Early postnatal high-dose fat-soluble enteral vitamin A supplementation for moderate or severe bronchopulmonary dysplasia or death in extremely low birthweight infants (NeoVitaA): a multicentre, randomised, parallel-group, double-blind, placebo-controlled, investigator-initiated phase 3 trial.

BACKGROUND: Vitamin A plays a key role in lung development, but there is no consensus regarding the optimal vitamin A dose and administration route in extremely low birthweight (ELBW) infants. We aimed to assess whether early postnatal additional high-dose fat-soluble enteral vitamin A supplementation versus placebo would lower the rate of moderate or severe bronchopulmonary dysplasia or death in ELBW infants receiving recommended basic enteral vitamin A supplementation. METHODS: This prospective, multicentre, randomised, parallel-group, double-blind, placebo-controlled, investigator-initiated phase 3 trial conducted at 29 neonatal intensive care units in Austria and Germany assessed early high-dose enteral vitamin A supplementation (5000 international units [IU]/kg per day) or placebo (peanut oil) for 28 days in ELBW infants. Eligible infants had a birthweight of more than 400 g and less than 1000 g; gestational age at birth of 32+0 weeks postmenstrual age or younger; and the need for mechanical ventilation, non-invasive respiratory support, or supplemental oxygen within the first 72 h of postnatal age after admission to the neonatal intensive care unit. Participants were randomly assigned by block randomisation with variable block sizes (two and four). All participants received basic vitamin A supplementation (1000 IU/kg per day). The composite primary endpoint was moderate or severe bronchopulmonary dysplasia or death at 36 weeks postmenstrual age, analysed in the intention-to-treat population. This trial was registered with EudraCT, 2013-001998-24. FINDINGS: Between March 2, 2015, and Feb 27, 2022, 3066 infants were screened for eligibility at the participating centres. 915 infants were included and randomly assigned to the high-dose vitamin A group (n=449) or the control group (n=466). Mean gestational age was 26·5 weeks (SD 2·0) and mean birthweight was 765 g (162). Moderate or severe bronchopulmonary dysplasia or death occurred in 171 (38%) of 449 infants in the high-dose vitamin A group versus 178 (38%) of 466 infants in the control group (adjusted odds ratio 0·99, 95% CI 0·73-1·55). The number of participants with at least one adverse event was similar between groups (256 [57%] of 449 in the high-dose vitamin A group and 281 [60%] of 466 in the control group). Serum retinol concentrations at baseline, at the end of intervention, and at 36 weeks postmenstrual age were similar in the two groups. INTERPRETATION: Early postnatal high-dose fat-soluble enteral vitamin A supplementation in ELBW infants was safe, but did not change the rate of moderate or severe bronchopulmonary dysplasia or death and did not substantially increase serum retinol concentrations. FUNDING: Deutsche Forschungsgemeinschaft and European Clinical Research Infrastructures Network (ECRIN).

Potentials and limitations of a food group-based algorithm to assess dietary nutrient intake of women in rural areas in Tanzania.

The aim of this study was to evaluate the accuracy of nutrient intake assessment with the food group-based algorithm "Calculator of Inadequate Micronutrient Intake" (CIMI) in comparison to the established nutrition software NutriSurvey. Using Food Frequency Questionnaires and 24-h dietary recalls of 1010 women from two rural districts in Tanzania, 23 relevant typical Tanzanian food groups were identified and subsequently the dietary protocols assessed via CIMI algorithm were compared by bivariate correlations and Bland-Altman analysis with the results of the NutriSurvey software (reference) and were set in relation to blood biomarkers of 666 participants. CIMI and NutriSurvey calculations regarding macro- and micronutrient intakes were similar. The Bland-Altman analyses and correlation coefficients of energy (0.931), protein (0.898), iron (0.775) and zinc (0.838) confirm the agreement of both calculations. The food group based CIMI algorithm is a practical tool to identify the inadequacy of macro- and micronutrient intake at population level.

ESPEN practical short micronutrient guideline.

BACKGROUND: Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. The importance of MNs in common pathologies is recognized by recent research, with deficiencies significantly impacting the outcome. OBJECTIVE: This short version of the guideline aims to provide practical recommendations for clinical practice. METHODS: An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL for the initial guideline. The search focused on physiological data, historical evidence (for papers published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS: The limited number of interventional trials prevented meta-analysis and led to a low level of evidence for most recommendations. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90 % of votes. Altogether the guideline proposes 3 general recommendations and specific recommendations for the 26 MNs. Monitoring and management strategies are proposed. CONCLUSION: This short version of the MN guideline should facilitate handling of the MNs in at-risk diseases, whilst offering practical advice on MN provision and monitoring during nutritional support.

