[Research on malnutrition. VI. Limits of resistance to malnutrition and daily percentage body weight loss of growing rats subjected to malnutrition].
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Animals↗
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Detrimental effects of malnutrition on the damage induced by alcoholism: a study of animal models that simulate chronic alcoholism and malnutrition of large human groups.
The specific influence of malnutrition on the pathophysiological changes induced by chronic alcoholism is controversial; most studies are inconclusive because they have been made in chronic alcoholics that develop malnutrition as a complication of alcoholism. However, in vast human groups, alcoholism evolves in individuals that belong to a chronically undernourished population. In an attempt to simulate real-life conditions of malnutrition-alcoholism in humans, we studied in rats: (1) the effects of chronic malnutrition with tortilla, a corn bread that constitutes the main diet of large human groups; (2) the effects of chronic alcoholism with commercial brandy; and (3) the effects of chronic alcoholism and malnutrition combined. The damage induced either by alcoholism or that induced by malnutrition alone were of similar degree, whereas the combination of malnutrition and alcoholism led to a worsening of some parameters studied: body weight, leucocyte count and, more remarkably, in the tissue damage of several areas of the central nervous system.
Alcoholism↗
Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults.
The 'malnutrition universal screening tool' ('MUST') for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between 'MUST' and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using 'MUST' and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using 'MUST', the prevalence of malnutrition risk ranged from 19-60% in inpatients and 30% in outpatients. 'MUST' had 'excellent' agreement (kappa 0.775-0.893) with MEREC, NRS and SGA tools, 'fair-good' agreement (kappa 0.551-0.711) with HH, MST and MNA-tool tools and 'poor' agreement with the URS tool (kappa 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between 'MUST' and MNA-tool (P=0.0005) and URS (P=0.039). 'MUST' and MST were the easiest, quickest tools to complete (3-5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19-60% with 'MUST') and 'fair-good' to 'excellent' agreement beyond chance between 'MUST' and most other tools studied. 'MUST' was quick and easy to use in these patient groups.
Adult↗
Diarrhea as a cause and an effect of malnutrition: diarrhea prevents catch-up growth and malnutrition increases diarrhea frequency and duration.
Diarrhea and malnutrition, alone or together, constitute major causes of morbidity and mortality among children throughout the tropical world. Data from northeast Brazil, taken with numerous other studies, clearly show that diarrhea is both a cause and an effect of malnutrition. Diarrheal illnesses impair weight as well as height gains, with the greatest effects being seen with recurrent illnesses, which reduce the critical catch-up growth that otherwise occurs after diarrheal illnesses or severe malnutrition. Malnutrition (whether assessed by impaired weight or height for age) leads to increased frequencies and durations of diarrheal illnesses, with a 37% increase in frequency and a 73% increase in duration accounting for a doubling of the diarrhea burden (days of diarrhea) in malnourished children. A multi-pronged approach focusing on those with prolonged diarrhea and severe malnutrition is suggested.
Brazil↗
The influence of early malnutrition on subsequent behavioral development III. Learning disabilities as a sequel to malnutrition.
The academic performance of 129 Barbadian children (77 boys and 52 girls), who were 5-11-yr-old and suffered moderate to severe protein-energy malnutrition in the first year of life, was compared with the performance of matched comparisons, children who had no history of malnutrition. Children with a history of malnutrition were found to have lower performance on eight out of nine academic subject areas, namely, language arts, mathematics, general science, social science, reading, health, religion, and arts/crafts. Socioeconomic factors in the backgrounds of the children were also examined. A model is presented clarifying the interrelationships of malnutrition, socioeconomic status and school performance. Reduced school performance in the previously malnourished children can be largely accounted for by deficits in classroom behavior, and, to a lesser extent by a reduction in I.Q. Current socioeconomic status is not directly involved in altering academic performance whereas the early history of malnutrition and its accompanying conditions at the time of the illness are leading contributors to altered behavioral outcome and school performance.
Analysis of Variance↗
Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group.
AIMS: The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity. METHODS: We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished. RESULTS: Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished. CONCLUSIONS: One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.
