Home-based vs inpatient education for children newly diagnosed with type 1 diabetes.

BACKGROUND: Initial management of children diagnosed with type 1 diabetes (T1D) varies worldwide with sparse high quality evidence regarding the impact of different models of care. AIM: To compare the inpatient model of care with a hybrid home-based alternative, examining metabolic and psychosocial outcomes, diabetes knowledge, length of stay, and patient satisfaction. SUBJECTS AND METHODS: The study design was a randomized-controlled trial. Inclusion criteria were: newly diagnosed T1D, aged 3 to 16 years, living within approximately 1 hour of the hospital, English-speaking, access to transport, absence of significant medical or psychosocial comorbidity. Patients were randomized to standard care with a 5 to 6 day initial inpatient stay or discharge after 2 days for home-based management. All patients received practical skills training in the first 48 hours. The intervention group was visited twice/day by a nurse for 2 days to assist with injections, then a multi-disciplinary team made 3 home visits over 2 weeks to complete education. Patients were followed up for 12 months. Clinical outcomes included HbA1c, hypoglycemia, and diabetes-related readmissions. Surveys measured patient satisfaction, diabetes knowledge, family impact, and quality of life. RESULTS: Fifty patients were recruited, 25 to each group. There were no differences in medical or psychosocial outcomes or diabetes knowledge. Average length of admission was 1.9 days shorter for the intervention group. Families indicated that with hindsight, most would choose home- over hospital-based management. CONCLUSIONS: With adequate support, children newly diagnosed with T1D can be safely managed at home following practical skills training.

Resting metabolic rate of Vietnamese adolescents.

OBJECTIVE: To evaluate the FAO/WHO/UNU equations for predicting resting metabolic rate (RMR) in Vietnamese adolescents. DESIGN: A cross-sectional study involving healthy subjects was carried out at the Basic Nutrition Department, National Institute of Nutrition, Vietnam. The RMR was measured by indirect calorimetry and anthropometric indices were recorded. Equations derived by linear regression of RMR and body weight were compared to the FAO/WHO/UNU (1985) predictive equations. SUBJECTS: A total of 110 subjects who had normal body mass index (5-85 percentile) and divided into two groups by sex. RESULTS: Mean RMRs (MJ/kg/day) were 0.1146+/-0.0054 for males and 0.1062+/-0.0103 for females. Compared to the FAO/WHO/UNU equation, our findings were 7.8% and 11.7% lower in the two groups, respectively (P<0.001). CONCLUSION: Our findings suggest that the FAO/WHO/UNU equations may overestimate RMR in Vietnamese adolescents. Further studies on establishing reference of daily energy needs for Vietnamese adolescents should be carried out.

FAO/WHO/UNU equations overestimate resting metabolic rate in Vietnamese adults.

OBJECTIVE: To evaluate the FAO/WHO/UNU equations for predicting resting metabolic rate (RMR) in Vietnamese adults. DESIGN: A cross-sectional study with healthy subjects was carried out at the Basic Nutrition Department, National Institute of Nutrition, Vietnam. RMR was measured by indirect calorimetry, and anthropometric indices were recorded. Equations derived by linear regression of RMR vs body weight were compared to the FAO/WHO/UNU 1985 predictive equations. SUBJECTS: A total of 188 subjects (98 males and 90 females) had a normal body mass index (BMI) and were divided into four groups by sex and age (male and female subjects 18-29 and 30-60 y old). RESULTS: Mean RMR (MJ/kg/day) in males was lightly significant by higher than that in female subjects in the 18-29 y old age group (0.1074+/-0.0100 vs 0.0965+/-0.0123) and the same result was seen in the 30-60 y old group (0.1018+/-0.0114 vs 0.0922+/-0.0129). However, differences were not statistically significant in the two age groups. Compared to the FAO/WHO/UNU equation, our findings were 7.4, 9.0, 11.7, and 13.5% lower in the four groups, respectively (P < 0.001). CONCLUSION: Our findings suggest that the FAO/WHO/UNU equations may overestimate RMR in Vietnamese adults. Further studies examining the relationship between body weight and RMR are needed, and establishing new predictive equations for RMR in Vietnamese should be a priority.

Premature complementary feeding is associated with poorer growth of vietnamese children.

The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and weaned infants gained weight more slowly than those exclusively or predominantly breast-fed. From 1 to 3 mo, exclusively breast-fed infants grew more quickly in both weight and length, followed by predominantly breast-fed infants. From 3 to 6 mo, exclusively breast-fed infants gained more weight compared with the other groups, but there was a slight difference (P = 0.047) in length gain only between exclusively and partially breast-fed infants. In the older period (6-12 mo), exclusively and predominantly breast-fed infants grew in length more quickly than partially breast-fed and weaned groups. However, there was no difference in weight gain among groups. Morbidity from diarrhea and acute respiratory infections was significantly lower for the >/=3 mo exclusively breast-fed group (chi(2) and Fisher-Exact Test). Over nearly the whole age range from 1 mo to 4 y, Z-scores for all indices (weight-for-age, height-for-age and weight-for-height) of the children who received complementary food were significantly lower than those of children who were exclusively breast-fed for at least 3 mo (repeated measures ANOVA, adjusted for sex, family size, maternal education and family income). These results show a long-term deterioration of physical growth in infants who received premature complementary feeding and confirm the importance of exclusive breast-feeding for infants for at least 3 mo.

Longitudinal observation of growth of Vietnamese children in Hanoi, Vietnam from birth to 10 years of age.

OBJECTIVE: To investigate the physical growth of Vietnamese children on a longitudinal basis and with regard to any secular trend. DESIGN: A longitudinal study with four birth cohorts: 1981, 1982, 1983 and 1984 followed up in their homes from birth to 10 y. SUBJECTS: Two-hundred twelve children (128 boys and 84 girls) from two (Hai Ba and Hoan Kiem) out of the four districts in Hanoi. MONITORING OF PHYSICAL GROWTH: Weight, height, feeding practices and diseases were recorded monthly from birth to 12 months, three monthly from 12-36 months, six monthly from 36-72 months, and annually thereafter until 10 y of age. RESULTS: Mean body weight and height of the children at birth was reduced and after the first 3-4 months were comparable to NCHS reference data. Thereafter weight and height fell progressively from the NCHS reference. The most intense period of growth retardation was 15-36 months. The highest proportion of stunting occurred at 21 months (59.4% of males and 58.3% of females). Anthropometric data of Vietnamese children living 1981-1995 in Hanoi were lower than from those living at the same time in Paris but higher than from those living in earlier decades in Vietnam. CONCLUSIONS: The longitudinally-followed children showed growth retardation at birth due to the poor nutritional and health status of their mothers. Children grew well during the first 3-4 months of age, then growth faltering was observed due to inadequate complementary feeding practices. There was a positive secular trend among Vietnamese children.