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Infection Status of Rural Schoolchildren and its Relationship with Vitamin D Concentrations.
Mandlik, R, Chiplonkar, S, Kajale, N, Khadilkar, V, Khadilkar, A
Indian journal of pediatrics. 2019;(8):675-680
Abstract
OBJECTIVES To assess the nutritional and infection status of rural schoolchildren and to study the relationship of infection status with serum 25(OH)D concentrations. METHODS This study was carried out in a primary school, in a rural setting, near Pune (18°N), Maharashtra. Data collected from 387 children included anthropometric, clinical, infection-related data (using a validated questionnaire) and dietary data (by 24-h recall method over 3 non-consecutive days, including a holiday) and serum 25(OH)D estimations (by ELISA). RESULTS Prevalence of underweight and stunting were 18% and 11% respectively. Upper respiratory tract infection (URTI) related symptoms were commonly reported. Episodes of URTI were found to be significantly and negatively correlated with serum 25(OH)D concentrations (rs = -0.14, p < 0.05) and lesser URTI episodes and duration were reported by children who were vitamin D sufficient as compared to those who were insufficient. No association of total infections was found with vitamin D status. CONCLUSIONS Moderate prevalence of underweight and stunting and frequent URTIs were observed in this population. Higher serum 25(OH)D concentrations and vitamin D sufficiency may be important for prevention of upper respiratory tract infections in rural children.
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Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial.
Zeng, L, Dibley, MJ, Cheng, Y, Dang, S, Chang, S, Kong, L, Yan, H
BMJ (Clinical research ed.). 2008;:a2001
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Abstract
OBJECTIVE To examine the impact of antenatal supplementation with multiple micronutrients or iron and folic acid compared with folic acid alone on birth weight, duration of gestation, and maternal haemoglobin concentration in the third trimester. DESIGN Cluster randomised double blind controlled trial. SETTING Two rural counties in north west China. PARTICIPANTS 5828 pregnant women and 4697 live births. INTERVENTIONS Villages were randomised for all pregnant women to take either daily folic acid (control), iron with folic acid, or multiple micronutrients with a recommended allowance of 15 vitamins and minerals. MAIN OUTCOME MEASURES Birth weight, length, and head circumference measured within 72 hours after delivery. Neonatal survival assessed at the six week follow-up visit. RESULTS Birth weight was 42 g (95% confidence interval 7 to 78 g) higher in the multiple micronutrients group compared with the folic acid group. Duration of gestation was 0.23 weeks (0.10 to 0.36 weeks) longer in the iron-folic acid group and 0.19 weeks (0.06 to 0.32 weeks) longer in the multiple micronutrients group. Iron-folic acid was associated with a significantly reduced risk of early preterm delivery (<34 weeks) (relative risk 0.50, 0.27 to 0.94, P=0.031). There was a significant increase in haemoglobin concentration in both iron-folic acid (5.0 g/l, 2.0 to 8.0 g/l, P=0.001) and multiple micronutrients (6.9 g/l, 4.1 to 9.6 g/l, P<0.001) groups compared with folic acid alone. In post hoc analyses there were no significant differences for perinatal mortality, but iron-folic acid was associated with a significantly reduced early neonatal mortality by 54% (relative risk 0.46, 0.21 to 0.98). CONCLUSION In rural populations in China antenatal supplementation with iron-folic acid was associated with longer gestation and a reduction in early neonatal mortality compared with folic acid. Multiple micronutrients were associated with modestly increased birth weight compared with folic acid, but, despite this weight gain, there was no significant reduction in early neonatal mortality. Pregnant women in developing countries need sufficient doses of iron in nutrient supplements to maximise reductions in neonatal mortality. Trial registration ISRCTN08850194.
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[Effects of perioperative enteral immunonutrition on nutritional status, immunity and inflammatory response of elderly patients].
