Background and Objectives: In Indonesia, stunting is one of the most public health concerns. This study aims to systematically review and meta-analyze childhood stunting risk factors in the country. Methods and Study Design: We did a systematic review and meta-analysis of observational (cross-sectional and longitudinal) studies on stunting risk factors published between 2010 and 2021 based on available publications in online databases of PubMed, ProQuest, EBSCO, and google scholar. The quality of the publications was evaluated using the Newcastle-Ottawa Quality Assessment Scale and organized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Publication bias was examined using Egger’s and Begg’s tests. Results: A total of 17 studies from the literature search satisfied the inclusion criteria, with 642,596 subjects. The pooled stunting prevalence was 30.9% (95% CI 25.0%-36.8%). Children born with low birth weight (POR 2.39, 2.07–2.76), female (POR 1.05, 1.03-1.08), and did not get the deworming program (1.10, 1.07-1.12) are the primary child characteristics that contributed to stunting. Meanwhile, maternal age ≥ 30 years (POR 2.33, 2.23-2.44), preterm birth (POR 2.12, 2.15-2.19), and antenatal care < 4 times (POR 1.25, 1.11-1.41) were among mother characteristics consistently associated with stunting. The primary household and community risk factors for stunting were food insecurity (POR 2.00, 1.37-2.92), unimproved drinking water (POR 1.42, 1.26-1.60), rural residence (POR 1.31, 1.20-1.42), and unimproved sanitation (POR 1.27, 1.12-1.44). Conclusions: A diverse range of risk factors associated with childhood stunting in Indonesia demonstrates the need to emphasize nutrition programs by scaling up to more on these determinants.
Background and Objectives: Gastrectomy causes vitamin B-12 deficiency since vitamin B-12 requires gastric acid and intrinsic factor for its absorption. Vitamin B-12 deficiency is considered to develop years after gastrectomy because of large hepatic storage. However, most gastric cancer develops after long-standing atrophic gastritis with vitamin B-12 malabsorption. Methods and Study Design: We have investigated vitamin B-12 status in 22 patients before gastrectomy and 53 patients after gastrectomy due to gastric cancer, also with consideration on post-gastrectomy anemia. Results: Blood vitamin B-12, folic acid, homocysteine concentrations, parameters of anemia, and dietary intake were evaluated. Percentage of patients with severe vitamin B-12 deficiency (serum vitamin B-12 < 150 pmol/L), vitamin B-12 deficiency (150 pmol/L to < 258 pmol/L) was 19.0 %, and 52.4 % respectively in patients gastrectomized within three years. Before gastrectomy, three and seven patients exhibited severe deficiency and deficiency, respectively. In gastrectomized patients, plasma homocysteine concentration was inversely associated with serum vitamin B-12 concentration, and vitamin B-12 deficiency- and iron deficiency- anemia coexisted with their mean corpuscular volume within the reference range. Conclusions: Vitamin B-12 deficiency is prevalent in patients early after and before gastrectomy. Coexistence of vitamin B-12 and iron deficiency obscures the diagnosis of post-gastrectomy anemia, and necessitates the blood vitamin B-12 measurement.
Background and Objectives: Home parenteral nutrition (HPN) is a life sustaining therapy for patients with chronic intestinal failure. Reported outcomes for Asian HPN patients are scarce. We aim to review the clinical outcomes of adult and paediatric HPN patients in our cohort which caters for 95% of Singaporean HPN patients. Methods and Study Design: This is a retrospective review of HPN patients from an adult (2002-2017) and paediatric cohort (2011-2017) from the largest tertiary PN centres in Singapore. Patient demographics and clinical outcomes were reviewed. Results: There were 41 adult and 8 paediatric HPN patients. Mean age was 53.0(±15.1) (adults) and 8(±1.8) years-old (paediatrics). Mean duration of HPN was 2.6(±3.5) and 3.5(±2.5) years. Leading indications for adult HPN were short bowel syndrome (SBS) (n=19,46.3%), mechanical obstruction (n=9,22.0%), and gastrointestinal dysmotility disorders (GID) (n=5,12.2%). Thirteen adult (31.7%) patients had underlying malignancy, with seven (17.3%) receiving palliative HPN. Indications for HPN amongst paediatric patients was GID (n=5,62.5%) and SBS (n=3,37.5%). Central line-associated bloodstream infection (CLABSI)/1000catheter-days was 1.0(±2.1) and 1.8(±1.3). Catheter associated venous thrombosis (CAVT)/1000catheter-days was 0.1(±0.4) and 0.7(±0.8). Biochemical Intestinal Failure Associated Liver Disease (IFALD) was found in 21.9% and 87.5%. For adults, median overall survival was 90-months (4.3,175.7,95%CI), with actuarial survival of 70.7%(1-year) and 39.0%(5-years). Median survival for adult patients with malignancy was 6-months (4.2,7.7,95%CI), actuarial survival of 85.7%(3-months) and 30.7%(1-year). One adult patient died from PN related complications. No paediatric deaths were noted. Conclusions: Whilst patient numbers were modest, we report comparable complication and survival rates to other international centres in both our adult and paediatric cohorts.
