Malnutrition Group Research Articles

Comparison of creatinine index and geriatric nutritional risk index for nutritional evaluation of patients with hemodialysis.

Malnutrition is prevalent in hemodialysis (HD) patients, and the risk of mortality is strongly correlated with malnutrition. Current methods of nutritional evaluation are mostly subjective, time-consuming, and cumbersome. Creatinine index (CI) and geriatric nutritional risk index (GNRI) are very simple and objective methods to assess the nutritional status of HD patients. The present study compares the performance of CI and GNRI as nutritional risk assessment tools. Eighty-eight patients with end-stage renal disease on HD were recruited from a single tertiary center. A clinical dietitian carried out individual interviews of all patients and made nutritional diagnosis. Demographic and clinical data were also used to derive GNRI and CI over 4 months. Thirty-eight out of 88 patients (44%) were diagnosed with normal nutritional status. Twenty-two patients (25%) were diagnosed with severe malnutrition and 27 (31%) had moderate malnutrition. Compared with patients with severe malnutrition, the normal group and those with moderate malnutrition showed significantly higher levels of body mass index and GNRI. Even though GNRI was associated with CI, protein intake, uric acid, and normalized protein nitrogen were not significantly correlated with GNRI, whereas the markers were highly associated with CI (P = 0.000). GNRI enable the identification of the severe malnutrition group but not the normal and moderate-malnutrition groups. However, based on CI, the normal group was distinguished while those with severe and moderate malnutrition were not. Either CI or GNRI was a valid tool for longitudinal observation of nutritional status of patients on chronic HD and facilitated the screening of cases with malnutrition. Compared with GNRI, CI ranked higher in performance for the assessment and monitoring of nutritional status in HD patients.

Correlation between malnutrition and acute coronary syndrome in the elderly with comprehensive geriatric assessment

Objective To analyze the influence of malnutrition in the elderly patients with acute coronary syndrome on related factors and short-term prognosis. Methods 415 elderly patients with acute coronary syndrome were selected.Comprehensive geriatric assessment was used to investigate the risk of acute coronary syndrome by examining coexisting diseases and using the NRS2000 score.The mortality and emergency visits were followed up. Results The patients were divided into two groups according to NRS2000 score: malnutrition group (n=179) and non-malnutrition group (n=236). (1) In malnutrition group, the proportions of female, over 85 years old, more than 3 kinds of coexisting diseases were 47.5%(85/179), 11.7%(21/179), 62.6%(112/179), respectively, which were higher than those of the non-malnutrition group[36.9%(87/236), 4.7%(11/236), 41.9%(99/236)](χ2=4.732, 7.152, 17.318, all P<0.05). (2) In malnutrition group, the incidence rates of geriatric syndromes such as uracratia, falls, visual disorder, hearing disorder, constipation, sleep disorders, oral problems were 47.5%(85/179), 30.2%(54/179), 40.2%(72/179), 41.9%(75/179), 54.7%(98/179), 52.0%(93/179), 76.5%(137/179), respectively, which were higher than those of the non-malnutrition group[31.4%(74/236), 14%(33/236), 29.2% (69/236), 29.7% (70/236), 30.5%(72/236), 36.0%(85/236), 53.0%(125/236)](χ2=11.206, 16.092, 5.477, 6.707, 24.732, 10.577, 24.297, all P<0.05). (3) In malnutrition group, the incidence rates of coexisting chronic diseases such as hypertension, chronic obstructive pulmonary disease, heart failure, severe renal insufficiency, cerebrovascular disease, dementia, anemia, osteoporosis were 77.1%(138/179), 16.2% (29/179), 22.9%(41/179), 17.9%(32/179), 46.9%(84/179), 6.7%(12/179), 27.4%(49/179), 26.8%(48/179), respectively, which were higher than those of the non-malnutrition group[61.9%(146/236), 7.6%(18/236), 14.4%(34/236), 7.2%(17/236), 32.2%(76/236), 1.3%(3/236), 13.1%(31/236), 17.4%(41/236)](χ2=10.931, 7.451, 4.965, 11.137, 9.315, 8.624, 13.262, 5.388, all P<0.05). (4)Cox regression analysis showed that malnutrition risk score was the independent risk predictor for all-cause mortality (HR=0.034, 95% CI: 0.072-0.904) and emergency department visits (HR=0.328, 95% CI: 0.197-0.548) in elderly patients with acute coronary syndrome. Conclusion Comprehensive geriatric assessment and nutritional assessment are useful to evaluate the clinical features of acute coronary syndrome in elderly patients.Malnutrition risk score is an independent predictor of all-cause mortality and emergency treatment in elderly patients with acute coronary syndrome. Key words: Coronary disease; Comprehensive geriatric assessment; Aged; Malnutrition

