Risk factor of growth faltering in infants aged 2-12 months

Background: Growth faltering is a condition of growth disturbance that marked by slower growth velocity compared with previous growth chart. Growth faltering can cause effects in immune response, cognitive, & physical and psychomotor disturbance, behavioral disorder, learning problems, higher risk of infection and mortality.Objectives: To analyze risk factor of growth faltering in infant aged 2-12 months.Materials and Methods: A case control study was conducted in Public Health Center in Semarang city. Subject were infants aged 2 until 12 months with growth faltering. Variables were divided to exclusive breastfeeding, mother’s education, mother’s employment, social economic status, infection, mother’s nutrition and gestational age. Anthropometric and questionnaire data were obtained and analyzed among 116 infants. Statistic test used Chi square and multivariate analysis.Results: Chi-square analysis showed that breastfeeding (p=0.016) and gender (p=0.04) had a significant relationship with growth faltering in infant 2-12 months. Under standard parent’s income (p=0.809), Acute Respiratory Tract Infection (ARTI) (p=0.377), diarrhea (p=0.243), mother’s nutrition (p=1.00), gestational age (p=0.77), low mother’s education (p=0.83) and working mother (p=0.26) didn’t have a significant relationship with growth faltering in infant aged 2-12 months. Multivariate analysis showed that gender (p=0.035) and breastfeeding (p=0.019) were the most influencing variable to growth faltering. In 2-6 group, breastfeeding pattern had significant relationship with growth faltering (p=0.77)Conclusions: Breastfeeding and gender were risk factors of growth faltering in infant aged 2-12 months. Further research needed on how to prevent growth faltering in first 1000 days of life so it may avoid stunting in later life.

Rural-urban disparities in the nutritional status of younger adolescents in Tanzania

Research on geographic differences in health focuses largely on children less than five years; little is known about adolescents—and even less regarding younger adolescents—a vulnerable group at a critical stage of the life course. Africa’s rapid population growth and urbanization rates, coupled with stagnant rates of undernutrition, further indicate the need for country-specific data on rural-urban health disparities to inform development policies. This study examined rural-urban disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among younger adolescents in Tanzania. Participants were randomly selected adolescents aged 10–14 years (N = 1,125) residing in Kilosa (rural) and Moshi (urban) districts of Tanzania. Individual and household-level data were collected using surveys and anthropometric data was collected on all adolescents. Age, sex, household living conditions, and assets were self-reported. BAZ and HAZ were calculated using the WHO reference guide. The prevalence of undernutrition was 10.9% among rural and 5.1% among urban adolescents (p<0.001). Similarly, stunting prevalence was greater in rural (64.5%) than urban (3.1%) adolescents (p<0.001). After adjusting for covariates, rural residence was significantly and inversely associated with BAZ (B = -0.29, 95% CI: -0.52, -0.70, p = 0.01), as well as with HAZ (B = -1.79, 95% CI: -2.03, -1.54, p<0.001). Self-identified males had lower BAZ (B = -0.23, 95% CI: -0.34, -0.11, p<0.001) and HAZ (B = -0.22, 95% CI: -0.35, -0.09, p = 0.001) than self-identified female adolescents. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ and HAZ among younger adolescents in Tanzania. Targeted gender-sensitive interventions are needed to limit growth faltering and improve health outcomes in rural settings.

Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web—A 20-Year Experience of a Referral Center

Background: Antral web is a rare cause of gastric outlet obstruction in children. The presentation is diverse, depending on the degree of obstruction. Unfortunately, the guidance of management is still lacking.Methods: This study retrospectively evaluated the presentations, management, and outcomes of the pediatric antral web based on a 20-year experience in a referral center.Results: A total of 23 cases were included. The median age of diagnosis was 10 months (interquartile range, IQR, 0.8–23 months). Main presentations comprised vomiting (83%) and upper gastrointestinal (UGI) bleeding (48%). Concurrent gastric ulcers were common (68%). A total of 13 cases (57%) underwent interventional treatment. The median duration from diagnosis to intervention (DtI) was 10 days, but five with longer DtI, ranged from 30 to 755 days. Among the 15 cases with concurrent gastric ulcers, 10 patients received intervention, immediately in six but delayed in four. Surgical treatments (N = 12) achieved a cure in 11, with one rescued by endoscopic treatment.Conclusions: Children who suffer from early gastric ulcers with outlet obstruction shall raise the suspicion of the antral web. Complete obstruction madates early intervention. Around half of the cases with adequate feeding and growth need no intervention. Recurrent obstructive symptoms or adjacent ulcers justify a switch from observation to intervention to avoid complications or growth faltering.

