Nutrition Consultation Research Articles

Enteral Access is not Required for Esophageal Cancer Patients Undergoing Neoadjuvant Therapy

The nutritional status of esophageal cancer patients during neoadjuvant therapy remains a challenging problem. The objective of this study was to determine whether routine enteral feeding tube placement improved nutritional status and perioperative outcomes for patients undergoing neoadjuvant therapy for esophageal cancer. The Society of Thoracic Surgeons database was used to identify patients who underwent neoadjuvant therapy and esophagectomy at our institution between 2010 and 2014. Nutritional status before and after neoadjuvant therapy was determined through standardized nutrition consultations. Predictors of change in nutrition and adverse events were evaluated with multivariable and univariate logistic regressions. Two hundred thirty-four esophagectomy patients were identified, and 127 (54%) received neoadjuvant therapy. Of those receiving neoadjuvant therapy, 80% (102/127) presented with dysphagia, and 48% (61/127) received enteral feeding access (EA). Multivariable regression revealed that high initial albumin level, high initial body mass index, and presence of EA were associated with nutritional stability during neoadjuvant therapy. However, 27.9% (17/61) of patients who received EA did not use their access at all or did not use it consistently during the course of preoperative treatment. The preoperative grades of malnutrition and esophagectomy outcomes were similar between groups (EA vs no EA). EA is associated with improved nutritional status for patients undergoing neoadjuvant therapy for esophageal cancer. However, adverse events and suboptimal use are common. Esophagectomy outcomes were similar for patients with and without EA. These results support judicious patient selection for EA, expedited neoadjuvant therapy, and close collaboration with nutritionists.

Nutritional Coaching Process Improve Nutritional Habits and Body Composition Without a Diet Prescription

One of the most important contemporary health problems is the global prevalence of overweight and obesity, but nutritional consultation per se has continuously failed to yield consistent and lasting results. A recent estimate reveals less than 1 in 100 persons will be successful in achieving sustained weight loss to normal weigh. PURPOSE: the aim of this case report is to detail and evaluate nutritional coaching (NC) in promoting lifestyle changes, enabling improvement of nutritional and body composition-associated parameters. The subject of this study had previously engaged into a series of different diet regimens, all of which failed in achieving the proposed aim. METHODS: nutritional intake, body composition, quality of life (WHOQOL-bref) were assessed at baseline, after 12 weeks of NC and 6 months after finishing NC. 12 sessions of NC (employing health coaching techniques: through motivational interviewing, wellness vision sharing, and goal settings). RESULTS: NC sessions (one per week) promoted reductions in body fat mass in 12 weeks (-6kg) that was even greater 6 months after finished the sessions (-10kgs, total of -16kgs). Nutritional habits also improved, as the subject showed decreased total energy intake (-20%), fat intake (-22%). The coaching program was able to induce immediate health benefits using a strategy with the patient at the core of promoting his own lifestyle changes. This behaviors changes seemed to be much more sustainable than just follow a diet prescription. CONCLUSIONS: the nutritional coaching strategy detailed was effective at helping our patient develop new eating patterns and improve related health parameters.

경기 지역 영양교사의 영양교육 현황 및 효과적인 영양교육 방안에 관한 연구

This study aimed to investigate current nutrition education and effective plans for nutrition teachers in schools. Data were collected by a face-to-face questionnaire. Surveyed schools were elementary, middle, and high schools at percentages of 32.4%, 35.1%, and 32.4%, respectively. Percentage of nutrition education was above 90%, whereas off-line education was very uncommon in middle (8.3%) and high schools (27.3%) compared with elementary schools (63.6%), (p ‘systematic education process (4.76 score)’ > ‘professional nutrition education (4.51 score)’. Most important duty was ‘nutrition education and consultation (51.4%)’, although it achieved the lowest satisfaction at a score of 2.46. Overall analysis, demand and awareness of nutrition teachers for nutrition education were very high. Therefore, an institutional strategy and environmental improvements are required by setting up curriculum subjects and developing diverse education programs for systematic nutrition education.

Osteoarthritic sclerotic subchondral osteoblasts secreted elevated concentration of Fibulin-3 fragments in vitro

Osteoarthritic sclerotic subchondral osteoblasts secreted elevated concentration of Fibulin-3 fragments in vitro

Strengthening health services to deliver nutrition education to promote complementary feeding and healthy growth of infants and young children: formative research for a successful intervention in peri-urban Trujillo, Peru.

