Moderate Malnutrition Research Articles

GLIM criteria-based identification of severe malnutrition and its relationship with the risk of mortality among older Chinese adults with arthritis or rheumatism

BackgroundMalnutrition is a well-known risk factor for mortality among older adults. Arthritis and rheumatism are characterized by chronic inflammation and are also related to malnutrition as diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. This study was thus developed to examine the associations linking malnutrition and all-cause death among older adults in China, employing the GLIM criteria to assess malnutrition.MethodsTwo waves of the China Health and Retirement Longitudinal Study from 2013 and 2018 were used to conduct this study. Moderate malnutrition was defined as low BMI (< 18.5 and < 20 for individuals < 70 and 70 + years of age, respectively), an unintended 10–20% decrease in weight, or low muscle mass based on the sex-specific lowest 20% of the height-adjusted muscle mass as < 5.039 kg/m2 in women and < 6.866 kg/m2 in men. Severe malnutrition was defined as a > 20% unintended decrease in weight only or the combination of both low muscle mass and an unintended reduction of over 10% in weight. Associations between malnutrition and the risk of all-cause death were assessed through Cox regression analyses.ResultsOverall, this study enrolled 1766 subjects 60 + years of age, of whom 57.36% (1033/1766) were female. Malnutrition was estimated to affect 418 (23.67%) of these individuals at baseline, with 21.06% and 2.60% affected by moderate and severe malnutrition, respectively. Over the 5-year follow-up, 189 of these individuals died. Covariate-adjusted Cox regression analyses confirmed a significant association between severe malnutrition and the risk of death in this cohort (HR = 2.196, 95%CI 1.125–4.286, P = 0.021).ConclusionsSevere malnutrition, identified through screening based on the GLIM criteria, was associated with an increased risk of all-cause death among older Chinese adults with arthritis or rheumatism.

The Effect of Giving Biscuits Made from Haruan Fish Flour and Yellow Pumpkin on the Nutritional Status of Toddlers

This study aims to investigate the effect of biscuits made from haruan fish flour and yellow pumpkin on the nutritional status of toddlers in the working area of Puskesmas Mangkupalas. A quasi-experimental pre-post test with control group design was employed, with a single-blind approach. The study was conducted from September to November 2021. A total of 22 toddlers were selected using purposive sampling. Respondents were divided into two groups: the intervention group, which received biscuits made from haruan fish and yellow pumpkin flour, and the control group, which received government-provided biscuits. Data on energy and protein intake were collected using a Food Recall, and nutritional status was assessed based on Weight-for-Age index using anthropometric measurements. In the control group, the average Z-score before the intervention was -1.4345 (normal nutritional status), which increased to -1.3536 post-intervention (still normal). The intervention group had an average Z-score of -2.0009 before the intervention, which decreased to -2.1691 (indicating moderate malnutrition). The control group's average energy intake was 956.864 kcal before the intervention and 792.564 kcal during the intervention. In the intervention group, energy intake was 1010.891 kcal before and 793.109 kcal during the intervention. Protein intake in the control group was 34.436 g before the intervention and decreased to 31.691 g during the intervention. The intervention group saw an increase from 38.164 g to 58.75 g. The intervention with biscuits made from haruan fish flour and yellow pumpkin flour did not significantly affect the nutritional status or energy and protein intake of the toddlers.

Growth at 2 years corrected age in preterm infants discharged on two different breast milk enhancements: An observational study.