Adolescent↗
[Protein and energy needs of the infant with severe malnutrition. Application in a hospital environment for the treatment of malnutrition caused by deficient intake].
Severe malnutrition is defined by a weight for height below 70% of international standards or by presence of oedema in a clinically undernourished child. Severe malnutrition associated with oedema is called kwashiorkor. The origin of oedemas of kwashiorkor is still debated, but its relation with protein deficiency is strongly questioned. The same dietary management is now recommended for malnutrition with or without oedema. Present recommendations are based, as for well nourished children, on the separate estimation of nutritional requirements for maintenance and growth. Total requirements vary between 0.7 g/kg/day in the first few days of treatment to 5 g/kg/day or more when weight gain is maximum. As a result of high energy requirement during catch-up growth, protein requirements never exceed 10 to 12% of total energy needs.
Child Nutrition Disorders↗
Thymulin (Zn-FTS) activity in protein-energy malnutrition: new evidence for interaction between malnutrition and infection on thymic function.
The combined effects of protein-energy malnutrition (PEM) and infection on thymic function evaluated by specific plasma thymulin activity were studied in Senegalese children: 29 hospitalized in Dakar for severe malnutrition and various diseases; 9 infected without sign of severe PEM, living in Dakar; 13 apparently healthy, uninfected, living in Dakar; and 7 apparently healthy, uninfected, living in Paris. Most of the free-living children in Dakar suffered from mild to moderate PEM. The specific thymulin activity (total plasma activity minus the activity recorded after adsorption of the plasma with a monoclonal antithymulin antibody) was almost undetectable in the infected children and was normal only in the children living in Paris. Such activity might be decreased by moderate and severe PEM and severe malnutrition may not be the only underlying cause of depressed level of thymulin in malnourished children from the Third World. Concurrent infections are important factors.
Blood Proteins↗
[Effect of moderate protein-energy malnutrition in preschool children on various biochemical parameters. Use of biochemical indicators for early detection of malnutrition].
The efficiency of several biochemical parameters as indicators of moderate protein-energy malnutrition was investigated. 810 children aged under 5 years were studied in the forest region of southern Cameroon. The children were divided into groups of controls children and moderately malnourished children based on anthropometry. The means values of most of the biochemical parameters were decreased in the malnourished group. Prealbumin, Transferrin, Hydroxyproline index and Albumin/Globulins ratio showed the most significant decreases. There were highly significant (P less than 0.001) correlations between the parameters and all the anthropometric tests. It is concluded that biochemical tests studied are of value in detection of mild protein-energy malnutrition but only when used together and compared with levels in a control group of the same age and the same population. Because of the slight decreases, large distributions of individual values and interaction of factors others than malnutrition, interpretation of a single test appears to be very complex.
Anthropometry↗
[Simplified malnutrition screening tool: Malnutrition Universal Screening Tool (MUST)].
MUST (Malnutrition Universal Screening Tool) is a nutritional screening tool easy to use by any trained care-giver and valid for any adult patient. It considers body mass index, weight change and acute disease effect equally and determines a malnutrition risk score. If necessary, anthropometric measures may be simpliyfied by alternative methods. MUST is reliable between different healthcare settings et promotes detection and management of malnutrition during the patient medical course.
Acute Disease↗
Is malnutrition overdiagnosed in older hospitalized patients? Association between the soluble interleukin-2 receptor and serum markers of malnutrition.
