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Purpose: To determine changes and potential differences in physical activity (PA), gross motor proficiency (MP), and health parameters after a 6-month follow-up (FU) period following participation in a parent-led PA intervention in youth with or without Prader-Willi syndrome (PWS). Methods: About 42 youth with PWS and 65 youth without PWS but with obesity (body fat percentage >95th percentile for age and sex), aged 8-16 years, participated. The intervention included preplanned PA sessions containing playground and console-based video games scheduled 4 days per week for 24 weeks. Families received training and curriculum materials. PA (accelerometry), MP (Bruininks-Oseretsky Test of MP), and health-related quality of life were obtained before (PRE), after completing the intervention (POST), and at FU. Results: There were no significant changes in PA at any time point. At FU and POST, participants showed higher bilateral coordination (PRE = 9.3 [0.4], POST = 11.7 [0.5], and FU= 11.1 [0.6]); speed and agility (PRE = 9.2 [0.4], POST= 10.8 [0.4], and FU= 11.5 [0.5]); and strength (PRE = 8.0 [0.3], POST = 9.2 [0.3], and FU = 9.2 [0.3]) than at PRE. At FU (80.3 [2.1]) and POST (79.8 [1.7]), youth without PWS showed higher health-related quality of life than PRE (75.0 [ 1.8]). Conclusion: The improvements in MP and health-related quality of life at FU suggest long-term durability of intervention outcomes. [ABSTRACT FROM AUTHOR]

Sepsis represents one of the leading causes of death in newborns and infants, and prompt diagnosis is essential for achieving favorable outcomes. Regarding malnourished children with concurrent infection, most studies have focused, besides blood culture, on C-reactive protein and procalcitonin. Because malnutrition has a deleterious effect on cellular immune competence, the present study characterized the acute-phase response, including hematological indices, in response to sepsis. Among the examined laboratory biomarkers, procalcitonin and neutrophil-to-lymphocyte ratio were the most accurate discriminators between sepsis patients and those with bacterial infection. Moreover, these two parameters showed a gradual increase between sepsis, severe sepsis, and septic shock patients (p < 0.001). Subgroup analysis of the sepsis group revealed positive correlations of NLR with prolonged ICU stay (<0.001), acute organ dysfunction (0.038), mechanical ventilation (<0.001), and fatality (<0.001). In summary, our results suggest that the neutrophil-to-lymphocyte ratio can be used as an auxiliary diagnostic index in discriminating the presence and severity of bacterial sepsis in malnourished infants. [ABSTRACT FROM AUTHOR]

(1) Introduction: Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism. The main treatment for PKU is to manage nutrition, thereby restricting phenylalanine intake. Part of patient management is analyzing eating habits to substitute missing nutrients and limit the overdose of nutrients. This is mainly done by analyzing food diaries. This is the first review of Latvian PKU patients eating habits performed by analyzing 72-h food diaries (FD). (2) Materials and Methods: This study included individuals between the ages of 18 and 31 years, PKU patients and 31 age- and sex-matched control groups. All respondents kept 72-h food diaries (FD) and underwent testing for zinc, selenium and ferritin levels in the blood. Food diary data were analyzed by Nutritics software to calculate the theoretical intake of nutrients, and these values were compared with the Ministry of Health of the Republic of Latvia's recommended values. (3) Results: A lack of motivation and diet therapy compliance in PKU patients was observed during this research. A total of 32% of PKU patients refused to fill out their FD or filled it out incorrectly. The analysis of nutrient intake was observed, and there was a statistically significant difference between PKU patients in the 1–3 age group and the control group in fat intake. Fat intake in PKU patients was below MRHL recommendations. The intake of iron was found to be surplus in all PKU patients in the age group of 1–3, 91% of PKU patients in the age group of 4–6 years, 63% in the age group of 7–12 and 71% in the 13–18 year age group. Although there were no instances in the PKU patients nor the control group who had ferritin levels above the normal range. Selenium intake was surplus in 80% of PKU patients in the 1–3 age group, 91% in PKU patients in the 4–6 age group, 88% in the 7–12 age group and 86% in the 13–18 age group. None of the patients had Se levels in the blood above the normal range. Zn intake was surplus in 100% of PKU patients in the 1–3 age group, 82% in PKU patients in the 4–6 age group, 88% in the 7–12 age group and 57% in the 13–18 age group, and no PKU patients had high Zn levels. None of the control group participants had levels below the normal range of Zn and Se while 11% of PKU patients in the 13–18 age group had inadequate levels of Se, although Se intake based on their FD was optimal. (4) Conclusions: Regular PKU patient nutritional status evaluation is important to define and prevent possible nutrient deficiency, and further investigation should be continued to find out the mechanism of nutrient absorption in PKU patients. To prevent macronutrient deficiency such as fat and micronutrient deficiency in PKU patients, one could use supplements or try an improved nutrient content of Phe-free formula in the future. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Current Pediatrics / Guncel Pediatri is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Why you should read this article: • To be aware of the link between malnutrition in children and faltering growth • To understand how regular surveillance of child growth can prevent or identify malnutrition • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Malnutrition can be defined as 'a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals cause measurable adverse effects on body composition, function or clinical outcome'. Identification of malnutrition in children, therefore, requires an understanding of their growth. Faltering growth is the failure to achieve the expected rate of weight gain, linear and brain growth at a normal rate for age, which is a known consequence of inadequate nutrition. There are many medical, social and behavioural factors that can place a child at risk of malnutrition and faltering growth. This article examines malnutrition and faltering growth in children. It discusses monitoring and measurement of child growth, the aetiology and consequences of malnutrition, some risk factors and malnutrition screening. The article also considers some prevention strategies and the role of the nurse in the prevention of malnutrition. [ABSTRACT FROM AUTHOR]

