Low Nutrition Research Articles

Low methyl nutrition microenvironment as a key regulator in modulating epigenetic regulation and switching energy metabolism to stimulate hepatocellular carcinoma stemness properties

The influence of changes in dietary habits, chemical treatments, variations in the activity of one-carbon enzyme gene modifications, and liver function impairment make hepatocellular carcinoma (HCC) patients prone to marginal methyl nutrient deficiency. Hepatocellular carcinoma has consistently ranked among the top five cancer incidence rates around the world, yet the issue of methyl nutrient deficiency still lacks systematic basic scientific assessment. This study aims to investigate whether the deficiency of methyl nutrients, specifically folate, choline, and betaine, induces the stem cell-like properties of hepatocellular carcinoma cells and promotes malignant progression, as well as to clarify the potential mechanisms involved. We found that human hepatocellular carcinoma cells (HepG2) cultured in a low methyl nutrient environment exhibited the following: (1) Methyl nutrient deficiency induced self-renewal cancer stem cell characteristics in hepatocellular carcinoma cells, forming tumor spheres on the seventh day, with a greater number and larger volume observed in environments with low folate and low choline. Upon isolating the tumor spheres and re-culturing, we found that the sphere cells induced by methyl nutrient deficiency (2) showed increased intracellular NADPH, accompanied by elevated lactate concentration in the microenvironment and changes in energy-related indicators of Warburg metabolism. At the same time, the expression of post-reprogramming related proteins Sirt1 and DNMT1 was altered. In summary, methyl nutrient deficiency may promote the malignant progression of hepatocellular carcinoma through both epigenetic modifications and energy conversion. National Science and Technology Council (NSTC112-2320-B-567-001). This is the full abstract presented at the American Physiology Summit 2024 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.

Do proportions of rooting ramets in the clone affect the overall growth of the stoloniferous clonal plant Zoysia japonica?

AbstractIt is naturally common that different proportions of ramets in a clone lose rooting conditions due to habitat stress or obstacles, which potentially affects the overall growth of the clonal plant to different extents. However, so far, little attention has been paid to such phenomena and much less to the underlying ecological mechanisms. Taking Zoysia japonica as material, through an experiment with two nutrition levels in the habitats and five rooting ramet proportions in the clones, the impacts of proportions of rooting ramets in the clone on the overall growth were tested and the ecological mechanisms were analyzed. The results showed that there was no significant difference in the total clonal biomasses among the clones with five rooting ramet proportions under high and low nutrition levels, except for that with 0% rooting ramet proportion. Under both high and low nutrition levels, the lower rooting ramet proportions (0% and 25%) in the clones significantly decreased the number of the so‐called A‐ and B‐ramets, root biomass, stolon length per unit biomass, and root–shoot ratio, but significantly increased the stolon biomass of the clones. Stolon elongation was promoted under high nutrient level, and biomass allocations to stolons and roots increased under low nutrition levels. A‐ramet biomasses accounted for about 50% and 30% of the total biomasses of the whole clone under high and low nutrition levels, respectively. These results might be reasonably explained in terms of clonal integration, compensatory growth, division of labor, and bet‐hedging strategy.

Prognostic value of combined psoas muscle mass and controlling nutritional status in patients with pancreatic ductal adenocarcinoma: a retrospective cohort study.

Pancreatic ductal carcinoma (PDAC) is an extremely poor prognostic disease. Even though multidisciplinary treatment for PDAC has developed, supportive therapies, such as nutritional therapy or perioperative rehabilitation to sustain and complete aggressive treatment, have not yet been well-established in PDAC. The aim of this study was to elucidate the relationship between the combined index using psoas muscle mass index (PMI) values and controlling nutritional status (CONUT) score and prognosis. We included 101 patients diagnosed with PDAC who underwent radical pancreatectomy with regional lymphadenectomy. The cut-off value was set at the first quartile (male, 6.3 cm2/m2; female 4.4 cm2/m2), and patients were classified into high PMI and low PMI groups. A CONUT score of 0 to 1 was classified as the normal nutritional status group, and 2 or more points as the malnutritional status group. Patients were further divided into three groups: high PMI and normal nutrition (good general condition group), low PMI and low nutrition (poor general condition group), and none of the above (moderate general condition group). We performed a prognostic analysis of overall survival (OS), stratified according to PMI values and CONUT scores. In the poor general condition group, the proportion of elderly people over 70 years of age was significantly higher than that in the other groups (p < 0.001). The poor general condition group had a significantly worse prognosis than the good and moderate general condition groups (p = 0.012 and p = 0.037). The 5-year survival rates were 10.9%, 22.3%, and 36.1% in the poor, moderate, and good general condition groups, respectively. In multivariate analysis, poor general condition, with both low PMI and malnutrition status, was an independent poor prognostic factor for postoperative OS (hazard ratio 2.161, p = 0.031). The combination of PMI and CONUT scores may be useful for predicting the prognosis of patients with PDAC after radical surgery.

