Nutritional Decline Research Articles

Physical frailty and oral health as risk factors for low bone density in community-dwelling residents

This study aimed to explore the association between bone mineral density and physical frailty including nutrition, muscle mass, and oral function. We included participants aged 35–80 years and examined their bone mineral density, serum albumin level, body composition, and variance of hue (VOH) of two-colored gum. We also used the geriatric oral health assessment index (GOHAI). These data were used to calculate the geriatric nutritional risk index (GNRI) and skeletal muscle index (SMI). Multinomial logistic regression was performed to assess the relationship between GNRI, SMI, VOH, GOHAI, and bone mineral density after adjusting for comorbidities, including hypertension, diabetes mellitus, and previous bone fracture. We included 228 participants and classified their bone mineral density as normal, osteopenic, or osteoporotic. Older age (odds ratio (OR) 1.15, 95% confidence interval (CI) [1.08, 1.23]), low GNRI (OR 0.90, 95% CI [0.83, 0.98]), low SMI (OR 0.43, 95% CI [0.27, 0.68]), and high VOH (OR 1.08, 95% CI [1.01, 1.17]) were significantly associated with osteoporosis. Older age (OR 1.08, 95% CI [1.04, 1.11]) and low GNRI (OR 0.93, 95% CI [0.87, 0.99]) were significantly associated with osteopenia. GNRI, SMI, and VOH were significantly associated with osteoporosis among male participants. Although the multinomial logistic regression analysis indicated that GNRI, SMI, VOH, and GOHAI were not significantly associated with osteoporosis or osteopenia among female participants, the demographic distribution showed that older age, low GNRI, and low SMI were significantly associated with bone mineral density decline. Physical frailty, including nutritional decline, muscle mass loss, and poor oral status, is associated with low bone density. This easy-to-use tool can be used to detect osteoporosis early and to prevent osteoporosis and osteoporosis-related fractures.

Supplemental tube feeding: qualitative study of patient perspectives in advanced pancreatic cancer

ObjectivesMalnutrition is associated with poor quality of life and survival outcomes for patients with cancer, but is challenging to prevent or treat in pancreatic cancer due to the multifactorial drivers...

Incidence and outcomes of in-hospital nutritional decline: A prospective observational cohort study in adult patients

Background and AimsHospital malnutrition is associated with higher healthcare costs and worse outcomes. Only a few prospective studies have evaluated trends in nutritional status during an acute stay, but these studies were limited by the short timeframe between nutrition assessments. The aim of this study was to investigate changes in nutritional status, incidence of hospital-acquired malnutrition (HAM), and the associated risk factors and outcomes in acute adult patients admitted for >14 days. MethodsA prospective observational cohort study was conducted in two medical and two surgical wards in a tertiary hospital in Brisbane, Australia. Nutrition assessments were performed using the Subjective Global Assessment at baseline (day eight) and weekly until discharge. Nutritional decline was defined as a change from well-nourished to moderate/severe malnutrition (HAM) or from moderate to severe malnutrition (further decline) >14 days after admission. ResultsOne hundred and thirty patients were included in this study (58.5% male; median age 67.0 years (IQR 24.4), median length of stay 23.5 days (IQR 14)). At baseline, 70.8% (92/130) of patients were well-nourished. Nutritional decline occurred in 23.8% (31/130), with 28.3% (26/92) experiencing HAM. Of the patients with moderate malnutrition on admission (n = 30), 16% (5/30) continued to decline to severe malnutrition. Improvement in nutritional status from moderate and severe malnutrition to well-nourished was 18.4% (7/38). Not being prescribed the correct nutrition care plan within the first week of admission was an independent predictor of in-hospital nutritional decline or remaining malnourished (OR 2.3 (95% CI 1.0–5.1), p = 0.039). In-hospital nutritional decline was significantly associated with other hospital-acquired complications (OR 3.07 (95% CI 1.1–8.9), p = 0.04) and longer length of stay (HR 0.63 (95% CI 0.4–0.9), p=0.044). ConclusionThis study found a high rate of nutritional decline in acute patients, highlighting the importance of repeated nutrition screening and assessments during hospital admission and proactive interdisciplinary nutrition care to treat or prevent further nutritional decline.