Background: Hunger and malnutrition are rampant among refugees and displaced populations, many of whom are infants and children. We sought to determine the prevalence and factors associated with thinness among children aged 5–17 years living in Nakivale refugee settlement, Isingiro district, southwestern Uganda. Methods: This was a cross sectional study that enrolled 420 children aged 5 to 17 years. The World Health Organization cluster sampling was used to select 30 villages from which 14 households were selected by consecutive sampling and participants were then chosen per household by simple random sampling. Data were collected on the participant socio-demographic, family, dietary, medical, hygiene and refugee status factors. Thinness was defined as having a z-score < -2 standard deviations of Body Mass Index-for-age from the median WHO growth standards. The prevalence of thinness was determined by ascertaining the total number of children with thinness over the total number of children studied. Multivariable logistic regression model was used to determine the factors independently associated with thinness with p < 0.05 level of significance. Results: A total of 420 children aged 5–17 years were enrolled into the study. The median age (IQR) was 8.6 (6.8–11.8) and majority 248 (59.1%) were female. The prevalence of thinness was 5.5% (95% CI: 3.7-8.1%). The factors independently associated with thinness were; living with a chronic disease (aOR 6.47, 95%CI; 1.63–24.64, p = 0.008), use of water from natural sources (aOR 3.32, 95%CI; 1.27–8.71, p = 0.015), and duration of stay in the settlement of less or equal to 10 years (aOR 3.19, 95%CI; 1.15–8.83, p = 0.025). Conclusion: Five in every 100 children aged 5–17 years in Nakivale refugee settlement have thinness. Thinness was more likely among children who are living with a chronic disease, used water from natural sources and those whose families had stayed shorter in the settlement. Our findings suggest that children with chronic disease should receive extra food supplementation and have routine growth monitoring as part of their chronic care. The study reiterates a need to have clean and safe water supply and close nutrition assessment and monitoring, especially for newly registered refugee children. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a determining factor of pediatric mortality and morbidity, especially in low and middle-income countries. Hospitalized children are at a higher risk of malnutrition. Several malnutrition screening tools have been used, among which STAMP, PYMS, and STRONGkids are valid tools with high sensitivity and specificity. The aim of this study was to compare these screening tools to find the best ones in identifying the risk of malnutrition in hospitalized children. Methods: This is a cross-sectional study performed on hospitalized children aged 1 to 16 years. The questionnaires of PYMS, STAMP, STRONGkids malnutrition risk assessment tools were filled. The weight for height and BMI for age Z-scores were calculated. The data were analyzed by SPSS. Sensitivity, specificity, positive predictive value, and negative predictive values of the risk scores based on weight for height and BMI for age Z-scores were calculated. Results: Ninety-three patients with a mean age of 5.53 ± 3.9 years were included. The frequency of malnutrition was reported as 26% and 39% according to weight for height and BMI for age Z-scores, respectively. A significant relationship was found between PYMS and Weight for height Z-score (P-value < 0.001), and BMI for age Z-score (P-value < 0.001). Moreover, STRONGkids was found to be associated with weight for height Z-score (P-value: 0.017). Conclusion: The PYMS is a practical and beneficial tool in early identifying the risk of severe malnutrition in hospitalized patients. It is a suitable method for patients in our settings. [ABSTRACT FROM AUTHOR]

