Inadequate Caloric Intake Research Articles

Stress Fractures (Care of the Young Athlete)

Patient Education| 2021 Stress Fractures (Care of the Young Athlete) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Stress Fractures (Care of the Young Athlete). Pediatric Patient Education 2021; 10.1542/peo_document272 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Care of the Young Athlete Stress fracture (also called a fatigue fracture) is a weakening or thin crack in a bone caused by repetitive stress on the bone. A stress fracture is an overuse injury. It is different from a fracture that occurs after a traumatic event, such as a fall. Stress fractures are more common in endurance athletes or athletes who perform repetitive, high-impact activities. With sufficient levels of stress to a bone, anyone can develop a stress fracture. However, there are additional risk factors related to the individual and to the training pattern that can further increase the risk of developing a stress fracture. Inadequate caloric intake; inadequate calcium intake.Low estrogen levels in females; menstrual dysfunction.Low body weight; rapid weight loss.Ethnicity. White athletes may be at greater risk.Biomechanical abnormalities. A high-arched foot is more rigid and transmits more stress to the... Copyright © 20102010American Academy of Pediatrics You do not currently have access to this content.

Prioritizing nutrition during recovery from critical illness.

Patients admitted to the intensive care unit (ICU) often experience a significant decline in nutritional status due to a combination of the physiologic response to critical illness and insufficient calorie intake. The majority of research related to nutrition interventions for this population focuses on nutrition support during the acute phase. Minimal attention is given to the nutritional status of ICU patients during the recovery phase. This review will describe calorie intake when ICU care ends, provide an overview of barriers that limit intake, and possible interventions to improve nutritional status. Current evidence suggests patients are consuming < 60% of calorie requirements after extubation and ICU discharge. This inadequate calorie intake may exacerbate weight loss and muscle and fat wasting. Physiologic, physical, and cognitive manifestations of critical illness can lead to multiple issues that cause poor intake. Possible interventions to improve calorie intake include a patient-centered approach that utilizes oral nutrition supplements and enteral nutrition. Consuming adequate caloric intake in the recovery phase of critical illness is essential for rehabilitation. A systematic, patient centered approach that includes close monitoring of calorie and protein and timely interventions may be the best method to improve overall intake.

Abstract 14928: The Factors Impacting on Resting Energy Expenditure in Refractory Heart Failure Patients and the Probability of Urine Amino Acids Analysis as an Indicator for Calorie Intake Insufficiency

Introduction: Cachexia is a critical issue in patients with refractory heart failure (HF). Although the elevation of resting energy expenditure (REE) can progress cachexia through relatively insufficient calorie intake, the detail of REE in HF patients remains uncertain and no useful marker for predicting insufficient calorie intake has been established. This study aimed to assess the REE of HF patients and to evaluate the detectability of serum and urine laboratory markers for insufficient calorie intake. Methods: We measured REE using indirect calorimetry in 69 HF patients (NYHA class II-IV) in our hospital. In 25 out of 69 patients, serum albumin, amino acids, and 24-hour urine amino acids were measured. The calorie intake insufficiency was determined based on measured REE multiplied by activity index Results: As compared to the predicted values by Harris-Benedict equation, 43 patients (63%) had an elevated REE and the mean REE was approximately 4% elevated. There was no significant correlation between the REE and parameters indicating HF severity, including cardiac index on right heart catheterization and BNP level. Only body mass index (BMI) negatively correlated with the REE (r=-0,66, p&lt;0.01). Of 25 patients, 16 (64%) had calorie intake insufficiency. The excreted amount of urine essential amino acids was lower and mostly under normal range, especially significantly decreased in Histidine and Phenylalanine levels in the patients with calorie intake insufficiency compared to those without calorie intake insufficiency, whereas serum levels of albumin and essential amino acids were kept within a normal range in the both. Conclusions: Our findings suggest that the patients with refractory HF, especially having low BMI, are likely to be under inadequate calorie intake due to elevated REE. The calorie intake insufficiency could not be identified with serum levels of albumin nor essential amino acids. Instead, urine essential amino acids would decrease first prior to plasma levels, indicating this measurement would be a useful marker to detect calorie intake insufficiency.

Esophageal cancer patients of heavier weight have more nutritional risk of inadequate calorie intake immediately after esophagectomy: a retrospective study.

