Moderate Malnutrition Research Articles

Standard RUTF vs. locally-made RUSF for acutely malnourished children: A quasi-experimental comparison of the impact on growth and compliance in a rural community of Pakistan.

The reduction in severe and moderate acute malnutrition (SAM and MAM) rates in Pakistan has been sub-optimal compared to other low-and middle-income countries (LMICs). Specially-formulated products have been designed globally to manage SAM and MAM, such as ready-to-use therapeutic food (RUTF) and ready-to-use supplementary food (RUSF), with variable efficacies. RUTF is primarily produced and patented in industrialized countries, raising supply challenges in resource-constrained regions with a high burden of acute malnutrition. RUSF minimizes costs by using locally-available ingredients while providing similar nutritional value. In this study, we compared the efficacy, side effects, and compliance of two months of supplementation with either RUTF or RUSF. Children aged nine months in the rural district of Matiari, Pakistan, with a weight-for-height z-score (WHZ) <-2 received either RUTF (500 kcal sachet) for two months in 2015 or RUSF (520 kcal sachet) for two months in 2018. The RUSF group had a higher height gain and mid-upper arm circumferences (MUAC) score. Higher compliance was noted with lower side effects in the RUSF group. A higher compliance rate did correlate with the growth parameters in respective groups. Our study found that both RUTF and RUSF partially improve the anthropometric status of acutely malnourished children, with neither being superior to the other.

Treatment outcomes and associated factors for hospitalization of children treated for acute malnutrition under the OptiMA simplified protocol: a prospective observational cohort in rural Niger.

Globally, access to treatment for severe and moderate acute malnutrition is very low, in part because different protocols and products are used in separate programs. New approaches, defining acute malnutrition (AM) as mid-upper arm circumference (MUAC) < 125 mm or oedema, are being investigated to compare effectiveness to current programs. Optimizing Malnutrition treatment (OptiMA) is one such strategy that treats AM with one product - ready-to-use therapeutic food, or RUTF - at reduced dosage as the child improves. This study aimed to determine whether OptiMA achieved effectiveness benchmarks established in the Nigerien National Nutrition protocol. A prospective cohort study of children in the rural Mirriah district evaluated outcomes among children 6-59 months with uncomplicated AM treated under OptiMA. In a parallel, unconnected program in one of the two trial sites, all non-malnourished children 6-23 months of age were provided small quantity lipid-based nutritional supplements (SQ-LNS). A multivariate logistic regression identified factors associated with hospitalization. From July-December 2019, 1,105 children were included for analysis. Prior to treatment, 39.3% of children received SQ-LNS. Recovery, non-response, and mortality rates were 82.3%, 12.6%, and 0.7%, respectively, and the hospitalization rate was 15.1%. Children who received SQ-LNS before an episode of AM were 43% less likely to be hospitalized (ORa=0.57; 0.39-0.85, p = 0.004). OptiMA had acceptable recovery compared to the Nigerien reference but non-response was high. Children who received SQ-LNS before treatment under OptiMA were less likely to be hospitalized, showing potential health benefits of combining simplified treatment protocols with food-based prevention in an area with a high burden of malnutrition such as rural Niger.

Malnutrition among Patients with Chronic Liver Disease Admitted to the Department of Gastroenterology and Hepatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. It is considered an independent predictor of mortality that leads to an increased number of complications. The aim of this study was to find out the prevalence of malnutrition among patients with chronic liver disease admitted to the Department of Gastroenterology and Hepatology in a tertiary care centre. Methods: This descriptive cross-sectional study was done among patients with chronic liver disease admitted to the Department of Gastroenterology and Hepatology in a tertiary care centre between 10 January 2021 to 15 February 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 394/077/078-IRC). The nutritional status of patients was assessed by subjective global assessment. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 110 patients with chronic liver disease, malnutrition was seen in 91 (82.72%) (75.65-89.79, 95% Confidence Interval). Out of 91 patients who were malnourished, 56 (61.53%) had moderate malnutrition whereas 35 (38.46%) had severe malnutrition. Seventy-six (83.51%) suffered from alcoholic cirrhosis. Conclusions: The prevalence of malnutrition among patients with chronic liver disease was higher than in other studies done in similar settings.

