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1.
Pan Afr Med J ; 33: 195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692657

RESUMO

Pellagra is a nutritional disorder of niacin deficiency which is characterized by triad of dermatitis, diarrhea and dementia. It is often seen in a state of poor nutrition among alcoholics, homeless and patients suffering from malabsorption. Though seldom occurs in children, its re-emerging is seen as a result of worsening food security in vulnerable population during conflict or insurgency. We report the case of 12-year-old female pastoralist who presented darkening and thickening of the hands, feet, ankles, neck and her upper trunk. Conflicts and insurgency usually occur in resource constraint settings where health workers are few and overworked. Therefore, continuously educating health workers and the general public regarding nutrition and its disorders like pellagra is a priority. Public Health authorities and policy makers also ought to take pediatric nutrition serious in order to avoid its escalation in internally displaced persons or children orphaned by insurgency.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Niacina/deficiência , Pelagra/diagnóstico , Criança , Feminino , Humanos
2.
Afr Health Sci ; 19(2): 1897-1909, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656473

RESUMO

Background: One of the public health problems in developing countries is child malnutrition. An important factor for children's well-being is good nutrition. Therefore, the malnutrition status of children under the age of five is an important outcome measure for children's health. This study uses the proportional odds model to identify risk factors associated with child malnutrition in Ethiopia using the 2016 Ethiopian Demographic and Health Survey data. Methods: This study uses the 2016 Ethiopian Demographic and Health Survey results. Based on weight-for-height anthropometric index (Z-score) child nutrition status is categorized into four levels namely- underweight, normal, overweight and obese. Since this leads to an ordinal variable for nutrition status, an ordinal logistic regression (OLR)proportional odds model (POM) is an obvious choice for analysis. Results: The findings and comparison of results using the cumulative logit model with and without complex survey design are presented. The study results revealed that to produce the appropriate estimates and standard errors for data that were obtained from complex survey design, model fitting based on taking the survey sampling design into account is better. It has also been found that for children under the age of five, weight of a child at birth, mother's age, mother's Body Mass Index (BMI), marital status of mother and region (Affar, Dire Dawa, Gambela, Harari and Somali) were influential variables significantly associated with underfive children's nutritional status in Ethiopia. Conclusion: This child's age of a child, sex, weight of child at birth, mother's BMI and region of residence were significant determinants of malnutrition of children under five years in Ethiopia. The effect of these determinants can be used to develop strategies for reducing child malnutrition in Ethiopia. Moreover, these findings show that OLR proportional odds model is appropriate assessing thedeterminants of malnutrition for ordinal nutritional status of underfive children in Ethiopia.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Antropometria , Índice de Massa Corporal , Peso Corporal , Criança , Transtornos da Nutrição Infantil/diagnóstico , Pré-Escolar , Etiópia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Desnutrição/etiologia , Obesidade/epidemiologia , Prevalência , Características de Residência , Fatores Socioeconômicos , Magreza/epidemiologia
3.
BMC Res Notes ; 12(1): 391, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296269

RESUMO

OBJECTIVE: The aim of this study was to assess the risk factors for malnutrition among children aged 0-59 months in Ethiopia. The analyzed data were obtained from the 2016 EDHS and 9495 under-5 years' children were considered in this analysis. The data was extracted, edited and analyzed by using SPSS Version 23.0. Both bivariate and multivariable binary logistic regression model was used to identify the determinants of children malnutrition. RESULTS: The prevalence of stunting, wasting, and underweight were 38.3%, 10.1%, and 23.3%, respectively. About 19.47% of children were both stunted and underweighted, and only 3.87% of children had all the three conditions. Among the factors that considered in this study, age of a child, residence region, mothers' education level, mothers' BMI, household wealth index, sex of a child, family size, water and toilet facility were significantly associated with malnutrition in Ethiopia. The authors concluded that malnutrition among under-five children was one of the public health problems in Ethiopia. Therefore, the influence of these factors should be considered to develop strategies for reducing malnutrition in Ethiopia.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Transtornos do Crescimento/diagnóstico , Estado Nutricional , Magreza/diagnóstico , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Etiópia/epidemiologia , Feminino , Transtornos do Crescimento/epidemiologia , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Magreza/epidemiologia
4.
BMC Res Notes ; 12(1): 434, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324270

