Clinical Predictors of Wheezing Among Children Infected With Mycoplasma Pneumoniae.

Background: Mycoplasma pneumoniae (MP) not only was a common pathogen of respiratory tract infections, but also could trigger the exacerbation of asthmatic symptoms in children with or without asthma. Objective: This study aimed to identify possible risk factors associated with wheezing among children diagnosed with MP infection. Methods: A retrospective analysis of medical records of children aged 28 days to 18 years old who visited the Shanghai Children's Hospital between January 2019 and January 2020 was carried out, and all children were then classified into three groups: two wheezing groups (with or without MP infection) and a non-wheezing group with MP infection. Information including patient's demographics, clinical features, laboratory data, and radiography findings was extracted from the electronic medical record system. Chest radiographs were reviewed independently by two board-certified, blinded pediatric radiologists. Results: A total of 1,512 patients were included in our study, and 21.9% of them belonged to the wheezing group without MP infection. Among 1,181 patients with MP infection, 295 people (25.0%) suffered from wheezing, and males accounted for 61%. Through the multivariable logistic regression analyses, we found that six variables were positively associated with wheezing attacks in children with MP infection: male gender (likelihood ratio [LR] = 2.124, 95% confidence interval [CI]: 1.478-3.053), history of allergy (LR= 3.301, 95% CI: 2.206-4.941), history of wheezing (LR = 7.808, 95% CI: 5.276-11.557), autumn in reference to summer (LR = 2.414, 95% CI: 1.500-3.885), non-end-point infiltration in reference to consolidation or pleural effusion (LR = 1.982, 95% CI: 1.348-2.914), and infiltration scope (LR = 1.773, 95% CI: 1.293-2.432). However, the model showed that the probability of wheezing after MP infection decreased as age increased (LR = 0.257, 95% CI: 0.196-0.337). Moreover, the area under the curve (AUC) of the regression model was as high as 0.901 (0.847-0.955). Conclusion: The model integrated with factors including gender, age, season, radiological patterns, infiltration scope, and history of allergy performed well in predicting wheezing attack after MP infection in children.

Validity and practicability of smartphone-based photographic food records for estimating energy and nutrient intake.

BACKGROUND AND OBJECTIVES: Image-assisted dietary assessment methods are frequently used to record individual eating habits. This study tested the validity of a smartphone-based photographic food recording approach by comparing the results obtained with those of a weighed food record. We also assessed the practicality of the method by using it to measure the energy and nutrient intake of college students. METHODS AND STUDY DESIGN: The experiment was implemented in two phases, each lasting 2 weeks. In the first phase, a labelled menu and a photograph database were constructed. The energy and nutrient content of 31 randomly selected dishes in three different portion sizes were then estimated by the photograph-based method and compared with a weighed food record. In the second phase, we combined the smartphone-based photographic method with the WeChat smartphone application and applied this to 120 randomly selected participants to record their energy and nutrient intake. RESULTS: The Pearson correlation coefficients for energy, protein, fat, and carbohydrate content between the weighed and the photographic food record were 0.997, 0.936, 0.996, and 0.999, respectively. Bland-Altman plots showed good agreement between the two methods. The estimated protein, fat, and carbohydrate intake by participants was in accordance with values in the Chinese Residents' Nutrition and Chronic Disease report (2015). Participants expressed satisfaction with the new approach and the compliance rate was 97.5%. CONCLUSIONS: The smartphone-based photographic dietary assessment method combined with the WeChat instant messaging application was effective and practical for use by young people.

The presence and accuracy of nutritional labelling of pre-packaged foods in Shanghai.

