Nutritional Deficits Research Articles

Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease.

Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients.

Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children

Anemia is a public health problem worldwide and is most prevalent in preschool children, for whom it is the most frequent cause of nutritional deficits. In turn, iron deficiency is the main cause of anemia, affecting 43% of children globally. Previous studies in Cuba show rates of iron deficiency in preschool children between 38.6% and 57.6%, higher in infants (71.2% to 81.1%). WHO recommends using serum ferritin as an indicator of iron deficiency accompanied by acute (C-reactive protein) and chronic (a1-acid glycoprotein) inflammation biomarkers. Assess how inflammation affects measuring and reporting of iron-deficiency anemia rates in Cuban preschool children. Data were obtained from serum samples contained in the National Anemia and Iron Deficiency Survey, and included presumably healthy preschool Cuban children (aged 6-59 months). Serum samples were collected from 1375 children from randomly selected provinces in 4 regions of the country from 2014 through 2018. We examined the association between ferritin and two inflammatory biomarkers: C-reactive protein and a1-acid glycoprotein. Individual inflammation-adjusted ferritin concentrations were calculated using four approaches: 1) a higher ferritin cut-off point (⟨30 g/L); 2) exclusion of subjects showing inflammation (C-reactive protein ⟩5 mg/L or a1-acid glycoprotein ⟩1 g/L); 3) mathematical correction factor based on C-reactive protein or a1-acid glycoprotein; and 4) correction by regression with the method proposed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia Group. We estimated confidence intervals of differences between unadjusted prevalence and prevalence adjusted for inflammation by each method. The proportion of children with inflammation according to C-reactive protein concentrations >5 mg/L was lower (11.1%, 153/1375) than the proportion measured according to the concentrations of a1-acid glycoprotein, at >1 g/L (30.8%, 424/1375). The percentage of children with high concentrations of at least one of the aforementioned biomarkers was 32.7% (450/1375). Thus, each correction method increased the observed prevalence of iron deficiency compared to unadjusted estimates (23%, 316/1375). This increase was more pronounced when using the internal regression correction method (based only on C-reactive protein) or the method based on a higher cut-off point. Adjustment using all four methods changed estimated iron deficiency prevalence, increasing it from 0.1% to 8.8%, compared to unadjusted values. One-third of preschool children had biomarkers indicating elevated inflammation levels. Without adjusting for inflammation, iron deficiency prevalence was underestimated. The significant disparity between unadjusted and inflammation-adjusted ferritin when using some approaches highlights the importance of selecting the right approach for accurate, corrected measurement. The internal regression correction approach is appropriate for epidemiological studies because it takes into account inflammation severity. However, other models should be explored that account for inflammation and also provide better adjusted ferritin concentrations.

Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial

Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. Methods: Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. Results: A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien–Dindo III–V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08–0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. Conclusions: Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications.

Omega-3 fatty acids as component of nutritional and metabolic treatment of patients with COVID-19 and other viral diseases (literature review)

Nutritional deficit in patients with viral diseases, including COVID-19, can reduce the efficacy of specific treatment, decrease the survival rate, and increase medical expenses. According to international guidelines, timely correction of nutritional status with supplemental enteral and parenteral nutrition containing omega-3 polyunsaturated fatty acid from fish oil (omega-3 PUFAs: ЕРА and DHA) is able to improve clinical outcomes of specific antiviral treatment. The authors conducted an analytical review to assess the results from the study of clinical use of omega-3 PUFAs for the prevention and treatment of COVID-19 and other viral infections. Supplementation of clinical (enteral and parenteral) nutrition with omega-3 PUFAs allows for symptom reduction, shorter stay in hospital, and quicker recovery of patients infected with SARS-CoV-2 and other viruses. When used in combination with adequate macronutrient support, it can reverse nutritional deficit and improve clinical outcomes.

Avoidant/restrictive food intake disorder and autism spectrum disorder: clinical implications for assessment and management.

