Behind the Protein Battle Lines in the 1970s: Nutritional Turmoil in the Postwar World.

This study examines the development of international debates about the perception of nutrients, particularly protein, with a focus on the "Protein Debate" of the late 20th century. The nutritional obsession with protein has been ongoing since the early 19th century, when scientific nutrition was established, and has been at the center of debates surrounding food, agriculture, healthcare, and the environment, changing in shape and form over time. In addition to being a nutrient necessary for optimal physical and mental performance, protein has been a marker of poverty and discrimination at the international level and explains differences in individual living standards. Kwashiorkor, also known as protein calorie disorder, medicalized the problem of poverty in the Third World or underdeveloped countries. By the 1970s, the nutritional discussion of protein had undergone a radical transformation, with implications for the entire development discourse, including poverty and human rights. This study of the historical discourse on protein deficiency goes beyond the scientific focus on nutritional status, food, and dietary health to identify the social, economic, and cultural implications of nutrition.

Hospital-acquired malnutrition: point prevalence, risk identifiers and utility of a digital Dashboard to identify high-risk, long-stay patients in five Australian facilities.

BACKGROUND: There are limited hospital-acquired malnutrition (HAM) studies among the plethora of malnutrition literature, and a few studies utilise electronic medical records to assist with malnutrition care. This study therefore aimed to determine the point prevalence of HAM in long-stay adult patients across five facilities, whether any descriptors could assist in identifying these patients and whether a digital Dashboard accurately reflected 'real-time' patient nutritional status. METHODS: HAM was defined as malnutrition first diagnosed >14 days after hospital admission. Eligible patients were consenting adult (≥18 years) inpatients with a length of stay (LOS) >14 days. Palliative, mental health and intensive care patients were excluded. Descriptive, clinical and nutritional data were collected, including nutritional status, and whether a patient had hospital-acquired malnutrition to determine point prevalence. Descriptive Fisher's exact and analysis of variance (ANOVA) tests were used. RESULTS: Eligible patients (n = 134) were aged 68 ± 16 years, 52% were female and 92% were acute admissions. HAM and malnutrition point prevalence were 4.5% (n = 6/134) and 19% (n = 26/134), respectively. Patients with HAM had 72 days greater LOS than those with malnutrition present on admission (p < 0.001). A high proportion of HAM patients were inpatients at a tertiary facility and longer-stay wards. The Dashboard correctly reflected recent ward dietitian assessments in 94% of patients at one facility (n = 29/31). CONCLUSIONS: HAM point prevalence was 4.5% among adult long-stay patients. Several descriptors may be suitable to screen for at-risk patients in future studies. Digital Dashboards have the potential to explore factors related to HAM.

Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral Nutrition consensus statement using the Delphi method.

BACKGROUND: Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting. METHODS: An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree." RESULTS: Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'. CONCLUSION: An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.

Prevalence and influencing factors of malnutrition in diabetic patients: A systematic review and meta-analysis.

The prevalence of malnutrition in diabetic patients and its influencing factors remain poorly described. We aim to investigate the prevalence of malnutrition and the influencing factors in diabetic patients through meta-analysis. Utilizing search terms, such as diabetes, malnutrition, and prevalence, we systematically searched eight databases, including Embase, PubMed, Web of Science, The Cochrane Library, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and VIP Database, from inception to May 4, 2023. The search aimed to identify studies related to the prevalence of malnutrition and its influencing factors in adult patients with diabetes. Cohort studies, case-control studies, and cross-sectional studies that met the inclusion criteria were included in the analysis. Stata 16.0 software was used for meta-analysis. Quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). The study protocol is registered with Prospective Register of Systematic Reviews (PROSPERO), CRD42023443649. A total of 46 studies were included, involving 18 062 patients with ages ranging from 18 to 95 years. The overall malnutrition prevalence was 33% (95% confidence interval [CI]: 0.25-0.40), compared with an at-risk prevalence of 44% (95% CI: 0.34-0.54). Sixteen factors associated with malnutrition in diabetic patients were identified. This meta-analysis provides insights into the prevalence of malnutrition and its risk factors in diabetic patients. Regular nutritional screening for patients with risk factors is essential for early detection and intervention.

