Situación nutricional y acciones implementadas en niños internados en salas de cuidados intermedios y moderados de un hospital pediátrico de alta complejidad de la ciudad de Buenos Aires / Nutritional status and actions implemented in children admitted to intermediate and moderate care wards of a tertiary-care pediatric hospital in the city of Buenos Aires

Introducción: La malnutrición es un estado de deficiencia o exceso de nutrientes que provoca efectos nocivos y puede alterar el crecimiento aumentando la morbi-mortalidad. Materiales y métodos: estudio retrospectivo, descriptivo. Incluyó niños/as de 1-18 años hospitalizados entre 2016-2018. Se obtuvieron datos de caracterización de la muestra y antropométricos. La herramienta de tamizaje nutricional pediátrico (HTNP) se utilizó para detectar riesgo nutricional y en este subgrupo se analizó: variación de peso, intervención nutricional, complicaciones infecciosas y estadía hospitalaria. El análisis de variables se realizó con SPSS Statistics 20. Resultados: Se evaluaron 745 pacientes, 373 niñas (50,1%). Mediana de edad 7,3 años. Estancia hospitalaria media de 4 días (1-123). Se observó 5,9% emaciados, 56,4% eutróficos, 16,8% sobrepeso y 20,9% obesidad. Con baja talla 13%. Se detectó riesgo nutricional con HTNP en 50,7% de los ingresos. Las patologías de base más frecuentes fueron cardiopatías y neoplasias. En pacientes con riesgo nutricional: estadía hospitalaria media de 5 días, 13,5% cursó con infecciones intrahospitalarias, 68% mantuvo o aumentó de peso durante la internación, 13,5% requirió apoyo nutricional (más utilizado el gavage en 59%). Conclusiones: El niño hospitalizado se encuentra en una situación de vulnerabilidad, por lo que el tamizaje y evaluación nutricional resultan acciones claves para prevenir el deterioro nutricional. En los niños con malnutrición las acciones llevadas a cabo por el Nutricionista Clínico como integrante del equipo de atención, revisten un rol clave para promover y garantizar el derecho de los pacientes a la alimentación adecuada y así mejorar su condición nutricional. (AU)

Introduction: Malnutrition is a state of nutrient deficiency or excess that causes harmful effects and can alter growth increasing morbidity and mortality. Materials and methods: retrospective, descriptive study. Children aged 1-18 years admitted to the hospital between 2016-2018 were included. Sample characterization and anthropometric data were collected. The pediatric nutritional screening tool (PNST) was used to identify nutritional risk and in this subgroup we analyzed: weight variation, nutritional intervention, infectious complications, and length of hospital stay. The analysis of variables was performed with SPSS Statistics 20. Results: 745 patients were evaluated, 373 were girls (50.1%). Median age was 7.3 years. Mean hospital stay was 4 days (1- 123). Among the patients, 5.9% were emaciated, 56.4% eutrophic, 16.8% overweight, and 20.9% obese. Thirteen percent of the patients had short stature. Nutritional risk was detected using HTNP in 50.7% of the admitted patients. The most frequent underlying diseases were heart disease and cancer. In patients at nutritional risk: mean hospital stay was 5 days, 13.5% had hospital-acquired infections, 68% maintained or gained weight during the hospital stay, 13.5% required nutritional support (gavage was the most frequently used in 59%). Conclusions: Hospitalized children are in a vulnerable situation, therefore nutritional screening and evaluation are key actions to prevent nutritional deterioration. In children with malnutrition, the Clinical Nutritionist, as a member of the health care team, plays a key role in promoting and guaranteeing the right of patients to adequate food and thus improve their nutritional condition (AU)

Ensaio randomizado sobre o impacto da multimistura no estado nutricional de crianças atendidas em escolas de educação infantil / Randomized clinical trial of the impact of a nutritional supplement \"multimixture\" on the nutritional status of children enrolled at preschools

OBJETIVO: Avaliar o efeito da multimistura adicionada à merenda escolar sobre o estado nutricional de crianças atendidas em escolas municipais de educação infantil. MÉTODOS: Estudo de intervenção, longitudinal e controlado, incluindo 24 escolas de educação infantil que foram comparadas antes e depois da intervenção. Os grupos controle e intervenção foram definidos por sorteio das escolas que haviam sido emparelhadas por situação nutricional. A intervenção consistiu em adicionar 10 g de multimistura à alimentação fornecida às crianças que freqüentavam as 12 escolas do grupo intervenção. As medidas de desfecho incluíram as diferenças de escore z dos três índices nutricionais e dos valores de hemoglobina no período de 6 meses em que a suplementação foi fornecida. Modelo multinível foi utilizado nas análises. RESULTADOS: As médias de escore z de peso por idade ao final do acompanhamento foram de 0,40 (±1,34) e 0,31 (±1,32), respectivamente, nos grupos intervenção e controle. A análise em multiníveis mostra diferenças não significativas a favor da intervenção nas médias de escore z de peso para idade (β 0,05; IC95 por cento -0,03 a 0,12) e de estatura para idade (β 0,02; IC95 por cento -0,06 a 0,09). A diferenηa média de hemoglobina foi contrária à intervenção, mas também não foi significativa (β -0,01; IC95 por cento -0,36 a 0,34). CONCLUSÃO: A suplementação com 10 g de multimistura não mostrou efeito significativo sobre nenhuma das medidas ou índices nutricionais estudados em crianças atendidas em escolas municipais de educação infantil.

