Treatment Of Malnutrition Research Articles

The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis

Background/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs is, however, sparse. We aimed to explore the potential caseload implications of the new criteria and explore how different cut-offs might affect them. Methods: We conducted a secondary analysis of data from 1048 Ethiopian infants u6m using STATA software version 17. Frequency tables and percentages were used to present malnutrition across various characteristics. The chi-square test with 95% confidence intervals (CIs) at a p value of < 0.05 was used to compare infant caseload identified by the WHO-2023 versus WHO-2013 criteria. Results: We found substantial overlaps among anthropometric indicators of malnutrition in infants defined by the WHO-2023 programme enrolment criteria. New WHO criteria result in a larger potential caseload (19.2% for 6 weeks to 6 months and 15.1% for infants under 6 weeks) compared with WHO-2013 criteria (2.4%). Whilst there are marked overlaps between low WAZ, low WLZ, and low MUAC, they capture different infants. An MUAC of < 110mm alone would capture only a third of all cases identified by WAZ and/or WLZ < −2. Conclusions: In Ethiopia, the WHO-2023 criteria markedly increase malnutrition caseloads compared with WHO-2013 criteria. There might be a case for increasing MUAC thresholds in MUAC-focused programs where WLZ or WAZ measurements are difficult. Future longitudinal data are needed to know which criteria best identify infants at highest risk of mortality/morbidity/poor development.

Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali

BackgroundAcute malnutrition treatment coverage remains low worldwide, causing significant morbidity and mortality. Decentralisation of treatment to Community Health Worker (CHW) sites has shown to be an effective strategy to improve access and increase coverage, but evidence on the cost and cost-effectiveness of this approach as well the use of simplified treatment protocols in conflict settings is lacking. The objective of this study was to determine cost per child treated as well as the cost-effectiveness of the hybrid model of treatment delivery (where treatment is provided at both health facilities and CHW sites) using either a standard protocol (Intervention 1) or simplified protocol (Intervention 2) compared to standard treatment at health facilities only (Control) in the conflict affected region of Gao in Northern Mali.MethodsThis economic evaluation was part of a three-arm cluster randomized controlled trial which enrolled 2038 children with moderate and severe acute malnutrition. Outcomes assessed were cost per child treated as well as average and incremental cost-effectiveness ratios for cost per child cured and disability adjusted life year (DALY) averted. A within study trial horizon, from March 2020 to July 2021, was used. Cost data were collected from accountancy records and through key informant interviews using a societal perspective. Treatment admission and outcome data were obtained from the main trial.ResultsIn the base case scenario the cost per child treated was 272 US$, 179 US$ and 210US$ in the Control, Intervention 1 and 2 groups, respectively. Cost per child cured was 356 US$ in the Control, 219 US$ in the Intervention 1 and 226 US$ Intervention 2 groups. Ready-to-use therapeutic foods (RUTF) costs among SAM children treated with a simplified protocol were 5.7 US$ less per child. The average cost per DALY averted was 173.1 US$ in the Control compared to 60.3 US$ in the Intervention 1 and 53 US$ in the Intervention 2.ConclusionThis study shows that involving CHWs in acute malnutrition treatment reduces the cost per child treated and is a cost-effective strategy, due to lower treatment costs and greater coverage in the decentralised model. Switching to a simplified protocol in a conflict setting can lead to cost savings particularly in terms of RUTF, and should be considered where weight-based admission, monitoring or dosage is not possible or RUTF stocks are running low.Trial registrationThe study protocol was registered under reference ISRCTN-60,973,756 on the 15th of October 2020.

