The Low Sensitivity and Specificity of a Nutrition Screening Tool in Real Circumstances in a Tertiary Care Hospital Setting.

Nutrition screening is an essential process to detect children at risk of malnutrition during hospitalization and provide appropriate nutrition management. STRONGkids is a nutrition screening tool which has been implemented in a tertiary-care hospital service in Bangkok, Thailand. This study aimed to evaluate the performance of STRONGkids in the real-situation setting. Electronic Medical Records (EMR) of hospitalized pediatric patients aged 1 month to 18 years from January to December 2019 were reviewed. Those with incomplete medical records and re-admission within 30 days were excluded. Nutrition risk scores and clinical data were collected. Anthropometric data were calculated to Z-score based on the WHO growth standard. The sensitivity (SEN) and specificity (SPE) of STRONGkids were determined against malnutrition status and clinical outcomes. In total, 3914 EMRs (2130 boys, mean age 6.22 ± 4.72 years) were reviewed. The prevalence of acute malnutrition (BMI-for-age Z-score < -2) and stunting (height-for-age Z-score < -2) were 12.9 and 20.5%. SEN and SPE of STRONGkids against acute malnutrition were 63.2 and 55.6%, stunting values were 60.6 and 56.7%, and overall malnutrition values were 59.8 and 58.6%. STRONGkids had low SEN and SPE to detect nutrition risks among hospitalized children in a tertiary-care setting. Further actions are required to improve the quality of nutrition screening in hospital services.

Masked hypertension and correlation between body composition and nighttime blood pressure parameters in children and adolescents with obesity.

INTRODUCTION: Masked hypertension is defined as having a normal blood pressure (BP) in the office but elevated BP outside the office. This study aimed to determine the prevalence of masked hypertension in participants with obesity and to examine the correlation between body composition, dietary intake and ambulatory blood pressure parameters. MATERIALS AND METHODS: The cross-sectional study of participants with obesity was conducted in the pediatric nutrition clinic of a University Hospital in Thailand. Demographic and anthropometric data, dietary intake, body composition analysis and ambulatory blood pressure monitoring were assessed in all participants. All parameters were compared between the group with masked hypertension and the normotensive group. Correlations between the parameters were analyzed. RESULTS: Among 49 children with obesity, 23 (47%, 95% confidence interval 34.7, 59.2%) had masked hypertension. Compared with the normotensive group, the group with masked hypertension had a greater mean BMI z-score (4.7 vs. 3.0, P = 0.003), a greater mean of body fat percentage (45 vs. 40, P = 0.012) and a greater total energy intake percentage of dietary reference intake (115 vs. 93, P = 0.034). Multivariate analysis showed that BMI z-score was significantly associated with masked hypertension. Interestingly, mean nighttime SBP positively correlated with BMI z-score and body fat percentage. Moreover, there were negative correlations between fruit intake portion per week and nighttime and 24-h SBP index. However, multivariate linear regression did not show significant correlation between these parameters. CONCLUSIONS: Masked hypertension was frequent in participants with obesity. The greater BMI z-score and percentage of body fat mass correlated with higher nighttime SBP.

Characterization and probiotic properties of Lactobacilli from human breast milk.

Several studies have reported a complex microbial community in human breast milk. This community impacts the shape of the infant gut microbiota and consequently impacts host health. Lactobacillus is an important probiotic and has many applications in the functional food industry. This study isolated and evaluated the potential probiotic bacteria from human milk. Two Lactobacillus species, L. plantarum and L. pentosus, were isolated from the breast milk of Thai women. L. pentosus HM04-22, L. pentosus HM04-3, L. plantarum HM04-80, L. plantarum HM04-88 and L. plantarum HM01-1 showed good adhesion activity (> 55%) and resistance in gastric (pH 2) and bile (pH 8) conditions. Characterization of the probiotic properties indicated that all selected Lactobacillus isolates had anti-adhesion properties against Escherichia coli and Salmonella Typhimurium. Lactobacillus isolates protected Caco-2 cells from pathogen adhesion at 25-40%. In addition, the five selected strains presented anti-inflammatory properties by reducing interleukin (IL)-8 expression at 0.14 ± 0.16 to 0.52 ± 0.117-fold. However, the strains had no effect on the expression of tight junction genes, including zona occludens (ZO)-1, occludin and claudin-1. In conclusion, five selected Lactobacillus isolates from human milk were candidates for use as probiotics to promote health. However, more tests in animal models and clinical trials need to be performed.