Background and Objectives: Assessing knowledge, self-efficacy, and practice among a given population using a validated and reliable questionnaire is crucial. The aim of this study was to translate, validate, and test the reliability of the knowledge, self-efficacy, and practice in the Arabic population. Methods and Study Design: A previously published knowledge, self-efficacy, and practice nutrition questionnaire was translated and validated into Arabic. A panel of translation and nutrition experts from Arab countries participated in translation and testing validity. A convenience sampling technique was used to recruit participants across 22 Arab countries. An online self-administered questionnaire was completed twice with an interval of 2 weeks. Tests of validity (face and content) and reliability (consistency and test-retest reliability) were used. Results: A total of 96 participants had a mean age of 21.5 years, 68.7% were female, and 80.2% were students. The mean expert proportional content validity index scale was 0.95, and intra class correlation values ranged from 0.59 to 0.76; all of these values were highly statistically significant at retest. Conclusions: The Arabic version of the questionnaire provided valid and reliable results for assessing knowledge, self-efficacy, and practice among Arab adolescents and young adults. This tool could assess nutritional education programs in a community setting and educational institutions targeting this population in Arab countries.
Background and Objectives: Malnutrition is associated with pulmonary tuberculosis (PTB). The aim of this study is to investigate the association between persistent malnutrition and the effect of PTB treatment. Methods and Study Design: A total of 915 PTB patients were included. Baseline demographic information, anthropometry, and nutritional indicators were measured. The treatment effect was assessed by combinations of clinical manifestations, sputum smear, chest computerized tomography, gastrointestinal symptoms, and the indexes of liver function. Persistent malnutrition was considered when one or more indicators of malnutrition were lower than the reference standards in two tests on admission and after one month of treatment. Clinical symptom score (TB score) was used to assess the clinical manifestations. The generalized estimating equation (GEE) was used to assess the associations. Results: In GEE analyses, patients with underweight had a higher incidence of TB score >3 (OR=2.95; 95% CI, 2.28-3.82) and lung cavitation (OR=1.36; 95% CI, 1.05-1.76). Hypoproteinemia was associated with a higher risk of TB score >3 (OR=2.73; 95% CI, 2.08-3.59) and sputum positive (OR=2.69; 95% CI, 2.08-3.49). Anemia was associated with a higher risk of TB score >3 (OR=1.73; 95% CI, 1.33-2.26), lung cavitation (OR=1.39; 95% CI, 1.19-1.63), and sputum positive (OR=2.23; 95% CI, 1.72-2.88). Lymphocytopenia was associated with a higher risk of gastrointestinal adverse reactions (OR=1.47; 95% CI, 1.17-1.83). Conclusions: Persistent malnutrition within one month of treatment can adversely affect anti-tuberculosis treatment. Nutritional status during anti-tuberculosis treatment should be continuously monitored.
