Protein Malnutrition Research Articles

Nutritional Support for Alcoholic Liver Disease.

Malnutrition is a common finding in alcohol use disorders and is associated with the prognosis of patients with alcoholic liver disease (ALD). These patients also frequently show deficiencies in vitamins and trace elements, increasing the likelihood of anemia and altered cognitive status. The etiology of malnutrition in ALD patients is multifactorial and complex and includes inadequate dietary intake, abnormal absorption and digestion, increased skeletal and visceral protein catabolism, and abnormal interactions between ethanol and lipid metabolism. Most nutritional measures derive from general chronic liver disease recommendations. Recently, many patients with ALD have been diagnosed with metabolic syndrome, which requires individualized treatment via nutritional therapy to avoid overnutrition. As ALD progresses to cirrhosis, it is frequently complicated by protein-energy malnutrition and sarcopenia. Nutritional therapy is also important in the management of ascites and hepatic encephalopathy as liver failure progresses. The purpose of the review is to summarize important nutritional therapies for the treatment of ALD.

Distalization of Standard Roux-en-Y Gastric Bypass: Indications, Technique, and Long-Term Results.

Weight loss failure or weight regain after primary Roux-en-Y gastric bypass (RYGB) is a challenge for bariatric surgeons. Failure to achieve a body mass index (BMI) <35 kg/m2 after RYGB occurs in up to 40.0%. The aim of this study was to evaluate long-term results of a novel technique for distalization of Roux-en-Y gastric bypass (DRYGB) as a revisional procedure. Retrospective data were reviewed for 22 patients who had undergone RYGB and failed to achieve an excess weight loss (EWL) >50% or BMI <35 kg/m2 and underwent limb distalization between 2013 and 2022. For this DRYGB procedure, the length of the common channel was 100 cm, and the lengths of the biliopancreatic limb and the alimentary limb were 1/3 and 2/3 of the remaining bowel, respectively. The mean BMI values before and after DRYGB were 43.7 kg/m2 and 33.5 kg/m2, respectively. Five years after DRYGB, mean % EWL was 74.3% and mean % total weight loss (TWL) was 28.8%. Mean % EWL and mean % TWL of the two procedures (RYGB and DRYGB) after 5 years were 80.9% and 44.7%, respectively. Three patients experienced protein calorie malnutrition. One was reproximalized and the others were treated with parenteral nutrition with no recurrence. There was a significant decrease in the incidence of diabetes type 2 and dyslipidemia after DRYGB. The DRYGB procedure results in substantial and sustained long-term weight loss. Due to the risk of malnutrition, patients must be strictly followed for life after the procedure.

Metabolic Effects of Infection by the Stomach Worm Obeliscoides cuniculi in Rabbits Fed Diets Varying in Nutritive Quality

Rabbits parasitized by Obeliscoides cuniculi were used as models for stomach worm parasitism in ruminants. A 3 × 4 randomized complete block design containing three levels of infection (NI, no infection; LI and HI, infections produced by 1,800 and 30,000 larvae, respectively) and four levels of diet (PC, high protein and carbohydrate; pc, low protein and carbohydrate; Pc, high protein, and low carbohydrate; pC, low protein and high carbohydrate) was replicated four times. Mean weight gains for rabbits on diets pc or PC were not influenced by infection level, whereas LI rabbits on diets Pc and pC gained as well as the NI animals and more than the HI ones. Only HI rabbits exhibited anorexia. NI and LI rabbits had positive feed conversion efficiencies, whereas those of HI rabbits were negative. The apparent digestibilities of organic matter, protein, and ash in rabits with different infection levels varied with diet. Daily nitrogen balances were positive. The changes in concentrations of amino acids in the plasma typically associated with systemic, fever-producing infections or with starvation or protein-calorie malnutrition did not occur in infected rabbits. Only the high level infections produced adverse effects on productivity. These effects occurred on diets pc, Pc and pC and were mediated by anorexia.infection parasites rabbits metabolic effects

