Nutritional status of Kamar tribal children in Chhattisgarh

OBJECTIVE

Assessment of the nutritional status among 309 Kamar children (161 boys and 148 girls) aged 4-12 years.

METHODS

In this cross-sectional study, 24-hours dietary recall method was used to assess dietary intakes of children. Height and weight were recorded and children were classified by WHO criterion (Z-score) using nutritional indices i.e. weight for age, height for age and weight for height. NCHS data were used as reference. Mean energy and protein intake per day were measured and compared with Recommended Dietary Allowances (RDA) of Indian standards.

RESULTS

More than 90 percent of children (both boys and girls) in the age group of 4-6 years suffered by underweight (<-2 SD weight for age), which was comparatively lower in 7-9 and 10-12 years age group children. 84.51 percent of boys suffered by stunting (<-2 SD height for age), which was much higher than girls (47.54%) in 4-6 years age group. Similarly, 80 percent of 4-6 years age group children were affected by wasting (<-2 SD weight for height). The consumption of energy and protein were also much lower among Kamar children than the RDA of India throughout the ages.

CONCLUSION

Undernutrition in the form of underweight, stunting and wasting and low consumption of dietary intake (energy and protein) was found to be widely prevalent among Kamar tribal children. Therefore, an urgent dietary intervention programme is necessary. Further studies are required to investigate into problem and to supplement the key nutrients which are required to ensure a good nutritional status in children.

Risk factors for protein-energy malnutrition in children under 5 years: study from Luangprabang province, Laos

BACKGROUND

Laos is one of the poorest countries in which chronic malnutrition is highest. The aim of the present study was to determine the prevalence of and to identify risk factors associated with protein-energy malnutrition (PEM) in children under 5 years of age in Luangprabang province, Laos.

METHODS

This cross-sectional study was undertaken from March to May 2004. Anthropometric measurements of 798 children were done and data were transformed into height-for-age, weight-for-age and weight-for-height ratios. Mothers were also interviewed with a semi-structured questionnaire. Anthropometric data were entered into Nutstat in Epi-Info 2000 and transferred to SPSS for analysis.

RESULTS

There was a high prevalence of stunting, underweight and wasting, that is, 54.6%, 35%, and 6% respectively. It was also noted that children aged 12-23 months and Khmu ethnic children had a higher prevalence of stunting (65% and 66%) and underweight (45% and 40%), respectively. However, it was also found that boys were more prone to be stunted and underweight. Furthermore, restricted intake of meats, vegetables during illness, and low maternal education were main risk factors for child malnutrition in the study area.

CONCLUSION

Socioeconomic-demographic factors, low maternal education, poor nutrition knowledge for mother and feeding practices for sick children are affecting children's health regarding stunting and underweight. It is recommended that an improvement in societal infrastructure, better maternal education and nutrition are needed to address the child malnutrition issue.

Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India

OBJECTIVE

The present study was undertaken to assess the impact of drought on the nutritional status of pre-school children aged 0-5 years from a rural population in a desert area facing drought conditions very frequently.

DESIGN

The sampling design for assessment was the three-stage sampling technique.

SETTING

The study was carried out in 24 villages belonging to six tehsils (sub-units of district) of Jodhpur District, a drought-affected desert district of western Rajasthan, during a drought in 2003.

SUBJECTS

A total of 914 children were examined at household level, with nutritional status assessed by anthropometry, dietary intake and clinical signs of nutritional deficiency.

RESULTS

The results revealed growth retardation. Stunting (malnutrition of long duration) was observed in 53% of children and underweight in 60%. Wasting, an indicator of short-duration malnutrition, was present in 28% of children. The extent of malnutrition was significantly higher in girls than boys (P<0.05). Vitamin A and B complex deficiencies were found in 0.7 and 3.0% of children, respectively. Prevalence of marasmus (protein-energy malnutrition, PEM) was 1.7% (2.3% in boys and 1.1% in girls). Overall deficits in mean energy and protein intakes were very high (76 and 54%, respectively). Comparison of the present drought results with earlier studies in desert normal and desert drought conditions showed higher prevalence of PEM and higher dietary energy and protein deficiencies.

