Re-examining chemically defined liquid diets through the lens of the microbiome.

Trends in nutritional science are rapidly shifting as information regarding the value of eating unprocessed foods and its salutary effect on the human microbiome emerge. Unravelling the evolution and ecology by which humans have harboured a microbiome that participates in every facet of health and disease is daunting. Most strikingly, the host habitat has sought out naturally occurring foodstuff that can fulfil its own metabolic needs and also the needs of its microbiota, each of which remain inexorably connected to one another. With the introduction of modern medicine and complexities of critical care, came the assumption that the best way to feed a critically ill patient is by delivering fibre-free chemically defined sterile liquid foods (that is, total enteral nutrition). In this Perspective, we uncover the potential flaws in this assumption and discuss how emerging technology in microbiome sciences might inform the best method of feeding malnourished and critically ill patients.

Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996-2017.

Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996-2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10-19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10-15 years old) were more likely to be underweight (+11 pp), have lower education (-24 pp), have less decision-making power (-10 pp), live in poorer households (-0.9 SD) with poorer sanitation (-15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (-3 to -24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height-for-age Z-scores (-0.29 SD for young and -0.10 SD for old adolescents (16-19 years old)), weight-for-age Z-score (-0.18 and -0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth.

Infectious disease and nutritional deficiencies in early industrialized South Africa.

OBJECTIVE: Real industrialization was late to arrive in South Africa and was associated with the development of mining in its northern regions. This paper explores the development and spread of infectious diseases (particularly tuberculosis), against the backdrop of metabolic disease. MATERIALS: Published data regarding skeletons from various mining sites and historical information are collated, including information from the early accessions into the Raymond A. Dart Collection. METHODS: While findings from several sites (e.g., Gladstone at Kimberley, Koffiefontein, Witwatersrand Deep Mine and Lancaster Mine) have been described individually, they have not been assessed collectively. This paper provides a broad overview by collating information from these sites, in comparison with a rural, pre-industrialized population. RESULTS: Malnutrition, including scurvy, was common in most mining groups. Tuberculosis was rare in earlier mining groups, and the first possible skeletal cases only occurred after the establishment of closed housing compounds. From there it spread rapidly across the subcontinent. CONCLUSIONS: Nutritional insufficiencies / metabolic disease and high death rates, due to trauma and infectious diseases, were common. Tuberculosis in South Africa is closely associated with development of the mining industry. SIGNIFICANCE: This research highlights the development of tuberculosis in South Africa and its association with the mining industry. The role of migrant labor and the associated housing practices is elucidated. LIMITATIONS: Sample sizes are limited, but the findings of this study are supported by documentary evidence. FUTURE RESEARCH: Sample sizes should be increased, and the association between closed compound living and the development of disease further explored.

[From the circumnavigation of the Vital de Oliveira to the new ration tables: nutrition and health on Brazilian Imperial Navy vessels, 1879-1886]. / Da circum-navegação da Vital de Oliveira às novas tabelas de rações: alimentação e saúde a bordo dos navios da Marinha Imperial Brasileira, 1879-1886.

The corvette Vital de Oliveira was the first Brazilian Navy vessel to circumnavigate the world, from 1879 to 1881. One of the items that concerned its captain, Júlio de Noronha, in his trip report was the food supply, which was further reinforced in the medical report for the expedition written by the head surgeon, Galdino Magalhães. This concern was notable due to the high numbers of sailors who sickened and died during the trip, which according to both reports may have been caused by shortages of certain foods. This article discusses the relationship between food and health in the crew, as well as the relationship between this journey and the implementation of a new ration table that took effect in 1886.

Entre 1879 e 1881 a corveta Vital de Oliveira realizou a primeira viagem de circum-navegação da Marinha Brasileira. Um dos itens que ocuparam as preocupações do comandante do navio, Júlio de Noronha, em seu relatório da viagem foi a alimentação; preocupação reforçada no relatório médico da expedição redigido pelo primeiro-cirurgião Galdino Magalhães. Essa preocupação ganhou destaque devido ao elevado saldo de enfermos e mortos durante a viagem, para o que teria contribuído a carência de determinados gêneros alimentícios, de acordo com ambos os relatórios. O artigo discute a relação entre a alimentação e a saúde das tripulações. Além disso, trata da relação entre a viagem da Vital e a implementação de uma nova tabela de rações efetivada em 1886.

