Malnourished Subjects Research Articles

Lack of association between serum apelin levels and sarcopenia in elderly malnourished subjects.

Sarcopenia is a condition characterized by muscle mass loss. Skeletal muscle is capable of producing and secreting different molecules called myokines, and apelin is one of them. The literature contains contradictory data on the relationship between apelin and sarcopenia. We decided to investigate the role of apelin in sarcopenia in subjects with disease-related malnutrition (DRM), a group of patients with a high rate of sarcopenia. 83 elderly patients with DRM assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria were included in the study, with a mean age of 69.9±3.8 years. Anthropometric data, muscle mass by ultrasound at the rectus femoris quadriceps (RFQ) level, bioimpedance [skeletal muscle mass (SMM), appendicular SMM (aSMM) and aSMM index (aSMMI)], dynamometry, biochemical parameters, dietary intake, circulating apelin levels were determined in all patients. a total of 33 patients (37.9%) were diagnosed with sarcopenia, while 54 patients did not present sarcopenia (60.1%). Body weight (-5.5±2.0 kg, p=0.01), calf circumference (-1.9±0.2 cm, p=0.02), phase angle (-0.6±0.2º, p=0.01), reactance (-6.8±2.3 Ohms, p=0.03), resistance (-38.8±12.3 Ohms, p=0.04), SMM (-2.2±0.3 kg, p=0.04), aSMM (-2.2±0.2 kg, p=0.03) and aSMMI (-0.6±0.2 kg, p=0.02), dominant muscle area (-0.6±0.2 cm2, p=0.04), dominant Y axis (-0.4±0.1 cm, p=0.03), dominant X/Y axis (1.1±0.3 cm, p=0.04), strength (-5.1±1.3 kg, p=0.01), albumin (-0.9±0.1 g/dl, p=0.02) and prealbumin (-4.6±0.7 mg/dl, p=0.02) were worse in patients with sarcopenia than non-sarcopenic patients. Circulating apelin levels were similar in both groups. No significant correlation of apelin levels was detected, either with bioimpedance data or with muscle ultrasonography data. The multivariant analysis did not detect a significant association of apelin with the presence of sarcopenia. Our study shows a lack of association between apelin and sarcopenia in elderly malnourished patients.

Nutritional status as independent prognostic factor of outcome and mortality until five years after hip fracture: a comprehensive prospective study

SummaryWe determined the prognostic value of nutritional status for outcome after hip fracture. Nutritional status was a strong independent prognostic factor for clinical outcome and 5-year mortality. Physical function showed incomplete recovery. Elderly care should focus on prevention already before hip fracture.PurposeTo determine the prognostic value of nutritional status in hip fracture patients for multiple clinical and functional outcomes over 6 months, and for new fractures and survival over 5 years post-fracture.MethodsWe included 152 well-characterized subjects (age 55+ years) with a hip fracture from a previously published randomized controlled trial. Nutritional status was appraised using the Mini Nutritional Assessment (MNA). Multivariable linear, logistic and Cox regression models were fitted, adjusted for age, sex, ASA score, group and additional prognostic covariates identified in backward regression models.ResultsAt baseline, impaired nutritional status was significantly associated with physical disability, depression, impaired cognition and lower quality of life. Prospective analyses showed that impaired baseline nutritional status was an independent prognostic factor for postoperative complications (OR 2.00, 95%CI 1.01–3.98, p = 0.047), discharge location from hospital (home vs. rehabilitation clinic, OR 0.41, 95%CI 0.18–0.98, p = 0.044), hospital readmission (OR 4.59, 95%CI 1.70–12.4, p = 0.003) and total length of hospital stay (HR of being discharged: 0.63, 96%CI 0.44–0.89, p = 0.008), as well as for 5-year mortality (HR 3.94, 95%CI 1.53–10.2, p = 0.005), but not for risk of new fractures (5y-HR 0.87, 95%CI 0.34–2.24, p = 0.769). Curves of physical disability over time showed that the three nutritional status categories followed almost parallel trajectories from baseline until 6 months after hip fracture, without complete recovery and even with further deterioration in malnourished subjects from 3 to 6 months post-fracture.ConclusionAs baselline nutritional status is a strong independent prognostic factor for clinical outcome after hip fracture, affecting even five-year survival, elderly health care should focus on prevention and identification of at-risk individuals already before hip fracture.