Perioperative malnutrition is common in patients undergoing esophagectomy, and nutritional support is critical for postoperative recovery in these patients. But few studies reported which characteristics of these patients were associated with post-esophagectomy inadequate calorie intake. This study aimed to explore which patients were more likely to have inadequate calories immediately after esophagectomy and the impact on clinical outcomes. From January 2018 to June 2019, patients undergoing esophagectomy were retrospectively divided into the "adequate calorie group" and the "inadequate calorie group" according to whether they met daily calorie requirements in a week after esophagectomy. Caloric requirements met rate and clinical outcomes were compared between patients with and without complications, and with weight > 70kg or ≤ 70kg. Patients in the inadequate calorie group (n = 104) had significantly higher weight (p < 0.001), lean body mass (p = 0.028), and BMI (p = 0.001) than the adequate calorie group (n = 46). Weight loss after esophagectomy was reduced (p = 0.043) in the adequate calorie group. Patients with complications had lower rate of adequate calorie intake (72.8% vs. 63.8%). The caloric requirements met rate in patients with weigh ≤ 70kg was significantly higher than those weight > 70kg (80.2% vs. 43.2%, p < 0.001). The weights of patients having inadequate calories in a week after esophagectomy were significantly heavier than those having adequate calories. Heavier patients after esophagectomy should attract more attention to their nutrition support. This trial was registered ( ChiCTR1900025557 ).

Short-term very low caloric intake causes endothelial dysfunction and increased susceptibility to cardiac arrhythmias and pathology in male rats.

New Findings What is the central question of this study? What are the effects of a 2 week period of severe food restriction on vascular reactivity of resistance arteries and on cardiac structure and function? What is the main finding and its importance? This study showed, for the first time, that a 2 week period of severe food restriction in adult male Fischer rats caused endothelial dysfunction in mesenteric arteries and increased the susceptibility to ischaemia–reperfusion‐induced arrhythmias and cardiac pathology. Our findings might have ramifications for cardiovascular risk in people who experience periods of inadequate caloric intake. Severe food restriction (sFR) is a common dieting strategy for rapid weight loss. Male Fischer rats were maintained on a control (CT) or sFR (40% of CT food intake) diet for 14 days to mimic low‐calorie crash diets. The sFR diet reduced body weight by 16%. Haematocrits were elevated by 10% in the sFR rats, which was consistent with the reduced plasma volume. Mesenteric arteries from sFR rats had increased sensitivity to vasoconstrictors, including angiotensin II [maximum (%): CT, 1.30 ± 0.46 versus sFR, 11.5 ± 1.6; P < 0.0001; n = 7] and phenylephrine [maximum (%): CT, 78.5 ± 2.8 versus sFR, 94.5 ± 1.7; P < 0.001; n = 7] and reduced sensitivity to the vasodilator acetylcholine [EC50 (nm): CT, 49.2 ± 5.2 versus sFR, 71.6 ± 6.8; P < 0.05; n = 7]. Isolated hearts from sFR rats had a 1.7‐fold increase in the rate of cardiac arrhythmias in response to ischaemia–reperfusion and more cardiac pathology, including myofibrillar disarray with contractions and cardiomyocyte lysis, than hearts from CT rats. The sFR dietary regimen is similar to very low‐calorie commercial and self‐help weight‐loss programmes, which provide ∼800–1000 kcal day−1. Therefore, these findings in rats warrant the study of cardiovascular function in individuals who engage in extreme dieting or are subjected to bouts of very low caloric intake for other reasons, such as socioeconomic factors and natural disasters.

Home artificial nutrition in palliative care cancer patients: Impact on survival and performance status

