Nutrition support of children with chronic liver disease: A rapid review and consensus statements from Australasian society of parenteral and enteral nutrition (AuSPEN) Paediatric liver group.

Enhancing prediabetes and diabetes detection through a machine learning-enabled self-assessment approach.

We investigated the influence of progressive overload (PO) on resistance exercise-induced muscle growth. Fifty-five untrained young women participated in the study. Each participant's arm was randomly assigned to one of the following conditions: 1) PO ( n = 37), 2) nonprogressive overload (N-PO, n = 32), and 3) time-matched nonexercise control (Control, n = 41). The training conditions performed unilateral elbow extension exercise in three sets of 8-12 repetitions, 3 d·wk -1 , for 8 wk. The PO condition increased the load whenever it reached the upper limit of the repetition range, whereas N-PO remained training with the same load and number of repetitions throughout the 8 wk. Triceps brachii (TB) muscle thickness was assessed using ultrasonography at 60% (TB60) and 70% (TB70) of the upper arm length, and the sum of both sites was calculated (∑TB). TB60 muscle thickness increased in both training conditions compared with Control, with greater increases in PO relative to N-PO (PO = 0.40 cm, +21.4% > N-PO = 0.22 cm, +11.3% > Control = 0.02 cm, +1.3%; P < 0.001). TB70 muscle thickness increased in both training conditions compared with Control, with greater increases in PO relative to N-PO (PO = 0.38 cm, +25.0% > N-PO = 0.19 cm, +12.0% > Control = 0.03 cm, +2.5%; P < 0.001). ∑TB increased in both training conditions compared with Control, with greater increases in PO relative to N-PO (PO = 0.79 cm, +22.9% > N-PO = 0.41 cm, +11.6% > Control = 0.05 cm, +1.8%; P < 0.001). Muscle growth appears to be more pronounced when resistance exercise is progressively overloaded. Notably, training without overload progression is sufficient to induce muscle hypertrophy in young, untrained women. Whether resistance training without increasing overload remains effective in promoting muscle growth when performed for longer periods remains an open question and warrants further investigation.

Access to effective vaccination is an important way to protect against infectious diseases. The Aotearoa-New Zealand immunisation handbook on safe and effective vaccination practice recommends a 38-mm needle length for intramuscular deltoid injections in very large individuals, using clinical judgment to ensure needle length is appropriate to reach muscle. It is not clear how vaccinators implement this guidance in practice. This study aimed to explore vaccinators' needle-length selection practice for big-bodied people and their views on a prototype arm circumference tool to guide needle choice. Vaccinators working with Māori and Pacific communities were recruited via researchers' networks to take part in one of six in-person focus groups in the Wellington region, Horowhenua district, and Tairāwhiti region (August-October 2025). Data were analysed qualitatively using a reflexive thematic approach. Twenty-five primary care-based vaccinators with varied roles and experience participated. Themes identified in the discussion included prioritisation of patient-centred care, influences on decision making (familiarity with guidance, training, workflow and equipment), and strengthening practice in these areas. The prototype tool was viewed positively, with discussion highlighting its potential to improve familiarity with arm size and needle-length criteria. Practical, workflow, and patient-centred considerations were raised, with particular focus on the importance of communicating use of the tool in a sensitive manner. Ensuring adequate supply and availability of 38-mm needles, along with clear guidance and education, are essential to support vaccinators' clinical judgement and effective vaccine delivery to big-bodied people. Use of an arm circumference assessment tool could strengthen vaccinators' decision making and help standardise needle length.

