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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">When considering the pathogenesis and pathophysiology of malnutrition&#44; it is useful to distinguish between malnutrition unrelated to organic disease&#44; that is&#44; malnutrition due to environmental factors &#40;access to foods&#41; or dietary habits&#44; and malnutrition related to disease&#46; In the first case&#44; malnutrition mainly results from a decreased dietary intake&#44; which generates an imbalance relative to nutritional requirements that may affect not only growth and development&#44; but also other aspects of health&#46; In case of disease-related malnutrition&#44; however&#44; malnutrition is preceded by a state of inflammation that contributes to the energy imbalance through various mechanisms&#58; increased catabolism&#44; decreased appetite&#44; increased energy losses&#44; etc&#46; When intake is inadequate in such situations&#44; malnutrition will worsen and will have a negative impact on clinical outcomes beyond its intrinsic detrimental effects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">On the other hand&#44; disease-related malnutrition is associated with a greater use of resources and increases in health care costs&#46; A recent study conducted in the Netherlands estimated that the direct costs of disease-related malnutrition in the paediatric population of this country amounted to approximately 80 million euro a year&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In children&#44; disease-related malnutrition may develop in the context of either acute or chronic disease and hinder recovery&#46; Malnutrition not only interferes with the normal growth of the child&#44; as sustained energy and protein imbalances lead to changes in body composition and functional impairment in organs and tissues&#44; with detrimental consequences in the short and the long term&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">One example of the association between disease and nutritional status is malnutrition in children with inflammatory bowel disease &#40;IBD&#41;&#44; a disorder in which loss of appetite and increased energy expenditure are associated with decreased serum levels of insulin-like growth factor 1 &#40;IGF-1&#41; secondary to the activity of proinflammatory cytokines&#46; The addition of biologic agents to the therapeutic armamentarium against paediatric IBD has achieved an improvement in growth outcomes in these children&#46; Bone health is also frequently affected in patients with IBD in association with micronutrient deficiencies&#44; decreased physical activity and inflammation itself&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gastrointestinal diseases are not the only diseases that can affect nutritional status&#46; There is ample evidence of the growth impairment experienced by children with chronic renal diseases&#44; and also of the positive impact that nutritional therapy can have on the outcomes of renal disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nutritional assessment and treatment should therefore be included in the comprehensive care of ill children&#46; In the current issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span>&#44; Santiago Lozano et al&#46; report a substantial prevalence of malnutrition in a sample of children managed with continuous renal replacement therapy in a paediatric intensive care unit&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In recent years&#44; there has been a growing interest in the early detection of patients at risk of developing complications related to nutrition during hospitalization&#46; This has led to the development of different nutritional screening tools designed specifically for this purpose&#44; and studies have been published documenting the association between nutritional risk in hospitalised children and the incidence of short-term complications&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; the use of such screening tools in children&#8217;s hospitals in Spain is not yet widespread&#44; and the importance of maintaining an adequate intake is often underestimated or overlooked in the management of ill children&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">From a nutritional standpoint&#44; every specific situation in which a child is ill requires correct assessment&#44; not only to determine the nutritional status itself&#44; but also to determine the impact that the underlying disease and its treatment may have on energy expenditure and the metabolic use of nutrients &#40;which will depend on the affected organs and the type of damage&#41;&#46; Doing this allows the establishment of specific goals and identifying the most suitable strategy of nutritional care&#46; The methods used for nutritional assessment range from basic techniques like anthropometric measurements&#44; which&#44; when performed by adequately trained staff following a standardised procedure&#44; can yield a significant amount of information&#44; to more sophisticated procedures such as bioelectrical impedance analysis to study body composition or indirect calorimetry to estimate the energy expenditure&#44; which are very useful when body weight is affected by non-nutritional factors or in cases in which it is difficult to estimate the degree of metabolic stress&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Maintenance of optimal growth should be one of the treatment goals in children with chronic disease&#46; In this regard&#44; when analysis of body composition is a possibility&#44; it can contribute relevant data to help plan nutritional interventions&#46; The original article included in this issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span>&#44; &#8220;Nutritional status of a population with moderate-severe cerebral palsy&#58; Beyond the weight&#8221;&#44; Mart&#237;nez de Zabarte Fern&#225;ndez <span class="elsevierStyleItalic">et al&#46;</span> demonstrated that the functional impairments associated with cerebral palsy can influence the development of fat-free mass and therefore have an impact on energy expenditure&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Children with cerebral palsy often exhibit a mixed form of malnutrition&#44; with a decrease in fat-free body mass and a relative excess of fat body mass&#46; Children with more severe forms of disease experience multiple circumstances that interfere with maintaining an adequate nutritional status&#58; impaired oral function&#44; dysphagia&#44; changes in intestinal motility&#44; prolongation of the time required to have one meal&#44; physical inactivity&#44; etc&#46; In many cases&#44; these impairments are indications for prescription of specific nutritional interventions delivered via gastrostomy tube&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The prescription of enteral nutrition in chronically ill children must be made with caution and taking into account not only factors related to nutrition and the underlying disease&#44; but also individual and family-related factors&#46; Adequate nutritional care should not only seek to improve growth and clinical outcomes&#44; but also the quality of life of children and their families&#46; Many children with chronic diseases would benefit from some form of nutritional intervention&#44; to be determined based on the type of disease and the degree of nutritional impairment&#46; To achieve this benefit&#44; it is essential that health care professionals become aware of the importance of nutrition as part of the treatment plan&#46;</p></span>"
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Editorial
Disease-related malnutrition: An aspect to consider
La malnutrición relacionada con la enfermedad: un aspecto a considerar
Ana Moráis-López
