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Undernutrition
Selected AbstractsLifting the Curse: Overcoming Persistent Undernutrition in IndiaIDS BULLETIN, Issue 4 2009Lawrence Haddad With rapid economic growth and little progress in banishing undernutrition, India is an economic powerhouse and a nutritional weakling. This article surveys the others in this collection and concludes that such a situation represents a failure of governance at many levels. The article suggests a number of ways in which the state and civil society in India can strengthen the governance of nutrition in terms of capability, responsiveness and accountability. It also calls for more frequent data collection on nutrition service delivery and nutrition outcomes so that the state and civil society can sustain pressure on the need to improve nutrition. Finally, the outlines of a new research focus are described. [source] Quality Indicators for the Care of Undernutrition in Vulnerable EldersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2007David B. Reuben MD First page of article [source] Long-Term Undernutrition Followed by Short-Term Refeeding Effects on the Corticotropin-Releasing Hormone Containing Neurones in the Paraventricular Nucleus: An Immunohistochemical Study in SheepJOURNAL OF NEUROENDOCRINOLOGY, Issue 4 2002E. Chaillou Abstract The effect of nutritional level on the immunoreactivity of corticotropin-releasing hormone (CRH) in neurones of the hypothalamic paraventricular nucleus was described in sheep, a ruminant, whose feeding strategy differs from that of monogastric species. Two groups of ewes were underfed (40%), or fed at maintenance (100%) for 167 days, after which one-half of each group was killed or ad libitum refed (at least 150% of maintenance) for 4 days before killing. The presence of CRH in the paraventricular nucleus was examined by immunohistochemistry. The number of CRH immunoreactive neurones was increased in underfed ewes, but without modification of the plasma concentration of cortisol, indicating that the rise of CRH was not released in the portal blood nor linked to the pituitary-adrenal axis. Refeeding did not modify significantly the number of CRH immunoreactive neurones in the nucleus although these neurones were increased, only in refed ewes that were previously underfed. These data differ from those for rats and mice where CRH expression is decreased or not modified by underfeeding which could reflect different effects of undernutrition on CRH immunoreactive neurones in monogastric compared to ruminants species. [source] Undernutrition among children in South and South-East AsiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2010Sant-Rayn Pasricha Abstract Undernutrition remains a major public health problem among children living in Asia. Although the burden is maximal among poorer, rural and Indigenous communities, the problem affects the majority in many Asian countries, especially in South Asia. In order to prevent the pervasive consequences of undernutrition, strategies that address this burden are required. Successful implementation of strategies may be limited by the complex aetiology of undernutrition, including the political setting. Rising food insecurity because of climate change, land use for biofuel production and the recent global financial crisis threaten to exacerbate childhood malnutrition. In this review, we describe the burden of undernutrition among Asian children and discuss contributing factors and potential solutions. [source] Review article: anorexia and cachexia in gastrointestinal cancerALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2005J. OCKENGA Summary In patients with gastrointestinal malignancies, i.e. cancers of the stomach, colon, liver, biliary tract or pancreas, progressive undernutrition can be regularly observed during the course of illness. Undernutrition significantly affects the patients' quality of life, morbidity and survival. Pathogenetically, two different causes are relevant in the development of undernutrition in patients with gastrointestinal cancer. One cause is reduced nutritional intake. This condition is referred to as anorexia and can be worsened by the side effects of cancer therapy. The other cause is the release of endogenous transmitters and/or other products of the tumour leading to the cachexia syndrome, which is characterized by loss of body weight, negative nitrogen balance and fatigue. Cancer anorexia and cancer cachexia may have synergistic negative effects in affecting the patients' status. In this review, current nutritional support strategies with respect to different clinically relevant situations are described. An algorithm of the treatment strategies, including dietetic counselling, oral supplements, enteral and parenteral nutritional support is given. One focus is the approach of nutrition-focused patient care, which shows promising results. In addition, the possibilities of pharmacological intervention are discussed. [source] Undernutrition and housebound older peopleNUTRITION & DIETETICS, Issue 4 2009Renuka VISVANATHAN Abstract Aim:, This paper outlines approaches to dealing with undernutrition in the older person. Method:, A series of case studies is presented to expose principles of