Nutritional Outcomes Research Articles

Recommendations on the surveillance and supplementation of vitamins and minerals for upper gastrointestinal cancer survivors: a scoping review.

Early-stage upper gastrointestinal (UGI) cancer patients, after surgery, have altered gastrointestinal functions, compromising their nutritional status and health outcomes. Nutritional care provision to UGI survivors rarely focuses on long-term survivorship. Here, we explore recommendations for surveillance of micronutrient deficiency and supplementation for UGI cancer survivors after surgery. A scoping review, based on the Joanna Briggs Institute methodology for scoping reviews. Six databases (Medline, Embase, CINAHL, Cochrane, Scopus, and PsycINFO) and 21 cancer-related organisation websites were searched. Publications between 2010 and March 2024 with recommendations aimed at adult UGI cancer (oesophageal, gastric, pancreatic, small bowel, and biliary tract) survivors were included. Twenty-six publications met the selection criteria: 11 reviews (8 narrative reviews, 2 systematic, 1 meta-analysis), 7 expert opinions, 6 guidelines, and 2 consensus papers. Twenty-two publications recommended monitoring of micronutrient deficiencies, and 23 suggested supplementation, with 8 lacking details. Most were targeted at patients with gastric cancer (n = 19), followed by pancreatic cancer (n = 7) and oesophageal cancer (n = 3) with none for biliary tract and small bowel cancers. Vitamin B12 and iron were the most consistently recommended micronutrients across the three tumour groups. Limited publications recommend surveillance of micronutrient status in UGI cancer survivors during the survivorship phase, especially for oesophageal and pancreatic cancer survivors; most were narrative reviews. These recommendations lacked details, and information was inconsistent. Long-term UGI cancer survivors are at risk of micronutrient deficiency after surgery. A standardised approach to prevent, monitor, and treat micronutrient deficiencies is needed.

Nutritional Mechanisms of Cancer Cachexia.

Cancer cachexia is a complex systemic wasting syndrome. Nutritional mechanisms that span energy intake, nutrient metabolism, body composition, and energy balance may be impacted by, and may contribute to, the development of cachexia. To date, clinical management of cachexia remains elusive. Leaning on discoveries and novel methodologies from other fields of research may bolster new breakthroughs that improve nutritional management and clinical outcomes. Characteristics that compare and contrast cachexia and obesity may reveal opportunities for cachexia research to adopt methodology from the well-established field of obesity research. This review outlines the known nutritional mechanisms and gaps in the knowledge surrounding cancer cachexia. In parallel, we present how obesity may be a different side of the same coin and how obesity research has tackled similar research questions. We present insights into how cachexia research may utilize nutritional methodology to expand our understanding of cachexia to improve definitions and clinical care in future directions for the field.

Impacts of women's work and childcare on child illness among Bangladeshi Shodagor communities

For decades, women's employment has been seen as crucial for achieving greater autonomy and empowerment for women, and for promoting better health and nutrition outcomes for children, particularly in low- and middle-income countries (LMIC). However, numerous empirical studies of the relationship between women's work and child outcomes have shown mixed results. Our study tests the assumptions of a model that suggests loss of maternal care during working hours may produce negative health outcomes for children. We use longitudinal data collected from traditionally semi-nomadic, boat-dwelling Shodagor families in Matlab, Bangladesh to determine the importance of maternal care as a mechanism influencing the relationship between women's work and child illness. We use Bayesian linear mixed models to assess the influence of occupation and amount of care on average days of child illness per month, and also to examine the role that allomothers play in buffering against potential negative impacts of lost maternal care on child illness. Results show that children who receive more care from mothers experience fewer days of illness, and that availability of high-quality alloparents mediates the relationship between maternal work and child health. These results indicate that both the care and resources provided by mothers influence children's biological outcomes. This has important implications for policy and aid interventions in LMIC, which have been developed to capitalize on an assumed positive relationship between maternal work and child health and nutrition.

