evidence-based blog of Filippo Dibari

Posts Tagged ‘medicine’

The State of Food and Agriculture 2013: Food systems for better nutrition

In Over-nutrition, Under-nutrition on June 4, 2013 at 8:19 pm

From the FAO web site.

Malnutrition in all its forms – undernutrition, micronutrient deficiencies, and overweight and obesity – imposes unacceptably high economic and social costs on countries at all income levels. Improving nutrition and reducing these costs requires a multisectoral approach that begins with food and agriculture and includes complementary interventions in public health and education. The traditional role of agriculture in producing food and generating income is fundamental, but the entire food system – from inputs and production, through processing, storage, transport and retailing, to consumption – can contribute much more to the eradication of malnutrition.

Agricultural policies and research must continue to support productivity growth for staple foods while paying greater attention to nutrient-dense foods and more sustainable production systems. Traditional and modern supply chains can enhance the availability of a variety of nutritious foods and reduce nutrient waste and losses. Governments, international organizations, the private sector and civil society can help consumers choose healthier diets, reduce waste and contribute to more sustainable use of resources by providing clear, accurate information and ensuring access to diverse and nutritious foods.

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Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery

In Under-nutrition on February 27, 2013 at 7:50 pm

J Nutr. 2013 Feb;143(2):215-20. doi: 10.3945/jn.112.168047. Epub 2012 Dec 19.

by Chang CYTrehan IWang RJThakwalakwa CMaleta KDeitchler MManary MJ.

Abstract

Moderate acute malnutrition (MAM) affects 11% of children <5 y old worldwide and increases their risk for morbidity and mortality. It is assumed that successful treatment of MAM reduces these risks.

A total of 1967 children aged 6-59 mo successfully treated for MAM in rural Malawi following randomized treatment with corn-soy blend plus milk  and oil (CSB++), soy ready-to-use supplementary food (RUSF), or soy/whey RUSF were followed for 12 mo. The initial supplementary food was given until the child reached a weight-for-height Z-score (WHZ) >-2. The median duration of feeding was 2 wk, with a maximum of 12 wk.

The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++.The primary outcome, remaining well-nourished, was defined as mid-upper arm circumference ≥12.5 cm or WHZ ≥-2 for the entire duration of follow-up.

During the 12-mo follow-up period, only 1230 (63%) children remained well-nourished, 334 (17%) relapsed to MAM, 190 (10%) developed severe acute malnutrition, 74 (4%) died, and 139 (7%) were lost to follow-up.

Children who were treated with soy/whey RUSF were more likely to remain well-nourished (67%) than those treated with CSB++ (62%) or soy RUSF (59%) (P = 0.01).

A seasonal pattern of food insecurity and adverse clinical outcomes was observed. This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished; however, all children successfully treated for MAM remain vulnerable.

 

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Six-Month Mortality among HIV-Infected Adults Presenting for Antiretroviral Therapy with Unexplained Weight Loss, Chronic Fever or Chronic Diarrhea in Malawi

In Under-nutrition on November 25, 2012 at 8:14 am

by Monique van Lettow, Ann Åkesson, Alexandra L. C. Martiniuk, Andrew Ramsay, Adrienne K. Chan, Suzanne T. Anderson, Anthony D. Harries, Elizabeth Corbett, Robert S. Heyderman, Rony Zachariah, Richard A. Bedell

from PLOs November 19, 2012

(downlowad the paper)

 

Abstract

Background

In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART). We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy.

Methods

A prospective cohort study was conducted in Malawi, investigating mortality in relation to ART uptake, microbiological findings and treatment of opportunistic infection (OIs), 6 months after meeting ART eligibility criteria.

Results

Of 469 consecutive adults eligible for ART, 74(16%) died within 6 months of enrolment, at a median of 41 days (IQR 20–81). 370(79%) started ART at a median time of 18 days (IQR 7–40) after enrolment. Six-month case-fatality rates were higher in patients with OIs; 25/121(21%) in confirmed/clinical TB and 10/50(20%) with blood stream infection (BSI) compared to 41/308(13%) in patients with no infection identified. Median TB treatment start was 27 days (IQR 17–65) after enrolment and mortality [8 deaths (44%)] was significantly higher among 18 culture-positive patients with delayed TB diagnosis compared to patients diagnosed clinically and treated promptly with subsequent culture confirmation [6/34 (18%);p = 0.04]. Adjusted multivariable analysis, excluding deaths in the first 21 days, showed weight loss >10%, low CD4 count, severe anemia, laboratory-only TB diagnosis, and not initiating ART to be independently associated with increased risk of death.

