Nutrition morbidity interactions in pre-school children

Background & objectives: Research studies in the 1970s reported that in pre-school children, undernutrition increased the risk of infections and infections aggravated undernutrition. Over decades, there has been a reduction in prevalence of undernutrition and improvement in access to healthcare for treatment of infections. A mixed longitudinal study was undertaken to assess whether over time there were any changes from the earlier reported effect of undernutrition prior to infection on the risk of morbidity and effect of morbidity on nutritional status in pre-school children. Methods: Pre-school (0-59 months of age) children from urban low- and middle-income families whose parents were willing to allow their participation in the study were enrolled. Information on sociodemographic profile of the families was collected at enrolment. Weight of all children and length in infants were recorded every month; length/height in children 12-59 months of age was recorded once in three months. Morbidity information was collected through fortnightly visits. Results: 3888 pre-school children were followed up in 74636 home visits. Among these children, underweight and wasting were associated with a small increase in risk of infections. The odds ratio for risk of infection for underweight children was 1.09 (95% CI: 1.02 to 1.16) and for wasting was 1.18 (95% CI: 1.08 to 1.29). The deterioration in Z scores for weight-for-age and body mass index-for-age in children during illness and convalescence was small but significant (P<0.001). Interpretation & conclusions: The increased risk of infections in undernourished children living in overcrowded tenements in areas with poor environmental hygiene was not significant, perhaps because the risk of infection in normally nourished children was also high. The deterioration in nutritional status following infection was small because of the ready access to and utilization of health and nutrition care.

Determinants Of Under-Nutrition Among Under Five Children in The Urban Slum of Ahmedabad, India

Introduction: In India, 6.8% of total population are under five children and 60 million are malnourished. Around 45% of deaths among children under five years are linked to under nutrition. The study aims to as-sess the nutritional status of under 5 children and associate it with various factors like age, gender, Immuniza-tion, birth weight, feeding practices, Anganwadi registration etc. Methodology: A community based cross-sectional study was conducted on 191 under five children in urban slum areas. Parents of under five children were interviewed with the help of a pre-designed questionnaire. Malnutrition was assessed using WHO recommended Z score category.Observations: Total 191 under 5 children were studied. Among them, 107 were male and 84 were female. Out of the assessed children two third were normal weight for age while one third were underweight. Nutri-tion status was significantly associated with age, birth weight, feeding practices and immunization status of children. Conclusions & Recommendations: One fourth of under-five children were under weight for age. Age, low birth weight, preterm delivery, faulty feeding practices and incomplete immunization were statistically signif-icantly associated with the underweight.

Giardia lamblia-infected preschoolers present growth delays independent of the assemblage A, B or E

BACKGROUND Intestinal parasite Giardia can affect children's physical development mainly stunting even in asymptomatic cases. The protozoa G. lamblia is divided into assemblages A-H. However, it is still unclear whether clinical manifestations and pathogenesis may vary according to the infecting assemblage. OBJECTIVES To investigate whether G. lamblia assemblages influence differently the physical development of preschoolers from a community of Rio de Janeiro, Brazil. METHODS Anthropometric parameters were analysed from children attending a daycare centre and stool samples were obtained for the G. lamblia diagnosis. G. lamblia isolates from positive samples were genotyped. Data were analysed in order to verify whether there is a relationship between G. lamblia infection and the physical development of children according to the assemblage. FINDINGS Herein we demonstrated that although eutrophic, G. lamblia-infected daycare preschoolers from a low-income community presented growth delay compared to non-infected ones. This effect was observed for the three assemblages (A, B or E) found infecting humans. MAIN CONCLUSION G. lamblia causes growth delays on children independent of infecting assemblage (A, B or E).

