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Growth retardation is an important problem in children with chronic renal disease, and malnutrition is a determinative factor.The study intends to assess the relationship between protein-energy malnutrition and stature-weight retardation in children enrolled in chronic dialysis program.The study group was composed of 16 children (5 boys and 11 girls--sex ratio of 2.2) hospitalized in the IVth Nephrology Clinic at Clinical Emergency Hospital "St. Maria" Iaşi, 13 rural and 3 urban, aged between 9 and 17 years, with chronic dialysis program. This was a follow-up study during a period of 4 years (2006-2009), resulting in correlations between anthropometric paremeters, biochemical, BIA and DEXA data.The stature-weight deficiency of the 16 patients was as follows: after an average period of 61.7 months of HD and 32.7 months of PD, in children older than 12 years (mean age 15.27 years), 7 of 10 had stature-weight deficits higher than (-3DS) or (-4DS). The group with less than (-2DS) stature-weight deficits showed the same mean age of 15.2 years, the protein energy-malnutrition was present in 2 cases (33%) and was attributed to a dialysis period shorter than 13.8 months.The late diagnosis of the disease (at an average age of 13 years), the long period of chronic dialysis program (over 39.5 months on average) and the early debut of malnutrition are favoring or worsening factors of stature-weight retardation. After correlating ESG with biochemical, BIA and DEXA data, in our group were identified 4 cases of moderate malnutrition and 9 cases of severe malnutrition.

Protein-calorie malnutrition is a common complication and an important predictive factor for mortality in patients with end-stage renal disease on maintenance dialysis. Therefore, nutritional status needs to be regularly assessed in these patients by using several methods. If malnutrition is diagnosed, its causes should be thoroughly searched for and properly treated.This cross-section study aimed at evaluating the nutritional status and the possible risk factors for malnutrition in 149 (82 men) hemodialysis patients by anthropometry, biochemical tests and bioelectrical impedance analysis (BIA). The patients' height (H), post-dialysis body weight (BW), mid-arm circumference (MAC), tricipital skin-fold thickness (TST) were measured and a 3-category subjective global assessment (SGA) was performed. Body mass index (BMI), mid-arm muscle circumference (MAMC), corrected mid-arm muscle area (cMAMA) and anthropometry-estimated percent body muscle mass (% AMM) were calculated from the above measurements by using specific equations. Biochemical tests included protein equivalent of nitrogen appearance (nPNA), and predialysis serum albumin, creatinine, total cholesterol, bicarbonate, and hemoglobin (Hb) levels. We used BIA to estimate body composition - i.e. percent body fat (% BBF), fat-free mass (% FFM), body cell mass (% BCM), extracellular mass (% ECM), muscle mass (% BMM)--and the phase angle (PhA). T-test was used to make comparisons and Pearson coefficient to analyze the correlations. P0.05 was considered statistically significant.The male patients had a higher mean muscle mass--as estimated by serum creatinine (9.8 s 8.3 mg/dl; P0.0001) and by % BMM (41.7% vs 34.7%)--and a lower fat mass--as estimated by TST (0.95 cm vs 1.2 cm; P = 0.016) and by % FAT (16.7% vs 31.3%; P0.0001) than the female patients. Age was found to be positively correlated with BMI (P = 0.001), but inversely correlated with % BCM (P = 0.013) and with % AMM (P = 0.003). Patients with diabetes had lower % BCM than those without diabetes (32.9 vs 35.9%; P = 0.041). The presence of heart failure was associated with significantly reduced MAMC (22.0 vs 23.6 cm2; P = 0.045), % AMM (28.5 vs 32.1; P = 0.021), % BCM (33.0 vs 36.1% ; P = 0.034), BMM/H2 (8.6 vs 9.4 kg/m2; P = 0.013), nPNA (1.17 vs 1.34 g/kg-d ; P = 0.047), serum albumin (39.7 vs 42.4 g/l; P = 0.010), serum creatinine (8.1 vs 9.4 mg/dl; P = 0.008) and Hb (10.5 vs 11.2 g/dl; P = 0.017). The serum Hb level was positively correlated with BMI (P = 0.005), BMM/H2 (P = 0.009), serum albumin (P = 0.002) and serum creatinine (P = 0.011). Also, patients with category B-SGA were older (63.7 vs 50.1 y.o.; P0.0001) and had more heart failure (42% vs 13%; P = 0.013) than those with category A-SGA. In hemodialysis patients, advancing age, diabetes, heart failure and decreasing Hb levels are associated with worse nutritional status, as estimated by anthropometry, biochemical markers and BIA. Whether treatment of comorbidities such as heart disease and anemia may improve nutritional status in these patients is an important issue that deserves further research.

Good nutrition is essential for normal growth and development. Cystic fibrosis (CF) is commonly associated with energy deficiency in children. Malnutrition is a very frequent complication and contributes significantly toward morbidity in CF. Although malnutrition due to pancreatic enzyme insufficiency is correctable, the majority of CF patients are underweight and have short stature. During the last few decades, improved treatment measures and nutritional support in CF have increased survival and quality of life in these patients. Patients with CF must receive a hypercaloric and hyper-proteic diet, with a high fat content, a normal quantity of carbohydrates and with pancreatic and liposoluble vitamin supplements in case of pancreatic insufficiency.

In a group of 34 infants with serious acute diarrheic disease, the authors study the total lipids, total and esterified cholesterol, triglycerides and lipidogram, in the acute phase of the disease and at a 10-day-interval from the first determination. Triglycerides have constantly increased values both at admittance and at the second determination, as a consequence of lipid mobilization in acute stage. This process continues due to the hypolipidic and hypocaloric diet. Esterified fraction of cholesterol has initially important decreases, tending to become normal in the interval studies, more evident in the healthy infant. Total lipids are increased in 10.5% of the cases and the lipidogram shows an increase of alpha-lipoproteins and prebeta-lipoproteins in 10.5% and 17.5% respectively of the cases in the first determination.

Acute dehydration of diarrhoea of the breast-fed child is a type of hypovolemic shock which, by its severity and frequency is one of the major emergencies of pediatrics. The liver, as the site of many metabolic processes is mainly affected in the frame of the multiple-tissue involvement which is characteristic for this condition. The authors carried out a study of several enzymes (total LDH and the thermally-labile fraction, gluthamatdehydrogenase, gammaglutamyltranspeptidase, acid and alkaline phosphatase) in 27 breast-fed children. Determination of the enzymes was done on hospitalization, and 10 days later. The study showed that all the enzymes that were evaluated had moderate increases in 40.7-71% of all cases. The increases were significant (p less than 0.001). After 10 days the enzyme titers showed a tendency to become normal again, and slightly higher values were found in only 15-12% of all cases. Minimal hepatopathy can be considered, associated to the clinico-biological evolution of this severe conditions of the breast-fed child pathology.