Greater Risk Of Malnutrition Research Articles

PREVALENCE AND DETERMINANTS OF MALNUTRITION AMONG UNDER- FIVE CHILDREN OF HOUSEHOLD IN SLUM AREAS OF DISTRICT FAISALABAD

Malnutrition refers to a pathological condition characterized by a lack of nutrients necessary for healthy body function. Malnutrition is one of the most common causes of death and disease among children under the age of five. About 96% percent of children in Pakistan do not receive adequate nutrition during childhood, such as soft food, milk, fruit, and vegetables. Food insecurity is a serious problem in Pakistan as a significant portion of the rural population is food insecure. A staggering 36.9% of households in the country are 'food insecure' and 18.3% are 'severely' food insecure. Pakistan is self-sufficient in basic food items, but only 63.1% of households have food security. Food insecurity is common, leaving women and children at greater risk of malnutrition. Drought-affected communities have exceptionally high rates of malnutrition. According to statistics in Pakistan, about 40, 29%, and 18% of children under the age of five are a stunt, underweight, and wasted, respectively. Therefore, this study aims to investigate the prevalence and determinants of malnutrition status in children under 5 years of age in the slums of Faisalabad District, Punjab, Pakistan. The data is based on household demographic and socioeconomic factors, including anthropometric information on children under the age of five living in a slum in Faisalabad. Anthropometric data were obtained from 150 randomly selected children from three slum areas of Faisalabad. Socioeconomic and behavioural data were collected from each mother. Three indicators were used to measure the nutritional status of children: (i) stunting, height–for– age, (ii) wasting weight–for–height, and (iii) under-weight¸ weight–for–age. These values ​​were transformed into z-scores to classify the child's nutritional status. Descriptive and logistic regression techniques were used to identify factors associated with children's nutritional status. According to this study, the prevalence of stunting, being underweight, and wasting among children under five years of age in Faisalabad District, Pakistan were 28%, 22.6%, and 18% respectively. Testing with logistic regression techniques revealed that demographic, socio-economic, and behavioural factors were significant predictors of all three indicators of child nutritional status. These main factors were household calorie intake and maternal education, father education, access to clean water, and maternal access to health facilities.

Experience and the nutritional relevance of protein-enriched ice cream in patients with heart failure - A pilot study

BackgroundPatients with heart failure have a greater risk of malnutrition and need an enhanced intake of nutrients. PurposeThe purpose of the study was to describe how patients admitted to a cardiac intensive care unit with heart failure, experience the intake of a protein-enriched ice cream, served as an in-between meal, and to explore this diet supplement's nutritional relevance in these patients. MethodIn the pilot study, interviews, and collection of diaries with both a qualitative and quantitative approach were used. Inductive, qualitative content analysis was performed of the interviews while data from the diaries were analysed with descriptive analysis. ResultsThe enriched ice cream supplement was perceived as appealing and tasty despite the patients illness and malaise. Different opinions about consistency were experienced according to the patients’ individual condition and they made further flavour suggestions. The patients ingested between 500 and 2550 ml each of the ice cream during the study period. ConclusionThe patients’ experiences can be valuable in order to improve the in-between meal/food snack thus improving the nutritional status of weak patients lacking appetite. The method used requires to be further developed to assess nutritional relevance for patients when consuming a protein-enriched ice cream.

#2896 Malnutrition is prevalent in hemodialysis patients—results from Croatian multicenter hemodialysis study

