Increasing the Level of Knowledge about Stunting and the First 1000 Days of Life in Jember Regency, East Java, Indonesia

Stunting is a developmental disorder experienced by children due to poor nutrition, recurrent infections, and inadequate psychosocial stimulation. In Jember Regency, the number of stunting cases increased from 2018 to 2019. In addition, restrictions on activities during the COVID-19 pandemic, such as nutrition services at Integrated Healthcare Center, can hamper access to consumption and nutrition and child health services. Therefore, education about stunting is urgently needed to implement appropriate parenting patterns in the mids of limited activities during the COVID-19 pandemic. The Jember community service program was carried out online in the form of a webinar activity that was attended by 30 participants. This study is a quantitative analytic research using a one-group pretest-posttest design. Data that have been analyzed are presented descriptively. There is a significant effect on the pretest and posttest scores in the webinar. It means an increase in participants' understanding after online education is carried out. It is hoped that the people of Jember Regency can apply knowledge about the importance of the first 1000 days of life to prevent stunting.

Virtual Digital Twins

Healthy ageing and disease prevention depends on nutritional and lifestyle changes. Available evidence accentuates the influence of genetic, metabolic, and host gut microbiota characteristics on how individuals respond to each nutrient leading the way for the stratification of dietary guidelines. In recent days, state-of-the-art changes are pursued in therapeutic nutrition services integrating information and communication technologies (ICT) such as big data analytics, artificial intelligence (AI), and deep learning. Furthermore, we live in the ‘omics' era, where individuals' dietary needs can be tailored according to their gene pattern. Digital twin typifies virtual representation that provides real-time digital technology counterpart of a physical process or object. This chapter discusses how to converge genetic information with other biochemical parameters to conceptualize a digital replica of oneself that may well be a reference tool to guide personalized nutrition.

Overview of Usual Food Leftovers in Inpatients at the Jailolo Regional General Hospital, West Halmahera Regency

Hospital nutrition services are part of a complete health service. Each hospital provides nutritional services, not only providing food for patients and staff, but the most important thing is the provision of food that meets the needs of human metabolism for recovery during treatment. Food waste is the amount of food that is not eaten or not consumed by the patient. The purpose of this study was to determine the type of food and the amount of leftover food that was not consumed by patients who received regular food at the Jailolo Hospital. The type of research used is descriptive with sampling using purposive sampling as many as 20 respondents. The results showed that of the 20 respondents using the Comstock method, the average patient leftover food left a lot (> 20%) in the staple food type 40%, animal side dishes 35%, vegetable side dishes 30%, vegetables 30% and fruit 40%. Based on the results of the study, it can be concluded that most of the respondents still left a lot of food and it is recommended for nutrition installations to improve the quality and taste of the food served so that there is no more food left.

A Case-Control Study for the Effectiveness of Oral Zinc in the Prevention and Mitigation of COVID-19

Background: The ongoing coronavirus disease-19 (COVID-19) pandemic (caused by an infection with severe acute respiratory syndrome (SARS)-coronavirus (CoV-2) has put a burden on the medical community and society at large. Efforts to reduce the disease burden and mortality over the course of the pandemic have focused on research to rapidly determine age-stratified seroepidemiologic surveys, a centralized research program to fast-track the most promising rapid diagnostics and serologic assays, and the testing of potential anti-viral agents, immunologic therapies, and vaccine candidates. Despite the lack of official recognition for the role of nutrition in the fight against COVID-19 infection, multiple groups proposed zinc supplementation as an adjuvant for the management of participants.Method: In an ambulatory, interventional, prospective, single-blind study, we evaluated the effectiveness of zinc supplementation in the prevention and mitigation of COVID-19 in two similar participant groups. In Clinic A (n = 104) participants were randomized to receive 10 mg, 25 mg, or 50 mg zinc picolinate daily, and Clinic B control participants paired according to their demographics and clinical parameters (n = 96). All participants were compared based on demographics, clinical comorbidities, blood counts, renal functions, vitamin D levels, and their development of symptomatic COVID-19 infection.Results: Symptomatic COVID-19 infection was significantly higher among the control group participants (N = 9, 10.4%) than the treatment participants (N = 2, 1.9%), p = 0.015. The unadjusted odds ratio indicates that symptomatic COVID-19 infection was 5.93 [95% CI: 1.51, 39.26] higher in the control group, p < 0.01. Controlling for co-morbidities, individuals in the control group were 7.38 (95% CI: 1.80, 50.28) times more likely to develop symptomatic COVID-19 infection as compared with individuals in the treatment group (p < 0.01). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.57 (95% CI: 1.16, 2.19) (p = 0.01).Discussion: The findings from our study suggest that zinc supplementation in all three doses (10, 25, and 50 mg) may be an effective prophylaxis of symptomatic COVID-19 and may mitigate the severity of COVID-19 infection.Conclusion: Zinc is a relatively inexpensive mineral nutrient that is an effective prophylactic agent to prevent and mitigate the potentially deadly symptomatic SARS-CoV-2 infection. As the COVID-19 pandemic continues with a lag in vaccinations in some regions and the continued emergence of dangerously infectious variants of SARS-CoV-2, it is important to replicate our data in other populations and locations and to engage public health and nutrition services on the emergent need to use zinc supplantation or fortification of staple foods in the prevention and mitigation of COVID-19 infection severity.