practice for management of undernutrition in the older person. Results:, Screening is a necessary first step. A more in-depth assessment of those at-risk may reveal contributory factors that if addressed, would result in better nutritional health outcomes. Preservation of muscle mass through adequate caloric and protein intake and exercise is important. Nutritional supplementation has been shown to reduce mortality risk and improve weight. A daily multivitamin may offer some benefit. Weight loss is also seen commonly in older people with dementia. There is a need to understand why this occurs as this could guide management strategies. There is also a need to consider conservative management when dysphagia occurs in the later stages of dementia. Percutaneous endoscopic gastrostomy feeding may not necessarily have that much to offer. Conclusion:, In older people, the prevalence of undernutrition increases with increasing frailty. If not treated, undernutrition is costly both to the individual and society. [source] Nutrients for Cognitive Development in School-aged ChildrenNUTRITION REVIEWS, Issue 8 2004Janet Bryan Ph.D. This review considers the research to date on the role of nutrition in cognitive development in children, with a particular emphasis on the relatively neglected post-infancy period. Undernutrition and deficiencies of iodine, iron, and folate are all important for the development of the brain and the emergent cognitive functions, and there is some evidence to suggest that zinc, vitamin B12, and omega-3 polyunsaturated fatty acids may also be important. Considerations for future research include a focus on the interactions between micronutrients and macronutrients that might be influential in the optimization of cognitive development; investigation of the impact of nutritional factors in children after infancy, with particular emphasis on effects on the developing executive functions; and selection of populations that might benefit from nutritional interventions, for example, children with nutrient deficiencies or those suffering from attention deficit-hyperactiv-ity disorder and dyslexia. [source] The Link Between Childhood Undernutrition and Risk of Chronic Diseases in Adulthood: A Case Study of BrazilNUTRITION REVIEWS, Issue 5 2003Ana L. Sawaya PhD Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with under-nourished children. This review summarizes data from Brazil - a developing country undergoing the nutrition transition - suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include longterm effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment. [source] Trends in Diet, Nutritional Status, and Diet-related Noncommunicable Diseases in China and India: The Economic Costs of the Nutrition TransitionNUTRITION REVIEWS, Issue 12 2001Dr. Barry M. Popkin Ph.D Undernutrition is being rapidly reduced in India and China. In both countries the diet is shifting toward higher fat and lower carbohydrate content. Distinct features are high intakes of foods from animal sources and edible oils in China, and high intakes of dairy and added sugar in India. The proportion of overweight is increasing very rapidly in China among all adults; in India the shift is most pronounced among urban residents and high-income rural residents. Hypertension and stroke are relatively higher in China and adult-onset diabetes is relatively higher in India. Established economic techniques were used to measure and project the costs of undernutrition and diet-related noncommunicable diseases in 1995 and 2025. Current WHO mortality projections of diet-related noncommunicable diseases, dietary and body composition survey data, and national data sets of hospital costs for healthcare, are used for the economic analyses. In 1995, China's costs of undernutrition and costs of diet-related noncommunicable diseases were of similar magnitude, but there will be a rapid increase in the costs and prevalence of diet-related noncommunicable diseases by 2025. By contrast with China, India's costs of undernutrition will continue to decline, but undernutrition costs did surpass overnutrition diet-related noncommunicable disease costs in 1995. India's rapid increase in diet-related noncommunicable diseases and their costs projects similar economic costs of undernutrition and overnutrition by 2025. [source] Nutrition and Brain Development: Social Policy ImplicationsAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2002Emily M. Tanner MSc Undernutrition among young children is widespread in the United States and has a detrimental impact on brain development. This article explores the risks associated with undernutrition and the potential for recovery when diet and the environment improve. Three policy implications are discussed: (a) increasing access to federal food programs, (b) promoting breastfeeding, and (c) working toward reducing child poverty. [source] Effect of Maternal Nutrient Restriction in Early Gestation on Responses of the Hypothalamic-Pituitary-Adrenal Axis to Acute Isocapnic Hypoxaemia in Late Gestation Fetal SheepEXPERIMENTAL PHYSIOLOGY, Issue 1 2000Paul Hawkins Epidemiological and experimental evidence suggests that maternal undernutrition during pregnancy may alter development of fetal organ systems. We have demonstrated previously that fetal hypothalamic-pituitary-adrenal (HPA) axis responses to exogenous corticotropin-releasing hormone (CRH) + arginine vasopressin (AVP), or adrenocorticotrophin hormone (ACTH), are reduced in fetuses of mildly undernourished ewes. To examine these effects further we tested HPA axis responses to acute isocapnic hypoxaemia in fetal sheep at 114-129 days gestation (dGA), following 15% reduction in maternal nutritional intake between 0 and 70 dGA. Fetuses from control (C) and nutrient-restricted (R) ewes were chronically catheterised and plasma ACTH and cortisol responses were determined at 114-115, 120-123 and 126-129 dGA during hypoxaemia (1 h) induced by lowering the maternal inspired O2 fraction (FI,O2). Basal plasma cortisol concentrations and HPA axis responses at 114-115 and 120-123 dGA did not differ between C and R fetuses. At 126-129 dGA, both plasma ACTH (P < 0.01) and cortisol (P < 0.05) responses were smaller in R fetuses compared to C fetuses. Fetal blood gas status, fetal body weight, body proportions and organ weights did not differ between the groups. We conclude that mild maternal undernutrition alters development of the fetal HPA axis producing a reduction in pituitary and adrenal responsiveness to endogenous stimuli. [source] Hospital inpatients' experiences of access to food: a qualitative interview and observational studyHEALTH EXPECTATIONS, Issue 3 2008Smriti Naithani BSc MSc Abstract Background, Hospital surveys indicate that overall patients are satisfied with hospital food. However undernutrition is common and associated with a number of negative clinical outcomes. There is little information regarding food access from the patients' perspective. Purpose, To examine in-patients' experiences of access to food in hospitals. Methods, Qualitative semi-structured interviews with 48 patients from eight acute wards in two London teaching hospitals. Responses were coded and analysed thematically using NVivo. Results, Most patients were satisfied with the quality of the meals, which met their expectations. Almost half of the patients reported feeling hungry during their stay and identified a variety of difficulties in accessing food. These were categorized as: organizational barriers (e.g. unsuitable serving times, menus not enabling informed decision about what food met their needs, inflexible ordering systems); physical barriers (not in a comfortable position to eat, food out of reach, utensils or packaging presenting difficulties for eating); and environmental factors (e.g. staff interrupting during mealtimes, disruptive and noisy behaviour of other patients, repetitive sounds or unpleasant smells). Surgical and elderly patients and those with physical disabilities experienced greatest difficulty accessing food, whereas younger patients were more concerned about choice, timing and the delivery of food. Conclusions, Hospital in-patients often experienced feeling hungry and having difficulty accessing food. These problems generally remain hidden because staff fail to notice and because patients are reluctant to request assistance. [source] Lifting the Curse: Overcoming Persistent Undernutrition in IndiaIDS BULLETIN, Issue 4 2009Lawrence Haddad With rapid economic growth and little progress in banishing undernutrition, India is an economic powerhouse and a nutritional weakling. This article surveys the others in this collection and concludes that such a situation represents a failure of governance at many levels. The article suggests a number of ways in which the state and civil society in India can strengthen the governance of nutrition in terms of capability, responsiveness and accountability. It also calls for more frequent data collection on nutrition service delivery and nutrition outcomes so that the state and civil society can sustain pressure on the need to improve nutrition. Finally, the outlines of a new research focus are described. [source] Making Nutrition Services Work for Socially Excluded Groups: Lessons from the Integrated Nutrition and Health ProjectIDS BULLETIN, Issue 4 2009Mukesh Kumar A relatively large proportion of India's underweight children belong to groups facing multiple disadvantages. Addressing child malnutrition among these communities is critical if India is to eliminate undernutrition and achieve the MDG goals. This article draws evidence from the Integrated Nutrition and Health Project II (INHP-II), a USAID funded project, implemented by CARE in India, to show how, by ensuring universal service coverage, a programme can enhance equity and inclusion. INHP-approaches such as: Nutrition and health days (NHD); prioritising home contacts; system strengthening; community participation; tracking left-out children; enhancing convergence and coverage of nutritional and health services, all help to improve nutritional outcomes among all sections of society, particularly socially excluded groups. [source] Minimising undernutrition in the older inpatientINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Dawn Vanderkroft BSc internshipNutr&Diet APD Abstract Background, Malnutrition among elderly hospitalised patients is widespread and has been shown to lead to adverse health outcomes. The effectiveness of