营养不良性肺水肿大鼠肺泡液体清除机制的研究

目的探讨营养不良性肺水肿大鼠肺泡液体清除功能的变化及其机制。方法制备营养不良性肺水肿大鼠动物模型,分别于48h和120h测定大鼠肺泡液体清除率（AFC）、总肺水量（TLW）和肺血管外水量（EVLW）。将钠通道阻断剂氨氯毗眯、Na-K-ATP酶阻断剂畦巴因及β2受体激动剂特布他林分别灌注到正常及禁食120h大鼠的肺泡腔内,测定AFC的变化。结果大鼠禁食48hAFC（19．7±3．22％）与正常大鼠AFC（18．5±2．21％）比较没有明显变化;120h时AFC（9．50±2．19％）明显降低。氨氯吡咪、哇巴因明显降低营养不良性肺水肿大鼠AFC（P＜0．05）,特布他林对营养不良性肺水肿大鼠AFC的作用与对照组大鼠比较差异无显著性（P＞0．05）。结论营养不良性肺水肿与钠通道及Na-K-ATP酶及的活性被抑制,导致肺泡液体清除能力降低有关。     

先天性心脏病患儿术前营养不良的危险因素分析及其对术后临床结局、免疫功能和生存质量的影响

摘要 目的：分析先天性心脏病（CHD）患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。方法：选取2020年1月-2022年6月期间江苏省人民医院收治的65例CHD患儿,采用世界卫生组织（WHO）推荐的美国国家卫生统计中心制订的相关营养诊断标准评估CHD患儿的营养情况,统计CHD患儿术前营养不良发生率,采用单因素和多因素Logistic回归分析CHD患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。结果：本次研究入选的患儿中,有31例出现术前营养不良,34例无营养不良。根据患儿的营养状况将患儿分为营养不良组（n=31）和非营养不良组（n=34）。多因素Logistic回归分析结果显示：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,母亲主动获取疾病知识则是其保护因素（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）,营养不良组的住院时间长于非营养不良组,住院费高于非营养不良组（P<0.05）。两组术后3个月CD3⁺、CD4⁺、CD4⁺/CD8⁺升高,CD8⁺下降,且非营养不良组的改善效果优于营养不良组（P<0.05）。两组术后3个月术前沟通问题、心脏问题和症状、治疗焦虑、感知身体外貌、认知心理问题评分均升高,且非营养不良组的改善效果均优于营养不良组（P<0.05）。结论：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,而母亲主动获取疾病知识是CHD患儿术前营养不良的保护因素。术前营养不良会导致CHD患儿术后免疫功能下降,生存质量降低,临床结局相对偏差。     

Malnutrition is Common and Increases the Risk of Adverse Medical Events in Older Adults With Femoral Fragility Fractures

BackgroundFemoral fragility fractures are one of the most common injuries managed by orthopedic surgeons. Malnutrition influences the poor outcomes observed in this population. Our purpose was to assess the annual trends of malnutrition diagnosis and determine risk factors for malnutrition and complications in patients 65 years and older presenting with femoral fragility fractures. We hypothesized that malnutrition would increase the risk of postoperative wound infection, wound dehiscence, non-union, and mortality.MethodsThe PearlDiver database was reviewed from 2010 to 2020. Patients ≥ 65-years-old with femur fractures treated with operative fixation were identified by CPT code. A preoperative diagnosis of malnourished state was defined by ICD-9 and ICD-10 codes and patients were divided into malnourished and non-malnourished cohorts. Patients were tracked for one year following operative fixation of a femoral fragility fracture for the occurrence of infection, wound dehiscence, nonunion and mortality. The rates of these complications were compared between malnourished and nonmalnourished cohorts.ResultsThere were 178,283 total femoral fragility fractures identified in patients aged 65-years or older. The overall prevalence of malnutrition diagnosis in this geriatric population was 12.8%. Documented malnutrition in femoral fragility fractures increased from 1.6% to 32.9% from 2010-2020 (P<0.0001). Compared to patients without malnutrition, patients with malnutrition are at increased risk of mortality (OR 1.31, 95% CI 1.2558 – 1.3752, p < 0.0001), are more likely to develop a wound infection (OR 1.49; 95% CI 1.252 – 1.7626; p < 0.0001), more likely to have a wound dehiscence (OR 1.55; 95% CI 1.3416 – 1.7949; p < 0.0001), and more likely to develop non-union (1.89; 95% CI 1.6946 – 2.1095; p < 0.0001). Multiple demographic variables were associated with malnutrition diagnosis including higher age, higher Charlson Comorbidity Index, female sex, dementia, and institutionalization. Parkinson’s disease, feeding difficulty and institutionalization demographic variables had the highest risk of malnutrition.ConclusionThe current study found that malnutrition diagnosis significantly increases the risk of adverse medical events in elderly adults with femoral fragility fractures. The rates of malnutrition increased steadily from 2010-2020. This trend is likely a result of increased awareness and testing for malnutrition, not reflecting an actual increased prevalence of malnutrition. Multiple expected demographic variables are associated with diagnosis of malnutrition. Level of Evidence: III     

