Subjective global nutritional assessment as a nutritional tool in childhood chronic liver disease.

Objective of the study was to assess subjective global nutritional assessment (SGNA) in children with chronic liver diseases (CLD). Children aged 3 months to 18 years with CLD were prospectively enrolled (January 2016 to October 2018). SGNA was performed as per validated pro forma for children. Nutritional categories were categorised into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). Agreement between SGNA and anthropometric measures, prediction of morbidity and death or liver transplantation (LT) at 1-year post-enrolment by SGNA and inter-observer reliability of SGNA were assessed. Ninety-two subjects were enrolled, median age 23·5 (3-216) months. SGNA classified 47 patients (51·1 %) in group A, 26 (28·3 %) in group B and 19 (20·6 %) in group C. Kendall coefficients disclosed significant association of SGNA with all anthropometric measurements, greatest with weight for age (r = -0·637), height for age (r = -0·581) and mid-arm fat area (r = -0·449). At 12 months follow-up, twenty children died and four received LT. A significantly higher number of children with malnutrition (groups B and C) had poor outcome (OR 6·74 (95 % CI 2·21, 20·55), P = 0·001), increased risk of hospital readmission (OR 12·2 (95 % CI 4·60, 35·88), P = 0·001), higher rate of infectious complications (OR 22·68 (95 % CI 7·29, 70·53), P < 0·0001) and lower median survival with native liver (Log Rank < 0·001) as compared with group A. Inter-observer agreement in assessment of SGNA was good (90·2 %). SGNA, in contrast to anthropometric measures, is a better nutritional assessment tool. It is reliable, comprehensive and predicts poor outcome in childhood CLD.

Hepatitis A Virus-related Pediatric Liver Disease Burden and its Significance in the Indian Subcontinent.

OBJECTIVE: To study the Hepatitis A virus (HAV) infection-related pediatric liver disease burden. METHODS: Hospital records of 431 children (age <18 y) diagnosed to be suffering from acute HAV infection during 2011 to 2018 were extracted and analyzed. Additionally, a seroprevalence study was done on 2599 participants (696 children and 1903 adults). RESULTS: HAV infection accounted for about half (48.6% of acute hepatitis and 46.5% (92/198) of acute liver failure cases) of all acute onset icteric illness, with significant morbidity and mortality. As per seroprevalence data, 16.2% of children between 10-18 years of age, and 10.3% of adults aged 18-30 years remained susceptible to HAV infection. CONCLUSIONS: HAV infection is the major contributor the overall pediatric liver disease burden. A significant proportion of subjects remain susceptible to HAV infection even after 10 years of age. Population-based studies are required to further delineate the epidemiology of HAV infection in India for deciding introduction of HAV vaccine in the national immunization schedule.