Da circum-navegação da Vital de Oliveira às novas tabelas de rações: alimentação e saúde a bordo dos navios da Marinha Imperial Brasileira, 1879-1886 / From the circumnavigation of the Vital de Oliveira to the new ration tables: nutrition and health on Brazilian Imperial Navy vessels, 1879-1886

Resumo Entre 1879 e 1881 a corveta Vital de Oliveira realizou a primeira viagem de circum-navegação da Marinha Brasileira. Um dos itens que ocuparam as preocupações do comandante do navio, Júlio de Noronha, em seu relatório da viagem foi a alimentação; preocupação reforçada no relatório médico da expedição redigido pelo primeiro-cirurgião Galdino Magalhães. Essa preocupação ganhou destaque devido ao elevado saldo de enfermos e mortos durante a viagem, para o que teria contribuído a carência de determinados gêneros alimentícios, de acordo com ambos os relatórios. O artigo discute a relação entre a alimentação e a saúde das tripulações. Além disso, trata da relação entre a viagem da Vital e a implementação de uma nova tabela de rações efetivada em 1886.

Abstract The corvette Vital de Oliveira was the first Brazilian Navy vessel to circumnavigate the world, from 1879 to 1881. One of the items that concerned its captain, Júlio de Noronha, in his trip report was the food supply, which was further reinforced in the medical report for the expedition written by the head surgeon, Galdino Magalhães. This concern was notable due to the high numbers of sailors who sickened and died during the trip, which according to both reports may have been caused by shortages of certain foods. This article discusses the relationship between food and health in the crew, as well as the relationship between this journey and the implementation of a new ration table that took effect in 1886.

Decreased Mortality of falciparum Malaria in Anemic Prisoners of War?

Modern clinical trials have suggested that anemia protects against malaria mortality. Military records of the Second World War in Asia were examined to see if there was support for this hypothesis. When relatively well-nourished Imperial Japanese Navy sailors captured on Nauru (n = 799) were imprisoned on the Fauro Islands, 26% died from falciparum malaria. Similarly treated but very malnourished colocated Imperial Army soldiers experienced low stable malaria mortality. One-fifth of previously healthy Australian Army soldiers (n = 252) retreating from New Britain died largely because of malaria in April 1942. Malnourished prisoners of war, who were as a group very anemic, both Australian Army soldiers in Thailand and Japanese Army soldiers in Papua New Guinea, had high malaria rates but very low (< 3%) mortality rates. Malaria immunity does not adequately explain this dichotomy, suggesting that severe nutritional deprivation may be protective against malaria mortality possibly because of iron-deficiency anemia.

Measles, Malnutrition and Mortality: Puerto Rico, 1917-1918.

OBJECTIVE: Recent measles outbreaks in the United States and Europe have highlighted the threat of the disease. We studied the 1917-1918 epidemic in Puerto Rico to better understand the social and place-specific risk factors and severity of such crises. METHODS: We reviewed medical and government reports, newspapers and private contemporary documents. RESULTS: The epidemic developed over two years, encompassed the Island, and caused nearly 2,000 deaths among more than 9,000 registered cases (with much underreporting). During the first six months, 59% of fatalities were children under 2 years of age. Officials recognized poor nutrition and living conditions as an important determinant of epidemic severity. Responses came from different social sectors before the central government mobilized to help. In San Juan, Catholic and Protestant churches and philanthropic women from both Spanish and Englishlanguage communities joined to provide free milk to needy children and create a temporary Infants' Hospital. Despite food scarcity and wartime conditions, central and municipal governments established hospitals and milk stations. CONCLUSION: Studies that examine the impact of reemerging diseases in a time and place-specific context look at disease severity together with the socioeconomic conditions of patients and health care systems. This type of investigation also suggests avenues into the history of pediatrics, the use of epidemiologic methods, the utility of historical statistics, nutritional history, and the history of disaster response. Historical and recent outbreaks show the need for health care professionals and public health systems to be prepared to confront measles epidemics.

Child development, physiological stress and survival expectancy in prehistoric fisher-hunter-gatherers from the Jabuticabeira II shell mound, South Coast of Brazil.

In this study, we shed light on the interdependency of child growth, morbidity and life expectancy in the fisher-hunter-gatherers of the Jabuticabeira II shell mound (1214-830 cal B.C.E. - 118-413 cal C.E.) located at the South Coast of Brazil. We test the underlying causes of heterogeneity in frailty and selective mortality in a population that inhabits a plentiful environment in sedentary settlements. We reconstruct osteobiographies of 41 individuals (23 adults and 18 subadults) using 8 variables, including age-at-death, stature, non-specific stress markers (cribra orbitalia, porotic hyperostosis, periosteal reactions, periapical lesions and linear enamel hypoplasia), as well as weaning patterns based on stable isotope data to examine how stress factors module growth and survival. Our results show that shorter adult statures were linked to higher morbidity around weaning age and higher chances of dying earlier (before 35 years) than taller adult statures. In addition, short juvenile stature was related to physiological stressors and mortality. The adult "survivors" experienced recurrent periods of morbidity during childhood and adulthood, possibly associated with the high parasite load of the ecosystem and dense settlement rather than to malnourishment. An association between early-stress exposure and premature death was not demonstrated in our sample. To explain our data, we propose a new model called "intermittent stress of low lethality". According to this model, individuals are exposed to recurrent stress during the juvenile and adult stages of life, and, nevertheless survive until reproductive age or later with relative success.