A Low-Protein Diet for Diabetic Kidney Disease: Its Effect and Molecular Mechanism, an Approach from Animal Studies.

A low-protein diet (LPD) can be expected to retard renal function decline in advanced stages of chronic kidney disease (CKD), including diabetic kidney disease (DKD), and is recommended in a clinical setting. Regarding the molecular mechanisms of an LPD against DKD, previous animal studies have shown that an LPD exerts reno-protection through mainly the improvement of glomerular hyperfiltration/hypertension due to the reduction of intraglomerular pressure. On the other hand, we have demonstrated that an LPD, particularly a very-LPD (VLPD), improved tubulo-interstitial damage, inflammation and fibrosis, through the restoration of autophagy via the reduction of a mammalian target of rapamycin complex 1 (mTORC1) activity in type 2 diabetes and obesity animal models. Thus, based on animal studies, a VLPD may show a more beneficial effect against advanced DKD. Previous clinical reports have also shown that a VLPD, not a moderate LPD, slows the progression of renal dysfunction in patients with chronic glomerular nephritis. However, there is insufficient clinical data regarding the beneficial effects of a VLPD against DKD. Additionally, the patients with CKD, including DKD, are a high-risk group for malnutrition, such as protein–energy wasting (PEW), sarcopenia, and frailty. Therefore, an LPD, including a VLPD, should be prescribed to patients when the benefits of an LPD outweigh the risks, upon consideration of adherence, age, and nutritional status. As the future predicts, the development of a VLPD replacement therapy without malnutrition may be expected for reno-protection against the advanced stages of DKD, through the regulation of mTORC1 activity and adequate autophagy induction. However, further studies to elucidate detailed mechanisms by which a VLPD exerts reno-protection are necessary.

Malnutrition and Malnutrition Risk Can Be Associated with Systolic Orthostatic Hypotension in Older Adults.

Malnutrition and orthostatic hypotension(OH) are the two important geriatric syndromes, which have similar negative outcomes such as falls. The aim of the study is to detect whether there is any relation between malnutrition and OH. 862 geriatric patients, who had undergone comprehensive geriatric assessment (CGA),were included in the retrospective study. OH was identified as 20 and/or 10 mmHg dropped for systolic and/or diastolic blood pressures with the active standing test when patients got up from supine to standing position. Nutritional status was checked according to Mini Nutritional Assesment-Short Form(MNA-SF). The mean age of the patients was 74±8.05, and %66.3 of them were female. The prevalence of malnutrition, malnutrition-risk and OH were detected as 7.7%, 26.9 % and 21.2%, respectively. When OH, systolic OH, diastolic OH and control group were compared with CGA parameters and the effects of age and gender were removed, the frequency of falls and Timed-Up and Go Test were higher, activity daily living indexes and TINETTI-Balance scores were lower in systolic OH than without it (p<0.05).Systolic OH was more frequent in malnutrition-risk and malnutrition group than control group (p<0.002 and p<0.05, respectively). Diastolic OH was not associated with nutritional status (p>0.05).OH was only higher in malnutrition-risk group than robust (p<0.05). Our findings suggest that not only malnutrition but also malnutrition-risk may be associated with systolic OH, which leads to many negative outcomes in older adults. Because malnutrition/ malnutrition risk is preventable and reversible, nutritional status should be checked during the evaluation of OH patients.

Geriatric nutritional risk index is not an independent predictor in patients with diffuse large B-cell lymphoma.

