Undernourished Group Research Articles

Tranexamic acid efficacy in geriatric hip fractures: impact of nutritional status on blood loss, transfusion rates, and safety

BackgroundTranexamic acid (TXA) is a widely employed intervention in orthopedic surgeries to minimize blood loss and the need for postoperative transfusions. This study focuses on assessing the efficacy and safety of TXA specifically in undernourished older adults undergoing hip fracture procedures.MethodsA total of 216 patients were classified into two groups based on the Geriatric Nutritional Risk Index: undernourished and normal. In total, 82 patients received intravenous TXA at a dosage of 15 mg/kg before incision, with an additional 1 g administered intravenously over a 3-hour period postoperatively. Postoperative hemoglobin (Hb) drop, blood transfusion rate, and the incidence of deep venous thrombosis (DVT) were assessed in each group according to the presence or absence of TXA. Additionally, demographic factors including age, sex, body mass index, and serum albumin were investigated.Results51.9% patients were identified as undernourished, experiencing progressive anemia (Hb: 10.9 ± 1.5 g/dL) and hypoalbuminemia (serum albumin: 31.9 ± 8 g/L). In comparison with the normal group, undernourished individuals were more likely to sustain femoral neck fractures (undernutrition vs. normal: 56.2 vs. 42.3%) and less likely to incur trochanteric fractures (undernutrition vs. normal: 43.8 vs. 57.7%) (P = 0.043). TXA administration significantly reduced the transfusion rate (P = 0.014) and Hb drop (P = 0.001) in the normal nutritional group, while its impact on the undernourished group remained less pronounced. There was no significant association between TXA administration and the rate of DVT complications, irrespective of the nutritional status.ConclusionsUndernutrition not only diminishes muscle strength and gait function, leading to various types of hip fractures, but it may also hinder the efficacy of TXA in reducing blood transfusion rates and blood loss.

Study the malnutrition status of children aged 6-24 months of the Cham ethnic group in Tan Chau town, An Giang province in 2018

Background: In recent years, according to the investigation report of the Institute of Nutrition, the malnutrition rate of children in remote, faraway, and ethnic minority areas is still high compared to children in other regions. Studying the malnutrition status of children aged 6 to 24 months of the Cham ethnic group in Tan Chau town, An Giang province is a practical need to provide some scientific evidence for interventions to reduce the malnutrition rate of children in the locality. This study aims to explore the nutritional status of children aged 6-24 months of the Cham ethnic group in Tan Chau town, An Giang province in 2018. Methods: Cross-sectional study. Subjects: Cham ethnic children from 6 to 24 months old at the time of the survey and the mothers of the children living in Tan Chau town, An Giang province. Results: Research shows that the average weight and length increase with age group, and boys have higher corresponding average values than girls. The malnutrition group has the highest malnutrition rate in the age group of 6-12 months at 27.2% and the lowest in the age group of 19-24 months at 2.6%. Undernourished group in the Stunted category has the highest undernourishment rate in the age group of 6-12 months at 44.1% and the lowest in the age group of 19-24 months at 25.7%. Undernourished group in the Wasted category has the highest undernourishment rate in the age group of 13-18 months at 13.9% and the lowest in the age group of 19-24 months at 2.6%. Conclusions: The malnutrition status of children aged 6-24 months of the Cham ethnic group in Tan Chau town, An Giang province in 2018 is still quite high.

