Risk Of Nutritional Deficiencies Research Articles

Dietary intakes and nutritional status in adults with Muscular Dystrophy

Muscular dystrophy (MD) is a group of inherited conditions causing progressive muscle weakness and wasting, for which no widely implementable treatment currently exists, although resistance training (Bostock et al., 2019, Frontiers in Neurology, 10) and corticosteroid treatment (Angelini, 2007, Muscle & Nerve, 36, 424-435), have been shown to improve health-related quality of life (HQoL). Compared to physical activity, dietary manipulation may be more modifiable to improve dystrophic populations HQoL as disease outcomes often restrict physical capabilities. Data exploring the relationship between diet, disease and HQoL outcomes in adults with MD is insufficient. This study evaluated the habitual dietary intake of a sex-inclusive dystrophic population, to identify possible links between dietary intake, HQoL, and physical function. Participants included 5 women (age 65 ± 14 yrs, BMI 23.2 ± 2.7 kg/m2) and 10 men (age 55 ± 19 yrs, 31.6 ± 7.9 kg/m2) with different MDs (varied distribution and severity of muscle weakness). Participants' dietary intake data was collected using 3-day food records: analysed using Nutritics. Dominant hand maximal grip strength was measured using a hand-held dynamometer; upper extremity function and pain were assessed using the upper extremity functional index-15 and visual analogue scale, respectively. QoL was assessed through three tools: SF-36V2, Barthel Index and EQ5D, previously used in dystrophic populations. We observed that 50% of men and 20% of women did not meet the recommended daily intake (RDI) for protein (0.8 g·kg−1), however women (1.13 ± 0.26 g·kg−1) had increased protein intake compared to men (0.82 ± 0.27 g·kg−1, p < 0.05). Of all participants 40% had a daily fat intake exceeding the RDI, with women having significantly higher relative average fat intakes (women = 1.03 ± 0.36 g·kg−1, men = 0.68 ± 0.29 g·kg−1, p < 0.05). RDI for calcium was met by 46% participants (1000 mg) whilst all failed to meet the vitamin D RDI (10 μg). Positive correlations between age and protein intake as a percentage of RDI (r2 = 0.82), protein (r2 = 0.82), carbohydrate intake (r2 = 0.55) relative to body mass, vitamin D intake (r2 = 0.54), and total caloric intake (r2 = 0.59, all p< 0.05) were observed. No other significant associations between dietary habits, physical function or HQoL outcomes were apparent. Despite these findings being observed in a small population it is apparent that many adults with muscular dystrophy may fail to meet RDI for protein, vitamin D, and calcium. This places this population at risk for nutritional deficiencies, incurring negative impacts on the musculoskeletal system. Further study of nutritional status in a larger population sample is needed to confirm these findings.

Frailty and nutrition.

As the ageing population grows and forms a significant category of over 65s in many societies, along with it comes the risk of developing physical and psychological degenerative changes. This presents many challenges for health and social care services in not only identifying those at risk but also managing that risk to try to preserve health and independence for as long as possible. Screening for frailty has supported services to identify those that may be at risk of hospitalisation, requiring long term care or support services at home in older age. Frailty can be exacerbated by the risk of nutritional deficiencies and more severe malnutrition. Therefore, screening for frailty should also include a nutritional assessment, which can be supported by a recognition of the need for nutritional support along with other holistic frailty management.

Iron Deficiency: A Reflection on Prevention

Iron deficiency is the main nutritional deficiency in the first years of life. In Brazil, studies show a prevalence of 10.1% to 40%, depending on the study. Worldwide, in low-income countries, the statistics are higher, as in India iron deficiency is 53%. The aim of this article is to highlight the importance of breastfeeding and adequate substitution when this is not possible in order to prevent iron deficiency anemia. Discussion: Adequate nutrition begins at preconception, pregnancy and continues throughout life, especially during the first 1000 days and 2200 days. Exclusive breastfeeding for up to 6 months and supplemented breastfeeding for up to 2 years or more is essential, as is the mother’s iron intake. In cases where breastfeeding is not possible, priority should be given to the use of dairy products that contain nutrients as close as possible to breast milk. In lower-income countries, cow’s milk is still widely used as a substitute for human milk. However, this can result in nutritional deficiencies and other health implications for infants. Inadequate infant feeding and the risk of nutritional deficiencies should be carefully assessed by health professionals. Thus, the choice of the best food allows for the full growth and development of the child as well as the prevention of iron deficiency.

