Dissertations / Theses on the topic 'Protein-Energy Malnutrition'

Malaria and malnutrition are causes of high morbidity and mortality in developing countries especially in sub-Saharan Africa and Asia. Malnourished children are at higher risk of developing malaria, a problem compounded by the fact that malnutrition affects the metabolism of different antimalarials including chloroquine and quinine. Emerging resistance to chloroquine, which was the drug of choice, has led to the widespread use of artemisinin combination therapy in the population including children. To date, no studies have been undertaken on the pharmacokinetics of artemisinin compounds in malnourished children. This thesis aims to fill this evidence gap by studying patients with uncomplicated malaria of different nutritional status in The Gambia. Analysis of the nutritional status of 97 children in The Gambia with uncomplicated malaria showed that 30% were both underweight and wasting, while 28% were categorised into stunting. This was much higher than the national average which has been estimated to be 17.4%, 9.5% and 23% for underweight, wasting and stunting, respectively, demonstrating a potential relationship between malaria and Protein energy malnutrition. In-vitro studies showed that although pre-treatment of HL-60 cells with the iron chelator (DFO) did not affect the bioactivation of artesunate, there was a 20% increase in cell viability with IC50 increasing from 7.0 ± 4.3 to 33.3 ± 2.9. This is believed to be as a result of DFO chelating the toxic iron generated as a result of artesunate bioactivation which increased from 0.32 ± 0.6 ng/mol in the control incubations to 0.84 ± 0.1ng/mol at 100 μmol artesunate concentration. In light of the fact that iron was important in the mechanism of action of these compounds, and the fact that iron deficiency is commonly in malnourished children, the effect of both PEM and anaemia on plasma drug levels of artemether and DHA was also studied. LC-MS/MS method was optimised and validated for the simultaneous analysis of artemether and DHA in plasma with ≥80% precision and accuracy. Plasma artemether and DHA concentration analysed 2h post first dose was 138.4 ± 80.9 ng/ml and 58.8 ± 43.7 ng/ml respectively. Severely wasted and wasted children had the highest artemether (156.5 ±69.6 ng/ml) and DHA (84.1 ±62.6) plasma concentrations respectively but values were not statistically significant. Anaemic status of children did not have an influence on drug plasma concentration with anaemic children having artemether and DHA plasma concentration of 138.5 ± 73.7 and 57.9 ± 36.6, respectively, and 138.43 ± 85.3 and 59.3 ± 46.8 for non-anaemic children respectively. However, conclusive results were limited by sample size. In conclusion, this thesis has demonstrated a relationship between malaria and Protein energy malnutrition, and highlighted the possible effects pathophysiological changes as a result of protein energy malnutrition can have on drug pharmacology and therapeutic effects in these children. There is a need for further studies in larger cohorts of children with protein energy malnutrition to determine whether therapeutic efficacy of artemisinin combination therapy is affected in an adverse manner, and whether there is a need for changes in dosing recommendations.

Introduction and Background Aventure AB has created a "between-meal beverage" with high protein and energy content aimed at older and/or physically active individuals. Aventure AB wished to transform this high energy drink to a plant-based product, because of the growing trend of plant-based diets. Aim The aim of this project was to replace the protein source in the beverage ”Skaka & smaka - strawberry taste”, while maintaining good flavour and texture. The original beverage contains whey protein, which was to be replaced with a vegetable source. Materials and methods A new plant-based beverage was developed from the original recipe. Four different alternative protein sources were added and evaluated with regard to taste, visual look, pH, dry matter, viscosity, brix, protein and energy content. To beverages based on different protein sources, four different juice concentrates were added in varying combinations and concentrations. Aromas were also added and a change of the fruit-purée recipe was made. The salt concentration was modified. The final product was evaluated through a consumer sensory analysis at a sports centre in Lund. The participants were asked to judge it by first impression, colour, odour, flavour, texture and overall impression on a 9-point hedonic scale. 76 individuals participated and compared the original beverage with the new plant-based one. Results and Discussion A beverage containing pea protein with a combination of a new fruit purée with a reduced amount of strawberries but an increased amount of bananas was selected as the most promising candidate. Further improvement of this beverage included addition of a juice concentrate mixture (6 mL/100 g), containing 50 % apple concentrate + 50 % lime concentrate. The salt content in the beverage was 0.03 g salt/100 g beverage. The sensory analysis revealed a significant difference regarding the first impression and flavour in favour of the original beverage, while a significant difference in colour appeared in favour of the new one containing pea protein. 19.6 % of the participating women, and 22.5 % of the men claimed that they would buy the new plant-based beverage. Conclusion A plant-based version of Skaka & smaka has been developed, and the sensory analysis indicates that the new product has potential on today's market. However, the beverage requires further development to satisfy all the needs within the target group.

Malnutrition is one of the serious childhood problems that affect children under five (5) years of age, and is common in developing countries Botswana included. The aim of this study was to explore the perceptions of mothers of children diagnosed with malnutrition in Botswana, specifically at Sekgoma Memorial Hospital, Serowe. The said hospital is a district hospital which renders services to Serowe community and the surrounding villages, as such; participants in this study were from Serowe and other surrounding villages like Mabou, Tshimoyapula, Mmashoro and Mogorosi. Applied research was used as a type of research because it is associated with the researcher’s motivation to assist in solving a particular problem facing a particular community. Collective case study was used as a research design. The researcher explored the perceptions of mothers regarding child malnutrition; through the use of semi-structured interviews. Twelve (12) mothers of children with malnutrition were interviewed using systematic random sampling method and subsequently data was analysed according to Creswell’s model. Literature study was done and the following aspects were discussed: Child malnutrition in developing countries; child malnutrition in Botswana; description of child malnutrition; causes of child malnutrition; symptoms of child malnutrition; treatment of child malnutrition; prevention of child malnutrition; psychosocial implications of child malnutrition on the patient, family and community and social work intervention (therapy and prevention). Literature was also compared with research findings when analysing data. The study revealed that mothers had limited knowledge on malnutrition as a condition, the signs and symptoms thereof; causes; prevention and treatment of child malnutrition. This lack of knowledge made mothers to have wrong perceptions about child malnutrition. It was revealed that mothers did not perceive malnutrition as a serious problem that can result in admission for treatment in a hospital, they expected a different diagnosis. They perceive malnutrition as a secondary diagnosis. The majority of mothers had a Setswana diagnosis for their children’s condition. Mothers perceived the signs and symptoms of malnutrition as those of Thibamo, Phogwana (fontanel), or Ntsana. They interpret malnutrition as a Setswana ailment that can be treated traditionally. Factors that were identified to be contributing to malnutrition among children at Sekgoma Memorial Hospital in Serowe were found to be; lack of knowledge about malnutrition, wrong perceptions of malnutrition by mothers, illiteracy and unemployment, and cultural factors like taking a child to a traditional healer instead of a medical health facility. The study shows that mothers’ social functioning is disrupted by their children’s illness and hospitalization and thus a need for support from the hospital multi-disciplinary team, especially the social worker who is a trained counselor. The social worker should provide ongoing supportive counseling during the process of the child’s illness.
Dissertation (MSW)--University of Pretoria, 2010.
Social Work and Criminology
Unrestricted

As of today, there is a challenge amongst the elderly to get the energy they need. Malnutrition is a fact for too many and protein is one of the most common deficiencies among macronutrients in this age group. Another group, also in the need of extra energy and protein, are those with a higher level of physical activity. Aventure AB in Lund, Sweden, has earlier developed an “in between meal beverage”, based on oats, with high energy and protein content called “Skaka & Smaka”. This beverage has with promising results been distributed to selected hospitals in Sweden as a pilot-trial. As an expansion of this product, Aventure wanted to create an oat-based, energy dense stirred yogurt. The aim of this study was to investigate the feasibility of addition of different protein sources to create an energy dense stirred yogurt with good texture and a balance of macronutrients. Four different types of protein sources were, separately or in combination, added to the original recipe of “Skaka & Smaka” (without added flavour), after which it was fermented and evaluated regarding sensory and physio-chemical properties. Three different fruit purée mixtures were added separately to the fermented oat-base in different proportions and evaluated by taste, color and flavour intensity. Salt concentration was adjusted and two final products were developed and evaluated through a sensory consumer test, at two different retirement homes in Hässleholm, Sweden. To measure the participants opinions a 9-point hedonic scale was used and attributes evaluated were first impression, color, taste, consistency, thickness, spoonability and total impression. All of the 11 individuals who participated were at the age of 75 and over, where of 2 were men and 9 were women. The proportions of added protein in the two final products were 10% casein and 90% whey. The two selected fruit purées, “skogen” and “havet”, were added in the concentration of 30%. The addition of salt was increased with 100%, resulting in a final concentration of 0.08 g per 100 grams. The sensory analysis revealed no statistical significance between any of the related attributes of the two yogurts. The attribute most important for general liking was taste, followed by texture and color.    Seven individuals (64%) said they could consume this kind of product a few times a week and all participants thought that there was a need for this kind of product. The two yogurts developed in this project, “skogen” and “havet”, and the concept behind them seem to have good potential for consumer liking, though further development of taste and texture is needed.
Som det ser ut idag så finns det en utmaning bland de äldre att få i sig den energi de behöver. Undernäring är ett faktum för allt för många och protein är en av de vanligaste bristerna bland makronäringsämnena inom denna åldersgrupp.    En annan grupp som också är i behov av extra energi och protein är de med en hög fysisk aktivitetsnivå. Aventure AB i Lund, Sverige, har tidigare utvecklat en mellanmåls dryck, baserad på havre, med ett högt energi- och proteininnehåll, kallad ”Skaka & Smaka”. Denna dryck har i ett pilot försök och med lovande resultat distribuerats till flertalet utvalda sjukhus i Sverige. Som en vidareutveckling av denna produkt ville Aventure skapa en havrebaserad, energität, rörd yoghurt. Syftet med denna studie var att undersöka geomförbarheten i tillsättning av olika proteinkällor för att skapa en energität, rörd yoghurt med bra konsistens och en balans av makronäringsämnen. Fyra olika typer av proteinkällor tillsattes, separat eller i kombination, till originalreceptet för ”Skaka & Smaka” (utan tillsatt smak), vartefter blandningen fermenterades och utvärderades utifrån sensoriska och fysio-kemikaliska egenskaper. Tre olika fruktpurée blandningar tillsattes separat till den fermenterade havrebasen i olika proportioner och utvärderades utifrån smak, färg och smakintensitet. Saltkoncentrationen justerades och två slutliga produkter utvecklades och utvärderades genom ett sensoriskt konsumenttest, vid två olika äldreboenden i Hässleholm, Sverige. För att mäta deltagarnas åsikter användes en 9-punkt hedonisk skala och de attribut som utvärderades var första intryck, färg, smak, konsistens, tjockhet, skedbarhet och totalt intryck. Alla de 11 individer som deltog var av ålder 75 och över, varav två var män och nio var kvinnor. Proportionerna av tillsatt protein i de två slutliga produkterna var 10% kasein och 90% vassle. De två valda fruktpuréerna, ”skogen” och ”havet”, tillsattes i en koncentration på 30%. Tillsatsen av salt ökades med 100%, vilket resulterade i en slutlig koncentration på 0.08g per 100 gram. Den sensoriska analysen visade inte på någon statistisk signifikant skillnad mellan de relaterade attributen för de två olika yoghurtarna. Attributen som var av störst vikt för generellt tycke var smak, följt av konsistens och färg. Sju individer (64%) sa att de kunde konsumera en produkt som denna ett par gånger i veckan och alla deltagande tyckte att det fanns ett behov av en produkt som denna. De två yoghurtarna som utvecklades i detta projekt, ”skogen” och ”havet”, och det bakomliggande konceptet tycks ha god potential bland konsumenter, men vidare utveckling av smak och konsistens är nödvändigt.