Objective: Malnutrition has been reported to be a rather common health problem in hospitalized children and it is recommended to be evaluated in these conditions. The objective of this prospective trial was to evaluate the nutritional status of hospitalized pediatric urology patients and find the prevalence of malnutrition in this specific subgroup of patients. Patients and Methods: All subsequent children between 1 and 18 years old who were hospitalized between January 2018 and January 2019 in the pediatric urology unit of a referral university hospital were included into the study. STRONGkids questionnaire was used to assess the nutritional status of the children. Malnutrition was evaluated according to anthropometric measurements based on the computer programs developed by the World Health Organization (WHO). Results: A total of 76 patients were included in the study. The mean age of the patients was 8.84±4.23; mean height was 121.03±22.49 cm; mean weight was 27.8±13.41 kg. Malnutrition risk, according to STRONGkids screening tool was high in 1 patient, medium in 8 patients and low in 67 patients. According to anthropometric measurements, 6 patients (7.9%) and 25 patients (32.9%) had acute and chronic malnutrition, respectively. Conclusion: The current prospective trial suggested that malnutrition is a significant issue also for hospitalized pediatric urology patients. [ABSTRACT FROM AUTHOR]

Glutamate (Glu) is the most abundant amino acid (AA) in human milk. Available information on Glu supply and metabolism was reviewed, based on an electronic literature search. In 22 cross-sectional global studies with 4,747 women, free Glu increases with lactation duration and contributes to about 38% of total and 63% of dispensable milk AA. Based on these data, a typical breastfed infant obtains a mean free Glu intake of 35.7 mg/kg body weight (bw; upper end of the normal range 134.6 mg/kg), while precisely collected longitudinal data indicate mean intakes of 40 mg/kg and upper range intakes of 70.2 mg/kg. Mean intakes with cows' milk formula at median concentrations are 0.7 mg/kg (upper range 1.0 mg/kg) and with extensive protein hydrolysate formula 171.7 mg/kg bw (upper range 249.8 mg/kg bw), with no indication of untoward effects. Infants almost entirely utilize dietary Glu in splanchnic organs, with no appreciable effect on plasma Glu concentrations. Estimated free Glu intakes in breastfed infants are up to 4.5-fold higher than the acceptable daily intake (ADI) set by the European Food Safety Authority for the total population including infants, and the respective intakes of infants fed a formula based on an extensive protein hydrolysate are up to 8.3-fold higher. There is no reason to assume that feeding human milk or an extensive protein hydrolysate infant formula would be unsuitable or unsafe for infants. Setting an ADI below the range of the normal intake with a safe diet in generally healthy individuals, that is, below 250 mg/kg per day, seems inappropriate. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) causes premature cardiovascular disease (CVD). Lipoprotein apheresis (LA) is recommended as first-line lipid-lowering treatment (LLT) for homozygous (ho) FH.Methods: Efficacy of multimodal LLT including lifestyle counseling, drug treatment, and LA was analyzed in 17 pediatric hoFH or compound heterozygous (c-het) FH patients, who commenced chronic LA in Germany before the age of 18.Results: At time of diagnosis, mean low-density lipoprotein cholesterol (LDL-C) concentration was 19.6 mmol/l (756 mg/dl). Multimodal LLT resulted in 73% reduction of mean LDL-C concentration including a 62% contribution of LA. Only three children (18%) achieved mean LDL-C concentrations below the recommended pediatric target of 3.5 mmol/l (135 mg/dl). In 13 patients (76%) during chronic LA, neither cardiovascular events occurred nor was CVD progression detected clinically or by routine imaging techniques. In four patients (24%), cardiovascular events documented progression of CVD despite weekly LA, including one death due to coronary and cerebrovascular CVD which was not stabilized after commencing LA. Based on the mutational status, only 6 out of the 17 children were candidates for proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibition. Two already responded with further LDL-C decrease by 40%.Conclusions: Next to drug therapy, regular LA is an essential component of LLT for approaching LDL-C targets in children with hoFH or c-hetFH, which was successful only in a minority of children. Progression of CVD morbidity and resulting mortality remain unresolved issues. Early and intensified multimodal LLT guided by risk factors beyond LDL-C concentration is needed to improve outcome. [ABSTRACT FROM AUTHOR]

