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1.
Nutrients ; 16(12)2024 Jun 17.
Article de Anglais | MEDLINE | ID: mdl-38931260

RÉSUMÉ

Taste disorders (TDs) are common among systemically treated cancer patients and negatively impact their nutritional status and quality of life. The novel food approved by the European Commission (EFSA), dried miracle berries (DMB), contains the natural taste-modifying protein miraculin. DMB, also available as a supplement, has emerged as a possible alternative treatment for TDs. The present study aimed to evaluate the efficacy and safety of habitual DMB consumption in malnourished cancer patients undergoing active treatment. An exploratory clinical trial was carried out in which 31 cancer patients were randomized into three arms [standard dose of DMB (150 mg DMB/tablet), high dose of DMB (300 mg DMB/tablet) or placebo (300 mg freeze-dried strawberry)] for three months. Patients consumed a DMB tablet or placebo daily before each main meal (breakfast, lunch, and dinner). Throughout the five main visits, electrochemical taste perception, nutritional status, dietary intake, quality of life and the fatty acid profile of erythrocytes were evaluated. Patients consuming a standard dose of DMB exhibited improved taste acuity over time (% change right/left side: -52.8 ± 38.5/-58.7 ± 69.2%) and salty taste perception (2.29 ± 1.25 vs. high dose: 2.17 ± 1.84 vs. placebo: 1.57 ± 1.51 points, p < 0.05). They also had higher energy intake (p = 0.075) and covered better energy expenditure (107 ± 19%). The quality of life evaluated by symptom scales improved in patients receiving the standard dose of DMB (constipation, p = 0.048). The levels of arachidonic (13.1 ± 1.8; 14.0 ± 2.8, 12.0 ± 2.0%; p = 0.004) and docosahexaenoic (4.4 ± 1.7; 4.1 ± 1.0; 3.9 ± 1.6%; p = 0.014) acids in erythrocytes increased over time after DMB intake. The standard dose of DMB increased fat-free mass vs. placebo (47.4 ± 9.3 vs. 44.1 ± 4.7 kg, p = 0.007). Importantly, habitual patients with DMB did not experience any adverse events, and metabolic parameters remained stable and within normal ranges. In conclusion, habitual consumption of a standard 150 mg dose of DMB improves electrochemical food perception, nutritional status (energy intake, fat quantity and quality, fat-free mass), and quality of life in malnourished cancer patients receiving antineoplastic treatment. Additionally, DMB consumption appears to be safe, with no changes in major biochemical parameters associated with health status. Clinical trial registered (NCT05486260).


Sujet(s)
Compléments alimentaires , Malnutrition , Tumeurs , Qualité de vie , Humains , Mâle , Femelle , Projets pilotes , Tumeurs/complications , Tumeurs/traitement médicamenteux , Adulte d'âge moyen , Malnutrition/étiologie , Malnutrition/traitement médicamenteux , Sujet âgé , État nutritionnel , Résultat thérapeutique , Perception du goût , Adulte
2.
Life Sci ; 346: 122636, 2024 Jun 01.
Article de Anglais | MEDLINE | ID: mdl-38614307

RÉSUMÉ

Malnutrition results in autonomic imbalance and heart hypertrophy. Overexpression of hyperpolarization-activated cyclic nucleotide-gated channels (HCN) in the left ventricles (LV) is linked to hypertrophied hearts and abnormal myocardium automaticity. Given that ivabradine (IVA) has emerging pleiotropic effects, in addition to the widely known bradycardic response, this study evaluated if IVA treatment could repair the autonomic control and cardiac damages in malnourished rats. AIM: Assess the impact of IVA on tonic cardiovascular autonomic control and its relationship with hemodynamics regulation, LV inflammation, and HCN gene expression in post-weaning protein malnutrition condition. MAIN METHODS: After weaning, male rats were divided into control (CG; 22 % protein) and malnourished (MG; 6 % protein) groups. At 35 days, groups were subdivided into CG-PBS, CG-IVA, MG-PBS and MG-IVA (PBS 1 ml/kg or IVA 1 mg/kg) received during 8 days. We performed jugular vein cannulation and electrode implant for drug delivery and ECG registration to assess tonic cardiovascular autonomic control; femoral cannulation for blood pressure (BP) and heart rate (HR) assessment; and LV collection to evaluate ventricular remodeling and HCN gene expression investigation. KEY FINDINGS: Malnutrition induced BP and HR increases, sympathetic system dominance, and LV remodeling without affecting HCN gene expression. IVA reversed the cardiovascular autonomic imbalance; prevented hypertension and tachycardia; and inhibited the LV inflammatory process and fiber thickening caused by malnutrition. SIGNIFICANCE: Our findings suggest that ivabradine protects against malnutrition-mediated cardiovascular damage. Moreover, our results propose these effects were not attributed to HCN expression changes, but rather to IVA pleiotropic effects on autonomic control and inflammation.


