Protein-calorie Undernutrition Research Articles

Novel Assessment of Collagen and Its Crosslink Content in the Humerus from Primiparous Dairy Cows with Spontaneous Humeral Fractures Due to Osteoporosis from New Zealand.

Simple SummaryCollagen and collagen crosslinking are important determinants of bone strength. For the first time, collagen and its crosslink content were measured in the humerus from primiparous dairy cows with spontaneous humeral fracture due to osteoporosis from New Zealand. The results were compared with the humerus from unfractured dairy cows. Cows with a humeral fracture have a lower total collagen content but higher total collagen crosslink content compared with unfractured cows. The results suggest that protein/calorie undernutrition might be an important factor associated with the incidence of spontaneous humeral fractures in dairy cows from New Zealand.Numerous cases of spontaneous humeral fracture in primiparous dairy cows from New Zealand have prompted the study of the condition to establish probable causes or risk factors associated with the condition. Previous studies identified inadequate protein-calorie malnutrition as an important contributory factor. Earlier case studies also reported that ~50% of cows have low liver and/or serum copper concentration at the time of humeral fracture. Because copper is so closely associated with the formation of collagen cross-links, the aim of this study was to compare collagen and collagen crosslink content in the humerus from primiparous cows with and without humeral fractures and to determine the role of copper in the occurrence of these fractures. Humeri were collected from cows with and without humeral fractures, ground, and the collagen and collagen cross-link content measured using high-performance liquid chromatography. Collagen content was significantly higher in the humeri of cows without humeral fractures, while total collagen crosslink content was significantly higher in the humerus of cows with humeral fractures. These results indicate other factor/s (e.g., protein-calorie undernutrition) might be more important than the copper status in the occurrence of humeral fractures in dairy cows in New Zealand.

Undernutrition and HIV Infection in Sub-Saharan Africa: Health Outcomes and Therapeutic Interventions.

Sub-Saharan Africa (SSA) is disproportionately burdened by the twin epidemics of food insecurity and HIV infection, and protein-calorie undernutrition is common among persons with HIV (PWH) initiating antiretroviral therapy (ART) in the region. In this review, we discuss the intersection of HIV infection and undernutrition, health outcomes among undernourished PWH starting ART, and the demonstrated and potential benefits of therapeutic interventions such as micro/macronutrient supplementation and pharmacological agents. A low body mass index (BMI), used as a general indicator of poor nutrition in most studies, is associated with impaired immune recovery and increased mortality in the early ART period. The increased risk of mortality is multifactorial, and contributors include undernutrition-related immune system dysfunction, increased susceptibility to opportunistic infections, and metabolic and cardiovascular dysregulation. Clinical trials of micro/macronutrient supplementary feeding, appetite stimulants (hormones and anabolic agents), and recombinant adipokines have shown a benefit for weight gain and metabolic health, but there are few data on mortality or immune recovery. A substantial proportion of PWH in SSA are undernourished, and undernutrition contributes to an increased risk of mortality and other adverse health outcomes. To date, there have been few prospective trials of nutritional supplementation and/or pharmacologic therapy among undernourished PWH in SSA, though findings from other settings suggest a potential benefit in this population.

The Case for a Bariatric-Centered Approach to CKD Care.

Not too long ago, nephrologists were mainly interested in nutrition to understand how uremic cachexia and resultant protein–calorie undernutrition influenced their patients’ wellbeing. How times have changed. As the prevalence of obesity skyrockets to over 650 million individuals worldwide, the

Protein-calorie nutritional state in elderly patients hospitalized in Lomé Campus university hospital: Pilot study about 33 patients versus 30 reference cases registered in three care units

Objective. The aim of this study was to determine the protein-calorie nutritional status of elderly hospitalized patients admitted to the hepato-gastroenterology, cardiology and internal medicine departments of the Lomé Campus University Hospital and identify the endogenous and mixed undernutrition to provide patients with better nutrition and assistance. Methodology. This cross-sectional study conducted between April 1 and July 31, 2009, included 33 hospitalized case patients aged at least 55 years and 30 age-matched outpatient control subjects. Patients were evaluated according to body mass index (BMI), the Mini Nutritional Assessment (MNA), and their serum albumin, serum prealbumin and orosomucoid levels. Results. Among the hospitalized case patients, 37% had protein-calorie undernutrition (low serum albumin), and 73% were at risk of this undernutrition (low serum prealbumin). Five patients (16%) were endogenously undernourished and 17 (57%) exogenously undernourished. Six to 13% of the oupatient controls were undernourished and 33% at risk of undernutrition according to the MNA scale. A significant difference existed between the mean albumin values of case patients and controls (38 ± 9g/L vs 46 ± 7g/L, p = 0.002). Conclusion. Our results confirm that the elderly inpatients were regularly malnourished. Knowledge of their nutritional profile has allowed us to launch an improved nutritional assistance program and to supervise it properly.