Abstract Background and Aims Malnutrition is a usually observed condition among patients on hemodialysis (HD) and is considered one of studiest indicators of mortality and morbidity. Malnutrition inflammation score (MIS) is associated with inflammation, nutritional status, quality of life, and 5-year prospective mortality. Also, phase angle (PhA) measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in HD patients and lower PhA was associated with a greater risk of malnutrition. The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Croatia using MIS, and to assess the association of MIS and PhA with body mass composition, sociodemographic characteristics and laboratory parameters related to HD. Method 166 HD patients aged 68.5 (58.8-76) years, 55 women (33%) and 111 (67%) men with mean HD duration of 4 (2-6) years from 6 HD center were included in this study. For each study participant, data about body composition measured with BIA, laboratory, sociodemographic and clinical parameters were obtained. Also, body mass index (BMI) was calculated, and the Malnutrition Inflammation Score (MIS) used to assess nutritional status. Results Using an MIS cut-off point of 5 for malnutrition, 53% of patients were malnourished (MIS≥5). Therefore, those malnourished HD patients were significantly older (p = 0.001), with longer HD duration (p = 0.002), lower residual renal function (p = 0.02), waist circumference (p = 0.001), BMI (p < 0.001), muscle (p = 0.002) and fat mass (p = 0.001) in kg, phase angle PhA (p < 0.001), serum creatinine (p = 0.002), albumin (p = 0.008), phosphate (p = 0.01), and urate (p = 0.008) level but have significantly higher ferritin (p = 0.004), and mean cellular volume level (p = 0.02). Therefore, total MIS score significantly negatively correlated with HD duration (r = −0.247, p < 0.001), waist circumference (r = −0.323, p < 0.001),muscle mass (r = −0.236, p < 0.001), fat mass (r = −0.352, p < 0.001), serum creatinine (r = −0.271, p < 0.001), phosphor (r = −0.245, p < 0.001), urate (r = −0.344, p < 0.001), and TIBC (r = −0.376, p < 0.001), albumin (r = 0.241, p < 0.001), ferritin (r = 0.273, p < 0.001). In contrast, PhA significantly positively correlated with muscle mass (kg) (r = 0.311, p < 0.001), creatinine (r = 0.313, p < 0.001), phosphate (r = 0.208, p = 0.01), urate (r = 0.305, p = 0.01) and Total Iron Binding Capacity (TIBC) (r = 0.245, p < 0.001) while significantly negative correlation with ferritin (r = −0.182, p = 0.03) was found. Also, there was a significant negative correlation between PhA and MIS (r = −0.362, p < 0.001). A multivariate regression analysis showed that age (ß = 0.09, p = 0.005), waist circumference (ß = −0.09, p = 0.004), serum albumin (ß = −0.23, p = 0.04), and urate (ß = −0.01, p = 0.02), were predictive factors for malnutrition. Conclusion The prevalence of malnutrition in HD patients in Croatian HD population was high. These results indicate and highlight the urgent need for individualized and structural nutritional screening (using MIS score and PhA) and nutritional support in Croatian HD patients, especially for older HD patients and those with longer HD duration.

Diet quality and nutritional status of HIV-exposed children aged between 6 and 18 months in the Greater Accra Region of Ghana

IntroductionHIV-exposed children, even when uninfected, have a greater risk of malnutrition than unexposed counterparts. WHO guidelines recommend children aged 6–23 months be fed a variety of foods to meet nutrient requirements. This study aimed to determine infant and young child feeding (IYCF) practices among HIV-exposed children under 2 years old enrolled in a dietary intervention and to explore correlates of the IYCF indicators and associations between IYCF and nutritional status.MethodologySix hundred and eighty mother–child pairs were recruited from 19 health facilities from the Greater Accra Region. The sociodemographic data, anthropometry, hemoglobin, and dietary intake were recorded.ResultsNinety-five percent of HIV-positive mothers breastfed their babies, and 53% initiated breastfeeding in a timely manner. Around one in five mothers (21%) introduced liquids other than breastmilk to their children within the first 2 days of birth, and only around one in four children (26%) aged 12–23 months had received breast milk on the day before assessment. Ninety-three percent of babies between 6 and 8 months had been introduced to solid, semi-solid, or soft foods. Eighteen percent of children reached the threshold for Minimum Dietary Diversity (MDD) by eating from over five of eight food groups. Fifty-four percent received Minimum Meal Frequency (MMF), eating between 2 and 4 meals in a day. Eleven percent received the Minimum Acceptable Diet (MAD). Thirty-two percent were anemic. Underweight and stunting were 12 and 11%, respectively. Children of mothers aged 31–40 years were more likely to meet the MDD and MAD [OR = 2.8, 95%CI (1.185, 6.519), p < 0.05 and OR = 2.8, 95%CI (1.256, 6.279), p < 0.05] compared to children of mothers aged 30 years or less or aged above 40 years. Children from households earning more than GHS 500 were more likely to meet MMF than those from households earning less. No associations were found between IYCF and nutritional status.ConclusionFindings highlight the need for nutrition programs to educate HIV-exposed children’s caregivers on optimal feeding practices. The importance of continued breastfeeding and dietary diversity needs to be highlighted. Affordable, iron-rich foods should be promoted. Special attention should be paid to younger, less educated, and lower socioeconomic status mothers.

