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The Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) comprising of Bangladesh, Bhutan, India, Myanmar, Sri Lanka, Thailand and Nepal is meant to bridge the South Asia and Southeast Asia region. The 2030 SDG Goal 2 agenda aims to 'End hunger, achieve food security and improved nutrition and promote sustainable agriculture'. The countries are putting the SDG 2 into practice by changing the priorities and capacity of the food system to ensure that nutritious food is available, affordable and accessible to everyone. What is needed may be a transformative action to beat the gaps in achieving the SDG. Some countries like Bangladesh, Bhutan, and Thailand have made headway in reducing malnutrition. Investing in women empowerment and agency, water and sanitation, and healthy diets are key to achieving food security. A holistic approach to improve women's health and nutrition that is scalable and replicable for other countries to learn is required. Investment in agriculture, being the most important economic sector for the BIMSTEC countries could pave way for availability, and accessibility of food and address malnutrition. This might also accelerate progress across SDGs on poverty, health, gender, inequality, and global climate change. [ABSTRACT FROM AUTHOR]

An integrated care pathway to manage small and nutritionally at‐risk infants under 6 months (u6m) and their mothers (MAMI Care Pathway) is consistent with 2023 WHO malnutrition guidelines and is being tested in a randomised controlled trial (RCT) in Ethiopia. To optimise trial implementation, we investigated contextual fit with key local stakeholders. We used scenario‐based interviews with 17 health workers and four district managers to explore perceived feasibility. Eighteen policymakers were also surveyed to explore policy coherence, demand, acceptability, evidence needs, opportunities and risks. The Bowen feasibility framework and an access to health care framework were adapted and applied. Health workers perceived the MAMI Care Pathway as feasible to implement with support to access services and provide care. The approach is acceptable, given consistency with national policies, local protocols and potential to improve routine care quality. Demand for more comprehensive, preventive and person‐centred outpatient care was driven by concerns about unmet, hidden and costly care burden for health services and families. Inpatient care only for severe wasting treatment is inaccessible and unacceptable. Support for routine and expanded components, especially maternal mental health, is needed for successful implementation. Wider contextual factors may affect implementation fidelity and strength. Policymakers cautiously welcomed the approach, which resonates with national commitments, policies and plans but need evidence on how it can work within varied, complex contexts without further system overstretch. A responsive, pragmatic randomised controlled trial will generate the most useful evidence for policymakers. Findings have informed trial preparation and implementation, including a realist evaluation to contextualise outcomes. Key messages: The MAMI Care Pathway integrated approach is perceived as acceptable, needed and possible to implement during a randomised control trial in outpatient clinics in Ethiopia.Contextualised inputs (training, staffing, space and supplies) will be needed to strengthen implementation of existing activities and for new components.Breastfeeding counselling skills and maternal care provision, especially maternal mental health, are varied and often limited in routine services.National policymakers need trial implementation evidence to contextualise RCT outcomes for policy development. [ABSTRACT FROM AUTHOR]

Addressing the intersection of food insecurity, malnutrition and climate change in Sub‐Saharan Africa requires meaningful adolescent and youth engagement to drive sustainable change. Drawing on empirical evidence and collective experiences from youth‐led initiatives and coalitions, four gaps and opportunities to better involve youth in programmes are discussed, including, the need to: (1) standardise the definition of youth to improve programme design and data harmonisation, (2) provide capacity building and mentorship for youth leadership in health service delivery, (3) foster youth leadership and multisectoral collaboration in food and health systems and (4) enhance capacity development for non‐youth actors to support genuine youth participation. This viewpoint underscores the importance of involving African youth in public health nutrition, climate change and food security programmes design and implementation—as drivers of change to addressing hunger and climate crises. By centering youth voices and experiences, programmes and policies can better address African communities' complex challenges, fostering inclusivity, sustainability and resilience in achieving better nutrition and public health programmes and outcomes. Key messages: Standardization of the definition of youth is critical to generate, accurate and harmonized data to inform on youth program design, implementation, and policy frameworks.Investment in youth capacity building, mentorship and leadership development is essential for strengthening health service delivery and addressing climate change and food insecurity.Youth leadership and multisectoral collaboration are key to driving change in food and health systems by actively involving young people in decision‐making and community engagement programmes.Sensitisation of nonyouth actors on the importance of meaningful adolescent and youth engagement (MAYE) is crucial for fostering inclusive collaboration and combatting youth tokenism. [ABSTRACT FROM AUTHOR]

People seeking substance use disorder (SUD) treatment could benefit from nutrition services, including nutrition education, addressing common concerns like malnutrition. This cross-sectional study assessed the inclusion of nutrition education and registered dietitian nutritionists (RDNs) at SUD treatment facilities in New Mexico (NM). Of 80 eligible facilities identified via SAMHSA's online database in 2020, 18 (23%) completed a survey. Eight (44%) offered nutrition education that reinforced basic or essential nutrition-related knowledge; just one (6%) had an RDN. Most NM SUD treatment facilities do not offer nutrition education, but nutrition education/counseling provided by an RDN should be considered in comprehensive SUD treatment. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) encompasses diverse conditions such as congenital anomalies, glomerulonephritis, and hereditary nephropathies, necessitating individualized nutritional interventions. Early detection is pivotal due to the heightened risk of adverse outcomes, including compromised growth and increased healthcare costs. The nutritional assessment in pediatric CKD employs a comprehensive, multidisciplinary approach, considering disease-specific factors, growth metrics, and dietary habits. The prevalence of malnutrition, as identified through diverse tools and guidelines, underscores the necessity for regular and vigilant monitoring. Nutritional management strategies seek equilibrium in calorie intake, protein requirements, and electrolyte considerations. Maintaining a well-balanced nutritional intake is crucial for preventing systemic complications and preserving the remaining kidney function. The nuanced landscape of enteral nutrition, inclusive of gastrostomy placement, warrants consideration in scenarios requiring prolonged support, with an emphasis on minimizing risks for optimized outcomes. In conclusion, the ongoing challenge of managing nutrition in pediatric CKD necessitates continuous assessment and adaptation. This review underscores the significance of tailored dietary approaches, not only to foster growth and prevent complications but also to enhance the overall quality of life for children grappling with CKD. [ABSTRACT FROM AUTHOR]