Sujet(s)
Système nerveux autonome , Rythme cardiaque , Hypertension artérielle , Ivabradine , Rat Wistar , Tachycardie , Animaux , Ivabradine/pharmacologie , Mâle , Rats , Tachycardie/traitement médicamenteux , Tachycardie/physiopathologie , Hypertension artérielle/traitement médicamenteux , Hypertension artérielle/physiopathologie , Rythme cardiaque/effets des médicaments et des substances chimiques , Système nerveux autonome/effets des médicaments et des substances chimiques , Système nerveux autonome/physiopathologie , Inflammation/métabolisme , Inflammation/traitement médicamenteux , Sevrage , Pression sanguine/effets des médicaments et des substances chimiques , Canaux contrôlés par les nucléotides cycliques et activés par l'hyperpolarisation/métabolisme , Malnutrition/traitement médicamenteux , Malnutrition protéinocalorique/traitement médicamenteux , Malnutrition protéinocalorique/physiopathologie , Malnutrition protéinocalorique/complications , Ventricules cardiaques/effets des médicaments et des substances chimiques , Ventricules cardiaques/physiopathologie , Remodelage ventriculaire/effets des médicaments et des substances chimiques
3.
Expert Opin Emerg Drugs ; 29(2): 81-91, 2024 Jun.
Article de Anglais | MEDLINE | ID: mdl-38549232

RÉSUMÉ

INTRODUCTION: Malnutrition and sarcopenia are common and impact the prognosis in patients with liver cirrhosis. The etiology is multifactorial and includes periods of reduced caloric intake, increased catabolism and direct molecular mechanisms that inhibit muscle synthesis. Although these conditions are widely acknowledged, and there is a growing interest in their diagnosis, robust evidence regarding the treatment and reversibility of these conditions is still lacking. AREAS COVERED: We have explored the current evidence on the pharmacological treatment of sarcopenia in patients with cirrhosis. Additionally, we have searched for drugs already in use and ongoing trials for other chronic diseases. EXPERT OPINION: The current guidelines recommend the use of a protein-adequate diet and moderate physical activity for treating sarcopenia in patients with cirrhosis. Currently, robust evidence is derived only from the supplementation of Branched-Chain Amino Acids, capable of increasing muscle mass and function. There are many drugs targeting various pathways that contribute to sarcopenia. However, evidence is sporadic and insufficient to suggest their use in clinical practice.Novel drugs specifically designed to enhance muscle mass and function should be developed. Finally, gender significantly influences the type of muscle alteration and therapeutic mechanisms; therefore, future studies should be designed taking gender differences into consideration.


Sujet(s)
Développement de médicament , Cirrhose du foie , Sarcopénie , Sarcopénie/traitement médicamenteux , Sarcopénie/physiopathologie , Humains , Cirrhose du foie/complications , Cirrhose du foie/traitement médicamenteux , Animaux , Pronostic , Facteurs sexuels , Malnutrition/traitement médicamenteux , Guides de bonnes pratiques cliniques comme sujet , Exercice physique/physiologie , Mâle , Femelle , Acides aminés à chaine ramifiée/administration et posologie , Conception de médicament
4.
Nutrients ; 16(3)2024 Jan 31.
Article de Anglais | MEDLINE | ID: mdl-38337711

RÉSUMÉ

In recent decades, following the spread of obesity, metabolic dysfunction has come to represent the leading cause of liver disease. The classical clinical presentation of the cirrhotic patient has, therefore, greatly changed, with a dramatic increase in subjects who appear overweight or obese. Due to an obesogenic lifestyle (lack of physical activity and overall malnutrition, with an excess of caloric intake together with a deficit of proteins and micronutrients), these patients frequently develop a complex clinical condition defined as sarcopenic obesity (SO). The interplay between cirrhosis and SO lies in the sharing of multiple pathogenetic mechanisms, including malnutrition/malabsorption, chronic inflammation, hyperammonemia and insulin resistance. The presence of SO worsens the outcome of cirrhotic patients, affecting overall morbidity and mortality. International nutrition and liver diseases societies strongly agree on recommending the use of food as an integral part of the healing process in the comprehensive management of these patients, including a reduction in caloric intake, protein and micronutrient supplementation and sodium restriction. Based on the pathophysiological paths shared by cirrhosis and SO, this narrative review aims to highlight the nutritional interventions currently advocated by international guidelines, as well as to provide hints on the possible role of micronutrients and nutraceuticals in the treatment of this multifaceted clinical condition.


Sujet(s)
Maladies du foie , Malnutrition , Sarcopénie , Humains , Sarcopénie/traitement médicamenteux , Obésité/thérapie , Obésité/traitement médicamenteux , Cirrhose du foie/thérapie , Cirrhose du foie/traitement médicamenteux , Maladies du foie/traitement médicamenteux , Malnutrition/traitement médicamenteux , Micronutriments/usage thérapeutique
5.
Biol Trace Elem Res ; 202(3): 1126-1139, 2024 Mar.
Article de Anglais | MEDLINE | ID: mdl-37393387

RÉSUMÉ

Protein diets are required for the normal development of the reproductive system and their inadequacy or deficiency might have hazardous functional complications during maturational and developmental stages. The study was carried out to evaluate the effect of selenium (Se) and zinc (Zn) supplementation on the male and female reproductive organs of rats with postnatal protein malnutrition. Male and female weanling rats were randomly assigned to six groups respectively. The adequate protein diet rats were fed with 16% casein diet while the protein malnourished diet (PMD) rats were fed with 5% casein diet. After the 8th week of feeding, Se (sodium selenite; Na2SeO3) and Zn (zinc sulfate; ZnSO4·7H2O) were supplemented for 3 weeks. The growth curve of body weights, lipid profile, testosterone and progesterone level, Na+-K+-ATPase activity, oxidative stress, and antioxidant status were evaluated. The results showed that PMD reduced the body weights of male and female rats. It also reduced the activities of catalase and glutathione peroxidase in the testes, but reductions in superoxide dismutase and glutathione-S-transferase activities, glutathione, vitamins C and E, testosterone, and progesterone levels were observed in both the testes and ovaries. Furthermore, PMD increased the nitric oxide level in both organs and altered the plasma lipid profiles in both sexes. Se and Zn supplementation, however, restored almost all the alterations observed in all the parameters analyzed. In conclusion, Se and Zn supplementation protects the male and female reproductive organs of rats against postnatal protein malnutrition.