Mid-Upper Arm Circumference (MUAC) is a widely used, rapid, and low-cost anthropometric tool for community-based screening of acute malnutrition among children. However, accurate MUAC assessment requires identification of the midpoint of the upper arm and proper tape placement, which may contribute to inter-observer variability and inconsistencies in field measurements. Random Upper Arm Circumference (RUAC) has been proposed as a simpler alternative for community screening. Nevertheless, evidence regarding the agreement and validity of RUAC compared with standard MUAC for identifying wasting among Ethiopian children remains limited. Therefore, this study aimed to assess the concordance and validity of RUAC compared with MUAC in identifying wasting among children aged 6-59 months in Southwest Ethiopia. A community-based cross-sectional study was conducted among 591 children aged 6-59 months in Southwest Ethiopia from June 2 to June 30, 2023. Participants were selected using simple random sampling from child registration lists used as the sampling frame. Paired RUAC and standard MUAC measurements were obtained from each child to assess agreement between the two methods. Children were classified as wasted using the MUAC cut-off value of < 12.5cm, and RUAC was categorized using the same threshold. Data were analyzed using SPSS version 26. Agreement between RUAC and MUAC was evaluated using Cohen's Kappa for categorical measures and Bland-Altman analysis for continuous measurements. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curve analysis. Assumptions for statistical analyses were checked before analysis. Among the participants, 61 (10.4%) children were classified as wasted using standard MUAC measurements. Significant agreement was observed between RUAC and standard MUAC classifications (κ = 0.69; 95% CI: 0.60-0.79; p < 0.001). Using standard MUAC as the reference method, RUAC demonstrated a sensitivity of 81.6% (95% CI: 71.9%-89.0%) and specificity of 95.2% (95% CI: 93.1%-96.9%) for identifying wasting among children aged 6-59 months. The positive predictive value and negative predictive value of RUAC were 66.2% (95% CI: 55.0%-76.2%) and 97.8% (95% CI: 96.1%-98.9%), respectively. RUAC also demonstrated excellent diagnostic performance, with an area under the curve of 0.99 (95% CI: 0.98-0.99) for severe acute malnutrition and 0.94 (95% CI: 0.93-0.96) for moderate acute malnutrition. RUAC showed substantial agreement with standard MUAC and acceptable diagnostic performance for identifying wasting among children aged 6-59 months in Southwest Ethiopia. However, the evidence is limited to a single-site cross-sectional study, therefore, generalization beyond the study population is not justified. Further validation across different Ethiopian settings is recommended.

Stunting is a multifactorial public health problem influenced by various risk factors that may emerge during the prenatal period. Early identification of stunting risk during pregnancy is important to support preventive interventions. This study aimed to develop a stunting risk prediction model based on maternal prenatal factors using the Random Forest algorithm. Secondary data from 172 pregnant women, consisting of 83 stunting cases and 89 non-stunting cases, were analyzed. The predictor variables included maternal age during pregnancy, height, hemoglobin level, mid-upper arm circumference (MUAC), smoking history, hypertension, asthma, and diabetes mellitus. The research stages consisted of data preprocessing, model training using Stratified 5-Fold Cross Validation, performance evaluation, external testing, and feature importance analysis. Internal evaluation results showed an accuracy of 60%, precision of 60.6%, recall of 57.3%, F1-score of 58.9%, and AUC of 0.6688. External testing yielded an accuracy of 70% and an AUC of 0.6167. Feature importance analysis identified maternal age during pregnancy as the most influential variable in the prediction process. The findings indicate that maternal prenatal factors have potential for early stunting risk identification, although the predictive performance remains moderate. This approach may serve as a foundation for developing early screening tools to support targeted interventions among high-risk pregnancies.

Effects of Preoperative Nutritional Status on Postoperative Delirium in Patients Undergoing Elective Non-cardiac Surgery: Implications for Preoperative Nursing Practice.