Breast milk (BM) enhancement is often used to meet the nutritional needs of preterm infants after hospital discharge to achieve optimal growth. This study compared growth at 18-28 months corrected age (CA) among very preterm (VP) and very low birth weight (VLBW) infants discharged from the neonatal intensive care units (NICUs) on two BM enhancements. We conducted a retrospective chart review study of infants born between January 1, 2013 and December 31, 2017, with gestational age < 32 weeks or birthweight < 1500 g, discharged from the NICU on BM enhancements; fortification of BM with infant formula additives (BM-F) or unfortified BM supplemented with bottle feeds of infant formula (BM-S). BM enhancements were nonrandomized and determined by the medical team. A linear mixed model regression analysis with propensity score matching was used to estimate the adjusted associations between the nutrition plan at discharge and growth outcomes at 18-28 months CA follow-up. Two hundred and fifty-one VLBW/VP infants were included. Compared with BM-S, infants discharged on BM-F were more likely to continue receiving BM at 8-12 months CA, and had lower head circumference, weight-for-length z scores, and higher incidence of moderate malnutrition (p ≤ 0.01). After adjusting for confounders, discharge on BM-F was associated with a lower incidence of overweight/obesity at 18-28 months CA (odds interval: 0.45; confidence interval: 0.21-0.96; p = 0.04). This retrospective study suggests that VLBW/VP infants discharged on BM-F received BM longer, had lower growth parameter and were less likely to be overweight/obese at 18-28 months CA. Further studies are needed to evaluate the role of postdischarge nutrition on preterm born children's growth, metabolic disease, and neurodevelopmental outcomes.

Using the Lives Saved Tool to inform global nutrition advocacy.

The global nutrition community has been interested in investigating investment strategies that could be used to promote an increased focus and investment in nutrition programming in low- and middle-income countries. The Lives Saved Tool (LiST) was used to evaluate lives saved and the costs of nutrition interventions in nine high-burden countries. In this case study, we detail the analyses that were conducted with LiST and how the results were packaged to develop Nourish the Future - a five-year proposal for the US government to scale up lifesaving malnutrition interventions. Scaling up a proposed package of critical nutrition interventions including micronutrient supplementation for pregnant women, breastfeeding support, Vitamin A supplementation for children, and treatments for moderate and severe acute malnutrition is an effective and cost-effective way to avert millions of child deaths and stillbirths. This is one of the few case studies that outlines how a nutrition modeling tool (in this case LiST) was used to engage in a prioritisation exercise to inform a US-based advocacy ask. We share reflections and provide practical insights into user motivation and preferences for existing and future modeling tool developers. This case study also emphasises how integral evidence translation and strategic advocacy are to ensure the use of the modeling results.

C-Reactive Protein-to-Prealbumin and C-Reactive Protein-to-Albumin Ratios as Nutritional and Prognostic Markers in Hospitalized Patients-An Observational Study.

This study aimed to evaluate the role of the C-reactive protein-to-prealbumin (CP) ratio and the C-reactive protein-to-albumin (CA) ratio as nutritional and prognostic markers. A retrospective study was conducted on hospitalized patients who underwent a nutritional assessment and the measurement of C-reactive protein, prealbumin, and albumin (n = 274). Receiver operating characteristic (ROC) curve analysis was used. The area under the curve (AUC) of the CP ratio for predicting mortality was 0.644, 95%CI (0.571 to 0.717), and the CA ratio had an AUC of 0.593, 95%CI (0.518 to 0.669). The AUC of the CP ratio for the differential diagnosis between severe and moderate disease-related malnutrition (DRM) was 0.643, 95%CI (0.564 to 0.722), and the CA ratio had an AUC of 0.650, 95%CI (0.572 to 0.728). The CP and CA ratios showed greater accuracy in predicting mortality compared to C-reactive protein as an isolated marker (p = 0.011 and p = 0.006, respectively). Both ratios also improved the ability of prealbumin and albumin to identify severe DRM (p = 0.002 and p = 0.044, respectively). In conclusion, these results suggest that the CP and CA ratios may have a limited role in predicting mortality and identifying severe DRM by outperforming isolated protein markers.

Time to recovery from moderate acute malnutrition and its predictors among children aged 6-59 months in Fedis Woreda, East Hararghe Zone, Eastern Ethiopia.