Unidad de Nutrición Infantil y Enfermedades Metabólicas, Hospital Universitario La Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">When considering the pathogenesis and pathophysiology of malnutrition&#44; it is useful to distinguish between malnutrition unrelated to organic disease&#44; that is&#44; malnutrition due to environmental factors &#40;access to foods&#41; or dietary habits&#44; and malnutrition related to disease&#46; In the first case&#44; malnutrition mainly results from a decreased dietary intake&#44; which generates an imbalance relative to nutritional requirements that may affect not only growth and development&#44; but also other aspects of health&#46; In case of disease-related malnutrition&#44; however&#44; malnutrition is preceded by a state of inflammation that contributes to the energy imbalance through various mechanisms&#58; increased catabolism&#44; decreased appetite&#44; increased energy losses&#44; etc&#46; When intake is inadequate in such situations&#44; malnutrition will worsen and will have a negative impact on clinical outcomes beyond its intrinsic detrimental effects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">On the other hand&#44; disease-related malnutrition is associated with a greater use of resources and increases in health care costs&#46; A recent study conducted in the Netherlands estimated that the direct costs of disease-related malnutrition in the paediatric population of this country amounted to approximately 80 million euro a year&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In children&#44; disease-related malnutrition may develop in the context of either acute or chronic disease and hinder recovery&#46; Malnutrition not only interferes with the normal growth of the child&#44; as sustained energy and protein imbalances lead to changes in body composition and functional impairment in organs and tissues&#44; with detrimental consequences in the short and the long term&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">One example of the association between disease and nutritional status is malnutrition in children with inflammatory bowel disease &#40;IBD&#41;&#44; a disorder in which loss of appetite and increased energy expenditure are associated with decreased serum levels of insulin-like growth factor 1 &#40;IGF-1&#41; secondary to the activity of proinflammatory cytokines&#46; The addition of biologic agents to the therapeutic armamentarium against paediatric IBD has achieved an improvement in growth outcomes in these children&#46; Bone health is also frequently affected in patients with IBD in association with micronutrient deficiencies&#44; decreased physical activity and inflammation itself&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gastrointestinal diseases are not the only diseases that can affect nutritional status&#46; There is ample evidence of the growth impairment experienced by children with chronic renal diseases&#44; and also of the positive impact that nutritional therapy can have on the outcomes of renal disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nutritional assessment and treatment should therefore be included in the comprehensive care of ill children&#46; In the current issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span>&#44; Santiago Lozano et al&#46; report a substantial prevalence of malnutrition in a sample of children managed with continuous renal replacement therapy in a paediatric intensive care unit&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In recent years&#44; there has been a growing interest in the early detection of patients at risk of developing complications related to nutrition during hospitalization&#46; This has led to the development of different nutritional screening tools designed specifically for this purpose&#44; and studies have been published documenting the association between nutritional risk in hospitalised children and the incidence of short-term complications&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; the use of such screening tools in children&#8217;s hospitals in Spain is not yet widespread&#44; and the importance of maintaining an adequate intake is often underestimated or overlooked in the management of ill children&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">From a nutritional standpoint&#44; every specific situation in which a child is ill requires correct assessment&#44; not only to determine the nutritional status itself&#44; but also to determine the impact that the underlying disease and its treatment may have on energy expenditure and the metabolic use of nutrients &#40;which will depend on the affected organs and the type of damage&#41;&#46; Doing this allows the establishment of specific goals and identifying the most suitable strategy of nutritional care&#46; The methods used for nutritional assessment range from basic techniques like anthropometric measurements&#44; which&#44; when performed by adequately trained staff following a standardised procedure&#44; can yield a significant amount of information&#44; to more sophisticated procedures such as bioelectrical impedance analysis to study body composition or indirect calorimetry to estimate the energy expenditure&#44; which are very useful when body weight is affected by non-nutritional factors or in cases in which it is difficult to estimate the degree of metabolic stress&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Maintenance of optimal growth should be one of the treatment goals in children with chronic disease&#46; In this regard&#44; when analysis of body composition is a possibility&#44; it can contribute relevant data to help plan nutritional interventions&#46; The original article included in this issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span>&#44; &#8220;Nutritional status of a population with moderate-severe cerebral palsy&#58; Beyond the weight&#8221;&#44; Mart&#237;nez de Zabarte Fern&#225;ndez <span class="elsevierStyleItalic">et al&#46;</span> demonstrated that the functional impairments associated with cerebral palsy can influence the development of fat-free mass and therefore have an impact on energy expenditure&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Children with cerebral palsy often exhibit a mixed form of malnutrition&#44; with a decrease in fat-free body mass and a relative excess of fat body mass&#46; Children with more severe forms of disease experience multiple circumstances that interfere with maintaining an adequate nutritional status&#58; impaired oral function&#44; dysphagia&#44; changes in intestinal motility&#44; prolongation of the time required to have one meal&#44; physical inactivity&#44; etc&#46; In many cases&#44; these impairments are indications for prescription of specific nutritional interventions delivered via gastrostomy tube&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The prescription of enteral nutrition in chronically ill children must be made with caution and taking into account not only factors related to nutrition and the underlying disease&#44; but also individual and family-related factors&#46; Adequate nutritional care should not only seek to improve growth and clinical outcomes&#44; but also the quality of life of children and their families&#46; Many children with chronic diseases would benefit from some form of nutritional intervention&#44; to be determined based on the type of disease and the degree of nutritional impairment&#46; To achieve this benefit&#44; it is essential that health care professionals become aware of the importance of nutrition as part of the treatment plan&#46;</p></span>"
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                            1 => "E&#46; van Puffelen"
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                            3 => "J&#46;M&#46; Hulst"
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Article information
ISSN: 23412879
Original language: English
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Idiomas
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