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Zuo J, Zhou D, Zhang L, Zhou X, Gao X, Hou W, Wang C, Jiang P, Wang X. Comparison of bioelectrical impedance analysis and computed tomography for the assessment of muscle mass in patients with gastric cancer. Nutrition 2024; 121:112363. [PMID: 38359703 DOI: 10.1016/j.nut.2024.112363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Low muscle mass was significantly correlated with poor clinical outcomes in cancer patients. This study aimed to compare the differences between bioelectrical impedance analysis (BIA) and computed tomography (CT) in measuring skeletal muscle mass and detecting low muscle mass in patients with gastric cancer (GC). METHOD This cross-sectional study included a total of 302 consecutive patients diagnosed with GC at our institution from October 2021 to March 2023. CT images were analyzed at the L3 level to obtain the cross-sectional area of skeletal muscle, which was subsequently used for calculating whole-body skeletal muscle mass via the Shen equation and skeletal muscle tissue density. BIA was utilized to measure skeletal muscle mass using the manufacturer's proprietary algorithms. Skeletal muscle mass (kg) was divided by height squared (m2) to obtain skeletal muscle index (SMI, kg/m2). Pearson's correlation coefficient was performed to assess the correlation between SMI measured by BIA and CT. The agreement between the two methods was assessed using Bland-Altman analyses. The clinically acceptable agreement was defined as the 95% limits of agreement (LOA) for the percentage bias falling within ± 10%. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BIA in identifying low muscle mass. RESULTS A total of 59 patients (19.5%) were identified as having low muscle mass based on CT analysis, whereas only 19 patients (6.3%) met the criteria for low muscle mass according to BIA analysis. BIA-measured SMI showed a strong positive correlation with CT-measured SMI in all patients (r = 0.715, P < 0.001). With Bland-Altman analysis, there was a significant mean bias of 1.18 ± 0.96 kg/m2 (95% CI 1.07-1.29, P < 0.001) between SMI measured by BIA and CT. The 95% LOA for the percentage bias ranged from -7.98 to 33.92%, which exceeded the clinically acceptable range of ± 10%. A significant difference was observed in the mean bias of SMI measured by BIA and CT between patients with and without GLIM malnutrition (1.42 ± 0.91 kg/m2 versus 0.98 ± 0.96 kg/m2, P < 0.001). The cut-off values for BIA-measured SMI in identifying low muscle mass using CT as the reference were 10.11 kg/m2 for males and 8.71 kg/m2 for females (male: AUC = 0.840, 95% CI: 0.772-0.908; female: AUC = 0.721, 95% CI: 0.598-0.843). CONCLUSIONS Despite a significant correlation, the values of skeletal muscle mass obtained BIA and CT cannot be used interchangeably. The BIA method may overestimate skeletal muscle mass in GC patients compared to CT, especially among those with GLIM malnutrition, leading to an underestimation of low muscle mass prevalence.
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Affiliation(s)
- Junbo Zuo
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Da Zhou
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Li Zhang
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaodong Zhou
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xuejin Gao
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wenji Hou
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Wang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Pengcheng Jiang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xinying Wang
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Willey MC, Owen EC, Miller A, Glass N, Kirkpatrick T, Fitzpatrick D, Wilken J, Marsh JL, Reider L. Substantial Loss of Skeletal Muscle Mass Occurs After Femoral Fragility Fracture. J Bone Joint Surg Am 2023; 105:1777-1785. [PMID: 37738373 DOI: 10.2106/jbjs.23.00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Femoral fragility fractures in older adults can result in devastating loss of physical function and independence. Skeletal muscle atrophy likely contributes to disability. The purpose of this study was to characterize the change in skeletal muscle mass, investigate the relationship with malnutrition and physical function, and identify risk factors for skeletal muscle loss. METHODS Adults ≥65 years of age who were treated with operative fixation of an isolated femoral fragility fracture were enrolled in this multicenter, prospective observational study. Skeletal muscle mass was assessed within 72 hours of admission using multifrequency bioelectrical impedance analysis, which was repeated at 6 weeks, 3 months, and 6 months. Sarcopenia was defined by sex-specific cutoffs for the appendicular skeletal muscle mass index. The Mini Nutritional Assessment was used to measure nutritional status at the time of injury. Physical function was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function domain. Linear mixed models were used to evaluate changes in skeletal muscle mass and PROMIS Physical Function scores over time and to evaluate factors associated with skeletal muscle mass changes. RESULTS Ninety participants (74% female) with a mean age of 77.6 ± 9.0 years were enrolled. At the time of injury, 30 (33%) were sarcopenic and 44 (49%) were at risk for malnutrition or had malnutrition. Older age was associated with lower skeletal muscle mass (age of ≥75 versus <75 years: least squares mean [and standard error], -3.3 ± 1.6 kg; p = 0.042). From the time of injury to 6 weeks, participants lost an average of 2.4 kg (9%) of skeletal muscle mass (95% confidence interval [CI] = ‒3.0 to ‒1.8 kg; p < 0.001). This early loss did not recover by 6 months (1.8 kg persistent loss compared with baseline [95% CI = ‒2.5 to ‒1.1 kg]; p < 0.001). Participants with normal nutritional status lost more skeletal muscle mass from baseline to 6 weeks after injury compared with those with malnutrition (1.3 kg more loss [standard error, 0.6 kg]; p = 0.036). A 1-kg decrease in skeletal muscle mass was associated with an 8-point decrease in the PROMIS Physical Function (model parameter estimate, 0.12 [standard error, 0.04]; p = 0.002). CONCLUSIONS We found that older adults with femoral fragility fractures lost substantial skeletal muscle mass and physical function. Participants with adequate baseline nutrition actually lost more muscle mass than those who were malnourished, indicating that future investigations of interventions to prevent muscle loss should focus on older adults regardless of nutritional status. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Erin C Owen
- Slocum Research and Education Foundation, Eugene, Oregon
| | - Aspen Miller
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | - Jason Wilken
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - J Lawrence Marsh
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Duan H, Zhang J, Wang P, Zhang J, Jiang J. Association between nutritional status and platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization. NUTR HOSP 2023; 40:1009-1016. [PMID: 37154025 DOI: 10.20960/nh.04447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Introduction Introduction: nutritional status and platelet-to-lymphocyte ratio (PLR) have been found to be associated with prognosis in patients with hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolization (TACE). Objectives: to evaluate the association between nutritional status and PLR in patients with HCC undergoing TACE. Methods: a total of 152 HCC patients received TACE were enrolled. The nutritional status was evaluated by Patient-Generated Subjective Global Assessment (PG-SGA). Patients with PG-SGA A and PG-SGA (B or C) were classified as the well-nourished and malnourished groups. Results: according to the PG-SGA, 130 (85.5 %) patients were malnourished. The median PLR was significantly different between well-nourished and malnourished groups (p = 0.008). A positive correlation was found between PLR and PG-SGA score (r = -0.265, p = 0.001). The optimal PLR cutoff value was 102.165 to predict malnutrition, with a sensitivity of 65.4 %, specificity of 72.7 %, and an area under the curve (AUC) of 0.677 (95 % confidence interval (CI): 0.550-0.804; p = 0.008). A logistic stepwise regression model showed that the PLR was associated with nutritional status in Model 1 without adjustment, as well as if adjusted by age, sex, type of TACE (c-TACE/DEB-TACE) and Child-Pugh stage (odds ratio, 0.190; 95 % CI: 0.062-0.582; p = 0.004). Conclusions: nutritional status measured by PG-SGA was significantly associated with PLR in patients with HCC undergoing TACE.
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Affiliation(s)
- Hongyan Duan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
| | | | - Peng Wang
- Department of Medical Imaging. The Affiliated Hospital of Jiangnan University
| | - Jie Zhang
- Department of Interventional Radiology. The Affiliated Hospital of Jiangnan University
| | - Jianwei Jiang
- Department of Interventional Radiology. The Affiliated Hospital of Jiangnan University
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Sato K, Tsuji H, Yorimitsu M, Uehara T, Okazaki Y, Takao S, Hata T, Fukuoka S, Noda T, Kanda H, Ozaki T. Associations among Preoperative Malnutrition, Muscle Loss, and Postoperative Walking Ability in Intertrochanteric Fractures: A Retrospective Study. Acta Med Okayama 2023; 77:511-516. [PMID: 37899262 DOI: 10.18926/amo/65973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Sarcopenia and malnutrition are increasing in older adults and are reported risk factors for functional impairment after hip fracture surgery. This study aimed to investigate the associations between skeletal muscle mass loss, malnutrition, and postoperative walking ability in patients with hip fracture. We retrospectively reviewed patients who underwent intertrochanteric fracture surgery at our institute. The psoas muscle index, controlling nutritional status score, and functional ambulation category (FAC) were used to evaluate skeletal muscle mass, nutritional status, and walking ability, respectively. Six months after surgery, walking ability was assessed as either "gait disturbance" or "independent gait". Multivariate binomial logistic regression analysis, with skeletal muscle mass, nutritional status, and other factors, was used to predict the risk of being assigned to the gait disturbance group. This study included 95 patients (mean age, 85.2 years; 70 women). Sixty-six patients had low skeletal muscle mass, 35 suffered from malnutrition, and 28 had both. Malnutrition and low skeletal muscle mass were significantly associated with postoperative gait disturbance (FAC < 3). Preoperative low skeletal muscle mass and malnutrition were risk factors for postoperative poor walking ability. Further preventive interventions focusing on skeletal muscle mass and nutritional status are required.
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Affiliation(s)
- Kohei Sato
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
- Department of Orthopedic Surgery, Okayama University Hospital
| | - Hironori Tsuji
- Department of Orthopedic Surgery, Japanese Red Cross Okayama Hospital
| | | | - Takenori Uehara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yuki Okazaki
- Department of Orthopedic Surgery, Tsuyama Chuo Hospital
| | | | - Toshiaki Hata
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
- Department of Orthopedic Surgery, Okayama University Hospital
| | - Shiro Fukuoka
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
- Department of Orthopedic Surgery, Okayama University Hospital
| | - Tomoyuki Noda
- Department of Orthopedic Surgery, Kawasaki Medical School, General Medical Center
| | - Hideyuki Kanda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Oriá RB, Costa DVS, de Medeiros PHQS, Roque CR, Dias RP, Warren CA, Bolick DT, Guerrant RL. Myeloperoxidase as a biomarker for intestinal-brain axis dysfunction induced by malnutrition and Cryptosporidium infection in weanling mice. Braz J Infect Dis 2023; 27:102776. [PMID: 37150212 PMCID: PMC10212782 DOI: 10.1016/j.bjid.2023.102776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Cryptosporidiosis is a waterborne protozoal infection that may cause life-threatening diarrhea in undernourished children living in unsanitary environments. The aim of this study is to identify new biomarkers that may be related to gut-brain axis dysfunction in children suffering from the malnutrition/infection vicious cycle, necessary for better intervention strategies. Myeloperoxidase (MPO) is a well-known neutrophil-related tissue factor released during enteropathy that could drive gut-derived brain inflammation. We utilized a model of environmental enteropathy in C57BL/6 weanling mice challenged by Cryptosporidium and undernutrition. Mice were fed a 2%-Protein Diet (dPD) for eight days and orally infected with 107-C. parvum oocysts. C. parvum oocyst shedding was assessed from fecal and ileal-extracted genomic DNA by qRT-PCR. Ileal histopathology scores were assessed for intestinal inflammation. Prefrontal cortex samples were snap-frozen for MPO ELISA assay and NF-kb immunostaining. Blood samples were drawn by cardiac puncture after anesthesia and sera were obtained for serum amyloid A (SAA) and MPO analysis. Brain samples were also obtained for Iba-1 prefrontal cortex immunostaining. C. parvum-infected mice showed sustained stool oocyst shedding for six days post-infection and increased fecal MPO and inflammation scores. dPD and cryptosporidiosis led to impaired growth and weight gain. C. parvum-infected dPD mice showed increased serum MPO and serum amyloid A (SAA) levels, markers of systemic inflammation. dPD-infected mice showed greater MPO, NF-kB expression, and Iba-1 immunolabeling in the prefrontal cortex, an important brain region involved in executive function. Our findings suggest MPO as a potential biomarker for intestinal-brain axis dysfunction due to environmental enteropathy.