Controlling nutritional status score predicts 2-year outcomes in elderly patients admitted for acute heart failure

BackgroundHeart failure (HF) is a major cause of death among the elderly. Its prevalence increases dramatically with age. The prevalence of malnourished subjects is high in hospitalized elderly patients. We aimed to investigate the prognostic role of malnutrition, assessed by controlling nutritional status (CONUT) score, on adverse clinical outcomes in the elderly admitted for acute HF.MethodsWe enrolled 293 patients (mean age 84 years; 48% men) consecutively admitted for acute HF to the Internal Medicine or Geriatrics Divisions at the ‘IRCCS Sacro Cuore-Don Calabria’ Hospital of Negrar (Verona, Italy) from 2013 to 2015. We predicted the risk of all-cause death, re-hospitalizations for HF and non-HF causes, and the composite of all-cause death or hospitalizations over 2-year follow-up. Patients were divided into four groups according to CONUT score: normal-CONUT (0–1; n = 30); mild-CONUT (2–3; n = 56); moderate-CONUT (4–7; n = 171); and severe-CONUT (≥ 8; n = 36).ResultsHigher CONUT scores were associated with older age and lower entry blood pressures. No difference in hemodynamics was noted at the discharge. Kaplan–Meier curves showed a significant association between worsening CONUT scores and risk of all-cause death (p < 0.01), re-hospitalizations (p < 0.01), or both (p < 0.001). Cox regression analysis revealed these significant associations persisted after adjustment for age, sex, pre-existing cardiovascular disease, diabetes, chronic kidney disease, heart rate, systolic blood pressure, and plasma brain natriuretic peptide levels at discharge (all-cause mortality HR = 1.29 (1.00–1.66), p = 0.049; hospitalization for HF HR = 1.36 (1.03–1.81), p = 0.033; hospitalization for non-HF HR = 1.38 (1.03–1.86), p = 0.034; composite outcome HR = 1.33 (1.07–1.64), p = 0.01).ConclusionsMalnutrition, assessed by the CONUT score, is common among elderly patients admitted for acute HF and is strongly related to increased long-term risk of all-cause death and re-hospitalizations.

Multidisciplinary Assessment and Individualized Nutritional Management of Dysphagia in Older Outpatients.

The evidence on the efficacy of nutrition therapy to prevent complications of dysphagia is based on observational studies that used different tools for nutritional and dysphagia assessment, and different scales for the definition of diet textures, rendering their results incomparable and the knowledge on dysphagia management inconclusive. This retrospective observational study was performed in 267 older outpatients who were assessed for dysphagia and nutritional status by a multidisciplinary team at the Clinical Nutrition Unit of IRCCS INRCA geriatric research hospital (Ancona, Italy) from 2018 to 2021. GUSS test and ASHA-NOMS measurement systems were used for dysphagia assessment, GLIM criteria for the assessment of nutritional status, and the IDDSI framework to describe the texture-modified diets. Descriptive statistics were used to summarize the characteristics of the subjects evaluated. Sociodemographic, functional and clinical parameters were compared between patients with and without BMI improvement overtime by an unpaired Student's t test, Mann-Whitney U test or Chi square test, as appropriate. Dysphagia was diagnosed in more than 96.0% of subjects; 22.1% (n = 59) of dysphagic subjects were also malnourished. Dysphagia was treated exclusively by nutrition therapy, prevalently by individualized texture-modified diets (77.4%). For the classification of diet texture, the IDDSI framework was used. The follow-up visit was attended by 63.7% (n = 102) of subjects. Aspiration pneumonia was registered only in one patient (less than 1%), and BMI improved in 13 of 19 malnourished subjects (68.4%). The improvement of nutritional status was primarily reached in subjects whose energy intake was increased and texture of solids modified, in younger subjects, and in those taking less drugs and not reporting any weight loss before the first assessment. The nutritional management of dysphagia must guarantee both an adequate consistency and energy-protein intake. Evaluations and outcomes should be described with universal scales, in order to allow for comparison between studies and contribute to the collection of a critical mass of evidence on the efficacy of texture-modified diets in the management of dysphagia and its complications.