Malnutrition in tribal people living with tuberculosis in India: A systematic review & meta-analysis.

Background & objectives Tuberculosis (TB) remains a persistent public health challenge in India. The country also has high proportions of malnutrition in different areas, making the population susceptible to TB. Among vulnerable populations, such as tribal communities, TB and malnutrition pose significant threats. Tribal populations exhibit disproportionately higher TB prevalence rates compared to non-tribal groups. Also, malnutrition prevalence among tribal communities far exceeds national averages in India. Amidst fragmented data, a systematic review of nutritional status among tribal populations with TB in India is imperative to inform comprehensive intervention strategies. Methods Cross-sectional, case-control, cohort and interventional studies reporting the nutritional status of active TB affected individuals among tribal populations in India were specifically included if terms such as "malnutrition" or "low BMI" were used. This systematic review followed PRISMA guidelines and was registered with PROSPERO (CRD42020168328). The data was assessed using a random-effects model and standardized mean with 95% confidence interval (CI). The I2 statistics indicated heterogeneity. Publication bias was evaluated using funnel plots. Results Out of 124 studies, 20 were selected for initial screening, 15 were excluded due to a lack of appropriate data, and five were included for the final analysis. The pooled prevalence estimates of malnutrition among Indian tribes living with TB was 514 per 1000 people, with 95% CI: 232-791. The sensitivity analysis showed that no individual study influenced the estimation of pooled prevalence. Interpretation & conclusions In the background of India, contributing considerably to the burden of TB-related morbidity and mortality alongside undernutrition, reviews have underscored undernutrition as the predominant risk factor for TB, affecting over 50 per cent of the population in some States. This situation is exacerbated among the tribal communities in India due to the dual burdens of undernutrition and TB being more pronounced. Our systematic review consolidates evidence from five studies, revealing the prevalence of malnutrition among tribal TB patients. Conducting well-planned implementation research to address this dual burden among the underprivileged population would help achieve the ambitious goal of a TB-free India 2025.

Construction of a metabolism-malnutrition-inflammation prognostic risk score in patients with heart failure with preserved ejection fraction: a machine learning based Lasso-Cox model.

BACKGROUND: Metabolic disorder, malnutrition and inflammation are involved and interplayed in the mechanisms of heart failure with preserved ejection fraction (HFpEF). We aimed to construct a Metabolism-malnutrition-inflammation score (MIS) to predict the risk of death in patients with HFpEF. METHODS: We included patients diagnosed with HFpEF and without infective or systemic disease. 20 biomarkers were filtered by the Least absolute shrinkage and selection operator (Lasso)-Cox regression. 1000 times bootstrapping datasets were generated to select biomarkers that appeared above 95% frequency in repetitions to construct the MIS. RESULTS: Among 1083 patients diagnosed with HFpEF, 342 patients (31.6%) died during a median follow-up period of 2.5 years. The MIS was finally constructed based on 6 biomarkers, they were albumin (ALB), red blood cell distribution width-standard deviation (RDW-SD), high-sensitivity C-reactive protein (hs-CRP), lymphocytes, triiodothyronine (T3) and uric acid (UA). Incorporating MIS into the basic predictive model significantly increased both discrimination (∆C-index = 0.034, 95% CI 0.013-0.050) and reclassification (IDI, 6.6%, 95% CI 4.0%-9.5%; NRI, 22.2% 95% CI 14.4%-30.2%) in predicting all-cause mortality. In the time-dependent receiver operating characteristic (ROC) analysis, the mean area under the curve (AUC) for the MIS was 0.778, 0.782 and 0.772 at 1, 3, and 5 years after discharge in the cross-validation sets. The MIS was independently associated with all-cause mortality (hazard ratio: 1.98, 95% CI [1.70-2.31], P < 0.001). CONCLUSIONS: A risk score derived from 6 commonly used inflammatory, nutritional, thyroid and uric acid metabolic biomarkers can effectively identify high-risk patients with HFpEF, providing potential individualized management strategies for patients with HFpEF.

