Indian perspective on childhood malnutrition:Prevalence,pathophysiology,risk factors,and prevention

BACKGROUND Childhood malnutrition contributes over half of the childhood mortality around the world,predominantly in South-Asian and sub-Saharan countries.AIM To summarize the childhood malnutrition epidemiology along with the comorbid factors associated with it and its management within the community.METHODS The data collection process involved conducting a comprehensive search using specific keywords such as child nutrition disorders and India with Boolean operators.The search was conducted in the Scopus and PubMed electronic databases.RESULTS Inadequate energy consumption initiates pathological alterations in the form of growth retardation,fat,visceral,and muscle loss,a reduction in basal metabolic rate,and a significant reduction in total energy expenditure.It has become evident that malnutrition shows an increased prevalence and incidence rate,despite available guidelines for the management of malnutrition.CONCLUSION Malnutrition can be a major player in the establishment of severe infections that result in significant post discharge mortalities in children.Future trials are required to fill the prime gaps in knowledge regarding the identification of other contributory factors in the pathogenesis of malnutrition and postdischarge infection.New biomarkers for early detection of malnutrition should be the priority of the scientific community for the early management of malnutrition.

Preoperative malnutrition in elderly gastric cancer patients and adverse postoperative outcomes of radical gastrectomy

Malnutrition is not only a prevalent condition among the elderly but also a common comorbidity in elderly people with gastric cancer(GC).Malnutrition is closely linked to high rates of postoperative complications and poor wound healing in elderly GC patients,which may lead to a higher incidence and mor-tality rate of GC.Malnutrition decreases the physical function of elderly GC patients after surgery,severely affecting their postoperative life quality and hindering subsequent treatments.This retrospective study was conducted by Zhao et al,focusing on the clinical baseline data,postoperative complications,and hospitalization times of elderly GC patients who underwent curative gastrectomy.Additionally,the underlying causes of poor outcomes for patients were discussed.This study may provide a solid basis for the clinical treatment of elderly GC patients in the future.Therefore,malnutrition can serve as a negative prognostic factor for curative surgery in GC patients.Addressing malnutrition and its adverse effects can benefit elderly GC patients from surgical treatment.

Evaluation of the Integrated Management Program for Acute Malnutrition in the Douentza Health District, Mopti Region, Mali

Introduction: Malnutrition is a major public health problem in Mali, despite the efforts of the government, its technical and financial partners. The aim of this study was to evaluate the integrated management program for acute malnutrition (IMPAM). Methodology: This was a descriptive cross-sectional study that took place from January to December 2020 in the Douentza health district. The study included anyone with at least one malnourished child aged 6 to 59 months in their care who agreed to take part in the study, community health center staff who had given their consent, and the URENI manager at the Douentza reference health center. Data collected via questionnaires were entered into Excel and then analyzed using Epi-Info version 7 software. Results: A total of 138 acutely malnourished children aged 6 - 59 months, including 71 girls (51.45%), 138 accompanying mothers and 11 health workers, were included in our case study. Among the malnourished, 54.34% were in the 12 - 23 months age group and 69.57% had the severe form. 93% of the mothers interviewed were satisfied with the care provided, and all the health staff interviewed stated that community conflicts had an impact on IMPAM’s activities. Cure rates were 81% in Moderate Outpatient Nutritional Recovery and Education Unit (URENAM), 84% in Severe Ambulatory Nutritional Recovery and Education Unit (URENAS) and 92% in Recovery and Intensive Nutritional Education Unit (URENI). Drop-out rates were 19% in URENAM, 16% in URENAS and 0% in URENI. The death rate was 8% in URENI and 0% in URENAM and URENAS. Conclusion: This study confirms the high prevalence of malnutrition in the district (10.54%). It also reveals that factors such as inter-community conflict and insecurity have seriously affected the IMPAM program.

