Canasta alimentaria normativa: perspectivas actuales e implicaciones para la salud pública en Venezuela / Normative Food Basket current perspectives and implications for public health in Venezuela

La Canasta Alimentaria Normativa (CAN) es un instrumento estratégico de planificación y seguimiento, que impacta el ámbito económico (fijación del salario mínimo SM y del umbral de la pobreza relativa), la seguridad alimentaria y la salud pública. El objetivo fue describir la evolución histórica de la CAN en Venezuela, contrastando su valoración económica respecto al SM durante el período 1990 ­ 2023. Tipo de estudio: Descriptivo. Se empleó la CAN del Instituto Nacional de Estadísticas/Instituto Nacional de Nutrición (INE/INN) y su comparación con la canasta del Centro de Documentación y Análisis Social de la Federación Venezolana de Maestros(CENDAS ­ FVM). Los valores mensuales de la CAN y del SM se recalcularon a dólares USA, de acuerdo a la tasa de cambio oficial. No se incluyó evaluación de la estructura interna, ni sus expresiones en términos de aporte de energía y nutrientes. Resultados: Desde 1990 hasta el año 2015, se requirieron entre1,0 y 1,8 SM y entre 0,6 y 1,7 Ingresos Mínimos Legales (IML)para acceder a la CAN. Para el año 2023 se requirieron hasta 78,3SM y 51,6 IML. El valor promedio de la canasta del CENDAS-FVM fue superior al valor de la CAN INE/INN, en una proporción de 1,7: 1. Conclusiones: la CAN resultó sensible en identificar los cambios y tendencias de su estimación económica, en el ambiente inflacionario venezolano. El uso de sus resultados está sujeta a cierto grado de discrecionalidad política. El costo de la CAN, expresa una contracción del poder de compra de los hogares venezolanos con potenciales impactos sobre la nutrición y la salud física y mental a corto y largo plazo.

The Normative Food Basket (NFB) represents astrategic planning and monitoring instrument, which impactsthe economic sphere (setting of the minimum wage (MW) andthe relative poverty threshold), food security and public health.The objective was to describe the historical evolution of the NFB in Venezuela, contrasting its economic valuation with respect to the MW during the period 1990 ­ 2023. Type of study: Descriptive. The NFB of the National Institute of Statistics/National Institute of Nutrition (NIS/NIN) was used and itscomparison with the basket of the Center for Documentationand Social Analysis of the Venezuelan Federation of Teachers (CENDAS ­ FVM). The monthly values of the NFB and theMW were recalculated into dollars (US$), according to theofficial exchange rate. No evaluation of the internal structurewas included, nor its expressions in terms of energy and nutrientcontribution. Results: From 1990 to 2015, between 1.0 and1.8 MW and between 0.6 and 1.7 Minimum Legal Income(MLI) were required to access the NFB. By 2023, up to 78.3MW and 51.6 MLI were required. The average value of the CENDAS-FVM basket was higher than the value of the NFBNIS/NIN, in a proportion of 1.7: 1. Conclusions: As a statistical operation, the NFB was sensitive in identifying changes andtrends in its estimate economic, in the Venezuelan inflationaryenvironment. The use of its results is subject to a certain degree ofpolitical discretion. The cost of CAN expresses a contraction inthe purchasing power of Venezuelan households with potentialimpacts on nutrition and physical/mental health in the shortand long term.

Causes and consequences of child growth faltering in low-resource settings.

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

A captura corporativa de sistemas alimentares

O controle sobre os sistemas alimentares - das sementes ao prato - está sempre mais concentrado nas mãos de algumas empresas.

The economic cost of not coding disease-related malnutrition: A study in cancer inpatients.

