Effectiveness of Enteral Versus Oral Nutrition With a Medium-Chain Triglyceride Formula to Prevent Malnutrition and Growth Impairment in Infants With Biliary Atresia.

OBJECTIVES: The aim of this study was to compare the effectiveness of oral (PO) versus enteral nutrition (EN) medium-chain triglyceride (MCT) containing-formula to prevent malnutrition and growth impairment in infants with biliary atresia (BA) waiting for a liver transplant. METHODS: A total of 15 infants, 3 to 9 months old with BA were included. They were randomly assigned to either PO or EN. For 12 weeks, both groups received an MCT formula fortified with glucose polymers and corn oil to reach a caloric density between 0.8 and 1 kcal/mL. The formula given to the PO group was administered ad libitum and that given via EN was infused through a nasogastric tube to reach 140% of the energy intake recommended by the Dietary Recommended Intake guidelines. Protein intake was adjusted to 4 to 5 g/kg present weight. Outcome variables were growth and nutritional status evaluated periodically by anthropometric indicators. Biochemical and hematological variables were evaluated through the study. RESULTS: Baseline clinical, nutritional, biochemical, and hematological variables showed no differences between the study groups. Baseline length/age was <-2 SD in 10 of the 15 patients; in the PO group, it fell <-3 SD, whereas in the EN group, it remained stable. Head circumference z score dropped 0.6 SD in the PO group, whereas in the EN group it remained stable. Triceps skinfold values improved in the infants taking EN, P < 0.001. The frequency of adverse effects--respiratory infection and diarrhea--was higher in the EN group. No biochemical or hematological differences were observed between the study groups throughout the study. CONCLUSIONS: A 12-week EN trial with an MCT-fortified formula prevented malnutrition and growth impairment in infants with BA waiting for a liver transplant.

[Focus of childhood obesity from pediatrics]. / Enfoque de la obesidad infantil desde la pediatría.

The prevalences of overweight and obesity have increased dramatically in the last two decades in the adult and children population. The Organization for Cooperation and Economic Development reported in 2010 that Mexico ranks first worldwide in childhood obesity. The 2006 National Health and Nutrition Survey reported that one of every three teenagers are overweight and obese. In the last decades, pediatric hospitals in different parts of the world reported the prevalence of secondary malnutrition, since in those days overweight and obesity did not represent health problems. Currently, the prevalence of overweight and obesity has been scarcely studied in pediatric hospitals. In the Hospital de Pediatría (Children's Hospital) of the Instituto Mexicano del Seguro Social's Centro Médico Nacional de Occidente it is reported a prevalence of overweight of 15.4 % and obesity of 12.2 %, which reflects a nutritional transition.Due to the high prevalence of overweight and obesity in this pediatric hospital of reference, one could conclude that the pediatrician should be able to make a correct evaluation of the nutritional state, because, if he does not detect these problems, we will be condemning children to suffer from a chronic disease for the rest of their lives, and with all the implications in the short, medium and long term.

Las prevalencias de sobrepeso y obesidad se han incrementado alarmantemente en las dos últimas décadas en la población adulta e infantil. La Organización para la Cooperación y el Desarrollo Económicos reportó en el 2010 que México era el primer lugar mundial de obesidad en niños. La Encuesta Nacional de Salud y Nutrición 2006 reporta que uno de cada tres adolescentes presentan sobrepeso y obesidad. En décadas pasadas los hospitales pediátricos en diferentes partes del mundo reportaban la prevalencia de desnutrición secundaria, ya que el sobrepeso y la obesidad no representaban problemas de salud. Actualmente la prevalencia de sobrepeso y obesidad ha sido poco estudiada en hospitales pediátricos. En el Hospital de Pediatría del Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social se reporta una prevalencia de sobrepeso de 15.4 % y de obesidad de 12.2 %, lo que refleja una transición nutricia. Debido a esta alta prevalencia de sobrepeso y obesidad en este hospital; pediátrico de referencia, se podría concluir que el pediatra debería estar capacitado para realizar una correcta evaluación del estado nutricio, ya que si él no detecta estos problemas, estaremos condenando a los niños a padecer una enfermedad crónica por el resto de su vida, con todas las implicaciones que tiene a corto, mediano y largo plazo.

Socio-demographic factors associated with caustic substance ingestion in children and adolescents.