We examined clinical and neurodevelopmental presentations of children with avoidant/restrictive food intake disorder (ARFID) to inform clinical assessment and management. Five hundred and thirty-six patients (mean age 6y 10mo, SD 3y 5mo, range 10mo-20y; 401 males, 135 females) seen by the tertiary multidisciplinary feeding service at the Evelina London Children's Hospital between January 2013 and June 2019 were included in this case-control study. These children experienced significant feeding difficulties impacting nutrition, development, and psychosocial functioning requiring tertiary specialized input. Data on ARFID diagnosis, demographics, comorbidity, and nutrition was extracted from electronic patient records. Forty-nine per cent of children met ARFID criteria. The remaining participants had other difficulties including feeding, medical, and/or neurodevelopmental conditions. ARFID is more prevalent among younger patients (4-9 years) and in children with comorbid autism spectrum disorder (ASD). Younger age, comorbid ASD, and male sex significantly predicted ARFID. Diet range and male sex significantly predicted nutritional inadequacy, while comorbid ASD did not. A trend was seen between younger age and nutritional inadequacy. Young children with ARFID should raise suspicion for ASD. Although significant nutritional deficiencies are common in children with comorbid ARFID and ASD, they are correctable with nutritional supplementation. Specialty perspective potentially limits generalizability of findings to community feeding services. We also emphasize the importance of early identification of nutritional deficits and management.

Lipid profile and nutritional status of a pediatric population with sickle cell anemia: differences between gender and association with severity markers

Objective: To investigate the associations between nutritional status and lipid profile with biomarkers of hemolysis and inflammation in sickle cell anemia, in addition to considering gender differences. Methods: This cross-sectional study analyzed nutritional, and biochemical data of pediatric patients carrying sickle cell anemia. Results: Vitamin A, apolipoprotein B, total cholesterol, low-density lipoprotein, and non-high-density lipoprotein cholesterol were lower in boys. Hemoglobin was significantly lower, and the white blood cells and lactate dehydrogenase were higher in boys. Body mass index, vitamin A, and triglycerides were associated with hemoglobin levels, while apolipoprotein A-I was associated with white blood cells and total bilirubin. Additionally, body mass index and vitamin A were associated with lactate dehydrogenase. Vitamin A showed significant predictive power in hemoglobin alteration and lactate dehydrogenase, while apolipoprotein A-I was able to predict high white blood cells values and total bilirubin. Conclusion: This study found in a pediatric population with sickle cell anemia that body mass index, vitamin A, triglycerides, and apolipoprotein A-I were associated with biomarkers of hemolysis and inflammation. Boys exhibited the greater nutritional deficit and severity of the disease.

Nutritional status and intake in patients with non-cystic fibrosis bronchiectasis (NCFB) - a cross sectional study

Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity. A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested. In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI. BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.

Development, evaluation and use of COVID-19 vaccines in older adults: Preliminary principles for the pandemic and beyond.

Development, evaluation and use of COVID-19 vaccines in older adults: Preliminary principles for the pandemic and beyond.

Nutritional status and food consumption of patients with Parkinson disease.

Parkinson's disease (PD) is a neurodegenerative disease that affects food intake as the disease progresses. The assessment of nutritional status is essential to identify early nutritional deficits. To investigate the nutritional status and food intake of patients diagnosed with PD. This was a descriptive, cross-sectional, and quantitative study. A structured questionnaire with restricted questions was applied to identify the sociodemographic profile and anthropometric measurements were taken. To evaluate the disease stage, the modified Hoehn & Yahr scale was used. Food intake was evaluated using the Food Frequency Questionnaire (FFQ). The acquired information was organized in the Microsoft Office Excel 2010 program and statistical analysis was performed using the BioEstat 5.3 program. The research was carried out with 40 patients; the majority was male (60%), over 60 years old (52.5%), single (55%), with a high school degree (42.5%), retirees (80%), and receiving one minimum salary (42.5%). Most were classified with eutrophic (42.5%) and overweight (42.5%). About food consumption, the most common foods were banana (60%), fish (52.5%), acerola (45%), and orange (32%). Among the high-risk foods, red meat (82.5%), fried foods (30%), heavy cream (25%), and filled sandwich cookies (25%) were the most common. Most patients had a high consumption of red meat and processed foods, with relevant consumption of some fruits and low consumption of grains and oilseeds. The disease stage was not associated with nutritional status.

