Therapeutic Food Research Articles

Factors influencing the implementation of severe acute malnutrition guidelines within the healthcare referral systems of rural subdistricts in North West Province, South Africa.

Severe acute malnutrition (SAM) is associated with 30.9% of South Africa's audited under-five children deaths regardless of available guidelines to reduce SAM at each level of a three tyre referral system. Existing research has explored and offered solutions for SAM guidelines implementation at each referral system level, but their connectedness in continuation of care is under-explored. Therefore, I examined implementation of SAM guidelines and factors influencing implementation within subdistrict referral systems. An explanatory qualitative case study design was used. The study was conducted in two subdistricts involving two district hospitals; three community health centres, four clinics, and two emergency service stations. Between February to July 2016 and 2018, data were collected using 39 in-depth interviews with clinical, emergency service and administrative personnel; 40 reviews of records of children younger than five years; appraisals of nine facilities involved in referrals and observations. Thematic content analysis was used to analyse all data except records which were aggregated to elicit whether required SAM guidelines' steps were administered per case reviewed. Record reviews revealed SAM diagnosis discrepancies demonstrated by incomplete anthropometric assessments; non-compliance to SAM management guidelines was noted through skipping some critical steps including therapeutic feeding at clinic level. Record reviews further revealed variations of referral mechanisms across subdistricts, contradictory documentation within records, and restricted continuation of care. Interviews, observations and facility appraisals revealed that factors influencing these practices included inadequate clinical skills; inconsistent supervision and monitoring; unavailability of subdistrict specific referral policies and operational structures; and suboptimal national policies on therapeutic food. SAM diagnosis, management, and referrals within subdistrict health systems need to be strengthened to curb preventable child deaths. Implementation of SAM guidelines needs to be accompanied by job aids and supervision with standardised tools; subdistrict-specific referral policies and suboptimal national policies to ensure availability and accessibility of therapeutic foods.

Decision tree model for early use of semi-elemental formula versus standard polymeric formula in critically ill Malaysian patients: A cost-effectiveness study.

Prevention of enteral feeding interruption (EFI) improves clinical outcomes of critically ill intensive care unit (ICU) patients. This leads to shorter ICU stays and thereby lowers healthcare costs. This study compared the cost of early use of semi-elemental formula (SEF) in ICU vs standard polymeric formula (SPF) under the Ministry of Health (MOH) system in Malaysia. A decision tree model was developed based on literature and expert inputs. An epidemiological projection model was then added to the decision tree to calculate the target population size. The budget impact of adapting the different enteral nutrition (EN) formulas was calculated by multiplying the population size with the costs of the formula and ICU length of stay (LOS). A one-way sensitivity analysis (OWSA) was conducted to examine the effect each input parameter has on the calculated output. Replacing SPF with SEF would lower ICU cost by MYR 1059 (USD 216) per patient. The additional cost of increased LOS due to EFI was MYR 5460 (USD 1114) per patient. If the MOH replaces SPF with SEF for ICU patients with high EFI risk (estimated 7981 patients in 2022), an annual net cost reduction of MYR 8.4 million (USD 1.7 million) could potentially be realized in the MOH system. The cost-reduction finding of replacing SPF with SEF remained unchanged despite the input uncertainties assessed via OWSA. Early use of SEF in ICU patients with high EFI risk could potentially lower the cost of ICU care for the MOH system in Malaysia.

