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Severe malnutrition following one-anastomosis gastric bypass (OAGB) remains a concern. Fifty studies involving 49,991 patients were included in this review. In-hospital treatment for severe malnutrition was needed for 0.9% (n = 446) of patients. Biliopancreatic limb (BPL) length was 150 cm in five (1.1%) patients, > 150 cm in 151 (33.9%), and not reported in 290 (65%) patients. OAGB was revised to normal anatomy in 126 (28.2%), sleeve gastrectomy in 46 (10.3%), Roux-en-Y gastric bypass in 41 (9.2%), and shortening of BPL length in 17 (3.8%) patients. One hundred fifty-one (33.8%) patients responded to treatment; ten (2.2%) did not respond and was not reported in 285 (63.9%) patients. Eight (0.02%) deaths were reported. Standardisation of the OAGB technique along with robust prospective data collection is required to understand this serious problem., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Malnutrition and low body mass index (BMI) are risk factors for mortality in hospitalized patients. Data substantiating this are unavailable for hospitalized general medical patients in our setting. We studied the prevalence of malnutrition among patients admitted to general medical wards in a tertiary care hospital and its role as a risk factor for 1-month mortality. We also investigated the association of BMI with mortality., Methods: In this prospective observational study, nutrition assessment using Subjective Global Assessment (SGA) and anthropometric measurements was performed in 395 hospitalized general medical patients. Charlson Comorbidity Index (CCI) and Modified Early Warning System (MEWS) score were calculated. Clinical course and vital status at 1 month after discharge was noted. Factors associated with mortality were identified using logistic regression., Results: The mean age of the study population was 46.2 + 16.1 years; 247 (62.5%) were males. Of 395 patients, 129 (32.7%) belonged to SGA A, 155 (39.2%) to SGA B, and 111 (28.1%) to SGA C. Mean (±SD) BMI was 23.38 (±5.33); 141 (35.6%) were obese. Mortality was observed in 61 (15.4%) patients. Patients in the lowest BMI quartile had the lowest mortality. The adjusted regression analysis showed that higher age and MEWS scores were independently associated with mortality. Severe malnourishment (SGA C) was another important predictor. Further, the odds of death increased consistently across the consecutive BMI quartiles., Conclusion: Higher age, higher MEWS scores, severe malnourishment, and higher BMI scores were independent risk factors for 1-month mortality in hospitalized general medical patients., (© 2022 American Society for Parenteral and Enteral Nutrition.)

The metabolic fate of [14C] benzoic acid administered i.p. to marasmic-kwashiorkor rats has been investigated. Rats fed a normal diet with benzoic acid administered i.p. at 200 mg/kg, excreted the benzoic acid mainly as hippuric acid (99% of 24 h excretion), while marasmic-kwashiorkor rats excreted 62--85% as hippuric acid and 14--37% as the glucuronide conjugate. 2 weeks after repletion metabolism of benzoic acid by the marasmic-kwashiorkor rats on the stock diet had returned to normal; most of the benzoate was excreted as hippuric acid.

Normal infants exhibited circadian rhythmicity of plasma F concentration. Infants from 2.1 to 3.2 months of age had CSR significantly higher than those of older infants. THF/THE urinary excretion ratios increased with age. The 17OHCS excretion was higher in the younger infants. Urinary excretions of free corticoids and cortisol were similar in all age groups. In marasmus, plasma F concentrations in the morning and evening were significantly elevated. Normal diurnal variation returned following therapy. CSR and 17OHCS excretions were not different from age controls, but were significantly lower than size controls, THF/THE ratios, urinary excretion of free corticoids and cortisol were normal. In marasmic kwashiorkor, plasma F concentrations were significantly elevated in the morning and evening. There was a suggestive decrease with therapy. CSR was low before and after treatment. THF/THE ratios, urinary 17OHCS excretion, and urinary free corticoids and cortisol were not significantly different from infants matched for size or patients with marasmus.