Acute malnutrition is a major global public health problem, particularly in low-and middle-income countries. A targeted supplementary feeding program is an approach recommended to address moderate acute malnutrition in food-insecure settings. Preventing and treating moderate acute malnutrition requires identifying factors shown to affect the treatment outcome and duration of stay on treatment. This study aimed to determine the time to recovery from moderate acute malnutrition and its predictors among children aged 6-59 months in Fedis Woreda East Hararghe Zone, Eastern Ethiopia, from January 1 to December 31, 2022. A facility-based retrospective cohort study was conducted on 567 children with moderate acute malnutrition in Fedis Woreda, East Hararghe Zone, eastern Ethiopia. A multi-stage sampling technique was employed, and data was collected using a structured checklist. Data were extracted from randomly selected records after obtaining ethical clearance. Data were cleaned, coded, entered into EpiData 4.6, and analyzed using STATA/SE version 14. Descriptive statistics and analytic analysis schemes, including bivariable and multivariable Cox proportional hazards models, were conducted, and finally, statistical significance was considered at p < 0.05. The overall median time to recovery was 16 weeks. The major predicting factors for time to recovery among children aged 6-59 months were admission with a mid-upper arm circumference of 12.1-12.4 centimeters (AHR = 1.02, 95% CI: 1.01-1.19), access to transportation to facilities (AHR = 0.62, 95% CI: 0.36-0.81), children using specialized nutritious foods (RUSF; AHR = 1.96, 95% CI: 1.36-3.11), and children who had diarrhea (AHR = 0.4, 95% CI: 0.31-0.71). The study found a median recovery time of 16 weeks for children with targeted supplementary feeding. Significant predictors included admission with a MUAC of 12.1-12.4 centimeters, transportation access, RUSF use, and the presence of diarrhea. These findings highlighted the importance of these factors in determining and improving recovery from moderate-acute malnutrition.

Association of Controlling Nutritional Status Score With Mortality in Patients With Chronic Limb-Threatening Ischemia Following Endovascular Revascularization

Chronic limb-threatening ischemia (CLTI) represents the severest manifestation of peripheral artery disease. Malnutrition is closely associated with poor clinical outcomes in patients with chronic diseases. The Controlling Nutritional Status (CONUT) score is a tool to evaluate the systemic inflammation and nutritional status. This study aimed to investigate the association of baseline CONUT score with mortality in patients with CLTI following endovascular revascularization. A single-center retrospective analysis of patients with CLTI undergoing endovascular revascularization between January 2015 and December 2022 was performed. Preoperative nutritional status was evaluated using CONUT score, which was calculated using the serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. A CONUT score ≥5 indicates moderate or severe malnutrition. The Kaplan-Meier and multivariate Cox proportional hazards regression were used for survival analysis and to evaluate the risk factors associated with mortality. Among 232 enrolled patients, 20.7% of patients had moderate or severe malnutrition defined by the CONUT score. During a median follow-up of 2.1 (interquartile ranges, 1.0-3.5) years, 87 (37.5%) patients died. The 3-year overall survival rate in patients with CLTI who underwent endovascular revascularization was 63.7%. The high CONUT (≥5) group had significantly worse 3-year overall survival (42.0% versus 68.8%, P=0.004) and limb salvage (73.3% versus 84.1%, P=0.005) rates than the low CONUT (<5) group. Multivariate analysis showed that high CONUT score was significantly associated with increased risk for mortality in patients with CLTI after endovascular revascularization (hazard ratio, 1.687; 95% confidence interval, 1.031-2.759; P=0.037). The present study indicated that moderate or severe malnutrition defined by the CONUT score was significantly associated with increased mortality in patients with CLTI following endovascular revascularization. Future study is required to evaluate the efficacy of nutritional intervention in these patients.

Development and Acceptability of Shelf-Stable Microbiota Directed Complementary Food Formulations.

