum dietary diversity or MMF, which are indicators of both Infant and Child Feeding Index I scores and WHO Infant and Young Child Feeding Indicator. It was concluded that World Health Organization Infant and Young Child Feeding Indicator indicators may be better than length for age z-scores in the weight for length z-scores explanation.

Cord blood vitamin A and vitamin D levels in relation to physical growth in exclusively breastfed infants aged 0-6 months.

Vitamins A and D are essential for the health of pregnant women and infants. Nevertheless, the relationship between umbilical cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants remains uncertain. This cohort study aims to examine the relationship between cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants aged 0-6 months. 140 singleton mother-infant pairs were recruited in total. Questionnaires were used to collect maternal and infant information, and liquid chromatography was utilized to quantify the levels of vitamins A and D in the umbilical cord blood. Anthropometric measurements were conducted at birth, at 3 and 6 months of age, and the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), head circumference-for-age z-score (HAZ), and BMI-for-age z-score (BMIZ) were calculated. Univariate and multivariate linear regression models were used for the analysis. The average concentration of vitamins A and D in cord blood was 0.58 ± 0.20 μmol/L and 34.07 ± 13.35 nmol/L, both below the normal range for children. After adjusting for confounding factors, vitamin A levels in cord blood positively correlated with HAZ growth in infants aged 3-6 months (β= 0.75, P < 0.01) while vitamin D levels negatively correlated with LAZ growth (β= -0.01, P = 0.01) and positively correlated with BMIZ growth (β= 0.02, P < 0.01). Higher Vitamin A levels at birth promote HAZ growth in infants aged 3-6 months while higher vitamin D levels at birth promote BMIZ growth in infants aged 3-6 months. https://register.clinicaltrials.gov, identifier NCT04017286.

Associations between body weight trajectories and neurodevelopment outcomes at 24 months corrected age in very-low-birth-weight preterm infants: a group-based trajectory modelling study.

This study aimed to explore the relationship between the trajectories of body weight (BW) z-scores at birth, discharge, and 6 months corrected age (CA) and neurodevelopmental outcomes at 24 months CA. Conducted as a population-based retrospective cohort study across 21 hospitals in Taiwan, we recruited 3,334 very-low-birth-weight (VLBW) infants born between 2012 and 2017 at 23-32 weeks of gestation. Neurodevelopmental outcomes were assessed at 24 months CA. Instances of neurodevelopmental impairment (NDI) were defined by the presence of at least one of the following criteria: cerebral palsy, severe hearing loss, profound vision impairment, or cognitive impairment. Group-based trajectory modeling was employed to identify distinct BW z-score trajectory groups. Multivariable logistic regression was used to assess the associations between these trajectories, postnatal comorbidity, and neurodevelopmental impairments. The analysis identified three distinct trajectory groups: high-climbing, mid-declining, and low-declining. Significant associations were found between neurodevelopmental impairments and both cystic periventricular leukomalacia (cPVL) [with an adjusted odds ratio (aOR) of 3.59; p < 0.001] and belonging to the low-declining group (aOR: 2.59; p < 0.001). The study demonstrated that a low-declining pattern in body weight trajectory from birth to 6 months CA, along with cPVL, was associated with neurodevelopmental impairments at 24 months CA. These findings highlight the importance of early weight trajectory and specific health conditions in predicting later neurodevelopmental outcomes in VLBW infants.

Education intervention model on clean and healthy living habits among mothers having children less than 2 years of age border in remote areas, Indonesia