In India, nutritional public health problems such as macronutrient malnutrition and diet-related non-communicable diseases are still persistent. Dietary assessment among the population is essential to understand the adequate consumption of nutrients in maintaining a balanced diet and most importantly to accomplish the Sustainable Development Goal-2, 'End hunger, achieve food security and improved nutrition', by 2030. Hence, an attempt was made in this paper to examine the nutrient consumption and compare it with the Recommended Dietary Allowances (RDAs)-given by Indian Council of Medical Research(ICMR)-2020 and also to assess the determinants of adequate intake of calorie and Protein among the rural households in Jhargram district of West Bengal, India. The study used primary data from a sample of 200 households collected during April–May, 2017. The daily intake of calorie and protein were calculated by following the RDAs by ICMR-2020 conversion table. Bivariate and multivariate logistic regression models were employed. Results found that the consumption of adequate calorie and protein intake was 30% and 40% respectively. Logistic regression found that age, gender of the household head, social category, size of household, major source of income, access to market, access to credit, type of house, monthly per-capita consumer expenditure and farm size were significantly associated with the consumption of calorie and protein. The study concludes the need to address the importance of socio-economic disparities in nutrient intake and accessibility of credit facilities to rural households. There is also a need for targeted interventions among female-headed households to foster balanced nutrition and avert malnutrition. [ABSTRACT FROM AUTHOR]

This integrative review aimed to summarise existing best evidence practice for preventing malnutrition within the First 1000 Days of Life in under-resourced communities. BioMed Central, EBSCOHOST (Academic Search Complete, CINAHL and MEDLINE), Cochrane Library, JSTOR, Science Direct and Scopus were searched as well as Google Scholar and relevant websites for grey literature. Most recent versions of strategies, guidelines, interventions and policies; published in English, focussing on preventing malnutrition in pregnant women and in children less than 2 years old in under-resourced communities, from January 2015 to November 2021 were searched for. Initial searches yielded 119 citations of which 19 studies met inclusion criteria. Johns Hopkins Nursing Evidenced-Based Practice Evidence Rating Scales for appraising research evidence and non-research evidence were used. Extracted data were synthesised using thematic data analysis. Five themes were derived from extracted data: 1. Improving social determinants of health using a multisector approach; 2. Enhancing infant and toddler feeding; 3. Managing healthy nutrition and lifestyle choices in pregnancy; 4. Improving personal and environmental health practices; and 5. Reducing low-birthweight incidence. Further exploration regarding preventing malnutrition in the First 1000 Days in under-resourced communities is required using high-quality studies. Systematic review registration number: H18-HEA-NUR-001 (Nelson Mandela University). [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to evaluate the correlation of mid-upper arm circumference (MUAC) z-scores with body mass index (BMI) and weight-for-height (WFH) z-scores to determine its reliability in identifying malnutrition and its potential in clinical practice in healthy children and adolescents. Methods: Our study included 906 healthy children and adolescents aged between 2 months and 18 years who were admitted to University Hospital's General Pediatrics Clinic and attended 12 primary schools in 6 additional Izmir provinces. Anthropometric measurements (weight, length/standing height, MUAC, BMI, WFH) were performed. The relationship between MUAC z-scores, BMI, and WFH z-scores of cases with malnutrition were evaluated. Results: According to the WHO BMI z-score classification, 6 (0.7%) of the children were defined as having severe undernutrition, 43 (4.7%) as moderate undernutrition, 146 (16.1%) as mild undernutrition, 486 (53.6%) as normal, 142 (15.7%) as overweight, and 83 (9.2%) as obese. At any age over two years, fair agreement was observed between MUAC z-scores and WHO BMI z-scores in defining malnutrition alone compared to other growth measures (weighted kappa = 0.371). Under two years of age, the correlation between MUAC z-scores and BMI z-scores showed moderate agreement in detecting overweight and obesity (weighted kappa = 0.479), and between MUAC and WHO WFH z-scores showed moderate agreement (kappa = 0.252). Conclusions: The study found a moderate and fair connection between MUAC z-scores and other criteria. However, further MUAC z-score screening and diagnostic power testing in larger pediatric populations are needed to validate its use alongside other key anthropometric indicators in malnutrition diagnosis. MUAC measurement should be popularized in routine pediatric outpatient clinics to detect malnutrition quickly. [ABSTRACT FROM AUTHOR]

Nutrition is fundamental to a child's growth and development. However, nutritional health is often compromised by acute and chronic conditions and treatments that can commonly result in malnutrition. Malnutrition encompasses undernutrition and overnutrition and may be exacerbated by food insecurity. Recent health policy efforts in the United States (US) include those focused on quality measurement and social determinants of health (SDOH) to reduce risks for malnutrition and food insecurity. Nutrition-focused quality improvement programs (QIPs) have emerged as a successful model for benchmarking current nutrition care in adult patients and creating pathways for establishing best practices for timely malnutrition screening, intervention, and appropriate follow-up and care coordination. However, less is known about opportunities for nutrition-focused QIPs in hospital pediatric malnutrition care. This Perspective helps fill the gap by discussing the problem of pediatric malnutrition and current US quality frameworks and child nutrition programs related to malnutrition and food insecurity. In addition, this Perspective summarizes how nutrition-focused QIPs can impact malnutrition, including how QIPs can link hospital care with patient discharge planning and outpatient interventions. Finally, the Perspective outlines specific opportunities for the implementation of pediatric nutrition-focused QIPs to reduce office visits and/or inpatient readmissions through appropriate nutrition screening, assessment, and interventions. [ABSTRACT FROM AUTHOR]

Background: Dysphagia, as a geriatric syndrome, is prevalent in the intensive care unit (ICU). Malnutrition resulting from swallowing disorders is likely to correlate with adverse ICU outcomes, including delirium, thereby escalating the costs of care and hospitalization. However, malnutrition has not received the attention it deserves in ICU clinical nursing practice. As two preventable and correctable conditions—malnutrition and delirium—the advantages of early identification and intervention are substantial. Exploring the relationship between malnutrition and delirium, starting from the high‐risk group of elderly patients with swallowing difficulties in the ICU, will aid us in managing patients promptly and effectively. Aim: To investigate the relationship between malnutrition and the incidence of delirium in elderly patients with dysphagia in the ICU. Study Design: This is a retrospective study. Data for this study were obtained from the Medical Information Mart for Intensive Care‐IV. All 2273 patients included were dysphagia older patients over 65 years of age admitted to the ICU, and logistic regression was used to explore the relationship between malnutrition and delirium. We also used propensity score matching (PSM) for sensitivity analysis. Results: Among the included patients with swallowing difficulties, 13% individuals (297/2273) exhibited malnutrition, with a delirium incidence rate of 55.9% (166/297). In the non‐malnutrition group (1976/2273), the delirium incidence rate is 35.6% (704/1976). After adjusting for 31 covariates, multifactorial logistic regression showed that malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.47–2.62). The results remained stable after analysis by PSM. Conclusion: Malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU. Malnutrition should be given adequate attention in the ICU. Relevance to Clinical Practice: ICU nurses should pay particular attention to malnutrition, especially among the high‐prevalence group of patients with dysphagia. Early identification and nutritional intervention for these patients may help reduce the costs of care and health care expenditures. [ABSTRACT FROM AUTHOR]