The prevalence of malnutrition is over 70% in advanced cancer patients and impacts negatively on survival and quality of life. Artificial nutrition can be integrated into a home palliative care program. This observational study aims to describe the criteria for identifying the cancer patients that could benefit from home artificial nutrition (HAN) and to evaluate its impact on survival and performance status. The selection criteria for patient's eligibility to HAN were: Karnofsky Performance Status (KPS) ≥40, life expectancy ≥6 weeks, inadequate caloric intake±malnutrition, suitable psycho-physical conditions and informed consent. The access route for nutritional therapy (home parenteral nutrition, HPN; home enteral nutrition, HEN) was chosen according to the ESPEN Guidelines. The parameters considered were: primary site of the tumor; oral food intake; nutritional status; stage of cachexia; fluid, energy and protein supplied by HAN; survival. From 1990 to 2019, 43,474 cancer patients were assisted at home in Bologna (Italy). HAN started in 969 patients (2.2% of total patients, 571 men and 398 women, mean age 65.7±12.7 years): HPN in 629 patients (64.9%), with gastrointestinal obstruction as the main indication; HEN in 340 patients (35.1%), with dysphagia as the main indication. Considering the 890 deceased patients, the mean survival after the start of HAN was 18.3 weeks and 649 patients (72.9%) survived more than 6 weeks. The mean survival was higher in HEN (22.1 weeks) compared to HPN patients (16.1 weeks) (p<.001). After one month, KPS was unchanged in 649 (67.0%), increased in 232 (23.9%) and decreased in 88 patients (9.1%). The mean KPS increased in patients starting HAN in pre-cachexia and cachexia (p<.001). Cachexia and refractory cachexia at the entry were associated with a reduced survival [odds ratio: 1.5 and 2.3 respectively, p<.001 for both condition] respect to pre-cachexia. The selection criteria allow the identification of the patient who can take advantage of HAN. HAN can be effective in avoiding death from malnutrition in 73% of patients, and in maintaining or improving the KPS at one month in 90% of cases. The benefits provided by HAN on survival and performance status depend on the cachexia degree at the entry.

Risk factors for severe acute malnutrition among children aged 6-59 months: A community-based case-control study from Vellore, Southern India.

Background:Malnutrition plays an important role in the economic burden of society as well as the country. This study aimed to identify the various risk factors and determinants of severe acute malnutrition (SAM) as defined by WHO growth reference standards in children aged 6 months to 59 months living in Vellore.Methods:A community-based case-control study matched for age (±2months), gender and location was done among the children of the age group 6- 59 months residing in both rural and urban Vellore. Children of age group 6-59 months with SAM according to WHO definition, i.e., weight for height of less than -3SD with or without nutritional oedema were classified as cases. Children with weight-for-height z-score more than -1 SD and MUAC ≥13.5cms were classified as controls. With 2 controls per case, the required sample size was 54 cases and 108 controls. A questionnaire used to identify the risk factors including dietary intake. Uni-variate and multivariate analysis was done to generate an odds ratio and 95% confidence interval for the risk factors.Results:Majority of the cases 64.8% and 50% of the controls belonged to low SES. After adjusting all confounders, Severe Acute Malnutrition was significantly associated with birth weight <2.499kg [AOR- 8.95 (95% CI: 2.98-26.85)], not exclusively breastfed for 6 months [AOR 4.67 (95% CI: 1.72-12.65)], inadequate calorie intake [AOR 8.09 (95% CI: 3.15-20.82)] and mother being underweight [AOR 6.87 (95% CI: 1.92-24.55)].Conclusion:Programs should be implemented to reduce the poor nutritional status of young girls and women in the reproductive age group. The importance of exclusive breastfeeding for the first six months, the time of weaning and appropriate feeding practice for the child should be emphasized to postnatal mothers during their hospital visits.

Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study.

Background:Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals.Design:This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3 days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5 days to assess the ability to achieve 50% of caloric goals within the first 3 days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes).Result:A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5 ± 16.9 years with mean body mass index (BMI) of 27.9 ± 7.5 kg/m2. Most (92%) subjects were on a mechanical ventilator and experienced organ failure. At least 50% of caloric and protein goals were achieved in 78.9% and 73.7% of the subjects, respectively, during the first 3 days. Overall, 75.0 ± 26.3% and 69.3 ± 26.7% of calorie and protein goals were achieved using the study formula.Conclusions:Subjects fed enterally with a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula exceeded 50% of caloric and protein goals in most critically ill subjects included in this study. Use of study formula did not lead to severe gastrointestinal intolerance.

A descriptive study of double burden of malnutrition in mothers of children with severe acute malnutrition admitted in Children Hospital and Institute of Child Health, Multan.

To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers. The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined for clinical signs of iron deficiency anaemia. Of the 100 women, 20(20%) were malnourished, 42(42%) were of normal weight, and 38(38%) were either overweight, pre-obese or obese. The caloric intake of 26(26%) mothers was less than 1500 kcal per day, while 42(42%) were taking between 2000-2500 kcal per day and 32(32%) were taking >2500 kcal daily. Also, 67(67%) women were suffering from anaemia and 80(80%) women had some myths related with dietary restrictions during pregnancy, lactation and complimentary feeding of children. Overall, 23(23%) women breastfed their babies.