The Effect of Nutrition Education on Nutrition Knowledge and Macronutrition Intake in Muay Thai Athletes

BACKGROUND: Athletes’ achievements require the support of sports science and technology. One of the supporting sciences is sports nutrition services by fulfilling athlete nutrition through foodservice and nutrition education in nutrition counseling or nutrition counseling according to the needs and conditions of athletes. AIM: This study aims to determine the effect of nutrition education on nutritional knowledge and macronutrient intake in Muay Thai athletes in Cimahi city. METHODS: This type of research is a Quasi experiment by applying a one group pre- and post-test design: Nutrition education using leaflets. The sample is Muay Thai athletes in Cimahi city who are actively practicing at the Empire Muaythai Camp as many as ten people. Data were collected by filling in the respondent’s characteristics, knowledge of nutrition, and intake of macronutrients. RESULTS: Based on the Wilcoxon test, it was found that there was an effect of providing nutrition education using leaflets on nutritional knowledge (p = 0.005) and protein intake (p = 0.047). CONCLUSION: It is recommended that regular and periodic nutrition education be given to athletes and coaches as well as collaborate with nutritionists regarding nutritional fulfillment for athletes to increase macronutrient intake so that the performance of Muay Thai athletes in Cimahi city is optimal.

Social Determinants of Health and Neurocognitive Functioning in Sickle Cell Disease

Sickle cell disease (SCD) is associated with significant neurocognitive risk due to a combination of disease and environmental factors. Neurological complications, including overt stroke, silent cerebral infarctions, and chronic insufficiencies in oxygen and/or glucose delivery to the brain contribute to neurocognitive decline. Environmentally, patients with SCD experience greater rates of poverty and fewer protective socioeconomic factors when compared with the Black population in the United States. Both personalized (e.g. familial education and occupation) and community measures of socioeconomic status uniquely contribute to neurocognitive outcomes. However, no studies have examined the specific community-level factors that contribute to neurocognitive performance. The primary objective of this study was to investigate associations between familial and community-level social determinants with cognitive and academic outcomes in a large prospectively recruited sample of patients with SCD ranging from childhood to young adulthood. We included 103 patients with SCD (51% HbSS/HbSβ 0-thalassemia). The mean age of participants was 12.86 (SD=4.04) years. Familial socioeconomic status was measured using the Barratt Simplified Measure of Social Status (BSMSS), a composite of parent education and occupation status. Community-level (based on census block) socioeconomic variables included: poverty rate, unemployment rate, percentage of individuals with a bachelor's degree, and access to food nutrition services. Following informed consent, patients completed gold-standard neurocognitive measures supervised by a psychologist, assessing intellectual (Wechsler Abbreviated Scale of Intelligence - Second Edition) and academic functioning (Woodcock Johnson Tests of Achievement - Third Edition). Multivariate linear regression was used to examine associations between community and familial level socioeconomic status with cognitive/academic outcomes after adjusting for age, sickle genotype, and hydroxyurea exposure. Stepwise linear regression was used to identify the independent factors associated with cognitive/academic outcomes. The False discovery rate (FDR) developed by Benjamini and Hochberg was used to control for multiple testing and FDR-adjusted p-values (pFDR) <0.05 were considered statistically significant. Otherwise, p-values <0.05 were considered significant. Patients with SCD lived in communities with high rates of poverty (26.57%) and unemployment (13.58%) and low rates of college education (13.26%). In multivariate analyses adjusting for age, sickle genotype, and hydroxyurea exposure, IQ was associated with the BSMSS (estimate = 0.31, standard error [SE] = 0.10, p=0.003) at pFDR<0.05 but measures of basic reading and math were not (all pFDR>0.05). In contrast, reduced intellectual functioning was associated with increased poverty rates (Estimate=-0.29, SE=0.09, p=0.003), increased unemployment rates (estimate=-0.43, SE=0.18, p=0.018), increased access to food nutrition services (Estimate=-0.21, SE=0.09, p=0.015), and decreased percentage of individuals with a bachelor's degree (Estimate=0.33, SE=0.10, p=0.003) at pFDR<0.05. Measures of basic reading and math were not associated with any of the community-level variables. Stepwise linear regression analysis showed that the BSMSS (Estimate=0.22, SE=0.11, p=0.04) and poverty rates (Estimate=-0.18, SE=0.09, p=0.049) are independently associated with full scale IQ after adjusting for age, sickle genotype and hydroxyurea exposure. Overall, community and familial socioeconomic factors accounted for greater variance in intellectual functioning than age, genotype, and hydroxyurea treatment exposure (see Figure 1). Social determinants at the community-level contribute to intellectual development in patients with SCD independent of familial socioeconomic status. Surprisingly, academic performance was not associated with community-level social determinants. Evaluation of community-level social determinants may provide insights into potential targets for neurodevelopmental interventions. Figure 1 Figure 1. Disclosures Estepp: Global Blood Therapeutics: Consultancy, Research Funding. Hankins: Bluebird Bio: Consultancy; UpToDate: Consultancy; Global Blood Therapeutics: Consultancy; Vindico Medical Education: Consultancy.

