Tesis sobre el tema "Risk of malnutrition"

Malnutrition är vanligt förekommande hos personer med demenssjukdomar och för denna utsatta grupp är det av vikt att fokusera på nutrition och omvårdnadsåtgärder. Syftet med ddenna litteraturstudie är att belysa malnutrition och riskfaktorer ho dementa personer samt beskriva vad sjuksköterskan bör vara uppmärksam på i sitt arbete för att förebygga malnutrition och hur bättre nutritionsstatus kan uppnås. Metoden i arbetet är en litteraturstudie i vilken 9 kvantitativa artiklar och 1 kantitativ/kvalitativ studie granskats ur ett vetenskapligt perspektiv. Resultatet presenteras utifrån tre huvudområden: nutritionsproblem och tillhörande faktorer,utbildning samt interventioner. Tillsammans visar de på förekomst av malnutrition och att det via utbildning och åtgärder går att påverka nutritionsstatus hos dementa personer. Slutsats är att det är väsentligt att det i sjuksköterskans omvårdnadsarbete läggs vikt på nutritionsfrågor både vad gäller riskbedömning och interventioner. Nutritionens betydelse behöver belysas starkare både i omvårdnads arbete men också under pågående utbildning.
Malnutrition is common among elderly with dementia and it is vital to focus on nutrition and care for this exposed group of individuals. The aim of this literary review is to illustrate malnutrition and risk factors among demented patients and describe what nurses should be observant of to prevent malnutrition and how to obtain better nutrition status. The method is a literary review in which 9 quantitative articles and 1 quantitative/qualitative article has been review with regard to scientific quality. The result is presented on the basis of three themes: nutrition problem and related factors,education and interventions. Altogether these three themes show presence of malnutrition and that it is possible through education and intervention to promote better nutrition status among patients with dementia. The conclusion is that it is important in nursing care to focus on nutrition issues both with regard to risk assessment and to interventions. The significance of nutrition needs to be illuminated both in nurse caring as well during the educational period.

Despite the high frequency and serious consequences of protein–energy malnutrition, prevention and treatment of malnutrition do not currently receive appropriate attention. Increased awareness of the importance of nutritional screening among older people is needed. The overall aim of this thesis was to extend our current knowledge about malnutrition and the consequences of a poor nutritional status in relation to preterm death, and to identify possible risk factors for developing malnutrition among older people. The aim of Paper I was to estimate the prevalence of malnutrition and to examine the associations between mealtime habits, meal provision, and malnutrition among older people admitted to a Swedish hospital. The aim of Paper II was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in older people. The baseline survey was a cross-sectional study of 1771 patients aged ³65 years who were admitted to hospital. Nutritional status was assessed using the MNA instrument, and possible risk factors associated with malnutrition were recorded during the hospital stay (Paper I). Overall survival was followed up after 35–50 months in a cohort study of 1767 participants (Paper II). Of the 1771 participants, 35.5% were well-nourished, 55.1% were at risk of malnutrition, and 9.4% were malnourished at baseline. An overnight fast >11 hours was associated with risk of malnutrition (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.14–1.87) and being malnourished (OR 1.67; 95% CI 1.04–2.69). Fewer than four eating episodes a day was associated with both risk of malnutrition (OR 1.88, 95% CI 1.52–2.32) and being malnourished (OR 3.10; 95% CI 2.14–4.49). Not cooking independently was also associated with both risk of malnutrition (OR 1.9; 95% CI 1.30–2.93) and being malnourished (OR 5.04; 95% CI 2.95–8.61). At the 50-month follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants. After adjusting for confounders, the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18–2.07) in the group at risk of malnutrition and 3.71 (2.28–6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicted preterm death in people aged 65 years and older. This thesis provides additional knowledge of the current nutritional situation among older people admitted to hospital. The high prevalence and serious consequences of malnutrition demonstrated in this thesis underline the importance of screening and taking actions to counteract malnutrition among older people. The data showing that the length of overnight fasting and number of eating episodes per day are possible risk factors for malnutrition are consistent with the current nutritional recommendations. This knowledge may stimulate care providers to decrease the length of overnight fasting and increase the number of eating episodes per day among older people at risk of malnutrition.

Aims The overall aim of this thesis was to extend current knowledge about the prevalence of malnutrition, to identify possible risk factors for development of malnutrition, and to describe the consequences of malnutrition in relation to all-cause and cause-specific mortality among older adults admitted to hospital. Methods The prevalence of malnutrition was estimated in a cohort of 1771 older adults (≥65 years) who were admitted to a Swedish hospital during 2008–2009 (15 months) and screened for malnutrition using the Mini Nutritional Assessment (MNA) instrument. Possible risk factors for malnutrition were recorded during the hospital stay (Study I). Dietary intake 10 years earlier (in 1997) was collected for 725 of these older adults (Study II). All-cause (Study III) and cause-specific (Study IV) mortality were followed up after medians of 3.5 and 5.1 years, respectively, for 1767 of the participants. Results The prevalence of malnutrition was 9.4% while 55.1% were at risk of malnutrition. Risk factors for malnutrition was an overnight fast >11 hours, <4 eating episodes a day, and not cooking independently. In middle-aged and older adults with a body mass index <25 kg/m2 in 1997, the risk of malnutrition increased for each additional percentage point of energy from total, saturated and monounsaturated fat at follow-up after 10 years. Malnourished older adults had almost four times higher risk of death during follow-up, while those at risk of malnutrition had a 56% higher risk, compared to well-nourished. Furthermore, well-nourished older adults had consistently lower risk of death, regardless of the cause of death. Conclusions Only 35.5% of older adults admitted to hospital were well-nourished. The identified risk factors could be used in interventions aimed at preventing malnutrition. Normal-weight and underweight middle-aged and older adults should consider limiting the intake of total fat and/or improve the quality of the fat in the diet in order to decrease the risk of becoming malnourished later in life. Malnutrition and risk of malnutrition were associated with increased overall and cause-specific mortality. These relationships emphasize the need for nutritional screening to identify individuals who may require nutritional support in order to avoid preterm death.

Magister Public Health - MPH (Public Health)
Over 80% of children with Cerebral Palsy (CP) present with feeding difficulties which consequently result in about 40-50% of them being malnourished. Many children with CP in low resource countries like Zambia, present with severe malnutrition and the extent of this problem remains unknown. The aim of this study was to identify the main risk factors associated with severe malnutrition in children with CP.

>Magister Scientiae - MSc
The Malawi Multiple Indicator Cluster Survey (MICS) in 2007 indicated that the prevalence of underweight in Lilongwe District was 29%, stunting was 49% and Global Acute Malnutrition was 11%. The aim of the study therefore was to determine the risk factors for malnutrition amongst children aged 0 to 5 years in Lilongwe district in Malawi. Study design It was a case-control study, conducted in randomly selected Community Therapeutic Care (CTC) Sites (Nutrition Rehabilitation Units (NRUs)) and Under-five Clinics at health facilities of the district. The study sample was comprised of 50 underweightfor- age children (25 girls and 25 boys) aged 0 to 5 years from NRUs of the district selected randomly. The controls were comprised of 44 normal weight-for-age children (22 girls and 22 boys) randomly selected within the same age group, routinely attending under-five growth monitoring and immunization sessions during the same period as the cases. The cases and controls were identified using the NRU and under-five clinic registers respectively. Data Collection There was a face to face interview with the mother/guardians of the children, conducted by trained NRU nurse specialists, the researcher and a research assistant, using a structured questionnaire. Questions about socio-economic status of the mother/caregiver, child feeding practices, nutritional status and diseases of the child were asked. Analysis of results Data was analyzed using EpiInfo 2002 software. Ethical approval for the study was requested from the Ethical committee of the University of the Western Cape. Informed written consent was obtained from all the participants.

Bakgrund: Undernäring definieras av att energi- och näringsintaget understiger behovet. Tillståndet resulterar i bl.a. viktnedgång. Ett mått för att mäta undernäring är kroppsmasseindex (BMI). Vid sjukdom ökar kroppens metabolism som gör att energi- och näringsbehovet ökar samtidigt som sjukdomen i sig försvårar matintaget. Riskbedömning är ett hjälpmedel för sjuksköterskor som bör utföras vid varje patient. Sjuksköterskan är enligt lag skyldig till att tidigt upptäcka undernäring eller risk för undernäring och sätta in relevanta åtgärder för att förhindra försämring.   Syfte: Syftet med studien var att belysa i vilken utsträckning sjuksköterskan dokumenterar riskbedömning för undernäring samt vilka åtgärder som utförs för att förebygga och/eller behandla undernäring under sjukhusvistelsen.   Metod: Studien har kvantitativ, prospektiv och deskriptiv design och har utförts genom journalgranskning.   Resultat: Resultatet visade att 31% av de inneliggande patienterna hade undernäring eller risk för undernäring. De tre vanligaste åtgärderna som sattes in mot undernäring var kostregistrering, beräknat energibehov samt daglig vikt. Riskbedömning utfördes på 47% av alla patienter, det innebär att ungefär hälften av alla patienter inte fått någon riskbedömning. Uppföljning av insatta åtgärder förekom inte i någon journal.   Slutsats: Endast 47% av alla inneliggande patienter hade fått en fullständig riskbedömning dokumenterad i journalen. De flesta insatta åtgärder är standardiserade evalueringar och motverkar i sig inte undernäring utan kräver kompletterande åtgärder.
Background: Malnutrition is defined by deficits in the energy- and nutrition levels. This state results in weight loss. One way to measure malnutrition is through a body-mass index (BMI). During illness, the body’s metabolism increases, which in return requires a greater intake of energy- and nutrition. At the same time, the state of the illness may make the food intake more difficult. Risk evaluation is an aid for nurses that should be performed with every patient. The nurse is required by law to discover malnutrition or risk of malnutrition at an early stage and put in relevant interventions to prevent deterioration of the patients’ physical health.   Objective: The aim of the study was to highlight to what extent the nurses document risk evaluation for malnutrition and what interventions were used to prevent malnutrition during the hospital stay.   Method: The study has a quantitative, prospective and descriptive design and was performed as a journal evaluation.   Result: The results showed that 31% of the inpatients suffered of malnutrition or risk thereof. The three most common interventions against malnutrition were: nutritional dietary records, estimated energy requirements and daily weight. Risk evaluation was performed on 47% of all patients, which means that half of the studied patients receive no evaluation at all. Follow up of the interventions were not presented in any journal.   Conclusion: Only 47% of all inpatients had a complete risk evaluation documented in their journal. Most of the interventions are standardized evaluations and do not in itself counteract malnutrition but need complementary interventions.

Thesis (MNutr)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Introduction: Malnutrition, as defined by the Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment (SGA), Nutritional Risk Screening Tool-2002 (NRS-2002), Short Nutritional Assessment Questionnaire (SNAQ), Nutritional Risk Indicator (NRI) and Malnutrition Screening Tool (MST), has been associated with adverse outcomes in hospitalised patients. Therefore nutritional risk screening is recommended for all hospitalised patients to improve the recognition and treatment of malnutrition. However, little is known about the use of screening tools in an intensive care unit (ICU) setting. The aim of this study was to assess which of these screening tools could best predict clinical outcomes in ICU patients and to comment on their feasibility, in order to make suggestions on their applicability for this patient population. Methods: Over an eight month study period all patients (>18years) with a surgical ICU stay of >48 hours were included. Patients were screened within 48 hours of admission using each of the seven screening tools. Clinical outcomes (mortality, APACHE II score, length of stay (LOS), length of ventilation (LOV), complications, serum-albumin, white cell count (WCC) and C-reactive protein) were recorded until discharge or death. Feasibility and applicability of the screening tools were also assessed. Results: A total of 206 patients (62.6% males) were included. The average age was 49.5 ±17.4 years and average LOS was 5.7 ± 5.5 days. Screening was not feasible in 18.3% of patients. The MUST classified 18.9% of patients as at risk of malnutrition and 30.1% as malnourished, but was not predictive of any clinical outcomes. According to the MNA-SF, 52.2% of patients were at risk of malnutrition and 16.5% were malnourished. This was associated with progressively decreasing serum-albumin levels (p<0.01) and WCC (p=0.01). The SGA classified 30.6% of patients as moderately and 18.4% of patients as severely malnourished and was significantly associated with LOS (p=0.03), LOV (p=0.01), mild complications (p=0.04) and serum-albumin (p=0.01). However, except for serum-albumin which progressively declined with a poorer nutritional status, the moderately malnourished patients showed the worst outcomes and the severely malnourished patients the best. According to the NRS-2002, 72.8% of patients were malnourished; and this correlated significantly with LOV (p=0.02) and the development of moderate (p=0.04) and total (p=0.01) complications. A non-significant but consistent trend for worse results in the malnourished group was also seen for the other outcomes studied. The SNAQ classified 35.9% of patients as malnourished or at risk thereof. This was associated with lower serum-albumin levels (p=0.04), but also with decreased LOV (p<0.01). The NRI classified 2.3% of patients as mildly malnourished, 21.0% as moderately malnourished and 75.0% as severely malnourished and only effectively predicted serum-albumin (p<0.01). The MST classified 78.2% of patients as malnourished and this was predictive of developing more complications (p<0.01). Almost all of the other variables also showed worse outcomes for the malnourished group, but this was not significant. Conclusion: Screening in an ICU seems to have only moderate feasibility and applicability and limited value. Only the NRS-2002 and MST showed potential for predicting clinical outcomes in ICU patients.
AFRIKAANSE OPSOMMING: Inleiding: Wanvoeding, soos gedefinineer deur die “Malnutrition Universal Screening Tool” (MUST), “Mini-Nutritional Assessment-Short Form” (MNA-SF), “Subjective Global Assessment” (SGA), “Nutritional Risk Screening Tool-2002” (NRS-2002), “Short Nutritional Assessment Questionnaire” (SNAQ), “Nutritional Risk Indicator” (NRI) en die “Malnutrition Screening Tool” (MST), is al met nadelige uitkomste in hospitaal pasiënte geassosieer. Daarom word voedings-risiko-sifting vir alle gehospitaliseerde pasiënte aanbeveel om die herkenning en behandeling van wanvoeding te verbeter. Daar is egter min bekend oor die gebruik van siftingshulpmiddele in ‘n intensiewe sorg eenheid (ISE) omgewing. Die doel van die studie was om te assesseer watter van hierdie siftingshulpmiddele kliniese uitkomste in ISE pasiënte die beste kon voorspel en om kommentaar te lewer op die uitvoerbaarheid daarvan, om sodoende voorstelle te maak oor die toepaslikheid daarvan vir hierdie pasiënt populasie. Metodes: Alle pasiënte (>18 jaar) met ‘n chirurgiese ISE verblyf van >48 uur gedurende ‘n ag maande studieperiode is ingesluit. Pasiënte is binne 48 uur na toelating gesif m.b.v. al sewe siftingshulpmiddele. Kliniese uitkomste (mortaliteit, APACHE II telling, lengte van verblyf (LVVer), lengte van ventilasie (LVVen), komplikasies, serum-albumien, witseltelling (WST) en C-reaktiewe proteïen) is genoteer tot en met ontslag of dood. Uitvoerbaarheid en toepaslikheid van die siftingshulpmiddele is ook geassesseer. Resultate: ‘n Totaal van 206 pasiënte (62.6% manlik) is ingesluit. Die gemiddelde ouderdom was 49.5 ±17.4 jare en die gemiddelde LVVer was 5.7 ± 5.5 dae. Siftings was onuitvoerbaar in 18.3% van die pasiënte. Die MUST het 18.9% van die pasiënte as wanvoeding-risikogevalle geklassifiseer en 30.1% as wangevoed, maar kon nie enige kliniese uitkomste voorspel nie. Volgens die MNA-SF was 52.2% van die pasiënte wanvoeding-risikogevalle en 16.5% was wangevoed. Dit was geassosieer met progressief dalende serum-albumienvlakke (p<0.01) sowel as WST (p=0.01). Die SGA het 30.6% van pasiënte as matig en 18.4% as erg wangevoed geklassifiseer en het ‘n beduidende assosiasie met LVVer (p=0.03), LVVen (p=0.01), ligte komplikasies (p=0.04) en serum-albumien (p=0.01) getoon. Behalwe vir serum-albumien wat progressief verlaag het met ‘n swakker voedingstatus, het die matig wangevoede pasiënte egter die swakste uitkomste getoon en die erg wangevoede pasiënte die beste. Volgens die NRS-2002 was 72.8% van die pasiënte wangevoed en dit het ‘n beduidende korrelasie met LVVen (p=0.02) en die ontwikkeling van matige (p=0.04) en totale (p=0.01) komplikasies gehad. ‘n Nie-beduidende, maar konsekwente neiging vir swakker resultate in die wangevoede groep is ook vir die ander studie-uitkomste gesien. Die SNAQ het 35.9% van pasiënte as wangevoed of as risikogevalle daarvoor geklassifiseer. Dit was geassosieer met laer serum-albumienvlakke (p=0.04), maar ook met ‘n korter LVVen (p<0.01). Die NRI het 2.3% van pasiënte as lig, 21.0% as matig en 75.0% as erg wangevoed geklassifiseer en het slegs serum-albumien effektief voorspel (p<0.01). Die MST het 78.2% van pasiënte as wangevoed geklassifiseer en dit het die ontwikkeling van meer komplikasies (p<0.01) voorspel. Amper al die ander veranderlikes het ook swakker uitkomste getoon in die wangevoede groep, maar dit was nie-beduidend. Gevolgtrekking: Dit blyk of sifting in ‘n ISE slegs matige uitvoerbaarheid en toepaslikheid en beperkte waarde het. Slegs die NRS-2002 en die MST het potensiaal gewys om kliniese uitkomste in ISE pasiënte te voorspel.

