Assessment of Nutritional Status in Children With Cancer and Effectiveness of Oral Nutritional Supplements

Malnutrition is a common consequence of cancer in children, but the most effective methods of nutrition intervention are under debate. We aimed to evaluate the nutritional status of children diagnosed with cancer, and to investigate the effect of oral nutritional supplements on anthropometric measurements, biochemical parameters, and outcome. A randomized clinical study of 45 newly diagnosed cancer patients was performed. Anthropometric and biochemical data and related factors were assessed at 0, 3, and 6 months after diagnosis. On initial anthropometric assessment, prevalence of malnutrition by weight or height was found to be lower as compared with body mass index (BMI), or weight for height (WFH), or arm anthropometry. Twenty-six of the patients (55%) received oral nutritional supplement. During the second 3 months after diagnosis, there was a statistically significant decrease in number of the patients with WFH <90th percentile and BMI <5th percentile (P = .003 and P = .04, respectively). Infectious complications occurred more frequently in malnourished patients during first 3 months, and survival of children who were malnourished at the 6th month was significantly lower than that of well-nourished children (P = .003). On laboratory assessment, serum prealbumin levels of the all subjects were below normal ranges, but no relation was found for serum prealbumin or albumin levels in patients who were malnourished or not at diagnosis. Nutritional intervention is necessary to promote normal development and increase functional status as a child receives intensive treatment. Protein- and energy-dense oral nutritional supplements are effective for preventing weight loss in malnourished children.     

Nutritional status and social behavior in preschool children: the mediating effects of neurocognitive functioning

Early malnutritional status has been associated with reduced cognitive ability in childhood. However, there are almost no studies on the effect of malnutrition on positive social behavior, and no tests of possible mediating mechanisms. This study tests the hypothesis that poor nutritional status is associated with impaired social functioning in childhood, and that neurocognitive ability mediates this relationship. We assessed 1553 male and female 3‐year‐olds from a birth cohort on measures of malnutrition, social behavior and verbal and spatial neurocognitive functions. Children with indicators of malnutrition showed impaired social behavior (p < .0001) as compared with children in the control group with adequate nutritional status. These associations even persisted after controlling for social adversity and parental education. Findings were not moderated by gender or ethnicity, and there was no interaction effect with parental education. A dose–response relationship was observed between degree of malnutrition and degree of social behavior, with increased malnutrition associated with more impaired social behavior. Neurocognitive ability was found to mediate the nutrition–social behavior relationship. The mediation effect of neurocognitive functioning suggests that poor nutrition negatively impacts brain areas that play important roles in developing positive social behavior. Findings suggest that reducing poor nutrition, alternatively promoting good nutrition, may help promote positive social behavior in early childhood during a critical period for social and neurocognitive development, with implications for improving positive health in adulthood.     

Nutritional status of Tajik children and women: Transition towards a double burden of malnutrition

The double burden of malnutrition, an emerging concern in developing countries, can exist at various levels: individual, household, and population. Here, we explore the nutritional status of Tajik women (15–49 years) and children (5–59 months) focusing on overweight/obesity along with undernutrition (underweight, stunting, and micronutrient deficiencies). For this, nutritional markers (haemoglobin (Hb), transferrin receptor (TfR), serum ferritin (Sf), retinol binding protein (RBP), vitamin D, serum folate, and urinary iodine), height, and weight were assessed from 2,145 women and 2,149 children. Dietary intake, weaning, and breastfeeding habits were recorded using a 24‐hr recall and a questionnaire. Overweight (24.5%) and obesity (13.0%) are increasing among Tajik women compared with previous national surveys (2003 and 2009). Prevalence of iron deficiency and anaemia was 38.0% and 25.8%, respectively; 64.5% of women were iodine deficient, 46.5% vitamin A deficient, and 20.5% had insufficient folate levels. Women in rural areas had significantly lower iron status and body mass index and higher iodine intake compared with urban areas; 20.9% of children were stunted, 2.8% wasted, 6.2% underweight, 52.4% iron deficient, and 25.8% anaemic; all more prominent in rural areas. Dietary diversity was higher among urban women. Intraindividual or household double burden was not seen. In summary, double burden of malnutrition constituted an increase in overweight among women, especially in urban areas, and persisting levels of undernutrition (stunting, iron, and vitamin A deficiency), predominately in rural areas. A holistic, innovative approach is needed to improve infant and young children feeding and advise mothers to maintain an adequate diet.     