Protein Energy Malnutrition (PEM) due to under nutrition is a major public health problem among children in Africa and other developing countries. Sorghum and bread wheat, which are important dietary staples in the semi-arid tropics of Africa, are suitable vehicles for delivering proteins to alleviate PEM. Formulation of foods from these low-lysine staples fortified with legumes is a sustainable approach to improve the protein nutritional quality of foods for young children. Biscuits offer a valuable vehicle for fortification as they are nutrient dense, ready-to-eat, have a long shelf-life and are popular. Therefore, this study investigated the effect of complementing sorghum and bread wheat with defatted soy flour on the nutritional and sensory quality and consumer acceptability of biscuits. Biscuits were formulated and developed by compositing sorghum and bread wheat flours with defatted soy flour at different ratios. To establish the nutritional characteristics of biscuits, proximate composition, lysine and reactive lysine contents and in vitro protein digestibility were determined. Protein Efficiency Ratio (PER), Food Efficiency Ratio (FER) True Digestibility and Biological Value (BV) of sorghum biscuits were determined using Sprague Dowley weanling male rats. The sensory characteristics of biscuits were evaluated using a descriptive panel and instrumental texture analysis. Acceptability was evaluated using eight to nine year old school children. Compared to the 100% cereal biscuits, sorghum-soy and bread wheat-soy composite biscuits in a 1:1 ratio had at least double the protein, mineral and crude fibre contents. The lysine contents of biscuits increased by 500-700%. For the sorghum-soy biscuits, in vitro protein digestibility increased by 170% and Protein Digestibility Corrected Amino Acid Score (PDCAAS) was 8 times higher. Two such biscuits of 28 g each could provide 50% of the recommended daily protein intake for 3 to 10 year olds. In the animal study, PER and FER for sorghum-soy biscuits were equivalent to the reference casein. True Digestibility was high for all diets, 85 to 95% and BV of sorghum biscuits was higher than sorghum-soy diet by 20%. Principal Component Analysis (PCA) revealed that 61% and a further 33% of the variation in sensory properties was due to the type of cereal and concentration of soy in biscuits, respectively. Maximum stress increased by 39% and 34% in sorghum-soy and bread wheat-soy biscuits, respectively at 1:1 ratio. Spread factor of biscuits increased by 7 to 32%. Biscuits were darker in colour (reduced L* value) by 14 to 56% and hardness increased by 84% in sorghum biscuits. Positive hedonic scores by 8 to 9 year old school children for fortified biscuits were sustained above 80% through 8 consumption occasions. This data shows that fortifying with defatted soy flour imparts positive sensory characteristics associated with biscuits to sorghum and bread wheat biscuits and the acceptance of such biscuits may be sustained over an extended period of time. This study indicates that soy fortified sorghum and bread wheat biscuits have high nutrient density, protein quality, positive sensory properties and high acceptability if consumed over an extended period. Hence, the biscuits have great potential as protein-rich supplementary foods to alleviate PEM among children and to provide an income to small holder farmers in rural African communities through purchase of grain for the Home Grown School Feeding Programme.
Thesis (PhD)--University of Pretoria, 2011.
Food Science
unrestricted

Made available in DSpace on 2014-06-11T19:30:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-03-08Bitstream added on 2014-06-13T20:21:28Z : No. of bitstreams: 1 000739144.pdf: 33924077 bytes, checksum: 26a331637fe3fc03cecbf7d8dfd983e6 (MD5)
A programação fetal por restrição proteica materna durante a gestação (PFG) torna o feto exposto a altas concentrações de hormônios maternos, predispõe o indivíduo a desenvolver síndrome metabólica, diminui a taxa de fertilidade e altera o tempo de instalação da puberdade. No entanto, pouca atenção tem sido destinada ao estudo dos efeitos da PFG sobre o desenvolvimento do sistema reprodutor masculino, particularmente a próstata que além de sua importância para a fertilidade apresenta alta incidência de doenças na idade adulta e senil. Assim, este projeto teve por objetivo investigar os impactos da PFG sobre o desenvolvimento da próstata e se a PFG promove o imprinting estrogênico na próstata. Para isso, ratos Wistar nascidos de ratas alimentadas com dieta padrão (grupo NP, dieta AIN93G contendo 17% de proteína) ou dieta com restrição proteica (grupo RP, dieta AIN93G modificada contendo 6% de proteína) foram divididos em três experimentos. Experimento 1: os lobos prostáticos ventral (PV) e dorsolateral (PDL) foram coletados de animais NP e RP sacrificados com 30, 120 e 360 dias para a padronização do modelo experimental e a descrição dos efeitos da PFG sobre o desenvolvimento, crescimento, maturação e envelhecimento da próstata. Experimento 2: as PV e PDL de animais NP e RP (17 semanas de idade) expostos durante 17 semanas aos hormônios testosterona e estradiol (implante subcutâneo com liberação diária de 0,08 mg de 17b-estradiol e 0,8 mg de propionato de testosterona) foram coletadas no intuito de avaliar se a PFG desencadeou imprinting hormonal e tornou a próstata mais susceptível a afecções na idade adulta. Experimento 3: animais NP e RP submetidos a castração cirúrgica ou castração química (0,08 mg/kg/dia de 17b-estradiol) ou suplementação androgênica (4 mg/kg/dia de cipionato de testosterona) tiveram a PV coletada para investigar se o imprinting hormonal desencadeado...
The fetal programming by maternal protein malnutrition (MPM) makes the fetus exposed to high concentrations of maternal hormones, predisposes individuals to develop metabolic syndrome, reduces the fertility rate and changes the time of onset of puberty. However, little attention has been devoted to studying the effects of MPM on the development of the male reproductive system, particularly the prostate that besides its importance for fertility, it has high incidence of disease in adulthood and senile. In this sence, the study aimed to investigate the impacts of MPM on development of the prostate and if the MPM is able to promote the estrogen imprinting in the prostate. For this, Wistar rats born from rats fed with standard diet (NP group, AIN93G diet = 17% protein) or a restricted protein diet (RP group, AIN93G modified diet = 6% protein) were divided into three experiments. Experiment 1: ventral prostate (VP) and dorsolateral (DLP) were collected from NP and RP animals sacrificed with 30, 120 and 360 days for the standardization of the experimental model and description of the PFG effects on prostate development, growth and maturation aging. Experiment 2: VP and the DLP from NP and RP animals (17 weeks-old) that were exposed for 17 weeks to hormones testosterone plus estradiol (subcutaneous implant of 0.08 mg of 17b-estradiol and 0.8 mg propionate testosterone day-release) were collected in order to assess whether the MPM triggered hormonal imprinting and become more susceptible to prostate disorders in adulthood. Experiment 3: VP from NP and RP animals underwent to surgical castration or chemical castration (0.08 mg/kg/day 17b-estradiol) or androgen supplementation (4 mg/kg/day of testosterone cypionate) were collected to investigate whether hormonal imprinting triggered by PFG changed the pattern of glandular response to these manipulations. Once dissected, the prostates were processed for ...