Exposure to the psychedelic substance 25 H-NBOMe disrupts maternal care in lactating rats and subsequently impairs the social play behavior of the offspring

Given the critical role of maternal care in the neurodevelopment of offspring, this study aimed to investigate the effects of the psychedelic substance 25 H-NBOMe on maternal behavior in lactating rats and its subsequent impact on the social and neurodevelopmental behavior of the offspring. We administered two different dosages of 25 H-NBOMe (0.3 mg/kg and 1.0 mg/kg; i,p,) to lactating rats and observed changes in maternal behaviors, such as nest-building and pup retrieval, and in offspring behaviors, including social play. Behavioral assessments were complemented by physiological measurements to rule out general health or nutritional decline. 25 H-NBOMe significantly disrupted maternal behaviors, including nest-building and pup retrieval, without affecting the weight of dams or offspring. Offspring of exposed dams exhibited reduced social play behavior. Higher doses led to more pronounced disruptions, while lower doses, despite not visibly affecting maternal behavior, still impacted offspring behavior, suggesting potential direct effects of 25 H-NBOMe. The study highlights the potential risks associated with the use of 25 H-NBOMe during lactation, emphasizing its detrimental impact on maternal care and offspring development. These findings contribute to understanding the neurobiological effects of psychedelic substances during critical developmental periods and underscore the importance of avoiding their use.

Role of cognitive impairment and malnutrition as determinants of quality of life in patients with systemic sclerosis.

Increasing evidence supports the presence of cognitive impairment in patients with systemic sclerosis. Malnutrition is a well-known severe complication of systemic sclerosis and is a consequence of multiple factors, mainly oropharyngeal and gastrointestinal involvement. Recent studies have shown a link between nutrition and cognitive decline in several chronic diseases. Thus, we decided to evaluate a possible association between malnutrition and cognitive impairment in patients with systemic sclerosis. In total, 100 consecutive systemic sclerosis patients were enrolled in a cross-sectional study to assess clinical and demographic features, nutritional status (body mass index, Global Leadership Initiative on Malnutrition criteria), gastrointestinal involvement (University of California Los Angeles Gastrointestinal Scale 2.0, Eat Assessment Tool 10), cognitive function (Montreal Cognitive Assessment), anxiety and depression (Patient Health Questionnaire 9, Beck Depression Inventory II), and quality of life (Short Form 36, Health Assessment Questionnaire-Disability Index, Scleroderma Health Assessment Questionnaire). Patients were stratified for the presence/absence of malnutrition and cognitive decline and compared for clinical characteristics and quality-of-life measures. Half of the patients had cognitive impairment (Montreal Cognitive Assessment < 26). These patients were older, had more comorbidities, and a significantly worse quality of life. There were no statistically significant associations with body mass index, malnutrition, and gastrointestinal involvement. About one-third of patients had clinically relevant malnutrition. They were older, had higher skin score, lung and esophageal involvement. They also showed significantly worse scores for dysphagia, gastrointestinal symptoms, functional disability, and quality of life. Gastrointestinal symptoms and dysphagia, but not body mass index and Montreal Cognitive Assessment, were significantly associated with depression scores, which in turn were negatively associated to quality-of-life measures. With regression analysis, cognitive impairment was predicted only by age, whereas malnutrition was significantly associated with age, dysphagia, and modified Rodnan skin scores. In this study, we showed that cognitive impairment and malnutrition are not directly linked but are both independently associated with greater functional disability and worse quality of life of patients with systemic sclerosis. Early recognition of these comorbidities is therefore pivotal to better address the chronic needs of patients affected by this disease.

Nitric oxide delays the postharvest nutritional quality decline of “Golden Hook” beans

