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Special Issue "Malnutrition and Public Health"

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (29 February 2012)

Special Issue Editor

Guest Editor
Dr. Kristina Norman

Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie (einschl. Arbeitsbereich Ernährungsmedizin), Charité Universitätsmedizin, Berlin Campus Charité Mitte Charitéplatz 1, 10117, Berlin
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Interests: disease related malnutrition / Cachexia; nutritional intervention; muscle function; body composition / bioelectrical impedance analysis and -vector analysis

Special Issue Information

Dear Colleagues,

Malnutrition is a one of the major health challenge world wide affecting approximately one in every five adults in developing countries. It accounts for about 50% of childhood mortality and takes particularly severe toll among preschool children. Chronic malnutrition during the first two years of life e.g., results in irreversible harm and is linked to higher rates of morbidity and mortality, impaired cognitive ability and school performance in children and decreased productivity and lifetime earnings for adults, thus contributing to the devastating cycle of starvation and poverty.

In developed countries, malnutrition is predominantly associated with disease. It affects morbidity and mortality in acute as well as chronic disease and quality of life is seriously impaired in malnourished patients. Despite current data showing that approximately 25% of hospital patients are malnourished to some extent, awareness of the problem remains low and nutritional status frequently worsens during hospital stay. In the elderly, the problem is augmented, as older patients do not have the same restorative capacity after weight loss as younger adults.

This special issue focuses on the various effects of malnutrition on people in developing as well as developed countries and its implications for economic and health care systems.

Dr. Kristina Norman
Guest Editor

Keywords

  • disease related/hospital malnutrition
  • micronutrient malnutrition/Hidden hunger
  • childhood malnutrition
  • impact on cognitive development
  • impact on quality of life
  • socioeconomic/financial implications
  • morbidity
  • mortality

Published Papers (17 papers)