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Affiliation(s)
- Reinaldo B Oriá
- Faculdade de Medicina da Universidade Federal do Ceará, Departamento de Morfologia e Instituto de Biomedicina, Laboratório de Cicatrização de Tecidos, Ontogenia e Nutrição, Fortaleza, CE, Brazil; University of Virginia School of Medicine, Department of Medicine, Division of Infectious Diseases and International Health, Center for Global Health Equality, Charlottesville, USA
| | - Deiziane V S Costa
- University of Virginia School of Medicine, Department of Medicine, Division of Infectious Diseases and International Health, Center for Global Health Equality, Charlottesville, USA
| | - Pedro Henrique Q S de Medeiros
- University of Virginia School of Medicine, Department of Medicine, Division of Infectious Diseases and International Health, Center for Global Health Equality, Charlottesville, USA; Faculdade de Medicina da Universidade Federal do Ceará, Instituto de Biomedicina, Laboratório de Doenças Infecciosas, Fortaleza, CE, Brazil
| | - Cássia R Roque
- Faculdade de Medicina da Universidade Federal do Ceará, Departamento de Morfologia e Instituto de Biomedicina, Laboratório de Cicatrização de Tecidos, Ontogenia e Nutrição, Fortaleza, CE, Brazil
| | - Ronaldo P Dias
- Faculdade de Medicina da Universidade Federal do Ceará, Departamento de Morfologia e Instituto de Biomedicina, Laboratório de Cicatrização de Tecidos, Ontogenia e Nutrição, Fortaleza, CE, Brazil
| | - Cirle A Warren
- University of Virginia School of Medicine, Department of Medicine, Division of Infectious Diseases and International Health, Center for Global Health Equality, Charlottesville, USA
| | - David T Bolick
- University of Virginia School of Medicine, Department of Medicine, Division of Infectious Diseases and International Health, Center for Global Health Equality, Charlottesville, USA.
| | - Richard L Guerrant
- University of Virginia School of Medicine, Department of Medicine, Division of Infectious Diseases and International Health, Center for Global Health Equality, Charlottesville, USA
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Gripshover TC, Wahlang B, Head KZ, Young JL, Luo J, Mustafa MT, Kirpich IA, Cave MC. The environmental pollutant, polychlorinated biphenyl 126, alters liver function in a rodent model of alcohol-associated liver disease. Alcohol Clin Exp Res (Hoboken) 2023; 47:60-75. [PMID: 36377258 PMCID: PMC9974797 DOI: 10.1111/acer.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of alcohol-associated liver disease (ALD), a subtype of fatty liver disease (FLD), continues to rise. ALD is a major cause of preventable death. Polychlorinated biphenyl (PCB) 126 is an environmentally relevant, dioxin-like pollutant whose negative metabolic effects have been well documented. In human and animal studies, PCB has been associated with the severity of nonalcoholic fatty liver disease (NAFLD). However, few studies have investigated whether exposures to environmental toxicants can worsen ALD. Thus, the objective of the current study was to develop an alcohol-plus-toxicant model to study how an environmental pollutant, PCB 126, impacts rodent ALD pathology. METHODS Briefly, male C57BL/6J mice were exposed to 0.2 mg/kg PCB 126 or corn oil vehicle four days prior to ethanol feeding using the chronic-binge (10-plus-one) model. RESULTS Concentrations of macromolecules, including hepatic lipids, carbohydrates, and protein (albumin) were impacted. Exposure to PCB 126 exacerbated hepatic steatosis and hepatomegaly in mice exposed to the chemical and fed an ethanol diet. Gene expression and the analysis of blood chemistry showed a potential net increase and retention of hepatic lipids and reductions in lipid oxidation and clearance capabilities. Depletion of glycogen and glucose was evident, which contributes to disease progression by generating systemic malnutrition. Granulocytic immune infiltrates were present but driven solely by ethanol feeding. Hepatic albumin gene expression and plasma levels were decreased by ~50% indicating a potential compromise of liver function. Finally, gene expression analyses indicated that the aryl hydrocarbon receptor and constitutive androstane receptor were activated by PCB 126 and ethanol, respectively. CONCLUSIONS Various environmental toxicants are known to modify or enhance FLD in high-fat diet models. Findings from the present study suggest that they interact with other lifestyle factors such as alcohol consumption to reprogram intermediary metabolism resulting in exacerbated ethanol-associated systemic malnutrition in ALD.
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Affiliation(s)
- Tyler C. Gripshover
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- University of Louisville Superfund Research Program, University of Louisville, Louisville, KY 40202, USA
| | - Banrida Wahlang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- Hepatobiology & Toxicology COBRE, University of Louisville School of Medicine, Louisville, KY 40202, USA
- University of Louisville Alcohol Research Center, University of Louisville, Louisville, KY 40202, USA
- University of Louisville Superfund Research Program, University of Louisville, Louisville, KY 40202, USA
| | - Kimberly Z. Head
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- Hepatobiology & Toxicology COBRE, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Jamie L. Young
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Jianzhu Luo
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Muhammad T. Mustafa
- The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Irina A. Kirpich
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- Hepatobiology & Toxicology COBRE, University of Louisville School of Medicine, Louisville, KY 40202, USA
- University of Louisville Alcohol Research Center, University of Louisville, Louisville, KY 40202, USA
| | - Matthew C. Cave
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Biochemistry and Molecular Genetics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
- The Robley Rex Veterans Affairs Medical Center, Louisville, KY 40206, USA
- The Liver Transplant Program at UofL Health - Jewish Hospital Trager Transplant Center, Louisville, KY 40202 USA
- Hepatobiology & Toxicology COBRE, University of Louisville School of Medicine, Louisville, KY 40202, USA
- University of Louisville Alcohol Research Center, University of Louisville, Louisville, KY 40202, USA
- University of Louisville Superfund Research Program, University of Louisville, Louisville, KY 40202, USA
- The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, 40202, USA
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Cayupe B, Troncoso B, Morgan C, Sáez-Briones P, Sotomayor-Zárate R, Constandil L, Hernández A, Morselli E, Barra R. The Role of the Paraventricular-Coerulear Network on the Programming of Hypertension by Prenatal Undernutrition. Int J Mol Sci 2022; 23:ijms231911965. [PMID: 36233268 PMCID: PMC9569920 DOI: 10.3390/ijms231911965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
A crucial etiological component in fetal programming is early nutrition. Indeed, early undernutrition may cause a chronic increase in blood pressure and cardiovascular diseases, including stroke and heart failure. In this regard, current evidence has sustained several pathological mechanisms involving changes in central and peripheral targets. In the present review, we summarize the neuroendocrine and neuroplastic modifications that underlie maladaptive mechanisms related to chronic hypertension programming after early undernutrition. First, we analyzed the role of glucocorticoids on the mechanism of long-term programming of hypertension. Secondly, we discussed the pathological plastic changes at the paraventricular nucleus of the hypothalamus that contribute to the development of chronic hypertension in animal models of prenatal undernutrition, dissecting the neural network that reciprocally communicates this nucleus with the locus coeruleus. Finally, we propose an integrated and updated view of the main neuroendocrine and central circuital alterations that support the occurrence of chronic increases of blood pressure in prenatally undernourished animals.
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Affiliation(s)
- Bernardita Cayupe
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170020, Chile
| | - Blanca Troncoso
- Escuela de Enfermería, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Carlos Morgan
- Laboratorio de Neurofarmacología y Comportamiento, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Patricio Sáez-Briones
- Laboratorio de Neurofarmacología y Comportamiento, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Ramón Sotomayor-Zárate
- Laboratorio de Neuroquímica y Neurofarmacología, Centro de Neurobiología y Fisiopatología Integrativa, Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso 2360102, Chile
| | - Luis Constandil
- Laboratorio de Neurobiología, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Alejandro Hernández
- Laboratorio de Neurobiología, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Eugenia Morselli
- Department of Basic Sciences, Faculty of Medicine and Sciences, Universidad San Sebastián, Santiago 7510157, Chile
| | - Rafael Barra
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170020, Chile
- Correspondence: ; Tel.: +56-983831083
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Takahashi K, Jia H, Takahashi S, Kato H. Comprehensive miRNA and DNA Microarray Analyses Reveal the Response of Hepatic miR-203 and Its Target Gene to Protein Malnutrition in Rats. Genes (Basel) 2021; 13:genes13010075. [PMID: 35052415 PMCID: PMC8774329 DOI: 10.3390/genes13010075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/25/2022] Open
Abstract
Adequate protein nutrition is essential for good health. Effects of protein malnutrition in animals have been widely studied at the mRNA level with the development of DNA microarray technology. Although microRNAs (miRNAs) have attracted attention for their function in regulating gene expression and have been studied in several disciplines, fewer studies have clarified the effects of protein malnutrition on miRNA alterations. The present study aimed to elucidate the relationship between protein malnutrition and miRNAs. Six-week old Wistar male rats were fed a control diet (20% casein) or a low-protein diet (5% casein) for two weeks, and their livers were subjected to both DNA microarray and miRNA array analysis. miR-203 was downregulated and its putative target Hadhb (hydroxyacyl-CoA dehydrogenase β subunit), known to regulate β-oxidation of fatty acids, was upregulated by the low-protein diet. In an in vitro experiment, miR-203 or its inhibitor were transfected in HepG2 cells, and the pattern of Hadhb expression was opposite to that of miR-203 expression. In addition, to clarifying the hepatic miRNA profile in response to protein malnutrition, these results showed that a low-protein diet increased Hadhb expression through downregulation of miR-203 and induced β-oxidation of fatty acids.
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Runco DV, Wasilewski-Masker K, Mazewski CM, Patterson BC, Mertens AC. Features Associated With Weight Loss and Growth Stunting for Young Children During Cancer Therapy. J Pediatr Hematol Oncol 2021; 43:301-307. [PMID: 34133373 PMCID: PMC9580507 DOI: 10.1097/mph.0000000000002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
Features associated with malnutrition are poorly elucidated in pediatric cancer care. We aimed to better understand characteristics associated with weight-for-height (WHZ) and height-for-age (HAZ) changes for infants and young children during cancer treatment. This retrospective study included 434 patients diagnosed <3 years old from 2007 to 2015 at a large pediatric cancer center. Patients starting treatment outside our center, those with relapsed or secondary malignancies, or with inaccurate information were excluded. Abstracted weights and heights for a 24-month period after treatment initiation were converted to sex-specific and age-specific z scores. Although not statistically different at baseline, patients with hematologic malignancies gained weight over time, while other tumor types did not. Higher treatment intensity and younger age at diagnosis increased odds of clinically significant weight loss. Older children had higher HAZ at diagnosis and HAZ also significantly decreased over time for all examined risk factors, which is distinctly different from patterns in WHZ over time. In conclusion, WHZ and HAZ are affected differently by cancer treatment in infants and young children. We identify key risk factors for weight loss and growth stunting which will be necessary to develop prospective trials to examine anthropometric, biochemical, and patient recorded outcomes around nutrition.
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Affiliation(s)
- Daniel V. Runco
- Department of Pediatrics, Division of Hematology/Oncology/BMT, Indiana University School of Medicine
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
| | - Claire M. Mazewski
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
| | - Briana C. Patterson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
- Department of Pediatrics, Division of Endocrinology and Diabetes, Emory University School of Medicine, Atlanta, GA
| | - Ann C. Mertens
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
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10
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Lee YC, Chen YC, Wang JT, Wang FD, Hsieh MH, Hii IM, Lee YL, Ho MW, Liu CE, Chen YH, Liu WL. Impact of Nutritional Assessment on the Clinical Outcomes of Patients with Non- albicans Candidemia: A Multicenter Study. Nutrients 2021; 13:3218. [PMID: 34579094 PMCID: PMC8465954 DOI: 10.3390/nu13093218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023] Open
Abstract
Several studies have demonstrated that malnutrition is a negative prognostic factor for clinical outcomes. However, there is limited evidence for the effect of malnutrition on clinical outcomes in patients with candidemia. We investigated the relationship between malnutrition and all-cause 28-day mortality among patients with non-albicans candidemia. Between July 2011 and June 2014, all adult patients with non-albicans candidemia, including C. tropicalis, C. glabrata, C. parapsilosis and so on, were enrolled. The Malnutrition Universal Screening Tool (MUST) scores were used to determine the patients' nutritional status before the onset of candidemia. A total of 378 patients were enrolled; 43.4% developed septic shock and 57.1% had a high risk of malnutrition (MUST ≥ 2). The all-cause 28-day mortality rate was 40.7%. The Cox proportional hazards model revealed that C. tropicalis (HR, 2.01; 95% CI, 1.24-3.26; p = 0.005), Charlson comorbidity index (HR, 1.10; 95% CI, 1.03-1.18; p = 0.007), Foley catheter use (HR, 1.68; 95% CI, 1.21-1.35; p = 0.002), concomitant bacterial infections (HR, 1.55; 95% CI, 1.11-2.17; p = 0.010), low platelet count (HR, 3.81; 95% CI, 2.45-5.91; p < 0.001), not receiving antifungals initially (HR, 4.73; 95% CI, 3.07-7.29; p < 0.001), and MUST ≥ 2 (HR, 1.54; 95% CI, 1.09-2.17; p = 0.014) were independently associated with all-cause 28-day mortality. A simple screening tool for nutritional assessment should be used for patients with non-albicans candidemia to detect early clinical deterioration, and a tailored nutritional care plan should be established for malnourished individuals, to improve their clinical outcomes.
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Affiliation(s)
- Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243, Taiwan;
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Yong-Chen Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan;
- Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;
- Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tsu-Nan County 350, Taiwan
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Min-Han Hsieh
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-H.H.); (Y.-H.C.)
| | - Ing-Moi Hii
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (I.-M.H.); (Y.-L.L.); (C.-E.L.)
| | - Yu-Lin Lee
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (I.-M.H.); (Y.-L.L.); (C.-E.L.)
| | - Mao-Wang Ho
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan;
| | - Chun-Eng Liu
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (I.-M.H.); (Y.-L.L.); (C.-E.L.)