Efficiency of a technology-assisted nutritional screening system: A retrospective analysis of 11,722 admissions in a tertiary hospital

Background and AimNutritional screening is essential for addressing malnutrition and its consequences. However, routine implementation in large hospitals faces several challenges. To overcome these obstacles, the Clinical Nutrition Service of a tertiary hospital developed a technology-assisted nutritional screening system. This study evaluates the system's efficiency in detecting and assessing patients at nutritional risk upon hospital admission. It also examines the association between nutritional risk, clinical outcomes, and sociodemographic characteristics. MethodsThis retrospective, analytical, observational study examined 11,722 hospital admissions of adult patients in 2019, each with a minimum hospital stay of 48 hours in a tertiary hospital. Rates and timing for the detection, referral, and assessment of patients at nutritional risk were calculated. Participants were divided into low (Malnutrition Screening Tool [MST] < 2 points) and moderate/high (MST ≥ 2) nutritional risk groups to evaluate the relationship between nutritional risk and clinical and demographic variables. ResultsWe found that 91% of patients underwent nutritional screening within the first hours of admission, with a median time of 9 hours from admission to screening (interquartile range [IQR] 3-19). The prevalence of nutritional risk (MST ≥ 2) was 21%. All patients identified as being at nutritional risk were immediately referred for a nutritional assessment once identified, with a median referral time of 0 hours (IQR 0-0). This assessment was carried out by a nutritionist for 98% of these patients, with a median time of 19 hours from referral to assessment (IQR 6-24). Compared to the low-risk group, patients with nutritional risk were older, had higher rates of mortality and admission to the intensive care unit (ICU), longer hospital stays, and a higher proportion of men and cancer diagnoses (p=0.00 for all comparisons). After adjusting for age and sex, nutritional risk was significantly associated with a higher probability of ICU admission (Odds Ratio [OR] 1.13; 95% CI 1.02-1.24) and in-hospital mortality (OR 2.32; 95% CI 1.97-2.73). ConclusionThe integration of technology into nutritional screening was highly efficient for early detection and assessment of at-risk patients upon hospital admission. Features of this system could guide other hospitals. The association found between nutritional risk and clinical outcomes emphasizes the importance of prompt and appropriate nutritional interventions.

Caregivers’ knowledge, attitude, and practices on complementary feeding of young children aged 6-23 months in Naga City, Philippines

A cross-sectional study was conducted to investigate the knowledge, attitudes, and practices of 60 caregivers regarding complementary feeding and its impact on the nutritional status of their children aged 6–23 months in Panicuason, Naga City, Philippines. Face-to-face interviews were conducted to collect data using pre-designed and pre-tested questionnaires. Descriptive statistics and Pearson’s R Correlation tests were used to analyze the data at p&lt;0.05. The results indicated that the households involved had poor conditions in terms of educational attainment, occupation, and household income of the caregivers. The prevalence rates revealed a medium level of underweight (10.0%) and stunting (23.4%), and a poor level of wasting (5.0%). The KAP results demonstrated medium knowledge, positive attitudes, and poor practices among the caregivers. Several KAP components were found to be significantly associated with socioeconomic factors and water sanitation practices. The study found a weak positive correlation between weight-for-age and employment and a weak negative correlation between height-for-age and caregiver-child relationship. This study highlights the urgent need for nutrition education interventions focused on complementary feeding to improve the knowledge and practices of the caregivers. Such interventions are essential for enhancing child nutrition outcomes and potentially influencing positive changes in the attitudes of the caregivers.