Obesity and Malnutrition in a Shantytown Population in the City of São Paulo,Brazil

To investigate the prevalence of obesity and malnutrition in the poor Brazilian population we conducted a survey on the socioeconomic and nutritional status of 535 families (comprising 2 411 individuals) living in shanty towns in the city of São Paulo. There was a 30% prevalence of malnutrition in the children, with chronic malnutrition as the most predominant problem. The prevalence of obesity was 6.4% in boys and 8.7% in girls. Overweight and obesity associated with stunting was found in 5.8% of boys and 6.8% girls. Adolescents showed a higher prevalence of malnutrition when weight-for-age distribution was used (boys 46.4%, girls 40.2%), but a right deviation in the distribution was observed with an increase in obesity and a decrease of malnutrition was observed (obesity was 21% in girls and 8.8% in boys; malnutrition was 15.5% in boys and 12.6% in girls) when the weight-for-height adjustment was made. Stunting was the most predominant type of malnutrition in both sexes. Obesity associated with stunting was more common than obesity without stunting, both in younger children and adolescents. Adults had a higher prevalence of obesity than malnutrition according to both the Metropolitan Life Insurance tables (1.7% of undernutrition, 16.7% of overweight, and 14.1% of obesity) and Body Mass Index (8.5% of undernutrition, 21.9% of overweight, and 14.6% of obesity). There was an increase in the percentage of obese children when at least one adult in the family was obese and an increased percentage of malnourished children when undernourished adults were present in the family. Obesity among the adults of the family decreased the occurrence of malnutrition among the children. In 9% of families there was a coexistence of obesity in the adults and malnutrition in the children. These results demonstrate a coexistence of malnutrition and obesity in poor urban Brazilian communities.     

Nutrition,general health status and oral health status in hospitalised elders

Biological malnutrition was assessed and correlated with salivary flow rates and oral health in 99 elderly, hospitalised non-psychiatric patients. The indicators of protein malnutrition used were arm circumference and serum albumin level and the indicators of energy malnutrition the body mass-index and the triceps skin-fold thickness. Unstimulated and stimulated salivary flow rates were measured according to Sreebny et al.¹. Of the patients, 40% showed severely and 46% moderately reduced serum albumin levels and the anthropometric measurements indicated malnutrition in about 50%. Unstimulated hyposialia ( 0.1 ml/min) and stimulated hyposialia ( 0.5 ml/min) were observed in 17% and 26.5%, respectively. Significant associations (P 0.05) were found between stimulated / unstimulated hyposialia and biological malnutrition. There was a negative relationship between the number of masticatory movements until swallowing a standard biscuit and skin fold thickness (P 0.05). Current weight loss and biological malnutrition were related to poor appetite (P 0.05). The study has confirmed poor general and oral health status as well as protein-energy malnutrition among elderly hospitalised patients. This situation was associated with loss of appetite, reduced salivary flow rates and a certain impairment of masticatory function which could jeopardise the reversibility of malnutrition and lead to increased morbidity and mortality.     

