12 research outputs found
Nutritional problems perceived by pediatricians in Spanish children younger than 3 years
Introducción: Los padres son los principales responsables
de la educación nutricional de sus hijos y es labor del pediatra
orientar y resolver problemas al respecto. En este estudio
se pretende conocer la relevancia de las cuestiones nutricionales
en la consulta del pediatra y los principales problemas
nutricionales percibidos en los menores de 3 años.
Métodos: Estudio descriptivo, transversal en dos fases.
La primera consistió en entrevistas y grupos de discusión
con 30 pediatras seleccionados aleatoriamente en Madrid
y Barcelona. Los resultados se utilizaron para diseñar el
cuestionario online (76 preguntas relacionadas con la
nutrición en niños de 0-3 años) de la siguiente fase, en la
que participaron pediatras seleccionados de forma aleatoria
y representativa del territorio nacional.
Resultados: De 258 pediatras seleccionados, completaron
el cuestionario 151, que atendían a una media de 588
pacientes/mes. Los principales problemas nutricionales
percibidos hasta los 12 meses fueron las deficiencias de hierro
y vitaminas y la escasa ganancia de peso, y posteriormente
la ingesta excesiva de carbohidratos y lípidos y el
sobrepeso. Los padres fueron considerados los actores principales
en la salud nutricional de sus hijos, pero su preocupación
por esta cuestión se reduce significativamente (p <
0,0001) con la edad del niño. Los aspectos considerados más
importantes para obtener unos buenos hábitos alimentarios
fueron la alimentación adaptada a las necesidades del niño
y respetar el tiempo de sueño. El porcentaje de pacientes
que recibe recomendaciones de hábitos nutricionales varió
del 88% (0-6 meses) al 61% (24-36 meses).
Conclusiones: A pesar de considerar la salud nutricional
importante, la intervención educativa del pediatra al
respecto no es óptima. Los problemas nutricionales percibidos
fueron distintos según la edadIntroduction: Parents are most responsible for nutritional
education of children, and pediatritians must
advise and help them with their doubts. The purpose of
this study was to know the relevance of nutritional topics
in daily practice and the main nutritional problems
perceived by pediatritians in children under 3 years of
age.
Methods: Descriptive, cross-sectional study performed
in 2 stages. First stage consisted on discussion meetings
with 30 random-selected pediatritians from Madrid and
Barcelona. Results were used to design the on-line questionnaire
of the second stage (76 questions related to
nutrition in children under 3 years). A random and representative
sample of Spanish pediatritians was selected for
this stage.
Results: One hundred and fifty one pediatritians, among
258 sampled, completed the questionnaire. They referred to
see a mean of 588 patients/month. The main perceived
nutritional problems in the first year of life were iron and
vitamin deficiencies and poor weight gain. In the next
months, excess in carbohydrates and lipid intake and overweight
were the main problems perceived. Parents were
considered the main actors regarding their children’s
nutritional health, but their concern in these questions
significantly reduced with children’s age (p < 0,0001).
Factors considered to have the greatest relevance in the
acquisition of good nutritional habits were to provide a
diet adjusted for children’s requirements and to observe
the appropriate sleeping hours. The proportion of children
who receive nutritional counseling varied from 88%
(0-6 months) to 61% (24-36 months).
Conclusions: Despite of the relevance given by pediatritians,
educational intervention regarding nutritional
health is not ideal. Nutritional problems perceived by
pediatritians varied with children’s ageEste estudio ha sido financiado por Almiron/Danone
Baby Nutrition
Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases
Nutrition in congenital heart disease: consensus document
Cardiopatías congénitas; Terapia nutricional; Técnica delfosCongenital heart defects; Nutrition therapy; Delphi techniqueCardiopaties congènites; Teràpia nutricional; Tècnica delfosIntroduction
The prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD.
Material and methods
We employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds.
Results
Thirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved.
Conclusions
These recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD.Introducción
La tasa de desnutrición entre los lactantes con cardiopatías congénitas (CC) es elevada. Una evaluación e intervención nutricional tempranas ayudan a su tratamiento y mejoran el pronóstico. El objetivo fue elaborar un documento de consenso para la evaluación y el tratamiento nutricional del lactante con CC.
