Chronic Protein-energy Malnutrition Research Articles

Using the Height-for-Age Z-score (HAZ) to predict protein-energy malnutrition in patients with congenital epidermolysis bullosa through the application of machine learning methods

Congenital epidermolysis bullosa (СЕВ) is a group of genetically and clinically heterogeneous diseases characterized by a tendency to form blisters and/or erosions on the skin and mucous membranes with minimal trauma. Nutritional deficiency stands as the most common complication observed in EB, with its development influenced by a multitude of contributing factors.Purpose of the study. To construct a predictive model for the development of protein-energy malnutrition in patients with various forms of EB, identify the main features affecting the sensitivity of the predictive model, and evaluate the model’s validity based on retrospective data on the presence of protein-energy malnutrition in this patient category.Methods. The study involved 101 patients aged 3 to 18 years with simplex (n=25), junctional (n=10), and dystrophic (n=66) СEB. The Birmingham EB Severity Score, laboratory and anthropometric parameters, as well as data on the presence of gastrointestinal complications, were used for the analysis of disease progression and predictive model construction. The Scikit-learn library of the programming language Python was utilized for building the machine learning model.Results. In the construction of the predictive model, the RandomForestClassifier model showed the best results. The developed machine learning model can correctly determine whether a patient has chronic protein-energy malnutrition (class 1, HAZ < –2) or not (class 0, HAZ > –2) with an accuracy of 92%, sensitivity of 85.7%, and specificity of 100%.Conclusions. The machine learning model presented in this study predicts the values of the Height-for-Age Z-score (HAZ) and can have practical significance in medical practice and clinical research. The model can be used for early diagnosis of protein-energy malnutrition in patients with EB, which may allow healthcare professionals to timely start nutritional support and prevent possible complications of the disease, as well as develop individual nutrition and treatment plans for patients.

Prevalence of Stunting and Its Associated Factors Among Children Residing in Internally Displaced Persons (IDP) Camps in Hargeisa, Somaliland: A Community-Based Cross-Sectional Study.

Stunting, a consequence of prolonged malnutrition, remains a critical global health issue affecting 165 million children under the age of five, with 10.6 million associated deaths. Its stunting prevalence is particularly pronounced in developing nations, notably Sub-Saharan Africa. Chronic protein-energy malnutrition, identified as a major cause of morbidity and mortality in displaced settings, underscores the urgency of understanding its impact in such contexts. This study aimed to assess the prevalence and associated factors of stunting among children aged 12-59 months and residing in IDP camps in Hargeisa, Somaliland. A community-based cross-sectional study was conducted in Hargeisa from May 5 to July 30, 2022, utilizing systematic random sampling, online mobile surveys, and caregiver interviews with anthropometric measurements. The SPSS version 25 was utilized in handled data entry, processing and analysis. Multivariable logistic regression, with p < 0.05 significance, included variables from bivariate analysis (p < 0.2). Stunting assessment utilized WHO AnthroPlus software, categorizing HAZ scores < -2.0 SD. The prevalence of stunting among children living in IDP camps was found to be 21.1% [95% CI: 17.0-24.91%]. Vaccination status (adjusted odds ratio [aOR] = 0.19, 95% CI: 0.09-0.38), deworming practice (aOR = 6.5, 95% CI: 2.91-14.52), place of delivery (aOR = 0.14, 95% CI: 0.07-0.30), measles experience in the last year (aOR = 0.12, 95% CI: 0.04-0.34), ANC visits (aOR = 0.33, 95% CI: 0.14-0.81), and maternal insufficient extra food intake (aOR = 2.15, 95% CI: 1.11-4.15) were significantly associated with stunting. The observed stunting prevalence in IDP camps (21.1%) was substantial, highlighting the need for targeted interventions. Future efforts should aim to reduce stunting from the current rate to an estimated 5-10%, emphasizing comprehensive measures such as deworming, maternal nutrition, postnatal care improvement, robust immunization, and promoting healthcare facility deliveries.