稳定期慢性阻塞性肺疾病患者营养不良与甲状腺激素、肺功能及血清IL-6、IL-18的关系研究

目的:观察稳定期慢性阻塞性肺疾病(COPD)患者营养不良与甲状腺激素、肺功能及血清白细胞介素(IL)-6、IL-18的关系。方法:选择2019年1月~2020年12月我院收治的稳定期COPD患者76例作为研究对象。根据患者的微型营养评定(MNA)评分将其分为营养不良组(n=31)和非营养不良组(n=45),比较两组患者的人口学资料、疾病相关因素,甲状腺激素[三碘甲状腺原氨酸(T3)、甲状腺激素(T4)、促甲状腺激素(TSH)]水平,肺功能[第1秒用力呼气量占预测值百分比(FEV1%pred)、第1秒用力呼气量与用力肺活量比值(FEV1/FVC)],血清IL-6、IL-18水平。分析MNA评分与甲状腺激素水平、肺功能及血清IL-6、IL-18水平的相关性。分析患者发生营养不良的危险因素。结果:营养不良组年龄高于非营养不良组(P<0.05)。营养不良组T3、T4、TSH、FEV1%pred、FEV1/FVC显著低于非营养不良组,血清IL-6、IL-18水平显著高于非营养不良组(P<0.05)。稳定期COPD患者的MNA评分与T3、T4、TSH、FEV1%pred、FEV1/FVC呈正相关,与IL-6、IL-18呈负相关(P<0.05)。多因素Logistic回归分析显示,年龄>60岁、T3≤1.60 nmol/L、T4≤73.00 nmol/L、TSH≤1.50 nmol/L、FEV1%pred≤60.00%、FEV1/FVC≤0.54、IL-6≥8.00 pg/mL、IL-18≥47.00 pg/mL是稳定期COPD患者营养不良的危险因素(P<0.05)。结论:稳定期COPD患者营养不良受多种因素影响,临床应针对相关因素给予有效干预,降低此类患者营养不良风险。     

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

INTRODUCTION: In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children''s nutritional status in rural south India. METHODS: A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital''s list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. RESULTS: Poor nutritional status was associated with socioeconomic variables such as sex of the child and father''s occupation. Female gender (OR = 3.44, p = .02) and father''s occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles. DISCUSSION: The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father''s occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.     

帕金森病患者营养不良的影响因素分析及与衰弱、认知功能和跌倒风险的关系研究

摘要 目的：分析帕金森病（PD）患者营养不良的影响因素,并观察营养不良对衰弱、认知功能和跌倒风险的影响。方法：选取江苏省人民医院2019年3月至2022年3月期间收治的100例PD患者。采用简易营养评价量表（MNA）对研究对象进行营养状态评估,将100例患者分为营养不良组（n=52）和无营养不良组（n=48）。获取所有患者的一般资料,经Logistic回归分析PD患者营养不良的影响因素。同时对比无营养不良组、营养不良组的衰弱、认知功能和跌倒风险情况。结果：PD患者营养不良与年龄、体质量指数、Hoehn-Yahr分级、居住地、婚姻状况、血红蛋白、白蛋白、前白蛋白、每日左旋多巴等效剂量（LEDDs）、睡眠状况、焦虑状况、抑郁状况、味觉障碍、吞咽障碍、食欲下降有关（P<0.05）。Logistic回归分析,结果显示：年龄偏大、Hoehn-Yahr分级为III~V级、睡眠状况偏差、焦虑/抑郁状况严重、味觉障碍、吞咽障碍、食欲下降、LEDDs偏高是PD患者出现营养不良的危险因素（P<0.05）。营养不良组的衰弱发生率高于无营养不良组,衰弱前期、无衰弱发生率低于无营养不良组（P<0.05）。营养不良组的简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MOCA）评分低于无营养不良组（P<0.05）。营养不良组的起立-行走计时测验（TUGT）时间、站起测验（CRT）时间长于无营养不良组,走直线步态测验（TGT）正确步数少于无营养不良组（P<0.05）。结论：PD患者营养不良发生风险较高,且受到年龄、睡眠状况、焦虑状况、抑郁状况、Hoehn-Yahr分级、味觉障碍、吞咽障碍、食欲下降、LEDDs的影响,且营养不良可加重衰弱、降低认知功能和增加跌倒风险。     

The multiple trauma victim: a nutritional cripple

Major trauma often precipitates major malnutrition. In many patients, this malnutrition underlies the morbidity and mortality associated with major injury, often leading to multiple organ failure and refractory sepsis. The clinical challenge is to anticipate these potential nutritional problems and intervene early and appropriately, recognizing that it is far easier to prevent malnutrition than it is to reverse it.     