Physical performance of patients with chronic kidney disease stage 5D and coronary heart disease

BACKGROUND. Assessment of physical performance in patients is usually based on the results of the 6-minute walk test, which is primarily associated with heart or respiratory failure. THE AIM: to analyze the results of the 6-minute walk test with clinical and laboratory parameters of patients with CKD 5D, including criteria for protein-energy malnutrition. PATIENTS AND METHODS. 67 people with CKD 5D were examined, including 42 men and 25 women, mean age 49.0 ± 14.9 and 57.2 ± 15.5 years, respectively, p = 0.036. The duration of RRT in men was 96.1 ± 80.3 months, in women 100.7 ± 66.1 months, p = 0.810. The diagnosis of coronary heart disease was established in 22 people, 7 of them had AMI. The muscle strength of the skeletal muscles was assessed using a hand dynamometer, the performance of the skeletal muscles – during a test with a 6-minute walk. All patients filled out food diaries, where they indicated the qualitative and quantitative composition of the food which they consumed for 3 days. RESULTS. Walking load was most easily tolerated by patients without clinical manifestations of CAD. Between patients with and without AMI in history, the number of points on the Borg scale was comparable and reached the maximum values. The highest concentration of C-reactive protein and the lowest concentration of serum albumin were observed in patients who had had AMI. Relationships were found between serum albumin with C-reactive protein and the results of the 6-minute walk test, as well as between the mass index of the left ventricular myocardium with the results of the 6-minute walk test. CONCLUSION. Left ventricular hypertrophy masks the clinical signs of reduced physical performance, but increases the risk of cardiovascular complications. The results of the 6-minute walk test in patients with CAD should be evaluated in more detail. A number of studies are needed to clarify how dietary recommendations should be modified depending on the level of systemic inflammation in CKD.

Protein-Energy Malnutrition during Gestation and Lactation in Rats Affects Growth Rate, Brain Development and Essential Fatty Acid Metabolism

The influence of feeding a low protein diet to rat dams during gestation and lactation on lipid metabolism in pups was studied. Wistar rats were fed 5, 10, 15 and 25% dietary protein during gestation and lactation. Pup growth was monitored until weaning, and brain weight, protein concentration, proteolipid concentration and total lipid phosphorus concentration of brain were analyzed. The levels of fatty acids in dam milk as well as in pup liver phospholipids and brain prosphatidylcholine and phosphatidylethanolamine were determined. The progressive deprivation of maternal dietary protein produced a reduction in the total saturated fatty acid concentration of dam milk and an increment in the concentration of nonmetabolized linoleic acid. Pup body and brain weights as well as proteolipid, protein and total lipid phosphorus concentrations in brain were reduced in proportion to the degree of dietary protein deficiency. The products:precursor ratio of (n-6) fatty acids in liver phospholipids revealed an impairment in the elongation-desaturation pathway due to maternal protein deficiency. Both (n-6) and (n-3) polyunsaturated fatty acids within brain phosphatidylethanolamine were decreased by reduced maternal dietary protein intake, whereas only the linoleic acid-derived products were similarly affected in the corresponding phosphatidylcholine fraction. These results demonstrate the widespread and profound deleterious effects of low protein levels of maternal diet on the growth rate, brain development and fatty acid metabolism of rat pups.

Longitudinal association between dietary protein intake and survival in peritoneal dialysis patients

