Protein-energy malnutrition: a risk factor for various ailments

Prenatal influences on postnatal neuroplasticity: Integrating DOHaD and sensitive/critical period frameworks to understand biological embedding in early development

Early environments can have significant and lasting effects on brain, body, and behavior across the lifecourse. Here, we address current research efforts to understand how experiences impact neurodevelopment with a new perspective integrating two well-known conceptual frameworks - the Developmental Origins of Health and Disease (DOHaD) and sensitive/critical period frameworks. Specifically, we consider how prenatal experiences characterized in the DOHaD model impact two key neurobiological mechanisms of sensitive/critical periods for adapting to and learning from the postnatal environment. We draw from both animal and human research to summarize the current state of knowledge on how particular prenatal substance exposures (psychoactive substances and heavy metals) and nutritional profiles (protein-energy malnutrition and iron deficiency) each differentially impact brain circuits' excitation/GABAergic inhibition balance and myelination. Finally, we highlight new research directions that emerge from this integrated framework, including testing how prenatal environments alter sensitive/critical period timing and learning and identifying potential promotional/buffering prenatal exposures to impact postnatal sensitive/critical periods. We hope this integrative framework considering prenatal influences on postnatal neuroplasticity will stimulate new research to understand how early environments have lasting consequences on our brains, behavior, and health.

Nutritional, Shelf-Life, and Sensory Evaluation of Cucumis callosus Based Optimized Syrup

Cucumis callosus or "Choti kachri" is feral species of Cucurbitaceae family grown commonly in the semi-arid zones. The current study aimed to optimize and develop a syrup by utilizing C. callosus. For optimization of various combinations of C. callosus (CC) and Malus domestica (MD), various treatments were prepared namely T1 (100:00), T2 (75:25), T3 (50:50), T4 (00:100). The developed syrups were analyzed for nutritional and sensory analysis for a storage period of three months. The maximum and minimum range of different blends and storage period for various parameters were reported as TSS (oBx) (65.06 ± 0.23 to 67.17 ± 0.25), pH (4.67 ± 0.17 to 5.02 ± 0.65), acidity (%citric acid) (0.61 ± 0.02 to 0.98 ± 0.11), reducing sugars (%) (35.98 ± 0.12 to 44.12 ± 0.03), total sugars (%) (57.12 ± 0.03 to 65.51 ± 0.07), and non-reducing sugars (%) (14.88 ± 0.19 to 26.65 ± 0.11). All the blends varied non- significantly in terms of TSS, pH and acidity while significant (p ≥ 0.05) difference was noted in sugars when blended with 75:25 ratio of CC: MD. The data with respect to storage study reveals that the TSS, PH and acidity varied non-significantly while reducing sugars increased significantly. However, total, and non-reducing sugars decreased significantly with the increase of storage period. The prepared blends were subjected for sensory evaluation using 9-point hedonic scale for assessing color, consistency, taste, aroma, and overall acceptability with noted values as 8.0 ± 0.54 to 7.0 ± 0.44, 7.2 ± 0.54 to 8.0 ± 0.70, 7.0 ± 0.44 to 8.0 ± 0.70, 7.2 ± 0.44 to 8.0 ± 0.70, and 7.2 ± 0.44 to 8.0 ± 0.83. The study indicated that C. callosus is an acceptable source for development of syrup.

Genomic prediction reveals unexplored variation in grain protein and lysine content across a vast winter wheat genebank collection

Globally, wheat (Triticum aestivum L.) is a major source of proteins in human nutrition despite its unbalanced amino acid composition. The low lysine content in the protein fraction of wheat can lead to protein-energy-malnutrition prominently in developing countries. A promising strategy to overcome this problem is to breed varieties which combine high protein content with high lysine content. Nevertheless, this requires the incorporation of yet undefined donor genotypes into pre-breeding programs. Genebank collections are suspected to harbor the needed genetic diversity. In the 1970s, a large-scale screening of protein traits was conducted for the wheat genebank collection in Gatersleben; however, this data has been poorly mined so far. In the present study, a large historical dataset on protein content and lysine content of 4,971 accessions was curated, strictly corrected for outliers as well as for unreplicated data and consolidated as the corresponding adjusted entry means. Four genomic prediction approaches were compared based on the ability to accurately predict the traits of interest. High-quality phenotypic data of 558 accessions was leveraged by engaging the best performing prediction model, namely EG-BLUP. Finally, this publication incorporates predicted phenotypes of 7,651 accessions of the winter wheat collection. Five accessions were proposed as donor genotypes due to the combination of outstanding high protein content as well as lysine content. Further investigation of the passport data suggested an association of the adjusted lysine content with the elevation of the collecting site. This publicly available information can facilitate future pre-breeding activities.

Severe Acute Malnutrition: The Potential of Non-Peanut, Non-Milk Ready-to-Use Therapeutic Foods

PURPOSE OF REVIEW

This review provides information on the prospect and effectiveness of ready-to-use therapeutic foods (RUTFs) produced locally without the addition of milk and peanut.

RECENT FINDINGS

The foods used in fighting malnutrition in the past decades contributed little to the success of the alleviation program due to their non-effectiveness. Hence, RUTFs are introduced to fight malnutrition. The peanut allergies, the high cost of milk, and the high production cost of peanut RUTF have made its distribution, treatment spread, and accessibility very slow, especially in areas where it is highly needed. There is a need, therefore, for a low-cost RUTF that is acceptable and effective in treating severe acute malnutrition among under-5 children. This review shows both the success and failure of reported studies on the use of non-peanut and non-milk RUTF, including their cost of production as compared to the standard milk and peanut-based RUTF. It was hypothesised that replacing the milk ingredient component with legumes like soybeans can reduce the cost of production of RUTFs while also delivering an effective product in managing and treating severe acute malnutrition (SAM). Consumers generally accept them better because of their familiarity with the raw materials.