RESUMO

OBJECTIVE: In humanitarian settings, children of pastoralists usually are the increased risk of malnutrition and its related complications. Consequently, as part of the program's targeted response to the burgeoning malnutrition caseloads, a nutrition and mortality survey was conducted using a global standardized methodology in humanitarian settings in Ikwotos country of the Eastern Equatoria of South Sudan. Additionally, in understanding the intricacies of food diversity consumed in the households, we used infants as a proxy of household feeding and collected information on the range of foods consumed by households. DATA DESCRIPTION: Data contained in this note is a standard cross-sectional survey conducted in South Sudan with children between the ages of 6 and 59 months, although the mortality component covered all members of the household. While data for mortality and infant feeding practices were self-reported, the assessment of nutritional status were in accordance to the World Health Organisation's guidelines for nutrition assessment. Age, sex, height and mid-upper arm circumference data were assessment and malnourished children were classified as those with Z-score between - 2 and - 3 and those above - 3 were classified as severely malnourished.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Fazendeiros/estatística & dados numéricos , Fazendas , Desnutrição/diagnóstico , Socorro em Desastres/estatística & dados numéricos , Doença Aguda , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Estudos Transversais , Comportamento Alimentar , Feminino , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Lactente , Masculino , Desnutrição/mortalidade , Mortalidade/tendências , Estado Nutricional , Sudão do Sul
5.
Nutrients ; 11(7)2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31284369

RESUMO

Even though limited evidence is available, the relationship between morbidity and under-nutrition among children under-five is likely to be a strong two-way association. This study aims to explore this vicious cycle by employing longitudinal data of four periods within a 24 month follow-up, whereby morbidity was captured between two subsequent anthropometric measures. Malnutrition was classified according to z-scores of anthropometric measures and morbidity by number of sick days experienced inbetween. Mixed-effects models were used to assess this relation, where dependency of morbidity and nutritional status were interchanged; models were adjusted for province, age, gender, wealth index score, maternal education level, diet, and Water, Sanitation, and Hygiene indicators. Stunting and wasting prevalences were 29.9% and 8.9%, respectively, where 21.3% of the children hadmultiple anthropometric failures. Children identified as wasted were 35% more likely to experience prolonged illness periods (OR: 1.35, 95% CI: 1.02-1.56). Those experiencing high proportion of sick days were found to be 64% more likely to become stunted (OR: 1.64, 95% CI: 1.18-2.29). This study suggests that the link between wasting and stunting could be partly explained by acute illness, where wasting increases the likelihood of prolonged epiosed of illness, which increases the risk of stunting.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Fatores Etários , Camboja/epidemiologia , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
Nutrients ; 11(7)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31261779

RESUMO

Little is known about the prevalence of anaemia and associated factors in school children in Vietnam. In this cross-sectional study, we aimed to determine the prevalence of anaemia and its subtypes, and the associations of types of anaemia with demographic, socio-economic and anthropometric factors among 6-9-year-old primary school children in rural areas of Hai Phong City, Vietnam. Haemoglobin (Hb) and mean corpuscular volume (MCV) were measured, and demographic, socio-economic and anthropometric data were collected in 893 children from eight primary schools. The prevalence of anaemia (Hb < 115 g/L) was 12.9% (95% CI: 8.1%, 19.9%), microcytic anaemia (Hb < 115 g/L and MCV < 80 fL) was 7.9% (95% CI: 5.3%, 11.6%) and normocytic anaemia (Hb < 115 g/L and MCV 80-90 fL) was 5.3% (95% CI: 2.9%, 9.5%). No child presented with macrocytic anaemia (Hb < 115 g/L and MCV > 90 fL). Children who were underweight, wasted, or in anthropometric failure (either underweight, stunted or wasted) were more likely to be anaemic (all p ≤ 0.004), and specifically, to have normocytic anaemia (all p ≤ 0.006), than those who were not underweight, wasted or in anthropometric failure. Stunted children were more likely to be anaemic (p = 0.018) than those who were not stunted. Overweight/obese children were less likely to be anaemic (p = 0.026) or have normocytic anaemia (p = 0.038) compared with children who were not overweight/obese. No anthropometric status indicator was associated with the risk of microcytic anaemia. No demographic or socio-economic factor was associated with any type of anaemia. Anaemia remains a public health issue in rural areas in Hai Phong City, Vietnam, and future approaches for its prevention and control should target undernourished primary school children.