Developing an Appetite

Developing an Appetite

MON-373 Pseudohypoaldosteronism Type 1, a Masquerader: Case Study

Background: Pseudohypoaldosteronism (PHA) Type 1 usually present in the newborn period as failure to thrive, hyponatremia and hyperkalemia. The spectrum of manifestation however ranges from asymptomatic to severe. Initial presentation may be easily confused with more common disease process like poor feeding with inadequate calorie intake, dehydration, Congenital Adrenal Hyperplasia (CAH), adrenal insufficiency (AI), urinary tract abnormality and hypoaldosteronism. Patients with PHA Type 1 have supraphysiological aldosterone and renin levels appropriate for the electrolyte abnormality but ineffective due to an abnormality in mineralocorticoid receptor or epithelial sodium channel (ENaC). Clinical case: We present a Caucasian female who was admitted for failure to thrive. At 3 weeks of age, she was found to have lost 14.5% of birth weight. She was afebrile and there was no vomiting. She had hyperkalemia, hyponatremia, hypercalcemia, and mild transaminitis (Na 129mmol/L (134-142mmol/L), K 6.8mmol/L (4-6.2mmol/L), Cl 91mmol/L (96-110mmol/L), Ca 11.8mg/dl (9-10.9mg/dl), ALT 35unit/L (8-32 units/L) with increased urine output (6-6.5ml/kg/hr (4-5ml/kg/hr). Genital examination, newborn screen, ECG, renal US, thyroid function, 17-OH progesterone, and ACTH stimulation tests were normal. No family history of similar electrolyte abnormalities. Treatment with sodium containing IVF and kayexalate improved her electrolytes. Her diagnosis at discharge was inadequate calorie intake and dehydration. Increased calorie intake resulted in continuous weight gain and resolution of electrolyte abnormality at discharge (Na 137mmol/L, K 5.6mmol/L, Cl 97, Ca 10.8mg/dl). Despite improvement in weight gain and being asymptomatic, follow up outpatient monitoring of electrolyte levels showed persistent hyponatremia and hyperkalemia (Na 129 mmol/L, K 7.8mmol/L). No gastrointestinal symptoms or skin abnormalities. Given her electrolyte abnormalities, the differential diagnoses included SIADH, Adrenal Insufficiency and hypoaldosteronism. The diagnosis of PHA Type 1 was made based on increased aldosterone and renin levels (Aldosterone 1031ng/dl (5-90ng/dl), Renin 277pmol/L (2-37pmol/L). She was started on oral Nacl supplement and high dose fludrocortisone resulting in resolution of electrolyte abnormality. Genetic evaluation is underway. Conclusion: PHA Type 1 is a rare clinical entity that can masquerade as other more common causes of malnutrition and electrolyte abnormality. Delay in prompt diagnosis and treatment of PHA Type 1 can be associated with morbidity and mortality. Follow up monitoring of serum and urine electrolyte levels is important in children presenting with malnutrition and electrolyte abnormalities to enable early recognition and adequate treatment initiation.

96. Further Support For Diagnostically Meaningful Symptom Presentations of Avoidant/Restrictive Food Intake Disorder In An Adolescent Medicine Eating Disorders Partial Hospitalization Program

