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(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.

Background: Micronutrient intake and status in lactating women may impact micronutrient levels in milk., Objectives: This study aimed to determine the micronutrient intake and status in lactating women, and their association with micronutrient levels in human milk., Methods: Lactating women were enrolled at 4-6 months postpartum. A 24h food recall was examined and nutrient intakes were analyzed using INMUCAL software. Human milk samples were collected to analyze calcium, copper, iron, and zinc levels. Plasma zinc and serum ferritin levels were determined., Results: Thirty-four women participated; 19 were classified as full breastfeeding and 15 as partial breastfeeding. Mean levels of calcium, copper, iron, and zinc in human milk were 243, 0.2, 0.2, and 1.56 mg/L, respectively. The prevalence of zinc deficiency (plasma zinc < 10.7 µmol/L) was 11.8%. No lactating women had iron deficiency. Nutrient intakes were lower than the recommended amounts in 38%-70% of participants, and were not correlated with corresponding nutrient levels in human milk. Multiple linear regression showed significant association between zinc levels in human milk and plasma for lactating women with full breastfeeding (β = 0.034, 95% confidence interval [0.003, 0.067], p = 0.040)., Conclusions: Lactating women were at risk of micronutrient deficiency. There was an association between zinc levels in human milk and plasma of lactating women with full breastfeeding. As the nutritional status of lactating women influences the quality of human milk, we should encourage good nutrient intake for lactating women.

Zinc and iron deficiencies among infants aged under 6 months may be related with nutrient store at birth. This study aimed to investigate the association between zinc and iron stores at birth with maternal nutritional status and intakes during pregnancy. 117 pregnant women were enrolled at the end of second trimester and followed until delivery. Clinical data during pregnancy, including pre-pregnancy body mass index (BMI) and at parturition were collected from medical record. Zinc and iron intakes were estimated from a food frequency questionnaire. Serum zinc and ferritin were determined in maternal blood at enrollment and cord blood. Mean cord blood zinc and ferritin were 10.8 ± 2.6 µmol/L and 176 ± 75.6 µg/L, respectively. Cord blood zinc was associated with pre-pregnancy BMI (adj. ß 0.150; p = 0.023) and serum zinc (adj. ß 0.115; p = 0.023). Cord blood ferritin was associated with pre-pregnancy BMI (adj. ß -5.231; p = 0.009). Cord blood zinc and ferritin were significantly higher among those having vaginal delivery compared to cesarean delivery (adj. ß 1.376; p = 0.007 and 32.959; p = 0.028, respectively). Maternal nutritional status and mode of delivery were significantly associated with zinc and iron stores at birth. Nutrition during preconception and pregnancy should be ensured to build adequate stores of nutrients for infants.

Breast milk provides adequate nutrients during the first 6 months of life. However, there are some reports of zinc deficiency in breastfed infants. This study was conducted to determine the prevalence of zinc deficiency in infants aged 4-6 months and the associated factors. Healthy infants aged 4-6 months and their mothers were enrolled. They were classified by feeding types as breastfed (BF), formula-fed (FF), and mixed groups (MF). Data collection included demographic data, perinatal data, given diets, and anthropometric measurement. Blood from infants and lactating mothers, and breast milk samples were collected to assess plasma and breast milk zinc concentrations. From 158 infants, the prevalence of zinc deficiency (plasma level below 10.7 mol/L) was 7.6%, and according to feeding groups 14.9%, 5.3%, and 2.9% in the BF, the FF, and the MF groups, respectively. Breastfed infants with zinc deficiency had significantly lower maternal zinc concentrations compared with those without zinc deficiency. There was a higher proportion of maternal zinc deficiency in zinc-deficient infants than those without zinc deficiency (66.7% vs 16.2%, p=0.02). There was a positive correlation between zinc concentrations in breast milk and plasma zinc concentrations of infants (r=0.62, p=0.01) and plasma zinc concentrations of lactating mothers (r=0.56, p=0.016). Using the regression analysis, infant zinc status was associated with maternal plasma zinc concentrations among breastfed infants. The results of this study suggest that breastfed infants aged 4-6 months may have a risk of zinc deficiency and that risk is associated with maternal zinc status and breast milk zinc concentrations.

Background and Objectives: Malnutrition is a major public health concern that increases morbidity and mortality in hospitalized patients, particularly those in developing countries. This study aimed to investigate its prevalence, risk factors, and impact on clinical outcomes in hospitalized children and adolescents. Methods and Study Design: We conducted a prospective cohort study in patients aged 1 month to 18 years who were admitted to four tertiary care hospitals between December 2018 and May 2019. We collected demographic data, clinical information, and nutritional assessment within 48 hours of admission. Results: A total of 816 patients with 883 admissions were included. Their median age was 5.3 years (interquartile range 9.3). Most patients (88.9%) were admitted with mild medical conditions (e.g., minor infection) or noninvasive procedures. The prevalence of overall malnutrition was 44.5%, while that of acute and chronic malnutrition was 14.3% and 23.6%, respectively. Malnutrition was significantly associated with age ≤2 years, preexisting diseases (cerebral palsy, chronic cardiac diseases, and bronchopulmonary dysplasia), and muscle wasting. Additional risk factors for chronic malnutrition included biliary atresia, intestinal malabsorption, chronic kidney disease, as well as inability to eat and decreased food intake for >7 days. Malnourished patients had a significantly longer hospitalization duration, higher hospital cost, and nosocomial infection rates than did well-nourished patients. Conclusions: Patients with chronic medical conditions on admission are at risk for malnutrition. Therefore, determination of admission nutritional status must be assessed, and its management are requisites for improved inpatient outcomes. [ABSTRACT FROM AUTHOR]