Standardization of Ready-to-use Therapeutic Food from Locally Available Food Ingredients in Gujarat, India

Background: Malnutrition is associated with high morbidity and death in children under the age of five. A large child population is suffering from severe acute malnutrition (SAM) and it is not possible to admit every child for treatment in hospitals. SAM may be treated simply by providing calorie-dense, protein-rich, vitamin- and mineral-fortified meals at home. In India, there are 132 million children under the age of five, and 8 million of them are affected by malnutrition. As a result, there is a demand for locally made ready-to-use therapeutic food (RUTF) comparable to WHO-recommended RUTF, which should be efficient, safe, and easily accessible. Objective: The aim of this study was to develop a RUTF from locally available raw materials, such as barley flour, ghee, peanut, sugar, and flaxseeds. Methods: For the development of optimized RUTF, an I-Optimal mixture design with three variable and three non-variable factors was used. Thirty semi-trained panelists participated in sensory analy-sis. The finally optimized RUTF (with high desirability) was further analyzed. The optimized RUTF composition included malted-roasted barley flour (25 gm), roasted peanut (25 gm), powdered sugar (20 gm), desi ghee (20 gm), and roasted flax seeds (10 gm). Results: The optimized RUTF (100gm) provided 522.72 ± 0.031 kcal total energy, and the protein-energy, fat–energy, and carbohydrate-energy ratio of RUTF were found to be 11.98 %, 51.66 %, and 37.45 %, respectively. Conclusion: The developed RUTF from locally produced is comparable to WHO-approved RUTFs.

Changes in polyunsaturated fatty acids during treatment of malnourished children may be insufficient to reach required essential fatty acid levels – A randomised controlled trial

Severe acute malnutrition (SAM) is a global concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on polyunsaturated fatty acids (PUFA) are almost non-existent. The aim was to investigate the change in whole-blood PUFA and nutrition and health markers among Cambodian children with SAM after treatment with RUTFs. The trial was an 8-week randomised clinical trial of the effectiveness of locally produced fish-based RUTF (L-RUTF) vs standard milk-based RUFT (S-RUTF). Whole-blood fatty acids were analysed using dried blood spots. Nutrition and health markers were assessed using anthropometric assessment and blood samples for markers of inflammation. The trial was conducted at the National Pediatric Hospital, Phnom Penh, Cambodia, with one hundred and twenty-one 6-59-month-old children in treatment for SAM. L-RUTF had a higher content of n-3 PUFA and a higher content of arachidonic acid (AA) and docosahexaenoic acid (DHA), while S-RUTF had the highest content of n-6 PUFA. At baseline, the children presented with a Mead acid level in whole-blood of around 0.08% of total fatty acids (FA%) and an omega-3 index of ∼0.91±0.44. After eight weeks of S-RUTF treatment, linoleic acid (LA), AA, n-6/n-3 PUFA ratio, and Mead acid levels were increased. The L-RUTF intervention did not change the whole-blood PUFAs from baseline. At discharge, the children in the L-RUTF group had a lower n-6/n-3 PUFA ratio than the children in the S-RUTF group, driven by a lower alpha-linolenic acid (ALA) (0.20 vs 0.27 FA%, p=0.004) and lower LA (15.77 vs 14.21 FA%, p=0.018) with no significant differences in AA or DHA levels. Weight-for-height z-score at discharge was negatively associated with total PUFA (β-1.4 FA%, 95%CI.-2.7;-0.1), n-6 LCPUFA (β-1.3 FA%, 95%CI.-1.3;-0.3), and AA (β-0.6 FA%, 95%CI.-1.0;-0.2). Age-adjusted height was negatively associated with the Mead acid:AA ratio (β-1.2 FA%, 95%CI.-2.2;-0.2). No significant change was seen in inflammation markers within groups or between groups during treatment, and n-3 and n-6 PUFAs were not associated with markers of inflammation or haemoglobin status at discharge. The trial found that whole-blood markers of PUFA status were low in children at admission and discharge from SAM treatment, indicating that the currently recommended composition of RUTFs are not able to correct their compromised essential fatty acid status. The higher content of DHA and AA in L-RUTF did not give rise to any improvement in PUFA status. No changes in health markers or associations between PUFA and health markers were found. ClinicalTrials.gov: NCT02907424.

