Oral Nutritional Supplementation Improves Growth in Children at Malnutrition Risk and with Picky Eating Behaviors

The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (<5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery; oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were >24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC; ONS2 + DC; and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p < 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p < 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.

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Association between oral nutritional supplementation and clinical and nutritional outcomes in the management of hospital malnutrition

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcshci.v11i4.1147 ◽

2021 ◽

Vol 11 (4) ◽

pp. 46-52

Author(s):

Ayla Nauane Ferreira dos Santos ◽

Kamila Luana do Nascimento Silva ◽

Vinícius Eponina dos Santos ◽

Ranna Adrielle Lima Santos ◽

Vivianne de Sousa Rocha

Keyword(s):

Nutritional Assessment ◽

Nutritional Supplement ◽

Nutritional Intervention ◽

Nutritional Supplementation ◽

University Hospital ◽

Nutritional Risk ◽

Hospital Malnutrition ◽

Significant Difference ◽

Oral Nutritional Supplements ◽

Nutritional Outcomes

Objective: To evaluate the association between oral nutritional supplementation and clinical and nutritional outcomes in the management of hospital malnutrition. Methods: This is a longitudinal observational study conducted by collecting electronic medical records of patients admitted to a university hospital between 2019 and 2020. Malnourished adult and elderly patients, who have been eating exclusively orally and using a nutritional supplement, were included.Sociodemographic, clinical, biochemical, nutritional risk, nutritional assessment, acceptance of nutritional prescription and characteristics of the nutritional supplement used were analyzed. An α = 5% was considered. Results: Forty patients were evaluated, most of them elderly and male. Among the oral nutritional supplements, the high-calorie and high-protein types were more prevalent, with an offer twice a day, average use of 39 days, and total acceptance of the nutritional prescription by only 30% of the patients. This nutritional intervention resulted in a slight improvement in anthropometric data, with no significant difference. Conclusion: Using the oral nutritional supplement for a longer period and better adherence would possibly present greater nutritional benefits to patients.

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Oral Nutritional Supplementation in Picky Eating Children (P11-114-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-114-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Deepti Khanna ◽

Menaka Yalawar ◽

Gaurav Verma ◽

Geraldine Baggs ◽

Amy Devitt ◽

...

Keyword(s):

Eating Behaviors ◽

Growth Parameters ◽

Double Blind Study ◽

Double Blind ◽

Dietary Counseling ◽

Picky Eating ◽

Dietary Recall ◽

Oral Nutritional Supplements ◽

Height For Age ◽

Weight For Age

Abstract Objectives This was a multicenter prospective randomized double-blind study with two parallel experimental groups (EXP GRPS) & an open-labeled control grp (CON). Objective was to investigate the effect of two oral nutritional supplements (ONS) along with dietary counseling (DC) vs DC alone on growth among picky eating children from India, aged > 24 m to ≤ 48 m over 90 days. Methods Study recruited 321 children [n = 107/grp] in ages mentioned above from urban/semi-urban India with a weight-for-height between 3rd–15th centile (WHO 2006) and picky eating behaviors. Subjects in the 2 EXP GRPS received a daily supplement of one of the two similar ONS [Pediasure (PDS) & Pediasure Advance (PDS Adv)} along with DC for 90 days, whereas subjects in CON received only DC. Children in both EXP GRPS consumed min of 1 & max to 2 servings of ONS/day & there were 5 study visits (Day 1, 7, 30, 60, 90). Primary variable was the change in WHO weight-for-height centile from Day 1 to 90. Secondary variables included change in weight-for-age, height-for-age, BMI-for-age, MUAC-for-age, average intake of energy, macros & micronutrients (using 24 hr. dietary recall) and change in appetite & palatability score. Results Post 90 days, both EXP GRPS had significantly higher change in growth parameters like weight-for-height centile (P = 0.0086), BMI-for-age centile (P = 0.0214 & P = 0.0203 for PDS & PDS Adv respectively) & weight-for-age centile (P = 0.0054) as compared to CON. PDS group reported a significant improvement in MUAC-for-age centile (P = 0.0241) vs CON post 90-days. Significant improvement in appetite score was reported by EXP GRPS (P = 0.0067 & P = 0.0245 for PDS & PDS Adv) vs CON. Significant improvement in avg. intake of energy, protein, fat, calcium, iron, vit C & thiamine was observed for EXP GRPS vs CON for all visit days except day1. Nutrient & energy intakes at baseline were lower than RDA's but ONS helped to fill the nutritional gaps at end of 90 days. There were no significant differences observed in the height-for-age and palatability score. Conclusions ONS's formulated with macro & micronutrients along with DC are more efficacious in catch up growth vs DC alone post 90 days supplementation. Funding Sources Abbott Nutrition has funded this study.