Prevalence of Malnutrition and Anaemia in Children ≤ 5 Years of Age in Some Conflict Hit Areas of Meme Division of the South West Region of Cameroon

Malnutrition refers to the deficiency, imbalances, or excesses in a person’s intake of energy or nutrients [1]. Khan defines anaemia as below level of Haemoglobin in red blood shown by a lower number of functioning red blood cells [2]. The crisis in the North West and South West Regions of Cameroon has led to several negative effects on children’s living conditions. There has been an increase in malnutrition and anaemia in the South West Region and Kumba in particular. The main objective of this study was “to examine the prevalence of malnutrition and anaemia in children ≤ 5 years of age in some conflict-hit areas of Meme Division”. A descriptive cross-sectional study was conducted in 2023 from March to June. We recruited 200 children ≤ 5 years into the study from three hospitals. The regional hospital annex in Kumba, Presbyterian General Hospital Kumba and the Ntam Hospital in Kumba. Socio-demographic factors were assessed using questionnaire, nutritional status was assessed by the use anthropometric measurements and an auto haematology analyser was used to determine anaemia. The overall prevalence of malnutrition in the study area was 40.5%. The prevalence of malnutrition varied significantly (P < 0.001) with the study sites. The overall prevalence of anaemia in the study area was 70.5%. The prevalence of anaemia was not significantly associated with the study sites. The prevalence of Malnutrition and Anaemia in children ≤ 5 years of age is very high in the Kumba municipalities. This could be attributed to the ongoing crisis which has caused a lot of social migrations from rural areas to Urban areas which are safer.

Prevalence of Malnutrition among Hospitalized Pediatric Patients in a Tertiary Hospital in Jordan: Pilot Study

Introduction: Failure to thrive (FTT) occurs when a child’s growth falls below expected standards, typically due to inadequate nutrient intake. Factors include insufficient oral intake, poor nutrient absorption, and increased metabolic demands. Previous studies have shown high malnutrition rates in hospitalized children due to illness-related metabolic demands, decreased appetite, and inadequate intake. Our objective was to assess the growth and nutritional status of children admitted to King Abdullah University Hospital (KAUH) and identify the prevalence of undernutrition and associated factors. Methods: This prospective, cross-sectional cohort study was conducted at KAUH from July to December 2022. We included children aged 2 months to 16 years, excluding those with conditions altering growth parameters. Data were collected through pediatric data sheets, physical examinations, and laboratory tests. Anthropometric measurements were taken, and growth was assessed using CDC growth charts. Nutritional anemia was defined as hemoglobin 16. Results: A total of 111 patients were included (56.8% male, median age 65 months). Most patients had normal height (82%) and weight (86.5%) upon admission. However, 14.4% were stunted, 11.7% were underweight, 14.4% were overweight, and 3.6% were obese. Growth impairment correlated with higher anemia rates (p = 0.042). Nutritional anemia was present in 12% of patients. No significant relation was found between breastfeeding history and growth retardation, but maternal perception of malnutrition correlated well with actual malnutrition. Conclusion: Our study found a malnutrition prevalence of 19.8%, highlighting the need for systematic nutritional screening in hospitalized children. The study’s limitations include its small sample size and specific patient population, suggesting the need for larger, multicenter studies for more generalizable results.

Malnutrition and Its Association with the Mortality of Patients with Femoral Intertrochanteric Fractures: A Retrospective Analysis of Japanese Patients

Background: The incidence of femoral intertrochanteric fractures in older adults is higher than that of femoral neck fractures;however, both conditions are often analyzed together as proximal femoral fractures. Considering the difference in treatment, postoperative complication, and mortality risk, these two fractures should be analyzed separately. This study aimed to analyze 1-year mortality and its risk factors in patients with surgically treated femoral intertrochanteric fractures. Methods: Consecutive patients with intertrochanteric fractures who underwent surgical interventions at our institution between January 2017 and December 2021 were retrospectively reviewed. A total of 238 patients were eligible for inclusion in this study. Patients’ demographic and clinical information were retrospectively collected. Patients were divided into the 1-year mortality (n = 16) and survival (n = 222) groups. The incidence of 1-year mortality and its independent risk factors were investigated using univariate and multivariate logistic regression analyses. Results: The mean age of patients was 85.6 ± 8.5 years. The 1-year mortality rate was 6.7% (16/238). Preoperative albumin level, the Geriatric Nutritional Risk Index (GNRI), and malnutrition status (GNRI p = 0.02, p = 0.02, and p = 0.0011, respectively). Multivariate analysis showed that malnutrition status (GNRI p = 0.035) was an independent risk factor for 1-year mortality. Conclusion: Malnutrition status assessed using GNRI (GNRI < 92) was an independent risk factor for 1-year mortality. Our findings suggest that GNRI may be an effective screening tool for predicting postoperative 1-year mortality of patients with surgically treated femoral intertrochanteric fractures.

