Prevalence Of Protein-energy Malnutrition Research Articles

Protein-energy malnutrition prevalence and influence on complications and outcome of severe stroke, requiring mechanical ventilation: a multicenter prospective observational trial

INTRODUCTION: Stroke is characterized by high prevalence and mortality. Protein-energy deficiency is a common syndrome in this category of patients, affecting the course and outcomes of cerebral stroke. OBJECTIVE: The purpose of the study was to analyze the prevalence and impact on the course and outcome of stroke of protein-energy deficiency in patients with mechanical ventilation. MATERIALS AND METHODS: A multicenter observational clinical study “Register of respiratory therapy in patients with stroke (RETAS)” was conducted under the auspices of the Russian Federation of Anesthesiologists and Reanimatologists. The study involved 14 centers, included 1289 acute stroke patients received respiratory support. RESULTS: Protein-energy deficiency in patients with stroke on mechanical ventilation was associated with a tendency to a greater risk of a lethal outcome (p = 0.0003). The absence of protein-energy malnutrition in patients with stroke severity less than 14 points during mechanical ventilation was associated with a greater likelihood of a positive outcome (Glasgow Outcome Scale, GOS 4 and 5) compared with patients with signs of malnutrition (p = 0.000002). Protein-energy malnutrition is associated with prolonged stay in ICU of patients with stroke on mechanical ventilation (p < 0.0001). At the same time, the group of patients with prolonged mechanical ventilation was characterized by a high prevalence of bedsores (p < 0.0001), hypoproteinemia, hypoalbuminemia (р = 0.0001), and decreased body weight 10 percent or more (p < 0.0001). The presence of protein-energy malnutrition was accompanied by an increased risk of ventilator-associated tracheobronchitis in patients with stroke (p < 0.0001). CONCLUSIONS: Protein-energy malnutrition significantly influences on the course and clinical outcome parameters of severe cerebral stroke patients on mechanical ventilation.

Health inequalities of global protein-energy malnutrition from 1990 to 2019 and forecast prevalence for 2044: data from the Global Burden of Disease Study 2019

ObjectivesProtein-energy malnutrition poses a serious medical problem worldwide. This study aims to describe the global burden, trends, and health inequalities of protein-energy malnutrition and forecasts for future prevalence. Study designThis was a comprehensive analysis based on data provided by the Global Burden of Disease Study 2019. MethodsData were obtained from the Global Health Data Exchange query tool, including prevalence, deaths, disability-adjusted life years (DALYs) and sociodemographic index (SDI). The estimated annual percentage changes were calculated to evaluate temporal trends. We quantified cross-country inequalities in protein-energy malnutrition burden and predicted the prevalence number and rate to 2044. ResultsGlobally, there were 147,672,757 (130,405,923 to 167,471,359) cases of protein-energy malnutrition in 2019, with 212,242 (185,403 to 246,217) deaths. Eastern Sub-Saharan Africa had the highest age-standardised death and DALY rates in 2019. From 1990 to 2019, the global age-standardised prevalence rate of protein-energy malnutrition showed an upward trend, while the age-standardised death rate showed a downward trend. A significant decline occurred in SDI-related health inequality, from 2126.1 DALYs per 100,000 persons between the poorest and richest countries in 1990 to 357.9 DALYs per 100,000 persons in 2019. There was a trend of decreasing age-standardised death and DALY rates along with increases in the SDI. Frontier analyses showed that there is much room for improving the current situation of protein-energy malnutrition in some countries. In the next 35 years, the prevalence of protein-energy malnutrition will continue to increase. ConclusionAlthough the disease burden of protein-energy malnutrition has greatly decreased since 1990 and health inequalities between countries are shrinking, the prevalence in Asian and African countries may continue to increase. Focussing on regional differences and strengthening the nutritional intake of people in underdeveloped areas are necessary to reduce future burdens.

Study of the feasibility of using an enriched product based on goat’s milk in the nutrition of vulnerable groups of the population

The diet of the majority of the adult population does not meet the principles of a healthy diet. Modifiable factors are associated with lifestyle and diet, which play an important role in the development of diseases. Sufficient intake of energy, protein and micronutrients from food serves as a prophylactic factor for a number of chronic non-communicable NCDs. Among all groups of the adult population, the most sensitive to unbalanced, deficient nutrition of women during pregnancy and breastfeeding, as well as the elderly. As a result, the prevalence of protein-energy malnutrition among the elderly and senile is from 15 to 90 %. The physiological course of pregnancy and the adequate formation of the fetus are impossible in conditions of a lack of nutrients. Protein-energy insufficiency and a lack of microelements in the body of a pregnant woman leads to complications of the gestational process, deterioration of the fetus, and can cause the development of a significant spectrum of chronic NCDs in a child. The choice of a product for optimizing the nutrition of vulnerable groups of the population, taking into account their physiological characteristics, seems to be an urgent task. The purpose of this study was to study the feasibility and relevance of using in the diet of vulnerable groups of the population (the elderly, pregnant and lactating women) an fortified product based on goat’s milk. Compared to cow’s milk, goat’s milk has a greater nutritional and biological value, is easier to digest, its fatty acid composition has an anti-inflammatory effect, helps reduce the risk of atherosclerosis and prevent cardiovascular diseases, and also helps strengthen the immune system, improves calcium absorption, and does not violate absorption of iron. Additional enrichment of goat milk products with vitamins and microelements increases their nutritional value. An actual way to correct the nutrition of vulnerable groups of the population is the introduction of fortified products made on the basis of goat’s milk into the diet.

The role of interleukin-6 in the pathogenesis of protein-energy malnutrition in patients treated with haemodialysis

BACKGROUND. Protein-energy malnutrition (PEM) often develops in patients receiving long-term treatment with programmed haemodialysis (HD). Its main causes are decreased intake of basic nutrients, increased losses, disorders inherent to the terminal renal failure itself (including chronic inflammation), as well as the influence of factors associated with the HD procedure. THE AIM: to clarify the role of interleukin-6 (IL-6 ) in the pathogenesis of BEN in patients treated with programmed haemodialysis. PATIENTS AND METHODS. We examined 645 patients receiving HD treatment, including 300 men and 345 women aged 56.8±12.8 years, the duration of renal replacement therapy was 8.4±5.3 years. Nutritional status was assessed according to International Society of Renal Nutrition and Metabolism (ISRNM) recommendations. Serum IL-6 levels were determined by a three-step "sandwich" version of a solid phase enzyme immunoassay using mono- and polyclonal antibodies to IL-6 using a commercial kit "Interleukin-6-IFA-BEST" from Vector-Best, Russia, under the manufacturer's instructions. The reference values for IL-6 are 0-7 pg/ml. RESULTS. The prevalence of BEN was 24.9 % (160 patients). Mean IL-6 concentration was 6.47±2.64 pg/ml in patients without evidence of BEN, and 23.20±10.40 pg/ml in patients with BEN, p<0.001. Elevated IL-6 levels revealed statistically significantly lower levels of total protein, albumin, prealbumin, total cholesterol, transferrin and blood lymphocyte counts. Patients with elevated IL-6 levels were also characterized by statistically significantly lower values of body mass index, skeletal muscle mass index and skeletal muscle mass index. CONCLUSION. The results of this study suggest that the high prevalence of PEM in patients treated with HD is closely related to an imbalance of pro- and anti-inflammatory cytokines. An increase in the duration of renal replacement therapy is accompanied by an increase in serum IL-6 levels. Therefore, this cytokine can be considered as a therapeutic target for prevention and treatment of sarcopenia in dialysis patients.

Influence of amino acid profile and secondary structure on nutritional and functional properties of Trichilia emetica and Trichilia dregeana protein concentrates

SummaryThe high prevalence of protein energy malnutrition (PEM) is a major concern in Africa. This problem could be resolved through the nutritional use of locally available underutilized tree seeds such as those from Trichilia species. This study determined and compared the amino acid profile, functional properties, and secondary structure of the proteins from Trichilia emetica and Trichilia dregeana oilseeds. The results showed that the essential amino acid levels of the two Trichilia seed proteins were above the recommended Food and Agricultural Organisation standard for adults, with essential‐to‐total (E/T) amino acid ratios (T. dregeana 52.8%; T. emetica 53.4%) and chemical scores of 100% for both species, which were not significantly different (P > 0.05) from those of soy proteins (53.0% and 100%, respectively). The amino acid profile results indicated that Trichilia oilseeds can serve as candidates for addressing protein malnutrition in economically disadvantaged communities of sub‐Saharan Africa. The secondary structure showed that the Trichilia oilseed proteins had significantly (P < 0.05) more β‐conformations compared to soybean proteins. Further, the functional properties suggested that Trichilia oilseed proteins can be used as ingredients in food and feed formulations due to their versatile functional properties.