BACKGROUND & AIMS: Disease-related malnutrition (DRM) coding rate is usually low in hospitalised patients. The objective of our study was to estimate the percentage of correct DRM coding in cancer inpatients and to calculate the economic losses caused by such lack of coding. METHODS: This was an observational, prospective study that was conducted in patients hospitalised in the Medical Oncology Unit of our hospital. A nutritional assessment was performed through subjective global assessment (SGA). The all patient refined-diagnosis related group (APR-DRG) weights were obtained at the moment of discharge; moreover, recalculation was done after including the diagnosis of malnutrition in the medical record of those patients in whom it had not been initially coded. The associated cost reimbursement were calculated based on the weight before and after revising the diagnosis of DRM. RESULTS: A total of 266 patients were evaluated. From them, 220 (82.7%) suffered from DRM according to the SGA. In 137 (51.5%) of these patients, diagnosis was coded, as opposed to 83 (31.2%) cases (33 subjects with moderate and 50 with severe DRM) in whom it was not coded. The sum of the APR-DRG weights before revising the diagnosis of malnutrition was 343.4 points (mean: 1.29 ± 0.89). Whereas, after revising the diagnosis, it increased up to 384.3 (1.44 ± 0.96). The total cost reimbursement for the hospital before revising the diagnosis of malnutrition was 1,607,861.21€ and after revision it increased up to 1,799,199.69€, which means that 191,338.48€ were not reimbursed to the hospital due to the lack of coding of malnutrition. The cost reimbursement for each admission increased an average of 719.32€. CONCLUSION: The prevalence of DRM in cancer inpatients is high. Nevertheless, the diagnosis is not coded in one third of patients, which results in important economic losses for the hospitals.

Estimating the Burden of Child Undernutrition for Smaller Electoral Units in India.

Importance: Geographic targeting of public health interventions is needed in resource-constrained developing countries. Objective: To develop methods for estimating health and development indicators across micropolicy units, using assembly constituencies (ACs) in India as an example. Design, Setting, and Participants: This cross-sectional study included children younger than 5 years who participated in the fourth National Family and Health Survey (NFHS-4), conducted between January 2015 and December 2016. Participants lived in 36 states and union territories and 640 districts in India. Children who had valid weight and height measures were selected for stunting, underweight, and wasting analysis, and children between age 6 and 59 months with valid blood hemoglobin concentration levels were included in the anemia analysis sample. The analysis was performed between February 1 and August 15, 2020. Exposures: A total of 3940 ACs were identified from the geographic location of primary sampling units in which the children's households were surveyed in NFHS-4. Main Outcomes and Measures: Stunting, underweight, and wasting were defined according to the World Health Organization Child Growth Standards. Anemia was defined as blood hemoglobin concentration less than 11.0 g/dL. Results: The main analytic sample included 222 172 children (mean [SD] age, 30.03 [17.01] months; 114 902 [51.72%] boys) from 3940 ACs in the stunting, underweight, and wasting analysis and 215 593 children (mean [SD] age, 32.63 [15.47] months; 112 259 [52.07%] boys) from 3941 ACs in the anemia analysis. The burden of child undernutrition varied substantially across ACs: from 18.02% to 60.94% for stunting, with a median (IQR) of 35.56% (29.82%-42.42%); from 10.40% to 63.24% for underweight, with a median (IQR) of 32.82% (25.50%-40.96%); from 5.56% to 39.91% for wasting, with a median (IQR) of 19.91% (15.70%-24.27%); and from 18.63% to 83.05% for anemia, with a median (IQR) of 55.74% (48.41%-63.01%). The degree of inequality within states varied across states; those with high stunting, underweight, and wasting prevalence tended to have high levels of inequality. For example, Uttar Pradesh, Jharkhand, and Karnataka had high mean AC-level prevalence of child stunting (Uttar Pradesh, 45.29%; Jharkhand, 43.76%; Karnataka, 39.77%) and also large SDs (Uttar Pradesh, 6.90; Jharkhand, 6.02; Karnataka, 6.72). The Moran I indices ranged from 0.25 to 0.80, indicating varying levels of spatial autocorrelation in child undernutrition across the states in India. No substantial difference in AC-level child undernutrition prevalence was found after adjusting for possible random displacement of geographic location data. Conclusions and Relevance: In this cross-sectional study, substantial inequality in child undernutrition was found across ACs in India, suggesting the importance of considering local electoral units in designing targeted interventions. The methods presented in this paper can be further applied to measuring health and development indicators in small electoral units for enhanced geographic precision of public health data in developing countries.