Food insecurity and malnutrition are rising worldwide due to disruptions in food systems related to interconnected health-, climate- and conflict-related crises. Although governments globally are committed to addressing nutritional challenges, policy responses have increasingly focused on food security and, particularly, on food affordability. However, these short-term measures often overlook the necessity of integrating nutritious foods into the food system to ensure improved long-term nutrition. By drawing on the United Nations Committee on World Food Security's Voluntary guidelines on food systems and nutrition, this article outlines opportunities for policy-makers to integrate nutrition into key elements of the crisis response. Key policy areas where nutrition could be further integrated include social protection, agricultural investment, trade policy and urban planning. Strengthening the focus of nutrition in these measures will be essential to establish long-term incentives that support food systems transformation for improved nutrition. Drawing on theories of the policy process, I propose that stronger governance and cross-sectoral dialogue will be critical to achieve sustained nutritional outcomes. Health policy-makers can play a leadership role in supporting cross-sectoral policy change by carefully framing the policy issues, advocating for institutional structures that promote collaboration across sectors to prioritize nutrition, and strengthening the management of conflicts of interest in food system policy-making. [ABSTRACT FROM AUTHOR]

Background: (Minimum Dietary Diversity for Women) MDD-W is crucial for both mothers and children, but significant disparities are present. The study was conducted to assess the factors influencing MDD-W among postnatal women of 15-49 years in Dibrugarh, Assam. Methodology: A cross-sectional study was carried out with 180 postnatal women using multi-stage sampling and interviewed using 24-hour recall method. Descriptive data was presented as proportions and frequencies, and analysed using Chi-square test and Fisher's exact test. Results: Lack of knowledge on dietary diversity was 77.8%. Only 55.6% consumed foods from ≥ 5 food groups. Women from rural residences, lower socio-economic status, and late antenatal visits were less likely, while women with higher education, family support were more likely to have MDD-W. Conclusion: Lack of diverse diets, particularly protein and vitamin A-rich foods, among postnatal women necessitates intervention to combat malnutrition. [ABSTRACT FROM AUTHOR]

Background: Under nutrition in infants is a critical public health concern with irreversible consequences on child growth and development, particularly during the crucial first six months of life. Maternal under nutrition has been associated with poor fetal growth which may result in low birth weight. Aims & Objectives: To understand the clinical profile and management of under nutrition in less than six months. This study aims to explore into the various factors of under nutrition in infants less than 6 months of age, identifying key factors that contribute to the problem and proposing practical solutions to address it. Methodology: This observational cross-sectional study was carried out in a tertiary care hospital with sample size of 194 infants.The pre validated questionnaire and structured proforma was used. Results: The infants aged between 0 and 6 months (average age 2.7± 1.5 months), a total of 194 infants,70.1% required NICU admissions,15.5% had congenital anomalies, 69.6% had weight for age, 39.2% length for age and 46.9% HC for age below -3 standard deviations and Weight for length <-3SD was observed in 57% of infants. Conclusion: Maternal parity, consanguineous marriages, and lower socioeconomic status shown to be associated with the congenital anomalies and low birth weight. [ABSTRACT FROM AUTHOR]

Nutrition is one of the cornerstones in the treatment and support of critically ill patients. Nutritional support includes the provision of calories, protein, electrolytes, vitamins, and trace elements through enteral or parenteral routes. Acute kidney injury (AKI) is a common problem in critically ill patients and can lead to severe consequences, impacting metabolism and nutritional status significantly. Furthermore, regardless of the modality used, renal replacement therapy (RRT) has profound effects on metabolism. Evidence on nutritional support during continuous renal replacement therapy (CRRT) is limited, and there are no established clinical guidelines for nutritional adaptations during CRRT in critically ill patients. This review outlines some essential principles for providing micronutrient support in critically ill patients undergoing CRRT and protein requirements in AKI patients. [ABSTRACT FROM AUTHOR]

Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in‐depth interviews and 8 focus‐group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door‐to‐door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long‐term systems‐owned BEP intervention. Key messages: Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight but its implementation through ANC, as recommended by WHO, is complex.Decisions about who bears the cost of the product should consider the feasibility of scaling solutions to different groups. Targeting the most in need and with government supported programmes should be considered.Door‐to‐door distribution emerged as the preferred delivery modality, though the feasibility of this mechanism at scale is a concern, particularly given the documented lack of human resources in health.Given the positive community perceptions around BEP supplements, delivery through ANC could increase ANC participation. [ABSTRACT FROM AUTHOR]

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Introduction: Malnutrition in children under 5 years is one of the leading problems affecting their growth and development. According to the National Family Health Survey-5 data in urban areas in India, 27.3% were undernourished, 30.1% were stunted, 18.5% were wasted, 7.6% were severely wasted, and 4.2% were overweight. Therefore, it is necessary to determine their nutritional gap and its factors to prevent complications. Materials and Methods: The analytical cross-sectional study was done in urban Mysore. The sample size was 171 under-five children. Malnutrition was assessed using the WHO standards by calculating weight for height. A questionnaire on associated factors was used. The calorie intake was calculated using the 24-h recall method. Statistical Analysis Used: Data were entered into an Excel spreadsheet and analyzed using SPSS software version 26 and inferential analysis was done using the Chi-square test. Results: The prevalence of nutritional gap is 28.1% among 171 under-five children. Factors such as socioeconomic status, education of the head of the family, energy requirement, and midupper arm circumference also were found to be have significant effects on nutritional status. Conclusion: Most of the under-five children were found to be deficient in calorie intake and the prevalence of wasting in the field practice area is lower than the national average. Few risk factors are associated with the nutritional gap in children under the age of five. [ABSTRACT FROM AUTHOR]