Effects of complementary food formulated from millet, soybean, and grasshopper on hematological parameters of malnourished weanling albino rats

Background: Malnutrition in under-five children remains an issue of public health, especially in low and middle-income countries, and is associated with inadequate child development and poor survival. Recent public health intervention strategies for malnourished children allow for localized targeted supplementation with locally available materials to replace the imported Ready-to-Use-Supplementary-Food (RUSF) for the target group. Aims: The aim of the study was to develop a local supplementary food and determine its effects on hematological parameters of weanling rats. Material and Methods: The experimental study involved thirty weanling albino rats, grouped into groups A, B, and C, each consisting of ten rats. All the groups were acclimatized for fourteen days, thereafter, groups A and B were induced with moderate acute malnutrition (MAM) by feeding with only corn starch for fourteen days. Weight, tail length, and hematological parameters (hemoglobin level, white blood cell count) of all the weanling albino rats were determined and recorded as baseline values on the fourteenth day. Therapeutic food made from millet, soybean, and grasshopper blends was produced and fed to group A as the intervention, Group B was fed with corn starch only and group C was fed on normal rat pellets for twenty-eight days. Weight, tail length, and hematological parameters were determined and recorded at the end of the intervention. Results: Experimental group A had the lowest packed cell volume (PCV) value with a difference of 2.20 ± 0.56 %, the lowest hemoglobin (Hb) level with a difference of 0.58 ± 0.02 g/dL, the control group had the highest PCV, Hb, and RBC with values of 4.10 ± 0.5 %, 1.58 ± 0.21 g/dL, and 0.9 ± 0.05 x 106 µ/L respectively. Conclusions: With the evidence provided by the parameters assessed in the study, it can be concluded that the developed therapeutic food is efficacious in the treatment of malnutrition especially in weanling albino rats. Keywords: Moderate Acute Malnutrition (MAM), Ready-to-Use-Supplementary-Food (RUSF) Malnutrition, Complementary feeding, Animal studies.

Influence of gender and malnutrition on QT dispersion in a north-Malagasy children population.

Children malnutrition involves simultaneous deficiency of nutrients, leading to cardiac morphological and functional alterations. In this complex condition repolarization abnormalities can evolve. Also, sexual dimorphism is a well-established phenomenon, but its influence on ventricular repolarization varies tremendously among races. No data are available about African children, so the aim of our work was to study the correlation between malnourishment and electrocardiographic repolarization parameters and evaluating the sex influence. Three hundred seven children (mean age 7.6±3 years old) were consecutively enrolled in the north of Madagascar. The QT interval was measured and corrected (QTc) following the Bazett formula (QT/√RR). QT dispersion (QTcd) was defined as the difference between maximum and minimum QTc. Malnutrition was defined in relation to age and sex specific BMI values. Grade mild, moderate and severe were defined as the value to pass through BMI of 16, 17 and 18.5 at the age of 18. One hundred twenty-six children (41%) were malnourished, 42 (13%) with mild, 61 (20%) moderate and 23 (7%) with a severe grade. No differences were found between normal weight and malnourished regarding the gender, age, height, or heart rate. They had similar QT and QTc intervals (respectively 362.4±36 ms vs. 365.1±47 ms for QT, P=0.59 and 476.9±43 ms vs. 470±53 ms for QTc, P=0.70). QTcd was statistically higher in malnourished children (53.2±16 ms vs. 44.4±15 ms, P<0.001). QTcd progressively increased from normal weight to severe malnutrition (P<0.001). At multivariate analysis, independently from sex category, children with moderate (C.I. 3.94-13.1, P<0.001) and severe (C.I. 8.38-22.0, P<0.001) malnutrition had a higher risk to have a higher QTcd). 146 children (48%) were male. Prolonged QTcd was found more frequently in male children (58% vs. 44%, P=0.04), showing also longer QTc and QTcd (respectively 475.8±52 ms vs. 462.3±42 ms, P=0.01; and 50.1±16 ms vs. 46.2±16 ms, P=0.03). At the multivariate analysis, males had a higher risk (C.I. 0.28-7.35, P=0.03) to have higher QTc dispersion with respect to female children, independently to the nutrition state. Moderate to severe malnourishment and male sex independently influence ventricular repolarization, with higher QTc dispersion times and eventually higher risk of future arrhythmic complications. In these children, precaution must be taken with intensive correction of malnutrition and a strict ECG follow-up.