A randomized controlled trial in Bangladeshi children aged 12 to 18 months with moderate acute malnutrition found that dietary supplementation with the microbiota-directed complementary food (MDCF-2) significantly improved weight gain and repaired gut microbiota compared to the ready-to-use supplementary food. However, the MDCF-2 formulation was made daily from locally available ingredients and the need for a packaged, nutritionally compliant, and organoleptically acceptable MDCF-2 prototype was essential for future large-scale clinical studies. The study aimed to develop and assess the acceptability of 3 alternative foil-packaged formulations of MDCF-2 in comparison to current MDCF-2. Of the 3 packaged formulations, the Jumpstart version was provided in 2 sachets, the other 2 formulations were provided in a retort-stable foil pouch extended by sterilization, and microbiological growth was monitored over 10 months. The acceptability study included 40 children aged 8 to 12 months living in an urban slum in Dhaka, and the organoleptic properties were assessed using a 7-point hedonic scale. In the 100 g distributed over the 2 sessions, children consumed 82.5 ± 7.84 g (mean ± SD) of kitchen-prepared MDCF-2, 85.4 ± 7.15 g of the "Jumpstart" MDCF-2 formulation, 85.4 ± 8.70 g of the MDCF-2 with green banana powder, and 86.2 ± 4.26 g of the MDCF-2 with sweet potato formulation. The "Jumpstart" MDCF-2 and MDCF-2 with sweet potato achieved the highest overall acceptability scores on the hedonic scale; although none of the shelf-stable formulations were significantly different from the kitchen-prepared MDCF-2. Packaged, shelf-stable prototypes of MDCF-2 exhibited comparable acceptability among Bangladeshi children aged 8 to 12 months to the original freshly prepared formulation.

Malnutrition Severity Predicts Clinical Outcomes in Alcoholic Hepatitis: Evidence from National Data

Objective Alcoholic hepatitis (AH) represents a severe manifestation of alcoholic liver disease (ALD) associated with a wide severity spectrum. ALD is linked to nutritional deficiencies, with the gravity of malnutrition escalating as alcohol abuse and ALD progress. This study aims to delve into the impact of malnutrition on the clinical trajectory of AH. Methods We identified adult patients admitted with AH using the National Readmission Database (NRD) 2016–2020. We further classified AH patients based on the severity of malnutrition. We compared the outcomes of AH hospitalizations using a multivariate regression model. Results We included 82,367 AH patients, of whom 15,693 (19.00%) had malnutrition. 4,243 (5.15%) patients exhibited mild to moderate malnutrition, 5,862 (7.07%) patients had severe malnutrition, and 5,588 (6.78%) patients had unspecified severity of malnutrition. We found that adjusted in-hospital mortality due to AH was higher in patients with malnutrition, corresponding to the severity of malnutrition (adjusted odds ratio [aOR] 1.62 and 3.14 in mild-moderate malnutrition and severe malnutrition, respectively; p < .01). Additionally, patients with malnutrition had progressively elevated odds of septic shock, vasopressor requirement, mechanical ventilation, and intensive care unit (ICU) admission with escalating intensity of malnutrition. Liver-related complications, such as spontaneous bacterial peritonitis, coagulopathy, hepatorenal syndrome, and hepatic encephalopathy, were also found to have an increased likelihood in the presence of malnutrition. Furthermore, resource utilization showed a progressive increase with increasing severity of malnutrition. Conclusion Our findings indicate that malnutrition is a common comorbidity in AH patients, with varying degrees of severity, which correlates with higher mortality rates, emphasizing the critical role of nutritional status in the prognosis of AH. These findings underscore the importance of addressing and managing malnutrition in patients with AH, not only for its potential contribution to mortality but also because of its association with a spectrum of complications and increased healthcare resource utilization.

Malnutrition in children from 3 to 5 years of patate city, ecuador 2022

Currently, it is responsible for almost a third of deaths in children &lt;5 years of age and a cause of intellectual and cognitive disability in the surviving population. 23.1% of children under five years of age in Ecuador have chronic child malnutrition or delayed growth, the figure increases by 28.7%. in rural communities. The main objective was to determine the incidence of child malnutrition in a CDI in Patate, Ecuador during 2022. The majority age group was from 0 to 2 years, with a predominance of males with 53.85%. Low stature predominated in the male sex with 13.33%, as well as low weight with 3.33%. Considering the BMI, 3.33% were found to be underweight; the PGC found 36.66% of moderate and severe malnutrition. 45% of the patients considered by BMI normal weight, were carriers of moderate and severe malnutrition according to PGC.

Impact of Malnutrition on the Outcomes in Patients Admitted with Heart Failure.

