Robyn Littlewood

Resting energy expenditure and body composition in children with myelomeningocele

Purpose : Myelomeningocele is a complex disease often complicated by obesity for reasons not well understood. The objectives of this study were to determine body composition and energy expenditure of children with MMC. Methods : Resting energy expenditure (REE), body composition and anthropometry were measured in 19 children with MMC (12 M, 7 F). Total energy expenditure (TEE) was estimated using a 3-day activity record. Energy intake (EI) was measured in seven children (5 M, 2 F) with MMC. Data were then compared with predicted values. Results : Mean REE ( n = 19) was 4680 - 1452 kJ/day (96.1 - 18.1% of predicted REE). The range was large (45.8-125.7% of predicted REE). TEE ( n = 7) was 4344 - 2376 kJ/day, hence only 73 34% of predicted TEE. EI ( n = 7) was 6560 - 1329 kJ/day, approximating a normal energy requirement. Overall, BCM was lower than expected values. Conclusions : REE in children with MMC is variable when compared to predicted values. TEE was found to be lower in children with MMC than predicted values and EI was similar to predicted values in this group of seven children. BCM is reduced in children with MMC when compared to expected values.

Simple Nutrition Screening Tool for Pediatric Inpatients

BACKGROUND Pediatric nutrition risk screening tools are not routinely implemented throughout many hospitals, despite prevalence studies demonstrating malnutrition is common in hospitalized children. Existing tools lack the simplicity of those used to assess nutrition risk in the adult population. This study reports the accuracy of a new, quick, and simple pediatric nutrition screening tool (PNST) designed to be used for pediatric inpatients. MATERIALS AND METHODS The pediatric Subjective Global Nutrition Assessment (SGNA) and anthropometric measures were used to develop and assess the validity of 4 simple nutrition screening questions comprising the PNST. Participants were pediatric inpatients in 2 tertiary pediatric hospitals and 1 regional hospital. RESULTS Two affirmative answers to the PNST questions were found to maximize the specificity and sensitivity to the pediatric SGNA and body mass index (BMI) z scores for malnutrition in 295 patients. The PNST identified 37.6% of patients as being at nutrition risk, whereas the pediatric SGNA identified 34.2%. The sensitivity and specificity of the PNST compared with the pediatric SGNA were 77.8% and 82.1%, respectively. The sensitivity of the PNST at detecting patients with a BMI z score of less than -2 was 89.3%, and the specificity was 66.2%. Both the PNST and pediatric SGNA were relatively poor at detecting patients who were stunted or overweight, with the sensitivity and specificity being less than 69%. CONCLUSION The PNST provides a sensitive, valid, and simpler alternative to existing pediatric nutrition screening tools such as Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Screening Tool Risk on Nutritional status and Growth (STRONGkids), and Paediatric Yorkhill Malnutrition Score (PYMS) to ensure the early detection of hospitalized children at nutrition risk.

Physical activity cost in children following an acquired brain injury: a comparative study

BACKGROUND Alterations in energy expenditure during activity post head injury has not been investigated due primarily to the difficulty of measurement. OBJECTIVE The aim of this study was to compare energy expenditure during activity and body composition of children following acquired brain injury (ABI) with data from a group of normal controls. DESIGN Energy expenditure was measured using the Cosmed K4b(2) in a group of 15 children with ABI and a group of 67 normal children during rest and when walking and running. Mean number of steps taken per 3 min run was also recorded and body composition was measured. RESULTS The energy expended during walking was not significantly different between both groups. A significant difference was found between the two groups in the energy expended during running and also for the number of steps taken as children with ABI took significantly less steps than the normal controls during a 3 min run. CONCLUSIONS Children with ABI exert more energy per activity than healthy controls when controlled for velocity or distance. However, they expend less energy to walk and run when they are free to choose their own desirable, comfortable pace than normal controls.

Prevalence of malnutrition, obesity and nutritional risk of Australian paediatric inpatients: A national one-day snapshot

Low prevalence rates of malnutrition at 2.5% to 4% have previously been reported in two tertiary paediatric Australian hospitals. The current study is the first to measure the prevalence of malnutrition, obesity and nutritional risk of paediatric inpatients in multiple hospitals throughout Australia.

Reduced body cell mass following severe head injury in children: implications for rehabilitation

STATEMENT OF PURPOSE Increased proteolysis, muscle catabolism and altered body composition have been well documented after severe head injury, but the extent of these effects in children, and whether they extend into rehabilitation, have not been studied. This study determined nutritional status and body composition, with particular reference to the body cell mass (BCM), of head injured children at entry into a rehabilitation programme, and compared body composition analysis with anthropometric nutritional assessment. METHODS Nineteen head injured children (nine males, 10 females, mean age 9.1 +/- 4.3 years range 1.2-15.1 years) were measured for height, weight and total body potassium (TBK, a measure of body cell mass) on referral to rehabilitation after the acute phase (mean 38.1 days post-injury). Data was compared with expected normative data derived from healthy age and gender matched children. Nutritional status was determined by two separate criteria based on either anthropometric or body composition methods. RESULTS The mean percentage of expected TBK for height was 84.4 +/- 15%, significantly below the clinically acceptable level for body cell mass (90% of expected). Using the anthropometric definition, only 1/19 was undernourished, whereas 12/19 had poor nutritional status using body composition (chi 2 = 7.58, p = 0.006). CONCLUSIONS The data revealed a significant depletion in the metabolically active BCM in the presence of normal anthropometry, suggestive of significant muscle wasting. These findings have important pathophysiological and clinical implications in the rehabilitation of children following major head trauma.