Association between severe acute malnutrition in childhood and hematological disorders in adulthood: the Lwiro follow-up study in the Eastern Democratic Republic of the Congo

BACKGROUND

Despite growing evidence on the short-term deleterious effects of severe acute malnutrition (SAM) in childhood on hematopoiesis, little is known about the long-term hematological effects of SAM in low-income countries (LICs). Our study explored the association between childhood SAM and hematological disorders in adults 11 to 30 years after post-SAM nutritional rehabilitation.

METHODS

This follow up study investigated 97 adults (mean age 32 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Participants were compared to 97 aged- and sex-matched adult controls living in the same community with no history of SAM. Outcomes of interest were hematological characteristics and disorders in adulthood, assessed by various biological markers. Logistic and linear regression models were used to estimate the association between SAM in childhood and risk of hematological abnormalities.

RESULTS

Compared to the unexposed, the exposed had higher mean white blood cells (/μl) [+ 840 (179 to 1501), p = 0.013], neutrophils [+ 504 (83 to 925), p = 0.019] and platelets (*103) [11.9 (8.1 to 17.9), p = 0.038] even after adjustment for food consumption in adulthood. No difference was observed in red blood cells (RBC), hemoglobin and erythrocytes parameters. With regard to the risk of hematological disorders, in contrast to the unexposed, exposed subjects had a risk of leukocytosis approximately three times higher [adjusted OR (95% CI): 2.98 (1.01 to 8.79), p = 0.048]. No difference was observed in terms of anemia, leukopenia, increased platelets and thrombocytopenia between the 2 groups.

CONCLUSION

Adults with a history of SAM in childhood have hematological characteristics that would be markers associated with chronic low-grade inflammatory or infectious diseases in an environment with no nutritional transition. Larger cohort studies with bone marrow analyses could provide further understanding of the impact of SAM on the overall hematological profile in adult life.

Nutrition knowledge, attitudes, and dietary practices among parents of children and adolescents in Weifang, China: A cross-sectional study

Parent's nutrition knowledge, attitudes, and dietary practices (KAP) play imperative roles in preventing malnutrition for themselves and their children. Our study aimed to determine the status and contributing factors of nutrition KAP among parents of children and adolescents. A total of 1746 parents (mean age 39.67 ± 5.38 years, females accounting for 69.82%) of primary and junior high school students in Weifang, China, completed a self-reported KAP questionnaire in August 2021. An analysis of Pearson product-moment correlation was conducted to determine the relationship between knowledge, attitudes, and practices. Chi-square test, followed by a multivariable robust Poisson regression analysis, was performed to identify the contributing factors to parents' KAP. A 65.94% awareness rate of nutritional knowledge was observed. The correlations between nutrition knowledge and attitudes (r = 0.03, P = 0.23), knowledge and practices (r = 0.02, P = 0.34), and attitudes and practices (r = 0.16, P < 0.01) were relatively weak. After adjusting for other contributing factors, females [prevalence ratio (PR) = 1.28, 95% confidence interval (CI) = 1.13-1.45], participants with secondary education (PR = 4.64, 95% CI = 1.60-13.50), junior college education (PR = 5.87, 95% CI = 2.01-17.13) and college degree or above education (PR = 6.58, 95% CI = 2.25-19.23) acquired higher nutrition knowledge scores. Moreover, healthy diet behaviors were more commonly implemented by females than males (PR = 1.42, 95% CI = 1.14-1.76), and which needed to be improved in those with abnormal body mass indexes (BMIs) [overweight (PR = 0.86, 95% CI = 0.74-0.99) and obese (PR = 0.76, 95% CI = 0.56-0.99)]. It was necessary for nutrition KAP promotion to be emphasized in nutritional knowledge and dietary practices, as well as health behavior guidance, especially for parents with low education and elevated BMIs.

Dietary Iron Intake and HIV-Related Outcomes Among Adults Initiating Antiretroviral Therapy in Tanzania

OBJECTIVE

Anemia is highly prevalent among people living with HIV (PLWHIV) and is often due to iron deficiency. This study evaluated the relationship of dietary iron intake levels and sources with mortality and clinical outcomes among adults initiating HAART.

DESIGN

We conducted a secondary analysis of a multivitamin supplementation trial among 2293 PLWHIV initiating HAART in Dar es Salaam, Tanzania.

METHODS

Dietary iron intake was assessed with a food frequency questionnaire at HAART initiation, and participants followed until death or censoring. Total, animal-, and plant-sourced iron were categorized into quartiles. Intake of food groups was categorized into 0-1, 2-3, and ≥4 servings/wk. Cox proportional hazards models estimated hazard ratios for mortality and incident clinical outcomes.

RESULTS

There were 175 deaths (8%). Red meat intake was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.35 to 0.83), AIDS-related mortality (HR: 0.49; 95% CI: 0.28 to 0.85), and severe anemia (HR: 0.57; 95% CI: 0.35 to 0.91), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Legume intake was a lower risk of associated with all-cause mortality (HR: 0.49; 95% CI: 0.31 to 0.77) and AIDS-related mortality (HR: 0.37; 95% CI: 0.23 to 0.61), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Although total dietary iron and overall plant-sourced iron intake were not associated with the risk of mortality or HIV-related outcomes, the highest quartile of animal-sourced iron intake was associated with a lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.35 to 0.90) and a lower risk of AIDS-related mortality (HR: 0.50; 95% CI: 0.30 to 0.90), compared with the lowest quartile.