OBJECTIVE: Caustic substance ingestion is a public health issue in some underdeveloped countries. Published information on socio-demographic factors related to this problem is scarce. The aim of this study was to evaluate the association of socio-demographic factors with caustic ingestion in children. DESIGN: case-control study. Cases were children with caustic substance ingestion who were attended to during 2006 (n=94) at a pediatric referral hospital in Guadalajara, Mexico; the controls were a random sample of children who were hospitalized or seen as outpatients in the same pediatric referral hospital (n=641). The socio-demographic variables were studied using a validated questionnaire (Children Nutrition Organization Survey). STATISTICS: OR, 95% CI and logistic regression. RESULTS: Mean age of the cases was 3.2 years (SD 2.4) and 37.2% of cases were girls. Caustic ingestion occurred at home in 63.8% of cases and at a relative's home in 23.4% of cases. Alkaline products were ingested by 85.1%; containers had no warning labels in 72.3% of cases and no childproof safety caps in 92.6% of cases. The socio-demographic variables associated with caustic ingestion included higher family income, lower educational level of the mother, higher proportion of fathers working as independent professionals, extended family, mother's age <30 years, and mother working outside the home. CONCLUSIONS: The observed family risk profile for caustic ingestion was higher family income, young working mother with low educational level, father working as independent professional, and extended family.

Seasonal variation of enteropathogens in infants and preschoolers with acute diarrhea in western Mexico.

The present study estimates the prevalence of some enteropathogens in infants and preschoolers with acute diarrhea. From 2006 to 2007, 5459 consecutive stool samples were evaluated. Cryptosporidium parvum was the parasite identified with the higher frequency (5.1%), followed by Giardia lamblia (1.2%). Campylobacter jejuni was isolated in 858 cases (15.7%) and was the most frequent enteropathogen overall. The rates of C parvum, Shigella, and Salmonella were higher in the summer. Rotavirus had the expected winter peak and it was the third enteropathogen because of its frequency. Overall frequency of stool-reducing substances was 15.6% and was associated with a rotavirus-positive test.

Secondary malnutrition and overweight in a pediatric referral hospital: associated factors.

OBJECTIVES: To establish the prevalence and identify the clinical and sociodemographic factors associated with malnutrition and overweight in a pediatric referral hospital. PATIENTS AND METHODS: We studied a cross-sectional, random sample from a pediatric hospital. Malnutrition was defined as acute when the z score of weight/height was less than -2.0 and as chronic if in addition the height/age z score was less than -2.0. Overweight risk was defined as a body mass index percentile between 85 and 94, and overweight as a body mass index percentile of 95 or higher. RESULTS: The study included 641 patients, with mean age 7.1 +/- 4.9 years (56% male). The overall prevalence of acute malnutrition was 8% and chronic malnutrition 17.0%. Overweight risk was present in 15.4% and overweight in 12.2%. Acute malnutrition was predicted by conditions on admission (hospitalization: odds ratio [OR] 2.3, confidence interval [CI] 1.3-4.3; nonsurgical subspecialty: OR 2.1, CI 1.0-4.3) and number of siblings (1 child, single mother: OR 2.6, CI 1.3-5.0). Chronic malnutrition was predicted by age (infants vs preschoolers: OR 2.0, CI 1.1-3.6; infants vs school children: OR 3.1, CI 1.8-5.5) and illness duration (>30 days: OR 2, CI 1.1-3.7). Overweight risk was associated with age (>36 months: OR 2.0, CI 1.6-3.4) and the father's educational level (college and university: OR 2.3, CI 1.3-4.3). Overweight was predicted by sex (boys: OR 2.0, CI 1.0-3.6) and age (>36 months: OR 1.7, CI 1.0-2.8). CONCLUSIONS: Overweight was as prevalent as malnutrition. Malnutrition was associated with clinical condition, age, family size, and illness duration, whereas overweight was related to age, sex, and father's education. Overweight appears as a novel finding in the nutritional profile of pediatric referral hospitals in Mexico.

Liver function test results predict nutritional status evaluated by arm anthropometric indicators.