Sujet(s)
Malnutrition , Sélénium , Femelle , Rats , Mâle , Animaux , Sélénium/pharmacologie , Zinc/pharmacologie , Caséines , Progestérone , Antioxydants/pharmacologie , Antioxydants/métabolisme , Compléments alimentaires , Glutathion/métabolisme , Glutathione peroxidase/métabolisme , Poids , Malnutrition/traitement médicamenteux , Testostérone , Lipides
6.
Am J Gastroenterol ; 119(1): 116-126, 2024 Jan 01.
Article de Anglais | MEDLINE | ID: mdl-37115908

RÉSUMÉ

INTRODUCTION: Effect of long-term growth-hormone (GH) therapy in decompensated cirrhosis (DC) is unknown. We studied the safety and efficacy of GH therapy on malnutrition, nitrogen metabolism, and hormonal changes in patients with DC. METHODS: Patients with DC were randomized to standard medical therapy plus GH (group A; n = 38) or standard medical therapy alone (group B; n = 38). Body mass index, midarm muscle circumference (MAMC), hand grip strength (HGS), liver frailty index (LFI), skeletal muscle index (SMI), nitrogen balance, Child-Turcotte-Pugh, model for end-stage liver disease, quality of life (QOL), serum albumin, GH, insulin like growth factor-1, and acid labile subunit (ALS) were assessed at baseline and at 12 months. RESULTS: The mean difference between baseline and 12-months in SMI (-6.122 [-9.460 to -2.785] cm 2 /m 2 ), body mass index (-2.078 [-3.584 to -0.5718] kg/m 2 ), MAMC (-1.960 [-2.928 to -0.9908] cm), HGS (-5.595 [-7.159 to -4.031] kg), albumin (-0.3967 [-0.6876 to -0.1057] g/dL), LFI (0.3328 [0.07786-0.5878]), Child-Turcotte-Pugh (0.9624 [0.1435-1.781]), model for end-stage liver disease (1.401 [0.04698-2.75]), insulin-like growth factor-1 (-6.295 [-11.09 to -1.495] ng/dL), and ALS (-8.728 [-14.12 to -3.341] pg/mL) were statistically significantly better ( P < 0.05) in group A. There was no improvement in nutritional parameters, clinical scores, QOL scores, or nitrogen balance in group B. The mean difference between group A and B in SMI, HGS, MAMC, LFI, ALS, physical component summary, and mental component summary at 12 months was also statistically significant. Survival at 12 months was similar in both groups ( P = 0.35). No serious adverse events were observed. DISCUSSION: Long-term use of GH is safe in DC and leads to improvement in malnutrition and possibly QOL. However, there is no improvement in 12-month survival (NCT03420144).


Sujet(s)
Maladie du foie en phase terminale , Hormone de croissance humaine , Malnutrition , Humains , Hormone de croissance/usage thérapeutique , Maladie du foie en phase terminale/traitement médicamenteux , Qualité de vie , Force de la main , Indice de gravité de la maladie , Hormone de croissance humaine/usage thérapeutique , Malnutrition/étiologie , Malnutrition/traitement médicamenteux , Cirrhose du foie/traitement médicamenteux , Azote
7.
Public Health Nurs ; 41(1): 90-100, 2024.
Article de Anglais | MEDLINE | ID: mdl-37897086

RÉSUMÉ

OBJECTIVE: There is conflicting evidence around prescription practices in the management of malnutrition; the study objective was to explore medication classifications prescribed and their relationship between time-to-recovery and specific demographic characteristics among children with malnutrition in Guatemala. DESIGN: Descriptive correlational study of data obtained in a retrospective record review. SAMPLE: Children aged 0-5 years with malnutrition treated in a Guatemalan Nutrition Rehabilitation Center between 2019 and 2020 (N = 155). MEASURES: Variables assessed were medication classification of prescribed medications, age, gender, time-to-recovery, malnutrition severity, and COVID cohort. RESULTS: The most frequently used medication classifications were vitamins (95%), respiratory (75%), antipyretic (68%), antibiotic (61%), and gastrointestinal agents (54%). Antibiotic, respiratory, corticosteroid, antipyretic, and gastrointestinal agents were prescribed significantly more in cases with a time-to-recovery of 6 weeks or greater. CONCLUSIONS: Medication classifications prescribed most often were related to common comorbidities of malnutrition and illnesses affecting children in Guatemala, such as respiratory and diarrheal diseases. The medication used in cases with a time-to-recovery of ≥6 weeks suggest these cases may have had more comorbidities, which could explain the longer recovery times. Caution is suggested in routine prophylactic antibiotic use in public health settings, given the lack of association with improved recovery times, the potential for antibiotic drug resistance, and the negative effects on renal function among children.