The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients

BackgroundMalnutrition is not uncommon among the elderly undergoing pancreatoduodenectomy (PD) and is related to increased complications. Previous studies have shown that the Geriatric Nutritional Risk Index (GNRI) predicts outcomes in various populations. Nevertheless, the research exploring the correlation between GNRI and postoperative outcomes in PD is scarce. This study aimed to investigate the preoperative malnutrition, as measured by GNRI, on outcomes in elderly patients undergoing PD.Materials and MethodsThis retrospective analysis enrolled 144 elderly patients underwent PD for periampullary tumors from November 2016 to December 2021. Patients were stratified based on the GNRI value: high/moderate nutrition risk (GNRI ≤ 92, N = 54), low nutrition risk (92 < GNRI ≤ 98, N = 35), and no nutrition risk (GNRI > 98, N = 55). Perioperative outcomes and postoperative surgical complications were compared between these groups. Univariate and multivariate analyses were performed on major postoperative complications and prolonged postoperative length of stay (PLOS).ResultsPatients in the high/moderate risk group were significantly older, with lower BMI (P = 0.012), higher mortality rate (11.1%, P = 0.024), longer PLOS (P < 0.001), and higher incidence of over grade IIIB complications (37.0%, P = 0.001), Univariate and multivariate analyses showed the high/moderate risk GNRI group (OR 3.61, P = 0.032), increased age (OR 1.11, P = 0.014) and operative time over 8 h (OR 3.04, P = 0.027) were significantly associated with increased major postoperative complications. The high/moderate risk GNRI group was also a significant predictor for prolonged PLOS (OR 3.91, P = 0.002).ConclusionsPreoperative GNRI has the potential to be a predictive tool for identifying high-risk elderly patients and monitoring nutritional status preoperatively to improve postoperative surgical outcomes following PD.

A Recipe for Success: How Cookbooks Bridge the Gap for Patient Health

Nutrition literacy is a subset of health literacy that helps patients understand which foods are best for their specific health profile. Cookbooks are collections of recipes that teach people how to cook. Through their brightly colored illustrations and easy to read language, cookbooks help patients with low nutrition literacy by both engaging their interest in food and increasing their nutritional education. Cookbooks are essential patient education resources, and healthcare professionals should be aware of the value cookbooks have in increasing patient education. This article explains the importance of nutrition literacy and explores how cookbooks are essential components to create a more robust health information experience for patients and libraries.

The Importance of Fulfilling Nutrition for Pregnant Women and Toddlers in Preventing Stunting to Improve the Quality of Human Resources in Batu Cepet Subdistrict, Tangerang

Stunting is a serious nutritional problem that occurs when a child's physical development is permanently hampered, due to chronic malnutrition in the early stages of growth. Stunting prevention requires a comprehensive approach involving government, society and the health sector. The main risk factors associated with stunting include poor nutrition during pregnancy, low nutrition during the first 1,000 days of life (from conception to two years of age), poor hygiene, and infectious diseases. Interventions to prevent stunting include providing nutritional education for pregnant women, encourage exclusive breastfeeding, provide nutritional supplements to children, and improve children's health, access to sanitation and drinking water. These programs must be implemented within a framework that allows fair and sustainable access for all community groups, including those at high risk.

