Prevention Of Malnutrition Research Articles

Decision Support Tools in Adult Long-term Care Facilities: Scoping Review.

BackgroundDigital innovations are yet to make real impacts in the care home sector despite the considerable potential of digital health approaches to help with continued staff shortages and to improve quality of care. To understand the current landscape of digital innovation in long-term care facilities such as nursing and care homes, it is important to find out which clinical decision support tools are currently used in long-term care facilities, what their purpose is, how they were developed, and what types of data they use.ObjectiveThe aim of this review was to analyze studies that evaluated clinical decision support tools in long-term care facilities based on the purpose and intended users of the tools, the evidence base used to develop the tools, how the tools are used and their effectiveness, and the types of data the tools use to contribute to the existing scientific evidence to inform a roadmap for digital innovation, specifically for clinical decision support tools, in long-term care facilities.MethodsA review of the literature published between January 1, 2010, and July 21, 2021, was conducted, using key search terms in 3 scientific journal databases: PubMed, Cochrane Library, and the British Nursing Index. Only studies evaluating clinical decision support tools in long-term care facilities were included in the review.ResultsIn total, 17 papers were included in the final review. The clinical decision support tools described in these papers were evaluated for medication management, pressure ulcer prevention, dementia management, falls prevention, hospitalization, malnutrition prevention, urinary tract infection, and COVID-19 infection. In general, the included studies show that decision support tools can show improvements in delivery of care and in health outcomes.ConclusionsAlthough the studies demonstrate the potential of positive impact of clinical decision support tools, there is variability in results, in part because of the diversity of types of decision support tools, users, and contexts as well as limited validation of the tools in use and in part because of the lack of clarity in defining the whole intervention.

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022).

Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

Egg consumption of children under two years of age through a child-owned poultry and nutrition intervention in rural Ethiopia: A community-based randomized controlled trial

Egg consumption is associated with better child health and nutrition. Though a relatively cheap animal source food, under-two years aged Ethiopian children rarely eat egg. This study tested effects of a child-owned poultry intervention integrated with nutrition education on egg intake. Targeting 6–18 months children, the trial was conducted in Southern Ethiopia from May to November 2018. Clusters were randomly selected and allocated to intervention and control arms. Children in the intervention group (N = 127) received two egg-laying local hens and caging materials in a cultural and religious gifting ceremony. Parents promised to not sell nor share the chickens and eggs, present two more hens, replace those that died, and feed all eggs produced to the chicken-owner child on the basis of one-egg-a-day. Cage utilization, proper poultry husbandry and environmental sanitation, as well as egg feeding, were promoted. Controls (N = 126) received the regular community-based nutrition and agriculture education. Child-owned poultry increased significantly in intervention ( p < 0.001 ) (β = 3.856; 95% CI of 3.553–4.159). Egg intake was 72% vs 20.7% among intervention and control children, respectively, at end line ( p < 0.001 ; Odds ratio = 3.841; 95% CI = 2.640–5.589). Mean eggs [SD] consumed by the week before end line significantly increased in intervention (4.85 [2.41]) compared to control (0.4 [0.61]) (p < 0.001; β = 2.202; 95% CI = 1.971–2.433) children. Child-owned hen flock size was strongly associated with egg intake (r = 0.975; p < 0.001 ). Nearly one-third of children in intervention met the minimum dietary diversity ( p = 0.016 ; Odds ratio = 1.857; 95% CI = 1.120–3.078). Vitamin-A rich fruits and vegetables consumption (p = 0.027) increased in intervention, as a result of sales of excess eggs. Enabling children to be owners of chickens together with nutrition education significantly increased chicken production and egg consumption. We recommend integration of child-owned poultry into ongoing malnutrition prevention activities particularly in resource-poor settings where undernutrition is high and animal source food intake is low. (Trial registration = NCT03355222). • Egg intake is very low among under two years age children of Halaba, South Ethiopia. • Enabling children to be owners of chickens coupled with nutrition promotion significantly increased chicken production and egg consumption sustainably. An added advantage of increased intake of Vitamin A-rich fruits and vegetables was observed from the sale of excess eggs. The intervention resulted in higher dietary diversity increasing the proportion of children who met the minimum dietary diversity cut off. • Nutrition-sensitive poultry intervention stressing child ownership is recommended to be integrated into ongoing malnutrition prevention programs particularly in countries like Ethiopia where the burden of undernutrition is high and intake of animal source foods is low.