Abstract: Background: In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)‐free protein substitute (PS) to help meet non‐Phe protein requirements. Semi‐solid weaning Phe‐free PS have been available for >15 years, although no long‐term studies have reported their efficacy. Methods: Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe‐free infant L‐amino acid formula; natural protein intake; and issues with administration of PS or food. Results: Median commencement age for weaning was 17 weeks (range 12–25 weeks) and, for weaning PS, 20 weeks (range 13–37 weeks). Median natural protein was 4 g day−1 (range 3–11 g day−1) and total protein intake was >2 g kg−1 day−1 from weaning to 2 years of age. Children started on 2–4 g day−1 protein equivalent (5–10 g day−1 of powder) from weaning PS, increasing by 0.2 g kg−1 day−1 (2 g day−1) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02). Conclusions: Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS. [ABSTRACT FROM AUTHOR]

Children with Phenylketonuria (PKU) and severe cow's milk protein allergy (CMPA) consume prescribed, specially formulated, foods for special medical purposes (FSMPs) as well as restricted amounts of normal foods. These patients are exposed to artificial sweeteners from the consumption of a combination of free and prescribed foods. Young patients with PKU and CMPA have a higher risk of exceeding acceptable daily intakes (ADI) for additives than age-matched healthy children. A predictive modelling approach has been adapted successfully to assess the additive exposure of young patients with PKU and CMPA to artificial sweeteners. Steviol glycosides (E960) are at various stages of regulatory approval for the various food categories in the EU but are not as yet permitted for use in products intended for young children. The aim of this study was to predict potential steviol glycoside exposure in young children with PKU and CMPA considering the potential for future provisions for the use of this sweetener. The recent introduction of steviol glycosides means that no exposure data are available for children with CMPA and PKU. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010-11). Specially formulated amino acid-based FSMPs are used to replace whole or milk protein foods and were included in the exposure model to replace restricted foods. The recommendations to ensure adequate protein intake in these patients were used to determine FSMP intake. Exposure assessment results indicated that the maximum permitted level (MPL) for FSMPs would warrant careful consideration to avoid exposures above the ADI. These data can be used to inform recommendations for the medical nutrition industry. [ABSTRACT FROM AUTHOR]

Artificial sweeteners are used in protein substitutes intended for the dietary management of inborn errors of metabolism (phenylketonuria, PKU) to improve the variety of medical foods available to patients and ensure dietary adherence to the prescribed course of dietary management. These patients can be exposed to artificial sweeteners from the combination of free and prescribed foods. Young children have a higher risk of exceeding acceptable daily intakes (ADI) for additives than adults, due to higher food intakes per kg body weight. Young patients with PKU aged 1–3 years can be exposed to higher levels of artificial sweeteners from these dual sources than normal healthy children and are at a higher risk of exceeding the ADI. Standard intake assessment methods are not adequate to assess the additive exposure of young patients with PKU. The aim of this study was to estimate the combination effect on the intake of artificial sweeteners and the impact of the introduction of new provisions for an artificial sweetener (sucralose, E955) on exposure of PKU patients using a validated probabilistic model. Food consumption data were derived from the food consumption survey data of healthy young children in the United Kingdom from the National Diet and Nutrition Survey (NDNS, 1992–2012). Specially formulated protein substitutes as foods for special medical purposes (FSMPs) were included in the exposure model to replace restricted foods. Inclusion of these protein substitutes is based on recommendations to ensure adequate protein intake in these patients. Exposure assessment results indicated the availability of sucralose for use in FSMPs for PKU leads to changes in intakes in young patients. These data further support the viability of probabilistic modelling as a means to estimate food additive exposure in patients consuming medical nutrition products. [ABSTRACT FROM PUBLISHER]