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-H.H.); (Y.-H.C.)
| | - Wei-Lun Liu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan;
- Division of Critical Care Medicine, Department of Emergency & Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243, Taiwan
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11
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Manjunath S, Mahajan R, De D, Handa S, Attri S, Behera BN, Bhasin SL, Bolia R. The severity of malnutrition in children with epidermolysis bullosa correlates with disease severity. Sci Rep 2021; 11:16827. [PMID: 34413404 PMCID: PMC8377149 DOI: 10.1038/s41598-021-96354-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
WHO defines malnutrition as severe if the z-scores are less than - 3 Standard deviation (SD), moderate if between - 2 and - 3 SD and mild if between - 2 SD to - 1 SD. This study was aimed to assess nutritional aspects of Indian children suffering from EB and to evaluate the effect of severity of EB on the severity of malnutrition. In this study, pediatric EB patients were evaluated prospectively for baseline nutritional status using anthropometric parameters and WHO growth charts, and its correlation with disease severity using instrument for Scoring Clinical Outcomes for Research of Epidermolysis Bullosa-iscorEB. In second phase, an individualized diet chart was given to meet the energy, protein and micronutrients needs and its effects were observed after 6 months. The median age of participants was 3 years (IQR-9). Of 57 patients, malnutrition was seen in 40.35% patients (22.81%-moderate and 17.54%-severe), and significantly correlated with iscorEB (r = 0.45, p < 0.0001). On bivariate regression analysis, iscorEB was independently associated with moderate-to-severe malnutrition (p = 0.047; OR 1.038, CI 1.011-1.066). iscorEB enabled the identification of patients with moderate-to-severe malnutrition with an Area Under Receiver Operating Curve (AUROC) of 0.72 (95%CI 0.58-0.85; p < 0.005). In phase 2, there was significant improvement in nutritional status in children with recessive dystrophic EB (RDEB) and dominant dystrophic EB (DDEB) subtype (p < 0.0001). The severity of malnutrition in EB children significantly correlates with disease severity, and is an independent predictor of moderate-to-severe malnutrition.
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Affiliation(s)
- Seema Manjunath
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Dipankar De
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Savita Attri
- Department of Pediatric Biochemistry, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Banchha Nidhi Behera
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Sadhna Lal Bhasin
- Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Rishi Bolia
- Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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12
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Teixeira GCM, Prado RDM, Oliveira KS, Buchelt AC, Rocha AMS, Santos MDS. Nutritional deficiency in scarlet eggplant limits its growth by modifying the absorption and use efficiency of macronutrients. PLoS One 2021; 16:e0252866. [PMID: 34086839 PMCID: PMC8177653 DOI: 10.1371/journal.pone.0252866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
The intensity damages caused by nutritional deficiency in growing plants can vary with nutrients. The effects caused by nutrient omission in the plant nutritional efficiency in relation to the absorption and use of the missing nutrient, and the reasons why these damages reflect in other nutrients have not yet been reported in the culture of scarlet eggplant. A better understanding of the nutritional mechanisms involved may clarify why certain nutrients cause greater limitations than other during plants growth. Thus, this study was designed with the aim of evaluating the damages caused by macronutrients deficiency in the culture of scarlet eggplant in the accumulation of these nutrients, nutritional deficiency, plants growth and in visual symptoms. The experiment was carried out in a controlled environment where plants were cultivated in a hydroponic system. Treatments consisted of supplying a complete Hoagland and Arnon solution (CS), and other nutrient solutions with individual omissions of nitrogen (-N), phosphorus (-P), potassium (-K), calcium (-Ca), magnesium (-Mg) and sulphur (-S). When a nutrient deficiency arose, nutritional analyses, growth and visual symptoms were analyzed. The omissions of N, S and K in the nutrient solution resulted in lower accumulation of all macronutrients in both the above and below ground biomass. Individual omissions resulted in nutritional imbalances with reflexes in the absorption efficiencies and use of the missing nutrient, as well as of other nutrients, revealing that the metabolism involves multiple nutritional interactions. Losses of nutritional efficiencies of macronutrients caused detrimental effects on plants growth, with reduced height, stem diameter, number of leaves, leaf area, and biomass production in above ground and below ground. From the losses in production in above ground biomass, the order of macronutrients limitation was N, S, K, Ca, Mg, and P, with reductions of 99, 96, 94, 76, 51 and 46%, respectively, in comparison to plants cultivated in CS. The most limiting nutrients were N, S, and K, seen that its deficiencies affected the metabolism of all other nutrients. This study demonstrates the importance of an adequate nutritional management of N, S, and K in the cultivation of scarlet eggplant.
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Affiliation(s)
| | - Renato de Mello Prado
- Department of Agricultural Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
| | - Kamilla Silva Oliveira
- Department of Agricultural Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
| | - Antonio Carlos Buchelt
- Department of Agronomy, Mato Grosso State University (UNEMAT), Alta Floresta, Mato Grosso, Brazil
| | | | - Michelle de Souza Santos
- Department of Agricultural Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
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13
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Wang MX, Gwee SXW, Pang J. Micronutrients Deficiency, Supplementation and Novel Coronavirus Infections-A Systematic Review and Meta-Analysis. Nutrients 2021; 13:1589. [PMID: 34068656 PMCID: PMC8151981 DOI: 10.3390/nu13051589] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Micronutrients play roles in strengthening and maintaining immune function, but their supplementation and/or deficiency effects on respiratory tract infections are inconclusive. This review aims to systematically assess the associations between micronutrient supplementation or deficiency, with novel coronavirus incidence and disease severity. METHODS Systematic literature searches conducted in five electronic databases identified 751 unique studies, of which 33 studies (five supplementation studies, one supplementation and deficiency study, and 27 deficiency studies) were eventually included in this review. Proportions of incidence and severity outcomes in each group, and adjusted summary statistics with their relevant 95% confidence intervaIs (CI) were extracted. Data from 19 studies were pooled in meta-analysis using the generic inverse variance method. FINDINGS A total of 360,346 patients across 16 countries, with a mean age between 32 and 87.7 years, were involved across 33 studies. All studies were on COVID-19 infections. In individuals without micronutrient deficiency, there was a significant reduction on odds of COVID-19 incidence (pooled OR: 0.37, 95% CI: 0.18, 0.78), and ICU admissions or severe/critical disease onset when combined as a severity outcome (pooled OR: 0.26, 95% CI: 0.08, 0.89). Insignificant protective effects were observed on other outcome measures, namely mortality, ICU admission, progression to respiratory-related complications, severe/critical disease onset or requiring respiratory support and hospitalization rate. CONCLUSION The absence of micronutrient deficiency significantly reduced COVID-19 incidence and clinical deterioration in hospitalized patients. Usage of micronutrients as prophylaxis and complementary supplement in therapeutic management of COVID-19 patients may be a promising and cost-effective approach warranting in-depth investigation.
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Affiliation(s)
- Min Xian Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.X.W.); (S.X.W.G.)
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore 117549, Singapore
| | - Sylvia Xiao Wei Gwee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.X.W.); (S.X.W.G.)
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore 117549, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.X.W.); (S.X.W.G.)
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore 117549, Singapore
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14
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Kim R, Bijral AS, Xu Y, Zhang X, Blossom JC, Swaminathan A, King G, Kumar A, Sarwal R, Lavista Ferres JM, Subramanian SV. Precision mapping child undernutrition for nearly 600,000 inhabited census villages in India. Proc Natl Acad Sci U S A 2021; 118:e2025865118. [PMID: 33903246 PMCID: PMC8106321 DOI: 10.1073/pnas.2025865118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There are emerging opportunities to assess health indicators at truly small areas with increasing availability of data geocoded to micro geographic units and advanced modeling techniques. The utility of such fine-grained data can be fully leveraged if linked to local governance units that are accountable for implementation of programs and interventions. We used data from the 2011 Indian Census for village-level demographic and amenities features and the 2016 Indian Demographic and Health Survey in a bias-corrected semisupervised regression framework to predict child anthropometric failures for all villages in India. Of the total geographic variation in predicted child anthropometric failure estimates, 54.2 to 72.3% were attributed to the village level followed by 20.6 to 39.5% to the state level. The mean predicted stunting was 37.9% (SD: 10.1%; IQR: 31.2 to 44.7%), and substantial variation was found across villages ranging from less than 5% for 691 villages to over 70% in 453 villages. Estimates at the village level can potentially shift the paradigm of policy discussion in India by enabling more informed prioritization and precise targeting. The proposed methodology can be adapted and applied to diverse population health indicators, and in other contexts, to reveal spatial heterogeneity at a finer geographic scale and identify local areas with the greatest needs and with direct implications for actions to take place.
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Affiliation(s)
- Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, 02841 Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 02841 Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, MA 02138
| | | | - Yun Xu
- SuperMap Software Co. Ltd, Beijing 100015, China
| | - Xiuyuan Zhang
- Institute of Remote Sensing and Geographic Information System, Peking University, Beijing 100871, China
| | - Jeffrey C Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138
| | | | - Gary King
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA 02138
| | - Alok Kumar
- Department of Medical Health and Family Welfare, Lucknow 226018, India
| | - Rakesh Sarwal
- National Institution for Transforming India Aayog, New Delhi 110001, India
| | | | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA 02138;
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115
- National Institution for Transforming India Aayog, New Delhi 110001, India (Non-Resident)
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15
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Svege S, Nkosi-Gondwe T, Lange S. "Satanism is witchcraft's younger sibling": Changing perceptions of natural and supernatural anaemia causality in Malawian children. PLoS One 2021; 16:e0250661. [PMID: 33930023 PMCID: PMC8087048 DOI: 10.1371/journal.pone.0250661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
In countries of sub-Saharan Africa, many children are admitted to hospital with severe forms of anaemia. The late hospital admissions of anaemic children contribute significantly to child morbidity and mortality in these countries. This qualitative study explores local health beliefs and traditional treatment practices that may hinder timely seeking of hospital care for anaemic children. In January of 2019, nine focus group discussions were conducted with 90 participants in rural communities of Malawi. The participants represented four groups of caregivers; mothers, fathers, grandmothers and grandfathers of children under the age of five. The Malawian medical landscape is comprised of formal and informal therapeutic alternatives–and this myriad of modalities is likely to complicate the healthcare choices of caregivers. When dealing with child illness, many participants reported how they would follow a step-by-step, ‘multi-try’ therapeutic pathway where a combination of biomedical and traditional treatment options were sought at varying time points depending on the perceived cause and severity of symptoms. The participants linked anaemia to naturalistic (malaria, poor nutrition and the local illnesses kakozi and kapamba), societal (the local illness msempho) and supernatural or personalistic (witchcraft and Satanism) causes. Most participants agreed that anaemia due to malaria and poor nutrition should be treated at hospital. As for local illnesses, many grandparents suggested herbal treatment offered by traditional healers, while the majority of parents would opt for hospital care. However, participants across all age groups claimed that anaemia caused by witchcraft and Satanism could only be dealt with by traditional healers or prayer, respectively. The multiple theories of anaemia causality combined with extensive use of and trust in traditional and complementary medicine may explain the frequent delay in admittance of anaemic children to hospital.
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Affiliation(s)
- Sarah Svege
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Thandile Nkosi-Gondwe
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Siri Lange
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Chr. Michelsen Institute, Bergen, Norway
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16
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Li X, Hui Y, Leng B, Ren J, Song Y, Che L, Peng X, Huang B, Liu S, Li L, Nielsen DS, Li Y, Dai X, Zhao S. Millet-based supplement restored gut microbial diversity of acute malnourished pigs. PLoS One 2021; 16:e0250423. [PMID: 33914799 PMCID: PMC8084169 DOI: 10.1371/journal.pone.0250423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
The tight association between malnutrition and gut microbiota (GM) dysbiosis enables microbiota-targeting intervention to be a promising strategy. Thus, we used a malnourished pig model to investigate the host response and GM alterations under different diet supplementation strategies. Pigs at age of 4 weeks were fed with pure maize diet to induce malnutrition symptoms, and followed by continuous feeding with maize (Maize, n = 8) or re-feeding using either corn-soy-blend (CSB+, n = 10) or millet-soy-blend based (MSB+, n = 10) supplementary food for 3 weeks. Meanwhile, 8 pigs were fed on a standard formulated ration as control (Ref). The effect of nutritional supplementation was assessed by the growth status, blood chemistry, gastrointestinal pathology, mucosal microbiota composition and colon production of short-chain fatty acids. Compared with purely maize-fed pigs, both CSB+ and MSB+ elevated the concentrations of total protein and globulin in blood. These pigs still showed most malnutrition symptoms after the food intervention period. MSB+ had superior influence on the GM development, exhibiting better performance in both structural and functional aspects. MSB+ pigs were colonized by less Proteobacteria but more Bacteroidetes, Firmicutes and Lachnospira spp. Pearson's correlation analysis indicated a strong correlation between the abundance of mucosal e.g., Faecalibacterium and Lachnospira spp. and body weight, crown-rump length and total serum protein. In conclusion, the malnutrition symptoms were accompanied by an aberrant GM, and millet-based nutritional supplementation showed promising potentials to restore the reduced GM diversity implicated in pig malnutrition.
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Affiliation(s)
- Xuejing Li
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
| | - Yan Hui
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Bingfeng Leng
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
- Neomics Institute, Life and Science Park 301, Pingshan, Shenzhen, China
| | - Junli Ren
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
| | - Yanni Song
- BGI Education Center, University of Chinese Academy of Sciences, Shenzhen, China
| | - Lianqiang Che
- Animal Nutrition Institute, Sichuan Agricultural University, Ya’an, Sichuan, China
| | - Xi Peng
- College of Life Science, China West Normal University, Nanchong, China
| | - Baojia Huang
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
| | - Songling Liu
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
| | - Lin Li
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
- ShenZhen Engineering Laboratory for Genomics-Assisted Animal Breeding, BGI-Shenzhen, Shenzhen, China
| | | | - Yong Li
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
- ShenZhen Engineering Laboratory for Genomics-Assisted Animal Breeding, BGI-Shenzhen, Shenzhen, China
| | - Xiaoshuang Dai
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
| | - Shancen Zhao
- BGI Institute of Applied Agriculture, BGI-Shenzhen, Shenzhen, China
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17
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Chapman I, Oberoi A, Giezenaar C, Soenen S. Rational Use of Protein Supplements in the Elderly-Relevance of Gastrointestinal Mechanisms. Nutrients 2021; 13:nu13041227. [PMID: 33917734 PMCID: PMC8068133 DOI: 10.3390/nu13041227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Protein supplements are increasingly used by older people to maintain nutrition and prevent or treat loss of muscle function. Daily protein requirements in older people are in the range of 1.2 gm/kg/day or higher. Many older adults do not consume this much protein and are likely to benefit from higher consumption. Protein supplements are probably best taken twice daily, if possible soon after exercise, in doses that achieve protein intakes of 30 gm or more per episode. It is probably not important to give these supplements between meals, as we have shown no suppressive effects of 30 gm whey drinks, and little if any suppression of 70 gm given to older subjects at varying time intervals from meals. Many gastrointestinal mechanisms controlling food intake change with age, but their contributions to changes in responses to protein are not yet well understood. There may be benefits in giving the supplement with rather than between meals, to achieve protein intakes above the effective anabolic threshold with lower supplement doses, and have favourable effects on food-induced blood glucose increases in older people with, or at risk of developing, type 2 diabetes mellitus; combined protein and glucose drinks lower blood glucose compared with glucose alone in older people.
