Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia.

PubMed

James, Philip; Sadler, Kate; Wondafrash, Mekitie; Argaw, Alemayehu; Luo, Hanqi; Geleta, Benti; Kedir, Kiya; Getnet, Yilak; Belachew, Tefera; Bahwere, Paluku

2016-01-01

Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0 cm and <12.5 cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6-59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11 cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4-15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

Preventing Acute Malnutrition among Young Children in Crises: A Prospective Intervention Study in Niger

PubMed Central

Langendorf, Céline; Roederer, Thomas; de Pee, Saskia; Brown, Denise; Doyon, Stéphane; Mamaty, Abdoul-Aziz; Touré, Lynda W.-M.; Manzo, Mahamane L.; Grais, Rebecca F.

2014-01-01

Background Finding the most appropriate strategy for the prevention of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) in young children is essential in countries like Niger with annual “hunger gaps.” Options for large-scale prevention include distribution of supplementary foods, such as fortified-blended foods or lipid-based nutrient supplements (LNSs) with or without household support (cash or food transfer). To date, there has been no direct controlled comparison between these strategies leading to debate concerning their effectiveness. We compared the effectiveness of seven preventive strategies—including distribution of nutritious supplementary foods, with or without additional household support (family food ration or cash transfer), and cash transfer only—on the incidence of SAM and MAM among children aged 6–23 months over a 5-month period, partly overlapping the hunger gap, in Maradi region, Niger. We hypothesized that distributions of supplementary foods would more effectively reduce the incidence of acute malnutrition than distributions of household support by cash transfer. Methods and Findings We conducted a prospective intervention study in 48 rural villages located within 15 km of a health center supported by Forum Santé Niger (FORSANI)/Médecins Sans Frontières in Madarounfa. Seven groups of villages (five to 11 villages) were allocated to different strategies of monthly distributions targeting households including at least one child measuring 60 cm–80 cm (at any time during the study period whatever their nutritional status): three groups received high-quantity LNS (HQ-LNS) or medium-quantity LNS (MQ-LNS) or Super Cereal Plus (SC+) with cash (€38/month [US$52/month]); one group received SC+ and family food ration; two groups received HQ-LNS or SC+ only; one group received cash only (€43/month [US$59/month]). Children 60 cm–80 cm of participating households were assessed at each monthly distribution from

Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger.

PubMed

Nackers, Fabienne; Broillet, France; Oumarou, Diakité; Djibo, Ali; Gaboulaud, Valérie; Guerin, Philippe J; Rusch, Barbara; Grais, Rebecca F; Captier, Valérie

2010-12-01

Standard nutritional treatment of moderate acute malnutrition (MAM) relies on fortified blended flours though their importance to treat this condition is a matter of discussion. With the newly introduced World Health Organization growth standards, more children at an early stage of malnutrition will be treated following the dietary protocols as for severe acute malnutrition, including ready-to-use therapeutic food (RUTF). We compared the effectiveness of RUTF and a corn/soy-blend (CSB)-based pre-mix for the treatment of MAM in the supplementary feeding programmes (SFPs) supported by Médecins Sans Frontières, located in the Zinder region (south of Niger). Children measuring 65 to <110 cm, newly admitted with MAM [weight-for-height (WHM%) between 70% and <80% of the NCHS median] were randomly allocated to receive either RUTF (Plumpy'Nut®, 1000 kcal day(-1)) or a CSB pre-mix (1231 kcal day(-1)). Other interventions were similar in both groups (e.g. weekly family ration and ration at discharge). Children were followed weekly up to recovery (WHM% ≥ 85% for 2 consecutive weeks). In total, 215 children were recruited in the RUTF group and 236 children in the CSB pre-mix group with an overall recovery rate of 79.1 and 64.4%, respectively (p < 0.001). There was no evidence for a difference between death, defaulter and non-responder rates. More transfers to the inpatient Therapeutic Feeding Centre (I-TFC) were observed in the CSB pre-mix group (19.1%) compared to the RUTF group (9.3%) (p = 0.003). The average weight gain up to discharge was 1.08 g kg(-1) day(-1) higher in the RUTF group [95% confidence interval: 0.46-1.70] and the length of stay was 2 weeks shorter in the RUTF group (p < 0.001). For the treatment of childhood MAM in Niger, RUTF resulted in a higher weight gain, a higher recovery rate, a shorter length of stay and a lower transfer rate to the I-TFC compared to a CSB pre-mix. This might have important implications on the efficacy and the quality of SFPs.

The MAM'Out project: a randomized controlled trial to assess multiannual and seasonal cash transfers for the prevention of acute malnutrition in children under 36 months in Burkina Faso.

PubMed

Tonguet-Papucci, Audrey; Huybregts, Lieven; Ait Aissa, Myriam; Huneau, Jean-François; Kolsteren, Patrick

2015-08-08

Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits. The MAM'Out research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa). The program is targeted to economically vulnerable households with children less than 1 year old at the time of inclusion. Cash is distributed to mothers and the transfers are unconditional, leading to beneficiaries' self-determination on the use of cash. The study is designed as a two-arm cluster randomized intervention trial, based on the randomization of rural villages. One group receives cash transfers via mobile phones and one is a control group. The main outcomes are the cumulative incidence of acute malnutrition and the cost-effectiveness. Child anthropometry (height, weight and MUAC) is followed, as well as indicators related to dietary diversity, food security, health center utilization, families' expenses, women empowerment and morbidities. 24 h-food recalls are also carried out. Individual interviews and focus group discussions allow collecting qualitative data. Finally, based on a theory framework built a priori, the pathways used by the cash to have an effect on the prevention of under-nutrition will be assessed. The design chosen will lead to a robust assessment of the effectiveness of the proposed intervention. Several challenges appeared while implementing the study and discrepancies with the research protocol, mainly due to unforeseen events, can be highlighted, such as

The Role of Dairy in Effectiveness and Cost of Treatment of Children With Moderate Acute Malnutrition: A Narrative Review.

PubMed

Suri, Devika J; Moorthy, Denish; Rosenberg, Irwin H

2016-06-01

Dairy is recommended in specially formulated supplementary foods to treat children with moderate acute malnutrition (MAM) but with limited evidence and added cost. Review studies of ready-to-use foods (RUFs) versus fortified blended foods (FBFs) to determine whether inclusion of dairy modifies the comparative effectiveness and cost. We reviewed literature comparing FBF and RUF in treatment of MAM among children younger than 5 years in developing countries. Outcomes of recovery from MAM, weight, and length gain were compared among treatment categories: FBF with dairy (FBF+), FBF without dairy (FBF-), RUF with dairy (RUF+), and RUF without dairy (RUF-). Supplement cost was compared per 500 kcal. Eight studies were included. Rations were heterogeneous in energy and type of dairy. Overall, RUF+, RUF-, and FBF+ performed similarly, with higher recovery and weight gain compared with FBF-. RUF+ had higher recovery (in 5 of 6 comparisons), weight gain (4 of 4), and length gain (1 of 4) versus FBF-. The RUF+ had higher recovery (1 of 2) versus FBF+, with no other differences. The RUF- versus FBF+ had no differences (0 of 2). The RUF- had higher recovery (1 of 2), weight gain (2 of 2) versus FBF-. Four studies reported supplement costs, which averaged US$0.15 (FBF-), US$0.18 (FBF+), US$0.18 (RUF-), and US$0.37 (RUF+) per 500 kcal. There is a consistent benefit of FBF that include dairy in treatment of children with MAM. Benefits of dairy in RUF require further investigation. Evidence from rigorous quantitative analysis of existing data, cost-effectiveness, and prospective trials will be essential in determining policy on treatment for children with MAM. © The Author(s) 2016.

M-Health for Improving Screening Accuracy of Acute Malnutrition in a Community-Based Management of Acute Malnutrition Program in Mumbai Informal Settlements.

PubMed

Chanani, Sheila; Wacksman, Jeremy; Deshmukh, Devika; Pantvaidya, Shanti; Fernandez, Armida; Jayaraman, Anuja

2016-12-01

Acute malnutrition is linked to child mortality and morbidity. Community-Based Management of Acute Malnutrition (CMAM) programs can be instrumental in large-scale detection and treatment of undernutrition. The World Health Organization (WHO) 2006 weight-for-height/length tables are diagnostic tools available to screen for acute malnutrition. Frontline workers (FWs) in a CMAM program in Dharavi, Mumbai, were using CommCare, a mobile application, for monitoring and case management of children in combination with the paper-based WHO simplified tables. A strategy was undertaken to digitize the WHO tables into the CommCare application. To measure differences in diagnostic accuracy in community-based screening for acute malnutrition, by FWs, using a mobile-based solution. Twenty-seven FWs initially used the paper-based tables and then switched to an updated mobile application that included a nutritional grade calculator. Human error rates specifically associated with grade classification were calculated by comparison of the grade assigned by the FW to the grade each child should have received based on the same WHO tables. Cohen kappa coefficient, sensitivity and specificity rates were also calculated and compared for paper-based grade assignments and calculator grade assignments. Comparing FWs (N = 14) who completed at least 40 screenings without and 40 with the calculator, the error rates were 5.5% and 0.7%, respectively (p < .0001). Interrater reliability (κ) increased to an almost perfect level (>.90), from .79 to .97, after switching to the mobile calculator. Sensitivity and specificity also improved significantly. The mobile calculator significantly reduces an important component of human error in using the WHO tables to assess acute malnutrition at the community level. © The Author(s) 2016.

Management of acute moderate and severe childhood malnutrition

USDA-ARS?s Scientific Manuscript database

Acute childhood malnutrition affects about a tenth of the world's children under 5 years of age, particularly those living in circumstances of extreme poverty in the developing world. Malnutrition is typically the result of an inadequate diet and is one of the most common diagnoses in children in he...

Malnutrition in Patients with Acute Stroke

PubMed Central

Bouziana, Stella D.; Tziomalos, Konstantinos

2011-01-01

Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding. PMID:22254136

Home-based therapy for severe acute malnutrition with ready-to-use food

USDA-ARS?s Scientific Manuscript database

Severe acute malnutrition is a devastating condition afflicting children under 5 years in many developing countries, but concentrated in sub-Saharan Africa. This paper examines the development of home-based lipid-nutrient therapeutic foods for the treatment of acute malnutrition in sub-Saharan Afric...

Ready-to-use foods for management of moderate acute malnutrition: considerations for scaling up production and use in programs.

PubMed

Osendarp, Saskia; Rogers, Beatrice; Ryan, Kelsey; Manary, Mark; Akomo, Peter; Bahwere, Paluku; Belete, Hilina; Zeilani, Mamane; Islam, Munirul; Dibari, Filippo; De Pee, Saskia

2015-03-01

Ready-to-use foods are one of the available strategies for the treatment of moderate acute malnutrition (MAM), but challenges remain in the use of these products in programs at scale. This paper focuses on two challenges: the need for cheaper formulations using locally available ingredients that are processed in a safe, reliable, and financially sustainable local production facility; and the effective use of these products in large-scale community-based programs. Linear programming tools can be used successfully to design local compositions that are in line with international guidelines, low in cost, and acceptable, and the efficacy of these local formulations in the treatment of MAM was recently demonstrated in Malawi. The production of local formulations for programs at scale relies on the existence of a reliable and efficient local production facility. Technical assistance may be required in the development of sustainable business models at an early stage in the process, taking into account the stringent product quality and safety criteria and the required investments. The use of ready-to-use products, as of any food supplement, in programs at scale will be affected by the practice of household sharing and diversion of these products for other uses. Additional measures can be considered to account for sharing. These products designed for the treatment and prevention of MAM are to be used in community-based programs and should therefore be used in conjunction with other interventions and designed so that they do not replace the intake of other foods and breastmilk. Remaining challenges and implications for the (operations) research agenda are discussed.

Severe acute malnutrition.

PubMed

Nel, E D

2016-05-01

The mortality and morbidity associated with severe acute malnutrition (SAM) remain high. A summary of recent studies that are of interest to clinicians treating children with SAM is provided. Three important themes emerged in 2015: the use of anthropometry in the diagnosis of SAM and its correlation with body composition; the composition of ready-to-use therapeutic feeds (RUTF); and an improved understanding of the pathophysiology of SAM. Standard anthropometry does not accurately predict body composition and mid-upper arm circumference more accurately reflects fat mass in children. As single measure, mid-upper arm circumference identifies those children who are most likely to die from SAM and is not influenced by dehydration. However, a significant proportion of SAM children requiring treatment will not be detected. Present RUTF formulations are deficient in long chain polyunsaturated fatty acids. Current evidence suggests that preformed docosahexaenoic acid should be added and/or the content of linoleic acid reduced in RUTF. In contrast to an animal model, stabile children with SAM have the same cardiac index as children without SAM. The situation in haemodynamically unstable children is unknown, continued conservative use of intravenous fluids seems advisable. A reduction in variability of the faecal DNA virome may account for increased susceptibility to malnutrition in vulnerable children.

Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial.

PubMed

Stobaugh, Heather C; Ryan, Kelsey N; Kennedy, Julie A; Grise, Jennifer B; Crocker, Audrey H; Thakwalakwa, Chrissie; Litkowski, Patricia E; Maleta, Kenneth M; Manary, Mark J; Trehan, Indi

2016-03-01

The utility of dairy ingredients in the supplementary foods used in the treatment of childhood moderate acute malnutrition (MAM) remains unsettled. We evaluated the effectiveness of a peanut-based ready-to-use supplementary food (RUSF) with soy protein compared with a novel RUSF containing dairy ingredients in the form of whey permeate and whey protein concentrate in the treatment of children with MAM. We conducted a randomized, double-blind clinical effectiveness trial involving rural Malawian and Mozambican children 6-59 mo of age with MAM treated with either soy RUSF or a novel whey RUSF treatment of ~75 kcal · kg(-1) · d(-1) for up to 12 wk. The proportion of children that recovered from MAM was significantly higher in the group that received whey RUSF (960 of 1144; 83.9%) than in the group that received soy RUSF (874 of 1086; 80.5%; P < 0.04; risk difference 3.4%, 95% CI: 0.3%, 6.6%). Children who consumed whey RUSF also demonstrated better growth markers, with a higher mean midupper arm circumference (MUAC) at the time of discharge (P < 0.009), greater MUAC gain during the course of treatment (P < 0.003), higher mean weight-for-height z score at discharge (P < 0.008), and greater weight gain (P < 0.05). No significant differences were identified in length gain or time to recovery between the 2 groups. This study highlights the importance of milk protein in the treatment of MAM, because the use of a novel whey RUSF resulted in higher recovery rates and improved growth than did soy RUSF, although the whey RUSF supplement provided less total protein and energy than the soy RUSF. This study was registered at clinicaltrials.gov as NCT01790048. © 2016 American Society for Nutrition.

Program Responses to Acute and Chronic Malnutrition: Divergences and Convergences123

PubMed Central

Bergeron, Gilles; Castleman, Tony

2012-01-01

Program approaches for addressing acute malnutrition and those for addressing chronic malnutrition have grown in different directions. Their specialization has led to productive advances in the efficacy of specific interventions but has also created divergences in implementation. Greater convergence and integration between the 2 sets of approaches would help programs respond to the diversity of conditions faced in the field and enable a more comprehensive continuum of care from prevention to treatment. After reviewing the causes of the differences in approach, this paper examines programmatic and scientific challenges to greater convergence and suggests steps to promote effective integration of acute and chronic malnutrition services. Steps include strengthening community linkages between program platforms, assessing the degree and type of integration needed in various situations, identifying cost efficiencies, and developing joint tools where possible. PMID:22516735

The MAM rodent model of schizophrenia

PubMed Central

Lodge, Daniel J.

2013-01-01

Rodent models of human disease are essential to obtain a better understanding of disease pathology, the mechanism of action underlying conventional treatments, as well as for the generation of novel therapeutic approaches. There are a number of rodent models of schizophrenia based on either genetic manipulations, acute or sub-chronic drug administration, or developmental disturbances. The prenatal methylazoxymethanol acetate (MAM) rodent model is a developmental disruption model gaining increased attention because it displays a number of histological, neurophysiological and behavioral deficits analogous to those observed in schizophrenia patients. This unit describes the procedures required to safely induce the MAM phenotype in rats. In addition, we describe a simple behavioral procedure, amphetamine-induced hyper-locomotion, which can be utilized to verify the MAM phenotype. PMID:23559309

Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries.

PubMed

Lazzerini, Marzia; Rubert, Laura; Pani, Paola

2013-06-21

Moderate acute malnutrition, also called moderate wasting, affects around 10% of children under five years of age in low- and middle-income countries. There are different approaches to addressing malnutrition with prepared foods in these settings; for example, providing lipid-based nutrient supplements or blended foods, either a full daily dose or in a low dose as a complement to the usual diet. There is no definitive consensus on the most effective way to treat children with moderate acute malnutrition. To evaluate the safety and effectiveness of different types of specially formulated foods for children with moderate acute malnutrition in low- and middle-income countries, and to assess whether foods complying or not complying with specific nutritional compositions, such as the WHO technical specifications, are safe and effective. In October 2012, we searched CENTRAL, MEDLINE, LILACS, CINAHL, BIBLIOMAP, POPLINE, ZETOC, ICTRP, mRCT, and ClinicalTrials.gov. In August 2012, we searched Embase. We also searched the reference lists of relevant papers and contacted nutrition-related organisations and researchers in this field.     We planned to included any relevant randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs), and interrupted time series (ITS) that evaluated specially formulated foods for the treatment of moderate acute malnutrition in children aged between six months and five years in low- and middle-income countries. Two authors assessed trial eligibility and risk of bias, and extracted and analysed the data. We summarised dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses using the random-effects model and assessed heterogeneity. The quality of evidence was assessed using GRADE methods. Eight randomised controlled trials, enrolling 10,037 children, met our

Acute malnutrition among under-five children in Faryab, Afghanistan: prevalence and causes

PubMed Central

Frozanfar, Muhammad Kamel; Yoshida, Yoshitoku; Yamamoto, Eiko; Reyer, Joshua A.; Dalil, Suraya; Rahimzad, Abdullah Darman; Hamajima, Nobuyuki

2016-01-01

ABSTRACT Acute malnutrition affects more than 50 million under-five (U5) children, causing 8.0% of global child deaths annually. The prevalence of acute malnutrition (wasting) among U5 children in Afghanistan was 9.5% nationally and 3.7% in Faryab province in 2013. A cross-sectional study was conducted for 600 households in Faryab to find the prevalence and causes of acute malnutrition. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Demographic results of this study showed that 54.0% of the household heads and 92.3% of the mothers had no education. Three-fourths of households had a monthly income ≤ 250 USD. According to the measurement of weight for height Z-score (WHZ), 35.0% (210/600) of the children had acute malnutrition (wasting, WHZ < −2). In more than half of the households, water, sanitation, and hygiene (WASH) conditions were poor. When adjusted, a significant association of acute malnutrition among U5 children was found with the education level of household heads (OR=1.49; 95% CI, 1.02–2.17), age of household heads (OR=2.01; 95% CI, 1.21–3.35), income (OR=1.66; 95% CI, 1.04–2.27), education level of mothers (OR=2.21; 95% CI, 1.00–4.88), age of children (OR=1.99; 95% CI, 1.32–2.93), history of children with diarrhea in the last two weeks of data collection (OR=1.57; 95% CI, 1.10–2.27), feeding frequency (OR=3.01; 95% CI, 1.21–7.46), water sources (OR=1.89; 95% CI, 1.26–2.83), and iodized salt (OR=0.59; 95% CI, 0.39–0.88). The present study indicated that an increase in education level of parents, household income, and quality of WASH would result in a significant decrease in prevalence of wasting among U5 children. PMID:27019527

[Economic impact of chronic, acute and global malnutrition in Peru].

PubMed

Alcázar, Lorena; Ocampo, Diego; Huamán-Espino, Lucio; Pablo Aparco, Juan

2013-01-01

To estimate the economic impact of chronic, acute and global malnutrition in Peru. This study, through an econometric model, estimated the economic impact of child malnutrition in two time horizons (incidental retrospective and prospective) during 2011, considering malnutrition-associated costs of health, education and productivity for the Peruvian economy. Information collected is a combination of data coming from the Demographic Survey of Family Health, the National Survey of Homes, the 2007 Census of Population and Housing, and public budget information, as well as estimates of risks a child is exposed to due to malnutrition during their first years of life. Nationwide it was found that in the perspective retrospective, the cost of child malnutrition in 2011 was 10,999 million soles, which was equal to 2.2% of GDP for that same year. Prospective costs nationwide, of those who by 2011 were 0 to 59 months, reached 4,505 million soles and represented 0.9% of GDP in 2011. Most cases stem from losses of productivity in both cases. Moreover, malnutrition affects much more both the Andes and jungle regions. The economic impact of child malnutrition represents a significant percentage of GDP, reason for which it is necessary to continue investing equitably in its prevention through participation with proven efficiency.

Acute malnutrition is common in Malawian patients with a Wilms tumour: A role for peanut butter.

PubMed

Israëls, Trijn; Borgstein, Eric; Jamali, Monica; de Kraker, Jan; Caron, Huib N; Molyneux, Elizabeth M

2009-12-15

Children with cancer in resource limited countries are often malnourished at diagnosis. Acute malnutrition is associated with more infectious complications and an increased risk of morbidity and mortality in major surgery. All new patients with the clinical diagnosis of a Wilms tumour admitted in the Queen Elizabeth Central Hospital, Blantyre, Malawi from January 2007 until June 2008 were included. We documented anthropometric parameters, tumour size and serum levels of micronutrients at diagnosis. Corrected weight (body weight - tumour weight) was repeated after 4 weeks of preoperative chemotherapy. During therapy oral feeds were encouraged and a locally made ready to use therapeutic peanut butter-based food (chiponde) supplied. A high rate of acute malnutrition was found in patients with Wilms tumour at diagnosis (45-55%), much higher than in community controls (11%). Patients (40%) and community controls (37%) had a similar, high rate of stunting (low height for age), a sign of chronic malnutrition. Tumour size at diagnosis and the degree of acute malnutrition at diagnosis was correlated; patients with a larger tumour had more severe acute malnutrition (r = -0.88, P < 0.01). With a supply of chiponde, 7 of 18 patients had a >5% increase in corrected weight during preoperative chemotherapy. Patients with a more positive nutritional course had a better tumour response to chemotherapy (r = 0.52, P < 0.05). Surprisingly, few micronutrient deficiencies were found, except for low serum levels of vitamin A (44% of patients). Acute malnutrition, superimposed on chronic malnutrition, is common in patients with Wilms tumour in Malawi. Earlier presentation needs to be encouraged. Chiponde, a peanut butter based ready-to-use-therapeutic-food, is an attractive means of nutritional support which needs further study. (c) 2009 Wiley-Liss, Inc.

Pancreatic Enzyme Replacement Therapy in Children with Severe Acute Malnutrition: A Randomized Controlled Trial.

PubMed

Bartels, Rosalie H; Bourdon, Céline; Potani, Isabel; Mhango, Brian; van den Brink, Deborah A; Mponda, John S; Muller Kobold, Anneke C; Bandsma, Robert H; Boele van Hensbroek, Michael; Voskuijl, Wieger P

2017-11-01

To assess the benefits of pancreatic enzyme replacement therapy (PERT) in children with complicated severe acute malnutrition. We conducted a randomized, controlled trial in 90 children aged 6-60 months with complicated severe acute malnutrition at the Queen Elizabeth Central Hospital in Malawi. All children received standard care; the intervention group also received PERT for 28 days. Children treated with PERT for 28 days did not gain more weight than controls (13.7 ± 9.0% in controls vs 15.3 ± 11.3% in PERT; P = .56). Exocrine pancreatic insufficiency was present in 83.1% of patients on admission and fecal elastase-1 levels increased during hospitalization mostly seen in children with nonedematous severe acute malnutrition (P <.01). Although the study was not powered to detect differences in mortality, mortality was significantly lower in the intervention group treated with pancreatic enzymes (18.6% vs 37.8%; P < .05). Children who died had low fecal fatty acid split ratios at admission. Exocrine pancreatic insufficiency was not improved by PERT, but children receiving PERT were more likely to be discharged with every passing day (P = .02) compared with controls. PERT does not improve weight gain in severely malnourished children but does increase the rate of hospital discharge. Mortality was lower in patients on PERT, a finding that needs to be investigated in a larger cohort with stratification for edematous and nonedematous malnutrition. Mortality in severe acute malnutrition is associated with markers of poor digestive function. ISRCTN.com: 57423639. Copyright © 2017 Elsevier Inc. All rights reserved.

Mitochondria-associated Endoplasmic Reticulum Membrane (MAM) Regulates Steroidogenic Activity via Steroidogenic Acute Regulatory Protein (StAR)-Voltage-dependent Anion Channel 2 (VDAC2) Interaction*

PubMed Central

Prasad, Manoj; Kaur, Jasmeet; Pawlak, Kevin J.; Bose, Mahuya; Whittal, Randy M.; Bose, Himangshu S.

2015-01-01

Steroid hormones are essential for carbohydrate metabolism, stress management, and reproduction and are synthesized from cholesterol in mitochondria of adrenal glands and gonads/ovaries. In acute stress or hormonal stimulation, steroidogenic acute regulatory protein (StAR) transports substrate cholesterol into the mitochondria for steroidogenesis by an unknown mechanism. Here, we report for the first time that StAR interacts with voltage-dependent anion channel 2 (VDAC2) at the mitochondria-associated endoplasmic reticulum membrane (MAM) prior to its translocation to the mitochondrial matrix. In the MAM, StAR interacts with mitochondrial proteins Tom22 and VDAC2. However, Tom22 knockdown by siRNA had no effect on pregnenolone synthesis. In the absence of VDAC2, StAR was expressed but not processed into the mitochondria as a mature 30-kDa protein. VDAC2 interacted with StAR via its C-terminal 20 amino acids and N-terminal amino acids 221–229, regulating the mitochondrial processing of StAR into the mature protein. In the absence of VDAC2, StAR could not enter the mitochondria or interact with MAM-associated proteins, and therefore steroidogenesis was inhibited. Furthermore, the N terminus was not essential for StAR activity, and the N-terminal deletion mutant continued to interact with VDAC2. The endoplasmic reticulum-targeting prolactin signal sequence did not affect StAR association with the MAM and thus its mitochondrial targeting. Therefore, VDAC2 controls StAR processing and activity, and MAM is thus a central location for initiating mitochondrial steroidogenesis. PMID:25505173

Acute malnutrition among children aged 6-59 months of the nomadic population in Hadaleala district, Afar region, northeast Ethiopia.

PubMed

Gizaw, Zemichael; Woldu, Wondwoson; Bitew, Bikes Destaw

2018-02-07

Acute malnutrition to be a major health burden in the world, particularly in the developing world. Acute malnutrition is associated with more than one third of the global disease burden for children. Malnourished children are physically, emotionally and intellectually less productive and suffer more from chronic illnesses and disabilities. The nature, magnitude and determinants of acute malnutrition are determined among the general populations; however, there is a lack of evidence in the nomadic communities. A cross-sectional study was conducted to assess the magnitude and factors associated with acute malnutrition among children aged 6-59 months in Hadaleala district, Afar Region. A total of 591 under-five children were included in this study, and subjects were recruited by the multistage cluster sampling technique. Data were collected by a pre-tested questionnaire and a simple anthropometric index so called mid-upper arm circumference (MUAC). The multivariable binary logistic regression analysis was used to identify factors associated with acute malnutrition on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. The prevalence of acute malnutrition was 11.8% (95% CI = 9.3, 14.8%). The highest prevalence (50%) of acute malnutrition occurred among children aged between 12.0-23.0 months. Childhood acute malnutrition was associated with the presence of two (AOR = 2.49, p < 0.05) and three (AOR = 12.87, p < 0.001) children in each household, unprotected drinking water sources (AOR = 3.78, p < 0.05), absence of the latrine (AOR = 5.24, p < 0.05), hand washing with soap (AOR = 0.21, p < 0.05), childhood diarrheal disease (AOR = 2.72, p < 0.05), and child vaccination (AOR = 0.15, p < 0.001). The prevalence of acute malnutrition among children aged 6-59 months was was higher than the national prevalence. The number of children in each household, drinking water sources

Mitochondria-associated endoplasmic reticulum membrane (MAM) regulates steroidogenic activity via steroidogenic acute regulatory protein (StAR)-voltage-dependent anion channel 2 (VDAC2) interaction.

PubMed

Prasad, Manoj; Kaur, Jasmeet; Pawlak, Kevin J; Bose, Mahuya; Whittal, Randy M; Bose, Himangshu S

2015-01-30

Steroid hormones are essential for carbohydrate metabolism, stress management, and reproduction and are synthesized from cholesterol in mitochondria of adrenal glands and gonads/ovaries. In acute stress or hormonal stimulation, steroidogenic acute regulatory protein (StAR) transports substrate cholesterol into the mitochondria for steroidogenesis by an unknown mechanism. Here, we report for the first time that StAR interacts with voltage-dependent anion channel 2 (VDAC2) at the mitochondria-associated endoplasmic reticulum membrane (MAM) prior to its translocation to the mitochondrial matrix. In the MAM, StAR interacts with mitochondrial proteins Tom22 and VDAC2. However, Tom22 knockdown by siRNA had no effect on pregnenolone synthesis. In the absence of VDAC2, StAR was expressed but not processed into the mitochondria as a mature 30-kDa protein. VDAC2 interacted with StAR via its C-terminal 20 amino acids and N-terminal amino acids 221-229, regulating the mitochondrial processing of StAR into the mature protein. In the absence of VDAC2, StAR could not enter the mitochondria or interact with MAM-associated proteins, and therefore steroidogenesis was inhibited. Furthermore, the N terminus was not essential for StAR activity, and the N-terminal deletion mutant continued to interact with VDAC2. The endoplasmic reticulum-targeting prolactin signal sequence did not affect StAR association with the MAM and thus its mitochondrial targeting. Therefore, VDAC2 controls StAR processing and activity, and MAM is thus a central location for initiating mitochondrial steroidogenesis. © 2015 by The American Society for Biochemistry and Molecular Biology, Inc.

A novel, efficient method for estimating the prevalence of acute malnutrition in resource-constrained and crisis-affected settings: A simulation study.

PubMed

Frison, Severine; Kerac, Marko; Checchi, Francesco; Nicholas, Jennifer

2017-01-01

The assessment of the prevalence of acute malnutrition in children under five is widely used for the detection of emergencies, planning interventions, advocacy, and monitoring and evaluation. This study examined PROBIT Methods which convert parameters (mean and standard deviation (SD)) of a normally distributed variable to a cumulative probability below any cut-off to estimate acute malnutrition in children under five using Middle-Upper Arm Circumference (MUAC). We assessed the performance of: PROBIT Method I, with mean MUAC from the survey sample and MUAC SD from a database of previous surveys; and PROBIT Method II, with mean and SD of MUAC observed in the survey sample. Specifically, we generated sub-samples from 852 survey datasets, simulating 100 surveys for eight sample sizes. Overall the methods were tested on 681 600 simulated surveys. PROBIT methods relying on sample sizes as small as 50 had better performance than the classic method for estimating and classifying the prevalence of acute malnutrition. They had better precision in the estimation of acute malnutrition for all sample sizes and better coverage for smaller sample sizes, while having relatively little bias. They classified situations accurately for a threshold of 5% acute malnutrition. Both PROBIT methods had similar outcomes. PROBIT Methods have a clear advantage in the assessment of acute malnutrition prevalence based on MUAC, compared to the classic method. Their use would require much lower sample sizes, thus enable great time and resource savings and permit timely and/or locally relevant prevalence estimates of acute malnutrition for a swift and well-targeted response.

Gut DNA viromes of Malawian twins discordant for severe acute malnutrition

USDA-ARS?s Scientific Manuscript database

The bacterial component of the human gut microbiota undergoes a definable program of postnatal development. Evidence is accumulating that this program is disrupted in children with severe acute malnutrition (SAM) and that their persistent gut microbiota immaturity, which is not durably repaired with...

Malnutrition and acute respiratory tract infections in Filipino children.

PubMed

Tupasi, T E; Mangubat, N V; Sunico, M E; Magdangal, D M; Navarro, E E; Leonor, Z A; Lupisan, S; Medalla, F; Lucero, M G

1990-01-01

The impact of malnutrition on morbidity and mortality associated with acute respiratory tract infection (ARI) was studied in Filipino children less than 5 years old. Malnutrition measured by weight-for-age Z-scores of less than -3 SD and less than -2 SD from the National Center for Health Statistics median reference population was associated with the following significant relative risks of morbidity: 1.24 (95% confidence interval [CI] = 1.14, 1.34) and 1.14 (95% CI = 1.08, 1.19), respectively, for ARI; and 1.9 (95% CI = 1.46, 2.39) and 1.2 (95% CI = 1.03, 1.47), respectively, for acute lower respiratory tract infection (ALRI). These risk ratios remained significant when adjusted for age, crowding, and parental smoking. Malnourished children with severe ALRI also had a mortality risk two to three times higher than that of healthy children. This risk remained significant even when adjusted for significant predictors of mortality, including clinical complications, concurrent measles, severe infections, and female gender; and for clinical factors, including extent of pneumonic infiltrates, dehydration, and hepatic enlargement. These findings underscore the importance of nutritional intervention in the control of morbidity and mortality among patients with ARI.

Deuterium dilution technique for body composition assessment: resolving methodological issues in children with moderate acute malnutrition.

PubMed

Fabiansen, Christian; Yaméogo, Charles W; Devi, Sarita; Friis, Henrik; Kurpad, Anura; Wells, Jonathan C

2017-08-01

Childhood malnutrition is highly prevalent and associated with high mortality risk. In observational and interventional studies among malnourished children, body composition is increasingly recognised as a key outcome. The deuterium dilution technique has generated high-quality data on body composition in studies of infants and young children in several settings, but its feasibility and accuracy in children suffering from moderate acute malnutrition requires further study. Prior to a large nutritional intervention trial among children with moderate acute malnutrition, we conducted pilot work to develop and adapt the deuterium dilution technique. We refined procedures for administration of isotope doses and collection of saliva. Furthermore, we established that equilibration time in local context is 3 h. These findings and the resulting standard operating procedures are important to improve data quality when using the deuterium dilution technique in malnutrition studies in field conditions, and may encourage a wider use of isotope techniques.

Screening for acute childhood malnutrition during the National Nutrition Week in mali increases treatment referrals.

PubMed

Nyirandutiye, Daniele H; Ag Iknane, Akory; Fofana, Amadou; Brown, Kenneth H

2011-01-01

To evaluate a pilot intervention designed to integrate mid-upper arm circumference (MUAC) screening for acute malnutrition into the semi-annual Child Nutrition Week (Semaine d'Intensification des Activités de Nutrition, or "SIAN") activities carried out in June 2008. A cross-sectional survey was conducted in Kolokani and Nara, two health districts in the Koulikoro region of Mali, 4-5 months after the SIAN, using a population-proportionate, multi-stage random sample of: 1) health centers, and 2) households in communities linked to each of the selected health centers. Caregivers of 1543 children who were 6-59 months of age at the time of the SIAN, 17 community-based volunteers and 45 health center staff members were interviewed. A total of 1278 children 6-59 months (83% of those studied) reportedly participated in SIAN. Of the participating children, 1258 received vitamin A (98% of SIAN participants; 82% of all eligible children), 945 received anti-helminth tablets (84% of participants; 71% of eligibles), and 669 were screened for acute malnutrition (52% of participants; 43% of eligibles). 186 of the children screened (27%) were reportedly identified as acutely malnourished. SIAN screening covered a significantly greater proportion of children than were examined in both community-based (22% of children) and health center-based screening activities (5% of children) combined during the 4-5 months after the SIAN (P<0.0001). In general, community volunteers and health personnel positively evaluated their experience adding MUAC screening to SIAN. Integrating MUAC screening for acute malnutrition in SIAN permits the assessment of a large number of children for acute malnutrition, and should be continued.

Screening for Acute Childhood Malnutrition during the National Nutrition Week in Mali Increases Treatment Referrals

PubMed Central

Nyirandutiye, Daniele H.; Ag Iknane, Akory; Fofana, Amadou; Brown, Kenneth H.

2011-01-01

Objective To evaluate a pilot intervention designed to integrate mid-upper arm circumference (MUAC) screening for acute malnutrition into the semi-annual Child Nutrition Week (Semaine d'Intensification des Activités de Nutrition, or “SIAN”) activities carried out in June 2008. Design A cross-sectional survey was conducted in Kolokani and Nara, two health districts in the Koulikoro region of Mali, 4–5 months after the SIAN, using a population-proportionate, multi-stage random sample of: 1) health centers, and 2) households in communities linked to each of the selected health centers. Caregivers of 1543 children who were 6–59 months of age at the time of the SIAN, 17 community-based volunteers and 45 health center staff members were interviewed. Results A total of 1278 children 6–59 months (83% of those studied) reportedly participated in SIAN. Of the participating children, 1258 received vitamin A (98% of SIAN participants; 82% of all eligible children), 945 received anti-helminth tablets (84% of participants; 71% of eligibles), and 669 were screened for acute malnutrition (52% of participants; 43% of eligibles). 186 of the children screened (27%) were reportedly identified as acutely malnourished. SIAN screening covered a significantly greater proportion of children than were examined in both community-based (22% of children) and health center-based screening activities (5% of children) combined during the 4-5 months after the SIAN (P<0.0001). In general, community volunteers and health personnel positively evaluated their experience adding MUAC screening to SIAN. Conclusion Integrating MUAC screening for acute malnutrition in SIAN permits the assessment of a large number of children for acute malnutrition, and should be continued. PMID:21731602

Gut Bacteria Missing in Severe Acute Malnutrition, Can We Identify Potential Probiotics by Culturomics?

PubMed Central

Tidjani Alou, Maryam; Million, Matthieu; Traore, Sory I.; Mouelhi, Donia; Khelaifia, Saber; Bachar, Dipankar; Caputo, Aurelia; Delerce, Jeremy; Brah, Souleymane; Alhousseini, Daouda; Sokhna, Cheikh; Robert, Catherine; Diallo, Bouli A.; Diallo, Aldiouma; Parola, Philippe; Golden, Michael; Lagier, Jean-Christophe

2017-01-01

Severe acute malnutrition is the world-leading cause of children under-five's death. Recent metagenomics studies have established a link between gut microbiota and severe acute malnutrition, describing an immaturity with a striking depletion in oxygen-sensitive prokaryotes. Amoxicillin and therapeutic diet cure most of the children with severe acute malnutrition but an irreversible disruption of the gut microbiota is suspected in the refractory and most severe cases. In these cases, therapeutic diet may be unable to reverse the microbiota alteration leading to persistent impaired development or death. In addition, as enteric sepsis is a major cause of death in this context, identification of missing gut microbes to be tested as probiotics (live bacteria that confer a benefit to the host) to restore rapidly the healthy gut microbiota and prevent the gut pathogenic invasion is of foremost importance. In this study, stool samples of malnourished patients with kwashiorkor and healthy children were collected from Niger and Senegal and analyzed by culturomics and metagenomics. We found a globally decreased diversity, a decrease in the hitherto unknown diversity (new species isolation), a depletion in oxygen-sensitive prokaryotes including Methanobrevibacter smithii and an enrichment in potentially pathogenic Proteobacteria, Fusobacteria and Streptococcus gallolyticus. A complex of 12 species identified only in healthy children using culturomics and metagenomics were identified as probiotics candidates, providing a possible, defined, reproducible, safe, and convenient alternative to fecal transplantation to restore a healthy gut microbiota in malnourished children. Microbiotherapy based on selected strains has the potential to improve the current treatment of severe acute malnutrition and prevent relapse and death by reestablishing a healthy gut microbiota. PMID:28588566

Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups.

PubMed

Laillou, Arnaud; Prak, Sophonneary; de Groot, Richard; Whitney, Sophie; Conkle, Joel; Horton, Lindsey; Un, Sam Oeurn; Dijkhuizen, Marjoleine A; Wieringa, Frank T

2014-01-01

Timely treatment of acute malnutrition in children <5 years of age could prevent >500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm Circumference (MUAC) of <115 mm to identify severe acute malnutrition (SAM). However, it is currently unclear how MUAC relates to the other indicator used to define acute malnutrition: weight-for-height Z-score (WHZ). Secondary data from >11,000 Cambodian children, obtained by different surveys between 2010 and 2012, was used to calculate sensitivity and ROC curves for MUAC and WHZ. The secondary analysis showed that using the current WHO cut-off of 115 mm for screening for severe acute malnutrition over 90% of children with a weight-for-height z-score (WHZ) <-3 would have been missed. Reversely, WHZ<-3 missed 80% of the children with a MUAC<115 mm. The current WHO cut-off for screening for SAM should be changed upwards from the current 115 mm. In the Cambodian data-set, a cut-off of 133 mm would allow inclusion of >65% of children with a WHZ<-3. Importantly, MUAC and WHZ identified different sub-groups of children with acute malnutrition, therefore these 2 indicators should be regarded as independent from each other. We suggest a 2-step model with MUAC used a screening at community level, followed by MUAC and WHZ measured at a primary health care unit, with both indicators used independently to diagnose severe acute malnutrition. Current guidelines should be changed to reflect this, with treatment initiated when either MUAC <115 mm or WHZ<-3.

Effect of a package of health and nutrition services on sustained recovery in children after moderate acute malnutrition and factors related to sustaining recovery: a cluster-randomized trial.

PubMed

Stobaugh, Heather C; Bollinger, Lucy B; Adams, Sara E; Crocker, Audrey H; Grise, Jennifer B; Kennedy, Julie A; Thakwalakwa, Chrissie; Maleta, Kenneth M; Dietzen, Dennis J; Manary, Mark J; Trehan, Indi

2017-08-01

Background: Children who recover from moderate acute malnutrition (MAM) have high rates of relapse in the year after nutritional recovery. Interventions to decrease these adverse outcomes are needed to maximize the overall effectiveness of supplemental feeding programs (SFPs). Objective: We evaluated the effectiveness of a package of health and nutrition interventions on improving the proportion of children who sustained recovery for 1 y after MAM treatment. We further explored factors related to sustained recovery. Design: We conducted a cluster-randomized clinical effectiveness trial involving rural Malawian children aged 6-62 mo who were enrolled on discharge from an SFP for MAM. We enrolled 718 children at 10 control sites and 769 children at 11 intervention sites. In addition to routine health and nutrition counseling, the intervention group received a package of health and nutrition interventions that consisted of a lipid nutrient supplement, deworming medication, zinc supplementation, a bed net, and malaria chemoprophylaxis. A survival analysis was used to determine the effectiveness of the intervention as well as to identify factors associated with sustained recovery. Results: Of 1383 children who returned for the full 12-mo follow-up period, 407 children (56%) and 347 children (53%) sustained recovery in the intervention and control groups, respectively. There was no significant difference in relapse-free survival curves between the treatment and control groups ( P = 0.380; log-rank test). The risk factors for relapse or death after initial recovery were a smaller midupper arm circumference on SFP admission ( P = 0.01) and discharge ( P < 0.001), a lower weight-for-height z score on discharge ( P < 0.01), and the receipt of ready-to-use supplementary food as opposed to ready-to-use therapeutic food during treatment ( P < 0.05). Conclusion: The provision of a package of health and nutrition services in addition to traditional SFP treatment has no

The effect of body shape on weight-for-height and mid-upper arm circumference based case definitions of acute malnutrition in Ethiopian children.

PubMed

Myatt, Mark; Duffield, Arabella; Seal, Andrew; Pasteur, Frances

2009-01-01

Nutritional anthropometry surveys from Somalia and Ethiopia have reported that standard weight-for-height z-score (WHZ) and mid-upper arm circumference (MUAC) case definitions return different estimates of the prevalence of acute malnutrition in pastoralist livelihood zones but similar estimates of the prevalence of acute malnutrition in the agrarian livelihood zones. A study undertaken in Somalia to investigate this finding reported that children from pastoralist livelihood zones tended to have longer limbs and lower SSRs than children from agrarian livelihood zones. The present study investigated the relationship between weight-for-height and body shape and the relationship between MUAC and body shape in different populations of Ethiopian children. Six cross-sectional nutritional anthropometry surveys were undertaken. The combined survey datasets form the study sample. Data sources were grouped according to the livelihood zone from which data originated (either settled agrarian or semi-nomadic pastoralist). Case definitions of acute malnutrition using WHZ calculated using the NCHS and WHO reference populations and MUAC uncorrected for age or height were used. The SSR was used as an index of body shape. The association between body shape and the different case definitions of acute malnutrition were investigated using standard statistical techniques. Weight-for-height and MUAC case definitions yielded similar estimates of the prevalence of acute malnutrition in agrarian children but different estimates of the prevalence of acute malnutrition in pastoralist children. These populations also exhibit different SSRs. The SSR is an important predictor of weight-for-height. The SSR is a poor predictor of MUAC. WHZ and WHZ case status in children are associated with body shape and may overestimate the prevalence of acute malnutrition in some populations. Consideration should be given as to whether WHZ should be replaced by MUAC for the purposes of estimating the prevalence

Socioeconomic factors associated with severe acute malnutrition in Jamaica.

PubMed

Thompson, Debbie S; Younger-Coleman, Novie; Lyew-Ayee, Parris; Greene, Lisa-Gaye; Boyne, Michael S; Forrester, Terrence E

2017-01-01

Severe acute malnutrition (SAM) is an important risk factor for illness and death globally, contributing to more than half of deaths in children worldwide. We hypothesized that SAM is positively correlated to poverty, low educational attainment, major crime and higher mean soil concentrations of lead, cadmium and arsenic. We reviewed admission records of infants admitted with a diagnosis of SAM over 14 years (2000-2013) in Jamaica. Poverty index, educational attainment, major crime and environmental heavy metal exposure were represented in a Geographic Information System (GIS). Cases of SAM were grouped by community and the number of cases per community/year correlated to socioeconomic variables and geochemistry data for the relevant year. 375 cases of SAM were mapped across 204 urban and rural communities in Jamaica. The mean age at admission was 9 months (range 1-45 months) and 57% were male. SAM had a positive correlation with major crime (r = 0.53; P < 0.001), but not with educational attainment or the poverty index. For every one unit increase in the number of crimes reported, the rate of occurrence of SAM cases increased by 1.01% [Incidence rate ratio (IRR) = 1.01 (95% CI = 1.006-1.014); P P<0.001]. The geochemistry data yielded no correlation between levels of heavy metals and the prevalence of malnutrition. Major crime has an independent positive association with severe acute malnutrition in Jamaican infants. This could suggest that SAM and major crime might have similar sociological origins or that criminality at the community level may be indicative of reduced income opportunities with the attendant increase in poor nutrition in the home.

Socioeconomic factors associated with severe acute malnutrition in Jamaica

PubMed Central

Thompson, Debbie S.; Younger-Coleman, Novie; Lyew-Ayee, Parris; Greene, Lisa-Gaye; Boyne, Michael S.; Forrester, Terrence E.

2017-01-01

Objectives Severe acute malnutrition (SAM) is an important risk factor for illness and death globally, contributing to more than half of deaths in children worldwide. We hypothesized that SAM is positively correlated to poverty, low educational attainment, major crime and higher mean soil concentrations of lead, cadmium and arsenic. Methods We reviewed admission records of infants admitted with a diagnosis of SAM over 14 years (2000–2013) in Jamaica. Poverty index, educational attainment, major crime and environmental heavy metal exposure were represented in a Geographic Information System (GIS). Cases of SAM were grouped by community and the number of cases per community/year correlated to socioeconomic variables and geochemistry data for the relevant year. Results 375 cases of SAM were mapped across 204 urban and rural communities in Jamaica. The mean age at admission was 9 months (range 1–45 months) and 57% were male. SAM had a positive correlation with major crime (r = 0.53; P < 0.001), but not with educational attainment or the poverty index. For every one unit increase in the number of crimes reported, the rate of occurrence of SAM cases increased by 1.01% [Incidence rate ratio (IRR) = 1.01 (95% CI = 1.006–1.014); P P<0.001]. The geochemistry data yielded no correlation between levels of heavy metals and the prevalence of malnutrition. Conclusion Major crime has an independent positive association with severe acute malnutrition in Jamaican infants. This could suggest that SAM and major crime might have similar sociological origins or that criminality at the community level may be indicative of reduced income opportunities with the attendant increase in poor nutrition in the home. PMID:28291805

Malian children with moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains and recovery rates than those treated with locally produced cereal-legume products: a community-based, cluster-randomized trial.

PubMed

Ackatia-Armah, Robert S; McDonald, Christine M; Doumbia, Seydou; Erhardt, Juergen G; Hamer, Davidson H; Brown, Kenneth H

2015-03-01

Moderate acute malnutrition (MAM), defined as weight-for-length z score between -3 and -2 or midupper arm circumference between 11.5 and 12.5 cm, affects ∼33 million children aged <5 y worldwide. The objective was to compare the effects of 4 dietary supplements for the treatment of MAM. Twelve community health centers in rural Mali were randomly assigned to provide to 1264 MAM children aged 6-35 mo one of 4 dietary supplements containing ∼500 kcal/d for 12 wk: 1) ready-to-use, lipid-based supplementary food (RUSF); 2) special corn-soy blend (CSB++); 3) locally processed, fortified flour (Misola); or 4) locally milled flours plus oil, sugar, and micronutrient powder (LMF). In total, 1178 children (93.2%) completed the study. The adjusted mean (95% CI) change in weight (kg) from baseline was greater with RUSF than with the locally processed blends and was intermediate with CSB++ [1.16 (1.08, 1.24) for RUSF, 1.04 (0.96, 1.13) for CSB++, 0.91 (0.82, 0.99) for Misola, and 0.83 (0.74, 0.92) for LMF; P < 0.001]. For length change, RUSF and CSB++ differed significantly from LMF. Sustained recovery rates were higher with RUSF (73%) than with Misola (61%) and LMF (58%), P < 0.0001; CSB++ recovery rates (68%) did not differ from any of the other groups. RUSF was more effective, but more costly, than other dietary supplements for the treatment of MAM; CSB++ yielded intermediate results. The benefits of treatment should be considered in relation to product costs and availability. © 2015 American Society for Nutrition.

Inpatient management of children with severe acute malnutrition: a review of WHO guidelines

PubMed Central

Tickell, Kirkby D

2016-01-01

Abstract Objective To understand how the World Health Organization’s (WHO’s) guidelines on the inpatient care of children with complicated severe acute malnutrition may be strengthened to improve outcomes. Methods In December 2015, we searched Google scholar and WHO’s website for WHO recommendations on severe acute malnutrition management and evaluated the history and cited evidence behind these recommendations. We systematically searched WHO International Clinical Trials Registry Platform, clinicaltrials.gov and the Controlled Trials metaRegister until 10 August 2015 for recently completed, ongoing, or pending trials. Findings WHO’s guidelines provide 33 recommendations on the topic. However, 16 (48.5%) of these recommendations were based solely on expert opinion – unsupported by published evidence. Another 11 (33.3%) of the recommendations were supported by the results of directly relevant research – i.e. either randomized trials (8) or observational studies (3). The other six recommendations (18.2%) were based on studies that were not conducted among children with complicated severe malnutrition or studies of treatment that were not identical to the recommended intervention. Trials registries included 20 studies related to the topic, including nine trials of alternative feeding regimens. Acute medical management and follow-up care studies were minimally represented. Conclusion WHO’s guidelines on the topic have a weak evidence base and have undergone limited substantive adjustments over the past decades. More trials are needed to make that evidence base more robust. If the mortality associated with severe malnutrition is to be reduced, inpatient and post-discharge management trials, supported by studies on the causes of mortality, are needed. PMID:27708469

Severe acute malnutrition and infection

PubMed Central

Jones, Kelsey D J; Berkley, James A

2014-01-01

Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. PMID:25475887

Optimal Screening of Children with Acute Malnutrition Requires a Change in Current WHO Guidelines as MUAC and WHZ Identify Different Patient Groups

PubMed Central

Laillou, Arnaud; Prak, Sophonneary; de Groot, Richard; Whitney, Sophie; Conkle, Joel; Horton, Lindsey; Un, Sam Oeurn; Dijkhuizen, Marjoleine A.; Wieringa, Frank T.

2014-01-01

Background Timely treatment of acute malnutrition in children <5 years of age could prevent >500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm Circumference (MUAC) of <115 mm to identify severe acute malnutrition (SAM). However, it is currently unclear how MUAC relates to the other indicator used to define acute malnutrition: weight-for-height Z-score (WHZ). Methods Secondary data from >11,000 Cambodian children, obtained by different surveys between 2010 and 2012, was used to calculate sensitivity and ROC curves for MUAC and WHZ. Findings The secondary analysis showed that using the current WHO cut-off of 115 mm for screening for severe acute malnutrition over 90% of children with a weight-for-height z-score (WHZ) <−3 would have been missed. Reversely, WHZ<−3 missed 80% of the children with a MUAC<115 mm. Conclusions The current WHO cut-off for screening for SAM should be changed upwards from the current 115 mm. In the Cambodian data-set, a cut-off of 133 mm would allow inclusion of >65% of children with a WHZ<−3. Importantly, MUAC and WHZ identified different sub-groups of children with acute malnutrition, therefore these 2 indicators should be regarded as independent from each other. We suggest a 2-step model with MUAC used a screening at community level, followed by MUAC and WHZ measured at a primary health care unit, with both indicators used independently to diagnose severe acute malnutrition. Current guidelines should be changed to reflect this, with treatment initiated when either MUAC <115 mm or WHZ<−3. PMID:24983995

Integration of childhood TB into guidelines for the management of acute malnutrition in high burden countries.

PubMed

Patel, L N; Detjen, A K

2017-06-21

Introduction: Childhood tuberculosis (TB) and undernutrition are major global public health challenges. In 2015, although an estimated 1 million children aged <15 years developed TB, the majority of the cases remain undiagnosed, partly due to a lack of awareness and capacity by providers who serve as the first point of care for sick children. This calls for better integration of TB with child health and nutrition services. TB can cause or worsen undernutrition, and undernutrition increases the risk of TB. Methods: Guidelines for the management of acute malnutrition from 17 high TB burden countries were reviewed to gather information on TB symptom screening, exposure history, and treatment. Results: Seven (41%) countries recommend routine TB screening among children with acute malnutrition, and six (35%) recommend obtaining a TB exposure history. Conclusion: TB screening is not consistently included in guidelines for acute malnutrition in high TB burden countries. Routine TB risk assessment, especially history of TB exposure, among acutely malnourished children, combined with improved linkages with TB services, would help increase TB case finding and could impact outcomes. Operational research on how best to integrate services at different levels of the health care system is needed.

Integration of childhood TB into guidelines for the management of acute malnutrition in high burden countries

PubMed Central

Detjen, A. K.

2017-01-01

Introduction: Childhood tuberculosis (TB) and undernutrition are major global public health challenges. In 2015, although an estimated 1 million children aged <15 years developed TB, the majority of the cases remain undiagnosed, partly due to a lack of awareness and capacity by providers who serve as the first point of care for sick children. This calls for better integration of TB with child health and nutrition services. TB can cause or worsen undernutrition, and undernutrition increases the risk of TB. Methods: Guidelines for the management of acute malnutrition from 17 high TB burden countries were reviewed to gather information on TB symptom screening, exposure history, and treatment. Results: Seven (41%) countries recommend routine TB screening among children with acute malnutrition, and six (35%) recommend obtaining a TB exposure history. Conclusion: TB screening is not consistently included in guidelines for acute malnutrition in high TB burden countries. Routine TB risk assessment, especially history of TB exposure, among acutely malnourished children, combined with improved linkages with TB services, would help increase TB case finding and could impact outcomes. Operational research on how best to integrate services at different levels of the health care system is needed. PMID:28695083

A novel fortified blended flour, corn-soy blend “plus-plus,” is not inferior to lipid-based ready-to-use supplementary foods for the treatment of moderate acute malnutrition in Malawian children12345

PubMed Central

LaGrone, Lacey N; Trehan, Indi; Meuli, Gus J; Wang, Richard J; Thakwalakwa, Chrissie; Maleta, Kenneth; Manary, Mark J

2012-01-01

Background: Children with moderate acute malnutrition (MAM) are often treated with fortified blended flours, most commonly a corn-soy blend (CSB). However, recovery rates remain <75%, lower than the rate achieved with peanut paste–based ready-to-use supplementary foods (RUSFs). To bridge this gap, a novel CSB recipe fortified with oil and dry skim milk, “CSB++,” has been developed. Objective: In this trial we compared CSB++ with 2 RUSF products for the treatment of MAM to test the hypothesis that the recovery rate achieved with CSB++ will not be >5% worse than that achieved with either RUSF. Design: We conducted a prospective, randomized, investigator-blinded, controlled noninferiority trial involving rural Malawian children aged 6–59 mo with MAM. Children received 75 kcal CSB++ · kg−1 · d−1, locally produced soy RUSF, or an imported soy/whey RUSF for ≤12 wk. Results: The recovery rate for CSB++ (n = 763 of 888; 85.9%) was similar to that for soy RUSF (795 of 806, 87.7%; risk difference: −1.82%; 95% CI: −4.95%, 1.30%) and soy/whey RUSF (807 of 918, 87.9%; risk difference: −1.99%; 95% CI: −5.10%, 1.13%). On average, children who received CSB++ required 2 d longer to recover, and the rate of weight gain was less than that with either RUSF, although height gain was the same among all 3 foods studied. Conclusions: A novel, locally produced, fortified blended flour (CSB++) was not inferior to a locally produced soy RUSF and an imported soy/whey RUSF in facilitating recovery from MAM. The recovery rate observed for CSB++ was higher than that for any other fortified blended flour tested previously. This trial is registered at clinicaltrials.gov as NCT00998517. PMID:22170366

Impact of new WHO growth standards on the prevalence of acute malnutrition and operations of feeding programs - Darfur, Sudan, 2005-2007.

PubMed

2009-06-05

Acute malnutrition among children aged 6-59 months is a key indicator routinely used for describing the presence and magnitude of humanitarian emergencies. In the past, the prevalence of acute malnutrition and admissions to feeding programs has been determined using the growth reference developed by the World Health Organization (WHO), CDC, and the National Center for Health Statistics (NCHS). In 2006, WHO released new international growth standards and recommended their use in all nutrition programs. To evaluate the impact of transitioning to the new standards, CDC analyzed anthropometric data for children aged 6-59 months from Darfur, Sudan, collected during 2005-2007. This report describes the results of that analysis, which indicated that use of the new standards would have increased the prevalence of global acute malnutrition on average by 14% and would have increased the prevalence of severe acute malnutrition on average by 100%. Admissions to feeding programs would have increased by 56% for moderately malnourished children and by 260% for severely malnourished children. For programs in Darfur, this would have resulted in approximately 23,200 more children eligible for therapeutic feeding programs. For the immediate future, the prevalence of acute malnutrition in children should be reported using both the old WHO/CDC/NCHS reference and the new WHO standards. More research is needed to better ascertain the validity of the admission criteria based on the new WHO standards in predicting malnutrition-related morbidity and mortality.

Impact of malnutrition on 12-month mortality following acute hip fracture.

PubMed

Bell, Jack J; Pulle, Ranjeev C; Crouch, Alisa M; Kuys, Suzanne S; Ferrier, Rebecca L; Whitehouse, Sarah L

2016-03-01

Studies investigating the relationship between malnutrition and post-discharge mortality following acute hip fracture yield conflicting results. This study aimed to determine whether malnutrition independently predicted 12-month post-fracture mortality after adjusting for clinically relevant covariates. An ethics approved, prospective, consecutive audit was undertaken for all surgically treated hip fracture inpatients admitted to a dedicated orthogeriatric unit (November 2010-October 2011). The 12-month mortality data were obtained by a dual search of the mortality registry and Queensland Health database. Malnutrition was evaluated using the Subjective Global Assessment. Demographic (age, gender, admission residence) and clinical covariates included fracture type, time to surgery, anaesthesia type, type of surgery, post-surgery time to mobilize and post-operative complications (delirium, pulmonary and deep vein thrombosis, cardiac complications, infections). The Charlson Comorbidity Index was retrospectively applied. All diagnoses were confirmed by the treating orthogeriatrician. A total of 322 of 346 patients were available for audit. Increased age (P = 0.004), admission from residential care (P < 0.001), Charlson Comorbidity Index (P = 0.007), malnutrition (P < 0.001), time to mobilize >48 h (P < 0.001), delirium (P = 0.003), pulmonary embolism (P = 0.029) and cardiovascular complication (P = 0.04) were associated with 12-month mortality. Logistic regression analysis demonstrated that malnutrition (odds ratio (OR) 2.4 (95% confidence interval (CI) 1.3-4.7, P = 0.007)), in addition to admission from residential care (OR 2.6 (95% CI 1.3-5.3, P = 0.005)) and pulmonary embolism (OR 11.0 (95% CI 1.5-78.7, P = 0.017)), independently predicted 12-month mortality. Findings substantiate malnutrition as an independent predictor of 12-month mortality in a representative sample of hip fracture inpatients. Effective strategies to identify and treat malnutrition in hip

Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes.

PubMed

Cerri, Anna Paola; Bellelli, Giuseppe; Mazzone, Andrea; Pittella, Francesca; Landi, Francesco; Zambon, Antonella; Annoni, Giorgio

2015-08-01

Data about the prevalence of sarcopenia among hospitalized patients is lacking and it is unclear whether the diagnostic criteria commonly used in community-dwellers is applicable in acutely ill subjects. The aims of this report are: (i) to assess the prevalence of sarcopenia among hospitalized patients; (ii) to assess whether the European Working Group on Sarcopenia in Older People (EWGSOP) criteria are applicable in an acute care setting; and (iii) to assess the mortality rate at 3 months. 103 patients admitted to the Acute Geriatric Clinic were enrolled. Inclusion criteria were: age ≥65 years and malnutrition or risk of malnutrition, according to the Mini Nutritional Assessment Short Form. Sarcopenia was diagnosed using the EWGSOP criteria by means of bioimpedance analysis, handgrip strength and gait speed, within 72 h of admission. Information on deaths was obtained by telephone interview at 3 months following discharge. Sarcopenia was diagnosed in 22 patients (21.4%). Twenty-three patients (22.3%) were not able to perform the gait speed and/or the handgrip strength because bedridden or requiring intensive treatments. In this group, a definite diagnosis of sarcopenia was not possible, lacking at least one EWGSOP criteria. Eleven (10.7%) patients died within the 3 months post-discharge period. Kaplan-Meier survival curves showed that sarcopenic patients died significantly more frequently than others (log-rank p ≤ 0.001). In a population of hospitalized elderly malnourished or at risk of malnutrition, sarcopenia is highly prevalent and associated with an increased risk to die in the short-term. Furthermore, the EWGSOP criteria cannot be satisfactorily applied in a relevant proportion of patients. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Management of severe acute malnutrition in low-income and middle-income countries

USDA-ARS?s Scientific Manuscript database

Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environm...

Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

PubMed

Bell, Jack; Bauer, Judith; Capra, Sandra; Pulle, Chrys Ranjeev

2013-06-01

Inadequate energy and protein intake leads to malnutrition; a clinical disease not without consequence post acute hip fracture. Data detailing malnutrition prevalence, incidence, and intake adequacy varies widely in this patient population. The limited success of reported interventional strategies may result from poorly defined diagnostic criteria, failure to address root causes of inadequate intake, or errors associated with selection bias. This pragmatic study used a sequential, explanatory mixed methods design to identify malnutrition aetiology, prevalence, incidence, intake adequacy, and barriers to intake in a representative sample of 44 acute hip fracture patients (73% female; mean age, 81.7 ± 10.8 years). On admission, malnutrition prevalence was 52.2%. Energy and protein requirements were only met twice in 58 weighed 24 h food records. Mean daily patient energy intake was 2957 kJ (50.9 ± 36.1 kJ·kg(-1)) and mean protein intake was 22.8 g (0.6 ± 0.46 g·kg(-1)). This contributed to a further in-patient malnutrition incidence of 11%. Barriers to intake included patient perceptions that malnutrition and (or) inadequate intake were not a problem, as well as patient and clinician perceptions that treatment for malnutrition was not a priority. Malnutrition needs to be treated as a disease not without consequence, and food should be considered as a medicine after acute hip fracture.

The Bacterial Actin MamK

PubMed Central

Ozyamak, Ertan; Kollman, Justin; Agard, David A.; Komeili, Arash

2013-01-01

It is now recognized that actin-like proteins are widespread in bacteria and, in contrast to eukaryotic actins, are highly diverse in sequence and function. The bacterial actin, MamK, represents a clade, primarily found in magnetotactic bacteria, that is involved in the proper organization of subcellular organelles, termed magnetosomes. We have previously shown that MamK from Magnetospirillum magneticum AMB-1 (AMB-1) forms dynamic filaments in vivo. To gain further insights into the molecular mechanisms that underlie MamK dynamics and function, we have now studied the in vitro properties of MamK. We demonstrate that MamK is an ATPase that, in the presence of ATP, assembles rapidly into filaments that disassemble once ATP is depleted. The mutation of a conserved active site residue (E143A) abolishes ATPase activity of MamK but not its ability to form filaments. Filament disassembly depends on both ATPase activity and potassium levels, the latter of which results in the organization of MamK filaments into bundles. These data are consistent with observations indicating that accessory factors are required to promote filament disassembly and for spatial organization of filaments in vivo. We also used cryo-electron microscopy to obtain a high resolution structure of MamK filaments. MamK adopts a two-stranded helical filament architecture, but unlike eukaryotic actin and other actin-like filaments, subunits in MamK strands are unstaggered giving rise to a unique filament architecture. Beyond extending our knowledge of the properties and function of MamK in magnetotactic bacteria, this study emphasizes the functional and structural diversity of bacterial actins in general. PMID:23204522

Severe childhood malnutrition.

PubMed

Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J; Kerac, Marko; Trehan, Indi; Briend, André

2017-09-21

The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.

The contributions of differing degrees of acute and chronic malnutrition to the intellectual development of Jamaican boys.

PubMed

Richardson, S A; Koller, H; Katz, M; Albert, K

1978-07-01

The purpose of this paper is to determine whether differing degrees and types of malnutrition cause differing degrees of mental impairment. Subjects were 59 Jamaican boys hospitalized for malnutrition in infancy and whose intelligence was assessed at school age. The measure used for degree of chronic malnutrition was height for age and for acute malnutrition weight for height. The measure of intelligence was the I.Q. (WISC). Because the social environment in which a child lives influences his intellectual development, a measure of social background was used as an independent variable in addition to the nutrition measures. Social background showed a significant effect on I.Q. but neither measure of nutrition was significant. A further analysis using comparisons who had not been hospitalized for malnutrition suggests that malnutrition may contribute to mental impairment, through a threshold effect rather than acting as a continuous variable where increasing degrees of malnutrition cause increasing degrees of mental impairment.

Effects of Malnutrition on Neutrophil/Mononuclear Cell Apoptotic Functions in Children with Acute Lymphoblastic Leukemia.

