Association of malnutrition with renal function in children with kidney disease

Background: Malnutrition is a serious and lasting burden worldwide. Woman, infants, children, and adolescents are at particular risk of malnutrition. Prevalence of malnutrition children under 5 years in 2020 was 45 million were estimated to be wasted, and 38.9 million were overweight or obese. Around 45% of deaths among children under 5 years old were related to undernutrition, especially in low- and middle-income countries. Children with kidney disease was a risk factor to become a malnutrition. Malnutrition increases morbidity and mortality in children with kidney disease. Earlier studies showed a high prevalence rate of malnutrition in children with chronic kidney disease. Objectives: The aim of the study to associate malnutrition with renal function in children with kidney disease. Methods: A cross-sectional study was conducted on children with kidney disease aged 2-17 years who met the inclusion criteria who were hospitalized at the Inpatient Department/SMF Department of Child Health Sciences, Dr. Hospital. Soetomo, Surabaya from October to December 2020 after taking approval from parents and institutional ethics committee in the department of Pediatrics. Detailed anthropometric measurements were taken and grading of malnutrition was calculated according to WHO, CDC, and Waterlow criteria. Serum creatinine was measured for each sample. Results: There were 157 samples met the inclusion criteria. Sex between male and female almost balanced (54.8%:45.2%) and the median age was 13 years-old. The most frequent diagnosis in this group was lupus nephritic (68%). Forty eight percent of total samples were malnutrition, which most of them were moderate malnutrition. Estimated glomerular filtration rate of moderate malnutrition was normal in 12 (23.5%) cases, decreased in 39 (76.5%) cases. A significant statistically was showed between malnutrition with severe estimated glomerular filtration rate (P 0.000) Conclusions: Malnutrition was a common finding in nutritional status of children with kidney disease. There was a correlation between nutritional status and renal function in children with kidney disease.

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

Background Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. Methods In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. Results Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d’Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). Conclusions This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. Trial registration PACTR202001816232398, June 01, 2020, retrospectively registered.

The correlation between skeletal muscle index of the L3 vertebral body and malnutrition in patients with advanced lung cancer

Background Studies have shown that the skeletal muscle index at the third lumbar vertebra (L3 SMI) had reasonable specificity and sensitivity in nutritional assessment and prognostic prediction in digestive system cancers, but its performance in lung cancer needs further investigation. Methods A retrospective study was performed on 110 patients with advanced lung cancer. The L3 SMI, the Patient-Generated Subjective Global Assessment score (PG-SGA score), body mass index (BMI), and serological indicators were analyzed. According to PG-SGA scores, patients were divided into severe malnutrition (≥9 points), mild to moderate malnutrition (≥3 points and ≤ 8 points), and no malnutrition (≤2 points) groups. Pearson correlation and logistic regression analysis were adopted to find factors related to malnutrition, and a forest plot was drawn. The receiver operating characteristic (ROC) curve was performed to compare the diagnostic values of malnutrition among factors, which were expressed by the area under curve (AUC). Results 1. The age of patients in the severe malnutrition group, the mild to moderate malnutrition group, and the no malnutrition group significantly differed, with mean ages of 63.46 ± 10.01 years, 60.42 ± 8.76 years, and 55.03 ± 10.40 years, respectively (OR = 1.062, 95%CI: 1.008 ~ 1.118, P = 0.024; OR = 1.100, 95%CI: 1.034 ~ 1.170, P = 0.002). Furthermore, the neutrophil to lymphocyte ratio (NLR) of the severe malnutrition group was significantly higher than that of the no malnutrition group, with statistical significance. The difference between the mild to moderate malnutrition group and the no malnutrition group were not statistically significant, with NLR of 4.07 ± 3.34 and 2.47 ± 0.92, respectively (OR = 1.657,95%CI: 1.036 ~ 2.649, P = 0.035). The L3 SMI of patients in the severe malnutrition and mild to moderate malnutrition groups were significantly lower than that of the patients in the no malnutrition group, with statistical significance. The L3 SMI of patients in the severe malnutrition group, mild to moderate malnutrition group, and no malnutrition group were 27.40 ± 4.25 cm2/m2, 38.19 ± 6.17 cm2/m2, and 47.96 ± 5.02 cm2/m2, respectively (OR = 0.600, 95%CI: 0.462 ~ 0.777, P < 0.001; OR = 0.431, 95%CI: 0.320 ~ 0.581, P < 0.001). 2. The Pearson correlation analysis showed that the PG-SGA score positively correlated with age (r = 0.296, P < 0.05) but negatively correlated with L3 SMI (r = − 0.857, P < 0.05). The L3 SMI was also negatively correlated with age (r = − 0.240, P < 0.05). 3. The multivariate analysis showed that the L3 SMI was an independent risk factor for malnutrition (OR = 0.446, 95%CI: 0.258 ~ 0.773, P = 0.004; OR = 0.289, 95%CI: 0.159 ~ 0.524, P < 0.001). Conclusion 1. The differences in the L3 SMI was statistically significant among advanced lung cancer patients with different nutritional statuses. 2. In the nutritional assessment of patients with lung cancer, the L3 SMI was consistent with the PG-SGA. 3. The L3 SMI is an independent predictor of malnutrition in patients with advanced lung cancer.