Assuntos
Anemia/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Desnutrição/epidemiologia , Estado Nutricional , Saúde da População Rural , Fatores Socioeconômicos , Estudantes , Fatores Etários , Anemia/sangue , Anemia/diagnóstico , Anemia Macrocítica/sangue , Anemia Macrocítica/diagnóstico , Anemia Macrocítica/epidemiologia , Biomarcadores/sangue , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Estudos Transversais , Feminino , Hemoglobinas/análise , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Vietnã/epidemiologia
7.
Nutr. hosp ; 36(3): 545-551, mayo-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184550

RESUMO

Objective: differences have been shown between males and females in terms of the prevalence of malnutrition in different parts of the world, which point to discrimination against females, including with respect to full breastfeeding. Therefore, the objective was to show that exclusive breastfeeding is less common for females in a population of medium-low and low socioeconomic strata. Methods: this was a cross-sectional analysis of a sample of 170 mother-infant dyads according to type of feeding (74 full breastfeeding, 57 partial breastfeeding and 39 human milk substitutes) at the Nuevo Hospital Civil de Guadalajara. Dependent variables according to type of feeding: full breastfeeding (exclusive and/or predominant), partial breastfeeding, and human milk substitutes. Independent variables: demographic data, schooling, occupation of mothers and/or parents, and family income. Kruskal-Wallis, Mann-Whitney U and Chi-square tests and odds ratio were used. Results: the probability of full breastfeeding was 3.8 times lower in females than in males. In a non-significant way, the likelihood of full breastfeeding was lower than that of partial breastfeeding, and full breastfeeding was lower than the combination of partial breastfeeding and human milk substitutes in females. Full breastfeeding and partial breastfeeding were lower than human milk substitutes, and partial breastfeeding was lower than human milk substitutes in females. Conclusion: there is a differentiated character in the privilege of full breastfeeding; it is four times lower in females than in males


Objetivo: se han observado diferencias entre niñas y varones en la prevalencia de desnutrición en diferentes partes del mundo, lo que apunta a la discriminación contra las niñas, incluso con respecto a la lactancia materna completa. El objetivo fue mostrar que la lactancia completa es menos común en las niñas en una población de estratos socioeconómicos medio-bajo y bajo. Métodos: se realizó un análisis transversal de una muestra de 170 díadas madre-lactante según el tipo de alimentación (74 de lactancia completa, 57 de lactancia parcial y 39 sucedáneos de la leche humana) en el Nuevo Hospital Civil de Guadalajara. Variables dependientes según el tipo de alimentación: lactancia completa (exclusiva y/o predominante), lactancia parcial y sucedáneos de leche humana. Variables independientes: datos demográficos, escolaridad, ocupación de madres y/o padres e ingresos familiares. Se utilizaron pruebas de Kruskal-Wallis, Mann-Whitney U y Chi-cuadrado y razón de momios. Resultados: la probabilidad de lactancia materna completa fue 3,8 veces menor en niñas que en varones. De manera no significativa, la probabilidad de lactancia completa fue menor que la de lactancia parcial y la frecuencia de lactancia completa fue menor que la combinación de lactancia parcial y sucedáneos de leche humana en niñas. La frecuencia de lactancia completa y lactancia parcial fue menor que los sucedáneos de leche humana y la lactancia parcial fue menos frecuente que los sucedáneos de leche humana en niñas. Conclusión: hay un carácter diferenciado en el privilegio de ofrecer lactancia materna completa. Es cuatro veces menor en las niñas que en varones


Assuntos
Humanos , Masculino , Feminino , Lactente , Aleitamento Materno/métodos , Transtornos da Nutrição Infantil/dietoterapia , Transtornos da Nutrição Infantil/diagnóstico , Desnutrição/epidemiologia , Gênero e Saúde , Igualdade de Gênero , México , Estudos Transversais
8.
Nutr. hosp ; 36(3): 611-617, mayo-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184559