Replacing protein via enteral nutrition in a stepwise approach in critically ill patients: the REPLENISH randomized clinical trial protocol

BackgroundProtein intake is recommended in critically ill patients to mitigate the negative effects of critical illness-induced catabolism and muscle wasting. However, the optimal dose of enteral protein remains unknown. We hypothesize that supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition formula to achieve high amount of enteral protein (range 2–2.4 g/kg/day) given from ICU day 5 until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve moderate amount enteral protein (0.8–1.2 g/kg/day) would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients.MethodsThe REPLENISH (Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial is an open-label, multicenter randomized clinical trial. Patients will be randomized to the supplemental protein group or the control group. Patients in both groups will receive the primary enteral formula as per the treating team, which includes a maximum protein 1.2 g/kg/day. The supplemental protein group will receive, in addition, supplemental protein at 1.2 g/kg/day starting the fifth ICU day. The control group will receive the primary formula without supplemental protein. The primary outcome is 90-day all-cause mortality. Other outcomes include functional and quality of life assessments at 90 days. The trial will enroll 2502 patients.DiscussionThe study has been initiated in September 2021. Interim analysis is planned at one third and two thirds of the target sample size. The study is expected to be completed by the end of 2025.Trial registrationClinicalTrials.gov Identifier: NCT04475666. Registered on July 17, 2020.

Severe acute malnutrition among infants under 6 months of age in the teaching hospital of Borgou / Alibori in Northen Benin

Background: Acute malnutrition in infants under six months is a scourge that is little studied in relation to the global problem of child malnutrition. This paper aims to describe the sociodemographic, clinical, therapeutic, and outcome features of this phenomenon in the Teaching Hospital of Borgou /Alibori based in Parakou in northern Benin. Patients and methods: This was a two years case-control retrospective and descriptive study carried out in the pediatric care unit of the said hospital from January 1, 2016, to December 31, 2018. It included infants aged 1 to 6 months presenting with severe acute malnutrition defined according to the WHO criteria. Variables investigated were sociodemographic, clinical, therapeutic, and outcome-related. Results: Total of 78 out of 508 infants less than 6 months of age were severely malnourished (5.35%). Their mean age was 4.65 months±1.28. Contributory factors were early dietary diversification (69.2%), and maternal death (14.1%). Marasmus and kwashiorkor were their clinical expressions. Associated complications were gastrointestinal infections (38.5%), septicemia (17.9%), and HIV infection (5.1%). Diluted F-100 was the most used therapeutic food (46.1%) with a recovery rate estimated at 41% and mortality at 19.3%. Conclusion: Severe acute malnutrition in infants under six months of age is real and it involves three out of twenty infants admitted to the hospital. In-hospital mortality is significant. It is urgent to review the policies related to exclusive breast feeding promotion.

Aqueous Extraction of Fine Curcumin for synthesizing Drug Delivery Vehicle of Montmorillonite/ Curcumin

The nutraceutical efficacy of phytochemical curcumin has been utilized in many therapeutic foods and drugs, thanks to their anti-inflammatory, antimicrobial, antioxidant, antitumor and anticancer activities. Therefore, it is necessary to develop green and scalable methods of isolating the natural products from the Curcuma longa plant. This study presents an environmentally friendly method of aqueous extraction to obtain fine curcumin powder with high purity (84.6 % quantified by HPLC). The fine curcumin combines with montmorillonite clay to synthesize an improved drug delivery vehicle. Synthetically, equilibrium adsorption of curcumin on montmorillonite results in a curcumin-loaded montmorillonite structure. The montmorillonite/ curcumin drug delivery vehicle shows good properties of aqueous dispersibility and curcumin stabilization in the environment of neutral water and natural/ ultraviolet lights. The innovative formulation of montmorillonite/curcumin helps to upgrade the bioavailability and stability of bioactive curcumin in nutraceutical delivery applications.

Standard RUTF vs. locally-made RUSF for acutely malnourished children: A quasi-experimental comparison of the impact on growth and compliance in a rural community of Pakistan.