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Effect of 3-Month Lysine Supplementation on Growth and Muscle Function Parameters in Pre-pubertal Indian Girls

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2018.55.4.21632 ◽

2018 ◽

Vol 55 (4) ◽

pp. 423

Author(s):

Sejil T. Verghese ◽

Maria Pauline ◽

Arun Das ◽

Anura V. Kurpad

Keyword(s):

Muscle Strength ◽

Growth Parameters ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Dominant Hand ◽

Indian Children ◽

Significant Difference ◽

Height Gain ◽

Hand Dynamometer

Lysine is the limiting amino acid in the predominantly cereal and legume based typical Indian diet and its supplementation has been shown to positively affect muscle strength in short term adult and animal models; but similar studies are lacking in children. This study looked at the effect of a 3-month lysine and iron intervention on muscle strength and growth parameters in prepubertal Indian girls. The study was a randomized controlled trial conducted in 40 normal Indian girls in the 9-10 yrs age group. The control group received only iron (6.25mg) supplementation, while the intervention group received both iron and lysine supplementation that increased the lysine intake to 50mg/kg/day. Muscle strength was estimated in both upper limbs with a hand dynamometer and muscle endurance was estimated in the non-dominant hand. Height and weight were recorded to assess growth. A significant difference was seen in the increase in the non-dominant hand grip strength between the groups (intervention: 1.4 vs control: 0.2 kg, p=0.042) at the end of the study. There was a trend of increased height gain (about 25%) and weight gain (about 50%) in the intervention group compared to control group. Lysine supplementation for 3 months increased non-dominant forearm muscle strength in Indian children.

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Nutrition in Cancer Patients

Journal of Clinical Medicine ◽

10.3390/jcm8081211 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1211 ◽

Cited By ~ 14

Author(s):

Paula Ravasco

Keyword(s):

Quality Of Life ◽

Body Composition ◽

Boolean Function ◽

Nutritional Intervention ◽

Nutritional Risk ◽

Cochrane Library ◽

Body Composition Assessment ◽

First Choice ◽

Oral Nutritional Supplements

Background: Despite being recognised that nutritional intervention is essential, nutritional support is not widely accessible to all patients. Given the incidence of nutritional risk and nutrition wasting, and because cachexia management remains a challenge in clinical practice, a multidisciplinary approach with targeted nutrition is vital to improve the quality of care in oncology. Methods: A literature search in PubMed and Cochrane Library was performed from inception until 26 March. The search consisted of terms on: cancer, nutrition, nutritional therapy, malnutrition, cachexia, sarcopenia, survival, nutrients and guidelines. Key words were linked using “OR” as a Boolean function and the results of the four components were combined by utilizing the “AND” Boolean function. Guidelines, clinical trials and observational studies written in English, were selected. Seminal papers were referenced in this article as appropriate. Relevant articles are discussed in this article. Results: Recent literature supports integration of nutrition screening/assessment in cancer care. Body composition assessment is suggested to be determinant for interventions, treatments and outcomes. Nutritional intervention is mandatory as adjuvant to any treatment, as it improves nutrition parameters, body composition, symptoms, quality of life and ultimately survival. Nutrition counselling is the first choice, with/without oral nutritional supplements (ONS). Criteria for escalating nutrition measures include: (1) 50% of intake vs. requirements for more than 1–2 weeks; (2) if it is anticipated that undernourished patients will not eat and/or absorb nutrients for a long period; (3) if the tumour itself impairs oral intake. N-3 fatty acids are promising nutrients, yet clinically they lack trials with homogeneous populations to clarify the identified clinical benefits. Insufficient protein intake is a key feature in cancer; recent guidelines suggest a higher range of protein because of the likely beneficial effects for treatment tolerance and efficacy. Amino acids for counteracting muscle wasting need further research. Vitamins/minerals are recommended in doses close to the recommended dietary allowances and avoid higher doses. Vitamin D deficiency might be relevant in cancer and has been suggested to be needed to optimise protein supplements effectiveness. Conclusions: A proactive assessment of the clinical alterations that occur in cancer is essential for selecting the adequate nutritional intervention with the best possible impact on nutritional status, body composition, treatment efficacy and ultimately reducing complications and improving survival and quality of life.

