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1.
Matern Child Nutr ; 15 Suppl 1: e12706, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30748121

RESUMO

This study reviews the performance of a community-based nutrition programme in preventing and treating wasting without complications among children under age three in urban informal settlements of India. Implemented by a non-profit organization, with national (Integrated Child Development Services [ICDS]) and city-level (Municipal Corporation of Greater Mumbai [MCGM]) government partners, the programme screened 7,759 children between May 2014 and April 2015. During this period, the programme admitted 705 moderately wasted and 189 severely wasted children into the treatment group and 6,820 not wasted children into the prevention group. Both prevention and treatment groups received growth monitoring, referrals to public health facilities, and home-based counselling (if <6 months) by community health workers. Treatment groups received additional home-based counselling and access to medical screenings. Severely wasted children also received access to ready-to-use therapeutic food. The study assessed default rates, wasting status, and average weight gain 3 months after admission. Factors associated with growth faltering in the prevention group were explored using logistic regression. Default rates for the severely wasted, moderately wasted, and prevention group were 12.7%, 20.4%, and 22.1%, respectively. Recovery rate was 42.4% for the severely wasted and 61.3% for the moderately wasted. For the moderately wasted, mean weight gain was 2.1 g/kg/day, 95% confidence interval (CI) [1.6, 2.6], and 4.5 g/kg/day for the severely wasted, 95% CI [3.1, 5.9]. Among prevention group children, 3.6% faltered into wasting-3.2% into moderate and 0.4% into severe. The paper gives insights into ways in which ICDS and MCGM can successfully integrate large-scale community-based acute malnutrition programming.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Transtornos da Nutrição Infantil/terapia , Serviços de Saúde Comunitária , Governo , Síndrome de Emaciação/prevenção & controle , Síndrome de Emaciação/terapia , Pré-Escolar , Agentes Comunitários de Saúde , Aconselhamento , Humanos , Índia , Lactente , Recém-Nascido , Governo Local , Terapia Nutricional , Estado Nutricional , Organizações sem Fins Lucrativos , Avaliação de Programas e Projetos de Saúde , Parcerias Público-Privadas , População Urbana , Ganho de Peso
2.
PLoS One ; 14(2): e0211988, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759133

RESUMO

Protein-energy wasting, which involves loss of fat and muscle mass, is prevalent and is associated with mortality in hemodialysis (HD) patients. We investigated the associations of fat tissue and muscle mass indices with all-cause mortality in HD patients. The study included 162 patients undergoing HD. The fat tissue index (FTI) and skeletal muscle mass index (SMI), which represent respective tissue masses normalized to height squared, were measured by bioimpedance analysis after dialysis. Patients were divided into the following four groups according to the medians of FTI and SMI values: group 1 (G1), lower FTI and lower SMI; G2, higher FTI and lower SMI; G3, lower FTI and higher SMI; and G4, higher FTI and higher SMI. The associations of the FTI, SMI, and body mass index (BMI) with all-cause mortality were evaluated. During a median follow-up of 2.5 years, 29 patients died. The 5-year survival rates were 48.6%, 76.1%, 95.7%, and 87.4% in the G1, G2, G3, and G4 groups, respectively (P = 0.0002). The adjusted hazard ratio values were 0.34 (95% confidence interval [CI] 0.10-0.95, P = 0.040) for G2 vs. G1, 0.13 (95%CI 0.01-0.69, P = 0.013) for G3 vs. G1, and 0.25 (95%CI 0.07-0.72, P = 0.0092) for G4 vs. G1, respectively. With regard to model discrimination, on adding both FTI and SMI to a model with established risk factors, the C-index increased significantly when compared with the value for a model with BMI (0.763 vs. 0.740, P = 0.016). Higher FTI and/or higher SMI values were independently associated with reduced risks of all-cause mortality in HD patients. Moreover, the combination of the FTI and SMI may more accurately predict all-cause mortality when compared with BMI. Therefore, these body composition indicators should be evaluated simultaneously in this population.


