BACKGROUND: The protein requirement of clinically normal but chronically undernourished (stunted) children is unknown. Stressors, similar to intestinal parasites, in poor environments may increase this requirement. The current protein requirement, which is based on factorial methods in healthy, well-nourished children, may be incorrect. OBJECTIVES: This study aimed to determine the effect of intestinal parasites on the protein requirement of chronically undernourished school-age South Indian children, by the indicator amino acid oxidation technique. METHODS: Eighteen undernourished school-age South Indian children (aged 6-11 y) were studied before and after treatment for the confirmed presence of intestinal parasites. They were randomly assigned to receive a low or high protein intake from a range of 8 protein concentrations (0.24-2.38 g/kg/d), provided as an egg protein-based amino acid mixture in an isocaloric experimental diet providing energy at 1.7 times the measured resting energy expenditure. A constant and generous intake of the indicator amino acid (phenylalanine and its metabolite tyrosine) was ensured across all intake amounts. A 2-phase linear regression crossover analysis of the pattern of 13C-phenylalanine oxidation across the protein intake amounts before and after treatment identified a minimal oxidation breakpoint that represented the mean protein requirement. RESULTS: The mean [95% confidence interval (CI)] protein requirement of undernourished school-age South Indian children with intestinal parasites was determined to be 1.25 (95% CI: 1.0, 1.5) g/kg/d. After antiparasite treatment, the requirement was not different at 1.43 (95% CI: 1.1, 1.8) g/kg/d. CONCLUSIONS: The presence of intestinal parasites does not increase the protein requirement of undernourished Indian children. However, the current mean [+2 standard deviation (SD)] protein requirement of 0.76 (SD: 0.95) g/kg/d might be inadequate for this group.
BACKGROUND: Children in underdeveloped countries frequently suffer from malnutrition, which can have both short-term and long-term consequences, including cognitive impairment (i.e., stunting), underweight, wasting and ultimately mortality. It is necessary to understand the underlying causes and risk factors associated with this burden. Therefore, this study aims to investigate how risk factors affect coexisting forms of undernutrition (CFU) among Bangladeshi children under the age of 5, with the aim of suggesting possible strategies to enhance nutritional outcomes. METHODS: This study is based on secondary data extracted from the BDHS 2022 dataset, consisting of 4085 children aged under 5. Descriptive statistics, the chi-square test, the Boruta algorithm and logistic regression are used in a Bayesian setting. RESULTS: Findings revealed that the prevalence of CFU is 19.44%, and the majority of them were from the Sylhet division. Children from lower wealth indices and those living in urban areas are at higher risk of CFU. Children of uneducated mothers have 3.4 times higher odds (95% CrI: 2.352, 5.001) of CFU than those of higher educated mothers; children of underweight mothers have 1.6 times higher odds (95% CrI: 1.338, 2.092); and children of overweight or obese mothers have 0.6 times higher odds (95% CrI: 0.532, 0.794) than children of mothers with a normal weight. The odds of having CFU are 1.2 and 1.4 times greater (95% CrI: 0.953, 1.553 and 1.103, 1.790) for children from the poorer and poorest households compared to children from middle wealth families and 0.8 and 1.7 times higher (95% CrI: 0.600, 1.145 and 1.405, 2.191) for children whose birth order is at least six and who are older than 23.9 months. A child's nutritional health is also influenced by a number of other important factors, including the child's age and birth order, the mother's age at first birth, breastfeeding status, TV access, toilet facilities, divisions and residence. CONCLUSION: The authors suggest that, in addition to improving mothers' health and other socio-demographic factors, targeted interventions should be developed to reduce the prevalence of CFU.