Management of Acute Malnutrition in Children Aged 0 to 24 Months Boulbinet Health Center

Introduction: Malnutrition is a pathological state resulting from the relative deficiency or excess of one or more essential nutrients, whether manifested clinically or detected only by biochemical, anthropometric or physiological analyses. The overall objective was to assess the quality of management of acute malnutrition in children aged 0 - 24 months at the Boulbinet health center. Methodology: This was a prospective descriptive study lasting six (06) months from May 5 to October 5, 2018. The study included all children aged 0 to 24 months. Results: Acute malnutrition in children aged 0 - 24 months accounted for 2.11% of cases. The sex ratio was 1.41 in favor of males. The mean age of our patients was 5 months 7 days, with extremes of 1 month and 6 months. The majority came from Ra toma (40.24%). Exclusive breastfeeding was most common (54.02%). The main clinical signs were: pallor 49.42%, diarrhea 46.67, oral lesions37.96%. SAM represented 89.66% and MAM 10.34%. Most associated pathologies: anemia 49.42% and oral candidiasis 37.93%. In terms of outcome, we recorded 56.32% cures, 20.69% deaths, 18.39% dropouts and 4.60% cures. Conclusion: Improving the quality of care for malnourished children aged 0 - 24 months requires raising awareness among mothers and the general public of the consequences of malnutrition.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Superior Mesenteric Artery Syndrome, a Rare Complication of Severe Malnutrition: Two Cases from a Subsaharian Endocrinology Department

Introduction: Superior mesenteric artery syndrome (SMAS), a rare diagnosis due to compression of the third duodenum between the superior mesenteric artery (SMA) and the aorta resulting in bowel obstruction, may lead to severe malnutrition. We report two cases of patients hospitalised in the Internal Medicine, Endocrinology, Diabetology, and Nutrition Department of the National Hospital Center (NHC) of Pikine. Observations: Patient 1: A 35-year-old female was referred for an aetiological diagnosis due to a rapid weight loss of 15 kilograms in one month, accompanied by persistent vomiting, following an appendectomy performed a month before admission. Upon clinical examination, she presented severe malnutrition (Buzby index of 76%), early post-prandial chronic vomiting, and a poor general condition. An abdominal CT scan revealed aortomesenteric clamp syndrome (AMCS) with an angulation between the aorta and the SMA of 13˚. The underlying cause in this patient was severe malnutrition. Fortunately, her condition improved with medical treatment. Patient 2: We report the case of a 30-year-old female hospitalized due to unusual weight-bearing post-prandial epigastric pain and intermittent vomiting over the past six months. Upon physical examination at admission, she exhibited severe malnutrition with a body mass index (BMI) of 14 kg/m2, a Buzby index of 71%, trophic disorders, and a stage IV general condition assessment according to the World Health Organization (WHO). An abdominal CT scan revealed AMCS with an angle between the aorta and the SMA of 22˚ and an aortomesenteric space of 4 mm. The outcome was poor with medical treatment failure and, unfortunately, the patient died before surgery. Conclusion: SMAS is rarely evoked in clinical practice despite the presence of contributing factors and suggestive clinical signs. The prognosis depends on management time.