To Evaluate Prealbumin as a Potential Biomarker of Malnutrition in Geriatric Population

Abstract Introduction: Aging refers to the inevitable biological process of getting older over time. As humans age, their bodies undergo various physical, physiological, and cognitive changes. As we grow older, practical and morphological adjustments arise, which result in a slow deterioration of the varied abilities of the organism and hence lead to multiple illnesses. Aims: The aim of this study was to evaluate the ability of prealbumin as a biomarker of malnutrition in geriatric population. Subjects and Methods: This is a quantitative cross-sectional study. We enrolled 140 elderly patients attending the Outpatient Department of Geriatric Medicine, and the data were analyzed with the help of SPSS v27. Results: The present study was undertaken in two groups, viz. Group I (underweight) and Group II (normal weight). A statistically significant correlation has been found between serum prealbumin and body mass index (BMI) in underweight subjects (r = 0.84). Conclusion: From the present study, in Group 1 with low BMI, low levels of serum prealbumin were seen as compared to Group 2 with normal BMI. A low value of serum prealbumin was found in malnourished subjects.

Chaotic Global Metric Analysis of Heart Rate Variability Following Six Power Spectral Manipulations in Malnourished Children

Background and Aim: The study objective was to assess chaotic global metrics in malnourished children following power spectral manipulations. Methods: We evaluated the complexity of heart rate (HR) variability (HRV) in malnourished subjects via six power spectra (Welch, multi-taper method (MTM), Burg, covariance, Yule-Walker, and periodogram) and then, when adjusted by the MTM parameters, for further refinement. Seventy children were split equally (controls &amp; malnourished) and the HR was monitored for 20 min; 1000 RR-intervals were attained for HRV analysis. Results: The results stipulate that CFP1 (chaotic forward parameter) and CFP3 are the best metrics to distinguish the two groups. The most appropriate power spectra were Welch, MTM, and Yule-Walker. Results indicate that CFP3 calculated using MTM power spectra is the best combination to discriminate between the two groups. Yet, if the RR intervals are set to 400, discrete prolate spheroidal sequences (DPSS) to 3, and Thomson’s nonlinear combination to ‘adaptive’, a greater level of significance can be achieved (Cohen’s ds = -1.57). This significantly outperforms that under default conditions (Glass’s ∆ Delta = -1.06, and Cohen’s ds = -0.95). Conclusion: Malnourished children have a lower response to chaotic global metrics than the control group. CFP3 with the aforementioned settings is the best combination to discriminate between these groups on the basis of RR intervals. It has the greatest significance by Cohen’s ds. Our data suggest impaired autonomic function in malnourished children, which may have consequences for cardiovascular risks.

Does lower quality of life and daily living activity increase nutritional risk of elderly residing in care home facilities?

Aging is a predictable phenomenon that its prevalence is increasing dramatically in the world. There is an association between quality of life, functional independence, and nutritional risk in elderlies, so the aim of the current study is the evaluation of the quality of life and functional independence's effects on nutritional status. A total of 160 elderly people that had a hospitalization for at least 6months in the care home facilities were selected from 2 care home facility centers to participate in the study. Quantitative and qualitative data were gathered using questionnaires for demographic characteristics, health data, eating habits, quality of life (WHOQOL-BREF), functional assessment (Barthel Index), and mini-nutrition assessment (MNA) throughout the face-to-face interview. The overall quality of life score, age, weight, and BMI differed significantly between malnourished and well-nourished subjects. Also, the daily living activity score of subjects who were well-nourished was higher than malnourished participants. Higher daily living activity decreased the risk of being malnourished (OR malnutrition/well-nourished=0.306, P<0.001). There was also a significant relationship between BMI (OR malnutrition/well-nourished=0.731, P=0.001; OR at-risk/well-nourished=0.786, P=0.003) and marital status with MNA score (OR single/married=1.460, P=0.001 for malnutrition; OR single/married=1.183, P=0.004 for being at risk of malnutrition). The elderly living in nursing homes are exposed to nutritional risks and mental disorders. So with timely assessment and interventions to improve the quality of life and physical and mental health of elder dwellers, their malnutrition can be prevented.