PURPOSE OF REVIEW: The purpose of this review was to summarise recent relevant studies examining refeeding syndrome risk and related outcomes in patients provided with enteral nutrition and discuss considerations for clinical practice and future research. RECENT FINDINGS: Recent studies investigating enteral nutrition and refeeding syndrome were heterogeneous. With the exception of physical indicators of nutritional status, there was no agreement across studies regarding commonly agreed upon risk factors including periods of fasting, feeding rates, or specific medical conditions. Comparisons of three different recommended risk criteria had highly variable results in one study. Confounding factors were evident across studies. Management of refeeding syndrome risk is becoming increasingly debated. Recent research has questioned the need for prolonged high thiamin dosages in adult patients with eating disorders. Conservative feeding practices are also called into question when serum electrolyte levels can be monitored and replaced assertively. SUMMARY: Clinical practice and research in refeeding syndrome is slowly changing, with a focus on preventing unnecessary and prolonged underfeeding in malnourished patients and in children during critical stages of growth. Future research should ensure risk criteria is specific to the clinical conditions and/or age groups being investigated. Refeeding syndrome and its subsequent management should also be considered along a spectrum, rather than as an all or nothing event. By incorporating these recommendations, research in the field will evolve to advance knowledge and enhance clinical practice.
Leveraging the Transplant Pregnancy Registry International, we conducted a retrospective study of children born to liver transplant (LT) recipients between 1986 and 2024 to evaluate long-term health outcomes of offspring. Child data were collected primarily from biyearly maternal phone interviews. Descriptive statistics and multivariate analyses were used to evaluate risk factors for adverse child outcomes. There were 599 children with follow-up data, born to 435 LT recipients, of whom 73.3% were White and 13.1% Hispanic, with a median age at conception of 29.4 years. The most common LT indications were autoimmune hepatitis (14.2%) and biliary atresia (13.9%); the median time from LT to delivery was 6.9 (interquartile range, 3.1-14.2) years; 21.0% of mothers required antihypertensive medications during their pregnancy, 20.7% developed preeclampsia, and 46.1% had cesarean delivery. Most (68.3%) children were healthy and developing well at a median follow-up time of 7.6 (interquartile range, 3.4-14.9) years. The most common pediatric conditions in offspring were allergies (6.5%), asthma/reactive airway disease (4.7%), attention deficit hyperactivity disorder/attention deficit disorder (4.7%), mild developmental delay (2.7%), autism spectrum disorder (2.0%), and mood disorders (1.2%). Most school-age children of LT recipients were healthy overall, without greater risk for growth or cognitive conditions than the general pediatric population.
Sarah L Maxwell, Lisa A Coscia, Serban Constantinescu et al.
BACKGROUND: Childhood malnutrition remains a critical public health challenge among hospitalized pediatric populations, contributing to increased morbidity and prolonged length of hospital stay (LOS). In countries undergoing nutritional transition, such as Türkiye, the "double burden of malnutrition"-characterized by the coexistence of undernutrition and obesity-is exacerbated by socio-economic inequities. This study aimed to assess the prevalence and risk factors of malnutrition in hospitalized children and to evaluate the predictive validity of two rapid screening tools: the Pediatric Yorkhill Malnutrition Score (PYMS) and mid-upper arm circumference (MUAC), with attention to their utility in identifying socio-economic vulnerability. METHODS: This pilot study was conducted between January and July 2024 in a tertiary university hospital in Türkiye. A total of 100 children (50 girls, 50 boys), aged 1 month to 18 years, were evaluated. Nutritional status was assessed using World Health Organization (WHO) anthropometric Z-scores. Malnutrition risk was screened via PYMS and age-adjusted MUAC Z-scores. A novel socio-economic malnutrition risk classification was developed based on household income, family size, and maternal employment status. This pilot study tested the combined use of routine anthropometric measurements and practical screening tools such as PYMS and MUAC for a later large-scale, school-based screening. RESULTS: The double burden of malnutrition was evident: 13.0% had acute malnutrition and 11.0% chronic malnutrition (stunting); among children aged 5-18 years, 34.5% were overweight and 21.8% obese. The LOS was significantly longer in the PYMS high-risk group compared to the low-risk group (p = 0.001), and in the MUAC moderate malnutrition group (p < 0.05). PYMS demonstrated high specificity (95.89%) for acute malnutrition but limited sensitivity for stunting. Among children aged > 5 years, MUAC Z-scores correlated significantly with body mass index (BMI) Z-scores (p < 0.05). Children classified as high-risk by the socio-economic model had significantly lower height-for-age Z-scores (p < 0.05). CONCLUSIONS: This study highlights the impact of socio-economic inequities-such as low income and household overcrowding-on chronic malnutrition and confirms the clinical relevance of the double burden of malnutrition. PYMS and MUAC effectively predict prolonged hospitalization and adverse clinical outcomes. The integration of socio-economic risk assessment with routine malnutrition screening may guide equitable resource allocation and improve care for vulnerable pediatric populations.