Background Decreased dietary protein intake (DPI) may lead to protein-energy malnutrition and may be associated with increased mortality risk. We hypothesized that longitudinal changes in dietary protein intake have independent associations with survival in peritoneal dialysis (PD) patients. Methods 668 stable PD patients were selected in the study from January 2006 to January 2018 and were followed up until December 2019. Their three-day dietary records were collected at the baseline (the sixth month after PD) and thereafter every 3 months for two and a half years. The latent class mixed models (LCMM) were used to identify subgroups of PD patients with similar longitudinal trajectories of DPI. The relation between DPI (baseline and longitudinal data) and survival was examined using Cox model to estimate death hazard ratios. Meanwhile, different formulae were used to assess nitrogen balance. Results The results showed that baseline DPI ≤ 0.60g/kg/day was associated with the worst outcome in PD patients. Patients with DPI 0.80–0.99g/kg/day and DPI ≥ 1.0g/kg/day both presented positive nitrogen balance; patients with DPI 0.61–0.79g/kg/day presented obviously negative nitrogen balance. Longitudinal association between time-dependent DPI and survival was found in PD patients. The consistently low DPI' (0.61–0.79g/kg/d) group was correlated with increased death risk as compared with the 'consistently median DPI' group (0.80–0.99g/kg/d, HR = 1.59, p = 0.008), whereas there was no difference in survival between 'consistently median DPI' group and 'high-level DPI' group (≥1.0 g/kg/d, p > 0.05). Conclusion Our study revealed that DPI ≥ 0.8 g/kg/day was beneficial to the long-term outcome for the PD population.

The CD45RA+ (Quiescent) Cellular Phenotype Is Overabundant Relative to the CD45RA- Phenotype within the Involuted Splenic T Cell Population of Weanling Mice Subjected to Wasting Protein-Energy Malnutrition

The objective of this investigation was to determine whether an imbalance between naive- and memory-phenotype cells occurs within CD4+ and/or CD8+ splenic T cell subsets in models of protein-energy malnutrition (PEM) which produce wasting disease (loss of ∼1.6% of body weight per day for 14 d) and profound depression in thymus-dependent immunity. Male and female weanling mice of disparate inbred strains, CBA/J and C57BL/6J, were allocated to the following groups: zero-time control (23 d old and 19 d old, respectively), ad libitum intake of a complete purified diet (19% crude protein, 17 kJ/g gross energy), restricted intake of the complete diet, and (C57BL/6J, only) ad libitum intake of an isocaloric low protein diet (0.6% crude protein). Surface expression of isoforms of CD45, a component of the T cell receptor complex, as well as of the accessory molecule, CD2, were assessed by flow cytometry of splenic mononuclear cell suspensions. Both major T cell subsets in the malnourished groups contained a significantly higher proportion of cells expressing the surface marker, CD45RA, than was found in the spleen cells of the control groups. CD45RA+ (naive-phenotype) T cells represent the extreme of quiescence and stringent activation requirements among thymic lymphocytes. The results provide the first clear evidence of a T cell subset imbalance in PEM which is consistent with depression in acquired immunity and which occurs, apart from antigenic challenge, in a site wherein immune responses take place. The T cell receptor complex may emerge as a focal point of the depressive influence of PEM on the competence of thymic lymphocytes.

Protein Energy Malnutrition-an Overview

Protein-energy malnutrition or PEM is the condition of lack of energy due to the deficiency of all the macronutrients and many micronutrients. It can occur suddenly or gradually. It can be graded as mild, moderate or severe. In developing countries, it affects children who are not provided with calories and proteins.

Pregnancy after Bariatric Surgery: Nutrition Recommendations and Glucose Homeostasis: A Point of View on Unresolved Questions.

Obesity is increasing in all age groups and, consequently, its incidence has also risen in women of childbearing age. In Europe, the prevalence of maternal obesity varies from 7 to 25%. Maternal obesity is associated with short- and long-term adverse outcomes for both mother and child, and it is necessary to reduce weight before gestation to improve maternal and fetal outcomes. Bariatric surgery is an important treatment option for people with severe obesity. The number of surgeries performed is increasing worldwide, even in women of reproductive age, because improving fertility is a motivating factor. Nutritional intake after bariatric surgery is dependent on type of surgery, presence of symptoms, such as pain and nausea, and complications. There is also a risk of malnutrition after bariatric surgery. In particular, during pregnancy following bariatric surgery, there is a risk of protein and calorie malnutrition and micronutrient deficiencies due to increased maternal and fetal demand and possibly due to reduction of food intake (nausea, vomiting). As such, it is necessary to monitor and manage nutrition in pregnancy following bariatric surgery with a multidisciplinary team to avoid any deficiencies in each trimester and to ensure the well-being of the mother and fetus.

