Prevalence of malnutrition and vitamin A deficiency in Nigerian preschool children subsisting on high intakes of carotenes

The prevalence of malnutrition and vitamin A deficiency was determined in 204 preschool children of both sexes aged 3–57 months. The children were recruited from 2 rural communities of Atakumosa Local Government Area of Osun State in South West Nigeria. Dietary vitamin A intake was estimated from frequency of consumption of locally available vitamin A containing food items. Vitamin A status of the children was assessed from concentration of retinol in plasma. Nutritional status was assessed from height and weight compared with international reference standards. The results indicate widespread malnutrition among the children. The prevalence of stunting (low height for age) was 60.8% while prevalence of wasting (low weight for height) was 7.4% and of underweight (low weight for age) 27.5%. Dietary vitamin A intake appeared to be adequate in the children. Intake of vitamin A is predominantly from plant sources. At least 43% of the children consumed the carotene rich red palm oil 6 or more times per week in contrast to less than 1% who consumed eggs or milk for 6 or more times per week. Vitamin A deficiency was low in the children. Only 11.3% of the children had plasma retinol concentration <0.70µmol/L. The results indicate that childhood malnutrition of public health magnitude can coexist with adequate dietary vitamin A intakes or vitamin A status

Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery

Background Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies.Methods The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study ('IMAGINE') of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study ('Tayside') in major abdominal surgery (2011-2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI.Results In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655-0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323-0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881-0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899).Conclusion The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity.Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK).Nephrolog