Malnutrition Prevention after Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT): A Prospective Explorative Interventional Study with an Oral Polymeric Formulation Enriched with Transforming Growth Factor Beta 2 (TGF-β2).

Malnutrition is common after allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT), and interventions directed to correct nutritional status are warranted to improve transplant outcomes. In this prospective study, an oral polymeric formulation enriched with TGF-β2 (TE-OPF) was explored to correct malnutrition according to Patient-Generated Subjective Global Assessment (PG-SGA). TE-OPF was proposed to 51 consecutive patients who received transplants at our institution for hematological malignancies, and sufficient dose intake was established per protocol as at least 50% of the prescribed dose of TE-OPF: group A received adequate nutritional support; group B, inadequate. The study met the primary outcomes in terms of safety (no adverse events reported during TE-OPF intake except for its disgusting taste) and malnutrition (PG-SGA C 28 days after transplant): severely malnourished patients (PG-SGA C) accounted for 13% in group A and 88.9% in group B (p = 0.000). At the end of the study, after a median follow-up of 416 days, the estimated median Overall Survival (OS) was 734 days for well or moderately nourished patients (PG-SGA A/B) in comparison to 424 for malnourished patients (p = 0.03). Inadequate TE-OPF intake was associated with an increase in acute gastrointestinal Graft Versus Host Disease (GVHD) cumulative incidence (38% vs. 0% p = 0.006). A higher incidence of pneumonia was reported in group B (p = 0.006). IGF-1 levels at 14 and 28 days after transplant were significantly higher in group A and were associated with a lower incidence of acute GVHD (aGVHD). Higher subsets of B, T, and NK cells were found in group A, and a higher number of CD16+ NK cells was associated with a lower incidence of acute GVHD (p = 0.005) and increased survival at the end of the study (p = 0.023). Artificial neural network analysis suggested that inadequate TE-OPF intake, pneumonia, and sepsis significantly affected malnutrition 28 days after alloHSCT and survival 365 days after alloHSCT (normalized importance 100%, 82%, and 68%, respectively). In this exploratory and preliminary study, the use of TE-OPF appeared to reduce the incidence of malnutrition after alloHSCT, but larger and controlled studies are required.

Solid state fermentation improves the quality of soy-cassava diet

Abstract Cassava is used as a staple food in many developing countries despite its low nutrient density. Fortification of cassava diets is needed for the prevention of malnutrition and achievement of food security. Cassava-soybean complementary foods were formulated from natural and solid state fermented cassava complemented with soybean. The proximate composition, physicochemical properties, nutritional quality, and sensory properties of the samples were determined (Table 2). The moisture content (7.51%) and ash (3.81%) content of the solid state fermented (SSF) cassava flour complemented with un-defatted soybean flour was significantly higher (P &lt; 0.05) than of the other samples. Solid state fermentation (SSF) led to the highest reduction in viscosity (from 2,855 to 2,052 cPs). Average weight gain and protein efficiency ratio (PER) of experimental animals fed SSF cassava were the highest. The colour and aroma of SSF diets and that of fermented cassava samples were similar (P &gt; 0.05). The texture of diets from SSF cassava were inferior (P &lt; 0.05) to the other samples. Solid state fermentation of cassava with Rhizopus oligosporus and supplementation with soybean can be used to produce a complementary food that is nutrient dense and nutritionally adequate, although the texture of the product might need to be improved.