Multivariate random forest prediction of poverty and malnutrition prevalence.

Advances in remote sensing and machine learning enable increasingly accurate, inexpensive, and timely estimation of poverty and malnutrition indicators to guide development and humanitarian agencies' programming. However, state of the art models often rely on proprietary data and/or deep or transfer learning methods whose underlying mechanics may be challenging to interpret. We demonstrate how interpretable random forest models can produce estimates of a set of (potentially correlated) malnutrition and poverty prevalence measures using free, open access, regularly updated, georeferenced data. We demonstrate two use cases: contemporaneous prediction, which might be used for poverty mapping, geographic targeting, or monitoring and evaluation tasks, and a sequential nowcasting task that can inform early warning systems. Applied to data from 11 low and lower-middle income countries, we find predictive accuracy broadly comparable for both tasks to prior studies that use proprietary data and/or deep or transfer learning methods.

Infection with Blastocystis spp. and its association with enteric infections and environmental enteric dysfunction among slum-dwelling malnourished adults in Bangladesh.

BACKGROUND: Blastocystis spp. (Blastocystis) is a widely distributed gastrointestinal protist frequently reported in countries with tropical and sub-tropical climate. We sought to determine the factors associated with Blastocystis infection and investigate its role on biomarkers of intestinal health among slum-dwelling malnourished adults in Bangladesh. METHODOLOGY: Total 524 malnourished adults with a body mass index ≤18.5 kg/m2 were included in this analysis. Presence of Blastocystis in feces was evaluated by TaqMan Array Card assays. PRINCIPAL FINDINGS: Blastocystis was tested positive in 78.6% of the participants. Prevalence of infection with atypical strains of enteropathogenic Escherichia coli (aEPEC) (56% vs. 38%, p<0.001), and Trichuris trichiura (28% vs. 15%, p-value = 0.02) was significantly greater in adults with Blastocystis, while Giardia intestinalis was significantly lower (8% vs. 14%, p-value = 0.04) in Blastocystis positive adults. Malnourished adults who were living in households with high crowding index (aOR = 2.18; 95% CI = 1.11, 4.65; p-value = 0.03), and infected with aEPEC (aOR = 2.14; 95% CI = 1.35, 3.44; p-value = 0.001) and Trichuris trichiura (aOR = 1.97; 95% CI = 1.08, 3.77; p = 0.03) were more likely to be infected with Blastocystis. A significant negative relationship was observed between Blastocystis and fecal concentrations of alpha-1 antitrypsin (ß = -0.1; 95% CI = -1.7, -0.1; p-value<0.001) and Reg1B (ß = -3.6; 95% CI = -6.9, -3.0; p-value = 0.03). CONCLUSIONS: The study findings suggest that the presence of Blastocystis in human intestine influences gut health and may have potential pathogenic role in presence of other pathogens.

Desnutrición relacionada con la enfermedad, parámetros funcionales y costes asociados en un hospital general / Disease-related malnutrition, functional parameters, and associated costs in a genaral hospital

Introducción: la desnutrición relacionada con la enfermedad (DRE) afecta en Europa a más de 30 millones de personas, lo que supone cada año unos 170.000 millones de euros. Es necesario implantar protocolos multidisciplinares para el abordaje de la DRE. Objetivo: estudiar la proporción de pacientes afectados o en riesgo de DRE al ingreso, la duración y el coste de su estancia en un hospital general.Métodos: estudio observacional de corte transversal con un tamaño muestral de 203 sujetos. De junio a diciembre de 2018 se realizó un cribado nutricional conforme al Nutritional Risk Screening 2002 (NRS-2002), se hizo un diagnóstico según los criterios de la Iniciativa de Liderazgo Mundial en Desnutrición (GLIM), se registró la duración del ingreso y se efectuó una estimación del coste de la estancia de todos los pacientes que ingresaron en medicina interna y cumplían los criterios de selección. Resultados: la proporción de personas en riesgo de DRE fue del 28 % (57/203; IC 95 %: 22 % a 34 %). La proporción de pacientes con diagnóstico de DRE fue del 19 % (36/192; IC 95 %: 13 % a 24 %). Los pacientes clasificados con riesgo o diagnóstico de DRE al ingreso tuvieron una estancia 3 días mayor que la de los normonutridos (p < 0,01) y un coste mayor que el de los normonutridos en 1.803,66 euros (p < 0,01). Conclusiones: se hace necesario un abordaje integral y multidisciplinar de la DRE coordinada desde la Comunidad, la Atención Primaria y los hospitales, especialmente en las mujeres de ≥ 70 años con patología pulmonar. (AU)