Background: Maternal malnutrition in developing countries is associated with adverse pregnancy and birth outcomes. Malnourished mothers are often faced with additional risk factors as a circumstance of poverty. Supplementary nutrition can improve the outcomes of both mother and infant. Identifying maternal nutritional and socioeconomic risk factors is critical for developing effective interventions. Objective: A secondary analysis to evaluate maternal risk factors associated with poor birth outcomes including pregnancy loss, low birth weight, stunting, and preterm delivery among moderately malnourished pregnant women in Sierra Leone. Maternal risk factors in the analysis are age, education, parity, BMI, MUAC, gestational weight gain, and recent exposure to malaria infection. Methods: Pregnant women were enrolled into a randomized controlled trial when presenting with a MUAC ≤ 23cm (N=1475). Demographic information was collected and women were randomly assigned two receive either a ready-to-use supplementary food (RUSF) or a corn-soy blended flour with an iron and folic acid supplement (CSB +IFA). Anthropometric measurements of height, weight, MUAC, and fundal height were measured every two weeks during pregnancy. Upon delivery the infant was measured for length, weight, MUAC, and head circumference and the mother was measured for MUAC. Infant outcomes of interest included stunting (length-for-age z-score Results: The mean age of enrolled pregnant women was 21.2 years with a mean BMI of 19.78 kg/m2. A total of 33.2% had never attended school. Controlling for weeks on treatment and BMI at enrollment, mothers receiving the RUSF treatment gained a mean 0.49 kg (p2 produced infants that were significantly smaller than women with a BMI ≥ 18.5 kg/cm2 . Similarly, infants born to women with a MUAC(p=0.004) and had a 0.26 cm smaller MUAC (p=0.008) compared to women with a MUAC ≤23. Additionally, for every one unit decrease in maternal MUAC, women has 1.2 greater odds of preterm delivery (p=0.022). Also, women with adequate weekly weight gain gave birth to infants with a 0.37 cm greater mean length (p=0.012), 7.0 g greater mean weight (p=0.030), and 0.08 cm greater mean MUAC (p=0.045) than women with inadequate weight gain. No association was found between recent exposure to malaria at enrollment and poor infant outcomes. Conclusion: In resource poor settings like Sierra Leone with high rates of maternal malnutrition and a high burden of stunting, LBW, and preterm delivery, use of RUSF improved maternal nutritional status but did not impact infant outcomes. The youngest adolescents had the most adverse infant outcomes. Education did not have the expected outcome, indicating other risk factors in this population may play a greater role in infant outcomes. Maternal risk factors of malnutrition such as BMI2and MUACpregnancy, women should be encouraged to gain adequate weight. Young primiparous adolescent are at the highest risk and interventions to postpone motherhood should be priority.

O objetivo deste estudo transversal foi a aplicação do enfoque de risco de acordo com a metodologia proposta pela Organização Mundial da Saúde em uma favela com alta mobilização social e organização comunitária, na zona leste do município de São Paulo. Foram identificadas familias (n=458) que possuiam crianças abaixo de cinco anos de idade (n=694), homogeneamente distribuidas entre sexo e faixa etária. A realização de entrevistas com as mães e tomada de medidas antropométricas das crianças permitiram identificar os fatores de risco e a desnutrição proteico-calórica (D.P.C.). A comunidade foi caracterizada em termos dos perfis do meio ambiente, da família, da mãe e da criança. A prevalência encontrada utilizando-se a classificação de Gomez, foi de 70,3 por cento eutróficos, 25,6 por cento desnutridos de I grau; 3,4 por cento desnutridos de II grau; e 0,6 por cento de III grau. Para o diagnóstico da desnutrição optou-se pelo padrão de referência NCHS, adotando-se o percentil 10 como nivel crítico e o indicador para peso/idade ( 19,7 por cento da população total). As 60 variáveis independentes identificadas foram analisadas considerando-se as categorias de \"risco\" e \"não risco\" para desnutrição. Foram selecionadas 17 variáveis estatisticamente associadas por meio do teste x2 (p<0.05) e Odds-Ratio. Os fatores de risco que compuseram a escala foram: água de torneira para beber, presença de chuveiro e de descarga na bacia, tamanho da família, número de cômodos na casa, presença de geladeira e de liquidificador, baixo peso ao nascer, morbidade e tipos de morbidade, diarréia, assistência médica, paridade, estado civil, suplementação alimentar, idade da mãe e pré-natal. Para alguns fatores de risco clássicos, como aleitamento materno, não ficou evidenciada a associação significante nesta comunidade de estudo. As variáveis da categoria risco que estatisticamente estavam associadas à desnutrição foram agrupadas e constituíram Escala de Risco, com faixas estatisticamente definidas, estabelecendo-se pontos de corte nas faixas, com base na validade por meio de modelo de regressão logística. Os achados demonstraram que esta escala é indicada pois foi desenvolvida baseada em dados reais da comunidade, com sensibilidade=85,606060 por cento e especificidade=31,760435 por cento . Concluiu-se que a referida escala pode ser usada pela comunidade e pelos serviços locais de saúde no combate conjunto a desnutrição.
The aim of this transversal study was to apply the nutritional approach, based on the World Health Organization risk approach methodology, on an slum in the east side of São Paulo city. From the slum, a highly organized community, were selected families (n=458) with children under five years old (n=694), with uniform sex and age distribution. The interviews with the mothers and the anthropometry measurements allowed the identification of the risk factors (independent variables) and the protein-energy malnutrition (dependent variable). The community was characterized in terms of environment, family/mother and children profiles. The adoption of Gomez-type nutrition classification presented prevalence of 70.3 per cent standard; 25.6 per cent first degree malnutrition; 3.4 per cent second degree malnutrition and 0.6 per cent third degree malnutrition. The malnutrition diagnosis used the NCHS - National Center for Health Statistics percentiles, adopting the 10th percentile as the critical level and the weight-for-age index (19.7 per cent of the total population). From the 60 independent variables analyzed as \"risk\" and \"no risk\" categories for the malnutrition, 17 were selected through the testing for significance -x2- p<0.05 as well as it was applied the Odds-Ratio to evaluate the strength of the association. The 17 risk factors that composed the risk scale were: drinking water; existing blender and refrigerator; shower and flush; family size; dwelling number of room; birth weight; morbidity and kinds of morbidity; diarrhoea; parity; marital status; medical assistance; nutritional supplementation; mother\'s age; and prenatal. Some classic risk factors, such as breast feeding, didn\' t present significance for the studied community. The risk scale was statistically defined in zones, establishing cut points based on the validity through multiple regression model. The findings showed that this scale is indicated because it was carried out based on actual community data, with sensibility = 85.606060 per cent and specifieity = 31.760435 per cent . In conel usion, is suggested the use of the scale in the community and by the local health services for joint action against the malnutrition.

The nutritional status of forty-five women aged 71 to 89 years, who met defined health criteria, was assessed by an analysis of three-day diet records and anthropometric measurements. Subjects were grouped, according to the average caloric intake at home <75%> of daily intake to reflect the dependency of the subjects. Subjects were also divided into seven groups according to the site from which they were recruited.For the total population, there was no correlation between calorie intake per day and age, and there were negative correlations between age and all of the measures of body composition. In addition, a higher intake of calories per kg was negatively correlated with weight, suggesting that the heavier subjects had proportionately lower levels of caloric intake per kg of body weight.There were no significant differences in the risk for protein-calorie malnutrition (PCM) among the healthy elderly women who were subjects of this study as measured by an analysis of their dietary intake and anthropometric status, and based upon their dependency on others for <_75%> of their average daily caloric intake. It is concluded that for this population, source of food at home or away, as an indication of dependency, did not significantly affect nutritional status.When grouped according to the site from which they were reecruited, subjects in two of the groups were found to have the potential for malnutrition. Subjects in one of the groups had poor intakes of vitamins and minerals, but adequate body fat and somatic protein stores, and were not at risk for PCM. However, subjects in the other group appeared to have good diets and adequate fat mass, but very low muscle protein stores, and were at significant risk for PCM.The role of socioeconomic factors were minimal in this population as the two groups found to be at greatest risk were those observed to be near opposite ends of the socioeconomic spectrum. Therefore, it is concluded that upper income elderly are as much at risk for PCM as those in lower income groups, and that women in upper socioeconomic groups must be assessed for risk for PCM.It is apparent that the nutritional needs of most of the healthy elderly women in the study were being met. For those groups found to be potentially at risk, there was a possibility that they may not have been as healthy as was indicated, suggesting that risk for PCM is more a function of poor health which results in associated dependency.
Department of Home Economics

Syftet med studien var att beskriva vårdpersonalens uppfattning om risker för undernäring och preventivt arbete hos personer 70 år och äldre, på olika vårdnivåer och inom en kommun. Studien hade en beskrivande design och tolv vårdpersonal deltog, varav fyra sjuksköterskor från en medicinavdelning, två sjuksköterskor, en sjukgymnast och en arbetsterapeut från en hälsocentral samt två sjuksköterskor, en enhetschef och en sjukgymnast från ett äldreboende inom en kommun. Intervjuer användes vid datainsamlingen. Data analyserades genom kvalitativ innehållsanalys och bildade kategorierna Tillstånd som utgör en risk för undernäring, Säkerställa näringsintaget, Ett strukturerat arbetssätt samt Samverkan och ansvar. Som risker för undernäring beskrevs sjukdomar, funktionsnedsättning samt förlorad uppfattning om vikten. Att säkerställa näringsintag innefattade mat, mellanmål och måltidsmiljö. Ett strukturerat arbetssätt handlade om riskbedömningar, åtgärder samt utvärdering. Vidare beskrevs samverkan inom och utanför den egna yrkesgruppen, vårdnivåer och ansvaret omkring arbetet med näringsfrågorna. Vårdpreventivt arbetssätt upplevdes spara tid, tydliggöra vad som skall göras och möjliggöra utvärderingar. Läkarens medverkan i det preventiva arbetet behöver klargöras och rutiner för spridning av arbetssättet till andra enheter formas. Vidare behövs beslut om hur näringstillstånd och behov ska dokumenteras och rapporteras för att säkerställas mellan vårdnivåerna

The purpose was to describe nursing staffs’ perceptions of risks for malnutrition and preventive efforts thereof, for patients 70 years and older, at different care levels within one municipality. Descriptive design was used and twelve participants included; two district nurses, one physiotherapist and one occupational therapist from a health care centre, two registered nurses, one unit director and one physiotherapist from a nursing home in the municipality and four registered nurses from an internal medicine hospital ward. Interviews and qualitative content analysis was used resulting in four categories Conditions of risks for malnutrition, Ensuring nutritional intake, Structured way to work and Collaboration and responsibilities. The participants’ described diseases, disabilities and lost of apprehension concerning weight constituting malnutrition risks. Meals and meal environment influence nutritional intake. Risk assessments, interventions and evaluations mirrored structured way of working. Collaboration with colleagues, other professionals and care levels were highlighted together with responsibilities. Physicians’ participation in malnutrition preventions needs clarification. Improvements like documentation of the nutritional status among the elderly and reports between the different levels of care are needed to ensure safe nutritional care.

 

Thesis (M.S.)--East Tennessee State University, 2004.
Title from electronic submission form. ETSU ETD database URN: etd-0329104-095404. Includes bibliographical references. Also available via Internet at the UMI web site.

Ce travail a pour objectif d’étudier, selon une approche psychosociale, les facteurs de vulnérabilité associés au risque de malnutrition au sein du binôme personne âgée démente/aidant familial. Cette étude transversale a été réalisée dans le cadre d’une intervention psychosociale effectuée à domicile et proposée par un Centre Local d’Information et de Coordination (CLIC) en milieu rural. Les caractéristiques socio-démographiques et des mesures sur la santé psychologique et physique ont été recueillies auprès d’un échantillon composé de 56 binômes. Nos résultats montrent que le risque de malnutrition des personnes âgées démentes serait plus particulièrement expliqué par leur dépendance dans les activités de base de la vie quotidienne et par le propre risque de malnutrition des aidants familiaux. Ce dernier serait lui-même expliqué par la dépression, leur niveau de dépendance, et la sévérité de l’apathie de leur proche dément. Après avoir défini des profils nutritionnels de binômes et les facteurs de vulnérabilité qui y sont associés, la description de leur vécu et de leurs interactions autour de l’alimentation permet de mieux comprendre les problématiques psychologiques en jeu. Ces résultats sont discutés en fonction de la dimension psychosociale de l’alimentation, entre dépendance comme facteur de vulnérabilité et interdépendance comme fonction d’affirmation et de maintien du lien au sein du binôme. Finalement, ces éléments de réponses ainsi que les limites identifiées nous amènent à proposer des perspectives de recherche et de prise en charge
This work aims to study psychosocial factors associated with risk of malnutrition in the dyad demented elderly/ family caregiver. This cross-sectional study comprising 56 community-dwelling demented elderly and 56 family caregivers was performed in a French gerontological institution providing psychosocial interventions. The data collected included their socio-demographic characteristics and measures of their psychological and physical health. Our results show that the risk of malnutrition of demented elderly would be particularly explained by their dependence in activities of daily life and the own risk of malnutrition of family caregivers. This one would be explained by their dependence, depression, and the severity of apathy of demented elderly. Nutritional profiles of caregiving dyads and vulnerability factors associated are presented. According to these profiles, description of their emotional experiences and their interactions concerning feeding-related activities is interesting to better understand the psychological issues. These results are discussed according to psychosocial dimension of feeding, between dependence as a vulnerability factor and interdependence as a function to affirm and preserve the link within caregiving dyad. Finally, the limits of this work and its implications for both clinical and research are argued

The overall aim was to follow the development of nutritional status and its significance for general health status using an epiemiologic method in a representative population‐based selection of older individuals in two cohorts. The main focus was to prospectively examine the significance of demographic, social and medical factors and to establish a basis to investigate the possibilities of preventive measures. Methods: Five hundred and eighty‐three individuals (278 women and 305 men), 75 and 80 years old, when included, living in a municipality in Östergötland in Sweden, participated in this study. Data collection took place 2001‐2006 with one examination yearly. The examination included a single question regarding self‐perceived health demographical questions, different questionnaires in the areas of nutritional status, symptoms of depression, cognitive function, health‐related quality of life and well being and objective assessments such as anthropometrical, physical and biochemical measurements. Results: Fifty percent of the women (I) and 58% of the men (II) perceived themselves as healthy. Important factors for women’s health (I) at baseline were no or few symptoms of depression, better physical mobility and better physical health. Among men who perceived themselves as healthy (II) at baseline, important factors were better physical health, maintaining a social network and the ability to walk outdoors. After one year 69% of the women and 75% of the men still perceived themselves as healthy. Among those women (I) who perceived themselves as healthy after one year, better physical mobility and better physical health were still important, with the addition of less or no pain. Important predictors for preserving health among men (II) were no symptoms of depression and the ability to walk up and down stairs. The prevalence of risk for malnutrition (III) was 14.5% (n=84), among women 18.8% and men 10.6%. Risk factors for malnutrition at baseline were a lower TSF, lower handgrip strength and worse physical health according to the PGC MAI. The incidence was 7.6%‐16.2%, and was distributed equally among women and men over time. Predictors for developing malnutrition were lower self‐perceived health, increased number of symptoms of depression.  Especially men with symptoms of depression ran a higher risk. Reported energy intake (IV) was low in relation to the estimated requirement, on average 74% among women and 67% among men. Intake of vitamins A, D, E and folate was below the recommended intake and the same pattern was found over time. A smaller weight loss was found among women and men from baseline to Follow‐up 2. Conclusions: The experience of a good physical health was the only common factor for a good self‐perceived health among women and men. The highest risk for developing malnutrition was a combination of impaired self‐perceived health and increased number of symptoms of depression. Clinical implications: A combination of nutritional status, self‐perceived health and symptoms of depression can be a base for clinical judgement and can be used by different professionals in ealth and medical care and in home care service.