Assessment of Oral Health-related Quality of Life and Nutritional Status in Institutionalized Elderly Goan Population: A Descriptive, Cross-sectional Study

Background: The geriatric population is continuously at risk for nutritional deficiency and malnutrition, especially in developing countries like India. The aim of this study was to determine if the oral health-related quality of life is associated with malnutrition among the institutionalized elderly Goan population. Materials and Methods: A cross-sectional study was conducted among the institutionalized elderly in Goa. The elderly was assessed by a 12-item Geriatric Oral Health Assessment Index (GOHAI) questionnaire and the Mini Nutritional Assessment (MNA) test. Descriptive statistics were used to analyze the data using the SPSS version 21. Results: There were 102 elderly participants, of which 60.8% were females. The majority of study subjects (83%) were between the age group of 65 and 74 years. Among the assessed subjects, nearly 55.9% of them had a total score of GOHAI between 12 and 57 which was categorized as “needed dental care.” As per MNA, 32.4% had adequate nutrition, 65.7% were at risk of malnutrition, and the remaining 2% of subjects were malnourished. There was a significant correlation between GOHAI and MNA scores. Conclusion: In the elderly, nutritional status played a significant role in the oral health quality of life. The geriatric denture population is particularly vulnerable to compromised nutritional health.

Vitamin B12 Status in Rural Adolescent School Girls in Mysuru, India: A Community-Based Cross-Sectional Study

Abstract Almost 56% of Indian adolescent girls aged 15–19 years suffer from anemia. Adolescent age is a period of many significant physiological changes that increase nutritional demand, and they remain at risk for nutritional deficiencies. Our aim is to assess the prevalence of Vitamin B12 deficiency among school-going adolescent girls aged 13–16 years of rural Mysore. This study was a cross-sectional study, conducted in two high schools in rural Mysuru. Adolescent girls aged 13–16 years were included. The chosen subjects underwent complete hemogram, peripheral smear examination, and vitamin B12 level estimation. Out of 98 subjects enrolled, 40.81% were found to be deficient in vitamin B12. Macrocytes and hyper-segmented neutrophils were found to have statistically significant (P value < 0.001) relationship with vitamin B12 deficiency. The relationship between vitamin B12 deficiency with either type of diet and anemia was statically insignificant (P > 0.05). The prevalence of vitamin B12 deficiency among rural adolescent girls in Mysuru is high. Other causes of nutritional anemia apart from iron deficiency, such as vitamin B12 deficiency, must be considered in the etiology of anemia and optimally treated. It is recommended to further strengthen the adolescent national health programs and food fortification programs.

The problems of long-term adherence to elimination diets in children with food allergies

In recent years, the challenge of the control and maintenance of nutritional status in patients on an elimination diet for food allergies has got a lot of attention. Due to the possibility of long-term elimination of important food groups without adequate replacement, the high efficiency of this treatment method has been linked with the risk of nutritional deficiency, impaired physical growth, and eating behavior disorders in children. This review takes into account physical growth disorders in children with food allergies due to insufficient intake of micronutrients (vitamins, fatty acids), as well as such behavioral disorders as a distortion of food and taste preferences and food neophobia. We also discuss the problems of artificial mixture choice in children who are in their first year of life, correction of the diet in children over one year of age with micronutrient supplementation, as well as the results of studies on the quality of life of both children with elimination diets and people from their families.
 When prescribing an elimination diet, the doctor must constantly monitor the diet and growth indices of the child. It is necessary to take to into account the childs age, his nutritional requirements, and possible deficiencies of nutrients while planning the diet, as well as determine the necessary and sufficient diet duration.