Nutritional knowledge, nutritional status and associated factors among pregnant adolescents in the West Arsi Zone, central Ethiopia

When pregnancy occur among teenagers; there is a competition for nutrients between the still-growing adolescent mother and her fetus. Pregnant adolescents’ nutrition issues are not addressed well and changes are too slow in Ethiopia. This study aimed to study, nutrition knowledge, nutritional status and associated factors among pregnant adolescents in West Arsi , central Ethiopia. We conducted a cross-sectional study of 426 pregnant adolescents between January 1 and January 25, 2023. Data were collected using kobo collect and analyzed using SPSS version 25. We performed linear regression to identify independent predictors of nutritional status and multivariable logistic regression analyses to identify nutritional knowledge. Odds ratios (ORs) with 95% confidence intervals were estimated to show the strength of the association. Magnitude of good nutrition knowledge was 23.7%, 95% CI (21.4–25.3%), and the odds of having good nutrition knowledge was 7.5 times higher among participants whose education level was above college compared with illiterate participants [(AOR = 7.5, 95% CI = (5.27–9.38)],the odds of having good nutrition knowledge was 8 times higher among adolescent who had ANC visits, [(AOR = 8, 95% CI = (3.63–13.85)], and the odds of having good nutrition knowledge was 5 times higher among adolescents who received nutrition education [(AOR = 5, 95% CI = (3.67- 13.53)]. Receiving nutrition education (β = 0.25, P = 0.002) and good nutrition knowledge (β = 0.08, P < 0.001) were positively associated with nutritional status; however, food insecurity (β = − 0.93, P < 0.001) was negatively associated with nutritional status. The nutrition knowledge of pregnant adolescents was suboptimal; educational status, ANC visits and nutrition education were associated with good nutrition knowledge, whereas food insecurity, low nutrition knowledge, and not receiving nutrition education were predictors of poor nutritional status. Nutritional education interventions, increasing utilization of ANC, and interventions for improving food security are strongly recommended.

Low Iodine Nutrition Knowledge in Chinese Breastfeeding Women despite Adequate Iodine Status.

There has been a scarcity of evidence about iodine nutrition knowledge among women during pregnancy and lactation. The aim of this study was to determine women's iodine knowledge and the relationship between knowledge and iodine status during pregnancy and lactation. Women were recruited from a hospital in the western part of China in the third trimester of pregnancy and followed until the end of the first week of lactation. The women's iodine status was measured by their urinary iodine concentration (UIC) and an iodine-specific, validated food frequency questionnaire (FFQ). Iodine nutrition knowledge was assessed using an iodine nutrition knowledge questionnaire. A total of 200 women (mean age of 29.0 ± 4.2 years) completed the whole study. The majority of the women did not consume enough iodine during both pregnancy and lactation (231.89 vs. 237.26 µg/day). The overall mean iodine knowledge scores in our sample of women during pregnancy and lactation were 4.77 and 4.87, indicating low iodine knowledge. The use of iodized salt and a higher education level were significantly associated with an increased iodine knowledge score. In conclusion, this study reported poor iodine nutrition knowledge in women, highlighting a public health concern. Therefore, the iodine knowledge of women should be improved, possibly via maternal health campaigns to avoid the consequences of iodine deficiency disorders in newborns.

Risk of low energy availability and nutrition knowledge among female team sport athletes.

Nutrition knowledge influences adequate dietary intake in athletes. Inadequate dietary intakes can result in low energy availability (LEA) which can lead to relative energy deficiency in sport (RED-S). To date, there is little information on the relationship between nutrition knowledge and the risk of LEA in female team sport athletes. This study investigates if general and sports nutrition knowledge are associated with the risk of LEA in female team athletes. A cross-sectional design was used. Female athletes (>16 years) who participate in team sports in New Zealand were asked to complete an online questionnaire. The LEA in Females Questionnaire and the Abridged Sport Nutrition Knowledge Questionnaire were included. LEA risk and general/sports nutrition knowledge were assessed. The relationship between LEA risk and knowledge was analyzed using the Kruskal-Wallis Test of independent variables and χ2 tests. Among 100 female athletes, 53% were at-risk for LEA, and 70% (N.=67) had poor nutrition knowledge. Athletes who were "at-risk" for LEA and those who were "not at-risk" for LEA did not differ statistically in terms of age (P=0.350) or BMI (P=0.576). Of those "not at risk" 54% had an A-NSK score between 50 and 60% (i.e., average knowledge), whereas 54% of the athletes who were "at risk" for LEA had poor nutrition knowledge. There was no statistical difference between the groups (P=0.273). The poor nutrition knowledge and the high rates of those "at risk" of LEA among team sports athletes indicates the need for more nutrition education in this population.