Calculator for inadequate micronutrient intake for Ethiopia (CIMI-Ethiopia): Validation of the software for lactating mothers and their children under 2 years.

Early identification of inadequate intake of nutrients from a person's diet is usually crucial to prevent the development of micronutrient malnutrition. However, there is no single dietary assessment tool for Ethiopia that can assess the nutrient intake of a person from the type of food she or he consumed with a given amount. Therefore, the Calculator for Inadequate Micronutrient Intake (CIMI) application was adapted in consideration of food and nutrition contexts in Ethiopia and validated for its suitability to compute nutrient intake and identify nutrient intake inadequacy. For this, a 24-h recall quantitative dietary data of children aged 12-23 months (n = 781) and lactating mothers (n = 1086) were collected between February 15 and 30, 2017, from rural Genta Afeshum district, Tigray region, Ethiopia. An individual nutrient intake was estimated by calculating using CIMI-Ethiopia and also by NutriSurvey (NS) software for comparison. The average (mean and median) intake of energy and most nutrients and the prevalence of inadequacy calculated by the two software for the children aged 12-23 months and lactating mothers were comparable, except that of the vitamin A. The correlation coefficients for the intake results calculated by CIMI-Ethiopia and NS were between 0.85 and 0.97 for the children and between 0.5 and 0.96 for the lactating mothers' group. Most of the mean intake differences calculated by the two methods were within the acceptable limits, except for the vitamins A, D, and B12 in the Bland-Altman plots. CIMI-Ethiopia is very sensitive to identifying energy, protein, and selected micronutrients inadequacy included in this study, both for the lactating mothers (84.1%-100%) and 12-23-month-old children (77.6%-100%) group. Our results showed that CIMI-Ethiopia estimates the energy and nutrient intake, and can be also used as a screening tool to identify energy, protein, and selected micronutrients inadequacy from an individual woman's and child's diet in rural Tigray, Ethiopia.

Nutrition-sensitive lockdowns: conceptual framework and empirical insights from Africa during COVID-19.

Motivation: Countries facing challenges of nutrition security confront a trade-off when dealing with pandemics such as COVID-19. Implementing lockdown measures, widely used worldwide, can help "flatten the curve" (of disease), but such measures may worsen nutrition security. Purpose: We aim to identify and justify nutrition-sensitive lockdown measures to reduce trade-offs with nutrition security. Methods and approach: We propose a conceptual framework which distinguishes eight lockdown measures and six pathways to nutrition security. To demonstrate the relevance of the pathways, we reviewed emerging literature on COVID-19 and nutrition security. We analysed the content of 1,188 newspaper articles on lockdown effects in five African countries - Benin, Ghana, Kenya, Uganda and Zambia. Findings: Some lockdown measures, such as closing workplaces and restricting movement, potentially worsen nutrition far more than others - banning events and public gatherings have far lesser impacts on nutrition. This can be seen from the framework, literature, and is supported by the analysis of newspaper reports in the five countries. Policy implications: It is better when possible to test and trace disease than to lockdown. But when lockdowns are needed, then first recourse should be to measures that have few nutritional consequences, such as banning public events. When more drastic measures are necessary, look to mitigate nutritional harm by, for example, exempting farm labour from restrictions on movement, by replacing school meals with take-home rations, and, above all, providing income support to households most affected and most vulnerable.

Women's health: optimal nutrition throughout the lifecycle.

Sex differences are an important consideration when researching and establishing policies for nutrition and optimal health. For women's health, there are important physiologic, neurologic, and hormonal distinctions throughout the lifecycle that impact nutritional needs. Distinct from those for men, these nutritional needs must be translated into appropriate nutrition policy that aims to not only avoid overt nutritional deficiency, but also to promote health and minimize risk for chronic disease. Through a series of webinars, scientific experts discussed the advances in the understanding of the unique nutritional needs, challenges and opportunities of the various life stages for women across the life course and identified emerging nutritional interventions that may be beneficial for women. Nevertheless, there is concern that existing nutrition policy intended for women's health is falling short with examples of programs that are focused more on delivering calories than achieving optimal nutrition. To be locally effective, targeted nutrition needs to offer different proposals for different cultural, socio-economic, and geographic communities, and needs to be applicable at all stages of growth and development. There must be adequate access to nutritious foods, and the information to understand and implement proven nutritional opportunities. Experts provided recommendations for improvement of current entitlement programs that will address accessibility and other social and environmental issues to support women properly throughout the lifecycle.

