Correction Of Nutritional Deficiencies Research Articles

Impact of Interventions to Improve Prenatal Nutrition in Developing Countries on Maternal Health: Obstetric Outcomes and Fetal Health

Maternal undernutrition has direct and indirect impacts on the mother’s health, that of the fetus, and may also transcend to future generations. Prenatal nutrition supplementation has been used for many years to reduce the adverse effects of maternal undernutrition. While a lot is known about the deleterious effects of poor nutrition periconception and during pregnancy, there are relatively very few effective interventions to prevent and correct nutritional deficiencies preconception and during pregnancy. The magnitude of maternal undernutrition is a cause of concern, and recently, there have been renewed efforts to find interventions that can address this problem considering its impact on human development. In this desk review, we highlight some of the proven interventions and highlight interventions that are showing promise.

Evaluation of selected aspects of the Nutrition Therapeutic Programme offered to HIV-positive women of child-bearing age in Western Cape Province, South Africa

BackgroundThe Nutrition Therapeutic Programme (NTP) involves the provision of food supplements at primary health clinics (PHCs) to correct nutritional deficiencies in vulnerable groups. Although previous studies have identified problems with implementing the programme at PHCs, assessments of its efficiency have been scarce.ObjectiveTo evaluate implementation of the NTP at PHCs that provide antiretroviral therapy.MethodsA cross-sectional, descriptive study was conducted at 17 PHCs located within 3 districts of Western Cape Province. Two target groups were chosen: 32 staff members working at the sites and 21 women of child-bearing age enrolled in the NTP. Questionnaires were used to obtain data.ResultsOnly 2 women (10%) lived in food-secure households; the rest were either at risk of hunger (29%) or classified as hungry (61%). Most of the women knew they had to take the supplements to improve their nutritional status, but the majority only recalled receiving basic nutritional advice, and the information was mainly given verbally. Ten of the women had shared their supplements with others, mostly with their children. The study identified lack of clearly defined NTP responsibilities at the PHCs, causing confusion amongst the staff. Although many staff members expressed problems with the NTP, only 38% of them reported having routine evaluations regarding the programme.ConclusionSeveral aspects compromised the effectiveness of the NTP, including socio-economic factors leading to clients' non-compliance. The strategic organisation and implementation of the NTP varied between different PHCs offering antiretroviral therapy, and staff experienced difficulties with the logistics of the programme.

The management of perioperative nutrition in patients with end stage liver disease undergoing liver transplantation.

Malnutrition is found in almost 100% of patients with end stage liver disease (ESLD) awaiting transplantation and malnutrition before transplantation leads to higher rates of post-transplant complications and worse graft survival outcomes. Reasons for protein energy malnutrition include several metabolic alterations such as inadequate intake, malabsorption, and overloaded expenditure. And also, stress from surgery, gastrointestinal reperfusion injury, immunosuppressive therapy and corticosteriods use lead to delayed bowl function recovery and disorder of nutrients absorption. In the pretransplant phase, nutritional goals include optimization of nutritional status and treatment of nutrition-related symptoms induced by hepatic decompensation. During the acute post-transplant phase, adequate nutrition is required to help support metabolic demands, replenish lost stores, prevent infection, arrive at a new immunologic balance, and promote overall recovery. In a word, it is extremely important to identify and correct nutritional deficiencies in this population and provide an adequate nutritional support during all phases of liver transplantation (LT). This study review focuses on prevalence, nutrition support, evaluation, and management of perioperative nutrition disorder in patients with ESLD undergoing LT.

PMM.71 Vitamin K deficiency: An under-reported phenomenon in Hyperemesis Gravidarum?

IntroductionHyperemesis gravidarum (HG) is a severe form of nausea and vomiting seen in women during pregnancy and often results in hospital admission.Case DescriptionA 33 year old Caucasian woman in her...

Effects of exclusive enteral nutrition on bone mass, linear growth and body composition in children with Crohn's disease.

