Higher Risk Of Undernutrition Research Articles

Nutritional status of people who inject drugs in Coastal Kenya: a cross-sectional study

IntroductionDespite documentation on injection drug use (IDU) in Kenya, the nutritional status of people who inject drugs (PWIDs) is under-explored. Elsewhere studies report under-nutrition among PWIDs which is attributed to food insecurity; competing priorities between drugs and food supply; chaotic lifestyle; reduced food intake; substance use induced malnutrition due to inflammation and comorbidities.MethodsThis was a cross-sectional study that sought to assess the nutritional status of PWIDs in Coastal Kenya. We recruited 752 participants of whom 371(49%) were on IDUs and 75 non-IDUs and 306 non-drug users using respondent driven sampling, traditional snowball, makeshift outreach and purposive sampling methods.ResultsMore than one half of the participants (56%) had BMI classified as normal while 35% had BMI < 18.5. The proportion with BMI < 18.5 was higher among IDUs (46%) compared to the non-IDUs (33%) and non-drug users (23%) at P < 0.001. Using the mid upper arm circumference (MUAC), 17% were classified as underweight and the proportion was lowest (11%) among non- drugs users compared to 22% among IDUs (P < 0.001). However, the IDUs had lower proportion of overweight (8.1%) compared to 55% among the non- drug users. The proportion with low waist-for-hip ratio was highest among the IDUs (74%) while high waist-for-hip ratio was lowest in the same group of IDUs (11%) at P < 0.001. One half (50%), of the participants had no signs of anaemia, (47%) had mild/moderate anaemia while 21 (2.8%) had severe anaemia. However, IDUs were more likely to be overweight based on waist circumference as a parameter. The IDUs had the highest proportion (54%) of mild to moderate anaemia compared to non-IDUs (37%) and 40% non- drug users (P < 0.001). In the multivariable models, IDUs (aRRR 2.83 (95%CI 1.84‒4.35)) and non-IDUs (aRRR 1.42 (95%CI 1.07‒1.88)) compared to non- drug users were positively associated with BMI < 18.5. Being an IDU was positively associated with mild or moderate anaemia (aRRR 1.65 (95%CI 1.13‒2.41)) while non-IDUs were positively associated with severe anaemia (aRRR 1.69 (95%CI 1.16‒2.48)).ConclusionA significant proportion of the participants were under-nourished with those injecting drugs bearing the heaviest brunt. Being an IDU was positively associated with the low BMI, MUAC, waist for hip ratio and mild or moderate anaemia but high waist circumference. People who inject drugs have high risk for under-nutrition and should be targeted with appropriate interventions.

Nutritional management of patients during surgical prehabilitation and rehabilitation programs

Undernutrition (UD) increases perioperative morbidity and mortality. Its prevention and treatment are therefore essential in surgical prehabilitation and rehabilitation programs. Nutritional treatment is individualized according to the patient's nutritional status, ingesta and protein-energy requirements. Oral nutrition is optimized to increase intakes through personalized dietary advice and oral nutritional supplements. Artificial nutrition support is indicated in cases of UD or high risk of UD before major surgery. Enteral nutrition is preferred to parenteral nutrition when the digestive tract is functional.

Effect of nutrition education on improving dietary diversity of children aged 6–23 months in Horo district, Oromia region, Ethiopia

