Screening for Hypothyroidism in children with severe acute malnutrition at Nutrition Rehabilitation Center, Children’s Hospital and Institute of Child Health Multan.

Objective: To determine the percentage of Hypothyroidism in children with severe acute malnutrition. Study Design: Cross Sectional study. Setting: Nutrition Rehabilitation Center, Children’s Hospital and Institute of Child Health Multan. Period: January 2019 to December 2019. Material & Methods: A total of 255 malnourished patients (as per inclusion criteria) were included in current study. A written Performa was designed to collect history, anthropometric measurements and systemic examination. Taking aseptic measures venous blood was sent for baseline tests as well as for T3, T4 and TSH, total serum protein albumin and total ferritin levels to hospital laboratory. Correlation between serum thyroid concentrations and total protein, albumin, hemoglobin and serum ferritin were estimated by using t-test and p-vlaue less than 0.05 was considered as significant. Total collected data was entered and analyzed in SPSS version 21.0. Results: A total of 255 malnourished children were included in this study. Majority of studied subjects were male (52.5%) with 83.92%, 3-5 years of age. Amongst the 255 children mean values of T3 in MAM and SAM patients were 105.4 ng/dl and 89.7 ng/dl respectively. There was a statistically significant (p <0.001) association between decreased T3 and type of malnutrition. Similarly, mean values of T4 in MAM and SAM patients were 6.3 ug/dl and 5.7 ug/dl respectively that was statistically significant (p <0.05). Lower values of T4 were higher among SAM children in 1 to 3 years age group compared to respective MAM children with p value .0.05 and high T4 value in 3-5 years age group of MAM children were both statistically insignificant. Higher mean Values of TSH was found in SAM compared to MAM children both age groups. Conclusion: Severe acute malnutrition (SAM) is associated with reduction in T3 and T4 levels and higher levels of TSH in SAM children as compared to MAM. The altered thyroid hormone status in children with PEM is perhaps a protective phenomenon to limit protein catabolism and lower energy requirements.

Effect of Moringa supplementation in the management of moderate malnutrition in children under 5 receiving ready-to-use supplementary foods in Niger: A randomized clinical trial

Each year in Niger, more than 40% of children under 5 years suffer from chronic malnutrition and more than 10% from acute malnutrition. The national nutrition rehabilitation protocol encourages the use of local foods. The objective of this work is to analyze the impact of supplementation in Moringa oleifera. We conducted a randomized double-blind clinical trial in 400 children with moderate acute malnutrition (MAM) aged 6 to 59 months admitted to outpatient nutritional recovery centers (CRENAM). The children were divided into two groups; one group received Ready-to-Use Supplemental Foods (RUSF) and dry leaf powder from Moringa oleifera and the other group received RUSF and placebo. We did not find any difference on average weight gain between the two groups or on mid-upper arm circumference and size. The median length of stay in CRENAM was 5 and 4 weeks for Moringa and placebo respectively, with no statistical difference (P=0.522). The cure rate was 82% (2.72) in the Moringa group with a RR of 1.03 (0.94 to 1.13) slightly in favor of Moringa. Renal and hepatic toxicity of Moringa was not observed. From this clinical trial, it could be held that Moringa supplementation, despite the presence of nutritional indices in favor of Moringa, does not have a significant effect on the nutritional recovery of MAM children but that Moringa has no renal or hepatic toxicity. Supplementation in subjects already on dietetic treatment, dose reduced to minimum and duration of supplementation seems to have played a role in this absence of effect of Moringa.