Dietary Adequacy in Older Adult Nursing Home Residents of the Northern Iberian Peninsula.

According to the latest data, Spain (19.4%) and Portugal (21.8%) are the two European countries with the highest percentage of older adults. Concerns about diet quality are increasing, especially among institutionalized older people, who are at the greatest risk of malnutrition. To assess the adequacy of dietary intake of 186 older adults (>65 y) institutionalized in public nursing homes (NH) in Galicia (Northwest Spain) and the Porto district (Northern Portugal), a cross-sectional study has been carried out. The double-weighing method and a country-specific food composition database were employed for nutritional assessment. Nutritional adequacy was assessed based on the recommendations of the EFSA and WHO. Caloric intake in Spanish NHs was higher than in Portuguese facilities; 20.3% and 35.8% of Spanish and Portuguese residents, respectively, had a protein intake below the EFSA recommendation, and 46.2% and 44.9% of residents in Portugal and Spain, respectively, had lipid intakes below the reference intake range. Further, 45.5% of the residents in Portugal and 66.9% in Spain had a carbohydrate intake within the recommended range. Salt intake was higher than the recommendation for 67.0% and 32.3% of the residents in Spain and Portugal, respectively. This study supports the notion that institutionalized older adults are prone to significant nutritional inadequacies.

Weaning Habits and Nutritional Status Determinants among under-5 Children in Nigeria

Introduction: High household income may not guarantee a satisfactory nutritional outcome of the children if households are lacking of care, dietary quality and health care access. Malnutrition will persist despite rapid income growth if more effective approach to combat the problem is absent. This study was carried out to determine the influence of correct feeding habits on the nutritional status among under-fives in an urban city in southwestern Nigeria.
 Methodology: This was a community based, cross-sectional, descriptive study, investigations such as dietary survey, anthropometry and clinical examination were done. A multistage sampling technique was used in the study. Data were collected via pretested, close ended, interviewer administered questionnaire. The questionnaires obtained from the study were analyzed using statistical package for social sciences (SPSS version 20) software program.
 Results: A total of 407 participants with the mean age of 26.58 ± 10.10 months were recruited into the study. Exclusive breastfeeding was practiced by 39.8 % of the mothers. About 56.5% of the mothers reported having given their babies the first milk (colostrum). The mean age of weaning off breast was 7.4 ±1.5 months. Immunization coverage among the respondents were BCG- 82.1%, Oral polio= 81.3%, Pentavalent [DPT 3] = 87.2% and Measles=88.7%. The mid upper arm circumference revealed 30(55.6%) of male were at greater risk of malnutrition than female 24(44.4%), while 45(56.1%) of males had severe malnutrition. Mean head circumference for age Z-score test between boys and girls in age group 13 to 24 months [p=0.009, C.I= -0.27-0.19] and 25 to 36 months were significant statistically (p =0.003, - 0.35-0.22). The value for age group 37-48 months was p=0.53, C.I= 0.015-0.59 and p=0.57, C.I= 2.59-1.70 for 49-60 months was not statistically significant.
 Conclusion: This study has shown that the mean age of weaning was 7.4 ±1.5 months. It also reported the mean values of head circumference to be significantly lower among girls than boys below 36 months and this may have developmental and nutritional implications in Nigeria and other African countries.