Prevalence and associated risk factors of chronic malnutrition amongst children under five in Eswatini.

BackgroundAbout 20 million children under fi-ve in Southern Africa have chronic malnutrition. This study determines the prevalence of chronic malnutrition and associated risk factors amongst children under five.AimTo determine the proportion of children with chronic malnutrition and investigate associated risk factors of chronic malnutrition.SettingThe study was conducted in communities in the four regions of Eswatini.MethodsThis study is a retrospective cross-sectional study that used data from a Multiple Indicator Cluster Survey (MICS) conducted in 2014. The study involved 3261 children who are under 5 years of age. Data on nutritional status and household characteristics were used. Logistic regression was used to identify factors associated with chronic malnutrition in the univariable and multivariable models, respectively.ResultsResults showed that 18.1% (confidence interval [CI]: 18.5–21.5) of children under five have chronic malnutrition. The highest prevalence was 20.8% (CI: 17.4–24.7) in the Shiselweni region, followed by the Manzini region with 17.6% (CI: 14.5–21.1) and the Lubombo region with 17.2% (CI: 13.9–21.2). The lowest prevalence of chronic malnutrition at 16.7% (CI: 13.6–20.3) was the Hhohho region. The results indicated that low birth weight (odds ratio [OR] = 4.63, CI: 1.12–19.2), mothers’ lack of education (OR = 1.50, CI: 1.04–2.17) and children aged 12–24 months (OR = 1.28, CI: 0.88–1.87) were significantly associated with chronic malnutrition.ConclusionThe findings showed that malnutrition is an important public health problem in children under five and needs a multisectoral response. Low birth weight, mothers’ education and the child’s age are risk factors associated with chronic malnutrition.ContributionThe results inform evidence-based programming for the prevention of chronic malnutrition in children thus assist the country to meet sustainable development goals.

Sex Differences in Dietary Patterns of Adults and Their Associations with the Double Burden of Malnutrition: A Population-Based National Survey in the Philippines.

A dietary pattern transition is a risk factor for the double burden of malnutrition (DBM), but related information is limited. This study aimed to identify sex differences in dietary patterns of adults in a low–middle income country and to examine their association with DBM. A total of 8957 adults (4465 men and 4492 non-pregnant and non-lactating women) who participated in the 2013 Philippine National Nutrition Survey were included in the analysis. Logistic regression models were formulated to investigate the relationship between dietary patterns and DBM. The factor analysis derived seven dietary patterns for males and six patterns for females. Results showed that approximately 30% of Filipino adults suffered from DBM. The rice pattern was associated with lower odds of DBM for males only. The meat and sugar pattern in males and the protein-rich foods, cereal, and sugar pattern in females decreased DBM likelihood. An inverse relationship was observed for the vegetables and corn patterns, wherein females had an increased risk for DBM. Our findings suggest that rice-based and meat-containing patterns could play protective roles in DBM development among adults in the Philippines. Understanding sex-specific dietary patterns can be utilized to guide public health nutrition interventions in the prevention of malnutrition in all its forms.

Network pharmacology and molecular docking analysis reveal insights into the molecular mechanism of shiliao decoction in the treatment of cancer-associated malnutrition.