Food restriction-induced myocardial dysfunction demonstrated by the combination of in vivo and in vitro studies

The aim of this study was to test the hypothesis that protein-calorie undernutrition decreases myocardial contractility jeopardizing ventricular function, and that ventricular dysfunction can be detected noninvasively. Five-month-old male Wistar-Kyoto rats were fed with regular rat chow ad libitum for 90 days (Control group, n = 14). A second group of rats received 50% of the amount of diet consumed by de control group (Food restricted group, n = 14). Global LV systolic function was evaluated in vivo, noninvasively, by transthoracic echocardiogram. After echocardiographic study, myocardial contractility was assessed in vitro in the isovolumetrically beating isolated heart in eight animals from each group (Langendorff preparation). The in vivo LV fractional shortening showed that food restriction depressed LV systolic function ( p < 0.05). Myocardial contractility was impaired as assessed by the maximal rate of rise of LV pressure (+dP/dt), and developed pressure at diastolic pressure of 25 mmHg ( p < 0.05). Furthermore, food restriction induced eccentric ventricular remodeling, and reduced myocardial elasticity and LV compliance ( p < 0.05). In conclusion, food restriction causes systolic dysfunction probably due to myocardial contractility impairment and reduction of myocardial elasticity.

Lipid Metabolism in the Preterm Infant

After completing this article, readers should be able to: 1. Describe the role of lipid in providing energy and essential fatty acids. 2. List the essential fatty acids, recommended intakes, and biochemical tests for deficiency. 3. Characterize the digestion and absorption of lipids and the effect of processing and storage on human milk lipids. Lipids play a fundamental role in providing the dietary energy density necessary to achieve positive energy balance, permitting optimal utilization of dietary protein for tissue growth, and supplying the essential n-6 and n-3 fatty acids. The effect of early malnutrition on infant growth and development, including long-term consequences to the central nervous system (CNS), is well recognized. Protein-calorie undernutrition results in decreased cell division and myelination in the developing brain, with potentially irreversible consequences to cognitive, motor, and behavioral development. Failure to provide an adequate lipid intake is likely to result in suboptimal energy intakes, which can significantly contribute to calorie undernutrition and proteolysis. Further, energy undernutrition in the preterm infant results in mobilization of limited adipose tissue lipids to provide metabolic fuel to support the essential physiologic processes needed to sustain life. Fatty acids have two broad functions: as sources of metabolic energy and as biologically active components of cell membranes (Fig. 1). These two functions are intimately entwined, particularly in the first days of life. The n-6 and n-3 polyunsaturated fatty acids cannot be synthesized by humans, but are required for a diverse array of essential biochemical and physiologic processes. These fatty acids are the precursors to oxygenated metabolites known as eicosanoids, and they are critically important in the developing CNS cell membranes, other membranes throughout the body, and many other processes. However, n-6 and n-3 fatty acids cannot be accreted optimally in tissue without providing sufficient lipid to ensure positive energy balance in addition to …

Neglect and Abuse Associated with Undernutrition in Long-Term Care in North America: Causes and Solutions

ABSTRACT Protein-calorie undernutrition in institutional long-term care is a significant cause of morbidity, mortality, increased health care costs, and poor quality of life. Failure to provide adequate nutrition constitutes neglect, and certain practices associated with feeding the dependent elder or adult with developmental disabilities can be abusive. The causes are multifactorial. They are related to conditions common to these persons; multiple medication use, difficulty in swallowing, gastrointestinal dysfunction, poor oral health and oral care, sensory changes with aging, and lack of education and training in the proper protocols required to provide adequate food and liquid to persons with cognitive and physical impairments. Solutions which are simple, cost-effective, easy to apply and cross national, ethnic, and cultural boundaries are described.