Optimal allocation of antenatal and young child nutrition interventions: an individual-based global burden of disease calibrated microsimulation

BackgroundUndernutrition remains a global crisis and is a focus of Sustainable Development Goals. While there are multiple known, effective interventions, complex interactions between prevention and treatment and resource constraints can lead to difficulties in allocating funding. Simulation studies that use in silico simulation can help illuminate the interactions between interventions and provide insight into the cost-effectiveness of alternative packages of options.MethodsWe developed an individual-based microsimulation model based on the Global Burden of Disease (GBD) 2021 study data to test a range of nutrition interventions, including antenatal interventions (iron and folic acid, multiple micronutrients, and balanced energy protein supplementation) and child interventions (treatment for severe acute malnutrition, treatment for moderate acute malnutrition, and wasting prevention with small-quantity lipid-based nutrient supplements). We also developed an analytic approach to process the results of the microsimulation and identify the optimal intervention funding allocation for a given budget size. We use Ethiopia as an example in this paper.ResultsIn our illustrative example of Ethiopia, the reallocation of the baseline budget to minimize disability-adjusted life years (DALYs) resulted in first funding the antenatal multiple micronutrients to their maximum coverage and then funding treatment for severe child acute malnutrition. Relative to the baseline allocation, the reallocation optimized to minimizing DALYs resulted in 592,000 fewer annual DALYs, constituting an 8.3% reduction in total DALYs in Ethiopia.For budgets larger than the baseline, our model recommended funding first targeted moderate acute malnutrition treatment, second universal moderate acute malnutrition treatment, third wasting prevention with small-quantity lipid-based nutrient supplements, and fourth balanced energy protein supplementation.ConclusionsOur simulation is a novel model for estimating optimal allocation of spending on antenatal and child health nutrition interventions which accounts for the interaction between preventive and therapeutic approaches. Our illustrative results show that an optimized reallocation of current spending can substantially improve pregnancy-related and child health without additional funding. We hope this model can add validity and confidence to prior results to aid stakeholders in funding decisions.

Treatment of malnutrition in total joint arthroplasty : Consensus statement of the Perioperative Management Committee of the German Society for Endoprosthetics

Pre- and perioperative management of malnutrition is crucial for the success of hip and knee arthroplasties. Various studies indicate that malnutrition, particularly when associated with vitaminD deficiency, significantly increases the risk of postoperative complications such as periprosthetic fractures and infections, prolonged hospital stays, and higher mortality rates. Adequate preoperative nutritional intake, including vitaminD supplementation, can improve arthroplasty outcomes. Current literature emphasizes the importance of comprehensive nutritional optimization before surgery to minimize the risk of complications and promote recovery.

A transmural intensive dietetic care-pathway for optimal protein intake and physical functioning in malnourished older patients: A protocol for the randomised ProIntens trial

Background Disease-related malnutrition is common among hospitalised and recently discharged older adults. Consequences of malnutrition are physical limitations, negative health outcomes, decreased quality of life and increased healthcare costs. Dietetic care can counteract the effects of malnutrition by increasing protein and energy intake. The ProIntens study aims to evaluate the impact of an intensive dietetic care pathway on dietary protein intake and physical functioning in older adults during hospitalisation and after discharge. Process and economic evaluations will be performed. Methods The ProIntens study is a multicentre two-armed parallel individually randomised trial in five hospitals in the Amsterdam region. In total, 250 hospitalised older adults, aged ≥55 years and at risk of malnutrition will be randomised to receive regular care (control) or intensive dietetic care (intervention). The intervention consists of intensive personalised care which involves transmural guidance by trained dietitians, supportive materials on protein intake in a social context and a mobilization program during hospitalisation until three months after discharge. Controls will receive regular care. The primary outcome will be the between-groups difference in the mean change on the Short Physical Performance Battery three months after discharge. Secondary outcomes include dietary protein intake, body composition, physical activity, activities of daily living, quality of life and healthcare costs. Discussion The ProIntens trial will study the effects and costs of an intensive dietetic treatment on recovery outcomes in hospitalised older adults at risk of malnutrition. The intervention will result in practical tools for care professionals which aim to improve malnutrition treatment for older patients. Trial registration Landelijk Trial Register (NL8041; NL72069.029.19); registered 2019-09-23; covering all WHO Trial Registration Data Set items.