Assuntos
Tecido Adiposo/metabolismo , Composição Corporal/fisiologia , Músculo Esquelético/metabolismo , Diálise Renal , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Síndrome de Emaciação/mortalidade , Adiposidade/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Causas de Morte , Impedância Elétrica , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Diálise Renal/mortalidade , Diálise Renal/estatística & dados numéricos , Fatores de Risco , Síndrome de Emaciação/terapia
3.
Matern Child Nutr ; 14 Suppl 4: e12623, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30499254

RESUMO

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6-59 months who were admitted to the programme with a mid-upper arm circumference (MUAC) < 115 mm (January 1-December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6-23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight-for-height (WHZ) < -3 and/or height-for-age (HAZ) < -2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ -2 at admission. The odds of recovery on the basis of WHZ ≥ -2 were significantly higher among children with WHZ ≥ -3 and/or HAZ < -2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population-level impact could be increased by giving priority to children 6-23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest.


Assuntos
Serviços de Saúde Comunitária , Desnutrição Aguda Grave , Síndrome de Emaciação , Antropometria , Peso Corporal , Criança , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Paquistão/epidemiologia , Estudos Retrospectivos , Desnutrição Aguda Grave/diagnóstico , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/terapia , Síndrome de Emaciação/diagnóstico , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/terapia
4.
Ann Med ; 50(8): 675-693, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30169116

RESUMO

Abnormalities in body composition can occur at any body weight. Low muscle mass is a predictor of poor morbidity and mortality and occurs in several populations. This narrative review provides an overview of the importance of low muscle mass on health outcomes for patients in inpatient, outpatient and long-term care clinical settings. A one-year glimpse at publications that showcases the rapidly growing research of body composition in clinical settings is included. Low muscle mass is associated with outcomes such as higher surgical and post-operative complications, longer length of hospital stay, lower physical function, poorer quality of life and shorter survival. As such, the potential clinical benefits of preventing and reversing this condition are likely to impact patient outcomes and resource utilization/health care costs. Clinically viable tools to measure body composition are needed for routine screening and intervention. Future research studies should elucidate the effectiveness of multimodal interventions to counteract low muscle mass for optimal patient outcomes across the healthcare continuum. Key messages Low muscle mass is associated with several negative outcomes across the healthcare continuum. Techniques to identify and counteract low muscle mass in clinical settings are needed.


Assuntos
Composição Corporal/fisiologia , Continuidade da Assistência ao Paciente , Músculo Esquelético/fisiopatologia , Atrofia Muscular/terapia , Síndrome de Emaciação/terapia , Peso Corporal/fisiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Atrofia Muscular/diagnóstico , Atrofia Muscular/etiologia , Atrofia Muscular/fisiopatologia , Qualidade de Vida , Síndrome de Emaciação/diagnóstico , Síndrome de Emaciação/etiologia , Síndrome de Emaciação/fisiopatologia
5.
Pan Afr Med J ; 29: 228, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30100981

RESUMO

Introduction: Nodding Syndrome (NS) is a neurological disorder affecting children 5-15 years at onset in East Africa. A major criterion for diagnosis is atonic seizure with dorso-ventral "nodding" of the head. Comorbidities include psychological and behavioral abnormalities, malnutrition, cognitive decline, school dropout and other seizure types. We aimed to describe the presentations and rehabilitation outcomes of NS children at Hope for HumaNs (HfH) centre in Gulu from September 2012 to October 2013. Methods: Data was obtained from a retrospective review of 32 NS children's medical records at HfH center. Ethical approval was obtained from Gulu University IRB. Data analysis was conducted using WHO AnthroPlus, SPSS and Excel software. Results: Growth statistics showed steady improvement over time using local nutrition and multivitamin supplementation. Severe and moderate stunting was reduced from a combined total of 54.8% to 7.7% and 12.8% respectively. Severe and moderate wasting was reduced from 29.1% to 2.6% and 5.1% respectively. Three groups of NS children were identified and compared in the review; Low seizure occurrence averaging <2 seizures/month (28.1%); Moderate averaging 2-4 seizures/month (34.4%) and High averaging >4 seizures/month (37.5%). Conclusion: NS is a neurological disorder of unknown etiology. Treatment with regular high quality local nutrition, multivitamin supplementation, anti-seizures, regular follow up and illness prevention; children's seizures can be reduced or stopped completely. The debilitating malnutrition and stunting of NS children in Uganda could be partially independent of the syndrome but attributable to poor nutrition. NS as observed is not "invariably fatal" but rather a treatable neurological disorder.


