Inadequate Caloric Intake Research Articles

Integrated Approach of The Health Team in The Management of Malnutrition Marasmus in Children

Objective: To analyze, through the scientific literature, the importance of the integrated approach of the health team in the management of childhood marasmus malnutrition. Theoretical framework: Childhood marasmus malnutrition is a severe medical condition that mainly affects children under five years of age, and is characterized by an extreme lack of calories and essential nutrients, resulting in a state of severe emaciation where the child's body consumes its own tissues in an attempt to survive. Method: A descriptive integrative review with a qualitative approach, in which a search was carried out in Sicelo, PubMed, LILACS and the Cochrane Library. The descriptors "Malnutrition", "Protein-Calorie Malnutrition", "Patient Care Team" and "Child Health" were used in combination with the Boolean operator AND. Initially, 9,887 studies were found, but this was reduced to 119 studies, of which 12 were selected. Results and Discussion: The management of childhood marasmus malnutrition was shown to be crucial to ensuring the recovery and healthy development of affected children. Marasmus is a severe form of energy-protein malnutrition, characterized by extreme weight loss and loss of fat and muscle tissue, caused mainly by inadequate calorie and protein intake. Research Implications: The implementation of solid policies, education, continuous support for families and the commitment of health professionals are fundamental pillars for reversing malnutrition and corroborating healthy child development. Originality/value: The study incorporates pertinent theories, corroborating the literature through contributions to clinical practice in the face of childhood stunting.

Assessment of risk factors associated with anemia among pregnant women attending the obstetrics and gynecology department in a tertiary care hospital, Prakasam District, Andhra Pradesh, India

Background: Anemia in pregnancy is a pervasive health issue, particularly in developing countries. Aims and Objectives: This study aims to assess various socio-demographic factors, nutritional intake, and other risk factors contributing to anemia among pregnant women attending a tertiary care hospital in Prakasam District, Andhra Pradesh, India. Materials and Methods: A cross-sectional study was conducted involving 160 pregnant women. Data were collected on socio-demographic factors (family type, religion, caste, residence, education, socio-economic status, age, occupation), anemia prevalence, antenatal care, birth spacing, nutritional intake (caloric, protein, and iron), and gravida status. Chi-square tests were used for statistical analysis to determine associations between anemia and various risk factors. Results: The study revealed a high prevalence of moderate anemia (74.4%) among the participants. Most women were from nuclear families (75%), lived in rural areas (89.4%), and were predominantly homemakers (83.1%) in the age group of 21–30 years. Nutritional analysis showed 74.6% of women had a calorie intake below 2000 K. Cal/day, 64.7% had a protein intake below 50 g/day, and 87.5% had an iron intake below 20 mg/day. A significant association was found between anemia and factors such as caloric intake (χ²=10.6654, P=0.001092), gravidity (χ²=7.0278, P=0.008025), and iron intake (χ²=27.277, P<0.00001), but not with protein intake (χ²=3.7547, P=0.052658). Conclusion: The study highlights a high prevalence of anemia among pregnant women in the Prakasam District, primarily associated with inadequate caloric and iron intake and increased gravidity. These findings emphasize the need for enhanced nutritional counseling and healthcare interventions focusing on diet and family planning for pregnant women in this region.

A Brief History of Child Nutrition Situation and Programme Interventions in Bangladesh

Since the independence in 1971, Bangladesh has madesteady progress in improving nutrition status of childrenin the country. As per the first nutrition survey afterindependence, “Nutrition Survey of Rural Bangladesh1975-76” carried out by the Institute of Nutrition and FoodScience (INFS), Dhaka University, revealed that 31% of12-23 months children and 28% of 24-35 months oldchildren were acutely malnourished; and 74% of children0-59 months old were stunted (moderate and severe). Nineout of ten families (i.e., 89%) were deficient in vitaminintake. The first nutrition survey in East Pakistan which is nowBangladesh, was conducted in 1962-64 but did not providemuch child-related data but found that over two-thirds ofthe daily diet consisted of rice, which was supplementedby curries, primarily of vegetables or fish, and Lentil.Milk and meat are consumed in small amounts, and fruitintake was only seasonal. Intake of cooking fats and oilswas scanty. The survey revealed that 46% of householdshad inadequate calorie intake. Carbohydrates constitutedabout 83% of the total calorie intake. Moreover, 85% ofthe people did not meet their recommended level of dailyprotein intake where almost 70% of protein was fromcereal proteins (plant sources) and only 14% was fromanimal sources. Eighty-four percent of all householdsconsumed less than the acceptable intake value of VitaminA (3,060 IU per person per day) and 40% of the populationhad deficient or low plasma concentration of Vitamin Aand carotene. As a result, night blindness was commonamong children and about 30,000 children became blindeach year. Also, about 25 percent of deaths under five wereattributable to Vitamin A deficiency.

