Nutritional Outcomes Research Articles

Food-Based Intervention for Boosting Micronutrient Status and Health - A Comprehensive Review

Food fortification and supplementation represent crucial strategies for combating the prevalence of micronutrient deficiencies, particularly among vulnerable populations such as children, adolescents, and pregnant women. However, the efficacy of interventions in increasing nutrient bioavailability primarily hinges on incorporating nutrient-rich foods and employing suitable food preparation techniques. Research underscores the significant potential of food-based approaches in augmenting micronutrient intake and fostering optimal growth and development. This comprehensive review assesses findings from 36 articles published within the last decade, focusing on food-based interventions aimed at alleviating micronutrient deficiencies in Africa. Analysis reveals that ten trials yielded positive outcomes across all growth metrics, albeit one study showed no significant changes in height Z scores. While two trials did not observe alterations in serum levels, twelve reported improvements in biochemical markers, and four noted enhanced cognitive and academic performance among school children. Despite these encouraging results, advancing food-based solutions to enhance dietary micronutrient quality and mitigate associated health challenges necessitates further investigation. It is imperative to underscore the importance of consuming a balanced diet comprising a diverse range of foods and adhering to recommended food preparation practices to minimize food loss and waste. By prioritizing these measures, individuals can safeguard against micronutrient deficiencies and promote sustained healthy growth and development. In conclusion, while food fortification and supplementation play pivotal roles in addressing micronutrient deficiencies, integrating nutrient-rich foods and appropriate food preparation methods emerges as crucial components in maximizing the effectiveness of interventions. Continued research efforts are essential to refine food-based solutions and ensure their widespread accessibility, ultimately contributing to improved nutritional outcomes and overall well-being in vulnerable populations across Africa and beyond.

Low Geriatric Nutritional Risk Index Predicts Early Complications following Distal Radius Fracture Open Reduction Internal Fixation

Abstract Background While previous studies have investigated the association between the Geriatric Nutritional Risk Index (GNRI) and functional outcomes following distal radius fracture (DRF), no large-scale studies have investigated the associations between GNRI and postoperative outcomes following DRFs. Objectives The purpose of this study is to investigate the association between GNRI, a simple multifaceted measure of malnutrition risk, and 30-day postoperative complications following DRF open reduction internal fixation (ORIF). Materials and Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent DRF ORIF from 2015 to 2021. Patients were organized into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Logistic regression analysis was conducted to investigate the relationship between preoperative GNRI and postoperative complications. Results Severe malnutrition was independently associated with a greater likelihood of any complication (odds ratio [OR]: 3.22, 95% confidence interval [CI]: 2.48–4.17; p < 0.001), sepsis (OR: 15.41, 95% CI: 1.66–143.32; p = 0.016), cardiac arrest or myocardial infarction (OR: 20.58, 95% CI: 1.62–261.26; p = 0.020), pulmonary embolism (OR: 9.40, 95% CI: 1.76–50.11; p = 0.009), surgical site infection (OR: 7.73, 95% CI: 1.99–30.02; p = 0.003), nonhome discharge (OR: 2.55, 95% CI: 1.87–3.49; p < 0.001), readmission (OR: 2.47, 95% CI: 1.47–4.14; p < 0.001), and length of stay > 2 days (OR: 3.51, 95% CI: 2.67–4.62; p < 0.001). Conclusions Malnutrition is an independent significant predictor of early complications following DRF ORIF. Level of Evidence Level III; retrospective cohort comparison; prognosis study.

The effect of oropharyngeal mother’s milk on nutritional outcomes in preterm infants: a randomized controlled trial