Formative research is critical for developing effective nutrition-specific interventions to improve infant and young child (IYC) feeding practices and promote healthy growth. Health workers interact with caregivers during health facility visits, yet there is limited research about how to optimize delivery of such interventions during these visits. The extensive reach of IYC health services globally calls for research to address this gap. In Trujillo, Peru, formative research was conducted to explore complementary feeding practices with caregivers as well as health worker routines and interactions with caregivers related to feeding and healthy growth; results informed the development and delivery of an educational intervention. Multiple qualitative methods were used to collect data on a purposive sample of health workers and caregivers from three health facilities and communities: household trials followed. Complementary feeding messages with doable behaviours were developed, and three were selected as key to promote based on their nutritional impact and cultural acceptability. In the health facilities, medical consultation, well-child visits and nutrition consultation all dealt with aspects of IYC nutrition/growth during their interactions with caregivers but were independent and inconsistent in approach. A nutrition education strategy was developed based on consistency, quality and coverage in the IYC health services. We conclude that formative research undertaken in the community and IYC health services was critical to developing a successful and culturally relevant intervention to promote optimal complementary feeding practices and healthy growth during interactions between health workers and caregivers at routine health facility visits. © 2016 John Wiley & Sons Ltd.

Hospitalists’ utilization of weight loss resources with discharge texts and primary care contact: a feasibility study

ABSTRACTObjectives: Obesity affects a large proportion of the U.S. population, and hospitalizations may serve as an opportunity to promote weight loss. We sought to determine if multidisciplinary patient-centered inpatient weight loss intervention that included counseling, consults, post-discharge telephone text messages, and primary care follow up was feasible.Methods: We conducted a feasibility study focusing on 25 obese hospitalized patients to understand the issues related to rolling out an intensive intervention. Actual weight loss was a secondary outcome and we compared these 25 patients to 28 control patients who were exposed to usual care; weight change was assessed at 1 and 6 months.Results: Ninety-six percent (24/25) of nutritional consults and 92% (23/25) of physical therapy consults were submitted by hospital providers. All of these doctors were also reminded to counsel their patients about the detrimental health consequences. Fifty-two percent (13/25) and 40% (10/25) were actually seen and counseled by nutrition and physical therapy services respectively, before being discharged. Sixty-eight percent (17/25) received a motivational interviewing counseling session from the principal investigator. All patients were sent text messages and followed with their primary care provider after discharge who received the personalized weight loss discharge instructions that had been given to the patient. The feasibility group lost a mean of 3.0 kg at 6 months and the control group gained an average of 0.20 kg at 6 months post discharge (p = 0.03).Conclusion: Executing a multifaceted weight loss intervention for hospitalized obese patients is feasible, and there may be associated persistent improvements in weight status over time.

Abstract 109: A Multidisciplinary Checklist for Management of Acute Decompensated Heart Failure: A Quality Improvement Initiative

Objectives: To determine the effect of a comprehensive checklist on readmission rate and providers adherence to 2013 AHA/ACC guidelines in the management of heart failure (HF) at Buffalo General Medical Center (BGMC). Background: HF is among the most common admitting diagnoses at BGMC. From prior studies, HF readmission can be prevented substantially by effective education, discharge instructions and appropriate medications. Intervention and Methods: A multidisciplinary checklist was developed as a tool to guide house staff physicians in the care of patients with acute decompensated HF. It includes optimal pharmacological therapy as recommended by guidelines, relevant HF education and counseling by dedicated nurse practitioner, nutrition consultation, physical therapy evaluation and treatment and scheduled out-patient follow up. The laminated checklist cards and brief presentation of current HF guideline were provided to house staff physicians on teaching cardiology service weekly from April to June 2015. The control group was randomly selected from the patients who were admitted with acute decompensated HF prior to intervention period. Results: Thirty-day readmission decreased from 47% (16 of 34) to 24% (8 of 34) following the implementation (adjusted OR = 0.32 95% CI = 0.11-0.97). A higher percentage of patients were discharged on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or had documentation of a reason for not prescribing the medication in the checklist group compared with the control group (31 of 34 vs 21 of 34, P<0.05). Similarly, a higher percentage of patients were discharged on β-blockers or had documentation of a reason for not prescribing the medication in the checklist group compared with the control group (34 of 34 vs 32 of 34, P 0.15). Conclusion: Our initiative, which consists of HF checklist use and reminders, was associated with decreased thirty-day readmission rate and increased providers adherence to current HF guidelines.