interventions to minimise undernutrition in elderly inpatients is not well documented. Objectives, To identify the best available practices, in the hospital setting, that minimise undernutrition or the risk of undernutrition, in the acute care patient especially for the older patient. The review will assesses the effectiveness of a range of interventions designed to promote adequate nutritional intake in the acute care setting, with the aim of determining what practices minimise malnutrition in the elderly inpatients. Search strategy, English language articles from 1980 onwards were sought using Medline, Premedline, Cinahl, Austrom-Australasian Medical Index and AustHealth, Embase and Science Citations Index. Selection criteria, For inclusion the study had to include an intervention aiming to minimise undernutrition in hospitalised elderly patients aged 65 years or older. All study designs were included. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, critically appraised the study quality and extracted data using standardised tools. For each outcome measure results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Main results, Twenty-nine studies met the inclusion criteria, with a total of 4021 participants. The focus of 15 interventions was the supplying of oral supplements to the participants, six focused on enteral nutrition therapy, four interventions made changes to the foods provided as part of the hospital diet, one included the services of an additional staff member and three incorporated the implementation of evidence-based guidelines. Ten meta-analyses were conducted from which the main findings were: significant improvements in weight status and arm muscle circumferences with an oral supplement intervention, P < 0.05. Reviewers' conclusions, The findings of the review support the use of oral supplements to minimise undernutrition in elderly inpatients. The results also emphasise the need for more high-quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level. [source] The Vulnerability of Middle-Aged and Elderly Patients to Hepatitis C Virus Infection in a High-Prevalence Hospital-Based Hemodialysis SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Anil K. Saxena MD Objectives: To determine the relationship between advancing age and the risk of acquiring hepatitis C virus (HCV) infection, through evaluation and statistical comparison of seroprevalence and seroconversion rates in different age groups of patients on long-term hemodialysis (HD). Design: Retrospective cohort study. Setting: Hemodialysis facility of King Fahad Hospital and Tertiary Care Center, Al-Hasa region of the eastern province of Saudi Arabia. Participants: One hundred ninety-eight patients with end-stage renal disease enrolled for long-term HD therapy from September 1995 to September 2000. Measurements: HCV seroprevalence and seroconversion rates. Results: The overall HCV seroprevalence of 43.4% (86/198) and seroconversion rate of 8.6% per year were recorded. Patients aged 55 to 64 had the highest anti-HCV prevalence (55.3% (26/47)) and annual seroconversion rates (11.0%). Those aged 65 to 74 had the next-highest prevalence (48.9% (24/49)) and seroconversion rate (9.7%), and patients aged 15 to 24 had the lowest prevalence (12.5% (1/8)) and seroconversion rate (2.5%) (reference group). Conclusion: Significantly higher annual seroconversion rates in those aged 55 to 64 and 65 to 74 during a shorter dialysis period (35.6 and 32.7 vs 58.0 months), suggest the greater susceptibility of the middle-aged and elderly patients to acquisition of HCV infection than the younger (15,24 years) group. This could be attributed to the combined effect of immunosuppression associated with advancing age, uremia, and undernutrition, but multicenter molecular follow-up studies with larger sample sizes would be needed to corroborate these findings and plan appropriate strategies for these high-risk groups. [source] Growth of functional cranial components in rats submitted to intergenerational undernutritionJOURNAL OF ANATOMY, Issue 2 2006Marķa F. Cesani Abstract The aim of the present study was to discover how intergenerational undernutrition affects the growth of major and minor functional cranial components in two generations of rats. Control animals constituted the parental generation (P). The undernourished generations (F1 and F2) were fed 75% of the control diet. Animals were X-rayed every 10 days from 20 to 100 days of age. The length, width and height of the major (neurocranium and splanchnocranium) and minor (anterior-neural, middle-neural, posterior-neural, otic, respiratory, masticatory and alveolar) cranial components were measured on each radiograph. Volumetric indices were calculated to estimate size variations of these components. Data were processed using the Kruskal,Wallis and Kolmogorov,Smirnov tests for two samples. Impairment in splanchnocranial and neurocranial growth was found, the latter being more affected than the former in F1. Comparison between F2 and F1 animals showed cumulative effects of undernutrition in both major and minor components (anterior-neural, respiratory, masticatory and alveolar in males, and middle-neural and respiratory in females). Such differential effects on minor components