Longitudinal association between nutritional status and behavioral and psychological symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer's disease

While cross-sectional studies report associations between behavioral and psychological symptoms of dementia (BPSD) and nutritional status as a modifiable factor, their causal relationship remains unclear. Therefore, this study investigated the impact of nutritional status on BPSD. This study included women with mild cognitive impairment (MCI) and early-stage Alzheimer's disease (AD) from Memory Clinic, National Center for Geriatrics and Gerontology. The participants were assessed for nutritional status and BPSD using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Dementia Behavior Disturbance Scale (DBD), respectively. Based on their MNA-SF scores, the subjects were classified as well-nourished, at risk of malnutrition, or malnourished. Nutritional status and change in BPSD was examined for association by univariate and multivariate linear regression analyses. This study analyzed 181 women (79 with MCI and 102 with early-stage AD). The multivariate analysis showed that the malnourished subjects or those at risk of malnutrition (54.1%) were significantly associated with increased DBD scores (β=0.255, P=0.003) during follow-up. In addition, multivariate regression analysis incorporating change in DBD sub-score as a dependent variable showed that the malnourished subjects or those at risk of malnutrition were associated with increased DBD sub-scores for "verbal aggressiveness/emotional disinhibition" (β=0.247, P=0.005). Poor nutritional status increased BPSD, especially verbal aggressiveness/emotional disinhibition, in those with MCI and early-stage AD during 2.5-year follow-up. Patients with MCI and early-stage AD may need to be assessed for nutritional status from early on, at the onset of mild cognitive decline, and require intervention to prevent worsening of BPSD. Further intervention studies in large prospective cohorts are needed to establish nutritional measures to prevent progression of BPSD in older adults with cognitive impairment.

Assessment of nutritional status of community-dwelling older adults in rural North India using mini nutritional assessment-short form

Objective: challenges of geriatric populace are plentiful and vexing, malnutrition being a critical issue. We studied the burden of malnutrition and determined its association with socio-demographic factors, depression, and other health variables. Methods: A cross-sectional study was conducted among 162 community-dwelling older adults to screen for malnutrition using mini nutritional assessment short-form (MNA-SF). Pearson's Chi-square test, one-way analysis of variance, correlation, and Multinominal logistic regression were used for data analysis. Results: Four-point nine percent older adults were malnourished and 42.6% were at risk of malnutrition. Malnutrition was higher in 60–69 years of age group (5.95%) and females (6.9%), while risk of malnutrition was high among >80 years (59.1%) and widowed (66.7%). Weight loss, decrease in food intake, dementia, stress, decreased mobility, and depression were significantly associated with malnutrition. Geriatric Depression and MNA-SF scores showed a significant negative correlation (r = −0.434). Comparison of means of MNA-SF and geriatric depression scale scores among well-nourished, at risk, and malnourished subjects showed significant difference (P < 0.001). Multinominal regression revealed that it is highly likely (P < 0.01) that the subjects were malnourished if they had body mass index <19 kg/m2, reported weight loss >3 kg or suffered from acute disease or stress in the past 3 months while the likelihood of being “at risk” increased significantly only if subjects had acute disease or stress in preceding 3 months. Conclusions: Screening with MNA-SF can help identify at low cost a sizable proportion of elderly who are malnourished and “at risk.” Timely intervention can be instrumental in preventing the progression of infirmity and reducing its catastrophic consequences.

Influence of oral nutritional agents rich in soluble dietary fiber on intestinal flora of elderly men with malnutrition.

ObjectiveObserve the influence of oral nutritional agents rich in soluble dietary (enteral nutritional suspension [TPF‐DM]) on intestinal flora of elderly male subjects with malnutrition.MethodSeventy‐eight subjects with good nutrition were considered as the healthy control group. Twenty‐eight male subjects who had malnutrition and were older than 70 years were included and randomly divided into the short‐term (3 months) intervention group (n = 20) and the long‐term (12 months) group (n = 8). They were provided with enteral nutritional suspension (TPF‐DM) 500 mL/day or maximum tolerance dose, so as to observe the changes in nutrition‐related indexes and intestinal flora after the elderly take enteral nutritional suspension (TPF‐DM).Results(1) For elderly male subjects with malnutrition, their body weight, body mass index, hemoglobin, total protein, and albumin were significantly lower than the control group with favorable nutrition. (2) There were obvious differences in intestinal flora between healthy elderly male subjects and those with malnutrition. After the treatment of enteral nutritional suspension (TPF‐DM), intestinal flora of the malnourished elderly subjects showed recovery toward the healthy elderly subjects. The obvious gradient changes of the flora were mainly in the bacteroidetes, firmicutes, and proteobacteria phyla, and the relative abundance of CAG2 clusters in the malnourished group was higher than that in the healthy control group, and the relative abundance decreased after long‐term treatment, and the change approached the healthy control group. The relative abundance of CAG3 and CAG6 clusters in the malnourished group was lower than that in the healthy control group, and the relative abundance increased after long‐term treatment, and the change approached the healthy control group.ConclusionMalnutrition has obvious impact on intestinal flora of the elderly. Enteral nutritional suspension (TPF‐DM) not only prevents the further decline in the state of nutrition but also helps the recovery in intestinal flora of the elderly. Long‐term application can produce better effects.