Evaluation of Sorghum-Oat-Soybean Ready-To-Use Therapeutic Food (RUTF) on Nutritional Recovery and Biochemical Profiles in Rats

Mortality due to severe acute malnutrition is one of the leading causes of death especially among children in developing countries. Ready-to-use therapeutic foods (RUTFs) have become the beacon of hope in the new management scene of malnutrition. The study is aimed at the management and assessing the effectiveness of nutritional rehabilitation of malnourished rats. A 33-day study was conducted on 20 Wistar rats which were divided into five different cages randomly and were fed with varying ratios of Sorghum-Oat-Soybean (SOS) Ready-to-Use-Therapeutic Food (RUTF) formulations as well as two controls RUTFS. Results showed pre-starvation body weights of the experimental animals ranged from 104.76g (S1 group) to 106.37g (C0 group). Subsequent to 5 days of starvation, a significant reduction in body weight was observed, with values ranging from 75.05g (S1 group) to 76.11g (S3 group). Following 21 days of nutritional intervention with SOS-RUTF, significant inter-group differences (p < 0.05) were detected in body and organ weights; hemoglobin, cholesterol, and triglyceride levels, ALT, AST, and ALP enzyme activities. The three SOS-RUTFs findings with of different ratios study revealed that SOS-RUTF enhanced formulations brought back the body weight, and organ weight was normal, balanced the biochemical parameters and corrected the hepatic and bone enzyme activities to near normal. These findings have important implications for the treatment of severe acute malnutrition. The study shows that the easily available, inexpensive, and nutritious SOS-RUTF can be used in clinical nutrition and is viable as an option for use in community interventions. This is especially so in developing countries where proper nutritious food is a luxury.

Prevalence of Malnutrition in Children With Congenital Ichthyoses in a Tertiary Care Centre in India.

Malnutrition has been reported in congenital ichthyoses in several studies, but its prevalence in Indian children with congenital ichthyoses (CI) as compared to unaffected children is unknown. The objective was to assess the prevalence of malnutrition in 32 children with CI and matched healthy controls and to study the correlation between clinical severity of ichthyosis using visual ichthyosis index severity (VIIS) score with malnutrition, biochemical parameters (hemoglobin, vitamin D, protein and albumin). Malnutrition was detected in 46.8% (15/32) [wasting 40.6%; stunting 37.5%] of children with CI and 18.8% (6/32) (wasting 15.6%; stunting 12.5%) of controls (p value < 0.001) and there was positive correlation between the severity of ichthyosis and malnutrition (p value < 0.001). Children with ichthyosis are at increased risk of malnutrition, and early identification and treatment of malnutrition could improve the severity of ichthyosis and growth potential.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

Nutritional properties of cookies enriched with Terminalia catappa (Combretaceae) almond flour

This study aims to analyze the nutritional properties of almond flour enriched cookies from Terminalia catappa in order to promote these almonds in the treatment of protein-energy malnutrition. To this end, five (5) types of cookies were produced, including a control cookie composed of 100% wheat flour (BFB) and four composite cookies in which the wheat flour was substituted by the almond flour Terminalia catappa at respective rates of 10% (BFTC10), 20% (BFTC20), 30% (BFTC30) and 40% (BFTC40). The cookies were prepared at the "Bivoire Abobo Banco bakery" which has an authorization from the Ministry of Commerce of the Republic of Côte d'Ivoire. The nutritional properties of cookies were evaluated on the basis of their physicochemical composition, physical and organoleptic characteristics. Analysis of the physical-chemical composition of the cookies showed a significant increase (p&lt; 0.05) in proteins (10.07 0.02 to 19.2 0.01%), lipids (14.3 0.1 to 27.4 0.2%), ash (0.66 0.02 to 1.66 0.8%) and fibres (1.12 0.01 to 1.56 0.01%). On the other hand, a significant decrease (p &lt; 0.05) in the carbohydrate content (70.31 0.01 to 46.64 0.03%) and a significant increase (p&lt; 0.05) in the energy value (450.2 0.01 to 510 0.01 kcal) of the cookies were observed. The physical parameters of the cookies (weight, diameter, thickness, spreading ratio) were influenced by the increase in the level of incorporation. Sensory analysis revealed that the overall acceptability of cookies was affected by the increased level of substitution. It seems that these composite cookies could help fight protein-energy malnutrition.