may reflect a residual mechanical strain resulting from the linkage between components. This phenomenon was clearly observed in the neurocranium and could be understood as an adaptive response to the demands of the associated functional matrices. [source] Protein Undernutrition-Induced Bone Loss Is Associated with Decreased IGF-I Levels and Estrogen DeficiencyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2000Patrick Ammann M.D. Abstract Protein undernutrition is a known factor in the pathogenesis of osteoporotic fracture in the elderly, but the mechanisms of bone loss resulting from this deficiency are still poorly understood. We investigated the effects of four isocaloric diets with varying levels of protein content (15, 7.5, 5, and 2.5% casein) on areal bone mineral density (BMD), bone ultimate strength, histomorphometry, biochemical markers of bone remodeling, plasma IGF-I, and sex hormone status in adult female rats. After 16 weeks on a 2.5% casein diet, BMD was significantly decreased at skeletal sites containing trabecular or cortical bone. Plasma IGF-I was decreased by 29,34% and no estrus sign in vaginal smear was observed. To investigate the roles of estrogen deficiency and protein undernutrition, the same protocol was used in ovariectomized (OVX) or sham-operated (SHAM) rats, pair-fed isocaloric diets containing either 15 or 2.5% casein. Trabecular BMD was decreased by either manipulation, with effects appearing to be additive. Cortical BMD was decreased only in rats on a low-protein diet. This was accompanied by an increased urinary deoxypyridinoline excretion without any change in osteocalcin levels, suggesting an uncoupling between resorption and formation. Isocaloric protein undernutrition decreased bone mineral mass and strength. This effect might be related to decreased plasma IGF-I and/or estrogen deficiency with a consequent imbalance in bone remodeling. [source] Food Security, Overweight, and Agricultural Research,A View from 2003JOURNAL OF FOOD SCIENCE, Issue 1 2004E. KENNEDY ABSTRACT: Some of the poorest countries of the world are facing an apparent paradox. Food insecurity, undernutrition, and overweight exist side by side within the same country. Indeed, food-insecure households often contain an overweight member. Data from 11 mega-countries (countries with a population of more than 100 million) will be presented to illustrate the magnitude of the problem. These 11 countries represent more than 60% of the world's population. Agriculture is still a dominant industry. The links between food insecurity, nutritional status, and agriculture will be presented. [source] Risk of malnutrition in a sample of acute and long-stay NHS Fife in-patients: an auditJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2008C. H. S. Ruxton Abstract Background, Hospital malnutrition (undernutrition) continues to attract concern. The implementation of standards for food and fluids in Scotland provided the stimulus for an audit of current practices in NHS Fife hospitals in order to provide baseline data with which to evaluate progress. Methods, One hundred and fifty in-patients were recruited from wards likely to yield those with a high risk of malnutrition. Using patient records and anthropometry, data were collected on weight, weight change, body mass index (BMI), mid-upper-arm circumference (MUAC), dietetic referral, therapeutic diets and patients' perceptions of nutritional status. Malnutrition was estimated by comparing BMI, weight change and MUAC with the Malnutrition Universal Screening Tool (MUST) and standards published by the Scottish Intercollegiate Guidelines Network (SIGN). Results, Depending upon the standard used, the minimum risk of malnutrition varied from 14 to 25%. The prevalence was lower than that reported previously, although methods were not directly comparable. Obesity was also evident with 42% of patients having a BMI > 25. Mean weight change from admission to audit was +0.4 kg, with a wide range (,11 kg to +13 kg). Most patients identified as malnourished were referred to the dietitian or given nutritional support. Conclusions, Fewer patients were at risk of malnutrition than expected. However, improving the provision of food and fluids remains a priority in Fife as malnutrition and eating problems can occur across the entire BMI spectrum. [source] Sensitivity of Galanin- and Melanin-Concentrating Hormone-Containing Neurones to Nutritional Status: An Immunohistochemical Study in the Ovariectomized EweJOURNAL OF NEUROENDOCRINOLOGY, Issue 5 2003E. Chaillou Abstract The sensitivities of galanin and melanin-concentrating hormone (MCH) neuronal systems to nutrition are poorly understood in sheep compared to rodents. The aim of this study was to describe the changes in the numbers of galanin and MCH neurones in ovariectomized ewes submitted to different nutritional levels. In the first experiment, ewes were fed ad libitum or food deprived for 24 h. In the second experiment, two groups of ewes were fed at maintenance level (group 100) or undernourished (group 40) for 167 days, after which one-half of each group was killed or refed ad libitum (group 100R and 40R) for 4 days. The MCH neuronal population located in the lateral hypothalamic area was not affected