High Prevalence Of Malnutrition Research Articles

Nutritional status of children with heart disease at the Komfo Anokye Teaching Hospital, Ghana

Background Undernutrition is associated with forty-five percent of all deaths in children under-five years. Irrespective of the type of heart disease (HD), malnutrition remains a constant phenomenon in children with both congenital and acquired HD. To minimize the long-term effect of malnutrition in a cohort of patient who have very limited chance of surgical treatment even when indicated, their nutritional statuses must be assessed periodically, and rehabilitation instituted early. The objective of this study was to assess the nutritional status of children attending the Pediatric Heart Disease clinic of the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.
 MethodsA retrospective review of children up to fourteen years, enrolled into the Pediatric Heart Disease clinic with confirmed HD from November 2020 to June 2021 were systematically recruited. Their ages, weights, heights and mid-upper arm circumferences (MUAC) were measured by standardized methods to assess their nutritional status. Subsequently, their Weight-for-Height (WfH), Height-for-Age (HfA), Weight-for-Age (WfA), Body Mass Index-for-Age (BfA) and MUAC-for-Age (MfA) z-scores were determined based on the WHO Child Growth Standards (2006). Z-scores less than -2 standard deviations (SDs) or greater than +2SDs were considered abnormal. Data was collected and analyzed using Epidata and R statistical software respectively.
 ResultsA hundred and sixty-seven patient were recruited with 86 (51.5%) being females. The median age was 56 months (Range: 1 to 172). The mean z-score for the WfH was -1.21 (95%CI: -1.48 to -0.94), HfA -1.18 (95%CI: -1.44 to -0.93), WfA -1.81 (95%CI: -2.06 to -1.56), BfA -1.41 (95%CI: -1.61 to -1.21) and MfA -1.66 (95%CI: -1.87 to -1.46). None of the patients had a z-score greater than +2SD for all anthropometric methods determined. The percentage of children with z-scores less than -2SD for WfH was 20.5% (95%CI: 12.0 to 31.6), HfA 21.3% (95%CI: 14.4 to 29.6), WfA 41.5% (95%CI: 33.1 to 50.3), BfA 31.1% (95%CI: 23.1 to 40.2) and MfA 36.0% (95%CI: 28.6 to 44.0).
 ConclusionThere is a high prevalence of malnutrition, wasting and stunting among children attending the Pediatric Heart Disease clinic at KATH. Strategies should be put in place to improve their nutritional status, which in turn could improve surgical and long-term developmental outcome.

Assessment of regional networks on nutrition in South Asia: a multi-methods study

BackgroundMany national and international organizations are working to improve maternal and child nutrition in countries with high malnutrition prevalence and burdens. While there has been progress in strengthening multi-organizational networks on nutrition at country and global levels, the regional level has received much less attention. We conducted a study to 1) determine the existing relationships and levels of engagement between international organizations working to improve nutrition at the regional level or in at least two countries in South Asia; and 2) examine the experiences and perspectives of international organizations on regional-level communication, coordination or collaboration on nutrition in South Asia.Methods A mixed methods approach involving organizational network analysis (ONA) and semi-structured interviews was used to develop an understanding of the existing network and relationships between international organizations working on nutrition in South Asia. ONA data from 43 international organizations was analysed using a social network analysis software (UCINET) to systematically quantify and visualize the patterns of relationships between organizations.ResultsWe found a high degree of connectivity between most of the international organizations in South Asia, but there were gaps between the many organizations that knew each other and the work they did together regionally on nutrition. Most organizations worked together only ‘rarely’ or ‘sometimes’ on nutrition at the regional level and high-intensity (collaborative) working relationships were uncommon. Organizations of the same type tended to cluster together, and a small number of UN agencies and multilateral organizations were central brokers in the nutrition working relationships. Perceived constraints to the nutrition working relationships included organizations’ agenda and mandate, threats to visibility and branding, human and financial resources, history, trust and power relations with other organizations, absence of a regional network for cooperation, and donor expectations. There was high demand to remedy this situation and to put network mechanisms in place to strengthen communication, coordination and collaboration on nutrition.ConclusionsOpportunities are being missed for organizations to work together on nutrition at the regional level in South Asia. The effectiveness of regional nutrition networks in influencing policy or programme decisions and resources for nutrition at country level should be explored.

Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

BackgroundThe Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure.MethodsAll first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing.ResultsAmong 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed.ConclusionEven though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

Tackling malnutrition with a new compact oral nutrient supplement among residents in aged care: a pilot study.

Introduction There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods Residents (n = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April-June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation.

Nutritional status of children under 5 years old in Namibia: adjusting for poor quality child anthropometry

The poor assessment of child malnutrition impacts both national-level trends and prioritisation of regions and vulnerable groups based on malnutrition burden. Namibia has reported a high prevalence of malnutrition among children younger than 5 years of age. The present study's aim was to identify the optimal methods for estimating child stunting and wasting prevalence in Namibia using two datasets with suspected poor data quality: Namibia Demographic and Health Surveys (NDHS) (1992-2013) and Namibia Household Income and Expenditure Survey (NHIES), 2015/16. This comparative secondary data analysis used two prevalence estimation methods: WHO flags and PROBIT. WHO flags is the standard analysis method for most national household surveys, while the PROBIT method is recommended for poor quality anthropometry. In NHIES (n 4960), the prevalence of stunting (n 4780) was 30·3 and 20·9 % for the WHO flags and PROBIT estimates, respectively, and the national wasting prevalence (n 4637) was 11·2 and 4·2 %, respectively. The trends in nutritional status from NDHS and NHIES showed improvement across WHO flags and PROBIT until 2013; however, from 2013 to 2016, PROBIT showed smaller increases in stunting and wasting prevalence (2·5 and 0·6 percentage points) than WHO flags (6·6 and 5·0 percentage points). PROBIT identified the Khoisan ethnic group and Northern geographical regions with the highest stunting and wasting prevalence, while WHO flags identified similar prevalence across most groups and regions. The present study supports the recommendation to use PROBIT when poor data quality is suspected for constructing trends, and for targeting regions and vulnerable groups.

Malnutrition in Congenital Heart Disease

Congenital heart disease accounts for nearly twenty-eight percent of all the major congenital malformations, posing a significant global health problem. Prevalence of both cyanotic and acyanotic varies from 0.7 to 5.3/1000 patients in community-based study while hospital-based study statistics range between 3.9 and 26.4/1000 live births. The increase in birth rate and the requirement of surgical and non-surgical intervention makes it a high and challenging need task for emerging nations like India, where the framework isn't created at the root level. In this population a high prevalence of malnutrition is seen especially in infants. In the era of high survival rates, nutrition provides opportunity for development, growth optimization and a better standard of living. The morbidity & mortality associated malnutrition in infant with congenital heart disease can be reduced by early diagnosis / optimum treatment. Approximately half of the pediatric age population suffering from Congenital Heart Disease (CHD) are found to be malnourished where the most of the affected factor is found to be weight worse than height. The various contributory factors for malnutrition in CHD patients are cyanosis, heart defects, heart failure, pulmonary hypertension, anemia, and delayed corrective surgery. Early and Timely diagnosis is crucial as most congenital heart disorders can be corrected if apt intervention is provided, leading to better prognosis. Decreased caloric requirement , reduction in prevalence of respiratory tract infection, and better absorption will lead to early normalization of their malnourishment. The major studies done in the recent past have focused on the mechanism of failure of growth in patients suffering from congenital heart malformation or on the modalities for improvement of growth of children with congenital heart disease. The severity and frequency of malnutrition associated with congenital heart diseases has not been focused on in the past decades.

Baseline maternal weight is associated with adverse birth outcomes in Botswana

The impact of baseline maternal weight on birth outcomes has been well studied in high-resource settings, but limited data exist from low and middle income countries (LMIC) where there is a higher prevalence of malnutrition.

Nutrition, Inflammation, and the Gut Microbiota among Outpatients with Active Tuberculosis Disease in India.