RESUMO

Introduction: the purpose of this study was to evaluate the relationship of arm anthropometric indicators with direct indicators of nutritional status in hospitalized pediatric patients. Methods: an analytical cross-sectional study with 760 patients hospitalized in the Pediatric Division of the Nuevo Hospital Civil de Guadalajara during 2014 was used. The anthropometric indices were weight/length, weight/height, weight/age, length/age, height/age, head circumference/age and body mass index (BMI)/age. The arm indicators were mid-upper arm circumference (MUAC), total arm area (TAA), arm muscle area (AMA), arm fat area (AFA) and fat percentage (FP). The ANOVA, Kruskall-Wallis, Mann-Whitney U and Pearson's correlation tests and also odds ratios were used to identify the probability of nutritional status impairment. Results: the prevalence of acute and chronic malnutrition was higher in infants (31% and 30%, respectively). With arm areas (TAA, AMA, AFA), the risk of deficit (≤ -2DE) was higher in infants and early preschoolers (p < 0.001). The correlation between the anthropometric indexes and the arm areas was direct and significant (p < 0.001). The BMI variability was explained in 68% by the AMA, AFA, and FP (p < 0.001); the variability of the height/age index was also explained in 34% by the AMA and AFA (p < 0.001). Conclusion: it is possible to diagnose both a chronic and acute deficit using the indirect indicators of the arm, while the body mass index only reflects an acute deficit. Therefore, arm areas would be more useful indicators in the assessment of nutritional status and the diagnosis of chronic-acute malnutrition in hospitalized pediatric patients


Introducción: el objetivo de este estudio fue evaluar la relación de los indicadores antropométricos de brazo con los indicadores directos del estado de nutrición en pacientes pediátricos hospitalizados. Métodos: se utilizó un estudio transversal analítico con 760 pacientes ingresados en la División de Pediatría del Nuevo Hospital Civil de Guadalajara durante 2014. Los índices antropométricos fueron peso/longitud, peso/altura, peso/edad, longitud/edad, altura/edad, circunferencia cefálica e IMC. Los indicadores del brazo fueron circunferencia media del brazo (CMB), área total del brazo (ATB), área muscular del brazo (AMB), área grasa del brazo (AGB) y porcentaje de grasa. Se utilizaron las pruebas de ANOVA, Kruskall-Wallis, U de Mann-Whitney, correlación de Pearson y razón de momios para identificar la probabilidad de deterioro del estado nutricional. Resultados: la prevalencia de desnutrición aguda y crónica fue mayor en lactantes (31% y 30%, respectivamente). Con las áreas del brazo (ATB, AMB, AFA), el riesgo de déficit (≤ -2 DE) fue mayor en lactantes y preescolares tempranos (p < 0,001). La correlación entre los índices antropométricos y las áreas del brazo fue directa y significativa (p < 0,001). La variabilidad del IMC fue explicada en un 68% por AMB, AGB y porcentaje de grasa (p < 0,001); la variabilidad del índice de talla/edad también fue explicada en un 34% por AMB y AGB (p < 0,001). Conclusión: es posible diagnosticar el déficit crónico y agudo utilizando los indicadores indirectos del brazo, mientras que el IMC solo refleja un déficit agudo. Las áreas de brazo serían indicadores más útiles en el diagnóstico de desnutrición crónica-aguda en pacientes pediátricos hospitalizados


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Braço/fisiologia , Circunferência Braquial , Antropometria/instrumentação , Composição Corporal/fisiologia , Hospitalização , Antropometria/métodos , Estado Nutricional , Transtornos da Nutrição Infantil/dietoterapia , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição do Lactente , Análise de Variância , Inquéritos e Questionários , Modelos Lineares
9.
Dev Med Child Neurol ; 61(10): 1175-1181, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30937885