Sujet(s)
Antipyrétiques , Malnutrition , Enfant , Humains , Études rétrospectives , Malnutrition/traitement médicamenteux , Malnutrition/épidémiologie , Agents gastro-intestinaux , Antibactériens/usage thérapeutique
8.
Nutrition ; 117: 112235, 2024 Jan.
Article de Anglais | MEDLINE | ID: mdl-37924623

RÉSUMÉ

OBJECTIVES: Numerous studies describe the role of zinc in the immune system and metabolism. Zinc may influence the pathogenesis and prognosis of cancer. The aim of this study to determine the prevalence of zinc deficiency in patients with cancer. The study's primary objective was to evaluate the frequency of zinc deficiency in White patients with cancer and characterize the clinical factors predisposing individuals to decreased zinc concentration. The study also aimed to estimate the dose of zinc supplementation that would prevent deficiency. METHODS: Retrospective data for this cross-sectional study were analyzed from 300 consecutive white patients diagnosed with neoplastic disease and admitted to a major oncology hospital for treatment. Zinc plasma concentration, nutritional status, body composition, and medical history of ailments and dysphagia were recorded. Supplementation was introduced in patients with zinc deficiency according to the local protocol. Zinc plasma levels were collected at follow-up visits. RESULTS: Zinc deficiency was diagnosed in 68% of the patients. Poor nutritional status was significantly associated with zinc deficiency (low body mass index, weight loss, low albumin level). Low lean body mass (P = 0.003) and adipose tissue (P = 0.045) correlated with zinc deficiency. Patients with zinc deficiency reported dysphagia more frequently than those with normal zinc levels (18 versus 8%; P = 0.03). Squamous cell carcinoma was significantly associated with zinc deficiency (P = 0.043). Oral zinc supplementation resulted in reaching laboratory norms for plasma concentration in only 27% of patients with zinc deficiency and was not dependent on lower (10-15 mg) or higher (25-30 mg) dosing (P > 0.05). CONCLUSIONS: Zinc deficiency is common in cachectic, malnourished patients with cancer. Nutritional guidelines for these patients should include screening for micronutrient deficiencies. Further studies are needed to determine the role, dosage, duration, and form of nutritional supplementation recommended for specific cancer diagnoses.


Sujet(s)
Troubles de la déglutition , Malnutrition , Tumeurs , Humains , Zinc , Études transversales , Études rétrospectives , État nutritionnel , Malnutrition/épidémiologie , Malnutrition/étiologie , Malnutrition/traitement médicamenteux , Tumeurs/complications , Tumeurs/traitement médicamenteux , Micronutriments ,
9.
EBioMedicine ; 99: 104921, 2024 Jan.
Article de Anglais | MEDLINE | ID: mdl-38101300

RÉSUMÉ

BACKGROUND: Sulfadoxine-pyrimethamine (SP) antimalarial therapy has been suggested to potentially increase the birth weight of infants in pregnant women in sub-Saharan Africa, independently of malarial infection. Here, we utilized female intestinal organoid-derived cells cultured within microfluidic Organ Chips to investigate whether SP could directly impact intestinal function and thereby improve the absorption of essential fats and nutrients crucial for fetal growth. METHODS: Using a human organ-on-a-chip model, we replicated the adult female intestine with patient organoid-derived duodenal epithelial cells interfaced with human intestinal endothelial cells. Nutrient-deficient (ND) medium was perfused to simulate malnutrition, resulting in the appearance of enteric dysfunction indicators such as villus blunting, reduced mucus production, impaired nutrient absorption, and increased inflammatory cytokine secretion. SP was administered to these chips in the presence or absence of human peripheral blood mononuclear cells (PBMCs). FINDINGS: Our findings revealed that SP treatment effectively reversed multiple intestinal absorptive abnormalities observed in malnourished female Intestine Chips, as validated by transcriptomic and proteomic analyses. SP also reduced the production of inflammatory cytokines and suppressed the recruitment of PBMCs in ND chips. INTERPRETATION: Our results indicate that SP could potentially increase birth weights by preventing enteric dysfunction and suppressing intestinal inflammation. This underscores the potential of SP as a targeted intervention to improve maternal absorption, subsequently contributing to healthier fetal growth. While SP treatment shows promise in addressing malabsorption issues that can influence infant birth weight, we did not model pregnancy in our chips, and thus its usefulness for treatment of malnourished pregnant women requires further investigation through clinical trials. FUNDING: The Bill and Melinda Gates Foundation, and the Wyss Institute for Biologically Inspired Engineering at Harvard University, and the HDDC Organoid Core of the P30 DK034854.