Background: Stunting in toddlers reflects a failure to grow due to nutritional deficiencies. Repeated exposure to fecal pathogens, especially prevalent in areas where open defecation practices exist, can lead to diarrhea, hindered growth, health issues, and irreversible developmental impairments.Purpose: To determine the effectiveness of Agamis Sistematis Interaktif Kreatif/ASIK (Religious, Systematic, Interactive, Creative) education model (focusing on water, sanitation, and hygiene) on clean and healthy living habit (CHLH) among toddlers at risk of stunting in the remote border areas of Enggano Island, Bengkulu Province in 2023.Method: The researcher employed a non-equivalent control group design, also known as a pre-test post-test control group design, for the experimental and control groups. This research involved a sample of 60 mothers having children less than 2 years of age, comprising 30 in the intervention group and 30 in the control group. Data collection utilized a questionnaire. Univariate and bivariate data analysis was conducted using the paired t-test statistical analysis. The results of this study revealed a difference in the mean values between the experimental and control groups concerning WAZ (weight-for-age z-scores), with values in the experimental group pre=72.7000, post=75.2667, and the control group pre=76.8167, post=78.4167.Results: The research findings indicated a difference in CHLH between the treatment and control groups (ρ=0.000, ρ&lt;0.05). The ASIK education model on CHLH among toddlers at risk of stunting is effectively applicable in the remote border areas of Enggano Island, Bengkulu Province in 2023.Conclusion: Government support in the form of budget allocation is crucial for the sustainability of continuous education aimed at stunting prevention in village communities.

Bioelectrical impedance vector analysis as an indicator of malnutrition in children under five years with and without pneumonia in Mchinji District, Malawi: An exploratory mixed-methods analysis

Background Bioelectrical impedance vector analysis (BIVA) is a non-invasive approach to assessing body composition and cellular health, which may improve the assessment of nutritional status in sick children. We explored the reliability, clinical utility, and acceptability of BIVA, as an indicator of nutritional status for children under five years with and without pneumonia, in Malawi. Methods We conducted a parallel convergent mixed-methods exploratory study in Mchinji District Hospital, Malawi, in 2017. We recruited a convenience sample of children aged 0–59 months with clinical pneumonia, and without an acute illness. Children had duplicate anthropometric and BIVA measurements taken. BIVA measurements of phase angle (PhA) were taken of the whole body, and trunk and arm segments. Reliability was assessed by comparing the variability in the two measures, and clinical utility by estimating the association between anthropometry and PhA using linear regression. Focus group discussions with healthcare workers who had not previously used BIVA instrumentation were conducted to explore acceptability. Results A total of 52 children (24 with pneumonia and 28 healthy) were analysed. The reliability of sequential PA measurements was lower than anthropometric measurements, but trunk and arm segments performed better. The largest associations with PhA were a negative relationship with weight-for-age z-score (WAZ) and PhA in children with pneumonia in the trunk segment, and a positive association with WAZ in the full body measurement in healthy children. Healthcare workers in focus group discussions expressed trust in BIVA technology and that it would enable more accurate diagnosis of malnutrition; however, they raised concerns about the sustainability and necessary resources to implement BIVA. Conclusions While healthcare workers were positive towards BIVA as a novel technology, implementation challenges should be expected. The differential direction of association between anthropometry and PhA for children with pneumonia warrants further investigation.

Association Between Infant and Young Child Feeding Practices and Nutritional Status Among Children Aged 6 to 24 Months in Terengganu

Infant and young child feeding practices (IYCF) have an important role in defining children's nutritional status and optimizing a child's development rate in the first two years of life. This study aimed to determine the association between infant and young child feeding practices and the nutritional status of children aged 6 to 24 months in Kuala Nerus and Kuala Terengganu, Terengganu. A total of 293 mothers and children aged between 6 to 24 months were recruited in this cross-sectional study. Anthropometrics comprised weight and height/length. The nutritional status of the children, namely weight-for-age z-scores (WAZ), height/length-for-age z-scores (LAZ) and weight-for-length z-scores (WLZ) were generated based on WHO Child Growth Standard. IYCF practices among participants were determined using a validated questionnaire adapted from FAO. A total of 52.2% boys and 47.8% girls participated in this study. The prevalence of stunting, wasting, and underweight among children were 26.3%, 6.8%, and 14.7% respectively. The majority (70.6%) of the participants have good practice on IYCF. However, there is no significant association between IYCF practices and the nutritional status of the children (p&gt;0.05). In conclusion, the majority of the participants have good practice with IYCF and only 1.7% have poor practice. Therefore, by promoting the IYCF practices, it can be a great tool to assess the health status of the children.

