Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes.

OBJECTIVE: To evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. STUDY DESIGN: A prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. RESULTS: Three hundred and forty-five children were enrolled in the cohort (n = 188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department visits and hospital readmissions, hospital length of stay (LOS), or health care resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more emergency department visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio 1.65, 95% CI: 1.09, 2.49, P = .018; high risk - incidence rate ratio 1.64, 95% CI: 1.05, 2.56, P = .028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, P = .023) for children at high risk compared with children at low risk after adjusting for patient characteristics. CONCLUSIONS: Malnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.

Nutritional risk assessment using the Nutritional Prognostic Index predicts mortality in Advanced Chronic Liver Disease patients.

OBJECTIVES: Early clinical prognosis and mortality reduction remains a challenge in chronic liver disease (CLD). The full potential of the Nutritional Prognostic Index (NPI) for nutritional assessment and management in CLD patients remains unexplored. The aim of this study was to establish an NPI cutoff point for the identification of nutritional risk in advanced CLD (ACLD) patients, as well as to assess the NPI's ability to predict ACLD-associated mortality. METHODS: This ethically approved prospective cohort study investigated malnutrition risk using both the NPI and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) in patients hospitalized for ACLD. NPI reference values were determined using a receiver operating characteristic curve. Associations between nutritional risk identified by the RFH-NPT and the NPI were assessed using Fisher's exact test, and agreement between tools was assessed using the Kappa index. The association between NPI-defined nutritional risk and 12-mo mortality was examined using Pearson Chi-square test. RESULTS: The sample population consisted of 120 adults, comprising 84 (70%) male and 57 (50.9%) of alcoholic etiology and presenting as Child-Pugh A, B, or C at admission. The identified cutoff point for NPI was <41, identifying nutritional risk in 82.5% of patients. The NPI presented a statistically significant association with the RFH-NPT, with a substantial agreement coefficient of 0.34. An association between NPI <41 cutoff and mortality were observed, with 82.1% of the sample below cutoff experiencing mortality within 12 mo. CONCLUSIONS: The NPI is a valuable nutritional marker for the identification of nutritional risk in ACLD and is a simple and effective assessment tool that can aid in early CLD prognosis assessment. Validation, however, remains necessary in other CLD populations of different etiologies.

Clinical and Nutritional Aspects and Outcomes of Covid-19 in Cancer and Non-Cancer Pediatric Patients.

The SARS-CoV-2 virus has been the subject of study by several researchers worldwide since 2020; however, there are points to be clarified. This study aimed to analyze the clinical and nutritional aspects of hospitalized cancer and non-cancer pediatric patients and the association with COVID-19 outcomes. This is a cohort study of hospitalized children and adolescents with a laboratory diagnosis of COVID-19. Patients were assessed according to the presence or absence of previous oncological diseases. Sociodemographic, clinical and nutritional data were investigated during the course of the infection. Outcomes included Intensive Care Unit (ICU) admission, longer length of stay (14 days), criticality, and death. Oncological disease was found in 16 (19.3%) patients, most of whom had B-type acute lymphoid leukemia. In Poisson regression, adjusted for age and comorbidity, an association was found between oncological disease and length of stay ≥14 days (RR 4.30; 95% CI 1.46 - 15.6; p = 0.013), COVID-19 criticality (RR 3.82; 95% CI 1.66 - 30.9; p = 0.010) and death (RR 3.42; 95% CI 0.94 - 9.96; p = 0.035). The research revealed that cancer patients had longer hospital stays, were more likely to have the severe form of COVID-19, and had a 3.42 times greater risk of dying.

Parenteral nutrition customization in pediatrics: A descriptive cohort study.

OBJECTIVES: The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital. METHODS: We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels. RESULTS: A total of 264 patients, with a median age of 2.2 years (IQR: 0.3-9.0 years), comprising intensive care (n = 216; 81.8%) and malnourished (n = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (n = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (n = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (n = 226) of cases in the first 48 h; 96.2% (n = 177) of cases on the fourth day; and 90.1% (n = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age z score and number of second individualizations (r = -0.222; P = 0.002). CONCLUSION: Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.

The predictive ability of Controlling Nutritional Status score on in-hospital mortality in patients admitted to coronary care unit.

