Malnutrition Group Research Articles

Effect of DHA Supplementation on The MDA and SOD Levels in Protein Malnourished Rats

Protein malnutrition interferes with the synthesis of enzymes served as antioxidants while reducing antioxidants concentration in tissues, leading to oxidative stress. One of the most stable markers of oxidative stress is malondialdehyde (MDA). Docosahexaenoic acid (DHA) has an important role in inhibiting oxidative stress and protecting the tissue from peroxidative damage to lipids and proteins, thereby reducing oxidative stress in the tissue. This study aimed to analyze the effect of DHA on the MDA and superoxide dismutase (SOD) levels in protein malnourished rats. This study was carried out using the rat model Rattus norvegicus. After delivery, the rats were classified into two groups, namely, the malnutrition group (MG) and the non-malnutrition group (NMG). The MG was given low-protein diet since birth until 50 days old. The MG was further classified into two subgroups, namely the control malnutrition group with normal feed recovery (CMG), and the treated malnutrition group with normal feed recovery and DHA supplementation for 6 weeks (TMG). At the end of treatment, the blood MDA and SOD levels were assessed. The results showed that the MDA levels in the NMG, CMG, and TMG were 812.75 μM, 647.75 μM, and 624.00 μM respectively. The SOD levels were 19.40 μM, 19.20 μM, and 26.80 μM, respectively. The Kruskal Wallis test showed a significant difference in MDA levels between groups (p = 0.001). The posthoc test using the Mann Whitney test showed that the MDA level in TMG was significantly different from that in NMG, but not significantly different from CMG. The Anova test showed a significant difference in SOD levels between groups (p = 0.000). The Tukey posthoc test showed that the SOD level in TMG was significantly different from that in NMG and CMG. DHA has been shown to play an antioxidant role in malnutrition. DHA can increase the levels of SOD enzymes so that oxidative stress that occurs in malnutrition can be reduced. This is proven by the decrease in MDA levels as a lipid peroxidation product. It can be concluded that DHA supplementation can reduce the MDA levels and increase the SOD levels in protein malnourished rats.

Vascular Surgery Patients at Risk for Malnutrition Are at an Increased Risk of Developing Postoperative Complications

Malnutrition is an important risk factor for adverse postoperative outcomes such as infection and delayed wound healing, often resulting in longer hospital stay and higher readmission and mortality rates. The aim of this study is to assess the relationship between the risk for malnutrition prior to elective vascular surgery and postoperative complications. In this observational cross-sectional study, elective vascular surgery patients were included from January 2015 until November 2018. Included were percutaneous, carotid, endovascular, peripheral bypass, abdominal, lower extremity amputation, and other interventions. The patients were assessed for risk for malnutrition using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), whereby <4 points was defined as low risk, 4-8 points as medium risk, and ≥9 points as high risk for malnutrition. Postoperative complications were registered using the Comprehensive Complication Index. Univariate and multivariate analyses were performed to evaluate the relationship between risk for malnutrition and postoperative complications. Of 468 patients, 113 (24.1%) were found to be at risk for malnutrition (PG-SGA SF ≥4 points). Occurrence of postoperative complications (23.9% in the low risk vs. 51.9% in the high risk group, P=0.006), length of hospital stay (5.5±4.3days in the low risk vs. 8.2±5.1 in the high risk group, P=0.005), 30-day readmission (4.7% in the low risk vs. 19.2% in the high risk group, P=0.009), and Comprehensive Complication Index (median score of 0 in the low risk vs. 8.7 in the high risk group, P=0.018) varied significantly between the 3 PG-SGA SF groups. After multivariate analysis, the medium risk for malnutrition group had a 1.39 (95% confidence interval 1.05-1.84) times higher Comprehensive Complication Index than the low risk for malnutrition group (P=0.02). Electively operated vascular surgery patients at risk for malnutrition are more likely to develop postoperative complications. This finding suggests that improving the nutritional status of vascular surgery patients prior to surgery has the potential to reduce the risk of complications.

P3626Malnutrition is a major factor to affect prognosis of coronary artery disease patients with myocardial damage