The Impact of Chemotherapy on Nutritional Status

Introduction: A state of malnutrition is so commonly associated with tumor disease that it is often considered an integral part of the evolution of cancers. Materials and Methods: This is a prospective monocentric study carried out in the Medical Oncology department of the PHE of Laghouat. Patients with cancer and followed in this service between October 4, 2020 and November 26, 2020 have been included. The main objective was to study the impact of chemotherapy on the nutritional status of cancer patients by assessing the nutritional status and quantifying its anthropometric and biological parameters. Malnutrition is defined as weight loss > 5% in one month or > 10% in six months and/or body mass index ≤ 18,5 kg/m² and/or albuminemia 30 g/L in adult patients aged < 70 and by weight loss 5% in one month or 10% in six months and/or body mass index ≤ 21 kg/m² and/or albuminemia 35 g/L in patients aged ≥70. Results: This study included 123 patients with a sex ratio of 0.6 and an average age of 51.81±14.33 years who were sectioned into 2 groups: undernutrition with a weight loss greater than 5% of usual weight and or BMI 18, 5kg/m² and or albuminemia 30g/L (in 70-year-old patients) and or BMI21 kg/m² and or albuminemia 35g/L (in 70-year-old patients) (n=16, 13%) and those without malnutrition (n=107, 87%). Men accounted for 34.6% of the not undernourished population and 56.3% of the malnourished population. The weight change in the undernourished group was on average -1.12%±5.4 with 30.1% of undernourished people have PDP>5% and 81.26% were on chemotherapy. The mean BMI of the undernourished population is 18.63kg/m² 3.98 and the mean albumin is 35.65 3.68 g/L in the undernourished population. Discussion and Conclusion: The undernutrition of cancer patients is common and associated with less benefit from chemotherapy and a derogatory prognosis.

Astaxanthin and DHA Supplementation Modulates the Maternal Undernutrition-induced Impairment of Cognitive Behavior and Synaptic Plasticity in Adult Life of Offspring's -Exploring the Molecular Mechanism.

Maternal nutrition was recognized as a significant part of brain growth and maturation in most mammalian species. Timely intervention with suitable nutraceuticals would provide long-term health benefits. We aim to unravel the molecular mechanisms of perinatal undernutrition-induced impairments in cognition and synaptic plasticity, employing animal model based on dietary nutraceutical supplementation. We treated undernourished dams at their gestational, lactational, and at both the time point with Astaxanthin (AsX) and Docosahexaenoic acid (DHA), and their pups were used as experimental animals. We evaluated the cognitive function by subjecting the pups to behavioral tests in their adult life. In addition, we assessed the expression of genes in the hippocampus related to cognitive function and synaptic plasticity. Our results showed downregulation of Brain-derived neurotrophic factor (BDNF), Neurotrophin-3 (NT-3), cAMP response-element-binding protein (CREB), and uncoupling protein-2 (UCP2) gene expression in pups born to undernourished dams in their adult life, which AsX and DHA modulated. Maternal AsX and DHA supplementation ameliorated the undernutrition-induced learning impairment in novel object recognition (NOR) tests and partially baited radial arm maze (RAM) tasks in offspring's. The expressions of Synapsin-1 and PSD-95 decreased in perinatally undernourished groups compared to control and AsX-DHA treated groups at CA1, CA2, CA3, and DG. AsX and DHA supplementation upregulated BDNF, NT-3, CREB, and UCP2 gene expressions in perinatally undernourished rats, which are involved in intracellular signaling cascades like Ras, PI3K, and PLC. The results of our study give new insights into neuronal differentiation, survival, and plasticity, indicating that the perinatal period is the critical time for reversing maternal undernutrition-induced cognitive impairment in offspring's.

Chronic Undernutrition in Ovine Twin Pregnancies Abolishes Differences in Birth Weight Due to Sex: An Evaluation of the Role of Nutritional and Antioxidant Supplementation.

In twin pregnancies of discordant sex, the male fetus grows larger than the female co-twin. Our study aimed to determine the effect of the sex of co-twins on lambs' birth weight in ovine pregnancies developed under natural undernourishment. Additionally, we investigated whether the nutritional and/or antioxidant supplementation provided to ewes during pregnancy could modulate the potential effects associated with the sex of co-twins. Ninety-six birth records of twin pregnancies of sheep grazing the natural Patagonian prairies were analyzed. The animals were divided into four groups: control (no supplementation), N (concentrate supplementation, 100% NRC), A (antioxidant supplementation), and NA (concentrate + antioxidant supplementation). Supplementation occurred from day 35 of gestation onwards until lambing. There were no differences in female or male birth weight in the control undernourished group. However, in group N, females or males with sex-discordant co-twins had a higher birth weight than did those with co-twins of the same sex. Group A males with female co-twins had a higher birth weight compared to males whose co-twins were also males. In NA lambs, males had a higher birth weight compared to females, regardless of their co-twin's sex. Therefore, chronic undernutrition abolished the differences in birth weight due to fetal sex. Restoring maternal nutrition or antioxidant supplementation tends to normalize birth weight and restore the differences between females and males. This effect is enhanced with the combined supplementation of concentrated food and antioxidants.