Introduction: Retroperitoneal soft tissue sarcomas (RPSs) are mesenchymal neoplasms. The prevalence of protein energetic malnutrition (PEM) and its impact in RPS patients who were candidates for surgery is unknown., Materials and Methods: A prospective feasibility study enrolled 35 patients with primary RPS who were candidates for extended multivisceral resection. PEM was screened at enrollment. Preoperative high protein β-hydroxy-β-methyl butyrate oral nutritional support (ONS) was provided according to the degree of PEM. After surgery, nutritional support followed standard practice, targeting at least 1 g/kg/day protein and 20 kcal/kg/day caloric intake within the third postoperative day (POD). PEM was re-evaluated before surgery on POD 10, and at 4 and 12 months after surgery. Primary outcomes were the patient's compliance to preoperative ONS and the physician's compliance to postoperative nutritional targets., Results: PEM was documented in 46% of patients at baseline; ONS met a 91% adherence (overall well tolerated). After ONS, PEM reduced to 38% (p = 0.45). The postoperative caloric target was reached on day 4.1 (standard error ± 2.7), with a protocol adherence rate of 52%. On POD 10, 91% of patients experienced PEM, the worsening of which was greater after resection of four or more organs (p = 0.06). At 4 and 12 months after surgery, almost all patients had fully recovered. A significant correlation between PEM at surgery and postoperative complications was found (p = 0.04)., Conclusions: Relevant PEM prevalence in RPS is documented for the first time. PEM correlates with greater morbidity. In this setting, preoperative ONS was feasible and well-tolerated. Disease-related factors for PEM and the ideal perioperative caloric target in the context of extended multivisceral resection need to be further investigated. Nutritional support should be included in enhanced recovery after surgery programs for RPS., Trial Registry: ClinicalTrials.gov identifier: NCT03877588.