by these nutritional changes. Long-term undernutrition enhanced the number of galanin neurones located in the infundibular nucleus and the dorsal hypothalamic area (DHA), refeeding resulted in an increase of neurones in the DHA and preoptic area, but short-term starvation had no effect on any galanin subpopulations. Our data suggest that the sensitivity of MCH neuronal populations to nutrition in sheep differs from that of rodents. Various populations of galanin-containing neurones differ in sensitivity in ewes subjected to long undernutrition and refeeding but not to short starvation. [source] Long-Term Undernutrition Followed by Short-Term Refeeding Effects on the Corticotropin-Releasing Hormone Containing Neurones in the Paraventricular Nucleus: An Immunohistochemical Study in SheepJOURNAL OF NEUROENDOCRINOLOGY, Issue 4 2002E. Chaillou Abstract The effect of nutritional level on the immunoreactivity of corticotropin-releasing hormone (CRH) in neurones of the hypothalamic paraventricular nucleus was described in sheep, a ruminant, whose feeding strategy differs from that of monogastric species. Two groups of ewes were underfed (40%), or fed at maintenance (100%) for 167 days, after which one-half of each group was killed or ad libitum refed (at least 150% of maintenance) for 4 days before killing. The presence of CRH in the paraventricular nucleus was examined by immunohistochemistry. The number of CRH immunoreactive neurones was increased in underfed ewes, but without modification of the plasma concentration of cortisol, indicating that the rise of CRH was not released in the portal blood nor linked to the pituitary-adrenal axis. Refeeding did not modify significantly the number of CRH immunoreactive neurones in the nucleus although these neurones were increased, only in refed ewes that were previously underfed. These data differ from those for rats and mice where CRH expression is decreased or not modified by underfeeding which could reflect different effects of undernutrition on CRH immunoreactive neurones in monogastric compared to ruminants species. [source] Undernutrition among children in South and South-East AsiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2010Sant-Rayn Pasricha Abstract Undernutrition remains a major public health problem among children living in Asia. Although the burden is maximal among poorer, rural and Indigenous communities, the problem affects the majority in many Asian countries, especially in South Asia. In order to prevent the pervasive consequences of undernutrition, strategies that address this burden are required. Successful implementation of strategies may be limited by the complex aetiology of undernutrition, including the political setting. Rising food insecurity because of climate change, land use for biofuel production and the recent global financial crisis threaten to exacerbate childhood malnutrition. In this review, we describe the burden of undernutrition among Asian children and discuss contributing factors and potential solutions. [source] Review article: anorexia and cachexia in gastrointestinal cancerALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2005J. OCKENGA Summary In patients with gastrointestinal malignancies, i.e. cancers of the stomach, colon, liver, biliary tract or pancreas, progressive undernutrition can be regularly observed during the course of illness. Undernutrition significantly affects the patients' quality of life, morbidity and survival. Pathogenetically, two different causes are relevant in the development of undernutrition in patients with gastrointestinal cancer. One cause is reduced nutritional intake. This condition is referred to as anorexia and can be worsened by the side effects of cancer therapy. The other cause is the release of endogenous transmitters and/or other products of the tumour leading to the cachexia syndrome, which is characterized by loss of body weight, negative nitrogen balance and fatigue. Cancer anorexia and cancer cachexia may have synergistic negative effects in affecting the patients' status. In this review, current nutritional support strategies with respect to different clinically relevant situations are described. An algorithm of the treatment strategies, including dietetic counselling, oral supplements, enteral and parenteral nutritional support is given. One focus is the approach of nutrition-focused patient care, which shows promising results. In addition, the possibilities of pharmacological intervention are discussed. [source] Mainstreaming interventions in the health sector to address maternal and child undernutritionMATERNAL & CHILD NUTRITION, Issue 2008Zulfiqar A. Bhutta [source] Nutrition and HIV/AIDS in infants and children in South Africa: implications for food-based dietary guidelinesMATERNAL & CHILD NUTRITION, Issue 4 2007Michael K. Hendricks Abstract The implications for food-based dietary guidelines (FBDGs) that are being developed in South Africa are reviewed in relation to HIV-exposed and -infected children. The nutritional consequences of HIV infection and nutritional requirements along with programmes and guidelines to address undernutrition and micronutrient deficiency in these children are also investigated. Based on studies for HIV-infected children