In Vivo Genotoxicity and Cytotoxicity Kinetics of Trimethoprim Sulfamethoxazole in Well-nourished and Undernourished Young Rats.

Undernutrition is a serious health problem prevalent in poor countries, affecting millions of people worldwide, especially young children, pregnant women, and sick elderly individuals. This condition increases vulnerability to infections, leading to widespread use of antibiotic treatments in undernourished populations. The objective of the present study was to determine the in vivo genotoxic and cytotoxic effects of trimethoprim-sulfamethoxazole (TMP-SMX) treatment according to nutritional conditions. The effects of TMP-SMX treatment were measured by analyzing the kinetics of micronucleated reticulocytes (MN-RET) induced in the peripheral blood of young, well-nourished (WN) and undernourished (UN) rats. In the WN group, two distinct peaks of MN-RET were observed, while the UN group had a significantly higher basal frequency of MN-RET compared to the WN group and only a later peak. Reticulocyte (RET) frequency slightly decreased in WN, indicating a poor cytotoxic effect. In contrast, in the UN, the treatment caused a significant increase in RET frequency. The results indicate that SMX's aromaticity index decreases when formed with TMP, suggesting potentially fewer toxic effects. In vivo TMP-SMX produces two MN-RET induction peaks in WN animals, indicating two DNA damage induction mechanisms and consequent micronucleus production. The UN rats did not display the two peaks, indicating that the first MN induction mechanism did not occur in UN, possibly due to pharmacokinetic effects, decreased metabolism or effects on cell proliferation. TMP-SMX has a slight cytotoxic effect on WN. In contrast, in the UN, the antibiotic treatment seems to favor early erythropoiesis.

Environmental enrichment changes the effects of prenatal and postnatal undernutrition on memory, anxiety traits, Bdnf and TrkB expression in the hippocampus of male adult rats

Environmental factors such as undernutrition and environmental enrichment can promote changes in the molecular and behavioural mechanisms related to cognition. Herein, we investigated the effect of enriched environment stimulation in rats that were malnourished in the pre- and postnatal periods on changes in the gene expression of brain-derived neurotrophic factor and its receptor in the hippocampus, as well as on anxiety traits and memory. Early undernutrition promoted weight reduction, increased the risk analysis, reduced permanence in the open arm of the elevated plus-maze and induced a reduction in the gene expression of brain-derived neurotrophic factor and tropomyosin receptor kinase B. However, exposure to an enriched environment from 30 to 90 days’ old maintained the malnourished phenotype, leading to weight reduction in the control group. In addition, the enriched environment did not alter the risk assessment in the undernourished group, but it did increase the frequency of labyrinth entries. Sixty-day exposure to the enriched environment resulted in a reversal in the gene expression of brain-derived neurotrophic factor and tropomyosin receptor kinase B in the hippocampus of malnourished rats and favoured of long-term memory in the object recognition test in the open-field. These results suggest that an enriched environment may have a protective effect in adult life by inducing changes in long-term memory and anxiety traits in animals that were undernourished in early life. Furthermore, reversing these effects of undernutrition involves mechanisms linked to the molecular signalling of brain-derived neurotrophic factor and tropomyosin receptor kinase B in the hippocampus.