CONCLUSION

Intake of iron-rich food groups may be associated with a lower risk of mortality and critical HIV-related outcomes among adults initiating HAART.

TRIAL REGISTRATION

The parent trial was registered at Clinicaltrials.gov . Identifier: NCT00383669.

Dietary Recommendations for Ethiopians on the Basis of Priority Diet-Related Diseases and Causes of Death in Ethiopia: An Umbrella Review

Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30-90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50-150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15-35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200-300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200-300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).

Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis

Background

Protein-energy malnutrition (PEM) has been recognized as a poor prognostic factor in many clinical issues. However, nationwide population studies concerning the impact of PEM on outcomes after major cancer surgery (MCS) are lacking. We aimed to evaluate the postoperative outcomes associated with PEM following MCS.

Methods

By using the Nationwide Inpatient Sample database, data of patients undergoing MCS including colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy, or prostatectomy were analyzed retrospectively from 2009 to 2015, resulting in a weighted estimate of 1,335,681 patients. The prevalence trend of PEM, as well as mortality and major complications after MCS were calculated. Multivariable regression analysis was applied to estimate the impact of PEM on postoperative outcomes after MCS.

Results

PEM showed an estimated annual percentage increase of 7.17% (95% confidence interval (CI): 4-10.44%) from 2009 to 2015, which contrasts with a 4.52% (95% CI: -6.58-2.41%) and 1.21% (95% CI: -1.85-0.56%) annual decrease in mortality and major complications in patients with PEM after MCS. PEM was associated with increased risk of mortality (odds ratio (OR)=2.26; 95% CI: 2.08-2.44; P < 0.0001), major complications (OR=2.46; 95% CI: 2.36-2.56; P < 0.0001), higher total cost ($35814 [$22292, $59579] vs. $16825 [$11393, $24164], P < 0.0001), and longer length of stay (14 [9-21] days vs. 4 [2-7] days, P < 0.0001), especially in patients underwent prostatectomy, hysterectomy and lung resection.

Conclusions

PEM was associated with increased worse outcomes after major cancer surgery. Early identification and timely medical treatment of PEM for patients with cancer are crucial for improving postoperative outcomes.

Protein-energy malnutrition worsens hospitalization outcomes of patients with pancreatic cancer undergoing open pancreaticoduodenectomy

To assess the role of protein-energy malnutrition on perioperative outcomes in patients with pancreatic cancer undergoing open pancreaticoduodenectomy. We conducted a retrospective observational cohort study and investigated patients ≥ 18 years old with pancreatic cancer undergoing open pancreaticoduodenectomy within the National inpatient sample database during 2012-2014. The study population was divided into two groups based on the presence of protein-energy malnutrition. In-hospital mortality, length of stay, cost of hospitalization, and in-hospital complications were compared between the two groups. Logistic and linear regression analyses were used to adjust for potential confounders. A trend analysis was further conducted on the in-hospital outcomes. Of the 12,785 patients aged ≥ 18 years undergoing open pancreaticoduodenectomy during years 2012-2014, 9865 (77.0%) had no protein-energy malnutrition and 2920 (23.0%) had protein-energy malnutrition. Patients with protein-energy malnutrition were found to have significantly higher mortality rate, longer length of hospital stay, and higher total hospital cost compared to those without protein-energy malnutrition. The risks of gastroparesis, small bowel obstruction, intraoperative and postoperative hemorrhage, infectious complications, and several systemic complications were found to be significantly higher in the protein-energy malnutrition group in a multivariate regression model. A study of trends from 2009 to 2012 revealed an increasing prevalence of protein-energy malnutrition, a declining trend in mortality and length of stay and a stable total hospital cost in the protein-energy malnutrition group. Protein-energy malnutrition was found to be associated with higher mortality, longer length of hospital stay and greater hospital cost in pancreatic cancer patients undergoing open pancreaticoduodenectomy, as well as increased occurrence of various systemic complications. Attention should be paid to patients' nutritional status, which can be corrected before surgery as an effective means to optimize postoperative results.

The influence of association between aging and reduced protein intake on some immunomodulatory aspects of bone marrow mesenchymal stem cells: an experimental study

PURPOSE

Dietary protein deficiency is common in the elderly, compromising hematopoiesis and the immune response, and may cause a greater susceptibility to infections. Mesenchymal stem cells (MSCs) have immunomodulatory properties and are essential to hematopoiesis. Therefore, this study aimed to investigate, in an aging model subjected to malnutrition due a reduced protein intake, aspects related to the immunomodulatory capacity of MSCs.

METHODS

Male C57BL/6 mice from young and elderly groups were fed with normoproteic or hypoproteic diets (12% and 2% of protein, respectively) and nutritional, biochemical and hematological parameters were evaluated. MSCs from bone marrow were isolated, characterized and their secretory parameters evaluated, along with gene expression. Additionally, the effects of aging and protein malnutrition on MSC immunomodulatory properties were assessed.

RESULTS

Malnourished mice lost weight and demonstrated anemia, leukopenia, and bone marrow hypoplasia. MSCs from elderly animals from both groups showed reduced CD73 expression and higher senescence rate; also, the malnourished state affected CD73 expression in young animals. The production of IL-1β and IL-6 by MSCs was affected by aging and malnutrition, but the IL-10 production not. Aging also increased the expression of NFκB, reducing the expression of STAT-3. However, MSCs from malnourished groups, regardless of age, showed decreased TGF-β and PGE₂ production. Evaluation of the immunomodulatory capacity of MSCs revealed that aging and malnutrition affected, mainly in lymphocytes, the production of IFN-γ and IL-10.