Edible insects are recognized as promising food sources due to their nutritional composition. Some species, such as Gryllus assimilis, contain proteins, lipids, and carbohydrates of high biological value, which regulate several metabolic functions, including the Renin-Angiotensin System (RAS). In this context, the present study aimed to assess the effects of dietary supplementation with whole Gryllus assimilis powder on the metabolism of malnourished mice. Thirty-two male Swiss mice were used and divided into four treatment groups. The groups were identified as (AIN93-M); AIN93-M + Gryllus assimilis diet (AIN93-M + GA); AIN93-M + Renutrition diet (AIN93-M + REN) and AIN93-M + Renutrition diet + Gryllus assimilis (AIN93-M + REN + GA). The results showed that whole Gryllus assimilis powder inclusion promotes recovery from protein-energy malnutrition, reduces adiposity, and improves glucose tolerance and insulin sensitivity. It also reduces total cholesterol, triglycerides, VLDL, and adipocyte area. We also observed a significant increase in the expression of RAS-related genes, such as ACE2 and MasR, followed by a reduction in Angiotensinogen and ACE. The main findings of the present study suggest the use of black cricket as a viable strategy for the prevention and treatment of protein-energy malnutrition, as well as the reduction of adiposity, and improvement of lipid and glycemic parameters, with antihypertensive potential., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Malnutrition is one of the most threatening conditions in geriatric populations. The gut microbiota has an important role in the host's metabolic and muscular health: however, its interplay with disease-related malnutrition is not well understood. We aimed to identify the association of malnutrition with the gut microbiota and predict clinical outcomes in hospitalized acutely ill older adults., Methods: We performed a secondary longitudinal analysis in 108 geriatric patients from a prospective cohort evaluated at admission and 72 h of hospitalization. We collected clinical, demographic, nutritional, and 16S rRNA gene-sequenced gut microbiota data. Microbiota diversity, overall composition, and differential abundance were calculated and compared between patients with and without malnutrition. Microbiota features associated with malnutrition were used to predict clinical outcomes., Results: Patients with malnutrition (51%) had a different microbiota composition compared to those who were well-nourished during hospitalization (ANOSIM R = 0.079, P = 0.003). Patients with severe malnutrition showed poorer α-diversity at admission (Shannon P = 0.012, Simpson P = 0.018) and follow-up (Shannon P = 0.023, Chao1 P = 0.008). Differential abundance of Lachnospiraceae NK4A136 group, Subdoligranulum, and Faecalibacterium prausnitzii were significantly lower and inversely associated with malnutrition, while Corynebacterium, Ruminococcaceae Incertae Sedis, and Fusobacterium were significantly increased and positively associated with malnutrition. Corynebacterium, Ruminococcaceae Incertae Sedis, and the overall composition were important predictors of critical care in patients with malnutrition during hospitalization., Conclusion: Older adults with malnutrition, especially in a severe stage, may be subject to substantial gut microbial disturbances during hospitalization. The gut microbiota profile of patients with malnutrition might help us to predict worse clinical outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Intradialytic parenteral nutrition (IDPN) remains a controversial nutrition support practice in hemodialysis. Multiple reviews and evidence-based clinical practice guidelines have been published in the past 20 years. Despite essentially looking at the same evidence, conclusions and recommendations vary significantly, leading to widespread uncertainty among clinicians on the value of and indications for IDPN. This paper aims to bring a clinical perspective to the current state of evidence and clinical practice, recognizing the strengths and weaknesses of current evidence and the clinical questions that remain unanswered, as well as providing guidance for using IDPN in clinical practice. IDPN should be considered a strategy to complement spontaneous oral intake in clinically stable patients receiving maintenance hemodialysis or who have or are at risk of malnutrition and who have substantial but not adequate protein and/or energy intake. There is a clear need for robust randomized controlled trials evaluating the impact of IDPN in appropriately selected patients. Additionally, future trials should include patient-centered outcome measures such as appetite, spontaneous oral intake, quality of life, and reliable measures of nutritional status., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Background: Malnutrition (i.e., protein-energy malnutrition) in older adults has severe negative clinical consequences, emphasizing the need for effective treatments. Many, often small, randomized controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and a need for meta-analyses and data pooling has been expressed. However, evidence synthesis is hampered by the wide variety of outcomes and their method of assessment in previous RCTs. This paper describes the protocol for developing a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk. Methods: The project consists of five phases. The first phase consists of a scoping review to identify frequently used outcomes in published RCTs and select additional patient-reported outcomes. The second phase includes a modified Delphi Survey involving experienced researchers and health care professionals working in the field of malnutrition in older adults, followed by the third phase consisting of a consensus meeting to discuss and agree what critical outcomes need to be included in the COS. The fourth phase will determine how each COS outcome should be measured based on a systematic literature review and a second consensus meeting. This will be followed by a dissemination and implementation phase. Patient and Public Involvement (PPI) representatives will contribute to study design, oversight, consensus, and dissemination. Conclusions: The result of this project is a COS that should be included in any RCT evaluating the effect of nutritional interventions in older adults with malnutrition and those at risk. This COS will facilitate comparison of RCT results, will increase efficient use of research resources and will reduce bias due to measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults. [ABSTRACT FROM AUTHOR]

Despite the prevalence of protein-calorie malnutrition (PCM) in acute-care hospitals and long-term care centers, a national and global consensus on nutrition screening and malnutrition diagnosis is lacking. PCM is associated with various acute and chronic complications, such as impaired wound healing, increased risk for infection, debility, and increased risk for rehospitalization. The consequences of PCM are also incredibly costly to both the patient and the healthcare facility. The purpose of this paper is to identify nutrition screening tools and malnutrition diagnosis tools currently being utilized in acute-care healthcare centers across the United States., (© 2021 American Society for Parenteral and Enteral Nutrition.)

