Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 640
Filtrar
2.
BMC Public Health ; 20(1): 511, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299403

RESUMO

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


Assuntos
Peso Corporal , Transtornos da Nutrição Infantil/diagnóstico , Hospitalização/estatística & dados numéricos , Estado Nutricional , Desnutrição Aguda Grave/diagnóstico , Antropometria/métodos , Composição Corporal , Tamanho Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Inquéritos Nutricionais , Sudão do Sul , Síndrome de Emaciação/diagnóstico , Ganho de Peso
3.
PLoS Med ; 17(3): e1003055, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32203504

RESUMO

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


Assuntos
Anemia/epidemiologia , Saúde da Criança , Transtornos da Nutrição Infantil/epidemiologia , Diarreia/epidemiologia , Habitação , Malária/epidemiologia , Determinantes Sociais da Saúde , África ao Sul do Saara/epidemiologia , Fatores Etários , Anemia/diagnóstico , Anemia/mortalidade , Anemia/prevenção & controle , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Estudos Transversais , Diarreia/diagnóstico , Diarreia/mortalidade , Diarreia/prevenção & controle , Água Potável , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Mosquiteiros Tratados com Inseticida , Malária/diagnóstico , Malária/mortalidade , Malária/prevenção & controle , Masculino , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Saneamento
4.
Med. infant ; 27(1): 17-24, Marzo de 2020. tab
Artigo em Espanhol | LILACS, BINACIS, UNISALUD | ID: biblio-1118590

RESUMO

Introducción: El niño hospitalizado se encuentra en estado de vulnerabilidad nutricional. El tamizaje nutricional permite identificar malnutrición y/o el riesgo de desarrollarla, para realizar un abordaje precoz. El Área de Alimentación del Hospital Garrahan desarrolló la "Herramienta de Tamizaje Nutricional Pediátrico" (HTNP), dada la falta de consenso sobre un estándar de oro y para ajustar criterios a la población asistida. El objetivo de esta investigación fue su validación para niños en cuidados intermedios/ moderados. Métodos: estudio prospectivo, descriptivo y transversal. Entre agosto de 2016 y abril de 2018 se reclutaron niños de 1 a 18 años internados en salas de cuidados intermedios/moderados seleccionadas, que cumplieran los criterios de inclusión. Se aplicaron: la HTNP y la valoración nutricional global subjetiva (VNGS) como prueba de comparación. La HTNP consta de tres criterios: Patología de base y motivo de internación- Disminución de peso- Deterioro de la actitud alimentaria. Se define riesgo nutricional si se cumple con dos criterios. Se analizaron: Sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN), factibilidad y reproducibilidad. Resultados: Se evaluaron 745 niños (50,1% sexo femenino; mediana de edad: 7,2 años). La HTNP detectó riesgo nutricional en 50,7% (n378) de los niños y la VNGS en 48,7% (n363). La HTNP presentó: Sensibilidad 87,3% (IC95% 83,8-90,9), Especificidad 84,0% (IC95% 80,2-87,8), VPP 83,9% (IC95%: 80,0­87,7) y VPN 87,5% (IC95%: 83,9-91,0). Del análisis de reproducibilidad con dos evaluadores independientes (n42) se obtuvo coeficiente kappa de 0,91 (0,74-1,0) y 0,78 (0,5-1,0) respectivamente. Su implementación llevo un promedio de tres minutos y medio (1-5 minutos). Conclusión: La HTNP es un instrumento simple, reproducible, práctico y factible de implementar para identificar pacientes en riesgo nutricional (AU)


