Introduction: Phosphate ion is common in the core of urinary stones and may initiate stone formation. However, the precise role of phosphate in the initiation of stone formation remains obscure. We assessed the effects of dietary phosphate load on urinary stone risk and phosphate metabolism.
Methods: Ten non-stone-forming healthy volunteers completed this randomized, crossover study. Each subject was provided a high- or low-phosphate diet for 3 days. After a 2-day equilibration period with a moderate-phosphate diet, the participants received a low- or high-phosphate diet for another 3 days. Serum, fecal, and 24-h urine samples were collected at the end of each intervention.
Results: High dietary phosphate load increased urinary phosphate excretion, and low dietary phosphate decreased urinary phosphate excretion. In addition, urine pH was lower and supersaturation (SS) index of uric acid (UA) was higher after a high-phosphate diet. There was no significant difference in the SS index for calcium oxalate, brushite and hydroxyapatite, or 24-h urinary citrate between the high and the low dietary phosphate. Also, no significant change was observed in fecal phosphate excretion after a high- or low-phosphate diet. The serum phosphate level increased after a high-phosphate diet, but there was no difference in serum phosphate between low-phosphate and moderate-phosphate diets.
Conclusion: High dietary phosphate load led to higher urinary phosphate excretion, a higher SS index of UA, and lower urine pH. Stone formers should be advised to limit the intake of high-phosphate source diet, including high-protein diets and phosphate-based food additives.
Introduction: The Global Leadership Initiative in Malnutrition (GLIM) consensus highlights the importance of using the GLIM criteria as a standardized approach to diagnosing malnutrition, particularly in patients with cachexia. Although many existing studies have utilized the GLIM criteria to assess the association between malnutrition and malignant tumor patients, there remains relatively little research exploring the specific relationship between malnutrition and sarcopenia. This study aimed to investigate the correlation between malnutrition under the GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies. By looking into the relationship, we hope to find better ways to prevent and treat sarcopenia in these patients, which will lead to better clinical outcomes.
Methods: In this study, we selected 210 patients with gastrointestinal malignant tumors from Northern Jiangsu People's Hospital between June 2022 and July 2023. We diagnosed and graded the nutritional status of these patients using the GLIM criteria. At the same time, body composition analysis, calf circumference, and grip strength were detected in all patients to observe whether they had sarcopenia.
Results: According to GLIM criteria, 30.1% of the patients were diagnosed with malnutrition, of which 25.1% were classified as moderate malnutrition and 15% as severe malnutrition. The risk of sarcopenia in patients with severe malnutrition was 2.5 times that of patients with good nutrition, and 1.19 times that of patients with moderate malnutrition. Patients with BMI <18.5 kg/m2 were 9.12 times more likely to develop sarcopenia than those with BMI ≥18.5 kg/m2. Due to inadequate nutrient intake and resultant malnutrition in patients with malignant tumors, muscle protein synthesis is affected, exacerbating muscle protein breakdown and leading to an overall decline in muscle strength and function.
Conclusion: This study highlights the urgent need for nutritional screening in early gastrointestinal tumor patients, revealing a strong link between sarcopenia and malnutrition. Higher malnutrition levels, low BMI, and high nutritional risk significantly predict sarcopenia, with risk increasing alongside worsening malnutrition and disease stage.
Background: Growth assessments are a pillar of public health surveillance, individual health screening, and clinical care. Normal growth is defined differently for individuals versus populations. The World Health Organization (WHO) growth standards were developed to describe the pattern of growth in healthy children without socioeconomic limitations whose mothers planned to breastfeed. The growth standards' cut-off points of ±2 standard deviations (z-scores) were defined for population assessments, based on attained size, to describe stunting and wasting at the lower end and overweight at the higher end. In a healthy population, one would expect 2.3% of the population to be above and below these cut-points. Higher child mortality rates associated with higher rates of stunting and wasting noted in observational studies validated these WHO cut-offs. There are knowledge gaps influencing the accuracy and effectiveness of growth assessments in individual children, posing challenges for health care providers.
Summary: The principles of assessing normal growth in children and preterm infants are reviewed, along with pitfalls to be avoided. Growth is determined by genetics and modified by the interplay with nutritional, environmental, socioeconomic, and possibly intergenerational factors. This complexity is reflected at both the population and individual level. However, normal growth in an individual has unique-specific factors so requires a comprehensive assessment. Normal growth for an individual child could be defined as the progression of changes in anthropometric measurements to achieve the individual's genetic potential. A misdiagnosis of growth faltering can occur if infants and children are asses with one-time rather than serial measures, and if age is not corrected for prematurity. Health care provider sensitivity and cognizance when communicating about a child's size is important for parental reassurance and avoiding stigma and unnecessary pressures or restrictions around feeding.
Background: Growth trajectories during the first 1,000 days from conception to 2 years influence human capital, predicting intelligence, skills and health in adults.