Background: Low-carbohydrate diets (LCD) are popular for weight loss but lack evidence about micronutrient sufficiency in real-life use. This study assessed the intake and biochemical status of selected micronutrients in people voluntarily following LCDs. Methods: A cross-sectional study was conducted (2018-20) among 98 adults recruited as self-reporting either LCD (n = 49) or diets not restricting carbohydrates (controls; n = 49). Diets were assessed using the 130-item EPIC-Norfolk food-frequency questionnaire. Red-blood-cell thiamine diphosphate (TDP) was measured for thiamine status using HPLC. Plasma magnesium, zinc, copper, and selenium were measured using inductively coupled plasma mass spectrometry. Between-group biomarker comparisons were conducted using ANCOVA and adjusted for age, sex, body mass index (BMI), and diabetes status. Results: LCD-followers (26% male, median age 36 years, median BMI 24.2 kg/m2) reported adhering to LCDs for a median duration of 9 months (IQR 4–36). The most followed LCD type was 'their own variations of LCD' (30%), followed by ketogenic (23%), 'palaeolithic' (15%), and Atkins diets (8%). Among controls, 41% were male (median age 27 years, median BMI 23 kg/m2). Median macronutrient intakes for LCD vs control groups were carbohydrate 16%Energy (E) vs. 50%E; protein 25%E vs. 19%E; and fat 55%E vs 34%E (saturated fat 18%E vs. 11%E). Two-thirds of LCD followers (32/49) and half of the controls (24/49) reported some use of dietary supplements (p = 0.19). Among LCD-followers, assessing from food data only, 21 (43%) failed to meet the reference nutrient intake (RNI) for thiamine (vs.14% controls, p = 0.002). When thiamine from supplementation (single- or multivitamin) was included, there appeared to be no difference in thiamine intake between groups. Still, red-blood-cell TDP was lower in LCD-followers than controls (407 ± 91 vs. 633 ± 234 ng/gHb, p < 0.001). Three LCD-followers were thiamine-deficient (RBC thiamine < 275 ng/gHb) vs. one control. There were no significant differences in dietary intakes or plasma concentrations of magnesium, zinc, copper, and selenium between groups. Conclusions: Following LCDs is associated with lower thiamine intake and TDP status than diets without carbohydrate restriction, incompletely corrected by supplement use. These data, coupled with a lack of RCT evidence on body weight control, do not support recommending LCDs for weight management without appropriate guidance and diet supplementation. [ABSTRACT FROM AUTHOR]

Background: Malnutrition often manifests as a body weight (BW) reduction and unhealthy alteration in body composition. The present study aimed to assess the efficacy of an oral nutritional supplement (ONS) in improving BW and body composition among older adults with malnutrition. Methods: An open‐label randomised controlled, parallel‐group study was conducted among older adults (age ≥ 60 years) with/at risk of malnutrition (mini nutrition assessment‐short form score ≤ 11). In total, 50 participants were randomly assigned to the intervention (IG) and control (CG) groups (1:1 ratio). The IG received the ONS (57 g/day; 247 kcal/serving, 12 g protein) before bedtime for 12 weeks. CG received 200 mL of water. Anthropometric measurements, body composition analysis, and dietary and physical activity assessments were performed at the beginning and end of the study. Results: Forty‐two participants (IG: 20, CG: 22) completed the study. The mean ± SD ages of the IG and CG were 75.4 ± 6.1 and 74.8 ± 5.2 years, respectively (p = 0.73). The IG had a significant increase in BW (+1.68 ± 1.16 vs. −0.46 ± 0.95 kg; p < 0.001), lean mass (+1.23 ± 0.93 vs. −0.45 ± 0.90 kg; p < 0.001) and fat mass (+0.54 ± 0.82 vs. −0.06 ± 0.82 kg; p = 0.02) compared to the CG. One‐quarter of the IG (n = 5) achieved a weight gain > 5% of BW, whereas none in the CG did (p = 0.01). No significant changes were observed in bone mineral content in either group. Conclusions: For malnourished older adults, supplementing with an ONS, along with regular food intake, significantly increased BW, lean mass and fat mass compared to control following the regular diet without supplementation. Highlights: Malnutrition in older adults has become a prevalent public health concern.Oral nutritional supplements (ONS) provide calories, high‐quality protein and micronutrients when a regular diet alone is insufficient.ONSs can be used as an effective intervention to prevent/treat malnutrition in older adults.Intervention with an ONS led to an increase in body weight and an improvement in body composition within the study group. [ABSTRACT FROM AUTHOR]

Background: Persons living with dementia and informal caregivers are at a higher risk for malnutrition. Most caregivers are not experts at identifying nutritional complications of dementia. Therefore, we aimed to identify nutrition knowledge and challenges related to feeding and caring for persons with dementia to develop a meaningful intervention. Methods: A mixed‐methods approach was used. Eight focus groups were conducted with caregivers of persons living with dementia (n = 28) and healthcare professionals (n = 23). Data was analysed using NVivo software. A questionnaire was administered to identify nutritional challenges. A modified food frequency questionnaire assessed food patterns of caregivers and persons with dementia. Results were compared to Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) dietary guidelines. Data were analysed using SPSS software. Results: Four major themes emerged: forgetting to eat, developing food aversions, strong preferences for sweets and weight changes. Findings revealed common strategies used to improve nutrition intake included cueing, supplements and quiet eating environment. Caregivers were impacted by stress leading to poorer food choices and exhaustion. Recommendations for a caregiver program made by participants included education, resources and support. Findings from the food frequencies questionnaire survey showed most participants had a lower dietary diversity compared to the MIND diet guidelines. Conclusions: With both groups being more prone to malnutrition, this research shows that participants were less likely to obtain adequate nutrition for brain health. Additionally, caregivers are dealing with nutrition issues themselves and their person living with dementia. The findings support the need for registered dietitians to provide tailored nutrition interventions for these families. Highlights: Caregivers for individuals living with dementia are stressed and exhausted leading to poorer food choices and low diet quality.Most persons living with dementia and their caregivers fell short on food choices in the Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet recommendations.Caregivers want a program that includes support, resources, and nutrition education. [ABSTRACT FROM AUTHOR]

Introduction: For 70% of patients, liver cirrhosis will be alcohol-related. Liver cirrhosis influences a long list of physical challenges and reduced appetite. The purpose of the study was to optimize nutritional therapy with the use of a nutrition project manager. Method: Patients diagnosed with liver cirrhosis and hospitalized longer than 48 hours were included. Outcomes were nutritional screening, fluid intake, diet registration, and weight. Patients were given a diet plan at discharge. Results: Nineteen patients were included in the project. Fluid intake and diet registration were measured in 72% of the cases. On average, the patients achieved their daily energy needs in 28% of their hospitalization. None of the patients had an unexplained weight loss. Conclusion: Even with a professional focussing only on nutrition, it is difficult to obtain full nutrition for the patients. We need to juxtapose the importance of nutrition with, for example, the consistent execution of medicine. [ABSTRACT FROM AUTHOR]