Abstract“Golden Hook” beans turn purple to different degrees due to the different compositions and contents of flavonoids during storage. At the same time, quality losses due to softening or pathogen invasion, and the deteriorations of flavor associated with carbohydrate metabolism occur. To reveal the effect of nitric oxide (NO) generated from sodium nitroprusside (SNP) on the postharvest quality of “Golden Hook” beans, we used metabolome, transcriptome, and assay for transposase‐accessible chromatin with high‐throughput sequencing approaches to compare beans at the time of treatment with untreated and SNP‐treated beans stored at 8°C for 12 days. The results showed that NO induced the expression of CERK1, FLS2, JAZ, and MYC2, stimulated the expression of polyphenol oxidase, CAT, and l‐ascorbate oxidase, the accumulation of flavonoids, and the synthesis of lignin in the antioxidant system, improving the ability of beans to resist stress while maintaining the balance of reactive oxygen species. High expressions of F3′H, FLS, INV, SUS, BCAT, and the accumulation of 6‐C‐methylquercetin‐3‐O‐rutinoside were associated with the maintenance of the fresh purplish red appearance of the beans in the SNP‐12d group, without loss of flavor. SNP treatment downregulated the transcription factors blimp‐1, OBP1, COG1, and AT1G6957 associated with bean senescence. These results provide insight into the postharvest quality control of “Golden Hook” beans.

Household food insecurity and its association with academic performance among primary school adolescents in Hargeisa City, Somaliland.

Academic achievement is crucial for the social and economic development of young people and determines the quality of education of a nation. According to different studies, food insecurity adversely affects children's health, nutrition, and subsequent decline in academic performance by impairing students' ability to learn and therefore affects the achievement of the Sustainable Development Goals (SDGs) of quality education and lifelong learning opportunities for all. To provide evidence on the association of food insecurity with academic performance is necessary. The current study assessed household food insecurity and its association with academic performance among primary school adolescents in Hargeisa City, Somaliland. A school-based cross-sectional study was conducted among 630 primary school adolescents from December 2021 to March 2022. Students were selected using a multistage sampling technique. An interviewer-administered questionnaire was used to collect data on household food security and socio-demographic variables and entered into Epi data version 3.1. The data was exported to SPSS version 26 for descriptive and multivariable logistic regression analysis. Odds ratios and their 95% confidence intervals together with p <0.05 were utilized to declare statistical significance. The prevalence of food insecurity among school adolescents was 59.21%. The majority (55.40%) of the school adolescents were poor academic performers. The frequency of adolescents' poor academic performance was significantly high (71.05%) among food insecure households (P < 0.001) as compared to their counterparts whose households were food secure (32.68%). On multivariable analysis, household food insecurity (AOR = 5.24, 95%CI = 3.17-8.65), school absenteeism (AOR = 3.49, 95%CI = 2.20-5.53), spending >2h/day watching TV / screen media use (AOR = 9.08, 95%CI = 4.81-17.13), high and middle wealth households (AOR = 0.51, 95%CI = 0.30-0.88) (AOR = 0.40, 95%CI = 0.21-0.76) and habitual breakfast consumption (AOR = 0.08, 95%CI = 0.03-0.20) had shown statistically significant association with academic performance among primary school adolescents. The present study revealed that household food insecurity has a high association with adolescents' academic performance. The prevalence of food insecurity is moderate, based on the household food insecurity access scale. The results indicate the need for policies and programs intended to improve household income by developing income-generation programs for lower-income families and enhance feeding programs such as national school lunch and school feeding across schools in the country.

Sweet potato flour (Ipomoea batatas) as natural antioxidant on carcass yield and meat physicochemical characteristics of Creole chickens of Mexico and Cobb 500.

Antioxidants are considered functional additives against oxidative stress since they avoid nutritional decline in the meat. The main objective of the present study is to evaluate the effect of sweet potato flour (SPF) as a natural antioxidant on carcass yield and physicochemical characteristics of Creole chickens of Mexico (CChM) and Cobb 500 broilers. In total, 210 chickens (105 CChM and 105 Cobb 500 chickens) were randomly assigned to three treatments: 0, 500, and 1000mg of SPF kg-1 of feed. The Cobb 500 chickens showed higher carcass yield (hot and cold), breast, and breast fillet, whereas the CChM had higher thigh yield (P ≤ 0.05). The yield on the previously mentioned variables was not affected by the inclusion levels of SPF. The initial pH differed because of the effect of the chicken's genotype and the addition of SPF, which was higher on Cobb 500 chicken and on those that were not supplemented with SPF. The birds' skin that consumed SPF presented higher yellowness after 24h (P ≤ 0.05). CChM manifested a higher dry matter and protein content and a lower content of ash and fat (P ≤ 0.05). In conclusion, Cobb 500 chickens present a higher carcass yield and its components, in addition to a less acid pH; however, CChM offer a higher nutritional contribution, whereas the 500 and 1000mg addition of SPF increases the skin yellowness, which makes it an alterorganic as a pigment on broiler chicken production.

