Search Results (3,257)

Background: Malnutrition contributes to frailty dementia, intensifying adverse health outcomes including mortality risk. Objectives: We aim to investigate the impact of malnutrition risk in those with frailty and functional decline on short-term mortality among older adults with dementia and/or cognitive impairment. Methods: We conducted a retrospective cohort study involving 2677 hospitalized patients aged ≥65 years with a diagnosis of dementia or cognitive impairment discharged between March 2022 and December 2023. Information was obtained from electronic medical records. Frailty was assessed using the Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), functional status using premorbid activity of daily living (ADL) scores, and malnutritional risk using the 3-Minute Nutrition Screening (3-Min NS) tool. Associations with 30- and 90-day mortality were examined using Kaplan–Meier analysis and multivariate logistic regression models. Results: A total of 29.2% were at risk of malnutrition, highest in the old-old (37.1%). Thirty-day mortality was significantly associated with CFS (aOR = 1.498, 95% CI: 1.349–1.664, p < 0.001), HFRS (aOR = 1.020, 95% CI: 1.001–1.040, p = 0.038), and ADL (aOR = 0.819, 95% CI: 0.753–0.890, p < 0.001). Malnutrition risk demonstrated the strongest association across all models (ADL: aOR = 2.573, 95% CI: 1.922–3.443, p < 0.001; CFS: aOR = 2.348, 95% CI: 1.738–3.156, p < 0.001; HFRS: aOR = 2.944, 95% CI: 2.210–3.922, p < 0.001). Associations between 90-day mortality and malnutrition risk remained significant across all models, including those adjusted for CFS and ADL. Notably, interactions between malnutrition and CFS further amplified mortality risk among the old-old (30-day: aOR = 1.435, 95% CI: 1.082–1.902, p = 0.012; 90-day: aOR = 1.263, 95% CI: 1.005–1.588, p = 0.045). Conclusions: Risk of malnutrition independently predicted short-term mortality in older adults with dementia or cognitive impairment, particularly among those with frailty, functional decline, and of advanced age. Full article

Aims: To investigate the nutritional status and feeding behaviours of nursing home residents and the impact of cognitive impairments and feeding difficulties on nutritional health. Design: A cross-sectional observational design was employed. Methods: The study assessed 51 nursing home residents using the Mini Nutritional Assessment Short-Form (MNA-SF) for nutritional status, the Feeding Difficulty Index (FDI) for mealtime behaviours, and the MoCA (Montreal Cognitive Assessment or The MoCA Test) for cognitive function. Results: The average age of participants was 87.8 years. Nearly half (47.1%) were at high risk of malnutrition, and 13.7% were classified as malnourished. The average MoCA score was 14, indicating moderate cognitive impairment, which was inversely associated with nutritional status. Feeding difficulties were common, as follows: 74.5% of residents paused feeding for over one minute, and 62.8% were distracted during meals. A longer duration of nursing home residency was associated with poorer nutritional outcomes. Overall, 65% of residents required mealtime assistance, with higher FDI scores correlating with greater support needs. Significant positive correlations were found between cognitive function and nutritional status (r = 0.401, p = 0.037) and between food intake and nutritional status (r = 0.392, p = 0.004). In contrast, residency duration (r = −0.292, p = 0.037) and feeding difficulties (r = −0.630, p < 0.001) were negatively associated with MNA-SF scores. FDI scores were strongly associated with the level of assistance required during meals (r = 0.763, p < 0.001). This study highlights the critical need for targeted nutritional assessments and interventions in nursing homes, especially for residents with dementia facing cognitive impairments and feeding difficulties. Enhancing staff training on recognising and addressing eating challenges and risk factors is essential for improving nutritional well-being. Conclusions: The study highlighted the profound impact of cognitive impairments and feeding difficulties on the nutritional health of nursing home residents, indicating a high prevalence of malnutrition and a need for comprehensive mealtime assistance. Full article