The choice of suitable normal foods is limited for individuals with particular medical conditions, e.g., inborn errors of metabolism (phenylketonuria – PKU) or severe cow’s milk protein allergy (CMPA). Patients may have dietary restrictions and exclusive or partial replacement of specific food groups with specially formulated products to meet particular nutrition requirements. Artificial sweeteners are used to improve the appearance and palatability of such food products to avoid food refusal and ensure dietary adherence. Young children have a higher risk of exceeding acceptable daily intakes for additives than adults due to higher food intakes kg–1body weight. The Budget Method and EFSA’s Food Additives Intake Model (FAIM) are not equipped to assess partial dietary replacement with special formulations as they are built on data from dietary surveys of consumers without special medical requirements impacting the diet. The aim of this study was to explore dietary exposure modelling as a means of estimating the intake of artificial sweeteners by young PKU and CMPA patients aged 1–3 years. An adapted validated probabilistic model (FACET) was used to assess patients’ exposure to artificial sweeteners. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010–11). Specially formulated foods for special medical purposes were included in the exposure model to replace restricted foods. Inclusion was based on recommendations for adequate protein intake and dietary adherence data. Exposure assessment results indicated that young children with PKU and CMPA have higher relative average intakes of artificial sweeteners than healthy young children. The reliability and robustness of the model in the estimation of patient additive exposures was further investigated and provides the first exposure estimates for these special populations. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of this study was to establish the role of angiotensin-converting enzyme gene insertion/deletion (ACE I/D) polymorphism in determining obesity or undernutrition in a child population in Romania. Methods: We assessed 293 consecutively hospitalized patients in a tertiary emergency pediatric hospital. The patients were divided, according to body mass index (BMI), into three groups: group I, the control group consisting of 126 children, group II patients with undernutrition (85 patients) and group III patients with obesity (82 patients). ACE I/D polymorphisms were performed in all three patient groups, as well as the measuring of anthropometric parameters [middle upper arm circumference (MUAC), tricipital skinfold thickness (TST)]. All patients also underwent paraclinical evaluations (protein and albumin). The cutoffs criteria for moderate undernutrition were: BMI between −2.0 SD and −3.0 SD, severe undernutrition: BMI <−3.0 SD, moderate obesity: BMI between +2.0 SD and +3.0 SD and severe obesity: BMI >+3.0 SD. Results: We observed that DD genotype (64.7 %) was prevalent in the moderate undernutrition group, while ID (35.3 %) and II genotypes were higher in the subgroup of severe undernutrition, with significant correlations in DD and ID genotype groups between BMI and MUAC, protein and albumin ( p < 0.0001). In the obese group, we observed significant correlations in DD genotype, between BMI and MUAC ( p = 0.0014) and TST, and for II genotype, between BMI and TST ( p = 0.0071). II genotype was associated with severe obesity, while D allele carriers were associated with moderate undernutrition and moderate obesity. Conclusion: BMI, MUAC, TST and serum protein levels are correlated with D allele carriers of ACE genes in children with moderate undernutrition and moderate obesity, whereas II genotype is an unfavorable prognostic factor corresponding to severe obesity and severe undernutrition. [ABSTRACT FROM AUTHOR]

Copyright of Jornal de Pediatria is the property of Sociedade Brasileira de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim Hospitalised children have higher rates of undernutrition. Early detection of at-risk patients could lead to prompt preventative or corrective interventions. Several nutritional risk screening tools are available for screening hospitalised children including the STRONGkids tool. This study was designed to assess the usefulness of STRONGkids when applied by nurses rather than a paediatrician. Methods The STRONGkids questionnaire was simplified to enhance clarity with nursing staff. Trained nursing staff were asked to apply the tool to children, aged 1 month to 17 years, admitted to the Christchurch Hospital, New Zealand. Each patient was also assessed by a paediatrician. In addition, the current nutritional state of each patient was defined by measuring their weight and height. Results Of the 162 children enrolled, 11.7% were undernourished and 13% overnourished. STRONGkids recognised 84% of undernourished children when the tool was applied by nurses and 90% when the tool was applied by a paediatrician, indicating substantial agreement (kappa = 0.65). A minor simplification to the questionnaire improved its utility. Conclusion STRONGkids successfully recognised at-risk children, when applied by either nurses or a paediatrician. It was suitable and feasible for nursing staff to use it to screen for children at risk of nutritional deterioration. [ABSTRACT FROM AUTHOR]

Copyright of Acta Pediátrica Española is the property of Ediciones Mayo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a study which examined whether a phenylaline-free protein substitute with prolonged release may be beneficial to the protein status of children with phenlyketonuria (PKU) compared to conventional substitutes. Topics discussed include the allocation either a prolonged-release or the current conventional protein substitute for 60 children. Also mentioned was the finding that protein substitutes with prolonged release might be beneficial to protein status in children with PKU.