Effect of breastfeeding promotions interventions on baby weight at three months of age

Background: Breastfeeding is common in developing countries, but exclusive breastfeeding is rare, and complementary foods are introduced to babies at an early age. Despite the proven risks associated with not exclusively breastfeeding, few mothers exclusively breastfeed their babies for six months as recommended by the World Health Organization. The objective of this study was to determine the effect of breast-feeding promotion interventions on baby weight at three months of age.Methods: A randomized experimental study was conducted for a period of 6 months from February 2019 till July 2019 in a tertiary care hospital. Weight- for-age (WA) indices have been determined for 95 infants from three to four months of age, participating in this study. They included 49 that started received promotion interventions support after delivery (till 2 weeks) and 46 that received routine care (control group). Collected data were analysed using SPSS software ver.11.5.Results: Weight-for-age indices were significantly lower for the early group than the control group (p=0.012). They suggest that the breast-feeding promotion interventions are very important educational tools to ensure healthy weight gain in infants.Conclusions: There is evidence that breastfeeding for at least 6 months, compared with feeding formula, prevents the possibility of atopic dermatitis, cow’s milk allergy and early childhood wheezing. Poorer nutritional status was significantly associated with earlier complementary feeding. The results suggest that exclusive breastfeeding along with promotion of weaning education should be promoted in India.

Assessment of nutritional status of children aged 34-92 months using various nutritional status indices and validity of age independent indices

Background: Even though there are many programs run by Government to tackle the problem of malnutrition in India, problem of malnutrition is still there. Malnutrition leads to infections and even can lead to death of child in severe cases. The mortality rate is very high compared to other countries. The objective of the study to study validity of age independent various nutritional status indices in comparison to gold standard of weight for ageMethods: Present study was institution based cross sectional study carried out at SDA high school, from January 2019 to July 2019 among 58 school children aged 34-92 months of age. Anthropometric measurements like weight, height, head circumference, chest circumference, mid arm circumference were recorded as per the standard guidelines. Weight for height, weight of age, Kanawati Index, Jeliffe's ratio, Rao index, and Dugdales index was calculated. Gold standard used was weight for age. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for these indices.Results: Majority of the children belonged to 48-60 months and 61-72 months i.e. 29.3% each. Males were more than females. Prevalence of malnutrition was 60.3%, 48.3%, 51.7%, 91.4%, and 56.8% based on weight for age, Kanawati index, Rao index, Jeliffe's ratio and Dugdale's index respectively. Dugdale's index was found to have high sensitivity (85.7%) and specificity (86.9%) compared to all other indices.Conclusions: Among age independent indices of nutritional status available, Dugdales index can be used as it has been found that it has remarkably higher sensitivity and specificity compared to other age independent indices of nutritional status.

The prevalence of malnutrition in children with cleft lip and cleft palate: a case-control study

Background: Children with cleft lip and cleft palate come across lot of impediment, hurdles in society. There are several social factors which hinders the proper nourishment of CL only, CP or CLP children, so majority of them tend to suffer malnutrition due to lack of standard care especially from their parents and society. Due to even low socio-economic status, impact on growth of these children is vexatious. However potential risk of malnutrition is particularly more during early childhood. Moreover, till date there are not much significant data on malnutrition in CL only, CP or CLP children. The aim of the study was to assess the prevalence of malnutrition in non syndromic CL only, CP or CLP in south India.Methods: Anthropometric parameters weight for age z score (WAZ), height for age z score (HAZ), of children with CLP were compared with age matched controls.Results: Prevalence of PEM and stunting for cleft group were 40% and 21.3% respectively compared to 33.33% and 17.33% for the control. Differences in the underweight, and stunting between the two groups were not statistically significant (?2=2.83, p value=0.58, and ?2=1.48, p value=0.69 respectively).Conclusions: There is no statistically significant difference in the occurrence of malnutrition in children with non- syndromic cleft lip and Palate compared with control.

Variation of weight for age Z scores in preterm infants with extrauterine growth restriction / 中华实用儿科临床杂志

