Nutritional Outcomes Research Articles

How Kinship and Marriage Customs Influence Nutritional Outcomes Among Males and Females

How Kinship and Marriage Customs Influence Nutritional Outcomes Among Males and Females

Extensively hydrolysed formula improves nutritional outcomes and decreases gut complication risk in infants with complex congenital heart disease

Extensively hydrolysed formula improves nutritional outcomes and decreases gut complication risk in infants with complex congenital heart disease

Creating and Assessing the Nutritional and Physicochemical Properties of Millet Based Composite Mixed Complementary Food: An Innovative Approach

The study developed millet-based composite complementary mixes in the form of convenience foods for children, as cost effective and easy approaches that offer variety, convenience and quality food that combat micro nutrient deficiencies. A complete randomized designed was used for the experiment. The household recipes with supplementation of nutrients rich food sources: millet, toasted soybean and sesame seeds flour samples were blended at the ratios of 6:2:1 while cray fish, orange flesh sweet potatoes, dried moringa leaves and baobab fruit pulp were supplemented at the ratio 2:1:1:1 using varying proportions 10% (MBF), 15% (MCF), 20% (MDF) respectively while millet alone served as control (MAF).Functional properties (bulk density, water and oil absorption capacity, swelling capacity) and proximate composition, micro nutrient composition were carried out on the individual flour samples. The proximate composition of flour samples showed increased in crude protein from 9.13±0.09 to 14.21±0.13, fat content 5.38±0.09 to 7.79±0.08, fibre from 3.05±1.03 to 5.68±2.43, ash from 2.17±0.79 to 3.41±0.42. There was decreased moisture content from 10.71±0.42to 7.61±0.25 and carbohydrates from 69.56±0.40to 61.65±0.28%. There was an increase in the micro nutrient composition with increasing incorporation level of other flours. The sensory evaluation revealed 15% (MCF) menu showed promising results, presenting a high level of acceptance and good protein digestibility (85.98%). These results suggest significant potential for development opportunities that enhanced dietary diversification and improved nutritional outcomes of malnourished children.

The performance of Indian States and Union Territories on Global Nutrition Targets: A rank-based analysis using a composite nutrition index

Background 
 The increased global discourse on nutrition challenges has underscored the imperative to comprehend and monitor diverse manifestations of malnutrition. The comprehensive monitoring of various forms of malnutrition, including undernutrition, overnutrition, and micronutrient deficiencies, plays a pivotal role in assessing the progress towards the Global Nutrition Targets (GNTs) established by the World Health Assembly (WHA), as well as nutrition-related SDGs (SDGs). To this end, a Composite Index (CI) of six nutrition indicators centred on GNTs has been formulated to gauge and appraise progress across India’s various States and Union Territories (UTs).
 Methods 
 To calculate the CI, the authors apply a methodology developed by Webb et al. (2015). Disparities in performance between Indian States and UTs are highlighted. The analysis uses data from two surveys: the National Family Health Survey (NFHS) of 2015-16 and the NFHS of 2019-21. The main analytical tool is a rank-order analysis of the CI scores among states and union territories, with higher scores representing greater progress in achieving the targets for the six indicators.
 Results 
 Based on data from both NFHS-4 and NFHS-5, India’s overall estimated CI-WHA score stood at 2.80 and 2.86, respectively. Notably, the CI-WHA exhibited considerable inter-State/UT variation, ranging from 2.16 in Dadra and Nagar Haveli and Daman and Diu to 5.07 in Manipur, as per NFHS-4, and from 2.14 in Gujarat to 5.25 in Manipur, as per NFHS-5. Among the 34 States/UTs for which complete data sets for all six WHA targets were available from NFHS-4, the top five performers according to the developed CI-WHA targets were Manipur (5.07), Mizoram (4.87), Nagaland (4.12), Kerala (4.00), and Telangana (3.80). In contrast, the bottom five States/UTs based on NFHS-4 data were Dadra and Nagar Haveli and Daman and Diu (2.16), Uttar Pradesh (2.31), Meghalaya (2.40), Haryana (2.40) and Madhya Pradesh (2.43). However, based on NFHS-5 data, the top five States/UTs were Manipur (5.25), Mizoram (4.29), Puducherry (UT) (4.15), Goa (3.89), and Kerala (3.87), while the bottom five were Gujarat (2.14), Tripura (2.16), West Bengal (2.20), Bihar (2.31), and Assam (2.46).
 Conclusions 
 Applying the CI to monitor States/UTs’ progress in reaching WHA targets. Furthermore, it offers a means to track the progress made on nutrition-related SDGs at the sub-national level. This can help identify States/UTs whose nutrition policies and programs require targeted enhancements to comprehensively improve India’s performance concerning GNTs. It aims to empower policymakers with the information required to make informed decisions and implement effective measures to enhance overall nutrition outcomes, especially in under-performing States/UTs.

