The risk of under-nutrition in hospitalised Malaysian children: Use of 3-minute nutrition screening-paediatrics (Paediatric 3-MinNS).

Objectives: To evaluate the under-nutrition risk of children admitted to hospitals using a validated tool. METHODS: The cross-sectional study was conducted from September 2017 to June 2018 in the paediatrics wards of a tertiary referral paediatric government hospital, a tertiary teaching hospital and a government district hospital in Malaysia. The sample comprised paediatric patients aged 2-12 years within 24-72 hours of hospital admission. Data was collected using the 3-Minute Nutrition Screening-Paediatrics tool. Data was analysed using SPSS 20. RESULTS: Of the 341 patients screened, 284(83.3%) were included; 170(59.9%) boys and 114(40.1%) girls. The overall median age was 4.85 years (interquartile range: 4.33 years). The median length of hospital stay was 3 days (interquartile range: 3 days). There were 72(25.4%) participants at high under-nutrition risk, with the highest proportion being at the district government hospital 31(33%). Among those with high risk, 5.4% subjects had severe acute malnutrition, 9.7% had severe chronic malnutrition, and 11.1% had severe thinness. Conclusion: The 3-Minute Nutrition Screening-Paediatrics scale was found to be effective as a nutrition screening tool for hospitalised children in Malaysia.

Using traditional healers to treat child malnutrition: a qualitative study of health-seeking behaviour in eastern Ethiopia.

BACKGROUND: Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children's malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents' treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people's health-seeking behaviour. METHODS: The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers' assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory. RESULTS: Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition. CONCLUSIONS: Through an exploration of people's own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres.

Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children.

AIM: To develop and perform an initial validation of a score to measure the severity of illness in hospitalised children with severe acute malnutrition (SAM). METHODS: A prospective study enrolled SAM children aged 6-59 months hospitalised in Borno State, Nigeria. Candidate items associated with inpatient mortality were combined and evaluated as candidate scores. Clinical and statistical methods were used to identify a preferred score. RESULTS: The 513 children enrolled had a mean age of 15.6 months of whom 48 (9%) died. Seven of the 10 evaluated items were significantly associated with mortality. Five different candidate scores were tested. The final score, Responses to Illness Severity Quantification (RISQ), included seven items: heart rate, respiratory rate, respiratory effort, oxygen saturation, oxygen delivery, temperature and level of consciousness. The mean RISQ score on admission was 2.6 in hospital survivors and 7.3 for children dying <48 h. RISQ scores <24 h before death had an area under the receiver operating characteristic curve (AUROC) of 0.93. The RISQ score performed similarly across differing clinical conditions with AUROCs 0.77-0.98 for all conditions except oedema. CONCLUSION: The RISQ score can identify high-risk malnourished children at and during hospital admission. Clinical application may help prioritise care and potentially improve survival.

Diagnosis of Malnutrition in Children and Adolescents with Identified Developmental Disabilities (IDD) Using Subjective Global Nutrition Assessment (SGNA).

BACKGROUND: Children with identified developmental disabilities (IDD) experience a higher risk of growth retardation. Anthropometric indicator is one common objective measurement used to determine malnutrition in those children. A comprehensive nutritional assessment tool should be introduced to offer a more robust approach in understanding their nutritional problems. OBJECTIVE: To determine the use of Subjective Global Nutrition Assessment (SGNA) as a nutrition assessment tool for children with IDD in comparison to the anthropometric indicators. METHODS: This cross-sectional study was conducted in local community settings. IDD included in this study were autism spectrum disorder (ASD), Down syndrome (DS) and cerebral palsy (CP). SGNA and anthropometry measurements including weight, height, mid-upper arm circumference and triceps skinfolds were performed on 93 children with IDD (40 ASD, 26 DS and 27 CP) aged 5-18 years. Cohen's Kappa, sensitivity, specificity and its 95% confidence interval were calculated between SGNA and anthropometric indicators for the agreement in determining malnutrition status of the children. RESULTS: SGNA identified a lower prevalence of malnutrition in children with IDD in comparison to the use of anthropometric indicators. SGNA obtained a moderate-to-fair agreement (above 80% agreement, except height-for-age parameter) and sensitivity (25.71-59.09%) against the use of a single anthropometric indicator in identifying the malnutrition status of the children. CONCLUSIONS: The use of SGNA as an adjunct to body mass index-for-age as an anthropometric measurement for diagnosing malnutrition in children and adolescents with IDD is recommended.