BackgroundUnmet minimum dietary diversity (MDD) feeding practices in poor nations place children at high risk of undernutrition and its related effects, which are far-reaching and difficult to correct later in life. ObjectiveThis study aimed to assess the effect of maternal nutrition education and another determinant on the dietary diversity of children aged 6–23 months. MethodsA community-based cluster randomized trial study design was conducted from July 2019 to January 2020 in the Horo district. Twenty-three kebeles were assigned to two clusters. From two clusters, two kebeles were selected by simple random sampling. Two kebeles were assigned as intervention (150) and control (150) groups by the lottery method, at the end of the line as intervention (139) and control (137) groups. Simple random sampling techniques were used to select the study subjects. The nutrition education intervention, which lasted three months and consisted of eight sessions, was given to the intervention group, which was made up of mothers and other caregivers of children aged 6–23 months.Data entry into Epi-data and analysis were done using IBM SPSS version 26 computer software. At a 95% confidence level, values with P ≤ 0.05 were considered statistically significant. B-ivariable and multivariable conditional fixed-effect logistic regression analyses were done to identify the determinants of the dietary diversity score. Variables with a p-value of less than 0.05 were considered statistically significant. The crude odds ratio (COR) and adjusted odds ratio (AOR) were used to describe the strength and direction of the association. ResultThe result was that the proportion of children with a good dietary diversity score was 52 (34.7%) and 40 (26.7%) in the control group and intervention groups at baseline, respectively. Household food security [AOR = 4.06, 95% CI: (2.45, 6.73] and being in the intervention group [AOR = 1.90, 95% CI: (1.10, 3.29] were both positive predictors of the dietary diversity score, while maternal age (35–45 years) was a negative predictor. ConclusionAt baseline, a high proportion of children aged 6–23 months did not receive the World Health Organization's minimum dietary diversity recommendation for both groups. The consumption of animal sources and vitamin-A-rich fruits and vegetables was poor among both groups. At the end of the day, after nutrition education, the dietary diversity score improved in the intervention groups but not in the control groups. New strategies and programs should be made at all levels to improve childhood nutritional status. This includes providing nutrition education for mothers aged between 35 and 45 years old.

Undernutrition and determinants among adolescent street children in DireDawa City, eastern Ethiopia: Vulnerability assessment

ObjectivesAdolescents go through rapid development and increased nutritional requirements that can put them at higher risk of undernutrition--a problem that can be highest among orphaned or street children. Evidence on nutritional risk and its contributing factors among this segment is lacking in the city of Dire Dawa, where many children are on the streets with limited access to proper care. The aim of this study was to identify determinants of undernutrition among street adolescents in Ethiopia. MethodsA community-based cross-sectional study was conducted with 358 street adolescents 12 to 19 y of age in Dire Dawa from January to February 2022. After conducting a preliminary survey and registering all available street children, a complete enumeration was made. For data collection, an interviewer-administered questionnaire was used along with anthropometric measurements using standard procedures. Height-for-age (HAZ) and body mass index (BMI) for age z scores were computed using World Health Organization (WHO) Anthroplus and statistical analysis was done using SPSS software version 26. Independent variables with P < 0.25 in bivariable analysis were included in multivariable logistic regression, and variables with P < 0.05 were considered statistically significant. A crude and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. ResultsAmong 358 street adolescents, 44% (38.9–49.5) and 56% (50.8–61.4) were thin and stunted, respectively. Thinness among street children could be associated with a longer stay on the street (AOR, 1.65; 95% CI, 1.40–1.90), infrequent meal frequency (AOR, 1.32; 95% CI, 1.19–1.45), unprotected drinking water sources (AOR, 1.55; 95% CI, 1.40–1.71), alcohol drinking (AOR, 2.92; 95% CI, 1.51–4.32), inadequately diversified diet (AOR, 1.21; 95% CI, 1.06–1.36), and illness history (AOR, 1.34; 95% CI, 1.21–1.47). Moreover, odds of stunting were significantly associated with staying on the street (AOR, 1.32; 1.10–1.54), unsafe drinking water (AOR, 1.63; 95% CI, 1.13–2.66), smoking cigarettes (AOR, 1.54; 95% CI, 1.21–2.52), dietary diversity (AOR, 2.34; 95% CI, 1.43–3.82), and acute illness (AOR, 2.12; 95% CI, 1.31–5.23). ConclusionThinness and stunting were prevalent among street children and are associated with infrequent meals, poor dietary diversity, substance abuse, unsafe water sources, and illness histories that could be targeted for multisectoral interventions.

Effect of percutaneous endoscopic gastrostomy prior to oesophageal cancer surgery on postoperative wound complications in patients: A meta-analysis.