Examining dietary interventions in Crohn's disease.

This editorial builds on the article by Shakhshir et al. We conducted an overview of evidence-based dietary interventions in adults with inflammatory bowel disease (IBD). In the IBD population, there may be a role for the Mediterranean diet due to its anti-inflammatory effects, long-term sustainability, and role in improving cardiovascular health. In active Crohn's disease, the use of exclusive enteral nutrition, the Crohn's disease exclusion diet, or the specific carbohydrate diet may be used as a short-term adjunct to medical therapy and may improve mucosal healing. The low-FODMAP diet can assist in reducing symptoms for patients without evidence of active bowel inflammation. As interest in nutritional therapy increases amongst clinicians and patients alike, it is integral that dietary therapies are understood and discussed in routine management of patients with IBD as part of holistic care, ideally through a multidisciplinary setting with involvement of experienced dietitians. This serves to improve clinician-patient engagement and reduce complications of IBD including micro and micronutrient deficiencies.

Undernutrition and associated factors among lactating mothers in Chiro district, eastern Ethiopia: a community-based cross-sectional study.

Background: Maternal undernutrition during lactation is a worldwide public health problem. It causes impaired cognitive ability, poor productivity, irreversible loss, and intergenerational malnutrition, which has harmful effects on the next generation. Overall, there is little information on undernutrition and risk factors among lactating mothers, especially in resource-poor settings, including Ethiopia. This study assessed undernutrition and associated factors among lactating mothers in rural Chiro district, eastern Ethiopia. Method: A community-based cross-sectional study was conducted among 629 lactating mothers in the Chiro district from July 2-30, 2019. Data were collected from participants using pretested, structured questionnaires and anthropometric measurements. Data were entered using EpiData version 3.1 and analyzed using SPSS version 27. Multivariable logistic regression analyses were used to identify factors associated with undernutrition. Results: Undernutrition among lactating mothers was 26.9% (95% CI: 23.2%, 30.2%). Female-headed household (AOR = 0.34, 95% CI:0.13, 0.94), medium (AOR = 0.58, 95% CI: 0.38, 0.95) and rich (AOR = 0.30, 95% CI: 0.18, 0.51) wealth quintiles, lack of dietary advice (AOR = 1.62, 95% CI: 1.10, 2.39), chewing khat (AOR = 1.82, 95% CI: 1.23, 2.70), low dietary diversity (AOR = 3.10, 95% CI: 1.82, 5.29), and household food insecurity (AOR = 3.67, 95% CI:1.47, 9.20) were factors significantly associated with undernutrition. Conclusions: Around one in every four lactating mothers in rural eastern Ethiopia had undernutrition. Poor wealth, lack of dietary feeding advice, substance use disorder, low minimum dietary diversity, and household food insecurity were factors significantly associated with the undernutrition of lactating mothers. Thus, focusing on implementing existing strategies/programs for effective nutritional interventions and poverty alleviation that enhance food security status would be essential to improving the nutritional status of lactating mothers and children.

People's Health in People's Hands: Dr. Abhay Bang and Dr. Rani Bang's Pioneering Approach to Rural Healthcare in India.

Dr. Abhay Bang and Dr. Rani Bang, a husband-and-wife team, have dedicated their lives to reforming healthcare in rural India. Their pioneering work in Gadchiroli, Maharashtra, through the Society for Education, Action, and Research in Community Health (SEARCH), has led to revolutionary interventions such as the Home-Based Newborn Care (HBNC) model, significantly reducing infant mortality rates. Their emphasis on women's health and community empowerment has revolutionized conventional healthcare practices and influenced global health policies. This review article sheds light on the historical context and lasting impact of their contributions to community-based healthcare and public health research.

