Assessment of nutritional status and nutritional risk in hospitalized Iranian children

Aims: This study aimed to define the nutritional state of children admitted to a tertiary Iranian hospital and to evaluate nutritional risk score tools in these children. Methods: The anthropometry of hospitalized and healthy children from the same community was determined. Three nutritional risk score tools were applied to all inpatients. Results: One hundred and nineteen inpatients were recruited along with a comparison group of 100 children. The prevalence of under‐nutrition in the inpatient group was 25.2% and 3% in the community group (p < 0.0001). Obesity/overweight was more prevalent in the community group than the inpatients (22% versus 2.5%: p = 0.04). Severely malnourished children had a longer hospital stay than those with normal nutrition (p < 0.0001). The nutritional risk score tools identified between 83% and 90% of the malnourished patients in the moderate and high‐risk groups. The STRONG_kids tool correlated more strongly with anthropometric measurements than the other tools. The length of hospital stay was associated with risk status (p = 0.004). Conclusion: Hospitalized Iranian children have higher rates of under‐nutrition than healthy children from the same community. NRS tools were able to identify children at nutritional risk; however, variable utility was observed. Further assessment of NRS tools in the developing setting is required.     

湖南省农村义务教育学龄儿童实施“营养改善计划”后营养状况评价

目的调查湖南省农村学龄儿童2012~2015学年的营养健康状况,评价"义务教育学生营养改善计划"(简称"营养改善计划")的实施效果。方法对湖南省实施"营养改善计划"的6~14岁学龄儿童的营养状况进行评估,并分析该计划实施后其营养状况的变化趋势。资料来源于"农村义务教育学生营养改善计划营养健康状况监测评估系统"内湖南省农村义务教育学生2012~2015年4个学年的监测数据。结果 2015年湖南省农村义务教育阶段学龄儿童除6岁组女性身高高于全国农村平均水平外,其余各年龄组学龄儿童身高、体重平均水平均低于全国平均水平,差异具有统计学意义(P0.05)。"营养改善计划"实施后,生长迟缓率呈下降趋势(P0.05),但消瘦率上升(P0.05);同时超重/肥胖率呈上升的趋势(P0.05);贫血率呈下降趋势(P0.05)。结论 "营养改善计划"的实施在湖南省农村学龄儿童中取得了一定的成效,但未能使学龄儿童的营养状况得到明显改善,超重/肥胖和营养不良现象尚同时存在,建议应进一步完善学龄儿童营养改善措施,改善儿童营养状况。     

Iodine nutritional status of adolescents

Objective: To estimate the nutritional status of the adolescent tribes in Purnia District of Bihar.Methods : Iodine nutritional status of the adolescent children (10–12 yrs) of tribal communities of Purnia District (Bihar) was studied. Urinary iodine levels of the children was estimated. Iodine content of the common salt samples consumed by the tribals has been determined. Goiter prevalence among the children has been assessed. Iodine deficiency status and goiter-proneness of the target population has been discussed in the light of the data.Result : Total goiter prevalence of 11.67% estimated among the tribals from six well populated markets.Conclusion : The tribals of Purnia District should be encouraged to consume iodised salt.     

Mother surrogate and nutritional status of preschool children

The study was conducted on 200 preschool children to find out the effect of mother surrogate on the nutritional status. The nutritional status of children was found to be affected by the time devoted by mother on child care activities, working status of mother and type of family independently and jointly. The children cared by mother had better nutritional status than those children who were cared by servants and any other family member in the absence of mother. It shows that no one can substitute the care provided by the mother.     

Anthropometry for assessment of nutritional status

Anthropometry has been accepted as an important tool for the assessment of nutritional status, particularly of children. Of the various parameters, weight for age, weight for height, arm circumference and height for age, either singly or in combination are extensively used for the purpose. Though local standards of reference are preferred for purposes of comparison, the use of a single international standard for all such as NCHS standards is now recommended to evaluate the nutritional status of children in developing countries. Anthropometric techniques, though apparently simple, require vigorous standardisation and practical training. For surveillance and monitoring malnutrition for long-term periods, the validity of weight for age, with the usual random errors in age data, remains better. For the purpose of assessment of type and duration of malnutrition Waterlow’s classification is recommended.     