O trabalho estudou o estado nutricional de uma amostra aleatória (n = 98) de idosos vivendo na zona urbana do Distrito Bonfim Paulista e procurou identificar alguns fatores relacionados ao risco de desnutrição. Os idosos selecionados foram avaliados quanto ao estado nutricional através da “Mini Avaliação Nutricional” (MAN) e através do recordatório alimentar de 24 horas. Também foi elaborado um questionário domiciliar especifico contendo questões relacionadas à escolaridade, renda do idoso e da família, perfil multidimensional, impressão subjetiva de saúde e de qualidade de vida, atividade de trabalho, moradia, doenças crônicas, atividade de vida diária e participação social. Procuramos, desta forma, identificar a prevalência de desnutrição e risco de desnutrição na comunidade e identificar fatores associados com a menor pontuação na MAN, ou seja, fatores que possam contribuir para um pior prognóstico nutricional. Participaram do trabalho 98 voluntários sendo 30 (30,6%) idosos do sexo masculino e 68 (69,4%) do sexo feminino. Detectamos a prevalência de 11,2% de idosos desnutridos, 37,7% de idosos sob risco de desnutrição e 51,1% de bem nutridos de acordo com MAN. Após avaliação da normalidade, usamos testes não paramétricos (Kruskall-Wallis) quando estes três grupos foram comparados em relação às diferentes variáveis estudadas como idade, IMC, consumo energético, gasto energético e variáveis neuropsiquiátricas. Observamos que a MAN é um método viável e de fácil aplicabilidade em idosos vivendo em comunidades brasileiras e que nossos resultados foram semelhantes à maioria dos estudos que usaram a MAN como instrumento de investigação da prevalência de “risco de desnutrição” na comunidade. Paralelamente, acreditamos que a variável IMC não é um bom parâmetro para caracterização de desnutrição e que o estado de saúde mental do idoso contribui fortemente para o seu estado nutricional. Em relação ao consumo energético podemos dizer que, continua sendo uma das principais causas de desnutrição na terceira idade e pode estar presente mesmo entre os idosos caracterizados como nutridos. Para avaliação de associações de determinados fatores, discriminados no questionário geral, com o estado nutricional, montamos tabelas 2X2 e usamos o teste exato de Fisher. Procuramos observar associações entre algumas variáveis com dois grupos: o primeiro que tinha escore inferior a 23,5 e outro que possuía escore superior a 24 na MAN acreditando que estes valores definem, respectivamente, um pior e melhor estado nutricional. Desta forma foi possível observar que fatores como o analfabetismo, baixa renda familiar, falta de participação social e em atividades de trabalho possuem forte correlação com escores inferiores na Mini Avaliação Nutricional apesar de não fazerem parte do seu conteúdo. A auto avaliação do estado de saúde ou impressão subjetiva de saúde possui forte correlação com a maior ou menor pontuação na MAN. Finalmente, apesar de não ter havido correlação estatística, acreditamos que haja uma tendência à maior prevalência de desnutrição em faixas etárias mais elevadas.
The present investigation was carried out to study the nutritional status of a random sample (n = 98) of aged subjects living in the urban zone of the Bonfim Paulista district and to identify some factors related to the risk of malnutrition. The chosen aged subjects were evaluated for nutritional status by the \"Mini Nutritional Assessment\" (MNA) and by the 24-hour food recall method. Also a specific domiciliary questionnaire was elaborated with questions related to educational level, income of the aged and of the family, multidimensional profile, self- reported health status, work activity, housing, chronic illnesses, activities of daily living and social participation. We were interested in identifying the prevalence of malnutrition and risk of malnutrition in the community and factors associated with the lower scores on the MNA, i.e., factors that can contribute to a worse nutritional prognosis. Ninety-eight (98) volunteers participated in the study, 30 of them (30.6%) males and 68 (69.4%) females. On the basis of the MNA, we detected an 11.2% prevalence of malnourished subjects, a 37.7% prevalence of subjects at risk of malnutrition and a 51.1% prevalence of well-nourished subjects. After evaluation of normality, we used nonparametric (Kruskall-Wallis) methods to compare these three groups. The groups had were compared for age, body mass index (BMI), energy intake, energy expenditure and psychiatrics variables. We observed that the MNA is a viable method of easy applicability in aged subjects living in Brazilian communities and that our results were similar to most of those obtained in studies using the MNA as an instrument of inquiry of the prevalence of \"risk of malnutrition\" in the community. At the same time, we believe that the BMI is not a good parameter for malnutrition characterization and that the mental health of the aged contributes strongly to their nutritional status. Regarding energy intake, we can say that it continues to be one of the main causes of malnutrition in the third age and can be present even among elderly subjects considered to be well-nourished. For evaluation of associations of determined variables, discriminated in the general questionnaire, with the nutritional status, we analyzed 2X2 contingency tables and used Fisher’s exact test. We were interested in determining associations between some variables in two groups: one with a score of less than 23.5 points and the other with a score of more than 24 points on the MNA, since we believe that these values define a worse and a better nutritional status, respectively. On this basis, it was possible to observe that factors such as illiteracy, low family income, and lack of social and work activities are strongly correlated with a low score on the MNA, although they are not part of its content. The self-reported health status or subjective impression of health is strongly correlated with a higher or lower score on the MNA. Finally, although the correlation was not statistically significant, we believe that malnutrition tends to be more prevalent in older age ranges.

Bakgrund : Det finns ett fastställt samband mellan undernäring och trycksårsutveckling. Förekomsten av undernäring bland patienter inom slutenvården har ökat de senaste åren trots att riskbedömningsinstrument finns i organisationerna. Trycksår är fortsatt en av de vanligaste vårdskadorna med en bristande patientsäkerhet och en negativ påverkan på patientens livskvalitet. Syfte : Syftet med studien var att beskriva sjuksköterskors arbete med förebyggande omvårdnadsåtgärder mot trycksår och undernäring. Metod : Studien har genomförts som en litteraturöversikt genom att sammanställa befintligt forskningsresultat för att få en överblick över det aktuella forskningsläget. Vetenskapliga artiklar söktes via databaserna Cinahl och Pubmed publicerade mellan år 2008 –2018. 19 artiklar valdes ut, kvalitetsgranskades, analyserades och sammanställdes till resultatet. Resultat : Sjuksköterskor förefaller ha en positiv attityd till förebyggande åtgärder mot trycksår och undernäring medan kunskapsnivån var generellt låg. Sjuksköterskorna skattade den egna kliniska bedömningen högt och upplevde att tidsbrist, hög arbetsbelastning och svårt sjuka patienter utgjorde hinder för fullgod tillämpning av förebyggande åtgärder. Det framkom organisatoriska brister för ett adekvat nyttjande och implementering av riskbedömningsinstrument. Avsaknaden av riktlinjer och rutiner för det förebyggande arbetet kunde resultera till en bristande patientsäkerhet med onödigt lidande och förlängd vårdtid. Slutsats : I resultatet framgår att majoriteten av sjuksköterskorna värderar nutritionen högt i det förebyggande och behandlande trycksårsarbetet men kunskapsnivån och tillämpningen av åtgärder var generellt låg. Införande av behandlingsriktlinjer kan leda till en ökad kunskap och implementering av trycksårsbehandling och nutritionsvård i det kliniska arbetet.
Background: There is an established correlation between malnutrition and development of pressure ulcers. The incidence of malnutrition among patients has increased in recent years despite that risk assessment instruments exist in the organisations. Pressure ulcers remain one of the most common adverse event with a negative impact on the patients ’ quality of life and lack of patient-safety. Aim: The aim of this study was to describe nurses’ work on preventive measures against pressure ulcers and malnutrition. Method: The study was conducted as a literature review including 19 articles, published between 2008-2018, with quantitative, qualitative and mixed-methods approaches. Searches were made in the PubMed and CINAHL databases. The articles were quality-reviewed, analyzed and compiled into a result. Results: : Nurses appear to have positive attitudes to preventive measures towards pressure ulcers and malnutrition while the level of knowledge was generally low. Nurses valued their own clinical judgement high and felt that lack of time, high workload and severely ill patients constituted obstacles to adequate application of preventive measures. Organisational shortcomings emerged for the adequate use and implementation of risk assessment instruments. Lack of guidelines and work routines for preventive work could result in a deficient patient safety. Conclusion: The results show that the majority of nurses value nutrition in the preventive work but the level of knowledge and the application of measures were generally low. Introduction of guidelines could lead to increased knowledge and implementation of pressure ulcers and nutritional treatment in clinical work.

Variáveis nutricionais têm sido consideradas preditoras de risco para o desenvolvimento de úlceras por pressão (UP). A subescala nutrição da escala de Braden, que avalia o consumo alimentar, parece apresentar certa fragilidade para especificar o risco. Muitos estudos ressaltam aspectos mais amplos do estado nutricional associados ao risco de UP. O objetivo deste estudo foi avaliar a capacidade da subescala Nutrição da escala de Braden para predizer o risco de desenvolver UP e verificar as associações estatísticas existentes entre essa subescala e indicadores nutricionais objetivos e sujetivos, além das variáveis demográficas e clínicas, e o desenvolvimento de UP. Após aprovação pelos comitês de ética de duas instituições privadas do Município de SP, 170 pacientes adultos hospitalizados, em risco para desenvolvimento de UP (escore de ?18), foram avaliados durante, no mínimo, uma semana. Os pacientes foram submetidos à avaliação do risco para UP – por meio da Escala de Braden - e da pele a cada 48 horas, às avaliações objetivas e subjetivas na admissão e a cada sete dias e avaliação da aceitação da terapia nutricional diariamente. Para estabelecer o poder preditivo das variáveis independentes em relação ao desenvolvimento de UP, empregaram-se análises de regressão logística univariada e múltipla (quatro modelos). A maioria dos pacientes era do sexo masculino (57,05%); média etária de 66,99 ±15,43 e 17,76 ± 16,77 dias de internação, em média. Os escores médios de risco foram 12,26 e 15,03, respectivamente para os pacientes com e sem UP (p<0,001). Quatorze pacientes desenvolveram UP, gerando incidência de 8,23%. Na modelo 4 da análise da regressão logística multivariada, a subescala nutrição não permanece, sendo a albumina (OR=5,226, p< 0,001), a ANSG (OR=3,246, p< 0,001) e a idade (OR=1,594, p< 0,001) as preditoras mais importantes. Os resultados evidenciaram que, ao não permanecer no modelo final de regressão, a subescala nutrição da escala de Braden não foi preditora para desenvolvimento de UP na amostra do estudo. Embora a albumina tenha sido o indicador preditivo mais importante – fato corroborado na literatura internacional – seu custo limita sua utilização. Por outro lado, a ANSG desponta como parâmetro nutricional complementar interessante e promissor por ser simples, de baixo custo e de uso multidisciplinar
The nutritional variables have been considered as risk predictors for development of pressure ulcers (PU). The nutrition sub scale of Braden scale – which assesses the usual food intake pattern – seems to be quite fragile in predicting those wounds. Plenty of studies have pointed out broad aspects of the nutritional status related the risk to develop pressure ulcer. The objective of this study is to evaluate the capacity of nutrition sub scale of Braden for predicting pressure sore risk and to determine the statistical associations with nutrition sub scale and objective and subjective nutritional indicators, demographic and clinic characteristics and PU development. The project was previously approved for both Hospitals Ethical Committes. A hundred and seventy adult patients from two private hospitals in São Paulo – Brazil, with risk but without pressure sores. Pressure ulcer risk was assessed using the Braden scale (score ? 18) on admission and every 48 hours for a minimum one week. The patients were submitted to skin each alternate days, to objective and subjective assessment at admission and every seven days and to caloric and protein intake assessment daily. Univariate and multivariate (four models) logistic regression analysis were used to determine the predictive power of independent variables related to the development of PU. Subjects were 57,05% male, had a mean age of 66,99 ± 15,43 and length of stay mean 17,76 ± 16,77.The mean Braden scale score for subjects without ulcers was 15,03, and it was 12,26 for those with ulcers (p< 0,001). Fourteen of 170 subjects (8,3%) developed pressure ulcers. After multivariate logistic regression, the nutrition sub scale of Braden did not appear as a powerful predictive factor for PU development. The best predictors were albumin (OR=5,226, p< 0,001), SGA (OR= 3,246, p< 0,001) and age (OR=1,594, p< 0,001). In this study the nutrition sub scale could not predicting PU because it was excluded from the final logistic regression. Despite albumin have been best predictor PU, in several international studies, the elevate cost limited uour utilization. However the SGA showed as simple, inexpensive and non-invasive nutritional assessment. It is very interesting because it can be performed at bedside and by a multidisciplinary team

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A desnutrição é um achado comum em pacientes hospitalizados e muitas vezes seu quadro é agravado pela falta de diagnóstico precoce. Cuidados nutricionais adequados começam com a identificação de pacientes em risco nutricional (RN) no momento do internamento, por intermédio de uma ferramenta de triagem. Entretanto, com o aumento de admissões hospitalares, torna-se impraticável ao profissional de saúde triar todos os pacientes em tempo hábil. O presente estudo, do tipo de avaliação, teve como objetivo avaliar a aplicabilidade de um instrumento de auto-triagem nutricional em pacientes adultos de ambos os sexos admitidos para internamento no período de julho a outubro de 2015 em um hospital público de Pernambuco. A auto-triagem nutricional foi realizada pelos pacientes elegíveis, como também pelo pesquisador, e ao final sua concordância foi avaliada pelo coeficiente Kappa. A avaliação da diferença entre a altura e o peso aferidos pelo avaliador e a altura referida e o peso aferido pelo paciente foi realizada por meio do teste de Wilcoxon, sendo construído o gráfico de Bland & Altman. Para avaliar a associação entre variáveis clínicas e sociodemográficas com o risco nutricional identificado pelo avaliador foi realizado teste do Qui-quadrado. O estudo envolveu 171 pacientes, sendo 59,1% do sexo feminino. A idade média dos pacientes foi de 51,7 ± 15,3 anos. Os resultados mostraram que um percentual elevado 47,9% (n=82) de pacientes não conseguiram realizar a auto-triagem, devolvendo o formulário ao pesquisador em branco ou incompleto, sendo o baixo grau de instrução e idade uma das principais razões. O peso médio registrado pelo paciente (68,4Kg ± 15,0) foi semelhante ao aferido pelo nutricionista (68,2Kg ± 15,1), resultado similar foi evidenciado na comparação entre a altura referida pelo paciente e a aferida pelo nutricionista, com diferencial de 0,03cm. Na comparação entre o RN avaliado pelo profissional de nutrição e o RN avaliado pelo paciente na auto-triagem, verifica-se que houve concordância no diagnóstico de RN em 91,9% dos casos e que 26,9% dos pacientes considerados sem risco pelo profissional foram incluídos como risco na auto-triagem. Na análise realizada pelo Kappa houve moderada concordância entre os dois diagnósticos (k=0,62; p=0,001). Na avaliação da concordância entre as duas aferições de peso e altura com o teste de Bland Altman, verificou-se uma boa concordância, com viés próximo a zero nas duas avaliações. De um modo geral, consideramos satisfatória, para a prática clínica, os resultados da auto-triagem. No entanto, como somente 52,1% da população foi capaz de responder o instrumento, conclui-se que ainda não é viável sua inclusão em um serviço que atenda pessoas de baixo grau de instrução, sugerindo então que novas pesquisas e adaptações para auto-triagem sejam realizadas.
Malnutrition is a common finding in hospitalized patients, and often the condition deteriorates for lack of an early diagnosis. Proper nutritional care begins with the identification of patients at nutritional risk by use of a screening tool on admission. However, as hospital admissions increase, it is impossible for health professionals to screen all patients in a timely manner. The present study aimed to assess the applicability of a nutritional self-screening tool in adult males and females admitted to a public hospital in Pernambuco between July and October of 2015. Nutritional self-screening was performed by eligible patients and by the researcher, and later their agreement was measured by the Kappa coefficient. The differences between the self-reported and measured weight and height were assessed by Wilcoxon’s test, with subsequent construction of the Bland & Altman graph. The chi-square test measured whether clinical and sociodemographic variables were associated with nutritional risk diagnosed by the researcher. The study included 171 patients, of which 59.1% were females. The mean age of the sample was 51.7 ± 15.3 years. A considerable percentage of patients (47.9%, n=82) could not screen themselves, returning the self-screening form in blank or incomplete mainly because of low education level. The mean self-reported weight (68.4 ± 15.0 Kg) was similar to the weight measured by a dietician (68.2 ± 15.1 kg). A similar result was obtained for height as the self-reported and measured heights differed by 0.03 cm. Self-assessed and professionally assessed nutritional risk agreed in 91.9% of the cases, and 26.9% of the patients considered not at risk by the professional were considered at risk according to their self-assessment.According to the Kappa coefficient, the two diagnoses had moderate agreement (k=0.62; p=0.001). The agreements between self-reported and measured weight and height according to the Bland &Altman test were good, with a bias close to zero. Generally, self-screening for clinical practice was considered satisfactory. However, since only 52.1% of the samplemanaged to answer the instrument, its use byhealth care facilities that cater to individuals with low education level is not yet viable, suggesting that new self-screening studies and adaptations are needed.