A study on factors leading to poor mental health of children in Punjab, Pakistan.

In this article, the several factors have been investigated relating to the poor mental health of the children in Punjab, Pakistan. Using the data of the survey conducted by the Punjab Bureau of Statistics, different determinants of child malnutrition and poverty were diagnosed based upon sufficient information of the children under 5 year of age. Logistic regression analysis methodology has been applied for screening the most influential factors of the study. It has been observed that the rise in poverty has prejudiced the nutritional position of the children, the mother's education, and the fitness of the youth. It has also been observed that male children are more at risk to poor mental health than female children. A number of policy issues came to light from the findings of the study. The wealth index of all three anthropometric measures, the child malnutrition status of uneducated mothers, and the child diarrhea menace are the significant areas.

Individual and combined association analysis of famine exposure and serum uric acid with hypertension in the mid-aged and older adult: a population-based cross-sectional study.

BACKGROUND: Malnutrition in early life may affect health in later life. The associations between malnutrition and serum uric acid (SUA) and hypertension were inconsistent. The present study aimed to investigate the individual and combined association between famine exposure and serum uric acid and hypertension in middle-aged and older Chinese. METHODS: Data were selected from the China Health and Retirement Longitudinal Study (CHARLS) Wave2011. The analytic sample included 9368 individuals aged 45 to 90. Differences between baseline characteristics and famine exposure/SUA level were evaluated using the Chi-square test, t-test, and F-test. Then, the differences in the prevalence of hypertension between characteristic groups was also estimated by the Chi-square and t-test. Finally, multivariable-adjusted logistic regression models examined association of famine exposure and serum uric acid with odds of prevalence of hypertension. RESULTS: A total of 9368 individuals were enrolled in the study, 4366 (46.61%) and 5002 (53.39%) were male and female, respectively. Among males, 459 (10.51%) had been exposed to the Chinese famine during the fetal stage, whereas 1760 (40.31%) and 1645 (37.68%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Among females, 635 (12.69%) had been exposed to the Chinese famine during the fetal stage, whereas 1988 (39.74%) and 1569 (31.37%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Regarding the participants with SUA level measurements, 290 (6.64%) reported having Hyperuricemia (HUA) in males and 234 (4.68%) in the females. Furthermore, 1357 (31.08%) reported having hypertension in male and 1619 (32.37%) in the female. In multivariable-adjusted model, famine exposure and serum uric acid were associated with prevalence of hypertension independently in total populations [(1) Model fourd, fatal exposed group vs non-exposed group: 1.25 (95% CI 1.03, 1.52); childhood-exposed group vs non-exposed group:1.60 (95% CI 1.37, 1.87); adolescence/adult exposed group vs non-exposed group: 2.87 (95% CI 2.44, 3.37), P for trend < 0.001; (2) Model four e, high vs normal:1.73 (95% CI 1.44, 2.08)]. When stratified by sex, the results in both males and females were similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal SUA level and no-exposed famine stage, all groups trended towards higher odds of prevalence of hypertension [the greatest increase in odds, adolescence/adult exposed stage and high SUA level in total participants: OR4.34; 95%CI 3.24, 5.81; P for interaction < 0.001]. When stratified by sex, the results in both males and females were also similar to those in the total population. CONCLUSION: Our data support a strongly positive individual and combined association of famine exposure and serum uric acid with hypertension in middle-aged and elderly Chinese.

Bivariate binary analysis on composite index of anthropometric failure of under-five children and household wealth-index.