Objective To understand variation of weight for age Z scores in premature infants with extrauterine growth restriction(EUGR).Methods Retrospective analysis was adopted with the data of very -low -gestational age (VLGA)preterm infants who met with the following criteria:admitted to Neonatal Medical Center of Huai′an Maternity and Child Healthcare Hospital from January 201 1 to December 201 3,gestational age <32 weeks,more than 4 weeks of hospital stay and survived when discharged.All VLGA premature infants were divided into non -EUGR group and EUGR group according to whether the standard weight on hospital discharge was below the 1 0th percentile of body weight at corrected age.The weight for age Z scores of preterm infants were calculated at each time point.The differences and trends between 2 groups were compared.The receiver operating characteristic (ROC)curve in diagnosing EUGR by weight for age Z scores was drawn.Results A total of 1 77 VLGA premature infants were enrolled,and among them there were was 1 04 cases of EUGR and the incidence amounted to 58.8%.The weight for age Z scores curve of EUGR group was under that of all preterm infants,and the curve of non -EUGR group was above that of all preterm infants. The weight for age Z scores of all preterm infants and EUGR group showed overall downward trend along with prolonged hospitalization.However,the weight for age Z scores of non -EUGR group did not change significantly at each week point except for the first week.The weight for age Z scores of EUGR group was lower than that of non -EUGR group at birth (-0.84 ±0.39 vs -0.31 ±0.41 ),the first week after birth (-1 .1 9 ±0.36 vs -0.74 ±0.40),the second week after birth (-1 .1 7 ±0.36 vs -0.68 ±0.40),the third week after birth (-1 .23 ±0.34 vs -0.64 ±0.39),the fourth week after birth (-1 .35 ±0.41 vs -0.65 ±0.42),the fifth week after birth (-1 .45 ±0.41 vs -0.56 ± 0.38),the sixth week (-1 .54 ±0.49 vs -0.70 ±0.36)and on discharge time (-1 .72 ±0.38 vs -0.67 ±0.42). The difference at each week point was statistically significant (all P =0.000).The weight for age Z scores on discharge were negatively correlated with start time of enteral feeding in preterm infants (r =-0.271 ,P <0.05),time of paren-teral nutrition up to 41 8 kJ/(kg·d)(r =-0.388,P <0.05),time of full enteral feeding (r =-0.332,P <0.05),a-mino cumulative dose (r =-0.298,P <0.05)and fat milk cumulative dose (r =-2.221 ,P <0.05).Area under the curve at each week point of the weight for age Z scores predicting the EUGR gradually increased along with prolonged hospitalization.There was a statistical significance in the weight for age Z scores value at each week point on the diagno-sis of EUGR(P =0.000).There was a high sensitivity and specificity at each week point.Conclusions Dynamic mo-nitoring weight of age Z scores of the premature infants can show the nutrition and growth trend,and may be a risk warning of the preterm infants suffering from EUGR.

The changes in protein and energy intakes and weight in 2 weeks after birth in appropriate for gestational age ;and small for gestational age preterm infants with gestational age less than 34 weeks / 临床儿科杂志

Objective To investigate the changes of protein and energy intakes and the z-score of weight for age in appropriate for gestational age (AGA) and small for gestational age (SGA) preterm infants with gestational age less than 34 weeks. Methods The data from 314 hospitalized premature infants ( 268 cases of AGA and 46 cases of SGA) during January 2012 to December 2014 were retrospectively collected. The intakes of protein and energy and the changes of weight within 2 weeks after birth were compared. Results Compared with AGA group, the hospital stays, durations of parenteral and enteral nutrition and total enteral nutrition, and time to achieve full dose feeding were signiifcantly longer in SGA group (P?

Weight-for-age standard score distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery.

Objective: To study the distribution of weight for age standard score (Z score) in pediatric cardiac surgery and its effect on in-hospital mortality. Introduction: WHO recommends Standard Score (Z score) to quantify and describe anthropometric data. The distribution of weight for age Z score and its effect on mortality in congenital heart surgery has not been studied. Methods: All patients of younger than 5 years who underwent cardiac surgery from July 2007 to June 2013, under single surgical unit at our institute were enrolled. Z score for weight for age was calculated. Patients were classified according to Z score and mortality across the classes was compared. Discrimination and calibration of the for Z score model was assessed. Improvement in predictability of mortality after addition of Z score to Aristotle Comprehensive Complexity (ACC) score was analyzed. Results: The median Z score was -3.2 (Interquartile range -4.24 to -1.91] with weight (mean±SD) of 8.4 ± 3.38 kg. Overall mortality was 11.5%. 71% and 52.59% of patients had Z score < -2 and < -3 respectively. Lower Z score classes were associated with progressively increasing mortality. Z score as continuous variable was associated with O.R. of 0.622 (95% CI- 0.527 to 0.733, P < 0.0001) for in-hospital mortality and remained significant predictor even after adjusting for age, gender, bypass duration and ACC score. Addition of Z score to ACC score improved its predictability for in-hosptial mortality (δC - 0.0661 [95% CI - 0.017 to 0.0595, P = 0.0169], IDI- 3.83% [95% CI - 0.017 to 0.0595, P = 0.00042]). Conclusion: Z scores were lower in our cohort and were associated with in-hospital mortality. Addition of Z score to ACC score significantly improves predictive ability for in-hospital mortality.

