Research Article
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Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition

Year 2020, Volume: 4 Issue: 9, 826 - 829, 01.09.2020
https://doi.org/10.28982/josam.790445

Abstract

Aim: Malnutrition is a serious and frequently encountered condition affecting more than 900 million individuals worldwide. Its relationship with negative clinical outcome, bad prognosis and susceptibility to diseases has been demonstrated in numerous studies alongside with the importance of early nutritional intervention. The aim of this study was to define the beneficial influence of a hypercaloric enteral supplement on body mass index (BMI) z-score as well as ferritin, vitamin B12 and vitamin D micronutrients.
Methods: This study is a retrospective observational study. Records of patients who were diagnosed with malnutrition via a physician by having height and weight scores below -2 standard deviation were collected from Gaziosmanpaşa Training and Resource Hospital, Istanbul, Turkey. A comparative statistical analysis was performed on 205 pediatric malnutrition patients (ages 1 to 16) by gathering their BMI, ferritin, b12 and vitamin D at baseline with their measurements at 2 follow-up visits after the administration of hypercaloric (1.5kcal/mL) enteral supplement over 6 months.
Results: There was a significant inverse correlation between BMI z-scores and the duration of enteral supplement administration, reflected by a 33.2% reduction of the mean BMI z-scores from -2.11 to -0.7 over 6 months (Z=-12.4, P<0.001). Additionally, there was a reduction in the number of patients with excessive or insufficient amounts of ferritin, b12 and vitamin D concentrations with 80%, 41.7% and 39.3% respectively over six months.
Conclusions: Hypercaloric enteral supplementation is a short-acting and highly beneficial nutritional intervention in pediatric patients diagnosed with malnutrition, which provides a robust improvement in the BMI z-scores as well as a 2-tailed improvement of aforementioned micronutrients after six months of supplementation.

