scholarly journals Prediction of mortality in severe acute malnutrition in hospitalized children by faecal volatile organic compound analysis: proof of concept

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Deborah A. van den Brink ◽  
Tim de Meij ◽  
Daniella Brals ◽  
Robert H. J. Bandsma ◽  
Johnstone Thitiri ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Machine Learning Algorithms ◽  
Acute Malnutrition ◽  
Intestinal Microbiome ◽  
Metabolic Dysfunction ◽  
Prediction Of Mortality ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Volatile Organic ◽  
Insight Into

Abstract Children with severe acute malnutrition (SAM) display immature, altered gut microbiota and have a high mortality risk. Faecal volatile organic compounds (VOCs) reflect the microbiota composition and may provide insight into metabolic dysfunction that occurs in SAM. Here we determine whether analysis of faecal VOCs could identify children with SAM with increased risk of mortality. VOC profiles from children who died within six days following admission were compared to those who were discharged alive using machine learning algorithms. VOC profiles of children who died could be separated from those who were discharged with fair accuracy (AUC) = 0.71; 95% CI 0.59–0.87; P = 0.004). We present the first study showing differences in faecal VOC profiles between children with SAM who survived and those who died. VOC analysis holds potential to help discover metabolic pathways within the intestinal microbiome with causal association with mortality and target treatments in children with SAM. Trial Registration: The F75 study is registered at clinicaltrials.gov/ct2/show/NCT02246296.

scholarly journals Ethnic and age differences in prediction of mortality by mid-upper arm circumference in children below 3 years of age in Nepal

2018 ◽  
Vol 21 (12) ◽  
pp. 2230-2237 ◽  
Author(s):  
Avni Gupta ◽  
James M Tielsch ◽  
Subarna K Khatry ◽  
Steven C LeClerq ◽  
Luke C Mullany ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Sociodemographic Factors ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Older Children ◽  
Upper Arm ◽  
Prediction Of Mortality ◽  
Arm Circumference ◽  
Increased Risk ◽  
Mid Upper Arm Circumference

AbstractObjectiveTo assess ethnicity- and age-modified associations between mid-upper arm circumference (MUAC) and mortality in Nepalese children and whether sociodemographic factors explain these associations.DesignSecondary data analysis of children followed until 3 years of age. Estimated mortality hazard ratios (HR) for MUAC<11·5cm (recommended cut-off for identifying severe acute malnutrition among children ≥6 months old) compared with ≥11·5cm in younger (<6 months) and older children (≥6 months) of Pahadi and Madhesi ethnicity, adjusting for sex, socio-economic status (SES) and mother’s education using Cox proportional hazard models.SettingSarlahi, Nepal (21 October 2001–2 February 2006).SubjectsChildren (n 48 492) enrolled in the Nepal Nutrition Intervention Project, Sarlahi-4.ResultsAmong children aged ≥6 months, MUAC<11·5 cm was associated with increased risk of mortality in both Pahadis (HR=4·01; 95 % CI 1·42, 11·76) and Madhesis (HR=5·60; 95 % CI 3·87, 8·11) compared with those with MUAC≥11·5 cm, after adjusting for sex, SES and maternal literacy. Among children <6 months old, MUAC<11·5 cm was not associated with mortality in Pahadis with (HR=1·12; 95 % CI 0·72, 1·73) or without adjusting (HR=1·17; 95 % CI 0·75, 1·18) as compared with Madeshis (adjusted HR=1·76; 95 % CI 1·35, 2·28).ConclusionsAmong older children, MUAC<11·5 cm is associated with subsequent mortality in both ethnicities regardless of other characteristics. However, among children aged <6 months, it predicted mortality only among Madhesis, while sociodemographic factors were more strongly associated with mortality than MUAC<11·5cm among Pahadis.

scholarly journals Author Correction: Prediction of mortality in severe acute malnutrition in hospitalized children by faecal volatile organic compound analysis: proof of concept

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Deborah A. van den Brink ◽  
Tim de Meij ◽  
Daniella Brals ◽  
Robert H. J. Bandsma ◽  
Johnstone Thitiri ◽  
...  
Keyword(s):  
Organic Compound ◽  
Volatile Organic Compound ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Hospitalized Children ◽  
Proof Of Concept ◽  
Prediction Of Mortality ◽  
Volatile Organic