Abstract Background Malnutrition is the important factor to cause frailty and sarcopenia which affect the prognosis of cardiovascular diseases. However, the effect of malnutrition on prognosis of coronary artery disease (CAD) patients with myocardial damage is still uncertain. Purpose The aim of the present study was to investigate the effect of malnutrition on prognosis of CAD patients with myocardial damage who received percutaneous coronary intervention (PCI). Methods The subjects were 241 CAD patients with myocardial damage due to myocardial ischemia by coronary artery stenosis or occlusion. These patients underwent successful revascularization for CAD by PCI using second-generation drug eluting stents and discharged. Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional status in this study, and patients with GNRI&lt;92 at baseline were defined as malnutrition group. The association between MACCE (major cardiovascular and cerebrovascular events) after discharged and patient's characteristics including nutritional status at baseline were assessed. Results The mean follow-up period was 546±310 days, with a maximum follow-up duration of 1092 days. MACCE within 3 years after PCI were 42 cases (17%) and malnutrition group had high rate of MACCE (38 vs. 11%, P&lt;0.01) compared with non- malnutrition group. In malnutrition group, age (77±9 vs. 67±11 years, P&lt;0.01) and high-sensitivity C-reactive protein (hs-CRP) level (5.52±6.63 vs. 0.72±1.86 mg/dl, P&lt;0.01) were higher than those of non-malnutrition group. The serum albumin (Alb) level (3.0±0.5 vs. 4.0±0.4 mg/dL, P&lt;0.01), hemoglobin (Hb) (10.4±1.9 vs. 12.8±2.4 g/dL, P&lt;0.01), total cholesterol (151.8±32 vs. 174.1±41.6 mg/dL, P&lt;0.01), triglycerides (96.9±49.1 vs. 140.6±128.3 mg/dL, P&lt;0.01), and left ventricular ejection fraction (LVEF) (50.2±15.9 vs. 55.9±15.3%, P=0.03) were lower in malnutrition group than those in non-malnutrition group. Moreover, malnutrition group had lower rate of hemodialysis (HD) (35 vs. 65%, P&lt;0.01), dyslipidemia (16 vs. 84%, P&lt;0.01) and using of statins (16 vs. 83%, P=0.02) than those in non-malnutrition group. As a result of Cox proportional hazards analysis, MACCE was associated with age [hazard ratio (HR): 1.04, 95% confidence interval (CI): 1.01–1.07, p p&lt;0.01)], hs-CRP (HR: 1.08, 95% CI: 1.03–1.11, p&lt;0.01), HD (HR: 2.63, 95% CI: 1.51–4.58, p&lt;0.01) and malnutrition (HR: 3.69, 95% CI: 2.11–6.42, p&lt;0.01) in the univariate analysis. The multivariate Cox proportional hazards analysis revealed that HD (HR: 2.24, 95% CI: 1.24–4.08, p&lt;0.01) and malnutrition (HR: 2.10, 95% CI: 1.04–4.23, p=0.03) were significantly associated with MACCE. Furthermore, malnutrition additively facilitated incidence of MACCE among patients underwent HD (GNRI &lt;92+HD: HR 4.19, 95% CI: 2.22–7.88, p&lt;0.001, GNRI &gt;92+HD: HR 1.26, 95% CI: 0.65–2.47, p=0.493). Conclusions In CAD patients with myocardial damage, malnutrition (GNRI&lt;92) is a major risk factor for MACCE after PCI.

P786Plasma volume status is associated with the change in nutritional status during hospitalization in acute decompensated heart failure patients with preserved left ventricular ejection fraction

Abstract Introduction Plasma volume (PV) expansion has an essential role in heart failure (HF). PV can be estimated by a simple formula using hematocrit and body weight, and PV status (PVS) provides prognostic information in patients (pts) with chronic HF. Nutritional status (NS) based on the prognostic nutritional index (PNI) and NS change during hospitalization have been shown to predict prognosis in pts admitted with acute decompensated HF (ADHF). Purpose We sought to assess the hypothesis that PVS is associated with NS change during hospitalization in pts with HF with preserved LVEF (HFpEF) who are admitted with ADHF. Methods We prospectively studied 411 pts who were admitted for ADHF with LVEF ≥50% and survived to discharge. Body weight measurement and venous blood sampling were performed on admission and at discharge. PVS was defined as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The pts were divided into 3 groups by PNI: normal (&gt;38), moderate malnutrition (35–38), and severe malnutrition (&lt;35). During admission, pts who remained in the moderate or severe malnutrition group or whose NS worsened were defined as no improvement in NS. Follow-up data was obtained in 203 cases. They were followed for up to 18 months, and the incidence of all-cause death was evaluated. Results On admission, PVS in the moderate (n=71, 13.3±13.9%) or severe malnutrition group (n=69, 14.8±10.8%) was significantly higher than in the normal PNI group (n=271, 5.4±10.8%, p&lt;0.001). During hospitalization, 123 pts had no NS improvement. Admission PVS was significantly higher in pts with no NS improvement than in pts with improved NS (13.9±11.2% vs 5.9±12.8%, p&lt;0.0001). In multivariate logistic regression analysis, admission PVS was independently associated with no NS improvement during hospitalization (OR 1.06, 95% CI 1.03–1.08, p&lt;0.0001). Receiver operating characteristics curve analysis revealed that the optimal cut-off value of admission PVS for predicting no NS improvement was 9.4% (sensitivity: 72%, specificity: 63%). The area under the curve for predicting no NS improvement using admission PVS was significantly greater than for other independent factors (Figure 1A). During the follow-up period (median 12.4 months), 68 of 203 patients had all-cause death. Kaplan-Meier analysis showed that the patients with no NS improvement had a significantly higher risk of all-cause death (Figure 1B). Figure 1 Conclusions In this multicenter study, admission PVS was shown to be associated with poor improvement in NS during hospitalization in HFpEF pts admitted for ADHF. Acknowledgement/Funding Roche diagnostics, FUJIFILM Toyama Chemical

