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Nutrition in Clinical Practice :... Feb 2017The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric... (Review)
Review
The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric malnutrition. This work introduced the paradigm shift of etiology-related definitions-nonillness and illness related-and the use of anthropometric z scores to help identify and describe children with malnutrition (undernutrition) in the developed world. Putting the new definition into practice resulted in some interesting observations: (1) Etiology-related definitions result in etiology-related interventions. (2) Illness-related malnutrition cannot always be immediately "fixed." (3) Using z scores in clinical practice often puts the burden of proof on the clinician to show that a child is not malnourished, rather than the other way around. (4) Children with growth failure severe enough to be admitted with "failure to thrive" should always be assessed for malnutrition, and when they meet the criteria, malnutrition should be documented and coded. The publication of the consensus statement came next, announcing the evidence-informed, consensus-derived pediatric malnutrition indicators. Since the indicators are a work in progress, clinicians are encouraged to use them and give feedback through an iterative process. This review attempts to respond to the consensus statement's call to action by thoughtfully appraising the indicators and making recommendations for future review. Coming together as a healthcare community to identify pediatric malnutrition will ensure that this vulnerable population is not overlooked. Outcomes research will validate the indicators and result in new discoveries of effective ways to prevent and treat pediatric malnutrition.
Topics: Adolescent; Adolescent Development; Body Composition; Child; Child Development; Child Nutrition Disorders; Child, Preschool; Consensus; Deficiency Diseases; Evidence-Based Medicine; Failure to Thrive; Growth Charts; Humans; Infant; Infant Nutrition Disorders; Malnutrition; Nutrition Assessment; Pediatrics; Practice Guidelines as Topic; Severity of Illness Index
PubMed: 27765878
DOI: 10.1177/0884533616671861 -
Annals of Nutrition & Metabolism 2015Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and...
Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.
Topics: Child, Preschool; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Infant; Infant, Newborn; Iodine; Iron Deficiencies; Iron, Dietary; Malnutrition; Micronutrients; Nutrition Disorders; Nutritional Status; Pregnancy; Risk Factors; Sodium Chloride, Dietary; Vitamin A Deficiency; Zinc
PubMed: 26045325
DOI: 10.1159/000371618 -
Ugeskrift For Laeger May 2017The prevalence of malnutrition has declined significantly over the last 30 years. Despite this, malnutrition remains a major cause of illness and death among children... (Review)
Review
The prevalence of malnutrition has declined significantly over the last 30 years. Despite this, malnutrition remains a major cause of illness and death among children worldwide, particularly in low- and medium-income countries. Marasmus and kwashiorkor are the most life-threatening forms of malnutrition. Treatment protocols enable effective treatment, but only a minority of malnourished children have access to treatment. Furthermore, treating children with complicated malnutrition requiring hospitalization remains a clinical challenge.
Topics: Acute Disease; Child; Child Nutrition Disorders; Humans; Infections; Kwashiorkor; Malnutrition; Protein-Energy Malnutrition
PubMed: 28504629
DOI: No ID Found -
The Journal of Nutrition May 2017The gut harbors an enormous diversity of microbes that are essential for the maintenance of homeostasis in health and disease. A growing body of evidence supports the... (Review)
Review
The gut harbors an enormous diversity of microbes that are essential for the maintenance of homeostasis in health and disease. A growing body of evidence supports the role of this microbiota in influencing host appetite and food intake. Individual species within the gut microbiota are under selective pressure arising from nutrients available and other bacterial species present. Each bacterial species within the gut aims to increase its own fitness, habitat, and survival via specific fermentation of dietary nutrients and secretion of metabolites, many of which can influence host appetite and eating behavior by directly affecting nutrient sensing and appetite and satiety-regulating systems. These include microbiota-produced neuroactives and short-chain fatty acids. In addition, the gut microbiota is able to manipulate intestinal barrier function, interact with bile acid metabolism, modulate the immune system, and influence host antigen production, thus indirectly affecting eating behavior. A growing body of evidence indicates that there is a crucial role for the microbiota in regulating different aspects of eating-related behavior, as well as behavioral comorbidities of eating and metabolic disorders. The importance of intestinal microbiota composition has now been shown in obesity, anorexia nervosa, and forms of severe acute malnutrition. Understanding the mechanisms in which the gut microbiota can influence host appetite and metabolism will provide a better understanding of conditions wherein appetite is dysregulated, such as obesity and other metabolic or eating disorders, leading to novel biotherapeutic strategies.
Topics: Appetite; Brain; Eating; Feeding and Eating Disorders; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Nutrition Disorders; Obesity
PubMed: 28356427
DOI: 10.3945/jn.116.240481 -
Nestle Nutrition Institute Workshop... 2020
Topics: Child Nutrition Disorders; Child Nutritional Physiological Phenomena; Child, Preschool; Growth Disorders; Humans; Infant; Infant Nutrition Disorders; Infant, Newborn; Nutrition Policy
PubMed: 31991440
DOI: 10.1159/000504231 -
International Journal of Molecular... Oct 2019The scientific literature has demonstrated that glutamine is one of the main beneficial amino acids. It plays an important role in gut microbiota and immunity. This...
The scientific literature has demonstrated that glutamine is one of the main beneficial amino acids. It plays an important role in gut microbiota and immunity. This paper provides a critical overview of experimental studies (in vitro, in vivo, and clinical) investigating the efficacy of glutamine and its effect on gut microbiota. As a result of this review, we have summarized that glutamine could affect gut microbiota via different mechanisms including the reduction in the ratio of to with the activation of NF-κB and PI3K-Akt pathways, reducing the intestinal colonization ( lesions) and bacterial overgrowth or bacterial translocation, increasing the production of secretory immunoglobulin A (SIgA) and immunoglobulin A+ (IgA) cells in the intestinal lumen, and decreasing asparagine levels. The potential applications of glutamine on gut microbiota include, but are not limited to, the management of obesity, bacterial translocation and community, cytokines profiles, and the management of side effects during post-chemotherapy and constipation periods. Further studies and reviews are needed regarding the effects of glutamine supplementation on other conditions in humans.
Topics: Animals; Diet; Gastrointestinal Microbiome; Glutamine; Humans; Nutrition Disorders
PubMed: 31652531
DOI: 10.3390/ijms20205232 -
The Medical Clinics of North America Sep 2000The use of nutrition for the medical patient, in the inpatient setting and at home, will likely continue to increase in the future. Each patient should be evaluated in... (Review)
Review
The use of nutrition for the medical patient, in the inpatient setting and at home, will likely continue to increase in the future. Each patient should be evaluated in an individualized but systematic fashion. Each patient in whom malnourishment is suspected should undergo a thorough assessment for the presence and degree of malnutrition with an accurate calculation of nutritional requirements. It is important to choose the correct method of delivery of nutrition, to monitor and recognize any complications or problems that may arise, and to tailor the nutritional therapy to the unique diseases that are encountered in medicine. Although increasingly new advances and changes are occurring in the field of nutrition, nutritional support and therapy are best delivered and supplied to the patient with a network of health care workers, including the physician, the nurse, the dietitian, the social worker, and pharmacist.
Topics: Critical Care; Ethics, Medical; Gastrointestinal Diseases; Humans; Inflammatory Bowel Diseases; Liver Diseases; Neoplasms; Nutrition Assessment; Nutrition Disorders; Nutritional Physiological Phenomena; Nutritional Requirements; Nutritional Support; Pancreatitis; Patient Care Team; Renal Insufficiency
PubMed: 11026925
DOI: 10.1016/s0025-7125(05)70283-2 -
Journal of Health, Population, and... Mar 2012Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five... (Review)
Review
Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations' Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.
Topics: Adolescent; Adult; Anemia; Avitaminosis; Bangladesh; Breast Feeding; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Developing Countries; Female; Health Promotion; Humans; Infant; Infant, Newborn; Male; Maternal Nutritional Physiological Phenomena; Nutrition Disorders; Pregnancy; Young Adult
PubMed: 22524113
DOI: 10.3329/jhpn.v30i1.11268 -
The Indian Journal of Medical Research Mar 2019Given the context that undernutrition in India co-exists with the problems of overweight/obesity and associated non-communicable diseases as well as micronutrient... (Review)
Review
Given the context that undernutrition in India co-exists with the problems of overweight/obesity and associated non-communicable diseases as well as micronutrient deficiencies, integrating nutritional concerns in developmental policies and governance is gaining significance. There are many schemes implemented to tackle malnutrition in India, but creating synergy and linking these schemes with each other to achieve a common goal are lacking. Nutrition communication can be an important component to create the synergy required to change malnourished India to malnutrition-free India. Although nutrition education/communication is recognized as a necessary component in various national nutrition programmes, there is not much evidence of distinct evaluation of these components. Only a minor proportion of community nutrition research has been devoted to nutrition education and communication. Although there are scattered efforts in experimenting with newer communication approaches and media for promoting nutrition, there is a dearth of published literature. In this review an attempt was made to critically examine the nutrition education and communication research and practice with special focus on India. This review provides a historical perspective of evolution of nutrition education and communication with an overview of communication approaches, media, methods and technologies used in various research studies and programmes as well as the lessons learnt.
Topics: Humans; India; Malnutrition; Micronutrients; Noncommunicable Diseases; Nutrition Disorders; Obesity; Overweight
PubMed: 31249198
DOI: 10.4103/ijmr.IJMR_1772_18 -
Pharmacology Research & Perspectives Apr 2021With the improvements in relevant policies, laws, and regulations regarding drug clinical trials in China, the quantity and quality of drug clinical trials have... (Review)
Review
With the improvements in relevant policies, laws, and regulations regarding drug clinical trials in China, the quantity and quality of drug clinical trials have gradually improved, and the development prospects of drug clinical trials for endocrine disorders and metabolism and nutrition disorders are promising. Based on information from the clinical trials from the online drug clinical trial registration platform of the National Medical Products Administration, we aimed to review and evaluate the development of clinical trials of drugs for endocrine disorders and metabolism and nutrition disorders in mainland China from 2010 to 2019, as well as the trends over time. A total of 861 trials were carried out on 254 types of drugs for endocrine disorders and metabolism and nutrition disorders, among which 531 (61.67%) involved endocrine disorders, and 330 (38.33%) addressed metabolism and nutrition disorders. The annual number of clinical trials has been increasing gradually, with a significant increase in 2017. Among them, the proportion of clinical trials with Chinese epidemiological characteristics was relatively large (Wu, Annual Report on Development Health Management and Health Industry in China, 2018). The largest number of trials were for diabetes drugs (55.63%), followed by trials of drugs for hyperlipidemia (19.4%) and those for hyperuricemia (7.9%). It was found that the geographical area of the leading units also showed obvious unevenness according to the analysis of the test unit data. Based on the statistics and evaluation of the data, comprehensive information is provided to support the cooperation of global pharmaceutical R&D companies and research units in China and the development of international multicenter clinical trials in China. This work additionally provides clinical trial units with a self-evaluation of scientific research competitiveness and hospital development strategies. At the same time, it provides a reference with basic data for sponsors and stakeholders in these trials to determine their development strategy goals.
Topics: China; Clinical Trials as Topic; Drug Development; Endocrine System Diseases; History, 21st Century; Humans; Metabolic Diseases; Nutrition Disorders
PubMed: 33660404
DOI: 10.1002/prp2.729