Impact of malnutrition on pupillary responses in pediatric population
Dilara Özkoyuncu Kocabas1, Fuat Yavrum2, Elmas Yüksel Şükün3
1Ophthalmology Department, TOBB Economics and Technology University Faculty of Medicine, Ankara, Turkey.
Insights
Malnourished children exhibit smaller pupil sizes and faster pupil dilation speeds compared to healthy children, suggesting potential autonomic nervous system dysfunction. This highlights the impact of poor nutrition on ocular responses in pediatric populations.
Area of Science:
- Ophthalmology
- Pediatrics
- Nutritional Science
Background:
- Nutritional status significantly impacts overall health, including neurological and physiological functions.
- Pupillary responses are sensitive indicators of autonomic nervous system function.
- Suboptimal nutrition in children can lead to various health complications, potentially affecting ocular parameters.
Purpose of the Study:
- To evaluate the influence of nutritional status on pupillary light reflexes in children aged 5 to 18 years.
- To compare pupillary responses between malnourished and healthy children.
- To investigate correlations between nutritional markers and pupillary behavior.
Main Methods:
- Cross-sectional study involving 92 malnourished and 80 healthy children (ages 5-18).
- Assessment of serum ferritin, hemoglobin, vitamin D, and B12 levels.
- Automated pupillometry (Sirius topography) measuring static (scotopic, mesopic, photopic) and dynamic pupil responses.
- Calculation of pupil dilation speed at 10 seconds.
Main Results:
- Malnourished children had significantly lower levels of hemoglobin, ferritin, vitamin D, and B12 (p < 0.001).
- The malnutrition group displayed smaller mean pupil diameters across all luminance conditions and a higher speed of pupil dilation (p < 0.05).
- BMI z-score correlated positively with mesopic/photopic pupil diameter and negatively with pupil dilation speed (p < 0.05).
Conclusions:
- Malnourished children demonstrate altered pupillary responses, characterized by reduced pupil size and increased dilation speed.
- These findings suggest impaired autonomic function in pediatric malnutrition.
- Nutritional status is a critical factor influencing pupillary dynamics and autonomic regulation in children.
Abstract:
PurposeTo investigate the effect of nutritional status on pupillary responses in children aged 5 to 18 years.MethodsThis cross-sectional study comprised 92 eyes of malnourished children and 80 eyes of age- and gender-matched healthy children based on BMI Z-score. Serum ferritin, hemoglobin, serum 25-hydroxyvitamin D, and vitamin B12 levels were recorded. Pupillary responses were taken using Sirius topography (CSO, Italy) with the automated pupillometry function. Static pupillometry consisted of pupil diameters at scotopic, mesopic, and photopic luminances. In dynamic pupillometry, the mean pupil dilation speed at the 10th second was calculated by dividing the distance by time in each 0.2 s period.ResultsNo significant difference was observed between the groups regarding age, gender, visual acuity, and spherical equivalent (p > 0.05). Mean hemoglobin, serum ferritin, serum 25-hydroxyvitamin D, and vitamin B12 levels were lower in malnourished children than healthy children (p < 0.001). The malnutrition group had lower mean pupil diameters under all luminance and higher speed of pupil dilation compared to the control group (p < 0.05). While malnutrition subgroups were similar in terms of pupil diameters under all luminance (p > 0.05), the speed of pupil dilation was significantly different between the groups (p = 0.024). BMI z-score was positively correlated with mesopic and photopic pupil diameter but also negatively correlated with the speed of pupil dilation (p < 0.05).ConclusionMalnourished children have smaller pupil diameters and higher speed of pupil dilation than healthy controls, indicating an autonomic impairment.
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