A Retrospective Study on the Clinical, Laboratory, and Nutritional Status of Pediatric Epidermolysis Bullosa in a Tertiary Referral Hospital in West Java, Indonesia.

Epidermolysis bullosa (EB) is a genodermatosis disease with bullae and erosions of the skin and mucous membrane that can last for a lifetime and decrease quality of life. Oral and gastrointestinal disorders inhibit the patients' ability to achieve optimal nutrition, making the patients prone to infection, leading to prolonged wound healing, and delayed growth and developmental process. However, there has been no research on the clinical, laboratory, and nutritional status of pediatric EB patients in Indonesia. This study aims to describe the clinical, laboratory, and nutritional characteristics of pediatric EB patients treated in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This was a retrospective descriptive study of pediatric EB patient records in Dermatology and Venereology Outpatient of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from April 2018-March 2020. Study results showed 12 pediatric EB patients consisting of 7 dystrophic EB (DEB) (4 recessive dystrophic EB [RDEB] patients and 3 dominant dystrophic EB [DDEB]), 3 junctional EB (JEB), and 2 EB simplex (EBS). The most extensive EB wounds was found affecting 10-20% of the body surface area with a <10% infected wound area. Pain was found in all patients. The most frequent abnormalities in laboratory examination were anemia and low zinc levels. Severe malnutrition was found in almost half of the patients. RDEB is the most commonly found type of pediatric EB. Wounds on the skin, tooth decay, hand deformity, pain when changing dressings, low zinc levels, and low hemoglobin levels are the clinical features and laboratory findings that contribute to the development of moderate and severe malnutrition in RDEB patients.

Analysis of Postdischarge Interventions for Children Treated for Moderate or Severe Wasting, Growth Faltering or Failure, or Edema

Children treated for acute malnutrition remain at increased risk of relapse, infection, and mortality after programmatic recovery. Global guidelines for the management of acute malnutrition currently provide no recommendations to sustain recovery following treatment discharge. To inform guideline development by evaluating the evidence on postdischarge interventions to improve outcomes within 6 months after discharge. In this systematic review, 8 databases were searched from inception through December 2021 and included randomized and quasi-experimental studies investigating interventions delivered after discharge from nutritional treatment for children aged 0 to 59 months. Outcomes were relapse, deterioration to severe wasting, readmission, sustained recovery, anthropometry, all-cause mortality, and morbidity within 6 months after discharge. The risk of bias was assessed using Cochrane tools, and the certainty of the evidence was evaluated with the GRADE approach. Of 7124 records identified, 8 studies, conducted in 7 countries between 2003 and 2019 with 5965 participants, were included. The study interventions included antibiotic prophylaxis (n = 1), zinc supplementation (n = 1), food supplementation (n = 2), psychosocial stimulation (n = 3), unconditional cash transfers (n = 1), and an integrated biomedical, food supplementation, and malaria prevention package (n = 1). Risk of bias was moderate or high for half the studies. Only unconditional cash transfers were associated with reduced relapse, while the integrated package was associated with improved sustained recovery. Zinc supplementation, food supplementation, psychosocial stimulation, and unconditional cash transfers were associated with improvements in postdischarge anthropometry, while zinc supplementation was associated with reductions in multiple postdischarge morbidities. In this systematic review of postdischarge interventions to reduce relapse and improve other postdischarge outcomes among children treated for acute malnutrition, evidence was limited. Biomedical, cash, and integrated interventions showed promise in improving certain postdischarge outcomes for children treated for moderate or severe acute malnutrition in single studies. Further evidence on the efficacy, effectiveness, and operational feasibility of postdischarge interventions in other contexts is needed to inform global guidance development.

