1 MINISTRY OF EDUCATION & TRAINING MINISTRY OF HEALTH NATIONAL INSITUTE OF NUTRITION NGUYEN THI LUONG HANH EFFICACY OF NUTRITIONAL INTERVENTION FOR ANOREXIC CHILDREN AGED 12-36 MONTHS AFTER USING ANTIBIOTICS IN PEDIATRICS DEPARTMENT OF GENERAL HOSPITAL IN BAC NINH PROVINCE Specialize: Nutrition Code: 9720401 SUMMARY OF PhD THESIS ON NUTRITION Hanoi - 2019 THIS THESIS WAS COMPLETED AT THE INSTITUTE OF NUTRITION Science Advisors: Asc Prof Nguyen Thi Lam, MD, PhD Asc Prof Truong Tuyet Mai, MD, PhD Reviewer 1: Reviewer 2: Reviewer 3: The thesis will be evaluated by the PhD evaluation committee at the Institute of Nutrition, At the time…….h, date ………….month…… years 2019 The thesis can be found at: - The National Library - Library of the National Institute of Nutrition INTRODUCTION Anorexia is a common symptom in children, widely distributed to different ages in different pathologies The data from Vietnam and other countries indicate that anorexia occurred in about 20-50% of children aged 6-36 months Anorexia will lead to adverse consequences for the child's development such as malabsorption of nutrients in the digestive tract, growth retardation in weight and height, micronutrient deficiency, and immunodeficiency The diarrhea and respiratory infections are two manning infectious diseases in children under years old The using antibiotics too widely, often unnecessarily, especially buying antibiotics without a doctor's prescription are the causes of the increasing resistance to bacteria T1he antibiotics can disrupt the intestinal microflora, affecting the activity of digestive enzymes, in which the digestive enzyme polysaccharide is most weakened, followed by protein digesting enzymes These eating disorders have led to anorexia, malnutrition, and micronutrient deficiencies in children Studies on evaluating anorexia, especially anorexia after using antibiotics, as well as research on the production of specific nutritional products for this target group have not been paid attention For this reason, the study on " Efficacy of nutritional intervention for Anorexic children aged 12-36 months after using antibiotics in Pediatric Department of General hospital in Bac Ninh province”was conducted Objectives of the study To describe the status of anorexia, nutritional status in children 1236 months after using antibiotics in Pediatric Department, Bac Ninh General Hospital To compare the efficacy in improving anorexia, serum zinc, hemoglobin in children 12-36 months of anorexia after using antibiotics, when using nutritional products: MTH.VC (contains bioenzyme, probiotic, zinc, lysine, vitamin B1) and VC (containing zinc, lysine, vitamin B1) in Pediatric Department, Bac Ninh General Hospital To evaluate the changes in weight, gastrointestinal disorders (microflora, stool excess) of the supplement of MTH.VC and VC products for children from 12 to 36 months of age anorexia after using antibiotics New contributions of the thesis: As the first study in Vietnam to assess anorexia status among 12-36 months old children with a history of infection diseases using antibiotics Given the prevalence of anorexia in this group of children, confirming whether antibiotic used is one of the causes, or co-factors, that contribute to anorexia in children Providing scientific evidence on the effects of both MTH.VC and VC nutritional products in improving the nutritional status, reducing the risk of underweight and anorexia; positive improve zinc status, anemia and digestive microflora balance in children after using antibiotics The layout of the thesis: The thesis consists of 133 pages (excluding references and appendices), of which: Introduction: pages; Research objectives: page; Overview of documents: 38 pages; Subjects and research methods: 26 pages; Research results: 33 pages; Discussion: 30 pages; Conclusion: pages; Recommendation: page The thesis has 29 tables, figures, charts and 202 references Chapter OVERVIEW DOCUMENTS 1.1 Anorexia: diagnostic criteria, causes and consequences 1.1.1 Definition and criteria for anorexia diagnosis: Classified by WHO 1993 and American Psychological Association DSM-5: - Reduced energy consumption compared to Recommendation Dietary Allowance leads to a significant reduction in body weight compared to age, gender, growth retardation - Fear of gaining weight or becoming obese, despite being underweight - Disorders of perception, evaluation of lean body weight, not noticed the excessive impact of the current weight loss of the body .Diagnosis of