Relationship between calorie-protein supply and nutritional decline in patients who died

Relationship between calorie-protein supply and nutritional decline in patients who died

Preventing Malnutrition through Adequate Management of Gastrointestinal Dysmotility in Systemic Sclerosis Patients: A Literature Review

Gastrointestinal dysmotility in systemic sclerosis occurs as the end result of extensive fibrosis of the gastrointestinal tract. The entire length of the tract from the esophagus to the anorectum could be affected, exerting various gastrointestinal symptoms. Clinical manifestations attributed to gastrointestinal dysmotility are associated with significant distress and an increased risk of nutritional impairment, reducing the the quality of life of systemic sclerosis patients. One of the most commonly overlooked gastrointestinal implications in systemic sclerosis is malnutrition. Once malnutrition ensues in the course of systemic sclerosis, the detrimental effects attributed to nutritional decline are difficult to reverse and pose an increased risk of mortality. Adequate management through timely diagnosis of gastrointestinal dysmotility and utilization of malnutrition screening tools for systemic sclerosis patients could prevent the progression to malnutrition and its negative impacts.

NUTRIENT TRANSFORMATION THROUGH NANOFERTILIZERS IN SOIL

Global population growth during the past ten years has compelled the agricultural industry to boost crop yield to meet the requirements of billions of emerging nations. Widespread nutrient shortage in soil has caused a major nutritional value decline and substantial financial losses for farmers. Agriculture can only grow by using modern innovations wisely to raise output. The application of nanotechnology to plant science and agriculture has increased recently. The development of nanotechnology has made it easier to produce physiologically significant metal nanoparticles on a large scale. These nanoparticles are currently utilized to enhance fertilizers formulation for greater plant cell absorption and reducing nutrient loss. Ongoing study provides a fresh impression of nanoparticles (NPs) biosynthesis, their use as nano-fertilizers and nano-pesticides, their application in agriculture, and their contribution to improving the performance of bio factors. An overview of NPs-plant interactions, the destiny and fate of nanomaterials in plants, and the role of NPs in reducing the negative impacts of toxicity and stress has been provided. The information in the current review paper is essential for identifying the restrictions and potential uses of nano-fertilizers as a replacement for traditional fertilizers in the future.

Beyond body condition: Experimental evidence that plasma metabolites improve nutritional state measurements in a free-living seabird

The ability to efficiently measure the health and nutritional status of wild populations in situ is a valuable tool, as many methods of evaluating animal physiology do not occur in real-time, limiting the possibilities for direct intervention. This study investigates the use of blood plasma metabolite concentrations, measured via point-of-care devices or a simple plate reader assay, as indicators of nutritional state in free-living seabirds. We experimentally manipulated the energy expenditure of wild black-legged kittiwakes on Middleton Island, Alaska, and measured the plasma concentrations of glucose, cholesterol, B-hydroxybutyrate, and triglycerides throughout the breeding season, along with measures of body condition (size-corrected mass [SCM] and muscle depth). Supplemental feeding improved the nutritional state of kittiwakes by increasing feeding rate (higher glucose and triglycerides, lower cholesterol), and flight-handicapping caused a slight nutritional decline (lower glucose and triglycerides, higher cholesterol and B-hydroxybutyrate). Glucose and triglycerides were the best indicators of nutritional state when used alongside SCM, and improved upon commonly used metrics for measuring individual condition (i.e. SCM or mass alone). Metabolite concentrations varied across the breeding period, suggesting that the pre-laying stage, when feeding rates tend to be lower, was the most nutritionally challenging period for kittiwakes (low glucose, high cholesterol). Muscle depth also varied by treatment and breeding stage, but differed from other nutritional indices, suggesting that muscle depth is an indicator of exercise and activity level rather than nutrition. Here we demonstrate potential for the use of blood plasma metabolites measured via point-of-care devices as proxies for evaluating individual health, population health, and environmental food availability.