Background: Heart failure, a major public health concern, significantly contributes to hospital admissions. This study evaluates the impact of malnutrition on both patient and hospital outcomes in heart failure admissions, with a specific focus on variations in outcomes based on the severity of malnutrition. Methods: Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Malnutrition was identified using the well-validated ICD 10 codes. We compared outcomes between patients with and without malnutrition, focusing on mortality, length of stay (LOS), hospital charges, cardiac arrest, and cardiogenic shock. Results: Out of 1,110,085 heart failure patients, 36,522 (3.29%) were malnourished. Malnourished patients exhibited significantly higher adjusted in-hospital mortality rates (aOR 3.32; 95% CI 3.03-3.64), longer LOS (mean increase of 4.67 days; p < 0.001), and higher hospital charges (mean increase of USD 77,416.9; p < 0.01). Increased rates of cardiac arrest (aOR 2.39; 95% CI 1.99-2.86; p < 0.001) and cardiogenic shock (aOR 3.74; 95% CI 3.40-4.12; p < 0.001) were also noted in malnourished patients. Severely malnourished patients faced worse outcomes compared to those with mild to moderate malnutrition. Conclusions: Heart failure patients with malnutrition experience higher mortality rates, longer hospital stays, increased hospitalization charges, and greater complication rates, including cardiac arrest and cardiogenic shock, compared to non-malnourished patients. Outcomes deteriorate with the increasing severity of malnutrition. Timely and individualized nutritional interventions may significantly improve outcomes for heart failure admissions.

Treatment of moderate acute malnutrition through community health volunteers is a cost-effective intervention: Evidence from a resource-limited setting.

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM).However, little is known about the cost-effectiveness of this integrated nutrition intervention. The present study investigates the cost-effectiveness of treating moderate acute malnutrition (MAM) through communityhealth volunteer(CHV) and integrating it with routine iCCM. A cost-effectiveness model compared the costs and effects of CHV sites plus health facility-based treatment (intervention) with the routine health facility-based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country-specific gross domestic productthreshold metrics. The intervention dominated the health facility-based strategy alone on all computed cost-effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively. Compared withfacility-based treatment, treating MAM by CHVs and health facilities was a cost-effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated.

Nutritional disorders and survival rate of elderly and geriatric patients with CKD 3B-5 stage

BACKGROUND. The prevalence of CKD in the population of the elderly and geriatric patients is varies from 23.4% to 35.8%. Nutritional status was recognized as an important factor of CKD prognosis. One of the factors affecting their survival is nutritional status. There have not been many studies on the effect of eating disorders on the survival of elderly and senile patients with CKD.THE AIM: to assess the impact of nutritional status on the survival of elderly patients with CKD stages 3b-5.PATIENTS AND METHODS. We’ve studied 190 people with CKD stages 3b-5 (eGFR&lt;45 ml/min/m2) with an average age of 76 [67;86]. Exclusion criteria’s: dialysis, acute cardiovascular disorders, oncology, and psychiatric disorders. Nutritional status was assessed by Subjective Global Assessment scale, the 5-year risk of the death was evaluated absolute by the Bansal scale. The duration of study - 36 month.RESULTS. In the group of elderly and geriatric patients with CKD stages 3b-5, normal nutritional status was determined in 40.1% of patients, mild to moderate malnutrition in 54.7%, and protein-energy wasting (PEW) in 5.2%; up to 2.8% of patients were underweight. The best 3-year survival rate was observed in patients with normal nutritional status, mild nutritional status disorders and obesity, the worst survival rate - in patients with PEW and underweight (p&lt;0,001). In the group of patients with CKD stage 4 the average Bansal score scale was 8 points, which corresponds to 69% of the absolute risk of death within 5 years; in patients with CKD stage 5, the average score was also 8 [7, 8]. CONCLUSION. In the group of elderly and geriatric patients with CKD stage 3b-5 and PEW survival rate was significantly lower than in patients without nutritional disorders and mild nutritional disorders; we didn’t find correlation between the estimated absolute risk of death according to the Bansal scale and actual survival in 3-year observation period.

