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The Indonesian Nutrition Status Study stated that cases of underweight or malnutrition with a weight for age index are around 17%. The efforts made by the government today to overcome the problem of malnutrition of children under five in Indonesia are still not optimal with programs that have been made by the government. The incidence of underweight continues to increase from 2019 to 2022 in Indonesia. The development of a culture-based intervention 'Papadangan' which is a communal eating activity was carried out to reduce this number. This study was conducted to develop the 'Papadangan' culture so that it becomes one of the efforts that can be done by the government. This eating habit can be used as an alternative for the community to increase the appetite of children under five in Tangerang, meaning that indirectly the community has made efforts to improve nutrition in children under five through eating together in the area. This research used Participatory Action Research (PAR) which consists of 2 cycles. This research was conducted from November 2022 to January 2024. Fifty participants consisting of children and caregivers were involved in this study. The Children under five weights were measured before and after the procedure using assessment instruments, the z score table, the camstock feeding scale and the toddler anthropometric table. Indepth interviews were conducted with mothers of children under five to explore the eating habits of Sundanese children under five with underweight and good nutritional status. 'Papadangan' can be developed into a strategy to prevent underweight nutrition problems by adding nutrition and health education: paying attention to the feeding schedule of children under five years old, variations in food consumption, education related to elements of balanced nutrition, and eating hygiene in the implementation of papadangan eating culture activities. 'Papadangan' can be used as one of the strategies to reduce the incidence of underweight in children under five years old. Developing the papadangan eating culture has become a new research, and this strategy is effective in changing the eating patterns of toddlers and reducing the rate of malnutrition among toddlers in Pekayon village, Sukadiri District, Tangerang City. Key words: Eating culture, children under five years old, malnutrition, qualitative, Indonesia, INTRODUCTION Malnutrition, specifically undernutrition, is a prevalent issue among children under the age of 5 and poses a significant health concern that impacts child development in numerous countries globally. The [...]

Background Innovations for undernourished pregnant women that improve newborn survival and anthropometry are needed to achieve the Sustainable Development Goals 1 and 3. This study tested the hypothesis that a combination of a nutritious supplementary food and several proven chemotherapeutic interventions to control common infections would increase newborn weight and length in undernourished pregnant women. Methods and findings This was a prospective, randomized, controlled clinical effectiveness trial of a ready-to-use supplementary food (RUSF) plus anti-infective therapies compared to standard therapy in undernourished pregnant women in rural Sierra Leone. Women with a mid-upper arm circumference (MUAC) [less than or equal to]23.0 cm presenting for antenatal care at one of 43 government health clinics in Western Rural Area and Pujehun districts were eligible for participation. Standard of care included a blended corn/soy flour and intermittent preventive treatment for malaria in pregnancy (IPTp). The intervention replaced the blended flour with RUSF and added azithromycin and testing and treatment for vaginal dysbiosis. Since the study involved different foods and testing procedures for the intervention and control groups, no one except the authors conducting the data analyses were blinded. The primary outcome was birth length. Secondary outcomes included maternal weight gain, birth weight, and neonatal survival. Follow-up continued until 6 months postpartum. Modified intention to treat analyses was undertaken. Participants were enrolled and followed up from February 2017 until February 2020. Of the 1,489 women enrolled, 752 were allocated to the intervention and 737 to the standard of care. The median age of these women was 19.5 years, of which 42% were primigravid. Twenty-nine women receiving the intervention and 42 women receiving the standard of care were lost to follow-up before pregnancy outcomes were obtained. There were 687 singleton live births in the intervention group and 657 in the standard of care group. Newborns receiving the intervention were 0.3 cm longer (95% confidence interval (CI) 0.09 to 0.6; p = 0.007) and weighed 70 g more (95% CI 20 to 120; p = 0.005) than those receiving the standard of care. Those women receiving the intervention had greater weekly weight gain (mean difference 40 g; 95% CI 9.70 to 71.0, p = 0.010) than those receiving the standard of care. There were fewer neonatal deaths in the intervention (n = 13; 1.9%) than in the standard of care (n = 28; 4.3%) group (difference 2.4%; 95% CI 0.3 to 4.4), (HR 0.62 95% CI 0.41 to 0.94, p = 0.026). No differences in adverse events or symptoms between the groups was found, and no serious adverse events occurred. Key limitations of the study are lack of gestational age estimates and unblinded administration of the intervention. Conclusions In this study, we observed that the addition of RUSF, azithromycin, more frequent IPTp, and testing/treatment for vaginal dysbiosis in undernourished pregnant women resulted in modest improvements in anthropometric status of mother and child at birth, and a reduction in neonatal death. Implementation of this combined intervention in rural, equatorial Africa may well be an important, practical measure to reduce infant mortality in this context. Trial registration ClinicalTrials.gov NCT03079388., Author(s): David Taylor Hendrixson 1, Kristie Smith 1, Patrick Lasowski 1, Meghan Callaghan-Gillespie 1, Jacklyn Weber 1, Peggy Papathakis 2, Per Ole Iversen 3, Aminata Shamit Koroma 4, Mark J. [...]

Highlights from News & Views published this year. Highlights from News & Views published this year., Author Affiliations: Robots, hominins and superconductors: 10 remarkable papers from 2019 Credit: Sylvain Cherkaoui/Reuters [see PDF for image] A porter carries fish from a fishing boat to the beach at [...]

Background Malnutrition underlies 3 million child deaths worldwide. Current treatments differentiate severe acute malnutrition (SAM) from moderate acute malnutrition (MAM) with different products and programs. This differentiation is complex and costly. The Combined Protocol for Acute Malnutrition Study (ComPAS) assessed the effectiveness of a simplified, unified SAM/MAM protocol for children aged 6-59 months. Eliminating the need for separate products and protocols could improve the impact of programs by treating children more easily and cost-effectively, reaching more children globally. Methods and findings A cluster-randomized non-inferiority trial compared a combined protocol against standard care in Kenya and South Sudan. Randomization was stratified by country. Combined protocol clinics treated children using 2 sachets of ready-to-use therapeutic food (RUTF) per day for those with mid-upper arm circumference (MUAC) < 11.5 cm and/or edema, and 1 sachet of RUTF per day for those with MUAC 11.5 to Conclusions Combined treatment for SAM and MAM is non-inferior to standard care. Further research should focus on operational implications, cost-effectiveness, and context (Asia versus Africa; emergency versus food-secure settings). This trial is complete and registered at ISRCTN (ISRCTN30393230). Trial registration The trial is registered at ISRCTN, trial number ISRCTN30393230., Author(s): Jeanette Bailey 1,2,*, Charles Opondo 3, Natasha Lelijveld 4, Bethany Marron 1, Pamela Onyo 5, Eunice N. Musyoki 6, Susan W. Adongo 6, Mark Manary 7, André Briend 8,9, [...]