Addressing Program Sustainability: A Time Series Analysis of the Supplemental Nutrition Assistance Program in the US

Food stamps, or, more formally, the Supplemental Nutrition Assistance Program (SNAP), form a crucial support system for many individuals in the United States. The welfare benefit has been associated with improved nutritional outcomes, making it an effective strategy to address hunger. Additionally, it has been found to enhance labour market outcomes for recipients and contribute to higher birth weights among children born to SNAP recipient mothers. Furthermore, it has been linked to improved height and overall health outcomes. Overall, this benefit is a crucial resource during times of need and helps mitigate the adverse effects of economic fluctuations. Even with the manifold advantages of the program, there exist notable apprehensions about the program’s long-term viability. SNAP has experienced significant expansion over more than 50 years. The recipients grew more than 14 times, from approximately 2.9 million individuals in 1969 to over 41 million in 2022. This study utilizes data from the United States Department of Agriculture to investigate the temporal characteristics of this massive expansion. Augmented Dickey-Fuller tests are performed with and without trend and optimally selected lag lengths. In all specifications, the presence of a unit root cannot be rejected. An overwhelming body of evidence suggests that the growth in SNAP beneficiaries may need to be revised. Results of the unit root tests provide credence to the argument that the historical growth rate in the number of SNAP beneficiaries is highly unpredictable and may pose significant challenges to policymakers. This study does not attempt to calculate fraud and abuse in the program. Neither does the study attempt to ascertain the number of beneficiaries that may not be worthy of receiving the benefits.

Determinants of nutritional outcome among beneficiaries of Nutrition Rehabilitation Centre

Background: Under Mission Balam Sukham, children of 6 months to 5 years having severe acute malnutrition (SAM) along with complications are managed at Nutrition Rehabilitation Centre (NRC). They are admitted for 14 days with the provision of a nutritional diet and medicines. Objectives: To explore determinants of nutritional outcome of SAM children admitted at NRC Methods: A prospective cohort study was conducted comprising 63 children aged 6 months to 5 years having SAM along with complications admitted at NRC of New Civil Hospital, Surat (NCHS) for 10 months. Results: The majority of participants were boys (54%), 12-23 months of age (50.8%), and Grade III socioeconomic class (39.6%). The duration of stay ranged from 2-36 days. The average duration of stay was 12.78 + 6.49 days; 14.26 ± 5.99 days for boys and 11.10 + 6.73 for girls. 18.8% stayed at NRC for 14 days. The average weight gain was 5.46 g/kg/day. A significant improvement in weight was seen in boys (t=2.20, p<0.05), working mothers (t=2.44, p<0.01), exclusively breastfed children (t=3.62, p<0.01) of 6-11 months, full-term children of 12-23 months (t=4.0, p<0.05). The children of 12-23 months (t=2.90, p<0.01) and boys (t=2.15, p<0.05) showed significant improvement in underweight (WAZ). Wasting improved significantly in age below 36 months (p<0.05). 20.6% could achieve the target weight. Conclusion: NRC is an effective life-saving modality for malnutrition but its outcome is associated with factors like boys, exclusive breastfeeding, and full-term.