Respiratory cryptosporidiosis in Malawian children with diarrheal disease

Background Respiratory cryptosporidiosis has been documented in children with diarrhea. We sought to describe the dynamics of respiratory involvement in children hospitalized with gastrointestinal (GI) diarrheal disease. Methods We conducted a prospective, observational longitudinal study of Malawian children 2–24 months hospitalized with diarrhea. Nasopharyngeal (NP) swabs, induced sputum and stool specimens were collected. Participants that were positive by Cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Results Of the 162 children recruited, participants had mild-moderate malnutrition (mean HAZ -1.6 (SD 2.1)), 37 (21%) were PCR-positive for Cryptosporidium at enrollment (37 stool, 11 sputum, and 4 NP) and 27 completed the majority of follow-up visits (73%). Cryptosporidium was detected in all compartments over the 4 post-enrollment visits, most commonly in stool (100% at enrollment with mean cycle thresholds (Ct) of 28.8±4.3 to 44% at 8 weeks with Ct 29.9±4.1), followed by sputum (31% at enrollment with mean Ct 31.1±4.4 to 20% at 8 weeks with Ct 35.7±2.6), then NP (11% with mean Ct 33.5±1.0 to 8% with Ct 36.6±0.7). Participants with Cryptosporidium detection in both the respiratory and GI tract over the study period reported respiratory and GI symptoms in 81% and 62% of study visits, respectively, compared to 68% and 27%, respectively, for those with only GI detection, and had longer GI shedding (17.5±6.6 v. 15.9±2.9 days). Conclusion Cryptosporidium was detected in both respiratory and GI tracts throughout the 8 weeks post-enrollment. The development of therapeutics for Cryptosporidium in children should target the respiratory as well as GI tract.

Quality attributes of maize-based supplementary diets in the in vitro for the management of moderately acute malnourished children