References

  • 1. Martins VJB, Toledo Florêncio TMM, Grillo LP, do Carmo P Franco M, Martins PA, Clemente APG, et al. Long-lasting effects of undernutrition. Int J Environ Res Public Health. 2011;8(6):1817-46. Epub 05/26. doi: 10.3390/ijerph8061817. PubMed PMID: 21776204.
  • 2. Kim DH. Nutritional issues in patients with cancer. Intestinal research. 2019;17(4):455-62. Epub 10/14. doi: 10.5217/ir.2019.00076. PubMed PMID: 31597414.
  • 3. Schaible UE, Kaufmann SH. Malnutrition and infection: complex mechanisms and global impacts. PLoS medicine. 2007;4(5):e115. Epub 2007/05/03. doi: 10.1371/journal.pmed.0040115. PubMed PMID: 17472433; PubMed Central PMCID: PMCPmc1858706.
  • 4. Amoroso L. The Second International Conference on Nutrition: Implications for Hidden Hunger. World Rev Nutr Diet. 2016;115:142-52. Epub 2016/05/21. doi: 10.1159/000442100. PubMed PMID: 27197665.
  • 5. Fakhoury M, Negrulj R, Mooranian A, Al-Salami H. Inflammatory bowel disease: clinical aspects and treatments. J Inflamm Res. 2014;7:113-20. doi: 10.2147/JIR.S65979. PubMed PMID: 25075198.
  • 6. Kotlyar DS, Shum M, Hsieh J, Blonski W, Greenwald DA. Non-pulmonary allergic diseases and inflammatory bowel disease: a qualitative review. World J Gastroenterol. 2014;20(32):11023-32. doi: 10.3748/wjg.v20.i32.11023. PubMed PMID: 25170192.
  • 7. Ludvigsson JF, Ludvigsson J, Ekbom A, Montgomery SM. Celiac Disease and Risk of Subsequent Type 1 Diabetes. A general population cohort study of children and adolescents. 2006;29(11):2483-8. doi: 10.2337/dc06-0794.
  • 8. Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990;44(1):45-60. Epub 1990/01/01. PubMed PMID: 2354692.
  • 9. Statistics NCfH. Percentile Data Files with LMS Values August 4, 2009 [cited 2019 July 3]. Available from: https://www.cdc.gov/growthcharts/percentile_data_files.htm.
  • 10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. Bmj. 2000;320(7244):1240-3. doi: 10.1136/bmj.320.7244.1240. PubMed PMID: 10797032.
  • 11. Barr RD, Gomez-Almaguer D, Jaime-Perez JC, Ruiz-Argüelles GJ. Importance of Nutrition in the Treatment of Leukemia in Children and Adolescents. Arch Med Res. 2016;47(8):585-92. doi: 10.1016/j.arcmed.2016.11.013. PubMed PMID: 28476186.
  • 12. Mathers CD, Lopez AD, Murray CJL. The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global Burden of Disease and Risk Factors. Washington (DC): World Bank, The International Bank for Reconstruction and Development/The World Bank Group.; 2006.
  • 13. Bundy DAP, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT. Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition. Lancet (London, England). 2018;391(10121):687-99. Epub 2017/11/21. doi: 10.1016/s0140-6736(17)32417-0. PubMed PMID: 29153316.
  • 14. Bauer J, Jürgens H, Frühwald MC. Important aspects of nutrition in children with cancer. Adv Nutr. 2011;2(2):67-77. Epub 03/10. doi: 10.3945/an.110.000141. PubMed PMID: 22332035.
  • 15. van Eys J. Effect of nutritional status on responses to therapy. Cancer Res. 1982;42(2 Suppl):747s-53s. Epub 1982/01/01. PubMed PMID: 6799193.
  • 16. Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition—A dynamic triangle in review. Cancer. 2004;100(4):677-87. doi: 10.1002/cncr.11833.
  • 17. Dhanapal R, Saraswathi T, Govind RN. Cancer cachexia. J Oral Maxillofac Pathol. 2011;15(3):257-60. doi: 10.4103/0973-029X.86670. PubMed PMID: 22144825.
  • 18. Nursing RCo, Fellow FGRCN. Nutrition in Children and Young People with Cancer: RCN Guidance: RCN; 2014.
  • 19. Schoeman J, Dannhauser A, Kruger M. Malnutrition in paediatric oncology patients2010.
  • 20. Nieuwoudt CH. Nutrition and the child with cancer: Where do we stand and where do we need to go? South Afr J Clin Nutr. 2011;24. doi: 10.1080/16070658.2011.11734376.
  • 21. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972;25(6):329-43. Epub 1972/07/01. PubMed PMID: 4650929.
  • 22. Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Crit Rev Oncol/Hematol. 2012;83(2):249-75. Epub 2012/01/24. doi: 10.1016/j.critrevonc.2011.12.003. PubMed PMID: 22264939.
  • 23. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization technical report series. 1995;854:1-452. Epub 1995/01/01. PubMed PMID: 8594834.
  • 24. Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol. 2010;115(5):982-8. doi: 10.1097/AOG.0b013e3181da9423. PubMed PMID: 20410772.
  • 25. Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today. 2015;50(3):117-28. Epub 04/07. doi: 10.1097/NT.0000000000000092. PubMed PMID: 27340299.
  • 26. Krishnan AV, Trump DL, Johnson CS, Feldman D. The role of vitamin D in cancer prevention and treatment. Endocrinol Metab Clin North Am. 2010;39(2):401-18, table of contents. Epub 2010/06/01. doi: 10.1016/j.ecl.2010.02.011. PubMed PMID: 20511060; PubMed Central PMCID: PMCPmc5788175.
  • 27. Fleet JC. Molecular actions of vitamin D contributing to cancer prevention. Mol Aspects Med. 2008;29(6):388-96. Epub 2008/08/30. doi: 10.1016/j.mam.2008.07.003. PubMed PMID: 18755215; PubMed Central PMCID: PMCPmc2613446.
  • 28. Kong J, Li YC. Molecular mechanism of 1,25-dihydroxyvitamin D3 inhibition of adipogenesis in 3T3-L1 cells. Am J Physiol Endocrinol Metabol. 2006;290(5):E916-24. Epub 2005/12/22. doi: 10.1152/ajpendo.00410.2005. PubMed PMID: 16368784.
  • 29. Arshad M, Rezvandoost N, Pazouki A, Riazi S, Aghababa Rangraz M, Mokhber S. Assessment of the Serum Levels of Hemoglobin, Ferritin, and Vitamin B12 in a Sample of Iranian Population with Morbid Obesity. J Minim Invasive Surg Sci. 2016;Inpress. doi: 10.17795/minsurgery-37637.
  • 30. Baltaci D, Kutlucan A, Turker Y, Yilmaz A, Karacam S, Deler H, et al. Association of vitamin B12 with obesity, overweight, insulin resistance and metabolic syndrome, and body fat composition; primary care-based study. Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina. 2013;10(2):203-10. Epub 2013/07/31. PubMed PMID: 23892832.

