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Acute lymphoblastic leukemia (ALL) is the most common childhood cancer in the world. Doxorubicin (Dox) is a very useful drug in these patients, however, one of the main adverse effects caused by the use of Dox is cardiotoxicity (CT). Protein-calorie malnutrition (PCM) is a factor that, among others, can influence the development of CT due to Dox. The aim of our study was to associate PCM as a risk factor for CT induced by Dox in Mexican children with ALL. We included 89 children with ALL who were treated with Dox, from October 2018 to July 2023, and of whom 14 developed some type of CT, 15 were underweight and 3 were overweight. The analysis of the association risk of CT due to PCM shows a statistically significant association of risk of developing CT due to PCM. On the other hand, healthy weight was associated with protection for developing CT due to Dox use. Of the total number of girls who presented CT, all had systolic dysfunction, while 6 of them also had diastolic dysfunction. On the other hand, of the total number of boys who presented CT, all of them had systolic dysfunction and only one of them also had diastolic dysfunction. These results show that in patients in which Dox is being administered, special attention is suggested for girls with PCM, since systolic failure is a precursor and occurs before diastolic failure in girls with PCM. [ABSTRACT FROM AUTHOR]

The first few months of hemodialysis (HD) are associated with a higher risk of mortality. Protein-energy malnutrition is a demonstrated major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has also been associated with increased mortality risk. The aim of this study was to determine the predictive value of CAR for six-month mortality in incident HD patients. Retrospective analysis of incident HD patients between January 2014 and December 2019. CAR was calculated at the start of HD. We analyzed six-month mortality. A Cox regression was performed to predict six-month mortality and the discriminatory ability of CAR was determined using the receiver operating characteristic (ROC) curve. A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older (p < 0.001), had more cardiovascular disease (p = 0.010), had central venous catheter at the start of HD (p < 0.001), lower parathyroid hormone (PTH) level (p = 0.014) and higher CAR (p = 0.015). The AUC for mortality prediction was 0.706 (95% CI (0.65–0.76), p < 0.001). The optimal CAR cutoff was ≥0.5, HR 5.36 (95% CI 3.21–8.96, p < 0.001). We demonstrated that higher CAR was significantly associated with a higher mortality risk in the first six months of HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD. [ABSTRACT FROM AUTHOR]