Mid-upper arm circumference (MUAC) is widely used for screening pediatric malnutrition due to its simplicity and feasibility. Although its relationship with anthropometric indicators including weight-for-height (WFH), body mass index (BMI)-for-age, and height-for-age has been previously examined, the degree of agreement and its clinical implications remain variable. This study aimed to evaluate the agreement and clinical relevance of MUAC in assessing acute, chronic, and concurrent malnutrition. This retrospective cross-sectional study included 473 children (0–18 years) evaluated for malnutrition at a tertiary pediatric gastroenterology clinic. Nutritional status was classified using World Health Organization growth standards based on WFH, BMI-for-age, and height-for-age z-scores. MUAC was analyzed as absolute values and MUAC-for-age z-score categories. Acute malnutrition was identified in 72.9% of participants, chronic malnutrition in 18.2%, and concurrent malnutrition in 8.9%. MUAC classified 83.7% of children as malnourished and detected a higher proportion of mild malnutrition than BMI-for-age and WFH classifications. MUAC severity showed a moderate correlation with WFH classifications in children <5 years (ρ = 0.447, P <.001) and a strong correlation with BMI-for-age classifications in those ≥ 5 years (ρ = 0.649, P <.001). Agreement between MUAC-based severity categories and anthropometric classifications was fair for WFH (κ = 0.33) and moderate for BMI-for-age (κ = 0.55). Children with concurrent malnutrition were more frequently classified into moderate or severe MUAC categories (P <.01). MUAC showed fair-to-moderate agreement and moderate-to-strong correlations with BMI-for-age and WFH indicators of acute malnutrition, whereas its associations with chronic malnutrition were weaker. It identifies a higher proportion of children with mild malnutrition and reflects the severity of concurrent malnutrition. These findings support the potential complementary role of MUAC in routine anthropometric assessment and suggest that it may contribute to the early identification of pediatric malnutrition.

Objective Malnutrition frequently complicates peritoneal dialysis (PD) and associates with adverse outcomes, underscoring the clinical importance of its timely identification. This study aimed to develop and internally validate a machine learning-based assessment model to identify PD patients currently at malnutrition risk who need nutritional intervention. Methods In this cross-sectional study, 144 PD patients were evaluated for malnutrition risk using the Patient-Generated Subjective Global Assessment (PG-SGA). A PG-SGA score ≥4 was prespecified to indicate malnutrition risk warranting dietitian-led intervention. Candidate predictors included demographic characteristics, laboratory indices, and physical function measures. To avoid overfitting and selection bias associated with comparing multiple algorithms in a modest sample, we pre-specified three representative models: logistic regression (LR) as a linear baseline, penalized logistic regression (ridge), and extreme gradient boosting (XGBoost). Feature selection was performed using LASSO regression. Instead of a single training-validation split, we employed 1,000 bootstrap resampling iterations for internal validation. Model performance was assessed using the C-index, Brier score, calibration intercept, and calibration slope, with bootstrap-derived 95% confidence intervals. Results Malnutrition risk was observed in 47.2% of participants (68/144). LASSO retained seven associated features: age, short physical performance battery (SPPB) score, timed up and go (TUG) test result, triceps skinfold thickness, handgrip strength, triglycerides, and serum albumin. Based on bootstrap internal validation, the XGBoost model achieved a mean C-index of 0.798 (95% CI 0.712–0.871) and a mean Brier score of 0.208 (95% CI 0.176–0.244). The calibration intercept was −0.12 (95% CI − 0.41 to 0.18) and calibration slope was 0.85 (95% CI 0.62–1.12), indicating no systematic overprediction but some risk of overconfidence in extreme predictions. For illustrative purposes only, a single 7:3 split yielded a C-index of 0.812 (95% CI 0.684–0.940), but this estimate is known to be unstable and optimistic; therefore, it is not reported as a primary finding. Conclusion An interpretable XGBoost model incorporating seven routinely available features showed good discrimination and reasonable calibration for associating with current malnutrition risk as defined by PG-SGA in PD patients. However, because several predictors (e.g., handgrip strength, triceps skinfold thickness) are components or direct reflections of nutritional status themselves, the observed performance may partly reflect conceptual overlap with the outcome rather than genuine predictive capacity. Given this conceptual overlap, the model’s performance may partly reflect inherent consistency with the PG-SGA rather than genuine independent predictive capacity. The model should therefore be viewed strictly as an alternative representation of the PG-SGA-based assessment, identifying correlates of current nutritional status, rather than as a tool providing independent risk prediction. Consequently, the model’s performance estimates, particularly the C-index with a 95% confidence interval whose lower bound is close to 0.7, are subject to considerable uncertainty. Given the modest sample size (events-per-variable ratio of 9.7, below the recommended minimum of 10), cross-sectional design, and the fact that three pre-specified models were tuned and compared simultaneously—an approach that carries a high risk of overfitting and chance findings—these findings should be interpreted as exploratory. Therefore, strong warnings against direct extrapolation of this model to clinical practice are warranted, and external validation in much larger cohorts is strictly required before any conclusion can be drawn regarding generalizability. The online tool is provided as an exploratory research prototype only and is not ready for clinical deployment.