The Need for Early Referral: Characteristics of Children and Adolescents Who Are Overweight and Obese Attending a Multidisciplinary Weight Management Service

There is a need to examine the issue of childhood obesity from a systems perspective. This study aimed to describe the baseline characteristics of children attending pediatric multidisciplinary weight management services and understand how this information will inform future service delivery. A total of 51 children and adolescents who were overweight and obese (27 male) and aged between two and 16 years participated. Body size measures such as body mass index (BMI) and body fat percentage were collected. Participants and their parents/guardians also completed questionnaires on dietary intake, behaviors and habits, physical activity and health-related quality of life. A total of 72% of participants were classified as morbidly obese. Adolescents had significantly lower scores for overall diet, physical activity and particular health-related quality of life scores. No significant correlations were found between BMI z-scores and diet, physical activity and health-related quality of life. In adolescents, correlations were detected between dietary scores and health-related quality of life. Results confirm the need to critically examine the current context to adapt and tailor interventions to individual circumstances, and when combined with focused referral, triaging and screening processes, should assist in delivering the right care at the right time.

Resting energy expenditure of children attending a rehabilitation programme following head injury

STATEMENT OF PURPOSE Increased resting energy expenditure following head injury is well documented, but whether this increase extends into rehabilitation and whether this is affected by changes in body composition have not been studied. The aim of this study was to determine whether children attending a rehabilitation program following head injury had altered energy expenditure and body composition. METHODS Measurements of resting energy expenditure by indirect calorimetry were performed in 21 head injured children (mean age 10.2 +/- 3.8 years). Measurement of body composition was performed using total body potassium. RESULTS Measured resting energy expenditure values were widely distributed, ranging from 52.3-156.4% of predicted values, yet the mean percentage predicted using Schofield weight, Schofield weight and height and World Health Organization predictive equations were 97.5%, 97.4% and 98.6%, respectively. Mean percentage of expected total body potassium for weight, height and age for head injured children were 85.1 +/- 15.5%, 89.1 +/- 14.1% and 86.9 +/- 15.9%, thus all showed significant depletion. CONCLUSIONS During rehabilitation, using predictive equations to estimate resting energy expenditure in this group revealed a small bias on average but very large bias at the individual level. Head injured children had altered resting energy expenditure and body composition.Statement of purpose: Increased resting energy expenditure following head injury is well documented, but whether this increase extends into rehabilitation and whether this is affected by changes in body composition have not been studied. The aim of this study was to determine whether children attending a rehabilitation program following head injury had altered energy expenditure and body composition. Methods

Measured Resting Energy Expenditure in Children With Myelomeningocele

Abstract Children with MMC have altered body composition characterized by reduced body cell mass and increased body fat. It has been hypothesized that low REE values in these children contribute to obesity in this condition. The purpose of this study was to determine whether children with MMC have low REE compared with predicted values for weight, gender and metabolically active body cell mass (BCM). REE was measured by indirect calorimetry in 18 children with MMC (12 males and 6 females, mean age 8.5±4 y, weight 32.2±19.7kg, Z-score weight for age from −2.9 to 5.5) and body composition was measured by anthropometry and total body potassium (TBK). Mean measured REE was 1095±342 kcal/day, 40±15 kcal/kg/day and 32±12 kcal/g K/day). Significant correlations were found between measured REE and weight (r=0.86, pO.OOOl) and REE and TBK (i-0.77, pO.OOl). Measured REE values varied widely ranging from 46% to 125% (group mean 96±19%) of predicted values by using Schofield (weight only) predictive equations. The mean difference between measured REE values and predicted value by Schofield equations was -60±194 kcal/day with the limits of agreement from -448 to 328 kcal/day. The mean difference between measured REE values and predicted values by the World Health Organization equations was -70±214 kcal/day with the limits of agreement from -502 to 354 kcal/day. These large limits of agreement indicate that the predictive equations cannot reliably estimate REE in children with MMC. The results of this study do not support the hypothesis that this group of children has significantly lower REE. However, the wide range of REE observed suggests the low level in some individuals possibly relates to the level of spinal lesion. In order to prevent obesity in these children, total energy expenditure, REE, and physical activity as well as energy intake should be considered in their nutritional management.