Conclusions

Mortality remains high among chronically ill patients eligible for ART. Prompt initiation of ART is vital: more than half of deaths were among patients who never started ART. Diagnostic and treatment delay for TB was strongly associated with risk of death. More than half of deaths occurred without identification of a specific infection. ART programmes need access to rapid point-of-care-diagnostic tools for OIs. The role of early empiric OI treatment in this population requires further evaluation in clinical trials.

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Predictors of stunting, wasting and underweight among Tanzanian children born to HIV-infected women

In Under-nutrition on October 24, 2012 at 7:52 am

McDonald CMKupka RManji KPOkuma JBosch RJAboud SKisenge RSpiegelman DFawzi WWDuggan CP.

Eur J Clin Nutr. 2012 Oct 3

Abstract

Background/Objectives: Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized.

The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months.

Subjects/Methods: Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant’s birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight.

Results: A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted.

Conclusions: Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women.

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Nutrition e-Education – Univ. of Southampton / Fac. of Medicine

In Over-nutrition, Under-nutrition on October 23, 2012 at 7:43 am

From the University of Southampton, Faculty of Medicine

 

Nutrition Portal is the first eLearning site dedicated to nutrition and public health nutrition learning in the UK. It is hosted by the Faculty of Medicine at the University of Southampton.

“The Portal has enabled comprehensive training needs analyses to be undertaken with front line public health practitioners for whom nutrition is a component of their work, and discussion between the Department of Health and academics to ensure the courses meet workforce needs.

“The Portal evolved out of the recognition that nutrition is central to health promotion, disease prevention and effective care and is a key element of government policy. Policy, however, can only be effective if the workforce is able to meet the needs and deliver effective nutrition in public health. Current and future health care professionals, be they doctors, nurses, community pharmacists or other health care professionals, must be equipped to deliver consistent and standardised information.

“The eLearning is delivered through interactive, multimedia courses that are validated by key professional bodies. They been developed to train health care professionals in the underlying principles of nutrition and to develop their competency in applying their knowledge to their workplace setting.”

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Development, acceptability, and nutritional characteristics of a low-cost, shelf-stable supplementary food product for vulnerable groups in Kenya

In Uncategorized, Under-nutrition on October 15, 2012 at 8:14 am

 Kunyanga, Catherine; Imungi, Jasper; Okoth, Michael; Vadivel, Vellingiri; Biesalski, Hans Konrad

Food & Nutrition Bulletin, Volume 33, Number 1, March 2012 , pp. 43-52(10)

Abstract:

Background. Food-based approaches have been advocated as the best strategies to curb hunger and malnutrition in developing countries. The use of low-cost, locally available, nutritious foods in the development of supplementary foods has been recommended.

 Objective. To develop low-cost food supplements using different traditionally processed local foods, consisting of cereals, legumes, nuts, fish, and vegetables, to meet the nutrient requirements for vulnerable groups in Kenya.

 Methods. Four food supplements were developed and evaluated by taste panel procedures. The product containing amaranth grain, pigeon pea, sweet potato, groundnuts, and brown sugar was found to be the most acceptable supplement. Evaluation of nutritional composition, shelf-life, and cost analysis of the acceptable supplement was carried out to assess if it could satisfactorily provide more than 50% of the Recommended Dietary Allowances (RDAs) of the basic nutrients for vulnerable groups.