Clinical and Evolutive Aspects of Severe Acute Malnutrition in Children Aged 0 - 59 Months at Maroua Regional Hospital in Cameroon’s Far North Region

Introduction: Severe acute malnutrition remains one of the most important causes of under-five mortality. In Cameroon, the northern regions have the highest prevalence, with 1.4% in the Far North in 2021. These children are managed at the Internal therapeutic and Nutrional Centre, one of which is located at Maroua Regional Hospital, the third level referral Hospital. We therefore proposed to carry out a study on the clinical and evolutive aspects of these children. Materials and Methods: it was a descriptive, cross-sectional study from January 2020 to December 2022, at the ITNC (CNTI) of Maroua Regional Hospital. The sample size was obtained from the Lorentz formula. Patient records were used for data collection. We excluded all incomplete records and patients with less than 24 hours of admission. Results: Out of the 873 patients we recruited, the prevalence of severe malnutrition was estimated at 18 %. The average age was 14 months, with a male predominance. The main reasons for consultation were fever (42%) and diarrhoea (35%). Marasmus was the predominant clinical form. The major medical complications were sepsis (32.9%) and malaria (16.8%). HIV prevalence was 2.5% and tuberculosis was 4.9%. Most patients had haemoglobin levels between 7 and 10g/dl. 79.3% were cured and 6.5% died. The main causes of death were sepsis and malaria. Conclusion: Severe acute malnutrition remains a major problem in the Far North region. Several joint actions are needed to break this cycle.

Analysis of Influencing Factors of Moderate to Severe Malnutrition in Elderly Patients with Lung Cancer during Chemotherapy

Objective:This study aims to identify the factors influencing moderate to severe malnutrition in elderly lung cancer patients undergoing chemotherapy and to provide a basis for developing clinical prevention and intervention strategies.Methods:The clinical data of 150 elderly lung cancer patients who received chemotherapy were retrospectively analyzed.Demographic data,clinical characteristics,laboratory indicators,treatment plans,and other relevant information were collected.Independent risk factors for moderate to severe malnutrition during chemotherapy were identified.Results:During chemotherapy,50 patients(33.33%)developed moderate to severe malnutrition.The BMI of patients with moderate to severe malnutrition was significantly lower than that of patients with no or mild malnutrition(21.20±1.60 vs.26.14±2.31,P<0.001),and the proportion of patients with stage IV tumors was significantly higher(60.00%vs.27.00%,P<0.001).Serum pre-albumin(pre-ALB)and hemoglobin(Hb)levels in patients with moderate to severe malnutrition were significantly lower than those in patients with no or mild malnutrition(152.67±30.41 g/L vs.252.47±51.24 g/L and 102.44±10.09 g/L vs.154.21±15.18 g/L,respectively,P<0.001 for all).Conclusion:Low BMI,decreased serum pre-ALB levels,and decreased serum Hb levels before chemotherapy are independent risk factors for moderate to severe malnutrition in elderly lung cancer patients during chemotherapy.Close clinical attention should be given to these patients,with early intervention measures such as nutritional support to reduce the incidence of malnutrition and improve patients’quality of life and prognosis.

Mechanism for development of malnutrition in primary biliary cholangitis

Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease that is associated with impaired biliary excretion processes.Along with the development of cholestasis,there is a deficient flow of bile acids into the intestinal lumen causing malnutrition(MN)that is manifested in deficiencies of both macro-and micronutrients.The mechanism for development of trophological insufficiency is multifactorial.However,the trigger of MN in PBC is impaired enterohepatic circulation of bile acids.The ingress of bile acids with a detergent effect into the general bloodstream,followed by elimination via the kidneys and skin,triggers a cascade of metabolic disturbances,which leads to the gradual development and progression of calorie MN.The latter gradually transforms into protein-calorie MN(PСM)(as marasmus)due to the insufficient entry of bile acids into the duodenum,which is accompanied by a decrease in the emulsification,hydrolysis,and absorption of fats and fat-soluble vitamins,as well as disturbance of intestinal motility and bacterial overgrowth.Fat-soluble vitamin deficiencies complement PСM with vitamin and mineral MN.The development of hepatocellular failure enhances the progression of PСM due to the impaired protein synthetic function of hepatocytes in the advanced stage of PBC,which results in deficiency of not only the somatic but also the visceral pool of proteins.A mixed PСM form of marasmus and kwashiorkor develops.Early recognition of energy,protein,micronutrient,and macronutrient deficiencies is of great importance because timely nutritional support can improve liver function and quality of life in patients with PBC.In this case,it is important to know what type(energy,proteincalorie,vitamin,and vitamin-mineral)and form(marasmus,marasmuskwashiorkor)of MN is present in the patient and how it is associated with the stage of the disease.Therefore,it is recommended to screen all patients with PBC for MN,from the early asymptomatic stage of the disease in order to identify and avoid preventable complications,such as fatigue,malaise,performance decrement,sarcopenia,osteoporosis,and hepatic encephalopathy,which will be able to provide appropriate nutritional support for correction of the trophological status.