手足口病患儿营养评估及营养干预研究

目的评价分析手足口病患儿的营养风险,探索合理可行的营养干预方案。方法采用定点连续抽样方法,收集桂林地区3所医院中手足口病患儿;采用询问调查、体格测量并结合临床诊断,采用儿童营养不良筛查工具（STAMP评分）进行营养风险评估与管理,以STAMP评分≥4分为存在高度营养风险。对存在高营养风险患儿实施营养干预和管理后再进行营养风险评估。结果共有192例手足口病患儿入选,存在高营养风险的发生率为68.75%（132/192）。有高营养风险的手足口病患儿住院时间延长,住院费用明显增加。对有高营养风险患儿进行营养支持治疗或营养健康教育,高营养风险发生率从入院时的68.75%下降至出院时的36.98%,差异有统计学意义（P<0.05）,接受营养干预的手足口病患儿临床结局改善显著,差异有统计学意义（P<0.05）。结论手足口病发病和预后与患儿营养状况密切相关,应及早进行营养风险评估、干预和管理。     

Nutritional status in pregnant adolescents: a systematic review of biochemical markers

Adolescent pregnancy is a major public health challenge for many industrialized countries and is associated with significant medical, nutritional, social and economic risk for mothers and their infants. Despite this, relatively little is known about the nutritional status of this population. The aim of this paper was to conduct a systematic review of the current evidence relating to the biochemical markers of nutritional status of pregnant adolescents living in industrialized countries. Six papers were identified that fulfilled the inclusion criteria, the majority of which were conducted in the United States. The studies were of variable quality and most failed to control for potential confounders which may have strongly influenced the findings. Due to limited research, conclusions cannot be drawn about the zinc and calcium status of pregnant adolescents, and data on folate and vitamin B(12) status appeared conflicting. There was some consensus among studies, however, to suggest that indicators of anaemia and iron status were compromised in pregnant adolescents, particularly during the third trimester of pregnancy. Chronological age did not appear to influence nutritional status, although there was some evidence to suggest that increasing gynaecologic age may positively influence plasma ferritin levels. Current research is limited by sampling and measurement bias, and research is urgently required to address these limitations. Further consideration should also be made of the influence of the role of socio-economic support on pregnant adolescents' nutritional status. The achievement of improved nutrition in pregnancy among adolescents requires multidisciplinary collaborations of adolescent healthcare providers, academics, professional organizations, policymakers, industry and service users. Only once this is achieved can adolescent nutrition, and adolescent nutrition in pregnancy, be significantly and sustainably optimized.     

Immunocompetence and prognosis in children with acute lymphoblastic leukemia: Combination of two different maintenance therapies

Intensive chemotherapy in patients with leukemia produces immunosuppression. The level of immunocompetence correlates with prognosis. The immunological function of 29 children with acute lymphoblastic leukemia (ALL) in complete remission and on 2 different maintenance therapies was evaluated and compared with 16 normal children (Group A). Sixteen children (Group B) with ALL received 6 mercaptopurine (6MP) daily and methotrexate (MTX) twice a week, and 13 children (Group C) received 6MP and MTX weekly for maintenance. There was depression of both cellular immunity, measured by the number of T cells and skin tests, and humoral immunity, measured by number of B cells, primary antibody production to typhoid vaccine, and levels of immunoglobulins. However, continuous maintenance therapy (Group B) produced significantly more severe immunosuppression of cellular immunity than the intermittent therapy (Group C). Humoral immunity was equally depressed in both groups of leukemia patients, but was less altered than cellular immunity. Concomitantly, patients with intermittent maintenance chemotherapy had less hematologic depression, fewer episodes of infection, and fewer died in complete remission. Patients of both groups with higher levels of immunocompetence had better prognosis with longer duration of complete remission than patients with severe immunosuppression. Out of 6 patients with “favorable immunocompetence” only 1 relapsed at 7 months and the other 5 remain in complete remission from 8 to 31 months. Among 23 leukemic patients with “unfavorable immunocompetence,” 15 relapsed and 8 remain in complete remission from 9 to 26 months.     