Impact of Nikshay Poshan Yojana on tuberculosis outcomes: preliminary evidence from eastern India

Background: National TB programme of India implemented Nikshay Poshan Yojana (NPY) through direct benefit transfer (DBT) in April 2018. This is to address the dual evils of under nutrition and unfavourable outcomes among tuberculosis patients in the country. This study aimed to understand the impact of Nikshay Poshan Yojana (NPY) through direct benefit transfer (DBT) on the outcomes of notified TB patients from the Indian state of Jharkhand for the year 2019. Methods: This was a retrospective cross sectional descriptive study using secondary data obtained from Nikshay web portal for the Indian state of Jharkhand for the year 2019. State level data on TB notification and NPY DBT scheme was downloaded in excel format and analysed using Excel 2016 version. Results: The study found higher odds (odds ratio 3.14, 95% CI: 2.97, 3.33; p value <0.00001) of having successful outcomes, among those who received at least one instalment of NPY. The risk of lost to follow up (LTFU) was 2.44 times (95% CI: 2.2-2.8, p value: 3.9×10-43) higher among those who did not receive any DBT payments as compared to those who received at least one DBT instalment. Conclusions: The ‘individual and health system enablers’ have a crucial role to play in successful TB treatment outcomes than NPY. However, LTFU rate reduces significantly with timely payment of NPY. This would facilitate improved treatment adherence and thus a favourable outcome.

Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia

ObjectiveChild malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. MethodsTo explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. ResultsThis study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. ConclusionsThis paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.

Comparative evaluation of different types of gastric conduits used for single-stage reconstruction during oesophageal cancer esophagectomy. Review

In the treatment of local and local‑regional oesophageal cancer, esophagectomy takes centre stage. It is a complex procedure with a high rate of postoperative complications. There are different methods for oesophageal reconstruction, including colon interposition, supercharged jejunal interposition, and gastric pull‑up. Each has both advantages and disadvantages. However, a gastric graft is the preferred option due to the less traumatic nature of the operation. Currently, there are different methods for forming a gastric graft. Gastric conduits are classified based on their shape and can be categorised as whole‑stomach, sub‑total stomach, or gastric tube. Previous research on the functional characteristics of gastric conduits revealed that the most effective solution is a typical gastric tube. Due to its width (3—6 cm), the gastric tube limits its impact on lung movement within the pleural cavity, hence decreasing the incidence of postoperative respiratory complications (e.g., pneumonia). Pulmonary complications and anastomotic leaks are the main contributing causes of postoperative morbidity and mortality after esophagectomy. Other complications include technical and functional issues, as well as delayed problems such as anastomotic strictures and disease recurrence. However, the rate of complications remains between 20 and 80%, prompting oncologic surgeons to develop new methods for gastric conduit formation. Over the past 5 years, innovative methods using a special‑shaped gastric tube have been suggested. They appear to decrease the incidence of postoperative complications and enhance nutritional outcomes. This study aimed to evaluate the advantages of using special‑shaped gastric tubes in clinical practice as opposed to whole‑stomach and typical gastric tubes.

Place of Residence Is Associated with Dietary Intake and BMI-SDS in Children and Adolescents: Findings from the DONALD Cohort Study.

We aimed to determine whether place of residence in the German urban food environment is associated with habitual dietary intake (energy, macronutrients, and food groups) and body mass index (standard deviation score of BMI and BMI-SDS). Our hypothesis was that place of residence may explain some variation in dietary intake and nutritional outcomes. For the cross-sectional analyses of DONALD study data, we grouped participants according to their geocoded residence in the north or south of Dortmund. We applied robust multi-level mixed effects regression models using residence as a predictor and (1) BMI-SDS or (2) dietary data (daily intake of energy (kcal), macronutrients (energy percentage), or food groups (g/1000 kcal)) as the outcome. Models were adjusted for age, sex, and household socio-economic status. An analysis was carried out on 1267 anthropometric measurements collected annually from 360 participants aged 6-18 years (935 3-day weighed dietary records from 292 participants) between 2014 and 2019. In the fully adjusted models, residence in the south was associated with a lower BMI-SDS (β = -0.42, p = 0.02), lower intake of sugar-sweetened beverages (β = -47.00, p = 0.04), and higher intake of vegetables (β = 11.13, p = 0.04). Findings suggest that the place of residence, beyond individuals' socio-economic statuses, may be a contributing factor to dietary quality.

