Biochemical Indices Of Nutritional Status Research Articles

Body Composition and Biochemical Parameters of Nutritional Status: Correlation with Health-Related Quality of Life in Patients with Colorectal Cancer

Up to 60% of colorectal cancer (CRC) patients develop malnutrition, affecting treatment effectiveness, increasing toxicity, postoperative complications, hospital stay, and worsening health-related quality of life (HRQOL). This cross-sectional study analyzed data from 48 women and 65 men with CRC. We correlated scores of the scales from the questionnaires EORTC (European Organisation for Research and Treatment of Cancer) Quality of Life Questionnaire Core 30 (QLQ)-C30 and Colorectal Cancer module Colorectal 29 (QLQ-CR29) with patients’ body composition and clinical and biochemical indicators of nutritional status. Results: Scores on quality of life were negatively associated with the lymphocyte count (rP = −0.386) and the fat trunk percentage (rP = −0.349) in the women’s group. Scores on the physical and role functioning were inversely associated with the adiposity percentage (rP = −0.486 and rP = −0.411, respectively). In men, total skeletal muscle mass (SMM) was positively associated with emotional functioning (rP = 0.450); the trunk SMM was negatively related to fatigue (rP = −0.586), nausea and vomiting (rP = −0.469), pain (rP = −0.506), and financial difficulties (rP = −0.475); additionally, serum albumin was positively related to physical, emotional, and social functioning scales (rPs = 0.395, 0.453, and 0.363, respectively) and negatively to fatigue (rP = −0.362), nausea and vomiting (rP = −0.387), and appetite loss (rP = −0.347). Among the men, the reduced SMM and biochemical, nutritional parameters were related to low scores on the EORTC QLQ-C30 and QLQ-CR29 functioning scales. In conclusion, in patients with CRC, malnourishment could have a profound effect on the patients’ functionality and QoL (quality of life).

Biochemical Indicators of Malnutrition in Children with Chronic Kidney Disease on Peritoneal Dialysis, Hemodialysis and Post-Transplant Kidney

Abstract Objectives To demonstrate differences in the profile of biochemical indicators of nutritional status in children with End-stage renal disease (ESRD) between peritoneal dialysis (PD), hemodialysis (HD), and renal transplantation (RT). Methods Analytical cross-sectional study. A total of 130 children and adolescents between 6 and 18 years of age with ESRD were included: 49 children in RT, 33 in PD, and 48 in HD. The biochemical indicators (hemoglobin, glucose, albumin, total cholesterol, and triglycerides) and anthropometric indicators of nutritional status were obtained. ANOVA, T-student, and Pearson correlation were performed. For nonparametric variables, Chi-square, U-Mann Whitney, Kruskal-Wallis, and odds ratio were used. Results The frequency of hypoalbuminemia was higher in the PD group than in the RT group [OR = 56.4 (6.9, 459) P < 0.001] and the HD group [OR = 10.08 (3.1, 319) P < 0.001]. Anemia was higher in the HD group compared with the RT group [OR = 4.9 (2.1, 11.2) P < 0.001] and the PD group [OR = 3.0 (1.3, 7.7), P = 0.02]. Cholesterol serum concentration was higher in the PD group compared to the RT group [OR = 27.4 (3.3, 225), P < 0.01] and the HD group [OR = 26.2 (3.2, 215), P < 0.001]. Patients in the PD group had a higher risk of hypertriglyceridemia than the RT group [OR = 5.5 (1.9, 15.7), P = 0.002] and the HD group [OR = 2.3 (1.1, 5.4), P = 0.04]. Albumin correlated with tricipital skinfold and mid-upper arm circumference (MUAC) in the RT group; with subscapular skinfold (SSF) in the HD group; and with height, SSF, and MUAC in PD group. Conclusions There are substantial differences in the biochemical indicators of nutritional status depending on the renal substitution program. Funding Sources Project supported by the National Council of Science and Technology of Mexico.