OBJECTIVES: To compare the anthropometric indicators based on weight and height with the anthropometric indicators based on arm measurements and to predict the anthropometric nutritional status with liver function tests (LFTs) in children with chronic liver disease (CLD). PATIENTS AND METHODS: A cross-sectional study in a referral pediatric hospital enrolled 79 children with CLD (mean age 72.6 +/- 61.8 months, 54% female). An independent variable of LFT was used to determine the outcome variable of nutritional status. Anthropometric indicators of height versus age, weight versus height, head circumference versus age, and arm indicators versus age were analyzed with Pearson correlation, the determination coefficient r, and multiple regression. RESULTS: A total of 44.3% of patients studied had growth impairment. The anthropomorphic indicator of weight for height identified malnutrition in 11.4%, compared with 43% identified by mid- to upper arm circumference (MUAC) and 40.5% identified with total arm area. MUAC (P < 0.001), total arm circumference (P < 0.001), arm muscle area (P = 0.009), and arm fat area (P = 0.023) identified more cases of z score less than -2 SD than weight/height. The presence of ascites misled weight-for-height measurements. Conjugated bilirubin and albumin had significant correlations with almost all of the anthropometric indicators. Alkaline phosphatase correlated significantly with all of the arm anthropometric indicators. A regression analysis led to 7 prediction models; the highest prediction of z score less than -2 SD was with triceps skinfold and conjugated bilirubin, albumin, and gamma-glutamyltransferase; height-for-age z score less than -2 SD was predicted by measurements of conjugated bilirubin, prothrombin time, and alanine aminotransferase. CONCLUSIONS: The data presented underline the correlation between the liver damage severity evaluated by LFT and the nutritional status estimated by anthropometric indicators. In our view these observations reflect the close relationship between liver function and the degree of liver damage to growth and current nutritional status.

Acute and recurrent pancreatitis in children: etiological factors.

OBJECTIVES: To describe the clinical picture and outcome, and to assess the etiological factors of acute and recurrent pancreatitis in children. METHODS: Thirty-six (65.5%) patients with acute and 19 (34.5%) with recurrent pancreatitis were studied. Mean age was 126 (41.3 SD) months; 27 (49.1%) were females. SETTING: A pediatric referral hospital. PERIOD: 2000-2005. DESIGN: Cross-sectional. VARIABLES: Clinical and laboratory data and etiological factors. STATISTICS: Chi2-test, Fisher test, OR, confidence interval, Student t-test and Mann-Whitney U-test. RESULTS: The most frequent symptom in acute and recurrent pancreatitis was abdominal pain, followed by vomiting and ileus. The severity of pancreatitis and complications were similar in both groups. Biliary stones, family history of pancreatitis, drug ingestion and hypercalcemia occurred in both groups. Abdominal trauma and acute hepatitis A occurred in patients with acute pancreatitis; triglyceride>5.65 mmol/L, pancreas divisum and DeltaF508 mutation occurred in patients with recurrent pancreatitis. No difference was observed when frequency factors between study groups were compared. CONCLUSIONS: The clinical picture and etiological factors were similar in both groups. Since one out of every three children with acute pancreatitis in this series presented recurrences, it was not considered to be a 'benign disease'. Fifteen different etiological factors were identified in two-thirds of the cases.

[Efficacy of two Helicobacter pylori eradication treatments in children with recurrent abdominal pain]. / Eficacia de dos esquemas de erradicación de Helicobacter pylori en niños con dolor abdominal recurrente.

OBJECTIVE: To compare clinical and bacteriologic efficacy of two therapeutic trials to eradicate Helicobacter pylori (H. pylori) in two series of pediatric patients with recurrent abdominal pain (RAP). MATERIALS AND METHODS: n = 36 children with RAP-associated H. pylori infection. Age 9.8 +/- 3.1 years, 19 boys and 17 girls. Clinical and bacteriologic efficacy of two therapeutic trials was compared: Group A (1996-1997), n = 9, amoxicillin, bismuth subsalicilate, and metronidazol, and group B (1991-1993), n = 27, omeprazol, amoxicillin, and clarithromycin. Initially and post-treatment, H. pylori evaluation was carried out with upper endoscopy and gastric biopsies. For statistics, we used Student t test, chi2, Fisher test, and Kruskal-Wallis analysis of variance (alpha = 0.05). RESULTS: We found that 33/36 cases had gastritis at endoscopy, two with duodenal ulcer; nodular gastritis was observed in more than one half of total cases. All cases fulfilled histologic criteria of gastritis according to Sydney Score. In group A eradication was achieved in 28.6%, while in group B eradication rose to 77.8% (p < 0.05). In group A, 8/9 and in group B 15/27 persisted with RAP (p = 0.113). CONCLUSIONS: High frequency of abnormal and histologic findings was observed in the series presented on children with RAP and H. pylori. Eradication efficacy in the omeprazol/amoxicillin/clarithromycin group was higher when compared with bismuth subsalicilate/amoxicillin/metronidazol trial. This efficacy is comparable to pediatric series treated with the same therapeutic trial.