RESUMO

AIM: To develop and validate a screening tool for feeding/swallowing difficulties and/or undernutrition in children with cerebral palsy (CP). METHOD: This cross-sectional, observational study included 89 children with CP (63 males, 26 females; median age 6y 0mo; interquartile range 4y 0mo-8y 11mo), across all Gross Motor Function Classification System levels. Children with feeding tubes were excluded. Children were classified as well-nourished or moderately to severely undernourished, using the paediatric Subjective Global Nutrition Assessment. Eating and drinking abilities were classified using the Eating and Drinking Ability Classification System (EDACS) from mealtime observation and videofluoroscopic swallow studies when indicated. Parents/caregivers answered 33 screening questions regarding their child's feeding/swallowing abilities and nutritional status. The diagnostic ability of each question for identifying children with feeding/swallowing difficulties and undernutrition was calculated and the combination of questions with the highest sensitivity and specificity identified. RESULTS: Feeding difficulties impacted on swallow safety in 26 children (29%) and 26 children (29%) were moderately or severely undernourished. The 4-item final tool had high sensitivity and specificity for identifying children with feeding/swallowing difficulties (81% and 79% respectively) and undernutrition (72% and 75% respectively). The tool successfully identified 100 per cent of children with severe undernutrition and 100 per cent of those classified as EDACS level IV or V. INTERPRETATION: Screening for feeding/swallowing difficulties and undernutrition will enable early identification, assessment, and management for those children in need. WHAT THIS PAPER ADDS: A screening tool with high sensitivities and specificities for identifying children with feeding/swallowing difficulties and undernutrition. The tool identified 100 per cent of children with severe undernutrition. The tool identified 100 per cent of children in Eating and Drinking Ability Classification System levels IV or V.


Assuntos
Paralisia Cerebral/diagnóstico , Transtornos da Nutrição Infantil/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Inquéritos e Questionários/normas , Paralisia Cerebral/complicações , Criança , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Estudos Transversais , Transtornos de Deglutição/complicações , Avaliação da Deficiência , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Feminino , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
10.
Dev Med Child Neurol ; 61(10): 1168-1174, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30927269

RESUMO

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).


Assuntos
Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/diagnóstico , Antropometria , Índice de Massa Corporal , Criança , Transtornos da Nutrição Infantil/complicações , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
East Mediterr Health J ; 25(1): 18-23, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30919921

RESUMO

Background: Identification of children at risk of malnutrition is not easily achieved in hospital settings. Aims: To assess the merits of using the Screening Tool for Risk on Nutritional status and Growth (STRONGkids) as a nutrition screening tool in hospitalized children aged < 3 years and correlate it with the severity of their nutritional derangements. Methods: This cross-sectional study was conducted on 500 children aged < 3 years admitted to the Children's Hospital, Ain Shams University, Cairo, Egypt. STRONGkids score was used to assess the risk for nutritional derangements and World Health Organization growth charts were used to define underweight, wasted and stunted patients upon admission and discharge. Results: According to STRONGkids score, 19.6% of patients were low risk, 42.6% were moderate risk and 37.8% were high risk. Out of the enrolled patients, 62.4% were underweight, 58.4% were stunted and 57.8% were wasted. Among the 66 patients with severe wasting, nutritional status improved in 6.06% while deterioration was observed in 13.0% of the moderately wasted patients. STRONGkids score was worse among those who deteriorated, which together with its significant positive correlation with the duration of hospital stay, emphasized that STRONGkids score can be a predictive tool. Conclusions: The use of STRONGkids screening tool can ensure early identification of children vulnerable to malnutrition, ensuring prompt interventions that may contribute to overall improvements in patient care, as well as shortening hospitalization period.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Criança Hospitalizada/estatística & dados numéricos , Programas de Rastreamento/métodos , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Egito/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Avaliação Nutricional , Estado Nutricional , Medição de Risco
12.
East Mediterr Health J ; 24(12): 1119-1126, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30799551