490. SIGNIFICANCE OF NUTRITIONAL EVALUATION USING GLIM CRITERIA IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Patients with advanced esophageal cancer may have dysphagia and weight loss from the first visit, and it is necessary to evaluate their nutritional status before starting treatment, especially for preoperative patients. On the other hand, since 2018, the global diagnostic criteria for malnutrition, the GLIM criteria, have been proposed to define malnutrition and its severity. Purpose The aim of the study is to examine the impact of malnutrition severity assessment using the GLIM criteria at the time of first visit in patients with advanced esophageal cancer on short-term prognosis (length of hospital stay after surgery) and long-term prognosis (presence or absence of recurrence, OS) in patients undergoing surgery for esophageal cancer. Method From 2011 to 2018, 197 advanced esophageal cancer patients have undergone esophagectomy, and we examined the distribution of malnutrition at the first visit of these patients. Based on the GLIM criteria, low BMI in Asians (<18.5: less than 70 years old, <20: over 70 years old) is defined as malnutrition, and moderate malnutrition and severe malnutrition are defined according to the weight loss rate. Result 42 patients (21.3%) were judged to be malnourished according to the GLIM criteria at the first visit. 23 patients were judged moderately malnourished, and 19 patients were judged severely malnourished. There was no significant difference in postoperative length of hospital stay between the normal nutrition group and the malnutrition group, regardless of the severity of the disease. There was no significant difference in recurrence, but the severely undernourished group had a significantly high rate of recurrences (p < 0.01). Regarding prognosis, the 3-year survival rate tended to be slightly lower in the malnutrition group (p = 0.081), but the 3-year survival rate was significantly lower in the severely malnutrition group (p < 0.001). Conclusion In patients with advanced esophageal cancer, the severe malnutrition group in the GLIM criteria at the time of the first visit was considered to have a poor long-term prognosis, although the short-term prognosis was similar to that of the eutrophic group. Currently, in Japan, NAC is usually performed for operable advanced esophageal cancer, so in the future, we plan to focus on improving the nutritional status from the beginning of NAC to surgery.

Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4).

India is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls. DERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16-18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), β-cell function (HOMA-β), insulin sensitivity (HOMA-S), and compensatory β-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes. The median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-β showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory β-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 μIU/ml vs. 17.1 μIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-β (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all. We have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor β-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.

Nutritional status of children and adolescents with Type 1 Diabetes Mellitus in Baghdad: a case-control study.

Diabetes mellitus (DM) is a major life-long non-communicable illness correlated with obesity and chronic undernutrition. It is particularly important to monitor the nutritional status of children with type 1 diabetes mellitus (T1DM), as they are still growing and may be affected by the disease or associated conditions like celiac disease. This study aimed to evaluate the nutritional status of children and adolescents with T1DM in Baghdad city and identify possible risk factors for undernutrition. A single-center, case-control study was conducted in Central Child's Teaching Hospital, Baghdad, Iraq, over 9 months from November 2021 to July 2022. The study included patients with T1DM and healthy controls. Detailed history, clinical examination, and anthropometric measures were performed for all participants in the study. The mean age of the sample was 10.0 ±3.73 years and 8.68±3.1 years in diabetic patients and controls, respectively. Anthropometric measures in patients with type 1 diabetes were significantly lower than those of controls (P<0.001). All patients within the undernourished group were from large-size families compared with 75.76% of the normally nourished group, with a significant difference. The mean age of disease onset in the normal nourished group was 6.61 ± 2.78 years which was significantly earlier than that of the undernourished group (8.83 ± 2.89). Weight-for-age and BMI z-score had a significant negative correlation with HbA1c (r=-0.312, p=0.004, and r=-0.295, p=0.006, respectively). Patients with T1DM had significantly lower anthropometric measures than the normal population. Older children, female gender, large family size, and disease duration are independent predictors of undernutrition in T1DM. BMI and weight-for-age have a significant negative correlation with metabolic control of diabetes represented by HbA1c.