RELATIONSHIP OF CARDIOVASCULAR RISK MARKERS IN CHILDREN SGAAND AGA

INTRODUCTION: Children born preterm usually experience an initial growth restriction, suggested to be caused by the immature organs and an inadequate nutritional intake.After this initial growth faltering, healthy preterm born children, and especially those born after 32 gestational weeks, usually fall back to the reference growth curve, following that of term born babies. For children born SGA, 80 % will experience a relative catch-up growth within the rst 6 months of life. OBJECTIVE: Role of different risk proles for children being born preterm vs being born SGA and early iron supplementation affect later cardiovascular risk RESULT: In Placebo group, 4.6(0.5) patients had Fasting glucose (mmol/L), 2.9(2.3-3.5) patients had Fasting insulin(µU/mL), 0.59(0.4-0.7) patients had HOMA-IR, 4.5(0.7) patients had Cholesterol(mmol/L), 0.58(0.2) patients had Triglyceride(mmol/L), 2.8(0.6) patients had LDL(mmol/L), 1.5(0.3) patients had HDL(mmol/L), 0.63(0.4) patients had ApoB(g/L and 0.20(0.1-0.6) patients had hs-CRP(mg/L). In Iron supplements group, 4.4(0.5) patients had Fasting glucose(mmol/L), 2.7(2.0-3.8) patients had Fasting insulin(µU/mL), 0.54(0.4-0.8) patients had HOMA-IR, 4.3(0.8) patients had Cholesterol(mmol/L), 0.59(0.3) patients had Triglyceride(mmol/L), 2.8(0.6) patients had LDL(mmol/L), 1.5(0.4) patients had HDL(mmol/L), 0.61(0.3) patients had ApoB(g/Land 0.24(0.2-0.8) patients had hs-CRP(mg/L). CONCLUSION: This literature showing that there is progression of these risk factors as children enter early adolescence. Further longer longitudinal studies are needed to elucidate the mechanisms responsible for progression of cardio-metabolic risk factors from infancy to adolescence in SGAand LGAsubjects.

Diarrhea Prevalence and Child Growth Faltering Are Associated with Subsequent Adverse Child Developmental Outcomes in Bangladesh (CHoBI7 Program)

Millions of young children annually are not meeting their developmental potential in low- and middle-income countries. Previous studies have shown that diarrheal diseases during early life are associated with subsequent malnutrition. This prospective cohort study of 576 children under 5 years was conducted in urban Dhaka, Bangladesh, to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Height and weight were measured at baseline and a 12-month follow-up. Diarrhea prevalence was assessed through monthly surveillance visits. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at the 12-month follow-up visit. To assess the association between diarrhea prevalence, child growth, and child developmental outcomes, linear regression models were fit using generalized estimating equations to account for clustering at the household level and to approximate 95% CIs. Diarrhea prevalence was negatively associated with change in height-for-age (HAZ) Z-scores from baseline to the 12-month follow-up (coefficient −0.85 [95% CI: −1.42, −0.28]). Diarrhea prevalence was a significant predictor of combined EASQ Z-scores with and without baseline stunting included in the model (−0.89 [95% CI: −1.67, −0.09] [baseline stunting included]) and (−0.88 [95% CI: −1.69, −0.07]). Change in HAZ from baseline to the 12-month follow-up was positively associated with follow-up combined EASQ Z-scores (0.28 [95% CI: 0.15, 0.42]). High diarrhea prevalence and linear growth faltering were associated with negative cognitive developmental outcomes among children residing in urban Dhaka, Bangladesh. Furthermore, high diarrhea prevalence was associated with negative child cognitive developmental outcomes with stunting included in the model, suggesting an effect of diarrhea on cognition independent of stunting.