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

2019 ◽  
Vol 75 (3) ◽  
pp. 709-717 ◽  
Author(s):  
Naouale Maataoui ◽  
Céline Langendorf ◽  
Fatou Berthe ◽  
Jumamurat R Bayjanov ◽  
Willem van Schaik ◽  
...  
Keyword(s):  
Placebo Group ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Double Blind ◽  
Adjusted Risk ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

scholarly journals Hypertension as a prognostic factor in the prediction of mortality in patients with COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C D P Pagdanganan ◽  
J Juangco ◽  
Keyword(s):  
Prognostic Factor ◽  
Odds Ratio ◽  
Positive Association ◽  
Hazard Ratio ◽  
P Value ◽  
Comorbid Condition ◽  
Significant Positive Association ◽  
Prediction Of Mortality ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) brought the majority of the world into a halt when it started to spread outside the virus epicenter in Wuhan, China. With the alarming increase in the number of cases and deaths worldwide, the possible risk factors should be determined in order to have a general idea on those who are more susceptible to have this disease. Hypertension, being one of the world's leading causes of noncommunicable diseases, was identified by the CDC to be one of underlying medical conditions that might pose an increased risk for severe illness from COVID-19. Objective The aim of this study is to determine the predictive value of hypertension as a comorbidity in COVID-19 mortality. Materials and methods Participants included all patients clinically diagnosed with COVID-19, and have hypertension as their pre-existing medical condition. Studies were selected based on study design, participants, exposure, outcome, timing, setting and language. The following databases were searched from June to August 2020 for case control and cohort studies on MEDLINE and CINAHL, ScienceDirect, Clinical Key, OVID database, Wiley Online library, and UpToDate. The criteria for evaluation of risk of bias were based on the selection bias, comparability bias and outcome bias. All information gathered were collated and evaluated using the Newcastle-Ottawa Quality Assessment Scale and CEBM. Results Individual studies all showed a significant relationship between hypertension and mortality in COVID-19 patients. Odds ratio ranging from 1.75 to 28.88, and hazard ratio ranging from 1.49 to 3.32 are present in the studies. For the data analysis, Mantel Haenszel method and random effects model was used for case control studies with odds ratio as effect measure; while Inverse variance method and fixed model was used for cohort studies with hazard ratio as effect measure. Both groups showed significant positive association between mortality and hypertension as a prognostic factor. Overall odds ratio is 5.25 (2.42–11.40) with a p value of &lt;0.ehab724.23931, and the pooled hazard ratio is 2.21 (1.75–2.80) with a p value of &lt;0.ehab724.23931. This shows that there is an increased risk of mortality among COVID-19 patients with hypertension as a comorbid condition. Conclusions Hypertension as a comorbid condition is a prognostic factor in the prediction of mortality in hospitalized COVID-19 patients. The ten included studies showed that there is a significant positive association suggesting an increased risk of mortality in COVID-19 patients with hypertension. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): University of the East Ramon Magsaysay Memorial Medical Center College of Medicine Forest Plot HR Hypertension COVID

scholarly journals Complicated severe acute malnutrition: anthropometric status from Southern Rajasthan, India

2017 ◽  
Vol 4 (4) ◽  
pp. 1466
Author(s):  
Rupali Jain ◽  
Rameshwar Lal Suman ◽  
Suresh Goyal ◽  
B. L. Meghwal ◽  
Suresh Kumar Meena
Keyword(s):  
Severe Acute Malnutrition ◽  
Tertiary Hospital ◽  
Acute Malnutrition ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Arm Circumference ◽  
Treatment Centre ◽  
Health And Development ◽  
Mid Upper Arm Circumference ◽  
Anthropometric Status