The Incidence, Prevalence and Clinical Characteristics of Failure to Thrive in Children at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia.

Introduction Failure to thrive (FTT) in children involves insufficient weight or height gain, affecting general and hospitalized populations which leads to cognitive and behavioral changes. Causes include inadequate caloric intake and underlying diseases (organic - OFTT) or psychosocial factors (non-organic - NOFTT). Our study in King Abdullah Specialized ChildrenHospital (KASCH) aims to assess FTT incidence, prevalence, and clinical characteristics, and also, to distinguish between different causes. Methodology It is a retrospective cohort study, conducted at KASCH, Riyadh, Saudi Arabia. This study includes children under three years old with documented FTT from 2017 to 2019. Data was collected from the hospital's electronic system and it was analyzed by the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 29.0, Armonk, NY). Results Our study, including 214 FTT patients, revealed a balanced gender distribution of 109 males (50.9%), and 105females (49.1%), with a majority of Saudi nationality 208 (97.2%). In most cases, 120 (56.1%) are in the 0-12 months age group. The prevalence of FTTwas 26.75% (267 cases per 1000). Antenatal/post-natal features showed diverse delivery modes and NICU admissions. Chronic diseases like gastrointestinal diseases62 (29.1%), cardiac 50 (23.4%), and pulmonary 50 (23.4%) conditions were prevalent. Associations were found between NICU admission and pre-term births, birth weight status, and congenital anomalies, highlighting significant clinical correlations. Conclusion Our study concluded the significant burden of FTTat KASCH. Chronic diseases were playing a major role as a cause of FTT. Thus, emphasizing the causes and knowing the importance of addressing the prevalence and incidence iseffective for appropriate intervention.

Nutritional status of children with cerebral palsy in a selected tertiary care hospital

Background: Nutritional status in children with chronic disease like cerebral palsy is crucial in growth and development. This study was conducted with the aim of assessing nutritional status of children with CP by using anthropometric indices and few associated factors. Methods: This cross-sectional study was conducted in ICMH, Dhaka from July 2020 to June 2021. A total of 30 children underwent proper history taking and thorough anthropometric examinations. Twenty-four hours dietary recall method was used for estimating approximate calorie intake. Results: Out of 30 children two thirds age was under 60 months and mean±SD age was 59.2±33.1 months. 60.0% children were male and majority (86.7%) of children were found calorie intake ≤50 percent of adequate calorie intake. Most (83.3%) of studied children presented with spastic quadriplegia, in according to age, 2 group were created (<60 months & ≥60 months). In children under 5 years age, 75.0% were severely wasted, 35.0% were severely stunted, 85.0% were severely underweight and 75.0% were severely malnourished. In ≥5 years, 60.0% were severely stunted and 90.0% were underweight or thin. Wasting and\underweight had significant association with swallowing difficulty and inadequate calorie intake in under 5 years age group and stunting had significant association with those factors in ≥5 years age group. Conclusions: This study shows that undernutrition affects a large number of children with CP in a selected tertiary care hospital. Risk of severe undernutrition increases with swallowing difficulty.

Pediatric growth faltering: Evaluation and management in primary care.