anorexia in Vietnam often relies on one of the following three signs: 1) Refusing to eat or keep food in the mouth for a long time; 2) Do not eat half of the child's food for age (by day); 3) Or the child eats> 1/2 the amount of food at one meal, but due to pressure, with a long meal time (> 30 minutes) 1.1.2 Anorexia consequences Lack of energy, growth retardation; Micronutrient deficiency (iron deficiency, zinc deficiency); Affect the psychology of the child 1.1.3 The situation of eating disorders and anorexia in children The statistic data from United States and some developed countries indicesan estimated about 5% of babies are born lazy feeding, but by the age of 2-3 years olds, up to 30-40% anorexic In Vietnam, some surveys conducted in Hanoi, TP Ho Chi Minh showed that anorexia in children 1-6 years old ranged from 16.33% - 46.9%, with fluctuations depending on the age group, the highest encounter rate at 12-24 months 1.1 Anorexia after using antibiotics With the increasing incidence of infectious diseases, along with the abuse of antibiotics, causing digestive disorders, fatigue, anorexia in children may be due to the following mechanisms: 1) Imbalance in intestinal microflora; 2) Disorders of the nervous system endocrine gastrointestinal tract; 3) Disorders of excretion of digestive enzymes; 4) Loss or malabsorption of micronutrients 1.2 Solutions to prevent and treat anorexia after using antibiotics 1.2.1 Principle: The treatment process requires a close cooperation between the physician and the child's parents, from antibiotic process therapy to other treatment with appropriate dietary changes 1.2.2 Direct or individual nutrition advice: Breastfeeding guidelines, about the importance of breast milk in the first months For older children, receiving supplemented food: Should eat soft foods, diverse food, easy to digest, divided into small meals How to change foods and offer foods that your child seems to like more to encourage them to eat more, stimulate appetite How to eat when your child has a digestive disorder in case of using antibiotics… 1.2.3 Nutritional supplements and some biological products Because the use of antibiotics may have an impact on the intestinal microflora, digestive enzymes, zinc lead to digestive disorders, anorexia so it can be used: digestive enzymes, probiotics, zinc , lysine, vitamin B1 for anorexia children - Digestive enzymes: They are produced and start working from the mouth, stomach, pancreas and intestines Each type of digestive enzyme participates in specific functions and helps food digested to the absorptional units then absorbed into the lymphatic system and blood vessels, providing nutrients for all activities of the body - Use of probiotics: Their effects are restoring natural microorganisms after antibiotic treatment, helping to balance intestinal microflora, preventing diarrhea and improving anorexia status - Zinc supplement: Zinc is included in the composition of hundreds of biological enzymes, with thousands of different functions in the human body, taking part in structural functions for some enzymes The role of zinc in growth function , immune capacity of people are increasingly concerned Zinc play the improtant roles in energy metabolism and celle/tissus developpment, in appetite and growth of the children - Lysine supplementation: Lyzine plays a key role in converting fatty acids into energy Lyzine helps children to increase appetite, increase metabolism, absorb maximum nutrients Lack of lyzine can cause children to grow slowly, anorexia, easily lack of digestive enzymes and hormones - Vitamin B1 supplement: involved in glucid metabolism, in the process of transmitting nerve impulses such as acetylcholine or thymidine triphosphate (TTP) in the transportation of sodium through the nerve cell membrane and many other functions Clinical signs of B1 deficiency are also common, starting with anorexia and weight loss, mental changes and muscle weakness Chapter SUBJECTS AND METHODOLOGY 2.1 Research subjects 2.1.1 Criteria for subject selection * For objective 1: Children 12-36 months old, residing in communes of Yen Phong district, Bac Ninh province; have been examined and treated with antibiotics at Bac Ninh hospital in the period from April 2015 to May 2016 * For objective and 3: Children 12-36 months of age who are from the target of objective 1: have been treated with antibiotics, ending week to month before selection time; existing the anorexia; have the weight for/ age Z score(WAZ) from -