Introduction: disease-related malnutrition (DRM) affects more than 30 million people in Europe, representing about 170 billion euros each year. Despite the growing consensus for the diagnosis of DRM, it is still necessary to implement multidisciplinary and coordinated protocols for a comprehensive approach to DRM in hospitals. Objetive: to study the proportion of patients affected by DRM upon admission, as well as the duration and the cost of their stay in a general hospital. Methods: an observational cross-sectional study with a sample size of 203 subjects. From June to December 2018, a nutritional screening was carried out according to the Nutritional Risk Screening 2002 (NRS-2002); diagnoses were made according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, length of stay was recorded, and the cost of stay was estimated for all patients admitted to Internal Medicine who met the selection criteria. Results: the proportion of people at risk of DRM was 28 % (57/203; 95 % CI: 22 % to 34 %). The proportion of patients diagnosed with DRM was 19 % (36/192; 95 % CI: 13 % to 24 %). Patients classified with risk or diagnosis of DRM upon admission had a longer stay than those with normal nutrition by 3 days (p < 0.01), and a higher cost by €1,803.66 (p < 0.01). Conclusions: a comprehensive, multidisciplinary approach to DRM coordinated from Primary Care to hospitals is necessary, especially in women aged ≥ 70 years with pulmonary disease. (AU)

[Disease-related malnutrition, functional parameters, and associated costs in a genaral hospital]. / Desnutrición relacionada con la enfermedad, parámetros funcionales y costes asociados en un hospital general.

INTRODUCTION: Introduction: disease-related malnutrition (DRM) affects more than 30 million people in Europe, representing about 170 billion euros each year. Despite the growing consensus for the diagnosis of DRM, it is still necessary to implement multidisciplinary and coordinated protocols for a comprehensive approach to DRM in hospitals. Objetive: to study the proportion of patients affected by DRM upon admission, as well as the duration and the cost of their stay in a general hospital. Methods: an observational cross-sectional study with a sample size of 203 subjects. From June to December 2018, a nutritional screening was carried out according to the Nutritional Risk Screening 2002 (NRS-2002); diagnoses were made according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, length of stay was recorded, and the cost of stay was estimated for all patients admitted to Internal Medicine who met the selection criteria. Results: the proportion of people at risk of DRM was 28 % (57/203; 95 % CI: 22 % to 34 %). The proportion of patients diagnosed with DRM was 19 % (36/192; 95 % CI: 13 % to 24 %). Patients classified with risk or diagnosis of DRM upon admission had a longer stay than those with normal nutrition by 3 days (p < 0.01), and a higher cost by €1,803.66 (p < 0.01). Conclusions: a comprehensive, multidisciplinary approach to DRM coordinated from Primary Care to hospitals is necessary, especially in women aged ≥ 70 years with pulmonary disease.

INTRODUCCIÓN: Introducción: la desnutrición relacionada con la enfermedad (DRE) afecta en Europa a más de 30 millones de personas, lo que supone cada año unos 170.000 millones de euros. Es necesario implantar protocolos multidisciplinares para el abordaje de la DRE. Objetivo: estudiar la proporción de pacientes afectados o en riesgo de DRE al ingreso, la duración y el coste de su estancia en un hospital general. Métodos: estudio observacional de corte transversal con un tamaño muestral de 203 sujetos. De junio a diciembre de 2018 se realizó un cribado nutricional conforme al Nutritional Risk Screening 2002 (NRS-2002), se hizo un diagnóstico según los criterios de la Iniciativa de Liderazgo Mundial en Desnutrición (GLIM), se registró la duración del ingreso y se efectuó una estimación del coste de la estancia de todos los pacientes que ingresaron en medicina interna y cumplían los criterios de selección. Resultados: la proporción de personas en riesgo de DRE fue del 28 % (57/203; IC 95 %: 22 % a 34 %). La proporción de pacientes con diagnóstico de DRE fue del 19 % (36/192; IC 95 %: 13 % a 24 %). Los pacientes clasificados con riesgo o diagnóstico de DRE al ingreso tuvieron una estancia 3 días mayor que la de los normonutridos (p < 0,01) y un coste mayor que el de los normonutridos en 1.803,66 euros (p < 0,01). Conclusiones: se hace necesario un abordaje integral y multidisciplinar de la DRE coordinada desde la Comunidad, la Atención Primaria y los hospitales, especialmente en las mujeres de ≥ 70 años con patología pulmonar.