Assuntos
Síndrome do Cabeceio/terapia , Apoio Nutricional/métodos , Convulsões/etiologia , Vitaminas/administração & dosagem , Adolescente , Criança , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/terapia , Humanos , Masculino , Síndrome do Cabeceio/epidemiologia , Síndrome do Cabeceio/reabilitação , Estudos Retrospectivos , Convulsões/epidemiologia , Convulsões/terapia , Resultado do Tratamento , Uganda/epidemiologia , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/etiologia , Síndrome de Emaciação/terapia
6.
BMC Res Notes ; 11(1): 118, 2018 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-29426366

RESUMO

OBJECTIVES: Severely undernourished young children clinically present with a typical nutritional oedema or none-oedematous. However, research evidence is limited on how these types predict treatment outcomes in Ethiopia. This study was aimed to compare oedematous and none-oedematous children for their treatment outcomes in Boloso Sore district in Southwest Ethiopia. RESULTS: The overall recovery rate was 396 (68%). From oedematous children; 235 (79.9%) recovered, 18 (6.1%) transferred, 6 (2.0%) defaulted, 3 (1.0%) died, and 32 (11%) remained none-respondents. The treatment outcomes among the none-oedematous children were 161 (55.9%), 12 (4.2%), 4 (1.4%), 3 (1.0%), and 108 (37.5%) in similar order. Treatment outcomes of severely undernourished children in the two arms were statistically different (Χ2 = 5.82, P < 0.016). Severely malnourished children with oedema were 2.3 times highly likely to recover as compared to those without it (adjusted hazard ratio = 2.3 at 95% confidence interval: 1.79, 2.82). We documented that oedematous children in the study area had a better likelihood of recovery as compared to those with severe wasting. We recommend targeted community outreach activities on severe acute malnutrition focusing on the types.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Transtornos da Nutrição Infantil/terapia , Edema/terapia , Síndrome de Emaciação/terapia , Doença Aguda , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Edema/epidemiologia , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pacientes Ambulatoriais , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome de Emaciação/epidemiologia
7.
Hum Gene Ther ; 29(3): 390-399, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28967304

RESUMO

Striated muscle wasting occurs with a variety of disease indications, contributing to mortality and compromising life quality. Recent studies indicate that the recombinant adeno-associated virus (serotype 6) Smad7 gene therapeutic, AVGN7, enhances skeletal and cardiac muscle mass and prevents cancer-induced wasting of both tissues. This is accomplished by attenuating ActRIIb intracellular signaling and, as a result, the physiological actions of myostatin and other ActRIIb ligands. AVGN7 also enhances isolated skeletal muscle twitch force, but is unknown to improve systemic muscle function similarly, especially exercise capacity. A 2-month-long dose-escalation study was therefore conducted using 5 × 1011, 1 × 1012, and 5 × 1012 vg/mouse and different tests of systemic muscle function. Body mass, skeletal muscle mass, heart mass, and forelimb grip strength were all increased in a dose-dependent manner, as was the fiber cross-sectional area of tibialis anterior muscles. Maximal oxygen consumption (VO2max), a measure of metabolic rate, was similarly enhanced during forced treadmill running, and although the total distance traveled was only elevated by the highest dose, all doses reduced the energy expenditure rate compared to control mice injected with an empty vector. Such improvements in VO2max are consistent with physiological cardiac hypertrophy, which is highly beneficial and a normal adaptive response to exercise. This was particularly evident at the lowest dose tested, which had minimal significant effects on skeletal muscle mass and/or function, but increased heart weight and exercise capacity. These results together suggest that AVGN7 enhances striated muscle mass and systemic muscle function. They also define minimally effective and optimal doses for future preclinical trials and toxicology studies and in turn will aid in establishing dose ranges for clinical trials.