Pediatric growth faltering (GF), previously known as failure to thrive and now also called pediatric malnutrition and weight faltering, is a common clinical finding in primary care. Most pediatric GF cases are caused by inadequate caloric intake, not organic disease states. Evaluation requires clinicians to obtain detailed nutritional, medical, psychosocial, and family histories; take accurate anthropometric measurements; and perform a careful physical examination. Evaluation findings should be analyzed to determine whether targeted diagnostic workup, specialty referral, or a trial of nutritional counseling is indicated. Management includes caregiver education about childhood nutrition and frequent monitoring of growth parameters. A multidisciplinary approach that includes nutritionist, developmental therapist, and other specialty team member involvement is desirable.

Refeeding Hypophosphatemia in Oldest Old Critically Ill Patients.

Refeeding syndrome is characterized by metabolic and electrolyte alterations that result from the initiation of feeding after a period of inadequate caloric intake. Especially, in the elderly with acute and/or chronic illness, nutritional deficiencies are common, and diminished oral intake with effects of catabolic status yields malnutrition. This study was conducted to evaluate refeeding hypophosphatemia and its consequences on outcomes in the oldest old critically ill patients. This study was designed as a retrospective cohort study that included patients who were 80 years old or older admitted to ICU. Patients were grouped depending on whether hypophosphatemia occurred after 48 hours of admission who started feeding. The median age of all patients was 87[82-90] years and 61(73%) of them were female. Refeeding hypophosphatemia was observed in 25(30%) patients. When patients were grouped depending on the occurrence of hypophosphatemia, groups were similar according to the severity scores, and comorbidities. Neither ICU mortality nor hospital mortality was different between groups (p=0.76 and p=0.19, respectively). Refeeding hypophosphatemia incidence was similar to previous studies, although study patients were the highest risk group. Outcome parameters including mortality rate and length of ICU stay were not different between patients with or without refeeding hypophosphatemia.

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey.

Malnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies. In this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined. Of the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024). Timely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.

Can We Rely on Resting Metabolic Rate Equations? Large Variance in Crohn Disease Pediatric Patients.

Inadequate caloric intake is common in Crohn disease (CD) and nutrition support plays an important role in remission induction and in meeting nutritional needs. For nutritional planning, determining resting metabolic rate (RMR) is essential in pediatric patients with CD. To measure RMR in CD pediatric patients using indirect calorimetry, and compare it with estimated RMR (eRMR) calculated by Schofield equation. Children with CD treated in a tertiary pediatric inflammatory bowel disease center in Israel participated in the cross-sectional study. At study visits, weight, height, clinical and laboratory assessments, bioelectrical impedance, and RMR measured by indirect calorimetry were done. Additionally, disease severity was determined by the Pediatric Crohn Disease Activity Index and eRMR was calculated using the Schofield equation. The ratio of the measured RMR to eRMR was performed in addition to the Spearman correlation test. The study group included 73 children (49 boys) with mean age of 13.9 ± 2.3 years. Children with moderate or severe disease had lower weight for age z score, lower BMI- z , and lower RMR compared to children with mild disease. However, when RMR was adjusted for fat free mass (n = 50), the association between RMR and disease severity disappeared. Variance in RMR was high between subjects. Our data suggest that the Schofield equation is inadequate for determining RMR in pediatric CD and that RMR should be measured to guarantee the most appropriate nutritional intervention.

Osteopathic Management of Pediatric Feeding Disorder, Oral Aversion, and Growth Faltering: A Case Report

Abstract Growth faltering is a complex problem in the pediatric population and can result from multiple mechanisms, including inadequate caloric intake. Feeding difficulties are common among children with growth faltering and can present significant challenges for achieving adequate nutrition and weight gain, particularly when coupled with any degree of oral aversion. The patient in this case is a 21-month-old child with oral aversion, pediatric feeding disorder (PFD), and growth faltering who had failed to gain weight while receiving the standard of care. Upon transitioning his care to an osteopathic pediatrician, who incorporated osteopathic manipulative treatment (OMT) into his care, he demonstrated weight gain, which was sustained over the 8 months of this study. This case report demonstrates the potential benefit of OMT for children with PFD, oral aversion, and growth faltering.