Research is required to determine whether the coinfections by Fasciola spp. and other parasite species result from poor rural hygiene or reflect underlying epidemiological patterns and causes. Therefore, the role of fascioliasis is analyzed concerning coinfection complexity, risk of multiparasitism, parasite associations, pathogenic implications and their multifactorial causes. Helminth and protozoan coinfections are studied in 2575 previously untreated individuals from four rural hyperendemic areas (Northern Bolivian Altiplano, Peruvian Altiplano and Cajamarca valley, and the Egyptian Nile Delta). This cross-sectional study was conducted from January 2011 to December 2023. Coinfections were coprologically assessed by the merthiolate–iodine–formalin and formol–ether concentration techniques. Infection intensity was measured as eggs/gram of feces (epg) with the Kato–Katz technique. Parasite and coinfection prevalences were stratified by age, sex and geographical location. High mixed infections, fascioliasis prevalences and very low non-coinfected Fasciola-infected subjects were associated with the following regions: Bolivian Altiplano, 96.5%, 16.8% and 3.5%; Peruvian Altiplano, 100%, 24.6% and 0%; Cajamarca valley, 98.7%, 21.4% and 1.8%; Nile Delta, 84.1%, 13.0% and 15.9%. Transmission routes and human infection sources underlie fascioliasis associations with protozoan and other helminth infections. Prevalence pattern of protozoan–helminth coinfections differed between Fasciola-infected individuals and individuals not infected with Fasciola, presenting higher prevalences in individuals with fascioliasis. Multiparasitism diagnosed in Fasciola-infected subjects included coinfections by up to nine parasite species, eight protozoan species, and five helminth species. The most prevalent pathogenic protozoan was Giardia intestinalis. The most prevalent helminth species differ according to environmental conditions. Several parasites indicate fecal environmental contamination. When the fascioliasis burden increases, the total number of parasite species also increases. The fascioliasis risk increases when the total helminth species number/host increases. Fasciola-infected subjects may present a modification in the clinical phenotypes of coinfecting parasitic diseases. Fascioliasis coinfection factors include transmission ways and immunological, environmental and social aspects. Coinfections must be considered when assessing the health impact of fascioliasis, including the analysis of the fascioliasis effects on malnutrition and physical/intellectual child development. Fascioliasis-control schemes should, therefore, integrate control measures mainly against other helminthiases. Full article

Background: Malnutrition is highly prevalent among older patients with hip fractures and significantly impacts recovery and survival. This narrative review synthesizes current evidence on the prevalence, pathophysiology, and clinical consequences of malnutrition in hip fracture patients, along with diagnostic tools and nutritional interventions. Methods: A literature search of studies from 2000 to 2025 identified consistent associations between malnutrition—defined using tools such as the Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index (GNRI), and serum albumin levels—and increased risks of postoperative complications, prolonged hospital stays, functional decline, and mortality. Pathophysiological mechanisms include sarcopenia, systemic inflammation, and impaired bone metabolism. Results: Notably, malnutrition is associated with fracture type, with low lean body mass and poor nutritional status correlating with intracapsular femoral neck fractures. Conclusions: Interventional studies demonstrate that oral nutritional supplementation (ONS) reduces complications and improves biochemical parameters but shows mixed effects on long-term mortality and function. The findings support routine nutritional screening and early intervention in older hip fracture patients to improve outcomes and reduce the healthcare burden. Full article

Background/Objectives: Anaemia and malnutrition remain global public health challenges, particularly affecting low-income countries such as Mozambique, especially during the complementary feeding period. This study aimed to assess caregivers’ knowledge, attitudes, and practices (KAPs) regarding infant feeding and to explore associations with anaemia and nutritional status among infants aged 6 to 8 months in urban Maputo. Methods: A cross-sectional baseline survey was conducted in 2024 in two primary health centres. A total of 496 caregiver–child pairs participated. Children underwent anthropometric measurements and haemoglobin testing, and caregivers completed a structured KAP questionnaire. Descriptive statistics were generated, and chi-square tests were used to examine associations between KAP domains and child health outcomes. Results: Anaemia was detected in 77.0% of children, with moderate anaemia being most common (48.6%). Eutrophic nutritional status was observed in 73.1% of children, 7.0% had acute malnutrition, and 14.1% were overweight. While 97.3% of caregivers demonstrated positive attitudes, only 52.1% had adequate knowledge and practices. Adequate knowledge was significantly associated with both the absence of anaemia (p = 0.001) and eutrophic status (p = 0.001). No significant associations were found for attitudes or practices. Caregiver practices were significantly associated with household income, and anaemia was more frequent among children from low-income households. Conclusions: Anaemia was highly frequent among 6–8-month-old infants, even among those with normal weight-for-length and knowledgeable caregivers. This paradox highlights the need for early, integrated interventions, such as nutrition education and home fortification with micronutrient powders, and supports the WHO’s recommendation to revisit haemoglobin thresholds in some contexts. Full article