India has the highest rates of tuberculosis (TB) globally and a high prevalence of malnutrition; however, the interplay between host nutritional status, inflammation, and the gut microbiome in active tuberculosis disease (ATBD) is less well-studied. We examined differences in gut microbial composition and diversity based on undernutrition and inflammation status among outpatients with ATBD at the time of treatment initiation. During this exploratory cross-sectional study, outpatients (N = 32) with ATBD (confirmed by Xpert MTB/RIF) were enrolled in anti-TB treatment initiated at a hospital in rural southern India. The 16S rRNA sequencing was used to assess the composition of the gut microbiome. We assessed multiple markers of nutritional status, including micronutrient status concentrations (vitamin D [25(OH)D], vitamin B12, ferritin), anthropometry (body mass index, mid-upper arm circumference, and height), and C-reactive protein (CRP), as indicators of inflammation. We found that 25(OH)D was positively associated with the relative abundance of Oscillospira spp., a butyrate-producing genus linked with anti-inflammation effects, and that ferritin was positively associated with Proteobacteria taxa, which have been associated with worse inflammation in other studies. Finally, we found a greater abundance of inflammation-associated taxa from the Proteobacteria phylum and lower alpha-diversity indices among those who were underweight or who had low mid-upper arm circumference or short stature. In summary, we found differences in the gut microbiota composition and diversity among those with undernutrition compared with those with adequate nutrition status at the time of initiation of treatment among patients with ATBD in India. Clinical implications of these findings will need to be examined by larger longitudinal studies.

Nutritional Status of the Children with Acute Lymphoblastic Leukemia at Diagnosis and after Completion of Induction

Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition and weight lost are common and are due to verity of mechanism involving the tumor, the host response to the tumor such as infection and pharmacokinetics of chemotherapeutic drugs. Objective: To evaluate and compare the nutritional status of children with ALL at diagnosis and after completion of induction therapy. Methodology: This prospective observational study included 60 children newly diagnosed as ALL, aged 2-15 years, over a period from April 2012 to September 2012 in the Department of Pediatric Hematology and Oncology, BSMMU. The anthropometric measurements and serum albumin level were taken. Anthropometric indices are calculated by NCHS (WHO-2000) and classified as Z score. Children <-2 SD are considered as underweight (WFA), stunted (HFA) and wasted (WFH). Serum albumin level below 21g/dl is considered as severely malnourished. The Hb values of the children are compared with normal values by age. The children got induction chemotherapy according to MRC-11 protocol. They were in regular follow up and again anthropometric measurements and serum albumin level were taken after completion of induction. Results: Out of 60 children with ALL, 48 (70%) were underweight, 45 (75%) were stunted 36 (60%) were wasted at diagnosis. Incidence of malnutrition among leukemia children after completion of induction were 24 (40%) underweight, 45 (75%) were stunted and 6 (10%) were wasted. The results showed that children in the newly diagnosed stage had a higher prevalence of malnutrition. However no statistically significant difference in the nutritional status was found among newly diagnosed and after completion of induction in term of underweight and stunting but newly diagnosed patients had statistically significant wasting than patients who had completed induction chemotherapy. No patient showed severe malnutrition based on the cut-off point for serum albumin on both stages. All the children (100%) had less than normal range hemoglobin levels. Conclusion: Malnutrition was higher in children with newly diagnosed leukemia. Children had significant differences in the nutritional status in term of wasting at diagnosis than after completion of induction therapy. So, the nutritional status of children with leukemia should be monitor periodically.

A multi-centre survey on hospital malnutrition: result of PNSI study

BackgroundDisease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university f.MethodsPersian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA).ResultsIn total, 2109 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.68 ± 14.65 years and 25.44 ± 6.25 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.92% of the patients, 26.23 and 21% of whom were among the admitted and discharged patients, respectively. The highest prevalence of malnutrition was in burns (77.70%) and heart surgery (57.84%) patients. Multivariate analysis presented male gender (OR = 1.02, P < 0.00), malignant disease (OR = 1.40, P < 0.00), length of hospital stay (OR = 1.20, P < 0.00), and polypharmacy (OR = 1.06, P < 0.00) as independent risk factors for malnutrition. Malnutrition was not associated with age (P = 0.10).ConclusionThis study provides an overall and comprehensive illustration of hospital malnutrition in Iran university hospitals, finding that one out of four patients were malnourished; thus, appropriate consideration and measures should be taken to this issue.