Malnutrition diagnosed by controlling nutrition status is a negative predictor of life prognosis in aortic arch aneurysm patients treated with thoracic endovascular aneurysm repair

Objectives Controlling Nutritional Status (CONUT) is a useful screening tool for malnutrition in patients with various diseases; however, how CONUT-diagnosed malnutrition affects patients with aortic arch aneurysm is unknown. This study aimed to reveal the utility of CONUT for detecting the patients with high-risk aortic arch aneurysm with malnutrition. Methods Sixty patients treated for aortic arch aneurysms with elective thoracic endovascular aneurysm repair from 2009 to 2015 were retrospectively analyzed at a single institution. Preoperative nutrition status was evaluated by CONUT, and a CONUT score ≥ 3 was defined as malnutrition. The influence of malnutrition on the patients’ overall survival, aneurysm-related death-free rates, and prevalence of re-interventions were also analyzed. Results Twenty-three patients were diagnosed with malnutrition. Overall survival was significantly lower in the malnutrition group ( P = 0.0036). The multivariate Cox proportional hazard analysis revealed that age ( P &lt; 0.0001) and malnutrition ( P = 0.0457) were negative predictors of overall survival. Conversely, the two groups did not differ significantly in aneurysm-related death-free rates ( P = 0.7879) and the prevalence of re-interventions ( P = 0.7879). Conclusions Malnutrition diagnosed by CONUT as well as age is a negative predictor of survival prognosis in patients with aortic arch aneurysm.

Concurrent and predictive validity of the Mini Nutritional Assessment Short-Form and the Geriatric Nutritional Risk Index in older stroke rehabilitation patients.

Malnutrition may worsen clinical outcomes in stroke patients. Few malnutrition screening tools have been validated in the rehabilitation setting. The present study aimed to assess the concurrent and predictive validity of two malnutrition screening tools. We retrospectively collected scores for the Mini Nutritional Assessment Short-Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI) in consecutive stroke patients aged ≥65years in a rehabilitation hospital. Concurrent validity was confirmed against the European Society for Clinical Nutrition and Metabolism diagnostic criteria for malnutrition (ESPEN-DCM). Malnutrition risk within the ESPEN-DCM process was assessed using the Malnutrition Universal Screening Tool. Cut-off values with maximum Youden index, and with sensitivity (Se) >90% and specificity (Sp) >50%, were defined as appropriate for identification and screening of malnutrition, respectively. The Functional Independence Measure and discharge destination were used to explore predictive validity. Overall, 420 patients were analysed. Of these, we included 125 patients in the malnutrition group and 295 in the non-malnutrition group based on the ESPEN-DCM. Cut-off values for the identification and screening of malnutrition were 5 (Se: 0.78; Sp: 0.85) and 7 (Se: 0.96; Sp: 0.57) for the MNA-SF; 92 (Se: 0.74; Sp: 0.84) and 98 (Se: 0.93; Sp: 0.50) for the GNRI, respectively. The GNRI predicted discharge to acute care hospital, whereas the MNA-SF did not predict all outcome measures. The MNA-SF and the GNRI have a fair concurrent validity in stroke patients, although lower cut-off values than currently used were required for the MNA-SF. The GNRI exhibits good predictive validity for discharge destination.

Is malnutrition associated with postoperative complications after cardiac surgery?

Malnutrition is the central component of frailty that has an adverse influence on the prognosis of patients undergoing cardiac surgery. The relationship between malnutrition and postoperative complications was evaluated in a retrospective cohort study. In 287 patients undergoing elective cardiac surgery, nutritional status was assessed by using the Geriatric Nutritional Risk Index (GNRI). Then the patients were divided into a malnutrition group (GNRI <91) and a nonmalnutrition group (GNRI ≥91), after which the postoperative course was compared. There were 51 patients (17.8%) in the malnutrition group. Nine patients died after surgery and the operative mortality rate was significantly higher in the malnutrition group than the nonmalnutrition group (five deaths [9.8%] vs four deaths [1.8%]; P = .003). In addition, the duration of intensive care unit stay and hospital stay were both significantly longer in the malnutrition group compared with the nonmalnutrition group. Multivariate analysis showed that malnutrition was an independent predictor of hospitalization for longer than 1 month (odds ratio [OR]: 3.428; 95% confidence interval [CI]:1.687-6.964; P = .001) and a postoperative bedridden state (OR: 7.377; 95% CI:1.874-29.041; P = .004). Preoperative evaluation of the nutritional status using the GNRI seems to be valuable for predicting the risk of postoperative complications.