The Importance of Screening for Food Insecurity in Children with Sickle Cell Anemia: An Ancillary Study to the Severe Acute Malnutrition Feasibility Trial in Nigeria

Introduction Household food insecurity-lacking access to, or having uncertain access to, food that meets a person's dietary needs-is a longstanding problem in Nigeria that has continued to worsen in recent years. One of its most severe consequences is malnutrition, particularly affecting children due to their high nutrient demand coupled with higher energy expenditure. Even in high-income countries, such as the United States, many children with sickle cell anemia have lower weights and heights than their healthy peers. Due to their elevated nutrient requirements, children with sickle cell anemia may be at an even greater risk of malnutrition when faced with limited access to adequate food. The relationship between childhood food insecurity and malnutrition has been previously studied in younger children in Nigeria, but rarely in older children, and to our knowledge, never in older children with sickle cell anemia. We tested the hypothesis that there is a direct association between increased food insecurity and more severe malnutrition (lower body mass index [BMI] z-score) in older children with sickle cell anemia in Nigeria. Methods This was a planned analysis of the data of children enrolled in a feasibility trial for managing severe acute malnutrition in older children with sickle cell anemia in Nigeria (SAMS trial; #NCT03634488). In this study, children 5-12 years old with sickle cell anemia and uncomplicated severe acute malnutrition (BMI z-score <-3.0) were randomly assigned to receive either supplemental ready-to-use therapeutic food (RUTF) only or RUTF combined with moderate fixed-dose hydroxyurea therapy for 12 weeks. Baseline anthropometric data were obtained for each participant. Upon enrollment in the trial, the participants' caregivers completed the US Household Food Security Survey Module (HFSSM). Using the eight questions in the childhood portion of this standardized survey, we categorized the participants into three food security statuses: food security (0-1), low food security (2-4), and very low food security (5-8). Childhood food security scores were also measured as a continuous variable on a scale of 0-8, with higher scores indicating greater food insecurity. We constructed a linear regression model to estimate the association between childhood food insecurity and baseline BMI z-score. Results Data were collected between August 2021 and May 2022. The median age of the 108 participants in the study was 10.3 years (IQR 8.8-11.5). Most participants had low (55%) or very low (34%) food security. BMI z-score was not associated with categorical food security status (p=0.108). However, higher food insecurity as a continuous variable was associated with a lower BMI z-score (Pearson correlation -0.23, p=0.015; Figure 1). In a multivariable linear regression with sex, age at study entry, total hemoglobin, employment status, and head of household educational status, the childhood food insecurity score was negatively associated with the BMI z-score (Beta coefficient = -.05, p=0.047). Conclusions Our study reveals a high prevalence of food insecurity among older children with sickle cell anemia in Nigeria. Moreover, children experiencing higher food insecurity also exhibited more severe malnutrition, as evidenced by their lower BMI z-scores. Based on these results, we have started implementing food insecurity assessment as routine medical care in children with sickle cell anemia at multiple clinics in northern Nigeria. Children experiencing higher levels of food insecurity are referred to nutritional counseling, where they receive guidance on locally available nutrient-dense foods and preparation strategies. Figure 1.The predicted baseline body mass index z-score with 95% confidence intervals based on childhood food insecurity scores from a linear regression model of the participants in the SAMS trial.

A user-centered approach to the development of a diet education tool for older adults with tooth loss.

Tooth loss is associated with suboptimal nutrient intake and greater risk of malnutrition. To develop and field-test a stakeholder-informed diet education tool that addresses the unique needs of older adults with tooth loss who do not wear dentures. An iterative user-centered approach was used. Initial content was developed based on findings from previous research. Stakeholder panels of older adults with 20 or fewer teeth, and dentists, were conducted at two time points to obtain feedback on the tool, which was revised following each panel. The tool was field-tested in a dental school clinic and evaluated using the Patient Education Materials Assessment Tool; it was further revised based on feedback. A diet education tool entitled "Eating Healthier With Tooth Loss" was developed. Sections for fruits and vegetables, grains, and proteins food groups, and one addressing socioemotional aspects of eating with missing teeth were included. Panel members provided constructive, positive feedback; recommendations for editing text, images, design, and content were integrated. Field-testing in the dental clinic with 27 pairs of student dentists and their patients resulted in scores of 95.7% for understandability and 96.6% for actionability, with over 85% agreement with each item. The tool was revised based on field-testing feedback. A diet education tool for older adults with tooth loss was developed using a user-centered approach, integrating the 'patient voice' and patient experiences with US dietary guidelines. Use of this tool is feasible in a dental clinic setting. Future research should explore usage in larger settings.

