Protein Malnutrition Research Articles

1689-P: Clinical Outcomes among Nondiabetic Obese Population with Concomitant Protein-Calorie Malnutrition—A Nationwide Study

1689-P: Clinical Outcomes among Nondiabetic Obese Population with Concomitant Protein-Calorie Malnutrition—A Nationwide Study

Proximal Jejuno-Ileal Bypass as Revision of Roux-en-Y Gastric Bypass.

Bariatric surgery is established as a possibility for the treatment of obesity, allowing weight reduction and remission of obesity comorbidities. Reported suboptimal clinical response rates are as high as 30-60% (insufficient weight loss or gain, defined as BMI greater than 35kg/m2 or excess weight loss less than 50%). Proximal jejuno-ileal bypass (PJIBP) is a promising option when re-intervention is required. To describe the standardization of a proprietary technique of modified PJIBP as a management procedure in patients with post-gastric bypass recurrent weight gain or insufficient post-intervention weight loss. This study evaluated a case series of 10 Latin American patients requiring post-bariatric re-intervention, between February 2018 and 2023, in a single-metabolic surgery center in Cali-Colombia. Median age was 45years (26-70 RIC), 60% female, and 40% male. Mean BMI at conversion was 36.7kg/m2 (6.4 SD). Median follow-up was 22months (RIC 16-30). Mean percentage of excess weight lost was 78% (22.4 SD). One hundred percent achieved glycemia control, only one patient persisted with dyslipidemia, and no patient presented hypoalbuminemia. At the end of follow-up, 100% received vitamin supplementation. PJIBP could be an effective procedure, associated with positive results in relation to weight loss and resolution of obesity comorbidities. Deficiencies of fat-soluble vitamins and protein malnutrition represent the main concern in the long term, so multidisciplinary management and continuous follow-up are required.

Dynamic Interplay of Age and Protein Malnutrition on the Pharmacokinetic Profile of Acetaminophen in Wistar Rats

Abstract Objectives Age and protein malnutrition (PMN) are well-known determinants of drug pharmacokinetics. The combined influence of age and nutrition on the pharmacokinetics of acetaminophen (APAP) remains insufficiently explored; therefore, this study investigates the role of age and PMN on APAP pharmacokinetics. Materials and Methods Wistar rat weanlings were divided into four groups. Groups ND-5 (n = 6) and ND-18 (n = 6) were fed with normal diet (ND, 18% protein) and groups LPD-5 (n = 6) and LPD-18 (n = 6) were fed with low-protein diet (LPD, 10%) for 5 and 18 months, respectively. Blood samples were collected at different time intervals (0, 0.5, 1, 3, 6, 24, 36, and 48 hours), and plasma was separated and analyzed for APAP using high-performance liquid chromatography. Pharmacokinetic data was analyzed by the noncompartmental model using Phoenix WinNonlin 8.3 software. Results The pharmacokinetic parameters of APAP were elevated in both LPD groups compared with their age-matched controls. The average area under the curve was increased by approximately 131% (LPD-5) and 17.57% (LPD-18), and the average maximum plasma concentrations (Cmax) was increased by 33.5% (LPD-5) and 26.3% (LPD-18) compared with their respective age-matched controls. The average mean retention time was approximately 114% (LPD-5) and 17.4% (LPD-18) higher than their respective age-matched controls, whereas the clearance rate (Cl/F) and volume distribution (Vz/F) of the drug were significantly lower. Consequently, there was a 68.5% (ND-5) and 4.73% (ND-18) prolongation in the mean half-life of APAP. Conclusion The altered pharmacokinetics may arise from the intricate interplay of dietary and age influences on physiology, protein binding, and cytochrome P450enzyme activity/expression. However, the exact reason requires further investigation for a better understanding of vulnerable populations.

Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index

Results from long-term follow-up after biliopancreatic diversion with duodenal switch (DS) are scarce. To compare weight loss, health outcomes, and quality of life 10 years or more after Roux-en-Y-gastric bypass (RYGB) and DS surgery in patients with severe obesity-that is, a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 50 to 60. This open-label randomized clinical trial was conducted at 2 academic bariatric centers in Sweden and Norway. Sixty patients with a BMI of 50 to 60 were included from March 1, 2006, to August 31, 2007. Data were analyzed from August 12, 2022, to January 25, 2023. Laparoscopic RYGB or laparoscopic DS. The main outcome was change in BMI after 10 or more years. Secondary outcomes included anthropometric measures, lipid and glycemic profiles, bone mass density, adverse events, gastrointestinal tract symptoms, and health-related quality of life. Forty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years (mean [SD] age, 48.0 [6.0] years; 35 women [73%]). At follow-up, the mean BMI reductions were 11.0 (95% CI, 8.3-13.7) for RYGB and 20.3 (95% CI, 17.6-23.0) for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; P < .001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (P = .001). Mean serum lipid levels, except high-density lipoprotein cholesterol and hemoglobin A1c, improved more in the DS group during follow-up. Bone mass was reduced for both groups from 5 to 10 years, with lower bone mass after DS at 10 years. Quality-of-life scores (Obesity-Related Problem Scale and the 36-Item Short Form Health Survey) were comparable across groups at 10 years. The total number of adverse events was higher after DS (135 vs 97 for RYGB; P = .02). More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; P = .008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; P = .005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, of whom 3 (10%) underwent revisional surgery. In this randomized clinical trial, BMI reduction was greater after DS, but RYGB had a better risk profile over 10 years. Biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50 to 60. ClinicalTrials.gov Identifier: NCT00327912.

Impact of protein energy malnutrition on hospitalized patients with acute myeloid and lymphoid leukemia: A United States population-based cohort study.

6548 Background: Acute leukemia poses a significant burden to the society and the healthcare system. Advances in chemotherapeutics and hematopoietic stem cell transplantation (HSCT) have increased survival in these patients. Protein energy malnutrition (PEM) frequently complicates the clinical picture in patients with cancer, however data on the impact of PEM in patients with acute myeloid and lymphoid leukemia is limited. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with acute leukemia (myeloid and lymphoid) and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with acute leukemia based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &lt;0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charge among patients with acute leukemia. Results: We identified a total of 30995 hospitalized patients with acute leukemia, of which 13.06% (4050/30995) had comorbid PEM. The overall in-hospital mortality among patients with acute leukemia was 8.95% (2775/30995). Among those with co-morbid PEM, the mortality rate was significantly higher at 12.47% (505/4050, p&lt;0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 1.50; 95% (confidence interval [CI], 1.18 -1.91); p=0.001), longer LOS (coefficient 10.50; CI 8.59 -12.41; p&lt;0.001), and higher total hospitalization charge ($208,308; CI $147,516- $269,100; p&lt;0.001). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with acute leukemia and significantly worsened outcomes including increased in-hospital mortality, LOS, and cost of healthcare utilization. A proactive approach for prevention and early management of cancer associated malnutrition is required. Further prospective multicentric studies are needed to better describe these associations.

Impact of protein energy malnutrition on hospitalized patients with lung cancer: A United States population-based cohort study.

11160 Background: Lung cancer is the leading cause of cancer related deaths in the United States. Patients with advanced lung cancer tend to have varying degrees of protein energy malnutrition (PEM), due to multiple reasons including cancer related cachexia, sarcopenia, and adverse effect of chemotherapy. However, the impact of PEM on clinical outcomes in this subgroup needs further exploration. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with lung cancer and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with lung cancer based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &lt;0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charge among hospitalized patients with lung cancer. Results: We identified a total of 92425 hospitalized patients with lung cancer, of which 10.53% (9739/92425) had comorbid PEM. The overall in-hospital mortality among patients with lung cancer was 5.79% (5360/92425). Among those with concomitant PEM, the mortality rate was significantly higher at 13.13% (1279/9739, p&lt;0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 2.11; 95% (confidence interval [CI] 1.77-2.51; p&lt;0.001), longer LOS (coefficient 3.02; CI 2.62-3.42; p&lt;0.001), and higher total hospitalization charge (coefficient $22105; CI $13423- $30786; p&lt;0.001). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with lung cancer and associated with worse outcomes. Efforts should be made to promote nutritional assessment and screening mechanisms with the aim to initiate early nutritional support as indicated. Further prospective studies are warranted to better understand these associations and guide management.