Nutritional status and survival of End-Stage Renal Disease patients treated with continuous ambulatory peritoneal dialysis

The objective of the work was to study the survival peculiarities ofend-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) depending on the nutritional status and informative markers associated with it. Methods. 105 ESRD patients who received CAPD treatment during 2012 - 2017 years at the Kyiv Scientific and Practical Center of Nephrology and Dialysis, which is the clinical base of the State Institution "Institute of Nephrology National Academy of Medical Sciences of Ukraine" were included in the cohort prospective open study. The survival analysis was carried out both in the studied population as a whole and in groups depending on the nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA) points: the first group (n = 51) consisted of patients without malnutrition, the second group (n = 30) - patients with a mild degree of malnutrition, the third group (n = 13) - patients with a moderate degree of malnutrition, and the fourth group (n = 11) - patients with a severe degree of malnutrition. The survival analysis was conducted both in the groups in compliance with NS, and depending on the informational markers associated with NS, in particular, albumin, body mass index (BMI), residual renal function (RRF). Survival were calculated using the Kaplan-Meier method, and the difference between survival rates was analyzed using the log-rank test and χ². The starting date of peritoneal dialysis treatment was considered as the starting point of the monitoring. The difference was considered to be accurate at p &lt;0.05. Analyzed cases were included till January 7, 2019. The event risk assessment was carried out with the probability of relative risk (RR) values calculating their confidence intervals (95% CI). Results.Forty-three (40.95%) patients died during the current analysis, 17 patients were switched to the hemodialysis (HD), 4 patients had undergone kidney transplantations. Cardiovascular disease was the leading cause of death (41.9%), the second cause of death by frequency was bacterial infections (20.9%). Longer monitoring periods death rate was significantly higher in patients of group with an average (11/84.6% vs 14/27.45%, p &lt;0.0001; RR - 3.08; 95% CI: 1.8 -5.09)and a mild degree of nutritional disorders (ND) (11/84.6% vs 11/36.7%, p = 0.0018, RR - 2.3, 95% CI: 1.36-3.89) compared with normal NS.Similarly, the percentage of died patients with a severe ND degree was significantly higher than those with a normal nutritional status (7/63.6% vs. 14/27.45%, p = 0.0091, RR - 2.31, 95% CI: 1.23 - 4.35). The cumulative survival during the 1- year amounted to 90% of patients for 3 and 5 years - 64% and 41%, respectively. It was found that the survival rate of PD patients is credibly higher in groups with normal NS ormild ND degree than patients of group with a moderate or severe degree of nutritional disorders (χ2 = 22,9; df = 3; p = 0,00004). The cumulative survival for 1 and 3 years was 97%, 98%, 70%, 81% and 76%, 70%, 24%, 36% in groups of patients without nutritional disorder, with mild nutritional disorders, moderate and severe disorders, respectively. The cumulative survival with serum albumin level &lt;35 g/l and ≥ 35 g/l in 1 and 3 years was 73% vs 96% and 37% vs 74%, respectively (p = 0.00005, log-rank test). Similarly, the proportion of survivors with BMI &gt; 24 kg/m2 was apparently higher than those with an indicatorBMI ≤ 24 kg/m2, and it was in 1 and 3 years 94% vs 86% and 79% vs 47%, respectively (p = 0.00321, log-rank test). Veritable differences have been registered in the cumulative frequencies of survivors depending on RRF value: the survival rate was significantly higher among patients with RRF ≥ 5 ml/min/1.73 m² and significantly lower among patients with RRF &lt;2 ml/min/1.73 m2 (χ² = 17.4; df = 2; p = 0.00016). Conclusions.Thus, our studyfound that serum albumin level, BMI and RRF magnitude are the markers for the survival of ESRD patientstreated with PD. Veritable difference between the survival of patients depending on the nutritional status was stated. Three-year cumulative survival with mild degree of malnutrition group was twice as high as in severe nutritional disorders and it was 70% vs 36% (p &lt;0.001). The relative risk of death from all causes increases by 3.1 and 2.32 times for moderate and severe nutritional disorders patients compared to the patients group with normal NS.