Protein-energy malnutrition (PEM) is a major factor contributing to morbidity and mortality in cancer patients. Empiric data are limited on the effect of PEM on the outcomes of patients receiving chemotherapy in diffuse large B cell lymphoma (DLBCL). A retrospective cohort study was designed using data from the National Inpatient Sample for 2016 to 2019. Adult patients admitted for chemotherapy with DLBCL were stratified based on the presence of PEM. Primary outcomes assessed were mortality, length of stay, and total hospital charges. PEM was associated with an increased odds of mortality, 2.21% vs 0.25% (adjusted odds ratio 8.20, P < 0.001, 95% confidence interval [CI] 4.92–13.69). There was also an increased length of stay in patients with PEM, 7.89 vs 4.85 days (adjusted difference of 3.01 days, P < 0.001, 95% CI 2.37–3.66), as well as an increase in total charges, $137,940 vs $69,744 (adjusted difference of $65,427, P < 0.001, 95% CI $38,075–$92,778). Similarly, the presence of PEM was associated with increased odds of several secondary outcomes measured, including neutropenia, Candida sepsis, septic shock, acute respiratory failure, and acute kidney injury compared to the other cohort. This study demonstrated an eightfold increased odds of mortality and concomitant prolonged length of stay with a 50% total charge increment in malnourished individuals with DLBCL compared to those without PEM. Prospective trials to evaluate PEM as an independent prognostic marker of chemotherapy tolerance and adequate nutritional support can improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Serum and liver samples from 35, 2-year-old dairy heifers that had fractured one or both humeri post-calving between July and December 2019 were submitted to a diagnostic laboratory for analysis. Serum samples were analysed for albumin, β-hydroxybutyrate (BHB), creatinine, Ca, Mg, phosphate, non-esterified fatty acids (NEFA), and serum Cu concentration. Liver samples were analysed for liver Cu concentration. Data were compared to published reference intervals. Data values for heifers that prior to fracture had grazed fodder beet were also compared to values for those that had grazed pasture. Sixty-nine percent of heifers with humeral fracture had serum creatinine concentrations below the lower value of the reference range (55–130 µmol/L). In 3/32 (9%) heifers, serum NEFA concentrations were increased above the reference value indicating body fat mobilisation (≥1.2 mmol/L for peri-partum cows) and in 20/35 (57%) heifers BHB serum concentrations were above the reference value indicating subclinical ketosis (≥1.1 mmol/L for peri-partum cows). In 24/35 (69%) heifers, liver Cu concentration was low (≤ 44 µmol/kg) or marginal (45–94 µmol/kg). The concentration of Cu in serum was low (≤ 4.5 µmol/L) in 2/33 (6%) heifers and marginal (4.6–7.9 µmol/L) in 5/33 (15%) heifers. There was moderate positive correlation between the logged concentrations of Cu in paired liver and serum samples, r(31) = 0.43; (95% CI = 0.1–0.79; p = 0.014). One heifer had a serum phosphate concentration below the lower limit of the reference range (< 1.10 mmol/L). For all heifers, the concentrations of albumin, Ca, and Mg in serum were within the reference intervals (23–38 g/L, 2.00–2.60 mmol/L, and 0.49–1.15 mmol/L respectively). Over winter, 15/35 (43%) heifers grazed predominantly pasture, 14/35 (40%) grazed fodder beet and 6/35 (17%) had a mixed diet. In some of these heifers with humeral fractures, there was evidence for protein and/or energy malnutrition in the form of elevated NEFA and BHB concentrations and low creatinine concentrations in serum. Liver Cu concentrations were also reduced in most affected heifers. However, the absence of a control group means it is not possible to determine if these are risk factors for fracture or features common to all periparturient heifers. Clinical trials and molecular studies are needed to determine the true contribution of Cu and protein-energy metabolism to the pathogenesis of spontaneous humeral fractures in dairy heifers. BHB: ß-hydroxybutyrate; NEFA: Non-esterified fatty acids [ABSTRACT FROM AUTHOR]

Introduction: Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM). Methods: This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. Hospitalizations of adults >/ = 18 years old with a principal diagnosis of DKA were obtained using ICD-10 codes and divided into groups based on a secondary diagnosis of PEM. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), and system-based complications. Results: Patients with PEM had a statistically significant difference in the adjusted odds for in-hospital mortality compared to patients without PEM (aOR 1.73, 95% CI: 1.20–2.49, p = 0.004). Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49–3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31–4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17–1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83–2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43–2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42–3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000–22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96–2.57, p < 0.001) in days when compared to patients without PEM. Conclusion: Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality. [ABSTRACT FROM AUTHOR]

The increase in local muscle cytokines produced during inflammation makes the muscle GH-resistant and reduces its own IGF-I production. Protein energy malnutrition, infection, inflammation, stunting, marasmus, kwashiorkor Keywords: Protein energy malnutrition; infection; inflammation; stunting; marasmus; kwashiorkor EN Protein energy malnutrition infection inflammation stunting marasmus kwashiorkor 213 216 4 09/07/21 20210901 NES 210901 1. [Extracted from the article]