 Results. The acceptable supplement contained 453.2 kcal energy, 12.7 g crude protein, 54.3 g soluble carbohydrates, 20.8 g crude fat, and 10.1 g crude fiber per 110 g. The micronutrient contents were 93.0 mg calcium, 172.4 mg magnesium, 2.7 mg zinc, 5.7 mg iron, 0.8 mg vitamin B1, 0.2 mg vitamin B2, 7.9 mg niacin, 100 μg folic acid, and 140 μg retinol equivalent per 110 g. The supplement also contained 21% total essential amino acid in addition to appreciable levels of palmitic, stearic, oleic, linoleic, and α-linolenic fatty acids. The shelf-life study showed that it could be stored in different packaging materials (polythene bags, gunny bags, and kraft paper) at 26°C without deleterious effects on its chemical composition for up to 4 months. Cost analysis of the supplement indicated that the product could be competitively sold at US$0.812/kg (KES 65.50/kg).

 Conclusions. Locally available indigenous foods can be used in the formulation of acceptable, low-cost, shelf-stable, nutritious supplementary foods for vulnerable groups.

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Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood (n=7,837)

In Under-nutrition on September 28, 2012 at 9:26 am

Annet F.M. van AbeelenSjoerd G. EliasPatrick M.M. BossuytDiederick E. GrobbeeYvonne T. van der SchouwTessa J. Roseboom and Cuno S.P.M. Uiterwaal

in Diabetes. 2012 Sep;61(9):2255-60

Abstract

The developmental origins hypothesis proposes that undernutrition during early development is associated with an increased type 2 diabetes risk in adulthood.

We investigated the association between undernutrition during childhood and young adulthood and type 2 diabetes in adulthood. We studied 7,837 women from Prospect-EPIC (European Prospective Investigation Into Cancer and Nutrition) who were exposed to the 1944-1945 Dutch famine when they were between age 0 and 21 years. We used Cox proportional hazards regression models to explore the effect of famine on the risk of subsequent type 2 diabetes in adulthood. We adjusted for potential confounders, including age at famine exposure, smoking, and level of education.

Self-reported famine exposure during childhood and young adulthood was associated with an increased type 2 diabetes risk in a dose-dependent manner. In those who reported moderate famine exposure, the age-adjusted type 2 diabetes hazard ratio (HR) was 1.36 (95% CI [1.09-1.70]); in those who reported severe famine exposure, the age-adjusted HR was 1.64 (1.26-2.14) relative to unexposed women. These effects did not change after adjustment for confounders.

This study provides the first direct evidence, using individual famine exposure data, that a short period of moderate or severe undernutrition during postnatal development increases type 2 diabetes risk in adulthood.

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Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study

In Over-nutrition on September 24, 2012 at 3:47 pm

by Mohsen Nematy, Maryam Alinezhad-Namaghi, Masoud mahdavi Rashed, Mostafa Mozhdehifard, Seyedeh Sania Sajjadi, Saeed Akhlaghi, Maryam Sabery, Seyed Amir R Mohajeri, Neda Shalaey, Mohsen Moohebati and Abdolreza Norouzy

Nutrition Journal 2012, 11:69 – Published: 10 September 2012

(download the provisional entire paper)

Abstract (provisional)

Background

Previous research has shown that Ramadan fasting has beneficial effects on cardiovascular risk factors, however there are controversies. In the present study, the effect of Ramadan fasting on cardiovascular risk factors has been investigated.

Method

This is a prospective observational study that was carried out in a group of patients with at least one cardiovascular risk factor (including history of documented previous history of either coronary artery disease (CAD), metabolic syndrome or cerebro-vascular disease in past 10 y). Eighty two volunteers including 38 male and 44 female, aged 29–70 y, mean 54.0 [PLUS-MINUS SIGN] 10 y, with a previous history of either coronary artery disease, metabolic syndrome or cerebro-vascular disease were recruited. Subjects attended the metabolic unit after at least 10 h fasting, before and after Ramadan who were been fasting for at least 10 days. A fasting blood sample was obtained, blood pressure was measured and body mass index (BMI) was calculated. Lipids profile, fasting blood sugar (FBS) and insulin, homocysteine (hcy), high-sensitivity C-reactive protein (hs-CRP) and complete blood count (CBC) were analyzed on all blood samples.