BACKGROUND: Malnutrition is the most common cause of mortality and morbidity of children in low and middle income countries including Ethiopia and household wealth index shares the highest contribution. Thus, in this study it is aimed to conduct bivariate binary logistic regression analysis by accounting the possible dependency of child composite index anthropometric failure and household wealth index. METHODS: In this study the data from Ethiopian Demographic and Health Survey (EDHS) 2016 involved 9411 under five children was considered. Child Composite Index Anthropometric Failure (CIAF) measures the aggregate child undernourished derived from the conventional anthropometric indices (stunting, underweight and wasting). The correlation between CIAF and wealth index was checked and significant correlation found. To address the dependency between the two outcome variables bivariate binary logistic regression was used to analyze the determinants of child CAIF and household wealth index jointly. RESULTS: Study results show that region, place of residence, religion, education level of women and husband/partner, sex of child, source of drinking water, household size and number of under five children in the household, mothers body mass index, multiple birth and anemia level of child had significant association with child CIAF. Female children were 0.82 times less likely to be CIAF compared to male and multiple birth children were more likely to be CIAF compared to single birth. Children from Oromia, Somalie, Gambela, SNNPR, Harari and Addis Ababa region were 0.6, 0.56, 0.67, 0.52, 0.6 and 0.44 times less likely to be CIAF compared to Tigray. A household from rural area were 15.49 times more likely poor compared to a household. The estimated odds of children whose mothers attended primary, and secondary and higher education was 0.82, and 0.52 times respectively the estimated odds of children from mothers who had never attended formal education. CONCLUSION: The prevalence of children with composite index anthropometric failure was high and closely tied with the household wealth index. Among the determinants, region, religion, family education level, and anemia level of child were statistically significant determinants of both CIAF and household wealth index. Thus, the authors recommend to concerned bodies and policymakers work on household wealth index to reduce the prevalence of child composite anthropometric failure.

Acute malnutrition and its determinants of preschool children in Bangladesh: gender differentiation.

BACKGROUND: Children acute malnutrition (AM) is a global public health concern, especially in low and middle income countries. AM is associated with multiple physiological vulnerabilities, including immune dysfunction, enteric barrier disruption, gut microbiome dysbiosis, and essential nutrient deficits. This study aimed to determine the prevalence of AM and its associated factors among preschool children in Rajshahi district, Bangladesh. METHODS: This cross-sectional study was conducted from October to December, 2016. Children acute malnutrition was assessed using mid-upper arm circumference. Multiple binary logistic regression analyses were employed to determine the associated factors after adjusting the effect of independent factors of children AM. RESULT: The prevalence of AM amongst preschool children was 8.7%, among them 2.2 and 6.5% were severe acute malnutrition and moderate acute malnutrition, respectively. Z-proportional test demonstrated that the difference in AM between girls (11.6) and boys (5.9%) was significant (p < 0.05). Children AM was associated with being: (i) children aged 6-23 months (aOR = 2.29, 95% CI: 1.20-4.37; p < 0.05), (ii) early childbearing mothers' (age < 20 years) children (aOR = 3.06, 95% CI: 1.08-8.66; p < 0.05), (iii) children living in poor family (aOR = 3.08, 95% CI: 1.11-8.12; p < 0.05), (iv) children living in unhygienic latrine households (aOR = 2.81, 95% CI: 1.52-5.09; p < 0.01), (v) Hindu or other religion children (aOR = 0.42, 95% CI: 0.19-0.92; p < 0.05). CONCLUSION: The prevalence of AM was high among these preschool children. Some modifiable factors were associated with AM of preschool children. Interventions addressing social mobilization and food security could be an effective way to prevent acute malnutrition among children in Bangladesh.

A machine learning classifier approach for identifying the determinants of under-five child undernutrition in Ethiopian administrative zones.

BACKGROUND: Undernutrition is the main cause of child death in developing countries. This paper aimed to explore the efficacy of machine learning (ML) approaches in predicting under-five undernutrition in Ethiopian administrative zones and to identify the most important predictors. METHOD: The study employed ML techniques using retrospective cross-sectional survey data from Ethiopia, a national-representative data collected in the year (2000, 2005, 2011, and 2016). We explored six commonly used ML algorithms; Logistic regression, Least Absolute Shrinkage and Selection Operator (L-1 regularization logistic regression), L-2 regularization (Ridge), Elastic net, neural network, and random forest (RF). Sensitivity, specificity, accuracy, and area under the curve were used to evaluate the performance of those models. RESULTS: Based on different performance evaluations, the RF algorithm was selected as the best ML model. In the order of importance; urban-rural settlement, literacy rate of parents, and place of residence were the major determinants of disparities of nutritional status for under-five children among Ethiopian administrative zones. CONCLUSION: Our results showed that the considered machine learning classification algorithms can effectively predict the under-five undernutrition status in Ethiopian administrative zones. Persistent under-five undernutrition status was found in the northern part of Ethiopia. The identification of such high-risk zones could provide useful information to decision-makers trying to reduce child undernutrition.

Housing and child health in sub-Saharan Africa: A cross-sectional analysis.