Sujet(s)
Antipaludiques , Malnutrition , Complications parasitaires de la grossesse , Sulfadoxine , Adulte , Femelle , Humains , Grossesse , Poids de naissance , Cellules endothéliales , Agranulocytes , Protéomique , Pyriméthamine/pharmacologie , Pyriméthamine/usage thérapeutique , Antipaludiques/usage thérapeutique , Association médicamenteuse , Intestins , Malnutrition/complications , Malnutrition/traitement médicamenteux
10.
Acta Otolaryngol ; 143(8): 714-720, 2023 Aug.
Article de Anglais | MEDLINE | ID: mdl-37537940

RÉSUMÉ

BACKGROUND: Although immune checkpoint inhibitors (ICIs) are approved for the treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), the response to ICIs remains unclear. AIMS/OBJECTIVES: To summarize the clinical outcomes of patients with HNSCC treated with nivolumab (Nivo) in our institution, and provide a basis for research on biomarkers that can predict the efficacy of ICIs. MATERIAL AND METHODS: Forty-four patients with R/M HNSCC who received Nivo (2017-2022) were retrospectively analysed. RESULTS: Despite the older age of this cohort (median age of 72 years), we observed favourable long-term outcomes, with an overall survival of 24.1 months, which could be attributed to our aggressive nutritional intervention. Older age, poor performance status (≥1), and higher Glasgow Prognostic Scores, reflecting the chronic inflammation and malnutrition of patients, were associated with poor prognoses, with hazard ratios for death of 2.63 (95% confidence interval [CI]; 1.07-6.46, p = .016), 3.50 (95% CI; 1.28-9.55, p = .001), and 2.69 (95% CI; 1.17-6.21, p = .029), respectively. Peripheral blood biomarker analysis revealed that systemic inflammation may negatively affect the efficacy of Nivo. CONCLUSIONS AND SIGNIFICANCE: Our results suggest that nutrition and inflammation must be the focus of future studies aiming to identify novel biomarkers.


Sujet(s)
Tumeurs de la tête et du cou , Malnutrition , Humains , Sujet âgé , Nivolumab/usage thérapeutique , Carcinome épidermoïde de la tête et du cou/traitement médicamenteux , Études rétrospectives , Récidive tumorale locale/anatomopathologie , Tumeurs de la tête et du cou/complications , Tumeurs de la tête et du cou/traitement médicamenteux , Malnutrition/complications , Malnutrition/traitement médicamenteux
11.
Arthritis Care Res (Hoboken) ; 75(12): 2501-2507, 2023 12.
Article de Anglais | MEDLINE | ID: mdl-37357024

RÉSUMÉ

OBJECTIVE: To assess adverse events (AEs) in relation to baseline body mass index (BMI) and the risk of malnutrition in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) treated with nintedanib. METHODS: Among patients with SSc-ILD randomized to receive nintedanib or placebo in the SENSCIS trial, we assessed AEs in subgroups by baseline BMI ≤20 kg/m2 and BMI >20 kg/m2 , and the risk of malnutrition using a modified version of the Malnutrition Universal Screening Tool (MUST), over 52 weeks. RESULTS: The AE profile of nintedanib was similar between subgroups with a baseline BMI ≤20 kg/m2 (n = 61) and a baseline BMI >20 kg/m2 (n = 515). In these subgroups, respectively, AEs led to treatment discontinuation in 16.7% and 15.9% of the nintedanib group and 13.5% and 8.0% of the placebo group, respectively. Based on the modified MUST, the proportions of patients who had a low risk of malnutrition at baseline and at their last assessment were 74.0% in the nintedanib group and 78.1% in the placebo group, while the proportions who were classified as at low risk at baseline but at high risk by their last assessment were 4.5% in the nintedanib group and 1.0% in the placebo group. CONCLUSION: In the SENSCIS trial, most patients with SSc-ILD remained at low risk of malnutrition over 52 weeks, but the proportion at high risk was higher in patients who received treatment with nintedanib compared to those who received placebo. Management of disease manifestations and AEs that may be associated with weight loss is important to reduce the risk of malnutrition in patients with SSc-ILD.


Sujet(s)
Pneumopathies interstitielles , Malnutrition , Sclérodermie systémique , Humains , Pneumopathies interstitielles/diagnostic , Pneumopathies interstitielles/traitement médicamenteux , Pneumopathies interstitielles/étiologie , Sclérodermie systémique/complications , Sclérodermie systémique/traitement médicamenteux , Indoles/effets indésirables , Malnutrition/diagnostic , Malnutrition/traitement médicamenteux , Malnutrition/étiologie , Évolution de la maladie , Capacité vitale
12.
PLoS One ; 18(6): e0287210, 2023.
Article de Anglais | MEDLINE | ID: mdl-37363896

RÉSUMÉ

Seasonal Malaria chemoprevention (SMC) is one of the large-scale life-saving malaria interventions initially recommended for the Sahel subregion, including Burkina Faso and recently extended to other parts of Africa. Initially, SMC was restricted to children 3 to 59 months old, but an extension to older children in some locations was recently recommended. Further characterization of SMC population profile beyond age criterion is necessary for understanding factors that could negatively impact the effectiveness of the intervention and to define complementary measures that could enhance its impact. Children were assessed through a cross-sectional survey during the first month of the 2020 SMC campaign (July-August 2020) as part of the SMC-NUT project in the health district of Nanoro. Parameters such as body temperature, weight, height, mid-upper arm circumference (MUAC) were assessed. In addition, blood sample was collected for malaria diagnosis by rapid diagnostic tests (RDT) and microscopy, and for haemoglobin measurement. A total of 1059 children were enrolled. RDT positivity rate (RPR) was 22.2%, while microscopy positivity rate (MPR) was 10.4%, with parasitaemia levels ranging from 40 to 70480/µL. RPR and MPR increased as patient age increased. Wasting was observed in 7.25% of children under SMC coverage while the prevalence of stunting and underweight was 48.79% and 23.38%, respectively. As the age of the children increased, an improvement in their nutritional status was observed. Finally, undernourished children had higher parasite densities than children with adequate nutritional status. In the health district of Nanoro, children who received Seasonal Malaria Chemoprevention (SMC) were mostly undernourished during the period of SMC delivery, suggesting the need for combining the SMC with synergistic interventions against malnutrition to achieve best impact.


