scholarly journals Impact of protein energy malnutrition on thyroid size in an iodine deficient population of Gujarat (India): Is it an aetiological factor for goiter?

2001 ◽  
pp. 11-17 ◽  
Author(s):  
SR Brahmbhatt ◽  
RM Brahmbhatt ◽  
SC Boyages
Keyword(s):  
Negative Correlation ◽  
Protein Energy Malnutrition ◽  
Linear Regression Analysis ◽  
Thyroid Volume ◽  
World Health ◽  
Aetiological Factor ◽  
Anthropometric Parameters ◽  
Thigh Circumference ◽  
Protein Energy ◽  
The Impact

OBJECTIVE: To assess the severity of protein energy malnutrition (PEM) in iodine deficient subjects and to assess the impact of PEM on thyroid size. METHODS: 1002 subjects (530 school-aged children and 472 adults) were assessed for PEM by direct anthropometric measurements of height, weight, triceps skinfold (TSF) thickness, mid upper arm circumference (MUAC) and thigh circumference (TC), and derived indices of body surface area (BSA), body mass index (BMI), and Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Severity of PEM was based on the World Health Organization (WHO) criteria and the threshold on the Waterlow classification. Thyroid size was measured by ultrasonography to determine the thyroid volume (TV). Linear regression analysis was performed between TV and anthropometric parameters. RESULTS: Children had severe PEM as evident from the WHO percentage prevalence of stunting (HAZ<-2SD)=64% (where <-2SD is the Z-score deficit), wasting (WHZ<-2SD)=43%, underweight (WAZ<-2SD)=82% and BMI<16 kg/m=90%. Waterlow classification showed that children were either stunted or wasted, or stunted and wasted, or stunted and obese. Nearly 100% (529/530) of the children had goiter as evidenced from enlarged TV-for-BSA when compared with the WHO reference. There was a weak but statistically significant (P<0.05) positive correlation between TV and BSA, weight, height, MUAC, TC and HAZ but a negative correlation between TV and WHZ, BMI and TSF (r=-0.1-0.2). Adults had PEM as evident from BMI<18.5 kg/m in 54% subjects. Median MUAC=22.7 cm reveals prolonged severe PEM. Eighty-two percent had enlarged TV (>20 ml). There was a significant (P=0.01) negative correlation between TV and MUAC. CONCLUSIONS: (i) The severity of acute (wasting) and chronic (stunting) PEM is very high in Gujarati children. They are stunted or wasted, or stunted and wasted, or stunted and obese. Gujarati adults are thin with low protein and fat reserves. (ii) Anthropometric parameters showed a significant (P<0.001) correlation (r=0.1-0.2) with thyroid size. (iii) Higher prevalence of goiter may be due to macro-nutrient malnutrition (PEM) in the face of micro-nutrient malnutrition (iodine deficiency disorders, IDD).

scholarly journals Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

2019 ◽  
Vol 45 (3) ◽  
pp. 640-660 ◽  
Author(s):  
Johanna T. Dwyer ◽  
Jaime J. Gahche ◽  
Mary Weiler ◽  
Mary Beth Arensberg
Keyword(s):  
Older Adults ◽  
Predictive Validity ◽  
Screening Tool ◽  
Protein Energy Malnutrition ◽  
The United States ◽  
Community Dwelling ◽  
Screening Tools ◽  
World Health ◽  
Community Settings ◽  
Protein Energy

Abstract Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

scholarly journals 3423 Poorer Outcomes Among Septic Patients with Protein Energy Malnutrition