Household and community socioeconomic influences on early childhood malnutrition in Africa

This paper uses multilevel modelling and Demographic and Health Survey data from five African countries to investigate the relative contributions of compositional and contextual effects of socioeconomic status and place of residence in perpetuating differences in the prevalence of malnutrition among children in Africa. It finds that community clustering of childhood malnutrition is accounted for by contextual effects over and above likely compositional effects, that urban-rural differentials are mainly explained by the socioeconomic status of communities and households, that childhood malnutrition occurs more frequently among children from poorer households and/or poorer communities and that living in deprived communities has an independent effect in some instances. This study also reveals that socioeconomic inequalities in childhood malnutrition are more pronounced in urban centres than in rural areas.     

Validez de la valoración subjetiva global como método de despistaje de desnutrición hospitalaria. Prevalencia de desnutrición en un hospital terciario

IntroductionHospital malnutrition is a highly prevalent problem that affects patient morbidity and mortality resulting in longer hospital stays and increased healthcare costs. Although there is no single nutritional screening method, subjective global assessment (SGA) may be a useful, inexpensive, and easily reproducible tool.MethodsA cross-sectional, observational, randomized study was conducted in 197 patients in a tertiary hospital. SGA, anthropometric data, and biochemical parameters were used to assess the nutritional status of study patients.ResultsFifty percent of subjects were malnourished according to SGA. A higher prevalence of malnutrition was found in medical (53%) as compared to surgical departments (47%). Half the subjects (50%) had malnutrition by SGA, but only 37.8% received nutritional treatment during their hospital stay. Mean hospital stay was longer for patients malnourished (13.5 days) or at risk of malnutrition (12.1 days) as compared to well nourished subjects (6.97 days). SGA significantly correlated (P < .012) with anthropometric and biochemical malnutrition parameters.ConclusionsPrevalence of hospital malnutrition is very high in both medical and surgical departments and is inadequately treated. SGA is a useful tool for screening hospital malnutrition because of its high degree of correlation with anthropometric and biochemical parameters.     

Post-weaning protein malnutrition increases blood pressure and induces endothelial dysfunctions in rats

Malnutrition during critical periods in early life may increase the subsequent risk of hypertension and metabolic diseases in adulthood, but the underlying mechanisms are still unclear. We aimed to evaluate the effects of post-weaning protein malnutrition on blood pressure and vascular reactivity in aortic rings (conductance artery) and isolated-perfused tail arteries (resistance artery) from control (fed with Labina®) and post-weaning protein malnutrition rats (offspring that received a diet with low protein content for three months). Systolic and diastolic blood pressure and heart rate increased in the post-weaning protein malnutrition rats. In the aortic rings, reactivity to phenylephrine (10⁻¹⁰–3.10⁻⁴ M) was similar in both groups. Endothelium removal or L-NAME (10⁻⁴ M) incubation increased the response to phenylephrine, but the L-NAME effect was greater in the aortic rings from the post-weaning protein malnutrition rats. The protein expression of the endothelial nitric oxide isoform increased in the aortic rings from the post-weaning protein malnutrition rats. Incubation with apocynin (0.3 mM) reduced the response to phenylephrine in both groups, but this effect was higher in the post-weaning protein malnutrition rats, suggesting an increase of superoxide anion release. In the tail artery of the post-weaning protein malnutrition rats, the vascular reactivity to phenylephrine (0.001–300 µg) and the relaxation to acetylcholine (10⁻¹⁰–10⁻³ M) were increased. Post-weaning protein malnutrition increases blood pressure and induces vascular dysfunction. Although the vascular reactivity in the aortic rings did not change, an increase in superoxide anion and nitric oxide was observed in the post-weaning protein malnutrition rats. However, in the resistance arteries, the increased vascular reactivity may be a potential mechanism underlying the increased blood pressure observed in this model.     