Material y Métodos
Se utilizó una técnica Delphi modificada. En base a la literatura y a su experiencia clínica, un comité científico elaboró un listado de afirmaciones que abordaban la derivación a Unidades de Nutrición Pediátrica (UNP), la evaluación y el manejo nutricional de los lactantes con CC. Especialistas en cardiología pediátrica, y gastroenterología y nutrición pediátrica evaluaron el cuestionario en 2 rondas.
Resultados
Participaron 32 especialistas. Tras dos rondas de evaluación, se consensuaron 150 de 185 ítems (81%). Se determinaron patologías cardiacas de bajo y alto riesgo nutricional y factores asociados cardíacos o extracardíacos que confieren riesgo nutricional alto. Se elaboraron recomendaciones para la evaluación y seguimiento en unidades de nutrición y sobre el cálculo de los requerimientos nutricionales, el tipo de nutrición y la vía de administración. Se enfatiza la necesidad de un tratamiento nutricional intensivo en el preoperatorio, del seguimiento por la UNP en el postoperatorio cuando se haya necesitado intervención preoperatoria, y de la reevaluación por el cardiólogo cuando no se alcancen los objetivos nutricionales.
Conclusiones
Estas recomendaciones pueden ser de ayuda para la detección precoz y derivación temprana de población vulnerable, su evaluación y tratamiento nutricional y para mejorar el pronóstico de su CC.The study received funding from Danone Nutricia to support in-person and online meetings of experts
Influence of Water Intake and Balance on Body Composition in Healthy Young Adults from Spain
The increasing prevalence of overweight and obesity has become an epidemic public health problem worldwide. In the last years, several investigations have suggested that water intake and retention could have important implications for both weight management and body composition. However, there is a lack of information about this issue globally, and mainly specifically in Spain. Thus, the aim of this study was to analyze the association between hydration status and body composition in a sample of healthy Spanish adults. The study involved 358 subjects, aged 18–39 years. The recently validated “hydration status questionnaire” was used to assess their water intake, elimination, and balance. Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK). Body composition variables were acquired by bioelectrical impedance analysis. Differences in anthropometric and body composition variables were assessed through the ANOVA test and considered significant at p < 0.05. Fluid intake was correlated with body water content. Inverse associations between water consumption, normalized by weight, with body weight, body fat mass, and waist circumference were found. Moreover, according to water balance, significant differences in body water content in females were observed. In conclusion, higher fluid intake seems to be related with a healthier body composition. Therefore, the improvement of water intake and water balance could be useful for overweight and obesity prevention, although further studies are needed to confirm the present findings
Recomendaciones del Comité de Nutrición y Lactancia Materna de la Asociación Española de Pediatría sobre las dietas vegetarianas
In the last few years, there are an increased number of families following a vegetarian
diet, including their children. In order to guarantee child heath, paediatricians need to
know the characteristics of this diet and the main foods that are used.
There are few data on the medium and long-term health outcomes when removing all animal
foods from the child’s diet, especially at younger ages. Nevertheless, new tools have recently
become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies.
In this document, the group of foods commonly used in vegetarian diets are reviewed, as well
as recommendations for each age group. It also mentions the need to use B12 supplements at
all ages, as well as other nutrients (iodine, iron, vitamin D3, poly-unsaturated fatty acid n-3),
when required.
A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed.
After reviewing current evidence, even though following a vegetarian diet at any age does
not necessarily mean it is unsafe, it is advisable for infant and young children to follow an
omnivorous diet or, at least, an ovo-lacto-vegetarian dietEn los últimos años ha aumentado el número de personas que optan por una dieta
vegetariana y que incluyen a sus hijos en esta opción de alimentación. Esto obliga a los
pediatras a conocer sus características principales y la composición de los alimentos usados más comúnmente, con el fin de garantizar la salud de los niños.
Existe una escasez de datos sobre el impacto a medio y largo de eliminar los productos de origen
animal en la dieta de los niños, en especial en la de los más pequeños. Sin embargo, en los
últimos años se han publicado herramientas (tablas de intercambios de alimentos, recomendaciones
de suplementación) que facilitan el cumplimiento de una dieta vegetariana disminuyendo
el riesgo de deficiencias.
