scholarly journals Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study

2017 ◽  
Vol 49 (4) ◽  
pp. 1601301 ◽  
Author(s):  
Natasha Lelijveld ◽  
Marko Kerac ◽  
Andrew Seal ◽  
Emmanuel Chimwezi ◽  
Jonathan C. Wells ◽  
...  
Keyword(s):  
Lung Function ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Hiv Positive ◽  
Z Score ◽  
Leg Length ◽  
Female Sex ◽  
Z Scores ◽  
Community Controls ◽  
The Impact

Early nutritional insults may increase risk of adult lung disease. We aimed to quantify the impact of severe acute malnutrition (SAM) on spirometric outcomes 7 years post-treatment and explore predictors of impaired lung function.Spirometry and pulse oximetry were assessed in 237 Malawian children (median age: 9.3 years) who had been treated for SAM and compared with sibling and age/sex-matched community controls. Spirometry results were expressed as z-scores based on Global Lung Function Initiative reference data for the African–American population.Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were low in all groups (mean FEV1z-score: −0.47 for cases, −0.48 for siblings, −0.34 for community controls; mean FVC z-score: −0.32, −0.38, and −0.15 respectively). There were no differences in spirometric or oximetry outcomes between SAM survivors and controls. Leg length was shorter in SAM survivors but inter-group sitting heights were similar. HIV positive status or female sex was associated with poorer FEV1, by 0.55 and 0.31 z-scores, respectively.SAM in early childhood was not associated with subsequent reduced lung function compared to local controls. Preservation of sitting height and compromised leg length suggest “thrifty” or “lung-sparing” growth. Female sex and HIV positive status were identified as potentially high-risk groups.

scholarly journals Growth and nutritional status, and their association with lung function: a study from the international Primary Ciliary Dyskinesia Cohort

2017 ◽  
Vol 50 (6) ◽  
pp. 1701659 ◽  
Author(s):  
Myrofora Goutaki ◽  
Florian S. Halbeisen ◽  
Ben D. Spycher ◽  
Elisabeth Maurer ◽  
Fabiën Belle ◽  
...  
Keyword(s):  
Lung Function ◽  
Primary Ciliary Dyskinesia ◽  
Repeated Measurements ◽  
World Health ◽  
Z Score ◽  
Multilevel Regression ◽  
Growth And Nutrition ◽  
Diagnostic Certainty ◽  
Z Scores ◽  
Ciliary Dyskinesia

Chronic respiratory disease can affect growth and nutrition, which can influence lung function. We investigated height, body mass index (BMI), and lung function in patients with primary ciliary dyskinesia (PCD).In this study, based on the international PCD (iPCD) Cohort, we calculated z-scores for height and BMI using World Health Organization (WHO) and national growth references, and assessed associations with age, sex, country, diagnostic certainty, age at diagnosis, organ laterality and lung function in multilevel regression models that accounted for repeated measurements.We analysed 6402 measurements from 1609 iPCD Cohort patients. Height was reduced compared to WHO (z-score −0.12, 95% CI −0.17 to −0.06) and national references (z-score −0.27, 95% CI −0.33 to −0.21) in male and female patients in all age groups, with variation between countries. Height and BMI were higher in patients diagnosed earlier in life (p=0.026 and p<0.001, respectively) and closely associated with forced expiratory volume in 1 s and forced vital capacity z-scores (p<0.001).Our study indicates that both growth and nutrition are affected adversely in PCD patients from early life and are both strongly associated with lung function. If supported by longitudinal studies, these findings suggest that early diagnosis with multidisciplinary management and nutritional advice could improve growth and delay disease progression and lung function impairment in PCD.

scholarly journals Predicted Values for Spirometry may Underestimate Long-Standing Asthma Severity

2016 ◽  
Vol 10 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Bruno Sposato
Keyword(s):  
Lung Function ◽  
Reference Point ◽  
Asthma Severity ◽  
Normal Lung ◽  
Bronchial Obstruction ◽  
Z Score ◽  
Lung Function Decline ◽  
Normal Lung Function ◽  
Z Scores ◽  
Predicted Values