Results

A significant improvement in 10 years coronary heart disease risk (based on Framingham risk score) was found (13.0 [PLUS-MINUS SIGN] 8 before Ramadan and 10.8 [PLUS-MINUS SIGN]7 after Ramadan, P <0.001, t test).There was a significant higher HDL-c, WBC, RBC and platelet count (PLT), and lower plasma cholesterol, triglycerides, LDL-c, VLDL-c, systolic blood pressure, body mass index and waist circumference after Ramadan (P <0.05, t test). The changes in FBS, insulin,Homeostasis Model Assessment Insulin Resistance (HOMA-IR), hcy, hs-CRP and diastolic blood pressure before and after Ramadan were not significant (P >0.05, t test).

Conclusions

This study shows a significant improvement in 10 years coronary heart disease risk score and other cardiovascular risk factors such as lipids profile, systolic blood pressure, weight, BMI and waist circumference in subjects with a previous history of cardiovascular disease.

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Unexpected evidence: “Hunter-Gatherer Energetics and Human Obesity”

In Over-nutrition on September 21, 2012 at 9:31 am

Herman Pontzer, David A. Raichlen, Brian M. Wood,Audax Z. P. Mabulla, Susan B. Racette, Frank W. Marlowe

PLoS ONE 7(7) 2012 

(download the entire paper)

Abstract

Western lifestyles differ markedly from those of our hunter-gatherer ancestors, and these differences in diet and activity level are often implicated in the global obesity pandemic. However, few physiological data for hunter-gatherer populations are available to test these models of obesity.

In this study, we used the doubly-labeled water method to measure total daily energy expenditure (kCal/day) in Hadza hunter-gatherers to test whether foragers expend more energy each day than their Western counterparts.

As expected, physical activity level, PAL, was greater among Hadza foragers than among Westerners. Nonetheless, average daily energy expenditure of traditional Hadza foragers was no different than that of Westerners after controlling for body size. The metabolic cost of walking (kcal kg−1 m−1) and resting (kcal kg−1 s−1) were also similar among Hadza and Western groups.

The similarity in metabolic rates across a broad range of cultures challenges current models of obesity suggesting that Western lifestyles lead to decreased energy expenditure. We hypothesize that human daily energy expenditure may be an evolved physiological trait largely independent of cultural differences.

 

Find more about obesity on this blog.

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Development of a crossover-randomized trial method to determine the acceptability and safety of novel ready-to-use therapeutic foods (ahead of print)

In Under-nutrition on September 19, 2012 at 5:07 pm

by Dibari F, Bahwere P, Huerga H, Irena AH, Owino V, Collins S, Seal A.

Nutrition (article in press).

Abstract

Objective: To develop a method for determining the acceptability and safety of ready-to-use therapeutic foods (RUTF) before clinical trialing. Acceptability was defined using a combination of three consumption, nine safety, and six preference criteria. These were used to compare a soy/maize/sorghum RUTF (SMS-RUTFh), designed for the rehabilitation of human immunodeficiency virus/tuberculosis (HIV/TB) wasted adults, with a peanut-butter/milk-powder paste (P-RUTF; brand: Plumpy’nut) designed for pediatric treatment.

Methods: A cross-over, randomized, controlled trial was conducted in Kenya. Ten days of repeated measures of product intake by 41 HIV/TB patients, >18 y old, body mass index (BMI) 18-24 kg/m^2, 250 g were offered daily under direct observation as a replacement lunch meal. Consumption, comorbidity, and preferences were recorded.

Results: The study arms had similar age, sex, marital status, initial BMI, and middle upper-arm circumference. No carryover effect or serious adverse events were found. SMS-RUTFh energy intake was not statistically different from the control, when adjusted for BMI on day 1, and the presence of throat sores. General preference, taste, and sweetness scores were higher for SMS-RUTFh compared to the control (P < 0.05). Most consumption, safety, and preference criteria for SMS-RUTFh were satisfied except for the average number of days of nausea (0.16 versus 0.09 d) and vomiting (0.04 versus 0.02 d), which occurred with a higher frequency (P < 0.05).

Conclusion: SMS-RUTFh appears to be acceptable and can be safely clinically trialed, if close monitoring of vomiting and nausea is included. The method reported here is a useful and feasible approach for testing the acceptability of ready-to-use foods in low income countries.

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