Insufficient Caloric Intake Research Articles

Correlation of calorie intake with 24-hour urinary urea nitrogen level changes in critically ill patients at RSUI Depok, Indonesia

Calorie together with protein intake has been proven to be important factors that play a role in critically ill patients. Hypermetabolism in the early acute phase increases energy expenditure and calorie requirement. Insufficient calorie intake will increase protein degradation for gluconeogenesis, which can be assessed by the level of 24-hour urinary urea nitrogen (UUN). Adequate daily calorie intake is expected to improve the UUN level in patients. This study aims to investigates the correlation of calorie intake with UUN level changes in critically ill patients.

Nutritional Status Is Associated With Physical Improvement of Palliative Cancer Patients During Cancer Rehabilitation.

Physical decline is accompanied with malnutrition in advanced cancer patients, thus nutritional care is often provided with cancer rehabilitation. However, a limited number of studies have focused on which nutritional index serves as an important marker to provide more intensive nutritional support for patients. We retrospectively reviewed advanced cancer patients who received chemotherapy and rehabilitation during hospitalization. In analysis 1, patients were divided into two groups: a Well group with caloric intake ≥ basal metabolism, calculated by the Harris-Benedict equation, and a Poor group with caloric intake less than their basal energy expenditure. The primary endpoint was the ratio of patients whose Eastern Cooperative Oncology Group Performance Status (ECOG PS) or Barthel index (BI) was maintained during rehabilitation. In analysis 2, the cohort was restratified into Responders, whose ECOG PS and BI improved, and Non-responders, comprising the remaining patients. Several nutritional indices were compared between the groups. Eighty-four patients were evaluated in analysis 1, namely 51 Well patients and 33 Poor patients. The ECOG PS-maintained rate was 98% and 91% (p=0.29), and the BI-maintained rate was 100% and 88% (p=0.02) in the Well and Poor groups, respectively. In analysis 2, 72 patients were evaluated after excluding 12 patients who lacked nutritional data after rehabilitation. Compared with the Responders group, caloric intake appeared worse in the Non-responders group, although their nutritional background tended to be better. Insufficient caloric intake might be a predictive marker of poor outcomes after rehabilitation in advanced cancer patients.

Towards calorie-adequate diets to mitigate environmental impacts from food consumption in Asia

Climate change, damage to human health, ecosystem, and resource scarcity associated with food consumption were assessed in forty-four Asian countries from a cradle-to-gate perspective with life cycle assessment. To propose nutritionally and environmentally sustainable diets in Asian countries of varying economic status, five healthy diet scenarios were proposed considering calorific adequacy, environmental impacts, and income status, specifically for each country. Reducing the animal-sourced food calorie intake could decrease environmental impacts by 40‐63 % in high-income countries and 18‐39 % in low-income countries. However, for certain Asian countries with inadequate animal-sourced food calorie intake, a combined adjustment in animal-sourced food and cereal was recommended, as cereal is the most consumed food group in the Asian context. This could reduce the environmental impact by 21‐33 % in high-income countries and 16‐22 % in low-income countries. In North Korea, Timor-Leste, Afghanistan, Maldives, and Yemen which have insufficient calorie intake, increase in cereal intake was recommended as it is a staple food group. Although this would increase the environmental impact by around 5 %, it is still lower than the Asian average impact. This study emphasized the importance of considering not only environmental but also economic aspects when developing diets, as different combinations of these factors lead to unique food consumption patterns, resulting in different environmental profiles for food consumption in each country. The study developed alternative diets customized for each country, considering environmental impacts, calorific sufficiency, and income levels, to promote more environmentally sustainable food consumption in Asia.