Under Five Girls Found More Prone to Protein Energy Malnutrition Compared to Boys: A Squatter Settlement Study from Karachi

Background: Protein-energy malnutrition (PEM), is an imbalance between protein and energy intake and the body’s requirement for optimal growth. In Pakistan, almost 40% of children, less than 5 years, have stunted growth, while 17.7% suffer from muscle wasting. This study aimed to explore the frequency of the different types of protein energy malnutrition in children under 5 years residing in Sikandarabad and evaluate the risk factors leading to this condition. Methods: This cross-sectional observational study, recruited 220 children less than 5 years of age. Previous health record was investigated. Physical examination was done and anthropometric measurements of each child were plotted on WHO/CDC Growth Standard Charts to classify the degree of protein energy malnutrition. Binary and multivariate logistic regression was computed to see a significant association with the outcome. Results: The prevalence of PEM was 136(61.5%). Overall girls were underweight (9±3.8 kg) and stunted (77.2±16.1) compared to boys. Delayed weaning was a significant risk factor for PEM (p=0.044). The majority of children belonged to Low socio-economic status 65(47.8%), with more than 2 siblings. However, 40(29.4%) of those below 5 years were malnourished. A positive association (OR:1.37,1.21) was found between PEM and acute illnesses (56.6%), worm infestation (14%) and measles outbreaks (5.9%). Conclusion: Young girls (9±3.8 kg) were found severely undernourished compared to boys. This is probably because of bias attitude toward gender preference in the distribution of quality food (p=0.14). Keywords: Protein Energy Malnutrition; Underweight; Stunting; Wasting; Overweight.

The ability of the Global Leadership Initiative on Malnutrition (GLIM) to diagnose protein-energy malnutrition in patients requiring vascular surgery: a validation study.

Identifying nutritional deficits and implementing appropriate interventions in patients requiring vascular surgery is challenging due to the paucity of appropriate screening and assessment tools in this group. This retrospective study aimed to determine the validity of the Global Leadership Initiative on Malnutrition (GLIM) in identifying protein-energy malnutrition (PEM) in inpatients admitted to a vascular surgery unit, using the PG-SGA as the comparator. Diagnostic accuracy and consistency were determined between the GLIM and the Patient-Generated Subjective Global Assessment (PG-SGA) global rating. The GLIM determination was made retrospectively using the relevant parameters collected at baseline in the original study. Two hundred and twenty-four (70·1 % male) participants were included. The prevalence of PEM was 28·6 % on GLIM and 17 % via the PG-SGA. Compared with the PG-SGA, the GLIM achieved sensitivity of 73·7 % and specificity of 80·6 %; however positive predictive value was 43·7 % indicating that the GLIM over-diagnosed malnutrition compared with the PG-SGA. Kappa reached 0·427 indicating moderate diagnostic consistency. Due to the absence of an ideal instrument and the complexity of malnutrition often seen in this group which extends beyond PEM to significant micronutrient deficiencies, further work is required to determine the most appropriate instrument in this patient group, and how micronutrient status can also be included in the overall assessment given the critical role of micronutrients in this group.

Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection

Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.
 The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.
 Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patients protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fishers test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p0.05.
 Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.478.56; p = 0.35) and six times (OR 6.11; 95% CI 1.0635.35; p0.04), respectively.
 Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.