Whole Oats Supplementation in a Low Calorie Diet Efficiently Reduces Cardio-Metabolic Disorders in Obese Rats

The hypocaloric diets (HCD) are an approach for controlling weight but can lead to a risk of nutritional deficiency. Whole grain contain bioactive com-pounds with health benefits; their incorporation into HCD can improve their nutritional value due to their richness in soluble fibers and their low glycae-mic index. The effects of incorporating oats in HCD were evaluated on growth parameters, lipid and glycaemic abnormalities, nitric oxide level and redox status in obese rats. Albinos rats were rendered obese after ingestion of a hyperlipidic (HL) diet and were then divided into three homogeneous groups: A first group was submitted for 28 days to a caloric restriction (CR) supplemented with oat (CR–Oat group). The second was fed a CR diet with-out supplementation (CR group) and the third obese group continued to con-sume the HL diet (Ob-HL). A fourth group (T) of normal weight rats is taken as a reference. Body weight, food and energy intake, glycaemia, glycosylated hemoglobin, insulinemia and blood lipids were decreased in obese rats treat-ed with HCD with or without oat compared with Ob-HL. However, glycaemia, glycosylated hemoglobin (HbA1c) and serum lipids were more reduced in CR–oat group and its value became similar to that of normoponderal rats. Fur-thermore, oxidative biomarkers in red blood cells, liver and adipose tissue were lowered in groups treated with HC diets, especially in oat diet. Further-more, we noted improved enzymatic antioxidant defense and endothelial dysfunction. Oats, by their functional properties seems to effectively rein-force the anti-obesity effect of the hypocaloric diet.

Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome.

Dietary treatments are growing in popularity as interventions for chronic digestive conditions. Patients with irritable bowel syndrome (IBS) often change their eating behaviors to mitigate symptoms. This can occur under the direction of their physician, a dietitian, or be self-directed. Poorly implemented and monitored diet treatments occur frequently with considerable risks for negative consequences. We aim to review the literature related to dietary treatments and risks associated with nutritional deficiencies and disordered eating. Searches were conducted from June to December 2020 on PubMed, MEDLINE, EMBASE, DARE and the Cochrane Database of Systematic Reviews using relevant keywords based on the Patient, Intervention, Comparator and Outcome (PICO) format. Studies included both adult and pediatric populations. Results are synthesized into a narrative review. While dietary approaches are efficacious in many research studies, their translation to clinical practice has been less clear. Patients with IBS are at risk for nutritional deficiencies, disordered eating, increased anxiety, and decreases in quality of life in both adult and pediatric groups. Physicians prescribing dietary treatment for IBS should be aware of nutritional and psychological risks and implement mitigation measures. These include using a combination of brief, validated questionnaires and clinical history, and collaboration with registered dietitians and/or psychologists. Recommendations for clinical decisions are provided.

Efectos en la salud asociados a la ingesta de frutas cítricas en infantes de 6 a 24 meses de edad: Protocolo de una revisión sistemática

Introduction: In Latin America, the recommendations about the introduction of citrus in the complementary feeding are heterogeneous. Food restriction during the first years of life can increase the risk of nutritional deficiencies. The objective of the review is to identify the health effects associated with the citrus intake in infants from 6 to 24 months of age.Material and Methods: We will include studies with preterm infants, without diseases or surgical interventions that require dietary modification. Citrus are considered as Orange, Camu Camu, Tangelo, Lemon, Mandarin, Lime, Cider, Grapefruit, and Clementine, consumed in the natural form or in juices or extracts, or in combination with other foods. All health effects associated with the intake of citrus will be reported. The databases of MEDLINE (through PubMed), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Epistemonikos, LILACS, and SciELO will be searched.Also, grey literature will be searched in international thesis repositories. Observational studies, randomized and non-randomized clinical trials will be included. Study selection, data extraction and risk of bias assessment will be done independently, in duplicate and with blinding. At the end of each stage, blinding will be lifted to resolve conflicts between reviewers through consensus. A narrative synthesis of the results of the primary studies and the risk of bias will be conducted.Ethics and Dissemination: The protocol is registered in PROSPERO: CRD42021230561.