Inflammatory bowel disease, especially Crohn's disease, is linked to significant growth stunting, sarcopenia (loss of skeletal muscle mass), deterioration of bone architecture and reduction in bone mass. Exclusive enteral nutrition (EEN) has been shown to correct nutritional deficiencies, provide adequate calories for growth, and alleviate intestinal inflammation in Crohn's disease with a favorable adverse effect profile. In this chapter, we report a summary of the effects of EEN on linear growth, skeletal health and lean body mass in children with Crohn's disease.

Male involvement in fertility and factors affecting semen quality in bulls

Fertility varies substantially among bulls. In general, methods to predict fertility are better for identifying bulls with low fertility than for ranking bulls with good to excellent fertility.Compensable sperm abnormalities can be overcome by increasing the dose used for artificial insemination; these are attributed to sperm reaching and penetrating the zona pellucida. In contrast, increasing the insemination dose does not improve fertility for uncompensable defects, implying that the sperm are able to cause fertilization and initiate development, but they do not sustain embryogenesis.Bull testes must be 2 to 6°C cooler than core body temperature for fertile sperm; consequently, increased testicular temperature reduces semen quality.Increased nutrition before 30 weeks of age increased luteinizing hormone pulse frequency, hastened puberty, and increased testicular size at maturity in bulls. However, attempts to correct nutritional deficiencies present during calfhood by supplemental nutrition later in life were unsuccessful. Fertility varies substantially among bulls. In general, methods to predict fertility are better for identifying bulls with low fertility than for ranking bulls with good to excellent fertility. Compensable sperm abnormalities can be overcome by increasing the dose used for artificial insemination; these are attributed to sperm reaching and penetrating the zona pellucida. In contrast, increasing the insemination dose does not improve fertility for uncompensable defects, implying that the sperm are able to cause fertilization and initiate development, but they do not sustain embryogenesis. Bull testes must be 2 to 6°C cooler than core body temperature for fertile sperm; consequently, increased testicular temperature reduces semen quality. Increased nutrition before 30 weeks of age increased luteinizing hormone pulse frequency, hastened puberty, and increased testicular size at maturity in bulls. However, attempts to correct nutritional deficiencies present during calfhood by supplemental nutrition later in life were unsuccessful.

Large Granular Lymphocytic Leukemia: A Treatable Form of Refractory Celiac Disease

Large granular lymphocyte leukemia (LGL) is characterized by clonal expansion of CD3+ T cells or CD3(-) natural killer cells and frequently is associated with autoimmune diseases. We describe 2 patients with celiac disease who no longer responded to gluten-free diets after they developed T-cell LGL, with intestinal localization of malignant lymphocytes. Flow cytometry phenotyping of isolated intestinal intraepithelial and lamina propria cells eliminated type II refractory celiac disease, identifying large-sized CD8(+)CD57(+) T cells. Treatment with a combination of cyclosporine and methotrexate restored the patients' sensitivity to gluten-free diets. LGL therefore might be a cause of refractory celiac disease that is sensitive to immunosuppressive therapy.

Diagnosis and management of alcoholic liver disease

Alcohol is the most commonly used hepatotoxin worldwide. About 90% of heavy drinkers (more than 60 g/day of alcohol) show evidence of fatty livers, while only 10-35% develop alcoholic hepatitis and 5-15% developed cirrhosis. The daily intake of alcohol that results in liver injury varies and depends on a number of risk factors. Alcoholic disease developes at lower doses in females, Hispanic, obese objects, and patients with hepatitis C. Insights into the pathogenesis of alcohol-induced liver injury has improved significantly but the translation into clinical benefit has been slow. The importance of continued abstinence and correction of nutritional deficiencies are major components in the long-term management of liver disease. Alcohol hepatitis has a variable mortality and the prognosis is determined most commonly by the modified discriminant function. The mocel of end-stage liver disease (MELD) is being increasingly used to predict outcome in alcoholic hepatitis even though standard cut offs are not available. Anti-inflammatory therapy with corticosteroids and anticytokine therapy with corticosteroids and pentoxifylline are effective for patients with severe alcoholic hepatitis. Patients with endstage liver disease should be considered for liver transplantation. Six months of abstinence is considered to be a requirement prior to transplant, but this length of time may be adjusted in individual bases.