CONCLUSIONS

The prevalence of wasting was high, greater than the cut-off point of 15% stated by the World Health Organization to indicate that the severity of malnutrition is critical. PEM, vitamin A and B complex deficiencies and anaemia, along with dietary deficits of energy and protein, were observed to be higher than in non-desert areas. This may be due to the harsh environmental conditions in desert areas where drought occurs quite frequently and adversely affects the economy, largely by eroding the coping capacity and economic potential of the people as a result of heavy livestock losses and reduced harvests, leading to increased poverty and poor food intake of the inhabitants. Due to inadequate consumption of daily food the children were suffering from wasting and PEM. Efforts should be made to incorporate measures, such as ensuring the supply of adequate energy and protein to all age groups and especially pre-school children, into ongoing nutrition programmes in order to improve the food security of local inhabitants in this area.

Oral candidiasis and nutritional deficiencies in elderly hospitalised patients

The prevalence of oral candidiasis and its association with malnutrition in terms of protein–energy malnutrition and mineral and vitamin depletion were evaluated in ninety-seven hospitalised older adults aged 82·1 (SD 8·6) years. Patients underwent a complete oral examination with microbiological investigation on admission to our geriatric rehabilitation unit. Patients were assessed nutritionally by evaluation of dietary intake and measurement of anthropometric variables, serum nutritional proteins, ferritin, Zn, folate, vitamins B12 and C. The prevalence of oral candidiasis was 37% (n 36); the proportion of patients with BMI <20 kg/m2 was 32% (n 31). The nutritional status of the population was studied by comparing two groups defined according to the absence (group I; n 61) or presence (group II; n 36) of oral candidiasis. The two groups did not differ on the basis of BMI and mid-arm circumference. However, group II had a smaller leg circumference, lower daily energy and protein intakes, lower albumin and transthyretin levels. Patients successfully treated with fluconazole increased their intake on day 30. The proportion of patients with hypozincaemia (<12·5 μmol/l) and vitamin C deficiency (<0·7 mg/l) was higher in group II. Treatment with antibiotics, poor oral hygiene, denture wearing, and vitamin C deficiency appeared as the most significant independent risk factors associated with oral candidiasis. The present findings show that oral candidiasis appears to be related to malnutrition and results in mucosal lesions that have a negative impact on energy intake, which may subsequently worsen nutritional status.

Association of resident, facility, and geographic characteristics with chronic undernutrition in a nationally represented sample of older residents in U.S. nursing homes

BACKGROUND

Undernutrition (also known as protein-calorie malnutrition or energy-deficiency) is associated with exacerbation of health conditions, increased frailty, and decline in physical, cognitive, and affective function. This is a critical problem for older adults who reside in nursing homes and have many limitations that contribute to reduced food intake.

OBJECTIVE

To determine the relationship of chronic undernutrition [body mass index (BMI) < 18.5 kg/m2] to resident, facility, and geographical characteristics in a national sample of nursing home residents aged 60 y or older in the U.S.

DESIGN

A cross-sectional, secondary analysis of a 10% nationally representative random sample of annual assessments of nursing home residents in the U.S. (n = 128,514), using the Minimum Data Set (MDS). Data included measured weight and height, resident characteristics, facility characteristics, and geographic location.

RESULTS

More than 12% (n = 15,566) were chronically undernourished (energy-deficient), with more than 27% of those being severely undernourished (BMI < 16). Independent correlates of chronic undernutrition (multivariate analysis) included resident characteristics (ADL, having chewing or swallowing problems, or leaving at least 25% of the meal uneaten), facility characteristics (% Medicare and for-profit status), and geographic characteristics (living in nursing home in urban or large towns).

CONCLUSION

This study found a high percentage of chronic undernutrition in this nationally representative sample of U.S. nursing home residents. Furthermore, resident, facility, and geographic characteristics were associated with chronic undernutrition. Strategies need to be developed and documented that ensure nutritional health to residents with a variety of health problems.