Improving Nutritional Habits With No Diet Prescription: Details of a Nutritional Coaching Process.

Thousands of dollars are spent today with policies encouraging physical activity and healthy eating, but nutritional consultation per se has continuously failed to yield consistent and lasting results. The aim of this case report is to detail and evaluate nutritional coaching (employing health coaching techniques) in promoting lifestyle changes, enabling improvement of nutritional and body composition associated parameters. The patient in this study had previously engaged in a series of different diet regimens, all of which failed in achieving the proposed aim. After 12 nutritional coaching sessions (one per week) with the strategy presented herein, reductions in body fat mass and in total body weight were attained. Nutritional habits also improved, as the patient showed decreased total energy intake, decreased fat intake, and increased fiber ingestion. Daily physical activity and energy expenditure were enhanced. The coaching program was able to induce immediate health benefits using a strategy with the patient at the core of promoting his own lifestyle changes. In conclusion, the nutritional coaching strategy detailed was effective at helping our patient develop new eating patterns and improve related health parameters.

P-056 YI Nutritional Parameters in Pregnant Women with Inflammatory Bowel Disease

The Institute of Medicine's guidelines for weight gain in pregnancy are based on women's pre-pregnancy body mass index (BMI). Data suggests that BMI may not be the best indicator for nutritional status in patients with inflammatory bowel disease (IBD) due to discordance among BMI, percentage of ideal body weight, and micronutrient deficiencies. The goal of this study was to determine the frequency with which nutritional data is obtained in pregnant women with IBD and the prevalence of abnormal nutritional parameters among these women based on pre-pregnancy BMI. We retrospectively reviewed the medical records of women with IBD with confirmed pregnancy at the University of Wisconsin School of Medicine and Public Health between January 2008 and October 2014. Subjects were identified using ICD-9 codes for Crohn's disease (CD), ulcerative colitis (UC), indeterminate colitis (IC) and for normal or abnormal pregnancy. Subject demographics, disease characteristics, pregnancy course, and nutritional data were abstracted from electronic health record (Epic Systems 2014 IU1). Descriptive statistics were calculated. Comparison between groups was performed with the student's t test and chi square test where P < 0.05 was considered significant. One hundred and thirty-six eligible patients were identified (CD = 66 [49%], UC = 66 [49%], IC = 4 [3%]). Seventy-nine patients (58%) had normal pre-pregnancy BMI, 36% were overweight or obese, and 5% were underweight. Of the 130 patients with available data, only 18% gained the recommended amount of weight during pregnancy based on pre-pregnancy BMI; 30% gained insufficient weight and 45% gained excessive weight. One hundred 3 patients (76%) saw a gastroenterology provider during pregnancy. Fifty-four patients (40%) had no nutritional parameters checked during pregnancy. Among the patients who had nutritional testing, protein stores were most frequently assessed (40%) followed by vitamin B12 (37%), vitamin D (35%), and iron studies (17%). Thirty-seven (45%) of these patients had at least one abnormal parameter. No difference was found in the prevalence of abnormal nutritional lab testing based on pre-pregnancy BMI. Of the 30 patients with active disease during pregnancy, 10 patients (33%) did not have any nutritional parameters checked. Fifty-nine (43%) patients had pregnancy complications. No difference was found in the proportion of patients with inappropriate weight gain between those with and without a pregnancy complication (P = 0.06). Thirty-five (60%) patients with a complication underwent nutritional assessment. Within this group 68% of women had at least one abnormal nutritional parameter. In our cohort of IBD patients 75% of women did not gain weight appropriately during pregnancy and many women experienced a pregnancy complication. Nutritional testing was not performed on a large number of patients despite follow-up by both obstetric and gastroenterology providers. Abnormal nutritional values were not associated with a single pre-pregnancy BMI category. Among patients with inappropriate weight gain, many patients were not nutritionally assessed using laboratory assessments or nutrition consultation. Further prospective studies are needed to determine the optimal means of assessing the nutritional status of pregnant women with IBD as nutritional deficiencies may increase the risk for a pregnancy complication and their prevalence may not be adequately reflected by pre-pregnancy BMI.

