Steven J. Melnick
Nicklaus Children’s Hospital, USA
Title: Pediatric Laboratory-Based Screening Methodology for Nutrition-based Disordersâ€
Biography
Biography: Steven J. Melnick
Abstract
Pediatric nutritional status assessment, typically reserved for children with overt clinical manifestation of nutrition-based disorders require comprehensive and time-consuming clinical and laboratory evaluation. However, many more children may be at risk for these disorders; long latency periods for clinical manifestation of primary and secondary (malabsorption, autoimmune, metabolic, genetic disorders and drug side-effects) nutritional deficiencies/insufficiencies and conditions related to over-nutrition, principally obesity and associated metabolic consequences. The latter form of malnutrition is complex and overlaps with conditions related to nutrient deficiency/insufficiency. Conventional nutritional evaluation is neither appropriate nor practical for the general pediatric population who are at risk for nutrition-based disorders. Given the scope of this societal health challenge, a more practical solution for recognizing children at risk for these disorders is beneficial. Such a screening tool must be evidence-based, easily administered and informative so that children with subtle manifestations of nutritional inadequacy or those at risk can be identified and directed to precise evaluation and nutritional/lifestyle interventions. This is the basis of the nutritional status screening panel known as the TOP™ (Test-Optimize-Perform) test. The panel addresses two principle categories of nutritional status; deficiency/insufficiency and nutrient metabolism. The analytes are; vitamin B12, folate, vitamin D, iron, ferritin, total cholesterol, HDL-c, Non-HDL-c, HbA1c, homocysteine, transthyretin, hs-CRP, GGT and ALT. The panel is designed to directly or indirectly assess nutrient or micronutrient inadequacies and nutrition-acquired metabolic disorders as suggested by analytes that reflect lipid and carbohydrate metabolism, protein status, inflammation/oxidative stress, insulin resistance and mitochondrial dysfunction. Details of the rationale are presented.