OBJECTIVE: Controlling Nutritional Status score was previously described and has been used in predicting short- and long-term outcomes in different patient populations. The aim of this study was to test the relationship between Controlling Nutritional Status score and in-hospital mortality in coronary care unit patients (MORCOR-TURK population). METHODS: In this multicenter and national study, all patients with an available Controlling Nutritional Status score were included in the analysis. The Controlling Nutritional Status score was calculated according to previously described criteria. To be able to understand the significance of the Controlling Nutritional Status score, we constructed two models. Model 1 included age, heart failure, chronic kidney disease, hypertension, diabetes mellitus, and coronary artery disease history. Model 2 included the Controlling Nutritional Status score and Model 1. We then statistically compared the performances of the two models. RESULTS: A total of 1,018 patients with known Controlling Nutritional Status scores were included in the analysis. Demographic characteristics are shown. In Model 1, the -2 log-likelihood ratio was 395.995, Nagelkerke R2 was 0.133, and area under the curve was 0.739 (95%CI 0.67-0.81). In the second model to which the Controlling Nutritional Status score is added (Model 2), the -2 log-likelihood ratio was 373.743, Nagelkerke R2 was 0.191, and area under the curve was 0.787 (95%CI 0.72-0.85). The area under the curve value of Model 2 was statistically higher than Model 1 (DeLong p-value: 0.01). A statistically significant correlation was found between death and Controlling Nutritional Status score in Model 2 [OR 1.347 (1.193-1.521), p<0.001]. CONCLUSIONS: Our study showed that the Controlling Nutritional Status score may be a significant predictor of in-hospital mortality in coronary care unit patients.

Effects of probiotic supplementation on the anthropometric nutritional status of patients with type 2 Diabetes mellitus: A systematic review and meta-analysis protocol.

BACKGROUND: Diabetes mellitus (DM) is characterized by hyperglycemia due to insufficient insulin production or utilization. Previous studies have shown a relationship between the gut microbiota and DM, driving interest in probiotic supplementation to modulate the microbiota and glucose metabolism in patients with DM, although the exact mechanisms remain unclear. Probiotics can influence metabolic factors and improve the composition of the microbiota, possibly helping to reduce weight in patients with DM. OBJECTIVE: The objective of this review is to compile and analyze the most relevant evidence on the effects of probiotic supplementation on the nutritional anthropometric status of patients with type 2 Diabetes mellitus (T2DM). METHODS: Methodological guidelines will be followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the study has been registered in the International Prospective Register of Systematic Reviews under reference number CRD42023480243. Studies will be selected through an active search of the PubMed, Science Direct, and SCOPUS databases using the following search descriptors: gut microbiota, body weight, and metabolic diseases, according to medical subject headings. The assessment of the methodological quality of the studies will be carried out using the Cochrane Collaboration instrument. The risk of bias will be analyzed using the Revised Cochrane tool for risk of bias in randomized controlled trials (RoB 2). A meta-analysis will be performed if heterogeneity is acceptable and justifiable; otherwise, the results will be presented in a qualitative narrative synthesis. EXPECTED RESULTS: The results of probiotic supplementation are expected to demonstrate improvements in anthropometric parameters such as body weight, BMI and abdominal and waist circumference in patients with T2DM, thus providing valuable evidence for clinical application.

Omega-3 Supplementation and Nutritional Status in Patients with Pancreatic Neoplasms: A Systematic Review.

OBJECTIVES: The purpose of this study was to synthesize and evaluate the evidence regarding the effects of omega-3 supplementation on the nutritional status of pancreatic cancer patients. METHODS: A systematic review of clinical trials was conducted, adhering to the PRISMA Statement. MEDLINE/PubMed, EMBASE, CENTRAL Cochrane, Scopus, and Web of Science databases were searched up to 31 December 2022 without restrictions on the publication date or language. Independent reviewers extracted data and assessed the risk of bias. The internal validity and risk of bias in randomized controlled trials (RCT) were assessed using the revised Cochrane risk of bias tool for randomized trials-RoB2, while the risk of bias in non-randomized intervention studies was evaluated using the ROBINS-I tool. RESULTS: Eight studies met all the inclusion criteria and were analyzed. Five of them were RCT, with the majority (n = 4) classified as low risk of bias, and the three quasi-experiments were deemed to have a moderate risk of bias. Among the studies investigating the outcome of weight gain/maintenance, six reported statistically significant positive results (p < 0.05). CONCLUSIONS: In conclusion, the presented evidence indicates that omega-3 supplementation in pancreatic cancer patients is safe, well-tolerated, and beneficial, as it contributes to the stabilization or increase in body weight, as well as a reduction in inflammatory biomarkers.