Aplikasi Seduhan Zingiber Officinale (Jahe) Terhadap Defisit Nutrisi Pada Ibu Hamil Trimester I Di Wilayah Kerja Puskesmas Cikalong kulon Kabupaten Cianjur

During pregnancy, mothers experience physical, social and emotional changes in the family environment. Any pregnancy can also develop into problems or complications at any time. That's why pregnant women need monitoring during pregnancy. Hormonal changes in women occur during pregnancy, namely an increase in the hormones progesterone and estrogen, resulting in placental HCG or (Human Chorionic Gonadotropine). This can cause complaints that will be experienced by pregnant women, one of which is emesis gravidarum or nausea and vomiting that occurs in pregnancy can cause nutritional disorders, dehydration, weakness, weight loss, and electrolyte imbalances in the body which can have a negative impact on development. such as abortion, low birth weight babies, premature birth, malformations of the fetus, stunted fetal growth. The purpose of this study was to understand and apply the infusion of zingiber officinale (ginger) to nutritional deficits in first trimester pregnant women. Data collection methods were interviews, observation, and lateral/documentation studies. Interventions were carried out to overcome nausea and vomiting by steeping ginger (zingiber officinale) to meet the nutritional needs of pregnant women. It can be concluded that the administration of steeping ginger (zingiber officinale) can reduce nausea and vomiting in pregnant women in the first trimester. The results of this study are expected to be a reference for future researchers.

COVID-19: gender characteristics of the course, perinatal risks and possible ways to prevent complications

The article contains modern data of the characteristics, course and impact on pregnant women, postpartum women, fetus and newborn of the SARS-CoV-2. The opinions of experts from different countries of the world on the consequences of coronavirus disease depending on racial, ethnic, age differences and delivery time. Immunological and hormonal protection during pregnancy against viral influences is noted. In the context of a pandemic, the number of premature births (for various reasons) and the birth of children with low birth weight significantly increased, but their relationship with COVID-19 infection has not been proven. Risk factors for the hospitalization of pregnant woman infected with COVID-19 are high body mass index, obesity and concomitant diseases (diabetes mellitus, hypertension. Women in older reproductive age also need hospitalization more often. During pregnancy, innate and adaptive immune responses shift from an inflammatory to an anti-inflammatory phenotype to prevent affection of the fetus and promote passive transmission of maternal antibodies to the fetus. These COVID-19 protection effects are largely mediated by estradiol and progesterone. New data on the impact of COVID-19 on erythropoiesis, hemoglobin and ferritin levels are presented, and risk groups of a more severe course of the disease are identified: elderly adults, patients, patients with arterial hypertension, obesity and diabetes mellitus, pregnant women, patients with primary and acquired immunodeficiency, with oppression of the hematopoiesis, HIV-infected and with cancer. The algorithm of outpatient monitoring of pregnant women during a pandemic (self-assessment of the state, online control, etc.) is given.Some current world protocols for the COVID-19 prevention and treatment have been analyzed and a modification adapted for Ukrainian pregnant women has been proposed. A method is proposed for the prevention miscarriage and nutritional deficits – one of the frequent and dangerous COVID-19 complications in pregnant women.