Advanced kidney disease and renal replacement therapy are associated with numerous metabolic and nutritional imbalances. Nutrition plays a major role in reducing complications and improving quality of life. The aim of this structured narrative review was to explore the specific nutritional and fluid management challenges among hemodialysis patients in Albania. A search of various databases (PubMed, Cochrane Library, Medscape, UpToDate, and Google Scholar) was conducted for publications from 2000 to 2025, identifying 49 studies for inclusion. Evidence from the literature indicates that patients undergoing hemodialysis present with multiple vitamin and mineral deficiencies. Common issues include vitamin C, vitamin D, B6, B12, carnitine deficiency, and malnutrition prevalence of 43%-61% across various studies. In Albania, care is constrained by low household incomes; traditional diets high in phosphorus, potassium, and salt; the absence of renal dietitians; inconsistent patient and family education; and excessive interdialytic weight gain. Recommendations emphasize the need to implement routine measurements of biochemical markers such as serum prealbumin, anthropometric measurements such as body mass index and mid-upper arm circumference, evaluation of dietary intake at least every 3 months and objective monitoring tools such as bioimpedance spectroscopy for assessing extracellular volume status. The lack of official data on the nutritional status of hemodialysis patients in Albania highlights the urgent need for multicenter, collaborative research, and the establishment of improved, evidence-based nutritional regimens. Implementing these clinical and policy measures is crucial for significantly enhancing patient outcomes and enabling dialysis care in Albania to approach global standards. Cite this article as: Pina P, Prifti E, Nasto F, Shella M, Shtӫmbari X, Kaca S. Nutritional challenges in hemodialysis: a perspective from Albania. Eurasian J Med. 2026;58(4):1196, doi: 10.5152/ eurasianjmed.2026.251196.

Patients with locally advanced breast cancer (LABC) undergoing axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NACT) face substantial risk of arm morbidity and lymphedema. Axillary reverse mapping (ARM) may preserve upper-limb lymphatic drainage; however, evidence in post-NACT LABC particularly from resource-constrained settings is limited. This phase I study evaluated the feasibility of a low-cost dual-dye ARM and its impact on arm-related quality of life using LYMPH-Q. In this prospective study, 32 patients with LABC undergoing axillary surgery after NACT were included: 16 underwent standard ALND and 16 underwent ALND with ARM. ARM was performed using fluorescein sodium injected into the ipsilateral first web space and methylene blue injected subareolarly. ARM structures were preserved when oncologically safe. LYMPH-Q Upper Extremity scores were assessed at baseline, 6months, and 12months. Arm circumference and lymphedema incidence were recorded. Baseline clinico-pathologic characteristics were comparable between groups. ARM did not significantly increase operative time (p=0.166) or compromise nodal yield (p=0.239). Fluorescent lymphatic channels were identified and preserved in 15/16 ARM cases. At 12months, LYMPH-Q Symptoms scores were significantly higher in the ARM group (p=0.039), with greater improvement from baseline p=0.017). Lymphedema incidence was lower with ARM, though not statistically significant (p=0.600). Increases in mid-upper arm and forearm circumference were significantly lower. Low-cost dual-dye ARM is feasible following NACT in LABC and may improve patient-reported arm symptoms while maintaining comparable operative and pathological outcomes.

malnutrition among children under five remains a major global public health concern, particularly in low -and middle- income countries. This systematic review aimed to evaluate the effectiveness of local food-based interventions in improving anthropometric outcomes, including body weight, height, and mid-upper arm circumference (MUAC), among under-five children with malnutrition. a systematic literature search was conducted in PubMed, ScienceDirect, and Google Scholar for studies published between 2015 and 2025, following PRISMA 2020 guidelines. Eligible studies included randomized controlled trials and quasi-experimental designs assessing local food-based nutritional interventions. Study selection was conducted independently by two reviewers. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for quasi-experimental studies. a total of 11 studies were included. Local food-based interventions, particularly ready-to-use therapeutic foods (RUTF) and lipid-based nutrient supplements (LNS), were generally associated with improvements in body weight, MUAC, and growth indicators. However, the magnitude of effect varied across studies depending on intervention type, duration, and study design. Some studies reported comparable or non-significant differences between intervention and control groups. local food-based interventions show potential in improving nutritional outcomes among under-five children, but the evidence remains heterogeneous. Further high-quality studies are needed to better establish their comparative effectiveness and long-term impact.