PurposeShiliao Decoction (SLD) was developed for treatment and prevention of cancer-associated malnutrition (CAM) in China. In this study, we aim to discover SLD’s active compounds and demonstrate the mechanisms of SLD that combat CAM through network pharmacology and molecular docking techniques.MethodsAll components of SLD were retrieved from the pharmacology database of Traditional Chinese Medicine Systems Pharmacology (TCMSP). The GeneCards database and the Online Mendelian Inheritance in Man database (OMIM) were used to identify gene encoding target compounds, and Cytoscape was used to construct the drug compound–target network. The network of target protein-protein interactions (PPI) was constructed using the STRING database, while gene ontology (GO) functional terms and the Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathways associated with potential targets were analyzed using a program in R language (version 4.2.0). Core genes linked with survival and the tumor microenvironment were analyzed using the Kaplan–Meier plotter and TIMER 2.0 databases, respectively. Protein expression and transcriptome expression levels of core gene were viewed using the Human Protein Atlas (HPA) and the Cancer Genome Atlas (TCGA). A component-target-pathway (C-T-P) network was created using Cytoscape, and Autodock Vina software was used to verify the molecular docking of SLD components and key targets.ResultsThe assembled compound–target network primarily contained 134 compounds and 147 targets of the SLD associated with JUN, TP53, MAPK3, MAPK1, MAPK14, STAT3, AKT1, HSP90AA1, FOS, and MYC, which were identified as core targets by the PPI network. KEGG pathway analysis revealed pathways involved in lipid and atherosclerosis, the PI3K/Akt signaling pathway, and immune-related pathways among others. JUN is expressed at different levels in normal and cancerous tissues, it is closely associated with the recruitment of different immune cells and has been shown to have a significant impact on prognosis. The C-T-P network suggests that the active component of SLD is capable of regulating target genes affecting these related pathways. Finally, the reliability of the core targets was evaluated using molecular docking technology.ConclusionThis study revealed insights into SLD’s active components, potential targets, and possible molecular mechanisms, thereby demonstrating a potential method for examining the scientific basis and therapeutic mechanisms of TCM formulae.

Effect of Amalgamation of Quinoa on Contents of Essential Amino Acids, Proximates, Dialyzable Minerals and Storage Stability of Gluten and Egg Free Maize Muffins

Background: Recently there has been increasing interest in the production of gluten-free (GF) foods from pseudo-cereals, without celiac activity, in order to fulfil the specific needs of people affected by celiac disease. Bakery products, particularly gluten-free muffins, represent one of the most consumed foods around the world and may be an interesting objective. Methods: The present study assessed the nutritional composition, dialyzable mineral contents, lysine, methionine and storage stability of maize and quinoa muffins. Result: The substitution of maize flour with quinoa flour augmented the crude protein (8.96 to 11.14%), fat (24.70 to 27.77%), fibre (1.54 to 6.28%), ash (1.86 to 2.62%) and carbohydrate (42.76 to 29.07%) in muffins. The lysine and methionine contents of quinoa muffins were 122.4 and 85.4 per cent higher than control muffins. The muffins could be stored at room temperature up to 3 days without any food additive. The distinctive protein, essential amino acid and mineral characteristics of quinoa muffins open a new promising prospect for utilization of quinoa flour not only on industrial scale but also at household scale, for prevention of hidden hunger and malnutrition. Quinoa muffins can also cater to the needs of wellness market segment with taste.

Prehabilitation for 62-year-old female patient with a transverse colon tumor and underweight

The present article discusses the perioperative management issues in patients with frailty and other geriatric syndromes focusing mainly on the prevention and correction of malnutrition, ESPEN practical guidelines: Clinical Nutrition in cancer. The concept of prehabilitation is described — a multimodal strategy that is implemented from the moment of diagnosis to surgical treatment, aimed at enhancing postoperative outcomes, which elements have a synergistic effect. The clinical case of 62-year-old female patient prehabilitation with a long-term underweight, prefrailty, sarcopenia, osteoporosis and developed because of a transverse colon tumor malnutrition syndrome is given.

