Impact of the COVID-19 pandemic on child malnutrition in Selangor, Malaysia: A pilot study.

BACKGROUND: Child malnutrition risk factors are globally recognized, but the specific impact of the COVID-19 pandemic on the prevalence of child malnutrition, considering socioeconomic burdens and changes in family lifestyles, remains underexplored. This study aims to identify the significance of COVID-19-related factors in relation to the prevalence of child malnutrition in Selangor, Malaysia. METHODS: Purposive sampling was employed in this pilot study to select the households with under-5 children and, a structured questionnaire was developed to gather data. Chi-squared tests, logistic regression modelling and World Health Organisation AnthroPlus software-based visualization were used for analyses. RESULTS: The present study's findings indicate that demographic and social factors, including 'Citizenship,' 'Type of House,' 'Number of Earning Members,' 'Father's Highest Educational Level,' and 'Number of Children in a Family,' have a statistically significant association with Wasting. Additionally, the mother's 'Highest Educational Level' is found to be linked to underweight prevalence. Within COVID-19 factors, "COVID-19 Impact on Employment/Business" demonstrated significance for both stunting and wasting. Multivariate analysis revealed disparities in childhood malnutrition by gender, age, and factors such as "COVID-19 impact on children's physical activity" and "COVID-19 impact on children's decrease in health over the last two weeks." CONCLUSIONS: This study identified COVID-19 factors alongside sociodemographic variables with statistically significant relationships impacting childhood malnutrition in Selangor, Malaysia. The results underscored the substantial influence of the COVID-19 pandemic on child malnutrition prevalence. Decision-makers at family and community levels can benefit by considering these factors in their actions. However, the study's limitation lay in its dataset, urging larger-scale analyses to explore further sub-categories of the examined variables.

Factors mediating the association between recurring floods and child chronic undernutrition in northern Bangladesh.

OBJECTIVES: Although there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association. METHODS: This cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y. RESULTS: In our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53-2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure-child undernutrition association. CONCLUSIONS: Flood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.

Escorbuto secundario a una dieta restrictiva en un niño con diagnóstico de trastorno del espectro autista: Reporte de un caso / Scurvy due to restrictive diet in a child with autism spectrum disorder: Case report

Actualmente, el escorbuto es una entidad infrecuente en pediatría. Se han publicado reportes de casos que describen la enfermedad en lactantes alimentados con leche hervida, en pacientes con sobrecarga de hierro por enfermedades hematológicas y en niños con restricciones alimentarias por trastornos del neurodesarrollo. Se reporta el caso de un paciente masculino de 4 años con diagnóstico de trastorno del espectro autista que desarrolló la enfermedad por un hábito alimentario selectivo de larga evolución, sin ingesta de frutas ni verduras. La importancia del reporte radica en informar al pediatra y a otros profesionales dedicados a la atención primaria de salud acerca del desarrollo de escorbuto como potencial consecuencia de las dietas restrictivas en niños con trastornos del neurodesarrollo y de la trascendencia de la anamnesis alimentaria en pacientes con patología para evitar enfermedades asociadas a micronutrientes.

Scurvy is a very uncommon entity in pediatric population. Some case reports have been published in infants fed with boiled milk, in patients with iron overload secondary to hematological diseases and in children with food restrictions secondary to neurodevelopmental disorders. We report a case of a 4-year-old male patient with a diagnosis of autism spectrum disorder, which developed scurvy secondary to a long-term selective eating habit without fruit or vegetable intake. The objective of this case report is to announce the pediatrician and other professionals dedicated to primary health care about scurvy as a potential consequence of restrictive diets in children with autism spectrum disorders as well as the importance of dietary history in sick patients to prevent associated micronutrient deficiencies.

Socioeconomic context of the community and chronic child malnutrition in Colombia / Contexto socioeconómico de la comunidad y desnutrición crónica infantil en Colombia

ABSTRACT OBJECTIVE To analyze the influence of the socioeconomic context of the community on chronic child malnutrition in Colombia. METHODS We estimated multilevel logistic models using data from the National Demographic and Health Survey in Colombia in 2010. The final sample included 11,448 children under the age of five gathered in 3,528 communities. In addition, we used the Principal Component Analysis with polychoric correlations for the construction of composed indicators of wealth, autonomy of the woman, and the use and access to the health system. RESULTS The average level of community wealth was significantly and independently associated with chronic malnutrition in early childhood, more than the socioeconomic status of the household itself. At the individual and household level, the probability of chronic malnutrition was higher for children from mothers with low levels of autonomy and use and access to the health system, mothers who had their first child in adolescence, and mothers who live in homes in the lowest wealth quintiles. In contrast, children from mothers with a body mass index > 25 and with at least secondary education (versus no education) were less likely to suffer from chronic malnutrition. CONCLUSIONS Research, programs, and interventions need to take into account the physical, economic, and social context of communities to contribute with the improvement of the nutritional status of early childhood in Colombia.