2019 ◽  
Vol 3 (s1) ◽  
pp. 124-124
Author(s):  
Adeyinka Charles Adejumo ◽  
Olalekan Akanbi ◽  
Lydie Pani
Keyword(s):  
Clinical Outcomes ◽  
Primary Care Physicians ◽  
Protein Energy Malnutrition ◽  
Community Dwelling ◽  
P Value ◽  
Protein Energy ◽  
Propensity Matching ◽  
Study Population ◽  
Clinical Conditions ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Protein Energy Malnutrition (PEM) could compromise the body’s defense systems resulting in sepsis, which further depletes calorie stores. Among hospitalized patients, we investigate 1) the relationship between PEM and sepsis, 2) the impact of PEM on trends in mortality from sepsis, and 3) the influence of PEM on clinical outcomes of sepsis. METHODS/STUDY POPULATION: Using the 2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) patient’s discharge records, we identified patients with sepsis, PEM, and other clinical conditions with ICD-9-CM codes. After stratifying sepsis into two: uncomplicated (without shock) and complicated (with shock), we estimated the adjusted odds (aOR) of developing sepsis (total, uncomplicated and complicated) with PEM. Then, we selected hospitalizations with sepsis from 2007-2014 years of the HCUP-NIS, and calculated the trend in mortality from sepsis, stratified by PEM status, as an effect modifier. Finally, we matched PEM to no PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the effect of having mortality, complicated sepsis and 10 other clinical outcomes and healthcare utilization (SAS 9.4). RESULTS/ANTICIPATED RESULTS: PEM was associated with higher odds for sepsis (aOR:3.97[3.89-4.05]), and complicated vs. uncomplicated sepsis (1.74[1.67-1.81]). Although mortality in sepsis has been trending down from 2007-2014 (−1.19%/year, p-trend<0.0001), the decrease was less pronounced among those with PEM vs. no-PEM (−0.86%/year vs. −1.29%/year, p-value < 0.0001). After propensity matching, PEM was associated with higher mortality (1.35[1.32-1.37]), cost ($160,724[159,517-161,940] vs. $86,650[85,931-87,375]), length of stay (14.76[14.68-14.84] vs. 8.49[8.45-8.56] days), and worse outcomes in general. DISCUSSION/SIGNIFICANCE OF IMPACT: PEM is a risk factor of sepsis and associated with poorer outcomes among septic patients. A concerted effort involving primary care physicians, nutritionists, nurses in identifying, preventing, and treatment of PEM in the community-dwelling individuals before hospitalization might mitigate against these devastating outcomes.

scholarly journals Study on impact of protein energy malnutrition on development in children

2019 ◽  
Vol 6 (6) ◽  
pp. 2566
Author(s):  
Dhara Patel ◽  
Greeshma Issac
Keyword(s):  
Protein Energy Malnutrition ◽  
Fine Motor ◽  
Maximum Effect ◽  
P Value ◽  
Normal Children ◽  
Social Domain ◽  
Gross Motor ◽  
Protein Energy ◽  
Grade 3 ◽  
The Impact

Background: Majority of the children in India who live below the poverty line in an environment of deprivation and starvation have physical and developmental retardation. The Objective of this study to study the impact and comparison of protein energy malnutrition on the development with normal children.Methods: This was a hospital based cross sectional study in which total 128 cases of protein energy malnutrition and 30 normal children were enrolled from nutritional rehabilitation center and in patients wards. The study population comprised of children less than 5 years of age, having weight for height/length ≤3 SD, with visible wasting, or bipedal oedema, with mid arm circumference <11.5 cm were assessed for their development in all four domains using Denver II developmental Screening Test (DDST-II).Results: The gross motor milestones are affected in 62.5% with grade4 PEM & 42.85% with grade 3, the fine motor component is affected more in grade 4 with other domains less affected, no significant relation of language delay with PEM was observed in this study, 40% of children with grade 4 PEM shows delay in social domain while 18.18% of the patients with grade 3 PEM show delay in social domain. No patients with grade 1 or grade 2 PEM showed delay in social domain. All four domains are affected in PEM with a maximum effect in gross motor, but the difference does not seem to be significant as the p value is 0.3 i.e.  >0.05 which is insignificant.Conclusions: My study on the effect of protein energy malnutrition on development proves that there in increasing delay in all the domains of development with increasing grade of malnutrition. Early detection of malnutrition in community can cause early intervention and increase the productivity of nation.

EFFECTIVENESS OF STRUCTURED NURSING INTERVENTION ON NUTRITIONAL STATUS OF UNDERFIVE CHILDREN, KNOWLEDGE AND PRACTICE OF MOTHERS REGARDING THE PREVENTION AND MANAGEMENT OF PROTEIN ENERGY MALNUTRITION IN SELECTED COASTAL VILLAGES OF KERALA.