Background Children with uncomplicated severe acute malnutrition (SAM) are treated at home with ready-to-use therapeutic foods (RUTFs). The current RUTF dose is prescribed according to the weight of the child to fulfil 100% of their nutritional needs until discharge. However, there is doubt concerning the dose, as it seems to be shared, resulting in suboptimal cost-efficiency of SAM treatment. We investigated the efficacy of a reduced RUTF dose in community-based treatment of uncomplicated SAM. Methods and findings We undertook a randomised trial testing the non-inferiority of weight gain velocity of children with SAM receiving (a) a standard RUTF dose for two weeks, followed by a reduced dose thereafter (reduced), compared with (b) a standard RUTF dose throughout the treatment (standard). A mean difference of 0.0 g/kg/day was expected, with a non-inferiority margin fixed at -0.5 g/kg/day. Linear and logistic mixed regression analyses were performed, with study site and team as random effects. Between October 2016 and July 2018, 801 children with uncomplicated SAM aged 6-59 months were enrolled from 10 community health centres in Burkina Faso. At admission, the mean age (± standard deviation [SD]) was 13.4 months (±8.7), 49% were male, and the mean weight was 6.2 kg (±1.3). The mean weight gain velocity from admission to discharge was 3.4 g/kg/day and did not differ between study arms ([DELTA] 0.0 g/kg/day; 95% CI -0.4 to 0.4; p = 0.92) confirming non-inferiority (p = 0.013). However, after two weeks, the weight gain velocity was significantly lower in the reduced dose with a mean of 2.3 g/kg/day compared with 2.7 g/kg/day in the standard dose ([DELTA] -0.4 g/kg/day; 95% CI -0.8 to -0.02; p = 0.041). The length of stay (LoS) was not different (p = 0.73) between groups with a median of 56 days (interquartile range [IQR] 35-91) in both arms. No differences were found between reduced and standard arm in recovery (52.7% and 55.4%; p = 0.45), referral (19.2% and 20.1%; p = 0.80), defaulter (12.2% and 8.5%; p = 0.088), non-response (12.7% and 12.5%; p = 0.95), and relapse (2.4% and 1.8%; p = 0.69) rates, respectively. However, the reduced RUTF dose had a small 0.2 mm/week (95% CI 0.04 to 0.4; p = 0.015) negative effect on height gain velocity with a mean height gain of 2.6 mm/week with reduced and 2.8 mm/week with standard RUTF dose. The impact was more pronounced in children under 12 months of age (interaction, p = 0.019) who gained 2.8 mm/week with reduced and 3.1 mm/week with standard dose ([DELTA] -0.4 mm/week; 95% CI -0.6 to -0.2; p < 0.001). Limitations include not blinding participants to the RUTF dose received and excluding all children with negative appetite test. The results are generalisable for relatively food secure contexts with a young SAM population. Conclusions Reducing the RUTF dose provided to children with SAM after two weeks of treatment did not reduce overall weight or mid-upper arm circumference (MUAC) gain velocity nor affect recovery or lengthen treatment time. However, it led to a small but significant negative effect on linear growth, especially among the youngest. The potential effect of reducing the RUTF dose in a routine program on treatment outcomes should be evaluated before scaling up. Trial registration ISRCTN registry ISRCTN50039021., Author(s): Suvi T. Kangas 1,2,*, Cécile Salpéteur 2, Victor Nikièma 3, Leisel Talley 4, Christian Ritz 1, Henrik Friis 1, André Briend 1,5, Pernille Kaestel 1 Introduction Worldwide, 19 million [...]

BACKGROUND/OBJECTIVES: Parenteral nutrition (PN) should be provided to the malnourished patient if enteral feeding is insufficient or unsafe. A nutrition support team (NST) may improve PN services. We compared the use and complications of hospital PN before and after the implementation of an NST. SUBJECTS/METHODS: All inpatients referred for PN outside of the intensive care unit and the intestinal failure unit were prospectively included from 2009 to 2012. The NST was introduced in 2010. Quality improvement methodology was applied. RESULTS: In 2009, a mean of 16 (limits of normal variation 4-28) patients were referred for PN each month. After introduction of the NST, this rose to 26 (10-42) referrals per month. The percentage of referrals where PN was not initiated increased from 5.3% in 2009 to 10.1% in 2012 (P = 0.03). This increase was restricted to teams that infrequently referred for PN, and enteral nutrition could replace PN in 31 of 51 patients (61%) as compared with 8 of 32 (25%) patients referred from teams that frequently referred for PN (P = 0.001). The frequency of PN started owing to an insufficient oral or enteral intake decreased from 11% to 3% (P = 0.01). The catheter-related bloodstream infection rate dropped from 6.7 to 0.7 episodes per 1000 catheter days (P < 0.001). CONCLUSIONS: Introduction of an NST increased both the total PN use and the percentage of referrals where enteral nutrition could replace PN. Medical specialty influenced the referral pattern and the likelihood that a referral resulted in PN being initiated. Safety of PN catheters improved significantly following NST introduction. European Journal of Clinical Nutrition (2014) 68, 1294-1299; doi: 10.1038/ejcn.2014.186; published online 24 September 2014, INTRODUCTION Malnutrition remains a major risk factor for in-hospital morbidity and mortality. (1,2) A stepwise algorithm can be applied to patients who do not meet their nutritional requirements, (3,4) and [...]