Frailty is a geriatric syndrome caused by a decrease in multi - system physiological reserve and function, which reduces the elderly's ability to stress the internal and external environment and maintain homeostasis, and increases the risk of adverse health events. The incidence of frailty and pre - frailty in stroke patients is the highest and significantly higher than that in non-stroke patients, while the prevalence of cerebrovascular disease in frailty patients is also significantly increased and the prognosis is worse. This paper intends to review the potential association between frailty and cerebrovascular disease. [ABSTRACT FROM AUTHOR]

This article discusses a study that examines the relationship between inflammatory bowel disease (IBD) and protein-calorie malnutrition (PCM). The study used a large national database to identify patients with IBD who also had PCM and assessed their use of parenteral nutrition (PN) or enteral nutrition (EN). The study found that PCM is more common in hospitalized patients with IBD and has clinical and financial consequences. The use of nutrition support, such as PN or EN, was associated with a decreased risk of readmission, but higher mortality rates. However, the study has limitations, and more research is needed to determine the effectiveness of nutrition support in patients with IBD and PCM. [Extracted from the article]

Background & Aims: Malnutrition is a significant barrier to healthy and independent ageing in older adults who live in their own homes, and accurate diagnosis is a key step in managing the condition. However, there has not been sufficient systematic review or pooling of existing data regarding malnutrition diagnosis in the geriatric community setting. The current paper was conducted as part of the MACRo (Malnutrition in the Ageing Community Review) Study and seeks to determine the criterion (concurrent and predictive) validity and reliability of nutrition assessment tools in making a diagnosis of protein-energy malnutrition in the general older adult community., Methods: A systematic literature review was undertaken using six electronic databases in September 2016. Studies in any language were included which measured malnutrition via a nutrition assessment tool in adults ≥65 years living in their own homes. Data relating to the predictive validity of tools were analysed via meta-analyses. GRADE was used to evaluate the body of evidence., Results: There were 6412 records identified, of which 104 potentially eligible records were screened via full text. Eight papers were included; two which evaluated the concurrent validity of the Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) and six which evaluated the predictive validity of the MNA. The quality of the body of evidence for the concurrent validity of both the MNA and SGA was very low. The quality of the body of evidence for the predictive validity of the MNA in detecting risk of death was moderate (RR: 1.92 [95% CI: 1.55-2.39]; P < 0.00001; n = 2013 participants; n = 4 studies; I 2 : 0%). The quality of the body of evidence for the predictive validity of the MNA in detecting risk of poor physical function was very low (SMD: 1.02 [95%CI: 0.24-1.80]; P = 0.01; n = 4046 participants; n = 3 studies; I 2 :89%)., Conclusions: Due to the small number of studies identified and no evaluation of the predictive validity of tools other than the MNA, there is insufficient evidence to recommend a particular nutrition assessment tool for diagnosing PEM in older adults in the community. High quality diagnostic accuracy studies are needed for all nutrition assessment tools used in older community samples, including measuring of health outcomes subsequent to nutrition assessment by the SGA and PG-SGA., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Purpose: Traditionally prepared enset-based products like bulla are characterised by low protein and vitamin contents and are highly viscous; this causes protein-energy malnutrition especially in infants and young children. This paper aims to improve the nutritional and sensory qualities of enset-based food with pumpkin and amaranth. Design/methodology/approach: Sixteen formulations of composite flour were generated using a D-optimal constrained mixture design with a range of 50-80 per cent bulla, 10-25 per cent pumpkin and 10-40 per cent amaranth flour. Nutritional and sensory qualities of the formulations were investigated using standard methods. Findings: Ash, fat and protein contents increased from 1.1-2.8 g/100 g (p < 0.001), 1.7-3.9 g/100 g (p < 0.001) and 6.1-9.0 g/100 g (p < 0.001) respectively with the increased amaranth flour. Crude fibre content increased with increasing percentage of the amaranth and pumpkin flours. On the other hand, carbohydrate content increased from 78.2 to 84.3 per cent (p < 0.001) with an increase of bulla flour. A significant increase in Fe, Zn and Ca from 6.8-10.5 (p < 0.01), 1.5-3.0 (p = 0.022) and 1.8-148.5 mg/g (p < 0.001) respectively was achieved with an increase in amaranth ratio in flour. The total carotenoid content increased with increase in the percentage of pumpkin flour. The best sensory attributes of the developed product were around the centre point of the three ingredients. Originality/value: The study showed that a product with good nutritional value and sensory acceptability could be prepared from enset-based ingredients and the optimal product was obtained by blending 57.8 per cent bulla, 18.9 per cent pumpkin and 23.3 per cent amaranth flour. The enriched flour can have application for snack food preparation. [ABSTRACT FROM AUTHOR]