INH and Streptomycin in Ethiopian Children with Tuberculosis and Different Nutritional Status

ABSTRACT. The plasma concentration of INH and streptomycin was followed in 45 Ethiopian children with tuberculosis. The children were grouped according to their nutritional status as normal, underweight, marasm and kwashiorkor. INH was well absorbed in all nutritional groups to give therapeutically active plasma levels. When terminal half life ( t 1/2) of INH was calculated for individual patients there were more children in all nutritional groups with t 1/2 ≥2 hours than <2 hours, indicating a slow acetylation of INH. Streptomycin was well absorbed in all nutritional groups and therapeutic levels were obtained with 20 mg/kg i.m. After 30mg/kg i.m. of streptomycin kwashiorkor children had an increased t 1/2 of streptomycin in-dictaing a decreased renal excretion of the drug in kwashiorkor. The clinical follow-up of the children indicated that serious tuberculosis could be successfully treated with INH and strpetomycin in the doses used.     

Selenium Status of Infants on Nutritional Support

ABSTRACT. We investigated the selenium status of 5 infants while on nutritional support. After 4 weeks of parenteral nutrition a significant fall in plasma selenium concentrations was observed (mean ± SD: 0.8±0.5 μg/dl; normal for this age: 3.6±0.9 μg/dl). In 1 infant the decline in selenium value occurred simultaneously with a transient rise in transaminases. A parallel but delayed decrease in red blood cell-glutathione peroxidase activity was seen in 3 patients. After reintroduction of enteral foods, the selenium levels increased progressively to and reached control values after 6 weeks, 4 and 5 months respectively in 3 patients, suggesting that the selenium requirement on TPN was not met. We consider it essential to provide longterm TPN patients with physiological amounts of selenium in order to prevent the progressive development of a deficiency state.     

Effectiveness of the national food supplementary program on children growth and nutritional status in Iran

This study aimed to evaluate the effectiveness of the national food distribution program on the growth and nutritional status of malnourished or growth‐retarded children in 2 provinces of Iran. A quasi‐experimental design was used for the effectiveness evaluation. Qualitative data were gathered to explain the results. An intervention group consisted of 362 children aged 6–72 months who were under coverage of the program. These children received monthly food as foodstuff, food vouchers, or cash. A comparison group included 409 children aged 6–72 months who were selected from those covered by the Primary Health Care system. Children anthropometric indices were measured at the baseline and also 6 months later. Twelve focus group discussions were held with mothers who had at least 1 child under the coverage of the program. At the end of the study, the mean weight‐for‐age Z scores, height‐for‐age Z scores, and weight‐for‐height Z scores increased compared with the baselines in both groups (p < .001). The differences between 2 groups in weight‐for‐age Z scores, height‐for‐age Z scores, and weight‐for‐height Z scores were not significant at the end of the study (p = .62, p = .91, and p = .94, respectively). According to the mothers' reports, factors affected the program outcome, that is, children anthropometric indices were low income, intrahousehold food sharing, irregular distribution, quantity and quality of the distributed food, and insufficient training. Providing foods for the malnourished children living in low‐income families helped to prevent a worsening of their nutritional status; however, it has not been effective in solving the problem, probably due to the weak implementation and lack of empowerment strategies.     

Would Control of Childhood Infectious Diseases Reduce Malnutrition?

Infectious diseases and especially diarrheal diseases have been noted to have an adverse effect on the growth of underprivileged children in developing countries. Diarrheal diseases have been estimated to account for 10–80% of growth retardation in the first few years of life, with the magnitude of effect possibly modified by other factors, such as the adequacy and source of dietary intake, treatment and feeding practices during and following illness and the opportunity for catch-up growth after illness. In the only study in which infectious diseases and routine dietary intake have been evaluated simultaneously, inadequate dietary intake rather than infectious diseases, was found to have the predominant role in growth faltering. Although reduction in infectious diseases is desirable for many reasons, the relative feasibility and cost of this approach to improve nutritional status must be compared with more direct nutrition interventions.     