Global, regional and national epidemiology and prevalence of child stunting, wasting and underweight in low- and middle-income countries, 2006-2018.

In 2016, undernutrition, as manifested in childhood stunting, wasting, and underweight were estimated to cause over 1.0 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life years globally. The objective of this study is to estimate the prevalence of undernutrition in low- and middle-income countries (LMICs) using the 2006-2018 cross-sectional nationally representative demographic and health surveys (DHS) data and to explore the sources of regional variations. Anthropometric measurements of children 0-59 months of age from DHS in 62 LMICs worldwide were used. Complete information was available for height-for-age (n = 624,734), weight-for-height (n = 625,230) and weight-for-age (n = 626,130). Random-effects models were fit to estimate the pooled prevalence of stunting, wasting, and underweight. Sources of heterogeneity in the prevalence estimates were explored through subgroup meta-analyses and meta-regression using generalized linear mixed-effects models. Human development index (a country-specific composite index based on life expectancy, literacy, access to education and per capita gross domestic product) and the United Nations region were explored as potential sources of variation in undernutrition. The overall prevalence was 29.1% (95% CI 26.7%, 31.6%) for stunting, 6.3% (95% CI 4.6%, 8.2%) for wasting, and 13.7% (95% CI 10.9%, 16.9%) for underweight. Subgroup analyses suggested that Western Africa, Southern Asia, and Southeastern Asia had a substantially higher estimated prevalence of undernutrition than global average estimates. In multivariable meta-regression, a combination of human development index and United Nations region (a proxy for geographical variation) explained 54%, 56%, and 66% of the variation in stunting, wasting, and underweight prevalence, respectively. Our findings demonstrate that regional, subregional, and country disparities in undernutrition remain, and the residual gaps to close towards achieving the second sustainable development goal-ending undernutrition by 2030.

Comorbid Dysphagia and Malnutrition in Elderly Hospitalized Patients.

OBJECTIVE/HYPOTHESIS: Elderly individuals account for one-third of all hospitalizations. The goal of this study was to evaluate the prevalence of dysphagia in elderly patients admitted to a tertiary care center. It also sought to investigate how dysphagia is identified, how it covaries with malnutrition and other conditions, and how it impacts hospital stay. STUDY DESIGN: Case Series. METHODS: A retrospective chart review was performed. All patients >65 years admitted to a tertiary care center in January and February 2016 were included. Patients with primary psychiatric diagnoses and patients with upper aerodigestive tract malignancy or surgery were excluded. RESULTS: A total of 655 patients were identified. Mean age was 76.6 years. Twenty-four percent (155 patients) had dysphagia while 43% (282 patients) had malnutrition. Thirteen percent (84 patients) had both dysphagia and malnutrition. Fifty percent of patients who had malnutrition were seen by speech language pathology (SLP). One hundred percent of malnourished patients that saw SLP were identified as having dysphagia. Three hundred and eighty-two patients (58%) were seen by the dietician but not by SLP. Multiple logistic regression indicated that the presence of dysphagia was positively associated with age, presence of malnutrition, admission to either cardiology or neurology service as compared to medicine service, and history of stroke. CONCLUSIONS: One-quarter of elderly patients admitted to our tertiary care center had dysphagia. Dysphagia, especially when linked with malnutrition, has poorer outcomes and increased healthcare costs. Our data suggests a possible disconnect between malnutrition diagnosis and dysphagia identification. This is an important area of intervention that has the potential to improve the treatment and outcomes of these patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2441-2447, 2021.