Background: Asthma may show an accelerated lung function decline. Asthmatics, although having FEV1 and FEV1/VC (and z-scores) higher than the lower limit of normality, may show a significant FEV1 decline when compared to previous measurements. We assessed how many asymptomatic long-standing asthmatics (LSA) with normal lung function showed a significant FEV1 decline when an older FEV1 was taken as reference point. Methods: 46 well-controlled LSA (age: 48.8±12.1; 23 females) with normal FEV1 and FEV1/VC according to GLI2012 references (FEV1: 94.8±10.1%, z-score:-0.38±0.79; FEV1/VC: 79.3±5.2, z-score:-0.15±0.77) were selected. We considered FEV1 decline, calculated by comparing the latest value to one at least five years older or to the highest predicted value measured at 21 years for females and 23 for males. A FEV1 decline >15% or 30 ml/years was regarded as pathological. Results: When comparing the latest FEV1 to an at least 5-year-older one (mean 8.1±1.4 years between 2 measurements), 14 subjects (30.4%) showed a FEV1 decline <5% (mean: -2.2±2.6%), 19 (41.3%) had a FEV1 5-15% change (mean: -9.2±2.5%) and 13 (28.3%) a FEV1 decrease>15% (mean: -18.3±2.4). Subjects with a FEV1 decline>30 ml/year were 28 (60.8%). When using the highest predicted FEV1 as reference point and declines were corrected by subtracting the physiological decrease, 6 (13%) patients showed a FEV1 decline higher than 15%, whereas asthmatics with a FEV1 loss>30 ml/year were 17 (37%). Conclusion: FEV1 decline calculation may show how severe asthma actually is, avoiding a bronchial obstruction underestimation and a possible under-treatment in lots of apparent “well-controlled” LSA with GLI2012-normal-range lung function values.

scholarly journals Examining Response to Treatment of Severe Acute Malnutrition in Children 6–59 Months Old in Afghanistan, Chad, Mali, and Niger (P12-002-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Erin Boyd
Keyword(s):  
Weight Gain ◽  
Health Center ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Z Score ◽  
Factors Affecting ◽  
Number Of Children ◽  
Status Number ◽  
Significant Factors

Abstract Objectives Identify the most significant factors affecting the trajectory of recovery from severe acute malnutrition (SAM), as measured by average daily weight gain in each child 6–59 months of age who were diagnosed and treated for SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Hypothesis 1a: Children 6–59 months enrolled in SAM treatment have slower times to recovery and slower weight gain if they are admitted for treatment at a lower anthropometric cut-off admission (weight for height z-score < −4) than children admitted for treatment at a higher anthropometric cut-off (weight for height z-score ≥ −4). Hypothesis 1b: Older children (24–59 months) recover more quickly than younger children (6–23 months) controlling for ration size. Methods A retrospective panel data analysis on children 6–59 months enrolled in standard outpatient treatment for severe acute malnutrition (SAM) between 2014 and 2016 was conducted. The study period was between September-December 2018. Children were exhaustively sampled. Children with edema, children with implausible z-scores for W/H (<−5 and >5) and H/A (<−6 and >6), children who were referred for inpatient therapeutic feeding to a stabilization center, and children from the same household, except in the case of twins, were eliminated from the analysis. There was one database per country. A total of 1384 children between 6–59 months were included in the analysis. Results The most significant factors affecting the proportional weight gain include age at enrollment (P = 0.001, 95%CI = −0.00—0.00) and Weight for height z-score (WHZ) (P = 0.00, 95%CI = 0.04—0.05) in each child 6–59 months of age who were diagnosed with SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Sex of child did not significantly affect proportional weight gain (P = 0.404, 95%CI = −0.012–0.005). Conclusions The existing protocol to treat severe acute malnutrition should be modified to treat younger children and children who are admitted with a lower weight for height z-score due to different vulnerabilities. Funding Sources The research was conducted as part of a dissertation at The Friedman School of Nutrition Science and Policy at Tufts University. Data were obtained from World Vision.