Contemporary association of preoperative malnutrition and outcomes of hiatal hernia repairs in the United States

BackgroundHypoalbuminemia has been used as a surrogate for malnutrition and is associated with worse postoperative outcomes across major operations. Because patients with hiatal hernia often have inadequate caloric intake, we examined the association of serum albumin levels with outcomes after hiatal hernia repair. MethodsAdults undergoing elective and non-elective hiatal hernia repair via any approach were tabulated from the 2012 to 2019 National Surgical Quality Improvement Program. Patients were stratified into the Hypoalbuminemia cohort if serum albumin <3.5 mg/dL using restricted cubic spline analysis. Major adverse events were defined as a composite of all-cause mortality and major complications per the American College of Surgeons National Surgical Quality Improvement Program risk calculator. Entropy balancing was used to adjust for intergroup differences. Multivariable regression models were then constructed to assess the association of preoperative albumin with major adverse events, postoperative length of stay, and 30-day readmission. ResultsOf 23,103 patients, 11.7% comprised the Hypoalbuminemia cohort. The Hypoalbuminemia group was older, less commonly of White race, and less likely to have an independent functional status than others. They were also more likely to undergo inpatient, non-elective surgery via laparotomy. After entropy balancing and adjustment, hypoalbuminemia remained associated with increased odds of major adverse events and multiple complications and longer adjusted postoperative length of stay. There was no significant difference in adjusted odds of readmission. ConclusionWe used a quantitative methodology to establish a serum albumin threshold of 3.5 mg/dL associated with increased adjusted odds of major adverse events, increased postoperative length of stay, and postoperative complications after hiatal hernia repair. These results may guide preoperative nutrition supplementation.

Up-regulation of the kidney renin angiotensin system contributes to long-term renal dysfunction in severe food restricted-refed female rats

Background: Severe food restriction (sFR) due to various psychological, environmental, and economical reasons can have adverse consequences to cardiovascular functioning and health. Less understood are the long-term risks for developing cardiovascular disease after the sFR period has ended. The renin-angiotensin system (RAS) is responsible for regulating blood pressure and we have found that the RAS is chronically upregulated months after the sFR is over and body weight (BW) recovered due to refeeding (sFR-Refed). AIM: Determine the role of the kidney in the chronic up-regulation of the RAS in sFR-Refed rats. Methods: We investigated the long-term consequences of sFR after refeeding on kidney structure and function in sFR-Refed rats. Female Fischer rats (3-months-old) were maintained on normal chow (Ctrl) ad libitum or a 60% caloric restricted diet for 2 weeks. Thereafter, all rats received regular chow ad libitum for 3 months. Kidney function was analyzed by precision ultrasound. ACE expression (qPCR) and activity (fluorescent assay) were measured and renal pathology was assessed by H&amp;E staining. Results: After 2 weeks of sFR, rats lost 15% of their initial BW [DFinal/Initial): Ctrl, 1.50±0.80 vs sFR, -15.4±1.1; p&lt;0.001; n=8]. After 3 months of refeeding, there was no detectable difference in BW, blood pressure and heart rate between Ctrl and sFR-Refed groups. However, the renal artery blood flow was reduced by 13% [(mm/s): Ctrl, 255 ± 12 vs sFR-Refed, 199 ± 7.8; p&lt;0.02; n=4-8 Glomeruli size was reduced [(mm): Ctrl, 399 ± 6.2 vs sFR-Refed, 383 ± 3.8; p&lt;0.05; n=9] and renal AT1R mRNA expression was increased by 1.3-fold [(fold of Ctrl): Ctrl, 1.00 ± 0.060 vs sFR-Refed, 1.29 ± 0.040; p&lt;0.005; n=8]. Conclusion: In summary, AT1Rs in the renal cortex are up-regulated under conditions in which kidney structure and function are impaired months after the sFR period has ended and BW is restored to normal levels. These findings suggest increased renal AT1R activity contributes to the long-term renal dysfunction observed in sFR-Refed rats. Further research is needed to understand how women who are subjected either voluntarily (e.g., crash diets) or involuntarily (e.g., very low food security) to periods of inadequate caloric intake could be at increased risk for developing renal disease later in life. AHA: 940246 (AS); IH 1R01HL119380 (KS) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care