Infertilité : moment clé pour entreprendre une prise en charge nutritionnelle médicale. Expérience lilloise sur 78 patientes

ObjectivesThe prevalence of female obesity is increasing. Obesity leads to increased infertility and difficulties in the management of Assisted Reproductive Technology (ART). A specialized nutritional consultation was created in 2008 at University Hospital of Lille, to support infertile obese and overweight patients and to achieve a BMI below 35kg/m2 before pregnancy. The aim of this retrospective study was to evaluate our practice of nutritional support on weight and pregnancy rate. MethodsSeventy-eight obese or overweight patients, followed in nutrition and ART for at least two years, were compared to a control group of 119 normal weight patients. The nutritional strategy was mainly based on lifestyle changes, to establish healthier food and higher physical activity. ResultsThe mean initial BMI was 37.5kg/m2 vs 35.6kg/m2 after nutritional support (significant weight loss, [P<0.001]). Obese or overweight patients had more frequently metabolic syndrome (P<0.01). The chances of pregnancy, after weight loss, were similar to the control group both in IUI and IVF/ICSI. However, gonadotropin doses were increased in the obese and overweight group (P=0.007). The hypocaloric diet was the most effective nutritional strategy to achieve a weight loss greater than 5% of initial weight (P=0.017). Regular physical activity practice allowed also more frequently to achieve this goal (P=0.074). Even after weight loss, a significant number of gestational diabetes (25% of pregnancies in our population) occurred in the obese or overweight group. ConclusionThis nutritional consultation promotes weight loss in infertile obese or overweight patients. The maternity desire is a strong motivational lever to weight loss, which leads to satisfying pregnancy rate.

Application of individualized nutritional support in patients with acute complete cervical spinal cord injury

Objective To explore the clinical effects of individualized nutritional support on patients with acute complete cervical spinal cord injury. Methods The patients with acute complete cervical spinal cord injury in the Trauma Emergency Center of a hospital between January 2011 and December 2012 were randomly divided into experimental group (n=49) and control group (n=54). The diets of patients in the control group were provided by family members guided by nurses in hospital, and the patients in the experimental group were given individualized nutritional supports which were formulated by nutrition consultation according to patients′ specific conditions. The incidence of complications (constipation, lung infection, hyponatremia and hypoproteinemia) within 14d and the average stay in hospital in two groups were compared. Results In the experimental group, the incidence of constipation, lung infection, hyponatremia and hypoproteinemia were significantly lower and the average stay in hospital was shorter than those in the control group. The differences between the two groups were statistically significant (P<0.05). Conclusions Providing individualized nutritional support for patients with acute complete cervical spinal cord injury can reduce the incidence of complications and the average stay in hospital. Key words: Cervical spinal cord injury; Nutritional support; Complication

Nutrition consultation in small animal practice - a field for specialized veterinarians

The study aimed to identify barriers to the implementation of nutrition consultation in veterinary practice. Differences between individual veterinarians in their problem-solving strategies in nutrition consultation were investigated. Representative online survey of 214 veterinarians (female/male) using a standardized questionnaire. Statistical analysis by correlations, t-test, analysis of variance and factor analysis as well as cluster analysis of types of veterinarians. Over 90% of vets had seen an increase in owners' questions on feeding pets. Forty-one percent estimated the percentage of patients suffering from nutrition-related diseases in their practice to be 20-30%. At the same time, 70% of vets agreed that nutrition consultation was neglected in every-day practice. Vets estimated that only 30% of owners complied with recommendations on nutrition. Over 80% of vets presumed that pet owners gave false information on feeding. For other sensitive questions, including domestic and financial situations, the percentage of presumed false information was below 60%. Approximately 50% of the vets did not feel sufficiently competent with regard to nutrition consultation. Less than 50% asked for payment of nutrition consultation. Only 18% had taken part in continuing education in animal nutrition. The cluster analysis identified five different strategies to cope with nutrition consultation, four of which were based on a low priority for nutrition in their own practice. Some vets referred nutrition problems to specialized colleagues (7.2%), others consulted with representatives of pet food companies (28.2%), another group offered free, quick tips (23.4%), and a small percentage ignored nutrition (13.4%). There was one group with a strong interest in nutrition (27.8%). It is remarkable that this group felt the least competent in small-animal nutrition. Conclusion and practical relevance: The study demonstrates that sound nutrition consultation in small-animal practice requires a high degree of specialization. In addition, special coping strategies to obtain a sound nutrition history and a fair payment are necessary. Vets fulfilling these conditions may find a wide field of work.