Undernutrition and its determinants among adolescent girls in low land area of Southern Ethiopia.

BACKGROUND: Undernutrition is one of the most common causes of morbidity and mortality among adolescent girls worldwide, especially in South-East Asia and Africa. Even though adolescence is a window of opportunity to break the intergenerational cycle of undernutrition, adolescent girls are a neglected group. The objective of this study was to assess the nutritional status and associated factors among adolescent girls in the Wolaita and Hadiya zones of Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted, and a multistage random sampling method was used to select a sample of 843 adolescent girls. Anthropometric measurements were collected from all participants and entered in the WHO Anthro plus software for Z-score analysis. The data was analyzed using EPI-data 4.4.2 and SPSS version 21.0. The odds ratios for logistic regression along with a 95% confidence interval (CI) were generated. A P-value < 0.05 was declared as the level of statistical significance. RESULT: Thinness (27.5%) and stunting (8.8%) are found to be public health problems in the study area. Age [AOR(adjusted odds ratio) (95% CI) = 2.91 (2.03-4.173)], large family size [AOR (95% CI) = 1.63(1.105-2.396)], low monthly income [AOR (95% CI) = 2.54(1.66-3.87)], not taking deworming tablets [AOR (95% CI) = 1.56(1.11-21)], low educational status of the father [AOR (95% CI) = 2.45(1.02-5.86)], the source of food for the family only from market [AOR (95% CI) = 5.14(2.1-12.8)], not visited by health extension workers [AOR (95% CI) = 1.72(1.7-2.4)], and not washing hand with soap before eating and after using the toilet [AOR (95% CI) = 2.25(1.079-4.675)] were positively associated with poor nutritional status of adolescent girls in the Wolaita and Hadiya zones, Southern Ethiopia. CONCLUSION: Thinness and stunting were found to be high in the study area. Age, family size, monthly household income, regularly skipping meals, fathers' educational status, visits by health extension workers, and nutrition services decision-making are the main predictors of thinness. Hand washing practice, visits by health extension workers, and nutrition services decision-making are the main predictors of stunting among adolescent girls. Multisectoral community-based, adolescent health and nutrition programs should be implemented.

A call to action to address COVID-19-induced global food insecurity to prevent hunger, malnutrition, and eating pathology.

The coronavirus 2019 disease (COVID-19) pandemic has led to food shortages, increased food prices, and loss of income. As a result, global food insecurity alerts have been issued. The pandemic threatens millions of children and adolescents and their families currently living with or at risk for development of food insecurity. The lack of consistent access to nutritious food sources is associated with chronic physical and mental health problems and death. Studies on food insecurity and eating pathology have heightened our concern about the impact the added effect of the pandemic may have on eating behaviors of children and adolescents. Here, we want to draw attention to the need for making food security and healthy eating attitudes and behaviors a global priority during the COVID-19 pandemic to guarantee the current and future health and well-being of our children and adolescents.

Examining calorie undernourishment in India: Is it due to choice or inadequacy?

BACKGROUND: Calorie undernourishment is often associated with poverty but India presents a unique scene of decline in money-metric poverty and rise in calorie deprivation. Existing literature has varied explanation towards this effect. However, neither are the poor entirely calorie compromised nor do all the non-poor qualify calorie compliance. AIM: This is an attempt at verifying whether calorie undernourishment is a result of choice of food basket or the inadequacy of food expenditure. METHOD: An answer to this question is attempted with the exploration of data obtained from the National Sample Survey Organization's Consumption Expenditure of Indian households for the periods 2004-2005 and 2011-2012. RESULTS: Findings reveal that over the last one decade, the average per capita per day calorie intakes have slightly increased from 2040.55 Kcal in 2004-2005 to 2087.33 Kcal in 2011-2012, which has led to the increased share of well-nourished households from 20.21% in the 61st round to 22.78% in the 68th round of survey in rural areas, whereas the similar increase in urban areas is from 36.1% to 40.65%. CONCLUSIONS: Calorie undernourishment among the non-poor is observed that calorie undernourishment, if any, among the non-poor is entirely due to choice but the same among the poor has a divide between choice and inadequacy. The urban poor are calorie compromised more due to choice rather than inadequacy as against their rural counterparts. With higher poverty, calorie, non-compliance among the poor is more due to choice when compared with lower magnitude of poverty. These observations form a basis for contesting the common understanding that calorie compromise is entirely driven by inadequacy/incapacity of food expenditure. could be viewed in terms of the food choices made, especially among the poor while setting the minimum threshold of food expenditure to be calorie compliant.