PubMed

Cakir, Fatma Betul; Berrak, Su Gülsün; Aydogan, Gonul; Tulunay, Aysin; Timur, Cetin; Canpolat, Cengiz; Eksioglu Demiralp, Emel

2017-04-01

Recent studies claim that apoptosis may explain immune dysfunction observed in malnutrition. The objective of this study was to determine the effect of malnutrition on apoptotic functions of phagocytic cells in acute lymphoblastic leukemia (ALL). Twenty-eight ALL patients (13 with malnutrition) and thirty controls were enrolled. Neutrophil and mononuclear cell apoptosis of ALL patients and the control group were studied on admission before chemotherapy and repeated at a minimum of three months after induction of chemotherapy or when the nutritional status of leukemic children improved. The apoptotic functions of both ALL groups on admission were significantly lower than those of the control group. The apoptotic functions were lower in ALL patients with malnutrition than those in ALL patients without malnutrition, but this was not statistically significant. The repeated apoptotic functions of both ALL groups were increased to similar values with the control group. This increase was found to be statistically significant. The apoptotic functions in ALL patients were not found to be affected by malnutrition. However, after dietary intervention, increased apoptotic functions in both ALL patient groups deserve mentioning. Dietary intervention should always be recommended as malnutrition or cachexia leads to multiple complications. Enhanced apoptosis might originate also from remission state of cancer.

Effectiveness of supplementary blended flour based on chickpea and cereals for the treatment of infants with moderate acute malnutrition in Iran: A randomized clinical trial.

PubMed

Javan, Roghayeh; Kooshki, Akram; Afzalaghaee, Monavvar; Aldaghi, Mitra; Yousefi, Mahdi

2017-12-01

Despite the decreasing rate of under nutrition children in recent years overall, the negative affect in growth and development make it as a main concern in the world. Applying an available and appropriate supplementary food is a major approach in treating children with Moderate Acute Malnutrition (MAM). To compare the effectiveness of a new supplementary blended flour (containing chickpea, rice, wheat and barley, named Shadameen) in combination with multivitamin/mineral supplement and nutritional counseling versus multivitamin/mineral supplement and nutritional counseling alone, in the treatment of children with MAM. This randomized controlled trial study was conducted at Heshmatiyeh Hospital in Sabzevar city in Iran, from January 2016 to December 2016. Seventy infants, aged 9 to 24 months with MAM who were referred from urban health centers to the hospital clinic were included. They were randomly assigned to receive, for about 3 months, either multivitamin / mineral supplement and nutritional counseling alone or in combination with an extra supplementary blended food. We analyzed weight, length, weight for length Z score (WLZ), weight for age Z score (WAZ) and length for weight Z score (LAZ), along with recovery rate and adverse events among the two groups. The data were analyzed using SPSS version 16. We used statistics, Chi-square, independent t-test, and Fisher's exact test for the analyses of primary and secondary outcomes. The food supplementation infant's mean weight and WLZ and WAZ were greater compared with the other group (0.81±0.29 gr and 0.55±0.33 gr, p=0.002), (0.36±0.36 and 0.02±0.52, p=0.003), (0.40±0.33 and 0.09±0.37, p=0.001). The recovery rate in the food supplemented group was significantly higher than the other group (68.4%, 31.6%, p=0.001). No adverse reactions were observed. There were no significant differences in LAZ at the end of the study between the two groups (p=0.53). This study showed that Shadameen in combination with

Prevalence of malnutrition and sarcopenia in a post-acute care geriatric unit: Applying the new ESPEN definition and EWGSOP criteria.

PubMed

Sánchez-Rodríguez, Dolores; Marco, Ester; Ronquillo-Moreno, Natalia; Miralles, Ramón; Vázquez-Ibar, Olga; Escalada, Ferran; Muniesa, Josep M

2017-10-01

The European Society of Clinical Nutrition and Metabolism (ESPEN) consensus definition of malnutrition has been applied in hospitalized older diabetics and middle-aged patients, geriatric outpatients, and healthy elderly and young individuals. In a post-acute care setting, our aim was to assess malnutrition (ESPEN definition) and determine its relationship with sarcopenia in older in-patients deconditioned due to an acute process. Eighty-eight in-patients aged ≥70 years with body mass index (BMI) <30 kg/m 2 were included (84.1 years old; 62% women) and screened for malnutrition risk using biochemical markers and Mini-Nutritional Assessment-Short Form (MNA-SF). The ESPEN definition was applied: 1) BMI <18.5 kg/m 2 or 2) unintentional weight loss plus a) low BMI or b) low fat-free mass index (FFMI). European Working Group on Sarcopenia in Older People (EWGSOP) criteria were also applied. Unintentional weight loss occurred in 27 (30.7%) of 88 in-patients considered "at risk" by MNA-SF. Malnutrition prevalence was 4.5%, 7.9%, and 17% using ESPEN definitions 1, 2a, and 2b, respectively; 19.3% were malnourished. Prevalence of sarcopenia was 37.5%, of which 90.9% fulfilled ESPEN malnutrition criteria, a significant association (p = 0.02). No differences in biochemical markers were observed between patients with or without malnutrition or sarcopenia. ESPEN criteria constitute an appropriate tool to establish a malnutrition diagnosis in post-acute care. Sarcopenia, as defined by EWGSOP, was present in 37.5% of patients, of which 90.9% fulfilled ESPEN criteria; therefore, malnutrition was significantly related to sarcopenia. Additional work is needed to determine further implications of the ESPEN consensus definition. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Evaluation of the acceptability of improved supplementary foods for the treatment of moderate acute malnutrition in Burkina Faso using a mixed method approach.

PubMed

Iuel-Brockdorf, Ann-Sophie; Draebel, Tania Aase; Ritz, Christian; Fabiansen, Christian; Cichon, Bernardette; Brix Christensen, Vibeke; Yameogo, Charles; Oummani, Rouafi; Briend, André; Michaelsen, Kim F; Ashorn, Per; Filteau, Suzanne; Friis, Henrik

2016-04-01

The objective of this study was to evaluate, within the context of a randomized controlled trial of product effectiveness, the acceptability of new formulations of six corn-soy blended flours (CSB) and six lipid-based nutrient supplements (LNS) with different quantities of milk and qualities of soy for the treatment of children with moderate acute malnutrition (MAM). Our study included 1546 children aged 6-23 months and involved questionnaires after one month of supplementation home visits and interviews with a sub-sample of 20 trial participants and their caretakers, and nine focus group discussion. All 12 products were well accepted in terms of organoleptic qualities and received good ratings. However, LNS were more appreciated by caretakers and children. Additionally, an effect of soy isolate was detected on child appreciation where products with high milk content also received better ratings. CSB were not consumed as readily; 33.9% (n = 257) of children receiving CSB were reported to have leftovers compared to 17.3% (n = 134) of children receiving LNS (p=<0.001). Both CSB and LNS were referred to as foods with medicinal properties and perceived as beneficial to child health. They were both reported to have high priority in the daily feeding of the child. In conclusion, there were minimal differences in acceptability of the various CSB and LNS formulations, although CSB were less readily consumed and required smaller meal volumes. Since all products were well-accepted, decisions regarding whether the more expensive products should be used for the treatment of MAM will need to be based on their effect on child nutrition, growth and health. Future supplementary feeding programs in similar contexts could furthermore consider introducing supplementary foods as a medical treatment, as this may increase adherence and decrease sharing. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Malnutrition and poverty in Colombia].

PubMed

Rico Velasco, J; Acciarri, G; Fajardo, L F

1982-01-01

A history of colonial exploitation and a development model that concentrates wealth and excludes a large proportion of the population from the development process are the principal determinants of income distribution in Colombia. This work analyzes the extent of malnutrition among the poorest 30% of the Colombian population. The National Plan for Feeding and Nutrition (PAN), an important component of the national development plan, strives to improve the nutritional status of the most vulnerable population groups living in rural areas and marginal urban neighborhoods, with particular emphasis on mothers and children. The program initially was focussed on 11 priority regions where 5 types of interventions were developed: primary health care, environmental sanitation, food production, food distribution, and nutrition education. Because of the good results initially obtained, PAN now covers the entire national territory. A 1977 survey stratified by socioeconomic levels indicated that among the poorest 30% of the population, 67% of the children examined had low weight for age caused by a combination of chronic and acute malnutrition. 12% were considered to have severe and 23% moderate malnutrition. 8% had severe and 17% had moderate problems of height for age. 26% had deficient weight for height. Comparison of the data to normal values published by the World Health Organization clearly demonstrates the pattern of overall malnutrition indicated by weight for age figures. It can be concluded at 33% of children in the poorest 30% of the population are normal, 31% have mild malnutrition, 23% moderate malnutrition, and 12% severe malnutrition. Data on height for age indicated that 43% were normal, 32% had mild chronic malnutrition, 17% had moderate chronic malnutrition, and 8% had severe chronic malnutrition. The prevalence of acute malnutrition in the poor population measured by the ratio of weight to height was less than that of chronic or overall malnutrition. 21% were

Prevalence of malnutrition in a cohort of 509 patients with acute hip fracture: the importance of a comprehensive assessment.

PubMed

Díaz de Bustamante, M; Alarcón, T; Menéndez-Colino, R; Ramírez-Martín, R; Otero, Á; González-Montalvo, J I

2018-01-01

Backgrounds/objectives:Malnutrition is very common in acute hip fracture (HF) patients. Studies differ widely in their findings, with reported prevalences between 31 and 88% mainly because of small sample sizes and the use of different criteria. The aim of this study was to learn the prevalence of malnutrition in a large cohort of HF patients in an comprehensive way that includes the frequency of protein-energy malnutrition, vitamin D deficiency and sarcopenia. A 1-year consecutive sample of patients admitted with fragility HF in a 1300-bed public University Hospital, who were assessed within the first 72 h of admission. Clinical, functional, cognitive and laboratory variables were included. Energy malnutrition (body mass index (BMI) <22 kg/m 2 ), protein malnutrition (serum total protein <6.5 g/dl or albumin <3.5 g/dl), vitamin D deficiency (serum 25-OH-vitamin D <30 ng/dl) and sarcopenia (low muscle mass plus low grip strength) were considered. Five hundred nine HF patients were included. The mean age was 85.6±6.9 years and 79.2% were women. Ninety-nine (20.1%) patients had a BMI <22 kg/m 2 . Four hundred nine patients (81.2%) had protein malnutrition. Eighty-seven (17.1%) patients had both energy and protein malnutrition. Serum vitamin D was <30 ng/ml in 466 (93%) patients. The prevalence of sarcopenia was 17.1%. Protein malnutrition and vitamin D deficiency are the rule in acute HF patients. Energy malnutrition and sarcopenia are also common. A nutritional assessment in these patients should include these aspects together.

What Health Service Provider Factors Are Associated with Low Delivery of HIV Testing to Children with Acute Malnutrition in Dowa District of Malawi?

PubMed

Chitete, Lusungu; Puoane, Thandi

2015-01-01

The Community-based Management of Acute Malnutrition is the national program for treating acute malnutrition in Malawi. Under this program's guidelines all children enrolled should undergo an HIV test, so that those infected can receive appropriate treatment and care. However, the national data of 2012 shows a low delivery of testing. Prior studies have investigated client-related factors affecting uptake of HIV testing in Community-based Management of Acute Malnutrition program. Lacking is the information on the service provider factors that are associated with the delivery of testing. This study investigated service provider factors that affect delivery of HIV testing among children enrolled in the program and explored ways in which this could be improved. A descriptive study that used qualitative methods of data collection. Client registers were reviewed to obtain the number of children enrolled in Community-based Management of Acute Malnutrition and the number of children who were tested for HIV over a 12-month period. In-depth interviews were conducted with Community-based Management of Acute Malnutrition and HIV Testing and Counselling focal persons to investigate factors affecting HIV test delivery. Descriptive statistics were used to analyze data from client registers. Information from interviews was analyzed using a thematic approach. Quantitative data revealed that 1738 (58%) of 2981 children enrolled in Community-based Management of Acute Malnutrition were tested for HIV. From in-depth interviews four themes emerged, that is, lack of resources for HIV tests; shortage of staff skilled in HIV testing and counseling; lack of commitment among staff in referring children for HIV testing; and inadequately trained staff. There is a need for a functioning health system to help reduce child mortality resulting from HIV related conditions.

Fidelity in Animal Modeling: Prerequisite for a Mechanistic Research Front Relevant to the Inflammatory Incompetence of Acute Pediatric Malnutrition.

PubMed

Woodward, Bill

2016-04-11

Inflammatory incompetence is characteristic of acute pediatric protein-energy malnutrition, but its underlying mechanisms remain obscure. Perhaps substantially because the research front lacks the driving force of a scholarly unifying hypothesis, it is adrift and research activity is declining. A body of animal-based research points to a unifying paradigm, the Tolerance Model, with some potential to offer coherence and a mechanistic impetus to the field. However, reasonable skepticism prevails regarding the relevance of animal models of acute pediatric malnutrition; consequently, the fundamental contributions of the animal-based component of this research front are largely overlooked. Design-related modifications to improve the relevance of animal modeling in this research front include, most notably, prioritizing essential features of pediatric malnutrition pathology rather than dietary minutiae specific to infants and children, selecting windows of experimental animal development that correspond to targeted stages of pediatric immunological ontogeny, and controlling for ontogeny-related confounders. In addition, important opportunities are presented by newer tools including the immunologically humanized mouse and outbred stocks exhibiting a magnitude of genetic heterogeneity comparable to that of human populations. Sound animal modeling is within our grasp to stimulate and support a mechanistic research front relevant to the immunological problems that accompany acute pediatric malnutrition.

Metabolome disruption of the rat cerebrum induced by the acute toxic effects of the synthetic cannabinoid MAM-2201.

PubMed

Zaitsu, Kei; Hayashi, Yumi; Suzuki, Kei; Nakayama, Hiroshi; Hattori, Nanpei; Takahara, Rina; Kusano, Maiko; Tsuchihashi, Hitoshi; Ishii, Akira

2015-09-15

The aim of this study is to investigate the metabolome disruption in the rat cerebrum induced by the recently abused synthetic cannabinoid MAM-2201. MAM-2201 was intraperitoneally administered to 6-week Wistar rats at 5 or 15mg/kg (n=5), and the cerebrum metabolome alteration was investigated using a gas chromatography/tandem mass spectrometry (GC/MS/MS)-based metabolomics technique. MAM-2201 induced oligopnea and hypokinesia at the 5mg/kg dose, while more abnormal symptoms like rotational and seizure-like behaviors were observed at the 15mg/kg dose, suggesting that MAM-2201 induced neurofunctional disruptions. GC/MS/MS detected 72 metabolites in the rat cerebrum. The cerebrum levels of 12 of these metabolites, including intermediates of the tricarboxylic acid cycle (malic acid and succinic acid) and glutamic acid (Glu), were significantly changed in MAM-2201 administered groups compared to the control group. The synthetic cannabinoid MAM-2201 can disrupt not only glutamatergic neurotransmission but also energy metabolism in the rat cerebrum. Such disruption may contribute to the abnormal symptoms induced by synthetic cannabinoids. Copyright © 2015 Elsevier Inc. All rights reserved.

Severe malnutrition evaluated by patient-generated subjective global assessment results in poor outcome among adult patients with acute leukemia

PubMed Central

Li, Ji; Wang, Chang; Liu, Xiaoliang; Liu, Qiuju; Lin, Hai; Liu, Chunshui; Jin, Fengyan; Yang, Yan; Bai, Ou; Tan, Yehui; Gao, Sujun; Li, Wei

2018-01-01

Abstract To evaluate nutritional status in adult patients with acute leukemia (AL) using patient-generated subjective global assessment (PG-SGA) and to investigate the influence of nutritional status on prognosis. We observationally investigated 68 adult patients with newly diagnosed AL who received PG-SGA at the First Hospital of Jilin University between May 2013 and July 2015. Clinical features, chemotherapy regimens, biochemical indexes, body composition, complete remission (CR) rate, minimal residual disease (MRD), survival time, and side-effects of chemotherapy were compared between patients with and without severe malnutrition. Mean PG-SGA scores of the total patients were 6.1 ± 4.0, and 19 of 68 (27.9%) patients had severe malnutrition (PG-SGA score ≥9). Patients with acute myeloid leukemia (AML) had higher scores than those with acute lymphocytic leukemia (ALL; P = .011) and high-risk patients had higher scores regardless of whether they had AML or ALL (AML, P = .012; ALL, P = .043). Univariate analysis showed that severe malnutrition was correlated with age (P = .041), transferrin (P = .042), Karnofsky Performance Status score (P = .006), and C-reactive protein (CRP) (P = .018). Multivariate analysis demonstrated that severe malnutrition was associated with CRP (hazard ratio [HR] = 1.020, 95% confidence interval [CI]: 1.002–1.039, P = .026). No difference was found in CR rate (P = .831) between patients with and without malnutrition, but those who were severely malnourished had higher MRD (P = .048 in AML patients, P = .036 in ALL patients) and more gastrointestinal side-effects (P = .014). Severe malnutrition was also associated with inferior overall survival (HR = 0.243, 95% CI: 0.063–0.945, P = .041) but not with event-free survival (HR = 0.808, 95% CI: 0.338–1.934, P = .663). Severe malnutrition defined by PG-SGA in adult patients with de novo AL may result in poor outcome

Risk factors for death in children during inpatient treatment of severe acute malnutrition: a prospective cohort study.

PubMed

Rytter, Maren Jh; Babirekere-Iriso, Esther; Namusoke, Hanifa; Christensen, Vibeke B; Michaelsen, Kim F; Ritz, Christian; Mortensen, Charlotte G; Mupere, Ezekiel; Friis, Henrik

2017-02-01

Children who receive in-hospital treatment of severe acute malnutrition often have high mortality rates, and the reasons are not well understood. We assessed risk factors for death in children who were treated for malnutrition in a hospital. In a prospective observational study of 120 children who were receiving in-hospital treatment of severe acute malnutrition in Uganda with therapeutic formulas F-75 and F-100, we collected data on symptoms, clinical findings, plasma markers of refeeding syndrome (electrolytes and phosphate), and acute phase reactants, and recorded the nutritional therapy given in hospital. Seventeen children (14%) died. Clinical risk factors for death were the presence of oral thrush (HR: 5.0; 95% CI: 1.6, 15.2), a caretaker-reported severity of illness on a visual analog scale (HR: 1.7; 95% CI: 1.1, 2.6), impaired consciousness (HR: 16.7; 95% CI: 3.1, 90.4), and a capillary refill time >2 s (HR: 3.9; 95% CI: 1.4, 11.3). HIV infection was not associated with mortality (HR: 3.0; 95% CI: 0.7, 12.4), which was most likely due to low power. Biochemical risk factors were a plasma C-reactive protein concentration >15 mg/L on admission and low plasma phosphate that was measured on day 2 (HR: 8.7; 95% CI: 2.5, 30.1), particularly in edematous children. The replacement of F-75 with unfortified rice porridge to ameliorate diarrhea was associated with a higher risk of death, particularly if given during the first 2 d (HR: 5.0; 95% CI: 1.9, 13.3), which was an association that remained after adjustment for potential confounders (HR: 69.5; 95% CI: 7.0, 694.6). Refeeding syndrome may occur in children who are treated for malnutrition, even with moderately low plasma phosphate, and, in particular, in children with edematous malnutrition. The replacement of F-75 with unfortified rice porridge is associated with increased risk of death, which is possibly mediated by lowering plasma phosphate. The identified clinical risk factors may potentially improve the

Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study

PubMed Central

Jacobsen, Ellisiv Lærum; Brovold, Therese; Bergland, Astrid; Bye, Asta

2016-01-01

Objectives Data on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status. Design A cross-sectional study. Setting Two acute geriatric hospital wards in Norway. Participants This study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination <23, language difficulties or severe aphasia. Main outcome measures Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification. Results On the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β −3.3, 95% CI −4.9 to −1.7), pulmonary disease (β −2.1, 95% CI −3.7 to −0.46), cancer (β −1.7, 95% CI −3.4 to −0.033) and nutritional status. Conclusions Our study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer

Understanding factors that influence the integration of acute malnutrition interventions into the national health system in Niger.

PubMed

Deconinck, Hedwig; Hallarou, Mahaman Elh; Pesonen, Anais; Gérard, Jean Christophe; Criel, Bart; Donnen, Philippe; Macq, Jean

2016-12-01

Since 2007 to address a high burden, integration of acute malnutrition has been promoted in Niger. This paper studies factors that influenced the integration process of acute malnutrition into the Niger national health system.We used qualitative methods of observation, key informant interviews and focus group discussions at national level, two districts and nine communities selected through convenience sampling, as well as document review. A framework approach constructed around the problem, intervention, adoption system, health system characteristics and broad context guided the analysis. Data were recorded on paper, transcribed in a descriptive record, coded by themes deduced by building on the framework and triangulated for comprehensiveness.Key facilitating factors identified were knowledge and recognition of the problem helped by accurate information; effectiveness of decentralized continuity of care; compatibility with goals, support and involvement of health actors; and leadership for aligning policies and partnerships and mobilizing resources within a favourable political context driven by multisectoral development goals. Key hindering factors identified were not fully understanding severity, causes and consequences of the problem; limited utilization and trust in health interventions; high workload, and health worker turnover and attrition; and high dependence on financial and technical support based on short-term emergency funding within a context of high demographic pressure.The study uncovered influencing factors of integrating acute malnutrition into the national health system and their complex dynamics and relationships. It elicited the need for goal-oriented strategies and alignment of health actors to achieve sustainability, and systems thinking to understand pathways that foster integration. We recommend that context-specific learning of integrating acute malnutrition may expand to include causal modelling and scenario testing to inform strategy

Dietary supplementation with aromatic amino acids increases protein synthesis in children wHh severe acute malnutrition

USDA-ARS?s Scientific Manuscript database

Although 2 earlier studies reported that aromatic amino acid (AAA) supplementation of children with severe acute malnutrition (SAM) improved whole-body protein anabolism during the early postadmission (maintenance) phase of rehabilitation, it is not known whether this positive effect was maintained ...

The Prevalence of Malnutrition and Effectiveness of STRONGkids Tool in the Identification of Malnutrition Risks among Pediatric Surgical Patients

PubMed Central

Durakbaşa, Çiğdem Ulukaya; Fettahoğlu, Selma; Bayar, Ahu; Mutus, Murat; Okur, Hamit

2014-01-01

Background: High prevalence of malnutrition along with the risk for the development of malnutrition in hospitalised children has been reported. However, this problem remains largely unrecognised by healthcare workers. Aims: To determine the prevalence of malnutrition and effectiveness of STRONGkids nutritional risk screening (NRS) tool in the identification of malnutrition risk among pediatric surgical patients. Study Design: Cross-sectional study. Methods: A total of 494 pediatric surgical patients (median age 59 months, 75.8% males) were included in this prospective study conducted over 3 months. SD-scores <−2 for Body Mass Index (BMI) for age or weight-for-height (WFH) and height-for-age (HFA) were considered to indicate acute and chronic malnutrition, respectively. The STRONGkids NRS tool was used to determine risk for malnutrition. Results: Malnutrition was detected in 13.4% in this group of pediatric surgical patients. Acute malnutrition was identified in 10.1% of patients and more commonly in patients aged ≤60 months than aged >60 months (13.4 vs. 6.6%, p=0.012). Chronic malnutrition was identified in 23 (4.6%) of patients with no significant difference between age groups. There were 7 (1.4%) children with coexistent acute and chronic malnutrition. The STRONGkids tool revealed that 35.7% of patients were either in the moderate or high risk group for malnutrition. Malnutrition, as revealed by anthropometric measurements, was more likely in the presence of gastrointestinal (26.9%, p=0.004) and inguinoscrotal/penile surgery (4.0%, p=0.031), co-morbidities affecting nutritional status (p<0.001) and inpatient admissions (p=0.014). Among patients categorized as low risk for malnutrition, there were more outpatients than inpatients (89.3 vs. 10.7%, p<0.001) and more elective surgery cases than emergency surgery cases (93.4 vs. 6.6%, p<0.001). Conclusion: Providing data on the prevalence of malnutrition and risk of malnutrition in a prospectively recruited group

Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia

PubMed Central

Fiorentino, Marion; Sophonneary, Prak; Laillou, Arnaud; Whitney, Sophie; de Groot, Richard; Perignon, Marlène; Kuong, Khov; Berger, Jacques; Wieringa, Frank T.

2016-01-01

Background Early identification of children <5 yrs with acute malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) <12.5 cm or a weight-for-height Z-score (WHZ) <-2. MUAC is a simple and low-cost indicator to screen for acute malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (<-2 (moderate malnourished) or r<-3 (severe malnourished). Also, no cut-offs for MUAC are established for children >5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition. Methods To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011–2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children <5yrs and thinness for children ≥5yrs as gold standards. Among the highest values of AUC, the cut-off with the highest sensitivity and a false positive rate ≤33% was selected as the optimal cut-off. Results Optimal cut-off values increased with age. Boys had higher cut-offs than girls, except in the 8–10.9 yrs age range. In children <2yrs, the cut-off was lower for stunted children compared to non stunted children. Sensitivity of MUAC to identify WHZ<-2 and <-3 z-scores increased from 24.3% and 8.1% to >80% with the new cut-offs in comparison with the current WHO cut-offs. Conclusion Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level. PMID:26840899

A Pilot Randomized Controlled Trial of a New Supplementary Food Designed to Enhance Cognitive Performance during Prevention and Treatment of Malnutrition in Childhood.

PubMed

Roberts, Susan B; Franceschini, Maria Angela; Krauss, Amy; Lin, Pei-Yi; de Sa, Augusto Braima; Có, Raimundo; Taylor, Salima; Brown, Carrie; Chen, Oliver; Johnson, Elizabeth J; Pruzensky, William; Schlossman, Nina; Balé, Carlito; Wu, Kuan-Cheng Tony; Hagan, Katherine; Saltzman, Edward; Muentener, Paul

2017-11-01

Cognitive impairment associated with childhood malnutrition and stunting is generally considered irreversible. The aim was to test a new nutritional supplement for the prevention and treatment of moderate-acute malnutrition (MAM) focused on enhancing cognitive performance. An 11-wk, village-randomized, controlled pilot trial was conducted in 78 children aged 1-3 or 5-7 y living in villages in Guinea-Bissau. The supplement contained 291 kcal/d for young children and 350 kcal/d for older children and included 5 nutrients and 2 flavan-3-ol-rich ingredients not present in current food-based recommendations for MAM. Local bakers prepared the supplement from a combination of locally sourced items and an imported mix of ingredients, and it was administered by community health workers 5 d/wk. The primary outcome was executive function abilities at 11 wk. Secondary outcomes included additional cognitive measures and changes in z scores for weight (weight-for-age) and height (height-for-age) and hemoglobin concentrations at 11 wk. An index of cerebral blood flow (CBF) was also measured at 11 wk to explore the use of this measurement as a biological index of cognitive impairment. There were no significant differences in any outcome between groups at baseline. There was a beneficial effect of random assignment to the supplement group on working memory at 11 wk in children aged 1-3 y ( P < 0.05). This difference contrasted with no effect in older children and was not associated with faster growth rate. In addition, CBF correlated with task-switching performance ( P < 0.05). These preliminary data suggest that cognitive impairment can be monitored with measurement of CBF. In addition, the findings provide preliminary data that suggest that it may be possible to improve poor cognitive performance in young children through changes in the nutritional formulation of supplementary foods used to prevent and treat MAM. Powered studies of the new supplement formulation are needed. This

Unconditional Seasonal Cash Transfer Increases Intake of High-Nutritional-Value Foods in Young Burkinabe Children: Results of 24-Hour Dietary Recall Surveys within the Moderate Acute Malnutrition Out (MAM'Out) Randomized Controlled Trial.

PubMed

Tonguet-Papucci, Audrey; Houngbe, Freddy; Huybregts, Lieven; Ait-Aissa, Myriam; Altare, Chiara; Kolsteren, Patrick; Huneau, Jean-François

2017-07-01

Background: Cash transfer programs have the potential to improve dietary intake by improving accessibility to food. However, quantitative data on the impact of cash transfer programs on children's energy and nutrient intakes are lacking. Objective: The aim of this study was to evaluate the effect of seasonal unconditional cash transfers on children's energy, micro- and macronutrient, and food group intakes during the lean season in Burkina Faso. Methods: Within the framework of the MAM'Out (Moderate Acute Malnutrition Out) cluster-randomized controlled trial, two 24-h dietary recall surveys were conducted in July and August 2014. Daily energy and macro- and micronutrient intakes, breastfeeding practices, and food group consumption were analyzed for 322 children aged 14-27 mo from an intervention group (benefiting from unconditional cash transfer during the lean season in 2013 and 2014) and a control group by using mixed linear, logistic, and Poisson regression models or a γ-generalized linear model with log-link. A dietary diversity score was calculated on the basis of 7 food groups. Results: Unconditional cash transfers during the lean season improved the diets of rural children through a higher consumption of eggs (11.3 ± 1.55 compared with 3.25 ± 0.79 g; P < 0.001), fat (20.6 ± 0.80 compared with 16.5 ± 0.89 g; P < 0.01), and vitamin B-12 (0.40 ± 0.02 compared with 0.34 ± 0.02 mg; P < 0.001) compared with controls and higher proportions of children consuming dairy products (OR: 4.14; 95% CI: 1.48, 11.6; P < 0.05), flesh foods (OR: 2.09; 95% CI: 1.18, 3.70; P < 0.05), and iron-rich or iron-fortified foods (OR: 2.23; 95% CI: 1.20, 4.13; P < 0.05). No difference was found in energy intake between the 2 groups. The minimum dietary diversity of two-thirds of the children who benefited from cash transfers was adequate compared with only one-third in the control group ( P < 0.001). Conclusions: Unconditional seasonal cash transfer increases intakes of high

Children treated for severe acute malnutrition experience a rapid increase in physical activity a few days after admission.

PubMed

Faurholt-Jepsen, Daniel; Hansen, Kristina Beck; van Hees, Vincent T; Christensen, Line Brinch; Girma, Tsinuel; Friis, Henrik; Brage, Søren

2014-06-01

To assess physical activity at admission and during recovery from severe acute malnutrition. Ethiopian children who were admitted with severe acute malnutrition received a clinical examination each week to monitor their recovery during rehabilitation. Using accelerometry (24 h/d for 5 consecutive days) at admission and again after 10 days of rehabilitation, we assessed the level and changes of physical activity. Among 13 children included, the mean (SD) age was 31.1 months (15.5). At baseline, the day-night activity difference was relatively small, whereas the level of activity had substantially increased at follow-up. The diurnal mean acceleration level was significantly greater at follow-up for wrist (1158.8 vs 541.4 counts per minute, P = .003) but not hip movements (204.1 vs 141.5, P = .261). During daytime (6 a.m. to 10 p.m.), hip activity increased by 38% from baseline to follow-up (e(B) 1.38, 95% CI 1.17-1.62), and wrist activity more than doubled (e(B) 2.50, 95% CI 2.17-2.87). The level of physical activity among children with severe acute malnutrition is very low but increases rapidly during recovery. Accelerometry may be a useful approach in the recovery phase as an indicator of early improvement. Copyright © 2014 The Authors. Published by Mosby, Inc. All rights reserved.

Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study.

PubMed

Jacobsen, Ellisiv Lærum; Brovold, Therese; Bergland, Astrid; Bye, Asta

2016-09-06

Data on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status. A cross-sectional study. Two acute geriatric hospital wards in Norway. This study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination <23, language difficulties or severe aphasia. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification. On the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β -3.3, 95% CI -4.9 to -1.7), pulmonary disease (β -2.1, 95% CI -3.7 to -0.46), cancer (β -1.7, 95% CI -3.4 to -0.033) and nutritional status. Our study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer and pulmonary disease are significantly associated with declines in nutritional status, as

Program changes are effective and cost-effective in increasing the amount of oil used in preparing corn soy blend porridge for treatment of moderate acute malnutrition in Malawi.

PubMed

Rogers, Beatrice Lorge; Wilner, Lauren B; Maganga, Gray; Walton, Shelley Marcus; Suri, Devika J; Langlois, Breanne K; Chui, Kenneth Kwan Ho; Boiteau, Jocelyn M; Vosti, Stephen A; Webb, Patrick

2017-10-01

Corn Soy Blend (CSB) porridge is commonly prepared with oil for treatment of moderate acute malnutrition (MAM). A recent review recommended that 30 g of oil be used with 100 g of CSB to increase energy density and micronutrient absorption. This study assessed the effectiveness and cost-effectiveness of program changes aimed at achieving that target oil:CSB ratio in prepared porridge. Caregivers of children in MAM supplementary feeding programs were assigned to three groups: a control group received monthly rations of 1 L oil, 8 kg CSB in bulk, and social and behavior change communication (SBCC); intervention groups received 2.6 L oil, 8 kg CSB provided either in bulk (Group 1) or four 2-kg packages with printed messages (Group 2), and enhanced SBCC emphasizing the target oil:CSB ratio. Compared to the control, both intervention groups had higher mean added oil per 100 g CSB (18 g, p < 0.01, and 13 g, p= 0.04, higher in groups 1 and 2, respectively), and greater odds of meeting or exceeding the target ratio (28.4, p< 0.01, and 12.7, p= 0.02, in groups 1 and 2, respectively). Cost per caregiver reaching the target ratio was most favorable in Group 1 ($391 in Group 1, $527 in Group 2, and $1,666 in the control). Enhanced SBCC combined with increased oil ration resulted in increased use of oil in CSB porridge in a supplementary feeding program. Modified packaging did not improve effectiveness. However, both interventions were more cost-effective than standard programming. © 2017 The Authors Maternal & Child Nutrition Published by John Wiley & Sons Ltd.

Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial.

PubMed

Karakochuk, Crystal; van den Briel, Tina; Stephens, Derek; Zlotkin, Stanley

2012-10-01

Moderate and severe acute malnutrition affects 13% of children <5 y of age worldwide. Severe acute malnutrition affects fewer children but is associated with higher rates of mortality and morbidity. Supplementary feeding programs aim to treat moderate acute malnutrition and prevent the deterioration to severe acute malnutrition. The aim was to compare recovery rates of children with moderate acute malnutrition in supplementary feeding programs by using the newly recommended ration of ready-to-use supplementary food (RUSF) and the more conventional ration of corn-soya blend (CSB) in Ethiopia. A total of 1125 children aged 6-60 mo with moderate acute malnutrition received 16 wk of CSB or RUSF. Children were randomly assigned to receive one or the other food. The daily rations were purposely based on the conventional treatment rations distributed at the time of the study in Ethiopia: 300 g CSB and 32 g vegetable oil in the control group (1413 kcal) and 92 g RUSF in the intervention group (500 kcal). The higher ration size of CSB was provided because of expected food sharing. The HR for children in the CSB group was 0.85 (95% CI: 0.73, 0.99), which indicated that they had 15% lower recovery (P = 0.039). Recovery rates of children at the end of the 16-wk treatment period trended higher in the RUSF group (73%) than in the CSB group (67%) (P = 0.056). In comparison with CSB, the treatment of moderate acute malnutrition with RUSF resulted in higher recovery rates in children, despite the large ration size and higher energy content of the conventional CSB ration.

Protein source and quality in therapeutic foods affect the immune response and outcome in severe acute malnutrition

USDA-ARS?s Scientific Manuscript database

Protein is a vital component of therapeutic foods designed to treat severe acute malnutrition (SAM) in children; however there are still unknowns about the quality and quantity of the proteins to use in these foods. This review examines two recent studies investigating several different qualities an...

Gut Microbiota in Children Hospitalized with Oedematous and Non-Oedematous Severe Acute Malnutrition in Uganda

PubMed Central

Kristensen, Kia Hee Schultz; Wiese, Maria; Rytter, Maren Johanne Heilskov; Özçam, Mustafa; Hansen, Lars Hestbjerg; Namusoke, Hanifa; Friis, Henrik; Nielsen, Dennis Sandris

2016-01-01

Background Severe acute malnutrition (SAM) among children remains a major health problem in many developing countries. SAM manifests in both an oedematous and a non-oedematous form, with oedematous malnutrition in its most severe form also known as kwashiorkor. The pathogenesis of both types of malnutrition in children remains largely unknown, but gut microbiota (GM) dysbiosis has recently been linked to oedematous malnutrition. In the present study we aimed to assess whether GM composition differed between Ugandan children suffering from either oedematous or non-oedematous malnutrition. Methodology/Principal Findings As part of an observational study among children hospitalized with SAM aged 6–24 months in Uganda, fecal samples were collected at admission. Total genomic DNA was extracted from fecal samples, and PCR amplification was performed followed by Denaturing Gradient Gel Electrophoresis (DGGE) and tag-encoded 16S rRNA gene-targeted high throughput amplicon sequencing. Alpha and beta diversity measures were determined along with ANOVA mean relative abundance and G-test of independence followed by comparisons between groups. Of the 87 SAM children included, 62% suffered from oedematous malnutrition, 66% were boys and the mean age was 16.1 months. GM composition was found to differ between the two groups of children as determined by DGGE (p = 0.0317) and by high-throughput sequencing, with non-oedematous children having lower GM alpha diversity (p = 0.036). However, beta diversity analysis did not reveal larger differences between the GM of children with oedematous and non-oedematous SAM (ANOSIM analysis, weighted UniFrac, R = -0.0085, p = 0.584; unweighted UniFrac, R = 0.0719, p = 0.011). Conclusions/Significance Our results indicate that non-oedematous SAM children have lower GM diversity compared to oedematous SAM children, however no clear compositional differences were identified. PMID:26771456

Gut Microbiota in Children Hospitalized with Oedematous and Non-Oedematous Severe Acute Malnutrition in Uganda.

PubMed

Kristensen, Kia Hee Schultz; Wiese, Maria; Rytter, Maren Johanne Heilskov; Özçam, Mustafa; Hansen, Lars Hestbjerg; Namusoke, Hanifa; Friis, Henrik; Nielsen, Dennis Sandris

2016-01-01

Severe acute malnutrition (SAM) among children remains a major health problem in many developing countries. SAM manifests in both an oedematous and a non-oedematous form, with oedematous malnutrition in its most severe form also known as kwashiorkor. The pathogenesis of both types of malnutrition in children remains largely unknown, but gut microbiota (GM) dysbiosis has recently been linked to oedematous malnutrition. In the present study we aimed to assess whether GM composition differed between Ugandan children suffering from either oedematous or non-oedematous malnutrition. As part of an observational study among children hospitalized with SAM aged 6-24 months in Uganda, fecal samples were collected at admission. Total genomic DNA was extracted from fecal samples, and PCR amplification was performed followed by Denaturing Gradient Gel Electrophoresis (DGGE) and tag-encoded 16S rRNA gene-targeted high throughput amplicon sequencing. Alpha and beta diversity measures were determined along with ANOVA mean relative abundance and G-test of independence followed by comparisons between groups. Of the 87 SAM children included, 62% suffered from oedematous malnutrition, 66% were boys and the mean age was 16.1 months. GM composition was found to differ between the two groups of children as determined by DGGE (p = 0.0317) and by high-throughput sequencing, with non-oedematous children having lower GM alpha diversity (p = 0.036). However, beta diversity analysis did not reveal larger differences between the GM of children with oedematous and non-oedematous SAM (ANOSIM analysis, weighted UniFrac, R = -0.0085, p = 0.584; unweighted UniFrac, R = 0.0719, p = 0.011). Our results indicate that non-oedematous SAM children have lower GM diversity compared to oedematous SAM children, however no clear compositional differences were identified.

Severe malnutrition evaluated by patient-generated subjective global assessment results in poor outcome among adult patients with acute leukemia: A retrospective cohort study.

PubMed

Li, Ji; Wang, Chang; Liu, Xiaoliang; Liu, Qiuju; Lin, Hai; Liu, Chunshui; Jin, Fengyan; Yang, Yan; Bai, Ou; Tan, Yehui; Gao, Sujun; Li, Wei

2018-01-01

To evaluate nutritional status in adult patients with acute leukemia (AL) using patient-generated subjective global assessment (PG-SGA) and to investigate the influence of nutritional status on prognosis.We observationally investigated 68 adult patients with newly diagnosed AL who received PG-SGA at the First Hospital of Jilin University between May 2013 and July 2015. Clinical features, chemotherapy regimens, biochemical indexes, body composition, complete remission (CR) rate, minimal residual disease (MRD), survival time, and side-effects of chemotherapy were compared between patients with and without severe malnutrition.Mean PG-SGA scores of the total patients were 6.1 ± 4.0, and 19 of 68 (27.9%) patients had severe malnutrition (PG-SGA score ≥9). Patients with acute myeloid leukemia (AML) had higher scores than those with acute lymphocytic leukemia (ALL; P = .011) and high-risk patients had higher scores regardless of whether they had AML or ALL (AML, P = .012; ALL, P = .043). Univariate analysis showed that severe malnutrition was correlated with age (P = .041), transferrin (P = .042), Karnofsky Performance Status score (P = .006), and C-reactive protein (CRP) (P = .018). Multivariate analysis demonstrated that severe malnutrition was associated with CRP (hazard ratio [HR] = 1.020, 95% confidence interval [CI]: 1.002-1.039, P = .026). No difference was found in CR rate (P = .831) between patients with and without malnutrition, but those who were severely malnourished had higher MRD (P = .048 in AML patients, P = .036 in ALL patients) and more gastrointestinal side-effects (P = .014). Severe malnutrition was also associated with inferior overall survival (HR = 0.243, 95% CI: 0.063-0.945, P = .041) but not with event-free survival (HR = 0.808, 95% CI: 0.338-1.934, P = .663).Severe malnutrition defined by PG-SGA in adult patients with de novo AL may result in poor outcome. Copyright �

Coverage of Community-Based Management of Severe Acute Malnutrition Programmes in Twenty-One Countries, 2012-2013

PubMed Central

Rogers, Eleanor; Myatt, Mark; Woodhead, Sophie; Guerrero, Saul; Alvarez, Jose Luis

2015-01-01

Objective This paper reviews coverage data from programmes treating severe acute malnutrition (SAM) collected between July 2012 and June 2013. Design This is a descriptive study of coverage levels and barriers to coverage collected by coverage assessments of community-based SAM treatment programmes in 21 countries that were supported by the Coverage Monitoring Network. Data from 44 coverage assessments are reviewed. Setting These assessments analyse malnourished populations from 6 to 59 months old to understand the accessibility and coverage of services for treatment of acute malnutrition. The majority of assessments are from sub-Saharan Africa. Results Most of the programmes (33 of 44) failed to meet context-specific internationally agreed minimum standards for coverage. The mean level of estimated coverage achieved by the programmes in this analysis was 38.3%. The most frequently reported barriers to access were lack of awareness of malnutrition, lack of awareness of the programme, high opportunity costs, inter-programme interface problems, and previous rejection. Conclusions This study shows that coverage of CMAM is lower than previous analyses of early CTC programmes; therefore reducing programme impact. Barriers to access need to be addressed in order to start improving coverage by paying greater attention to certain activities such as community sensitisation. As barriers are interconnected focusing on specific activities, such as decentralising services to satellite sites, is likely to increase significantly utilisation of nutrition services. Programmes need to ensure that barriers are continuously monitored to ensure timely removal and increased coverage. PMID:26042827

Nutritional repletion of children with severe acute malnutrition does not affect VLDL apolipoprotein B-100 synthesis rate

USDA-ARS?s Scientific Manuscript database

VLDL apo B-100 is essential for the secretion of liver fat. It is thought that synthesis of this lipoprotein is impaired in childhood severe acute malnutrition (SAM), especially in the edematous syndromes, and that this contributes to the common occurrence of hepatic steatosis in this condition. How...

Effects of unconditional cash transfers on the outcome of treatment for severe acute malnutrition (SAM): a cluster-randomised trial in the Democratic Republic of the Congo.

PubMed

Grellety, Emmanuel; Babakazo, Pélagie; Bangana, Amina; Mwamba, Gustave; Lezama, Ines; Zagre, Noël Marie; Ategbo, Eric-Alain

2017-04-26

Cash transfer programs (CTPs) aim to strengthen financial security for vulnerable households. This potentially enables improvements in diet, hygiene, health service access and investment in food production or income generation. The effect of CTPs on the outcome of children already severely malnourished is not well delineated. The objective of this study was to test whether CTPs will improve the outcome of children treated for severe acute malnutrition (SAM) in the Democratic Republic of the Congo over 6 months. We conducted a cluster-randomised controlled trial in children with uncomplicated SAM who received treatment according to the national protocol and counselling with or without a cash supplement of US$40 monthly for 6 months. Analyses were by intention to treat. The hazard ratio of reaching full recovery from SAM was 35% higher in the intervention group than the control group (adjusted hazard ratio, 1.35, 95% confidence interval (CI) = 1.10 to 1.69, P = 0.007). The adjusted hazard ratios in the intervention group for relapse to moderate acute malnutrition (MAM) and SAM were 0.21 (95% CI = 0.11 to 0.41, P = 0.001) and 0.30 (95% CI = 0.16 to 0.58, P = 0.001) respectively. Non-response and defaulting were lower when the households received cash. All the nutritional outcomes in the intervention group were significantly better than those in the control group. After 6 months, 80% of cash-intervened children had re-gained their mid-upper arm circumference measurements and weight-for-height/length Z-scores and showed evidence of catch-up. Less than 40% of the control group had a fully successful outcome, with many deteriorating after discharge. There was a significant increase in diet diversity and food consumption scores for both groups from baseline; the increase was significantly greater in the intervention group than the control group. CTPs can increase recovery from SAM and decrease default, non-response and relapse rates during and

Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles.

PubMed

Cuneo, C Nicholas; Dansereau, Emily; Habib, Anand R; Davies, Mary; Ware, Samuel; Kornetsky, Kenneth

Haiti has the worst malnutrition rate in the Western hemisphere. In October 2010, a cholera epidemic erupted and spread rapidly throughout the country, straining Haiti's already fragile health infrastructure across all levels of care. This study reviews data from an outpatient therapeutic feeding program (OTP) for acute childhood malnutrition at a clinic in rural Haiti with a focus on the effect of the 2010 cholera epidemic on program operations. A retrospective chart review was conducted for the complete set of patients who were enrolled in the OTP from its inception in March 2009 through January 2014. A total of 187 charts were retrieved representing 176 unique patients, of whom 5 were currently enrolled in care. At admission, 96 (51.3%) met criteria for severe acute malnutrition, 88 (47.1%) met criteria for moderate acute malnutrition, and 3 (1.6%) did not meet criteria for acute malnutrition. Of the 182 completed charts, 119 (65.4%) reached their target weight (≥-1 weight-for-height z-score) by discharge (ie, were "cured"), 43 (23.6%) defaulted, 11 (6.0%) were discharged prematurely, 8 (4.4%) died, and 1 (0.5%) was hospitalized. A total of 11 patients (6.3%) who were initially admitted relapsed after discharge and were later readmitted. Data from 170 complete records (93.4%) were included in a multivariate logistic regression. Severe (vs moderate) acute malnutrition was negatively associated with likelihood of being cured when controlling for other patient- and care-related factors (OR = 0.261, P = .002). Average cholera burden was negatively correlated with likelihood of OTP treatment cure when controlling for patient- and care-related variables (OR = 0.859, P = .002) but was insignificant when controlling for year. Results from the study have been used to inform a restructuring of the clinic's acute malnutrition program toward a more community-centered model of management, the context and implications of which are discussed in relation to the existing

Dietary cysteine is used more efficiently by children with severe acute malnutrition with edema compared with those without edema

USDA-ARS?s Scientific Manuscript database

Children with edematous severe acute malnutrition (SAM) produce less cysteine than do their nonedematous counterparts. They also have marked glutathione (GSH) depletion, hair loss, skin erosion, gut mucosal atrophy, and depletion of mucins. Because GSH, skin, hair, mucosal, and mucin proteins are ri...

Tuberculosis caseload in children with severe acute malnutrition related with high hospital based mortality in Lusaka, Zambia.

PubMed

Munthali, Tendai; Chabala, Chishala; Chama, Elson; Mugode, Raider; Kapata, Nathan; Musonda, Patrick; Michelo, Charles

2017-06-12

Tuberculosis and severe acute malnutrition (SAM) in children pose a major treatment and care challenge in high HIV burden countries in Africa. We investigated the prevalence of Tuberculosis notifications among hospitalised under-five children with severe acute malnutrition. A retrospective review of medical records for all children aged 0-59 months admitted to the University Teaching Hospital from 2009 to 2013 was performed. Descriptive statistics were employed to estimate TB caseload. Logistic regression was used to identify predictors of the TB caseload. A total of (n = 9540) under-five children with SAM were admitted over the period reviewed. The median age was 16 months (IQR 11-24) and the proportion diagnosed with TB was 1.58% (95% CI 1.3, 1.8) representing 151 cases. Of these, only 37 (25%) were bacteriologically confirmed cases. The HIV seroprevalence of children with SAM and TB was 46.5%. Children with SAM and TB were 40% more likely to die than children with SAM and without TB. Tuberculosis contributes to mortality among children with SAM in high TB and HIV prevalence settings. The under detection of cases and association of TB with HIV infection in malnutrition opens up opportunities to innovate integrative case finding approaches beyond just HIV counselling and testing within existing mother and child health service areas to include TB screening and prevention interventions, as these are critical primary care elements.

Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital.

PubMed

Carrión, Silvia; Cabré, Mateu; Monteis, Rosa; Roca, Maria; Palomera, Elisabet; Serra-Prat, Mateu; Rofes, Laia; Clavé, Pere

2015-06-01

Oropharyngeal dysphagia and malnutrition are prevalent conditions in the older. The aim of this study was to explore the relationship between oropharyngeal dysphagia, nutritional status and clinical outcome in older patients admitted to an acute geriatric unit. We studied 1662 patients ≥70 years consecutively hospitalized with acute diseases, in whom dysphagia could be clinically assessed by the volume-viscosity swallow test and nutritional status with the Mini Nutritional Assessment(®). Anthropometric and laboratory measurements were taken and mortality recorded during hospital stay, at 6 months and one year after discharge was recorded. 47.4% (95% CI 45-49.8%) patients presented oropharyngeal dysphagia and 30.6% (95% CI 27.9%-33.3%), malnutrition. Both conditions were associated with multimorbidity, multiple geriatric syndromes and poor functional capacity (p < 0.001). However, patients with dysphagia presented increased prevalence of malnutrition (MNA(®) < 17 45.3% vs 18%, p < 0.001) regardless of their functional status and comorbidities (OR 2.31 (1.70-3.14)) and lower albumin and cholesterol levels. Patients with malnutrition presented an increased prevalence of dysphagia (68.4% (95% CI 63.3-73.4)). Patients with dysphagia and patients with malnutrition presented increased intrahospital, 6-month and 1-year mortality rates (p < 0.05). The poorest outcome was for patients with both conditions (1-year mortality was 65.8%). Prevalence of dysphagia was higher than malnutrition in our older patients. Dysphagia was an independent risk factor for malnutrition, and both conditions were related to poor outcome. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

A multi-center, open-label trial to compare the efficacy and pharmacokinetics of Artemether-Lumefantrine in children with severe acute malnutrition versus children without severe acute malnutrition: study protocol for the MAL-NUT study.

PubMed

Denoeud-Ndam, Lise; Dicko, Alassane; Baudin, Elisabeth; Guindo, Ousmane; Grandesso, Francesco; Sagara, Issaka; Lasry, Estrella; Palma, Pedro Pablo; Parra, Angeles M Lima; Stepniewska, Kasia; Djimde, Abdoulaye A; Barnes, Karen I; Doumbo, Ogobara K; Etard, Jean-François

2015-06-12

Malnutrition and malaria frequently coexist in sub-Saharan African countries. Studies on efficacy of antimalarial treatments usually follow the WHO standardized protocol in which severely malnourished children are systematically excluded. Few studies have assessed the efficacy of chloroquine, sulfadoxine-pyrimethamine and quinine in severe acute malnourished children. Overall, efficacy of these treatments appeared to be reduced, attributed to lower immunity and for some antimalarials altered pharmacokinetic profiles and lower drug concentrations. However, similar research on the efficacy and pharmacokinetic profiles of artemisinin-combination therapies (ACTs) and especially artemether-lumefantrine in malnourished children is currently lacking. The main objective of this study is to assess whether artemether-lumefantrine is less efficacious in children suffering from severe acute malnutrition (SAM) compared to non-SAM children, and if so, to what extent this can be attributed to a sub-optimal pharmacokinetic profile. In two sites, Ouelessebougou, Mali and Maradi, Niger, children with uncomplicated microscopically-confirmed P. falciparum malaria aged between 6 and 59 months will be enrolled. Two non-SAM children will be enrolled after the enrolment of each SAM case. Children with severe manifestations of malaria or complications of acute malnutrition needing intensive treatment will be excluded. Treatment intakes will be supervised and children will be followed-up for 42 days, according to WHO guidance for surveillance of antimalarial drug efficacy. Polymerase Chain Reaction genotyping will be used to distinguish recrudescence from re-infection. SAM children will also benefit from the national nutritional rehabilitation program. Outcomes will be compared between the SAM and non-SAM populations. The primary outcome will be adequate clinical and parasitological response at day 28 after PCR correction, estimated by Kaplan-Meier analysis. To assess the pharmacokinetic

Cost analysis of the treatment of severe acute malnutrition in West Africa.

PubMed

Isanaka, Sheila; Menzies, Nicolas A; Sayyad, Jessica; Ayoola, Mudasiru; Grais, Rebecca F; Doyon, Stéphane

2017-10-01

We present an updated cost analysis to provide new estimates of the cost of providing community-based treatment for severe acute malnutrition, including expenditure shares for major cost categories. We calculated total and per child costs from a provider perspective. We categorized costs into three main activities (outpatient treatment, inpatient treatment, and management/administration) and four cost categories within each activity (personnel; therapeutic food; medical supplies; and infrastructure and logistical support). For each category, total costs were calculated by multiplying input quantities expended in the Médecins Sans Frontières nutrition program in Niger during a 12-month study period by 2015 input prices. All children received outpatient treatment, with 43% also receiving inpatient treatment. In this large, well-established program, the average cost per child treated was €148.86, with outpatient and inpatient treatment costs of €75.50 and €134.57 per child, respectively. Therapeutic food (44%, €32.98 per child) and personnel (35%, €26.70 per child) dominated outpatient costs, while personnel (56%, €75.47 per child) dominated in the cost of inpatient care. Sensitivity analyses suggested lowering prices of medical treatments, and therapeutic food had limited effect on total costs per child, while increasing program size and decreasing use of expatriate staff support reduced total costs per child substantially. Updated estimates of severe acute malnutrition treatment cost are substantially lower than previously published values, and important cost savings may be possible with increases in coverage/program size and integration into national health programs. These updated estimates can be used to suggest approaches to improve efficiency and inform national-level resource allocation. © 2016 John Wiley & Sons Ltd.

Possible role of the microbiome in the development of acute malnutrition and implications for food-based strategies to prevent and treat acute malnutrition

USDA-ARS?s Scientific Manuscript database

A pattern of changes in the microbiome composition have been observed in the normal maturation of the human gut. Perturbations from this pattern have been described in malnourished humans and reproduced in animal models of severe malnutrition. Treatment and prevention of malnutrition in the future m...

Psychosocial stimulation interventions for children with severe acute malnutrition: a systematic review

PubMed Central

Daniel, Allison I; Bandsma, Robert H; Lytvyn, Lyubov; Voskuijl, Wieger P; Potani, Isabel; van den Heuvel, Meta

2017-01-01

Background The WHO Guidelines for the inpatient treatment of severely malnourished children include a recommendation to provide sensory stimulation or play therapy for children with severe acute malnutrition (SAM). This systematic review was performed to synthesize evidence around this recommendation. Specifically, the objective was to answer the question: “In children with severe acute malnutrition, does psychosocial stimulation improve child developmental, nutritional, or other outcomes?” Methods A review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO 2016: CRD42016036403). MEDLINE, Embase, CINAHL, and PsycINFO were searched with terms related to SAM and psychosocial stimulation. Studies were selected if they applied a stimulation intervention in children with SAM and child developmental and nutritional outcomes were assessed. Findings were presented within a narrative synthesis and a summary of findings table. Quality of the evidence was evaluated using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings Only two studies, both non–randomized controlled trials, met the selection criteria for this review. One was conducted in Jamaica (1975) with a follow–up period of 14 years; the other was done in Bangladesh (2002) with a six–month follow–up. At the individual study level, each of the included studies demonstrated significant differences in child development outcomes between intervention and control groups. Only the study conducted in Bangladesh demonstrated a clinically significant increase in weight–for–age z–scores in the intervention group compared to the control group. Conclusions The evidence supporting the recommendation of psychosocial stimulation for children with SAM is not only sparse, but also of very low quality across important outcomes. High–quality trials are needed to determine the effects of

Psychosocial stimulation interventions for children with severe acute malnutrition: a systematic review.

PubMed

Daniel, Allison I; Bandsma, Robert H; Lytvyn, Lyubov; Voskuijl, Wieger P; Potani, Isabel; van den Heuvel, Meta

2017-06-01

The WHO Guidelines for the inpatient treatment of severely malnourished children include a recommendation to provide sensory stimulation or play therapy for children with severe acute malnutrition (SAM). This systematic review was performed to synthesize evidence around this recommendation. Specifically, the objective was to answer the question: "In children with severe acute malnutrition, does psychosocial stimulation improve child developmental, nutritional, or other outcomes?" A review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO 2016: CRD42016036403). MEDLINE, Embase, CINAHL, and PsycINFO were searched with terms related to SAM and psychosocial stimulation. Studies were selected if they applied a stimulation intervention in children with SAM and child developmental and nutritional outcomes were assessed. Findings were presented within a narrative synthesis and a summary of findings table. Quality of the evidence was evaluated using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Only two studies, both non-randomized controlled trials, met the selection criteria for this review. One was conducted in Jamaica (1975) with a follow-up period of 14 years; the other was done in Bangladesh (2002) with a six-month follow-up. At the individual study level, each of the included studies demonstrated significant differences in child development outcomes between intervention and control groups. Only the study conducted in Bangladesh demonstrated a clinically significant increase in weight-for-age z-scores in the intervention group compared to the control group. The evidence supporting the recommendation of psychosocial stimulation for children with SAM is not only sparse, but also of very low quality across important outcomes. High-quality trials are needed to determine the effects of psychosocial stimulation interventions on outcomes in children

Increased Gut Redox and Depletion of Anaerobic and Methanogenic Prokaryotes in Severe Acute Malnutrition

PubMed Central

Million, Matthieu; Tidjani Alou, Maryam; Khelaifia, Saber; Bachar, Dipankar; Lagier, Jean-Christophe; Dione, Niokhor; Brah, Souleymane; Hugon, Perrine; Lombard, Vincent; Armougom, Fabrice; Fromonot, Julien; Robert, Catherine; Michelle, Caroline; Diallo, Aldiouma; Fabre, Alexandre; Guieu, Régis; Sokhna, Cheikh; Henrissat, Bernard; Parola, Philippe; Raoult, Didier

2016-01-01

Severe acute malnutrition (SAM) is associated with inadequate diet, low levels of plasma antioxidants and gut microbiota alterations. The link between gut redox and microbial alterations, however, remains unexplored. By sequencing the gut microbiomes of 79 children of varying nutritional status from three centers in Senegal and Niger, we found a dramatic depletion of obligate anaerobes in malnutrition. This was confirmed in an individual patient data meta-analysis including 107 cases and 77 controls from 5 different African and Asian countries. Specifically, several species of the Bacteroidaceae, Eubacteriaceae, Lachnospiraceae and Ruminococceae families were consistently depleted while Enterococcus faecalis, Escherichia coli and Staphylococcus aureus were consistently enriched. Further analyses on our samples revealed increased fecal redox potential, decreased total bacterial number and dramatic Methanobrevibacter smithii depletion. Indeed, M. smithii was detected in more than half of the controls but in none of the cases. No causality was demonstrated but, based on our results, we propose a unifying theory linking microbiota specificity, lacking anaerobes and archaea, to low antioxidant nutrients, and lower food conversion. PMID:27183876

Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition.

PubMed

Tennant, Ingrid A; Barnett, Alan T; Thompson, Debbie S; Kips, Jan; Boyne, Michael S; Chung, Edward E; Chung, Andrene P; Osmond, Clive; Hanson, Mark A; Gluckman, Peter D; Segers, Patrick; Cruickshank, J Kennedy; Forrester, Terrence E

2014-09-01

Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls. We studied 116 adult SAM survivors, 54 after marasmus, 62 kwashiorkor, and 45 age/sex/body mass index-matched community controls who had standardized anthropometry, blood pressure, echocardiography, and arterial tonometry performed. Left ventricular indices and outflow tract diameter, carotid parameters, and pulse wave velocity were measured, with systemic vascular resistance calculated. All were expressed as SD scores. Mean (SD) age was 28.8±7.8 years (55% men). Adjusting for age, sex, height, and weight, SAM survivors had mean (SE) reductions for left ventricular outflow tract diameter of 0.67 (0.16; P<0.001), stroke volume 0.44 (0.17; P=0.009), cardiac output 0.5 (0.16; P=0.001), and pulse wave velocity 0.32 (0.15; P=0.03) compared with controls but higher diastolic blood pressures (by 4.3; 1.2-7.3 mm Hg; P=0.007). Systemic vascular resistance was higher in marasmus and kwashiorkor survivors (30.2 [1.2] and 30.8 [1.1], respectively) than controls 25.3 (0.8), overall difference 5.5 (95% confidence interval, 2.8-8.4 mm Hg min/L; P<0.0001). No evidence of large vessel or cardiac remodeling was found, except closer relationships between these indices in former marasmic survivors. Other parameters did not differ between SAM survivor groups. We conclude that adult SAM survivors had smaller outflow tracts and cardiac output when compared with controls, yet markedly elevated peripheral resistance. Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity. © 2014 American Heart Association, Inc.

Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition

USDA-ARS?s Scientific Manuscript database

World Health Organization (WHO) guidelines recommend for children with severe acute malnutrition (SAM), high-dose vitamin A (VA) supplements be given on day 1 of admission, and on days 2 and 14 in the case of clinical signs of vitamin A deficiency (VAD). Daily low-dose VA follows, delivered in a pre...

Impaired contextual fear-conditioning in MAM rodent model of schizophrenia.

PubMed

Gill, Kathryn M; Miller, Sarah A; Grace, Anthony A

2018-05-01

The methylazoxymethanol acetate (MAM) rodent neurodevelopmental model of schizophrenia exhibits aberrant dopamine system activation attributed to hippocampal dysfunction. Context discrimination is a component of numerous behavioral and cognitive functions and relies on intact hippocampal processing. The present study explored context processing behaviors, along with dopamine system activation, during fear learning in the MAM model. Male offspring of dams treated with MAM (20mg/kg, i.p.) or saline on gestational day 17 were used for electrophysiological and behavioral experiments. Animals were tested on the immediate shock fear conditioning paradigm, with either different pre-conditioning contexts or varying amounts of context pre-exposure (0-10 sessions). Amphetamine-induced locomotor activity and dopamine neural activity was measured 1-week after fear conditioning. Saline, but not MAM animals, demonstrated enhanced fear responses following a single context pre-exposure in the conditioning context. One week following fear learning, saline rats with 2 or 7min of context pre-exposure prior to fear conditioning also demonstrated enhanced amphetamine-induced locomotor response relative to MAM animals. Dopamine neuron recordings showed fear learning-induced reductions in spontaneous dopamine neural activity in MAM rats that was further reduced by amphetamine. Apomorphine administration confirmed that reductions in dopamine neuron activity in MAM animals resulted from over excitation, or depolarization block. These data show a behavioral insensitivity to contextual stimuli in MAM rats that coincide with a less dynamic dopamine response after fear learning. Copyright © 2017 Elsevier B.V. All rights reserved.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh.

PubMed

Puett, Chloe; Sadler, Kate; Alderman, Harold; Coates, Jennifer; Fiedler, John L; Myatt, Mark

2013-07-01

This study assessed the cost-effectiveness of adding the community-based management of severe acute malnutrition (CMAM) to a community-based health and nutrition programme delivered by community health workers (CHWs) in southern Bangladesh. The cost-effectiveness of this model of treatment for severe acute malnutrition (SAM) was compared with the cost-effectiveness of the 'standard of care' for SAM (i.e. inpatient treatment), augmented with community surveillance by CHWs to detect cases, in a neighbouring area. An activity-based cost model was used, and a societal perspective taken, to include all costs incurred in the programme by providers and participants for the management of SAM in both areas. Cost data were coupled with programme effectiveness data. The community-based strategy cost US$26 per disability-adjusted life year (DALY) averted, compared with US$1344 per DALY averted for inpatient treatment. The average cost to participant households for their child to recover from SAM in community treatment was one-sixth that of inpatient treatment. These results suggest that this model of treatment for SAM is highly cost-effective and that CHWs, given adequate supervision and training, can be employed effectively to expand access to treatment for SAM in Bangladesh.

Treatment Outcome of Severe Acute Malnutrition Cases at the Tamale Teaching Hospital

PubMed Central

Saaka, Mahama; Osman, Shaibu Mohammed; Amponsem, Anthony; Ziem, Juventus B.; Abdul-Mumin, Alhassan; Akanbong, Prosper; Yirkyio, Ernestina; Yakubu, Eliasu

2015-01-01

Objective. This study investigated the treatment outcomes and determinant factors likely to be associated with recovery rate. Methods. A retrospective chart review (RCR) was performed on 348 patients who were enrolled in the outpatient care (OPC) during the study period. Results. Of the 348 cases, 33.6% recovered (having MUAC ≥125 mm), 49.1% defaulted, and 11.5% transferred to other OPC units to continue with treatment. There were 187 (53.7%) males and 161 (46.3%) females with severe malnutrition. The average weight gain rate was 28 g/kg/day. Controlling for other factors, patients who completed the treatment plan had 3.2 times higher probability of recovery from severe acute malnutrition (SAM) as compared to patients who defaulted (adjusted odds ratio (AOR) = 3.2, 95% CI = 1.9, 5.3, and p < 0.001). The children aged 24–59 months had 5.8 times higher probability of recovery from SAM as compared to children aged 6–11 months (AOR = 5.8, 95% CI = 2.5, 10.6, and p < 0.001). Conclusions. Cure rate was low and the default rate was quite high. Children who were diagnosed as having marasmus on admission stayed longer before recovery than their kwashiorkor counterparts. Younger children were of greater risk of nonrecovery. PMID:26064678

High prevalence of acute respiratory tract infections among Warao Amerindian children in Venezuela in relation to low immunization coverage and chronic malnutrition.

