Rocío Macías-Rosales

Acute and recurrent pancreatitis in children: etiological factors

Objectives: To describe the clinical picture and outcome, and to assess the etiological factors of acute and recurrent pancreatitis in children.

Liver function test results predict nutritional status evaluated by arm anthropometric indicators.

Objectives: To compare the anthropometric indicators based on weight and height with the anthropometric indicators based on arm measurements and to predict the anthropometric nutritional status with liver function tests (LFTs) in children with chronic liver disease (CLD). Patients and Methods: A cross-sectional study in a referral pediatric hospital enrolled 79 children with CLD (mean age 72.6 ± 61.8 months, 54% female). An independent variable of LFT was used to determine the outcome variable of nutritional status. Anthropometric indicators of height versus age, weight versus height, head circumference versus age, and arm indicators versus age were analyzed with Pearson correlation, the determination coefficient r2, and multiple regression. Results: A total of 44.3% of patients studied had growth impairment. The anthropomorphic indicator of weight for height identified malnutrition in 11.4%, compared with 43% identified by mid- to upper arm circumference (MUAC) and 40.5% identified with total arm area. MUAC (P < 0.001), total arm circumference (P < 0.001), arm muscle area (P = 0.009), and arm fat area (P = 0.023) identified more cases of z score less than −2 SD than weight/height. The presence of ascites misled weight-for-height measurements. Conjugated bilirubin and albumin had significant correlations with almost all of the anthropometric indicators. Alkaline phosphatase correlated significantly with all of the arm anthropometric indicators. A regression analysis led to 7 prediction models; the highest prediction of z score less than −2 SD was with triceps skinfold and conjugated bilirubin, albumin, and γ-glutamyltransferase; height-for-age z score less than −2 SD was predicted by measurements of conjugated bilirubin, prothrombin time, and alanine aminotransferase. Conclusions: The data presented underline the correlation between the liver damage severity evaluated by LFT and the nutritional status estimated by anthropometric indicators. In our view these observations reflect the close relationship between liver function and the degree of liver damage to growth and current nutritional status.

Socio-demographic factors associated with caustic substance ingestion in children and adolescents.

OBJECTIVE Caustic substance ingestion is a public health issue in some underdeveloped countries. Published information on socio-demographic factors related to this problem is scarce. The aim of this study was to evaluate the association of socio-demographic factors with caustic ingestion in children. METHODS DESIGN case-control study. Cases were children with caustic substance ingestion who were attended to during 2006 (n=94) at a pediatric referral hospital in Guadalajara, Mexico; the controls were a random sample of children who were hospitalized or seen as outpatients in the same pediatric referral hospital (n=641). The socio-demographic variables were studied using a validated questionnaire (Children Nutrition Organization Survey). STATISTICS OR, 95% CI and logistic regression. RESULTS Mean age of the cases was 3.2 years (SD 2.4) and 37.2% of cases were girls. Caustic ingestion occurred at home in 63.8% of cases and at a relatives home in 23.4% of cases. Alkaline products were ingested by 85.1%; containers had no warning labels in 72.3% of cases and no childproof safety caps in 92.6% of cases. The socio-demographic variables associated with caustic ingestion included higher family income, lower educational level of the mother, higher proportion of fathers working as independent professionals, extended family, mothers age <30 years, and mother working outside the home. CONCLUSIONS The observed family risk profile for caustic ingestion was higher family income, young working mother with low educational level, father working as independent professional, and extended family.

Secondary malnutrition and overweight in a pediatric referral hospital: associated factors.

Objectives: To establish the prevalence and identify the clinical and sociodemographic factors associated with malnutrition and overweight in a pediatric referral hospital. Patients and Methods: We studied a cross-sectional, random sample from a pediatric hospital. Malnutrition was defined as acute when the z score of weight/height was less than −2.0 and as chronic if in addition the height/age z score was less than −2.0. Overweight risk was defined as a body mass index percentile between 85 and 94, and overweight as a body mass index percentile of 95 or higher. Results: The study included 641 patients, with mean age 7.1 ± 4.9 years (56% male). The overall prevalence of acute malnutrition was 8% and chronic malnutrition 17.0%. Overweight risk was present in 15.4% and overweight in 12.2%. Acute malnutrition was predicted by conditions on admission (hospitalization: odds ratio [OR] 2.3, confidence interval [CI] 1.3–4.3; nonsurgical subspecialty: OR 2.1, CI 1.0–4.3) and number of siblings (1 child, single mother: OR 2.6, CI 1.3–5.0). Chronic malnutrition was predicted by age (infants vs preschoolers: OR 2.0, CI 1.1–3.6; infants vs school children: OR 3.1, CI 1.8–5.5) and illness duration (>30 days: OR 2, CI 1.1–3.7). Overweight risk was associated with age (>36 months: OR 2.0, CI 1.6–3.4) and the fathers educational level (college and university: OR 2.3, CI 1.3–4.3). Overweight was predicted by sex (boys: OR 2.0, CI 1.0–3.6) and age (>36 months: OR 1.7, CI 1.0–2.8). Conclusions: Overweight was as prevalent as malnutrition. Malnutrition was associated with clinical condition, age, family size, and illness duration, whereas overweight was related to age, sex, and fathers education. Overweight appears as a novel finding in the nutritional profile of pediatric referral hospitals in Mexico.