Background and objectiveOropharyngeal interventions are an accepted method to improve the nutritional performance of premature infants. Considering the countless benefits of breast milk and the few studies on the use of breast milk as an oral-pharyngeal intervention, this study was conducted with the aim of determining the effect of oral-pharyngeal administration of breast milk on nutritional outcomes in premature infants.Materials and methodsIn this clinical trial, 80 premature infants hospitalized in the neonatal intensive care unit of Amir al-Mu’minin Hospital in Semnan (a city in Iran) were randomly assigned to intervention (n = 40) and control groups (n = 40). Infants in the intervention group were given breast milk, and infants in the control group were given sterile water as a placebo. The data collection tool included demographic and clinical questions checklist, including sex, gestational age, weight, milk administration time, lavage and its amount, vomiting, abdominal distension, and so on. Data analysis was performed using SPSS23.ResultsThe mean volume of total milk received by infants (p = 0.047) and the mean volume of milk received by mouth (p < 0.000) at the time of discharge were higher in the intervention group. Moreover, the time to start enteral nutrition in the intervention group was lower than in the control group (P = 0.012). Administering mother’s milk through the oropharyngeal method led to a reduction in infants’ length of stay in the hospital (P = 0.022).ConclusionBased on the results of the present study, the oropharyngeal administration of breast milk in the first days after the birth of premature infants admitted to the hospital improves the outcomes related to their nutritional status. Therefore, it is suggested that this convenient, safe, and feasible method be used in hospitalized premature infants as soon as possible so that premature infants can benefit from the important advantages of breast milk.

Pairwise fitting of piecewise mixed models for the joint modeling of multivariate longitudinal outcomes, in a randomized crossover trial.

Many statistical models have been proposed in the literature for the analysis of longitudinal data. One may propose to model two or more correlated longitudinal processes simultaneously, with a goal of understanding their association over time. Joint modeling is then required to carefully study the association structure among the outcomes as well as drawing joint inferences about the different outcomes. In this study, we sought to model the associations among six nutrition outcomes while circumventing the computational challenge posed by their clustered and high-dimensional nature. We analyzed data from a 2 2 randomized crossover trial conducted in Kenya, to compare the effect of high-dose and low-dose iodine in household salt on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in women of reproductive age and their household matching pair of school-aged children. Two additional outcomes, namely, urinary iodine concentration (UIC) in women and children were measured repeatedly to monitor the amount of iodine excreted through urine. We extended the model proposed by Mwangi etal. (2021, Communications in Statistics: Case Studies, Data Analysis and Applications, 7(3), 413-431) allowing flexible piecewise joint models for six outcomes to depend on separate random effects, which are themselves correlated. This entailed fitting 15 bivariate general linear mixed models and deriving inference for the joint model using pseudo-likelihood theory. We analyzed the outcomes separately and jointly using piecewise linear mixed-effects (PLME) model and further validated the results using current state-of-the-art Jones and Kenward methodology (JKME model) used for analyzing randomized crossover trials. The results indicate that high-dose iodine in salt significantly reduced blood pressure (BP) compared to low-dose iodine in salt. Estimates for the random effects and residual error components showed that SBP and DBP had strong positive correlation, with effect of the random slope indicating that significantly related outcomes are strongly associated in their evolution. There was a moderately strong inverse relationship between evolutions of UIC and BP both in women and children. These findings confirmed the original hypothesis that high-dose iodine salt has significant lowering effect on BP. We further sought to evaluate the performance of our proposed PLME model against the widely used JKME model, within the multivariate joint modeling framework through a simulation study mimicking a crossover design. From our findings, the multivariate joint PLME model performed exceptionally well both in estimation of random-effects matrix (G) and Hessian matrix (H), allowing satisfactory model convergence during estimation. It allowed a more complex fit to the data with both random intercepts and slopes effects compared to the multivariate joint JKME model that allowed for random intercepts only. When a hierarchical viewpoint is adopted, in the sense that outcomes are specified conditionally upon random effects, the variance-covariance matrix of the random effects must be positive definite. In some cases, additional random effects could explain much variability in the data, thus improving precision in estimation of the estimands (effect size) parameters. The key highlight in this evaluation shows that multivariate joint JKME model is a powerful tool especially while fitting mixed models with random intercepts only, in crossover design settings. Addition of random slopes may lead to model complexities in most cases, resulting in unsatisfactory model convergence during estimation. To circumvent convergence pitfalls, extention of JKME model to PLME model allows a more flexible fit to the data (generated from crossover design settings), especially in the multivariate joint modelingframework.

Outcomes of parenteral nutrition in patients with advanced cancer and malignant bowel obstruction.