Malnutrition defined by global leadership initiative on malnutrition criteria impedes home discharge in acute care hospital admissions.

BACKGROUND & AIMS: Limited evidence exists on the association between malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospitalized acute care patients and their outcomes; several aspects still require clarification. This study aimed to evaluate the relationship between malnutrition, as defined by the GLIM criteria, at the time of acute hospital admission and discharge to home. METHODS: This retrospective observational study was conducted at a hospital that provides acute care in Japan. Adult patients admitted between July 2023 and April 2024 were included in this study. The primary outcome was the number of patients discharged to home, with in-hospital mortality as the secondary outcome. To ensure the reliability of the cohort-wide results, background factors were adjusted using propensity score matching. The two groups were compared based on the presence or absence of malnutrition, as defined by the GLIM criteria at admission. Furthermore, multiple logistic regression analysis was conducted, with the outcome as the dependent variable and malnutrition, diagnosed using the GLIM criteria, as the explanatory variable, adjusting for covariates. RESULTS: A total of 1007 patients were included in the final analysis, of whom 492 (49 %) were diagnosed without malnutrition, while 515 (51 %) were diagnosed with malnutrition according to the GLIM criteria. In the multivariate logistic regression analysis after matching, malnutrition defined by the GLIM criteria emerged as an independent factor associated with discharge to home (odds ratio [OR] = 0.37, 95 % confidence interval = 0.25-0.56, P < 0.001) when adjusting for age, sex, and various comorbidities. Among the GLIM sub-criteria, reduced muscle mass, reduced food intake or assimilation, and disease burden or inflammation were independently associated with discharge to home. Notably, disease burden/inflammation exhibited the lowest OR among the GLIM sub-criteria for discharge. CONCLUSION: Malnutrition diagnosed using the GLIM criteria upon admission in patients admitted to a regional hospital providing acute care was associated with decreased rates of discharge to home and increased in-hospital mortality. Specifically, attention should be paid to the criteria for reduced muscle mass and disease burden or inflammation within the GLIM framework.

Current Pharmacotherapy and Nutrition Therapy of Alcohol-Associated Liver Disease.

Patients with alcohol-associated liver disease (ALD) consume large amounts of empty calories and are at risk for malnutrition. Malnutrition can present with micro- or macro-nutrient deficiencies. The standard-of-care drug treatment for severe alcohol-associated hepatitis (AH) is corticosteroids. While still in the standard treatment there are limitations in efficacy and certain patients do not respond to treatment (Lille score ≥.45). This article will focus on important concepts related to nutrition and ALD and on recent findings on predicting corticosteroid response and prognosis for AH patients.

Should a single growth standard be used to judge the nutritional status of children under age 5 y globally? Debate consensus.

The participants in this debate agreed that: 1) target-based advocacy is required for ensuring countries' engagement and political commitments toward reducing child malnutrition, and the tools used for monitoring progress should be accurate and pose no risk of harmful consequences; and 2) physical growth is not the only dimension of nutritional status to be monitored in clinical and public health practice; anthropometry is thus only one of the diagnostic indicators of nutritional status. Key disagreements included methodological approaches for developing a single growth standard to evaluate nutritional status globally; the relative utility of universal and contextual growth standards for clinical practice and public health; the balance of benefits, harms, and acceptability among stakeholders; and their use as a screening or a definitive tool in individual and public health nutrition. Noteworthy agreements for research priorities included comparison of benefits and harms of using universal compared with contextual growth standards/references and different stakeholders' perception of expectations from and utility of growth standards.

Baseline Nutritional Status and Rehabilitation Progress in Individuals Requiring Inpatient Rehabilitation: A Retrospective Cohort Study.