Objective: Dysphagia is common among elderly patients after hip fracture surgery and can lead to aspiration pneumonia, malnutrition, and delayed rehabilitation. This study aims to present current clinical practice patterns of assessment and intervention for dysphagia in this patient group. Methods: The study was conducted through a two-round online questionnaire targeting Danish occupational therapists with expertise in dysphagia post hip fracture. Results: A total of 71 therapists participated in round one, and 44 (62%) completed round two. Triggers for assessment included coughing, recurrent pneumonia, voice changes, altered eating habits, unplanned weight loss, functional decline, and comorbidities; age was rarely used. Frequently used assessment tools were Facio-Oral Tract Therapy (57.1%), the Minimal Eating Observation Form—Version II (40%) and the Volume–Viscosity Swallow Test (41.4%). Key interventions included texture modification, posture correction, patient education, oral hygiene optimization, compensatory strategies, and dysphagia training; oral screens and electrical stimulation were less common. Conclusions: This study provides a descriptive overview of current dysphagia assessment triggers, tools, and interventions used for elderly hip fracture patients in Denmark. The findings highlight clinical practice patterns that can inform future research on patient outcomes and the effectiveness of specific interventions in this population. Full article

Gastrointestinal (GI) involvement is frequent in systemic sclerosis (SSc). Recent studies have highlighted a possible association between GI symptoms, gut microbiota (GM), and nutrition. In this systematic review, the evidence supporting these relationships was evaluated. Articles selected from the MEDLINE database and published between 2010 and 2025 were included. Keywords used in the sources included “systemic sclerosis”, “gut microbiota”, “malnutrition”, and “gastrointestinal symptoms”. Forty-nine articles were selected, for a total of 6270 SSc patients. The evidence suggests a complex relationship between SSc, GI symptoms, and GM dysbiosis. Both are manifestations of the disease, and in turn they influence its severity. Digestive tract fibrosis and dysbiosis alter nutrient absorption, which can lead to malnutrition. However, data considering these complex relationships between the GI tract, microbiome, and nutritional status are few and very heterogeneous. Further studies are needed to investigate these complex interwinings and identify nutritional interventions able to reduce GI dysfunction and simultaneously counteract malnutrition. Full article

The food consumption stage, the final step in the food supply chain (FSC), where food has already undergone resource-intensive processes, plays a central role in the transition to a sustainable food system. Consumers’ food choices and consumption practices directly influence food demand, production methods, and resource use across the FSC. These factors affect global challenges such as overconsumption, malnutrition, hunger, and food waste (FW)—issues integral to the UN Sustainable Development Goals (SDGs). Therefore, this study aims to identify key aspects of the food consumption stage that influence the shift toward sustainability and to develop a conceptual framework to guide this transition. To achieve this, an integrative literature review (ILR), supported by bibliometric analysis and narrative review elements, was conducted to strengthen the conceptual foundation. The results reveal four central aspects: FW and its reduction, the need for dietary shifts, changes in consumer behaviour, and policy reform, highlighting the consumer and their behaviour as the central connecting element. Based on the findings, a framework was developed linking the identified problems with targeted solutions, which can be implemented through various tools that also act as drivers of change, enhancing sustainable food consumption, food system sustainability, and the achievement of global SDGs. Full article