Malignant bowel obstruction (MBO) affects 3% to 15% of all cancer patients. In patients with advanced cancer and inoperable MBO, the average survival varies between four to nine weeks. Parenteral nutrition (PN) may improve survival in specific patient populations with malignant bowel obstruction. This retrospective, single-center cohort study aimed to review individual patient outcomes on PN in the setting of advanced cancer with a diagnosis of MBO and identify clinical and laboratory markers predictive of short- and long-term survival to further highlight patients that would benefit from PN in the setting of an inoperable MBO. In a retrospective analysis of 68 patients receiving PN for inoperable MBO, the median survival was 142 (IQR: 63.3-239.5) days. Patients experienced a median number of two hospital readmissions (range: 0-10) and spent a median of 29days (range: 0-105) in the hospital after starting PN. Eighteen (26.5%) patients developed a catheter-related bloodstream infection (CRBSI). A diagnosis of appendiceal cancer was identified as a predictive marker of improved survival (HR: 0.53, 95% CI: 0.29-0.92, p = 0.023). The use of PN in the context of end-of-life cancer care is a practice that necessitates improvement. Recognizing the outcomes and patient experiences of PN utilization is essential to physicians and patients.

Inflammatory and Nutritional Biomarkers in Patients With Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Chemotherapy and Radiation Therapy.

To investigate the relationship between pretreatment inflammatory and nutritional biomarkers in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemotherapy and radiation therapy (nCRT). 213 patients with newly diagnosed stage II-III ESCC who received nCRT at an academic hospital in Taiwan. Electronic health record data were used. Records on inflammatory and nutritional biomarkers and clinical outcomes were extracted. Logistic regression analysis was used to predict treatment-related adverse events, Cox regression was used for survival outcomes, and receiver operating characteristic curve analysis was used to determine optimal cutoff values. There was a significant association between low prognostic nutritional index (PNI) and nCRT toxicities and survival. Advanced cancer stage, high platelet-to-lymphocyte ratio, and occurrence of pneumonia/infection were linked to survival outcomes. PNI shows promise in predicting prognosis, helps identify high-risk patients, and enables nurses to apply tailored interventions.

Periodic mobile application (eMOM) with self-tracking of glucose and lifestyle improves treatment of diet-controlled gestational diabetes without human guidance: a randomized controlled trial

Digitalization with minimal human resources could support self-management among women with gestational diabetes and improve maternal and neonatal outcomes. This study aimed to investigate if a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes among women with diet-controlled gestational diabetes without additional guidance from healthcare personnel. Women with gestational diabetes were randomly assigned in a 1:1 ratio at 24 to 28 weeks' gestation to the intervention or the control arm. The intervention arm received standard care in combination with use of the periodic eMOM, whereas the control arm received only standard care. The intervention arm used eMOM with a continuous glucose monitor, an activity tracker, and a food diary 1 week/month until delivery. The primary outcome was the change in fasting plasma glucose from baseline to 35 to 37 weeks' gestation. Secondary outcomes included capillary glucose, weight gain, nutrition, physical activity, pregnancy complications, and neonatal outcomes, such as macrosomia. In total, 148 women (76 in the intervention arm, 72 in the control arm; average age, 34.1±4.0 years; body mass index, 27.1±5.0 kg/m2) were randomized. The intervention arm showed a lower mean change in fasting plasma glucose than the control arm (difference,-0.15 mmol/L vs-2.7 mg/mL; P=.022) and lower capillary fasting glucose levels (difference,-0.04 mmol/L vs-0.7 mg/mL; P=.002). The intervention arm also increased their intake of vegetables (difference, 11.8 g/MJ; P=.043), decreased their sedentary behavior (difference,-27.3 min/d; P=.043), and increased light physical activity (difference, 22.8 min/d; P=.009) when compared with the control arm. In addition, gestational weight gain was lower (difference,-1.3 kg; P=.015), and there were less newborns with macrosomia in the intervention arm (difference,-13.1 %; P=.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (P=.0006) and postprandial glucose levels (P=.017), weight gain (P=.028), intake of energy (P=.021) and carbohydrates (P=.003), and longer duration of the daily physical activity (P=.0006). There were no significant between-arm differences in terms of pregnancy complications. Self-tracking of lifestyle factors and glucose levels without additional guidance improves self-management and the treatment of gestational diabetes, which also benefits newborns. The results of this study support the use of digital self-management and education tools in maternity care.