BACKGROUND: Many researchers have speculated that markers of malnutrition such as albumin, prealbumin, cholesterol, and transferrin are influenced by inflammation. The mechanism of this interaction has not been well understood. METHODS: This was a prospective cross-sectional study. We evaluated 72 male patients older than 60 years admitted to a geriatric rehabilitation unit. Subjects with severe hepatic or renal diseases were excluded. We measured body mass index, caloric intake, serum albumin, prealbumin, cholesterol, transferrin, hemoglobin, and total lymphocyte count. To detect inflammation, we measured C-reactive protein, Westergren sedimentation rate, fibrinogen, and cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), IL-6, IL-2, and the soluble IL-2 receptor. RESULTS: Soluble IL-2 receptor was negatively associated with albumin (r = -.479, p < .0001), prealbumin (r = -.520, p = < .0001), cholesterol (r = -.487, p = .0001), transferrin (r = -.455, p = .0002), and hemoglobin (r = -.371, p = .002). TNF-alpha, IL-1 beta, IL-6, and IL-2 were not associated with these measures. CONCLUSIONS: Inflammation increases the incidence of hypoalbuminemia and hypocholesterolemia, potentially leading to overdiagnosis of malnutrition. We suggest that albumin, cholesterol, prealbumin, and transferrin be used with caution when assessing the nutritional status of older hospitalized patients. In the future, soluble IL-2 receptor levels might be used to correct for the impact of inflammation on these markers of malnutrition.
Aged↗
Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980.
Nutritional status is the best global indicator of well-being in children. Although many surveys of children have been conducted since the 1970s, lack of comparability between them has made it difficult to monitor trends in child malnutrition. Cross-sectional data from 241 nationally representative surveys were analysed in a standard way to produce comparable results of low height-for-age (stunting). Multilevel modelling was applied to estimate regional and global trends from 1980 to 2005. The prevalence of stunting has fallen in developing countries from 47% in 1980 to 33% in 2000 (i.e. by 40 million), although progress has been uneven according to regions. Stunting has increased in Eastern Africa, but decreased in South-eastern Asia, South-central Asia and South America; Northern Africa and the Caribbean show modest improvement; and Western Africa and Central America present very little progress. Despite an overall decrease of stunting in developing countries, child malnutrition still remains a major public health problem in these countries. In some countries rates of stunting are rising, while in many others they remain disturbingly high. The data we have presented provide a baseline for assessing progress and help identify countries and regions in need of populationwide interventions. Approaches to lower child malnutrition should be based on successful nutrition programmes and policies.
Child↗
The utility of cross-sectional measurements of weight and length for age in screening for growth failure (chronic malnutrition) and clinically severe protein-energy malnutrition.
The accuracy of identifying children with growth failure and/or clinically severe protein-energy malnutrition (PEM) from a single measure of length or weight for age from birth to 36 months was determined. Growth data were treated cross-sectionally and compared with National Center for Health Statistics growth standards in order to determine the sensitivity, specificity and positive predictive value of a single cross-sectional measure of weight-for-age or length-for-age in identifying children diagnosed via longitudinal records. Under 6 months of age, neither weight nor length for age was an adequate predictor of growth failure or clinical malnutrition; from 12 to 36 months, screening measures based on anthropometry were much improved. It was concluded that a single measure of weight or length for age taken close to the first birthday could identify up to 78% of the future second and third year cases of clinically severe PEM. Implications and limitations are discussed.
Body Height↗
Malnutrition and microcephaly in Australian aboriginal children.
OBJECTIVE: To examine the association between malnutrition and microcephaly in the first two years of life. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Royal Darwin Hospital (a tertiary referral centre); 157 of 165 previously studied Aboriginal children aged under two years who were admitted with diarrhoea between May 1990 and April 1991. Birth weight, birth length, birth head circumference, admission head circumference and admission nutritional status were examined. Nutritional status was categorised according to World Health Organization (WHO) criteria for wasting (thinness) and stunting (shortness). Microcephaly on admission was defined as a head circumference less than the second percentile on Australian reference charts. Small-for-gestational-age (SGA) and birth microcephaly were defined as being less than the tenth percentile for an Australian hospitalised population, corrected for gestational age at confinement. Low birth weight (LBW) was defined as less than 2500 g. MAIN OUTCOME MEASURE: Microcephaly on admission. RESULTS: Of the 157 children, 76 (48%) were wasted, 36 (23%) stunted and 37 (24%) microcephalic on admission. A total of 26 (17%) children had been of LBW, 17 (11%) SGA and 21 (13%) microcephalic at birth. On univariate analysis, microcephaly on admission was associated with wasting (crude odds ratio [OR], 3.91; 95% confidence interval [CI], 1.6-9.7; P < 0.005), but not stunting. There were no significant associations between microcephaly on admission and LBW, being SGA, microcephaly at birth, age or sex. With multivariate analysis, birth head circumference was significantly associated with microcephaly on admission (adjusted OR, 3.62; 95% CI, 1.28-10.23; P < 0.05), as was wasting (adjusted OR, 4.38; 95% CI, 1.88-10.20; P < 0.001). CONCLUSIONS: Wasting was significantly associated with microcephaly, independent of intrauterine growth retardation (as measured by being SGA) and LBW. As malnutrition in critical periods of both intra- and extrauterine development may have irreversible effects on intellectual potential and behaviour, the emphasis on improved nutrition must begin during pregnancy, and should continue in infancy and early childhood.