Prevalence and associated factors for malnutrition among children under 6 years of age in Hunan province

Objective: To analyze the prevalence and associated factors of malnutrition among children under 6 years of age in Hunan province. Methods: This study was a cross-sectional study. A combination of multistage stratified cluster sampling and systematic sampling approach was used to recruit 10 442 children aged 0-71 months from 144 communities (villages) across 48 streets(towns) in 24 districts(counties) from Hunan province between August and November 2019. Data concerning the children and their mothers, caregivers, and family conditions was collected using unified questionnaire, with the lengths/heights and weights of the children being measured using unified instruments. The length/height for age, weight for age, weight for length/height, and body mass index for age Z scores were calculated and used to evaluate the prevalence of children's stunting, underweight, and wasting. The chi-square test was used to compare the prevalence of malnutrition among children with different characteristics. The multivariate Logistic regression model was used to conduct multivariate analysis for childrens' malnutrition. Results: The prevalence of protein-energy malnutrition (PEM) among children under 6 years of age was 6.8% (710/10 442), and the prevalence of stunting, underweight, and wasting were 3.1% (328/10 442), 2.7% (280/10 442), and 3.3% (343/10 442), respectively. Rural areas (OR=1.60), older age of children (compared with children of 0-11 months, the OR for 12-23, 24-35, 36-47, 48-59, and 60-71 months were 1.42, 1.75, 1.55, 1.70, and 1.88, respectively), low birth weight (OR=2.72), caregivers of minority ethnicity (OR=1.95), and large family size (OR=1.25) were risk factors for children's PEM. Rural areas and low birth weight were risk factors for stunting in children (OR=2.13 and 3.28). Rural areas, low birth weight, caregivers of minority ethnicity, and large family size were risk factors for underweight in children (OR=2.57, 3.34, 1.86, and 1.32). Rural areas (OR=1.43), older age of children (compared with children of 0-11 months, the OR for 24-35, 36-47, 48-59, and 60-71 months were 1.63, 1.80, 1.84 and 2.17, respectively), low birth weight (OR=2.36), caregivers of minority ethnicity (OR=2.88), and large family size (OR=1.42) were risk factors for children's wasting. Higher education level of caregivers was a common protective factor for PEM, stunting, and underweight (OR=0.85, 0.76, and 0.82). Conclusions: The prevalence of stunting, underweight, and wasting among children under 6 years of age in Hunan province were all at a low level. Nevertheless, the urban-rural differences still existed, with these prevalence being affected by children age, birth weight, ethnicity of caregivers, education level, and family size.

Prevalence of Protein Energy Malnutrition among Under-five children in Odisha: A Review

The WHO has identified PEM as one of the major problems among the children round the world. Also, over the years it has been found that developing countries like India have been facing the issue of PEM among children particularly at the most crucial stage of their development. Moreover, this is prevalent mostly among the rural masses and the poor and arises due to issues relating to poverty, poor environmental sanitation, poor dietary practices, low socioeconomic status, maternal education, frequent infection, and poor household food security, high consumption of rice, frequency of acute illness and low birth weight of child. This paper is a review on the status of PEM among young children (under the age of five) in Odisha. The study is based on analysis and meta-analysis of secondary sources of relevant literature and the inferences thereof suggesting possible strategies to combat this problem.

Prevalence of protein energy malnutrition in HIV-infected under five children and the effects of highly active antiretroviral therapy on their nutritional status in Nigeria

Aim: To determine the prevalence of malnutrition among HIV- infected under-five children and effect of highly active antiretroviral therapy (HAART) on the nutritional status. Method: This cross-sectional and descriptive study was conducted among under-fives presenting at the Paediatric HIV clinic in a tertiary centre in Nigeria. HIV positive children aged less than five years, who were on HAART and whose parents/caregivers gave consent were included. Odds ratios (ORs) and their 95% confidence intervals (CIs) were determined in a multivariate logistic regression analysis and p-values of <0.05 were considered significant. Result: A total of 92 HIV positive children comprising 52 (56.5%) males and 40 (43.5%) females were recruited, giving a ratio of 1.3:1. Children who were more than 48 months of age were (46.7%), while (9.8%) were aged 24 months or less. The mean age of the children was 44.5+12.9 months, while that of the male and female children were 43.9 +13.1 months and 45.2+12.6 months, respectively, and their age difference was statistically insignificant. The prevalence of undernutrition was 40.2% with a significantly higher proportion of them being male children (P= 0.02) while 1.1% of the children was overweight. The prevalence of severe wasting, severe underweight and severe stunting were 2.1, 3.3 and 17.4% respectively. A total of 12 (13.0%) were wasted, 14 (15.2%) were underweight, and 26 (28.3%) were stunted. Children who received HAART for more than 12 months were less likely to be wasted (P=0.02). Multivariate logistic regression also showed that being a male increased the risk of being underweight (OR=2.55, 95%CL=1.06-6.16) and stunted (OR=2.67, 95%CL=1.32-5.40). Conclusion: Malnutrition remains a problem of children living with HIV even while they are on HAART. The longer duration of HAART is significantly associated with better nutritional status.