Pancrelipase for pancreatic disorders: An update

Pancrelipase is a porcine pancreatic extract which contains the digestive enzymes lipases, proteases and amylases. In patients with pancreatic exocrine insufficiency (PEI) from conditions such as chronic pancreatitis, pancreatectomy and cystic fibrosis, pancrelipase can be used as pancreatic enzyme replacement therapy (PERT). Pancrelipase can reverse steatorrhea, prevent weight loss, control pain and correct other nutritional deficiencies resulting from exocrine insufficiency. Various forms of pancreatic enzymes were being marketed as over-the-counter medications prior to the recent FDA declaration that all pancreatic enzyme products had to obtain approval as new drugs before marketing. On the basis of evidence from recent randomized controlled trials, three pancrelipase formulations (Creon®, Zenpep® and Pancreaze®) have been approved by the FDA as effective treatments for PEI. Although several tests exist for the detection of PEI, early diagnosis still remains a challenge. Individualization of the timing of treatment initiation and dosage requirements is needed to achieve optimal effectiveness. When used at recommended doses, pancrelipase is a safe medication. Appropriate use of pancrelipase in patients with pancreatic exocrine insufficiency can achieve symptomatic relief, prevent morbidity/mortality and also improve quality of life.

Neurologic complications of anorexia nervosa.

The records of 100 patients with anorexia nervosa were reviewed. Neurologic complications were present in 47 patients. Neuromuscular abnormalities were most common and were present in 45% of patients. Generalized muscle weakness was detected in 43% of patients and peripheral neuropathies in 13%. Less common neurologic complications included headaches (6%), seizures (5%), syncope in the absence of orthostatic hypotension (4%), diplopia (4%), and movement disorders (2%). Neurologic problems due to chronic deficiency diseases were rare; only one patient had symptoms directly attributable to a vitamin B12 deficiency and none had evidence of Wernicke's encephalopathy. In most patients, the neurologic complications were reversed completely after correction of nutritional deficiencies and fluid and electrolyte imbalances.

Palm Nutrition and Fertilization

Palms (Arecaceae) growing in containers have similar nutritional requirements as other tropical ornamental plants and grow well with fertilizers having an elemental ratio of 3N:0.4P:1.7K. However, palms growing in the landscape or field nurseries have very different nutritional requirements from dicotyledonous plants. Whereas nitrogen (N) is the primary limiting nutrient element in container production, potassium (K), manganese (Mn), magnesium (Mg), boron (B), and iron (Fe) deficiencies are more widespread than N deficiency in most landscape soils. Because palms have a single apical meristem, deficiencies of K, Mn, or B can be fatal. In addition to insufficient nutrients in the soil, palm nutrient deficiencies can be caused by high soil pH, certain types of organic matter, deep planting, poor soil aeration, cold soil temperatures, and nutrient imbalances. Correction of nutritional deficiencies in palms can take up to 2 years or longer and therefore prevention of deficiencies by proper fertilization is important. Research has shown that high N:K ratio fertilizers applied directly, or indirectly via application to adjacent turfgrass in a landscape, can exacerbate K and Mg deficiencies in palms, sometimes fatally. For sandy Atlantic coastal plain soils in the southeastern United States, an analysis of 8N–0.9P–10K–4Mg plus micronutrients has been recommended.