Objective: To evaluate the relationships between baseline nutritional status, medical events (MEs), and rehabilitation outcomes in individuals undergoing inpatient rehabilitation (IR). Design: A retrospective single center cohort study. Setting: An IR ward. Participants: This study included 409 patients (mean age, 80 years; men, 170 [42%]) undergoing IR for hospital-associated deconditioning, neurologic disorders, or musculoskeletal diseases. Participants were grouped according to the Controlling Nutritional Status score at admission: normal nutrition (NN): 0 to 1, mild malnutrition (MM): 2 to 4, and moderate/severe malnutrition (M/SM): 5 to 12. Interventions: None. Main Outcome Measures: The primary outcomes included MEs leading to death or acute illness requiring transfer to other hospitals for specialized treatments. The secondary outcomes were the rehabilitation efficiency scores (changes in Functional Independence Measure [FIM] score divided by length of stay) for motor function (FIM-M) and cognitive function (FIM-C). Results: Among the 409 participants, 300 (73%) were malnourished at admission. The adjusted hazard ratios (95% confidence interval) for MEs in the MM and M/SM groups relative to the NN group were 1.48 (0.67-3.27) and 0.98 (0.34-2.81), respectively. No significant differences were observed among the 3 groups in FIM-M efficiency scores (mean ± SD, NN: 0.49±0.51 vs MM: 0.41±0.57 vs M/SM: 0.44±1.06, P=.7) or FIM-C efficiency scores (0.04±0.06 vs 0.04±0.06 vs 0.08±0.4, P=0.1). Analysis of covariance showed no significant association between MM or M/SM group and FIM-M efficiency score (beta coefficient = -0.038, P=.6; beta coefficient = 0.15, P=.1, respectively) or FIM-C efficiency score (beta coefficient = 0.004, P=.8; beta coefficient = 0.047, P=.08, respectively). Conclusion: No significant associations were observed between the baseline nutritional status and MEs, FIM-M efficiency score, or FIM-C efficiency score in individuals undergoing IR.

Comparative Analysis of Tools for Assessment of Protein-Energy Wasting in Chronic Kidney Disease Patients on Maintenance Hemodialysis.

Background: Patients with chronic kidney disease have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. The present study assessed the prevalence of protein-energy wasting in dialysis-dependent chronic kidney disease population and evaluated the validity of various nutritional assessment tools in diagnosing protein-energy wasting. Materials and Methods: All patients above 18 years undergoing dialysis for more than 3 months without any active infection or malignancy were included in our study. Data from anthropometric measurements, dietary assessment, and blood investigations were collected. Protein-energy wasting was assessed by the International Society of Renal Nutrition and Metabolism 2008 criteria. Diagnostic validity of the nutritional assessment tools to predict protein-energy wasting was estimated by area under the curve, sensitivity, specificity, and accuracy statistics. Results: A total of 146 patients were studied. The prevalence of protein-energy wasting was 56.8%. Protein-energy wasting was significantly associated with socioeconomic status, hospitalization days, and catheter days. Normalized protein catabolism rate had the highest sensitivity (90.4%) for predicting protein-energy wasting. Malnutritional inflammatory score had the highest area under the curve (0.858), specificity (82.5%), and accuracy (82.2%). Mid-upper arm circumference, Dialysis Malnutrition Score, and albumin were also found to be significant predictors of protein-energy wasting. Conclusion: Lack of advanced equipment in suburban and rural centers to detect protein-energy wasting in India can be overcome by using the various stand-alone and combination nutrition assessment tools which have been validated in the present study.

Exploring the reduction in aquaporin-4 and increased expression of ciliary neurotrophic factor with the frontal-striatal gliosis induced by chronic high-fat dietary stress.