The risk of refeeding syndrome among severely malnourished tuberculosis patients in Chhattisgarh, India

BackgroundA secondary care hospital in rural India serving a highly tuberculosis (TB) and malnutrition endemic region. ObjectiveIn this study conducted on patients with chronic protein energy malnutrition (PEM) and TB, we sought to compare nurse-estimated vs. smartphone photograph analytic methods for assessing caloric intake and determine the incidence of refeeding hypophosphatemia (RH) and refeeding syndrome (RFS) in patients with TB. MethodsInpatients were prospectively enrolled. Baseline demographic, comorbidity and preadmission caloric data were collected. Nurse estimated caloric intake was compared with digital “before and after” meal images. Serum phosphorus was measured on days 1, 3 and 7 post admission. Patients with RH underwent further evaluation for RFS-associated findings. Results27 patients were enrolled. 85% were at risk of RFS by National Institute for Health and Care Excellence (NICE) criteria. Significant discrepancy (>700 calories) was noted between nurse-estimated caloric intake compared to digital images. RH was found in 37% (10/27). None developed clinical RFS. ConclusionsOur study suggests more standardized methods of caloric intake are needed in resource-limited settings with high co-prevalence of PEM and TB. We noted that despite RH being common in inpatients with PEM+TB given high caloric diets, RFS was not detected.

Red meat snacks for chronic hemodialysis patients: effect on inflammatory activity (A Pilot Study)

Rational: Among the alternatives to reverse chronic hemodialysis protein-energy malnutrition is the enhancement of intradialytic oral nutritional therapy. Although foods of animal origin are a source of nutrients and represent a feasible diet, there is uncertainty about their health consequences. Objectives: We assessed the relationship of intradialytic high-protein red meat snack supplementation with patient inflammatory status and protein losses (nitrogen) during this supplementation. Fourteen patients submitted to low-flux chronic hemodialysis for one month were divided into two groups receiving 2 g (group 1) and 29 g (group 2) of oral intradialytic protein during the initial phase, respectively. In the subsequent phase, group 1 was supplemented with 27 g protein (a red meat snack) for a total of 29 g per dialysis. Group 2 continued to receive 29 g protein. Nutritional status, total nitrogen losses through the dialysate and acute inflammatory phase protein (CRP) were assessed before and after dialysis. Reuse of the dialyzer was also determined on each occasion. Main findings: Red meat supplementation did not interfere with CRP, nitrogen loss through the dialysate (18 ± 7 to 19 ± 4 g in group 1, ns, and 20 ± 7 to 21 ± 4 g in group 2, ns) or with nutritional status. However, the data showed a positive correlation between pre- and post-hemodialysis CRP values (r = 0.84, p < 0.01) in both groups, suggesting an increase of the values after ultrafiltration. Reuse of the dialyzer was not correlated with CRP values. Principle conclusions: The results suggest that snacks were not acutely correlated with increased inflammatory levels and indicated that a protein-rich red meat snack may be beneficial for chronic hemodialysis patients.

Perioperative Nutritional Support and Malnutrition in Infants and Children with Congenital Heart Disease

To assess the effect of nutritional status and cardiovascular risk on hospital outcomes after congenital heart surgery in infants and children. Retrospective study. Cardiac intensive care unit in a tertiary-care children's hospital. One hundred twenty-one patients <24 months of age admitted to the cardiovascular intensive care unit (CVICU) for >48 hours following cardiac surgery. Demographics, Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), Paediatric Index of Mortality 2, and Pediatric Risk of Mortality III scores were obtained on admission. CVICU nutritional intake was calculated for 7 days. Energy and protein needs were estimated using recommended guidelines. Risk Adjustment for Congenital Heart Surgery-1 was categorized as (1-3) or (4-6). Malnutrition was categorized by Waterlow criteria and correlated with mortality risk, days of mechanical ventilation, and hospital and CVICU length of stay. Ninety-one patients who underwent cardiac surgery were categorized as RACHS-1 (1-3) and RACHS-1 scores of (4-6) (n = 30). Patients with RACHS-1 (4-6) had higher mortality risk by Pediatric Risk of Mortality III (4.9% vs. 2.6%, P < .01), longer CVICU (10.4 days vs. 4.8 days) and hospital stays (28 days vs.14 days), and more days of mechanical ventilation (4 days vs. 2 days) (all P < .005) than RACHS-1 (1-3). The prevalences of acute protein-energy malnutrition and chronic protein-energy malnutrition were 51.2% and 40.5%. The median hospital stay for mild, moderate, and severe chronic protein-energy malnutrition was 31, 10, and 22.5 days, respectively, vs. normal, 15 days (Kruskal-Wallis, P < .005). The average energy and protein requirements met on day 7 were 68 ± 27(SD)% and 68 ± 40%, respectively. Although nearly half of the patients were malnourished at surgery, only two-thirds of their recommended caloric and protein requirements were provided by week 1. To improve hospital outcomes, care should be taken to optimize the nutritional condition of infants and children prior to and following surgical correction of congenital heart disease to improve hospital outcomes.