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Affiliation(s)
- Ian Chapman
- Adelaide Medical School and Centre of Research Excellence (C.R.E.) in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (I.C.); (A.O.)
| | - Avneet Oberoi
- Adelaide Medical School and Centre of Research Excellence (C.R.E.) in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (I.C.); (A.O.)
| | - Caroline Giezenaar
- Riddett Institute, Massey University, Palmerston North 9430, New Zealand;
| | - Stijn Soenen
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia
- Correspondence: ; Tel.: +61-07-55595-1390
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Ssentongo P, Ssentongo AE, Ba DM, Ericson JE, Na M, Gao X, Fronterre C, Chinchilli VM, Schiff SJ. Global, regional and national epidemiology and prevalence of child stunting, wasting and underweight in low- and middle-income countries, 2006-2018. Sci Rep 2021; 11:5204. [PMID: 33664313 PMCID: PMC7933191 DOI: 10.1038/s41598-021-84302-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/15/2021] [Indexed: 01/06/2023] Open
Abstract
In 2016, undernutrition, as manifested in childhood stunting, wasting, and underweight were estimated to cause over 1.0 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life years globally. The objective of this study is to estimate the prevalence of undernutrition in low- and middle-income countries (LMICs) using the 2006-2018 cross-sectional nationally representative demographic and health surveys (DHS) data and to explore the sources of regional variations. Anthropometric measurements of children 0-59 months of age from DHS in 62 LMICs worldwide were used. Complete information was available for height-for-age (n = 624,734), weight-for-height (n = 625,230) and weight-for-age (n = 626,130). Random-effects models were fit to estimate the pooled prevalence of stunting, wasting, and underweight. Sources of heterogeneity in the prevalence estimates were explored through subgroup meta-analyses and meta-regression using generalized linear mixed-effects models. Human development index (a country-specific composite index based on life expectancy, literacy, access to education and per capita gross domestic product) and the United Nations region were explored as potential sources of variation in undernutrition. The overall prevalence was 29.1% (95% CI 26.7%, 31.6%) for stunting, 6.3% (95% CI 4.6%, 8.2%) for wasting, and 13.7% (95% CI 10.9%, 16.9%) for underweight. Subgroup analyses suggested that Western Africa, Southern Asia, and Southeastern Asia had a substantially higher estimated prevalence of undernutrition than global average estimates. In multivariable meta-regression, a combination of human development index and United Nations region (a proxy for geographical variation) explained 54%, 56%, and 66% of the variation in stunting, wasting, and underweight prevalence, respectively. Our findings demonstrate that regional, subregional, and country disparities in undernutrition remain, and the residual gaps to close towards achieving the second sustainable development goal-ending undernutrition by 2030.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA.
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
| | - Anna E Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
- Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Djibril M Ba
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
- Center for Applied Studies in Health Economics, The Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Jessica E Ericson
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Muzi Na
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Xiang Gao
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, UK
| | - Vernon M Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Steven J Schiff
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA
- The Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Neurosurgery, The Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
- Department of Physics, The Pennsylvania State University, University Park, PA, 16802, USA
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Mueller TC, Reik L, Prokopchuk O, Friess H, Martignoni ME. Measurement of body mass by bioelectrical impedance analysis and computed tomography in cancer patients with malnutrition - a cross-sectional observational study. Medicine (Baltimore) 2020; 99:e23642. [PMID: 33327343 PMCID: PMC7738080 DOI: 10.1097/md.0000000000023642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Malnutrition and cachexia affects the majority of cancer patients and significantly worsens their quality of life and prognosis. However, the diagnostic criteria of malnutrition and cachexia remain a topic under constant debate. To overcome this hurdle, diagnostic tools to objectively detect and quantify the loss of muscle and fat mass are needed. Computed tomography (CT)-based measurement is currently considered the golden standard. Bioelectrical impedance analysis (BIA) is an economical, non-invasive tool but it is seen controversial in patients with cancer and malnutrition because of possible estimation errors.BIA and CT-based analysis of body mass compartments were performed 172 times in 118 cancer patients, within the nutrition program of our institution. Prevalence of malnutrition was determined according to the global leadership initiative on malnutrition criteria. Data obtained for muscle and fat mass from both BIA and CT were correlated using Pearson's ρ. All analyses were performed with an explorative significance level of 5%.45.7% of the cohort were classified as "malnourished." No significant differences were observed between the 2 groups regarding demographic data. Median body mass index, Karnofsky performance status, and nutritional risk score were lower in the malnourished group. Values for muscle and fat mass by BIA and CT were significantly lower in malnourished patients. Correlation of the measured parameters were highly significant between CT-based and BIA measurement. In the overall cohort, correlation of measured muscle mass values by CT and BIA was significant with Pearson's ρ = 0.794 (P < .01). Looking at patients without malnutrition only, Pearson's ρ was 0.754 (P < .01). The correlation of measured fat mass values was equally significant, with Pearson's ρ of 0.748 (P < .01) in the overall cohort and 0.771 (P < .01) in patients with malnutrition.To our knowledge, this is the first study comparing BIA to CT-based body mass analysis in a large cohort of cancer patients with malnutrition. The results suggest that BIA is a valid diagnostic tool for the assessment of muscle and fat mass, even in patients with malnutrition, and could be implemented for the early detection and short-term follow-up of malnutrition and cachexia.
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Wubie A, Seid O, Eshetie S, Dagne S, Menber Y, Wasihun Y, Petrucka P. Determinants of chronic energy deficiency among non-pregnant and non-lactating women of reproductive age in rural Kebeles of Dera District, North West Ethiopia, 2019: Unmatched case control study. PLoS One 2020; 15:e0241341. [PMID: 33119701 PMCID: PMC7595398 DOI: 10.1371/journal.pone.0241341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/13/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Ethiopia about 25% of rural women are chronically malnourished. Non-pregnant and non-lactating women present an opportunity to implement strategies to correct maternal and child health status and to potentiate improved pregnancy outcomes in developing countries like Ethiopia. The determinant factors of chronic energy deficiency vary across settings and contexts; hence, it is important to identify local determinant factors in order to implement effective and efficient intervention strategies. OBJECTIVE To assess the determinants of chronic energy deficiency of non-pregnant, non-lactating rural women within the reproductive age group (15-49 years), in rural kebeles of Dera district, North West Ethiopia, 2019. METHODS A community based unmatched case control study was conducted. A total of 552 participants were involved and a multi-stage sampling technique was used to select the samples. Data was collected from January 15 to February 30, 2019 using face-to-face interviews and anthropometric assessments. EPI-info version 7 and SPSS™ version 23 were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression models were used to analyze the association between dependent and independent variables. Association was considered statistically significant at 95% CI with p-value < 0.05 in multivariable logistic regression. RESULT A total of 548 non-pregnant, non-lactating women with 137 cases and 411 controls were included in the study with a response rate of 99.3%. High family size (AOR = 1.88, 95% CI: 1.085, 3.275), low educational status (AOR = 3.389, 95% CI: 1.075, 10.683), inadequate meal frequency (AOR = 5.345, 95% CI: 2.266, 12.608), absence of home garden (AOR = 5.612, 95% CI: 3.177, 9.915) and absence of latrine facility (AOR = 6.365, 95% CI: 3.534, 11.462) were found positively associated with chronic energy deficiency. CONCLUSION AND RECOMMENDATION Inadequate meal frequency, absence of home gardening, absence of latrine facility, high family size and educational status of illiterate were the determinants of chronic energy deficiency, thus indicating the imperative for a multi-sectoral approach with health, agriculture and education entities developing and delivering interventions.
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Affiliation(s)
- Asmare Wubie
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Omer Seid
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Sisay Eshetie
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Samuel Dagne
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yonatan Menber
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yosef Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Meyer F, Bannert K, Wiese M, Esau S, Sautter LF, Ehlers L, Aghdassi AA, Metges CC, Garbe LA, Jaster R, Lerch MM, Lamprecht G, Valentini L. Molecular Mechanism Contributing to Malnutrition and Sarcopenia in Patients with Liver Cirrhosis. Int J Mol Sci 2020; 21:E5357. [PMID: 32731496 PMCID: PMC7432938 DOI: 10.3390/ijms21155357] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
Liver cirrhosis is frequently accompanied by disease-related malnutrition (DRM) and sarcopenia, defined as loss of skeletal muscle mass and function. DRM and sarcopenia often coexist in cirrhotic patients and are associated with increased morbidity and mortality. The clinical manifestation of both comorbidities are triggered by multifactorial mechanisms including reduced nutrient and energy intake caused by dietary restrictions, anorexia, neuroendocrine deregulation, olfactory and gustatory deficits. Maldigestion and malabsorption due to small intestinal bacterial overgrowth, pancreatic insufficiency or cholestasis may also contribute to DRM and sarcopenia. Decreased protein synthesis and increased protein degradation is the cornerstone mechanism to muscle loss, among others mediated by disease- and inflammation-mediated metabolic changes, hyperammonemia, increased myostatin and reduced human growth hormone. The concise pathophysiological mechanisms and interactions of DRM and sarcopenia in liver cirrhosis are not completely understood. Furthermore, most knowledge in this field are based on experimental models, but only few data in humans exist. This review summarizes known and proposed molecular mechanisms contributing to malnutrition and sarcopenia in liver cirrhosis and highlights remaining knowledge gaps. Since, in the prevention and treatment of DRM and sarcopenia in cirrhotic patients, more research is needed to identify potential biomarkers for diagnosis and development of targeted therapeutic strategies.
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Affiliation(s)
- Fatuma Meyer
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
| | - Karen Bannert
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Mats Wiese
- Division of Gastroenterology, Endocrinology and Nutritional Medicine, Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (M.W.); (A.A.A.); (M.M.L.)
| | - Susanne Esau
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
| | - Lea F. Sautter
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Luise Ehlers
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Ali A. Aghdassi
- Division of Gastroenterology, Endocrinology and Nutritional Medicine, Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (M.W.); (A.A.A.); (M.M.L.)
| | - Cornelia C. Metges
- Institute of Nutritional Physiology ‘Oskar Kellner’, Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany;
| | - Leif-A. Garbe
- Department of Agriculture and Food Sciences, University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany;
| | - Robert Jaster
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Markus M. Lerch
- Division of Gastroenterology, Endocrinology and Nutritional Medicine, Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (M.W.); (A.A.A.); (M.M.L.)
| | - Georg Lamprecht
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Luzia Valentini
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
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Kaspar D, Hastreiter S, Irmler M, Hrabé de Angelis M, Beckers J. Nutrition and its role in epigenetic inheritance of obesity and diabetes across generations. Mamm Genome 2020; 31:119-133. [PMID: 32350605 PMCID: PMC7368866 DOI: 10.1007/s00335-020-09839-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
Nutritional constraints including not only caloric restriction or protein deficiency, but also energy-dense diets affect metabolic health and frequently lead to obesity and insulin resistance, as well as glucose intolerance and type 2 diabetes. The effects of these environmental factors are often mediated via epigenetic modifiers that target the expression of metabolic genes. More recently, it was discovered that such parentally acquired metabolic changes can alter the metabolic health of the filial and grand-filial generations. In mammals, this epigenetic inheritance can either follow an intergenerational or transgenerational mode of inheritance. In the case of intergenerational inheritance, epimutations established in gametes persist through the first round of epigenetic reprogramming occurring during preimplantation development. For transgenerational inheritance, epimutations persist additionally throughout the reprogramming that occurs during germ cell development later in embryogenesis. Differentially expressed transcripts, genomic cytosine methylations, and several chemical modifications of histones are prime candidates for tangible marks which may serve as epimutations in inter- and transgenerational inheritance and which are currently being investigated experimentally. We review, here, the current literature in support of epigenetic inheritance of metabolic traits caused by nutritional constraints and potential mechanisms in man and in rodent model systems.
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Affiliation(s)
- Daniela Kaspar
- Institute of Experimental Genetics, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Sieglinde Hastreiter
- Institute of Experimental Genetics, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Martin Irmler
- Institute of Experimental Genetics, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Martin Hrabé de Angelis
- Institute of Experimental Genetics, Helmholtz Zentrum München GmbH, Neuherberg, Germany
- Chair of Experimental Genetics, Technische Universität München, Weihenstephan, Germany
- Deutsches Zentrum für Diabetesforschung E.V. (DZD), Neuherberg, Germany
| | - Johannes Beckers
- Institute of Experimental Genetics, Helmholtz Zentrum München GmbH, Neuherberg, Germany.
- Chair of Experimental Genetics, Technische Universität München, Weihenstephan, Germany.
- Deutsches Zentrum für Diabetesforschung E.V. (DZD), Neuherberg, Germany.