Gestational osteoporosis: Myth or true?

Gestational osteoporosis is an existent rare clinical disease presenting with vertebral fractures and is quite often underdiagnosed. Etiology is heterogeneous and risk factors include family history of osteoporosis, low body mass index individuals, women with low physical activity, smoking, failure to achieve maximum bone mass and low level calories nutrition. In our review, we recorded the main hormones and biological markers involved in bone metabolism during pregnancy and breastfeeding period. Regarding imaging methods, ultrasound and magnetic resonance are useful diagnostic tools and MRI can be used as a gold standard when examining hip pain in women who are in the third trimester of pregnancy. Available therapeutic approaches are recorded regarding conservative management and use of medication. The implication of our work is to emphasize the importance of early identification of gestational osteoporosis. Medical specialties dealing with women during pregnancy and postpartum (obstetricians, endocrinologists, orthopedists) should assess the risk factors and be able to make the right diagnosis as early as possible for prognosis optimization.

Low Nutrition before Injury Is a Risk Factor for Dysphagia in Older Patients with Cervical Spinal Cord Injury: Based on a Multicenter Data of 707 Patients.

For older adults, dysphagia is a serious problem that can occur after spinal cord injury (SCI), but its risk factors are unclear. This study aimed to identify risk factors for dysphagia in elderly patients (≥65 years) with cervical SCI. This multicenter study included 707 patients with cervical SCI (mean age 75.3 years). Univariate and multivariate analyses were conducted for patient characteristics and geriatric nutritional risk index (GNRI). Dysphagia occurred in 69 patients (9.8%). The significant factors were as follows: male sex (odds ratio [OR] 3.43), GNRI <92 (1.83), dementia (2.94), fracture (3.40), complete paralysis (3.61), anterior surgery (3.74), and tracheostomy (17.06). Age was not identified as a risk factor. Low GNRI before injury was one of the independent risk factors for dysphagia after geriatric cervical SCI. GNRI represents the comprehensive nutritional status of the elderly and reflects feeding function and its recovery capacity.

Principles and Applications of Non-Thermal Technologies for Meat Decontamination.

Meat contains high-value protein compounds that might degrade as a result of oxidation and microbial contamination. Additionally, various pathogenic and spoilage microorganisms can grow in meat. Moreover, contamination with pathogenic microorganisms above the infectious dose has caused foodborne illness outbreaks. To decrease the microbial population, traditional meat preservation methods such as thermal treatment and chemical disinfectants are used, but it may have limitations for the maintenance of meat quality or the consumers acceptance. Thus, non-thermal technologies (e.g., high-pressure processing, pulsed electric field, non-thermal plasma, pulsed light, supercritical carbon dioxide technology, ozone, irradiation, ultraviolet light, and ultrasound) have emerged to improve the shelf life and meat safety. Non-thermal technologies are becoming increasingly important because of their advantages in maintaining low temperature, meat nutrition, and short processing time. Especially, pulsed light and pulsed electric field treatment induce few sensory and physiological changes in high fat and protein meat products, making them suitable for the application. Many research results showed that these non-thermal technologies may keep meat fresh and maintain heat-sensitive elements in meat products.