Background and Objectives: To investigate the capacity of clinical nutrition services in secondary and tertiary hospitals in the Sichuan Province, China. Methods and Study Design: Convenience sampling was used. Equestionnaires were distributed to all eligible medical institutions in Sichuan through the official network of provincial and municipal clinical nutrition quality control centers. The data obtained were sorted in Microsoft Excel and analyzed by SPSS. Results: A total of 519 questionnaires were returned, of which 455 were valid. Only 228 hospitals were accessible to clinical nutrition services, of which 127 hospitals had independently set up clinical nutrition departments (CNDs). The ratio of clinical nutritionists to beds was 1:214. During the last decade, the rate of constructing new CNDs was maintained at approximately 5 units/year. A total of 72.4% of hospitals managed their clinical nutrition units as part of their medical technology departments. The specialist number ratio of senior, associate, intermediate and junior is approximately 1:4:8:10. There were 5 common charges for clinical nutrition. Conclusions: The sample representation was limited, and the capacity of clinical nutrition services may have been overestimated. Secondary and tertiary hospitals in Sichuan are currently in the second high tide of department establishment, with a positive trend of departmental affiliation standardization and a basic formation of a talent echelon.
Background and Objectives: Few studies have explored the relationship between overall diet quality and stress load. Therefore, we have evaluated the association between dietary quality and allostatic load (AL) in adults. Methods and Study Design: The data were derived from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). Dietary intake information was obtained by 24-hour dietary recall. The Healthy Eating Index (HEI) 2015 version was estimated as an indicator of dietary quality. The AL was indicative of the accumulated chronic stress load. The weighted logistic regression model was used to explore the relationship between dietary quality and the risk of high AL in adults. Results: A total of 7557 eligible adults older than 18 years were enrolled in this study. After being fully adjusted, we found a significant association between HEI score and the risk of high AL (ORQ2 =0.73, 95% CI: 0.62,0.86; ORQ3 =0.66, 95% CI: 0.55,0.79; ORQ4 =0.56, 95% CI: 0.47,0.67) in logistic regression model. Increased intake of total fruits and whole fruits or decreased intake of sodium, refined grains, saturated fats and added sugars were associated with the risk of high AL (ORtotal fruits =0.93, 95%CI: 0.89,0.96; ORwhole fruits =0.95, 95%CI: 0.91,0.98; ORwhole grains =0.97, 95%CI: 0.94,0.997; ORfatty acid =0.97, 95%CI: 0.95,0.99; ORsodium =0.95, 95%CI: 0.92,0.98; ORrefined grains =0.97, 95%CI: 0.94,0.99; ORsaturated fats =0.96, 95%CI: 0.93,0.98; ORadded sugars =0.98, 95%CI: 0.96,0.99). Conclusions: We found that dietary quality was inversely associated with allostatic load. High dietary quality presumptively less cumulative stress.
Background and Objectives: The effects of muscle meat and vegetable intake on body fat mass remain unclear in the general population. This study aimed to investigate the association of body fat mass and fat distribution with a muscle meat-vegetable intake (MMV) ratio. Methods and Study Design: In total, 29,271 participants aged 18–80 years were recruited from the Shaanxi cohort of the Regional Ethnic Cohort Study in Northwest China. The associations of muscle meat, vegetable and MMV ratio, as the independent variable, with body mass index (BMI), waist circumference, total body fat percentage (TBF) and visceral fat (VF), as dependent variables were evaluated by gender-specific linear regression models. Results: There was 47.9% of men whose MMV ratio was greater than or equal to 1 and this figure was about 35.7% for women. For men, higher muscle meat intake was associated with higher TBF (standardized coefficient [ß], 0.508; 95% CI, 0.187–0.829), higher vegetable intake was associated with lower VF (ß, -0.109; 95% CI, -0.206 – -0.011), and higher MMV ratio was associated with higher BMI (ß, 0.195; 95% CI, 0.039–0.350) and VF (ß, 0.523; 95% CI, 0.209–0.838). For women, both higher muscle meat consumption and MMV ratio were associated with all fat mass markers, but vegetable intake was not correlated with body fat mass markers. The positive association of MMV on body fat mass was more pronounced in higher MMV ratio group, with both men and women. The intake of pork, mutton and beef was associated positively with fat mass markers but no such association was observed for poultry or seafood. Conclusions: An increased intake of muscle meat or a higher MMV ratio was associated with increased body fat, especially among women, and such impact may mainly be attributed to increasing intake of pork, beef and mutton. The dietary MMV ratio could be thus a useful parameter for nutritional intervention.