Background and aimsModerate Acute Malnutrition (MAM) is a major global health problem threatening the life of approximately 33 million children and affects 15% of under- five children in sub-Saharan Africa. The efforts to reduce the burden of severe acute malnutrition and drop child mortality rate require appropriate dietary management of MAM through promotion of an affordable, readily available and locally produced supplementary food. The aim of this study was therefore to formulate and evaluate the quality of locally produced maize-peanut and maize-soybean supplementary food.ResultProximate composition was moisture (74.62%±0.02; 69.11%±0.01), crude protein (7.59%±0.02; 7.19%±0.02), crude fat (3.81%±0.02; 4.79%± 0.04), crude fiber (0.17%±0.02; 0.28%±0.03), ash (0.11%±0.02; 0.10%±0.02), carbohydrate (88.31%±0.02; 87.63%±0.06) and energy (417.96 ± 0.08; 424.05 ± 0.22) Kcal for MSB and MPN gruels, respectively. The mineral contents were calcium (14.15 ± 0.00; 11.81 ± 0.00) mg, iron (5.54 ± 0.00; 4.84 ± 0.00) mg, zinc (3.98 ± 0.00; 3.13 ± 0.00) mg, and iodine (297.33 ± 1.16; 293.00 ± 2.00) µg for MSB and MPN gruels, respectively. Vitamin contents of MSB and MPN gruels were B1 (2.30 ± 0.02; 2.22 ± 0.03) mg, B3(0.08 ± 0.02; 0.06 ± 0.03) mg, B9 (300.00 ± 26.46; 150.00 ± 17.32) mg, A (1.24 ± 0.05; 1.13 ± 0.04) RE, and K (0.86 ± 0.02; 1.98 ± 0.02) µg, respectively. Tannin (0.90 ± 0.03; 0.93 ± 0.02) %, saponin (0.30 ± 0.04; 0.34 ± 0.03) %, oxalate (0.24 ± 0.02; 0.11 ± 0.01) mg and alkaloid (0.12 ± 0.02; 0.10 ± 0.02) mg contents were not significantly different between MSB and MPN gruels.ConclusionThe formulation diets are suitable as supplementary food for the management of moderate malnutrition in children6-59 months, they provided all the required macro and micronutrients as recommended for children under this condition.

Respiratory cryptosporidiosis in Malawian children with diarrheal disease

Background: Respiratory cryptosporidiosis has been documented in children with diarrhea. We sought to describe the dynamics of respiratory involvement in children hospitalized with gastrointestinal (GI) diarrheal disease. Methods: We conducted a prospective, observational longitudinal study of Malawian children 2-24 months hospitalized with diarrhea. Nasopharyngeal (NP) swabs, induced sputum and stool specimens were collected. Participants that were positive by cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Results: Of the 162 children recruited, participants had mild-moderate malnutrition, 36 (22%) were PCR-positive for cryptosporidium at enrollment (34 stool, 11 sputum, and 4 NP) and 27 completed the majority of follow-up visits (75%). Cryptosporidium was detected in all compartments over the 4 post-enrollment visits, most commonly in stool (94% at enrollment with mean cycle thresholds (Ct) of 28.8+/-4.3 to 44% at 8 weeks with Ct 29.9+/-4.1), followed by sputum (31% at enrollment with mean Ct 31.1+/-4.4 to 20% at 8 weeks with Ct 35.7+/-2.6), then NP (11% with mean Ct 33.5+/-1.0 to 8% with Ct 36.6+/-0.7). Participants with cryptosporidium detection in both the respiratory and GI tract over the study period reported respiratory and GI symptoms in 81% and 62% of study visits, respectively, compared to 68% and 27%, respectively, for those with only GI detection, and had longer GI shedding (17.5+/-6.6 v. 15.9+/-2.9 days). Conclusion: Cryptosporidium was detected in both respiratory and GI tracts throughout the 8 weeks post-enrollment. The development of therapeutics for cryptosporidium in children should target the respiratory as well as GI tract.