Biomorphological traits and leaf dry matter content are important to plant persistence in a highly unstable volcanic ground

The colonisation of newly formed territories by plants during primary succession is a crucial stage in the formation of ecosystems. Adaptations of species to withstand harsh environment allow them to survive and form pioneer communities. We analysed ten categorical and quantitative plant traits to examine their role in plant resistance to substrate instability in primary volcanic habitats. The research questions were: 1) which plant traits enable plants to persist under the most unstable ground conditions?; 2) what are the ecological strategies of species that grow under the condition of stress, such as low mineral nutrition, coupled with intense disturbance, such as unstable ground? The research was conducted on the Tolbachinsky Dol plateau in Kamchatka, Russia, on loose volcanic sediments of the 1975 eruption. At altitudes ranging from 700 m a.s.l. to 1000 m a.s.l., 40 sample plots were established along the gradients of altitude and degrees of ground instability. The species composition of vascular plants and the percentage cover of species, as well as other habitat characteristics, were assessed. Linear models were used to investigate the relationship between traits and ground instability. The principal component analysis was used to identify groups of characteristic traits. Leaf dry matter content (LDMC) had the largest explained variance. The LDMC community weighted means decreased with increasing disturbance (ground instability). A whole set of categorical traits, i.e. plant functional types, characterised the adaptation of plants to unstable ground. These characteristics include life-form (according to Serebryakov classification), density of shoots arrangement, morphology of underground organs, and, to a lesser extent, dispersal mode. The study analysed 45 species, and it was found that only four of them were adapted to perform under conditions of high substrate instability. The study showed that the mutual interaction of a suite of biomorphological traits and leaf density characteristics formed a syndrome of pioneer species adapted to unstable ground. The ecological strategies of the majority of species in the studied communities were characterised by the predominance of the stress-tolerant strategy, explained by the extremely poor mineral nutrition in the primary habitats. Under conditions of both low nutrient availability and high disturbance intensity, species with a mixed stress-tolerant-ruderal strategy are favoured. In the gradient of increasing disturbance, the role of the ruderal axis increased while stress tolerance decreased. However, the role of ecological strategy may be weakened by the presence of other important adaptive traits.

Reversal and prevention of deregulated autophagy in cutaneous autoimmune disorders—a pilot study on vitiligo with nutrigenomics based approach of “Maximum Nutrition and Minimum Medication”

Abstract Nutritional status of patients, specially prolonged starvations is an important sub-component of the environmental factors, speculated to have indirect impact on the initiation, propagation, resolution, and exacerbation stages of autoimmunity. The study was based on the hypothesis of conscious, selective, and self-destruction, that is, deregulated autophagy of skin and hair in low dietary protein scenario triggered with prolonged starvations. It was aimed to reverse the self-destruction/deregulated autophagy by providing early morning, low carb-high protein nutrition, and correcting underlying micronutrient deficiency and studying its effect on reducing auto-immunity and eventually reducing disease burden and recurrence. Methods: In this retrospective study, patients were divided into two categories based on disease activity and nutrition. Group A: “novice group” of vitiligo patients who presented at an early stage of their disease were managed with basic standard of therapeutics. Group B: “stabilized group” of vitiligo who were given surgical treatment and followed up for 3 years for any recurrences. Personalized diet plan aimed at reversing high carb-low protein diet and avoiding prolonged overnight starvation adhering to early morning breakfast respecting the circadian rhythm and balanced with additional plant based protein was advised. All detectable underlying micronutrient deficiencies were corrected. Results: Thirty patients were enrolled in the study, 20 in group A and 10 in group B. We observed visible signs of improvement in group A, with early vitiligo (90%) with topical therapy and nutritional intervention as early as 3 weeks. Following surgical procedure in group B, 50% patients had near complete pigmentation at the end of 3 months and 30% within next 3 months. At the end of 6 months, all patients had significant improvement in VASI and VIDA score, however two patients in each group had recurrence at end of 1 year who deviated from nutritional protocol and were found to be deficient in protein intake and micronutrients deficiency was detected on blood investigation. The improvement in VASI scores with conventional treatment and nutritional intervention was found to be statistically significant at 6 months and 1-year interval in group A with paired t test (P = 0.013). Similarly, improvement in VASI was statistically very significant at 6 months and 1-year duration in surgically treated vitiligo group B (P = 0.001). These patients were put on immunosuppressive therapies in first group after correction of deficiencies and managed with supportive and conventional therapy in second group in subsequent 3 years follow up. Conclusion: Nutritious diet aimed at correction of underlying protein and micronutrient deficiency with special emphasis on circadian rhythm may arrest the natural progression of disease at an early stages of the disease and prime the body for oral immunosuppressive drugs. This approach may prevent the recurrence in patients already stabilized with standard care of therapeutics and surgery in future.