Wang, ZD, Peng, JS, Chen, S, Huang, ZM, Huang, L
Zhonghua yi xue za zhi. 2006;(20):1410-3
Abstract
OBJECTIVE To evaluate the effects of perioperative enteral immunonutrition on the nutritional status, immunity, and inflammatory response of the elderly patients. METHODS Eighty malnourished patients aged over 60 with malignant gastrointestinal tumors undergoing radical surgery were randomly divided into 2 groups: experimental group (immunonutrition group, n = 37), and control group (n = 43). In the experimental group Supportan and glutamine, with the calorific value of 125.4 kJ.kg(-1).d(-1), were given orally or by nasointestinal tube for 5 days before operation, through jejunostomy or nasointestinal tube during operation, and then through nasointestinal tube since the day 2 to day 9 after post-operationally. In the control group Nutrition with the same amount of calorific value was given in the same manner as mentioned above. Peripheral blood samples were collected 5 and 1 days pre-operationally, and 1 and 9 days post-operatively to examine the serum albumin (ALB), prealbumin (PA), transferrin (TFN), CD3, CD4, CD8, CD4/CD8, immunoglobulin (Ig) G, IgA, IgM, and C-reactive protein (CRP). RESULTS Nine days after operation, the serum TFN was 2.18 g/L +/- 0.29 g/L, PA was 0.23 g/L +/- 0.09 g/L, CD4 was 33.8% +/- 5.4%, CD4/CD8 was 1.17 +/- 0.12, and IgG was 13.2 g/L +/- 1.8 g/L. all significantly higher than those of the control group (1.95 g/L +/- 0.28 g/L, 0.19 g/L +/- 0.03 g/L, 31.1% +/- 5.2%, 1.05 +/- 0.10, and 12.11 g/L +/- 1.53 g/L respectively, all P < 0.05). CONCLUSION Perioperative enteral immunonutrition improves the nutritional status and immune function, und reduces the acute inflammatory response of elderly patients.
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Daily requirement for total sulfur amino acids of chronically undernourished Indian men.
Kurpad, AV, Regan, MM, Varalakshmi, S, Gnanou, J, Young, VR
The American journal of clinical nutrition. 2004;(1):95-100
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BACKGROUND Earlier studies of the requirement for total sulfur amino acids (SAAs; methionine in the absence of cystine) in healthy, well-nourished Indians indicated a value of 15 mg.kg(-1).d(-1), but it is unknown whether this estimate is applicable to chronically undernourished subjects. OBJECTIVE We assessed the total SAA requirement in otherwise clinically healthy, young, chronically undernourished adult Indians by using 7 test methionine intakes (3, 6, 9, 13, 18, 21, and 24 mg.kg(-1).d(-1)), without cystine, and by using both the 24-h indicator amino acid oxidation (24-h IAAO) and the 24-h indicator amino acid balance (24-h IAAB) methods. DESIGN Twenty-one men were studied during each of 3 randomly assigned 7-d diet periods supplying methionine intakes (diet devoid of cystine) above and below the putative total 1985 FAO/WHO/UNU SAA requirement of 13 mg.kg(-1).d(-1). Twenty-four-hour IAAO and IAAB were measured on day 7 by use of a 24-h [(13)C]leucine tracer infusion. The breakpoint in the relation between these values and methionine intake was determined. RESULTS Two-phase linear regression of daily leucine oxidation or the daily leucine balance against methionine intake estimated a breakpoint in the response curve at a methionine intake of 16 mg.kg(-1).d(-1) (95% Fiellers CI: 13, 22 mg.kg(-1).d(-1)). CONCLUSIONS On the basis of the 24-h IAAO-IAAB approach, a mean total SAA requirement of 16 mg.kg(-1).d(-1) is proposed for undernourished Indian adults. This is not significantly different from that determined in Western and Indian well-nourished adults.
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Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients.
Cai, B, Zhu, Y, Ma, Yi, Xu, Z, Zao, Yi, Wang, J, Lin, Y, Comer, GM
Nutrition (Burbank, Los Angeles County, Calif.). 2003;(3):229-32
Abstract
OBJECTIVE One of the goals in treating patients with chronic obstructive pulmonary disease (COPD) who suffer from hypoxemia, hypercapnia, and malnutrition is to correct the malnutrition without increasing the respiratory quotient and minimize the production of carbon dioxide. This 3-wk study evaluated the efficacy of feeding a high-fat, low-carbohydrate (CHO) nutritional supplement as opposed to a high-carbohydrate diet in COPD patients on parameters of pulmonary function.S METHODS Sixty COPD patients with low body weight (<90% ideal body weight) were randomized to the control group, which received dietary counseling for a high-CHO diet (15% protein, 20% to 30% fat, and 60% to 70% CHO), or the experimental group, which received two to three cans (237 mL/can) of a high-fat, low-CHO oral supplement (16.7% protein, 55.1% fat, and 28.2% CHO) in the evening as part of the diet. Measurements of lung function (forced expiratory volume in 1 s or volume of air exhaled in 1 s of maximal expiration, minute ventilation, oxygen consumption per unit time, carbon dioxide production in unit time, and respiratory quotient) and blood gases (pH, arterial carbon dioxide tension, and arterial oxygen tension) were taken at baseline and after 3 wk. RESULTS Lung function measurements decreased significantly and forced expiratory volume increased significantly in the experimental group. CONCLUSION This study demonstrates that pulmonary function in COPD patients can be significantly improved with a high-fat, low-CHO oral supplement as compared with the traditional high-CHO diet.