The Concept of Sustainable Eco-Urban Settlement in Yogyakarta Peri-urban Area Regarding to Public Health Prevalence Reduction Efforts

Settlement quality has always been a concern in development issues in Indonesia. Humans as residents who live in a settlement act as subjects and objects in development so the role of humans in the quality of settlements is also closely related. Settlement quality is one of the goals of the Sustainable Development Goals (SDGs), more precisely, the 11th goal which aims to make cities and settlements inclusive, safe, resilient, and sustainable. The general problem related to the quality of settlements is that most areas still have inadequate quality settlements and the density of existing settlements exceeds the carrying capacity and carrying capacity of the environment. This can affect the decline in environmental quality in these settlements. Diseases that occur due to environmental conditions can occur due to interactions between humans, human behavior, and the environment in which they live that have the potential to transmit disease. Poor residential environmental conditions will increase the risk of environmental-based disease transmission. One of the common environmental-based diseases that occurs in settlements is leptospirosis which is usually caused by poor environmental sanitation conditions and the presence of rats. Poor environmental conditions will indirectly affect the health conditions of residents, such as mothers and children in the house. Poor maternal and child health creates opportunities for stunting to occur. Stunting is a nutritional status outcome that occurs when a child has a height of less than −2.0 standard deviation (SD) compared to the population average.

Teaching critical thinking in nutritional sciences: a model course and assignments.

Critical thinking is a common and important learning outcome in college curricula. Case-based and problem-based learning can be used to assess and foster critical thinking skills. HNF 250-Contemporary Issues in Human Nutrition is a critical thinking course developed during the redesign of a nutritional sciences major program. Course assignments were designed to assess the course and nutritional sciences major learning outcomes. The nutrition and health claim assignment is scaffolded across the academic semester as three assignments: 1) bibliography assignment; 2) poster presentation; and 3) paper. Course lectures and materials have been designed to prepare students for completion of each assignment. The assignments have been modified over time based on classroom observations and student performance. In 2021, the course learning outcomes were examined by assessing several assignments including the nutrition and health claim poster and paper. Course learning outcome benchmarks using these assessments generally included 80% of students achieving an 80% for each criterion. Results revealed that students were not meeting most of these assessment benchmarks during the 2021 iteration, although benchmark data from other course assessments were more satisfactory. It is possible that the transition from a virtual to an in-person format negatively influenced student performance on these course learning outcomes. This course and the nutrition and health claim assignment example can provide a course design and learning outcome assessment framework for other higher education critical thinking courses.NEW & NOTEWORTHY This paper describes how a scaffolded nutrition and health claim assignment is used to teach critical thinking skills among nutritional sciences students and examine the program's learning outcomes. Further, this course example is to serve as an model for STEM majors on how to incorporate case-based and problem-based learning strategies into an undergraduate course.

Factors Associated with the Nutritional Status of Mechanically Ventilated Patients in Intensive Care Unit: A Cross Sectional Study

Background: Nutritional status significantly impacts the outcomes of critically ill patients in intensive care units (ICU), with malnutrition being a common complication that can exacerbate morbidity and mortality rates. The Nutrition Risk in the Critically ill (NUTRIC) score is a valuable tool for identifying patients at risk of malnutrition and guiding nutritional interventions. Objective: This study aimed to evaluate the factors influencing the nutritional status, as assessed by the NUTRIC score, of mechanically ventilated patients in ICUs across tertiary care hospitals, and to explore the association between nutritional risk and patient outcomes. Methods: A cross-sectional descriptive study was conducted in five tertiary care hospitals in Khyber Pakhtunkhwa, Pakistan, from August to December 2023. The study included patients aged 18 and above, who were mechanically ventilated for more than 48 hours. The NUTRIC score was calculated based on data collected on demographics, clinical characteristics, and laboratory investigations. Multiple linear regression analysis was performed to identify factors affecting the NUTRIC score using SPSS version 25. Results: Out of 335 patients, 75.2% were male, and 51.3% were aged between 50-75 years. A high NUTRIC score (indicating higher risk of malnutrition) was found in 25% of patients, while 74.9% had a low NUTRIC score. Factors significantly affecting the NUTRIC score included ventilation status (invasive/non-invasive), number of comorbidities, age, status of life (alive/deceased), and length of stay in ICU. The mortality rate was 3.9%, with a higher prevalence in older age groups. Conclusion: The study highlights the prevalence of nutritional risk among mechanically ventilated ICU patients and underscores the importance of early nutritional assessment and intervention. Targeted nutritional support, especially for patients with higher risk profiles, is crucial for improving outcomes and reducing mortality rates in this vulnerable population.

Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study.

The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support. A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization. A total of 261 patients were evaluated, with a median age of 61.0 (49.0-69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass. There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.

The application of enhanced recovery after surgery protocol after distal gastrectomy for patients with gastric cancer: a prospective randomized clinical trial

BackgroundThis study aimed to evaluate the clinical outcomes and efficacy of enhanced recovery after surgery (ERAS) protocol in patients undergoing distal gastrectomy for gastric cancer (GC). MethodsPatients were randomly assigned to the ERAS group (EG) and the conventional care group (CG) by stratified randomization according to age and sex. The primary endpoint was adjusted postoperative hospital stay, calculated using discharge criteria developed to evaluate recovery. Nutritional data and quality of life (QoL) (European Organisation for Research and Treatment of Cancer [EORTC] C30 and STO22) during the perioperative period were also analyzed. ResultsWe enrolled 198 eligible patients with GC for the study between June 2017 and January 2019. A total of 147 patients were finally enrolled in this study (full analysis set) and were assigned to EG (n = 71) and CG (n = 76). First flatus was faster significantly in EG (3.6 ± 1.5 vs 4.1 ± 1.2 days, P = .019). EG showed a faster start of the sips and soft diet than CG (1.3 ± 0.7 vs 3.1 ± 0.4 days, P < .001; 2.4 ± 0.9 vs 5.2 ± 0.7 days, P < .001) according to the protocol. The recorded hospital stay was not significantly different; however, adjusted hospital stay was significantly shorter in EG than in CG (6.5 ± 3.1 vs 7.8 ± 2.1 days, P = .005). There was no difference in morbidity, and no mortality occurred in both groups. EG did not show significant superiority in nutritional outcome and QoL improvement, except for pain scale in EORTC-STO22. ConclusionThe application of the ERAS protocol could reduce the adjusted hospital stay without an increase in postoperative complications. There was no significant difference in long-term nutritional outcome and QoL of the 2 groups.

Changes in Nutritional Intake, Body Composition, and Handgrip Strength in Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Retrospective Study

Patients who undergo autologous hematopoietic stem cell transplantation (autoHSCT) often experience reduced oral intake and wasting. We examined their daily nutritional intake, assessed alterations in body composition and muscle strength, and explored associations between decreased nutritional intake and treatment outcomes. This retrospective study included 64 patients. Their food record charts and parenteral nutrition (PN) prescriptions from medical records were used to assess nutritional intake. Body composition and handgrip strength data were obtained from dietitian records. Patients consumed >75% of their nutritional requirements through an oral diet in 6.7 days, 50–75% in 4.8 days, 25–50% in 5.0 days, and <25% in 3.1 days. The average oral intake was 62% of the requirement and was partially supplemented with PN. Patients experienced a mean decrease in body weight of 2.9 ± 3.0 kg, with 2.3 ± 3.4 kg of lean mass, and a mean reduction in handgrip strength of 3.5 ± 3.6 kg. We found a positive correlation of caloric deficits with weight loss and handgrip strength reduction and negative correlation with time to neutrophil engraftment and duration of hospitalization. This study highlighted a notable reduction in oral nutritional intake following autoHSCT. While caloric deficits might affect outcomes, further investigation is warranted to explore this observation.

Nutrition and outcomes in venovenous extracorporeal membrane oxygenation: An observational cohort study.