The prognostic value of geriatric nutritional risk index (GNRI) for diffuse large B-cell lymphoma (DLBCL) treated in the rituximab era was not clear. To investigate the prognostic impact of GNRI in patients with DLBCL in our hospital. DLBCL patients were recruited and classified into two groups with and without malnutrition based on GNRI. Clinical features, concentration of T-helper cell type (Th1/Th2/Th17) cytokine profiles and overall survival were compared between these two groups. One hundred and five (39%) out of 267 patients were classified into malnutrition group. Patients with malnutrition had lower levels of albumin and hemoglobin, but older age, higher lactate dehydroxygenase (LDH) level, higher frequencies of advanced stage, poor performance status, B symptoms and extranodal involvement, higher scores of NCCN-IPI and higher level of INF-γ. Moreover, patients with malnutrition had poor overall survival in univariate analyses. But these significances did not stand after stratified analyses by NCCN-IPI, or in the context of NCCN-IPI in the multivariate analyses. GNRI is not an independent predictor for DLBCL patients.

Assessing nutritional status of severe malnutrition patients by bioelectrical impedance technique: a multicenter prospective study

To assess the nutritional status of severe malnutrition patients with anorexia nervosa by multi-frequency bioelectrical impedance technique, and to provide the basis for nutritional support therapy. A prospective study was conducted. Twenty-six severe malnutrition patients with anorexia nervosa, body mass index (BMI) ≤ 16 kg/m2 admitted to intensive care unit (ICU) of Peking University Third Hospital and general three ward of Peking University Sixth Hospital from June 1st to September 30th, 2017 were enrolled. The extracellular water (ECW), intracellular water (ICW), ECW/ICW ratio, adipose tissue mass (ATM), lean tissue mass (LTM), total body water/body weight (TBW/WT), ATM/WT, and LTM/WT were measured by multi-frequency bioelectrical impedance meter. Thirty-eighty healthy volunteers with normal nutritional status (23.0 kg/m2 > BMI > 18.5 kg/m2) matched by gender and height were enrolled as healthy control group. The predictive value of main body composition for nutritional status were analyzed by receiver operating characteristic (ROC) curve. All the patients were female. There was no significant difference in height between two groups, but WT and BMI in the severe malnutrition group were significantly higher than those in the healthy control group [WT (kg): 38.1±4.9 vs. 54.2±3.3, BMI (kg/m2): 13.6±2.5 vs. 21.2±1.1, both P < 0.01]. Compared with the healthy control group, the ECW, ICW, ATM, LTM, ATM/WT and LTM/WT were significantly decreased in the severe malnutrition group [ECW (L): 9.02±0.42 vs. 10.19±0.77, ICW (L): 12.6±0.9 vs.19.1±1.3, ATM (kg): 9.3±1.1 vs. 16.6±1.9, LTM (kg): 16.5±1.5 vs. 26.1±1.7, ATM/WT: 0.26±0.02 vs. 0.30±0.02, LTM/WT: 0.22±0.02 vs. 0.26±0.01, all P < 0.01], the ECW/ICW and TBW/WT were significantly increased in the severe malnutrition group (ECW/ICW: 0.72±0.06 vs. 0.54±0.06, TBW/WT: 0.58±0.02 vs. 0.52±0.02, both P < 0.01). It was shown by ROC curve analysis that the area under ROC curve (AUC) of TBW/WT, ATM/WT, LTM/WT for evaluating severe malnutrition were 0.999, 0.919, 0.954 respectively; when the cut-off of TBW/WT, ATM/WT, LTM/WT were 0.58, 0.28, 0.24 respectively, the sensitivity were 100%, 85%, 80% respectively, and the specificity were 95%, 80%, 91% respectively. Main body composition of severe malnutrition patients with anorexia nervosa changed significantly. Bioelectrical impedance technology can be an effective assessment tool for the nutritional status of such patients.

Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival.