Nutritional efficacy of Astaxanthin in modulating orexin peptides and fatty acid level during adult life of rats exposed to perinatal undernutrition stress

ABSTRACT Perinatal undernutrition stress predisposes several disorders in adult life, which could be programed using nutraceuticals. However, the effect of perinatal undernutrition stress on orexin peptides, brain lipids, and its amelioration by a potent antioxidant (Astaxanthin) needs exploration. The present study focussed on the effect of perinatal undernutrition stress on brain fatty acid levels, Orexin peptides A and B, and its amelioration by Astaxanthin. Twenty-four male Wistar rats (Rattus norvegicus) were allocated to four groups (n = 6) as Normal, Perinatally Undernourished (UN), Astaxanthin treated (AsX, 12mg/kg), and perinatally Undernourished-but-Astaxanthin treated (UNA), and are allowed to grow for 1, 6 and 12 months. The fatty acid and orexin peptides A & B at different brain parts were measured and compared. Orexin peptides were assessed using an ELISA kit. Fatty acid levels were estimated using HP 5890 gas chromatograph. Data were analyzed by ANOVA followed by Tukey’s posthoc test. P < 0.05 was considered significant. The hair cortisol, Orexin-A, and B were significantly increased (p < 0.001) in the UN group compared to normal and were modulated significantly by AsX in the UNA group. Undernutrition stress during the perinatal period altered the lipid profile, Total SFA, Total MUFA, Total n-3 PUFA, Total n-6 PUFA, n-3: n-6 PUFA, which Astaxanthin effectively modulated at 6 and 12 months of postnatal life. There was no difference between DHA and AA ratio. These results indicate that nutritional enrichment with Astaxanthin during the perinatal period positively contributes to adult health. Further, the mechanism of regulation of brain chemistry by Astaxanthin is warranted.

Gut Microbiota Composition in Undernourished Children Associated with Diet and Sociodemographic Factors: A Case-Control Study in Indonesia.

Malnutrition, which consists of undernutrition and overnutrition, is associated with gut microbiota composition, diet, and sociodemographic factors. Undernutrition is a nutrient deficiency that that should be identified to prevent other diseases. In this study, we evaluate the gut microbiota composition in undernourished children in association with diet and sociodemographic factors. We observed normal children (n= 20) and undernourished children (n= 20) for ten days in Lombok and Yogyakarta. Diet, sociodemographic factors, and medical records were recorded using food records, screening forms, and standard household questionnaires. Gut microbiota analysis was performed using 16S rRNA gene sequencing targeting the V3–V4 region. The result showed that the undernourished group had lower energy intake. In addition, the undernourished group had lower quality of medical records, parent knowledge, education, and exclusive breastfeeding. Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, and Verrucomicrobia were significantly different between normal and undernourished children. Based on LefSe, we determined that Akkermansia is a biomarker for undernourished children. In conclusion, diet and sociodemographic factors affect the gut microbiota composition of undernourished children.

Development of pups born to rats established as a model of underweight Japanese women and the onset of impaired glucose tolerance

An increasing number of Japanese women of childbearing age are underweight (BMI <18.5), but the association between this and the increased number of low-birth-weight babies born remains unclear. Here, a rat model was established to mimic the undernutrition (85% of the energy required for those with normal activity levels) experienced by such women and to evaluate the associated impaired glucose tolerance. The undernourished Wistar rat group showed increased serum corticosterone level reflecting stress, and greater adrenal weight and size. It also showed greater insulin resistance, higher expression of FOXO-1, a transcription factor related to muscle atrophy, and lower expression of p-Akt, an insulin-dependent signaling factor. Overall, this work shows the key role of undernutrition during pregnancy as a cause of impaired glucose tolerance and increased diabetes risk in offspring. The findings of this study may inform preemptive measures to prevent the development of metabolic syndrome in offspring of undernourished mothers.