Orientador: Sérgio Luis Felisbino
Coorientador: Luis Antonio Justulin Júnior
Banca: Estela Sasso Cerri
Banca: Sebastião Roberto Taboga
Banca: Raquel Fantin Domeniconi
Banca: Maria de Fátima Magalhães Lazari
Banca: Rejane Maira Goes
Banca: Cleida Aparecida Oliveira
Banca: Patricia Fernanda Felipe Pinheiro
Banca: Wellerson Rodrigo Scarano
Banca: Wagner José Fávaro
Resumo: A programação fetal por restrição proteica materna durante a gestação (PFG) torna o feto exposto a altas concentrações de hormônios maternos, predispõe o indivíduo a desenvolver síndrome metabólica, diminui a taxa de fertilidade e altera o tempo de instalação da puberdade. No entanto, pouca atenção tem sido destinada ao estudo dos efeitos da PFG sobre o desenvolvimento do sistema reprodutor masculino, particularmente a próstata que além de sua importância para a fertilidade apresenta alta incidência de doenças na idade adulta e senil. Assim, este projeto teve por objetivo investigar os impactos da PFG sobre o desenvolvimento da próstata e se a PFG promove o imprinting estrogênico na próstata. Para isso, ratos Wistar nascidos de ratas alimentadas com dieta padrão (grupo NP, dieta AIN93G contendo 17% de proteína) ou dieta com restrição proteica (grupo RP, dieta AIN93G modificada contendo 6% de proteína) foram divididos em três experimentos. Experimento 1: os lobos prostáticos ventral (PV) e dorsolateral (PDL) foram coletados de animais NP e RP sacrificados com 30, 120 e 360 dias para a padronização do modelo experimental e a descrição dos efeitos da PFG sobre o desenvolvimento, crescimento, maturação e envelhecimento da próstata. Experimento 2: as PV e PDL de animais NP e RP (17 semanas de idade) expostos durante 17 semanas aos hormônios testosterona e estradiol (implante subcutâneo com liberação diária de 0,08 mg de 17b-estradiol e 0,8 mg de propionato de testosterona) foram coletadas no intuito de avaliar se a PFG desencadeou imprinting hormonal e tornou a próstata mais susceptível a afecções na idade adulta. Experimento 3: animais NP e RP submetidos a castração cirúrgica ou castração química (0,08 mg/kg/dia de 17b-estradiol) ou suplementação androgênica (4 mg/kg/dia de cipionato de testosterona) tiveram a PV coletada para investigar se o imprinting hormonal desencadeado ...
Abstract: The fetal programming by maternal protein malnutrition (MPM) makes the fetus exposed to high concentrations of maternal hormones, predisposes individuals to develop metabolic syndrome, reduces the fertility rate and changes the time of onset of puberty. However, little attention has been devoted to studying the effects of MPM on the development of the male reproductive system, particularly the prostate that besides its importance for fertility, it has high incidence of disease in adulthood and senile. In this sence, the study aimed to investigate the impacts of MPM on development of the prostate and if the MPM is able to promote the estrogen imprinting in the prostate. For this, Wistar rats born from rats fed with standard diet (NP group, AIN93G diet = 17% protein) or a restricted protein diet (RP group, AIN93G modified diet = 6% protein) were divided into three experiments. Experiment 1: ventral prostate (VP) and dorsolateral (DLP) were collected from NP and RP animals sacrificed with 30, 120 and 360 days for the standardization of the experimental model and description of the PFG effects on prostate development, growth and maturation aging. Experiment 2: VP and the DLP from NP and RP animals (17 weeks-old) that were exposed for 17 weeks to hormones testosterone plus estradiol (subcutaneous implant of 0.08 mg of 17b-estradiol and 0.8 mg propionate testosterone day-release) were collected in order to assess whether the MPM triggered hormonal imprinting and become more susceptible to prostate disorders in adulthood. Experiment 3: VP from NP and RP animals underwent to surgical castration or chemical castration (0.08 mg/kg/day 17b-estradiol) or androgen supplementation (4 mg/kg/day of testosterone cypionate) were collected to investigate whether hormonal imprinting triggered by PFG changed the pattern of glandular response to these manipulations. Once dissected, the prostates were processed for ...
Doutor

This research is one of the first trials to evaluate the effectiveness of tailored nutritional counselling in treating malnutrition in outpatients with COPD. Nearly three-quarters of outpatients in Vietnam were identified with malnutrition. This research identified that malnutrition in COPD patients was associated with adverse health outcomes and that tailored nutritional counselling could modify malnutrition status by changing eating behaviours and dietary intake of patients. It emphasized the important role of dietitians in developing appropriate food-based strategies tailored to individual circumstances to promote weight gain, prevent weight loss, improve nutritional status, functional outcomes, and quality of life for COPD patients. While undertaken in Vietnam, the results may be applicable globally with implications of clinical nutrition practice.

Protein energy malnutrition (PEM) is a range of pathological conditions arising from coincident deficiency of proteins and calories in varying proportions occurring mostly in infants and young children.
According to Welcome classification, PEM is classified into mild form (underweight) and severe form (marasmus, kwashiorkor or marasmic kwashiorkor) (Wellcome, 1970).
The assessment of nutritional condition may be done through clinical examination, anthropometric measures or biochemical tests.
The insulin-like growth factors (IGFS), are defined as polypeptide growth factors secreted by the liver and other tissues in response to stimulation by growth hormone (GH) (Guyton, 1996).
In humans, there are two main forms of IGFS: Irsulin-like growth foctor-1 (IGF-1) and insulin-like growth foctor-11 (IGF-11). The most important of these is IGF-1, its synthesis is GH dependent, and its plasma levels are very sensitive to changes in GH availability (Berne et al, 1998).
The IGFS circulate in plasma in complex with a family of binding proteins that extend the serum half-life of the IGF peptides, transport the IGFS to target cells and modulate the interaction of the IGFS with surface membrane receptors (Reiter and Rosenfeld, 1998).
There are six IGF - binding proteins (IGFBPS) designated IGFBP-1 to IGFBP-6. They are designated on the basis of their amino acid sequence (Berne et al, 1998).
IGFBP-1 is generating much interest, because it possesses properties that are a typical for a classical binding protein. It is an important modulator of IGF activities (Martina et al, 1997).
IGFBP-3 is the major IGFBP in the circulation (Boisclair et al, 2001).
The prealbumin is a protein synthesized by the liver. It plays an important role in the plasma transport of vitamin A, and also involved in the transport of thyroid hormones (Silverman and Christenson, 1994)
The aminoterminal peptide of procollagen, are removed during processing of collagen and released into the circulation. The level of procollagen peptides may provide a clinically useful index of growth (Raisz et al., 1998).
-Aim of work :
The aim of work is to evaluate serum levels of IGF-1 , IGFBP-1 , IGFBP-3 , prealbumin and aminoterminal propeptide of type 1 procollagen in malnourished children and demonstrate the effect of malnutrition on these parameters.

A desnutrição altera o sistema imunológico, freqüentemente modificando a resposta do hospedeiro frente a patógenos e predispondo o indivíduo à infecções. Neste trabalho, utilizando ensaios clonogênicos e imunofenotipagem, avaliamos os efeitos da desnutrição protéica em precursores hematopoéticos esplênicos. Camundongos Swiss Webster, machos, com dois a três meses de idade, foram alimentados com ração contendo 4% e 20% de proteína constituindo os grupos desnutridos e controle, respectivamente. A fonte protéica das rações foi a caseína. Os animais foram mantidos em gaioleiros metabólicos, sob temperatura ambiente de 22° a 25°C e ciclo de luz de 12 horas. A desnutrição experimental foi induzida após período de adaptação às condições do gaioleiro metabólico. O consumo de ração, de água e a variação do peso corporal inicial, foram avaliados a cada 48 horas. Após a perda de 20-25% do peso corpóreo inicial, foram colhidas amostras sangüíneas para a verificação do perfil hematológico, determinação das concentrações séricas de proteínas e da albumina. As células esplênicas foram colhidas para a realização do esplenograma, dos ensaios clonogênicos e da imunofenotipagem, utilizando-se painel de anticorpos monoclonais. Para a obtenção de progenitores granulocíticos (CFC-GM), empregou-se a associação dos fatores de crescimento G-CSF (1ng) e GM-CSF (0,1ng). A obtenção de progenitores granulocíticos e eritróides (CFC-Mix) se deu pela associação dos fatores de crescimento IL-3 (1ng) e EPO (5UI). Os resultados obtidos indicaram redução significativa no grupo desnutrido, do consumo de ração e peso corpóreo, das concentrações séricas de proteínas totais e albumina, bem como do volume do hematócrito, concentração de hemoglobina e do número global de leucócitos. A celularidade esplênica também apresentou redução significativa no grupo desnutrido, quando comparada a do grupo controle. Nos ensaios clonogênicos, o grupo desnutrido apresentou menor formação de \"clusters\" e de colônias frente aos fatores de crescimento utilizados. Na imunofenotipagem, o mesmo grupo apresentou aumento na percentagem de células CD34+, bem como de precursores linfóides T, identificados por anti CD2 e anti CD5 e de precursores linfóides B, identificados por anti CD19 e anti CD22. Estes resultados sugerem que a desnutrição protéica induz, in vivo, a redução das células primitivas e bloqueio maturativo em células precursoras esplênicas. Os ensaios clonogênicos indicaram que as células de animais desnutridos não respondem adequadamente aos fatores de crescimento, sugerindo alterações em receptores e, ou processos transducionais e, ou transcricionais.
Malnutrition usually affects the immune system, most of the times modifying the immunological response to pathogens, predisposing the individuals to infections. In this work the effect of protein malnutrition on splenic hematological precursors were investigated by clonogenic assays and immunephenotyping. Two months old male Swiss Webster mice were fed with chow containing 4% and 20% casein, respectively the deprived and the control groups. The animals were observed in metabolic cages, at 22-25° C and light-controlled during 12 hours. The experimental procedure was started after the animals were accustomed to the environment. The chow and water consumption as well as the weight were recorded every 48 hours. Soon after a 20-25% weight loss, blood samples were collected in order to determine hematological parameters, and serum protein and albumin. The splenic cells were collected and used to do the splenogram, clonogenic assays and immunephenotyping with monoclonal antibodies. Growth factors G-CSG (1 ng) and GM-CSF(0.1 ng) combination were employed to obtain the granulocytic progenitors CFC-GM. The growth factors IL-3 and EPO (5 UI) association were used to obtain the granulocytic and erythroid progenitors (CFC-Mix). The obtained data indicated significative reduction of weight, chow consumption, serum proteins, blood hematocrit, hemoglobin concentration and leucocytes in the deprived group. The deprived group splenic cellularity exhibited decrease in comparison to the control group as well. The clonogenic assays disclosed decreased formation of clusters and colonies at exposure to specific growth factors in the deprived group. In this group the immunephenotyping showed CD34+ cells increase, as well as linfoid T precursors, identified by anti CD2 and anti CD5, as well as linfoid B precursors, identified by anti CD19 and anti CD22. These data suggest that protein malnutrition leads, in vivo, to primitive cells reduction and progenitor cells maturative blocking. The clonogenic assays indicated that the hematopoietic cells from deprived animals did not respond to growth factors, suggesting that receptors, transduction and, or transcriptional modifications may have occurred.