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Ciências da Nutrição
A desnutrição é o estado nutricional do indivíduo caracterizado pela ingestão insuficiente de energia e nutrientes, que resulta da complexa interação entre a alimentação, condições socioeconómicas e, estado de saúde. Com este trabalho pretendeu-se realizar uma revisão da literatura sobre a desnutrição e de tudo o que a envolve, como as alterações metabólicas, os parâmetros bioquímicos e a terapia nutricional. A desnutrição está muito presente em países em desenvolvimento e em meio hospitalar. A desnutrição pode ser classificada em desnutrição calórica-proteica, kwashiorkor e marasmo, sendo que cada uma tem a sua especificidade e repercussões graves. Quando a desnutrição não é diagnosticada nos grupos de risco (crianças e idosos) precocemente, resulta no agravamento da saúde. As alterações metabólicas podem surgir em qualquer altura da vida, como consequência de causas externas. Na desnutrição, dependendo do grau, é muito importante ter a noção do impacto das alterações metabólicas. Deste modo, é necessário a utilização de métodos nutricionais mais precisos para avaliação do estado nutricional, como os parâmetros bioquímicos. Por exemplo, a concentração de albumina e de transferrina quando conjugadas tornam-se bons indicadores, mas quando isoladas podem ser indicadores tardios da desnutrição. Contudo, é necessário a sua interpretação tendo em consideração as limitações, pois os seus valores podem ser mascarados devido a estado inflamatório ou na presença de uma patologia. O papel do nutricionista é importante, uma vez que é dotado de conhecimento para identificar precocemente o risco nutricional. Deste modo, consegue intervir na alimentação de forma a prevenir e controlar quadros de desnutrição, bem como na melhoria da evolução da doença e na qualidade de vida.
Malnutrition is the nutritional state of the individual characterized by insufficient intake of energy and nutrients, resulting from the complex interaction between diet, socioeconomic conditions and health status. This work aimed a literature review on malnutrition and all that it involves, such as metabolic changes, biochemical parameters and nutritional therapy. Malnutrition is widespread in developing countries and in hospitals and. Malnutrition can be classified as caloric-protein malnutrition, kwashiorkor and marasmus, each of them has its own specificity and serious repercussions. When malnutrition is not diagnosed in the risk groups (children and the elderly) early, it results in an aggravation of health. Metabolic changes can occur at any life stage, as a consequence of external causes. In malnutrition, depending on the degree, it is very important to have a notion of the impact of metabolic changes. Therefore, it is necessary to use more precise nutritional methods for assessing nutritional status, such as biochemical parameters. For example, the concentration of albumin and of transferrin when conjugates become good indicators, but when isolated they may be late indicators of malnutrition. However, its interpretation is necessary considering the limitations, because its values can be masked due to the inflammatory state or in the presence of a pathology. The role of the nutritionist is important, since he is endowed with the knowledge to identify the nutritional risk early. In this way, it is able to intervene in food in order to prevent and control malnutrition, as well as to improve the evolution of the disease and quality of life.
N/A

Thesis (Ph. D.)--Ohio State University, 2003.
Title from first page of PDF file. Document formatted into pages; contains xviii, 233 p.: ill. Includes abstract and vita. Advisor: Douglas E. Crews, Dept. of Anthropology. Includes bibliographical references (p. 209-233).

Objetivo. A desnutrição em indivíduos hospitalizados tem apresentado elevada prevalência no Brasil e no mundo e é conseqüência de uma série de fatores. O presente trabalho teve por objetivo estudar os fatores associados ao risco de desnutrição em adultos hospitalizados. Casuística e Métodos. Foi um estudo transversal e a amostra constituída por 300 indivíduos hospitalizados com idade de 18 a 64 anos, sorteados na listagem de internação das ultimas 48 horas. Foram conduzidos dois modelos de regressão logística múltipla, adotando-se a desnutrição como variável dependente. O diagnóstico do estado nutricional foi obtido com uma avaliação nutricional completa. No primeiro modelo, foram selecionadas e incluídas todas variáveis de interesse e que apresentaram nível de significância de 20por cento (p<0,20). No segundo modelo, as variáveis mais fortemente associadas no primeiro foram retiradas com o objetivo de avaliar outros fatores. A partir das variáveis estudadas, foram desenvolvidos e propostos dois instrumentos de triagem nutricional. Resultados. No primeiro modelo, as variáveis associadas à desnutrição foram perda de peso recente, ossatura aparente, redução de apetite, diarréia, ingestão energética inadequada e sexo masculino. Perda de peso (odds ratio de 58,03 e p<0,001) e ossatura aparente (odds ratio de 47,62 e p<0,001) foram os fatores mais fortemente associados. No segundo modelo, as variáveis associadas foram redução de apetite, sexo masculino, mudança recente na alimentação, presença de dor que prejudica a alimentação, câncer e internações hospitalares no último ano. A partir das variáveis significativas (p<0,05) e dos coeficientes de regressão obtidos na análise estatística, foram propostos dois instrumentos de triagem nutricional (TRINUT 1 e TRINUT 2). Com o objetivo de avaliar instrumentos de triagem nutricional, analisou-se a concordância de três instrumentos disponíveis na literatura e os propostos, adotando-se a avaliação nutricional completa como padrão ouro. Observou-se adequada concordância de todos os instrumentos e os de melhor concordância foram o MST (Malnutrition Screening Tool) (k=0,84) e o TRINUT 1 (k=0,86). Conclusões. Conclui-se que a triagem nutricional é o primeiro passo para o atendimento ao indivíduo hospitalizado, deve ser adotado por hospitais e seu desenvolvimento deve ser realizado a partir da identificação dos fatores associados ao risco de desnutrição na população
Malnutrition in hospitalized patients has shown a high prevalence in Brazil and in the world and is consequence of several factors. The objective of this study was to assess the factors associated with risk of malnutrition in hospitalized adult patients. It was a cross-sectional study with a sample composed by 300 hospitalized adults patients, ranging from 18 and 64 years of age. Two multiple logistic regression were conducted, with malnutrition established as the dependent variable. Nutritional status was assessed by a full nutritional assessment. In the first model, all variables of interest and with a statistical significance of 20per cent (p<0,20), tested by a simple analysis, were included. In second model, stronger variables associated in the first model were excluded, with the intention of assessing others variables with malnutrition. The variables associated with malnutrition in the first model were recent loss weight, apparent ossature, decreased appetite, diarrhea, inadequate energy intake and male sex. Weight loss (odds ratio 58,03; p<0,001) and apparent ossature (odds ratio 47,62; p<0,001) were strongest risks factors. In the second model, the variables associated were decreased appetite, male sex, recent change intake, pain while eating, cancer and hospitalization during last year. Based on significant variables (p<0,05) and regression coefficients, two nutritional screening tools were proposed (TRINUT 1 and TRINUT 2). To assess nutritional screening tools, a concordance analysis was conducted with three tools available in published literature and the proposed tools, adopting the nutritional the full nutritional assessment as gold standard. The concordance analysis between all tools was adequate and stronger agreement was the MST (Malnutrition Screening Tool) (k=0,84) and TRINUT 1 (k=0,86). In conclusion, nutritional screening is the first step to attend hospitalized patients, should be used in hospitals and its development must be realized based on the identification of risk factors within the population

Orientador: Paula Schmidt Azevedo Gaiolla
Resumo: O Transplante de Células Progenitoras Hematopoiéticas (TCPH) é um método terapêutico utilizado no tratamento de diversas doenças que envolvem o tecido linfo-hematopoiético, doenças autoimunes e condições não-malignas. As evidências apontam que o reconhecimento precoce de pacientes em grupos de risco nutricional no TCPH e a elaboração de um plano terapêutico para tal tem impacto positivo na redução da mortalidade. A monitorização diária das necessidades energéticas, proteicas e de nutrientes é um dos pontos cruciais da terapia, pois o paciente que é incapaz de suprir mais do que 60% das necessidades nutricionais diárias por via oral torna-se candidato a outras modalidades de terapia (enteral ou parenteral), a depender da viabilidade do trato gastrointestinal, das contra-indicações relativas a cada método (plaquetopenia na introdução de sonda nasoenteral, por exemplo) e das complicações associadas aos procedimentos (aumento das taxas de infecção de corrente sanguínea na nutrição parenteral). Se o paciente atingir mais do que 60% das necessidades nutricionais por via oral e mantiver esse aporte por pelo menos 3 dias, o suporte por nutrição enteral ou parenteral pode ser descontinuado. A literatura científica ainda não elucidou todos os questionamentos quanto à melhor abordagem nutricional em pacientes submetidos a TCPH, podendo-se observar grande variação entre as condutas orientadas pelas diretrizes internacionais mais recentes e o que se adota como prática clínica diária, cham... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Hematopoietic Stem Cell Transplantation (HSCT) is a therapeutic method used for treatment of various diseases involving lymphohematopoietic tissue, autoimmune diseases and non-malignant conditions. Evidence indicates that the early recognition of nutritional risk in HSCT patients and the elaboration of a therapeutic plan for them has a positive impact in reducing mortality. Monitoring daily needs of energy, protein and nutrient is one of the crucial points of therapy, because individuals who are unable to supply more than 60% of the daily nutritional needs orally become candidates for other modalities of therapy (enteral or parenteral), depending on the viability of the gastrointestinal tract, contraindications for each method (thrombocytopenia in the introduction of nasoenteral probe, for example) and complications associated with procedures (increased bloodstream infection rates in parenteral nutrition) . If the patient reaches more than 60% of nutritional needs orally and maintains this intake for at least 3 days, enteral or parenteral nutrition support may be discontinued. The scientific literature has not yet elucidated all the questions regarding the best nutritional approach in patients undergoing HSCT and a great variation between the conducts guided by the most recent international guidelines and what is adopted as daily clinical practice can be observed, drawing attention to the need for nutritional protocols that could reduce these divergences. Objectives​: elabora... (Complete abstract click electronic access below)
Mestre

Introdução: A doença renal crônica afeta de 10 a 15 % da população adulta mundial e a piora da função renal, se associa com várias complicações, tais como: desnutrição, inflamação, doenças cardiovasculares e distúrbios do metabolismo mineral. A mortalidade desses pacientes é elevada sendo de 6 a 8 vezes maior que a de indivíduos saudáveis. Cerca de 22% dos pacientes incidentes, ou seja, no primeiro ano de diálise, vão a óbito. O objetivo do presente estudo foi avaliar as características clínicas, laboratoriais de pacientes incidentes em diálise além de identificar fatores de risco que contribuíssem para a mortalidade desses pacientes. Métodos: Estudamos 424 pacientes com sinais e sintomas de uremia e indicação de tratamento dialítico admitidos no serviço de emergência do Hospital das Clínicas entre Janeiro de 2006 e Dezembro de 2012. O tempo de acompanhamento foi de um ano. Analisamos os parâmetros clínicos, tipo de via de acesso para hemodiálise, fatores de risco ligados a doenças cardiovasculares e as alterações do metabolismo mineral bem como eventos clínicos ocorridos durante o seguimento. Avaliamos a sobrevida e os fatores que influenciaram a sobrevida dos pacientes, pela curva de Kaplan-Meier e análise de regressão de Cox, respectivamente. Resultados: A média de idade foi de 50±18 anos, 58,7% eram homens e 69,1% brancos. Hipertensão arterial foi a principal etiologia da doença renal primária (31,8%) seguida de DM (29,5%). Os principais fatores de risco encontrados foram tabagismo (19,6%), dislipidemia (48,8%), doenças cardiovasculares (41%) e na admissão a maioria dos pacientes não tinha acesso vascular para hemodiálise (89,4%). Os resultados dos exames laboratoriais revelaram que a maioria dos pacientes estava anêmico (83,7%), com níveis de PCR elevados (79,9%). Os distúrbios do metabolismo mineral como hipocalcemia, hiperfosfatemia, elevação dos níveis de paratormônio e diminuição dos níveis de 25(OH) vitamina D estavam presentes em praticamente todos os pacientes. Ao término de um ano, 60 pacientes faleceram (14,1%). Esses pacientes eram significativamente mais idosos, apresentavam sinais de insuficiência cardíaca congestiva, de desnutrição, de inflamação, níveis reduzidos de 25 (OH) vitamina D, desenvolveram maior número de infecções e não tinham acesso vascular definitivo para hemodiálise. Conclusões: A avaliação conjunta de parâmetros clínicos, laboratoriais e dos fatores de risco revelou que a idade mais avançada, presença de insuficiência cardíaca congestiva, desnutrição, inflamação, deficiência de vitamina D e a falta de via de acesso para hemodiálise foram fatores preditores de mortalidade em pacientes incidentes em hemodiálise
Introduction: Chronic kidney disease affects 10-15% of the world adult population, and the worsening of renal function is associated with several complications, such as malnutrition, inflammation, cardiovascular diseases and disorders of mineral metabolism. Mortality of those patients is high and 6 to 8 times higher than that of healthy individuals. About 22% of incident patients, that is, during the first year of dialysis, will die. The aim of this study was to evaluate the clinical and laboratory characteristics of incident dialysis patients and identify risk factors that contribute to the mortality of these patients. Methods: We studied 424 patients with signs and symptoms of uremia and dialysis indication admitted to the emergency service at Hospital das Clínicas between January 2006 and December 2012. Follow-up time was one year. We analyzed the clinical parameters, type of hemodialysis access road, risk factors linked to cardiovascular diseases and changes in mineral metabolism as well as clinical events occurred during follow-up. We evaluated survival and the factors that influenced patient survival by Kaplan-Meier curves and Cox regression analysis respectively. Results: Mean age was 50 ± 18 years old; 58.7% were males and 69.1% were white. Hypertension was the main cause of primary kidney disease (31.8%) followed by DM (29.5%). Major risk factors found were smoking (19.6%), dyslipidemia (48.8%), cardiovascular disease (41%), and upon admission most patients had no vascular access for hemodialysis (89.4%). Results of laboratory tests showed that most patients were anemic (83.7%), with high CRP levels (79.9%). Disturbances of mineral metabolism such as hypocalcemia, hyperphosphatemia, elevated parathyroid hormone levels and decreased levels of 25(OH) vitamin D were present in almost all patients. At the end of a year, 60 patients died (14.1%). These patients were significantly older, had signs of congestive heart failure, malnutrition, inflammation, low levels of 25(OH) vitamin D, developed greater number of infections and had no definitive vascular access for hemodialysis. Conclusions: The joint evaluation of clinical and laboratory parameters and risk factors revealed that older age, presence of congestive heart failure, malnutrition, inflammation, vitamin D deficiency and lack of hemodialysis access road were predictors of mortality in incident patients undergoing hemodialysis