Handgrip strength is a well-established indicator of muscular fitness and an early predictor of adverse long-term health outcomes. However, limited research has examined HGS and its determinants among young adults in East Asia. This cross-sectional study investigated the association between lifestyle and physiological factors and low HGS in 501 Taiwanese university students aged 18–25 (168 men, 333 women). Participants completed questionnaires on physical activity, sedentary time, and dietary behavior, and underwent anthropometric measurements including body mass index (BMI), mid-upper arm circumference, and handgrip strength. Low handgrip strength was defined using the sex-specific criteria established by the Asian Sarcopenia Working Group in 2019 (men < 28 kg; women <18 kg). Results showed that 6.2% of participants had low handgrip strength (8.3% in men, 5.1% in women). Men had significantly higher average handgrip strength than women (38.0 ± 7.8 kg vs. 24.6 ± 4.4 kg, p < .001). Upper arm circumference and handgrip strength showed the strongest correlation in both sexes (p < .001). Logistic regression analysis revealed that smaller upper arm circumference (OR = 0.80, p = .003 per 1 cm increase), insufficient moderate-to-vigorous physical activity (OR = 0.40, p = .055), and male sex (OR = 5.28, p = .001) were significantly associated with poor handgrip strength. Dietary habits and sedentary time were not significantly associated with handgrip strength. These findings highlight the importance of early identification of muscle weakness and promoting physical fitness training in young adults. Men with smaller arm circumference and lower activity levels showed a significant association with low HGS and may benefit from early monitoring and targeted intervention. Incorporating muscle strength assessment and activity promotion into early adulthood health programs may help preserve muscular fitness, prevent future sarcopenia, and support healthier aging trajectories in East Asian populations.

Mass administration of azithromycin reduced child mortality in parts of sub-Saharan Africa. Promotion of infant growth may be an additional benefit of azithromycin treatment. To investigate whether the provision of mass administration of azithromycin for infants aged 1 to 11 months improves growth outcomes. This cluster randomized clinical trial conducted from December 1, 2020, to December 31, 2024, included 1151 villages in southwestern Mali. Villages were randomized in a 3:4:2 ratio to placebo, twice-yearly azithromycin, or quarterly azithromycin. Participants and study personnel were masked. The prespecified growth substudy, conducted from August 31, 2022, to July 31, 2023, was conducted in 59 villages in the Kita region. Eligible participants were infants aged 1 to 11 months, weighing 3.0 kg or more, with no macrolide allergy or severe illness. Anthropometric data were collected cross-sectionally from children aged 6 to 8 months and 12 to 14 months at 15, 18, 21, and 24 months after village enrollment. Infants received a single oral dose of azithromycin, 20 mg/kg, at each quarterly visit: placebo at all rounds (control); azithromycin at 2 rounds from January to June and placebo at 2 rounds from July to December (twice-yearly azithromycin); or azithromycin at all rounds (quarterly azithromycin). Prespecified outcomes were weight and length; weight-for-age (WA), length-for-age (LA), weight-for-length (WL), and mid-upper-arm circumference (MUAC) z scores; and underweight, stunting, and wasting. Analysis was performed on an intention-to-treat basis. A total of 1205 infants (mean age, 5.7 months [95% CI, 5.6-5.9 months]; 633 boys [52.5%]) were included in the trial at baseline. Among 1789 children (923 boys [51.6%]) assessed for growth, the mean anthropometric indices did not differ between the placebo, twice-yearly azithromycin, and quarterly azithromycin groups: weight, 7.8 kg (95% CI, 7.7-7.9 kg), 7.8 kg (95% CI, 7.7-7.9 kg), and 7.8 kg (95% CI, 7.7-7.9 kg), respectively; length, 70.2 cm (95% CI, 69.9-70.8 cm), 70.6 cm (95% CI, 70.2-70.9 cm), and 70.6 cm (95% CI, 70.1-71.0 cm), respectively; WA z score, -1.12 (95% CI, -1.23 to -0.95), -1.10 (95% CI, -1.19 to -0.98), and -1.12 (95% CI, -1.27 to -1.01), respectively; LA z score, -0.86 (95% CI, -1.06 to -0.70), -0.79 (95% CI, -0.93 to -0.65), and -0.78 (95% CI, -0.98 to -0.63), respectively; WL z score, -0.87 (95% CI, -1.00 to -0.68), -0.89 (95% CI, -1.01 to -0.77), and -0.95 (95% CI, -1.12 to -0.81), respectively; and MUAC z score, -0.30 (95% CI, -0.43 to -0.10), -0.24 (95% CI, -0.37 to -0.12), and -0.26 (95% CI, -0.41 to -0.10), respectively. The proportions of underweight, stunting, and wasting did not differ between groups. In this prespecified analysis of secondary outcomes of a cluster randomized clinical trial of the provision of mass administration of azithromycin for infants aged 1 to 11 months, growth outcomes did not differ between azithromycin and placebo groups. These findings suggest that mass administration of azithromycin to infants is unlikely to promote growth. ClinicalTrials.gov Identifier: NCT04424511.