CONCLUSION

Aging and reduced protein intake are factors that, alone or together, influence the immunomodulatory properties of MSCs and provide basic knowledge that can be further investigated to explore whether MSCs' therapeutic potential may be affected.

Exploratory Analysis of Selected Components of the mTOR Pathway Reveals Potentially Crucial Associations with Childhood Malnutrition

Dysregulations in the mammalian target of rapamycin (mTOR) pathway are associated with several human anomalies. We aimed to elucidate possible implications for potential aberrations in the mTOR pathway with childhood malnutrition. We analyzed the activity of phospho-mTORC1 and the expressions of several mTOR pathway genes, namely: MTOR, TSC1, LAMTOR2, RPS6K1 and RICTOR from peripheral blood mononuclear cells isolated from venous blood of children suffering from different forms of malnutrition and compared them with those from healthy children. Significant reduction in the phosphorylation of mTORC1 was noted, as well as a decrease in expression of LAMTOR2 gene and increase in TSC1 gene expression were observed between malnourished children in comparison to the healthy children. The deregulation in the activity of the TSC1 and LAMTOR2 gene was significantly associated with all forms of childhood malnutrition. Our findings provide key insights into possible down-modulation in the overall activity of the mTOR pathway in childhood malnutrition. Further studies focusing on the analysis of a multitude of components involved in the mTOR pathway both at the gene and protein expression levels are required for conclusive evidence for the aforementioned proposition.

Association of pre-admission opioid abuse and/or dependence on major complications in traumatic brain injury (TBI) patients

SETTING

In the last few decades, an opioid related health crisis has been a challenging problem in many countries around the world, especially the United States. Better understanding of the association of pre-admission opioid abuse and/or dependence (POAD) on specific major complications in traumatic brain injury (TBI) patients can aid the medical team in improving patient care management and outcomes.

STUDY OBJECTIVE

Our goal is to assess and quantify the risk of POAD on in-hospital mortality and major complications in TBI patients.

DESIGN

We conducted a retrospective study and used the National Inpatient Sample (NIS) database from 2004 to 2015 to investigate the impact of POAD on in-hospital mortality and major complications in TBI patients. We utilized propensity score matching and conditional logistic regression models, adjusted with injury severity score (ISS) and comorbidities, to obtain the adjusted odds ratios (OR).

MAIN RESULTS

POAD TBI patients had lower risks of in-hospital mortality (OR 0.58; p < 0.001) and acute myocardial infarction (OR 0.53; p = 0.045), while a higher risk of respiratory (OR 1.59; p < 0.001) and neurologic complications (OR 2.54; p < 0.001), compared to non-POAD TBI patients. Additionally, POAD patients were significantly more likely to have sepsis (OR 2.16, p < 0.001), malnutrition (OR 1.56, p < 0.001), delirium (OR 2.81, p < 0.001), respiratory failure (OR 1.79, p < 0.001), and acute renal failure (OR 1.83, p < 0.001). POAD TBI patients had shorter length of hospital stay compared to non-POAD TBI patients (mean 8.0 vs 9.2 days, p < 0.001).

CONCLUSIONS

POAD TBI patients have a lower in-hospital mortality, shorter duration of hospitalization and a lower risk of acute myocardial infarction, while they are more likely to have respiratory failure, delirium, sepsis, malnutrition, and acute renal failure compared to TBI patients without POAD. Prospective study is warranted to further confirm these findings.

Underlying Causes and Co-existence of Malnutrition and Infections: An Exceedingly Common Death Risk in Cancer

In nutrition science, malnutrition is a state of imbalance between intake and the needs of the organism, leading to metabolic changes, impaired physiological functions, and weight loss. Regardless of the countless efforts being taken and researched for years, the burden of malnutrition is still alarming and considered a significant agent of mortality across the globe. Around 45% of 12 million children deaths (0–5 years old) annually are due to malnutrition, mostly from developing countries. Malnutrition develops associations with other infections and leads to substantial clinical outcomes, such as mortality, more visits to hospitals, poor quality of life and physical frailty, and socioeconomic issues. Here, in this review, we intend to provide an overview of the current burden, underlying risk factors, and co-existence of malnutrition and other infections, such as cancer. Following the rising concern of the vicious interplay of malnutrition and other medical illnesses, we believed that this narrative review would highlight the need to re-make and re-define the future strategies by giving comprehensive and sustainable programs to alleviate poverty and combat the rampant infectious diseases and those nutrition-related health problems. Furthermore, the study also raises the concern for hospitalized malnourished cancer patients as it is crucially important to knowledge the caregiver healthcare staff for early interventions of providing nutritional support to delay or prevent the onset of malnutrition.