BACKGROUND: Several guidelines recommend systematic screening for malnutrition in elderly inpatients for early dietary intakes assessment and treatment, but data demonstrating the efficacy of such interventions are scarce. The aim of this study was to evaluate a critical medical pathway for the detection and management of malnutrition in elderly inpatients. METHODS: In a 3-month prospective controlled study, 694 recently admitted inpatients were assigned to an intervention group (critical medical pathway; n = 465) or a standard care control group (n = 229). Nutritional status was assessed at the time of admission with a Mini Nutritional Assessment. A renutrition program tailored to the initial dietary assessment results was applied in the intervention group. The efficacy of the program was verified by measuring the evolution of serum insulin-like growth factor 1 (IGF-I) between admission and 3 weeks later. RESULTS: In the intervention group at baseline, 23% were malnourished, 51% were at risk and 26% were eunourished. Serum IGF-I increased in the intervention group (from 84 ± 45 µg/l to 95 [+ or -] 50 µg/l, P < 0.0001; mean ± s.d., n = 209), but remained stable in the controls (from 79 ± 43 [MICRO]g/l to 81 [+ or -] 35 [MICRO]g/l, P = 0.4;n = 99), with a statistically significant between group difference (P < 0.01). CONCLUSION: Early malnutrition assessment and targeted renutrition program in elderly inpatients were associated with an increase in serum IGF-I. It remains to be determined whether such variations are clinically relevant. European Journal of Clinical Nutrition (2013) 67, 1175-1181; doi: 10.1038/ejcn.2013.166; published online 16 October 2013 Keywords: Mini Nutritional Assessment; protein and energy malnutrition; length of stay; mortality; undernutrition; IGF-I, INTRODUCTION In Western countries, malnutrition prevalence is ~7-8% among adults and rises to 12-15% in the geriatric population. (1) Thirty to 60% of patients admitted to hospital are either malnourished [...]

BACKGROUND/OBJECTIVES: Recommendations state that all hospital patients should be screened for malnutrition and for each level of risk, a suitable care plan should be available. This study investigates current practice at ward level regarding adherence to a care plan generated from a nutrition screening tool, and then aims to improve basic nutritional support actions by modifying a care plan and finally evaluates change in practice. SUBJECTS/METHODS: Pro formas were completed on nutrition care plans of 100 patients. Subsequently, 7 focus groups were conducted, which included 30 ward staff and 6 dietitians. Care plans were re-designed using information from focus groups, followed by a second set of pro formas on the care plans of 103 patients. RESULTS: Themes regarding barriers and facilitators for completion of care plans were derived from the focus groups including: 'duplication', 'time pressures', 'leadership support', 'operational issues', 'document style' and 'training'. Pro formas before and after re-design showed that nutritional support actions increased from 13 (9%) to 98 (52%) for patients at moderate or severe risk of malnutrition (P = 0.033). CONCLUSIONS: Focus groups allowed engagement with ward staff to explore how care plans were used, which assisted in re-designing the care plan, while the pro formas identified limitations of initial procedures and then evaluated change. Subsequently, basic nutritional support actions that resulted from screening improved. The suitability of care plans to facilitate basic nutritional support and documentation was enhanced. However, improvements are still required, emphasising the necessity for continued training and a strategic approach to the delivery of basic nutritional care. doi: 10.1038/ejcn.2012.196; published online 12 December 2012 Keywords: MUST; screening; malnutrition; action plan; hospital; qualitative, INTRODUCTION Nutritional screening has been recommended by a number of reports including Food and Nutritional Care in Hospitals, (1) Nutrition Support in Adults, (2) Essence of Care (3) and Patient [...]

Background/Objectives: Nutritional intervention with oral nutritional supplements (ONS) has been shown to increase quality of life in malnourished patients. We investigated whether post-hospital supplementation with ONS is cost-effective according to international benchmarks in malnourished patients. Subjects/Methods: In total, 114 malnourished patients (50.6 [+ or -] 16.1 years, 57 female) with benign gastrointestinal disease were included and randomised to receive either ONS for 3 months and dietary counselling at discharge (intervention, n = 60) or only dietary counselling at discharge (control group, n = 54). Nutritional status was assessed with Subjective Global Assessment. Intervention patients documented daily intake of ONS; quality of life was assessed with Short-Form (SF)-36 Health Survey and SF-36 values were transformed into health-status utilities. Quality-adjusted life years (QALYs) were calculated by adopting the area under the curve method. We used two different pricing scenarios for ONS (minimum price: 2.30 € and maximum: 2.93 €/ tetrapack). The incremental cost-effectiveness ratio (ICER) of supplementation with ONS was calculated for both price scenarios. All analyses were corrected for age and gender. Results: Intervention patients consumed 2.4 ± 0.8 ONS per day. Intervention and control patients did not differ in their health status utilities at baseline (0.594 ± 0.017 vs 0.619 ± 0.018), but after 3 months, the health status utilities were significantly higher in intervention patients than in control patients (0.731 ± 0.015 vs 0.671 ± 0.016, P = 0.028). Intervention was associated with significantly higher costs (ICER: 9497 € and 12 099 €/additional QALY, respectively) but deemed cost-effective according to international thresholds ( Conclusions: A 3-month intervention with ONS increases quality of life in malnourished patients. This treatment appears to be cost-effective according to international benchmarks. European Journal of Clinical Nutrition (2011) 65, 735-742; doi: 10.1038/ejcn.2011.31; published online 16 March 2011 Keywords: disease-related malnutrition; cost-effectiveness; quality of life; nutritional supplements; quality of life adjusted life years, Introduction Disease-related malnutrition remains a major challenge in hospital, despite the growing body of evidence demonstrating both its clinical and economical consequences. Depending on the population, malnutrition affects approximately 25-50% [...]