Age-dependent diagnostic performance of mid-upper arm circumference Z-score in pediatric neurology: A multicenter study with a cerebral palsy subgroup.

Integrated community case management plus compared with outpatient therapeutic programs: a quasi-experimental study among children with severe acute malnutrition in Jowhar, Somalia.

Impact of a Prenatal Nutrition Package with Balanced Energy Supplementation on Gestational Weight Gain in Amhara, Ethiopia.

Agreement of nutritional screening tools with GLIM-defined malnutrition in older hospitalized people.

IntroductionAdditional investigation is needed to better understand the associations between prenatal and early child malaria and early childhood growth outcomes.MethodsWe leveraged the Ghana Randomized Air Pollution and Health Study which enrolled 1414 pregnant women from Kintampo, Ghana, and followed the mother-child dyads through the child’s first year of life. We defined prenatal malaria exposure by histopathological examination of placenta tissue. We defined early child malaria exposure by active health surveillance over the child’s first year of life and malaria rapid diagnostic testing when clinically indicated. We employed latent class growth analyses to construct growth trajectories for each anthropometric measure (weight and height and corresponding WHO z-scores, mid-upper arm circumference and head circumference (HC)), which we measured at birth, 3, 6, 9 and 12 months of age. We then used unadjusted and adjusted ordinal and multinomial regression to identify associations between prenatal and early child malaria growth trajectories, considered separately.ResultsOf the 1306 live births, 1144 children had prenatal and early child malaria exposure and growth data and were included in the analysis; 250 (21.9%) had prenatal malaria exposure, and 525 (45.9%) had early child malaria infection. Children with prenatal malaria as compared to those without had higher risk for poorer length growth (OR=1.46, 95% CI 1.08 to 1.98; multivariable OR=1.46, 95% CI 1.05 to 2.02), poorer length-for-age z-scores (OR=1.43, 95% CI 1.09 to 1.88; multivariable OR=1.53 95% CI 1.14 to 2.05) and smaller HC (OR=1.56, 95% CI 1.16 to 2.09; multivariable OR=1.43, 95% CI 1.04 to 1.98). Children with early childhood malaria as compared to those without had higher risk for poorer length-for-age z-score (OR=1.13, 95% CI 1.03 to 1.24; multivariable OR=1.12, 95% CI 1.01 to 1.24). Children with prenatal malaria as compared to without showed a trend for persistent stunting (multivariable OR=1.63, 95% CI 0.98 to 2.71).ConclusionMalaria beginning in pregnancy was associated with poorer growth outcomes. Public health preventative strategies beginning in pregnancy may reduce malaria incidence and improve early childhood growth.

Efficacy of a high-protein food for special medical purposes in midlife and older adults at risk of malnutrition: a multicenter, randomized, active-controlled clinical study