Moderate Malnutrition Research Articles

Preparation of Ready-to-use Therapeutic Foods Based on Soy, Millet, Rice, Corn, and Sugar for the Management of infant with Moderate Acute Malnutrition

The prevalent number of children in developing countries from suffering MAM is increasing daily and this has significant cost implications for their treatment. Therefore, the management of MAM should be a public health priority. Ready-to-use therapeutic foods (RUTF) play a fundamental role in the management protocol for severe acute malnutrition in children aged 6 to 59 months. In our study, we aim to enhance the value of ready-to-use foods prepared from local products, namely soya, millet, rice, maize and sugar (SOMRIS<sup>10-16</sup>). The objective was to develop a formula meeting the recommended nutritional and microbiological requirements in order to use it as a substitute for reference products for the treatment of moderate acute malnutrition. It has allowed to develop a ready-to-use therapeutic food using the linear programming technique, then produced according to traditional methods. The nutritional and microbiological qualities have been determined and confirm that the formula based on soy, millet, rice, corn, and sugar (SOMRIS<sup>10-16</sup>), meets the nutritional and microbiological needs recommended for children with moderate acute malnutrition. It will be subjected to the clinical trial processes in force in order to use it with complete peace of mind.

Malnutrition disrupts adaptive immunity during visceral leishmaniasis by enhancing IL-10 production.

Protein-energy malnutrition (PEM) is a risk factor for developing visceral leishmaniasis (VL). While nutrient deficiency can impair immunity, its mechanistic impact on protective adaptive immune responses following Leishmania infection remains unknown. To determine the potential negative impacts of malnutrition on anti-parasitic responses in chronic VL, we provided mice with a polynutrient-deficient diet (deficient protein, energy, zinc, and iron) that mimics moderate human malnutrition. The polynutrient-deficient diet resulted in growth stunting and reduced mass of visceral organs and following infection with Leishmania infantum, malnourished-mice harbored more parasites in the spleen and liver. Malnourished and infected mice also had fewer T lymphocytes, with reduced T cell production of IFN-γ required for parasite clearance and enhanced production of the immunosuppressive cytokine, IL-10. To determine if IL-10 was causative in disease progression in the malnourished mice, we treated infected mice with monoclonal antibody α-IL-10R. α-IL-10R treatment reduced the parasite number in malnourished mice, restored the number of T cells producing IFN-γ, and enhanced hepatic granuloma formation. Our results indicate that malnutrition increases VL susceptibility due to defective IFN-γ-mediated immunity attributable to increased IL-10 production.

Burden of acute malnutrition in the conflict-affected urban communities of Tigray, Northern Ethiopia: a cross-sectional study

BackgroundMalnutrition impedes the growth, development, and survival of children. Conflict has severely affected the livelihoods of families and caused an alarming increase in food insecurity, population displacements, and extreme poverty in Tigray. Therefore, this study aimed to assess the prevalence and factors associated with acute malnutrition among 6- to 23-month-old children in the armed conflict-affected urban areas of Tigray.MethodsThe study population were randomly selected children aged 6 to 23 months. A cross-sectional study design was used. Data was collected from July 13 to 28, 2022 in Tigray region, Northern Ethiopia. A systematic random sampling technique was used to select the participants. Sociodemographic, lifestyle, anthropometric, and clinical variables were collected using a structured questionnaire. The data were analyzed using SPSS version 24 and presented using descriptive and analytical statistics. Binary logistic regression was used to identify independent predictors of acute malnutrition. All variables were declared statistically significant at a p-value of < 0.05.ResultsA total of 368 participants aged 6–23 months were included in the study. Half (50.5%) and around three-fourths (72.6%) of the participants were females and 12 to 23 months old children, respectively, with a mean (SD) age of 15.2 (5.1) months. The overall proxy global acute malnutrition rate was 44.3%, with 34.5% and 9.8% being moderate acute malnutrition and severe acute malnutrition, respectively. In the multivariable logistic regression model, three variables (consumption of legumes, maternal nutritional status, and household access to clean water) were identified as significant predictors of proxy global acute malnutrition. Children who didn’t eat legumes (AOR (95%CI): 2.39 (1.44, 3.97)), children of acutely malnourished mothers (AOR (95%CI): 1.60 (1.02, 2.51)), and children from households with insufficient water supply (AOR (95%CI): 1.99 (1.20, 3.31)) were significantly associated with an increased likelihood of acute malnutrition as compared with their counterparts.ConclusionsChildren from the armed conflict areas of Tigray are disproportionally impacted by acute malnutrition. Nearly half of the children were acutely malnourished, with one in ten suffering from the more serious severe acute malnutrition. Hence, urgent action is needed to prevent their permanent mental and physical deterioration and death by improving consumption of high protein foods, nutritional status of mothers, and access to clean water.