The association between different types of amino acid intake and physical growth among children

Background & aimsRestricted linear growth and abnormal weight status are commonly observed among children in low-income countries, possibly due to inadequate protein intake. Considering the role of protein intake and amino acid (AA) synthesis in growth and development, it has been suggested that there may be an association between AA intake and physical growth. We aimed to investigate the association between different types of AA intake and physical growth among children. MethodsA cross-sectional study including 780 six-year-old children referred to 10 health care centers for vaccination between October 2017 and March 2018 was conducted. Anthropometric data was collected using standard methods, and dietary intake was assessed using a validated food-frequency questionnaire (FFQ)‏ in an interview by a trained technician. ResultsChildren in the highest tertile (3rd) of branched-chain amino acids (BCAA) intake had a higher weight-for-age z-score (WAZ) (P = 0.02) and body mass index-for-age z-score (BAZ) (P = 0.001) compared to those in the lowest tertile (1rd). Interestingly, BAZ was significantly associated with the highest tertile of acidic AA intake (P = 0.04), while an inverse association was observed between the highest tertile of aromatic AA (phenylalanine and tyrosine) intake and BAZ (P = 0.01) . No significant associations were observed between the highest tertile of sulfuric, aliphatic, or neutral AA and BAZ, height-for-age z-score (HAZ) or WAZ. Further, underweight was associated with the 3rd tertile of aromatic, alcoholic, aliphatic or neutral AA and BCAA intake. Aliphatic and neutral AA intake was also increased the risk of overweight. Finally, stunted growth patterns were associated with the highest tertile of acidic, alcoholic. ConclusionFindings presented in this study showed that higher BAZ and WAZ are associated with 3rd tertiles of BCAA intake, but lower BAZ were associated with 3rd tertiles of aromatic AA (phenylalanine and tyrosine) intake.Future research in other populations are needed to confirm these findings.

Biomass smoke exposure and somatic growth among children: The RESPIRE and CRECER prospective cohort studies in rural Guatemala

BackgroundCooking-related biomass smoke is a major source of household air pollution (HAP) and an important health hazard. Prior studies identified associations between HAP exposure and childhood stunting; less is known for underweight and wasting. Few studies had personal HAP measurements. Methods557 households in rural Guatemala were enrolled in the CRECER study, the follow-up study of the RESPIRE randomized intervention trial. They were assigned to three groups that received chimney stoves at different ages of the study children. Multiple personal carbon monoxide (CO) exposure measurements were used as proxies for HAP exposures. Children’s heights and weights were measured from 24 to 60 months of age. Height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ) were calculated based on the World Health Organization’s Multicentre Growth Reference Study. HAZ, WAZ, and WHZ below −2 were classified as stunting, underweight, and wasting, respectively. Generalized linear models and mixed effects models were applied. Results541 children had valid anthropometric data, among whom 488 (90.2 %) were stunted, 192 (35.5 %) were underweight, and 2 (0.3 %) were wasted. A 1 ppm higher average CO exposure was associated with a 0.21 lower HAZ (95 % CI: 0.17–0.25), a 0.13 lower WAZ (95 % CI: 0.10–0.17) and a 0.06 lower WHZ (95 % CI: 0.02–0.10).The associations for HAZ were stronger among boys (coefficient = −0.29, 95 % CI: −0.35 – −0.22) than among girls (coefficient = −0.15, 95 % CI: −0.20 – −0.10). A 1 ppm-year higher cumulative CO exposure was associated with a higher risk of moderate stunting among boys (OR = 1.27, 95 % CI: 1.05-1.59), but not among girls. DiscussionIn this rural Guatemalan population, higher HAP exposure was associated with lower HAZ and WAZ. The associations between HAP and HAZ/stunting were stronger among boys. Reducing HAP might benefit childhood somatic growth in rural populations of low-income countries.