Anemia and nutritional status of pre-school children in Kerala

A study on the pattern of anemia and its relation to nutritional status and dietary habits was conducted among 3633 pre-school children of 108 selectedanganwadi centers in rural areas of Kerala State during the period 1996 to 1998. Children were invited with their parent or guardian. Capillary blood was collected from each child and hemoglobin was estimated by cyanomethemoglobin method. Weight and height of children were taken for assessing their nutritional status. The information regarding their age, sex, clinical condition and dietary habits was collected in a performa through an interview. Chi-square test was used to assess the relationship of anemia to sex, dietary habits, and nutritional status. For multivariate analysis logistic regression model was employed. The prevalence of anemia was 11.4%. The percentage of anemic children among male and female children was 10.25 and 12.55 respectively and statistical analysis showed that female childre were more susceptible to anemia. Normal nutritional status was seen among 46.7% of the children. When 187 (11.78%) of the mild undernourished children were anemic, the percentage anemic among the moderate undernourished children was 57, (16.37%). Moderate under nutrition and anemia showed a significant association. Anemia was reported among both vegetarians and non-vegetarians. Among 927 vegetarians, 86 (9.27%) were anemic and among 2,706 non-vegetarians, 328 (12.1%) were anemic. Dietary survey revealed that, consumption of iron sources, whether haem or non-haem, was below the recommended level. Undernutrition can be attributed as the major reason for nutritional anemia. Changes in eating behaviour could have potentially affected the iron bio-availability.     

Physical growth and nutritional status of garhwali girls

Objective: The present study was conducted to evaluate physical growth and nutritional status of 214 school-going girls ranging in age from 5 to 12 years of rural area in Pauri Garhwal district of Uttaranchal.Methods: Physical growth was evaluated using eleven standard anthropometric measurementsviz., height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold. To assess the nutritional status, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated using NCHS standards.Results: It has been observed that the well nourished Indian girls and American girls show better performance in physical growth parameters as compared to the Garhwali girls at all ages. The Garhwali girls were found to be comparable with rural Indian girls in their growth status. Grade-I and Grade-II malnutrition was prevalent among the Garhwali girls, however, Grade-III malnutrition was found to be present in only a few girls.Conclusion: This average to poor nutritional status of the present Garhwali girls may be attributed to low dietary intake, low-middle socio-economic background, uneducated or partially educated parents, large family size, gender discrimination etc.     

慢性疾病患儿营养现状及临床营养支持

慢性疾病患儿由于病程迁延,普遍存在着营养不良和高营养风险.营养不良不仅影响儿童生长发育,增加营养相关性并发症和感染的风险等.慢性疾病导致患儿长期摄入和吸收障碍、丢失增加以及因感染、炎症反应,引起机体能量代谢改变等机制影响患儿的营养过程.针对不同疾病特点予以营养支持和管理,有助于改善慢性疾病儿童的临床预后,促进儿童康复.该文就慢性疾病患儿的营养现状、营养风险评估及营养支持的研究进展作一综述.     

Growth and nutritional status of Bengali adolescent girls

Objective  Assessment of the growth and nutritional status among healthy Bengali adolescent schoolgirls at peri-urban area. Methods  In this cross sectional study, sample consists of 527 school going adolescent girls, aged 10 to 18 years. The sample of the present study was collected from a peri-urban area (Duttapukur) of north 24 parganas district of West Bengal, India. Standard anthropometric measurements including linear, curvilinear and skinfold thickness were collected from each subject. Percentile curves and nutritional indices were used to determine the growth and nutritional status respectively. Results  The nature of distance curves and percentile curves of the body measurements showed a high rate of increase in 10–11 years of age group corresponding to an earlier adolescent growth spurt than average Indian girls. The adolescent girls in the current study were found to be significantly (p<0.0001) taller than Indian girls and heavier than both Indian and urban Bengali girls but slightly shorter than urban Bengali girls. They are significantly (p<0.0001) shorter and lighter than American girls, which also corresponded to 50^th percentile curves. Age specific nutritional assessment shows different grades of malnutrition among them. Gomez’s classification indicates about 60 % to 70 % adolescent girls show either moderate to mild malnutrition during their growth period. Both the indices of Waterlow’s classification show least percentage of least malnutrition among the girls. Conclusion  The growth pattern and nutritional status observed among adolescent girls in peri-urban situation show heterogeneity with respect to some anthropometric traits and in conformity with the growth pattern and nutritional status of urban girls.     