Infant Feeding Practices and Growth Pattern in the First Six Months of Life: A Cross-Sectional Study of Babies Attending the Infant Welfare Clinic of the Nnamdi Azikiwe University Teaching Hospital.

Background: Malnutrition which mostly is a consequence of improper feeding practices has been shown to contribute to over 50% of under-5 mortality. This means that appropriate age-specific nutritional prescription is the surest way of significantly shrinking childhood mortality especially in sub-Saharan Africa. Aim: This cross-sectional descriptive and analytical study aims to determine the relationship between different infant feeding practices and the nutritional status of apparently healthy infants below six months of age attending the infant welfare clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Methods: Mother infant pairs attending the infant welfare clinic that meets the inclusion criteria were consecutively enrolled over a six months period. Results: Four hundred infants were enrolled for this study. Educational level (P=0.003), socioeconomic class (P=0.010), occupation (P=0.025) and infants age (P=0.001) significantly determined exclusive breast feeding (EBF) practice. Exclusively breast feed infants showed higher weight and length indices for age and sex compared to infants in other feeding group (P=0.001). Significantly lower proportion of infants in the EBF group (1.9%) compared to infants in the predominant breast feeding (PBF) 5.2% and complementary breast feeding (CBF) 9.7% feeding group showed evidence of under-weight (P=0.015). Binary logistic regression analysis showed that EBF infants were 0.12 and 0.51 times less likely to be under-weight (OR 0.12; CI 0.02-0.93) and stunted (OR 0.51; CI 0.27-0.96) respectively. Conclusion: Since malnutrition is a major contributor to neonatal and infant’s mortality in Africa, the campaign for EBF practice should not only be sustained but further strengthened as a way of halting and possibly reversing the gloomy trend.

Respiratory syncitial virus in children with acute respiratory infections.

Objective. To study the nutritional status of children with Respiratory Syncitial virus infection. Methods. One hundred and twenty six children with acute respiratory infection, between the age of 4-24 months, were investigated for RSV infection with bronchiolitis, pneumonia and upper respiratory tract infection. Nasopharyngeal aspirates were collected and cytokine responses were determined by ELISA. Upper respiratory tract infections were detected in 16.66%, bronchiolitis in 30.15% and Pneumonia in 53.17% children. Results. Of the 126 patients, 46.66% children were positive for RSV while 58.33% were negative for RSV. Children with bronchiolitis were more commonly positive for RSV compared to URTI and pneumonia. RSV was almost equally distributed among boys (42.5%) and girls (48.7%). More children were RSV positive when the mean age lesser (8.4 mo) was compared to RSV negative (9.93 mo). Well nourished children and children with normal birth weight had more RSV positives, though not statistically significant. In a sub sample analysis of cytokines done (n=25), Interleukin-2 and Interleukin-8 levels were higher in the RSV positive children and these levels declined after 5 days of illness. Conclusions. RSV is more commonly associated with bronchiolitis in younger infants with normal birth weight or more weight for age (WFA). Proinflammatory cytokine IL-8 was secreted at high concentrations in the nasopharyngeal aspirate in all the children.