Promoting Health Nutrition: Strategies for Reducing Malnutrition and Improving Overall Health

Malnutrition still poses a serious threat to world health and has far-reaching effects on both individuals and societies. The objective of this study is to objectively evaluate and assess the efficacy of various approaches used to combat hunger and promote healthy nutrition on a worldwide scale. We used a mixed-methods approach to gather quantitative and qualitative information from a variety of demographics, including kids, teens, adults, and elderly people, in order to evaluate their nutritional health and the prevalence of malnutrition. The prevalence of stunting and wasting among children under the age of five was found to be alarming, highlighting the urgent need for focused interventions to enhance child nutrition. The study also brought attention to the dual effects of malnutrition, with considerable rates of undernutrition and overnutrition seen across a range of age groups. Programs for nutrition education have been demonstrated to be helpful at raising participants' nutrition-related knowledge and encouraging healthier eating habits. Initiatives to fortify foods have shown promise in treating micronutrient deficiencies, and improvements to agriculture and food production have had a favorable influence on the variety and accessibility of food. Programs for maternal and child health made a significant contribution to the decrease in stunting and low birth weight by highlighting the value of comprehensive prenatal care in ending the cycle of malnutrition. The study emphasizes the need for context-specific and evidence-based measures to combat malnutrition and promote healthy nutrition, offering insightful information for decision-makers in healthcare and policy. We may endeavor to find lasting and fair solutions to this global health issue by utilizing effective tactics and resolving constraints. In order to enhance nutrition outcomes and general health on a larger scale, more study is needed to examine the cost-effectiveness and long-term effects of interventions.

Relationship between nutritional status and clinical outcomes among older individuals using long-term care services: A systematic review and meta-analysis

Nutritional status is a significant issue in an aging society; however, the impact of the nutritional status of older individuals using long-term care services on the caregiving burden remains unclear. This systematic review and meta-analysis aimed to investigate the impact of nutritional issues on adverse outcomes in older individuals using long-term care services. We used data from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science, CINAHL, and Ichu-shi Web databases. Original articles published in English or Japanese between January 2000 and July 2022 were included. The inclusion criteria were interventional and observational studies on individuals using long-term care services with aged ≥65 years and a focus on body weight or weight loss. Data on adverse outcomes related to caregiving burden, including the number of people requiring care, mortality, complications, activities of daily living (ADL), and quality of life, were collected. The literature search yielded 7873 studies, of which 35 were ultimately included. Seven observational studies investigated mortality outcomes, and seven examined ADL outcomes. The meta-analysis revealed significantly higher mortality rates in individuals classified as underweight (BMI <18.5kg/m2) than in those with BMI ≥18.5kg/m2 (risk ratio [RR] 1.49; 95% confidence interval [CI] 1.31 to 1.73, 0.22; I2 93%). Further, on categorising the participants based on a BMI cutoff of 25kg/m2, those with a BMI of <25kg/m2 had a significantly increased mortality rate (RR 1.21; 95% CI 1.04-1.40; I2=98%). BMI and weight loss did not affect ADL. Our findings indicate that underweight and weight loss are significantly associated with increased mortality in older individuals using long-term care services. Therefore, appropriate weight management is recommended for this population. However, further research is necessary owing to the high heterogeneity observed in this study.