A comparative analysis of heme vs non-heme iron administration: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Bioavailability studies and observational evidence suggest that heme iron (HI) may have greater impact on iron status indicators compared with non-heme iron (NHI). This systematic review and meta-analysis aimed to review the current evidence on the effect of the administration of HI compared with NHI for improving iron status in non-hospitalized population groups. METHODS: We searched Pubmed, CENTRAL, Scopus, Web of Science, and LILACS from inception to July 2024. There was no language restriction or exclusion based on age or iron status. Only randomized controlled trials comparing HI with NHI were considered. A random-effects meta-analysis was performed to compare the effect of treatments for iron status indicators and total side effects (including gastrointestinal side effects). We measured the certainty of the evidence (CoE) using GRADE assessment. RESULTS: After screening 3097 articles, 13 studies were included. Most of the interventions used HI in low doses combined with NHI. The meta-analysis showed higher hemoglobin increases in children with anemia or low iron stores receiving HI (MD 1.06 g/dL; 95% CI: 0.34; 1.78; CoE: very low). No statistically significant difference between interventions were found for any iron status indicator in the other population subgroups (CoE: very low). Participants receiving HI had a 38% relative risk reduction of total side effects compared to NHI (RR 0.62; 95% CI 0.40; 0.96; CoE: very low). CONCLUSION: The current evidence comparing HI with NHI is very limited, preliminary findings suggest that interventions using HI may result in fewer side effects and may be superior in children with iron deficiency or anemia. However, given the very low certainty of the evidence, these results need further investigation through high-quality clinical trials. PROTOCOL REGISTRATION: CRD42023483157.

Prognostic Nutritional Index is a valuable preoperative prognostic biomarker in Mexican patients surgically intervened on gastrointestinal stromal tumors: a retrospective cohort study.

PURPOSE: The immunonutritional status of cancer patients has a profound impact on lifespan. Prognostic Nutritional Index (PNI) evaluates prognosis in operated patients with both neoplastic and non-neoplastic conditions. This study estimates the overall survival (OS) of Mexican patients operated on gastrointestinal stromal tumors (GIST) based on PNI. METHODS: Immune-nutritional status was retrospectively analyzed in a cohort of 104 patients operated on GIST. Receiver operating characteristic (ROC) curves and X-tile software were used to estimate the optimal cutoff point and predict OS stratifying patients by PNI. Survival curves were obtained through Kaplan-Meier and log-rank methods. Multivariate analysis of survival was performed by Cox regression. RESULTS: PNI (≥ 36.5) (p = 0.024) and mitotic index (≥ 5) (p = 0.013) were the only independent prognostic scores; the PNI-high group had better survival with 81.5% less risk of death (HR = 0.185). High PNI was correlated with favorable characteristics, i.e., low/intermediate risk (p = 0.046), reduced mitotic index (< 5) (p = 0.001), and younger age (< 55 years, p = 0.047). CONCLUSIONS: PNI ≥ 36.5 entails a better prognosis for Mexican patients with surgically resected GIST. PNI represents a simple, reliable, and cost-effective prognostic tool, besides the pathological approach.

Effectiveness and tolerance of enteral nutrition in critically ill patients with COVID-19.

This study compared the efficacy and tolerability of three enteral formulas in critically ill patients with COVID-19 who were ventilated and in the prone position: (a) immunomodulatory (IMM), (b) ω3 and (c) maltodextrins (MD). Primary outcome was the percentage of patients who received both 80 % of their protein and calorie targets at 3 d after enrolment. Secondary, mechanical ventilation-free time, ICU mortality and markers of nutritional status. Tolerance of enteral nutrition was evaluated by diarrhoea and gastroparesis rate. A total of 231 patients were included, primary outcome achieved was in ω3 group (76·5 % v. 59·7 and 35·2 %, P < 0·001) v. IMM and MD groups. Mechanical ventilation-free time was longer in ω3 and MD groups: 23·11 (sd 34·2) h and 22·59 (sd 42·2) h v. 7·9 (sd 22·6) h (P < 0·01) in IMM group. Prealbumin final was 0·203 ± 0·108 g/L and 0·203 ± 0·095 g/L in IMM and ω3 groups v 0·164 ± 0·070 g/L (p < 0·01) MD group. Transferrin were 1·515 ± 0·536 g/L and 1·521 ± 0·500 g/L in IMM and ω3 groups v 1·337 ± 0·483 g/L (p < 0·05) MD group. Increase of lymphocytes was greater in ω3 group: 1056·7 (sd 660·8) cells/mm3v. 853·3 (sd 435·9) cells/mm3 and 942·7 (sd 675·4) cells/mm3 (P < 0·001) in IMM and MD groups. Diarrhoea and gastroparesis occurred in 5·1 and 3·4 %, respectively. The findings of this study indicate that enteral nutrition is a safe and well-tolerated intervention. The ω3 formula compared with IMM and MD did improve protein and calorie targets.