En este documento se revisan los grupos de alimentos que habitualmente forman parte de la
dieta vegetariana, así como las recomendaciones para cada grupo de edad. Se señala también
la necesidad de utilizar suplementos de vitamina B12 en todas las edades, y en aquellos otros
nutrientes (yodo, hierro, vitamina D3, ácidos grasos polinsaturados n-3) en riesgo de deficiencia.
Una alimentación vegetariana o vegana, como cualquier otro tipo de alimentación, debe estar
bien planificada. A la luz de la evidencia disponible, a pesar de que seguir una dieta vegetariana
en cualquier etapa de la infancia no signifique necesariamente que sea insegura, es preferible aconsejar que durante el periodo de lactalactante y en el niño de corta edad se siga una dieta omnívora o, al menos, ovo o lactovegetariana
Nutrition in congenital heart disease: consensus document
Introduction: The prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD. Material and methods: We employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds. Results: Thirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved. Conclusions: These recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD. Resumen: Introducción: La tasa de desnutrición entre los lactantes con cardiopatías congénitas (CC) es elevada. Una evaluación e intervención nutricional tempranas ayudan a su tratamiento y mejoran el pronóstico. El objetivo fue elaborar un documento de consenso para la evaluación y el tratamiento nutricional del lactante con CC. Material y Métodos: Se utilizó una técnica Delphi modificada. En base a la literatura y a su experiencia clínica, un comité científico elaboró un listado de afirmaciones que abordaban la derivación a Unidades de Nutrición Pediátrica (UNP), la evaluación y el manejo nutricional de los lactantes con CC. Especialistas en cardiología pediátrica, y gastroenterología y nutrición pediátrica evaluaron el cuestionario en 2 rondas. Resultados: Participaron 32 especialistas. Tras dos rondas de evaluación, se consensuaron 150 de 185 ítems (81%). Se determinaron patologías cardiacas de bajo y alto riesgo nutricional y factores asociados cardíacos o extracardíacos que confieren riesgo nutricional alto. Se elaboraron recomendaciones para la evaluación y seguimiento en unidades de nutrición y sobre el cálculo de los requerimientos nutricionales, el tipo de nutrición y la vía de administración. Se enfatiza la necesidad de un tratamiento nutricional intensivo en el preoperatorio, del seguimiento por la UNP en el postoperatorio cuando se haya necesitado intervención preoperatoria, y de la reevaluación por el cardiólogo cuando no se alcancen los objetivos nutricionales. Conclusiones: Estas recomendaciones pueden ser de ayuda para la detección precoz y derivación temprana de población vulnerable, su evaluación y tratamiento nutricional y para mejorar el pronóstico de su CC
Recommendations for the Diagnosis and Therapeutic Management of Hyperammonaemia in Paediatric and Adult Patients
Hyperammonaemia is a metabolic derangement that may cause severe neurological damage and even death due to cerebral oedema, further complicating the prognosis of its triggering disease. In small children it is a rare condition usually associated to inborn errors of the metabolism. As age rises, and especially in adults, it may be precipitated by heterogeneous causes such as liver disease, drugs, urinary infections, shock, or dehydration. In older patients, it is often overlooked, or its danger minimized. This protocol was drafted to provide an outline of the clinical measures required to normalise ammonia levels in patients of all ages, aiming to assist clinicians with no previous experience in its treatment. It is an updated protocol developed by a panel of experts after a review of recent publications. We point out the importance of frequent monitoring to assess the response to treatment, the nutritional measures that ensure not only protein restriction but adequate caloric intake and the need to avoid delays in the use of specific pharmacological therapies and, especially, extrarenal clearance measures. In this regard, we propose initiating haemodialysis when ammonia levels are >200–350 µmol/L in children up to 18 months of age and >150–200 µmol/L after that age
Lymphocyte Medium-Chain Acyl-CoA Dehydrogenase Activity and Its Potential as a Diagnostic Confirmation Tool in Newborn Screening Cases