BACKGROUND: Housing is essential to human well-being but neglected in global health. Today, housing in Africa is rapidly improving alongside economic development, creating an urgent need to understand how these changes can benefit health. We hypothesised that improved housing is associated with better health in children living in sub-Saharan Africa (SSA). We conducted a cross-sectional analysis of housing conditions relative to a range of child health outcomes in SSA. METHODS AND FINDINGS: Cross-sectional data were analysed for 824,694 children surveyed in 54 Demographic and Health Surveys, 21 Malaria Indicator Surveys, and two AIDS Indicator Surveys conducted in 33 countries between 2001 and 2017 that measured malaria infection by microscopy or rapid diagnostic test (RDT), diarrhoea, acute respiratory infections (ARIs), stunting, wasting, underweight, or anaemia in children aged 0-5 years. The mean age of children was 2.5 years, and 49.7% were female. Housing was categorised into a binary variable based on a United Nations definition comparing improved housing (with improved drinking water, improved sanitation, sufficient living area, and finished building materials) versus unimproved housing (all other houses). Associations between house type and child health outcomes were determined using conditional logistic regression within surveys, adjusting for prespecified covariables including age, sex, household wealth, insecticide-treated bed net use, and vaccination status. Individual survey odds ratios (ORs) were pooled using random-effects meta-analysis. Across surveys, improved housing was associated with 8%-18% lower odds of all outcomes except ARI (malaria infection by microscopy: adjusted OR [aOR] 0.88, 95% confidence intervals [CIs] 0.80-0.97, p = 0.01; malaria infection by RDT: aOR 0.82, 95% CI 0.77-0.88, p < 0.001; diarrhoea: aOR 0.92, 95% CI 0.88-0.97, p = 0.001; ARI: aOR 0.96, 95% CI 0.87-1.07, p = 0.49; stunting: aOR 0.83, 95% CI 0.77-0.88, p < 0.001; wasting: aOR 0.90, 95% CI 0.83-0.99, p = 0.03; underweight: aOR 0.85, 95% CI 0.80-0.90, p < 0.001; any anaemia: aOR 0.87, 95% CI 0.82-0.92, p < 0.001; severe anaemia: aOR 0.89, 95% CI 0.84-0.95, p < 0.001). In comparison, insecticide-treated net use was associated with 16%-17% lower odds of malaria infection (microscopy: aOR 0.83, 95% CI 0.78-0.88, p < 0.001; RDT: aOR 0.84, 95% CI 0.79-0.88, p < 0.001). Drinking water source and sanitation facility alone were not associated with diarrhoea. The main study limitations are the use of self-reported diarrhoea and ARI, as well as potential residual confounding by socioeconomic position, despite adjustments for household wealth and education. CONCLUSIONS: In this study, we observed that poor housing, which includes inadequate drinking water and sanitation facility, is associated with health outcomes known to increase child mortality in SSA. Improvements to housing may be protective against a number of important childhood infectious diseases as well as poor growth outcomes, with major potential to improve children's health and survival across SSA.

Pediatric screening tools for malnutrition: an update.

PURPOSE OF REVIEW: There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods. RECENT FINDINGS: We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting. SUMMARY: Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutritional risk score and anthropometric parameters of malnutrition, new studies in children with cancer, burns, and biliary atresia show significant associations between high nutritional risk and short-term outcome measures such as increased complication rate and weight loss. For implementation of a nutritional care process incorporating nutritional screening in daily practice, simplicity seems to be of great importance.

A 2-month intervention study of preventive clothing against mosquito bites among malnourished and well-nourished children under 5 years of age living on the Atlantic Ocean Coast of Lagos, Southwest Nigeria.