Objective: A health economic analysis was performed to assess the cost-effectiveness of oral nutritional supplements (ONS), being a medical nutrition product, in the Netherlands. Methods: This analysis is based on a comparison of the use of ONS versus 'no use' of ONS in patients undergoing abdominal surgery. The costs and benefits of the two treatment strategies were assessed using a linear decision analytical model reflecting treatment patterns and outcomes in abdominal surgery. The incremental cost difference was based on costs associated with ONS and hospitalization. Clinical probabilities and resource utilization were based on clinical trials and published literature; cost data were derived from official price tariffs. Results: The use of ONS reduces the costs with a 252 € (7.6%) cost saving per patient. The hospitalization costs reduce from 3,318 € to 3,044 € per patient, which is a 8.3% cost saving and corresponds with 0.72 days reduction in length of stay. The use of ONS would lead to an annual cost saving of a minimum of 40.4 million € per year. Sensitivity analyses showed that the use of ONS remains cost saving compared with 'no use' of ONS. A threshold analysis on the length of stay shows that at 0.64 days, the use of ONS is still cost-effective, which is an unrealistic value. Conclusions: This analysis shows that the use of medical nutrition, ONS in this case, is a cost-effective treatment in the Netherlands and is dominant over standard care without medical nutrition: it leads to cost savings and a higher effectiveness. European Journal of Clinical Nutrition (2010) 64, 1229-1234; doi: 10.1038/ejcn.2010.147; published online 18 August 2010 Keywords: medical nutrition; cost-effectiveness; health economic model; oral nutritional supplements, Introduction Nutritional depletion in Western countries is usually caused by the joint action of an underlying disease, for example, cancer and dietary deficiency (Naber et al., 1997), also known as [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2009.11.020 Byline: Sarah J. Peterson, Annalisa A. Tsai, Celina M. Scala, Diane C. Sowa, Patricia M. Sheean, Carol L. Braunschweig Abstract: Hospital malnutrition is associated with increased morbidity and mortality, particularly among patients admitted to intensive care units (ICUs). The purpose of this observational study (August to November 2007) was to examine the adequacy of oral intake and to identify predictors of oral intake after ICU patients were removed from invasive mechanical ventilation. Patients aged [greater than or equal to]18 years who required mechanical ventilation for at least 24 hours, advanced to an oral diet postextubation, and did not require supplemental enteral or parenteral nutrition were included. The first 7 days of oral intake after extubation were assessed via modified multiple-pass 24-hour recall and the numbers of days on therapeutic diets and reasons for decreased intake were collected. Oral intake <75% of daily requirements was considered inadequate. Descriptive statistics, I.sup.2, Student t tests, and logistic regression analyses were conducted. Of the 64 patients who met eligibility criteria, 50 were included. Of these 50 patients, 54% were women and intubated for 5.2 days, with a mean age of 59.1 years, body mass index of 28.7, and Acute Physiology and Chronic Health Evaluation II score of 21.9. Subjective Global Assessment determined 44% were malnourished upon admission to the ICU. The average daily energy and protein intake failed to exceed 50% of daily requirements on all 7 days for the entire population. The majority of patients who consumed <75% of daily requirements were prescribed a therapeutic diet and/or identified "no appetite" and nausea/vomiting as the barriers to eating. Although more research is needed, these data call into question the use of restrictive oral diets and suggest that alternative medical nutrition therapies are needed to optimize nutrient intake in this unique patient population. Article History: Accepted 4 September 2009

Fortified blended foods were developed in the 1960s to improve the nutritional status of children suffering from malnutrition. The present review was conducted to examine the impact that fortified blended foods used in humanitarian relief programs have had on the health and nutritional status of infants and young children with moderate malnutrition, or at risk of undemutrition, in developing countries. Published articles were identified using electronic databases and general Web searches. Search terms included commodity types and names and terms related to food assistance and fortification programs. Positive effects on recovery from moderate acute malnutrition and weight gain were observed when fortified blended foods were distributed as dietary supplements. Prevention of severe micronutrient deficiencies in populations reliant on food aid has been reported, but measurements of micronutrient status have rarely been conducted. Evidence of the efficacy of fortified blended foods for improving nutritional outcomes is currently limited and weak. [c] 2009 International Life Sciences Institute doi: 10.1111/j.1753-4887.2009.00255.x

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2008.11.028 Byline: Rachel E. Amthor, Stephanie M. Cole, Mark J. Manary Abstract: When the international community declared a famine in Malawi in January of 2006, emergency food aid reached only populations with pre-existing health care services. To treat the widespread childhood malnutrition in Machinga district, a rural area lacking health care facilities, in February 2006 five outpatient therapeutic programs were implemented that utilized home-based therapy and ready-to-use therapeutic food. Children with severe malnutrition, defined as the presence of edema and/or a weight-for-height less than 70% of the reference standard, were enrolled in the program. Two senior clinical nurses trained village health aides in each of the five communities. Children visited the health aides biweekly. During the visits, health aides collected demographic and anthropometric information and distributed a 2-week supply of ready-to-use therapeutic food, providing 175 kcal/kg/d. Treatment continued for 8 weeks; children were discharged before 8 weeks if they reached a weight-for-height more than 100% of the reference standard, or required admission to the hospital due to systemic infection or recurrence of edema. Of the 826 children enrolled, 775 (93.7%) recovered, 13 (1.8%) remained malnourished, 30 (3.6%) defaulted, and 8 (0.9%) died. Mean weight gained was 2.7[+ or -]3.7 g/kg/d, height gained 0.3[+ or -]0.9 mm/d, and mid-upper arm circumference gained 0.2[+ or -]0.3 mm/d. Home-based therapy with ready-to-use therapeutic food administered by village health aides is an effective approach to treating malnutrition during food crises in areas lacking health services. Article History: Accepted 13 June 2008

Background Important differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of the WHO standards and the NCHS reference in predicting death in a population of malnourished children in a large nutritional program in Niger. Methods and Findings We analyzed data from 64,484 children aged 6-59 mo admitted with malnutrition ( Conclusions These results suggest that in this population of children being treated for malnutrition, WH indicators calculated using WHO standards were more accurate for predicting mortality risk than those calculated using the NCHS reference. The findings are valid for a population of already malnourished children and are not necessarily generalizable to a population of children being screened for malnutrition. Future work is needed to assess which criteria are best for admission purposes to identify children most likely to benefit from therapeutic or supplementary feeding programs., Introduction In 2006, the World Health Organization (WHO) introduced the Child Growth Standards for assessing the growth and development of children from birth to 60 mo of age, in order [...]