PCN369 - RELATION OF HEALTH RELATED QUALITY OF LIFE WITH INDICATORS OF NUTRITIONAL STATUS IN HEAD AND NECK CANCER PATIENTS ATTENDED IN A MEXICAN THIRD LEVEL PUBLIC FACILITY

Malnutrition is frequent in head and neck cancer patients and its presence affects their quality of life. Due the existence of several nutritional indicators to diagnose malnutrition, this report presents preliminary results of a correlational study oriented to determine the relation between health related quality of life (HR-QoL) and indicators of nutritional status. To determine the relation of HR-QoL with indicators of nutritional status in head and neck cancer patients attended in a Mexican third level public facility. Nineteen patients with locally advanced head and neck cancer were analyzed. HR-QoL was evaluated using EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. Body composition (using bioelectric impedance analysis) and biochemical indicators of nutritional status were assessed, and clinical data were collected from patients’ clinical charts. Results are reported in mean and standard deviation (SD) or median (Md) and interquartile interval (IQI), according to data distribution. Pearson correlation was applied to identify relation between variables. The mean of age was 61[±5], 12 (63%) patients were male. Score of Global Health Scale/Quality of Life (QoL) Md:66.6 (IQI:62.5-91.7). Serum albumin levels were negatively correlated to Nutritional supplements item (rP=-0.504,p=0.02). Appendicular muscle mass index had a positive correlation with QoL (rP=0.558,p=0.01), Physical (rP=0.517,p=0.02) and Cognitive (rP=0.567,p=0.01) functioning scales; and negative correlation with Nausea and vomiting scale (rP=-0.553,p=0.1). Fat mass percentage had a positive correlation with Nausea and vomiting (rP=0.531,p=0.01), Dyspnea (rP=.515,p=0.02) and Pain killers (rP=0.509,p=.02) items; and negative correlation with Physical (rP=-0.648,p=0.002) and Rol (rP=-0.578,p=0.009) functioning scales. Biochemical and body composition parameters of nutritional status are strongly related with health related quality of life. A close monitoring of nutritional status is needed in order to maintain or improve quality of life of locally advanced head and neck cancer patients.

Strategies of Increased Protein Intake in ELBW Infants Fed by Human Milk Lead to Long Term Benefits.

Objective: The aim of this observational study was to evaluate the effects of two different protein intake regimes on feeding tolerance, in-hospital growth, anthropometric data and psychomotor outcome up to 24 months corrected age (CA) in extremely low birth-weight (ELBW; birth weight <1000 g) infants.Methods: During the period 2008–2013, 52 ELBW infants admitted at birth to two Neonatal Intensive Care Units of Emilia Romagna (Italy) were fed according to different protocols of protein fortification of human milk: an estimated protein intakes at maximum fortification levels of 3.5 gr/kg/day in the Standard Nutrition Population-SNP group (n = 26) and 4.8 g/kg/day in the Aggressive Nutrition Population-ANP group (n = 26). During hospitalization, infants' growth, biochemical indices of nutritional status, enteral intake, feeding tolerance, clinical history and morbidity were evaluated. After discharge, anthropometric data and psychomotor outcome, evaluated by Revised Griffiths Mental Development Scales (GMDS-R) 0–2 years, were assessed up to 24 months CA.Results: During hospitalization, the ANP group showed significantly higher weight (18.87 vs. 15.20 g/kg/day) and head circumference (0.70 vs. 0.52 cm/week) growth rates compared to SNP, less days of parenteral nutrition (7.36 ± 2.7 vs. 37.75 ± 29.6) and of hospitalization (60.0 ± 13.3 vs. 78.08 ± 21.32). After discharge, ANP infants had a greater head circumference compared to SNP (45.64 ± 0.29; 46.80 ± 0.31). Furthermore, the General Quotient of GMDS-R mean scores in the SNP group significantly decreased from 12 to 24 months CA, while no difference was seen in the ANP group.Conclusions: Increased protein intake may provide short and long term benefits in terms of growth and neurodevelopment in human milk-fed ELBW infants.

Urban and rural dietary patterns are associated with anthropometric and biochemical indicators of nutritional status of adolescent Mozambican girls.

The objective of the present study was to explore whether dietary patterns (DP) are associated with nutritional status indicators among adolescent Mozambican girls. Design/Setting/Subjects In this population-based cross-sectional study we used the FFQ data of 547 girls aged 14-19 years from Central Mozambique to derive dietary patterns by means of principal component analysis. We used two-level linear regression models to examine the associations between the DP and anthropometric and biochemical indicators of nutritional status. We identified three DP: 'Urban bread and fats', 'Rural meat and vegetables' and 'Rural cassava and coconut'. The 'Urban bread and fats' DP was positively associated with BMI-for-age Z-score (BMIZ), mid-upper arm circumference (MUAC), triceps skinfold (P for all<0·001) and blood Hb (P=0·025). A negative association was observed between the 'Urban bread and fats' DP and serum folate (P<0·001). The 'Rural meat and vegetables' DP and the 'Rural cassava and coconut' DP were associated negatively with BMIZ, MUAC and triceps skinfold (P for all<0·05), but the 'Rural meat and vegetables' DP was associated positively with serum ferritin (P=0·007). Urban and rural DP were associated with nutritional status indicators. In a low-resource setting, urban diets may promote body fat storage and blood Hb concentrations but compromise serum folate concentration. It is important to continue valuing the traditional, rural foods that are high in folate.