Nutritional status of children under five in three state foster care institutions in Sri Lanka

This study evaluated the prevalence of protein energy malnutrition (PEM) in children under five years (n = 52), in three randomly selected, State operated foster care institutions in Sri Lanka. The prevalence of PEM, was (51.9%), underweight (63.5%) and wasting (25.0%) was found to be considerably higher than the national prevalence (13.5%, 29.4%, 14.0%, respectively). Based on this preliminary evidence, it is recommended that a study representative of all institutionalised children in both State and private facilities be conducted to identify deficiencies and recommend improvements to institutional care in Sri Lanka.

Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition?

To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger, we analysed three cohorts of severely malnourished patients in terms of daily weight gain, length of stay, recovery, case fatality and defaulting. A total of 1937 children aged 6-59 months were followed prospectively from 15 August 2002 to 21 October 2003. For the three cohorts, 660 children were maintained in the therapeutic feeding centre (TFC) during the entire treatment, 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home. For all cohorts, average time in the programme and average weight gain met the international standards (30-40 days, >8 g/kg/day). Default rates were 28.1, 16.8 and 5.6% for TFC only, TFC plus home-based and home-based alone strategies, respectively. The overall case fatality rate for the entire programme was 6.8%. Case fatality rates were 18.9% for TFC only and 1.7% for home-based alone. No deaths were recorded in children transferred to rehabilitation at home. This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies.

Hypovitaminosis D in internal medicine inpatients

Some studies have suggested that hypovitaminosis D may be a consequence of protein-calorie malnutrition. This study assessed both the relationship between vitamin D status, malnutrition, calcium and phosphorus metabolism indices and the importance attached by internists to these alterations. There were 239 patients admitted to an internal medicine division who underwent examinations to assess nutritional state, liver and renal function, and bone metabolism. At the end of the study, the clinical data included in the discharge letter, the treatment prescribed, and the diagnosis assigned to patients on their hospital discharge form were collected. Hypovitaminosis D was found in 72% and hypoalbuminemia in 34.3% of patients. Subjects with hypovitaminosis were generally older and had lower albumin levels than those with mild or no hypovitaminosis. 25-Hydroxyvitamin D was inversely related with parathyroid hormone and directly related with albumin. Alterations of calcium and phosphorus metabolism were present in 55.6% and recorded by the division's physicians for only 13.53% of patients, of whom 72.37% were not specifically treated. There is a direct correlation between 25-hydroxyvitamin D and albumin levels. The high incidence and the metabolic consequence of hypovitaminosis D and of protein-calorie malnutrition is significantly underestimated and undertreated by physicians.

Malnutrition, inflammation, atherosclerosis in hemodialysis patients

Protein-energy malnutrition with muscle wasting occurs in a large proportion of patients with chronic renal failure and is, in addition to atherosclerosis, a strong risk factor for cardiovascular mortality in dialysis patients. There is evidence that a chronic inflammation with activation of C-reactive protein and proinfalammatory cytokines is associated with increased oxidative stress and endothelial dysfunction. Strong relations between malnutrition, inflammation and atherosclerosis in dialysis patients suggest the presence of a MIA (malnutrition, inflammation and atherosclerosis) syndrome, which is associated with high mortality rate. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis would improve survival in dialysis patients.

Serum iron status in Orang Asli children living in endemic areas of soil-transmitted helminths

We conducted a cross sectional study to examine the association of intestinal parasitic infections and protein energy malnutrition (PEM) with iron-status indicators and anaemia among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2 - 15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis for blood and faecal samples. All children were infected either by A. lumbricoides, T. trichiura or hookworm and almost 19%, 26% and 3% of the children had severe infection of ascariasis, trichuriasis and hookworm infection respectively. The prevalence of giardiasis among them was 24.9%. Overall, 41.5% of the children were anaemic (haemoglobin < 11.0 g/dL). Of these 61.0% of the children had iron deficiency and 36.5% had iron deficiency anaemia (IDA), which accounted for 88.0% of anaemia in this population. Severe trichuriasis had the most significant correlation with anaemia and iron deficiency in this population. It contributed to low concentrations of haemoglobin, serum iron and serum ferritin and high total iron binding capacity (TIBC). Significant underweight and stunting were associated with low concentrations of haemoglobin and serum iron while significant wasting was significantly associated with low concentration of serum ferritin. Logistic regression analysis confirmed that severe trichuriasis was a strong predictor of IDA. It also confirmed that children who were significantly underweight and whose mother was working were independent predictors of IDA in this population.