Impact of nutritional status on antibody responses to different vaccines in undernourished Gambian children

AIM: To test the efficacy of T-cell-dependent and T-cell-independent vaccines in rural Gambian children suffering from a range of energy/protein and micronutrient deficiencies. METHODS: Nutritional status (anthropometry, haemoglobin, plasma leptin and micronutrient status) and response to two vaccinations (23 valent pneumococcal capsular polysaccharide vaccine, Pneumovax and the Human Diploid-Cell Rabies Vaccine) were assessed in 472 children aged 6 1/2 h to 9 1/2 y. RESULTS: Anthropometry and micronutrient status (as z-scores against European reference values) indicated a range from moderate to severe levels of undernutrition [mean (interquartile range): weight-for-age z-score -1.58 (-2.18 to -0.95); height-for-age z-score -0.94 (-1.51 to -0.35); body-mass-index-for-age z-score -1.43 (-2.05 to -0.84); mid-upper arm circumference -1.41 (-1.72 to -1.13); leptin -1.06 (-1.10 to -1.03); haemoglobin (Hb) -0.30 (-1.18 to 0.79); zinc -1.29 (-2.42 to -0.55); vitamin C -0.01 (-1.18 to 1.15); retinol -1.33 (-1.97 to -0.77)]. A seasonal effect was observed in haemoglobin levels and in all micronutrients (with the exception of zinc and retinol) and in the response to vaccination. After adjusting for seasonality, age and gender, no consistent associations were found between any of the measures of nutritional status and the effectiveness of seroconversion to either of the vaccines. CONCLUSION: The successful short-term seroconversion to whole inactivated viral and bacterial polysaccharide vaccines indicates that the processes leading to antibody secretion remain intact over a wide range of single and combined nutrient deficiencies.     

先天性心脏病婴儿生长发育状况及其危险因素分析

目的 调查评估先天性心脏病婴儿生长发育状况,探讨其生长落后的发生率及其危险因素.方法 采用Z评分法对2010年8月至2011年8月期间在我科住院行心脏手术的354例先天性心脏病婴儿进行营养状况评估,根据评估结果分为营养不良组及非营养不良组,采用卡方检验及多元回归分析对造成生长发育落后的可能危险因素进行单因素及多因素回归分析.结果 354例中低体重患儿108例(30.5％),经多元回归分析,低出生体重(OR=3.844,P=0.001)、肺动脉高压(OR=5.702,P=0.000)、肺炎(OR=2.161,P=0.005)与其显著相关;生长迟缓患儿62例(17.5％),经多元回归分析,低出生体重(OR=4.137,P=0.000)、肺动脉高压(OR=2.352,P=0.047)、肺炎(OR=3.417.P=0.000)与其显著相关;消瘦患儿95例(26.8％),经多元回归分析,肺动脉高压(OR=2.747,P=0.001)与其显著相关.结论 低出生体重、肺动脉高压、肺炎对先天性心脏病婴儿生长发育可产生显著影响;是否紫绀与小婴儿营养不良无显著相关.     

液态奶喂养对早产儿营养状况的影响

研究液态奶喂养对胎龄＜ 36周早产儿营养状况的影响,并对早产儿喂养方式提出建议。方法2009年11月至2010年5月收住我科治疗的符合标准的95例早产儿研为究对象,将其分为两组,分别应用足月儿配方奶粉喂养（48例）及早产儿液态奶喂养（47例）,观察在达到全肠道营养前后两组早产儿的体质量、身长及头围增长速度,并作组间比较...     