PubMed

Verhagen, Lilly M; Warris, Adilia; Hermans, Peter W M; del Nogal, Berenice; de Groot, Ronald; de Waard, Jacobus H

2012-03-01

Higher prevalence rates of acute respiratory tract infections (ARTIs) have been described in Australian and Canadian indigenous populations than in nonindigenous age-matched counterparts. Few studies on ARTIs in South American indigenous populations have been published. We performed a cross-sectional survey to describe the prevalence of upper respiratory tract infections and acute lower respiratory tract infections (ALRTIs) and associations with malnutrition and immunization status. From December 1, 2009 to May 31, 2010, 487 Warao Amerindian children 0 to 59 months of age living in the Delta Amacuro in Venezuela were included in a cross-sectional survey. Data were obtained through parent questionnaires, vaccination cards, and physical examinations including anthropometric measurements. Of the 487 children, 47% presented with an ARTI. Of these, 60% had upper respiratory tract infections and 40% were ALRTI. Immunization coverage was low, with only 27% of all children presenting a vaccination card being fully immunized. The prevalence of malnutrition was high (52%), with stunting (height-for-age <-2 standard deviations) being the most frequent presentation affecting 45% of children. ARTI and ALRTI prevalence diminished with increasing age (odds ratio for ALRTI in children 25-59 months of age vs. children younger than 12 months, 0.49; 95% confidence interval, 0.26-0.93). Furthermore, significant differences in ARTI prevalence were seen between villages. No significant associations between immunization status or malnutrition and ARTI or ALRTI prevalence were identified. A high prevalence of ARTIs and chronic malnutrition in combination with a low immunization status highlights the need for an integrated approach to improve the health status of indigenous Venezuelan children.

TGF-β1 expression in wound healing is acutely affected by experimental malnutrition and early enteral feeding.

PubMed

Alves, Claudia Cristina; Torrinhas, Raquel Susana; Giorgi, Ricardo; Brentani, Maria Mitzi; Logullo, Angela Flavia; Waitzberg, Dan Linetzky

2014-10-01

Malnutrition is associated with the delay or failure of healing. We assessed the effect of experimental malnutrition and early enteral feeding with standard diet or diet supplemented with arginine and antioxidants on the levels of mRNA encoding growth factors in acute, open wound healing. Standardised cutaneous dorsal wounds and gastrostomies for enteral feeding were created in malnourished (M, n = 27) and eutrophic control (E, n = 30) Lewis male adult rats. Both M and E rats received isocaloric and isonitrogenous regimens with oral chow and saline (C), standard (S) or supplemented (A) enteral diets. On post-trauma day 7, mRNA levels of growth factor genes were analysed in wound granulation tissue by reverse transcription polymerase chain reaction (RT-PCR). M(C) rats had significantly lower transforming growth factor β(TGF-β1 ) mRNA levels than E(C) rats (2·58 ± 0·83 versus 3·53 ± 0·57, P < 0·01) and in comparison with M(S) and M(A) rats (4·66 ± 2·49 and 4·61 ± 2·11, respectively; P < 0·05). VEGF and KGF-7 mRNA levels were lower in M(A) rats than in E(A) rats (0·74 ± 0·16 versus 1·25 ± 0·66; and 1·07 ± 0·45 versus 1·79 ± 0·89, respectively; P≤ 0·04), but did not differ from levels in E(C) and M(C) animals. In experimental open acute wound healing, previous malnutrition decreased local mRNA levels of TGF-β1 genes, which was minimised by early enteral feeding with standard or supplemented diets. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Gut DNA viromes of Malawian twins discordant for severe acute malnutrition

PubMed Central

Reyes, Alejandro; Blanton, Laura V.; Cao, Song; Zhao, Guoyan; Manary, Mark; Trehan, Indi; Smith, Michelle I.; Wang, David; Virgin, Herbert W.; Rohwer, Forest; Gordon, Jeffrey I.

2015-01-01

The bacterial component of the human gut microbiota undergoes a definable program of postnatal development. Evidence is accumulating that this program is disrupted in children with severe acute malnutrition (SAM) and that their persistent gut microbiota immaturity, which is not durably repaired with current ready-to-use therapeutic food (RUTF) interventions, is causally related to disease pathogenesis. To further characterize gut microbial community development in healthy versus malnourished infants/children, we performed a time-series metagenomic study of DNA isolated from virus-like particles (VLPs) recovered from fecal samples collected during the first 30 mo of postnatal life from eight pairs of mono- and dizygotic Malawian twins concordant for healthy growth and 12 twin pairs discordant for SAM. Both members of discordant pairs were sampled just before, during, and after treatment with a peanut-based RUTF. Using Random Forests and a dataset of 17,676 viral contigs assembled from shotgun sequencing reads of VLP DNAs, we identified viruses that distinguish different stages in the assembly of the gut microbiota in the concordant healthy twin pairs. This developmental program is impaired in both members of SAM discordant pairs and not repaired with RUTF. Phage plus members of the Anelloviridae and Circoviridae families of eukaryotic viruses discriminate discordant from concordant healthy pairs. These results disclose that apparently healthy cotwins in discordant pairs have viromes associated with, although not necessarily mediators, of SAM; as such, they provide a human model for delineating normal versus perturbed postnatal acquisition and retention of the gut microbiota’s viral component in populations at risk for malnutrition. PMID:26351661

The prevalence of malnutrition according to the new ESPEN definition in four diverse populations.

PubMed

Rojer, A G M; Kruizenga, H M; Trappenburg, M C; Reijnierse, E M; Sipilä, S; Narici, M V; Hogrel, J Y; Butler-Browne, G; McPhee, J S; Pääsuke, M; Meskers, C G M; Maier, A B; de van der Schueren, M A E

2016-06-01

Consensus on the definition of malnutrition has not yet been reached. Recently, The European Society for Clinical Nutrition and Metabolism (ESPEN) proposed a consensus definition of malnutrition. The aim of the present study was to describe the prevalence of malnutrition according to the ESPEN definition in four diverse populations. In total, 349 acutely ill middle-aged patients, 135 geriatric outpatients, 306 healthy old individuals and 179 healthy young individuals were included in the study. Subjects were screened for risk of malnutrition using the SNAQ. The ESPEN definition of malnutrition, i.e. low BMI (< 18.5 kg/m(2)) or a combination of unintentional weight loss and low FFMI or low BMI was applied to all subjects. Screening identified 0, 0.5, 10 and 30% of the healthy young, the healthy old, the geriatric outpatients and the acutely ill middle-aged patients as being at risk of malnutrition. The prevalence of malnutrition ranged from 0% in the healthy young, 0.5% in healthy old individuals, 6% in the geriatric outpatients to 14% in the acutely ill middle-aged patients. Prevalence of low FFMI was observed in all four populations (14-33%), but concurred less frequently with weight loss (0-13%). Using the ESPEN definition, 0%-14% malnutrition was found in the diverse populations. Further work is needed to fully address the validity of a two-step approach, including risk assessment as an initial step in screening and defining malnutrition. Furthermore, assessing the predictive validity of the ESPEN definition is needed. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Gut microbiota and malnutrition.

PubMed

Million, Matthieu; Diallo, Aldiouma; Raoult, Didier

2017-05-01

Malnutrition is the leading cause of death worldwide in children under the age of five, and is the focus of the first World Health Organization (WHO) Millennium Development Goal. Breastfeeding, food and water security are major protective factors against malnutrition and critical factors in the maturation of healthy gut microbiota, characterized by a transient bifidobacterial bloom before a global rise in anaerobes. Early depletion in gut Bifidobacterium longum, a typical maternal probiotic, known to inhibit pathogens, represents the first step in gut microbiota alteration associated with severe acute malnutrition (SAM). Later, the absence of the Healthy Mature Anaerobic Gut Microbiota (HMAGM) leads to deficient energy harvest, vitamin biosynthesis and immune protection, and is associated with diarrhea, malabsorption and systemic invasion by microbial pathogens. A therapeutic diet and infection treatment may be unable to restore bifidobacteria and HMAGM. Besides refeeding and antibiotics, future trials including non-toxic missing microbes and nutrients necessary to restore bifidobacteria and HMAGM, including prebiotics and antioxidants, are warranted in children with severe or refractory disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mitochondria-Associated Membranes (MAMs): Overview and Its Role in Parkinson's Disease.

PubMed

Rodríguez-Arribas, M; Yakhine-Diop, S M S; Pedro, J M Bravo-San; Gómez-Suaga, P; Gómez-Sánchez, R; Martínez-Chacón, G; Fuentes, J M; González-Polo, R A; Niso-Santano, M

2017-10-01

Mitochondria-associated membranes (MAMs) are structures that regulate physiological functions between endoplasmic reticulum (ER) and mitochondria in order to maintain calcium signaling and mitochondrial biogenesis. Several proteins located in MAMs, including those encoded by PARK genes and some of neurodegeneration-related proteins (huntingtin, presenilin, etc.), ensure this regulation. In this regard, MAM alteration is associated with neurodegenerative diseases such as Parkinson's (PD), Alzheimer's (AD), and Huntington's diseases (HD) and contributes to the appearance of the pathogenesis features, i.e., autophagy dysregulation, mitochondrial dysfunction, oxidative stress, and lately, neuronal death. Moreover,, ER stress and/or damaged mitochondria can be the cause of these disruptions. Therefore, ER-mitochondria contact structure and function are crucial to multiple cellular processes. This review is focused on the molecular interaction between ER and mitochondria indispensable to MAM formation and on MAM alteration-induced etiology of neurodegenerative diseases.

Rab32 modulates apoptosis onset and mitochondria-associated membrane (MAM) properties.

PubMed

Bui, Michael; Gilady, Susanna Y; Fitzsimmons, Ross E B; Benson, Matthew D; Lynes, Emily M; Gesson, Kevin; Alto, Neal M; Strack, Stefan; Scott, John D; Simmen, Thomas

2010-10-08

The mitochondria-associated membrane (MAM) has emerged as an endoplasmic reticulum (ER) signaling hub that accommodates ER chaperones, including the lectin calnexin. At the MAM, these chaperones control ER homeostasis but also play a role in the onset of ER stress-mediated apoptosis, likely through the modulation of ER calcium signaling. These opposing roles of MAM-localized chaperones suggest the existence of mechanisms that regulate the composition and the properties of ER membrane domains. Our results now show that the GTPase Rab32 localizes to the ER and mitochondria, and we identify this protein as a regulator of MAM properties. Consistent with such a role, Rab32 modulates ER calcium handling and disrupts the specific enrichment of calnexin on the MAM, while not affecting the ER distribution of protein-disulfide isomerase and mitofusin-2. Furthermore, Rab32 determines the targeting of PKA to mitochondrial and ER membranes and through its overexpression or inactivation increases the phosphorylation of Bad and of Drp1. Through a combination of its functions as a PKA-anchoring protein and a regulator of MAM properties, the activity and expression level of Rab32 determine the speed of apoptosis onset.

Early mortality in children with acute lymphoblastic leukemia in a developing country: the role of malnutrition at diagnosis. A multicenter cohort MIGICCL study.

PubMed

Martín-Trejo, Jorge Alfonso; Núñez-Enríquez, Juan Carlos; Fajardo-Gutiérrez, Arturo; Medina-Sansón, Aurora; Flores-Lujano, Janet; Jiménez-Hernández, Elva; Amador-Sanchez, Raquel; Peñaloza-Gonzalez, José Gabriel; Alvarez-Rodriguez, Francisco Javier; Bolea-Murga, Victoria; Espinosa-Elizondo, Rosa Martha; de Diego Flores-Chapa, José; Pérez-Saldivar, Maria Luisa; Rodriguez-Zepeda, María Del Carmen; Dorantes-Acosta, Elisa María; Núñez-Villegas, Nora Nancy; Velazquez-Aviña, Martha Margarita; Torres-Nava, José Refugio; Reyes-Zepeda, Nancy Carolina; González-Bonilla, César Raúl; Flores-Villegas, Luz Victoria; Rangel-López, Angélica; Rivera-Luna, Roberto; Paredes-Aguilera, Rogelio; Cárdenas-Cardós, Rocío; Martínez-Avalos, Armando; Gil-Hernández, Ana Elena; Duarte-Rodríguez, David Aldebarán; Mejía-Aranguré, Juan Manuel

2017-04-01

The role of malnutrition at diagnosis as a predictor of early mortality in Mexican leukemia children remains controversial. The objective of present study was to investigate whether malnutrition was a predictor of early mortality during the first year of treatment in Mexican acute lymphoblastic leukemia (ALL) children through the first population-based study. A total of 794 newly diagnosed ALL pediatric patients from public hospitals of Mexico City were enrolled. A multivariate Cox proportional hazards regression model was constructed and adjusted by patient's age at diagnosis, gender, hospital of treatment, and socioeconomic status. Early mortality was high (12.1%) and malnutrition by different indicators was not associated with mortality at induction phase and at 6th month; a high risk of dying (RR = 2.08; 95% CI: 1.08-4.01) was observed in the group of malnourished children with a high-risk ALL.

MAMS: High resolution atmospheric moisture/surface properties

NASA Technical Reports Server (NTRS)

Jedlovec, Gary J.; Guillory, Anthony R.; Suggs, Ron; Atkinson, Robert J.; Carlson, Grant S.

1991-01-01

Multispectral Atmospheric Mapping Sensor (MAMS) data collected from a number of U2/ER2 aircraft flights were used to investigate atmospheric and surface (land) components of the hydrologic cycle. Algorithms were developed to retrieve surface and atmospheric geophysical parameters which describe the variability of atmospheric moisture, its role in cloud and storm development, and the influence of surface moisture and heat sources on convective activity. Techniques derived with MAMS data are being applied to existing satellite measurements to show their applicability to regional and large process studies and their impact on operational forecasting.

Bayes-LQAS: classifying the prevalence of global acute malnutrition

PubMed Central

2010-01-01

Lot Quality Assurance Sampling (LQAS) applications in health have generally relied on frequentist interpretations for statistical validity. Yet health professionals often seek statements about the probability distribution of unknown parameters to answer questions of interest. The frequentist paradigm does not pretend to yield such information, although a Bayesian formulation might. This is the source of an error made in a recent paper published in this journal. Many applications lend themselves to a Bayesian treatment, and would benefit from such considerations in their design. We discuss Bayes-LQAS (B-LQAS), which allows for incorporation of prior information into the LQAS classification procedure, and thus shows how to correct the aforementioned error. Further, we pay special attention to the formulation of Bayes Operating Characteristic Curves and the use of prior information to improve survey designs. As a motivating example, we discuss the classification of Global Acute Malnutrition prevalence and draw parallels between the Bayes and classical classifications schemes. We also illustrate the impact of informative and non-informative priors on the survey design. Results indicate that using a Bayesian approach allows the incorporation of expert information and/or historical data and is thus potentially a valuable tool for making accurate and precise classifications. PMID:20534159

Bayes-LQAS: classifying the prevalence of global acute malnutrition.

PubMed

Olives, Casey; Pagano, Marcello

2010-06-09

Lot Quality Assurance Sampling (LQAS) applications in health have generally relied on frequentist interpretations for statistical validity. Yet health professionals often seek statements about the probability distribution of unknown parameters to answer questions of interest. The frequentist paradigm does not pretend to yield such information, although a Bayesian formulation might. This is the source of an error made in a recent paper published in this journal. Many applications lend themselves to a Bayesian treatment, and would benefit from such considerations in their design. We discuss Bayes-LQAS (B-LQAS), which allows for incorporation of prior information into the LQAS classification procedure, and thus shows how to correct the aforementioned error. Further, we pay special attention to the formulation of Bayes Operating Characteristic Curves and the use of prior information to improve survey designs. As a motivating example, we discuss the classification of Global Acute Malnutrition prevalence and draw parallels between the Bayes and classical classifications schemes. We also illustrate the impact of informative and non-informative priors on the survey design. Results indicate that using a Bayesian approach allows the incorporation of expert information and/or historical data and is thus potentially a valuable tool for making accurate and precise classifications.

Malnutrition: The Importance of Identification, Documentation, and Coding in the Acute Care Setting

PubMed Central

Kyle, Greg; Itsiopoulos, Catherine; Naunton, Mark; Luff, Narelle

2016-01-01

Malnutrition is a significant issue in the hospital setting. This cross-sectional, observational study determined the prevalence of malnutrition amongst 189 adult inpatients in a teaching hospital using the Patient-Generated Subjective Global Assessment tool and compared data to control groups for coding of malnutrition to determine the estimated unclaimed financial reimbursement associated with this comorbidity. Fifty-three percent of inpatients were classified as malnourished. Significant associations were found between malnutrition and increasing age, decreasing body mass index, and increased length of stay. Ninety-eight percent of malnourished patients were coded as malnourished in medical records. The results of the medical history audit of patients in control groups showed that between 0.9 and 5.4% of patients were coded as malnourished which is remarkably lower than the 52% of patients who were coded as malnourished from the point prevalence study data. This is most likely to be primarily due to lack of identification. The estimated unclaimed annual financial reimbursement due to undiagnosed or undocumented malnutrition based on the point prevalence study was AU$8,536,200. The study found that half the patients were malnourished, with older adults being particularly vulnerable. It is imperative that malnutrition is diagnosed and accurately documented and coded, so appropriate coding, funding reimbursement, and treatment can occur. PMID:27774317

Malaria and nutritional status among children with severe acute malnutrition in Niger: a prospective cohort study.

PubMed

Oldenburg, Catherine E; Guerin, Philippe J; Berthé, Fatou; Grais, Rebecca F; Isanaka, Sheila

2018-03-07

The relationship between malaria infection and nutritional status is complex and previous studies suggest malaria may increase the incidence and severity of malnutrition while malnutrition may increase the risk of malaria infection. Here, we report bi-directional associations between malaria and nutritional status among children with uncomplicated severe acute malnutrition (SAM). The present study is a secondary analysis of a randomized controlled trial for the treatment of uncomplicated SAM in Niger. Children between 6-59 months were enrolled and followed for 12 weeks. Malaria infection was assessed using an HRP2 rapid diagnostic test at admission and at any follow-up visit with fever. We assessed the association of 1) nutritional status at admission on malaria incidence using Cox proportional hazards regression, and 2) malaria infection at admission on nutritional recovery, weight and height gain using linear regression. Of 2,399 children included in the analysis, 1,327 (55.3%) were infected with malaria at admission. Malaria incidence was 12.1 cases per 100 person-months among those without malaria infection at admission. Nutritional status at admission was not associated with malaria incidence. Children with malaria infection at admission, subsequently treated with an artemisinin based combination therapy, had increased weight gain (0.38 g/kg/day, 95% confidence interval [CI] 0.07 to 0.69) and reduced height gain (-0.002 mm/day, 95% CI -0.004 to -0.0008). Malaria infection was common among children treated for uncomplicated SAM. Malaria infection may impair height gain. Proper medical and nutritional management should be assured to prevent adverse effects of malaria infection.

[Malnutrition in children admitted to hospital. Results of a national survey].

PubMed

Moreno Villares, José Manuel; Varea Calderón, Vicente; Bousoño García, Carlos

2017-05-01

Malnutrition on admission is closely related to a longer hospital stay and a higher morbidity. The prevalence of hospital malnutrition has been reported as almost as high as 50%, with 6% being the lowest. DHOSPE study investigates nutrition status in Spanish hospitals and its outcome during the hospital stay. A longitudinal, multicentre, descriptive, cross-sectional study, with a short follow-up period was conducted in 32 hospitals during 2011. A total of 991 patients were included, with ages from 0 to 17 years. Each patient was measured at admission (weight, length, weight for length -W/L-, length for age -L/A-), and at 7 and 14 days. The STAMP nutritional screening tool was completed on admission. Anthropometric measurements were reported as z-score, and nutrition status classified according to W/L and L/A for acute and chronic malnutrition, respectively. The prevalence of malnutrition was 7.1% for moderate, and 0.7% for severe acute malnutrition. For chronic malnutrition, it was 2.7% moderate, and 1.4% severe. There were significant differences according to the underlying condition but not according to age. Results of STAMP show that around 75% of patients had a moderate to high risk of malnutrition. Nutritional status changed during admission for weight, as well as W/L and L/A. A worst nutritional status at admission and a higher STAMP score were positively correlated with the need for nutrition support. The prevalence of undernutrition was slightly lower (<8%) than previously reported, probably in relation to the variety of hospitals in the survey. Nevertheless, nutritional risk when evaluated with STAMP showed a high risk of malnutrition. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Chronic obstructive pulmonary disease and malnutrition in developing countries.

PubMed

Sehgal, Inderpaul S; Dhooria, Sahajal; Agarwal, Ritesh

2017-03-01

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disorder characterized by progressive, poorly reversible airflow limitation. In addition to its pulmonary manifestations, COPD is also associated with several systemic expressions including anemia, osteoporosis, coronary artery disease, and malnutrition. In COPD, malnutrition is a consequence of reduced nutritional intake and muscle loss, further compounded by systemic inflammation. In the developing world, malnutrition is a significant problem by itself, even without any systemic illness. It is likely that the occurrence and consequence of malnutrition in COPD may be even more profound in developing countries. In this review, we discuss the relationship between malnutrition and COPD and their overall impact in the developing world. COPD is highly prevalent in developing countries with an estimated 15-43 million patients suffering from COPD. The pooled prevalence of malnutrition in COPD was found to be 47.6% [95% confidence interval (CI), 23.5-71.5%] with the prevalence being higher in acute exacerbations of COPD compared to stable COPD. There is a need for generating good quality evidence from the developing world regarding the prevalence of malnutrition in COPD, the role of nutritional supplementation and its impact on exercise capacity, and overall health-related quality of life in patients with COPD.

Malnutrition

MedlinePlus

... fats, vitamins, and minerals - you may suffer from malnutrition. Causes of malnutrition include: Lack of specific nutrients in your diet. ... the lack of one vitamin can lead to malnutrition. An unbalanced diet Certain medical problems, such as ...

Aetiology and management of malnutrition in HIV-positive children

PubMed Central

Rose, Anna M; Hall, Charles S; Martinez-Alier, Nuria

2014-01-01

Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent. PMID:24406803

Perspectives for integration into the local health system of community-based management of acute malnutrition in children under 5 years: a qualitative study in Bangladesh.

PubMed

Kouam, Camille Eric; Delisle, Hélène; Ebbing, Hans J; Israël, Anne Dominique; Salpéteur, Cécile; Aïssa, Myriam Aït; Ridde, Valery

2014-03-20

Acute malnutrition is a major cause of death among under-five children in low- and middle-income countries. United Nations agencies recommend the integration of community-based management of acute malnutrition (CMAM) into the local health systems for sustainability. The objective of the study was to assess the preparedness of the health system to implement CMAM targeting children under-five years in two sub-districts of Bangladesh. The assessment was performed through direct observation of 44 health centres, individual interviews of seven policy makers, three donors, four health and nutrition implementing partners, 29 health workers, and review of secondary data. Assessment themes, derived from the WHO six Building Blocks, were nutrition governance, nutrition financing, health service delivery, human resources, equipment and supply, referral, monitoring and supervision mechanism. They were subdivided into 16 criteria. Findings were compared with CMAM operational recommendations according to WHO, Valid International and Food and Nutrition Technical Assistance guidelines. The government of Bangladesh has developed inpatient and outpatient CMAM guidelines, and a policy offering free-of-charge health care for under-five children. Nutrition coordination was not under full government leadership. Most of funds (74%) dedicated to CMAM were provided by donors, for short-term interventions. Of the total 44 health centres assessed, 39 (88.6%) were active, among which 4 (10.2%) delivered inpatient services, 35 (89.8%) outpatient services, and 24 (61.5%) outreach services. These were regarded as opportunities to include CMAM activities. There were 48.9% vacant positions and the health workers were not trained for management of acute malnutrition. Equipment and supplies did not meet the operational recommendations for management of acute malnutrition. Implementing CMAM through the health centres of both sub-districts would warrant progressive strengthening of the overall health

Perspectives for integration into the local health system of community-based management of acute malnutrition in children under 5 years: a qualitative study in Bangladesh

PubMed Central

2014-01-01

Background Acute malnutrition is a major cause of death among under-five children in low- and middle-income countries. United Nations agencies recommend the integration of community-based management of acute malnutrition (CMAM) into the local health systems for sustainability. The objective of the study was to assess the preparedness of the health system to implement CMAM targeting children under-five years in two sub-districts of Bangladesh. Methods The assessment was performed through direct observation of 44 health centres, individual interviews of seven policy makers, three donors, four health and nutrition implementing partners, 29 health workers, and review of secondary data. Assessment themes, derived from the WHO six Building Blocks, were nutrition governance, nutrition financing, health service delivery, human resources, equipment and supply, referral, monitoring and supervision mechanism. They were subdivided into 16 criteria. Findings were compared with CMAM operational recommendations according to WHO, Valid International and Food and Nutrition Technical Assistance guidelines. Results The government of Bangladesh has developed inpatient and outpatient CMAM guidelines, and a policy offering free-of-charge health care for under-five children. Nutrition coordination was not under full government leadership. Most of funds (74%) dedicated to CMAM were provided by donors, for short-term interventions. Of the total 44 health centres assessed, 39 (88.6%) were active, among which 4 (10.2%) delivered inpatient services, 35 (89.8%) outpatient services, and 24 (61.5%) outreach services. These were regarded as opportunities to include CMAM activities. There were 48.9% vacant positions and the health workers were not trained for management of acute malnutrition. Equipment and supplies did not meet the operational recommendations for management of acute malnutrition. Conclusion Implementing CMAM through the health centres of both sub-districts would warrant

Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case-control study.

PubMed

Pravana, Nilesh Kumar; Piryani, Suneel; Chaurasiya, Surendra Prasad; Kawan, Rasmila; Thapa, Ram Krishna; Shrestha, Sumina

2017-08-28

Malnutrition is one of the leading causes of morbidity and mortality among children under the age of 5 years in low and middle income countries like Nepal. Children with severe acute malnutrition (SAM) are nine times more likely to die than children without malnutrition. The prevalence of SAM has increased in Nepal over the past 15 years; however, the determinants of SAM have not been clearly assessed in the country. To assess the determinants of SAM among children aged 6-59 months in the Bara district of Nepal. A community-based case-control study was conducted in 12 randomly selected Village Development Committees (VDCs) of the Bara district of Nepal. A random sample of 292 children aged 6-59 months (146 as cases and 146 as controls) from 12 VDCs were included in this study. The prevalence of SAM among children under the age of 5 years was 4.14%. The following factors were significantly associated with SAM: low socioeconomic status (adjusted odds ratio (AOR) 17.13, 95% CI 5.85 to 50.13); mother's age at birth <20 or >35 years (AOR 3.21, 95% CI 1.30 to 7.94); birth interval <24 months (AOR 4.09, 95% CI 1.87 to 8.97); illiterate father (AOR 3.65, 95% CI 1.62 to 8.20); bottle feeding (AOR 2.19, 95% CI 1.73 to 12.03); and not initiating complementary feeding at the age of 6 months (AOR 2.91, 95% CI 1.73 to 12.03). Mother's educational level, initiation of breastfeeding, colostrum feeding, and exclusive breastfeeding were not significantly associated with SAM. The mother's age at birth, birth interval, socioeconomic status, father's educational level and initiation of complementary feeding at the age of 6 months were important determinants of SAM among children. A multi-sector approach is essential to address SAM. There is a need for further studies not only focusing on SAM but also moderate acute malnutrition. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

Evidence-based prevention of childhood malnutrition.

PubMed

Imdad, Aamer; Sadiq, Kamran; Bhutta, Zulfiqar A

2011-05-01

Childhood malnutrition is prevalent in developing countries and contributes to one-third of all deaths in these countries. There have been advances in prevention of childhood malnutrition and the purpose of this article was to review the current evidence in the field. Multiple micronutrient (MMN) supplements during pregnancy reduce the incidence of maternal anemia and small for gestational-age babies. Recent evidence suggest that combined supplementation of MMNs with protein energy supplement is more effective than MMN supplementation alone. It is now recommended that HIV-infected mothers can exclusively breast-feed their infants for 6 months when the mother or infant is on effective antiretroviral therapy. Home fortification of complementary foods reduces the prevalence of anemia in infancy and combined supplementation of MMNs with lipid-based supplements improves growth in young children. Ready-to-use therapeutic foods have been successfully used to manage severe acute malnutrition in the community. Zinc supplementation is associated with a reduction in diarrhea and respiratory disease morbidity and improves linear growth. Vitamin A supplementation decreases the incidence of diarrhea and measles. Water supply, sanitation, and hygiene are important for the prevention of malnutrition because of their direct impact on infectious disease. There is clear evidence on the causes and consequences of malnutrition as well as effective interventions to prevent undernutrition. The next step is to implement these packages of interventions at large scale. A global effort is required that should entail unified and compelling advocacy among governments, lead organizations, and institutions.

Microgravity Acceleration Measurement System (MAMS) Flight Configuration Verification and Status

NASA Technical Reports Server (NTRS)

Wagar, William

2000-01-01

The Microgravity Acceleration Measurement System (MAMS) is a precision spaceflight instrument designed to measure and characterize the microgravity environment existing in the US Lab Module of the International Space Station. Both vibratory and quasi-steady triaxial acceleration data are acquired and provided to an Ethernet data link. The MAMS Double Mid-Deck Locker (DMDL) EXPRESS Rack payload meets all the ISS IDD and ICD interface requirements as discussed in the paper which also presents flight configuration illustrations. The overall MAMS sensor and data acquisition performance and verification data are presented in addition to a discussion of the Command and Data Handling features implemented via the ISS, downlink and the GRC Telescience Center displays.

A non-inflammatory form of immune competence prevails in acute pre-pubescent malnutrition: new evidence based on critical mRNA transcripts in the mouse.

PubMed

Monk, Jennifer M; Richard, Cynthia L; Woodward, Bill

2012-05-01

The declining inflammatory immune competence of acute (i.e. wasting) pre-pubescent protein-energy malnutrition has been regarded as reflecting an unregulated immunological disintegration. Recent evidence, however, suggests that malnutrition stimulates a regulated immunological reconfiguration to achieve a non-inflammatory form of competence, perhaps offering protection against autoimmune reactions - the 'Tolerance Model'. Our objective was to determine the influence of acute pre-pubescent malnutrition on the expression of genes critical to tolerogenic regulation. Male and female C57BL/6J mice, initially 19 d old, consumed a complete purified diet either ad libitum (age-matched controls) or in restricted daily quantities (mimicking marasmus), or consumed an isoenergetic low-protein diet ad libitum (mimicking incipient kwashiorkor) for 14 d (six animals per dietary group). Gene expression in the spleen, typically an inflammatory organ, and in the small intestine, a site designed for non-inflammatory defence, was assessed by real-time quantitative RT-PCR, and normalised to β-actin. In the spleen of the malnourished groups, both IL-10 and transforming growth factor-β1 mRNA expression increased compared with controls (P < 0.05), whereas mRNA expression of IL-12p40 decreased (P < 0.05). Conversely, malnutrition exerted no influence on the expression of mRNA for these cytokines in the small intestine (P>0.05). Moreover, forkhead box P3 mRNA expression, indicative of cell-based tolerogenic potential, was sustained in both the spleen and intestine of the malnourished groups (P>0.05). Thus, despite limited supplies of energy and substrates, the spleen shifted towards a non-inflammatory character and the intestine was sustained in this mode in advanced pre-pubescent weight loss. These findings provide the first support for the Tolerance Model at the level of mRNA transcript expression.

Improved capabilities of the Multispectral Atmospheric Mapping Sensor (MAMS)

NASA Technical Reports Server (NTRS)

Jedlovec, Gary J.; Batson, K. Bryan; Atkinson, Robert J.; Moeller, Chris C.; Menzel, W. Paul; James, Mark W.

1989-01-01

The Multispectral Atmospheric Mapping Sensor (MAMS) is an airborne instrument being investigated as part of NASA's high altitude research program. Findings from work on this and other instruments have been important as the scientific justification of new instrumentation for the Earth Observing System (EOS). This report discusses changes to the instrument which have led to new capabilities, improved data quality, and more accurate calibration methods. In order to provide a summary of the data collected with MAMS, a complete list of flight dates and locations is provided. For many applications, registration of MAMS imagery with landmarks is required. The navigation of this data on the Man-computer Interactive Data Access System (McIDAS) is discussed. Finally, research applications of the data are discussed and specific examples are presented to show the applicability of these measurements to NASA's Earth System Science (ESS) objectives.

Effect of Malnutrition at Diagnosis on Clinical Outcomes of Children With Acute Lymphoblastic Leukemia.

PubMed

Yazbeck, Nadine; Samia, Loma; Saab, Raya; Abboud, Miguel R; Solh, Hassan; Muwakkit, Samar

2016-03-01

Acute lymphoblastic leukemia (ALL) is the most common malignancy among children. Although studies have shown that malnutrition can negatively affect treatment outcome, results are controversial. This retrospective study aims at determining the prevalence of malnutrition and its association with treatment outcome among children with ALL treated at the Children's Cancer Institute in Lebanon. A total of 103 patients diagnosed with ALL between April 2002 and May 2010 were enrolled. Anthropometric data were collected from medical records upon diagnosis, at 3 and 6 months, and at the end of treatment. Body mass index was calculated for children 2 years of age and older, whereas weight-for-height ratio was used for patients below 2 years. Patients were considered underweight, stunted, or wasted if their Z-scores were <-2 SD. The prevalence of malnourished children was 25.2% at diagnosis and remained almost the same at the end of treatment. The odds of having a poor outcome (death and relapse) was higher among malnourished children and more so among stunted children with an odds ratios=2.15; 95% confidence interval, 0.5-8.3 and odds ratio=2.63; 95% confidence interval, 0.6-11.5, respectively. Although there was a trend showing worse outcomes in malnourished children with ALL at diagnosis when compared with well-nourished children larger studies using additional tools like arm anthropometry need to be conducted to prove the association.

The effects of malnutrition on cardiac function in African children.

PubMed

Silverman, Jonathan A; Chimalizeni, Yamikani; Hawes, Stephen E; Wolf, Elizabeth R; Batra, Maneesh; Khofi, Harriet; Molyneux, Elizabeth M

2016-02-01

Cardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children. Prospective cross-sectional study. Public referral hospital in Blantyre, Malawi. We enrolled 272 stable, hospitalised children ages 6-59 months, with and without WHO-defined severe acute malnutrition. Cardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia. Our primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m(2) (95% CI -0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=-8.6 mm Hg (95% CI -12.7 to -4.6) and difference=-200 dyne s/cm(5)/m(2) (95% CI -320 to -80), respectively. In this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study

PubMed Central

Rizzi, Massimiliano; Mazzuoli, Silvia; Regano, Nunzia; Inguaggiato, Rosa; Bianco, Margherita; Leandro, Gioacchino; Bugianesi, Elisabetta; Noè, Donatella; Orzes, Nicoletta; Pallini, Paolo; Petroni, Maria Letizia; Testino, Gianni; Guglielmi, Francesco William

2016-01-01

AIM: To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population. METHODS: The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss > 10% in the last three-six months. Values of Malnutrition Universal Screening Tool (MUST) > 2, NRS-2002 > 3, and Mini Nutritional Assessment (MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases. RESULTS: A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition (OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients. CONCLUSION: More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment. PMID:27559436

ThermoSpots to detect hypothermia in children with severe acute malnutrition.

PubMed

Mole, Thomas B; Kennedy, Neil; Ndoya, Noel; Emond, Alan

2012-01-01

Hypothermia is a risk factor for increased mortality in children with severe acute malnutrition (SAM). Yet frequent temperature measurement remains unfeasible in under-resourced units in developing countries. ThermoSpot is a continuous temperature monitoring sticker designed originally for neonates. When applied to skin, its liquid crystals are designed to turn black with hypothermia and remain green with normothermia. To (i) estimate the diagnostic accuracy of ThermoSpots for detecting WHO-defined hypothermia (core temperature <35.5°C or peripheral temperature <35.0°C) in children with SAM and (ii) determine their acceptability amongst mothers. Children with SAM in a malnutrition unit in Malawi were enrolled during March-July 2010. The sensitivity and specificity of ThermoSpots were calculated by comparing the device colour against 'gold standard' rectal temperatures taken on admission and follow up peripheral temperatures taken until discharge. Guardians completed a questionnaire to assess acceptability. Hypothermia was uncommon amongst the 162 children enrolled. ThermoSpot successfully detected the one rectal temperature and two peripheral temperatures recorded that met the WHO definition of hypothermia. Overall, 3/846 (0.35%) temperature measurements were in the WHO-defined hypothermia range. Interpreting the brown transition colour (between black and green) as hypothermia improved sensitivities. For milder hypothermia definitions, sensitivities declined (<35.4°C, 50.0%; <35.9°C, 39.2%). Specificity was consistently above 94%. From questionnaires, 40/43 (93%) mothers reported they were 90-100% happy with the device overall. Free-text answers revealed themes of "Skin Rashes", "User-satisfaction" and "Empowerment". Although hypothermia was uncommon in this study, ThermoSpots successfully detected these episodes in malnourished children and were acceptable to mothers. Research in settings where hypothermia is common is needed to determine performance with

Survival function and protein malnutrition in burns patients at a rural hospital in Africa.

PubMed

Kingu, H J; Longo-Mbenza, Benjamin; Dhaffala, A; Mazwai, E L

2011-07-01

The aim of this study was to estimate the incidence of acute malnutrition and to identify predictors of case fatality among burn patients in the poorest South African province, Eastern Cape. This longitudinal follow-up study was conducted among consecutive burn patients admitted to Nelson Mandela Academic Hospital, Mthatha, South Africa, between 2006 and 2008. Patients were monitored and treated daily from admission to discharge. Outcomes were acute protein malnutrition and mortality. Patients' demography, total body surface area (TBSA) of the burn, cause of the burn, weight, height, location of the burn, hemoglobin, serum albumin, wound infection, and antibiotics after culture and sensitivity results were the potential predictors of in-hospital mortality. A Cox's proportional hazards model for the time to death was then used to identify independent predictors of mortality after adjusting for confounding factors. Kaplan-Meier survival curves were generated for each arm of exposure status. In all, 67 patients (35 males, 59 children) were studied. The mean (range) age was 8±12 years (1 month to 59 years). The cumulative incidence of acute malnutrition was 62.0% (n=42): 46.3% (n=31) at admission and 15.7% (n=11) after 7 days of hospitalization. Incidence of mortality was 16.4% (n=11 with in-hospital acute malnutrition). The only significant and independent predictors of mortality were total body surface area (TBSA) burn>40% [hazard ratio (HR) 10.5, 95% confidence interval (CI) 1.7-63; P<0.01] and affected anterior trunk (HR 4.4, 95% CI 1.3-14.7; P=0.018). Urgent prevention strategies of burns and evidence-based practice with early nutritional supplementation are needed to reduce high rates of malnutrition and mortality.

Cardiac Dysfunction in a Porcine Model of Pediatric Malnutrition

PubMed Central

Fabiansen, Christian; Lykke, Mikkel; Hother, Anne-Louise; Koch, Jørgen; Nielsen, Ole Bækgaard; Hunter, Ingrid; Goetze, Jens P.; Friis, Henrik; Thymann, Thomas

2015-01-01

Background Half a million children die annually of severe acute malnutrition and cardiac dysfunction may contribute to the mortality. However, cardiac function remains poorly examined in cases of severe acute malnutrition. Objective To determine malnutrition-induced echocardiographic disturbances and longitudinal changes in plasma pro-atrial natriuretic peptide and cardiac troponin-T in a pediatric porcine model. Methods and Results Five-week old piglets (Duroc-x-Danish Landrace-x-Yorkshire) were fed a nutritionally inadequate maize-flour diet to induce malnutrition (MAIZE, n = 12) or a reference diet (AGE-REF, n = 12) for 7 weeks. Outcomes were compared to a weight-matched reference group (WEIGHT-REF, n = 8). Pro-atrial natriuretic peptide and cardiac troponin-T were measured weekly. Plasma pro-atrial natriuretic peptide decreased in both MAIZE and AGE-REF during the first 3 weeks but increased markedly in MAIZE relative to AGE-REF during week 5–7 (p≤0.001). There was overall no difference in plasma cardiac troponin-T between groups. However, further analysis revealed that release of cardiac troponin-T in plasma was more frequent in AGE-REF compared with MAIZE (OR: 4.8; 95%CI: 1.2–19.7; p = 0.03). However, when release occurred, cardiac troponin-T concentration was 6.9-fold higher (95%CI: 3.0–15.9; p<0.001) in MAIZE compared to AGE-REF. At week 7, the mean body weight in MAIZE was lower than AGE-REF (8.3 vs 32.4 kg, p<0.001), whereas heart-weight relative to body-weight was similar across the three groups. The myocardial performance index was 86% higher in MAIZE vs AGE-REF (p<0.001) and 27% higher in MAIZE vs WEIGHT-REF (p = 0.025). Conclusions Malnutrition associates with cardiac dysfunction in a pediatric porcine model by increased myocardial performance index and pro-atrial natriuretic peptide and it associates with cardiac injury by elevated cardiac troponin-T. Clinical studies are needed to see if the same applies for children suffering from

Aetiology and management of malnutrition in HIV-positive children.

PubMed

Rose, Anna M; Hall, Charles S; Martinez-Alier, Nuria

2014-06-01

Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Flight solar calibrations using the Mirror Attenuator Mosaic (MAM): Low scattering mirror

NASA Technical Reports Server (NTRS)

Lee, Robert B., III

1992-01-01

Measurements of solar radiances reflected from the mirror attenuator mosaic (MAM) were used to calibrate the shortwave portions of the Earth Radiation Budget Experiment (ERBE) thermistor bolometer scanning radiometers. The MAM is basically a low scattering mirror which has been used to attenuate and reflect solar radiation into the fields of view for the broadband shortwave (0.2 to 5 micrometers) and total (0.2 to 50.0+ micrometers) ERBE scanning radiometers. The MAM assembly consists of a tightly packed array of aluminum, 0.3175-cm diameter concave spherical mirrors and field of view limiting baffles. The spherical mirrors are masked by a copper plate, electro-plated with black chrome. Perforations (0.14 centimeter in diameter) in the copper plate serve as apertures for the mirrors. Black anodized aluminum baffles limit the MAM clear field of view to 7.1 degrees. The MAM assemblies are located on the Earth Radiation Budget Satellite (ERBS) and on the National Oceanic and Atmospheric Administration NOAA-9 and NOAA-10 spacecraft. The 1984-1985 ERBS and 1985-1986 NOAA-9 solar calibration datasets are presented. Analyses of the calibrations indicate that the MAM exhibited no detectable degradation in its reflectance properties and that the gains of the shortwave scanners did not change. The stability of the shortwave radiometers indicates that the transmission of the Suprasil W1 filters did not degrade detectably when exposed to Earth/atmosphere-reflected solar radiation.

Malnutrition induces gut atrophy and increases hepatic fat infiltration: studies in a pig model of childhood malnutrition.

PubMed

Lykke, Mikkel; Hother, Anne-Louise; Hansen, Christian F; Friis, Henrik; Mølgaard, Christian; Michaelsen, Kim F; Briend, André; Larsen, Torben; Sangild, Per T; Thymann, Thomas

2013-01-01

Childhood malnutrition is a problem in developing countries, and pathological changes in digestive organs such as the intestine and liver are poorly understood. An animal model to study the progression of severe acute malnutrition could elucidate pathological changes in the intestine and liver. We sought to characterize growth and clinical changes during malnutrition related to structural and functional indices in the intestine and liver. Newly weaned piglets were given ad libitum access to a maize flour diet (MAIZE, n=9) or a nutritionally optimized reference diet (REFERENCE, n=12) for 7 weeks. Growth, hematology and clinical biochemistry where recorded weekly. After 7 weeks, the MAIZE pigs had lower body weights than the REF pigs (8.3 kg vs. 32.4 kg, P < 0.001), indicating severe stunting and moderate to severe wasting. This was paralleled by lower values for hematocrit, hemoglobin and mean cell volume in MAIZE vs. REFERENCE (P < 0.01), indicating anemia. Although the observed temporal changes in MAIZE were associated with atrophy of the small intestinal mucosa (P < 0.001), digestive enzyme activity was only marginally reduced. Serum alanine aminotransferase, bilirubin and albumin were increased in the MAIZE pigs (P < 0.001), and the liver had a vacuolated appearance and tendency toward increased triglyceride content (P=0.054). We conclude that liver and intestinal indices are compromised during malnutrition and are associated with temporal changes in growth and hematological and biochemical endpoints. The pig model is relevant for malnourished infants and can act as a valuable tool for understanding the pathophysiology of malnutrition.

Malnutrition induces gut atrophy and increases hepatic fat infiltration: studies in a pig model of childhood malnutrition

PubMed Central

Lykke, Mikkel; Hother, Anne-Louise; Hansen, Christian F; Friis, Henrik; Mølgaard, Christian; Michaelsen, Kim F; Briend, André; Larsen, Torben; Sangild, Per T; Thymann, Thomas

2013-01-01

Childhood malnutrition is a problem in developing countries, and pathological changes in digestive organs such as the intestine and liver are poorly understood. An animal model to study the progression of severe acute malnutrition could elucidate pathological changes in the intestine and liver. We sought to characterize growth and clinical changes during malnutrition related to structural and functional indices in the intestine and liver. Newly weaned piglets were given ad libitum access to a maize flour diet (MAIZE, n=9) or a nutritionally optimized reference diet (REFERENCE, n=12) for 7 weeks. Growth, hematology and clinical biochemistry where recorded weekly. After 7 weeks, the MAIZE pigs had lower body weights than the REF pigs (8.3 kg vs. 32.4 kg, P < 0.001), indicating severe stunting and moderate to severe wasting. This was paralleled by lower values for hematocrit, hemoglobin and mean cell volume in MAIZE vs. REFERENCE (P < 0.01), indicating anemia. Although the observed temporal changes in MAIZE were associated with atrophy of the small intestinal mucosa (P < 0.001), digestive enzyme activity was only marginally reduced. Serum alanine aminotransferase, bilirubin and albumin were increased in the MAIZE pigs (P < 0.001), and the liver had a vacuolated appearance and tendency toward increased triglyceride content (P=0.054). We conclude that liver and intestinal indices are compromised during malnutrition and are associated with temporal changes in growth and hematological and biochemical endpoints. The pig model is relevant for malnourished infants and can act as a valuable tool for understanding the pathophysiology of malnutrition. PMID:23977413

Malnutrition in hospitalized children: prevalence, impact, and management.

PubMed

Groleau, Veronique; Thibault, Maxime; Doyon, Myriam; Brochu, Eve-Emmanuelle; Roy, Claude C; Babakissa, Corentin

2014-01-01

Malnutrition in hospitalized children has been reported since the late 1970s. The prevalence of acute and chronic malnutrition was examined in hospitalized patients in a general pediatric unit, and the impact and management of malnutrition were assessed. The nutritional risk score (NRS) and nutritional status (NS) (weight, height, body mass index, and skinfold thickness) of children aged zero to 18 years were assessed upon hospital admission. Growth and energy intake were monitored every three days until discharge. A total of 173 children (median age three years, 88 girls) participated; 79.8% had a moderate to severe NRS and 13.3% were acutely and/or chronically malnourished. A high NRS was associated with a longer hospital stay in children older than three years (P<0.05), while a poor NS (weight for height percentile) was correlated with prolonged hospitalization in children aged three years or younger (P<0.05). Although weight did not change during hospitalization, a decrease in skinfolds was documented (n=43, P<0.05). Patients with a high NRS had lower energy intake than those not at risk. However, children with abnormal NS received 92.5% of recommended energy intake. This study suggests that all children admitted to hospital should have an evaluation of their NRS and NS, so that they can receive appropriate nutrition interventions provided by a multidisciplinary nutrition team.

[Risk factors for malnutrition in 0-59-month-old infants in 2 districts of Niger].

PubMed

Quelin, G; Pecoul, B; Amadou, B; Baker, S

1991-01-01

A nutritional survey by cluster sampling at 2 degrees, carried out in April 1987 within a range of action of 6 health structures in Niger, has permitted the calculation of the weight/height index among children aged from 0 to 59 months and the malnutrition rate, according to the socio-economic status, the demographic variables, the intercurrent diseases, the use of health departments, alimentary and weaning habits. The standardized rate of acute malnutrition for the age among of 0-59 months is 12.3%. The risk factors for acute malnutrition retained after logistical regression are the age groups of 6-17 months and 18-29 months, the areas of Guidan Roumdji, Tahoua, Tajae, Guidan Sori and the group of children that have contracted diarrhea during the 15 days preceding the survey.

Childhood Malnutrition and the Intestinal Microbiome Malnutrition and the microbiome

PubMed Central

Kane, Anne V.; Dinh, Duy M.; Ward, Honorine D.

2015-01-01

Malnutrition contributes to almost half of all deaths in children under the age of 5 years, particularly those who live in resource-constrained areas. Those who survive frequently suffer from long-term sequelae including growth failure and neurodevelopmental impairment. Malnutrition is part of a vicious cycle of impaired immunity, recurrent infections and worsening malnutrition. Recently, alterations in the gut microbiome have also been strongly implicated in childhood malnutrition. It has been suggested that malnutrition may delay the normal development of the gut microbiota in early childhood or force it towards an altered composition that lacks the required functions for healthy growth and/or increases the risk for intestinal inflammation. This review addresses our current understanding of the beneficial contributions of gut microbiota to human nutrition (and conversely the potential role of changes in that community to malnutrition), the process of acquiring an intestinal microbiome, potential influences of malnutrition on the developing microbiota and the evidence directly linking alterations in the intestinal microbiome to childhood malnutrition. We review recent studies on the association between alterations in the intestinal microbiome and early childhood malnutrition and discuss them in the context of implications for intervention or prevention of the devastation caused by malnutrition. PMID:25356748

Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries.

PubMed Central

Rice, A. L.; Sacco, L.; Hyder, A.; Black, R. E.

2000-01-01

INTRODUCTION: Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. METHODS: MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. RESULTS: The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. DISCUSSION: The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles. PMID:11100616

Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis

PubMed Central

Pereira, Suzette L.; Matheson, Eric M.

2017-01-01

Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition. PMID:28771192

Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis.

PubMed

Zhang, Zhiying; Pereira, Suzette L; Luo, Menghua; Matheson, Eric M

2017-08-03

Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI ( p < 0.001) and concentrations of albumin ( p < 0.001), hemoglobin ( p < 0.001), total cholesterol ( p < 0.001), prealbumin ( p < 0.001) and total protein ( p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.

The REFANI-N study protocol: a cluster-randomised controlled trial of the effectiveness and cost-effectiveness of early initiation and longer duration of emergency/seasonal unconditional cash transfers for the prevention of acute malnutrition among children, 6-59 months, in Tahoua, Niger.

PubMed

Sibson, Victoria L; Grijalva-Eternod, Carlos S; Bourahla, Leila; Haghparast-Bidgoli, Hassan; Morrison, Joanna; Puett, Chloe; Trenouth, Lani; Seal, Andrew

2015-12-23

The global burden of acute malnutrition among children remains high, and prevalence rates are highest in humanitarian contexts such as Niger. Unconditional cash transfers are increasingly used to prevent acute malnutrition in emergencies but lack a strong evidence base. In Niger, non-governmental organisations give unconditional cash transfers to the poorest households from June to September; the 'hunger gap'. However, rising admissions to feeding programmes from March/April suggest the intervention may be late. This cluster-randomised controlled trial will compare two types of unconditional cash transfer for 'very poor' households in 'vulnerable' villages defined and identified by the implementing organisation. 3,500 children (6-59 months) and 2,500 women (15-49 years) will be recruited exhaustively from households targeted for cash and from a random sample of non-recipient households in 40 villages in Tahoua district. Clusters of villages with a common cash distribution point will be assigned to either a control group which will receive the standard intervention (n = 10), or a modified intervention group (n = 10). The standard intervention is 32,500 FCFA/month for 4 months, June to September, given cash-in-hand to female representatives of 'very poor' households. The modified intervention is 21,500 FCFA/month for 5 months, April, May, July, August, September, and 22,500 FCFA in June, providing the same total amount. In both arms the recipient women attend an education session, women and children are screened and referred for acute malnutrition treatment, and the households receive nutrition supplements for children 6-23 months and pregnant and lactating women. The trial will evaluate whether the modified unconditional cash transfer leads to a reduction in acute malnutrition among children 6-59 months old compared to the standard intervention. The sample size provides power to detect a 5 percentage point difference in prevalence of acute malnutrition between trial

Perceptions of Acute Malnutrition and Its Management in Infants Under 6 Months of Age: A Qualitative Study in Rural Bangladesh

PubMed Central

Arafat, Yasir; Islam, M Munirul; Connell, Nicki; Mothabbir, Golam; McGrath, Marie; Berkley, James A; Ahmed, Tahmeed; Kerac, Marko

2018-01-01

Background: World Health Organization guidelines advise community-based care (CBC) for “uncomplicated” severe acute malnutrition (SAM) infants <6 months old (u6m), whereas current national protocols refer to inpatient care. Our aim was to inform and shape future management strategies by understanding caregivers’ and different stakeholders’ perceptions on malnutrition among infants u6m on barriers/facilitators to future CBC. Methods: The methods used in this study are as follows: in-depth interviews and focus group discussions (FGDs) in southern Bangladesh, thematic analysis of transcripts, and sample size by data saturation. Results: We conducted 5 FGDs with 29 caregivers, 4 with 29 health care workers, 4 key informant interviews each with community leaders and health supervisors. Five themes emerged. 1) Identification of SAM infants and care-seeking behavior: malnutrition was not noticed until severe, caregivers focused on clinical symptoms. Both allopathic and traditional healers were consulted. (2) Perceived causes of infant malnutrition: underlying illness, poor feeding practices, poverty, and local superstitions. (3) Views and preferences on treatment: hospitals and doctors were perceived as offering the best treatment, health care workers were also important, and respondents highlighted the need care of the caregiver/mother along with the infant. (4) Perceived benefits and risks of CBC: lower cost and greater accessibility were appreciated but worried about quality. (5) Community networks: wider family and social support networks were considered important aspects of care. Conclusions: There is considerable potential for CBC but needs to be better and earlier identification of at-risk infants, strengthening of health systems to avoid community options being perceived as “second best,” engagement with families and communities to tackle “upstream” determinants of SAM, and care for mother-infant pairs. PMID:29760577

Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso.

PubMed

Fabiansen, Christian; Yaméogo, Charles W; Iuel-Brockdorf, Ann-Sophie; Cichon, Bernardette; Rytter, Maren J H; Kurpad, Anura; Wells, Jonathan C; Ritz, Christian; Ashorn, Per; Filteau, Suzanne; Briend, André; Shepherd, Susan; Christensen, Vibeke B; Michaelsen, Kim F; Friis, Henrik

2017-09-01

Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m2 (95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m2; 95% CI -0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m2 (95% CI -0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m2; 95% CI -0.047, 0.146; p = 0.32). There was no effect modification by season, admission

Severe acute malnutrition in childhood: hormonal and metabolic status at presentation, response to treatment, and predictors of mortality.

PubMed

Bartz, Sarah; Mody, Aaloke; Hornik, Christoph; Bain, James; Muehlbauer, Michael; Kiyimba, Tonny; Kiboneka, Elizabeth; Stevens, Robert; Bartlett, John; St Peter, John V; Newgard, Christopher B; Freemark, Michael

2014-06-01

Malnutrition is a major cause of childhood morbidity and mortality. To identify and target those at highest risk, there is a critical need to characterize biomarkers that predict complications prior to and during treatment. We used targeted and nontargeted metabolomic analysis to characterize changes in a broad array of hormones, cytokines, growth factors, and metabolites during treatment of severe childhood malnutrition. Children aged 6 months to 5 years were studied at presentation to Mulago Hospital and during inpatient therapy with milk-based formulas and outpatient supplementation with ready-to-use food. We assessed the relationship between baseline hormone and metabolite levels and subsequent mortality. Seventy-seven patients were enrolled in the study; a subset was followed up from inpatient treatment to the outpatient clinic. Inpatient and outpatient therapies increased weight/height z scores and induced striking changes in the levels of fatty acids, amino acids, acylcarnitines, inflammatory cytokines, and various hormones including leptin, insulin, GH, ghrelin, cortisol, IGF-I, glucagon-like peptide-1, and peptide YY. A total of 12.2% of the patients died during hospitalization; the major biochemical factor predicting mortality was a low level of leptin (P = .0002), a marker of adipose tissue reserve and a critical modulator of immune function. We have used metabolomic analysis to provide a comprehensive hormonal and metabolic profile of severely malnourished children at presentation and during nutritional rehabilitation. Our findings suggest that fatty acid metabolism plays a central role in the adaptation to acute malnutrition and that low levels of the adipose tissue hormone leptin associate with, and may predict, mortality prior to and during treatment.

Severe Acute Malnutrition in Childhood: Hormonal and Metabolic Status at Presentation, Response to Treatment, and Predictors of Mortality

PubMed Central

Bartz, Sarah; Mody, Aaloke; Hornik, Christoph; Bain, James; Muehlbauer, Michael; Kiyimba, Tonny; Kiboneka, Elizabeth; Stevens, Robert; Bartlett, John; St Peter, John V.; Newgard, Christopher B.

2014-01-01

Objective: Malnutrition is a major cause of childhood morbidity and mortality. To identify and target those at highest risk, there is a critical need to characterize biomarkers that predict complications prior to and during treatment. Methods: We used targeted and nontargeted metabolomic analysis to characterize changes in a broad array of hormones, cytokines, growth factors, and metabolites during treatment of severe childhood malnutrition. Children aged 6 months to 5 years were studied at presentation to Mulago Hospital and during inpatient therapy with milk-based formulas and outpatient supplementation with ready-to-use food. We assessed the relationship between baseline hormone and metabolite levels and subsequent mortality. Results: Seventy-seven patients were enrolled in the study; a subset was followed up from inpatient treatment to the outpatient clinic. Inpatient and outpatient therapies increased weight/height z scores and induced striking changes in the levels of fatty acids, amino acids, acylcarnitines, inflammatory cytokines, and various hormones including leptin, insulin, GH, ghrelin, cortisol, IGF-I, glucagon-like peptide-1, and peptide YY. A total of 12.2% of the patients died during hospitalization; the major biochemical factor predicting mortality was a low level of leptin (P = .0002), a marker of adipose tissue reserve and a critical modulator of immune function. Conclusions: We have used metabolomic analysis to provide a comprehensive hormonal and metabolic profile of severely malnourished children at presentation and during nutritional rehabilitation. Our findings suggest that fatty acid metabolism plays a central role in the adaptation to acute malnutrition and that low levels of the adipose tissue hormone leptin associate with, and may predict, mortality prior to and during treatment. PMID:24606092

Gestational treatment with methylazoxymethanol (MAM) that disrupts hippocampal-dependent memory does not alter behavioural response to cocaine.

PubMed

Featherstone, Robert E; Burton, Christie L; Coppa-Hopman, Romina; Rizos, Zoë; Sinyard, Judy; Kapur, Shitij; Fletcher, Paul J

2009-10-01

Schizophrenia is associated with increased rates of substance abuse that are thought to be the result of changes in cortical and mesolimbic dopamine activity. Previous work has shown that gestational methylazoxymethanol acetate (MAM) treatment induces increased mesolimbic dopamine activity when given around the time of embryonic day 17 (ED17), suggesting that MAM treatment may model some aspects of schizophrenia. Given that increased dopaminergic activity facilitates aspects of drug self-administration and reinstatement of drug seeking, the current experiments sought to assess cocaine self-administration in MAM treated animals. Experiment 1 examined the acquisition of cocaine self-administration in ED17 MAM and saline treated rats using a sub-threshold dose of cocaine. In experiment 2 ED17 MAM and saline treated animals were trained to self-administer cocaine and were then assessed under varying doses of cocaine (dose-response), followed by extinction and drug-induced reinstatement of responding. A subset of these animals was trained on a win-shift radial maze task, designed to detect impairments in hippocampal-dependent memory. In experiment 3, MAM and saline treated animals were assessed on a progressive ratio schedule of cocaine delivery. Finally, in experiment 4 MAM and saline treated animals were assessed on cocaine-induced locomotor activity across a range of doses of cocaine. MAM treatment disrupted performance of the win-shift task but did not alter cocaine self-administration or cocaine-induced locomotion. Implications of these results for the MAM model of schizophrenia are discussed.

Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System

PubMed Central

Barker, Lisa A.; Gout, Belinda S.; Crowe, Timothy C.

2011-01-01

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition. PMID:21556200

Malnutrition in Hospitalised Older Adults: A Multicentre Observational Study of Prevalence, Associations and Outcomes.

PubMed

O'Shea, E; Trawley, S; Manning, E; Barrett, A; Browne, V; Timmons, S

2017-01-01

Malnutrition is common in older adults and is associated with high costs and adverse outcomes. The prevalence, predictors and outcomes of malnutrition on admission to hospital are not clear for this population. Prospective Cohort Study. Six hospital sites (five public, one private). In total, 606 older adults aged 70+ were included. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. Socio-demographic and clinical data, including nutritional status (Mini-Nutritional Assessment - short form), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and new institutionalisation. The mean age was 79.7; 51% were female; 29% were elective admissions; 67% were admitted to a medical specialty. Nutrition scores were available for 602/606; 37% had a 'normal' status, 45% were 'at-risk', and 18% were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition, compared to normal status (p < .001). Malnutrition was associated with outcomes including an increased length of stay (p < .001), new institutionalisation (p =<0.001) and in-hospital mortality (p < .001). These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.

Predictors of nutritional recovery time and survival status among children with severe acute malnutrition who have been managed in therapeutic feeding centers, Southern Ethiopia: retrospective cohort study.

PubMed

Gebremichael, Delelegn Yilma

2015-12-21

Malnutrition remains to be one of the most common causes of morbidity and mortality among children in developing countries. The prevalence of wasting in Ethiopia remained about 10 % for the past ten years. Mortality rate of children with severe acute malnutrition treated in inpatient set ups has remained unacceptably high. A retrospective cohort study was conducted in Southern Ethiopia. The study population were children with severe acute malnutrition aged from 6 to 59 months who have been managed at Karat and Fasha stabilization centers between September 30, 2013, and Sep. 29, 2014. The total sample size was 420 and pretested questionnaire was used. Kaplan Meier analysis was used to estimate time to nutritional recovery and Cox proportional-hazard regression analysis was carried out to determine independent predictors. Nutritional recovery rate was 3.61 per 100 person day observations. Median nutritional recovery time was 22 and 29 days for edematous malnourished and severely wasted children respectively. The independent predictors of nutritional recovery rate were: stabilization center (AHR = 1.4, 95 % CI: 1.1-1.7), malnutrition status (AHR = 1.8, 95 % CI: 1.3-2.4), weight (AHR = 1.5, 95 % CI: 1.2-1.9), mid- upper arm circumference (AHR = 1.4, 95 % CI: 1.1-1.9), inpatient complications (AHR = 2.2, 95 % CI: 1.4-3.5) and did not lose edema within four days of inpatient treatment (AHR = 2.3, 95 % CI: 1.1-4.8). The findings of this study confirm the probability of surviving gets slimmer with inpatient complications and staying longer in stabilization centers. So, to prevent complications and enhance recovery rate due emphasis should be given in improving early detection and treatment of severely malnourished children in Ethiopia.

Memory deficits with intact cognitive control in the methylazoxymethanol acetate (MAM) exposure model of neurodevelopmental insult.

PubMed

O'Reilly, Kally C; Perica, Maria I; Fenton, André A

2016-10-01

Cognitive impairments are amongst the most debilitating deficits of schizophrenia and the best predictor of functional outcome. Schizophrenia is hypothesized to have a neurodevelopmental origin, making animal models of neurodevelopmental insult important for testing predictions that early insults will impair cognitive function. Rats exposed to methylazoxymethanol acetate (MAM) at gestational day 17 display morphological, physiological and behavioral abnormalities relevant to schizophrenia. Here we investigate the cognitive abilities of adult MAM rats. We examined brain activity in MAM rats by histochemically assessing cytochrome oxidase enzyme activity, a metabolic marker of neuronal activity. To assess cognition, we used a hippocampus-dependent two-frame active place avoidance paradigm to examine learning and spatial memory, as well as cognitive control and flexibility using the same environment and evaluating the same set of behaviors. We confirmed that adult MAM rats have altered hippocampal morphology and brain function, and that they are hyperactive in an open field. The latter likely indicates MAM rats have a sensorimotor gating deficit that is common to many animal models used for schizophrenia research. On first inspection, cognitive control seems impaired in MAM rats, indicated by more errors during the two-frame active place avoidance task. Because MAM rats are hyperactive throughout place avoidance training, we considered the possibility that the hyperlocomotion may account for the apparent cognitive deficits. These deficits were reduced on the basis of measures of cognitive performance that account for motor activity differences. However, though other aspects of memory are intact, the ability of MAM rats to express trial-to-trial memory is delayed compared to control rats. These findings suggest that spatial learning and cognitive abilities are largely intact, that the most prominent cognitive deficit is specific to acquiring memory in the MAM

An integrated community-based outpatient therapeutic feeding programme for severe acute malnutrition in rural Southern Ethiopia: Recovery, fatality, and nutritional status after discharge.

PubMed

Tadesse, Elazar; Worku, Amare; Berhane, Yemane; Ekström, Eva-Charlotte

2018-04-01

A scaled up and integrated outpatient therapeutic feeding programme (OTP) brings the treatment of severely malnourished children closer to the community. This study assessed recovery from severe acute malnutrition (SAM), fatality, and acute malnutrition up to 14 weeks after admission to a programme integrated in the primary health care system. In this cohort study, 1,048 children admitted to 94 OTPs in Southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Only 32.7% (248/759) of children with SAM on admission fulfilled the programme recovery criteria at the time of discharge (i.e., gained 15% in weight, or oedema, if present at admission, was resolved at discharge). Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely malnourished, and 37.5% (348/928) were moderately malnourished; thus, 72.1% were acutely malnourished. Of the children, 27/982 (2.7%) had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). The median length of admission to the programme was 6.6 weeks (interquartile range: 5.3, 8.4 weeks). Despite children participating for the recommended duration of the programme, many children with SAM were discharged still acutely malnourished and without reaching programme criteria for recovery. For better outcome of OTP, constraints in service provision by the health system as well as challenges of service utilization by the beneficiaries should be identified and addressed. © 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference: contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh.

PubMed

Roberfroid, Dominique; Huybregts, Lieven; Lachat, Carl; Vrijens, France; Kolsteren, Patrick; Guesdon, Benjamin

2015-08-25

The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC125) or a Weight-for-Height Z-score<-2 (WHZ-2), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<-2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy. Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ-2 or MUAC125 as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ-2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ<-2) but no linear growth retardation (HAZ≥-2), was modified by the contributors. Overall 23.1% of the 14,409 children were identified as acutely malnourished by either WHZ-2 or MUAC125, but only 28.5% of those (949/3,328) were identified by both indicators. Being stunted (+17.8%; 95 % CI: 14.8%; 22.8%), being a female (+16.5%; 95 % CI: 13.5%; 19.5%) and being younger than 24 months (+33.6%; 95 % CI: 30.4%; 36.7%) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ-2, whereas having 'longer legs' moderately increased the diagnosis by WHZ-2 (+4.2%; 95 % CI: 0.7%; 7.6%). The sensitivity to detect slim children by MUAC125 was 31.0% (95 % CI: 26.8%; 35.2%) whereas it was 70.6% (95 % CI: 65.4%; 75.9%) for WHZ-2. The sensitivity of MUAC125 was particularly affected by age (57.4% vs. 18.1% in children aged < 24 months vs. ≥ 24 months). Specificity was high for both indicators. MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim

Some Considerations on {sup 242m}Am Production in Thermal Reactors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cesana, Alessandra; Mongelli, Sara Tania; Terrani, Mario

2004-10-15

Recently, it has been suggested to consider {sup 242m}Am as a potential nuclear fuel. This artificial nuclide can be produced through {sup 241}Am neutron capture carried on in a neutron field typical of a thermal reactor. In order to suppress the thermal neutron flux, which will cause {sup 242m}Am depletion mainly through fission, proper neutron filters should be adopted. In a very intense neutron field, the {sup 242m}Am enrichment depends mainly on the energy distribution of the neutrons, the sample thickness, and the cutoff energy of the neutron filter.An investigation on different geometries of the sample to be irradiated usingmore » Cd, B, Sm, and Gd as neutron filters has been carried out by means of Monte Carlo simulation. The most favorable results have been obtained irradiating thin {sup 241}Am samples (11 {mu}g/cm{sup 2}) covered with a Gd (0.2-mm-thick) or Sm (1-mm-thick) filter. In these cases the theoretical {sup 242m}Am enrichment can reach 20%.The preparation of significant quantities of this unconventional nuclear fuel implies isotopic separation techniques operating in high radioactive environments and hopefully characterized by very high recovery factors, which are in no way trivial problems.« less

Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya.