Legal Protection for Malnourished Children for Fulfillment of Health Services

A child whose health is disturbed, both physically and psychologically is a reflection of not achieving the child's welfare. To get the welfare of the child, every child has the right to get services from the government and the community. The government stipulates laws and regulations in order to enforce the right of children to obtain health services. However, the reality that occurs in the community is that children do not get maximum nutritional health services both at the puskesmas and hospital levels so that there is no decrease in the number of children suffering from malnutrition. There is a need for legal protection for malnourished children so that children's welfare can maximize the growth and development process properly. In this case, the law is tasked with ensuring the welfare of children and guarding the interests of children in providing child protection. This study uses a qualitative approach with empirical legal research techniques in data collection and uses content analysis in describing the data obtained. The results of the study found that the legal protection for malnourished children for the fulfillment of health services in the prevention of malnutrition in children who were not carried out optimally. Various cross-sectoral roles are needed in the effort to fulfill the rights of malnourished children. The implementation of legal health services based on Health Law no. 36 of 2009 must be implemented, especially in overcoming the problem of malnutrition so that all health problems can be overcome in an effort to overcome malnutrition.

Tomato By-Products, a Source of Nutrients for the Prevention and Reduction of Malnutrition.

Malnutrition is a global phenomenon that mainly affects children under five years old, the elderly and food insecure people. It can be linked to undernourishment or overnutrition. To prevent it, a healthy and balanced diet, rich in energy and micronutrients, is necessary. The objective of this study was to evaluate the nutritional composition and contribution of tomato by-products to prevent and reduce malnutrition. Thus, standard methods were used for proximate composition and bioactive compounds. Results showed that tomato by-products are rich in macronutrients and micronutrients capable of preventing undernutrition and reducing the incidence of the effects of overnutrition. The average carbohydrate, protein and lipid contents were 15.43%, 11.71% and 5.4% (DM) in peels and for seeds the contents were 58.75%, 15.4% and 22.2%, respectively. The average energy values were 280.47 kcal/100 g and 472.8 kcal/100 g DM for peels and seeds, respectively. The main minerals found were, in decreasing order, potassium, magnesium, sodium, iron and zinc. High contents of phenolic compounds, lycopene, β-carotene and vitamin C were also found in these by-products. They also presented important antioxidant activities. Due to their nutritional and bioactive compounds, tomato by-products may be included in functional food formulation programs to reduce the incidence of nutritional diseases.

Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 – 2018

BackgroundThe under-five mortality rates of children in South Africa (SA) remain high despite successful HIV prevention and treatment programs. The in-hospital mortality of children with severe acute malnutrition remains a key obstacle. This study identifies and describes changes in the mortality of under-five children with severe acute malnutrition (SAM) following the implementation of HIV and malnutrition prevention and treatment programmes.MethodsThis was a retrospective review of in-hospital mortality records and databases. The study was based at a large referral hospital in KwaZulu-Natal (KZN), where HIV and malnutrition rates are high, and SAM children are managed with standard WHO guidelines. Records of children under five years old who died from 2009 to 2018 were analysed.ResultsOf the 698 under-five children who died in this period, 285 (40, 8% of all under-5 deaths) were classified as having SAM. The number of HIV-infected SAM deaths dropped significantly, especially those below six months of age, mirroring the expansion of HIV treatment and prevention programmes. Despite this and a significant drop in the proportion of SAM admissions identified, there was no change in SAM case fatality rates over the ten years. Septicaemia remained the most common cause of death in children with SAM.ConclusionsDespite significant decreases in HIV-related malnutrition deaths over ten years, the lack of change in SAM case fatality rates is a concern at this referral hospital. Standardised WHO inpatient management protocols, may require review, especially where underlying medical conditions may contribute to SAM deaths in HIV-negative children.

Prevention, identification and management of malnutrition in older people in the community.

Malnutrition, specifically undernutrition, is a significant health concern among older people, yet it is under-detected and under-treated in the community. The causes of malnutrition are complex and multifactorial, and the risk has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic due to social isolation and loneliness, which can affect older people's appetite and thus reduce their nutritional intake. This article discusses the causes and consequences of malnutrition in older people and describes what is involved in malnutrition screening, person-centred care planning and treatment. The author considers various approaches to overcoming the barriers associated with identifying malnutrition in older people in the community and outlines the role of the nurse in the effective management of malnutrition in this population.