Assuntos
Dependovirus , Terapia Genética , Força Muscular , Músculo Esquelético , Condicionamento Físico Animal , Proteína Smad7 , Animais , Camundongos , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiopatologia , Doenças Musculares/genética , Doenças Musculares/fisiopatologia , Doenças Musculares/terapia , Consumo de Oxigênio , Proteína Smad7/biossíntese , Proteína Smad7/genética , Síndrome de Emaciação/genética , Síndrome de Emaciação/fisiopatologia , Síndrome de Emaciação/terapia
8.
Nutr Clin Pract ; 33(3): 397-403, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28659014

RESUMO

Pediatric heart failure is a complex disease occurring when cardiac output is unable to meet the metabolic demands of the body. With improved surgical interventions and medical therapies, survival rates have improved, and care has shifted from focusing on survival to optimizing quality of life and health outcomes. Based on current literature, this review addresses the nutrition needs of infants and children in heart failure and describes the pathophysiology and metabolic implications of this disease. The prevalence of wasting in pediatric heart failure has been reported to be as high as 86%, highlighting the importance of nutrition assessment through all stages of treatment to provide appropriate intake of energy, protein, and micronutrients. The etiology of malnutrition in pediatric heart failure is multifactorial and involves hypermetabolism, decreased intake, increased nutrient losses, inefficient utilization of nutrients, and malabsorption. Children in heart failure often present with tachypnea, tachycardia, fatigue, nausea, and vomiting and consequently may not be able to meet their nutrition requirements through oral intake alone. Nutrition support, including enteral nutrition and parenteral nutrition, should be considered an essential part of routine care. The involvement of multiple allied health professionals may be needed to create a feeding therapy plan to support patients and their families. With appropriate nutrition interventions, clinical outcomes and quality of life can be significantly improved.


Assuntos
Nutrição Enteral , Insuficiência Cardíaca/terapia , Avaliação Nutricional , Nutrição Parenteral , Síndrome de Emaciação/epidemiologia , Adolescente , Cálcio na Dieta/administração & dosagem , Criança , Pré-Escolar , Proteínas na Dieta/administração & dosagem , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Magnésio/administração & dosagem , Desnutrição/fisiopatologia , Micronutrientes/administração & dosagem , Necessidades Nutricionais , Estado Nutricional , Pediatria , Qualidade de Vida , Vitamina D/administração & dosagem , Síndrome de Emaciação/terapia
9.
J Cachexia Sarcopenia Muscle ; 8(6): 870-880, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29168628

RESUMO

Wasting embraces muscle and tissue wasting in sarcopenia and cachexia. This article describes recent advances in the field published in the Journal of Cachexia, Sarcopenia and Muscle concerning diagnostic tools, biomarker development, pathophysiology, and treatment. Studies discussed herein embrace those on sarcopenia and cachexia in heart failure, chronic obstructive pulmonary disease, and cancer including also animal models.


Assuntos
Caquexia/diagnóstico , Caquexia/etiologia , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Síndrome de Emaciação/diagnóstico , Síndrome de Emaciação/etiologia , Animais , Caquexia/epidemiologia , Caquexia/terapia , Modelos Animais de Doenças , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/metabolismo , Humanos , Neoplasias/complicações , Neoplasias/etiologia , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Respiração Artificial/efeitos adversos , Sarcopenia/epidemiologia , Sarcopenia/terapia , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/terapia
10.
Clin Nutr ; 36(3): 663-671, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27371993