Clinical Characteristics and Therapeutic Management of Osteogenesis Imperfecta in Iraqi Children

Background: Osteogenesis imperfecta (OI) is a rare congenital condition that results in bone fragility, recurrent fractures, and various extra-skeletal manifestations. Currently, intravenous bisphosphonate is the mainstay of medical treatment in OI. Objective: To identify the effect of current management strategies on Iraqi children diagnosed with OI. Methods: A retrospective study enrolled OI patients who were registered in Central Child Teaching Hospital, Baghdad, Iraq, from January 2015 to December 2022. We enrolled confirmed OI cases (either clinically and/or radiologically) who received cyclic pamidronate therapy for at least 3 cycles. They neither received other types of bisphosphonates nor underwent surgical intervention. Results: A total of 52 cases of OI had been identified, but only 36 patients were eligible for the current study. The mean age of the patients was 6.64±4.22 years. A statistically significant drop in the annual fracture rate in OI patients who received intravenous pamidronate cycles was seen, along with a significant rise in weight for age Z-score, lumbar spine bone mineral density DEXA Z-score, and alkaline phosphate levels. No significant improvement was documented in height for age Z-score in OI patients. Conclusions: Intravenous pamidronate cycles for Iraqi children with osteogenesis imperfecta work to lower their risk of breaking bones every year and raise their weight, lumbar spine bone mineral density, and alkaline phosphate levels. Pamidronate did not result in an improvement in the height of OI children.

Postnatal growth in small vulnerable newborns: a longitudinal study of 2 million Brazilians using routine register-based linked data

BackgroundPreterm, low–birth weight (LBW) and small-for-gestational age (SGA) newborns have a higher frequency of adverse health outcomes, including linear and ponderal growth impairment. ObjectiveTo describe the growth trajectories and to estimate catch-up growth during the first 5 y of life of small newborns according to 3 vulnerability phenotypes (preterm, LBW, SGA). MethodsLongitudinal study using linked data from the 100 Million Brazilian Cohort baseline, the Brazilian National Live Birth System (SINASC), and the Food and Nutrition Surveillance System (SISVAN) from 2011 to 2017. We estimated the length/height-for-age (L/HAZ) and weight-for-age z-score (WAZ) trajectories from children of 6–59 mo using the linear mixed model for each vulnerable newborn phenotype. Growth velocity for both L/HAZ and WAZ was calculated considering the change (Δ) in the mean z-score between 2 time points. Catch-up growth was defined as a change in z-score > 0.67 at any time during follow-up. ResultsWe analyzed 2,021,998 live born children and 8,726,599 observations. The prevalence of at least one of the vulnerable phenotypes was 16.7% and 0.6% were simultaneously preterm, LBW, and SGA. For those born at term, all phenotypes had a period of growth recovery from 12 mo. For preterm infants, the onset of L/HAZ growth recovery started later at 24 mo and the growth trajectories appear to be lower than those born at term, a condition aggravated among children with the 3 phenotypes. Preterm and female infants seem to experience slower growth recovery than those born at term and males. The catch-up growth occurs at 24–59 mo for males preterm: preterm + AGA + NBW (Δ = 0.80), preterm + AGA + LBW (Δ = 0.88), and preterm + SGA + LBW (Δ = 1.08); and among females: term + SGA + NBW (Δ = 0.69), term + AGA + LBW (Δ = 0.72), term + SGA + LBW (Δ = 0.77), preterm + AGA + LBW (Δ = 0.68), and preterm + SGA + LBW (Δ = 0.83). ConclusionsChildren born preterm seem to reach L/HAZ and WAZ growth trajectories lower than those attained by children born at term, a condition aggravated among the most vulnerable.