Efficacy of Dairy Protein and Essential Nutrient Density in Formulated Food Products for Treating Severe and Moderate Acute Malnutrition at the Community Level: A Narrative Review.

Community-based management of acute malnutrition (CMAM) relies on a food-based approach. However, a comprehensive assessment of their nutrient composition and its impact on treatment outcomes is currently lacking in the extant literature. This narrative review summarizes recent evidence on the efficacy of formulations that contain dairy protein and maintain the density of essential nutrients (type I and type II) in managing uncomplicated acute malnutrition at the community level. The literature used for the evidence synthesis was identified using a two-stage screening process. An electronic search was run on PubMed and Cochrane Library, followed by a backward snowball search to identify efficacy studies. A total of 26 efficacy studies involving food formulations used to treat uncomplicated severe and moderate acute malnutrition were identified. The review found that while more evidence favours the inclusion of dairy in formulations as efficacious in supporting recovery from malnutrition, ambiguity in the conclusive findings between dairy and non-dairy formulations remains due to the varied percentages of dairy protein in different formulations. The type of protein source used in a formulation matters, but other approaches, including fortification, can aid in maintaining the nutrient density of formulations, thereby improving the chances of recovery. However, the inclusion of high-added sugar in therapeutic formulations exceeding the WHO norms is a concern that warrants more attention. Future clinical research should assess outcomes like lean or fat mass changes to confirm the benefits of using dairy or non-dairy formulations to treat moderate and severe acute malnutrition.

Acceptability of microbiota-directed complementary foods in treating Indian children with moderate acute malnutrition – eACT-MAM pre-proof of concept study

Acceptability of microbiota-directed complementary foods in treating Indian children with moderate acute malnutrition – eACT-MAM pre-proof of concept study

Malnutrition and Growth Failure in Cyanotic and Acyanotic Congenital Heart Diseases with and Without Pulmonary Hypertension

Objective: To determine the status of malnutrition and growth failure in cyanotic and acyanotic congenital heart diseases with and without pulmonary hypertension. Study Design: Cross sectional study. Place and Duration of Study: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Tando Muhammad Khan, Pakistan, from Jan 2020 to Oct 2021. Methodology: A total of 250 children, with echocardiography confirmed congenital heart disease, of both genders and aged below 5 years were included. All cases were divided into 4 groups, these being, acyanotic congenital heart disease with PH, acyanotic congenital heart disease without pulmonary hypertension, cyanotic congenital heart disease with pulmonary hypertension and cyanotic Congenital heart disease without pulmonary hypertension. Gender, age, body weight, height, area of residence and malnutrition status were determined in all cases and compared in between study groups. Results: There were 41(16.4%) patients with acyanotic PH, 115(46.0%) acyanotic without PH, 34(13.6%) cyanotic with pulmonary hypertension and 60(24.0%) cyanotic without pulmonary hypertension among a total of 250 cases. Significant differences were noted in terms of age, weight, and height among different study groups (p&lt;0.001). Nutritional status as normal was noted in 51(20.4%) cases, mild malnutrition in 50(20.0%), moderate malnutrition in 65(26.0%) and 84(33.6%) with severe malnutrition. Children having cyanotic congenital heart disease and pulmonary hypertension were also found to have failure to thrive (p=0.009). Conclusion: Malnutrition and growth failure were found to be very prevalent among children with CHDs under the age of 5 years. Malnutrition was significantly more pronounced among children having cyanotic CHDs with PH.

Development and validation of a novel prognostic prediction system based on GLIM-defined malnutrition for colorectal cancer patients post-radical surgery.