RESUMEN OBJETIVO Analizar la influencia del contexto socioeconómico de la comunidad sobre la desnutrición infantil crónica en Colombia. MÉTODOS Utilizando datos de la Encuesta Nacional de Demografía y Salud en Colombia en 2010, se estimaron modelos logísticos multinivel. La muestra final incluyó 11.448 niños menores de cinco años anidados en 3.528 comunidades. Además, se utilizó el Análisis de Componentes Principales usando correlaciones policóricas para la construcción de indicadores compuestos de riqueza, autonomía de la mujer y el uso y acceso al sistema de salud. RESULTADOS El nivel de riqueza promedio de la comunidad resultó significativa e independientemente asociado con la desnutrición crónica en la primera infancia, por encima y más allá del propio estatus socioeconómico del hogar. A nivel individual y del hogar, la probabilidad de desnutrición crónica fue mayor para niños de madres con bajos niveles de autonomía y uso y acceso al sistema de salud, que han tenido su primer hijo en la adolescencia y que viven en hogares en los quintiles más bajos de riqueza. En contraste, niños de madres con un índice de masa corporal > 25 y con al menos educación secundaria (versus sin educación) tuvieron menor probabilidad de padecer desnutrición crónica. CONCLUSIONES Investigaciones, programas e intervenciones que tengan en cuenta el contexto físico, económico y social de las comunidades son necesarias para contribuir a mejorar el estado nutricional de la primera infancia en Colombia.

Riesgo biomédico de desnutrición en niños hospitalizados / Biomedical risk of undernutrition in hospitalized children

La desnutrición hospitalaria constituye un importante problema de salud, tanto en países desarrollados como subdesarrollados. Identificarla es fundamental para evitar o minimizar la repercusión en la evolución clínica, complicaciones e incremento de la estancia hospitalaria. Objetivo: Se evaluó el riesgo biomédico de desnutrición en pacientes hospitalizados del Departamento de Pediatría y Puericultura del Hospital Militar "Dr. Carlos Arvelo" en el periodo de septiembrenoviembre 2016. Métodos: diseño descriptivo, prospectivo, transversal; se aplicó un instrumento para riesgo biomédico de desnutrición en niños y adolescentes, previamente validado para la población venezolana, a los pacientes hospitalizados, por medio de datos registrados en la historia clínica e interrogatorio de los representantes y/o cuidadores. A cada categoría obtenida se le asignó una ponderación, según su mayor o menor repercusión sobre el estado nutricional. La puntuación final permitió caracterizar al niño de acuerdo al riesgo. Resultados: Se evaluaron un total de 60 niños donde predominó el sexo femenino 60 % y los pacientes mayores de 2 años de edad fue de 61,6 %. De la población más frecuente, 55 % cursó con diarrea aguda. Dentro de las patologías crónicas más frecuente se reportó asma (21,6 %), y de las agudas, neumonía (30%). Los pacientes que reportaron mayor riesgo biomédico de desnutrición fueron los mayores de 2 años de edad. Conclusión: Son muchos los factores e indicadores biomédicos identificados como condicionantes(AU)

Hospital undernutrition is an important health problem, both in developed and underdeveloped countries. Identifying it is essential to avoid or minimize the impact on clinical evolution, complications and increase in hospital stay. Objective: The biomedical risk of malnutrition in hospitalized patients of the Department of Pediatrics and Child Care of the Military Hospital "Dr. Carlos Arvelo "in the period of September-November 2016. Methods: descriptive, prospective, transversal design; an instrument for Biomedical Risk of Malnutrition in children and adolescents, previously validated for the Venezuelan population, was applied to hospitalized patients, through data recorded in the clinical history and questioning of representatives and / or caregivers. Each weight category was assigned a weighting, according to its greater or lesser impact on nutritional status. The final score allowed to characterize the child according to the risk. Results: A total of 60 children were evaluated, where 60% of females predominated and 61.6% of patients over 2 years of age. Of the most frequent population, 55% had acute diarrhea. Among the most frequent chronic diseases, asthma (21.6%) was reported, and acute pneumonia (30%). The patients who reported the highest biomedical risk of malnutrition were those over 2 years of age. Conclusion: There are many biomedical factors and indicators identified as determinants of hospital malnutrition risk in the different scales, its frequency and importance varies in context of the study population, associated morbidity, health and socioeconomic conditions(AU)

Métodos de avaliação do estado nutricional de crianças e adolescentes com Paralisia Cerebral Tetraespástica / Assessment of nutritional status of children and adolescents with spastic quadriplegic cerebral palsy