Determinants of Anishinabeck infant and early childhood growth trajectories in Northwestern Ontario, Canada: a cohort study

BackgroundThe Developmental Origins of Health and Disease (DOHaD) paradigm emphasizes the significance of early life factors for the prevention of chronic health conditions, like type 2 diabetes (T2DM) and obesity, which disproportionately affect First Nations communities in Canada. Despite increasing DOHaD research related to maternal health during pregnancy, early childhood growth patterns, and infant feeding practices with many populations, data from First Nations communities in Canada are limited. In partnership with Sandy Lake First Nation, the aims of this project were to characterize birthweights and growth patterns of First Nations infants/children over the first 6 years of life and to study the impact of maternal and infant social and behavioral factors on birthweight and growth trajectories.MethodsWe recruited 194 families through community announcements and clinic visits. Infant/child length/height and weight were measured at 1 and 2 weeks; 1, 2, 6, 12, and 18 months; and 2, 3, 4, 5 and 6 years. Maternal and infant/child questionnaires captured data about health, nutrition, and social support. Weight-for-Age z-score (WAZ), Height-for-Age z-score (HAZ), and BMI-for-Age z-score (BAZ) were calculated using WHO reference standards and trajectories were analyzed using generalized additive models. Generalized estimating equations and logistic regression were used to determine associations between exposures and outcomes.ResultsWAZ and BAZ were above the WHO mean and increased with age until age 6 years. Generalized estimating equations indicated that WAZ was positively associated with age (0.152; 95% CI 0.014, 0.29), HAZ was positively associated with birthweight (0.155; 95% CI 0.035, 0.275), and BAZ was positively associated with caregiver’s BMI (0.049; 95% CI 0.004, 0.090). There was an increased odds of rapid weight gain (RWG) with exposure to gestational diabetes (OR: 7.47, 95% CI 1.68, 46.22). Almost 70% of parents initiated breastfeeding, and breastfeeding initiation was modestly associated with lower WAZ (-0.18; 95% CI -0.64, 0.28) and BAZ (-0.23; 95% CI -0.79, 0.34).ConclusionsThis work highlights early life factors that may contribute to T2DM etiology and can be used to support community and Indigenous-led prevention strategies.

Health Problems and Nutritional Status among Children Under-Five Years in Diocese of Agats: A Cross-Sectional Study

From September to February 2018, the number of measles and under-nutrition cases among children under five years in Agats reached a peak of 651 cases and 223 cases, respectively. It was reported that measles and undernutrition were responsible for 91% of child mortality in Agats. This study aimed to identify the correlation between health problems with nutritional status among children under five in the Diocese of Agats, Asmat. A descriptive quantitative with a cross-sectional approach was conducted from May to September 2018 among 39 mothers and 53 children. Data were collected by using an attendance list that consisted of mother and child characteristics, nutritional status was measured by using steelyard balance and microtoise, and the results would subsequently be converted to the standardized anthropometry: Weight for Age Z-score (WAZ) and Weight for Height Z-Score (WHZ). Results revealed that child health problems were cough and influenza (28%), febrile (1,9%), and itches (3,8%) while the nutritional status categorized normal (43.3%), underweight (33.1%), and waste (23.3%). ChiSquare test found that there was a significant correlation between health problems and nutritional status of children under-five (p-value: 0,035; CI 95% = 0,68 – 0,79). It is concluded that health problems are associated with nutritional status among children under five. It is recommended that regular health promotion to improve mothers’ knowledge should be conducted by healthcare workers, volunteers, teachers, stakeholders, and the local government of Asmat Regency.

Racial disparities affect the association between gestational urinary phthalate mixtures and infant genital measures.