Objective: To evaluate diagnostic instruments for assessment of nutritional status in patients with rheumatoid arthritis (RA) in relation to objective body composition data. Subjects and methods: Study subjects include 60 in-ward patients (83% women, median age 65 years). Anthropometric measures and the nutritional tools Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening tool 2002 (NRS-2002). Body composition was determined by dual-energy X-ray absorptiometry and fat-free mass index (FFMI; kg/[m.sup.2]) and fat mass index (FMI; kg/[m.sup.2]) were calculated. Results: Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/[m.sup.2], respectively. Twelve per cent of the women and none of the few men had BMI < 18.5 kg/[m.sup.2], that is, the cutoff value for malnutrition. FFMI indicated 52% of the women and 30% of the men to be malnourished. The sensitivity and specificity for BMI to detect malnutrition according to FFMI were 27 and 100%, whereas for arm muscle circumference the sensitivity was 36% and the specificity 89% and for triceps skin fold 43 and 93%, respectively. For MNA, sensitivity was 85% and specificity 39% and for SGA 46 and 82%. Both MUST and NRS-2002 had sensitivity of 45% and specificity of 19%. Conclusion: A large proportion of in-ward RA patients had reduced FFMI. Concurrent elevation of fat mass made BMI a nonreliable tool to detect malnutrition. Of the tested clinical evaluation tools, MNA might be used as a screening instrument, but because of its low specificity it should be followed by body composition determination. doi:10.1038/sj.ejcn.1602845; published online 18 July 2007 Keywords: rheumatoid arthritis; body composition; fat-free mass; fat-free mass index; nutritional questionnaires; body mass index, Introduction Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease that causes destruction of joint cartilage and bone. In addition, the inflammation makes the patients exposed to catabolic effects. This [...]

Objective: Evaluation of the influence of intradialytic parenteral nutrition (IDPN) in patients suffering from Malnutrition-Inflammation Complex Syndrome (MICS) on nutritional status, inflammation, adipocytokines and serum lipids. Subjects: Six patients with MICS were assigned to IDPN, whereas six patients matched for age, sex, body mass index (BMI) and co-morbidity without malnutrition served as controls. Patients were recruited from Outpatient Dialysis Unit, Medical University Innsbruck and from Dialysis Unit, Hospital Feldkirch. Results: In all patients with IDPN, dry body weight increased during the interventional period whereas body weight remained stable in patients without IDPN. Tumor necrosis factor (TNF)-[alpha] levels were higher in patients with MICS compared with controls at all time points. Total cholesterol, LDL- and HDL-levels significantly increased during dialysis at all time points in controls but not in patients with MICS. Albumin, C-reactive protein, interleukin-6 (IL-6), soluble interleukin-2 receptor (sIL-2R) and adipocytokines did not differ between patients and controls during the study period. Conclusions: IDPN in patients with MICS increases body weight despite not influencing inflammatory status. Furthermore, IDPN does not induce a pro-atherogenic lipid composition enhancing the risk for atherosclerosis. Thus, IDPN is a safe and effective treatment of malnutrition in patients with MICS. doi:10.1038/sj.ejcn.1602777; published online 16 May 2007 Keywords: MICS; intradialytic parenteral nutrition; hemodialysis, Introduction In patients with end-stage renal disease (ESRD), malnutrition is a common problem and has been claimed to influence morbidity and even mortality (Capelli et al., 1994; Kopple, 1997; Kalantar-Zadeh [...]

Purpose: The purpose of this study was to identify relationships between medical, functional, economic, oral health, social, religious, and psychological factors and under-eating in homebound older adults. The focus of the study was on identifying potentially modifiable factors amenable to social and behavioral interventions. Design and Methods: A total of 230 homebound older adults who were currently receiving home health services participated in interviews in their homes using a questionnaire to assess eating behaviors and factors that could possibly affect those eating behaviors. Interviewers measured height and weight, and participants completed three 24-hr dietary recalls. Results: The mean age of participants was 79.1 years. The sample comprised 78% women and 38% African Americans. We found that 70% of participants were under-eating, defined as not consuming enough calories to maintain their current body weight. Participants who were at higher risk of under-eating included men, those receiving either infrequent care or very frequent care by a caregiver, those who had been hospitalized prior to receipt of home health services, and those with a higher body mass index. Implications: Findings from the study have implications for both practice and policy. Experts must develop evidence-based interventions targeted at under-eating in this particularly vulnerable and growing population of homebound older adults. This study provides an initial foundation for the development of targeted evidence-based behavioral nutritional interventions that are noninvasive and cost effective. Key Words: Under-eating, Undernutrition, Nutrition policy

Latest estimates indicate that nutritional deficiencies account for 3 million child deaths each year in less-developed countries. Targeted nutritional interventions could therefore save millions of lives. However, such interventions require careful optimization to maximize benefit and avoid harm. Progress toward designing effective life-saving interventions is currently hampered by some serious gaps in our understanding of nutrient metabolism in humans. In this Personal Perspective, we highlight some of these gaps and make some proposals as to how improved research methods and technologies can be brought to bear on the problems of undernourished children in the developing world., Introduction Malnutrition, in its various guises, represents the greatest modifiable threat to global health and survival. This is especially so among children in the poorest nations of the world, where [...]