Serum cholinesterase as indicator of parenteral nutrition efficacy in protein energy malnutrition: Four case reports

Summary Pseudocholinesterase, an enzyme synthesized in the liver, is recently considered also a marker of Protein Energy Malnutrition. In this study we evaluated the acute effects of Total Parenteral Nutrition on Pseudocholinesterase serum levels in 4 patients with Protein Energy Malnutrititon secondary to organic diseases: 2 with Short Bowel Syndrome, 1 with chronic Protein Energy Malnutrition for jejuno-ileal bypass for obesity, and 1 with Eosinophilic Gastroenteritis. All patients were hospitalized for a Central Venous Catheter Related-Bloodstream Infection; Parenteral Nutrition was suspended, which led to an acute deterioration of the nutritional status, as confirmed by weight loss, decreased serum concentrations of Prealbumin, Lymphocyte count, Pseudocholinesterase and Cholesterol. During hospitalization long-term tunnelled Central Venous Catheter was removed and a specific antibiotic therapy was administered; therefore, patients received Peripheral Parenteral Nutrition or Total Parenteral Nutrition with a temporary Central Venous Catheter. In all cases baseline Pseudocholinesterase levels were low, with a sensitive prompt recovery at Total Parenteral Nutrition restoration; to a lesser degree, the other nutritional parameters were considered also improved. In conclusion, in patients receiving long-term Parenteral Nutrition with acute clinical deterioration due to catheter infection, Pseudocholinesterase could be considered a useful indicator of nutritional status, as well as, of the efficacy of nutritional intervention.

Cognitive development in children with chronic protein energy malnutrition

BackgroundMalnutrition is associated with both structural and functional pathology of the brain. A wide range of cognitive deficits has been reported in malnourished children. Effect of chronic protein energy malnutrition (PEM) causing stunting and wasting in children could also affect the ongoing development of higher cognitive processes during childhood (>5 years of age). The present study examined the effect of stunted growth on the rate of development of cognitive processes using neuropsychological measures.MethodsTwenty children identified as malnourished and twenty as adequately nourished in the age groups of 5–7 years and 8–10 years were examined. NIMHANS neuropsychological battery for children sensitive to the effects of brain dysfunction and age related improvement was employed. The battery consisted of tests of motor speed, attention, visuospatial ability, executive functions, comprehension and learning and memoryResultsDevelopment of cognitive processes appeared to be governed by both age and nutritional status. Malnourished children performed poor on tests of attention, working memory, learning and memory and visuospatial ability except on the test of motor speed and coordination. Age related improvement was not observed on tests of design fluency, working memory, visual construction, learning and memory in malnourished children. However, age related improvement was observed on tests of attention, visual perception, and verbal comprehension in malnourished children even though the performance was deficient as compared to the performance level of adequately nourished children.ConclusionChronic protein energy malnutrition (stunting) affects the ongoing development of higher cognitive processes during childhood years rather than merely showing a generalized cognitive impairment. Stunting could result in slowing in the age related improvement in certain and not all higher order cognitive processes and may also result in long lasting cognitive impairments.

Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa

Anorexia nervosa is associated with lower left ventricular mass (LVM) and systolic dysfunction. Whether these abnormalities reflect chronic protein-energy malnutrition or are primarily related to lower cardiac workload is unclear. The objective of the study was to verify whether low LVM in anorexia nervosa is explained by low hemodynamic load. Ninety-one women with anorexia nervosa [macro x +/- SD age: 20.5 +/- 6.1 y; body mass index (in kg/m(2)): 15.6 +/- 1.9; group 1] and 62 normal-weight female control subjects (age: 22.5 +/- 5.5 y; body mass index: 20.9 +/- 1.2; group 2) underwent Doppler echocardiography. LVM was evaluated as the percentage predicted by body height, sex, and stroke work (systolic blood pressure x stroke volume). The left ventricular chamber dimension was smaller and the chamber walls were thinner in group 1 than in group 2, which resulted in significantly lower LVM and LVM indexes (P < 0.0001). Ejection fraction, heart rate, stroke volume, and cardiac output were significantly (P < 0.007) lower in group 1, but peripheral resistance was substantially higher (P < 0.0001). The deviation of LVM from predicted values was lower and the proportion of subjects with inadequate LVM was significantly higher in group 1 than in group 2 (P < 0.0001). This difference was attenuated after adjustment for body weight and heart rate. There were no relations between LVM and laboratory tests in group 1. Anorexia nervosa is a condition of low hemodynamic load that leads to low LVM. Even with adjustment for stroke work, however, LVM is lower than would be predicted by height, because of the effect of body weight reduction (ie, wasting of lean body mass).

Malnutrition, nutritional indices, and early enteral feeding in critically ill children

We measured the incidences of protein and fat depletions and the frequencies of acute and chronic protein-energy malnutrition during stress states in children and investigated the influence of early enteral feeding on nutrition indices and acute-phase proteins. Seventy-one, consecutively enrolled, critically ill children received early enteral feeding (energy intakes equal to 0.50, 1, 1.25, 1.5, and 1.5 of the predicted basal metabolic rates on days 1 through 5, respectively) through nasogastric tubes. On the first day of the study, 16.7% of the patients already were depleted of protein and 31% of fat stores. Overall, 16.9% were at risk for chronic protein-energy malnutrition and 21.1% for acute protein-energy malnutrition, whereas 4.2% and 5.6% already had chronic and acute, respectively protein-energy malnutrition. Only 22.7% of patients without protein deficiencies versus 37% of those at risk or already deficient developed multiple-organ system failure. Transferrin and prealbumin levels improved at the end of the period of early enteral feeding (187 ± 6.6 versus 233 ± 7 mg/dL, P < 0.0001; 15.1 ± 2 versus 21.9 ± 2.9 mg/dL, P < 0.0001; respectively); survivors had higher prealbumin levels than non-survivors (22.3 versus 15.5 mg/dL). With logistic regression analysis, only repleted energy, not anthropometric or nutrition indices, was independently associated with survival ( P = 0.05). These results reinforce the observation that critically ill children are at risk for fat or protein depletion and development of malnutrition, which is associated with increased morbidity and mortality. We conclude that early enteral nutrition improves nutrition indices and outcomes.

Growth Hormone Promotes Somatic and Skeletal Muscle Growth Recovery in Rats Following Chronic Protein-Energy Malnutrition

The efficacy of recombinant human growth hormone (GH) and/or a diet enriched in protein and energy to improve growth recovery following prolonged malnutrition was examined in male rats food-restricted from birth until 120 d of age. At d 121, restricted rats were randomly assigned to recovery groups receiving either a control or enriched diet with or without daily subcutaneous injections of GH. Rats were killed after 16 or 47 d of recovery. At d 16, GH treatment stimulated liver, heart, plantaris, soleus, carcass and body weight gain and inhibited fat gain when compared to recovery controls. Rats receiving GH also exhibited the highest serum insulin-like growth factor-I (IGF-I) concentrations and total muscle protein. At d 47, GH effects on body and muscle recovery were minimal, and differences among recovery groups in serum IGF-I concentration and total muscle protein were no longer present. Consumption of an enriched diet increased fat pad and liver mass, but did not promote muscle recovery. There were no differences among treatment groups in skeletal muscle IGF-I mRNA levels at d 16 or 47. In summary, GH had positive effects on somatic and skeletal muscle growth early in the recovery process, possibly via endocrine IGF-I-stimulated protein accretion. In contrast, the enriched diet promoted fat deposition with no impact on skeletal muscle growth recovery.