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Appetite, food intake, and plasma concentrations of cholecystokinin, ghrelin, and other gastrointestinal hormones in undernourished older women and well-nourished young and older women.
Sturm, K, MacIntosh, CG, Parker, BA, Wishart, J, Horowitz, M, Chapman, IM
The Journal of clinical endocrinology and metabolism. 2003;(8):3747-55
Abstract
Aging is associated with a reduction in appetite and food intake, predisposing to protein-energy malnutrition. The causes of this "anorexia of aging" are largely unknown. To investigate possible contributions of enhanced satiating effects of cholecystokinin (CCK) and reduced stimulation of food intake by ghrelin, eight undernourished older women [age, 80.4 +/- 2.6 yr; body mass index (BMI), 16.9 +/- 0.57 kg/m(2)], eight well-nourished older women (age, 77 +/- 0.9 yr; BMI, 23.7 +/- 0.8 kg/m(2)), and eight well-nourished young women (age, 22 +/- 1.3 yr; BMI, 20.5 +/- 0.4 kg/m(2)), in randomized order, ate on 1 d a 280-kCal preload and on the other no preload, 90 min before an ad libitum meal. At baseline the undernourished, but not the well-nourished, older subjects were less hungry (P < 0.05) than young subjects. Before and after the preload, plasma CCK levels were higher (P < 0.05) in the older than young subjects, with no difference between the older groups. Plasma ghrelin concentrations were higher in the undernourished than both well-nourished groups and decreased similarly after the preload in all groups. The preload suppressed food intake in the well-nourished older and young subjects (P < 0.05), but was without effect in the undernourished old. These observations suggest that reduced basal hunger, rather than increased meal-induced satiety, contributes to the anorexia of aging and that changes in CCK and ghrelin are unlikely to be responsible.
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[Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients;effect of infectious morbidity and mortality].
Grau, T, Ruiz de Adana, JC, Zubillaga, S, Fuerte, S, Girón, C
Nutricion hospitalaria. 2003;(3):159-66
Abstract
GOAL: Lipid infusions of a physical mixture of medium-chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only long-chain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. PATIENTS AND METHODS A total of 72 severely undernourished patients subjected to planned or emergency laparotomy were prospectively recruited and stratified by the presence or absence of cancer, on admission to the departments of General Surgery and Intensive Care Medicine at a teaching hospital. The main outcome was the incidence of intra-hospital nosocomial infection and the secondary outcome was mortality. RESULTS The patients in the study group (MCT/LCT) and the control group (LCT) shared similar characteristics. The patients in the MCT/LCT group had a significantly lower incidence of intra- abdominal abscesses (2/26) than those in the LCT group (10/31) (p < 0.05; RR 0.18; CI 95%; 0.03-0.89). There were no significant differences in the incidence of other infections. Nor was there a difference between the two groups in terms of the intra-hospital mortality (4/26 versus 11/31). In the stratified analysis, patients without cancer treated with MCT/LCT presented significantly fewer intra-abdominal abscesses (2/14) than those with LCT (5/8) (p < 0.05; RR 0.1; CI 95%; 0.01-0.79) and a significantly lower mortality (2/14 versus 5/8; p < 0.05; RR 0.1; CI 95%; 0.01-0.79). CONCLUSIONS Lipid infusions of MCT/LCT used in peri-operative TPN protect severely undernourished surgical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures.
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A controlled trial of intermittent enteral nutrient supplementation in maintenance hemodialysis patients.