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Research

Jump to: Review

Open AccessArticle Prevalence and Risk Factors for Poor Nutritional Status among Children in the Kilimanjaro Region of Tanzania
Int. J. Environ. Res. Public Health 2012, 9(10), 3506-3518; doi:10.3390/ijerph9103506
Received: 18 June 2012 / Revised: 27 August 2012 / Accepted: 7 September 2012 / Published: 5 October 2012
Cited by 15 | PDF Full-text (154 KB) | HTML Full-text | XML Full-text
Abstract
The current study investigated the prevalence and risk factors for poor nutritional status among children less than 36 months of age in the Kilimanjaro region of Tanzania. Using a cross sectional study design, children and their caregivers were recruited into the study. Anthropometric
[...] Read more.
The current study investigated the prevalence and risk factors for poor nutritional status among children less than 36 months of age in the Kilimanjaro region of Tanzania. Using a cross sectional study design, children and their caregivers were recruited into the study. Anthropometric measures were taken based on established protocol while a standard questionnaire was utilized to collect socio-demographic data. A finger-prick blood sample was collected from all the children and haemoglobin (Hb) concentration analyzed using a HemoCue photometer (HemoCue AB, Angelholm, Sweden). Four hundred and twenty three (423) children (214 females) took part in this study. Participating children were aged between 1–35 months (mean = 13.04, SD = 7.70). We observed high rates of stunting (44.2%) and underweight (19.1%). Nearly 70% (n = 295) of the sample was anaemic (Hb < 11 g/dL). In a multivariate logistic regression model concerns on child growth, maternal education, and child’s age were found to independently predict stunting; whereas concerns over child’s growth and development, and distance to water source were found to uniquely predict being underweight. Maternal education was the only factor related to the child’s anaemia. The current study further emphasizes the need to implement context relevant interventions to combat malnutrition in this region of Tanzania and other similar settings. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Child Acute Malnutrition and Mortality in Populations Affected by Displacement in the Horn of Africa, 1997–2009
Int. J. Environ. Res. Public Health 2012, 9(3), 791-806; doi:10.3390/ijerph9030791
Received: 19 January 2012 / Revised: 23 February 2012 / Accepted: 28 February 2012 / Published: 6 March 2012
Cited by 7 | PDF Full-text (595 KB) | XML Full-text
Abstract
Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected
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Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997–2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < −2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997–2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20–25% GAM in pastoral populations and 10–15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Nutritional Rehabilitation of HIV-Exposed Infants in Malawi: Results from the Drug Resources Enhancement Against AIDS and Malnutrition Program
Int. J. Environ. Res. Public Health 2012, 9(2), 421-434; doi:10.3390/ijerph9020421
Received: 19 October 2011 / Revised: 7 January 2012 / Accepted: 11 January 2012 / Published: 30 January 2012
Cited by 4 | PDF Full-text (340 KB) | HTML Full-text | XML Full-text
Abstract
Infant malnutrition in sub-Saharan Africa is a public health priority and a challenge in high HIV prevalence areas. The Drug Resources Enhancement Against AIDS and Malnutrition program, with multiple medical centers in Sub-Saharan Africa, developed an innovative intervention for the surveillance and control
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Infant malnutrition in sub-Saharan Africa is a public health priority and a challenge in high HIV prevalence areas. The Drug Resources Enhancement Against AIDS and Malnutrition program, with multiple medical centers in Sub-Saharan Africa, developed an innovative intervention for the surveillance and control of malnutrition. In a pilot initiative, 36 HIV-exposed children were evaluated at baseline upon presentation for malnutrition and at six months post- treatment. Parameters included HIV-free survival, nutritional status and change in diet. Food diary data was entered and processed using the Nutrisurvey (WHO) software. At 6 months post-intervention, a significant improvement in anthropometric parameters was noted. Slowing of linear growth was observed in patients with malaria with a mean gain in centimetres of 4.4 ± 1.7 as compared to 5.6 ± 1.7 in children with no malaria, p < 0.048 (CL 95%: −2.32, −0.01). Dietary diversity scores increased from 5.3 ± 1.9 to 6.5 ± 1.3, p < 0.01 at 6 months. A significant increase (+25%, p < 0.02) in the number of children eating fish meals was noted. Our pilot data describes positive outcomes from a rehabilitative nutritional approach based on use of local foods, peer education, anthropometric and clinical monitoring in areas of high food insecurity. The relationship between malaria and linear growth retardation requires further investigation. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Changes in Physical Fitness, Bone Mineral Density and Body Composition During Inpatient Treatment of Underweight and Normal Weight Females with Longstanding Eating Disorders