Malnutrition often occurs in patients with colorectal cancer. This study aims to develop a predictive model based on GLIM criteria for patients with colorectal cancer who underwent radical surgery. From December 2015 to May 2021, patients with colorectal cancer who underwent radical surgery at our center were recruited for this study. We prospectively collected data on GLIM-defined malnutrition and other clinicopathological characteristics. Using Cox regeneration, we developed a novel nomogram for prognostic prediction, which was validated and compared to traditional nutritional factors for predictive accuracy. Among the 983 patients enrolled in this study, malnutrition was identified in 233 (23.70%) patients. Multivariate analysis indicated that GLIM-defined malnutrition is the independent risk factor for overall survival (HR = 1.793, 95% CI = 1.390-2.313 for moderate malnutrition and HR = 3.485, 95% CI = 2.087-5.818 for severe malnutrition). The novel nomogram based on the GLIM criteria demonstrated a better performance than existing criteria, with AUC of 0.729, 0.703, and 0.683 for 1-year, 3-year, and 5-year OS, respectively, in the validation cohort. In addition, the risk score determined by this system exhibited significantly poorer short-term and long-term clinical outcomes in high-risk groups in both malnourished and well-nourished patients. Combining handgrip strength, serum albumin level, and TNM stage would help improve the predictive effect of GLIM criteria for colorectal cancer patients post-radical surgery and benefit the individual prognostic prediction of colorectal cancer.

Infant Food Flours Made from Local Products to Combat Acute Malnutrition in Children Under 5 Years Old in Côte D’ivoire

In Côte d'Ivoire, recurring stock shortages and difficulties in accessing specialized food products compromise nutritional treatment. This study proposes food formulas of flours composed of locally available products capable of meeting the protein-energy needs of children aged 6 to 59 months diagnosed with moderate acute malnutrition. The methodological approach consists of formulating and determining the physicochemical, nutrient, and functional characteristics of four new formulations (1F, 2F, 3F, 4F, and 5F). The results indicate that the formulated foods have high levels of calcium (215.60-252,29 mg/100g MS), potassium (555,70-789,29 mg/100 g MS), magnesium (261,26-200,63 mg/100g MS), iron (4,86-7,03 mg/100g MS) and phosphorus (392,36 -469,36 mg/100g MS). The fat content varies from 9.66% to 23.86%. The energy value determined for all flours corresponds well to the Codex. The food formulas developed would also be able to meet more than 100% of the daily requirement of vitamins E and B1. The phytate (180.26 - 227.05 mg/100 g) and oxalate (66.00 - 88.00 mg/100 g) contents are low. The presence of phenolic compounds, including flavonoids (7.78-15.44 mg/100 g) and antioxidant activity (31.09-32.84%) would be a significant asset. The levels of deoxynivalenol (62 μg/kg) recorded in flours are below 200 μg/kg recommended for infants and young children. The proposed formulations have high-water absorption capacity (136.15 -252.94%) and high solubility index (56.84 -59.2%). The wettability time ranges from 3.66 ± 0.16 s to 33.71 ± 0.23 s. Flours (1F, 2F, 3F, 5F) have a better absorption capacity for refined palm oil (132 %, 139 %, 121 %; 115 %). The proposed new formulations have nutritional characteristics close to standard data and could therefore be recommended for children aged 6 to 59 months for complementary feeding in the context of the fight against moderate acute malnutrition.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

Metabolic and histopathological impact of local resource food consumption on blood markers in rats previously subjected to moderate acute malnutrition

Malnutrition is caused by dietary and nutritional imbalances that can have an impact on blood parameters and vital organs. The use of local agricultural resources for adapted diets appears to be an effective solution to post-weaning infant malnutrition. The aim of this study was to evaluate the effectiveness of four newborn diets made from local agricultural resources in improving biochemical, hematological, and histological parameters in rats that had previously experienced mild acute malnutrition. A total of 42 juvenile male rats, with an average age of 80 ±5 days and an average weight of 103.46 ± 5.10 g, were divided into six groups. Each group consisted of seven rats, with two control groups (LTC and LSA) and four experimental groups (LAR1A, LAR1B, LAR2A, and LAR2B). The experiment had three distinct phases: an initial adaptation period lasting 5 days, followed by a phase of inducing malnutrition lasting 19 days, and finally a phase of nutritional rehabilitation lasting 14 days. At the conclusion of the malnutrition induction and nutritional rehabilitation phases, blood samples were collected and used to evaluate biochemical and haematological markers. Kidneys and liver were removed for histological analysis.The findings revealed that the period of inducing malnutrition had a detrimental impact on several parameters, such as urea, triglyceride, total protein, C-reactive protein, albumin, ALAT, ASAT, WBC, hemoglobin, hematocrit, and MCV. Nevertheless, the ingestion of LAR diet derived from indigenous ingredients successfully returned all of these blood markers to the required levels for rats. Furthermore, histological examinations demonstrated that there were no kidney or liver abnormalities at the end of the trial.The LAR diets have rehabilitative effects on the biochemical and haematological parameters of rats. This suggests that these diets can be used therapeutically to treat moderate acute malnutrition and meet the nutritional needs of children aged 6 to 36 months.

