Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders

Lactose malabsorption (LM), celiac disease (CD), non-celiac gluten sensitivity (NCGS), and irritable bowel syndrome (IBS) are conditions associated with food triggers, improvement after withdrawal, treatment with dietary restriction, and subsequent nutritional detriments. LM occurs when there is incomplete hydrolysis of lactose due to lactase deficiency and frequently produces abdominal symptoms; therefore, it can cause lactose intolerance (LI). A lactose-restricted diet is frequently recommended, although it can potentially lead to nutrient deficiencies. Furthermore, lactose is an essential component of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) and is subsequently associated with intolerance to these compounds, especially in IBS. LM commonly presents in CD. Nutritional deficits are common in CD and can continue even on a gluten-free diet (GFD). Conditions triggered by gluten are known as gluten-related disorders (GRDs), including CD, wheat allergy, and NCGS. IBS can also be associated with a gluten sensitivity. A GFD is the treatment for CD, GRDs, and gluten sensitive IBS, although compliance with this restricted diet can be difficult. Strict dietary therapies can have a negative effect on quality of life. This review aims to provide an overview of the difficult nutritional elements of these disorders, which are critical for medical providers to recognize when managing these patients.

Endoscopic Treatment of Obesity and Nutritional Aspects of Bariatric Endoscopy

Obesity is a significant problem worldwide. Several serious diseases that decrease patient quality of life and increase mortality (high blood pressure, dyslipidaemia, type 2 diabetes etc.) are associated with obesity. Obesity treatment is a multidisciplinary and complex process that requires maximum patient compliance. Change of lifestyle is fundamental in the treatment of obesity. While pharmacotherapeutic options are available, their efficacy is limited. Surgical treatment though highly effective, carries the risk of complications and is thus indicated mostly in advanced stages of obesity. Endoscopic treatments of obesity are less invasive than surgical options, and are associated with fewer complications and nutritional deficits. Currently, there is a large spectrum of endoscopic methods based on the principles of gastric volume reduction, size restriction and gastric or small bowel bypass being explored with only few available in routine practice. The aim of this publication is to present an up-to-date summary of available endoscopic methods for the treatment of obesity focusing on their efficacy, safety and nutritional aspects.

Associations Between Nutritional Deficits and Physical Performance in Community-Dwelling Older Adults

Background: Whether multiple nutritional deficiencies have a synergic effect on mobility loss remains unknown. This study aims to evaluate associations between multi-nutritional deficits and physical performance evolution among community-dwelling older adults.Methods: We included 386 participants from the Multidomain Alzheimer Preventive Trial (MAPT) (75.6 ± 4.5 years) not receiving omega-3 polyunsaturated fatty acid (PUFA) supplementation and who had available data on nutritional deficits. Baseline nutritional deficits were defined as plasma 25 hydroxyvitamin D <20 ng/ml, plasma homocysteine >14 μmol/L, or erythrocyte omega-3 PUFA index ≤ 4.87% (lower quartile). The Short Physical Performance Battery (SPPB), gait speed, and chair rise time were used to assess physical performance at baseline and after 6, 12, 24, 36, 48, and 60 months. We explored if nutrition-physical performance associations varied according to the presence of low-grade inflammation (LGI) and brain imaging indicators.Results: Within-group comparisons showed that physical function (decreased SPPB and gait speed, increased chair rise time) worsened over time, particularly in participants with ≥2 nutritional deficits; however, no between-group differences were observed when individuals without deficit and those with either 1 or ≥2 deficits were compared. Our exploratory analysis on nutritional deficit-LGI interactions showed that, among people with ≥2 deficits, chair rise time was increased over time in participants with LGI (adjusted mean difference: 3.47; 95% CI: 1.03, 5.91; p = 0.017), compared with individuals with no LGI.Conclusions: Accumulated deficits on vitamin D, homocysteine, and omega-3 PUFA were not associated with physical performance evolution in older adults, but they determined declined chair rise performance in subjects with low-grade inflammation.Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT00672685], identifier [NCT00672685].

