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1.
Malnutrition and sarcopenia.
Sieber, CC
Aging clinical and experimental research. 2019;(6):793-798
Abstract
Risk for or established malnutrition is frequent in older adults, accompanied by functional limitations, increased morbidity and mortality. Protein-energy malnutrition is often observed and leads besides other predisposing factors to sarcopenia, the increased loss of muscle mass with aging. Sarcopenia is an integral correlate of the physical component of the frailty syndrome. Even though sarcopenia often reaches levels where mobility, balance and functionality on overall are hampered, its diagnosis has not become part of the standard diagnostic and therapeutic repertoire of geriatric medicine. This will hopefully change with a recently published revised international definition of sarcopenia, as well an own ICD-number. From a pathophysiological point of view, both malnutrition and sarcopenia share many components, a low-inflammatory state (inflamm-aging) being an important one. Nutritional interventions with and without parallel physical activity programs can prevent and often also reverse sarcopenia. It is hoped that upcoming even more potent nutritional treatment options-including for sarcopenic obesity-will lower the burden of malnutrition and sarcopenia for many older adults.
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2.
Evidence-based nutrition for the malnourished, hospitalised patient: one bite at a time.
Merker, M, Gomes, F, Stanga, Z, Schuetz, P
Swiss medical weekly. 2019;:w20112
Abstract
Although malnutrition is a highly prevalent condition in the inpatient setting, particularly in older patients with multiple morbidities, the medical community has struggled to find efficient, evidence-based approaches for its prevention and treatment. From an evolutionary perspective, illness-related low appetite may be seen as a protective response with the goals to accelerate recovery from disease by improving autophagy. In line with this, earlier trials in the intensive care setting including severely ill patients have demonstrated unwarranted effects of overnutrition on patient outcomes. Uncertainties regarding the best approach to the malnourished inpatient in conjunction with a lack of strong trial data may, in part, explain the low level of attention that hospital medical staff have paid to the issue of malnutrition in the non-critical care inpatient setting. The recent Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) study, however, has shown that individualized nutritional support reduces severe complications and improves mortality in medical inpatients, with positive effects on functional outcomes and quality of life. These results from a high quality effectiveness trial in conjunction with other studies, such as the NOURISH trial, should prompt us to improve our management of malnutrition in the inhospital setting. This procedure should start with a systematic screening for risk of malnutrition of admitted patients, effective assessment of nutritional status in multidisciplinary teams including dieticians, nurses and physicians, and early start of individualized adequate nutritional support of at risk patients to reach nutritional goals. Understanding the optimal use of nutritional support in patients with acute illness is complex because timing, route of delivery, and the amount and type of nutrients may all affect patient outcomes. Also, particularly for patients on the medical ward, factors like the logistics of catering, staffing to provide food and support the patient (i.e., number of nurses and dieticians), motivation/understanding of the patient to eat in defiance of appetite, the empathic human factor of nutritional care, the quality of meals, the taste of supplements, and unnecessary fasting for diagnostic or therapeutic procedures have a strong influence on nutritional care of patients. Further research and clinical trials are required to better understand, step by step, how we can use clinical nutrition best to maximize recovery of our patient and improve their functional status and their quality of life. Such evidence regarding nutritional therapy may allow us to implement personalized nutrition-driven interventions in the future.
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3.
Malnutrition: evaluating the effectiveness of supplements.
Collins, AJ, Clemett, V, McNaughton, A
British journal of community nursing. 2019;(Sup7):S18-S25
Abstract
This article explores the effectiveness of oral nutritional supplements through a literature review. A literature search was performed throughout various medical databases and one article was selected for a critical appraisal. The study focused on the use of high-energy, low-volume supplements for people living in care homes who are at risk of malnutrtion or who are already manourished. The methods and conclusions of the study are then scrutinised. This article recommends further research to be carried out into the type and volume of supplements needed and the implementation of evidence-based practice.
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4.
Nutrition risk screening in the ICU.
Kondrup, J
Current opinion in clinical nutrition and metabolic care. 2019;(2):159-161
Abstract
PURPOSE OF REVIEW To review recent studies that may help to identify patients in the ICU who benefit from nutrition support. RECENT FINDINGS One recent controlled trial did not show any clinical benefit of nutrition support among a sample of ICU patients who were hitherto believed to benefit from nutrition support. Several recent observational studies suggest benefit of nutrition support among patients who have a high nutric score, in itself derived from an observational study. SUMMARY Regrettably, the decision about nutrition support in ICU patients still depends on physiological reasoning: a high degree of inflammation/stress metabolism, which will last for a considerable time, especially among those who are fragile (already malnourished, elderly, those with chronic diseases and/or other comorbidities).
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5.
Reuniting overnutrition and undernutrition, macronutrients, and micronutrients.
Kim, M, Basharat, A, Santosh, R, Mehdi, SF, Razvi, Z, Yoo, SK, Lowell, B, Kumar, A, Brima, W, Danoff, A, et al
Diabetes/metabolism research and reviews. 2019;(1):e3072
Abstract
Over-nutrition and its late consequences are a dominant theme in medicine today. In addition to the health hazards brought on by over-nutrition, the medical community has recently accumulated a roster of health benefits with obesity, grouped under "obesity paradox." Throughout the world and throughout history until the 20th century, under-nutrition was a dominant evolutionary force. Under-nutrition brings with it a mix of benefits and detriments that are opposite to and continuous with those of over-nutrition. This continuum yields J-shaped or U-shaped curves relating body mass index to mortality. The overweight have an elevated risk of dying in middle age of degenerative diseases while the underweight are at increased risk of premature death from infectious conditions. Micronutrient deficiencies, major concerns of nutritional science in the 20th century, are being neglected. This "hidden hunger" is now surprisingly prevalent in all weight groups, even among the overweight. Because micronutrient replacement is safe, inexpensive, and predictably effective, it is now an exceptionally attractive target for therapy across the spectrum of weight and age. Nutrition-related conditions worthy of special attention from caregivers include excess vitamin A, excess vitamin D, and deficiency of magnesium.