Palm Nutrition and Fertilization

Palms (Arecaceae) growing in containers have similar nutritional requirements as other tropical ornamental plants and grow well with fertilizers having an elemental ratio of 3N:0.4P:1.7K. However, palms growing in the landscape or field nurseries have very different nutritional requirements from dicotyledonous plants. Whereas nitrogen (N) is the primary limiting nutrient element in container production, potassium (K), manganese (Mn), magnesium (Mg), boron (B), and iron (Fe) deficiencies are more widespread than N deficiency in most landscape soils. Because palms have a single apical meristem, deficiencies of K, Mn, or B can be fatal. In addition to insufficient nutrients in the soil, palm nutrient deficiencies can be caused by high soil pH, certain types of organic matter, deep planting, poor soil aeration, cold soil temperatures, and nutrient imbalances. Correction of nutritional deficiencies in palms can take up to 2 years or longer and therefore prevention of deficiencies by proper fertilization is important. Research has shown that high N:K ratio fertilizers applied directly, or indirectly via application to adjacent turfgrass in a landscape, can exacerbate K and Mg deficiencies in palms, sometimes fatally. For sandy Atlantic coastal plain soils in the southeastern United States, an analysis of 8N–0.9P–10K–4Mg plus micronutrients has been recommended.

Correcting Multiple Nutritional Deficiencies via Intradialytic Parenteral Nutrition Infusions in a Hemodialysis Patient

The dietitian will recognize the benefits of adding nutritional additives to intradialytic parenteral nutrition formula to correct nutritional deficiencies.

Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy

The objective of this study was to identify, through multivariate analyses, the configuration of factors that most closely impact the development of pharyngocutaneous fistula (PCF). Incidence and treatment of PCF was also revisited. A retrospective longitudinal study of 218 patients who have undergone total laryngectomy (TL) was conducted in a tertiary academic referral center. There were 47 patients (21.6%) developing PCF within 1 month after surgery (median 14 days, range 2-26 days). Non-surgical closure of the PCF was achieved in 36 patients (76.6%) within a median of 16.5 days (range 8-27 days). Eleven patients (23.4%) required a surgical closure of the PCF. In nine patients the surgical approach consisted in resuturing of the pharyngeal mucosa. Major surgery with the use of flaps (pectoralis major myocutaneous flap and free forearm flap) was required in two patients. Multivariate analysis revealed that diabetes mellitus (odd ratio 23.41 [95% CI 8.46-64.78]), preoperative hypoalbuminemia (odd ratio 9.42 [95% CI 3.60-24.61]), chronic pulmonary diseases (odd ratio 6.64 [95% CI 1.97-22.56]) and chronic hepatopathy (odd ratio 3.26 [95% CI 1.19-9.96]) were independent predictors for PCF formation. PCF results in prolonged hospitalization with increased medical costs, delay of adjuvant postoperative therapy and potentially life-threatening complications such as carotid rupture. In order to reduce the risk of PCF and avoid a delayed TL, optimization of comorbidities and correction of nutritional deficiencies with enteral or parenteral nutritional supplements should be achieved as early as possible.

Advances in the management of gastroparesis

The treatment goals for patients with gastroparesis are to control symptoms; to correct fluid, electrolyte, and nutritional deficiencies; and to identify and treat the underlying cause of gastroparesis. For mild symptoms, dietary modifications and a low-dose antiemetic and/or prokinetic agent might provide satisfactory control of symptoms. Dietary treatments include decreasing the solid food component while increasing the liquid nutrient component of meals. Fat and fiber intake should be minimized. Metoclopramide, despite its potential for neurological side effects, remains a prokinetic treatment for symptomatic patients. In patients with diabetic gastroparesis, careful regulation of glycemic control may help to reduce symptoms. Medical management of patients with gastroparesis who do not respond to initial antiemetic or prokinetic therapy or who develop medication-related side effects involves the use of other prokinetic and antiemetic agents with different mechanisms of action. Combinations of prokinetic and antiemetic agents often are tried in patients with persistent symptoms. In some patients with persistent refractory symptoms and failure to maintain adequate fluid and/or nutritional intake, bypassing the stomach with jejunostomy feedings may be necessary. Gastric electrical stimulation is a treatment for refractory gastroparesis. Based on initial studies showing symptom benefit, especially in patients with diabetic gastroparesis, gastric electrical stimulation was granted humanitarian US Food and Drug Administration approval for the treatment of chronic, refractory nausea and vomiting secondary to idiopathic or diabetic gastroparesis. However, which patients are likely to respond, the optimal electrode position, and the optimal stimulation parameters remain areas that need to be addressed.