Body Mass Index Alters the Predictive Value of the Neutrophil-to-Lymphocyte Ratio and Systemic Inflammation Response Index in Laryngeal Squamous Cell Carcinoma Patients

Laryngeal squamous cell carcinoma (LSCC) is a frequent cancer subtype among head and neck cancers. Exacerbated inflammation and nutritional deficit are common features in this type of cancer and can be used as a prognostic marker. This study aimed to investigate the relationship between body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) on overall survival (OS) of LSCC patients. In this retrospective cohort study, 168 patients were followed for 5 years. Data on clinical factors, patients’ life habits, height, weight, and hematological parameters were collected. BMI, NLR, and SIRI were calculated. Pretreatment NLR≥ 2.02 and SIRI≥ 1160.85 were independent prognostic factors for poor OS. Low BMI did not significantly affect the OS. However, the inflammatory parameters had their predictive capacity altered when stratified by the BMI classification. NLR≥ 2.02 + Low BMI or SIRI≥ 1160.85 + Low BMI increased in 8.6 and 3.8 times the risk of death, respectively. In contrast, stratification by normal/high BMI classification eliminated the predictive capacity of NLR and SIRI. Here, we demonstrated the possible ability of BMI to change the prognostic capacity of inflammatory markers NLR and SIRI in patients with LSCC. Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1952447

Afectarea cardiovasculară ȋn anorexia nervoasă

Objective. Demonstrating cardiovascular injury amoung a group of female patients suffering from anorexia, compared to a similarly-aged group of women with body mass within the normal range. Materials and methods. Clinical, biological and paraclinical parameters were determined in the two patient groups: Group A, consisting of 39 patients suffering from anorexia, and Group B, consisting of 40 patients of similar ages, but having a normal body-mass index (BMI). Results. Compared to the normal-BMI cohort, the female patients diagnosed with anorexia are more bradycardic, have lower blood pressure, biologically were found to suffer from various degrees of anemia (hypochromic, microcytic, caused by iron deficiency), leucocytosis, thrombocytosis, hypoglicemia, slight nitrogen compounds retention, hyponatremia, hypokalemia, hypochloremia, hypomagnesemia, hypocalcemia, hypophosphatemia, low levels of triglycerides and of all cholesterol fractions, hypoproteinemia with hypoalbuminemia, mild hepatic cytolysis, increased levels of creatine kinase and cortisol. In terms of echocardiographic findings, the patients with anorexia have decreased dimensions of all cardiac chambers and of the inferior vena cava, lower cardiac output and index, diminished A-wave velocity, with an increase in E/A ratio, lower E', A' and S' velocities for the lateral ventricular wall, along with lower E' and A' velocities for the interventricular septum, and a decrease in both tricuspid annular and mitral annular systolic excursions. Discussions. There is an obvious link between the magnitude of clinical, biological and paraclinical abnormalities and low BMI. Further studies are needed in order to establish the degree of reversibility of said abnormalities following the total or partial correction of the patients' nutritional deficit. Conclusions. The patients suffering from anorexia present with multiple abnormal findings, both biological and clinical in nature, alongside a subclinical negative impact on the cardiovascular system. Early detection of these negative changes could impose the adoption of a realimentation plan, possibly accompanied by the use of specific pharmacological agents, that would bring about improvements in these patients' overall status.

Short‐term responses to a human‐altered landscape do not affect fat dynamics of a migratory ungulate

Abstract According to risk‐sensitive foraging theory, animals should make foraging decisions that balance nutritional costs and gains to promote fitness. Human disturbance is a form of perceived risk that can prompt avoidance of risky habitat over acquisition of food. Consequently, behavioural responses to perceived risk could induce nutritional costs. Population declines often coincide with increases in human disturbance, which likely is associated with direct and indirect habitat loss. Nevertheless, behavioural and physiological responses to perceived risks associated with human disturbance could be an added nutritional deficit with population‐level repercussions. Using GPS‐collar data from three populations of migratory mule deer Odocoileus hemionus exposed to a gradient of established industrial energy development on winter ranges where direct and indirect habitat loss were well documented, we evaluated whether exposure and behavioural responses to human disturbance alter changes in nutritional condition (i.e. fat reserves) over winter. Although animals exhibited behaviours indicative of perceived risk of human disturbance, such as increased movement rates and avoidance of infrastructure, exposure and behavioural responses to human disturbance had little to no measurable effect on fat loss over a winter. Instead, catabolism of fat reserves occurred primarily as a function of the amount of fat animals had entering winter, suggesting that, in the short term, animals were able to mitigate the energetic costs of perceived risk of human disturbance over winter. Animals, however, did not appear to overcome persistent food limitations, and animals with less food availability lost more fat over winter. Our findings heed caution in using short‐term behavioural and physiological responses to inform long‐term nutritional consequences of human disturbance. Although animals appear to mitigate the energetic costs of perceived risk, food limitations exacerbated by broader‐scale avoidance of food near human disturbance may be the primary pathway causing the frequently observed population declines following human disturbance to pristine landscapes. A free Plain Language Summary can be found within the Supporting Information of this article.