Seasonal variation of enteropathogens in infants and preschoolers with acute diarrhea in western Mexico.

The present study estimates the prevalence of some enteropathogens in infants and preschoolers with acute diarrhea. From 2006 to 2007, 5459 consecutive stool samples were evaluated. Cryptosporidium parvum was the parasite identified with the higher frequency (5.1%), followed by Giardia lamblia (1.2%). Campylobacter jejuni was isolated in 858 cases (15.7%) and was the most frequent enteropathogen overall. The rates of C parvum, Shigella, and Salmonella were higher in the summer. Rotavirus had the expected winter peak and it was the third enteropathogen because of its frequency. Overall frequency of stool-reducing substances was 15.6% and was associated with a rotavirus-positive test.

Effectiveness of Enteral Versus Oral Nutrition With a Medium-Chain Triglyceride Formula to Prevent Malnutrition and Growth Impairment in Infants With Biliary Atresia

Objectives: The aim of this study was to compare the effectiveness of oral (PO) versus enteral nutrition (EN) medium-chain triglyceride (MCT) containing–formula to prevent malnutrition and growth impairment in infants with biliary atresia (BA) waiting for a liver transplant. Methods: A total of 15 infants, 3 to 9 months old with BA were included. They were randomly assigned to either PO or EN. For 12 weeks, both groups received an MCT formula fortified with glucose polymers and corn oil to reach a caloric density between 0.8 and 1 kcal/mL. The formula given to the PO group was administered ad libitum and that given via EN was infused through a nasogastric tube to reach 140% of the energy intake recommended by the Dietary Recommended Intake guidelines. Protein intake was adjusted to 4 to 5 g/kg present weight. Outcome variables were growth and nutritional status evaluated periodically by anthropometric indicators. Biochemical and hematological variables were evaluated through the study. Results: Baseline clinical, nutritional, biochemical, and hematological variables showed no differences between the study groups. Baseline length/age was <−2 SD in 10 of the 15 patients; in the PO group, it fell <−3 SD, whereas in the EN group, it remained stable. Head circumference z score dropped 0.6 SD in the PO group, whereas in the EN group it remained stable. Triceps skinfold values improved in the infants taking EN, P < 0.001. The frequency of adverse effects—respiratory infection and diarrhea—was higher in the EN group. No biochemical or hematological differences were observed between the study groups throughout the study. Conclusions: A 12-week EN trial with an MCT-fortified formula prevented malnutrition and growth impairment in infants with BA waiting for a liver transplant.

Liver Damage Severity Evaluated by Liver Function Tests and the Nutritional Status Estimated by Anthropometric Indicators

Pediatric patients with chronic liver disease (CLD) may present impaired growth and acute malnutrition. In most pediatric series the prevalence of these nutritional-related conditions is high. Secondary malnutrition mechanisms include low caloric intake, malabsorption of lipids and fat soluble vitamins and increased energy expenditure. In children younger than 5 years, the degree of liver damage is closely related to growth impairment and their current nutritional status; both may be predicted by liver function tests such as direct bilirubin, albumin and gamma-glutamyl transpeptidase. Anthropometry has been widely used to evaluate the nutritional status of children with CLD. In infants and toddlers, growth can be properly assessed by measuring head circumference and length; in older children growth may be evaluated by height. When ascitis and/or hepatosplenomegaly are present, weight for height might underestimate the current nutritional status. Arm anthropometrics could become an alternative tool in identifying malnutrition since it estimates muscle mass or fat stores; recent observations of DXA in infants with CLD have shown a good correlation between body compartments and arm anthropometric indicators. In addition to its prognostic value, the crucial reason for anthropometrically evaluating a patient with CLD is to recommend nutritional intervention which will improve growth and current nutritional status or at least avoid its deterioration.