PubMed

Mogeni, Polycarp; Twahir, Hemed; Bandika, Victor; Mwalekwa, Laura; Thitiri, Johnstone; Ngari, Moses; Toromo, Christopher; Maitland, Kathryn; Berkley, James A

2011-12-01

To determine the diagnostic value of visible severe wasting in identifying severe acute malnutrition at two public hospitals in Kenya. This was a cross-sectional study of children aged 6 to 59.9 months admitted to one rural and one urban hospital. On admission, mid-upper arm circumference (MUAC), weight and height were measured and the presence of visible severe wasting was assessed. The diagnostic performance of visible severe wasting was evaluated against anthropometric criteria. Of 11,166 children admitted, 563 (5%) had kwashiorkor and 1406 (12.5%) were severely wasted (MUAC < 11.5 cm). The combined sensitivity and specificity of visible severe wasting at the two hospitals, as assessed against a MUAC < 11.5 cm, were 54% (95% confidence interval, CI: 51-56) and 96% (95% CI: 96-97), respectively; at one hospital, its sensitivity and specificity against a weight-for-height z-score below -3 were 44.7% (95% CI: 42-48) and 96.5% (95% CI: 96-97), respectively. Severely wasted children who were correctly identified by visible severe wasting were consistently older, more severely wasted, more often having kwashiorkor, more often positive to the human immunodeficiency virus, ill for a longer period and at greater risk of death. Visible severe wasting had lower sensitivity for determining the risk of death than the anthropometric measures. There was no evidence to support measuring both MUAC and weight-for-height z-score. Visible severe wasting failed to detect approximately half of the children admitted to hospital with severe acute malnutrition diagnosed anthropometrically. Routine screening by MUAC is quick, simple and inexpensive and should be part of the standard assessment of all paediatric hospital admissions in the study setting.

An emergency cash transfer program promotes weight gain and reduces acute malnutrition risk among children 6-24 months old during a food crisis in Niger

PubMed Central

Bliss, Jessica; Golden, Kate; Bourahla, Leila; Stoltzfus, Rebecca; Pelletier, David

2018-01-01

Background Assessment of the impact of emergency cash transfer programs on child nutritional status has been difficult to achieve due to the considerable logistic and ethical constraints that characterize humanitarian settings. Methods We present the findings from a quasi-experimental longitudinal study of a conditional emergency cash transfer program implemented by Concern Worldwide in 2012 during a food crisis in Tahoua, Niger, in which the use of a concurrent control group permits estimation of the program’s impact on child weight gain. Program beneficiaries received three transfers totaling approximately 65% of Niger’s gross national per capita income; mothers attended mandatory sessions on child and infant feeding and care practices. Dietary and anthropometric data from 211 vulnerable households and children targeted by the intervention were compared with 212 similarly vulnerable control households and children from the same 21 villages. We used multilevel mixed effects regression to estimate changes in weight and weight-for-height Z scores (WHZ) over time, and logistic regression to estimate the probability of acute malnutrition. Results We found the intervention to be associated with a 1.27 kg greater overall weight gain (P < 0.001) and a 1.82 greater overall gain in WHZ (P < 0.001). The odds of having acute malnutrition at the end of the intervention were 25 times higher among children in the comparison group than those in households receiving cash (P < 0.001). Conclusions We conclude that this emergency cash transfer program promoted child weight gain and reduced the risk of acute malnutrition among children in the context of a food crisis. We suspect that the use of strategic conditional terms and a valuable transfer size were key features in achieving this result. Limitations in study design prevent us from attributing impact to particular aspects of the program, and preclude a precise estimation of impact. Future studies of this nature

Factors associated with malnutrition among children in internally displaced person's camps, northern Uganda.

PubMed

Olwedo, Mary Abwola; Mworozi, Edison; Bachou, Hanifa; Orach, Christopher Garimoi

2008-12-01

Since mid 1990s, Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in the northern and eastern districts. A major cause of morbidity and mortality amongst children in displaced settings is protein energy malnutrition. To estimate the prevalence of and describe the risk factors for protein energy malnutrition among under five years old children living in internally displaced persons camps in Omoro county Gulu district. This was a cross sectional study undertaken among internally displaced people's in Omoro county, Gulu district during 13 - 23(rd) September 2006. Anthropometric measurements of 672 children aged 3 - 59 months were undertaken and all their caretakers interviewed. The anthropometric measurements were analyzed using z-scores of height-for-age (H/A) and weight-for-height (W/H) indices. Qualitative data were collected through 6 focus group discussions, key informant interviews and observation. Data were captured using Epi Data version 3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0 computer packages respectively. ResultsThe prevalence of global stunting was found to be 52.4% and of global acute malnutrition 6.0%. Male children are at risk of being stunted Adjusted OR 1.57 95% CI 1.15-2.13; p value=0.004. Children in the age group 3 - 24 months were at risk of acute malnutrition Adjusted OR 2.78 95% CI 1.26-6.15; p value=0.012 while de-worming was protective Adjusted OR 0.44 95% CI 0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs include food rations distributed by WFP, cultivation and purchase. There is high prevalence of protein energy malnutrition (stunting) among children in the internally displaced people's camps in Gulu district. Male children are at an increased risk of stunting while children aged between 3 - 24 months are at an increased risk of suffering from acute malnutrition. Stakeholders including local government and relief organizations should intensify efforts to improve the

Calcium regulates cell death in cancer: Roles of the mitochondria and mitochondria-associated membranes (MAMs).

PubMed

Danese, Alberto; Patergnani, Simone; Bonora, Massimo; Wieckowski, Mariusz R; Previati, Maurizio; Giorgi, Carlotta; Pinton, Paolo

2017-08-01

Until 1972, the term 'apoptosis' was used to differentiate the programmed cell death that naturally occurs in organismal development from the acute tissue death referred to as necrosis. Many studies on cell death and programmed cell death have been published and most are, at least to some degree, related to cancer. Some key proteins and molecular pathways implicated in cell death have been analyzed, whereas others are still being actively researched; therefore, an increasing number of cellular compartments and organelles are being implicated in cell death and cancer. Here, we discuss the mitochondria and subdomains of the endoplasmic reticulum (ER) that interact with mitochondria, the mitochondria-associated membranes (MAMs), which have been identified as critical hubs in the regulation of cell death and tumor growth. MAMs-dependent calcium (Ca 2+ ) release from the ER allows selective Ca 2+ uptake by the mitochondria. The perturbation of Ca 2+ homeostasis in cancer cells is correlated with sustained cell proliferation and the inhibition of cell death through the modulation of Ca 2+ signaling. This article is part of a Special Issue entitled Mitochondria in Cancer, edited by Giuseppe Gasparre, Rodrigue Rossignol and Pierre Sonveaux. Copyright © 2017 Elsevier B.V. All rights reserved.

Malnutrition: Modulator of Immune Responses in Tuberculosis

PubMed Central

Chandrasekaran, Padmapriyadarsini; Saravanan, Natarajan; Bethunaickan, Ramalingam; Tripathy, Srikanth

2017-01-01

Nutrition plays a major role in the management of both acute and chronic diseases, in terms of body’s response to the pathogenic organism. An array of nutrients like macro- and micro-nutrients, vitamins, etc., are associated with boosting the host’s immune responses against intracellular pathogens including mycobacterium tuberculosis (M.tb). These nutrients have an immunomodulatory effects in controlling the infection and inflammation process and nutritional deficiency of any form, i.e., malnutrition may lead to nutritionally acquired immunodeficiency syndrome, which greatly increases an individual’s susceptibility to progression of infection to disease. This narrative review looks at the various mechanisms by which nutrition or its deficiency leads to impaired cell mediated and humoral immune responses, which in turn affects the ability of an individual to fight M.tb infection or disease. There is very little evidence in the literature that any specific food on its own or a specific quantity can alter the course of TB disease or be effective in the treatment of malnutrition. Further clinical trials or studies will be needed to recommend and to better understand the link between malnutrition, tuberculosis, and impaired immunity. PMID:29093710

The impact of malnutrition on childhood infections.

PubMed

Walson, Judd L; Berkley, James A

2018-06-01

Almost half of all childhood deaths worldwide occur in children with malnutrition, predominantly in sub-Saharan Africa and South Asia. This review summarizes the mechanisms by which malnutrition and serious infections interact with each other and with children's environments. It has become clear that whilst malnutrition results in increased incidence, severity and case fatality of common infections, risks continue beyond acute episodes resulting in significant postdischarge mortality. A well established concept of a 'vicious-cycle' between nutrition and infection has now evolving to encompass dysbiosis and pathogen colonization as precursors to infection; enteric dysfunction constituting malabsorption, dysregulation of nutrients and metabolism, inflammation and bacterial translocation. All of these interact with a child's diet and environment. Published trials aiming to break this cycle using antimicrobial prophylaxis or water, sanitation and hygiene interventions have not demonstrated public health benefit so far. As further trials are planned, key gaps in knowledge can be filled by applying new tools to re-examine old questions relating to immune competence during and after infection events and changes in nutritional status; and how to characterize overt and subclinical infection, intestinal permeability to bacteria and the role of antimicrobial resistance using specific biomarkers.

The immune system in children with malnutrition--a systematic review.

PubMed

Rytter, Maren Johanne Heilskov; Kolte, Lilian; Briend, André; Friis, Henrik; Christensen, Vibeke Brix

2014-01-01

Malnourished children have increased risk of dying, with most deaths caused by infectious diseases. One mechanism behind this may be impaired immune function. However, this immune deficiency of malnutrition has not previously been systematically reviewed. To review the scientific literature about immune function in children with malnutrition. A systematic literature search was done in PubMed, and additional articles identified in reference lists and by correspondence with experts in the field. The inclusion criteria were studies investigating immune parameters in children aged 1-60 months, in relation to malnutrition, defined as wasting, underweight, stunting, or oedematous malnutrition. The literature search yielded 3402 articles, of which 245 met the inclusion criteria. Most were published between 1970 and 1990, and only 33 after 2003. Malnutrition is associated with impaired gut-barrier function, reduced exocrine secretion of protective substances, and low levels of plasma complement. Lymphatic tissue, particularly the thymus, undergoes atrophy, and delayed-type hypersensitivity responses are reduced. Levels of antibodies produced after vaccination are reduced in severely malnourished children, but intact in moderate malnutrition. Cytokine patterns are skewed towards a Th2-response. Other immune parameters seem intact or elevated: leukocyte and lymphocyte counts are unaffected, and levels of immunoglobulins, particularly immunoglobulin A, are high. The acute phase response appears intact, and sometimes present in the absence of clinical infection. Limitations to the studies include their observational and often cross-sectional design and frequent confounding by infections in the children studied. The immunological alterations associated with malnutrition in children may contribute to increased mortality. However, the underlying mechanisms are still inadequately understood, as well as why different types of malnutrition are associated with different immunological

Metabolomic changes in serum of children with different clinical diagnoses of malnutrition

USDA-ARS?s Scientific Manuscript database

Mortality in children with severe acute malnutrition (SAM) remains high despite standardized rehabilitation protocols. Two forms of SAM are classically distinguished: kwashiorkor and marasmus. Children with kwashiorkor have nutritional edema and metabolic disturbances, including hypoalbuminemia and ...

Hunger and Malnutrition

MedlinePlus

... Videos for Educators Search English Español Hunger and Malnutrition KidsHealth / For Parents / Hunger and Malnutrition What's in ... to meet their needs. What Are Hunger and Malnutrition? Everyone feels hungry at times. Hunger is the ...

Hunger and Malnutrition

MedlinePlus

... Videos for Educators Search English Español Hunger and Malnutrition KidsHealth / For Teens / Hunger and Malnutrition What's in ... most of the time. What Are Hunger and Malnutrition? We all feel hungry at times. Hunger is ...

Visualization of Iron-Binding Micelles in Acidic Recombinant Biomineralization Protein, MamC

DOE PAGES

Kashyap, Sanjay; Woehl, Taylor; Valverde-Tercedor, Carmen; ...

2014-01-01

Biological macromolecules are utilized in low-temperature synthetic methods to exert precise control over nanoparticle nucleation and placement. They enable low-temperature formation of a variety of functional nanostructured materials with properties often not achieved via conventional synthetic techniques. Here we report on the in situ visualization of a novel acidic bacterial recombinant protein, MamC, commonly present in the magnetosome membrane of several magnetotactic bacteria, including Magnetococcus marinus , strain MC-1. Our findings provide an insight into the self-assembly of MamC and point to formation of the extended protein surface, which is assumed to play an important role in the formation ofmore » biotemplated inorganic nanoparticles. The self-organization of MamC is compared to the behavior of another acidic recombinant iron-binding protein, Mms6.« less

Visualization of Iron-Binding Micelles in Acidic Recombinant Biomineralization Protein, MamC

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kashyap, Sanjay; Woehl, Taylor; Valverde-Tercedor, Carmen

2014-03-07

Biological macromolecules are utilized in low-temperature synthetic methods to exert precise control over nanoparticle nucleation and placement. They enable low-temperature formation of a variety of functional nanostructured materials with properties often not achieved via conventional synthetic techniques. Here we report on the in situ visualization of a novel acidic bacterial recombinant protein, MamC, commonly present in the magnetosome membrane of several magnetotactic bacteria, including Magnetococcus marinus, strain MC-1. Our findings provide an insight into the self-assembly of MamC and point to formation of the extended protein surface, which is assumed to play an important role in the formation of biotemplatedmore » inorganic nanoparticles. The self-organization of MamC is compared to the behavior of another acidic recombinant iron-binding protein, Mms6.« less

Recognition and Prevention of Nosocomial Malnutrition: A Review and A Call to Action!

PubMed

Kirkland, Lisa L; Shaughnessy, Erin

2017-12-01

Nosocomial malnutrition in hospitalized adults is a morbid, costly, and potentially preventable and treatable problem. Although recognized as contributing to many serious complications of hospitalization, malnutrition is often missed when present on admission and rarely diagnosed if it occurs during hospital stay. Many routine clinical practices such as holding nutrition for testing or failing to address poor intake, when added to acute inflammatory disease states, cause rapid deterioration in nutritional status in up to 70% of inpatients. Malnutrition during hospitalization is associated with increased mortality for years after discharge. In addition, unrecognized (and under-coded) malnutrition is associated with potential lost revenues for hospital systems. Low-cost interventions of recognizing at-risk patients and providing adequate nutrition have the potential to improve patient outcomes and reduce health care costs. Physicians must champion implementation of these interventions, using guidance from national organizations. Copyright © 2017 Elsevier Inc. All rights reserved.

Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition: A randomised 2 × 2 × 3 factorial trial in Burkina Faso

PubMed Central

Yaméogo, Charles W.; Iuel-Brockdorf, Ann-Sophie; Kurpad, Anura; Filteau, Suzanne

2017-01-01

Background Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p < 0.01) comprising 93.5% (95% CI 89.5, 97.3) FFM. As compared to children who received CSB, FFMI accretion was increased by 0.083 kg/m2 (95% CI 0.003, 0.163; p = 0.042) in those who received LNS. In contrast, SI did not increase FFMI compared to DS (mean difference 0.038 kg/m2; 95% CI −0.041, 0.118; p = 0.35), irrespective of matrix. Having 20% milk protein was associated with 0.097 kg/m2 (95% CI −0.002, 0.196) greater FFMI accretion than having 0% milk protein, although this difference was not significant (p = 0.055), and there was no effect of 50% milk protein (0.049 kg/m2; 95% CI −0.047, 0.146; p = 0.32). There was no

Lay-screeners and use of WHO growth standards increase case finding of hospitalized Malawian children with severe acute malnutrition.

PubMed

LaCourse, Sylvia M; Chester, Frances M; Preidis, Geoffrey; McCrary, Leah M; Maliwichi, Madalitso; McCollum, Eric D; Hosseinipour, Mina C

2015-02-01

Strategies to effectively identify and refer children with severe acute malnutrition (SAM) to Nutritional Rehabilitation units (NRU) can reduce morbidity and mortality. From December 2011 to May 2012, we conducted a prospective study task-shifting inpatient malnutrition screening of Malawian children 6-60 months to lay-screeners and evaluated World Health Organization (WHO) criteria vs. the National Center for Health Statistics (NCHS) guidelines for SAM. Lay-screeners evaluated 3116 children, identifying 368 (11.8%) with SAM by WHO criteria, including 210 (6.7%) who met NCHS criteria initially missed by standard clinician NRU referrals. Overall case finding increased by 56.7%. Mid-upper arm circumference (MUAC) and bipedal edema captured 86% (181/210) NCHS/NRU-eligible children and 89% of those who died (17/19) meeting WHO criteria. Mortality of NCHS/NRU-eligible children was 10 times greater than those without SAM (odds ratio 10.5, 95% confidence interval 5.4-20.6). Ward-based lay-screeners and WHO guidelines identified high-risk children with SAM missed by standard NRU referral. MUAC and edema detected the majority of NRU-eligible children. © The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Minorities and Malnutrition.

ERIC Educational Resources Information Center

Kornegay, Francis A.

Various aspects of the relationship between minorities and malnutrition are discussed in this brief paper. Malnutrition, one of the byproducts of low economic status, is creating a crisis-proportion health problem affecting minority citizens. Malnutrition seriously affects children, older people in poverty, and chronically unemployed or…

Celiac Disease in Children with Severe Acute Malnutrition (SAM): A Hospital Based Study.

PubMed

Beniwal, Neetu; Ameta, Gaurav; Chahar, Chandra Kumar

2017-05-01

To evaluate the prevalence and clinical features of Celiac disease among children with severe acute malnutrition (SAM). This prospective observational study was conducted in PBM Children Hospital, Bikaner from July 2012 through December 2013. All consecutively admitted children with SAM were recruited. All subjects were screened for Celiac disease by serological test for IgA-anti tissue Transglutaminase (IgA tTG) antibodies. All seropositive children underwent upper gastrointestinal endoscopy for small bowel biopsy for the confirmation. Clinical features of patients with and without celiac disease were compared. The sero-prevalence (IgA tTg positivity) of Celiac disease was found to be 15.38% while prevalence of biopsy confirmed Celiac disease was 14.42% among SAM children. Abdominal distension, diarrhea, anorexia, constipation, pain in abdomen, vitamin deficiencies, edema, clubbing and mouth ulcers were more common in patients of Celiac disease compared to patients without Celiac disease but the difference was statistically significant only for abdominal distension and pain abdomen. There is a high prevalence of Celiac disease in SAM. Screening for Celiac disease (especially in presence of pain abdomen and abdominal distension) should be an essential part of work-up in all children with SAM.

Choice of design and outcomes in trials among children with moderate acute malnutrition.

PubMed

Friis, Henrik; Michaelsen, Kim F; Wells, Jonathan C

2015-03-01

There is a need for trials on the effects of food aid products for children with moderate acute malnutrition, to identify how best to restore body tissues and function. The choice of control intervention is a major challenge, with both ethical and scientific implications. While randomized trials are needed, special designs, such as cluster-randomized, stepped-wedged or factorial designs may offer advantages. Anthropometry is widely used as the primary outcome in such trials, but anthropometric traits do not refer directly to specific organs, tissues, or functions. Thus, it is difficult to understand what components of health might be impacted by public health programs, or the underlying mechanisms whereby improved nutritional status might benefit short- and long-term health. Measurement of body composition, specific growth markers and functional outcomes may provide greater insight into the nature and implications of growth failure and recovery. There are now several methodologies suitable for application in infants and young children, e.g., measuring body composition with deuterium dilution, physical activity with accelerometers and linear growth with knemometers. To evaluate the generalizability of the findings from nutrition trials, it is important to collect data on baseline nutritional status.

Malnutrition related deaths.

PubMed

Sparre-Sørensen, Maja; Kristensen, Gustav N

2016-10-01

Studies have shown that malnutrition increases the risk of morbidity, mortality, the length of hospital stay, and costs in the elderly population. Approximately one third of all patients admitted to geriatric wards in Denmark are malnourished according to the Danish Geriatric database. The aim of this study is to describe and examine the sudden increase in deaths due to malnutrition in the elderly population in Denmark from 1999 and, similarly, the sudden decline in malnutrition related deaths in 2007. A descriptive epidemiologic study was performed. All Danes listed in the national death registry who died from malnutrition in the period from 1994 to 2012 are included. The number of deaths from malnutrition increased significantly during the period from 1999 to 2007, especially in the age group 70 years and over. Additionally, we document a surprising similarity between the development in excess mortality from malnutrition in the five Danish regions during the same period. During the period 1999-2007 malnutrition was the direct cause of 340 extra deaths, and probably ten times more registered under other diseases. This development in excess mortality runs parallel in all five Danish regions over time. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Post heroin dose tissue distribution of 6-monoacetylmorphine (6-MAM) with MALDI imaging.

PubMed

Teklezgi, Belin G; Pamreddy, Annapurna; Baijnath, Sooraj; Gopal, Nirmala D; Naicker, Tricia; Kruger, Hendrik G; Govender, Thavendran

2017-08-01

Heroin is an illicit opioid drug which is commonly abused and leads to dependence and addiction. Heroin is considered a pro-drug and is rapidly converted to its major active metabolite 6-monoacetylmorphine (6-MAM) which mediates euphoria and reward through the stimulation of opioid receptors in the brain. The aim of this study was to investigate the distribution and localization of 6-MAM in the healthy Sprague Dawley rat brain following intraperitoneal (i.p) administration of heroin (10 mg/kg), using matrix-assisted laser desorption/ionization mass spectrometric imaging (MALDI-MSI), in combination with quantification via liquid chromatography mass spectrometry (LC-MS/MS). These findings revealed that 6-MAM is present both in plasma and brain tissue with a T max of 5 min (2.8 µg/mL) and 15 min (1.1 µg/mL), respectively. MSI analysis of the brain showed high intensities of 6-MAM in the thalamus-hypothalamus and mesocorticolimbic system including areas of the cortex, caudate putamen, and ventral pallidum regions. This finding correlates with the distribution of opioid receptors in the brain, according to literature. In addition, we report a time-dependent distribution in the levels of 6-MAM, from 1 min with the highest intensity of the drug observed at 15 min, with sparse distribution at 45 min before decreasing at 60 min. This is the first study to use MSI as a brain imaging technique to detect a morphine's distribution over time in the brain.

Community-based management of severe acute malnutrition in India: new evidence from Bihar.

PubMed

Burza, Sakib; Mahajan, Raman; Marino, Elisa; Sunyoto, Temmy; Shandilya, Chandra; Tabrez, Mohammad; Kumari, Kabita; Mathew, Prince; Jha, Amar; Salse, Nuria; Mishra, Kripa Nath

2015-04-01

An estimated one-third of the world's children who are wasted live in India. In Bihar state, of children <5 y old, 27.1% are wasted and 8.3% have severe acute malnutrition (SAM). In 2009, Médecins Sans Frontières (MSF) initiated a community-based management of acute malnutrition (CMAM) program for children aged 6-59 mo with SAM. In this report, we describe the characteristics and outcomes of 8274 children treated between February 2009 and September 2011. Between February 2009 and June 2010, the program admitted children with a weight-for-height z score (WHZ) <-3 SD and/or midupper arm circumference (MUAC) <110 mm and discharged those who reached a WHZ >-2 SDs and MUAC >110 mm. These variables changed in July 2010 to admission on the basis of an MUAC <115 mm and discharge at an MUAC ≥120 mm. Uncomplicated SAM cases were treated as outpatients in the community by using a WHO-standard, ready-to-use, therapeutic lipid-based paste produced in India; complicated cases were treated as inpatients by using F75/F100 WHO-standard milk until they could complete treatment in the community. A total of 8274 children were admitted including 5149 girls (62.2%), 6613 children aged 6-23 mo (79.9%), and 87.3% children who belonged to Scheduled Caste, Scheduled Tribe, or Other Backward Caste families or households. Of 3873 children admitted under the old criteria, 41 children (1.1%) died, 2069 children (53.4%) were discharged as cured, and 1485 children (38.3%) defaulted. Of 4401 children admitted under the new criteria, 36 children (0.8%) died, 2526 children (57.4%) were discharged as cured, and 1591 children (36.2%) defaulted. For children discharged as cured, the mean (±SD) weight gain and length of stay were 4.7 ± 3.1 and 5.1 ± 3.7 g · kg(-1) · d(-1) and 8.7 ± 6.1 and 7.3 ± 5.6 wk under the old and new criteria, respectively (P < 0.01). After adjustment, significant risk factors for default were as follows: no community referral for admission, more severe wasting on

Crystal Structure of the Neuropilin-1 MAM Domain: Completing the Neuropilin-1 Ectodomain Picture.

PubMed

Yelland, Tamas; Djordjevic, Snezana

2016-11-01

Neuropilins (NRPs) are single-pass transmembrane receptors involved in several signaling pathways that regulate key physiological processes such as vascular morphogenesis and axon guidance. The MAM domain of NRP, which has previously been implicated in receptor multimerization, was the only portion of the ectopic domain of the NRPs for which the structure, until now, has been elusive. Using site-directed mutagenesis in the linker region preceding the MAM domain we generated a protein construct amenable to crystallization. Here we present the crystal structure of the MAM domain of human NRP1 at 2.24 Å resolution. The protein exhibits a jellyroll topology, with Ca 2+ ions bound at the inter-strand space enhancing the thermostability of the domain. We show that the MAM domain of NRP1 is monomeric in solution and insufficient to drive receptor dimerization, which leads us to propose a different role for this domain in the context of NRP membrane assembly and signaling. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Use of Technology in Identifying Hospital Malnutrition: Scoping Review.

PubMed

Trtovac, Dino; Lee, Joon

2018-01-19

Malnutrition is a condition most commonly arising from the inadequate consumption of nutrients necessary to maintain physiological health and is associated with the development of cardiovascular disease, osteoporosis, and sarcopenia. Malnutrition occurring in the hospital setting is caused by insufficient monitoring, identification, and assessment efforts. Furthermore, the ability of health care workers to identify and recognize malnourished patients is suboptimal. Therefore, interventions focusing on the identification and treatment of malnutrition are valuable, as they reduce the risks and rates of malnutrition within hospitals. Technology may be a particularly useful ally in identifying malnutrition due to scalability, timeliness, and effectiveness. In an effort to explore the issue, this scoping review synthesized the availability of technological tools to detect and identify hospital malnutrition. Our objective was to conduct a scoping review of the different forms of technology used in addressing malnutrition among adults admitted to hospital to (1) identify the extent of the published literature on this topic, (2) describe key findings, and (3) identify outcomes. We designed and implemented a search strategy in 3 databases (PubMed, Scopus, and CINAHL). We completed a descriptive numerical summary and analyzed study characteristics. One reviewer independently extracted data from the databases. We retrieved and reviewed a total of 21 articles. We categorized articles by the computerized tool or app type: malnutrition assessment (n=15), food intake monitoring (n=5), or both (n=1). Within those categories, we subcategorized the different technologies as either hardware (n=4), software (n=13), or both (n=4). An additional subcategory under software was cloud-based apps (n=1). Malnutrition in the acute hospital setting was largely an unrecognized problem, owing to insufficient monitoring, identification, and initial assessments of identifying both patients who are

Beneficiaries' perceptions and reported use of unconditional cash transfers intended to prevent acute malnutrition in children in poor rural communities in Burkina Faso: qualitative results from the MAM'Out randomized controlled trial.

PubMed

Tonguet-Papucci, Audrey; Houngbe, Freddy; Lompo, Palamanga; Yameogo, Wambi Maurice Evariste; Huneau, Jean-François; Ait Aissa, Myriam; Kolsteren, Patrick

2017-05-30

Acute malnutrition is a public health issue worldwide, and particularly in the Eastern region of Burkina Faso. Following a needs assessment, unconditional seasonal, multiannual cash transfers were implemented as a safety net to prevent childhood undernutrition. The objectives of this study were to explore the types of purchases made by beneficiaries of this cash transfer program and to understand the perceived effects of and changes induced by regular cash transfers in the daily lives of women, and at the household and community level. The design of this study was a two-arm cluster randomized controlled trial. Qualitative data were collected each month during the cash transfer period for two years, leading to a total of more than 300 interviews and focus group discussions with various participants: beneficiary mothers, heads of households, mothers-in-law, co-wives, key members of the community, and participants of the control group. The two main types of expenses reported were food and health care for the child and the whole family. The program was also associated with positive perceived changes at the household level, mainly related to gender equality and improvement of women's status, and has promoted an increase in dignity and social integration of the poorest at the community level through cash sharing. Unexpected effects of this program included some women planning new pregnancies and some individuals not expecting the transfers to end. Although the transfers were unconditional, the cash was mainly used to improve the children's and households' food security and health, which correspond to two main underlying causes of undernutrition. Therefore, spending mainly in these areas can help to prevent undernutrition in children. ClinicalTrials.gov , identifier: NCT01866124 , registered May 7, 2013.

Nutritional variables predict chances of returning home and activities of daily living in post-acute geriatric care

PubMed Central

Maeda, Keisuke; Koga, Takayuki; Akagi, Junji

2018-01-01

Background Little is known about the association between malnutrition and the chances of returning home from post-acute facilities in older adult patients. This study aimed to understand whether malnutrition and malnutrition-related factors would be determinants for returning home and activities of daily living (ADL) at discharge after post-acute care. Methods Patients aged ≥65 years living at home before the onset of an acute disease and admitted to a post-acute ward were enrolled (n=207) in this prospective observational study. Malnutrition was defined based on the criteria of the European Society for Clinical Nutrition and Metabolism. Nutritional parameters included the nutritional intake at the time of admission and oral conditions evaluated by the Oral Health Assessment Tool (OHAT). The Barthel Index was used to assess daily activities. A Cox regression analysis of the length of stay was performed. Multivariable linear regression analyses to determine associations between malnutrition, returning home, and ADL at discharge were performed, after adjusting the variables of acute care setting. Results The mean patient age was 84.7±6.7 years; 38% were men. European Society for Clinical Nutrition and Metabolism-defined malnutrition was observed in 129 (62.3%) patients, and 118 (57.0%) of all patients returned home. Multivariable regression analyses showed that malnutrition was a negative predictor of returning home (hazard ratio: 0.517 [0.351–0.761], p=0.001), and an increase in the nutritional intake (kcal/kg/d) was a positive predictor of the Barthel Index at discharge (coefficient: 0.34±0.15, p=0.021). The OHAT was not associated with returning home and ADL. Conclusion Malnutrition and nutritional intake are associated with returning home and ADL at discharge, respectively, after post-acute care. Further studies investigating the effects of a nutritional intervention for post-acute patients would be necessary. PMID:29416323

Tuberculosis in HIV-infected South African children with complicated severe acute malnutrition.

PubMed

Adler, H; Archary, M; Mahabeer, P; LaRussa, P; Bobat, R A

2017-04-01

Academic tertiary referral hospital in Durban, South Africa. To describe the incidence and diagnostic challenges of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children with severe acute malnutrition (SAM). Post-hoc analysis of a randomised controlled trial that enrolled antiretroviral therapy naïve, HIV-infected children with SAM. Trial records and hospital laboratory results were explored for clinical diagnoses and bacteriologically confirmed cases of TB. Negative binomial regression was used to explore associations with confirmed cases of TB, excluding cases where the clinical diagnosis was not supported by microbiological confirmation. Of 82 children enrolled in the study, 21 (25.6%) were diagnosed with TB, with bacteriological confirmation in 8 cases. Sputum sampling (as opposed to gastric washings) was associated with an increased risk of subsequent diagnosis of TB (adjusted relative risk [aRR] 1.134, 95%CI 1.02-1.26). Culture-proven bacterial infection during admission was associated with a reduced risk of TB (aRR 0.856, 95%CI 0.748-0.979), which may reflect false-negative microbiological tests secondary to empiric broad-spectrum antibiotics. TB is common in HIV-infected children with SAM. While microbiological confirmation of the diagnosis is feasible, empiric treatment remains common, possibly influenced by suboptimal testing and false-negative TB diagnostics. Rigorous microbiological TB investigation should be integrated into the programmatic management of HIV and SAM.

Challenges and opportunities of integration of community based Management of Acute Malnutrition into the government health system in Bangladesh: a qualitative study.

PubMed

Ireen, Santhia; Raihan, Mohammad Jyoti; Choudhury, Nuzhat; Islam, M Munirul; Hossain, Md Iqbal; Islam, Ziaul; Rahman, S M Mustafizur; Ahmed, Tahmeed

2018-04-10

Severe acute malnutrition (SAM) in children is the most serious form of malnutrition and is associated with very high rates of morbidity and mortality. For sustainable SAM management, United Nations recommends integration of community based management of acute malnutrition (CMAM) into the health system. The objective of the study was to assess the preparedness of the health system to implement CMAM in Bangladesh. The assessment was undertaken during January to May 2014 by conducting document review, key informant interviews, and direct observation. A total of 38 key informant interviews were conducted among government policy makers and program managers (n = 4), nutrition experts (n = 2), health and nutrition implementing partners (n = 2), development partner (n = 1), government health system staff (n = 5), government front line field workers (n = 22), and community members (n = 2). The assessment was based on: workforce, service delivery, financing, governance, information system, medical supplies, and the broad socio-political context. The government of Bangladesh has developed inpatient and outpatient guidelines for the management of SAM. There are cadres of community health workers of government and non-government actors who can be adequately trained to conduct CMAM. Inpatient management of SAM is available in 288 facilities across the country. However, only 2.7% doctors and 3.3% auxiliary staff are trained on facility based management of SAM. In functional facilities, uninterrupted supply of medicines and therapeutic diet are not available. There is resistance and disagreement among nutrition stakeholders regarding import or local production of ready-to-use therapeutic food (RUTF). Nutrition coordination is fragile and there is no functional supra-ministerial coordination platform for multi-sectoral and multi-stakeholder nutrition. There is an enabling environment for CMAM intervention in Bangladesh although health system

Malnutrition, a Global Problem

USDA-ARS?s Scientific Manuscript database

Malnutrition is a general term for medical conditions caused by an inadequate diet and poor nutrition. Hunger and malnutrition are among the major difficulties confronting many countries around the world. Malnutrition can be caused by several factors, such as the sharp increase in population (curren...

Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique.

PubMed

Nhampossa, Tacilta; Sigaúque, Betuel; Machevo, Sónia; Macete, Eusebio; Alonso, Pedro; Bassat, Quique; Menéndez, Clara; Fumadó, Victoria

2013-09-01

To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years. Retrospective study of hospital-based data systematically collected from January 2001 to December 2010. Rural Mozambican district hospital. All children aged <5 years admitted with severe malnutrition. During the 10-year long study surveillance, 274 813 children belonging to Manhiça’s Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6% (17 188/274 813) with severe malnutrition. Of these, only 15% (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence. Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

Effects of malnutrition on treatment-related morbidity and survival of children with cancer in Nicaragua.

PubMed

Pribnow, Allison K; Ortiz, Roberta; Báez, Luis Fulgencio; Mendieta, Luvy; Luna-Fineman, Sandra

2017-11-01

Most children with cancer live in resource-limited countries where malnutrition is often prevalent. We identified the relationship between malnutrition and treatment-related morbidity (TRM), abandonment of therapy, and survival of children with cancer in Nicaragua to better inform targeted nutritional interventions. We conducted a retrospective review of patients aged 6 months to 18 years with newly diagnosed acute lymphoblastic leukemia, acute myeloid leukemia (AML), Wilms tumor, Hodgkin lymphoma, or Burkitt lymphoma (BL) who were treated between January 1, 2004, and December 31, 2007 at Children's Hospital Manuel de Jesus Rivera in Managua, Nicaragua. Statistical analysis examined the relations among nutritional status and cancer type, risk category, TRM, and event-free survival (EFS). Sixty-seven percent of patients (189/282) were malnourished at diagnosis. Malnutrition was highest among patients with Wilms tumor (85.7%), BL (75%), and AML (74.3%). A total of 92.2% of patients (225/244) experienced morbidity during the first 90 days. Malnutrition was associated with severe infection (P = 0.033). Severely malnourished patients had ≥grade 3 TRM on more days (P = 0.023) and were more likely to experience severe TRM on >50% of days (P = 0.032; OR, 3.27 [95% CI, 1.05-10.16]). Malnourished patients had inferior median EFS (2.25 vs. 5.58 years; P = 0.049), and abandoned therapy more frequently (P = 0.015). In Nicaragua, pediatric oncology patients with malnutrition at diagnosis experienced increased TRM, abandoned therapy more frequently, and had inferior EFS. Standardized nutritional evaluation of patients with newly diagnosed cancer and targeted provision of nutritional support are essential to decrease TRM and improve outcomes. © 2017 Wiley Periodicals, Inc.

Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study.

PubMed

Jesson, Julie; Masson, David; Adonon, Arsène; Tran, Caroline; Habarugira, Capitoline; Zio, Réjane; Nicimpaye, Léoncie; Desmonde, Sophie; Serurakuba, Goreth; Kwayep, Rosine; Sare, Edith; Konate, Tiefing; Nimaga, Abdoulaye; Saina, Philemon; Kpade, Akossiwa; Bassuka, Andrée; Gougouyor, Gustave; Leroy, Valériane

2015-05-26

The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa. A cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2-19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d'Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition. Overall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7-13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6-12 %), 26 % (95% CI: 23-28 %), and 7 % (95% CI: 5-10 %), respectively. Among those malnourished, more than half of children didn't receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5

Community-based management of severe acute malnutrition in India: new evidence from Bihar123

PubMed Central

Burza, Sakib; Mahajan, Raman; Marino, Elisa; Sunyoto, Temmy; Shandilya, Chandra; Tabrez, Mohammad; Kumari, Kabita; Mathew, Prince; Jha, Amar; Salse, Nuria; Mishra, Kripa Nath

2015-01-01

Background: An estimated one-third of the world’s children who are wasted live in India. In Bihar state, of children <5 y old, 27.1% are wasted and 8.3% have severe acute malnutrition (SAM). In 2009, Médecins Sans Frontières (MSF) initiated a community-based management of acute malnutrition (CMAM) program for children aged 6–59 mo with SAM. Objective: In this report, we describe the characteristics and outcomes of 8274 children treated between February 2009 and September 2011. Design: Between February 2009 and June 2010, the program admitted children with a weight-for-height z score (WHZ) <−3 SD and/or midupper arm circumference (MUAC) <110 mm and discharged those who reached a WHZ >−2 SDs and MUAC >110 mm. These variables changed in July 2010 to admission on the basis of an MUAC <115 mm and discharge at an MUAC ≥120 mm. Uncomplicated SAM cases were treated as outpatients in the community by using a WHO-standard, ready-to-use, therapeutic lipid-based paste produced in India; complicated cases were treated as inpatients by using F75/F100 WHO-standard milk until they could complete treatment in the community. Results: A total of 8274 children were admitted including 5149 girls (62.2%), 6613 children aged 6–23 mo (79.9%), and 87.3% children who belonged to Scheduled Caste, Scheduled Tribe, or Other Backward Caste families or households. Of 3873 children admitted under the old criteria, 41 children (1.1%) died, 2069 children (53.4%) were discharged as cured, and 1485 children (38.3%) defaulted. Of 4401 children admitted under the new criteria, 36 children (0.8%) died, 2526 children (57.4%) were discharged as cured, and 1591 children (36.2%) defaulted. For children discharged as cured, the mean (±SD) weight gain and length of stay were 4.7 ± 3.1 and 5.1 ± 3.7 g · kg−1 · d−1 and 8.7 ± 6.1 and 7.3 ± 5.6 wk under the old and new criteria, respectively (P < 0.01). After adjustment, significant risk factors for default were as follows: no community

Disruption of the mitochondria-associated ER membrane (MAM) plays a central role in palmitic acid-induced insulin resistance.

PubMed

Shinjo, Satoko; Jiang, Shuying; Nameta, Masaaki; Suzuki, Tomohiro; Kanai, Mai; Nomura, Yuta; Goda, Nobuhito

2017-10-01

The mitochondria-associated ER membrane (MAM) is a specialized subdomain of ER that physically connects with mitochondria. Although disruption of inter-organellar crosstalk via the MAM impairs cellular homeostasis, its pathological significance in insulin resistance in type 2 diabetes mellitus remains unclear. Here, we reveal the importance of reduced MAM formation in the induction of fatty acid-evoked insulin resistance in hepatocytes. Palmitic acid (PA) repressed insulin-stimulated Akt phosphorylation in HepG2 cells within 12h. Treatment with an inhibitor of the ER stress response failed to restore PA-mediated suppression of Akt activation. Mitochondrial reactive oxygen species (ROS) production did not increase in PA-treated cells. Even short-term exposure (3h) to PA reduced the calcium flux from ER to mitochondria, followed by a significant decrease in MAM contact area, suggesting that PA suppressed the functional interaction between ER and mitochondria. Forced expression of mitofusin-2, a critical component of the MAM, partially restored MAM contact area and ameliorated the PA-elicited suppression of insulin sensitivity with Ser473 phosphorylation of Akt selectively improved. These results suggest that loss of proximity between ER and mitochondria, but not perturbation of homeostasis in the two organelles individually, plays crucial roles in PA-evoked Akt inactivation in hepatic insulin resistance. Copyright © 2017 Elsevier Inc. All rights reserved.

MamO Is a Repurposed Serine Protease that Promotes Magnetite Biomineralization through Direct Transition Metal Binding in Magnetotactic Bacteria

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hershey, David M.; Ren, Xuefeng; Melnyk, Ryan A.

2016-03-16

Many living organisms transform inorganic atoms into highly ordered crystalline materials. An elegant example of such biomineralization processes is the production of nano-scale magnetic crystals in magnetotactic bacteria. Previous studies have implicated the involvement of two putative serine proteases, MamE and MamO, during the early stages of magnetite formation in Magnetospirillum magneticum AMB-1. Here, using genetic analysis and X-ray crystallography, we show that MamO has a degenerate active site, rendering it incapable of protease activity. Instead, MamO promotes magnetosome formation through two genetically distinct, noncatalytic activities: activation of MamE-dependent proteolysis of biomineralization factors and direct binding to transition metal ions.more » By solving the structure of the protease domain bound to a metal ion, we identify a surface-exposed di-histidine motif in MamO that contributes to metal binding and show that it is required to initiate biomineralization in vivo. Finally, we find that pseudoproteases are widespread in magnetotactic bacteria and that they have evolved independently in three separate taxa. In conclusion, our results highlight the versatility of protein scaffolds in accommodating new biochemical activities and provide unprecedented insight into the earliest stages of biomineralization.« less

Vitamin D deficiency causes rickets in an urban informal settlement in Kenya and is associated with malnutrition

PubMed Central

Hachmeister, C. Ulrich; Khasira, Maureen; Cox, Lorna; Schoenmakers, Inez; Munyi, Caroline; Nassir, H. Samira; Hünten‐Kirsch, Barbara; Prentice, Ann; Berkley, James A.

2017-01-01

Abstract The commonest cause of rickets worldwide is vitamin D deficiency, but studies from sub‐Saharan Africa describe an endemic vitamin D‐independent form that responds to dietary calcium enrichment. The extent to which calcium‐deficiency rickets is the dominant form across sub‐Saharan Africa and in other low‐latitude areas is unknown. We aimed to characterise the clinical and biochemical features of young children with rickets in a densely populated urban informal settlement in Kenya. Because malnutrition may mask the clinical features of rickets, we also looked for biochemical indices of risk in children with varying degrees of acute malnutrition. Twenty one children with rickets, aged 3 to 24 months, were identified on the basis of clinical and radiologic features, along with 22 community controls, and 41 children with either severe or moderate acute malnutrition. Most children with rickets had wrist widening (100%) and rachitic rosary (90%), as opposed to lower limb features (19%). Developmental delay (52%), acute malnutrition (71%), and stunting (62%) were common. Compared to controls, there were no differences in calcium intake, but most (71%) had serum 25‐hydroxyvitamin D levels below 30 nmol/L. These results suggest that rickets in young children in urban Kenya is usually driven by vitamin D deficiency, and vitamin D supplementation is likely to be required for full recovery. Wasting was associated with lower calcium (p = .001), phosphate (p < .001), 25‐hydroxyvitamin D (p = .049), and 1,25‐dihydroxyvitamin D (p = 0.022) levels, the clinical significance of which remain unclear. PMID:28470840

Vitamin D deficiency causes rickets in an urban informal settlement in Kenya and is associated with malnutrition.

PubMed

Jones, Kelsey D J; Hachmeister, C Ulrich; Khasira, Maureen; Cox, Lorna; Schoenmakers, Inez; Munyi, Caroline; Nassir, H Samira; Hünten-Kirsch, Barbara; Prentice, Ann; Berkley, James A

2018-01-01

The commonest cause of rickets worldwide is vitamin D deficiency, but studies from sub-Saharan Africa describe an endemic vitamin D-independent form that responds to dietary calcium enrichment. The extent to which calcium-deficiency rickets is the dominant form across sub-Saharan Africa and in other low-latitude areas is unknown. We aimed to characterise the clinical and biochemical features of young children with rickets in a densely populated urban informal settlement in Kenya. Because malnutrition may mask the clinical features of rickets, we also looked for biochemical indices of risk in children with varying degrees of acute malnutrition. Twenty one children with rickets, aged 3 to 24 months, were identified on the basis of clinical and radiologic features, along with 22 community controls, and 41 children with either severe or moderate acute malnutrition. Most children with rickets had wrist widening (100%) and rachitic rosary (90%), as opposed to lower limb features (19%). Developmental delay (52%), acute malnutrition (71%), and stunting (62%) were common. Compared to controls, there were no differences in calcium intake, but most (71%) had serum 25-hydroxyvitamin D levels below 30 nmol/L. These results suggest that rickets in young children in urban Kenya is usually driven by vitamin D deficiency, and vitamin D supplementation is likely to be required for full recovery. Wasting was associated with lower calcium (p = .001), phosphate (p < .001), 25-hydroxyvitamin D (p = .049), and 1,25-dihydroxyvitamin D (p = 0.022) levels, the clinical significance of which remain unclear. © 2017 The Authors Maternal & Child Nutrition Published by John Wiley & Sons Ltd.

Malnutrition and intestinal parasitic infections in school children of Gondar, North West Ethiopia.

PubMed

Worku, Netsanet; Erko, Berhanu; Torben, Workineh; Belay, Mulugeta; Kasssu, Afework; Fetene, Teshome; Huruy, Kahsay

2009-01-01

In developing countries, malnutrition is a considerable health problem with prevalence ranges of 4-46%, with 1-10% severely malnourished. This study aimed to determine the prevalence of malnutrition and intestinal parasitoses and identify risk factors of malnutrition in schoolchildren. A cross-sectional study was carried out on 322 schoolchildren, of age 6 to 14 years, attending private and government primary schools, in Gonder town, North West Ethiopia. The study was conducted from December 2006 to February 2007. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and weight-for-height). Epi Info 2000 software was used to evaluate anthropometric results of each individual and formol-ether concentration technique was employed to identify parasites. The prevalence of underweight, stunting, wasting and intestinal parasitoses was 34.8%, 27%, 50% and 55.6%, respectively. Parasites encountered during the study were Ascaris lumbricoides (17.8%), Trichuiris trichiura (3.4%), hookworm (4.3%), Giardia lamblia (9%), Entamoeba histolytica (2.1%), Schistosoma mansoni (2.4%), Hymenolepis nana (4.7%) and Enterobius vermicularis (0.31%), respectively, in single infections. Only two cases of Strongyloides stercoralis was found in multiple infections and none in single infections. The prevalence of multiple parasitoses was 10.9%. Maternal literacy status, sex and age of the child were significantly associated with malnutrition (p < 0.05). Even though chronic type of malnutrition (stunting) was decreasing, indicators of acute type of malnutrition were increasing at a higher rate in the area. Implementation of maternal education and school feeding programs, avoidance of students from getting in contact with waste and river water were recommended to avoid malnutrition and intestinal parasitoses in children of the study area.

Prevention of acute malnutrition: distribution of special nutritious foods and cash, and addressing underlying causes--what to recommend when, where, for whom, and how.

PubMed

de Pee, Saskia; Grais, Rebecca; Fenn, Bridget; Brown, Rebecca; Briend, André; Frize, Jacqueline; Shoham, Jeremy; Kiess, Lynnda

2015-03-01

Acute malnutrition is associated with increased morbidity and mortality risk. When episodes are prolonged or frequent, acute malnutrition is also associated with poor growth and development, which contributes to stunting Nutrition-specific and nutrition-sensitive strategies to prevent undernutrition during the first 1,000 days from conception to 24 months of age can reduce the risks of wasting, stunting, and micronutrient deficiencies. Under circumstances that exacerbate the underlying causes of undernutrition and increase the incidence of wasting, such as food insecurity related to lean seasons or emergencies, or increased incidence of illness, such as diarrhea or measles, additional efforts are required to prevent and treat wasting. Special nutritious foods directly meet the increased nutrient requirements of children at risk for wasting; assistance to vulnerable households, in the form of cash or food, enables households to better meet the food, health, and other needs of household members and may increase resilience; water, sanitation, and hygiene (WASH) and health interventions help prevent and address illness and hence reduce wasting risk. The contributions of specific interventions to reducing the incidence of wasting are difficult to assess under emergency conditions, due to ethical constraints and to the fact that multiple strategies are implemented at the same time. However, pragmatic studies under real-life circumstances, using different designs, e.g., including a group receiving "best possible" treatment, can provide evidence about what works, to what extent, at what cost, and under which circumstances. Programs should address the most important causes in given contexts, be feasible to implement at scale, and assess implementation, coverage, and outcomes.

[Malnutrition and cognitive development if infants in rural marginalized areas in Mexico].

PubMed

Carrasco Quintero, María Del Refugio; Ortiz Hernández, Luis; Roldán Amaro, José Antonio; Chávez Villasana, Adolfo

2016-01-01

To analyze the relationship between nutritional status measured by anthropometry and the mental, psychomotor and language development of infants in marginalized rural areas of Mexico. Cross-sectional study with 576 infants aged from 7 to 26 months in four rural locations. Variables consisted of measures of anthropometric and cognitive development. Infants with short stature had a lower rate of language development, while birth weight was marginally associated with psychomotor development. Although acute malnutrition (identified by underweight) is no longer a problem in rural areas of Mexico, chronic malnutrition (expressed as stunting) is still common and is associated with alterations in mental development in the child population. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Improving best-phase image quality in cardiac CT by motion correction with MAM optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rohkohl, Christopher; Bruder, Herbert; Stierstorfer, Karl

2013-03-15

Purpose: Research in image reconstruction for cardiac CT aims at using motion correction algorithms to improve the image quality of the coronary arteries. The key to those algorithms is motion estimation, which is currently based on 3-D/3-D registration to align the structures of interest in images acquired in multiple heart phases. The need for an extended scan data range covering several heart phases is critical in terms of radiation dose to the patient and limits the clinical potential of the method. Furthermore, literature reports only slight quality improvements of the motion corrected images when compared to the most quiet phasemore » (best-phase) that was actually used for motion estimation. In this paper a motion estimation algorithm is proposed which does not require an extended scan range but works with a short scan data interval, and which markedly improves the best-phase image quality. Methods: Motion estimation is based on the definition of motion artifact metrics (MAM) to quantify motion artifacts in a 3-D reconstructed image volume. The authors use two different MAMs, entropy, and positivity. By adjusting the motion field parameters, the MAM of the resulting motion-compensated reconstruction is optimized using a gradient descent procedure. In this way motion artifacts are minimized. For a fast and practical implementation, only analytical methods are used for motion estimation and compensation. Both the MAM-optimization and a 3-D/3-D registration-based motion estimation algorithm were investigated by means of a computer-simulated vessel with a cardiac motion profile. Image quality was evaluated using normalized cross-correlation (NCC) with the ground truth template and root-mean-square deviation (RMSD). Four coronary CT angiography patient cases were reconstructed to evaluate the clinical performance of the proposed method. Results: For the MAM-approach, the best-phase image quality could be improved for all investigated heart phases, with a

High-oleic ready-to-use therapeutic food maintains docosahexaenoic acid status in severe malnutrition

USDA-ARS?s Scientific Manuscript database

Ready-to-use therapeutic food (RUTF) is the preferred treatment for uncomplicated severe acute malnutrition. It contains large amounts of linoleic acid and little a-linolenic acid, which may reduce the availability of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) to the recovering child...

Cognitive Dysfunction and Malnutrition Are Independent Predictor of Dysphagia in Patients with Acute Exacerbation of Congestive Heart Failure.

PubMed

Yokota, Junichi; Ogawa, Yoshiko; Yamanaka, Shinsuke; Takahashi, Yoshimi; Fujita, Hiroshi; Yamaguchi, Nobuhiro; Onoue, Noriko; Ishizuka, Takeshi; Shinozaki, Tsuyoshi; Kohzuki, Masahiro

2016-01-01

Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia.

Functional Analysis of the Magnetosome Island in Magnetospirillum gryphiswaldense: The mamAB Operon Is Sufficient for Magnetite Biomineralization

PubMed Central

Lohße, Anna; Ullrich, Susanne; Katzmann, Emanuel; Borg, Sarah; Wanner, Gerd; Richter, Michael; Voigt, Birgit; Schweder, Thomas; Schüler, Dirk

2011-01-01

Bacterial magnetosomes are membrane-enveloped, nanometer-sized crystals of magnetite, which serve for magnetotactic navigation. All genes implicated in the synthesis of these organelles are located in a conserved genomic magnetosome island (MAI). We performed a comprehensive bioinformatic, proteomic and genetic analysis of the MAI in Magnetospirillum gryphiswaldense. By the construction of large deletion mutants we demonstrate that the entire region is dispensable for growth, and the majority of MAI genes have no detectable function in magnetosome formation and could be eliminated without any effect. Only <25% of the region comprising four major operons could be associated with magnetite biomineralization, which correlated with high expression of these genes and their conservation among magnetotactic bacteria. Whereas only deletion of the mamAB operon resulted in the complete loss of magnetic particles, deletion of the conserved mms6, mamGFDC, and mamXY operons led to severe defects in morphology, size and organization of magnetite crystals. However, strains in which these operons were eliminated together retained the ability to synthesize small irregular crystallites, and weakly aligned in magnetic fields. This demonstrates that whereas the mamGFDC, mms6 and mamXY operons have crucial and partially overlapping functions for the formation of functional magnetosomes, the mamAB operon is the only region of the MAI, which is necessary and sufficient for magnetite biomineralization. Our data further reduce the known minimal gene set required for magnetosome formation and will be useful for future genome engineering approaches. PMID:22043287

The elephant moves into the sunlight: progress in childhood malnutrition.

PubMed

Duggan, Maureen B

2012-01-01

Beginning with a historical summary of investigative work into protein-energy malnutrition, now termed 'severe acute malnutrition', this review ends by summarizing recent initiatives to tackle the global problem of malnutrition, specifically Scaling-Up Nutrition (SUN). In early years, macronutrient deficiency or imbalance was considered the principal cause of complex metabolic disturbances, including kwashiorkor, whereas, now, micronutrient deficiency infections, including HIV, and a background of deprivation are implicated. Different approaches to management are reviewed. The rehabilitation of individual children by protocolised-phased feeding has largely given way to community-based therapeutic feeding. Despite sporadic successes, the overall impact on morbidity and mortality has been so disappointing that the global community now plans a new initiative, viz. SUN. Its focus on the critical window of 1000 days (from conception to 2 years) is similar to the earlier focus on early childhood vulnerability which inspired the under-5 clinics and their integration into maternal and child health programmes. 'Targeted' interventions, recently more prominent than integrated community-based primary care, often undertaken by NGOs, have been effective, although sometimes imperfectly accountable. Will SUN, aiming for a broad approach, and the participation of recipient communities finally succeed in integrating nutrition into child health?

Degree of malnutrition and its relationship with major structural and eating factors in Honduran preschool population. Prevalence of breastfeeding

PubMed

Fernández Palacios, Lorena; Barrientos Augustinus, Elsa; Raudales Urquía, Carolina; Frontela Saseta, Carmen; Ros Berruezo, Gaspar

2017-06-05

Introduction: Child malnutrition remains a serious public health problem in Honduras, with a national prevalence according to the World Health Organization (WHO) reference values of 29% in children under fi ve. In addition, the average chronic malnutrition in the region amounts to 80% in poor and indigenous communities, making Honduras the second country in Central America with the highest incidence of chronic malnutrition. Another problem of the region is the early cessation of exclusive breastfeeding: only 29.7% of children were exclusively breastfed until they were six months. Therefore, the study seeks to understand, identify and quantify the situation determinants and provide information for the design of public policies. Material and method:: The study consisted of a cross-sectional descriptive anthropometric assessment in which the nutritional status and the prevalence of undernourishment, malnutrition and malnutrition in 141 children aged between six months and fi ve years, belonging to urban and rural regions of the country, were analyzed, as well as assessing the prevalence of breastfeeding in fi ve Honduran departments (Intibucá, Lempira, Atlántida, Olancho and Francisco Morazán). Results and conclusion: When making the analysis by departments, differences regarding nutritional status and breastfeeding were observed between urban and rural areas, the latter being doubled in the case of chronic malnutrition and underweight, with percentages of 14.6% in urban areas versus28.8% in rural areas, and 4.6% in urban areas compared to 9% in rural areas, respectively. However, with respect to acute malnutrition and overweight in both regions, similar values were observed, above 1.1% for acute and 14% for overweight malnutrition. In relation to exclusive breastfeeding for six months, the departments of Olancho and Lempira maintained it for two years, with a percentage distribution of 80% and 48%, respectively. It must be noted that 36% of mothers did not provide

Hospital Malnutrition Related to Fasting and Underfeeding: Is It an Ethical Issue?

PubMed

Arenas Moya, Diego; Plascencia Gaitán, Alejandra; Ornelas Camacho, Denisse; Arenas Márquez, Humberto

2016-06-01

Hospital malnutrition is a relevant clinical issue present in about 50% of patients that is associated with increased morbidity, mortality, and cost of care. Because of the relation of malnutrition with chronic and acute inflammatory processes secondary to disease, nutrition therapy is considered an important medical treatment. However, there is little discussion about the impact of another critical issue related to hospital malnutrition, that is, lack of appropriate food or nutrition therapy given to the patients. Unnecessary fasting practices and the use of inappropriate nutrition prescriptions result in underfeeding that can be a related or direct cause of hospital malnutrition, independent of disease or inflammatory state. Suboptimal prescription of oral, enteral, and parenteral nutrition should be analyzed and discussed from an ethical perspective since this practice has the potential to harm patients. In addition, absence or inadequate provision of nutrition may present barriers for improved patient outcomes and could be prevented by simply recognizing lack of knowledge, skills, or experience in nutrition and entrusting nutrition prescription to interdisciplinary teams with clinicians well prepared in nutrition sciences. This article reviews potential barriers to the prevention or treatment of hospital malnutrition and proposes specific actions that can help clinicians to overcome and implement optimal nutrition not just as medical therapy but also as a basic comfort care that may help patients nutritionally, clinically, physically, and emotionally. © 2016 American Society for Parenteral and Enteral Nutrition.

Childhood malnutrition and the intestinal microbiome.

PubMed

Kane, Anne V; Dinh, Duy M; Ward, Honorine D

2015-01-01

Malnutrition contributes to almost half of all deaths in children under the age of 5 y, particularly those who live in resource-constrained areas. Those who survive frequently suffer from long-term sequelae including growth failure and neurodevelopmental impairment. Malnutrition is part of a vicious cycle of impaired immunity, recurrent infections, and worsening malnutrition. Recently, alterations in the gut microbiome have also been strongly implicated in childhood malnutrition. It has been suggested that malnutrition may delay the normal development of the gut microbiota in early childhood or force it toward an altered composition that lacks the required functions for healthy growth and/or increases the risk for intestinal inflammation. This review addresses our current understanding of the beneficial contributions of gut microbiota to human nutrition (and conversely the potential role of changes in that community to malnutrition), the process of acquiring an intestinal microbiome, potential influences of malnutrition on the developing microbiota, and the evidence directly linking alterations in the intestinal microbiome to childhood malnutrition. We review recent studies on the association between alterations in the intestinal microbiome and early childhood malnutrition and discuss them in the context of implications for intervention or prevention of the devastation caused by malnutrition.

The REFANI-S study protocol: a non-randomised cluster controlled trial to assess the role of an unconditional cash transfer, a non-food item kit, and free piped water in reducing the risk of acute malnutrition among children aged 6-59 months living in camps for internally displaced persons in the Afgooye corridor, Somalia.

PubMed

Jelle, Mohamed; Grijalva-Eternod, Carlos S; Haghparast-Bidgoli, Hassan; King, Sarah; Cox, Cassy L; Skordis-Worrall, Jolene; Morrison, Joanna; Colbourn, Timothy; Fottrell, Edward; Seal, Andrew J

2017-07-06

The prevalence of acute malnutrition is often high in emergency-affected populations and is associated with elevated mortality risk and long-term health consequences. Increasingly, cash transfer programmes (CTP) are used instead of direct food aid as a nutritional intervention, but there is sparse evidence on their nutritional impact. We aim to understand whether CTP reduces acute malnutrition and its known risk factors. A non-randomised, cluster-controlled trial will assess the impact of an unconditional cash transfer of US$84 per month for 5 months, a single non-food items kit, and free piped water on the risk of acute malnutrition in children, aged 6-59 months. The study will take place in camps for internally displaced persons (IDP) in peri-urban Mogadishu, Somalia. A cluster will consist of one IDP camp and 10 camps will be allocated to receive the intervention based on vulnerability targeting criteria. The control camps will then be selected from the same geographical area. Needs assessment data indicates small differences in vulnerability between camps. In each trial arm, 120 households will be randomly sampled and two detailed household surveys will be implemented at baseline and 3 months after the initiation of the cash transfer. The survey questionnaire will cover risk factors for malnutrition including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, WASH, and access to health care. A community surveillance system will collect monthly mid-upper arm circumference measurements from all children aged 6-59 months in the study clusters to assess the incidence of acute malnutrition over the duration of the intervention. Process evaluation data will be compiled from routine quantitative programme data and primary qualitative data collected using key informant interviews and focus group discussions. The UK Department for International Development will provide funding for this study. The European Civil Protection and

MAM (E17) rodent developmental model of neuropsychiatric disease: disruptions in learning and dysregulation of nucleus accumbens dopamine release, but spared executive function.

PubMed

Howe, William M; Tierney, Patrick L; Young, Damon A; Oomen, Charlotte; Kozak, Rouba

2015-11-01

Gestational day 17 methylazoxymethanol (MAM) treatment has been shown to reproduce, in rodents, some of the alterations in cortical and mesolimbic circuitries thought to contribute to schizophrenia. We characterized the behavior of MAM animals in tasks dependent on these circuitries to see what behavioral aspects of schizophrenia the model captures. We then characterized the integrity of mesolimbic dopamine neurotransmission in a subset of animals used in the behavioral experiments. MAM animals' capacity for working memory, attention, and resilience to distraction was tested with two different paradigms. Cue-reward learning and motivation were assayed with Pavlovian conditioned approach. Measurements of electrically stimulated phasic and tonic DA release in the nucleus accumbens with fast-scan cyclic voltammetry were obtained from the same animals used in the Pavlovian task. MAM animals' basic attentional capacities were intact. MAM animals took longer to acquire the working memory task, but once learned, performed at the same level as shams. MAM animals were also slower to develop a Pavlovian conditioned response, but otherwise no different from controls. These same animals showed alterations in terminal DA release that were unmasked by an amphetamine challenge. The predominant behavioral-cognitive feature of the MAM model is a learning impairment that is evident in acquisition of executive function tasks as well as basic Pavlovian associations. MAM animals also have dysregulated terminal DA release, and this may contribute to observed behavioral differences. The MAM model captures some functional impairments of schizophrenia, particularly those related to acquisition of goal-directed behavior.

The malnutrition screening tool versus objective measures to detect malnutrition in hip fracture.

PubMed

Bell, J J; Bauer, J D; Capra, S

2013-12-01

The Malnutrition Screening Tool (MST) is the most commonly used screening tool in Australia. Poor screening tool sensitivity may lead to an under-diagnosis of malnutrition, with potential patient and economic ramifications. The present study aimed to determine whether the MST or anthropometric parameters adequately detect malnutrition in patients who were admitted to a hip fracture unit. Data were analysed for a prospective convenience sample (n = 100). MST screening was independently undertaken by nursing staff and a nutrition assistant. Mid upper arm circumference (MUAC) was measured by a trained nutrition assistant. Nutritional risk [MST score ≥ 2, body mass index (BMI) < 22 kg m(-2) , or MUAC < 25 cm] was compared with malnutrition diagnosed by accredited practicing dietitians using International Classification of Diseases version 10-Australian Modification (ICD10-AM) coding criteria. Malnutrition prevalence was 37.5% using ICD10-AM criteria. Delirium, dementia or preadmission cognitive impairment was present in 65% of patients. The BMI as a nutrition risk screen was the most valid predictor of malnutrition (sensitivity 75%; specificity 93%; positive predictive value 73%; negative predictive value 84%). Nursing MST screening was the least valid (sensitivity 73%; specificity 55%; positive predictive value 50%; negative predictive value 77%). There was only fair agreement between nursing and nutrition assistant screening using the MST (κ = 0.28). In this population with a high prevalence of delirium and dementia, further investigation is warranted into the performance of nutrition screening tools and anthropometric parameters such as BMI. All tools failed to predict a considerable number of patients with malnutrition. This may result in the under-diagnosis and treatment of malnutrition, leading to case-mix funding losses. © 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.

Severe Malnutrition: A Global Approach.

ERIC Educational Resources Information Center

Pelletier, Jean-Gerard

1993-01-01

This report examines the immediate and underlying causes of malnutrition in the developing world. The first section discusses the effects of malnutrition on childhood development and examines the efficacy of nutritional rehabilitation. The second section addresses the medical effects of severe malnutrition, including the onset of ponderostatural…

Childhood tuberculosis and malnutrition.