BACKGROUND: Malnutrition is appreciated as a global leading paediatric burden that indirectly or directly contributes to child mortality. In children, malnutrition has profound effects on health and development; and has been associated with poor outcomes in paediatric diseases. However, it is not clear if malnourished children are at an increased risk of having malaria. This study was conducted to evaluate the risk of malaria infection in children with malnutrition. METHODS: The study design was pre-post. A protective clothing against mosquitoes (pCAM) was given to 102 under-five children in two coastal communities, after screening for malaria parasitaemia. The children's weight, height and body temperature were measured at recruitment. Blood was also taken at recruitment and monthly for malaria parasitaemia, haemoglobin concentration and random blood sugar. The parents/care-givers were visited daily for 1 month only, after recruitment, to ensure that the children wore the pCAM daily from 5 pm and the children were followed up monthly for 2 months. RESULTS: Of the 102 study participants, 60 (24 males and 36 females) were rapid diagnostic test (RDT)-positive at recruitment, indicating 58.8% prevalence of malaria parasitaemia. The prevalence of malnutrition and of stunting were 32.3% (33/102) and 54.9% (56/102), respectively, while 7.8% (8/108) children were wasted. Twenty (60.6%) of the malnourished children and 30 (53.6%) of those stunted were RDT-positive at recruitment. At the first post-intervention screening, only 7 (31.8%) of the malnourished and 13 (28.9%) of those stunted were RDT-positive. Malnourished and stunted children were 2.57 times and 2.31 times more likely to be malaria infected (OR = 2.57, 95% CI 0.97, 6.79; OR = 2.31, 95% CI 1.01, 5.26 respectively). Malnourished females were 2.72 times more likely to be RDT-positive compared to malnourished males (OR = 2.72, 95% CI 0.54, 11.61) and stunted females were 1.73 times more likely to the positive for malaria parasites than stunted males (OR 1.73, 95% CI 0.59, 5.03). The prevalence of anaemia at recruitment decreased from 82.4 to 69.6% after intervention. The mean haemoglobin concentration (g/dl) at recruitment was significantly lower (P < 0.05) than that at 1st and 2nd post-intervention measurements (9.6 ± 1.4, t = - 3.17, P-value = 0.0009 and 10.2 ± 1.3, t = - 2.64, P-value = 0.004, respectively). Mean random blood sugar (mg/dl) of females (91.8 ± 12.7) was significantly lower (t = 2.83, P-value = 0.003) than that of males (98.5 ± 11.2). CONCLUSION: Results from this study suggest a higher risk of malaria infection among malnourished and lower risks among stunted and wasted children. Females were at a higher risk of malnutrition, stunting and wasting than males. Protective clothing against malaria seemed to reduce malaria infection and improve anaemia status.

Assessment of nutritional status in children with cancer: A narrative review.

A child's appropriate development stems in large part from proper nutrition. Malnutrition is an adverse prognostic factor in children with cancer, and its prevalence is highly variable. Currently, there is no standardized definition and assessment method of nutritional status in pediatric oncology. A complete nutritional assessment includes anthropometry, biochemical, clinical, and dietary assessments. In this article, we explore these methods and suggest practical approaches for pediatric cancer units depending on the levels of care that these can provide. We also advise on the monitoring and follow-up of children with cancer during and after treatment, and discuss potential areas for future research.

Environmental exposures and child and maternal gut microbiota in rural Malawi.

BACKGROUND: Gut microbiota composition is associated with child health, but the effect of the environment on microbiota composition is not well understood. Few studies have been conducted in low-income settings where childhood malnutrition is common and possibly related to microbiota composition. OBJECTIVES: To investigate whether gut microbiota composition in young children and their mothers is associated with different environmental exposures in rural Malawi. We hypothesized that more adverse environmental exposures would be associated with lower levels of microbiota maturity and diversity. METHODS: Faecal samples from up to 631 children and mothers participating in a nutrition intervention trial were collected at 1, 6, 12, 18, and 30 months (children) and at 1 month (mothers) after birth and analysed for microbiota composition with 16S rRNA sequencing. Bacterial OTU and genus abundances, measures of microbiota maturity and diversity, and UniFrac distances were compared between participants with different environmental exposures. The exposure variables included socio-economic status, water source, sanitary facility, domestic animals, maternal characteristics, season, antibiotic use, and delivery mode. RESULTS: Measures of microbiota maturity and diversity in children were inversely associated with maternal education at 6, 18, and 30 months and did not otherwise differ consistently between participants with different environmental exposures. Phylogenetic distance was related to season of stool sample collection at all time points. At the level of individual OTUs and genera, season of stool sample collection, type of water source, and maternal education showed most associations with child gut microbiota, while HIV status was the most important predictor of relative OTU and genus abundances in mothers. CONCLUSION: The results do not support the hypothesis that adverse environmental exposures are broadly associated with lower microbiota maturity and diversity but suggest that environmental exposures influence the abundance of several bacterial OTUs and genera and that low maternal education is associated with higher microbiota maturity and diversity.

Body Composition in Egyptian Children With Transfusion-dependent Thalassemia: The Impact of Nutrition and Metabolic Profile.