Decline of instrumental activities of daily living is a risk factor for nutritional deterioration in older adults: a prospective cohort study

BackgroundThe association between functional capacity and the subsequent risk of nutritional deterioration is yet to be understood. The purpose of this study was to elucidate the relationship between functional capacity, comprising instrumental activities of daily living (IADL), intellectual activity, and social function, and future decline in nutritional status.MethodsThe current study is a two-year prospective cohort study. A total of 468 community-dwelling older adults without nutritional risks were enrolled. We used the Mini Nutritional Assessment Screening Form. Functional capacity, including IADL, intellectual activity, and social function, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline. The nutritional status was reassessed at a 2-year follow-up. Risk ratios (RR) of functional capacity for the incidence of nutritional decline were estimated.ResultsLow functional capacity was significantly associated with future deterioration of nutritional status (RR 1.12, 95% confidence interval [CI] 1.02–1.25). Of the subdomains of functional capacity, IADL decline (adjusted RR 2.21, 95% CI 1.18–4.13) was an independent risk factor for the incidence of nutritional risk. Intellectual and social activities were not significant.ConclusionDecline in functional capacity, especially IADL, is a risk factor for future deterioration in nutritional status. Further studies are required to elucidate the effect of interventions for IADL decline on maintaining nutritional status in older adults.

Correlation between community participation, nutritional appetite and psychological distress among comorbid older persons

BackgroundPoor appetite is a common problem among older people; it is known to contribute to weight loss, nutritional deficiencies, and increased mortality, which can affect their community participation and psychological status. In this study, we aimed to identify the relationship between community participation, nutritional appetite, and psychological distress among comorbid older people. This cross-sectional study included 300 elderly people, of whom 100 participated in geriatric clubs and 200 did not. Older people assessment sheet, the Australian Community Participation Questionnaire, the Council on Nutrition Appetite Questionnaire, and Kessler Psychological Distress Scale were used.ResultsMajority of geriatric club members had high community participation, while half of the older people who were not members of the club had moderate community participation levels. Approximately 41.0% of the participants at geriatric clubs had no risk at this time for a nutritional decline, while less than three-quarters of those who are not geriatric club members need frequent appetite reassessment. A correlation was observed between community participation with appetite and psychological distress in those who attended geriatric clubs. Those who are not geriatric club members had correlation between appetite with community participation and psychological distress (P ≤ 0.001).ConclusionsGood appetite and psychological status are positively impacted by engaging in social activities among older people. Findings suggest that community programs, such as Meal on Wheels programs, and shared group activities can improve appetite and social interaction among older people.

Serum transthyretin and aminotransferases are associated with lean mass in people with coronary heart disease: Further insights from the CARE-CR study.

Low muscle mass disproportionately affects people with coronary heart disease compared to healthy controls but is under-researched and insufficiently treated. Inflammation, poor nutrition, and neural decline might contribute to low muscle mass. This study aimed to assess circulatory biomarkers related to these mechanisms [albumin, transthyretin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and C-terminal agrin fragment] and their relationship with muscle mass in people with coronary heart disease. Our findings could be beneficial to indicate mechanisms of sarcopenia, detect sarcopenia, and evaluate treatment. Serum blood samples from people with coronary heart disease were analysed for biomarker concentrations using enzyme-linked immunosorbent assays. Skeletal muscle mass was estimated using dual X-ray absorptiometry derived appendicular lean mass and reported as skeletal muscle index (SMI; kg m-2), and as a proportion of total body mass [appendicular skeletal mass (ASM%)]. Low muscle mass was defined as a SMI <7.0 and <6.0 kg m-2, or ASM% <25.72 and <19.43% for men and women, respectively. Associations between biomarkers and lean mass were adjusted for age and inflammation. Sixty-four people were assessed; 14 (21.9%) had low muscle mass. People with low muscle mass had lower transthyretin (effect size 0.34, p = 0.007), ALT (effect size 0.34, p = 0.008), and AST (effect size 0.26, p = 0.037) concentrations, compared to those with normal muscle mass. SMI was associated with inflammation-corrected ALT (r = 0.261, p = 0.039) and with inflammation- and age-adjusted AST/ALT ratio (r = -0.257, p = 0.044). Albumin and C-terminal agrin fragment were not associated with muscle mass indices. Circulatory transthyretin, ALT and AST were associated with low muscle mass in people with coronary heart disease. Low concentrations of these biomarkers might indicate that low muscle mass is partially explained by poor nutrition and high inflammation in this cohort. Targeted treatments to address these factors could be considered for people with coronary heart disease.