Phthalates are ubiquitous anti-androgenic endocrine disrupting chemicals found in personal care products, medications, and many plastics. Studies have shown a racial disparity in phthalates exposure among U.S. women, which may also impact fetal development. We conducted a prospective cohort study of gestational exposure to a phthalates mixture in a racially-diverse population to determine their association with genital development. Mid-gestation (18-22 weeks) urine was collected from 152 women who self-identified as non-Hispanic Black and 158 women who self-identified as non-Hispanic White in Charleston, South Carolina between 2011 and 2014. We measured eight phthalate monoester metabolites in urine using liquid chromatography tandem-mass spectrometry. Mid-gestational penile dimensions were measured using ultrasound and anogenital distances were measured postnatally. We used Bayesian kernel machine regression to estimate the associations among the mixture of phthalate metabolites and mid-gestation penile dimensions and postnatal anogenital distance measures among singleton male (n = 179) and female (n = 131) infants, adjusted for urinary specific gravity, maternal age, body mass index, education level, cigarette smoking, and gestational age at enrollment or birth weight z-score. We found a stronger association between greater phthalates and decreased anopenile distance among infants born to women who self-identified as Black. Mono (2-ethylhexyl) phthalate (MEHP) was the driving mixture component among Black women, and monobutyl phthalate (MBP) and monoethyl phthalate (MEP) were drivers among White women. We also identified a non-linear association between phthalates and lesser ultrasound penile volume among women who self-identified as Black with monoisobutyl phthalate (MiBP) and MBP being most important. We also found an association between greater phthalates and shorter anoclitoral distance among infants born to women who self-identified as Black, with MEP and monobenzyl phthalate (MBzP) contributing most to this association. Our results suggest a disparity in the association between gestational exposure to a mixture of phthalates and fetal genital development among women who self-identified as Black compared to White.

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 &lt; 0.001). Moreover, through a regression test, we found a negatively predicted weight gain (P &lt; 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.

Human Milk Fortifier After Neonatal Intensive Care Unit Discharge Improves Human Milk Usage Rates for Preterm Infants

BackgroundA common neonatal intensive care unit (NICU) discharge feeding strategy for preterm infants with growth failure who are fed exclusively expressed human milk (EHM) has been to enrich mother’s own milk with formula powder or supplement 2–3 feeds per day with formula. However, this strategy displaces human milk from the diet. Our NICU recently adopted the standard practice of adding commercial human milk fortifier (HMF) to human milk feedings after discharge. ObjectivesWe aimed to compare breastfeeding rates and growth using the aforementioned 2 strategies. MethodsPreterm infants (<34 wk of gestation at birth) exclusively feeding EHM fortified with HMF at 2 weeks before discharge were included in this retrospective study. The HMF group (n = 92) continued fortifying with HMF at home, whereas the historical comparison group (n = 35) received our previous guidance to enrich or supplement using postdischarge formula. ResultsRates of human milk exclusivity after discharge decreased significantly less in the HMF group than those in the historical comparison group (to 83% compared with 39% at the first outpatient visit and 27% compared with 6%, respectively, at the second outpatient visit). Rates of any EHM feedings were also significantly higher in the HMF group. Fenton z-scores for weight, length, and head circumference were not significantly different between the groups. ConclusionsContinuing EHM fortification with HMF after NICU discharge, rather than enriching or supplementing with postdischarge infant formula, increases rates of feeding EHM for ≥3 mo but does not affect growth.

Prenatal exposure to organophosphate esters and growth trajectory in early childhood

Maternal exposure to organophosphate esters (OPEs) has been linked to an increased risk of adverse birth outcomes. However, the impact of OPEs on childhood growth remains uncertain. This study assessed the associations between prenatal concentrations of OPE metabolites and the growth trajectory in early childhood. 212 singleton pregnant women were included in this study, and they were recruited between August 2014 and August 2016 in Wuhan, China. We measured the urinary concentrations of OPE metabolites during the 1st, 2nd, and 3rd trimesters. Standard deviation scores for weight and length were calculated for children at birth, 1, 6, 12, and 24 months. Trajectories of weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) were classified into four groups using group-based trajectory modeling. Trajectories of length-for-age z-score (LAZ) were classified into three groups with the same model. Then, we calculated odds ratios (ORs) and 95 % confidence interval (95%CI) using multinomial logistic regression to estimate increases in odds of different growth trajectories per doubling in OPE concentrations compared with moderate-stable trajectory. For average concentrations of OPE metabolites and growth trajectory, our results indicated that higher bis(2-butoxyethyl) phosphate, total aromatic OPE metabolites, and total OPE metabolites during pregnancy were associated with a higher likelihood of children falling into the low-stable and low-rising WAZ trajectory. Furthermore, compared to the moderate-stable LAZ trajectory, increased concentrations of 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate were linked to an elevated risk of a low-stable LAZ trajectory. Additionally, the 1st and 2nd trimesters may represent critical windows of heightened vulnerability to the effects of OPE metabolites on childhood growth. In conclusion, our study proves that prenatal exposure to OPE metabolites is inversely related to childhood growth. It is essential to conduct further research involving larger populations and to consider other compounds with known developmental toxicity to obtain more reliable and comprehensive results.