Co-factor Influences the Severity of Zika Virus-Associated Microcephaly

Microcephaly has been regarded the most remarkable consequence of the Zika virus (ZIKV) epidemic in Brazil 2015. It remains to be determined whether there are factors that contribute to the degree of brain lesion associated with ZIKV infection during pregnancy. Previous studies showed that socioeconomic conditions correlate with ZIKV-associated microcephaly. Certain nutritional deficits display the potential to interfere in the mechanistic target of rapamycin (mTOR) signaling, which plays a major role in the pathophysiology of ZIKV-associated microcephaly. We hypothesize that a nutritional or environmental co-factor that interferes in mTOR signaling correlates with ZIKV-associated birth defects. To assess this hypothesis, we plan to: 1) develop a mouse model of ZIKV-associated microcephaly through intravenous injection of ZIKV and rapamycin for a straightforward interference on mTOR receptor; 2) determine in the experimental model and in cases of ZIKV-associated microcephaly the epigenetic signature (DNA methylation pattern) in neurons and muscle cells harvested by biopsy, and in hematopoietic and mesenchymal stem cells sorted from blood; 3) analyze through mass spectrometry in serum of pregnant female mice submitted to ZIKV and rapamycin injection and in serum of mothers of children with ZIKV-associated microcephaly the metabolomic pattern of cholesterol (a nutritional status marker), vitamin A and its metabolite retinoic acid, folate, and other metabolites related to these three nutritional factors; 4) check whether pregnant female mice submitted to intravenous injection of ZIKV and feed with a deficient diet of the most likely co-factor found in this study give birth to microcephalic mice with features that mimic clinical cases. In summary, our general objective is to develop an experimental model that mimics ZIKV-associated microcephaly cases and to find a co-factor involved in the microcephaly outbreak in Brazil 2015.

PENGELOLAAN DEFISIT NUTRISI PADA BAYI DENGAN MALNUTRISI DI DESA MRANGGEN KIDUL

Abstrak Latar Belakang: Malnutrisi merupakan kondisi seseorang mengalami kekurangan atau kelebihan nutrisi yang dapat menyebabkan pertumbuhan dan perkembangan orang tersebut terganggu. Malnutrisi banyak ditemukan pada bayi dengan usia diatas 6 bulan dikarenakan banyak keluarga yang belum memahami kebutuhan bayi secara khusus, belum mengerti cara membuat makanan pendamping yang bernutrisi sehingga menyebabkan bayi mengalami penurunan berat badan. Penurunan berat badan ini diakibatkan karena adanya gangguan dalam penyerapan makanan, sehingga terjadi defisit nutrisi Defisit nutrisi merupakan keadaan dimana asupan nutrisi tidak cukup untuk metabolisme tubuh. Tujuan: Penulisan ini bertujuan untuk memberikan deskripsi atau gambaran tentang pengelolaan defisit nutrisi pada bayi dengan malnutrisi di Desa Mranggen Kidul. Metode: Jenis penelitian deskriptif dengan pendekatan asuhan keperawatan berupa pengkajian, analisis data, merumuskan diagnosa keperawatan, perencanaan, pelaksanaan, dan evaluasi dalam penanganan malnutrisi. Hasil: Hasil pengelolaan yang dilakukan pada pasien dengan teknik pengumpulan data menggunakan wawancara, pemeriksaan fisik dan observasi. Kemudian dilakukan rencana keperawatan yaitu monitor berat badan dan identifikasi status nutrisi. Didapatkan hasil akhir berat badan pasien 5,1 kg dan status nutris pasien (BB/U: -4,3 SD (gizi buruk), PB/U: -4,1 SD (sangat pendek), BB/PB: -3,6 SD (sangat kurus), IMT/U: -3,7 SD (sangat kurus)). Kesimpulan: Berdasarkan tindakan keperawatan yang dilakukan, maka dapat disimpulkan malnutrisi pada pasien belum teratasi. Saran bagi keluarga agar lebih memperhatikan dan mengetahui bagaimana cara penanganan malnutrisi pada bayi. Kata kunci : Malnutrisi, Defisit Nutrisi, Bayi Abstract Background: Malnutrition is a condition of a person experiencing a lack or excess of nutrients that can cause the growth and development of the person to be disrupted. Malnutrition is often found in infants aged over 6 months because many families do not understand the baby's specific needs, do not understand how to make nutritious complementary foods, causing babies to lose weight. This weight loss is caused by a disturbance in the absorption of food, resulting in a nutritional deficit. A nutritional deficit is a condition where the intake of nutrients is not sufficient for the body's metabolism. Purpose: This paper aims to provide a description or description of the management of nutritional deficits in malnourished infants in Mranggen Kidul Village. Method: This type of descriptive research with nursing care approach in the form of assessment, data analysis, formulating nursing diagnoses, planning, implementation, and evaluation in the handling of malnutrition. Result: The results of the management carried out on patients with data collection techniques using interviews, physical examinations and observations. Then a nursing plan is carried out, namely weight monitoring and identification of nutritional status. The final results obtained were the patient’s weight was 5.1 kg and the nutritional status of the patient (BB/U: -4,3 SD (poor nutrition), PB/U: -4,1 SD (very short), BB/PB: -3,6 SD (very thin), BMI/U: -3,7 SD (Very thin)). Conclution: Based on the nursing acions taken, it can be concluded that malnutrition in the patient has not been resolved. Suggestions for families to pay more attention and know how to handle malnutrition in infants. Keywords : Malnutrition, Nutritional Deficit, Infant

Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease

Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients.