Introduction: Hospitalized children are nutritionally vulnerable. Nutritional screening may identify malnutrition and/or the risk of developing malnutrition in order to start early intervention. The Food Services Area of Garrahan Hospital has developed a "Pediatric Nutritional Screening Tool (PNST) because of the lack of consensus on a gold standard and to finetune the criteria to the care population. The aim of this study was to validate the tool in children in intermediate/moderate care. Methods: A prospective, descriptive, cross-sectional study was conducted. Between August 2016 and April 2018 children from 1 to 18 years of age who met the inclusion criteria were enrolled on selected intermediate/ moderate care wards. The PNST was administered together with the Subjective Global Assessment (SGA) as a comparison test. The PNST consists of three criteria: Underlying disease and reason for admission- Weight loss- Deterioration of eating behavior. A patient was defined as being at nutritional risk was defined if two criteria were met. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), feasibility, and reproducibility were analyzed. Results: 745 children (50.1% female; median age: 7.2 years) were assessed. The PNST detected nutritional risk in 50.7% (n378) and the SGA in 48,7% (n363) of the children. The PNST showed: Sensitivity 87.3% (95%CI: 83.8-90.9), specificity 84.0% (95%CI: 80.2-87.8), PPV 83.9% (95%CI: 80.0­87.7), and NPV 87.5% (95%CI: 83,9-91,0). In a reproducibility analysis with two independent evaluators (n42) kappa coefficients of 0.91 (0.74-1.0) and 0.78 (0.5-1.0) were obtained, respectively. Administration of the tool took a mean of 3.5 inutes (1-5 minutes). Conclusion: The PNST is a simple, reproducible, practical, and feasible tool to use for the identification of patients at nutritional risk (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Transtornos da Nutrição Infantil/diagnóstico , Avaliação Nutricional , Criança Hospitalizada , Programas de Rastreamento/métodos , Estado Nutricional , Medição de Risco/métodos , Estudos Transversais , Estudos Prospectivos
5.
Pediatr Blood Cancer ; 67 Suppl 3: e28211, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32096326

RESUMO

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


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Neoplasias/metabolismo , Avaliação Nutricional , Fatores Etários , Criança , Transtornos da Nutrição Infantil/metabolismo , Transtornos da Nutrição Infantil/patologia , Humanos , Neoplasias/patologia , Estado Nutricional
6.
Nutrients ; 12(1)2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31936112

RESUMO

The double burden of malnutrition (under- and overnutrition) is a serious public health issue in childhood. The mid-upper arm circumference (MUAC) is a simple tool for screening nutritional status, but studies of the optimal cutoff to define malnutrition are limited. This study aimed to explore the prediction of malnutrition by MUAC in Sri Lankan schoolchildren. The participants were 538 students (202 boys, 336 girls) aged 5-10 years. Spearman's rank correlation was calculated for MUAC and both body-mass-index-for-age z-score (BAZ) and height-for-age z-score (HAZ). Receiver operating characteristic (ROC) analysis was conducted to assess the ability of MUAC to correctly classify malnutrition, after stratifying for age and birth weight. MUAC correlated significantly with BAZ (r = 0.84) and HAZ (r = 0.35). The areas under the ROC curve for thinness, overweight, obesity, and stunting were 0.88, 0.97, 0.97, and 0.77, respectively. The optimal MUAC cutoff values for predicting thinness and stunting were 167.5 mm and 162.5 mm, respectively; the optimal cutoffs for predicting overweight and obesity were 190.5 mm and 218.0 mm, respectively. These cutoffs differed after stratification by age group and birth weight. Our results confirm MUAC to be a useful tool for monitoring growth in schoolchildren.


Assuntos
Antropometria/métodos , Transtornos da Nutrição Infantil/diagnóstico , Estado Nutricional , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino
7.
Arch Dis Child ; 105(1): 32-39, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31362946

RESUMO

BACKGROUND: Scaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity. OBJECTIVE: To investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM. DESIGN: A 2-year preintervention and postintervention study between January 2015 and February 2017. SETTING: Eleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador. INTERVENTION: Scenario-based eLearning course 'Caring for infants and young children with severe malnutrition'. MAIN OUTCOME MEASURES: Identification of children with SAM, quality of care, case-fatality rate. METHODS: Medical record reviews of children aged 0-60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel. RESULTS: Postintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO 'Ten Steps' of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=-3.9%, 95% CI -6.6 to -1.7, p<0.001). CONCLUSIONS: High quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality.