Overfeeding and underfeeding are associated with negative outcomes during critical illness. The purpose of this retrospective study was to assess the association between nutrition intake and outcomes for patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO). Adults who received VV ECMO August 2017 to June 2020 were screened. Patients with <3 ECMO nutrition support days were excluded. Age, sex, height, weight, ideal body weight (IBW), body mass index, sequential organ failure assessment score, respiratory ECMO survival prediction score, energy, and protein goals were collected. All nutrition intake was collected for the first 14 days of ECMO or until death, decannulation, or oral diet initiation. Outcomes analyzed included mortality and VV ECMO duration. The relationship between nutrition delivery and outcomes was tested with multivariate analysis. Univariate analyses were conducted on obese and nonobese subgroups. A total of 2044 nutrition days in 178 patients were analyzed. The median estimated needs were 24 (interquartile range: 22.3-28.3) kcal/kg/day and 2.25 (interquartile range: 2.25-2.77) g/kg/day of protein using IBW in patients with obesity and actual weight in patients without obesity. Patients received 83% of energy and 63.3% of protein targets. Patients with obesity who received ≥2 g/kg IBW of protein had a significantly shorter ECMO duration (P = 0.037). Increased protein intake was independently associated with a reduced risk of death(odds ratio: 0.06; 95% confidence interval: 0.01-0.43). Higher protein intake was associated with reduced mortality. Optimal energy targets for patients receiving ECMO are currently unknown and warrant further study.

Partial substitutions of animal with plant protein foods in Canadian diets have synergies and trade-offs among nutrition, health and climate outcomes.

Dietary guidelines emphasize the consumption of plant protein foods, but the implications of replacing animal with plant sources on a combination of diet sustainability dimensions are unknown. Using a combination of data from a national nutrition survey, greenhouse gas emissions from dataFIELD and relative risks from the Global Burden of Disease Study 2017, we assess the impact of partially substituting red and processed meat or dairy with plant protein foods in Canadian self-selected diets on nutrition, health and climate outcomes. The substitutions induced minor changes to the percentage of the population below requirements for nutrients of concern, but increased calcium inadequacy by up to 14% when dairy was replaced. Replacing red and processed meat or dairy increased life expectancy by up to 8.7 months or 7.6 months, respectively. Diet-related greenhouse gas emissions decreased by up to 25% for red and processed meat and by up to 5% for dairy replacements. Co-benefits of partially substituting red and processed meat with plant protein foods among nutrition, health and climate outcomes are relevant for reshaping consumer food choices in addressing human and planetary health.

Systemic Inflammation Response Index and weight loss as prognostic factors in metastatic pancreatic cancer: A concept study from the PANTHEIA-SEOM trial.

The prognostic value of the Systemic Inflammation Response Index (SIRI) in advanced pancreatic cancer is recognized, but its correlation with patients´ nutritional status and outcomes remains unexplored. To study the prognostic significance of SIRI and weight loss in metastatic pancreatic cancer. The PANTHEIA-Spanish Society of Medical Oncology (SEOM) study is a multicentric (16 Spanish hospitals), observational, longitudinal, non-interventional initiative, promoted by the SEOM Real World-Evidence work group. This pilot study sought to analyze the association between weight loss and inflammatory status as defined by SIRI. The cohort stems from a proof-of-concept pilot study conducted at one of the coordinating centers. Patients with pathologically confirmed metastatic pancreatic adenocarcinoma, treated from January 2020 to January 2023, were included. The index was calculated using the product of neutrophil and monocyte counts, divided by lymphocyte counts, obtained within 15 days before initiation chemotherapy. This study evaluated associations between overall survival (OS), SIRI and weight loss. A total of 50 patients were included. 66% of these patients were male and the median age was 66 years. Metastasis sites: 36% liver, 12% peritoneal carcinomatosis, 10% lung, and 42% multiple locations. Regarding the first line palliative chemotherapy treatments: 50% received gemcitabine plus nab-paclitaxel; 28%, modified fluorouracil, leucovorin, irinotecan and oxaliplatin, and 16% were administered gemcitabine. 42% had a weight loss > 5% in the three months (mo) preceding diagnosis. 21 patients with a SIRI ≥ 2.3 × 103/L exhibited a trend towards a lower median OS compared to those with a SIRI < 2.3 × 103/L (4 vs 18 mo; P < 0.000). Among 21 patients with > 5% weight loss before diagnosis, the median OS was 6 mo, in contrast to 19 mo for those who did not experience such weight loss (P = 0.003). Patients with a weight loss > 5% showed higher SIRI levels. This difference was statistically significant (P < 0.000). For patients with a SIRI < 2.3 × 103/L, those who did not lose > 5% of their weight had an OS of 20 mo, compared to 11 mo for those who did (P < 0.001). No association was found between carbohydrate antigen 19-9 levels ≥ 1000 U/mL and weight loss. A higher SIRI was correlated with decreased survival rates in patients with metastatic pancreatic cancer and associated with weight loss. An elevated SIRI is suggested as a predictor of survival, emphasizing the need for prospective validation in the upcoming PANTHEIA-SEOM study.