in South Africa, more than 50% are underweight and stunted, while more than 60% have multiple micronutrient deficiencies. Nutritional problems in these children are currently addressed through the Prevention-of-Mother-to-Child Transmission Programme (PMTCT), the Integrated Nutrition Programme and Guidelines for the Management of HIV-infected Children which include antiretroviral (ARV) therapy in South Africa. Evaluations relating to the implementation of these programmes and guidelines have not been conducted nationally, although certain studies show that coverage of the PMTCT and the ARV therapy programmes was low. FBDGs for infants and young children could complement and strengthen the implementation of these programmes and guidelines. However, FBDGs must be in line with national and international guidelines and address key nutritional issues in these infants and young children. These issues and various recommendations are discussed in detail in this review. [source] Undernutrition and housebound older peopleNUTRITION & DIETETICS, Issue 4 2009Renuka VISVANATHAN Abstract Aim:, This paper outlines approaches to dealing with undernutrition in the older person. Method:, A series of case studies is presented to expose principles of practice for management of undernutrition in the older person. Results:, Screening is a necessary first step. A more in-depth assessment of those at-risk may reveal contributory factors that if addressed, would result in better nutritional health outcomes. Preservation of muscle mass through adequate caloric and protein intake and exercise is important. Nutritional supplementation has been shown to reduce mortality risk and improve weight. A daily multivitamin may offer some benefit. Weight loss is also seen commonly in older people with dementia. There is a need to understand why this occurs as this could guide management strategies. There is also a need to consider conservative management when dysphagia occurs in the later stages of dementia. Percutaneous endoscopic gastrostomy feeding may not necessarily have that much to offer. Conclusion:, In older people, the prevalence of undernutrition increases with increasing frailty. If not treated, undernutrition is costly both to the individual and society. [source] Fetal programming: link between early nutrition, DNA methylation, and complex diseasesNUTRITION REVIEWS, Issue 2 2010Agata Chmurzynska Complex traits, including those involved in diet-related diseases, are determined by multiple genes and environmental influences. Factors influencing the development of complex traits should be expanded to include epigenetic factors, such as DNA methylation, which occurs in utero. Epigenetic factors regulate gene expression and thereby cell differentiation and organogenesis. The process of epigenotype establishment is sensitive to environmental conditions, with nutrition being one of the most important related factors. For example, DNA methylation depends on the availability of several nutrients including methionine and vitamins B6, B12, and folate. Epidemiological studies show that undernutrition during fetal life is associated with increased susceptibility to complex diseases. Numerous studies have been conducted on prenatal caloric and protein undernutrition. A reduction in the number of cells and changes in the structure and functioning of organs, as well as permanent changes in DNA methylation and gene expression, have been considered the molecular mechanisms responsible for metabolism programming. [source] Malnutrition as an enteric infectious disease with long-term effects on child developmentNUTRITION REVIEWS, Issue 9 2008Richard L Guerrant Malnutrition is a major contributor to mortality and is increasingly recognized as a cause of potentially lifelong functional disability. Yet, a rate-limiting step in achieving normal nutrition may be impaired absorptive function due to multiple repeated enteric infections. This is especially problematic in children whose diets are marginal. In malnourished individuals, the infections are even more devastating. This review documents the evidence that intestinal infections lead to malnutrition and that malnutrition worsens intestinal infections. The clinical data presented here derive largely from long-term cohort studies that are supported by controlled animal studies. Also reviewed are the mechanisms by which enteric infections lead to undernutrition and by which malnutrition worsens enteric infections, with implications for potential novel interventions. Further intervention studies are needed to document the relevance of these mechanisms and, most importantly, to interrupt the vicious diarrhea-malnutrition cycle so children may develop their full potential. [source] The Link Between Childhood Undernutrition and Risk of Chronic Diseases in Adulthood: A Case Study of BrazilNUTRITION REVIEWS, Issue 5 2003Ana L. Sawaya PhD Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with under-nourished children. This review summarizes data from Brazil - a developing country undergoing the nutrition transition - suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include longterm effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment. [source] | ||||||||||||||||||||||||||||||||||