Aim Children requiring hospitalization are at risk of malnutrition. This study aimed to define the nutritional status of paediatric inpatients in comparison with healthy children and to compare and contrast the feasibility and validity of three nutritional risk screening ( NRS) tools in the hospitalized children. Methods A total of 162 children admitted to Christchurch Hospital were assessed along with a similar group of healthy children. Their nutritional state was assessed and classified using standard criteria. The NRS tools were applied, and patients were classified into low-, medium- and high-risk groups. The feasibility and validity of the tools were assessed. Results Under-nutrition was more frequent in the inpatient group (9.9% vs. 3.7%; p = 0.04), whereas both groups had similar rates of overweight/obesity. NRS tools were able to identify between 81% and 100% of the malnourished patients in the medium- to high-risk groups. Undernourished patients had longer hospital stay than well-nourished patients. Conclusion Hospitalized children have higher rates of under-nutrition than healthy children in NZ. The three NRS tools were able to identify children at nutritional risk with differing utility. In this setting, STRONGkids was the most reliable tool. [ABSTRACT FROM AUTHOR]

Copyright of Marmara Medical Journal is the property of Marmara Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This study aimed to define the nutritional state of children admitted to a tertiary Iranian hospital and to evaluate nutritional risk score tools in these children. Methods: The anthropometry of hospitalized and healthy children from the same community was determined. Three nutritional risk score tools were applied to all inpatients. Results: One hundred and nineteen inpatients were recruited along with a comparison group of 100 children. The prevalence of under-nutrition in the inpatient group was 25.2% and 3% in the community group (p < 0.0001). Obesity/overweight was more prevalent in the community group than the inpatients (22% versus 2.5%: p = 0.04). Severely malnourished children had a longer hospital stay than those with normal nutrition (p < 0.0001). The nutritional risk score tools identified between 83% and 90% of the malnourished patients in the moderate and high-risk groups. The STRONGkids tool correlated more strongly with anthropometric measurements than the other tools. The length of hospital stay was associated with risk status (p = 0.004). Conclusion: Hospitalized Iranian children have higher rates of under-nutrition than healthy children from the same community. NRS tools were able to identify children at nutritional risk; however, variable utility was observed. Further assessment of NRS tools in the developing setting is required. [ABSTRACT FROM AUTHOR]

How to cite this article Wiskin A.E., Owens D.R., Cornelius V.R., Wootton S.A. & Beattie R.M. (2012) Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet. 25, 319-322 Abstract Background: There has been increasing interest in the use of nutrition risk assessment tools in paediatrics to identify those who need nutrition support. Four non-disease specific screening tools have been developed, although there is a paucity of data on their application in clinical practice and the degree of inter-tool agreement. Methods: The concurrent validity of four nutrition screening tools [Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk On Nutritional status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Simple Paediatric Nutrition Risk Score (PNRS)] was examined in 46 children with inflammatory bowel disease. Degree of malnutrition was determined by anthropometry alone using World Health Organization International Classification of Diseases (ICD-10) criteria. Results: There was good agreement between STAMP, STRONGkids and PNRS (kappa > 0.6) but there was only modest agreement between PYMS and the other scores (kappa = 0.3). No children scored low risk with STAMP, STRONGkids or PNRS; however, 23 children scored low risk with PYMS. There was no agreement between the risk tools and the degree of malnutrition based on anthropometric data (kappa < 0.1). Three children had anthropometry consistent with malnutrition and these were all scored high risk. Four children had body mass index SD scores < −2, one of which was scored at low nutrition risk. Conclusions: The relevance of nutrition screening tools for children with chronic disease is unclear. In addition, there is the potential to under recognise nutritional impairment (and therefore nutritional risk) in children with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

This study was aimed to compare the subjective and objective nutritional assessments and to analyse the performance of subjective global assessment (SGA) of nutritional status in diagnosing undernutrition in paediatric patients. One hundred and forty children (aged 2–12 years) hospitalized consecutively in Tabriz Paediatric Hospital from June 2008 to August 2008 underwent subjective assessment using the SGA questionnaire and objective assessment, including anthropometric and biochemical measurements. Agreement between two assessment methods was analysed by the kappa ( κ) statistic. Statistical indicators including (sensitivity, specificity, predictive values, error rates, accuracy, powers, likelihood ratios and odds ratio) between SGA and objective assessment method were determined. The overall prevalence of undernutrition according to the SGA (70.7%) was higher than that by objective assessment of nutritional status (48.5%). Agreement between the two evaluation methods was only fair to moderate ( κ = 0.336, P < 0.001). The sensitivity, specificity, positive and negative predictive value of the SGA method for screening undernutrition in this population were 88.235%, 45.833%, 60.606% and 80.487%, respectively. Accuracy, positive and negative power of the SGA method were 66.428%, 56.074% and 41.25%, respectively. Likelihood ratio positive, likelihood ratio negative and odds ratio of the SGA method were 1.628, 0.256 and 6.359, respectively. Our findings indicated that in assessing nutritional status of children, there is not a good level of agreement between SGA and objective nutritional assessment. In addition, SGA is a highly sensitive tool for assessing nutritional status and could identify children at risk of developing undernutrition. [ABSTRACT FROM AUTHOR]