Prevalence and determinants of Protein Energy Malnutrition (PEM) among children under five years of age in rural communities of Lahore, Pakistan.

Objectives: To investigate the prevalence and determinants of Protein energy malnutrition among children under five years of age in rural areas of Lahore, Pakistan. Study Design: Cross-sectional study. Setting: Four Rural Communities (Hussainabad, Shershah Colony, Dubai Town and Bhobtia Pind) of Lahore, Pakistan. Period: September 2016 to March 2017. Material & Methods: Convenient sampling technique was used to collect data. Anthropometric measures were obtained from children under five years of age. Results: Prevalence of PEM was found to be 52.8% in children under five years of age in the rural communities of Lahore, Pakistan. Significant association was found in PEM and number of siblings, mother’s literacy, father’s educational level, socioeconomic status, Knowledge of mother regarding diet, housing condition. So, all these factors are considered as significant determinants of PEM. Conclusion: More children suffer from the burden of PEM. Risk factors like age, sex, type of family, number of siblings, mother’s literacy, father’s educational level, socioeconomic status, Knowledge of mother regarding diet, housing condition contribute greatly to develop PEM. There is a need to take measures to prevent the nation from this suffering. Steps must be taken to implement polices to prevent PEM. Government should launch educational interventions on large scale to alleviate this suffering. Health professional must pay special attention to this debilitating issue.

Prevalence and determinants of protein energy malnutrition among under five children in slums of Kannauj district

Introduction: Protein Energy Malnutrition (PEM) in children is a leading public health problem in developing countries like India and is a direct or indirect cause of most of infant and child morbidity and mortality. Objective: To study the prevalence and determinants of protein energy malnutrition among under five children of Kannauj district. Materials and Methods: The present study was a cross-sectional study conducted among children in the age group 0-60 months in the slums of Kannauj district. The statistical tools used for analysis were percentages, Pearson's Chi-square test and multiple logistic regression. Results: The prevalence of PEM in the study population was found to be 59.1%. The study revealed a significant association of age (OR=0.438), timing initiation of breast feeding (OR=0.682), colostrum feeding (OR=0.364), practice of breast feeding (OR=3.611) and initiation of complementary feeding at 6 months (OR=2.651) were significantly associated with PEM. Conclusion: The present study emphasizes the need to correct behavioural factors like breast feeding practices among Indian mothers to bring down the problem of PEM in under five children. Keywords: PEM, Under five children, Malnutrition, Determinants.

Malnutrition as predictor of poor outcome after total hip arthroplasty

IntroductionThe aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA).HypothesisPatients with PEM would have inferior post-operative outcome after THA.Materials and methodWe retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database.ResultsThe prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1).ConclusionWe observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.

Characterization of The Nutritional Properties of Sorghum Composite Flours Using Different Food to Food Fortification Approaches