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Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13093036 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3036

Author(s):

Zhiying Zhang ◽

Fei Li ◽

Bridget A. Hannon ◽

Deborah S. Hustead ◽

Marion M. Aw ◽

...

Keyword(s):

Systematic Review ◽

Repeated Measures ◽

Meta Analysis ◽

Intervention Group ◽

Nutritional Intervention ◽

Nutritional Risk ◽

Anthropometric Measures ◽

Oral Nutritional Supplements ◽

Z Scores ◽

Usual Diet

Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).

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Serum Thiamine Values in End-Stage Renal Disease Patients under Maintenance Hemodialysis

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000242 ◽

2015 ◽

Vol 85 (5-6) ◽

pp. 348-355 ◽

Cited By ~ 2

Author(s):

Masamitsu Ubukata ◽

Nobuyuki Amemiya ◽

Kosaku Nitta ◽

Takashi Takei

Keyword(s):

Thiamine Deficiency ◽

Risk Index ◽

Nutritional Risk ◽

Maintenance Hemodialysis ◽

Dialysis Patients ◽

Significant Difference ◽

Nutritional Risk Index ◽

Serum Aspartate Aminotransferase ◽

Stage Renal Disease ◽

End Stage

Abstract. Objective: Hemodialysis patients are prone to malnutrition because of diet or many uremic complications. The objective of this study is to determine whether thiamine deficiency is associated with regular dialysis patients. Methods: To determine whether thiamine deficiency is associated with regular dialysis patients, we measured thiamine in 100 patients undergoing consecutive dialysis. Results: Average thiamine levels were not low in both pre-hemodialysis (50.1 ± 75.9 ng/mL; normal range 24 - 66 ng/mL) and post-hemodialysis (56.4 ± 61.7 ng/mL). In 18 patients, post-hemodialysis levels of thiamine were lower than pre-hemodialysis levels. We divided the patients into two groups, the decrease (Δthiamine/pre thiamine < 0; - 0.13 ± 0.11) group (n = 18) and the increase (Δthiamine/pre thiamine> 0; 0.32 ± 0.21)) group (n = 82). However, there was no significance between the two groups in Kt/V or type of dialyzer. Patients were dichotomized according to median serum thiamine level in pre-hemodialysis into a high-thiamine group (≥ 35.5 ng/mL) and a low-thiamine group (< 35.4 ng/mL), and clinical characteristics were compared between the two groups. The low-thiamine value group (< 35.4 ng/ml; 26.8 ± 5.3 ng/ml) exhibited lower levels of serum aspartate aminotransferase and alanine aminotransferase than the high-thiamine value group (≥ 35.4 ng/ml; 73.5 ± 102.5 ng/ml) although there was no significance in nutritional marker, Alb, geriatric nutritional risk index , protein catabolic rate and creatinine generation rate. Conclusion: In our regular dialysis patients, excluding a few patients, we did not recognize thiamine deficiency and no significant difference in thiamine value between pre and post hemodialysis.

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Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Nutrients ◽

10.3390/nu13010057 ◽

2020 ◽

Vol 13 (1) ◽

pp. 57

Author(s):

Adam Brewczyński ◽

Beata Jabłońska ◽

Sławomir Mrowiec ◽

Krzysztof Składowski ◽

Tomasz Rutkowski

Keyword(s):

Head And Neck ◽

Nutritional Support ◽

Nutritional Intervention ◽

Nutritional Risk ◽

Percutaneous Gastrostomy ◽

Critical Weight ◽

Oncological Treatment ◽

Feeding Tubes ◽

Hpv Status ◽

Percutaneous Gastrostomy Tube

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.

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Outcome of nutritional intervention measures at a nutrition rehabilitation centre in Krishna district, Andhra Pradesh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20184782 ◽

2018 ◽

Vol 5 (12) ◽

pp. 5150

Author(s):

Deepthi Pagali ◽

Suneetha Bollipo ◽

Harsha B. Korrapolu ◽

Mohammed Abdul Rahman

Keyword(s):

Standard Deviation ◽

Severe Acute Malnutrition ◽

Nutritional Intervention ◽

High Rate ◽

Acute Malnutrition ◽

Rehabilitation Centre ◽

District Health ◽

Target Weight ◽

Significant Difference ◽

Nutrition Rehabilitation

Background: Nutrition rehabilitation centre (NRC) is a unit in a district health facility, where children with severe acute malnutrition are admitted and provided with nutritional and therapeutic care.Methods: Analysis of nutritional data of all the children admitted to NRC at Krishna district from January 2017 to July 2018. Statistical analysis was done using SPSS.Results: A total of 200 children were included in the study. The overall mean weight at admission was found to be 8.30 kg with a standard deviation of 2.35 kg and the mean weight at the time of discharge is 9.57 kg with a standard deviation of 2.61 kg. There is a statistically significant difference in weight and mid arm circumference at admission and discharge. Mean duration of hospital stay is around 18.67±5.4 days. Target weight is achieved in 71% of the study group.Conclusions: Present study reflects that NRCs have been playing a key role to cope up with the problem of severe acute malnutrition as demonstrated by a high rate of weight gain at discharge as well as during follow ups.