Sujet(s)
Antipaludiques , Paludisme , Malnutrition , Humains , Enfant , Nourrisson , Adolescent , Enfant d'âge préscolaire , Antipaludiques/usage thérapeutique , Burkina/épidémiologie , Saisons , Études transversales , Paludisme/épidémiologie , Paludisme/prévention et contrôle , Paludisme/traitement médicamenteux , Chimioprévention , Malnutrition/traitement médicamenteux
13.
Tohoku J Exp Med ; 260(2): 135-140, 2023 May 27.
Article de Anglais | MEDLINE | ID: mdl-36990744

RÉSUMÉ

Dialysis technology has made remarkable progress. However, many patients still suffer from malnutrition and hypertension. They cause many complications and significantly impact patients' quality of life and prognosis. To solve these problems, we developed a new dialysis modality, extended-hours hemodialysis without dietary restrictions. Here we report a case of a man who has received this treatment for 18 years. He had been on conventional hemodialysis (three times a week for 4 hours) since his dialysis initiation. He suffered from hypertension and was on five antihypertensive drugs to control his blood pressure. In addition, dietary restrictions were strict, and the nutritional status was somewhat poor. After being transferred to our clinic, the dialysis time was gradually extended to 8 hours, and dietary restrictions were greatly relaxed. Interestingly, his body mass index (BMI) increased, and his hypertension was controlled. After 3 years, he stopped all antihypertensive drugs. This result suggests that improving nutritional status may control hypertension. However, salt intake was substantially increased. Serum phosphorus and serum potassium levels were at a slightly higher level but were controlled by medications. At the time of transfer, anemia was treated with erythropoiesis-stimulating agents and glycated iron oxide, but these drugs were gradually reduced and discontinued. However, he maintained high average erythrocyte counts and normal hemoglobin levels. Dialysis conditions were wholly slow dialysis, lower than conventional dialysis methods, but the dialysis efficiency was satisfactory. In conclusion, we speculate that extended-hours hemodialysis without dietary restrictions reduces the risk of malnutrition and hypertension.


Sujet(s)
Hypertension artérielle , Défaillance rénale chronique , Malnutrition , Mâle , Humains , Indice de masse corporelle , Défaillance rénale chronique/complications , Défaillance rénale chronique/thérapie , Antihypertenseurs/usage thérapeutique , Qualité de vie , Dialyse rénale/effets indésirables , Hypertension artérielle/thérapie , Hypertension artérielle/traitement médicamenteux , Malnutrition/complications , Malnutrition/traitement médicamenteux
14.
CPT Pharmacometrics Syst Pharmacol ; 12(5): 656-667, 2023 05.
Article de Anglais | MEDLINE | ID: mdl-36919202

RÉSUMÉ

African children are at risk of malaria and malnutrition. We quantified relationships between malaria and malnutrition among young Ugandan children in a high malaria transmission region. Data were used from a randomized controlled trial where Ugandan HIV-unexposed (n = 393) and HIV-exposed (n = 186) children were randomized to receive no malaria chemoprevention, monthly sulfadoxine-pyrimethamine, daily trimethoprim-sulfamethoxazole, or monthly dihydroartemisinin-piperaquine (DP) from age 6-24 months, and then were followed off chemoprevention until age 36 months. Monthly height and weight, and time of incident malaria episodes were obtained; 89 children who received DP contributed piperaquine (PQ) concentrations. Malaria hazard was modeled using parametric survival analysis adjusted for repeated events, and height and weight were modeled using a Brody growth model. Among 579 children, stunting (height-for-age z-score [ZHA] < -2) was associated with a 17% increased malaria hazard (95% confidence interval [CI] 10-23%) compared with children with a ZHA of zero. DP was associated with a 35% lower malaria hazard (hazard ratio [HR] [95% CI], 0.65 [0.41-0.97]), compared to no chemoprevention. After accounting for PQ levels, stunted children who received DP had 2.1 times the hazard of malaria (HR [95% CI] 2.1 [1.6-3.0]) compared with children with a ZHA of zero who received DP. Each additional malaria episode was associated with a 0.4% reduced growth rate for height. Better dosing regimens are needed to optimize malaria prevention in malnourished populations, but, importantly, malaria chemoprevention may reduce the burden of malnutrition in early childhood.


Sujet(s)
Antipaludiques , Infections à VIH , Paludisme , Malnutrition , Enfant d'âge préscolaire , Enfant , Humains , Nourrisson , Antipaludiques/usage thérapeutique , Ouganda/épidémiologie , Paludisme/épidémiologie , Paludisme/prévention et contrôle , Association médicamenteuse , Malnutrition/complications , Malnutrition/traitement médicamenteux , Infections à VIH/traitement médicamenteux
15.
Nutrients ; 15(2)2023 Jan 10.
Article de Anglais | MEDLINE | ID: mdl-36678209