Assuntos
Transtornos da Nutrição Infantil/terapia , Instrução por Computador , Melhoria de Qualidade , Fortalecimento Institucional/métodos , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Instrução por Computador/métodos , El Salvador/epidemiologia , Gana/epidemiologia , Guatemala/epidemiologia , Política de Saúde , Humanos , Lactente , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/estatística & dados numéricos , Qualidade da Assistência à Saúde , Resultado do Tratamento
8.
Am J Trop Med Hyg ; 102(2): 427-435, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31802732

RESUMO

Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary care centers in Tanzania. The clinical outcome of children with severe malnutrition defined by anthropometric measures and clinical signs was compared between two electronic clinical diagnostic algorithms: ePOCT, which uses weight-for-age and mid-upper arm circumference to identify and manage severe malnutrition, and ALMANACH, which uses the clinical signs of edema of both feet and visible severe wasting. Those identified as having severe malnutrition by the algorithms in each arm were prescribed antibiotics and referred to the hospital. From December 2014 to February 2016, 106 febrile children were enrolled and randomized in the parent study, and met the criteria to be included in the present analysis. ePOCT identified 56/57 children with severe malnutrition using anthropometric measures, whereas ALMANACH identified 2/49 children with severe malnutrition using clinical signs. The proportion of clinical failure, defined as the development of severe symptoms by day 7 or persisting symptoms at day 7 (per-protocol), was 1.8% (1/56) in the ePOCT arm versus 16.7% (8/48) in the Algorithm for the MANagement of Childhood illnesses arm (risk difference -14.9%, 95% CI -26.0%, -3.8%; risk ratio 0.11, 95% CI 0.01, 0.83). Using anthropometric measures to identify and manage febrile children with severe malnutrition may have resulted in better clinical outcomes than by using clinical signs alone.


Assuntos
Antropometria , Transtornos da Nutrição Infantil/dietoterapia , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tanzânia/epidemiologia , Resultado do Tratamento
9.
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
11.
Pediatr Ann ; 48(11): e425-e433, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31710361

RESUMO

A new approach to comprehensive growth and nutrition assessment of infants, children, and adolescents that is etiology based and relatively simple to implement is now available. It encompasses five domains: anthropometry (growth measurements), assessment of change in growth (growth dynamism), duration of the growth abnormalities, etiology of the nutritional imbalance, and impact of the nutritional state on functional outcomes. Its increased use will help to standardize the screening, diagnosis, and documentation of malnutrition in both ambulatory and hospitalized patients. [Pediatr Ann. 2019;48(11):e425-e433.].


Assuntos
Antropometria/métodos , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Avaliação Nutricional , Paralisia Cerebral/classificação , Criança , Avaliação da Deficiência , Transtornos do Crescimento/diagnóstico , Humanos , Lactente , Estado Nutricional , Exame Físico , Valores de Referência
12.
Pediatr Ann ; 48(11): e441-e447, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31710363

RESUMO

Exocrine pancreatic insufficiency in children can lead to lifelong complications related to malnutrition and poor growth. The clinical presentation can be subtle in the early stages of insufficiency as the large functional capacity of the pancreas is gradually lost. The pediatrician plays a crucial role in the early identification of these children to ensure a timely referral so that a diagnosis can be made and therapy initiated. Early nutritional therapy allows for prevention and correction of deficiencies, which leads to improved outcomes and survival. When insufficiency is suspected, the workup should start with an indirect test of exocrine pancreatic function, such as fecal elastase, to establish the diagnosis. Once a diagnosis is established, further testing to delineate the etiology should be pursued, with cystic fibrosis being high on the differential list and assessed for with a sweat test. Assessment of anthropometry at every visit is key, as is monitoring of laboratory parameters and physical examination findings that are suggestive of malabsorption and malnutrition. The mainstay of management is administration of exogenous pancreatic enzymes to facilitate digestion and absorption. [Pediatr Ann. 2019;48(11):e441-e447.].