Background and Objectives: To investigate the association between frailty, malnutrition, comorbid medical conditions and activities of daily living (ADL) in older adult patients with fractures, and to analyse the influential
factors of frailty. Methods and Study Design: The FRAIL scale including five components: fatigue, resistance, ambulation, illness, and loss of weight, was used to evaluate frailty. Participants were divided into frailty, prefrailty and non-frailty groups. The ADL was assessed using the Barthel Index, while the nutrition risk screening tool, NRS-2002, was used to assess the nutritional risk, and the Global Leadership Initiative on Malnutrition diagnostic criteria were used to diagnose the nutritional status. Statistical analysis was performed using univariate and multivariate logistic regression to determine the factors associated with frailty. Results: A total of 166 patients were included in the study, and the incidences of frailty, pre-frailty and non-frailty were 39.2%, 33.1% and 27.7%, respectively. The severe dependence rate (ADL scale of <40) in the frailty, pre-frailty and non-frailty groups was 49.2%, 20.0% and 6.52%, respectively. The prevalence of nutritional risk was 33.7% (56/166), including 56.9% (31/65) in the frailty group and 32.7% (18/55) in the pre-frailty group. Of the 166 patients, 45 (27.1%) were diagnosed with malnutrition, including 47.7% (31/65) in the frailty group and 23.6% (13/55) in the pre-frailty group. Conclusions: Frailty in older adult patients with fractures is widespread, and the prevalence of malnutrition is high. The occurrence of frailty may be related to an advanced age, increased medical comorbidity and impairment in ADL.
Background and Objectives: Cow milk protein allergy (CMPA) can mimic surgical disease, gastroenteritis, sepsis, and necrotizing enterocolitis in the neonatal period. For this reason, we aimed to evaluate the clinical features, differential diagnosis, and treatment methods of neonates with CMPA. Methods and Study Design: The charts of twenty-six breastfed full-term and preterm newborns presenting with CMPA between October 2018 and February 2021 were retrospectively reviewed. The clinical symptoms, laboratory findings, and methods used in diagnosis and treatment were analyzed. Results: CMPA was diagnosed in preterm infants 50% (n=13) at the same rate as in full-term infants 50% (n=13) between 32 to 38 weeks corrected age (median 36 weeks). Among patients with CMPA, 69.2% (n=18) had blood in the stool at the onset. Cow's Milk-related Symptom Score score was found to be significantly higher prior to diagnosis vs. after treatment with the cow milk protein-free mom’s milk diet [12(11-13) vs. 4(3-5), p<0.001]. Seventy-two hours after the commencement of the mothers’ elimination diet, macroscopic blood in stool disappeared in all patients except one patient. Oral food challenge (OFC) for the diagnosis of CMPA was carried out on all (n=26) neonates. Eosinophilia was seen in 46.2% of patients (n=12). The methemoglobin concentration was 1.1 to 1.5% (median 1.3%). Conclusions: CMPA should be kept in mind for well-appearing preterm and full-term infants suspected of necrotizing enterocolitis and gastroenteritis, respectively, presenting with bloody stool and eosinophilia. The use of OFC can be implemented since neonates were very well monitored in the neonatal intensive care unit. Treatment is possible by continuing breastfeeding.
Background and Objectives: Amino acids (AAs) are crucial nutrients and fundamental building blocks of organisms that can be utilized to assess nutritional status and detect diseases. However, insufficient information has been reported on plasma AA in the Eastern Chinese population. Methods and Study Design: 1859 persons who underwent physical examination in our hospital from January to December 2020 were enrolled. Plasma AA levels were determined by ultra-performance liquid chromatography mass spectrometry (UPLC-MS/MS.), and the effects of age and sex on 19 plasma AA profiles were analyzed. The Python language was used for data analysis and graphic visualization. Results: Plasma arginine, proline, threonine, asparagine, phenylalanine, and glycine in males, and plasma lysine, leucine, proline, valine, isoleucine, alanine, tyrosine, phenylalanine, and hydroxyproline levels in females increased with age. The 2-aminobutyric acid and serine levels in both sexes, and isoleucine, valine, leucine, and histidine levels in males decreased with age. Glycine level was higher in females than in males, and other 17 AAs except arginine and aspartate were higher in males than in females. Conclusions: Our study indicated that plasma AA levels can reflect the nutritional status and dietary structure of the population, with high obesity rate and high incidence of chronic diseases in eastern China. Age has certain effects on plasma AA levels, especially compared with sex.