Background Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings Between September 9, 2013, and August 29, 2014, a randomised 2 x 2 x 3 factorial trial recruited 6- to 23-month-old children with MAM in Burkina Faso. The intervention comprised 12 weeks of food supplementation providing 500 kcal/day as LNS or CSB, each containing SI or DS, and 0%, 20%, or 50% of protein from milk. Fat-free mass (FFM) was assessed by deuterium dilution technique. By dividing FFM by length squared, the primary outcome was expressed independent of length as FFM index (FFMI) accretion over 12 weeks. Other outcomes comprised recovery rate and additional anthropometric measures. Of 1,609 children, 4 died, 61 were lost to follow-up, and 119 were transferred out due to supplementation being switched to non-experimental products. No children developed allergic reaction. At inclusion, 95% were breastfed, mean (SD) weight was 6.91 kg (0.93), with 83.5% (5.5) FFM. In the whole cohort, weight increased 0.90 kg (95% CI 0.88, 0.93; p 0.05). LNS compared to CSB resulted in 128 g (95% CI 67, 190; p < 0.01) greater weight gain if both contained SI, but there was no difference between LNS and CSB if both contained DS (mean difference 22 g; 95% CI -40, 84; p = 0.49) (interaction p = 0.017). Accordingly, SI compared to DS increased weight by 89 g (95% CI 27, 150; p = 0.005) when combined with LNS, but not when combined with CSB. A limitation of this and other food supplementation trials is that it is not possible to collect reliable data on individual adherence. Conclusions Based on this study, children with MAM mainly gain fat-free tissue when rehabilitated. Nevertheless, LNS yields more fat-free tissue and higher recovery rates than CSB. Moreover, current LNSs with DS may be improved by shifting to SI. The role of milk relative to soy merits further research. Trial registration ISRCTN registry ISRCTN42569496, Author(s): Christian Fabiansen 1,2, Charles W. Yaméogo 1,3, Ann-Sophie Iuel-Brockdorf 1,2, Bernardette Cichon 1,2, Maren J. H. Rytter 1, Anura Kurpad 4, Jonathan C. Wells 5, Christian Ritz 1, Per [...]

Summary Susan Holmes argues that prevention of hospital-related malnutrition should be a primary aim for nurses. Keywords Vulnerable patients * Malnutrition * Dietetics * Recovery * Protected mealtimes * Wastage [...]

Universal periodic high-dose vitamin A capsule distribution is a cost-effective intervention to increase child survival in developing countries. It is unclear whether children who are missed by the program are at higher risk for malnutrition and infectious disease morbidity. Based on data from the Nutritional Surveillance System, we compared nutritional status and other health indicators of children aged 12-59 mo in rural Indonesia who did and did not receive a vitamin A capsule within the last 6 mo. A total of 241,087 of 335,034 children (72.0%) received a vitamin A capsule between 1999 and 2003. In children who did and did not receive a vitamin A capsule, respectively, the proportion with weight-for-age, height-for-age, and weight-for-height Z scores

Currently, there is no consensus about how to best treat malnutrition in elderly long-term care residents. A recent study found that the traditional treatment method of serving small, frequent meals was not effective at increasing energy intake. This review describes strategies to treat malnutrition in this vulnerable population. Key words: aged, deglutition disorders, elderly, fortified food, long-term care, malnutrition doi: 10.1301/nr.2007.mar.135-138

We investigated whether supplementation with an aromatic amino acid (AAA) cocktail consisting of 0.5 mmol each of phenylalanine, tryptophan, and tyrosine compared with isonitrogenous amounts of alanine (Ala) would improve measures of protein kinetics in 14 (8 with AAA, 6 Ala) children with edematous malnutrition (aged 6-24 mo) during the infected acute malnourished state. Supplementation started immediately after the baseline experiment, 2 d postadmission and continued to the end of the acute phase of treatment. The second (post-supplementation) experiment was done ~12 d postadmission. We measured leucine kinetics, phenylalanine and tyrosine fluxes, using an i.g. 8-h prime continuous infusion of [sup.2][H.sub.3]-leucine, and an i.v. 6-h prime continuous infusion of [sup.13]C-leucine, [sup.2][H.sub.2]-tyrosine, and [sup.2][H.sub.5]-phenylalanine in the fed state. Leucine flux tended to be faster (P = 0.06) in the AAA group compared with Ala group after supplementation (mean difference [+ or -] SEM): 22.6 [+ or -] 10.9 [micro]mol/(kg - h). The rate of leucine appearance from protein breakdown [28.1 [+ or -] 9.4 [micro]mol/(kg * h)] and the nonoxidative disposal of leucine [i.e., leucine to protein synthesis; 35.4 [+ or -] 12.9 [micro]mol/(kg * h)] were faster (P < 0.02) in the AAA group than in the Ala group. There was no significant effect of supplementation on leucine splanchnic metabolism, phenylalanine, and tyrosine fluxes. These findings are consistent with the hypothesis that the blunting of the protein catabolic response to infection in children with edematous malnutrition syndrome is due to limited availability of aromatic amino acids. KEY WORDS: * leucine kinetics * aromatic amino acids * protein metabolism * edematous protein-energy malnutrition * stable isotope

Malnutrition, considered for the purpose of the present data set as undernutrition, is a major risk factor of mortality in elderly people. Such protein-energy malnutrition should be detected as soon as possible. Once established, this malnutrition state must be corrected by appropriate diet, supplementation, artificial nutrition, or therapeutic treatment. If carried out well, these interventions should reduce the risk of mortality and, for some diseases such as degenerative diseases, may postpone morbidity and dependence. The efficiency of nutritional interventions has already been evaluated by different means including the measurement of anthropometric and laboratory parameters. However, in the absence of a consensus on the use of these parameters, comparison between studies and even effectiveness of the proposed treatment are frequently unconvincing. The relevance of the most common markers used in epidemiologic studies on malnutrition and nutritional interventions in elderly persons was studied for establishing a minimum data set. The aim of this task force was to provide investigators and operators in the field of clinical nutrition with clear and expert validated clinical outcomes allowing them to design and set up conclusive trials.