Int. J. Environ. Res. Public Health 2012, 9(1), 315-330; doi:10.3390/ijerph9010315
Received: 25 October 2011 / Revised: 20 December 2011 / Accepted: 16 January 2012 / Published: 19 January 2012
Cited by 2 | PDF Full-text (274 KB) | HTML Full-text | XML Full-text
Abstract
The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI i.e., >33%) managed to reduce
[...] Read more.
The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI < 18.5, n = 7) and normal weight (BMI ≥ 18.5, n = 22) inpatients (mean (SD) age: 31.0 (9.0) years, ED duration: 14.9 (8.8) years, duration of treatment: 16.6 (5.5) weeks) completed this prospective naturalistic study. The treatment consisted of nutritional counseling, and 2 × 60 min weekly moderate intensive physical activity in addition to psychotherapy and milieu therapy. Underweight patients aimed to increase body weight with 0.5 kg/week until the weight gain goal was reached. Aerobic fitness, muscular strength, BMD and body composition were measured at admission and discharge. Results showed an increase in mean muscular strength, total body mass, fat mass, and body fat percentage, but not aerobic capacity, among both underweight and normal weight patients. Lumbar spine BMD increased among the underweight patients, no changes were observed in BMD among the normal weight patients. Three out of seven underweight patients were still underweight at discharge, and only three out of nine patients with excessive body fat (i.e., >33%) managed to reduce body fat to normal values during treatment. These results calls for a more individualized treatment approach to achieve a more optimal body composition among both underweight and normal to overweight patients with longstanding ED. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Migration, Agribusiness and Nutritional Status of Children under Five in Northwest Mexico
Int. J. Environ. Res. Public Health 2012, 9(1), 33-43; doi:10.3390/ijerph9010033
Received: 1 November 2011 / Revised: 10 December 2011 / Accepted: 20 December 2011 / Published: 28 December 2011
Cited by 1 | PDF Full-text (309 KB) | HTML Full-text | XML Full-text
Abstract
The aim of this study was to examine the nutritional status of children of Mexican migrant worker families under five years of age within the context of global food markets. The sample included 404 children less than five years old from farms and
[...] Read more.
The aim of this study was to examine the nutritional status of children of Mexican migrant worker families under five years of age within the context of global food markets. The sample included 404 children less than five years old from farms and agricultural communities in northwest Mexico. Prevalence of stunting and underweight of children appeared very similar to that of indigenous children from the national sample survey (difference 0.9 and 1.6 percentage points, respectively). Compared to the national sample of Mexican children, stunting and underweight seemed higher in migrant children (difference 17.7 and 4.5 percentage points, respectively), but wasting, an indicator of both chronic and acute undernutrition, appeared to indicate a process of nutritional recuperation. Migrant children living in poverty and suffering from chronic undernutrition, poor performance and scarce education opportunities, can be expected to eventually become agricultural workers with low productivity and poor general health. Consumer’s demands on social and environmental standards of fresh food production in developed countries could be an opportunity to impact the lives of migrant agricultural workers, their families and communities. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Constitutive, but Not Challenge-Induced, Interleukin-10 Production Is Robust in Acute Pre-Pubescent Protein and Energy Deficits: New Support for the Tolerance Hypothesis of Malnutrition-Associated Immune Depression Based on Cytokine Production in vivo
Int. J. Environ. Res. Public Health 2011, 8(1), 117-135; doi:10.3390/ijerph8010117
Received: 3 December 2010 / Revised: 6 January 2011 / Accepted: 8 January 2011 / Published: 13 January 2011
Cited by 7 | PDF Full-text (234 KB) | HTML Full-text | XML Full-text
Abstract
The tolerance model of acute (i.e., wasting) pre-pubescent protein and energy deficits proposes that the immune depression characteristic of these pathologies reflects an intact anti-inflammatory form of immune competence that reduces the risk of autoimmune reactions to catabolically released self antigens.
[...] Read more.