It is still a matter of controversy whether percutaneous endoscopic gastrostomy(PEG) should be used prior to the operation for the purpose of feeding the patient with resectable oesophageal carcinoma (EC). Comparison was made between EC and preoperatively treated PEG and non-preoperative PEG. An extensive literature review has been conducted to determine the results about PEG and No-PEG trials. In this paper, we chose 4 papers out of 407 of them through a strict selection process. In this trial, there were 1027 surgical cases of oesophagus carcinoma, 152 with PEG pre-surgery and 875 without PEG. The total sample size ranged from 14 to 657. Two studies showed that there was no statistically significant difference in the occurrence of postoperative wound infection among PEG and No-PEG(OR, 1.03; 95% CI, 0.38, 2.80 p = 0.96), there was no statistical significance in the likelihood of anastomotic leak among PEG after surgery compared to No-PEG in 4 trials (OR, 1.13; 95% CI, 0.62-2.07 p = 0.69), and there were no statistical differences between PEG and No-PEG before operation on anastomotic stricture for esophagectomy(OR, 0.70; 95% CI, 0.31-1.56 p = 0.38). No wound or anastomosis complications were observed in the PEG group. Thus, PEG preoperatively is an effective and safe procedure without any harmful influence on gastrointestinal structure or anastomosing. It can be applied to patients with oesophagus carcinoma who have a high risk of undernutrition. Nevertheless, because of the limited number of randomized controlled trials in this meta-analysis, caution should be exercised in their treatment. More high-quality research involving a large sample is required to confirm the findings.

Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study.

Protein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in HD patients after 12 months of therapeutic intervention with oral nutritional supplements (ONS). A total of 92 HD adult patients were enrolled in the study after 3 months of wash-out period. Baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis, and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on HD day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle, and hand-grip strength was analysed in 71 surviving patients. After 12 months, data for 71 patients, 39 (54.9%) men, 62.4 ± 12.9 years, and median haemodialysis vintage 53.3 (IQR 27.5-92.8) months, were available. Patients were divided into three groups: group A patients were with normal nutritional status at baseline not necessitating ONS; group B patients received ONS; and group C patients were entitled to receive but refused to take ONS. The baseline results showed statistically significant differences between the groups in serum albumin levels and phase angle but not hand-grip strength. Differences between the groups remained statistically significant at month 12; we did not find any statistically significant positive changes within the groups, indicating no positive effect of intervention with ONS. In a prospectively designed interventional single-centre study, we did not find a statistically significant change in surrogate markers of PEW in our cohort of HD patients, receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of HD patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during HD treatment, possibly providing psychological support and motivation.

Social Determinants of Child Undernutrition in Adivasi Population in Northern Kerala: A Study Using Syndemic Framework.

To understand the complex interaction of structural inequalities, co-occurring health conditions, and child undernutrition among the Adivasi population in North Kerala, India. A mixed-method approach was employed in this study, which combined a cross-sectional survey and a case study design. A multistage cluster sampling method was used to select 167 children aged 24 to 60 mo from the study population. The mothers of these children were interviewed using a structured questionnaire to assess individual, parental, and household-level factors associated with child undernutrition. Two Paniya settlements, one with a high prevalence of child undernutrition (HPS) and the other with a low prevalence (LPS), were chosen as the primary units of the case study. The study found that the absence of a kitchen garden with fruits and vegetables [adjusted odds ratio (AOR) 2.85; 95% confidence interval (CI): 1.04-7.81] and a history of cough and fever (AOR2.93; 95% CI: 1.24-6.93) were both associated with a higher risk of undernutrition in children. The case studies revealed that Adivasi children are undernourished due to a complex set of factors that persist throughout their lives, including unequal access to social capital, healthcare, and food security, as well as differences in hygiene practices due to the lack of access to clean water and sanitation. The findings underscore the need for social interventions to complement the current focus almost entirely on food supplementation programmes. Equitable action on Adivasi child malnutrition requires urgent policy and programmatic attention to social inequalities and access to basic amenities in Adivasi areas.