Analysis of Variance↗
Malnutrition and immunity. III. Effect of malnutrition on the number of rosettes that form splenic lymphocytes in rats.
Although malnutrition is considered to be a secondary immunodeficiency, some authors have reported that a deficient protein-calorie intake can improve the quality of immune responses in specific circumstances. It is possible that the deficient function of some T lymphocytes in malnourished individuals can be compensated by an increase in the number or biologic activity of others. Sprague-Dawley rats were subjected to experimental malnutrition for five weeks; this was followed by the utilization of splenic lymphocytes for rosette formation with sensitized red cells (EA) and Leydig cells. In animals with a hypoproteic diet there was a significant increase in lymphocytes forming EA rosettes; on the other hand there was a decrease in those united to Leydig cells. This can mean that malnourished rats compensate this deficit increasing its K lymphocytes or that ratios between suppressor and helper lymphocytes were altered.
Animals↗
The relationship of growth failure (chronic undernutrition) to the prevalence of clinically severe protein-energy malnutrition and to growth retardation in protein-energy malnutrition.
A total of 72 of 276 children from a rural Mexican village were chronically undernourished as judged by their growth failure between 6 and 36 months of age. Fourteen of the 72 and five of the remaining 204 children developed clinically severe protein-energy malnutrition (PEM) as judged by clinical signs other than weight or length. This amounted to an 8-fold higher prevalence of PEM in the group of children with growth failure. When children were grouped into quartiles of length at 6 months by sex, quartile was not related to the subsequent occurrence of PEM or to the age when PEM developed. However, analysis indicated that the growth of children with PEM and growth failure had slowed relative to their quartiles before PEM developed; they were also retarded according to the Harvard standards. The children with PEM were then compared to others with a similar growth history (growth failure, no growth failure) who never developed PEM. PEM children did not differ significantly in over weight or length and displayed a significant difference in upper arm muscle circumference at only one age. The 14 with growth failure and PEM had poorer overall growth, including arm muscle circumference, than the five with PEM and no growth failure.
Anthropometry↗
Partnership with fathers in combating malnutrition: their views as to causes and treatment of protein energy malnutrition.
Fathers of children suffering from overt protein energy malnutrition (PEM) attending our Nutrition Rehabilitation Clinic in Ile-Ife, Nigeria, were visited at their homes to enquire, by means of interview, about their perceptions of the local names given to PEM, its causes and treatment. From the 56 homes visited, 23 fathers were met and participated in the study. Approximately 44% of the fathers recognized PEM as a cause of childhood disease. About 35% of the respondents attributed the cause of PEM to childhood infection and 26% attributed it to congenital disease transferred from pregnant mothers. One-sixth of the fathers were able to link PEM to lack of good feeding. Hospital-based treatment was advocated by 70% of the fathers, whilst 13% opted for traditional medicine and 17% opted for modern medicine. About 35% of the fathers were of the view that child welfare should be mainly the responsibility of the mother. Ignorance, prolonged absence of fathers from the home and poor sanitation were found to be some of the important aetiological factors of PEM. Strategies for prevention of PEM through active involvement by the fathers, and the vital role of home visits are discussed.
Attitude to Health↗
The developing brain and the damage inflicted by malnutrition: an introduction. In: lipids, malnutrition & the developing brain.
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Adult↗