Malnutrition levels among type-2 diabetes mellitus patients in Pakistani a multi center study

Objective: To determine the frequency of malnutrition among T2DM patients in tertiary care. Place and Duration of Study: Departments of Medicine Hayatabad medical complex peshawar Pakistan from jan 2020 to July 2021. Methodology: this Multi-center study conducted in department of medicine hmc hospital Peshawar from jan 2020 to July 2021. total of 130 T2DM patients were assessed for nutritional evaluation with the assistance of a nurse and supporting staff. With the use of a questionnaire and a Subjective Global Assessment form, the data was collected (SGA). With the aid of MS Excel and SPSS, the nutritional risk factors and malnutrition status were determined, and the data was statistically examined. Results: The results of our recent study showed that, of the 130 patients, 62 48% were at intermediate risk of malnutrition and 68/52% were at high risk. Similar to this, 48 individuals had severe malnutrition, while 80 patients were classified as having moderate malnutrition. Obese Class-I, with the greatest risk of malnutrition and the highest frequency of severe malnutrition, has been proven to have the highest incidence among the different BMI categories. 0.920 is the correlation coefficient R2.

Intervenções nutricionais em crianças e adolescentes com paralisia cerebral: revisão sistemática

ABSTRACT Objective: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). Data source: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: “children” OR “childhood” AND “nutritional therapy” OR “nutritional intervention” OR “nutrition” OR “nutritional support” OR “diet” AND “cerebral palsy” OR “cerebral injury”. Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. Data synthesis: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. Conclusions: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

The truth behind food and cancer: Simple explanations based on scientific evidence

Background: Specialist oncology dietetic care is lacking in Ireland. This results in knowledge gaps that are filled by unreliable information from unqualified outlets such as the media and alternative-health providers, who promote complementary/alternative medicine (CAM). The aim of this resource is to provide cancer survivors with up-to-date, evidence-based information on cancer and nutrition. Methods: Common myths about nutrition and cancer and the most popular CAM used by Irish cancer survivors were included. National cancer organisations were also reviewed. To ensure readability, content was written according to the National Adult Literacy Agency recommendations, and peer-reviewed by other dietitians. Patient feedback was sought from patient advocates. Funding was secured from Breakthrough Cancer Research to print 20,000 copies for free distribution. Results: ‘The Truth Behind Food and Cancer: Simple Explanations based on Scientific Evidence’ is a coloured printed resource written by dietitians. It discussed popular diet-based CAM and food avoidance patterns practiced by patients with cancer and provides an evidence-based response to myths and unproven dietary strategies. Conclusion: Following a restrictive dietary strategy can place vulnerable cancer patients at an even greater risk of malnutrition and its debilitating effects. Research shows that a significant number of cancer survivors turn to unproven dietary strategies in the absence of dietetic care or reliable resources.

Loss of body weight and skeletal muscle negatively affect postoperative outcomes after major abdominal surgery in geriatric patients with cancer