Enhanced susceptibility to seizures modulated by high interleukin‐1β levels during early life malnutrition

Early malnutrition in life has permanent consequences on brain development and has been suggested to influence seizure susceptibility. Despite malnutrition is not a direct cause of seizures, we hypothesize that malnutrition may modulate inflammatory response and result in cerebral vulnerability to seizures. In this study, we provide evidence that malnutrition may increase susceptibility to seizures in the postnatal period by interleukin‐1β (IL‐1β) in the hippocampus. Malnourished rats were maintained on a nutritional deprivation regimen from postnatal day 1 (P1) to P10. From P7 to P10, the threshold to seizures induced by flurothyl was used as an index of seizure susceptibility. ELISA and western blot was performed to evaluate levels of IL‐1β, IL‐1R1, PSD‐95 and synapsin. The role of inflammation in the changes of seizure threshold was studied with inhibitors of IL‐1β and IL‐1R1. A significant decrease in body weight and seizure threshold was observed in postnatal malnourished rats. Early malnutrition modulates inflammation by high levels of IL‐1β in hippocampus and in serum. Furthermore, our malnutrition paradigm induced an increase in corticosterone levels. Injection of IL‐1β and IL‐1R1 inhibitors before seizure induction augments seizure threshold in malnourished rats similar to nourished group. Malnutrition did not change PSD‐95 and synapsin expression in the hippocampus. We suggest that malnutrition‐induced inflammation might contribute to seizure susceptibility in the postnatal period. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 76: 1150–1159, 2016     

老年心力衰竭患者营养不良的影响因素分析及早期肠内营养对营养不良患者心功能、营养状况和肠道黏膜屏障功能的影响

摘要 目的：探讨老年心力衰竭（HF）患者营养不良的影响因素及早期肠内营养对营养不良患者心功能、营养状况和肠道黏膜屏障功能的影响。方法：选取2021年2月~2022年4月期间在我院接受治疗的180例老年HF患者作为研究对象。入院后采用微型营养评价简表（MNA-SF）评估患者的营养状况。根据MNA-SF评分结果分为营养不良组（n=83）和营养正常组（n=97）。应用单因素及多因素Logistic回归分析老年HF患者营养不良的危险因素。对老年HF营养不良患者给予早期肠内营养干预,观察其治疗前、治疗一周后心功能、营养状况和肠道黏膜屏障功能的变化情况。结果：老年HF患者营养不良与性别、居住地、饮酒史、病因、职业类别、谷丙转氨酶、血肌酐、收缩压（SBP）、舒张压（DBP）无关（P>0.05）,而与年龄、医保类型、病程、婚姻状况、美国纽约心脏病学会（NYHA）分级、文化程度、C反应蛋白（CRP）、家庭人均月收入、B型脑钠肽（BNP）、吸烟史、左心室射血分数（LVEF）有关（P<0.05）。Logistic回归分析结果显示：病程偏长、CRP偏高、BNP偏高、NYHA分级为IV级、年龄偏大、吸烟史是老年HF患者发生营养不良的危险因素（P<0.05）。治疗1周后,营养不良组老年HF患者的LVEF升高,BNP下降（P<0.05）。治疗1周后,营养不良组老年HF患者的前白蛋白（PA）、转铁蛋白（TRF）升高（P<0.05）。治疗1周后,营养不良组老年HF患者的D-乳酸（D-Lac）、二胺氧化酶（DAO）、肠脂肪酸结合蛋白（IFABP）下降（P<0.05）。结论：老年HF患者营养不良受到病程、CRP、BNP、NYHA分级、年龄、吸烟史等多种因素的影响,针对老年HF患者营养不良给予早期肠内营养,有助于改善患者心功能、营养状况和肠道黏膜屏障功能。     

Nutritional Supplementation Is a Necessary Complement to Dietary Counseling among Tuberculosis and Tuberculosis-HIV Patients