A Matter of Timing\u2014Pregnancy After Bariatric Surgery

PurposeCurrent guidelines recommend to avoid pregnancy for 12–24 months after bariatric surgery because of active weight loss and an increased risk of nutritional deficiencies. However, high-quality evidence is lacking, and only a few studies included data on gestational weight gain. We therefore evaluated pregnancy and neonatal outcomes by both surgery-to-conception interval and gestational weight gain.Materials and MethodsA multicenter retrospective analysis of 196 singleton pregnancies following Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was conducted. Pregnancies were divided into the early group (≤ 12 months), the middle group (12–24 months), and the late group (> 24 months) according to the surgery-to-conception interval. Gestational weight gain was classified as inadequate, adequate, or excessive according to the National Academy of Medicine recommendations.ResultsPregnancy in the early group (23.5%) was associated with lower gestational age at delivery (267.1 ± 19.9 days vs 272.7 ± 9.2 and 273.1 ± 13.5 days, P = 0.029), lower gestational weight gain (− 0.9 ± 11.0 kg vs + 10.2 ± 5.6 and + 10.0 ± 6.4 kg, P < 0.001), and lower neonatal birth weight (2979 ± 470 g vs 3161 ± 481 and 3211 ± 465 g, P = 0.008) than pregnancy in the middle and late group. Inadequate gestational weight gain (40.6%) was associated with lower gestational age at delivery (266.5 ± 20.2 days vs 273.8 ± 8.4 days, P = 0.002) and lower neonatal birth weight (3061 ± 511 g vs 3217 ± 479 g, P = 0.053) compared to adequate weight gain. Preterm births were also more frequently observed in this group (15.9% vs 6.0%, P = 0.037).ConclusionOur findings support the recommendation to avoid pregnancy for 12 months after bariatric surgery. Specific attention is needed on achieving adequate gestational weight gain.

Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients. Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, isolated parenteral and mixed types of nutritional support in the early postoperative period. Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI). Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient. Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

Postbariatric Surgery Hypoglycemia and Nutritional Deficiencies: Long-Term Follow-Up

Background: The aim was to assess the long-term impact of laparoscopic sleeve gastrectomy (LSG) on weight loss, postload hypoglycemia, and nutritional status of 25-OH-vitamin D, cyanocobalamin, albumin, creatinine, ferritin, and hemoglobin. Methods: A prospective, longitudinal analysis of collected data from 60 sleeve gastrectomy patients was performed on a 5-year follow-up period. Results: Therapeutic success rate (excess body mass index loss ≥60%) was 80% at 5 years. The prevalence of postload hypoglycemia increased progressively, reaching a maximum at 1 year (20.3%) and then drop out to 0% at 5 years postoperatively. Glycemic profile and insulin resistance improved significantly from the 1st month postoperatively, remaining stable thereafter, whereas the C peptide had a decreasing trend throughout the study period. Prevalence of nutritional deficiencies at baseline, 1 month, 3 months, 1 year, and 5 years postsurgery were specifically for cyanocobalamin (0%, 3.3%, 15.5%, 27.1%, and 30.0%), vitamin D (21.7%, 48.3%, 63.8%, 76.3%, and 85%), and albumin (0%, 16.7%, 1.7%, 1.7%, and 11.7%, respectively). Ferritin and hemoglobin levels showed a significant drop in the 1st month postoperative and remain stable afterward, whereas creatinine decreased significantly after the 1st year postoperative in comparison with preoperative. Conclusions: LSG was effective in terms of weight loss, insulin sensitivity, and glycemic profile improvement, but with the risk of nutritional deficiencies and postload hypoglycemia.

Nutritional Support for Critically Ill Patients (Review)