Background: The World Health Organization has a clinical and syndromic approach to the management of severe acute malnutrition which recognises that laboratory investigations are often not possible where children with severe malnutrition present. In low- and middle-income countries including Papua New Guinea, rates of death from severe malnutrition in many hospitals remain 10% or more. Aim: To evaluate the clinical predictors of death and the association between disturbances of electrolytes and haematological investigations in children with severe malnutrition and the risk of mortality. Methods: The clinical and laboratory predictors of death in a prospective cohort of 150 children with severe malnutrition admitted to a provincial hospital in Papua New Guinea were analysed. The clinical signs and electrolytes, complete blood count and liver function tests at presentation and on Days 3 and 5 were recorded. Results: The strongest independent predictors of mortality at assessment on admission were a low child Glasgow coma scale (≤12), hypoxaemia (SpO2 <90%), prolonged capillary refill (>3 seconds) and dysnatraemia (<130 or >150 mmol/L). The area under the receiver operating characteristics curve for these four variables was 0.93. Conclusions: That three of these four criteria correspond closely to the WHO Emergency Clinical Signs reinforces the value of a system of triage and risk assessment in children with severe malnutrition. If a child has emergency signs they should be managed in an area on the ward where close monitoring and supportive care can be provided, the WHO guidelines for severe malnutrition followed, and other specific care provided. Measurements of serum sodium, particularly in children with diarrhoea and dehydration, is also important in risk assessment and management. [ABSTRACT FROM AUTHOR]

Kwashiorkor syndrome is a form of severe protein-energy malnutrition characterized by protein deficiency and bilateral extremity swelling. Worldwide, most affected regions include Southeast Asia, South Africa and Central America; it is rare in developed countries such as the USA. We report a case of profound kwashiorkor in a 38-year-old male with an underlying psychiatric disorder and restricted diet who presented with extensive abdominal distention and systemic findings indicative of protein malnutrition. [ABSTRACT FROM AUTHOR]

The present research work aimed to investigate the melting and solidification characteristics of NPCM. The NPCM was prepared using paraffin as the PCM and high conductive MWCNT as the nanomaterial without using any dispersant. The NPCM was prepared by dispersing MWCNTs with volume fractions of 0.3%, 0.6% and 0.9% in PCM as the base PCM. SEM morphology showed the uniform dispersion of MWCNTs in the paraffin wax. The MWCNT nano-additives PCMs showed two peaks in the heating curve by DSC measurement. Lessening in melting and solidification time of 30% and 43% was attained in the case of NPCM with 0.3% and 0.9%, respectively. It is observed from the DSC analysis that the latent heat of pure paraffin during freezing and melting cycle was 139.2 J/g (at 56.61 °C) and 131.8 J/g (at 57.55 °C), respectively. Whereas, the latent heat of NPCM with 0.9% of nanofluid was 150.7 J/g (at 56.36 °C) and 148.3 J/g (58.35 °C). It is construed that a maximum change in latent heat of 7.6% and 11% was observed between pure PCM and NPCM during freezing and melting cycle. For the lesser nanoparticle concentration (0.3% and 0.6%), the percentage change in latent heat was lesser than 0.9%. [ABSTRACT FROM AUTHOR]

Vitamin A deficiency (VAD) is a serious and widespread public health problem and the leading cause of preventable blindness in young children. It is also associated with increased rates of death from severe infections, especially in developing countries. Over the past 35 years, researchers have examined the numerous activities of vitamin A in different tissues of the human body. VAD can lead to a series of ocular symptoms, anemia, and weak resistance to infection, which can increase the severity of infectious diseases and the risk of death. Cell development, vision, growth, and normal metabolism are among the vital processes that are insufficiently supported in the presence of VAD. VAD leads to impaired tissue function especially during the developmental periods of infancy, childhood, pregnancy, and lactation. We describe a multidirectional model of VAD that demonstrates how VAD can have progressive, negative effects on vital processes of the human body throughout the life cycle. This model starts with impaired intake and its link to decreased absorption and digestion and includes outcomes such as malnutrition, inflammation, and improper growth processes, including possible mechanisms. Together, these clinical and biochemical manifestations contribute to the vicious cycle of VAD. [ABSTRACT FROM AUTHOR]