Nutritional status and some related factors of the elderly at the Central of Care for the Ages Tuyet Thai, Ha Noi in 2023

The elderly have many changes in physiological functions in the body, especially changes in nutritional status, but more specifically, malnutrition. Objectives: To describe nutritional status and analyze some factors related to nutritional status of the elderly at Tuyet Thai Elderly Care Center from January 2023 to June 2023. Subjects and methods: Research on 100 elderly people at Tuyet Thai Elderly Care Center. Nutritional status was assessed by anthropometric methods measuring weight, height, leg circumference, nutritional status by MNA toolkit, and assessment of albumin index, serum protein. Results: Average weight and height were 48.8 ± 9.7 (kg) and 155.5 ± 8.1 (cm). According to MNA, 20.0% of subjects had normal nutritional status; 47.0% are at risk of malnutrition and 33.0% are malnourished. The rate of malnutrition (SDD) according to waist circumference, albumin, protein was 70.0%, respectively; 22.4% and 47.1%. The group ≥ 75 years old has a higher risk of malnutrition according to MNA than the group &lt; 75 years old, the group with dementia has the risk of malnutrition according to MNA 8.5 times higher than the group without dementia, the This difference is statistically significant (p &lt; 0.05). There was a statistically significant difference in both albumin and protein malnutrition between the groups with and without dementia. Conclusion: The proportion of elderly people at risk of malnutrition at Tuyet Thai Elderly Care Center is quite high, accounting for 70.0% according to the circumference of the abdomen and legs; 80.0% by MNA; 22.4% by albumin and 47.1% by protein. Key words: nutritional status, relationship, elderly care center.

Racial disparities in patients with ALL according to a national dataset.

e13733 Background: Racial disparities in healthcare refer to differences in health outcomes, access to healthcare &amp;quality of care among racial or ethnic groups. Aim of study is to investigate the characteristics and clinical outcomes of racial differences in patients admitted with ALL. Methods: We queried the National Inpatient Sample between 2017-2020 for adult patients of different races who were hospitalized with ALL. The primary outcome was inpatient mortality; secondary outcomes were cardiac arrest, invasive mechanical ventilation, length of stay &amp; hospital cost. Multivariable logistic, linear &amp; Poisson regression analyses were used to estimate clinical outcomes with p-value &lt; 0.05 was significant. Results: Total 110999 hospitalizations with ALL. Mean age 46 years &amp; 55.8% male. Among admitted, 59599 (53.7 %) were Caucasian, 9205 (8.3 %) were Black, 27565 (24.8%) were Asian, 4540 (4.1%) were Hispanic, and 10090 (9.1%) were others. Subgroup with Caucasian, Blacks, Asians, Hispanics, and other races had Medicare 34.9% vs 30.2% vs 13.5% vs 17.9% vs 12.5%, Medicaid 13.3% vs 29.7% vs 41.4% vs 19.2 vs 34.8%, Non-insured 2.1% vs 5.1% vs 10.6% vs 4.2% vs 7.7%; DM 19% vs 23.8% vs 24.6% vs 17.4% vs 20.7%; Protein calorie malnutrition 11 % vs 10.6% vs 10.1% vs 12.6% vs 10.2%, respectively. All-cause mortality was 3810, where subgroup with Caucasian, Black, Asian, Hispanic, and others were 2085 (3.5%) vs 410 (4.4%) vs 885 (3.2%) vs 145 (3.2%) vs 285 (2.8%). Conclusions: Among the racial categories, Caucasians comprised the largest portion followed by Asians, Blacks, Hispanics. Mortality and intubation proportion was highest among Blacks followed by Hispanics &amp; Asians. Cardiac arrest proportion was highest among Blacks followed by Hispanics and Asians. LOS was highest among Hispanics followed by Asians &amp; Blacks. Resource utilization was highest in Hispanics followed by Asians &amp; Blacks. Understanding these disparities is essential for improving healthcare equity and ensuring that all patients receive appropriate &amp; equitable care regardless of their racial/ethnic background. Interventions include improving access to healthcare, culturally competent care and addressing social determinants of health that affect racial/ethnic groups. [Table: see text]

Impact of protein-energy malnutrition on patients with breast cancer hospitalized for acute decompensated heart failure: Insight from the NIS database 2020.

Impact of protein-energy malnutrition on patients with breast cancer hospitalized for acute decompensated heart failure: Insight from the NIS database 2020.

The association of protein-energy malnutrition and in-hospital clinical outcomes among patients with colorectal cancer hospitalized for gastrointestinal bleeding: A nationwide analysis.

The association of protein-energy malnutrition and in-hospital clinical outcomes among patients with colorectal cancer hospitalized for gastrointestinal bleeding: A nationwide analysis.