Assess the knowledge, attitude and practice regarding dietary practices in prevention of malnutrition among mothers with under five children in selected anganwadi in view of preparing self instructional module

Assess the knowledge, attitude and practice regarding dietary practices in prevention of malnutrition among mothers with under five children in selected anganwadi in view of preparing self instructional module

Effect of nutritional counselling for using anthropometric indices among Indians.

Malnutrition in children under 5 years is a major public health problem in developing countries. Malnutrition complex comprises of under-nutrition including multiple conditions like acute, chronic malnutrition, micronutrient deficiencies and nutrition related to obesity. Therefore, it is of interest to report data on the individualized nutritional counselling on nutritional status among mild to moderately malnourished children aged 2 - 5 years at one, three and six month follow up. Their dietary habits will help to determine the aetiology of mild/moderate malnutrition.150 Children attending outpatient department of the Department of Paediatrics of D Y Patil Medical College and admitted with mild/moderate malnutrition were included in the study after taking informed consent from their parents. The children were randomly allocated into 4 groups (group 1 - 4). The groups consisted of children where dedicated nutritional counselling was provided at 1 month, 1 and 3 month follow up and where-in no dedicated counselling was provided. A diet chart was provided with counselling. Group 4 followed up with routine care without any dietary intervention. Detailed dietary, socio economic history, clinical examination with anthropometry was done followed-up at 1, 3, 6 months from date of inclusion. Majority (57.3%) belonged to lower socio-economic class according to Kuppuswamy scale. The mean birth weight was 2.4 kg, age 34.5 months and age of weaning 7.6 months. Data shows that 70% children had mild malnutrition and 30% moderate malnutrition. At 6 month follow up amongst 105 children with mild malnutrition, 82 still had mild malnutrition, 4 normal, 19 had moderate malnutrition. Under-five childhood malnutrition is highly prevalent in poor socioeconomic strata of the society. Nutritional counselling provided by trained healthcare providers in existing settings are effective in improving nutritional status, daily calorie/protein intake, prevention of malnutrition. Prevention/treatment of co-existing illness bears equal importance.

A study to assess knowledge, attitude and practices of mothers of under five children regarding prevention of Protein Energy Malnutrition

A study to assess knowledge, attitude and practices of mothers of under five children regarding prevention of Protein Energy Malnutrition

Impact of malnutrition on clinical outcomes in patients diagnosed with COVID-19.

BackgroundCoronavirus disease 2019 (COVID‐19) is now the third leading cause of death in the United States. Malnutrition in hospitalized patients increases risk of complications. However, the effect of malnutrition on outcomes in patients infected is unclear. This study aims to identify the impact of malnutrition on mortality and adverse hospital events in patients hospitalized with COVID‐19.MethodsThis study used data from the National COVID Cohort Collaborative (N3C), a COVID‐19 repository containing harmonized, longitudinal electronic health record data from US health systems. Malnutrition was categorized into three groups based on condition diagnosis: (1) none documented, (2) history of malnutrition, and (3) hospital‐acquired malnutrition. Multivariable logistic regression was performed to determine whether malnutrition was associated with mortality and adverse events, including mechanical ventilation, acute respiratory distress syndrome, extracorporeal membrane oxygenation, and hospital‐acquired pressure injury, in hospitalized patients with COVID‐19.ResultsOf 343,188 patients hospitalized with COVID‐19, 11,206 had a history of malnutrition and 15,711 had hospital‐acquired malnutrition. After adjustment for potential confounders, odds of mortality were significantly higher in patients with a history of malnutrition (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.63–1.79; P < 0.001) and hospital‐acquired malnutrition (OR, 2.5; 95% CI, 2.4–2.6; P < 0.001). Adjusted odds of adverse hospital events were also significantly elevated in both malnutrition groups.ConclusionsResults indicate the risk of mortality and adverse inpatient events in adults with COVID‐19 is significantly higher in patients with malnutrition. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.