Impact of nutritional and educational support on home enteral nutrition

BackgroundHome Enteral Nutrition (HEN) is used to prevent or correct malnutrition in outpatients. Due to the complexity of this process, the indication, follow-up, and results of an educational program of HEN patients was evaluated.MethodsA prospective, observational, real-life, multicenter study was performed in 21 Spanish Hospital. Patients receiving HEN by nasogastric tube or ostomy were included. The following variables were collected: age, gender, HEN indication, type of formula, nutritional requirements, laboratory variables, complications, and quality standards of the educational program. To calculate the energy and protein requirements, the FAO/WHO/UNU formula was used considering the adjusted weight of the patients. All data were analyzed using SPSS.24.Results414 patients were included. Most conditions diagnosed were neurodegenerative diseases (64.8%). 100 (25.3%) were diabetic. The mean weight was 59.3 ± 10.4 kg and BMI 22.6 ± 3.2. Moderate protein-calorie malnutrition was predominant at baseline (46.4%). Improvement in nutritional status at six months was recorded in more than 75% of patients (p < 0.05). Tolerance problems, diarrhea and abdominal distension fell between the 3- and 6-month visits (p < 0.05). Patients who received intermittent EN had fewer tolerance-related effects (OR 0.042; 95% CI 0.006–0.279) and less diarrhoea (OR 0.042; 95% CI 0.006–0.279). At the baseline and 6-month visits, compliance with the educational measures proposed by the prescriber was ≥ 99%.ConclusionThe nutritional assessment to prescribe individualized HEN to each patient, together with educational measures and training in the proper use of this treatment for both patients and trainers, improves nutritional status and reduces the onset of adverse events.

Correction of nutritional status in patients with focal liver diseases

Purpose of the research. To study the effect of nutritional support on the results of treatment of patients after liver resection for its focal neoplasms.Materials and methods. Nutritional status at the pre- and inpatient stages was studied based on the examination of 74 patients with focal liver neoplasms. Through a comprehensive clinical and laboratory examination, were identified groups of patients with mild, moderate and severe malnutrition were identified. Comparison groups were formed from them to develop corrective measures aimed at minimizing the phenomena of nutritional deficiency and reducing the frequency ofpurulent- septic complications from wounds.Results. As a result of the study, it was revealed that after undergoing large and extended liver resections, a mild degree of malnutrition was noted in 18 (47.4%) patients in the main group and in 16 (44.4%) patients in the control group (p = 0.796). The average degree of malnutrition was recorded in 7 (18.4%) patients in the main group and in 5 (13.9%) patients in the control group (p = 0.641). Severe malnutrition was observed in 3 (7.9% and 8.3%, respectively) patients in the analyzed groups (p = 0.796). It has been proven that the use of ATP allows accelerating the normalization of nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p &lt;0.001). Nutritional support with the use of enteral nutrition on day 2 after surgery makes it possible to improve PS markers, which, as a result, helps to reduce the number of septic complications by 9% in the main group.Conclusion. The use of ATP allows to normalize the nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p &lt; 0.001). After liver resection in the early postoperative period, nutritional support with enteral nutrition on day 2 after surgery allows improving PS markers, which, as a result, helps to reduce the number of purulent- septic complications by 9% compared to patients who did not receive nutritional support.

Diaphragm thickness by ultrasound in pediatric patients with primary malnutrition.

Skeletal muscle atrophy is known to be a marker for nutritional deficiency. The diaphragm is both a skeletal muscle and a respiratory muscle. There is not enough data in the literature about the change in diaphragm thickness (DT) in children with malnutrition. We think that malnutrition may have negative effects on diaphragm thickness. Therefore, in this study, we aimed to compare the diaphragm thicknesses of pediatric patients with primary malnutrition and a healthy control group. The DT of pediatric patients diagnosed with primary malnutrition by a pediatric gastroenterologist was prospectively evaluated by a radiology specialist by ultrasonography (USG). The obtained data were statistically compared with the data of the healthy control group. There was no statistically significant difference between the groups in terms of age and gender (p = 0.244, p = 0.494). We found that right and left diaphragm thicknesses were significantly thinner in the malnourished group than in the healthy control group (p = 0.001, p = 0.009, respectively). We found that right and left diaphragm thicknesses were thinner in those with moderate and severe malnutrition compared to the normal group (p < 0.001, p = 0.003, respectively). We found a significant weak positive correlation between weight and height Z score and right and left diaphragm thickness (respectively, r: 0.297, p < 0.001; r: 0.301, p < 0.001). Conclusion: Malnutrition is a disease that affects all systems. Our study shows that the DT is thinner in patients with malnutrition. What is Known: •Malnutrition causes skeletal muscle atrophy. What is New: •Diaphragm muscle thickness decreases in malnutrition. •There is a significant positive correlation between diaphragm muscle thickness and height, weight and BMI z scores.