BACKGROUND: Growth failure is a common complication in children with beta-thalassemia major (ß-TM) that has persisted despite major treatment advances. It could stem from malnutrition, especially in those who live in poor countries and who have inadequate nutrient intake. AIM: The aim of this study was to assess the influence of nutrition on growth, total body composition, and metabolic profile in Egyptian children with ß-TM. SUBJECTS AND METHODS: This cross-sectional study included 200 children with ß-TM and 50 age-matched and sex-matched healthy children. All subjects underwent full clinical assessment, which included assessment of growth and total body composition using anthropometric measurements (weight, height, mid-arm circumference, skinfold thickness, and body mass index) and bioelectric impedance analysis device (TANITA SC330). Nutritional assessment was performed using 24-hour dietary recall. Fasting serum insulin, C-peptide, and fasting serum lipid profile (high-density lipoprotein, low-density lipoprotein, cholesterol, and triglyceride) were measured. RESULTS: Children with ß-TM had a significantly lower mean value of the daily consumption of the studied nutrient elements including kilocalories, protein, carbohydrate, calcium, and phosphorus (P<0.001). ß-TM had a negative impact on anthropometric measures; the mean of all measurements recorded in children with ß-TM was significantly lower than that in the control group (P<0.001). Children with ß-TM had a significant abnormality in lipid profile, with higher triglyceride levels and lower cholesterol, low-density lipoprotein, and high-density lipoprotein than controls. They had significantly lower serum insulin and C-peptide. Age, sex, serum ferritin, and caloric intake have a significant impact on body composition in children with ß-TM. CONCLUSION: Regular assessment of nutrition is crucial for the health of children with ß-TM.

Do we need to reconsider the CMAM admission and discharge criteria?; an analysis of CMAM data in South Sudan.

BACKGROUND: Weight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria. However, there exists disparity between the groups identified as malnourished by them. Thus, here we aim to investigate the clinical features and linkage with chronicity of the acute malnutrition cases identified by either WHZ or MUAC. Besides, there exists evidence indicating that fat restoration is disproportionately rapid compared to that of muscle gain in hospitalized malnourished children but related research at community level is lacking. In this study we suggest proxy measure to inspect body composition restoration responding to malnutrition management among the malnourished children. METHODS: The data of this study is from World Vision South Sudan's emergency nutrition program from 2006 to 2012 (4443 children) and the nutrition survey conducted in 2014 (3367 children). The study investigated clinical presentations of each type of severe acute malnutrition (SAM) by WHZ (SAM-WHZ) or MUAC (SAM-MUAC), and analysed correlation between each malnutrition and chronic malnutrition. Furthermore, we explored the pattern of body composition restoration during the recovery phase by comparing the relative velocity of MUAC3 with that of weight gain. RESULTS: As acutely malnourished children identified by MUAC more often share clinical features related to chronic malnutrition and minimal overlapping with malnourished children by WHZ, Therefore, MUAC only screening in the nutrition program would result in delayed identification of the malnourished children. CONCLUSIONS: The relative velocity of MUAC3 gain was suggested as a proxy measure for volume increase, and it was more prominent than that of weight gain among the children with SAM by WHZ and MUAC over all the restoring period. Based on this we made a conjecture about dominant fat mass gain over the period of CMAM program. Also, considering initial weight gain could be ascribed to fat mass increase, the current discharge criteria would leave the malnourished children at risk of mortality even after treatment due to limited restoration of muscle mass. Given this, further research should be followed including assessment of body composition for evidence to recapitulate and reconsider the current admission and discharge criteria for CMAM program.

A descriptive study of double burden of malnutrition in mothers of children with severe acute malnutrition admitted in Children Hospital and Institute of Child Health, Multan.

OBJECTIVE: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers. METHODS: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined for clinical signs of iron deficiency anaemia. RESULTS: Of the 100 women, 20(20%) were malnourished, 42(42%) were of normal weight, and 38(38%) were either overweight, pre-obese or obese. The caloric intake of 26(26%) mothers was less than 1500 kcal per day, while 42(42%) were taking between 2000-2500 kcal per day and 32(32%) were taking >2500 kcal daily. Also, 67(67%) women were suffering from anaemia and 80(80%) women had some myths related with dietary restrictions during pregnancy, lactation and complimentary feeding of children. Overall, 23(23%) women breastfed their babies.

Decoding the Metabolome and Lipidome of Child Malnutrition by Mass Spectrometric Techniques: Present Status and Future Perspectives.