THE IMPACT OF SOCIOECONOMIC FACTORS ON NUTRITIONAL KNOWLEDGE AND DIETARY PRACTICES AMONG SCHOOL-GOING ADOLESCENTS

Objectives: This study investigates the impact of socioeconomic factors on nutritional knowledge and dietary practices among school-going adolescents in rural areas of Jodhpur, Rajasthan. The primary objectives were to assess the relationship between socioeconomic status and adolescents' nutritional knowledge and dietary practices, and to identify barriers to adopting healthy dietary practices in the context of socioeconomic disparities. Methods: A cross-sectional survey was conducted, encompassing data from 385 adolescents, with variables such as family income, parental education, and access to nutritional resources being analyzed. Results: The results revealed significant correlations between higher socioeconomic status and better nutritional knowledge and dietary practices. Adolescents from wealthier families and those with more educated parents demonstrated superior understanding and adherence to healthy dietary guidelines, while those from lower socioeconomic backgrounds exhibited gaps in knowledge and poorer dietary habits. Additionally, the study highlighted the presence of nutritional health issues, including both underweight and overweight adolescents, indicating a dual burden of malnutrition in the region. Conclusion: The conclusion emphasizes the need for targeted public health interventions that address the socioeconomic disparities influencing adolescent nutrition. Such interventions should include enhanced nutritional education, improved access to affordable nutritious foods, and culturally sensitive programs that respect local dietary practices while promoting balanced nutrition. The findings underscore the critical role of socioeconomic factors in shaping adolescents' nutritional behaviors and call for multi-faceted approaches to improve nutritional outcomes in rural communities. KEYWORDS: Nutrition knowledge, Dietary practices, Adolescent Nutrition, Public Health, Nutritional Education

Assessing behavioural and nutritional outcomes in paediatric iron deficiency anaemia: an observational study

Background: Iron deficiency anemia (IDA) is a prevalent nutritional disorder among children, significantly impacting their growth, development, and behavior. This study aims to assess the behavioral and nutritional outcomes in pediatric IDA in Bangladesh. Methods: This observational study was conducted at Ad-din Barrister Rafique-ul Huq Hospital, along with various private hospitals, from June 2023 to June 2024. A total of 114 children diagnosed with IDA were included. Data on demographic characteristics, clinical parameters, nutritional habits, developmental milestones, and behavioral patterns were collected and analyzed. Results: The majority of participants (60.53%) were aged between 6 to 12 months, with a mean age of 16.13±14.99 months. Boys constituted 75.44% of the sample. Significant symptoms included weakness (84.21%), frequent infections (82.46%), and fatigue (76.32%). The mean hemoglobin level was 8.51±0.95 g/dl, indicating severe anemia. Nutritional assessments revealed that 39.47% were breastfed for 6-12 months, and 31.58% were not given any formula. Developmental delays were observed in 55.26% of the children. Behavioral assessments showed 78.95% exhibited picky eating habits, 63.16% were frequently crying, and 60.53% had a strong attachment to their caregivers. Conclusion: The study underscores the profound impact of IDA on the developmental and behavioral health of children. There is a critical need for targeted interventions, including improved iron supplementation programs and timely introduction of solid foods, to address the nutritional deficiencies and developmental delays associated with IDA. Future research should focus on long-term studies to evaluate the efficacy of these interventions.

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

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

Advancements in nutritional diagnosis and support strategies during the perioperative period for patients with liver cancer.

Liver cancer represents a grave hepatic condition and constitutes a significant global health concern. Surgical resection remains the principal therapeutic modality for liver cancer. Nevertheless, perioperative malnutrition exerts a notable impact on patients with liver cancer, emerging as an independent risk factor for disease mortality and adverse outcomes. Hence, precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients. This study represents a meticulous foray into the literature, extracting data from PubMed, Web of Science, and EMBASE databases, with a focus on the past 5 years. It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery, the etiological underpinnings of malnutrition within this patient cohort, the critical assessment of perioperative nutritional status, and the strategic approaches to nutritional support. Utilizing rigorous inclusion and exclusion criteria, the amassed scholarly works are meticulously synthesized, methodically organized, and categorically elaborated upon. Ultimately, the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period, comprising nutritionists, pharmacists, physicians, nurses, psychologists, and rehabilitation therapists, among other specialized professionals. Together, they collaborate to devise and implement personalized nutritional support plans, monitor patients' nutritional status, and make necessary adjustments as required. Through comprehensive management and intervention, improvements in the nutritional status of liver cancer patients can be achieved, thereby enhancing surgical success rates and facilitating postoperative recovery. It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer, aiding in ameliorating patients' nutritional status and treatment outcomes.