A Comparative Analysis of Nutritional Assessment Using Global Leadership Initiative on Malnutrition Versus Subjective Global Assessment and Malnutrition Inflammation Score in Maintenance Hemodialysis Patients

Malnutrition is a prevalent condition in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the performance of the recently developed GLIM (Global Leadership Initiative on Malnutrition) in MHD by assessing the agreement, accuracy, sensitivity, specificity, and survival prediction of GLIM when compared to 7-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS). We investigated 2 cohorts: MHDltaly (121 adults from Italy; 67±16years, 65% men, body mass index 25±5kg/m2) and MHDBrazil (169 elderly [age>60years] from Brazil; 71±7years, 66% men, body mass index 25±4kg/m2), followed for all-cause mortality for median 40 and 17months, respectively. We applied the 2-step approach from GLIM: (1) screening and (2) confirming malnutrition by phenotypic and etiologic criteria. For 7p-SGA and MIS, a score ≤5 and ≥8, respectively, defined malnutrition. Malnutrition was present in 38.8% by GLIM, 25.6% by 7p-SGA, and 29.7% by MIS in the MHDItaly cohort, and in 47.9% by GLIM, 59.8% by 7p-SGA, and 49.7% by MIS in the MHDBrazil cohort. Cohen's kappa coefficient (κ) showed only "fair" agreement between GLIM and SGA (MHDItaly: κ = 0.26, P = .003; MHDBrazil: κ = 0.22, P = .003) and between GLIM and MIS (MHDItaly: κ= 0.33, P<.001; MHDBrazil: κ = 0.25, P = .001). Cox regression analysis showed that all 3 methods were able to predict mortality in crude analysis; however in the adjusted model, the association seemed more consistent and stronger in magnitude for 7p-SGA and MIS. In MHD patients, GLIM showed low agreement, sensitivity, and accuracy in identifying malnourished subjects by either 7p-SGA or MIS. Considering the specific wasting characteristics that predominate in MHD, the well-established 7p-SGA and MIS methods may be more useful in this clinical setting.

Hypertension in Prenatally Undernourished Young-Adult Rats Is Maintained by Tonic Reciprocal Paraventricular-Coerulear Excitatory Interactions.

Prenatally malnourished rats develop hypertension in adulthood, in part through increased α1-adrenoceptor-mediated outflow from the paraventricular nucleus (PVN) to the sympathetic system. We studied whether both α1-adrenoceptor-mediated noradrenergic excitatory pathways from the locus coeruleus (LC) to the PVN and their reciprocal excitatory CRFergic connections contribute to prenatal undernutrition-induced hypertension. For that purpose, we microinjected either α1-adrenoceptor or CRH receptor agonists and/or antagonists in the PVN or the LC, respectively. We also determined the α1-adrenoceptor density in whole hypothalamus and the expression levels of α1A-adrenoceptor mRNA in the PVN. The results showed that: (i) agonists microinjection increased systolic blood pressure and heart rate in normotensive eutrophic rats, but not in prenatally malnourished subjects; (ii) antagonists microinjection reduced hypertension and tachycardia in undernourished rats, but not in eutrophic controls; (iii) in undernourished animals, antagonist administration to one nuclei allowed the agonists recover full efficacy in the complementary nucleus, inducing hypertension and tachycardia; (iv) early undernutrition did not modify the number of α1-adrenoceptor binding sites in hypothalamus, but reduced the number of cells expressing α1A-adrenoceptor mRNA in the PVN. These results support the hypothesis that systolic pressure and heart rate are increased by tonic reciprocal paraventricular–coerulear excitatory interactions in prenatally undernourished young-adult rats.