Dietary practices associated with prevalence of malnutrition among the elderly in Kiambu County, Kenya

Ageing is often associated with various needs as well as changes, which make elderly people susceptible to malnutrition. A healthy diet helps to protect against malnutrition in all its forms, as well as noncommunicable diseases. Malnutrition is a major risk factor of cardiovascular and metabolic diseases and therefore the importance of good dietary practices and balanced diet cannot be overemphasized. The percentage of older people at risk of malnutrition in most Kenyan Counties has increased to 29.6% from 20.1% in 2015. This study therefore study sought to assess the effect of dietary practices on malnutrition among the elderly in Kiambu County. The research design was cross sectional descriptive research design. The target population in this study was the elderly population from the age of 60 years and above. A sample of 398 respondents was determined with the help of Yamane Formula. A questionnaire was used to collect data. Descriptive, chi-square and correlation analysis were conducted with the help of SPSS. Results showed that prevalence of malnutrition stands at 42%. Results also showed poor dietary practices. Only 26.6% of the sample had 3 meals per day. The results showed that gender (p=0.000) and education level (p=0.035) were significant. Results also showed that skipping of meals (p=0.003) and number of meals (p=0.042) were significant. Cross tabulation showed that respondents who had less than 3 meals and who skipped at least one meal were more likely to be malnourished. The study concluded that the high prevalence of malnutrition in the sample can be attributed to poor dietary practices. This study recommended an increase in food supplementation efforts by the county government to old people.

Nutritional status and functional status of the pancreatic cancer patients and the impact of adjacent symptoms

Pancreatic cancer (PC) is the third most common type of gastrointestinal tract cancer in Europe and the fourth leading cause of death by cancer. Its initial stage is asymptomatic Therefore, the diagnosis tends to be late leading to locally advanced stages that presuppose late and debilitating symptoms, which consequently makes the Nutritional Status (NS) get worse. The weight loss (WL), malnutrition, and oncologic cachexia, which are quite prevalent in PC patients, reflect a poor prognosis. We aimed to track and evaluate the NS and Functional Status (FS) of PC patients (hospitalized patients - HP and Day Hospital patients - DHP) and associate NS with symptoms with nutritional impact and FS. Observational cohort study in PC patients from Garcia de Orta Hospital. NS was tracked and evaluated using Nutritional Risk Screening (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA). To assess FS we used the Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Scale Index (KPSI) and Handgrip Dynamometer (HGD). 41PC patients (30-HP and 11-DHP). 29 patients in stage IV of the tumor. 24 with a WL >10% in the last 6 months. 37 manifest symptoms with nutritional impact. 30 to 34 malnourished according to the GLIM criteria and PG-SGA, respectively. 11 in ECOG level 2 and corresponding KPSI, 10 in level 3 and 8 in level 4. 28 patients had a value of HGD below the 10th percentile. NRS-2002, PG-SGA and GLIM criteria were positively correlated with the symptoms (p<0.01), % WL (p<0.01) and ECOG (p<0.01) and negatively correlated with HGS (p<0.05 - NRS-2002; p<0.01 - PG-SGA and GLIM criteria). PC patients manifest debilitating symptoms with nutritional impact, namely severe WL and anorexia, which in turn lead to deterioration of the NS and FS. It is an oncology population with high nutritional risk and a higher prevalence of malnutrition, associated with severe % WL and symptoms and a sharp decline in FS.

A COMMUNITY-BASED STUDY OF MILK ADULTERATION AND CHILDHOOD MALNUTRITION IN BANGALORE RURAL DISTRICT, INDIA

Background: Milk promotes child growth; however, adulterated milk reduces nutritional value and exposes children to harmful chemicals. Therefore, this study aimed to assess the nutritional status of children aged 1–5 years living in the selected study area and test milk samples from the children's households for common adulterants. The study further aimed to explore the association between malnutrition and milk adulteration.Methods: We used a community-based cross-sectional study design conducted in the service area of a tertiary healthcare institute in Bangalore Rural District, Karnataka state, India. Systematic random sampling was used to recruit 180 children aged 1–5 years. Primary data was collected through interviews, anthropometry, and strip tests for milk adulteration. Statistical analysis consisted of descriptive analysis, Chi-square tests, odds ratios, and 95% confidence intervals.Results: Prevalence of underweight, stunting, wasting, and low Body Mass Index (BMI) was 13.33%, 38.33%, 15.0%, and 26.7%, respectively. General adulterants detected were neutralizers in 97 (53.9%) and maltodextrin in 90 (50%) samples. Higher proportions of stunting, underweight and low BMI were found in children drinking adulterated milk. Low BMI was significantly associated with joint family and lower maternal education.Conclusion: Our study found a high prevalence of malnutrition in children, particularly stunting. The study also detected widespread adulterants in milk and a potential association with malnutrition. The authors recommend further studies with a larger sample size to accurately delineate the relationship between milk adulteration and malnutrition.