Prevalence of Chronic Energy Deficiency and its Socio-Demographic Correlates among Ethnic Adult Population of Punjab, India

Introduction: Chronic Energy Deficiency is a condition characterized by a long-term insufficient intake of calories and/or nutrients relative to a person’s energy expenditure, leading to a negative energy balance. It is typically associated with inadequate nutrition and can result in various health issues.Objectives: 1) To find out prevalence of CED in ethnic Punjabi population. 2) To determine the sociodemographic factors affecting CED the study subjects.Materials & Methods: The study was a cross sectional study using simple random sampling technique. Taking the prevalence of CED as 30%, sample size came out to be 336, but for ease of convenience, 400 subjects were selected.Results: The study subjects comprised of 183 males and 217 females and there were 24 cases of CED in males and 52 in females. Maximum cases of CED were found in the age group of 20-29 years, in lower castes and low-income groups and in illiterates.Conclusion: According to this study, maximum number of CED was found in the age group of 20-29 years.Prevalence was significantly higher in females than males and its was maximum in lower castes at 35.8%. In lower income group and in the illiterate group, it was maximum and the results were statistically significant.

EVALUATION OF CALORIC INTAKE, KNOWLEDGE, AND PRACTICES ON POSTOPERATIVE REFEEDING IN DIGESTIVE SURGERY IN NGAOUNDERE HOSPITALS, ADAMAWA REGION, CAMEROON

Background and objective: Insufficient caloric intake among postoperative digestive surgery patients, linked to a lack of knowledge and practices regarding their re-feeding, is a frequent health problem in developing countries. The aim of this study was to assess the caloric intake of postoperative digestive surgery patients, as well as the knowledge and practices related to their refeeding in two hospitals in the city of Ngaoundere. Methods: This was an observational, analytical, cross-sectional, prospective cohort study over a 5 months period from June to November 2022, focusing on the patients, the diets of post-digestive surgery patients, their nurses, and the operating theatre nursing staff. Caloric targets were defined as those with mean intakes above 15 kcal/kg/day at day 3 and 25 kcal/kg/day at discharge. Results: A total of 134 patients, 240 caretakers, 20 nursing staff, and 614 dieters (meals) were included in the study. Males were more represented, with rates of 82.1%, 56.7%, and 75% for patients, nurses, and staff respectively. 25.4% of day-3 caloric targets and 24.6% of discharge caloric targets were met. The Kruskal-Wallis test was used to investigate daily variations in means for each macronutrient, the difference being significant at p<0.05. Lack of information and practice on the composition of a porridge, food frequency score, feeding chronology, and lack of nursing practice on the part of operating room nursing staff, were the main reasons observed. Conclusion: The dietary balance in postoperative digestive surgery patients and the practices of re-feeding are deficient in the 2 hospitals in the town of Ngaoundere, suggesting an in-depth study of the dietary consequences they may have, such as undernutrition. Peer Review History: Received: 15 June 2023; Revised: 13 July; Accepted: 29 August, Available online: 15 September 2023 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, gehankandeel9@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Muhammad Zahid Iqbal, AIMST University, Malaysia, drmmziqbal@gmail.com

¿Se ha hecho lo suficiente y lo necesario? O ¿lo necesario no ha sido suficiente?

Many factors affect the nutritional status of children. The insufficient intake of protein and/or calories, necessary to meet the nutritional needs of the child's body, unfortunately sometimes responds to the social conditions of the country. While WHO aspires to eliminate all forms of malnutrition from the world, and for all populations to enjoy health and well-being, the reality is that much remains to be done.

Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes.

Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners. To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength. Cross-sectional. Clinical research center. 39 men (20 runners, 19 controls), ages 16-30 years. Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability. Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA <median had lower lumbar spine (-1.5 ± 0.7, P = .028), while runners with EA ≥median had higher hip (0.3 ± 0.7 vs -0.4 ± 0.5, P = .002), BMD Z-scores vs controls. After adjusting for calcium intake and running mileage, runners with EA <median had lower mean tibial total and trabecular volumetric BMD, trabecular bone volume fraction, cortical porosity, and apparent modulus vs controls (P < .05). Appendicular lean mass and serum estradiol (R ≥ 0.45, P ≤ .046), but not testosterone, were positively associated with tibial failure load among runners. Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.

The Relationship between Mortality and the Modified Nutrition Risk in Critically Ill (mNUTRIC) and Nutritional Risk Screening 2002 (NRS-2002) Scores in the Intensive Care Unit.

