Effects of Perioperative Oral Nutrition Supplementation in Malaysian Patients Undergoing Elective Surgery for Breast and Colorectal Cancers-A Randomised Controlled Trial.

This study aimed to investigate the effectiveness of preoperative and an extended 90-days postoperative use of ONS among patients undergoing elective surgery for breast and colorectal cancers. Ninety-one patients were randomised into (i) Group SS received ONS up to 14 days preoperatively and postoperatively up to discharge, (ii) Group SS-E received ONS up to 14 days preoperatively, postoperatively up to discharge and for an extended 90-days after discharge and (iii) Group DS received ONS postoperatively up to discharge. Preoperatively, SS had significantly higher body weight (66.1 ± 15.3 kg vs. 62.5 ± 12.0 kg, p = 0.010) and BMI (26.8 ± 6.8 kg/m2 vs. 26.1 ± 6.7 kg/m2, p = 0.022) than DS when adjusted for baseline values. Postoperatively, SS-E had significantly higher handgrip strength (26 ± 9 kgF vs. 24 ± 6 kgF, p = 0.044) than DS at 90-days post-discharge after adjusted for preoperative values. At 90-days post-discharge, the proportions of patients in SS with albumin < 35 g/d, CAR ≥ 0.1, mPINI ≥ 0.4, mGPS score 1 or 2 were significantly reduced while in SS-E, the reduction in proportions of patients with high hsCRP and mPINI ≥ 0.4 was significant compared to upon discharge. Preoperative ONS had modest benefits in attenuating weight loss whilst postoperative supplementation up to 90-days post-discharge improved handgrip strength and inflammatory prognostic markers.

Vitamin D Status Is Associated with Modifiable Lifestyle Factors in Pre-Adolescent Children Living in Urban Kuala Lumpur, Malaysia.

Studies on vitamin D status and its determinants in growing children in countries with ample sunshine such as Malaysia have been limited. The aim of our study was to determine factors associated with serum 25(OH)D concentrations such as lifestyle, dietary intake, anthropometry, and body composition in 243 pre-adolescent Malaysian children from low-income families living in Kuala Lumpur. This cross-sectional study measured bone density and body composition using dual-energy X-ray absorptiometry (DXA), while serum 25(OH)D was measured using LC-MS/MS. Time spent outdoors, body surface area exposed to sunlight, dietary intake, and physical activity level were assessed using questionnaires. Multiple linear regression and stepwise analysis were performed to identify significant predictors for serum 25(OH)D. About 69.4% had 25(OH)D < 50 nmol/L, and 18.9% were vitamin-D-deficient with 25(OH)D < 30 nmol/L. Girls had a nine-fold higher prevalence of vitamin D deficiency than boys. Body surface area exposed to sunlight, Sun Index, and fat mass were significant predictors of 25(OH)D concentrations in this population. Modifiable lifestyle factors such as sun exposure and reducing obesity are important public health guidance to ensure optimal vitamin D status in these children.

Validation of Paediatric Nutrition Screening Tool (PNST) among Hospitalized Malaysian Children.

BACKGROUND: It is recommended to screen hospitalized children to identify those at risk of malnutrition. Constricted schedule in tertiary care settings calls for the needs of a less burdensome yet effective nutrition screening tool. This study aimed to validate the use of Paediatric Nutrition Screening Tool (PNST) among hospitalized children in a Malaysian tertiary hospital. METHODS: This cross-sectional study recruited children below 18 years old admitting into general paediatric ward in a public hospital. The PNST and Subjective Global Nutritional Assessment (SGNA) were performed on 100 children (64 boys and 36 girls). The objective measurements include anthropometry (z-scores for weight, height and body mass index), dietary history and biochemical markers were measured. These were used to classify malnutrition as per Academy of Nutrition and Dietetics/American Society of Parental and Enteral Nutrition (AND/ASPEN) Consensus Statement for identification of paediatric malnutrition and WHO growth standards for children. Cohen's kappa was computed to report the level of agreement. RESULTS: The PNST identified 57% of hospitalized children as being at risk of malnutrition. In this study, there was a stronger agreement between PNST with AND/ASPEN malnutrition classification (k = 0.602) as when PNST was compared with WHO (k = 0.225) and SGNA (k = 0.431). The PNST shows higher specificity (85.29%) and sensitivity (78.79%) when compared with AND/ASPEN than with WHO malnutrition criteria (55.81% specificity and 66.67% sensitivity). CONCLUSION: This study showed the usefulness of routine use of PNST for screening the malnutrition risk of hospitalized children in Malaysian tertiary hospital settings.

Validation of the Subjective Global Nutrition Assessment (SGNA) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) to Identify Malnutrition in Hospitalized Malaysian Children.

Background: Early detection of malnutrition in hospitalized children helps reduce length of hospital stay and morbidity. A validated nutrition tool is essential to correctly identify children at risk of malnutrition or who are already malnourished. This study compared the use of the Subjective Global Nutrition Assessment (SGNA, nutrition assessment tool) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP, nutrition screening tool) with objective nutritional parameters to identify malnutrition in hospitalized children. Methods: A cross-sectional study was carried out in two general paediatric wards in a public hospital. SGNA and STAMP were performed on 82 children (52 boys and 30 girls) of age 1-7 years. The scores from both methods were compared against Academy of Nutrition and Dietetics/American Society of Parental and Enteral Nutrition Consensus Statement for identification of paediatric malnutrition. The objective measurements include anthropometry (weight, height and mid-arm circumference), dietary intake and biochemical markers (C-reactive protein, total lymphocytes and serum albumin). Kappa agreement between methods, sensitivity, specificity and cross-classification were computed. Results: SGNA and STAMP identified 45% and 79% of the children to be at risk of malnutrition, respectively. Using a compendium of objective parameters, 46% of the children were confirmed to be malnourished. The agreement between SGNA and objective measurements (k = 0.337) was stronger than between STAMP and objective measurements (k = 0.052) in evaluating the nutritional status of hospitalized children. SGNA also has a 4-fold higher specificity (70.45%) than STAMP (18.18%) in detecting children who are malnourished. Conclusion: SGNA is a valid nutrition assessment tool in diagnosing malnutrition status among hospitalized children in Malaysia. The discrepancy in specificity values between the two methods explains the distinguished roles between SGNA and STAMP. The use of STAMP will have to be followed up with a more valid tool such as SGNA to verify the actual nutrition status of the paediatric population.