Utjecaj moći odlučivanja žena na status uhranjenosti ruralne djece u državi Ogun u Nigeriji

Women's authority over specific family decisions tends to increase their financial security and power, which has an impact on their children's general health and well-being. A multistage sampling process was employed to choose 120 households. Primary data on the children's nutritional status, the household's socioeconomic characteristics, and women decision making were gathered using a well-structured questionnaire. The children's mean body mass index was 9.62 kg/m2, indicating underweight. It was also demonstrated that women had little influence over the quantity of farm produce consumed or sold, nor the number and spacing of their children. On the other hand, rural women make decisions about the daily diet of the home, the education of the children, the kind of medical assistance the child receives while ill, and the amount of parental guidance the youngster receives. However, the women decision making index (WDMI) which measures the negotiating power of women was 0.537. With the age of the mother, gender of child, women decision making index, farm size, farmers association, and farming experience influencing the children nutritional status. Therefore, as it tends to improve the nutritional outcomes for children, it is advised that women be given more control.

Comprehensive Care and Education Can Improve Nutritional and Growth Outcomes in Children with Persistent Cow's Milk, Egg, or Peanut Allergies: A Five-Year Follow-Up Study of Nutritional Status.

Data suggest that food allergies greatly impact a child's health and growth due to inadequate nutrient intake. Our study aimed to establish the long-term outcome of children with food allergies compared to a control group. This study was a retrospective cohort study with longitudinal follow-up with a mean period of 4.85 years from the diagnosis to the last study visit. The patients' nutritional intake was assessed using a three-day food diary and analysed by a dietitian. Patients (61 boys and 33 girls, mean age 6.9 years) had a single food allergy including 21 patients with cow's milk, 34 with egg, and 39 with peanut allergies. The control group included 36 children (19 boys and 17 girls, mean age 8.03 years). Blood analysis was performed on all participants. Data from our study showed that patients with cow's milk, egg or peanut allergies had normal growth and achieved catch-up growth from the diagnosis until the last study visit. In the cow's milk allergy group, the allergy was shown to affect calcium intake (p < 0.05), while egg and peanut allergies did not impact the dietary intake of nutrients. None of the investigated food allergies affected blood results (p < 0.05). In the present study, we showed that single food allergies do not compromise growth in children if they are provided with appropriate support and that the affected children reach catch-up growth from the diagnosis.

Extent of integration of nutrition assessment counselling and support interventions in the health system and respective drivers: A case of Tororo district, Uganda.

Uganda embraced Nutrition Assessment Counselling and Support (NACS) since 2009 as a health system strengthening approach to improve health and nutrition outcomes. However, scant evidence exists on NACS integration and drivers. This study therefore assessed the extent of NACS integration in the health system and identified key drivers and barriers. A mixed method design was employed. In a facilitated panel discussions at each of the 17 health facilities, 4-5 health staff participated, responding to a semi-structured questionnaire. Integration was assessed on a 5-point scoring scale of 1 for not done nor integrated, 2-4 for partial and 5 for fully integration. Data was captured, analysed in microsoft excel and presented using as bar and spider charts. Integration drivers were identified deductively from key informant and in-depth interviews using Atlas.ti 9 and thematic analysis. The NACS integration across the health facility level was partial at a score of 2.9 indicating a weak integration into the health system. Integration across the health system building blocks was partial at; service delivery (3.8), health work force (3.7), health information (3.3), community support system (3.0), governance and leadership (3.0) signifying that NACS activities are provided by Ministry of Health but sub-optimal due to weak capacities. Health financing (2.2) and Health supplies (1.5) were the least integrated due to partner dependence. Under service delivery, deworming (5) was fully integrated and provided by Ministry of Health. The key drivers for integration were; good leadership, financing, competent staff, quality improvement approaches, nutrition talks, community dialogues, nutrition logistics and supplies. The NACS integration in the health system was generally low and lacked adequate support. Governance, financing and community follow-up under service delivery require more government investment for enhanced integration.

Portal Hypertension in Malnutrition and Sarcopenia in Decompensated Cirrhosis-Pathogenesis, Implications and Therapeutic Opportunities.