Anthropometric recovery of children 6-59 months with complicated severe acute malnutrition, treated in public hospitals of Sana’a City

Background: The management of severe acute malnutrition (SAM) in inpatient therapeutic feeding centers (TFCs) is a life-saving intervention for children 6-59 months in Yemen. Aims: To evaluate the anthropometric recovery of children admitted to the TFCs and transferred to complete treatment in outpatient programs (OTPs) of Sana’a City Public Hospitals. Methods: A prospective follow-up study for children admitted to TFCs from September 2023 to April 2024 was conducted. The anthropometry measurements of the Weight-for-Height Z score (WHZ) and Mid-Upper Arm Circumference (MUAC) were calculated and used to follow the progression in recovery until the discharge from OTPs. Results: Of the total 150 children admitted to TFCs, 48 (32%) were males, and 75 (50%) were aged 6-&lt;12 months; 99 (66%) had both WHZ &lt;-3 and MUAC &lt;11.5); 25 (17%) had WHZ &lt;-3; and 26 (17%) had MUAC&lt;11.5 cm. At the point of transfer from TFCs, 72% (108) were with SAM, and 28% (42/150) with Moderate Acute Malnutrition (MAM). At discharge from OTP, 19% (28/150) were with non-acute malnutrition (NAM); the progression to NAM was among 48% (20/42) and 7% (8/108) of children transferred with MAM and SAM, P value (&lt;0.001). In conclusion, 88% (132/150) of children transferred from TFCs were discharged as cured from OTP, 21% (28/132) of them were anthropometrically recovered, and 79% were prematurely discharged.

Concurrent and predictive validity of the Global Leadership Initiative on Malnutrition criteria for adult patients in convalescent rehabilitation wards

Background & aimsThe Global Leadership Initiative on Malnutrition (GLIM) criteria has been recognised as major diagnostic criteria for malnutrition in adults worldwide; however, its validity in rehabilitation settings remains unclear. This study investigated the concurrent and predictive validity of the GLIM criteria for adult patients in convalescent rehabilitation wards. MethodsThis retrospective cohort study was conducted using pre-established datasets from convalescent rehabilitation wards in a hospital. The inclusion criteria were adults aged ≥18 years admitted to the wards between November 2018 and October 2020 who were available for body composition assessment. Malnutrition diagnoses were determined by registered dietitians (RDs) using the GLIM criteria. The Subjective Global Assessment (SGA) was performed by another RD and used for the malnutrition reference standard. The GLIM criteria sensitivity and specificity were examined for SGA. The odds ratios and hazard ratios of GLIM-defined malnutrition for the total score of the Functional Independence Measure (tFIM) effectiveness and non-home discharge were calculated using univariable and multivariable logistic regression analyses and Cox proportional hazard models. ResultsData from 723 patients were extracted from the dataset. GLIM-defined malnutrition was confirmed in 207 (28.6%) patients, 87 (12.0%) with moderate malnutrition and 120 (16.6%) with severe malnutrition. The SGA graded 146 (20.2%) patients with moderate malnutrition (grade B) and 86 (11.9%) with severe malnutrition (grade C). The GLIM criteria (malnutrition/ no malnutrition) had fair sensitivity (76.7%, 95% confidence interval [CI]: 70.7–82.0%) and good specificity (94.1%, 95% CI: 91.6–96.0%), indicating acceptable concurrent validity. GLIM-defined moderate malnutrition had poorer sensitivity than severe malnutrition (42.5% vs 81.4%). Logistic regression analyses revealed no evidence for the association between GLIM-defined malnutrition and poor tFIM effectiveness (adjusted odds ratio [AOR]: 1.09, 95% CI: 0.71–1.69) and non-home discharge (AOR: 1.19, 95% CI: 0.76–1.84). The Cox proportional hazard analyses also showed no effect of malnutrition on outcomes. ConclusionThe GLIM criteria had fair sensitivity and good specificity, indicating acceptable criteria for diagnosing malnutrition in rehabilitation settings. However, its predictive validity for functional recovery and discharge outcomes was insufficient.