The tolerance model of acute (i.e., wasting) pre-pubescent protein and energy deficits proposes that the immune depression characteristic of these pathologies reflects an intact anti-inflammatory form of immune competence that reduces the risk of autoimmune reactions to catabolically released self antigens. A cornerstone of this proposition is the finding that constitutive (first-tier) interleukin(IL)-10 production is sustained even into the advanced stages of acute malnutrition. The IL-10 response to inflammatory challenge constitutes a second tier of anti-inflammatory regulation and was the focus of this investigation. Weanling mice consumed a complete diet ad libitum, a low-protein diet ad libitum (mimicking incipient kwashiorkor), or the complete diet in restricted daily quantities (mimicking marasmus), and their second-tier IL-10 production was determined both in vitro and in vivo using lipopolysaccharide (LPS) and anti-CD3 as stimulants of innate and adaptive defences, respectively. Both early (3 days) and advanced (14 days) stages of wasting pathology were examined and three main outcomes emerged. First, classic in vitro systems are unreliable for discerning cytokine production in vivo. Secondly, in diverse forms of acute malnutrition declining challenge-induced IL-10 production may provide an early sign that anti-inflammatory control over immune competence is failing. Thirdly, and most fundamentally, the investigation provides new support for the tolerance model of malnutrition-associated inflammatory immune depression. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle The Impact of Nutritional Status and Longitudinal Recovery of Motor and Cognitive Milestones in Internationally Adopted Children
Int. J. Environ. Res. Public Health 2011, 8(1), 105-116; doi:10.3390/ijerph8010105
Received: 1 December 2010 / Revised: 30 December 2010 / Accepted: 6 January 2011 / Published: 10 January 2011
Cited by 9 | PDF Full-text (167 KB) | HTML Full-text | XML Full-text
Abstract
Internationally adopted children often arrive from institutional settings where they have experienced medical, nutritional and psychosocial deprivation. This study uses a validated research assessment tool to prospectively assess the impact of baseline (immediately post adoption) nutritional status on fifty-eight children as measured by
[...] Read more.
Internationally adopted children often arrive from institutional settings where they have experienced medical, nutritional and psychosocial deprivation. This study uses a validated research assessment tool to prospectively assess the impact of baseline (immediately post adoption) nutritional status on fifty-eight children as measured by weight-for-age, height-for-age, weight-for-height and head circumference-for-age z scores, as a determinant of cognitive (MDI) and psychomotor development (PDI) scores longitudinally. A statistical model was developed to allow for different ages at time of initial assessment as well as variable intervals between follow up visits. The study results show that both acute and chronic measures of malnutrition significantly affect baseline developmental status as well as the rate of improvement in both MDI and PDI scores. This study contributes to the body of literature with its prospective nature, unique statistical model for longitudinal evaluation, and use of a validated assessment tool to assess outcomes. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Dyslipidaemia and Undernutrition in Children from Impoverished Areas of Maceió, State of Alagoas, Brazil
Int. J. Environ. Res. Public Health 2010, 7(12), 4139-4151; doi:10.3390/ijerph7124139
Received: 11 October 2010 / Revised: 23 November 2010 / Accepted: 24 November 2010 / Published: 30 November 2010
Cited by 7 | PDF Full-text (209 KB) | HTML Full-text | XML Full-text
Abstract
Chronic undernutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. In the present study, the biochemical profiles of chronically undernourished children were determined in order to test the hypothesis that chronic undernutrition also causes changes in lipid profile
[...] Read more.
Chronic undernutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. In the present study, the biochemical profiles of chronically undernourished children were determined in order to test the hypothesis that chronic undernutrition also causes changes in lipid profile in pre-school children. The study population comprised 80 children aged between 12 and 71 months, including 60 with moderate undernutrition [height-for-age Z (HAZ) scores ≤ −2 and > −3] and 20 with severe undernutrition (HAZ scores ≤ −3). Socioeconomic, demographic and environmental data were obtained by application of a questionnaire, and anthropometric measurements and information relating to sex, age and feeding habits were collected by a trained nutritionist. Blood samples were analysed for haemoglobin, vitamin A, insulin-like growth factor 1 (IGF-1) and serum lipids, while cortisol was assayed in the saliva. Faecal samples were submitted to parasitological investigation. Analysis of variance and χ2 methods were employed in order to select the variables that participated in the multivariate logistic regression analysis. The study population was socioeconomically homogeneous, while the lack of a treated water supply was clearly associated with the degree of malnutrition. Most children were parasitised and anaemia was significantly more prevalent among the severely undernourished. Levels of IGF-1 decreased significantly with increasing severity of undernutrition. Lipid analysis revealed that almost all of the children had dyslipidemia, while low levels of high-density lipoprotein were associated with the degree of undernutrition. It is concluded that chronic malnutrition causes endocrine changes that give rise to alterations in the metabolic profile of pre-school children. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Is Malnutrition Associated with Crowding in Permanent Dentition?