Effect of nutritional status on total parasite count in malaria

Effect of nutritional status as reflected by weights for age on total malarial parasite count was studied in 75 children. P. vivax was seen in 31 and P. falciparum in 44 of them. In 15 patients with normal weight for age mean absolute parasite count was 12200. The mean total malaria parasite count in PEM grade I was 9741; 4260 in grade II; 4286 in grade III and 596 in PEM grade IV. Statistical evaluation revealed a significant positive correlation (r=0·98) between nutritional status and total parasite count.     

Feeding problems,growth and nutritional status in children with cerebral palsy

Aim: The aim was to estimate the prevalence of feeding and nutritional problems in children with cerebral palsy (CP) in Norway. Methods: Data were abstracted from the Norwegian CP Register for 661 (368 boys) children born 1996–2003 (mean age 6 years 7 months; SD: 1.5). For children born from 1999 to 2003, weight and height were available. Body mass index (BMI) (kg/m²) was used to assess nutritional status. Results: One hundred and thirty‐two (21%) children with CP were completely dependent on assistance during feeding. The prevalence of gastrostomy tube feeding was 14%. Longer duration of gastrostomy tube feeding was associated with higher weight and BMI, but not with height. Only 63% of the children with CP had normal BMI, 7% had grade 3 thinness, while the prevalence of overweight and obesity in our study was 16%. In all, 20% of the children had mean z‐scores for weight and/or height below – 2 SD. Conclusion: Feeding problems in children with CP were common and associated with poor linear growth. A high proportion of the children were undernourished. Moreover, our results suggest that gastrostomy tube feeding may have been introduced too late in some children.     

Association between paternal smoking and nutritional status of under-five children attending Diarrhoeal Hospital, Dhaka, Bangladesh

Aim: The study aimed at determining whether there is an association between paternal smoking and nutritional status of children aged 0–59 months. Furthermore, the study looked at the presence of any nutritional differentials within different socio‐economic groups. Methods: Secondary analysis of data on children aged 0–59 months enrolled in the Hospital Surveillance System of International Centre for Diarrhoeal Disease Research, Dhaka Hospital, Bangladesh, during 1996–2006. Results: Among 13,555 under‐five children, fathers of 49% were smokers. In multivariate logistic regression models adjusting for potential confounders, fathers’ smoking was significantly associated with increased risk of moderate underweight (OR 1.16, 95% CI 1.08–1.25), severe underweight (OR 1.15, 95% CI 1.06–1.26), moderate stunting (OR 1.15, 95% CI 1.06–1.23) and severe stunting (OR 1.13, 95% CI 1.03–1.25). In middle and lower socio‐economic strata, risk of moderate and severe child malnutrition was found to be significantly increased in the group where the father was a smoker. Conclusion: Results indicate that there is an association between fathers’ smoking and malnutrition of under‐five children particularly in lower socio‐economic group. A possible mechanism – if this association is causal – may be through a negative effect on family economy.     

积极的营养支持对住院期间早产儿的影响

目的 探讨生后早期积极的营养支持对住院期间早产儿的影响.方法 研究对象选择胎龄大于28周出生体重1000 g至2000 g、生后12 h内转入我院NICU、住院时间2周以上、无明显畸形且存活出院的早产儿,其中A组(2005年1月1日至2006年6月30日出生)81例,B组(2009年6月1日至2010年11月30日出生)79例.比较营养摄入、早产儿的生长速率及体重Z评分和血生化营养指标的差异.结果 B组生后第3、7天氨基酸用量明显高于A组[2.00(2.00,2.50) g/kg比1.50(1.50,2.00) g/kg,3.00(2.00,3.00) g/kg比2.00(1.80,2.60) g/kg,P均＜0.001].B组第3天奶量和总热卡摄入明显高于A组[9.41(2.66,18.74) ml/kg比14.47(4.23,30.77) ml/kg,P＜0.05,(64.87±16.04) kcal/kg比(55.62±17.68) kcal/kg,P=0.001].两组第1周后总热卡摄入相似.B组母乳强化剂使用率较前升高(62.8％比14.3％,P＜0.005).无论是出生体重1000～1499 g的早产儿,还是出生体重1500～2000 g的早产儿,B组生长速率均更快[(20.6±3.4)g/( kg·d)比(15.4±3.2)g/( kg·d),(20.3±9.1)g/(kg·d)比(14.3±4.9) g/(kg·d),P均＜0.001].A组生长迟缓的比例出院时较出生时增加(65.4％比40.7％,P＜0.05),B组差异无统计学意义.两组出生体重Z评分相似,而B组出院体重Z评分明显高于A组[(-1.24±0.79)比(-1.54±0.84),P＜0.05].出生时血清白蛋白、前白蛋白、尿素水平两组差异无统计学意义,而生后2周和出院前B组明显高于A组.结论 早产儿生后早期营养措施的改善有效促进了早产儿住院期间的生长和营养状况.     