To measure the effects on mortality of the Modified Nutrition Risk in Critically Ill (mNUTRIC) and Nutritional Risk Screening 2002 (NRS-2002) scores in critical patients in the Intensive Care Unit (ICU) and to investigate the relationship between macronutrient deficiency and the mNUTRIC and NRS-2002 scores. A descriptive study. The Department of Intensive Care, Burdur Public Hospital, Turkey, between 01st October 2019 and 01st November 2021. The study included 311 patients aged >18 years, treated in the ICU for more than 7 days, and who received more than 48 hours of mechanical ventilation when required. The patients were divided into two groups according to calorie sufficiency as those who received <70% or >70% of the energy calculated for the first 5 days in ICU. Of the 311 patients included in the study, the high nutritional risk was determined in 20.9% according to the NRS-2002, and 62.7% according to the mNUTRIC. In patients classified as having high nutritional risk in nNUTRIC (score ≥5), the in-hospital mortality risk was 3-fold higher (p<0.001), and in patients classified as having high nutritional risk in NRS-2002 (score ≥5), it was 2-fold higher (p=0.002). There was a strong relationship found between a high mNUTRIC score and insufficient calorie intake and there was no relationship between the mNUTRIC score and protein intake (p=0.058). While the mNUTRIC score was a significant scoring system to show 28-day in-hospital survival, the efficacy of NRS-2002 in showing mortality could not be demonstrated. Intensive care unit, Mortality, mNUTRIC, Nutritional status, NRS-2002.

Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy.

Recently, it has been shown that directly starting oral feeding (DOF) from postoperative day one (POD1) after a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) can further improve postoperative outcomes. However, in some patients, tube feeding by a preemptively placed jejunostomy is necessary. This single-center cohort study investigated risk factors associated with failure of DOF in patients that underwent a MIE-IL between October 2015 and April 2021. A total of 165 patients underwent a MIE-IL, in which DOF was implemented in the enhanced recovery after surgery program. Of these, 70.3% (n = 116) successfully followed the nutritional protocol. In patients in which tube feeding was needed (29.7%; n = 49), female sex (compared to male) (OR 3.5 (95% CI 1.5–8.1)) and higher ASA scores (III + IV versus II) (OR 2.2 (95% CI 1.0–4.8)) were independently associated with failure of DOF for any cause. In case of failure, this was either due to a postoperative complication (n = 31, 18.8%) or insufficient caloric intake on POD5 (n = 18, 10.9%). In the subgroup of patients with complications, higher ASA scores (OR 2.8 (95% CI 1.2–6.8)) and histological subtypes (squamous-cell carcinoma versus adenocarcinoma and undifferentiated) (OR 5.2 (95% CI 1.8–15.1)) were identified as independent risk factors. In the subgroup of patients with insufficient caloric intake, female sex was identified as a risk factor (OR 5.8 (95% CI 2.0–16.8)). Jejunostomy-related complications occurred in 17 patients (10.3%). In patients with preoperative risk factors, preemptively placing a jejunostomy may be considered to ensure that nutritional goals are met.

DEPRIVATIONS OF THE URBAN POOR IN MULTIDIMENSIONAL CONTEXT IN THE NORTH EASTERN INDIAN STATE OF MIZORAM

It is now widely accepted that poverty everywhere is no longer a question of lack of income or insufficient calorie intake, it has broadened to include several areas of deprivation such as inadequate housing, health &amp; nutrition, assets, etc. So, multidimensional poverty index has been developed and used to examine the levels deprivations of people on basic necessities of life. Multidimensional poverty index has been constructed based on the sample survey data to examine deprivation of the poor people living in urban areas of Mizoram, India. It is observed that a quarter of the urban poor are severely deprived, while substantial proportion of the poor can easily fall back to severe deprivation with a slight change in their access to basic necessities of life. KEY WORDS: Multidimensional Poverty Index, Deprivation, Urban Poverty, Assets, Standard of Living, Health &amp; Nutrition, Financial Inclusion.