Higher Muscle Mass and Higher Serum Prealbumin Levels Are Associated with Better Survival in Hemodialysis Patients during a Five-Year Observation Period.

Dialysis is the most commonly used renal replacement therapy in patients with end-stage renal disease. The mortality rate of hemodialysis patients is 15-20%, with cardiovascular complications being the most common. There is an association between the severity of atherosclerosis and both the development of protein-calorie malnutrition and inflammatory mediators. The aim of this study was to assess the relationship between biochemical markers of nutritional status, body composition and survival in hemodialysis patients. Fifty-three hemodialysis patients were included in the study. Serum albumin, prealbumin, and IL-6 levels were measured, as well as body weight, body mass index, fat content and muscle mass. The five-year survival of patients was calculated using Kaplan-Meier estimators. The long-rank test was used for univariate comparison of survival curves, and the Cox proportional hazards model was used for multivariate analysis of survival predictors. There were 47 deaths, 34 of which were due to cardiovascular disease. The hazard ratio (HR) for age in the middle-aged group (55-65 years) was 1.28 (confidence interval [CI] 0.58, 2.79) and 5.43 (CI 2.1, 14.07; statistically significant) for the oldest age group (over 65 years). A prealbumin level above 30 mg/dl was associated with an HR of 0.45 (CI 0.24, 0.84). Serum prealbumin (odds ratio [OR] = 5.23; CI 1.41, 19.43; p = 0.013) and muscle mass (OR = 7.5; CI 1.31, 43.03; p = 0.024) were significant predictors of all-cause mortality. Prealbumin level and muscle mass were associated with increased mortality risk. Identification of these factors may improve the survival of hemodialysis patients.

Incorporating handgrip strength examination into dietetic practice: A quality improvement project.

Protein-energy malnutrition is both prevalent and costly within the inpatient rehabilitation population. Registered dietitians play a key role in identifying, diagnosing, and treating protein-energy malnutrition. Handgrip strength has been shown to correlate with clinical outcomes, including malnutrition. Reduced handgrip strength is included as a criterion in national and international consensus guidelines of malnutrition diagnoses for functional changes. However, limited research and quality improvement projects have reported on its actual use in the clinical setting. The purpose of this quality improvement project was to (1) implement handgrip strength testing into dietitian care on three inpatient rehabilitation units to allow dietitians to identify and treat nutrition-related muscle function losses and (2) evaluate the feasibility, clinical utility, and clinical impact of this project. This quality improvement educational intervention demonstrated that handgrip strength is feasible, does not impact dietitian efficiency, and is clinically useful. Dietitians reported three areas in which handgrip strength provided value: assessing nutrition status, motivating patients, and monitoring responses to nutrition interventions. Specifically, they were able to shift away from focusing solely on change in weight to focusing on functional ability and strength. Although outcome measures demonstrated favorable outcomes, the results must be interpreted cautiously because of the small sample and pre-post uncontrolled design. Further high-quality research is required to provide more in-depth information on the utility and limitations of handgrip strength as an assessment, motivational, and monitoring tool for clinical dietetics.

Prolonged Egg Supplement Advances Growing Child's Growth and Gut Microbiota.