Emre Çelik, Muhammet Furkan Korkmaz, Yunus Özkaya et al.
Background/Objectives: Malnutrition is common in paediatric inflammatory bowel disease (IBD) and may affect growth, disease severity, and clinical outcomes. The aim of our study was to assess nutritional status and linear growth at diagnosis and during follow up and to evaluate their association with clinical outcomes in paediatric IBD. Methods: This multicentre retrospective cohort study included children diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) at two paediatric IBD referral centres. Clinical, biochemical, and anthropometric data were collected at diagnosis and throughout follow-up. Underweight was defined as BMI z-score ≤ -2; growth failure (stunting) was defined as height-for-age z-score ≤ -2. Results: Among 128 children with IBD (69 CD, 59 UC; mean age: 157.2 ± 29.5 months), 23% (29/128) were underweight at diagnosis, 68% (87/128) had normal BMI, and 9% (12/128) were overweight at diagnosis. Underweight status was more frequent in the CD than UC groups (30% vs. 15%; p = 0.022). Growth failure affected 7.0% of patients at diagnosis and was observed in 5.3% of patients with available data at 36 months. Stunting was more frequent in CD than UC. Biologic therapy was more frequently initiated in underweight patients (41% vs. 17%, p = 0.06). At a mean follow-up of 29.4 months, 86% (25/29) of underweight patients achieved a normal or elevated BMI. Underweight status was not associated with an increased risk of relapse (adjusted OR 0.52, 95% CI 0.19-1.30; adjusted HR 0.60, 95% CI 0.28-1.29). Conclusions: Malnutrition is frequent at diagnosis in paediatric IBD, particularly in Crohn's disease, and is associated with increased inflammatory burden. Although most patients showed improvement in nutritional status during follow-up, baseline underweight status was not independently associated with subsequent disease relapse. These findings highlight the importance of early and longitudinal assessment of nutritional status and linear growth as integral components of paediatric IBD management.
Chiara Cesari, Carla Maria Grimaldi, Matteo Motta et al.
RATIONALE: Iodine is a micronutrient crucial in the early stages of human development, as it is essential for synthesising thyroid hormones involved in somatic growth and neurodevelopment. It is far better to prevent iodine deficiency than to treat it, since children are particularly vulnerable to iodine deficiency disorders, which involve a broad spectrum of consequences including endemic goitre, delayed growth and development of the central nervous system, intellectual impairment, and infant mortality. The primary dietary sources of iodine are iodised salt, seafood (animals and plants concentrate iodine from seawater), and grains from iodine-rich soils. Reliable evidence is needed on the benefits and harms of direct iodine supplementation in children and adolescents before considering its use to prevent the health consequences of iodine deficiency. OBJECTIVES: To assess the benefits and harms of iodine supplementation for preventing iodine deficiency in children and adolescents. SEARCH METHODS: We searched CENTRAL, MEDLINE, eight other databases, and two trials registries to 8 May 2025. We also searched the reference lists of retrieved studies. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) evaluating the benefits and harms of iodine supplementation alone (orally or by injection) or in combination with vitamins and minerals (orally or by injection) compared with placebo. OUTCOMES: Our critical outcomes were cognitive function assessed by validated scales, growth, hypothyroidism, and adverse events. Important outcomes included health-related quality of life, all-cause mortality, and goitre. RISK OF BIAS: We used the Cochrane RoB 2 tool to assess the risk of bias in the included studies. SYNTHESIS METHODS: Two review authors independently selected trials, extracted data, and assessed risk of bias. We used random-effects meta-analysis to combine data. We assessed the certainty of the evidence using GRADE. INCLUDED STUDIES: We included eight RCTs with a total of 2528 participants. The trials were conducted in seven countries between 1982 and 2009. The trials compared iodine supplementation (alone or with iron in one study) versus placebo. In one study, iodine supplementation was 150 μg daily for 28 weeks, while in the remaining studies, iodine supplementation was done in a single dose: 100 mg in a study on infants younger than 1 year, and a dose between 400 mg and 490 mg for children 6 to 17 years. Follow-up ranged from 3 to 22 months. SYNTHESIS OF RESULTS: Iodine supplementation versus placebo Iodine supplementation results in a slight increase in cognitive function compared to placebo (standardised mean difference 0.19, 95% confidence interval (CI) 0.04 to 0.34; 1 study, 166 participants; high-certainty evidence). Iodine supplementation may result in little to no difference in children's weight (kg) compared to placebo (mean difference (MD) -0.20, 95% CI -1.92 to 1.52; I² = 44%; 3 studies, 658 participants; low-certainty evidence). We downgraded the certainty of evidence by one level for imprecision and one level for heterogeneity. Iodine supplementation likely results in a large reduction in hypothyroidism compared to placebo (risk ratio (RR) 0.03, 95% CI 0.00 to 0.23; 1 study, 264 participants; moderate-certainty evidence). We downgraded the certainty of evidence by one level for risk of bias. No study reported adverse events related to iodine or quality of life. Iodine supplementation likely reduces all-cause mortality in infants compared to placebo (RR 0.32, 95% CI 0.14 to 0.73; 1 study, 617 participants; moderate-certainty evidence). We downgraded the certainty of evidence by one level for risk of bias. The evidence is very uncertain about the effect of iodine supplementation on the reduction of goitre (RR 0.68, 95% CI 0.15 to 3.07; I² = 97%; 2 studies, 432 participants; very low-certainty evidence). We downgraded the certainty of evidence by one level for imprecision, one level for heterogeneity, and one level for risk of bias. However, a sensitivity analysis removing the study with high risk of bias showed that iodine likely results in a large reduction in goitre (RR 0.31, 95% CI 0.22 to 0.45; 1 study, 230 participants; moderate-certainty evidence). Iodine plus iron supplementation versus placebo Iodine plus iron supplementation was compared to placebo in a single study. The evidence is very uncertain about the effect of iodine plus iron on weight (MD -0.40, 95% CI -1.44 to 0.64; 1 study, 146 participants; very low-certainty evidence). We downgraded the certainty of evidence by two levels for imprecision and one level for risk of bias. No other outcomes were assessed for this comparison. AUTHORS' CONCLUSIONS: Iodine supplementation, in the doses and follow-up periods evaluated in published RCTs, results in a slight increase in cognitive function and may result in little to no difference in growth. It likely reduces hypothyroidism and the risk of death in infants, but the evidence is very uncertain about its effect on the reduction of goitre. Future studies should focus on areas or populations in which iodine deficiency could be a problem, and include children of lower socioeconomic levels. They should evaluate higher doses of iodine administered during longer periods of treatment and follow-up times. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol (2023). DOI: 10.1002/14651858.CD014475.
Ines Velasco, Mikel Rueda-Etxebarria, Maria Angelica Trak-Fellermeier et al.
Breastmilk, with its unique biological components, is the optimal source of neonatal nutrition, and WHO global feeding guidance recommends that all infants are exclusively breastfed for the first 6 months. The composition of human milk depends on multiple factors such as maternal diet, exposure to pathogens, metabolic or autoimmune disorders, smoking, mental health, and genetics. Breastfeeding not only transfers nutrients to the child, but it also influences the infant immune function, through the transfer of immune cells, antibodies, microbiota from the mother, cytokines, or growth factors. Among these, human milk-derived extracellular vesicles (hMEVs) are emerging as key yet understudied elements in neonatal growth, development, and immunity. This review explores their structure, formation, uptake, and roles in supporting development, modulating immune responses during early life, and influencing allergic outcomes, highlighting their potential significance in infant health.
Tinevimbo Weidner Baricholo, Amiq Gazdhar, Matthias V Kopp et al.
Fetal alcohol spectrum disorders (FASD) exhibit wide phenotypic variability not explained by prenatal alcohol exposure (PAE) alone. While genetic factors may modify vulnerability, there are no prior FASD genome-wide association studies (GWAS). We performed genome-wide single-marker and gene-based analyses of two South African prospective birth cohorts (Cape Town Longitudinal Cohorts (CTLC); n=328 mother-child dyads) and the US Collaborative Initiative on Fetal Alcohol Spectrum Disorders cohort (CIFASD n=429 children only). We examined main genetic and gene-by-PAE interaction effects on working memory, recognition memory, height, and FASD diagnosis using single-marker and gene-based analyses and the Haplotype-based Transmission Disequilibrium Test (HTDT), which integrates maternal-child genetics. Genome-wide genotype array data were used; TOPMed-imputed data were used to refine results. Risk-modifying genes were then tested for differential mRNA expression based on PAE in placenta and child blood. Gene*PAE interaction gene-based analyses identified STX6 associated with height-for-age Z-scores (p=2.2×10-6) and FOXD3 with recognition memory performance (p=4.7×10-6) in children. Single-marker analysis detected one child SNP approaching significance (rs2833924, p=8.8x10-8) with Gene*PAE interaction for working memory performance. CTLC+CIFASD meta-analysis in children identified one significant locus (HTR1E; pmeta =2.75×10-6) with Gene*PAE interaction for working memory performance. The HTDT test in CTLC imputed data identified three haplotypes associated with FASD diagnosis risk: COP1 (padj=0.029), WWOX (padj =2×10-4), TMEM38B (padj= 0.019). WWOX, STX6, and TMEM38B were differentially expressed in placenta and/or child blood based on PAE. In this first-ever genome-wide investigation of maternal and child genetics in FASD, we identified multiple biologically plausible risk-modifying loci for FASD neurobehavioral, growth, and FASD diagnosis outcomes.
Vivek Ruhela, Corina Lesseur, Ariadna Cilleros-Portet et al.
OBJECTIVE: To examine the association between trajectories of gestational weight gain (GWG) during early and mid-pregnancy and hypertensive disorders of pregnancy (HDP). A trajectory approach was used because total GWG or a single measurement cannot represent the timing and pattern of weight change. METHODS: This retrospective cohort included 11,278 women who attended the nutrition clinic and delivered at Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China, between March 2014 and May 2018. Interval-specific GWG through 28 weeks was characterized using latent class growth modeling. Logistic regression estimated associations with HDP; the fully adjusted model included maternal age, pre-pregnancy body mass index, parity, platelet count, lactate dehydrogenase, and alanine aminotransferase. RESULTS: The current analysis used four reported GWG patterns: stable-low (Group 1; n=9,314, 82.6%), early-slow/mid-fast (Group 2; n=70, 0.6%), early-fast/mid-slow (Group 3; n=301, 2.7%), and moderate-growth (Group 4; n=1,593, 14.1%). Compared with Group 1, the fully adjusted odds of HDP were higher in Group 3 (odds ratio [OR]=2.285, 95% confidence interval [CI] 1.370-3.613; P=0.001) and Group 4 (OR=1.356, 95% CI 1.037-1.752; P=0.023), but not Group 2 (OR=1.084, 95% CI 0.176-3.528; P=0.911). CONCLUSION: In this hospital-based cohort, early- and mid-pregnancy GWG patterns were associated with HDP. The estimates for the smallest groups were imprecise, and the observational design does not establish causality or predictive utility. Studies with prospectively recorded HDP diagnosis timing and external validation are required before clinical use.