The effect of nutrition consultation on dietary diversity score of cardiac patients referred to cardiac rehabilitation research center Isfahan cardiovascular research institute during 2008-2013

Background:Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose.Methods:Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant.Results:The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001).Conclusions:Dietary diversity was increased after nutrition counseling among patients with cardiac disease.

Multiple Sclerosis Coupled with Ataxia, Muscle Atrophy, Dysautonomia and Anhydrosis: A Functional Neurology Approach

Event Abstract Back to Event Multiple Sclerosis Coupled with Ataxia, Muscle Atrophy, Dysautonomia and Anhydrosis: A Functional Neurology Approach Gil S. Jaudy1* 1 Jaudy Treatment Center, United States Background and Aims A 56-year-old male, presented to our office complaining of insidious neurological dysfunctions that started on 10, 1991. He reported consistent numbness and inability to walk without assistant device since 2009. He also complained of neck pain and low back pain on a scale of 8/10 (10 being the worst pain). History included right shoulder dislocation, whiplash, mononucleosis, bad reaction to Swine Flu Vaccine in 1977, MVA in 1983 which ended plastic surgery to his forehead, bad reaction to Hepatitis B Vaccine in 1988, Diagnosed with parasites and Lyme disease in 1989. 1990 he experienced the first episode of anhydrosis. 1992 was diagnosed with Multiple Sclerosis and was administered oral steroid, prednisone and Copaxone. 2010 he had exacerbation of Multiple Sclerosis symptoms. Advanced radiology brain MRI 09/22/2006 described new lesions since the previous study, dated 06/26/2002. The report stated progression of callosal volume loss and cerebral atrophy. Methods Upon examination, on 04/19/2011, spontaneous legs movement was observed. Opthalmoscopic examination showed V:A ratio 3:1 on the right. OPK showed abnormal upward to downward saccades ratio. Horizontal saccades preserved. Irregular pursuits, and square wave jerks were observed. Right soft palate paresis was observed. Left facial weakness. Cardiac auscultation split S2. Positive convergence and cardinal fields. Romberg’s stance with severe sway. Bilateral positive Babinski sign and jerky myoclonic activity. Paresis of left big toe. Bilateral dysmetria. Positive Myerson’s sign. Bilateral decreased DTR’s. Bilateral muscle spasticity in the lower extremity and hypotonia in the upper extremity. Cortical blind spot showed right partial hemianopia. Treatment consisted of Brain-Based therapeutic activities, segmental coupled motion reduction, myofascial release, vestibular stimulation, timed breathing exercises, complex movement activities, visual stimulation, sound stimulation, SEP, activities of daily living, and nutritional consultation. Results Patient showed progressive improvement in his motor function and decrease in muscle spasticity. Pathological reflexes were resolved. He showed improvement in gait and reported that he was able to take couple of steps without assistance. He reported ability to move his left big toe after he had lost this function for more than 20 years. A laboratory test obtained on 04/21/2012 by his primary showed no signs of Multiple Sclerosis. Acknowledgements Abstracts are clinically documented by the Jaudy Treatment Center. All clinical data is available upon request. Jaudy Treatment Center (JTC), all rights reserved, 2016. References Jaudy Treatment Center clinical data, 2016. Keywords: multiple sclerosis (MS), Ataxia, muscle atrophy, dysautonomia, Anhydrosis Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Jaudy GS (2016). Multiple Sclerosis Coupled with Ataxia, Muscle Atrophy, Dysautonomia and Anhydrosis: A Functional Neurology Approach. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00086 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Gil S Jaudy, Jaudy Treatment Center, Palm Desert, CA, United States, drjaudy@hotmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Gil S Jaudy Google Gil S Jaudy Google Scholar Gil S Jaudy PubMed Gil S Jaudy Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Effects of the repeated nutritional guidance and consultation on the clinical courses of Crohn&apos;s disease patients during Infliximab administration.