A desnutrição proteico-energética (DPE) altera a hemopoese e, portanto, a geração de células imunológicas, bem como compromete o sistema imune. Desta forma, indivíduos desnutridos apresentam maior susceptibilidade a infecções. As células tronco mesenquimais (CTMs) possuem propriedades imunomodulatórias e são importantes na formação do estroma medular que sustenta a hemopoese. Visto que a L-glutamina (GLUT) é o aminoácido condicionalmente essencial mais consumido por CTMs, e que também apresenta capacidade imunomoduladora, investigou-se, neste trabalho, se a GLUT exerceria efeito sobre aspectos imunomodulatórios das CTMs em um modelo experimental de DPE. Para tanto, utilizou-se camundongos da linhagem BALB/c, os quais receberam rações normoproteica ou hipoproteica isocalóricas contendo, respectivamente, 12% e 2% de proteína por um período de 5 semanas. Após o isolamento e a caracterização de CTMs provenientes dos grupos controle (CTMct) e desnutrido (CTMdesn), cultivou-se essas células em 0, 0,6, 2 e 10mM GLUT, a fim de determinar a influência deste aminoácido sobre a expressão de fatores de transcrição e produção de citocinas por CTMct e CTMdesn. Adicionalmente, avaliou-se o efeito dos sobrenadantes das culturas de CTMct e CTMdesn sobre a proliferação e produção de citocinas por macrófagos e linfócitos esplênicos. Os animais desnutridos apresentaram anemia, leucopenia, hipoplasia medular e diminuição na concentração de proteínas séricas, albumina e préa-lbumina. A DPE não modificou a morfologia e o fenótipo das CTMs, bem como não alterou a expressão de proteínas reguladoras do ciclo celular. Por outro lado, a expressão de NFkB e STAT-3 e a produção de IL-1β, IL-6, IL-10 e TGF-β por CTMs foram alteradas pela DPE e variaram de acordo com as concentrações de GLUT testadas. O aumento na concentração de GLUT diminuiu a expressão de NFkB e induziu a expressão de STAT-3 por CTMs obtidas de ambos os grupos. Quanto a produção de citocinas por essas células, observou-se uma diminuição nos níveis de IL-β e IL-6 e uma elevação nos níveis de IL-10 e TGF-β com o aumento na concentração de GLUT. Variações na concentração desse aminoácido não alteraram a produção de IL-17 ou IFN-γ por CTMct e CTMdesn. Ademais, a concentração de GLUT alterou, de forma diretamente proporcional, a taxa de proliferação das CTMs. Os meios condicionados de CTMct e CTMdesn diminuíram a proliferação de macrófagos e linfócitos esplênicos estimulados com LPS, induziram aumento na produção da citocina antiinflamatória IL-10 por ambos os tipos celulares e diminuíram a produção das citocinas pró-inflamatórias IL-12 e TNF-α por macrófagos e IL-17 por linfócitos. Portanto, conclui-se que a GLUT possui efeito sobre a proliferação das CTMs, bem como a capacidade de imunomodular estas células.
Protein-energy malnutrition (PEM) alters hemopoiesis and, therefore, the generation of immune cells, and compromises the immune system. In this way, malnourished individuals are more susceptible to infections. Mesenchymal stem cells (MSCs) have immunomodulatory properties and are important in the formation of bone marrow stroma that supports hemopoiesis. Since L-glutamine (GLUT) is a conditionally essential amino acid, which is most consumed by MSCs, and present immunomodulatory capacity, this work investigated whether GLUT would have an effect on immunomodulatory aspects of MSCs in a PEM experimental model. For this purpose, BALB/c mice were used, which received isocaloric normoproteic or hypoproteic diets, containing respectively, 12% and 2% of protein for a period of 5 weeks. After isolation and characterization of MSCs from control (MSCct) and malnourished (MSCmaln) groups, these cells were cultured with 0, 0.6, 2 and GLUT 10mM in order to determine the influence of this amino acid on the expression of transcription factors and cytokine production by MSCct and MSCmaln. Besides that, the effect of MSCct and MSCmaln culture supernatants on proliferation and cytokine production by macrophages and splenic lymphocytes was evaluated. Malnourished animals presented anemia, leucopenia, marrow hypoplasia and decreased concentration of serum proteins, albumin and prealbumin. PEM did not change morphology and phenotype of MSCs or altered the expression of cell cycle regulatory proteins. On the other hand, the expression of NFkB and STAT-3 and the production of IL-1β, IL-6, IL-10 and TGF-β by MSCs were modified by PEM and varied according to the tested GLUT concentrations. An increase in GLUT concentration decreased NFkB expression and induced STAT-3 expression by MSCs obtained from both groups. Regarding the production of cytokines by these cells, an increase in GLUT concentration resulted in decreased IL-1β and IL-6 levels and increased IL- 10 and TGF-β levels. Changes in the concentration of this aminoacid did not alter IL- 17 or IFN-γ production by MSCct and MSCmaln. Furthermore, the concentration of GLUT changed, in direct proportion, the proliferation of MSCs. The conditioned media MSCct and MSCmaln decreased the proliferation of macrophages and splenic lymphocytes stimulated with LPS, induced an increase in the production of the antiinflammatory cytokine IL-10 by both cell types, and decreased the production of proinflammatory cytokines IL-12 and TNF-α by macrophages and IL-17 by lymphocytes. Therefore, it can be concluded that GLUT has an effect on the proliferation of MSCs and it has the capacity to immunomodulate these cells.

Em estudos epidemiológicos. Os desfechos são freqüentemente medidos em escalas ordinais, entretanto são analisados por técnicas tradicionais. como a reg ressão logística que requer desfecho binário. Consequentemente. informações importantes podem ser perdidas devido a arbitrariedade na escolha do ponto de corte. Modelos de regressão para respostas ordinais têm sido desenvolvidos e têm vantagens de reter a ordinalidade dos dados e fornecer estimativas interpretáveis para os epidemiologistas. Esse artigo descreve o modelo de odds proporcionais proposto por McGullagh e o aplica aos dados da coorte de cnanças nascidas em Pelotas em 1993. usando o pacote estatístico SAS. O objetivo desse artigo foi comparar os resultados do modelo de odds proporcionais e da regressão logística tradicional usando diferentes pontos de corte. O desfecho foi déficit de estatura para idade expressa em escore-z. com três níveis ordinais. Concluiu-se que o modelo de odds proporcionais produz uma estimativa interpretável. similar a uma razão de odds. que sumariza o efeito sobre todos pontos de corte. Na presente análise. as estimativas pontuais resultantes da regressão ordinal foram similares ás obtidas através da regressão logística tradicional usando o ponto de corte do escore-z em -1. Entretanto, a regressão ordinal produziu intervalos de confiança menores (e, portanto, aumento do poder estatístico), evitando a arbitrariedade de ter um único ponto de corte. Uma limitação para uso mais amplo do modelo ordinal é a falta de pacotes estatísticos que o incluam.
Outcomes in epidemiological studies are often measured using ordinal scales, but are nevertheless analyzed through traditional techniques such as logistic regression that require a single dychotomous outcome. Therefore, important information may be lost due to arbitrariness in the choice of a cut-off point. Regression models for ordinal responses have been developed and have the advantages of nr.aking full use of the ordinality of the data, while still providing interpretable estimates for epidemiologists. This paper describes the proportional odds model proposed by McGulla~h and applies it to data from a birth cohort in Southern Brazil. using the statistical package SAS. The objective of this paper was to compare the results of the proportional odds model and of traditional logistic regression using different cut-offs. The outcome was heighUage deficit. expressed in z-scores, with three ordinal leveis. We conclude that the proportional odds model produces an interpretable estimate. similar to an odds ratio, that summarizes the effect over ali leveis of the outcome In the present analysis, the point estimates resulting from ordinal regression were similar to those obtained through traditional logistic regression using a cut-off of -1 z-score. However, ordinal regression lead to smaller confidence intervals (and therefore increased study power), avoiding the arbitrariness of having a single cut-off point. A restriction to the wider use of the ordinal model is the lack of statistical packages that include it.