Hospital Malnutrition: Quality Indicator in the ICU of a Hospital in Huancavelica, Periods 2015-2017

The objective of the present investigation was to ascertain whether malnutrition in hospitalised patients is a quality indicator in the Intensive Care Unit of a hospital in Huancavelica, during the periods 2015-2017. The study employed an observational, analytical-relational, retrospective, and longitudinal approach. A total of 51 critically ill patients treated at the Hospital Departmental Huancavelica were analyzed. Clinical-epidemiological characteristics, nutritional status, and mortality were evaluated using anthropometric and biochemical parameters. A statistical analysis was conducted using the Chi-square test, with a significance level of 5%. The results demonstrated that the mean age of critically ill patients who received artisan formula was 60 ± 22.8 years. Of these patients, 54.9% were women, and 70.6% were admitted to the ICU due to septic shock. Additionally, the mean height, time in the ICU, and days of receipt of artisan formula were 1.54 ± 0.1 m, 13.6 ± 8.0 days, and 11.5 ± 7.9 days, respectively. In contrast, the anthropometric and biochemical parameters exhibited lower averages when the admission data were compared with those obtained seven days later, with the exception of lymphocyte levels, which demonstrated a slight increase. The nutritional variable albumin was found to be related to mortality in patients (p = 0.022). It was observed that 75% of patients who died suffered from moderate malnutrition, compared to 30.8% of survivors. It can be concluded that critically ill patients who received artisan enteral formula after seven days exhibited greater malnutrition associated with mortality. This was evidenced by a decline in the anthropometric parameters (weight and BMI) and biochemical parameters (albumin, hemoglobin, and lymphocytes) as observed in the laboratory analyses. It is noteworthy that albumin demonstrated the strongest correlation with mortality. This study demonstrates that hospital malnutrition is an indicator of quality and has a significant impact on morbidity and mortality in critical patients of the ICU of the Departmental Hospital of Huancavelica, between the years 2015 and 2017.

Association of early-term birth and breastfeeding practices with nutritional outcomes in singleton term infants: a multicenter cross-sectional study

BackgroundLimited research has explored the associations of gestational age (GA) and breastfeeding practices with growth and nutrition in term infants.MethodsThis multicenter cross-sectional study recruited 7299 singleton term infants from well-child visits in Shandong, China, between March 2021 and November 2022. Data on GA, gender, ethnicity, birth weight, parental heights, gestational diabetes and hypertension, age at visit, breastfeeding practices (point-in-time data at visit for infants < 6 months and retrospective data at 6 months for infants ≥ 6 months), complementary foods introduction, infant length and weight, were collected. 7270 infants were included in the analysis after excluding outliers with Z-scores of length (LAZ), weight or weight for length (WLZ) <-4 or > 4. Linear regression models adjused for covariates explored the impact of GA and breastfeeding practices on LAZ and WLZ, while logistic regression models evaluated their effect on the likelihood of moderate and severe stunting (MSS, LAZ<-2), moderate and severe acute malnutrition (MSAM, WLZ<-2) and overweight/obesity (WLZ > 2). Sensitivity analysis was conducted on normal birth weight infants (2.5–4.0 kg).ResultsInfants born early-term and exclusively breastfed accounted for 31.1% and 66.4% of the sample, respectively. Early-term birth related to higher WLZ (< 6 months: β = 0.23, 95% confidence interval (CI): 0.16, 0.29; ≥6 months: β = 0.12, 95% CI: 0.04, 0.20) and an increased risk of overweight/obesity throughout infancy (< 6 months: OR: 1.41, 95% CI 1.08, 1.84; ≥6 months: OR: 1.35, 95% CI 1.03, 1.79). Before 6 months, early-term birth correlated with lower LAZ (β=-0.16, 95% CI: -0.21, -0.11) and an increased risk of MSS (OR: 1.01, 95%CI 1.00, 1.02); Compared to exclusive breastfeeding, exclusive formula-feeding and mixed feeding linked to lower WLZ (β=-0.15, 95%CI -0.30, 0.00 and β=-0.12, 95%CI -0.19, -0.05, respectively) and increased risks of MSAM (OR: 5.57, 95%CI 1.95, 15.88 and OR: 3.19, 95%CI 1.64, 6.19, respectively). Sensitivity analyses confirmed these findings.ConclusionsThe findings emphasize the health risks of early-term birth and the protective effect of exclusive breastfeeding in singleton term infants, underscoring the avoidance of nonmedically indicated delivery before 39 weeks and promoting exclusive breastfeeding before 6 months.