Measles Outbreak Investigation in Garda Marta District, Southwestern Ethiopia, 2022: Community-Based Case-Control Study.

A measles outbreak can occur in the presence of an increased number of unvaccinated children; however, the vaccine was available many decades ago, and it is the foremost cause of child mortality, claiming 568 lives (mostly children) worldwide each day. The investigation was aimed at assessing the magnitude and identifying contributing factors for the measles outbreak in the Garda Marta District of Gamo Zone, Southwestern Ethiopia. From January 20 to February 10, 2022, a descriptive and unmatched case-control study was used to describe the measles outbreak and identify the associated risk factors for measles infection. The descriptive analysis employed all 140 cases from the line list, while the case-control study used 51 cases and 102 controls to investigate factors associated with measles infection. Epi-data version 4.6.0.6 was used to code and enter data, which was then exported to SPSS version 27 for analysis. A standardized questionnaire was used to collect data. To declare statistical significance for the association, multivariable logistic regression with an adjusted odds ratio (AOR) and 95% CI was used. From a total of 140 measles cases reported from October 12, 2021, to March 09, 2022, 75 (54%) were females. Marta Laddo kebele was most affected (104 cases). Being unvaccinated (AOR: 2.84, 95% CI: 1.10-7.32), having a travel history (AOR: 4.24, 95% CI: 1.61-11.15), having a contact history (AOR: 6.34, 95% CI: 2.35-17.40), being unaware of the mode of transmission (AOR: 2.68, 95% CI: 1.16-6.37), and having moderate acute malnutrition (AOR: 4.44, 95% CI: 1.74-11.31) were factors significantly associated with the measles outbreak. Being unvaccinated, travel history to measles outbreak area, contact history, knowledge of caretakers/mothers on the mode of transmission, and acute malnutrition were associated with the measles outbreak in the district. Therefore, strengthening routine measles immunization, mounting vaccination awareness and nutritional screening are recommended.

Efficacy of Ayurveda Interventions in Protein Energy Malnutrition in Children: A Systematic Review and Meta-Analysis

According to United Nations International Children's Emergency Fund (UNICEF), in India, around 46 percent of all children below the age of three are too small, and 35.7% are underweight and come under MAM (Moderate Acute Malnutrition). Protein Energy Malnutrition (PEM) can be correlated with Karshya, Balashosha, Phakka, Parigarbhika, Sushka Revati, and Apatarpanjanya Vyadhi based on similar clinical features. Multiple evidencebased clinical studies are conducted in this sector, but no comparative conclusion of results or systemic review is accomplished. The study aims to evaluate and compare Ayurveda interventions' efficacy in managing children's protein energy malnutrition and to assess the effect of Ayurveda Interventions on weight gain and serum protein values in children suffering from PEM. This systemic review was conducted according to the guidelines of the Cochrane Handbook of Systemic review of interventions and is reported following the Preferred Reporting Guideline for Systemic review and meta-analysis guidelines (PRISMA). All study groups showed significant p values within the group and insignificant p values in the fixed random effect model. Though the p-value is insignificant between the groups, one group among the four shows better results in the fixed effect model. In the primary outcome of weight, group 3, i.e., the category of drugs having Bruhana and Pachana combination, shows better results than other groups in the fixed effect model. In the outcome of serum protein values, BMI, and Head circumference, group 4, i.e., drugs with only Bruhana properties, show better results than other groups. Based on this review, few policies or treatment protocols can be hypothesized for managing PEM at the national level. The Ayurveda intervention combinations have worked better because they work on multiple aetiological factors and biological variations in PEM in Children.