THE POTENTIAL OF ECONOMIC LOSS DUE TO STUNTING IN INDONESIA

Stunting cases continue to increase, along with the high risk of undernutrition, the increasing prevalence of malnutrition, and decreasing productivity. If this condition is not handled correctly, it can affect Indonesia's development performance, inequality, and poverty. Stunting can hinder economic growth and labor productivity, affecting 11% of GDP (gross domestic product) and reducing the income of adult workers by up to 20%. Based on this, it is necessary to make prevention and control efforts in nutrition intervention activities an economic investment. Therefore, this study estimates the economic potential lost due to stunting in children under five. This descriptive study is based on processing secondary data from various related agencies. We employed Konig's formula and correction factors from Horton's study. The results of this study show that the incidence of stunting in children under five in Indonesia in 2021 was 24.4%. Nationally, Indonesia has the potential for economic loss due to stunting in toddlers, which ranges from IDR 15,062 to IDR 67,780 billion. These are equivalent to a range of 0.89-3.99% of the total GDP in 2021 (IDR 16,970.8 trillion).

Dietary diversity and nutritional status of children aged 6–59 months from rural fishing and non-fishing communities in Zambia

Low-quality complementary foods combined with inappropriate feeding practices put children under the age of five in developing countries at high risk for undernutrition. This study explored dietary diversity, fish consumption patterns and nutritional status of children in Luapula, a rural province in Zambia, where households rely on capture fisheries for their livelihoods. In the cross-sectional study, households with children aged 6–59 months were enrolled in the study. A semi-structured questionnaire was utilised to collect socioeconomic characteristics, dietary intake and anthropometric data. Descriptive statistics and bivariate associations were conducted. 23% of children aged 6–23 months met the minimum dietary diversity. About 49% and 41% of the children were fed on fresh small pelagic fish and large dried fish once to twice a week, respectively. Imbilya (Serranochromis mellandi), Chisense (Poecilothrissa moeruensis), and amatuku (Tilapia sparrmanii) were the most preferred fish species due to their availability and affordability. Only 3.5% of children consumed porridge to which fish powder had been added. There was a significant difference in the height for age z scores of children in the two communities (χ2= 12.404; p = 0.002, d.f = 2). Low dietary diversity was observed across the fishing and non-fishing communities and less than half of the children consumed fish despite proximity of the study sites to one of the largest water bodies in Zambia. Better nutrition outcomes were observed among children in capture fisheries dependent households. Nutrition education in growth monitoring and promotion centres should address the issue of adequacy of diets with regard to frequency and diversity.

Attention, Praxis, and Reasoning Are Associated with Risk of Undernutrition in Older People with Cognitive Impairment.

Dementia is a risk factor for undernutrition. However, it is not clear if specific cognitive deficits have a higher risk of undernutrition and how much appetite/nutritional problems and caregiver stress mediate this association. To evaluate the relationship between nutritional status and severity of global and function-specific scores of cognitive dysfunctions, and to which extent this association is mediated by appetite/nutritional problems and caregiver stress. Cross-sectional analysis of the ReGAl study data, including 761 older adults attending a Memory Clinic. Nutritional status was evaluated with Mini Nutritional Assessment (MNA). The relationship between scores at neuro-cognitive tests and risk of undernutrition was evaluated using logistic regression models adjusted for potential confounders. To allow comparison between different tests, all scores were standardized. Mediation analysis was used to evaluate how much appetite/nutritional problems and caregiver stress mediate this association. Mean age was 77 years (SD: 9), 37.3% were women. Exploring different cognitive domains, a stronger association was documented for attentive matrices (OR:0.49, 95% CI: 0.34-0.72), the figure copy test (OR:0.63, 95% CI: 0.45-0.88), and the verbal judgement test (OR:0.61, 95% CI: 0.42-0.91). The proportion of the effect of cognition (MMSE) on nutritional status mediated by caregiver distress was 9.5% (95% CI: 0.002-0.27), the proportion mediated by appetite/nutritional problems was 11% (95% CI: -4.8-3.18). Risk of undernutrition is associated to cognitive decline; a stronger association was observed for attention, praxis, and reasoning. Caregiver distress is a mediator of this association. This information should be considered in the management plans of this population.