Maintaining School Foodservice Operations During COVID-19: The Case of Ohio

ObjectivesCOVID-19-related school closures hindered the provision of meals to school-age youth nationwide, risking deficits in nutrition, health, and development. Foodservice staff faced substantial difficulties in their efforts to maintain foodservice operations. The state of Ohio, in which the prevalence of child food insecurity exceeds the national average (18.9% versus 15.2%), offers an illustrative case for exploration of these adaptations. The objective of this study was to characterize COVID-19-related foodservice adaptations, including impacts on both summer and school year meal provision.MethodsAn administrative representative from each Ohio school district was emailed in December 2020 and invited to complete an online survey. This cross-sectional analysis focuses on public school district experiences.ResultsAmong responding districts (n = 298 of 611, 49%), the majority continued providing meals after the Spring 2020 shutdowns(73%) and functioned as an ‘open site’ (63%), offering food to students’ families and households without district affiliation. Most schools offered meals either once weekly (41%) or once per weekday (30%) and offered an average of 3.7 days-worth of meals at a time. Half (48%) of the districts employed a pre-order system. Districts used various distribution methods: 76% had central school or district-affiliated pick-up point(s); 38% delivered meals to community location(s); and 34% delivered directly to some households. Supply chain disruptions led the vast majority of schools to seek USDA meal pattern waivers. Only 39% of districts maintained food service operations during summer 2020. The majority of districts were hybrid (59%) or fully online (24%) for at least a portion of Fall 2020, yet only 12% reported offering meal delivery or pick-up. Districts reported many “successes” (e.g., feeding students safely) and “challenges” (e.g., extra costs, poor parental participation).ConclusionsPublic school districts in Ohio made numerous COVID-related foodservice adaptations in order to serve both their students and the community at large, though districts reported poor utilization of this service. Future research should evaluate whether reduced access to school meals impacted child food security and food security-related outcomes during this period.Funding SourcesOffice of Research at The Ohio State University

Heat Stress-Associated Growth Retardation in the First 1000 Days Is Mitigated by Preconception Nutritional Supplementation