Child malnutrition (CM) is a global public health problem. It contributes to poor health in one in four children under five years worldwide and causes serious health problems in children, including stunted, wasted, and overweight growth. These serious public health issues lead to a higher chance of living in poverty in adulthood. Malnutrition is related with reduced economic productivity and increases the serious national and international burden. Currently, there is no meaningful therapeutic intervention of CM, and the use of different therapeutic foods has shown poor outcomes among supplemented malnourished children. The role of metabolites and lipids has been extensively recognized as early determinants of child health, but their contribution in CM and its pathobiology are poorly understood. This perspective provides a most recent update on these aspects. After briefly introducing the disciplines of metabolomics and lipidomics, we describe a mass spectrometry-based metabolic workflow for analysis of both metabolites and lipids and summarize several recent applications of metabolomics and lipidomics in CM. Finally, we discuss the future directions of the field toward the development of meaningful interventions for CM through metabolomics and lipidomics advances.

Population pharmacokinetics of abacavir and lamivudine in severely malnourished human immunodeficiency virus-infected children in relation to treatment outcomes.

AIMS: Describe the pharmacokinetics (PK) of the antiretroviral drugs abacavir and lamivudine in malnourished paediatric patients and relate to viral load outcomes after 12 and 48 weeks of treatment. METHODS: Severely malnourished human immunodeficiency virus-infected children were randomized to early (within 14 days) or delayed (after nutritional recovery) initiation of antiretroviral treatment (ART) using World Health Organization weight-band dosages. Abacavir and lamivudine concentrations were measured as a secondary objective on day 1 and day 14 and patients were followed-up to week 48. Population PK of abacavir and lamivudine were described using NONMEM. RESULTS: In total, 623 abacavir and 627 lamivudine concentrations were collected from 75 paediatric patients aged 0.1-10.8 (median 1.4) years. Abacavir PK was described by a 2-compartment model, patients randomized to early ART showed increased bioavailability of 31%. Apparent clearance (CL/F, L/h/7 kg) of abacavir increased from day 1 to day 14 from 3.33 (95% confidence interval 2.71-4.12) to 5.86 (95% confidence interval 4.78-7.3). A 1-compartment model described lamivudine PK, variability on CL/F was explained by maturation with age, with age at half-matured CL/F being 4 months. For both drugs allometrically scaled total body weight was related to CL/F and apparent volume of distribution. PK exposure did not correlate with virological outcomes or death at 12 or 48 weeks. CONCLUSION: Increases in Abacavir's CL/F between day 1 to day 14, bioavailability and PK variability with early start of ART was found in this cohort of severely malnourished children; however, these changes did not influence virological outcomes. The study supports the use of weight-band dosage tables.

Anthropometric measurements to identify undernutrition in children with cerebral palsy.

AIM: To evaluate the diagnostic performance of anthropometric indicators to identify undernutrition in children with cerebral palsy (CP). METHOD: The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. Undernutrition was defined as a z-score for dual-energy X-ray absorptiometry (DXA) determined body fat percentage less or equal to -2.0. The cut-off values for body mass index (BMI) of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and the cut-off values for BMI and height for age of the Robert Koch Institut (RKI) were evaluated. RESULTS: In total, 329 children with CP (181 males, 148 females, Gross Motor Function Classification System levels I-V) were eligible for analysis. The mean age was 12 years 4 months (SD 2y 9mo). The BMI cut-off values showed the following sensitivities and specificities: WHO, sensitivity of 0.474 (95% confidence interval [CI] 0.244-0.711), specificity of 0.897 (95% CI: 0.857-0.928); CDC, sensitivity of 0.632 (95% CI: 0.384-0.837), specificity of 0.819 (95% CI: 0.772-0.861); RKI, sensitivity of 0.789 (95% CI: 0.544-0.939), specificity of 0.732 (95% CI: 0.679-0.781); and for height for age, sensitivity of 0.263 (95% CI: 0.091-0.512), specificity of 0.668 (95% CI: 0.612-0.720). INTERPRETATION: BMI had a high specificity but very low sensitivity in identifying undernutrition in children with CP. Z-scores for height for age had even lower specificity and sensitivity and seemed not to be appropriate for predicting undernutrition in children with CP. WHAT THIS PAPER ADDS: Body mass index (BMI) z-scores had a high specificity but very low sensitivity in identifying undernutrition in children with cerebral palsy (CP). Height z-scores were not appropriate for predicting undernutrition in children with CP. Undernutrition assessed by BMI was overestimated in children with CP versus when assessed by dual-energy X-ray absorptiometry (DXA).