Nutritional status at age 1 year in patients born with esophageal atresia: A population-based, prospective cohort study.

ObjectiveDespite recent progress in caring for patients born with esophageal atresia (EA), undernutrition and stunting remain common. Our study objective was to assess nutritional status in the first year after birth with EA and to identify factors associated with growth failure.Study designWe conducted a population-based study of all infants born in France with EA between 2010 and 2016. Through the national EA register, we collected prenatal to 1 year follow-up data. We used body mass index and length-for-age ratio Z scores to define patients who were undernourished and stunted, respectively. Factors with P < 0.20 in univariate analyses were retained in a logistic regression model.ResultsAmong 1,154 patients born with EA, body mass index and length-for-age ratio Z scores at 1 year were available for about 61%. Among these, 15.2% were undernourished and 19% were stunted at the age of 1 year. There was no significant catch-up between ages 6 months and 1 year. Patients born preterm (41%), small for gestational age (17%), or with associated abnormalities (55%) were at higher risk of undernutrition and stunting at age 1 year (P < 0.05). Neither EA type nor surgical treatment was associated with growth failure.ConclusionUndernutrition and stunting are common during the first year after birth in patients born with EA. These outcomes are significantly influenced by early factors, regardless of EA type or surgical management. Identifying high-risk patient groups with EA (i.e., those born preterm, small for gestational age, and/or with associated abnormalities) may guide early nutritional support strategies.

Stunting Status of Ever-Married Adolescent Mothers and Its Association with Childhood Stunting with a Comparison by Geographical Region in Bangladesh.

The adolescence period is considered a life stage worthy of strategic health investments since it is a critical period of physical and neuro-maturational development. Adolescent girls face different health difficulties in that phase of life. Children born to adolescent mothers are at a higher risk of undernutrition. This paper aims to estimate the prevalence of stunting among adolescent mothers and their children in Bangladesh by time period and determine the associated factors of adolescent maternal stunting status. We also sought to establish the relationship between maternal and childhood stunting by comparing the geographical regions in Bangladesh. We derived data from the nationally representative Bangladesh Demographic and Health Survey, which was conducted between 2007 and 2017/18. The outcome variables of this study were ever-married adolescent girls’ stunting status and their children’s stunting status. Interaction analysis between administrative division and maternal stunting status was conducted with childhood stunting as the outcome variable to investigate the impact of maternal stunting status on their children’s stunting compared to geographical location. Our results indicated that in comparison to other divisions, the frequency of stunting among children and adolescent mothers was higher in the Sylhet region. It also revealed that children whose mothers were stunted had a 2.36 times increased chance of being stunted. Our study suggests that education for women could help them attain self-sufficiency and, as a result, reduce the prevalence of poor childhood nutrition, especially stunting.

Relationship between High Risk of Undernutrition and Increased Risk of Physical and Psychosocial Health Problems among Older Adults Living Alone through Study of Luncheon

Relationship between High Risk of Undernutrition and Increased Risk of Physical and Psychosocial Health Problems among Older Adults Living Alone through Study of Luncheon

Short Nutritional Assessment Questionnaire as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy: A retrospective study.

The purpose of this retrospective study was to verify whether the revised Short Nutritional Assessment Questionnaire© (SNAQ), a simplified nutritional assessment, could be comparable with serum albumin (ALB) levels as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. Of 111 patients, 79 patients with baseline ALB levels ≥3.5g/dL were included in the analysis. Patients completed the revised SNAQ, which evaluated items including appetite loss, weight loss, nutritional supplement usage, age, and body mass index, using a maximum of 12 points (a score of ≥3 was marked as severe undernutrition). ALB levels were then monitored for 1 year using patient medical records. There was a significant difference in event-free survival (EFS) when the SNAQ scores were classified into two groups [i.e., scores of ≤3 (SNAQ3) or scores of ≥4 (SNAQ4)]. The 150-day EFS rate was 86.8% and 57.6% for SNAQ3 and SNAQ4, respectively (hazard ratio: 2.92; 95% confidence interval: 1.31-6.51; p=0.009). Based on the Cox proportional-hazards analysis, a higher risk of undernutrition was associated with SNAQ4 (compared with SNAQ3), C-reactive protein levels, and serum transthyretin levels. The revised SNAQ is a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. In particular, it is important that patients with a SNAQ score of ≥4 receive dietary guidance at an early stage as they are likely to become undernourished within a year.