Growth performance, biochemical and haematological parameters of BALB/c mice fed on staple grains and bee larvae (Apis Mellifera) blended complementary foods

In Sub-Saharan Africa, inadequate complementary feeding practices and being nutritionally inadequate are primary factors in infant and young child malnutrition, growth failure, and high morbidity and mortality. Therefore, novel complementary foods need to be developed to alleviate malnutrition problems in IYC. Therefore, this experimental study aimed to assess the effects of newly developed grain-bee larvae blended complementary foods on the growth performance, haematological, and biochemical parameters of BALB/c mice. A complete randomized design was used and a total of 75 BALB/c mice were assigned to each of the five treatments. The treatments were: T1 = Casein diet; T2 = 57 % Maize, 29 % Teff, 14 % Soybean; T3 = 58 % Maize, 29 % Teff, 13 % Bee larvae; T4 = Commercial wean mix; and T5 = Basal diet alone. The in vivo experiment trial was done for 28 days along with seven days of adaptation. Dietary intake was not significantly different (P = 0.96) between treatments, but it was noted that T3 had gained the highest final body weight (38.52 g). The examined biochemical parameters showed T4 had the lowest serum protein (6.27 mg/dl) and globulin (3.61 mg/dl). Compared to others, T3 significantly (P < 0.001) increased WBC (4 × 10⁶ mm³), RBC (11.37 × 10³ mm³), Haemoglobin (16.42 g/dl), and Hematocrit (63.04 %). The highest serum levels of zinc (0.55 mg/dl) and iron (2.08 mg/dl) were reported on T2, while the highest serum calcium content (10.64 mg/dl) was reported on T1. The results indicated that T3 can aid body growth, health, and prevent malnutrition in infants and young children.

Determinants of severe acute malnutrition among children aged 6-59 months in the pastoral community of Liban District, Guji Zone, Oromia Regional State, Southeastern Ethiopia: a case-control study

Malnutrition remains one of the most common causes of morbidity and mortality among children, particularly in Ethiopia. The present study aimed to assess determinants of severe acute malnutrition among children aged 6-59 months in the pastoral community of Liban District, Southeastern Ethiopia. A case-control study design was conducted on 89 cases and 177 controls from 1-30 December 2020. A simple random sampling technique was used to select study participants. Data collected using interviewer-administered structured questionnaire were used, and anthropometric measurements were done by standardised calibrated instruments to collect data. Data were entered into EPI data version 3.1 and then exported to SPSS version 25.0 software for analysis. All candidate variables with P < 0⋅25 in bivariate analysis were then entered into multivariable logistic regression. Associated factors were identified at P < 0⋅05 and 95 % CI. A total of 266 (89 cases and 177 controls) having a response rate of 96⋅6 % being underweight [adjusted odds ratio (AOR) = 11⋅8, 95 % CI 3⋅17, 43⋅89], illness previous 2 weeks (AOR = 3⋅47, 95 % confidence interval (CI) 1⋅34, 8⋅99), family member with malnutrition (AOR = 4⋅52, 95 % CI 1⋅45, 14⋅01), greater than five family size, (AOR = 5⋅33, 95 % CI 2⋅08, 13⋅66), mothers unable to read and write (AOR = 3⋅66, 95 % CI 1⋅27, 10⋅56), mothers with low decision autonomy (AOR = 5⋅67, 95 % CI 2⋅26, 14⋅27), not handwashing at all critical time (AOR = 7⋅23, 95 % CI 2⋅74, 19⋅07), not feeding child animal source (AOR = 7⋅13, 95 % CI 1⋅98, 25⋅59), bottle feeding (AOR = 7⋅06, 95 % CI 2⋅34, 21⋅28) and being married (AOR = 0⋅05, 95 % CI 0⋅02, 0⋅19) were significantly associated with acute malnutrition. The present study has confirmed the association of acute malnutrition with maternal education, underweight, family size and inappropriate infant caring practices.

Maternal intake restriction programs the energy metabolism, clock circadian regulator and mTOR signals in the skeletal muscles of goat offspring probably via the protein kinase A-cAMP-responsive element-binding proteins pathway

The biological mechanism by which maternal undernutrition increases the metabolic disorder risk of skeletal muscles in offspring is not fully understood. We hypothesize that maternal intake restriction influences metabolic signals in the skeletal muscles of offspring via a glucagon-mediated pathway. Twenty-four pregnant goats were assigned to the control group (100% of the nutrients requirement, n = 12) and restricted group (60% of the control feed allowance from pregnant days 45 to 100, n = 12). Blood and L ongissimus thoracis muscle were sampled from dams (100 d of gestation), fetuses (100 d of gestation), and kids (90 d after birth) in each group. The data were analyzed using the linear MIXED model, with the multiple comparison method of SIDAK applied. Intake restriction reduced (P < 0.05) the total blood protein of dams and fetuses. Maternal restriction decreased (P < 0.05) the cAMP-responsive element-binding protein 1 (CREB1), CREB-binding protein (CREBBP), protein kinase A (PKA), aryl hydrocarbon receptor nuclear translocator-like protein 1 (BMAL1), protein kinase B (AKT1), mammalian target of rapamycin (mTOR), and regulatory-associated protein of mTOR (RPTOR) mRNA expression in the fetuses, and reduced (P < 0.05) the CREBBP, nuclear receptor subfamily 1 group H member 3 (NR1H3), D-box binding PAR bZIP transcription factor (DBP) and PKA mRNA levels in the kids, but increased (P < 0.05) the peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC1 A) and tuberous sclerosis 2 (TSC2) mRNA levels in the fetuses. The mRNA expression of clock circadian regulator (CLOCK) and TSC2 genes was increased (P < 0.05) in the restricted kids. The protein expression of total PKA and phosphorylated PKA in the restricted fetuses and kids were downregulated (P < 0.05), and the protein expression of total mTOR and phosphorylated mTOR were reduced (P < 0.05) in the restricted fetuses and kids. Maternal intake restriction regulated fat oxidation, protein synthesis, and circadian clock expression in the muscles of the offspring probably via the glucagon-mediated PKA-CREB pathway, which reveals a noteworthy molecular pathway that maternal undernutrition leads to metabolic adaptation of skeletal muscle in offspring.