In contrast to “traditional” eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN), individuals with avoidant/restrictive food intake disorder (ARFID) exhibit eating pathology that is not driven by weight or shape concerns. ARFID can be diagnosed in individuals of any age whose pattern of inadequate caloric intake and/or dietary variety leads to acute weight loss or chronic growth failure, nutritional deficiency, supplement dependence, and/or significant psychosocial interference. Patients with ARFID made up 12.5-25% of patients presenting to adolescent medicine eating disorders settings across several retrospective chart reviews. Three patterns of restrictive eating that can lead to ARFID are described in the DSM-5: (1) extreme selectivity about foods based on their sensory properties, (2) limited interest in eating or poor appetite, and (3) fear of aversive consequences from eating (e.g. choking). Although ARFID captures an array of eating symptoms, there is virtually no empirical data on the distinctness of these presentations from one another, their prevalence in treatment settings, or their clinical presentation. We conducted retrospective chart review of 83 patients ages 8-17 admitted to an adolescent medicine eating disorders partial hospital program and diagnosed with ARFID. Charts were independently reviewed by two coders, with high interrater agreement (κ=.77). Distinct categories were identified and groups were compared on demographics, anthropometrics, co-morbid psychopathology, and core ARFID symptoms. Chart data included medical comorbidities, weight/nutritional ARFID symptoms (e.g., weight loss, supplement dependence) diagnosed by physicians, and DSM-5 psychiatric diagnoses given by psychologists, psychiatrists, or clinical social workers. We identified cases characterized by predominantly selective eating based on aversions to the sensory properties of foods (Selective; 5.1%), lack of interest in eating/low appetite (Appetite; 11.2%), and fear of aversive consequences from eating (Fear; 49.0%). We also distinguished a subset of patients with eating restrictions consistent with both selectivity and limited interest/appetite (Co-primary; 16.1%). A significantly higher proportion of male patients were diagnosed with the Co-primary and Appetite presentations (χ2(3)=12.11, V=.37). Patients with the Appetite presentation were significantly more likely to be adolescents 13-17 years (χ2(3)=13.40, V=.43). Patients with the Fear and Appetite presentations were more likely to have acute weight loss than those with the Selective and Co-primary presentations (χ2(3)=16.70, V=.45), whereas ,ore patients with the Co-primary presentation had a history of poor growth (χ2(3)=10.78, V=.38). Co-primary patients experienced significantly longer illness duration than any other group (F(3,61)=7.94, η2=.24). Patients with the Appetite presentation were more likely than other patients to have a medical condition (χ2(3)=8.3, V=.31) or mood disorder (χ2(3)=20.43, V=.54). The present findings suggest that there are diagnostically meaningful ARFID subtypes that can be differentiated based on the nature of their eating restrictions, as well as other demographic, illness history features, and psychiatric co-morbidity. As treatments for childhood/adolescent ARFID are developed and refined, it will be important to take into consideration not only demographic differences, but the variability in symptoms, as this might require distinct interventions and levels of care. Additionally, differing mechanisms that maintain different types of eating restrictions might necessitate unique psychological and psychiatric interventions.

Micronutrients Are Not Deficient in Children with Nonorganic Failure to Thrive.

PurposeInadequate calorie intake is one of the most important causes of nonorganic failure to thrive (NOFTT) and is thought to lead to multiple micronutrient deficiencies. However, there have been few studies on NOFTT and micronutrients. The aim of this study was to evaluate the micronutrient status of children with NOFTT.MethodsWe conducted a retrospective cohort study in 161 children (106 with NOFTT and 55 health controls) at a single institution. Data on weight for age, height for age, body mass index, and biochemical parameters, indicating the children's nutritional and micronutrient status were reviewed via electronic medical records, and the two groups were compared.ResultsExcept inorganic phosphate levels, no statistically significant differences were seen in the laboratory findings indicating the children's nutritional and micronutrient status; notably, the inorganic phosphate levels were within the normal range in both groups. We then compared the severe NOFTT (weight for age below the first percentile) and control groups; however, no statistically significant differences were seen for any of the measured parameters.ConclusionMost children with NOFTT in this study had normal micronutrient levels and other laboratory findings. Therefore, element deficiencies should not be considered a natural consequence of NOFTT or in healthy children. Close monitoring and additional evaluations are needed.

Failure to Thrive in Infants and Toddlers

Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment. This review contains 7 figures, 8 tables and 26 references Key words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss

Resting energy expenditure in infants with congenital diaphragmatic hernia without respiratory support at time of neonatal hospital discharge

BackgroundInfants with congenital diaphragmatic hernia (CDH) are at risk for growth failure because of inadequate caloric intake and high catabolic stress. There is limited data on resting energy expenditure (REE) in infants with CDH. AimsTo assess REE via indirect calorimetry (IC) in term infants with CDH who are no longer on respiratory support and nearing hospital discharge with advancing post-conceptional age and to assess measured-to-predicted REE using predictive equations. MethodsA prospective cohort study of term infants with CDH who were no longer on respiratory support and nearing hospital discharge was conducted to assess REE via IC and caloric intake. Baseline characteristics and hospital course data were collected. Three day average caloric intake around time of IC testing was calculated. Change in REE with advancing post-conceptional age and advancing post-natal age was assessed. The average measured-to-predicted REE was calculated for the cohort using predictive equations [22]. ResultsEighteen infants with CDH underwent IC. REE in infants with CDH increased with advancing postconceptional age (r2 = 0.3, p < 0.02). The mean REE for the entire group was 53.2 +/− 10.9 kcal/kg/day while the mean caloric intake was 101.2 +/− 17.4 kcal/kg/day. The mean measured-to-predicted ratio for the cohort was in the normal metabolic range (1.10 +/− 0.17) with 50% of infants considered hypermetabolic and 11% of infants considered hypo-metabolic. ConclusionsInfant survivors of CDH repair who are without respiratory support at time of neonatal hospital discharge have REE, as measured by indirect calorimetry, that increases with advancing post-conceptional age and that is within the normal metabolic range when compared to predictive equations. Level of EvidenceIII