Preoperative malnutrition can worsen morbidity and mortality; however, the role of postgastrectomy nutritional status remains unclear. Our purpose was to clarify whether malnutrition after gastrectomy could predict long-term survival. Patients with pathological stage I, II, and III gastric cancer who underwent gastrectomy between 2002 and 2013 were included. The nutrition risk index (NRI) was evaluated before and at 1, 3, 6 and 12months after gastrectomy. The patients were divided into normal (NRI>97.5) or malnutrition (NRI≤97.5) groups, and we compared the correlations of clinicopathological characteristics, surgical treatment, and overall survival between the two groups. Among the 760 participants, patients in the malnutrition group were significantly older and had higher incidences of comorbidity and advanced cancer than the patients in the normal group. Multivariate analysis showed that overall survival was poorer in the malnutrition group before gastrectomy [hazard ratio (HR) 1.68] and at 1month (HR 1.77), 3months (HR 2.18), 6months (HR 1.81) and 12months (HR 2.17) after gastrectomy (all p<0.01). Malnutrition at 1 and 3months after gastrectomy was significantly associated with poor cause-specific survival. Total gastrectomy, preoperative malnutrition, older age, and adjuvant chemotherapy were independent risk factors of postoperative malnutrition at 12months postgastrectomy. Malnutrition before gastrectomy and at 1, 3, 6 and 12months after gastrectomy significantly and adversely affects overall survival. Nutritional interventions to lessen the impact of postoperative malnutrition offer hope for prolonged survival.

Evaluation of perioperative nutritional status with subjective global assessment method in patients undergoing gastrointestinal cancer surgery.

This study was designed to evaluate the perioperative nutritional status of patients undergoing surgery for gastrointestinal cancer using Subjective Global Assessment and surgeon behavior on nutritional support. We recruited 100 patients undergoing surgery for gastrointestinal cancer in one university and two state teaching hospitals. Subjective Global Assessment was administered to evaluate preoperative and postoperative nutritional status. Fifty-two patients in the state hospitals (Group 1) and 48 in the university hospital were assessed. Anthropometric and biochemical measurements were performed. Changes in preoperative Subjective Global Assessment scores and scores at the time of discharge and types of nutritional support were compared. Subjective Global Assessment-B was regarded as moderate and Subjective Global Assessment-C as heavy malnutrition. Ten patients had Subjective Global Assessment-B and 29 had Subjective Global Assessment-C malnutrition in Group 1 and nine had Subjective Global Assessment-B and 31 had Subjective Global Assessment-C malnutrition in Group 2 during preoperative assessment. Respective numbers in postoperative assessment were 12 for Subjective Global Assessment-B and 30 for Subjective Global Assessment-C in Group 1 and 14 for Subjective Global Assessment-B and 26 for Subjective Global Assessment-C in Group 2. There was no difference between two groups. Nutritional methods according to Subjective Global Assessment evaluation in pre- and postoperative periods were not different between the groups. This study demonstrated that the malnutrition rate is high among patients scheduled for gastrointestinal cancer surgery and the number of surgeons were inadequate to provide perioperative nutritional support. Both university and state hospitals had similar shortcomings. Subjective Global Assessment is an easy and reliable test and if utilized will be helpful to detect patients requiring nutritional support.

RELATIONSHIP BETWEEN NUTRITIONAL CONDITIONS AND RATE OF PROTEIN DEGRADATION LEVELS IN PATIENTS CHRONIC KIDNEY DISEASE HEMODIALYSIS

Objectives: To investigate malnutrition and the correlation between nutrient status and rate of protid degeneration (nPCR) in end stage renal disease patients undergoing dialysis. Object and method: A crosssectional study of 207 hemodialysis patients in the Department of Internal Medicine - Urology - Hemodialysis, Can Tho General Hospital. Results: The malnutrition rate according to SGA_3 for cyclic renal dialysis patients was severe malnutrition (27.8%), with statistically significant difference (p &lt;0.05), severe body mass index (BMI) was 2.9% in dialysis patients. The difference between men and women was statistically significant (p &lt;0.05) Serum malnutrition, 4.8% in patients with cyclic human nephropathy, was statistically significant (p &lt;0.05) between levels of malnutrition and concentration Serum prevalence, severe malnutrition, accounted for 17.9% in patients with cyclic human renal disease, statistically significant (with p &lt;0.05) among malnutrition groups. The nPCR concentration was positively correlated with serum albumin concentration. In multivariate logistic regression, nPCR concentrations correlated with BMI. Conclusion: Severe malnutrition according to SGA_3 accounts for 27.8%, there is a difference between men and women, severe BMI malnutrition accounts for 2.9%, Serious albumin malnutrition accounts for 4.8 % and severe malnutrition under serum prealbumin accounted for 17.9% between the different methods, the difference was statistically significant when p &lt;0.05. The level of nPCR is positively correlated with serum albumin. In multivariate logistic regression, nPCR concentrations correlated with BMI. Key words: nPCR, BMi, SGA_3, serum albumin, serum albumin, serum leptin, end stage renal disease, renal dialysis, malnutrition

Central Hematocrit Levels in Fetal Malnourished Term Infants.