Malnutrition and poststroke depression in patients with ischemic stroke

BackgroundIdentifying high-risk patients based on modifiable clinical characteristics, such as malnutrition, is critical to intervening with these variables to reduce the risk of post-stroke depression (PSD). The aim of this study was to investigate the effect of nutritional status on the risk of incident PSD and the trajectory of PSD risk. MethodsConsecutive patients with acute ischemic stroke were recruited in this observational cohort and followed up for 1 year. Multivariate logistic regressions and multilevel mixed-effects logistic regressions with random intercepts and slopes were used to investigate the effects of nutritional indexes [the Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Prognostic Nutritional Index (PNI)] and body mass index (BMI) on the risk of incident PSD and the trajectory of PSD risk over the 12-month observation period. ResultsA total of 538 patients were included in the final analysis. Worsening CONUT [odds ratio (OR) = 1.36; confidence interval (CI): 1.15–1.61], NRI (OR = 0.91; CI: 0.87–0.96) and PNI (OR = 0.89; CI: 0.84–0.95) scores were significantly associated with an increased risk of incident PSD. Moderate and severe risk malnutrition statuses were associated with higher incidences of PSD regardless of the malnutrition index (CONUT, NRI or PNI). Additionally, PSD risk decreased over time with a significant two-way interaction between time and CONUT, NRI, and PNI, implying that patients with elevated exposure to malnutrition showed a slower decline in PSD risk. BMI had no significant effect on the occurrence and development of PSD. ConclusionMalnutrition, but not BMI, was associated with a higher probability of incident PSD and was more likely to lead to a slower rate of decline in PSD risk.

Doris Howes Calloway

Throughout her career, Doris Howes Calloway sought to understand what influences human protein and energy requirements and metabolism in controlled and field settings. Much of her research became the basis for national and international dietary recommendations, many of which are in use today. She served on many committees of the US Food and Nutrition Board/National Research Council/Institute of Medicine and the Food and Agriculture Organization/World Health Organization of the United Nations. Concerned about populations where marginal malnutrition is often overlooked, Dr Calloway led a major United States Agency for International Development–funded multiuniversity research project in low-income countries to better understand the effects of moderate malnutrition on growth and health. She led this extensive multinational study while serving as provost, the first woman in the senior administration at the University of California, Berkeley campus. Toward the end of her professional career, she was appointed chair of the 1995 Dietary Guidelines for Americans Advisory Committee. Her interest in food and nutrition policy helped reorient dietary guidance both in the United States and internationally. Dr Calloway's scientific and humanitarian accomplishments were extended further through the subsequent research and leadership activities of her colleagues, graduate students, and others whom she mentored.

Outcomes of a food voucher program and factors associated with the recovery rate of children with moderate acute malnutrition in Far North Cameroon

BackgroundResearch on moderate acute malnutrition (MAM) is limited, despite its high prevalence. This study examined outcomes of bi-weekly locally available foods provided via a food voucher program (FVP) on nutritional recovery [mid-upper arm circumference (MUAC) ≥ 125 mm] from MAM (defined as MUAC between 115 and 124 mm) and identified the factors associated with recovery rate in Kaélé health district, Far North Region of Cameroon.MethodsThis was a prospective study with 474 MAM children aged 6–59 months. Food voucher distribution and MUAC screening were conducted at 6 bi-weekly visits or until the child was recovered. Time to recovery was evaluated with multivariate Cox proportional regression hazard models with associations quantified using adjusted hazard ratio (aHR). The trend for MUAC, including its determinants, was examined with multivariate linear mixed effect models.ResultsThe recovery rate was 78.3% by 6 weeks after the first food basket; 3.4% remained MAM, and 5.9% were transferred for treatment for severe acute malnutrition (SAM defined as MUAC < 115 mm). Boys were 34% more likely to recover from MAM than girls [aHR = 1.34, 95%CI (1.09, 1.67)]. Children aged 24–53 months were 30% more likely to recover than those aged 6–11 months [aHR = 1.30, 95%CI (0.99, 1.70)]. A one unit increase in weight-for-height Z-score (WHZ) was associated with 1.89-fold greater likelihood of recovery [aHR = 1.89, 95%CI (1.66, 2.14)]. Male children had on average 1.82 mm greater increase in MUAC than female children (p < 0.001). One unit increase in WHZ was associated with 3.42 mm increase in MUAC (p = 0.025). Children aged 12–23 and 24–53 months had 1.03 mm and 2.44 mm, respectively, greater increase in MUAC over the program than children aged 6–11 months (all p < 0.01).ConclusionThe recovery rate of MAM children treated with the FVP met the Sphere standards for targeted supplementary feeding programs (> 75%). Child’s WHZ, gender and age were significant factors associated with MUAC increase and recovery from MAM in the FVP. These findings indicate the FVP approach shows promise as an effective alternative treatment for MAM with consideration of associated factors and merits further evaluation.