Analyzing the Role of Malnourishment in Malocclusion: A Cross-sectional Study.

Background:Malocclusion is defined as an occlusion in which there is malrelationship between the arches in any of the three planes or anomalies in tooth position beyond normal limits, the etiology being multifactorial. Malnutrition may also be allied to malocclusion, predominantly crowding, due to insufficient space for the teeth to erupt in the correct place.Objectives:The present study was conducted to investigate the role of diet as an etiological factor in the occurrence of malocclusion.Materials and Methods:Two hundred and twenty malnourished subjects were examined by a single experienced dental professional and the occlusal relationships were evaluated at a centric occlusion position by instructing the subject to swallow and then bite on the teeth together.Results:Ninety-eight subjects (44.54%) had Angle's Class I malocclusion with crowding: 18 (8.1%) presented with spacing. Angle's Class II division 1 malocclusion was evident in 52 subjects (23.63%), while Class II division 2 in 38 subjects (17.27%). Only 14 subjects (6.3%) presented with Angle's class III malocclusion.Conclusion:Dietary factors and dentition measures from a subset 220 malnourished subjects found that malnourished subjects with basal metabolic index <18.5 had statistically significant relationships with the crowding variables.

Malnutrition, assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria but not by the mini nutritional assessment (MNA), predicts the incidence of sarcopenia over a 5-year in the SarcoPhAge cohort.

The capacity of malnutrition screening to predict the onset of sarcopenia is unknown. Our first objective is to explore the association between the screening of malnutrition and the incidence of sarcopenia and then, to assess the added value of the diagnosis of malnutrition to predict sarcopenia over a 5-year follow-up. Malnutrition was screened at baseline according to the MNA short-form (MNA-SF) and long-form (MNA-LF) and was diagnosed by the GLIM definition. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Kaplan-Meier analysis and adjusted Cox regression were performed to explore the association between nutritional status and the incidence of sarcopenia. A total of 418 participants were analyzed (median age 71.7 years (67.7 - 76.8), 60% women) for our first objective. Among them, 64 (15.3%) became sarcopenic during the follow-up period. In the adjusted model, the incidence of sarcopenia was nonsignificantly associated with the risk of malnutrition for both forms of the MNA (MNA-SF: HR of 1.68 (95% CI 0.95 - 2.99); MNA-LF: HR of 1.67 (95% CI 0.86 - 3.26)). However, among the 337 participants for which a GLIM assessment was possible and in which 46 participants became sarcopenic, malnourished subjects had a higher risk than well-nourished participants of developing sarcopenia after 5 years, with an adjusted HR of 3.19 (95% CI 1.56 - 6.50). A full diagnosis of malnutrition seems more useful than a simple malnutrition screening to predict the incidence of sarcopenia over 5 years.

Gut bacterial profile in Indian children of varying nutritional status: a comparative pilot study.

PurposeChildhood malnutrition is a multifactorial disease, responsible for nearly half of all deaths in children under five. Lately, the probable association of a dysbiotic gut to malnutrition is also being eagerly investigated. The current study is an attempt to investigate this purported association through assessing the abundance of major gut bacterial phyla (Firmicutes, Bacteroidetes, Actinobacteria and Proteobacteria), probionts (Bifidobacteria and Lactobacillus), butyrogens (Faecalibacterium and Roseburia) and pathogens (Escherichia and Klebsiella).MethodsThe study was conducted in the suburbs of Chandigarh, India in the year 2017. The children enrolled in the study were part of Anganwadis (Rural Child Care Centres) set up under Integrated Child Development Scheme (ICDS) of Government of India where community-based management approach is being widely used for treatment of malnutrition. We used qPCR based absolute quantification as well as the 16S rRNA amplicon sequencing approach for our study. The study population included 30 children in the age group of 2–5 years who were categorized into three groups Healthy, Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM), with 10 children in each group. The selection of participants was made based on Z scores. Further, statistical tools like the One-way ANOVA, PCA and PLSDA were employed to analyze and compare the gut bacterial profile.ResultsOur investigation through the qPCR (Absolute quantification) approach revealed a significantly higher abundance of Actinobacteria in healthy, in comparison to children suffering from Severe Acute Malnutrition (SAM). Consequently, the same trend was also reflected with respect to Bifidobacterium, a prominent member of the Actinobacteria phylum. Conversely, a significant higher abundance of Lactobacillus with the diminishing nutritional status was recorded. Escherichia showed a significant higher abundance in healthy subjects compared to the malnourished; however, no such difference in abundance of Klebsiella was observed. The other target phyla [Bacteroidetes, Firmicutes and Proteobacteria] and genera (Faecalibacterium and Roseburia) showed differences in abundance; however, these were non-significant. Similarly, the bacterial taxonomy analysis of 16S rRNA gene amplicon sequencing data revealed the higher abundance of phylum Actinobacteria and its member Bifidobacterium with lower prevalence of Lactobacillus in healthy children.ConclusionThe pattern of gut microbiota profile in malnourished subjects suggests a dysbiotic gut depleted in Bifidobacteria, a core member of the consortia of beneficial anaerobes of the healthy child gut.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00394-021-02571-7.