Advances in the management of gastroparesis

The treatment goals for patients with gastroparesis are to control symptoms; to correct fluid, electrolyte, and nutritional deficiencies; and to identify and treat the underlying cause of gastroparesis. For mild symptoms, dietary modifications and a low-dose antiemetic and/or prokinetic agent might provide satisfactory control of symptoms. Dietary treatments include decreasing the solid food component while increasing the liquid nutrient component of meals. Fat and fiber intake should be minimized. Metoclopramide, despite its potential for neurological side effects, remains a prokinetic treatment for symptomatic patients. In patients with diabetic gastroparesis, careful regulation of glycemic control may help to reduce symptoms. Medical management of patients with gastroparesis who do not respond to initial antiemetic or prokinetic therapy or who develop medication-related side effects involves the use of other prokinetic and antiemetic agents with different mechanisms of action. Combinations of prokinetic and antiemetic agents often are tried in patients with persistent symptoms. In some patients with persistent refractory symptoms and failure to maintain adequate fluid and/or nutritional intake, bypassing the stomach with jejunostomy feedings may be necessary. Gastric electrical stimulation is a treatment for refractory gastroparesis. Based on initial studies showing symptom benefit, especially in patients with diabetic gastroparesis, gastric electrical stimulation was granted humanitarian US Food and Drug Administration approval for the treatment of chronic, refractory nausea and vomiting secondary to idiopathic or diabetic gastroparesis. However, which patients are likely to respond, the optimal electrode position, and the optimal stimulation parameters remain areas that need to be addressed.

Nutrition for the liver transplant patient

Patients with end-stage liver disease (ESLD) frequently have diverse abnormalities of carbohydrate, lipid, and protein metabolism that cause progressive deterioration of their clinical condition and lead to malnutrition. Malnutrition is almost universally present in patients with ESLD undergoing liver transplantation and has been associated with increased morbidity and mortality. It is essential to identify and correct nutritional deficiencies in this population and provide an adequate nutritional support during all phases of liver transplantation. In conclusion, this article reviews the etiologic factors, prevalence, assessment and management guidelines of nutritional disorders seen in patients with ESLD undergoing liver transplantation.

NEUROLOGIC SYMPTOMS AND ACIDOSIS IN 2 PATIENTS WITH SHORT BOWEL SYNDROME

Metabolic acidosis caused by the production of D-lactic acid is a rare complication seen in patients with short bowel syndrome (SBS) who have residual colon. We present two cases of D-lactic acidosis in patients with SBS. Patient 1 is a 26 year-old man with SBS secondary to a mid-gut volvulus at the age of five. His course had been complicated by small intestinal bacterial overgrowth (SIBO). He was weaned off of home parenteral nutrition (HPN) at the age of nineteen. Three weeks prior to presentation he began experiencing episodes of slurred speech and confusion. During the first episode, he fell unconscious and was taken to an outside hospital. He was acidemic and improved with intravenous sodium bicarbonate and fluid resuscitation. He presented repeatedly with similar symptoms and treatment results. He eventually presented to our facility. A D-lactate level was 3.07 mmol/L (normal 0–0.25 mmol/L). Multiple micronutrient deficiencies were identified. Following treatment with intravenous sodium bicarbonate and fluids, TPN was initiated. A low-carbohydrate diet and antibiotics were begun. He has had no further episodes of confusion. Patient 2 is an 18 year-old man with SBS secondary to a mid-gut volvulus as a newborn. HPN was initiated soon after birth. His course had been complicated by SIBO. One year prior to presentation, an attempt to wean HPN was initiated. He began experiencing episodes of slurred speech and confusion. A D-lactate level was elevated (5.01 mmol/L). He was found to have multiple micronutrient deficiencies. Antibiotics and a carbohydrate-restricted diet were begun. The nutritional composition of the TPN was adjusted and oral rehydration solution was started. Subsequently, only one other mild episode has occurred. The delivery of undigested carbohydrates to the colon is enhanced when the small bowel is removed, bypassed or diseased. D-lactate is produced by bacterial fermentation within the colon, usually from overgrowth of gram-positive organisms. D-lactate accumulates and remains in the body until it is excreted unchanged in the urine. It is unknown if the clinical presentation of D-lactic acidosis is the direct or indirect effect of the accumulation of D-lactate. Patients typically present with episodic acidosis and characteristic neurologic changes. Therapy includes administration of sodium bicarbonate, antimicrobial agents and a low carbohydrate diet. Correction of nutritional deficiencies and optimization of hydration status may also play vital roles.