Effects of the repeated nutritional guidance and consultation on the clinical courses of Crohn&apos;s disease patients during Infliximab administration.

Rural Beninese Children Are at Risk of Zinc Deficiency According to Stunting Prevalence and Plasma Zinc Concentration but Not Dietary Zinc Intakes

Background: Three commonly recommended indicators for risk assessment of population zinc deficiency are stunting rates among children aged <5 y, prevalence of inadequate dietary zinc intake, and prevalence of low plasma zinc (PZn). Data on zinc status in Benin are mainly drawn from stunting rates and data on PZn and dietary zinc intake are lacking.Objectives: The aims of this study were 1) to assess the risk of zinc deficiency in preschool and school-age children from rural communities in northern Benin by means of the 3 indicators for population assessment, 2) to evaluate their level of agreement, and 3) to identify predictors of PZn and height-for-age z scores (HAZ).Methods: We analyzed preintervention data collected during 2 efficacy trials and cross-sectionally assessed the risk of zinc deficiency in preschool (1–5 y, n = 326) and school-age children (5–10 y, n = 272) by 1) conducting a 3-d weighed food record survey, coupled with direct zinc and phytic acid analysis of consumed foodstuffs, and calculating usual dietary zinc intakes in a subsample of school-age children (n = 36); 2) analyzing PZn in all children (n = 598); and 3) measuring anthropometry indexes for assessment of stunting (HAZ <−2 SD) in all children (n = 594) and in <5-y-old children only (n = 273). We derived predictors of PZn and HAZ by using multivariate regression with mixed-effect models.Results: Prevalence of inadequate intakes of zinc ranged from 11% to 80% depending on whether the estimated average requirements (EARs) by the International Zinc Nutrition Consultative Group or the EARs derived from the WHO's recommended nutrient intakes were used. Prevalence of low PZn adjusted for acute-phase protein status was 45.7%, with higher rates among preschoolers than school-age children (P = 0.002). The stunting rate in <5-y-old children was 51.3%. PZn was predicted by age, methodologic factors, and socioeconomic status, whereas HAZ was predicted by age, sex, hemoglobin, and socioeconomic status.Conclusions: The prevalence of <5-y stunting and the prevalence of low PZn indicate that the risk of zinc deficiency is elevated in this population. Risk estimates based on the prevalence of inadequacy of zinc intakes varied depending on the EARs used, and a consensus would facilitate nutrition survey evaluations. These trials were registered at clinicaltrials.gov as NCT01472211 and NCT01790321.

Condicionalidades de saúde do Programa Bolsa Família: reflexões a partir de um centro médico municipal no Rio de Janeiro.

Este artigo descreve e analisa a experiência de acompanhamento de mulheres beneficiárias do Programa Bolsa Família em um centro de saúde municipal na zona oeste do Rio de Janeiro. Através de pesquisa empírica, busca-se contribuir com dados qualitativos para a compreensão do universo que envolve o cumprimento das condicionalidades exigidas por essa política social. A metodologia utilizada é a observação participante empreendida nos atendimentos semanais oferecidos às participantes do Programa. As condições materiais e as atividades práticas que envolviam a realização das consultas nutricionais são apresentadas, assim como a relação destas com a gestão da estrutura burocrática que rege o funcionamento da instituição. Na conclusão, são discutidos os fatores que se tornam limitantes dentro desta estrutura e, sua relação com as beneficiárias, assim como as estratégias desenvolvidas pelos gestores e profissionais de saúde para contorná-los. A análise demonstra a complexidade de fatores que incidem sobre o cumprimento das condicionalidades do PBF nas unidades de saúde, problematizando perspectivas que tendem a responsabilizar moralmente as mães, apontando a sua conduta como fator exclusivo do qual depende a realização das contrapartidas exigidas.

Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013.