The reduction in severe and moderate acute malnutrition (SAM and MAM) rates in Pakistan has been sub-optimal compared to other low-and middle-income countries (LMICs). Specially-formulated products have been designed globally to manage SAM and MAM, such as ready-to-use therapeutic food (RUTF) and ready-to-use supplementary food (RUSF), with variable efficacies. RUTF is primarily produced and patented in industrialized countries, raising supply challenges in resource-constrained regions with a high burden of acute malnutrition. RUSF minimizes costs by using locally-available ingredients while providing similar nutritional value. In this study, we compared the efficacy, side effects, and compliance of two months of supplementation with either RUTF or RUSF. Children aged nine months in the rural district of Matiari, Pakistan, with a weight-for-height z-score (WHZ) <-2 received either RUTF (500 kcal sachet) for two months in 2015 or RUSF (520 kcal sachet) for two months in 2018. The RUSF group had a higher height gain and mid-upper arm circumferences (MUAC) score. Higher compliance was noted with lower side effects in the RUSF group. A higher compliance rate did correlate with the growth parameters in respective groups. Our study found that both RUTF and RUSF partially improve the anthropometric status of acutely malnourished children, with neither being superior to the other.

Flax Seeds and Their Role in Human Health

When it arrives at human health benefits flax seeds play an essential part. Flax seed or linseed (Linum usitatissimum) derived from flax plants has several medicinal properties when consumed. Flaxseeds are abundant in lignans, linolenic acid, omega-3 fatty acids, secoisolariciresinol, and other nutrients and proteins that aid in the prevention of illnesses such as cardiovascular disease, cancer, and diabetes. Linen fibre is derived from flax plants, which are employed in the textile industry, in addition to nutritional advantages. Flax seeds are utilized in a variety of food processing products (bakery, dairy, snack, fermented) because they have physicochemical, phytochemical, and sensory qualities. Flax seed is a potential nutraceutical that may be used to make preventive, therapeutic, and medicinal foods. Flax seeds are anti-inflammatory and antioxidant. This article addresses the nutritional health benefits and dietary fibre of flax seeds.

Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria

AbstractChildren with sickle cell anemia (SCA) living in Nigeria are at an increased risk of malnutrition, which contributes to increased morbidity and mortality. However, evidence-based guidelines for managing malnutrition in children with SCA are lacking. To address this gap, we conducted a multicenter, randomized controlled feasibility trial to assess the feasibility and safety of treating children with SCA aged from 5 to 12 years and having uncomplicated severe acute malnutrition (body mass index z score of <−3.0). Children with SCA and uncomplicated severe acute malnutrition were randomly allocated to receive supplemental ready-to-use therapeutic food (RUTF) with or without moderate-dose hydroxyurea therapy (20 mg/kg per day). Over a 6-month enrollment period, 3190 children aged from 5 to 12 years with SCA were evaluated for eligibility, and 110 of 111 children who were eligible were enrolled. During the 12-week trial, no participants withdrew or missed visits. One participant died of unrelated causes. Adherence was high for hydroxyurea (94%, based on pill counts) and RUTF (100%, based on the number of empty sachets returned). No refeeding syndrome event or hydroxyurea-related myelosuppression occurred. At the end of the trial, the mean change in body mass index z score was 0.49 (standard deviation = 0.53), and 39% of participants improved their body mass index z score to ≥−3.0. Our findings demonstrate the feasibility, safety, and potential of outpatient treatment for uncomplicated severe acute malnutrition in children with SCA aged from 5 to 12 years in a low-resource setting. However, RUTF sharing with household and community members potentially confounded the response to malnutrition treatment. This trial was registered at clinicaltrials.gov as #NCT03634488

Effect of ready-to-use therapeutic foods on time to recovery among children with severe acute malnutrition in Ethiopia: a prospective cohort study

BackgroundThe therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6–59 months admitted to the TFU in Ethiopia.MethodsHealth Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables.ResultsThe median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62–7.38) compared to F-100 (10 days; 95% CI: 8.94–11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42–0.69), dehydrated (AHR = 1.34, 95% CI: 1.07–1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03–1.61), and anemic (AHR = 2.57, 95% CI: 1.90–3.48) during admission were associated with time to recovery.ConclusionsChildren who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.