Hospital mortality in critical illness has decreased over the last decade. At the same time, there has been an increase in the number of patients diagnosed with post-intensive care syndrome (PIT-syndrome) which reduces the life quality after discharge. One of the most important components preventing the development of PIT syndrome is nutritional support. The aim of the review is to highlight the need for a differentiated approach to nutritional support of critically ill patients during their treatment and rehabilitation. Among more than 200 primary sources of literature from various databases (Scopus, Web of science, RINC, etc.), 82 sources mainly published in the last 5 years were selected for review. Earlier publications maintaining clinical relevance were also included into the analysis. The review presents data on real practice of nutritional support in critically ill patients. In most cases, the risk of nutritional deficiencies is not assessed before treatment, and protein and energy requirements are not fully met. The algorithm of nutritional support is provided based on the phases of critical illness. Conclusion . Contemporary approaches to the nutrient and energy provision to critically ill patients suggest the differentiated nutritive support prescription depending on the disease stage. The emphasis is made on gradual achievement of target values of protein and energy provision, priority of enteral administration of nutrients, continuity in nutritional support between departments, as well as hospital and outpatient treatment periods. This approach allows both optimization of medical care for this extremely challenging category of patients and a reduction in the severity and duration of the PIT syndrome.

Influence of specific management practices on blood selenium, vitamin E, and beta‐carotene concentrations in horses and risk of nutritional deficiency

BackgroundSelenium or alpha‐tocopherol deficiency can cause neuromuscular disease. Beta‐carotene has limited documentation in horses.ObjectiveTo evaluate the effect of owner practices on plasma beta‐carotene concentration and risk of selenium and alpha‐tocopherol deficiencies.AnimalsThree‐hundred and forty‐nine adult (≥1 year), university and privately owned horses and mules.MethodsCross‐sectional study. Whole blood selenium, plasma alpha‐tocopherol, and plasma beta‐carotene concentrations were measured once. Estimates of daily selenium and vitamin E intake, pasture access, and exercise load were determined by owner questionnaire. Data were analyzed using t tests, Mann‐Whitney tests, parametric or nonparametric analysis of variance (ANOVA), Kruskal‐Wallis test, Spearman's correlation and contingency tables (P < .05).ResultsNearly 88% of the horses received supplemental selenium; 71.3% received ≥1 mg/d. Low blood selenium concentration (<80 ng/mL) was identified in 3.3% of horses, and 13.6% had marginal concentrations (80‐159 ng/mL). Non‐supplemented horses were much more likely to have low blood selenium (odds ratio [OR], 20.2; 95% confidence interval [CI], 9.26‐42.7; P < .001). Supplemental vitamin E was provided to 87.3% of horses; 57.7% received ≥500 IU/d. Deficient (<1.5 μg/mL) and marginal (1.5‐2.0 μg/mL) plasma (alpha‐tocopherol) occurred in 15.4% and 19.9% of horses, respectively. Pasture access (>6 h/d) and daily provision of ≥500 IU of vitamin E was associated (P < .001) with higher plasma alpha‐tocopherol concentrations. Plasma beta‐carotene concentration was higher in horses with pasture access (0.26 ± 0.43 versus 0.12 ± 0.13 μg/mL, P = .003).Conclusions and Clinical ImportanceSuboptimal blood selenium and plasma alpha‐tocopherol concentrations occurred in 16.7% and 35.5% of horses, respectively, despite most owners providing supplementation. Inadequate pasture access was associated with alpha‐tocopherol deficiency, and reliance on selenium‐containing salt blocks was associated with selenium deficiency.

Rehabilitation after stroke: nutritional status and its correction

This article presents the results of our study of the nutritional status of patients after cerebral stroke who were hospitalized to the medical rehabilitation unit. Among all patients, 16 % had an increased risk of nutritional deficiency by all scales with the highest numbers in patients over 65 (44 % had a risk of nutritional deficiency on all scales). Among patients with swallowing disorders, 100 % of patients had a risk of nutritional deficiency. Out of all anthropometric indicators, only the circumference of the shoulder muscles was significantly lower in patients with nutritional deficiency. Assessment and correction of malnutrition during rehabilitation after stroke is recommended during the acute treatment and follow-up. Special clinical nutrition products can be a good support for balanced feeding for more rapid rehabilitation.

Vegetarian and Vegan Weaning of the Infant: How Common and How Evidence-Based? A Population-Based Survey and Narrative Review.

