Risk of metabolic consequences of rapid weight gain and catch-up growth in the first two years of life: a systematic review protocol.

REVIEW QUESTION: The specific review question to be addressed in this review is: what is the risk of metabolic outcomes for individuals who experience rapid weight gain or catch-up growth during the first two years of life?

Audit of the dietetic care of patients with type 1 diabetes at a large Australian paediatric tertiary hospital and comparison with the International Society for Paediatric and Adolescent Diabetes nutrition guidelines.

AIM: Optimal glycaemic control is important in children and adolescents with type 1 diabetes (T1D) to reduce the risk of developing microvascular complications. Modest reductions in HbA1c translate to significant risk reductions of these complications. Research indicates that targeted dietetic care using evidence-based guidelines improves HbA1c levels. The aim of this study was to audit the dietetic care provided to patients with T1D at the Women's and Children's Hospital (WCH) and compare the service provided to the International Society for Paediatric and Adolescent Diabetes (ISPAD) nutrition guidelines. METHODS: A retrospective medical records audit of the dietetic service was conducted on 410 (99% of eligible) patients who attended the WCH Diabetes Outpatient Clinic between 1 January 2010 and 30 June 2013. These data were then compared to the ISPAD nutrition guidelines, with a focus on the key service delivery targets. RESULTS: Of the newly diagnosed patients (n = 128), 100% received initial dietary advice by a paediatric diabetes dietitian; 61% of these patients then received a follow-up appointment within one month of diagnosis. Of those who were >1 year post-diagnosis (n = 389), only 6% were seen annually; 79% of patients were identified with a condition requiring more frequent review, of whom 23% were seen more frequently. CONCLUSIONS: This large and comprehensive audit, conducted for a 3.5-year period, has shown that the dietetic care of newly diagnosed children and adolescents is mostly in line with ISPAD guidelines, but there is suboptimal follow-up after diagnosis.

Relationships Between Childhood Experiences and Adulthood Outcomes in Women with PKU: A Qualitative Analysis.

BACKGROUND: The enduring impact of the childhood experiences of people with phenylketonuria (PKU) on their adulthood outcomes is equivocal. As the effect of childhood experiences on adulthood is well documented amongst the general population, the aim of this study was to explore childhood experiences considered significant by women with PKU as they relate to adult experiences and management of PKU, and psychological wellbeing. METHOD: Eight women with PKU in South Australia underwent semi-structured interviews. The audio-recorded interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS: Interviews revealed that feeling different to peers as a child, challenges with management of the condition during adolescence, parental and extended family support, and the perception of PKU as a burden during childhood were associated with adulthood experiences. CONCLUSIONS: Thus, it is proposed that these childhood factors have a combined, long-term impact. These findings have significant clinical implications, suggesting that early psychosocial intervention relating to these identified childhood experiences has the potential to enhance positive outcomes for adults with PKU.

Prevalence of malnutrition, obesity and nutritional risk of Australian paediatric inpatients: a national one-day snapshot.

AIM: Low prevalence rates of malnutrition at 2.5% to 4% have previously been reported in two tertiary paediatric Australian hospitals. The current study is the first to measure the prevalence of malnutrition, obesity and nutritional risk of paediatric inpatients in multiple hospitals throughout Australia. METHODS: Malnutrition, obesity and nutritional risk prevalence were investigated in 832 and 570 paediatric inpatients, respectively, in eight tertiary paediatric hospitals and eight regional hospitals across Australia on a single day. Malnutrition and obesity prevalence was determined using z-scores and body mass index (BMI) percentiles. High nutritional risk was determined as a Paediatric Yorkhill Malnutrition Score of 2 or more. RESULTS: The prevalence rates of malnourished, wasted, stunted, overweight and obese paediatric patients were 15%, 13.8%, 11.9%, 8.8% and 9.9%, respectively. Patients who identified as Aboriginal and Torres Strait Islander were more likely to have lower height-for-age z-scores (P < 0.01); however, BMI and weight-for-age z-scores were not significantly different. Children who were younger, from regional hospitals or with a primary diagnosis of cardiac disease or cystic fibrosis had significantly lower anthropometric z-scores (P = 0.05). Forty-four per cent of patients were identified as at high nutritional risk and requiring further nutritional assessment. CONCLUSIONS: The prevalence of malnutrition and nutritional risk of Australian paediatric inpatients on a given day was much higher when compared with the healthy population. In contrast, the proportion of overweight and obese patients was less.

Promoting psychological well-being in women with phenylketonuria: Pregnancy-related stresses, coping strategies and supports.

OBJECTIVE: To explore the pregnancy-related stresses anticipated and experienced by women with phenylketonuria (PKU) and the coping strategies and supports utilised or anticipated to be beneficial during pregnancy. METHODS: Thematic analysis of interview data from eight women with PKU in a cross-sectional, qualitative study. Five of the participants had never had a pregnancy but were planning to in the future, two participants had children, and one participant was pregnant. RESULTS: The central concern regarding pregnancy was achieving and maintaining the essential low Phe levels, in the context of the devastating effects of high levels. The Transactional Model of Stress and Coping was utilised to understand the coping strategies and supports utilised or anticipated to be beneficial during pregnancy. Similarities and differences between the women who had experienced pregnancy, and those who were planning a pregnancy in the future were evident in key coping strategies, with knowledge seeking, positive reappraisal, and reassurance seeking reported. Support from health professionals and other mothers with PKU was key for all women. Psychological support was identified as a resource perceived to be beneficial to promote psychological well-being during pregnancy but not yet provided. CONCLUSION: Pregnancy is associated with significant stresses for women with PKU. Clinical implications of the findings include provision of psychological support.