Effect of nutritional status before femoral neck fracture surgery on postoperative outcomes: a retrospective study

BackgroundAlthough nutritional status is crucial in gait recovery after femoral neck fracture surgery, the relationship between preoperative nutritional status and postoperative outcomes remains unknown. This study examined the effects of preoperative nutritional status on postoperative outcomes in patients undergoing femoral neck fracture surgery.MethodsData regarding the joints of 137 patients (29 men, 108 women) who underwent bipolar hemiarthroplasty for femoral neck fractures at our hospital from January 2015 to December 2019 were retrospectively examined. The Geriatric Nutritional Risk Index (GNRI), an index of nutritional status, was used to classify patients into two groups: a normal group (GNRI ≥92; n = 62) and an undernourished group (GNRI < 92; n = 75). The study endpoints included age at surgery, sex, Mini Mental State Examination (MMSE), American Society of Anesthesiologists Physical Status (ASA) classification, preoperative waiting period, intraoperative blood loss, surgery time, perioperative hemoglobin levels, blood transfusion rate, complication rate, 6-month mortality rate, transfer rate, percentage of patients unable to walk at discharge or transfer, and inability to walk 6 months postoperatively.ResultsThe patients in the undernourished group was significantly older at surgery (p < 0.01) and had a lower perioperative hemoglobin levels (p < 0.01), a higher blood transfusion rate (p < 0.01), a lower MMSE (p < 0.01), a longer preoperative waiting period (p < 0.05), a higher transfer rate (p < 0.05), were more likely to be unable to walk 6 months postoperatively (p < 0.01), a higher complication rate (p < 0.05), and a higher 6-month mortality rate (p < 0.01) than the normal group. Patients in the undernourished group had worse rates of postoperative complications, transfer, mortality, and inability to walk 6-month after surgery than those in the normal group.ConclusionsA poor nutritional status affects the gait function and systemic condition of patients undergoing femoral neck fracture surgery; therefore, early nutritional interventions may reduce mortality rates and shorten rehabilitation. These results suggest that the GNRI effectively predicts postoperative complications, mortality, and gait function.

Calcium Bioavailability and Serum Calcium Level in Pregnant Rats After Administration of Milk-Based Drinks Containing Lactic Acid Bacteria

This study aims to evaluate calcium bioavailability through serum calcium level in pregnant rats treated with two Milk-Based Drinks (MBD) containing Lactic Acid Bacteria (LAB), i.e Lactobacillus Casei Shirota Strain (LcS) drink, and Four Strains Bacteria (FS) (Lactobacillus rhamnosus, Lactobacillus paracasei, Lactobacillus delbrueckii subp. bulgaricus, Streptococcus thermophiles). It was a completely randomized experimental study using 24 Sprague Dawley rats. Rats were divided into one negative control group with a normal nutritional status (A0) and three undernourished groups. The undernourished groups were divided into one positive control group (A1), one group receiving MBD containing LcS group (A2), and another group receiving MBD containing FS (A3). All rats received high protein diets during pregnancy. The intervention was started in early pregnancy (D0) until 19 days of pregnancy (D19). Blood samples were collected at the D0 and D19. No significant differences in food intake were found among the rats in all groups. Administration of MBD containing LAB in A2 and A3 showed significant (p 0.05). The results suggest that MBDs containing LAB are useful in enhancing calcium bioavailability.

Ameliorative effects of nutritional minerals on lead-induced hematological alterations in male Wistar albino rats

The deficiency of essential minerals increases lead absorption and thus aggravates the lead-induced toxic effects. This study was aimed at understanding the ameliorative effect of essential minerals on lead-induced alterations in hematological parameters in rats. To achieve this objective, the study was conducted in 320 male Wistar albino rats, grouped into two, with equal numbers. One of the groups of rats was fed on a mineral-supplemented food referred to as a ‘well-nourished group’ and another group ‘undernourished group’ on food without mineral supplements. Each group of rats was further subdivided into ‘Subjects’ and ‘Controls.’ Subjects of both the groups of rats were exposed to 500 ppm lead acetate up to a period of 300 days (10 months) in drinking water and the role of minerals on lead-induced alterations in hematological parameters was evaluated. A significant decrease (p < 0.001) in hemoglobin (Hb) and δ-aminolevulinic acid dehydratase (δ-ALAD) levels and a significant increase (p < 0.001) in urinary δ-aminolevulinic acid (δ-ALAU) levels were seen in subjects without mineral supplementation compared to those fed on a mineral-enriched diet. A positive correlation was observed between blood lead levels (PbB) and δ-ALAU (r = 0.792) and a negative correlation with Hb (r = −0.926) and δ-ALAD (r = −0.836) in the subjects. These changes were very prominent in the undernourished subjects when compared to the well-nourished subjects. Observations of the present study indicate that mineral supplementation with ongoing lead exposure may help in minimizing the absorption of lead and reduce lead-induced toxic effects.

