-
Nutrients Dec 2023Malnutrition and sarcopenia are highly prevalent in patients with decompensated cirrhosis and are associated with poorer clinical outcomes. Their pathophysiology is... (Review)
Review
Malnutrition and sarcopenia are highly prevalent in patients with decompensated cirrhosis and are associated with poorer clinical outcomes. Their pathophysiology is complex and multifactorial, with protein-calorie malnutrition, systemic inflammation, reduced glycogen stores and hormonal imbalances all well reported. The direct contribution of portal hypertension to these driving factors is however not widely documented in the literature. This review details the specific mechanisms by which portal hypertension directly contributes to the development of malnutrition and sarcopenia in cirrhosis. We summarise the existing literature describing treatment strategies that specifically aim to reduce portal pressures and their impact on nutritional and muscle outcomes, which is particularly relevant to those with end-stage disease awaiting liver transplantation.
Topics: Humans; Sarcopenia; Malnutrition; Protein-Energy Malnutrition; Hypertension, Portal; Liver Cirrhosis
PubMed: 38201864
DOI: 10.3390/nu16010035 -
European Journal of Trauma and... Oct 2020In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood.... (Review)
Review
PURPOSE
In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients.
METHODS
A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines.
RESULTS
Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7-62.5% were malnourished at admission and 35.6-60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life.
CONCLUSIONS
Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results.
Topics: Hospitalization; Humans; Length of Stay; Malnutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Prevalence; Quality of Life; Risk Factors; Wounds and Injuries
PubMed: 31974669
DOI: 10.1007/s00068-020-01304-5 -
Advances in Nutrition (Bethesda, Md.) Nov 2016Malnutrition is the result of an inadequate balance between energy intake and energy expenditure that ultimately leads to either obesity or undernutrition. Several... (Review)
Review
Malnutrition is the result of an inadequate balance between energy intake and energy expenditure that ultimately leads to either obesity or undernutrition. Several factors are associated with the onset and preservation of malnutrition. One of these factors is the gut microbiota, which has been recognized as an important pathophysiologic factor in the development and sustainment of malnutrition. However, to our knowledge, the extent to which the microbiota influences malnutrition has yet to be elucidated. In this review, we summarize the mechanisms via which the gut microbiota may influence energy homeostasis in relation to malnutrition. In addition, we discuss potential therapeutic modalities to ameliorate obesity or undernutrition.
Topics: Animals; Appetite; Energy Intake; Energy Metabolism; Fatty Acids, Volatile; Fecal Microbiota Transplantation; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Malnutrition; Obesity; Prebiotics; Probiotics
PubMed: 28140325
DOI: 10.3945/an.116.012914 -
Annals of Nutrition & Metabolism 2016From the 1950s to the mid-1970s, United Nations (UN) agencies were focused on protein malnutrition as the major worldwide nutritional problem. The goal of this review is... (Review)
Review
BACKGROUND
From the 1950s to the mid-1970s, United Nations (UN) agencies were focused on protein malnutrition as the major worldwide nutritional problem. The goal of this review is to examine this era of protein malnutrition, the reasons for its demise, and the aftermath.
SUMMARY
The UN Protein Advisory Group was established in 1955. International conferences were largely concerned about protein malnutrition in children. By the early 1970s, UN agencies were ringing the alarm about a 'protein gap'. In The Lancet in 1974, Donald McLaren branded these efforts as 'The Great Protein Fiasco', declaring that the 'protein gap' was a fallacy. The following year, John Waterlow, the scientist who led most of the efforts on protein malnutrition, admitted that a 'protein gap' did not exist and that young children in developing countries only needed sufficient energy intake. The emphasis on protein malnutrition waned. It is recently apparent that quality protein and essential amino acids are missing in the diet and may have adverse consequences for child growth and the reduction of child stunting. Key Messages: It may be time to re-include protein and return protein malnutrition in the global health agenda using a balanced approach that includes all protective nutrients.
Topics: Adult; Amino Acids, Essential; Child; Child Nutritional Physiological Phenomena; Developing Countries; Diet, Healthy; Diet, Protein-Restricted; Female; Global Health; Health Transition; Humans; Infant; Kwashiorkor; Male; Malnutrition; Maternal Nutritional Physiological Phenomena; Nutritional Requirements; Pregnancy; Protein-Energy Malnutrition; United Nations
PubMed: 27576545
DOI: 10.1159/000449175 -
Archives of Disease in Childhood Jun 2014Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic... (Review)
Review
Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent.
Topics: Child; Child, Preschool; Disease Management; HIV Infections; Humans; Malnutrition; Nutritional Status; Risk Factors
PubMed: 24406803
DOI: 10.1136/archdischild-2012-303348 -
European Archives of... Apr 2023Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck...
PURPOSE
Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC.
METHODS
In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors.
RESULTS
In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients.
CONCLUSIONS
Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.
Topics: Humans; Aged; Frailty; Retrospective Studies; Malnutrition; Head and Neck Neoplasms; Treatment Outcome; Nutritional Status; Geriatric Assessment; Nutrition Assessment
PubMed: 36484854
DOI: 10.1007/s00405-022-07728-6 -
Clinical Medicine (London, England) Dec 2010
Review
Topics: Body Composition; Digestive System Diseases; Health Status; Humans; Malnutrition; Morbidity; Nutrition Assessment; Risk Assessment
PubMed: 21413492
DOI: 10.7861/clinmedicine.10-6-624 -
Reumatologia Clinica 2012Systemic sclerosis is a connective tissue disease characterized by inflammation and fibrosis of multiple organs (skin, gastrointestinal tract, lung, kidney and heart).... (Review)
Review
Systemic sclerosis is a connective tissue disease characterized by inflammation and fibrosis of multiple organs (skin, gastrointestinal tract, lung, kidney and heart). After the skin, the organ most affected with a frequency of 75 to 90%, the gastrointestinal tract is more often involved. Gastrointestinal tract involvement is manifested by the appearance of oropharyngeal dysphagia, esophageal dysphagia, gastroesophageal reflux, gastroparesis, pseudo-obstruction, bacterial overgrowth and intestinal malabsorption, constipation, diarrhea and/or fecal incontinence. These effects influence food intake and intestinal absorption leading to the gradual emergence of nutritional deficiencies. About 30% of patients with systemic sclerosis are at risk of malnutrition. In 5-10%, gastrointestinal disorders are the leading cause of death. Therapeutic strategies currently available are limited and aimed at reducing clinical symptoms. The multidisciplinary management of these patients, including nutritional intervention, helps improve gastrointestinal symptoms, and avoid malnutrition, morbidity and improve quality of life.
Topics: Gastrointestinal Diseases; Humans; Malnutrition; Scleroderma, Systemic
PubMed: 22197834
DOI: 10.1016/j.reuma.2011.09.006 -
Public Health Nutrition Aug 2020To estimate the prevalence of malnutrition (undernutrition and excess BMI) among children under the age of 5 years and women of reproductive age in Bolivia considering...
OBJECTIVE
To estimate the prevalence of malnutrition (undernutrition and excess BMI) among children under the age of 5 years and women of reproductive age in Bolivia considering three socioeconomic indicators: wealth, education and ethnicity.
DESIGN
We used the 2008 nationally representative Bolivian Demographic and Health Survey (DHS). Malnutrition's prevalence was estimated by wealth, ethnicity and educational level. Wealth index was measured based on the DHS methodology and nutritional status by using WHO standards and indicators. Education level (EL) was categorized by years of formal education.
SETTING
Bolivia.
PARTICIPANTS
In total, 5·903 children <5 years, 3·345 adolescent women (15-19 years) and 12·297 women (20-49 years) with available information on anthropometric measurements·.
RESULTS
A disproportionate prevalence of malnutrition was observed among different wealth groups: lower wealth tertiles show the higher prevalence of stunting (>30 %) and anaemia (>40 %) in all ages· The prevalence of overweight and obesity tends to rise with age from childhood (10·02-11·60) to adolescence (27·9-31·03), reaching highest levels in women of reproductive age (56·02-57·76). According to wealth tertiles, higher prevalence of overweight and obesity was found in children of high tertile (12·23), adolescent women of low (32·56) and adult women of medium tertile (63·08).
CONCLUSIONS
The present study shows that currently Bolivia is in a transitional stage, faces not only the problem of undernutrition but also those of overnutrition, showing strong inequalities according to socioeconomic and education status. This study calls for state-specific policies keeping in view of the nature of inequality in malnutrition in the country and its differential characteristics across wealth status.
Topics: Adolescent; Adult; Anemia; Body Mass Index; Bolivia; Child, Preschool; Economic Factors; Educational Status; Ethnicity; Female; Growth Disorders; Health Surveys; Humans; Male; Malnutrition; Middle Aged; Nutritional Status; Obesity; Overweight; Prevalence; Social Class; Socioeconomic Factors; Young Adult
PubMed: 32157979
DOI: 10.1017/S1368980019003896 -
Revista Espanola de Enfermedades... Jul 2021In patients with cirrhosis, frailty represents a status of global physical dysfunction associated with a multiplicity of factors, including muscle wasting,...
In patients with cirrhosis, frailty represents a status of global physical dysfunction associated with a multiplicity of factors, including muscle wasting, undernutrition and malnutrition, and functional impairment. This condition is particularly prevalent among those with advanced cirrhosis, such as liver transplant (LT) candidates. Studies in this vulnerable population have demonstrated that its presence is independently predictive of adverse outcomes both pre- and post-transplantation, and thus that its incorporation into clinical practice could result in improved clinical decision-making, particularly regarding the identification of candidates for physical and nutritional interventions. There are, however, some limitations to its immediate incorporation into organ allocation prioritization models, including the wide heterogeneity of instruments used for measuring frailty, and particularly the lack of a single one suitable in all LT clinical scenarios (inpatient vs outpatient; pre- vs post-transplant). Finally, the data on the potential effects of frailty improvement on the diverse range of outcome measures are still preliminary.
Topics: Clinical Decision-Making; Frailty; Humans; Liver Cirrhosis; Liver Transplantation; Malnutrition
PubMed: 33371691
DOI: 10.17235/reed.2020.7448/2020