孕期甲基供体营养素与子代DNA甲基化关系的研究进展

孕期的营养对子代的健康起着非常重要的作用。叶酸、维生素B_(12)、胆碱、甜菜碱和蛋氨酸等营养素作为甲基基团供体直接影响DNA的甲基化,与子代健康关系密切。作为表观遗传学的重要组成部分之一,DNA甲基化在维持正常细胞功能、调节基因表达以及胚胎发育过程中起着重要作用。近年来的研究表明孕期营养可通过改变基因组DNA和/或特定基因启动子区域甲基化水平,进而对子代健康造成深远的影响。因此,该文就孕期甲基供体营养素对DNA甲基化的影响,从分子水平探讨其对子代健康的作用。     

The upper arm muscle and fat area of Santal children: an evaluation of nutritional status

Aims: The purpose of this study is to determine the growth pattern of upper arm muscle area (UAMA), upper arm fat area (UAFA) and upper arm muscle area by height (UAMAH) and assessment of magnitude of undernutrition on the basis of these parameters in Santal children.
Methods: UAMA and UAFA of 890 (473 boys and 417 girls) Santal children aged 5–12 years were calculated from mid-upper arm circumference and triceps skinfold.
Results: Growth curves of UAFA-for-age and UAMA by height in Santal boys and girls are placed at lower level of reference curve indicating severe undernutrition. The growth curves of UAMA-for-age in Santal children of both sexes do not indicate severe undermutrition. 17.13% Santal boys and 20.63% girls were truly undernourished on the basis of three Z-scores of height-for-age, weight-for-height and UAMAH of each subject. Santal children have more UAMA and less UAFA compared to similar undernourished children of Sugalis.
Conclusion: Growth curves of UAFA-for-age and UAMA by height are good indicators of nutritional status in Santal children. UAMA and UAFA may not be similarly affected in undernourished children of every community. A comprehensive approach to identify the truly undernourished child has been suggested from this study.     

Influence of maternal literacy on the nutritional status of preschool children

The impact of maternal literacy status on the nutritional status of preschool children in Parbhani was studied. Results revealed that the children of literate mothers had better anthropometric measurements than children of illiterate mothers. Nutrient deficiency signs especially of protein energy malnutrition were more predominant among the children of illiterate mothers. Food consumption pattern was better in children with literate mothers as compared to children of illiterate mothers. The consumption of milk and milk products, fruits, sugar and jaggery was significantly greater in children with literate mothers.     

Perceptual development in relation to nutritional status

The present study was conducted on 180 children in the age group 5–10 years. These children were divided accordingly their ages into 3 sub-groups i.e. 5–6, 7–8 and 9–10 years respectively. In each group 60 children were studied. For the assessment of perceptual skills each child was tested with the help of Picture Ambiguity Test. Responses to the ambiguous cards were scored with respect to time taken to react in each card and ability of the child to perceive figure and ground relationship i.e. centration and decentration. The observations showed that with increase in age, centration effect reduces and majority of the children start decentring their perception by middle childhood. Further, children in higher age group took lesser time to respond on different ambiguous cards. When the responses of well-nourished and undernourished children were compared for perceptual flexibility in terms of part-whole perception i.e. centration and decentration; no difference was observed between the two groups. There was a significant difference in the performance of well-nourished and undernourished children when time to respond on ambiguous card was compared. Well-nourished children took lesser time to respond on different ambiguous cards. These observations in general suggest that poor nutrition may result in impaired perceptual abilities in children.