Assuntos
Transtornos da Nutrição Infantil/etiologia , Insuficiência Pancreática Exócrina/diagnóstico , Acil-CoA Desidrogenase de Cadeia Longa/deficiência , Anus Imperfurado/complicações , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/terapia , Quimotripsina/metabolismo , Síndrome Congênita de Insuficiência da Medula Óssea/complicações , Fibrose Cística/complicações , Gorduras na Dieta/metabolismo , Displasia Ectodérmica/complicações , Terapia de Reposição de Enzimas , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/terapia , Fezes/enzimologia , Transtornos do Crescimento/complicações , Perda Auditiva Neurossensorial/complicações , Humanos , Hipotireoidismo/complicações , Deficiência Intelectual/complicações , Erros Inatos do Metabolismo Lipídico/complicações , Doenças Mitocondriais/complicações , Doenças Musculares/complicações , Nariz/anormalidades , Avaliação Nutricional , Pâncreas/diagnóstico por imagem , Pâncreas/fisiologia , Pancreatopatias/complicações , Elastase Pancreática/metabolismo , Testes de Função Pancreática , Pancreatite Crônica/complicações , Pancreatite Crônica/etiologia , Síndrome de Shwachman-Diamond/complicações , Esteatorreia/etiologia , Tripsinogênio/sangue
13.
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
14.
Nutrients ; 11(10)2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31623183

RESUMO

BACKGROUND: Understanding the drivers contributing to the decreasing trend in stunting is paramount to meeting the World Health Assembly's global target of 40% stunting reduction by 2025. METHODS: We pooled data from 50 Demographic and Health Surveys since 2000 in 14 countries to examine the relationships between the stunting trend and potential factors at distal, intermediate, and proximal levels. A multilevel pooled trend analysis was used to estimate the association between the change in potential drivers at a country level and stunting probability for an individual child while adjusting for time trends and child-level covariates. A four-level mixed-effects linear probability regression model was fitted, accounting for the clustering of data by sampling clusters, survey-rounds, and countries. RESULTS: Stunting followed a decreasing trend in all countries at an average annual rate of 1.04 percentage points. Among the distal factors assessed, a decrease in the Gini coefficient, an improvement in women's decision-making, and an increase in urbanization were significantly associated with a lower probability of stunting within a country. Improvements in households' access to improved sanitation facilities and drinking water sources, and children's access to basic vaccinations were the important intermediate service-related drivers, whereas improvements in early initiation of breastfeeding and a decrease in the prevalence of low birthweight were the important proximal drivers. CONCLUSIONS: The results reinforce the need for a combination of nutrition-sensitive and -specific interventions to tackle the problem of stunting. The identified drivers help to guide global efforts to further accelerate stunting reduction and monitor progress against chronic childhood undernutrition.


Assuntos
Desenvolvimento Infantil , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Países em Desenvolvimento/economia , Saúde Global/economia , Transtornos do Crescimento/epidemiologia , Transtornos da Nutrição do Lactente/epidemiologia , Desnutrição/epidemiologia , Pobreza , Fatores Etários , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/economia , Transtornos do Crescimento/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Lactente , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/economia , Transtornos da Nutrição do Lactente/fisiopatologia , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Desnutrição/diagnóstico , Desnutrição/economia , Desnutrição/fisiopatologia , Estado Nutricional , Prevalência , Medição de Risco , Fatores de Risco , Determinantes Sociais da Saúde , Fatores de Tempo
16.
Nutr Metab Cardiovasc Dis ; 29(11): 1230-1236, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31427048