Sharma, M, Rao, M, Jacob, S, Jacob, CK
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002;(4):229-37
Abstract
OBJECTIVE This controlled trial was undertaken to evaluate the benefits of short-term enteral nutrient supplementation in maintenance hemodialysis (MHD) patients using a high-calorie and high-protein blend formula (low-cost home-prepared [HP] blend or a commercially available supplement) and to study its effect on selected parameters of nutritional status. The acceptability and palatability of the HP blend formula, ease of use, and cost were also assessed in comparison with the commercial nutritional supplement (CNS). DESIGN Randomized controlled trial. SETTING Hemodialysis (HD) unit of a tertiary referral care hospital in Southern India. PATIENTS Nondiabetic adult MHD patients with no intercurrent illness, on regular thrice weekly MHD for at least 1 month before recruitment, with a body mass index (BMI) <20 and a serum albumin level of <4.0 g/dL. Patients were randomized into control group and experimental group, the latter in turn to recieve either CNS or HP blend. INTERVENTION The control group received appropriate monitoring, including dietary recall and counselling for the prescribed diet (protein intake of 1.2 g/kgIBW/d and energy of 35 to 45 kcal/kgIBW/d) but no specific post-HD supplement. Patients in the supplement group received the respective supplement post-HD (providing 500 kcal and 15 g protein) for 1 month in addition to the monitored diet prescription. MAIN OUTCOME MEASURES (1) Nutritional status parameters, BMI and serum albumin; (2) functional status on a 10-point Karnofsky scale; (3) adverse metabolic effects, hyperphosphatemia at start and end of study; and (4) subjective scoring for appetite, and acceptability of and tolerance to supplement. RESULTS Both groups showed an improvement in dry weight and BMI. In addition, the supplement group showed a significant increase in serum albumin level and functional scoring. Mild hyperphosphatemia occurred in the supplement group. An increase in baseline food intake was seen in the control group, but not in the supplemented group. No intolerance was reported to either supplement. CONCLUSION Enteral nutrient supplementation was shown to bring about a significant improvement in serum albumin level even in a short-term study. Use of an HP supplement was beneficial, acceptable, and inexpensive.
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Enteral nutrition in surgical patients.
Saluja, SS, Kaur, N, Shrivastava, UK
Surgery today. 2002;(8):672-8
Abstract
PURPOSE Malnutrition is well-recognized as a potential cause of increased morbidity and mortality in surgical patients; however, enteral and parenteral nutritional support given pre- and postoperatively have been shown to decrease these rates. We conducted a prospective study to assess the short-term efficacy of oral dietary supplementation in malnourished patients undergoing major abdominal surgery. METHODS Sixty patients undergoing major abdominal surgery were divided according to nutritional risk index into borderline (BM), moderately (MM), and severely (SM) malnourished categories. The patients in each category were randomly divided into a treatment group (TG) and a control group (CG). TG patients were given an oral sip feed containing 500 kcal of energy and 16.66 g of protein in addition to their daily oral intake. The differences in nutritional intake, in terms of energy and protein, and the changes in nutritional status, as assessed by anthropometric, biochemical, and hematological values, complication rates, and duration of stay were compared. RESULTS The supplemented feeds were well tolerated and the total caloric and protein intake in the TG was significantly higher than in the CG, at 1798 vs 1182 kcal ( P < 0.01), protein 55.71 vs 39.48 g ( P < 0.01), respectively. Weight loss in the SM patients was significantly less in the TG than in the CG, at 2.15 vs 4.6 kg ( P < 0.001), respectively. Complications developed in 7 of the 30 TG patients and in 10 of the 30 CG patients, with maximum reduction seen in the SM category (7 in the CG vs 4 in the TG). CONCLUSIONS Patients with severe malnutrition are likely to develop large energy deficits postoperatively, resulting in loss of body mass and a higher incidence of infective complications. Oral nutritional supplements are well tolerated by these patients, and help to improve their energy and routine intake and reduce the risk of complications.
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Severe dietary protein restriction in overt diabetic nephropathy: benefits or risks?
Meloni, C, Morosetti, M, Suraci, C, Pennafina, MG, Tozzo, C, Taccone-Gallucci, M, Casciani, CU
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002;(2):96-101
Abstract
OBJECTIVE To evaluate whether restricting protein intake may delay the progression of chronic renal failure caused by overt diabetic nephropathy and also whether this increases the risk of malnutrition. DESIGN Prospective clinical trial. SETTING Nephrology outpatients. PATIENTS Sixty-nine patients (32 affected by type 1 and 37 by type 2 diabetes, all treated with insulin) affected by both overt diabetic nephropathy and hypertension. INTERVENTION The study was started once hypertension and glycemia had been under control for at least 3 months. Two groups of patients, matched for similar mean glomerular filtration rate value and nutritional status, were studied: a low-protein diet (0.6 g/kg/d) was randomly prescribed to 35 patients, whereas in the other 34 patients a free diet intake was maintained for 12 months. MAIN OUTCOME MEASURE Renal function and nutritional status. RESULTS The protein intake was significantly different in the 2 groups of patients, whereas the average decline of glomerular filtration rate during the follow-up was comparable. In the low-protein diet group, serum prealbumin concentration significantly decreased after 9 months, whereas serum albumin decreased at the end of the study. CONCLUSION Severe dietary protein restriction does not seem to delay the progression of renal disease in patients with overt diabetic nephropathy, whereas it may induce malnutrition.