Nutritional and treatment-related characteristics of pediatric oncology patients referred or not referred for nutritional support

Nutritional problems often result from malignancies and aggressive multimodal treatment. Early identification of reliable risk factors associated with malnutrition and need for nutritional support is necessary for development of preventative approaches. Nutritional and treatment-related characteristics were examined for 173 pediatric oncology patients referred for nutritional support and a comparison sample of 43 patients matched on treatment protocol and/or diagnosis who had never been referred for nutritional support. Abnormally low serum albumin levels, poor oral intake, mucositis, prior radiation therapy, and increased gastrointestinal toxicity were significantly more frequent among referred than non-referred patients. A discriminant function analysis indicated that poor oral intake was the single best predictor of need for nutritional support. Patients with solid tumors were more nutritionally depleted at the time of referral; all bone marrow transplant patients received nutritional support. Patients with central nervous system (CNS) tumors required nutritional support for longer time periods. We conclude that routine documentation of poor oral intake (i.e., observation of change in a child's eating patterns) is the most reliable indicator of children who eventually require nutritional support and who may benefit from interventions that could delay or prevent nutritional problems. Prophylactic interventions should be tailored to meet the specific needs of individual diagnostic groups. © 1995 Wiley-Liss, Inc.     

The Principles and Strategic Steps of a Simple Nutrition Message

High prevalences of protein-energy malnutrition, anemia, vitamin A and iodine deficiencies have persisted since their identification by the National Nutrition Survey of Pakistan, 1966. While diarrhoea can be managed with oral rehydration therapy and iodine deficiency prevented with iodinization of salts, no simple tool for management of malnutrition is available. Strategies vary. In Pakistan, where the literacy rate is low but food grains are sufficient, precise and correct messages about nutrition education can potentially reduce the problem.     

Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study

The interactions between infections, malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined. Therefore, four groups of infants from an area with a high incidence of malnutrition (Lahore, Pakistan) were enrolled in a prospective, randomized nutritional intervention study. Between 122 and 365 days of age, the infants from one community received either a milk cereal without iron fortification ( n = 29), a milk cereal fortified with ferrous fumarate (7.5 mg/100 g; n = 30), or a milk cereal fortified with ferric-pyrophosphate (7.5 mg/100 g; n = 27). Forty-four infants from a neighbouring community did not receive a nutritional supplement and served as the control group. Calculated mean daily energy- and protein intake with the cereals was between 259–287 kcal, and 9.6–10.6 g at 12 months of age, respectively. Mean daily iron intake with the fortified cereals was between 4.1–5.1 mg at corresponding age. Nutritional supplementation resulted in significantly lower incidence of malnutrition and heigher weight gain. Incidence of acute diarrhoea was significantly ( p <0.05) lower in the supplemented groups. The infants fed the iron-fortified milk cereals had significantly higher hemoglobin (mean 10.4 vs. 9.8 gdl^-1) and serum ferritin (mean 13.3 vs. 8.5 ngml^-1) values than the infants fed the non-fortified milk cereals. However, no differences in the incidence of infections were found between the supplemented groups. It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants.     

Nutritional status of students in Kocaeli,Turkey: A population‐based study

Background: The aim of this study was to determine the nutritional status of students in Kocaeli, Turkey. Methods: This cross‐sectional study was carried out among the students of secondary schools in Kocaeli. Of the students, 2491 subjects were selected using multi‐stage stratified sampling. Results: Of the students, 51.1% were male and 48.9% were female. Mean age was 14.35 ± 1.87 (range 10.1–19.8) in overall subjects, 14.38 ± 1.87 in boys and 14.31 ± 1.85 in girls. The prevalence of obesity and of overweight was estimated as 7.3% and 11.8%, respectively. Also, 3.1% of the subjects were underweight and 2.9% were thin. The rate of obesity was 1.5 times higher in girls and that of overweight was 1.2 times higher in girls. Similarly, students aged 15 years old and younger were 1.2 times more obese and 1.7 times more overweight than older students. Students living in urban areas had a higher prevalence of obesity and of overweight. Conclusion: Nutritional problems in students should be dealt with by some regulations in schools; for example, providing healthy food in schools or food aid, particularly in poor regions.     