Determinants of Undernutrition among Adult Tuberculosis Patients Receiving Treatment in Public Health Institutions in Shashemane Town, Southern Ethiopia.

Background Undernutrition and tuberculosis are the major concerns of underdeveloped regions of the world. Tuberculosis makes undernutrition worse and undernutrition weakens immunity, thereby increasing the likelihood that latent tuberculosis will develop into active disease. Nevertheless, little has been understood about undernutrition among patients with infectious disease like tuberculosis in Ethiopia. This study was conducted to determine the magnitude of undernutrition and its determinants among tuberculosis patients in Shashemane public health institutions, Southern Ethiopia. Methods An institution-based cross-sectional study was conducted in two public hospitals and ten health centers of Shashemane Town from March 12, to April 12, 2017, among 368 adult tuberculosis patients on treatment follow-up. Sociodemographic and socioeconomic characteristics and anthropometric data were collected. Data were entered into EpiData version 3.3 computer software and analyzed using SPSS version 20. Bivariable logistic regression analyses were done to assess the association between outcome variable at bivariate analysis, and multivariable logistic regression model was used to assess factors that were independently associated with undernutrition. Odds ratios along with 95% confidence interval (CI) were estimated to measure the strength of the association, and level of statistical significance was declared at P value ≤0.05. Result The overall magnitude of undernutrition among adult tuberculosis patients in this study was 28.8% (95% CI = 0.25–0.34). Patients in the age group of forty-five and above ((AOR = 3.39, 95% CI = (1.6–7.18)), residents in rural area ((AOR = 1.95, 95% CI = (1.07–3.54)), those with problem with eating ((AOR = 2.361, 95% CI = (1.332–4.185)), and those who are not on food supplementation ((AOR = 2.21, 95% CI = (1.06–4.58)) were significantly at higher risk of undernutrition. Conclusion The magnitude of undernutrition in the study setting was found to be significantly higher. Age greater than forty-five, living in rural area, and lack of nutritional care and support were identified as the factors associated with undernutrition. Thus, relevant actors should give attention to fast nutritional intervention together with standard therapeutic regimen in the management of pulmonary tuberculosis patients to curb their nutritional derangement.

An intersectional analysis of the composite index of anthropometric failures in India

BackgroundNutritional inequality in India has been estimated typically using stunting, wasting and underweight separately which hide the overall magnitude and severity of undernutrition. We used the Composite Index of Anthropometric Failure (CIAF) that combines all three forms of anthropometric failures to assess the severity of undernutrition and identify the most vulnerable social groups and geographical hotspots.MethodCIAF was constructed using child anthropometric data from the fourth round of the National Family Health Survey (NFHS-4, 2015–16). We considered 24 intersecting sub-groups based on intersections across four main axes of inequality i.e., caste [Scheduled Tribe (ST), Scheduled Caste (SC) and Other], economic position (poor and non-poor), place of residence (rural and urban) and gender (male and female) (eg. ST-Poor-Rural-Female). Cross-tabulation and logistic regression were done to assess the odds of CIAF among intersecting groups and to identify the most vulnerable sub-groups. Concentration curve was plotted to visualise economic position inequality in child undernutrition across caste categories. Choropleth maps were constructed and descriptive analysis of the district-level prevalence of CIAF was performed to identify the geographic clustering of undernutrition.ResultsOverall 55.32% of children were undernourished by CIAF and 6.62% of children have simultaneous three anthropometric failure. In sub-group analysis, children from ST and SC caste have a higher risk of undernutrition irrespective of other axis of inequality. Compared with CIAF, economic position inequality was amplified for simultaneous-three-failures among all caste categories. Economic position inequalities within caste are more for other caste and SC categories than with ST. Economic position, caste and gender based inequality in all three failures is more consistent in rural areas than with urban areas. Based on the analysis of the high prevalence in the co-occurrence of two or three failures, 111 districts from 12 of 29 states in India were identified across four geographic clusters.ConclusionsThe study shows social and eco-geographical clustering of multi-dimensional anthropometric failures and indicates the need for focused nutritional interventions among SC and ST community in general and ST children from the poor households. Furthermore, governance interventions that target entire regions across districts and states combined with decentralised planning are needed.