Nutritional Risk Is Associated with Earlier Death in Older Service Users with Common Chronic Diseases

ObjectivesThe objective of the study was to investigate associations of nutritional risk with mortality in older service users with common chronic diseases. MethodsWe used data from 2017–2018 in national registries in Norway (KPR and NPR) to investigate associations of nutritional risk with six months mortality in a cohort of service users ≥65 years (n = 45,701, mean age 83 years(range 63–106)) with common chronic diseases (COPD, heart failure, osteoporosis, stroke, type 2 diabetes or dementia). Nutritional risk status of the service users was assessed using validated screening tools recommended in the Norwegian guideline on prevention and treatment of malnutrition (either MNA or MUST). We applied Cox regression models to analyse associations of nutritional risk with death in service users with the six chronic diseases. The analyses were done on diagnose specific strata, and adjusted for age, gender and living situation (i.e., living with others vs living alone). ResultsOf the 45,701 service users, 27,160 (59%) were at nutritional risk and 7,269 (16%) died within six months. Service users that were at nutritional risk had increased risk of death compared to service users not at nutritional risk (20% vs 10%). Adjusted Hazard Ratios (HR) were 2.26 (95% confidence interval: 1.95, 2.61) for service users with COPD, 2.15(1.93, 2.41) for heart failure, 2.37(1.99, 2.84) for osteoporosis, 2.07(1.80, 2.38) for stroke, 2.65(2.30, 3.06) for type 2 diabetes and 1.94(1.74, 2.16) for service users with dementia. ConclusionsNutritional risk in older service users with common chronic diseases was strongly associated with earlier death. The finding warrant increased attention to prevention and treatment of malnutrition in community health services. Funding SourcesThe project was funded by Helse Fonna Local Health Authority, Norway.

Acquired Hypothyroidism Masquerading As Post Hepatitis Sequelae in a Moderate Acute Malnutrition Child

ObjectivesThe thyroid hormone influences the physiological process of almost all organ systems in children .It is essential for modulation of cardiovascular, neurological, gastrointestinal and metabolic function. In children at the early ages, it influences growth, physical and neurological development. As it is a preventable cause of intellectual disability, prompt recognition and treatment of hypothyroidism is integral to optimize physical and neurodevelopmental outcome.MethodsA 5 year 6 months old female child presented with history of 5 days of abdominal distension, fever and 1 episode of bloody stools. Examination showed icterus and bilateral pedal edema. Liver function test was deranged. Triglycerides and total cholesterol were elevated. Hepatitis serologies were negative. As there was no clinical improvement paediatric thyroid profile was requested which showed low T4 and significantly elevated TSH of 100 uIU/ml. Thyroid ultrasound was suggestive of thyroiditis .Anti-TPO antibodies were elevated. Treatment for Hashimoto's thyroiditis was initiated. Oral thyroxine was started at the dose of 5mcg/kg/day. The child improved symptomatically and icterus resolved. On follow up, her weight for height plotted was between −2 and −3 standard deviations and classified as moderate acute malnutrition. Diet counselling and nutritional supplements was initiated.ResultsAutoimmune thyroiditis is the most common cause of acquired hypothyroidism. Studies have shown thyroiditis to be linked with genetic loci such as CTLA-4, PTPN22. A goitre may not be present due to rapid immune-mediated destruction of the gland. Thyroid ultrasound is usually diagnostic. This child presented with jaundice, edema and abdominal distension. A post hepatitis sequelae was suspected but all serum markers were negative. Subsequently, hypothyroidism was diagnosed. On follow up, child was labelled as moderate acute malnutrition. This child is at risk for severe malnutrition; supplementary feeding and monitoring of growth curves should be done to ensure proper growth and development of the child.ConclusionsChildhood malnutrition is a public health crisis and a major cause of mortality under five years of age. Prevention of severe malnutrition is a global health goal. In a country like India, health programmes should focus on maternal and child malnutrition.Funding SourcesNone.