Home artificial nutrition in advanced cancer patients.

Malnutrition is over 50% in advanced cancer patients and is related to a decreased survival. Cachexia is the first reason for death in 4-23% of cases. The aim of the study was to estimate the appropriateness of the criteria to select patients for home artificial nutrition and its effectiveness to avoid death from cachexia and to improve quality of life in patients with advanced cancer assisted at home by the National Tumor Association (ANT) Foundation. The criteria for patient selection are: inadequate caloric intake ± malnutrition; life expectancy ≥6 weeks; suitable psycho-physical conditions; informed consent. The measured parameters were sex, age, tumor site, food intake, nutritional status, Karnofsky performance status, indication for home artificial nutrition, type of home artificial nutrition (enteral or parenteral), and survival after starting home artificial nutrition. The ANT Foundation assisted 29,348 patients in Bologna and its province from July 1990 to July 2012. Home artificial nutrition had been submitted to 618 patients (2.1%): enteral to 285/618 (46.1%) and parenteral to 333/618 (53.9%). Access routes for home artificial nutrition were: 39% nasogastric tube, 26% percutaneous endoscopic gastrostomy, 33% digiunostomy, and 2% gastrostomy. The central venous catheters used for home artificial nutrition were: 61% non-tunneled, 13 peripherally inserted, 8% partially tunneled, and 18% totally implanted. By July 2012, all the patients had died. Duration of life ≥6 weeks was 78% (484/618). Karnofsky performance status was related to survival ( P <0.0001): one month after starting home artificial nutrition, it decreased in 73 patients (12%), was unchanged in 414 (67%), and increased in 131 (21%). The low incidence of home artificial nutrition over all the patients assisted by the ANT Foundation and the achievement to avoid death from cachexia in 78% prove the efficacy of the criteria of patient selection in order to prevent its excessive and indiscriminate use. It was effective in maintaining and improving the performance status in 88% of patients. Karnofsky performance status is a reliable prognostic index to start home artificial nutrition.

Nutritional status of elderly people using Mini Nutritional Assessment tool in an urban slum of Hyderabad

Background: The elderly people are growing rapidly in India, and nutrition is an important element of health among them. Objectives: The objectives of this study were to assess the nutritional status of the elderly in an urban slum, Hyderabad. Materials and Methods: A cross-sectional study was conducted in the Shaikpet slum, Hyderabad. The people age 60 years and above were included in the study. To assess the nutritional health of the individual, three parameters are taken into consideration that they are dietary assessment, screening tool which includes mini nutritional assessment (MNA), and anthropometric assessment. Results: Malnutrition was found in 14.5% of the elderly people. It was due to the inadequate calorie intake. The mean age of the elderly people was 70.5 ± 4.6 years, mean body mass index was 22 ± 3 kg/m2, and the mean MNA score was 21.5 ± 4.7. Conclusions: The study emphasizes increased need to give attention to the nutritional needs of elderly and also to routinely screen malnutrition in elderly individuals.

Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): A measure of three restrictive eating patterns