Reduction in childhood malnutrition in Vietnam from 1990 to 2004

Reduction in childhood malnutrition in Vietnam between 1990 and 2004 was assessed using data from 5 national surveys. The prevalence of malnutrition, including stunting, declined significantly for underweight from 45% in 1990 to 26.6% in 2004. While the average reduction was 1.3% per year in the period from 1990 to 2000, it was 1.8% per year in the period from 2000 to 2004. The prevalence of stunting declined from 56.5% in 1990 to 30.7% in 2004, with an average reduction of 2% per year in the period from 1990 to 2000 and 1.5% per year in the period from 2000 to 2004. There were clear differences in the decrease in malnutrition prevalence between urban, rural and mountainous areas, the reduction being highest in the urban regions and lowest in the mountainous areas. Regression analysis showed that the nutrition status of the child is positively related to better household living conditions and to the educational level of the father, but not the mother. Stunting is higher in children whose parents are farmers and higher in households with more children. Stunting prevalence is lower in households with safe water access and hygienic toilets. In future , the dramatic reduction is childhood malnutrition as seen in the period 1990 to 2004 might not continue. More comprehensive apptoaches will be needed to lower childhood malnutrition in Vietnam further.

Improved nutritional status in elderly patients 6 months after stroke

INTRODUCTION

Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced.

AIMS

To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery, length of stay in hospital and infectious complications.

SUBJECTS AND METHODS

89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months and 6 months. Nutritional status was evaluated by body weight, body mass index (BMI), mid upper arm circumference (MAC), triceps skinfold thickness (TSF) and serum concentrations of albumin and transferrin. Malnutrition was defined if the patients had 2 or more abnormal nutritional variables.

RESULTS

We found a significant increase in albumin from 1 week to 6 months (P < 0.0001), and a significant increase in transferrin form 5 weeks to 6 months (P < 0.05). There was no significant change in weight or BMI from 1 week to 6 months. The number of patients with 2 or more abnormal nutritional variables was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months.

CONCLUSION

35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables showed improvement for serum proteins, and 22 % of the patients were malnourished 6 months after stroke.

Nutritional status, body composition and health conditions of the Karen hill tribe children aged 1-6 years in Northern Thailand

INTRODUCTION

In Thailand, according to the national nutrition survey of the Thai population who live in the cities by the Ministry of Public Health, about 12% of preschool children aged 1-6 years were malnourished. The rate of malnutrition is much higher among mountain minority ('hill tribe') children than city children. This paper reports a study of malnutrition, body composition and health conditions of Karen hill tribe children aged 1-6 years in Thailand.

METHODS

All children aged 1-6 years (N = 158; 83 boys, 75 girls) from the three Karen villages (Mae Hae Tai, Mae Yot, Mae Raek) of Mae Chaem district in the north of Thailand were studied. Anthropometric measurements of all children were obtained and body composition data were derived. All children were examined by a qualified medical doctor. A stool sample and blood smear for malaria from all children were examined by a well qualified medical technologist.

RESULTS

All families of the study boys and girls had incomes lower than the Thailand poverty line (US $ 1,000/year). There were no significant differences in weight, height or body mass index of boys and girls from each of the three villages. Malnutrition in children were found 85.5% by using weight-for-age, 73% by height-for-age (stunting) and 48.4% by weight-for-height (wasting). Boys had more total body fat mass than girls. However, all of them had low lean body mass and fat mass. Nearly all children (98%) suffered from either upper respiratory tract infection, skin infection, scabies and/or diarrhoea. Also, nearly all of them (97%) had scaly and dry skin over their chest walls and legs. About 10% of children had either angular stomatitis (5%) or bleeding per gums (3%) or bow legs (1%) or frontal bossing (1%) with their implications for micronutrient deficiency. None of the children from the three villages were infested with the malarial parasite. On average, 54% of children from Mae Hae Tai village and 85% of children from Mae Yot village but only 4% of the children from Mae Raek village were infested with parasites. Ascaris lumbricoides was the most common infestation in all children from three villages.