Malnutrition – specifically undernutrition – is a state in which a deficiency of energy, protein and other nutrients causes adverse effects on the body, its function and clinical outcomes. Malnutrition can be disease-related or caused by social factors; the two are often inter-related. More than 3 million people in the UK are malnourished or 'at risk' of malnutrition, 93% of whom reside in the community. It commonly affects older people and those with certain medical conditions. With a pivotal role in providing care in secondary and community settings, prescribers are increasingly involved in quality improvement programmes to manage malnutrition, including the appropriate use of oral nutritional supplements. This article seeks to improve understanding of the impact of malnutrition on individuals and the wider healthcare economy, identification of those at risk and the effective use of oral nutrition support. [ABSTRACT FROM AUTHOR]

Background: Malnutrition and poor weight gain has been reported in infants with congenital heart defects (CHDs); however data in older children with CHDs are limited. In order to obtain representative data on the nutritional status, dietary behavior, and potential influencing factors in school-aged children with CHDs, we performed a nationwide online survey. Methods: Patients aged 6 to 17 years registered in the German National Register for CHDs were asked to participate in this study by completing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) eating study questionnaire in order to assess their self-reported dietary habits. The use of the same questionnaire enabled a comparison with a representative subset of 4569 participants of the KiGGS study. Results: A total of 894 patients (mean age 12.5 ± 3.0 years; 47.2% female) were enrolled. Patients were allocated according to anatomic complexity into simple (23.8%), moderate (37.8%), and complex CHDs (38.4%). The consumption of sugar-containing food (p < 0.001) and fast food (p < 0.05) was significantly lower among the CHD patients than in the healthy children. Children with CHDs showed significantly lower body mass index (BMI) percentiles (p < 0.001) compared with their healthy peers, while children with complex and moderate CHDs had the lowest BMI. While in CHD patients, the BMI percentiles were not related to unhealthy food, there was a strong correlation with the CHD severity and number of previous interventions (p < 0.01). Conclusions: According to this nationwide survey, school-aged children with complex CHD are at risk of undernutrition, which is not due to dietary habits but to CHD severity and repeated surgery. [ABSTRACT FROM AUTHOR]

Malnutrition is a global problem that affects all countries in one or more of its forms, representing one of the greatest challenges worldwide. One of the key contributing factors is food insecurity, which must be evaluated in children with moderate and severe acute malnutrition, as they are at imminent risk of death. Objective: Our objective was to assess food insecurity among children under 5 years old with moderate, and severe malnutrition from Valle del Cauca, a state located in the southwestern region of Colombia. Methods: A descriptive observational study was conducted, including children whose weight-for-height (W/H) indicator was below 2 SD, as recorded on the World Health Organization (WHO) growth charts, or who exhibited severe malnutrition phenotypes such as marasmus or Kwashiorkor. Family and child food security were evaluated using the Latin American and Caribbean Food Security Scale (ELCSA). Results: 58.6% of households with acutely malnourished children experienced food insecurity. A statistically significant relationship was found between food insecurity and children of Afro-Colombian and Indigenous descent. According to caregivers' perceptions, 30.2% of child malnutrition cases were related to poor feeding and caregiving practices. Conclusions: Not all children with acute malnutrition suffer from food insecurity. Therefore, the findings of this research suggest that governmental efforts should focus not only on ensuring food availability, but also on educating caregivers about the importance of a balanced and nutritious diet tailored to the specific characteristics of each region and promoting appropriate caregiving practices. [ABSTRACT FROM AUTHOR]

Reduced appetite with ageing is a key factor that may increase risk of undernutrition. The objective of this study is to determine the impact of innovative plant protein fibre (PPF) products within a personalised optimised diet (PD), a physical activity (PA) programme, and their combination on appetite, and other nutritional, functional and clinical outcomes in community-dwelling older adults in a multi-country randomised controlled intervention trial. One hundred and eighty community-dwelling adults (approximately sixty per trial centre in Germany, Ireland and Italy) aged 65 years and over will be recruited to participate in a 12-week, parallel-group, controlled trial. Participants will be randomised into one of four groups: 1, PD (incorporating two PPF products): 2, PA; 3, PD + PA; and 4, no intervention (control). The primary outcome is appetite measured by visual analogue scales and energy intake from an ad libitum test meal. Secondary outcomes include fasting and postprandial appetite-related gut hormones, Simplified Nutritional Appetite Questionnaire score, body composition, cardiorespiratory fitness, muscle strength, physical function and PA. In addition, self-efficacy, cognitive status, dietary restraint, depressive symptoms and compliance and acceptability of the intervention will be assessed. Metabolomic profiles, RMR, muscle motor unit properties and gut microbiome will also be assessed to explore potential underlying mechanisms. This multi-centre randomised controlled trial will advance knowledge on how PD (incorporating PPF products), PA and their combination influence appetite, nutritional status and related health outcomes in community-dwelling older adults and contribute to the prevention of undernutrition. Trial registration: Clinical Trials.gov Registry NCT05608707 (registered on 2 November 2022). Protocol Version: NCT05608707 Version 4 (registered on 29 September 2023). [ABSTRACT FROM AUTHOR]

Background: The South Korean government implemented a multidisciplinary nutritional support team (NST) system to focus on the proper evaluation and supply of nutritional status in hospitalized patients who are at a higher risk of malnutrition. Methods: This nationwide population-based cohort study included patients diagnosed with sepsis who were admitted to hospitals from 2016 to 2020. The NST should consist of four professional personnel (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). The NST group included patients with sepsis admitted to a hospital with an NST system, whereas the non-NST group included patients with sepsis admitted to a hospital without an NST system. Results: A total of 323,841 patients with sepsis were included in the final analysis, and 120,274 (37.1%) admitted to a hospital with an NST system were included in the NST group. In the multivariable Cox regression analysis, the NST group showed a 15% lower 90-day mortality than the non-NST group (hazard ratio [HR]:0.85, 95% confidence interval [CI]:0.83, 0.86; P < 0.001). The NST group shows 11% lower 1-year all-cause mortality than the non-NST group (HR:0.89, 95% CI:0.87, 0.90; P < 0.001). In subgroup analyses, a more evident association of the NST group with lower 90-day mortality was shown in the intensive care unit admission group and age ≥65 years old group. Conclusions: Multidisciplinary NST intervention is associated with improved survival outcomes in patients with sepsis. Moreover, this association was more evident in patients with sepsis aged ≥65 years old who were admitted to the ICU. [ABSTRACT FROM AUTHOR]