The refeeding syndrome is an underappreciated entity characterized by acute electrolyte derangements--notably hypophosphatemia--that occur during nutritional repletion of patients with significant suboptimal caloric intake. Adverse effects of hypophosphatemia include cardiac failure, muscle weakness, immune dysfunction, and death. Hypokalemia and hypomagnesemia commonly complicate refeeding syndrome as well; however, this report briefly reviews the clinical manifestations of refeeding-induced hypophosphatemia. Key words: refeeding syndrome, hypophosphatemia, hypokalemia, hypomagnesemia

This study arises from a general proposition that different levels and types of exposure to war are crucial in shaping health outcomes in a population under war-induced duress. We analyze civil war-related regional and ethnolinguistic differentials in age-adequate immunization (complete vaccination for age) and levels of malnutrition in Angola. Our analysis is based on data from a nationally representative survey conducted in 1996, some 2 years after the end of one of the most destructive periods of hostilities in the history of Angolan civil war. The data show that despite Angola's unique mineral wealth, the nation's levels of child age-adequate immunization is lower and malnutrition rates are higher than in most of sub-Saharan Africa. To examine age-adequate immunization and chronic malnutrition we fit logistic regression models that include the regional degree of war impact and ethnolinguistic group, in addition to rural-urban differences and other conventional sociodemographic characteristics. The tests reveal a significant disadvantage of rural children relative to urban children in both immunization and chronic malnutrition. Net of the rural-urban differences, we also detect a significant disadvantage of children residing in parts of the country that had been most affected by the fighting. The tests also point to a lower level of immunization and higher level of chronic malnutrition among children from the ethnolinguistic group commonly identified with the opposition. These associations tend to be stronger among children who were born and/or grew up during war than among children who were born after peace was re-established. Keywords: Angola; War; Child health; Malnutrition; Immunization; Sub-Saharan Africa

Malnutrition may result in a phosphate-deficient state owing to a chronically insufficient phosphate intake. Concomitant iron deficiency is common and often supplemented by the intravenous route. It is not widely recognized that some parenteral iron formulations can induce hypophosphatemia. Herein we report a case of a severe and symptomatic hypophosphatemia (0.18 mM, normal range 0.8-1.4 mM) associated with an inappropriately reduced tubular reabsorption of phosphate (33%, norm >95%) in a malnourished patient with anorexia/bulimia who received 2 x 500 mg iron carboxymaltose (FCM) intravenously. Despite intravenous and oral phosphate supplements, it required 2 months to achieve a normal serum phosphate level. Our case demonstrates that in a chronically malnourished and phosphate-deficient state intravenous FCM could potentially be dangerous. If this form of iron application cannot be avoided, phosphate supplementation before and after iron infusion as well as close monitoring of phosphate levels are needed. European Journal of Clinical Nutrition (2014) 68, 531-533; doi:10.1038/ejcn.2014.20; published online 26 February 2014, INTRODUCTION Intravenous iron carboxymaltose (FCM) administration has been reported to induce hypophosphatemia. (1-4) Severe hypophosphatemia (< 0.32 mM (normal range 0.8-1.4 mM)) can result in a variety of clinical symptoms [...]

Uremic malnutrition and chronic inflammation are important comorbid conditions that predict poor clinical outcome in end-stage renal disease (ESRD) patients. These conditions are also closely associated with cardiovascular disease, the major cause of death in ESRD patients. A pathophysiologic link between malnutrition, inflammation, and atherosclerosis has been proposed in this patient population. Indeed, multiple lines of evidence suggest that chronic inflammation can predispose ESRD patients to a catabolic and atherogenic state. Malnutrition can also result from chronic inflammation and can accelerate the progression of cardiovascular disease. Whereas a single common etiology has not been identified in this complex process, nutritional and anti-inflammatory interventions provide potential treatment options to counter the high mortality and morbidity in ESRD patients. Key Words: end-stage renal disease, uremic malnutrition, chronic inflammation, atherosclerosis

Abstract The introduction of highly active antiretroviral therapy (HAART) has resulted in marked improvements in HIV disease outcome with improved long-term survival. These changes in disease treatment have necessitated changes [...]

A multi-player approach to helping people with deficiencies of iron, iodine, and vitamin A is needed. An international model with special emphasis on iron supplementation is proposed.

Enteral nutrition may benefit some children with diseases that affect their ability to eat. Enteral nutrition is food that is delivered through a tube placed in the gastrointestinal tract. Researchers evaluated the effect of enteral nutrition in 78 children with various diseases causing malnutrition. Enteral nutrition led to catch-up growth and weight gain in many of the children, especially those with stunting and wasting., Objective. This study was designed to determine the effect of home enteral nutrition on the outcomes of growth and the relationship between growth and entrance anthropometric criteria. Methods. We reviewed the medical records of 78 consecutive children (median age, 20 months) who were enrolled in the home enteral feeding program at the Alberta Children&apos;s Hospital (Calgary, Alberta, Canada) between 1993 and 1995. Weights, heights, and weight-for-heights were expressed as Z scores, using the Centers for Disease Control and Prevention anthropometric growth curve software. To evaluate growth outcome, the total group was further subdivided using anthropometric criteria into appropriate, wasted, or stunted at the time of entry to the program. In a subgroup of 36 children on whom anthropometric data was available for a median length of 5.7 months, Z scores were compared at 3 points in time: before entry, at time of entry, and last follow-up. Results. Patients were classified into five main groups: 11 (14%) had pulmonary disease, 26 (33%) had a gastrointestinal disorder, 21 (27%) had congenital defects, 10 (13%) had a neurologic disorder, and the remaining 10 (13%) had a variety of other illnesses, including malignancies and metabolic disorders. Patients were on the program for a median duration of 8.9 months. It was found that during the period of support within the program, enteral feeding was successful in improving weight-for-age Z scores by 0.42 standard deviations but the effect on height-for-age Z scores and weight-for-height Z scores did not reach significance for this population. The subgroup of 36 children on whom longitudinal anthropometric data was available before entering the program was found to have had a significant drop in weight Z scores between the time before program entry (median length of time, 5.7 months) and the time of program entry, which indicates that these children were falling off the growth curve before commencing enteral feeding. To evaluate growth outcome, the total group was further subdivided using anthropometric criteria into appropriate, wasted, or stunted at the time of entry to the program. In the group of appropriate growth patients, while in the program, 50% had catch-up growth for weight (positive change in Z scores) and 33% for height. In the wasted patients, 92% improved their weight percentile and 75% their height percentile. In the stunted group, 71% had catch-up growth for weight and 74% for height. Conclusion. We concluded that the enteral feeding program was able to promote catch-up growth or maintain growth along percentiles in the majority of children. Pediatrics 1998;102:951-955; enteral nutrition, nutritional support, children, growth., ABBREVIATIONS. G, gastrostomy; SD, standard deviation; SE, standard error; CI, confidence interval; HIV, human immunodeficiency virus. Malnutrition or difficulty with feeding can be a complication of many childhood diseases[1] and, [...]