ObjectivesMalnutrition characterized by the involuntary loss of body weight and skeletal muscle can be the result of both aging and malignancy. As a result, geriatric patients could face an increased nutritional risk. This study aimed to investigate the nutritional and functional status of geriatric patients and their association with postoperative complications. MethodsPatients who underwent abdominal surgery for digestive cancer in our center between January 2020 and August 2021 were included in the study. Computed tomography scans were collected to evaluate muscle mass and density. Changes in body weight, muscle strength, physical performances, nutritional risk, and status were evaluated upon admission. Postoperative outcomes collected included postoperative length of stay, complications, and 30-d readmission. ResultsA total of 1513 patients were included for the analysis. Of these, 72.8% were at risk for malnutrition (70.3% in the non-geriatric group and 75.4% in the geriatric group; P = 0.031), and 28.9% had malnutrition according to the Subjective Global Assessment (26.0% in the non-geriatric group and 31.8% in the geriatric group; P = 0.016). Compared with younger patients, geriatric patients have decreased muscle mass (skeletal muscle index, 44.8 versus 47.4; P < 0.001) and skeletal muscle density. Significant weight loss and loss of skeletal muscle occurred concurrently in 18.8% of the patients and were more frequent in the geriatric group (22.3% versus 14.7%; P < 0.001). In multivariate analysis, an age of 65 y or older (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.07–1.86; P = 0.014), a serum albumin level ≤4.11 g/dL (OR, 1.35; 95% CI, 1.03–1.77; P = 0.03), skeletal muscle loss (OR, 1.69; 95% CI, 1.28–2.24; P < 0.001), declined functional status (OR, 1.5; 95% CI, 1.14-1.98; P = 0.004), systematic inflammation (OR, 1.71; 95% CI, 1.09–2.8; P = 0.026), and significant weight loss (OR, 1.4; 95% CI, 1.06–2.85; P = 0.017) were independent predictors of overall postoperative complications. Although there was a trend of interactions between advanced age, skeletal muscle loss, and significant weight loss, multivariate analysis showed none of the interactions were significantly predictive of overall postoperative complications. ConclusionsGeriatric patients are at greater risk for malnutrition. Their declined nutritional and functional status together with advanced age could increase the risk for postoperative complications. Nutrition evaluation should be part of the preoperative workup, and timely interventions should be initiated if needed, especially in geriatric patients.

Stunting, double orphanhood and unequal access to public services in democratic South Africa

Orphans who lack household or community support face significant socio-economic disadvantages. In particular, they are at greater risk of malnutrition and stunting in developing countries. Children who have no living parents, also called double orphans, are most likely to require support from extended families or public institutions. This paper explores how WASH infrastructure, and public health and social services relate to stunting. It is one of the first studies to analyse these factors with a specific focus on double orphans, who tend to live in under-serviced areas with high stunting rates and poor access to public resources. We collate a cross sectional spatial dataset with local child stunting rates from 2013, rates of double orphanhood, private household resources, and public services from 2011 for South Africa, a country where the HIV/AIDS pandemic has led to high rates of double orphanhood. We estimate spatial econometric models that account for unobserved regional shocks and measurement bias, but which do not address other biases. Our results show that high stunting rates, particularly in areas with high proportions of double orphans, overlap strongly with poor provision of WASH and the availability of household resources. By contrast, other softer services accessed outside the home, such as access to health, social welfare and early childhood development facilities are not correlated with stunting in the same way. WASH is more strongly related to reduced stunting when infrastructure covers larger geographic areas and with the combined use of services from adjacent areas. This occurs because of economies of scale in provision and preventing transmission of disease across regions. Policy makers can explore the option to reduce stunting by expanding geographic networks of WASH service delivery into under-serviced areas where double orphans tend to locate.

Home-delivered meal programme participants may be at greater risk of malnutrition without the meal programme.

(1) To examine total quality of foods consumed on the day a home-delivered meal (HDM) of the Older Americans Act Nutrition Program (OAANSP) was served, and when a HDM was not served; and (2) to estimate proportion of HDM participants and non-participants meeting the daily average recommendations for guidance-based foods and nutrients. Cross-sectional study. Data were obtained from the national 2015-2017 Outcomes Evaluation Study of HDM participants in the USA. Adults aged 67 years and older (n 1227), 620 HDM recipients and 607 matching non-participants examined in three groups: (1) meal recipients who received a HDM on the day of the 24-h dietary recall; (2) no-meal recipients who did not receive a HDM on the day of the recall and (3) matching HDM non-participants. Healthy Eating Index (HEI)-2010 scores of HDM participants were significantly lower on the day the meal was not received compared with when a meal was received (52·5 v. 63·4, P < 0·0001). There was no significant difference in the total HEI-2010 scores of HDM meal recipients and HDM non-participants. Despite the meal, less than 20 % of HDM participants and non-participants met the 2010-Diet Guidelines for Americans recommended average daily intake for fruit, vegetables, dairy, protein foods and solid fats. HDM participants' diet quality is poorer when they do not receive a meal putting them at increased risk of malnutrition. Expanding the OAANSP to offer meals on weekends and/or to include more than one meal/d is recommended to improve the diet of this vulnerable population.