The association of klotho protein and nutrition status for maintenance hemodialysis patients

Objective To explore the association between klotho protein and nutrition status for maintenance hemodialysis patients. Methods From June 2016 to November 2016, 100 patients who received maintenance hmodialysis were divided into three groups, group A: 28 cases in good nutrition group, group B: 44 cases in mild and moderate malnutrition group, and group C: 28 cases in severe malnutrition group in our hospital and 60 health controls were enrolled in our study. Subjective global assessment of nutritional status(SGA) was used to assess the nutrition status between two groups, the level of serum klotho protein was measured by ELISA, and other related· biochemical indexes were detected. Pearson correlative analysis was used to analyze the relationship between serum klotho protein and related biochemical indexes. Results There was a significant difference of the incidence of malnutrition between study group and control group (72%>18.32%, P<0.05), and there was significant difference of biochemical indexes among different nutrition status of groups A, B and C (P<0.05), compared with A group, the level of ALB, Hb, MAMC, klotho protein and BMI were lower in group B and C, and the level of PTH and FGF-23 was higher (P<0.05). Compared with group B, the level of Scr, ALB, Hb, MAMC, klotho protein was lower, and the level of PTH and FGF-23 was higher (P<0.05). Serum klotho protein was positively related with ALB, MAMC and Hb (P<0.05), and negatively related with Scr, BUN, FGF23 and PTH (P<0.05), while there was no relationship between serum klotho protein and BMI (P=0.165). Conclusions There is a high incidence of malnutrition in maintenance hemodialysis patients, and the low expression of serum klotho protein may be related with maintenance hemodialysis patients, which may provide a new basis for the diagnosis and treatment of malnutrition in uremic patients. Key words: Renal Dialysis; Proteins; Nutritional Status

Nutritional Status in Iranian Non-Syndromic Patients with Acyanotic Congenital Heart Disease Undergoing Surgical Repair

Background: To normally grow and develop, children with congenital heart diseases (CHD) in the hypermetabolic state need 50% more energy than healthy ones. Objectives: This study aimed to investigate the prevalence of malnutrition and its association with other factors among the non-syndromic acyanotic patients with CHD undergoing palliative or corrective surgery. Methods: A retrospective study of medical records of 812 children with acyanotic congenital heart disease undergoing palliative or corrective surgery was performed from March 2011 to March 2017. Collected data consisted of the age at the time of the surgery, gender, weight at the time of the surgery, height at the time of the surgery, birth weight, length of ICU stay, and 1-year mortality. The WAZ, WLZ, LAZ, and BMI Z-scores were calculated based on World Health Organization (WHO) standards. We classified the Z-scores into 4 groups, including normal (Z-scores > -1), mild (-2 to > -1), moderate (-3 to > -2), and severe (< -3) malnutrition groups. Results: Total amount of 812 patients, 375 (46.2%) were female and 437 (53.8%) male, participated in this study. The average age, weight, and height at the time of the surgery were 23.52 + 29.38 months, 9.086 + 6.71 kilograms, and 76.93 + 23.37 centimeters, respectively. Moreover, 68.7% and 66.4% of the patients suffered from mild to severe forms of malnutrition based on WAZ and WLZ, respectively (P value < 0.0001, 0.025). There was no significant difference between males and females in WAZ, WLZ, LAZ and, BMIZ (P value: 0.154, 0.265, 0.965, and 0.667, respectively). Generally, in acyanotic defects, we found that more severe malnutrition causes an increment in length of ICU stay (P value = 0.001) and lesser birth weight has a significant relationship with the severity of growth failure in infancy or childhood (P value < 0.0001). Conclusions: In our study, the high prevalence of the malnutrition and related complications during and after surgical repair shows the importance of nutritional support and interventions in patients with CHD.

Malnutrition worsens fluorosis-induced damage in hypothalamic-pituitary-ovarian axis of rats

This study aimed to evaluate the effects of malnutrition on the hypothalamic-pituitary-ovarian axis (HPOA) sex hormones in female rats with coal burning-type fluorosis. Female rats were divided into four groups: control, malnutrition, fluorosis, and fluorosis with malnutrition. Rats in the control and malnutrition groups were fed pollution-free corn with either regular or low protein content. Rats in the fluorosis and fluorosis with malnutrition groups were fed corn roasted with coals from the fluorosis endemic areas of Zhijin, China,with either regular or low protein content. Results revealed that the body weight of rats with protein malnutrition was significantly reduced compared with that of the control and fluorosis rats. Urinary fluoride was significantly decreased and bone fluoride was significantly increased in the fluorosis with malnutrition group compared to the fluorosis group. Moreover, protein malnutrition significantly enhanced the effect of fluoride on gonadotropin-releasing hormone, follicle-stimulating hormone, luteinizing hormone, and testosterone. Histological and ultrastructural analyses revealed that protein malnutrition intensified fluoride-induced ovary damage. Malnourishment could promote the abnormal secretion of HPOA sex hormones in females with fluorosis.