CONCLUSION

The prevalence of malnutrition was high among the Karen hill tribe children aged 1-6 years, Thailand. Most of the children suffered from upper respiratory tract infection, skin infection, scabiasis and/or diarrhrea. Nearly all of them had scaly and dry skin over their chest walls and legs which indicated essential fatty acid deficiencies. However, only 10% of them had vitamin deficiencies such as B2, C, and D.

Body mass index in Central India: inter district variation

Basic causes of poor state of nutrition and infections in developing countries are poverty, low level of hygienic conditions and little access to preventive and health care. Central India is known for its high rate of population growth and mortality, which persisted over time along with a low level of social, economic and infrastructure development. In the present study the body mass index (BMI) of 31 populations residing in 38 districts of Central India (comprising the States of Madhya Pradesh and Chhattisgarh) is assessed. Anthropometric data collected by the Anthropological Survey of India were utilized in this context. The mean body mass index values of the populations of total backward and non-backward districts are found to be lower than that of well-to-do individuals of India (Bharati 1989, Khongsdier 1997, Reddy 1998), but it is not as low as that found among the South Indian populations (Ferro-Luzzi et al. 1992). In the present investigation, it is also found that the majority of the backward districts fall in the category of different grade of chronic energy deficiency (CED), while in the non-backward districts a considerably less number of districts follows this trend. A better level of the nutritional status among the populations of the non-backward districts corroborates the findings of the Ministry of Health and Family Welfare (NFHS 1992). It reveals that the apparently healthy individuals with CED grade I in the present study may be thin but physically active and healthy. The present study, however, narrates further intensive investigations in these populations, because the BMI as a measure of the CED should incorporate the aspects like morbidity and health status of a population.

Nutritional implications of patient–provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients

OBJECTIVE

To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion).

DESIGN

In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions.

SETTING

Dining room of a geriatric rehabilitation unit.

SUBJECTS

Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1).

RESULTS

Meal-level frequency of patient-provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029).

CONCLUSION

Results present evidence that the amount and nature of patient-provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population.

SPONSORSHIP

This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Québec and by the Danone Institute (Doctoral fellowship to Danielle St-Arnaud McKenzie).

The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us?

To review the literature on the MNA to Spring 2006, we searched MEDLINE, Web of Science and Scopus, and did a manual search in J Nutr Health Aging, Clin Nutr, Eur J Clin Nutr and free online available publications.

VALIDATION AND VALIDITY

The MNA was validated against two principal criteria, clinical status and comprehensive nutrition assessment using principal component and discriminant analysis. The MNA shortform (MNA-SF) was developed and validated to allow a 2-step screening process. The MNA and MNA-SF are sensitive, specific, and accurate in identifying nutrition risk.

NUTRITIONAL SCREENING

The prevalence of malnutrition in community-dwelling elderly (21 studies, n = 14149 elderly) is 2 +/- 0.1% (mean +/- SE, range 0- 8%) and risk of malnutrition is 24 +/- 0.4% (range 8-76%). A similar pattern is seen in out-patient and home care elderly (25 studies, n = 3119 elderly) with prevalence of undernutrition 9 +/- 0.5% (mean +/- SE, range 0-30%) and risk of malnutrition 45 +/- 0.9% (range 8-65%). A high prevalence of undernutrition has been reported in hospitalized and institutionalized elderly patients: prevalence of malnutrition is 23 +/- 0.5% (mean +/- SE, range 1- 74%) in hospitals (35 studies, n = 8596) and 21 +/- 0.5% (mean +/- SE, range 5-71%) in institutions (32 studies, n = 6821 elderly). An even higher prevalence of risk of malnutrition was observed in the same populations, with 46 +/- 0.5% (range 8-63%) and 51 +/- 0.6% (range 27-70%), respectively. In cognitively impaired elderly subjects (10 studies, n = 2051 elderly subjects), detection using the MNA, prevalence of malnutrition was 15 +/- 0.8% (mean +/- SE, range 0-62%), and 44 +/- 1.1% (range 19-87%) of risk of malnutrition.