ObjectivesThis study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. MethodsIn this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). ResultsA total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01–3.47; malnourished: OR = 1.06; 95% CI, 1.01–1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04–2.47), higher educational level (OR = 1.39; 95% CI, 1.13–2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02–2.81) were also associated with the outcome. ConclusionsUsing the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Cognitive performance of 4-6-year-old children: a longitudinal study

Background Many children in low and middle-income countries (LMIC) have reduced cognitive abilities, but few studies have explored the influencing factors.&#x0D; Objective To determine the determinants of children's low cognitive development at 4 to 6-year-old.&#x0D; Methods This is a retrospective cohort study in year 2021. The data was obtained from Bogor Longitudinal Study of Child Growth and Development (BLSCGD) that started from year 2012. For this analysis, we considered 165 of children aged 4-6 years. The dependent variable in this analysis was cognitive development as measured by the Indonesian Wechsler Preschool and Primary Scale of Intelligence (WPPSI) with the indicators of full-scale IQ (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ). The independent variables were determinants of children’s cognitive development at 4-6 years, consisted of socio-demographic factors, determinants from early life (0-23 months), as well as determinants from current conditions. Multivariate analysis done with the logistic regression test.&#x0D; Results Bivariate analysis revealed that paternal education level was significantly associated with FSIQ and inadequate calorie intake in infancy and poor child stimulation were significantly associated with VIQ. In the final model of multivariate analysis, low paternal education level retained a significant association with FSIQ. Psychosocial stimulation was significantly associated with VIQ and inadequate calorie intake during infancy was significantly associated with PIQ.&#x0D; Conclusion Low paternal education level and inadequate psychosocial stimulation are risk factors for reduced child cognitive development in 4-6-year-olds. Inadequate calorie intake in infancy even though not statistically significant it has high OR values for low VIQ and PIQ, thus the results showed the importance of calory intake in infancy.

Effects of High-protein, Leucine-enriched Oral Nutritional Supplement and Resistance Exercise on Physical Performance among Malnourished Older Adults with Sarcopenia

Background: Malnutrition combined with sarcopenia among older adults has resulted in poor outcomes, diminished quality of life (QoL), and increased mortality rates. Inadequate calorie and protein intake are factors contributing to sarcopenia. Specific nutritional interventions and exercise regimens may improve muscle strength and health outcomes. Aim: To determine the effects of a high-protein, leucine-enriched oral nutritional supplement (ONS) and resistance training (RT) on physical performance, muscle strength, QoL, and other outcomes among adults with sarcopenia. Methods: This was a single arm, open-label, 12-week prospective, multicenter study that involved outpatient malnourished older adults with sarcopenia from four hospitals in Thailand. During the 12-week period, subjects were given two servings of high-protein, leucine-enriched ONS per day with RT four times/week. Accordingly, short physical performance battery (SPPB), hand grip strength, muscle mass by dual-energy x-ray absorptiometry (DXA), QoL, frailty, and functional status of all subjects were assessed. Results: A total of 47 participants were enrolled in this study. After 12 weeks, 5-time chair stand results decreased from 11.59 ± 3.31 to 8.97 ± 1.85 seconds (pConclusions: High-protein, leucine-enriched ONS and RT have benefits for malnourished sarcopenic older adults through improvements in physical performance, muscle strength, muscle mass, recovery rates from malnutrition, frailty, and QoL.

The Effects of Protein Intake on Clinical Outcome in Pediatric Intensive Care Units.