#2900 Appetite changes as a predictor of mortality among end-stage renal disease patients (ESRD) on maintenance hemodialysis: one year survival analysis

Abstract Background and Aims End-stage renal disease (ESRD) has become a major health problem worldwide. Appetite loss is a dominant feature of the disease which plays an important role in protein energy wasting and malnutrition, with subsequent higher rates of mortality. The study aimed to examine appetite changes among patients with ESRD on maintenance hemodialysis and its association with one-year mortality. Method This is a prospective observational study that was conducted at Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University and Aga Hospital Dialysis Unit over a period of one-year Patients who fulfilled inclusion and exclusion criteria were included. The study was explained to all participants and informed consent was obtained. All demographic, clinical, and laboratory data were collected. Appetite was assessed using the following 4 scores: subjective assessment of appetite, the self-assessment of appetite changes for 30 days, The Visual Analog Scale (VAS), and The Functional Assessment of Anorexia/Cachexia Therapy (FAACT). All patients were followed up for one year to report the mortality events. Results The current study included 162 hemodialysis patients whose age (SD) was 48.72±12.64 years, and males constituted 57.4% of them. Around 44.4% of the cases reported having good appetite using the subjective assessment score, and 13% reported decreased appetite using the self-assessment of appetite score. The median VAS score was 80, and the FAACT score ranged from 7 to 32 with a mean value of 15.85. After one year of observation, death occurred in 24/162 (14.8%). There were statistically significant differences in mean values of three appetite scores among both dead and alive groups with lower values reported in the deceased one [self-assessment of appetite (p=0.019), VAS score (p=0.001), and FACCT (p=&amp;lt;0.001)]. The ROC analysis shows that FACCT &amp; VAS scores were able to determine patients who destinated to mortality with area under curve (AUC) of (0.774 &amp;0.704), at a cut-off point of (14.5%, and 75), with sensitivity of (83.3% &amp;and 66.7%) and specificity of (61.6%, and 53.6%), respectively. Kaplan Meier survival analysis demonstrated that VAS &amp; FACCT scores had a statistically significant effect on median survival time among studied cases. Lower median survival time was detected among cases with decreased appetite by self-assessment tool, VAS score less than 80, and FACCT score less than 15. Kaplan-Meier and hazard curves for the included sample showed lower Median survival time (95% CI) among patients with diminished appetite by the 4 scores: 311.67(265.98-357.36) by self-assessment score (p=0.008), 344.28 (329.57-358.9) days by subjective assessment of appetite (p=0.28), 342.33(330.46-354.19) days by VAS score (p=0.016), and 332.01(314.6-349.43) days by FAACT score (p&amp;lt;0.0001). Cox regression analysis demonstrated that VAS and FACCT scores were statistically significant predictors of median survival time among studied cases (p&amp;lt;0.001, &amp;lt;0.001) and hazard ratio (HR) of (0.968 &amp; 0.734), respectively. Conclusion Diminished appetite is prevalent among hemodialysis patients. Poor appetite is associated with higher mortality. Lower appetite score values can predict mortality among such patients.

Effect of Culinary Treatments on Nutritional and Anti- nutritional Profils of Sesame Oilcake for Use in Fighting Protein Malnutrition

To tackle protein malnutrition, the valorization of sesame cake has been initiated. A by-product of sesame oil extraction, it is commonly used as livestock feed. However, it could be used to enrich staple foods and improve their nutritional value, particularly in rural areas where access to quality protein sources is limited. In order to highlight its nutritional richness, certain soaking, roasting and hulling treatments were used to assess their impact on nutritional quality. Then extraction of the oil from the seeds using a mechanical press to obtain sesame cake was proceeded. Standard methods were used for physicochemical characterization of nutritional, mineral and anti-nutritional compounds. The results showed that the sesame oilcake obtained from the various treatments contained significant levels of total protein (26.55- 36.72g/100g DM), residual lipids (24.19- 32.37g/100g DM), carbohydrates (10.86- 18.74g/100g DM), ash (4.32 - 6.19 g/100g DM) and fiber (10.71-20.76 g/100g DM). Similarly, evaluation of the mineral composition of these meal concentrates showed their richness in phosphorus (20.47 - 176.66 mg/100g DM), calcium (15.75 - 467.42 mg/100g DM), magnesium (13.45 - 340.33 mg/100g DM), iron (4.90-14.70 mg/100g DM), and zinc (0.71-4.39 mg/100g DM). However, these sesame cake concentrates also contained anti-nutritional factors such as oxalates (0.48 - 1.04 mg/100g DM), phytates (0.08 - 0.12 mg/100g DM), saponins (0.084 - 1.10 mg/100g DM) and tannins (0.33 - 1.36 mg/100g DM). Fortunately, these were considerably reduced by pretreatment. Indeed, a 40.07, 83.33, 64.64 and 60.95% reduction in tannins, phytates, oxalates and saponins respectively were observed. The considerable reduction in anti-nutrients in the various cakes is an advantage for the digestibility and nutrient availability of this feed. Its high protein and mineral content could therefore be considered for use in protein malnutrition.