Int. J. Environ. Res. Public Health 2010, 7(9), 3531-3544; doi:10.3390/ijerph7093531
Received: 6 August 2010 / Accepted: 19 September 2010 / Published: 27 September 2010
Cited by 4 | PDF Full-text (130 KB) | HTML Full-text | XML Full-text
Abstract
Evidence suggests that energy-protein malnutrition is associated with impaired growth and development of facial bones. The objective of this study was to investigate the association between nutritional status and reduced space for dental eruption (crowding) in permanent dentition. A cross-sectional study with probabilistic
[...] Read more.
Evidence suggests that energy-protein malnutrition is associated with impaired growth and development of facial bones. The objective of this study was to investigate the association between nutritional status and reduced space for dental eruption (crowding) in permanent dentition. A cross-sectional study with probabilistic sampling design was used. We evaluated 2,060 students aged 12 to 15 years enrolled in schools in the northeast of Brazil. Crowding was defined according to World Health Organization (WHO) as misalignment of teeth due to lack of space for them to erupt in the correct position. Nutritional status was evaluated by means of body mass index and height-for-age, using the WHO’s reference curves. Parents and adolescents responded to a questionnaire about demographic, socioeconomic, biological and behavioral characteristics. The associations were estimated by odds ratio (OR) in multivariate logistic regression analysis (alpha = 0.05). Confounding and effect-modification were taken into account. An association between low height-for-age (z-score < –1SD) and crowding was only observed in adolescents with a prolonged history of mouth breathing (OR = 3.1). No association was observed between underweight and crowding. Malnutrition is related to crowding in permanent dentition among mouth-breathing adolescents. Policy actions aimed at reducing low height-for-age and unhealthy oral habits are strongly recommended. However, further studies are needed to increase the consistency of these findings and improve understanding of the subject. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessArticle Association between Chronic Arsenic Exposure and Nutritional Status among the Women of Child Bearing Age: A Case-Control Study in Bangladesh
Int. J. Environ. Res. Public Health 2010, 7(7), 2811-2821; doi:10.3390/ijerph7072811
Received: 14 May 2010 / Revised: 13 June 2010 / Accepted: 30 June 2010 / Published: 2 July 2010
Cited by 8 | PDF Full-text (116 KB) | HTML Full-text | XML Full-text
Abstract
The role of nutritional factors in arsenic metabolism and toxicity is yet to be fully elucidated. A low protein diet results in decreased excretion of DMA and increased tissue retention of arsenic in experimental studies. Malnourished women carry a higher risk of adverse
[...] Read more.
The role of nutritional factors in arsenic metabolism and toxicity is yet to be fully elucidated. A low protein diet results in decreased excretion of DMA and increased tissue retention of arsenic in experimental studies. Malnourished women carry a higher risk of adverse pregnancy outcomes. Chronic exposure to high arsenic (>50 µg/L) through drinking water also increases the risk of adverse pregnancy outcomes. The synergistic effects (if any) of malnutrition and chronic arsenic exposure may worsen the adverse pregnancy outcomes. This population based case control study reports the association between chronic arsenic exposure and nutritional status among the rural women in Bangladesh. 348 cases (BMI < 18.5) and 360 controls (BMI 18.5–24.99) were recruited from a baseline survey conducted among 2,341 women. An excess risk for malnutrition was observed among the participants chronically exposed to higher concentrations of arsenic in drinking water after adjusting for potential confounders such as participant’s age, religion, education, monthly household income and history of oral contraceptive pills. Women exposed to arsenic >50 µg/L were at 1.9 times (Odds Ratio = 1.9, 95% CI = 1.1–3.6) increased risk of malnutrition compared to unexposed. The findings of this study suggest that chronic arsenic exposure is likely to contribute to poor nutritional status among women of 20–45 years. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)