Malnutrition in hospitalized pediatric patients. Current prevalence.

To document the current prevalence of protein-energy malnutrition compared with that reported from the same institution in 1976. All inpatients of this tertiary-care facility were assessed by anthropometric, laboratory, and clinical nutrition assessment methods in a 1-day cross-sectional survey. The comparison study from 1976 was also a 1-day cross-sectional survey. A tertiary-care facility in Boston, Mass. The entire inpatient population was assessed on a single weekday in September 1992. Prevalence of acute and chronic malnutrition as judged by anthropometric and laboratory data. Data on demographics, admission classification, underlying disease, route of nutrition, and global nutritional status were also assessed. The prevalence of acute protein-energy malnutrition (weight for height) based on the Waterlow criteria was as follows: severe, 1.3%; moderate, 5.8%; mild, 17.4%; and none, 75.5%. The prevalence of chronic protein-energy malnutrition (height for age) was as follows: severe, 5.1%; moderate, 7.7%; mild, 14.5%; and none, 72.8%. Although the prevalence of acute and chronic protein-energy malnutrition was significantly less in 1992 than in 1976 (P = .03 and P < .001, respectively), the numbers are still alarmingly high. Children younger than 2 years and older than 18 years and those with chronic medical conditions had a higher prevalence of protein-energy malnutrition. Twenty-four percent of patients had a serum albumin level less than 30 g/L, 34.8% had a total lymphocyte count less than 1.5 x 10(9)/L, and 24.9% had a hemoglobin concentration less than 105 g/L. One fourth of all patients were obese (> 120% weight for height), with the greatest prevalence in children aged 2 to 18 years. Acute and chronic protein-energy malnutrition remains common in hospitalized pediatric patients in the United States. Important risk factors may be underlying chronic disease, periods of normally rapid growth, and recognized need for nutrition intervention.

Saliva composition in Indian children with chronic protein-energy malnutrition.

The composition of paraffin-stimulated and unstimulated whole saliva was compared between two groups of 8-12-year-old Indian children-one group with severe to moderate chronic protein-energy malnutrition (PEM group) and an age- and sex-matched control group with normal protein status or mild PEM. The classification of PEM was based on anthropometric measurements compared with Indian standards. Stimulated saliva was analyzed for the following variables: electrolytes (Na+, K+, Ca2+, Cl-, and PO4(3-)), total protein, hexosamines, fucose, sialic acid, and amylase. Unstimulated saliva samples were analyzed for total protein, salivary and myeloperoxidase, thiocyanate, lactoferrin, lysozyme, a bacteria-agglutinating protein (BAGP), total IgG, total IgA, and specific anti-S. mutans IgA. The results show that the PEM group had a reduced secretion rate of stimulated but not unstimulated saliva. Further, the Ca2+ and Cl- concentrations in stimulated saliva were significantly lower in the PEM group compared with the control group, but the other electrolyte levels were similar. No differences were found in total protein concentration or glycoprotein bound carbohydrates in stimulated saliva between the two groups, but the quantity of total protein secreted per min was reduced by 20% in the PEM group. Significantly lower levels of lactoferrin, BAGP, and anti-S mutans IgA were found in unstimulated saliva from children in the PEM group, but significantly higher levels of total IgG. We conclude that children with severe or moderate PEM, who have reduced secretion rate, buffer capacity, lower Ca2+, and protein secretion in stimulated saliva, also have impaired immunological and agglutinating defense factors in unstimulated saliva.

HIV-1 infection among malnourished children in Butare, Rwanda.