Relation of QLQ-C30 and QLQ-CR29 Health Related Quality of Life Scales and Biochemical Indicators of Nutritional Status

Relation of QLQ-C30 and QLQ-CR29 Health Related Quality of Life Scales and Biochemical Indicators of Nutritional Status

Effects on Weight, Blood Lipids, Serum Fatty Acid Profile and Coagulation by an Energy-Dense Formula to Older Care Residents: A Randomized Controlled Crossover Trial

ObjectivesDietary intake in frail old adults is often lower than estimated needs. The aim of this study was to evaluate the effects of an energy-dense oral supplement on nutritional status, food intake, and physical function in residents living in care residential homes. DesignRandomized controlled intervention trial with a crossover design. SettingFive care residential homes in the southern Stockholm area. ParticipantsOlder people living at care residential homes: age 65 or older, malnourished or at risk of malnutrition according to Mini Nutritional Assessment-Short Form (MNA-SF). InterventionEnergy-dense formula (oleic and linoleic acid emulsion enriched with protein and micronutrients) (Calogen Extra, Nutricia) 30 mL distributed 3 times daily for 6 weeks. MeasurementsBody weight, 3-day food and fluid record, appetite rating, and physical function (ie, Short Physical Performance Battery, grip strength, and peak expiratory flow). Biochemical indicators of nutritional status, blood lipids, and serum phospholipid fatty acid (FA) profile. ResultsTwenty-eight participants completed the 2 phases of the crossover study; group A (n = 14, 87 ± 6 years, 50% women) and group B (n = 14, 82 ± 8 years, 71% women). The intervention periods combined resulted in significantly (P < .05) increased energy intake (238 ± 544 kcal), weight gain (1.4 ± 3.7 kg), improved appetite, relative reduction of saturated FA and increase in polyunsaturated FA, increased apoliporotein A, and reduced serum fibrinogen (–0.9 ± 1.5 g/L). ConclusionDistribution of an oleic and linoleic acid based fat emulsion enriched with protein and micronutrients (Calogen Extra) 3 times daily to old people in care residential homes improved nutritional status, had positive effects on fatty acid profile and blood lipids, and a potential antithrombotic effect. ClinicalTrials.gov IdentifierNCT01259999

Optimization of calcium and vitamin D status during initial military training: a randomized, double‐blind, placebo‐controlled trial (250.4)

Poor vitamin D status is linked to musculoskeletal injuries, such as stress fracture, during military training. The objective of this trial was to determine the effect of daily calcium (Ca) and vitamin D supplementation (2000 mg and 800 IU/day, respectively) on biochemical indicators of nutritional status and bone health, including ionized Ca (iCa), serum vitamin D (25[OH]D), and parathyroid hormone (PTH) during initial military training (IMT). Biomarkers were assessed in volunteers (n = 164, males = 104, females = 60, age [mean ± SD] = 21 ± 4 yrs) at the start of IMT (PRE), and at the end of the 9‐wk course (POST). Supplemental Ca and vitamin D were provided in a fortified snack food, which was consumed 2x/day throughout IMT; overall compliance was 84%. As compared to placebo, Ca and vitamin D supplementation resulted in increased circulating iCa POST‐IMT (group X time interaction, P &lt; 0.05), but not serum 25(OH)D. Increased PTH levels observed in the placebo group at the end of IMT (PRE vs. POST, P &lt; 0.05; 28.5 ± 13.2 vs. 31.3 ± 16.3 pg/ml) were attenuated in the supplemented group (group X time interaction, P &lt; 0.05; 26.9 ± 12.7 vs. 25.3 ± 13.7). Although serum 25(OH)D was not affected, these data indicate that supplementation with Ca and vitamin D during IMT resulted in positive changes in Ca status by preventing the mobilization of Ca from bone through stabilization of PTH. Research supported by USAMRMC.