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6.
Poor Oral Health as a Determinant of Malnutrition and Sarcopenia.
Azzolino, D, Passarelli, PC, De Angelis, P, Piccirillo, GB, D'Addona, A, Cesari, M
Nutrients. 2019;(12)
Abstract
Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.
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7.
Legume biofortification is an underexploited strategy for combatting hidden hunger.
Rehman, HM, Cooper, JW, Lam, HM, Yang, SH
Plant, cell & environment. 2019;(1):52-70
Abstract
Legumes are the world's primary source of dietary protein and are particularly important for those in developing economies. However, the biofortification potential of legumes remains underexploited. Legumes offer a diversity of micronutrients and amino acids, exceeding or complementing the profiles of cereals. As such, the enhancement of legume nutritional composition presents an appealing target for addressing the "hidden hunger" of global micronutrient malnutrition. Affecting ~2 billion people, micronutrient malnutrition causes severe health effects ranging from stunted growth to reduced lifespan. An increased availability of micronutrient-enriched legumes, particularly to those in socio-economically deprived areas, would serve the dual functions of ameliorating hidden hunger and increasing the positive health effects associated with legumes. Here, we give an updated overview of breeding approaches for the nutritional improvement of legumes, and crucially, we highlight the importance of considering nutritional improvement in a wider ecological context. Specifically, we review the potential of the legume microbiome for agronomic trait improvement and highlight the need for increased genetic, biochemical, and environmental data resources. Finally, we state that such resources should be complemented by an international and multidisciplinary initiative that will drive crop improvement and, most importantly, ensure that research outcomes benefit those who need them most.
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8.
Body Composition Technology: Implications for the ICU.
Mundi, MS, Patel, JJ, Martindale, R
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2019;(1):48-58
Abstract
Malnutrition continues to be highly prevalent in hospitalized and critically ill patients and is associated with significant morbidity and mortality. Additionally, survivors of critical illness have an increased risk for sarcopenia, which leads to weakness and physical debilitation that can persist for years. Nutrition risk assessment tools have been developed and validated in critically ill patients but have limitations. Variables such as body weight, body mass index, weight change, or percentage of food intake can be difficult to obtain in critically ill patients and may be misleading given changes in body composition, such as an increase in body water. Assessment of body composition through new techniques provides a unique opportunity to counter some of these limitations and develop improved methods of nutrition risk assessment based on objective data. The present manuscript provides a review of the most commonly available clinical technology for assessment of body composition (bioimpedance, computed tomography, and ultrasound), including data from trials in critically ill patients highlighting the benefits and weaknesses of each modality.
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9.
Biotechnological Approaches for Generating Zinc-Enriched Crops to Combat Malnutrition.
Hefferon, K
Nutrients. 2019;(2)
Abstract
The past twenty years have seen the application of biotechnology to generate nutritionally improved food crops. Biofortified rice, cassava, maize, sorghum and other staple crops biofortified with essential micronutrients have great potential to benefit the world's poor, in terms of both health and economics. This paper describes the use of genetic modification to generate crops that are biofortified with zinc. Examples of zinc-enhanced crops which have been developed using biotechnological approaches will be discussed, and new approaches for research and development will be outlined. The impact of these biofortified crops on human health and well-being will be examined. This paper will conclude with a discussion of the obstacles that must be overcome to enable zinc-fortified crops to be accessible for the world's malnourished.
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10.
Environmental enteric dysfunction and growth.
Morais, MB, Silva, GAPD
Jornal de pediatria. 2019;:85-94
Abstract
OBJECTIVE To describe the current indicators of environmental enteric dysfunction and its association with linear growth deficit and the height-for-age anthropometric indicator. DATA SOURCES Narrative review with articles identified in PubMed and Scopus databases using combinations of the following words: environmental, enteric, dysfunction, enteropathy, and growth, as well as the authors' personal records. DATA SYNTHESIS In the last 15 years, new non-invasive markers have been investigated to characterize environmental enteric dysfunction; however, the best tests to be used have not yet been identified. There is evidence that, in environmental enteric dysfunction, a systemic inflammatory process may also occur as a consequence of increased intestinal permeability, in addition to intestinal mucosa abnormalities. Bacterial overgrowth in the small intestine and changes in fecal microbiota profile have also been identified. There is evidence indicating that environmental enteric dysfunction can impair not only full growth but also the neuropsychomotor development and response to orally administered vaccines. It is important to emphasize that the environmental enteric dysfunction is not a justification for not carrying out vaccination, which must follow the regular schedule. Another aspect to emphasize is the greater risk for those children who had height impairment in early childhood, possibly associated with environmental enteric dysfunction, to present overweight and obesity in adulthood when exposed to a high calorie diet, which has been called "triple burden." CONCLUSIONS According to the analyzed evidence, the control of environmental enteric dysfunction is very important for the full expression of growth, development, and vaccine response in the pediatric age group.