Broccoli-Soybean-Mangrove Food Bar as an Emergency Food for Older People during Natural Disaster.

Older people risk poor nutritional status during natural disasters due to low intakes of energy, carbohydrates, protein, and fat. A food bar is a form of emergency food product that contains carbohydrate and protein, and is practical for disaster situations. The study aimed to investigate the effect of a broccoli-soybean-mangrove food bar on older people’s weight following natural disasters. A quasi-experimental pre-post intervention study was designed using 33 subjects at the treatment group of various nutritional status types of older people during two weeks with balanced nutrition education over two weeks. Bivariate analysis with a paired t-test used to test whether weight, macronutrient intakes, and balanced nutrition knowledge were significantly different before and after the study. The study showed broccoli-soybean-mangrove food bar consumption resulted in a significantly increased weight of 0.2 kg, energy (291.9 kcal), protein (6.1 g), carbohydrate (31.1 g), dan fat (15.6 g) intakes. Balanced nutrition education of older people could also substantially increase knowledge of older people regarding nutrition (11.8 points). The proportion of malnourished subjects who gained weight was more remarkable than normal subjects in the first and second weeks of the intervention. However, the proportion of normal nutritional status subjects having increased macronutrients intakes was higher than the malnourished subjects. These findings recommend broccoli-soybean-mangrove food bar consumption to significantly improve weight and macronutrients intakes in older people following a natural disaster. It is necessary to make the broccoli-soybean-mangrove food bar more available, accessible, and affordable to all people in emergencies, mainly for older people.

Complete Blood Count Profile and Derived Inflammatory Markers in Children with Severe Acute Malnutrition Seen in Sokoto, North-Western Nigeria

Severe acute malnutrition (SAM) is a major cause of mortality among children in Nigeria. Majority of affected children die from sepsis related complications. The complete blood count includes inflammatory markers which have been found to be useful in predicting sepsis and mortality in children, but these findings have not been corroborated in our population. The aim of this study was to compare the haematological profile and inflammatory markers of severely malnourished children to age matched controls admitted for febrile illnesses. It was a cross sectional study carried out in the emergency paediatric unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Severely malnourished children aged 6 months to 5 years and a comparative cohort who were not severely malnourished were consecutively recruited as they presented for admission. Relevant data were entered into a proforma and blood samples taken for complete blood count amongst others. Total and differential white cell counts, lymphocyte-neutrophil ratio and platelet indices were compared. There were 64 children comprising 32 severely malnourished and 32 well-nourished children. Mean white cell count, absolute lymphocyte and monocytes were significantly higher among the malnourished while mean platelet volume (MPV) and platelet distribution width (PDW) were significantly lower for the malnourished subjects. There were eight mortalities all among the malnourished children and mean neutrophil count was significantly higher among the mortalities. In conclusion, severely malnourished children had more lymphocytosis, however, mortality was associated with neutrophilia. Platelet indices of inflammation were lower in malnourished than non-malnourished subjects.