Small Intestinal Bacterial Overgrowth and Childhood Malnutrition: A Comprehensive Review of Available Evidence.

The gut microbiome is essential for children's normal growth and development, with its formation aligning closely with key stages of growth. Factors like birth method, feeding practices, and antibiotic exposure significantly shape the composition and functionality of the infant gut microbiome. Small intestinal bacterial overgrowth (SIBO) involves an abnormal increase in bacteria within the small intestine. This overgrowth can interfere with digestion, impair nutrient absorption, and lead to both local and systemic inflammation, potentially contributing to malnutrition. In this review, we provide a comprehensive overview of the current understanding of the relationship between SIBO and malnutrition, with a particular focus on the pediatric population. SIBO seems to play an important role in nutrient malabsorption through the gut microbiome imbalance, local inflammation, and disruption of the mucosal intestinal barrier. Additionally, SIBO is more prevalent in digestive disorders linked to malabsorption and malnutrition. Different therapeutic strategies for addressing malnutrition-related SIBO have been proposed. While antibiotics are the primary treatment for SIBO, their effectiveness in promoting weight gain among malnourished children remains uncertain. Hence, future research directed at the impact of microbiome imbalance on nutrient intake and absorption could bring to light new strategies for the effective prevention and treatment of malnutrition.

Association between Nutritional Status and Severity of Pneumonia in Under Five Years of Children Admitted at Birat Medical College Teaching Hospital

Introduction: Childhood malnutrition is common in low-income and middle-income countries and increases the frequency and severity of pneumonia. The objective of this study was to determine the association between nutritional status and severity of pneumonia in under five children. Materials and Methods: This was a hospital-based cross-sectional study of data of children between 3 months to 5 years admitted in the Department of Pediatrics of Birat Medical College Teaching Hospital with a clinical diagnosis of pneumonia from December 2023 to July 2024. Results: One hundred seventy children were included in the study with a majority of age group 3 to 12 months (46.5 %) and male to female ratio of 3:1. There were 69 (40.6%) undernourished children and 73 (42.9%) anemic. On applying bivariate analysis, undernourishment(p&lt;0.001, unadjusted OR=8.2, and 95%CI,3.9-17.5) and anemia (p&lt;0.001, unadjusted OR=6, and 95%CI,2.9-12.6) were statically significant for severe pneumonia. Conclusions: The risk of having severe pneumonia was higher in children with under-nutrition and anemia. Prevention and treatment of malnutrition in children should be prioritized to reduce severe pneumonia as well as pneumonia-related mortality.

Using Machine Learning to Fight Child Acute Malnutrition and Predict Weight Gain During Outpatient Treatment with a Simplified Combined Protocol.

Child acute malnutrition is a global public health problem, affecting 45 million children under 5 years of age. The World Health Organization recommends monitoring weight gain weekly as an indicator of the correct treatment. However, simplified protocols that do not record the weight and base diagnosis and follow-up in arm circumference at discharge are being tested in emergency settings. The present study aims to use machine learning techniques to predict weight gain based on the socio-economic characteristics at admission for the children treated under a simplified protocol in the Diffa region of Niger. The sample consists of 535 children aged 6-59 months receiving outpatient treatment for acute malnutrition, for whom information on 51 socio-economic variables was collected. First, the Variable Selection Using Random Forest (VSURF) algorithm was used to select the variables associated with weight gain. Subsequently, the dataset was partitioned into training/testing, and an ensemble model was adjusted using five algorithms for prediction, which were combined using a Random Forest meta-algorithm. Afterward, Receiver Operating Characteristic (ROC) curves were used to identify the optimal cut-off point for predicting the group of individuals most vulnerable to developing low weight gain. The critical variables that influence weight gain are water, hygiene and sanitation, the caregiver's employment-socio-economic level and access to treatment. The final ensemble prediction model achieved a better fit (R2 = 0.55) with respect to the individual algorithms (R2 = 0.14-0.27). An optimal cut-off point was identified to establish low weight gain, with an Area Under the Curve (AUC) of 0.777 at a value of <6.5 g/kg/day. The ensemble model achieved a success rate of 84% (78/93) at the identification of individuals below <6.5 g/kg/day in the test set. The results highlight the importance of adapting the cut-off points for weight gain to each context, as well as the practical usefulness that these techniques can have in optimizing and adapting to the treatment in humanitarian settings.

