First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study

We conducted a pilot study of a potential endoscopic alternative to bariatric surgery. We developed a Natural Orifice Transluminal Endoscopic Surgery (NOTES) gastric bypass with controlled bypass limb length using four new devices including a dedicated lumen-apposing metal stent (GJ-LAMS) and pyloric duodenal exclusion device (DED). We evaluated procedural technical success, weight change from baseline, and adverse events in growing Landrace/Large-White pigs through 38 weeks after GJ-LAMS placement. Six pigs (age 2.5 months, mean baseline weight 26.1 ± 2.7 kg) had initial GJ-LAMS placement with controlled bypass limb length, followed by DED placement at 2 weeks. Technical success was 100%. GJ-LAMS migrated in 3 of 6, and DED migrated in 3 of 5 surviving pigs after mucosal abrasion. One pig died by Day 94. At 38 weeks, necropsy showed 100–240 cm limb length except for one at 760 cm. Weight gain was significantly lower in the pigs that underwent endoscopic bypass procedures compared to expected weight for age. This first survival study of a fully endoscopic controlled bypass length gastrojejunostomy with duodenal exclusion in a growing porcine model showed high technical success but significant adverse events. Future studies will include procedural and device optimizations and comparison to a control group.

Outcome of food intake and nutritional status after discontinuation of a cow’s-milk-free diet post negative oral food challenge in infants and children

Objective: To evaluate the outcome of food intake and nutritional status post discontinuation of a cow’s-milk-free diet after a negative oral food challenge.Methods: This was a prospective, uncontrolled study that evaluated food intake and nutritional status of a cohort of 80 infants and children under 5 years of age. Food intake and nutritional status were evaluated on the day of the oral food challenge test and after 30 days. Weight and height were measured on the day of the test and after 30 days.Results: The mean age of the patients was 18.7 ± 12.4 months, and 58.7% were male. After discontinuation of the elimination diet, the children showed daily intake increases in (P < 0.001), protein (P < 0.001), carbohydrates (P = 0.042), calcium from foods (P < 0.001), calcium from foods and supplements (P < 0.001), phosphorus (P < 0.001), and vitamin D from foods (P = 0.006). The Z-scores (n = 76) on the day of the oral food challenge test and 30 days after restarting the consumption of cow’s milk were as follows: weight-for-age (P < 0.001) and height-for-age (P < 0.001), respectively.Conclusion: Cow’s milk protein in the diet was associated with increased intake of energy, proteins, carbohydrates, calcium, phosphorus, and vitamin D, in addition to an increase in the Z-scores for weight-for-age and height-for-age.

Infant malnutrition in low- and middle-income countries: assessment and prevalence of small and nutritionally at-risk infants aged under 6 months in 54 Demographic & Health Survey datasets

Background There is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting and underweight as measures of malnutrition by determining the strength and consistency of associations with biologically plausible risk factors. Methods We performed a cross-sectional secondary analysis of Demographic and Health Survey (DHS) datasets, focussing on infants u6m. We calculated underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age), and concurrent wasting and stunting. We explored data quality by recording extreme (flagged, as per standard criteria) or missing values. We calculated the population-weighted prevalence of each type of malnutrition and extrapolated the burden to all low- and middle- income countries (LMICs). We explored associations between infant, maternal and household risk factors with underweight and wasting using logistic regression models. Results We analysed 54 DHS surveys. Data quality in terms of refusals and missingness was similar for both weight and length. There were more extreme (flagged) values for length-based measures (6.1% flagged for weight-for-length, 4.8% for length-for-age) than for weight-for-age (1.0% flagged). Overall, 20.1% of infants (95% CI: 19.5, 20.7) were underweight, 21.3% (95% CI: 20.7, 22.3) were wasted, 17.6% (95% CI: 17.0, 18.2) were stunted, and 2.0% (95% CI: 1.8, 2.2) were concurrently wasted and stunted. This corresponds to an estimated burden in LMICs of 23.8m underweight infants, 24.5m wasted infants, 21.5m stunted infants and 2.2m concurrently wasted and stunted. Logistic regression models showed that numerous risk factors were associated with wasting and underweight. Effect sizes of risk factors tended to be stronger and more consistently associated with underweight compared to wasting. Conclusion Malnutrition in infants u6m is a major problem in LMICs. This is true whether assessed by underweight, wasting or stunting. Our data build on other evidence suggesting that underweight may be a better anthropometric case definition than wasting: data quality is better when length is not involved; biologically plausible risk factors are better reflected by an infant being underweight. Future research, ideally from intervention trials, should further explore how best to identify malnourished (small and nutritionally at-risk) infants u6m. For now, treatment programmes should note that many factors might underlie problems in this age group: services should thus consider how to address maternal health and wider social circumstances as well as caring for infants themselves.