The Brazilian Ministry of Health and the World Health Organization recommend dietary counseling for patients with malnutrition during tuberculosis treatment. Patients under tuberculosis therapy (infected and not infected with HIV) were followed-up to evaluate the effectiveness of dietary counseling. Objective: describe the nutritional status of patients with tuberculosis. Methods: an observational follow-up study over a 180-day period of tuberculosis therapy in adults was conducted. Subjects were assessed for body composition (using BMI, TSF and MUAC parameters), serum biomarkers and offered dietary counseling. The data obtained at each visit (D15, D30, D60, D90, D120, D150, and D180) were analyzed, showing trajectories over time and central tendencies each time. Results: at baseline, the mean age was 41.1 (±13.4) years; they were predominantly male, with income lower than a local minimum wage and at least six years of schooling. Patients showed predominantly pulmonary tuberculosis. At baseline, all patients suffered from malnutrition. The overall energy malnutrition prevalence was of 70.6%. Anemia at baseline was observed in both groups (63.2%), however, it was significantly more pronounced in the HIV+. At the end, energy malnutrition was reduced to 57.1% (42.9% of HIV- and 71.4% of the HIV+). Micronutrients malnutrition was evident in 71.4% of the HIV- patients and 85.7% of HIV+ patients at the end of tuberculosis therapy. Using BMI (≤18.5 kg/m²cutoff) as an index of malnutrition, it was detected in 23.9% of the HIV- and 27.3% of the HIV+ patients at baseline, with no evident improvement over time; using TSF (≤11.4mm as cutoff) or MUAC (≤28.5cm as cutoff), malnutrition was detected in 70.1% and 85.3% of all patients, respectively. Nevertheless, combining all biomarkers, at the end of follow-up, all patients suffered from malnutrition. Conclusion: Although with a limited number of patients, the evidence does not support that dietary counseling is effective to recover from malnutrition in our population.     

Phosphorylated ATM and H2AX in T and B lymphocytes from rats with moderate and severe malnutrition

Protein calorie malnutrition (PCM) occurs when insufficient nutrients are consumed to satisfy the biological needs of an organism. The literature supports the relationship between malnutrition and DNA damage, and among the injuries to genetic material, DNA double-strand breaks (DSBs) are the most dangerous. This study aimed to determine whether the ability of splenic and peripheral blood T and B lymphocytes from nursing rats to recognize DSB-induced DNA damage is affected by PCM. Wistar strain rats were used, and experimental malnutrition was induced by creating food competition during lactation by increasing the number of offspring per wet nurse. Due to its high specificity, the phosphorylated H2AX variant histone assay associated with pATM (Ser1981) combined with flow cytometry was herein used to demonstrate the impact of malnutrition on the DNA damage response. Flow cytometry data indicated that splenic T and B lymphocytes from rats with severe PCM have the capacity to detect genetic material damage, as shown by an increased number of pATM + cells and altered signaling pathway continuity. Collectively, these data suggest that severe malnutrition compromises the continuity of the DNA damage response.     

Effects of protein malnutrition on hematopoietic regulatory activity of bone marrow mesenchymal stem cells

Protein malnutrition causes anemia and leukopenia as it reduces hematopoietic precursors and impairs the production of mediators that regulate hematopoiesis. Hematopoiesis occurs in distinct bone marrow niches that modulate the processes of differentiation, proliferation and self-renewal of hematopoietic stem cells (HSCs). Mesenchymal stem cells (MSCs) contribute to the biochemical composition of bone marrow niches by the secretion of several growth factors and cytokines, and they play an important role in the regulation of HSCs and hematopoietic progenitors. In this study, we investigated the effect of protein malnutrition on the hematopoietic regulatory function of MSCs. C57BL/6NTaq mice were divided into control and protein malnutrition groups, which received, respectively, a normal protein diet (12% casein) and a low protein diet (2% casein). The results showed that protein malnutrition altered the synthesis of SCF, TFG-β, Angpt-1, CXCL-12, and G-CSF by MSCs. Additionally, MSCs from the protein malnutrition group were not able to maintain the lymphoid, granulocytic and megakaryocytic-erythroid differentiation capacity compared to the MSCs of the control group. In this way, the comprehension of the role of MSCs on the regulation of the hematopoietic cells, in protein malnutrition states, is for the first time showed. Therefore, we infer that hematopoietic alterations caused by protein malnutrition are due to multifactorial alterations and, at least in part, the MSCs’ contribution to hematological impairment.     

