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The Indian Journal of Medical Research Nov 2009Oedematous malnutrition, represented by its most severe form kwashiorkor, is rampant in many parts of the world and is associated with a high case fatality rate. Despite... (Review)
Review
Oedematous malnutrition, represented by its most severe form kwashiorkor, is rampant in many parts of the world and is associated with a high case fatality rate. Despite being first described more than a century ago, the pathogenesis of kwashiorkor is still not clear. The traditional thinking is that it results from a deficiency of dietary protein and is usually associated with an infection. This has now been challenged by the finding that there is no difference in diets of children developing marasmus or kwashiorkor. Nutritional oedema is associated with an increased secretion of anti-diuretic substance (probably antidiuretic hormone) which prevents the normal excretory response to water administration. Experimental studies have shown that feeding low-protein, low-calorie diets results in delayed and incomplete response to a water load, and that the livers of the animals show a reduced capacity for inactivating anti-diuretic hormone. There is now evidence that links generation of free radicals and depletion of anti-oxidants with the development of oedema in kwashiorkor.
Topics: Aldosterone; Animals; Child; Edema; Ferritins; Humans; Kwashiorkor; Malnutrition; Models, Biological; Oxidative Stress; Protein-Energy Malnutrition; Vasopressins
PubMed: 20090122
DOI: No ID Found -
Frontiers in Bioscience (Elite Edition) Feb 2022Nutritional status plays a vital role in the growth of children. In pediatric patients, disease-related malnutrition is a dynamic and multifactorial process supported by... (Review)
Review
Nutritional status plays a vital role in the growth of children. In pediatric patients, disease-related malnutrition is a dynamic and multifactorial process supported by several factors such as inflammation, increased energy expenditure, decreased intake or reduced utilization of nutrients. In pediatric patients with malignancies, sarcopenia may coexist with malnutrition, amplifying its negative impact on prognosis. Careful monitoring of nutritional status both at diagnosis and during chemotherapy treatment allows early detection of the risk and/or presence of malnutrition. A rapid and personalized nutritional intervention can improve adherence to treatment, reduce complications and improve the patients' quality of life.
Topics: Child; Humans; Malnutrition; Neoplasms; Nutritional Status; Quality of Life; Sarcopenia
PubMed: 35320908
DOI: 10.31083/j.fbe1401004 -
Current Opinion in Clinical Nutrition... Mar 2018Disruption of metabolic homeostasis is universal in the critically ill. Macronutrients and micronutrients are major environmental regulators of metabolite production... (Review)
Review
PURPOSE OF REVIEW
Disruption of metabolic homeostasis is universal in the critically ill. Macronutrients and micronutrients are major environmental regulators of metabolite production through their gene regulation effects. The study of large numbers of circulating metabolites is beginning to emerge through the comprehensive profiling of the critically ill. In the critically ill, metabolomic studies consistently show that changes in fatty acids, lipids and tryptophan metabolite pathways are common and are associated with disease state and outcomes.
RECENT FINDINGS
Metabolomics is now being applied in research studies to determine the critical illness response to nutrient deficiency and delivery. Nutritional metabolomics approaches in nutrient deficiency, malnutrition and nutrient delivery have included single time point studies and dynamic studies of critically ill patients over time. Integration of metabolomics and clinical outcome data may create a more complete understanding of the control of metabolism in critical illness.
SUMMARY
The integration of metabolomic profiling with transcription and genomic data may allow for a unique window into the mechanism of how nutrient deficiency and delivery alters cellular homeostasis during critical illness and modulates the regain of cellular homeostasis during recovery. The progress and the challenges of the study of nutritional metabolomics are reviewed here.
Topics: Critical Illness; Humans; Malnutrition; Metabolome; Metabolomics; Randomized Controlled Trials as Topic; Transcriptome
PubMed: 29251691
DOI: 10.1097/MCO.0000000000000451 -
Alcoholism, Clinical and Experimental... May 2011Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of... (Review)
Review
Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol. The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy.
Topics: Animals; Energy Intake; Humans; Liver Diseases, Alcoholic; Malnutrition; Nutritional Status; Nutritional Support
PubMed: 21284673
DOI: 10.1111/j.1530-0277.2010.01405.x -
World Journal of Gastroenterology Aug 2021Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients... (Review)
Review
Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients with liver cirrhosis. The etiology of cirrhosis differs in the South Asian region compared to the West, with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time. Comorbid malnutrition worsens outcomes for cirrhosis patients. Urgent attention to address malnutrition is needed to improve patient outcomes. The etiology and pathophysiology of malnutrition in liver diseases is multifactorial, as reduction in liver function affects both macronutrients and micronutrients. A need for nutritional status assessment for liver disease patients exists in all parts of the world. There are many widely studied tools in use to perform a thorough nutritional assessment, of which some tools are low cost and do not require extensive training. These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan. Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world, but the knowledge and practice of nutritional counseling in Pakistan is poor, both amongst patients and physicians. Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed. Simultaneously, treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.
Topics: Developing Countries; Humans; Liver Diseases; Malnutrition; Nutrition Assessment; Pakistan
PubMed: 34497430
DOI: 10.3748/wjg.v27.i30.4985 -
American Family Physician Dec 2021Nutrition support therapy is the delivery of formulated enteral or parenteral nutrients to restore nutritional status. Family physicians can provide nutrition support...
Nutrition support therapy is the delivery of formulated enteral or parenteral nutrients to restore nutritional status. Family physicians can provide nutrition support therapy to patients at risk of malnutrition when it would improve quality of life. The evidence for when to use nutrition support therapy is inconsistent and based mostly on low-quality studies. Family physicians should work with registered dietitian nutritionists to complete a comprehensive nutritional assessment for patients with acute or chronic conditions that put them at risk of malnutrition. When nutrition support therapy is required, enteral nutrition is preferred for a patient with a functioning gastrointestinal tract, even in patients who are critically ill. Parenteral nutrition has an increased risk of complications and should be administered only when enteral nutrition is contraindicated. Family physicians can use the Mifflin-St Jeor equation to calculate the resting metabolic rate, and they should consult with a registered dietitian nutritionist to determine total energy needs and select a nutritional formula. Patients receiving nutrition support therapy should be monitored for complications, including refeeding syndrome. Nutrition support therapy does not improve quality of life in patients with dementia. Clinicians should engage in shared decision-making with patients and caregivers about nutrition support in palliative and end-of-life care.
Topics: Enteral Nutrition; Humans; Malnutrition; Mass Screening; Nutritional Support; Parenteral Nutrition; Referral and Consultation
PubMed: 34913658
DOI: No ID Found -
Nutrients Jul 2022Malnutrition in older adults impacts health status, increased mortality, and morbidity. Malnutrition may increase the development of geriatric syndromes and contribute... (Review)
Review
Malnutrition in older adults impacts health status, increased mortality, and morbidity. Malnutrition may increase the development of geriatric syndromes and contribute to a higher prevalence of falls and osteoporotic fractures that lead to loss of independence and an increased rate of institutionalization. The role of malnutrition in the pathogenesis of other geriatric syndromes seems to be well established. However, the data concerning nutritional interventions are confounding. Moreover, long-term undernutrition seems to be one of the factors that strongly influences the efficacy of interventions. This review outlines the current literature on this topic, and aims to guide physicians to make proper decisions to prevent the vicious cycle of falls, fractures, and their negative outcomes in patients with malnutrition.
Topics: Aged; Fractures, Bone; Geriatric Assessment; Humans; Institutionalization; Malnutrition; Nutritional Status; Prevalence; Syndrome
PubMed: 35956299
DOI: 10.3390/nu14153123 -
Acta Gastro-enterologica Belgica 2010Malnutrition, characterized by protein and energy deficiency, is considered the most prevalent complication of liver disease. The pathofysiology includes reduced food... (Review)
Review
Malnutrition, characterized by protein and energy deficiency, is considered the most prevalent complication of liver disease. The pathofysiology includes reduced food intake, maldigestion and malabsorption but also avoidable iatrogenic factors, such as prescribed fasting, frequent paracenteses and "liver-diets" poor in fat and protein. Liver insufficiency corresponds to a state of accelerated starvation. The diminished glucose tolerance and low glycogen stores in cirrhotic patients result in a reduced availability of glucose as energy source. The prevalence of undernutrition depends upon the severity of the liver insufficiency and the method of nutritional assessment. The aim of the nutritional plan is to realize a sufficient oral diet which includes enough proteins and calories. Several extra calorie supplements are indicated to surmount the lack of available glucose. The evidence in support of branched chain amino acid supplements is limited. Salt intake should be moderately restricted in case of ascites. Nasogastric tube feeding is indicated when patients are unable to maintain an adequate oral intake. In case tube feeding is not possible, total parenteral nutrition may be necessary to maintain an anabolic state.
Topics: Humans; Liver Cirrhosis; Malnutrition; Nutritional Support
PubMed: 21299163
DOI: No ID Found -
BMJ (Clinical Research Ed.) Dec 2020Healthy diets are a human right and the foundation of just, resilient societies
Healthy diets are a human right and the foundation of just, resilient societies
Topics: COVID-19; Food Supply; Global Health; Humans; Malnutrition; Pandemics; Prevalence; SARS-CoV-2
PubMed: 33262147
DOI: 10.1136/bmj.m4593 -
PLoS Neglected Tropical Diseases Mar 2022Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries....
BACKGROUND
Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries. However, not enough data concerning this issue is available. The aim of this study was to assess the distribution of nutritional indicators, anemia and micronutrient deficiency and their underlying risk factors among schoolchildren in south-eastern Tanzania.
METHODOLOGY/PRINCIPAL FINDINGS
This cross-sectional study enrolled primary schoolchildren aged 6-12 years from Kikwawila and Kiberege wards, Tanzania. In total, 471 schoolchildren underwent a physical examination and provided blood, stool and urine samples for an assessment of the levels of different micronutrients, nutritional and anemia status, and parasitic infection status. We employed bivariate and multivariate logistic regression to determine the association between nutritional statuses, anemia, micronutrient deficiency and parasitic infections. We found that 23.90%, 12.60% and 16.20% of schoolchildren were stunted, underweight and wasted, respectively. About 14.0% of schoolchildren were found to be anemic. Children diagnosed with Plasmodium falciparum infection were more likely to have low levels of ferritin (aOR: 10.40, 95% CI: 2.88-40.53) and elevated levels of serum soluble transferrin receptor (aOR: 3.59, 95% CI: 1.27-11.23), respectively. Vitamin A (34.71%) and vitamin B12 (8.79%) were the most prevalent micronutrients found to be deficient in diagnosed children. Finally, we found that schoolchildren attending the most rural schools were five times more likely to be diagnosed with at least one micronutrient deficiency (aOR: 5.04, 95% CI: 2.38-11.44).
CONCLUSIONS/SIGNIFICANCE
Malnutrition, anemia and micronutrient deficiency still pose a significant health burden among schoolchildren living in rural Tanzania. To effectively tackle this burden, health interventions such as deworming, micronutrient supplementation, vector control, health education and access to clean water and improved sanitation should be strengthened and made sustainable.
Topics: Anemia; Child; Cross-Sectional Studies; Humans; Malaria, Falciparum; Malnutrition; Micronutrients; Nutritional Status; Prevalence; Tanzania
PubMed: 35245314
DOI: 10.1371/journal.pntd.0010261