Tooth Loss and Nutritional Status in Older Adults: A Systematic Review and Meta-analysis.

Older adults are at risk for tooth loss and compromised nutritional status. Our objective was to conduct a systematic review and meta-analysis to answer the following question: Among adults aged ≥60 y living in developed countries, what are the associations between tooth loss and nutritional status as assessed by a validated nutrition screening or assessment tool? PRISMA guidelines were followed. PubMed, Scopus, CINAHL, Web of Science, and MEDLINE were searched for studies published in English between 2009 and 2019 that met inclusion criteria. Data extracted included study and participant characteristics, dentition, and nutritional status. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. Random effects meta-analysis was used. Of the 588 unduplicated articles identified, 78 were reviewed in full text, and 7 met inclusion criteria. Six studies were combined for a meta-analysis, which revealed that individuals who were completely edentulous or who lacked functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished, as compared with those who were dentulous or had functionally adequate dentition (risk ratio, 1.21; 95% CI, 1.11 to 1.32; I2 = 70%). Whether the article statistically adjusted for medical history explained most of the heterogeneity in the pooled effect. Findings suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Use of validated tools to assess risk of malnutrition in older adults with tooth loss is important to promote early intervention and referral to optimize nutrition and oral health status. Findings were limited by heterogeneity, risk of bias, and overall quality of the studies reviewed. Cohort studies that adjust for known confounders and use consistent approaches to assess tooth loss and nutritional status are needed. The results of this study suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Screening of this population for malnutrition by health care professionals, including dentists and dietitians, may result in corresponding referrals to optimize nutrition and oral health status. Further research is needed with consistent approaches to assess tooth loss and nutritional status.

Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool.

Malnutrition prevails in considerable proportions of children with Cystic Fibrosis (CF), and is often associated with adverse outcomes. For this, routine screening for malnutrition is pivotal. In the present cross-sectional study, we aimed to assess the risk for malnutrition in pediatric outpatients with CF. A total of 76 outpatients (44 girls, 11.9 ± 3.9 years old, 39.5% adolescents) were recruited and anthropometric, clinical, dietary and respiratory measures were collected. All outpatients were screened for malnutrition risk with a validated disease-specific instrument. Most children exhibited a low risk for malnutrition (78.9%), whereas none of the participants were characterized as having a high malnutrition risk. In the total sample, malnutrition risk was positively associated with age (r = 0.369, p = 0.001), and inversely related to the body mass index (r = −0.684, p < 0.001), height z-score (r = −0.264, p = 0.021), and forced expiratory volume (FEV1%, r = −0.616, p < 0.001). Those classified as having a low malnutrition risk were younger (p = 0.004), heavier (p < 0.001) and taller (p = 0.009) than their counterparts with a moderate risk. On the other hand, patients in the moderate risk group were more likely pubertal (p = 0.034), with a reduced mid-upper arm fat area (p = 0.011), and worse pulmonary function (p < 0.001). Interestingly, none of the children attaining ideal body weight were classified as having a moderate malnutrition. risk, whereas 37.5% of the patients allocated at the moderate risk group exhibited physiological lung function. In this cohort of outpatients with CF that were predominantly well-nourished and attained physiological lung function, malnutrition risk was identified only in small proportions of the sample. Our data support that patients that are older, pubertal, or have diminished fat mass are at greater risk for malnutrition.