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Tesfay F, Ziersch A, Mwanri L, Javanparast S. Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study. PLoS One 2020; 15:e0231859. [PMID: 32339181 PMCID: PMC7185904 DOI: 10.1371/journal.pone.0231859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 04/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Addressing malnutrition is one of the key components of HIV care among people living with HIV. Since 2010, a nutritional program has been implemented to address malnutrition amongst HIV patients in Ethiopia, with patients enrolled in the program for 3 months (for mild acute malnutrition) and 6 months (for severe acute malnutrition). However, utilisation and effectiveness of the nutritional programs remain unexplored. This study aimed to examine individual level determinants and contextual factors influencing the effectiveness of the nutritional program in the Tigray region of Ethiopia. METHODS AND SETTING The study employed a mixed-methods approach involving quantitative and qualitative research methods. In the quantitative phase of the study, records from 1757 adult patients, including socio-demographic characteristics, clinical and nutritional program outcomes were retrieved from three selected hospitals in the Tigray region, Ethiopia. Logistic regression analysis was used to identify the individual demographic and socioeconomic, clinical and immunological, and anthropometric and nutritional determinants of nutritional outcomes. The qualitative study included 33 individual interviews with adult patients, health providers, and program managers. Interview data were analysed using a framework analysis approach. RESULTS Amongst study participants, 55.3% (95% CI = 53.2‒57.4) recovered from malnutrition, 19% (95% CI, 17.3‒20.7) did not complete the program, and 21% (95% CI = 19.7‒23.4) completed the program but failed to recover from malnutrition. In the multivariable logistic regression analysis, those who were: living in urban areas (AOR = 1.44, 95% CI = 1.05‒1.97), employed (AOR = 1.39, 95% CI = 1.01‒1.93), attending Shul (AOR = 4.6, 95% CI = 3.15‒6.71) and Lemlem Karl (AOR = 2.5, 95% CI = 1.69‒3.71) hospitals, in clinical stages II (AOR = 2.49, 95% CI = 1.59‒3.91) and III (AOR = 1.46(1.02‒2.07), on ART for less than six months (AOR = 1.61, 95% CI = 1.09‒2.39), anaemic (AOR = 1.77, 95% = 1.29‒2.41), and diagnosed with severe acute malnutrition at enrolment (AOR = 6.43, 95% CI = 4.69‒8.3); were less likely to complete the program. Results for those who completed the program indicated that urban residence, (AOR = 1.46, 95% CI = 1.4‒2.91), attending Shul (AOR = 2.92, 95% CI = 2.04‒4.19) and Lemlem Karl (AOR = 1.49, 95% CI 1.05‒2.11) hospitals, having bedridden functional status (AOR = 0.36, 95% CI = 0.15‒0.83), advanced WHO clinical stage (WHO clinical stage IV) (AOR = 0.52, 95% CI = 0.28‒0.98) and severe malnutrition at enrolment (AOR = 4.25, 95% CI = 3.02‒5.98)) predicted non-response to the nutritional program. Qualitative interviews revealed that the taste and perceived side effects of the nutritional supplement provided as part of the nutritional program, sharing/selling practices, religious and sociocultural issues, distance and poor access to the health services were barriers to program utilisation. Nutritional counselling and health service-related factors such as a previous enrolment in the program and positive experience in the health service were enablers of program utilisation. CONCLUSION There was a clear nexus between contextual factors such as distance, quality of health service and sociocultural factors, and individual patient characteristics with the effectiveness of the nutritional program. Taking individual and contextual factors into consideration in program design, planning and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV.
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Affiliation(s)
- Fisaha Tesfay
- Southgate Institute for Health, Society and Equity, Flinders University- Australia, Bedford Park, Australia
- School of Public Health, Mekelle University–Ethiopia, Addis Ababa, Ethiopia
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University- Australia, Bedford Park, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University-Australia, Bedford Park, Australia
| | - Sara Javanparast
- College of Medicine and Public Health, Flinders University-Australia, Bedford Park, Australia
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Rey-Cadilhac L, Cariou R, Ferlay A, Jondreville C, Delavaud C, Faulconnier Y, Alcouffe S, Faure P, Marchand P, Le Bizec B, Jurjanz S, Lerch S. Undernutrition combined with dietary mineral oil hastens depuration of stored dioxin and polychlorinated biphenyls in ewes. 1. Kinetics in blood, adipose tissue and faeces. PLoS One 2020; 15:e0230629. [PMID: 32231376 PMCID: PMC7108735 DOI: 10.1371/journal.pone.0230629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
Food safety crises involving persistent organic pollutants [POPs, e.g. dioxins, polychlorinated biphenyls (PCBs), organochlorine pesticides] lead to systematic slaughter of livestock to prevent their entry into the food chain. Therefore, there is a need to develop strategies to depurate livestock moderately contaminated with POPs in order to reduce such economic and social damages. This study aimed to test a POPs depuration strategy based on undernutrition (37% of energy requirements) combined with mineral oil (10% in total dry matter intake) in nine non-lactating ewes contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and PCBs 126 and 153. In order to better understand the underlying mechanisms of the depuration process, POPs kinetics and body lipids dynamics were followed concomitantly over 57-day of depuration in POPs storage (adipose tissue, AT), central distribution (blood) and excretion (faeces) compartments. Faecal POPs concentrations in underfed and mineral oil supplemented ewes increased by 2.0 to 2.6-fold, but not proportionally to lipids concentration which increased by 6-fold, compared to the control ewes. Nonetheless, after 57 days of depuration in undernutrition and mineral oil supplementation, AT POPs concentrations were 1.5 to 1.6-fold higher while serum concentrations remained unchanged compared to the control ewes. This was concomitant with a decrease by 2.7-fold of the AT estimated lipids weight along the depuration period. This reduction of the volume of the storage compartment combined with the increase of POPs faecal excretion in underfed and mineral oil supplemented ewes led to a reduction by 1.5-fold of the PCB 126 AT burden, while no changes were observed for TCDD and PCB 153 burdens (vs. no change for PCB 126 and increases for TCDD and PCB 153 AT burdens in control ewes). The original approach of this study combining the fine description at once of POPs kinetic and of body lipids dynamic improved our understanding of POPs fate in the ruminant.
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Affiliation(s)
- Lucille Rey-Cadilhac
- UR AFPA, Université de Lorraine, INRAE, Nancy, France
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
| | | | - Anne Ferlay
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
| | | | - Carole Delavaud
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
| | - Yannick Faulconnier
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
| | | | - Pascal Faure
- UE Herbipôle, INRAE, Saint-Genès-Champanelle, France
| | | | | | | | - Sylvain Lerch
- UR AFPA, Université de Lorraine, INRAE, Nancy, France
- Ruminant Research Unit, Agroscope, Posieux, Switzerland
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25
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Lerch S, Rey-Cadilhac L, Cariou R, Faulconnier Y, Jondreville C, Roux D, Dervilly-Pinel G, Le Bizec B, Jurjanz S, Ferlay A. Undernutrition combined with dietary mineral oil hastens depuration of stored dioxin and polychlorinated biphenyls in ewes. 2. Tissue distribution, mass balance and body burden. PLoS One 2020; 15:e0230628. [PMID: 32231383 PMCID: PMC7108722 DOI: 10.1371/journal.pone.0230628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
Food safety crises involving persistent organic pollutants (POPs) lead to systematic slaughter of livestock to prevent contaminants from entering the food chain. Therefore, there is a need to develop strategies to depurate livestock moderately contaminated with POPs to reduce economic and social damage. This study aimed to test undernutrition (37% of energy requirements) combined with mineral oil (10% in total dry matter intake) in nine non-lactating ewes contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and polychlorinated biphenyls (PCBs) 126 and 153 as a strategy to enhance the depuration of POPs through faecal excretion. To better understand the underlying mechanisms of the depuration process, lipophilic POPs and lipid fluxes were co-monitored in various body and excretion compartments. Body compartments (adipose tissues, muscle, liver and blood) and the total empty body were analyzed for lipids and POPs concentrations and burdens at slaughter, as well as excretion compartments (faeces and wool) collected during the depuration period. Decreases in empty body total and lipid weights were 6-fold higher in underfed and supplemented ewes compared to control ewes. In addition, over the depuration period undernutrition and supplementation treatment increased faecal TCDD, PCBs 126 and 153 excretions by 1.4- to 2.1-fold but tended to decrease wool PCB 153 excretion by 1.4-fold. This induced 2- to 3-fold higher decreases in the empty body POPs burdens for underfed and supplemented ewes. Nonetheless, when expressed relative to the calculated initial empty body burdens, burdens at slaughter decreased only slightly from 97%, 103% and 98% for control ewes to 92%, 97% and 94% for underfed and supplemented ones, for TCDD, PCBs 126 and 153, respectively. Fine descriptions at once of POPs kinetic (companion paper 1) and mass balance (companion paper 2), and of body lipid dynamics were very useful in improving our understanding of the fate of POPs in the ruminants.
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Affiliation(s)
- Sylvain Lerch
- UR AFPA, Université de Lorraine, INRAE, Nancy, France
- Ruminant Research Unit, Agroscope, Posieux, Switzerland
| | - Lucille Rey-Cadilhac
- UR AFPA, Université de Lorraine, INRAE, Nancy, France
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
| | | | - Yannick Faulconnier
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
| | | | - Denis Roux
- UE Herbipôle, INRAE, Saint-Genès-Champanelle, France
| | | | | | | | - Anne Ferlay
- UMR Herbivores, Université Clermont Auvergne, INRAE, VetAgro Sup, Saint-Genès-Champanelle, France
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Chowdhury F, Shahid ASMSB, Ghosh PK, Rahman M, Hassan MZ, Akhtar Z, Muneer SME, Shahrin L, Ahmed T, Chisti MJ. Viral etiology of pneumonia among severely malnourished under-five children in an urban hospital, Bangladesh. PLoS One 2020; 15:e0228329. [PMID: 32017782 PMCID: PMC6999894 DOI: 10.1371/journal.pone.0228329] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 01/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In Bangladesh, pneumonia has a higher mortality among malnourished children aged <5 years. Evaluating pneumonia etiology among malnourished children may help improve empiric treatment guidelines. METHODS During April 2015-December 2017, we conducted a case-control study among severe acute malnourished (SAM) children aged <5 years admitted to the Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). We enrolled hospital admitted SAM children with clinical or radiological pneumonia as cases (during April 2015 to March 2017) and hospital admitted SAM children without any respiratory symptom in the past 10 days before admission as controls (during February 2016 to December 2017). We tested nasopharyngeal wash from both case and control for respiratory syncytial virus (RSV), human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV), rhinovirus and adenovirus by singleplex real-time reverse transcriptase polymerase chain reaction. To identify the independent association of pneumonia with viral pathogens during February 2016 to March 2017, we used multivariable logistic regression for calculating adjusted odds ratios. RESULTS We enrolled 360 cases and 334 controls. For case and control the median age was 8 months (IQR: 5-13) and 11 months (IQR: 6-18) (p = 0.001) respectively. Weight/age Z-score was -4.3 (SD ±0.7) for cases and -4.1 (SD ±1.1) for controls (p = 0.01). Among cases 68% had both clinical and radiological pneumonia, 1% had clinical pneumonia and 31% had only radiological pneumonia. Respiratory virus detection was high in cases compared to controls [69.9% (251) vs. 44.8% (148), p = 0.0001]. The most frequently detected viruses among cases were rhinoviruses (79, 22.0%) followed by RSV (32, 8.9%), adenovirus (23, 6.4%), HPIV (22, 6.1%), influenza virus (16, 4.5%), and HMPV (16, 4.5%). Among the controls, rhinoviruses (82, 24.8%) were most commonly detected one followed by adenovirus (26,7.9%), HMPV (5, 1.5%), HPIV (4, 1.2%), RSV (3, 0.9%), and influenza virus (2, 0.6%). RSV (OR 13.1; 95% CI: 1.6, 106.1), influenza virus (OR 8.7; 95% CI: 1.0, 78.9), HPIV (3.8; 95% CI: 1.0, 14.8), and HMPV (2.7; 95% CI: 1.3, 5.5) were independently associated with pneumonia while compared between 178 cases and 174 controls. CONCLUSION Viral etiology of pneumonia in SAM children were mainly attributable to RSV, influenza, HPIV and HMPV. Our study findings may help in planning further studies targeting vaccines or drugs against common respiratory viruses responsible for pneumonia among SAM children.
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Affiliation(s)
- Fahmida Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Probir Kumar Ghosh
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Zakiul Hassan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zubair Akhtar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S. Mah-E- Muneer
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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McKenna CG, Bartels SA, Pablo LA, Walker M. Women's decision-making power and undernutrition in their children under age five in the Democratic Republic of the Congo: A cross-sectional study. PLoS One 2019; 14:e0226041. [PMID: 31809519 PMCID: PMC6897415 DOI: 10.1371/journal.pone.0226041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/19/2019] [Indexed: 11/18/2022] Open
Abstract
Undernutrition in children remains a major global health issue and the prevalence of undernutrition in children under age five in the Democratic Republic of the Congo (DRC) is among the highest in the world. Both biological and socioeconomic factors contribute to undernutrition, and the literature reports an association between women’s empowerment and lower rates of child undernutrition in sub-Saharan Africa. However, the relationship between women’s decision-making power and child undernutrition is less understood. The objective of this study was to evaluate the association between women’s decision-making power and stunting/wasting in their children under age five in the DRC. This study used cross-sectional data from the 2013–2014 DRC Demographic and Health Survey, from which a sample of 3,721 woman-child pairs were identified. Women were classified as having decision-making power in five decision-making dimensions if they participated in the decision either alone or jointly with their husband or partner or someone else. Child height-for-age and weight-for-height Z-scores were used to determine stunting and wasting, respectively, according to the World Health Organization Child Growth Standards. Multivariate regression analyses demonstrated that none of the five dimensions of decision-making power were associated with stunting or wasting in children. Further research that evaluates women’s decision-making power with more detailed, relevant and context-specific measures is warranted to more accurately investigate women’s decision-making power and undernutrition in children.