Nutritional Status of Children with Pediatric Acute Lymphoblastic Leukemia

Aim: To analyze the nutritional status of children with pediatric Acute Lymphoblastic Leukemia (ALL) at presentation. Study design: Descriptive prospective study Place and duration of study: Department of Paediatric Haematology Oncology, Children Hospital, Lahore from March 2018 to April 2019. Methodology: A total of 195 children diagnosed as acute lymphoblastic leukemia on bone marrow biopsy were included. Anthropometric measurements were taken for each patient. Results: Out of 195 diagnosed patients with ALL, majority were having B-cell ALL 165(84.6%) and 30(15.4%) T-cell ALL. There was almost equal number of both standard and high risk patients (49% vs 51%) respectively. Mean age of children was 6.79±3.78 years and there was male predominance 120(61.5%). The percentage of children having weight for age <5th centile was 91(47), only 8(4%) were overweight or obese. Children under the age of five years had a slightly higher propensity of weight <5th centile i.e. 47(51.6%) as compared to older age group 5-10 years 26(28.7%) and >10 years 18(19.7%) (p=0.295).Similarly height for age was <5th centile in 50(26%) children in total, and in under 5 year age group 26(13.3%) but there was no statistically significant difference related to age above 5 years (p=0.547). Conclusion: Pediatric ALL has overall high prevalence of under nutrition and both weight for age and height for age is lower in under-five children as compared to older age group. Keywords: Children, cancer, nutrition, malnutrition, Acute Lymphoblastic leukemia

Growth in achondroplasia including stature, weight, weight-for-height and head circumference from CLARITY: achondroplasia natural history study—a multi-center retrospective cohort study of achondroplasia in the US

Background Achondroplasia is the most common genetic skeletal disorder causing disproportionate short stature/dwarfism. Common additional features include spinal stenosis, midface retrusion, macrocephaly and a generalized spondylometaphyseal dysplasia which manifest as spinal cord compression, sleep disordered breathing, delayed motor skill acquisition and genu varus with musculoskeletal pain. To better understand the interactions and health outcomes of these potential complications, we embarked on a multi-center, natural history study entitled CLARITY (achondroplasia natural history study). One of the CLARITY objectives was to develop growth curves (length/height, weight, head circumference, weight-for-height) and corresponding reference tables of mean and standard deviations at 1 month increments from birth through 18 years for clinical use and research for achondroplasia patients. Methods All available retrospective anthropometry data including length/height, weight and head circumference from achondroplasia patients were collected at 4 US skeletal dysplasia centers (Johns Hopkins University, AI DuPont Hospital for Children, McGovern Medical School University of Texas Health, University of Wisconsin School of Medicine and Public Health). Weight-for-age values beyond 3 SD above the mean were excluded from the weight-for-height and weight-for-age curves to create a stricter tool for weight assessment in this population. Results Over 37,000 length/height, weight and head circumference measures from 1374 patients with achondroplasia from birth through 75 years of age were compiled in a REDCap database. Stature and weight data from birth through 18 years of age and head circumference from birth through 5 years of age were utilized to construct new length/height-for-age, weight-for-age, head circumference-for-age and weight-for-height curves. Conclusion Achondroplasia-specific growth curves are essential for clinical care of growing infants and children with this condition. In an effort to provide prescriptive, rather than purely descriptive, references for weight in this population, extreme weight values were omitted from the weight-for-age and weight-for-height curves. This well-phenotyped cohort may be studied with other global achondroplasia populations (e.g. Europe, Argentina, Australia, Japan) to gain further insight into environmental or ethnic influences on growth.

Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka

Background High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children. Methods The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples. Results The dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort. Conclusions Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.

Nutrition Status of Children, Teenagers, and Adults From National Health and Nutrition Surveys in Mexico From 2006 to 2020

Background: Population-level health and nutrition surveys provide critical anthropometric data used to monitor trends of the prevalence of under nutrition and overweight in children under 5 years old, and overweight and obesity in the population over 5 years of age.Objective: Analyze the children malnutrition and overweight and obesity in children, teenagers and adults through the National Health and Nutrition Surveys information available from public databases.Materials and Methods: Comparable anthropometric data was gathered by five Mexican National Health and Nutrition Surveys (in Spanish, ENSANUT). In pre-school-age children, under nutrition status was identified through underweight (Z-score below −2 in weight-for-age), stunting (chronic malnutrition) (Z-score below −2 for length/height-for-age), or wasting (Z-score below −2, for weight-for-length/height); overweight status was defined as a body mass index (BMI, kg/m2) for age over +2. For school-age children and adolescents, a Z-score BMI between +1 and +2 deviations was defined as overweight, and between +2 and +5.5 as obesity. In adults (≥20 years of age), overweight status was classified as a BMI between 25.0 and 29.9, and obesity as ≥30.Results: The anthropometric data presented derives from the databases of five survey years of the Mexican National Health and Nutrition Survey: 2006, 2012, 2016, 2018, and 2020. They include a total of 210,915 subjects with complete anthropometric data (weight, length/height) distributed on five survey moments; subjects were categorized by age group: pre-school-age children (n = 25,968), school-age children (n = 42,255), adolescents (n = 39,275), and adults (n = 103,417). Prevalence of malnutrition by indicator was calculated: in pre-school-age children: low height- and weight-for-age, low weight-for-height, and overweight; and in school-age children, adolescents, and adults, the indicators calculated were overweight and obesity.Conclusions: Results demonstrate the importance of maintaining systematic, reliable, and timely national anthropometric data in the population, in order to detect and track trends and to form the basis of nutrition-related public policy.

Mobile phone addiction among children aged 5-12 years, a hospital-based study in South Kerala

Background: The uncontrolled, inappropriate or excessive use of the mobile phone can give rise to social, behavioural and affective problems. Mobile phone addiction has emerged as a challenging public health issue. The aim of the study was to find out the proportion and associated factors of mobile phone addiction among children aged 5-12 years.Methods: A cross-sectional study was conducted among 222 children in the age group of 5-12 years. Data collection was done using a semi-structured questionnaire and outcome variable measured using the diagnostic criteria developed by Lin et al. Chi-square test and binary logistic regression was done to find out the association between exposure and outcome variables.Results: 42.3% of children aged 5-12 years had mobile phone addiction. Factors like higher socio-economic status of the family, educated father, children with normal weight for age, presence of visual problems, headache, poor concentration and disturbed sleep were found to have statistically significant association with the mobile phone addiction. The predictor variables found on regression were higher socio-economic status, children with normal weight for age, disturbed sleep and poor concentration.Conclusions: This study found nearly half of the children belonging to 5-12 years was addicted to mobile phones which is higher than expected and is a serious matter for the growing children. The risk factors found in the study are modifiable to an extent and hence regional and national level strategies has to be implemented in accordance with the available studies to tackle this public health problem.

Ecology of the Possum (Trichosurus Vulpecula Kerr) in the Karori Water Supply Reserve, Wellington, Sounds Ecological District