RESUMO

BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is the depletion of protein/energy stores observed in the most advanced stages of Chronic Kidney Disease (CKD). PEW is highly prevalent among patients on chronic dialysis, and is associated with adverse clinical outcomes, high morbidity/mortality rates and increased healthcare costs. This narrative review was aimed at exploring the pathophysiology of PEW in end-stage renal disease (ESRD) on hemodialysis. The main aspects of nutritional status evaluation, intervention and monitoring in this clinical setting were described, as well as the current approaches for the prevention and treatment of ESRD-related PEW. METHODS: An exhaustive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, nutritional intervention and outcome of PEW in ESRD on hemodialysis. RESULTS AND CONCLUSION: The pathogenesis of PEW is multifactorial. Loss of appetite, reduced intake of nutrients and altered lean body mass anabolism/catabolism play a key role. Nutritional approach to PEW should be based on a careful and periodic assessment of nutritional status and on timely dietary counseling. When protein and energy intakes are reduced, nutritional supplementation by means of specific oral formulations administered during the hemodialysis session may be the first-step intervention, and represents a valid nutritional approach to PEW prevention and treatment since it is easy, effective and safe. Omega-3 fatty acids and fibers, now included in commercially available preparations for renal patients, could lend relevant added value to macronutrient supplementation. When oral supplementation fails, intradialytic parenteral nutrition can be implemented in selected patients.


Assuntos
Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Apoio Nutricional , Desnutrição Proteico-Calórica/epidemiologia , Desnutrição Proteico-Calórica/terapia , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/terapia , Composição Corporal , Índice de Massa Corporal , Comorbidade , Bases de Dados Factuais , Fibras na Dieta/administração & dosagem , Suplementos Nutricionais , Exercício , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Estilo de Vida , Avaliação Nutricional , Estado Nutricional , Guias de Prática Clínica como Assunto , Diálise Renal/efeitos adversos
11.
Nephrol Dial Transplant ; 32(7): 1127-1136, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27208727

RESUMO

The number of older people on dialysis is increasing, along with a need to develop specialized health care to manage their needs. Aging-related changes occur in physiological, psychosocial and medical aspects, all of which present nutritional risk factors ranging from a decline in metabolic rate to assistance with feeding-related activities. In dialysis, these are compounded by the metabolic derangements of chronic kidney disease (CKD) and of dialysis treatment per se, leading to possible aggravation of protein-energy wasting syndrome. This review discusses the nutritional derangements of the older patient on dialysis, debates the need for specific renal nutrition guidelines and summarizes potential interventions to meet their nutritional needs. Interdisciplinary collaborations between renal and geriatric clinicians should be encouraged to ensure better quality of life and outcomes for this growing segment of the dialysis population.


Assuntos
Estado Nutricional , Desnutrição Proteico-Calórica/terapia , Qualidade de Vida , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/terapia , Síndrome de Emaciação/terapia , Idoso , Humanos , Desnutrição Proteico-Calórica/etiologia , Insuficiência Renal Crônica/complicações , Síndrome de Emaciação/etiologia
14.
Curr Opin Clin Nutr Metab Care ; 19(3): 182-7, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26910194

RESUMO

PURPOSE OF REVIEW: Regardless of the underlying cause, skeletal muscle wasting is detrimental for a person's life quality, leading to impaired strength, locomotion, and physiological activity. Here, we propose a series of studies presenting tissue engineering-based approaches to reconstruct artificial muscle in vitro and in vivo. RECENT FINDINGS: Skeletal muscle tissue engineering is attracting more and more attention from scientists, clinicians, patients, and media, thanks to the promising results obtained in the last decade with animal models of muscle wasting. The use of novel and refined biomimetic scaffolds mimicking three-dimensional muscle environment, thus supporting cell survival and differentiation, in combination with well characterized myogenic stem/progenitor cells, revealed the noteworthy potential of these technologies for creating artificial skeletal muscle tissue. In vitro, the production of three-dimensional muscle structures offer the possibility to generate a drug-screening platform for patient-specific pharmacological treatment, opening new frontiers in the development of new compounds with specific therapeutic actions. In vivo, three-dimensional artificial muscle biomimetic constructs offer the possibility to replace, in part or entirely, wasted muscle by means of straight reconstruction and/or by enhancing endogenous regeneration. SUMMARY: Reports of tissue engineering approaches for artificial muscle building appeared in large numbers in the specialized press lately, advocating the suitability of this technology for human application upon scaling up and a near future applicability for medical care of muscle wasting. VIDEO ABSTRACT: http://links.lww.com/COCN/A9