Background: Disease-related malnutrition is highly prevalent, and has prognostic implications for patients with chronic kidney disease (CKD); however, few studies have investigated the impact of malnutrition, or protein-energy wasting (PEW), on healthcare utilization and medical expenditure among CKD patients.Methods: Using claim data from the National Health Insurance in Taiwan, this study identified patients with CKD between 2009-2013 and categorized them into those with mild, moderate, or severe CKD. Cases with PEW after CKD was diagnosed were propensity-score matched with controls in a 1:4 ratio. Healthcare resource utilization metrics were compared, including outpatient and emergency department visits, frequency and duration of hospitalization, and the cumulative costs associated with different CKD severity.Results: From among 347,501 CKD patients, eligible cohorts of 66,872 with mild CKD (49.2%), 27,122 with moderate CKD (19.9%), and 42,013 with severe CKD (30.9%) were selected. Malnourished CKD patients had significantly higher rates of hospitalization (p < .001 for all severities) and re-admission (p = .015 for mild CKD, p = .002 for severe CKD) than non-malnourished controls. Cumulative medical costs for outpatient and emergency visits, and hospitalization, were significantly higher among all malnourished CKD patients than non-malnourished ones (p < .001); total medical costs were also higher among malnourished patients with mild (62.9%), moderate (59.6%), or severe (43.6%) CKD compared to non-malnourished patients (p < .001).Conclusions: In a nationally-representative cohort, CKD patients with PEW had significantly more healthcare resource utilization and higher aggregate medical costs than those without, across the spectrum of CKD: preventing PEW in CKD patients should receive high priority if we would like to reduce medical costs. [ABSTRACT FROM AUTHOR]

The potential of bambara groundnut as a crop-based approach for the sustainable reduction of protein–energy malnutrition prevalent in Nigeria is still being explored. However, one of the limitations to sustainable production of this adapted species is low and unstable yield. Here, we employed multiple statistical analyses to determine traits that could be useful in predicting grain yield. Furthermore, additive main effect and multiplicative interaction and genotype × genotype × environment models were used to identify high yielding and stable landraces. Twenty-four bambara landraces were evaluated in two contrasting dry land growing seasons at four environments. Based on the results of correlation, path coefficient values and stepwise multiple regression analysis, it is reasonable to assume that seed growth rate would be effective as indirect selection criteria for grain yield improvement in this set of breeding materials under early and late planting environment. However, optimizing biomass growth rate, pod fill period, 100-seed weight, number of pods per plant and time to flowering may have important role in the improvement of grain yield in bambara groundnut. Due consideration should be given to 100-seed weight and time to flowering in the early dry and late planting environment. The possibility of successful cultivation of bambara groundnut in forest–savannah transition agricultural zone of Nigeria, particularly when planting is done around early August has been established in this study. However, based on the strong association between seed yield and its related characters in early and late planting environments, selection for higher seed growth rate combined with large number of pods appears to be the best indirect traits when selecting bambara groundnut plants to enhance grain yield under early and late planting environments. While landraces TVSu 1520 and 1578 were considered the best adapted landraces, TVSu 1670 and 1518 are promising landraces that could contribute to increasing grain yield stability. [ABSTRACT FROM AUTHOR]

Malnutrition and tuberculosis are both problems mostly of the developing countries. Tuberculosis can lead to malnutrition and malnutrition may predispose to tuberculosis. Poor nutrition leads to protein–energy malnutrition and micronutrients deficiencies which lead to immunodeficiency. This secondary immunodeficiency increases the host's susceptibility to infection and hence increase the risk for developing tuberculosis. Tuberculosis itself leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting and poor nutritional status. Nutritional status and dietary intake and hence nutritional status of patients get improved during antituberculosis treatment. [ABSTRACT FROM AUTHOR]

The various types of oedema in man are considered in relation to Starling's hypothesis of fluid movement from capillaries, with the main emphasis on nutritional oedema and the nephrotic syndrome in children. It is concluded that each condition has sufficient anomalous findings to render Starling's hypothesis untenable. The finding that the endothelial glycocalyx is key to control of fluid movement from and into the capillaries calls for complete revision of our understanding of oedema formation. The factors so far known to affect the function of the glycocalyx are reviewed. As these depend upon sulphated proteoglycans and other glycosaminoglycans, the argument is advanced that the same abnormalities will extend to the interstitial space and that kwashiorkor is fundamentally related to a defect in sulphur metabolism which can explain all the clinical features of the condition, including the formation of oedema. [ABSTRACT FROM AUTHOR]