MEDICIONES ANTROPOMÉTRICAS PARA IDENTIFICAR DESNUTRICIÓN EN NIÑOS CON PARÁLISIS CEREBRAL: OBJETIVO: Evaluar el rendimiento diagnóstico de los indicadores antropométricos para identificar la desnutrición en niños con parálisis cerebral (PC). MÉTODO: El presente estudio realizado en un solo centro de atención, fue un análisis retrospectivo de datos recopilados prospectivamente entre niños y adolescentes con PC que participan en un programa de rehabilitación. La desnutrición se definió como una puntuación z para la absorciometría de rayos X de energía dual (DXA), y porcentaje de grasa corporal determinado menor o igual a -2,0. Fueron evaluados los valores de corte para el índice de masa corporal (IMC) de la Organización Mundial de la Salud (OMS) y los Centros para el Control y la Prevención de Enfermedades (CDC), y los valores de corte para el IMC y la altura para la edad del Robert Koch Institut (RKI). RESULTADOS: En total, 329 niños con PC (181 varones, 148 mujeres, con niveles I - V del Sistema de clasificación de la función motora gruesa) fueron elegibles para el análisis. La edad media fue de 12 años 4 meses (DS 2a 9m). Los valores de corte del IMC mostraron las siguientes sensibilidades y especificidades: OMS, sensibilidad de 0,474 (intervalo de confianza del 95% [IC] 0,244-0,711), especificidad de 0,897 (IC del 95%: 0,857-0,928); CDC, sensibilidad de 0,632 (IC del 95%: 0,384 a 0,837), especificidad de 0,819 (IC del 95%: 0,772 a 0,861); RKI, sensibilidad de 0,789 (IC 95% 0,544-0,939), especificidad de 0,732 (IC 95% 0,679-0,781); y para la altura para la edad, la sensibilidad de 0,263 (IC del 95%: 0,091 a 0,512), la especificidad de 0,668 (IC del 95%: 0,612 a 0,720). INTERPRETACIÓN: El IMC tenía una alta especificidad, pero una sensibilidad muy baja para identificar la desnutrición en niños con PC. Las puntuaciones Z para la altura para la edad tenían una especificidad y sensibilidad aún más bajas y no parecían ser adecuadas para predecir la desnutrición en niños con PC.

MEDIDAS ANTROPOMÉTRICAS PARA IDENTIFICAR SUBNUTRIÇÃO EM CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Avaliar o desempenho diagnóstico de indicadores antropométricos para avaliar subnutrição em crianças com paralisia cerebral (PC). MÉTODO: O presente estudo foi uma análise monocêntrica retrospectiva de dados coletados prospectivamente entre crianças e adolescentes com PC que participavam de um programa de reabilitação. A subnutrição foi definida como um escore z para porcentagem de gordura corporal determinada por absorciometria de dupla energia de raio-X (DXA) menor ou igual a -2.0. Os valores de corte para o índice de massa corporal IMC) da Organização Mundial de Saúde (OMS) e dos Centros para Controle e Prevenção de Doenças (CCPD), e os valores de corte para IMC e altura por idade do Robert Koch Institut (RKI) foram avaliados. RESULTADOS: No total, 329 crianças com PC (181 do sexo masculino, 148 do sexo feminino, níveis do Sistema de Classificação da Função Motora Grossa I-V) foram elegíveis para análise. A média de idade foi 12 anos e 4 meses (DP 2a 9m). Os valores de corte do IMC mostraram as seguintes sensibilidades e especificidades: OMS, sensibilidade de 0,474 (intervalo de confiança [IC] a 95% 0,244-0,711), especificidade de 0,897 (IC 95% 0,857-0,928); CCPD, sensibilidade de 0,632 (IC 95% 0,384-0,837), especifididade de 0,819 (IC 95% 0,772-0,861); RKI, sensibilidade de 0,789 (IC 95% 0,544-0,939), especificidade de 0,732 (IC 95% 0,679-0,781); e de altura por idade, sensibilidade de 0,263 (IC 95% 0,091-0,512), especificidade de 0,668 (IC 95% 0,612-0,720). INTERPRETAÇÃO: O IMC teve alta especificidade mas sensibilidade muito baixa para identificar subnutrição em crianças com PC. Os escores z para altura por idade tiveram especificidade ainda menor e não pareceram apropriados para predizer subnutrição em crianças com PC.