Malnutrisyonlu çocuklarda enteral beslemeye dayalı vücut kitle indeksi'nin kademeli iyileştirilmesi ve mikrobesinlerin normalleşmesi

Year 2020, Volume: 4 Issue: 9, 826 - 829, 01.09.2020
https://doi.org/10.28982/josam.790445

Abstract

Amaç: Malnutrisyon, dünya çapında 900 milyondan fazla insanı etkileyen ciddi ve sık karşılaşılan bir durumdur. Malnutrisyon; olumsuz klinik sonuç, kötü prognoz ve hastalıklara yatkınlık ile yakından ilişkilidir, bu yüzden erken müdahalenin öneminin altını çizen çok sayıda çalışma yapılmıştır. Bu çalışmanın amacı, hiperkalorik enteral beslenme tedavisinin vücut kitle indeksi (VKİ) z-skorunun yanı sıra ferritin, B12 vitamini ve D vitamini mikro-besinlerinin üzerindeki yararlı etkilerini tanımlamaktır.
Yöntemler: Bu çalışma geriye dönük gözlemsel bir çalışmadır. Doktor tarafından boy ve kilo ölçümleri -2 standart deviasyonun altında olarak malnütrisyon tanısı almış hastaların kayıtları, Türkiye’nin İstanbul ilinde bulunan Gaziosmanpaşa Eğitim ve Araştırma Hastanesinden toplanmıştır. Toplamda 205 pediatrik malnutrisyon hastasının (1-16 yaş) ilk ziyaretine ait VKİ, ferritin, B12 vitamini ve D vitamini kayıtları, hiperkalorik (1,5 kcal/mL) müdahaleye başlandıktan 6 ay sonrasına kadar yapılan 2 vizite ölçümleri ile karşılaştırılarak istatistiksel olarak analiz edilmiştir.
Bulgular: VKİ z-skorları ile enteral beslenme tedavisi uygulama süresi arasında görsel ve istatistiksel olarak ek hastalık durumları farketmeksizin anlamlı bir ters korelasyon görülmüştür (Z=-12,4, P<0,001). Ortalama VKİ z-skoru %33,2'lik bir düzelme ile 6 aylık müdahale sonrası -2,11’den -0,7’ye yükselmiştir. Ek olarak, altı ay boyunca ferritin, B12 vitamini ve D vitamini konsantrasyonları gereğinden fazla veya yetersiz olan hasta sayısında sırasıyla %80, %41,7 ve %39,3 oranında azalma görülmüştür.
Sonuçlar: Hiperkalorik beslenme tedavisi, malnutrisyon teşhisi konan pediyatrik hastalarda hızlı, etkili ve oldukça faydalı bir beslenme müdahalesi olup, altı aylık takviye sonrası BMI z-skorlarında anlamlı düzelme ve yukarıda bahsedilen mikro besinlerde 2-taraflı iyileşme sağlamıştır.