BACKGROUND AND OBJECTIVES: The Chinese government officially enacted the Regulation on the Management of Food Nutrition Labelling in 2007 and the General Rules for Nutrition Labelling of Pre-packaged Foods in 2011. Our investigation examined the presence and accuracy of nutrition labelling of pre-packaged foods in Shanghai and provides baseline data for future studies. METHODS AND STUDY DESIGN: Nutrition labels on pre-packaged foods were recorded by photograph, transcription, or purchase in four supermarkets in Shanghai. We compared the observed labelling rate with results from a survey conducted in 2008. To assess labelling accuracy, we sent randomly selected foods to an analytical laboratory to test food energy and nutrient content. RESULTS: The overall labelling rate was 54.8%, representing a great improvement over the rate measured prior to implementation of the Regulation (35.4%). The labelling rate for energy content and core nutrients were all above 98%, whereas the rates for saturated fat, trans-fatty acids, and iron were 11.5%, 7.0%, and 10.7%, respectively. Pre-packaged foods manufactured by domestic Chinese companies were labelled less frequently (45.8%) than foods manufactured by companies from Taiwan/Hong Kong (67.0%) or overseas (65.7%). The accuracy of carbohydrate content on labels was as high as 100%, while the accuracy of protein and fat content were 94.4% and 96.0%, respectively. CONCLUSION: Pre-packaged food manufacturers and government agencies should collaborate to improve the management of nutrition labelling. Mandatory regulations may be the best way to ensure that nutrition labelling facilitates informed consumer decision-making.

Limitations of studies on school-based nutrition education interventions for obesity in China: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: School-based nutrition education has been widely implemented in recent years to fight the increasing prevalence of childhood obesity in China. METHODS AND STUDY DESIGN: A comprehensive literature search was performed using six databases to identify studies of school-based nutrition education interventions in China. The methodological quality and the risk of bias of selected literature were evaluated. Stratified analysis was performed to identify whether different methodologies influenced the estimated effect of the intervention. RESULTS: Seventeen articles were included in the analysis. Several of the included studies had inadequate intervention duration, inappropriate randomization methods, selection bias, unbalanced baseline characteristics between control and intervention groups, and absent sample size calculation. Overall, the studies showed no significant impact of nutrition education on obesity (OR=0.76; 95% CI=0.55-1.05; p=0.09). This can be compared with an OR of 0.68 for interventions aimed at preventing malnutrition and an OR of 0.49 for interventions aimed at preventing iron-deficiency anemia. When studies with unbalanced baseline characteristics between groups and selection bias in the study subjects were excluded, the impact of nutrition education on obesity was significant (OR=0.73; 95% CI=0.55-0.98; p=0.003). An analysis stratified according to the duration of intervention revealed that the intervention was effective only when it lasted for more than 2 years (OR=0.49, 95% CI=0.42-0.58; p<0.001). CONCLUSION: Studies of school-based nutrition education programs in China have some important limitations that might affect the estimated effectiveness of the intervention.

Optimal timing for introducing enteral nutrition in the neonatal intensive care unit.

OBJECTIVE: To identify the optimal time for introducing enteral nutrition to critically ill neonates. METHODS: This prospective cohort study included all eligible critically ill neonates who were admitted to a multidisciplinary tertiary neonatal intensive care unit (NICU) between 1st June and 30th November 2013. Nutrient intake and clinical outcomes during NICU stay were recorded. The effect of early (<24 hours after NICU admission) and delayed (>=24 hours) enteral nutrition introduction on clinical outcomes was assessed. RESULTS: Energy deficit in critically ill neonates was frequent: 84.7% could not achieve the caloric goal during the NICU stay. Growth retardation was common especially among the preterm: the frequency of neonates whose weight was below the 10th percentile increased significantly from 21.6% on admission to 67.6% at discharge. Compared with delayed enteral nutrition, early enteral nutrition was associated with better median time to starting weight gain (0 vs 6 days, p=0.0002), a lower chance of receiving parenteral nutrition (41.7% vs 95.9%, p<0.0001), shorter NICU stays (196 vs 288 hours, p=0.0001), fewer hours on mechanical ventilation and a lower chance of developing pulmonary infection (37.5% vs 56.0%, p=0.005). The accumulated energy deficit to the subjects who were exposed to delayed nutrition could not be compensated by subsequent nutrition. Neonates who underwent mechanical ventilation had suboptimal nutrient delivery: they took longer to gain weight and were more likely to develop respiratory distress and receive parenteral nutrition. CONCLUSIONS: Early enteral nutrition initiation (<24 hours) is recommended. Neonates with mechanical ventilation should be monitored with particular attention.