<p>The abundance and condition of possums in various areas of the Karori Reserve, Wellington - Sounds Ecological District was assessed. Possums were most abundant in the upper part of the reserve in an area dominated by bishop and radiata pines with an undergrowth of native species and in an area dominated by gorse and flax shrublands. In the lower part of the reserve, possums were less abundant and there a number of characteristics were observed: possums had a higher body weight for age, their reproductive output was higher and the population was marked by a higher proportion of females and juveniles. This was interpreted as a "compensatory response" characteristic of possum populations maintained at low densities. Possum stomachs were sampled in spring and their contents analysed in order to investigate the importance of Fuchsia excorticata and other plant species to possum diet. In the lower part of the reserve the leaves of Fuchsia excorticata and the flowers of Cytisus scoparius made up more than 50 percent of the possums' forage. In the upper part of the reserve exotic species such as the flowers of Cytisus scoparius and Ulex europeans as well as the leaves of native species such as Aristotelia serrata, Pseudopanax arboreus and Coprosma robusta made up the bulk of possum forage. Exotic plants accounted for a significant proportion of the spring possum diet in the reserve. Whereas most leaves originated from native plants, the exotic species contributed mainly carbohydrate-rich flowers and pollen. The canopy condition of two possum-susceptible tree species Fuchsia excorticata and Pseudopanax arboreus was assessed early in autumn over the years 1993, 1995 and 1996. Over these years, 47 percent of marked fuchsia trees were completely defoliated and most trees are unlikely to recover even if possums are eradicated from the reserve. All defoliated fuchsia trees were located in the upper part of the reserve. On the other hand, 37 percent of marked fuchsia trees exhibited only a little possum damage. Most of these trees were located in the lower part of the reserve where possum density was lower. Increasing possum densities could therefore be correlated with an increasing level of possum damage to fuchsia canopies. Even though Pseudopanax arboreus leaves and petioles were encountered in 10 percent of possum stomachs, the canopies leaves and petioles were encountered in 10 percent of possum stomachs, the canopies of assessed trees did not seem to be greatly affected. It appeared that due to the high abundance of this plant species in the reserve the effects of possum browse were spread over the whole reserve to levels which could be tolerated by an individual Pseudopanax arboreus tree.</p>

Ecology of the Possum (Trichosurus Vulpecula Kerr) in the Karori Water Supply Reserve, Wellington, Sounds Ecological District

<p>The abundance and condition of possums in various areas of the Karori Reserve, Wellington - Sounds Ecological District was assessed. Possums were most abundant in the upper part of the reserve in an area dominated by bishop and radiata pines with an undergrowth of native species and in an area dominated by gorse and flax shrublands. In the lower part of the reserve, possums were less abundant and there a number of characteristics were observed: possums had a higher body weight for age, their reproductive output was higher and the population was marked by a higher proportion of females and juveniles. This was interpreted as a "compensatory response" characteristic of possum populations maintained at low densities. Possum stomachs were sampled in spring and their contents analysed in order to investigate the importance of Fuchsia excorticata and other plant species to possum diet. In the lower part of the reserve the leaves of Fuchsia excorticata and the flowers of Cytisus scoparius made up more than 50 percent of the possums' forage. In the upper part of the reserve exotic species such as the flowers of Cytisus scoparius and Ulex europeans as well as the leaves of native species such as Aristotelia serrata, Pseudopanax arboreus and Coprosma robusta made up the bulk of possum forage. Exotic plants accounted for a significant proportion of the spring possum diet in the reserve. Whereas most leaves originated from native plants, the exotic species contributed mainly carbohydrate-rich flowers and pollen. The canopy condition of two possum-susceptible tree species Fuchsia excorticata and Pseudopanax arboreus was assessed early in autumn over the years 1993, 1995 and 1996. Over these years, 47 percent of marked fuchsia trees were completely defoliated and most trees are unlikely to recover even if possums are eradicated from the reserve. All defoliated fuchsia trees were located in the upper part of the reserve. On the other hand, 37 percent of marked fuchsia trees exhibited only a little possum damage. Most of these trees were located in the lower part of the reserve where possum density was lower. Increasing possum densities could therefore be correlated with an increasing level of possum damage to fuchsia canopies. Even though Pseudopanax arboreus leaves and petioles were encountered in 10 percent of possum stomachs, the canopies leaves and petioles were encountered in 10 percent of possum stomachs, the canopies of assessed trees did not seem to be greatly affected. It appeared that due to the high abundance of this plant species in the reserve the effects of possum browse were spread over the whole reserve to levels which could be tolerated by an individual Pseudopanax arboreus tree.</p>