Nutritional status and factors associated with gestational weight gain in the city of São Paulo, 2012 to 2020: a retrospective cohort study.

BACKGROUND: Gestational weight gain (GWG) is a critical issue related to postpartum health in newborns and mothers. In Brazil, pregnant women's public health recommends monitoring GWG. Therefore, the objective of this study is to evaluate gestational weight gain and associated health factors of pregnant women monitored at Unified Health System (SUS) in the city of São Paulo between 2012 and 2020. METHODS: This is a retrospective cohort study of pregnant women seen from 2012 to 2020 in São Paulo, Brazil. The database used was from the Integrated Health Care Management System related to the Live Birth Information System. Data distribution was assessed using the Kolmogorov-Smirnov test. Comparisons between groups according to weight gain (LWG vs. AWG vs. EWG) were performed using analysis of variance (ANOVA) with Tukey post hoc. Inclusion criteria considered that pregnant women had a recorded initial weight before 13 weeks and up to 15 days before delivery and a single pregnancy. The final database includes 276.220 pregnant women. RESULTS: The frequency of women according to initial body mass index (BMI) was 12.004 (4.4%) underweight, 132.049 (48.3%) normal weight, 78.856 (28.8%) overweight, and 50.660 (18.5%) living with obesity. The population consisted of 59.881 (21.9%), 37.217 (13.6%) and 176.471 (64.5%) women with LWG, AWG and EWG, respectively. Weight gain was associated with initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits. CONCLUSION: The proportion of pregnant women with inadequate weight gain is high, relating initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits. Interventions such as nutritional education should be suggested to help achieve adequate GWG.

Evaluation of the Aral Region Adolescent Nutrition with the FFQ_KZ Questionnaire.

The rapid drop in the Aral Sea's level since the 1960s has resulted in an environmental disaster and major shifts in quality of life. The research aims to determine the eating habits of adolescents from 11 to 17 years old living in the Aral Sea Basin by using an FFQ questionnaire. The respondents' diets were found to be unbalanced due to a shortage of proteins, polyunsaturated fatty acids, and complex carbohydrates, with a predominance of easily digestible carbohydrates and plant proteins. The study highlights the need for educational efforts to increase awareness of the consequences of poor nutrition.

[Hemodialysis nutritional status and Malnutrition Inflammation Score]. / Estado nutricional de hemodiálisis y Score de malnutrición e inflamación.

Background: Patients with chronic kidney disease (CKD) have risk of multiple nutritional and metabolic alterations, including loss of protein and energy, obesity, nutritional deficiency, and complications derived from uremia that manifest with changes in taste and lack of appetite. However, the nutritional status of patients on hemodialysis (HD) is unknown. Objective: To determine the nutritional status of patients with CKD with renal replacement therapy receiving HD in a tertiary care center. Material and methods: Observational, ambispective, longitudinal study. The population included patients receiving HD in a third-level hospital. The Malnutrition and Inflammation Score (MIS) was administered to patients who agreed to participate. Together with the identification card, data on name, age, sex, body mass index (BMI), leukocytes, albumin, transferrin level, and HD time were collected. Results: 52 patients were included. Mean age was of 46.51 years (15.54); 34 patients (65.4%) were male and 18 female (34.6%); 1 (1.9%) presented normal MIS, 32 (61.5%) mild MIS, 18 (34.6%) moderate MIS, and 1 (1.9%) severe MIS. Conclusions: Nutritional status is poor in patients with CKD receiving HD, which is why it must include a monitoring protocol that translates into a benefit in the face of patient morbidity and mortality.