Long-term supplementation of isomalto-oligosaccharides improved colonic microflora profile, bowel function, and blood cholesterol levels in constipated elderly people—A placebo-controlled, diet-controlled trial

Objectives The main purpose of this study was to determine the long-term (8 wk) effects of isomalto-oligosaccharide (IO) supplementation on fecal microflora, bowel function, and biochemical indicators of nutritional status in constipated elderly subjects. We also assessed whether the effect of IO was sustained after its withdrawal. Methods Thirteen (five male) constipated subjects (age 82.5 ± 1.9 y) participated in this diet-controlled study that consisted of a 4-wk placebo period, two 4-wk IO (10 g/d) -supplementation periods (IO1 and IO2), and a 4-wk post period. Fasting blood was collected on the last day of each period. Stools were collected during the last week of each period. The bowel function was monitored throughout the study. Results The fecal bifidobacteria, lactobacilli, and bacteroides counts (log counts/g wet feces) significantly increased and clostridia count decreased at the end of the IO1 period. The effects were more pronounced in the IO2 period and then returned to the levels of the IO1 period at the end of the post period. Daily fecal excretion of acetate and propionate increased along with IO supplementation. The frequency of spontaneous defecation increased in the IO2 period, and wet fecal mass increased by 24% in both the IO1 and the IO2 periods. The effects of IO on bowel function diminished in the post period. Plasma total and low-density lipoprotein cholesterol levels were lower with 4- or 8-wk IO supplementation as compared with the placebo and post period, respectively. Conclusions IO supplementation into a low-fiber diet improved colonic microflora profile and bowel movement in a time-dependent fashion in constipated elderly subjects. These beneficial effects decreased after discontinuation of the supplements.

Behavioral and physiological responses of a wild teleost fish to cortisol and androgen manipulation during parental care

Proximate mediators of reproductive behaviors in vertebrates have a long history of study. In fishes, relatively few studies have focused on hormonal control of parental care, despite a comprehensive background on the general physiology of fishes, and the frequent occurrence of parental care behaviors. Studies on this taxon have repeatedly found that the relationships between androgens and paternal care do not follow the predictions made in the avian and mammalian literature. Glucocorticoids may also have a role in mediating parental behaviors, possibly through their role as regulators of metabolism. As such, we investigated the role of 11-ketotestosterone (11-KT) and cortisol in mediating parental effort of male smallmouth bass ( Micropterus dolomieu) by manipulating hormone titers in wild fish. In smallmouth bass, males spawn annually with a single female and defend a single brood for up to 30 days. Treatment of parental fish with cyproterone acetate (CYA; an androgen receptor antagonist) resulted in a decrease in nest defense in response to a simulated brood predator; however, no changes in nest success, nest tending or biochemical indicators of nutritional status were detected. Treatment with exogenous cortisol did not change parental behavior, but did increase the rate of nest failure, possibly owing to the energetic cost of chronically elevated cortisol concentrations. We discuss these findings in the context of resource-driven trade-offs and highlight life history as an important factor controlling parental effort in species with costly parental care behaviors.

Zinc and micronutrient combinations to combat gastrointestinal inflammation

To examine current evidence for dietary supplementation with zinc and other micronutrients for primary prevention of multiple micronutrient deficiencies that are known to result from therapies used in the treatment of gastrointestinal inflammatory disorders. Epidemiological observations and clinical findings have strengthened the concept that both nutritional deficiencies and nutritional excesses impair the gastrointestinal response(s) and alter susceptibility to inflammation and other diseases. The interaction of micronutrient intake, biochemical indicators of nutritional status, and four specific gastrointestinal inflammation states are reviewed. These conditions include celiac disease and concomitant micronutrient deficiencies resulting from the sustained adherence to a gluten-free diet; micronutrient nutrition as an important determinant of immunity for two major types of inflammatory bowel disease: ulcerative colitis and Crohn's disease; and HIV/AIDS-related diarrhea and concomitant micronutrient deficiencies which may be exacerbated by the initiation of highly active antiretroviral therapy. For each inflammation 'state', enhancement of micronutrient status can improve immunocompetance and minimize therapeutic side-effects. The impact of single-micronutrient deficiencies on immune responses, and the possible impact of uncorrected micronutrient status are discussed.