Study of Obesity and Fat Distribution in Young Medical Students

The Body Mass Index (BMI) and body weight do not give enough information about a person’s body composition. Measuring the fat free mass gives us the extra information we need. The body composition can be measured in several ways. Unfortunately none of these techniques is a gold standard. That is why different techniques are combined in a full body composition assessment. This study aims to assess the prevalence of overweight, obesity and the fat distribution in medical students. Two hundred (200) preclinical, 100 male and 100 female age matched students (mean 18.93 ± 0.75 years) were included in the study. BMI, waist hip ratio, body fat, skeletal muscle mass and their bodily distribution were recorded by using an electronic body composition analyzer. The subjects were divided into undernourished (UN=BMI&lt;18.5 kg/m2), normal (N=BMI&gt;18.5–22.9 kg/m2), overweight (OW=BMI&gt;23-27.99 kg/m2) and obese (OB=BMI &gt;28 Kgm2) groups based on BMI cut off values for Asians. The data analyzed showed that 32% of the Male (mean BMI = 25.41 ±1.46 kg/m2) 33% of the Female (mean BMI =25.03 ± 1.44 kg/m2) were over weight and 16% of Males (mean BMI =31.08 ±1.91) 8% Females(mean BMI= 30.73 ± 1.66) were obese. The average total body fat in males was 20.75 ± 6.69% and 28.55 ± 5.86% in females. The total body fat was high in obese males and females 26.67±4.37, 36.73 ±0.46% respectively as compared to other groups. The visceral fat was high in obese males (14.40 ± 2, 27%) and whereas obese females had normal levels at (9.5 ± 1.0%). The subcutaneous fat was more in the lower limbs than in the trunk area in both males and females. The skeletal muscle mass was about 34.5 ± 3.44% in males and 26.98 ± 2.55% in females which was slightly less than the recommended values. The leg area had more muscle mass than other areas. The findings clearly indicate increase in total body fat increases with BMI and WHR.

Relationship between Low Pretreatment Geriatric Nutritional Risk Index and Poor Tolerability of Azacitidine in Patients with Myelodysplastic Syndromes

Background: Predicting tolerability and treatment-related risks associated with azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) before the initiation of therapy is required for appropriate treatment. Thus, in this study, the nutritional status of patients with MDS prior to AZA treatment was evaluated using the geriatric nutritional risk index (GNRI). Tolerability and overall survival (OS) after AZA initiation were also investigated. Methods: This was a single-center retrospective observational study. A total of 59 patients with MDS treated with AZA were assessed using GNRI, and a comparison of undernourished (GNRI <92, n = 27) and non-undernourished (GNRI ≥92, n = 32) patients was performed. Results: The undernourished group had a significant reduction in the number of patients that successfully completed 4 cycles of AZA treatment compared with the non-undernourished group (undernourished group, 11/27 patients, 40.7% vs. non-undernourished group, 24/32 patients, 75.0%; p = 0.009). Factors associated with the difference included karyotype and GNRI. There was also a significant increase in the rate of infectious complications in the undernourished group compared with the non-undernourished group (undernourished group, 33/60 cycles, 55.0% vs. non-undernourished group, 31/92 cycles, 33.7%; p = 0.012). Lastly, a significant reduction in OS was observed in the undernourished group compared with the non-undernourished group (undernourished group, 11.5 months; 95% CI, 5.2–16.7 vs. non-undernourished group, 21.9 months; 95% CI, 13.8–24.0; p = 0.026). Factors associated with OS included both the revised International Prognostic Scoring System (IPSS-R) and GNRI. Conclusions: These results indicate that predicting treatment completion and adverse events in patients with MDS prior to AZA treatment is important. This study suggests GNRI may be a valuable nutritional assessment tool for determining tolerability and OS of AZA treatment.