RESUMO

Background: Impaired nutritional status is a major health problem affecting young children in developing countries that has a significant impact on child morbidity and mortality. Aims: This study aimed to assess the prevalence of undernutrition among children aged < 5 years, using conventional indices and the Composite Index of Anthropometric Failure (CIAF), and then comparing their estimated results. Methods: A community-based cross-sectional study was conducted and information was collected through house-tohouse visits using precoded structured records. We analysed data from 1292 children aged 6-59 months, from Ahwar and Al-Mahfed rural districts in Abyan Governate, South Yemen, with reference to the 2006 World Health Organization growth standards. Results: CIAF identified undernutrition in 70.1% of children, while conventional anthropometric indices revealed 38.5% stunting, 39.9% wasting, and 55.1% underweight. Compared with conventional indices, CIAF aggregate recognized 31.6%, 30.2% and 15% more undernourished children than stunting, wasting and underweight separately. According to CIAF, 21% had a single anthropometric failure and 49.2% exhibited multiple failures. Stunting Index, Wasting Index and Underweight Index were 0.55, 0.57 and 0.79, respectively. Conclusions: CIAF gives a better estimate of undernutrition than currently used conventional indices; identifies more children with multiple anthropometric failures; and reflects a wider view of the extent and pattern of undernutrition of children living in communities with limited resource settings.


Assuntos
Antropometria/métodos , Transtornos da Nutrição Infantil/diagnóstico , Avaliação Nutricional , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Prevalência , População Rural , Iêmen/epidemiologia
13.
Nutr Clin Pract ; 34(4): 581-588, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30644589

RESUMO

OBJECTIVES AND STUDY: Failure to thrive (FTT) is an interruption in the normal pattern of growth. We aimed to evaluate the clinical characteristics, underlying etiologies, diagnostic workup, and frequency of micronutrient deficiencies (MDs) in children with FTT. METHODS: This retrospective study was done with 729 children (319 male, mean age 6.8 ± 5.5 years) with FTT (weight for age <3rd percentile) who had visited the Pediatric Gastroenterology outpatient clinic between 2011 and 2016. Children who had previously known chronic diseases, inadequate intake, or inadequate absorption were excluded. Acute malnutrition was considered if weight-for-age z-scores were below -2 and height-for-age z-scores were above -2, and chronic malnutrition was defined if height-for-age z-scores were below -2. RESULTS: The malnutrition rate was 57.1% (acute: 37.8%, chronic: 19.3%). Of children, 98.7% had laboratory evaluation. We found that 1.1% of laboratory tests, 0.4% of imaging studies, 27% of endoscopic findings, and biopsy results led to a specific diagnosis, equating to a total of 1.3% of diagnostic workup leading to a diagnosis related to FTT. The causes of FTT were inadequate nutrition (61.4%), psychiatric and behavioral disorders (17.2%), endocrinologic disorders (9%), recurrent infections (6.4%), gastrointestinal diseases (1.9%), and cardiac disorders (0.1%). Vitamin A and D deficiencies were the most common MD. CONCLUSION: We showed that the most common cause of FTT is "purely nutrition" FFT because of inadequate caloric intake, and extensive diagnostic workup is rarely helpful to reveal the etiology. These results implicate the importance of clinical evaluation and anthropometry to evaluate a child with FTT.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Insuficiência de Crescimento/diagnóstico , Gastroenteropatias/diagnóstico , Micronutrientes/deficiência , Criança , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Diagnóstico Diferencial , Insuficiência de Crescimento/etiologia , Feminino , Gastroenteropatias/etiologia , Humanos , Masculino , Estudos Retrospectivos
14.
Nutr Clin Pract ; 34(3): 406-413, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30294809