Refeeding Patients with Moderate and Severe Eating Disorders: A Retrospective Cohort Study

Background: Anorexia Nervosa (AN) is a life-threatening mental illness that can cause significant medical complications, including the potentially fatal refeeding syndrome. Registered dietitians (RDs) are a critical part of an eating disorder multidisciplinary team that focuses treatment on safe weight restoration and nutrition rehabilitation. Method: This study is a description of how the nutrition rehabilitation protocol of 395 adult patients diagnosed with AN and admitted to residential eating disorder treatment is implemented, how the protocol is sustained throughout a patient’s treatment stay to achieve desired weight gain, and how the patients’ biochemical and clinical progress proceeded between admission and discharge, including laboratory results and body mass index (BMI). Results: One hundred twenty-six patients required phosphorus supplementation for refeeding hypophosphatemia (RH); admission BMI was not significantly different between those with and without RH. The 15% of patients who required enteral nutrition at any point during their admission gained significantly less weight than patients who only received an oral meal plan. 34.4% of patients admitted with starvation induced hepatitis, 28.6% experienced refeeding hepatitis at some point, 21.0% of patients had elevated liver function tests 2 weeks into refeeding and 28.6% at discharge. Conclusions: This study demonstrated overall effectiveness in achieving weight restoration goals with aggressive kcal increases without a single incidence of refeeding syndrome and infrequent RH. No significant biochemical changes were observed during refeeding. With close medical supervision and concurrent RD oversight, a refeeding approach with consistent calorie increases that is more aggressive than previously recommended appears to be safe.

Demographic Profile, Clinical Profile and Outcome of Severe Acute Malnutrition among Children Aged 6 to 59 Months at a Tertiary Care Hospital, North East India

BACKGROUND Malnutrition is one of the leading causes of morbidity and mortality in children under 5 years of age. Children with severe acute malnutrition have nine times higher mortality than those in well-nourished children. The purpose of this study was to describe the demography, clinical profile, and outcome of children with severe acute malnutrition aged between 6 months to 59 months admitted in nutrition rehabilitation centre at a tertiary care hospital in North East India. METHODS A cross sectional-observational hospital-based study was conducted between May 2019 and April 2020 on 140 children. Severe acute malnutrition was diagnosed as per WHO criteria by using standard techniques. Variables recorded were demographic factors, anthropometry, clinical profile, laboratory tests, and medical complications. The outcome indicators including hospital course were studied. RESULTS In the present study 63.6 % were males and the mean age of presentation was 20.0 ± 1.54 months. 57.1 % children were found to be having both weight for height z-score below – 3 SD and mid upper arm circumference less than 115 mm together. Acute gastroenteritis (45.2 %) was the most common co-morbid condition followed by respiratory tract infection (26.2 %). Iron deficiency anaemia was found in 70.7 % of study children. Recovery rate from severe acute malnutrition was 86.4 % with average weight gain of 6.4 g / kg / day. CONCLUSIONS Children with severe acute malnutrition tend to suffer from serious co-morbid conditions. Early identification and treatment in nutrition rehabilitation centre with facility for critical care support should become a key component of continuum of care for children with severe acute malnutrition. KEYWORDS Children, Clinical Profile, Facility-Based Care, Severe Acute Malnutrition, Outcome

Crohn’s disease in childhood: modern approaches to treatment (a literature review)

The aim of the work. To provide world experience and features of Crohn’s disease (CD) treatment in children by reviewing and analyzing modern scientific literary sources, given the need to develop a unified therapeutic strategy for CD in childhood. The relevance of CD treatment in children stems from its debut in childhood in a large number of patients, in connection with this, a more severe and aggressive course; the presence of various surgical complications, a high risk of malignancy, and the absence of generally accepted approaches to conservative and surgical treatment. The analysis of the results of modern scientific and clinical studies on the treatment of CD in children with the characteristics of drug groups and their individual representatives, methods of treatment for patients with surgical complications of CD in childhood, lifestyle correction, psychosocial adaptation, enteral nutrition, rehabilitation, and dispensary observation is presented. The principle of a cascade approach to the treatment of CD is illustrated by an example of the WGO recommendations. Conclusions. The treatment of CD should be individual and comprehensive, with the simultaneous correction of local manifestations of the disease, surgical complications and changes in the general condition of a patient, as well as with dieting and lifestyle correction. The expected therapeutic effect of the use in children with CD of a large number of the proposed groups of medications is debatable or clinically unproven, which necessitates the implementation of further scientific and clinical research. The information presented will help doctors determine the optimal range of individual medical, rehabilitation measures and recommendations for everyone with CD in childhood and effectively provide active follow-up for patients.