Prognostic Impact of Malnutrition Diagnosed by the GLIM Criteria for Resected Extrahepatic Cholangiocarcinoma.

Recently, the Global Leadership Initiative on Malnutrition (GLIM), which includes the world's leading clinical nutrition societies, proposed the first global diagnostic criteria for malnutrition. However, the association between malnutrition diagnosed by the GLIM criteria and prognosis in patients with resected extrahepatic cholangiocarcinoma (ECC) remains unknown. This study aimed to investigate the predictive validity of the GLIM criteria for the prognosis of patients with resected ECC. Between 2000 and 2020, 166 patients who underwent curative-intent resection for ECC were retrospectively analyzed. Prognostic significance of preoperative malnutrition diagnosed by the GLIM criteria was investigated using a multivariate Cox proportional hazards model. Eighty-five (51.2%) and 46 (27.7%) patients were diagnosed with moderate and severe malnutrition, respectively. Increased malnutrition severity tended to be correlated with increased lymph node metastasis rate (p-for-trend=0.0381). The severe malnutrition group had worse 1-, 3-, and 5-year overall survival rates than the normal (without malnutrition) group (82.2% vs. 91.2%, 45.6% vs. 65.1%, 29.3% vs. 61.5%, respectively, p=0.0159). In multivariate analysis, preoperative severe malnutrition was an independent predictor for poor prognosis (hazard ratio=1.68, 95% confidence interval=1.06-2.66, p=0.0282), along with intraoperative blood loss >1,000 ml, lymph node metastasis, perineural invasion, and curability. Severe preoperative malnutrition diagnosed by the GLIM criteria was associated with poor prognosis in patients who underwent curative-intent resection for ECC.

Nutritional status, nutrient imbalances, food-related behaviors and dietary supplements use among patients with celiac disease on a gluten free diet in Lebanon: a national cross-sectional study.

Background: Celiac disease is an autoimmune disorder triggered by gluten, that occurs in susceptible individuals and is associated with dietary restriction and subsequent nutritional deficiencies. This study investigated the diet quality, nutrition imbalances and nutrition status among young children,adolescents and adults with CD who were referred to several hospitals in Lebanon. Methods: A cross-sectional study in 50 individuals (31.74 ± 15.64 years) with CD who follow a gluten free diet was conducted, using biochemical parameters, anthropometric measurements, dietary and physical activity assessments. Results: Of the 50 participants, 38% and 16% were presenting low serum levels of iron and vitamin B12, respectively. The majority of participants were physically inactive and around 40% of them had low muscle mass. A weight loss of 10% to 30% indicating mild to moderate malnutrition was shown in 14% of individuals. The assessment of food-related behaviors shows that 80% of participants were reading nutrition labels and 96% of them were following gluten-free diets (GFD). Some barriers including family ignorance (6%), language of the nutrition labels (20%) and expensive GF products (78%) were limiting the adherence to GFD. The inadequacy of the daily energy intake along with insufficient intakes of calcium and vitamin D were remarked among individuals with CD. However, protein and iron intake were exceeding the recommendations among all age groups, except in males aged 4-8 years and 19-30 years. Half the study participants were using dietary supplements where 38%, 10%, 46%, 18%, 16% and 4% used vitamin D, vitamin B12, iron, calcium, folate and probiotics, respectively. Conclusion:GFD is the key treatment for CD. However, it is not without inadequacies and may cause certain deficiencies such as calcium and vitamin D leading to reduced bone density. This underlines the critical role of dietitians in education and maintenance of healthy GFD among individuals with CD.