Introducción: los pacientes con enfermedad renal crónica (ERC) tienen riesgo de múltiples alteraciones nutricionales y metabólicas, que incluyen la pérdida de proteínas, energía, la obesidad, la deficiencia de nutrientes y las complicaciones derivadas de la uremia, que se manifiestan con cambios en el gusto y la falta de apetito. Sin embargo, se desconoce cuál es el estado nutricio de los pacientes que se encuentran en hemodiálisis (HD). Objetivo: determinar el estado nutricio de pacientes con ERC con terapia de remplazo renal en HD en un centro de tercer nivel. Material y métodos: estudio observacional, ambispectivo, longitudinal. La población incluyó pacientes en hemodiálisis crónica de un hospital de tercer nivel. Se aplicó el Score de malnutrición e inflamación (MIS) a los pacientes que aceptaron participar. De forma conjunta a la ficha de identificación se recabaron datos de nombre, edad, sexo, índice de masa corporal (IMC), leucocitos, albúmina, nivel de transferrina, tiempo en HD. Resultados: se incluyeron 52 pacientes. La media de edad fue de 46.51 años (15.54); 34 pacientes (65.4%) fueron del sexo masculino y 18 pacientes (34.6%) de sexo femenino; 1 (1.9%) tuvo MIS normal, 32 (61.5%) MIS leve, 18 (34.6%) MIS moderado y 1 (1.9%) MIS grave. Conclusiones: el estado nutricio es malo en los pacientes con ERC en HD, por lo que se debe incluir un protocolo de seguimiento que se traduzca en un beneficio ante la morbimortalidad del paciente.

Nutritional, Metabolic, and Inflammatory Alterations in Children with Chylous Effusion in the Postoperative Period of Cardiac Surgery: A Descriptive Cohort.

OBJECTIVE: The occurrence of chylous effusion in children undergoing cardiac surgery is progressively increasing due to technical advances that have led to a rise in the number of surgeries. In this context, the objective was to describe the clinical profile of a cohort of patients at the time of chylous effusion diagnosis. METHODS: A retrospective cohort analysis was conducted between January 2011 and July 2023, involving 23 patients, aged 0 to 18 years, treated at a quaternary university hospital in southeastern Brazil. Data were obtained from the follow-up records of the Multidisciplinary Nutritional Therapy Team (MNTT) for patients who received nutritional support after developing chylous effusion in the postoperative period of cardiac surgery. RESULTS: The younger population predominated (median age of 6 months), with a high prevalence of malnutrition (60.9%). At the time of chylous effusion diagnosis, 83% had lymphopenia, and 74% had hypoalbuminemia. The longer the time elapsed after surgery for the onset of chylous effusion, the lower the HDL cholesterol, the lower the albumin levels, the greater the surgical complexity, the younger the patient, and the lower their weight. Hypocalcemia occurred in nearly half of the sample and hypophosphatemia in 26% of the analyzed cases. CONCLUSIONS: There was a notable presence of lymphopenia, hypoalbuminemia, and low HDL cholesterol, as well as a high incidence of mineral imbalances, particularly hypocalcemia and hypophosphatemia, which, if untreated, may lead to unfavorable outcomes. Therefore, clinical and laboratory monitoring of children in the postoperative period of cardiac surgery is important and can aid in the early diagnosis of chylous effusion and, consequently, in the timely initiation of treatment.

Nutritional Status and Quality of Life: Urban-Rural Disparities and the Impact of Obesity.

The shift in dietary habits has reshaped the population's health profile, leading to a rise in overweight individuals and a subsequent decline in health-related quality of life (HRQoL). This study evaluated the correlations between demographic, social, and health-related factors and HRQoL in rural and urban areas of Bahia, Brazil. The cross-sectional study included 124 participants aged 18-60 who underwent interviews, anthropometric measurements, and laboratory tests. The WHOQol-BREF instrument assessed the HRQoL. The results showed that rural participants had lower educational levels, income, and access to sanitation. Despite these challenges, rural residents reported better HRQoL in psychological, social relations, and health satisfaction domains, although differences diminished after age adjustment. Urban participants, who had higher rates of obesity and related metabolic risks experienced a negative correlation between BMI and HRQoL, especially in the social relationships domain. The study highlights that environmental and social factors, such as weight-related stigma and social connections, significantly influence HRQoL in urban areas, emphasizing the need for public health interventions that address both nutritional status and urban-specific challenges.