Abstract Objectives Understanding the interactions between nutrition and climate-driven health outcomes is increasingly necessary. Employing data from the Women First trial conducted in Thatta, Pakistan, we examined the interactions between maternal nutritional deficits and heat stress (HS) on birth outcomes. Methods Women of child-bearing age either consumed a small quantity lipid-based nutrition supplement (sqLNS) prior to conception (Arm 1), from 12 wk of gestation until delivery (Arm 2); or were not supplemented with sqLNS (Arm 3). At the Pakistan site, samples sizes with birth outcomes obtained within 48 h of delivery for Arms 1, 2 and 3 were 157,150 and 138, respectively. Daily maximal air temperatures were used to were compute the average daily maximal temperatures (Tmax) for each infant over four 90-day windows representing each trimester of gestation and 3 mo preconception. The number of days in each period when the Tmax was &amp;gt; 39°C was computed to assess ‘heat stress days’. Results Linear regression models assessing the associations between heat exposure and outcome variables (gestational age adjusted Z-scores of birth length (LGAZ), birth weight (WGAZ) and head circumference (HCGAZ) revealed a striking negative association of both ambient temperature and HS days in the first trimester on birth length (LGAZ) and head circumference (HCGAZ) (p &amp;lt; 0.005). For each 5°C increase in the Tmax in the first trimester, LGAZ decreased by 0.15 z-scores and HCGAZ decreased by 0.11 z-scores. Heat exposure (Tmax) in the second trimester also associated with HCGAZ (p = 0.02 and z-score of −0.11 for every 5°C) but not with birth length or birth weight. RNA-sequencing of placenta indicated a robust association of 1st trimester HS with genes involved in protein targeting to ER, protein biosynthesis, and cytoplasmic translation. Finally, while non-intervention groups (Arms 2 and 3) showed a robust negative association of excessive HS with LGAZ (p &amp;lt; 0.05), preconception intervention with sqLNS (Arm 1) significantly mitigated heat-associated decreases in birth length. Conclusions These findings indicate that excessive HS in the first trimester is associated with decreased linear growth in utero. Importantly, sqLNS mitigated growth restriction in newborns implicating nutritional status as a driving force in resilience to HS. Funding Sources Supported by The BMGF and NICHD.

P381 Fatigue is an independent disease manifestation largely independent of chronicity, comorbidity and disease activity in patients with Inflammatory Bowel Disease

Abstract Background Fatigue is a common reported symptom by patients with inflammatory bowel disease (IBD) and often with profound negative impact on quality of life including daily activities. The aim of this study was to encircle clusters of key components associated with fatigue to explore if fatigue is an independent IBD disease manifestation. Methods A cross-sectional study was conducted in patients with IBD receiving biologic therapies at the tertiary IBD Clinic at Herlev Hospital, Denmark, from March to May 2019. Consecutive patients were asked to participate in a questionnaire survey when visiting the clinic. The questionnaire included: FACIT-Fatigue, Harvey-Bradshaw Index/Simple Clinical Colitis Activity Index, short health scale, short IBD Questionnaire, and EQ-5D-5L. Additional disease-related information was retrieved from medical records. Principal component analysis (PCA) was used to identify factors associated with fatigue. Results Three hundred patients with IBD (Crohn’s disease n=190 (62%); ulcerative colitis n=110 (38%), mean age 44 years, SD 14) treated with biologics were included. The median FACIT F-score was 39 for the population, and scores ≤39 were considered moderate-to-severe fatigue. A high proportion of patients had moderate-to-severe fatigue (n=152 (51%)), these patients had significantly higher clinical disease activity (moderate-to-severe, n=56 (37%); remission, n=47 (31%)), compared to those with none-to-mild fatigue (n=148 (49%)) (moderate-to-severe, n=10 (7%); remission, n=105 (71%)) (p&amp;lt;0.005). Initial correlation analysis showed high clinical association between moderate-to-severe fatigue and patient reported outcomes, notably quality of life (rs=0.78), general well-being (rs=0.67), and disease worry (rs=0.52). The PCA subsequently reduced co-variables associated with fatigue into 3 main components, explaining 37% of fatigue (Figure). The first major component, explaining 15% of total fatigue, included ‘chronic disease related factors’, such as long disease duration, increasing age, previous use of biologics and corticosteroids, and previous surgery. The second component contributed to 13% of fatigue and comprised ‘comorbidity factors’, e.g., other chronic diseases, high body mass index (BMI), and self-reported disease activity. The third major component, explaining 11% of fatigue, comprised ‘disease activity and nutrition factors’ such as of high c-reactive protein, low iron, and low BMI. Conclusion Fatigue in IBD is only to a lesser extent driven by disease activity and nutritional deficits, chronicity, and co-morbidity. This indicates that fatigue is an independent disease manifestation in IBD.