Nutrition for all? Input subsidies and equitable diets

AbstractWhile agricultural input subsidies can improve productivity and nutrition, a key unanswered question is whether such government initiatives influence equitable nutrition access across genders. We study gender disparities in dietary diversity among 7783 smallholder farms in Zambia, evaluating the potential of subsidies to mitigate gaps. Using Oaxaca‐Blinder decomposition methods, results reveal female‐headed households (FHHs) have significantly lower dietary diversity than male‐headed ones, with gaps ranging from 6% to 12% along the distribution. Male‐headed households (MHHs) also show 9% higher input subsidy participation, influenced by education and agricultural extension access among others. Crucially, increased FHHs' participation in input subsidies could potentially close the gendered dietary diversity gap, even surpassing MHHs by 17.8%, underscoring the promise of targeted efforts to improve gender equity. However, achieving socioeconomic parity with MHHs further amplifies positive impacts. Given these findings, facilitating FHHSs' access to input subsidies can promote more equitable nutrition outcomes between genders. Broader participation could be enabled by strengthening agricultural extension and education to equip farmers, especially marginalized female‐headed and remote households, to leverage subsidized inputs. Overall, this study demonstrates that prioritizing female‐headed households' inclusion in input subsidy programs, alongside integrated support, holds strong potential to narrow gendered disparities in dietary diversity among smallholder farms in Zambia. It provides key insights to inform the design of nutrition‐sensitive, gender‐aware agricultural policies.

Impact of the Combination of Anamorelin and Rehabilitation on Functional and Nutritional Outcomes in Patients with Cancer Cachexia

Cancer cachexia, characterized by the progressive loss of skeletal muscle mass, leads to functional impairment and poor prognosis. Anamorelin is approved for treating cancer cachexia in Japan; however, the factors influencing its discontinuation and the impact of combining anamorelin with rehabilitation remain unclear. Therefore, we retrospectively analyzed 82 patients with cancer cachexia to identify factors associated with anamorelin discontinuation and assess changes in nutritional status and motor function using non-dominant handgrip strength after 12 wk. Patients received outpatient rehabilitation, combining resistance and aerobic training every two weeks, alongside anamorelin therapy. Our findings indicate that patients with an ECOG performance status of 1 or 2 were less likely to continue anamorelin therapy for 12 wk compared to those with a performance status of 0 (odds ratio 2.71; 95% CI 1.05 − 7.00; p = 0.040). Significant improvements were observed in body weight (48.8 to 53.7 kg, p < 0.001), skeletal muscle mass (6.4 to 6.9 kg/m2, p < 0.001), FAACT score (11.5 to 18.0, p < 0.001), and non-dominant handgrip strength (20.5 to 21.7 kg, p = 0.018) after 12 wk. Early initiation of anamorelin with regular rehabilitation is recommended to enhance nutritional status and motor function in patients with cancer cachexia.

Machine Learning to Predict the Risk of Malnutrition in Hospitalized Patients with Pneumonia and Analysis of Related Prognostic Factor.

This study explored machine learning's potential in predicting the nutritional status and outcomes for pneumonia patients. It focused on 4,368 patients in a Taiwan medical center from Jan 2016 to Feb 2022, excluding ICU cases. The average age was 77.6 years, with 10.2% well-nourished, 76.3% at-risk, and 13.5% malnourished. Machine learning models, particularly LightGBM and XGBoost, showed high accuracy in predicting hospital stays, mortality rates, and readmissions. These findings emphasize the role of data-driven methods in enhancing patient care and managing conditions like pneumonia more effectively.