Nutrition Therapy in Patients Requiring Noninvasive Ventilation in the Intensive Care Unit: Feasibility, Tolerance, and Complications

Background: Patients requiring noninvasive ventilation (NIV) in the intensive care unit (ICU) are likely to have a high prevalence of malnutrition. Nutrition provision in these patients is of utmost importance; however, data on its feasibility, tolerance, and complications are largely unavailable. Objective: The objective of the study was to assess the prevalence of malnutrition in patients requiring NIV in the ICU and to analyze feasibility, tolerance, and complications of nutrition therapy in this population. Methods: This was a prospective, observational study of consecutive patients requiring NIV admitted to the multidisciplinary ICU of a tertiary care, teaching hospital between April 2017 and November 2017. Baseline nutrition status was assessed using subjective global assessment (SGA). Nutrition requirement calculation and prescription were standardized. All included patients were monitored for pattern of nutrition provision, adequacy of delivery tolerance, and complications. Relevant outcomes such as intubation rates, ICU length of stay (LOS), and mortality were also noted. Results: A total of 34 patients were included in the study. Seventy-six percent of patients (26 out of 34 patients) were malnourished as determined by SGA. The mean Acute Physiology, Age and Chronic Health Evaluation II score was 15.1 ± 6.9. The average time for feed initiation was 12.4 h, and the most common reason for the delay (in 43%) was an impending intubation. The mean percentages of calorie and protein requirement that was delivered by day 3 were 67.2% and 48.3%, respectively. Thirteen patients (38.2%) required continuous nasogastric (NG) feeding, while the others could be fed orally. In 14 patients (41.1%), we were able to achieve 80% or more of target calorie requirement by day 3, and among these patients, the mean percentage of target protein intake that could be achieved was 66.6% by day 3. Feed intolerance was observed only in three patients. One patient had an inadvertent dislodgement of NG tube. Six patients (17.6%) required intubation and three (8.8%) died. Mean ICU LOS was 5.6 ± 3.9 days. Conclusion: Patients requiring NIV in the ICU have a high prevalence of malnourishment. Protocol-driven nutrition delivery is feasible in this population and is well tolerated.

Malnutrition at diagnosis and throughout therapy in pediatric patients with solid tumors: A single-institution study in a developing country.

Changesin nutritional status can constitute a risk factor for reduced tolerance and effectiveness of antineoplastic treatment. Knowledge of the nutritional status of pediatric patients is important for implementing interventions to improve outcomes. We aimed to evaluate nutritional status at diagnosis and throughout therapy in pediatric patients with solid tumors. To study the prevalence of malnutrition at diagnosis, compare different assessment tools, and examine longitudinal changes in nutritional status during the treatment of pediatric patients with solid tumors in a Brazilian institution. This prospective single-center study enrolled patients with solid tumors (age <19years) from June 2017 to May 2018. Nutritional evaluations were performed at diagnosis and after 3 and 6months of treatment. z-Scores for height for age (H/A) and body mass index for age (BMI/A) were calculated using the Anthro/AnthroPlus software and mid-upper arm circumference (MUAC) percentile was used for nutritional classification. The prevalence of nutritional status at diagnosis was 29.3% malnourished, 49.5% adequate, and 21.2% overweight/obese. Nutritional status improved during the first 3months of treatment, with a reduction in the proportion of malnourished patients and an increased number of patients with adequate nutritional status. The two combined indices, BMI/A and MUAC, facilitated the diagnosis of a greater number of patients with solid tumors who had nutritional alterations. A high prevalence of malnutrition was present at diagnosis. Nutritional status improved in the first 3months of treatment and could be related to the multidisciplinary institutional approach following the diagnosis.

Nutrition and exercise prehabilitation in elderly patients undergoing cancer surgery.