The World Health Organization defines protein-energy malnutrition as a range of pathological conditions that appear by a deficient supply, transport or use of nutrients by the body s cells causing an essential amino acid deficiency in DNA and RNA synthesis, which can lead to a substantial immune system impairment. The focus of this research was to evaluate humoral and cellular immunity in children suffering from moderate to severe chronic malnutrition. The cross-sectional study was conducted with children 24-59 months old and 29 days, semi-interned at the Nutritional and Education Recovery Center (CREN), Maceió/AL, suffering from chronic malnutrition. At the same time creating a control group using normal similar aged children, randomly selected enrolled elementary school students from the same community. For data collection a standardized questionnaire was administered to children s parents and guardians addressing the history of infectious diseases. Cellular immunity assessment was performed by counting leukocytes and lymphocytes, B lymphocytes and T and delayed hypersensitivity test. Humoral immunity assessment was determined by immunoglobulins IgA, IgG and IgM in serum and IgG antibody by tetanus toxoid. Nutritional status was determined by the height-for-age (H/A) index. Data analysis used parametric and nonparametric statistics with a significance level (p<0.05). Research participants consisted of 68 children, 34 chronically malnourished and 34 well nourished. Among the malnourished 56% were male versus 47% normal weight, and the (H/A) index ranged from -4.61 to -2.02 in malnourished children versus -0.99 to 1.17 in eutrophic children. The history of airway infections, acute diarrhea, mumps and whooping cough was higher among the malnourished, but there was no statistical difference. The number of leukocytes and lymphocytes was significantly higher in malnourished children (p = 0.00). The number of B and T lymphocytes and delayed hypersensitivity test was not statistically different between the two groups. Serum immunoglobulins IgG and IgA were significantly (p = 0.00) higher among malnourished. Among the malnourished children an apparent decrease of 70.5% of IgG antibodies specific for tetanus toxoid versus 41.2% for normal weight (p = 0.01). Conclusion: There was no humoral and cellular immunity impairment in malnourished children but the number of T lymphocytes was lower and the production of IgG antibodies to tetanus toxoid was significantly lower in severely malnourished children.
A Organização Mundial da Saúde define Desnutrição Energético-Protéica como uma gama de condições patológicas que aparece por deficiência de aporte, transporte ou utilização de nutrientes pelas células do organismo provocando uma deficiência de aminoácidos essenciais na síntese de DNA e RNA, que pode levar a um considerável comprometimento do sistema imune. O objetivo do presente estudo foi avaliar a imunidade humoral e celular de crianças com desnutrição crônica moderada e grave. Estudo do tipo transversal realizado com crianças de 24 a 59 meses e 29 dias, semi-internas no Centro de Recuperação e Educação Nutricional, Maceió/AL, portadoras de desnutrição crônica. No mesmo período constituiu-se um grupo controle composto de crianças eutróficas da mesma faixa etária, selecionado aleatoriamente entre os alunos matriculados na escola de ensino fundamental da mesma comunidade. Para coleta de dados foi utilizado um questionário padronizado, aplicado aos pais ou responsáveis, abordando o histórico das crianças sobre doenças infecciosas. A avaliação da imunidade celular foi realizada através da contagem dos leucócitos e linfócitos totais, linfócitos B e T, e do teste de hipersensibilidade tardia. Para avaliar a imunidade humoral foi feita a determinação das imunoglobulinas IgA, IgG e IgM séricas, e anticorpo do tipo IgG para toxóide tetânico. O estado nutricional foi determinado pelo índice altura para idade (A/I). Na análise dos dados utilizou-se estatística paramétrica e não-paramétrica com nível de significância (p<0,05). Participaram do estudo 68 crianças, sendo 34 desnutridas crônicas e 34 eutróficas. Entre os desnutridos 56% eram do sexo masculino versus 47% dos eutróficos; o índice A/I variou de -4,61 a -2,02 nas crianças desnutridas versus -0,99 a 1,17 nas eutróficas. O histórico de infecções das vias aéreas, diarréia aguda, caxumba e coqueluche foi maior entre os desnutridos, porém não foi observada diferença estatística. O número de leucócitos e linfócitos totais foi significativamente maior nas crianças desnutridas (p = 0,00). O número de linfócitos B e T, e o teste de hipersensibilidade tardia não diferiu estatisticamente entre os dois grupos. As imunoglobulinas séricas IgA e IgG foram significativamente (p = 0,00) mais elevadas entre os desnutridos. Entre as crianças desnutridas 70,5% apresentaram diminuição de anticorpos específicos do tipo IgG para toxóide tetânico versus 41,2% das eutróficas (p = 0,01). Concluiu-se que não houve comprometimento da imunidade celular e humoral nas crianças desnutridas, porém é preciso ressaltar que o número de linfócitos T foi menor e a produção de anticorpos do tipo IgG para toxóide tetânico foi significativamente menor nas crianças desnutridas crônicas.

O epitélio gástrico de ratos passa por modificações morfofisiológicas importantes durante o primeiro mês de vida pós-natal e a dieta é um dos principais fatores que influenciam esse desenvolvimento. Ratos receberam dieta com 20% (C) ou 8% (RP) de proteína, durante o período pré e pós-natal. Avaliamos em ratos de 14, 30 e 50 dias os efeitos da restrição protéica sobre proliferação celular no epitélio gástrico, massa do estômago e corpórea, comprimento do intestino e, expressão de ghrelina no estômago e no plasma. O grupo RP apresentou proliferação celular, massa do estômago e corpórea e comprimento do intestino reduzidos em relação ao grupo C. E maior imunomarcação para ghrelina em animais RP com 30 e 50d em comparação ao grupo C. Não houve diferença na imunomarcação entre animais de 14d. Os níveis plasmáticos de ghrelina apresentaram a mesma tendência observada na imunomarcação. O consumo de quantidade adequada de proteína é importante durante o desenvolvimento gástrico de ratos e a ghrelina apresenta resposta hormonal diferente de acordo com a idade do animal.
The gastric epithelium of rats undergoes morphophysiological changes throughout the first month of life and diet is one of the main factors influencing the development. Rats were fed a 20% (NP) or 8% (RP) protein diet throughout the pre- and post-natal life. We analyzed the cell proliferation and observed the body and stomach weight and small intestine length at 14, 30 and 50 days rats. Additionally, we evaluated ghrelin in gastric epithelium and its plasma levels. Cell proliferation in the gastric epithelium, body and stomach weight and small intestine length were reduced in RP animals when compared to NP animals. We observed an increase in the number of labeled cells for ghrelin in 30- and 50-d-old RP rats when compared to the NP group and no difference was found in 14-d-old animals. Plasma ghrelin levels showed the same results observed in immunohistochemical reactions. These results emphasize the importance of diet protein on the development of gastric mucosa and protein restriction seems to differently modulate ghrelin response at different ages.

Background: Ageing is correlated with nutritional status imbalance. Protein Energy-Malnutrition (PEM) can lead to hydration balance impairment and sarcopenia, a loss of muscle mass. Sarcopenia syndrome can be worsened by the excess of fat mass leading to sarcopenic obesity. These conditions are associated with an increasing risk of morbidity, mortality and of cognitive, functional and psychological decline. Screening analysis features an important tool to prevent negative outcomes. The most accurate body composition assessment techniques, such as Computed Tomography, Magnetic Resonance Imaging and Dual energy X-ray Absorptiometry (DXA) are weakly invasive and not easily accessible to investigators because of their high operational costs. Among the other techniques (anthropometry and impedance), Bioelectrical Impedance Vector Analysis (BIVA) is easy to use, inexpensive, non invasive and can be used in biomedical field and clinical practice to evaluate hydration and nutritional status. However, its validity in assessing body composition was lacking. Objective: Ascertaining the accuracy of BIVA to assess body composition variations and validating an analytic variant, specific BIVA. Classic and specific BIVA will be applied in different samples of elderly subjects in order to evaluate body composition variations in relation to psycho-functional status and health condition. Design: Several samples of healthy (658 subjects, 60 y or older) and pathological elderly (227 subjects, 65 y or older, with Alzheimer’s disease or type 2 diabetes mellitus), and a sample of healthy adults from U.S. (1594 subjects, 21-49 y) were considered (NHANES 2003-2004). Six anthropometric measurements were taken (height, weight, calf, waist and arm circumferences, body mass index (BMI)). Classic BIVA and the new variant (specific BIVA), that adjust bioelectrical values for body geometry, were applied. DXA was used as the reference method. Classic and specific BIVA results were compared by Receiver Operating Curve (ROC curve) analysis and by a probit multiple-regression. The psycho-functional status was assessed by Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Muscle strength was measured by the Hand Grip Strength (HGS) and Short Physical Performance Battery (SPPB) tests. Results: Classic BIVA distinguished individuals with different amounts of fat and fat-free mass, according to DXA, but not those with different proportions of fat mass (FMDXA%). Specific bioelectrical values detected changes in body composition, resulting significantly more accurate than classic BIVA in evaluating FMDXA% (ROC areas: 0.84 - 0.92 and 0.49 - 0.61 respectively; p=0.002). The evaluation of extracellular water/intracellular water ratio was accurate (ROC areas between 0.83 and 0.96) and similarly performed by the two procedures (p=0.829). Classic and specific BIVA detected significant differences between sarcopenic and nonsarcopenic individuals. Moreover, specific BIVA recognized bioelectrical differences between sarcopenic and sarcopenic obese men. Classic BIVA showed that patients with Alzheimer's disease have a worse psycho-functional and nutritional status compared to a control group. Patients with diabetes showed greater body dimensions and a reduced muscular area, compared to healthy controls. Specific BIVA showed no association with muscular strength tests. The specific bioelectrical standards for the Italian elderly population have been proposed. Conclusions: Specific BIVA proved to be an accurate technique and a promising tool to assess age-related changes in body composition. Older patients with sarcopenia, sarcopenic obesity, Alzheimer’s disease, and type 2 diabetes were characterized by peculiar bioelectrical patterns, which can be related to their body composition characteristics. The newly proposed bioelectrical standards for the Italian elderly population allow the application of classic and specific BIVA in the geriatric routine.