Nutritional support for children with cancer.

Children with cancer are at risk of suffering from under nutrition, which can affect tolerance of therapy and may influence their overall survival. The goals of nutritional support in the cancer patient are to achieve and maintain desirable weight and to prevent or correct nutritional deficiencies. So early identification of patients at high risk for malnutrition is essential. There are different options for nutritional support. Oral feeding, when possible, is the first line. Enteral nutrition should be considered for those patients who cannot consume adequate macronutrients by mouth. Options are nasogastric tube or gastrostomy tube feeding. The advantages of enteral nutrition, when compared with parenteral nutrition, include better maintenance of the structural and functional integrity of the gastrointestinal tract, a decreased risk of bacterial translocation, greater ease and safety of administration, more physiologic and efficient use of nutrient substrates, decreased hepato-biliary complications, improved outcome and cost-effectiveness. Thus, parenteral nutrition should be considered if the gut is not functioning adequately to allow the normal absorption and digestion of nutrients or if enteral nutritional support is not sufficient to meet nutritional needs. Nutritional assessment and support should be integrated into treatment protocols for all children with neoplastic diseases.

RESPONSE OF MAIZE TO FOLIAR VS. SOIL APPLICATION OF NITROGEN–PHOSPHORUS–POTASSIUM FERTILIZERS

ABSTRACT Foliar fertilization is a widely used practice to correct nutritional deficiencies in plants caused by improper supply of nutrients to roots. The aim of the present study was to determine the efficiency of different forms of nitrogen–phosphorus–potassium (NPK) fertilizers applied to maize (Zea mays L.), either to the soil or to the leaves. Two sweet corn plants (CV Jubilee) were grown in plastic bags with 10.5 kg silt loam desert soil (Typic Haplocalcid). Before planting, the soil was mixed with zero (control), half or full dose of 0.6 g N, 0.4 g P, and 0.3 g K per pot as mineral forms, or as the “Global-Green” (GG) foliar fertilizer. Three forms of foliar fertilization were applied once a week in equivalent concentrations of N, P, and K (0.12 g N, 0.08 g P, and 0.06 g K/L): Mineral forms (NPK), GG, and “Fertilizers & Chemicals” (F&C) foliar fertilizers; plain water acted as the control. The plants were harvested after 55 days. The roots were washed from the soil and length measured. The shoots were measured for leaf area, fresh and dry wt, and leaf contents of chlorophyll, N, P, and K. All indices increased in response to all forms of foliar fertilization (FF), but no significant difference was obtained between the different forms. Global-Green was less effective as a soil fertilizer (SF) than NPK. The effectiveness of FF appeared to be limited by the holding capacity of leaf surface area for the liquid fertilizer. It was concluded that FF may partially compensate for insufficient uptake by the roots, but requires sufficient leaf area to become effective.