The wheel of industrialization that spun throughout the last century resulted in urbanization coupled with modifications in lifestyles and dietary habits. However, the communities living in developing economies are facing many problems related to their diet and health. Amongst, the prevalence of nutritional problems especially protein–energy malnutrition (PEM) and micronutrients deficiencies are the rising issues. Moreover, the immunity or susceptibility to infect-parasitic diseases is also directly linked with the nutritional status of the host. Likewise, disease-related malnutrition that includes an inflammatory component is commonly observed in clinical practice thus affecting the quality of life. The PEM is treatable but early detection is a key for its appropriate management. However, controlling the menace of PEM requires an aggressive partnership between the physician and the dietitian. This review mainly attempts to describe the pathophysiology, prevalence and consequences of PEM and aims to highlight the importance of this clinical syndrome and the recent growth in our understanding of the processes behind its development. Some management strategies/remedies to overcome PEM are also the limelight of the article. In the nutshell, early recognition, prompt management, and robust follow up are critical for best outcomes in preventing and treating PEM. [ABSTRACT FROM PUBLISHER]

Nutritional deficiencies are independent risk factors for adverse outcomes in patients with nervous system disease. Patients with nervous system disease can often become malnourished due to swallowing difficulties or unconsciousness. This malnourishment increases hospitalization duration; average total hospital cost; occurrence of infection, pressure ulcers, and other complications. These problems need to be addressed in the clinic. In this paper, we review the relevant literature, including studies on influencing factors, evaluations, indexes, and methods: Our aim is to understand the current status of malnutrition in patients with nervous system disease and reasons associated with nutritional deficiencies by using malnutrition evaluation methods to assess the risk of nutritional deficiencies in the early stages. [ABSTRACT FROM AUTHOR]

Background: All systems in an organism are affected by protein-energy malnutrition (PEM), but one of the worst affected is the hematopoietic system. Today PEM remains a very serious problem in developing countries. We examined the relationships between clinical features, hematological, and bone marrow changes with severe PEM from Turkey. Method: We evaluated 34 (11 females and 23 males) consecutive cases of severe PEM, with no underlying diseases aged 3-20 months. The clinical nutritional conditions of the patients were determined using the Wellcome-Trust PEM classification. Ten of the patients were in the Marasmic-Kwashiorkor (M-K) group, 10 were in the Kwashiorkor (KW) group, and 14 were in the Marasmic (M) group. Full blood count, protein, albumin, serum iron (SI), iron-binding capacity (TIBC), ferritin, vitamin B12, folic acid, complement-3 (C3), complement-4 (C4), and bone marrow were investigated in all groups. Results: Anemia was detected in 97% of patients. We determined serum iron levels were low in 67.6% of the patients, TS levels were low in 76.4% of the patients and ferritin levels were low in 20.5%. The level of vitamin B12 was normal in all patients. Bone marrow analysis showed erythroid series hypoplasia in 28.5% of patients in the M group, 50% in the KW group, and 30% in the M-K group. Marrow iron was absent in 58.8% of patients. Conclusion: The most common hematologic change in the children with PEM was anemia and major cause of anemia was iron deficiency in this study. Patients with severe PEM have normal Vit B12 and serum folate levels. Most of the patients with severe PEM had normal cellularity with megaloblastic and dysplastic changes in bone marrow due to the inadequate and imbalanced intake of protein and energy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old male with end-stage kidney disease (ESKD) and hypertension who was treated through continuous ambulatory peritoneal dialysis for 10 years and was died due to surgical complications. Topics discussed include the management of patient with encapsulating peritoneal sclerosis, the use of intradialytic parenteral nutrition as a nutrition therapeutic intervention, and nutritional recommendations for adults with ESKD on haemodialysis.