Effect of Substitution of Cowpea Sprouts Flour (Vigna unguiculata L.) and Sorghum Flour (Sorghum bicolor L.) of Chemical Quality and Organoleptic Quality on Biscuits as Supplementary Feeding Recovery for Protein Energy Malnutrition School Age Children

Abstract: Malnutrition status in school-age children (5 – 12 years) based on BMI/U nationally reaches 9.2% (very thin category 2.4% and thin 6.8%) while the prevalence of malnutrition in East Java Province is 8% and Malang city region is 7.69%. Overcoming PEM in school-age children by providing diet therapy in the form of Providing Supplementary Food to School Children (PMT-AS). Additional food based on local food ingredients using cowpea sprout flour (Vigna unguiculata L.) and sorghum flour (Sorghum bicolor L.). The aim of the research was to analyze the effect of substitution of cowpea sprout flour and sorghum flour on the chemical quality and organoleptic quality of biscuits as PMT for PEM school-age children. This type of experimental research with a RAL design consists of 4 treatment levels with 3 repetitions, namely P0 (100:0:0), P1 (40:55:5), P2 (40:45:15), P3 (40:35:25). The chemical quality results of biscuits using the calculated value method are carbohydrate content (59.27 – 62.27 g/100 g), protein content (7.31 – 10.56 g/100 g), fat content (16.16 – 16.64 g/100 g), and energy value (423.75 – 428.45 Kcal). The organoleptic quality of biscuits had a significant effect on the panelists’ liking for color (p=0.000), taste (p=0.000), and aroma (p=0.000) but did not have a significant effect on texture (p=0.221). The best formulation of PMT biscuits with the substitution of cowpea sprout flour and sorghum flour for PEM school-aged children is treatment P2 (40:45:15).

Effects of thermal processing on the nutritional and antinutritional properties of African yam bean (Sphenostylis stenocarpa) seed flours

The study was carried out to evaluate the effects of thermal processing treatments on nutrient and antinutrient contents of African yam bean seed flours. The African yam bean seeds were sorted, cleaned and divided into five equal lots of one kilogram each. Four lots were processed into boiled, blanched, roasted and autoclaved African yam bean flours, while the last lot was processed raw and used as control. The flour samples obtained were analysed for proximate, mineral, vitamin and antinutrient contents using standard methods. The proximate composition of the samples revealed that the flours had a range of 6.14-11.24% moisture, 8.18-14.37% crude protein, 3.06-4.61% fat, 2.04–3.32% ash, 3.18–3.56% crude fibre, 62.90–76.98% carbohydrate and 350.57–368.50 kJ/100g energy, respectively. The mineral composition of the samples showed that the flours contained 128.81–174.16 mg/100g calcium, 88.86–212.20 mg/100g, potassium, 134.71–166.77 mg/100g phosphorus, 89.17 – 122.76 mg/100g, magnesium, 14.28–18-11 mg/100g iron and 3.24–5.59 mg/100g zinc, respectively. The vitamin composition of the flours were 1.15–1.37 mg/100g ascorbic acid, 1.15–135 mg/100g thiamine, 1.19–1.55 mg/100g niacin, 1.34–1.85 mg/100g riboflavin, 1.09–1.29 mg/100g folic acid, 1.37–1.95 mg /100g vitamin A and 1.27–1.66 mg/100g vitamin E, respectively. The results showed that the roasted and autoclaved African yam bean flours generally had higher crude protein, fat, ash, crude fibre, mineral and vitamin contents than the boiled and blanched flour samples compared to the raw sample. The antinutrient composition of the flours also showed that the levels of trypsin inhibitor activity, tannin, phytate, oxalate, saponin and haemagglutinin of the samples were significantly (p&lt;0.05) reduced by boiling, autoclaving roasting and blanching treatments compared to the raw sample. However, the study revealed that the processed African yam bean flours have the potentials to be used as nutrient dense ingredients in the preparation of a wide range of food products than the raw sample especially in both underdeveloped and developing countries where the problems of protein-energy malnutrition and micronutrients deficiencies are prevalent.