Description of the etiological factors behind acute moderate and severe malnutrition in children under 5 years hospitalized at two high-complexity referral centers: Case series.

Acute malnutrition in children <5 years of age has a direct relationship with medical complications and mortality. We aimed to describe the etiologic factors in children with moderate and severe non-illness-related acute malnutrition who required hospitalization for treatment of malnutrition in two high-complexity hospital centers in Bogotá, Colombia. This is a multicenter case series (December 2016 to December 2020) including patients aged 1-59 months with a weight/height indicator less than -2 SD. Electronic health records were reviewed, and demographic (sex, age, city of origin, and socioeconomic status) and clinical data (gestational age at birth, edema, and nutrition status) were collected. Descriptive analysis of information was performed. An exploratory bivariate analysis by diagnostic categories of moderate and severe acute malnutrition vs days of hospitalization was also performed. Forty-five patients were included, 62.2% of whom were male, with a median age of 14 months (Q1-Q3: 7-24). The main etiologic factors of malnutrition were related to problems with total food intake (33.3%), transition in consistency of feeding (31.1%), and breastfeeding technique (22.2%). Only 13.3% had problems related to food insecurity. There were no statistically significant differences between moderate (median: 7 days; Q1-Q3: 5-12) and severe (median: 8 days; Q1-Q3: 5-16) acute malnutrition when compared by days of hospitalization. The main etiologic factors of malnutrition in our study population were related to problems in the amount of food provided and transition in consistency of complementary feeding.

Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes

ObjectiveTo evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. Study designA prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. ResultsThree hundred and forty-five children were enrolled in the cohort (n=188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department (ED) visits and hospital readmissions, hospital length of stay (LOS), or healthcare resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more ED visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio [IRR] 1.65, 95% confidence interval [CI]: 1.09, 2.49, p = 0.018; high risk - IRR 1.64, 95% CI: 1.05, 2.56, p = 0.028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, p = 0.023) for children at high risk compared with children at low risk after adjusting for patient characteristics. ConclusionsMalnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.

The Impact of Milk on Gut Permeability, Fecal 16S rRNA Gene Microbiota Profiling, and Fecal Metabolomics in Children with Moderate Malnutrition in Sierra Leone: A Double-Blind, Randomized Controlled Trial

Background. ObjectivesOur objectives were to determine the effect of dietary milk protein and milk carbohydrate on the intestinal permeability, fecal 16S rRNA gene configuration, and fecal metabolomics of children with moderate malnutrition. MethodsThis was a randomized, double-blind, controlled trial among 413 children with wasting in rural Sierra Leone who received 1 of the following 4 supplementary foods, which differed in sources of protein and carbohydrate: milk protein and milk carbohydrate (MPMC), milk protein and vegetable carbohydrate (MPVC), vegetable protein and milk carbohydrate (VPMC), or a control group consuming entirely vegetable-based food (VPVC). After 4 wk, urine and stool were collected from participants enrolled with mid-upper arm circumference of <12.1 cm. Urine was analyzed for lactulose excretion (%L). Stool samples were subjected to both 16S rRNA gene analysis to assess β-diversity and untargeted metabolomic abundance. ResultsAmong the 386 children who completed permeability testing, the mean difference (95% CI) in %L excretion as compared with VPVC was 0.01 (−0.05, 0.07) for MPMC, 0.05 (−0.01, 0.11) for MPVC, and 0.01 (−0.05, 0.07) for VPMC. Of the 374 children who provided a stool sample that was analyzed, the β-diversity among bacterial taxa was similar between dietary groups (P > 0.05 for all comparisons). No significant differences between dietary groups were seen among the 20 most abundant bacterial taxa. Among the 5769 unique metabolomic features identified, greater flavonoid levels in VPVC were seen. ConclusionsAbnormal intestinal permeability do not improve with 4 wk of supplementary feeding. Fecal rRNA do not differ with consumption of different diets.This trial was registered at clinicaltrials.gov as NCT04216043.

A retrospective study of resting energy expenditure in children hospitalized with different nutritional status.