CHARACTERISTICS

The large variability is due to differences in level of dependence and health status among the elderly. In hospital settings, a low MNA score is associated with an increase in mortality, prolonged length of stay and greater likelihood of discharge to nursing homes. Malnutrition is associated with functional and cognitive impairment and difficulties eating. The MNA(R) detects risk of malnutrition before severe change in weight or serum proteins occurs.

NUTRITIONAL INTERVENTION

Intervention studies demonstrate that timely intervention can stop weight loss in elderly at risk of malnutrition or undernourished and is associated with improvements in MNA scores. The MNA can also be used as a follow up assessment tool.

CONCLUSION

The MNA is a screening and assessment tool with a reliable scale and clearly defined thresholds, usable by health care professionals. It should be included in the geriatric assessment and is proposed in the minimum data set for nutritional interventions.

Training nurses to save lives of malnourished children

A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/ caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Severe malnutrition is a major cause of death among paediatric patients in many hospitals in South Africa. A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of severe malnutrition through implementing the World Health Organisation (WHO) guidelines. Focus group discussions were conducted in isiXhosa following a semi-structured discussion guide. Three themes emerged from these discussions, i.e. nurses placed blame on the mothers for not giving adequate care at home; nurses valued malnourished children less than those with other conditions; and nurses felt resentment towards caregivers. Underlying reasons for the negative attitudes towards severely malnourished children and their caregivers were misunderstandings of the causes of malnutrition, misinterpretation of clinical signs, especially poor appetite, and high mortality during treatment. However, the training course and successful application of the treatment guidelines altered these perceptions and helped nurses to have a better understanding of the causes of the presenting clinical signs. These nurses have begun advocating for raised awareness of the physiological differences that occur in malnutrition and the need to include the WHO Ten Steps of treatment in the nursing curricula and inservice training. A cadre of volunteer nurse-trainers has been formed in Eastern Cape. Experience in this province has shown that in-service training changes attitudes to malnutrition and treatment practices, as well as saving lives.

Nutritional study of the 1-4 year old population of the Lower Jimi Valley, Western Highlands Province, Papua New Guinea

Malnutrition is a significant problem in parts of Papua New Guinea, including the Lower Jimi Valley. There is evidence of specific nutritional deficiencies, such as endemic cretinism, but this study focused on protein-energy malnutrition. It found that, in the 1-4 year old population of three remote villages in the Jimi, only 26% were nutritionally normal, 65% were stunted, 7% were wasted and 2% were stunted and wasted. With respect to weight for age, 16% were 80-100% weight for age, 77% were 60-80% and 7% were < 60%. These figures are considerably higher than those of the National Nutrition Survey of 1982-1983; although the Survey data originated from the entire Jimi District rather than only the villages in this study, these findings suggest that malnutrition is a significant and worsening problem in the Lower Jimi Valley.

Nutritional disorders in the elderly

Undernutrition is common in older people and has serious adverse effects. Weight loss and low body weight are key markers. Correctable causes, such as depression, are common and should be sought. Structured efforts to encourage food intake, together with nutritional supplements, often are of benefit. It is hoped that a better understanding of the underlying mechanisms will lead to targeted treatments. Overweight and obesity also are common in older people, and are associated with morbidity and impaired function. It is probably appropriate to recommend weight loss to obese older people who have associated comorbidities, particularly reduced mobility, but seldom, if ever, for increased weight alone.

Somatic growth after ventricular septal defect in malnourished infants

OBJECTIVE

To assess somatic growth after ventricular septal defect (VSD) repair in severely malnourished infants.

STUDY DESIGN

Ninety consecutive infants (age at surgery: 7.2 +/- 3.2 months) were followed after VSD closure at a referral center in southern India to evaluate somatic growth.