P53 Budget Impact Analysis of a Possible Extension of Public Funding for the Treatment of Disease-Related Malnutrition in Spain

P53 Budget Impact Analysis of a Possible Extension of Public Funding for the Treatment of Disease-Related Malnutrition in Spain

Effects of prebiotics on microbial diversity and abundance in young children with acute malnutrition: study protocol for a multi-centered, double-blinded randomized controlled trial.

The anti-inflammatory and antimicrobial benefits of prebiotics may present an affordable and cost-effective strategy for not only the prevention but also treatment of malnutrition. Therefore, the present trial has been designed with the aim to evaluate the role of prebiotics on the gut microbiome of severe acute malnourished (SAM) children. The study is designed as a prospective, double-blinded, triple-armed, multi-centered randomized controlled trial, with 6-59months old uncomplicated SAM children recruited to the experimental group receiving ready-to-use therapeutic food (RUTF) plus prebiotics and the active comparator group receiving RUTF plus starch for 2months duration (8weeks). Healthy children with matching age and gender will be recruited to placebo comparator group and will receive starch as a placebo during the study period. A total of 58 participants will be recruited to each arm with 1:1:1 allocation ratio following a pre-defined inclusion and exclusion criteria. The results of the gut microbiome diversity will serve as the primary outcome, while weight-for-height/length z-score, mid-upper-arm circumference, neurodevelopment assessment, and body mass accumulation will serve as the secondary outcome. Data collection and evaluations will be conducted at baseline and at the end of the trial (week 8), while the safety monitoring will be conducted at every second week. For analysis, the principles of intention-to-treat will be followed. Conclusively, the results of the present trial would provide useful insights and high-quality data for the treatment and management of SAM children by evaluating the effect of RUTF plus prebiotic on the gut microbiome diversity of children, leading to medical evidence for designing the large-scale studies. The present trial is registered at ClinicalTrials.gov with identifier No: NCT06155474 and registration date 4 December 2023.

Nutritional Risk, Nutritional Status and Some Biochemical Parameters In Adult Burn Patients in Burn Intensive Care Unit: A Prospective Study

Nutritional therapy is very important in burn patients and plays a role in the prevention and treatment of malnutrition. Therefore, it is necessary to assess nutritional status, prevent or minimize nutritional problems, and monitor nutritional therapy. This study was conducted to determine the nutritional risk, nutritional status and biochemical parameters of adult burn patients in the burn intensive care unit. The 59 patients (women: 16, men: 43) between the ages of 19-64 were included in the study. Parameters such as NRS-2002 (admission and discharge), dietary intake, nutritional support status, serum albumin, and total protein (admission and discharge) were evaluated to determine the nutritional risk and nutritional status of the patients. In addition, body weight, mid-upper arm circumference, and triceps skinfold thickness were measured and body mass index was calculated (admission and discharge). The duration of hospitalization and burn percentage of men patients were higher than women (P

Preparation of Ready-to-use Therapeutic Foods Based on Soy, Millet, Rice, Corn, and Sugar for the Management of infant with Moderate Acute Malnutrition