Resting energy expenditure (REE) refers to the energy consumption of the body in a resting state without skeletal muscle activity. This study aimed to examine the REE among children hospitalized with varying nutritional status. This was a retrospective study. We enrolled 109 pediatric cases that underwent indirect calorimetry (IC) and divided into four groups: mild malnutrition group (15 cases), moderate malnutrition group (30 cases), severe malnutrition group (32 cases), and obesity group (32 cases). We compared and analyzed the measured REE (mREE) using IC with the predicted REE (pREE) using five energy equations. The paired t-test was used to compare the results of two samples. Pearson analysis was used to assess the correlation between two values. The agreement analysis was performed using the Bland-Altman method. There was no significant difference in mREE between the mild, moderate, and severe malnutrition groups, but each differed significantly from the obesity group. All populations exhibited significant correlation between the mREEs and all five energy equations, and the equation with the highest predictive accuracy was the Schofield equation, which achieved an accuracy of 47.7%. In subgroup analysis, there was no significant difference between mREE and pREE for each of the five equations in the mild, moderate malnutrition groups. Only the prediction result of the Liu equation was not significantly different from the mREE in the severe malnutrition group. The prediction accuracy of the Liu equation was relatively the highest (34.4%). However, in the obese group, there were significant differences in pREE and mREE between the Liu equation and Mifflin equation. Under different nutritional statuses, the results of the Bland-Altman analysis suggested that deviation values between REEs predicted by each equation and mREE were greater than ±10%. There were differences in REE among children with different nutritional status. The results obtained from the five predictive energy equations deviated from the IC results. When REE cannot be measured by IC, it is essential to choose an appropriate predictive energy equation based on the nutritional status of the individual.

A case of concurrent malnutrition in maple syrup urine disease: challenges and solutions in Indonesia

BackgroundMaple syrup urine disease (MSUD) is a rare autosomal recessive inborn error of metabolism characterised by the impaired breakdown of branched-chain amino acids. Detecting MSUD in newborns is challenging due to the lack of distinctive signs, especially in resource-limited settings like Indonesia.Case presentationA 2-year-old boy presented to the paediatric metabolic clinic with inactivity, a history of uncontrolled epilepsy, global developmental delay and moderate malnutrition. He was born at 40 weeks of gestation, weighing 3100 g, to consanguineous parents. The patient faced feeding problems and was lethargic after birth, with recurrent episodes of generalised seizure and spasticity. Diagnosed with MSUD at four months, the initial response to thiamine supplementation and MSUD Anamix formula was positive. However, weight loss occurred after switching to unregulated family food, as MSUD-specific infant formula became inaccessible and unsustainable due to high costs for the caregivers. Upon compliance with nutritional advice, the child regained weight and progressed appropriately for his age.ConclusionInborn errors of metabolism like MSUD should be considered in atypical disease presentations. In resource-limited settings, management should be tailored to local product availability and accessibility to ensure effective care.

Overcoming obstacles in taluk nutritional rehabilitation centres-baby steps

Background: While the effectiveness of nutrition rehabilitation centres (NRC) in combating severe and moderate malnutrition has been proven beyond doubt, their ability to reach out to all the target population is limited. The consensus of several studies is that NRCs are “under-utilized.” Hence, with a goal to improve utilization of NRCs, we aimed to set-up an assist system that may enhance the outreach of modified nutritional rehabilitation centre (mNRC)/taluk NRC) by enrolling more children within the existing ecosystem and thereby combat the malnourishment of under-5 children in the community. Methods: A rural facility-based, longitudinal, rehabilitative, case control pilot study conducted over a period of 1 year from March 2023 to March 2024 in our mNRC, Crawford General Hospital, Sakaleshpur. Our study compared the results between 2 groups, the conventional admission group, and the day-care group. The outcome parameter of percentage weight gain was used as the control variable. Results: The percentage weight gain assessed in our study showed that the weight gain in the day-care clinics was comparable to the admitted children with no statistically significant difference. Conclusions: Day-care clinics are an effective, feasible, practical adjuvant to mNRC that may be established at taluk as well as community health centre levels. This novel Assist System can overcome the difficulty of poor bed occupancies in NRC and boost the compliance and hence improve the community outreach for nutritional rehabilitation manifold.