RESULTS

At surgery, 44% and 30% of patients had weight and height Z score <-3, respectively. On follow-up (age 5.4 +/- 0.8 years), despite a significant improvement from baseline (Z score -1.8 +/- 1.2 vs -2.8 +/- 1.3, P <.001), weight was significantly lower compared with healthy Indian children, particularly for boys. Height Z score improved significantly only in girls (-0.8 +/- 1.3 vs -1.8+/-2.1, P = .01). Weight, height, and combined weight and height Z scores (failure to thrive) of <-2 were observed in 42%, 27%, and 18 % of patients, respectively. On multivariate analysis, weight Z score <-2 on follow-up was predicted by weight Z score at surgery and male sex, height Z score <-2 by maternal height and male sex, and failure to thrive by maternal height and caloric intake.

CONCLUSIONS

There is suboptimal recovery of somatic growth after repair of VSD in severely malnourished infants. Preoperative malnutrition affected only weight on follow-up, whereas height recovery and failure to thrive were influenced by constitutional factors.

[Nutritional status of peritoneal dialysis patients and parameters of dialysis adequacy]

The aim of our study was to evaluate relations between peritoneal dialysis (PD) adequacy and nutritional parameters of PD patients. Patients (n = 124), who finished PD treatment, were separated on 2 groups according to the mean total Kt/V for the entire PD course being below 2.0 (group I) or over 2.0 (group II). Adequacy parameters, daily intake of food products and nutritional indices were evaluated in each patient every 3-6 months during the entire PD course. Mean values of examined parameters were used for comparison of differences observed between both groups. Group I included 63 men, 16 women, age 50.3 +/- 13.8 years, PD duration 13.2 +/- 10.1 months. Group II consisted of 12 men, 33 women, age 49.1 +/- 14.9 years, PD duration 8.8 +/- 6.0 months. Due to a significant difference in sex distribution, dialysis duration and ideal body mass (IBM) between groups, statistical analysis was performed with adjustment of results to these parameters. Absolute amounts of daily intake of food components were higher in group I for animal protein, sodium, retinol, niacin, saturated and polyunsaturated fatty acids and cholesterol. When daily food intake was normalized to IBM, group II showed higher both protein nitrogen appearance (I - 0.92 +/- 0.25, II - 1.12 +/- 0.45 g/kg IBM, p = 0.005) and intake of vegetable protein (I - 0.29 +/- 0.10, II - 0.34 +/- 0.09 g/kg IBM, p = 0.040), carbohydrates (I - 3.30 +/- 1.08, II - 3.80 +/- 1.34 g/kg IBM, p = 0.029), potassium (I - 33.2+/-10.6, II - 38.3 +/- 13.2 mg/kg IBM, p = 0.034), calcium (I - 5.81 +/- 2.46, II - 7.20 +/- 3.54 mg/kg IBM, p = 0.028), magnesium (I - 2.86 +/- 0.86, II - 3.41 +/- 1.36 mg/kg IBM, p = 0.004), beta-carotene (I 22.4 +/- 15.8, II - 34.9 +/- 29.1 mg/kg IBM, p = 0.002) as well as calorie delivered from protein (I - 0.22 +/- 0.04, II - 0.26 +/- 0.07%, p = 0.001) and carbohydrates (I - 0.79 +/- 0.15, II - 0.94 +/- 0.21, p = 0.000) in relation to total amount of ingested calorie. Group I showed significantly lower serum levels of albumin (I - 2.45, 1-3, II - 2.83, 1-3 scores, p = 0.023) and cholesterol (I - 5.54 +/- 1.06, II - 6.35 +/- 1.63 mmol/l, p = 0.009), but higher serum iron (I - 16.7 +/- 4.4, II - 15.8 +/- 5.2 micromol/l, p = 0.042) and ferritin (I - 615, 28-5113, II - 377, 24-3376 ng/ml, p = 0.021) concentrations as well as transferrin saturation (I - 31.1 +/- 9.2, II - 28.5 +/- 9.2%, p = 0.032). We conclude that PD patients with Kt/V over 2.0 as compared to those with Kt/V below 2.0 show tendency for better nutritional indices excluding serum iron parameters.

