Metabolically Unhealthy Phenotype: A Key Factor in Determining “Pediatric” Frailty

Abstract

Frailty (FI) and metabolic syndrome (MS) are each associated with adverse health outcomes. A relationship between FI and MS has previously been described in adults. We considered the prevalence of a metabolically unhealthy phenotype (MUP) in malnourished children with neurological impairment and in subjects with obesity in comparison to a group of elderly individuals at risk of FI, and we did so in order to define the potential similarities that may underline the risk of FI in specific children. We considered 50 undernourished (defined as having a body mass index of BMI ≤ 2, standard deviation score, SDS, according to World Health Organization) disabled children; 50 children with obesity (BMI ≥ 2 SDS); 50 children who were a normal weight (−1 SDS ≤ BMI ≤ +1 SDS); 21 patients who were >75 years old. MUP was defined as the presence of at least one of the following risk factors: hypertension, hyperglycemia or diabetes, hypercholesterolemia, and hypertriglyceridemia. In children with a disability and obesity, a higher prevalence (p < 0.001) and risk (disability OR 54.88, obesity OR 13.37) of MUP was noted compared to children of a normal weight. Compared to elderly patients, the prevalence of MUP did not differ in disabled children. On the contrary, MUP was lower in children with obesity (p < 0.001) and in pediatric subjects of a normal weight (p < 0.01). MS might play a key role in “pediatric” frailty. The extremities of the aging process and malnutrition are likely key factors in the development of FI. A multidisciplinary approach to FI may represent an important milestone for pediatric care.

Clinical characteristics of children with severe neurologic impairment: A scoping review

“…Gastroesophageal reflux and feeding tubes ( n = 57, 56%) was the most common topic, with subtopics of gastroesophageal reflux ( n = 7), 7,42–44,102–104 gastrostomy tube outcomes ( n = 24), 9,39,45,46,56–65,81–84,105–110 and antireflux procedures ( n = 26) 8,47–55,66–71,85,86,111–118 . Other topics included aspiration and respiratory issues ( n = 13, 13%) 72,73,87–93,119–122 ; symptoms, palliative care, and quality of life ( n = 12, 12%) 38,41,74–77,94–97,123,124 ; growth and endocrinology ( n = 10, 10%) 78,98,99,125–131 ; caregivers and care burden ( n = 7, 7%) 10,37,40,79,80,100,132 ; other ( n = 2, 2%) 101,133 ; and musculoskeletal ( n = 1, 1%) 134 . Most studies ( n = 54, 53%) were retrospective cohorts or case series (Supporting Information: eFigure ), with a median sample size of 48 patients (range 20–240).…”

Metabolic, Endocrine, and Cardiovascular Risks in Children with Overnutrition and Undernutrition

“…There is a growing body of evidence suggesting that nutritional status can both positively and negatively modulate the organ systems involved in body homeostasis and development, thereby influencing the health risk [ 3 ]. Thus, malnourished children represent a “fragile” population and have an increased vulnerability as individuals to adverse health outcomes, including metabolic derangement, compared to others of the same age [ 4 ].…”

“…Thus, it is important to consider that different conditions of pediatric malnutrition, including childhood obesity, prenatal malnutrition, and undernutrition and overnutrition in children with disabilities and/or other chronic diseases, such as inflammatory bowel diseases, chronic respiratory disorders, and cancers, are characterized by an altered body composition and a high metabolic load on a depleted capacity for homoeostasis [ 2 ], and they may be strongly associated with a functional decline across multiple inter-related systems, as well as with resistance to stressors, which can cause vulnerability [ 4 , 11 , 12 ] to the risk of cardiovascular disease, diabetes, metabolic syndrome, endocrine disorders, immune dysfunction, and chronic inflammation.…”