RESUMO

BACKGROUND: Underrecognition of pediatric malnutrition may affect nutrition interventions and outcomes. Pediatric malnutrition uses more specific etiology-based criteria but lacks clarity in implementation guidelines. Study goals were to identify malnutrition and risk among hospitalized patients, characterize malnutrition risk factors, and assess reliability of criteria against outcome measures. MATERIALS AND METHODS: All children 44 weeks postmenstrual age-18 years, admitted for 48 hours during a 16-day period, were included (n = 528). Trained dietitians assessed patients in physical assessments (PA), growth, energy intake, increased nutrient losses (IL), altered absorption of nutrients (AA), hypermetabolism and inflammation, laboratory information, micronutrient deficiency, and functional status. Outcome data assessed were length of stay (LOS), intensive care unit (ICU) LOS, ventilation days, nutrition support, and dietitian intervention. RESULTS: Malnutrition prevalence upon admission was 19.7%. Weight/length or BMI/age z-score (ZS) had no effect on LOS. AA and IL upon admission were independently associated with malnutrition (both, P<.01). Wasting and hypermetabolism were independently associated with longer LOS (P<.01). Other factors associated with longer LOS included IL and inflammation (P < .05). Those with hypermetabolism had significant ZS improvements if followed by a dietitian (P < .05). Wasting via PA was the only factor associated with longer ICU LOS (P < .05). CONCLUSIONS: Identification of risk factors (wasting, hypermetabolism, AA, IL) beyond anthropometrics to define malnutrition and risk is important in prioritizing care in a tertiary pediatric facility. Of great significance is the ability of dietitian-based PA to predict LOS and need for intervention.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Criança Hospitalizada , Medição de Risco/métodos , Adolescente , Antropometria , Índice de Massa Corporal , Criança , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Doença Crônica/terapia , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Avaliação Nutricional , Projetos Piloto , Fatores de Risco
15.
Nutr Clin Pract ; 34(4): 589-596, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30071151

RESUMO

BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Programas de Rastreamento/normas , Avaliação Nutricional , Antropometria , Criança , Estudos de Viabilidade , Feminino , Humanos , Linguagem , Tempo de Internação/estatística & dados numéricos , Masculino , Programas de Rastreamento/métodos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha , Traduções
16.
Pediatr Ann ; 47(11): e445-e451, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423187

RESUMO

More than one-half of children with chronic liver disease suffer from malnutrition, which leads not only to a poor quality of life and even possibly catastrophic complications, but also to poor outcomes after a liver transplantation. These children have increased metabolic demands but often decreased intake with malabsorption and altered nutrient utilization, all of which make it difficult to keep up with nutritional demands. Assessment of a patient's nutritional status should be timely, and it should be performed routinely and proactively. When specific nutritional needs are identified, these should be addressed with a multidisciplinary team approach and with the close guidance of an experienced pediatric dietician. The assessment includes anthropometric and laboratory assessments, in addition to a careful physical examination and a detailed patient history. The specific nutritional needs vary, but generally dietary intervention focuses on increasing caloric intake, supplementation with medium-chain triglycerides, and prevention of essential fatty acid and fat-soluble vitamin deficiencies. [Pediatr Ann. 2018;47(11):e445-e451.].


Assuntos
Transtornos da Nutrição Infantil/etiologia , Hepatopatias/complicações , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/terapia , Doença Crônica , Humanos , Hepatopatias/dietoterapia , Estado Nutricional
17.
Pediatr Ann ; 47(11): e465-e469, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423190

RESUMO

Traditionally, nutritional risk has been defined by growth failure, with clinical intervention indicated when a child falls below the third to fifth percentile on growth charts. Although the velocity of linear growth and weight gain during the first years are unparalleled at any other time of life, this period is also unique for other reasons. Nutrition not only supports increased bone length, muscle mass, and tissue growth, but also continued development of several highly metabolic organs such as the gastrointestinal tract, the immune system, the cardiorespiratory system, the kidneys, and the central nervous system. Just as growth depends on consistent nutrients, so too does organ development, especially the brain. The undernourished child may exhibit compromised optimal development and future cognitive performance, irrespective of weight status. It is often challenging in early childhood to ensure that a child is receiving high-quality nutrition. Primary care clinicians are positioned to identify the child with potential nutritional risk and design an appropriate intervention that promotes optimal development. [Pediatr Ann. 2018;47(11):e465-e469.].


Assuntos
Desenvolvimento Infantil/fisiologia , Transtornos da Nutrição Infantil/diagnóstico , Insuficiência de Crescimento/diagnóstico , Atenção Primária à Saúde/métodos , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Insuficiência de Crescimento/etiologia , Gráficos de Crescimento , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Necessidades Nutricionais , Estado Nutricional , Medição de Risco/métodos
18.
PLoS One ; 13(10): e0205320, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30356325