ABSTRACT BACKGROUND: Due to several factors, such as gastrointestinal's diseases and difficulty in feeding, children with Spastic Quadriplegic Cerebral Palsy tend to present nutritional deficits. OBJECTIVE: To assess the nutritional status of pediatric patients with Spastic Quadriplegic Cerebral Palsy according to reference curves for this population and with the measures of folds and circumferences, obtained by the upper arm circumference and triceps skin fold. METHODS: The data were obtained from: knee-height, estimated height, weight, upper arm circumference, and triceps skin fold. Values of folds and circumferences were compared with Frisancho, and specific curves for these patients were used as reference. The relationship between the values in the growth curve for healthy children, Z-Score, and comparison with the reference curve were verified by Fisher's exact test. We adopted the significance level of 5%. RESULTS: We evaluated 54 patients. The mean age was 10.2 years, and 34 were male, 25 fed by gastrostomy and 29, orally. The frequency of low weight by the reference curve was 22.22%. More than half of the patients presented the parameters indicating lean mass below the 5th percentile. The height of all patients was classified as adequate for the age by the reference curve. CONCLUSION: Low weight was found in 22% of patients, and there is a greater tendency to present reduced muscle mass and increased fat mass, showing the need for evaluation and appropriate interventions for patients with Spastic Quadriplegic Cerebral Palsy.

RESUMO CONTEXTO: Devido a diversos fatores, como doenças do trato gastrointestinal e dificuldade de alimentação, frequentemente crianças com Paralisia Cerebral Tetraespástica apresentam prejuízo no estado nutricional. OBJETIVO: Avaliar o estado nutricional de pacientes pediátricos com Paralisia Cerebral Tetraespástica de acordo com curvas de referência para essa população e comparar com as curvas de referência utilizadas para a população pediátrica em geral. MÉTODOS: Foram obtidos os dados de: altura do joelho, estatura estimada, peso, circunferência braquial e dobra cutânea triciptal. Valores de dobras e circunferências foram comparados com Frisancho e curvas específicas para esses pacientes foram utilizadas como referência. A relação entre os valores plotados na curva de crescimento para crianças saudáveis, Escore-Z e comparação com a curva referencial foram verificados através do teste exato de Fisher. O nível de significância adotado foi de 5%. RESULTADOS: Foram avaliados 54 pacientes. A média de idade foi de 10,2 anos, 34 eram do sexo masculino. Vinte cinco se alimentavam via gastrostomia e 29 via oral. A frequência de baixo peso pela curva referencial foi de 22,22%. Mais da metade dos pacientes apresentaram os parâmetros indicativos de massa magra abaixo do percentil 5. A estatura de todos os pacientes foi classificada como adequada para idade pela curva referencial. CONCLUSÃO: O baixo peso foi encontrado em 22% dos pacientes, e há maior tendência para que esses pacientes apresentem massa muscular reduzida e aumento da massa gorda, mostrando a necessidade de avaliação e intervenções apropriadas para pacientes com Paralisia Cerebral Tetraespástica.

Disability due to maternal common mental disorders (CMDs) as a risk factor for chronic childhood malnutrition: cross-sectional study / Incapacidade decorrente de transtornos mentais comuns (TMC) maternos como fator de risco para desnutrição crônica infantil: estudo transversal

ABSTRACT: CONTEXT AND OBJECTIVE: The disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mother's ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs. DESIGN AND SETTING: Cross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil. METHOD: The cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores < 2. The controls were 70 eutrophic children of the same age who were attending a day care center in the same area as the cases. The Self-Report Questionnaire made it possible to identify likely cases of maternal CMD. The Sheehan Disability Scale enabled evaluation of the associated disability. RESULTS: Chronic childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs. CONCLUSIONS: If confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.

RESUMO: CONTEXTO E OBJETIVO: A incapacidade associada aos transtornos mentais comuns (TMCs) maternos está entre as explicações possíveis para a associação entre a desnutrição infantil crônica e os TMCs. Os TMCs podem comprometer a capacidade materna de desempenhar seu papel, especialmente em ambientes precários. O presente estudo objetivou avaliar se a incapacidade relacionada com TMCs pode fazer parte do processo de associação entre a desnutrição infantil e TMCs maternos. DESENHO E LOCALIZAÇÃO: Estudo transversal realizado em duas instituições, uma para crianças desnutridas e outra para crianças eutróficas vivendo em uma comunidade de baixa renda no estado de Alagoas, Brasil. METODOLOGIA: Casos foram 55 crianças desnutridas de 12 a 60 meses atendidas num centro de recuperação nutricional com escore z da idade para altura < 2. Controles foram 70 crianças eutróficas da mesma idade que frequentavam uma creche na mesma área do que os casos. O "Self-Report Questionnaire" permitiu identificar casos prováveis de TMCs maternos; a "Sheehan Disability Scale" possibilitou a avaliação de incapacidade associada. RESULTADOS: A desnutrição crônica infantil e a incapacidade maternal relacionada ao TMCs mostraram-se associados (OR = 2.28, IC 95% 1.02-5.1). O melhor modelo de regressão logística utilizando desnutrição crônica infantil como variável dependente incluiu um maior número de residentes na casa, ausência do pai biológico na residência e incapacidade materna relacionada ao TMCs como variáveis independentes. CONCLUSÕES: Se confirmada, a associação entre desnutrição crônica infantil e incapacidade materna relacionada a TMCs pode ser útil para ajudar a identificar a cadeia causal entre a desnutrição infantil e os TMCs maternos e indicar fatores de risco ambientais associados com a desnutrição crônica infantil.