Assessment of anorexia and weight loss during the infection and recovery period of patients with coronavirus disease 2019 (COVID-19)

Objectives

Patients with coronavirus disease 2019 (COVID-19) can present anorexia and weight loss due to their symptoms and eating disorder which can lead to immune system weakness and increase the duration of recovery time. We aim to assess the severity and duration of anorexia and weight loss within the infection and recovery period in these patients.

Method

We retrospectively identified 233 COVID-19 patients (older than 18 years) were admitted to the Rasoul-e Akram Hospital, from August to December 2020. Their medical records were reviewed by researchers. Then, patients who had inclusion criteria were asked about duration and severity of anorexia, and also weight alternation during the infection and after the recovery period.

Result

Analyzed data were collected from 233 COVID-19 patients showed the mean duration of anorexia was 7.08 ± 10.41 days with a significant loss of appetite (- 75.55 ± 88.09, P-value < 0.001) at the period of anorexia compare to appetite improvement. Also, results demonstrated patients, especially males and severe illness subjects, significantly lost weight (P-value <0.001).

Conclusion: anorexia and weight loss occur in people infected with the coronavirus and may affect the recovery process of these patients by reducing their food intake. The underlying mechanisms of SARS-CoV-2 related to interaction to the gastrointestinal tract and development of anorexia in these patients need to clarify in future studies.

Undernutrition and HIV Infection in Sub-Saharan Africa: Health Outcomes and Therapeutic Interventions

PURPOSE OF REVIEW

Sub-Saharan Africa (SSA) is disproportionately burdened by the twin epidemics of food insecurity and HIV infection, and protein-calorie undernutrition is common among persons with HIV (PWH) initiating antiretroviral therapy (ART) in the region. In this review, we discuss the intersection of HIV infection and undernutrition, health outcomes among undernourished PWH starting ART, and the demonstrated and potential benefits of therapeutic interventions such as micro/macronutrient supplementation and pharmacological agents.

RECENT FINDINGS

A low body mass index (BMI), used as a general indicator of poor nutrition in most studies, is associated with impaired immune recovery and increased mortality in the early ART period. The increased risk of mortality is multifactorial, and contributors include undernutrition-related immune system dysfunction, increased susceptibility to opportunistic infections, and metabolic and cardiovascular dysregulation. Clinical trials of micro/macronutrient supplementary feeding, appetite stimulants (hormones and anabolic agents), and recombinant adipokines have shown a benefit for weight gain and metabolic health, but there are few data on mortality or immune recovery. A substantial proportion of PWH in SSA are undernourished, and undernutrition contributes to an increased risk of mortality and other adverse health outcomes. To date, there have been few prospective trials of nutritional supplementation and/or pharmacologic therapy among undernourished PWH in SSA, though findings from other settings suggest a potential benefit in this population.

The influences of low protein diet on the intestinal microbiota of mice

Recent research suggests that protein deficiency symptoms are influenced by the intestinal microbiota. We investigated the influence of low protein diet on composition of the intestinal microbiota through animal experiments. Specific pathogen-free (SPF) mice were fed one of four diets (3, 6, 9, or 12% protein) for 4 weeks (n = 5 per diet). Mice fed the 3% protein diet showed protein deficiency symptoms such as weight loss and low level of blood urea nitrogen concentration in their serum. The intestinal microbiota of mice in the 3% and 12% protein diet groups at day 0, 7, 14, 21 and 28 were investigated by 16S rRNA gene sequencing, which revealed differences in the microbiota. In the 3% protein diet group, a greater abundance of urease producing bacterial species was detected across the duration of the study. In the 12% diet protein group, increases of abundance of Streptococcaceae and Clostridiales families was detected. These results suggest that protein deficiency may be associated with shifts in intestinal microbiota.

Effect of soy fortification on the quality of Mkarango a traditional Kenyan fermented maize meal snack

This study aimed at improving the quality and nutrient density of a Kenyan fermented maize meal snack (mkarango) through soy fortification to alleviate protein-energy malnutrition (PEM) in children. Nine variations of the snack were prepared by replacing 0, 30, and 50% maize with soy and fermenting each for 0, 3, and 5 days at ambient temperature. To establish the physico-chemical characteristics, the proximate composition, bulk density, water, and oil absorption capacities and titratable acidity were determined. Consumer acceptability was evaluated using a panel of 55 individuals. Fortification of maize with 50% soy increased protein, lipid, and ash content by 256, 284, and 78%, respectively, while carbohydrates reduced by 30%. Fermentation increased lipids and slightly reduced carbohydrate content. Energy ranged from 1,600 to 1641 kJ/100 g. Oil absorption capacity and bulk density reduced with fortification and fermentation while water absorption capacity increased. Fermentation reduced pH by 29 and 31% after days 3 and 5, respectively. There was no significant difference at p ≤ .05 between liking of the fortified snacks and the conventional mkarango, but increase in number of fermentation days reduced the overall acceptance. All fortified snack variations meet more than half the Recommended Daily Allowance for children aged 0.5 to 10 years. Fortification and fermentation improve nutrient density of snacks in terms of proteins, lipids, and ash as well as the functional properties. Preference for all fortified snacks was above average. The soy fortified fermented snack has the potential to alleviate protein-energy malnutrition in developing countries.