PubMed

Jaganath, Devan; Mupere, Ezekiel

2012-12-15

Despite the burden of both malnutrition and tuberculosis in children worldwide, there are few studies on the mechanisms that underlie this relationship. From available research, it appears that malnutrition is a predictor of tuberculosis disease and is associated with worse outcomes. This is supported through several lines of evidence, including the role of vitamin D receptor genotypes, malnutrition's effects on immune development, respiratory infections among malnourished children, and limited work specifically on pediatric tuberculosis and malnutrition. Nutritional supplementation has yet to suggest significant benefits on the course of tuberculosis in children. There is a critical need for research on childhood tuberculosis, specifically on how nutritional status affects the risk and progression of tuberculosis and whether nutritional supplementation improves clinical outcomes or prevents disease.

Childhood Tuberculosis and Malnutrition

PubMed Central

Jaganath, Devan; Mupere, Ezekiel

2012-01-01

Despite the burden of both malnutrition and tuberculosis in children worldwide, there are few studies on the mechanisms that underlie this relationship. From available research, it appears that malnutrition is a predictor of tuberculosis disease and is associated with worse outcomes. This is supported through several lines of evidence, including the role of vitamin D receptor genotypes, malnutrition's effects on immune development, respiratory infections among malnourished children, and limited work specifically on pediatric tuberculosis and malnutrition. Nutritional supplementation has yet to suggest significant benefits on the course of tuberculosis in children. There is a critical need for research on childhood tuberculosis, specifically on how nutritional status affects the risk and progression of tuberculosis and whether nutritional supplementation improves clinical outcomes or prevents disease. PMID:23033147

Cognitive Dysfunction and Malnutrition Are Independent Predictor of Dysphagia in Patients with Acute Exacerbation of Congestive Heart Failure

PubMed Central

Yamanaka, Shinsuke; Takahashi, Yoshimi; Fujita, Hiroshi; Yamaguchi, Nobuhiro; Onoue, Noriko; Ishizuka, Takeshi; Shinozaki, Tsuyoshi; Kohzuki, Masahiro

2016-01-01

Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia. PMID:27898735

Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition. A qualitative study in Southern Ethiopia.

PubMed

Tadesse, Elazar; Berhane, Yemane; Hjern, Anders; Olsson, Pia; Ekström, Eva-Charlotte

2015-12-01

Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers' and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia. This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied. RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs. Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical

Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition. A qualitative study in Southern Ethiopia

PubMed Central

Tadesse, Elazar; Berhane, Yemane; Hjern, Anders; Olsson, Pia; Ekström, Eva-Charlotte

2015-01-01

Background: Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers’ and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia. Methods: This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied. Results: RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs. Conclusion: Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child. PMID:25749873

Disruption of Mitochondria-Associated Endoplasmic Reticulum Membrane (MAM) Integrity Contributes to Muscle Insulin Resistance in Mice and Humans.

PubMed

Tubbs, Emily; Chanon, Stéphanie; Robert, Maud; Bendridi, Nadia; Bidaux, Gabriel; Chauvin, Marie-Agnès; Ji-Cao, Jingwei; Durand, Christine; Gauvrit-Ramette, Daphné; Vidal, Hubert; Lefai, Etienne; Rieusset, Jennifer

2018-04-01

Modifications of the interactions between endoplasmic reticulum (ER) and mitochondria, defined as mitochondria-associated membranes (MAMs), were recently shown to be involved in the control of hepatic insulin action and glucose homeostasis, but with conflicting results. Whereas skeletal muscle is the primary site of insulin-mediated glucose uptake and the main target for alterations in insulin-resistant states, the relevance of MAM integrity in muscle insulin resistance is unknown. Deciphering the importance of MAMs on muscle insulin signaling could help to clarify this controversy. Here, we show in skeletal muscle of different mice models of obesity and type 2 diabetes (T2D) a marked disruption of ER-mitochondria interactions as an early event preceding mitochondrial dysfunction and insulin resistance. Furthermore, in human myotubes, palmitate-induced insulin resistance is associated with a reduction of structural and functional ER-mitochondria interactions. Importantly, experimental increase of ER-mitochondria contacts in human myotubes prevents palmitate-induced alterations of insulin signaling and action, whereas disruption of MAM integrity alters the action of the hormone. Lastly, we found an association between altered insulin signaling and ER-mitochondria interactions in human myotubes from obese subjects with or without T2D compared with healthy lean subjects. Collectively, our data reveal a new role of MAM integrity in insulin action of skeletal muscle and highlight MAM disruption as an essential subcellular alteration associated with muscle insulin resistance in mice and humans. Therefore, reduced ER-mitochondria coupling could be a common alteration of several insulin-sensitive tissues playing a key role in altered glucose homeostasis in the context of obesity and T2D. © 2018 by the American Diabetes Association.

Mam33 promotes cytochrome c oxidase subunit I translation in Saccharomyces cerevisiae mitochondria.

PubMed

Roloff, Gabrielle A; Henry, Michael F

2015-08-15

Three mitochondrial DNA-encoded proteins, Cox1, Cox2, and Cox3, comprise the core of the cytochrome c oxidase complex. Gene-specific translational activators ensure that these respiratory chain subunits are synthesized at the correct location and in stoichiometric ratios to prevent unassembled protein products from generating free oxygen radicals. In the yeast Saccharomyces cerevisiae, the nuclear-encoded proteins Mss51 and Pet309 specifically activate mitochondrial translation of the largest subunit, Cox1. Here we report that Mam33 is a third COX1 translational activator in yeast mitochondria. Mam33 is required for cells to adapt efficiently from fermentation to respiration. In the absence of Mam33, Cox1 translation is impaired, and cells poorly adapt to respiratory conditions because they lack basal fermentative levels of Cox1. © 2015 Roloff and Henry. This article is distributed by The American Society for Cell Biology under license from the author(s). Two months after publication it is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Treating malnutrition in the community.

PubMed

Dera, Merceline; Woodham, Diane

2016-11-02

Malnutrition is a clinical and public health problem. It has adverse effects on the physical and psycho-social wellbeing of individuals by predisposing to disease, negatively affecting its outcome and reducing the likelihood of independence. An estimated 3 million people in the UK are affected by malnutrition, most of whom live in the community ( BAPEN, 2011 ). Despite the scale of this problem, it remains under-detected, under-treated, underresourced and often overlooked by those involved in the care of at risks individuals such as the elderly. In most cases malnutrition is a treatable condition that can be managed by optimising food intake and using oral nutritional supplements (ONS) where necessary. The main focus of this article is on the dangers of malnutrition for older people in the community and the use of ONS in the treatment and management of malnutrition.

Metabolic characterization of (1-(5-fluoropentyl)-1H-indol-3-yl)(4-methyl-1-naphthalenyl)-methanone (MAM-2201) using human liver microsomes and cDNA-overexpressed cytochrome P450 enzymes.

PubMed

Kong, Tae Yeon; Kim, Ju-Hyun; Choi, Won Gu; Lee, Joo Young; Kim, Hee Seung; Kim, Jin Young; In, Moon Kyo; Lee, Hye Suk

2017-02-01

MAM-2201 is a synthetic cannabinoid that is increasingly found in recreational drug abusers and cases of severe intoxication. Thus, characterization of the metabolic pathways of MAM-2201 is necessary to predict individual pharmacokinetics and toxicity differences, and to avoid toxic drug-drug interactions. Collectively, 19 phase 1 metabolites of MAM-2201 were identified using liquid chromatography-Orbitrap mass spectrometry following human liver microsomal incubations in the presence of NADPH: 7 hydroxy-MAM-2201 (M1-M7), 4 dihydroxy-MAM-2201 (M8-M11), dihydrodiol-MAM-2201 (M12), N-(5-hydroxypentyl)-MAM-2201 (M13), hydroxy-M13 (M14), N-dealkyl-MAM-2201 (M15), 2 hydroxy-M15 (M16, M17), MAM-2201 N-pentanoic acid (M18), and hydroxy-M18 (M19). On the basis of intrinsic clearance values in human liver microsomes, hydroxy-MAM-2201 (M1), N-(5-hydroxypentyl)-MAM-2201 (M13), and hydroxy-M13 (M14) were the major metabolites. Based on an enzyme kinetics study using human cDNA-expressed cytochrome P450 (CYP) enzymes and an immunoinhibition study using selective CYP antibodies in human liver microsomes, CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 enzymes were responsible for MAM-2201 metabolism. The CYP3A4 enzyme played a prominent role in MAM-2201 metabolism, and CYP1A2, CYP2B6, CYP2C8, and CYP2C9 enzymes played major roles in the formation of some metabolites. MAM-2201 is extensively metabolized by multiple CYP enzymes, indicating that MAM-2201 and its metabolites should be used as markers of MAM-2201 abuse and toxicity. Graphical abstract In vitro metabolic pathways of MAM-2201 were characterized in human liver microsomes and recombinant CYPs using LC-HRMS analysis. Total 19 phase I metabolites were identified with predominant contribution of CYP3A4.

The prevalence of urinary tract infection in children with severe acute malnutrition: a narrative review

PubMed Central

Uwaezuoke, Samuel N

2016-01-01

This article aims to review the current evidence which shows that the prevalence of urinary tract infection (UTI) has been increasing in children with severe acute malnutrition (SAM). UTI remains one of the most common causes of febrile illness in pediatric practice. Most studies conducted among hospitalized children with complicated SAM have reported high prevalence rates of UTI. Clearly, the knowledge of baseline risk of UTI can help clinicians to make informed diagnostic and therapeutic decisions in these children. From the global reports reviewed in this article, UTI prevalence rates range from as low as 6% to as high as 37% in developing countries, while the most common bacterial isolates from urine cultures are Gram-negative coliform organisms such as Escherichia coli and Klebsiella species. These findings form the basis for the current diagnostic and therapeutic guidelines for clinicians managing children with complicated SAM. With the reported high prevalence of UTI among these children and concerns over antibiotic resistance, more extensive data are required using standardized microbiological methods. Thus, the assessment of the performance of urine dipsticks and microscopy against the gold standard urine culture is an important step toward strengthening the evidence for the therapeutic guidelines for UTI in children with SAM. PMID:29388594

Ero1alpha requires oxidizing and normoxic conditions to localize to the mitochondria-associated membrane (MAM).

PubMed

Gilady, Susanna Y; Bui, Michael; Lynes, Emily M; Benson, Matthew D; Watts, Russell; Vance, Jean E; Simmen, Thomas

2010-09-01

Protein secretion from the endoplasmic reticulum (ER) requires the enzymatic activity of chaperones and oxidoreductases that fold polypeptides and form disulfide bonds within newly synthesized proteins. The best-characterized ER redox relay depends on the transfer of oxidizing equivalents from molecular oxygen through ER oxidoreductin 1 (Ero1) and protein disulfide isomerase to nascent polypeptides. The formation of disulfide bonds is, however, not the sole function of ER oxidoreductases, which are also important regulators of ER calcium homeostasis. Given the role of human Ero1alpha in the regulation of the calcium release by inositol 1,4,5-trisphosphate receptors during the onset of apoptosis, we hypothesized that Ero1alpha may have a redox-sensitive localization to specific domains of the ER. Our results show that within the ER, Ero1alpha is almost exclusively found on the mitochondria-associated membrane (MAM). The localization of Ero1alpha on the MAM is dependent on oxidizing conditions within the ER. Chemical reduction of the ER environment, but not ER stress in general leads to release of Ero1alpha from the MAM. In addition, the correct localization of Ero1alpha to the MAM also requires normoxic conditions, but not ongoing oxidative phosphorylation.

Malnutrition: The Wasting of Human Potential.

ERIC Educational Resources Information Center

Taylor, Patricia S.

The paper discusses the prevalence of malnutrition in developing countries and the United States, particularly as it relates to debilitating physical and psychological disorders. Educational, social, and political factors which influence the cycle of malnutrition are described. Research on the relationship between malnutrition and intellectual…

State of malnutrition in hospitals of Ecuador.

PubMed

Gallegos Espinosa, Sylvia; Nicolalde Cifuentes, Marcelo; Santana Porbén, Sergio

2014-08-01

Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women: 37.5%; Ages ≥ 60 years: 35.1%; Length of stay ≤ 15 days: 91.2%) admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patient's age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

[Screening of malnutrition risk versus indicators of nutritional status and systemic inflammatory response in newly diagnosed lung cancer patients].

PubMed

Illa, P; Tomíšková, M; Skřičková, J

2014-01-01

Most lung cancers are already advanced at the time of dia-gnosis. In these patients, a frequent symptom is protein energy malnutrition, often diagnosed prior to oncological treatment. Malnutrition results in poor tolerance of treatment and increased morbidity and mortality. Nutritional Risk Screening (NRS) 2002 adapted for oncological patients was used to assess the risk of undernutrition in a group of 188 lung cancer patients. The risk was evaluated on a 6- point scale according to common signs of nutritional status and tumor and its treatment risk factors. A score of 3 and more (called "nutritional risk") means a significant risk of malnutrition. Furthermore, pretreatment nutritional characteristics were evaluated in patients (including the value of BMI) and laboratory values indicating malnutrition/ acute phase response (albumin/ C reactive protein - CRP). Acceptable NRS score was found in 50.6%, while in 45.3% was suggested into risk of malnutrition ("nutritional risk"). Only 6.6% of our patients had a BMI less than 20 kg/ m2. Significant differences in albumin and CRP values in various categories of NRS were confirmed. Initial signs of cancer malnutrition may be overlooked in patients who fall within or above the range of BMI for adequate weight, although these patients may be at significant risk of malnutrition. The indicators of nutritional status and systemic inflammatory responses were significantly associated with resulting values NRS score.

Manganese toxicity and Saccharomyces cerevisiae Mam3p, a member of the ACDP (ancient conserved domain protein) family

PubMed Central

2004-01-01

Manganese is an essential, but potentially toxic, trace metal in biological systems. Overexposure to manganese is known to cause neurological deficits in humans, but the pathways that lead to manganese toxicity are largely unknown. We have employed the bakers' yeast Saccharomyces cerevisiae as a model system to identify genes that contribute to manganese-related damage. In a genetic screen for yeast manganese-resistance mutants, we identified S. cerevisiae MAM3 as a gene which, when deleted, would increase cellular tolerance to toxic levels of manganese and also increased the cell's resistance towards cobalt and zinc. By sequence analysis, Mam3p shares strong similarity with the mammalian ACDP (ancient conserved domain protein) family of polypeptides. Mutations in human ACDP1 have been associated with urofacial (Ochoa) syndrome. However, the functions of eukaryotic ACDPs remain unknown. We show here that S. cerevisiae MAM3 encodes an integral membrane protein of the yeast vacuole whose expression levels directly correlate with the degree of manganese toxicity. Surprisingly, Mam3p contributes to manganese toxicity without any obvious changes in vacuolar accumulation of metals. Furthermore, through genetic epistasis studies, we demonstrate that MAM3 operates independently of the well-established manganese-trafficking pathways in yeast, involving the manganese transporters Pmr1p, Smf2p and Pho84p. This is the first report of a eukaryotic ACDP family protein involved in metal homoeostasis. PMID:15498024

Cluster designs to assess the prevalence of acute malnutrition by lot quality assurance sampling: a validation study by computer simulation

PubMed Central

Olives, Casey; Pagano, Marcello; Deitchler, Megan; Hedt, Bethany L; Egge, Kari; Valadez, Joseph J

2009-01-01

Traditional lot quality assurance sampling (LQAS) methods require simple random sampling to guarantee valid results. However, cluster sampling has been proposed to reduce the number of random starting points. This study uses simulations to examine the classification error of two such designs, a 67×3 (67 clusters of three observations) and a 33×6 (33 clusters of six observations) sampling scheme to assess the prevalence of global acute malnutrition (GAM). Further, we explore the use of a 67×3 sequential sampling scheme for LQAS classification of GAM prevalence. Results indicate that, for independent clusters with moderate intracluster correlation for the GAM outcome, the three sampling designs maintain approximate validity for LQAS analysis. Sequential sampling can substantially reduce the average sample size that is required for data collection. The presence of intercluster correlation can impact dramatically the classification error that is associated with LQAS analysis. PMID:20011037

Cluster designs to assess the prevalence of acute malnutrition by lot quality assurance sampling: a validation study by computer simulation.

PubMed

Olives, Casey; Pagano, Marcello; Deitchler, Megan; Hedt, Bethany L; Egge, Kari; Valadez, Joseph J

2009-04-01

Traditional lot quality assurance sampling (LQAS) methods require simple random sampling to guarantee valid results. However, cluster sampling has been proposed to reduce the number of random starting points. This study uses simulations to examine the classification error of two such designs, a 67x3 (67 clusters of three observations) and a 33x6 (33 clusters of six observations) sampling scheme to assess the prevalence of global acute malnutrition (GAM). Further, we explore the use of a 67x3 sequential sampling scheme for LQAS classification of GAM prevalence. Results indicate that, for independent clusters with moderate intracluster correlation for the GAM outcome, the three sampling designs maintain approximate validity for LQAS analysis. Sequential sampling can substantially reduce the average sample size that is required for data collection. The presence of intercluster correlation can impact dramatically the classification error that is associated with LQAS analysis.

Seasonal effect and long-term nutritional status following exit from a Community-Based Management of Severe Acute Malnutrition program in Bihar, India.

PubMed

Burza, S; Mahajan, R; Marino, E; Sunyoto, T; Shandilya, C; Tabrez, M; Kumar, K; Jha, A; Mathew, P; Salse, N; Casademont, C; Mishra, N K

2016-04-01

Children aged 6 months to 5 years completing treatment for severe acute malnutrition (SAM) in a Médecins Sans Frontières Community Management of Acute Malnutrition (CMAM) program in Bihar, India, showed high cure rates; however, the program suffered default rates of 38%. This report describes the nutritional status of 1956 children followed up between 3 and 18 months after exiting the program. All children aged 6-59 months discharged as cured with mid-upper arm circumference (MUAC) ⩾120 mm or who defaulted from the program with MUAC <115 mm were traced at 3, 6, 9, 12 and 18 months (±10 days) before three exit reference dates: first at the end of the food insecure period, second after the 2-month food security and third after the 4-month food security. Overall, 68.7% (n=692) of defaulters and 76.2% (n=1264) of children discharged as cured were traced. Combined rates of non-recovery in children who defaulted with MUAC <115 mm were 41%, 30.1%, 9.9%, 6.1% and 3.6% at 3, 6, 9, 12 and 18 months following exit, respectively. Combined rates of relapse among cured cases (MUAC ⩾120 mm) were 9.1%, 2.9%, 2.1%, 2.8% and 0% at 3, 6, 9, 12 and 18 months following discharge, respectively. Prevalence of undernutrition increased substantially for both groups traced during low food security periods. Odds of death were much higher for children defaulting with MUAC <110 mm when compared with children discharged as cured, who shared the same mortality risk as those defaulting with MUAC 110-<115 mm. Seasonal food security predicted short-term nutritional status after exit, with relapse rates and non-recovery from SAM much higher during food insecurity. Mortality outcomes suggest that a MUAC of 110 mm may be considered an appropriate admission point for SAM treatment programs in this context.

Malnutrition in the UK.

PubMed

Blades, Mabel

2013-05-01

Malnutrition is estimated to cost the UK twice that of obesity every year, but it is still an often overlooked problem. Dr Mabel Blades, a freelance Registered Dietician and Nutritionist, looks at the problems that malnutrition presents and the solutions that we can use to combat it.

Prediction of Outcome From Adult Bacterial Meningitis in a High-HIV-Seroprevalence, Resource-Poor Setting Using the Malawi Adult Meningitis Score (MAMS).

PubMed

Wall, Emma C; Mukaka, Mavuto; Scarborough, Matthew; Ajdukiewicz, Katherine M A; Cartwright, Katharine E; Nyirenda, Mulinda; Denis, Brigitte; Allain, Theresa J; Faragher, Brian; Lalloo, David G; Heyderman, Robert S

2017-02-15

Acute bacterial meningitis (ABM) in adults residing in resource-poor countries is associated with mortality rates >50%. To improve outcome, interventional trials and standardized clinical algorithms are urgently required. To optimize these processes, we developed and validated an outcome prediction tool to identify ABM patients at greatest risk of death. We derived a nomogram using mortality predictors derived from a logistic regression model of a discovery database of adult Malawian patients with ABM (n = 523 [65%] cerebrospinal fluid [CSF] culture positive). We validated the nomogram internally using a bootstrap procedure and subsequently used the nomogram scores to further interpret the effects of adjunctive dexamethasone and glycerol using clinical trial data from Malawi. ABM mortality at 6-week follow-up was 54%. Five of 15 variables tested were strongly associated with poor outcome (CSF culture positivity, CSF white blood cell count, hemoglobin, Glasgow Coma Scale, and pulse rate), and were used in the derivation of the Malawi Adult Meningitis Score (MAMS) nomogram. The C-index (area under the curve) was 0.76 (95% confidence interval, .71-.80) and calibration was good (Hosmer-Lemeshow C-statistic = 5.48, df = 8, P = .705). Harmful effects of adjunctive glycerol were observed in groups with relatively low predicted risk of poor outcome (25%-50% risk): Case Fatality Rate of 21% in the placebo group and 52% in the glycerol group (P < .001). This effect was not seen with adjunctive dexamethasone. MAMS provides a novel tool for predicting prognosis and improving interpretation of ABM clinical trials by risk stratification in resource-poor settings. Whether MAMS can be applied to non-HIV-endemic countries requires further evaluation. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Hematological alterations in protein malnutrition.

PubMed

Santos, Ed W; Oliveira, Dalila C; Silva, Graziela B; Tsujita, Maristela; Beltran, Jackeline O; Hastreiter, Araceli; Fock, Ricardo A; Borelli, Primavera

2017-11-01

Protein malnutrition is one of the most serious nutritional problems worldwide, affecting 794 million people and costing up to $3.5 trillion annually in the global economy. Protein malnutrition primarily affects children, the elderly, and hospitalized patients. Different degrees of protein deficiency lead to a broad spectrum of signs and symptoms of protein malnutrition, especially in organs in which the hematopoietic system is characterized by a high rate of protein turnover and, consequently, a high rate of protein renewal and cellular proliferation. Here, the current scientific information about protein malnutrition and its effects on the hematopoietic process is reviewed. The production of hematopoietic cells is described, with special attention given to the hematopoietic microenvironment and the development of stem cells. Advances in the study of hematopoiesis in protein malnutrition are also summarized. Studies of protein malnutrition in vitro, in animal models, and in humans demonstrate several alterations that impair hematopoiesis, such as structural changes in the extracellular matrix, the hematopoietic stem cell niche, the spleen, the thymus, and bone marrow stromal cells; changes in mesenchymal and hematopoietic stem cells; increased autophagy; G0/G1 cell-cycle arrest of progenitor hematopoietic cells; and functional alterations in leukocytes. Structural and cellular changes of the hematopoietic microenvironment in protein malnutrition contribute to bone marrow atrophy and nonestablishment of hematopoietic stem cells, resulting in impaired homeostasis and an impaired immune response. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Malnutrition

MedlinePlus

... permanent, even though you survive. Poverty, natural disasters, political problems, and war can all contribute to malnutrition ... verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. ...

Verification of small-scale water vapor features in VAS imagery using high resolution MAMS imagery. [VISSR Atmospheric Sounder - Multispectral Atmospheric Mapping Sensor

NASA Technical Reports Server (NTRS)

Menzel, Paul W.; Jedlovec, Gary; Wilson, Gregory

1986-01-01

The Multispectral Atmospheric Mapping Sensor (MAMS), a modification of NASA's Airborne Thematic Mapper, is described, and radiances from the MAMS and the VISSR Atmospheric Sounder (VAS) are compared which were collected simultaneously on May 18, 1985. Thermal emission from the earth atmosphere system in eight visible and three infrared spectral bands (12.3, 11.2 and 6.5 microns) are measured by the MAMS at up to 50 m horizontal resolution, and the infrared bands are similar to three of the VAS infrared bands. Similar radiometric performance was found for the two systems, though the MAMS showed somewhat less attenuation from water vapor than VAS because its spectral bands are shifted to shorter wavelengths away from the absorption band center.

Infant Malnutrition: Shame of our Nation

ERIC Educational Resources Information Center

Low, Merritt Burnham

1975-01-01

Argues that severe infant malnutrition is shockingly widespread in the United States, that the effects of malnutrition in infancy are now recognized to be much more devastating than had hitherto been known, and that the probable relationship between poverty, malnutrition, and mental deficiency is far too strong to overlook. [Available from…

BacMam immunization partially protects pigs against sublethal challenge with African swine fever virus.

PubMed

Argilaguet, Jordi M; Pérez-Martín, Eva; López, Sergio; Goethe, Martin; Escribano, J M; Giesow, Katrin; Keil, Günther M; Rodríguez, Fernando

2013-04-01

Lack of vaccines and efficient control measures complicate the control and eradication of African swine fever (ASF). Limitations of conventional inactivated and attenuated virus-based vaccines against African swine fever virus (ASFV) highlight the need to use new technologies to develop efficient and safe vaccines against this virus. With this aim in mind, in this study we have constructed BacMam-sHAPQ, a baculovirus based vector for gene transfer into mammalian cells, expressing a fusion protein comprising three in tandem ASFV antigens: p54, p30 and the extracellular domain of the viral hemagglutinin (secretory hemagglutinin, sHA), under the control of the human cytomegalovirus immediate early promoter (CMVie). Confirming its correct in vitro expression, BacMam-sHAPQ induced specific T-cell responses directly after in vivo immunization. Conversely, no specific antibody responses were detectable prior to ASFV challenge. The protective potential of this recombinant vaccine candidate was tested by a homologous sublethal challenge with ASFV following immunization. Four out of six immunized pigs remained viremia-free after ASFV infection, while the other two pigs showed similar viremic titres to control animals. The protection afforded correlated with the presence of a large number of virus-specific IFNγ-secreting T-cells in blood at 17 days post-infection. In contrast, the specific antibody levels observed after ASFV challenge in sera from BacMam-sHAPQ immunized pigs were indistinguishable from those found in control pigs. These results highlight the importance of the cellular responses in protection against ASFV and point towards BacMam vectors as potential tools for future vaccine development. Copyright © 2013 Elsevier B.V. All rights reserved.

Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study.

PubMed

Luma, Henry Namme; Eloumou, Servais Albert Fiacre Bagnaka; Mboligong, Franklin Ngu; Temfack, Elvis; Donfack, Olivier-Tresor; Doualla, Marie-Solange

2017-07-03

Malnutrition is common in acutely ill patients occurring in 30-50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m 2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m 2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5-12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p < 0.0001) and malnutrition by the two methods showed moderate agreement (κ = 0.56; p < 0.0001). Using the two methods in combination, the prevalence of malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients.

Malnutrition, Learning, and Behavior.

ERIC Educational Resources Information Center

Read, Merrill S.; Felson, David

The problems of those children who are chronically malnourished, the cultural environment of malnutrition, and the extent to which children are temporarily or permanently handicapped in learning because of malnutrition are discussed in this booklet. It also describes hunger and its effects on child development. The topics addressed are: definition…

Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn-soya blend (CSB+): a randomized controlled trial.

PubMed

Medoua, Gabriel Nama; Ntsama, Patricia M; Ndzana, Anne Christine A; Essa'a, Véronique J; Tsafack, Julie Judith T; Dimodi, Henriette T

2016-02-01

To compare an improved corn-soya blend (CSB+) with a ready-to-use supplementary food (RUSF) to test the hypothesis that satisfactory recovery rate will be achieved with CSB+ or RUSF when these foods provide 50 % of the child's energy requirement, the 50 % remaining coming from usual diet. A comparative efficacy trial study was conducted with moderately wasted children, using a controlled randomized design, with parallel assignment for RUSF or CSB+. Every child received a daily ration of 167 kJ (40 kcal)/kg body weight during 56 d with a follow-up performed every 14 d. Every caregiver received nutrition counselling at enrolment and at each follow-up visit. Health districts of Mvog-Beti and Evodoula in the Centre region of Cameroon. Eight hundred and thirty-three children aged 6-59 months were screened and eighty-one malnourished children (weight-for-height Z-score between -3 and -2) aged 25-59 months were selected. Of children treated with CSB+ and RUSF, 73 % (95 % CI 59 %, 87 %) and 85 % (95 % CI 73 %, 97 %), respectively, recovered from moderate acute malnutrition, with no significant difference between groups. The mean duration of treatment required to achieve recovery was 44 d in the RUSF group and 51 d in the CSB+ group (log-rank test, P=0·0048). There was no significant difference in recovery rate between the groups. Both CSB+ and RUSF were relatively successful for the treatment of moderate acute malnutrition in children. Despite the relatively low ration size provided, the recovery rates observed for both groups were comparable to or higher than those reported in previous studies, a probable effect of nutrition education.

The effects of malnutrition on the motor, perceptual, and cognitive functions of Filipino children.

PubMed

Reyes, M R; Valdecanas, C M; Reyes, O L; Reyes, T M

1990-01-01

The motor, perceptual, and cognitive abilities of 99 Filipino children, aged 4-6 years with a documented history of malnutrition from a nutritionally depressed area of Manila were determined using the Revised Manila Motor-Perceptual Screening Test. They were classified into four groups of: (1) normal; (2) acutely malnourished; (3) stunted but not malnourished; and (4) chronically malnourished using the Waterlow classification. Thirty-one normal children of comparable ages and background from a nationwide pool were similarly tested and served as the control group. Motor (p = 0.001) and perceptual skill (p less than 0.03 to less than 0.001) scores were significantly lower than in their normal counterparts, especially in the chronically malnourished children. Cognitive abilities were not evidently affected by malnutrition.

Agriculture and malnutrition in India.

PubMed

Gulati, Ashok; Ganesh-Kumar, A; Shreedhar, Ganga; Nandakumar, T

2012-03-01

Despite the high and relatively stable overall growth of the economy, India's agriculture sector is underperforming and a vast section of the population remains undernourished. To explore the possible interplay between agricultural performance and malnutrition indicators to see whether states that perform better in agriculture record better nutritional outcomes. Correlation analysis and a simple linear regression model were used to study the relationship between agricultural performance and malnutrition among children under 5 years of age and adults from 15 to 49 years of age at 20 major states using data from the National Family Health Survey-3 for the year 2005/06 and the national accounts. Indicators of the level of agricultural performance or income have a strong and significant negative relationship with indices of undernutrition among adults and children, a result suggesting that improvement of agricultural productivity can be a powerful tool to reduce undernutrition across the vast majority of the population. In addition to agriculture, access to sanitation facilities and women's literacy were also found to be strong factors affecting malnutrition. Access to healthcare for women and child-care practices, in particular breastfeeding within 1 hour after birth, are other important determinants of malnutrition among adults and children. Malnutrition is a multidimensional problem that requires multisectoral interventions. The findings show that improving agricultural performance can have a positive impact on nutritional outcomes. However, improvements in agriculture alone cannot be effective in combating malnutrition if several other mediating factors are not in place. Interventions to improve education, health, sanitation and household infrastructure, and care and feeding practices are critical. Innovative strategies that integrate agriculture and nutrition programs stand a better chance of combating the malnutrition problem.

Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition.

PubMed

Laur, Celia V; McNicholl, Tara; Valaitis, Renata; Keller, Heather H

2017-05-01

There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.

Malnutrition, Learning, and Behavior.

ERIC Educational Resources Information Center

Kallen, David J.

Malnutrition can be defined as a lack of a sufficient quantity or quality of nutrients to maintain the body system at some definable level of functioning. It has been estimated that nearly half the children in the world today grow and develop under conditions of protein or protein-calorie malnutrition sufficient to impair their physical…

Characteristics and Outcomes of Adult Inpatients With Malnutrition.

PubMed

Vest, Michael T; Papas, Mia A; Shapero, Mary; McGraw, Patty; Capizzi, Amanda; Jurkovitz, Claudine

2017-12-27

The diagnosis of malnutrition remains controversial. Furthermore, it is unknown if physician diagnosis of malnutrition impacts outcomes. We sought to compare outcomes of patients with physician diagnosed malnutrition to patients recognized as malnourished by registered dietitians (RDs), but not physicians, and to describe the impact of each of 6 criteria on the diagnosis of malnutrition. We conducted a retrospective cohort study of adult patients identified as meeting criteria for malnutrition. Pediatric, psychiatric, maternity, and rehabilitation patients were excluded. Patient demographics, clinical data, malnutrition type and criteria, nutrition interventions, and outcomes were abstracted from the electronic medical record. RDs identified malnutrition for 291 admissions during our study period. This represents 4.1% of hospital discharges. Physicians only diagnosed malnutrition on 93 (32%) of these cases. Physicians diagnosed malnutrition in 43% of patients with a body mass index <18.5 but only 26% of patients with body mass index higher than 18.5. Patients with a physician diagnosis had a longer length of stay (mean 14.9 days vs 7.1 days) and were more likely to receive parenteral nutrition (PN) (20.4% vs 4.6%). Of the patients, 62% had malnutrition due to chronic illness. Of the 6 criteria used to identify malnourished patients, weight loss and reduced energy intake were the most common. Malnutrition is underrecognized by physicians. However, further research is needed to determine if physician recognition and treatment of malnutrition can improve outcomes. The most important criteria for identifying malnourished patients in our cohort were weight loss and reduced energy intake. © 2017 American Society for Parenteral and Enteral Nutrition.

Hypothermia-induced acute kidney injury in a diabetic patient with nephropathy and neuropathy.

PubMed

Yamada, Shunsuke; Shimomura, Yukiko; Ohsaki, Masato; Fujisaki, Akiko; Tsuruya, Kazuhiko; Iida, Mitsuo

2010-01-01

Hypothermia is a life-threatening medical condition defined as an unintentional fall in body temperature below 35 degrees C. Exposure to cold environment stimulates the thermoregulatory system to maintain the body temperature within the physiological range. Patients with malnutrition and/or diabetes mellitus are at high risk for accidental hypothermia, and acute kidney injury, which is mainly caused by pre-renal factors, occurs in relation to hypothermia. However, acute exacerbation of pre-existing chronic kidney disease has been rarely reported. Here, we present a patient with diabetes mellitus and malnutrition who developed two separate episodes of hypothermia followed by acute exacerbation of chronic kidney disease.

Malnutrition and ageing

PubMed Central

Hickson, M

2006-01-01

This article aims to provide an overview of the problems that exist in relation to malnutrition and the elderly population. The changes that occur in body composition during ageing are described and how this may affect disease risk. The possible metabolic processes behind weight loss are discussed and the numerous factors that affect nutritional status in the older age group are described. Prevention of malnutrition in this group is important and so the roles of nutrition screening and assessment are examined. PMID:16397072

Measurement of neutron-induced reactions on 242mAm

NASA Astrophysics Data System (ADS)

Buckner, M. Q.; Wu, C.-Y.; Henderson, R. A.; Bucher, B.; Chyzh, A.; Bredeweg, T. A.; Baramsai, B.; Couture, A.; Jandel, M.; Mosby, S.; Ullmann, J. L.; Dance Collaboration

2016-09-01

Neutron-induced reaction cross sections of 242mAm were measured at the Los Alamos Neutron Science Center using the Detector for Advanced Neutron-Capture Experiments array along with a compact parallel-plate avalanche counter for fission-fragment detection. A new neutron-capture cross section was determined relative to a simultaneous measurement of the well-known 242mAm(n,f) cross section. The (n, γ) cross section was measured from thermal to an incident energy of 1 eV. Our new 242mAm fission cross section was normalized to ENDF/B-VII.1 and agreed well with the (n,f) cross section reported in the literature from thermal energy to 1 keV. The capture-to-fission ratio was determined from thermal energy to En = 0.1 eV, and it was found to be (n, γ)/(n,f) = 26(4)% compared to 19% from ENDF/B-VII.1. Our latest results will be reported. US Department of Energy by Lawrence Livermore National Security, LLC Contract DE-AC52-07NA27344 and Los Alamos National Security, LLC Contract DE-AC52-06NA25396 and U.S. DOE/NNSA Office of Defense Nuclear Nonproliferation Research and Development.

Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial.

PubMed

Schneider, Michael; Haas, Mitchell; Glick, Ronald; Stevans, Joel; Landsittel, Doug

2015-02-15

Randomized controlled trial with follow-up to 6 months. This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC). Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC. A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months. Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = -8.1, P = 0.009; pain = -1.4, P = 0.002) and UMC (disability = -6.5, P = 0.032; pain = -1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months. MTM provides greater short-term reductions in self-reported disability and pain scores compared with UMC or MAM. 2.

Discordance between bioelectrical impedance vector analysis and the new ESPEN definition of malnutrition for the diagnosis of hospital malnutrition.

PubMed

Dehesa-López, Edgar; Martínez-Felix, Jesús Israel; Ruiz-Ramos, Arturo; Atilano-Carsi, Ximena

2017-04-01

No universally accepted diagnostic criteria for malnutrition are available to date. The aim was to assess the concordance for the diagnosis of hospital malnutrition between the bioelectrical impedance vector analysis (BIVA) and the new definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). A total of 140 adult hospitalized patients were included. The malnutrition risk was assessed by the Nutritional Risk Screening. The ESPEN malnutrition criteria (body mass index (BMI) <18.5 kg/m 2 , weight loss (WL) + low BMI, and WL + low fat free mass index (FFMI) were applied to each patient. The bioelectrical impedance of each patient was measured, and malnutrition was diagnosed using the BIVA method. Diagnostic concordance between the BIVA and the new ESPEN definition was assessed with the Kappa coefficient. The malnutrition prevalence was higher with the BIVA vs ESPEN definition (22.1% vs 13.6%) in the global population and was similar (12.8% vs 12.1%) in the population at risk of malnutrition. The diagnostic performance of the BIVA was acceptable, with higher sensitivity in patients with fluid overload (FO) and more specificity in euvolemic patients. Diagnostic concordance between the BIVA and the ESPEN definition was poor for the global population (kappa = 0.56) and the population at risk of malnutrition (kappa = 0.67) but was acceptable in patients with FO (kappa = 0.78). However, the discordant BIVA+/ESPEN- patients classified as false positives for BIVA showed clinical and body composition data (low FFMI, low phase angle) consistent with malnutrition. According to the clinical and bioelectrical characteristics of the discordant BIVA+/ESPEN- patients, the BIVA could perform better that the new ESPEN definition for the diagnosis of hospital malnutrition, which should be confirmed with other studies. Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights

Identifying Protein-Calorie Malnutrition Workshop.

ERIC Educational Resources Information Center

Walker, Susan S.; Barker, Ellen M.

Instructional materials are provided for a workshop to enable participants to assist in identifying patients at risk with protein-calorie malnutrition and in corrrecting this nutritional deficiency. Representative topics are nutrients; protein, mineral, and vitamin sources, functions, and deficiency symptoms; malnutrition; nutritional deficiency…

Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study.

PubMed

Bell, J J; Bauer, J D; Capra, S; Pulle, R C

2014-03-01

Differences in malnutrition diagnostic measures impact malnutrition prevalence and outcomes data in hip fracture. This study investigated the concurrent and predictive validity of commonly reported malnutrition diagnostic measures in patients admitted to a metropolitan hospital acute hip fracture unit. A prospective, consecutive level II diagnostic accuracy study (n=142; 8 exclusions) including the International Classification of Disease, 10th Revision, Australian Modification (ICD10-AM) protein-energy malnutrition criteria, a body mass index (BMI) <18.5 kg/m(2), the Mini-Nutrition Assessment Short-Form (MNA-SF), pre-operative albumin and geriatrician individualised assessment. Patients were predominantly elderly (median age 83.5, range 50-100 years), female (68%), multimorbid (median five comorbidities), with 15% 4-month mortality. Malnutrition prevalence was lowest when assessed by BMI (13%), followed by MNA-SF (27%), ICD10-AM (48%), albumin (53%) and geriatrician assessment (55%). Agreement between measures was highest between ICD10-AM and geriatrician assessment (κ=0.61) followed by ICD10-AM and MNA-SF measures (κ=0.34). ICD10-AM diagnosed malnutrition was the only measure associated with 48-h mobilisation (35.0 vs 55.3%; P=0.018). Reduced likelihood of home discharge was predicted by ICD-10-AM (20.6 vs 57.1%; P=0.001) and MNA-SF (18.8 vs 47.8%; P=0.035). Bivariate analysis demonstrated ICD10-AM (relative risk (RR)1.2; 1.05-1.42) and MNA-SF (RR1.2; 1.0-1.5) predicted 4-month mortality. When adjusted for age, usual place of residency, comorbidities and time to surgery only ICD-10AM criteria predicted mortality (odds ratio 3.59; 1.10-11.77). Albumin, BMI and geriatrician assessment demonstrated limited concurrent and predictive validity. Malnutrition prevalence in hip fracture varies substantially depending on the diagnostic measure applied. ICD-10AM criteria or the MNA-SF should be considered for the diagnosis of protein-energy malnutrition in frail, multi

Decomposition of childhood malnutrition in Cambodia.

PubMed

Sunil, Thankam S; Sagna, Marguerite

2015-10-01

Childhood malnutrition is a major problem in developing countries, and in Cambodia, it is estimated that approximately 42% of the children are stunted, which is considered to be very high. In the present study, we examined the effects of proximate and socio-economic determinants on childhood malnutrition in Cambodia. In addition, we examined the effects of the changes in these proximate determinants on childhood malnutrition between 2000 and 2005. Our analytical approach included descriptive, logistic regression and decomposition analyses. Separate analyses are estimated for 2000 and 2005 survey. The primary component of the difference in stunting is attributable to the rates component, indicating that the decrease of stunting is due mainly to the decrease in stunting rates between 2000 and 2005. While majority of the differences in childhood malnutrition between 2000 and 2005 can be attributed to differences in the distribution of malnutrition determinants between 2000 and 2005, differences in their effects also showed some significance. © 2013 John Wiley & Sons Ltd.

Differential Impact of Malnutrition on Health Outcomes Among Indigenous and Non-Indigenous Adults Admitted to Hospital in Regional Australia-A Prospective Cohort Study.

PubMed

Morris, Natasha; Stewart, Simon; Riley, Malcolm; Maguire, Graeme

2018-05-19

The burden of malnutrition in Indigenous people is a major health priority and this study's aims are to understand health outcomes among Indigenous and non-Indigenous patients. This cohort study includes 608 medical inpatients in three regional hospitals. Participants were screened for malnutrition using the Subjective Global Assessment tool. Hospital length of stay, discharge destination, 30-day and six-month hospital readmission and survival were measured. Although no significant difference was observed between Indigenous participants who were malnourished or nourished ( p = 0.120), malnourished Indigenous participants were more likely to be readmitted back into hospital within 30 days (Relative Risk ( RR ) 1.53, 95% CI 1.19⁻1.97, p = 0.002) and six months ( RR 1.40, 95% Confidence Interval (CI) 1.05⁻1.88, p = 0.018), and less likely to be alive at six months ( RR 1.63, 95% CI 1.20⁻2.21, p = 0.015) than non-Indigenous participants. Malnutrition was associated with higher mortality (Hazards Ratio ( HR ) 3.32, 95% CI 1.87⁻5.89, p < 0.001) for all participants, and independent predictors for six-month mortality included being malnourished ( HR 2.10, 95% CI 1.16⁻3.79, p = 0.014), advanced age ( HR 1.04, 95% CI 1.02⁻1.06, p = 0.001), increased acute disease severity (Acute Physiology and Chronic Health Evaluation score, HR 1.03, 95% CI 1.01⁻1.05, p = 0.002) and higher chronic disease index (Charlson Comorbidity Index, HR 1.36, 95% CI 1.16⁻3.79, p = 0.014). Malnutrition in regional Australia is associated with increased healthcare utilization and decreased survival. New approaches to malnutrition-risk screening, increased dietetic resourcing and nutrition programs to proactively identify and address malnutrition in this context are urgently required.

Suppression of Methamphetamine Self-Administration by Ketamine Pre-treatment Is Absent in the Methylazoxymethanol (MAM) Rat Model of Schizophrenia.

PubMed

Ruda-Kucerova, Jana; Babinska, Zuzana; Stark, Tibor; Micale, Vincenzo

2017-07-01

Ketamine may prove to be a potential candidate in treating the widespread drug addiction/substance abuse epidemic among patients with schizophrenia. Clinical studies have shown ketamine to reduce cocaine and heroin cravings. However, the use of ketamine remains controversial as it may exacerbate the symptoms of schizophrenia. Therefore, the aim of this study is to characterize the effects of ketamine on drug addiction in schizophrenia using the methylazoxymethanol (MAM) acetate rat model on operant IV methamphetamine (METH) self-administration. MAM was administered intraperitoneally (22 mg/kg) on gestational day 17. Locomotor activity test and later IV self-administration (IVSA) were then performed in the male offspring followed by a period of forced abstinence and relapse of METH taking. After reaching stable intakes in the relapse phase, ketamine (5 mg/kg) was administered intraperitoneally 30 min prior to the self-administration session. As documented previously, the MAM rats showed a lack of habituation in the locomotor activity test but developed stable maintenance of METH self-administration with no difference in operant behaviour to control animals. Results show that ketamine treatment significantly reduced the METH intake in the control animals but not in MAM animals. Ketamine effect on METH self-administration may be explained by increased glutamatergic signalling in the prefrontal cortex caused by the N-methyl-D-aspartate antagonism and disinhibition of GABA interneurons which was shown to be impaired in the MAM rats. This mechanism may at least partly explain the clinically proven anti-craving potential of ketamine and allow development of more specific anti-craving medications with fewer risks.

Malnutrition in South Asia-A Critical Reappraisal.

PubMed

Akhtar, Saeed

2016-10-25

Malnutrition continues to be a major public health challenge especially in South Asian developing countries. The aim of the present review is to spotlight the magnitude of the prevalence of malnutrition and its dynamics in South Asian region and to suggest potential approaches for the prevention and control of this issue of public health significance. An extensive review of literature, covering malnutrition and its determinants, health and economic consequences and pragmatic preventive strategies was performed on computer based bibliographic databases (PubMed, Google Scholar, Scopus, Medline and Sciencedirect.com ) to retrieve abstracts and full texts for India, Pakistan, Bangladesh, Sri Lanka and Nepal. All relevant titles and abstracts were examined and evaluated for malnutrition and its prevalence in South Asia. The results revealed malnutrition to be a major public health problem and a potential cause of high disease burden and mortality in South Asia. Compelling evidence suggests malnutrition to be the leading cause of stunting, wasting and underweight with drastic economic consequences among vulnerable populations. Reduced cognitive performance and low productivity have also been associated with micronutrients malnutrition. Suboptimal breastfeeding, inadequate food supply, micronutrient deficiencies, low household income, poor health care system, increased healthcare costs, illiteracy, unhygienic and substandard living, inappropriate child's care and the caregiver, food insecurity and on top of that vicious cycle of poverty, have been recognized as principal indicators for growing malnutrition prevalence in South Asia. Global organizations, local governments, program managers, NGOs, academia, industry in particular and the society at large need to take up the challenge to completely confiscate malnutrition from the region for economic prosperity and a healthier future.

Disease Specific Aspects of Malnutrition in Neurogeriatric Patients

PubMed Central

Prell, Tino; Perner, Caroline

2018-01-01

Malnutrition in elderly patients is a common condition. Nevertheless, there is evidence on specific risk factors and problems of malnutrition in geriatric patients with neurological diseases. In this review, we summarize recent knowledge on malnutrition in different neurological diseases with a focus on elderly patients. This overview also provides strategies for a more specific and profound assessment of neurogeriatric patients to improve identification and treatment of malnutrition. Early and consequent treatment of malnutrition can lead to a decreased progression of the neurological disease and to a better quality of life in geriatric patients. PMID:29628887

Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh.

PubMed

Hossain, M Iqbal; Dodd, Nina S; Ahmed, Tahmeed; Miah, Golam Mothabbir; Jamil, Kazi M; Nahar, Baitun; Alam, Badrul; Mahmood, C B

2009-02-01

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean +/- SD age 23.5 +/- 15.3 months) were admitted during June 2005-May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of > or = 500 and > or = 700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of -1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses

High risk of malnutrition is associated with low muscle mass in older hospitalized patients - a prospective cohort study.

PubMed

Pierik, Vincent D; Meskers, Carel G M; Van Ancum, Jeanine M; Numans, Siger T; Verlaan, Sjors; Scheerman, Kira; Kruizinga, Roeliene C; Maier, Andrea B

2017-06-05

Malnutrition, low muscle strength and muscle mass are highly prevalent in older hospitalized patients and associated with adverse outcomes. Malnutrition may be a risk factor for developing low muscle mass. We aimed to investigate the association between the risk of malnutrition and 1) muscle strength and muscle mass at admission and 2) the change of muscle strength and muscle mass during hospitalization in older patients. The EMPOWER study included 378 patients aged seventy years or older who were acutely or electively admitted to four different wards of an academic teaching hospital in Amsterdam. Patients were grouped into low risk of malnutrition and high risk of malnutrition based on the Short Nutritional Assessment Questionnaire (SNAQ) score and were assessed for hand grip strength and muscle mass using hand held dynamometry respectively bioelectrical impedance analysis (BIA) within 48 h after admission and at day seven, or earlier at the day of discharge. Muscle mass was expressed as skeletal muscle mass, appendicular lean mass, fat free mass and the skeletal muscle index. The mean age of the patients was 79.7 years (SD 6.39), 48.9% were female. At admission, being at high risk of malnutrition was significantly associated with lower muscle mass (Odds Ratio, 95% CI, 0.90, 0.85-0.96), but not with muscle strength. Muscle strength and muscle mass did not change significantly during hospitalization in both groups. In older hospitalized patients, a high risk of malnutrition is associated with lower muscle mass at admission, but not with muscle strength nor with change of either muscle strength or muscle mass during hospitalization.

Subjective Global Assessment-Dialysis Malnutrition Score and cardiovascular risk in hemodialysis patients: an observational cohort study.

PubMed

Spatola, Leonardo; Finazzi, Silvia; Calvetta, Albania; Reggiani, Francesco; Morenghi, Emanuela; Santostasi, Silvia; Angelini, Claudio; Badalamenti, Salvatore; Mugnai, Giacomo

2018-06-23

Malnutrition is an important risk factor for cardiovascular mortality in hemodialysis (HD) patients. However, current malnutrition biomarkers seem unable to accurately estimate the role of malnutrition in predicting cardiovascular risk. Our aim was to investigate the role of the Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS) compared to two well-recognized comorbidity scores-Charlson Comorbidity Index (CCI) and modified CCI (excluding age-factor) (mCCI)-in predicting cardiovascular events in HD patients. In 86 maintenance HD patients followed from June 2015 to June 2017, we analyzed biohumoral data and clinical scores as risk factors for cardiovascular events (acute heart failure, acute coronary syndrome and stroke). Their impact on outcome was investigated by linear regression, Cox regression models and ROC analysis. Cardiovascular events occurred in 26/86 (30%) patients during the 2-year follow-up. Linear regression showed only age and dialysis vintage to be positively related to SGA-DMS: B 0.21 (95% CI 0.01; 0.30) p 0.05, and B 0.24 (0.09; 0.34) p 0.02, respectively, while serum albumin, normalized protein catabolic rate (nPCR) and dialysis dose (Kt/V) were negatively related to SGA-DMS: B - 1.29 (- 3.29; - 0.81) p 0.02; B - 0.08 (- 1.52; - 0.35) p 0.04 and B - 2.63 (- 5.25; - 0.22) p 0.03, respectively. At Cox regression analysis, SGA-DMS was not a risk predictor for cardiovascular events: HR 1.09 (0.9; 1.22), while both CCI and mCCI were significant predictors: HR 1.43 (1.13; 1.87) and HR 1.57 (1.20; 2.06) also in Cox adjusted models. ROC analysis reported similar AUCs for CCI and mCCI: 0.72 (0.60; 0.89) p 0.00 and 0.70 (0.58; 0.82) p 0.00, respectively, compared to SGA-DMS 0.56 (0.49; 0.72) p 0.14. SGA-DMS is not a superior and significant prognostic tool compared to CCI and mCCI in assessing cardiovascular risk in HD patients, even it allows to appraise both malnutrition and comorbidity status.

Validity of subjective global assessment as a screening method for hospital malnutrition. Prevalence of malnutrition in a tertiary hospital.

PubMed

Moriana, Miriam; Civera, Miguel; Artero, Ana; Real, Jose T; Caro, Juan; Ascaso, Juan F; Martinez-Valls, Jose F

2014-04-01

Hospital malnutrition is a highly prevalent problem that affects patient morbidity and mortality resulting in longer hospital stays and increased healthcare costs. Although there is no single nutritional screening method, subjective global assessment (SGA) may be a useful, inexpensive, and easily reproducible tool. A cross-sectional, observational, randomized study was conducted in 197 patients in a tertiary hospital. SGA, anthropometric data, and biochemical parameters were used to assess the nutritional status of study patients. Fifty percent of subjects were malnourished according to SGA. A higher prevalence of malnutrition was found in medical (53%) as compared to surgical departments (47%). Half the subjects (50%) had malnutrition by SGA, but only 37.8% received nutritional treatment during their hospital stay. Mean hospital stay was longer for patients malnourished (13.5 days) or at risk of malnutrition (12.1 days) as compared to well nourished subjects (6.97 days). SGA significantly correlated (P<.012) with anthropometric and biochemical malnutrition parameters. Prevalence of hospital malnutrition is very high in both medical and surgical departments and is inadequately treated. SGA is a useful tool for screening hospital malnutrition because of its high degree of correlation with anthropometric and biochemical parameters. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Metabolic changes in malnutrition.

PubMed

Emery, P W

2005-10-01

This paper is concerned with malnutrition caused by inadequate intake of all the major nutrients rather than deficiency diseases relating to a single micronutrient. Three common situations are recognised: young children in third world countries with protein-energy malnutrition; adults in the same countries who are chronically adapted to subsisting on marginally inadequate diets; and patients who become malnourished as a result of chronic diseases. In all these situations infectious diseases are often also present, and this complicates the interpretation of biochemical and physiological observations. The metabolic response to starvation is primarily concerned with maintaining a supply of water-soluble substrates to supply energy to the brain. Thus there is an initial rise in metabolic rate, reflecting gluconeogenic activity. As fasting progresses, gluconeogenesis is suppressed to minimise muscle protein breakdown and ketones become the main fuel for the brain. With chronic underfeeding the basal metabolic rate per cell appears to fall, but the mechanistic basis for this is not clear. The main adaptation to chronic energy deficiency is slow growth and low adult body size, although the reduction in energy requirement achieved by this is partially offset by the preservation of the more metabolically active organs at the expense of muscle, which has a lower metabolic rate. The interaction between malnutrition and the metabolic response to trauma has been studied using an animal model. The rise in energy expenditure and urinary nitrogen excretion following surgery were significantly attenuated in malnourished rats, suggesting that malnutrition impairs the ability of the body to mobilise substrates to support inflammatory and reparative processes. However, the healing process in wounded muscle remained unimpaired in malnutrition, suggesting that this process has a high biological priority.

[Prevalence of malnutrition in Spanish schoolchildren].

PubMed

Pérez-Ríos, Mónica; Santiago-Pérez, María I; Leis, Rosaura; Malvar, Alberto; Suanzes, Jorge; Hervada, Xurxo

2017-11-01

The term malnutrition includes malnutrition due to excess or obesity, underweight as well as stunted growth. Its prevalence in a population can be estimated using anthropometric variables. The aim of this study is to estimate the prevalence of malnutrition in Galician schoolchildren aged 6 to 15years in the school year 2013-2014. A cross-sectional study was conducted on a representative sample by gender and age of the Galician population of 6 to 15years old. The prevalence of obesity, underweight, and short stature was estimated by age and gender using the reference standards proposed by the World Health Organisation. Of the total of 7,438 schoolchildren weighed and measured, 16.4% had malnutrition. The prevalence of obesity was 14.8%, underweight was 0.7%, and short stature for age was estimated at 1%. Obesity was more prevalent among boys. As regards underweight and short stature, when there were differences, prevalence was higher among girls. In Galicia, 16 out of every 100 schoolchildren aged 6 to 15years had malnutrition, with that due to excess or obesity being the most frequent. Prevalence of underweight and short stature did not exceed 1%. This data shows that primary prevention measures should be promoted at an early age to reduce malnutrition due to excess or adiposity, in particular. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Malnutrition in elderly: social and economic determinants.

PubMed

Donini, L M; Scardella, P; Piombo, L; Neri, B; Asprino, R; Proietti, A R; Carcaterra, S; Cava, E; Cataldi, S; Cucinotta, D; Di Bella, G; Barbagallo, M; Morrone, A

2013-01-01

Malnutrition occurs frequently in the frailest groups of the population, especially in people who are on a low income and elderly subjects, overall if they are institutionalized. The aim of this study was to assess the prevalence of malnutrition in a sample of elderly people living in different settings and to identify the determinants of malnutrition. A total of 718 subjects, 472 females (F) and 246 males (M), were recruited from nursing homes or were free living in three different regions in Italy. Nutritional status, depression, social, functional and cognitive status, were evaluated. According to the Mini Nutritional Assessment (MNA), a high prevalence of malnutrition was found out in both genders: 26% of F and 16.3% of M were classified as being malnourished (MNA<17); 40.9% of F and 35% of M were at risk of malnutrition (MNA 17-23,5). The prevalence of malnutrition was significantly higher in NH subjects in both sexes. Moreover, a relationship was shown between malnutrition and inability to shop, prepare and cook meals because of a low income, distance from markets or supermarkets as well as impossibility to drive the car or to use public transportation. This study confirms the necessity to routinely perform nutritional status evaluation in elderly subjects, to carry out training courses for health workers (doctors, nurses, psychologists, dietitians), to implement nutritional education of the geriatric population, to develop tools and guidelines for health workers and caregivers, to identify and reduce clinical, functional, social or economic risk factors for malnutrition.

The influence of early malnutrition on subsequent behavioral development III. Learning disabilities as a sequel to malnutrition.

PubMed

Galler, J R; Ramsey, F; Solimano, G

1984-04-01

The academic performance of 129 Barbadian children (77 boys and 52 girls), who were 5-11-yr-old and suffered moderate to severe protein-energy malnutrition in the first year of life, was compared with the performance of matched comparisons, children who had no history of malnutrition. Children with a history of malnutrition were found to have lower performance on eight out of nine academic subject areas, namely, language arts, mathematics, general science, social science, reading, health, religion, and arts/crafts. Socioeconomic factors in the backgrounds of the children were also examined. A model is presented clarifying the interrelationships of malnutrition, socioeconomic status and school performance. Reduced school performance in the previously malnourished children can be largely accounted for by deficits in classroom behavior, and, to a lesser extent by a reduction in I.Q. Current socioeconomic status is not directly involved in altering academic performance whereas the early history of malnutrition and its accompanying conditions at the time of the illness are leading contributors to altered behavioral outcome and school performance.

Determination of atmospheric moisture structure and infrared cooling rates from high resolution MAMS radiance data

NASA Technical Reports Server (NTRS)

Menzel, W. Paul; Moeller, Christopher C.; Smith, William L.

1991-01-01

This program has applied Multispectral Atmospheric Mapping Sensor (MAMS) high resolution data to the problem of monitoring atmospheric quantities of moisture and radiative flux at small spatial scales. MAMS, with 100-m horizontal resolution in its four infrared channels, was developed to study small scale atmospheric moisture and surface thermal variability, especially as related to the development of clouds, precipitation, and severe storms. High-resolution Interferometer Sounder (HIS) data has been used to develop a high spectral resolution retrieval algorithm for producing vertical profiles of atmospheric temperature and moisture. The results of this program are summarized and a list of publications resulting from this contract is presented. Selected publications are attached as an appendix.

Malnutrition and vaccination in developing countries

PubMed Central

Prendergast, Andrew J.

2015-01-01

Malnutrition contributes to an estimated 45% of deaths among children under 5 years of age in developing countries, predominantly due to infections. Malnourished children therefore stand to benefit hugely from vaccination, but malnutrition has been described as the most common immunodeficiency globally, suggesting that they may not be able to respond effectively to vaccines. The immunology of malnutrition remains poorly characterized, but is associated with impairments in mucosal barrier integrity, and innate and adaptive immune dysfunction. Despite this, the majority of malnourished children can mount a protective immune response following vaccination, although the timing, quality and duration of responses may be impaired. This paper reviews the evidence for vaccine immunogenicity in malnourished children, discusses the importance of vaccination in prevention of malnutrition and highlights evidence gaps in our current knowledge. PMID:25964453

Wildfire and MAMS data from STORMFEST

NASA Technical Reports Server (NTRS)

Jedlovec, Gary J.; Carlson, G. S.

1993-01-01

Early in 1992, NASA participated in an inter-agency field program called STORMFEST. The STORM-Fronts Experiment Systems Test (STORMFEST) was designed to test various systems critical to the success of STORM 1 in a very focused experiment. The field effort focused on winter storms in order to investigate the structure and evolution of fronts and associated mesoscale phenomena in the central United States. This document describes the data collected from two instruments onboard a NASA ER2 aircraft which was deployed out of Ellington Field in Houston, Texas from February 13 through March 15, 1992, in support of this experiment. The two instruments were the Wildfire (a.k.a. the moderate resolution imaging spectrometer-nadir (MODIS-N) Airborne Simulation (MAS)) and the Multispectral Atmospheric Mapping Sensor (MAMS).

Mitochondria-associated ER Membranes (MAMs) and Glycosphingolipid Enriched Microdomains (GEMs): Isolation from Mouse Brain

PubMed Central

d'Azzo, Alessandra

2013-01-01

Intracellular organelles are highly dynamic structures with varying shape and composition, which are subjected to cell-specific intrinsic and extrinsic cues. Their membranes are often juxtaposed at defined contact sites, which become hubs for the exchange of signaling molecules and membrane components1,2,3,4. The inter-organellar membrane microdomains that are formed between the endoplasmic reticulum (ER) and the mitochondria at the opening of the IP3-sensitive Ca2+ channel are known as the mitochondria associated-ER membranes or MAMs4,5,6. The protein/lipid composition and biochemical properties of these membrane contact sites have been extensively studied particularly in relation to their role in regulating intracellular Ca2+ 4,5,6. The ER serves as the primary store of intracellular Ca2+, and in this capacity regulates a myriad of cellular processes downstream of Ca2+ signaling, including post-translational protein folding and protein maturation7. Mitochondria, on the other hand, maintain Ca2+ homeostasis, by buffering cytosolic Ca2+ concentration thereby preventing the initiation of apoptotic pathways downstream of Ca2+ unbalance4,8. The dynamic nature of the MAMs makes them ideal sites to dissect basic cellular mechanisms, including Ca2+ signaling and regulation of mitochondrial Ca2+ concentration, lipid biosynthesis and transport, energy metabolism and cell survival 4,9,10,11,12. Several protocols have been described for the purification of these microdomains from liver tissue and cultured cells13,14. Taking previously published methods into account, we have adapted a protocol for the isolation of mitochondria and MAMs from the adult mouse brain. To this procedure we have added an extra purification step, namely a Triton X100 extraction, which enables the isolation of the glycosphingolipid enriched microdomain (GEM) fraction of the MAMs. These GEM preparations share several protein components with caveolae and lipid rafts, derived from the plasma membrane or

Major Barriers Responsible for Malnutrition in Hemodialysis Patients: Challenges to Optimal Nutrition

PubMed Central

Ekramzadeh, Maryam; Mazloom, Zohreh; Jafari, Peyman; Ayatollahi, Maryam; Sagheb, Mohammad Mahdi

2014-01-01

Background: Nutritional barriers may contribute to malnutrition in hemodialysis (HD) patients. Higher rates of morbidity and mortality rates have been reported in malnourished HD patients. These patients are faced with different challenges affecting their nutritional status. Objectives: The aim of this cross-sectional study was to identify most important barriers responsible for malnutrition in HD patients. Patients and Methods: We randomly selected 255 of 800 stable HD patients from three HD centers with an age range of 18-85 years, who had been on hemodialysis for at least three months without any acute illness. Each patient was interviewed to evaluate malnutrition [subjective global assessment (SGA), malnutrition inflammation score (MIS)], and potential medical, behavioral and socioeconomic barriers. Body composition of patients was checked through bioelectrical impedance analysis (BIA). Routine clinical markers of malnutrition such as serum albumin and total protein were measured using standard automated techniques. Binary logistic regression model was used to find the association between nutritional markers and potential barriers. Results: Patients with higher SGA had lower knowledge about general nutrition [odds ratio (OR), 1.3], potassium (OR, 1.89), difficulty chewing (OR, 1.16), and shopping (OR, 1.16). Those with greater MIS scores had poor appetite (OR, 1.3), depression (OR, 1.21), and difficulty with cooking (OR, 1.15). Lower BCM (body cell mass) was associated with poor appetite (OR, 0.92) and needed help for cooking (OR, 0.88). Patients with higher BFMI (body fat mass index) had insufficient general nutrition (OR, 1.15), and protein (OR, 1.27) knowledge, and needed help for shopping (OR, 1.14). Moreover, patients with higher SGA scores were those with older age and longer duration of HD. Conclusions: Three medical barriers (poor appetite, depression and difficulty chewing), one behavioral barrier (poor total nutrition, protein, and potassium knowledge

Malnutrition Tests

MedlinePlus

... Time and International Normalized Ratio (PT/INR) PSEN1 Quantitative Immunoglobulins Red Blood Cell (RBC) Antibody Identification Red ... by a number of conditions other than malnutrition. Research is continuing in order to better understand the ...

Malnutrition: A Deterrent to Human Progress

ERIC Educational Resources Information Center

Johnson, Nancy E.; Found, R. Elaine

1971-01-01

Authors discuss the effects of malnutrition on retardation of mental development and intellectual capacity. Research findings on undernourished experimental animals are cited as well as studies involving children suffering the effects of malnutrition in infancy. (Editor/LF)

Dialysis Malnutrition and Malnutrition Inflammation Scores: screening tools for prediction of dialysis-related protein-energy wasting in Malaysia.

PubMed

Harvinder, Gilcharan Singh; Swee, Winnie Chee Siew; Karupaiah, Tilakavati; Sahathevan, Sharmela; Chinna, Karuthan; Ahmad, Ghazali; Bavanandan, Sunita; Goh, Bak Leong

2016-01-01

Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predicting protein-energy wasting (PEW) among Malaysian dialysis patients. A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW. MIS cut-off score of >=5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r2=0.552, p<0.001) and PD (r2=0.466, p<0.001) patients. DMS and MIS had higher sensitivity values in PD (81% and 82%, respectively) compared to HD (59% and 60%, respectively) patients. The MIS cut-off scores for malnutrition classification were established (score >=5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutrition screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more practical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers.

[Cancer and Malnutrition].

PubMed

Tsuzuki, Norimasa; Higashiguchi, Takashi; Ito, Akihiro; Ohara, Hiroshi; Futamura, Akihiko

2015-07-01

A Japanese proverb says that a balanced diet leads to a healthy body. However, the relation between healthy life and nutrition has not been established precisely and quantitatively. Cancer cachexia, which is malnutrition in cancer patients, has been studied extensively. Appropriate nutrition support can prevent the progression of malnutrition in cancer patients and advance the tolerance for anticancer therapy. In refractory cachexia (terminally cancer patients), we will judge the necessity of reduction of nutrition support, what it is called "gear-change", because the support is burden for the body. It is important to restrict the quantity of nutrition and to give medical treatment to retain bodily function in these patients.

Frailty Is a Major Related Factor for at Risk of Malnutrition in Community-Dwelling Older Adults.