Red kidney bean protein isolate was prepared and incorporated into wheat flour at levels of 0, 5, 10, 15, and 20% to prepare protein-enriched cookies which were then evaluated for various quality attributes. Nutritional evaluation of cookies showed that the supplementation of bean protein isolate increased the protein content of the cookies from 7.87% in T1 (control or wheat flour cookies) to 16.92% in T6 (cookies supplemented with 20% bean protein isolate), which indicated a 115% increase in protein content. The physical characteristics of cookies such as width, thickness and spread factors differed significantly. Sensory attributes of all the supplemented cookies were within the acceptable range but cookies supplemented with 20% level of protein isolate were less preferred due to slightly darker colour and harder texture. Conclusively, the red kidney bean protein isolate can be successfully utilised for the production of high-protein cookies. Such high-protein products can be advantageously utilised to cope with the problem of protein-energy malnutrition. Moreover, such nutritious products can also be used as emergency foods during natural disasters as well as during war times. [ABSTRACT FROM AUTHOR]

Malnutrition is a serious problem in Ethiopia as a result of which there is a high rate of mortality of children under the age of five years. The main objective of this paper is, therefore, to identify the prevalence of protein energy malnutrition and determine factors contributing to it for children under the age of five years that were admitted to Asella Referral and Teaching Hospital in Arsi administrative zone, central Ethiopia. Data were collected from 367 sample households selected randomly from a total of 6554 respondents. The data were analyzed using descriptive statistics and binary logistic regression model. The results revealed that 12%, 46% and 14% children were underweight, stunted and wasted, respectively. This implied that there is less severe problem form of protein energy malnutrition status. It was also found that sex of children, educational level of parents, distance of work place of caregiver from home, age of children, age of caregiver, marital status, family size, and family income were predictors of protein energy malnutrition. In addition, educational level of parents and economy of parents were important components for ensuring good nutritional of children. Therefore, improving parents' economy and literacy of the community (especially female literacy) is instrumental in minimizing protein energy malnutrition for under five-year children. Moreover, it is advisable if nutritional status of children be assessed periodically to monitor the situation and to take appropriate measures for combating and preventing malnutrition in children. [ABSTRACT FROM AUTHOR]

This paper describes the elaboration via an electrochemistry route of a PEM carbon‐free cathode made of a periodic array of vertically aligned platinum copper nanotubes. Nanotubes synthesis is assisted with a porous alumina mold made on a silicon substrate to perform growth of copper nanowires. After optimization of an original confined galvanic displacement with H2PtCl6 salt, PtCu nanotubes are embedded into porous alumina template and directly integrated onto a Nafion® membrane. Therefore, our process does not need any step of purification or catalyst dispersion. The performances in fuel cell of these new electrodes are compared to conventional structures made of Tanaka Pt/C with the same electrocatalytic surface area. Significant improvement in the specific activity at 0.9 V and reduction in mass transport limitations are observed compared with standard Tanaka Pt/C catalyst in real operating conditions. [ABSTRACT FROM AUTHOR]