Invasive candidiasis (IC), characterized by the most common clinical manifestation of candidemia, is a fungal infection with a high mortality rate and a significant impact on global public health. It is estimated that each year there are between 227,000 and 250,000 hospitalizations related to IC, with more than 100,000 associated deaths. In Latin America and the Caribbean (LA&C), the absence of a standardized surveillance system has led to multicenter studies documenting incidences ranging from 0.74 to 6.0 cases per 1000 hospital admissions, equivalent to 50,000–60,000 hospitalizations annually, with mortality rates of up to 60% in certain high-risk groups. Armed conflicts and structural violence in LA&C cause forced displacement, the collapse of health systems, and poor living conditions—such as overcrowding, malnutrition, and lack of sanitation—which increase vulnerability to opportunistic infections, such as IC. Insufficient specialized laboratories, diagnostic technology, and trained personnel impede pathogen identification and delay timely initiation of antifungal therapy. Furthermore, the empirical use of broad-spectrum antibiotics and the limited availability of echinocandins and lipid formulations of amphotericin B have promoted the emergence of resistant non-albicans strains, such as Candida tropicalis, Candida parapsilosis, and, in recent outbreaks, Candidozyma auris. Full article

Background/Objectives: Health education plays a vital role in training health professionals and caregivers, supporting both prevention and the promotion of self-care. In this context, technology serves as a valuable ally by enabling continuous and flexible learning. Among the various domains of health education, nutrition stands out as a key element in the management of Amyotrophic Lateral Sclerosis (ALS), helping to prevent malnutrition and enhance patient well-being. Accordingly, this study aimed to evaluate the effectiveness of the teaching and learning processes within a learning pathway focused on food and nutrition in the context of ALS. Methods: This study adopted a longitudinal, quantitative design. The learning pathway, titled “Food and Nutrition in ALS,” consisted of four self-paced and self-instructional Massive Open Online Courses (MOOCs), offered through the Virtual Learning Environment of the Brazilian Health System (AVASUS). Participants included health professionals, caregivers, and patients from all five regions of Brazil. Participants had the autonomy to complete the courses in any order, with no prerequisites for enrollment. Results: Out of 14,263 participants enrolled nationwide, 182 were included in this study after signing the Informed Consent Form. Of these, 142 (78%) completed at least one course and participated in the educational intervention. A significant increase in knowledge was observed, with mean pre-test scores rising from 7.3 (SD = 1.8) to 9.6 (SD = 0.9) on the post-test across all courses (p < 0.001). Conclusions: The self-instructional, technology-mediated continuing education model proved effective in improving participants’ knowledge about nutrition in ALS. Future studies should explore knowledge retention, behavior change, and the impact of such interventions on clinical outcomes, especially in multidisciplinary care settings. Full article

The National Adaptation Plan of Bangladesh identifies eleven climate-stressed zones, placing nearly 100 million people at high risk of climate-related hazards. Vulnerable groups such as the poor, floating populations, daily laborers, and slum dwellers are particularly affected. However, there is a lack of data on climate-sensitive diseases and related hospital visits in these areas. This study explored the prevalence of such diseases using the Delphi method through focus group discussions with 493 healthcare professionals from 153 hospitals in 156 upazilas across 21 districts and ten zones. Participants were selected by district Civil Surgeons. Key climate-sensitive diseases identified included malnutrition, diarrhea, pneumonia, respiratory infections, typhoid, skin diseases, hypertension, cholera, mental health disorders, hepatitis, heat stroke, and dengue. Seasonal surges in hospital visits were noted, influenced by factors like extreme heat, air pollution, floods, water contamination, poor sanitation, salinity, and disease vectors. Some diseases were zone-specific, while others were widespread. Regions with fewer hospital visits often had higher disease burdens, indicating under-reporting or lack of access. The findings highlight the need for area-specific adaptation strategies and updates to the Health National Adaptation Plan. Strengthening resilience through targeted investment and preventive measures is crucial to reducing health risks from climate change. Full article