Are physical performance and frailty assessments useful in targeting and improving access to adjuvant therapy in patients undergoing resection for pancreatic cancer?

BackgroundMany patients fail to receive adjuvant chemotherapy following pancreatic cancer surgery. This study implemented a multimodal, multidisciplinary approach to improving recovery after pancreatoduodenectomy (the ‘Fast Recovery’ programme) and measured its impact on adjuvant chemotherapy uptake and nutritional decline. The predictive accuracies of a bundle of frailty and physical performance assessments, with respect to the recipient of adjuvant chemotherapy, were also evaluated.ResultsThe N = 44 patients treated after the introduction of the ‘Fast Recovery’ programme were not found to have a significantly higher adjuvant chemotherapy uptake than the N = 409 treated before the pathway change (80.5 vs. 74.3%, p = 0.452), but did have a significantly lower average weight loss at six weeks post-operatively (mean: 4.3 vs. 6.9 kg, p = 0.013). Of the pre-operative frailty and physical performance assessments tested, the 6-min walk test was found to be the strongest predictor of the receipt of adjuvant chemotherapy (area under the ROC curve: 0.91, p = 0.001); all patients achieving distances ≥ 360 m went on to receive adjuvant chemotherapy, compared to 33% of those walking < 360 m.ConclusionsThe multimodal ‘Fast Recovery’ programme was not found to significantly improve access to adjuvant chemotherapy, but did appear to have benefits in reducing nutritional decline. Pre-operative assessments were found to be useful in identifying patients at risk of non-receipt of adjuvant therapies, with markers of physical performance appearing to be the best predictors. As such, these markers could be useful in targeting pre- and post-habilitation measures, such as physiotherapy and improved dietetic support.

Effect of dietary supplementation with multinutrient soy flour on body composition and cognitive function in elderly individuals at the risk of low protein: a randomized, double-blind, placebo-controlled study.

Insufficient protein intake and cognitive decline are common in older adults; however, there have been few studies on low protein risk screening and complex nutrient interventions for elderly individuals in rural communities. This study aimed to evaluate the effect of dietary multinutrient soy flour (MNSF) on body composition and cognitive function in elderly individuals who are at risk of protein deficiency in a randomized, double-blind, placebo-controlled clinical trial. Nutritional interventions were given to those found to have low protein levels using bioelectrical impedance analysis (BIA). Among 733 older adults screened, 62 participants were included and randomly assigned into two groups, one taking soy flour and the other taking MNSF for 12 weeks. A previous cross-sectional survey found that 35.1% of the elderly people with an average age of 71.61 ± 5.94 years had an inadequate body protein mass proportion. After the intervention, the MNSF group demonstrated a significant improvement in protein mass, muscle mass, mineral levels, skeletal muscle mass, and fat-free mass compared with baseline (all P < 0.05), as well as a better upward trend compared with the soy flour group (P = 0.08; P = 0.07; P = 0.05; P = 0.08; P = 0.07). Regarding the mini-mental state examination (MMSE) scores, the MNSF group showed a significant decrease after 12 weeks (P < 0.05), which were significantly different compared with the soy flour group (P < 0.05). In the future, the application of MNSF as a food-based supplement to improve nutrition and delay cognitive decline in older adults at the risk of protein deficiency may be considered.

Relationship between motor dysfunction and chewing movement in patients with Parkinson's disease: A transversal study.

To assess the impact of chewing movement in patients with Parkinson's disease (PD), we examined the relation between chewing movement and motor dysfunction in association with PD progression. Thirty patients with PD (mean age, 68.9 ± 9.0 years; mean Hoehn and Yahr stage, 3.0 ± 0.7) were recruited. The PD condition was assessed in each patient by using the score of Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) part III score, body mass index (BMI), serum albumin (Alb), and tongue pressure, number of chews, mealtime, and chewing speed were collected. The patients were divided into two groups (mild and moderate PD groups) based on an MDS-UPDRS part III cut-off value of 32. The chewing speed positively correlated with tongue pressure (rho = 0.69, p < 0.01) in the mild group, and with BMI (rho = 0.54, p = 0.03), serum Alb (rho = 0.63, p = 0.02), and number of chews (rho = 0.69, p < 0.01) in the moderate group. The MDS-UPDRS part III scores for all participants correlated negatively with chewing speed (rho = -0.48, p < 0.01), serum Alb (rho = -0.49, p < 0.01), and positively with mealtime (rho = 0.43, p = 0.01). Tongue pressure and serum Alb were identified to be as factors affecting the chewing speed (β= 0.560, p < 0.01; β= 0.457, p < 0.01, respectively). These results indicated that the progression of motor dysfunction in patients with PD is likely to affect chewing speed and the nutritional status decline may be linked to the impairment of chewing movement in these patients.