Objective:To assess prospectively the consumption of fruit and vegetables and its' correlation to the parental consumption in boys and girls taking part in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study).Hypothesis:Nutrition counselling focused on cardiovascular health effects vegetable and fruit consumption.Design:A prospective, randomised, clinical trial.Subjects:Children were recruited to the STRIP study between 1989 and 1992. At the age of 7 months, children were randomised to the intervention (n=540) or the control group (n=522) and were followed up until the age of 11 years.Intervention:Families in the intervention group have, since randomisation, received biannual individualised dietary counselling aimed at reduction of cardiovascular risk factors, especially saturated fat intake. Food records were used to assess fruit and vegetable consumption of children and parents.Results:The percentage of total energy intake provided by fruit and vegetables decreased when the children grew older (P for age <0.001). The 1- to 10-year-old intervention boys consumed more vegetables (mean difference 3.18 g/day; CI 1.48–4.86; P<0.001) and fruit (mean difference 10.1 g/day; CI 5.28–14.94; P<0.001) than did the control. Mother's consumption correlated with the consumption of their daughters and sons, whereas father's consumption correlated only with the consumption of their sons.Conclusions:Finnish children taking part in the atherosclerosis prevention study had a remarkably low fruit and vegetable consumption, which furthermore decreased with age. The children's consumption correlated with the parental consumption, except between boys and mothers. A slight intervention effect was present only among boys.European Journal of Clinical Nutrition (2006) 60, 172–180. doi:10.1038/sj.ejcn.1602283; published online 12 October 2005 [ABSTRACT FROM AUTHOR]

Summary. Nutrition during childhood and adolescence is an important determinant of development and health, both for the child and the later adult. In industrialised countries as well as in many countries of economic transition, emphasis has moved from combating nutrient deficiencies to research on the effects of overnutrition and food selection. Prevention of chronic diseases including obesity have become a major focus in research. However, the complex relation between infant growth and its related endocrine and metabolic changes on the one hand and the influence of nutrition and nutritional status on the other hand still need to be understood in detail. Studies aiming to elucidate this have to follow children and adolescents during their growth period. The following pages display the features of the German DONALD Study (DOrtmund Nutritional and Anthropometric Longitudinally Designed Study) which was specifically designed to address these complex research questions. Finally, comparisons to other studies are made and the specific strength and weaknesses of this study are discussed. As the DONALD study offers unique research opportunities and due to its long follow-up an abundance of data, collaborative research is encouraged. [ABSTRACT FROM AUTHOR]

Background: Adults and children in Mediterranean countries are believed to consume a Mediterranean-type diet which is higher in monounsaturated and n–3 polyunsaturated fatty acids than compared to central and northern parts of Europe and has preventive effects for cardiovascular risks. Subjects and Methods: In preschool children from Porto, Portugal (n = 35) and Munich, Germany (n = 18) we determined the plasma phospholipid fatty acid composition considered as a biomarker for dietary fat intake. Results: The plasma phospholipid contents of total saturated fatty acids are similar in both groups, but the Portuguese children have lower values of monounsaturated and n–3 polyunsaturated fatty acids. The results indicate that the food habits of Portuguese children are even less close to the traditional Mediterranean diet than those of German children. Conclusions: Efforts should be made to encourage young families as well as manufacturers and distributors of food products in Portugal to emphasize traditional Mediterranean food habits, especially in young children.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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The article reports a study which examined the feedback of hospital nursing staff on aspects of the Paediatric Yorkhill Malnutrition Score (PYMS) use in clinical practice. The results revealed that the majority of nurses found PYMS easy to use in routine clinical practice and during the admission of the patient. Registered nurses and staff who attended a training session needed less time to complete the tool and a higher proportion of them reported PYMS being practical for all patients.