Child Undernutrition in Sudan: The Social and Economic Impact and Future Perspectives.

The nutrition situation in Sudan is one of the worst in northeast Africa and it is characterized by persistently high levels of acute and chronic malnutrition that have increased over the last two decades. The underlying causes of malnutrition are multi-sectoral and are mainly due to inequalities, inadequate food practices, and limited access to healthcare services. Based on the report The Economic and Social Impacts of Child Undernutrition in Sudan, this study assesses the impact that malnutrition has on health, education, and productivity in Sudan. The country is estimated to have lost an equivalent of about 11.6 billion Sudanese pound (1 United States dollar = 55.3 Sudanese pound) in 2014, which represented 2.6% of the gross domestic product (GDP). Productivity-related losses contributed the largest costs at 1.5% of GDP followed by health and education sectors at 1.1% and 0.1%, respectively. In 2020, the outbreak of the COVID-19 pandemic further exposed the fragility of Sudan's health, social, and economic system. It is mandatory that all stakeholders address child nutrition as a main concern and stunting is incorporated in the center of the development agenda. In particular, the national development frameworks should be updated to ensure the reduction of the stunting prevalence and to put in place a comprehensive multi-sectoral nutrition policy, strategy, and plan of action.

A simplified, combined protocol versus standard treatment for acute malnutrition in children 6-59 months (ComPAS trial): A cluster-randomized controlled non-inferiority trial in Kenya and South Sudan.

BACKGROUND: Malnutrition underlies 3 million child deaths worldwide. Current treatments differentiate severe acute malnutrition (SAM) from moderate acute malnutrition (MAM) with different products and programs. This differentiation is complex and costly. The Combined Protocol for Acute Malnutrition Study (ComPAS) assessed the effectiveness of a simplified, unified SAM/MAM protocol for children aged 6-59 months. Eliminating the need for separate products and protocols could improve the impact of programs by treating children more easily and cost-effectively, reaching more children globally. METHODS AND FINDINGS: A cluster-randomized non-inferiority trial compared a combined protocol against standard care in Kenya and South Sudan. Randomization was stratified by country. Combined protocol clinics treated children using 2 sachets of ready-to-use therapeutic food (RUTF) per day for those with mid-upper arm circumference (MUAC) < 11.5 cm and/or edema, and 1 sachet of RUTF per day for those with MUAC 11.5 to <12.5 cm. Standard care clinics treated SAM with weight-based RUTF rations, and MAM with ready-to-use supplementary food (RUSF). The primary outcome was nutritional recovery. Secondary outcomes included cost-effectiveness, coverage, defaulting, death, length of stay, and average daily weight and MUAC gains. Main analyses were per-protocol, with intention-to-treat analyses also conducted. The non-inferiority margin was 10%. From 8 May 2017 to 31 March 2018, 2,071 children were enrolled in 12 combined protocol clinics (mean age 17.4 months, 41% male), and 2,039 in 12 standard care clinics (mean age 16.7 months, 41% male). In total, 1,286 (62.1%) and 1,202 (59.0%), respectively, completed treatment; 981 (76.3%) on the combined protocol and 884 (73.5%) on the standard protocol recovered, yielding a risk difference of 0.03 (95% CI -0.05 to 0.10, p = 0.52; per-protocol analysis, adjusted for country, age, and sex). The amount of ready-to-use food (RUTF or RUSF) required for a child with SAM to reach full recovery was less in the combined protocol (122 versus 193 sachets), and the combined protocol cost US$123 less per child recovered (US$918 versus US$1,041). There were 23 (1.8%) deaths in the combined protocol arm and 21 (1.8%) deaths in the standard protocol arm (adjusted risk difference 95% CI -0.01 to 0.01, p = 0.87). There was no evidence of a difference between the protocols for any of the other secondary outcomes. Study limitations included contextual factors leading to defaulting, a combined multi-country power estimate, and operational constraints. CONCLUSIONS: Combined treatment for SAM and MAM is non-inferior to standard care. Further research should focus on operational implications, cost-effectiveness, and context (Asia versus Africa; emergency versus food-secure settings). This trial is complete and registered at ISRCTN (ISRCTN30393230). TRIAL REGISTRATION: The trial is registered at ISRCTN, trial number ISRCTN30393230.