Treatment outcomes and associated factors for hospitalization of children treated for acute malnutrition under the OptiMA simplified protocol: a prospective observational cohort in rural Niger.

Globally, access to treatment for severe and moderate acute malnutrition is very low, in part because different protocols and products are used in separate programs. New approaches, defining acute malnutrition (AM) as mid-upper arm circumference (MUAC) < 125 mm or oedema, are being investigated to compare effectiveness to current programs. Optimizing Malnutrition treatment (OptiMA) is one such strategy that treats AM with one product - ready-to-use therapeutic food, or RUTF - at reduced dosage as the child improves. This study aimed to determine whether OptiMA achieved effectiveness benchmarks established in the Nigerien National Nutrition protocol. A prospective cohort study of children in the rural Mirriah district evaluated outcomes among children 6-59 months with uncomplicated AM treated under OptiMA. In a parallel, unconnected program in one of the two trial sites, all non-malnourished children 6-23 months of age were provided small quantity lipid-based nutritional supplements (SQ-LNS). A multivariate logistic regression identified factors associated with hospitalization. From July-December 2019, 1,105 children were included for analysis. Prior to treatment, 39.3% of children received SQ-LNS. Recovery, non-response, and mortality rates were 82.3%, 12.6%, and 0.7%, respectively, and the hospitalization rate was 15.1%. Children who received SQ-LNS before an episode of AM were 43% less likely to be hospitalized (ORa=0.57; 0.39-0.85, p = 0.004). OptiMA had acceptable recovery compared to the Nigerien reference but non-response was high. Children who received SQ-LNS before treatment under OptiMA were less likely to be hospitalized, showing potential health benefits of combining simplified treatment protocols with food-based prevention in an area with a high burden of malnutrition such as rural Niger.

Recovery Rate and Treatment Outcome in Children Aged 6–59 Months with Severe Acute Malnutrition Admitted to Outpatient Therapeutic Feeding, in Ethiopia

ABSTRACT Different factors influence the recovery rate and treatment outcome of children with wasting using ready-to-use therapeutic food (OTP). Hence, our study aimed to assess determinants of the recovery rate among children with severe acute malnutrition (SAM) managed in OTP. A facility-based retrospective cohort study was conducted on 561 children treated in OTP. The proportion of recovery was 77.4%. The presence of edema, provision of amoxicillin, folic acid, and weight gain in the first 3 weeks were determinants of improved recovery rate. A better recovery rate could be achieved through improving the adherence to the proper administration of routine medications.

Determination of nitrate and nitrite levels in enteral nutrition formula marketed in Turkey: A risk assessment study.

In this study, the nitrite and nitrate levels of 37 enteral nutrition formulas of three different international brands marketed in Turkey were evaluated using high-performance liquid chromatography with diode-array detection (HPLC-DAD). Also, risk assessment of non-carcinogenic was calculated by models including hazard quotient (HQ) and hazard index (HI) in the deterministic model. Enteral nutrition formula consumption amounts obtained from individuals between the ages of 6-36 volunteers voluntarily participated in the study, and health risk assessments were calculated. The range of concentration of nitrate levels in enteral formulas of brands (B1, B2, and B3) was determined as 11.08±2.88 (2.90-15.79), 11.64±3.39 (2.92-22.93), and 10.66±3.46 (4.92-15.37) mg/kg, respectively. The range of concentration of nitrite levels in enteral formulas of brands (B1, B2, and B3) was determined as 4.18±1.10 (1.86-5.82), 3.70±1.25 (1.29-5.26), and 3.38±1.67 (2.00-5.29) mg/kg, respectively. The mean nitrate and nitrite levels of exposure from consumption of enteral nutrition formulas were determined as 0.14 and 0.11, 0.06 and 0.07mg/kg bw/day for females and males, respectively. Nitrate and nitrite exposure levels calculated in the study did not exceed the ADI threshold values given by JECFA. The average HQ value calculated for the exposure of nitrate to male and female individuals was less than 1. Still, the P95 values calculated for nitrate were greater than 1.00 except for female and male individuals (24-36 ages). The HI value was found to be greater than 1.00 in all age groups of both genders. The presence of nitrites and nitrates in enteral nutrition formulas may lead to health problems in sensitive groups.