El 2014, el percentatge de persones de 80 anys o més va ser del 5,7 %. Segons les projeccions demogràfiques, el 2080 aquest segment de població serà del 12,3 %, això comportarà un desafiament sanitari i social. La malnutrició és la presencia d’un desequilibri per deficiència o per excés d’energia, proteïnes o altres nutrients que provoca canvis mesurables en l’organisme, capacitat funcional o en els resultats analítics. Per detectar risc de malnutrició es necessari la realització d’una valoració geriàtrica amb un enfocament multidisciplinar. El Mini- Nutritional Assessment (MNA) és l’instrument de valoració per a la detecció de risc malnutrició en les persones grans. En una cohort de 328 persones de 85 anys (nascudes el 1914) que viuen a la comunitat es va realitzar un seguiment longitudinal, on en el perfil inicial va destacar que eren persones molt grans amb acceptable estat de salut, funcionalitat preservada, bona cognició i morbiditat escassa. Les dones presentaven major discapacitat, vivien soles patien més caigudes i presentaven més risc social i nutricional, en canvi, els homes arribaven en millors condicions, estaven casats amb millor cognició, funcionalitat, i major comorbiditat als 85 anys. En l’ avaluació inicial va mostrar que 113 (34,5 %) individus presentaven un MNA ≤ 23,5, compatible amb risc nutricional. Els factors predictors a presentar risc nutricional va mostrar que el gènere femení i la polifarmacia multiplicaven per 2 i per 5 respectivament la probabilitat d’aquest risc, i també que la disminució d’un punt en l’Índex de Lawton (IL) o l’existència de risc social augmentaven un 40 % i 15 % respectivament la probabilitat d’aquest trastorn. Després de dos anys de seguiment, es va constatar que la incidència de risc nutricional es va presentar en 42 (19,5 %) subjectes. Com a factors predictors a deteriorament en l’estat nutricional, es va comprovar que el gènere femení, l’alta comorbiditat i la polifarmàcia, eren factors que influenciaven en la disminució del MNA, però era el deteriorament cognitiu el factor més fort que determinava l’evolució dels valors de MNA en el segon anys de seguiment. Cent seixanta dos (49,3 %) individus tenien la condició d’envelliment satisfactori, valorat amb la presència d’Índex de Barthel ≥ 91 i un Mini-Examen-cognitiu ≥ 24. El perfil d’envelliment satisfactori a l’inici de l’estudi era ser homes, vidus amb estudis, majors puntuacions de MNA i baixa comorbiditat Als 12 mesos de la visita basal es va valorar la fragilitat segons els criteris adaptats de Fried, on es va comprovar que 56 (20,5 %) subjectes presentaven criteris de fragilitat, i que la presència de MNA ≤ 23,5 multiplicava per 2 la probabilitat de presentar fenotip de fragilitat. Un fet que demostra l’estreta relació entre fragilitat i l’estat nutricional en persones grans, era que un 68 % i un 31 % de persones fràgils i prefràgils, respectivament, presentaven MNA < 23. Als tres anys de seguiment de la cohort Octabaix, el 17,3 % de subjectes havien mort. La taxa anual mitjana de mortalitat era de 5,7 %. Els subjectes que no van sobreviure tenien pitjor estat funcional per a les activitats instrumentals en la vida diària, major comorbiditat, risc de malnutrició i de caigudes, pitjor qualitat de vida i major prescripció crònica en la cohort inicial, però els factors predictors de mortalitat eren tenir pitjor puntuació en IL i polifarmàcia, totes elles variables bàsiques de la recollida de dades en la valoració geriàtrica en aquestes persones. En definitiva, l’estudi Octabaix ha permès definir el perfil de persones de 85 en el nostre país, on la interdependència de risc nutricional i fragilitat representarà la base per a estratègies de tractament amb èxit.
In Spain, old-old individuals are making up an increasingly large segment of the population. Nutritional assessment in the elderly population requires a multidisciplinary approach. The Mini Nutritional Assessment (MNA) is a reliable, standardized instrument for detect risk of malnutrition in the elderly. A total of 328 community-dwelling inhabitants born in 1924 (85 years old at the time of inclusion) were followed for 3 years. At baseline, 113 (34, 5 %) individuals had MNA ≤ 23, 5, compatible with nutritional risk. The independent risk factors for being undernourished ( MNA < 23,5 ) were being a female, inability to perform instruments activities of daily living, a higher social risk and taking a higher number of drugs overall. After two years of follow-up, the incidence of nutritional risk was present in 42 (19, 5 %) subjects, and cognitive impairment was an independent factor strongly associated with a decline in nutritional status. According to a phenotypic definition of frail of Fried, at the beginning of the second year, in the 273 subjects in the study at that point, 56 (20, 5 %) were frail, and the presence of MNA ≤ 23, 5 multiplied by 2 the probability of phenotype of frailty. A factor that demonstrates the close relationship between fragility ant nutritional status in older people, which was that 68 % and 31 % of frail people and pre-fragile respectively presented MNA < 23,5. The mortality rate after 36 months of follow-up was 17, 3 %, and the only predictors of mortality, among the variables studied, were less capacity to carry out instrumental activities and the use of higher numbers of prescription drugs. In short, the study Octabaix allowed to define the profile of 85 people in our country, where the interdependence and fragility of nutritional risk represents the basis for successful treatment strategies.

Orientadores: José Antônio Rocha Gontijo, Patrícia Aline Boer
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O presente estudo investigou as alterações pós-natais dos receptores de angiotensina II (AngII) do tronco encefálico resultantes da restrição proteica materna (LP) e seu impacto na programação da hipertensão na idade adulta. Os resultados demonstraram que a massa corpórea da prole ao nascer de machos LP foi reduzida significativamente quando comparado ao grupo controle (NP) ou com a prole LP suplementada com taurina (LPT). Esta redução foi revertida rapidamente nos primeiros 12 dias de vida. A redução da massa corpórea foi acompanhada por uma expressiva redução no número de neurônios do tronco cerebral de ratos, recém-nascidos LP, comparados aos controles adequados e LPT pareados por idade. A análise imunoistoquímica para receptores da AngII também demonstrou que em LP de 16 semanas de vida ocorre diminuição significativa na expressão dos receptores de angiotensina tipo 1 (AT1R) no núcleo do trato solitário (NTS) sendo mais intensa na parte medial do mesmo, comparativamente a NP e LPT. Contrariamente, a expressão dos receptores tipo 2 (AT2R) em LP com 16 semanas de vida não foi diferente na região medial embora estivesse reduzida nas regiões rostral e caudal do NTS. O presente trabalho mostrou redução precoce na excreção urinária de sódio na prole LP, a qual foi abolida pela suplementação de taurina. A redução na fração de excreção de sódio foi acompanhada por um aumento na reabsorção proximal de sódio que ocorreu a despeito de uma inalterada filtração glomerular estimada pela depuração renal de creatinina. No presente estudo é plausível supor uma associação entre o decréscimo no desenvolvimento fetal do NTS, uma menor expressão central de AT1R associada a menor razão AT1R/AT2R e, um decréscimo na excreção urinaria hidrossalina. Estas alterações poderiam estar relacionadas à elevação dos níveis pressóricos em LP (progênie deficiente em taurina) comparativamente a prole NP e LPT da mesma idade
Abstract: The current study pays attention to changes of the postnatal brainstem angiotensin receptors by maternal protein restriction (LP), and its impact on in uteri programming of hypertension in adult life. The data shows that LP male pup body weight was significantly reduced when compared to that of control (NP) or LP taurine-supplemented (LPT) pups. That fall in in-born LP body weight was rapidly reverted in 12-wk-old LP offspring. The reduced body weight was associated with striking decreases in the neurons number in inborn brainstem LP offspring, when compared to age-matched LP and LPT. Also, the immunohistochemistry analysis demonstrated a significantly decreased expression of type 1 AngII receptors (AT1R) in the entire medial solitary tract nuclei (NTS) of LP rats at 16-week of age compared to age-matched NP and LPT offspring. Conversely, the immunostained type 2 AngII (AT2R) receptors in 16- wk-old LP medial NTS were unchanged, although, they were expressively decreased in rostral and caudal NTS subnuclei. The present investigation shows an early decrease in fractional urinary sodium excretion in maternal proteinrestricted offspring reverted by diet taurine supplementation. The decreased fractional sodium excretion was accompanied by a fall in proximal sodium excretion and occurred despite unchanged creatinine clearance. In the present study it is plausible to hypothesized an association of decreasing of NTS neuronal development, AT1R/AT2R ratio, and water-electrolyte renal excretion with the higher blood pressure levels found in LP (a taurine-deficient progeny), compared with age-matched NP and LPT offspring
Doutorado
Fisiopatologia Médica
Doutor em Ciências

Dans un pays sahélien comme le Niger, l'espace social dédié à l'alimentaire est culturellement riche de savoirs. Pourtant, peu d'écrits font de ce constat un objet d'étude sociologiquement pertinent. La présente réflexion se donne pour tâche d'analyser la portée des déterminants culturels dans la survenance des famines. S'appuyant sur des matériaux de nature socio-anthropologiques, cette thèse met en exergue des problèmes de gouvernance pour expliquer le prégnance des crises de subsistance. Malgré le poids des facteurs culturels sous-tendant le modèle de consommation des Gouréens, il est intellectuellement risqué d'affirmer que les tabous alimentaires peuvent constituer des causes sérieuses de disettes dans cette partie du Niger confrontée à une succession de déficit de productions vivrières. Toutefois, notre contribution montre que ces interdits demeurent un élément amplificateur, surtout dans des milieux à forte croyance traditionnelle. La méthodologie utilisée tout au long de cette démarche se fonde sur des méthodes qualitatives et quantitatives et prend appui sur divers outils de collecte comme les guides d'entretien semi-directifs, les focus groups et un questionnaire de type CAP (connaissance, attitudes, pratiques)
In a Sahelian country like Niger, the space dedicated to food is culturally rich for learnings. However, there are a few writings which make this as a valid sociologically subject of study. This reflection gives itself a taskto analyze the scope of cultural determinants in the occurence of famines. Based on socio-anthropological materials, this thesis highlights social governance to explain the salience of subsistence crises. Despite the weight of cultural factors underlying consumption model of the people in Goure, it is intellectually risky to assert that food taboos may constitute serious causes of food shortages in this part of Niger which faces a succession of food production deficit. However, our contribution shows that these taboos remain enhancing element, especially in high-traditional belief backgrounds. The methodology used in this approach is based on qualitative and quantitative methods using the following collection tools : semi-structured interview guides, focus groups and a questionnaire type KAP (knpwledge, attitudes, practices)

碩士
國立臺灣大學
臨床動物醫學研究所
104
Nutrition has enormous effect on cancer management and early intervention is indispensable. Patients with head and neck cancer have unique oral feeding problem directly caused by physical obstruction and functional impairment of the tumor. Identifying factors associated with malnutrition, different clinical behavior and final outcome between dogs and cats would help clinicians to identify high-risk individuals, improving clinical treatment response, patient quality of life and ultimately patient survival. Our study objectives is to estimate the percentage and to identify malnutrition risk factors associated with malnutrition in canine and feline head and neck tumor patients attended at Animal Cancer Treatment Center (ACTC) of National Taiwan University Veterinary Hospital. This study is a single-center prospective study. Patient Signalment, tumor staging and feeding strategy were also recorded. Percentage of malnutrition was adjusted for the sampling approach. Chi-square test was used to identify factors associated with malnutrition. Study was conducted between February 2015 and January 2016. Head and neck cancer accounts for 21%(135/641) in all patients attending ACTC, which site is the second most common cancer location. 28/76 (37%) dogs and 24/29 (83%) cats were malnourished at the time of presentation. In dogs, there is strong association with cancer-related malnutrition and tumor stage (P<0.001). But the correlation was absent in cats. The duration of clinical signs prior to diagnostic approach and initial chief complain show strong association in cats (P = 0.001). Dogs have unique high percentage of home made diet feeding (36%) compared to cats (7%). But, compared to other food type, home made diet feeding has high proportion of insufficient calorie intake (P <0.001). Head and neck has higher percentage of cancer-related malnutrition compared to other location.37% Dogs and 83% cats had malnutrition at the time of presentation, which showed significant difference between species. The prevalence of cancer-related malnutrition among cats is high regardless of tumor stage, but is less common in dogs and always limited to higher tumor stage subgroup. Environment has tremendous effect on malnutrition. Homemade food feeding dogs and large family size with ad libitum feeding cats are high-risk population. The knowledge of identified risk factors for cancer-related malnutrition and species differences between dog and cat could help us prevent the occurrence and consider the proper timing and indication of advanced nutritional intervention.

碩士
高雄醫學大學
護理學系碩士班
106
Among the elderly group who visited outpatient department for certain medical treatment, it was easy to see the obvious fact that the ones had more comorbidity and also had higher risk of frailty, malnutrition and fall events. However, in outpatient department service modes, we do not have the opportunity to perform detailed assessment in these debilitating elderly groups. In hypothesis of frailty, malnutrition was one of those aggravating factors and both contributed to worse consequences, such as fall events. In Contemporary articles and reviews, in the elderly groups at outpatient clinic services, it had few convincing references to know how much correlation it was among frailty, malnutrition and fall. For the purpose, this study aimed to understand the followings: (1) To know the extent of frailty in elderly in outpatient clinic services (2) To evaluate the extent of malnutrition risk in elderly in outpatient clinic services (3) To evaluate the extent of fall risk in elderly in outpatient clinic services (4) To know how much correlation it was among frailty, malnutrition and fall. In this study, we executed a cross-sectional design and recruited the elderly volunteers in outpatient clinics, including integrated-geriatric, geriatric and general medicine department in the medical center of Southern Taiwan. A total of 145 cases were recruited during the study. All participants had accepted questionnaire analysis, including (1) Key individual clinical characteristics (2) Edmonton Frail Scale in Chinese version (3) Malnutrition Universal Screening Tool (4) Peninsula Health-Fall RiskAssessmentTool. Also, all participants had accepted further 3-meter walking test and grasp muscle power measurement. For the statistical analysis, we had used software with version 14.0 of SPSS for Windows. The statistical data included the average, percentage, Standard Deviation and inferential statistics of Spearman Rank Correlation and Chi-square distribution. Among those participants, it was in average age of 73.43 (± 8.27) years-oid and female predominant, 58.6% included. In subgroups analysis, it was present in 71%, 14.5%, and 14.5% of the nonfrail, prefrail, and frail subjects. Malnutrition risk was present in 90.3% and 9.7% of low risk and mid/high risk groups and fall risk was present in 96.6% and 3.4% of low risk and mid/high risk groups. We analyzed those data in Spearman correlation coefficient and showed positive correlation in frailty and fall (r=.21, p＜.01), but neither correlation in frailty and malnutrition (r= –.07, p＝.39) nor in fall and malnutrition(r= –.06, p＝.46). In conclusion, in the elderly at outpatient clinic, the result showed the more frailty and the higher fall risks. It benefits from earlier risk assessment of frailty and fall in the elderly at outpatient practice, and we could do the individual intervention to avoid worse consequences, like more frailty and falls. However, the undetermined result had been among malnutrition, frailty and falls and need more analysis in future study.

PhD, Faculty of Health Sciences, University of the Witwatersrand
Background: In low- to middle-income countries, rising levels of overweight and obesity are a result of multiple transitions, in particular, a nutrition transition. Consequently, in these countries, metabolic diseases are contributing increasingly to disease burden, despite the persisting burden of undernutrition and infectious diseases. Understanding the patterns and factors associated with persistent undernutrition and emerging obesity in children and adolescents, and concomitant risk for metabolic disease, is therefore of criticial importance. This should contribute to public health policy on interventions to prevent adult disease. Aims: To better understand the double burden of malnutrition in a poor, high HIV prevalent, transitional society in a middle-income country; In so doing, to inform policies and interventions to address the double burden of malnutrition. Methods: A cross-sectional growth survey was conducted in 2007 targeting 4000 children and adolescents 1-20 years of age living in rural South Africa. The survey was nested within the ongoing Agincourt Health and Socio-demographic Surveillance System, which acted as the sampling frame and also provided data for explanatory variables. Anthropometric measurements were performed on all participants using standard procedures. In addition, HIV testing was done on children aged 1 to 5 years and Tanner pubertal assessment was conducted among adolescents 9-20 years. A one-year follow-up of HIV positive children included a matched control group of HIV negative counterparts. Data collection involved both quantitative and qualitative methods. Growth z-scores were used to determine stunting, underweight and wasting and were generated using the 2006 WHO growth standards for children up to five years and the 1977 NCHS/WHO reference for older children. Overweight and obesity were determined using the International Obesity Task Force cut-offs for BMI for children aged up to 17 years and adult cut offs of BMI =25 and =30 kg/m2 for overweight and obesity respectively for adolescents 18 to 20 years. Waist circumference cut-offs of =94cm for males and =80cm for females, and waist-to-height ratio of 0.5 for both sexes, were used to determine central obesity and hence metabolic disease risk in ix adolescents. Descriptive analysis described patterns of nutritional status by age, sex, pubertal stage and HIV status. Linear and logistic regression was done to determine predictors of nutrional outcomes. A p-value of <0.05 was considered statistically significant. Results: Prevalence of undernutrition, particularly stunting, was substantial: 18% among children aged 1-4 years, with a peak of 32% in children at one year of age. Stunting and underweight were also substantial in adolescent boys, with underweight reaching a peak of 19% at 14 years of age. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was prominent among adolescent girls, increasing with age, and reaching a peak of 25% at 18 years. Risk for metabolic disease using waist circumference cut-offs was substantial among adolescents, particularly girls, increasing with sexual maturation, and reaching a peak of 35% at Tanner stage 5. Prevalence of HIV in children aged 1-4 years was 4.4%. HIV positive children had poorer nutritional outcomes than that of HIV negative children in 2007. The impact of paediatric HIV on nutritional status at community level was, however, not significant. Significant predictors of undernutrition in children aged 1-4 years, documented at child, maternal, household and community levels, included child’s HIV status, age and birth weight; maternal age; age of household head; and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease in adolescents aged 10-20 years, documented at individual/child and household levels included child’s age, sex and pubertal development; and household-level food security, socio-economic status, and household head’s highest education level. There was a high acceptance rate for the HIV test (95%). One year following the test, almost all caregivers had accepted and valued knowing their child’s HIV status, indicating that it enhanced their competency in caregiving. Additionally, nutritional status of HIV positive children had improved significantly within a year of follow-up. Conclusions: The study describes co-existing child stunting and adolescent overweight/obesity and risk for metabolic disease in a society undergoing nutrition transition. While likely that this profile reflects changes in nutrition and diet, variation in infectious disease burden, physical activity patterns, and social influences need to be investigated. The findings are critical in the wake of the rising public health importance of metabolic diseases in low- to middle-income countries, despite the unfinished agenda of undernutrition and infectious diseases. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged. In addition, gender-biased nutritional patterns call for gender-sensitive policies and interventions. The study further documents a significant role of paediatric HIV on nutritional status, and the potential for community-based paediatic HIV testing to ameliorate this. Targeted early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.

A Thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in ful lment of the requirements for the degree of Doctor of Philosophy in Medicine Johannesburg, South Africa 2017.
Background: The persistent burden of undernutrition, with increasing prevalence of obesity and metabolic disease risk among children and adolescents, has become a global public health problem. Research has shown that risk factors established in childhood and adolescence may contribute to the development of non-communicable diseases (NCDs) in adulthood. This is of particular concern in South Africa, given its rapid socio-economic, political and epidemiological transitions. Research into the trends of nutrition transition in rural children and adolescents, whose particular health needs have been under-served and poorly delineated in the past, provides a unique opportunity to study the e ects of rapid health transitions on development. Aim: To determine the association of nutrition, body composition and metabolic disease risk in rural South African children and adolescents. Study design: Three cross-sectional studies were undertaken to address the overall aim of this research. The speci c objectives of each study were: (1) to determine the association of nutrition on body composition and metabolic disease risk in children and adolescents; (2) to examine the associations between body mass index (BMI), disordered eating attitude and body dissatisfaction in female adolescents, and descriptive attributes assigned to silhouettes of di ering body habitus in male and female adolescents; and (3) to investigate associations between diet and cardiovascular disease (CVD) risk factors in adolescents. Method: One cross-sectional study, 3 analyses were nested within the Agincourt Health and Socio-demographic Surveillance System (HDSS) site, in the Bushbuckridge subdistrict, Mpumalanga Province, South Africa. In 2009, a random sample of 600 children and adolescents, from age groups 7 to 8 years, 11 to 12 years and 14 to 15 years, were selected from 3489 children who had participated in a 2007 growth survey. These children and adolescents had to have lived in Agincourt at least 80% of the time since birth or since 1992, when enrolment into the Agincourt Health and Socio-Demographic Surveillance System (HDSS) began. Height and weight were measured to determine BMI. Age and sex-speci c cut-o s for underweight and overweight/obesity were determined using those of the International Obesity Task Force. Body image satisfaction using Feel-Ideal Discrepancy (FID) scores, Eating Attitudes Test-26 (EAT-26), perceptual female silhouettes and pubertal assessment were collected through self-administered questionnaires. Blood pressure (systolic (SBP) and diastolic (DBP)) was measured, fasting blood samv ples were collected for the determination of glucose and lipids. Waist to hip ratio cut-o s of (WHR) >0.85 for females, >0.90 for males, waist to height ratio (WHtR) of >0.5 for both sexes, and waist circumference (WC) of >80 cm for females and >94 cm for males were used to determine the risk of adiposity. For abnormal lipids: high density lipoprotein cholesterol (HDL-C) cut-o s of >1.03 mmol/l, low density lipoprotein-cholesterol (LDL-C) of >2.59 mmol/l, triglycerides (TGs) of >1.7 mmol/l and total cholesterol (TC) of >5.17 mmol/l were used. Pre-hypertension prevalence was computed using the average of 2 readings of SBP or DBP, being >90th but <95th percentile for age, sex and height. Dietary intake was assessed using semi-quantitative food frequency questionnaire. T-test and ANOVAs for normally distributed data and Wilcoxon-Mann- Whitney test was used to determine signi cant di erences by sex and by pubertal stages for EAT-26 and EAT-26 sub-scores. Chi square tests were done to determine signi cant associations between the categorical variables. Bivariate linear regression was employed to test associations and signi cant tests were set at the p<0.05 level. Results: Study component (1): Stunting levels were higher in the boys than in the girls in mid to late childhood and combined overweight and obesity prevalence was higher in girls than in boys. The girls' BMI was signi cantly greater at ages 11 and 12 years than that of the boys [girls: 18 3.4, 95% con dence interval (CI): 17.33- 18.69; boys: 17 2, 95% CI: 16.46-17.25; p-value 0.004] and at ages 14-15 years (girls: 22 4.1, 95% CI: 20.82-22.47; boys: 19 2.4, 95% CI: 18.39-19.38; p-value < 0.001). Prehypertension (de ned as < 90th centile for age, sex and height) was higher in girls (15%) than boys (10%). Further, impaired fasting glucose was detected in 5.3% of girls and 5% of boys. High-density lipoprotein cholesterol (>1.03 mmol/l) concentrations were observed in 12% of the girls and 0.7% of the boys, which is indicative of cardiometabolic risk. Study component (2): The prevalence of overweight and obesity was higher in girls than boys in early and mid to post pubertal stages. The majority (83.5%) of the girls reported body image dissatisfaction (a desire to be thinner or fatter). The girls who wanted to be fatter had a signi cantly higher BMI than the girls who wanted to be thinner (p=0.001). There were no di erences in EAT-26 score between pubertal groups, or between boys and girls within the two pubertal groups. The majority of the boys and the girls in both pubertal groups perceived the underweight silhouettes to be \unhappy" and \weak" and the majority of girls in both pubertal groups perceived the normal silhouettes to be the \best". Study component (3): Added sugar and sweets contributed 10% and maize meal and vi bread contributed 7.2% to the total number of food items consumed respectively. Girls had higher intakes of total fat, saturated fat and cholesterol after adjusting for dietary energy intake and age (all p<0.001). The prevalence of combined overweight and obesity was 13.8% in girls and 3.1% in boys (p<0.001). In addition, indicators of adiposity were higher in females, abnormal waist circumference (WC) (6.7%), waist to hip ratio (WHR) (22.0%) and waist to height ratio (WHtR) (18.0%), compared to males, (0%), (3.1%) and (6.2%) respectively (all p<0.001). Girls had higher low-density lipoprotein (LDL) (12(9.3%) vs. 3(2.3%), p=0.01), total cholesterol (17(12.7%) vs. 5(3.5%), p<0.001) and were more pre-hypertensive (28(15.3%) vs.15(8.4%), p=0.04) than the boys. Furthermore, the bivariate associations between dietary intakes (total energy, total carbohydrate (CHO), total dietary fat and saturated fat) and anthropometric indices (BMI and WC) showed that body mass index (BMI) was associated with total energy (p=0.05) and BMI and WC were associated with total fat (p=0.01, p=0.03) and saturated fat (p<0.001, p=0.02) in females respectively. Conclusions: In conclusion, this thesis highlights that girls in rural South Africa had a higher prevalence of combined overweight and obesity than did boys, stunting was more prevalent amongst boys than girls in mid to late childhood and metabolic risk factors that were associated with adiposity, and linked to diet, were higher in girls than in boys. This study has provided useful information for targeting critical health promotion intervention programmes to optimise child nutrition as part of a noncommunicable disease preventative strategy, especially, in remote areas in rapidly transitioning South Africa.
LG2018

Thesis (M. Sc.(Physiology)) -- University of Limpopo, 2019
Aim: The purpose of this study was to assess the prevalence and risk factors associated with malnutrition and nutritional status of rural and urban primary school children aged 6–9 years. Literature background: Malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries, affecting 10.9% of people globally, particularly in Southern Asian (15.7%) and sub-Saharan African (23.2%) countries undergoing urbanisation. Urbanisation affects diet, physical activity levels, body fatness, body composition and socio-economic factors. There is currently a shortage of information on the effect of urbanisation on nutritional status, especially in poor areas such as the Limpopo Province of South Africa. It is important to understand the effects that body fatness and associated risk factors have on stunting, wasting, underweight, and overweight/obesity in urban and rural children. Subjects and design: This was a cross-sectional study including rural (n=106) and urban (n=68) primary school children aged 6–9 years. Anthropometric (weight and height) and skinfold measurements were taken and a 24-hour recall dietary assessment was conducted twice to include a week day and a weekend day. A questionnaire was used to gather demographic, health, dietary and physical activity information. Results: The prevalence of stunting, wasting, underweight, and overweight/obese children in this population was 14%, 6%, 20%, and 26% respectively. Furthermore, the prevalence stunting, wasting, and underweight were higher in rural areas compared to urban areas. Meanwhile, the prevalence of overweight/obesity was higher in urban areas as compared to rural areas. Gender, area (urban/rural) (p=0.0001), birthweight, time spent on sedentary activities, monthly household income (p=0.0210), mode of transport to school, and breastfeeding (p=0.0560) were all found to be significantly associated with malnutrition. Weekday dietary intake of Vitamins A and D was significally associated with BF%, whereas weekend consumption of energy, protein, calcium, iron, phosphorus, and zinc were not significantly associated with BF%. The mean energy and calcium intake between the urban and rural vi population only differed significantly over weekends and not during the week, while vitamin D differed significantly between urban and rural populations during the week only. Conclusions: The current study demonstrates that children in rural areas were significantly more wasted than those residing in urban areas, while those residing in urban areas were significantly more overweight/obese compared to rural areas. All indicators used for undernutrition were associated significantly with gender and the prevalence were higher males compared to females, but this significance disappeared for overnutrition. Families with a higher income tended to have children who were overweight or obese compared to families with a lower income. Children spending a lot of time on sedentary activities were more likely to be overweight or obese, and breastfeeding seemed to protect children from becoming overweight or obese, while low birth weight was associated with stunting. The weekaday and week-end diets indicate that school feeding schemes in the rural areas may be effective in increasing total energy intake in children and this should be further investigated. In this population, stunting, wasting, and underweight were not limited to rural areas, and should still be a health concern in urban areas, despite the fact that overweight/obesity is also prevalent in urban areas. Thus, overweight/obesity in this population can be prevented by promoting breastfeeding and physical activity, while at the same time discouraging children from partaking in too many sedentary activities.
National Research Foundation (NRF)

碩士
嘉南藥理科技大學
保健營養系
100
Malnutritin is a major problem in elderly living in long-term care facility，it is associated with increased infections, poor wound healing, morbidity and mortality. The aim of this study was to evaluate the effect of nutritional intervention on nutritional status in elderly at risk of malnutrition. After a multifaceted nutritional intervention model, No significant differences were observed in height, weight, BMI, HC, BMI classification number, total cholesterol, triglyceride, creatinine, hemoglobin and white blood cell, but significantly increased in MAC, CC, albumin, MNA-SF score, MNA-LF score and MNA-LF group (anthropometric assessment score vs general assessment score). Furthermore, there was significantly increased in energy, macronutrients, vitamin and mineral intake in the elderly at risk of malnutrition. Conclusion: A multifaceted nutritional intervention is feasible in elderly at risk of malnutrition living in long-term care facility and result in significant improvement of nutritional status with respect to MAC, CC and Alb.

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district
Health Studies
M.A. (Public Health)

L’objectif de l’étude conduite à Ouagadougou était d’évaluer l’état nutritionnel et les habitudes de vie des écoliers ainsi que leurs pratiques alimentaires et certains déterminants, afin d’orienter puis plus tard d’évaluer une intervention nutritionnelle. L’étude a inclus 799 écoliers du cours moyen (âge moyen : 11,7 ± 1,4a) fréquentant 12 écoles privées ou publiques, urbaines ou péri-urbaines. Le poids, la taille, la tension artérielle et l’hémoglobine ont été mesurés et la thyroïde évaluée par palpation. Les lipides sanguins, la glycémie et le rétinol sérique ont été mesurés dans un sous-échantillon (N=208). Un questionnaire complété en classe portait sur la fréquence de consommation d’aliments « santé » (fruits, légumes, viande, poisson, légumineuses) et «superflus » (gâteaux, biscuits, bonbons, glaces, soda), les déterminants du comportement alimentaire ainsi que les pratiques d’hygiène et d’activité physique. Les signes carentiels étaient : une faible rétinolémie, l’anémie, la maigreur, le retard de croissance et le goitre. Les facteurs de risque cardio-métabolique (RCM) consistaient en une tension artérielle élevée, le surpoids/obésité, l’hyperglycémie et la dyslipidémie. Au moins une carence était présente chez 57% des participants. L’anémie (40,4%) et la carence en vitamine A (CVA) (38,7%) étaient fortement prévalentes. Le retard de croissance touchait 8,8% et la maigreur 13,7% des enfants. L’anémie (p=0,001) et la CVA (p<0.001) étaient significativement plus élevées dans les écoles publiques que privées. Aucun cas de goitre n’a été détecté. Le surpoids/obésité était rare (2,3%) . La maigreur et le retard de croissance étaient significativement plus élevés en milieu périurbain. Au moins un facteur de RCM était présent chez 36% des écoliers dont le principal était un taux de cholestérol-HDL-(HDL-C) bas (19,3%), suivi du cholestérol total et du LDL-C élevés (11,6% chacun) et la pression systolique élevée (9,7%). Le sexe féminin était indépendamment et positivement associé aux taux de lipides sanguins dont paradoxalement le HDL-C. L’IMC était indépendamment associé à une tension élevée. On observait que le double fardeau de la malnutrition (DFM) affectait 27,5% des participants. Le score de fréquence de consommation des aliments superflus était plus élevé que celui des aliments santé (p=0,001). Pendant la semaine précédant l’étude, 25 % des enfants n’avaient pas consommé de fruits, 20% pas de viande, 20% pas de légumineuses alors que 18,3% consommaient des glaces tous les jours. Les écoliers du privé consommaient plus fréquemment autant les aliments santé que superflus que ceux des écoles publiques. Les écoliers du milieu urbain avaient un score plus élevé de consommation des aliments superflus que ceux du milieu péri-urbain. La consommation des aliments santé ou superflus était essentiellement expliquée par le contrôle perçu, la disponibilité des produits ainsi que l’influence de la mère pour les aliments santé et l’influence des pairs pour les aliments superflus parmi les explications explorées. Cette étude a montré que les signes de carence nutritionnelle sont répandus et prédominent encore chez les écoliers du milieu urbain, mais aussi que la fréquence des marqueurs de risque cardiométabolique n’est pas négligeable. Des mesures préventives devraient être entreprises pour contrer tant les problèmes de carences que de surcharge.
The aim of this study carried out in Ouagadougou was to assess the nutritional status of schoolchildren and to assess their lifestyle practices as well as their food habits and determinants, for the guidance and evaluation of a nutrition intervention. The cross-sectional survey included 799 schoolchildren in 5th grade (mean age 11.7 ± 1.4y) attending 12 private or public, urban or peri-urban schools. Weight, height, blood pressure and haemoglobin were measured and thyroid palpation was performed. Fasting serum lipids, glycaemia and serum retinol were measured in a sub-sample (N=208). A questionnaire was filled in classroom to assess consumption frequency of ‘healthy’ foods (fruits, vegetables, meat, fish, legumes) and ‘unhealthy’ items (cakes, cookies, candies, ice, soda) and underlying factors as well as hygiene and physical activity practices. Deficiencies signs were: low serum retinol, anaemia, thinness, stunting and goitre whereas cardiometabolic risk factors (CRF) signs consisted of elevated blood pressure (BP), overweight/obesity, hyperglycaemia, and dysglyceamia. At least one malnutrition sign was found in 57% pupils. Anaemia (40.4 %) and vitamin A deficiency (VAD) (38.7 %) were highly prevalent. Stunting affected 8.8% of children while thinness affected 13.7 % of them. Anaemia (p = 0.001) and DVA (p < 0.001) were significantly higher in public than private schools. Goitre was not detected. Overweight/obesity was rare (2.3 %). Thinness and stunting were significantly higher in peri-urban compared to urban schools. At least one CRF was found in 36% schoolchildren. The main risk factors were low HDL-cholesterol (HDL-C) (19.3%) followed by high total cholesterol, high LDL-cholesterol (11.6% each) and elevated systolic blood pressure (9.7%). Being a girl was independently associated with increased serum lipids including HDL-C paradoxically. Body Mass Index was independently associated with increased BP. It was found that the double burden of malnutrition (DBM) affected 27.5% children. Consumption scores of unhealthy food were significantly higher than healthy foods’ (p= 0.001). During the week prior to the survey, 25% of children had eaten no fruit, 20% no meat, 20% no legume, while 18.3% ate ice pop every day. Compared to public-school pupils, those from private schools consumed both healthy and unhealthy items more frequently. Urban school children had significantly higher unhealthy food scores compared to peri-urban schools. Children’s healthy and unhealthy food consumption was primarily explained by perceived control and availability for both types of foods, and maternal reinforcement for healthy foods and peers’ reinforcement for consumption of unhealthy items among the investigated explanations. This study showed that malnutrition is widely prevalent in schoolchildren in cities, concurrently with a sizeable prevalence of cardiometabolic risk factors. Preventive measures should be tailored to prevent both dietary inadequacies and excess.
Ce travail financé par l'ACDI a été réalisé au Laboratoire TRANSNUT de l'Université de Montréal (Canada)en collaboration avec le Laboratoire National de Santé Publique (Burkina Faso) et HKI-Burkina Faso.