Clinical outcomes and financial impacts of malnutrition in sepsis.

BACKGROUND: In the United States in 2014 approximately 1.7 million adults were hospitalized with sepsis, resulting in about 270,000 deaths. Malnutrition in hospitalized patients contributes to increased morbidity, mortality, and costs, especially in the critically ill population. AIM: Our goal was to investigate the prevalence of malnutrition in sepsis and the impact it has on clinical and financial outcomes in our most critically ill patients. METHODS: We implemented nutritional screening by a registered dietitian of 1000 patients admitted with sepsis to specialized care units. We calculated the prevalence of malnutrition, and compared outcomes including mortality, length of stay, and financial costs. RESULTS: About 10% of patients with sepsis admitted to our specialized care units were diagnosed with malnutrition on admission after implementation of mandatory assessment. CONCLUSIONS: Although mortality did not reach statistical significance, these patients had more comorbidities, longer hospital stays, and higher total costs.

Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes.

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence-practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre-post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.

Current diagnosis-related group-based bundling for upper-extremity arthroplasty: a case of insufficient risk adjustment and misaligned incentives.

BACKGROUND: The current Centers for Medicare & Medicaid Services diagnosis-related group (DRG) bundled-payment model for upper-extremity arthroplasty does not differentiate between the type of arthroplasty (anatomic total shoulder arthroplasty [ATSA] vs. reverse total shoulder arthroplasty vs. total elbow arthroplasty [TEA] vs. total wrist arthroplasty) or the diagnosis and indication for surgery (fracture vs. degenerative osteoarthritis vs. inflammatory arthritis). METHODS: The 2011-2014 Medicare 5% Standard Analytical Files (SAF5) database was queried to identify patients undergoing upper-extremity arthroplasty under DRG-483 and -484. Multivariate linear regression modeling was used to assess the marginal cost impact of patient-, procedure-, diagnosis-, and state-level factors on 90-day reimbursements. RESULTS: Of 6101 patients undergoing upper-extremity arthroplasty, 3851 (63.1%) fell under DRG-484 and 2250 (36.9%) were classified under DRG-483. The 90-day risk-adjusted cost of an ATSA for degenerative osteoarthritis was $14,704 ± $655. Patient-level factors associated with higher 90-day reimbursements were male sex (+$777), age 75-79 years (+$740), age 80-84 years (+$1140), and age 85 years or older (+$984). Undergoing a TEA (+$2175) was associated with higher reimbursements, whereas undergoing a shoulder hemiarthroplasty (-$1000) was associated with lower reimbursements. Surgery for a fracture (+$2354) had higher 90-day reimbursements. Malnutrition (+$10,673), alcohol use or dependence (+$6273), Parkinson disease (+$4892), cerebrovascular accident or stroke (+$4637), and hyper-coagulopathy (+$4463) had the highest reimbursements. In general, states in the South and Midwest had lower 90-day reimbursements associated with upper-extremity arthroplasty. CONCLUSIONS: Under the DRG-based model piloted by the Centers for Medicare & Medicaid Services, providers and hospitals would be reimbursed the same amount regardless of the type of surgery (ATSA vs. hemiarthroplasty vs. TEA), patient comorbidity burden, and diagnosis and indication for surgery (fracture vs. degenerative pathology), despite each of these factors having different resource utilization and associated reimbursements. Lack of risk adjustment for fracture indications leads to strong financial disincentives within this model.