Intervention using blended composite flours can reduce malnutrition in sub Saharan Africa. Prevalence of protein-energy malnutrition among the vulnerable children has necessitated research on cost effective food product development like food to food fortification of common staples like sorghum. An investigation was carried out on the nutritional properties of selected sorghum composite flours for the production of porridge for both home and industrial applications. In this study, composite flours V1 to V4 were made from sorghum, maize, grain amaranth, baobab and butternut at different rations; V1-(42.5:22.5:5:15:15),V2-(22.5:42.5:5:15:15), V3-(32.5:32.5:5:15:15) and V4-(65:0:5:15:15) were compared against composite flours AV1 to AV4 made from sorghum, cassava, chickpea, orange fleshed sweet potatoes (OFSP) and baobab; AV1-(42.5:22.5:5:15:15) AV2-(22.5:42.5:5:15:15), AV3-(32.5:32.5:5:15:15) and AV4-(65:0:5:15:15). Standard methods were used in determining the chemical characteristics of the composite flours. Composite flour formulations were based on Concept4â creative software. Results on proximate composition indicated a significant (p &lt; 0.05) difference in moisture content of the control composite (V5) and the other composite flours with the moisture content ranging from 9.1% to 12.1% in V5 and V3 respectively. Carbohydrates were the most abundant nutrient in the composite flours 66.0 to 72.7% in V1 and V5 respectively, followed by fat 5.5% (AV3) to 9.2% (AV1), protein 5.1 (AV2) to 8.6% (AV4), crude fibre 1.5 (V2) to 4.3% (V5), and ash 1.4 (AV1) to 2.8% (AV4). The total energy ranged between 359.25 kcal (V4) to 379.94 kcal (V1) however, these values were not significantly different (p &gt; 0.05). Zinc, calcium and magnesium concentration were significantly different (p &lt;0.05) between the sorghum-maize-grain amaranth-baobab-butternut, on one hand and sorghum-cassava-chickpea-OFSP-baobab composite flours on the other. The concentrations of phosphorus and Iron were not significantly different (p &gt; 0.05). Correlation analysis revealed significant negative correlation between crude protein and fibre (-0.512, p ≤ 0.001) and crude protein and iron (-0.386, p ≤ 0.047), whereas crude protein and magnesium had a significant positive correlation (0.455, p ≤ 0.017). The results indicate that both categories of flour composites have the potential to improve nutritional status of consumers. Thus, consumption of V1 and V4 composite flours with a protein content of 8.1% and 8.6% maybe encouraged for children aged 6 - 59 months who need products with good nutritional composition for proper growth and development.

S0058 The Prevalence and Burden of Protein Energy Malnutrition Among Patients Hospitalized for Chronic Pancreatitis in the United States

INTRODUCTION: Chronic pancreatitis (CP) is associated with inflammatory destruction of the pancreas, suboptimal digestion, and absorption of nutrients, resulting in an elevated risk of Protein Energy Malnutrition (PEM). We sought to provide a national estimate of the prevalence, trends, characteristics, and the burden of PEM among patients hospitalized for CP. METHODS: Adult (age ≥18 years) hospital records were selected from the Nationwide Inpatient Sample (2007–2014). The prevalence and trends of PEM was calculated, stratified by concomitant presence of CP, and the impact of CP on the trends of PEM was measured. Among patients hospitalized for CP (Nationwide Inpatient Sample, 2012–2014), those with concomitant PEM and its associated factors (demographic, hospital, and co-morbid) were identified. CP patients with PEM were propensity-matched (1:1) to those without PEM, and the impact of PEM on clinical outcomes were estimated (SAS 9.4). RESULTS: From 2007–2014 (Figure 1A), the average prevalence of PEM was 506 per 10,000 hospitalizations, increasing from 337/10,000 (2007) to 626/10,000 (2014). The annual rate of increase in PEM was steeper (2.3x higher, Figure 1B) among patients with CP vs. no-CP (93/10,000 vs. 41/10,000 hospitalization/year). From 2012–2014, 11.5% (3,694 of 32,024) of CP hospitalizations had concomitant PEM, which was higher than patients without CP (5%) or with cirrhosis (6.1%). Odds for PEM was higher among Whites, advanced age, Medicare-insured, low-income earners, non-Northeastern regions, and patients with multiple co-morbidities such as alcohol and tobacco use, biliary stones, malignancies, and chronic diseases of the lung, heart, liver, and kidney. After propensity-matching, concomitant PEM was associated with very poor outcomes (Figure 2), including: mortality (AOR: 3.55 [95% CI: 1.73–7.31], P < 0.0001), acute kidney injury (AOR: 1.48 [95% CI: 1.28–1.70], P < 0.0001), parenteral nutrition (AOR: 5.58 [95% CI: 4.47–6.97], P < 0.0001), longer hospital stay (PEM: 8.3- vs. no-PEM: 4.8-days P < 0.0001), higher charges (PEM: US$59,334 vs. no-PEM: US$33,249 P < 0.0001) and higher discharge to secondary facilities (AOR: 1.74 [95% CI: 1.53–1.97], P < 0.0001). CONCLUSION: In conclusion, there is a higher prevalence and steeper increase of PEM among patients with CP than the general population. PEM is associated with higher mortality and poorer outcomes. Prevention, early recognition, and treatment of PEM among the high-risk categories may curb these dismal outcomes.Figure 1.: A: Increasing trend in the rate of PEM among Hospitalized Patients in the US (2007 to 2014). B: Among hospitalized patients, frequency and rate of increase in PEM is higher among patients with chronic pancreatitis (2007 to 2014).Figure 2.: Impact of Protein Energy Malnutrition on Outcomes of Hospitalizations for Chronic Pancreatitis.