Association between geospatial disparities in food security with weight loss and nutritional outcomes of metabolic surgery

BackgroundFood insecurity has been linked to higher rates of obesity. It has also been shown to diminish the effectiveness of weight loss strategies, including intensive lifestyle interventions. One essential component of food insecurity is having a geospatial disadvantage in access to healthy, affordable food, such as living within a food desert. This study aims to determine if food insecurity also impacts weight loss and nutritional outcomes in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).MethodsClinical outcomes of patients who underwent RYGB or SG at Cleveland Clinic or affiliate regional hospitals in the United States from 2010 to 2018 were collected. Modified Retail Food Environmental Index (mRFEI) data was collected from the Center for Disease Control and merged with patient census tract data, allowing the patient cohort to be divided into those living in areas identified as food secure (mRFEI > 10%), food swamps (mRFEI = 1–10%), or food deserts (mRFEI = 0). Postoperative weight change was evaluated with quadratic growth mixture models and stratified by surgery type.ResultsA total of 5097 patients were included in this study cohort, including 3424 patients who underwent RYGB and 1673 who underwent SG. The median duration of follow-up was 2.3 years (IQR 0.89–3.6 years). Food security status was not associated with postoperative weight change (RYGB p = 0.73, SG p = 0.60), weight loss nadir (RYGB p = 0.60, SG p = 0.79), or weight regain (RYGB p = 0.93, SG p = 0.85). Deficiencies in nutritional markers at 1–2 years after surgery were also not significantly different between food security groups.ConclusionDespite the established relationship between food insecurity and obesity, food insecurity does not negatively impact weight loss or nutritional outcomes following RYGB or SG, demonstrating metabolic surgery as a powerful and equitable tool for treating obesity.Level of EvidenceIV.

Peri-urban agriculture and household food and nutrition security around Eldoret, Kenya

Rapid urbanisation in low- and middle-income countries, which has encroached on agricultural lands but has not been consistently accompanied by corresponding improvements in water and sanitation services, has raised questions about its impact on the food and nutrition security of households living in transitional, peri-urban areas. Through an analysis of survey data collected from 518 households living around the town of Eldoret, Kenya, we investigate the existing links between peri-urban households’ engagement in agriculture, their dietary behaviour, and their children’s nutrition outcomes. We find that peri-urban households engaged in agriculture, particularly in crop growing and in the sales of their agricultural produce, have more diverse and nutritious diets than agriculturally non-engaged households, all other things being equal. However, a significant improvement in children’s health outcomes is observed in these households only when coupled with improved water, sanitation, and hygiene conditions.

The Impact of Dietary Intake and Nutritional Status on Birth Outcomes Among Pregnant Adolescents: A Systematic Review

Birth outcomes have been linked to the overall maternal general health including nutrition as well as maternal age during pregnancy. Compared to adults, delivery outcomes during adolescence are poor. Nutrient intake and nutrition status during adolescent pregnancy may be linked to birth outcomes. This review aims to identify the association between dietary intake and nutrition status of pregnant adolescents and their maternofetal outcomes. Literature search on nutrient intake and nutritional status of pregnant adolescents (aged 11-19 years) which identified 17 English papers from 1995 to 2019 was reviewed. Papers that did not include data on birth outcomes in relation to nutrient intake or nutritional status were excluded. The review showed that most micronutrients with the exception of Riboflavin, vitamins B12 and C were below the recommended levels whilst macronutrients levels were above the recommended levels. Energy intakes were also below the recommended levels. Most studies presented normal hemoglobin levels in the first trimester of pregnancy but these levels decreased as pregnancy progressed to the third trimester leading to a high prevalence of anemia. Well-regulated provision and intake of micronutrient supplementation and nutrition education to improve healthy eating habits will significantly reduce poor birth outcomes such as low birth weights (LBW), still births, preterm deliveries, small or large for gestational age (SGA and LGA) and intrauterine growth restrictions in pregnant adolescents. This review provides to a large extent evidence to support the importance of adolescent nutrition and birth outcomes. There is the need to implement policies to improve adolescent nutrition through a multisectoral approach.

Effects of a Specialized Oral Nutritional Supplement with Dietary Counseling on Nutritional Outcomes in Community-Dwelling Older Adults at Risk of Malnutrition: A Randomized Controlled Trial.