Nutritional support in patients with chronic liver disease

Malnutrition is highly prevalent among patients with chronic liver disease and is nearly universal among patients awaiting liver transplantation. Malnutrition in patients with cirrhosis leads to increased morbidity and mortality rates. Furthermore, patients who are severely malnourished before transplant surgery have a higher rate of complications and a decreased overall survival rate after liver transplantation. In light of the high incidence of malnutrition among patients with chronic liver disease and the complications that result from malnutrition in these patients, it is essential to assess the nutritional status of all patients with liver disease, and to initiate treatment as indicated. This review addresses the etiologies of malnutrition, methods used to assess nutritional status, and appropriate treatment strategies.

Promotion of the Feeding Minds and Fighting Hunger Initiative in Selected Rural Schools in Andhra Pradesh, India

Background

Schoolchildren are good agents of change and need to be educated and sensitized to specific issues of hunger and malnutrition through a question-and-answer process. Feeding Minds and Fighting Hunger (FMFH), a global project initiated by the Food and Agriculture Organization and partner organizations, attempts to help schoolchildren learn about these issues by introducing concepts in the prevention of hunger and malnutrition to teachers, and by facilitating transfer of knowledge to the children through a set of model lessons.

Objective

To test the feasibility of the FMFH approach to improve the nutrition knowledge of rural schoolchildren in three rural schools in Medak District of the South Indian state of Andhra Pradesh.

Methods

Participatory workshops for teachers were conducted to facilitate knowledge transfer to the children through interactive classroom teaching and other activities. The change in knowledge and thinking of children in the seventh and eighth grades was assessed by a questionnaire administered before and after the intervention. The questionnaire also assessed, in part, the status of local food security based on the sources of different food items in the households.

Results

The responses to the questionnaire suggested that the children's knowledge of nutrients and their functions was not good initially but improved after the intervention. However, their understanding of the social factors responsible for hunger and malnutrition was fairly good prior to the intervention. Improvement in responses to the question of what should be done to combat malnutrition also occurred after intervention. The community had village-level food security for rice and maize but depended partially or fully on outside sources for pulses, fruits and vegetables, and animal products.

Conclusions

The FMFH approach can be applied in rural schools where “the poorest of the poor” children can improve their understanding of balanced diets, better nutrition, the causes of malnutrition, and approaches to combat malnutrition.

[Heart failure, malnutrition and inflammation. Prevalence and relevant aspects in its assessment]

Heart failure is associated to alterations in the nutritional status that contributes to a worse prognosis of the disease.

OBJECTIVE

To study protein-calorie malnutrition (PEM) prevalence, micronutrient deficits and increase of inflammatory parameters in patients with cardiac failure (CF).

MATERIAL AND METHODS

Cross-sectional, observational study in 98 heart failure patients of Internal Medicine Service have been evaluated. We have analyzed biomedical, anthropometric variables (weight, size, BMI, tricipital fold), search of treatments, echocardiogram valuation and determination of albumin, pre-albumin, A and E group vitamins, ESR and C-reactive protein. We have defined protein malnutrition (PN) as albumin values

RESULTS

Average age was 76.6 +/- 7.5. A total of 77.7% showed a functional class II-III/IV. Prevalence of PEM was 40%. Low albumin and prealbumin was found in 12.8% and 38.3% respectively (p < 0.05). Using BMI, 5.3% of patients had malnutrition. Nevertheless, if tricipital fold is used, EM was found in the 25.3% of the cases (p < 0.05). Iron iron, vitamin A and C-reactive protein levels were different in heart failure patients with PM (p < 0.05). The percentage of protein malnutrition in patients with LVEF < 45% was 16.4% versus 5.5% in diastolic dysfunction (p = 0.01). Treatment with ACE-inhibitors was 42.2%; in this group the malnutrition for any criterion was 13% vs 26% in the group of patients without ACE-inhibitors (p = 0.08).

CONCLUSIONS

There is a high prevalence of nutritional and inflammatory disturbances (low in diastolic dysfunction) in patients with moderate status of heart failure. Treatment with an ACE-inhibitor improves the nutritional parameters.