The determination of acylcarnitines (AC) in dried blood spots (DBS) by tandem mass spectrometry in newborn screening (NBS) programs has enabled medium-chain acyl-coA dehydrogenase deficiency (MCADD) to be identified in presymptomatic newborns. Nevertheless, different confirmatory tests must be performed to confirm the diagnosis. In this work, we have collected and analyzed the NBS results and confirmatory test results (plasma AC, molecular findings, and lymphocyte MCAD activity) of forty individuals, correlating them with clinical outcomes and treatment, with the aim of obtaining useful diagnostic information that could be applied in the follow-up of the patients. Our results led us to classify patients into two groups. The first group (14 cases) had high increased octanoylcarnitine (C8) levels, biallelic pathogenic variants, and severe impaired enzyme activity (<10% of the intra-assay control (IAC)); all of these cases received nutritional therapy and required carnitine supplementation during follow-up, representing the most severe form of the disease. The second group (16 patients) was a heterogeneous group presenting moderate increases in C8, biallelic likely pathogenic/pathogenic variants, and intermediate activity (<41% IAC). All of them are currently asymptomatic and could be considered as having a milder form of the disease. Finally, eight cases presented a normal–mild increase in plasma C8, with only one pathogenic variant detected, and high–intermediate residual activity (15–100%). Based on our results, we confirm that combined evaluation of acylcarnitine profiles, genetic findings, and residual enzyme activities proves useful in predicting the risk of future metabolic decompensation, in making decisions regarding future treatment or follow-up, and also in confirming the clinical effects of unknown clinical variants
Documento de consenso SENPE/SEGHNP/ANECIPN/SECP sobre vías de acceso en nutrición enteral pediátrica
Standardization of clinical procedures has become a
desirable objective in contemporary medical practice. To
this effect, the Spanish Society of Parenteral and Enteral
Nutrition (SENPE) has endeavoured to create clinical
practice guidelines and/or documents of consensus as well
as quality standards in artificial nutrition. As a result, the
SENPE’s Standardization Team has put together the
“Document of Consensus in Enteral Access for Paediatric
Nutritional Support” supported by the Spanish Society of
Pediatric Gastroenterology, Hepatology and Nutrition
(SEGHNP), the National Association of Pediatric and
Neonatal Intensive Care Nursery (ANECIPN), and the
Spanish Society of Pediatric Surgery (SECP). The present
publication is a reduced version of our work; the
complete document will be published as a monographic
issue. It analyzes enteral access options in the pediatric
patient, reviews the levels of evidence and provides the
team-members’ experience. Similarly, it details general
and specific indications for pediatric enteral support,
current techniques, care guidelines, methods of administration
and complications of each enteral access. The data
published by the American Society for Parenteral and
Enteral Nutrition (ASPEN) and several European Societies
has also been incorporatedLa estandarización de procedimientos clínicos se ha
convertido en un objetivo deseable en la práctica médica
actual. La Sociedad Española de Nutrición Parenteral y
Enteral (SENPE) está haciendo un considerable esfuerzo
para desarrollar guías clínicas y/o documentos de consenso
así como marcadores de calidad en nutrición artificial.
Como fruto de ese esfuerzo el Grupo de Estandarización
de SENPE ha elaborado un Documento de Consenso
sobre Vías de Acceso en Nutrición Enteral Pediátrica,
avalado también por la Sociedad Española de Gastroenterología,
Hepatología y Nutrición Pediátrica (SEGHNP),
la Asociación Nacional de Enfermería de Cuidados Inten-
sivos Pediátricos y Neonatales (ANECIPN) y la Sociedad
Española de Cirugía Pediátrica (SECP). Esta publicación
es una síntesis del documento consensuado que ha
incluido el estudio en profundidad del acceso enteral
pediátrico, la revisión de los niveles de evidencia y la experiencia
de los componentes del Grupo. Se han considerado
también los datos publicados por la American
Society for Parenteral and Enteral Nutrition (ASPEN) y
por diversas sociedades europeas. El texto completo se
publicará como un número monográfico. En este trabajo
se detallan las indicaciones generales y específicas de la
nutrición enteral pediátrica, las técnicas, los cuidados
generales y específicos, el modo de administración y las
complicaciones de las diversas vías de acces