Protein-energy malnutrition (PEM) is a risk factor for developing visceral leishmaniasis (VL). While nutrient deficiency can impair immunity, its mechanistic impact on protective adaptive immune responses following Leishmania infection remains unknown. To determine the potential negative impacts of malnutrition on anti-parasitic responses in chronic VL, we provided mice with a polynutrient-deficient diet (deficient protein, energy, zinc, and iron) that mimics moderate human malnutrition. The polynutrient-deficient diet resulted in growth stunting and reduced mass of visceral organs and following infection with Leishmania infantum, malnourished-mice harbored more parasites in the spleen and liver. Malnourished and infected mice also had fewer T lymphocytes, with reduced T cell production of IFN-γ required for parasite clearance and enhanced production of the immunosuppressive cytokine, IL-10. To determine if IL-10 was causative in disease progression in the malnourished mice, we treated infected mice with monoclonal antibody α-IL-10R. α-IL-10R treatment reduced the parasite number in malnourished mice, restored the number of T cells producing IFN-γ, and enhanced hepatic granuloma formation. Our results indicate that malnutrition increases VL susceptibility due to defective IFN-γ-mediated immunity attributable to increased IL-10 production. Author summary: Malnutrition contributes to the development of visceral leishmaniasis (VL) following Leishmania infection. Despite the clear association, the impact of malnutrition on the adaptive immune mechanisms required for parasite control is still unclear. We found that malnutrition disrupts the ability to control parasite replication in the spleen and liver due to defective IFN-γ-mediated immunity, reduced hepatic granuloma formation, and enhanced IL-10 production. Blocking IL-10R signaling restored the protective mechanisms to control parasite replication in the malnourished mice without interfering with the undernutrition state. Thus, we demonstrate that increased IL-10 production driven by malnutrition disrupts protective immunity against Leishmania, thereby enhancing the susceptibility of VL. Understanding the association between malnutrition and VL will provide insights into therapeutic approaches to treat this aggressive disease. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the nutritional status of children undergoing cancer treatment and to assess changes in their nutritional status depending on selected clinical, demographic, and social factors. Material and methods: This was a single-center prospective cohort study of children aged 2 to 18 years who were diagnosed with cancer and received treatment between October 2019 and January 2022. The nutritional status of patients was evaluated before and after cancer treatment based on measurements of weight, body mass index (BMI), height, and arm anthropometry (MUAC, mid-upper arm circumference; TSFT, triceps skinfold thickness, and SCFT, subscapular skinfold thickness). Body composition (UMA, upper arm muscle area), arm fat index (AFI), and the sum of SCFT and TSFT (SFsum) were also assessed. Additionally, the nutritional status of patients at baseline was compared to that of a control group consisting of 30 healthy children. The obtained results were analyzed depending on selected demographic, clinical, and social factors. Results: The study included 40 patients (median age 11.29 years [range 2.08--17.67]; male 67.5%). At baseline, malnutrition was reported in 5% and 7.5% of children based on weight and BMI respectively, and in 7.5% of patients based on MUAC. At follow-up, malnutrition increased by 17.5% based on body weight and BMI, and by 2.5% based on MUAC. UMA allowed the diagnosis of protein-energy malnutrition in 27.5% of patients. Moreover, low UMA was significantly more common in children with cancer than in controls. Overnutrition at follow-up was identified in a higher percentage of patients based on AFI and SFsum measurements than based on BMI (27.5%, 35%, and 10%, respectively). There were no differences in anthropometric measurements or body composition depending on the type of cancer, intensity of treatment, or place of residence. However, weight, BMI, MUAC, UMA, and SFsum were higher in males, suggesting the possible effect of sex. A higher prevalence of underweight determined by BMI was noted in patients whose parents had university education or were between the ages of 18 and 35. Conclusions: Children with cancer show changes in the nutritional status compared to healthy children. Body composition can be used to identify these changes with greater accuracy than anthropometric measurements such as weight, height, BMI, and arm anthropometry. The risk of changes in nutritional status can be determined based on selected clinical, demographic, and social factors. [ABSTRACT FROM AUTHOR]