Review

Jump to: Research

Open AccessReview Is Early Puberty Triggered by Catch-Up Growth Following Undernutrition?
Int. J. Environ. Res. Public Health 2012, 9(5), 1791-1809; doi:10.3390/ijerph9051791
Received: 23 March 2012 / Revised: 19 April 2012 / Accepted: 30 April 2012 / Published: 9 May 2012
Cited by 7 | PDF Full-text (210 KB) | HTML Full-text | XML Full-text
Abstract
Undernutrition during fetal and postnatal life is still a major problem in many low- and middle-income countries. Even in high-income countries malnutrition may exist in cases of intrauterine growth retardation, as well as in chronic conditions such as anorexia nervosa and inflammatory bowel
[...] Read more.
Undernutrition during fetal and postnatal life is still a major problem in many low- and middle-income countries. Even in high-income countries malnutrition may exist in cases of intrauterine growth retardation, as well as in chronic conditions such as anorexia nervosa and inflammatory bowel disease. Children adopted from developing countries are often chronically malnourished. Nutritional rehabilitation, resulting in catch-up growth, is often complicated by influences originating in fetal life as well as during postnatal growth. This may result in hormonal and metabolic changes as well as alterations in pubertal development. The present review focuses on fetal, postnatal and fetal-postnatal undernutrition and subsequent catch-up growth as well as catch-up growth in relation to pubertal development. Catch-up growth in children can be associated with early puberty following fetal or combined fetal-postnatal undernutrition. However, early puberty does not seem to occur following catch-up growth after isolated postnatal undernutrition. Gonadotropins have been reported to be elevated in prepubertal adopted girls as well as during catch-up growth in animals. Even if other factors may contribute, linear catch-up growth seems to be associated with the timing of pubertal development. The mechanisms behind this are still unknown. Future research may elucidate how to carry out nutritional rehabilitation without risk for early pubertal development. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessReview Malnutrition in the Critically Ill Child: The Importance of Enteral Nutrition
Int. J. Environ. Res. Public Health 2011, 8(11), 4353-4366; doi:10.3390/ijerph8114353
Received: 25 October 2011 / Revised: 15 November 2011 / Accepted: 15 November 2011 / Published: 21 November 2011
Cited by 16 | PDF Full-text (67 KB) | HTML Full-text | XML Full-text
Abstract
Malnutrition affects 50% of hospitalized children and 25–70% of the critically ill children. It increases the incidence of complications and mortality. Malnutrition is associated with an altered metabolism of certain substrates, increased metabolism and catabolism depending on the severity of the lesion, and
[...] Read more.
Malnutrition affects 50% of hospitalized children and 25–70% of the critically ill children. It increases the incidence of complications and mortality. Malnutrition is associated with an altered metabolism of certain substrates, increased metabolism and catabolism depending on the severity of the lesion, and reduced nutrient delivery. The objective should be to administer individualized nutrition to the critically ill child and to be able to adjust the nutrition continuously according to the metabolic changes and evolving nutritional status. It would appear reasonable to start enteral nutrition within the first 24 to 48 hours after admission, when oral feeding is not possible. Parenteral nutrition should only be used when enteral nutrition is contraindicated or is not tolerated. Energy delivery must be individually adjusted to energy expenditure (40–65 kcal/100 calories metabolized/day) with a protein delivery of 2.5–3 g/kg/day. Frequent monitoring of nutritional and metabolic parameters should be performed. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessReview Long-Lasting Effects of Undernutrition
Int. J. Environ. Res. Public Health 2011, 8(6), 1817-1846; doi:10.3390/ijerph8061817
Received: 11 April 2011 / Revised: 12 May 2011 / Accepted: 19 May 2011 / Published: 26 May 2011
Cited by 30 | PDF Full-text (634 KB) | HTML Full-text | XML Full-text
Abstract
Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in
[...] Read more.
Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessReview Malnutrition and Gastrointestinal and Respiratory Infections in Children: A Public Health Problem
Int. J. Environ. Res. Public Health 2011, 8(4), 1174-1205; doi:10.3390/ijerph8041174
Received: 12 February 2011 / Revised: 7 April 2011 / Accepted: 11 April 2011 / Published: 18 April 2011
Cited by 60 | PDF Full-text (639 KB) | HTML Full-text | XML Full-text
Abstract