Global Subjective Assessment and Mini Nutritional Assessment Short Form Better Predict Mortality Than GLIM Malnutrition Criteria in Elderly Patients with Hip Fracture.

This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3-25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3-11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02-13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3-8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35-6.7; p = 0.007] at 12 months. The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.

Nutritional Status, Refeeding Syndrome and Some Associated Factors of Patients at COVID-19 Hospital in Vietnam.

Multisystem inflammatory syndrome is associated with COVID-19 and can result in reduced food intake, increased muscle catabolism, and electrolyte imbalance. Therefore COVID-19 patients are at high risk of being malnourished and of refeeding syndrome. The present study aimed to determine the prevalence and correlates of malnutrition and refeeding syndrome (RS) among COVID-19 patients in Hanoi, Vietnam. This prospective cohort study analyzed data from 1207 patients who were treated at the COVID-19 hospital of Hanoi Medical University (HMUH COVID-19) between September 2021 and March 2022. Nutritional status was evaluated by the Global Leadership Initiative on Malnutrition (GLIM) and laboratory markers. GLIM-defined malnutrition was found in 614 (50.9%) patients. Among those with malnutrition, 380 (31.5%) and 234 (19.4%) had moderate and severe malnutrition, respectively. The prevalence of risk of RS was 346 (28.7%). Those with severe and critical COVID symptoms are more likely to be at risk of RS compared to those with mild or moderate COVID, and having severe and critical COVID-19 infection increased the incidence of RS by 2.47 times, compared to mild and moderate disease. There was an association between levels of COVID-19, older ages, comorbidities, the inability of eating independently, hypoalbuminemia and hyponatremia with malnutrition. The proportion of COVID-19 patients who suffered from malnutrition was high. These results underscore the importance of early nutritional screening and assessment in COVID-19 patients, especially those with severe and critical infection.

Prognostic significance of controlling nutritional status in older adults with heart failure with preserved ejection fraction: a prospective comparative study with other objective nutritional indices

ObjectiveWe explored the prognostic significance of controlling nutritional status (CONUT) score in older adults with heart failure with preserved ejection fraction (HFpEF) and compared CONUT with other objective nutritional indices.MethodsThis is a single-center retrospective cohort study in older adult coronary artery disease patients undergoing HFpEF. Clinical data and laboratory results were collected before discharge. CONUT, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) were calculated according to the formula. The primary endpoint of this study was readmission due to heart failure and all-cause mortality in the first year after hospitalization.ResultsA total of 371 older adults were enrolled. All patients were discharged and followed up for 1 year, and readmission for heart failure was 26% while all-cause mortality was 20%. Compared with the none and mild malnutrition risk group, the readmission rate for heart failure (HF) within 1 year (36% vs. 18%, 23%) and all-cause mortality rate in the moderate and severe malnutrition risk group (40% vs. 8%, 0%) were higher (P < 0.05). On multivariate logistic analysis, CONUT was not associated with readmission due to HF within 1 year. CONUT was significantly associated with all-cause mortality independently of GNRI or PNI, after adjustment for major confounders including age, bedridden; length of stay; history of chronic kidney disease; loop diuretics use; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-adrenergic blocking agents use; New York Heart Association (NYHA) functional class; hemoglobin; potassium; Creatinine; triglycerides; glycosylated hemoglobin; brain natriuretic peptide; left ventricular ejection fraction; GNRI and PNI via multivariable Cox analysis (HR (95% CI) 1.764 (1.503, 2.071); 1.646 (1.359, 1.992); 1.764 (1.503, 2.071), respectively). Kaplan–Meier analysis revealed that the risk of all-cause mortality significantly increased in accordance with a higher CONUT (CONUT 5–12 compare to 0–1:HR (95% CI) 6.16 (3.78, 10.06); CONUT 2–4 compare to 0–1:HR (95% CI) 0.16 (0.10, 0.26)). CONUT showed the best area under the curve value (0.789) for the prediction of all-cause mortality compared with the other objective nutritional indices.ConclusionCONUT is a simple and strong prognostic indicator for the prediction of all-cause mortality in older adults with HFpEF.Clinical Trials.gov IdentifierNCT05586828.