Abstract P238: Sociodemographic Factors Associated With Under- and Overweight Among Women of Reproductive Age in Sub-Sahara Africa

Introduction: In the last three decades, many countries in SSA have undergone rapid epidemiological and nutritional transitions, with an ever-increasing prevalence of cardio-metabolic conditions. Because of these changes, health care systems in the sub-region are faced with the simultaneous challenge of handling both underweight and overweight related sequelae. There is still limited epidemiological evidence on the drivers of this phenomenon within and across countries in SSA. Hypotheses: We assessed the following hypotheses: 1) SSA countries vary in terms of the type and extent of malnutrition; 2) Macro (country level) and micro (individual level) sociodemographic factors are associated with the double burden of malnutrition (i.e. under- and overweight) in SSA. Methods: Macro- and micro-level data for 34 SSA countries were acquired from the World Bank data base and Demographic and Health (DHS) surveys respectively. A total of 247,691 eligible participants (women between the age of 15 and 49) from the DHS surveys were analyzed. We first determined malnutrition categories in SSA from country level prevalence estimates of underweight and overweight using statistically defined logic expressions. Second, we used random forest analysis to investigate the association between the malnutrition groups and macro-level variables. Third, we used random forest analysis and multivariable multinomial logistic regression models to investigate the association between micro level variables and the three BMI categories i.e. underweight (BMI &lt;18.5), normal weight (BMI 18.5 to 24.9) and overweight (BMI≥25). Results: Out of the 34 countries studied, the prevalence of underweight was greater than 10% in 3 countries, whereas 13 countries had both underweight and overweight prevalence exceeding 10%. Overweight (BMI 25 to 29.9) prevalence exceeded 10% in 7 countries, while the obese (BMI≥30) prevalence was at least 10% in 11 countries. Macro level random forest analysis showed that fertility rate and gross domestic product (GDP) were key correlates of the malnutrition groups found in SSA. However, age, wealth and parity were key correlates of women’s nutritional status at the micro level. Old age and wealth were consistently associated with overweight across all the countries. However, parity was a risk factor for underweight in underweight countries, and a risk factor for overweight in overweight countries. Conclusion: In conclusion, we observed consistent cross-sectional associations between measures of fertility, wealth and age and the dual forms of malnutrition (under- and overweight) among women in SSA.

Cardiac evaluation in children with malnutrition.

Aim:The main purpose of this study was to identify myocardial changes in malnourished children.Material and Methods:This prospective study included 47 patients with malnutrition and 44 healthy controls. The subjects who had malnutrition were classified according to the method of Gomez and Waterlow. Electrocardiographic and echocardiographic examinations, 24-h Holter monitoring, and biochemical assessments were performed in all subjects.Results:The malnutrition group included 20 (42.5%) males, and the control group included 19 (43.1%) males (p<0.05). There was no difference between the malnutrition and control groups with regard to mean age (69.4±57.3 months and 68.9±48.2 months, respectively, p=0.5). Although the left ventricular mass was lower in the patient group compared with the control group, the left ventricular mass index was not different (42.3±24.5 g, 53.4±23.9 g, p=0.049 and 60.7±13.3 g/m2, 61.9±12.1 g/m2, p=0.67, respectively). The left ventricular ejection fraction and fractional shortening were lower in the patient group compared with the control group (66.2±5.3%, 69.2±4.07%, p=0.04 and 35.4±4.2%, 37.9±3.4%, p=0.03, respectively). The myocardial performance index was higher in the patient group (0.45±0.09, 0.36±0.05, respectively, p=0.001). The deterioration of cardiac functions was associated with the severity and duration of malnutrition. Troponin concentrations were not elevated in any patients. The corrected QT dispersion was significantly higher in patients with malnutrition (47.9±16.8, 32.9±10.6, respectively, p=0.001). Complex ventricular arrhythmias were not noted in any patients.Conclusion:The malnourished children in this study exhibited impairment in the functions of cardiac contraction including mainly systolic functions and in cardiac conduction system. Cardiac morbidity and mortality can be prevented by early detection and treatment of malnutrition in these patients.

Analysis of nutritional status and influence factors in PICU children with mechanical ventilation