Fetal malnutrition is especially important for common chronic diseases in adult life. They could potentially be prevented by achieving optimal fetal nutrition. The aim of this study was to investigate hematocrit levels of malnourished, term, appropriate for gestational age (AGA) neonates. A total of 80 AGA neonates (between 10% and 90% percentiles interval according to birth week), born with spontaneous vaginal delivery between 37 and 42 weeks of gestation, detected by both last menstrual period and ultrasonography measurements, were included in the study. Neonates with fetal malnutrition constituted the study group and the control group consisted of well-nourished neonates. We analyzed central venous hematocrit levels obtained 4 hours after birth and maternal risk factors for both groups. Although there were no differences in gestational age, head circumference, maternal factors (gravidity, parity, abortions and curettage counts, maternal tobacco use, preeclampsia, hypertension, diabetes mellitus, gestational diabetes mellitus, and history of urinary tract infections), first minute APGAR scores, and sex, Clinical Assessment of Nutritional Status score was lower (29.91±2.87 vs. 21.25±1.65) and hematocrit levels were higher (51.33±2.740 vs. 59.53±5.094) in the fetal malnutrition group (P<0.0001). Central hematocrit levels in malnourished term AGA neonates were found significantly higher than well-nourished term AGA newborns.

The Prognostic Impact of Controlling Nutritional Status (CONUT) in Intrahepatic Cholangiocarcinoma Following Curative Hepatectomy: A Retrospective Single Institution Study.

Several studies have examined controlling nutritional status (CONUT), which is one of the useful biomarkers for predicting patients' prognosis following cancer treatment. The aim of this study was to evaluate the value of CONUT as a postoperative prognostic marker in patients with intrahepatic cholangiocarcinoma (ICC) following curative hepatectomy. We retrospectively analyzed 71 patients who underwent curative hepatectomy for ICC between May 2002 and November 2016. Patients were divided into two groups according to their preoperative CONUT score (i.e., CONUT≧2 or CONUT<2). The number of patients assigned to the normal, mild, moderate, or severe malnutrition groups was 40, 28, two, and one, respectively. The high CONUT group (CONUT≧2) consisted of 31 patients (43.7%) and had a poor prognosis with regard to overall survival (OS) (p=0.0149). A high CONUT score is also identified as one of the independent predictors of poor prognosis in OS (hazard ratio 3.02; 95% confidence interval 1.4-6.8; p=0.007). However, in the current study, a high CONUT score was not associated with postoperative complications (Clavien-Dindo classification≧III or more). CONUT may be useful for the preoperative assessment of prognosis in patients with ICC who have undergone curative hepatectomy.

Beneficial effects of curcumin nano-emulsion on spermatogenesis and reproductive performance in male rats under protein deficient diet model: enhancement of sperm motility, conservancy of testicular tissue integrity, cell energy and seminal plasma amino acids content