This study investigated the effects of oral nutritional supplements (ONSs) along with dietary counseling (DC) in community-dwelling older adults at risk of malnutrition. In this randomized controlled trial, 196 older adults who were at risk of malnutrition, as identified by the Malnutrition Universal Screening Tool (MUST) were randomly assigned to receive ONSs twice daily with DC (intervention) or DC-only (control) for 60 days. Primary outcome was change in body weight from baseline to day 60. Nutritional status, energy, and macronutrient intakes were measured. A significant larger weight gain was observed in the intervention compared to the control from baseline to day 60 (1.50 ± 0.22 kg, p < 0.0001). The intervention group also showed a significantly greater increase in weight at day 30 (p < 0.0001). Intakes of energy and macronutrients were significantly higher in the intervention group compared to the control group at both days 30 and 60 (all p < 0.0001). The odds of achieving better nutritional status were significantly higher in the intervention group than in the control group (OR:3.9, 95% CI: 1.9, 8.2, p = 0.0001). ONS supplementation combined with DC significantly improved body weight and nutritional outcomes in community-dwelling older adults at risk of malnutrition.

Religious Dietary Practices: Health Outcomes and Psychological Insights From Various Countries.

Religious beliefs profoundly influence dietary practices across diverse cultures and communities, guiding what foods are acceptable, how they are prepared, and the timing of consumption. This narrative review examines the intricate relationship between religious dietary practices and their health and psychological well-being implications. Religious dietary practices, deeply rooted in various cultural and historical contexts, significantly influence followers' food consumption patterns. This narrative review aims to discuss how religions such as Judaism, Islam, Hinduism, and Buddhism prescribe specific dietary laws and guidelines, impacting nutritional intake and health outcomes. Furthermore, it delves into the psychological mechanisms, such as cognitive dissonance and social identity theories, that underpin adherence to these dietary practices. The review also highlights the role of community and social support in reinforcing dietary habits within religious contexts, contributing to mental health and social cohesion. By synthesizing insights from nutrition, psychology, and religious studies, this narrative review aims to provide healthcare providers with culturally sensitive dietary advice, ultimately improving patient care and promoting holistic health. Religious dietary practices provide numerous health benefits, including reduced risks of chronic diseases and enhanced mental well-being, achieved through disciplined and conscientious eating habits. Nevertheless, these practices also pose nutritional challenges that necessitate meticulous management and dietary planning.

A five domains assessment of sow welfare in a novel free farrowing system.

The Maternity Ring was developed as a free farrowing alternative to crates that preserved space whilst providing the sow with unrestricted movement. This experiment aimed to apply the Five Domains model to assess sow welfare in the Maternity Ring in comparison with the farrowing crate. Eighty-eight sows were housed in a farrowing crate (FC) and 83 in a Maternity Ring (MR), and measures collected focussed on nutrition, environment, health, behaviour, and mental state outcomes. MR sows consumed less feed than FC sows (total feed intake: 93.8 ± 3.06 kg vs. 111.2 ± 3.13 kg; p < 0.001) but had reduced P2 backfat loss during lactation (0.0 ± 0.11 vs. 1.2 ± 0.11, p < 0.001). Fewer frustrated and pain-related behaviours during farrowing were observed in MR sows (bar biting: FC 3.3 ± 2.12 vs. MR 0.5 ± 0.29 events, p = 0.038, and back leg forward: FC 227 ± 50.7 vs. MR 127 ± 26.4 events, p = 0.019), and a decreased proportion of MR sows had facial injuries after farrowing (10% CI [5, 20] vs. 67% CI [47, 95], p < 0.001). More FC sows had udder damage at weaning (70% CI [48, 97] vs. 10% CI [6, 24], p < 0.001), and their piglets were medicated more frequently when compared to those in MR (51% CI [40, 61] vs. 30% [21, 41], p = 0.008). MR sows tended to have a higher reaction score to piglet processing (MR 2.0 ± 0.38 vs. FC 1.2 ± 0.27, p = 0.094) and had more contact with piglets once the procedure was complete than FC sows (13.5 ± 2.55 vs. 6.9 ± 1.26 events, respectively, p = 0.016). Whilst there was no difference in anticipation of a feeding event (p > 0.05), MR sows displayed a reduced startle response to an aversive noise stimulus at day 18 (FC 2.8 ± 0.35, MR 0.7 ± 0.16, p < 0.001). Using the Five Domains framework, sows housed in the MR during farrowing and lactation have improved welfare than those in FC and can be thought of as being in a positive affective state.