Aims: Immune checkpoint inhibitor therapy used for lung cancer has significantly changed response and survival rates, however, the impact on patients' nutritional status remains largely unexplored. This review aims to identify common adverse events that increase nutrition risk induced in non‐small cell lung cancer patients treated with immune checkpoint inhibitor therapy and assess impact on nutritional status. Methods: PubMed, Medline and CINAHL were systematically searched in September 2023 for randomised controlled trials comparing immune checkpoint inhibitor treatment of non‐small cell lung cancer to a control group. Treatment‐related adverse events that increased nutrition impact symptoms identified in the patient‐generated subjective global assessment and clinical guidelines were extracted and qualitatively analysed. Risk of bias was assessed using Cochrane Risk of Bias tool 2. Results: Eleven eligible randomised controlled trial studies were identified and analysed. The data demonstrated immune checkpoint inhibitor treatment was associated with a lower percentage of reported nutrition impact symptoms, for example, decreased appetite, nausea, vomiting, compared to chemotherapy treatment. Conversely, immune checkpoint inhibitor treated patients recorded a greater percentage of immune‐related adverse events that alter metabolism or nutrient absorption. Conclusion: Non‐small cell lung cancer patients treated with immune checkpoint inhibitors still experience nutrition impact symptoms but less frequently than patients treated with chemotherapy. This combined with unique nutrition‐related consequences from colitis and thyroid disorders induced by immune checkpoint inhibitor therapy indicates patients should be screened, assessed and interventions implemented to improve nutrition. [ABSTRACT FROM AUTHOR]

Aims: To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model. Method: The type 1 hybrid effectiveness‐implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool. Results: Thirty‐two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation. Conclusion: Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered. [ABSTRACT FROM AUTHOR]

Aims: Hospital inpatients often eat poorly and report barriers related to mealtime care. This study aimed to measure and describe the mealtime environment and care practices across 16 acute wards in a tertiary hospital to identify opportunities for improvement. Methods: A prospective cross‐sectional audit was undertaken over a two‐month period in 2021. A structured audit tool was used at one breakfast, lunch and dinner on each ward to observe the mealtime environment (competing priorities, lighting, tray table clutter) and care practices (positioning, tray within reach, mealtime assistance). Data were analysed descriptively (%, count), with analyses by meal period and ward to identify variation in practices. Results: A total of 892 observations were completed. Competing priorities (59%), poor lighting (43%) and cluttered tray tables (41%) were common. Mealtime assistance was required by 300 patients (33.6%; 5.9% eating assistance, 27.7% set‐up assistance) and was provided within 10 min for 203 (66.7%) patients. A total of 54 patients (18.0%) did not receive the required assistance. We observed 447 (50.2%) patients lying in bed at meal delivery, with 188 patients (21.1%) sitting in a chair. Competing priorities, poor lighting, poor patient positioning and delayed assistance were worse at breakfast. Mealtime environments and practices varied between wards. Conclusion: This audit demonstrates opportunities to improve mealtimes in our hospital. Variation between wards and meal periods suggest that improvements need to be tailored to the ward‐specific barriers and enablers. Dietitians are ideally placed to lead a collaborative approach alongside the wider multidisciplinary team to improve mealtime care and optimise intake. [ABSTRACT FROM AUTHOR]

Millets are a group of small, drought-resistant grains that have been grown for more than thousands of years. They are highly nutritious, rich in essential vitamins and minerals, and have gained attention in recent years due to their potential to address global food security and environmental challenges. This review article provides an overview of millets, their nutritional benefits, environmental advantages, and their role in promoting sustainable agriculture and processing of millets. The article also discusses the various types of millets, their cultivation, and their potential to improve human health and combat malnutrition. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3–5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition. Methods: Children aged 3–5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition. Results: A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05). Conclusions: The risk of ECC among children aged 3–5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3–5 years was positively associated with undernutrition. The caries activity among children aged 3–5 years was positively associated with undernutrition and negatively associated with overnutrition. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to assess the nutritional status of children and adolescents with celiac disease (CD) in Kuwait and investigate the nutritional deficiencies and sociodemographic factors associated with growth stunting in this population. Methods: This case–control study included 77 CD patients aged 3–18 years diagnosed with CD using IgA anti-tissue transglutaminase and duodenal biopsy and 33 healthy controls. Nutritional status was evaluated based on demographic and clinical characteristics, anthropometric measurements, and biochemical parameters. Univariate and multivariate logistic regression models were used to determine the association between CD and growth stunting. Results: Approximately one-third (31%) of children with CD had stunted growth, 20.8% had a low body mass index for their age, and 5.2% had both growth stunting and wasting. Children with CD had higher odds of iron-deficiency anemia, vitamin D deficiency, anemia, and lower socioeconomic status. They were also younger and had decreased serum levels of vitamin D compared to the controls. These factors were all significantly associated with an increased risk of CD, collectively explaining over 50% of the risk. For growth stunting, lower education status among mothers, family income, and serum ferritin were identified as risk factors. Conclusions: A significant proportion of children and adolescents with CD had malnutrition, overt deficiencies, and impaired growth despite coherence with a gluten-free diet. Recommendation: Routine monitoring and targeted nutritional interventions are recommended for children and adolescents with CD to address malnutrition and growth stunting. Addressing socioeconomic disparities and enhancing maternal education may also help mitigate the risk factors. [ABSTRACT FROM AUTHOR]

The global food system depends on a limited number of plant species. Plants with unsatisfactory nutritional value are overproduced, whereas the wide variety of nutrient-rich plant species used in earlier times remains neglected. Basing our diet on a few crops has wide-ranging negative consequences on nutrition and food security. Although still under-researched, underutilized plants are slowly starting to receive increased recognition. These plants have superior nutritional content and immense potential to contribute to food and nutrition security and increased sustainability. This narrative review provides evidence to encourage the promotion, domestication, and commercialization of underutilized plants. The anti-inflammatory, antidiabetic, and anticancer effects of some of underutilized plants are presented in this review. The outstanding ability of forgotten plants to increase food and nutrition security, boost dietary diversity, reduce malnutrition, and enhance human health and well-being is demonstrated. The main barriers and obstacles to reintroducing underutilized foods are reviewed and recommendations for overcoming nutrition and dietary-related challenges for re-establishing underutilized plants into the global food system are presented. The expansion of underutilized plants for human use is of paramount importance. The exceptional nutritional properties, bioactive potential, and proven health benefits of underutilized plants indicate that increased promotion, domestication, and commercialization of these plants should be strongly supported. Besides health benefits, marginalized plants have the potential to enhance human well-being and improve people's lives in many ways, retain biodiversity, and develop local economies. Therefore, underutilized plants should be used in the broader context of well-balanced and healthy diets. [ABSTRACT FROM AUTHOR]