ESPEN micronutrient guideline.

BACKGROUND: Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. OBJECTIVE: This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". METHODS: The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS: There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. CONCLUSION: This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.

Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children.

Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.

The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study.

BACKGROUND: Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. METHODS: This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. RESULTS: Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. CONCLUSIONS: Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.

Micronutrients and bioactive substances: Their potential roles in combating COVID-19.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic is seriously threatening public health and setting off huge economic crises across the world. In the absence of specific drugs for COVID-19, there is an urgent need to look for alternative approaches. Therefore, the aim of this paper was to review the roles of micronutrients and bioactive substances as potential alternative approaches in combating COVID-19. METHODS: This review was based on the literature identified using electronic searches in different databases. RESULTS: Vitamins (A, B, C, D, and E), minerals (selenium and zinc), and bioactive substances from curcumin, echinacea, propolis, garlic, soybean, green tea, and other polyphenols were identified as having potential roles in interfering with spike glycoproteins, angiotensin converting enzyme 2, and transmembrane protease serine 2 at the entry site, and inhibiting activities of papain-like protease, 3 chymotrypsin-like protease, and RNA-dependent RNA polymerase in the replication cycle of severe acute respiratory syndrome coronavirus 2. Having immunomodulating, antiinflammatory, antioxidant, and antiviral properties, such micronutrients and bioactive substances are consequently promising alterative nutritional approaches to combat COVID-19. CONCLUSIONS: The roles of micronutrients and bioactive substances in the fight against COVID-19 are exciting areas of research. This review may suggest directions for further study.

Maternal nutritional status and child feeding practices: a retrospective study in Santal communities, Birbhum District, West Bengal, India.

BACKGROUND: In West Bengal, according to the National Family Health Survey (NFHS-4) 2015-16, undernutrition and anemia are particularly common among scheduled tribe women and children. The purpose of this research is to assess the nutritional status of Adivasi mothers and child feeding patterns, relevant for clinical practice and the design of future preventive actions. These baseline characteristics were obtained in the scope of a feeding trial aimed at improving the hemoglobin concentration of the index child (6-39 months). METHODS: In February 2015, the baseline survey was conducted in 21 tribal villages. In total, 288 mothers and 307 children were recruited for their hemoglobin levels (HemoCue Hb201+), as well as anthropometric indices height/length, weight and MUAC. By questionnaire-based interview aspects on child feeding practices, childcare, family scheduling, and prenatal care were elucidated. RESULTS: The majority of mothers belong to the Santal tribe (93.8%). Nearly half of mothers suffered from underweight including severe forms (BMI < 18.5: 49.4%), and the majority of mothers were anemic (Hb < 12 g/dl: 86.2%). Similarly, undernutrition was highly prevalent among the index children. Ever breastfeeding was almost universal in the study area (99.6%), with all infants aged < 12 months at the time of the interview still being breastfed. The majority of children were breastfed within the first hour after birth (75.7%), still every third child (32.2%) was deprived of colostrum. Merely 32.9% of infants were exclusively breastfed for 6 months (180 days) according to the recommendations of the WHO/UNICEF. When relating to the proposed complementary feeding (CF) indicator then 89.6% of children have received CF (mainly family foods/biscuits/plain rice) during the first 6 to 8 months, and 46.8% of children aged 6 to 23 months fulfilled the minimum acceptable diet (2 to 3 meals per day and ≥ 4 food groups per day), corresponding to 58.1% among children aged 12 to 23 months versa 25% among infants aged 6 to 11 months. CONCLUSION: The maternal nutritional status was poor and showed interrelations with the nutritional status of the index child. Inadequate feeding and caring practices were common. In particular the younger age group (< 12 months) was found at risk of being offered inadequate CF, which needs to be tackled by future programs. TRIAL REGISTRATION: The trial was retrospectively registered at the German Clinical Trials Register on the 1st July 2019 (DRKS00017388).

Prevalence of Undernutrition and Anemia among Santal Adivasi Children, Birbhum District, West Bengal, India.