Background Modern neonatal care has improved the survival rate of extremely preterm infants. These infants are at high risk of malnutrition and growth failure during 3-4 months of hospital care. The objectives of this study was to investigate nutritional intakes during hospitalization and explore associations between nutritional intakes, postnatal growth and retinopathy of prematurity (ROP). Perioperative nutrition in infants undergoing surgery for patent ductus arteriosus (PDA) was also investigated. Methods This is a population-based study of Swedish extremely preterm infants (<27 weeks) born during 2004-2007 (n=602). Detailed data on nutritional supply and anthropometric measurements during hospitalization were retrospectively retrieved from hospital records. Comprehensive data on cohort characteristics, neonatal morbidity and infant mortality were obtained from the Extremely Preterm Infants in Sweden Study (EXPRESS). Results During the first 70 days of life, intakes of energy, protein and several micronutrients, with the exception of iron and some vitamins, were less than estimated requirements, and infants showed severe postnatal growth failure. Energy and protein intake predicted growth in all anthropometric outcomes even when adjusting for severity of illness, and fat intake was positively associated with head growth. Low folate intake was positively correlated with poor weight and length gain while high iron intake, mainly explained by blood transfusions, was negatively associated with poor length gain. Furthermore, a low energy intake was associated with severe ROP (stage 3-5). An increased energy intake of 10 kcal/kg/d was associated with 24% decrease in severe ROP (p=0.01). During the first month, 99% of the infants were exclusively fed human milk. Infants who underwent surgery for PDA (n=140) were malnourished, with energy and macronutrient intakes below minimum estimated requirements before, during and after surgery. Conclusions The severe postnatal growth failure observed in Swedish extremely preterm infants may be prevented by improved intakes of energy, protein, fat and folate and a reduction of the number of blood transfusions. Human milk is the main enteral food source and analyses of human milk macronutrient contents facilitates individualized fortification. Provision of adequate energy intakes during the first four weeks of life may be an effective way to reduce the risk of severe ROP. Perioperative nutrition in infants undergoing PDA surgery needs to be improved. The study results have important implications for nutritional regimens, postnatal growth and health outcome in this new generation of survivors.

A desnutrição proteico-energética (DPE) provoca anemia e leucopenia decorrente da redução de precursores hematopoéticos e comprometimento da produção de mediadores indutores da hematopoese, bem como alterações estruturais e ultra-estruturais na matriz extracelular medular. A hematopoese ocorre em nichos medulares distintos - endosteal e perivascular - que modulam os processos de diferenciação, proliferação e auto-renovação da célula tronco hematopoética (CTH). As células tronco mesenquimais (CTM) tem um papel importante na formação destes nichos, através da sua diferenciação nos diversos tipos celulares que os compõe. Adicionalmente, a CTM pode modular a função de outras células, como a CTH e a célula endotelial (CE) medular, através da liberação de diversos fatores de crescimento e citocinas. As CE expressam proteínas que regulam a diferenciação e movimentação das CTH na MO. Há sinais que a CTM pode ser a precursora da CE medulares, pois in vitro a CTM pode se diferenciar em CE-like. Desta forma, a CTM é um ponto chave no estudo das alterações causadas pela DPE no nicho perivascular e sobre a regulação da hematopoese. Neste trabalho, investigamos se a DPE afeta a diferenciação in vitro da CTM medular em CE-like e avaliamos se essas células apresentam diferentes capacidades em produzir alguns mediadores regulatórios da hematopoese (CXCL-12, SCF, Ang-1, IL-11, GM-CSF e TFG-β), bem como possíveis alterações no perfil de expressão gênica de marcadores de função das CTM e CE-like. Utilizamos camundongos C57BL/6 machos, divididos em grupos Controle e Desnutrido, sendo que o grupo Controle recebeu ração normoprotéica (12% caseína) e o grupo Desnutrido recebeu ração hipoprotéica (2% caseína), ambos durante 5 semanas. Após este período, os animais foram eutanasiados, foi realizada a avaliação nutricional e hematológica, caracterizando a DPE. As CTM foram isoladas, caracterizadas e diferenciadas in vitro em CE-like, o que foi evidenciado pela maior expressão gênica de NT5E, FLT1, KDR, PECAM1 e VCAM1. Avaliamos a expressão dos genes CDH5, CSPG4, LEPR, NES, CSF1, CSF2, CSF3, MCAM, PROM1, ANGPT1, CXCL12, ENG, IGF1, IL3, IL11, KITL, TGFB1, WNT3A, WNT5A, ICAM1, PDGFB1 e VWF. Encontramos alterações causadas pela DPE na expressão gênica e quantificação de CXCL-12, SCF e Ang-1, os quais mostraram que as células avaliadas do grupo Desnutrido encontram-se em um estado \"pró-proliferativo\", em um esforço para restabelecer a hematopoese na DPE. Entretanto, foi observado neste trabalho e nos demais trabalhos do grupo que há hipoplasia medular na DPE e, portanto, pode-se inferir que as alterações hematopoéticas observadas na DPE não são ocasionadas por alterações na síntese de SCF, CXCL-12 ou Ang-1.
Protein-energy malnutrition (PEM) causes anemia and leukopenia as it reduces hematopoietic precursors, impairs the production of mediators that induce hematopoiesis and alters structural and ultrastructural changes in bone marrow (BM) extracellular matrix. Hematopoiesis occurs in distinct BM niches - endosteal and perivascular - which modulate the processes of differentiation, proliferation and self-renewal of hematopoietic stem cell (HSC). Mesenchymal stem cells (MSC) play an important role in the formation of these niches through their differentiation in several cell types that compose them. Additionally, MSC can modulate the function of other cells, such as HSC and endothelial cells (EC), through the release of several growth factors and cytokines. The EC express proteins that regulate the differentiation and migration of HSC in the BM. MSC seem to be the precursor of medullary EC because in vitro MSC can differentiate into EC-like cells. Thus, MSC are a key point in the study of changes caused by DPE on the perivascular niche and on the regulation of hematopoiesis. In this study, we investigated whether PEM would affect BM-MSC in vitro differentiation into EC-like cells and evaluated whether these cells would have distinct capacities of producing some regulatory mediators of hematopoiesis (CXCL- 12, SCF, Ang-1, IL-11, GM -CSF and TFG-β), as well as analyzed possible changes in the gene expression profile of MSC function and EC-like cells related markers. C57BL/6 mice were divided into Control and Malnourished groups, which received for 5 weeks, respectively, a normal protein diet (12% casein) and a low protein diet (2% casein). After this period, animals were euthanized, nutritional and hematological evaluations were performed, featuring the PEM. MSC were isolated, characterized and differentiated in vitro into EC-like cells, which were evidenced by increased gene expression of NT5E, FLT1, KDR, PECAM1 and VCAM1. The expression of CDH5, CSPG4, LEPR, NES, CSF1, CSF2, CSF3, MCAM, PROM1, ANGPT1, CXCL12, ENG, IGF1, IL3, IL11, KITL, TGFB1, Wnt3a, WNT5A, ICAM1, PDGFB1 and VWF genes was also evaluated. Changes caused by PEM on gene expression and quantification of CXCL-12, SCF and Ang-1 were found, indicating that tested cells from the Malnourished group were in a \"pro-proliferative\" state in an effort to restore hematopoiesis. However, our results are in accordance to the literature regarding bone marrow hypoplasia as a consequence of PEM. Therefore, we infer hematopoietic changes observed in this work are not related to changes in the synthesis of SCF, 12 CXCL-12 or Ang-1.

Objective: To know the nutritional status of children under 5 years old who live in Quilombos (Brazilian hinterland settlement founded by people of African origin) from Alagoas state in Brazil. Methods: A cross-sectional study involving 1114 children. The nutritional status was evaluated by anthropometry, clinical examination and measurement of hemoglobin level. The study data were: weight and height for formation of the weight -for age, weight for height and height for age. To characterizes underweight, wasting and stunting, it was applied to these indices, the cutoff z<-2. The Anthropometric standard used was proposed by OMS -2006. The Anemia was diagnosed when the hemoglobin level was < 11mg/dL. It was measured by a portable photometer (Hemocue). The Clinical Evaluations were preceded by a pediatrician, following the standard guide. Results: The prevalence of stunting, underweight and wasting was respectively 9,5%, 2,6% and 1,4 % . The anemia was found in 52,7% of the children . More usual clinical signs founded were : Pallor (61, 6%) , dental caries ( 38, 2%) , dull hair ( 26,9%) , skin xerosis (26,7%) and presence of infectious processes (22,3%) . Conclusion: Stunting, which indicates chronic mal nutrition, was the most common anthropometric deficit. The anemia presented so strong that characterizes it as a serious public health problem. The deficits of underweight and wasting however, were considered irrelevant under the epidemiologic point of view. The clinical evaluation, although subjective for most signals, revealed a lot of problems. And those problems lead to a better characterization of the mal nutritional profile of the studied communities, making possible an improved planning of future interventions.
Objetivo: Caracterizar o estado nutricional das crianças menores de 5 anos residentes nas comunidades remanescentes dos quilombos do Estado de Alagoas. Métodos: estudo transversal envolvendo 1114 crianças. O estado nutricional foi avaliado por meio da antropometria, exame clínico e aferição do nível de hemoglobina. Coletaram-se dados de peso e estatura para formação dos índices peso-para-idade (PI), peso-para-altura (PA) e altura-para-idade (AI). Para caracterizar baixo peso, magreza e nanismo, aplicou-se a esses índices, respectivamente, o ponto de corte z<-2. O padrão antropométrico utilizado foi o proposto pela OMS-2006. A anemia foi diagnosticada quando o nível hemoglobina era <11mg/dL. Sua aferição foi procedida em fotômetro portátil (Hemocue). A avaliação clínica foi procedida por uma pediatra, seguindo roteiro padrão. Resultados: As prevalências de nanismo, baixo peso e magreza foram, respectivamente, 9,5%, 2,6% e 1,4%. A anemia foi encontrada em 52,7% das crianças. Os sinais clínicos encontrados com maior freqüência foram: palidez (61,6%), cáries (38,2%), cabelos sem brilho (26,9%), xerose cutânea (26,7%) e presença de processos infecciosos (22,3%). Conclusão: O déficit estatural, indicativo da desnutrição crônica foi o déficit antropométrico mais prevalente. A anemia apresentou-se em magnitude tal que a caracteriza como grave problema de saúde pública. Os déficits de baixo peso e magreza, no entanto, foram considerados irrelevantes sob o ponto de vista epidemiológico. A avaliação clínica, embora de caráter subjetivo para a maioria dos achados, revelou uma série de problemas que contribuíram para uma melhor caracterização do status nutricional nas comunidades estudadas, possibilitando um melhor planejamento das intervenções a serem empreendidas.