Trends in food and nutrition literacy in obesity: A bibliometric analysis

Background Low food and nutrition literacy is a significant factor in obesity prevalence, adversely impacting economic and individual health outcomes, with limited research impeding effective public health interventions. Objectives This study seeks to provide a comprehensive overview of scientific research conducted over the past three decades on food and nutrition literacy in relation to obesity. The objective is to evaluate the thematic focus of studies in this domain. Methods A bibliometric analysis methodology, known as a quantitative technique, was employed to investigate scientific studies published in the Web of Science database between 1995 and 2023. The analysis, conducted using the Bibliometrix library in R StudioIDE, considers key variables such as publication year, authorship, countries of origin, high-impact journals, citations, collaborations, and keywords. Results The research encompasses 755 articles, revealing a notable surge in publications post-2007. Remarkably, studies predominantly concentrate on the food and nutrition literacy of children and adolescents. The most cited author is Velardo, whose 2015 article focuses on defining nutritional literacy. The total number of publications from the 10 countries with the most productive authors in this field is 590, accounting for 78.15% of the dataset. The integration of digital media tools among this demographic has sparked innovative research trends. Conclusions Analysis of the data underscores a shortage of research in the literature, emphasizing the need for future studies to prioritize investigating the connection between food and nutrition literacy and obesity in children and adolescents. Bridging this knowledge gap is imperative for developing effective strategies to address and mitigate the obesity epidemic in these specific age groups.

Low prognostic nutrition index as a prognostic biomarker in elderly patients with early gastric cancer after gastrectomy.

Purpose Non-invasive biomarkers including systemic inflammatory or nutrition-based index including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) lymphocyte to monocyte ratio (LMR), and prognostic nutritional index (PNI) can be useful in determining treatment strategies for elderly patients with early gastric cancer (EGC). The aim of this study was to investigate the significance of these index for predicting the long-term survival of EGC patients aged 80 years over. Methods This study included 80 elderly EGC patients with pStageIA after gastrectomy. Optimal cutoff value for PNI, NLR, PLR and LMR were set by using receiver operating curve analysis. The long-term outcomes after gastrectomy were analyzed by univariate and multivariate Cox regression analyses. Results Cut-off value for PNI, NLR, PLR and LMR was set at 46.5, 2.8, 210 and 4.6, respectively. By univariate analyses, low PNI, high NLR, high PLR and low LMR were significantly associated with worse prognosis. By multivariate analysis, low PNI was confirmed as an independent prognostic factor after gastrectomy (HR 0.17 ; 95% CI 0.03-0.91 ; P = 0.04). 5-year overall survival rate of patients with low PNI (≤ 46.5) were 52.4%. Conclusion Low PNI might be useful biomarker to predict worse prognosis of elderly EGC patients after gastrectomy. J. Med. Invest. 71 : 113-120, February, 2024.

Body Image, Dietary Intake, and Nutrition Knowledge in Relation to Body Composition in Ballerinas

Body composition in relation to body image, dietary intake, and nutrition knowledge among ballerinas were assessed in this study. This cross-sectional study collected data from ballet schools in Jakarta and Bekasi using anthropometric measurements and interviews. Among participants aged 8‒39 years, more than 50% had normal range body composition, 65.4% had self-perceived negative body image, more than 71% had normal dietary intake; however, 67.3% had low nutrition knowledge score. Overweight ballerinas had significantly higher body fat, fat-free mass, fat-free mass index and muscle mass index, except for total-body-water (p&lt;0.05). There is correlation between body composition and body image among ballerinas resided in Jakarta and Bekasi.