India's Adivasi scheduled tribe population is disproportionately affected by undernutrition and anemia, thereby prevailing in the poorest wealth deciles denominated as socially and economically vulnerable. This study was designed to assess the extent of child undernutrition (conventional and composite index of anthropometric failure (CIAF) classification), as well as the burden of anemia in children and its independent nutrition specific and sensitive drivers, moreover to reflect the living conditions of Santal Adivasis. The research survey was conducted in 21 Santal villages, Birbhum District, West Bengal, in 2015. An overall 307 children (aged 6-39 months) and their mothers (n = 288) were assessed for their hemoglobin (Hb) levels (HemoCue Hb201+) and anthropometric indices such as height/length, weight and mid-upper arm circumference (MUAC). Moreover, socio-demographic household characteristics were surveyed. The study confirmed Adivasi children lagging behind national average with a high prevalence of undernutrition (height-for-age z-score (HAZ) 51.9%, weight-for-age z-score (WAZ) 49.2%, weight-for-height z-score WHZ 19.0% and CIAF 61.6%) and of moderate and severe anemia (Hb < 10 g/dL, 73.3% altogether). Child's age <24 months, low WAZ scores, morbidity (any fever, diarrhea or respiratory infection) on the checkup day or during previous week, low maternal Hb level, and lack of dietary diversification were identified as predictors for anemia, thereby warrant targeted interventions to decrease the high anemia rates assessed in the study site.

Glut-1 explains the evolutionary advantage of the loss of endogenous vitamin C-synthesis: The electron transfer hypothesis.

INTRODUCTION: During evolution, some species including humans, monkeys and fruit bats lost the ability for ascorbic acid (AA) biosynthesis due to inactivation of the enzyme l-gulono-lactone oxidase (GLO) and subsequently became dependent on dietary vitamin C. There are four current hypotheses in relation to the benefit of vitamin C dependence in the context of adaptation and reproduction. Here we advance and test a new 'electron transfer hypothesis', which focusses on the role of the expression of glucose transporter 1 (Glut-1) in red blood cells (RBCs) in recycling vitamin C, thereby increasing the efficiency of micronutrient uptake. METHODS: To evaluate the benefit of Glut-1 expression, we determined vitamin C uptake into RBCs and potential release from two different species, humans with l-Gulono-lactone-oxidase (GLO-loss) and pigs with functional GLO. RESULTS: The oxidized form of vitamin C (dehydroascorbate, DHA) was transported into human RBCs via Glut-1. There was no transport of either the reduced (AA) or the oxidized vitamin in pig erythrocytes. CONCLUSION: We propose that the transport of vitamin C increases an intracellular electron pool, which transfers electrons from intracellular ascorbate to extracellular substances like ascorbyl free radical or DHA, resulting in 100-fold smaller daily requirement of this essential redox sensitive micronutrient. This would be an advantage during seasonal changes of the availability from food and may be the key for the survival of individuals without vitamin C biosynthesis. LAY SUMMARY: 40 million years ago some individuals lost the ability to synthesize vitamin C. Why did they survive such as humans until now? Individuals with a specific glucose transporter Glut-1 on their erythrocytes which transports vitamin C need less and are protected from scarcity due to seasons and food competitors.

Impact of the natural resource of UVB on the content of vitamin D2 in oyster mushroom (Pleurotus ostreatus) under subtropical settings.

Vitamin D deficiency is a pandemic problem. Non-animal source of vitamin D is obtained from edible mushrooms. Oyster mushroom (Pleurotus ostreatus) was sliced into the size of 1 cm3, 4 cm3 and 9 cm3, and treated with the sun as a natural resource of UVB under subtropical settings in Ethiopia. The content of vitamin D was measured by using high-performance liquid chromatography (HPLC). After sun treatment, there was a significant increment in the content of vitamin D2 from nil to 67.4 ±â€¯28.0 µg/g dry weight (DW). Based on the results of the overall pairwise comparisons, 1 cm3 size of slice group had the highest content of vitamin D2. Duration of sun exposure, sizes of mushroom slices and moisture content were identified as determining factors for vitamin D2 synthesis. Exposing slices of oyster mushroom to the sunlight for <30 min provides the amount that satisfies the current recommended dietary allowance (RDA) of vitamin D without any visible change in color and texture. Thus, sun treatment of oyster mushroom is an effective and economically cheap strategy in the fight against vitamin D deficiency.

Consumption of Dark Green Leafy Vegetables Predicts Vitamin A and Iron Intake and Status among Female Small-Scale Farmers in Tanzania.