Growth Failure in Preterm Infants with Cerebral Palsy

Developmental and Behavioral Pediatrics| April 01 1999 Growth Failure in Preterm Infants with Cerebral Palsy AAP Grand Rounds (1999) 1 (4): 34. https://doi.org/10.1542/gr.1-4-34 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Growth Failure in Preterm Infants with Cerebral Palsy. AAP Grand Rounds April 1999; 1 (4): 34. https://doi.org/10.1542/gr.1-4-34 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cerebral palsy, infant, premature Source: Rogers B, Andrus J, Msall ME, et al. Growth of preterm infants with cystic periventricular leukomalacia. Dev Med & Child Neuro. 1998;40:580–586. The cause of growth failure in children with cerebral palsy is poorly understood. Rogers and colleagues studied the growth patterns of an unselected cohort of 51 preterm infants with cystic periventricular leukomalacia (CPVL) with a gestational age of <33 weeks admitted to Children’s Hospital of Buffalo from 1988 to 1993. Of 41 survivors, 39 developed CP. Twenty-four infants had oral feeding impairments which included requiring over 30 minutes to complete a feeding, coughing and gagging while feeding, abnormal chewing, or failure to drink from a cup by 2 years of age. Eighteen subjects developed growth failure during infancy. Of these, the majority (13 of 18) had signs of protein-calorie undernutrition using the Waterlow1 criteria and a growth pattern suggestive of chronic malnutrition in which body mass is gradually lost until linear growth is compromised. The presence of an oral feeding impairment was found to be the sole risk factor for the occurrence of growth failure (p<0.005). Birth weight, gestational age, sex, multiple birth and selected neonatal complications were not significantly associated with growth failure. The authors call for close, early monitoring of feeding abilities and growth in preterm infants, particularly when risk factors for CP such as CPVL are present. This study supplies compelling evidence that undernutrition is associated with growth failure in preterm infants with CPVL and CP, and underscores the need for systematic monitoring of growth and feeding. Despite the relatively small study cohort, a retrospective design, and the lack of raw data on nutritional intake or body composition, this study is noteworthy for its methodological strengths including a well-defined population, inclusion of head circumference data, longitudinal evaluations in the earliest months of life, and the use of well-established norms for undernutrition. The authors note that nutritional disorders are not as frequently recognized and treated in children with CP as they are in children with Crohn’s disease or cystic fibrosis.2 In children with CP, nutritional deficiencies can often be corrected and result in improved growth and cognitive, behavioral and social outcomes.3,4 The authors studied former preemies with CP due to cystic periventricular leukomalacia. While their conclusion cannot be extrapolated to all children with CP, their results do argue for a careful assessment of feeding and protein-calorie intake in any child with CP before growth failure is evident. A larger, equally rigorous study of children with CP from other causes is needed. You do not currently have access to this content.

Use of a Multidisciplinary Performance Improvement Team to Decrease the Incidence of Protein-calorie Undernutrition in a Gero-psychiatric Population

LEARNING OUTCOME: How to utilize a Performance Improvement Team and Continuous Quality Improvement tools to decrease the incidence of protein-calorie undernutrition in a gero-psychiatric population. Elderly patients with protein-calorie undernutrition (pcu), in long-stay institutions, have a 45.6% higher mortality rate than other patients. The elderly are major consumers of health care resources and, when malnourished, incur excess hospital costs and charges ranging from $1,730 to $6,157. In this institution, one hospital area with a census of 114 was perceived to be at particular risk due to the age, mental impairment, length of stay, and medical conditions of its patients. Hence, a multidisciplinary Performance Improvement (PI) Team was charted by Leadership. The objectives of the PI Team were to (1) confirm the incidence of pcu using accepted criteria; (2) identify related variables; (3) implement and monitor corrections; and (4) decrease the incidence of pcu in this population. Initial results confirmed that 21.8% of this population met the pcu criteria. To identify related variables, the PI Team did extensive literature review and used the technique of brainstorming to develop a cause and effect (fishbone) diagram. Identified variables and actions were prioritized based on feasibility and efficiency. The Team focused improvement activities on staff training in sensitization and feeding techniques, environmental changes in dining areas, adaptive feeding equipment assessment, and improving the quality of consistency diets. Corrections were monitored and 11 months later the data revealed that the incidence of pcu had decreased to 16.5%. It is concluded that the use of a multidisciplinary PI Team, using several continuous quality improvement tools, was successful in making improvements in the patients' nutritional status

Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients

To determine whether the level of protein-calorie undernutrition at presentation correlated with the subsequent risk of developing in-hospital complications independently of nonnutrition factors influencing outcomes, a prospective study was conducted of 110 consecutive admissions to a Geriatric Rehabilitation Unit (GRU) of a Veteran's Administration hospital. In total, 54 variables were evaluated as possible predictors of outcomes. The risk of developing at least one complication while on the GRU was studied by using multivariate techniques (discriminant function analysis) and was found to correlate with, in order of significance, functional status as admission, serum albumin concentration at admission, amount of weight lost in the year before admission, and the presence or absence of a renal or pulmonary disease. Nutrition variables also independently correlated with the risk of developing an infectious complication or a major life-threatening complication and dying within the hospital. These data indicate the importance of nutrition status in geriatric rehabilitation patients.