Surgical resection is the primary and most effective treatment for cancer patients. While such a traumatic intervention often accompanies different degrees of postoperative risk largely depending on the patient's health status. Due to the high prevalence of malnutrition or low cardiorespiratory fitness in elderly cancer patients, prehabilitation is an optimal program to reduce postoperative complications and enhance recovery from surgical trauma. An increasing body of evidence suggests that improving nutrition and taking aerobic exercise or strength training prior to major surgery can help reduce postoperative morbidity, mortality, or length of stay. However, there are still controversies regarding the manner, intensity, or duration of preoperative nutrition and exercise training in elderly patients, as well as the impact on delaying cancer treatment. This article reviews the impact of prehabilitation on improving postoperative outcomes in the multi-modal or single-modal pathway, aiming to maximize its effectiveness and increase medical practitioners' attention on enhancing the physical condition of the elderly cancer patients preoperatively.

Healthy sustainable food patterns and systems: a planetary urgency.

Food choice impacts human health and planetary sustainability. The feeding patterns that reduce risk factors for noncommunicable diseases and various mortality causes are recognized as healthy eating habits. The average world population is far from reaching these habits due to the lack of access to healthy foods and a high prevalence of malnutrition. Understanding the impact of healthy sustainable food systems is growing worldwide to reach food security for the global population and future generations. A systemic perspective of this concept includes the health and well-being of individuals and the environmental, economic, socio-cultural, public policies context, besides food, agriculture, and ecological sciences. We need to confront the menaces and challenges represented by the ongoing changes of our era, which strongly generate global food insecurity. This issue is relevant not only for human health but also for climate change and other threats, based on modifications in production, handling, and consumption of foods that consider health and welfare impact at individual and planetary levels. In this review, some key concepts related to healthy and sustainable food systems are presented.

Malnutrition and Some Related Factors in Primary School Children in Saudi Arabia: Systemic Review

Background: Malnutrition is an underlying factor in many diseases in both children and adults, and it contributes greatly to the disability-adjusted life years worldwide. It is a major public health concern in developing countries among children since it places a heavy burden on already disadvantaged communities.&#x0D; Methods: This is systematic review was carried out, including PubMed, Google Scholar, and EBSCO using the following terms in different combinations: Malnutrition, overweight, underweight, systemic review, primary school children, Saudi Arabia.&#x0D; Results: The review included 9 studies from different countries that assess the level of malnutrition and associated factors among school children. Many of studies reported high prevalence of malnutrition among school children which included overweight, stunting, wasting and underweight. The studies reported that age, gender, regularity of father’s employment, and dietary factors were associated with malnutrition. Also, the type of school attended was found to be associated with malnutrition.&#x0D; Conclusion: This review concluded that there was high malnutrition prevalence among school children in different parts and its affected by many factors like age and gender.

Nuevo enfoque en el tratamiento nutricional de la enfermedad renal crónica avanzada

IntroductionPatients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns. ObjectivesTo determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment. Secondary objectivesTo determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia. Material and methodsA single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall. ResultsAt the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group. ConclusionsMalnutrition is not exclusively an intake deficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease.

The Combined Usage of the Global Leadership Initiative on Malnutrition Criteria and Controlling Nutrition Status Score in Acute Care Hospitals

Introduction: The Global Leadership Initiative on Malnutrition (GLIM) lacks reliable blood tests for evaluating the nutrition status. We retrospectively compared the GLIM criteria, Controlling Nutrition Status (CONUT) score, and Subjective Global Assessment (SGA) to establish effective malnutrition screening and provide appropriate nutritional interventions according to severity. Methods: We classified 177 patients into 3 malnutrition categories (normal/mild, moderate, and severe) according to the GLIM criteria, CONUT score, and SGA. We investigated the malnutrition prevalence, concordance of malnutrition severity, predictability of clinical outcome, concordance by etiology, and clinical outcome by inflammation. Results: The highest prevalence of malnutrition was found using the GLIM criteria (87.6%). Concordance of malnutrition severity was low between the GLIM criteria and CONUT score. Concordance by etiology was low in all groups but was the highest in the “acute disease” group. The area under the curve of clinical outcome and that of the “with inflammation group” were significantly higher when using the CONUT score versus using the other tools (0.679 and 0.683, respectively). Conclusion: The GLIM criteria have high sensitivity, while the CONUT score can effectively predict the clinical outcome of malnutrition. Their combined use can efficiently screen for malnutrition and patient severity in acute care hospitals.