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Effect of BMI and Perceived Importance of Health on the Health Behavior of College Students: Cross-Sectional Study

Journal of Medical Internet Research ◽

10.2196/17640 ◽

2020 ◽

Vol 22 (6) ◽

pp. e17640

Author(s):

Wan-Chen Hsu ◽

Chia-Hsun Chiang

Keyword(s):

College Students ◽

Health Behavior ◽

Health Behaviors ◽

Eating Behaviors ◽

Cross Sectional Study ◽

Cross Sectional ◽

Exercise Behaviors ◽

Significant Difference ◽

Perceived Importance ◽

Perception Of Health

Background Both body mass index (BMI) and the perceived importance of health have received a lot of attention, but few studies have fully investigated the interaction of their effects on health behaviors. Objective This study investigates the effects of BMI and the perceived importance of health on health behaviors (patterns of eating, sleeping, and exercising) among college students in Taiwan. Methods A survey was conducted with 334 students to assess their perception of the importance of health (using indicators) and their health behavior (using the Health Behaviors Scale). Respondent BMI was calculated from self-reported body weight and height. Descriptive statistical analysis, independent t test analysis, two-way analysis of variance (ANOVA), and one-way ANOVA were conducted. Results The results showed a significant difference between genders in health behaviors among college students (eating: t332=2.17, P=.03; exercise: t332=5.57, P<.001; sleep: t332=2.58, P=.01). Moreover, there was an interaction between BMI and perception (of the importance of health) for exercise behaviors (F2,328=3.50, P=.03), but not for eating behaviors (F2,328=0.12, P=.89) or sleep behaviors (F2,328=1.64, P=.20). Conclusions This study establishes, for the first time, the interaction of BMI and the perceived importance of health on health behaviors. The perception of health was found to have a significant effect on exercise behaviors. Thus, the perception of health plays a significant role in the exercise behaviors of college students in Taiwan. This finding provides researchers, policy makers, and practitioners with evidence, and consequently, opportunities for focusing on preventive actions. The findings suggest that increasing the importance of health in the perception of college students, should be the focus of efforts to help students exercise more regularly.

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The Frequency of Malnutrition in Patients with Type 2 Diabetes

Medeniyet Medical Journal ◽

10.5222/mmj.2021.44270 ◽

2021 ◽

Author(s):

Miraç Vural Keskinler ◽

Güneş Feyizoğlu ◽

Kübra Yıldız ◽

Aytekin Oğuz

Keyword(s):

Type 2 Diabetes ◽

Outpatient Clinic ◽

High Body Mass Index ◽

Cross Sectional Study ◽

University Hospital ◽

Nutritional Risk ◽

Cross Sectional ◽

Significant Difference ◽

Nrs 2002

Objective: Obesity is one of the most common comorbidities of diabetes mellitus (DM) whose frequency is rapidly increasing nowadays. Although obesity caused by excessive and unbalanced nutrition often accompanies diabetes; malnutrition is another complication of diabetes. This study was conducted to investigate the frequency of malnutrition in individuals with diabetes. Method: This study is a cross-sectional study. The patients with type 2 diabetes followed up in the diabetes outpatient clinic of a university hospital between February and March 2018 were included in the study. Anthropometric measurements of the patients and “Nutritional Risk Screening-2002” (NRS-2002) scores were recorded. Results: A total of 222 (F: 132 59.4%) patients were included in the study. When two groups with higher NRS (≥3) and lower NRS (<3) scores less than 3 were compared, any significant difference was not detected between two groups in terms of age, waist circumference and HbA1c values. Only BMI was found to be lower in the group with malnutrition risk (p: 0.030). When the patients were evaluated in terms of diabetes treatments and risk of malnutrition, any significant intergroup difference was not found (p: 0.847). Conclusion: It was found that there is a risk of malnutrition in one of every seven diabetics with a high body mass index who were being followed up in the diabetes outpatient clinic.

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