Protein-energy malnutrition still impacts children's growth and development. We investigated the prolonged effects of egg supplementation on growth and microbiota in primary school children. For this study, 8-14-year-old students (51.5% F) in six rural schools in Thailand were randomly assigned into three groups: (1) whole egg (WE), consuming 10 additional eggs/week (n = 238) (n = 238); (2) protein substitute (PS), consuming yolk-free egg substitutes equivalent to 10 eggs/week (n = 200); and (3) control group (C, (n = 197)). The outcomes were measured at week 0, 14, and 35. At the baseline, 17% of the students were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the C group the weight and height difference increased significantly in the WE group (3.6 ± 23.5 kg, p < 0.001; 5.1 ± 23.2 cm, p < 0.001). No significant differences in weight or height were observed between the PS and C groups. Significant decreases in atherogenic lipoproteins were observed in the WE, but not in PS group. HDL-cholesterol tended to increase in the WE group (0.02 ± 0.59 mmol/L, ns). The bacterial diversity was similar among the groups. The relative abundance of Bifidobacterium increased by 1.28-fold in the WE group compared to the baseline and differential abundance analysis which indicated that Lachnospira increased and Varibaculum decreased significantly. In conclusion, prolonged whole egg supplementation is an effective intervention to improve growth, nutritional biomarkers, and gut microbiota with unaltered adverse effects on blood lipoproteins.

Causes of death in children with congenital Zika syndrome in Brazil, 2015 to 2018: A nationwide record linkage study.

Children with congenital Zika syndrome (CZS) have severe damage to the peripheral and central nervous system (CNS), greatly increasing the risk of death. However, there is no information on the sequence of the underlying, intermediate, immediate, and contributing causes of deaths among these children. The aims of this study are describe the sequence of events leading to death of children with CZS up to 36 months of age and their probability of dying from a given cause, 2015 to 2018. In a population-based study, we linked administrative data on live births, deaths, and cases of children with CZS from the SINASC (Live Birth Information System), the SIM (Mortality Information System), and the RESP (Public Health Event Records), respectively. Confirmed and probable cases of CZS were those that met the criteria established by the Brazilian Ministry of Health. The information on causes of death was collected from death certificates (DCs) using the World Health Organization (WHO) DC template. We estimated proportional mortality (PM%) among children with CZS and among children with non-Zika CNS congenital anomalies (CA) by 36 months of age and proportional mortality ratio by cause (PMRc). A total of 403 children with confirmed and probable CZS who died up to 36 months of age were included in the study; 81.9% were younger than 12 months of age. Multiple congenital malformations not classified elsewhere, and septicemia unspecified, with 18 (PM = 4.5%) and 17 (PM = 4.2%) deaths, respectively, were the most attested underlying causes of death. Unspecified septicemia (29 deaths and PM = 11.2%) and newborn respiratory failure (40 deaths and PM = 12.1%) were, respectively, the predominant intermediate and immediate causes of death. Fetuses and newborns affected by the mother's infectious and parasitic diseases, unspecified cerebral palsy, and unspecified severe protein-caloric malnutrition were the underlying causes with the greatest probability of death in children with CZS (PMRc from 10.0 to 17.0) when compared to the group born with non-Zika CNS anomalies. Among the intermediate and immediate causes of death, pneumonitis due to food or vomiting and unspecified seizures (PMRc = 9.5, each) and unspecified bronchopneumonia (PMRc = 5.0) were notable. As contributing causes, fetus and newborn affected by the mother's infectious and parasitic diseases (PMRc = 7.3), unspecified cerebral palsy, and newborn seizures (PMRc = 4.5, each) were more likely to lead to death in children with CZS than in the comparison group. The main limitations of this study were the use of a secondary database without additional clinical information and potential misclassification of cases and controls. The sequence of causes and circumstances involved in the deaths of the children with CZS highlights the greater vulnerability of these children to infectious and respiratory conditions compared to children with abnormalities of the CNS not related to Zika.