Background: Vegetarian and vegan weaning have increasing popularity among parents and families. However, if not correctly managed, they may lead to wrong feeding regimens, causing severe nutritional deficiencies requiring specific nutritional support or even the need for hospitalization. Aim: To assess the prevalence of vegetarian and vegan weaning among Italian families and to provide an up-to-date narrative review of supporting evidence. Materials and methods: We investigated 360 Italian families using a 40-item questionnaire. The narrative review was conducted searching scientific databases for articles reporting on vegetarian and vegan weaning. Results: 8.6% of mothers follow an alternative feeding regimen and 9.2% of infants were weaned according to a vegetarian or vegan diet. The breastfeeding duration was longer in vegetarian/vegan infants (15.8 vs. 9.7 months; p < 0.0001). Almost half of parents (45.2%) claim that their pediatrician was unable to provide sufficient information and adequate indications regarding unconventional weaning and 77.4% of parents reported the pediatrician’s resistance towards alternative weaning methods. Nine studies were suitable for the review process. The vast majority of authors agree on the fact that vegetarian and vegan weaning may cause severe nutritional deficiencies, whose detrimental effects are particularly significant in the early stages of life. Discussion and conclusion: Our results show that alternative weaning methods are followed by a significant number of families; in half of the cases, the family pediatrician was not perceived as an appropriate guide in this delicate process. To date, consistent findings to support both the safety and feasibility of alternative weaning methods are still lacking. Since the risk of nutritional deficiencies in the early stages of life is high, pediatricians have a pivotal role in guiding parents and advising them on the most appropriate and complete diet regimen during childhood. Efforts should be made to enhance nutritional understanding among pediatricians as an unsupervised vegetarian or vegan diet can cause severe nutritional deficiencies with possible detrimental long-term effects.

One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150cm: Weight Loss, Nutritional Outcomes, Endoscopic Results, and Quality of Life at 8-Year Follow-Up.

One anastomosis gastric bypass (OAGB) is now recognized as a mainstream bariatric procedure, nonetheless concerns about the risk of nutritional deficiencies and biliary reflux persist, and the ideal length of the biliopancreatic limb (BPL) is debated. Data of patients who underwent OAGB between May 2010 and December 2010 were collected prospectively and analyzed retrospectively. At an 8-year follow-up, a complete evaluation included clinical examination, blood tests, upper gastrointestinal endoscopy, and quality of life (QoL) assessed through the BAROS score. Overall, 115 patients underwent OAGB with a BPL of 150cm. Thirty-six (31%) were lost at the 8-year follow-up. Mean preoperative weight was 117 ± 20.8kg and mean BMI 43.2 ± 5.8kg/m2. At 8years, weight was 76.5 ± 17.3kg, BMI 28.3 ± 5.8, %TWL 34.8 ± 10.7, and %EWL 84.8 ± 27.1. No patients were readmitted for nutritional complications or underwent revisional surgery for malnutrition; 6 patients were converted to Roux-en-Y gastric bypass for intractable reflux. High rates of vitamin D and A deficiencies and secondary hyperparathyroidism were found at 8years. The BAROS score was > 3 at 8years for 93% of patients. Upper gastrointestinal endoscopy was available for 46 patients and found esophagitis in 6.5% of cases but no cases of Barrett's esophagus. OAGB performed with a 150-cm BPL is an effective bariatric procedure, associated with good long-term outcomes in relation to weight loss, QoL, resolution of comorbidities, and a very low rate of protein-calorie malnutrition. Fat-soluble vitamin deficiencies represent the main long-term concern. Endoscopic findings at 8years are reassuring.