High-fat diet (HFD)-induced obesity induces peripheral inflammation and hypothalamic pathogenesis linking the activation of astrocytes and microglia. Clinical evidence indicates a positive correlation between obesity and psychiatric disorders, such as depression. The connectivity of the frontal-striatal (FS) circuit, involving the caudate putamen (CPu) and anterior cingulate cortex (ACC) within the prefrontal cortex (PFC), is known for its role in stress-induced depression. Thus, there is a need for a thorough investigation into whether chronic obesity-induced gliosis, characterized by the activation of astrocytes and microglia, in these brain regions of individuals with chronic obesity. The results revealed increased S100ß+ astrocytes and Iba1+ microglia in the CPu and ACC of male obese mice, along with immune cell accumulation in meningeal lymphatic drainage. Activated GFAP+ astrocytes and Iba1+ microglia were observed in the corpus callosum of obese mice. Gliosis in the CPu and ACC was linked to elevated cleaved caspase-3 levels, indicating potential neural cell death by chronic HFD feeding. There was a loss of myelin and adenomatous polyposis coli (APC)+ oligodendrocytes (OLs) in the corpus callosum, an area known to be linked with injury to the CPu. Additionally, reduced levels of aquaporin-4 (AQP4), a protein associated within the glymphatic systems, were noted in the CPu and ACC, while ciliary neurotrophic factor (CNTF) gene expression was upregulated in these brain regions of obese mice. The in vitro study revealed that high-dose CNTF causing a trend of reduced astrocytic AQP4 expression, but it significantly impaired OL maturation. This pathological evidence highlights that prolonged HFD consumption induces persistent FS gliosis and demyelination in the corpus callosum. An elevated level of CNTF appears to act as a potential regulator, leading to AQP4 downregulation in the FS areas and demyelination in the corpus callosum. This cascade of events might contribute to neural cell damage within these regions and disrupt the glymphatic flow.

Localized Pneumocystis jirovecii pneumonia in a malnourished, non-HIV-infected man in the absence of any established or diagnosed immunosuppressive condition: a case report.

BACKGROUND: Pneumocystis jirovecii infection is an opportunistic infection that mostly affects patients with immunosuppressive conditions like human immunodeficiency virus (HIV) infection or medications, like corticosteroids. This study reports a rare case of Pneumocystis Jiroveci infection in a relatively immunocompetent patient which presented with uncommon radiological findings. CASE PRESENTATION: A 46-year-old man with a malnourished appearance and a history of opium dependence presented with dry cough, dyspnea, and weight loss to the hospital. There was no evidence of an immunocompromised condition or use of any immunosuppressive medication in the history of the patient. A lung high-resolution computed tomography (HRCT) scan revealed a crazy-paving appearance and localized infiltration. Methenamine silver staining and the histopathological findings in the transbronchial lung biopsy confirmed the diagnosis of PJP. Antibiotics and bronchodilators were administrated and the patient was discharged after 6 days of hospitalization. HIV testing and immunoglobulin levels were normal in the hospital course as well as his follow-up visits. After a 2-month follow-up, the patient was in good condition despite of mild remaining infiltration in his lung. CONCLUSIONS: PJP typically affects HIV-infected patients, but due to excessive use of immunosuppressive medications, its prevalence is increasing in non-HIV-infected patients. Malnutrition may predispose the patients to PJP, even in the absence of immunosuppressive conditions.

A 10-year (2014-2023) review of complementary food development in sub-Saharan Africa and the impact on child health.

Complementary foods (CFs) commonly consumed by infants and young children (IYC) in sub-Saharan Africa (SSA) are processed using either single or multi-grain ingredients through simple technologies such as fermentation, malting and roasting. Interestingly, CFs (e.g., ogi, kunu, and dabo) are prepared and fed to infants alongside breastmilk until they are completely weaned up to the infant's second birthday. The grains used for preparing CFs can be contaminated with bacterial and chemical contaminants as a result of poor harvesting, handling or storage practices. The stage at which IYC are introduced to CFs is of utmost importance as it aids in addressing malnutrition and improving their overall health and well-being. Complementary feeding practices across SSA are influenced by socio-economic, cultural and geographical factors such that improper introduction can result in dire health consequences including immune suppression, severe foodborne diseases, poor child growth and development, and sometimes death from malnutrition. Malnutrition often occurs from inadequacies of nutrient intakes and assimilation which affect the ability to maintain normal body functions such as growth, learning abilities, resistance to and recovery from diseases. In SSA, IYC malnutrition still poses an enormous concern, therefore indicating the need for intervention strategies such as the promotion of indigenous crops and elevating traditional knowledge and technologies for formulating CFs. This paper clearly highlights the diversity of CFs in SSA, ingredients utilized, processing techniques, contamination by bacteria and chemicals, and demonstrates the consequences of consuming contaminated CFs, and their influence on IYC health as well as approaches to ensuring safety and scaling up indigenous CFs.