Diagnostic Accuracy of the Malnutrition Screening Tool (MST) in Adult Cancer Patients: a Systematic Literature Review and Meta-Analysis

Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.

Preliminary validation of Global Leadership Initiative on Malnutrition criteria in cancer patients:A cross-sectional study

Background:The Global Leadership Initiative on Malnutrition(GLIM)has been used in China since 2019.This study aimed to test the use of the GLIM criteria in Chinese cancer patients and to compare the diagnostic performance of the GLIM criteria with the Patient-Generated Subjective Global Assessment(PG-SGA)and modified PG-SGA(mPG-SGA). Methods:A total of 2,000 cancer patients were consecutively screened using the Nutritional Risk Screening 2002 instrument on ad-mission.Patients at nutritional risk(Nutritional Risk Screening 2002 score≥3)were enrolled to obtain the complete GLIM,PG-SGA,and mPG-SGA criteria.To evaluate the convergent validity,Spearman correlation analysis was used to compare the test-retest reliability of the GLIM criteria and its results with the scores of various nutritional tools and objective parameters.Kruskal-Wallis tests and χ2 tests were used to test the discriminant validity among groups with different nutritional status.We calculated the sensitivity,specificity,positive predictive value,and negative predictive value for the various tools. Results:There were 562 patients found to be at nutritional risk,accounting for 28.1%of all patients.One hundred seventy-four patients(8.7%)were diagnosed as moderately malnourished,and 333 patients(16.6%)were severely malnourished based on the PG-SGA.When assessed using the GLIM criteria,185 patients(9.3%)were diagnosed as moderately malnourished and 311 patients(15.5%)were severely malnourished.The content validity of the GLIM criteria was 95%,evaluated by 60 medical staff members.The test-retest reliability was good.For the diagnosis of malnutrition versus the PG-SGA,the sensitivity of the GLIM was"good"(90.5%;95%confidence interval[95%CI]=88.0%-93.1%),with a positive predictive value of 92.5%(95%CI=90.2%-94.9%),but the spec-ificity and negative predictive value were"poor."Similar results were obtained when the mPG-SGA was used as the criterion. Conclusions:Overall,this cross-sectional study suggests that the GLIM criteria comprise a valid and reliable tool to assess the nutri-tional status of Chinese cancer patients.

Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.

Effects of Malnutrition on Economic Productivity in China As Estimated by PROFILES

Objective To calculate the effects of malnutrition on economic productivity in China. Methods PROFILES was used to quantify the function consequences of malnutrition in term of protein energy malnutrition, iron deficiency and iodine deficiency. Results Productivity gained due to improved iodine nutrition. The reduction in the TGR in 1992 to 2001 increased the net present value of further economic productivity by $142 billion. Reduction of the TGR rate to 5% over next 10 years would result in future productivity gains with value of $40 billion. Productivity gain due to reductions in child stunting would result in future economic productivity gains with the value of $101 billion. Reducing stunting further over the next 10 years would gain $20 billion. Productivity gain due to reduction of iron deficiency anemia reduced by 30% over the next 10 years would gain worth $107 billion and if childhood anemia reduced by 30% over next 10 years would gain $348 billion. Conclusion These interventions have huge economic payoff. That is likely to exceed their costs many times over.