Nutritional evaluation of children with chronic cholestatic disease / Avaliação nutricional de crianças com colestase crônica

Abstract Objective: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. Methods: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). Results: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below −2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below −2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. Conclusion: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.

Resumo Objetivo: Avaliar a situação nutricional de crianças com colestase persistente e comparar os índices antropométricos entre crianças com e sem cirrose hepática e crianças com e sem icterícia. Métodos: Foram incluídas crianças com colestase persistente, ou seja, aumento da bilirrubina direta ou alterações na enzima canalicular, gamaglutamiltransferase (GGT). As medidas antropométricas foram peso, estatura ou altura, circunferência do braço (CB), espessura da prega cutânea do tríceps (TST), circunferência muscular do braço (CMB) e índice de massa corporal (IMC). Resultados: Foram avaliadas 91 crianças com colestase, com idade média de 12 meses; 33% e 30,8% dos pacientes apresentaram índices P/I e A/I com escore Z abaixo de –2, respectivamente. Com relação ao índice P/A e IMC, somente 12% e 16% dos pacientes, respectivamente, apresentaram escore Z abaixo de –2. Com relação à CB, 43,8% de 89 pacientes avaliados apresentaram alguma depleção. Observando a TST, 64% dos pacientes que apresentaram depleção, 71,1% dos 45 pacientes avaliados apresentaram algum grau de depleção com relação ao índice de CMB. Conclusão: A avaliação do peso em pacientes com doenças hepáticas crônicas poderá superestimar a situação nutricional devido a visceromegalia, edema subclínico ou ascite. Os índices que correlacionam peso e altura, como P/A e IMC, também podem não mostrar depleção devido à doença crônica em que há depleção tanto do peso quanto da altura. A TST, BC e CMB são parâmetros que estimam melhor a situação nutricional e devem fazer parte de gestão de pacientes com doenças hepáticas e colestase.

Association between order of birth and chronic malnutrition of children: a study of nationally representative Bangladeshi sample / Associação entre ordem de nascimento e desnutrição crônica em crianças: estudo de uma amostra nacional representativa em Bangladesh / Asociación entre el orden de nacimiento y la desnutrición crónica infantil: un estudio de una muestra representativa Bangladesí a nivel nacional

Abstract This paper examines the net effect of birth order on child nutritional status in Bangladesh using data from the Bangladesh Demographic Health Survey, 2011 (BDHS). Analyses were restricted to 4,120 surviving, lastborn singleton children who were younger than 36 months at the time of the survey. Logistic regression was used to assess the association between birth order and child nutritional status. Results indicate 38.1% children are stunted and 8.2% children are fifth or higher order birth. Order of birth is one of the significant predictors of child being stunted. Third order, fourth order, and fifth or higher order children are 24%, 30%, and 72%, respectively, more likely to be stunted after adjusting for all other variables. Besides birth order, results also indicate that child age, size at birth, birth intention, maternal education, maternal body mass index, wealth index, place of residence and mass media access exert strong influences over child malnutrition. Reducing birth rates which limit number of births and birth order as well may reduce child malnutrition in Bangladesh.

Resumo O estudo analisa o efeito ajustado da ordem de nascimento sobre estado nutricional em crianças de Bangladesh, com base em dados do Inquérito Nacional de Demografia e Saúde daquele país (BDHS) em 2011. As análises se limitaram a 4.120 nascidos vivos de parto único, últimos na ordem de nascimento e vivos e com menos de 36 meses de idade no momento do inquérito. A regressão logística foi utilizada para avaliar a associação entre ordem de nascimento e estado nutricional. Segundo os resultados, 38,1% das crianças apresentavam baixa estatura para a idade e 8,2% ocupavam quinto lugar ou mais na ordem de nascimento. A ordem de nascimento é preditor significativo de baixa estatura para a idade em crianças de Bangladesh. A terceira, quarta ou quinta posição ou mais na ordem de nascimento mostrou um aumento de probabilidade de 24%, 30% e 72%, respectivamente, de baixa estatura para a idade, depois de ajustar para todas as outras variáveis. Além da ordem de nascimento, os resultados indicam que a idade da criança, comprimento cabeça-nádega ao nascer, intenção da gravidez, escolaridade materna, índice de massa corporal materna, índice de riqueza familiar, lugar de residência e acesso aos meios de comunicação de massa têm forte influência sobre a desnutrição infantil. A redução da taxa de natalidade e consequente limitação do número de nascimentos e da ordem de nascimento podem também reduzir a desnutrição infantil em Bangladesh.