Protein‐Calorie Undernutrition in the Nursing Home

Protein‐Calorie Undernutrition in the Nursing Home

The role of protein in nutrition, with particular reference to the composition and use of enteral feeding formulas. A consensus report.

In its proposed classification scheme for reimbursement for enteral feeding formulas, the United States Health Care Financing Administration (HCFA) has neglected to consider the importance of making available formulas of varying protein content. In responding to HCFA's proposal, this consensus report reviews information currently available regarding different protein requirements in healthy, ill, and undernourished adults and elderly individuals. HCFA's reimbursement guidelines should reflect sound medical and nutritional practice rather than influencing it adversely, which its original proposal could do. Clinicians should have at their disposal enteral feeding formulas of varying protein/calorie ratios, especially since the following groups often have higher than average protein requirements relative to calorie requirements: the elderly, individuals with physiologic stress such as infection and injury, and patients with protein-calorie undernutrition.

Hyperalimentation of the cancer patient with protein-calorie undernutrition

Hyperalimentation of the cancer patient with protein-calorie undernutrition

Some effects of protein-calorie undernutrition on the developing central nervous system of the rat.

Some effects of undernutrition were noted in the brains of 21-day-old pups undernourished from birth by being reared by nursing dams fed on a low protein diet. As compared to the normally fed control pups, the body weight, brain weight, and thickness of the parietal neocortex and paravermal cerebellar cortex were significantly lower in the undernourished pups (p less than 0.001), while the thickness of the cortices of the dentate gyrus and hippocampus CA3 only reached significance at the 5% level. Again, as compared to the control pups, the number of spines per unit length on the distal dendritic segments of the pyramidal cells of lamina III of the parietal neocortex and of the hippocampus CA3 reached significance at the 5% level whereas that of the granule cells of dentate gyrus and Purkinje cells of the paravermis did not reach significance at the 5% level. The myelination of the pyramidal tract and spinal trigeminal tract in the lower medulla was less advanced in the undernourished pups. To date, the demonstration of precise functional correlates for the observed changes of morphological and physiological parameters in animals subjected to undernutrition has been elusive. An approach that may lead to unraveling this problem is suggested in a discussion of relating sources of input to the specific dendritic segments where the spine counts were made.

Prenatal undernutrition: Effects on behavior, brain chemistry and neuroanatomy in rats

The behavior and cerebral effects of prenatal protein-calorie undernutrition were investigated in newborn and postweanling rat pups. At birth, prenatally undernourished (PU) animals showed a deficit in body weight; however, by day 15 the difference was diminished and not significant. On days 13–18, PU pups required more trials for reversal learning of a water-escape response in a T-maze than control (C) pupsl however, on days 31–35, there was no difference between groups when trained to learn an active-avoidance response. Assessment of brain development showed that at birth, DNA and protein content were severely reduced in PU animals; however, normalization was noted in regional sections of the brain at 35 days of age. Brainstem reticular cells from PU pups at birth show less dendritic arborization and less terminal branching than cells from C pups. The results are discussed in terms of a delayed rate of maturation.

Protein-calorie undernutrition in hospitalized cancer patients

A survey of the nutritional status of hospitalized cancer patients was conducted in two phases. In phase 1, protein-calorie nutrition was evaluated in 54 ward patients by anthropometries, creatinine excretion and serum albumin. In phase two, 30 cancer patients with protein-calorie undernutrition were transferred to the Clinical Research Unit for study of the underlying mechanisms. Evaluation in this group included anthropometries, serum albumin, creatinine excretion, vitamin levels, caloric intake, basal metabolic rate and stool fat content. Duration of survival from study was recorded in both phases. We found a nearly universal prevalence of protein-calorie undernutrition in advanced cancer, with loss of adipose tissue, visceral protein and skeletal muscle varying unpredictably from patient to patient. The creatinine to height ratio was the most sensitive indicator of protein-calorie undernutrition; 88 per cent of the patients in both phases had a creatinine to height ratio less than 80 per cent of standard, whereas only 42 per cent and 23 per cent of these patients had values less than 80 per cent of standard for triceps skin fold and mid-arm muscle area, respectively. In phase 2, plasma folate, ascorbic acid and vitamin A levels were low in 20 to 45 per cent. Steatorrhea was rare. Neither the basal metabolic rate nor caloric intake differed from expected values for normal sedentary subjects of comparable size. The degree of malnutrition significantly correlated with survival. Patients who died within 70 days of study generally had a creatinine to height ratio <60 per cent of standard (18 of 19 patients), albumin <3.5 g/dl (16 of 23 patients) and/or triceps skin fold thickness <60 per cent of standard (12 of 19 patients). We conclude that protein-calorie undernutrition is present in most hospitalized cancer patients but that it varies widely in degree between subjects and is often obscured at the bedside by residual obesity. The creatinine to height ratio, however, is a sensitive quantitative indicator of this condition. There appear to be nutritional thresholds below which survival is decreased. Survival might be enhanced if nutrition could be maintained above these critical levels.