Unusual low plasma levels of zinc in non-pregnant Congolese women

Zn is an essential trace element required throughout the life cycle. Although suboptimal Zn status is thought to be common in many sub-Saharan countries, there is a paucity of data in the Democratic Republic of Congo. The objective of the study was to determine Zn status in non-pregnant Congolese women. We measured plasma Zn and indicators of nutritional status (albumin, prealbumin, retinol-binding protein) and inflammation (C-reactive protein (CRP), ceruloplasmin, alpha1-acid glycoprotein (AGP)) in seventy-seven lactating and thirty non-lactating women (mean age 28 and 31 years, respectively). Blood samples were collected in summer 1989 in rural Bas-Congo during a survey on Fe status. Mean lactation period was 8.3 months. Mean parity was higher in lactating (3.6) than in non-lactating (2.2) women (P < 0.05). Mean biochemical indicators of nutritional status, CRP and ceruloplasmin were within normal range and not different between groups. Mean AGP concentrations were above normal (>1.2 g/l) and higher in lactating (1.365 g/l) than in non-lactating (1.178 g/l) women (P < 0.05). Mean Zn concentration (540 microg/l) of the overall study population was below normal (700 microg/l); and the mean was lower in lactating (455 microg/l) than in non-lactating (759 microg/l) women (P < 0.05). Multiple regression analysis suggested that parity (P < 0.05), but not inflammation, was the most important factor associated with low Zn levels. Despite the lack of data on dietary intake, the results suggest that suboptimal Zn status may be common in the studied population.

Biochemical indices for the assessment of nutritional status during hematopoietic stem cell transplantation: are they worth using? A single center experience

Hematopoietic stem cell transplantation (HSCT) is being used increasingly in an attempt to cure many hematological disorders, solid tumors and autoimmune diseases. One of the major challenges in the post-transplant period is nutrition. The purpose of this investigation was to assess changes in the biochemical indices of nutritional status during HSCT and compare them with acute-phase protein levels to find the best parameters for nutritional support qualification. Nutritional status was assessed in 54 patients during autologous (30 cases) and allogeneic (24 cases) transplantation. Fifteen patients had to be treated with total parenteral nutrition (TPN), eight of them needing prolonged hospitalization. All nutritional indices and acute-phase protein levels were evaluated during the day before the beginning of conditioning regimen, after chemotherapy completion and every 7 days until engraftment, at least three times after stem cells infusion. Wilcoxon test and canonical analysis were used for statistical analyses. The measurement of retinol-binding protein and transferrin can be useful for nutritional assessment during autologous and allogeneic HSCT, respectively. Prealbumin level, measured 8 days after the end of conditioning regimen, is helpful in making a decision about starting TPN.

Micronutrient dilution associated with added sugar intake in elderly black South African women

To investigate the association between added sugar and macronutrient and micronutrient intakes, and to assess whether added sugar intake is related to biochemical indices of nutritional status, Mini-Nutritional Assessment (MNA) score, body mass index (BMI) and performance on physical function tests. A cross-sectional, analytical study. Convenient sample of 285 institutionalised and community-dwelling black South African men and women aged 60+ y. An interviewer-administered 24-h dietary recall and MNA were performed. Serum albumin, vitamin B12, ferritin, cholesterol, haemoglobin, red blood cell (RBC) folate and plasma vitamin C were measured. Handgrip strength, BMI, 'sit-to-stand' and 'get-up-and-go' tests were measured. Outcome variables were analysed according to tertiles of added sugar, in grams and as a percentage of total energy (% E). In each tertile of sugar intake, mean MNA score fell in the 'at-risk' classification. In women, energy, protein, % E protein, fibre, thiamin, riboflavin, niacin, vitamin B6, folate, pantothenic acid, biotin, vitamin C, calcium, iron, magnesium, phosphorus, zinc, copper and selenium intake were significantly lowest in subjects in the highest % E sugar tertile. In men, no differences were found for micronutrient intake according to tertiles of total added sugar or % E added sugar. Physical function declined with increasing sugar intake, and suboptimal RBC folate and plasma ascorbic acid status was associated with increasing sugar intake (in women). No relationship was found between added sugar intake and the very high prevalence (65%) of obesity in women. A nutrient-diluting effect of added sugars intake was demonstrated in elderly black South African women. Further studies in this population are required in order to develop food-based dietary guidelines, which include messages on added sugar intake.