BackgroundMalnutrition resulting from protein and calorie deficiency continues to be a major concern worldwide especially in developing countries. Specific deficiencies in the protein intake can adversely influence reproductive performance. The present study aimed to evaluate the effects of curcumin and curcumin nano-emulsion on protein deficient diet (PDD)-induced testicular atrophy, troubled spermatogenesis and decreased reproductive performance in male rats.MethodsJuvenile rats were fed the protein deficient diet (PDD) for 75 days. Starting from day 60 the rats were divided into 4 groups and given the corresponding treatments for the last 15 days orally and daily as follows: 1st group; curcumin group (C) received 50 mg/kg curcumin p.o. 2ndgroup; curcumin nano-form low dose group (NCL) received 2.5 mg/kg nano-curcumin. 3rd group; curcumin nano-form high dose group (NCH) received 5 mg/kg nano-curcumin. 4th group served as malnutrition group (PDD group) receiving the protein deficient diet daily for 75 days and received distilled water ingestions (5 ml/kg p.o) daily for the last 15 days of the experiment. A normal control group was kept under the same conditions for the whole experiment and received normal diet according to nutrition requirement center daily for 75 days and received distilled water ingestions (5 ml/kg p.o) daily for the last 15 days of the experiment.ResultsPDD induced significant (P < 0.05) reduction in serum testosterone level, sperm motility, testicular GSH, CAT, SOD, testicular cell energy (ATP, ADP and AMP), essential and non-essential amino acids in seminal plasma, an increase in testicular MDA, NOx, GSSG and 8-OHDG. Data was confirmed by histological examination and revealed pathological alteration in the PDD group. Ingestion of curcumin (50 mg/kg) and curcumin nano-emulsion (2.5 and 5 mg/kg) showed significant (P< 0.05) amelioration effects against PDD-induced disrupted reproductive performance as well as biochemical and pathological alterations and the overall results of the nano-emulsion (5 mg/kg) were comparable to curcumin (50 mg/kg).ConclusionsThe present study suggests that administration of curcumin nano-emulsion as a daily supplement would be beneficial in malnutrition- induced troubled male reproductive performance and spermatogenesis cases.

Factors associated with malnutrition in adolescent and adult patients with cystic fibrosis.

To determine the prevalence of malnutrition in patients attending an adult cystic fibrosis (CF) program and to investigate the associations of malnutrition with the clinical characteristics of those patients. This was a cross-sectional study involving patients with clinically stable CF patients (16 years of age or older). The patients underwent clinical assessment, nutritional assessments, pulmonary function tests, and pancreatic function assessment. They also completed a questionnaire regarding diet compliance. On the basis of their nutritional status, the patients were classified divided into three groups: adequate nutrition; at nutritional risk; and malnutrition. The study has included 73 patients (mean age, 25.6 ± 7.3 years), 40 of whom (54.8%) were female. The mean body mass index was 21.0 ± 3.0 kg/m2 and the mean FEV1 was 59.7 ± 30.6% of predicted. In this sample of patients, 32 (43.8%), 23 (31.5%), and 18 (24.7%) of the patients were allocated to the adequate nutrition, nutritional risk, and malnutrition groups, respectively. The logistic regression analysis identified three independent factors associated with the risk of malnutrition: Shwachman-Kulczycki score, percent predicted FEV1; and age. Malnutrition remains a common complication in adolescents and adults with CF, despite dietary advice. Malnutrition is associated with age, clinical severity, and lung function impairment.

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia

AbstractBackgroundSarcopenic dysphagia is characterized by difficulty swallowing due to loss of whole‐body skeletal and swallowing muscle mass and function. Despite multiple reports regarding sarcopenic dysphagia, no verified diagnostic methods exist. The purpose of this study was to develop a diagnostic algorithm for sarcopenic dysphagia and verify its reliability and validity.MethodsFirst, our research group, the Working Group on Sarcopenic Dysphagia, developed a diagnostic algorithm for sarcopenic dysphagia. Patients 65 years and older who could follow commands were eligible for assessment using the algorithm. Patients without whole‐body sarcopenia, with normal swallowing function, and with a disease that was an obvious cause of their dysphagia were considered not to have sarcopenic dysphagia. Then, swallowing muscle strength was assessed by tongue pressure. Those with poor swallowing muscle strength were deemed to be at probable risk for sarcopenic dysphagia and those with normal swallowing muscle strength to be at possible risk for sarcopenic dysphagia. Second, we applied the algorithm to inpatients 65 years and older and investigated their characteristics, muscle mass, muscle strength, motor function, swallowing muscle strength, swallowing function, and nutritional status. We investigated the reliability of the algorithm by analyzing intra‐ and inter‐class correlation coefficients using kappa statistics. Third, we investigated the validity of the algorithm by analyzing the difference in the proportion of patients with sarcopenic dysphagia between the no malnutrition and malnutrition groups and investigated the risk factors for sarcopenic dysphagia using logistic regression analysis.ResultsA total of 119 patients participated in this study. Their mean age was 86.1 years, and 55 (46%) were men. Among the 119 patients, 32 were categorized as having possible sarcopenic dysphagia, 18 probable sarcopenic dysphagia, and 69 no sarcopenic dysphagia. The intra‐class coefficient for the algorithm was 0.87 (95% confidence interval [CI]: 0.73‐1.01), and the inter‐class coefficient was 0.98 (95% CI: 0.92‐1.02), indicating high intra‐ and inter‐rater reliabilities. In the investigation of the algorithm's validity, 67 patients were analyzed. The proportion of patients with sarcopenic dysphagia was significantly higher in the malnutrition than in the no malnutrition group (P = 0.028). Malnutrition and age were independently associated with sarcopenic dysphagia (P = 0.013 and 0.003, respectively).ConclusionsA diagnostic algorithm for sarcopenic dysphagia was developed, and its reliability and validity were verified. All older patients with sarcopenia or dysphagia should be assessed for sarcopenic dysphagia, which requires treatment involving not only rehabilitation for dysphagia but also nutritional improvement.

