EDITORIAL: The Metabolic Syndrome and Childhood Obesity: A Critical Public Health Issue

editorio

Malnutrition and medical nutrition therapy in hospitalized children: a case study of using national malnutrition screening tools in northeastern Iran

Background: Nationwide studies have focused only on prevalence of malnutrition in hospitalized children, while medical nu- trition therapies and assessing nutritional interventions is neglected.Methods: This research was conducted in tertiary level children hospitals in the NorthEastern region of Iran for 1 year from 2016 to 2017. Five questions were included in the initial assessment form and, if there was even one positive response, nutrition- al interventions were prescribed for the patients.Results: A total of 65 children aged ≥ 5 years and hospitalized for ≥ two days were included. 24.6% of patients had 2 >BMI Z-score>-2 at time of admission. At the beginning of the study, weight loss more than 10%, and appetite loss or decreased food intake was observed in 10.8% and 20% of the study population, respectively. Median BMI percentile of patients with nutritional intervention was 8.9 (0.1-98.7) at the beginning of the study and 12.7 (0.1-98.4) at discharge time which shows a significant difference (P=0.01).Conclusion: Medical nutrition therapy employed in this study prevented deterioration of nutritional status of children during hospitalization and was effective in stabilizing indices of nutritional status.Keywords: Body mass index, hospitalized children, malnutrition

Delay presentation of congenital diaphragmatic hernia with gastrointestinal manifestations: A case report

Congenital diaphragmatic hernia (CDH) is usually accompanied by pulmonary hypoplasia, pulmonary hypertension, and other associated anomalies which result in high mortality rates in these cases. This condition occurs when there is a defect in the diaphragm (mostly to the left and posterolateral) from which herniation of the abdominal contents into the thorax can take place. Morgagni hernia is a less common CDH (only 5-10% of CDH cases), in which congenital herniation of the abdominal content through the triangular parasternal gaps of the anterior diaphragm happen. Morgagni hernia usually affects the right side, and the patients are usually asymptomatic. Herein, we present the case of a 15-month-old male infant with large Morgagni hernia resulting in poor weight gain. The presentation was unique due to its huge orifice, its gastrointestinal obstruction presentation and also its unremarkable radiologic findings. The patient was monitored by the follow up team for 12 months. The follow-up revealed no recurrence, and the patient had favorable weight gain without any gastrointestinal symptoms

Assessment of Nutritional Status Based on STRONGkids Tool in Iranian Hospitalized Children

Background & Objective: Malnutrition is very common in hospitalized children and is associated with related clinical consequences such as increased risk of infections, increased muscle loss, impaired wound healing, longer hospital stay and higher morbidity and mortality. The estimated prevalence of acute malnutrition in hospitalized children varies from 6.1 to 40.9% in different countries. The current study was conducted with the aim of evaluating the efficiency of STRONGkids (Screening Tool for Risk On Nutritional Status and Growth) tool for assessing malnutrition in hospitalized children in Iran. Methods: All children older than 28 days admitted to the pediatric hospital (Dr. Sheikh, Mashhad, Iran) were enrolled in this study and the screening tool named STRONGkids was applied for them. The anthropometric measurements were measured by a trained operator using standard methods and equipments. The children were classified in three groups of being at high risk, moderate risk and low risk of malnutrition. Results: According to STRONGkids score; 17% of children were classified as low risk, 75% as moderate risk and 8% as high risk group. According to WFH, HFA and WFA z-scores31.4%, 19.2% and 28% of children were identified as moderately and severely malnourished respectively. According to MUAC cut-offs, 3.4% of children were classified as having moderate malnutrition and there was no child with severe malnutrition. Conclusion: It is very important to recognize the nutritional status of the children as early as possible because of its effects on children’s growth. Therefore, evaluating the nutritional status of the hospitalized children is an essential step in clinical assessment. We suggest to apply the STRONGkids score aside with other clinical and anthropometric data

Effects of Probiotic Cells on the Mechanical and Antibacterial Properties of Sodium-Caseinate Films

Background and Objective: Food processing conditions such as heat, mechanical or osmotic stress can lead to considerable losses of probiotics’ survival in food. Recently, the addition of probiotics into edible films has been proposed as an emerging technology for the delivery of probiotic cells. In this study, Lactobacillus acidophilus and Lactobacillus casei cells were incorporated into sodium caseinate matrix to develop a probiotic-based film which can improve food safety.Material and Methods: Probiotic cells were separately added to the film forming solutions and the active films were prepared by casting method. The physical, optical and mechanical characteristics of the films were examined. Color properties were determined using a colorimeter and the mechanical properties of the films were evaluated by an Instron Universal Testing Machine. The viability of Lactobacillus acidophilus and Lactobacillus casei in the films was determined during a period of 12 days. The antibacterial activities of the films were also tested against Listeria monocytogenes on Trypticase Soy Agar medium at 4°C.Results and Conclusion: Results demonstrated that lactic acid bacteria cells remained viable during a storage period of 12 days (> 4 Log CFU cm-2). The incorporation of lactic acid bacteria cells into the film polymer had no significant effect on tensile strength (p>0.05) whereas it significantly improves the appearance of films. Indeed, samples covered with the lactic acid bacteria film displayed higher anti-listerial activity than the control group on day 6 of preservation (p≤0.05). These findings show that the sodium caseinate film containing lactic acid bacteria cells can be used as a new effective packaging method for improving food safety

Malnutrition and medical nutrition therapy in hospitalized children: a case study of using national malnutrition screening tools in northeastern Iran

Background: Nationwide studies have focused only on prevalence of malnutrition in hospitalized children, while medical nutrition therapies and assessing nutritional interventions is neglected. Methods: This research was conducted in tertiary level children hospitals in the NorthEastern region of Iran for 1 year from 2016 to 2017. Five questions were included in the initial assessment form and, if there was even one positive response, nutritional interventions were prescribed for the patients. Results: A total of 65 children aged 65 5 years and hospitalized for 65 two days were included. 24.6% of patients had 2 >BMI Z-score>-2 at time of admission. At the beginning of the study, weight loss more than 10%, and appetite loss or decreased food intake was observed in 10.8% and 20% of the study population, respectively. Median BMI percentile of patients with nutritional intervention was 8.9 (0.1-98.7) at the beginning of the study and 12.7 (0.1-98.4) at discharge time which shows a significant difference (P=0.01). Conclusion: Medical nutrition therapy employed in this study prevented deterioration of nutritional status of children during hospitalization and was effective in stabilizing indices of nutritional status. DOI: https://dx.doi.org/10.4314/ahs.v19i1.31 Cite as: Malek A, Hashemi M, Anjomrooz M, Torabi P, B I. Malnutrition and medical nutrition therapy in hospitalized children: a case study of using national malnutrition screening tools in northeastern Iran. Afri Health Sci. 2019;19(1). 1566-1573. https://dx.doi.org/10.4314/ahs. v19i1.3

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe