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Background/objectives: Assessment of infant body composition (BC) is crucial to understand the consequences of suboptimal nutritional status and postnatal growth, and the effects of public health interventions. Bioelectrical impedance analysis (BIA) is a feasible, relatively inexpensive and noninvasive method for assessing BC. However, very little research has been conducted in low- and middle-income populations, where efforts to prevent or treat malnutrition in early life are a public health priority. We aimed to develop equations for predicting fat-free mass (FFM) and fat mass (FM) based on BIA in 0- to 6-month-old Ethiopian infants.Subjects/methods: The study comprised a total of 186 BC assessments performed in 101 healthy infants, delivered at Jimma University Specialized Hospital. Infant air-displacement plethysmography (IADP) was the criterion method, whereas weight, length, sex, age and an impedance index (L(2)/Z50) were predictors. Prediction equations were developed using stepwise multiple linear regression and the accuracy was evaluated with a 10-fold cross-validation approach.Results: A linear regression model based on body weight, age and sex predicted FFM, estimated by IADP, with an adjusted R(2) and root mean square error (RMSE) of 0.94 and 200 g, respectively. Adding impedance index to the model resulted in a significantly improved model fit (R(2)=0.95; RMSE=181 g). For infants below 3 months of age, inclusion of impedance index did not contribute to an improved model fit for predicting FFM compared with a model already comprising weight, sex and age.Conclusions: The derived equations predicted FFM with acceptable accuracy and may be used in future field surveys, epidemiological studies and clinical trials conducted in similar sub-Saharan African population groups aged 0-6 months. [ABSTRACT FROM AUTHOR]

Background/objectives: Since 2007, our institution has used validated guidelines for the insertion of proactive gastrostomy feeding tubes in patients with head and neck cancer. Helical intensity-modulated radiotherapy (H-IMRT) delivered by Tomotherapy, is an advanced radiotherapy technique introduced at our centre in 2010. This form of therapy reduces long-term treatment-related toxicity to normal tissues. The aim of this study is to compare weight change and need for tube feeding following H-IMRT (n=53) with patients that would have previously been treated with three-dimensional conformal radiotherapy (n=134).Subjects/methods: Patients with head and neck cancer assessed as high nutritional risk with recommendation for proactive gastrostomy were identified from cohorts from 2007 to 2008 and 2010 to 2011. Retrospective data were collected on clinical factors, weight change from baseline to completion of treatment, incidence of severe weight loss (⩾ 10%) and tube feeding. Statistical analyses to compare outcomes between the two treatments included χ(2)-test, Fisher's exact and two-sample Wilcoxon tests (P<0.05).Results: The H-IMRT cohort had higher proportions of patients with definitive chemoradiotherapy (P=0.032) and more advanced N stage (P<0.001). Nutrition outcomes were not significantly different between H-IMRT and conformal radiotherapy, respectively: need for proactive gastrostomy (n=49, 92% versus n=115, 86%, P=0.213), median percentage weight change (-7.2% versus -7.3%, P=0.573) and severe weight loss incidence (28% versus 27%, P=0.843).Conclusions: Both groups had median weight loss >5% and high incidences of tube feeding and severe weight loss. Nutrition intervention remains critical in this patient population, despite advances in radiotherapy techniques, and no changes to current management are recommended. [ABSTRACT FROM AUTHOR]

It is estimated that there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common cancers, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high-quality information on body composition, including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans in determining the influence of reduced muscle mass on clinical outcome in abdominal cancer. A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal were undertaken. Ten cohort studies met the inclusion criteria. Seven studies demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3-66.7%) were identified as sarcopenic using CT scans compared with numbers identified as malnourished using body mass index. CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective. [ABSTRACT FROM AUTHOR]

Background/objectives: Multi-frequency bioelectrical impedance analysis (MFBIA) is becoming more widely used to assess hydration status and body composition in haemodialysis patients. Most centres only measure MFBIA pre dialysis when patients are overhydrated. We wished to determine whether body composition assessments change post dialysis following fluid removal.Subjects/methods: Lean body and fat mass were measured by MFBIA pre and post haemodialysis in 676 stable outpatients.Results: Weight fell post dialysis from 72.9 ± 17.8 to 70.9 ± 19.9 kg, P<0.001, soft lean mass from 48.2 ± 12.1 to 45.4 ± 11.0 kg and fat-free mass from 51.8 ± 19.2 to 48.1 ± 11.8 kg, P<0.001, whereas percentage body fat (PBF) increased from 28.8 ± 11.9 to 30.8 ± 12.1% post dialysis, P<0.001, with a mean increase post dialysis of 2.0% (95% confidence limits 1.55 to 2.45). There were correlations between the fall in total body water and extracellular water and skeletal muscle mass (r=0.826, P<0.001 and r=0.711, P<0.001, respectively), and negative correlation between the fall in total body water and ICW and the increase in PBF (r=-0.72, P<0.001, and -0.72, P<0.001, respectively). The relative changes were greater for the arms compared with the legs.Conclusions: Although more convenient for both patients and staff to undertake bioimpedance measurements pre dialysis, overhydration over estimates muscle mass and under estimates fat. For more reliable and reproducible assessments of nutritional status, we suggest that bioimpedance measurements of body composition should be made when patients are closer to their target weight than when overhydrated. [ABSTRACT FROM AUTHOR]

Background/objectives: The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI).Subjects/methods: A longitudinal study was conducted on 161 NH residents aged ⩾ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾ 25 and weight stable/gain, BMI ⩾ 25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss).Results: People with a BMI ⩾ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾ 25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P=0.005; in association with weight stable/gain: HR=2.45, P=0.01), and the mortality risk was also increased in people with a BMI ⩾ 25 and weight loss (HR=1.74, P=0.03).Conclusions: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese. [ABSTRACT FROM AUTHOR]

In developing countries, deficiencies of micronutrients are thought to have a major impact on child development; however, a consensus on the specific relationship between dietary zinc intake and cognitive function remains elusive. The aim of this systematic review was to examine the relationship between zinc intake, status and indices of cognitive function in children and adults. A systematic literature search was conducted using EMBASE, MEDLINE and Cochrane Library databases from inception to March 2014. Included studies were those that supplied zinc as supplements or measured dietary zinc intake. A meta-analysis of the extracted data was performed where sufficient data were available. Of all of the potentially relevant papers, 18 studies met the inclusion criteria, 12 of which were randomised controlled trials (RCTs; 11 in children and 1 in adults) and 6 were observational studies (2 in children and 4 in adults). Nine of the 18 studies reported a positive association between zinc intake or status with one or more measure of cognitive function. Meta-analysis of data from the adult's studies was not possible because of limited number of studies. A meta-analysis of data from the six RCTs conducted in children revealed that there was no significant overall effect of zinc intake on any indices of cognitive function: intelligence, standard mean difference of <0.001 (95% confidence interval (CI) -0.12, 0.13) P=0.95; executive function, standard mean difference of 0.08 (95% CI, -0.06, 022) P=0.26; and motor skills standard mean difference of 0.11 (95% CI -0.17, 0.39) P=0.43. Heterogeneity in the study designs was a major limitation, hence only a small number (n=6) of studies could be included in the meta-analyses. Meta-analysis failed to show a significant effect of zinc supplementation on cognitive functioning in children though, taken as a whole, there were some small indicators of improvement on aspects of executive function and motor development following supplementation but high-quality RCTs are necessary to investigate this further. [ABSTRACT FROM AUTHOR]

Background/Objectives:Neuropeptide Y (NpY) is an important factor in neuropeptide signalling, and significantly change in the blood and cerebrospinal fluid (CSF) during chronic kidney disease (CKD) progression. However, the role of NpY remains unclear. We aimed to investigate the associations between NpY levels, nutritional status and cardiovascular disease (CVD) in patients with CKD.Subjects/Methods:In this cohort study, we performed Pearson's correlation analysis and multiple linear regressions to assess the relationship between CSF and serum NpY levels, as well as nutritional indices. Receiver operating characteristic curves were used to evaluate the sensitivity and specificity of CSF NpY levels. As NpY affects the cardiovascular system, Kaplan-Meier analysis was used to investigate the relationship between serum NpY levels and CVD.Results:CSF NpY levels and nutritional indices were related during CKD progression (energy intake: β=0.236, P<0.001; mid-arm muscle circumference: β=0.953, P=0.014; prealbumin: β=0.067, P<0.001), and had high specificity (79.9%). High serum NpY levels may be a risk factor associated with CVD (relative risk=1.8015, 95% confidence interval: 1.0509-3.0881).Conclusions:Our results suggested a relationship between CSF NpY levels and nutritional indices in CKD patients. High serum NpY concentrations may be a risk factor associated with CVD. [ABSTRACT FROM AUTHOR]

Background and Objectives:Little information is available on severe obesity in childhood. This study estimates the prevalence of severe obesity in 8- to 9-year-old children resident in Italy and its association with gender, age, geographical area and parents' nutritional status and education using the World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria.Subjects/Methods:A nationally representative sample of grade 3 Italian students was measured in 2010 (N=42 431) using standardized instruments and methodology. Severe obesity in children was assessed using definitions provided by the WHO and by the IOTF. Prevalence was estimated within categories of sociodemographic variables and their independent effects were estimated using multivariate logistic regression.Results:The estimated prevalence of severe obesity in 2010 was 4.5% (95% confidence interval (CI): 4.2-4.7) according to the WHO definition and 2.7% (95% CI: 2.5-2.9) with IOTF cutoffs. These values were slightly lower than those observed in 2008. The prevalence was higher in males, in 8-year-old children and in the South. Parental low education and high body mass index were strongly associated with childhood severe obesity.Conclusion:According to the definition used, between 30 000 and 50 000 children aged 8-9 years suffer severe obesity in Italy. [ABSTRACT FROM AUTHOR]

Background/Objectives:The objectives were to evaluate the effects of improvement of vitamin D status on biomarkers of oxidative stress (OS) in type 2 diabetic (T2D) subjects and whether vitamin D receptor (VDR)-FokI polymorphisms could modulate the response to vitamin D3 intake.Subjects/Methods:Subjects with T2D were allocated to one of the two groups to receive either plain doogh (PD; containing 150 mg calcium and no vitamin D/250 ml, n1=50) or vitamin D3-fortified doogh (FD; containing 500 IU/250 ml, n1=50) twice a day for 12 weeks. Outcomes were changes in serum 25-hydroxyvitamin D (25(OH)D), superoxide dismutase, glutathione (GSH), total antioxidant capacity (TAC) and malondialdehyde (MDA). VDR genotypes in 140 T2D subjects in FD were determined by FokI restriction enzyme.Results:After 12 weeks, serum 25(OH)D increased significantly in FD (from 38.5±202.2 to 72.0±23.5, P<0.001) as compared with PD (from 38.8±22.8 to 33.4±22.8, P=0.28). Comparisons between FD and PD revealed significant differences in changes of serum MDA (−0.54±0.82 μmol/l vs +0.17±1 μmol/l, P<0.001), GSH (+8.4±40.1 ng/l vs −13.1±29.4 ng/l, P=0.002) and TAC (+0.14±0.43 mmol/l vs +0.02±0.45 mmol/l bovine serum albumin equivalent, P=0.03). Although there was no significant association between FokI genotypes and OS biomarkers, ff variant subgroup showed the weakest response to vitamin D.Conclusions:Improvement of vitamin D status via daily intake of FD ameliorates OS biomarkers in T2D subjects and the interactive effect of FokI genotypes cannot be ruled out. [ABSTRACT FROM AUTHOR]

Background/Objective:The aim of this study was to assess the validity of body fatness estimations based on skinfolds and bioelectrical iImpedance analyses (BIA) measurements compared to a three-component model (3C model) in prepubertal Chilean children, considering potential differences by sex and nutritional status.Subjects/Methods:Four hundred and twenty four Chilean children (198 females and 226 males) were assessed for body composition. Body fat percentage (BF%) was evaluated by Skinfold equations (Slaughter, Ramirez and Huang) and Bioelectrical impedance (BIA: Tanita BC-418MA) using both the equipment and the Ramirez equation. Measurements based on a 3C model constructed from total body water estimates by isotope dilution and from body volume estimates by air displacement plethysmography were used as gold standard.Results:Coefficient of determination (R2) values were higher in overweight and in the whole group of both gender. All slopes were differed significantly from 1, and most intercepts were significantly different from 0. Skinfold Equations: an underestimation of BF% was found for all equations, being higher with the Slaughter equation. BIA: Tanita underestimated BF% in all groups, whereas Ramirez equation shows an overestimation.Conclusions:Skinfolds and bio-impedance equations serve well to rank children according to their BF%. However, these methods are not accurate for describing body composition in prepubertal Chilean children. [ABSTRACT FROM AUTHOR]

Background/objectives:The compounding of personalized parenteral nutrition mixtures (PPNMs) for home parenteral nutrition (HPN) gives the possibility to better satisfy nutritional requirements for patients in selected clinical conditions. The objective of this study was to compare the composition of PPNMs prescribed in selected cases, by a practitioner nutritionist, with that of industrially manufactured standard parenteral nutrition mixtures (SPNMs).Subjects/methods:Two hundred and ninety-eight patients (151 men, 147 women, aged 17-87 years) on HPN, followed up in 2011 at our Center, were retrospectively recruited.Results:Industrially manufactured SPNMs were prescribed in 230 (77.2%) patients, whereas compounded PPNMs were prescribed in 68 (22.8%). Formulation of PPNMs, adjusted for body weight, did not significantly differ from SPNMs as regards total daily calorie amount, but was significantly different as far as nutrient composition is concerned (P<0.01). Analysis on the daily amount of nutrients per kg of body weight and per patient disease showed that 16/34 (47%) benign chronic intestinal failure (CIF) patients, 47/233 (20%) cancer patients and 5/31 (16%) patients grouped as 'having other diseases' needed personalized mixtures (in PPNMs 4-9 nutrients were significantly different from those in SPNMs). Moreover, in CIF patients receiving PPNMs, frequent changes in the formulation (mean 6 times per year, range 1-28) were necessary.Conclusions:Our data suggest that, presently, PPNMs cannot be completely replaced by SPNMs owing to special needs in macro and/or micronutrients of some patients and/or the necessity of frequent changes in the nutritional mixture composition, at least until stabilization of clinical and metabolic conditions. [ABSTRACT FROM AUTHOR]

Background/objectives:Low vitamin D status during pregnancy may be associated with infant skeletal growth. However, evidence on the longer-term effect is limited. This study aims to assess the association between maternal vitamin D status in early pregnancy and markers of linear growth (height, leg length and relative leg length) of the child at age 5-6 years.Subjects/methods:A subsample of data from the Amsterdam Born Children and Development (ABCD) study was used. Ethnic Dutch pregnant women and their children (n=1208) were included. Maternal serum vitamin D level was determined at first antenatal visit (median 13 weeks, interquartile range: 12-14). We investigated the association of maternal vitamin D, corrected for season, with height, leg length and relative leg length at age 5-6 years.Results:Linear regression analyses showed no significant association between maternal vitamin D levels (nmol/l) and height (cm) (B=−0.006; P=0.205), leg length (cm) (B=−0.002, P=0.540) or relative leg length (%) (B=0.001; P=0.579). Adjustment for potential confounders (parental heights, maternal educational level, alcohol use during pregnancy, child sex, child age at measurement and child screen time) did not change these results.Conclusions:Maternal vitamin D level was not associated with early linear growth in children. Other factors, such as parental height, appear to be more important. [ABSTRACT FROM AUTHOR]

Background/objectives:To implement nutritional risk screening and evaluate the relationship of nutritional risk to complication rate and quality of life in patients with cancer.Subjects/methods:A total of 687 patients with cancer from two teaching hospitals in China were consecutively enrolled. Data were collected on the nutritional risk screening, application of nutritional support, complication and quality of life.Results:The prevalence of nutritional risk at admission among the total, younger and elderly patients was 45.6%, 38.7% and 58.0%, respectively. There was a significant increase in the prevalence from admission to 2 weeks after admission in all patients (P=0.011). The prevalence in those patients 70 years was significantly higher than that in the younger ones (P<0.001). The highest prevalence of nutritional risk was in pancreas cancer (81.8%). Only 46.7% of at-risk patients received nutritional support and the average PN:EN ratio was 7.0:1. Complications were noted in 29.0% of all patients and were significantly more frequent in 'at-risk' patients (P<0.001). Among the scales of quality of life (SF-36), the scores of physical functioning (P<0.001), role-physical (P<0.001), bodily pain (P=0.012), energy/fatigue (P<0.001) and general health (P<0.001) were significant lower in the patients at risk.Conclusions:A large proportion of cancer inpatients were at nutritional risk and tended to worsen during the course of admission, which has been associated with increased complication rate and lower scores of quality of life. The application of PN and EN was inappropriate in patients with cancer in China. [ABSTRACT FROM AUTHOR]

Background/Objectives:High sensitivity C-reactive protein (hs-CRP) and low birthweight have emerged as predictors of cardiovascular diseases (CVDs). In studies involving adults, higher concentrations of hs-CRP have been associated with low birthweight. This study assessed the relationship between hs-CRP and birthweight, and other risk markers for CVDs in childhood.Subjects/Methods:A total of 459 Brazilian children aged 5-8 years were included in the study. hs-CRP was measured by particle-enhanced immunonephelometry. The nutritional status of the children was assessed by BMI and waist circumference. Total cholesterol and fractions, triglycerides and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment (HOMA) method. Blood pressure was measured by the HDI/Pulse Wave CR-2000 equipment (Hypertension Diagnostics, Eagan, MN, USA). A multivariate linear regression analysis investigated the association between hs-CRP and birthweight, and risk markers for CVDs.Results:There were positive associations between hs-CRP and gender (P=0.001), waist circumference (P<0.001) and systolic blood pressure (SBP) (P=0.03), and negative associations between hs-CRP and age (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P=0.005) (R2=0.14). Abnormal values of hs-CRP, waist circumference, HDL-c and SBP, respectively, were observed in 27.7, 26.4, 14.4 and 34.7% of the children.Conclusions:Opposite to studies involving adults, there was no association between hs-CRP and birthweight, implying that time may strengthen the relationship, considering that hs-CRP-concentration-associated metabolic changes increase from childhood to adulthood. The associations between hs-CRP and waist circumference, HDL-c and SBP in very young ages is a matter of concern, especially in females, in view of the large number of children with abnormal values of these measurements. [ABSTRACT FROM AUTHOR]

Recent criticisms of the glycaemic index (GI) focus on its validity with assertions that GI methodology is not valid, GI values are inaccurate and imprecise, GI does not predict what foods are healthy and that whole grain and fibre are better markers of carbohydrate quality than GI. None of the critics provide sound reasons for rejecting GI because some of their arguments are based on flagrant errors in understanding and interpretation while others are not supported by current data or are inconsistent with other nutritional recommendations. This paper addresses current criticisms of GI and outlines reasons why GI is valid: (1) GI methodology is accurate and precise enough for practical use; (2) GI is a property of foods; and (3) GI is biologically meaningful and relevant to virtually everyone. Current dietary guidelines recommend increased consumption of whole grains and dietary fibre but do not mention GI. However, this is illogical because the evidence that GI affects health outcomes is at least as good or better than that for whole grains and fibre. GI is a novel concept from a regulatory point of view and a number of problems need to be addressed to successfully translate GI knowledge into practice. The problems are not insurmountable but no progress can be made until bias and misunderstanding about GI can be overcome and there is better agreement about what is the actual state of knowledge on GI so that the real issues can be identified and addressed. [ABSTRACT FROM AUTHOR]

Over the last 30 years, major advances have occurred in our understanding of the disorder cystic fibrosis (CF) with the discoveries of the underlying chloride transport defect and the 'CF gene', the CF transmembrane conductance regulator gene. Equally important from a clinical and patient perspective are the improvements in median survival from less than 10 to 20 years prior to 1980, approaching 30 years during the 1980s and over 45 years more recently. Improved antibiotic regimens and lung clearance therapy contributed to the enhanced survival, but a key factor accredited as adding a further 10 years to the median survival was improving and then maintaining normal growth and nutrition. In the main, the latter were achieved by adherence to a 'high-fat high-energy' diet rather than the advocated virtually universal policy of the 'low fat', which was associated with wasting and linear growth failure. The high-fat diet in conjunction with better control of malabsorption due to microspheric pancreatic enzyme replacement therapy, attention to adequate fat-soluble vitamin supplementation and newborn screening has ensured that at least 80-90% of children with CF will achieve better health and survival through their adult years. [ABSTRACT FROM AUTHOR]

Stroke, one of the most prevalent geriatric diseases, is a leading cause of death worldwide that often results in permanent physical disability and decreased quality of life, and can have a negative impact on families both financially and emotionally. Although many previous studies have shown relationships between the risk of stroke and nutritional factors, clear dietary recommendations for the prevention and reduction of stroke recurrence have not been established. Several factors should be considered to control and manage stroke. For example, a considerable number of patients with stroke are poorly nourished, have several comorbidities and undesirable health-related behaviors may be present. Stroke patients are less likely to consume beneficial foods, have poorer eating habits and have impoverished dietary quality. In addition, psychological factors such as depression must also be considered in stroke management. Given these factors, dietary recommendations for stroke patients should be established. In this article, we summarized the nutritional status and dietary quality of stroke patients. We also suggested some nutritional guidelines for stroke patients and for those who are at risk for stroke. [ABSTRACT FROM AUTHOR]

Objective:The objective of this work is to evaluate the association between Selenium (Se)-, Copper (Cu)- and Zinc (Zn)-circulating concentrations and indicators of nutritional status.Subjects/Methods:This study enroled 428 institutionalised elderly. The diagnostic tools used are a form to collect data regarding gender, age, duration of stay in nursing home, number of prescribed drugs, chronic diseases, Mini Nutritional Assessment (MNA), anthropometric measurements, albumin, transferrin and serum concentrations of Se, Cu and Zn. The collected data were analysed with descriptive assessments of the differences χ2, Student's t-test and analysis of variance. Multivariate linear regression were performed to evaluate the association between the concentrations of each trace elements and the other variables.Results:The study population was represented by 327 women and 101 men, of whom 13.8% were 65-75 years old and 47.4% were older than 85 years. According to the MNA score, 58.4% were at risk of malnutrition and 21.3% were malnourished. The results show a significant reduction in the average concentrations of Se and Zn in women when the nutritional status gets worse. The same trend, although not statistically significant, is also observed in men. In both genders, the Cu concentration does not show a statistically significant association with nutritional status. Multivariate linear regression show some positive or negative associations.Conclusions:Our study seems to confirm the association between Se and nutritional status, as well as with some blood chemistry parameters. The length of institutionalisation seems to be an independent predictor of Se concentration. [ABSTRACT FROM AUTHOR]

Background/Objective:Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau.Subjects/Methods:The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995-96 and a lower mortality cohort of children born in 2005-06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value.Results:Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR)=1.74 (1.52;2.01)) and more children aged 6-11 months than children aged 12-35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6-35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants.Conclusion:In the age group 6-35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk. [ABSTRACT FROM AUTHOR]

Objective:(1) To determine whether nutritional supplementation (energy and micronutrients) in institutionalised elderly has a positive effect on dietary intake and nutritional status. (2) To investigate whether individuals tend to compensate for the energy content of the intervention product by decreasing their habitual food consumption.Methods:A 24-week, randomised, double-blind, placebo-controlled, intervention trial in homes for the elderly (n=3), in nursing homes (n=3) and ‘mixed’ homes (n=3) in The Netherlands. Institutionalised elderly people (n=176) older than 60 years of age, with a body mass index 30 kg/m2 and a Mini-Mental State Examination score of 10 points or higher, randomly received a nutrient-enriched drink or a placebo drink twice a day during 24 weeks in addition to their usual diet. Allocation to treatment took into account of sex, the Mini-Mental State Examination score and the plasma homocysteine level. Body weight and several nutrition-related analyses in fasting blood samples were measured in all participants. Data on dietary intake were collected in a subsample (n=66).Results:A significantly favourable effect (P<0.001) of the intervention drink was observed on vitamin intake, mineral intake and vitamin status in blood (for example, homocysteine decreased from 14.7 to 9.5 μmol/l in the intervention group as compared with that in the placebo group (17.2–15.9)). The difference in change in total energy intake between the two treatment groups was 0.8 MJ/day (P=0.166). Energy intake from food decreased in both groups to the same extent (−0.5 MJ/day). Therefore, this decrease cannot be considered as compensation for the energy content of the product.Conclusions:This group of institutionalised elderly people does not compensate for the energy content of a concentrated nutritional supplement. Therefore, this supplement is effective for counteracting the development of malnutrition in this population. [ABSTRACT FROM AUTHOR]

Objective:To assess the nutritional status of patients with gynaecological cancer.Design:A prospective study assessing the nutritional status of gynaecological patients with suspected or proven gynaecological cancer.Setting:Queensland Centre for Gynaecological Cancer, Brisbane, Australia; a tertiary referral centre for gynaecological cancer.Subjects:One hundred forty-five patients with suspected or proven gynaecological cancer aged 20–91 years.Intervention:Scored patient-generated subjective global assessment (PG-SGA) and serum albumin before treatment.Results:One hundred and sixteen (80%) patients were categorized as PG-SGA class A, 29 (20%) patients were PG-SGA B and none of the patients were PG-SGA C. Ovarian cancer patients had significantly lower serum albumin levels (P=0.003) and higher PG-SGA scores (P<0.001) than patients with other types of cancer and benign conditions. Sixty-seven per cent of patients with ovarian cancer were classified as PG-SGA B. After adjusting for patient's age, body mass index and albumin level, ovarian cancer patients were 19 times more likely to be categorized as PG-SGA class B compared to patients with benign conditions (95% confidence interval: 3.03–129.8; P=0.002).Conclusion:Malnutrition in gynaecological cancer patients is a significant problem, especially among those patients diagnosed with ovarian cancer.European Journal of Clinical Nutrition (2007) 61, 642–646. doi:10.1038/sj.ejcn.1602540; published online 4 October 2006 [ABSTRACT FROM AUTHOR]

Objective:To define fatty acid and macronutrient intakes in a rural Chinese preschool population, and relate these intakes to anthropometric indices.Design:Cross-sectional survey of anthropometry and diet (three 24-h recalls). National Centers for Health Statistics/World Health Organization growth reference charts were used to determine the prevalence of malnutrition (z-scores less than −2 standard deviation (s.d.) below the mean): height-for-age (stunted), weight-for-age (underweight), weight-for-height (wasted) and mid-upper-arm-circumference-for-age (low fat/muscle).Subjects and setting:A total of 196 children aged 1–5 years old were volunteered by their families to participate in the survey, located in Heqing County, Yunnan Province, China.Results:The respective prevalence of stunting, underweight, wasting and low fat/muscle was: 38, 21, 2 and 8%. Daily intakes of linoleic acid (LA; 18:2n-6), α-linolenic acid (LNA; 18:3n-3), arachidonic acid (AA; 20:4n-6) and docosahexaenoic acid (DHA; 22:6n-3), averaged for all children, were 2 100±1200, 300±250, 55±35 and 30±140 mg/day, respectively. As percent of total fat intake, LA contributed 11.9%, LNA 1.8%, AA 0.3% and DHA 0.2%. Height-for-age and weight-for-age z-scores were negatively correlated with g/kg/day intake of LA and AA (P<0.05). Weight-for-height z-score was negatively correlated with AA g/kg/day intake (P<0.05).Conclusions:This study provided polyunsaturated fatty acids (PUFA) intakes in rural preschool children in a developing country. The associations of PUFA intake with early childhood growth suggest that growth in preschool-aged children could be significantly and specifically related to n-6 fatty acid intakes.Sponsorship:ECOFund and NSERC.European Journal of Clinical Nutrition (2006) 60, 1100–1107. doi:10.1038/sj.ejcn.1602424; published online 15 March 2006 [ABSTRACT FROM AUTHOR]

Objective:To investigate the relationship between osteoporosis and nutritional status as determined by the Mini-Nutritional Assessment (MNA).Design:A cross-sectional study.Setting:Stockholm, Sweden.Subjects:A total of 351 elderly free-living women (mean age 73±2.3 years).Methods:MNA (range 0–30 points; <17 indicates malnutrition, 17.5–23.5 risk of malnutrition and 24 well nourished), measurements of bone mineral density of the left hip and lumbar spine using Hologic QDR 4500, and of the heel using Calscan DEXA-T.Results:The median MNA score was 27 (range 12.5–30). One woman was classified as malnourished and 7.4% were at risk of malnutrition. Osteoporosis of the femoral neck was observed in 22% and a fracture after the age of 50 was reported by 31% of the participants. The following items in the MNA questionnaire exhibited an increased risk of having osteoporosis in the femoral neck and/or total hip: an MNA score of <27 (odds ratio (OR)=2.09; CI=1.14–3.83); a mid-arm circumference of less than 28 cm (OR=2.97; CI=1.29–6.81); and regular use of more than 3 drugs each day (OR=2.12; CI=1.00–4.50). A body weight of more than 70 kg exhibited a decreased risk of having osteoporosis (OR=0.31; CI=0.14–0.70).Conclusions:In general, the nutritional status was good in this population of free-living elderly women. Nevertheless, half of the women who displayed an MNA score <27 points had a twofold increased risk of having osteoporosis.Sponsorship:Karolinska Institutet, Stockholm County Council.European Journal of Clinical Nutrition (2006) 60, 486–493. doi:10.1038/sj.ejcn.1602341; published online 14 December 2005 [ABSTRACT FROM AUTHOR]

Objective:Low antioxidant intake and status have been shown to be associated with an elevated risk for various diseases. Data on the status of antioxidant vitamins, selenium and coenzyme Q10 of younger female seniors are scarce. The aim of this study was to assess the status of these antioxidants, as well as influencing factors such as dietary intake, anthropometric data and educational level in female seniors (60–70 years) in Germany.Design:Dietary intake of alpha-tocopherol, beta-carotene and ascorbic acid was determined by a 3-day diet record. Serum concentrations of alpha-tocopherol, beta-carotene, ascorbic acid, selenium and coenzyme Q10 were measured. Anthropometric measures, socioeconomic and educational status were assessed.Setting:In total, 178 elderly women without severe diseases in the region of Hannover, Germany, were included in the study. The mean (±s.d.) age and BMI of the women was 63.2 (2.73) years and 25.6 (3.77) kg/m2, respectively. The study participants were generally better educated than the overall German female population.Results:Dietary intake of the ascorbic acid and alpha-tocopherol was below RDA in six and 75% of the women, respectively. In comparison to estimated desirable serum concentrations of alpha-tocopherol, ascorbic acid, beta-carotene and selenium, lower concentrations were found in 23, 1, 6, and 39% of the women, respectively. Ascorbic acid (r=0.205, P=0.009) and beta-carotene (r=0.173, P=0.025) intake were significantly associated with serum concentrations. Beta-carotene concentrations were influenced by the type of diet, BMI, and school education (R 2=0.128, P<0.001). Serum selenium was positively associated with alcohol intake (r=0.229, P=0.003). Neither employment nor vocational training was predictive for the serum concentrations of antioxidant vitamins, selenium or coenzyme Q10.Conclusions:Poor status of selenium and alpha-tocopherol is highly prevalent even among younger, well-educated female seniors, whereas ascorbic acid and beta-carotene status seems sufficient in most women.Sponsorship:The study was supported by grants from the Stoll Vita Foundation, Waldshut-Tiengen, Germany.European Journal of Clinical Nutrition (2006) 60, 85–91. doi:10.1038/sj.ejcn.1602271; published online 24 August 2005 [ABSTRACT FROM AUTHOR]

Objective:Patients with rectal cancer receive curative radiotherapy towards the pelvis for 5 weeks. Little is known about the impact of radiotherapy on dietary intake and nutritional status. The objective was to examine whether curative radiotherapy for rectal cancer promoted altered intake of energy and nutrients, and change in nutritional indicators.Design:Prospective study.Setting:Department of Oncology in a tertiary care hospital.Subjects:A total of 31 consecutive patients receiving radiotherapy for rectal cancer (50 Gray).Interventions:A 7-day food intake registration, body weight, upper arm circumference, and analyses of blood samples were performed at the start and the end of radiotherapy, and at follow-up 4–6 weeks and 1 year after the end of radiotherapy.Results:At the end of 5 weeks of radiotherapy, the mean daily energy intake was reduced by 15% from 8.9 to 7.6 MJ as compared with baseline (P=0.002), and the intake of several nutrients was reduced (P<0.01). The percentages of energy derived from fat, protein, and carbohydrates did not change, nor did the nutrient density. A transient body weight reduction of<1 kg was observed (P=0.009). Serum concentrations of vitamin A and 25-OH vitamin D did not change during radiotherapy. The daily intake of energy and nutrients, and body weight, had increased towards pretreatment values 4–6 weeks after radiotherapy.Conclusions:Radiotherapy for rectal cancer caused a transient reduction in energy intake and nutritional indicators. The nutritional quality of the diet was unchanged during radiotherapy.Sponsorship:The first author was a research fellow funded by the Norwegian Cancer Society.European Journal of Clinical Nutrition (2006) 60, 113–119. doi:10.1038/sj.ejcn.1602274; published online 5 October 2005 [ABSTRACT FROM AUTHOR]

Objective:To assess the prevalence of obesity, overweight (including obesity) and thinness in children of the city of Florianopolis (southern Brazil).Design:Cross-sectional study.Subjects:Representative sample of 7–10-y-old schoolchildren of the first four grades of elementary schools (1432 girls, 1504 boys).Methods:Measurements of weight, height and triceps skinfold thickness (TSF) were taken following standard techniques. The body mass index (BMI) was computed as weight/height2. Nutritional status was defined using two references: (1) the Must et al reference for BMI and TSF to define thinness, overweight and obesity (5th, 85th and 95th percentiles, respectively); (2) the International Obesity Task Force (IOTF) BMI cutoffs to define overweight and obesity.Results:Using BMI, according to the Must et al, and IOTF references, the prevalence of obesity was 10.6 and 5.5%, respectively; overweight (including obesity) affected 26.2 and 22.1% of children, respectively. According to the Must et al reference, the prevalence of thinness was 3.2%. Using TSF rather than BMI, according to the Must et al references, fewer children were classified as obese (8.0%) or overweight (20.2%) and more children were classified as thin (4.9%).Conclusion:This study supports the previously reported high frequencies of childhood overweight and obesity in developing countries. The data allow comparisons with other studies carried out in Brazil and other parts of the world.European Journal of Clinical Nutrition (2005) 59, 1015–1021. doi:10.1038/sj.ejcn.1602206; published online 22 June 2005 [ABSTRACT FROM AUTHOR]

Objective:To study the prevalence and current predictors of low body mass index (BMI) in a population undergoing a rapid nutritional transition.Design:Population-based cross-sectional study.Settings:Individuals living in the urban area of Pelotas, a medium-sized southern Brazilian city, were interviewed at home.Subjects:A multiple-stage sampling strategy was used. Out of 3372 eligible subjects, 3047 were interviewed. The study was restricted to adults (≥20 y).Main outcome measure:Low BMI was defined as <18.5 kg/m2.Results:The prevalence of low BMI was 2.7% (95% confidence interval: 2.1; 3.3), higher in women than men (3.8 vs 1.3%; P<0.001). In the whole sample (men and women combined), living without a partner and current smoking were positively associated with low BMI. Among women, low BMI presented a U-shaped relationship with age and was positively associated with educational level. The prevalence of low BMI in young women was 6.3%, and in highly educated young women was 8.9%.Conclusions:Consistently with previous Brazilian studies, a decline in the overall prevalence of low BMI is clear. However, differently from these studies, the predictors of low BMI in women are similar to those observed within developed countries (including low age and high education), possibly indicating an increase in eating disorders.European Journal of Clinical Nutrition (2005) 59, 1002–1006. doi:10.1038/sj.ejcn.1602204; published online 22 June 2005 [ABSTRACT FROM AUTHOR]

Objective:We investigated the nutritional, cognitive and functional status in residents of two service-flat (SF) complexes and the effects of a nutrition education programme for care staff.Design:Controlled nonrandomised study.Setting:Two SF complexes, that is community-assisted accommodation.Subjects:Of 115 eligible SF residents, 80 subjects participated (age 83±7 y, 70% women).Intervention:The nutritional status was assessed using body mass index (BMI, kg/m2), subjective global assessment (SGA), serum concentrations of albumin, insulin-like growth factor-I (IGF-I) and vitamin B12. Cognitive and functional status were evaluated using the Mini Mental State Examination (MMSE, 0–30 points, <24 points indicates impaired cognition) and the Katz activities of daily living (ADL) index, respectively. Two assessments were made with a 5-month interval. At the start, a 12-h education programme was given to the staff at one of the SF complexes.Results:At baseline, the means of BMI and the biochemical nutritional indices were normal, whereas one-third had BMI <22 kg/m2 and one-fourth had lost ≥10% of previous weight. According to SGA, 30% demonstrated possible or serious malnutrition. The median MMSE was 23 points (19.5–26.5, 25–75th percentile). Nearly 70% were ADL-independent. At the 5-month follow-up there were no differences in the nutritional and cognitive status of the residents. The nutritional knowledge of the staff improved slightly (P<0.05) at both SF complexes (NS between groups).Conclusions:Around one-third of SF residents appeared to be at nutritional risk. Five months after a 12-h staff nutrition education programme, no objective changes were seen in the nutritional status of the SF residents.Sponsorship:Supported by grants from the Swedish National Board of Health and Welfare and by the Swedish Research Council.European Journal of Clinical Nutrition (2005) 59, 947–954. doi:10.1038/sj.ejcn.1602163; published online 8 June 2005 [ABSTRACT FROM AUTHOR]

A cross-sectional study was undertaken to assess the nutritional status of children aged 3-15 y in remote villages of Lao PDR. Study sites were chosen from two provinces: Luang namtha (north) and Sekong province (south). All the sampled 1075 children were measured for anthropometry, following the standard methods. Dietary intake, morbidity and socio-economic data were obtained by interviews with parents. This study confirmed the high prevalence of growth retardation among children, as well as persistent food insecurity in the remote areas of Lao PDR. Prevalence of stunting was 74.1% in Luang namtha and 62.6% in Sekong province, with school-aged children being worse-off than under-five ones. Children's diets were inadequate in quality as well as in quantity, with very limited availability of rice and other food items throughout the year. Our findings also suggest the negative outcomes of government's development programme were often overlooked, and that more attention should be paid on the fragile living conditions in the resettlement villages, especially for the ethnic minority. [ABSTRACT FROM AUTHOR]

OBJECTIVES:: To develop scores for food variety and diversity to assess the overall dietary quality in an African rural area; and to study their relationship with the nutritional status of women of childbearing age. DESIGN:: Cross-sectional. SETTING:: Sahelian rural area in the North-East Burkina Faso (West Africa). SUBJECTS:: A total of 691 mothers with children below the age of 5?y, selected at random in 30 villages. METHODS:: A qualitative recall of women's food consumption during the previous 24?h made it possible to calculate a food variety score (FVS=count of food items consumed) and a dietary diversity score (DDS=count of food groups, among 14 groups). These scores were then divided into terciles. Body mass index (BMI), mid-upper arm circumference (MUAC) and body fat percentage (BFP) were used to determine the women's nutritional status. RESULTS:: The overall dietary quality was poor: mean FVS (s.d.)=8.3 (2.9) food items; mean DDS=5.1 (1.7) food groups. A clear relationship was shown between both FVS and DDS (in terciles) and most nutritional indices. Women with a FVS in the lowest tercile had a mean BMI of 20.1, while those in the highest tercile had a BMI of 20.9 (P=0.009). Those in the lowest tercile of DDS had a 22.8%prevalence of underweight vs 9.8%in the highest tercile (P<0.0001). The latter relationship remained significant even when the subjects'sociodemographic and economic characteristics were accounted for. CONCLUSION:: Dietary scores measured at the individual level are good proxies for overall dietary quality of women living in a poor rural African area. These scores were also shown to be linked with the nutritional status of women. FINANCING:: IRD financed the study with the assistance of UNICEF for the purchase of anthropometric equipment. The first author received a research allowance from the French Ministry of Research through the doctoral school 393 of Pierre and Marie Curie University (Paris VI).European Journal of Clinical Nutrition (2005) 59, 703-716. doi:10.1038/sj.ejcn.1602135 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland. DESIGN:: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents'backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care. SETTING:: All nursing homes in Helsinki community, the capital of Finland. SUBJECTS:: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82?y, were examined. RESULTS:: One-third (29%) of the studied residents suffered from malnutrition (MNA<17), and 60%were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95%CI 2.76-4.99), swallowing difficulties (OR 3.03, 95%CI 2.10-4.37), dementia (OR 2.06, 95%CI 1.45-2.93), constipation (OR 1.84, 95%CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95%CI 2.21-4.15). CONCLUSIONS:: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.European Journal of Clinical Nutrition (2005) 59, 578-583. doi:10.1038/sj.ejcn.1602111 Published online 3 March 2005 [ABSTRACT FROM AUTHOR]

AIM:: Screening and extended assessment of the nutritional status of patients on admission and on discharge from hospital were carried out. DESCRIPTION:: The studies were carried out in four teaching hospitals, four provincial hospitals and four county hospitals in Poland. SUBJECTS:: Screening examinations were carried out for 3310 randomly selected patients (every 10th patient admitted to hospital, including 1916 female cases aged from 16 to 92?y and 1394 male patients aged from 16 to 100?y). Extended examinations were carried out on 210 patients aged from 16 to 87?y (including 122 female and 88 male). MAIN ASSESSMENT PARAMETERS:: Anthropometric (height, weight, body mass index (BMI), waist-to-hip ratio (WHR), arm circumference) and biochemical indices (erythrocyte count, haemoglobin concentration, white blood cell count, blood lymphocyte count and serum albumin serum concentration). The extended examinations included determination of antioxidant vitamins (A, C, E), vitamin B12 and folic acid. RESULTS:: On admission to hospital, 10.43%of the patients surveyed had a BMI below 20?kg/m2, in 20.74%of patients serum albumin concentration was below 3.5?g/dl, indicating possible protein energy malnutrition. In addition, 21.02%had lymphocyte count below 1.5×103/mm3. During hospitalisation, deterioration in the nutritional status of the patient population occurred. On discharge from hospital, the percentage of patients with BMI<20?kg/m2 increased to 11.21%and the percentage with low blood albumin (<3.5?g/dl) increased to 28.57%. On admission, vitamin C deficiency was present in 51.8%of patients, folic acid deficiency in 32%, vitamin E deficiency in 10%, vitamin B12 deficiency in 6.8%and vitamin A deficiency in 1.4%. Vitamin deficiencies were present equally in malnourished, overweight and obese patients. CONCLUSIONS:: In patients admitted to hospitals in Poland, malnutrition risk demonstrated by BMI was observed in 10.43%of patients. On the basis of biochemical indices, increased nutritional risk was demonstrated in 21%of patients. Vitamin malnutrition was seen in the majority of patients. A significant correlation between weight, BMI, arm circumference, blood lymphocyte count and the number of days spent in hospital was observed. SPONSORSHIP:: The Committee of Scientific Research and the Ministry of Health-PBZ 012-14.European Journal of Clinical Nutrition (2005) 59, 552-560. doi:10.1038/sj.ejcn.1602117 Published online 16 February 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To investigate nutritional status and its relationship to cognition, well-being, functional ability and energy intake in frail elderly service flat residents. DESIGN:: Cross-sectional and prospective study. SETTING:: Two municipal service flat complexes. SUBJECTS:: A total of 80 residents (median age 85.5 (79-90)?y) with regular home care assistance participated. A subgroup of 35 residents took part in a re-examination 1?y later. METHODS:: Mini Nutritional Assessment (MNA), Short Portable Mental Status Questionnaire, Barthel Index and Health Index were used for the evaluation of nutritional, cognitive and ADL function and well-being, respectively. RESULTS:: In all, 30%of the frail and chronically ill service flat residents were assessed as malnourished and 59%were at risk of malnutrition. The malnourished residents had worse cognitive conditions (P<0.001) and well-being (P<0.05), lower functional ability (P<0.01) and they had a greater need for daily assistance (P<0.05) than the other residents. The median night fast period was 14.0 (12.5-15.0)?h. Five subjects classified as malnourished at baseline had lost a median of-9.6?kg (range-11.0 to+7.3?kg) (P<0.05) in body weight at the 1-y follow-up, which contrasted significantly from the weight stability in residents classified as at risk for malnutrition or well-nourished. CONCLUSION:: Out of 10 residents, nine were assessed to have impending nutritional problems that related to impaired well-being, cognition, and functional ability. Malnourished residents had a significant weight loss over one year. Studies are needed to determine whether weight loss and nutrition-related dysfunction in service flat residents are preventable or treatable. SPONSORSHIP:: Karolinska Institutet, Vårdal Foundation and the Swedish Medical Research Council.European Journal of Clinical Nutrition (2005) 59, 263-270. doi:10.1038/sj.ejcn.1602067 Published online 13 October 2004 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids (VLPD+KA) in comparison with a conventional low-protein diet (LPD) in chronic kidney disease (CKD) patients. DESIGN:: Prospective, randomized, controlled clinical study. SETTING:: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. SUBJECTS:: The study involved 24 patients with advanced CKD (creatinine clearance<25?ml/min) that were randomly assigned to either a VLPD+KA (VLPD+KA group, 12 patients) or to a conventional LPD with 0.6?g/kg/day (LPD group, 12 patients). The patients were followed for 4 months. RESULTS:: Nutritional status was adequately maintained with both diets for the studied period. Protein intake and serum urea nitrogen decreased significantly only in the VLPD+KA group (from 0.68±0.17 to 0.43±0.12?g/kg/day, P<0.05; from 61.4±12.8 to 43.6±14.9?mg/dl, P<0.001; respectively). Ionized calcium did not change in the VLPD+KA group but tended to decrease in the LPD group. Serum phosphorus tended to decrease in the VLPD+KA group probably as a result of a significant reduction in dietary phosphorus (529±109 to 373±125?mg/day, P<0.05) associated to the phosphorus-binding effect of the ketoacids. No change in these parameters was found in the LPD group. Serum parathormone increased significantly only in the LPD group (from 241±138 to 494±390?pg/ml, P<0.01). The change in PTH concentration was negatively correlated with changes in ionized calcium concentration (r=-0.75, P=0.02) and positively correlated with changes in serum phosphorus (r=0.71, P=0.03) only in the LPD group. CONCLUSION:: This study indicates that a VLPD+KA can maintain the nutritional status of the patients similarly to a conventional LPD. Besides, an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD+KA. Thus, VLPD+KA can constitute another efficient therapeutic alternative in the treatment of CKD patients. SPONSORSHIP:: This study was supported by CAPES, Oswaldo Ramos Foundation and Fresenius Kabi, Ltda.European Journal of Clinical Nutrition (2005) 59, 129-136. doi:10.1038/sj.ejcn.1602050 Published online 8 September 2004 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To assess the nutritional status, food consumption and physical activity (PA) habits of Chilean school children, as a baseline for developing an educational intervention. DESIGN:: Cross-sectional study. SUBJECTS:: A total of 1701 children from 3rd to 7th grade in nine schools located in three geographical regions. METHODS:: We determined body mass index, food consumption (quantified FFQ which we categorised into five groups), PA in terms of TV viewing and frequency of after school PA. The data were analysed according to age, nutritional status and gender. A logistic regression analysis was performed using obesity as outcome. RESULTS:: Obesity was higher among boys; younger children presented higher prevalence in both genders. Daily intake of dairy products varied between 240 and 308?g, fruits/vegetables, between 197 and 271?g, energy-dense foods between 343 and 460?g. In all, 22.3 and 47% of the children watched over 3?h of TV during the week and weekend, respectively. Older children watched significantly more TV during the week, while on weekends all children increased this time significantly. Boys were more active than girls after school. The logistic regression analysis showed a significant association between obesity and low intake of dairy products. CONCLUSIONS:: Prevalence of obesity among Chilean children is high. Although TV time, intake of energy dense foods and fruits/vegetables appeared as risk factors for obesity, only dairy consumption was significantly associated with obesity. SPONSORSHIP:: FAOEuropean Journal of Clinical Nutrition (2004) 58, 1278-1285. doi:10.1038/sj.ejcn.1601962 Published online 31 March 2004 [ABSTRACT FROM AUTHOR]

INTRODUCTION:: Bolivia, as one of the poorest Latin American countries, has dealt with the problems of undernutrition for the last 50?y. Little importance has been given to the increase in overweight and obesity among the population, despite the scientific evidence linking overweight and obesity with mortality and morbidity. OBJECTIVE:: To describe the social and demographic determinants of the nutritional status among women in Bolivia between 1989 and 1998 to gain a better understanding of the nutrition transition phenomena and to identify urgent research needs. METHODOLOGY:: Secondary analysis of the raw data of the Bolivian National Demographic and Health Surveys of 1994 and 1998. Changes in the prevalence of underweight, obesity and overweight are described by sociodemographic characteristics of Bolivian women. Social and demographic determinants of nutritional status have been fitted into a logistic model. RESULTS:: The prevalence of overweight (defined as 25=BMI<30?kg/m2) among women of reproductive age (20-44?y) increased by 9 percentage points between 1994 and 1998 (P<0.001), while the prevalence of normal BMI decreased by 10 percentage points (P<0.001). The decrease in the prevalence of underweight (defined as BMI <18.5?kg/m2) from 2.4% in 1994 to less than 1% in 1998 was statistically significant (P<0.001). Obesity (defined as BMI =30?kg/m2) was positively associated with geographical region (P=0.001), educational level (P<0.001), age (P=0.003) and total number of children (P=0.001) and negatively associated to rural locality (P=0.001) and native languages (P<0.001). Overweight was inversely associated with rural locality (P=0.013) and with Quechua language (P=0.04), while the total number of children (P<0.001) and year of survey (P<0.001) were positively associated. Underweight decreased dramatically (P<0.001), being positively associated with the region of residence (P=0.04) and inversely associated with the total number of children (P=0.006). CONCLUSION:: The present study suggests that the population of Bolivia is in a transitional stage, with overweight becoming as much of a problem as undernutrition.European Journal of Clinical Nutrition (2004) 58, 660-666. doi:10.1038/sj.ejcn.1601862 [ABSTRACT FROM AUTHOR]

AIM:: To describe plasma retinol values according to age, gender and pubertal maturation. TYPE OF STUDY:: Comparative, transverse and descriptive. PLACE:: Medellín, Colombia. SUBJECTS AND METHODS:: Plasma retinol values were determined in 588 boys and 531 girls aged between 6 and 18?y. For this, we used spectrophotometry by UV oxidation of retinol, results below 0.87?mmol/l were confirmed by high-performance liquid chromatography. RESULTS:: Mean retinol plasma concentrations were slightly higher in girls under 10?y. However, above this age, values are generally higher in boys. Plasma retinol concentrations increased with pubertal maturation in both boys and girls in a statistically significant manner. The highest values were observed in girls with mammary development grades 3 and 4 (P<0.05) and in boys with external genitalia development grades 1 and 2 (P<0.05). Vitamin A deficiency based on plasma retinol concentration (<0.70?mmol/l), was observed in 3.6% of all individuals regardless of gender. CONCLUSIONS:: Plasma retinol concentration is correlated to pubertal maturation in both boys and girls. Vitamin A deficiency in school children and adolescents of Medellín is not a major health problem.European Journal of Clinical Nutrition (2004) 58, 456-461. doi:10.1038/sj.ejcn.1601828 [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a daily oral iron supplementation on hematological status, cell-mediated immunity and susceptibility to infections in children living in an environment where iron deficiency, malaria and other infections are frequent.Design: Randomized, double-blind iron supplementation including a placebo group.Setting: A village in Togo, West Africa.Subjects: Of the 229 6-36-month-old children of both sexes recruited, 197 with hemoglobin concentration >/=80 g/l were included and 163 completed the study.Intervention: Children received daily a placebo (n=79) or a dose of 2-3 mg of elemental iron per kg of body weight (n=84) for 3 months. Hematological, nutritional and immune status were assessed at the beginning and at the end of the supplementation period, and 6 months later. Morbidity was recorded throughout the study.Results: Iron supplementation had a significant and positive effect on iron status of children and no impact on the incidence of infections, especially malaria. Its probable effect on immune status was masked by interference of infections and their treatment, which contributed to improve hematological and immune status in both groups.Conclusion: According to the negative consequences of anemia and iron deficiency on global child development, control of iron deficiency by oral iron supplementation in young children has to be conducted, associated with prophylaxis and treatment of malaria and repeated deworming.Sponsorship: Program supported by IRD. European Journal of Clinical Nutrition (2000) 54, 29-35 [ABSTRACT FROM AUTHOR]

Autonomic imbalance, measured as heart rate variability (HRV), and an increased cardiovascular risk are described for overweight children, as well as for patients with anorexia nervosa. We investigate whether body mass index or actual caloric intake influences HRV. In our cross-sectional study, we compared HRV parameters for a healthy control group (n=52), anorexia nervosa patients (n=17), thin (n=18) and overweight children (n=19). Anorexia nervosa patients showed significantly lower heart rates at night (P<0.001) and significantly higher SDNN (standard deviation of all RR-intervals) (P<0.001 ), whereas overweight children showed an opposing pattern. SDNN and heart rate at night are highly correlated (r=0.89, R2=0.79, P<0.001). We conclude that not current body mass index but caloric intake determines HRV. Obesity and anorexia nervosa are characterized by a specific pattern of autonomic imbalance. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether succeeding pregnancies will affect the maternal and neonatal docosahexaenoic acid (DHA, 22:6n-3) status.Design: Cross-sectional study.Subjects: Women who were pregnant for the 1st to 7th time and took part in a longitudinal study to investigate the essential fatty acid status of pregnant women and their infants. The total study population comprised 98 primigravidae (PG) and 146 multigravidae (MG).Main Outcome Measures: Fatty acid profiles of phospholipids isolated from maternal plasma samples collected during pregnancy and after delivery, and of umbilical plasma, vein and artery, obtained immediately after birth.Results: The absolute (mg/L) and relative (% of total fatty acids) amounts of DHA in maternal plasma phospholipids (PL) were significantly lower in MG than in PG. In addition, a significant negative correlation was observed between gravida number and the DHA content in maternal plasma samples. The DHA deficiency index (22:5n-6/22;4n-6) was significantly higher and the DHA sufficiency index (22:6n-3/22:5n-6) was significantly lower in umbilical plasma of infants born of MG than in that of infants born of PG. The relative DHA content of umbilical artery and vein vessel walls was significantly lower in MG- than in PG-neonates and significant negative associations were observed between birth order and the relative amounts of DHA in cord tissues.Conclusions: These results indicate that the maternal DHA status becomes reduced after each following pregnancy, which may result in a lower neonatal DHA status. Whether or not this has also functional consequences needs to be investigated further. [ABSTRACT FROM AUTHOR]

Objective:To explore incidence and prevalence rates of nutritional deficiency in adults in general practice.Methods:Six Dutch general practice research and registration networks supplied incidence and prevalence rates of nutritional deficiency by the International Classification of Primary Care (ICPC) or ‘E-list’ labels (‘loss of appetite, feeding problem adult, iron, pernicious/folate deficiency anaemia, vitamin deficiencies and other nutritional disorders, weight loss’). In case of disease-related nutritional deficiency, we asked whether this was labelled separately (‘co-registered’) or included in the registration of the underlying disease.Results:‘Iron deficiency anaemia’ had highest incidence (0.3–8.5/1000 person years), and prevalence rates (2.8–8.9/1000 person years). Nutritional deficiency was mostly documented in the elderly. In two networks ‘co-registration’ was additional, two only documented the underlying disease and two did not specify ‘co-registration’. No clear difference was found between networks considering the difference in ‘co-registration’.Conclusion:Nutritional deficiency is little documented in general practice, and generally is not registered separately from the underlying disease.European Journal of Clinical Nutrition (2005) 59, Suppl 1, S187–S194. doi:10.1038/sj.ejcn.1602195 [ABSTRACT FROM AUTHOR]