Nutritional rehabilitation of malnourished children: are nutritional supplements a must?

OBJECTIVE: Malnutrition threatens children worldwide. The objective of the current study was to highlight the role of nutritional screening, evaluate the effectiveness of nutritional intervention program, and whether nutritional supplements have surplus benefit. PATIENTS AND METHODS: Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) was used to screen 3640 clinically stable 2-5 years old children recruited from the outpatient clinics, Children's Hospital, Ain Shams University. A total of 100 patients at high risk of malnutrition were enrolled. Full nutritional assessment was done and according to the distribution of the calories in the daily meal plan, the patients were randomly divided into two groups each comprised 50 patients. Group A received tailored nutritional dietary rehabilitation plan including dietary supplements, while Group B received only dietary advice. Anthropometric measurements, laboratory tests, as well as STAMP scoring were reassessed after the nutritional rehabilitation programs. RESULTS: Nutritional screening revealed that 5.14% were at high risk of malnutrition. Both studied groups showed significant improvement in caloric intake and all anthropometric measurements upon nutritional rehabilitation, except for the height z scores. Patients who received nutritional supplements showed significantly better changes regarding weight, BMI, caloric intake, and hemoglobin. Regarding STAMP categories during follow up, Group A had only 6% of the patients still in the high-risk category and 76% were at low risk compared to 14% high risk and only 54% were at low risk in Group B. CONCLUSIONS: Nutritional screening in pediatric outpatient facilities can lead to implementing prompt nutritional rehabilitation, which can reflect on the patients' overall health. Tailored nutritional plan can accomplish good response in terms of improvement of caloric intake, anthropometric measurements and laboratory parameters. Adding a nutritional supplement to the dietary plan during nutritional rehabilitation isn't a must but it ensures superior goal achievement.

Is There a Benefit of Vitamin D Supplementation in Deficient Children and Adolescents Suffering from Obesity? A Meta-Analysis.

This systematic review/meta-analysis aims to highlight the effect of vitamin D supplementation in deficient children suffering from obesity. Published clinical studies on vitamin D supplementation in obese children and adolescents with vitamin D deficiency were identified through a comprehensive MEDLINE/PubMed search (from July 1966 to November 2017). Outcomes intended after vitamin D supplementation were improvements in vitamin D status, BMI alterations and appetite changes. The inclusion criteria were children aged 2 to 18 years of both sexes in clinical trials that specified the oral and/or intramuscular dose of vitamin D supplementation. Ten studies were retrieved, but only 6 were relevant. First, supplemented obese children and adolescents were compared to non-obese controls; thereafter, supplemented obese children and adolescents were compared to matching obese peers given placebo. Pooled risks from the 2 studies that evaluated the number of obese and non-obese children and adolescents who improved upon vitamin D supplementation revealed that obesity poses a risk for not benefiting from the vitamin D supplementation regardless of the dose and the duration of supplementation. Pooled results from the 6 retrieved studies that compared supplemented obese children and adolescents to matching non-obese or obese peers given placebo revealed significantly lower vitamin D levels in obese participants than in non-obese peers. Vitamin D levels are significantly lower in obese children and adolescents with obesity, posing a risk for not benefiting from vitamin D supplementation regardless of the dose and duration of supplementation.

Cognitive functions in protein-energy malnutrition: in relation to long chain-polyunsaturated fatty acids.

Aiming to find out a correlation between plasma LC-PUFA levels and neurodevelopmental status of malnourished infants, the present study was conducted on 42 infants suffering from PEM, with a mean age of 11.28 +/- 4.59 months. They were divided clinically into edematous and non-edematous groups. Fifteen age and sex matched well nourished apparently healthy infants were chosen to serve as controls. All patients were subjected to a 3-phase workup, while controls were subjected only to phase 1. Phase I: includes clinical assessment, laboratory investigations including plasma LC-PUFA levels and Neurodevelopmental assessment. In Phase II: An interventional program of 8 weeks duration; where all patients were receiving an initial supportive treatment followed by nutritional rehabilitation according to WHO guidelines, 1999 as well as developmental stimulation. According to the formula supplied to patients, they were randomly divided into either PUFA supplemented (+ve group) or nonBsupplemented (-ve group). In Phase III: All patients were re-assessed clinically and neurodevelopmentaly as well as re-evaluation for plasma LC-PUFA levels. The study revealed that, the mean plasma AA and DHA levels as well as the mean MDI and PDI scores of BSID-II were significantly lower in PEM patients compared to those levels after nutritional rehabilitation and to controls. Moreover, the mean MDI score was significantly lower in edematous subgroup compared to non-edematous one. Meanwhile, the mean rate of change in plasma DHA level was significantly higher in edematous subgroup compared to non-edematous one. However, there was no significant difference in the mean of rate of change in AA level or MDI and PDI scores between the 2 subgroups. Further, the mean rate of change in plasma AA and DHA levels as well as MDI score were significantly higher in PUFA +ve patients compared to PUFA Bve ones after nutritional rehabilitation. Finally, the study showed significant positive correlations between plasma AA and DHA levels and both MDI and PDI scores. From the course of this study we concluded that malnourished infants had impaired neurodevelopmental functions that could be related to the poor status of plasma LC-PUF. Thus, we recommend early intervention including nutritional rehabilitation and LC-PUFA supplementation as well as stimulation program, so as to have a better effect on future cognitive abilities of these infants.