Resumen Este trabajo analiza el efecto neto del orden de nacimiento en el status nutricional infantil en Bangladés, utilizando datos de la Encuesta Demográfica Bangladesí sobre la Salud, 2011 (BDHS). Los análisis se restringieron a los últimos 4,120 bebés nacidos vivos, procedentes de un embarazo único, y que fueran menores de 36 meses en el momento de la realización de la encuesta. Se usó la regresión logística para evaluar la asociación entre el orden de nacimiento y el estado nutricional infantil. Los resultados indican que un 38.1% de los niños sufren retraso en su crecimiento y un 8.2% de los niños ocupan el quinto o un orden más elevado de nacimiento. El orden de nacimiento es uno de los predictores significativos del retraso en el crecimiento en los niños. Quienes ocupan el tercer, cuarto, quinto o puestos más elevados en este orden son niños que en un 24%, 30% y un 72%, respectivamente, tienen más probabilidad de sufrir retraso en su crecimiento tras ajustar para todos otras variables. Asimismo, los resultados en el orden del nacimiento también indicaban que la edad y tamaño del niño tras el parto, así como el carácter del nacimiento, la educación materna, el índice de masa corporal materna, de riqueza, el lugar de residencia y el acceso a medios de comunicación ejercen fuertes influencias sobre la desnutrición infantil. Reduciendo la tasa de natalidad que limita el número de nacimientos y el orden de nacimientos se podría llegar a reducir la desnutrición infantil en Bangladés.

Características psicológicas del niño/niña desnutrido / Psychological characterization of malnourished children

La desnutrición es considerada un tema de interés mundial ya que en ella se involucran derechos humanos básicos de las personas afectadas. Se ha escrito mucho sobre la desnutrición en sus aspectos médicos y nutricionales, tal vez menos desde la psicología y la educación. En ese sentido este artículo tiene como objetivo presentar el estado del arte acerca de la caracterización psicológica de niñas y niños que están sometidos a una condición de desnutrición clínica o subclínica y hacer un aporte desde la educación para su detección desde las escuelas con el posicionamiento del docente como un guardián n )=utricional. Se asume como una investigación de carácter documental con una metodología cualitativa de carácter crítico interpretativo orientada a recopilar información que se ha generado en relación a la caracterización psicológica de infantes que viven bajo esa condición, revisar nuevos aportes y proponer una perspectiva teórica desde la psicología y la educación que permita el análisis y comprensión del asunto tratado. Se recomienda su promoción y difusión en la comunidad académica interesada en esta problemática(AU)

Malnutrition is considered an issue of global concern since it involves basic human rights of affected people. Much has been written about malnutrition in its medical and nutritional aspects, perhaps less from psychology and education. In this sense, this article aims to present the state of art about the psychological characterization of children who are subjected to a clinical or subclinical malnutrition condition and make a contribution from the education for its detection from the schools with the positioning of the teacher as a nutritional guardian. It is assumed as a documental research with a qualitative methodology of critical interpretive character aimed at gathering information that has been generated in relation to the psychological characterization of infants living under this condition, to review new contributions and to propose a theoretical perspective since psychology and education that allows the analysis and understanding of the subject matter. It is recommended its promotion and diffusion in the academic community interested in this problem(AU)

Factores de riesgo de malnutrición por defecto en niños de 1 a 5 años / Risk factors of malnutrition default in children 1 to 5 years

Se realizó un estudio de caso y control en el Policlínico Universitario César Fornet de Banes, Holguín, 2010, para identificar factores de riesgo influyentes en la malnutrición por defecto de niños entre 1 a 5 años. El universo estuvo constituido por el total de niños de 1-5 años malnutridos por defecto (42 casos) y a la vez fue seleccionado un grupo control (83) a razón de 2 niños por 1 caso malnutrido que le siguió en el orden de registro de dispensarización, de la misma edad, sexo y presentar riesgo de malnutrición. Fueron revisadas las historias clínicas individuales y aplicadas una encuesta previamente validada. Se determinó la razón de productos cruzados y X2. Se encontró asociación significativa entre inadecuado hábito nutricional e higiénico de las madres, inadecuada situación económica y la disfunción familiar con la malnutrición por defecto en niños en tres 1-5 años. Se recomienda diseño e implementación de una intervención educativa(AU)

A case study and control was performed in the Teaching Polyclinic César Fornet Banes, Holguin, 2010, to identify risk factors, its influential malnutrition default of children between 1-5 years old. The universe: total malnourished children 1-5 years by default (42 cases) and also was selected a control (83) group at two malnourished children for each case followed in the order of registration of medical classification, at the same age, sex and at risk of malnutrition. Individual medical records were revised and applied a previously validated. The odds ratio was determined and X2 products. Significant associations between poor nutritional and hygienic habits of mothers, poor economic status and family dysfunction and malnutrition default in children 1-5 years were found. Design and implementation of an educational intervention is recommended(AU)

Inseguridad alimentaria y estado de nutrición en menores de cinco años de edad en México / Food insecurity and nutritional status of preschool children in Mexico

Objetivo. Estudiar la relación entre la desnutrición infantil y la inseguridad alimentaria (IA) en una muestra de hogares con preescolares en México. Material y métodos. Se analizó la información de 10 513 preescolares y sus familias. Se midió la IA de los hogares con la Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA). Se describen prevalencias de IA y desnutrición con variables asociadas y modelos logísticos. Resultados. 31% de los hogares presentaron IA moderada y severa. Los hogares rurales, del sur, los Q1 y Q2 y los indígenas presentaron las mayores prevalencias de IA moderada y severa. Se observa una tendencia de mayores prevalencias de desnutrición en el grupo con IA severa; las prevalencias de sobrepeso son similares en los cuatro grupos de IA. Conclusiones. El riesgo de desnutrición crónica es 42% mayor en menores de cinco años de hogares con IA severa en relación con los que viven en situación de seguridad alimentaria.