High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal,West Africa

Background

Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.

Methods

We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.

Results

One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).

Conclusions

Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.     

Prevalence and Characteristics Associated with Malnutrition at Hospitalization among Patients with Acquired Immunodeficiency Syndrome in Brazil

Background

Brazil’s National STD/AIDS Program is considered a model of success worldwide. However, AIDS-associated malnutrition continues in subgroups of Brazilian patients despite access to free highly active antiretroviral therapy (HAART). We aimed to identify the prevalence of malnutrition and associated factors among patients hospitalized with AIDS.

Methods

We conducted a cross-sectional nutritional assessment among 127 adults hospitalized with AIDS in Brazil’s third largest city. Using anthropometric measurements, we determined the prevalence of malnutrition (body mass index <18.5 kg/m2) at hospitalization. Prevalence ratios of malnutrition by demographic, socioeconomic, and clinical conditions were estimated using log-binomial regression.

Results

One-third of participants were first informed of their HIV disease during the current hospitalization and recent treatment interruption was common (71%) among those on HAART. Forty-three percent were malnourished and 35% had severe weight loss at admission. Patient characteristics independently associated with malnutrition were older age (2% increased prevalence for each year; 95% confidence interval [CI] 0–4%) and very low daily per capita household income. Living on <USD 2.00, USD 2.00–4.99 or USD 5.00–9.99 increased the prevalence of malnutrition by 2.01 (95% CI 1.06–3.81), 1.75 (95% CI 0.92–3.35) and 1.42 (95% CI 0.76–2.65) times, respectively, compared to ≥USD 10.00 per day. Chronic diarrhea was marginally associated with malnutrition (RR 1.42; 95% CI 0.99–2.04). Overall, 16% of the patients died during hospitalization. We observed a trend toward higher in-hospital case fatality among malnourished patients (22% vs. 12% for patients with and without malnutrition, respectively; chi square P = 0.14).

Conclusions

Unacceptably high rates of malnutrition persist in Brazilians hospitalized with AIDS and our results reinforce the importance of nutritional evaluations in these patients. Improved early testing and treatment adherence strategies may continue to help reduce AIDS-related morbidity and mortality in Brazil, yet novel interventions to disrupt the cycle of poverty, HIV, and malnutrition are also urgently needed.     

基于控制营养状况评分的2型糖尿病住院患者营养状况评价及其危险因素的多因素Logistic回归分析

摘要 目的：应用控制营养状况（CONUT）评分评价2型糖尿病（T2DM）住院患者营养状况并通过多因素Logistic回归分析营养不良的危险因素。方法：选取2021年1月～2022年1月在我院住院的454例T2DM患者,根据CONUT评分分为营养不良组68例和营养正常组386例。收集患者基线资料,采用多因素Logistic回归分析T2DM住院患者营养不良的危险因素。结果：454例T2DM住院患者营养不良发生率为14.98％（68/454）。单因素分析显示,两组患者糖化血红蛋白A1c（HbA1c）、年龄、高密度脂蛋白胆固醇（HDL-C）、体质指数（BMI）、C反应蛋白（CRP）、病程、淋巴细胞计数、吸烟、血红蛋白、白蛋白、餐后2 h血糖比较,差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示,白蛋白降低、年龄≥60岁、血红蛋白降低、BMI降低、HDL-C降低、病程延长、吸烟、CRP升高为T2DM住院患者营养不良的独立危险因素（P＜0.05）。结论：T2DM住院患者营养不良发生率较高,年龄、BMI、病程、吸烟、白蛋白、血红蛋白、HDL-C、CRP为T2DM住院患者营养不良的独立影响因素,CONUT评分能快速筛查T2DM住院患者营养状况,有助于指导临床及时采取干预措施。