PubMed

Chang, Shu-Fang

2017-01-01

We investigated the relationships among geriatric syndrome, physiological functions, and body composition in community-dwelling older people with varying nutritional statuses. Other factors correlated with nutritional status in community-dwelling older people were also explored. The World Health Organization has initiated preventive programs for addressing malnutrition. However, few studies have focused on the correlations among geriatric syndrome, physiological functions, and body composition in older people at risk of malnutrition. We conducted a cross-sectional study. Older people who lived in an urban Taiwanese community were recruited for this research study. The inclusion criteria were age 65 years or older, ability to communicate in Taiwanese, clear consciousness, and ability to communicate independently. The nutritional status of participants was evaluated with the Mini Nutritional Assessment-Short Form. The frailty status was assessed with the Study of Osteoporotic Fractures (SOF) index. The SOF index included the following three items: body weight loss of >5% within 1 year, difficulty in standing from a sitting position in a chair without an armrest five times, and feeling deprived of energy. Participants over 65 years of age, living in a community and without mental illness or acute disease were included in the study. Compared with well-nourished older adults, those at risk of malnutrition were predominantly male; presented with lower body weight, lower body mass index values, lower skeletal mass indices, and poorer muscle strength; and were unable to rise from a seated position in a chair without using the armrest five times. Subjects at risk of malnutrition were less energetic, were more commonly characterized as being sarcopenia, and demonstrated frailty. Body composition analysis demonstrated that a skeletal muscle index of approximately 9.93 and a body fat mass of less than 12.25 kg were related to an increased risk of malnutrition. Older people

Bacterial infections in HIV-infected children admitted with severe acute malnutrition in Durban, South Africa.

PubMed

Archary, Moherndran; Adler, Hugh; La Russa, Philip; Mahabeer, Prasha; Bobat, Raziya A

2017-02-01

Bacterial infections in HIV-infected children admitted with severe acute malnutrition (SAM) contribute to higher mortality and poorer outcomes. This study describes the spectrum of bacterial infections in antiretroviral treatment (ART)-naïve, HIV-infected children admitted with SAM. Between July 2012 and February 2015, 82 children were prospectively enrolled in the King Edward VIII Hospital, Durban. Specimens obtained on and during admission for microbiological evaluation, if clinically indicated, included blood, urine (obtained by catheterisation or suprapubic aspiration), induced sputum and cerebrospinal fluid. All positive bacterial cultures between admission and 30 days after enrollment were documented and characterised into samples taken either within 2 days of admission (infections on admission) or within 2-30 days of admission (hospital-acquired infections, HAIs). On admission, 67% of patients had abnormal white blood cell counts (WBCC) (>12 or <4 × 10 9 /L) and 70% had elevated CRP; 65% were classified as severely immunosuppressed according to the WHO immunological classification. 1 A pathogen was isolated on the admission blood culture in four patients (6%) and in 27% of urine specimens. HAIs were predominately Gram-negative (39/43), and 39.5% were extended-spectrum β-lactamase-positive. Mortality was not significantly associated with isolation of a bacterial pathogen. Routine pre-hospital administration of antibiotics as per the Integrated Management of Childhood Illness (IMCI) guidelines may be responsible for the low rates of positive admission blood cultures. HAIs with drug-resistant Gram-negative organisms are an area of concern and strategies to improve the prevention of HAIs in this vulnerable population are urgently needed.

Calibration, navigation, and registration of MAMS data for FIFE

NASA Technical Reports Server (NTRS)

Jedlovec, G. J.; Atkinson, R. J.

1993-01-01

The International Satellite Land Surface Climatology Project (ISLSCP) was conducted to study the interaction of the atmosphere with the land surface and the research problems associated with the interpretation of satellite data over the Earth's land surface. The experimental objectives of the First ISLSCP Field Experiment (FIFE) were the simultaneous acquisition of satellite, atmospheric, and surface data and to use these data to understand the processes controlling energy/mass exchange at the surface. The experiment site is a 15 x 15 km area southeast of Manhattan, Kansas, intersected by Interstate 70 and Kansas highway 177. The Konza Prairie portion is 5 x 5 km and is a controlled experiment site consisting primarily of native tall grass prairie vegetation. The remainder of the site is grazing and farm land with trees along creek beds that are scattered over the area. Airborne multispectral imagery from the Multispectral Atmospheric Mapping Sensor (MAMS) was collected over this region on two days during Intensive Field Campaign-1 (1FC-1) to study the time and space variability of remotely-sensed geophysical parameters. These datasets consist of multiple overflights covering about a 60-min period during late morning on June 4, 1987 and shortly after dark on the following day. Image data from each overpass were calibrated and Earth located with respect to each other using aircraft inertial navigation system parameters and ground control points. These were the first MAMS flights made with 10-bit thermal data.

Malnutrition, Learning and Intellectual Development: Research and Remediation.

ERIC Educational Resources Information Center

Ricciuti, Henry N.

After a discussion of the problem of malnutrition and its effect on intellectual development, this paper concentrates on the study of protein-calorie malnutrition in infants and children as it occurs in postnatal and subsequent development. An overview and summary of the principal investigations on the relationship of malnutrition to intellectual…

The expression of heterologous MAM-7 in Lactobacillus rhamnosus reduces its intrinsic capacity to inhibit colonization of pathogen Vibrio parahaemolyticus in vitro.

PubMed

Beltran, Sebastian; Munoz-Bergmann, Cristian A; Elola-Lopez, Ana; Quintana, Javiera; Segovia, Cristopher; Trombert, Annette N

2016-01-07

Vibrio parahaemolyticus (V. parahaemolyticus) is a Gram-negative, halophilic bacterium recognized as one of the most important foodborne pathogen. When ingested, V. parahaemolyticus causes a self-limiting illness (Vibriosis), characterized mainly by watery diarrhoea. Treatment is usually oral rehydration and/or antibiotics in complicated cases. Since 1996, the pathogenic and pandemic V. parahaemolyticus O3:K6 serotype has spread worldwide, increasing the reported number of vibriosis cases. Thus, the design of new strategies for pathogen control and illness prevention is necessary. Lactobacillus sp. grouped Gram positive innocuous bacteria, part of normal intestinal microbiota and usually used as oral vaccines for several diarrheic diseases. Recombinants strains of Lactobacillus (RL) expressing pathogen antigens can be used as part of an anti-adhesion strategy where RL block the pathogen union sites in host cells. Thus, we aimed to express MAM-7 V. parahaemolyticus adhesion protein in Lactobacillus sp. to generate an RL that prevents pathogen colonization. We cloned the MAM-7 gene from V. parahaemolyticus RIMD 2210633 in Lactobacillus expression vectors. Recombinant strains (Lactobacillus rhamnosus pSEC-MAM7 and L. rhamnosus pCWA-MAM7) adhered to CaCo-2 cells and competed with the pathogen. However, the L. rhamnosus wild type strain showed the best capacity to inhibit pathogen colonization in vitro. In addition, LDH-assay showed that recombinant strains were cytotoxic compared with the wild type isogenic strain. MAM-7 expression in lactobacilli reduces the intrinsic inhibitory capacity of L. rhamnosus against V. parahaemolyticus.

Trends in malnutrition and mortality in Darfur, Sudan, between 2004 and 2008: a meta-analysis of publicly available surveys.

PubMed

Nielsen, Jens; Prudhon, Claudine; de Radigues, Xavier

2011-08-01

The humanitarian response to the crisis in Darfur is the largest humanitarian operation in the world. To investigate the evolution of the conditions of the affected population, we analysed trends in malnutrition and mortality, the most widely accepted indicators for assessing the degree of severity of a crisis. We did a meta-analysis of 164 publicly available surveys taking into account changes in the contextual situation and humanitarian aid; type of population [residents and internally displaced persons (IDPs)]; and seasonal variations. Data on global acute malnutrition (GAM), severe acute malnutrition (SAM), crude death rate (CDR) and under-five death rate (U5DR) were analysed using a random effect model. GAM and SAM decreased by 16% and 28%, respectively, in 2004-05, whereas CDR dropped by 44-75% per year depending on state and type of population and U5DR decreased by an overall 50% yearly. Both security and the humanitarian contexts became increasingly complex after 2005, but levels of malnutrition stabilized in North and South Darfur. In West Darfur, GAM remained stable but SAM tended to increase for IDPs, although mortality rates remained constant. Mortality increased slightly for residents in South Darfur after 2005, even though nutritional status was stable. GAM, SAM, CDR and U5DR fluctuated markedly with seasons. A meta-analysis of myriads of surveys permitted us to draw an overall picture of the situation in Darfur and to identify some of its influencing factors. The large humanitarian operation, which gained momentum through 2004-05, was able to contain the crisis despite huge difficulties, but did not compensate for seasonal variations. The situation has remained fragile with some negative patterns tending to emerge. It is crucial that the humanitarian situation continues to be closely monitored.

Alterations in dopamine system function across the estrous cycle of the MAM rodent model of schizophrenia.

PubMed

Perez, Stephanie M; Chen, Li; Lodge, Daniel J

2014-09-01

Clinical studies have reported differences in the incidence and severity of schizophrenia symptoms between male and female schizophrenia patients. Unfortunately, the cause of these differences is not currently known due, in part, to the fact that preclinical studies largely focus on male subjects. Dopamine neuron activity has been previously demonstrated to change across the estrous cycle, and may therefore be of relevance, as aberrant dopamine signaling is thought to underlie the positive symptoms of schizophrenia. Here we examine dopamine neuron activity across the estrous cycle in the MAM rodent model of schizophrenia. We demonstrate that the elevation in dopamine neuron activity, consistently observed in male MAM-treated rats, is most prominent during estrus and attenuated in met-estrus. Furthermore, this appears to be mediated, in part, by progesterone in the ventral hippocampus, as increases in dopamine neuron population activity (observed in estrus) were normalized by the intra-hippocampal administration of the progesterone receptor antagonist, mifepristone (but not the estrogen receptor antagonists, fulvestrant). Taken together, these data suggest that changes in dopamine system function occur across the estrous cycle in MAM-treated rats and may contribute to the differences in symptomatology between male and female schizophrenia patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents.

PubMed

Donini, Lorenzo M; Poggiogalle, Eleonora; Molfino, Alessio; Rosano, Aldo; Lenzi, Andrea; Rossi Fanelli, Filippo; Muscaritoli, Maurizio

2016-10-01

Malnutrition plays a major role in clinical and functional impairment in older adults. The use of validated, user-friendly and rapid screening tools for malnutrition in the elderly may improve the diagnosis and, possibly, the prognosis. The aim of this study was to assess the agreement between Mini-Nutritional Assessment (MNA), considered as a reference tool, MNA short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and Nutrition Risk Screening (NRS-2002) in elderly institutionalized participants. Participants were enrolled among nursing home residents and underwent a multidimensional evaluation. Predictive value and survival analysis were performed to compare the nutritional classifications obtained from the different tools. A total of 246 participants (164 women, age: 82.3 ± 9 years, and 82 men, age: 76.5 ± 11 years) were enrolled. Based on MNA, 22.6% of females and 17% of males were classified as malnourished; 56.7% of women and 61% of men were at risk of malnutrition. Agreement between MNA and MUST or NRS-2002 was classified as "fair" (k = 0.270 and 0.291, respectively; P < .001), whereas the agreement between MNA and MNA-SF was classified as "moderate" (k = 0.588; P < .001). Because of the high percentage of false negative participants, MUST and NRS-2002 presented a low overall predictive value compared with MNA and MNA-SF. Clinical parameters were significantly different in false negative participants with MUST or NRS-2002 from true negative and true positive individuals using the reference tool. For all screening tools, there was a significant association between malnutrition and mortality. MNA showed the best predictive value for survival among well-nourished participants. Functional, psychological, and cognitive parameters, not considered in MUST and NRS-2002 tools, are probably more important risk factors for malnutrition than acute illness in geriatric long-term care inpatient settings and may account for the low predictive

Impact of Childhood Malnutrition on Host Defense and Infection.

PubMed

Ibrahim, Marwa K; Zambruni, Mara; Melby, Christopher L; Melby, Peter C

2017-10-01

The global impact of childhood malnutrition is staggering. The synergism between malnutrition and infection contributes substantially to childhood morbidity and mortality. Anthropometric indicators of malnutrition are associated with the increased risk and severity of infections caused by many pathogens, including viruses, bacteria, protozoa, and helminths. Since childhood malnutrition commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies, the causal factors involved in impaired host defense are usually not defined. This review focuses on literature related to impaired host defense and the risk of infection in primary childhood malnutrition. Particular attention is given to longitudinal and prospective cohort human studies and studies of experimental animal models that address causal, mechanistic relationships between malnutrition and host defense. Protein and micronutrient deficiencies impact the hematopoietic and lymphoid organs and compromise both innate and adaptive immune functions. Malnutrition-related changes in intestinal microbiota contribute to growth faltering and dysregulated inflammation and immune function. Although substantial progress has been made in understanding the malnutrition-infection synergism, critical gaps in our understanding remain. We highlight the need for mechanistic studies that can lead to targeted interventions to improve host defense and reduce the morbidity and mortality of infectious diseases in this vulnerable population. Copyright © 2017 American Society for Microbiology.

Computer-based malnutrition risk calculation may enhance the ability to identify pediatric patients at malnutrition-related risk for unfavorable outcome.

PubMed

Karagiozoglou-Lampoudi, Thomais; Daskalou, Efstratia; Lampoudis, Dimitrios; Apostolou, Aggeliki; Agakidis, Charalampos

2015-05-01

The study aimed to test the hypothesis that computer-based calculation of malnutrition risk may enhance the ability to identify pediatric patients at malnutrition-related risk for an unfavorable outcome. The Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART), incorporating the World Health Organization (WHO) growth reference data and malnutrition-related parameters, was used. This was a prospective cohort study of 500 pediatric patients aged 1 month to 17 years. Upon admission, the PeDiSMART score was calculated and anthropometry was performed. Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool Risk on Nutritional Status and Growth (STRONGkids), and Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) malnutrition screening tools were also applied. PeDiSMART's association with the clinical outcome measures (weight loss/nutrition support and hospitalization duration) was assessed and compared with the other screening tools. The PeDiSMART score was inversely correlated with anthropometry and bioelectrical impedance phase angle (BIA PhA). The score's grading scale was based on BIA Pha quartiles. Weight loss/nutrition support during hospitalization was significantly independently associated with the malnutrition risk group allocation on admission, after controlling for anthropometric parameters and age. Receiver operating characteristic curve analysis showed a sensitivity of 87% and a specificity of 75% and a significant area under the curve, which differed significantly from that of STRONGkids and STAMP. In the subgroups of patients with PeDiSMART-based risk allocation different from that based on the other tools, PeDiSMART allocation was more closely related to outcome measures. PeDiSMART, applicable to the full age range of patients hospitalized in pediatric departments, graded according to BIA PhA, and embeddable in medical electronic records, enhances efficacy and reproducibility in identifying pediatric patients at

Language skills and intelligence quotient of protein energy malnutrition survivors.

PubMed

Nassar, May F; Shaaban, Sanaa Y; Nassar, Jilan F; Younis, Neveen T; Abdel-Mobdy, Ahmad E

2012-06-01

The study was conducted on 33 children aged 3-6 years who suffered from protein energy malnutrition (PEM) during infancy in comparison to 30 matching children to assess the long-term deficits in cognition and language skills. The patients' files were revised to record their admission and follow-up data and history, clinical examination, intelligence quotient and language assessment were done. The study revealed that 2-5 years from the acute attack the PEM patients were still shorter than the controls and their cognitive abilities were poorer. Their mental ages and language skills were mostly determined by their height and the duration of follow-up during their acute illness. Additionally their diet after the 3-5 years is still defective and does not meet their recommended daily allowance. These observations urge us to continue following these patients for longer durations to make sure no permanent damage occurs due to the PEM insult to the growing brain.

Genetic and biochemical investigations of the role of MamP in redox control of iron biomineralization in Magnetospirillum magneticum.

PubMed

Jones, Stephanie R; Wilson, Tiffany D; Brown, Margaret E; Rahn-Lee, Lilah; Yu, Yi; Fredriksen, Laura L; Ozyamak, Ertan; Komeili, Arash; Chang, Michelle C Y

2015-03-31

Magnetotactic bacteria have evolved complex subcellular machinery to construct linear chains of magnetite nanocrystals that allow the host cell to sense direction. Each mixed-valent iron nanoparticle is mineralized from soluble iron within a membrane-encapsulated vesicle termed the magnetosome, which serves as a specialized compartment that regulates the iron, redox, and pH environment of the growing mineral. To dissect the biological components that control this process, we have carried out a genetic and biochemical study of proteins proposed to function in iron mineralization. In this study, we show that the redox sites of c-type cytochromes of the Magnetospirillum magneticum AMB-1 magnetosome island, MamP and MamT, are essential to their physiological function and that ablation of one or both heme motifs leads to loss of function, suggesting that their ability to carry out redox chemistry in vivo is important. We also develop a method to heterologously express fully heme-loaded MamP from AMB-1 for in vitro biochemical studies, which show that its Fe(III)-Fe(II) redox couple is set at an unusual potential (-89 ± 11 mV) compared with other related cytochromes involved in iron reduction or oxidation. Despite its low reduction potential, it remains competent to oxidize Fe(II) to Fe(III) and mineralize iron to produce mixed-valent iron oxides. Finally, in vitro mineralization experiments suggest that Mms mineral-templating peptides from AMB-1 can modulate the iron redox chemistry of MamP.

A field test of three LQAS designs to assess the prevalence of acute malnutrition.

PubMed

Deitchler, Megan; Valadez, Joseph J; Egge, Kari; Fernandez, Soledad; Hennigan, Mary

2007-08-01

The conventional method for assessing the prevalence of Global Acute Malnutrition (GAM) in emergency settings is the 30 x 30 cluster-survey. This study describes alternative approaches: three Lot Quality Assurance Sampling (LQAS) designs to assess GAM. The LQAS designs were field-tested and their results compared with those from a 30 x 30 cluster-survey. Computer simulations confirmed that small clusters instead of a simple random sample could be used for LQAS assessments of GAM. Three LQAS designs were developed (33 x 6, 67 x 3, Sequential design) to assess GAM thresholds of 10, 15 and 20%. The designs were field-tested simultaneously with a 30 x 30 cluster-survey in Siraro, Ethiopia during June 2003. Using a nested study design, anthropometric, morbidity and vaccination data were collected on all children 6-59 months in sampled households. Hypothesis tests about GAM thresholds were conducted for each LQAS design. Point estimates were obtained for the 30 x 30 cluster-survey and the 33 x 6 and 67 x 3 LQAS designs. Hypothesis tests showed GAM as <10% for the 33 x 6 design and GAM as > or =10% for the 67 x 3 and Sequential designs. Point estimates for the 33 x 6 and 67 x 3 designs were similar to those of the 30 x 30 cluster-survey for GAM (6.7%, CI = 3.2-10.2%; 8.2%, CI = 4.3-12.1%, 7.4%, CI = 4.8-9.9%) and all other indicators. The CIs for the LQAS designs were only slightly wider than the CIs for the 30 x 30 cluster-survey; yet the LQAS designs required substantially less time to administer. The LQAS designs provide statistically appropriate alternatives to the more time-consuming 30 x 30 cluster-survey. However, additional field-testing is needed using independent samples rather than a nested study design.

Challenges of Estimating the Annual Caseload of Severe Acute Malnutrition: The Case of Niger

PubMed Central

Hallarou, Mahaman; Gérard, Jean-Christophe; Donnen, Philippe; Macq, Jean

2016-01-01

Introduction Reliable prospective estimates of annual severe acute malnutrition (SAM) caseloads for treatment are needed for policy decisions and planning of quality services in the context of competing public health priorities and limited resources. This paper compares the reliability of SAM caseloads of children 6–59 months of age in Niger estimated from prevalence at the start of the year and counted from incidence at the end of the year. Methods Secondary data from two health districts for 2012 and the country overall for 2013 were used to calculate annual caseload of SAM. Prevalence and coverage were extracted from survey reports, and incidence from weekly surveillance systems. Results The prospective caseload estimate derived from prevalence and duration of illness underestimated the true burden. Similar incidence was derived from two weekly surveillance systems, but differed from that obtained from the monthly system. Incidence conversion factors were two to five times higher than recommended. Discussion Obtaining reliable prospective caseloads was challenging because prevalence is unsuitable for estimating incidence of SAM. Different SAM indicators identified different SAM populations, and duration of illness, expected contact coverage and population figures were inaccurate. The quality of primary data measurement, recording and reporting affected incidence numbers from surveillance. Coverage estimated in population surveys was rarely available, and coverage obtained by comparing admissions with prospective caseload estimates was unrealistic or impractical. Conclusions Caseload estimates derived from prevalence are unreliable and should be used with caution. Policy and service decisions that depend on these numbers may weaken performance of service delivery. Niger may improve SAM surveillance by simplifying and improving primary data collection and methods using innovative information technologies for single data entry at the first contact with the health

Addressing Disease-Related Malnutrition in Healthcare

PubMed Central

Correia, Maria Isabel; Hegazi, Refaat A.; Diaz-Pizarro Graf, José Ignacio; Gomez-Morales, Gabriel; Fuentes Gutiérrez, Catalina; Goldin, Maria Fernanda; Navas, Angela; Pinzón Espitia, Olga Lucia; Tavares, Gilmária Millere

2015-01-01

Alarmingly high rates of disease-related malnutrition have persisted in hospitals of both emerging and industrialized nations over the past 2 decades, despite marked advances in medical care over this same interval. In Latin American hospitals, the numbers are particularly striking; disease-related malnutrition has been reported in nearly 50% of adult patients in Argentina, Brazil, Chile, Costa Rica, Cuba, Dominican Republic, Ecuador, Mexico, Panama, Paraguay, Peru, Puerto Rico, Venezuela, and Uruguay. The tolls of disease-related malnutrition are high in both human and financial terms—increased infectious complications, higher incidence of pressure ulcers, longer hospital stays, more frequent readmissions, greater costs of care, and increased risk of death. In an effort to draw attention to malnutrition in Latin American healthcare, a feedM.E. Latin American Study Group was formed to extend the reach and support the educational efforts of the feedM.E. Global Study Group. In this article, the feedM.E. Latin American Study Group shows that malnutrition incurs excessive costs to the healthcare systems, and the study group also presents evidence of how appropriate nutrition care can improve patients’ clinical outcomes and lower healthcare costs. To achieve the benefits of nutrition for health throughout Latin America, the article presents feedM.E.’s simple and effective Nutrition Care Pathway in English and Spanish as a way to facilitate its use. PMID:25883116

Prevalence of malnutrition and its etiological factors in hospitals.

PubMed

Burgos, R; Sarto, B; Elío, I; Planas, M; Forga, M; Cantón, A; Trallero, R; Muñoz, M J; Pérez, D; Bonada, A; Saló, E; Lecha, M; Enrich, G; Salas-Salvadó, J

2012-01-01

Malnutrition among inpatients is highly prevalent, and has a negative impact on their clinical outcome. The Working Group for the Study of Malnutrition in Hospitals in Catalonia was created to generate consensus guidelines for the prevention and/or treatment of malnutrition in hospitals in Catalonia, Spain. The objectives of the study were to determine the prevalence of malnutrition on admission to hospital in Catalonia and to assess relationships between malnutrition, social and demographic data, overall costs, and mortality. Prospective and multicenter study conducted with 796 patients from 11 hospitals representative of the hospitalized population in Catalonia. Nutritional status was evaluated using the Nutritional Risk Screening 2002 method. Overall, 28.9% of the patients are malnourished or at nutritional risk. Elderly patients, non-manual workers, those admitted to hospital as emergencies and with higher co-morbidities had higher risk of malnutrition. The type of hospital (second level vs. tertiary or University referral) to which they were admitted was also a factor predisposing to malnutrition. Length of hospital stay was longer in malnourished patients (10.5 vs. 7.7 days, p < 0.0001). The need for a convalescent home on leaving hospital was higher as well as the risk of mortality (8.6% malnourished vs. 1.3% nonmalnourished, p < 0.0001). The prevalence of malnutrition is high in patients on admission to hospital in our community, resulting in elevated overall costs and higher risk of mortality. Age, social class and characteristics of the Unit and the Hospital are the main factors involved in hospital malnutrition.

Obesity as a form of malnutrition: over-nutrition on the Uganda "malnutrition" agenda.

PubMed

Ngaruiya, Christine; Hayward, Alison; Post, Lori; Mowafi, Hani

2017-01-01

The objectives were to highlight the burden of overweight and obesity as an additional area of importance for the malnutrition agenda in Uganda and to provide evidence-based considerations for stakeholders involved. Mirroring other Low- and Middle-Income Countries (LMICs), Uganda is experiencing a "double burden" of over-nutrition related issues - both obesity and overweight, and related non-communicable diseases (NCDs) alongside the under-nutrition that has long plagued the country. Despite the commonplace assumption that under-nutrition is the predominant form of malnutrition in Uganda, we explore recent literature that in fact, challenges this notion. While food insecurity has contributed to the under-nutrition problem, a lack of dietary diversity also has a demonstrated role in increasing over-nutrition. We cannot afford to ignore over-nutrition concomitant with stunting and wasting in the country. Increase in the burden of this less acknowledged form of malnutrition in Uganda is critical to investigate, and yet poorly understood. A move towards increased regionally targeted over-nutrition research, funding, government prioritization and advocacy is needed.

The effect of malnutrition on norovirus infection.

PubMed

Hickman, Danielle; Jones, Melissa K; Zhu, Shu; Kirkpatrick, Ericka; Ostrov, David A; Wang, Xiaoyu; Ukhanova, Maria; Sun, Yijun; Mai, Volker; Salemi, Marco; Karst, Stephanie M

2014-03-04

Human noroviruses are the primary cause of severe childhood diarrhea in the United States, and they are of particular clinical importance in pediatric populations in the developing world. A major contributing factor to the general increased severity of infectious diseases in these regions is malnutrition-nutritional status shapes host immune responses and the composition of the host intestinal microbiota, both of which can influence the outcome of pathogenic infections. In terms of enteric norovirus infections, mucosal immunity and intestinal microbes are likely to contribute to the infection outcome in substantial ways. We probed these interactions using a murine model of malnutrition and murine norovirus infection. Our results reveal that malnutrition is associated with more severe norovirus infections as defined by weight loss, impaired control of norovirus infections, reduced antiviral antibody responses, loss of protective immunity, and enhanced viral evolution. Moreover, the microbiota is dramatically altered by malnutrition. Interestingly, murine norovirus infection also causes changes in the host microbial composition within the intestine but only in healthy mice. In fact, the infection-associated microbiota resembles the malnutrition-associated microbiota. Collectively, these findings represent an extensive characterization of a new malnutrition model of norovirus infection that will ultimately facilitate elucidation of the nutritionally regulated host parameters that predispose to more severe infections and impaired memory immune responses. In a broad sense, this model may provide insight into the reduced efficacy of oral vaccines in malnourished hosts and the potential for malnourished individuals to act as reservoirs of emergent virus strains. IMPORTANCE Malnourished children in developing countries are susceptible to more severe infections than their healthy counterparts, in particular enteric infections that cause diarrhea. In order to probe the

Malnutrition coding 101: financial impact and more.

PubMed

Giannopoulos, Georgia A; Merriman, Louise R; Rumsey, Alissa; Zwiebel, Douglas S

2013-12-01

Recent articles have addressed the characteristics associated with adult malnutrition as published by the Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). This article describes a successful interdisciplinary program developed by the Department of Food and Nutrition at New York-Presbyterian Hospital to maintain and monitor clinical documentation, ensure accurate International Classification of Diseases 9th Edition (ICD-9) coding, and identify subsequent incremental revenue resulting from the early identification, documentation, and treatment of malnutrition in an adult inpatient population. The first step in the process requires registered dietitians to identify patients with malnutrition; then clear and specifically worded diagnostic statements that include the type and severity of malnutrition are documented in the medical record by the physician, nurse practitioner, or physician's assistant. This protocol allows the Heath Information Management/Coding department to accurately assign ICD-9 codes associated with protein-energy malnutrition. Once clinical coding is complete, a final diagnosis related group (DRG) is generated to ensure appropriate hospital reimbursement. Successful interdisciplinary programs such as this can drive optimal care and ensure appropriate reimbursement.

Starved Guts: Morphologic and Functional Intestinal Changes in Malnutrition.

PubMed

Attia, Suzanna; Feenstra, Marjon; Swain, Nathan; Cuesta, Melina; Bandsma, Robert H J

2017-11-01

Malnutrition contributes significantly to death and illness worldwide and especially to the deaths of children younger than 5 years. The relation between intestinal changes in malnutrition and morbidity and mortality has not been well characterized; however, recent research indicates that the functional and morphologic changes of the intestine secondary to malnutrition itself contribute significantly to these negative clinical outcomes and may be potent targets of intervention. The aim of this review was to summarize current knowledge of experimental and clinically observed changes in the intestine from malnutrition preclinical models and human studies. Limited clinical studies have shown villous blunting, intestinal inflammation, and changes in the intestinal microbiome of malnourished children. In addition to these findings, experimental data using various animal models of malnutrition have found evidence of increased intestinal permeability, upregulated intestinal inflammation, and loss of goblet cells. More mechanistic studies are urgently needed to improve our understanding of malnutrition-related intestinal dysfunction and to identify potential novel targets for intervention.

The influence of severe malnutrition on rehabilitation in patients with severe head injury.

PubMed

Dénes, Zoltán

2004-10-07

The purpose of the study was to evaluate the consequences of severe malnutrition in patients with severe head injury during rehabilitation. The data were collected from medical records of patients admitted to the neurorehabilitation unit over the last 5 years. Twenty of 1850 patients had severe malnutrition, the body mass index (BMI) of these patients were under 15 (10-14) kg/m2. The majority of patients suffered traumatic brain damage (17/20). Thirteen patients arrived with percutaneous endoscopic gastrotomy /PEG, three nasogastric tube in 3 cases we placed PEG. The nutritional strategy included a high-calorie diet, by means of bolus feeding five times during the day, continuous feeding during the night; the daily intake target being more than 2500 kcal. During rehabilitation treatment the majority of patients (13/20) revealed weight gain with a rate of 0.5-2 kg/week. The following complications were treated during the rehabilitation phase: 20 pressure sores, 20 contractures, 11 urinal infections, 6 cases of pneumonia, 2 of purulent bronchitis, 6 of sepsis, 1 penoscrotal abscess, epidydymitis, and 1 case of purulent arthritis. The patients required total assistance at the time of admission. At discharge 10 patients remained completely dependent, 6 patients needed minimal assistance, and 4 patients could perform daily activities independently. The average length of stay in our unit was 78/6-150/days. Patients with head injury suffering from severe malnutrition exhibit serious complications at the time of admission as well as during rehabilitation treatment. The patients were very difficult to mobilize. The length of stay at the rehabilitation unit was 28 days longer when complicated by malnutrition, than head injuries showing normal nutritional status. These findings underline the importance of adequate nutrition in patients with head injury in both the acute ward and in the rehabilitation unit.

Coulomb excitation of the 242mAm isomer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hayes, A; Cline, D; Moody, K

2006-10-24

The {sup 242m}Am isomer, a well-known candidate for photo-depopulation research, has been studied in this first ever Coulomb excitation of a nearly pure ({approx} 98%) isomer target. Thirty new states, including a new rotational band built on a K{sup {pi}} = 6{sup -} state have been identified. Strong K-mixing results in nearly equal populations of the K{sup {pi}} = 5{sup -} and 6{sup -} states. Newly identified states have been assigned to the K{sup {pi}} = 3{sup -} rotational band, the lowest states of which are known to decay into the ground-state band. Implications regarding K-mixing and Coulomb excitation pathsmore » to the ground state are discussed.« less

Effects of randomized supplementation of methionine or alanine on cysteine and glutathione production during the early phase of treatment of children with edematous malnutrition

USDA-ARS?s Scientific Manuscript database

We have shown that a low glutathione concentration and synthesis rate in erythrocytes are associated with a shortage of protein-derived cysteine in children with edematous severe acute malnutrition (SAM). We tested the hypothesis that methionine supplementation may increase protein-derived cysteine ...

Description and evaluation of a new four-mode version of the Modal Aerosol Module (MAM4) within version 5.3 of the Community Atmosphere Model

NASA Astrophysics Data System (ADS)

Liu, X.; Ma, P.-L.; Wang, H.; Tilmes, S.; Singh, B.; Easter, R. C.; Ghan, S. J.; Rasch, P. J.

2016-02-01

Atmospheric carbonaceous aerosols play an important role in the climate system by influencing the Earth's radiation budgets and modifying the cloud properties. Despite the importance, their representations in large-scale atmospheric models are still crude, which can influence model simulated burden, lifetime, physical, chemical and optical properties, and the climate forcing of carbonaceous aerosols. In this study, we improve the current three-mode version of the Modal Aerosol Module (MAM3) in the Community Atmosphere Model version 5 (CAM5) by introducing an additional primary carbon mode to explicitly account for the microphysical ageing of primary carbonaceous aerosols in the atmosphere. Compared to MAM3, the four-mode version of MAM (MAM4) significantly increases the column burdens of primary particulate organic matter (POM) and black carbon (BC) by up to 40 % in many remote regions, where in-cloud scavenging plays an important role in determining the aerosol concentrations. Differences in the column burdens for other types of aerosol (e.g., sulfate, secondary organic aerosols, mineral dust, sea salt) are less than 1 %. Evaluating the MAM4 simulation against in situ surface and aircraft observations, we find that MAM4 significantly improves the simulation of seasonal variation of near-surface BC concentrations in the polar regions, by increasing the BC concentrations in all seasons and particularly in cold seasons. However, it exacerbates the overestimation of modeled BC concentrations in the upper troposphere in the Pacific regions. The comparisons suggest that, to address the remaining model POM and BC biases, future improvements are required related to (1) in-cloud scavenging and vertical transport in convective clouds and (2) emissions of anthropogenic and biomass burning aerosols.

Most children who took part in a comprehensive malnutrition programme in Madagascar reached and maintained the recovery threshold.

PubMed

Magnin, Margot; Stoll, Beat; Voahangy, Rajaobelina; Jeannot, Emilien

2017-06-01

The benefits of including nutritional education in programmes that tackle moderate and severe acute malnutrition remain poorly documented. This study in Madagascar evaluated the nutritional status of children who took part in an innovative programme that included maternal education, on completion and after a year. Each year, this outpatient programme admits 2400 malnourished children from six months to 59 months in the lower districts of Antananarivo, Madagascar. Children were drawn by lots, and their anthropometric data were measured. A descriptive retrospective longitudinal study was conducted on 573 children who took part between 2010 and 2013. The programme lasted an average of 38 days and, on completion, 82.2% had reached the recovery threshold, and 16.2% had moved up to mild malnutrition. This was achieved with food supplements of 720 kcal per day, despite the Malagasy Public Health recommendation of 1000-1500 kcal per day. After one year, 79.1% were still above the recovery threshold, and 15% had mild malnutrition. The recovery rate was higher for children under 24 months of age (odds ratio 2.9, 95% confidence interval 1.93-4.59). Most children who attended this malnutrition programme with maternal education in Madagascar reached the recovery threshold on completion and had maintained it after one year. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

What increases the risk of malnutrition in Parkinson's disease?

PubMed

Tomic, Svetlana; Pekic, Vlasta; Popijac, Zeljka; Pucic, Tomislav; Petek, Marta; Kuric, Tihana Gilman; Misevic, Sanja; Kramaric, Ruzica Palic

2017-04-15

Parkinson's disease (PD) patients are at a higher risk of malnutrition. The prevalence has been estimated to 0-24%, while 3%-60% of PD patients are reported to be at risk of malnutrition. To date, there is no clear explanation for malnutrition in these patients. The aim of this study was to determine the prevalence of malnutrition and to analyze factors that influence its appearance. The Mini Nutritional Assessment (MNA) was used to determine normal nutritional status; at risk of malnutrition; and already malnourished status. The Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV, Hoehn and Yahr scale (H&Y scale), Beck Depression Inventory (BDI), Mini Mental State Examination (MMSE), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale - eating part (QUIP-RS) and Mini Nutritional Assessment (MNA) were used to evaluate the factors affecting patient nutritional status. Out of 96 patients, 55,2% were at risk of malnutrition, while 8,3% had already been malnourished. Age, H&Y scale, UPDRS part III, 'off' periods and depression influence negatively on MNA. More patients with 'off' periods were rigor dominant. Thyroid gland hormone therapy was related to malnutrition, while patients with normal nutritional status used ropinirole more often than pramipexole. Factors affecting nutritional status are age, motor symptoms and stage severity, 'off' states, rigidity dominant type with 'off' states, and thyroid hormone replacement therapy. Ropinirole exhibited the possible 'protective' effect against malnutrition. Copyright © 2017 Elsevier B.V. All rights reserved.

Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition.

PubMed

Iannotti, Lora L; Trehan, Indi; Manary, Mark J

2013-09-12

World Health Organization (WHO) guidelines recommend for children with severe acute malnutrition (SAM), high-dose vitamin A (VA) supplements be given on day 1 of admission, and on days 2 and 14 in the case of clinical signs of vitamin A deficiency (VAD). Daily low-dose VA follows, delivered in a premix added to F-75 and F-100. This study aimed to systematically review the evidence for safety and effectiveness of high-dose VA supplementation (VAS) in treatment of children with SAM. A comprehensive literature review was undertaken for all relevant randomized controlled trials (RCT) and observational studies from 1950 to 2012. Studies identified for full review were evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology using a set of pre-defined criteria: indirectness; inconsistency; imprecision; and study limitations. A quality rating of high, moderate, or low was then assigned to each study, and only those attaining moderate to high were considered in making recommendations. Of the 2072 abstracts screened, 38 met criteria for full review, and 20 were rated moderate to high quality. Only one study replicated the WHO VA protocol in children with SAM. Indirectness was a critical limitation, as studies were not exclusive to children with SAM. There was inconsistency across trials for definitions of malnutrition, morbidities, and ages studied; and imprecision arising from sub-group analyses and small sample sizes. Evidence showed improved outcomes associated with low-dose compared to high-dose VAS, except in cases presenting with signs of VAD, measles, and severe diarrhea or shigellosis. Adverse outcomes related to respiratory infection, diarrhea, and growth were associated with high-dose VAS in children who were predominantly adequately nourished. No adverse effects of the high dose were found in children with SAM in the trial that replicated the WHO VA guideline. This is the first systematic review of the safety and

Morphomic Malnutrition Score: A Standardized Screening Tool for Severe Malnutrition in Adults.

PubMed

Lee, Christopher; Raymond, Erica; Derstine, Brian A; Glazer, Joshua M; Goulson, Rebecca; Rajasekaran, Avinash; Cherry-Bukowiec, Jill; Su, Grace L; Wang, Stewart C

2018-05-22

Granular diagnostic criteria for adult malnutrition are lacking. This study uses analytic morphomics to define the Morphomic Malnutrition Score (MMS), a robust screening tool for severe malnutrition. The study population (n = 643) consisted of 2 cohorts: 1) 124 emergency department patients diagnosed with severe malnutrition by a registered dietitian (RD) and an available computed tomography (CT) scan within 2 days of RD evaluation, and 2) 519 adult kidney donor candidates to represent a healthy cohort. Body composition markers of muscle area and abdominal adiposity were measured from patient CT scans using analytic morphomic assessment, and then converted to sex- and age-adjusted percentiles using the Reference Analytic Morphomics Population (RAMP). RAMP consists of 6000 patients chosen to be representative of the general population. The combined cohort was then randomly divided into training (n = 453) and validation (n = 190) sets. MMS was derived using logistic regression. The model coefficients were transformed into a score, normalized from 0 to 10 (10 = most severe). Severely malnourished patients had lower amounts of muscle and fat than kidney donors, specifically for dorsal muscle group area at the twelfth thoracic vertebral level (P < 0.001), psoas muscle area at the fourth lumbar vertebral level (P < 0.001), and subcutaneous fat area at the third lumbar vertebral level (P < 0.001)-all parameters in MMS. MMS for severely malnourished patients was higher than kidney donors (7.7 ± 2.2 vs 3.8 ± 2.0, respectively; P-value < 0.001). An MMS > 6.1 was accurate in determining nutrition diagnosis (82.1% sensitivity; 88.3% specificity; 85.2% balanced accuracy). MMS provides an evidence-based, granular assessment to distinguish severely malnourished adults from a healthy population. © 2018 American Society for Parenteral and Enteral Nutrition.

[COPD disease and malnutrition].

PubMed

Casanova Macario, Ciro; de Torres Tajes, Juan Pablo; Palmero, María Angeles Martín

2009-01-01

Weight loss and malnutrition related mainly to lean mass loss can develop in advanced stages of chronic obstructive pulmonary disease (COPD) and are a clear indication of phenotypic heterogeneity. The presence of weight loss and malnutrition is associated with a worse prognosis, independently of forced expiratory volume in 1 second (FEV(1)). The most widely accepted thresholds for risk are 21 for the body mass index (BMI) and 17 and 14 for men and women, respectively, for the fat-free mass index (FFMI). The coexistence of both defines a situation of greater nutritional risk (cachexia). Nevertheless, a reduction in FFMI is an independent risk factor, although not superior to a low BMI. Therefore, although obtaining FFMI by bioelectric impedanciometry is reliable and relatively easy, we recommend the use of this procedure only in patients with COPD and low weight (BMI < 21), together with more specific nutritional evaluation. Currently, longitudinal studies providing data on the behavior of BMI within the natural course of the disease are lacking. Moreover, there is no solid scientific evidence that confirms the main mechanisms of malnutrition in COPD. This lack of evidence explains the difficulty of the therapeutic management of these patients, which has not advanced in the last few decades. Nevertheless, current evidence suggests that initiating individually-tailored nutritional treatment combined with pulmonary rehabilitation programs (exercise) is reasonable in patients with cachexia. Further studies are required to provide greater insight into the physiopathology and the role of other therapeutic options (hormones, antiinflammatory drugs) in malnutrition in patients with COPD. Copyright © 2009 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

Immune Dysfunction as a Cause and Consequence of Malnutrition.

PubMed

Bourke, Claire D; Berkley, James A; Prendergast, Andrew J

2016-06-01

Malnutrition, which encompasses under- and overnutrition, is responsible for an enormous morbidity and mortality burden globally. Malnutrition results from disordered nutrient assimilation but is also characterized by recurrent infections and chronic inflammation, implying an underlying immune defect. Defects emerge before birth via modifications in the immunoepigenome of malnourished parents, and these may contribute to intergenerational cycles of malnutrition. This review summarizes key recent studies from experimental animals, in vitro models, and human cohorts, and proposes that immune dysfunction is both a cause and a consequence of malnutrition. Focusing on childhood undernutrition, we highlight gaps in current understanding of immune dysfunction in malnutrition, with a view to therapeutically targeting immune pathways as a novel means to reduce morbidity and mortality. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Intestinal Helminth Infections and Nutritional Status of Children Attending Primary Schools in Wakiso District, Central Uganda

PubMed Central

Francis, Lwanga; Kirunda, Barbara Eva; Orach, Christopher Garimoi

2012-01-01

A cross-sectional study to assess the prevalence of intestinal helminth infections and nutritional status of primary school children was conducted in the Wakiso district in Central Uganda. A total of 432 primary school children aged 6–14 years were randomly selected from 23 schools. Anthropometric measurements of weight, height, MUAC were undertaken and analyzed using AnthroPlus software. Stool samples were examined using a Kato-Katz method. The prevalence of stunting, underweight and moderate acute malnutrition (MAM) was 22.5%, 5.3% and 18.5% respectively. Males had a threefold risk of being underweight (OR 3.2, 95% CI 1.17–9.4, p = 0.011) and 2 fold risk of suffering from MAM (OR 2.1, 95% CI 1.21–3.48, p = 0.004). Children aged 10–14 years had a 2.9 fold risk of stunting (OR 2.9, 95% CI 1.37–6.16, p = 0.002) and 1.9 risk of MAM (OR 1.9, 95% CI 1.07–3.44, p = 0.019). Attending urban slum schools had 1.7 fold risk of stunting (OR 1.7, 95% CI 1.03–2.75, p = 0.027). Rural schools presented a twofold risk of helminth infection (OR 1.95, 95% CI 1.12–3.32, p = 0.012). The prevalence of helminth infections was (10.9%), (3.1%), (1.9%), (0.2%) for hookworm, Trichuria trichiura, Schistosoma mansoni and Ascaris lumbricoides, respectively. The study revealed that 26.6%, 46% and 10.3% of incidences of stunting, underweight and MAM respectively were attributable to helminth infections. PMID:23066405

Childhood malnutrition: Toward an understanding of infections, inflammation, and antimicrobials

PubMed Central

Jones, Kelsey D.; Thitiri, Johnstone; Ngari, Moses; Berkley, James A.

2014-01-01

Background Undernutrition in childhood is estimated to cause 3.1 million child deaths annually through a potentiating effect on common infectious diseases, such as pneumonia and diarrhea. In turn, overt and subclinical infections, and inflammation, especially in the gut, alter nutrient intake, absorption, secretion, diversion, catabolism, and expenditure. Objective A narrative overview of the current understanding of infections, inflammation, and antimicrobials in relation to childhood malnutrition. Methods Searches for pivotal papers were conducted using PUBMED 1966-January 2013; hand searches of the references of retrieved literature; discussions with experts; and personal experience from the field. Results Although the epidemiological evidence for increased susceptibility to life-threatening infections associated with malnutrition is strong, we are only just beginning to understand some of the mechanisms involved. Nutritional status and growth are strongly influenced by environmental enteric dysfunction (EED), which is common among children in developing countries, and by alterations in the gut microbiome. As yet, there are no proven interventions against EED. Antibiotics have long been used as growth promoters in animals. Trials of antibiotics have shown striking efficacy on mortality and on growth in children with uncomplicated severe acute malnutrition (SAM) or HIV infection. Antibiotics act directly by preventing infections and may act indirectly by reducing subclinical infections and inflammation. We describe an ongoing multicenter, randomized, placebo-controlled trial of daily cotrimoxazole prophylaxis to prevent death in children recovering from complicated SAM. Secondary outcomes include growth, frequency and etiology of infections, immune activation and function, the gut microbiome, and antimicrobial resistance. The trial is expected to be reported in mid-2014. Conclusions As well as improving nutritional intake, new case management strategies need to

Childhood malnutrition: toward an understanding of infections, inflammation, and antimicrobials.

PubMed

Jones, Kelsey D; Thitiri, Johnstone; Ngari, Moses; Berkley, James A

2014-06-01

Undernutrition in childhood is estimated to cause 3.1 million child deaths annually through a potentiating effect on common infectious diseases, such as pneumonia and diarrhea. In turn, overt and subclinical infections, and inflammation, especially in the gut, alter nutrient intake, absorption, secretion, diversion, catabolism, and expenditure. A narrative overview of the current understanding of infections, inflammation, and antimicrobials in relation to childhood malnutrition. Searches for pivotal papers were conducted using PUBMED 1966-January 2013; hand searches of the references of retrieved literature; discussions with experts; and personal experience from the field. Although the epidemiological evidence for increased susceptibility to life-threatening infections associated with malnutrition is strong, we are only just beginning to understand some of the mechanisms involved. Nutritional status and growth are strongly influenced by environmental enteric dysfunction (EED), which is common among children in developing countries, and by alterations in the gut microbiome. As yet, there are no proven interventions against EED. Antibiotics have long been used as growth promoters in animals. Trials of antibiotics have shown striking efficacy on mortality and on growth in children with uncomplicated severe acute malnutrition (SAM) or HIV infection. Antibiotics act directly by preventing infections and may act indirectly by reducing subclinical infections and inflammation. We describe an ongoing multicenter, randomized, placebo-controlled trial of daily cotrimoxazole prophylaxis to prevent death in children recovering from complicated SAM. Secondary outcomes include growth, frequency and etiology of infections, immune activation and function, the gut microbiome, and antimicrobial resistance. The trial is expected to be reported in mid-2014. As well as improving nutritional intake, new case management strategies need to address infection, inflammation, and microbiota

Description and evaluation of a new four-mode version of the Modal Aerosol Module (MAM4) within version 5.3 of the Community Atmosphere Model

DOE PAGES

Liu, X.; Ma, P. -L.; Wang, H.; ...

2016-02-08

Atmospheric carbonaceous aerosols play an important role in the climate system by influencing the Earth's radiation budgets and modifying the cloud properties. Despite the importance, their representations in large-scale atmospheric models are still crude, which can influence model simulated burden, lifetime, physical, chemical and optical properties, and the climate forcing of carbonaceous aerosols. In this study, we improve the current three-mode version of the Modal Aerosol Module (MAM3) in the Community Atmosphere Model version 5 (CAM5) by introducing an additional primary carbon mode to explicitly account for the microphysical ageing of primary carbonaceous aerosols in the atmosphere. Compared to MAM3,more » the four-mode version of MAM (MAM4) significantly increases the column burdens of primary particulate organic matter (POM) and black carbon (BC) by up to 40 % in many remote regions, where in-cloud scavenging plays an important role in determining the aerosol concentrations. Differences in the column burdens for other types of aerosol (e.g., sulfate, secondary organic aerosols, mineral dust, sea salt) are less than 1 %. Evaluating the MAM4 simulation against in situ surface and aircraft observations, we find that MAM4 significantly improves the simulation of seasonal variation of near-surface BC concentrations in the polar regions, by increasing the BC concentrations in all seasons and particularly in cold seasons. However, it exacerbates the overestimation of modeled BC concentrations in the upper troposphere in the Pacific regions. As a result, the comparisons suggest that, to address the remaining model POM and BC biases, future improvements are required related to (1) in-cloud scavenging and vertical transport in convective clouds and (2) emissions of anthropogenic and biomass burning aerosols.« less

Bacteriophage ϕMAM1, a Viunalikevirus, Is a Broad-Host-Range, High-Efficiency Generalized Transducer That Infects Environmental and Clinical Isolates of the Enterobacterial Genera Serratia and Kluyvera

PubMed Central

Matilla, Miguel A.

2014-01-01

Members of the enterobacterial genus Serratia are ecologically widespread, and some strains are opportunistic human pathogens. Bacteriophage ϕMAM1 was isolated on Serratia plymuthica A153, a biocontrol rhizosphere strain that produces the potently bioactive antifungal and anticancer haterumalide oocydin A. The ϕMAM1 phage is a generalized transducing phage that infects multiple environmental and clinical isolates of Serratia spp. and a rhizosphere strain of Kluyvera cryocrescens. Electron microscopy allowed classification of ϕMAM1 in the family Myoviridae. Bacteriophage ϕMAM1 is virulent, uses capsular polysaccharides as a receptor, and can transduce chromosomal markers at frequencies of up to 7 × 10−6 transductants per PFU. We also demonstrated transduction of the complete 77-kb oocydin A gene cluster and heterogeneric transduction of a plasmid carrying a type III toxin-antitoxin system. These results support the notion of the potential ecological importance of transducing phages in the acquisition of genes by horizontal gene transfer. Phylogenetic analyses grouped ϕMAM1 within the ViI-like bacteriophages, and genomic analyses revealed that the major differences between ϕMAM1 and other ViI-like phages arise in a region encoding the host recognition determinants. Our results predict that the wider genus of ViI-like phages could be efficient transducing phages, and this possibility has obvious implications for the ecology of horizontal gene transfer, bacterial functional genomics, and synthetic biology. PMID:25107968

Prevalence of malnutrition at the time of admission among patients admitted to a Canadian tertiary-care paediatric hospital

PubMed Central

Baxter, Jo-Anna B; Al-Madhaki, Fatma Ibrahim; Zlotkin, Stanley H

2014-01-01

BACKGROUND: Malnutrition among hospitalized children is known to negatively influence their response to therapy and to prolong their admission. It also has short- and long-term consequences for growth, development and well-being. It is commonly regarded as a condition affecting children in low-income countries; however, malnutrition has been found to be variably prevalent among hospitalized children in higher-income countries. At the time the present study was conducted, it had been >30 years since the nutritional status of Canadian hospitalized children was last published. OBJECTIVES: To determine and communicate the prevalence of malnutrition among children in a Canadian tertiary-care paediatric hospital at the time of their admission. METHODS: In the present cross-sectional study, anthropometric measures were obtained from 322 children admitted to The Hospital for Sick Children in Toronto, Ontario. Nutritional indexes (BMI for age, weight for age, weight for length/height and length/height for age) were generated from anthropometric measures using the WHO igrowup software, and summarized according to WHO definitions. RESULTS: The overall prevalence of malnutrition using BMI for age was 39.6% (95% CI 33% to 46%), of which 8.8% and 30.8% of participants were under- and overnourished, respectively. Furthermore, 6.9% (95% CI 3% to 13%) were determined to be acutely malnourished (weight for length/height <−2 SD) and 13.4% (95% CI 10% to 18%) chronically malnourished (length/height for age <−2 SD). CONCLUSION: The high prevalence of overall malnutrition observed among study participants suggests that initial screening using simple anthropometric measures should be conducted on hospital admission so that patients can receive appropriate nutrition-specific care. PMID:25382997

Child Malnutrition in Pakistan: Evidence from Literature

PubMed Central

Asim, Muhammad; Nawaz, Yasir

2018-01-01

Pakistan has one of the highest prevalences of child malnutrition as compared to other developing countries. This narrative review was accomplished to examine the published empirical literature on children’s nutritional status in Pakistan. The objectives of this review were to know about the methodological approaches used in previous studies, to assess the overall situation of childhood malnutrition, and to identify the areas that have not yet been studied. This study was carried out to collect and synthesize the relevant data from previously published papers through different scholarly database search engines. The most relevant and current published papers between 2000–2016 were included in this study. The research papers that contain the data related to child malnutrition in Pakistan were assessed. A total of 28 articles was reviewed and almost similar methodologies were used in all of them. Most of the researchers conducted the cross sectional quantitative and descriptive studies, through structured interviews for identifying the causes of child malnutrition. Only one study used the mix method technique for acquiring data from the respondents. For the assessment of malnutrition among children, out of 28 papers, 20 used the World Health Organization (WHO) weight for age, age for height, and height for weight Z-score method. Early marriages, large family size, high fertility rates with a lack of birth spacing, low income, the lack of breast feeding, and exclusive breastfeeding were found to be the themes that repeatedly emerged in the reviewed literature. There is a dire need of qualitative and mixed method researches to understand and have an insight into the underlying factors of child malnutrition in Pakistan. PMID:29734703

Early childhood malnutrition predicts depressive symptoms at ages 11-17.

PubMed

Galler, J R; Bryce, C P; Waber, D; Hock, R S; Exner, N; Eaglesfield, D; Fitzmaurice, G; Harrison, R

2010-07-01

We examined the prevalence of depressive symptoms in Barbadian youth with histories of infantile malnutrition and in a healthy comparison group and the extent to which the effect of malnutrition was mediated/moderated by maternal depression. Depressive symptoms were assessed using a 20-item scale administered to youths (11-17 years of age) who had experienced an episode of protein-energy malnutrition (marasmus or kwashiorkor) during the first year of life and in a comparison group of healthy youths without a history of malnutrition. Their mothers completed the same questionnaire on the same test on three occasions when their children were 5-17 years of age at 2-5-year intervals. The prevalence of depressive symptoms was elevated among previously malnourished youth relative to healthy comparison children (p < .001). When youth depression scores were subjected to a longitudinal multiple regression analysis, adjusting for the effect of maternal depressive symptoms, significant effects due to the history of early childhood malnutrition remained and were not discernibly attenuated from an unadjusted analysis. We also found significant independent effects of maternal depressive symptoms on youth depressive symptoms. Early childhood malnutrition contributed independently to depressive symptoms in youths who experienced a significant episode of malnutrition in the first year of life. This relationship was not mediated or moderated by the effects of maternal depression. Whether the later vulnerability to depression is a direct effect of the episode of malnutrition and related conditions early in life or whether it is mediated by the more proximal neurobehavioral effects of the malnutrition remains to be determined.

Performance of UNHCR nutrition programs in post-emergency refugee camps

PubMed Central

2011-01-01

Background The United Nations High Commissioner for Refugees (UNHCR) launched a health information system (HIS) in 2005 to enhance quality and consistency of routine health information available in post-emergency refugee camps. This paper reviews nutrition indicators and examines their application for monitoring and evaluating the performance of UNHCR nutrition programs in more than 90 refugee camps in 18 countries. Methods The HIS is a primary source of feeding program data which is collected using standardized case definitions and reporting formats across refugee camps in multiple settings. Data was aggregated across time periods and within and across countries for analysis. Basic descriptive statistics were then compared to UNHCR program performance standards. Results Camp populations covered by the HIS ranged from 192,000 to 219,000 between 2007 and mid-2009; 87% of under five children covered by the HIS were in Africa and 13% in Asia. Average moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) rates reported in 74 of 81 camps for the 2007-2009 time periods were 7.0% and 1.6%, respectively. The supplementary feeding program (SFP) admission rate was 151/1000/yr with 93% of SFP admissions occurring in Africa. SFP performance consistently exceeded all UNHCR standards with the exception of length of enrollment. Average length of SFP enrollment was 12 weeks in Africa and 22 weeks in Asia as compared to the UNHCR standard of < 8 weeks. The therapeutic feeding program (TFP) admission was 22/1000/yr with 95% of TFP admissions in Africa. TFP performance met UNHCR standards with the exception of daily weight gain. Conclusions Inclusion of children identified as moderately and severely wasted in the HIS would allow UNHCR to better track and respond to changes in nutrition status. Improved growth monitoring coverage or active malnutrition surveillance would increase UNHCR's ability to identify and treat cases of acute malnutrition. Expansion of nutrition

Does the cycad genotoxin MAM implicated in Guam ALS-PDC induce disease-relevant changes in mouse brain that includes olfaction?

PubMed

Kisby, Glen; Palmer, Valerie; Lasarev, Mike; Fry, Rebecca; Iordanov, Mihail; Magun, Eli; Samson, Leona; Spencer, Peter

2011-11-01

Western Pacific amyotrophic lateral sclerosis (ALS) and parkinsonism-dementia complex (PDC), a prototypical neurodegenerative disease (tauopathy) affecting distinct genetic groups with common exposure to neurotoxic chemicals in cycad seed, has many features of Parkinson's and Alzheimer's diseases (AD), including early olfactory dysfunction. Guam ALS-PDC incidence correlates with cycad flour content of cycasin and its aglycone methylazoxymethanol (MAM), which produces persistent DNA damage (O(6)-methylguanine) in the brains of mice lacking O(6)-methylguanine methyltransferase (Mgmt(-/-)). We described in Mgmt(-/-)mice up to 7 days post-MAM treatment that brain DNA damage was linked to brain gene expression changes found in human neurological disease, cancer, and skin and hair development. This addendum reports 6 months post-MAM treatment- related brain transcriptional changes as well as elevated mitogen activated protein kinases and increased caspase-3 activity, both of which are involved in tau aggregation and neurofibrillary tangle formation typical of ALS-PDC and AD, plus transcriptional changes in olfactory receptors. Does cycasin act as a "slow (geno)toxin" in ALS-PDC?

Disease-Homologous Mutation in the Cation Diffusion Facilitator Protein MamM Causes Single-Domain Structural Loss and Signifies Its Importance

PubMed Central

Barber-Zucker, Shiran; Uebe, René; Davidov, Geula; Navon, Yotam; Sherf, Dror; Chill, Jordan H.; Kass, Itamar; Bitton, Ronit; Schüler, Dirk; Zarivach, Raz

2016-01-01

Cation diffusion facilitators (CDF) are highly conserved, metal ion efflux transporters that maintain divalent transition metal cation homeostasis. Most CDF proteins contain two domains, the cation transporting transmembrane domain and the regulatory cytoplasmic C-terminal domain (CTD). MamM is a magnetosome-associated CDF protein essential for the biomineralization of magnetic iron-oxide particles in magnetotactic bacteria. To investigate the structure-function relationship of CDF cytoplasmic domains, we characterized a MamM M250P mutation that is synonymous with the disease-related mutation L349P of the human CDF protein ZnT-10. Our results show that the M250P exchange in MamM causes severe structural changes in its CTD resulting in abnormal reduced function. Our in vivo, in vitro and in silico studies indicate that the CTD fold is critical for CDF proteins’ proper function and support the previously suggested role of the CDF cytoplasmic domain as a CDF regulatory element. Based on our results, we also suggest a mechanism for the effects of the ZnT-10 L349P mutation in human. PMID:27550551

Food insecurity and malnutrition in Chinese elementary school students.

PubMed

Shen, Xiuhua; Gao, Xiang; Tang, Wenjing; Mao, Xuanxia; Huang, Jingyan; Cai, Wei

2015-09-28

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6-14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number = 4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6.1% in the entire studied population and 16.3% in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1.14 v. 0.96; P=0.043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3.08; 95% CI 1.47, 6.46; P=0.003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community.

Risk Factors for Malnutrition Among Children With Cerebral Palsy in Botswana.

PubMed

Johnson, Allison; Gambrah-Sampaney, Claudia; Khurana, Esha; Baier, James; Baranov, Esther; Monokwane, Baphaleng; Bearden, David R

2017-05-01

Children with cerebral palsy in low-resource settings are at high risk of malnutrition, which further increases their risk of poor health outcomes. However, there are few available data on specific risk factors for malnutrition among children with cerebral palsy in the developing world. We performed a case-control study among children with cerebral palsy receiving care at a tertiary care hospital in Gaborone, Botswana. Children with cerebral palsy and malnutrition were identified according to World Health Organization growth curves and compared with subjects with cerebral palsy without malnutrition. Risk factors for malnutrition were identified using multivariable logistic regression models. These risk factors were then used to generate a Malnutrition Risk Score, and Receiver Operating Characteristic curves were used to identify optimal cutoffs to identify subjects at high risk of malnutrition. We identified 61 children with cerebral palsy, 26 of whom (43%) met criteria for malnutrition. Nonambulatory status (odds ratio 13.8, 95% confidence interval [CI] 3.8-50.1, P < 0.001) and a composite measure of socioeconomic status (odds ratio 1.6, 95% CI 1.0-2.5, P = 0.03) were the strongest risk factors for malnutrition. A Malnutrition Risk Score was constructed based on these risk factors, and receiver operating characteristic curve analysis demonstrated excellent performance characteristics of this score (area under the curve 0.92, 95% CI 0.89-0.94). Malnutrition is common among children with cerebral palsy in Botswana, and a simple risk score may help identify children with the highest risk. Further studies are needed to validate this screening tool and to determine optimal nutritional interventions in this population. Copyright © 2017 Elsevier Inc. All rights reserved.

[Research advances in the relationship between childhood malnutrition and gut microbiota].

PubMed

Wang, Hui-Hui; Wen, Fei-Qiu; Wei, Ju-Rong

2016-11-01

Childhood malnutrition is an important disease threatening healthy growth of children worldwide. Gut microbiota has close links to food digestion, absorption and intestinal function. Current research considers that alterations in gut microbiota have been strongly implicated in childhood malnutrition. This review article addresses the latest understanding and evidence of interrelationship between gut microbiota and individual nutrition status, the changes of gut microbiota in different types of malnutrition, and the attribution of gut microbiota in the treatment and prognosis of malnutrition. It provides in depth understanding of childhood malnutrition from the perspective of microbiome.

Causes, assessment and treatment of malnutrition in older people.

PubMed

Willis, Helen

2017-02-28

Malnutrition is a growing problem in the UK with as many as 14% of people aged over 65 at risk. It is of particular concern in care homes where more than one third of residents are undernourished. Weight loss is not the only symptom of malnourishment and nurses should examine any changes to a person's health and well-being to identify causes. Regular monitoring of patients' risk of malnutrition through use of screening assessments, such as the Malnutrition Universal Screening Tool, ensures undernourishment is identified early. As the population ages, it is more important than ever that the implications of malnutrition are recognised and addressed.

Malnutrition, poverty and intellectual development.

PubMed

Brown, J L; Pollitt, E

1996-02-01

New findings with important policy implications have revealed that malnutrition in childhood impairs intellectual function in more ways than was previously recognized, but also that some of the damage to the brain caused by malnutrition may be reversed. Early research indicated that malnourished animals lacked the energy to interact with their environment and, thus, performed poorly on tests of mental ability. To determine the effect of poor diet and an impoverished environment on mental development in humans, an extensive follow-up study was made of Guatemalan children who received two different nutritional supplements in a 1969-77 study. Mothers and children in two villages received a high-protein supplement (Atole), and those in two additional villages received a supplement with no protein (Fresco). Both supplements reduced mortality, but Atole villages saw a 69% reduction in infant mortality (vs. 24% in the Fresco villages). The 1988-89 follow-up of 70% of the original participants involved extensive cognitive testing and socioeconomic assessment. Atole subjects performed significantly better on the cognitive tests, and the lowest-income children did as well as their more economically advantaged (but still poor) peers. Those who received Atole exhibited an increased benefit from their years of education and grew up faster and stronger than those who received Fresco. Smaller children who appear younger than their age may receive less stimulation from adult expectations than larger children. These findings indicate that the deleterious effects of early malnutrition on intellectual development can continue into adulthood. Other research has revealed that iron supplements can improve the intellectual and motor abilities of infants. While enriched educational programs can ameliorate some of the problems associated with malnutrition, poor children rarely live where such programs are available. The best and least expensive policy would be to prevent malnutrition among

[Classification of Colombian children with malnutrition according to NCHS reference or WHO standard].

PubMed

Velásquez, Claudia; Bermúdez, Juliana; Echeverri, Claudia; Estrada, Alejandro

2011-12-01

A descriptive study was conducted to evaluate the concordance of National Center for Health Statistics reference (NCHS) used to classify undernourished children from Colombia with the WHO Child Growth Standards. We used data from children aged 6 to 59 months with acute malnutrition (Z <-2) and severe (Z <-3) who were admitted to the "Unidad Vida Infantil" nutrition program in Colombia. Indicators height-for-age, weight for-height were analyzed when they were admitted to the hospital and weight for-height leaving the hospital. A statistical method used to compare means was T-student. Correlation coefficient intraclass (CCI) and Kappa index evaluated the concordance between NCHS and OMS; McNemar method evaluated the changes on the nutritional classification for children according to growth devices used. Of the total number of children classified as normal by NCHS, 10.4% were classified as stunted by WHO. 64% of the children admitted to the hospital presented acute malnutrition according to NCHS, of these 44,8% presented severe emaciation according to OMS, indeed severe emaciation increased of 36,0% to 63,3% using OMS. 5% of children leaving the hospital could need to stay more days if they had been evaluated with OMS. Growth devices shown high concordance in height-for-age (CCI = 0,988; k= 0,866) and weight for-height (CCI = 0,901; k = 0,578). Concluded that OMS growth standards classified more malnourished children and more severe states, in addition more malnourished children could be hospitalized and they could stay more days.

Warts, malnutrition, and sunshine.