Objective To investigate the nutritional status of children with mechanical ventilation, explore the influencing factors of nutritional status, and provide a basis for clinical nutrition support for children with mechanical ventilation. Methods The children with mechanical ventilation who had ventilated for more than 5 days during the period from February 1, 2017 to October 31, 2017 were selected as subjects.According to the mechanical ventilation time, they were divided into group A (5-16 d) and group B(17-29 d). We assessed malnutrition, screened nutritional risk, and measured albumin both on the admission and withdrawal of the ventilator, respectively.We also calculated the average caloric intake value (EI) and fluid volume during mechanical ventilation.Measured resting energy expenditure (MREE)was calculated by using the Schofield-HTWT formula.Feeding status during mechanical ventilation was assessed by average EI/MREE. Results The incidence of malnutrition at admission was 36.1%(13/36), and the incidence of malnutrition was 55.6%(20/36) when evacuated from the ventilator.There was a significant difference(P<0.05). The incidence of malnutrition was similar in group A and group B on admission, but the incidence of malnutrition in group B(62.5%) was significantly higher than that in group A (53.6%) when weaning.The average calorie in group B[(32.25±7.36)kcal/(kg·d)]was significantly lower than that in group A[(40.11±6.00)kcal/(kg·d)]. The mechanical ventilation time of group B[(540.63±89.66)h]was significantly longer than that of group A[(224.46±64.06)h](P<0.05). Conclusion Children with mechanical ventilation in the PICU have a higher incidence of malnutrition and the nutritional status deteriorates further during hospitalization, which may be related to calorie supply, duration of mechanical ventilation, fluid volume, and primary disease. Key words: Mechanical ventilation; Nutritional status; Malnutrition assessment; Nutritional risk screening

The impact of malnutrition on efficacy of resistance training in community-dwelling older adults.

Few studies have focused on the effect of resistance training under conditions of malnutrition in older adults requiring long-term care. The purpose of this study was to investigate the influence of nutritional status in older adults on resistance training-induced changes in physical performance. A total of 91 community-dwelling older adults participated in 24weeks of resistance training. Participants used the 60% of one repetition maximum for three sets of 10 repetitions for resistance training. Short Physical Performance Battery (SPPB), Mini Nutritional Assessment Short Form (MNA-SF), Barthel Index, and grip strength were measured before and after the resistance training. The participants were classified into three groups according to the MNA-SF score at baseline (0 to 7 as malnutrition group, 8 to 11 as at risk group, and 12 to 14 as well-nourished group). In comparing the preintervention and postintervention changes in functional fitness of the groups, there was a significant Group×Time interaction for SPPB scores (F=11.59, p<0.01), 4-m walk speed (F=5.87, p<0.01), and grip strength (F=3.27, p<0.05). Multivariate logistic regression analysis showed that well-nourished group was significantly more likely to improvement of physical function (odds ratio 3.08, 95% confidence interval [1.54, 6.15], p<0.01). The results of study revealed that malnutrition was an independent negative factor of effects of resistance training in older adults. These results suggested that effects of resistance training may be affected by the nutritional state.

Relationship between nutritional status and the clinical outcomes of critically ill children

Objective To investigate the nutritional status and the clinical outcome of the critically ill children, and to provide scientific evidence for further clinical nutrition management. Methods Nutritional risk screening was performed on 1 183 critically ill children hospitalized at the Intensive Care Unit (ICU), Children′s Hospital of Nanjing Medical University from October 2016 to October 2017 by using the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the ICU including of Pediatric Intensive Care Unit (PICU), Surgical Intensive Care Unit (SICU) and Coronary Care Unit (CCU). Median age of the children was (2.6±2.4) years (29 d-12.9 years). Nutritional status was estimated, and scores of anthropometric parameters such as weight-for-age Z-score (WAZ) (<5 years) or body mass index-for-age Z-score (BAZ) (≥5 years)were calculated.The data on incidence of infectious complications, duration of ICU stay and mechanical ventilation, the total hospital expenses and in-hospital mortality were recorded. Results Of the 1 183 cases, 134 children(11.3%) had low nutritional risk, 746 children(63.1%) had moderate nutritional risk and 303 children(25.6%) high nutritional risk.The prevalence of severe malnutrition, moderate malnutrition and mild malnutrition was 8.1% (96/1 183 cases), 8.2% (97/1 183 cases), and 12.8% (151/1 183 cases) respectively.The severe malnutrition group had a higher incidence of high nutritional risk than other groups [74.0%(71/96 cases) vs.67.0%(65/97 cases), 40.4%(61/151 cases), 12.6%(106/839 cases)], and the differe-nce was statistically significant (P<0.001). The incidence of high nutritional risk in the CCU was higher than that than that in the PICU and SICU, and the difference was statistically significant [36.5%(96/263 cases), 23.8%(125/524 cases) and 20.7%(82/396 cases) respectively, P<0.01]. And the incidence of high nutritional risk was higher in infants[37.6%(198/527 cases)] than those in the other age groups[18.4%(52/282 cases), 12.0%(21/175 cases), 16.0%(32/199 cases)], and the difference was statistically significant (χ2=68.90, P<0.000 1). Children with a high nutritional risk had increased incidence of infectious complications [8.6%(26/303 cases) vs.4.7%(35/746 cases), 3.7%(5/134 cases)], incidence of mechanical ventilation[66.0%(200/303 cases) vs.41.4%(309/746 cases), 38.8%(52/134 cases)] and total hospital expenses (￥52 500 vs.￥39 700 and ￥48 700 RMB) compared with those with the moderate or the low nutritional risk, and the differences were statistically significant(all P<0.05). There were 16 deaths and 8 deaths (2.7%) in the high nutrition risk group, which was significantly higher than those in the moderate nutrition risk group [8 cases (1.1%)] and the low nutrition risk group[0 case(0)] (χ2=7.60, P=0.02). Conclusions Moderate or high nutritional risk is seen in the critically ill children, especially in infants and the children with congenital heart disease.Nutritional risk score is correlated with clinical outcomes.Nutritional risk screening and standard nutritional support are recommended so as to improve clinical treatment outcomes. Key words: Nutritional risk screening; Critically ill; Clinical outcome; Child