Factors such as increased metabolic needs and inadequate calorie and protein intake increase the risk of malnutrition in critically ill children admitted to the pediatric intensive care unit. This study aimed to determine the risk of malnutrition and associated clinical outcomes. Data from all patients aged 1 month to 18 years in 4 pediatric intensive care units in Adana, Turkey, were prospectively collected. Patient anthropometric data, the duration of mechanical ventilation, the length of stay in pediatric intensive care unit, 60-day mortality, nutritional status, and calorie and protein intake were recorded. A total of 111 patients were included in the study. There was a significant difference between survivor and non-survivor patients in terms of calorie and protein intake 48 hours after admission and protein intake on the seventh day after admission (P = .001, P = .000, and P = .003, respectively). No significant correlation was found between the length of pediatric intensive care unit stay, sepsis, and calorie intake in the first week. It was found that 1 g/kg/ day increase in protein intake on the seventh day of intensive care hospitalization decreased the risk of mechanical ventilation by 0.49 times (P = .035; sensitivity: 83.3%; specificity: 34.5%). Nutritional status should be evaluated fully in patients admitted to the pediatric intensive care unit and early detected malnutrition should be monitored closely to determine the need for early intervention. The risk of developing malnutrition is high in critically ill children. Providing the necessary energy and protein intake with nutritional therapy affects the clinical course in children with critical illness. Protein intake causes prolongation of mechanical ventilation time, delaying clinical recovery.

623: ASSESSING CLINICAL VARIABLES ASSOCIATED WITH FEMORAL MUSCLE DECAY IN CRITICALLY ILL CHILDREN

Introduction: Skeletal muscle wasting is a well-described entity of critical illness and has been found to be associated with prolonged ICU and hospital stays and acquired morbidities. Recent studies have shown ultrasound measurements of the quadriceps femoris muscle are a reliable method to track muscle decay in the pediatric population. Our study aims to identify significant clinical variables that are associated with muscle decay in critically ill mechanically ventilated children. Methods: A prospective, single center analysis was performed on sixty-seven sedated and mechanically ventilated patients admitted to the pediatric ICU between February 2021-March 2022. Point of care ultrasound was used to measure the thickness of the quadriceps femoris muscle serially for up to the first 7 days of study enrollment. Average daily change in muscle thickness was calculated for each subject. Clinical variables measured included nutritional adequacy, fluid overload, sedative and paralytic use, steroid exposure, early mobilization, disease severity, mortality, and ICU and hospital length of stay (LOS). Results: Change in muscle thickness in our patient population was similar to prior studies with a mean daily change of -1.9% [IQR -0.8, -5.0]. Patients with adequate cumulative caloric intake, as defined by >60% of goal, were shown to have less muscle decay compared to those with inadequate caloric intake (-1.8% vs. -2.4%, p< 0.001). Average daily change in muscle thickness was found to correlate with both ICU and hospital LOS (r = 0.328, p = 0.007 and r = 0.393, p = 0.001). No correlation was found between daily change in muscle thickness and mortality, disease severity, and fluid balance. Similarly, early mobilization, sedative and paralytic use, and steroid exposure did not show significant associations with change in muscle thickness. Conclusions: We demonstrate quadriceps femoris muscle decay in critically ill children as measured by ultrasonography. Average daily muscle decay was associated with longer ICU and hospital length of stay. Children with adequate cumulative caloric intake were found to have less muscle decay than those with inadequate caloric intake.

Significant Loss of Skeletal Muscle Mass Occurs After High-Energy Trauma in Young Adults

ObjectivesSignificant loss of skeletal muscle mass occurs early after high-energy trauma, leading directly to prolonged functional limitations. As we investigate nutrition interventions to reduce loss of muscle mass, we need to quantify changes in muscle mass after these devastating injuries. The aim of this study was to characterize baseline nutrition and changes in muscle mass after high-energy trauma in a young adult population.MethodsWe enrolled patients 18–55 years old indicated for operative fixation of either, an open pelvic or extremity fracture, or ≥2 pelvic and/or extremity fractures due to a high-energy mechanism. Baseline assessment of body composition (Lean Body Mass [LBM], Skeletal Muscle Mass [SMM]), was measured within 72 hours of admission using bioelectrical impedance and repeated 6 weeks after injury. Results are reported as median (IQR). Changes in LBM and SMM were evaluated using Wilcoxon Signed Rank tests. Sarcopenia was defined by gender-specific cutoffs for appendicular skeletal mass index. Dietary intake was evaluated using food frequency questionnaires. Inadequate protein intake was classified using the Estimated Average Requirement cut-point method, while inadequate caloric intake was defined as intake below basal metabolic rate.ResultsSixteen subjects (14 male) age 38.4 ± 9.6 years were enrolled. At baseline, 3 reported inadequate protein intake and 5 reported inadequate caloric intake. Six weeks after injury participants experienced significant losses in LBM (−4.5kg (−8.8 to −1.4), P = 0.019) and SMM (−3.1kg (−5.6 to −0.3), P = 0.043). The injured extremity had significantly greater loss of LBM compared to the uninjured extremity (−4.0 (−17.1–3.5), P = 0.0495). Five were baseline sarcopenic, with one additional participant meeting the criteria by 6 weeks. Baseline protein and calorie deficiency was not significantly associated with muscle loss.ConclusionsThis study documented devastating loss of lean body mass and skeletal muscle mass after high-energy trauma in young adults. These losses are likely a combination of immobilization and catabolic response for wound and fracture healing. Understanding loss of muscle mass after injury is important to design impactful rehabilitative and nutrition interventions in this complicated patient population.Funding SourcesNone.