In order to investigate the relationship between human immunodeficiency virus (HIV-1) infection and protein-energy malnutrition (PEM), all 101 malnourished children who were admitted to the Department of Pediatrics of the National University Hospital between February and July of 1989 (median age = 2.5 years), and who were accompanied by their mother were screened for HIV-1 antibody. Mothers were also screened and interviewed. Mother-child pairs were followed-up 2 years later to determine mortality and clinical status. Fourteen per cent of malnourished children were HIV-1 seropositive. Only one seropositive child had a seronegative mother. This child had a history of multiple blood transfusions and injections. Among children above 15 months of age, HIV-1 seropositivity was more common among marasmic children than among malnourished children presenting with oedema at admission to the hospital. Also, HIV-1 infection was found more frequently among chronically malnourished children (low height for age and weight for age) than among acutely malnourished children (low weight for height). Mortality during the 2-year follow-up was 75 per cent among HIV-1 seropositive children and 23 per cent among HIV-1 seronegatives (mortality density ratio = 6.2; 95 per cent confidence interval = 2.2-17.4). Severe, chronic PEM should always alert health workers to the possible diagnosis of pediatric AIDS, and its implications for treatment and prognosis.

Malnutrition and food consumption patterns in Malaysia

In a rapidly developing country like Malaysia problems related to nutrition present themselves with contrasting features. While health indicators such as the toddler mortality rate, incidence of low birth weight and food balance sheet data suggest an improving nutritional situation, direct nutrition assessment indicates that chronic protein energy malnutrition is still common amongst children in rural areas and urban slums. Initial surveys of the adult urban population indicate about 10% prevalence of chronic energy deficiency in both sexes. Food consumption data revealed an average energy intake below the recommended daily intake for Malaysia in most age groups. Although death due to malnutrition is rare in Malaysia, it is known to cause considerable ill-health, impaired mental performance in children, loss of productivity in adults and an overall decline in quality of life. This paper reports the prevalence of malnutrition in the last two decades, the possible contributing factors and recommendations fo...

Salivary flow and dental caries in Indian children suffering from chronic malnutrition.

Chronic protein-energy malnutrition during the period of growth and development causes permanent disturbances of salivary gland function and tooth structure. Moderate protein-energy deficiency also causes impaired saliva secretion rate and composition in the adult rat. These impairments have been shown to coincide with an increased incidence of dental caries. In the present investigation we studied the effect of chronic malnutrition on saliva secretion rate and susceptibility to dental caries in Indian children. It was found that chronic malnutrition reduced the secretion rate of stimulated saliva, but not that of unstimulated saliva. The salivary buffer capacity was continuously decreased as the secretion rate decreased with the level of malnutrition in the Indian children. The malnourished children developed increased caries. Thus, it could be concluded that chronic malnutrition in growing children enhances the cariogenic potential stemming from fermentable carbohydrates.

Effects of malnutrition on microvillus membrane glucose transport and physical properties

We examined sodium-dependent glucose transport, membrane lipid composition, and membrane fluidity in microvillus membrane vesicles isolated from the distal intestine of infant rabbits subjected to protein-energy malnutrition and age-matched controls. In vesicles from malnourished animals, sodium-dependent glucose transport was significantly enhanced, as evidenced by a twofold increase in maximal transport capacity, Jmax. Carrier affinity for glucose, as assessed by the Km of the transport process, was unaffected. These alternations were associated with marked changes in microvillus membrane composition. Malnourished animals had an increase in the lipid-to-protein ratio of the microvillus membrane, which suggests that malnutrition might be associated with either a reduction in membrane protein or an increase in membrane lipid. This would be expected to increase the fluidity of the microvillus membrane. However, we observed no differences in either the static or dynamic component of membrane fluidity, using multiple fluorescent probes, between dietary groups. Further analysis of membrane lipids was undertaken to establish whether quantitative differences in lipid subclasses could explain this discrepancy. We found that nutrient deprivation produced numerous alterations in membrane lipids. The major findings were an increase in both the cholesterol-to-phospholipid and phosphatidylethanolamine-to-phosphatidylcholine ratios. Both alterations would be expected to decrease membrane fluidity and presumably represent a compensatory response to the loss of membrane protein. Thus chronic postnatal protein-energy malnutrition initiates several adaptive responses that include major alterations in the chemical composition of the microvillus membrane. The resulting effect preserves efficient glucose transport and maintains the physical properties of the microvillus membrane.