Prospective study of preoperative nutritional support in malnutritional pancreato-biliary cancer patients

Background and purpose: The purpose of this study is to evaluate the clinical impact of preoperative nutritional support for malnourished cancer patients. Methods: A total of 90 patients, 45 patients with nutrition support group and 45 patients with well-nourish group, in anticipating major surgery of pancreato-biliary cancer were enrolled in this study. We evaluated nutrition status by weight loss (>10% within 6 months), Patient-Generated Subjective Global Assessment (PG-SGA) grade B or C, serum albumin level (<3.0 g/dl) and assigned malnourished patients to the nutrition support group. Results: The postoperative complication rate in the nutrition support group was 51.1% and 42.2% in well-nourish group. The postoperative complications and day of hospital stay after operation were not different between each group. Although the patients whose nutritional status improved after nutritional support showed lower complication rate than other patients whose nutritional status were not improved, the complications rate in these patients were inferior to well-nourished patients. postoperative length of stay of subgroup (PG-SGA grade B/C à B/C) was marginally longer than that of well-nourished group (21.0 vs. 15.0 days, p = 0.050). Initial body mass index (OR, 1.49; 95% CI, 1.07–2.07; p = 0.020) and the amount of protein supplied (OR, 1.84; 95% CI 1.21–2.80; p= 0.004) were independently inhibit the nutritional improvement in malnutrition group. Conclusion: It is suggested that preoperative nutritional support in malnutritional pancreato-biliary cancer patients may be helpful to improve the clinical outcomes, but the postoperative results were still inferior to well-nourished patients in clinical implications.

Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long-term survival for gastric cancer patients after radical gastrectomy?

Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan‐Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five‐year overall survival (OS) and recurrence‐free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long‐term survival in GC after RG, but this finding must be confirmed by prospective trials.

Preoperative nutritional status is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery.

Progression of cardiac rehabilitation after cardiovascular surgery can be affected by frailty. The nutritional status of the patient has been proposed as an indicator of frailty. In this study, we aimed to evaluate the influence of preoperative nutritional status on the progress of postoperative cardiac rehabilitation. This study included 146 patients (82 males, 64 females, average age 71.9 ± 12.0years) who underwent elective cardiovascular surgery. In-hospital mortality cases were excluded to focus on postoperative cardiac rehabilitation. We classified patients with a Geriatric Nutritional Risk Index of 92 or higher as the good nutrition group and those with a Geriatric Nutritional Risk Index less than 92 as the malnutrition group. Preoperative patient characteristics and postoperative cardiac rehabilitation progress were compared between the good nutrition (n = 93) and malnutrition (n = 53) groups. The patients in the good nutrition group had an earlier progression to walking after postoperative rehabilitation (p = 0.002), a shorter postoperative hospital stay (p = 0.004), and a higher rate of discharge home (p = 0.028) than those in the malnutrition group. Multivariable analysis demonstrated preoperative malnutrition to be an independent predictor for the day to 100m walking (p = 0.010). Preoperative nutritional status was associated with progression of postoperative cardiac rehabilitation.

Application of Quantile Regression: Modeling Body Mass Index in Ethiopia

Background:Child malnutrition is the leading public health problem in developing countries. It is a major cause of child morbidity and mortality. Under-five children are the most vulnerable group for malnutrition. Body Mass Index (BMI) is a measure of nutritional status and is defined as the ratio of weight (kg) to squared height (m2). Studying the determinants of under-five children’s BMI is an important issue that needs to be addressed. This study applies quantile regression to study the determinants of under-five children BMI in Ethiopia.Methods:The weight-for-height index measures BMI. Quantiles are a generalization of percentiles for continuous random variables. Because it makes no distributional assumption about the error term in the model, quantile regression offers considerable model robustness.Results:The findings using quantile regression at different quantile levels were presented. The estimates across quantile levels were also performed. The findings of this study identified that for children under the age of five, the current age of mother, mother’s BMI, region (SNNPR and Somali) and weight of the child at birth (average and large) were found to be significantly affecting under-five children’s BMI across quantile levels.Conclusion:Quantile regression allows us to study the impact of predictors on different quantiles of the response distribution, and thus provides a complete picture of the relationship between the dependent and explanatory variables.