Enhancing Cancer Supportive Care: Integrating Psychosocial Support, Nutrition, and Physical Activity Using Telehealth Solutions.

This review explores current guidelines for integrating psychosocial support, nutrition, and physical activity into cancer care and examines the resources available to deliver comprehensive care effectively and equitably, with a focus on telehealth solutions. A review of current guidelines related to psychosocial support, nutrition, and exercise in oncology published between the years 2020 and 2024 was conducted. Additionally, relevant articles from the authors' personal archives were included. Current guidelines emphasize routine psychosocial distress screening, nutritional assessment, and tailored physical activity interventions for patients with cancer. The National Comprehensive Cancer Network and ASCO highlight the need for regular psychosocial evaluations and the management of common psychiatric disorders. The American Cancer Society and the Academy of Nutrition and Dietetics recommend nutritional screening, personalized counseling, and exercise to improve treatment tolerance and overall quality of life. Despite these recommendations, challenges such as resource limitations, time constraints, and financial barriers hinder their implementation. Integrating psychosocial support, medical nutrition therapy, and physical activity into cancer care is essential to enhancing patients' quality of life. Telehealth offers a viable solution to overcome barriers by providing remote access to supportive services, facilitating comprehensive care, and promoting patient engagement. The effectiveness of telehealth in delivering psychosocial, nutritional, and physical activity support highlights its potential to improve patient outcomes and overcome barriers to care. Telehealth technologies hold high potential to optimize cancer care delivery, ensuring personalized support for patients throughout their cancer journey.

IS THERE AGREEMENT BETWEEN THE GLIM AND THE NRS CRITERIA IN THE NUTRITIONAL DIAGNOSIS OF HOSPITALIZED SURGICAL PATIENTS? PILOT STUDY.

BACKGROUND: There is no consensus on which nutritional diagnosis methods are most relevant in the hospital clinical practice. OBJECTIVE: This study investigated the agreement between the global leadership initiative on malnutrition (GLIM) criterion and the nutritional risk screening (NRS) instrument for the nutritional diagnosis of in-patients. METHODS: Cross-sectional study with 95 hospitalized surgical patients. Clinical data, nutritional risk using the NRS and malnutrition using the GLIM criteria were evaluated. The data were analyzed using the chi-square, Mann-Whitney, McNemar and Kappa coefficient tests. RESULTS: There was good agreement between the two methods (Kappa=0.6067). Patients who were malnourished according to the GLIM or at nutritional risk by NRS were older (P=0.0461 by GLIM and P=0.0200 by NRS) and had a higher diagnosis rate of neoplasms (38.5%, P=0.0006 by GLIM and 32.7%, P=0.0030 by NRS). The GLIM criterion identified a lower percentage of patients with malnutrition (41.05%) in relation to the NRS regarding patients with nutritional risk (54.7%). CONCLUSION: The GLIM criteria and the NRS instrument are concordant methods for diagnosing malnutrition and nutritional risk in hospitalized surgical patients respectively.

Food insecurity, nutritional status and socioeconomic factors in the transgender population: a cross-sectional study in the Metropolitan Region of Baixada Santista, Brazil, 2023.

OBJECTIVE: To describe the distribution of nutritional status and food insecurity among the adult transgender population in the Baixada Santista region of the state of São Paulo and to identify associated factors. METHODS: This was a cross-sectional study using data from the research project entitled Mapping the Transgender Population in Baixada Santista of the state of São Paulo, conducted through a structured questionnaire administered between August and December 2023. The outcomes were nutritional status and food and nutrition insecurity (FNI). The association analysis was performed using Fisher's exact test. RESULTS: A total of 237 people took part in the study. High prevalence of FNI was associated with an income of less than 2 minimum wages (p < 0.001), difficulty finding a job (p < 0.001) and lack of family support related to gender (p = 0.001). Difficulty reading/writing (p = 0.025) and proximity to an open-air market (p = 0.033) were negatively or positively associated with adequate nutritional status, respectively. CONCLUSION: The high prevalence of FNI among the most vulnerable population and the adequate nutritional status associated with proximity to open-air markets indicate the need for policies aimed at reducing inequities and expand access to adequate food.