Formulation of Snack Bar Based on White Mussel as TFA (Therapeutic Food for Anemia) To Improve Adolescents Nutrition

Formulation of Snack Bar Based on White Mussel as TFA (Therapeutic Food for Anemia) To Improve Adolescents Nutrition

Effects of complementary food formulated from millet, soybean, and grasshopper on hematological parameters of malnourished weanling albino rats

Background: Malnutrition in under-five children remains an issue of public health, especially in low and middle-income countries, and is associated with inadequate child development and poor survival. Recent public health intervention strategies for malnourished children allow for localized targeted supplementation with locally available materials to replace the imported Ready-to-Use-Supplementary-Food (RUSF) for the target group. Aims: The aim of the study was to develop a local supplementary food and determine its effects on hematological parameters of weanling rats. Material and Methods: The experimental study involved thirty weanling albino rats, grouped into groups A, B, and C, each consisting of ten rats. All the groups were acclimatized for fourteen days, thereafter, groups A and B were induced with moderate acute malnutrition (MAM) by feeding with only corn starch for fourteen days. Weight, tail length, and hematological parameters (hemoglobin level, white blood cell count) of all the weanling albino rats were determined and recorded as baseline values on the fourteenth day. Therapeutic food made from millet, soybean, and grasshopper blends was produced and fed to group A as the intervention, Group B was fed with corn starch only and group C was fed on normal rat pellets for twenty-eight days. Weight, tail length, and hematological parameters were determined and recorded at the end of the intervention. Results: Experimental group A had the lowest packed cell volume (PCV) value with a difference of 2.20 ± 0.56 %, the lowest hemoglobin (Hb) level with a difference of 0.58 ± 0.02 g/dL, the control group had the highest PCV, Hb, and RBC with values of 4.10 ± 0.5 %, 1.58 ± 0.21 g/dL, and 0.9 ± 0.05 x 106 µ/L respectively. Conclusions: With the evidence provided by the parameters assessed in the study, it can be concluded that the developed therapeutic food is efficacious in the treatment of malnutrition especially in weanling albino rats. Keywords: Moderate Acute Malnutrition (MAM), Ready-to-Use-Supplementary-Food (RUSF) Malnutrition, Complementary feeding, Animal studies.

Lipid profile and cost of enteral nutrition formula with addition of fish oil used in a public hospital

Background & aimsThe present study evaluated the lipid profile of enteral nutrition formulas with added fish oil used in a public hospital, with an emphasis on the fatty acid (FA) composition. MethodsFA composition was determined using gas chromatography coupled to a flame ionization detector (GC-FID). Nine enteral nutrition formulas were evaluated and the results obtained were compared with those reported on the formulas labels. ResultsThe sample with the highest percentage of added fish oil according to the label information had the lowest total amounts of eicosapentaenoic acid and docosahexaenoic acid (EPA + DHA) (p < 0.05). In the evaluation of the total amount of polyunsaturated fatty acids/saturated fatty acids (ΣPUFA/ΣSFA) ratio, five samples were not within the values recommended by Brazilan and international health regulatory agencies. Regarding the n-6/n-3 fatty acids ratio, five samples showed values higher than the recommended ratio. It was observed that EPA + DHA content was positively correlated with the cost of the diet. Importantly, we also found that there was a significant difference between the results of our analysis and the descriptions found on the labels for fatty acids n-6, n-3, EPA, DHA, SFA, PUFA and MUFA. ConclusionsWe conclude that the discrepancies for fatty acids between the values obtained in the analyses and the values reported on the labels highlight the need for more rigorous inspection when public hospitals purchase enteral nutrition formulas with added fish oil, since the administration of formulas with inadequate levels of FA in hospitalized patients can compromise clinical results during the hospitalization period.