RÉSUMÉ

The differences in outcomes after weaning off intravenous support (IVS) for chronic intestinal failure (IF) are unclear. Adult IF patients who are weaned off IVS at a tertiary care center (June 2019−2022) were included in this study, and nutritional and functional markers were assessed before, during, and after weaning. Short bowel syndrome (SBS) was present in 77/98 of the IF patients, with different outcomes according to the final anatomy. The body weight and the BMI increased during IVS in those with a jejunocolonic (JC) anastomosis (p < 0.001), but weight loss was significant during follow-up (p < 0.001). Malnutrition was present in >60%, with a reduced muscle mass, which was found using bioelectrical impedance analysis (BIA), in >50% of SBS-JC patients. Although reduced hand-grip strength and sarcopenia were less common, the muscle quality, or phase angle (BIA), decreased during follow-up, also correlating with serum albumin and muscle mass (p ≤ 0.01). The muscle quality and albumin were low in the patients restarting IVS, which was only the case with ≤60 cm of small bowel. Closer follow-up and earlier treatment with teduglutide (TED) should be considered in these patients, as none of the TED-treated patients were malnourished or sarcopenic. Studies on the potential benefits of nutritional and physical interventions for low muscle mass and associations with outcomes are needed in chronic IF patients.


Sujet(s)
Maladies intestinales , Insuffisance intestinale , Malnutrition , Nutrition parentérale à domicile , Syndrome de l'intestin court , Adulte , Humains , Sevrage , Agents gastro-intestinaux/usage thérapeutique , Malnutrition/traitement médicamenteux , Maladies intestinales/induit chimiquement , Nutrition parentérale à domicile/effets indésirables , Syndrome de l'intestin court/thérapie
16.
Nutrition ; 109: 111958, 2023 05.
Article de Anglais | MEDLINE | ID: mdl-36716614

RÉSUMÉ

OBJECTIVES: The aim of the present study was to clarify the effect of malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria on compliance with postoperative adjuvant chemotherapy and relapse-free survival (RFS) in patients with gastric cancer. METHODS: This single-center, retrospective cohort study included 281 consecutive patients with gastric cancer who underwent radical gastrectomy for pathologic stages II and III and received postoperative S-1 adjuvant chemotherapy between April 2008 and June 2018. Treatment failure was defined as discontinuation of adjuvant chemotherapy ≤1 y. Nutritional assessment was preoperatively performed according to the GLIM criteria for all patients. We analyzed risk factors for treatment failure and poor prognostic factors for RFS using multivariate analyses. RESULTS: Treatment failure and recurrence were observed in 50 (17.8%) and 97 (34.5%) of the 281 patients, respectively. The median follow-up period was 52 mo. The treatment failure rate was higher (P = 0.032) and RFS was worse (P = 0.017) in the malnutrition group. In multivariate analyses, GLIM criteria-defined malnutrition was an independent risk factor for treatment failure (odds ratio = 3.110; 95% confidence interval [CI], 1.020-9.470; P = 0.046). Furthermore, severe malnutrition was an independent poor prognostic factor for RFS (hazard ratio = 1.767; 95% CI, 1.132-2.759; P = 0.012). CONCLUSIONS: Preoperative malnutrition as defined by the GLIM criteria was an independent risk factor for poor compliance with adjuvant S-1 chemotherapy and a poor prognostic factor for RFS after radical gastrectomy in patients with advanced gastric cancer.


Sujet(s)
Malnutrition , Tumeurs de l'estomac , Humains , Tumeurs de l'estomac/complications , Tumeurs de l'estomac/traitement médicamenteux , Tumeurs de l'estomac/chirurgie , Études rétrospectives , Leadership , Récidive tumorale locale , Malnutrition/étiologie , Malnutrition/traitement médicamenteux , Traitement médicamenteux adjuvant , Évaluation de l'état nutritionnel , État nutritionnel
17.
Clin Nutr ; 42(2): 108-115, 2023 02.
Article de Anglais | MEDLINE | ID: mdl-36525797

RÉSUMÉ

BACKGROUND & AIMS: The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration. METHODS: The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50 ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients. RESULTS: From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n = 100, control group n = 104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ -3%, 95%CI -11 to 4%), p = 0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ -3%, 95% CI -12 -7%), p = 0.57, average daily intake of ONS (170 vs 173 ml (Δ - 3 ml, 95% CI -14 to 8 ml), p = 0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p = 0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p = 0.29, p = 0.14, p = 0.65 and p = 0.94, respectively). The per protocol analysis including 178 patients showed similar results. CONCLUSION: Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03761680.


Sujet(s)
Malnutrition , Élimination des déchets , Humains , Sujet âgé , Force de la main , Compléments alimentaires , Malnutrition/traitement médicamenteux , Poids , Administration par voie orale , État nutritionnel
18.
Biomolecules ; 12(12)2022 11 24.
Article de Anglais | MEDLINE | ID: mdl-36551176

RÉSUMÉ

During the last few decades, the micronutrient zinc has proven to be an important metal ion for a well-functioning immune system, and thus also for a suitable immune defense. Nowadays, it is known that the main cause of zinc deficiency is malnutrition. In particular, vulnerable populations, such as the elderly in Western countries and children in developing countries, are often affected. However, sufficient zinc intake and homeostasis is essential for a healthy life, as it is known that zinc deficiency is associated with a multitude of immune disorders such as metabolic and chronic diseases, as well as infectious diseases such as respiratory infections, malaria, HIV, or tuberculosis. Moreover, the modulation of the proinflammatory immune response and oxidative stress is well described. The anti-inflammatory and antioxidant properties of zinc have been known for a long time, but are not comprehensively researched and understood yet. Therefore, this review highlights the current molecular mechanisms underlying the development of a pro-/ and anti-inflammatory immune response as a result of zinc deficiency and zinc supplementation. Additionally, we emphasize the potential of zinc as a preventive and therapeutic agent, alone or in combination with other strategies, that could ameliorate infectious diseases.