PubMed

Orozco-Topete, Rocío; Villa, Antonio; Leyva Santiago, Jaime; Scholtes, Christian; Archer-Dubon, Carla; Ysunza, Alberto

2008-01-01

Viral warts are common in poor rural settings but their relationship to malnutrition has not been studied. We sought to determine the prevalence of warts in children of two communities in Oaxaca, Mexico, and compared it with their nutritional status. Children from Santa Catarina Yahuio and Santiago Laxopa of the state of Oaxaca were examined. Localization, number, and type of verruca were noted. Date of birth, height, and weight were obtained to determine nutritional status. A total of 213 children (116 girls and 97 boys), 107 in Yahuio and 106 in Laxopa, were studied. Mean age was 10.24 years. Thirty children (14.1%) had warts and 80% (24/30) of these lived in Yahuio (p = 0.0002). Almost half were teenagers. Most lesions were on sun-exposed areas. First degree malnutrition was found in 24.5%; second degree in 23.6% and third degree in 14.2%. A higher frequency of warts than previously reported was found. Malnutrition was prevalent in both groups but did not correlate positively with verruca. Verruca were more frequent in females, adolescents, sun-exposed areas, and higher altitude. We believe that the higher altitude of Yahuio facilitates greater exposure to ultraviolet light-induced immune suppression.

Early Malnutrition and Central Nervous System Function

ERIC Educational Resources Information Center

Scrimshaw, Nevin S.

1969-01-01

Discusses the consequences of severe malnutrition in young experimental animals. Development of the brain is permanently impaired. Studies of the effects of malnutrition on children are included. (This paper was presented at the Eighth Annual Lecture of the Merrill-Palmer Historical Library in Child Development and Family Life, October 25, 1968.)…

Defining malnutrition: A plea to rethink.

PubMed

Soeters, P; Bozzetti, F; Cynober, L; Forbes, A; Shenkin, A; Sobotka, L

2017-06-01

In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these elements. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Senior Health: How to Prevent and Detect Malnutrition

MedlinePlus

Healthy Lifestyle Caregivers Malnutrition is a serious senior health issue. Know the warning signs and how to help an older loved one avoid ... nutrient-rich diet for an older loved one. Malnutrition in older adults can lead to various health ...

A critical appraisal of guidelines used for management of severe acute malnutrition in South Africa's referral system.

PubMed

Mambulu-Chikankheni, Faith Nankasa; Eyles, John; Eboreime, Ejemai Amaize; Ditlopo, Prudence

2017-10-18

Focusing on healthcare referral processes for children with severe acute malnutrition (SAM) in South Africa, this paper discusses the comprehensiveness of documents (global and national) that guide the country's SAM healthcare. This research is relevant because South African studies on SAM mostly examine the implementation of WHO guidelines in hospitals, making their technical relevance to the country's lower level and referral healthcare system under-explored. To add to both literature and methods for studying SAM healthcare, we critically appraised four child healthcare guidelines (global and national) and conducted complementary expert interviews (n = 5). Combining both methods enabled us to examine the comprehensiveness of the documents as related to guiding SAM healthcare within the country's referral system as well as the credibility (rigour and stakeholder representation) of the guideline documents' development process. None of the guidelines appraised covered all steps of SAM referrals; however, each addressed certain steps thoroughly, apart from transit care. Our study also revealed that national documents were mostly modelled after WHO guidelines but were not explicitly adapted to local context. Furthermore, we found most guidelines' formulation processes to be unclear and stakeholder involvement in the process to be minimal. In adapting guidelines for management of SAM in South Africa, it is important that local context applicability is taken into consideration. In doing this, wider stakeholder involvement is essential; this is important because factors that affect SAM management go beyond in-hospital care. Community, civil society, medical and administrative involvement during guideline formulation processes will enhance acceptability and adherence to the guidelines.

Underweight and malnutrition in home care: A multicenter study.

PubMed

Lahmann, Nils A; Tannen, Antje; Suhr, Ralf

2016-10-01

This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI < 20 kg/m(2)) and 10.2% (clinical judgment). Missing values were high in both malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Hospital malnutrition in Latin America: A systematic review.

PubMed

Correia, Maria Isabel T D; Perman, Mario Ignacio; Waitzberg, Dan Linetzky

2017-08-01

Disease-related malnutrition is a major public health issue in both industrialised and emerging countries. The reported prevalence in hospitalised adults ranges from 20% to 50%. Initial reports from emerging countries suggested a higher prevalence compared with other regions, with limited data on outcomes and costs. We performed a systematic literature search for articles on disease-related malnutrition in Latin American countries published between January 1995 and September 2014. Studies reporting data on the prevalence, clinical outcomes, or economic costs of malnutrition in an adult (≥18 years) inpatient population with a sample size of ≥30 subjects were eligible for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. We identified 1467 citations; of these, 66 studies including 29 ,474 patients in 12 Latin American countries met the criteria for inclusion. There was considerable variability in methodology and in the reported prevalence of disease-related malnutrition; however, prevalence was consistently in the range of 40%-60% at the time of admission, with several studies reporting an increase in prevalence with increasing duration of hospitalisation. Disease-related malnutrition was associated with an increase in infectious and non-infectious clinical complications, length of hospital stay, and costs. Disease-related malnutrition is a highly prevalent condition that imposes a substantial health and economic burden on the countries of Latin America. Further research is necessary to characterise screening/assessment practices and identify evidence-based solutions to this persistent and costly public health issue. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

The effect of childhood malnutrition on externalizing behavior.

PubMed

Liu, Jianghong; Raine, Adrian

2006-10-01

Childhood externalizing behavior (aggression, hyperactivity, and conduct disorder) has been increasingly viewed as a public health problem because of its etiology and outcome. The association between malnutrition and externalizing behavior has begun to receive attention. This review summarizes recent empirical findings on malnutrition as a risk factor for the development of externalizing behavior, with an emphasis on micronutrient deficiency, and explores brain dysfunction as a possible mechanism. Externalizing behavior is associated with both macromalnutrition (e.g. protein) and micromalnutrition (e.g. iron and zinc). Both prenatal and postnatal malnutrition is implicated. The long-term effects of malnutrition on behavior could be reversible. The effects of docosahexaenoic acid/omega-3 long-chain essential fatty acid on externalizing behavior are more mixed. From animal and human findings, it is hypothesized that malnutrition impairs neurocognitive functioning by reducing neurons, alternating neurotransmitter functioning, and increasing neurotoxicity, and that such neurocognitive impairments predispose to externalizing behavior. Different lines of evidence support the view that poor nutrition contributes to the development of child behavior problems. More randomized, controlled trials that manipulate nutritional intake and evaluate behavior in children are needed to evaluate the etiological role of nutrition in externalizing behavior in order to inform intervention and prevention efforts.

with idiopathic chronic malnutrition

PubMed

Acar, Sezer; Çatlı, Gönül; Küme, Tuncay; Tuhan, Hale; Gürsoy Çalan, Özlem; Demir, Korcan; Böber, Ece; Abacı, Ayhan

2018-04-30

Background/aim: Nesfatin-1, an anorexigenic molecule, seems to play a role in appetite regulation and energy homeostasis. The goal of this study was to evaluate the relation of nesfatin-1 with anthropometric and metabolic (ghrelin, leptin) parameters in children with idiopathic chronic malnutrition. Materials and methods: The study included 37 underweight and 38 healthy children who were similar regarding age, sex, and pubertal status. Anthropometric and biochemical (nesfatin-1, ghrelin, and leptin levels) variables were assessed. Results: A total of 37 underweight subjects (mean age 10.5 ± 2.6 years) and 38 heathy subjects (mean age 10.3 ± 2.3 years) were recruited. Underweight children had significantly higher nesfatin-1 (2.76 ± 0.4 vs. 1.56 ± 0.7, P < 0.001) and lower leptin levels (2.21 ± 2.0 vs. 5.21 ± 2.4, P < 0.001) than those of the control subjects. Nesfatin-1 levels were significantly associated with only leptin levels, after adjusting for age and BMI (r = –0.371, P = 0.001). Conclusion: The present study is the first to evaluate nesfatin-1 levels in relation with anthropometric and metabolic parameters in children with chronic malnutrition, who were subsequently found to have significantly higher nesfatin-1 levels. Our study underlines that nesfatin-1 may play a role in the development of malnutrition by inhibiting food intake in children.

Nurses' Perceptions Regarding the Prevalence, Detection, and Causes of Malnutrition in Canadian Hospitals: Results of a Canadian Malnutrition Task Force Survey.

PubMed

Duerksen, Donald R; Keller, Heather H; Vesnaver, Elisabeth; Laporte, Manon; Jeejeebhoy, Khursheed; Payette, Hélène; Gramlich, Leah; Bernier, Paule; Allard, Johane P

2016-01-01

Given the high prevalence of malnutrition in hospitalized patients, nurses frequently encounter patients with significantly impaired nutrition status. The objective of this study was to determine nurses' attitudes and perceptions regarding the prevalence, detection, and causes of malnutrition in Canadian tertiary care and community hospitals. In this descriptive study, a survey that focused on guidelines for nutrition support of hospitalized patients was completed by Canadian nurses working on medical and surgical wards in 11 hospitals participating in the Canadian Malnutrition Task Force study. The survey was completed by 346 of 723 nurses (response rate 48%). Over 50% of nurses underestimated the documented prevalence of malnutrition in hospitalized patients. Nurses considered identification of malnourished patients very relevant (mean 8.4 on a 10-point scale) and would integrate a 3-question nutrition screen into their admission histories (92.5%). Nurses perceived lack of assistance with eating as a significant contributor to hospital malnutrition (17% felt this was a major contributor). While only 39% of nurses reported access to nutrition-related education, 92% were interested in receiving this form of updating. Nurses consider nutrition assessment important and relevant and require access to training to improve their capacity to detect malnutrition in their patients. Nurses are vital to the nutrition care of hospitalized patients and are well positioned to screen for nutrition risk and assist in nutrition management. The role of nurses in nutrition care needs to be linked to hospital policy. © 2014 American Society for Parenteral and Enteral Nutrition.

Malnutrition and Learning.

ERIC Educational Resources Information Center

Bakan, Rita

The characteristics of malnourished children bear a striking resemblance to a number of the known characteristics of "disadvantaged children," e.g. apathy, irritability, sickliness, and a reduced attention span. The combination of malnutrition and the other negative effects of poverty perpetuates a cycle of illness, educational failure, and more…

Infections associated with severe malnutrition among hospitalised children in East Africa.

PubMed

Sunguya, B F P; Koola, J I; Atkinson, S

2006-09-01

Severe protein-energy malnutrition (PEM) predisposes affected children to various infections, which either worsens their nutritional status or causes malnutrition, hence complicating their management and outcome. This study was carried out to determine the infections associated with severe malnutrition among children admitted at Kilifi District Hospital (KDH) in Kenya and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Data was collected from hospital register books and online system database. A total of 1121 children with severe malnutrition were admitted during a period of one year (2004-2005) (MNH = 781; KDH = 340). The proportion of male children with malnutrition was higher than that of female children. Non-oedematous malnutrition was more prevalent at MNH (N = 504; 64%) than KDH (N = 130; 38%). Conversely, oedematous was more prevalence than non-oedematous malnutrition among children admitted at KDH (N = 2 10; 61.7%). More than 75% of all patients with severe PEM were children < 2 years old. Thirty-six per cent of all severe PEM cases had malaria in both hospitals. Forty-five per cent of all admitted patients with severe PEM at KDH had diarrhoea. Two hundred twenty two (28%) and 64 (19%) of the children with severe malnutrition died at MNH and KDH, respectively. Oedematous PEM was associated with a higher case fatality rate than non-oedematous one (P < 0.05). At MNH, 86% of the patients who died with severe malnutrition had other co-morbidities. More (46%) oedematous malnourished patients with co-infections died at MNH than non-oedematous malnourished patients (19%). At KDH, septicaemia was the leading cause of death (55%) among severely malnourished patients. In conclusion, coinfections complicate the management of severe malnutrition and are associated with higher death rate. Management of such infections is of paramount importance to reduce case fatality rates.

Can wheat bran mitigate malnutrition and enteric pathogens?

USDA-ARS?s Scientific Manuscript database

Child malnutrition is a complex global problem, of which lack of food is only one component. Enteric pathogens and malnutrition work in a cyclic manner to depress a child’s intestinal immunity, while decreasing nutrient absorption. This cycle leads to stunting, wasting, and death. Often malnourished...

Costs of hospital malnutrition.

PubMed

Curtis, Lori Jane; Bernier, Paule; Jeejeebhoy, Khursheed; Allard, Johane; Duerksen, Donald; Gramlich, Leah; Laporte, Manon; Keller, Heather H

2017-10-01

Hospital malnutrition has been established as a critical, prevalent, and costly problem in many countries. Many cost studies are limited due to study population or cost data used. The aims of this study were to determine: the relationship between malnutrition and hospital costs; the influence of confounders on, and the drivers (medical or surgical patients or degree of malnutrition) of the relationship; and whether hospital reported cost data provide similar information to administrative data. To our knowledge, the last two goals have not been studied elsewhere. Univariate and multivariate analyses were performed on data from the Canadian Malnutrition Task Force prospective cohort study combined with administrative data from the Canadian Institute for Health Information. Subjective Global Assessment was used to assess the relationship between nutritional status and length of stay and hospital costs, controlling for health and demographic characteristics, for 956 patients admitted to medical and surgical wards in 18 hospitals across Canada. After controlling for patient and hospital characteristics, moderately malnourished patients' (34% of surveyed patients) hospital stays were 18% (p = 0.014) longer on average than well-nourished patients. Medical stays increased by 23% (p = 0.014), and surgical stays by 32% (p = 0.015). Costs were, on average, between 31% and 34% (p-values < 0.05) higher than for well-nourished patients with similar characteristics. Severely malnourished patients (11% of surveyed patients) stayed 34% (p = 0.000) longer and had 38% (p = 0.003) higher total costs than well-nourished patients. They stayed 53% (p = 0.001) longer in medical beds and had 55% (p = 0.003) higher medical costs, on average. Trends were similar no matter the type of costing data used. Over 40% of patients were found to be malnourished (1/3 moderately and 1/10 severely). Malnourished patients had longer hospital stays and as a result cost more than well

Malnutrition determinants in young children from Burkina Faso.

PubMed

Beiersmann, Claudia; Bermejo Lorenzo, Justo; Bountogo, Mamadou; Tiendrébeogo, Justin; Gabrysch, Sabine; Yé, Maurice; Jahn, Albrecht; Müller, Olaf

2013-10-01

Childhood malnutrition remains a major challenge to public health in poor countries. Data on malnutrition determinants in African children are scarce. A cross-sectional survey was performed in eight villages of Burkina Faso in June 2009, including 460 children aged 6-31 months. Demographic, socioeconomic, parasitological, clinical and anthropometric characteristics were collected. The main outcome variable was weight-for-length (WFL) z-score (i.e. wasting). A multiple regression model identified village, age group, religion and the presence of younger siblings as significantly associated with wasting. Villages differed in their mean WFL z-score by up to one unit. Compared with younger children, the mean WFL z-score of children aged 24-35 months was 0.63 units higher than the WFL z-score in younger children. This study confirms the still unacceptable high level of malnutrition in young children of rural West Africa and supports the fact that childhood malnutrition is a complex phenomenon highly influenced by contextual variables.

Community covariates of malnutrition based mortality among older adults.

PubMed

Lee, Matthew R; Berthelot, Emily R

2010-05-01

The purpose of this study was to identify community level covariates of malnutrition-based mortality among older adults. A community level framework was delineated which explains rates of malnutrition-related mortality among older adults as a function of community levels of socioeconomic disadvantage, disability, and social isolation among members of this group. County level data on malnutrition mortality of people 65 years of age and older for the period 2000-2003 were drawn from the CDC WONDER system databases. County level measures of older adult socioeconomic disadvantage, disability, and social isolation were derived from the 2000 US Census of Population and Housing. Negative binomial regression models adjusting for the size of the population at risk, racial composition, urbanism, and region were estimated to assess the relationships among these indicators. Results from negative binomial regression analysis yielded the following: a standard deviation increase in socioeconomic/physical disadvantage was associated with a 12% increase in the rate of malnutrition mortality among older adults (p < 0.001), whereas a standard deviation increase in social isolation was associated with a 5% increase in malnutrition mortality among older adults (p < 0.05). Community patterns of malnutrition based mortality among older adults are partly a function of levels of socioeconomic and physical disadvantage and social isolation among older adults. 2010 Elsevier Inc. All rights reserved.

Risk Factors for Malnutrition in Seniors Aged 75+ Living in Home Environment in Selected Regions of the Czech Republic.

PubMed

Brabcová, Iva; Trešlová, Marie; Bártlová, Sylva; Vacková, Jitka; Tóthová, Valerie; Motlová, Lenka

2016-09-01

Nutrition is an important social determinant of health that influences the ageing process. The aim of this study was to evaluate the nutritional condition of a group of seniors and identify the bio-psycho-social factors that increase the risk of malnutrition. The research was conducted using a quantitative method. The standardised scales Mini Nutritional Assessment - Short Form (MNA-SF) and the Geriatric depression scale (GDS-5) were used to evaluate the nutritional condition and tendency towards depression of the tested group. This group consisted of seniors aged 75 and above living in home environment in the České Budějovice region. The group was comprised of 320 seniors, 115 men (35.9%) and 205 women (64.1%), which corresponds to the composition of the population in the chosen region of the Czech Republic. Statistical data analysis was conducted using SASD 1.4.10 and SPSS 15.0 programs. Pearson's chi-squared test (Χ²) and Cramér's V were chosen for statistical testing. The significance level was set at 5%. The average BMI value of the seniors was 26.2 kg/m² (overweight). This value decreased with age. More than one third of the respondents were evaluated as being at risk of malnutrition (36.3%). Unintended weight loss was determined as the strongest risk factor of malnutrition. Seniors who had lowered their food intake stated unintended weight loss 10 times more often than respondents with no noticeable reduction in food intake. Seniors who showed signs of depression indicated weight loss three and a half times more often than respondents without depression. Meanwhile acute illness increased the risk by three times. Depression was found to be the cause and also the consequence of malnutrition. Despite the high prevalence of overweight and obesity, a large proportion of the respondents were running the risk of malnutrition. It was concluded that the strongest risk factors for malnutrition in the respondents were unintended weight loss, depression and

[Malnutrition in the elderly: the Mini Nutritional Assessment (MNA)].

PubMed

Guigoz, Y; Vellas, B J

1997-06-01

Frail elderly in the community, in nursing homes or in hospitals are at increased risk of malnutrition. In many instances, their existing nutritional disorders go unrecognised and adversely affect their health, ability to overcome disease, and so is associated with poor clinical outcome. The prevalence of malnutrition ranges from 5-10% in free-living elderly to 30-85% in homebound, nursing home, and hospitalised elderly. Possibilities exist to prevent or correct this malnutrition, but have not been frequently used until now due to the lack of a specific validated tool to screen for malnutrition. The goal of the Mini Nutritional Assessment (MNA) is to determine who is at risk of malnutrition, and hence to permit early nutritional intervention. It has been designed for easy use by general practitioners as well as health professionals involved in admitting patients to hospitals and nursing homes. The test, which comprises simple measurements and a brief questionnaire, can be performed in about 10 minutes. It involves: anthropometric assessment (weight, height and weight loss) general assessment (lifestyle, medication and mobility) dietary assessment (number of meals, food and fluid intake, autonomy of eating self assessment (self-perception of health and nutrition). The MNA has now been validated in three studies involving more than 600 elderly individuals, from the very frail to the very active in free-living and long-term care environments. The MNA was validated against a clinical evaluation and a comprehensive nutritional assessment. It can classify the elderly as well-nourished, undernourished, or at risk of malnutrition. The MNA can be an important tool in evaluating the risk of malnutrition in the elderly, if integrated into geriatric assessment programs.

Malnutrition in the Philippines.

PubMed

Ravenholt, A

1982-01-01

In the Philippines poverty and pervasive malnutrition are not limited to families of deprived seasonal workers. Undernourishment is endemic and increasing throughout most of this archipelago of some 7100 islands, and is compounded by the prevalence of intestinal parasites and gastrointestinal diseases which health workers estimate deprive youngsters of at least 5-10% of the nutritional value in food they do consume. This problem is particularly prevalent in rural villages and city slums where many people eat with their fingers. According to the Philippine Ministry of Health, nearly 1/2 of all reported deaths are among infants and children through age 4, and about 1/2 of the accelerated death rate among those age 5 and younger is related to malnutrition, compounded by diarrhea, measles, and malaria which is returning to areas where it once was almost eradicated. 3 factors critically affect a newborn's survival prospects: the family size he or she is born into; the time or spacing between the mother's pregnancies; and the child's birth order. Evidence indicates that, during the 1970s, as US aid and other family planning assistance became available, they were used most among families in the 2 highest income classes, where reduction of family size is under way. Poverty is the most fundamental cause of malnutrition, although many other factors contribute. Land reform has brought security of tenure and increasingly is transferring ownership of fields to former tenants of rice and corn lands. For the former tenants enhanced security brings greater income and better eating for the farm families retain more of the crop. The undernourished and truly poor of the Philippines number about 1/2 of the population. Although dispersed throughout most of the archipelago, there are important regional differences. These related to marked geographic patterns that affect fertility of the soil, length of the dry season, fortunes of predominant crops, vulnerability to destructive typhoons

The Effect of Malnutrition on Norovirus Infection

PubMed Central

Hickman, Danielle; Jones, Melissa K.; Zhu, Shu; Kirkpatrick, Ericka; Ostrov, David A.; Wang, Xiaoyu; Ukhanova, Maria; Sun, Yijun; Mai, Volker; Salemi, Marco; Karst, Stephanie M.

2014-01-01

ABSTRACT Human noroviruses are the primary cause of severe childhood diarrhea in the United States, and they are of particular clinical importance in pediatric populations in the developing world. A major contributing factor to the general increased severity of infectious diseases in these regions is malnutrition—nutritional status shapes host immune responses and the composition of the host intestinal microbiota, both of which can influence the outcome of pathogenic infections. In terms of enteric norovirus infections, mucosal immunity and intestinal microbes are likely to contribute to the infection outcome in substantial ways. We probed these interactions using a murine model of malnutrition and murine norovirus infection. Our results reveal that malnutrition is associated with more severe norovirus infections as defined by weight loss, impaired control of norovirus infections, reduced antiviral antibody responses, loss of protective immunity, and enhanced viral evolution. Moreover, the microbiota is dramatically altered by malnutrition. Interestingly, murine norovirus infection also causes changes in the host microbial composition within the intestine but only in healthy mice. In fact, the infection-associated microbiota resembles the malnutrition-associated microbiota. Collectively, these findings represent an extensive characterization of a new malnutrition model of norovirus infection that will ultimately facilitate elucidation of the nutritionally regulated host parameters that predispose to more severe infections and impaired memory immune responses. In a broad sense, this model may provide insight into the reduced efficacy of oral vaccines in malnourished hosts and the potential for malnourished individuals to act as reservoirs of emergent virus strains. PMID:24595373

[Malnutrition as a prognostic factor in elderly patients with hip fractures].

PubMed

Montero Pérez-Barquero, Manuel; García Lázaro, Milagros; Carpintero Benítez, Pedro

2007-05-19

Hip fracture occurs frequently in elderly patients, with devastating effects on the quality of life due to the high financial burden and the high mortality rate in patients with this condition. Malnutrition is prevalent in the elderly and it can negatively influence patients' recovery from hip fracture. Our proposal was to assess the relationship between malnutrition and the recovery of patients with hip fracture. A total of 110 patients with hip fractures who were admitted to the orthopedic unit at the Reina Sofía Hospital were reassessed one year after discharge. A prospective cohort design and logistic regression analysis was used. Mean age was 81.4, and 80% of patients were women. After one year 19.7% of patients had died. A multivariate analysis showed a significant relationship between a poor functional recovery and age (odds ratio [OR] = 1.19), caloric malnutrition (OR = 290), protein malnutrition (OR = 125); and there was a significant relationship between being confined to bed and a worse situation before fracture (OR = 10.02); caloric malnutrition (OR = 9.57) and protein malnutrition (OR = 15.23). Caloric and protein malnutrition were associated with a worse functional recovery in elderly patients with hip fracture.

Gendered effects of siblings on child malnutrition in South Asia: cross-sectional analysis of demographic and health surveys from Bangladesh, India, and Nepal.

PubMed

Raj, Anita; McDougal, Lotus P; Silverman, Jay G

2015-01-01

This study examines the effects of number and sex of siblings on malnutrition of boys and girls under-5 in South Asia. Cross-sectional analyses were conducted on Demographic and Health Surveys data on children under-5 in Bangladesh (N = 7,861), India (N = 46,655) and Nepal (N = 2,475). Data were pooled across countries, and multinomial logistic regression was used to assess the relationship between number and sex of siblings and malnutrition outcomes (wasting, stunting, underweight; based on anthropometric data), adjusting for country and key social and maternal-child health indicators in sex stratified analyses. Number of brothers increased the odds for severe wasting [1 vs. 0 brothers adjusted odds ratio (AOR) = 1.31, 95 % CI = 1.11, 1.55; 2 vs. 0 brothers AOR = 1.36, 95 % CI = 1.07, 1.73] for girls but not boys. Having more male siblings and more female siblings increased the odds of stunting for boys and girls, but effect of 3+ sisters on severe stunting was significantly stronger for girls than boys (girls- 3+ vs. 0 sisters AOR = 2.25, 95 % CI = 1.88, 2.70; boys- 3+ vs. 0 sisters AOR = 1.37, 95 % CI = 1.13, 1.67). For underweight, three or more sisters increased the odds for severe underweight for girls (AOR = 1.27, 95 % CI = 1.04, 1.57) but not boys. Having brothers heightens girl risk for acute malnutrition (wasting), where having multiple sisters increases girl risk for chronic malnutrition (stunting/underweight). Boy malnutrition is less affected by siblings. Findings suggest that issues of son preference/daughter aversion may affect child malnutrition in South Asia.

Malnutrition and the disproportional burden on the poor: the case of Ghana

PubMed Central

Van de Poel, Ellen; Hosseinpoor, Ahmad Reza; Jehu-Appiah, Caroline; Vega, Jeanette; Speybroeck, Niko

2007-01-01

Background Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups. Methods This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey. Results The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population. Conclusion Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition. PMID:18045499

Nutritional intervention on malnutrition in 3-6 years old rural children in Qazvin Province, Iran.

PubMed

Zavoshy, R; Noroozi, M; Jahanihashemi, H; Kiamiri, D

2012-04-01

Malnutrition is one of the major causes of mortality and morbidity in children. Not only include acute effects on children's health, but also it has long-term effects on their cognitive development and economic growth in the society. Wasting (weight for height with Z<-1) is one of the malnutrition indices in children. The aim of this study was to determine the effect of a cooked meal for 175 days on the anthropometric indices of weight, height and weight for height (wasting) of 3-6 years old children in all the rural nursery of Qazvin province, in Iran. In this interventional study, 2385 children (48.8% female and 51.2% male) were recruited. Data were collected by a census in 2010. The children were received a cooked meal based on 360 +/- 20 kcal energy, 17% protein, 53% carbohydrate and 30% fat per day for 175 days at lunch time. The anthropometric indices were collected before and after the intervention. The results were analyzed using paired t-test by SPSS V.16 software. Prevalence of wasting (mild and moderate) and (sever malnutrition) after intervention reduced from 14.2 and 0.95-12.6 and 0.5%, respectively (p < 0.05). Receiving a cooked meal significantly decreased wasting (15.2-13.2%) in all children (p < 0.05). Nutritional intervention with cooked meal for 175 days had significant reduction in wasting in all children.

Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

PubMed

Ali, Engy; Zachariah, Rony; Shams, Zubair; Vernaeve, Lieven; Alders, Petra; Salio, Flavio; Manzi, Marcel; Allaouna, Malik; Draguez, Bertrand; Delchevalerie, Pascale; Harries, Anthony D

2013-05-01

Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<-3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality. Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored. Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to <115 mm (5/9 children), weight loss ≥ 10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of <-3. Cough was less frequent among those whose nutritional status improved. It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.

The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition.

PubMed

Poulia, Kalliopi-Anna; Klek, Stanislaw; Doundoulakis, Ioannis; Bouras, Emmanouil; Karayiannis, Dimitrios; Baschali, Aristea; Passakiotou, Marili; Chourdakis, Michael

2017-08-01

The new definition of malnutrition in adults proposed recently by The European Society for Clinical Nutrition and Metabolism (ESPEN) changed the view on the issue and raised the question of the reliability of available diagnostic tools. Therefore, the aim of this study was to verify the accuracy of the two most commonly used screening tools by comparing their findings with the new ESPEN criteria. Nutritional screening was performed in 1146 (median age 60 years, interquartile range: 44-73 years, 617 males, 529 females) patients on admission to hospitals with two nutritional screening tools: Nutritional Risk Screening 2002 (NRS2002) and Malnutrition Universal Screening Tool (MUST). The screening results were then compared to the ESPEN new diagnostic criteria for malnutrition. According to the NRS2002 13.5% and 27.9% of the outpatients and hospitalized patients respectively were found to be at moderate/high risk of malnutrition. With the use of MUST 9.1% and 14.9% of the outpatients and hospitalized patients respectively were found to be at moderate/high risk of malnutrition. According to the ESPEN diagnostic criteria 6.4% and 11.3% of outpatients and hospitalized patients respectively were classified as malnourished. MUST was found to be better correlated to the latter for both outpatients (K = 0.777, p < 0.001) and hospitalized patients (K = 0.843, p < 0.001) as compared to NRS2002 (k = 0.256, p < 0.001 and k = 0.228, p < 0.001). ROC plots Area Under the Curve (AUC) was found to be higher for MUST compared to NRS2002 (0.964 vs. 0.695 for outpatients and 0.980 vs 0.686 for hospitalized patients respectively). To our knowledge, this study is the first to analyze the clinical value of a malnutrition screening tool in the light of the new ESPEN definition for malnutrition. According to our results, MUST was better correlated with ESPEN criteria for the definition of malnutrition, leading us to the conclusion that it can more efficiently identify the

Serum Leptin Is a Biomarker of Malnutrition in Decompensated Cirrhosis

PubMed Central

Rachakonda, Vikrant; Borhani, Amir A.; Dunn, Michael A.; Andrzejewski, Margaret; Martin, Kelly; Behari, Jaideep

2016-01-01

Background and Aims Malnutrition is a leading cause of morbidity and mortality in cirrhosis. There is no consensus as to the optimal approach for identifying malnutrition in end-stage liver disease. The aim of this study was to measure biochemical, serologic, hormonal, radiographic, and anthropometric features in a cohort of hospitalized cirrhotic patients to characterize biomarkers for identification of malnutrition. Design In this prospective observational cohort study, 52 hospitalized cirrhotic patients were classified as malnourished (42.3%) or nourished (57.7%) based on mid-arm muscle circumference < 23 cm and dominant handgrip strength < 30 kg. Anthropometric measurements were obtained. Appetite was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ) score. Fasting levels of serum adipokines, cytokines, and hormones were determined using Luminex assays. Logistic regression analysis was used to determine features independently associated with malnutrition. Results Subjects with and without malnutrition differed in several key features of metabolic phenotype including wet and dry BMI, skeletal muscle index, visceral fat index and HOMA-IR. Serum leptin levels were lower and INR was higher in malnourished subjects. Serum leptin was significantly correlated with HOMA-IR, wet and dry BMI, mid-arm muscle circumference, skeletal muscle index, and visceral fat index. Logistic regression analysis revealed that INR and log-transformed leptin were independently associated with malnutrition. Conclusions Low serum leptin and elevated INR are associated with malnutrition in hospitalized patients with end-stage liver disease. PMID:27583675

[Understanding the pathophysiology of malnutrition for better treatment].

PubMed

De Bandt, J-P

2015-09-01

Malnutrition results from an imbalance between intake and protein-energy requirements resulting in tissue losses with adverse functional consequences. However, it would be better to speak of "states of malnutrition" rather than "malnutrition". Indeed, the mechanisms involved associate, with varying degrees, intake deficiency and increased needs with different clinical consequences. Adaptation to nutrient deficiency aims at establishing lasting saving conditions by promoting optimization of energy reserve utilization while preserving protein pool. This is achieved by reducing basal metabolism (low T3), by decreasing the secretion of anabolic factors and moderately increasing catabolic hormones. Unlike the previous process, the metabolic response to injury or stress, which will sometime induce major increase in requirements, will have as immediate purpose the defense of the organism. The body will draw sometime substantially in its protein pool to produce the glucose required for example by the immune cells. Stress response stems from both an endocrine response, and an immuno-inflammatory one with the important role of pro-inflammatory cytokines released in response to pathogens and more recently alarmins in response to endogenous stress in the inflammatory phenomena of the stress response and in the resulting malnutrition state. Treatment of these malnutrition conditions will thus differ: promoting anabolism in one case and fighting resistance to anabolism and hypercatabolism in the other. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Treatment outcomes of severe acute malnutrition in children treated within Outpatient Therapeutic Program (OTP) at Wolaita Zone, Southern Ethiopia: retrospective cross-sectional study.

PubMed

Kabalo, Mulugeta Yohannis; Seifu, Canaan Negash

2017-03-09

Children in third world countries suffer from severe acute malnutrition (SAM) in an extent of public health important. SAM management protocol available this time brought the approach from facility-based to community-based by Outpatient Therapeutic Program (OTP). But, little was known about the treatment outcomes of the program in Ethiopia. Thus, this study was aimed to assess treatment outcomes of SAM and identify factors associated among children treated at OTP in Wolaita Zone. A retrospective facility-based cross-sectional study was conducted in OTP records of 794 children, treated at 24 health posts retrieved from January to December 2014. Population proportion to size (PPS) was used to allocate sample for each selected district and OTP sites within district. Individual cards of children were selected by systematic random sampling. Data were entered, thoroughly cleaned, and analyzed in SPSS version 20. The recovery rate was revealed as 64.9% at 95% CI (61, 68). Death rate, default rate, weight gain, and length of stay were 1.2%, 2.2%, 4.2 g/kg/day, and 6.8 weeks respectively. Children living in <25 min were with 1.53 times higher odds of recovery than children residing in ≥25 min (AOR = 1.53 at 95% CI (1.11, 2.12)). The likelihood of recovery was 2.6 times higher for children with kwashiorkor than for those with marasmus (AOR = 2.62 at 95% CI (1.77, 3.89)). Likewise, children provided with amoxicillin were 1.52 times more likely to recover compared to their counterparts (AOR = 1.52 at 95% CI (1.09, 2.11)). The recovery rate and weight gain were lower than sphere standard. Distance from OTP, provision of amoxicillin, and type of malnutrition were factors identified as significantly associated with treatment outcome of SAM. Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol were recommended.

The impact of integrated prevention and treatment on child malnutrition and health: the PROMIS project, a randomized control trial in Burkina Faso and Mali.

PubMed

Huybregts, Lieven; Becquey, Elodie; Zongrone, Amanda; Le Port, Agnes; Khassanova, Regina; Coulibaly, Lazare; Leroy, Jef L; Rawat, Rahul; Ruel, Marie T

2017-03-09

Evidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso. The PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model. The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country

Comparison of Mid-Upper Arm Circumference and Weight-for-Height to Diagnose Severe Acute Malnutrition: A Study in Southern Ethiopia

PubMed Central

Tadesse, Amare Worku; Tadesse, Elazar; Berhane, Yemane; Ekström, Eva-Charlotte

2017-01-01

Weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC) are two independent anthropometric indicators for diagnosing and admitting children with severe acute malnutrition (SAM) for treatment. While severely wasted children are at high risk of mortality, MUAC and WHZ do not always identify the same population of children as having SAM. Understanding how this discrepancy relates to age and sex may provide valuable information for care programmes for children with SAM. Age and sex distribution for differences between children identified as SAM by MUAC and WHZ were examined and the degree of agreement calculated. Children (n = 4297) aged 6–59 months with validated anthropometric measures were recruited from a population-based survey conducted in rural southern Ethiopia. MUAC < 115 mm and WHZ < −3 were used to define severe wasting as per the World Health Organization (WHO) classification. The kappa coefficient (κ) was calculated. There was fair agreement between the MUAC and WHZ definitions of severe wasting in boys (κ = 0.37) and children younger than 24 months (κ = 0.32) but poor agreement in girls (κ = 0.15) and children aged 24 months and above (κ = 0.13). More research is needed on response to treatment and prediction of mortality using different anthropometric measurements in relation to ages and sex of children. PMID:28287482

Infant malnutrition predicts conduct problems in adolescents

PubMed Central

Galler, Janina R.; Bryce, Cyralene P.; Waber, Deborah P.; Hock, Rebecca S.; Harrison, Robert; Eaglesfield, G. David; Fitzmaurice, Garret

2013-01-01

Objectives The purpose of this study was to compare the prevalence of conduct problems in a well-documented sample of Barbadian adolescents malnourished as infants and a demographic comparison group and to determine the extent to which cognitive impairment and environmental factors account for this association. Methods Behavioral symptoms were assessed using a 76-item self-report scale in 56 Barbadian youth (11–17 years of age) with histories of protein–energy malnutrition (PEM) limited to the first year of life and 60 healthy classmates. Group comparisons were carried out by longitudinal and cross-sectional multiple regression analyses at 3 time points in childhood and adolescence. Results Self-reported conduct problems were more prevalent among previously malnourished youth (P < 0.01). Childhood IQ and home environmental circumstances partially mediated the association with malnutrition. Teacher-reported classroom behaviors at earlier ages were significantly correlated with youth conduct problems, confirming the continuity of conduct problems through childhood and adolescence. Discussion Self-reported conduct problems are elevated in children and adolescents with histories of early childhood malnutrition. Later vulnerability to increased conduct problems appears to be mediated by the more proximal neurobehavioral effects of the malnutrition on cognitive function and by adverse conditions in the early home environment. PMID:22584048

Infant malnutrition predicts conduct problems in adolescents.

PubMed

Galler, Janina R; Bryce, Cyralene P; Waber, Deborah P; Hock, Rebecca S; Harrison, Robert; Eaglesfield, G David; Fitzmaurice, Garret

2012-07-01

The purpose of this study was to compare the prevalence of conduct problems in a well-documented sample of Barbadian adolescents malnourished as infants and a demographic comparison group and to determine the extent to which cognitive impairment and environmental factors account for this association. Behavioral symptoms were assessed using a 76-item self-report scale in 56 Barbadian youth (11-17 years of age) with histories of protein-energy malnutrition (PEM) limited to the first year of life and 60 healthy classmates. Group comparisons were carried out by longitudinal and cross-sectional multiple regression analyses at 3 time points in childhood and adolescence. Self-reported conduct problems were more prevalent among previously malnourished youth (P < 0.01). Childhood IQ and home environmental circumstances partially mediated the association with malnutrition. Teacher-reported classroom behaviors at earlier ages were significantly correlated with youth conduct problems, confirming the continuity of conduct problems through childhood and adolescence. Self-reported conduct problems are elevated in children and adolescents with histories of early childhood malnutrition. Later vulnerability to increased conduct problems appears to be mediated by the more proximal neurobehavioral effects of the malnutrition on cognitive function and by adverse conditions in the early home environment.

The rise and fall of protein malnutrition in global health

PubMed Central

Semba, Richard D.

2016-01-01

BACKGROUND From the 1950s to the mid-1970s, United Nations (UN) agencies were focused on protein malnutrition as the major worldwide nutritional problem. The goal of this review is to examine this era of protein malnutrition, the reasons for its demise, and the aftermath. SUMMARY The UN Protein Advisory Group was established in 1955. International conferences were largely concerned about protein malnutrition in children. By the early 1970s, UN agencies were ringing the alarm about a “protein gap”. In The Lancet in 1974, Donald McLaren branded these efforts as “The Great Protein Fiasco”, declaring that the “protein gap” was a fallacy. The following year, John Waterlow, the scientist who led most of the efforts on protein malnutrition, admitted that a “protein gap” did not exist and that young children in developing countries only needed sufficient energy intake. The emphasis on protein malnutrition waned. It is recently apparent that quality protein and essential amino acids are missing in the diet and may have adverse consequences for child growth and the reduction of child stunting. KEY MESSAGES It may be time to rethink protein and return protein malnutrition back to the global health agenda using a balanced approach that includes all protective nutrients. PMID:27576545

Inequity and health. Is malnutrition really caused by poor nutrition?

PubMed

Bharmal, F Y

2000-08-01

To look at inequities leading to malnutrition and from the wider picture to find root causes and deal with them in order to alleviate malnutrition. Literature review. The health of the population is adversely affected by the inequities in the country. Women and children being most vulnerable are worst affected. The prevalence of Protein Energy Malnutrition (P.E.M.) in children under five years of age is 51 percent. Such a magnitude of malnutrition in a country, where availability of food per capita is more than adequate, points towards the fact that the inequities within the country are at the root of the problem. Poor income is not the only predictor of malnutrition, gender, urban-rural differences in access, utilization and quality of health care also influence health. In addition, there are some underlying factors such as illiteracy, unawareness of the mother about healthy behaviors, lack of decision-making power of women, along with deep-rooted cultural values of a patriarchal system. Malnutrition is caused by a multitude of factors, some of which are biological, others are environmental, cultural or social. Education of the invisible half of the population, who actually look after the children and the family, is an important strategy to alleviate this problem.

Risk factors for severe acute malnutrition in children below 5 y of age in India: a case-control study.

PubMed

Mishra, Kirtisudha; Kumar, Praveen; Basu, Srikanta; Rai, Kiran; Aneja, Satinder

2014-08-01

To determine the possible risk factors for severe acute malnutrition (SAM) in children below 5 y admitted in a hospital in north India. This case-control study was conducted in a medical college hospital in children below 5 y of age. All cases of SAM (diagnosed as per WHO definition) between 6 and 59 mo of age were compared with age-matched controls with weight for height above -2SD of WHO 2006 growth standards. Data regarding socio-demographic parameters, feeding practices and immunization were compared between the groups by univariable and multivariable logistic regression models. A total of 76 cases and 115 controls were enrolled. Among the 14 factors compared, maternal illiteracy, daily family income less than Rs. 200, large family size, lack of exclusive breast feeding in first 6 mo, bottle feeding, administration of pre-lacteals, deprivation of colostrum and incomplete immunization were significant risk factors for SAM. Regarding complementary feeding, it was the consistency, rather than the age of initiation, frequency and variety which showed a significant influence on occurrence of SAM. Multivariate analysis revealed that the risk of SAM was independently associated with 6 factors, namely, illiteracy among mothers, incomplete immunization, practice of bottle feeding, consistency of complementary feeding, deprivation of colostrum and receipt of pre-lacteals at birth. The present study identifies certain risk factors which need to be focused on during health planning and policy making related to children with SAM in India.

[Screening for malnutrition among hospitalized patients in a Colombian University Hospital].

PubMed

Cruz, Viviana; Bernal, Laura; Buitrago, Giancarlo; Ruiz, Álvaro J

2017-04-01

On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Dairy food supplementation may reduce malnutrition risk in institutionalised elderly.

PubMed

Iuliano, Sandra; Poon, Shirley; Wang, Xiaofang; Bui, Minh; Seeman, Ego

2017-01-01

Malnutrition in institutionalised elderly increases morbidity and care costs. Meat and dairy foods are high-quality protein sources so adequate intakes may reduce malnutrition risk. We aimed to determine whether inadequate intakes of meat and dairy foods contribute to malnutrition in institutionalised elderly. This cross-sectional study involved 215 elderly residents (70·2 % females, mean age 85·8 years) from twenty-one aged-care facilities in Melbourne, Australia. Dietary intake was assessed using observed plate waste. Food groups and serving sizes were based on the Australian Guide to Healthy Eating. Nutrient content was analysed using a computerised nutrient analysis software (Xyris). Malnutrition risk was assessed using the Mini Nutrition Assessment (MNA) tool; a score between 24 and 30 indicates normal nutritional status. Data were analysed using robust regression. Mean MNA score was 21·6 (sd 2·7). In total, 68 % of residents were malnourished or at risk of malnutrition (MNA score≤23·5). Protein intake was 87 (sd 28) % of the Australian recommended dietary intake (RDI). Consumption averaged 1 serving each of dairy foods and meat daily. Number of dairy and meat servings related to proportion of protein RDI (both P24 points). Provision of meat and dairy foods did not meet recommended levels. On the basis of current dietary intakes in aged-care residents, increasing consumption of dairy foods to the recommended four servings daily ensures protein adequacy and may reduce malnutrition risk in institutionalised elderly, and so reduce risk of comorbidities and costs associated with malnutrition.

Malnutrition and School Feeding. Bulletin, 1921, No. 37

ERIC Educational Resources Information Center

Gebhart, John C.

1922-01-01

Malnutrition is a term used to indicate a general condition of less than normal physical and mental vigor. While the causes of malnutrition are many, incorrect or inadequate diet appears all too often as one of the causes. School feeding, which affords not only an opportunity, to supplement the home food supply but also to teach correct food…

Malnutrition among Preschool-Aged Autistic Children in Oman

ERIC Educational Resources Information Center

Al-Farsi, Yahya M.; Al-Sharbati, Marwan M.; Waly, Mostafa I.; Al-Farsi, Omar A.; Al Shafaee, Mohammed A.; Deth, Richard C.

2011-01-01

To assess prevalence of malnutrition indicators among preschool children with autism spectrum disorder (ASD) a cross-sectional study was conducted among 128 Omani autistic children 3-5 years of age. Based on standardized z-scores, the overall prevalence of malnutrition was 9.2 per 100 preschool ASD children (95% CI 4.1, 11.6). The most common type…

Malnutrition and child feeding practices in Western Samoa.

PubMed

Jansen, A A

1977-12-01

Mild protein-calorie malnutrition is common in Western Samoa. Severe protein-calorie malnutrition is also an important cause of death in infants and toddlers, and anemia is frequently found in small children. This paper investigates child feeding practices because of its possible relationship with the occurrence of severe early malnutrition. Data on infant and toddler feeding practices were collected from 90 mothers from the town of Apia and 38 mothers from the island is Savai'i. Average age of mothers in Apia was 29.0 years and in Savai'i, 30 years. Most belonged to the low income group. Average interval between births in Apia was 22.3 months, in Savai'i, 25.7 months. The proportion of bottlefed children was much lower in Savai'i than in urban Apia, 28.2 vs. 57.9%. 31.3% of Apian mothers weaned their last child abruptly compared with 41.6% of Savai'i mothers. In Apia, weaning foods consisted of milk, meat, and other protein-rich foods; in Savai'i, taro, orange leaf tea, rice, and other were the main weaning foods. Generally, semisolids were not introduced before the child was more than 6 months of age. Some mothers in Savai'i appeared to give their children monotonous diet. A number of cultural taboos appear to affect the children's diet as well as that of pregnant and lactating mothers. Many women believed in them and would not eat or do certain things. Overall, it appears that many of the mothers are ignorant about the nutritional needs of their children. Almost 7% of the 0-5 year old children suffered from borderline malnutrition. 9% of the total number of admissions during the period October 1968 to April 1972 were malnourished children. The increase in borderline malnutrition and severe malnutrition among the children towards the end of the 1st year is attributed mainly to the late introduction of semisolid and solid foods. Other causes of malnutrition include lack of money, especially in urban areas, large families, changes in the diet because of higher

Clinical dietetic practice in the treatment of severe acute malnutrition in a high HIV setting.

PubMed

Biggs, C

2013-04-01

In Sub-Saharan Africa, children commonly present with severe acute malnutrition (SAM) complicated by HIV/AIDS. In 2005, the South African Department of Health implemented the World Health Organization (WHO) Ten Step programme for the inpatient treatment of SAM. Dietary management with F75 and F100 (where the terms F75 and F100 refer to a mixture of milk, sugar, oil and a vitamin and mineral mix) may not be appropriate for relatively well resourced settings such as South Africa. A structured questionnaire aiming to determine current clinical practice was e-mailed to all dietitians working in hospitals (n = 53) in KwaZulu-Natal who routinely treated SAM. When initially refeeding with no diarrhoea (ND), F75 was used exclusively by 16% of dietitians to treat infants, and by 42% of dietitians to treat children. If diarrhoea, 16% of dietitians used F75 to treat infants/children. Acidified infant formula (IF) was given if ND and lactose-free IF was given if diarrhoea. Children were often started on a lactose-free F100 equivalent omitting cautious refeeding. Some gave reduced amounts for cautious refeeding; however, the feeds osmolality was too high. The use of partially hydrolysed feeds increased if the child/infant presented with diarrhoea and/or hypoalbuminea. In the post-initial feeding phase, approximately 14% of dietitians used F100 to treat infants/children. Most gave F100 equivalents as high-energy infant/paediatric formulas. The dietetic practices for infants with SAM followed current expert opinion closely rather than the WHO protocol. The omission of cautious refeeding follows neither current expert opinion, nor the WHO protocol, and may predispose to the refeeding syndrome. Limited evidence indicates that partially hydrolysed formulas are less effective than low lactose low osmolality feeds in the treatment of SAM. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

Do Children with Uncomplicated Severe Acute Malnutrition Need Antibiotics? A Systematic Review and Meta-Analysis

PubMed Central

Alcoba, Gabriel; Kerac, Marko; Breysse, Serge; Salpeteur, Cécile; Galetto-Lacour, Annick; Briend, André; Gervaix, Alain

2013-01-01

Background Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation. Methods and Findings OVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT), five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05). However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p = 0.27). Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27–55%) vs 22% (IQR 17–23%) and population-weighted-means 52.9% (range 23–57%) vs 35.4% (range 6.7–42%). Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM. Conclusions The evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use

Role of T Cells in Malnutrition and Obesity

PubMed Central

Gerriets, Valerie A.; MacIver, Nancie J.

2014-01-01

Nutritional status is critically important for immune cell function. While obesity is characterized by inflammation that promotes metabolic syndrome including cardiovascular disease and insulin resistance, malnutrition can result in immune cell defects and increased risk of mortality from infectious diseases. T cells play an important role in the immune adaptation to both obesity and malnutrition. T cells in obesity have been shown to have an early and critical role in inducing inflammation, accompanying the accumulation of inflammatory macrophages in obese adipose tissue, which are known to promote insulin resistance. How T cells are recruited to adipose tissue and activated in obesity is a topic of considerable interest. Conversely, T cell number is decreased in malnourished individuals, and T cells in the setting of malnutrition have decreased effector function and proliferative capacity. The adipokine leptin, which is secreted in proportion to adipocyte mass, may have a key role in mediating adipocyte-T cell interactions in both obesity and malnutrition, and has been shown to promote effector T cell function and metabolism while inhibiting regulatory T cell proliferation. Additionally, key molecular signals are involved in T cell metabolic adaptation during nutrient stress; among them, the metabolic regulator AMP kinase and the mammalian target of rapamycin have critical roles in regulating T cell number, function, and metabolism. In summary, understanding how T cell number and function are altered in obesity and malnutrition will lead to better understanding of and treatment for diseases where nutritional status determines clinical outcome. PMID:25157251

[Estimates of the prevalence of child malnutrition in Brazilian municipalities in 2006].

PubMed

Benício, Maria Helena D'Aquino; Martins, Ana Paula Bortoletto; Venancio, Sonia Isoyama; Barros, Aluísio Jardim Dornellas de

2013-06-01

To estimate the prevalence of malnutrition in children for all Brazilian municipalities. A multilevel logistic regression model was used to estimate the individual probability of malnutrition in 5,507 Brazilian municipalities in 2006, in terms of predictive factors grouped according to hierarchical levels. The response variable was child malnutrition (children aged from six to 59 months with height for age and sex below -2 z-scores, according to the World Health Organization standard). The predictive variables were determinants of malnutrition measured similarly by the National Demographics and Health Survey-2006 and the Sample from the 2000 Demographic Census. At level 1 (individual): sex and age, level 2 (household): socioeconomic variables, water and indoor plumbing, urban or rural area and level 3 (municipal): location of the municipality and coverage of the Family Health Strategy (FHS) in 2006. The study detected a statistically significant chance of malnutrition in male children, those living in households with two or more individuals per room, those belonging to the lowest quintiles of the socioeconomic score, those with three or more children under five in the household, those with no access to running water or located in the North. There was a negative dose-response association between FHS coverage and the chance of malnutrition (p = 0.007). FHS coverage in the municipality equal to or greater than 70% showed a 45% reduction in the chance of infant malnutrition. Estimates of the prevalence of child malnutrition show that most of the cities have the risk of malnutrition under control, very low or low. Risks of greater magnitude exist only in 158 municipalities in the North Region. Childhood malnutrition as a public health problem is concentrated in the cities of the North region, where FHS coverage is lower. A protective effect of FHS in relation to child malnutrition was found in the country as a whole, irrespective of other determinants of the problem.

Prevalence of anemia and malnutrition and their association in elderly nursing home residents.

PubMed

Sahin, Sevnaz; Tasar, Pinar Tosun; Simsek, Hatice; Çicek, Zeynep; Eskiizmirli, Hulya; Aykar, Fisun Senuzun; Sahin, Fahri; Akcicek, Fehmi

2016-10-01

Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents. Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the χ (2) test and logistic regression analysis. The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively). The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.

Malnutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem!

PubMed Central

Konturek, Peter C.; Herrmann, Hans J.; Schink, Kristin; Neurath, Markus F.; Zopf, Yurdagül

2015-01-01

Background Malnutrition is an under-recognized problem in hospitalized patients. Despite systematic screening, the prevalence of malnutrition in the hospital did not decrease in the last few decades. The aim of our study was to evaluate the prevalence of malnutrition and to determine the explicit daily calorie intake of hospitalized patients, to identify the risk factors of developing malnutrition during hospitalization and the effect on the financial reimbursement according to the German DRG-system. Material/Methods 815 hospitalized patients were included in this study. The detection of malnutrition was based on the nutritional-risk-screening (NRS) and subjective-global-assessment (SGA) scores. A trained investigator recorded the daily calorie and fluid intake of each patient. Furthermore, clinical parameters, and the financial reimbursement were evaluated. Results The prevalence of malnutrition was 53.6% according to the SGA and 44.6% according the NRS. During hospitalization, patients received on average 759.9±546.8 kcal/day. The prevalence of malnutrition was increased in patients with hepatic and gastrointestinal disease and with depression or dementia. The most important risk factors for malnutrition were bed rest and immobility (OR=5.88, 95% CI 2.25–15.4). In 84.5% of patient records, malnutrition was not correctly coded, leading to increased financial losses according to the DRG-system (94.908 Euros). Conclusions Hospitalized patients suffer from inadequate nutritional therapy and the risk for developing malnutrition rises during the hospital stay. The early screening of patients for malnutrition would not only improve management of nutritional therapy but also, with adequate coding, improve financial reimbursement according to the DRG-system. PMID:26431510

Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia.

PubMed

Endris, Neima; Asefa, Henok; Dube, Lamessa

2017-01-01

Child malnutrition continues to be the leading public health problem in developing countries. In Ethiopia, malnutrition is a leading cause of child illness and death. Recently the composite index of anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete picture compared with the previous conventional indices. In this study, CIAF was used to determine the prevalence of malnutrition among children aged 0-59 months in rural Ethiopia. Data was extracted from the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) for this study. A total of 3095 children were included in the analysis. The composite index of anthropometric failure (CIAF) was used to measure the nutritional status of the children. Logistic regression was fitted, to identify factors associated with malnutrition among children in rural Ethiopia, using STATA 13. The prevalence of malnutrition among rural children in Ethiopia was 48.5%. Age of the children, preceding birth interval, educated status of mother, wealth status, and region were factors independently associated with nutritional status of children in rural Ethiopia. The prevalence of malnutrition among children in rural Ethiopia was high. A child older than 12 months, having uneducated mother, living in a household with poor wealth status, born with short birth interval, and living in some region of the country are associated with increased odds of being malnourished.

Malnutrition and Gastrointestinal and Respiratory Infections in Children: A Public Health Problem

PubMed Central

Rodríguez, Leonor; Cervantes, Elsa; Ortiz, Rocío

2011-01-01

Infectious disease is the major cause of morbidity and mortality in developing countries, particularly in children. Increasing evidence suggests that protein-calorie malnutrition is the underlying reason for the increased susceptibility to infections observed in these areas. Moreover, certain infectious diseases also cause malnutrition, which can result in a vicious cycle. Malnutrition and bacterial gastrointestinal and respiratory infections represent a serious public health problem. The increased incidence and severity of infections in malnourished children is largely due to the deterioration of immune function; limited production and/or diminished functional capacity of all cellular components of the immune system have been reported in malnutrition. In this review, we analyze the cyclical relationship between malnutrition, immune response dysfunction, increased susceptibility to infectious disease, and metabolic responses that further alter nutritional status. The consequences of malnutrition are diverse and included: increased susceptibility to infection, impaired child development, increased mortality rate and individuals who come to function in suboptimal ways. PMID:21695035

Hospital Admissions for Malnutrition and Dehydration in Patients With Dementia.

PubMed

Marshall, Katherine A; Burson, Rosanne; Gall, Kristyn; Saunders, Mitzi M

2016-01-01

Dehydration and malnutrition are commonly experienced by patients with dementia and can result in hospitalizations and decreased quality of life. The purpose of this study was to explore and describe retrospectively, the incidence and correlations of variables that may precede hospitalizations for dehydration/malnutrition in the community-dwelling patient with dementia. Data from the Outcome and Assessment Information Set (OASIS) Start of Care (SOC) on 44 patients served by a Michigan home care agency were retrieved for analysis. This study did not reveal any single or collection of variables that would predict risk for hospitalization for dehydration/malnutrition. With the lack of specific predictors of hospitalization related to dehydration and malnutrition, clinicians need to place high priority on risk-lowering strategies and preventive education for patients, family, and caregivers.

Infant malnutrition is associated with persisting attention deficits in middle adulthood.

PubMed

Galler, Janina R; Bryce, Cyralene P; Zichlin, Miriam L; Fitzmaurice, Garrett; Eaglesfield, G David; Waber, Deborah P

2012-04-01

Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.

Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia

PubMed Central

Endris, Neima; Asefa, Henok

2017-01-01

Background Child malnutrition continues to be the leading public health problem in developing countries. In Ethiopia, malnutrition is a leading cause of child illness and death. Recently the composite index of anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete picture compared with the previous conventional indices. In this study, CIAF was used to determine the prevalence of malnutrition among children aged 0–59 months in rural Ethiopia. Methods Data was extracted from the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) for this study. A total of 3095 children were included in the analysis. The composite index of anthropometric failure (CIAF) was used to measure the nutritional status of the children. Logistic regression was fitted, to identify factors associated with malnutrition among children in rural Ethiopia, using STATA 13. Result The prevalence of malnutrition among rural children in Ethiopia was 48.5%. Age of the children, preceding birth interval, educated status of mother, wealth status, and region were factors independently associated with nutritional status of children in rural Ethiopia. Conclusion The prevalence of malnutrition among children in rural Ethiopia was high. A child older than 12 months, having uneducated mother, living in a household with poor wealth status, born with short birth interval, and living in some region of the country are associated with increased odds of being malnourished. PMID:28596966

Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.

PubMed

Rogers, Eleanor; Ali, Muhammad; Fazal, Shahid; Kumar, Deepak; Guerrero, Saul; Hussain, Imtiaz; Soofi, Sajid; Alvarez Morán, Jose Luis

2018-02-01

To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Cross-sectional quality-of-care study. The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. LHW implementing treatment for uncomplicated SAM in the community. Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

The nutritional status and factors contributing to malnutrition in children with chronic pancreatitis.

PubMed

Kolodziejczyk, E; Wejnarska, K; Dadalski, M; Kierkus, J; Ryzko, J; Oracz, G

2014-01-01

The present study was undertaken to determine the prevalence of malnutrition among children with chronic pancreatitis (CP). Furthermore, we aimed to evaluate the relationship between etiological factors of CP, its clinical characteristics, and the severity of malnutrition. The study included 208 children with CP (113 girls and 95 boys; mean age: 10.8 years, range: 1.6-18 years), hospitalized at our center between 1988 and 2012. The severity of malnutrition was graded on the basis of Cole's ratios, and its prevalence was analyzed according to the etiological factors of pancreatitis. Moreover, the analysis of discrimination was performed to identify the factors contributing to malnutrition among the following variables: age at CP onset, duration of CP, number of CP exacerbations, the number of ERCPs performed, the grade of pancreatic damage documented on imaging, co-occurrence of diabetes, and the results of 72-h fecal fat quantification. We documented features of malnutrition in 52 (25%) children with CP, including 36 (17.3%) patients with moderate malnutrition, and 2 (0.96%) with severe malnutrition. There was no significant difference in the prevalence of malnutrition between groups of patients with various etiological factors of chronic pancreatitis. The age at CP onset showed the best discrimination ability of malnourished patients: the mean age at disease onset in a subgroup of malnourished children was significantly higher than in children with Cole's index >85%. A considerable percentage of children with CP can suffer from clinically significant malnutrition. Later age at CP onset predisposes to development of malnutrition. Copyright © 2014 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010.

PubMed

Agarwal, Ekta; Ferguson, Maree; Banks, Merrilyn; Bauer, Judith; Capra, Sandra; Isenring, Elisabeth

2012-02-01

One aim of the Australasian Nutrition Care Day Survey was to determine the nutritional status and dietary intake of acute care hospital patients. Dietitians from 56 hospitals in Australia and New Zealand completed a 24-h survey of nutritional status and dietary intake of adult hospitalised patients. Nutritional risk was evaluated using the Malnutrition Screening Tool. Participants 'at risk' underwent nutritional assessment using Subjective Global Assessment. Based on the International Classification of Diseases (Australian modification), participants were also deemed malnourished if their body mass index was <18.5 kg/m(2). Dietitians recorded participants' dietary intake at each main meal and snacks as 0%, 25%, 50%, 75%, or 100% of that offered. 3122 patients (mean age: 64.6 ± 18 years) participated in the study. Forty-one percent of the participants were "at risk" of malnutrition. Overall malnutrition prevalence was 32%. Fifty-five percent of malnourished participants and 35% of well-nourished participants consumed ≤50% of the food during the 24-h audit. "Not hungry" was the most common reason for not consuming everything offered during the audit. Malnutrition and sub-optimal food intake is prevalent in acute care patients across hospitals in Australia and New Zealand and warrants appropriate interventions. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Malnutrition screening tools for hospitalized children.

PubMed

Hartman, Corina; Shamir, Raanan; Hecht, Christina; Koletzko, Berthold

2012-05-01

Malnutrition is highly prevalent in hospitalized children and has been associated with relevant clinical outcomes. The scope of this review is to describe the five screening tools and the recent European Society for Parenteral and Enteral Nutrition (ESPEN) research project aimed at establishing agreed, evidence-based criteria for malnutrition and screening tools for its diagnosis in hospitalized children. Five nutrition screening tools have recently been developed to identify the risk of malnutrition in hospitalized children. These tools have been tested to a limited extent by their authors in the original published studies but have not been validated by other independent studies. So far, such screening tools have not been established widely as part of standard pediatric care. Although nutrition screening and assessment are recommended by European Society for Parenteral and Enteral Nutrition and the European Society for Pediatric Gastroenterology Hepatology and Nutrition and are often accepted to be required by healthcare facilities, there is no standardized approach to nutritional screening for pediatric inpatients. The near future will provide us with comparative data on the existing tools which may contribute to delineating a standard for useful nutrition screening in pediatrics.

Update on the prevalence of malnutrition among children in Asia.

PubMed

Khor, Geok Lin

2003-12-01

Approximately 70.0% of the world's malnourished children live in Asia, resulting in the region having the highest concentration of childhood malnutrition. About half of the preschool children are malnourished ranging from 16.0% in the People's Republic of China to 64.0% in Bangladesh. Prevalence of stunting and underweight are high especially in South Asia where one in every two preschool children is stunted. Besides protein-energy malnutrition, Asian children also suffer from micronutrient deficiency. Iron deficiency anaemia affects 40.0-50.0% of preschool and primary school children. Nearly half of all vitamin A deficiency and xeropthalmia in the world occurs in South and Southeast Asia, with large numbers of cases in India (35.3 million), Indonesia (12.6 million) and China (11.4 million). Another major micronutrient problem in the region is iodine deficiency disorders, which result in high goiter rates as manifested in India, Pakistan and parts of Indonesia. While under-nutrition problem persists, overweight problem in children has emerged in Asia, including Taiwan, Singapore and urban China and Malaysia. The etiology of childhood malnutrition is complex involving interactions of multiple determinants that include biological, cultural and socio-economic influences. Protein-energy malnutrition and micronutrient deficiency leading to early growth failure often can be traced to poor maternal nutritional and health care before and during pregnancy, resulting in intrauterine growth retardation and children born with low birth weight. While significant progress has been achieved over the past 30 years in reducing the proportion of malnourished children in developing countries, nonetheless, malnutrition persists affecting large numbers of children. The socio-economic cost of the malnutrition burden to the individual, family and country is high resulting in lower cognitive outcomes in children and lower adult productivity. Interventions that are cost-effective and

Effect of childhood malnutrition on salivary flow and pH.

PubMed

Psoter, Walter J; Spielman, Andrew L; Gebrian, Bette; St Jean, Rudolph; Katz, Ralph V

2008-03-01

While protein-energy malnutrition may have multiple effects on oral tissues and subsequent disease development, reports of the effect of malnutrition on the human salivary glands are sparse. A retrospective cohort study of the effect of early childhood protein-energy malnutrition (EC-PEM) and adolescent nutritional status on salivary flow and pH was conducted with rural Haitian children, ages 11-19 years (n=1017). Malnutrition strata exposure cohorts were based on 1988-1996 weight-for-age records which covered the birth through 5-year-old period for all subjects. Then, data on current anthropometrical defined nutritional status categories, stimulated and unstimulated salivary flow rates, and salivary pH were collected for the same subjects of 11-19 years old during field examinations in the summer of 2005. Multivariate analysis of variance (MANOVA) was used for the analyses. Stimulated and unstimulated salivary flow rates were reduced at statistically significant levels in subjects who had experienced severe malnutrition in their early childhood or who had continuing nutrition stress which resulted in delayed growth, as measured at ages 11-19 years. Salivary pH demonstrated little clinically meaningful variability between malnourished and nonmalnourished groups. This study is the first to report of a continuing effect on diminished salivary gland function into adolescence as a result of early childhood malnutrition (EC-PEM) and suggests that exocrine glandular systems may be compromised for extended periods following EC-PEM, which may have important implications for the body's systemic antimicrobial defences.

Change in quality of malnutrition surveys between 1986 and 2015.

PubMed

Grellety, Emmanuel; Golden, Michael H

2018-01-01

Representative surveys collecting weight, height and MUAC are used to estimate the prevalence of acute malnutrition. The results are then used to assess the scale of malnutrition in a population and type of nutritional intervention required. There have been changes in methodology over recent decades; the objective of this study was to determine if these have resulted in higher quality surveys. In order to examine the change in reliability of such surveys we have analysed the statistical distributions of the derived anthropometric parameters from 1843 surveys conducted by 19 agencies between 1986 and 2015. With the introduction of standardised guidelines and software by 2003 and their more general application from 2007 the mean standard deviation, kurtosis and skewness of the parameters used to assess nutritional status have each moved to now approximate the distribution of the WHO standards when the exclusion of outliers from analysis is based upon SMART flagging procedure. Where WHO flags, that only exclude data incompatible with life, are used the quality of anthropometric surveys has improved and the results now approach those seen with SMART flags and the WHO standards distribution. Agencies vary in their uptake and adherence to standard guidelines. Those agencies that fully implement the guidelines achieve the most consistently reliable results. Standard methods should be universally used to produce reliable data and tests of data quality and SMART type flagging procedures should be applied and reported to ensure that the data are credible and therefore inform appropriate intervention. Use of SMART guidelines has coincided with reliable anthropometric data since 2007.