Protein-calorie undernutrition in hospitalized cancer patients: Nixon DW, Heymsfield SB, Cohen AE, Kutner MH, Ansley J, Lawson DH, Rudman D: Am J Med 1980; 68: 683–690

Protein-calorie undernutrition in hospitalized cancer patients: Nixon DW, Heymsfield SB, Cohen AE, Kutner MH, Ansley J, Lawson DH, Rudman D: Am J Med 1980; 68: 683–690

The effect of chronic protein-calorie undernutrition in the rat on myocardial function and cardiac function.

The effect of chronic protein-calorie undernutrition in the rat on myocardial function and cardiac function.

A radiographic method of quantifying protein-calorie undernutrition

Estimation of midarm adipose tissue and muscle by the anthropometric technique is based on the idealized assumption that the arm and its muscle compartments are circular, and that fat is distributed evenly around the arm. We examined the validity of these assumptions by computerized axial tomography of the midarm in 21 subjects ranging from 65 to 255% of ideal body weight. Computerized axial tomography identified three errors inherent in the anthropometric method: 1) The arm and its muscle compartment were rarely circular, but resembled instead an ellipse and “cloverleaf”, respectively; 2) fat was distributed asymmetrically around the arm, and furthermore when triceps skinfold was <5 mm, no fat was radiographically detectable, and 3) muscle area calculated by the anthropometric method includes bone area. Since bone area was not influenced by nutritional status, anthropometric “muscle area” underestimated the degree of muscle atrophy in undernutrition. Despite these limitations, in subjects 60 to 120% of ideal body weight anthropometric estimates of midarm muscle area (MAMA) and fat area did not differ greatly from the radiographic values. Anthropometric MAMA was consistently greater than the radiographic value by 15 to 25%, while midarm fat area agreed within ± 10%. The error in the anthropometric MAMA could be nearly eliminated by two types of correction: expressing MAMA as a percentage of normal, and correcting for bone content by subtracting midarm bone area (6.3 and 4.7 cm2 for men and women). In subjects >150% ideal body weight, however, anthropometric estimates of MAMA and midarm fat area differed from the radiographic values by >50% even after the above two types of correction. Midarm computerized axial tomography scan provides an accurate alternative to the anthropometric method for estimating midarm muscle and fat in these obese individuals.

Postnatal differentiation and growth of skeletal muscle fibres in normal and undernourished rats: A histochemical and morphometric study

The postnatal differentiation and growth patterns of the different histochemical muscle fibre types were studied at frequent age intervals in the extensor digitorum longus (EDL) muscle of normal rats and animals subjected to pre- and postnatal protein-calorie undernutrition. Three stepwise changes were seen in the fibre type composition of the EDL muscle during maturation. In newborn normal rats 2 histochemically and morphometrically distinct fibre populations occurred: small foetal type (type F) fibres or myotubes (about 90%), with the staining characteristics of the so-called type 2C fibres, and larger type 1 fibres (10%). At 5 days of age the percentage of type F fibres had dropped to 50 simultaneously with the emergence of a new population (40%) of type 2B fibres, intermediate in cross-sectional area between the remaining type F fibres and type 1 fibres. Between 15 and 20 days the small type F fibres practically disappeared with the emergence of a corresponding percentage (40%) of type 2A fibres, smaller than both type 1 and type 2B fibres. Between 20 and 60 days the percentage of type 1 rose from 10 to almost 30, type 2B fibres correspondingly diminishing in number but growing at a faster rate than either type 1 or type 2A fibres. In the undernourished rats the histochemical differentiation was retarded at birth, all fibres or myotubes being of the foetal type. However, large type 1 and type 2B fibres were seen at the age of 5 days and the histochemical maturation proceeded almost normally at later stages. On the other hand, at all ages there was a proportional reduction in the cross-sectional area of all fibre types, amounting to about 50% at 180 days, and not fully restituted by nutritional rehabilitation. These observations suggest that type F (type 2C) fibres are the undifferentiated precursors of all mature muscle fibres, their stepwise histochemical transformation raising the question of maturational differences in the different types of motoneurones.