Why market orientation matters for agriculture and fishery workers? Unravelling the association between households\u2019 occupational background and caloric deprivation in India

BackgroundDevelopmental policies in low- and middle-income countries pose immense potential within the agriculture sectors to escalate economic growth and development. Almost one-half of the workforces continue to be engaged in agriculture and allied activities with a relatively lower economic contribution than those employed in other sectors. Hence, realizing such potential however requires tremendous scaling up of skill development activities in the sector. Investing in skill development of workers engaged in agricultural and allied activities can potentially display notable value additions, income generation and therefore reductions in widespread deprivations in the form of food insecurity and undernutrition. Further with the direct link between nutrition and productivity, economic gains, it is further imperative to impart market exposure among subsistence and unskilled workers. This study therefore empirically investigates the association between households’ primary occupation and caloric deprivation in India. In particular, in a multivariate and multilevel framework, we identified how closely primary occupation of households explain the variation in caloric deprivation in India.MethodsDrawing upon data from 68th round (2011–12) of nationally representative cross-sectional Household Consumer Expenditure Survey (HCES) of National Sample Survey (NSS), Government of India, we examined the association between occupational backgrounds of households and caloric deprivation (average caloric consumption as well as low calorie intake) among Indian households.ResultsEvidences show that agricultural and fishery labor households have lowest calorie intake (2086 kcal) across all the occupational groups. However, market oriented skilled agricultural and fishery workers’ (2261 kcal – rural, 2165 kcal - urban) have higher calorie intakes than those belonging to subsistence agricultural (2165 kcal – rural, 2149 kcal - urban). Further, the multilevel logistic regression estimates suggest that in rural areas, households engaged in skilled agricultural and fishery works have significantly (at 5% level) lower odds ratio (OR: 0.72, with 95% CI: 0.63; 0.82) of having insufficient calorie intake compared to the unskilled agricultural and fishery laborer households. Estimates from variance partitioning based on multilevel logistic regression models suggest that the households’ occupational group accounts for 7 to 14% of total variation in calorie consumption.ConclusionThese insights when combined with the occupation-specific random-effects suggest that investing in skill development of agricultural and fishery workers may have immense potential to strengthen their nutritional status and to reduce deprivation levels.

Potential Mechanisms of Overtraining

Frequent/intense training increases the risk of overtraining in athletes.When overtrained, despite high effort in training, performance stagnates and/or deteriorates (Cadegiani &amp; Kater, 2018). A growing body of literature has attempted to decipher the pathophysiology of overtraining. However, the majority of these literatures focus on the metabolic, biochemical, hormonal, and immunological aspects of overtraining. Few studies have analyzed more applicable biomarkers of overtraining such as eating and sleeping patterns, body composition, mood, and libido with conclusive results. A previous study entitled “Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)” has attracted researchers’ attention as they measured relevant/applicable biomarkers for overtraining. The purpose of the study by Cadegiani and Kater (2018) is to elaborate the EROS study and understand the mechanisms of overtraining more comprehensively. Male volunteers (age 18-50 years) were screened based on health history, drug use, exercise patterns, and overtraining symptoms (i.e., unexplained performance decreases). After prescreening, selected participants (n=51) were further tested on their sleeping, eating, and social patterns (self-reported), and psychological state by the POMS (Profile of Mood States) questionnaire. Based on these answers, participants were divided into three groups: healthy athletes (ATL), overtrained athletes (OTS), and non-physically active controls (NCS). Using bioimpedance and air-displacement, body hydration and composition were measured. Daily caloric/macronutrient intake, POMS, time spent studying/working (hours/day), libido on a scale 1-10, and basal metabolic rate (BMR) by indirect calorimetry were also measured for analysis. Compared to ATL, OTS reported reduced relative calorie intake (26.4 kcal/kg/day in OTS vs. 52.7 kcal/kg/day in ATL), worse sleep quality on a scale 1-10 (6.5 vs. 8.0), worse mood (POMS scores of 15.0 vs. 5.0 on anger, 5.0 vs. 2.0 on confusion, 7.5 vs. 0.0 on depression, 20.0 vs. 2.0 on fatigue, 16.5 vs. 6.0 on tension, and 9.5 vs. 26.0 vigor), lower measured-to-predicted BMR (100.5% vs. 109.0%), higher body fat (15.3% vs. 10.3%), and diminished libido on a scale 1-10 (7.0 vs. 8.0) and hydration (60.8% vs. 64.9% body water) (all P&lt;0.05). OTS had greater musculature than NCS (40.2 kg vs. 33.7 kg) and spent more time studying/working than ATL (8 vs. 7 hours/day) (all P&lt;0.05). Declining performance observed in OTS may originate from inadequate sleep, which prevents optimal reparative processes. Disproportionally high body fat may have caused reduced BMR in OTS. Excessive working/studying may impair physical performance as cognition requires energy. Critical risk factors for overtraining are likely inadequate sleep, excessive cognition, and insufficient caloric intake (Figure 1). The recruitment method likely involved self-selection bias and limits the validity of the findings. Furthermore, this study disregards metabolic adaptations. OTS consumed less calories than ATL, despite both groups being athletes. It is well-established that metabolism can change depending on diet/lifestyle, thus a slower metabolism observed in OTS may have been caused by previous undereating rather than from overtraining (Heilbronn et al., 2006). Future overtraining studies should record previous patterns of eating prior to participation in an effort to account for potential metabolic adaptions. Lastly, a rigorous recruitment criterion (i.e., randomized controlled setting) should be utilized to minimize potential participation bias.

Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes

Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome that includes the many complex health and performance consequences of low energy availability (EA) in athletes, when there is insufficient caloric intake to meet exercise-related energy expenditure and to support basic physiologic functions. There is a high prevalence of urinary incontinence (UI) in female athletes and it is more common in female athletes than non-athletes. The objective of this study was to determine if low EA is associated with UI in a population of adolescent and young adult female athletes and to evaluate for an association between sport categories and UI. 1000 nulliparous female patients, ages 15-30 years, presenting to a sports medicine subspecialty clinic, provided informed consent/assent to participate in a cross-sectional study involving a comprehensive survey, anthropomorphic measurements, and medical record review. Low EA was defined as meeting ≥1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), and/or a high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or a high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed using questions adapted from the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), questions regarding timing of UI onset/duration, and a binary question regarding UI during sport activities. A total of 36 sport types were included in the survey and sub-divided into categories. Of the 1000 female athletes surveyed, 165 (16.5%) reported a history of experiencing UI during athletic activities. ICIQ- UI-SF responses indicated that 14% (137/1000) of the cohort experienced slight incontinence, 4% (35/1000) moderate incontinence, and 2 athletes experienced severe incontinence. There was a significant difference between UI categories in age (p=0.01), low EA (p<0.001), and sport category (p<0.001). Females who had low EA had twice the likelihood (OR=1.97; 95% CI=1.39 to 2.81; p<0.001) of UI compared to those with adequate EA, controlling for sports category and menstrual dysfunction. Females who participated in high impact sports were 4.5 times more likely (OR=4.47; 95% CI=2.29 to 8.74; p<0.001) to have had UI compared to females who participated in ball sports, controlling for EA and menstrual dysfunction. UI during athletic activities is a common problem among nulliparous adolescent and young adult female athletes, occurring in 16.5% of female athletes surveyed. UI was significantly associated with low EA across all sport categories. Sport type was significantly associated with UI, with the highest impact sport group demonstrating a higher prevalence and symptom severity compared to other sport categories.

Coronavirus diseases 2019 and kidney injury: a brief review based on current evidence.

Coronavirus diseases 2019 and kidney injury: a brief review based on current evidence.

Novel Markers of Recovery From Overtraining Syndrome: The EROS-LONGITUDINAL Study.