Comparative analysis of different therapeutic approaches in the management of protein-energy malnutrition: Case reports from a clinical setting.

Severe protein-energy malnutrition (PEM) presents a significant clinical challenge, often compounded by comorbidities such as type 2 diabetes. This case report aims to elucidate the intricacies of managing severe PEM in conjunction with type 2 diabetes, emphasizing the importance of personalized interventions and multidisciplinary collaboration in achieving optimal outcomes. By addressing the unique challenges this complex clinical scenario poses, this report contributes valuable insights to the medical literature and guides clinicians in effectively managing similar cases. The patient, pseudonymously identified as Emma Thompson, underwent a comprehensive diagnostic evaluation to assess her symptoms' severity and underlying causes. This included a thorough physical examination, laboratory testing, imaging studies, and collaboration with specialists to formulate a tailored treatment plan. Interventions were meticulously administered, with dosages, strengths, and durations adjusted based on ongoing assessments and patient response. Implementing multidisciplinary therapeutic interventions significantly improved the patient's nutritional status, glycemic control, and overall well-being. Objective measures such as BMI, serum albumin levels, and physical functioning showed marked improvement throughout treatment. Patient-reported outcomes indicated enhanced quality of life, reduced fatigue, and increased energy levels, underscoring the comprehensive success of the integrated therapeutic approach. This case report highlights the efficacy of a holistic, patient-centered approach in managing severe PEM and comorbid type 2 diabetes. Optimal outcomes were achieved by addressing the complex interplay of medical conditions through tailored interventions and multidisciplinary collaboration. The lessons from this case underscore the importance of individualized care, ongoing assessment, and long-term follow-up in enhancing patient well-being and guiding future clinical practice.

Optimization of Blending Ratio of Emmer Wheat Flour, White Sesame Powder and Sweet Potato Leaves Powder to Produce Nutrient-Dense and Sensory Acceptable Gruel

ABSTRACT This study focuses on optimizing the blending ratio of Emmer Wheat Flour (EWF), White Sesame Powder (WSP), and Sweet Potato Leaf Powder (SPLP) to improve the nutritional and sensory properties of gruel for children up to 2 years of age. Thirteen formulations were created with the help of D-optimal mixture design (Minitab Ver. 19.2), considering EWF (70–80%), WSP (10–20%), and SPLP (5–10%). The resulting gruel underwent analysis for proximate, mineral, functional, anti-nutritional, and sensory properties. Graphical optimization revealed that a blend of 71.30% EWF, 20% WSP, and 8.70% SPLP yielded nutrient-enriched gruel with high sensory acceptability (Desirability: 0.85). This optimized gruel contains essential nutrients, including fat (8.35%), protein (15.058%), fiber (8.27%), carbohydrates (62.073%), energy (425.91 kcal/100 g), and minerals (Fe: 9.17, Zn: 3.79, Ca: 393.027 mg/100 g). Overall, the study concludes that EWF, WSP, and SPLP-based gruel can effectively address protein-energy malnutrition and iron deficiency in infants. Novelty Impact Statement Preparation of gruel from the locally available and cost-effective materials are considered in this study. Preparation of the gruel from the emmer wheat, sesame powder and sweet potato leaves powder is not reported yet. The SPLP is rich in different nutrients, and they are the waste produced in the production system. So, using these locally available ingredients to alleviate malnutrition is very important.

Evaluation of storage stability of dietary fibre incorporated aerobically packaged spent hen meat snacks at ambient temperature