Current status: Although it was developed and published in many studies pointing to the impact of malnutrition and its relationship to the patient and the economy of the health systems, malnutrition remains a silent guide of hospitalized patients. In the year of 2014, the authors of the study group feedM.E. indicate in their articles the worldwide prevalence of malnutrition as a common and a costly (especially for the elderly). The rate of prevalence of malnutrition in a group of hospitalized patients is around 50%, according to this working group. Objectives: The goal of the project was to describe the methods for screening the patients with nutritional needs interventions by the nurses, the continuity of the care for patients in the risk of malnutrition, transmitting the information about the nutritional status of the patient during his hospitalization and delivery of care to another provider of health services and interdisciplinary co-workers involved in the care of patients in the risk of malnutrition. Methods: The research investigation conducted by the method of the qualitative research. The research subject was the process of detecting malnutrition and continuity of nutritional care for recipients of health services from the perspective of persons providing these services. The research method was chosen a depth interview. The sample of respondents was intentional and the file size was determined by saturation of the collected data. For data processing was used open coding and following categorization of the data which was obtained from interviews. The results were interpreted by using the "showdown". Participants: The request to facilitate the initiation of research has been mostly refused and addressed to the health service providers. Selection of interviewees was intentional by the circle of my former colleagues. With research have expressed their consent five nurses and five dietitians, which are working in the Czech Republic. Results: For identification of patients at the risk of malnutrition, all respondents have described the identification of patients at the risk of malnutrition on admission to the hospital by collecting of nursing history. During the interviews, the respondents have reported the problems both with the absence the reports including detection of patients at the risk of malnutrition from some stations at hospitals, as well as the jurisdictional disputes about the role of the dietitians in patient nutrition at intensive care unit, the complications with material and technical equipment of nursing stations and its applicability for use in specific patients. Also expressed the ignorance of screening tools which are used at the sites of all respondents, including dietitians. The inaccurate ideas of some respondents were in the terms of the skills and the competencies of individual professionals which are involved in the care of patients in the risk of malnutrition. Three nurses of the five indicated that information about the nutritional balance of the patient and their needs should affect the assessment of the patient's overall condition and could lead to changes in the nursing care plan or risk assessment (eg. the risk of pressure ulcers, etc.). Conclusion: The method of providing nutritional care in hospitals, in which respondents are employed, is headed toward pursuing the recommendations of the professional associations. In detail, however, they differ and are often close to the boundaries defined as a legal standards. Breaks are noticeable in continuity of the care, or are put excessive approval procedures, which can lead to delay of required nutritional interventions. Here is a lack of information about the various screening tools and their applicability to the certain groups of patients. Therefore I recommend issuing guidelines by professional society, in the direction of the definition of screening tools and their using in the certain groups of patients, for the healthcare providers in

Cette étude s’inscrit dans le cadre du projet « Pôle francophone africain sur le Double Fardeau Nutritionnel » (DFN) du laboratoire TRANSNUT, centre collaborateur OMS sur la transition nutritionnelle du Département de Nutrition de l’Université de Montréal, en collaboration avec ses partenaires au Burkina Faso, à savoir l’Institut de Recherche en Sciences de la Santé (IRSS) et l’Institut Supérieur des Sciences de la Population (ISSP). Elle est l’une des premières à s’intéresser au double fardeau de la malnutrition en Afrique francophone. Cette étude avait pour objectif de démontrer l’existence du double fardeau de la malnutrition parmi les adultes de Ouagadougou au Burkina Faso, d’en donner l’ampleur et d’identifier ses liens avec les facteurs du mode de vie. Plus spécifiquement, elle visait à décrire les carences nutritionnelles, les facteurs de risque cardiométabolique (FRCM), et la typologie du double fardeau de la malnutrition; examiner les caractéristiques du mode de vie des adultes et leurs liens avec le double fardeau de la malnutrition selon les conditions économique, et enfin d’examiner l’association entre inflammation subclinique, les carences nutritionnelles et les FRCM selon les facteurs du mode de vie. Ces objectifs faisaient suite à nos principales hypothèses qui stipulaient que : parmi les adultes de Ouagadougou, le phénotype de double fardeau de la malnutrition le plus fréquemment observé est l’association de surpoids/obésité avec une ou plusieurs carences nutritionnelles, surtout chez les femmes, puis qu’une alimentation de piètre qualité, en lien avec de mauvaises conditions socioéconomiques et de vie est associée tant aux FRCM qu’aux carences nutritionnelles, contribuant ainsi au double fardeau de malnutrition, et enfin qu’un état d’inflammation subclinique joue un rôle de médiateur entre le mode de vie et aussi bien les carences nutritionnelles que les FRCM. Afin de répondre à ces objectifs, une étude transversale descriptive et analytique a été conduite auprès d’un échantillon aléatoire de 330 adultes âgés de 25 à 60 ans recrutés au sein de l’Observatoire de Population de Ouagadougou, situé à la partie nord de la ville. Cet échantillon a été subdivisé en terciles du score de possessions matérielles, proxy du statut socioéconomique, avec 110 personnes respectivement dans chaque strate de niveau socioéconomique bas, moyen et élevé. Chaque participant a fourni des données sociodémographiques, anthropométriques, cliniques et comportementales; il a aussi fourni un échantillon de sang. Les principales variables de l’étude étaient les suivantes : l’âge, les conditions socioéconomiques (insécurité alimentaire, éducation et proxy du revenu), le mode de vie (les apports alimentaires et la qualité de l’alimentation, l’activité physique, la consommation d’alcool et de tabac, la perception de l’image corporelle, le stress psychosocial); l’inflammation subclinique; les FRCM [surpoids/obésité, tension artérielle élevée (TAE) ou hypertension artérielle (HTA), hyperglycémie, dyslipidémie et insulino-résistance]; les carences nutritionnelles (maigreur, anémie, carence en fer et en vitamine A). Des phénotypes de double fardeau de la malnutrition ont été identifiés en combinant FRCM et carences nutritionnelles. Les résultats ont montré une prévalence élevée de surpoids/obésité, d’obésité abdominale, d’hypertension artérielle, d’hyperglycémie, de résistance à l’insuline et du taux de lipoprotéine de haute densité (HDL-C) bas, respectivement de 24,2 %, 12,5 %, 21,9 %, 22,3 %, 25,1 % et 30,0 %. En utilisant les seuils plus sensibles de la Fédération Internationale du Diabète (FID), l’obésité abdominale, la tension artérielle élevée (TAE), l’hyperglycémie était respectivement de 23,5 %; 36,1 % et 34,5 %. Des carences nutritionnelles étaient également présentes, l’anémie, la carence en fer et en vitamine A, ainsi que la maigreur atteignant respectivement 25,5 %, 15,4 %, 12,7 % et 9,7 % de la population étudiée. Les femmes étaient significativement plus touchées que les hommes autant par les FRCM que par les carences nutritionnelles. Le double fardeau de la malnutrition touchait 23,5 % des personnes et même 25,8 % avec les seuils de la FID pour l’obésité abdominale, la TAE, et l’hyperglycémie. Les deux principaux phénotypes observés étaient : l’association de « surpoids/obésité avec au moins une carence en micronutriment », touchant 7,8 % (11,8 % ♀ vs. 3,4 % ♂) des personnes et l’association d’au moins un FRCM autre que le surpoids/obésité avec au moins une carence en micronutriment, qui touchait 9.0 % (12,4 % ♀ vs. 5,4 % ♂) des personnes. La prévalence de ces phénotypes était plus élevée en utilisant les seuils de la FID plutôt que les seuils de l’OMS. Près de 72,9 % des personnes ou 81,2 % (seuils de la FID) avaient au moins un FRCM. Nous avons identifié à partir de l’analyse typologique, deux schémas alimentaires; « urbain » et « traditionnel », dans cette étude. Les carences nutritionnelles étaient davantage associées au schéma alimentaire « traditionnel », alors que les FRCM se retrouvaient dans les deux schémas alimentaires. Le schéma « urbain » regroupait significativement plus d’hommes et de personnes de niveau socioéconomique élevé, alors que les personnes de niveau socioéconomique bas et les femmes étaient proportionnellement plus nombreuses dans le schéma « traditionnel ». Le temps dévolu aux activités sédentaires était significativement plus important que celui consacré aux activités d’intensité modérée à vigoureuse. L’activité physique était inversement associée à l’indice de masse corporelle (IMC), au tour de taille (TT), à la masse grasse corporelle, à la tension artérielle systolique (TAS) et diastolique (TAD), à la triglycéridémie et au taux de lipoprotéine de faible densité (LDL-C). L’IMC et le TT augmentaient en outre avec le temps de sédentarité. Ainsi, le double fardeau de malnutrition était associé au statut socioéconomique bas, au sexe féminin et à la sédentarité. Nous avons aussi trouvé que 39,4 % des personnes avaient une inflammation subclinique qui était associée de façon indépendante et positive à la ferritinémie, à l’IMC, au TT et à la masse grasse corporelle, et négativement au HDL-C. L’exploration du stress psychosocial et de l’image corporelle a révélé une association entre le stress psychosocial, l’HTA et une perception positive de l’embonpoint. Les personnes ayant peut-être accusé un retard de croissance à l’enfance (d’après l’indice de Cormic) étaient significativement plus touchées par le surpoids/obésité, l’obésité abdominale et la résistance à l’insuline. Ces résultats nous ont permis d’atteindre nos objectifs, mais aussi de vérifier nos hypothèses de recherche. Comme on peut le constater, les FRCM sont une réalité à Ouagadougou, qui se compliquent par leur coexistence avec des carences en micronutriments dont la prévalence est tout aussi importante. Une transition nutritionnelle est en cours dans cette ville et contribue au bouleversement des comportements alimentaires et du style de vie favorisant l’émergence de ce double fardeau, dans un contexte où le passé nutritionnel de la population offre des conditions idéales pour un niveau de risque particulièrement élevé pour ces FRCM. Cependant, l’évolution de cette prévalence pourrait être inversée ou tout au moins ralentie si des actions étaient entreprises dès maintenant.
This study is a part of a project on the double burden of malnutrition in sub-Saharan Africa, developed and implemented by TRANSNUT, a WHO collaborating centre on nutrition changes and development, of the Department of Nutrition, Université de Montréal, in collaboration with its partners in Burkina Faso (Institut de Recherche en Sciences de la Santé and Institut Supérieur des Sciences de la Population). The study is among the first to focus on the double burden of malnutrition in French speaking Africa and aimed to describe the occurrence of the double burden among adults living in Ouagadougou, Burkina Faso, by determining its prevalence and to what extent it was related to life style factors. More specifically, the study aimed to: 1) describe nutrition deficiencies, cardio-metabolic risk factors (CMRF) and double burden phenotypes, to 2) examine the relationship between lifestyle characteristics and the double burden of malnutrition, and finally, 3) to examine the relationship between subclinical inflammation and both CMRF and nutrition deficiencies. We hypothesised that: ‘among the adults of Ouagadougou, the more frequent phenotype of double burden of malnutrition is the association of overweight/obesity with at least one micronutrient deficiency, which is more prevalent in women’; ‘an inadequate quality of the diet related to poor socioeconomic and living conditions is associated to both CMRF and micronutrients deficiencies’ and finally, that ‘subclinical inflammation is a mediator variable between lifestyle and both CMRF and nutrition deficiencies’. We carried out a population based cross-sectional study, descriptive and analytical, with a random sample of 330 adults aged 25-60y, selected from the population observatory of Ouagadougou located in the northern district. This sample was stratified in three income groups using household assets as a proxy of socioeconomic status, with 110 subjects in the following three income strata: low, middle and high. Each subject provided sociodemographic, anthropometric, clinical and lifestyle data and a blood sample for the assessment of the following study variables: age, and socioeconomic conditions (food insecurity, education and income); lifestyle factors (dietary intake and diet quality, physical activity, alcohol and tobacco consumption, body image perception, and psychosocial stress); subclinical inflammation; CMRF (overweight/obesity, high blood pressure or hypertension, hyperglycaemia, dyslipidemia, insulin resistance); nutritional deficiency markers ( underweight, anaemia, iron and vitamin A deficiencies); the double burden of malnutrition phenotypes featured by combining CMRF with nutrition deficiencies factors. We reported a high prevalence of overweight/obesity, abdominal obesity, hypertension, hyperglycaemia, insulin resistance and low concentration of high density lipoprotein cholesterol (HDL-C), which was 24.2%, 12.5%, 21.9%, 22.3%, 25.1%, and 30.0% respectively. When using International Diabetes Federation (IDF) cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia, their prevalence were 23.5%, 36.1%, and 34.5% respectively. Anaemia, iron and vitamin A deficiencies and underweight were found in 25.5%, 15.4%, 12.7%, and 9.7% of subjects, respectively. Women were more affected by both CMRF and deficiencies than men. When combining CMRF and deficiencies within the same individual, the double burden of malnutrition was reported in 23.5% of subjects and even in 25.8% of them when IDF cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia were used. Two main phenotypes were reported: the co-occurrence of ‘overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 7.8% (11.8 % ♀ vs. 3.4 % ♂); and the co-occurrence of ‘CMRF other than overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 9.0% (12.4 % ♀ vs. 5.4 % ♂). This prevalences was higher when using IDF cut-offs instead of WHO cut-offs. Finally, 72.9% of the subjects exhibited at least one CMRF and even 81.2% of the subjects when using IDF cut-offs. We also identified in this study population two dietary patterns: “urban” and “traditional”. Nutritional deficiencies were associated with ‘traditional’ dietary pattern, whereas CMRF were found in both patterns without statistical difference. The “urban” dietary pattern was significantly more common in men, high income subjects, whereas low income subjects and women were significantly more numerous in the ‘traditional’ one. Time devoted to sedentary activities was significantly higher than time spent in moderate to vigorous activities. Time in moderate to vigorous activities was significantly and negatively associated with body mass index (BMI), waist circumference (WC), and body fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceridemia, and low density lipoprotein cholesterol (LDL-C), while BMI and WC were associated to sedentary time. The double burden of malnutrition was associated to low income status, women, and sedentary time. We reported that 39.4% of the subjects exhibited subclinical inflammation, which was independently and positively associated with serum ferritin, BMI, WC, body fat mass, and negatively to HDL-C. Body image evaluation revealed that overweight was perceived as desirable body image among the study subjects. Psychosocial stress was associated with hypertension and subjects who probably faced stunting during infancy (using Cormic Index) exhibited significantly higher prevalence of overweight/obesity, abdominal obesity and insulin resistance. The results allowed us to achieve the study objectives and confirm our hypotheses. CMRF represents an overwhelming issue in adults of Ouagadougou complicated with their coexistence with nutritional deficiencies, also highly prevalent. A nutrition transition is at play in the city, contributing to lifestyle changes favorable to the double burden of malnutrition in such a context where the early life nutritional conditions of the subjects may put them at further enhancement of CMRF. The progression of this prevalence can still be averted or at least be slowed if suitable actions were taken from now.