RESUMO

The usefulness of anthropometry to define childhood malnutrition is undermined by poor measurement quality, which led to calls for new measurement approaches. We evaluated the ability of a 3D imaging system to correctly measure child stature (length or height), head circumference and arm circumference. In 2016-7 we recruited and measured children at 20 facilities in and around metro Atlanta, Georgia, USA; including at daycare, higher education, religious, and medical facilities. We selected recruitment sites to reflect a generally representative population of Atlanta and to oversample newborns and children under two years of age. Using convenience sampling, a total of 474 children 0-5 years of age who were apparently healthy and who were present at the time of data collection were included in the analysis. Two anthropometrists each took repeated manual measures and repeated 3D scans of each child. We evaluated the reliability and accuracy of 3D scan-derived measurements against manual measurements. The mean child age was 26 months, and 48% of children were female. Based on reported race and ethnicity, the sample was 42% Black, 28% White, 8% Asian, 21% multiple races, other or race not reported; and 16% Hispanic. Measurement reliability of repeated 3D scans was within 1 mm of manual measurement reliability for stature, head circumference and arm circumference. We found systematic bias when analyzing accuracy-on average 3D imaging overestimated stature and head circumference by 6 mm and 3 mm respectively, and underestimated arm circumference by 2 mm. The 3D imaging system used in this study is reliable, low-cost, portable, and can handle movement; making it ideal for use in routine nutritional assessment. However, additional research, particularly on accuracy, and further development of the scanning and processing software is needed before making policy and clinical practice recommendations on the routine use of 3D imaging for child anthropometry.


Assuntos
Antropometria/instrumentação , Desenvolvimento Infantil/fisiologia , Transtornos da Nutrição Infantil/diagnóstico , Imagem Tridimensional/instrumentação , Grupo com Ancestrais do Continente Asiático , Estatura/fisiologia , Peso Corporal/fisiologia , Cefalometria/instrumentação , Pré-Escolar , Grupos Étnicos , Feminino , Georgia , Humanos , Lactente , Recém-Nascido , Masculino , Software
19.
Afr J Prim Health Care Fam Med ; 10(1): e1-e6, 2018 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-30198286

RESUMO

BACKGROUND:  Malnutrition is a major public health challenge in developing countries. It has been identified as an important cause of child mortality and morbidity and leads to inadequate physical and cognitive development in children. The South African government implemented a strategy for malnutrition assessment in children under 5 years by community caregivers (CCGs), who would then refer children at risk or those having developed malnutrition to primary health care clinics. Irrespective of this strategy, children still present at clinics with severe malnutrition. AIM:  The aim of the study was to explore and describe the experiences of community caregivers with the assessment of malnutrition in children under 5 years old. SETTING:  The study was conducted in North Area six of eThekwini district in the province of KwaZulu-Natal. METHODS:  A qualitative, exploratory descriptive approach was used to collect data from 13 purposively selected CCGs. Content analysis was used to analyse data. RESULTS:  The majority of participants were dissatisfied with the training, as it was conducted in a language in which they were not proficient. They reported a lack of support and supervision in their performance such that mid-upper arm circumference was non-prioritised. They were dissatisfied with work overload not matched by remuneration and they worked under unsafe conditions. CONCLUSION:  Effective training of CCGs needs to be conducted in the language that they understand to combat malnutrition in children under 5 years. CCGs have multiple roles and may need to prioritise their work; this is not easy and requires specific guidance from skilled health professionals.


Assuntos
Antropometria , Braço/patologia , Transtornos da Nutrição Infantil/diagnóstico , Agentes Comunitários de Saúde , Adulto , Antropometria/métodos , Braço/anatomia & histologia , Transtornos da Nutrição Infantil/patologia , Pré-Escolar , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/psicologia , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pesquisa Qualitativa , África do Sul
20.
Arch Argent Pediatr ; 116(5): e667-e670, 2018 10 01.
Artigo em Espanhol | MEDLINE | ID: mdl-30204995

RESUMO

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.


Assuntos
Astrocitoma/diagnóstico , Transtornos da Nutrição Infantil/diagnóstico , Doenças Hipotalâmicas/diagnóstico , Astrocitoma/complicações , Doença Celíaca/diagnóstico , Pré-Escolar , Doença Crônica , Humanos , Doenças Hipotalâmicas/etiologia , Masculino
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