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Affiliation(s)
- Caroline G. McKenna
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Susan A. Bartels
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
| | - Lesley A. Pablo
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Melanie Walker
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
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McHenry MS, Apondi E, Ayaya SO, Yang Z, Li W, Tu W, Bi G, Sang E, Vreeman RC. Growth of young HIV-infected and HIV-exposed children in western Kenya: A retrospective chart review. PLoS One 2019; 14:e0224295. [PMID: 31800588 PMCID: PMC6892498 DOI: 10.1371/journal.pone.0224295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/09/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction The objective of this study was to determine the growth patterns, rates of malnutrition, and factors associated with malnutrition in children born to HIV-infected mothers in western Kenya using data from an electronic medical record system. Methods This study was a retrospective chart review of HIV-infected (HIV+) and–exposed (HEU) children (<5 years) using data collected prospectively in the course of routine clinical care and stored in the electronic medical record system in western Kenya between January 2011 and August 2016. Demographics and anthropometrics were described, with Chi-square testing to compare proportions. Multiple variable logistic regression analysis was used to identify correlates of children being stunted, underweight, and wasted. We also examined growth curves, using a resampling method to compare the areas under the fitted growth curves to compare males/females and HIV+/HEU. Results Data from 15,428 children were analyzed. The children were 51.6% (n = 7,955) female, 5.2% (n = 809) orphans, 83.3% (n = 12,851) were HEU, and 16.7% (n = 2,577) were HIV+. For HIV+ children assessed at 24 months, 50.9% (n = 217) were stunted, 26.5% (n = 145) were underweight, and 13.6% (n = 58) were wasted, while 45.0% (n = 577) of HEU children were stunted, 14.8% (n = 255) were underweight, and 5.1% (n = 65) were wasted. When comparing mean z-scores, HIV+ children tended to have larger and earlier dips in z-scores compared to HIV-exposed children, with significant differences found between the two groups (p<0.001). Factors associated with an increased risk of malnutrition included being male, HIV+, and attending an urban clinic. Maternal antiretroviral treatment during pregnancy and mixed feeding at 3 months of age decreased the risk of malnutrition. Conclusions HIV+ and HEU children differ in their anthropometrics, with HIV+ children having overall lower z-scores. Continued efforts to develop and implement sustainable and effective interventions for malnutrition are needed for children born to HIV+ mothers.
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Affiliation(s)
- Megan S. McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- * E-mail:
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Samuel O. Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Wenfang Li
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Guanying Bi
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rachel C. Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Schlomer T, Di Lucca J, Bart PA. [Cutaneous manifestations of nutritional deficiencies]. Rev Med Suisse 2019; 15:2125-2130. [PMID: 31746568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In elderly or chronically ill patients, nutritional deficiencies are common and the presence of related skin lesions is not unusual. Recognition of such cutaneous involvement is important regarding the diagnosis essentially based on clinical elements. By using some clinical case reports, we will describe several pathologies related to nutritional deficiencies like scurvy, pellagra and acquired acrodermatitis enteropathica.
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Affiliation(s)
- Tatiana Schlomer
- Service de médecine interne, Département de médecine, CHUV, 1011 Lausanne
| | - Julie Di Lucca
- Service de dermatologie, Département de médecine, CHUV, 1011 Lausanne
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Colston JM, Peñataro Yori P, Moulton LH, Paredes Olortegui M, Kosek PS, Rengifo Trigoso D, Siguas Salas M, Schiaffino F, François R, Fardus-Reid F, Swann JR, Kosek MN. Penalized regression models to select biomarkers of environmental enteric dysfunction associated with linear growth acquisition in a Peruvian birth cohort. PLoS Negl Trop Dis 2019; 13:e0007851. [PMID: 31730639 PMCID: PMC6881068 DOI: 10.1371/journal.pntd.0007851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/27/2019] [Accepted: 10/16/2019] [Indexed: 12/02/2022] Open
Abstract
Environmental enteric dysfunction (EED) is associated with chronic undernutrition. Efforts to identify minimally invasive biomarkers of EED reveal an expanding number of candidate analytes. An analytic strategy is reported to select among candidate biomarkers and systematically express the strength of each marker’s association with linear growth in infancy and early childhood. 180 analytes were quantified in fecal, urine and plasma samples taken at 7, 15 and 24 months of age from 258 subjects in a birth cohort in Peru. Treating the subjects’ length-for-age Z-score (LAZ-score) over a 2-month lag as the outcome, penalized linear regression models with different shrinkage methods were fitted to determine the best-fitting subset. These were then included with covariates in linear regression models to obtain estimates of each biomarker’s adjusted effect on growth. Transferrin had the largest and most statistically significant adjusted effect on short-term linear growth as measured by LAZ-score–a coefficient value of 0.50 (0.24, 0.75) for each log2 increase in plasma transferrin concentration. Other biomarkers with large effect size estimates included adiponectin, arginine, growth hormone, proline and serum amyloid P-component. The selected subset explained up to 23.0% of the variability in LAZ-score. Penalized regression modeling approaches can be used to select subsets from large panels of candidate biomarkers of EED. There is a need to systematically express the strength of association of biomarkers with linear growth or other outcomes to compare results across studies. Childhood undernutrition is widespread throughout the world and has severe, long-lasting health impacts. Substances measured in blood, urine and stool could be used as biomarkers to identify children undergoing growth failure before these impacts occur. However, it is not yet known which of the many markers that can be identified are accurate and clinically useful predictors of poor growth in infants and children. This study used a large number of candidate biomarkers of immune activation, metabolism and hormones and applied statistical methods to narrow them down from 110 different substances, to the 36 best predictors of growth in 258 Peruvian infants. It also estimated how large the effect of each of these markers was on height two months later. The biomarker with the largest effect was transferrin, a glycoprotein that can be measured in blood samples. 15-month old children with elevated transferrin were around two thirds of a centimeter taller on average at 17 months than those with low levels. Transferrin and other proteins, glycoproteins, hormones and antibodies that this study identified, can be measured easily and affordably in standard laboratories making them feasible to be used broadly as prognostic markers as part of child health and nutrition programs in under-resourced settings.
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Affiliation(s)
- Josh M. Colston
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | | | - Peter S. Kosek
- Oregon Neurosurgery, Eugene, Oregon, United States of America
| | | | | | - Francesca Schiaffino
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Ruthly François
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Fahmina Fardus-Reid
- Division of Integrative Systems Medicine and Digestive Diseases, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan R. Swann
- Division of Integrative Systems Medicine and Digestive Diseases, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Margaret N. Kosek
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
- * E-mail:
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Oliwa JN, Gathara D, Ogero M, van Hensbroek MB, English M, van’t Hoog A. Diagnostic practices and estimated burden of tuberculosis among children admitted to 13 government hospitals in Kenya: An analysis of two years' routine clinical data. PLoS One 2019; 14:e0221145. [PMID: 31483793 PMCID: PMC6726144 DOI: 10.1371/journal.pone.0221145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND True burden of tuberculosis (TB) in children is unknown. Hospitalised children are low-hanging fruit for TB case detection as they are within the system. We aimed to explore the process of recognition and investigation for childhood TB using a guideline-linked cascade of care. METHODS This was an observational study of 42,107 children admitted to 13 county hospitals in Kenya from 01Nov 15-31Oct 16, and 01Nov 17-31Oct 18. We estimated those that met each step of the cascade, those with an apparent (or "Working") TB diagnosis and modelled associations with TB tests amongst guideline-eligible children. RESULTS 23,741/42,107 (56.4%) met step 1 of the cascade (≥2 signs and symptoms suggestive of TB). Step 2(further screening of history of TB contact/full respiratory exam) was documented in 14,873/23,741 (62.6%) who met Step 1. Step 3(chest x-ray or Mantoux test) was requested in 2,451/14,873 (16.5%) who met Step 2. Step 4(≥1 bacteriological test) was requested in 392/2,451 (15.9%) who met Step 3. Step 5("Working TB" diagnosis) was documented in 175/392 (44.6%) who met Step 4. Factors associated with request of TB tests in patients who met Step 1 included: i) older children [AOR 1.19(CI 1.09-1.31)]; ii) co-morbidities of HIV, malnutrition or pneumonia [AOR 3.81(CI 3.05-4.75), 2.98(CI 2.69-3.31) and 2.98(CI 2.60-3.40) respectively]; iii) sicker children, readmitted/referred [AOR 1.24(CI 1.08-1.42) and 1.15(CI 1.04-1.28) respectively]. "Working TB" diagnosis was made in 2.9%(1,202/42,107) of all admissions and 0.2%(89/42,107) were bacteriologically-confirmed. CONCLUSIONS More than half of all paediatric admissions had symptoms associated with TB and nearly two-thirds had more specific history documented. Only a few amongst them got TB tests requested. TB was diagnosed in 2.9% of all admissions but most were inadequately investigated. Major challenges remain in identifying and investigating TB in children in hospitals with access to Xpert MTB/RIF and a review is needed of existing guidelines.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- University of Nairobi, Department of Paediatrics and Child Health, Nairobi, Kenya
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Morris Ogero
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Michaël Boele van Hensbroek
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- Oxford University, Nuffield Department of Medicine, Oxford, England, United Kingdom
| | - Anja van’t Hoog
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
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Deus AFD, Silva VLD, de Souza SLB, Mota GAF, Sant'Ana PG, Vileigas DF, Lima-Leopoldo AP, Leopoldo AS, Campos DHSD, de Tomasi LC, Padovani CR, Kolwicz SC, Cicogna AC. Myocardial Dysfunction after Severe Food Restriction Is Linked to Changes in the Calcium-Handling Properties in Rats. Nutrients 2019; 11:nu11091985. [PMID: 31443528 PMCID: PMC6770438 DOI: 10.3390/nu11091985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Severe food restriction (FR) impairs cardiac performance, although the causative mechanisms remain elusive. Since proteins associated with calcium handling may contribute to cardiac dysfunction, this study aimed to evaluate whether severe FR results in alterations in the expression and activity of Ca2+-handling proteins that contribute to impaired myocardial performance. Male 60-day-old Wistar–Kyoto rats were fed a control or restricted diet (50% reduction in the food consumed by the control group) for 90 days. Body weight, body fat pads, adiposity index, as well as the weights of the soleus muscle and lung, were obtained. Cardiac remodeling was assessed by morphological measures. The myocardial contractile performance was analyzed in isolated papillary muscles during the administration of extracellular Ca2+ and in the absence or presence of a sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) specific blocker. The expression of Ca2+-handling regulatory proteins was analyzed via Western Blot. Severe FR resulted in a 50% decrease in body weight and adiposity measures. Cardiac morphometry was substantially altered, as heart weights were nearly twofold lower in FR rats. Papillary muscles isolated from FR hearts displayed mechanical dysfunction, including decreased developed tension and reduced contractility and relaxation. The administration of a SERCA2a blocker led to further decrements in contractile function in FR hearts, suggesting impaired SERCA2a activity. Moreover, the FR rats presented a lower expression of L-type Ca2+ channels. Therefore, myocardial dysfunction induced by severe food restriction is associated with changes in the calcium-handling properties in rats.
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Affiliation(s)
- Adriana Fernandes de Deus
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Vítor Loureiro da Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Sérgio Luiz Borges de Souza
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | | | - Paula Grippa Sant'Ana
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Danielle Fernandes Vileigas
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Ana Paula Lima-Leopoldo
- Department of Sports, Center of Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075-910, Brazil
| | - André Soares Leopoldo
- Department of Sports, Center of Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075-910, Brazil
| | | | - Loreta Casquel de Tomasi
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Carlos Roberto Padovani
- Department of Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu 18618970, Brazil
| | - Stephen C Kolwicz
- Department of Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA
| | - Antonio Carlos Cicogna
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil.
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Chang CB, Yang RS, Chang LY, Peng JK, Tsai KS, Huang WJ, Yang TH, Chan DC. Fracture types affect clinical outcomes of patients managed within the fracture liaison and osteoporosis medication management services. Sci Rep 2019; 9:10089. [PMID: 31300660 PMCID: PMC6626060 DOI: 10.1038/s41598-019-46315-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/21/2019] [Indexed: 12/15/2022] Open
Abstract
Osteoporosis medication in fragility fracture patients is associated with better outcomes. However, limited studies have investigated whether fracture types affect outcomes among patients undergoing treatment. We performed a secondary data analysis on participants from a fracture liaison service and an osteoporosis medication management service. Participants (n = 974) were regrouped into hip fracture (HF), vertebral fracture (VF), HF + VF, and NO HF/VF groups at baseline. Bivariate and multivariate logistic regressions were performed to identify baseline correlates on one-year mortality, incident refractures, and falls. Baseline characteristics were different among fracture groups. The HF group was oldest, with the lowest body mass index (BMI), lowest FRAX® T-score and had the highest 10-year fracture risk. After intervention, the HF group still had the highest mortality, but the HF + VF group had the highest refracture and incident fall rates. In the multivariate regression analysis, prevalent HF and VF, lower BMI and albumin level, and having chronic kidney disease or cancer were associated with higher mortality rates. HF + VF patients had the highest refracture risk. Prevalent HF and VF, older age and higher BMI, and having cancer or osteoarthritis were associated with a greater fall risk. HF and VF are associated with adverse outcomes, even under an optimal fracture care.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, Chu-Tung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Rong-Sen Yang
- Department of Orthopaedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Lo-Yu Chang
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, Bei-Hu Branch, National Taiwan University Hospital, Taipei, Taiwan
| | - Keh-Sung Tsai
- Superintendent Office, Far Eastern Polyclinic of Far Eastern Medical Foundation, Taipei, Taiwan
| | - Wei-Jia Huang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Han Yang
- Department of Orthopaedics, Hsinchu Branch, National Taiwan University Hospital, Hsinchu City, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Superintendent Office, Chu-Tung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan.