Background/Objectives: Cancer is a complex disease that affects patients’ nutritional and psychological status. This study aimed to assess the nutritional status of patients diagnosed with lung and gastrointestinal system cancers and evaluate its association with anthropometric measurements, nutrient intake, and psychological symptoms. Methods: This cross-sectional study was conducted with 180 patients with lung and gastrointestinal system cancers. Data were collected face-to-face by a questionnaire that included the Subjective Global Assessment-(SGA), Cachexia Assessment Criteria, 24 h Food Consumption Record, and Symptom Checklist-90-Revised-(SCL-90-R). Some anthropometric measurements were collected. Results: Body Mass Index (BMI) was found to be significantly lower (p < 0.001) in SGA-B (moderately malnourished) and SGA-C (severely malnourished) compared to those in SGA-A (well-nourished). The calf circumference was significantly lower (p = 0.002) in SGA-C compared to those in SGA-A and SGA-B. The mean SGA scores were found to be higher in cachexia-diagnosed participants (p < 0.001). The energy intake of SGA-C was significantly lower than SGA-A and SGA-B (p < 0.001). In addition, the energy intake of SGA-B was lower than SGA-A (p < 0.001). The protein intake of SGA-C was lower than SGA-A and SGA-B (p < 0.001). The protein intake of SGA-B was lower than SGA-A (p < 0.001). Regarding the intake of vitamins A, C, E, B1, and B6 and carotene, folate, potassium, magnesium, phosphorus, iron, and zinc, SGA-B and SGA-C were significantly lower than SGA-A (p < 0.001). Additionally, only phobic anxiety was found to be significantly higher in SGA-B than in SGA-A (p: 0.024). Conclusions: As the level of malnutrition increased, a reduction in some nutrient intake and anthropometric measurements was observed. No significant difference was found in any psychological symptoms except phobic anxiety. With this in mind, it is important that every cancer patient, regardless of the stage of the disease, is referred to a dietitian from the time of diagnosis. Full article

Background: Congenital diarrhea is persistent diarrhea that manifests during the neonatal period. Mutations in DGAT1, which is crucial for triglyceride synthesis and lipid absorption in the small intestine, are causal factors for congenital diarrhea. In this study, we aimed to determine the value of tissue RNA sequencing (RNA-seq) for assisting with the clinical diagnosis of some genetic variants of uncertain significance. Methods: We clinically evaluated a patient with watery diarrhea, vomiting, severe malnutrition, and total parenteral nutrition dependence. Possible pathogenic variants were detected using whole-exome sequencing (WES). RNA-seq was utilized to explore the transcriptional alterations in DGAT1 variants identified by WES with unknown clinical significance, according to the American College of Medical Genetics guidelines. Systemic examinations, including endoscopic and histopathological examinations of the intestinal mucosa, were conducted to rule out other potential diagnoses. Results: We successfully diagnosed a patient with congenital diarrhea and protein-losing enteropathy caused by a DGAT1 mutation and reviewed the literature of 19 cases of children with DGAT defects. The missense mutation c.620A>G, p.Lys207Arg located in exon 15, and the intronic mutation c.1249-6T>G in DGAT1 were identified by WES. RNA-seq revealed two aberrant splicing events in the DGAT1 gene of the patient’s small intestinal tissue. Both variants lead to loss-of-function consequences and are classified as pathogenic variants of congenital diarrhea. Conclusions: Rare DGAT1 variants were identified as pathogenic evidence of congenital diarrhea, and the detection of tissue-specific mRNA splicing and transcriptional effects can provide auxiliary evidence. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background/Objectives: Malnutrition is an imbalance of nutrients required for growth, development, and organ function. Its impact on bone development is known, but its effects on cartilage remain unclear. This study aimed to evaluate the femoral cartilage thickness in children with primary malnutrition. Methods: In this cross-sectional observational study, 83 children with primary malnutrition and 62 age- and sex-matched healthy controls were included. Patients with primary malnutrition were classified as mild, moderate and severe. Femoral cartilage thickness measurements of all children were taken by ultrasound from the femoral lateral condyle, femoral medial condyle and intercondylar area for both knees with the patient in a supine position with the knees flexed 90 degrees. Results: The right lateral, right medial, left lateral, and left medial femoral cartilages were significantly thicker in patients with malnutrition compared to those without malnutrition (p = 0.002, 0.004, <0.001, and 0.001, respectively). A significant negative correlation was found between age, weight Z-score, and height Z-score and triceps skinfold thickness. Conclusions: Distal femoral cartilage thickness is significantly greater in children with primary malnutrition. This demonstrates the effect of nutritional factors on cartilage tissue and suggests that children with chronic malnutrition are at risk for both knee joint problems and short stature later in life. Full article