2021 ◽  
pp. 57-59
Author(s):  
Lija R Nath
Keyword(s):  
Nutritional Status ◽  
Protein Energy Malnutrition ◽  
Nursing Intervention ◽  
P Value ◽  
Anthropometric Parameters ◽  
Knowledge Questionnaire ◽  
Protein Energy ◽  
Childhood Morbidity ◽  
Post Test ◽  
Knowledge And Practice

Malnutrition is not only an important cause of childhood morbidity and mortality, but leads also to permanent impairment of physical and possibly, of mental growth of those who survive. The study was carried out to nd out the effectiveness of structured nursing intervention on nutritional status of underve children, knowledge and practice of mothers regarding prevention and management of malnutrition in selected coastal villages of Kerala. Samples consisted of 122 underve children who were identied with different degrees of malnutrition and their mothers. Pre experimental study design was used. Anthropometric parameters (Weight, Height, MUAC) were checked. Structured knowledge questionnaire and practice check list were used to measure the knowledge and practice of mothers related to the prevention and management of malnutrition. All the measurements were carried out once before the Structured Nursing Intervention and three times after the intervention. Structured Nursing Intervention was found to be effective in improving the knowledge and practice of mothers related to prevention and management of malnutrition among underve children (p < 0.001). Percentage of grade I malnutrition reduced from 83.6% in pre test to 63.69% in post test III. Z test was carried out and it was concluded that Structured Nursing Intervention had signicant inuence on the nutritional status of underve children (Z = 3.33**, p value <0.01).

Anaemia as a challenge to world health

2020 ◽  
pp. 5366-5371
Author(s):  
David J. Roberts ◽  
David J. Weatherall
Keyword(s):  
Chronic Infection ◽  
Protein Energy Malnutrition ◽  
Tropical Sprue ◽  
Reproductive Age ◽  
World Health ◽  
Nutritional Deficiencies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Protein Energy ◽  
Glucose 6 Phosphate Dehydrogenase

Anaemia is a very common problem in low- and middle-income countries (LMICs): 27% of the world’s population or 1.93 billion people are affected by anaemia (2013) and more than 90% of people with anaemia live in the developing world. Preschool children and women of reproductive age are particularly affected by anaemia and more 60% of anaemia is caused by iron deficiency. Causes of anaemia in LMICs—this is often multifactorial, with causes including (1) nutritional deficiencies—iron, folate, vitamin B12; (2) chronic infection—including malaria, tuberculosis, AIDS; (3) blood loss—hookworm, schistosomiasis; (4) protein–energy malnutrition; (5) malabsorption—for example, tropical sprue; (6) hereditary—for example, thalassaemias, haemoglobin variants, glucose-6-phosphate dehydrogenase deficiency. A series of vicious cycles exist in LMICs—maternal anaemia due to iron or folate deficiency and chronic malaria is associated with the birth of underweight infants who frequently have low iron stores, may also be folate deplete, and are usually anaemic from about 6 months of age. Such infants are prone to infection, particularly gastrointestinal, and may be further depleted of iron or folate by inappropriately prolonged breastfeeding or weaning onto an inadequate diet. They are exposed to hookworm infection as soon as they start to crawl, malaria becomes an important problem after 6 months, and in many populations the increasingly common haemoglobinopathies are a further cause of anaemia after the first few months of life.

scholarly journals 3417 Impact of Protein-Energy Malnutrition on Outcomes of Heart Failure Hospitalizations

2019 ◽  
Vol 3 (s1) ◽  
pp. 123-123
Author(s):  
Adeyinka Charles Adejumo ◽  
Olumuyiwa Ogundipe
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Protein Energy Malnutrition ◽  
Low Grade ◽  
Protein Energy ◽  
The Us ◽  
Study Population ◽  
Comorbidity Index ◽  
The Impact ◽  
Low Grade Inflammation

OBJECTIVES/SPECIFIC AIMS: Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. METHODS/STUDY POPULATION: From the 2012-2014 Nationwide Inpatient Sample (NIS) patient’s discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). RESULTS/ANTICIPATED RESULTS: There were 32,771 (~163,885) cases of PEM among the 541,679 (~2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs. no-PEM:72 years), Whites (70.75% vs. 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs. 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48[2.31-2.66]), cardiogenic shock (3.11[2.79-3.46]), cardiac arrest (2.30[1.96-2.70]), acute kidney failure (1.49[1.44-1.54]), acute respiratory failure (1.57[1.51-1.64]), mechanical ventilation (2.72[2.50-2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17-2.31]), hospital cost ($80,534[78,496-82,625] vs. $43,226[42,376-44,093]) and longer duration of admission (8.61[8.49-8.74] vs. 5.28[5.23-5.34] days). DISCUSSION/SIGNIFICANCE OF IMPACT: In the US, PEM is a common comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in heart failure subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.

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