Biochemical Indicators of Nutritional Status and Dietary Intake in Costa Rican Cabécar Indian Adolescents

The purpose of this study was to determine the blood levels of selected nutritional status indicators and the dietary intake of Costa Rican Cabécar Indians aged 10 to 16 years. The results showed that 65% of the adolescents had an adequate body mass index (BMI) for their age, and 32% had a BMI < 5th percentile. Likewise, the study revealed a high prevalence of anemia (57%), deficient serum folate levels (54%), deficient vitamin B12 levels (31%), and subclinical vitamin A deficiency (10%). Additionally, the youngsters had elevated prevalences of high triglyceride levels (77%), borderline high-density lipoprotein (HDL) cholesterol levels (46%), homocysteine levels > 10 micromol/L (29%), and homozygous mutation of methylenetetrahydrofolate reductase (MTHFR) (49%). The diet was poor, being high in saturated fat and low in polyunsaturated fat, fiber, and several micronutrients. The dietary intakes of more than 55% of the adolescents did not meet 50% of the estimated average requirements (EAR) for zinc, vitamin A, vitamin C, vitamin B12, vitamin B2, and folate. Furthermore, a high prevalence of parasitosis was found (68%). Our results show an adolescent Cabécar population with a mosaic of nutritional deficiencies and cardiovascular risk factors.

Review of the Derivation and Applicability of Selected Biochemical Indicators of Nutritional Status as Predictors of Chronic Disease in the Elderly

Efforts of the US Department of Agriculture (USDA) Northeast -172 Technical Committee (1990–2004) have focused on assessing biochemical markers of nutritional status as predictors for chronic diseases that plague the elderly. Variance in determinations of iron status (with and without rheumatoid arthritis) was established; utility of plasma transferrin receptors for discriminating anemia of chronic disease from iron deficiency was determined; it was determined that low levels of vitamin E and carotenoids presented risk for coronary heart disease cardiovascular disease (CHD). Alternative methodologies for assessing lipoproteins were evaluated for predicting the risk for CHD. These efforts made significant contributions to the science of diagnosing iron deficiency and predicting the risk for CHD in the elderly.

Indicators of nutritional status in restricting-type anorexia nervosa patients: a 1-year follow-up study

Background & aim: Despite severely reduced intakes, anorexia nervosa (AN) patients seem to maintain serum biochemical parameters within the safe limit. The aim of this study was to assess the evolution of some traditional serum biochemical indicators of nutritional status in a 1-year follow-up of patients with restricting-type AN.Methods: 14 adolescent female patients were studied at four different time points: (1) on hospital admission (t0), (2) 1 month later (t1), (3) 6 months after admission (t6) and (4) 12 months after admission (t12). At each time point serum albumin, prealbumin, retinol-binding protein, transferrin, complement factors C3 and C4, zinc and iron status were analysed. 15 healthy adolescents formed the control group.Results: Among the liver-synthesised proteins, a significant time effect was only demonstrated on transferrin and C3 and C4 (ANOVA, P<0.05). Transferrin level in patients on admission was lower than in controls, increased significantly during the first month and showed an opposite pattern in subjects gaining and non-gaining weight between t1 and t12, decreasing only in the group failing to gain further weight. C3 and C4 decreased significantly in t12. Changes in ferritin and zinc showed significant negative correlations with changes in anthropometrical parameters.Conclusions: The changes in transferrin, C3 and C4 levels during the out-patient treatment reveal an increased risk of relapses after 1 year since hospital admission. Ferritin and zinc levels seem to be affected by the nutrient requirements for anabolic processes during nutritional recovery.

O0032 AN OBSERVATIONAL STUDY TO ASSESS WHETHER THE PRESCRIPTION OF PARENTERAL NUTRITION REQUIRES THE SUPPORT OF A SPECIALIZED NUTRITION TEAM