Nutritional status and treatment outcomes of tuberculosis in Mizan Tepi University Teaching Hospital, a five -year retrospective study.

Public health problems related to tuberculosis (TB) remain substantial globally, particularly in resource-limited countries. Determining TB treatment outcomes and identifying contributing factors are the basic components of the TB control strategy. In Ethiopia, different studies have been done on treatment outcomes and multiple associated factors, and there is also a little information on the effect of nutritional status on TB treatment outcomes. So there is a need for comprehensive research that examines the combined effects of multiple factors along with nutritional status. A five-year institution-based retrospective cross-sectional study was conducted at Mizan Tepi University Teaching Hospital, South West Ethiopia. This study included all tuberculosis patients who were documented in the TB registration and had known treatment outcomes at the treatment facility between January 1, 2016, and December 31, 2020. Data was collected through a pretested structured data extraction checklist. Data were entered into Epidata version 3.1 and analyzed through SPSS version 22. Multiple logistic regression was employed to assess the association between dependent and independent variables. A p-value of less than 0.05 was considered statistically significant. Of the total 625 TB patients, 283 (45.3%), 175 (28%), and 167 (26.7%) had smear-positive, extra-pulmonary, and smear-negative tuberculosis, respectively. The majority of study participants had normal weight (62.2%), were in the age group of 15-44 (67.4%), were new cases (73.8%), and were from urban areas (69.4%). About 32.2% of cases were HIV-positive. The overall unsuccessful treatment rate was 25%. From the total unsuccessful treatment rates, the highest proportion was a death rate of 90 (14.4%), followed by a treatment failure of 56 (9%). Being female (AOR = 1.7, 95% CI: 1.2-2.5), HIV positive (AOR = 2.7, 95% CI: 1.9-4.1), undernutrition (BMI<18.5kg/m2) (AOR = 1.9, 95% CI: 1.3-2.9), and smear-negative pulmonary TB (AOR = 1.6, 95% CI: 1-2.5) were independent predictors of unsuccessful treatment outcomes. The treatment success rate in the study area is very poor. Poor treatment outcomes were associated with undernutrition, female gender, HIV positivity and smear-negative pulmonary TB. So, continuous and serious supervision and monitoring of directly observed treatment short course (DOTS) program accomplishment, early detection of HIV and TB, prompt anti TB and antiretroviral treatment initiation and adherence, enhanced nutritional assessment, and counseling services need to be strengthened to improve treatment outcomes.

Dietary Practices of Caregivers to Children Aged 6 to 23 Months at Narok County Referral Hospital, Kenya