Predictors of oedema among children hospitalized with severe acute malnutrition in Jimma University Hospital, Ethiopia: a cross sectional study.

PubMed

Girma, Tsinuel; Kæstel, Pernille; Mølgaard, Christian; Michaelsen, Kim F; Hother, Anne-Louise; Friis, Henrik

2013-12-06

Severe acute malnutrition has two main clinical manifestations, i.e., oedematous and non-oedematous. However, factors associated with oedema are not well established. Children 0.5-14 years of age with SAM (MUAC < 11.0 cm or weight-for-height < 70 % of median and/or nutritional oedema) admitted to the nutrition unit were included. Information on infections before and during admission was collected together with anthropometry. Predictors of oedema was analysed separately for younger (< 60 months) and older children (≥ 60 months). 351 children were recruited (median age: 36 months (interquartile range 24 to 60); 43.3% females). Oedema was detected in 61.1%. The prevalence of oedema increased with age, peaked at 37-59 months (75%) and declined thereafter. Infection was more common in the younger group (33% vs. 8.9%, p < 0.001) and in this group children with oedema had less infections (25.2% vs. 45.1%, p = 0.001). In the older group the prevalence of infections was not different between oedematous and non-oedematous children (5.5% v. 14.3%, p = 0.17). In the younger group oedema was less common in children with TB (OR = 0.20, 95% CI: 0.06, 0.70) or diarrhea (OR = 0.40, 95% CI: 0.21, 0.73). The proportion of oedema in SAM peaked at three to five years of age and a considerable proportion was above 5 years. Furthermore, the prevalence of infection seemed to be lower among children with oedema. Further studies are needed to better understand the role of infection-immunity interaction.

Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana.

PubMed

Aheto, Justice Moses K; Keegan, Thomas J; Taylor, Benjamin M; Diggle, Peter J

2015-11-01

Childhood malnutrition adversely affects short- and long-term health and economic well-being of children. Malnutrition is a global challenge and accounts for around 40% of under-five mortality in Ghana. Limited studies are available indicating determinants of malnutrition among children. This study investigates prevalence and determinants of malnutrition among children under-five with the aim of providing advice to policymakers and other stakeholders responsible for the health and nutrition of children. The study used data from the 2008 Ghana Demographic and Health Survey (GDHS). Analyses were conducted on 2083 children under 5 years old nested within 1641 households with eligible anthropometric measurements, using multilevel regression analysis. Results from the multilevel models were used to compute probabilities of malnutrition. This study observed that 588 (28%), 276 (13%), and 176 (8%) of the children were moderately 'stunted', moderately 'underweight', and moderately 'wasted' respectively. Older ages are associated with increased risk of stunting and underweight. Longer breast-feeding duration, multiple births, experience of diarrhoeal episodes, small size at birth, absence of toilet facilities in households, poor households, and mothers who are not covered by national health insurance are associated with increased risk of malnutrition. Increase in mother's years of education and body mass index are associated with decreased malnutrition. Strong residual household-level variations in childhood nutritional outcomes were found. Policies and intervention strategies aimed at improving childhood nutrition and health should address the risk factors identified and the need to search for additional risk factors that might account for the unexplained household-level variations. © 2015 John Wiley & Sons Ltd.

Post-Weaning Protein Malnutrition Increases Blood Pressure and Induces Endothelial Dysfunctions in Rats

PubMed Central

Siman, Fabiana D. M.; Silveira, Edna A.; Meira, Eduardo F.; da Costa, Carlos P.; Vassallo, Dalton V.; Padilha, Alessandra S.

2012-01-01

Malnutrition during critical periods in early life may increase the subsequent risk of hypertension and metabolic diseases in adulthood, but the underlying mechanisms are still unclear. We aimed to evaluate the effects of post-weaning protein malnutrition on blood pressure and vascular reactivity in aortic rings (conductance artery) and isolated-perfused tail arteries (resistance artery) from control (fed with Labina®) and post-weaning protein malnutrition rats (offspring that received a diet with low protein content for three months). Systolic and diastolic blood pressure and heart rate increased in the post-weaning protein malnutrition rats. In the aortic rings, reactivity to phenylephrine (10−10–3.10−4 M) was similar in both groups. Endothelium removal or L-NAME (10−4 M) incubation increased the response to phenylephrine, but the L-NAME effect was greater in the aortic rings from the post-weaning protein malnutrition rats. The protein expression of the endothelial nitric oxide isoform increased in the aortic rings from the post-weaning protein malnutrition rats. Incubation with apocynin (0.3 mM) reduced the response to phenylephrine in both groups, but this effect was higher in the post-weaning protein malnutrition rats, suggesting an increase of superoxide anion release. In the tail artery of the post-weaning protein malnutrition rats, the vascular reactivity to phenylephrine (0.001–300 µg) and the relaxation to acetylcholine (10−10–10−3 M) were increased. Post-weaning protein malnutrition increases blood pressure and induces vascular dysfunction. Although the vascular reactivity in the aortic rings did not change, an increase in superoxide anion and nitric oxide was observed in the post-weaning protein malnutrition rats. However, in the resistance arteries, the increased vascular reactivity may be a potential mechanism underlying the increased blood pressure observed in this model. PMID:22529948

Hemodialysis and nutritional status in children: malnutrition and cachexia.

PubMed

Fischbach, Michel; Dheu, Céline; Seuge, Laure; Orfanos, Nadia

2009-01-01

Malnutrition is a common state in chronic hemodialyzed children. More than malnutrition, which infers that dietary supplementation would be curative, cachexia, which implies loss of protein stores, are combined factors of impaired linear growth and reduced muscle mass in uremic patients. Adequate diet to prevent malnutrition is of major importance. But to avoid cachexia in children on chronic hemodialysis, the management of acidosis, inflammation, abnormal metabolic rate, and endocrine disturbances should not, be forgotten. Daily hemodialysis regimen using convective flow therapy and ultrapure dialysate, i.e., on line hemodiafiltration together with growth hormone therapy, appears as a hopeful strategy for the chronic dialyzed child to achieve catch-up growth, a parameter of optimal nutrition.

BacMam virus-based surface display of the infectious bronchitis virus (IBV) S1 glycoprotein confers strong protection against virulent IBV challenge in chickens.

PubMed

Zhang, Jie; Chen, Xiao-Wei; Tong, Tie-Zhu; Ye, Yu; Liao, Ming; Fan, Hui-Ying

2014-02-03

Avian infectious bronchitis virus (IBV) is associated with production inefficiencies in domestic fowl, and causes massive economic losses to the poultry industry worldwide. Progress has been made in designing novel and efficient candidate vaccines to control IBV infection. BacMam virus, a modified baculovirus mediating transgene expression under the control of a mammalian promoter, has emerged as a versatile and safe vector during vaccine development. In previous work, we generated the BacMam virus Ac-CMV-S1, which expressed the S1 glycoprotein of IBV-M41. We showed that Ac-CMV-S1 induced excellent cellular immunity, but did not confer adequate protection in chickens compared with the conventional inactivated vaccine. In the current study, we generated an improved BacMam virus, BV-Dual-S1. This virus displayed the S1 glycoprotein on the baculovirus envelope, and was capable of expressing it in mammalian cells. BV-Dual-S1 elicited stronger humoral and cell-mediated immune responses, and showed greater capacity for induction of cytotoxic T lymphocyte responses, compared with Ac-CMV-S1 in specific pathogen-free chickens. A significant difference was not observed for protection rates between chickens immunized with BV-Dual-S1 (83%) or inactivated vaccine (89%) following challenge with virulent IBV-M41. Our findings show that the protective efficacy of BV-Dual-S1 could be significantly enhanced by baculovirus display technology. BacMam virus-based surface display strategies could serve as effective tools in designing vaccines against IB and other infectious diseases. Copyright © 2013. Published by Elsevier Ltd.

Pharmacological Effects of a Monoclonal Antibody against 6-Monoacetylmorphine upon Heroin-Induced Locomotor Activity and Pharmacokinetics in Mice.

PubMed

Kvello, Anne Marte Sjursen; Andersen, Jannike Mørch; Øiestad, Elisabeth Leere; Mørland, Jørg; Bogen, Inger Lise

2016-08-01

Immunotherapy can provide a supplemental treatment strategy against heroin use on the principle of sequestering the active drug in the bloodstream, thereby reducing its distribution to the brain. Previous studies have shown that heroin's first metabolite, 6-monoacetylmorphine (6-MAM), is the main mediator of acute heroin effects. The objective of the present study was to characterize the pharmacological potential of a monoclonal antibody against 6-MAM (anti-6-MAM mAb) to counteract the heroin response. The individual contributions from heroin and 6-MAM to heroin effects were also examined by pretreating mice with anti-6-MAM mAb (10-100 mg/kg) prior to either heroin or 6-MAM injection (1.25-2.5 μmol/kg). The opioid-induced behavioral response was assessed in a locomotor activity test, followed by opioid and antibody quantification in blood and brain tissue. Pretreatment with mAb caused a profound reduction of heroin- and 6-MAM-induced behavior, accompanied by correspondingly decreased levels of 6-MAM in brain tissue. mAb pretreatment was more efficient against 6-MAM injection than against heroin, leading to an almost complete blockade of 6-MAM-induced effects. mAb pretreatment was unable to block the immediate (5-minute) transport of active metabolites across the blood-brain barrier after heroin injection, indicating that heroin itself appears to enhance the immediate delivery of 6-MAM to the brain. The current study provides additional evidence that 6-MAM sequestration is crucial for counteracting the acute heroin response, and demonstrates the pharmacological potential of immunotherapy against heroin use. Copyright © 2016 by The American Society for Pharmacology and Experimental Therapeutics.

The multidimensional background of malnutrition among rural older individuals in Bangladesh--a challenge for the Millennium Development Goal.

PubMed

Ferdous, Tamanna; Kabir, Zarina Nahar; Wahlin, Ake; Streatfield, Kim; Cederholm, Tommy

2009-12-01

To investigate the associations and relative impact of illness, socio-economic and social indicators for nutritional status among elderly persons in rural Bangladesh. A multidisciplinary, cross-sectional study employing home interviews to collect information on demographic, socio-economic and social status; clinical examination to classify medical diagnoses; and Mini Nutritional Assessment (MNA) to assess the nutritional status of each participant. Matlab, Bangladesh. A total of 625 randomly selected individuals (>or=60 years of age) participated in home interviews and 473 underwent clinical examination. Complete information on nutritional status was available for 457 individuals, median age 68 years, 55 % women. Twenty-six per cent of the elderly participants were undernourished and 62 % were at risk of malnutrition according to MNA. More than three-quarters of the participants had acute infections, 66 % suffered from chronic illnesses, 36 % had sensory impairments and 81 % were suffering from gastrointestinal disorders. Acute infections (P < 0.001), gastrointestinal disorders (P < 0.01), depressive symptoms (P < 0.001) and impaired cognitive function (P < 0.01) were significantly and independently associated with poorer nutritional status. Moreover, female gender (P < 0.05), having no income (P < 0.01), being illiterate (P < 0.01) and not receiving regular financial support (P < 0.05) were also independently associated with poor nutritional status. Malnutrition among elderly people in rural Bangladesh is associated with female gender, medical, psychological, socio-economic and social indicators. A multidimensional approach is probably needed to reduce undernutrition in older populations in low-income countries like Bangladesh.

Protein - Calorie Malnutrition in Children and its Relation to Psychological Development and Behavior

ERIC Educational Resources Information Center

Latham, Michael C.

1974-01-01

Encompassing only human and excluding animal studies, this review surveys the literature on protein-calorie malnutrition and its possible role in retarding psychological, intellectual or behavioral development. Areas reviewed include types of protein-calorie malnutrition, the effects of malnutrition on brain development, cross-sectional and…

[Malnutrition screening in hospitalized children: influence of the hospital unit on its management].

PubMed

Marteletti, O; Caldari, D; Guimber, D; Mention, K; Michaud, L; Gottrand, F

2005-08-01

The aims of this study were to assess the prevalence of malnutrition in a pediatric population hospitalized in a French regional hospital and to evaluate the influence of type of hospital unit (pediatric or not) in the screening and the management of malnutrition. This one-day cross-sectional survey was performed in three different seasons during 2003. Every child aged 2 months to 16 years old, hospitalized for more than 48 hours was included. Weight for height, Z-score and Body Mass Index Z-score were used for nutritional assessment. Type of hospitalisation unit, date of admission, associated diagnosis, screening and treatment of malnutrition were also taken into account. Two hundred and eighty hospitalized children were undernourished (11%) and thirty-one children were obese (11%) with no difference in prevalence of malnutrition between pediatric and non-pediatric units. At the time of the study, malnutrition was recognized in one third of the children, at a similar rate whatever the type of hospitalized unit. The children hospitalized in pediatrics wards benefited more frequently from nutritional intervention, i.e. dietician care (43 vs. 16% P < 0.01). Prevalence of malnutrition in hospitalized children is low and the same in pediatric or non-pediatric units. Screening of malnutrition remains unsatisfactory in hospital. However, malnutrition is more frequently treated in pediatric unit compared with non-pediatric unit.

Factors associated with malnutrition in adolescent and adult patients with cystic fibrosis.

PubMed

Barni, Gabriela Cristofoli; Forte, Gabriele Carra; Forgiarini, Luis Felipe; Abrahão, Claudine Lacerda de Oliveira; Dalcin, Paulo de Tarso Roth

2017-01-01

To determine the prevalence of malnutrition in patients attending an adult cystic fibrosis (CF) program and to investigate the associations of malnutrition with the clinical characteristics of those patients. This was a cross-sectional study involving patients with clinically stable CF patients (16 years of age or older). The patients underwent clinical assessment, nutritional assessments, pulmonary function tests, and pancreatic function assessment. They also completed a questionnaire regarding diet compliance. On the basis of their nutritional status, the patients were classified divided into three groups: adequate nutrition; at nutritional risk; and malnutrition. The study has included 73 patients (mean age, 25.6 ± 7.3 years), 40 of whom (54.8%) were female. The mean body mass index was 21.0 ± 3.0 kg/m2 and the mean FEV1 was 59.7 ± 30.6% of predicted. In this sample of patients, 32 (43.8%), 23 (31.5%), and 18 (24.7%) of the patients were allocated to the adequate nutrition, nutritional risk, and malnutrition groups, respectively. The logistic regression analysis identified three independent factors associated with the risk of malnutrition: Shwachman-Kulczycki score, percent predicted FEV1; and age. Malnutrition remains a common complication in adolescents and adults with CF, despite dietary advice. Malnutrition is associated with age, clinical severity, and lung function impairment.

[Death rate by malnutrition in children under the age of five, Colombia].

PubMed

Quiroga, Edwin Fernando

2012-01-01

Much higher mortalities occur in children under five in developing countries with high poverty rates compared with developed countries. Causes of death are related to perinatal conditions, measles, HIV/AIDS, diarrhea, respiratory diseases and others. Throughout the world, malnutrition has been identified as the underlying cause of approximately half of these deaths. Death rate due to malnutrition was described using an adjusted method that takes into account the difficulties of identifying malnutrition as a direct cause of death. A descriptive study included analysis of the International Classification of Diseases (ICD-10) vital statistics from 2003-2007. Death rates were estimated, a method of analysis of multiple causes was applied for infectious diseases, along with calculations of death probabilities. Malnutrition was associated with infectious diseases. The frequency of infectious disease as a direct cause of death was almost seven times higher in cases with the antecedent of malnutrition. When adjusted death rate values were used, the initial value increased nearly five times. The probability of death after the adjustment for inadequate classification increased approximately four times. The Analysis of Multiple Causes Method was established as an effective method in analyzing malnutrition and infectious diesease mortality in Colombia. Malnutrition may be a direct underlying cause of death in one of eight deaths in children <1 year old and one of three deaths in 1-4-year-olds.

Household and community socioeconomic influences on early childhood malnutrition in Africa.

PubMed

Fotso, Jean-Christophe; Kuate-Defo, Barthelemy

2006-05-01

This paper uses multilevel modelling and Demographic and Health Survey data from five African countries to investigate the relative contributions of compositional and contextual effects of socioeconomic status and place of residence in perpetuating differences in the prevalence of malnutrition among children in Africa. It finds that community clustering of childhood malnutrition is accounted for by contextual effects over and above likely compositional effects, that urban-rural differentials are mainly explained by the socioeconomic status of communities and households, that childhood malnutrition occurs more frequently among children from poorer households and/or poorer communities and that living in deprived communities has an independent effect in some instances. This study also reveals that socioeconomic inequalities in childhood malnutrition are more pronounced in urban centres than in rural areas.

Extending MAM5 Meta-Model and JaCalIV E Framework to Integrate Smart Devices from Real Environments

PubMed Central

2016-01-01

This paper presents the extension of a meta-model (MAM5) and a framework based on the model (JaCalIVE) for developing intelligent virtual environments. The goal of this extension is to develop augmented mirror worlds that represent a real and virtual world coupled, so that the virtual world not only reflects the real one, but also complements it. A new component called a smart resource artifact, that enables modelling and developing devices to access the real physical world, and a human in the loop agent to place a human in the system have been included in the meta-model and framework. The proposed extension of MAM5 has been tested by simulating a light control system where agents can access both virtual and real sensor/actuators through the smart resources developed. The results show that the use of real environment interactive elements (smart resource artifacts) in agent-based simulations allows to minimize the error between simulated and real system. PMID:26926691

Extending MAM5 Meta-Model and JaCalIV E Framework to Integrate Smart Devices from Real Environments.

PubMed

Rincon, J A; Poza-Lujan, Jose-Luis; Julian, V; Posadas-Yagüe, Juan-Luis; Carrascosa, C

2016-01-01

This paper presents the extension of a meta-model (MAM5) and a framework based on the model (JaCalIVE) for developing intelligent virtual environments. The goal of this extension is to develop augmented mirror worlds that represent a real and virtual world coupled, so that the virtual world not only reflects the real one, but also complements it. A new component called a smart resource artifact, that enables modelling and developing devices to access the real physical world, and a human in the loop agent to place a human in the system have been included in the meta-model and framework. The proposed extension of MAM5 has been tested by simulating a light control system where agents can access both virtual and real sensor/actuators through the smart resources developed. The results show that the use of real environment interactive elements (smart resource artifacts) in agent-based simulations allows to minimize the error between simulated and real system.

A review of reagents for fluorescence microscopy of cellular compartments and structures, part I: BacMam labeling and reagents for vesicular structures.

PubMed

Dolman, Nick J; Kilgore, Jason A; Davidson, Michael W

2013-07-01

Fluorescent labeling of vesicular structures in cultured cells, particularly for live cells, can be challenging for a number of reasons. The first challenge is to identify a reagent that will be specific enough where some structures have a number of potential reagents and others very few options. The emergence of BacMam constructs has allowed more easy-to-use choices. Presented here is a discussion of BacMam constructs as well as a review of commercially-available reagents for labeling vesicular structures in cells, including endosomes, peroxisomes, lysosomes, and autophagosomes, complete with a featured reagent for each structure, recommended protocol, troubleshooting guide, and example image. © 2013 by John Wiley & Sons, Inc.

Is urolithiasis in children associated with obesity or malnutrition?

PubMed

Selimoğlu, Mukadder Ayşe; Menekşe, Engin; Tabel, Yılmaz

2013-03-01

Although it is known that obesity predisposes to urolithiasis, a tendency for malnutrition in children with urolithiasis owing to recurrent urinary infections and abdominal pain also makes sense. In this study, we aimed to determine the nutritional status of infants and children with urolithiasis, and to observe whether obesity or malnutrition is more prevalent in that population. One hundred eighty-seven children aged 4 months to 17 years (mean, 4.9 ± 4.4 years) with urolithiasis, and 278 age- and sex-matched children without any chronic diseases were included. Anthropometric evaluations, including weight and height standard deviation score (SDS), body mass index, and triceps and subscapular skinfold thickness (SFT), were performed. Mean weight SDSs of the patients was statistically lower than that of the control subjects (P < .0001). Malnutrition rate was statistically higher in the patients with urolithiasis when evaluated according to weight SDS and percentiles of body mass index and SFT. When the age factor was taken into account, the percentage of malnutrition, determined by the percentiles of triceps and subscapular SFT measurements, was found to be higher in children younger than 2 years. Short stature was more prevalent in older children. Malnutrition among children with urolithiasis is not as rare as thought previously. A careful anthropometric evaluation should be included in the clinical assessment of those children. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Mortality and malnutrition among populations living in South Darfur, Sudan: results of 3 surveys, September 2004.

PubMed

Grandesso, Francesco; Sanderson, Frances; Kruijt, Jenneke; Koene, Ton; Brown, Vincent

2005-03-23

Mass violence against civilians in the west of Sudan has resulted in the displacement of more than 1.5 million people (25% of the population of the Darfur region). Most of these people are camped in 142 settlements. There has been increasing international concern about the health status of the displaced population. To perform rapid epidemiological assessments of mortality and nutritional status at 3 sites in South Darfur for relief efforts. In August and September 2004, mortality surveys were conducted among 137,000 internally displaced persons (IDPs) in 3 sites in South Darfur (Kass [n = 900 households], Kalma [n = 893 households], and Muhajiria [n = 900 households]). A nutritional survey was performed concomitantly among children aged 6 to 59 months using weight for height as an index of acute malnutrition (Kass [n = 894], Kalma [n = 888], and Muhajiria [n = 896]). A questionnaire detailing access to food and basic services was administered to a subset of households (n = 210 in each site). Crude and under 5-year mortality rates and nutritional status of IDPs in Kass, Kalma, and Muhajiria, South Darfur. Crude mortality rates, expressed as deaths per 10,000 per day, were 3.2 (95% confidence interval [CI], 2.2-4.1) in Kass, 2.0 (95% CI, 1.3-2.7) in Kalma, and 2.3 (95% CI, 1.2-3.4) in Muhajiria. Under 5-year mortality rates were 5.9 (95% CI, 3.8-8.0) in Kass, 3.5 (95% CI, 1.5-5.7) in Kalma, and 1.0 (95% CI, 0.03-1.9) in Muhajiria. During the period of displacement covered by our survey in Muhajiria, violence was reported to be responsible for 72% of deaths, mainly among young men. Diarrheal disease was reported to cause between 25% and 47% of deaths in camp residents and mainly affected the youngest and oldest age groups. Acute malnutrition was common, affecting 14.1% of the target population in Kass, 23.6% in Kalma, and 10.7% in Muhajiria. This study provides epidemiological evidence of the high rates of mortality and malnutrition among the displaced population in

Malnutrition and Psychological Development.

ERIC Educational Resources Information Center

Ricciuti, Henry N.

What is the status of our present knowledge concerning the influence of malnutrition on intellectual development, learning, and behavior in children? This paper focuses primarily on an identification of some of the major issues and questions which are of concern to investigators in the field. The major concern of this review is with…

Malnutrition among Cognitively Intact, non-Critically Ill Older Adults in the Emergency Department

PubMed Central

Pereira, Greg F.; Bulik, Cynthia M.; Weaver, Mark A.; Holland, Wesley C.; Platts-Mills, Timothy F.

2014-01-01

Objectives We estimate the prevalence of malnutrition among older patients presenting to an emergency department (ED) in the southeastern United States and identify subgroups at increased risk. Methods We conducted a cross-sectional study with random time block sampling of cognitively intact patients aged 65 years and older. Nutrition was assessed using the Mini Nutritional Assessment Short-Form (0–14 scale) with malnutrition defined as a score of 7 or less and at-risk for malnutrition defined as a score of 8–11. The presence of depressive symptoms was defined as a Center for Epidemiological Studies Depression-10 score of 4 or more (0–10 scale). Results Among 138 older adults, 16% (95% Confidence Interval [CI], 10%–22%) were malnourished and 60% (95% CI, 52%–69%) were either malnourished or at-risk for malnutrition. Seventeen of the 22 malnourished patients (77%) denied previously being diagnosed with malnutrition. The prevalence of malnutrition was not appreciably different between males and females, across levels of patient education, or between those living in urban and rural areas. However, the prevalence of malnutrition was higher among patients with depressive symptoms 52%, those residing in assisted living 50%, those with difficulty eating 38%, and those reporting difficulty buying groceries 33%. Conclusion Among a random sample of cognitively intact older ED patients, more than half were malnourished or at-risk for malnutrition, and the majority of malnourished patients had not previously been diagnosed. Higher rates of malnutrition among those with depression, difficulty eating, and difficulty buying groceries suggest the need to explore multifaceted interventions. PMID:25129819

Not by Bread Alone: Reversing the Effects of Childhood Malnutrition.

ERIC Educational Resources Information Center

Carson, David K.; Greeley, Sharon

1988-01-01

Investigates three central findings in human malnutrition research: (1) behavioral changes in infants and young children are observable outcomes of malnutrition; (2) non-nutritional factors in the environment affect child development; (3) nutritional supplementation with a consistent and varied regimen of stimulation hold potential for reversing…

A new score for screening of malnutrition in patients with inoperable gastric adenocarcinoma.

PubMed

Esfahani, Ali; Somi, Mohammad Hossein; Asghari Jafarabadi, Mohammad; Ostadrahimi, Alireza; Ghayour Nahand, Mousa; Fathifar, Zahra; Doostzadeh, Akram; Ghoreishi, Zohreh

2017-06-01

Malnutrition is common in patients with gastric cancer. Early identification of malnourished patients results in improving quality of life. We aimed to assess the nutritional status of patients with inoperable gastric adenocarcinoma (IGA) and finding a precise malnutrition screening score for these patients before the onset of chemotherapy. Nutritional status was assessed using patient generated subjective global assessment (PG-SGA), visceral proteins, and high-sensitivity C reactive protein. Tumor markers of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125) and CA 19-9 and their association with nutritional status were assessed. Then a new score for malnutrition screening was defined. Seventy-one patients with IGA completed the study. Malnourished and well-nourished patients (based on PG-SGA) were statistically different regarding albumin, prealbumin and CA-125. The best cut-off value for prealbumin for prediction of malnutrition was determined at 0.20 mg/dl and using known cut-off values for albumin (3.5 g/dl) and CA-125 (35 U/ml), a new score was defined for malnutrition screening named MS-score. According to MS-score, 92% of the patients had malnutrition and it could predict malnutrition with 96.8% sensitivity, 50% specificity and accuracy of 91.4%. MS-score has been suggested as an available and easy-to-use tool for malnutrition screening in patients with IGA. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Infant Malnutrition Is Associated with Persisting Attention Deficits in Middle Adulthood123

PubMed Central

Galler, Janina R.; Bryce, Cyralene P.; Zichlin, Miriam L.; Fitzmaurice, Garrett; Eaglesfield, G. David; Waber, Deborah P.

2012-01-01

Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37–43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition. PMID:22378333

[Child malnutrition in children under 5 years of age in Peru: trends and determinants].

PubMed

Sobrino, Manuel; Gutiérrez, César; Cunha, Antonio J; Dávila, Miguel; Alarcón, Jorge

2014-02-01

Analyze malnutrition and anemia trends in Peruvian children under 5 years of age and their association with determinants in the 2000-2011 period. Nutritional indicators for children under 5 years of age from the 2011 Demographic and Family Health Survey (ENDES), and their evolution based on data from the 2000, 2005, and 2008 ENDES, were analyzed. Chronic malnutrition (CM) (height/age ≤ 2 SD), acute malnutrition (AM), (height/weight ≤ 2 SD), and anemia trends were estimated. Associations were found with factors such as sex, age, area of residence (urban or rural), region of residence, mother's education, wealth quintile, availability of public water system, sewer availability, altitude, presence of other children in household, birth order, presence of diarrhea in previous 15 days, and presence of cough in previous 15 days. AM, CM, and anemia in Peruvian children under 5 years of age decreased from 2000-2011. This reduction was not uniform for the three conditions, with decreases of 1.1% to 0.4% recorded for AM, 31.6% to 19.6% for CM, and 50.4% to 30.7% for anemia. Although the factors analyzed were related to the prevalence of these three illnesses, calculation of the adjusted odds ratios showed significant differences for CM (mother's education, Sierra region, altitude greater than 2 500 m above sea level, presence of two or more children in household, and being the third or successive child) and anemia (child sex [higher in males], children under 2 years of age, Resto de costa region and Selva region, altitude greater than 2 500 m above sea level, availability of public water system, sewer availability, presence of two or more children in household, and presence of diarrhea within 15 days prior to the survey). For AM, differences were observed according to some factors but they were not significant in the adjusted model. In the 2000-2011 period, Peru achieved reduction of its CM, AM, and anemia rates. AM rates decreased to almost one-third, with overall

Content validity across methods of malnutrition assessment in patients with cancer is limited.

PubMed

Sealy, Martine J; Nijholt, Willemke; Stuiver, Martijn M; van der Berg, Marit M; Roodenburg, Jan L N; van der Schans, Cees P; Ottery, Faith D; Jager-Wittenaar, Harriët

2016-08-01

To identify malnutrition assessment methods in cancer patients and assess their content validity based on internationally accepted definitions for malnutrition. Systematic review of studies in cancer patients that operationalized malnutrition as a variable, published since 1998. Eleven key concepts, within the three domains reflected by the malnutrition definitions acknowledged by European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN): A: nutrient balance; B: changes in body shape, body area and body composition; and C: function, were used to classify content validity of methods to assess malnutrition. Content validity indices (M-CVIA-C) were calculated per assessment method. Acceptable content validity was defined as M-CVIA-C ≥ 0.80. Thirty-seven assessment methods were identified in the 160 included articles. Mini Nutritional Assessment (M-CVIA-C = 0.72), Scored Patient-Generated Subjective Global Assessment (M-CVIA-C = 0.61), and Subjective Global Assessment (M-CVIA-C = 0.53) scored highest M-CVIA-C. A large number of malnutrition assessment methods are used in cancer research. Content validity of these methods varies widely. None of these assessment methods has acceptable content validity, when compared against a construct based on ESPEN and ASPEN definitions of malnutrition. Copyright © 2016 Elsevier Inc. All rights reserved.

High malnutrition rate in Venezuelan Yanomami compared to Warao Amerindians and Creoles: significant associations with intestinal parasites and anemia.

PubMed

Verhagen, Lilly M; Incani, Renzo N; Franco, Carolina R; Ugarte, Alejandra; Cadenas, Yeneska; Sierra Ruiz, Carmen I; Hermans, Peter W M; Hoek, Denise; Campos Ponce, Maiza; de Waard, Jacobus H; Pinelli, Elena

2013-01-01

Children in rural areas experience the interrelated problems of poor growth, anemia and parasitic infections. We investigated the prevalence of and associations between intestinal helminth and protozoan infections, malnutrition and anemia in school-age Venezuelan children. This cross-sectional study was conducted in 390 children aged 4-16 years from three rural areas of Venezuela: the Amazon Region, Orinoco Delta and Carabobo State. Stool samples were collected for direct parasitic examinations. Anthropometric indicators of chronic (height-for-age Z score) and acute (weight-for-height and Body Mass Index (BMI)-for-age Z score in respectively children under 5 years of age and children aged 5 years and above) malnutrition were calculated. Multivariate linear and logistic regression models were built to determine factors associated with nutritional status and polyparasitism. Hookworm and Strongyloides stercoralis prevalences were highest in children from the Amazon rainforest (respectively 72% and 18%) while children from the Orinoco Delta and Carabobo State showed higher rates of Ascaris lumbricoides (respectively 28% and 37%) and Trichuris trichiura (40% in both regions). The prevalence of Giardia lamblia infection was not significantly different between regions (average: 18%). Anemia prevalence was highest in the Amazon Region (24%). Hemoglobin levels were significantly decreased in children with a hookworm infection. Malnutrition was present in respectively 84%, 30% and 13% of children from the Amazon Region, Orinoco Delta and Carabobo State. In multivariate analysis including all regions, G. lamblia and helminth infections were significantly and negatively associated with respectively height-for-age and weight-for-height/BMI-for-age Z scores. Furthermore, hemoglobin levels were positively associated with the height-for-age Z score (0.11, 95% CI 0.02 - 0.20). In rural populations in Venezuela helminthiasis and giardiasis were associated with acute and chronic

Malnutrition in hospitalized patients: results from La Rioja.

PubMed

Martín Palmero, Ángela; Serrano Pérez, Andra; Chinchetru Ranedo, Mª José; Cámara Balda, Alejandro; Martínez de Salinas Santamarí, Mª Ángeles; Villar García, Gonzalo; Marín Lizárraga, Mª Del Mar

2017-03-30

There is a high malnutrition prevalence in hospitalized patients. To determine the malnutrition prevalence in hospitalized patients of La Rioja Community (Spain) when evaluated with different screening/ evaluation tools and its relationship with hospital stay and mortality. Cross sectional observational study of hospitalized adult patients (age > 18 years old) from medical and surgical departments that underwent within 72 h of their admission a nutritional screening with Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS) 2002, Controlling Nutritional Status (CONUT) y Subjective Global Assessment (SGA). 384 patients (273 medical and 111 surgical) were evaluated. Almost fifty percent of them were considered malnourished independently of the screening/assessment tool used. High concordance was found between SGA and NRS-2002 (k = 0.758). Malnourished patients had a longer hospital stay than those well-nourished (9.29 vs. 7.10 days; p = 0.002), used a greater number of medicines (9.2 vs. 7.4; p = 0.001) and underwent a higher number of diagnostic tests (16.4 vs. 12.5; p = 0,002). Half of the hospitalized patients in the medical and surgical department of La Rioja are malnourished. This is associated with a longer hospital stay, higher use of medicines, diagnostics tests and greater mortality. Malnutrition could be detected with easy screening tools to treat it appropriately.

Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon.

PubMed

Masterson, Erin E; Fitzpatrick, Annette L; Enquobahrie, Daniel A; Mancl, Lloyd A; Conde, Esther; Hujoel, Philippe P

2017-10-01

We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects. © 2017 Wiley Periodicals, Inc.

Reduction in childhood malnutrition in Vietnam from 1990 to 2004.

PubMed

Khan, Nguyen Cong; Tuyen, Le Danh; Ngoc, Tran Xuan; Duong, Phan Hoai; Khoi, Ha Huy

2007-01-01

Reduction in childhood malnutrition in Vietnam between 1990 and 2004 was assessed using data from 5 national surveys. The prevalence of malnutrition, including stunting, declined significantly for underweight from 45% in 1990 to 26.6% in 2004. While the average reduction was 1.3% per year in the period from 1990 to 2000, it was 1.8% per year in the period from 2000 to 2004. The prevalence of stunting declined from 56.5% in 1990 to 30.7% in 2004, with an average reduction of 2% per year in the period from 1990 to 2000 and 1.5% per year in the period from 2000 to 2004. There were clear differences in the decrease in malnutrition prevalence between urban, rural and mountainous areas, the reduction being highest in the urban regions and lowest in the mountainous areas. Regression analysis showed that the nutrition status of the child is positively related to better household living conditions and to the educational level of the father, but not the mother. Stunting is higher in children whose parents are farmers and higher in households with more children. Stunting prevalence is lower in households with safe water access and hygienic toilets. In future , the dramatic reduction is childhood malnutrition as seen in the period 1990 to 2004 might not continue. More comprehensive apptoaches will be needed to lower childhood malnutrition in Vietnam further.

[Influence of malnutrition on childhood mortality in a rural hospital in Rwanda].

PubMed

Ngirabega, J-d-D; Munyanshongore, C; Donnen, P; Dramaix, M

2011-10-01

Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda. A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression. At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively. The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study.

PubMed

Burks, Collin E; Jones, Christopher W; Braz, Valerie A; Swor, Robert A; Richmond, Natalie L; Hwang, Kay S; Hollowell, Allison G; Weaver, Mark A; Platts-Mills, Timothy F

2017-08-01

Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury. To identify modifiable risk factors associated with malnutrition in older patients. Prospective cross-sectional multicenter study. 3 EDs in the South, Northeast, and Midwest. Non-critically ill, English-speaking adults aged ≥65 years. Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor. In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%). Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Malnutrition in pediatric patients with cancer at diagnosis and throughout therapy: A multicenter cohort study.

PubMed

Zimmermann, Karin; Ammann, Roland A; Kuehni, Claudia E; De Geest, Sabina; Cignacco, Eva

2013-04-01

Malnutrition is a common problem in pediatric patients with cancer. Reported prevalence varies widely and has often been assessed only in a subset of childhood types of cancer. This study aimed to describe the prevalence of malnutrition among pediatric patients newly diagnosed with cancer, to describe the occurrence and course of malnutrition during therapy and to identify factors associated with malnutrition during therapy. In a retrospective cohort study of 327 patients diagnosed from 2003 to 2006 in three Swiss tertiary care hospitals, weight and height measures together with patient-, disease-, and treatment-related characteristics were assessed. Malnutrition was defined as body mass index (BMI) below -2 standard deviation scores (SDS) or a weight loss >10% from diagnosis. Malnutrition was assessed at diagnosis and continuously during anticancer therapy. At diagnosis, 5.8% of the patients (19) were malnourished based on BMI. During anticancer therapy, the cumulative incidence of malnutrition rose to 22% (70 patients) after 30 days, to 36% (116 patients) after 60 days, and finally to 47% (155 patients). In these 155 patients, the median duration of malnutrition was 60 days (interquartile range, 21-122). Age above 10 years at diagnosis, BMI ≤ -1.0 SDS at diagnosis, and a diagnosis of medulloblastoma were positively associated with a higher proportion of malnutrition time during therapy. The rapid increase of malnutrition after the start of treatment underlines the need to develop evidence-based and efficient methods to provide nutritional support for children with cancer. Copyright © 2012 Wiley Periodicals, Inc.

Malnutrition in healthcare settings and the role of gastrostomy feeding.

PubMed

Kurien, Matthew; Williams, Jake; Sanders, David S

2017-08-01

Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.

Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers.

PubMed

Tobert, Conrad M; Mott, Sarah L; Nepple, Kenneth G

2018-01-01

Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis. The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations. The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis. All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated. Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code. Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition. A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01). Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which

High oleic ready-to-use therapeutic food maintains docosahexaenoic acid status in severe malnutrition: a randomized, blinded trial

PubMed Central

Hsieh, Ji-Cheng; Liu, Lei; Zeilani, Mamane; Ickes, Scott; Trehan, Indi; Maleta, Ken; Craig, Christina; Thakwalakwa, Chrissie; Singh, Lauren; Brenna, J. Thomas; Manary, Mark J.

2015-01-01

Objective Ready-to-use therapeutic food (RUTF) is the preferred treatment for uncomplicated severe acute malnutrition. RUTF contains large amounts of linoleic acid and very little α-linolenic acid, which may reduce the availability of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) to the recovering child. A novel high oleic RUTF (HO-RUTF) was developed with less linoleic acid to determine its effect on DHA and EPA status. Methods We conducted a prospective, randomized, double-blinded, clinical effectiveness trial treating rural Malawian children with severe acute malnutrition. Children were treated with either HO-RUTF or standard RUTF. Plasma phospholipid (PL) fatty acid status was measured upon enrollment and after 4 weeks and compared between the two intervention groups. Results Among the 141 children enrolled, 48/71 receiving HO-RUTF and 50/70 receiving RUTF recovered. Plasma PL samples were analyzed from 43 children consuming HO-RUTF and 35 children consuming RUTF. The change in DHA content during the first 4 weeks was +4% and −25% in the HO-RUTF and RUTF groups, respectively (P = 0.04). For EPA, the change in content was 63% and −24% in the HO-RUTF and RUTF groups (P < 0.001). For arachidonic acid, the change in content was −3% and 13% in the HO-RUTF and RUTF groups (P < 0.009). Conclusions The changes in DHA and EPA seen in the children treated with HO-RUTF warrant further investigation as they suggest HO-RUTF support improved PUFA status, necessary for neural development and recovery. PMID:25633498

Effects of socio-economic and behavioural factors on childhood malnutrition in Yemen.

PubMed

Sunil, T S

2009-07-01

This study examined the effects of socio-economic and behavioural factors on childhood malnutrition in Yemen. The three anthropometric indicators such as height-for-age, weight-for-height and weight-for-age are used to examine the nutritional status of children aged less 5 years in Yemen. The independent variables include background characteristics, behavioural risk factors and illness characteristics. Data for the study come the most recent Yemen Demographic and Health Survey, a nationally representative sample, conducted in Yemen in 1997. Logistic regression analysis is used to estimate the odds of being malnourished. The three anthropometric indicators show high to very high levels of child malnutrition in Yemen. The prevalence of stunting and underweight is so widespread that almost every other child under the age of 5 is either stunted or underweight. Social, economic and behavioural factors show very significant association with childhood malnutrition. The study results indicate the importance of social and behavioural factors in describing childhood malnutrition in Yemen. The study results will help develop nutritional and health promotion policies in order to improve childhood malnutrition in this country.

High Malnutrition Rate in Venezuelan Yanomami Compared to Warao Amerindians and Creoles: Significant Associations WITH Intestinal Parasites and Anemia

PubMed Central

Verhagen, Lilly M.; Incani, Renzo N.; Franco, Carolina R.; Ugarte, Alejandra; Cadenas, Yeneska; Sierra Ruiz, Carmen I.; Hermans, Peter W. M.; Hoek, Denise; Campos Ponce, Maiza; de Waard, Jacobus H.; Pinelli, Elena

2013-01-01

Background Children in rural areas experience the interrelated problems of poor growth, anemia and parasitic infections. We investigated the prevalence of and associations between intestinal helminth and protozoan infections, malnutrition and anemia in school-age Venezuelan children. Methods This cross-sectional study was conducted in 390 children aged 4-16 years from three rural areas of Venezuela: the Amazon Region, Orinoco Delta and Carabobo State. Stool samples were collected for direct parasitic examinations. Anthropometric indicators of chronic (height-for-age Z score) and acute (weight-for-height and Body Mass Index (BMI)-for-age Z score in respectively children under 5 years of age and children aged 5 years and above) malnutrition were calculated. Multivariate linear and logistic regression models were built to determine factors associated with nutritional status and polyparasitism. Results Hookworm and Strongyloides stercoralis prevalences were highest in children from the Amazon rainforest (respectively 72% and 18%) while children from the Orinoco Delta and Carabobo State showed higher rates of Ascaris lumbricoides (respectively 28% and 37%) and Trichuris trichiura (40% in both regions). The prevalence of Giardia lamblia infection was not significantly different between regions (average: 18%). Anemia prevalence was highest in the Amazon Region (24%). Hemoglobin levels were significantly decreased in children with a hookworm infection. Malnutrition was present in respectively 84%, 30% and 13% of children from the Amazon Region, Orinoco Delta and Carabobo State. In multivariate analysis including all regions, G. lamblia and helminth infections were significantly and negatively associated with respectively height-for-age and weight-for-height/BMI-for-age Z scores. Furthermore, hemoglobin levels were positively associated with the height-for-age Z score (0.11, 95% CI 0.02 - 0.20). Conclusions In rural populations in Venezuela helminthiasis and giardiasis were

Prevalence of Demodex folliculorum and Demodex brevis in childhood malnutrition and malignancy.

PubMed

Kaya, Sadik; Selimoglu, Mukadder Ayse; Kaya, Ozlem Aycan; Ozgen, Unsal

2013-02-01

Hair follicle mites, Demodex folliculorum and Demodex brevis, are known to accompany immune-deficiency states, however no study so far has investigated their presence in malnutrition. In this study we aimed to determine the prevalence of those mites in childhood malnutrition, malignancy and risk factors. One hundred children with malnutrition, 31 children with malignancy and 63 children without any chronic disease and infection were included in this study. History, physical examination, anthropometric measurements and routine laboratory findings were recorded. Demodex spp. were investigated by standard superficial skin biopsies. Demodex was found in 25 patients (25%), 10 patients (32.3%), and one patient (1.6%) among malnutrition, malignancy, and control groups, respectively (P = 0.001). By using multilogistic regression binary method, it was found that malnutrition, malignancy and low socioeconomic level increased the risk 17.37 times (P = 0.006), 27.29 times (P = 0.002), and 2.3 times (P = 0.037), respectively. Of 22 children who were evaluated after 6 months, 13 (59.1%) were negative for Demodex. In 11 (84.6%) of those 13, nutritional status was improved. Demodex was detected in approximately in one-quarter and one-third of children with malnutrition and malignancy, respectively. Eliminating the cause of immunosuppression, such as poor nutritional status, seems also to be an effective method for eliminating Demodex. © 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society.

Evaluation of Malnutrition Risk after Liver Transplantation Using the Nutritional Screening Tools

PubMed Central

Lim, Hee-Sook; Kim, Hyung-Chul; Park, Yoon-Hyung

2015-01-01

Malnutrition is a common problem in patients with end-stage liver disease requiring liver transplantation. The aim of this study was to evaluate nutritional status by using nutritional screening tools [Nutritional Risk Screening (NRS) 2002, Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA)] in patients before and after liver transplantation. We analyzed medical record, blood test, nutrient intake and malnutrition rate just before transplantation and at discharge, and at 3, 6, 12 months after transplantation respectively. Initially 33 patients enrolled as study subjects and finally 28 patients completed the study. Nutrients intake such as energy, fiber, calcium, potassium, vitamin C, and folate were insufficient at 12 months after transplantation. The rates of malnutrition before transplantation were very high, reported at 81.8% for the NRS 2002, 87.9% for the MUST, and 84.8% for the SGA. By 12 months after operation, malnutrition rates reported at NRS, MUST and SGA had decreased to 6.1%, 10.7%, and 10.7%, respectively. Sensitivity was 87.1% for the NRS 2002, 82.0% for the MUST, and 92.0% for the SGA. Of these screening tools the SGA was the highest sensitive tool that predict the risk of mortality in malnutrition patients who received transplantation. Further studies on nutritional status of patients and proper tools for nutrition intervention are needed to provide adequate nutritional care for patients. PMID:26566519

Evaluation of Malnutrition Risk after Liver Transplantation Using the Nutritional Screening Tools.

PubMed

Lim, Hee-Sook; Kim, Hyung-Chul; Park, Yoon-Hyung; Kim, Soon-Kyung

2015-10-01

Malnutrition is a common problem in patients with end-stage liver disease requiring liver transplantation. The aim of this study was to evaluate nutritional status by using nutritional screening tools [Nutritional Risk Screening (NRS) 2002, Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA)] in patients before and after liver transplantation. We analyzed medical record, blood test, nutrient intake and malnutrition rate just before transplantation and at discharge, and at 3, 6, 12 months after transplantation respectively. Initially 33 patients enrolled as study subjects and finally 28 patients completed the study. Nutrients intake such as energy, fiber, calcium, potassium, vitamin C, and folate were insufficient at 12 months after transplantation. The rates of malnutrition before transplantation were very high, reported at 81.8% for the NRS 2002, 87.9% for the MUST, and 84.8% for the SGA. By 12 months after operation, malnutrition rates reported at NRS, MUST and SGA had decreased to 6.1%, 10.7%, and 10.7%, respectively. Sensitivity was 87.1% for the NRS 2002, 82.0% for the MUST, and 92.0% for the SGA. Of these screening tools the SGA was the highest sensitive tool that predict the risk of mortality in malnutrition patients who received transplantation. Further studies on nutritional status of patients and proper tools for nutrition intervention are needed to provide adequate nutritional care for patients.

High Prevalence of Malnutrition among Elderly Veterans in Home Based Primary Care.

PubMed

Win, A Z; Ceresa, C; Arnold, K; Allison, T A

2017-01-01

Elderly Veterans enrolled in VA Home Based Primary Care (HBPC) programs suffer from many diseases including malnutrition. Nutrition screening tools exist in the VA system but they are inconsistently utilized across ambulatory care programs and are neither research validated nor comparable with non-VA populations. The Mini-Nutritional Assessment short-form (MNA-SF) has been validated in international studies in a variety of settings. The primary aim of this study was to find the prevalence of malnutrition among Veterans enrolled in HBPC programs. The secondary objective was to determine the feasibility of adopting a validated nutrition screening tool (Mini-Nutritional Assessment short-form (MNA-SF)). 2252 veterans age 65 and older from 18 HBPC programs from across the country participated in the study. The study period was between April and September 2012. WinPepi (version 11.25) was used for descriptive analysis. We found that the prevalence of malnutrition was 15% (344/2252) and the prevalence of at risk for malnutrition was 40.3% (909/2252). The MNA-SF is an efficient nutrition screening tool and it can be successfully used for the elderly veterans. The prevalence of malnutrition among veterans was high compared to the community dwelling U.S. civilian elderly population. By preventing and treating malnutrition, health care systems should be able to reduce overall health care costs.

Association between gait abnormality and malnutrition in a community-dwelling elderly population.

PubMed

Misu, Shogo; Asai, Tsuyoshi; Doi, Takehiko; Sawa, Ryuichi; Ueda, Yuya; Saito, Takashi; Nakamura, Ryo; Murata, Shunsuke; Sugimoto, Taiki; Yamada, Minoru; Ono, Rei

2017-08-01

Malnutrition is common in older adults, and contributes to the risk of falls and functional impairment. Gait performance also contributes to falls and functional impairment; however, the association between malnutrition and gait performance remains unclear. The purpose of the present study was to investigate the association between malnutrition risk and gait performance. The study participants included 204 community-dwelling older adults with a mean age of 73.4 ± 4.3 years. Nutritional status was evaluated using the short version of the Mini-Nutritional Assessment. A score of 11 points was used as the cut-off, and the participants were categorized into two groups: ≤11, malnutrition-risk group; and ≥12, well-nourished group. Gait performance was assessed by gait speed and walking smoothness. Walking smoothness was quantified by harmonic ratios (HR), which were derived from vertical (VT), mediolateral (ML) and anteroposterior trunk accelerations, recorded during over-ground walking. Skeletal muscle mass index, handgrip strength and physical functions were also measured. HR in the ML direction was significantly lower in the malnutrition-risk group than the well-nourished group (P = 0.002); however, no differences between the two groups were observed in gait speed or HR in the VT and anteroposterior directions. The relationship between malnutrition and HR in the ML direction was independent of skeletal muscle mass index, handgrip strength, physical function, gait speed, and other confounders (P < 0.05). In community-dwelling older adults, malnutrition is related to decreased walking smoothness in the ML direction, suggesting that nutritional status affects lateral trunk control during walking. Geriatr Gerontol Int 2017; 17: 1155-1160. © 2016 Japan Geriatrics Society.

Inflammation-driven malnutrition: a new screening tool predicts outcome in Crohn's disease.

PubMed

Jansen, Irene; Prager, Matthias; Valentini, Luzia; Büning, Carsten

2016-09-01

Malnutrition is a frequent feature in Crohn's disease (CD), affects patient outcome and must be recognised. For chronic inflammatory diseases, recent guidelines recommend the development of combined malnutrition and inflammation risk scores. We aimed to design and evaluate a new screening tool that combines both malnutrition and inflammation parameters that might help predict clinical outcome. In a prospective cohort study, we examined fifty-five patients with CD in remission (Crohn's disease activity index (CDAI) <200) at 0 and 6 months. We assessed disease activity (CDAI, Harvey-Bradshaw index), inflammation (C-reactive protein (CRP), faecal calprotectin (FC)), malnutrition (BMI, subjective global assessment (SGA), serum albumin, handgrip strength), body composition (bioelectrical impedance analysis) and administered the newly developed 'Malnutrition Inflammation Risk Tool' (MIRT; containing BMI, unintentional weight loss over 3 months and CRP). All parameters were evaluated regarding their ability to predict disease outcome prospectively at 6 months. At baseline, more than one-third of patients showed elevated inflammatory markers despite clinical remission (36·4 % CRP ≥5 mg/l, 41·5 % FC ≥100 µg/g). Prevalence of malnutrition at baseline according to BMI, SGA and serum albumin was 2-16 %. At 6 months, MIRT significantly predicted outcome in numerous nutritional and clinical parameters (SGA, CD-related flares, hospitalisations and surgeries). In contrast, SGA, handgrip strength, BMI, albumin and body composition had no influence on the clinical course. The newly developed MIRT was found to reliably predict clinical outcome in CD patients. This screening tool might be used to facilitate clinical decision making, including treatment of both inflammation and malnutrition in order to prevent complications.

The influence of deprivation on malnutrition risk in outpatients with chronic obstructive pulmonary disease (COPD).

PubMed

Collins, P F; Elia, M; Kurukulaaratchy, R J; Stratton, R J

2018-02-01

The social gradient in chronic obstructive pulmonary disease (COPD) is considerable, but the influence of deprivation on common clinical risk factors such as malnutrition is unclear. This study aimed to explore the relationship between COPD disease-severity, deprivation and malnutrition. 424 outpatients with a confirmed diagnosis of COPD were routinely screened for malnutrition risk using the 'Malnutrition Universal Screening Tool' ('MUST') while attending respiratory clinics across two hospitals; a large city hospital (site A) and a smaller community hospital (site B). Deprivation was assessed for each outpatient according to their address (postcode) using the English governments' index of multiple deprivation (IMD) and related to malnutrition risk. Each postcode was attributed to both an IMD score and IMD rank, where a higher IMD score and a lower IMD ranking indicated increased deprivation. Overall prevalence of malnutrition was 22% (95% CI 18-26%; 9% medium risk, 13% high risk). It was significantly higher at site A (28% vs 17%; p = 0.004) where patients were also significantly more likely to reside in areas of more deprivation than those at site B (IMD rank: 15,510 SD 8137 vs 22,877 SD 6827; p < 0.001). COPD disease-severity was positively associated with malnutrition (p < 0.001) whilst a higher rank IMD was negatively associated with malnutrition (p = 0.014). Deprivation is a significant independent risk factor for malnutrition in outpatients with COPD. Consideration of deprivation is important in the identification of malnutrition and the nutritional management of patients with COPD. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Uganda.

PubMed

van der Kam, Saskia; Roll, Stephanie; Swarthout, Todd; Edyegu-Otelu, Grace; Matsumoto, Akiko; Kasujja, Francis Xavier; Casademont, Cristian; Shanks, Leslie; Salse-Ubach, Nuria

2016-02-01

Globally, Médecins Sans Frontières (MSF) treats more than 300,000 severely malnourished children annually. Malnutrition is not only caused by lack of food but also by illnesses and by poor infant and child feeding practices. Breaking the vicious cycle of illness and malnutrition by providing ill children with nutritional supplementation is a potentially powerful strategy for preventing malnutrition that has not been adequately investigated. Therefore, MSF investigated whether incidence of malnutrition among ill children <5 y old could be reduced by providing a fortified food product or micronutrients during their 2-wk convalescence period. Two trials, one in Nigeria and one in Uganda, were conducted; here, we report on the trial that took place in Kaabong, a poor agropastoral region of Karamoja, in east Uganda. While the region of Karamoja shows an acute malnutrition rate between 8.4% and 11.5% of which 2% to 3% severe malnutrition, more than half (58%) of the population in the district of Kaabong is considered food insecure. We investigated the effect of two types of nutritional supplementation on the incidence of malnutrition in ill children presenting at outpatient clinics during March 2011 to April 2012 in Kaabong, Karamoja region, Uganda, a resource-poor region where malnutrition is a chronic problem for its seminomadic population. A three-armed, partially-blinded, randomised controlled trial was conducted in children diagnosed with malaria, diarrhoea, or lower respiratory tract infection. Non-malnourished children aged 6 to 59 mo were randomised to one of three arms: one sachet/d of ready-to-use therapeutic food (RUTF), two sachets/d of micronutrient powder (MNP), or no supplement (control) for 14 d for each illness over 6 mo. The primary outcome was the incidence of first negative nutritional outcome (NNO) during the 6 mo follow-up. NNO was a study-specific measure used to indicate progression to moderate or severe acute malnutrition; it was defined as

Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Uganda

PubMed Central

van der Kam, Saskia; Roll, Stephanie; Swarthout, Todd; Edyegu-Otelu, Grace; Matsumoto, Akiko; Kasujja, Francis Xavier; Casademont, Cristian; Shanks, Leslie; Salse-Ubach, Nuria

2016-01-01

Background Globally, Médecins Sans Frontières (MSF) treats more than 300,000 severely malnourished children annually. Malnutrition is not only caused by lack of food but also by illnesses and by poor infant and child feeding practices. Breaking the vicious cycle of illness and malnutrition by providing ill children with nutritional supplementation is a potentially powerful strategy for preventing malnutrition that has not been adequately investigated. Therefore, MSF investigated whether incidence of malnutrition among ill children <5 y old could be reduced by providing a fortified food product or micronutrients during their 2-wk convalescence period. Two trials, one in Nigeria and one in Uganda, were conducted; here, we report on the trial that took place in Kaabong, a poor agropastoral region of Karamoja, in east Uganda. While the region of Karamoja shows an acute malnutrition rate between 8.4% and 11.5% of which 2% to 3% severe malnutrition, more than half (58%) of the population in the district of Kaabong is considered food insecure. Methods and Findings We investigated the effect of two types of nutritional supplementation on the incidence of malnutrition in ill children presenting at outpatient clinics during March 2011 to April 2012 in Kaabong, Karamoja region, Uganda, a resource-poor region where malnutrition is a chronic problem for its seminomadic population. A three-armed, partially-blinded, randomised controlled trial was conducted in children diagnosed with malaria, diarrhoea, or lower respiratory tract infection. Non-malnourished children aged 6 to 59 mo were randomised to one of three arms: one sachet/d of ready-to-use therapeutic food (RUTF), two sachets/d of micronutrient powder (MNP), or no supplement (control) for 14 d for each illness over 6 mo. The primary outcome was the incidence of first negative nutritional outcome (NNO) during the 6 mo follow-up. NNO was a study-specific measure used to indicate progression to moderate or severe acute

The economic dimensions of malnutrition in young children.

PubMed

Reutlinger, S; Selowsky, M

1979-06-01

1 billion people - 1/3 of them children under the age of 10 - live on diets that are deficient in essential calories. Focus in this discussion is on the magnitude of the problem. The economic implications of specific intervention programs designed to solve the problem are reviewed. Caloric intake is closely associated with per capita income, and malnutrition characterizes the poorest segments of the population. Since the lowest-income groups have larger families, the incidence of malnutrition among children is certain to be higher than the incidence among adults. 3 factors will determine whether, on the basis of current trends, caloric malnutrition can be expected to be eliminated among the poorest segments of the population of the development countries: 1) the future income growth of the malnourished groups; 2) their propensity to use additional income to increase their caloric consumption; and 3) the future changes in the relative price of the main staples, basically cereals. The problem of malnutrition cannot be resolved quickly enough without explicit measures to raise the level of caloric consumption. Governments can initiate a wide range of programs and policies in an effort to augment the caloric consumption of children in the target population - transfer of cash to target households, target group oriented food programs, and food stamps for certain groups. In order for a food program to have more of an effect on consumption than would an equivalent transfer of income, 2 conditions need to be met: 1) the food must be made available at lower prices and in larger quantities than that previously consumed; and 2) reselling of the food must be precluded. In sum, the only effective solution for dealing with the problem of malnutrition among children of developing countries is either a more equitable distribution of income or supplying the food to the target population at a price far below its normally supply price.

Type 1 Diabetes in a Resource-Poor Setting: Malnutrition Related, Malnutrition Modified, or Just Diabetes?

PubMed

Balcha, Shitaye Alemu; Phillips, David I W; Trimble, Elisabeth R

2018-06-14

Very little is known about the occurrence of type 1 diabetes (T1DM) in resource-poor countries and particularly in their rural hinterlands. Studies of the epidemiology of T1DM in Ethiopia and similar countries in sub-Saharan Africa show that the pattern of presenting disease differs substantially from that in the West. Typically, the peak age of onset of the disease is more than a decade later with a male excess and a low prevalence of indicators of islet-cell autoimmunity. It is also associated with markers of undernutrition. These findings raise the question as to whether the principal form of T1DM seen in these resource-poor communities has a different pathogenesis. Whether the disease is a direct result of malnutrition or whether malnutrition may modify the expression of islet-cell autoimmunity is unclear. However, the poor prognosis in these settings underlines the urgent need for detailed clinical and epidemiological studies.

Malnutrition is associated with dementia severity and geriatric syndromes in patients with Alzheimer disease.

PubMed

Yildiz, Demet; Büyükkoyuncu Pekel, Nilüfer; Kiliç, Ahmet Kasim; Tolgay, Elif Nalan; Tufan, Fatih

2015-01-01

Malnutrition is associated with increased morbidity and mortality in patients with Alzheimer disease (AD). In this study, we aimed to screen for malnutrition and geriatric syndromes and seek their associations in patients with AD. The Mini Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), Katz Activities of Daily Living (ADL), and Lawton Instrumental Activities of Daily Living (IADL) tests were applied. Mean daily oral fluid intake was assessed according to patients' and relatives' declarations. Seventy-six patients with a mean age of 79 ± 7.4 years were included. Most of the patients had mild or moderate dementia. Malnutrition was associated with increased rates of hospitalization and falls, dysphagia, insomnia, agitation, delusions, hallucinations, immobility, and incontinence. A daily fluid intake of < 1100 mL was associated with malnutrition risk. Multivariate linear regression analysis revealed independent correlations of lower MNA score with lower ADL score, lower daily oral fluid intake, lower MMSE score, and female sex. Dependency, inadequate fluid intake, advanced dementia stage, and female sex were independently associated with malnutrition. Malnutrition also seemed to be associated with sleep disturbances, psychological problems, immobility, falls, and increased hospitalization risk in these patients. Daily oral fluid intake may be a practical tool in the screening of malnutrition.

How maternal malnutrition affects linear growth and development in the offspring.

PubMed

Papathakis, Peggy C; Singh, Lauren N; Manary, Mark J

2016-11-05

Maternal malnutrition is common in the developing world and has detrimental effects on both the mother and infant. Pre-pregnancy nutritional status and weight gain during pregnancy are positively related to fetal growth and development. Internationally, there is no agreement on the method of diagnosis or treatment of moderate or severe malnutrition during pregnancy. Establishing clear guidelines for diagnosis and treatment will be essential in elevating the problem. Possible anthropometric measurements used to detect and monitor maternal malnutrition include pre-pregnancy BMI, weight gain, and mid upper arm circumference. Food supplements have the potential to increase gestational weight gain and energy intake which are positively associated with fetal growth and development. Overall more studies are needed to conclude the impact of food/nutrient supplements on infant growth in undernourished pregnant women in developing countries. Currently, a study underway may provide much needed documentation of the benefits of treating malnutrition in pregnancy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Malnutrition in childhood cancer patients: a review on its prevalence and possible causes.

PubMed

Brinksma, Aeltsje; Huizinga, Gea; Sulkers, Esther; Kamps, Willem; Roodbol, Petrie; Tissing, Wim

2012-08-01

To perform a systematic literature review for critical evaluation of prevalence and factors contributing to malnutrition in childhood cancer. A systematic search resulting in 46 suitable articles. Due to lack of uniform criteria and adequate studies, the prevalence rates of malnutrition can only be estimated. Based on strengths and weaknesses of included references, prevalence rates are estimated to be 0-10% for leukemia, 20-50% for neuroblastoma, and 0-30% for other malignancies. Whether energy deficiency or inflammation contributed to malnutrition could not be confirmed because the occurrence of energy deficit (low energy intake, increased metabolic rate) or inflammation (related to cachexia) was not convincing. Also, a relationship between these factors and malnutrition was not studied. Longitudinal studies are needed to determine which children are at risk of malnutrition, and to investigate the impact of energy deficiency and inflammation on the nutritional status and body composition of childhood cancer patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Weight Loss and Malnutrition in Patients with Parkinson's Disease: Current Knowledge and Future Prospects

PubMed Central

Ma, Kai; Xiong, Nian; Shen, Yan; Han, Chao; Liu, Ling; Zhang, Guoxin; Wang, Luxi; Guo, Shiyi; Guo, Xingfang; Xia, Yun; Wan, Fang; Huang, Jinsha; Lin, Zhicheng; Wang, Tao

2018-01-01

Parkinson's Disease (PD) is currently considered a systemic neurodegenerative disease manifested with not only motor but also non-motor symptoms. In particular, weight loss and malnutrition, a set of frequently neglected non-motor symptoms, are indeed negatively associated with the life quality of PD patients. Moreover, comorbidity of weight loss and malnutrition may impact disease progression, giving rise to dyskinesia, cognitive decline and orthostatic hypotension, and even resulting in disability and mortality. Nevertheless, the underlying mechanism of weight loss and malnutrition in PD remains obscure and possibly involving multitudinous, exogenous or endogenous, factors. What is more, there still does not exist any weight loss and malnutrition appraision standards and management strategies. Given this, here in this review, we elaborate the weight loss and malnutrition study status in PD and summarize potential determinants and mechanisms as well. In conclusion, we present current knowledge and future prospects of weight loss and malnutrition in the context of PD, aiming to appeal clinicians and researchers to pay a closer attention to this phenomena and enable better management and therapeutic strategies in future clinical practice. PMID:29403371

Impact of Childhood Nutritional Status on Pathogen Prevalence and Severity of Acute Diarrhea

PubMed Central

Tickell, Kirkby D.; Pavlinac, Patricia B.; John-Stewart, Grace C.; Denno, Donna M.; Richardson, Barbra A.; Naulikha, Jaqueline M.; Kirera, Ronald K.; Swierczewski, Brett E.; Singa, Benson O.; Walson, Judd L.

2017-01-01

Abstract. Children with acute and chronic malnutrition are at increased risk of morbidity and mortality following a diarrheal episode. To compare diarrheal disease severity and pathogen prevalence among children with and without acute and chronic malnutrition, we conducted a cross-sectional study of human immunodeficiency virus-uninfected Kenyan children aged 6–59 months, who presented with acute diarrhea. Children underwent clinical and anthropometric assessments and provided stool for bacterial and protozoal pathogen detection. Clinical and microbiological features were compared using log binomial regression among children with and without wasting (mid-upper arm circumference ≤ 125 mm) or stunting (height-for-age z score ≤ −2). Among 1,363 children, 7.0% were wasted and 16.9% were stunted. After adjustment for potential confounders, children with wasting were more likely than nonwasted children to present with at least one Integrated Management of Childhood Illness danger sign (adjusted prevalence ratio [aPR]: 1.3, 95% confidence interval [CI]: 1.0 to 1.5, P = 0.05), severe dehydration (aPR: 2.4, 95% CI: 1.5 to 3.8, P < 0.01), and enteroaggregative Escherichia coli recovered from their stool (aPR: 1.8, 1.1–2.8, P = 0.02). There were no differences in the prevalence of other pathogens by wasting status after confounder adjustment. Stunting was not associated with clinical severity or the presence of specific pathogens. Wasted children with diarrhea presented with more severe disease than children without malnutrition which may be explained by a delay in care-seeking or diminished immune response to infection. Combating social determinants and host risk factors associated with severe disease, rather than specific pathogens, may reduce the disparities in poor diarrhea-associated outcomes experienced by malnourished children. PMID:29140236