NUTRITIONAL ASSESSMENT OF INFANTS AND CHILDREN PRESENTING WITH ACUTE RESPIRATORY INFECTIONS (ARIS)

Abstract

SUMMARY A cute respiratory infections are a common reason for hospital admissions; they are also responsible for 39% of outpatient consultations in Egypt at PHC facilities (MOHP, 2000). Deficiency in macronutrients such as protein, carbohydrates and fat provoke protein- energy malnutrition (PEM), and when combined with micronutrient deficiencies, they are among the most important nutritional problems with young children particularly affected (Pelletier et al., 1995). There are multiple mechanisms of action in the relationship between malnutrition and susceptibility to bacterial infections diseases. For instance, PEM impairs normal immune system development (Keusch, 2003). A strong and consistent association has been demonstrated between malnutrition and mortality from respiratory infections; further, malnutrition is considered to be a more important risk factor for pneumonia than for diarrhea (Victora et al., 1990; Berkowitz, 1992). The infection may be either aggravating a previously existing deficient nutritional status or triggering malnutrition through disease pathogenesis (Borelli et al., 2004). It has been demonstrated that certain infectious diseases cause malnutrition. These diseases cause a reduction in food intake. One example of how respiratory infections can contribute to malnutrition is that repeated or chronic infections may cause cachexia (Meléndez, 2015). The overall function of a nutritional assessment is to correctly identify nutritional problems early and provide education to treat the problem and prevent it from becoming a larger problem (Scott et al., 1992). Nutritional assessment should be an integral part of the care for every paediatric patient, those patients with repeated infections and those at risk for malnutrition should have detailed nutritional assessments (Mascarenhas et al., 1998). This clinical study was conducted to assess the nutritional state of infants and children presenting with ARIs, and to assess the effect of ARIs on infants and children's feeding. This work included 250 patients presented with respiratory symptoms and diagnosed as ARIs, 138 males and 112 females with age range between 1 to 60 months, age median (IQR) 36 (10 - 48) months, during a period of six months between the start of December 2014 to the end of May 2015, every Sunday (Convenient non random sample). All patients were subjected to medical history taking, with special emphasis on the respiratory symptoms (onset, course, duration, and severity) and other symptoms (nausea, vomiting) with analysis for each symptom (onset, course, duration, frequency, severity, and the relation to the respiratory symptoms). Patients were asked about food intake (normal / increase / decreased / markedly decreased), weight loss (+ve or –ve), breast feeding, age of weaning (in months), food frequency and 24 hours dietary recall (for older children) with analysis of the food contents by computerized diet analysis program for calories and nutrients (national nutritional institute 2006 (NNI) and it's food composition tables) and the results were compared to RDA. Patients were subjected to careful clinical examination with special emphasis on vital data (heart rate, respiratory rate, and temperature), anthropometric measurements (weight, length/ height; head circumference, mid-arm circumference) and chest examination (retraction, breath sounds, type of breath, and adventitious sounds). Some patients asked for chest x-ray especially when pneumonia was clinically suspected. It was found that frequency of ARIs as follows: URTIs 68.80% and LRTIs 31.20 % and were differentiated to: common cold 22.70 %, tonsillopharyngitis 41.90%, AOM 26.20 %, acute sinusitis 3.50 %, croup 5.80 %, acute bronchitis 23.10 %, acute bronchiolitis 44.90 % and pneumonia 32.10 %. The mostly presented symptoms were fever 90.8%, rhinorrhea 74.4% then cough 66.8%. Food intake was decreased in 48% of the patients and severely decreased in 34.8% during ARI, patients with vomiting 49.6% , weight loss 32 %, breast feeding 52.4%, artificial feeding 22.8 %, mixed feeding 24.8% while those with appropriate age of weaning (4-6 months) 45.2 %, early weaned (before 4 months) 40.8% and 14% with delayed weaning (after 6months). ARI decreased weekly intake of milk, egg, meat, fish, rice, fat and vegetables, while the intake of fruit juice increased during ARI. There was significant decrease in the weekly intake of milk during ARIs as 44% of patient frequently consumed milk before illness while 54% never consumed it during illness. There was significant decrease in the weekly intake of egg during ARIs as 56% of patient frequently consumed egg before illness while 58% never consumed it during illness. There was significant decrease in the weekly intake of meat during ARIs as 60% of patient frequently consumed meat before illness while 34% frequently consumed it during illness. There was significant decrease in the weekly intake of fish during ARIs as 16% of patient never consumed fish before illness while 86% never consumed it during illness. There was significant decrease in the weekly intake of rice during ARIs as 44% of patient regularly consumed rice before illness while 20% regularly consumed it during illness. There was significant decrease in the weekly intake of fat during ARIs as 30% of patient never consumed fat before illness while 70% never consumed it during illness. There was significant decrease in the weekly intake of vegetables during ARIs as 26% of patient regularly consumed vegetables before illness while only 2% regularly consumed it during illness and18% never consumed it during illness. There was significant increase in the weekly intake of fruit juices during ARIs as 16% of patient regularly consumed fruit juice before illness while 30% regularly consumed it during illness. There was insignificant effect of ARIs on the weekly intake of fruit. Weekly egg intake decreased in 82 % of patients during ARIs, milk decreased in 74 %, fish decreased in 72 %, fat decreased in 58%, vegetables decreased in 56%,meat decreased in 50%, rice decreased in 40% while weekly fruit juice consumption increased in 40% of patients during ARI. There was insufficient daily supplementation of the different nutrients during ARIs as 88% of the children received insufficient daily supply of iron when compared to RDA and 66% received insufficient zinc, 94 % received insufficient calcium, 42 % received insufficient vitamin C,80 % received insufficient vitamin A, 38% received insufficient CHO ,and 72% received insufficient total calorie. There was significant difference between patients with URTI and patients with LRTI regarding order of birth as 15.7% of patients with URTI where 4th or more order of birth compared to 29.5% among patients with LRTI. There was significant difference between patients with URTI and patients with LRTI regarding food intake as 55.1% of patients with LRTI had severely decreased food intake compared to 25.6% among patients with URTI. There was significant difference between patients with URTI and patients with LRTI regarding type of feeding as 60.5% of patients with URTI were breast fed compared to 34.6% among patients with URTI. There was significant difference between patients with URTI and patients with LRTI regarding age of weaning as 52.9% of patients with URTI had appropriate age of weaning while 53.8% of patients with LRTI were early weaned. There was significant difference between patients with URTI and patients with LRTI regarding complexion as 34.9% of patients with URTI has pallor compared to 15.4% among patients with LRTI and 57.7% of patients with LRTI has cyanosis compared to 2.3% among patients with URTI.