Birth-to-childhood tracking of linear growth and weight gain in the MINA-Brazil Study.

To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.

The association between human milk fatty acid composition in mothers with an elevated body mass index and infant growth changes

Few studies have investigated alternations in human milk polyunsaturated fatty acid (PUFA) composition in the context of maternal obesity and its effects on infant growth trajectories. This study explored whether maternal weight status and breastfeeding type influence human milk FA composition and infant anthropometry during the first six months of life. Mother-infant dyads were enrolled from the Prediction of Allergies in Taiwanese Children birth cohort study. Data concerning maternal pre-pregnancy weight, infants' breastfeeding practices, and anthropometric data were obtained regularly. We identified and compared between the composition of 30 FAs in the colostrum and 2-month milk, respectively, in obese/overweight (OB/OW) and normal-weight (NW) mothers. Multiple linear regression analyses were performed to determine the association between PUFA composition at different lactation stages and infant anthropometric parameter changes and to identify the independent variables for body mass index (BMI) z-scores by six months of age. We included 338 mother-infant dyads (OB/OW mothers, 16.9%). OB/OW mothers exhibited lower total n-3 PUFAs (P=0.035), higher ratios of arachidonic acid (C20:4n-6)/eicosapentaenoic acid (C20:5n-3)+docosahexaenoic acid (C22:6n-3), and n-6/n-3 PUFA in colostrum (P=0.037 and 0.011, respectively), and their offspring had higher body weight and BMI z-scores. Nevertheless, no PUFA composition or n-6/n-3 PUFA ratios in colostrum and 2-month milk were associated with anthropometric parameter changes by age 6 months. Infant birth weight z-scores were independently associated with BMI outcomes at age 6 months (adjusted β=0.16, 95% confidence interval (0.05-0.35), P=0.010) CONCLUSION: Neither n-3 nor n-6 PUFA profiles nor n-6/n-3 PUFA ratios at different lactation stages were found to be associated with anthropometric changes by age 6 months, suggesting that human milk PUFA composition may not be an important determinant of early infant growth trajectories.

Demographic, Clinical, and Laboratory Characteristics of Children with Renal Tubular Acidosis

This study included patients followed up for primary renal tubular acidosis (RTA) between 1991 and 2012. Clinical characteristics at presentation, physical examination findings, laboratory test results, and treatments were recorded. The patients’ laboratory results, drug doses, height, and weight were recorded every 3 months for the first year of follow-up. Standard deviation scores (Z-scores) of height and weight for age were determined and the patients’ growth rates were evaluated. Of 50 patients followed up for primary RTA, 31 (62%) had distal RTA and 19 (38%) had proximal RTA. The median age at diagnosis was 3 months (range, 1-174 months) for patients with distal RTA and 10 months (range, 2-33 months) for patients with proximal RTA. The median follow-up times in these two groups were 96 months (range, 6-204 months) and 89 months (range, 6-180 months), respectively. Family history of RTA was more common among patients with distal RTA than those with proximal RTA (p=0.013). Nephrocalcinosis and deafness were detected more frequently in the distal RTA group (p=0.001), while ocular pathologies were more common in the proximal RTA group (p&lt;0.001). In patients with distal RTA, older age at diagnosis was associated with lower weight and height Z-scores (p&lt;0.05). Early diagnosis had a positive effect on the growth of patients with primary RTA.