Acute Malnutrition in Children: Pathophysiology, Clinical Effects and Treatment

Acute malnutrition is a nutritional deficiency resulting from either inadequate energy or protein intake. Children with primary acute malnutrition are common in developing countries as a result of inadequate food supply caused by social, economic, and environmental factors. Secondary acute malnutrition is usually due to an underlying disease causing abnormal nutrient loss, increased energy expenditure, or decreased food intake. Acute malnutrition leads to biochemical changes based on metabolic, hormonal, and glucoregulatory mechanisms. Most children with primary acute malnutrition can be managed at home with nutrition-specific interventions (i.e., counseling of parents, ensuring household food security, etc.). In case of severe acute malnutrition and complications, inpatient treatment is recommended. Secondary acute malnutrition should be managed by treating the underlying cause.

Cultivation of methanotrophic bacteria in a novel bubble-free membrane bioreactor for microbial protein production

Microbial protein is proposed as an alternative protein source with low environmental impact. Methane oxidizing bacteria are already produced at commercial scale from natural gas. However, their productivity is limited because of the creation of explosive atmospheres in the fermenters during production. This work demonstrates the applicability of bioreactors with a membrane-based gas supply via diffusion. Methanotrophic bacteria were successfully cultivated, with growth yields from 0.26 to 0.43 g-VSS g-CH₄^-1, slightly below those observed in analogous fermenters relying on bubbling. However, ammonia yields ranged from 5.2 to 6.9 g-VSS g-NH₃^-1, indicating higher nitrogen assimilation than in conventional fermenters. Indeed, protein content increased during the operational period reaching up to 51% of dry weight. The amino acid profile included the majority of the essential amino acids, demonstrating suitability as feed ingredient. Never during the operational period was an explosive atmosphere established in the reactor. Thus, bubble-free membrane bioreactors are a promising technology for microbial protein production relying on explosive gas mixtures.

The impact of maternal and early life malnutrition on health: a diet-microbe perspective

BACKGROUND

Early-life malnutrition may have long-lasting effects on microbe-host interactions that affect health and disease susceptibility later in life. Diet quality and quantity in conjunction with toxin and pathogen exposure are key contributors to microbe-host physiology and malnutrition. Consequently, it is important to consider both diet- and microbe-induced pathologies as well as their interactions underlying malnutrition.

MAIN BODY

Gastrointestinal immunity and digestive function are vital to maintain a symbiotic relationship between the host and microbiota. Childhood malnutrition can be impacted by numerous factors including gestational malnutrition, early life antibiotic use, psychological stress, food allergy, hygiene, and exposure to other chemicals and pollutants. These factors can contribute to reoccurring environmental enteropathy, a condition characterized by the expansion of commensal pathobionts and environmental pathogens. Reoccurring intestinal dysfunction, particularly during the critical window of development, may be a consequence of diet-microbe interactions and may lead to life-long immune and metabolic programming and increased disease risk. We provide an overview of the some key factors implicated in the progression of malnutrition (protein, fat, carbohydrate, iron, vitamin D, and vitamin B12) and discuss the microbiota during early life that may contribute health risk later in life.

CONCLUSION

Identifying key microbe-host interactions, particularly those associated with diet and malnutrition requires well-controlled dietary studies. Furthering our understanding of diet-microbe-host interactions will help to provide better strategies during gestation and early life to promote health later in life.

Formulation, standardization and characterization of novel sattu beverage enriched with beetroot juice

The existing market of beverages is in utmost need of non-conventional and cheaper option of a functional protein beverage. The primary goal of this research was to formulate a beverage using prepared from roasted Bengal gram (sattu) which can provide health benefits. Fortified sattu beverage was prepared by incorporating pectin, citric acid, ascorbic acid and sugar as additives with beetroot juice was added for the enrichment and coloration of beverage in four different proportions viz. 5%, 10%, 15% and 20% labelled as A, B, C and D. Beverage without enrichment was taken as blank sample. After formulation, physio-chemical parameters of beverage were measured which included pH, TSS, protein content, sedimentation index and color. For antioxidant potential, DPPH and ABTS methods were performed followed by measurement of TPC, TFC and Betalain content. Sensory analysis of beverage was also performed to determine the consumer acceptability. Sample containing 10% beetroot juice was observed to have the optimal formulation amongst all with regards to sedimentation index (24.86), protein content (28.10%), pH (3.83), TSS (7.43°Brix), acidity (0.522%), DPPH activity (83.22%), ABTS scavenging assay (70.38%), phenolic content (42.49 mg GAE/g), flavonoid content (50.51 mg RE/g). The lightness L* (- 6.3), redness a* (3.2) and greenness b* (0.8) were the color values of this sample.

A System Dynamics Model of Supply-Side Issues Influencing Beef Consumption in Nigeria

The per capita consumption of beef in Nigeria is reducing amidst a rising population that is dependent on beef as a major source of animal protein. In this paper, a system dynamics (SD) model was developed with the aim of testing exploratory policies aimed at reversing this trend. The simulations of various policy tests showed that, of all the policies tested, having a higher carcass yield seems to be the most efficient solution, but its feasibility faces some steep biological and ecological challenges. However, a combination of policies that cuts across the land–cattle–market nexus is necessary to obtain a consumption level that almost meets the World Health Organization (WHO) standards for recommended animal protein intake. Complex inter-linked systems, like beef production and consumption, require a systemic approach that considers dynamic feedback to avoid fixes that fail or shift the burden when making policy decisions.