scholarly journals Optimal design for a psychosocial intervention on severely acute malnourished children in humanitarian settings: results of an expert survey

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1073
Author(s):  
Dieynaba S N'DIAYE ◽  
Cécile Salpéteur ◽  
Cécile Bizouerne ◽  
Karine Le Roch
Keyword(s):  
Optimal Design ◽  
Online Survey ◽  
Psychosocial Support ◽  
Severe Acute Malnutrition ◽  
Psychosocial Interventions ◽  
Acute Malnutrition ◽  
Design Stage ◽  
Humanitarian Settings ◽  
The Impact ◽  
Combined Intervention

Background: Common psychosocial interventions focus on feeding, stimulation, emotional responsiveness and childcare and parenting. Inclusion of such a component in the outpatient management of severe acute malnutrition (SAM) children is recommended. However, clinical assessment of such interventions is tedious in humanitarian settings and modalities evidence on the impact of psychosocial interventions alongside nutrition protocol for SAM is scarce.  This survey aimed to gather expert opinions on the optimal design of a combined psychosocial and nutrition intervention feasible in humanitarian settings. Methods: From March to May 2018, an online survey was emailed to international experts in nutrition and mental health and psychosocial support, mainly from academia and international non-governmental organisations (INGOs). It included multiple choices questions on the key components of an optimal combined intervention. Results: Of the 76 experts targeted, 20 responded. 11 (55%) belonged to INGOs, 2 (10%) to academia, and 4 (20%) to international organizations and donors. For most respondents, a combined intervention should be provided in weekly 45-minuites counselling sessions, provided individually (rather than in a group) and at home (rather than at a health center). None of the proposed ideal duration (two, four or six months) gained the majority of votes. Experts thought that 35% staff training should be in “Active listening for psychosocial support”, and 30% in “Early child development”, 25% in “Maternal depression” and 9% in “Anthropometric measurements”. They estimated that a combined intervention could improve SAM recovery rate by 10% (min-max: 0-19%) vs. the nutritional protocol alone. Qualitative results highlighted the importance of tailoring the intervention to the individual, the population and the settings; as well as considering feasibility and scalability at the design stage. Conclusion: These findings could guide further research on the impact of psychosocial interventions on SAM children’s health and development, and help designing innovative approaches to treat undernutrition.

scholarly journals Double burden of malnutrition among Indian schoolchildren and its measurement: a cross-sectional study in a single school

2020 ◽  
Vol 4 (1) ◽  
pp. e000505
Author(s):  
Subhashchandra Daga ◽  
Sameer Mhatre ◽  
Abhiram Kasbe ◽  
Eric Dsouza
Keyword(s):  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Z Score ◽  
Sectional Study ◽  
Score Distribution ◽  
Double Burden ◽  
Cross Sectional ◽  
Lower Socioeconomic ◽  
Z Scores ◽  
Double Burden Of Malnutrition