The prevalent number of children in developing countries from suffering MAM is increasing daily and this has significant cost implications for their treatment. Therefore, the management of MAM should be a public health priority. Ready-to-use therapeutic foods (RUTF) play a fundamental role in the management protocol for severe acute malnutrition in children aged 6 to 59 months. In our study, we aim to enhance the value of ready-to-use foods prepared from local products, namely soya, millet, rice, maize and sugar (SOMRIS&amp;lt;sup&amp;gt;10-16&amp;lt;/sup&amp;gt;). The objective was to develop a formula meeting the recommended nutritional and microbiological requirements in order to use it as a substitute for reference products for the treatment of moderate acute malnutrition. It has allowed to develop a ready-to-use therapeutic food using the linear programming technique, then produced according to traditional methods. The nutritional and microbiological qualities have been determined and confirm that the formula based on soy, millet, rice, corn, and sugar (SOMRIS&amp;lt;sup&amp;gt;10-16&amp;lt;/sup&amp;gt;), meets the nutritional and microbiological needs recommended for children with moderate acute malnutrition. It will be subjected to the clinical trial processes in force in order to use it with complete peace of mind.

Cost- effectiveness of a simplified acute malnutrition program: a secondary analysis of the OptiMA randomized clinical trial in the Democratic Republic of the Congo.

Acute malnutrition (AM) causes large loss of life and disability in children in Africa. Researchers are testing innovative approaches to increase efficiency of treatment programs. This paper presents results of a cost-effectiveness analysis of one such program in the Democratic Republic of the Congo (DRC) based on a secondary analysis of a randomized controlled trial Optimizing Treatment for Acute Malnutrition (OptiMA), conducted in DRC in 2018-20. 896 children aged 6-59 months with a mid-upper arm circumference (MUAC) <125 mm or with oedema were treated and followed for six months. Cost-effectiveness of OptiMA using ready-to-use therapeutic food (RUTF) at a tapered dose was compared with the standard national program in which severe cases (SAM) received RUTF proportional to weight, and moderate cases (MAM) were referred to another clinic for a fixed dose regimen of ready-to-use supplementary food. Cost analysis from provider perspective used data collected during the trial and from administrative records. Statistical differences were derived using t-tests. The mean cost per enrolled child under OptiMA was $123 [95%CI: 114-132], not statistically different from the standard group ($127 [95%CI: 118-136], p=0.549), while treatment success (i.e. recovery to MUAC > 125mm and no relapse for 6 months) under OptiMA was 9 percentage points higher (72% vs 63%, p=0.004). Among children with SAM at enrollment, there was no significant difference in treatment success between OptiMA and standard (70% vs 62%, p=0.12) but OptiMA's mean cost per enrolled child was 23% lower ($128 vs $166, p<0.0001). OptiMA was more effective at preventing progression to SAM among those enrolled with MAM (5% vs 16%, p<0.0001) with an incremental cost-effectiveness ratio (ICER) of $234 per progression to SAM prevented. Overall, OptiMA had significantly better outcomes and was no more expensive than standard care. Its adoption could enable more children to be successfully treated in contexts where therapeutic food products are scarce.

A Review on Malnutrition in Children: Management and Treatment

Abstract: Malnutrition in children is a major problem in developing countries. An increased number of children are dying because of a lack of nutrition in their regular diet. The nutritional value of food during the growing stage of children is important. The development of the human body requires various types of nutrition for normal growth, which is obtained from a regular healthy diet. In this study, an exhaustive literature survey was done using Pubmed, Google Scholar, and various other internet sources, and also other reference records were studied. This review highlighted the causes and consequences of the perpetual lack of a healthy diet that leads to malnutrition. It also summarized the steps taken for the management and treatment of malnutrition. This review may be a vital tool for the researchers working on malnutrition for its proper understanding.