Inhibition of Osteoclast Differentiation and Promotion of Osteogenic Formation by Wolfiporia extensa Mycelium.

Osteoporosis, Greek for "porous bone," is a bone disease characterized by a decrease in bone strength, microarchitectural changes in the bone tissues, and an increased risk of fracture. An imbalance of bone resorption and bone formation may lead to chronic metabolic diseases such as osteoporosis. Wolfiporia extensa, known as "Bokryung" in Korea, is a fungus belonging to the family Polyporaceae and has been used as a therapeutic food against various diseases. Medicinal mushrooms, mycelium and fungi, possess approximately 130 medicinal functions, including antitumor, immunomodulating, antibacterial, hepatoprotective, and antidiabetic effects, and are therefore used to improve human health. In this study, we used osteoclast and osteoblast cell cultures treated with Wolfiporia extensa mycelium water extract (WEMWE) and investigated the effect of the fungus on bone homeostasis. Subsequently, we assessed its capacity to modulate both osteoblast and osteoclast differentiation by performing osteogenic and anti-osteoclastogenic activity assays. We observed that WEMWE increased BMP-2-stimulated osteogenesis by inducing Smad-Runx2 signal pathway axis. In addition, we found that WEMWE decreased RANKL-induced osteoclastogenesis by blocking c-Fos/NFATc1 via the inhibition of ERK and JNK phosphorylation. Our results show that WEMWE can prevent and treat bone metabolic diseases, including osteoporosis, by a biphasic activity that sustains bone homeostasis. Therefore, we suggest that WEMWE can be used as a preventive and therapeutic drug.

Protein Quality of Ready to Use Therapeutic Food (RUTF) Bar Product for Children Under Five Years with Severe Acute Malnutrition

Protein Quality of Ready to Use Therapeutic Food (RUTF) Bar Product for Children Under Five Years with Severe Acute Malnutrition

The impact of perioperative high-protein oral nutrition supplements on postoperative outcomes in primary lung cancer: the protocol of Russian prospective, randomised, multicenter study

BACKGROUND: Nutritional support, including oral nutrition supplements, is an integral part of anticancer treatment, including during surgical treatment of non-small cell lung cancer. Existing evidence for the effectiveness of nutritional support in this cohort of patients is limited. We suggest that the perioperative administration of a balanced polymeric hypercaloric high-protein enteral nutritional formula by sipping as an additional nutrition can have a positive effect on the results of surgical treatment.&#x0D; AIMS: 1) to assess the impact of perioperative nutritional support with high-protein oral nutrition supplements on the risk of postoperative complications, postoperative recovery of respiratory functions, nutritional status and quality of life in patients with primary lung cancer; 2) identification of possible side effects and complications when using high-protein high-energy oral nutrition supplements in patients with non-small cell lung cancer.&#x0D; MATERIALS AND METHODS: Russian prospective, randomised, multicenter low-intervention study of perioperative effect of high-protein nutritional support on postoperative outcomes in the treatment of primary lung cancer with parallel groups, 1:1 randomization. The study will include 114 patients with primary non-small cell lung cancer who are scheduled for surgery. It is expected to provide nutritional support in the perioperative period for 14 days before surgery and for 14 days after it.&#x0D; CONCLUSION: The present study may become one of the first evidence-based studies confirming the effectiveness of perioperative nutritional support with high-protein mixtures in patients with non-small cell lung cancer and will allow further study of the strategy of nutritional support in this category of patients.