Oral, enteral and parenteral nutritional therapies in scleroderma: A systematic review.

Scleroderma is a multi-system disease that causes hardening of connective tissue. The gastrointestinal (GI) tract is affected in 90% of patients, which may cause nutritional decline. Due to the rarity of the disease, current nutritional guidelines in scleroderma are extrapolated from evidence in other chronic diseases. This systematic review examines the effects of oral nutrition supplements (ONS), enteral nutrition (EN) and parenteral nutrition (PN) on both clinical and nutritional outcomes of scleroderma patients. Three separate systematic searches for scleroderma and ONS, EN, and PN were performed. The searches were conducted using EMBASE, PubMed and Web of Science databases. A total of 9 studies (ONS: 2, EN: 1 and PN: 6) met the inclusion and exclusion criteria and were included in the review. All patients had scleroderma and were malnourished or at risk of malnutrition [weighted average age: 53 years, Body Mass Index (BMI): 19kg/m2]. Artificial nutrition support was shown to be an effective therapy for preventing nutritional decline and reversing malnutrition but had no impact on disease progression. Mean BMI increased with home parenteral nutrition (HPN) and EN, from 15kg/m2 to 21.0kg/m2. Weight was maintained with ONS, and sarcopenia decreased. Only HPN positively impacted quality of life and GI symptoms, with complication rates similar to patients with other indications. Scleroderma patients should be routinely screened for malnutrition. Malnutrition is treated in a stepwise manner, starting with ONS, then EN and finally PN, based on GI sufficiency and tolerance of the patient. HPN is an effective therapy for patients with advanced disease and intestinal failure. However, larger, long-term, prospective studies for each nutritional therapy are required to make firm conclusions.

Change in nutritional status of urban slum children before and after the first COVID-19 wave in Bangladesh: A repeated cross-sectional assessment.

The onset of COVID-19 severely disrupted economies and increased acute household food insecurity in developing countries. Consequently, a global rise in childhood undernutrition was predicted, especially among vulnerable populations, but primary evidence on actual changes in nutritional status remained scarce. In this paper, we assessed shifts in nutritional status of urban slum children in Bangladesh pre- and post- the country's first wave of COVID-19 and nationwide lockdown. We used two rounds of cross-sectional data collected before and after the pandemic's first year in two large slum settlements (Korail and Tongi) of Dhaka and Gazipur, Bangladesh (n = 1119). Regression models estimated pre-post changes in: 1) predictors of childhood undernutrition (household income, jobs, food security, dietary diversity, healthcare utilization, and hand hygiene); and 2) under-five children's nutritional status (average height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), stunting, and wasting). Subgroup analysis was done by household migration status and slum area. Over the sample period, average monthly household income dropped 23% from BDT 20,740 to BDT 15,960 (β = -4.77; 95% CI:-6.40, -3.15), and currently employed fathers slightly declined from 99% to 95% (β = -0.04; 95% CI:-0.05, -0.02). Average HAZ among the slum children improved 0.13 SD (95% CI: 0.003, 0.26). Among non-migrant children in Tongi, the odds of stunting increased (OR = 2.01, 95% CI: 1.16, 3.48) and average WHZ reduced -0.40 SD (95% CI: -0.74, -0.06). Despite great economic hardship, and differential patterns of representativeness by household geography and migration status, slum children in Bangladesh generally demonstrated resilience to nutritional decline over the first year of the pandemic. While underlying threats to nutritional deterioration persisted, considerable job and income recovery in the post-lockdown period appeared to have cushioned the overall decline. However, as the pandemic continues, monitoring and appropriate actions are needed to avert lasting setbacks to Bangladesh nutritional progress.