First trimester pregnant woman's complaint during COVID-19 pandemic

First trimester pregnant women will adapt to various things of discomfort, one of which is morning sickness. If not given a virginity intervention, then this pregnant woman could experience nutritional deficit. The aim of this case study is to provide an overview of how pregnant women in their first trimester cope with their complications during the COVID-19 pandemic. This research method uses in-depth interviews and observations of pregnant women in their first trimester at home. The results obtained were that there were three problems described by Mrs. L, namely; physical discomfort such as dizziness, nausea and fatigue, which can be dealt by taking a warm bath, or smelling some aromatherapy oil such as mint, disturbance of nutritional fulfilment which can be overcome by consuming fresh food, ginger water in a small portion yet frequently and the risk of stress which can be overcome by praying five times a day and gardening, cleaning up the house, discussing with other pregnant friends in whatsapp group. This study can serve as a guide for nurses in providing nursing interventions to pregnant women in the first trimester during the COVID-19 pandemic.

Assessment of the Nutritional Status of Children on Arvs in the Prevention of Mother Transmission (PMTCT) Child Centers in the Ruashi Health Zone in Lubumbashi in Dr Congo

Introduction: HIV infection causes and promotes enormous nutritional deficits in children. The objective of this work was to analyze the nutritional status of children infected with HIV placed on antiretrovirals in the Ruashi Health Zone in Lubumbashi. Methods: We carried out a cross-sectional descriptive study which focused on 51 children aged 3 months to 17 years selected in 8 care structures for People Living with HIV AIDS, from January to June 2016. Data was collected by documentary review and the usual descriptive statistics and anthropometric indicators were used. Result: The prevalence of overall malnutrition was 31.37% (n = 51) including 7.84% moderate malnutrition. The average weight is 19.25 kg with a minimum weight of 4.5 kg and a maximum of 49 kg. The overall prevalence of anemia (hemoglobin &lt;11g / dl) was 9.8%. Wasting affected 3.92% of children and 7.84% were victims of chronic malnutrition. The prevalence of acute malnutrition was 25.48%, of which 3.92% was severe acute malnutrition. Immune deficiency (CD4 &lt;350) in 5.88% of cases, undetectable viral load at 88.37% and treatment compliance at 92.16% Conclusion: HIV / AIDS affects the state of health of children in Ruashi with 31.37% overall malnutrition and 7.84% stunted growth. Good nutritional and therapeutic support for children is necessary

Integrating behaviour, physiology and survival to explore the outcome of reintroductions: a case study of grey partridge

Personalities, i.e. consistent individual differences in behaviour, have been found in many animal populations. However, the reasons why personalities emerge, how they persist and the consequences they have in a changing environment are poorly understood. Factors influencing personalities include genetic background, prenatal (e.g. hormonal) and postnatal (e.g. environmental) conditions, and the strength of these factors can affect the consistency of personalities over time, and hence their flexibility in a changing environment. In birds, for example, hormones in eggs deposited by mothers can modulate aggressiveness of offspring and environmentally induced nutrition deficits in offspring can reduce neophobia later in life. Hence, investigating the fitness consequences of personalities requires the integration of physiological, behavioural and survival measures. We used the opportunity of a reintroduction project of grey partridge, Perdix perdix , to experimentally explore how multiple pre- and postnatal factors including measures of the hormone corticosterone were related to three behavioural traits. Then, we investigated whether the behaviours were repeatable and related to survival after release into the wild. Grey partridges showed distinct personalities affected by multiple pre- and postnatal factors. Proactive birds had low baseline levels of circulating corticosterone and survived longer after release into the wild compared to reactive and passive personalities. Consequently, the number of survivors after 6 months was substantially higher for proactive than for reactive and passive birds. Integrating data on behaviour, physiology and survival thus allows the investigation of the complex interplay of personality and fitness in a changing environment. • Animals have personalities but what are their fitness consequences in the wild? • We explored factors relating to behaviour of grey partridge bound for release. • Genetic, physiological, individual and social factors affected personalities. • After release, bold birds survived longer than passive and shy individuals. • Integration data on behaviour and physiology can support reintroduction outcome.