ObjectiveThis cross-sectional study set in a single school on the outskirts of a large city aimed to document the extent of double burden of malnutrition (coexistence of overnutrition and undernutrition) among Indian schoolchildren from lower socioeconomic groups, and to determine if mid-upper arm circumference (MUAC) can be used as a proxy for body mass index (BMI).SubjectsThe total number of participants was 1444, comprising 424 girls and 1020 boys belonging to playgroups and grades 1 to 7.MeasurementsAnthropometric measurements, such as participants’ MUAC, height and weight were measured using standard techniques. Descriptive statistics for BMI and MUAC were obtained based on gender; z-scores were computed using age-specific and sex-specific WHO reference data. The distribution of variables was calculated for three groups: girls, boys and all participants. Homogeneous subsets for BMI and MUAC were identified in the three groups. Age-wise comparisons of BMI and MUAC were conducted for each gender.Main outcome measures(1) To know if MUAC and BMI are correlated among boys and girls. (2) To study BMI and MUAC z-score distribution among the participants.ResultsMUAC was positively correlated with BMI in both boys and girls. The following BMI z-score distribution was observed: severe acute malnutrition (SAM), 5 (0.3%); moderate acute malnutrition (MAM), 146 (10.1%) and undernourished, at risk of MAM/SAM, 141 (9.8%); obese, 21 (1.5%); overweight, 36 (2.5%) and pre-obese, 136 (9.4%). The distribution of categories of children based on MUAC z-scores was: SAM, 7 (0.5%); MAM, 181 (12.5%) and undernourished, at risk of MAM/SAM, 181 (12.5%); obese, 19 (1.3%); overweight, 178 (12.3%) and pre-obese, 135 (9.3%).ConclusionsSAM/MAM/undernourished states and obesity/overweight/pre-obese states, indicating undernutrition more than overweight, coexist among Indian schoolchildren from lower middle/lower socioeconomic categories. BMI and MUAC were significantly correlated. MUAC identifies both undernutrition and overnutrition by early detection of aberrant growth.

scholarly journals Organophosphate and carbamate insecticide exposure is related to lung function change among smallholder farmers: a prospective study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-214609
Author(s):  
Martin Rune Hassan Hansen ◽  
Erik Jørs ◽  
Annelli Sandbæk ◽  
Daniel Sekabojja ◽  
John C Ssempebwa ◽  
...  
Keyword(s):  
Lung Function ◽  
Prospective Study ◽  
Family Relationships ◽  
Repeated Measures ◽  
Smallholder Farmers ◽  
Z Score ◽  
Carbamate Insecticides ◽  
Z Scores ◽  
A Prospective Study

Introduction and aimExposure to some insecticides may cause airway obstruction, but existing evidence is limited by cross-sectional designs and inadequate confounder control. We investigated the relation between organophosphate and carbamate insecticides and pulmonary function in a prospective study accounting for important confounders.MethodsIn a cohort of 364 smallholder farmers in Uganda (69% women), participants underwent pre-bronchodilator spirometry at baseline (September/October 2018) and at two follow-up visits (November/December 2018 and January/February 2019). Exposure to carbamate and organophosphate insecticides was assessed using haemoglobin-adjusted erythrocyte acetylcholinesterase (AChE/Hb). Less than 3% of participants were lost to follow-up. We calculated Z-scores for FEV1, FVC and FEV1/FVC using the Global Lung Function Initiative equations. Data were analysed in linear mixed and fixed effect models accounting for family relationships and repeated measures of exposure and outcome.ResultsLow AChE/Hb was significantly associated with low FEV1 Z-score in both unadjusted and adjusted analyses. Compared with individuals with AChE/Hb 25.90 U/g (50th percentile, reference), those with lower AChE/Hb 24.50 U/g (35th percentile) had mean FEV1 Z-score 0.045 (0.003 to 0.087) lower, and persons with higher AChE/Hb 27.30 U/g (65th percentile) had a mean FEV1 Z-score 0.043 (−0.002 to 0.087) higher compared with the reference. Similar, but numerically smaller and statistically non-significant effects were seen for Z-scores of FVC and FEV1/FVC.ConclusionExposure to organophosphate and carbamate insecticides may lead to lung function decline. Our results add to the growing evidence of health effects in relation to exposure to organophosphate and carbamate insecticides, underlining the importance of minimising exposure.

Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children

2009 ◽  
Vol 30 (3_suppl3) ◽  
pp. S434-S463 ◽  
Author(s):  
Saskia de Pee ◽  
Martin W. Bloem
Keyword(s):  
Severe Acute Malnutrition ◽  
Essential Fatty Acids ◽  
Food Supplements ◽  
Complementary Food ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Malnourished Children ◽  
Nutrient Density ◽  
Animal Source ◽  
The Impact

Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources with few animal-source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal-source foods, e.g., milk, or other specific nutrients. Options include using specially formulated foods (fortified blended foods, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn–soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.

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