MAIN RESULTS: The high prevalence of FNI was associated with low income, difficulty finding a job and lack of family support. Adequate nutritional status among the transgender population analyzed was associated with proximity to open-air markets. IMPLICATIONS FOR SERVICES: Service teams should incorporate the assessment of nutritional status and food and nutrition security into their routine practices in order to provide adequate service that addresses the demands and social situation of the transgender people they serve. PERSPECTIVES: There is a need for public policies aimed at reducing socioeconomic disparities exacerbated by discrimination against transgender people and facilitating access to establishments that offer diverse and quality food.

Longitudinal transitions of the double burden of overweight and stunting from childhood to early adulthood in India, Peru, and Vietnam.

BACKGROUND: Examining trajectories of undernutrition and overnutrition separately limits understanding of the double burden of malnutrition. We investigated transitions between normal, stunting, overweight and concurrent stunting and overweight (CSO) and associations with sociodemographic factors in children and adolescents. METHODS: We used data from the Young Lives cohort in India, Peru and Vietnam, which follow children 1-15 (N = 5413) and 8-22 years (N = 2225) over five rounds between 2002 and 2016. We estimated transitions between nutritional states using a Markov chain model and estimated sociodemographic associations employing a logit parametrization. RESULTS: Transitions into stunting peaked in ages 1-5 years (India: 22.9%, Peru: 17.6%, Vietnam: 14.8%), while stunting reversal was highest during adolescence across all countries. Transitions into overweight peaked in ages 19-22, while overweight reversal increased in ages 1-5 and 12-15 years. Transitions away from stunting to overweight were rare; more commonly, stunted individuals developed overweight while remaining stunted, leading to a CSO state. In Peru, 20.2% of 19-year-olds who were stunted reached CSO by age 22, with 4% shifting from stunted to overweight. Reversion to a normal state is least likely for those in a CSO state. Household wealth gradually reduced the likelihood of transitioning into stunting [odds ratios (ORs) for wealthiest quartile in Peru: 0.29, 95% confidence interval (CI) 0.20-0.41; India: 0.43, 95% CI 0.32-0.57; Vietnam: 0.36, 95% CI 0.26-0.50), with stunting reversal only being more likely in the two wealthiest quartiles across all countries (ORs for wealthiest quartile in Peru: 2.39, 95% CI 1.57-3.65; India: 1.28, 95% CI 1.05-1.54; Vietnam: 1.89, 95% CI 1.23-2.91). In Vietnam, only the richest quartile was at higher risk of transitioning into overweight (OR 1.87, 95% CI 1.28-2.72), while in Peru and India, the risk gradually rose across all wealth quartiles (ORs for wealthiest quartile in Peru: 2.84, 95% CI 2.14-3.77; India: 2.99, 95% CI 1.61-5.54). CONCLUSIONS: Childhood and adolescence represent critical periods for prevention and reversal of stunting and overweight, thereby averting the development of CSO later in life. Context-specific interventions are crucial for preventing disparate transitions towards the double burden of malnutrition across socioeconomic groups.

Relationship Between Vitamin D Insufficiency and Anemia in Older Adults: An Approach Considering Clinical Aspects and Food Insecurity.

BACKGROUND/OBJECTIVES: Studies have shown a high prevalence of anemia and vitamin D insufficiency in older adults, and the literature suggests a relationship between these two conditions, as vitamin D insufficiency may impair erythrocyte synthesis. Food insecurity refers to the lack of regular access to sufficient and nutritious food, which can directly affect health by worsening conditions such as anemia and vitamin D insufficiency. This study evaluated the association between vitamin D insufficiency and anemia in older adults. METHODS: We conducted a cross-sectional study with 430 individuals aged 60 and older, using personal interviews and blood tests for data collection. Anemia was identified with serum hemoglobin levels of <12 g/dL for women and <13 g/dL for men, while vitamin D insufficiency was defined as serum levels <30 ng/mL. We used multiple logistic regression to analyze associations through Stata version 17.0 software. RESULTS: The prevalence of anemia was identified in 14.7% of the sample, and vitamin D insufficiency was observed in 63.5%. We found an association between vitamin D insufficiency and anemia (OR = 2.4; 95% CI = 1.2-4.7). In the final model, factors such as male sex (OR = 2.7; 95% CI = 1.5-4.9) and polypharmacy use (OR = 2.0; 95% CI = 1.0-3.9) were also associated, regardless of age group, food insecurity, and multimorbidity. CONCLUSIONS: Vitamin D insufficiency increased the likelihood of anemia among the older adults evaluated, suggesting that prevention and treatment strategies for anemia should consider vitamin D serum levels.