Inadequate consumption of micronutrient-dense foods such as vegetables and meat are an important contributing cause for anemia and deficiencies of iron and vitamin A in rural communities of Tanzania. A cross-sectional study was conducted in 2016 to examine nutritional and micronutrient status and their associations to the diet of female small-scale farmers in the sub-humid Kilosa (n = 333) and the semi-arid Chamwino (n = 333) districts, in the Morogoro and Dodoma region. An overall higher prevalence of overweight (19.7%) and obesity (7.1%) than of underweight (5.9%) was detected. Significantly more women in the two villages of Kilosa (27-40%) than in the two villages of Chamwino district (19-21%) were overweight/obese, but also more frequently had anemia (34-41% vs. 11-17%), iron deficiency (24-32% vs. 15-17%), and low serum retinol (21-24% vs. 8-9%). Overall, only a small proportion of women reached recommended daily micronutrient intakes: 27% for vitamin A, 17% for iron, 7% for zinc, and 12-38% for B-vitamins. The amount of dark green leafy vegetables (DGLV) consumed was the main determinant of vitamin A and iron intake by women in Chamwino and corresponded to higher hemoglobin, serum retinol and iron status than in the villages of the Kilosa district; in agreement, DGLV consumption also predicted iron and vitamin A intake in Kilosa district. DGLV consumed with wholemeal millet was advantageous in terms of women's vitamin A and iron intake and status over the predominantly maize-rice-based diet lacking vegetables.

Feeding Practices and Undernutrition in 6⁻23-Month-Old Children of Orthodox Christian Mothers in Rural Tigray, Ethiopia: Longitudinal Study.

Fasting period and fasting status affect the feeding practices and nutritional status of Ethiopian Orthodox mothers. Even if children are exempted from fasting, some mothers do not prepare their food from animal sources as it could contaminate utensils for cooking family foods. Therefore, the objective of this study was to assess feeding practices and undernutrition in 6⁻23-months old children whose mothers are Ethiopian Orthodox religion followers during lent fasting and non-fasting periods in rural Tigray, Northern Ethiopia, and to identify associated factors. A community-based longitudinal study was carried out in Ethiopian Orthodox lent fasting and non-fasting periods. Using a multi-stage systematic random sampling technique, 567 and 522 children aged 6⁻23 months old participated in the fasting and non-fasting assessments, respectively. Statistical analyses were done using logistic regression, an independent sample t-test, Wilcoxon signed-rank (WSRT) and McNemar's tests. The prevalences of stunting, underweight and wasting were 31.6⁻33.7%, 11.7⁻15.7% and 4.4⁻4.8%, respectively. The weight-for-height (WHZ) and height-for-age (HAZ) values for children of fasting mothers were significantly lower (p < 0.05) compared to those of non-fasting mothers. Likewise, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly higher in non-fasting than in fasting periods. A small proportion of children (2.3⁻6.7%) met the minimum acceptable diet (MAD) in the study population, but these measures were significantly increased (p < 0.001) in the children of non-fasting mothers. Mother's fasting during lactation period of the indexed child was amongst the independent factors common in child stunting, underweight and wasting. Nutritional status and feeding practices of 6⁻23-month-old children are affected by maternal fasting during the fasting period. Therefore, without involvement of religious institutions in the existing nutritional activities, reduction of undernutrition would not be successful and sustainable.

Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome.

Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered.

Prevalence of thiamine deficiency in older hospitalized patients.

PURPOSE: Despite some reports of high prevalence of thiamine deficiency in elderly people, the reported prevalence is controversial mainly due to the methods used in assessing thiamin concentrations. In this study, we sought to investigate the prevalence of vitamin B1 deficiency, using the high-performance liquid chromatography (HPLC) method, among older hospitalized patients. PATIENTS AND METHODS: This cross-sectional study retrospectively analyzed the results of routine measurements of vitamin B1 of 238 older patients who were consecutively hospitalized to a geriatric acute care ward. Whole blood vitamin B1 concentrations were measured using the HPLC method at hospital admission, and the whole blood vitamin B1 level of <20 ng/mL was considered as deficiency. RESULTS: Of 238 patients, with a mean age of 82.1±7.1 years, 63% of patients were women. In total, the mean whole blood vitamin B1 level was 66.1±24.8 ng/mL (range 29.5-215 ng/mL), indicating no vitamin B1 deficiency in the entire population. In addition, no significant differences in the mean whole blood vitamin B1 concentrations between sexes were observed (P=0.356). CONCLUSION: This study indicates that the mean whole blood vitamin B1 concentrations using the HPLC method were within the normal range in older hospitalized patients suggesting that thiamine deficiency appears to be rather uncommon among these patients.