Weight and height growth of malnourished school-age children during re-feeding. Three historic studies published shortly after World War I.

BACKGROUND: In view of the ongoing debate on "chronic malnutrition" and the concept of "stunting" as "a better measure than underweight of the cumulative effects of undernutrition and infection (WHO)", we translate, briefly comment and re-publish three seminal historic papers on catch-up growth following re-feeding after severe food restriction of German children during and after World War I. The observations were published in 1920 and 1922, and appear to be of particular interest to the modern nutritionist. RESULTS: The papers of Abderhalden (1920) and Bloch (1920) describe German children of all social strata who were born shortly before World War I, and raised in apparently "normal" families. After severe long-standing undernutrition, they participated in an international charity program. They experienced exceptional catch-up growth in height of 3-5 cm within 6-8 weeks. Goldstein (1922) observed 512 orphans and children from underprivileged families. Goldstein described very different growth patterns. These children were much shorter (mean height between -2.0 and -2.8 SDS, modern WHO reference). They mostly failed to catch-up in height, but tended to excessively increase in weight particularly during adolescence. CONCLUSION: Whereas Abderhalden and Bloch illustrate rapid height catch-up in children from intact social background, Goldstein's observations in orphans and children from poor social background parallel the growth patterns observed in children of modern middle and low-income countries. The historic observations question the current concept of stunting as prima facie evidence of malnutrition and chronic infection, and support the view that "the child's longitudinal growth is largely independent of the extent and nature of the diet".

[The Institute of Professional Orientation of Barcelona (1917-1936): an anthropometric study]. / El Instituto de Orientación Profesional de Barcelona (1917-1936): un estudio antropométrico.

OBJECTIVE: the anthropometric data of the Instituto de Orientación Profesional (Institute of Vocational Guidance) (IOP) is introduced and analysed. The IOP during its activity years (1917- 1935) advised youngsters of the city (mainly 13-19 y.) in their job seeking process. MATERIAL AND METHODS: the statistical information provided by IOP has been analysed through two types of sources. One, secondary, based on statistics published in a monograph in the year 1936. Other, primary, from 305 individual cards found in the archives. Tables of growth of child and young populations of Spain as a model have been applied in order to assess the nutritional condition of the young attending the IOP. RESULTS: social and residential differences reflected in heights and weights of young applicants for employment (15-19 y.). 6.5 cm height and 4.5 kg weight as average between Wealthy and Middle and Working Class. Between 2 and 3 cm and 2 and 4 kg from residents in Ensanche compared to Casco Antiguo and Barriadas. Levels of moderate malnutrition would be of 17% and severe malnutrition between 3% and 5% in young population (13-16 y.) As determinant factor of height and weight, dilution hypothesis suggest the size of sibling. Regression results show a negative effect of this variable of 0.35 cm on height and 0.41 Kg on weight. CONCLUSIONS: anthropometrical and nutritional outputs from the IOP's young population revealed the consequences of social and spatial segregation and current Malthusian tensions in Barcelona in the first third of the 20th century.

Objetivos: este artículo presenta y analiza los datos antropométricos del Instituto de Orientación Profesional de Barcelona (IOP) entre sus años de actividad (1917 a 1935). El IOP asesoraba a un sector de la población juvenil de la ciudad (principalmente, de 13 a 19 años) en su inserción laboral.Materiales y métodos: se han analizado dos tipos de fuentes. Una, secundaria, en base a las estadísticas publicadas en una monografía de 1936. Otra, primaria, a partir de 305 fichas individuales localizadas en los archivos. Se han aplicado tablas modelo de crecimiento de la población infantil y juvenil española para estimar niveles de malnutrición.Resultados: desigualdad social y residencial de tallas y pesos entre los jóvenes, especialmente entre los de 15 y 19 años: 6,5 cm de talla y 4,5 kg de peso de media entre los de clase acomodada y los de las clases media y obrera; entre 2 y 3 cm y 2 y 4 kg entre los residentes en el Ensanche y en el Casco Antiguo o las Barriadas; niveles de malnutrición moderada del 17% y severa del 3-5% en los jóvenes de 13 a 16 años. Entre los factores determinantes de talla y de peso de cada individuo, además de la edad, se encontraría el número de hermanos (hipótesis de dilución), que reduciría las tallas 0,35 cm y los pesos 0,41 kg por hermano.Conclusiones: los resultados antropométricos y nutricionales reflejarían las consecuencias de la segregación social, territorial y las tensiones maltusianas vigentes en Barcelona en el primer tercio del siglo xx.