Understanding the complexity of barriers and facilitators to adherence to oral nutritional supplements among patients with malnutrition: a systematic mixed-studies review.

The aim of this systematic mixed-studies review is to summarise barriers/facilitators to adherence to and/or consumption of oral nutritional supplements (ONS) among patients with disease-related malnutrition. In March 2022, the Cochrane CENTRAL, PUBMED, PsycINFO (Ovid) and CINAHL were searched for articles with various study designs, published since 2000. Articles were identified on the basis of 'population' (patients ≥18 years with malnutrition/at nutritional risk), 'intervention' (ONS with ≥2 macronutrients and micronutrients), 'comparison' (any comparator/no comparator) and 'outcome' (factors affecting adherence or consumption) criteria. A sequential exploratory synthesis was conducted: first, a thematic synthesis was performed identifying barriers/facilitators; and second, the randomised controlled trials (RCTs) were used to support these findings. The five WHO dimensions of adherence guided the analysis. Study inclusion, data extraction, analysis and risk-of-bias assessment (MMAT 2018) were carried out independently by two researchers. From 21 835 screened articles, 171 were included with 42% RCTs and 20% qualitative studies. The two major populations were patients with malignancies (34%) and older adults (35%). In total, fifty-nine barriers/facilitators were identified. Patients' health status, motivation, product tolerance and satisfaction as well as well-functioning healthcare routines and support were factors impacting ONS consumption. Few barriers/facilitators (n = 13) were investigated in RCTs. Two of those were serving a small ONS volume and integrating ONS into ward routines. Given the complexity of ONS adherence, non-adherence to ONS should be addressed using a holistic approach. More studies are needed to investigate the effect of different approaches to increase adherence to ONS.

Mapping the Evidence for Measuring Energy Expenditure and Indicating Hypermetabolism in Motor Neuron Disease: A Scoping Review.

OBJECTIVE: To map the international methods used to measure energy expenditure of adults living with motor neuron disease (MND) and to highlight discrepancies when indicating hypermetabolism in the MND literature. BACKGROUND: A decline in the nutritional status of patients is associated with exacerbated weight loss and shortened survival. Assessments of energy expenditure, using a variety of methods, are important to ensure an adequate energy intake to prevent malnutrition-associated weight loss. Assessments of energy expenditure are also commonly used to indicate hypermetabolism in MND, although these approaches may not be optimal. METHODS: A protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Guidelines was developed. Three electronic databases (Medline [Ovid], CINAHL [EBSCO], and Web of Science) were exhaustively searched. Identified publications were systematically screened according to predefined PICOS eligibility criteria. The primary outcome was the identification of methods used to measure energy expenditure in MND. The secondary outcome was the identification of applications of energy expenditure assessments to indicate hypermetabolism in MND. RESULTS: Thirty-two observational primary research publications were identified. Thirteen (40.6%) were longitudinal in design, with data on repeated measurements of energy expenditure presented in 3 (9.4%). Thirteen (40.6%) were case-control studies, of which 11 use a matched control group. Pulmonary function was used to assess eligibility in 10 publications. Energy expenditure was measured using indirect calorimetry (IC) in 31 studies. Discrepancies in the durations of fasted, measurement, and washout periods were observed. Of all included publications, 50% used assessments of resting energy expenditure to identify hypermetabolism. Bioelectrical impedance analysis was used to assess body composition alongside energy expenditure in 93.8% of publications. CONCLUSIONS: Resting energy expenditure is most frequently measured using an open-circuit IC system. However, there is a lack of a standardized, validated protocol for the conduct and reporting of IC and metabolic status in patients with MND.