Objective. To describe the relation between malnutrition and food insecurity (FI) in preschool children from Mexico. Material and methods. Information of 10 513 preschool children and their families was analyzed. The FI was measured through the Latin American and Caribbean Food Security Scale (ELCSA). Adjusted prevalence of FI and malnutrition with related variables were assessed by logistic regression. Results. 31% of households had moderate and server FI. Rural and south, indigenous households, in the Q1 and Q2, showed the highest prevalence of moderate and severe FI as well. We observed a high tendency of malnutrition in the severe FI group; the prevalence of overweight was similar in the four groups of FI. Conclusions. The risk of chronic malnutrition is 42% bigger in children less than five years old with severe FI than in those that experienced food security.

Avaliação antropométrica dos pacientes com paralisia cerebral: quais as curvas mais adequadas? / Anthropometric assessment of patients with cerebral palsy: which curves are more appropriate?

OBJETIVO: Descrever a avaliação nutricional de crianças com paralisia cerebral, verificando a concordância de curvas de crescimento específicas para paralisia cerebral com curvas gerais, além de avaliar a presença das manifestações digestórias associadas a agravos nutricionais. MÉTODOS: Corte transversal de 187 indivíduos com paralisia cerebral, avaliando-se dados antopométricos em curvas habitualmente utilizadas em pediatria e em curvas específicas para paralisia cerebral, além da descrição da presença de disfagia, constipação intestinal e infecções respiratórias de repetição. RESULTADOS: Dos indivíduos, 58% eram masculinos; média de idade de 5,6 anos ± 3,5 anos. Dados antopométricos de peso abaixo do percentil 10 ocorreu em 10% da amostra, considerando a escala para paralisia cerebral, contra 51% na referência do Center of Disease Control (p < 0,01; Kappa 0,19). A maioria dos indivíduos comprometidos com disfagia, infecções respiratórias de repetição e constipação intestinal encontrava-se abaixo do percentil 50, com porcentagens respectivas de 67%, 75% e 72%. CONCLUSÃO: As referências habitualmente utilizadas em pediatria tendem a superestimar a desnutrição em indivíduos com paralisia cerebral, e sua concordância com referências específicas para paralisia cerebral é baixa. As manifestações digestórias foram encontradas principalmente naqueles indivíduos cujas medidas antropométricas encontram-se abaixo do percentil 50.

OBJECTIVE: To describe the nutritional assessment of children with cerebral palsy, verifying the correlation of growth curves specific for cerebral palsy with general curves, in addition to assessing the presence of digestive manifestations associated with nutritional problems. METHODS: This was a cross-sectional study of 187 individuals with cerebral palsy, evaluating anthropometric data in curves commonly used in pediatrics and specific curves for cerebral palsy, in addition to the description of presence of dysphagia, constipation, and respiratory infections. RESULTS: 58% of patients were males, with a mean age of 5.6±3.5 years. Anthropometric data of weight below the 10th percentile occurred in 10% of the sample considering the cerebral palsy scale, versus 51% when considering the reference from the Centers for Disease Control and Prevention (p < 0.01; Kappa 0.19). The weight of most individuals with dysphagia, recurrent respiratory infections, and constipation was below the 50th percentile, with respective percentages of 67%, 75%, and 72%. CONCLUSION: The references commonly used in pediatrics tend to overestimate malnutrition in individuals with cerebral palsy, and their correlation with specific references for cerebral palsy is low. Digestive manifestations were mainly found in those individuals whose anthropometric measurements were below the 50th percentile.

Disfunción familiar como factor asociado a desnutrición crónica en niños menores de 5 años en un centro de salud de Lima - Perú, 2012 / Family dysfunction as a factor associated with chronic malnutrition in children less than 5 years in a health center in Lima - Peru, 2012