Rational: Among the alternatives to reverse chronic hemodialysis protein-energy malnutrition is the enhancement of intradialytic oral nutritional therapy. Although foods of animal origin are a source of nutrients and represent a feasible diet, there is uncertainty about their health consequences. Objectives: We assessed the relationship of intradialytic high-protein red meat snack supplementation with patient inflammatory status and protein losses (nitrogen) during this supplementation. Fourteen patients submitted to low-flux chronic hemodialysis for one month were divided into two groups receiving 2 g (group 1) and 29 g (group 2) of oral intradialytic protein during the initial phase, respectively. In the subsequent phase, group 1 was supplemented with 27 g protein (a red meat snack) for a total of 29 g per dialysis. Group 2 continued to receive 29 g protein. Nutritional status, total nitrogen losses through the dialysate and acute inflammatory phase protein (CRP) were assessed before and after dialysis. Reuse of the dialyzer was also determined on each occasion. Main findings: Red meat supplementation did not interfere with CRP, nitrogen loss through the dialysate (18 ± 7 to 19 ± 4 g in group 1, ns, and 20 ± 7 to 21 ± 4 g in group 2, ns) or with nutritional status. However, the data showed a positive correlation between pre- and post-hemodialysis CRP values ( r = 0.84, p < 0.01) in both groups, suggesting an increase of the values after ultrafiltration. Reuse of the dialyzer was not correlated with CRP values. Principle conclusions: The results suggest that snacks were not acutely correlated with increased inflammatory levels and indicated that a protein-rich red meat snack may be beneficial for chronic hemodialysis patients. [ABSTRACT FROM AUTHOR]

Objectives: Early malnutrition is a highly prevalent condition in developing countries. Different rodent models of postnatal early malnutrition have been used to approach the subject experimentally, inducing early malnutrition by maternal malnutrition, temporal maternal separation, manipulation of litter size or the surgical nipple ligation to impair lactation. Studies on the behaviour of (previously) malnourished animals using animal models have produced sometimes contradictory results regarding the effects of early postnatal malnutrition and have been criticized for introducing potential confounding factors. The present paper is a first report on the behavioural effects of early malnutrition induced by an alternative approach: mice nursed by α-casein-deficient knockout dams showed a severe growth delay during early development and substantial catch-up growth after weaning when compared with animals nursed by wild-type females. Methods: Established behavioural tests were used to study the consequences of early postnatal malnutrition on mouse pups at weaning and after partial weight recovery. Results: Despite the impaired growth, the only behavioural difference between malnourished and normally growing animals was found in exploratory behaviour during acute malnutrition at the time of weaning. After partial catch-up in weight early protein malnourished animals showed no indication of lasting effects on general activity, emotionality and exploration, memory, and pain reactivity. Discussion: These results suggest that the role of early nutrition on behavioural development after recovery in animal models may have been overestimated. Further careful examination of this animal model in terms of maternal care and offspring behaviour will be necessary to confirm if mice nursed by α-casein-deficient dams offer an alternative to existing models while eliminating potential confounding factors. [ABSTRACT FROM AUTHOR]

Objective: To determine serum zinc (Zn), total anti-oxidant capacity (TAC), malondialdehyde (MDA), alkaline phosphatase (ALP) and albumin in protein energy malnutrition (PEM) and to analyse the appropriateness of using low weight-for-age for detecting childhood under-nutrition. Methods: This study comprised 455 children (355 malnourished and 100 normal). They were classified according to the Nutrition Subcommittee of Indian Academy of Pediatrics, Z-Score Classification and Composite Index of Anthropometric Failure. Serum Zn, TAC, MDA, ALP and albumin levels were determined. Results: The serum Zn, TAC, ALP and albumin levels were found to be significantly decreased and MDA levels were significantly increased in malnourished children as compared with control ( P < 0.001). Conclusion: The significant increase in serum MDA concentration associated with the decrease in serum TAC, Zn and ALP in malnourished children suggest that these children were potentially susceptible to high oxidative stress. Current study also suggest that conventional measures of detecting under-nutrition (low weight-for-age) may be missing out a considerable proportion of undernourished children present in the population. [ABSTRACT FROM AUTHOR]