Intestinal Parasites in School-Aged Children of Rumuodogo, Emohua Local Government Area, Rivers State, Nigeria

Aim: This epidemiological survey was carried out to assess the prevalence of intestinal parasites in School aged Children.&#x0D; Place and Duration of study: The study was carried out in Rumuodogo Community in Emohua Local Government area of Rivers State, Nigeria between the months of March to June 2019.&#x0D; Methodology: Microscopic examination of stool samples from 200 school-aged pupils between the ages 3-18 years was carried out using formol-ether concentration and direct wet mount, and stained iodine. Demographic as well as epidemiological data were obtained using a questionnaire.&#x0D; Results: The finding reveals an overall prevalence of 49.5%. However, there was a significant difference in the parasite prevalence values between the age groups (P = 0.01). The common intestinal parasites identified were Ascaris lumbricoides 19.5%, Ancylostoma duodenale 9.5%, Trichuris spp. 6%, Strongyloides spp. 4.5%, Enterobius spp. 1%, Taenia solium, 1.5%, Taenia saginata 1%, Entamoeba histolytica 4.5%, Giardia lamblia 4% and Schistosoma mansoni 2%. The prevalence of intestinal parasites infections with respect to the available and use of toilet facility revealed that Pit toilet users had the highest prevalence of 62 (56.9%) while no infection was recorded among users of water closet toilet. When age groups were compared, the result showed that age group 3-6 years were significantly more infected than the other age groups (P = 0.01). There was no significant difference between other age groups. The findings however, showed that age groups 6-10 years had the highest prevalence of 55.6%. Maximum of seven children had multiple infections. The male female ration was 62:37 while the percentage for males was 43.2% and 50% for females.&#x0D; Conclusion: Intestinal parasitic infections are associated with reduced development of children manifested by a reduced physical fitness which may result from vitamin deficiencies, inducing intestinal bleeding, and protein energy malnutrition. Therefore, the high prevalence of intestinal parasites recorded in this study calls for an intensified effort in the control of the infections. Regular deworming of children and environmental sanitation should be carried out to further reduce the prevalence.

The Relationship Between Child Anthropometry and Mortality in Developing Countries: Implications for Policy, Programs and Future Research

The prevention of child mortality is a commonly stated health goal in developing countries and the target of much international assistance in the health sector. Over the past decade the primary strategy for accelerating the reduction in child mortality has been the dissemination of simple, low-cost technologies, such as immunization, oral rehydration therapy and antibiotics, that target specific diseases (Huffmann and Steel 1994). This is done despite the knowledge that malnutrition and disease have a synergistic relationship (Scrimshaw et al. 1968) and that the optimal strategy may involve a combination of health and nutrition interventions. In the 1970s, for instance, it was estimated that malnutrition (notably protein-energy malnutrition--PEM) was the underlying or contributing cause of death for roughly half of all deaths to children aged 1-4 years in several Latin American countries (Puffer and Serrano 1973). Apart from this early study, however, there has been little effort to quantify the contribution of malnutrition to child mortality in other regions of the world in ways which are meaningful to policy. This paper reviews the results of 28 community-based, prospective studies, in 12 Asian and Sub-Saharan African countries, which examined the relationship between anthropometric indicators of malnutrition and child mortality. One purpose is to estimate the contribution of malnutrition to child mortality--distinguishing the effects of severe malnutrition from mild-to-moderate malnutrition--and to examine a number of related issues relevant to policy, programs and research in this area. The accumulated results are consistent in showing that the risk of mortality is inversely related to anthropometric indicators of nutritional status and that there is elevated risk even in the mild-to-moderate range of malnutrition. This latter result contradicts the findings from an earlier, landmark study which suggested that mild-to-moderate malnutrition was not associated with an increased risk of mortality (Chen et al. 1980). The present results indicate that somewhere between 20% and 75% of child deaths are statistically attributable to anthropometric deficits, with most estimates falling in the range 25-50%. When taking account of the relative proportions of severe versus mild-to-moderate malnutrition in the population, the results show further than 16-80% of all nutrition-related deaths are associated with mild-to-moderate malnutrition rather than severe malnutrition. In most studies 46-80% of all nutrition-related deaths are in the mild-to-moderate category.(ABSTRACT TRUNCATED AT 400 WORDS)

Healthcare utilization and outcomes in testicular cancer with and without HIV.