Introducción: Desnutrición infantil es un problema de salud pública. La disfunción familiar ha sido asociada a desnutrición infantil. Investigación en esta línea se ha desarrollado en algunos países latinoamericanos pero no se tiene información en Perú. El objetivo fue demostrar la asociación entre disfunción familiar y desnutrición crónica en niños menores de 5 años. Material y métodos: Estudio cuantitativo, diseño analítico transversal. Muestra: 92 niños menores de 5 años, usuarios del C.S. Surquillo (Lima) en 2012. Datos recogidos: edad, talla, peso de los niños para índices talla/edad, peso/talla, peso/edad (v. dependiente). Además funcionalidad familiar, institucionalidad del parto, grado de instrucción y ocupación de la madre (v. independiente). Cálculos realizados con nivel de confianza 95 por ciento y valor alfa 0,05. Resultados: 53,3 por ciento niños y 46,7 por ciento niñas. Parto no institucional: 4 (4,3 por ciento); 63 por ciento de las madres trabajaban y la mayoría tenía instrucción secundaria (65,22 por ciento). Funcionalidad familiar: Buena: 9,8 por ciento, disfunción leve: 55,4 por ciento, disfunción moderada: 27,2 por ciento y disfunción severa: 7,6 por ciento. La muestra se estratificó según puntuaciones Z, obteniendo que 9,8 por ciento estuviera en riesgo de talla baja y 22,8 por ciento con sobrepeso. La funcionalidad familiar estuvo asociada con los índices T/E, P/T y P/E, realizándose Chi cuadrado y simulación de Monte Carlo para variables categóricas y las pruebas de correlación de Pearson y regresión lineal para variables cuantitativas. También mostró asociación el grado de instrucción materno con los índices T/E y P/E. Institucionalidad del parto y ocupación de la madre no mostraron asociación con el estado nutricional. Conclusiones: La funcionalidad familiar y el grado de instrucción materno estuvieron asociados al estado nutricional de los niños de la muestra. Es conveniente realizar estudios de corte poblacional y con muestreo...

Introduction: Children’s malnutrition is a public health problem. Family dysfunction has been associated with children's malnutrition. Investigation in this topic has been done in some Latin-Americans countries, but in Peru there’s no information. The objective was to demonstrate association between family dysfunction and chronic malnutrition in children under five years-old. Methods: Quantitative study. Design: transversal analytic. Were enrolled 92 children under 5 years-old, users of Surquillo Health Center (Lima) in 2012. Data collected: age, length, weight of children for length/age, weight/length and weight/age index. Also were collected family functionality, institutional birth, instruction grade and mothers occupation. Analysis was done with CI: 95 per cent and 0.05 alpha value. Results: 53.3 per cent was male and 46.7 per cent female. Non institutional birth: 4.3 per cent; 63 per cent of mothers work and the majority have high school instruction (65.22 per cent). Family functionality: good 9.8 per cent, mild dysfunction 55.4 per cent, moderate dysfunction 27.2 per cent and severe dysfunction 7.6 per cent. Participants were stratified by Z punctuations, obtaining 9.8 per cent with low length risk and 22.8 per cent with overweight. Family functionality was associated with L/A, W/L and W/A index, using Chi squared and Monte Carlo simulation for categorical variables and Pearson correlation test and lineal regression test for quantitative variables. Also mothers instruction grade was associated with L/A and W/A index. Institutional birth and mother’s occupation were not associated with nutritional status. Conclusions: Family functionality and mother’s instruction grade were associated with nutritional status of children enrolled. It is convenient to do population studies and with randomized samples for to evaluate family dysfunction and its association with chronic malnutrition in children. Diffusion of these results will let to promote strategies for to...

Fallo de medro / Failure to thrive

El fallo de medro es un síndrome caracterizado por aumentos de peso y talla inadecuados y actitudes anómalas en las comidas y que pueden ocasionar un retraso en el desarrollo motor y en posibilidades de avance social. Aunque tradicionalmente se habla de un fallo de medro de origen orgánico cuando es posible detectar una enfermedad de base que lo ocasione y de fallo de medro no orgánico cuando este nexo no existe, en la práctica en la mayoría de casos ambos factores concurren. En todo caso en su mantenimiento existe una ingesta insuficiente para cubrir los requerimientos de energía y de otros nutrientes y, por tanto, es preciso garantizar un aporte nutricional suficiente. La identificación de la enfermedad y de los factores causantes del mismo de una forma temprana mejora la recuperación y el pronóstico. Junto al consejo nutricional y el apoyo psicológico se precisa, en muchas ocasiones, un soporte nutricional específico. Para mejorar el aporte calórico podemos recurrir al empleo de alimentos de uso ordinario, al uso de módulos nutricionales o de dietas enterales. En los casos más graves incluso se precisa el concurso de nutrición enteral por sonda u ostomía. En los casos más graves de fallo de medro no orgánico puede ser necesario la valoración y el seguimiento por un equipo de salud mental. El cálculo de los requerimientos para conseguir la rehabilitación nutricional (catch-up growth) se basa en determinar la cantidad de tejido magro y de tejido graso que es preciso recuperar y el tiempo que se precisa para la recuperación. Junto al desarrollo de herramientas de cribado para la detección precoz del desmedro, en especial en el paciente hospitalizado, es preciso adecuar el tratamiento nutricional a las características de la enfermedad, distinguiendo las que son órgano-específicas de las que tienen una participación sistémica (AU)