The high prevalence of hospital protein-energy malnutrition is associated with several factors, including implemented dietary conducts. Most hospitalized patients receive oral diets as their only source of nutrition. Study objectives were to evaluate the consumption of oral diets, the presence of reasons for not ingesting or incomplete food intake, and the evolution of the nutritional status of adult patients admitted to the Hospital de Clínicas, Universidade Federal de Uberlândia (HC-UFU). It was also objective of the study, analyze the general oral diet (GOD) served to inpatients in HC-UFU. The study was prospective, observational and descriptive for the inpatients, and prospective, descriptive, with semi-quantitative/qualitative approach for the food of the hospital GOD. Patients were included in the first 48 hours of hospitalization and maintained in follow-up throughout the period of hospital stay in the internal medicine ward. The supply, intake, minimum and adjusted energy needs (MEN; AEN) and minimum and adjusted protein needs (MPN; APN), and the reasons for not ingesting or incomplete food intake were assessed daily using the 24h Food Record form. The nutritional status of patients was assessed by anthropometric measurements (weight, height, body mass index) and Subjective Global Assessment (SGA). GOD was evaluated during 28 consecutive days, it was performed the weighing of each food served in the styrofoam lunch boxes of the lunch (n=3/day) and dinner (n=3/day) of the four implemented menus. The food options served in snacks (breakfast, afternoon snack and dinner) were not heavy because the portions are standard and known. Tables of nutritional composition were used to calculate the total energy value (TEV) and the energy distribution of macronutrients (percentage) of the food meals served daily, as well as to quantify the portions of foods from different food groups. Twenty-three patients who did not have a classification of malnutrition in the first 48 hours of hospitalization (SGA A) were included in the study, it corresponded to 204 days of follow-up. The supplied oral diets were sufficient to meet the AEN in 148 days (72.5%) and the APN in 80 days (39.2%). Dietary intake was insufficient to meet the AEN in 100 days (49%) and the APN in 156 days (76%). The mean intake of energy and/or protein was lower than the MEN and MPN for 7 patients (30.4%) and smaller than the AEN and APN for 21 patients (91.3%). A large number of reasons for not ingesting or incomplete food intake (n=1193) were reported, of which 1119 (93.8%) was present in food records of days in which food intake was below that adjusted need. The most common reasons were \"fasting\" (27.1%), \"lack of appetite\" (18.1%), \"satiety\" (13.4%) and \"sensory characteristics of food\" (9.1%). At the end of the follow-up period, one patient changed the classification of nutritional status of AGS A to AGS B, and 16 patients (69.6%) showed loss of body weight (-1.4±1.2kg). Negative associations were observed for \"difference between total energy intake and AEN\" and the number of \"reasons for not ingesting or incomplete food intake\" (  =-0.7268; p-value<0.0000), and \"difference between the total amount of protein intake and APN\" and the number of \"reasons for not ingesting or incomplete food intake\" (  =-0.8381; pvalue< 0.0000). And positive associations for \"difference between total energy intake and AEN\" and \"weight difference\" (  =0.5034; p-value=0.0143), and \"difference between the total amount of protein intake and NPA\" and the number of \"weight difference\" (  =0.6441; p-value=0.0009). In assessing the GOD, which presented TEV of the average offer of 2396.53±152.55 kcal/day, the mean energy distribution was adequate for protein (13.47%), carbohydrates (65.08%) and lipids (22%). Variable energy supply (percentage of TEV) was identified at breakfast (15.57%-20.61%), lunch (26.19%-36.59%), dinner (22.21%-31.06%), afternoon snack and supper (8.41%-15.50%). The period of overnight fasting was up to 13h. Regarding food groups, the supply was excessive for beans, meat/eggs, oils/fats/oilseed and sugar/sweets, and deficient for fruit/juices, legumes/vegetables, milk/derivatives. The supply of oral diets and the food intake of energy and protein were insufficient to meet the needs adjusted of considerable proportion of patients. The reasons that interfere the adequate food intake should be investigated and implemented measures to reduce them. It is essential to characterize the quantitative/qualitative aspects of GOD served to inpatients. Reducing the period of overnight fasting, as well as adjustments in the supply of food groups and in the food fractionation can contribute to better meet the nutritional needs and preventing the onset/worsening of nutritional deficiencies.
A alta prevalência da desnutrição proteico-energética hospitalar está associada a diversos fatores, incluindo condutas dietéticas implementadas. A maioria dos pacientes hospitalizados recebe dietas orais como única fonte de nutrição. Os objetivos do estudo foram avaliar o consumo de dietas orais, a presença de motivos para não ingestão ou ingestão incompleta de alimentos, e a evolução do estado nutricional de pacientes adultos internados no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU). Também foi objetivo do estudo, analisar a dieta geral oral (DGO) servida aos pacientes internados no HC-UFU. O estudo foi desenvolvido de forma prospectiva, observacional e descritiva em relação aos pacientes internados, e de forma prospectiva, descritiva, com abordagem semiquantitativa/ qualitativa para alimentos da DGO hospitalar. Os pacientes foram incluídos no estudo nas primeiras 48h de internação e mantidos em seguimento durante todo período de internação na enfermaria de Clínica Médica. A oferta, ingestão, necessidades mínimas e ajustadas de energia (NEM; NEA) e proteínas (NPM; NPA), e os motivos para não ingestão ou ingestão incompleta de alimentos, foram avaliados diariamente, utilizando formulário de Registro Alimentar de 24h. O estado nutricional dos pacientes foi avaliado por medidas antropométricas (peso, altura, índice de massa corporal) e Avaliação Global Subjetiva (AGS). A DGO foi avaliada durante 28 dias consecutivos, em que foi realizada pesagem de cada alimento servido nas marmitas do almoço (n=3/dia) e jantar (n=3/dia) dos quatro cardápios implementados. As opções alimentares servidas nos lanches (desjejum, lanche da tarde e ceia) não foram pesadas porque as porções são padronizadas e conhecidas. Tabelas de composição foram utilizadas para o cálculo do valor energético total (VET) e da distribuição energética percentual dos macronutrientes dos alimentos das refeições servidas diariamente, assim como, para quantificar as porções de alimentos dos diferentes grupos alimentares. Foram incluídos 23 pacientes que não apresentaram a classificação de desnutrição nas primeiras 48h de internação (AGS A), correspondendo a 204 dias de seguimento. As dietas orais ofertadas foram suficientes para suprir a NEA em 148 dias (72,5%) e a NPA em 80 dias (39,2%). A ingestão alimentar foi insuficiente para suprir a NEA em 100 dias (49%) e a NPA em 156 dias (76%). A ingestão média de energia e/ou proteína foi menor do que as NEM e NPM para 7 pacientes (30,4%) e menores do que as NEA e NPA para 21 pacientes (91,3%). Foram relatados 1193 motivos para não ingestão ou ingestão incompleta de alimentos, sendo 1119 (93,8%) presentes em registros alimentares de dias em que a ingestão alimentar foi inferior à necessidade ajustada. Os motivos mais frequentes foram jejum (27,1%), inapetência (18,1%), saciedade (13,4%) e características sensoriais dos alimentos (9,1%). Ao final do período de seguimento, um paciente mudou a classificação do estado nutricional de AGS A para AGS B, e 16 pacientes (69,6%) apresentaram perda de peso corporal (- 1,4±1,2kg). Foram observadas associações negativas para diferença entre quantidade total de energia ingerida e a NEA e o número de motivos para não ingestão ou ingestão incompleta de alimentos (  =-0,7268; p-valor<0,0000), e para diferença entre quantidade total de proteína ingerida e a NPA e o número de motivos para não ingestão ou ingestão incompleta de alimentos (  =-0,8381; pvalor< 0,0000). E associações positivas para diferença entre quantidade total de energia ingerida e a NEA e diferença de peso (  =0,5034; p-valor=0,0143), e para diferença entre quantidade total de proteína ingerida e a NPA e o número de diferença de peso (  =-0,6441; p-valor=0,0009). Na avaliação da DGO, que apresentou VET da oferta média de 2396,53±152,55 kcal/dia, a distribuição energética média foi adequada para proteínas (13,47%), carboidratos (65,08%) e lipídios (22%). Oferta energética variável (porcentagem do VET) foi identificada no desjejum (15,57%-20,61%), almoço (26,19%-36,59%), jantar (22,21%-31,06%), lanche da tarde e ceia (8,41%-15,50%). O período de jejum noturno foi de até 13h. Em relação aos grupos alimentares, a oferta foi excessiva para feijões, carnes/ovos, óleos/gorduras/oleaginosas e açúcares/doces e deficiente para frutas/sucos, legumes/verduras, leite/derivados. A oferta de dietas orais e ingestão alimentar de energia e proteínas foram insuficientes para atender as necessidades ajustadas de proporção considerável de pacientes. Os motivos que interferem a ingestão alimentar adequada devem ser investigados e implementadas medidas para reduzílos. É essencial realizar a caracterização quantitativa/qualitativa da DGO servida a pacientes hospitalizados. Redução do período de jejum noturno, assim como, adequações na oferta de grupos alimentares e no fracionamento alimentar podem contribuir para melhor atendimento das necessidades nutricionais e prevenção da instalação/agravamento de deficiências nutricionais.
Mestre em Ciências da Saúde