PurposeThe purpose of the study was to produce a healthier, convenient and traditional ready-to-eat (RTE) snack option with increased nutritional value, using spent hen meat, dietary fibre (DF) and simple technological methods. The product was designed to be stable without refrigeration and be easily adoptable by local self-help groups, rural women and youth and entrepreneurs in urban and semi-urban areas.Design/methodology/approachConventional binder used for making snacks, i.e. rice flour was partially replaced by different sources of antioxidant DFs, i.e. oat flour (T1 – 10%), finger millet flour (T2 – 5%) and amaranth flour (T3 –15%) to prepare spent hen snack sticks (SHSS). The snacks were then packaged in low density polyethylene (LDPE) pouches and evaluated for their storage stability at ambient temperature for a period of 35 days. Their physico-chemical, sensory and microbiological quality was evaluated at a regular interval of 7 days. The proximate composition of developed SHSS was compared to commercially available snack products (chakli/murukku – snacks without meat).FindingsThe fibre-enriched SHSS showed significant improvement in nutritive value, as they contained more fibre (p = 0.001) and protein (p = 0.029) than control SHSS. When compared to commercially available snack product SHSS showed three-fold significant increase in protein (p = 0.000) and ash content (p = 0.001) and only 11%–12% total fat as compared to 31% fat in the market-available product. The most acceptable treatment in terms of overall sensory quality and nutritional aspects was T3; however, T2 was more shelf-stable during the storage period. The study showed that fibre-enriched snacks can be stored at ambient temperature for up to 35 days without substantial loss in physico-chemical, sensory and microbial quality. Hence, substituting rice flour with DFs can lead to the development of products with better sensory attributes and improved functionality.Social implicationsThe simplicity of the product in terms of composition, machinery and low production costs makes it an easily adoptable one by small-scale entrepreneurs, especially those belonging to semi-urban areas.Originality/valueIncorporation of spent hen meat, a relatively cheap but abundant source of protein, in RTE products can serve as an effective way to alleviate protein malnutrition, whereas addition of fibre further improves the functionality of the product. The methodology can be easily taken up by small-scale entrepreneurs and create a market for snack-based functional meat products.

Ivabradine restores tonic cardiovascular autonomic control and reduces tachycardia, hypertension and left ventricular inflammation in post-weaning protein malnourished rats

Malnutrition results in autonomic imbalance and heart hypertrophy. Overexpression of hyperpolarization-activated cyclic nucleotide-gated channels (HCN) in the left ventricles (LV) is linked to hypertrophied hearts and abnormal myocardium automaticity. Given that ivabradine (IVA) has emerging pleiotropic effects, in addition to the widely known bradycardic response, this study evaluated if IVA treatment could repair the autonomic control and cardiac damages in malnourished rats. Aim: Assess the impact of IVA on tonic cardiovascular autonomic control and its relationship with hemodynamics regulation, LV inflammation, and HCN gene expression in post-weaning protein malnutrition condition. Main methods: After weaning, male rats were divided into control (CG; 22 % protein) and malnourished (MG; 6 % protein) groups. At 35 days, groups were subdivided into CG-PBS, CG-IVA, MG-PBS and MG-IVA (PBS 1 ml/kg or IVA 1 mg/kg) received during 8 days. We performed jugular vein cannulation and electrode implant for drug delivery and ECG registration to assess tonic cardiovascular autonomic control; femoral cannulation for blood pressure (BP) and heart rate (HR) assessment; and LV collection to evaluate ventricular remodeling and HCN gene expression investigation. Key findings: Malnutrition induced BP and HR increases, sympathetic system dominance, and LV remodeling without affecting HCN gene expression. IVA reversed the cardiovascular autonomic imbalance; prevented hypertension and tachycardia; and inhibited the LV inflammatory process and fiber thickening caused by malnutrition. Significance: Our findings suggest that ivabradine protects against malnutrition-mediated cardiovascular damage. Moreover, our results propose these effects were not attributed to HCN expression changes, but rather to IVA pleiotropic effects on autonomic control and inflammation.

ПРИМЕНЕНИЕ ЛЕЙЦИНА У ПАЦИЕНТА С СИНДРОМОМ ШВАХМАНА-ДАЙМОНДА: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Schwachman-Diamond syndrome (SDS) is a rare autosomal recessive disease from the group of ribosomopathies characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, malnutrition, protein-energy malnutrition, growth retardation, skeletal abnormalities and a predisposition to the development of myelodysplastic syndrome and acute myeloid leukemia. Severe hematological disorders, a high risk of developing MDS/AML, with a high percentage of unfavorable outcomes, prompted the consideration of alternative routes for the therapy in these circumstances. The possibility for the use of L-leucine, an essential amino acid, as a pathogenetic therapy in patients with severe dyshematopoiesis in SDS by analogy with its use in another ribosomopathy disease, Diamond-Blackfan anemia (DBA), is discussed in the Article.

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: an Evidence-based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.