Effect of non-aspirated gastric residual content on preterm infants' health status

Background: Gastric residuals (GR) aspiration is considered standard practice for preterm infants in the neonatal intensive care unit (NICU). Unfortunately, there is little information about the dangers and advantages of this routine procedure. Various care procedures, such as the measurement of gastric residual volume (GRV), may contribute to the problem of inadequate calorie intake in preterm newborns. Aim: The current study aimed to evaluate the effect of non-gastric residual aspiration on preterm infant weight, necrotizing enterocolitis, and time to reach full enteral feeding. Methods: A quasi-experimental (control and intervention) design was used in the study. El-Manial University Hospital and Elmonira Pediatric Hospital NICUS cared for sixty preterm infants. Four different tools were used: (I) Neonatal personal information; (II) a gastric residual observational checklist; (III) the Fenton Growth Weight Chart; and (IV) Modified Bell's Staging Criteria for Necrotizing Enterocolitis. The results: The mean number of days required to achieve full enteral intake of 120 ml kg per day in the intervention group was 7.21 ± 0.66, whereas, in the control group, it was 9.72 ± 0.85, a difference that was slightly significant at the p-value &lt; 0.05.

Nutrition in old age-key to maintaining functionality and quality of life

Jenseits des 70. Lebensjahrs ist bei älteren Menschen regelhaft eine Abnahme der Muskelmasse sowie eine Zunahme der Fettmasse zu beobachten. Diese Veränderungen der Körperzusammensetzung stellen eine wesentliche Prädisposition für den im Alter drohenden Verlust an Funktionalität und Selbstständigkeit dar. In diesem Kontext kommt der richtigen Ernährung sowie insbesondere dem Vermeiden einer Mangelernährung große Relevanz zu. Da die ältere Bevölkerung hinsichtlich der Geschwindigkeit und Ausprägung der Alterungsvorgänge sowie ihrer Komorbiditäten als äußerst heterogen zu betrachten ist, müssen Ernährungsempfehlungen individualisiert erfolgen. In Hinblick auf eine potenzielle Gefährdung durch eine Sarkopenie ist selbst eine beabsichtigte Gewichtsabnahme im Alter kritisch zu sehen. Fastenepisoden sollten generell vermieden werden. Dies betrifft insbesondere eine unzureichende Kalorienzufuhr im Kontext von akuten oder chronischen Erkrankungen. Im höheren Lebensalter sollten daher regelmäßige Gewichtskontrollen erfolgen, um das Auftreten einer Mangelernährung frühzeitig zu erkennen und entsprechende Maßnahmen einleiten zu können. Zum Erhalt der Muskelmasse und -funktion sollte eine gegenüber jüngeren Menschen erhöhte Eiweißzufuhr von 1,0 g/kgKG angestrebt werden. Bei älteren Menschen mit Sarkopenie wird dieses Ziel auf 1,2 g/kg KG angehoben. Während sich im Alter restriktive Diäten als nachteilig erweisen können, scheinen gesunde Ernährungsformen wie z. B. die mediterrane Ernährung den Erhalt der muskulären und kognitiven Funktion zu fördern.