Background: Childhood under-nutrition is an important public health and development challenge in India. Undernourished children have significantly higher risk of mortality and morbidity. Objective of present study was to identify the anthropometric status of complicated Severe acute malnutrition (SAM) in Southern Rajasthan, India.Methods: It was a retrospective study conducted in children admitted at Malnutrition Treatment Centre attached to a tertiary hospital. Basic socio-demographic and anthropometric records of all children between 6 months to 5 years of age were analysed.Results: Out of the total 1554 SAM children admitted in last two years, 855 (55.01%) were males and 699 (44.98%) were females. Mean weight was 6.17±1.59 kg, mean height was 71.65±8.6 cm and Mid upper arm circumference (MUAC) was 10.99±1.53 cm. Among these, 1375 (88.48%) children fulfilled weight for height (WFH) criteria, 919 (59.13%) fulfilled MUAC criteria and 246 (15.83%) had edema. On WFH Zscore analysis, 53% had <-3SD and <-4SD, 19.88% had <-5SD, 9.97% had <-6SD, 3.47% had <-7SD and 1.67% had <-8SD. Also, we observed that lower values of MUAC ranging from <11.5cm to <9cm. MUAC of 11.5-10cm was in 43.43% of children and 15% had MUAC <10cm. Among the children of all age group, we observe that males of 6-24 months of age are more significantly affected as compared to females.Conclusions: The study highlights the fact that extreme grades of malnutrition exist in our area ranging upto Z-score of -8SD and beyond, and is not limited to -3SD and -4SD. Also, males are the more affected of the two sexes in our rural and tribal area setting. 

scholarly journals Development of a legume-enriched feed for treatment of severe acute malnutrition

2021 ◽  
Vol 6 ◽  
pp. 206
Author(s):  
Kevin Walsh ◽  
Gael Delamare de la Villenaise de Chenevarin ◽  
Joe McGurk ◽  
Kathryn Maitland ◽  
Gary Frost
Keyword(s):  
Resistant Starch ◽  
Inpatient Treatment ◽  
Severe Acute Malnutrition ◽  
Food Product ◽  
Acute Malnutrition ◽  
Intestinal Microbiome ◽  
Infant Food ◽  
Infant Foods ◽  
Nutritional Characteristics ◽  
Target Characteristics

Background: Outcomes in children hospitalised with severe acute malnutrition (SAM) remain poor. The current milk-based formulations focus on restoring weight-gain but fail to address modification of the integrity of the gut barrier and may exacerbate malabsorption owing to functional lactase, maltase and sucrase deficiency. We hypothesise that nutritional feeds should be designed to promote bacterial diversity and restore gastrointestinal (GI) barrier function. Methods: Our major objective was to develop a lactose-free, fermentable carbohydrate-containing alternative to traditional F75 and F100 formulae for the inpatient treatment of SAM. New target nutritional characteristics were developed and relevant food and infant food specific legislation were reviewed. Suitable certified suppliers of ingredients were identified. Processing and manufacture steps were evaluated and optimised for safety (nutritional, chemical and microbiological), and efficacy at meeting target characteristics (lactose-free, containing resistant starch 0.4-0.5% final product weight). Results: A final validated production process was developed and implemented to produce a novel food product for the inpatient treatment of SAM in children in Africa designed to reduce risk of osmotic diarrhoea and support symbiotic gut microbial populations. The final product matched the macronutrient profile of double-concentrated F100, adhered to all relevant legislation regulating infant foods, was lactose free, and contained 0.6% resistant starch. Chickpeas were selected as the source of resistant starch, since they are widely grown and eaten throughout Africa. Micronutrient content could not be matched in this ready-to-use product, so this was replaced at the point of feeding, as was fluid lost through concentration. Conclusions: The processes and product described illustrate the development steps for a novel nutritional product. The new feed product was ready for evaluation for safety and efficacy in a phase II clinical trial in Ugandan children admitted to hospital with SAM (Modifying Intestinal MicroBiome with Legume-Based feed 2: MIMBLE feed 2 (ISRCTN10309022)).

scholarly journals Long-term outcomes for children with disability and severe acute malnutrition in Malawi

2020 ◽  
Vol 5 (10) ◽  
pp. e002613
Author(s):  
Natasha Lelijveld ◽  
Nora Groce ◽  
Seema Patel ◽  
Theresa Nnensa ◽  
Emmanuel Chimwezi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
School Achievement ◽  
Acute Malnutrition ◽  
Health Issues ◽  
Physical Strength ◽  
Children With Disability ◽  
Increased Risk ◽  
Outcomes For Children

IntroductionSevere acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM.MethodsA longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called ‘the Washington Group Questionnaire’ was used.Results60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors.The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged.ConclusionDisability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.

scholarly journals Serum vitamin B12 levels in severe acute malnutrition hospitalized children between age group 6 months to 59 months in Kangra, India