Malnutrition and its Risk Factors in Renal Patients on Dialysis

Patients with end stage kidney disease (ESKD) on hemodialysis (HD) should follow a strict diet during the inter-dialytic period(1). Compliance to treatment, including diet, is key for optimal disease management and health outcomes and to protect against malnutrition(2,3). The objective of this study was to assess renal nutrition-related knowledge, compliance with dietary guidelines, adherence to treatment and risk of malnutrition among patients with ESKD in Lebanon.A convenience sample of 119 patients with ESKD on HD was recruited from the dialysis units of the Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH) and Hammoud Hospital University Medical Center (HHUMC) in Lebanon. Demographic characteristics, 24 hour-recall and a validated food frequency questionnaire(4) were collected from participants, while anthropometrics including weight status in the past 3 months, as well as biochemical data were collected from medical charts. Bioelectrical impedance tests were conducted on the patients, 30 mins after HD hemodialysis session, to assess body composition. Nutrition knowledge was assessed using a validated questionnaire(5), whereby “poor knowledge” corresponds to &lt;70% correct answers. Compliance to treatment (HD sessions, medications, fluids, and diet) was collected from participants using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ)(6)) (Kim et al., 2010) and scored using the tool guide. Accordingly, adherence was classified as “poor” (scores &lt;500), “moderate” (scores: 500-799), or “good” (scores: 800-1000).100 of the 119 participants (85.5%) were found to have malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria(7). Malnourished patients were mostly found with lower education (57%), poor nutrition knowledge (68%), poor to moderate overall compliance (82%), and with no adequate caloric intake (67%). Weight loss was the most common phenotypic criterion among malnourished patients, whereby 22% of malnourished patients had weight loss of &gt; 3Kg in the past 3 months. Malnourished patients with weight loss had a higher (p = 0.008) prevalence of poor overall compliance (36%), compared to those with mild or no weight loss (14%). Additionally, malnourished people with poor compliance tended to be younger (&lt;55 years of age) and with lower levels of income and education (p&lt;0.05).Malnutrition rates are alarmingly high among patients with ESKD in our sample and are linked with low nutrition knowledge and poor adherence to treatment, including dietary compliance. Future studies with a larger more representative cohort are required to confirm our results. Accordingly, intervention trials targeting knowledge and adherence among ESKD patients in Lebanon are warranted to prevent malnutrition and to achieve better clinical outcomes.

Unveiling the intrinsic role of malnutrition in patients with Crohn's disease undergoing major surgery using entropy balancing weighting analysis.

The negative role of malnutrition in patients with Crohn's disease is known; however, many coexisting disease-related factors could cause misinterpretation of the real culprit. This study aimed to describe the role of malnutrition using a novel methodology, entropy balancing. This was a retrospective analysis of consecutive patients undergoing elective major surgery for Crohn's disease, preoperatively screened following the European Society for Clinical Nutrition guidelines. Two-step entropy balancing was applied to the group of malnourished patients to obtain an equal cohort having a null or low risk of malnutrition. The first reweighting homogenised the cohorts for non-modifiable confounding factors. The second reweighting matched the two groups for modifiable nutritional factors, assuming successful treatment of malnutrition. The entropy balancing was evaluated using the d-value. Postoperative results are reported as mean difference or OR, with a 95 % CI. Of the 183 patients, 69 (37·7 %) were at moderate/high risk for malnutrition. The malnourished patients had lower BMI (d = 1·000), Hb (d = 0·715), serum albumin (d = 0·981), a higher lymphocyte count (d = 0·124), Charlson Comorbidity Index (d = 0·257), American Society of Anaesthesiologists (d = 0·327) and Harvey-Bradshaw scores (d = 0·696). Protective loop ileostomy was more frequently performed (d = 0·648) in the malnourished group. After the first reweighting, malnourished patients experienced a prolonged length of stay (mean difference = 1·9; 0·11, 3·71, days), higher overall complication rate (OR 4·42; 1·39, 13·97) and higher comprehensive complication index score (mean difference = 8·9; 2·2 15·7). After thesecond reweighting, the postoperative course of the two groups was comparable. Entropy balancing showed the independent role of preoperative malnutrition and the possible advantages obtainable from a pre-habilitation programme in Crohn's disease patients awaiting surgery.