Overtraining syndrome (OTS) is an unexplained underperformance syndrome triggered by excessive training, insufficient caloric intake, inadequate sleep, and excessive cognitive and social demands. Investigation of the recovery process from OTS has not been reported to date. The objective was to unveil novel markers and biochemical and clinical behaviors during the restoration process of OTS. This was a 12-week interventional protocol in 12 athletes affected by OTS, including increase of caloric intake, transitory interruption of training, improvement of sleep quality, and management of stress, followed by the assessment of 50 parameters including basal and hormonal responses to an insulin tolerance test and nonhormonal biochemical markers, and body metabolism and composition. Early cortisol (P = .023), late ACTH (adrenocorticotrophic hormone) (P = .024), and early and late growth hormone (P = .005 and P = .038, respectively) responses, basal testosterone (P = .038), testosterone:estradiol ratio (P = .0005), insulinlike growth factor 1 (P = .004), cortisol awakening response (P = .001), and free thyronine (P = .069) increased, while basal estradiol (P = .033), nocturnal urinary catecholamines (P = .038), and creatine kinase (P = .071) reduced. Conversely, markers of body metabolism and composition had slight nonsignificant improvements. After a 12-week intervention, athletes affected by actual OTS disclosed a mix of non-, partial, and full recovery processes, demonstrating that remission of OTS is as complex as its occurrence.

The role and its mechanism of intermittent fasting in tumors: friend or foe?

Intermittent fasting (IF) is becoming a prevailing topic worldwide, as it can cause changes in the body’s energy metabolism processes, improve health, and affect the progression of many diseases, particularly in the circumstance of oncology. Recent research has shown that IF can alter the energy metabolism of tumor cells, thereby inhibiting tumor growth and improving antitumor immune responses. Furthermore, IF can increase cancer sensitivity to chemotherapy and radiotherapy and reduce the side effects of these traditional anticancer treatments. IF is therefore emerging as a promising approach to clinical cancer treatment. However, the balance between long-term benefits of IF compared with the harm from insufficient caloric intake is not well understood. In this article, we review the role of IF in tumorigenesis and tumor therapy, and discuss some scientific problems that remain to be clarified, which might provide some assistance in the application of IF in clinical tumor therapy.

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.

Gestational Anemia: The Factors Associated and the Outcomes in the Mother and the Infant

Background: Maternal anemia is considered a risk factor for pregnancy, because it is hazardous to both mother and fetus. Our study aimed to determine in each trimester of pregnancy the factors associated with anemia and the outcomes in the mother and infant in a cohort of Algerian pregnant women. Methods: We conducted a prospective and longitudinal cohort study of 300 women from December 2013 to July 2016. All consenting women attending antenatal consultation and had undergone complete blood count were included in the study. Sociodemographic characteristics and individual’s obstetrical history were collected. Factors associated to maternal anemia were investigated during each trimester of pregnancy. Data on delivery term, delivery mode and birth outcomes were collected. We performed a bivariate analysis using the Chi-square test for proportions, Student’s t-test, or one-way ANOVA for continuous variables and multiple comparisons. Results: The rate of gestational anemia was 58.0%. The average concentration of hemoglobin, hematocrit, blood volume and platelets were lower in anemic pregnant women. Factors associated with anemia were: lower hemoglobin levels, lower BMI in the 3rd trimester, inadequate gestational weight gain, insufficient caloric intake in the 1st and 3rd trimesters and non supplementation with iron. Maternal anemia increased the risk of low birth weight in early and late pregnancy and the risk of overrun term in mid and late pregnancy. Conclusion: Various antropomethric, haematological and nutritional factors affected gestational anemia. Gestational anemia was associated with increased risks of maternal and fetal complications. Community-based interventions should be enhanced considering the identified associated factors.

Insufficient Calorie Intake Worsens Post-Discharge Quality of Life and Increases Readmission Burden in Heart Failure

ObjectivesThe purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF). BackgroundMalnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake. MethodsIn a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks. ResultsAmong 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m2); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = −14.6; 95% confidence interval [CI]: −27.3 to −1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3). ConclusionsDespite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679)