[Malnutrition and inequalities in developmentalist Spain: rural food and nutrition surveys]. / Malnutrición y desigualdades en la España del desarrollismo: las encuestas rurales de alimentación y nutrición.

INTRODUCTION: the stage of autarky and early years of developmentalism was one of the periods in the contemporary history of Spain when inequalities in food and nutrition became more pronounced. OBJECTIVES: to examine malnutrition among the rural population (municipalities with fewer than 2000 inhabitants), including territorial inequalities and the delayed onset of a rural food and nutrition transition. METHODS: we analysed the rural food and nutrition surveys carried out by the General Commission for Supplies and Transport (Spanish initials: CAT) and the Food and Nutrition Education Programme (Spanish initials: EDALNU) between 1964 and 1972. RESULTS: the rural population presented a deficit of animal proteins, calcium and vitamins A and B2, due to scant consumption of protective foods. Andalucía and inland Spain were the regions with the highest percentage of people whose diet did not meet nutritional requirements. These deficiencies were not only responsible for the prevalence of caries and skin, mucous membrane and eye lesions, but were also behind delayed growth (height and weight). This was not the result so much of poverty as of the persistence of poor eating habits. CONCLUSIONS: besides evidencing the delayed onset of a food and nutritional transition in the Spanish rural population, our findings document policies that sought to encourage the consumption of protective foods in rural areas and empower the population with regard to food and nutrition.

Introducción: la etapa de la autarquía y los primeros años del desarrollismo fue uno de los periodos de la historia contemporánea de España en el que las desigualdades en materia alimentaria y nutricional se hicieron más evidentes.Objetivos: abordar la malnutrición que afectaba a la población rural (municipios de menos de 2000 habitantes), sus desigualdades territoriales y el retraso que mostraba su transición alimentaria y nutricional.Métodos: se han analizado las encuestas rurales de alimentación y nutrición que llevaron a cabo la Comisaría General de Abastecimientos y Transportes (CAT) y el Programa de Educación en Alimentación y Nutrición (Edalnu) entre 1964 y 1972.Resultados: la población rural mostraba un déficit de proteínas animales, de calcio, de vitamina A y de vitamina B2, justificado por el escaso consumo que realizaba de alimentos protectores. Andalucía y la España interior eran las regiones que mostraban mayores porcentajes de personas que no alcanzaban los requerimientos nutricionales. Dichas carencias, que explicaban la prevalencia de caries, así como de lesiones en la piel, en mucosas y oculares, también estaban detrás del retraso en la talla y el peso. No respondían tanto a la escasez de recursos económicos como a la persistencia de hábitos alimentarios inadecuados.Conclusiones: los resultados, además de mostrar el retraso de la población rural española en términos de transición alimentaria y nutricional, avalan las políticas que buscaban estimular en el ámbito rural el consumo de alimentos protectores y empoderar a la población en materia de alimentación y nutrición.

Malnutrition and skin disease in Far East prisoners-of-war in World War II.

During the Second World War, thousands of captured British and Commonwealth troops were interned in prisoner-of-war (POW) camps in the Far East. Imprisonment was extremely harsh, and prisoners developed multiple pathologies induced by physical hardship, tropical infections and starvation. Immediately after the war, several POW doctors published their clinical experiences, including reports of skin disease caused by malnutrition. The most notable deficiency dermatoses seen in Far East POWs were ariboflavinosis (vitamin B2 or riboflavin deficiency) and pellagra (vitamin B3 or niacin deficiency). A lack of vitamin B2 produces a striking inflammatory disorder of scrotal skin. Reports of pellagra in POWs documented a novel widespread eruption, developing into exfoliative dermatitis, in addition to the usual photosensitive dermatosis. A review of the literature from 70 years ago provides a reminder of the skin's response to malnutrition.

Diagnosing clinical malnutrition: Perspectives from the past and implications for the future.

This review, intended for both researchers and clinicians, provides a history of the definition of clinical malnutrition. Despite global efforts, we remain without one clear, objective, internationally accepted definition; clarity in this regard will ultimately improve our evaluation and monitoring of nutritional status to achieve optimal patient outcomes. In this review we explore the development of the term malnutrition and its diagnosis and application in the setting of acute and chronic disease. We begin in the second century A.D. with the work of the Greek physician Galen who is credited as the first to apply the term marasmus to characterize three categories of malnutrition, which are surprisingly similar to components of current international definitions. We then highlight significant developments over the next 2000 years culminating in our current application of the clinical diagnosis of malnutrition. A perspective on historical practices may inform current efforts toward a global definition and diagnosis of malnutrition.