Influence of maternal and paternal pre-conception overweight/obesity on offspring outcomes and strategies for prevention

Overweight, obesity, and their comorbidities remain global health challenges. When established early in life, overweight is often sustained into adulthood and contributes to the early onset of non-communicable diseases. Parental pre-conception overweight and obesity is a risk factor for overweight and obesity in childhood and beyond. This increased risk likely is based on an interplay of genetic alterations and environmental exposures already at the beginning of life, although mechanisms are still poorly defined. In this narrative review, potential routes of transmission of pre-conceptional overweight/obesity from mothers and fathers to their offspring as well as prevention strategies are discussed. Observational evidence suggests that metabolic changes due to parental overweight/obesity affect epigenetic markers in oocytes and sperms alike and may influence epigenetic programming and reprogramming processes during embryogenesis. While weight reduction in overweight/obese men and women, who plan to become pregnant, seems advisable to improve undesirable outcomes in offspring, caution might be warranted. Limited evidence suggests that weight loss in men and women in close proximity to conception might increase undesirable offspring outcomes at birth due to nutritional deficits and/or metabolic disturbances in the parent also affecting gamete quality. A change in the dietary pattern might be more advisable. The data reviewed here suggest that pre-conception intervention strategies should shift from women to couples, and future studies should address possible interactions between maternal and paternal contribution to longitudinal childhood outcomes. Randomized controlled trials focusing on effects of pre-conceptional diet quality on long-term offspring health are warranted.

Economics and Profitability of Goat Breeding in the Maghreb Region

This chapter presents a review of the North-African goats, with particular focus on their current state, constraints and research prospects and development. In recent years, goat milk and meat have become acceptable and recognized as the source of healthy nutrient in the Maghreb countries. However, goat populations are generally confronted with severe nutritional deficits during feed scarcity period which exacerbate disease and health troubles and consequently low performances. They are mainly elevated in small herds and their productions are commercialized throughout an informal sector. Thus, if the informal sector is to be convinced to market goats commercially through formal ways, then knowledge of the economics of goat farming should be provided in the Maghreb countries. Under the economics of farming goat, we will investigate the trend in the demand and supply of goat milk or meat, trend in the number of goats slaughtered, and the cost of raising goats in the Maghreb region. We are going to evaluate the economics and profitability of goats as farm animal and their marketing strategies in the Maghreb region.

The Public’s Health

The war saw a protracted mortality crisis among civilians. The movement of millions of refugees and evacuees with little access to sanitary facilities, clean water, or medical care led to widespread epidemics. Evacuation took an especially heavy toll on small children, who died from a measles epidemic as well as starvation, diarrhea, and pneumonia. Widespread hunger and nutritional deficits damaged the health of people of all ages. In 1943 and 1944 starvation and tuberculosis—a disease highly sensitive to malnutrition—together became the largest single contributor to adult mortality. Defense production exposed workers to new, toxic chemicals. The war made unprecedented demands on public health, but health officials and medical staff lacked almost everything they needed. After the majority of medical professionals were drafted, only a “skeleton staff” remained to treat the civilian population. Yet public health officials managed to contain the worst epidemic outbreaks. During the final years of the war starvation and malnutrition became the country’s primary health hazard.

Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus

Preterm infants have a lower level of nutrient body stores and immature body systems, resulting in a higher risk of malnutrition. Imbalanced complementary feeding could lead to further risk of nutritional deficits and excesses. However, evidence on their nutritional requirements following hospital discharge is limited. When planning complementary feeding, appropriate micronutrient intake should be considered for their critical role in supporting various body functions. This narrative review summarizes the need for iron, zinc, vitamin D, calcium, phosphate and long-chain polyunsaturated fatty acids (LCPUFAs) supplementation in preterm infants during complementary feeding. Regarding iron and vitamin D, the scientific community is reaching an agreement on supplementation in some categories of prematures. On the contrary, there is still not enough evidence to detail possible recommendations for LCPUFAs, zinc, calcium and phosphorus supplementation. However, these micronutrients are paramount for preterms’ health: LCPUFAs can promote retinal and brain development while calcium and phosphorus supplementation is essential to prevent preterms’ metabolic bone disease (MBD). Waiting for a consensus on these micronutrients, it is clear how the knowledge of the heterogeneity of the prematures population can help adjust the nutritional planning regarding the growth rate, comorbidities and comprehensive clinical history of the preterm infant.