MALNUTRITION IN SURGICAL EMERGENCY PATIENTS: UN UNKOWN ISSUE

INTRODUCTION Malnutrition in hospitals is increasingly becoming more problematic, although its severity in surgical emergency patients has yet to be researched in depth. It entails higher rates of morbimortality as well as an increase in both days hospitalized and re-admissions which inflates health care-related costs. MATERIAL AND METHODS Using GLIM (Global Leadership Initiative on Malnutrition) criteria, we evaluated the nutritional state of 84 patients admitted through the emergency department in the Oesophago-Gastric and Bariatric Surgery Unit in our centre. RESULTS Of the total patients sampled, 57 (67,85%) were at risk of malnutrition. The percentage of patients suffering malnutrition was 44.04%, of which 15.8% were diagnosed with moderate malnutrition and 48.1% severe malnutrition. Patients suffering malnutrition stay at hospital for 24 days on average, which implies a longer stay that those without malnutrition (13 days hospitalized on average), but no relation was found regarding any increase in overall complications. After performing an analysis, malnutrition was significantly higher in oncological patients than in those who were admitted for other causes (58,3% vs 36.6%). However, the age analysis (over-70 vs under-70) showed no significant difference. CONCLUSION 50% patients admitted through emergency services were diagnosed from malnutrition. Oncological patients suffer greater risk and severity of malnutrition. Malnutrition does imply longer stays at hospital; however there is no correlation with further complications.

The Correlation between Skeletal Muscle Index of the L3 Vertebral Body and Malnutrition in Patients with Advanced Lung Cancer

Background: By analyzing the L3 skeletal muscle index in patients with advanced lung cancer, we determined whether this index could be an independent predictor of malnutrition in such patients and its role in nutritional assessments.Methods: Retrospective analysis was performed on patients with advanced lung cancer who received medical treatment at the Cancer Center of The First Hospital of Jilin University from January 2017 to July 2017, and relevant data were collated and analyzed. Abdominal CT was used to analyze the L3 skeletal muscle index, and PG-SGA score, body mass index (BMI), and serological indicators were analyzed. According to PG-SGA scores, patients were divided into severe malnutrition (≥9 points), mild to moderate malnutrition (≥3 points and ≤8 points), and no malnutrition (≤2 points) groups. Pearson correlation analysis was conducted between the skeletal muscle index and PG-SGA score, BMI, and laboratory test indices. Univariate and multivariate logistic regression analyses were conducted on the factors related to malnutrition, and a forest plot was drawn to identify malnutrition risk and protection factors.Results:1. The age of patients in the severe malnutrition group, the mild to moderate malnutrition group, and the no malnutrition group significantly differed, with mean ages of 63.46±10.01 years, 60.42±8.76 years, and 55.03±10.40 years, respectively. Furthermore, the NLR of the severe malnutrition group was significantly higher than that of the no malnutrition group, with statistical significance. The difference between the mild to moderate malnutrition group and the no malnutrition group were not statistically significant, with NLRs of 4.07±3.34, 3.09±1.47, and 2.47±0.92, respectively. The L3 skeletal muscle mass indices of patients in the severe malnutrition and mild to moderate malnutrition groups were significantly lower than that of the patients in the no malnutrition group, with statistical significance. The L3 skeletal muscle mass index of patients in the severe malnutrition group, mild to moderate malnutrition group, and no malnutrition group were 27.40±4.25 cm2/m2, 38.19±6.17 cm2/m2, and 47.96±5.02 cm2/m2, respectively.2.The multivariate analysis showed that the L3 skeletal muscle index was an independent risk factor for malnutrition (OR=0.627, p=0.000; OR=0.454, p=0.000).3.The Pearson correlation analysis showed that the PG-SGA score positively correlated with age (r=0.296), but negatively correlated with L3 skeletal muscle mass index (r=-0.857) (P≤0.05). The L3 skeletal muscle mass index also negatively correlated with age (r=-0.240) (P≤0.05).Conclusion：1. The differences in the L3 skeletal muscle index, age, PA, and NLR were statistically significant among patients with advanced lung cancer with different nutritional statuses.2. In the nutritional assessment of patients with lung cancer, the L3 skeletal muscle index was consistent with the PG-SGA.3. The L3 skeletal muscle index is an independent predictor of malnutrition in patients with advanced lung cancer.