Cette étude s’inscrit dans le cadre du projet « Pôle francophone africain sur le Double Fardeau Nutritionnel » (DFN) du laboratoire TRANSNUT, centre collaborateur OMS sur la transition nutritionnelle du Département de Nutrition de l’Université de Montréal, en collaboration avec ses partenaires au Burkina Faso, à savoir l’Institut de Recherche en Sciences de la Santé (IRSS) et l’Institut Supérieur des Sciences de la Population (ISSP). Elle est l’une des premières à s’intéresser au double fardeau de la malnutrition en Afrique francophone. Cette étude avait pour objectif de démontrer l’existence du double fardeau de la malnutrition parmi les adultes de Ouagadougou au Burkina Faso, d’en donner l’ampleur et d’identifier ses liens avec les facteurs du mode de vie. Plus spécifiquement, elle visait à décrire les carences nutritionnelles, les facteurs de risque cardiométabolique (FRCM), et la typologie du double fardeau de la malnutrition; examiner les caractéristiques du mode de vie des adultes et leurs liens avec le double fardeau de la malnutrition selon les conditions économique, et enfin d’examiner l’association entre inflammation subclinique, les carences nutritionnelles et les FRCM selon les facteurs du mode de vie. Ces objectifs faisaient suite à nos principales hypothèses qui stipulaient que : parmi les adultes de Ouagadougou, le phénotype de double fardeau de la malnutrition le plus fréquemment observé est l’association de surpoids/obésité avec une ou plusieurs carences nutritionnelles, surtout chez les femmes, puis qu’une alimentation de piètre qualité, en lien avec de mauvaises conditions socioéconomiques et de vie est associée tant aux FRCM qu’aux carences nutritionnelles, contribuant ainsi au double fardeau de malnutrition, et enfin qu’un état d’inflammation subclinique joue un rôle de médiateur entre le mode de vie et aussi bien les carences nutritionnelles que les FRCM. Afin de répondre à ces objectifs, une étude transversale descriptive et analytique a été conduite auprès d’un échantillon aléatoire de 330 adultes âgés de 25 à 60 ans recrutés au sein de l’Observatoire de Population de Ouagadougou, situé à la partie nord de la ville. Cet échantillon a été subdivisé en terciles du score de possessions matérielles, proxy du statut socioéconomique, avec 110 personnes respectivement dans chaque strate de niveau socioéconomique bas, moyen et élevé. Chaque participant a fourni des données sociodémographiques, anthropométriques, cliniques et comportementales; il a aussi fourni un échantillon de sang. Les principales variables de l’étude étaient les suivantes : l’âge, les conditions socioéconomiques (insécurité alimentaire, éducation et proxy du revenu), le mode de vie (les apports alimentaires et la qualité de l’alimentation, l’activité physique, la consommation d’alcool et de tabac, la perception de l’image corporelle, le stress psychosocial); l’inflammation subclinique; les FRCM [surpoids/obésité, tension artérielle élevée (TAE) ou hypertension artérielle (HTA), hyperglycémie, dyslipidémie et insulino-résistance]; les carences nutritionnelles (maigreur, anémie, carence en fer et en vitamine A). Des phénotypes de double fardeau de la malnutrition ont été identifiés en combinant FRCM et carences nutritionnelles. Les résultats ont montré une prévalence élevée de surpoids/obésité, d’obésité abdominale, d’hypertension artérielle, d’hyperglycémie, de résistance à l’insuline et du taux de lipoprotéine de haute densité (HDL-C) bas, respectivement de 24,2 %, 12,5 %, 21,9 %, 22,3 %, 25,1 % et 30,0 %. En utilisant les seuils plus sensibles de la Fédération Internationale du Diabète (FID), l’obésité abdominale, la tension artérielle élevée (TAE), l’hyperglycémie était respectivement de 23,5 %; 36,1 % et 34,5 %. Des carences nutritionnelles étaient également présentes, l’anémie, la carence en fer et en vitamine A, ainsi que la maigreur atteignant respectivement 25,5 %, 15,4 %, 12,7 % et 9,7 % de la population étudiée. Les femmes étaient significativement plus touchées que les hommes autant par les FRCM que par les carences nutritionnelles. Le double fardeau de la malnutrition touchait 23,5 % des personnes et même 25,8 % avec les seuils de la FID pour l’obésité abdominale, la TAE, et l’hyperglycémie. Les deux principaux phénotypes observés étaient : l’association de « surpoids/obésité avec au moins une carence en micronutriment », touchant 7,8 % (11,8 % ♀ vs. 3,4 % ♂) des personnes et l’association d’au moins un FRCM autre que le surpoids/obésité avec au moins une carence en micronutriment, qui touchait 9.0 % (12,4 % ♀ vs. 5,4 % ♂) des personnes. La prévalence de ces phénotypes était plus élevée en utilisant les seuils de la FID plutôt que les seuils de l’OMS. Près de 72,9 % des personnes ou 81,2 % (seuils de la FID) avaient au moins un FRCM. Nous avons identifié à partir de l’analyse typologique, deux schémas alimentaires; « urbain » et « traditionnel », dans cette étude. Les carences nutritionnelles étaient davantage associées au schéma alimentaire « traditionnel », alors que les FRCM se retrouvaient dans les deux schémas alimentaires. Le schéma « urbain » regroupait significativement plus d’hommes et de personnes de niveau socioéconomique élevé, alors que les personnes de niveau socioéconomique bas et les femmes étaient proportionnellement plus nombreuses dans le schéma « traditionnel ». Le temps dévolu aux activités sédentaires était significativement plus important que celui consacré aux activités d’intensité modérée à vigoureuse. L’activité physique était inversement associée à l’indice de masse corporelle (IMC), au tour de taille (TT), à la masse grasse corporelle, à la tension artérielle systolique (TAS) et diastolique (TAD), à la triglycéridémie et au taux de lipoprotéine de faible densité (LDL-C). L’IMC et le TT augmentaient en outre avec le temps de sédentarité. Ainsi, le double fardeau de malnutrition était associé au statut socioéconomique bas, au sexe féminin et à la sédentarité. Nous avons aussi trouvé que 39,4 % des personnes avaient une inflammation subclinique qui était associée de façon indépendante et positive à la ferritinémie, à l’IMC, au TT et à la masse grasse corporelle, et négativement au HDL-C. L’exploration du stress psychosocial et de l’image corporelle a révélé une association entre le stress psychosocial, l’HTA et une perception positive de l’embonpoint. Les personnes ayant peut-être accusé un retard de croissance à l’enfance (d’après l’indice de Cormic) étaient significativement plus touchées par le surpoids/obésité, l’obésité abdominale et la résistance à l’insuline. Ces résultats nous ont permis d’atteindre nos objectifs, mais aussi de vérifier nos hypothèses de recherche. Comme on peut le constater, les FRCM sont une réalité à Ouagadougou, qui se compliquent par leur coexistence avec des carences en micronutriments dont la prévalence est tout aussi importante. Une transition nutritionnelle est en cours dans cette ville et contribue au bouleversement des comportements alimentaires et du style de vie favorisant l’émergence de ce double fardeau, dans un contexte où le passé nutritionnel de la population offre des conditions idéales pour un niveau de risque particulièrement élevé pour ces FRCM. Cependant, l’évolution de cette prévalence pourrait être inversée ou tout au moins ralentie si des actions étaient entreprises dès maintenant.
This study is a part of a project on the double burden of malnutrition in sub-Saharan Africa, developed and implemented by TRANSNUT, a WHO collaborating centre on nutrition changes and development, of the Department of Nutrition, Université de Montréal, in collaboration with its partners in Burkina Faso (Institut de Recherche en Sciences de la Santé and Institut Supérieur des Sciences de la Population). The study is among the first to focus on the double burden of malnutrition in French speaking Africa and aimed to describe the occurrence of the double burden among adults living in Ouagadougou, Burkina Faso, by determining its prevalence and to what extent it was related to life style factors. More specifically, the study aimed to: 1) describe nutrition deficiencies, cardio-metabolic risk factors (CMRF) and double burden phenotypes, to 2) examine the relationship between lifestyle characteristics and the double burden of malnutrition, and finally, 3) to examine the relationship between subclinical inflammation and both CMRF and nutrition deficiencies. We hypothesised that: ‘among the adults of Ouagadougou, the more frequent phenotype of double burden of malnutrition is the association of overweight/obesity with at least one micronutrient deficiency, which is more prevalent in women’; ‘an inadequate quality of the diet related to poor socioeconomic and living conditions is associated to both CMRF and micronutrients deficiencies’ and finally, that ‘subclinical inflammation is a mediator variable between lifestyle and both CMRF and nutrition deficiencies’. We carried out a population based cross-sectional study, descriptive and analytical, with a random sample of 330 adults aged 25-60y, selected from the population observatory of Ouagadougou located in the northern district. This sample was stratified in three income groups using household assets as a proxy of socioeconomic status, with 110 subjects in the following three income strata: low, middle and high. Each subject provided sociodemographic, anthropometric, clinical and lifestyle data and a blood sample for the assessment of the following study variables: age, and socioeconomic conditions (food insecurity, education and income); lifestyle factors (dietary intake and diet quality, physical activity, alcohol and tobacco consumption, body image perception, and psychosocial stress); subclinical inflammation; CMRF (overweight/obesity, high blood pressure or hypertension, hyperglycaemia, dyslipidemia, insulin resistance); nutritional deficiency markers ( underweight, anaemia, iron and vitamin A deficiencies); the double burden of malnutrition phenotypes featured by combining CMRF with nutrition deficiencies factors. We reported a high prevalence of overweight/obesity, abdominal obesity, hypertension, hyperglycaemia, insulin resistance and low concentration of high density lipoprotein cholesterol (HDL-C), which was 24.2%, 12.5%, 21.9%, 22.3%, 25.1%, and 30.0% respectively. When using International Diabetes Federation (IDF) cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia, their prevalence were 23.5%, 36.1%, and 34.5% respectively. Anaemia, iron and vitamin A deficiencies and underweight were found in 25.5%, 15.4%, 12.7%, and 9.7% of subjects, respectively. Women were more affected by both CMRF and deficiencies than men. When combining CMRF and deficiencies within the same individual, the double burden of malnutrition was reported in 23.5% of subjects and even in 25.8% of them when IDF cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia were used. Two main phenotypes were reported: the co-occurrence of ‘overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 7.8% (11.8 % ♀ vs. 3.4 % ♂); and the co-occurrence of ‘CMRF other than overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 9.0% (12.4 % ♀ vs. 5.4 % ♂). This prevalences was higher when using IDF cut-offs instead of WHO cut-offs. Finally, 72.9% of the subjects exhibited at least one CMRF and even 81.2% of the subjects when using IDF cut-offs. We also identified in this study population two dietary patterns: “urban” and “traditional”. Nutritional deficiencies were associated with ‘traditional’ dietary pattern, whereas CMRF were found in both patterns without statistical difference. The “urban” dietary pattern was significantly more common in men, high income subjects, whereas low income subjects and women were significantly more numerous in the ‘traditional’ one. Time devoted to sedentary activities was significantly higher than time spent in moderate to vigorous activities. Time in moderate to vigorous activities was significantly and negatively associated with body mass index (BMI), waist circumference (WC), and body fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceridemia, and low density lipoprotein cholesterol (LDL-C), while BMI and WC were associated to sedentary time. The double burden of malnutrition was associated to low income status, women, and sedentary time. We reported that 39.4% of the subjects exhibited subclinical inflammation, which was independently and positively associated with serum ferritin, BMI, WC, body fat mass, and negatively to HDL-C. Body image evaluation revealed that overweight was perceived as desirable body image among the study subjects. Psychosocial stress was associated with hypertension and subjects who probably faced stunting during infancy (using Cormic Index) exhibited significantly higher prevalence of overweight/obesity, abdominal obesity and insulin resistance. The results allowed us to achieve the study objectives and confirm our hypotheses. CMRF represents an overwhelming issue in adults of Ouagadougou complicated with their coexistence with nutritional deficiencies, also highly prevalent. A nutrition transition is at play in the city, contributing to lifestyle changes favorable to the double burden of malnutrition in such a context where the early life nutritional conditions of the subjects may put them at further enhancement of CMRF. The progression of this prevalence can still be averted or at least be slowed if suitable actions were taken from now.

碩士
國立成功大學
老年學研究所
103
Summary This is a case control study by using chart audit to collect data, to investigate factors for increasing risk of malnutrition in older adults during hospitalization. Those over 65 years old patients admitted to wards of the Department of Internal Medicine in a medical center in southern Taiwan in 2012 and received more than two screenings by using Malnutrition Universal Screening were enrolled. Our study found malnutrition risk during hospitalization from patient’s charts, hoping to improve the sensitivity and accuracy of the medical staffs in assessing patients’ nutritional status, to reduce malnutrition in hospitalization .

博士
國立成功大學
生命科學系
103
Malnutrition has been recognized as a significant risk factor for the post operated patients, especially for those patients undergoing abdominal operations. This research is mainly aimed aggressive perioperative nutrition care for malnutrition risk abdominal surgery patients. The purposes of the study were to investigate the application of modified peripheral parenteral nutrition (PPN) support, to evaluate the influence of proximal jejunostomy output (PJO) reinfusion into the distal small bowel for short bowel syndrome (SBS) patients, and to compare the tolerance and nutritional outcomes between the dipeptide- and tripeptide-based enteral formula and a standard enteral formula in abdominal surgery patients. Preoperative nutritional support should be given after the nutritional assessment of the patient is admitted. Patients are confirmed malnutrition can start receiving nutritional support, and most of the studies of this period of preoperative nutritional support advocated in 7 to 10 days by use total parenteral nutrition (TPN). The results of this study indicated that the time frame for hypo-calories with multiple vitamins (MTV), trace elements (TE) and fat emulsion of preoperative PPN support is merely 5.6 ± 2.6 days, shorter than previous studies, which is about 7-10 days and can significantly improve postoperative prognosis. It is critical to shorten the waiting for the surgery to reduce patients discomfort and reduce the complication rate, as well as lower postoperative inflammatory responses and better prognosis. PPN with added fat emulsion, MTV, and TE provides valid and effective preoperative nutritional support. Patients suffering from proximal jejunum perforation had better to avoid primary anastomosis and require exteriorization of proximal jejunum. These patients usually have major problems with short bowel due to the high output of the stoma. The output of a proximal jejunostomy contains abundant amounts of enzymes and electrolytes. Therefore, it is a feasible approach to re-infuse jejunostomy output to regain homeostasis. Parenteral nutrition (PN) was initiated immediately after surgery. When patients started enteral nutrition, we started the proximal jejunostomy output reinfusion protocol. Proximal jejunostomy output reinfusion was performed by the patients, and continued by them after discharge. When proximal jejunostomy output reinfusion could be performed stably, PN was stopped. The study showed the median length of the proximal jejunum was 20 cm and of the distal small bowel was 77.5 cm in patients who could stably receive proximal jejunostomy output reinfusion alone. Three patients did not require home PN; they only required PN during hospitalization. Four patients successfully underwent stoma takedown with intestinal anastomosis after 6–7 months without any nutritional or metabolic complications. In conclusion, short bowel syndrome patients with an adequate length of small bowel and functional colon could avoid long-term PN by receiving reinfusion of proximal jejunostomy output into the distal small bowel. Enteral nutrition is a preferred means of support for stimulating gut hormones, modulating immunity, and maintaining the barrier function of the intestinal mucosa. However, malabsorption, poor emptying, and hypoalbuminemia often occur in patients given enteral nutrition. Studies have demonstrated that dipeptides and tripeptides are the major products of proteins that are digested. Few clinical trials, however, have investigated the clinical benefits of dipeptide- and tripeptide-based enteral formulas. We compared a dipeptide- and tripeptide-based enteral formula with a standard enteral formula for tolerance and nutritional outcomes in abdominal surgery patients. A retrospective study design was used to assess the differences between a whole-protein formula (WPF) and a dipeptide- and tripeptide-based formula (PEF) in clinical outcomes. Seventy-two adult intensive care unit patients with serum albumin concentrations less than 3.0 g/dL were enrolled in this study. Intervention: Patients were divided into two groups (WPF group = 40 patients, PEF group = 32 patients). The study patients were fed for at least 7 days, with ≥ 1000 mL of enteral formula infused on at least 3 of the days. The results showed the mean serum albumin level on postoperative day (POD) 10, prealbumin levels on POD-5 and POD-10, and total lymphocyte count on POD-5 were significantly higher for the PEF group compared to those for the WPF group (P 〈0.05). The average maximum gastric residual volume of the PEF patients during their intensive care unit (ICU) stays was significantly lower than that for WPF patients. In conclusions, the dipeptide- and tripeptide-based enteral formulas are more efficacious and better tolerated than whole-protein formulas.

Chronic kidney disease (CKD) and acute kidney injury (AKI) are major public health problems. It is important to be able to identify those at high risk of adverse outcome, CKD progression and associated cardiovascular disease. The aim of the thesis was to study novel promising biomarkers, their relationship to kidney function, chronic inflammation and/or cardiovascular risk - placental growth factor (PlGF), pregnancy associated plasma protein A (PAPP-A), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), soluble receptor for advanced glycation end products (sRAGE), calcium binding protein S100A12 or extracellular newly identified RAGE binding protein (EN-RAGE), and high mobility group box protein-1 (HMGB-1) in patients with renal diseases including CKD, haemodialysis (HD), AKI patients, and healthy controls for comparison. First study revealed that PlGF is elevated in patients with decreased renal function. Second study demonstrated the association of MMP-2 and PAPP-A with proteinuria in patients with CKD. Moreover, serum MMP-2, MMP-9 and PAPP-A levels significantly differed in patients with various nephropathies. EN-RAGE levels are not elevated in patients with CKD, but are related to inflammatory status. PAPP-A, EN-RAGE and HMGB-1 levels are significantly elevated, but sRAGE and PlGF...