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made.
Health Studies
M.A. (Nursing Science)

碩士
國立陽明大學
臨床護理研究所
87
The purpose of this study was to investigate the factors related to protein-energy malnutrition on residents in institutions. Subjects were sampled from six intermediate care facilities. Of the 138 residents consenting to participate this study, 105 completed the biochemical data collection necessary for acceptance as valid subjects. Descriptive analysis, one-way ANOVA, Pearson product moment correlation, multiple regression and logistic regression were used for data analysis. The research results revealed the prevalent rate of protein-energy malnutrition at 21.9%, which consisted of 15.2% energy malnutrition, 5.7% protein malnutrition, and 1% mixed type malnutrition.Body mass index(BMI) had a significantly negative correlation with cancer, pressure sore presence, method of feeding and dental status, but had a significantly positive correlation with endocrine-metabolism drugs, cognitive status, self-care ability and feeding ability. Serum albumin concentration had a significant negative correlation with cancer, pressure sores, method of feeding, antibiotics, swallowing ability and dental status, and a significant positive correlation with education level, duration of institutionalization, cognitive status, self-care ability, feeding ability, licensure status of institutions and professional nursing manpower. Malnutrition had a significant positive correlation with cerebral vascular accident, cancer, pressure sore, method of feeding and antibiotics, and a negative correlation with education level, duration of institutionalization, cognitive status, self-care ability, feeding ability, dental status, licensure status of institutions and professional nursing manpower. In multiple regression, BMI and albumin were used as dependent variables, with educational level, cerebral vessel accident, cancer, pressure sore, way of feeding, antibiotics, institutionalized duration, cognitive status, self-care ability, feeding ability, dental status, licensure status of institutions and nursing manpower used as predictors. The research results for the above models yielded a 25.7% explained variance for BMI, and 50.2% explained variance for albumin. In logistic regression, the above predictors were also used to predict malnutrition, but only cancer had significant prediction. To improve institutionalized care, periodically assessing residents'' nutritional status is needed. Further studies are needed to develop practical methods to reduce the rate of malnutrition in institutions.

Little is known about the effects of protein-energy malnutrition (PEM) developing after stroke on brain recovery. The goal of this project was to develop two experimental models in the adult rat to allow evaluation of nutritional effects on post-stroke recovery: (1) a PEM model, and (2) a photothrombotic stroke model. Experiment 1 examined the hypothesis that a diet containing either 1% or 0.5% protein will produce an acute state of mild-moderate PEM in adult rats. Male, Sprague-Dawley rats (16 wk) were trained in the Montoya staircase before being randomized to diets containing 0.5% (n=8), 1% (n=8), or 12.5% protein (n=10 [CON]) for 31d. Both low protein diets increased liver lipid content (p< 0.001) and decreased food intake (p= 0.005) and body weight (p< 0.001) compared to the 12.5% protein diet. The 0.5% protein group best mimicked the stroke patient, as judged by decreased serum albumin (p= 0.018) and an acute decrease in mean (±SEM) body weight (g) by d7 (0.5%= 424±15; 1%= 428±14; CON= 477±10; p = 0.011). Increased concentrations of the positive acute phase proteins, alpha-2-macroglobulin and alpha-1-acid glycoprotein, were greatest in the 0.5% group (p< 0.001). No differences were observed in the Montoya test on d3, 15, or 30 (p= 0.26). Values on d30 were: 0.5%= 109.5±4.4% of pre-diet performance; 1%= 97.2±5.5%; CON= 98.5±10.2%. Experiment 2 tested the hypothesis that targeted laser irradiation and 30 mg/kg of rose Bengal injection will cause an infarct in the forepaw region of the cortex with accompanying functional deficits. Male adult rats trained in the Montoya staircase were randomized to ISCHEMIA (n=15) or SHAM (n=3) surgery. A cortical infarct occurred in 86% of rats, with some misplacement and variability in volume (5.7-12.8 mm3). Forepaw impairments were confirmed by decreased performance in the staircase at d3 (34.3±7.3 % of pre-stroke performance, p<0.001) and diminished use in the cylinder test (30.3±4.0% affected limb use versus 53.9±1.93% prestroke, p< 0.001). At d30, mean recovery was incomplete in the staircase (p< 0.001). These experimental models, with additional refinements, can be used to address the hypothesis that deteriorating nutritional status after a stroke interferes with brain recovery.

This study assessed aspects of targeting of the PEM scheme in Gauteng province. This food supplementation scheme targets beneficiaries including children 0-6 years, using largely anthropometric criteria. Routine provincial intervention data was analysed and related to available data cm expenditure, population and indices of socio-economic need. Only 28% were children in the critical 7-36 month age group; and coverage was very low, with no correlation between indices of need and programme implementation by area. An exit interview to a sample of caretakers of 0-6 year old children in four clinics (two Local Authority, two provincial) examined the process of identification of beneficiaries. Low attendance by children over 1 year and 40% errors in growth monitoring, more frequent among sick children, effectively reduced screening coverage among the most at-risk. Health worker misclassification resulted in an 81% exclusion error among those meeting entry criteria, while 4% of the total were wrongly enrolled. Advice and nutrition promotion to caregivers was inadequate. Recommendations include service re-organisation, community-based initiatives and better monitoring.

The overarching aim of the thesis research was to investigate mechanisms altered by protein-energy malnutrition (PEM), a common stroke co-morbidity factor that could affect the extent of brain damage and recovery following stroke. To model stroke, the rat 2-vessel occlusion model of global brain ischemia was employed. To characterize the effects of PEM, three states of malnutrition were assessed: PEM co-existing with brain ischemia (Study 1), effects of PEM independent of brain ischemia (Study 2), and PEM developing after brain ischemia (Study 3). The first hypothesis tested was co-existing PEM triggers an exacerbated glial response to global brain ischemia. The failure to achieve a consistent model of global ischemia prevented us from drawing conclusions on whether co-existing PEM exacerbates reactive gliosis. Nonetheless, this study demonstrated that mean temperature and temperature fluctuation are increased within the first 24hr of exposure to a low protein diet. The second hypothesis tested was PEM causes sustained changes in core temperature that are associated with an inflammatory response. Exposure to a low protein diet caused an immediate small and transient increase in mean temperature and a larger sustained increase in temperature amplitude. As malnutrition evolved, mean temperature declined. PEM stimulated an acute-phase response, characterized by an increase in the positive acute-phase protein, alpha-2-macroglobulin (A2M), and a decrease in the negative acute-phase protein, albumin. This response appeared to be aberrant, since the positive acute-phase protein, alpha-1-acid glycoprotein (AGP), was decreased with PEM. The final hypothesis tested was PEM developing after global brain ischemia exacerbates systemic and hippocampal inflammation, which is associated with diminished neuroplasticity. The effects of PEM on the acute-phase response are persistent following brain ischemia, as demonstrated by decreased serum albumin and increased serum A2M. A decrease in the positive acute-phase protein, haptoglobin, strengthened the evidence that PEM triggers an atypical reaction. The strong glial response elicited by global ischemia was unaltered by PEM. However, PEM influenced hippocampal neuroplasticity mechanisms, as GAP-43 and synaptophysin were significantly lower at d21. In summary, it has been demonstrated that PEM affects core temperature, the systemic acute-phase reaction and the neuroplasticity response to global brain ischemia.

Forage of beta-carotene-fortified orange-fleshed sweet potato is essential for alleviation cattle malnutrition. The study aims were to determine effects of supplementing sweet potato (SP) roots and sun dried forage on degradation of dietary legumes, intake and milk yield in dairy cattle. Mature SP roots were oven dried and forage vines and leaves (V&L) sun dried. Lactating dairy were supplied meals with total mixed ration (TMR) constituting varying levels of sweet potato forage and concentrate. The SP flour was rapidly and completely degraded In Sacco while degradability of V&L was comparable to that of Lucerne hay. Rumen degradation of Lucerne was reduced when the legume was incubated proximal to SP. Substitution of TMR with fresh SP forage and flour meal increased degradability of diets. Glucose post-feeding was increased (P<0.05) by SP roots but no change in milk yield. Orange-fleshed SP forage is recommended for improving energy supply in lactating cow diets
Agriculture and  Animal Health
M. Sc. (Agriculture)

The collection and utilisation of statistical data is an integral component of rendering primary health care services. This study aimed to assess the utilisation of statistics on certain statistical forms submitted regularly to the Department of Health, by professional nurses at local authority primary health care clinics. Results revealed the following important shortcomings: • Statistics on different forms are viewed in isolation, resulting in a lack of necessary comparisons being made to determine trends. • Several targeted issues in the Reconstruction and Development Programme received insufficient attention, for example, immunisations, teenage pregnancies, tuberculosis treatment, sexually transmitted diseases. • A general managerial inability to analyse, display and utilise collected data by professional nurses. Recommendations centred around increasing the knowledge regarding maternal health care, more focus on prioritised areas of the Reconstruction and Development Programme, appropriate training regarding analysis and utilisation of collected statistics at local primary health care level.
Health Studies
M.A. (Nursing)