Conceptualizing factors impacting nutrition services coverage of treatment for acute malnutrition in children – an application of the Three Delays Model in Niger

Objective: The Three Delays Model is a conceptual model traditionally used to understand contributing factors of maternal mortality. It posits that most barriers to health services utilization occur in relation to one of three delays: Delay 1: delayed decision to seek care; Delay 2: delayed arrival at health facility; Delay 3: delayed provision of adequate care. We applied this model to understand why a community-based management of acute malnutrition (CMAM) services may have low coverage. Design: We conducted a Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) over three phases using mixed methods to estimate program coverage and barriers to care. In this manuscript, we present findings from 51 semi-structured interviews with caregivers and program staff, as well as 72 structured interviews among caregivers only. Recurring themes were organized and interpreted using the Three Delays Model. Setting: Madaoua, Niger Participants: 123 caregivers and CMAM program staff Results: Overall, 11 barriers to CMAM services were identified in this setting. Five barriers contribute to Delay 1, including lack of knowledge around malnutrition and CMAM services, as well as limited family support, variable screening services, and alternative treatment options. High travel costs, far distances, poor roads, and competing demands were challenges associated with accessing care (Delay 2). Finally, upon arrival to health facilities, differential caregiver experiences around quality of care contributed to Delay 3. Conclusions: The Three Delays Model was a useful model to conceptualize the factors associated with CMAM uptake in this context, enabling implementing agencies to address specific barriers through targeted activities.

Pengukuran Antropometri Balita dan Perempuan Usia Subur Pasca Bencana Erupsi Gunung Sinabung di Desa Pertenguhen Kecamatan Simpang Empat Kabupaten Karo

<em>Indonesia is a country that is very prone to natural disasters. Nutritional problems that usually arise in natural disasters are malnutrition in the age group of infants and toddlers who do not get breast milk (ASI) because the child is separated from his mother when a natural disaster occurs. The worsening nutritional status of a group of people due to frequent delays in food aid and limited food availability in evacuation sites can exacerbate existing conditions. Nutrition problem is essentially a public health problem, however, the prevention cannot be done with a medical approach and health services. The cause of the emergence of nutritional problems is multi-factor, therefore the tackling approach involves various related sectors. Emergency nutrition management during a disaster becomes the first priority where food and nutrition services are an integral part of emergency management. Nutrition counseling provided by nutrition officers during a disaster emergency has significant meaning. Extension is an effort to change human behavior, both individuals and society so that it can create mental attitudes and the ability to solve problems it faces in order to improve and maintain good nutrition. The hope of this effort is that people can understand the importance of food and nutrition, so that they are willing to behave and act according to nutritional norms.</em>