Health and Nutrition Considerations in Education Planning. 1. Educational Consequences of Health Problems among School-Age Children

This paper utilizes recent findings to address, from the perspective of an educational planner, the question of how educational systems can intervene to improve the health and nutritional status of school-age children. Evidence is reviewed on the linkages between health conditions and three of the most important educational problems in developing countries-children who are unprepared to begin school at the usual age, the failure of many students to learn adequately in school, and the unequal participation in schooling by girls. It is clear that although less attention has been paid to the health and nutrition status of school-age children than to that of children of preschool age or of adults, existing data are adequate to identify several widespread problems among school-age children that have well established negative consequences for school participation and performance. These problems include chronic protein-energy malnutrition, iron-deficiency anaemia, iodine deficiency and intestinal helminth infection. It was also observed that a number of other infectious diseases, as well as disability, premature fertility, and substance abuse, are also likely to undermine the health and educational success of many school-age children.

Effect of Chronic Protein-Energy Malnutrition on Fecundability, Fecundity and Fertility in Rats

To assess the effect of chronic protein-energy malnutrition on fecundability (ovulation rate), fecundity (percentage of animals bred that conceived) and fertility (live fetuses at d 18 of pregnancy), 42-d-old female rats were assigned to six groups: two dietary treatment groups and, within each treatment group, three outcome groups. Rats were fed ad libitum (AL) or were chronically restricted (CR) to 50% of AL intake for 28 d before ovulation was assessed and then until implantation and fetal viability were measured. In the ovulation groups, corpora lutea were counted at estrus. In the implantation groups, blastocyst implantation sites were quantified by using Pontamine Blue dye at d 5 of pregnancy. In the viability groups, live and dead fetuses and metrial nodes were counted at d 18 of pregnancy. CR rats had 74% as many corpora lutea as AL rats; however, fecundity did not differ between dietary treatments. CR rats had 71% as many blastocyst implantation sites and 65% as many viable fetuses as AL rats. Chronic malnutrition negatively affected weight gain before and during pregnancy as well as reproductive performance. These findings help to explain why CR rats have fewer progeny.

Nutritional depletions in critically ill children: associations with physiologic instability and increased quantity of care.

The association of nutritional depletions with physiologic instability and quantity of care was examined in 60 critically ill children. Nutritional status was evaluated by anthropometric techniques. Physiologic stability was measured by the Physiologic Stability Index and quantity of care was measured by the Therapeutic Intervention Scoring System. Acute protein-energy malnutrition was significantly associated with increased physiologic instability and increased quantity of care (p less than 0.01). This association was present for the total group, children less than 24 months of age, and for these two groups with nonsurvivors excluded. Mortality was also significantly associated with acute protein-energy malnutrition (p less than 0.001). Physiologic instability and increased quantity of care were not associated with chronic protein-energy malnutrition, fat store depletion, or somatic protein store depletion. We conclude that acute protein-energy malnutrition in critically ill children is associated with increased physiologic instability and increased quantity of care.

Malnutrition in critically ill infants and children.

The prevalences of acute and chronic protein-energy malnutrition (PEM) and deficiencies in stores of fat and somatic protein have not been previously examined in pediatric intensive care unit. One hundred eight nutritional assessments were performed using anthropometric techniques on infants and children in a multidisciplinary intensive care unit. Overall, the prevalence of acute PEM was 19% and chronic PEM was 18%. The prevalence of fat store depletion was 14% and somatic protein store depletion was 21%. In general, children less than 2 years had poorer nutritional status compared to children greater than 2 years. There was not a statistically significant difference between medical and surgical patients. It is concluded that PEM and deficiencies in the macronutrient stores of fat and somatic protein are common in critically ill infants and children.