Validation of nutritional risk index method against patientgenerated subjective global assessment in screening malnutrition in colorectal cancer patients

Objective：To validate malnutrition screening tool of nutrition risk index （NRI） against patent-generated subjective global assessment （PG-SGA） as a gold standard tool in colorectal cancer patients before radiotherapy.Methods：Nutritional status of 52 volunteer colorectal cancer patients with a mean age of 54.1±16.8 years who referred to radiotherapy center were assessed by PG-SGA （gold standard method） and NRI.Serum albumin levels of patients were determined by colorimetric method.A contingency table was used to determine the sensitivity,specificity,and predictive value of the NRI in screening patients at risk of malnutrition,in comparison with the PG-SGA in patients before radiotherapy.Results：The findings of PG-SGA and NRI showed that 52％ and 45％ of patients in our study were moderately or severely malnourished respectively.The NRI had a sensitivity of 66％ and a specificity of 60％ against PG-SGA.The positive predictive value was 64％ and the negative predicative value was 62％.The agreement between NRI and PG-SGA was statistically insignificant （kappa =0.267; P＞0.05）.Conclusions：The findings of present study showed that the prevalence of malnutrition was high in patients with colorectal cancer.Moreover,NRI method had low sensitivity and specificity in assessing nutritional status of patients with cancer.It seems that the combination of anthropometric,laboratory parameters and a subjective scoring system may be helpful tools in screening of malnutrition in cancer patients.

Malnutrition affects quality of life in gastroenterology patients

AIM： To investigate the association between malnutrition and quality of life in patients with benign gastrointestinal disease.METHODS： Two hundred patients （104 wellnourished and 96 malnourished） were assessed according to the Subjective Global Assessment, anthropometric measurements and bioelectrical impedance analysis. Quality of life was determined with the validated Medical Outcomes Study 36-item Short-Form General Health Survey （SF 36）. Muscle function was assessed by hand grip strength and peak flow.RESULTS： Body mass index, body cell mass, arm muscle area and hand grip strength were significantly lower in the malnourished patients. Quality of life was generally lower when compared to norm values. Seven out of eight quality of life scales （excluding bodily pain） were significantly reduced in the malnourished patients. Comparing patients with liver cirrhosis and inflammatory bowel disease （IBD）, patients with IBD experienced significantly lower values in the perception of bodily pain, social functioning and rnenta/health. Malnourished liver cirrhotics suffered reductions in more scales （six out of eight） than malnourished IBD patients did （four out of eight）.CONCLUSION： Quality of life is generally low in benign gastrointestinal disease and is further reduced in patients who are classified as malnourished. It appears that liver cirrhosis patients experience a higher quality of life than IBD patients do, but the impact of malnutrition seems to be greater in liver cirrhosis than in IBD.

Malnutrition in cirrhosis:More food for thought

Malnutrition is highly prevalent in liver cirrhosis and its presence carries important prognostic implications.The clinical conditions and pathophysiological mechanisms that cause malnutrition in cirrhosis are multiple and interrelated.Anorexia and liver decompensation symptoms lead to poor dietary intake;metabolic changes characterised by elevated energy expenditure,reduced glycogen storage,an accelerated starvation response and protein catabolism result in muscle and fat wasting;and,malabsorption renders the cirrhotic patient unable to fully absorb or utilise food that has been consumed.Malnutrition is therefore a considerable challenge to manage effectively,particularly as liver disease progresses.A high energy,high protein diet is recognised as standard of care,yet patients struggle to follow this recommendation and there is limited evidence to guide malnutrition interventions in cirrhosis and liver transplantation.In this review,we seek to detail the factors which contribute to poor nutritional status in liver disease,and highlight complexities far greater than“poor appetite”or“reduced oral intake”leading to malnutrition.We also discuss management strategies to optimise nutritional status in this patient group,which target the inter-related mechanisms unique to advanced liver disease.Finally,future research requirements are suggested,to develop effective treatments for one of the most common and debilitating complications afflicting cirrhotic patients.

Malnutrition in Relation with Dietary, Geographical, and Socioeconomic Factors among Older Chinese

Objective Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary,geographical, and socioeconomic factors.Methods A total of 13,987 ≥ 60-year-old persons from the 2010–2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight,overweight or obesity, and micronutrient inadequacy.Results Overall, the prevalence of obesity, overweight, and underweight was 12.4%, 34.8%, and 5.7%,respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old(≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75% of the elderly do not meet the Dietary Reference Intakes for vitamins A, B1, B2, and E, folate, calcium, selenium, potassium, biotin,and choline, with the prevalence of inadequate intake increasing with age for most nutrients. At the population level, the mean intakes of numerous food groups did not meet the recommendations by the Chinese Dietary Guideline.Conclusions Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China.