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disorder characterized by inadequate nutritional or caloric intake leading to weight loss, nutritional deficiency, supplement dependence, and/or significant psychosocial impairment. DSM-5 lists three different eating patterns that can lead to symptoms of ARFID: avoidance of foods due to their sensory properties (e.g., picky eating), poor appetite or limited interest in eating, or fear of negative consequences from eating. Research on the prevalence and psychopathology of ARFID is limited by the lack of validated instruments to measure these eating behaviors. The present study describes the development and validation of the nine-item ARFID screen (NIAS), a brief multidimensional instrument to measure ARFID-associated eating behaviors. Participants were 455 adults recruited on Amazon's Mechanical Turk, 505 adults recruited from a nationally-representative subject pool, and 311 undergraduates participating in research for course credit. Exploratory and confirmatory factor analyses provided evidence for three factors. The NIAS subscales demonstrated high internal consistency, test-retest reliability, invariant item loadings between two samples, and convergent/discriminant validity with other measures of picky eating, appetite, fear of negative consequences, and psychopathology. The scales were also correlated with measures of ARFID-like symptoms (e.g., low BMI, low fruit/vegetable variety and intake, and eating-related psychosocial interference/distress), although the picky eating, appetite, and fear scales had distinct independent relationships with these constructs. The NIAS is a brief, reliable instrument that may be used to further investigate ARFID-related eating behaviors.

Plasma Amino Acid Abnormalities in Chronic Heart Failure. Mechanisms, Potential Risks and Targets in Human Myocardium Metabolism.

The goal of this study was to measure arterial amino acid levels in patients with chronic heart failure (CHF), and relate them to left ventricular function and disease severity. Amino acids (AAs) play a crucial role for heart protein-energy metabolism. In heart failure, arterial AAs, which are the major determinant of AA uptake by the myocardium, are rarely measured. Forty-one subjects with clinically stable CHF (New York Heart Association (NYHA) class II to IV) were analyzed. After overnight fasting, blood samples from the radial artery were taken to measure AA concentrations. Calorie (KcalI), protein-, fat-, carbohydrate-intake, resting energy expenditure (REE), total daily energy expenditure (REE × 1.3), and cardiac right catheterization variables were all measured. Eight matched controls were compared for all measurements, with the exception of cardiac catheterization. Compared with controls, CHF patients had reduced arterial AA levels, of which both their number and reduced rates are related to Heart Failure (HF) severity. Arterial aspartic acid correlated with stroke volume index (r = 0.6263; p < 0.0001) and cardiac index (r = 0.4243; p = 0.0028). The value of arterial aspartic acid (µmol/L) multiplied by the cardiac index was associated with left ventricular ejection fraction (r = 0.3765; p = 0.0076). All NYHA groups had adequate protein intake (≥1.1 g/kg/day) and inadequate calorie intake (KcalI < REE × 1.3) was found only in class IV patients. This study showed that CHF patients had reduced arterial AA levels directly related to clinical disease severity and left ventricular dysfunction.

Review Article: Maternal nutrition in Nigeria

Introduction: Nutrition refers to intake of food necessary for optimal growth, function, and health. A well‑nourished mother is likely to have healthy infants with appropriate birth weight. Objective: To review nutrition including the dietary habit of the pregnant and postpartum women in Nigeria. Materials and Methods : Review involving Internet and literature search. Results: Undernutrition in women aged 15–49 years decreased from 15% (2003) to 11% (2013), while overnutrition increased from 21% (2003) to 25% (2013). Inadequate intake of calories and micronutrient is a major feature of studies on the dietary pattern of Nigerian pregnant women. Multinutrient malnutrition and micronutrient deficiencies are a consequence of low content of macronutrients and micronutrients in diet and staple foods in Nigeria. Food restriction/taboos occur in association with primigravidity; teenage pregnancy; lack of formal education; low household income, signifying low socio-economic status and a low body mass index. Food restrictions/taboos are common with proteins and vegetable. Commonly consumed vegetable contain adequate mineral and vitamins. Poor food preparation habit e.g blanching of vegetable and parboiling of rice occur. Postpartum mother has poor dietary intake—malnutrition, overweight, and obese body mass index. Caloric intake is high with low intake of protein and fat. There is intake of spices and peppery food believed to flush out lochia, and consumption of palm wine believed to assist breast flow. Consequences of anemia include—folic acid and iron deficiency, malaria, hookworm infestation, and urinary tract infections. Conclusion : Dietary habit on nutrition in pregnancy and postpartum women in Nigeria is poor. Recommendation: Recommended measures to improve maternal nutrition in Nigeria include development of dietary guideline for pregnancy and postpartum; health education on nutrition in pregnancy, using information, education and communication materials; provision of adequate rest and reduction of workload; counselling of pregnant women on intake of diversified food, and provision of treatment supplement; encouraging exclusive breastfeeding; and micronutrient supplementation/food fortification for postpartum mothers. Key words : Maternal; nutrition; Nigeria.