Assuntos
Músculo Esquelético , Engenharia Tecidual/métodos , Síndrome de Emaciação/terapia , Animais , Regeneração Tecidual Guiada/métodos , Regeneração Tecidual Guiada/tendências , Humanos , Engenharia Tecidual/tendências , Síndrome de Emaciação/fisiopatologia , Síndrome de Emaciação/cirurgia
16.
Saudi Med J ; 37(3): 293-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26905352

RESUMO

OBJECTIVES: To evaluate the nutritional status, to screen for the presence of malnutrition, and to study the possible risk factors associated with malnutrition in patients with cystic fibrosis (CF). METHODS: A retrospective cross-sectional review of medical records of all diagnosed CF patients in the Pediatric Department, Salmaniya Medical Complex, Manama, Kingdom of Bahrain, between January 1984 and May 2015 was conducted. Demographic and anthropometric data were collected from records of last visit to CF clinic. Nutritional status and risk factors of malnutrition were assessed. RESULTS: All records of 109 CF patients were reviewed. Forty-seven pediatric patients were included in the study. All included patients were on pancreatic enzyme replacement and 42 (89%) received high-calorie supplementation. Growth failure was noted in 34 (72%) patients, 19 (56%) were wasted and stunted, 8 (23.5%) were wasted only, and 7 (20.5%) were stunted. Low birth weight (p=0.032), and the presence of gastroesophageal reflux disease (GERD) (p=0.039) were the significant risk factors for malnutrition. CONCLUSIONS: Most CF patients in Bahrain (72%) are malnourished. Low birth weight and the presence of GERD are risk factors.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Fibrose Cística/epidemiologia , Suplementos Nutricionais , Terapia de Reposição de Enzimas , Refluxo Gastroesofágico/epidemiologia , Transtornos do Crescimento/epidemiologia , Síndrome de Emaciação/epidemiologia , Adolescente , Barein/epidemiologia , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Estudos Transversais , Fibrose Cística/terapia , Feminino , Transtornos do Crescimento/terapia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Avaliação Nutricional , Estado Nutricional , Estudos Retrospectivos , Fatores de Risco , Síndrome de Emaciação/terapia
17.
Nephrol Dial Transplant ; 31(7): 1070-7, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-25910496

RESUMO

Muscle wasting (or sarcopenia) is a common feature of the uremic phenotype and predisposes this vulnerable patient population to increased risk of comorbid complications, poor quality of life, frailty and premature death. The old age of dialysis patients is in addition a likely contributor to loss of muscle mass. As recent evidence suggests that assessment of muscle strength (i.e. function) is a better predictor of outcome and comorbidities than muscle mass, this opens new screening, assessment and therapeutic opportunities. Among established treatment strategies, the benefit of resistance exercise and endurance training are increasingly recognized among nephrologists as being effective and should be promoted in sedentary chronic kidney disease patients. Testosterone and growth hormone replacement appear as the most promising among emerging treatments strategies for muscle wasting. As treatment of muscle wasting is difficult and seldom successful in this often old, frail, sedentary and exercise-hesitant patient group, novel treatment strategies are urgently needed. In this review, we summarize recent studies on stimulation of mitochondrial biogenesis, myogenic stem (satellite) cells and manipulation of transforming growth factor family members, all of which hold promise for more effective therapies to target muscle mass loss and function in the future.


Assuntos
Falência Renal Crônica/complicações , Mortalidade Prematura , Síndrome de Emaciação/terapia , Humanos , Síndrome de Emaciação/mortalidade
18.
JPEN J Parenter Enteral Nutr ; 40(4): 475-86, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-25634161

RESUMO

Heart failure is a growing public health concern. Advanced heart failure is frequently associated with severe muscle wasting, termed cardiac cachexia This process is driven by systemic inflammation and tumor necrosis factor in a manner common to other forms of disease-related wasting seen with cancer or human immunodeficiency virus. A variable degree of malnutrition is often superimposed from poor nutrient intake. Cardiac cachexia significantly decreases quality of life and survival in patients with heart failure. This review outlines the evaluation of nutrition status in heart failure, explores the pathophysiology of cardiac cachexia, and discusses therapeutic interventions targeting wasting in these patients.