Determinants of stunting in children under five: a scoping review

Background: Inadequate diet, socioeconomic condition, and maternal and child characteristics can damage stunted children under five's mental and physical development. As a result, they have difficulty developing physically and cognitively, have low intellectual abilities, are more susceptible to disease, and have less creativity and innovation. Objective: This study seeks to investigate and summarize the determinants of stunted children under five.Materials and Methods: The study used a scoping review method. The literature search was carried out on indexed databases of Scopus, PubMed, Google Scholar, Crossref, and Pro-Quest in English and Indonesian. There were 720 research articles, and 18 of them met the inclusion criteria. From the 18 journals, information was collected from the publication year 2015-2021. Relevant study articles related to the topic were analyzed qualitatively using NVIVO-12 Plus.Results: Our findings identify that maternal education, low birth weight (LBW), gender, exclusive breastfeeding, parental income, parental age, and child age are the dominant determinants of stunting among under-five children.Conclusion: Higher risk factors of stunting among children are parents' lack of knowledge, low family income, low nutrition, low level of mother's education, and lack of parents' supervision and parenting skills.

THE IMPACT OF 3 GENERATIONS OF VIOLENCE ON THE MENTAL HEALTH OF COLOMBIAN OLDER ADULTS: COMPARATIVE MULTI-SITE SURVEY

Abstract Endemic violence across Colombia for 70 years has displaced generations of the poorest among Colombian society particularly in (semi)rural and peri-urban settings, approximately (10m- 20% total population). In 2022, 12.5% (1.2m) were older adults living with the health and socioeconomic consequences, losses and life-changing disruptions. Our joint Colombian UK-funded project in Turbo explores ways to co-produce and pilot an intervention to help mitigate impacts older-adults’ mental-health and wellbeing. This survey explores their burden of ill-health and adversity. We compared our 2022 older-adults survey in Turbo ( n=611) with 2016 (n=~0.5m) survey findings from three other Colombian regions with different exposures to ‘La Violencia’. Both surveys measured Cognitive status, Functionality, Autonomy, Depression, Anxiety, Alcohol-use, Well-being, Social support, Loneliness, Nutrition and Maltreatment plus demographics and used probability cluster two-stage sampling to enhance representativeness. Mental health is not a concept used by older adults, ‘depression’ (5-28%) and ‘anxiety’ (4-21%) were lower than anticipated. An unexpectedly high proportion in Turbo respondents had at least some cognitive deficit (62%), much higher than elsewhere (1.3-5.1%). Most respondents were living in significant poverty with low educational attainment, low or minimal income, low nutrition, poor housing and social isolation. Reported elder abuse rates ranged from 4-30% across sites. The survey findings confirm high rates of vulnerability among older adults living with the severe consequences of ’La Violencia’ upon mental-health. Our project co-producing and delivering affordable and sustainable interventions, seeks to improve mental health and wellbeing, self-esteem and belonging, within a society that largely neglects older adults.

Policy Triangle Analysis of Stunting Issues in Urban Areas: A Case Study of Yogyakarta City

Stunting reduction is one of Indonesia’s major projects. While one-size-fits-all regulations were no longer promoted, understanding the characteristics of each region imposed a strong policy foundation. Many studies had been conducted in rural areas, but the analysis of urban areas was scarce. A study was conducted in Yogyakarta City to understand the characteristics of stunting intervention, despite the high human development index, education level, and access to health facilities. This made it important to examine the characteristics of stunting reduction efforts, based on the analysis of the contents, contexts, processes, and actors involved, in Yogyakarta City, to help with its ambition for zero stunting. A desk review and focus group discussion were conducted involving four local government staff, consisting of the Regional Planning and Development Agency, Health Office, and Office of Women's Empowerment, Child Protection, and Population Control and Family Planning, which were elaborated with literature following the policy triangle framework. A total of 13 open-access official documents and dashboards were obtained for analysis. Decrees from the local government showed a strong commitment to ending malnutrition. While most intervention packages were similar to those across Indonesia, targeted interventions for specific subjects were needed to support people who were unable to be covered by general services. Furthermore, Yogyakarta City has smaller open spaces than other districts in the province, a contradictory low nutrition awareness despite high school participation, and other factors were cross-linked with its culture in the community, implementer, to the authority levels. Stunting reduction programs were multisectoral, involving not only government offices but also non-government, mass media, community, private sectors, and academia. This study is expected to provide lessons learned for decision-makers, private sectors, academia, and public health practitioners to implement good collaboration in stunting reduction efforts.