RESUMO

BACKGROUND AND AIMS: The Great Leap Forward Famine during 1959-1961 was the world's largest famine, and its adverse long-term effects might be more apparent in the coming decade with ageing of the exposed populations. The aim of this study was to examine whether the Chinese Famine modified the effect of hyperglycaemia on cardiovascular disease (CVD). METHODS AND RESULTS: We used data of 4337 adults born between 1952 and 1964 collected from the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression was used to estimate the odds ratios (ORs) and confidence intervals (CIs) between hyperglycaemia and CVD. The prevalence of CVD showed significant difference among different famine exposure cohorts (P = 0.0156). After multivariable adjustment, the ORs (95% CIs) were as follows: 1.46 (0.94, 2.26) for late childhood, 1.76 (1.06, 2.90) for mid childhood, 1.40 (0.86, 2.27) for early childhood, 2.55 (1.30, 5.02) for the foetal cohort and 1.10 (0.63, 1.95) for the non-exposed cohort. There was a significant interaction between hyperglycaemia and famine exposure for CVD (P = 0.0374). In addition, the subgroup analyses showed that the effect of hyperglycaemia on CVD in the foetal exposure cohort was significantly higher than those in any of the other famine-exposed cohorts, especially in those who lived in rural areas (OR: 4.67, 95% CI: 1.70-12.84), those who lived in severe famine areas (OR: 5.01, 95% CI: 1.22-20.66) and those who were men (OR: 3.66, 95% CI: 1.01-13.33). CONCLUSION: Exposure to the Chinese Famine, especially during the foetal stage of life, aggravated the association between hyperglycaemia and CVD.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Fome Epidêmica , Hiperglicemia/epidemiologia , Acontecimentos que Mudam a Vida , Desnutrição/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Fatores Etários , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
17.
Saudi J Kidney Dis Transpl ; 30(4): 924-931, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464251

RESUMO

Nutrition is essential for children with end-stage renal disease, especially for those suffering from peritoneal dialysis (PD). Although the number of PD children has increased annually at the Vietnam National Hospital of Pediatrics, studies about the diet and nutritional deficiencies status of PD children is still limited. The aim of this study was to describe the actual diet and status of nutritional deficiencies of PD patients. This cross-sectional study was conducted on 31 PD children aged 2-15 years old using the 24-h dietary recall and biochemical parameters in blood (albumin, hemoglobin, calcium, sodium, potassium, and chloride). The energy intake was lowest in children over 13-year-old with only 32.9% of dietary reference intakes (DRIs). Carbohydrate intake among 10-15-year-old children was 38.1% of DRIs. Daily consumption of sodium was 65.6% and 33%-35% of DRIs for children under and over three-year-old, respectively. In comparison with DRIs, daily consumption of magnesium, iron, and calcium of over 10-year-old children was lower than that of younger children. In terms of vitamins, B-group vitamins, Vitamin C achieved the recommended levels except Vitamin A (63.0%) and Vitamin D (20.0%). The prevalence of children with serum albumin concentration lower than the normal range was 45.2% and prevalence of anemia was 51.6%. The proportion of children with decreased plasma calcium, sodium, and potassium levels was 83.8%, 77.4%, and 12.9%, respectively. PD children's diet lacks energy, protein, lipid, carbohydrate, as well as micronutrients. The prevalence of nutritional deficiencies is remarkably high in PD children.


Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Fenômenos Fisiológicos da Nutrição Infantil , Dieta/efeitos adversos , Falência Renal Crônica/terapia , Desnutrição/fisiopatologia , Estado Nutricional , Valor Nutritivo , Diálise Peritoneal/efeitos adversos , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Ingestão de Energia , Feminino , Hospitais Pediátricos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Prevalência , Fatores de Risco , Vietnã/epidemiologia
18.
Indian Pediatr ; 56(10): 825-830, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31441435