Background: Protein-energy malnutrition and vitamin A deficiency (VAD) are the most important public health issues, and a food-based strategy is crucial to combat those health problems among the vulnerable group of people. Methods: Composite biscuits were made with 100:0:0, 90:5:5, 80:10:10, 70:15:15, 60:20:20, and 50:25:25 percent wheat, haricot bean, and orange-fleshed sweet potato (OFSP) flours.Standard methods were used to evaluate the proximate compositions, β-carotene, physical properties, functional properties, and sensory acceptability. A one-way analysis of variance model was used to statistically evaluate the data using the statistical analysis system software package, version 9.0 standard methods. Results: The results showed that partially replacing wheat with haricot beans and OFSP increased the β-carotene and proximate compositions significantly. When wheat was replaced with haricot beans and OFSP, the physical characteristics of the biscuits did not vary significantly from those of biscuits made entirely of wheat flour. Sensory acceptability (appearance, color, flavor, taste and overall acceptability) was higher in the composite biscuits with up to 40% wheat substitution than in the 100% wheat flour biscuits. Conclusion: Based on the findings of this report, replacing wheat with OFSP and haricot beans in biscuit formulation appears to be promising in improving nutritional quality, sensory acceptability, and beta carotene. It is proposed that these products can mitigate food insecurity and deficiency of vitamin A.

Background: An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. Methods: A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure. An agreement amongst ≥ 70.0% of the experts was considered to indicate a consensus. Results: A consensus was achieved for 48 of the 55 proposed statements after two rounds of voting. There was no consensus for seven statements. Remarkably, 100.0% of the experts felt that OAGB/MGB was an 'acceptable mainstream surgical option' and 96.0% felt that it could no longer be regarded as a new or experimental procedure. Approximately 96.0 and 91.0% of the experts felt that OAGB/MGB did not increase the risk of gastric and oesophageal cancers, respectively. Approximately 94.0% of the experts felt that the construction of the gastric pouch should start in the horizontal portion of the lesser curvature. There was a consensus of 82, 84, and 85% for routinely supplementing iron, vitamin B, and vitamin D, respectively. Conclusion: OAGB/MGB experts achieved consensus on a number of aspects concerning this procedure but several areas of disagreements persist emphasising the need for more studies in the future. [ABSTRACT FROM AUTHOR]

In order to tackle the increasing problem of malnutrition ( i.e. protein-energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly ( MaNu EL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative ( JPI) A Healthy Diet for a Healthy Life ( HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNu EL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence-based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNu EL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web-based questionnaires, MaNu EL will provide insight into current clinical practice, policies and health professionals' education on malnutrition and will make recommendations for improvement. MaNu EL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies. [ABSTRACT FROM AUTHOR]

Aims: To explore adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition' and to identify the terms that adult inpatients report are used by themselves and health workers to describe malnutrition. Design: This qualitative study was conducted using data collected for a separate qualitative study that investigated factors that influence the dietary intake of long‐stay, acute adult inpatients. Methods: Semi‐structured interviews were conducted with a purposive sample of current inpatients. Data were analysed using inductive content analysis. Results: Nineteen interviews were included (mean age 64 years (standard deviation ±17), 10 female (53%), 12 malnourished (63%)). Four categories were identified. 'Variation in patients' recognition of malnutrition' represents the differing abilities of patients to understand and identify with the term 'malnutrition'. 'Recognising individuals' needs and preferences' highlights patients' varying beliefs regarding whether 'malnutrition' is or is not an appropriate term and participants' suggestion that health workers should tailor the term used to each patient. 'Inconsistencies in health workers' and patients' practice regarding malnutrition terminology' encapsulates the multiple terms that were used to describe malnutrition by health workers and patients. 'Importance of malnutrition education' summarises patients' views that health workers should provide patient education on malnutrition prevention, management and complications. Conclusion: Findings highlight variations in patients' perceptions and understanding of the term 'malnutrition' and differences in the terms used by patients and health workers to describe malnutrition. Implications for the Profession and/or Patient Care: The terminology used by health workers to describe malnutrition risk or malnutrition to their patients can influence patients' recognition of their nutritional status and thus the multidisciplinary management of the condition. To ensure that patients receive information about their malnutrition risk or diagnosis in a way that meets their needs, health workers' practices must be revised. To do this, it is imperative to conduct further collaborative research with patients and health workers to identify optimum terms for 'malnutrition' and how health workers should communicate this to patients. Impact: There is a disparity in patients' perceptions, understanding and preferences for the term 'malnutrition' and there are inconsistencies in how health workers communicate malnutrition to patients.To support patients' recognition and understanding of their nutritional status, it is imperative for health workers to consider how they discuss malnutrition with patients. Reporting Method: Adheres to the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007). Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