Women's empowerment, household dietary diversity, and child anthropometry among vulnerable populations in Odisha, India.

Women's empowerment has been promoted by researchers and development practitioners as one of the most promising strategies to address widespread hunger and malnutrition. However, the relationship between women's empowerment and dietary diversity and child nutrition has rarely been studied among vulnerable populations or individuals at greater risk of poor physical and social health status. Moreover, the effects of different domains of women's empowerment on nutritional outcomes, including dietary diversity and child anthropometry, have rarely been examined, especially with panel data. Using two rounds of panel data from 1900 households and fixed effects regression models, we analyze the effect of women's empowerment on household dietary diversity score (HDDS) and child anthropometry among the particularly vulnerable tribal groups in Odisha, India. We also estimate the effects of various decision-making domains of women's empowerment on HDDS and child anthropometry to understand which empowerment domains matter for nutrition. Results show that women's empowerment is positively associated with HDDS (coef. 0.41 food groups; p < 0.1) and reduces the prevalence of underweight (coef. 39%; p < 0.05) and wasting (coef. 56%; p < 0.1) in children but has no effect on the prevalence of child stunting. Women's empowerment in agricultural input use; output sales; income; food purchases; and credit, group membership, and employment contribute to improved dietary diversity and child nutrition. We conclude that women's empowerment contributes to improved dietary diversity and child nutrition and is a promising strategy to improve farm household diets and child nutrition among vulnerable populations. Strengthening women's empowerment through the promotion of women's access to land and other agricultural inputs, market participation, access to information, capital, and credit is important.

Baseline Nutritional Status and Rehabilitation Progress in Individuals Requiring Inpatient Rehabilitation: A Retrospective Cohort Study

ObjectiveTo evaluate the relationships between baseline nutritional status, medical events (MEs), and rehabilitation outcomes in individuals undergoing inpatient rehabilitation (IR). DesignA retrospective single center cohort study. SettingAn IR ward. ParticipantsThis study included 409 patients (mean age, 80 years; men, 170 [42%]) undergoing IR for hospital-associated deconditioning, neurologic disorders, or musculoskeletal diseases. Participants were grouped according to the Controlling Nutritional Status score at admission: normal nutrition (NN): 0 to 1, mild malnutrition (MM): 2 to 4, and moderate/severe malnutrition (M/SM): 5 to 12. InterventionsNone. Main Outcome MeasuresThe primary outcomes included MEs leading to death or acute illness requiring transfer to other hospitals for specialized treatments. The secondary outcomes were the rehabilitation efficiency scores (changes in Functional Independence Measure [FIM] score divided by length of stay) for motor function (FIM-M) and cognitive function (FIM-C). ResultsAmong the 409 participants, 300 (73%) were malnourished at admission. The adjusted hazard ratios (95% confidence interval) for MEs in the MM and M/SM groups relative to the NN group were 1.48 (0.67-3.27) and 0.98 (0.34-2.81), respectively. No significant differences were observed among the 3 groups in FIM-M efficiency scores (mean ± SD, NN: 0.49±0.51 vs MM: 0.41±0.57 vs M/SM: 0.44±1.06, P=.7) or FIM-C efficiency scores (0.04±0.06 vs 0.04±0.06 vs 0.08±0.4, P=0.1). Analysis of covariance showed no significant association between MM or M/SM group and FIM-M efficiency score (beta coefficient = -0.038, P=.6; beta coefficient = 0.15, P=.1, respectively) or FIM-C efficiency score (beta coefficient = 0.004, P=.8; beta coefficient = 0.047, P=.08, respectively). ConclusionNo significant associations were observed between the baseline nutritional status and MEs, FIM-M efficiency score, or FIM-C efficiency score in individuals undergoing IR.