Introduction: Previous studies have demonstrated the value of nutrition support teams (NST) in patient care, quality control issues and possibly in hospital cost savings. Despite this, the majority of tertiary pediatric centres in Canada do not have nutrition support teams. The purpose of this study was to determine the appropriateness of parenteral nutrition (PN) utilization in non-acute hospital areas in the absence of a nutrition support team. When compared to standards of care, this data was used to estimate potential cost avoidance. Methods: This observational survey included all patients between the ages of 0–18 years on 3 general paediatric and surgical wards admitted between March-June 2002. Fifteen out of 120 patients admitted and placed on PN by the attending physicians were included. The medical conditions were as follows: inflammatory bowel disease (n=6), cystic fibrosis (n=3), pancreatic trauma (n=2), duodenal atresia (n=1), hirschsprung’s disease (n=1), paralytic ileus (n=1) and proximal small bowel obstruction (n=1). Results: A total of 160 patient days of PN was analyzed. Thirty three percent of patients failed to receive an appropriate nutritional assessment prior to initiation of PN including, weight, height, estimation of nutrient requirements and assessment of biochemical indices of nutritional status. Only 53% of patients received a baseline nutritional assessment by both physician and dietitian. Enteral nutrition could have been utilized over parenteral nutrition in 53% of the cases. This represented an additional cost of CDN$115 /patient/day not including differential labour costs. Only 27% of patients were started on an age-appropriate macronutrient profile and 33% had safe progression of macronu-trients. The majority of patients did not have calorie counts done either at baseline or during transition to enteral feeds (87%) thus preventing the determination of appropriate caloric achievement. It was estimated that 21% of the PN days could have been avoided had PN therapy been more appropriately initiated and discontinued. Conclusion: This observational study demonstrates that the selection of patients eligible for PN, its initiation, progression and discontinuation could be further optimized to achieve nutritional goals. Moreover, this study suggests that the more appropriate prescription of PN by a dedicated NST would improve the standard of patient care and may have costs saving benefits. Future efforts should focus on such implementation in pediatric tertiary care centres.

Nutritional status of preschool Senegalese children: long-term effects of early severe malnutrition.

The prevalence of malnutrition remains high in many developing countries. However, data relating to the long-term effects of severe malnutrition, specifically, serum levels of biochemical indicators of nutritional status, are still scarce in the literature. Hence the present study aimed to investigate the nutritional, biological and growth status of Senegalese preschool children previously hospitalised for severe malnutrition. The study involved twenty-four 7-year-old children who had suffered from marasmus 5 years earlier, twenty-four siblings living in the same household, and nineteen age-matched children living in the centre of Dakar. The siblings were of similar age to the post-marasmic children. Anthropometry, serum biochemical indicators of nutritional status, growth factors, and haematological and mineral parameters were measured. The prevalence of stunting and wasting was the same in the post-marasmic children as in the siblings. Body-fat and fat-free-mass (FFM) deficits in both groups were corroborated by abnormally low concentrations of transthyretin, osteocalcin, insulin-like growth factor (IGF)-1, and insulin-like growth factor-binding protein (IGFBP)-3. FFM was positively and significantly correlated with concentrations of IGF-1 and IGFBP-3. In the post-marasmic children, height for age was also correlated with IGF-1. Of the post-marasmic children, 53 % had Fe-deficiency anaemia, as did 35 % of the siblings and 29 % of the controls. No significant associations were found between the serum concentrations of Ca, Cu, K, Mg, Na, P, Se, Zn and growth retardation. At 5 years after nutritional rehabilitation, the post-marasmic children remained stunted with nutritional indices significantly lower than the control children. However, these children were doing as well as their siblings except for minor infections.

Assessment of thiamin (vitamin B1) and riboflavin (vitamin B2) status in an adult Mediterranean population.

The aim of the present study was to assess the nutritional status for thiamin (vitamin B1) and riboflavin (vitamin B2) in an adult Mediterranean population, in order to identify patterns of intake, groups at risk for deficiency and factors that might influence this risk. A cross-sectional survey was carried out in Andalusia, a western Mediterranean region in southern Spain. Nutrient intakes were studied in a random sample of 3390 subjects (1746 men, 1644 women) who were between 25 and 60 years of age. Blood samples were obtained for biochemical assays in a random subsample of 372 subjects (181 men, 191 women). Food consumption was assessed by 48 h recall. Vitamin B1 and B2 were measured as erythrocyte transketolase and as erythrocyte glutathione reductase activation coefficients, respectively. Energy and vitamin intakes were significantly higher in men than in women. Intakes were below two-thirds of the recommended dietary allowance for vitamin B1 in 7.80 % of the men and 4.50 % of the woman, and were below this level for vitamin B2 in 18.00 % of the men and 11.70 % of the women. Age, educational level, alcohol use and smoking were also associated with differences in the intake of these nutrients. Biochemical analyses showed that vitamin B1 and B2 status was deficient in 6.40 and 5.30 % of the population, respectively. Although factors such as gender, age, level of education, drinking and smoking can have an effect on the risk of inadequate intake of these nutrients, these factors did not affect biochemical indices of nutritional status in the present study.