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Zhou XL, Zhu WG, Zhu ZJ, Wang WW, Deng X, Tao WJ, Ji FZ, Tong YS. Lymphopenia in Esophageal Squamous Cell Carcinoma: Relationship to Malnutrition, Various Disease Parameters, and Response to Concurrent Chemoradiotherapy. Oncologist 2019; 24:e677-e686. [PMID: 31040254 PMCID: PMC6693723 DOI: 10.1634/theoncologist.2018-0723] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/18/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022] Open
Abstract
Management of esophageal squamous cell carcinoma remains challenging, because detection often occurs at advanced stages and because of the high incidence of lymph node metastasis. This article focuses on whether lymphopenia is associated with response and tumor progression in patients with advanced esophageal squamous cell carcinoma who received concurrent chemotherapy. Background. Lymphopenia occurs commonly in esophageal squamous cell carcinoma (ESCC) and may influence treatment outcomes. We aimed to examine its association with treatment response and tumor progression in patients with locally advanced ESCC treated with concurrent chemoradiotherapy (CCRT). Materials and Methods. A total of 286 patients with stage II–IVa ESCC treated with CCRT between 2015 and 2017 were analyzed. Total lymphocyte counts were assessed at baseline, weekly, and 4 weeks after CCRT. Pretreatment lymphopenia was defined as total lymphocyte count <1,000 cells per mm3 at diagnosis, and treatment‐related lymphopenia was defined as total lymphocyte count <200 cells per mm3 with 6 weeks after starting CCRT. Univariate and multivariate logistic regression methods were used to analyze factors associated treatment‐related lymphopenia and treatment response. Results. Lymphopenia was observed in 44 patients (15.4%) at initial diagnosis. Pretreatment lymphopenia was significantly associated with greater tumor length, worse T status, body mass index ≤18.5 kg/m2, and weight loss ≥3 kg in the previous 3 months. Six weeks after starting CCRT, 89 patients (31%) developed treatment‐related lymphopenia. Tumor progression and cancer‐related death were more frequently observed in treatment‐related lymphopenia group than those without (76.4% vs. 52.8% and 58.4% vs. 39.6%). A complete response (CR) was achieved in 62 patients (21.7%). In multivariate analysis, treatment‐related lymphopenia was significantly associated with lack of clinical CR, and older age, lower tumor location, greater tumor length, and larger planning target volume were independent predictors of treatment‐related lymphopenia. Conclusion. Treatment‐related lymphopenia during CCRT is an independent predictor for poor treatment response in ESCC. Implications for Practice. A total of 286 patients with locally advanced esophageal squamous cell carcinoma were treated with concurrent chemoradiotherapy (CCRT), and treatment‐related lymphopenia occurred in 31% of patients within 6 weeks from the start of CCRT. Treatment‐related lymphopenia was significantly associated with lack of treatment response, and older age, lower tumor location, greater tumor length, and larger planning target volume were independent predictors of treatment‐related lymphopenia. Lymphocyte count is an inexpensive biomarker that may be easily used by clinicians to identify patients who are most likely to benefit from CCRT.
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Affiliation(s)
- Xi-Lei Zhou
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Wei-Guo Zhu
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Zhi-Jian Zhu
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Wan-Wei Wang
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Xue Deng
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Wei-Jing Tao
- Department of Radiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Fu-Zhi Ji
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Yu-Suo Tong
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
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Hoyt KJ, Sarkar S, White L, Joseph NM, Salgame P, Lakshminarayanan S, Muthaiah M, Vinod Kumar S, Ellner JJ, Roy G, Horsburgh CR, Hochberg NS. Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis. PLoS One 2019; 14:e0214011. [PMID: 30917170 PMCID: PMC6436704 DOI: 10.1371/journal.pone.0214011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. METHODS Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2. RESULTS Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP. CONCLUSION We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.
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Affiliation(s)
- Kacie J. Hoyt
- Department of Epidemiology, Boston University, Boston, MA, United States of America
- * E-mail: (KH); (NSH)
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - Laura White
- Department of Biostatistics, Boston University, Boston, MA, United States of America
| | | | - Padmini Salgame
- Rutgers—New Jersey Medical School, Newark, NJ, United States of America
| | | | - Muthuraj Muthaiah
- Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India
| | | | - Jerrold J. Ellner
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Gautam Roy
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - C. Robert Horsburgh
- Department of Epidemiology, Boston University, Boston, MA, United States of America
- Department of Biostatistics, Boston University, Boston, MA, United States of America
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Natasha S. Hochberg
- Department of Epidemiology, Boston University, Boston, MA, United States of America
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
- * E-mail: (KH); (NSH)
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Hsu YH, Chou MY, Chu CS, Liao MC, Wang YC, Lin YT, Chen LK, Liang CK. Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study. J Nutr Health Aging 2019; 23:876-882. [PMID: 31641739 DOI: 10.1007/s12603-019-1246-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. DESIGN Prospectively longitudinal cohort study. SETTING AND PARTICIPANTS The study recruited 354 men aged 65 years and older in the veteran's retirement community. MEASURES Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. RESULTS According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). CONCLUSIONS Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.
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Affiliation(s)
- Y-H Hsu
- Chih-Kuang Liang, Address: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.), Phone: 886-7-3422526, E-mail:
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Abstract
Leptin, a pleiotropic protein has long been recognized to play an important role in the regulation of energy homeostasis, metabolism, neuroendocrine function, and other physiological functions through its effects on the central nervous system (CNS) and peripheral tissues. Leptin is secreted by adipose tissue and encoded by the obese (ob) gene. Leptin acts as a central mediator which regulates immunity as well as nutrition. Importantly, leptin can modulate both innate and adaptive immune responses. Leptin deficiency/resistance is associated with dysregulation of cytokine production, increased susceptibility toward infectious diseases, autoimmune disorders, malnutrition and inflammatory responses. Malnutrition induces a state of immunodeficiency and an inclination to death from communicable diseases. Infectious diseases are the disease of poor who invariably suffer from malnutrition that could result from reduced serum leptin levels. Thus, leptin has been placed at the center of many interrelated functions in various pathogenic conditions, such as bacterial, viruses and parasitic infections. We review herein, the recent advances on the role of leptin in malnutrition in pathogenesis of infectious diseases with a particular emphasis on parasitic diseases such as Leishmaniasis, Trypanosomiasis, Amoebiasis, and Malaria.
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Affiliation(s)
- Radheshyam Maurya
- Department of Animal Biology, School of Life Science, University of Hyderabad, Hyderabad, India
| | - Parna Bhattacharya
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Ranadhir Dey
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Hira L. Nakhasi
- Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
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Husseini M, Darboe MK, Moore SE, Nabwera HM, Prentice AM. Thresholds of socio-economic and environmental conditions necessary to escape from childhood malnutrition: a natural experiment in rural Gambia. BMC Med 2018; 16:199. [PMID: 30382849 PMCID: PMC6211595 DOI: 10.1186/s12916-018-1179-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood malnutrition remains highly prevalent in low-income countries, and a 40% reduction in under-5 year stunting is WHO's top Global Target 2025. Disappointingly, meta-analyses of intensive nutrition interventions reveal that they generally have low efficacy at improving growth. Unhygienic environments also contribute to growth failure, but large WASH Benefits and SHINE trials of improved water, sanitation and hygiene (WASH) recently reported no benefits to child growth. METHODS To explore the thresholds of socio-economic status (SES) and living standards associated with malnutrition, we exploited a natural experiment in which the location of our research centre within a remote rural village created a wide diversity of wealth, education and housing conditions within the same ecological setting and with free health services to all. A composite SES score was generated by grading occupation, education, income, water and sanitation, and housing and families were allocated to 5 groups (SES1 = highest). SES ranged from very poor subsistence-farming villagers to post graduate staff with overseas training. Nutritional status at 24 m was obtained from clinic records for 230 children and expressed relative to WHO Growth Standards. RESULTS Height-for-age (HAZ) and weight-for-age (WAZ) Z-scores were strongly predicted by SES group. HAZ varied from - 0.67 to - 2.23 (P < 0.001) and WAZ varied from - 0.90 to - 1.64 (P < 0.001), from SES1 to SES5, respectively. Weight-for-height (WHZ) showed no gradient. Children in SES1 showed greater dispersion so were further divided in a post hoc analysis. Children resident in Western housing on the research compound (SES1A) had HAZ = + 0.68 and WAZ = + 0.36. The residual gradient between those in SES1B and SES5 spanned only 0.65 Z-score for HAZ (- 1.58 to - 2.23) and was not significant for WAZ or WHZ. CONCLUSIONS The large difference in growth between children in SES1A living in Western-type housing and SES1B children living in the village, and the very shallow gradient between SES1B and SES5, implies a very high SES threshold before stunting and underweight will be eliminated. This may help to explain the lack of efficacy of the recent WASH interventions and points to the need for what is termed 'Transformative WASH'. Good quality housing, with piped water into the home, may be key to eliminating malnutrition.
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Affiliation(s)
- Mayya Husseini
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Regional Activity Centre for Sustainable Consumption and Production (SCP/RAC), Sant Pau Art Nouveau Site, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Momodou K Darboe
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Helen M Nabwera
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
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Daghma DES, Malhan D, Simon P, Stötzel S, Kern S, Hassan F, Lips KS, Heiss C, El Khassawna T. Computational segmentation of collagen fibers in bone matrix indicates bone quality in ovariectomized rat spine. J Bone Miner Metab 2018; 36:297-306. [PMID: 28589410 DOI: 10.1007/s00774-017-0844-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 04/25/2017] [Indexed: 12/13/2022]
Abstract
Bone loss varies according to disease and age and these variations affect bone cells and extracellular matrix. Osteoporosis rat models are widely investigated to assess mechanical and structural properties of bone; however, bone matrix proteins and their discrepant regulation of diseased and aged bone are often overlooked. The current study considered the spine matrix properties of ovariectomized rats (OVX) against control rats (Sham) at 16 months of age. Diseased bone showed less compact structure with inhomogeneous distribution of type 1 collagen (Col1) and changes in osteocyte morphology. Intriguingly, demineralization patches were noticed in the vicinity of blood vessels in the OVX spine. The organic matrix structure was investigated using computational segmentation of collagen fibril properties. In contrast to the aged bone, diseased bone showed longer fibrils and smaller orientation angles. The study shows the potential of quantifying transmission electron microscopy images to predict the mechanical properties of bone tissue.
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Affiliation(s)
- Diaa Eldin S Daghma
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Deeksha Malhan
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Paul Simon
- Max Planck Institute for Chemical Physics of Solids, Dresden, Germany
| | - Sabine Stötzel
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Stefanie Kern
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Fathi Hassan
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Katrin Susanne Lips
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Christian Heiss
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Giessen-Marburg, Campus Giessen, Giessen, Germany
| | - Thaqif El Khassawna
- Experimental Trauma Surgery, Justus-Liebig University, Giessen, Aulweg 128, 35392, Giessen, Germany.
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Abstract
Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.
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Affiliation(s)
- M Wleklik
- Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland,
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Abstract
OBJECTIVES Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders. DESIGN Cross-sectional study. SETTING Five community centers run by non-government organizations (NGOs). PARTICIPANTS 195 community dwelling elders (65 or above). MEASUREMENTS An interviewer-administered questionnaire was completed to collect information on elders' socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders' nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA). RESULTS The mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL. CONCLUSION Elders' tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition.
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Affiliation(s)
- L L Wu
- Dr. Xiaoli Gao, Dental Public health, Faculty of Dentistry, The University of Hong Kong, 3rd Floor, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, ;
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Sampaio LS, da Silva PA, Ribeiro VS, Castro-Chaves C, Lara LS, Vieyra A, Einicker-Lamas M. Bioactive lipids are altered in the kidney of chronic undernourished rats: is there any correlation with the progression of prevalent nephropathies? Lipids Health Dis 2017; 16:245. [PMID: 29246161 PMCID: PMC5732436 DOI: 10.1186/s12944-017-0634-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/03/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Undernutrition during childhood leads to chronic diseases in adult life including hypertension, diabetes and chronic kidney disease. Here we explore the hypothesis that physiological alterations in the bioactive lipids pattern within kidney tissue might be involved in the progression of chronic kidney disease. METHODS Membrane fractions from kidney homogenates of undernourished rats (RBD) were submitted to lipid extraction and analysis by thin layer chromatography and cholesterol determination. RESULTS Kidneys from RBD rats had 25% lower cholesterol content, which disturb membrane microdomains, affecting Ca2+ homeostasis and the enzymes responsible for important lipid mediators such as phosphatidylinositol-4 kinase, sphingosine kinase, diacylglicerol kinase and phospholipase A2. We observed a decrease in phosphatidylinositol(4)-phosphate (8.8 ± 0.9 vs. 3.6 ± 0.7 pmol.mg-1.mim-1), and an increase in phosphatidic acid (2.2 ± 0.8 vs. 3.8 ± 1.3 pmol.mg-1.mim-1), being these lipid mediators involved in the regulation of key renal functions. Ceramide levels are augmented in kidney tissue from RBD rats (18.7 ± 1.4 vs. 21.7 ± 1.5 fmol.mg-1.min-1) indicating an ongoing renal lesion. CONCLUSION Results point to an imbalance in the bioactive lipid generation with further consequences to key events related to kidney function, thus contributing to the establishment of chronic kidney disease.