Linear Growth Faltering Is Associated with Subsequent Adverse Child Cognitive Developmental Outcomes in the Democratic Republic of the Congo (REDUCE Program)

Globally, 140 million children under 5 years of age are estimated to be stunted. Previous studies have found an association between stunting and poor cognitive outcomes. However, there is limited evidence of this association in sub-Saharan African settings such as the Democratic Republic of the Congo (DRC). This prospective cohort study of 286 children under 5 years was conducted in rural DRC to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6-month follow-up visit. Height and weight were measured at baseline and a 6-month follow-up. Diarrhea prevalence was assessed through surveillance visits. Diarrhea prevalence was not associated with follow-up combined EASQ Z-scores at the 6-month follow-up (coefficient: −0.06 [95% CI: −0.29, 0.17]). Each additional standard deviation (SD) increase in height for age z-scores from baseline to the 6-month follow-up increased combined EASQ Z-scores by 0.22 (95%: 0.14, −0.31) SDs. Each additional SD increase in weight for age z-scores from baseline to the 6-month follow-up increased combined EASQ Z-scores by 0.21 (95%: 0.10, −0.32) SDs. Linear growth faltering and reduced weight gain were associated with reduced cognitive developmental outcomes among children residing in rural DRC. Interventions are urgently needed for this susceptible pediatric population to improve child growth and cognitive developmental outcomes.

PSVII-7 Prematurity alters the regulation of Akt signaling in skeletal muscle of piglets

Objectives: Postnatal growth faltering is common after preterm birth. Recently we showed that premature birth in piglets impairs normal postnatal weight gain and skeletal muscle protein synthesis compared to piglets born at term. This response is associated with a reduction in the feeding-induced activation of Akt and subsequent downstream signaling, despite no change in insulin receptor activation. The aim of this study was to identify key regulators of Akt responsible for the blunted anabolic response in preterm muscle. Methods: Piglets delivered by cesarean section 11 d (preterm/PT) or 2 d (term/T) before term birth were fed by total parenteral nutrition. On day 3, after 4 h fasting, piglets were fasted one additional h or fed orally a sow milk replacer (per kg body weight: 31.5 kcal, 1.3 g carbohydrate, 2.7 g amino acids BW, 1.6 g lipid). Positive and negative regulators of Akt activity in longissimus dorsi muscle were determined by Western blot. Results: Phosphorylation of Akt1 and Akt2, but not Akt3, was lower in PT than in T pigs (P &lt; 0.05). Phosphorylation of Akt activators, PDK1 and mTORC2, and the abundance of Ubl4A, a positive regulator of Akt, were lower in PT than in T (P &lt; 0.05). Abundance of Akt inhibitors, PHLPP and SHIP2, but not PTEN, was higher in PT than in T (P &lt; 0.05). Activation of the Akt phosphatase, PP2A, was unaffected by feeding in PT but inhibited by feeding in T pigs (P &lt; 0.05). Conclusions: These results show that the feeding-induced activation of positive regulators of Akt is reduced by preterm birth, whereas the activation of negative regulators is enhanced. Our findings suggest that premature birth impairs the activation of Akt that is essential for channeling dietary nutrients for anabolism and likely contributes to the postnatal growth faltering of prematurity. Research Support: NIH and USDA.

Local accessory gene sharing drives lineage-specific acquisition of antimicrobial resistance in Egyptian Campylobacter spp.

Campylobacter is the most common cause of bacterial gastroenteritis worldwide and diarrheal disease is a major cause of child morbidity, growth faltering and mortality in low- and middle-income countries (LMICs). Despite evidence of high incidence and differences in disease epidemiology, there is limited genomic data from studies in developing countries. In this study, we characterized the genetic diversity and accessory genome content of a collection of Campylobacter isolates from Cairo, Egypt. In total, 112 Campylobacter isolates were collected from broiler carcasses (n=31), milk and dairy products (n=24) and patients (n=57) suffering from gastroenteritis. Among the most common sequence types (STs) we identified were the globally disseminated, host generalist ST-21 clonal complex (CC21) and the poultry specialist CC206, CC464 and CC48. Notably, CC45 and the cattle-specialist CC42 were under-represented with a total absence of CC61. Comparative genomics were used to quantify core and accessory genome sharing among isolates from the same country compared to sharing between countries. Lineage-specific accessory genome sharing was significantly higher among isolates from the same country, particularly CC21 which demonstrated greater local geographical clustering. In contrast, no geographic clustering was noted in either the core or accessory genomes of the CC828, suggesting a highly admixed population. A greater proportion of C. coli isolates were multidrug resistant (MDR) compared to C. jejuni. This is a significant public health concern as MDR food chain pathogens are difficult to treat and often pose increased mortality risk demanding enhanced prevention strategies in the Egyptian market to combat such a threat.