457 NUTRITION, SARCOPENIA AND FRAILTY

Abstract Many older people admitted to hospital are malnourished/at risk of malnourishment (30%), have swallowing problems (55%), are frail (25%), have sarcopenia (50%) or a combination of these. On admission to hospital frail older people are at significant risk of worsening nutritional status and prolonged hospital stay. Nutritional status should be identified, documented, food intake monitored and where appropriate they should be referred to the dietitian. The question remains, do staff recognise that frail older people may not eat their food increasing their risk of poor nutrition and outcome. Methods Older people admitted to a ‘Frailty’ Ward were directly observed during lunchtime by WD. The Minimal Eating Observation Form –Version II (MEOF-II) was used to document how much they ate. Frailty status (CFS), presence of Sarcopenia (Sarc-F) and whether a referral to dietetics or speech and language therapy (SLT) was completed. Results 39 patients were observed. Mean age was 82.38 years; median CFS 6 (3–8); median Sarc-F 4(0–9). Median MEOF II was 0 (0–5). Two patients were referred to dietetics and 4 to SLT. 7/40 (17,5%) were at high risk for undernutrition, a further 8/40(20%) were at moderate risk. 82% were severely frail, the remaining were mildly frail. 94% (16/17) exhibited sarcopenia. There was significant correlation between MEOF II and CFS (r = 0.4887, p = 0.00162); MEOFII and Sarc-F (r = 0.4395, p = 0.00512). There was correlation between CFS and Sarc-F (r = 0.80296, p &amp;lt; 0.00001). Only one (6%) was referred to the dietitian. Conclusion Frail older adults are often undernourished on admission to hospital. Nutritional intake is often poor with acute illness. Screening, observation and monitoring of nutritional intake should highlight concerns and needs for intervention. These study high lights that a significant number of older people are frail, fail to complete meals, are at significant risk of under nutrition, yet proactive intervention does not occur.

Magnitude and Associated Factors of Undernutrition Among Children Aged 6-59 Months in Ethiopian Orphanage Centres.

BackgroundChildren without parental care are at high risk for under-nutrition. Ethiopia counts as one of the largest populations of orphans in the world. However, there is no information about the nutritional status of children in Ethiopian orphanage centers. Thus, we aimed to assess magnitude and associated factors of undernutrition among children aged 6–59 months in Ethiopian orphanage centres.MethodsInstitution-based descriptive and analytical cross-sectional study was conducted on 227 children aged 6–59 months in selected orphanage centers of Addis Ababa, Ethiopia from July to August 2019. A simple random sampling technique was used to select the study participants. Interviewer administered structured pretested questionnaire, document review and anthropometric measurements were used to collect the data. Epi info version 7.2.1.0 and SPSS version 23.0 were used for data entry and analysis respectively. Anthropometric indices were generated using the WHO Anthro software version 3.2.2. A cut-off point below -2 standard deviation used to determine under-nutrition (stunting, underweight, and wasting). All variables with p-value < 0.25 in the bivariable analysis were considered for further multivariable binary logistic regression analysis. The level of statistical significance was declared at a p-value <0.05.ResultsThe prevalence of wasting, underweight, and stunting were 4.4%, 12.3%, and 34.8%, respectively. Being a double orphaned child [AOR= 2.9 (1.201, 7.167)] and lack of vitamin A supplement in the last six months (AOR=1.9 (1.049, 3.799) were significant predictors of stunting and illness in the last two weeks before the survey [AOR= 4.9 (1.345, 1.865)] was a significant predictor of wasting.ConclusionThe prevalence of stunting was high when compared with WHO’s classification. Being a double orphaned, lack of vitamin A supplement, and illness in the last two weeks were associated with undernutrition. Therefore, intensified efforts to increase rates of vitamin A supplementation and as well as other disease prevention measures should be strengthened by the orphanage administrators and the health authorities.