411 Background: Risk of testicular cancer (TC) was higher in HIV patients before combined antiretroviral therapy (cART) era. However the risk has decreased and outcomes reported to be similar since cART (PMID 17548695, 34592009). We evaluated the characteristics, outcomes, and healthcare utilization of patients with TC with and without HIV from a national sample. Methods: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database was queried to identify all TC patients with and without HIV from 2016-2019. The groups were compared for socio-demographic differences, medical comorbidities, inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included rates of orchiectomy, sepsis, septic shock, acute kidney injury, UTI, anemia, and protein energy malnutrition. Statistics were performed using t-test, univariate and multinomial logistic regression. Results: A total 265 admissions of HIV-TC and 29,450 non-HIV-TC were identified. HIV-TC patients were more likely to be in middle age group (45-65yrs) (38 vs 19% 40, p = 0.08) than non-HIV-TC who were younger &lt;45yrs (76 vs 62%, p = 0.08). Compared to non-HIV-TC, HIV-TC patients were more likely to be Black (36% vs 5%, p&lt;0.001), on Medicaid (47% vs 33%, p=0.002) or uninsured (12% vs 8%, p=0.002), treated at a teaching hospital (94% vs 84%, p=0.036). HIV-TC had a significantly higher comorbidity burden, prevalence of CKD and coinfection with Hepatitis B/C (all p&lt;0.05). Other comorbidities and secondary outcomes were not significantly different. The overall adjusted all-cause mortality was not significantly different between groups (aOR = 0.6, 95% CI 0.08-4.24, p = 0.61), however on subgroup analysis mortality was significantly increased for blacks (aOR = 1.98, 95% CI 1.07-3.66, p = 0.02) and Asians (aOR = 1.84, 95% CI 1.05-3.21, p = 0.03) compared to Caucasians. Mean LOS (7 vs 6 days, p = 0.49) and THC ($68,766 vs $69,371, p = 0.17) were similar between cohorts. Conclusions: HIV-TC patients were older, in the middle age compared to more younger (&lt;45 years) for non-HIV-TC patients. Although overall mortality and outcomes were similar between the groups, a racial disparity was seen with higher mortality in African American patients, the cause of which should be investigated in future studies.

Biotransformation of gluten-free composite flour mediated by probiotics via solid-state fermentation process conducted under different moisture contents.

Staple foods produced from composite flour are considered feasible to alleviate protein-energy malnutrition (PEM). However, one of the major limitations of composite flour is poor protein digestibility. The biotransformation process mediated by probiotics via solid-state fermentation (SSF) holds a promising potential to address the poor protein digestibility in composite flour. Yet, there is no report established in this regard to the best of our knowledge. Therefore, 4 strains of Lactiplantibacillus plantarum and Pediococcus pentosaceus UP2 isolated from Malaysian foods that were previously reported to produce versatile extracellular hydrolytic enzymes were employed to biotransform gluten-free composite flour derived from rice, sorghum, and soybean. The SSF process was performed under 30-60% (v/w) moisture content for 7 days, where samples were withdrawn at 24 h intervals for various analyses such as pH, total titratable acidity (TTA), extracellular protease activity, soluble protein concentration, crude protein content, and in vitro protein digestibility. The pH of the biotransformed composite flour showed a significant reduction from the initial range of pH 5.98-6.67 to the final pH of 4.36-3.65, corresponding to the increase in the percentage of TTA in the range of 0.28-0.47% to 1.07-1.65% from days 0 to 4 and remained stable till day 7 of the SSF process. The probiotics strains exhibited high extracellular proteolytic activity (0.63-1.35 U/mg to 4.21-5.13 U/mg) from days 0 to 7. In addition, the treated composite flour soluble protein increased significantly (p ≤ 0.05) (0.58-0.60 mg/mL to 0.72-0.79 mg/mL) from days 0 to 7, crude protein content (12.00-12.18% to 13.04-14.39%) and protein digestibility (70.05-70.72% to 78.46-79.95%) from days 0 to 4 of SSF. The results of biotransformation of 50% (v/w) moisture content were mostly comparable to 60% (v/w) moisture content, implying 50% (v/w) moisture content was the most suitable moisture content for the effective biotransformation of gluten-free composite flour mediated by probiotics via SSF since flour quality is better at lower moisture content. As for the overall performance, L. plantarum RS5 was ranked the best strain, attributed to the general improvement in the physicochemical properties of composite flour.