Background: This study was designed to determine the prevalence of protein-energy wasting (PEW) and its various types in hemodialysis (HD) patients in Tehran, Iran. Methods: For this cross-sectional study, 291 HD patients were randomly selected. The nutritional status of the patients was determined by subjective global assessment (SGA) and their dietary intakes were assessed using a 4-day dietary recall. In addition, serum high-sensitive C-reactive protein (hs-CRP) was measured. Results: The prevalence of mild-to-moderate and severe PEW based on SGA was 60.5% and 1% in Tehran HD patients, respectively. The prevalence of various types of PEW in HD patients was 20.5% type I (inadequate energy or protein intake without inflammation), 65.5% type IIa (inadequate energy or protein intake with inflammation), and 14% type IIb (adequate energy and protein intake with inflammation). Of the total HD patients with no PEW based on SGA, about 3.5% had type 0 normal nutritional status (adequate energy and protein intake without inflammation), 34% had type I normal nutritional status (inadequate energy or protein intake without inflammation), 55.5% had type IIa normal nutritional status (inadequate energy or protein intake with inflammation), and 7% had type IIb normal nutritional status (adequate energy and protein intake with inflammation). Conclusion: PEW in Tehran HD patients is considerably prevalent and PEW type IIa is the most common type. In addition, HD patients with no PEW based on SGA should also be paid attention because they may be in the early stages of inadequate intake of energy and/or protein and inflammation. [ABSTRACT FROM AUTHOR]

Beginning with a historical summary of investigative work into protein-energy malnutrition, now termed 'severe acute malnutrition', this review ends by summarizing recent initiatives to tackle the global problem of malnutrition, specifically Scaling-Up Nutrition (SUN). In early years, macronutrient deficiency or imbalance was considered the principal cause of complex metabolic disturbances, including kwashiorkor, whereas, now, micronutrient deficiency infections, including HIV, and a background of deprivation are implicated. Different approaches to management are reviewed. The rehabilitation of individual children by protocolised-phased feeding has largely given way to community-based therapeutic feeding. Despite sporadic successes, the overall impact on morbidity and mortality has been so disappointing that the global community now plans a new initiative, viz. SUN. Its focus on the critical window of 1000 days (from conception to 2 years) is similar to the earlier focus on early childhood vulnerability which inspired the under-5 clinics and their integration into maternal and child health programmes. 'Targeted' interventions, recently more prominent than integrated community-based primary care, often undertaken by NGOs, have been effective, although sometimes imperfectly accountable. Will SUN, aiming for a broad approach, and the participation of recipient communities finally succeed in integrating nutrition into child health? [ABSTRACT FROM AUTHOR]

The objective of this study is to report the effects of cysteine on the pharmacokinetics of intravenous and oral docetaxel in rats with protein–calorie malnutrition (PCM). The in vivo pharmacokinetics and in vitro hepatic/intestinal metabolism of docetaxel were assessed using control, CC (control with cysteine), PCM and PCMC (PCM with cysteine) rats. The effects of cysteine on the intestinal absorption of docetaxel were further investigated through in vitro transport studies using rat intestine and Caco-2 cell monolayers. The AUCs (the areas under the plasma concentration-time curve from time zero to time infinity) of intravenous docetaxel in PCM rats were significantly greater than in the control rats because of the significant decrease in the hepatic CYP3A. In PCMC rats, the elevated AUCs in PCM rats returned to control levels. The AUC0–6 hs of oral docetaxel in PCM rats were significantly smaller than that in the control rats, mainly due to the decrease in gastrointestinal absorption. In CC and PCMC rats, oral cysteine supplement enhanced the gastrointestinal absorption of docetaxel probably via intestinal P-gp inhibition. If the present rat data could be expressed to humans, the alterations in docetaxel absorption and metabolism should be considered in designing a dosage regimen for cancer patients with PCM state after cysteine supplement. [ABSTRACT FROM AUTHOR]