Role of pre-operative serum albumin level in predicting the post-operative outcomes in gastrointestinal surgery

Background: The prevalence of protein-energy malnutrition in surgical patients is seen in 30-50% of surgical patients with gastrointestinal disease. Malnutrition and hypalbuminaemia contribute to increased morbidity and mortality. Serum albumin level is a low-cost key element in nutritional assessment. Clavien-Dindo classification of post-operative complications enables stratification of post-operative complication.Methods: We retrospectively analysed the prospectively maintained data of 136 patients who underwent major gastro intestinal procedures from October 2019 to March 2020. We assessed the pre-operative; intra operative parameters, outcome variables and the postoperative complications were graded according to Clavien-Dindo severity, length of ICU stay, length of hospitalization and mortality.Results: Out of the 136 patients (M: F=3:2), the procedures were hepatopancreaticobiliary (n=40), colorectal (n=39), small bowel (n=36) and esophago-gastric (n=19). Pre-operative serum albumin was identified to be single most statistically significant pre-operative variable predicting post-operative complication of Clavien-Dindo severity grade III and above. The ROC curve of the serum albumin level predicting the severe post-operative complication suggested optimal cut off value of 3.1 gm/dl (AUC=0.76; 5% CI=0.64-0.87; p&lt;0.001). Linear regression analysis of serum albumin level predicting the severe post-operative complication suggested good correlation with (r2=0.133; b=0.689; p&lt;0.001). Further analysis of serum albumin level in predicting the length of ICU and the hospital stays suggested a significant negative correlation with both of these dependent outcome variables. The serum albumin level correlated inversely with the length of ICU stay and hospitalization.Conclusions: Low pre-operative albumin (serum level &lt;3.1 gm/dl) in patients undergoing major gastrointestinal surgery predicts severe post-operative complications, prolonged ICU and hospital stays.

A study on prevalence and factors associated with protein energy malnutrition among 1 - 5 years of children's: A cross sectional study