Treatment of high blood pressure in diabetic patients and risk of undernutrition in a population in extreme Western Algeria

Introduction: Assessing the risk of undernutrition in hypertensive diabetics is essential. It makes it possible to detect undernutrition for better care. The objective of our study is to describe the factors influencing this undernutrition.&#x0D; Methods: A descriptive study was conducted on a sample of 366 diabetics with hypertension and 326 with normo-glycemic hypertension aged 50 years and over. Patients were enrolled at the University Hospital in Tlemcen from January to June 2018. The data collection was carried out using a questionnaire: The MNA (The Mini Nutritional Assessment).&#x0D; Results: The study made it possible to establish the profile of subjects at high risk of undernutrition. In our sample, age was not correlated with risk of malnutrition in diabetic hypertensives and normo-glycemic hypertensives respectively (p = 0.304 and p = 0.444). The linear regression model uses gender as an age-independent factor that affects the risk of undernutrition (p = 0.001). BMI was one of the most relevant variables for predicting the occurrence of undernutrition (p = 0.000). Thus, diabetic hypertensive patients in our study who were treated with an Angiotensin II receptor blockers , an angiotensin converting enzyme inhibition or an ARB/diuretic combination were more at risk of undernutrition (p = 0.009, p = 0.026 and p = 0.013).&#x0D; Conclusion: Particular attention should be paid to diabetic hypertensive subject. The treatment of hypertension in diabetics aggravates this malnutrition. Thus, a nutritional status assessment should be established in any diabetic hypertensive patient allowing appropriate therapeutic management to avoid all complications associated with undernutrition.

LINC-08. INCREASED TREATMENT TOXICITIES AND INFERIOR OUTCOMES IN UNDERNOURISHED CHILDREN WITH BRAIN TUMOURS

BACKGROUNDChildren on treatment for brain tumours are known to be at high risk of undernutrition, the impact on outcome and toxicity is not well understood.METHODSRetrospective audit of children(<18 years)diagnosed January 2017-December 2018 with embryonal brain tumours (medulloblastoma, primitive neuro-ectodermal tumors, pinealoblastoma, atypical teratoid/rhabdoid tumour) and treated at our centre. Data was retrieved from case records and electronic medical records. Nutritional status(NS) was defined as per World Health Organization (WHO) into severe malnutrition (SAM),moderate malnutrition (MAM),well nourished (WN) and overweight. Undernutrition(UN) was defined as SAM/MAM.Toxicity was documented till end of treatment,defined as treatment delay>1week,significant infection or toxic death.RESULTSOf 124 eligible patients who received entire chemotherapy at our centre, NS data was available in 73 at diagnosis and 58 at follow-up. At diagnosis-29,16,26 and 2 and at follow-up-20,16,22 and 0 were SAM,MAM,WN and overweight. During treatment, weight gain was documented in 26%, stable weight in 55% and weight loss in 19%. Those UN at diagnosis had worse outcomes at follow-up with 70% alive in remission compared to 88% of WN(p-0.14). There was increased toxicity in UN group(50%) compared to WN(24%),p-0.04.All 3 toxic deaths were in UN. Those who lost weight during treatment had higher toxicities(70%) compared to those with stable weight (30%)or weight gain(20%),p-0.02.CONCLUSIONSIn spite of nutritional intervention, children on treatment for brain tumours tend to lose weight. Increased treatment toxicities and inferior outcomes in undernourished children with brain tumours necessitates proactive and aggressive nutritional monitoring and intervention.