Malnutrition and sarcopenia are highly prevalent in patients with decompensated cirrhosis and are associated with poorer clinical outcomes. Their pathophysiology is complex and multifactorial, with protein-calorie malnutrition, systemic inflammation, reduced glycogen stores and hormonal imbalances all well reported. The direct contribution of portal hypertension to these driving factors is however not widely documented in the literature. This review details the specific mechanisms by which portal hypertension directly contributes to the development of malnutrition and sarcopenia in cirrhosis. We summarise the existing literature describing treatment strategies that specifically aim to reduce portal pressures and their impact on nutritional and muscle outcomes, which is particularly relevant to those with end-stage disease awaiting liver transplantation.

Validation of selected 2021 infant and young child feeding indicators for appropriate complementary feeding in relation to dietary adequacy and anthropometric status

Introduction: With the new set of 2021 infant and young child feeding (IYCF) indicators released by WHO and UNICEF, there is a need for its validation in the Philippine setting. The study evaluated the validity of cut-off points used for minimum dietary diversity and minimum feeding frequency in terms of micronutrient and energy intake adequacy, respectively, and minimum acceptable diet (MAD) in relation to anthropometric status. Methods: The study covered 8360 infants and young children aged 6-23.9 months with complete information on IYCF, anthropometric measurements, maternal information, and household characteristics from the 2018-2019 Expanded National Nutrition Survey (ENNS). Bivariate and correlation analyses using STATA version 15 (Corp LLC, Texas, USA 2017) were performed to determine the association of specific IYCF indicators: dietary diversity and feeding frequency with nutrient and energy intake adequacy, and MAD with anthropometric status. Sensitivity and specificity analyses were performed to evaluate the accuracy of dietary diversity score (DDS) and feeding frequency in identifying children with adequate nutrient and energy intakes, respectively. Results: Significant associations were found between DDS and micronutrient adequacy, and between feeding frequency and energy intake adequacy, regardless of breastfeeding status. A DDS of 5 and 6 and feeding frequency of 4-5 and 8 maximised sensitivity and specificity in identifying breastfed and non-breastfed children meeting 100% nutrient and energy adequacy, respectively. Conclusion: The selected 2021 complementary feeding indicators are practical guidelines to reflect dietary adequacy, but may not capture the entire process related to nutritional outcomes, especially stunting.

The intergenerational effect of tuition-free lower-secondary education on children’s nutritional outcomes in Africa

ABSTRACT One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children’s nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.

Parenteral nutrition-related complications in older patients with acute intestinal failure: A descriptive cohort study.

Reported outcomes for parenteral nutrition (PN)-related complications in older adult patients with acute intestinal failure who are receiving PN in the acute hospital setting are limited. Our study aims to compare PN-related complications between older and younger adult patients. A retrospective descriptive study of inpatients who were administered PN from January 1, 2019, to December 31, 2019, was performed. Patients were categorized into older (≥65 years old) and younger (<65 years old) adult groups. Two hundred thirty-five patients were included. There were 103 patients in the older adult group (mean age: 73.9 [SD: 6.9] years) and 132 patients in the younger adult group (mean age: 52.4 [SD: 12.5] years). There was a significantly higher Charlson Comorbidity Index score and lower Karnofsky score in the older adult group. The older adult group received significantly lower total energy (20.8 [SD: 7.8] vs 22.8 [SD: 6.3] kcal/kg/day), dextrose (3.1 [SD: 1.4] vs 3.6 [SD: 1.4] g/kg/day), and protein (1.1 [SD: 0.4] vs 1.2 [SD: 0.3] g/kg/day) than the younger group received. The mean length of stay was significantly shorter in the older adult group (35.9 [SD: 21.3] vs 59.8 [SD: 55.3]; P < 0.05). There was no significant difference in PN-related complications and clinical outcomes (catheter-related bloodstream infections, hypoglycemia or hyperglycemia, fluid overload, or inpatient mortality) between the two groups. Despite more comorbidities in the older adult, the usage of PN in older adult patients with acute intestinal failure was associated with neither an increased rate of PN-related complications nor worse clinical outcomes when compared with that of younger patients.

Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China.

To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6 months (range: 3-40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (-0.56 (-1.47, 0.23) vs. -0.44 (-1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571-14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010-2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.