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Affiliation(s)
- Luzia S Sampaio
- Instituto de Biofísica Carlos Chagas Filho - CCS, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Paulo A da Silva
- Instituto de Biofísica Carlos Chagas Filho - CCS, UFRJ, Rio de Janeiro, RJ, Brazil
- Programa de Pós-Graduação em Biomedicina Translacional, Universidade do Grande Rio, Duque de Caxias, RJ, Brazil
| | | | | | - Lucienne S Lara
- Instituto de Ciências Biomédicas, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Adalberto Vieyra
- Instituto de Biofísica Carlos Chagas Filho - CCS, UFRJ, Rio de Janeiro, RJ, Brazil
- Programa de Pós-Graduação em Biomedicina Translacional, Universidade do Grande Rio, Duque de Caxias, RJ, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagem (CENABIO), UFRJ, Rio de Janeiro, Brazil
| | - M Einicker-Lamas
- Instituto de Biofísica Carlos Chagas Filho - CCS, UFRJ, Rio de Janeiro, RJ, Brazil.
- Present Address: Laboratório de Biomembranas, Sala G1-037, Bloco G, Instituto de Biofísica Carlos Chagas Filho - CCS, UFRJ, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
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Lee SW, Lee A, Yu MY, Kim SW, Kim KI, Na KY, Chae DW, Kim CH, Chin HJ. Is Frailty a Modifiable Risk Factor of Future Adverse Outcomes in Elderly Patients with Incident End-Stage Renal Disease? J Korean Med Sci 2017; 32:1800-1806. [PMID: 28960032 PMCID: PMC5639060 DOI: 10.3346/jkms.2017.32.11.1800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022] Open
Abstract
Little is known about the clinical significance of frailty and changes of frailty after dialysis initiation in elderly patients with end-stage renal disease (ESRD). We prospectively enrolled 46 elderly patients with incident ESRD at a dialysis center of a tertiary hospital between May 2013 and March 2015. Frailty was assessed by using a comprehensive geriatric assessment protocol and defined as a multidimensional frailty score of ≥ 10. The main outcome was the composite of all-cause death or cardiovascular hospitalization, as determined in June 2016. The median age of the 46 participants was 71.5 years, and 63.0% of them were men. During the median 17.7 months follow-up, the rate of composite outcome was 17.4%. In multivariate logistic regression analysis, after adjusting for age, sex, diabetes, body mass index (BMI), and time of predialytic nephrologic care, female sex, and increased BMI were associated with increased and decreased odds of frailty, respectively. In multivariate Cox proportional hazards analysis, after adjusting for age, sex, diabetes, BMI, and time of predialytic nephrologic care, frailty was significantly associated with the composite adverse outcome. In repeated frailty assessments, the multidimensional frailty score significantly improved 12 months after the initiation of dialysis, which largely relied on improved nutrition. Therefore, frailty needs to be assessed for risk stratification in elderly patients with incident ESRD.
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Affiliation(s)
- Sung Woo Lee
- Department of Internal Medicine, Seoul National University Postgraduate School, Seoul, Korea
- Department of Internal Medicine, Eulji General Hospital, Seoul, Korea
| | - Anna Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Yeon Yu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Postgraduate School, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Wan Chae
- Department of Internal Medicine, Seoul National University Postgraduate School, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Moussa YY, Tawfik SH, Haiba MM, Saad MI, Hanafi MY, Abdelkhalek TM, Oriquat GA, Kamel MA. Disturbed nitric oxide and homocysteine production are involved in the increased risk of cardiovascular diseases in the F1 offspring of maternal obesity and malnutrition. J Endocrinol Invest 2017; 40:611-620. [PMID: 28028785 DOI: 10.1007/s40618-016-0600-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 12/11/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The present study aimed to evaluate the changes in levels of different independent risk factors for vascular diseases in the rat offspring of maternal obesity and malnutrition as maternal health disturbances are thought to have direct consequences on the offspring health. The effect of postnatal diet on the offspring was also assessed. METHODS Three groups of female Wistar rats were used (control, obese and malnourished). After the pregnancy and delivery, the offspring were weaned to control diet or high-caloric (HCD) diet and followed up for 30 weeks. Every 5 weeks postnatal, 20 pups (10 males and 10 females) of each subgroup were sacrificed after overnight fasting, the blood sample was obtained, and the rats were dissected out to obtain heart muscle. The following parameters were assessed; lipid profile, NEFA, homocysteine (Hcy), nitric oxide end product (NOx) and myocardial triglyceride content. RESULTS Maternal obesity and malnutrition caused significant elevation in the body weight, triglycerides, NEFA, Hcy and NOx in the F1 offspring especially those maintained under HCD. Also, the male offspring showed more prominent changes than female offspring. CONCLUSIONS Maternal malnutrition and obesity may increase the risk of the development of cardiovascular diseases in the offspring, especially the male ones.
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Affiliation(s)
- Y Y Moussa
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - S H Tawfik
- Molecular Medicine Department, Padova University, Padua, Italy
- Department of Biochemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - M M Haiba
- Department of Biochemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - M I Saad
- Department of Biochemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt.
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia.
| | - M Y Hanafi
- Department of Biochemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - T M Abdelkhalek
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - G A Oriquat
- Faculty of Pharmacy and Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - M A Kamel
- Department of Biochemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Kim EJ, Choi MJ, Lee JH, Oh JE, Seo JW, Lee YK, Yoon JW, Kim HJ, Noh JW, Koo JR. Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients. PLoS One 2017; 12:e0170272. [PMID: 28099511 PMCID: PMC5242490 DOI: 10.1371/journal.pone.0170272] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/02/2017] [Indexed: 01/12/2023] Open
Abstract
Background In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex. Methods Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively. Results The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01–1.25) and 1.09 (1.01–1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio. Conclusions Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.
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Affiliation(s)
- Eun-Jung Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
- Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
| | - Myung-Jin Choi
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jeoung-Hwan Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Ji-Eun Oh
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jang-Won Seo
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
- Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hyung-Jik Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
- Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
- * E-mail:
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Hother AL, Lykke M, Martinussen T, Poulsen HD, Mølgaard C, Sangild PT, Briend A, Hansen CF, Friis H, Michaelsen KF, Thymann T. Corn-Soy-Blend Fortified with Phosphorus to Prevent Refeeding Hypophosphatemia in Undernourished Piglets. PLoS One 2017; 12:e0170043. [PMID: 28081252 PMCID: PMC5231358 DOI: 10.1371/journal.pone.0170043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soy-blends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified product (CSB+) and a product further fortified with skim milk powder (CBS++). METHODS Using a piglet model of undernourished children, we hypothesized that feeding of CSB+, CSB++ or CSB+ with added whey permeate (CSB+/wp) would help to prevent refeeding hypophosphatemia. Pigs were weaned at 4 weeks of age and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). RESULTS Following induction of undernutrition, body weight and length were 29±5% and 67±4% (means±SD) of values in age-matched pigs fed a nutritionally adequate diet, and the mean serum P level was 1.77±0.34 mmol/l. During the first week of refeeding, P levels in the CSB+ pigs decreased to 55% of values before refeeding (P < 0.05) while values in the CSB++ and CSB+/wp pigs were able to maintain their plasma phosphate at a similar level as before refeeding. CONCLUSION We conclude that fortification of CSB with only monocalcium-phosphate does not prevent hypophosphatemia. Dairy products like skim milk powder or whey permeate may represent relevant sources of phosphorus during refeeding. The content and form of phosphorus in such diets need to be carefully evaluated, and the undernourished piglet may be used to test the efficacy of such diets.
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Affiliation(s)
- Anne-Louise Hother
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Mikkel Lykke
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Department of Clinical Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Torben Martinussen
- Department of Public Health, University of Copenhagen, Frederiksberg, Denmark
| | | | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Per Torp Sangild
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Department of Clinical Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Department of International Health, University of Tampere, Tampere, Finland
| | - Christian Fink Hansen
- Department of Large Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Thomas Thymann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Department of Clinical Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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van der Pols-Vijlbrief R, Wijnhoven HAH, Visser M. Perspectives on the Causes of Undernutrition of Community-Dwelling Older Adults: A Qualitative Study. J Nutr Health Aging 2017; 21:1200-1209. [PMID: 29188880 DOI: 10.1007/s12603-017-0872-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults. DESIGN Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed. SETTING Community-dwelling. PARTICIPANTS Older adults. MEASUREMENTS A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition. RESULTS 33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food and appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization. CONCLUSIONS This study provides guidance to better understand the underlying causes of undernutrition from an older adult's perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.
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Affiliation(s)
- R van der Pols-Vijlbrief
- Rachel van der Pols-Vijlbrief, Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands, E-mail address: ; Telephone number: +31 (0)20 59 83 701; Fax number: +31 (0)20 59 86 940
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Sharma Y, Thompson C, Shari R, Hakendorf P, Miller M. Malnutrition in Acutely Unwell Hospitalized Elderly - "The Skeletons Are Still Rattling in the Hospital Closet". J Nutr Health Aging 2017; 21:1210-1215. [PMID: 29188881 DOI: 10.1007/s12603-017-0903-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Malnutrition is common in hospitalized patients with prevalence rates of up to 30% in Australian hospitals with adverse consequences for both the patients and health care services. Despite formulation of nutritional screening protocols, not all hospitalized patients get nutritional screening. Real life screening rates of hospitalized elderly patients are unknown. AIM The present study explored nutrition screening rate in acutely unwell elderly patients admitted in a large tertiary hospital and how these patients fared depending upon their nutrition status. METHODS A prospective cross-sectional study involving 205 general medical patients ≥60years recruited between November 2014 and November 2015. The number of patients who missed nutrition screening were noted and all patients underwent nutritional assessment by a qualified dietitian using PG-SGA and quality of life was measured using EQ-5D 5L. A survival curve was plotted and multivariate cox proportional hazard model was used to adjust for confounders. RESULTS Only 99 (49.7%) patients underwent nutritional screening. One hundred and six (53.5%) patients were confirmed as malnourished by PG-SGA. Malnourished patients had significantly longer length of hospital stay and had worse quality of life. Mortality was significantly higher in malnourished patients at one year (23 (21.7%) vs 4 (4.3%); p<0.001) and cox proportional hazard model suggests that malnutrition significantly affects survival even after adjustment for confounders like age, sex, Charlson index and polypharmacy. CONCLUSION This study confirms that nutrition screening is still suboptimal in elderly hospitalized patients with adverse consequences and suggests need for review of policies to improve screening practices.
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Affiliation(s)
- Y Sharma
- Michelle Miller, Flinders University, Australia,
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He Z, Pu L, Yuan C, Jia M, Wang J. Nutrition deficiency promotes apoptosis of cartilage endplate stem cells in a caspase-independent manner partially through upregulating BNIP3. Acta Biochim Biophys Sin (Shanghai) 2017; 49:25-32. [PMID: 27864279 DOI: 10.1093/abbs/gmw111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/09/2016] [Indexed: 01/07/2023] Open
Abstract
Nutrition deficiency is reported to induce apoptosis of chondrocytes and degeneration of cartilage endplate (CEP) in rabbit. Cartilage endplate stem cells (CESCs) are important for the integrity of structure and function of CEP. Bcl-2/adenovirus E1B 19-kDa-interacting protein 3 (BNIP3) has been reported to regulate apoptosis, autophagy, and cytoprotection. In this study, we aimed to determine whether nutrition deficiency induces apoptosis of CESCs, and whether or not the BNIP3-related pathway is activated in CESCs during nutrition deficiency. CESCs isolated from degenerated human CEP were cultured under normal or nutrition-deficient condition. Then, apoptosis was analyzed by flow cytometry. The expression and intracellular localization of BNIP3 were detected by quantitative real-time polymerase chain reaction, western blot analysis, and immunofluorescence assay, respectively. Mitochondrial membrane potential (MMP) and caspase-3 activity were measured by JC-1 staining and caspase-3 activity assay. Our results showed that nutrition deficiency promotes apoptosis and BNIP3 expression in CESCs. Notably, knockdown of BNIP3 could partially decrease nutrition deficiency-induced apoptosis of CESCs. In addition, nutrition deficiency could also induce upregulation of BNIP3, resulting in mitochondrial translocation of BNIP3 and loss of MMP in CESCs in a time-dependent manner. However, nutrition deficiency showed no effects on caspase-3 activity in CESCs. In summary, nutrition deficiency may promote CESC apoptosis partially through upregulating BNIP3, which might lead to activation of the BNIP3-related pathway and apoptosis of CESCs in a caspase-independent manner.
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Affiliation(s)
- Zhiliang He
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400038, China
| | - Luqiao Pu
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400038, China
| | - Chao Yuan
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400038, China
| | - Min Jia
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jian Wang
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400038, China
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Kristensen KHS, Rytter MJH, Sørensen ACK, Christensen VB, Namusoke H, Skov M, Andreassen BU, Friis H. [Oedematous malnutrition can also be seen in Danish children]. Ugeskr Laeger 2016; 178:V03160185. [PMID: 27697120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe two children with oedematous malnutrition; one admitted to a nutrition unit in Uganda and another to a paediatric department in Denmark. Both children received nutritional therapy and recovered. Although oedematous malnutrition is rarely seen in industrialized countries, the condition has been associated with chronic diseases. It is a life-threatening condition, and the pathogenesis remains unknown. Specialized nutrition products have been developed for low-resource clinics in developing countries, however, no specific protocols or products are available for physicians in Denmark.
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