Plasmodium chabaudi Infection Alters Intestinal Morphology and Mucosal Innate Immunity in Moderately Malnourished Mice

Plasmodium falciparum is a protozoan parasite which causes malarial disease in humans. Infections commonly occur in sub-Saharan Africa, a region with high rates of inadequate nutrient consumption resulting in malnutrition. The complex relationship between malaria and malnutrition and their effects on gut immunity and physiology are poorly understood. Here, we investigated the effect of malaria infection in the guts of moderately malnourished mice. We utilized a well-established low protein diet that is deficient in zinc and iron to induce moderate malnutrition and investigated mucosal tissue phenotype, permeability, and innate immune response in the gut. We observed that the infected moderately malnourished mice had lower parasite burden at the peak of infection, but damaged mucosal epithelial cells and high levels of FITC-Dextran concentration in the blood serum, indicating increased intestinal permeability. The small intestine in the moderately malnourished mice were also shorter after infection with malaria. This was accompanied with lower numbers of CD11b+ macrophages, CD11b+CD11c+ myeloid cells, and CD11c+ dendritic cells in large intestine. Despite the lower number of innate immune cells, macrophages in the moderately malnourished mice were highly activated as determined by MHCII expression and increased IFNγ production in the small intestine. Thus, our data suggest that malaria infection may exacerbate some of the abnormalities in the gut induced by moderate malnutrition.

Evaluation of the Effects of Malnutrition Detected in Children and Adolescents on the Adult Final Height

Aim: It is known that chronic malnutrition observed in the early childhood creates many negative results in adult life. Studies examining the effects of nutritional deficiency experienced at older ages and in adolescence are quite limited. In other words, the long-term consequences of nutritional defect in acute/ chronic moderate or mild malnutrition patients still remains important as an issue to be investigated. For this purpose; In this study, it was aimed to determine the final adult height (predicted adult height) of children and adolescents with different age distribution and who were diagnosed with malnutrition as a result of nutritional-endocrinological anthropometric evaluations, and to compare these data with their genetic potential. Material and Methods: The study included 21 cases diagnosed with malnutrition in the pediatric endocrinology department. After the detailed history of the cases, anthropometric measurements and physical examination, biochemistry, hormonal and micronutritional status, celiac antibody levels were evaluated. In the anthropometric evaluation of all cases, body weight, height, height deviation, bone age, target height, target height deviation parameters were used. Patients’ pubertal development was determined according to Tanner-Marshall staging. In the determination of the nutritional status of the patients, data including Weight for Age (WA), Height for Age (HA) and Weight for Height (WH) were used as a nutritional anthropometric measurement using the Gomez-Waterlow classification. In addition, the predicted adult height was calculated with special formulas based on skeletal ages in all cases. Predicted adult height data were obtained using Bayley N Pinneau tables. Results: Of the 21 cases with an average age of 9.81±4.34 years, 12 were prepubertal and 9 were pubertal. Acute episode over chronic malnutrition was found in 19 cases, chronic in 2 cases and acute malnutrition in one case. Considering the severity of malnutrition; WA parameter was determined as severe malnutrition in 1 case, mild-moderate malnutrition in 20 cases, HA parameter was determined as normal in 12 cases, mild-moderate malnutrition in 9 cases, WH parameter was determined as normal in 3 cases, mild-moderate malnutrition in 18 cases. While the predicted adult height of all cases was 164.89±7.96 cm, the target height average of these cases was 166.5±8.09 cm. It was observed that the predicted adult height compared to the target height was the lowest in the chronic group. In seven cases with bone age below 6 years of age, the actual height deviations were distinctly behind the target height deviation. All of these cases were compatible with chronic malnutrition. Conclusion: These results are valuable in terms of showing that malnutrition experienced in any period of growth may negatively affect the predicted adult height. On the other hand, this research; It emphasizes the importance of nutritional anthropometry in all cases with or without short stature. In addition, in another study we conducted in 11 adolescents, it was found that nutritional defect negatively affected growth by decreasing IGF1/IGFBP3 levels, and growth factors increased and growth was supported in the cases that were nutritionally supported. In this study, if the nutritional deficiency is not replaced in patients with malnutrition, it suggests that even if the actual height is not affected, there will be retardation in the final height of the patients.