Sujet(s)
Maladies transmissibles , Paludisme , Malnutrition , Oligoéléments , Enfant , Humains , Sujet âgé , Zinc/usage thérapeutique , Maladies transmissibles/traitement médicamenteux , Antioxydants/pharmacologie , Antioxydants/usage thérapeutique , Paludisme/traitement médicamenteux , Paludisme/prévention et contrôle , Malnutrition/traitement médicamenteux
19.
Clin Nutr ; 41(10): 2244-2263, 2022 10.
Article de Anglais | MEDLINE | ID: mdl-36081299

RÉSUMÉ

Low muscle mass and malnutrition are prevalent conditions among adults of all ages, with any body weight or body mass index, and with acute or chronic conditions, including COVID-19. This article synthesizes the latest research advancements in muscle health and malnutrition, and their impact on immune function, and clinical outcomes. We provide a toolkit of illustrations and scientific information that healthcare professionals can use for knowledge translation, educating patients about the importance of identifying and treating low muscle mass and malnutrition. We focus on the emerging evidence of mitochondrial dysfunction in the context of aging and disease, as well as the cross-talk between skeletal muscle and the immune system. We address the importance of myosteatosis as a component of muscle composition, and discuss direct, indirect and surrogate assessments of muscle mass including ultrasound, computerized tomography, deuterated creatine dilution, and calf circumference. Assessments of muscle function are also included (handgrip strength, and physical performance tests). Finally, we address nutrition interventions to support anabolism, reduce catabolism, and improve patient outcomes. These include protein and amino acids, branched-chain amino acids, with a focus on leucine; ß-hydroxy-ß-methylbutyrate (HMB), vitamin D; n-3 polyunsaturated fatty acids (n-3 PUFA), polyphenols, and oral nutritional supplements. We concluded with recommendations for clinical practice and a call for action on research focusing on evaluating the impact of body composition assessments on targeted nutrition interventions, and consequently their ability to improve patient outcomes.


Sujet(s)
COVID-19 , Acides gras omega-3 , Malnutrition , Adulte , Acides aminés/métabolisme , Acides aminés à chaine ramifiée , Créatine , Prestations des soins de santé , Compléments alimentaires , Acides gras omega-3/métabolisme , Acides gras insaturés/métabolisme , Force de la main , Humains , Leucine , Malnutrition/traitement médicamenteux , Force musculaire , Muscles squelettiques/physiologie , Valérates , Vitamine D/usage thérapeutique
20.
PLoS One ; 17(9): e0274870, 2022.
Article de Anglais | MEDLINE | ID: mdl-36121865

RÉSUMÉ

Zinc deficiency is common among children with Moderate Acute Malnutrition (MAM) and contributes to growth failure, increased morbidity and mortality. Diarrhoea and poor dietary practices are the main causes of zinc deficiency. Corn-soy Blend (CSB), the standard product in management of children with MAM has a limitation of poor micronutrient bioavailability. Micronutrient powders (MNPs) which are added at the point of consumption have a potential in improving micronutrient status however, scientific evidence on efficacy on improving the zinc status is scarce. A cluster-randomized clinical trial was designed to establish bioequivalence of MNPs to CSB on serum zinc status among children (6-36 months) with MAM in Thika informal settlements, Kenya. Sample size was calculated to show bioequivalence within ±20% limit. Twelve villages were randomized to four study groups. Three experimental groups received different formulations of MNPs added to unfortified CSB porridge as; multiple micronutrients containing zinc (CSB-MNP-A n = 84), multiple micronutrients without zinc (CSB-MNP-B n = 88) and zinc only (CSB-MNP-C n = 94). Control group (n = 80) received standard CSB fortified with multiple micronutrients. Standard amount of CSB was consumed in feeding centres for six months. Serum zinc concentration was assessed pre- and post-intervention. Data was analyzed based on treatment assignment regardless of adherence and drop-out status. Mixed effects linear regression was used to model pre-post change in serum zinc concentration, adjusting for clustering effect and baseline differences. Bioequivalence was assessed using two one-sided t-tests. At baseline, 84.4% were zinc deficient (serum zinc <65µg/dL) and zinc intake was sub-optimal (<3 mg/day) for 95.7% of children. Mean change in serum zinc concentration was significantly higher (p = 0.024) in CSB-MNP-A (18.7 ± 2.1) µg/dL compared to control group (11.8 ± 2.6 µg/dL). MNPs are not bioequivalent to CSB within the ±20% bioequivalence limit. MNPs are more effective in improving serum zinc status compared to CSB. Trials with larger sample sizes are recommended to validate the current findings. Trial registration: Pan African Clinical Trials Registry: PACTR201907492232376.


Sujet(s)
Malnutrition , Oligoéléments , Enfant , Humains , Kenya , Malnutrition/traitement médicamenteux , Micronutriments/usage thérapeutique , Zones de pauvreté , Poudres , Équivalence thérapeutique , Zea mays , Zinc
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