Keywords: Nutrition; Enteral nutrition; Malnutrition; Intensive care; Critical illness Abstract: Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence. Article History: Registration Date: 23/03/2009 Received Date: 07/04/1998 Accepted Date: 24/04/1998 Article note: Reprint requests to the European Society of Intensive Care Medicine, 40 Ave Joseph Wybran, B-1070 Brussels, Belgium E-mail esicm@pophost.eunet.be

It is argued that weight-based indicators are not effective in assessing recovery from malnutrition in adolescents with anorexia nervosa. It is hypothesized that these indicators would leave some patients with incomplete body cell mass (BCM) accretion and could result in premature termination of refeeding programs. The findings suggest that body compartmental analysis, especially of BCM and body fat, is superior to body mass index as a tool for determining recovery from malnutrition.

Malnutrition is a common problem in HIV-seropositive people, according to research undertaken among people attending an AIDS clinic in Paris, France. Preventing, detecting, monitoring and treating malnutrition can have a positive impact on the survival and quality of life of HIV-seropositive people. It is important to maintain patients in a good nutritional state so that they are more able to cope with nutritional disorders linked with episodes of opportunistic infections.

Since 1944 various international organizations have worked to improve the nutrition levels of people throughout the world. Nutritional groups have worked to decrease infant mortality rates, reduce poverty levels worldwide, increase peoples' access to clean water, and educate persons about proper nutrition. Fifty years later nutritionists continue to try to disrupt the cycle of malnutrition and poverty. New ways of improving the nutrition of everyone are waiting to be discovered.

Objectives. This study assessed the effect of vitamin A supplementation at 6-month intervals on child growth. Methods. Sudanese children (n = 28 740) 6 to 72 months of age were weighed and measured at baseline and at each of three follow-up visits. Results. Periodic vitamin A supplementation had no effect on the rate of weight or height gain in the total population or on the incidence of wasting, stunting, or wasting and stunting among children who were normally nourished at baseline. Conclusions. Reducing poverty and improving access to adequate diets should remain the goals of programs designed to improve the nutritional status of malnourished populations. (Am J Public Health. 1997;87:1359-1362)

Liver disease patients often suffer from malnutrition. Patients should follow prescribed guidelines on energy intake, protein consumption, fluid restriction, and sodium restriction. Nutrition supplements should be taken as needed. Early assessment is important, since dietetic intervention may be necessary for patients with decompensated liver disease.

Protein-energy malnutrition (PEM) is as common today in adult medical and surgical patients as it was when it was first identified more than 25 years ago. Under the current diagnosis-related group (DRG) payment system, malnutrition is considered a comorbidity or complicating condition. Thus, the identification and coding of malnutrition through the use of the International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) malnutrition codes can potentially change a patient's DRG and subsequently increase the amount of reimbursement a hospital receives. Unfortunately, the definitions for the current ICD-9-CM malnutrition diagnosis codes were developed principally in relation to clinical syndromes of primary PEM seen in pediatric age groups in less developed countries, rather than in relation to syndromes seen in hospitalized adult patients in industrialized societies. This discrepancy often leads to confusion and inconsistency when institutions attempt to code adult patients for malnutrition. Furthermore, inaccurate coding can result in inadequate reimbursement or rejection of a claim. Clearly, a separate description of the different forms of PEM seen in adults is needed not only for optimal application of nutrition support therapies but also for accurate medical records, quality assurance procedures, and reimbursement purposes. On the basis of 20 years of experience providing nutrition support to hospitalized adult patients, this article presents a schema developed at the Deaconess Hospital (Boston, Mass) that attempts to better define adult PEM using the ICD-9-CM malnutrition codes. The purpose of this article is to foster discussion and ultimately promote general agreement about a definition of adult PEM., More than 25 years ago protein-energy malnutrition (PEM) was definitely shown to be present in more than 25% of adult medical and surgical patients in acute care settings (1,2). This [...]

Malnutrition is not a new or a rare problem. In studies involving more than 1,327 hospitalized adult patients, 40% to 55% were found to be either malnourished or at risk for malnutrition, and up to 12% were severely malnourished. Surgical patients with likelihood of malnutrition are two to three times more likely to have minor and major complications as well as increased mortality; and their length of stay can be extended by 90% compared with the stay of well-nourished patients. Hospital charges are reported to be from 35% to 75% higher for malnourished patients than for well-nourished patients. Obtaining data to assess the nutritional status of patients is essential to optimal patient care, especially for patients at high risk for malnutrition. Nutrition assessment can be done with readily available and relatively inexpensive methods. But it is not enough to assess and identify malnutrition. Outcomes are improved and costs are saved only when appropriate intervention follows. This article identifies many well-conducted, published studies that support the findings that health outcomes of malnourished patients can be improved and that overall use of resources can be reduced by nutrition counseling, oral diet and oral supplements, enteral formula delivered via tube, and parenteral nutrition support via central or peripheral line. Early nutrition assessment and appropriate nutrition intervention must be accepted as essential for the delivery of quality health care. Appropriately selected nutrition support can address the problem of malnutrition, improve clinical outcomes, and help reduce the costs of health care., Malnutrition is defined as a state of nutritional insufficiency attributable to either inadequate dietary intake or defective assimilation or use of food ingested (1). Clinically important malnutrition is frequently diagnosed [...]

Cardiac cachexia represents the weight loss and malnutrition that occur in patients with chronic congestive heart failure. Anorexia is a known cause of cardiac cachexia and metabolic malfunctions may be a reason for the occurrence of this syndrome. Cardiac cachexia can be prevented by treating malnutrition in patients. A cytokine-mediated host response is one of the processes that facilitate the change in body composition in response to cachexia.

Total parenteral nutrition (TPN) benefits patients with malnutrition whose oral intake is insufficient to meet their daily nutritional requirement. Peripheral vein TPN is most suited for parenteral administration as it provides the energy requirements for hospitalized patients who do not exceed 2000 kcal/day. However, many patients receiving preoperative nutritional support do not withstand the metabolic and fluid overload of TPN resulting in myocardial insufficiency and impaired psychomotor functions.