Efforts to expand Medicaid while controlling spending must be informed by a deeper understanding of the extent to which the high medical costs associated with severe obesity (having a body mass index of [Formula: see text] or higher) determine spending at the state level. Our analysis of population-representative data indicates that in 2013, severe obesity cost the nation approximately $69 billion, which accounted for 60 percent of total obesity-related costs. Approximately 11 percent of the cost of severe obesity was paid for by Medicaid, 30 percent by Medicare and other federal health programs, 27 percent by private health plans, and 30 percent out of pocket. Overall, severe obesity cost state Medicaid programs almost $8 billion a year, ranging from $5 million in Wyoming to $1.3 billion in California. These costs are likely to increase following Medicaid expansion and enhanced coverage of weight loss therapies in the form of nutrition consultation, drug therapy, and bariatric surgery. Ensuring and expanding Medicaid-eligible populations' access to cost-effective treatment for severe obesity should be part of each state's strategy to mitigate rising obesity-related health care costs.

Metabolizable energy intake of client-owned adult cats.

A retrospective analysis of the metabolizable energy (ME) intake of privately owned pet cats from the authors' nutrition consultation practice (years 2007-2011) was carried out to test whether current recommendations are suitable for pet cats. Data of 80 adult cats (median age: 9.0 years, median deviation from ideal weight: +22.5%, majority neutered) at maintenance were available. Six percentage of the cats were healthy and the others were affected by various chronic diseases. A standardized questionnaire was used, cat owners weighed cat and food. For ration calculation, the software Diet Check Munich(™) was used (ME prediction according to National Research Council, 2006: Nutrient Requirements of Dogs and Cats. National Academy Press, Washington, DC). Data were analysed for the factors deviation from ideal weight, breed, age, gender, disease and type of feeding [prepared food (dry, wet) vs. home-made]. Over- or underweight were defined as ≥15% deviation from ideal body weight (BW) according to Kienzle and Moik (British Journal of Nutrition 2011, 106, Suppl 1: S113). Cat owner's estimation of ideal BW was higher than literature data from Kienzle and Moik (2011). Based on literature data, 26.3% of the pet cats were normal weight, 63.7% overweight and 10% underweight. The mean ME intake of all adult cats amounted to 0.40 ± 0.14 MJ/kg actual BW(0.67) (n = 80). When the data were analysed according to normal, over- and underweight, there was a significant effect with normal weight cats eating 0.46 MJ/kg BW(0.67) . Underweight cats ate even more (0.49 MJ/kg BW(0.67) ), whereas overweight cats ate considerably less (0.36 MJ/kg BW(0.67) ). The other factors had no influence on ME intake of adult cats.

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children.

Delayed enteral nutrition, defined as enteral nutrition started 48 hours or more after admission to the PICU, is associated with an inability to achieve full enteral nutrition and worse outcomes in critically ill children. We reviewed nutritional practices in six medical-surgical PICUs and determined risk factors associated with delayed enteral nutrition in critically ill children. Retrospective cross-sectional study using medical records as source of data. Six medical-surgical PICUs in northeastern United States. Children less than 21 years old admitted to the PICU for 72 hours or more excluding those awaiting or recovering from abdominal surgery. A total of 444 children with a median age of 4.0 years were included in the study. Enteral nutrition was started at a median time of 20 hours after admission to the PICU. There was no significant difference in time to start enteral nutrition among the PICUs. Of those included, 88 children (19.8%) had delayed enteral nutrition. Risk factors associated with delayed enteral nutrition were noninvasive (odds ratio, 3.37; 95% CI, 1.69-6.72) and invasive positive-pressure ventilation (odds ratio, 2.06; 95% CI, 1.15-3.69), severity of illness (odds ratio for every 0.1 increase in pediatric index of mortality 2 score, 1.39; 95% CI, 1.14-1.71), procedures (odds ratio, 3.33; 95% CI, 1.67-6.64), and gastrointestinal disturbances (odds ratio, 2.05; 95% CI, 1.14-3.68) within 48 hours after admission to the PICU. Delayed enteral nutrition was associated with failure to reach full enteral nutrition while in the PICU (odds ratio, 4.09; 95% CI, 1.97-8.53). Nutrition consults were obtained in less than half of the cases, and none of the PICUs used tools to assure the adequacy of energy and protein nutrition. Institutions in this study initiated enteral nutrition for a high percentage of patients by 48 hours of admission. Noninvasive positive-pressure ventilation was most strongly associated with delay enteral nutrition. A better understanding of these risk factors and assessments of nutritional requirements should be explored in future prospective studies.