Nutritional Assessment in Patients with Early-Onset Autosomal Dominant Alzheimer's Disease Due to PSEN1- E280A Genetic Variant: A Cross-Sectional Study.

Weight loss and malnutrition are frequent findings in late-onset and sporadic presentations of Alzheimer's Disease (AD). However, less is known about nutritional status in Early-Onset Autosomal Dominant AD (EO-ADAD). To analyze the association between nutritional status and other clinical and sociodemographic characteristics in individuals with a genetic form of EO-ADAD. Cross-sectional study with 75 non-institutionalized participants from a cohort of Autosomal Dominant AD (13 with mild cognitive impairment and 61 with dementia, ages from 38 to 67 years) underwent a structured clinical assessment with emphasis on nutritional status. Primary outcome was nutritional status and it was measured using the Mini Nutritional Assessment (MNA). Patients were categorized according to MNA total score, as undernourished (MNA ≤23.5) and well-nourished (MNA ≥ 24). Sociodemographic and clinical variables identified as potential predictors or confounders of nutritional status were also collected. Undernourishment by MNA was present in 57.3% of the sample. Forty-two percent of participants had abnormal BMI values considered lower than 18.5 or higher than 24.9 kg/m2. Total BMI values were similar in well and undernourished patients (median 24.2 IQR 3.59 and median 23.9 IQR 4.42, respectively, p=0.476). When comparing well and undernourished groups, we found statistically significant differences for variables: severity of dementia (p=0.034), frailty (p=0.001), multimorbidity (p=0.035) and, polymedication (p=0.045). Neither adjusted logistic regression nor the Poisson regression showed that any clinical or sociodemographic variables explained undernourishment. Undernourishment was a frequent finding in our sample of EO-ADAD, especially in later stages of the disease. Patients with polymedication, multimorbidity, frailty and severe dementia show differences in their nutritional status with a tendency to be more frequently undernourished. Further studies with larger sample sizes are needed to establish this association.

The presence of an embryo affects day 14 uterine transcriptome depending on the nutritional status in sheep. b. Immune system and uterine remodeling

Transcriptomics and bioinformatics were used to investigate the potential interactions of undernutrition and the presence of the conceptus at the time of maternal recognition of pregnancy on uterine immune system and remodeling. Adult Rasa Aragonesa ewes were allocated to one of two planes of nutrition for 28 days: maintenance energy intake (control; 5 cyclic, 6 pregnant ewes) providing 7.8 MJ of metabolisable energy and 0.5 maintenance intake (undernourished; 6 cyclic, 7 pregnant ewes) providing 3.9 MJ of metabolisable energy per ewe. Uterine gene expression was measured using Agilent 15 K Sheep Microarray chip on day 14 of estrus or pregnancy. Functional bioinformatics analyses were performed using PANTHER (Protein ANalysis THrough Evolutionary Relationships) Classification System. Pregnancy affected the expression of 18 genes in both control and undernourished ewes, underscoring the relevance for embryo-maternal interactions. Immune system evidenced by classical interferon stimulated genes were activated in control and -in a lesser extent-in undernourished pregnant vs cyclic ewes. Genes involved in uterine remodeling such as protein metabolism were also upregulated with the presence of an embryo in control and undernourished ewes. However, relevant genes for the adaptation of the uterus to the embryo were differentially expressed between pregnant vs cyclic ewes both in control and undernourished groups. Undernutrition alone led to an overall weak activation of immune system pathways both in cyclic and pregnant ewes. Data revealed that cellular and immune adaptations of the uterus to pregnancy are dependent on the nutritional status.