Pengaruh Pemberian Makanan Pendamping Asi ( MP – ASI) Dini Terhadap Kejadian Kekurangan Energi Protein (KEP) Pada Anak Umur 0 – 24 Bulan Di Wilayah Kota Kediri

Should we know that Mother’s Milk Complementary Foods is begin giving when someday after the baby was born. This is deficient think, because Mother’s Milk Complementary Foods present can make malnutrition consist or disturb child development (Energy-Protein Malnutrition). The destination of this research is to find out effect of giving too early Mother’s Milk complementary Foods with Energy-Protein Malnutrition incident to children on zero until twenty four months old. The methode of this research is the corelation with analitic case control characteristic that is eight child as case and eight others as control of fill up inclusion criteria . The samples will take by purposive sampling tehnis . The finishing data collection are using questionaire by weight and height measurement. The data analitic are using fisher exact probability test with 5% significancy. The result of this research is giving Mother’s Milk Complementary Foods to 87,5% Energy-Protein Malnutrition group and 25% non Energy-Protein Malnutrition is not timely. 100% Energy-Protein Malnutrition is nasty. There is an effect of giving too early Mother’s Food Complementary Foods in Energy-Protein Malnutrition accident on children at zero untill six months old. Be expected for the health personnel to give information and counseling about to give too early Mother’s Milk Complementary Foods about effect and the interval, at the same time for a children whio has Energy-Protein Malnutrition must give supplementary food that appropriate with the local program and integrated by Department of health.; Keywords = Giving too early Mother’s Milk Complementary Foods, Energy-Protein Malnutrition

Cysteine, Malondyaldehide (MDA) and Glutathione (GSH) Levels in Marasmic Type Malnutrition

Micronutrien deficiency in severe malnutrition will reduce antioxidant capacity that needed for oxidative stress defense. Cysteine, a non-essential amino acid, is one of an important component for reduced glutha-tione (GSH). This study aims to prove the difference between the levels of cysteine, MDA and GSH levels in children with marasmic malnutrition and well-nourished children and prove whether there is a relationship between those parameters. Fiftysix patients participated in this study were grouped into two groups of sam-ples that were marasmic type malnutrition group (28 patients) and control groups that were well nourished group (28 patients). Examination begins with a complete laboratory screening, followed by examination of cysteine, MDA and GSH level. Of the 28 patients included in marasmic type malnutrition group consisting of 15 male patients (53.6%) and 13 female patients (46.4%), while the well-nourished group consisted of 13 male patients (46.4%) and 15 female patients (53.6%). The average age is 54.61±56.35 months in the group of ma-rasmic type malnutrition and 48.25±45.34 months in the well-nourished group. By using the Mann Whitney test, there were significant difference between the levels of cysteine and GSH in marasmic malnutrition and control group (p = 0.000 and p = 0.000 respectively). Spearman correlation test between cysteine and GSH levels, cysteine and MDA levels, MDA and GSH levels in marasmic malnutrition children shows no significant correlation (R = -0.206, p = 0.294; R = -0.036, p = 0.856; R = 0.210, p = 0.284 respectively). In well-nourished group Spearman correlation test between cysteine and GSH levels, cysteine and MDA levels, MDA and GSH levels also shows no significant correlation (R = -0.053, p=0.789; R = -0.146, p = 0.458; R = -0.079, p = 0.688 re-spectively). From this study it can be concluded that there are significant differences of the levels of cysteine and GSH between severe malnutrition groups compared with the control one. But this study shows no signif-icant correlation between the levels of cysteine and GSH levels in marasmic type malnutrition and well-nourished children.