Sarcopenia in a patient with most serious complications after highly invasive surgeries treated with nutrition, rehabilitation, and pharmacotherapy: a case report

Background Several studies have reported the implementation of nutrition therapy and rehabilitation for acute and critical illnesses. However, rehabilitation nutrition for elderly sarcopenia patients with extremely severe postoperative complications during hospitalization has not yet been established. Case presentation We report the case of a 70-year-old man with sarcopenia that developed as a postoperative complication of the surgical resection of perihilar cholangiocarcinoma and left the patient bedridden from prolonged malnutrition and muscle weakness. The patient’s general condition improved after a nearly 6-month intervention by our Nutrition Support Team (NST) that combined nutrition, exercise, and pharmacotherapy. Conclusions The appropriate timing and order of pharmacotherapy, nutrient administration, exercise therapy, and team collaboration may enable elderly patients with severe (secondary) sarcopenia and postoperative complications to regain self-sustained walking.

Etiological factors of severe acute malnutrition and impact of nutrition rehabilitation centre: a prospective observational study from Bhavnagar

Background: Severe acute malnutrition (SAM) causes almost half of childhood deaths in children <5 years in developing countries. In India, as National Family Health Survey (NFHS), prevalence of SAM has increased from 6.4 in NFHS-3 (2005-2006) to 7.5% in NFHS-4 (2015-1016); [5.8 to 9.5% Gujarat]. The aim of study was to determine the etiological factors and outcome of SAM and the benefit of nutrition rehabilitation centre (NRC) among 6 months to 5 years children at the Pediatrics, NRC ward, Sir T. General Hospital.Methods: A prospective observational study of 151 SAM children over nine months. Etiological factors were determined by history and relevant investigations, exclude other systemic disorders. Therapeutic nutrition was provided for 14 days. Cases were followed up two weekly for 2 months by monitoring weight after NRC admission.Results: Association was found between Small for gestational age (64.9%), joint family (59.6%) and low birth spacing (59.6%) as etiological factors leading to SAM. 81.5% children gained weight during 14 days NRC stay. Weight gain was noted at follow-up. Defaulter rate increased from 9.9% at discharge to 28.5% at 2 months follow-up. Weight was static for 9% children. 34.4% children were from rural area and 65.6% from urban area. 23.8% children had received pre lacteal feed. Timing of complementary feeding was incorrect in 29%. There were no deaths.Conclusions: Small for gestational age, joint family, low birth spacing, and incorrect feeding practices and urban residence were etiological factors. NRC stay (defaulter rate 26%), produced weight gain in SAM children.

Malnutrition assessed by mini nutritional assessment tool among Indian elderly: a systematic review and meta-analysis

Overall health and nutritional status of elderly population of India is not satisfactory. Therefore, present systematic review was conducted to determine the overall occurrence of malnutrition of Indian elderly and furthermore attempted to find out the underlying causes of malnutrition. Present review considered published article reported malnutrition of elderly as assessed by mini nutritional assessment (MNA) tool. Thus, literature searching, screening and data synthesis was made and recorded following preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. All published literature looked through utilizing the accompanying keywords. The MedCalc software was applied to estimate the overall prevalence of malnutrition by using meta-analysis statistical method. Thirty of 147 articles were included in this analysis. Overall mean MNA scores was 19.47±4.17. Study found overall prevalence of malnutrition among elderly was 17.93% (95% CI: 14.23-21.84). The prevalence of malnutrition was significantly higher in rural elderly (21.67%, 95% CI: 16.44-27.40) than urban (14.23%, 95% CI: 10.02-19.05) elderly of India. Rural elderly more likely to be 1.8 (OR: 1.76; CI: 1.56-1.99) times greater chance to be developed malnutrition than the urban elderly. Moreover, present study estimated that about 18.6 million Indian elderly population was malnourished and expected to be 22 million by 2021 due to elderly population growth, morbidity, poverty and joblessness by COVID-19 pandemic. Given the expansion of elderly malnutrition in future, there is felt need a special nutrition intervention programme for the rural elderly population. Thus, a dedicated geriatric friendly nutrition rehabilitation center (GFNRC) may be setup at every community development block of India.