In Narok County, Kenya, where the challenge of achieving optimal child nutrition persists, particularly in the context of its arid and semi-arid climate, the prevalence of stunting among children is alarmingly high compared to other regions. Addressing this critical issue necessitates an enhancement of caregivers’ dietary practices. A gap in dietary practices among caregivers of children aged 6 to 23 months extends beyond Narok County to encompass broader regions in Africa, including Kenya. Consequently, this study was designed to establish the dietary practices of caregivers within Narok County for children in this age group. All approvals including ethical clearance from the Kabarak University Research and Ethics Committee (KUREC), a research permit from NACOSTI, and a permit from Narok County Referral Hospital were sought before the commencement of the study. This research adopted a descriptive cross-sectional design and a sample size of 108 children aged 6 to 23 months and caregivers were purposively recruited. Data were analysed using SPSS version 25 and ENASMART soft wares. Findings indicate a variation in dietary practices where 68.5% of children were still breastfeeding at the time of data collection; 88% of children were exclusively breastfed during the first 6 months of age. Cereals were consumed more than four times a week by 85.2% of the children although the majority of them (76.9%) did not meet the minimum dietary score. The overall prevalence of wasting, underweight and stunting was 29.6%,15.7%, and 23.1% respectively. The occurrence of stunting in children was related to dietary practices (χ0.245=2, p-value=0.011). The timing of complementary feeding displayed a moderate positive correlation with WAZ (r=0.305, p=0.001) and WHZ (r=0.047, p=0.627). In conclusion, caregivers’ dietary practices varied across the caregivers and contributed to the nutrition outcome of the children in dietary diversity, food adequacy, and nutrient intake. There need to promote proper responsive feeding practices among caregivers to children of this age group.

The presence of enteropathy in HIV infected children on antiretroviral therapy in Malawi.

Undernutrition and malnutrition in children in low- and middle-income countries contribute to high mortality rates. Stunting, a prevalent form of malnutrition, is associated with educational and productivity losses. Environmental enteric dysfunction (EED) and human immunodeficiency virus (HIV) infection worsen these conditions. This study seeks to investigate the presence of enteropathy using EED fecal biomarkers in HIV-infected children who are stable on antiretroviral therapy (ART) across various nutritional statuses. By understanding the interplay between EED, HIV, and nutritional status, this study aims to provide insights that can inform targeted interventions to optimize nutritional outcomes in HIV infected children. This study evaluated the levels of alpha-1-antitrypsin, calprotectin and myeloperoxidase in frozen fecal samples from 61 HIV infected (mean age 9.16 ±3.08 years) and 31 HIV uninfected (6.65 ±3.41 years) children in Malawi. Anthropometric measurements and clinical data were collected. The height-for-age z-score (-1.66 vs -1.27, p = 0.040) and BMI-for-age z-score (-0.36 vs 0.01, p = 0.037) were lower in HIV infected children. Enzyme-linked immunosorbent assays were used to measure biomarker concentrations. Statistical tests were applied to compare biomarker levels based on HIV status and anthropometric parameters. Myeloperoxidase, alpha-1-antitrypsin, and calprotectin concentrations did not differ between HIV infected and HIV uninfected children of different age groups. In HIV infected children from 5-15 years, there is no difference in biomarker concentration between the stunted and non-stunted groups. Our study found a higher prevalence of stunting in HIV infected children compared to uninfected children, but no significant differences in biomarker concentrations. This suggests no causal relationship between enteropathy and stunting in HIV infected children. These results contribute to the understanding of growth impairment in HIV infected children and emphasize the need for further research, particularly a longitudinal, biopsy-controlled study.

The effect of women's decision-making on child nutritional outcomes in South Africa

Women’s decision-making is a phenomenon in children's nutritional outcomes. This study investigated the causal effect of women’s decision-making on child nutritional outcomes using a panel dataset from the South African National Income Dynamic Survey (NIDS) from 2014/15–2017. The child's nutritional outcomes comprised three anthropometric measurements, which included weight-for-height, weight-for-age, and height-for-age. The study used variables, which include daily expenditure, large purchases, where children attended school, who lived with the family, and where the household lived, to create a decision-making index using Multiple Correspondence Analysis (MCA). A control function approach (CFA) was used to control for endogeneity issues. Using this approach, the findings suggested that women’s decision-making had a significant positive effect on the child's nutritional outcomes. While women's decision-making improves a child’s weight-for-age and weight-for-height, the result was inconclusive on the child’s height-for-age. The policy implications of these findings indicate that the role of women's empowerment is important and could significantly help in achieving better child nutritional outcomes. Overall, the findings suggest the evaluation of policies that ameliorate gender inequality and children's health and well-being.