Assuntos
Caquexia/complicações , Insuficiência Cardíaca/complicações , Desnutrição/complicações , Apetite , Caquexia/terapia , Metabolismo Energético , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Resistência à Insulina , Desnutrição/epidemiologia , Miocárdio/metabolismo , Estado Nutricional , Qualidade de Vida , Fator de Necrose Tumoral alfa/fisiologia , Síndrome de Emaciação/complicações , Síndrome de Emaciação/fisiopatologia , Síndrome de Emaciação/terapia
19.
Artigo em Inglês | MEDLINE | ID: mdl-26544599

RESUMO

In cancer patients, oral nutrition is the preferred route of feeding since it is a significant part of the patient's daily routine and contributes to the patient's autonomy. It represents a privileged time to spend with family and friends, avoiding the tendency for isolation in these patients. The acknowledgement that the prescribed diet is individualized, adapted and adequate to individual needs empowers the patient with a feeling of control, and thus it is also a highly effective approach of psychological modulation. All these factors may potentially contribute to improve the patient's quality of life and may modulate treatment morbidity. The referral to a nutrition professional responsible for the individualized dietary counseling should always be based on evidence-based decision-making plans. The implementation of individualized nutritional counseling should consider the common causes for a poor nutritional intake in elderly cancer patients. A proper approach through counseling requires professionals with specific experience in both nutrition and oncology. Oral nutritional supplements are a simple and practical way to meet nutritional requirements when normal food intake is compromised. Ideally, oral nutritional supplements should be in addition to and not instead of meals. Supplements should be administered at a time which does not interfere with the appetite of the patient. The administration after the meal theoretically potentiates the anabolic effect on protein metabolism. Supplements with high energy density (>1 kcal/ml) or enriched with ω-3 fatty acid are probably the most effective.


Assuntos
Neoplasias/dietoterapia , Necessidades Nutricionais , Estado Nutricional , Tecido Adiposo/metabolismo , Aconselhamento , Suplementos Nutricionais , Ingestão de Energia , Humanos , Metabolismo dos Lipídeos/fisiologia , Neoplasias/complicações , Nutricionistas , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome de Emaciação/etiologia , Síndrome de Emaciação/terapia
20.
Curr Opin Clin Nutr Metab Care ; 18(5): 501-7, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26164328

RESUMO

PURPOSE OF REVIEW: The purpose of this study was to review the most recent findings on approaches to managing the obesity and muscle wasting that are found in patients before and after liver transplantation. RECENT FINDINGS: A number of articles have contributed to the accumulating evidence that morbid obesity is not an absolute contraindication to liver transplantation with survival outcomes similar across BMI groups. Obesity is, however, a risk factor for early post-transplant complications and obesity-related comorbidities markedly increase this risk. Very limited data are as yet available, dietary, or otherwise, related to amelioration of these comorbidities and evidence that weight loss leads to improved outcomes in obese patients is lacking. Abdominal computed tomography imaging is increasingly being used to identify muscle wasting, and poorer post-transplant survival is seen in patients with significant muscle wasting. This modality has confirmed the persistence of depleted muscle stores after transplant extending well beyond 1 year. Coupled with this is a high incidence of weight gain and metabolic syndrome and the associated risks. Although dietary intervention and exercise are considered possible approaches to address these issues, work in these areas so far is sparse. SUMMARY: An urgent need exists for interventional studies on the basis of nutrition and/or exercise to address the challenges presented by both obesity and muscle wasting, which likely coexist in many patients in both the pretransplant and the post-transplant periods.


Assuntos
Transplante de Fígado/efeitos adversos , Estado Nutricional , Obesidade/complicações , Síndrome de Emaciação/complicações , Índice de Massa Corporal , Comorbidade , Dietoterapia , Terapia por Exercício , Humanos , Incidência , Transplante de Fígado/mortalidade , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Obesidade/terapia , Fatores de Risco , Síndrome de Emaciação/terapia , Ganho de Peso
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