Background: Malnutrition is a major health problem, especially in developing countries. It affects almost 800 million people. Prevalence rates vary among different continents of the world. PEM is undoubtedly the most serious nutritional problem affecting several thousand young children in India. Objective: To find the prevalence of Protein energy malnutrition between urban and rural areas to study the factors associated with PEM among children of age 1 5 years in Guntur District. Study design: Cross-sectional study carried out during 01 Jan 2018 to 31 Dec 2018 in the Department of Paediatrics, KATURI Medical College & Hospital, Guntur, Andhra Pradesh, India. Comprised children of age group 1 5 years and total of 180 included in this study. Method of Collection of Data: The instrument used is a predesigned and pretested semi structured questionnaire. Physical measurements such as height and weight measured using standard methods. Statistical Analysis: Proportion, Chi square test, Independent t test. Results: The prevalence of Protein energy malnutrition is 67.7% (122). The prevalence of PEM is high among rural children (71.1%) compared to urban children (64.4%) and this difference is found to be statistically significant. Many preventable variables are found to be significant associates of Protein energy malnutrition. Study subjects included were both boys and girls, boys constituted 43.3% (78) and girls 56.7% (102). Each Urban and rural area constituted 50% i.e urban 50%(90) and rural 50% (90). Among 180 study subjects, 70% of children have MAC more than 13.5cms and 22.3% of children have MAC between 12.5 cms and13.5 cms whereas only 7% of children have MAC less than 12.5%. Mean weight was more among urban children(10.86) compared to rural children(9.54) and also mean height was higher among urban children(84.98) than rural children(81.69).The prevalence of Protein energy malnutrition is 67.7% (122).The prevalence of PEM is high among rural children (71.1%) compared to urban children (64.4%).36% of study subjects have Grade I PEM followed by Grade II (24.6%), Grade III (21.4%) and Grade IV (18.0%).Among urban children Grade I(43.1%) is common whereas among rural children, Grade II and III are common. The prevalence of PEM is high in 2 3 years of age group (97.9%). The prevalence of PEM is more among boys (74.3%) compared to girls (62.7%). The prevalence of PEM is more among Hindus (78.9%) compared to Muslims (48.2%). The prevalence of PEM is high among the subjects who belong to family size more than five (72.1%). The prevalence of PEM is high among socioeconomic class IV (82.5%). The prevalence of PEM is high among those study subjects whose fathers are illiterates (76.9%). The prevalence of PEM is high among those study subjects whose mothers are educated up to primary (75.0%). The prevalence is found to be high in those students whose fathers are unemployed (50.0%) /unskilled (69.6%) /semiskilled (68.6%). The prevalence is found to be high in those students whose mothers are unemployed (68.4%) /unskilled (71.2%) /semiskilled (33.3%).The prevalence of PEM is high among study subjects of Nuclear family (76.3%). The prevalence of PEM is more among study subjects mother who had ANC visits of less than 6 (around 80%). There is no statistical difference in prevalence of PEM among study subjects based on mode of delivery. The prevalence of PEM is more among birth weight less than 2.5 kgs (85.4%). The prevalence of PEM is more among study subjects mother who had initiated breast feeding after four hours (85%).The prevalence of PEM is more among study subjects mother who had not fed colostrum (78.5%).The prevalence of PEM is high among non exclusive breast feeding (71%).Housing conditions revealed that prevalence of PEM is more among semi puccka house (73.0%), in adequate ventilation (73.8%), overcrowding (77.2%) and solid fuel user (74.0%). Conclusion: Since it is a cross sectional study, no causal relationships can be established from this study. Dietary intake was assessed by 24-hour recall basis method and application of better and elaborate methods of dietary intake assessment was beyond the scope of the study.

Role of serum albumin and body mass index in the outcome of major elective abdominal surgery

Background: The prevalence of protein-energy malnutrition in surgical patients is high, ranging from 10% to 54%. The correct assessment of the nutritional studies of such patients is crucial since malnutrition is a risk factor for morbidity and mortality. There is a substantial evidence to show that patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves.Methods: 150 patients were selected for the study. All the collected data was entered in Microsoft Excel sheet. It was then transferred to SPSS ver. 21 software for statistical analysis. Quantitative data was compared by using student’s t-test and chi-square test, qualitative data compared using frequency, standard deviation and percentage. P&lt;0.05 considered as significant.Results: The mean serum albumin was found to be 3.7 gm%±0.3. There was increase rate of complication and duration of hospital stay in those patients with serum albumin &lt;3.5 gm% and BMI&gt;25 kg/m2 and wound infection was found to be the most common complication among these patients.Conclusions: Majority of patients had serum albumin &gt;3.5 gm/dl and more complications were seen with serum albumin &lt;3.5 gm/dl which was statistically significant (p=0.01). Serum albumin is a good prognostic indicator because of its ability to detect protein energy malnutrition.

Prevalence of protein energy malnutrition among children: a cross sectional study

Background: In the world, hunger and malnutrition are most significant threat. Malnutrition is global risk factor for significant death among infants and pregnant woman. malnutrition increases the chances of several infections.Methods: A cross sectional study was undertaken in children age group of 1 to 18 years, suffering from protein energy malnutrition, attending Department of Paediatrics, tertiary care hospital, Bangalore during the period January 2016 to December 2016. Results: In the present study, maximum number of cases (44) belongs to age group of 1-5 years, followed by 32 cases belongs to 6-12-year age group and 24 cases belong to 13-18-year age group. Maximum cases (59) belongs to female with male female ratio is 1:1.4. In the present study out of 100 cases, 81 cases came positive for protein energy malnutrition. Out of 81 cases positive for PEM, 34 cases belong to grade I followed by 24 cases belongs to grade II, 13 cases belong to grade III and 1o cases belongs to grade IV protein-energy malnutrition (PEM).Conclusions: Malnutrition is like an iceberg, most people in the developing countries live under the burden of malnutrition.