Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research.

OBJECTIVE: An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. METHODS: A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. RESULTS: Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. CONCLUSION: Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.

Aspartate aminotransferase to platelet ratio index correlates with hepatic cirrhosis but not with fibrosis in pediatric patients with intestinal failure.

BACKGROUND AND OBJECTIVES: Patients with intestinal failure (IF) require parenteral nutrition (PN) support to obtain enough nutrients to sustain growth; long-term PN use is associated with significant liver damage. The aim of this study was to analyze the use of a noninvasive test, the aspartate aminotransferase to platelet ratio index (APRI), in the diagnosis of liver disease in pediatric patients with IF. METHODS: Medical records of all Boston Children's Hospital patients who received PN and underwent a liver biopsy from January 2006 until November 2010 were reviewed. Patients with IF with a clinical diagnosis were selected. APRI was calculated as (aspartate aminotransferase [U/L]/upper normal limit) × 100/platelets (10(9) cells/L). Presence of fibrosis and cirrhosis was estimated using the METAVIR score in liver biopsies. RESULTS: Sixty-two liver biopsies from 48 patients (22 girls) were studied. Mean APRI values in the different METAVIR categories (0-1, 2-3, 4) were 1.80, 1.17, and 4.24, respectively (analysis of variance P = 0.053; Bonferroni test for cirrhosis vs fibrosis P = 0.048). APRI could significantly predict cirrhosis (odds ratio 1.2; 95% confidence interval [CI] 1.001-1.43) but not fibrosis (METAVIR 2-3, odds ratio 1.00; 95% CI 0.86-1.18). Area under the receiver operating characteristic curve for cirrhosis was 0.67 (95% CI 0.45-0.89; P = 0.13). CONCLUSIONS: APRI, a noninvasive, easy-to-obtain bedside test, significantly predicts cirrhosis but not fibrosis in pediatric patients with IFALD. Because the clinicians need a noninvasive test to differentiate among different stages of liver fibrosis rather than differentiating cirrhosis from normal, we cannot recommend the use of this test in pediatric patients with IFALD for this purpose.

Efficacy of ethanol locks in reducing central venous catheter infections in pediatric patients with intestinal failure.

PURPOSE: We sought to determine whether a regimen of 70% ethanol locks could reduce the rate of central venous catheter (CVC) infections in parenteral nutrition-dependent children with intestinal failure. METHODS: We performed a retrospective review of 23 parenteral nutrition-dependent children in our multidisciplinary intestinal rehabilitation clinic who started ethanol lock therapy between September 2007 and June 2009. The treatment regimen consisted of a 70% ethanol lock instilled 3 times per week in each catheter lumen. The rate of CVC infections before and after initiation of ethanol lock therapy was compared using the Wilcoxon signed ranks test with significance set at P < .05. RESULTS: The most common diagnoses leading to intestinal failure were necrotizing enterocolitis (26.1%), gastroschisis (21.7%), and intestinal atresia (14.3%). Ethanol locks were well tolerated with no reported adverse side effects. The infection rate decreased from 9.9 per 1000 catheter days prior to initiation of ethanol locks to 2.1 per 1000 catheter days during therapy (P = .03). CONCLUSIONS: A regimen of ethanol lock therapy administered three days per week appears to be a safe and effective means of reducing the rate of CVC infections in parenteral nutrition-dependent children with intestinal failure.

Better living through chemistry, constant monitoring, and prompt interventions: 26 years on home parenteral nutrition without major complications.

OBJECTIVE: We discuss 26 y of home parenteral nutrition (HPN) in an otherwise healthy patient with severe short bowel syndrome demonstrating a decrease in life-threatening complications after various management changes. METHODS: The patient is a 41-y-old male with a midgut volvulus from malrotation who developed short bowel syndrome and has been HPN dependent since the age of 15 y. His surgical and nutritional data were collected retrospectively and prospectively and included nutritional history, anthropometric parameters, laboratory results, activity levels and types, and treatments for complications. His entire HPN course has been prospectively followed. RESULTS: Since becoming HPN dependent, the patient's energy intake range has been 20-45 kcal.kg(-1).d(-1), with 0.8-1.6 g of protein.kg(-1).d(-1). He receives HPN with electrolytes, multivitamins, and trace elements nightly and his intravenous fat emulsion ranges from one to seven times per week. Adjustments to magnesium, iron, zinc, selenium, vitamin E, and carnitine are often required. During his first years of HPN, he had six episodes of catheter-related sepsis and two central venous catheter occlusions. The current central venous catheter has been in place for >13 y without infection or replacement. He developed mild osteopenia but has maintained an active lifestyle without fractures. In the second and third decades of HPN, episodes of hepatic dysfunction occurred, with improvement or resolution using various interventions including oral fish oil. CONCLUSION: This case illustrates the successful management of a life-long HPN-dependent patient in whom PN complications have been minimized, including a very recent occurrence of parenteral nutrition-associated cholestasis.

Childhood obesity: etiology, prevention, and treatment.

The rapid increase in the prevalence of obesity in children and adolescents is alarming, particularly in light of its many medical and psychosocial consequences. In this review, we discuss key concepts of nutrition and physical activity. Etiology, prevention, and treatment strategies are also discussed, focusing on the macronutrient content of the diet, portion control, meal patterns, physical activity, and sedentary behaviors. Television viewing, lack of physical activity, and intake of fast food and soft drinks are also examined as potential contributing factors in the obesity epidemic. Children should be helped to develop healthy nutrition and exercise habits early, since interventions are most effective when behaviors are still being formed.