Clinical Evolution of Preschool Picky Eater Children Receiving Oral Nutritional Supplementation during Six Months: A Prospective Controlled Clinical Trial.

OBJECTIVE: To determine if oral nutritional supplementation of picky eater children has a beneficial effect in addition to nutritional guidance on anthropometric parameters, nutrient intake, appetite, physical activity, and health complications. METHODS: This is a randomized, single-blind, controlled clinical trial that included Brazilian picky eater children aged 24 to 60 months. The individuals were randomized into a control group (CG) (n = 17) and an intervention group (IG) (n = 18), and were followed up in seven meetings for 180 days (baseline plus one meeting every 30 days). The CG received nutritional guidance for food selectivity, while the IG received the same guidance plus oral nutritional supplementation. Anthropometric and nutrient intake assessments were carried out, and appetite, physical activity and health complications were investigated. RESULTS: In the IG, the z-score of weight and height increased significantly over time (p < 0.05), while the body fat percentage (BFP) and BMI z-score remained unchanged. The percentage of inadequate intake of vitamins D, C and folate reduced in the IG over time compared to the CG (p < 0.05). In the IG, the score assigned by parents to the appetite scale increased over time (p < 0.05). There was no difference between the groups in the scores on the physical activity and global health scales, and in the number of health complications. CONCLUSIONS: Picky eater children that were supplemented increased their weight not by gaining fat, but due to an increase in stature, as shown by BMI z-score and BFP, that remained unchanged. Furthermore, they showed a decrease in inadequate micronutrient intake during the intervention. An improvement in appetite was also observed over time, attesting to the benefit of supplementation.

Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis.

BACKGROUND & AIMS: Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS: The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS: gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS: We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION: Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.

Effectiveness of an Integrated Nutrition Rehabilitation on Growth and Development of Children under Five Post 2018 Earthquake in East Lombok, Indonesia.

BACKGROUND: In August 2018 Lombok Island in Indonesia was hit by a 7 Richter scale earthquake. This study aimed to assess the effectiveness of comprehensive nutrition disaster rehabilitation, based on the holistic integrated early child development concept, on the growth and development of children under five. METHODS: A community-based intervention was performed in the East Lombok district; four villages in two sub-districts were randomly allocated into intervention or control groups. Mothers of 6-49-month-old children in the intervention group (n = 240) attended parenting classes (twice weekly) and received shredded fish/liver/anchovy and optimized complementary feeding/food-based recommendations, developed using linear programming. Health staff from the public health center and teachers from early childhood education (ECE) centers delivered parenting sessions on health-nutrition and care-education. The control group (n = 240) received existing health services. Indicators measured at baseline and the end line point were weight, length/height, hemoglobin, feeding practices, psychosocial care (HOME) and maternal stress (SRQ). At the end line point, child development was assessed using BSID-III. RESULTS: At the end line point, maternal stress and child morbidity (cough) were lower and dietary diversity (+1) in 6-23-month-old children, and weight-for-age Z-score (+0.26) and social emotional score (+10 points) in ≥24-month-old children were higher in the intervention group. CONCLUSIONS: The nutrition rehabilitation intervention delivered through ECE centers has a positive effect on the growth and development of children under five in post-disaster conditions.

Application Status of Chinese Medicine on Cancer Rehabilitation: A Preliminary Questionnaire Survey.

OBJECTIVE: To investigate the application status of Chinese medicine (CM) in cancer rehabilitation, so as to provide references for improving the level of CM cancer rehabilitation. METHODS: A survey questionnaire regarding "application status of CM rehabilitation in cancer patients" for oncologists (doctor version) and cancer patients (patient version) were developed, respectively. From September 2014 to November 2016, a total of 1,000 doctors from oncology department in 48 hospitals and 2,000 cancer patients from CM oncology department from 8 hospitals in China were recruited in this survey. The psychological, nutrition and exercise rehabilitation guidance for cancer patients provided by doctors, their mastery conditions regarding cancer staging treatment and CM syndrome differentiation, and recommendation from doctors on CM rehabilitation were investigated. Cancer patients' awareness on the importance of psychological, nutrition and exercise rehabilitation, as well as their knowledge and needs for rehabilitation were also analyzed. The impact of gender, age, professional title, hospitals grades of physicians on their knowledge of cancer staging treatment and CM syndrome differentiation, and the relationship between gender, age, education level and economic conditions and patient's knowledge along with the needs of CM rehabilitation were further analyzed. RESULTS: Totally 1,000 questionnaires were issued to doctors and 963 questionnaires returned, among which 948 were valid representing a response rate of 94.80%. A total of 2,000 questionnaires were issued to patients and 1,705 valid data finally returned with a response rate of 85.25%. The survey showed that cancer patients generally paid much attention to psychological, nutritional and sports rehabilitation, and had a strong demand for CM rehabilitation. Knowledge of CM rehabilitation was not well provided by oncologists, and the rehabilitation guidance as well as CM rehabilitation measures were obviously insufficient in cancer patients. Educational and economic levels were positively correlated with cognition level of CM rehabilitation knowledge among cancer patients (Kendall-tau_b correlation coefficients=0.130, 0.057, respectively; P<0.05). Gender and education level were positively correlated with the patients' willingness for taking CM measures (Kendall-tau_b correlation coefficient=0.057, 0.105, respectively; P<0.05). Age was negatively correlated with intention of applying CM measures (kendall-taub correlation coefficient=-0.105, P<0.05). CONCLUSIONS: Health education and professional training for both cancer patients and oncologists should be strengthened and CM rehabilitation knowledge among cancer patients and oncologists should be improved, so as to give full play to CM in cancer rehabilitation.

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.

A prospective observational study to evaluate the efficacy of facility-based management in malnourished children at NRC, district Meerut.

BACKGROUND: Scarcity of suitable food, lack of purchasing power of the family as well as traditional beliefs and taboos about what the baby should eat, often lead to a sufficient balanced diet, resulting in malnutrition. In children, malnutrition is synonymous with growth failure. Malnourished children are shorter and weigh less than they should be for their age and height. MATERIALS AND METHODS: The present study was conducted from September 2017 to November 2017.112 malnourish children, aged 6-60 months who were admitted to NRC during the study period at district hospital Meerut were assessed. Checklist based on operational guidelines on facility based management was used. Data was analyzed in Microsoft Excel and Epi info. RESULT: In the studied population, there were 45 males and 67 females, out of which highest representation was from the age group of 13 to 24 months.67% of studied population belonged to schedule caste. The average weight gain during the stay at the center was 9.92±5.43g/kg/day. The average duration of stay at NRC was 12.01±1.61 days. Only 30% of mothers had appropriate knowledge regarding therapeutic diet and only 50% of the mothers know about the preparation of nutritious food from locally available foods. CONCLUSION: Targeted supplementary nutrition and therapeutic nutrition with specific micronutrients when provided to malnourish children for 14 days by Nutrition Rehabilitation Center can be helpful to improve their nutritional status. There is need to scale up community awareness and community participation for NRCs.