OBJECTIVE: To evaluate the effect of adding a nutritional supplement "multimixture" to school meals on the nutritional status of children enrolled at municipal preschools. METHODS: Longitudinal, controlled intervention study of 24 preschools which were compared before and after an intervention. The control and intervention groups were defined by drawing lots to choose schools that had previously been paired for nutritional status. The intervention consisted of the addition of 10 g of multimixture to the meals provided to children attending the 12 schools in the intervention group. Outcome measures include changes in z scores for the three nutritional indices and hemoglobin values over the 6-month period during which the supplement was added. A multilevel model was used for analyses. RESULTS: Mean z scores for weight for age at the end of follow-up were 0.40 (±1.34) and 0.31 (±1.32) for the intervention and control groups, respectively. The multilevel analysis demonstrated non-significant differences in favor of the intervention in mean z scores for weight for age (β 0.05; 95 percentCI -0.03 to 0.12) and height for age (β 0.02; 95 percentCI -0.06 to 0.09). Mean change in hemoglobin was against the intervention, but this was also without significance (β -0.01; 95 percentCI -0.36 to 0.34). CONCLUSIONS: Supplementation with 10 g of multimixture did not have a significant effect on any of the nutritional indices or measurements of the municipal preschool pupils studied here.

Evaluación del impacto de una intervención alimentario nutricional en niños chilenos con malnutrición por déficit / Impact evaluation of a nutritional intervention in Chilean children with malnutrition

Background: In the year 2003, the Ministry of Health replaced rice from the Complementary Nutritional National Program destined to malnourished and in risk children, for a product with higher nutritional value ("Mi Sopita"). Objective: Evaluate the effect of this intervention in the nutritional evolution of children under 6 years-old, in risk or suffering malnutrition. Method: Retrospective cohort of 1.576 children registered in the program 6 months earlier in 300 Primary Care establishments. Analysis of the evolution of anthropometric indicators for a period of 6 months, in function of the initial diagnosis and age. Logistic regressions of multiple factors to determine the variables associated to a better nutritional evolution. Results: 80 percent of cases presented nutritional risk and the rest malnutrition. In 6 months, the median value of change in Z score for weight/age was + 0,3 SD (95 percent IC 0,3-0,3), height/age +0,3 SD (0,3-0,4) and weight/height +0,5 SD (0,3-0,6) in children with initial values < -2 SD. The change was approximately 0,1 SD for the group with nutritional risk. Between 44 percent and 69 percent of the children with malnutrition got partially better or normalized their nutritional status according to the different indicators (p < 0,001). The most determinant factor for better evolution was major initial nutritional deficit (OR 4,4 IC 3,2-6,1 p < 0,001 for weight/age). Conclusions: The program has a positive effect in the recovery of malnourished children and it avoids major nutritional deterioration in children at risk.

Antecedentes: El 2003 el Ministerio de Salud introdujo un nuevo alimento de mayor valor nutricional (Mi Sopita) en el Programa Nacional de Alimentación Complementaria de refuerzo destinado a niños en riesgo nutricional y desnutridos. Objetivo: Evaluar el efecto de esta intervención en la evolución de los indicadores antropométricos y estado nutricional de menores de 6 años en riesgo y desnutridos. Material y Método: Cohorte retrospectiva de 1 576 niños ingresados al programa 6 meses atrás en 300 establecimientos de atención primaria. Análisis de la evolución de la relación peso-edad, talla-edad y peso-talla entre el ingreso y los 6 meses, en función del diagnóstico inicial y la edad. Regresiones logísticas multivariadas para determinar los factores asociados a una mejor evolución nutricional. Resultados: El 80 por ciento de la muestra presentaba riesgo nutricional y el resto desnutrición. En 6 meses la mediana de cambio del puntaje Z en niños que ingresaron con valores < - 2 DE fue de + 0,3 DE (95 por ciento IC 0,3-0,3) para peso-edad, + 0,3 DE (0,3-0,4) para talla-edad y +0,5 DE (0,3-0,6) para peso-talla. El cambio fue menor (aproximadamente + 0,1 DE para el grupo en riesgo nutricional. El 44 al 69 por ciento de los niños desnutridos mejoró parcialmente o normalizó su estado nutricional según los diferentes indicadores (p < 0,001). El factor más determinante de una mejor evolución fue un mayor déficit nutricional inicial (OR 4,4 IC 3,2-6,1 p < 0,001, para la relación peso-edad). Conclusiones: El programa tiene un efecto positivo en la recuperación de los niños con desnutrición y evita un mayor deterioro nutricional en los niños en riesgo.

Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition.

The study was a controlled, comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi. Being at risk of malnutrition was defined as weight-for-height <85%, but >80% of the international standard. A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food (RUTF) (n=331) or micronutrient-fortified corn/soy-blend (n=41) for up to eight weeks. The primary outcomes were recovery, defined as weight-for-height >90%, and the rate of weight gain. Children receiving RUTF were more likely to recover (58% vs 22%; difference 36%; 95% confidence interval [CI] 20-52) and had greater rates of weight gain (3.1 g/kg.d vs 1.4 g/kg x d; difference 1.7; 95% CI 0.8-2.6) than children receiving corn/soy-blend. The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the standard fortified cereal/legume-blended food.

Consumo de harina de maíz precocida y su aporte de hierro y vitamina A en preescolares de bajos recursos económicos / Pre-cooked corn flour intake and its contribution of iron and vitamin A in low income preschoolers

The objective of this study was to determine whether the addition of iron and vitamin A (VA) to corn flour, supplied through a national enrichment program since 1993, allows preschoolers to achieve an adequate intake of these nutrients. Data from the assessment of 196 children (4-6 year old) from Valencia, Venezuela is presented, including socio-demographic, anthropometric, anemia, VA deficiency (by conjunctival impression cytology (CIC) and serum retinol), and food intake. 92 of the children lived in poverty. 12 were below the norm for weight-for-height. 13 had anemia, 9 had VA deficiency according to CIC, and 0.5 according to serum retinol (< 0.70 mumol/L), 30 were at risk of VA deficiency (0.70-1.05 mmol/L). 17, 37, and 5 of the sample had an insufficient intake (< 80 of RDA) of energy, iron, and VA, respectively. When excluding from the analysis the amount of iron and VA from corn flour enrichment, an additional 38 and 10 of the sample showed deficient intakes of each nutrient, respectively. According to the weight-for-height indicator, iron intake was significantly lower in undernourished children (p < 0.05) than in those normal or above the norm; this was not so for VA. It is concluded that iron enrichment contributes to the improvement of the intake of this nutrient but is not enough to provide an adequate amount of it; and that the addition of VA does not seem to have an important effect on the diet of this age group.

Impacto nutricio del consumo de una leche entera adicionada con vitaminas y minerales en niños / Nutritional impact of a full strenght milk with added vitamins and minerals in children

Objetivo. Determinar el impacto nutricio del consumo de leche entera fortificada con vitaminas y minerales en niños. Material y métodos. Se hizo un estudio prospectivo, longitudinal, en 227 niños de entre 8 a 60 meses de edad. Se ofreció a los menores 500 ml diarios de leche entera fortificada por 90 días. Se registró ingestión, aceptación, peso, talla, hemoglobina (Hb), hierro (Fe), vitamina B12 y folatos séricos. El análisis estadístico se realizó con medidas de tendencia central y dispersión en variables dimensionales utilizando prueba t de Student para comparación de promedios y X² para variables nominales. Resultados. Al inicio de la suplementación 45 niños estaban desnutridos, y 36, anémicos. Al final de la misma estas cifras disminuyeron: 35 desnutridos (p< 0.21) y 18 niños anémico (p< 0.01). Al inicio nueve niños teían desnutrición severa y, al finalizar, sólo eran cinco los que la padecían. La comparación ingreso-egreso en los datos antropométricos fue como sigue (media ñ desviación estándar): Z pero/talla, -0.35 ñ 0.88 vs. -0.14 ñ 0.9 (p= 0.01); Hb en g/dl, 11 ñ 1.3 vs. 11.9 ñ 1.9 (p< 0.001); Fe en mg/dl, 108 44 vs. 115 ñ 31 (p= 0.06); vitamina B12 en pg/ml, 649 ñ 494 vs. 1 053 ñ 854 (p< 0.001). El apego y la aceptación fueron de 100 y 85 por ciento, respectivamente. Conclusiones. El consumo de leche entera fortificada durante 90 días mejora significativamente el estado nutricio de los niños, reduce significativamente el estado nutricio de los niños, reduce significativamente el número de niños con anemia e incrementa los niveles plasmáticos de Hb, vitamina B12 y folatos

Nutrición en el niño con daño neurológico / Nutrition in the neurologically damaged child

Los niños con daño neurológico tienen frecuentemente dificultades para alimentarse y crecer, por diferentes factores y hace falta normas sistematizadas que orienten su manejo. Tomando a la parálisis cerebral como modelo, en esta revisión se analizan algunos aspectos nutricionales que inciden en su evolución, con especial énfasis en evaluación nutricional, conducta alimentaria, complicaciones y tratamiento nutricional. Asimismo se mencionan ciertas interacciones de medicamentos con la nutrición y algunas dificultades éticas que pueden presentarse