RESUMO

OBJECTIVE: To determine occurrence of malnutrition in children with cystic fibrosis and identify predictors of malnutrition at time of enrolment and after 2 years of follow up. DESIGN: Retrospective chart review. PATIENTS: Cystic fibrosis patients enrolled between 2009-2015 with at least 3 years follow-up. SETTING: Pediatric chest clinic at a tertiary-care center in northern India. PROCEDURE: Weight and height were noted at enrolment, and after 1 year and 2 years of follow-up. Clinical details, medications, and pulmonary exacerbations during second year were recorded. MAIN OUTCOME MEASURE: Occurrence of malnutrition i.e. weight for age Z-score < -2. RESULTS: 61 medical records were reviewed. Occurrence of malnutrition at baseline, and 1- and 2-year follow-up was 65.5%, 54.1% and 57.3%, respectively. Weight for age Z-score at enrolment significantly correlated with time to diagnosis from onset r=0.015, P=0.029). Weight for age Z-score at 2-year follow-up was significantly associated with steatorrhea (P=0.03), increased frequency of stools (P<0.01) and pulmonary exacerbation (P=0.03) during second year. Linear regression showed significant association between weight for age Z-score at 2 years with steatorrhea and pulmonary exacerbations [r=-0.795 (-1.527, -0.062)] and [r=-0.261 (-0.493, -0.028)]. Pulmonary exacerbations during second and third year had significant correlation with weight for age Z-score at the beginning of respective years (r = -0.219, P=0.015). CONCLUSIONS: Occurrence of malnutrition is high in children with cystic fibrosis in this region, with uncontrolled fat malabsorption and recurrent respiratory infections being significant risk factors.


Assuntos
Peso Corporal , Desenvolvimento Infantil/fisiologia , Transtornos da Nutrição Infantil/epidemiologia , Fibrose Cística/diagnóstico , Fibrose Cística/epidemiologia , Adolescente , Fatores Etários , Instituições de Assistência Ambulatorial , Antropometria , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Estudos de Coortes , Comorbidade , Fibrose Cística/terapia , Progressão da Doença , Feminino , Humanos , Índia , Lactente , Modelos Lineares , Masculino , Oxigenoterapia/métodos , Valor Preditivo dos Testes , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Centros de Atenção Terciária
19.
Nutr Metab Cardiovasc Dis ; 29(11): 1237-1244, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31378624

RESUMO

BACKGROUND AND AIMS: Undernutrition in early life may have a lifelong effect on adult health. The conclusions on the association of exposure to famine with the risk of hypertension were inconsistent. The aim of this study was to examine the association of exposure to the Chinese famine with incident hypertension. METHODS AND RESULTS: Data were obtained from the China Health and Nutrition Survey. All included participants were divided into five birth cohorts: no exposure, born in or after 1962 (N = 2 088); fetal exposure, between 1959 and 1961 (N = 880); early childhood exposure, between 1956 and 1958 (N = 1 214); mid-childhood exposure, between 1953 and 1955 (N = 1 287); and late childhood exposure, between 1949 and 1952 (N = 1 445). Hypertension was defined as SBP/DBP ≥140/90 mmHg, use of hypertensive medications, or a self-reported diagnosis. A total of 6 914 participants were included. The exposure to famine decreased the incidence of hypertension (P = 0.0018, 0.0001, <0.0001, and <0.0001; HR: 0.715, 0.686, 0.622, and 0.527, respectively) in males. Similarly, the exposure to famine might also decrease incident hypertension in the rural areas (P = 0.0013, <0.0001, <0.0001, and <0.0001; HR: 0.735, 0.706, 0.679, and 0.539, respectively). There were interaction effects between famine severity and exposure to famine in early (P = 0.024) and late childhood (P = 0.009). CONCLUSION: Exposure to the Chinese famine decreased the incidence of hypertension, especially in males and in the rural areas. Furthermore, the exposure postponed the age at the onset of hypertension.


Assuntos
Pressão Sanguínea , Transtornos da Nutrição Infantil/epidemiologia , Fome Epidêmica , Hipertensão/epidemiologia , Acontecimentos que Mudam a Vida , Desnutrição/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Adulto , Fatores Etários , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA