In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure op... more In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure optimal macro- and micro-nutrient intake in order to avoid malnutrition, disease-related complications and growth rate reduction. Children with CKD and their families encounter many difficulties in adjusting to the renal diet. Even though adherence to the recommended dietary plan is important in CKD, it is rarely measured partly due to the lack of robust, unbiased assessment methods. In this review of 22 papers, the techniques used to assess adherence in children with CKD are reviewed, alongside their advantages and disadvantages. Although dietary surveys, biochemical index assessment and clinician ratings have been found not to be efficient when used as a single tool, they should be used in combination in order to give the opportunity to the health providers to perceive adherence from as many angles as possible.
Background: Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and ... more Background: Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essential to be recognized as early as possible. Aim of our study was to assess the nutrition status of children with CKD. Methods: Nutrition status of 30 children (1-16 years) with CKD stages IIIV and on peritoneal dialysis was evaluated. Malnutrition risk was assessed by Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART) score software.Anthropometry was expressed as Z-scores for age and sex. Phase angle (PhA) and body cell mass were assessed by bioelectrical impedance analysis (BIA). Three-day food intake was recorded and analyzed. Biochemical indexes were assessed. Results: Depending on the marker used for assessment 20-40% of our patients were malnourished. Intake/requirements ratio (median) was 86.5% for actual energy intake and 127% for actual protein intake. Multiple regression analysis has shown that the most determinant factor for Mid Upper Arm Circumference (MUAMC) was actual protein intake, Glomerular Filtration Rate (GFR) and age at diagnosis. PhA was mainly affected by GFR and energy intake. Statistically significant inverse correlation was found between PeDiSMART score and PhA (p=0.001), MUAMC (p=0.008) as well as protein intake (p=0.016). Conclusions: A considerable proportion of children with advanced CKD are undernourished. Regular dietitian evaluation based on novel tools as PeDiSMART score and PhA may identify earlier patients at risk for malnutrition. Hippokratia 2014; 18 (3): 212-216.
Journal of Parenteral and Enteral Nutrition, Apr 9, 2014
Background: The study aimed to test the hypothesis that computer‐based calculation of malnutritio... more Background: The study aimed to test the hypothesis that computer‐based calculation of malnutrition risk may enhance the ability to identify pediatric patients at malnutrition‐related risk for an unfavorable outcome. The Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART), incorporating the World Health Organization (WHO) growth reference data and malnutrition‐related parameters, was used. Materials and Methods: This was a prospective cohort study of 500 pediatric patients aged 1 month to 17 years. Upon admission, the PeDiSMART score was calculated and anthropometry was performed. Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool Risk on Nutritional Status and Growth (STRONGkids), and Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) malnutrition screening tools were also applied. PeDiSMART's association with the clinical outcome measures (weight loss/nutrition support and hospitalization duration) was assessed and compared with the other screening tools. Results: The PeDiSMART score was inversely correlated with anthropometry and bioelectrical impedance phase angle (BIA PhA). The score's grading scale was based on BIA Pha quartiles. Weight loss/nutrition support during hospitalization was significantly independently associated with the malnutrition risk group allocation on admission, after controlling for anthropometric parameters and age. Receiver operating characteristic curve analysis showed a sensitivity of 87% and a specificity of 75% and a significant area under the curve, which differed significantly from that of STRONGkids and STAMP. In the subgroups of patients with PeDiSMART‐based risk allocation different from that based on the other tools, PeDiSMART allocation was more closely related to outcome measures. Conclusion: PeDiSMART, applicable to the full age range of patients hospitalized in pediatric departments, graded according to BIA PhA, and embeddable in medical electronic records, enhances efficacy and reproducibility in identifying pediatric patients at malnutrition‐related risk for an unfavorable outcome. Patient allocation according to the PeDiSMART score on admission is associated with clinical outcome measures.
Follistatin may affect lean and fat mass and be implicated in metabolic diseases. We aimed to elu... more Follistatin may affect lean and fat mass and be implicated in metabolic diseases. We aimed to elucidate physiological predictors of circulating follistatin variation in healthy young humans. This was an observational, cross-sectional study with two additional prospective observational arms (circadian, seasonal sub-studies) and one prospective interventional arm (mixed meal sub-study). Healthy, young individuals of both sexes (n=122) were subjected to anthropometric and body composition measurements and their eating and exercise behavior profiles were assessed by validated questionnaires. Sub-groups were subjected to standardized meal ingestion (n=36), day-night rhythm (n=20) and seasonal variation (n=20) studies. Main outcome of the study were circulating follistatin levels. At baseline follistatin levels were correlated with creatinine (r=0.24; p=0.01), creatine phosphokinase (rs=0.22; p=0.02), and with lean body mass (rs=0.19; p=0.04) and were higher in males than females (p=0.004) after adjustment for leptin, which was its major predictor. Follistatin levels showed a circadian (p<0.001), but not a seasonal, variation, and were also affected by the phase of menstrual cycle in females (p=0.034). Follistatin levels were not affected by dietary or exercise habits but levels increased after a standardized meal ingestion (250kcal) (p=0.002). In healthy young individuals circulating follistatin levels are correlated with muscle mass. Follistatin levels are associated with circulating leptin levels and display a day-night rhythm and a menstrual cycle, but not a seasonal, variation.
Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essent... more Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essential to be recognized as early as possible. Aim of our study was to assess the nutrition status of children with CKD. Nutrition status of 30 children (1-16 years) with CKD stages IIIV and on peritoneal dialysis was evaluated. Malnutrition risk was assessed by Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART) score software.Anthropometry was expressed as Z-scores for age and sex. Phase angle (PhA) and body cell mass were assessed by bioelectrical impedance analysis (BIA). Three-day food intake was recorded and analyzed. Biochemical indexes were assessed. Depending on the marker used for assessment 20-40% of our patients were malnourished. Intake/requirements ratio (median) was 86.5% for actual energy intake and 127% for actual protein intake. Multiple regression analysis has shown that the most determinant factor for Mid Upper Arm Circumference (MUAMC) was actual protei...
In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure op... more In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure optimal macro- and micro-nutrient intake in order to avoid malnutrition, disease-related complications and growth rate reduction. Children with CKD and their families encounter many difficulties in adjusting to the renal diet. Even though adherence to the recommended dietary plan is important in CKD, it is rarely measured partly due to the lack of robust, unbiased assessment methods. In this review of 22 papers, the techniques used to assess adherence in children with CKD are reviewed, alongside their advantages and disadvantages. Although dietary surveys, biochemical index assessment and clinician ratings have been found not to be efficient when used as a single tool, they should be used in combination in order to give the opportunity to the health providers to perceive adherence from as many angles as possible.
... computer: a case study S. Lampoudi Department of Computer Science University of California, S... more ... computer: a case study S. Lampoudi Department of Computer Science University of California, Santa Barbara, California, USA A ... ghrelin. Lampoudi, T., . Apostolou, S. Lampoudi, C. Kotsani, A. Savvi-dou, & K. Kotzampassi (2007a). ...
In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure op... more In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure optimal macro- and micro-nutrient intake in order to avoid malnutrition, disease-related complications and growth rate reduction. Children with CKD and their families encounter many difficulties in adjusting to the renal diet. Even though adherence to the recommended dietary plan is important in CKD, it is rarely measured partly due to the lack of robust, unbiased assessment methods. In this review of 22 papers, the techniques used to assess adherence in children with CKD are reviewed, alongside their advantages and disadvantages. Although dietary surveys, biochemical index assessment and clinician ratings have been found not to be efficient when used as a single tool, they should be used in combination in order to give the opportunity to the health providers to perceive adherence from as many angles as possible.
Background: Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and ... more Background: Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essential to be recognized as early as possible. Aim of our study was to assess the nutrition status of children with CKD. Methods: Nutrition status of 30 children (1-16 years) with CKD stages IIIV and on peritoneal dialysis was evaluated. Malnutrition risk was assessed by Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART) score software.Anthropometry was expressed as Z-scores for age and sex. Phase angle (PhA) and body cell mass were assessed by bioelectrical impedance analysis (BIA). Three-day food intake was recorded and analyzed. Biochemical indexes were assessed. Results: Depending on the marker used for assessment 20-40% of our patients were malnourished. Intake/requirements ratio (median) was 86.5% for actual energy intake and 127% for actual protein intake. Multiple regression analysis has shown that the most determinant factor for Mid Upper Arm Circumference (MUAMC) was actual protein intake, Glomerular Filtration Rate (GFR) and age at diagnosis. PhA was mainly affected by GFR and energy intake. Statistically significant inverse correlation was found between PeDiSMART score and PhA (p=0.001), MUAMC (p=0.008) as well as protein intake (p=0.016). Conclusions: A considerable proportion of children with advanced CKD are undernourished. Regular dietitian evaluation based on novel tools as PeDiSMART score and PhA may identify earlier patients at risk for malnutrition. Hippokratia 2014; 18 (3): 212-216.
Journal of Parenteral and Enteral Nutrition, Apr 9, 2014
Background: The study aimed to test the hypothesis that computer‐based calculation of malnutritio... more Background: The study aimed to test the hypothesis that computer‐based calculation of malnutrition risk may enhance the ability to identify pediatric patients at malnutrition‐related risk for an unfavorable outcome. The Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART), incorporating the World Health Organization (WHO) growth reference data and malnutrition‐related parameters, was used. Materials and Methods: This was a prospective cohort study of 500 pediatric patients aged 1 month to 17 years. Upon admission, the PeDiSMART score was calculated and anthropometry was performed. Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool Risk on Nutritional Status and Growth (STRONGkids), and Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) malnutrition screening tools were also applied. PeDiSMART's association with the clinical outcome measures (weight loss/nutrition support and hospitalization duration) was assessed and compared with the other screening tools. Results: The PeDiSMART score was inversely correlated with anthropometry and bioelectrical impedance phase angle (BIA PhA). The score's grading scale was based on BIA Pha quartiles. Weight loss/nutrition support during hospitalization was significantly independently associated with the malnutrition risk group allocation on admission, after controlling for anthropometric parameters and age. Receiver operating characteristic curve analysis showed a sensitivity of 87% and a specificity of 75% and a significant area under the curve, which differed significantly from that of STRONGkids and STAMP. In the subgroups of patients with PeDiSMART‐based risk allocation different from that based on the other tools, PeDiSMART allocation was more closely related to outcome measures. Conclusion: PeDiSMART, applicable to the full age range of patients hospitalized in pediatric departments, graded according to BIA PhA, and embeddable in medical electronic records, enhances efficacy and reproducibility in identifying pediatric patients at malnutrition‐related risk for an unfavorable outcome. Patient allocation according to the PeDiSMART score on admission is associated with clinical outcome measures.
Follistatin may affect lean and fat mass and be implicated in metabolic diseases. We aimed to elu... more Follistatin may affect lean and fat mass and be implicated in metabolic diseases. We aimed to elucidate physiological predictors of circulating follistatin variation in healthy young humans. This was an observational, cross-sectional study with two additional prospective observational arms (circadian, seasonal sub-studies) and one prospective interventional arm (mixed meal sub-study). Healthy, young individuals of both sexes (n=122) were subjected to anthropometric and body composition measurements and their eating and exercise behavior profiles were assessed by validated questionnaires. Sub-groups were subjected to standardized meal ingestion (n=36), day-night rhythm (n=20) and seasonal variation (n=20) studies. Main outcome of the study were circulating follistatin levels. At baseline follistatin levels were correlated with creatinine (r=0.24; p=0.01), creatine phosphokinase (rs=0.22; p=0.02), and with lean body mass (rs=0.19; p=0.04) and were higher in males than females (p=0.004) after adjustment for leptin, which was its major predictor. Follistatin levels showed a circadian (p<0.001), but not a seasonal, variation, and were also affected by the phase of menstrual cycle in females (p=0.034). Follistatin levels were not affected by dietary or exercise habits but levels increased after a standardized meal ingestion (250kcal) (p=0.002). In healthy young individuals circulating follistatin levels are correlated with muscle mass. Follistatin levels are associated with circulating leptin levels and display a day-night rhythm and a menstrual cycle, but not a seasonal, variation.
Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essent... more Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essential to be recognized as early as possible. Aim of our study was to assess the nutrition status of children with CKD. Nutrition status of 30 children (1-16 years) with CKD stages IIIV and on peritoneal dialysis was evaluated. Malnutrition risk was assessed by Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART) score software.Anthropometry was expressed as Z-scores for age and sex. Phase angle (PhA) and body cell mass were assessed by bioelectrical impedance analysis (BIA). Three-day food intake was recorded and analyzed. Biochemical indexes were assessed. Depending on the marker used for assessment 20-40% of our patients were malnourished. Intake/requirements ratio (median) was 86.5% for actual energy intake and 127% for actual protein intake. Multiple regression analysis has shown that the most determinant factor for Mid Upper Arm Circumference (MUAMC) was actual protei...
In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure op... more In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure optimal macro- and micro-nutrient intake in order to avoid malnutrition, disease-related complications and growth rate reduction. Children with CKD and their families encounter many difficulties in adjusting to the renal diet. Even though adherence to the recommended dietary plan is important in CKD, it is rarely measured partly due to the lack of robust, unbiased assessment methods. In this review of 22 papers, the techniques used to assess adherence in children with CKD are reviewed, alongside their advantages and disadvantages. Although dietary surveys, biochemical index assessment and clinician ratings have been found not to be efficient when used as a single tool, they should be used in combination in order to give the opportunity to the health providers to perceive adherence from as many angles as possible.
... computer: a case study S. Lampoudi Department of Computer Science University of California, S... more ... computer: a case study S. Lampoudi Department of Computer Science University of California, Santa Barbara, California, USA A ... ghrelin. Lampoudi, T., . Apostolou, S. Lampoudi, C. Kotsani, A. Savvi-dou, & K. Kotzampassi (2007a). ...
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