Summary: This review describes current evidence on the impacts of adverse pregnancy outcomes such as low birth weight, preterm birth, small for gestational age, and infant nutrition on long-term neurodevelopment and summarizes interventions that have proven to be effective in improving child development and further impact human capital. To date, no globally standardized measurements of child development in low-medium-income countries exist, and comparisons among studies using different developmental scales are challenging. In the perinatal period, birth weight, gestational age at delivery and elevated placental blood flow resistance have been identified as the main risk factors for global neurological delay, poor neurosensory development and cerebral palsy. Although these adverse neurological outcomes have decreased in developed settings, it is still a problem in low-resource populations. Nutritional deficiencies are the main drivers of developmental impairment, notably iron, iodine and folate deficiencies, and environmental stressors during pregnancy such as air pollution, exposure to chemicals, substance abuse, smoking, and maternal/parental psychiatric disorders can affect the developing brain. Interventions aiming to improve maternal macro- and micronutrient status, delayed cord clamping, exclusive breastfeeding and nurturing care have demonstrated to be effective strategies to prevent perinatal complications known to affect child development.
Introduction: Cancer poses a significant burden in Africa, where limited resources and infrastructure compound the challenges of managing the disease. Undernutrition, a critical concern among cancer patients, can profoundly affect treatment outcomes and overall prognosis. Despite its importance, the prevalence of undernutrition among African cancer patients remains poorly understood.
Methods: Five major databases were searched for observational studies that reported the prevalence of undernutrition, from inception till February 2024. Study selection, data extraction, and quality assessment were conducted by at least two independent reviewers. The NIH criteria for observational studies were used for quality assessment. A random-effects meta-analysis model was used to estimate the overall undernutrition prevalence, with subgroup analyses conducted based on country and population characteristics.
Results: Twenty-four studies involving 4,283 participants met the inclusion criteria and most studies included children (41%), followed by adults (37%) and women (19%). The overall undernutrition prevalence among African cancer patients was estimated at 32.8% (95% CI, 25.1%, 41.67%) with substantial heterogeneity observed (I2 = 95.4%, p < 0.0001). Subgroup analyses revealed significant variations in prevalence across countries and population groups.
Conclusion: Undernutrition is a serious issue among African cancer patients and requires an urgent response with targeted interventions. Tailored nutritional support strategies, considering demographic and regional contexts, are essential for improving patient outcomes.
Background: The term "faltering growth" (FG) is widely used to refer to a slower rate of weight gain in childhood than expected for age and gender. The prevalence varies depending on the definition and the studied population. Early recognition is important when considering the short- and long-term consequences, which include reduced cognitive development and increased risk of morbidity and mortality.
Summary: The causes of FG are traditionally classified into being either illness- or non-illness-related. However, such a rigid classification does not acknowledge the fact that poor growth may be multifactorial. While many definitions for FG exist, a recent consensus document suggested that a drop of weight-for-height of 1 z-score warrants the consideration for FG. The nutritional assessment supports the calculation of energy and protein requirements, which should be tailored to the underlying cause.
Introduction: Vitamin D deficiency is associated with bone metabolism and immune disorders. Radiation's seasonal variation affects vitamin D status more at the poles. In Mexico, near the equator, there have been reports of 10-20% vitamin D deficiency in children. There is no consensus on the definition of vitamin D deficiency, different organizations consider that a vitamin D level should be above 20-30 ng/mL. This study aimed to analyze vitamin D serum concentrations in children and adolescents from Mexico City and the Metropolitan Area (MA) during different seasons.
Methods: Cross-sectional study in children and adolescents aged 5-20 years from Mexico City and Metropolitan Area, from autumn 2016 to winter 2017. Variables of interest such as anthropometric measurements, food consumption, and physical activity were analyzed.
Results: A total of 816 children and adolescents were included. A high frequency of vitamin D deficiency was detected in 40.7% of the sample. The lowest vitamin D status occurred in winter 2016 and winter 2017.
Conclusion: We found a higher frequency of vitamin D deficiency during winter in children and adolescents in Mexico City and MA. This risk persisted after adjusting for age, sex, body mass index Z-score, milk consumption, physical activity, and screen time.
Introduction: This study aimed to determine the effects of Stored Energy on changes in body weight (BW) and skeletal muscle mass (SMM) in patients with post-acute stroke and sarcopenia.
Methods: This retrospective cohort study included patients with stroke and sarcopenia consecutively admitted to a Japanese rehabilitation hospital between 2015 and 2022. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia in 2019 criteria. Total Stored Energy (kcal) was defined as total energy intake minus total energy requirements during hospitalization, and energy requirements were estimated as actual BW (kg) × 30 (kcal/day). Multiple regression analysis was used to adjust for the effects of confounders and to analyze the association between Total Stored Energy divided by length of hospital stay (= Stored Energy) and changes in BW and SMM during hospitalization.
Results: Of the total 556 patients, 193 patients (mean age, 80 years; 43% male) were analyzed. The median (IQR) Total Stored Energy was -1,544 (-18,524, 16,566) kcal and Stored Energy was -23 (-169, 165) kcal/day; 90 patients had Stored Energy >0. Multiple linear regression analysis showed that Stored Energy was independently and positively associated with BW gain (β = 0.412, p < 0.001) and SMM gain (β = 0.263, p < 0.001).
Conclusion: Stored Energy has a positive impact on BW and SMM in patients with post-acute stroke and sarcopenia.
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