COMPLEMENTARY FEEDING PRACTICES IN AFGHANISTAN

Background: Children in Afghanistan are at greater risk of malnutrition. Over 50% of children were suffering from malnutrition in Afghanistan in 2012, which has a long-lasting physical, mental, social, and impact on children. Study purpose: The purpose of this research study was to explore the association between parents knowledge, attitudes, and practices about complementary feeding and stunting in children in Afghanistan. The predictor variables were mothers knowledge, attitudes, and practices about complementary feeding and the outcome variable was stunting status of children aged 6 to 24 months. Research methods:A quantitative cross-sectional survey was conducted with randomly selected participants who were living in Kabul, Afghanistan. Logistic regressionmodels were used to analysethe data. Research setting: This research was conducted in 6 hospitals in Kabul, Afghanistan. Study participants: The study participants included 306 mothers who had children aged between 6-24 months. Results: Mothers knowledge, attitudes, and practices were significant predictors of stunting in children, χ2 (9, N = 306) = 45.33, p &lt; .001 χ2 (9, N = 306) = 26.71, p &lt; .01 and χ2 (9, N = 306) = 56.97, p &lt;.001.Mothers who did not practice responsive feeding were 7.1 times more likely to have stunted children than mothers who practiced responsive feeding. Social and policy implications: The social and policy implications of this research study include reviewing nutrition policies, investing in nutrition programs, and increasing public education and awareness in promoting appropriate complementary infant feeding practices in Afghanistan.

Responsibility to Protect Doctrine to Support Children in Armed Conflict

Children are so vulnerable in armed conflicts. They are international targets of violence, victims of indiscriminate violence, and traumatized witnesses of violence against others. They are disproportionately affected by war, being at greater risk of malnutrition and disease and highly vulnerable to abuse and exploitation. Despite the emerging acceptance to embrace the responsibility to protect (R2P) doctrine, the use and abuse of children by armed groups, State and non-State, has continued. The Responsibility to Protect claims to offer a solution to one of the gravest issues in world politics – mass atrocities. Ten years after the International Commission on Intervention and State Sovereignty (ICISS) detailed the concept, and five years after it was endorsed by the United Nations, we are presented an opportune moment to critically explore fundamental questions as to whether R2P has, or is able to, deliver on its promise. The article discusses the lack of discourse associated with the child soldier problem and how this relates to responsibility to protect.

Nutritional profile and biochemical alterations in non-institutionalized senior citizens with Alzheimer disease: a case-control study

Assess the nutritional and biochemical state of patients with Alzheimer Disease (AD) compared to a control group. This is an observational, case-control and descriptive type study, based on the recruiting of 22 elderly individuals with a clinical diagnosis of AD considered as the case group, and 22 other elderly individuals considered as the control group. Evaluations were made using the results from the following scales Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE), anthropometric measurements for obtaining the body mass index (BMI) and biochemical analyses. The analyses were performed on the program SPSS version 20.0, using absolute and relative measures, T test for independent samples for measurement comparisons and the Spearman correlation test. In the cognitive evaluation MMSE, those participants with AD present higher risk of cognitive decline (81.8%), greater risk of malnutrition according to MNA (45.5%) and altered levels of leptin (90.9%). Upon performing the comparison analysis between the group with AD and the control group, there existed noteworthy differences between the means for the variables MNA (4.40; BMI95% 2.75 – 6.06), MMSE (10.54; BMI95% 7.09 – 13.99) and doses of HDL (High Density Lipoproteins) (14.53; BMI95% 6.18 – 22.88). As well as differences in the p-value &lt; 0.09 in the leptin doses (11.54; BMI95% (-24.98 – 1.89) and transferrin dose (-72.31; BMI95% -159.48 – 14.84). The Spearman correlation demonstrated that the cognitive decline in the group of senior citizens with AD was strongly associated with nutritional conditions MNA (R 0.484) and the leptin dose (R 0.590). Senior citizens with AD present worse nutritional conditions, cognitive decline and biochemical alterations when compared to senior citizens in the control group. As such, the study demonstrated the need for an integrated healthcare assistance concerning senior citizens with AD.

Opinion: Challenges for Indonesia Zero Hunger Agenda in the Context of COVID-19 Pandemic

The rapid spread of COVID-19 has not only threatened the lives of infected persons but also affected a broader community socially and economically. The pandemic has also challenged Goal 2 of the 17 Sustainable Development Goals (SDGs) to eradicate all forms of hunger by 2030. The most disadvantaged society may have a greater risk of malnutrition and poor health as they cannot access safe, nutritious, affordable, and sustainable diets. At this moment, saving lives by focusing on the health-care system should not be the only priority, emphasis should be made in other essential aspects, including agri-food sector, in order not to cause the additional burden of hunger, malnutrition, and overall health.