The predictive value of GLIM criteria on clinical outcomes and responses to nutritional support in patients with neurocritical illnesses

Neurocritically ill patients frequently exhibit coma, gastroparesis, and intense catabolism, leading to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition was created to achieve a consistent malnutrition diagnosis across diverse populations. This study aimed to validate the concurrent and predictive validity of GLIM criteria in patients with neurocritical illnesses. A total of 135 participants were followed from admission to the neurocritical unit (NCU) until discharge. Comparing GLIM criteria to the Subjective Global Assessment (SGA), sensitivity was 0.95 and specificity was 0.69. Predictive validity of GLIM criteria was assessed using a composite adverse clinical outcome, comprising mortality and various major complications. Adjusted hazard ratios for moderate and severe malnutrition were 2.86 (95% CI 1.45–5.67) and 3.88 (95% CI 1.51–9.94), respectively. Changes in indicators of nutritional status, including skeletal muscle mass and abdominal fat mass, within 7 days of admission were obtained for 61 participants to validate the predictive capability of the GLIM criteria for the patients’ response of standardized nutritional support. The GLIM criteria have a statistically significant predictive validity on changes in rectus femoris muscle thickness and midarm muscle circumference. In conclusion, the GLIM criteria demonstrate high sensitivity for diagnosing malnutrition in neurocritically ill patients and exhibit good predictive validity.

Prevalence of Iron Deficiency Anemia and Iron Deficiency Without Anemia Among Moderate and Severely Acute Malnourished Children.

Iron deficiency remains one of the globally recognized leading causes of morbidity and mortality in children, among developing countries like India as compared to the Western world. To estimate the prevalence of iron deficiency anemia (IDA) and iron deficiency without anemia (IDWA) among malnourished children. This cross-sectional study was conducted in the Department Of Pediatrics, Tertiary Care Hospital, Western Rajasthan. Demographic data and serum samples were collected and analyzed. Hematological and biochemical values were determined for 300 children aged 6 months to 59 months. A total of 93.9% of severe acute malnutrition (SAM) children and 83.24% of moderate acute malnutrition (MAM) children had anemia as perWHO definition, with moderate anemia (47.66%) being the predominant type of anemia. About 64% of children showed iron deficiency with a prevalence of IDA and IDWA being 94.27% and 5.72%, respectively. The mean values of serum ferritin, serum iron, serum total iron binding capacity (TIBC), and transferrin saturation in children with IDWA were 8.34±2.85, 17.43±7.57, 454.09±40.76, and 4.09±1.44, respectively. The proportion of anemic children in both SAM and MAM groups was very high. Our study shows that more than 60% of the MAM and SAM children were iron deficient. We recommend future measures for the prevention and control of anemia, including increased coverage of nutritional supplementation, fortification programs, and supplement iron in this sub-group (IDWA) to take care of their symptoms due to iron deficiency even before the development of overt IDA.

Nutritional assessment in the elderly on chronic haemodialysis in subsaharan Africa

Background Nutritional disorders and metabolic dysfunctions are numerous and common in chronic kidney disease. They frequently lead to malnutrition, however, these complications are worsened as chronic kidney disease progresses and becomes more significant at the dialysis stage. The aim of this study was to compare nutritional assessment according to the Seven-Point Subjective Global Assessment with that according to anthropometric parameters in elderly people on hemodialysis. Patients and Methods This was a cross-sectional, descriptive, and analytical study over 1 month from 01 August 2020 to 31 August 2020 in 10 hemodialysis centers in Dakar, in elderly people on chronic hemodialysis. Nutritional assessment was performed according to Seven-Point Subjective Global Assessment and anthropometric parameters. Results There were 92 patients included, 52 women and 40 men. The mean age of the patients was 66.05 ± 5.48 years. Anorexia was present in 48.91% of patients. The average body mass index was 23.75 ± 3.77 kg/m². The average body fat percentage was 34.99 ± 5.32%. The mean brachial circumference was 28.49 ± 3.99 cm. The mean brachial muscle circumference was 21.85 ± 3.14 cm. With 7-point SGA assessment, there were 14.10% of patients with mild to moderate malnutrition and no patients with severe malnutrition. In bivariate analysis, the 7-point SGA was correlated with the presence of anorexia (P = 0.001), body mass index (P = 0.001), brachial muscle circumference (P = 0.030), and brachial circumference (P = 0.010). Conclusion We found that Seven-Point Subjective Global Assessment was correlated with anthropometric parameters for nutritional assessment in elderly people on hemodialysis.