Implemented nutritional intervention algorithm in pediatric oncology compared to standard nutritional supportive care outcomes

AimTo implement a childhood cancer-specific nutritional algorithm adapted for the South African context for interventions at time-set intervals to evaluate differences in the nutritional status of newly diagnosed children with cancer. MethodChildren with newly diagnosed cancer were assessed for stunting, underweight, wasting, and moderate to severe malnutrition (MUAC < -2SD and < - 3 SD) between October 2018 and December 2020 in a longitudinal nutritional assessment study with monthly assessments. Two pediatric oncology units (POUs) served as the intervention group that implemented the nutritional algorithm-directed intervention and three other POUs formed the control group that implemented standard supportive nutritional care. ResultsA total of 320 patients were enrolled with a median age of 6.1 years (range three months to 15.3 years) and a male-to-female ratio of 1.1:1. The malnourished patients in the intervention group showed significant improvement at six months after diagnosis for stunting (P =0.028), underweight (P < 0.001), and wasting until month five (P = 0.014). The improvements in the control group were not significant. Moderate acute malnutrition (MAM) significantly improved over the first six months of cancer treatment in the intervention group (P <0.001), while MAM improvement was only significant in the control group for the children under five years of age (P = 0.004). The difference in mean z-scores over time for the nutritional parameters between the intervention and control groups was insignificant. ConclusionWe established that the nutritional algorithm adapted for South Africa as an intervention tool for childhood cancer assisted in optimizing nutritional interventions and improved nutritional outcomes over the first six months of cancer treatment.

Change in body weight is positively related to the change in muscle mass of the quadriceps in older inpatients with severely low BMI according to the GLIM criteria

Background & aimsBody weight is one of the essential indicators of nutritional status, and body weight management is vital in nutritional care. In addition, low body mass index (BMI) was included as a phenotypic criterion in the Global Leadership Initiative on Malnutrition (GLIM) criteria. Furthermore, low BMI has been used in grading the severity of malnutrition (moderate or severe malnutrition) in the GLIM criteria. A recent cross-sectional study reported that muscle mass of the quadriceps in older inpatients with severely low BMI is less than those of older inpatients with moderately low BMI and non-low BMI. However, the longitudinal relationship between body weight and muscle mass of the quadriceps in older inpatients in each BMI category according to the GLIM criteria remains unclear. This study aimed to examine the longitudinal relationship between body weight and muscle mass of the quadriceps in older inpatients in each BMI category according to the GLIM criteria.MethodsThis retrospective cohort study included 179 older inpatients (aged ≥ 70 years) (median [IQR] age: 84.0 [79.0–89.0]). The period of this study was between January 2017 and March 2020. In accordance with the cut-off value of a low BMI for patients aged ≥ 70 years in the Asian population according to the GLIM criteria, the participants were divided into the following three groups: the severely low BMI group (< 17.8 kg/m2) (n = 47), moderately low BMI group (≥ 17.8 to < 20.0 kg/m2) (n = 38), and non-low BMI group (≥ 20.0 kg/m2) (n = 94). The medians (IQR) of the length of hospital stay of the severely low BMI, moderately low BMI, and non-low BMI groups were 71.0 (49.0–98.0) days, 71.0 (50.0–98.0) days, and 50.5 (36.5–103.0) days, respectively. The primary outcome was a change in muscle mass of the quadriceps. The muscle mass of the quadriceps was examined using ultrasound images (i.e., quadriceps thickness). The changes in quadriceps thickness and body weight were calculated by subtracting the quadriceps thickness and body weight at admission from those values at discharge. Multiple linear regression analysis adjusting for confounding factors was used to determine whether the change in body weight was independently and significantly related to the change in quadriceps thickness in the severely low BMI, moderately low BMI, and non-low BMI groups.ResultsThe means (SD) of the change in quadriceps thickness of the severely low BMI group, moderately low BMI group, and non-low BMI group were 0.0 ± 0.3 cm, 0.1 ± 0.3 cm, and 0.1 ± 0.5 cm, respectively. The means of the change in body weight in those groups were 0.4 ± 2.8 kg, − 1.1 ± 2.7 kg, and − 1.3 ± 4.3 kg, respectively. In the severely low BMI group, the change in body weight (β = 0.34, p = 0.006) and quadriceps thickness at admission (β = −0.62, p < 0.001) were significantly and independently related to the change in quadriceps thickness (R2 = 0.645, f2 = 1.817, statistical power = 1.000). In the moderately low BMI and non-low BMI groups, there were no factors that were significantly and independently related to the change in quadriceps thickness.ConclusionsThe results of this study suggest that change in body weight is positively related to the change in muscle mass of the quadriceps in older inpatients with severely low BMI according to the GLIM criteria. These results imply the importance of body weight management for older inpatients with severely low BMI perspective from the muscle mass of the quadriceps.