Failure to thrive is a syndrome characterized by inappropriate weight and height increases and abnormal attitude towards foods that may lead to delayed motor development and progression in social capabilities. Traditionally, failure to thrive is classify as organic when an underlying disease can be diagnosed and non-organic failure when there is no such relationship: however, in the clinical practice both instances may coexist. Whatever the case, insufficient food intake to cover the demands of energy and other nutrients perpetuates the situation and therefore it is necessary to warrant sufficient nutritional support. Early identification of the disease and the causing factors improves the recovery and prognosis. Many times, specific nutritional support is needed, besides nutritional counseling and psychological support. In order to improve the caloric intake, one may use ordinary foods, nutritional modules, or enteral diets. In the most severe cases, enteral nutrition through nasogastric tube or ostomy may be necessary. In the most severe cases of non-organic failure to thrive, assessment and follow-up by the mental health team may be indicated. The calculation of the nutritional demands to achieve nutritional rehabilitation (catch-up growth) is based on the determination of the amount of lean and fat tissues that have to be recovered, and the time needed for the recovery. Together with the development of screening tools for early detection of failure to thrive, especially in the hospitalized patient, it is necessary to match the nutritional therapy to the disease characteristics, differentiating between those that are organ-specific from those that have a systemic participation (AU)

Nutrición parenteral intrahemodialítica / Intrahemodialytic parenteral nutrition

Los estudios demuestran grandes ventajas al manejar nutrición parenteral intrahemodialítica (NPID). La ventaja más trascendente es respecto a la condición clínico metabólica del paciente. Las desventajas puedenser metabólicas, mecánicas, y económicas. La valoración del estado nutricional considera aspectos antropométricos y bioquímicos. Los carbohidratos se indican a 5mg/kg/min de dextrosa; los aminoácidosdeben proveer 1.3g de proteínas kg/día; los lípidos se administran a 0.5ml/min al inicio de la infusión; elvolumen se realizará en función a cada uno de los nutrimentos; los oligoelementos y vitaminas no estánindicadas en la NPID.

Studies show great advantages in handling intrahemodialytic parenteral nutrition (NPID). The most significant advantage is to the metabolic clinical condition of the patient. The disadvantages may be metabolic, mechanical, and economic. The assessment of nutritional status must considered anthropometricand biochemical aspects. Carbohydrates are listed 5 mg/kg/min dextrose, amino acids should provideprotein 1.3 g/kg/ day, lipids must be administered 0.5 ml/min at the start of the infusión, the volumen is madeaccording to each nutrients, trace elements and vitamins are not listed in the NPID.

Una ingesta inadecuada de manganeso podría contribuir a la aparición de resistencia a la insulina en niñas / An inadequate intake of manganese may favour insulin resistance in girls

Objetivo: Estudiar la relación entre la adecuación de la ingesta de manganeso (Mn) y los niveles de glucosa, de insulina y la existencia de resistencia a la insulina en escolares sanos de la Comunidad de Madrid (España). Material y métodos: Se estudiaron 573 escolares entre 8 y 13 años. La ingesta de energía y nutrientes (entre ellos el Mn) se determinó mediante un registro del consumo de alimentos durante 3 días. La ingesta de Mn se comparó con las Ingestas Adecuadas (IA) existentes para dicho mineral. Los parámetros antropométricos estudiados fueron el peso y la talla y se determinó el índice de masa corporal (IMC) a partir de los mismos. Se determinaron los niveles de insulina y glucosa en ayunas y se calculó el índice HOMA para determinar la presencia de resistencia a la insulina en los escolares. Resultados: Las niñas con ingesta de Mn inadecuadas (no llegaron a cubrir el 100% de las IA) presentaron, a su vez, mayores niveles de insulina y de HOMA que las niñas con ingestas superiores o iguales al 100% de las IA marcadas. Al tener en cuenta diferentes factores de confusión (ingesta energética, ingesta de hidratos de carbono y lípidos, IMC y edad), se observó una relación positiva y significativa entre la cobertura de las IA de Mn y los niveles de HOMA en niñas. Conclusión: Se destaca la importancia de cubrir el 100% de las IA de Mn en las niñas con el fin de prevenir la aparición de resistencia a la insulina y una futura diabetes tipo 2 (AU)

Aim: to study the relationship between an adequate manganese (Mn) intake and glucose, insulin levels and insulin resistance among healthy children from Madrid (Spain). Materials and methods: 573 schoolchildren between 8 and 13 years old were studied. Energy and nutrients intake (especially Mn) was calculated with a "3-day diet record". Mn intake was compared to Adequate Intakes (AI) for this mineral. Weight and height were measured and body mass index (BMI) calculated. Fasting glucose and insulin were determined and the HOMA index was calculated to establish the presence of insulin resistance in children. Results: Girls with and inadequate intake (below the 100% of the AI value) had higher insulin and HOMA values than girls with adequate AI values (equal or higher to 100% of AI). Having in mind confounding factors (energy, carbohydrates and lipids intake, BMI and age), a significant positive correlation was found between the contribution of Mn intake to AI and HOMA levels in girls. Conclusion: It seems important to ensure an adequate Mn intake in girls in order to prevent insulin resistance and diabetes type 2 in the future (AU)