2018 ◽  
Vol 5 (5) ◽  
pp. 1997
Author(s):  
Ajay Vaid ◽  
Milap Sharma ◽  
Jamunashree B. ◽  
Piyush Gautam
Keyword(s):  
Vitamin B12 ◽  
Severe Acute Malnutrition ◽  
Megaloblastic Anemia ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Work Capacity ◽  
Acute Malnutrition ◽  
Age Group ◽  
Female Ratio ◽  
Increased Risk

Background: Child malnutrition is a major global health problem contributing to childhood morbidity, mortality, impaired intellectual development, suboptimal adult work capacity and increased risk of diseases in adulthood. Severe acute malnutrition, among children below five years of age remains a major embarrassment, and impediment to optimal human capital development in India.Methods: The study was an observational study conducted in the Department of Pediatrics and Biochemistry at Dr. RPGMC Kangra at Tanda, Himachal Pradesh. All children aged between 6 to 59 months presenting in the Department of Pediatrics with SAM (Severe Acute Malnutrition) and fulfilling the inclusion and exclusion criteria were included in the study after taking the informed consent from the guardian in local language.Results: Out of 48 children included in the study, 28 (58%) children were Males and 20 (42%) children were females with male to female Ratio 1.3:1. Out of 48 children 28 (58%) were vitamin B12 deficient and 20 (42%) were non-deficient. In the present study 53.5% (15) of males were vitamin B12 deficient. Out of 20 females 65% (13) of females were vitamin B12 deficient, showed slight preponderance of females over males. It has been observed that younger age group children mostly <2-year-old were, the most vulnerable group as far as vitamin B12 deficiency is considered (16%)Conclusions: Micronutrients play a central part in metabolism and in maintenance of tissue functions. All severely malnourished children have vitamin and mineral deficiencies. The most common type of anemia was microcytic followed by megaloblastic anemia.

scholarly journals Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

2015 ◽  
Vol 18 (14) ◽  
pp. 2575-2581 ◽  
Author(s):  
Emmanuel Grellety ◽  
L Kendall Krause ◽  
Manal Shams Eldin ◽  
Klaudia Porten ◽  
Sheila Isanaka
Keyword(s):  
Severe Acute Malnutrition ◽  
South Sudan ◽  
Patient Characteristics ◽  
Acute Malnutrition ◽  
Upper Arm ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Admission Criterion ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference

AbstractObjectiveThe present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.DesignWe performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6–59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<−3 and MUAC≥115 mm.ResultsOf 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<−3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<−3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<−3 alone and 100 % by MUAC<130 mm.ConclusionsThe study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications.

scholarly journals Improving risk estimates for metabolically healthy obesity and mortality using a refined healthy reference group

2017 ◽  
Vol 177 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Mark Hamer ◽  
William Johnson ◽  
Joshua A Bell
Keyword(s):  
Reference Group ◽  
Hdl Cholesterol ◽  
Metabolic Dysfunction ◽  
Metabolically Healthy Obesity ◽  
Reactive Protein ◽  
Risk Estimates ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Referent Group ◽  
Metabolically Healthy

Objective We aimed to re-examine mortality risk estimates for metabolically healthy obesity by using a ‘stable’ healthy non-obese referent group. Design Prospective cohort study. Methods Participants were 5427 men and women (aged 65.9 ± 9.4 years, 45.9% men) from the English Longitudinal Study of Ageing. Obesity was defined as body mass index ≥30 kg/m2 (vs non-obese as below this threshold). Based on blood pressure, HDL cholesterol, triglycerides, glycated hemoglobin and C-reactive protein, participants were classified as ‘healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥2 metabolic abnormalities). Results Totally, 671 deaths were observed over an average follow-up of 8 years. When defining the referent group based on 1 clinical assessment, the unhealthy non-obese (hazard ratio (HR) = 1.22; 95% CI: 1.01, 1.45) and unhealthy obese (HR = 1.29; CI: 1.05, 1.60) were at greater risk of all-cause mortality compared to the healthy non-obese, yet no excess risk was seen in the healthy obese (HR = 1.14; CI: 0.83, 1.52). When we re-defined the referent group based on 2 clinical assessments, effect estimates were accentuated and healthy obesity was at increased risk of mortality (HR = 2.67; CI: 1.64, 4.34). Conclusion An unstable healthy referent group may make ‘healthy obesity’ appear less harmful by obscuring the benefits of remaining never obese without metabolic dysfunction.

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