Nutritional evaluation, oxidative indexes, and functional properties of Irish potatoes, eggs, and red kidney beans based complementary food

Background: Protein-energy malnutrition (PEM) remains a serious public health concern in Cameroon. This disorder is frequent in childhood and is primarily caused by a deficiency in energy, protein, and micronutrients. Aims: This study aimed to develop novel complementary foods from suitable sources of proteins and minerals such as Irish potatoes (Solanum tuberosum L.), red kidney beans (Phaseolus vulgaris L.), and egg flours. Material and Methods: Different flours were prepared from local raw materials. Four blends (1 to 4) were formulated at different proportions and the nutritional composition, oxidative indexes, urease activity, and techno-functional properties of blends were assessed and compared to the Irish potato flour (control). Results: The protein (16.1 to 24.23 %) content was significantly (p &lt; 0.05) higher in blends than in the control (10.88 %). Blend 3 (60 % Irish potato, 25% Egg yolk, 15 % Egg white) showed the highest total calorie value (396.69 Kcal/100 g). Magnesium (2084 to 2470 mg/100 g), and iron (10.9 to 14.7 mg/100 g) contents were higher in blends than in the control (2053 and 9.9 mg/100 g respectively). Vitamins C and β-carotene contents in blends were 9.99 – 13.03 and 0.94 – 2.34 mg/ 100 g respectively. The peroxide value ranged from 5.3 to 8.98 meq O2 /Kg oil. Blend 3 showed the lowest urease activity (0.73 expressed as ΔpH). Concerning the techno-functional properties, the lowest bulk density (0.79 g/cm3) was obtained in blend 3. Blends 3 and 4 showed the lowest water absorption capacity (2.35 and 2.25 mL/g) and swelling capacity with 5.86 and 5.16 mg/g respectively. Conclusions: From our investigation, blend 3 could be used as a base for complementary foods as this blend presents the most nutritive and present the best techno-functional characteristics. Keywords: Blends, nutritional composition, peroxide value, urease activity, techno-functional properties.

Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review

Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. Twenty-six observational studies (n=9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.

Nutritional therapy for protein-energy malnutrition in children with sepsis

This review presents meta-analyses on nutrition in patients with critical illness using ASPEN/SCCM (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. The ESPNIC (2020) guideline, based on new evidence, complements most of the existing ASPEN (2017) guidelines for critical pediatrics. Childrens SSC (2020) did not find direct evidence and sufficient data to develop strong nutritional recommendations for children with sepsis/SS. Many issues remain unresolved, requiring systematic analysis. In the literature search, only a few randomized clinical trials have focused on the assessment and correction of protein-energy malnutrition in pediatric intensive care. Over the past decade, small and large pediatric studies have recommended nutritional therapy. However, given the heterogeneity of children admitted to intensive care units in terms of age, pathology, disease severity, presence of comorbidities, and nutritional status, it is unrealistic to expect that one nutrition strategy applies to all patients requiring intensive care. Therefore, most clinicians emphasize the need for an individualized approach to nutrition support in children, taking into account the pathology, severity, initial nutritional status, and riskbenefit ratio of different nutritional therapies. An extensive search of the literature on the problem did not reveal strong nutritional recommendations for children with sepsis/SS, which dictates the need for future research on the topic and correction of protein-energy malnutrition in children with sepsis/SS.