A107 PATIENT PERSPECTIVES ON THE LONG-TERM MANAGEMENT OF CELIAC DISEASE

Abstract Background Celiac disease (CD) is a common chronic gastrointestinal illness with a range of manifestations. The only available treatment is strict gluten avoidance, therefore patients are effectively self-managed. Despite the critical role patients play in their treatment, patient perspectives on long-term CD care have not been formally assessed and are therefore not represented in current clinical guidelines. Aims To determine the opinions of CD patients on the need for long-term CD follow-up, the utility of various aspects of CD follow-up, and the areas in which further information is desired. Methods The Manitoba Celiac Disease Cohort includes newly diagnosed adults with elevated TTG and/or EMA antibodies and Marsh III histology. At the 24-month follow-up visit, participants were asked to rate the utility of various aspects of CD care from 1–5 (low-high) and their desire for further information on CD-related issues from 1–6 (low-high). Results A total of 213 patients were recruited and 137 participants completed the online survey (median age 41 [interquartile range 29–57] years; 68% female). Adherence to a gluten free diet was variable, with 29% of patients having TTG antibodies above the upper limit of normal. Two-thirds of participants felt they should be seen regularly for their celiac disease, while 79.8% of those who wished to be followed felt they should be seen every 6–12 months. Blood tests were the most highly rated component of CD care (scored ≥4 by 78% of respondents). Celiac symptom review, information on research in celiac disease, and the opportunity to ask questions about vitamins and supplements were also positively regarded. Diet review was not generally considered helpful. 79% of patients desired further information on research in CD, while approximately 60% desired information on the long-term complications of CD and the risk of nutritional deficiencies. Conclusions The majority of CD patients find regular specialist follow-up helpful, particularly for biochemical assessment of disease activity and its complications. Further information on CD research and the long-term complications of CD should be addressed in follow-up visits. These aspects of follow-up care should be reflected in future guidelines. Funding Agencies None

Impacts of Mainstream Hydropower Development on Fisheries and Human Nutrition in the Lower Mekong

Dams provide energy and irrigation water, but also alter natural water flows that support fisheries. This tradeoff presents a risk for human nutrition in regions dependent on aquatic foods, including the Lower Mekong Basin (LMB), where over 100 dams are planned or in construction. Previous models estimate significant reductions in fishery production resulting from these dams. This study estimates the number of new nutritionally insecure people (i.e., those at risk for nutritional deficiencies) associated with Mekong damming. We calculated population-level nutritional needs based on the Estimated Average Requirements (EARs) for Cambodia and the entire LMB. We then estimated fish-derived nutrient supplies by integrating data on annual fishery production and fish nutrient content for a wide range of species. Finally, we synthesized available literature and modeling results on the impacts of damming on fisheries production, and estimated the consequent impact on inadequate intakes of protein, zinc, niacin, thiamin, riboflavin, and calcium, as well as potential vulnerability to losses of dietary iron. Hydropower development could restrict access to subsistence fish from the Mekong River Basin and lead to increased risk of nutritional deficiencies in Cambodia and the LMB. Our median estimates suggest that by 2030, relative to 2010, inadequate intakes could lead to an increased population at risk of nutritional deficiencies in the LMB by 0.21 to 2.23 million people for protein, 0.12 to 1.17 million people for zinc, 0.41 to 1.58 million people for niacin, 0.47 to 0.87 million people for thiamin, 0.70 to 2.31 million people for riboflavin, and approximately 10,000 people for calcium. This increased population at risk is additional to those currently malnourished. We then calculated that the average iron intake of many age-sex groups (constituting 58% of the population) will be below 150% of their EAR in 2030, indicating a potential risk of increased inadequate iron intake. Fish is the main source of animal source foods and critical micronutrients in the LMB. In the absence of mitigation efforts, any reductions in fishery production could increase already high levels of nutrient deficiency, creating a widespread risk of nutrition insecurity.

NUTRITIONAL REHABILITATION IN ONCOLOGY AFTER SURGERY IN THE UPPER GASTROINTESTINAL TRACT

Rehabilitation in oncology is the process of assisting a patient diagnosed with a “malignant tumor” in order to maintain optimal physical fitness, psychological and social comfort within the limits possible, limited by the disease itself and its treatment. A key component of this approach is nutritional-metabolic support (NMS), including a regular, modified diet, functional foods, and nutritional supplements with pharmaconutrients. In cancer patients, the risk of nutritional deficiency is especially high, since the tumor itself, surgical intervention, as well as high-dose chemo-and radiation therapy, lead to a violation of nutritional status (NS). Nutritional and metabolic support in the postoperative period involves not only improving treatment outcomes and disease prognosis, but also the impact on improving the rehabilitation potential, the possibility of the full implementation of rehabilitation measures, and the quality of life of patients. In the case of radical or palliative surgery, the perioperative period should help improve the long-term prognosis.