Nutritional status of low-birthweight ethnic minority infants in Backan province, Vietnam

BACKGROUND: Birthweight and length have been reported to be important determinants of infant growth and future nutritional status. The study aims to describe the weight and length growth patterns during the first year of life of low-birthweight (LBW) ethnic minority infants in the mountainous province Backan, Vietnam. METHODS: A total of 64 LBW and normal birthweight infants of ethnic minority mothers were recruited from 2001 to 2002 into a prospective cohort study. The weight and length of infants were measured monthly for 1 year. Data on nutritional status and feeding practices of the infants were collected from monthly health records and face-to-face interviews with mothers while their infants were 6 and 12 months of age. RESULTS: Most of the increase in weight, length and catch-up to the 10th percentile for LBW infants occurred during the first 3 and 6 months for boys and for girls, respectively. After these ages, the mean weight and length diverged from National Center for Health Statistics (NCHS) reference curves to below the 10th percentile. LBW infants' weight-for-age z-scores was below the NCHS standard at birth (-2.16 SD), caught up after birth, became sustainable by 4 months, fell rapidly from the sixth month, then decreased to -2 SD at 12 months of age. LBW infants' length-for-age z-scores increased in the first month after birth, decreased in the second month and sharply increased again until 5 months of age before decreasing. CONCLUSIONS: For LBW infants, it is difficult to achieve the same weight or length curves at 12 months of age as the NCHS standard.     

How do nutrition professionals working in low‐income countries perceive and prioritize actions to prevent wasting? A mixed‐methods study

Despite a shared commitment to achieving global nutrition targets, development and emergency‐humanitarian actors tend to prioritize different nutrition outcomes and actions. New approaches are needed to bridge the divide between these communities and to strengthen the overall evidence base for prevention of wasting. To better understand how these different groups perceive and prioritize actions for wasting prevention, key informant interviews (n = 21) were conducted, and an online survey was fielded among nutrition professionals working in low‐income countries (n = 107). Additionally, nutrition policy and strategy documents for select global and country institutions (n = 12) were analysed to identify interventions and approaches for addressing different forms of undernutrition. The findings of this study suggest that at both global and country levels, development actors tend to prioritize stunting prevention, and emergency‐humanitarian actors tend to prioritize treatment of acute malnutrition. It was less common for wasting prevention to be mentioned as an explicit priority. Many interventions were perceived by respondents to influence both stunting and wasting despite limited published evidence of effectiveness on wasting for water, sanitation and hygiene, growth monitoring and promotion, breastfeeding promotion and micronutrient supplementation. To help unify the nutrition community around prevention of wasting, the discourse about priority interventions should shift from ‘stunting versus wasting’ and ‘prevention versus treatment’ to a life‐course framing around child survival, growth and development. Respondents identified a need for more programme and research funding that prioritizes both wasting and stunting as outcomes. They also suggest leveraging existing national coordination bodies that bring development and emergency‐humanitarian partners together.     

Findings from a cluster randomised trial of unconditional cash transfers in Niger

Unconditional cash transfers (UCTs) are used as a humanitarian intervention to prevent acute malnutrition, despite a lack of evidence about their effectiveness. In Niger, UCT and supplementary feeding are given during the June–September “lean season,” although admissions of malnourished children to feeding programmes may rise from March/April. We hypothesised that earlier initiation of the UCT would reduce the prevalence of global acute malnutrition (GAM) in children 6–59 months old in beneficiary households and at population level. We conducted a 2‐armed cluster‐randomised controlled trial in which the poorest households received either the standard UCT (4 transfers between June and September) or a modified UCT (6 transfers from April); both providing 130,000 FCFA/£144 in total. Eligible individuals (pregnant and lactating women and children 6–<24 months old) in beneficiary households in both arms also received supplementary food between June and September. We collected data in March/April and October/November 2015. The modified UCT plus 4 months supplementary feeding did not reduce the prevalence of GAM compared with the standard UCT plus 4 months supplementary feeding (adjusted odds ratios 1.09 (95% CI [0.77, 1.55], p = 0.630) and 0.93 (95% CI [0.58, 1.49], p = 0.759) among beneficiaries and the population, respectively). More beneficiaries receiving the modified UCT plus supplementary feeding reported adequate food access in April and May (p < 0.001) but there was no difference in endline food security between arms. In both arms and samples, the baseline prevalence of GAM remained elevated at endline (p > 0.05), despite improved food security (p < 0.05), possibly driven by increased fever/malaria in children (p < 0.001). Nonfood related drivers of malnutrition, such as disease, may limit the effectiveness of UCTs plus supplementary feeding to prevent malnutrition in this context. Caution is required in applying the findings of this study to periods of severe food insecurity.