This paper identifies a common nutritional pathway relating maternal through to fetal protein-energy malnutrition (PEM) and compromised fetal kidney development. Thirty-one twin-bearing sheep were fed either a control (n=15) or low-protein diet (n=16, 17 vs. 8.7 g crude protein/MJ metabolizable energy) from d 0 to 65 gestation (term, ∼ 145 d). Effects on the maternal and fetal nutritional environment were characterized by sampling blood and amniotic fluid. Kidney development was characterized by histology, immunohistochemistry, vascular corrosion casts, and molecular biology. PEM had little measureable effect on maternal and fetal macronutrient balance (glucose, total protein, total amino acids, and lactate were unaffected) or on fetal growth. PEM decreased maternal and fetal urea concentration, which blunted fetal ornithine availability and affected fetal hepatic polyamine production. For the first time in a large animal model, we associated these nutritional effects with reduced micro- but not macrovascular development in the fetal kidney. Maternal PEM specifically impacts the fetal ornithine cycle, affecting cellular polyamine metabolism and microvascular development of the fetal kidney, effects that likely underpin programming of kidney development and function by a maternal low protein diet., (© FASEB.)

Protein-energy malnutrition (PEW) is highly prevalent in patients with end-stage renal disease (ESRD) and is associated with a significant increase of the already high mortality and morbidity risk typical of this clinical setting. Since a key mechanism of PEW in ESRD is inadequate nutrient intake, oral nutritional supplements are extensively employed, and have been demonstrated to be highly effective in PEW prevention and treatment. Intradialytic parenteral nutrition (IDPN), i.e. the administration of nutrients through the extracorporeal circuit during hemodialysis, has also been proposed as a modality of nutritional support for patients with ESRD. However, even though metabolic/nutritional status is improved by this nutritional approach, the evidence linking IDPN to decreased hospitalization rate and lower mortality risk is still scant. The aim of the present paper is to review the role of IDPN as a modality of nutritional supplementation for ESRD patients on hemodialysis. To this end, quantitative and qualitative aspects, practical management, the indications, and limits of IDPN are discussed. On the basis of the available evidence, it is suggested that IDPN is a safe and efficacious modality of nutritional support in ESRD, and could represent an adjunctive strategy for patients with reduced spontaneous dietary intake when intensive dietetic counseling and oral supplementation have failed.

Anthropometric differences between the two Koreas are of considerable public and scientific interest given the unique socio-political status of North Korea and the fact that the nations share the same genetic ancestry. This study provides new biosocial evidence on these differences by analysing mid-upper arm circumference (MUAC) as a human welfare indicator. This is the first study to compare the nutritional status of adults surveyed inside North Korea with South Koreans. The MUAC measurements of 2793 North Korean women obtained through a household survey conducted in 2002 were compared with those of 1428 South Korean women surveyed around 2003. Comparative analysis was conducted by plotting centiles and calculating mean differences in MUAC by age. This paper finds that the MUAC of the South Koreans was on average 2.8 cm greater than that of their North Korean peers, with MUAC gaps ranging from 1.6 cm to 3.9 cm and becoming more pronounced with age. This research confirms previous studies on height and weight in the two Germanies and in the two Koreas that have shown that biosocial performance is worse in socialist economies as compared with free-market regimes.

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.