Combination of lymphocyte number and function in evaluating host immunity

Accurate monitoring of host immunity is hampered by the flaws of conventional tests. The relationship between lymphocyte number and function is unknown. The function of lymphocytes was analyzed based on IFN-γ secretion assay. Lymphocyte number and function was investigated in individuals under various states. The number of CD4⁺ and CD8⁺ T cells was gradually decreased, whereas the function of them was gradually increased with increasing age. A significantly negative correlation existed between the number and function of both CD4⁺ and CD8⁺ T cells. Differently, both the number and function of NK cells are maintained at a high level after birth. Staying up all night was found to impair the function of CD4⁺, CD8⁺ T cells, or NK cells. Lymphocyte number and function were both decreased in patients with immunosuppressive conditions or opportunistic infections, while the opposite phenomenon was observed in patients with some autoimmune diseases (except for NK cells). In kidney transplant recipients, the number and function of CD4⁺ and CD8⁺ T cells were increased or decreased when rejection or infection occurred. We demonstrated that evaluation of host immunity based on combination of lymphocyte number and function plays an important role in the diagnosis, treatment, and prognosis of diseases.

Mycoprotein: environmental impact and health aspects

The term mycoprotein refers to the protein-rich food made of filamentous fungal biomass that can be consumed as an alternative to meat. In this paper, the impact caused by the substitution of animal-origin meat in the human diet for mycoprotein on the health and the environment is reviewed. Presently, mycoprotein can be found in the supermarkets of developed countries in several forms (e.g. sausages and patties). Expansion to other markets depends on the reduction of the costs. Although scarce, the results of life cycle analyses of mycoprotein agree that this meat substitute causes an environmental impact similar to chicken and pork. In this context, the use of inexpensive agro-industrial residues as substrate for mycoprotein production has been investigated. This strategy is believed to reduce the costs involved in the fungal cultivation and lower the environmental impact of both the mycoprotein and the food industry. Moreover, several positive effects in health have been associated with the substitution of meat for mycoprotein, including improvements in blood cholesterol concentration and glycemic response. Mycoprotein has found a place in the market, but questions regarding the consumer's experience on the sensory and health aspects are still being investigated.

Association between blood marker analyses regarding physical fitness levels in Spanish older adults: A cross-sectional study from the PHYSMED project

Biomarkers have been postulated as essential variables to measure the effects of exercise on the human body. To investigate the relationship between physical fitness (PF) and blood biomarkers that are associated with disease risk in Spanish older adults, four hundred and twenty-nine adults (57% females) aged older than 55 years from a cross-sectional study were included. A battery of PF test was performed, and participants were divided into 3 groups: low, medium and high fitness. Blood samples were collected, and subjects were also grouped based on a particular biomarker being within its reference range. Furthermore, drug intake and dietary intake were considered for each participant. Higher concentrations out of the reference range were observed for vitamin 25(OH)D (67.9%) and total cholesterol (TC) (58.6%). Participants from the low PF group presented lower significant concentrations out of the reference range for vitamin B₁₂ and triglycerides; however, participants in the low PF group showed higher significant concentrations out of the reference range for total homocysteine, creatinine, TC, HDL-cholesterol and LDL-cholesterol (LDL-c) than those in the high PF group (all p<0.05). Considering drugs related to blood lipid modifications, subjects who regularly consumed lipid reducers presented higher significant concentrations out of the reference range for TC and LDL-c than participants who did not take these drugs (p<0.01). Participants from the high PF group presented better blood marker profiles, namely, lower blood markers related to disease risk out of the reference range. These blood markers could be used as a routine method for considering PF groups in older adults.

Qualitative assessment of 'highly digestible' protein mutation in hard endosperm sorghum and its functional properties

Sorghum mutants with altered protein body structure have improved protein nutritional quality; however, practical methods to accurately track heritability of the trait are lacking. We evaluated suitability of the in vitro pepsin assay, and a new high-resolution field emission electron microscopy (FE-SEM) method to detect the mutation (HD) in hard-endosperm sorghum; and compared the physicochemical properties of experimental HD sorghums to wild type (LD) lines. FE-SEM reliably resolved sorghum protein body structure, allowing for qualitative classification of sorghum as HD or LD. The pepsin assay was less reliable, with significant variations across environments. Nevertheless, HD lines averaged higher protein digestibility (69.4% raw, 57.6% cooked) than LD lines (61.7% raw, 45.6% cooked). The HD lines also had better water solubility and starch pasting profiles than LD lines. FE-SEM, but not pepsin assay, reliably detects HD nutation in sorghum. The HD trait may improve food-use functionality of sorghum.

Finger on the Pulse: Pumping Iron into Chickpea

Iron deficiency is a major problem in both developing and developed countries, and much of this can be attributed to insufficient dietary intake. Over the past decades several measures, such as supplementation and food fortification, have helped to alleviate this problem. However, their associated costs limit their accessibility and effectiveness, particularly amongst the financially constrained. A more affordable and sustainable option that can be implemented alongside existing measures is biofortification. To date, much work has been invested into staples like cereals and root crops-this has culminated in the successful generation of high iron-accumulating lines in rice and pearl millet. More recently, pulses have gained attention as targets for biofortification. Being secondary staples rich in protein, they are a nutritional complement to the traditional starchy staples. Despite the relative youth of this interest, considerable advances have already been made concerning the biofortification of pulses. Several studies have been conducted in bean, chickpea, lentil, and pea to assess existing germplasm for high iron-accumulating traits. However, little is known about the molecular workings behind these traits, particularly in a leguminous context, and biofortification via genetic modification (GM) remains to be attempted. This review examines the current state of the iron biofortification in pulses, particularly chickpea. The challenges concerning biofortification in pulses are also discussed. Specifically, the potential application of transgenic technology is explored, with focus on the genes that have been successfully used in biofortification efforts in rice.