Introduction: As part of the development of an agreed minimum set of outcomes or Core Outcome Set (COS) for future nutritional intervention trials in older adults with malnutrition or at risk of malnutrition, this work reports on the Delphi surveys and final consensus. Methods: Outcomes from a scoping review were incorporated into a two-round Delphi survey. Researchers and healthcare professionals experienced in malnutrition in older adults were invited to take part in an online survey to rate 38 selected outcomes on a nine-point Likert scale ranging from 'not important' to 'critical' for their setting (community, hospital, or long-term care). Consensus for inclusion was reached when ≥75% (or ≥60% if a patient-reported outcome) of the participants scored the outcome as 'critical' and <15% as 'not important'. Resulting outcomes were voted for inclusion or exclusion in the COS in a final online consensus meeting. Results: Ninety-three and 72 participants from diverse professional backgrounds and countries participated in the 1st and 2nd Delphi round, respectively. After both rounds eleven outcomes met the inclusion criteria, largely irrespective of setting. Fifteen participants, representing academia, health care, health policy, industry, and PPI, voted in a final online consensus meeting resulting in ten outcomes: malnutrition status, dietary intake, appetite, body weight or BMI, muscle strength, muscle mass, functional performance, functional limitations, quality of life, and acceptability of the intervention. Conclusions: Ten outcomes will form the COS which is intended to be used by the scientific community in all future nutritional intervention studies for older adults with malnutrition or at risk of malnutrition. The subsequent phase will establish the appropriate methods to measure these outcomes. [ABSTRACT FROM AUTHOR]

The incidence and mortality of ST-elevated myocardial infarction are increasing year by year, causing a huge economic burden to patients' families due to its severe clinical symptoms, high mortality, and poor prognosis. Percutaneous coronary intervention is the best treatment strategy for reducing myocardial infarction area, prolonging survival, and improving prognosis. To further improve the clinical effect of percutaneous coronary intervention in the treatment of ST-elevated myocardial infarction, this study explored the application value of nicorandil in the procedure. Oral nicorandil tablets were found to improve the cardiac function and myocardial microcirculation of patients with ST-elevated myocardial infarction, enhance their nutritional status, and reduce the risk of malnutrition. In the 6-month prognostic follow-up, nicorandil tablets provided more effective prognostic myocardial protection for patients. Therefore, we recommend the use of nicorandil tablets for adjuvant therapy during primary percutaneous coronary intervention in the future. [ABSTRACT FROM AUTHOR]

Aims: To explore adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition' and to identify the terms that adult inpatients report are used by themselves and health workers to describe malnutrition. Design: This qualitative study was conducted using data collected for a separate qualitative study that investigated factors that influence the dietary intake of long‐stay, acute adult inpatients. Methods: Semi‐structured interviews were conducted with a purposive sample of current inpatients. Data were analysed using inductive content analysis. Results: Nineteen interviews were included (mean age 64 years (standard deviation ±17), 10 female (53%), 12 malnourished (63%)). Four categories were identified. 'Variation in patients' recognition of malnutrition' represents the differing abilities of patients to understand and identify with the term 'malnutrition'. 'Recognising individuals' needs and preferences' highlights patients' varying beliefs regarding whether 'malnutrition' is or is not an appropriate term and participants' suggestion that health workers should tailor the term used to each patient. 'Inconsistencies in health workers' and patients' practice regarding malnutrition terminology' encapsulates the multiple terms that were used to describe malnutrition by health workers and patients. 'Importance of malnutrition education' summarises patients' views that health workers should provide patient education on malnutrition prevention, management and complications. Conclusion: Findings highlight variations in patients' perceptions and understanding of the term 'malnutrition' and differences in the terms used by patients and health workers to describe malnutrition. Implications for the Profession and/or Patient Care: The terminology used by health workers to describe malnutrition risk or malnutrition to their patients can influence patients' recognition of their nutritional status and thus the multidisciplinary management of the condition. To ensure that patients receive information about their malnutrition risk or diagnosis in a way that meets their needs, health workers' practices must be revised. To do this, it is imperative to conduct further collaborative research with patients and health workers to identify optimum terms for 'malnutrition' and how health workers should communicate this to patients. Impact: There is a disparity in patients' perceptions, understanding and preferences for the term 'malnutrition' and there are inconsistencies in how health workers communicate malnutrition to patients.To support patients' recognition and understanding of their nutritional status, it is imperative for health workers to consider how they discuss malnutrition with patients. Reporting Method: Adheres to the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007). Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Adequate micronutrient intake and status are global public health goals. Vitamin and mineral deficiencies are widespread and known to impair health and survival across the life stages. However, knowledge of molecular effects, metabolic pathways, biological responses to variation in micronutrient nutriture, and abilities to assess populations for micronutrient deficiencies and their pathology remain lacking. Rapidly evolving methodological capabilities in genomics, epigenomics, proteomics, and metabolomics offer unparalleled opportunities for the nutrition research community to link micronutrient exposure to cellular health; discover new, arguably essential micronutrients of microbial origin; and integrate methods of molecular biology, epidemiology, and intervention trials to develop novel approaches to assess and prevent micronutrient deficiencies in populations. In this review article, we offer new terminology to specify nutritional application of multiomic approaches and encourage collaboration across the basic to public health sciences to advance micronutrient deficiency prevention. [ABSTRACT FROM AUTHOR]

Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcers, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Patients requiring enteral nutrition (EN) after neurological insults experience feeding interruptions, contributing to inadequate nutrition delivery. This prospective cohort study investigated if volume‐based enteral feeding (VBF) improved the delivery of prescribed EN volume in ward patients with acute neurological conditions. Methods: Over two sequential periods, the usual care group received standard continuous rate‐based feeding, and the intervention group received VBF with bi‐daily EN rate adjustments to achieve target daily volume. The primary outcome was percentage of prescribed daily EN formula volume delivered. Differences in energy and protein provision, weight, malnutrition and safety were explored. An evaluation survey captured nurse acceptability of the protocol. Results: The intervention group (n = 32) achieved greater median interquartile range (IQR) EN adequacy of prescribed volume at 92% (88–97) compared to 67% (54–78) for usual care (n = 35) (p < 0.001). VBF compared to rate‐based feeding resulted in patients receiving more kilojoules (131 [121–138] kJ/kg vs. 84 [64–99] kJ/kg; p < 0.001) and protein (1.3 [1.2–1.5] g/kg vs. 0.9 [0.6–1.1] g/kg; p < 0.001). There were no differences in gastrointestinal intolerance between groups. Compliance to the VBF protocol was 90%, and 78% of staff reported high confidence using the protocol. The intervention group had less median weight loss at discharge (−1.4 [0.1 to −4.3] kg) than usual care (−3.6 [−1.3 to 8.4] kg; p < 0.011), but no differences in malnutrition status were observed. Conclusion: A VBF protocol delivered greater EN volume, energy and protein following neurological injury. The VBF protocol was feasible with high acceptability from nursing staff. Key points: The volume‐based feeding (VBF) protocol improved the delivery of enteral nutrition (EN) volume, energy and protein in ward patients with acute neurological conditions.The protocol was feasible to implement, with high nursing acceptance.Further investigation of the impact of VBF on patient‐centred outcomes is warranted. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is crucial for child health and development, yet its practices and their implications on children's nutritional status vary. Aim & Objectives: This study aimed to explore the determinants of breastfeeding practices and their effects on the nutritional status of children in an Indian population. Methodology: This study is conducted in four villages of Udaipur district, Rajasthan, among 120 mother-child pairs. The data is collected on anthropometric measurements, socioeconomic factors, and child health parameters. Results: We found that only 37.5% of children were exclusively breastfed. Significant associations were observed with birth month (P=<0.001) and nearly significant associations with mode of delivery (P=0.06) and undernutrition (P=0.07). Conclusion: These findings highlight the need for larger-scale research to further investigate these associations and enhance breastfeeding practices to improve child health outcomes. [ABSTRACT FROM AUTHOR]

Children under the age of five (the under-five) from low-income families are more vulnerable to experience underweight. This nutritional vulnerability is evident in the preliminary study, where 35.1% of the under-five experience underweight, and 28.48% are low-income families. This study aimed to explore Positive Deviance (PD) behaviors in preventing underweight among the under-five. The study applied a qualitative approach with a case study design. Data collection took place in July-August 2022, focusing on low-income families in the Gunung Brintik area. Data were collected through two focus group discussions, seven in-depth interviews, and five key informant interviews. Coding, subtheme, and theme development were facilitated using the ATLAS.ti trial package. Triangulation of the study results yielded four major themes influencing the prevention of underweight in the under-five: interventions by health workers and cadres, community awareness and concern, family support, and maternal nutrition literacy. The identified PD behaviors practiced by the community in the study location have been shown to contribute to the prevention of underweight in the under-five. Strengthening these identified PD behaviors and their implementation in other areas is essential to support efforts to combat underweight in the under-five. [ABSTRACT FROM AUTHOR]

There are few studies in the scientific literature on Peruvian native cereal-based instant mixes. Food aid programs of the Peruvian government allow food to be distributed to infants in public schools, and in general, these foods contain carbohydrates and a protein fraction, but there is some rejection on the part of consumers due to the sensory aspect of the product that does not has been considered in this population. The objective of this study is to know the bioactive, nutritional potential and the level of sensory acceptance of infant food made from Andean pseudocereals from the Ancash region and tropical fruits from the Piura region, Peru. Three formulations were prepared based on mango, banana, quinoa and kiwicha flours (T1, T2 and T3) and were compared with a commercial product based on kiwicha and oatmeal. The total amounts of phenolic compounds, vitamin C, antioxidant activity, composition, water absorption index, oil, milk was determined; viscosity and sensory evaluations were carried out with the participation of preschool children (4 and 5 years). The content of phenols, ascorbic acid (AA) and antioxidant capacity of T1 and T2 were 10 times higher than the control treatment. Physical and chemical composition analysis showed that there were no significant differences among the treatments evaluated. Banana four contributes to the water and oil absorption capacity and viscosity. Finally, the addition of quinoa and kiwicha four improves milk absorption capacity. The characteristics of the developed mixtures allow the incorporation of more food and less water to increase viscosity acceptance. The greatest preferences were obtained by T2 and T1, obtaining a level of acceptance above 82%, which shows that today children have a healthy food alternative such as mixtures of Andean pseudocereals and tropical fruits without sacrificing their nutritional qualities. [ABSTRACT FROM AUTHOR]

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The management of wasting in Ethiopia is heavily reliant on the Community‐based Management of Acute Malnutrition (CMAM) programme that has been implemented in more than 18,000 service delivery points scattered across the country. Despite the full‐scale implementation of the CMAM, the number of child death averted, and the cost per child death averted remains unknown. This study aimed to estimate the cost and the number of child death averted by the CMAM programme between 2008 and 2020. Using data from routine monitoring of the CMAM programme, we estimated the excess mortality averted by the programme and estimated the cost per averted child death based on supply and labour. Over the past 13 years between 2008 and 2020, 3.6 million children under 5 years were admitted to the Ethiopian CMAM programme. The yearly average admission of 317,228 was achieved since 2011. On average, ~34,000 child deaths were averted yearly. The CMAM programme was estimated to have saved 437,654 (95% confidence interval [CI]: 320,161; 469,932) child deaths between 2008 and 2020, approximately 12% of the admitted cases. The average cost of the programme per adverted death was estimated at US$762/child death averted (95% CI = 639; 1001). The CMAM programme in Ethiopia is cost‐effective and has continued to avert a significant number of child death. Given the high short‐ and long‐term economic and health consequences of child wasting, concerted multi‐sectoral efforts are needed to accelerate progress not only in its treatment but also in its prevention. Key messages: A total of 3.6 million children were admitted between 2008 and 2020, increasing annually from 92,000 in 2008 to 390,000 in 2020 due to improvement in case findings and referral.Death rate in Community‐based Management of Acute Malnutrition (CMAM) programmes has decreased by sixfold between 2008 and 2020 from 1.23% to 0.22%During 13 years of implementation, the Ethiopian CMAM programme averted the death of >400 thousand children under five. [ABSTRACT FROM AUTHOR]