References

  • 1. Martins VJB, Toledo Florêncio TMM, Grillo LP, do Carmo P Franco M, Martins PA, Clemente APG, et al. Long-lasting effects of undernutrition. Int J Environ Res Public Health. 2011;8(6):1817-46. Epub 05/26. doi: 10.3390/ijerph8061817. PubMed PMID: 21776204.
  • 2. Kim DH. Nutritional issues in patients with cancer. Intestinal research. 2019;17(4):455-62. Epub 10/14. doi: 10.5217/ir.2019.00076. PubMed PMID: 31597414.
  • 3. Schaible UE, Kaufmann SH. Malnutrition and infection: complex mechanisms and global impacts. PLoS medicine. 2007;4(5):e115. Epub 2007/05/03. doi: 10.1371/journal.pmed.0040115. PubMed PMID: 17472433; PubMed Central PMCID: PMCPmc1858706.
  • 4. Amoroso L. The Second International Conference on Nutrition: Implications for Hidden Hunger. World Rev Nutr Diet. 2016;115:142-52. Epub 2016/05/21. doi: 10.1159/000442100. PubMed PMID: 27197665.
  • 5. Fakhoury M, Negrulj R, Mooranian A, Al-Salami H. Inflammatory bowel disease: clinical aspects and treatments. J Inflamm Res. 2014;7:113-20. doi: 10.2147/JIR.S65979. PubMed PMID: 25075198.
  • 6. Kotlyar DS, Shum M, Hsieh J, Blonski W, Greenwald DA. Non-pulmonary allergic diseases and inflammatory bowel disease: a qualitative review. World J Gastroenterol. 2014;20(32):11023-32. doi: 10.3748/wjg.v20.i32.11023. PubMed PMID: 25170192.
  • 7. Ludvigsson JF, Ludvigsson J, Ekbom A, Montgomery SM. Celiac Disease and Risk of Subsequent Type 1 Diabetes. A general population cohort study of children and adolescents. 2006;29(11):2483-8. doi: 10.2337/dc06-0794.
  • 8. Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990;44(1):45-60. Epub 1990/01/01. PubMed PMID: 2354692.
  • 9. Statistics NCfH. Percentile Data Files with LMS Values August 4, 2009 [cited 2019 July 3]. Available from: https://www.cdc.gov/growthcharts/percentile_data_files.htm.
  • 10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. Bmj. 2000;320(7244):1240-3. doi: 10.1136/bmj.320.7244.1240. PubMed PMID: 10797032.
  • 11. Barr RD, Gomez-Almaguer D, Jaime-Perez JC, Ruiz-Argüelles GJ. Importance of Nutrition in the Treatment of Leukemia in Children and Adolescents. Arch Med Res. 2016;47(8):585-92. doi: 10.1016/j.arcmed.2016.11.013. PubMed PMID: 28476186.
  • 12. Mathers CD, Lopez AD, Murray CJL. The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global Burden of Disease and Risk Factors. Washington (DC): World Bank, The International Bank for Reconstruction and Development/The World Bank Group.; 2006.
  • 13. Bundy DAP, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT. Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition. Lancet (London, England). 2018;391(10121):687-99. Epub 2017/11/21. doi: 10.1016/s0140-6736(17)32417-0. PubMed PMID: 29153316.
  • 14. Bauer J, Jürgens H, Frühwald MC. Important aspects of nutrition in children with cancer. Adv Nutr. 2011;2(2):67-77. Epub 03/10. doi: 10.3945/an.110.000141. PubMed PMID: 22332035.
  • 15. van Eys J. Effect of nutritional status on responses to therapy. Cancer Res. 1982;42(2 Suppl):747s-53s. Epub 1982/01/01. PubMed PMID: 6799193.
  • 16. Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition—A dynamic triangle in review. Cancer. 2004;100(4):677-87. doi: 10.1002/cncr.11833.
  • 17. Dhanapal R, Saraswathi T, Govind RN. Cancer cachexia. J Oral Maxillofac Pathol. 2011;15(3):257-60. doi: 10.4103/0973-029X.86670. PubMed PMID: 22144825.
  • 18. Nursing RCo, Fellow FGRCN. Nutrition in Children and Young People with Cancer: RCN Guidance: RCN; 2014.
  • 19. Schoeman J, Dannhauser A, Kruger M. Malnutrition in paediatric oncology patients2010.
  • 20. Nieuwoudt CH. Nutrition and the child with cancer: Where do we stand and where do we need to go? South Afr J Clin Nutr. 2011;24. doi: 10.1080/16070658.2011.11734376.
  • 21. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972;25(6):329-43. Epub 1972/07/01. PubMed PMID: 4650929.
  • 22. Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Crit Rev Oncol/Hematol. 2012;83(2):249-75. Epub 2012/01/24. doi: 10.1016/j.critrevonc.2011.12.003. PubMed PMID: 22264939.
  • 23. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization technical report series. 1995;854:1-452. Epub 1995/01/01. PubMed PMID: 8594834.
  • 24. Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol. 2010;115(5):982-8. doi: 10.1097/AOG.0b013e3181da9423. PubMed PMID: 20410772.
  • 25. Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today. 2015;50(3):117-28. Epub 04/07. doi: 10.1097/NT.0000000000000092. PubMed PMID: 27340299.
  • 26. Krishnan AV, Trump DL, Johnson CS, Feldman D. The role of vitamin D in cancer prevention and treatment. Endocrinol Metab Clin North Am. 2010;39(2):401-18, table of contents. Epub 2010/06/01. doi: 10.1016/j.ecl.2010.02.011. PubMed PMID: 20511060; PubMed Central PMCID: PMCPmc5788175.
  • 27. Fleet JC. Molecular actions of vitamin D contributing to cancer prevention. Mol Aspects Med. 2008;29(6):388-96. Epub 2008/08/30. doi: 10.1016/j.mam.2008.07.003. PubMed PMID: 18755215; PubMed Central PMCID: PMCPmc2613446.
  • 28. Kong J, Li YC. Molecular mechanism of 1,25-dihydroxyvitamin D3 inhibition of adipogenesis in 3T3-L1 cells. Am J Physiol Endocrinol Metabol. 2006;290(5):E916-24. Epub 2005/12/22. doi: 10.1152/ajpendo.00410.2005. PubMed PMID: 16368784.
  • 29. Arshad M, Rezvandoost N, Pazouki A, Riazi S, Aghababa Rangraz M, Mokhber S. Assessment of the Serum Levels of Hemoglobin, Ferritin, and Vitamin B12 in a Sample of Iranian Population with Morbid Obesity. J Minim Invasive Surg Sci. 2016;Inpress. doi: 10.17795/minsurgery-37637.
  • 30. Baltaci D, Kutlucan A, Turker Y, Yilmaz A, Karacam S, Deler H, et al. Association of vitamin B12 with obesity, overweight, insulin resistance and metabolic syndrome, and body fat composition; primary care-based study. Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina. 2013;10(2):203-10. Epub 2013/07/31. PubMed PMID: 23892832.
There are 30 citations in total.