Comparação entre distribuições de referência para a classificação do estado nutricional de crianças e adolescentes com síndrome de Down / Assessment of anthropometric indexes of children and adolescents with Down syndrome

OBJETIVO: Avaliar a concordância da categorização dos índices peso para idade (P/I) e estatura para idade (E/I) em indivíduos com síndrome de Down segundo diferentes curvas. MÉTODOS: Desenvolveu-se estudo transversal em crianças (2 a 9,9 anos de idade) e adolescentes (10 a 17,9 anos de idade) com síndrome de Down assistidos em instituições da região metropolitana do Rio de Janeiro. Os índices de P/I e E/I foram categorizados segundo os percentis de três curvas: duas para indivíduos com síndrome de Down e outra para indivíduos saudáveis. Os limites utilizados na categorização foram o percentil 5 (P5) e o percentil 95 (P95). Utilizou-se o Kappa ponderado na avaliação da concordância das classificações (significativo quando p < 0,05). RESULTADOS: Foram obtidas informações de 98 crianças e 40 adolescentes. Entre as crianças, o P/I < P5 variou de 1,0 a 18,4 por cento; a concordância para essa categorização foi considerada fraca (Kappa = 0,16; IC95 por cento -0,03-0,34; p < 0,01); para E/I, não foi observada concordância na classificação. Entre os adolescentes, a categorização do P/I < P5 variou de 2,5 a 5,0 por cento; a concordância para essa classificação foi fraca (Kappa = 0,16; IC95 por cento -0,15-0,48; p > 0,05); para E/I, a concordância foi boa (Kappa = 1,00; IC95 por cento 0,23-1,00; p < 0,01). CONCLUSÃO: A concordância entre as classificações dos índices P/I e E/I geradas por diferentes distribuições mostrou-se fraca. Os dados indicam que o desenvolvimento de curvas específicas para indivíduos com síndrome de Down seria útil para a identificação de distúrbios ponderais, como o excesso de peso, que é freqüentemente observado nesse grupo.

OBJECTIVE: To compare the agreement between classifications of children and adolescents with Down syndrome (DS) by weight for age (W/A) and height for age (H/A) indexes according to a selection of international reference curves. METHODS: A cross-sectional study was carried out of children (2 to 9.9 years old) and adolescents (10 to 17.9 years old) with DS from cities in the state of Rio de Janeiro, Brazil, in 2005. The W/A and H/A indexes were classified according to the percentiles of two curves developed for individuals with Down syndrome and one distribution developed for healthy subjects. The cut-off limits applied for categorization were: below the 5th percentile (< P5) and above the 95th percentile (> 95). The weighted Kappa index was estimated to assess agreement between the classifications (p < 0.05). RESULTS: Information was obtained on 98 children and 40 adolescents. From 1.0 to 18.4 percent of the children were < P5 for W/A and the agreement for this index was considered weak (Kappa = 0.16; 95 percentCI -0.03-0.34; p < 0.01) no agreement was observed between the H/A classifications. For adolescents, W/A < P5 varied from 2.5 to 5.0 percent; and once more there was no agreement for this classification (Kappa = 0.16; 95 percentCI -0.15-0.48; p > 0.05). There was good agreement for the H/A index (Kappa = 1.00; 95 percentCI 0.23-1.00; p < 0.01). CONCLUSION: There was weak agreement between classifications of anthropometric indexes according to three different distributions. The data indicate that the construction of specific curves for individuals with DS would facilitate the identification of overweight, which is often observed among these patients.

Research on the growth references of height, weight and body mass index for children under 7 years old / 中华流行病学杂志

Objective To understand the varying features and the trend of length/height-for-age,weight-for-age and body masa index(BMI)-for-age of children under six years old in Ningbo city,Zhejiang province.Methods By random clustered sampling,64 038 healthy children under six years old in Ningbo were chosen and their length/height and weight measured.Means,standard deviation and percentiles of length/height-for-age,weight-for-age and BMI were calculated by SAS systems.Results of this study were compared with growth standards from WHO 2006 and nine urban areas of China,in 2005.Results Data from our study showed that the annual growth rates were basically the same in boys and girls.All these indicators increased along with age but the younger the age,the faster the growth rate appeared.There were notable differences seen between genders and urban-rural distribution.BMIs were also varied with age and sex.BMI reached peak between 4 to 6 months,then dropped slowly when age increased.Conclusion The means of length/height-for-age,weight-for-age in Ningbo city had exceeded the WHO standards,and the growth by year under six year-olds in Ningbo was close to the data from nine urban areas of China in 2005.

Enviromental Factors and Factors Associated with Feeding on Infant's Growth / 대한지역사회영양학회지

No abstract available.