An integrative approach to detect protein–energy wasting among chronic kidney disease maintenance hemodialysis patients

<br><b>Background:</b> Malnutrition is a major predictor of overall outcome in patients on hemodialysis. Regular and frequent evaluation of the nutritional status of these patients is advisable. <b>Aims and Objectives:</b> This study aimed to look at nutritional status of a hemodialysis cohort and to evaluate whether multiple assessment tools improve the detection of malnutrition in this cohort. <b>Materials and Methods:</b> A prospective study in two outpatient hemodialysis centers was conducted over 6 months. Stable patients without any irreversible organ damage and preserved cognitive function were included in the study. Data collected included demographics, comorbid conditions, and baseline laboratory investigations. The nutritional assessment tools included body mass index (BMI), 7-point Subjective Global Assessment, Global Leadership In Malnutrition (GLIM), handgrip strength, and body composition analysis. <b>Results:</b> A total of 121 subjects (77 males, 44 females) participated in the study. Based on BMI, only 14% were underweight. 7-point SGA detected 77 malnourished subjects, whereas according to GLIM criteria, all patients had some degree of malnutrition. Body composition analysis showed depleted total body protein mass in majority of patients. There was a correlation between total body protein mass and handgrip strength. The assessment tools showed some degree of correlation in patients who were malnourished. <b>Conclusions:</b> Use of a single assessment tool often underdiagnoses malnutrition in hemodialysis patients. An integrative approach using multiple evaluation tools may be beneficial in these groups of patients.<br>

The Impact of Malnutrition on Acute Muscle Wasting in Frail Older Hospitalized Patients.

Very little is known about the effect of malnutrition on short-term changes of body composition, particularly muscle, among older hospitalized patients. We sought to investigate the association of malnutrition as assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria with changes of thigh muscle mass and muscle strength among older patients during hospitalization. Forty-one patients (age range 66–97 years, 73% female) participated in this prospective longitudinal observational study. Nutritional status was evaluated using the GLIM criteria on admission and at discharge. Functional status and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and before discharge. In all, 17% were malnourished and 83% had no malnutrition. Mean mid-thigh muscle CSA declined by 7.0 cm2 (−9%) in malnourished patients during hospitalization (p = 0.008) and remained unchanged among non-malnourished patients (−1%, p = 0.390). Mean mid-thigh CSA of subcutaneous and intermuscular fat did not change significantly during hospitalization in both groups. Malnourished subjects lost 10% of handgrip strength (−1.8 kg) and 12% of knee extension strength (−1.5 kg) during hospitalization. However, the magnitude of both changes did not differ between groups. In a stepwise multiple regression analysis, malnutrition and changes in body weight during hospitalization were the major independent risk factors for the reduction of muscle CSA. Malnutrition according to the GLIM criteria was significantly and independently associated with acute muscle wasting in frail older patients during 2-week hospitalization.

The influence of diet therapeutic intervention on the sarcopenic index of patients with metabolic syndrome.

The published data showed the importance of metabolic control in preventing complications in metabolic syndrome (MS) and the role of nutritional medical therapy in glycemic control and in the control of dyslipidemia, hypertension, weight loss/normalization (in overweight or malnourished subjects). This study follows the evolution of sarcopenic index (SI) and other clinical parameters (body mass index (BMI), homeostasis evaluation index (HOMA index)) correlated with MS after diet therapy or diet therapy combined with sports, in patients with MS. Our research was conducted during 12 months, on 110 patients >18 years of age, with HOMA index>2, divided into three groups: control group (CG, N=20), diet therapy group (DTG, N=58), diet therapy and sports group (DTSG, N=32). HOMA index for insulin resistance was calculated as the product of resting plasma insulin (in microunits/milliliter) and plasma glucose (in millimoles/liter), divided by 22.5. SI was determined using BIA, as being the ratio between muscle mass and fat mass, measured in cm2/m2. A significant decrease of BMI (p<0.05) in DTG (from 31.63 to 24.50) and DTSG (from 30.18 to 24.17) vs. CG was observed (Pearson coefficient r=0.281, p<0.001). Weight status changed significantly (p<0.05) in the high-risk patients. There was a significant decrease of HOMA index (p<0.05) in DTG (from 5.93 to 2.57), DTSG (from 3.93 to 2.23), and in CG an increase was observed (from 3.15 to 3.37). The best results in the prevention/ treatment of sarcopenia in MS patients were obtained for DTSG, which benefited from both the positive effect of diet and physical activity.