Details

Primary Language English
Subjects Paediatrics
Journal Section Research article
Authors

Meryem Keçeli Başaran 0000-0001-8362-8618

Nur Zengın This is me 0000-0001-7926-0064

Ali Doğan 0000-0002-9040-2737

Alihan Sursal This is me 0000-0001-8073-3033

Fatih Ozdener 0000-0002-0163-318X

Publication Date September 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 9

Cite

APA Keçeli Başaran, M., Zengın, N., Doğan, A., Sursal, A., et al. (2020). Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition. Journal of Surgery and Medicine, 4(9), 826-829. https://doi.org/10.28982/josam.790445
AMA Keçeli Başaran M, Zengın N, Doğan A, Sursal A, Ozdener F. Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition. J Surg Med. September 2020;4(9):826-829. doi:10.28982/josam.790445
Chicago Keçeli Başaran, Meryem, Nur Zengın, Ali Doğan, Alihan Sursal, and Fatih Ozdener. “Enteral Feed Based Gradual Improvement of Body Mass Index and Normalization of Micronutrients in Children With Malnutrition”. Journal of Surgery and Medicine 4, no. 9 (September 2020): 826-29. https://doi.org/10.28982/josam.790445.
EndNote Keçeli Başaran M, Zengın N, Doğan A, Sursal A, Ozdener F (September 1, 2020) Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition. Journal of Surgery and Medicine 4 9 826–829.
IEEE M. Keçeli Başaran, N. Zengın, A. Doğan, A. Sursal, and F. Ozdener, “Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition”, J Surg Med, vol. 4, no. 9, pp. 826–829, 2020, doi: 10.28982/josam.790445.
ISNAD Keçeli Başaran, Meryem et al. “Enteral Feed Based Gradual Improvement of Body Mass Index and Normalization of Micronutrients in Children With Malnutrition”. Journal of Surgery and Medicine 4/9 (September 2020), 826-829. https://doi.org/10.28982/josam.790445.
JAMA Keçeli Başaran M, Zengın N, Doğan A, Sursal A, Ozdener F. Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition. J Surg Med. 2020;4:826–829.
MLA Keçeli Başaran, Meryem et al. “Enteral Feed Based Gradual Improvement of Body Mass Index and Normalization of Micronutrients in Children With Malnutrition”. Journal of Surgery and Medicine, vol. 4, no. 9, 2020, pp. 826-9, doi:10.28982/josam.790445.
Vancouver Keçeli Başaran M, Zengın N, Doğan A, Sursal A, Ozdener F. Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition. J Surg Med. 2020;4(9):826-9.