Protein–calorie malnutrition (PCM) occurs frequently in advanced cancer patients and has a profound impact on the toxicity of many drugs. Thus, the pharmacokinetics of etoposide were evaluated in control, control with cysteine (CC), PCM, and PCM with cysteine (PCMC) rats. Etoposide was administered intravenously (2 mg/kg) or orally (10 mg/kg). Changes in hepatic and intestinal cytochrome P450s (CYPs) and effects of cysteine on intestinal P-glycoprotein (P-gp)-mediated efflux were also measured. In PCM rats, the CLNR (AUC0–∞) of intravenous etoposide was significantly slower (greater) than that in controls, because of the significant decrease in the hepatic CYP3A subfamily and P-gp. In PCMC rats, the slowed CLNR of etoposide in PCM rats was restored to the control level by cysteine treatment. PCMC rats showed a significantly greater AUC0–6 h of oral etoposide than PCM rats, primarily because of the increased gastrointestinal absorption of etoposide as a result of the inhibition of intestinal P-gp by cysteine. The gastrointestinal absorption of an oral anticancer drug, which is a substrate of P-gp, may be improved by co-administration of cysteine in advanced cancer patients if the present rat data can be extrapolated to patients. [ABSTRACT FROM AUTHOR]

The rate of weight gain of malnourished children in realimentation programmes varies substantially; however, predictors of variation are infrequently reported. The aim of this study was to assess a set of hypothesized predictors to the rate of weight gain of a sample of children attending a partial day treatment programme in the Dominican Republic. Data were available for 105 consecutive admissions (82% of total) to the programme between July 2004 and June 2006. Mean rate of weight gain, adjusted for initial weight, was 3.8 (SD 4.2) g kg-1 day-1 during the first 28 days of treatment. Rate of weight gain was associated with the amount of calories consumed by the child from the enriched milk-based formula consumed within the clinic. This relationship depended upon the initial degree of wasting and the amount of diarrhoea, such that caloric intake had a greater impact on those with the most wasting and greater amounts of diarrhoea. Other hypothesized variables were not related to rate of weight gain. Further investigation is required to identify other predictors of the variability in weight gain within nutrition treatment programmes with tighter control of possible sources of measurement error. [ABSTRACT FROM AUTHOR]

Our laboratory is investigating the effects of protein-energy malnutrition (PEM) on cognitive outcome following global ischemia. Here, we investigated whether PEM independently impairs working memory in the T-maze and if the associated food reward reverses PEM. Gerbils were fed 12.5% (control diet) or 2% protein. A loss of body weight (20.1%) in the 2% protein group and decreased food intake and serum albumin concentration compared to controls (17.5% and 18.2%, respectively) indicated that PEM was achieved. Based on T-maze criterion frequently used in ischemia studies, no difference was observed in the mean ( ± SEM) number of trials required (control 5.2 ± 0.7; PEM 4.9 ± 0.4; p = 0.758) or the number of animals reaching criterion (control 10/12; PEM 12/12; p = 0.140). Using more stringent criterion, PEM animals required fewer trials (control 7.3 ± 0.7; PEM 5.4 ± 0.4; p = 0.035), and more reached criterion (control 8/12; PEM 12/12; p = 0.028). PEM may increase motivation to obtain a food reward. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the possibility of delayed health effects of a natural disaster and develop insight into the circumstances where such delays may be likely, we examined the existing Haitian Health Foundation (HHF) database of children for the years surrounding the events of Hurricane Gilbert. Subjects and methods: The HHF database was limited to records of children with valid entries that were age 60 months or younger and who first entered the HHF program between the years of 1988 and 1992. This resulted in a sample of 4413 children available for the study. The outcomes for this study were malnutrition and mortality. Results: Haitian children appear to have been immediately affected by Hurricane Gilbert through increased levels of malnutrition and mortality. Even higher numbers of pediatric deaths were recorded throughout the following year, after which the number of deaths decreased and began a return toward pre-Gilbert levels. Conclusion: Our study found substantial amounts of delayed mortality a year subsequent to Hurricane Gilbert. These findings suggest that additional planning for agricultural infrastructure support and for extended relief should be considered under certain circumstances, including situations where the affected area has food sources and infrastructure that are affected by the disaster and where the local population is highly dependent on these food sources and infrastructure. [ABSTRACT FROM AUTHOR]