Infectious disease is the major cause of morbidity and mortality in developing countries, particularly in children. Increasing evidence suggests that protein-calorie malnutrition is the underlying reason for the increased susceptibility to infections observed in these areas. Moreover, certain infectious diseases also cause malnutrition,
[...] Read more.
Infectious disease is the major cause of morbidity and mortality in developing countries, particularly in children. Increasing evidence suggests that protein-calorie malnutrition is the underlying reason for the increased susceptibility to infections observed in these areas. Moreover, certain infectious diseases also cause malnutrition, which can result in a vicious cycle. Malnutrition and bacterial gastrointestinal and respiratory infections represent a serious public health problem. The increased incidence and severity of infections in malnourished children is largely due to the deterioration of immune function; limited production and/or diminished functional capacity of all cellular components of the immune system have been reported in malnutrition. In this review, we analyze the cyclical relationship between malnutrition, immune response dysfunction, increased susceptibility to infectious disease, and metabolic responses that further alter nutritional status. The consequences of malnutrition are diverse and included: increased susceptibility to infection, impaired child development, increased mortality rate and individuals who come to function in suboptimal ways. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessReview Early Postnatal Protein-Calorie Malnutrition and Cognition: A Review of Human and Animal Studies
Int. J. Environ. Res. Public Health 2011, 8(2), 590-612; doi:10.3390/ijerph8020590
Received: 1 January 2011 / Revised: 26 January 2011 / Accepted: 10 February 2011 / Published: 23 February 2011
Cited by 35 | PDF Full-text (361 KB) | HTML Full-text | XML Full-text
Abstract
Malnutrition continues to be recognized as the most common and serious form of children’s dietary disease in the developing countries and is one of the principal factors affecting brain development. The purpose of this paper is to review human and animal studies relating
[...] Read more.
Malnutrition continues to be recognized as the most common and serious form of children’s dietary disease in the developing countries and is one of the principal factors affecting brain development. The purpose of this paper is to review human and animal studies relating malnutrition to cognitive development, focusing in correlational and interventional data, and to provide a discussion of possible mechanisms by which malnutrition affects cognition. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessReview Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System
Int. J. Environ. Res. Public Health 2011, 8(2), 514-527; doi:10.3390/ijerph8020514
Received: 20 December 2010 / Revised: 10 January 2011 / Accepted: 4 February 2011 / Published: 16 February 2011
Cited by 124 | PDF Full-text (166 KB) | HTML Full-text | XML Full-text
Abstract
Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths
[...] Read more.
Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)
Open AccessReview The Role of Food and Nutrition System Approaches in Tackling Hidden Hunger
Int. J. Environ. Res. Public Health 2011, 8(2), 358-373; doi:10.3390/ijerph8020358
Received: 15 December 2010 / Revised: 21 January 2011 / Accepted: 25 January 2011 / Published: 31 January 2011
Cited by 30 | PDF Full-text (361 KB) | HTML Full-text | XML Full-text
Abstract
One of the World’s greatest challenges is to secure sufficient and healthy food for all, and to do so in an environmentally sustainable manner. This review explores the interrelationships of food, health, and environment, and their role in addressing chronic micronutrient deficiencies, also
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One of the World’s greatest challenges is to secure sufficient and healthy food for all, and to do so in an environmentally sustainable manner. This review explores the interrelationships of food, health, and environment, and their role in addressing chronic micronutrient deficiencies, also known as “hidden hunger”, affecting over two billion people worldwide. While the complexity and underlying determinants of undernutrition have been well-understood for decades, the scaling of food and nutrition system approaches that combine sustainable agriculture aimed at improved diet diversity and livelihoods have been limited in their development and implementation. However, an integrated system approach to reduce hidden hunger could potentially serve as a sustainable opportunity. Full article
(This article belongs to the Special Issue Malnutrition and Public Health)

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