Nutritional status of elders in Galle district, Sri Lanka

Introduction: Geriatric population in Sri Lanka is a potentially vulnerable group for malnutrition. The present study was carried out to assess the nutritional status of elderly in Galle and to identify the relationships of their nutritional status with gender, age, area of residence, level of education and income. Methods : A cross sectional study was done using a sample of elders aged 60 years and above living in Galle district. An interviewer administered questionnaire was used to collect data. Mini Nutritional Assessment (MNA) tool was used to assess nutritional status. Results : A total of 396 elders participated in the study. Mean age of the participants was 69 years ( SD = 7.2) and the majority were females (n = 268, 67.7%). MNA showed that 0.5% elderly were malnourished and 30.8% were at risk of malnutrition. Older age ( p 0.05), lower monthly family income ( p p p 0.05) were found to be possible risk factors of malnutrition. Conclusions : Nutritional status is considerably poor in the elderly in Galle district. Therefore, geriatric nutritional interventions in low income older age elders in rural population segments in the area are needed.

Prevalence and Risk Factors of Malnutrition among HIV-Infected Children Aged 2-18 Years: A Cross Sectional Study

Background: Malnutrition and underweightness are common problems among HIV-infected children in low and middle income countries. Methods and findings: A single-centered, retrospective, cross-sectional cohort survey was conducted between January 1, 2014 and June 30, 2014 to assess the prevalence and risk factors of malnutrition among HIV-infected children aged 2-18 years at the Bamrasnaradura Infectious Diseases Institute (BIDI), Thailand. Clinical and laboratory data were compared between a malnutrition group, (Group A): body mass index (BMI) for age 5th percentile and <95th percentile. One hundred and ninety-five HIVinfected children were retained for analyses. The prevalence of malnutrition was 43% (83 of 195). The following proportions were higher in Group A than B, respectively: advanced clinical staging (83% vs. 12%), PI-based HAART (73% vs. 38 %) and anaemia (48% vs. 8%) (all p<0.05). The median of Log10 plasma HIV RNA was higher in Group A than B (1.7 vs. 1.6, respectively; p<0.05). The proportions of RNA ≤ 40 copies/mL and parent caregivers in Group A were lower than B (48% vs. 86% and 35% vs. 54%, respectively; all p<0.05). Other factors did not differ significantly. In multivariate analysis, malnutrition was significantly associated severity (WHO stages 3 and 4) (OR=184.50, 95% CI=[35.72-952.73]), PI (OR= 5.38, 95% CI=[1.97-14.67]) and parent as caregivers (OR= 0.56, 95% CI=[0.34-0.92]). No significant differences between Group A and B were found in Log10 plasma HIV RNA, RNA ≤ 40 copies/mL, hemoglobin and anemia. Conclusion: The prevalence of malnutrition was 43%. Malnutrition among HIV-infected children was associated with the severity of disease, PI-based HAART and nonparent caregiver.

Nutritional profile of hemodialysis patients concerning treatment time.

The mortality of the population with chronic kidney disease (CKD) on hemodialysis (HD) is very high and the protein-energy malnutrition stands out as one of the most common consequences in relation to this condition. To evaluate the association between time of hemodialysis and nutritional parameters of patients. It is a cross-sectional study with secondary data, developed of the University Hospital of the Federal University of Juiz de Fora (HU/UFJF). This study was approved by the Research Ethics Committee (Nº 1.233.142), a total of 36 patients. The medical records and collected data were analyzed for anthropometric markers, biochemical and diet, considering two groups: HD time less than three and greater than or equal to three years. There was reduction of mass of somatic protein with increased duration of HD. In relation to food intake was observed that in patients with increased duration of dialysis, an increase in average consumption of protein / kg of weight, calories, phosphorus and potassium, with a significant difference from the mean protein intake / kg (p = 0.04) and phosphorus (p = 0.045). Increasing HD time has altered body composition of patients, indicating a decline in the nutritional status of these individuals. HD patients are a risk group for protein-energy malnutrition, where HD time interferes with the nutritional status and food profile of the patient. The group HD time greater than or equal to 3 years presented worsening nutritional status.