Prevalence and factors associated with the correlation between malnutrition and pain in hemodialysis patients

Malnutrition and pain are common in patients with chronic kidney disease who undergo hemodialysis. Although both pain and malnutrition are associated with increased morbidity and mortality, few studies have explored the correlation between pain and nutritional status. This study aimed to investigate the factors associated with pain intensity in patients undergoing hemodialysis, focusing on the risk of malnutrition. This was a cross-sectional study conducted at a regional dialysis center in a large tertiary hospital. Convenience sampling was used to recruit adult patients who had undergone hemodialysis for more than three months. An interviewer-administered questionnaire was used to gather sociodemographic and clinical data related to dialysis status, comorbidities, and body mass index (BMI). Pain severity and pain interference with functioning domains of the Brief Pain Index (BPI) were used to assess pain, and the malnutrition inflammation score (MIS) was used to assess nutritional status. Descriptive and inferential statistics were used to report the findings. The data were analyzed using the 25th version of the Statistical Package for the Social Sciences (IBM-SPSS) software. Of the final sample of 230 patients, 63.0% were males and 37.0% were females, with an average age of 58.3 years. Almost one-third of the participants had a BMI within the normal range (33.9%), and nearly one-third had a BMI within the underweight range (33.9%). Slightly more than half had a normal nutritional status or mild malnutrition (54.8%), while just under half had moderate or severe malnutrition (45.2%). The prevalence of pain was 47.0%. At the multivariate level, the severity of pain was associated with malnutrition (p < 0.001). Pain interference with function was associated with marital status (p = 0.045), number of comorbidities (p = 0.012), and malnutrition (p < 0.001). The MIS was positively correlated with both the severity of pain and the interference score. Pain and malnutrition were found to be prevalent in patients undergoing hemodialysis. Pain severity was associated with malnutrition, and pain interference was associated with malnutrition, marital status, and the number of comorbidities. Hemodialysis treatment should follow a patient-tailored approach that addresses pain, nutritional status, and associated chronic conditions. In addition, pain assessment and management should be included in the curriculum of nephrology training programs.

A microbiome-directed therapeutic food for children recovering from severe acute malnutrition.

Severe acute malnutrition (SAM), defined anthropometrically as a weight-for-length z-score more than 3 standard deviations below the mean (WLZ<-3), affects 19 million children under 5-years-old worldwide. Complete anthropometric recovery after standard inventions is rare with children often left with moderate acute malnutrition (MAM; WLZ -2 to -3). Here we conduct a randomized controlled trial (RCT), involving 12-18-month-old Bangladeshi children from urban and rural sites, who after hospital-based treatment for SAM received a 3-month intervention with a microbiota-directed complementary food (MDCF-2) or a ready-to-use supplementary food (RUSF) as they transitioned to MAM. The rate of WLZ improvement was significantly greater with MDCF-2 than the more calorically-dense RUSF, as we observed in a previous RCT of Bangladeshi children with MAM without antecedent SAM. A correlated meta-analysis of aptamer-based measurements of 4,520 plasma proteins in this and the prior RCT revealed 215 proteins positively-associated with WLZ (prominently those involved in musculoskeletal and CNS development) and 44 negatively-associated proteins (related to immune activation), with a significant enrichment in levels of the positively WLZ-associated proteins in the MDCF-2 arm. Characterizing changes in 754 bacterial metagenome-assembled genomes in serially collected fecal samples disclosed the effects of acute rehabilitation for SAM on the microbiome, its transition as each child achieves a state of MAM, and how specific strains of Prevotella copri function at the intersection between MDCF-2 glycan metabolism and the rescue of growth faltering. These results provide a rationale for further testing the generalizability of the efficacy of MDCF and identify biomarkers for defining treatment responses.