Analysis of Current Use of Early Parenteral Nutrition and Clinical Significance of Non-protein Calorie: Nitrogen in Surgical Critically Ill Patients

PUROPOSE: Surgical critically ill patients require adequate nutrition support and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend low non-protein calorie:nitrogen ratio (NPC:N ratio, 70~100) for critically ill pateints. In this study, we assess the current use of early parenteral nutrition of surgical critically ill patients and analyze the clinical significance of NPC:N. METHODS: This is a retrospective study of critically ill adult patients who remained in the intensive care unit (ICU) for over 3 days and could not receive enteral nutrition for the first 7 days. Data on parenteral intake of patients were collected from electronic medical records. Association of NPC:N scores with clinical outcome (length of ICU stay, length; of hospital stay, duration of ventilation, and mortality) were analyzed using Pearson correlation and multiple regression. RESULTS: The study included 72 cases, average parenteral calorie intake was 14.6 kcal/kg/day and protein intake was 0.5 g/kg/day. We assessed the NPC:N scores to determine the patients' NPC:N for the first 7 days in ICU close to the A.S.P.E.N guidelines. NPC:N scores showed weak negative correlation with length of hospital stay and duration of mechanical ventilation (r=-0.259, P=0.028; r=-0.495, P=0.001). Multiple regression adjusted with APACHE (Acute Physiology and Chronic Health Evaluation) II score, age, and body mass index showed correlation of higher NPC:N score with decreased length of hospital stay and shorter duration of ventilation (P=0.0001, P=0.035, respectively). However, length of ICU stay and mortality within 60 days showed no significant correlation with NPC:N scores. CONCLUSION: Parenteral calories and protein intakes of critically ill patients in ICU were lower in comparison to A.S.P.E.N. recommendation in this study. Low NPC:N scores might be related to shorter length of hospital stay, duration of mechanical ventilation. Consultation of a nutritional support team could have a positive effect in providing appropriate nutrition support.

Desnutrición infantil y daño del capital humano: damage to the human capital / Infant undernutrition

Different evaluations and research carried out between 1950 and 1970 showed that undernutrition and poverty during the early years of life were the main cause for early mortality (50% of all deaths in children 0 to 15 years of age) and permanent damage in those who survived. These were a "hidden threat" which hampered the advancement to equal opportunity and the socioeconomic improvement of the country. Making people aware of this reality was crucial to implement interventions to prevent the damage to children before and after birth.

Diversas evaluaciones e investigaciones científicas realizadas en Chile durante el periodo 1950-1970, permitieron ir comprobando que la desnutrición y la pobreza durante los primeros periodos de la vida, constituían las principales causantes, tanto de la elevada mortalidad temprana (50% de las muertes antes del 15 años de vida), como de los daños permanentes en los que sobrevivían. "Un mal oculto", que ancestralmente estaba impidiendo avanzar hacia la igualdad de oportunidades y el desarrollo económico y social del país. La llamada de atención y toma de conciencia de la realidad, era indispensable como primera etapa pragmática para lograr implementar intervenciones destinadas a prevenir el daño desde el momento de nacer y aun antes, durante el embarazo.

A gravidade da cárie está associada à desnutrição proteico-calórica em pré-escolares? / Is the severity of caries associated with malnutrition in preschool children?

Avaliou-se se gravidade da cárie está associada à desnutrição proteico-calórica em pré-escolares. Foi realizado um estudo seccional aninhado a uma coorte retrospectiva de 625 crianças entre 24 -71 meses, em São Luís, Maranhão. Um modelo hierarquizado foi avaliado em cinco níveis: 1º) Variáveis socioeconômicas (classe econômica, escolaridade materna, cor da pele); 2º) Variáveis de acesso; 3º) Baixo peso ao nascer e amamentação exclusiva; 4º) Peso para altura aos 12 meses e 5º) Gravidade da cárie e níveis de albumina (Alb). O desfecho foi desnutrição proteico-calórica (z escore altura para idade < -2). A prevalência do desfecho foi de 5,0 %, e da cárie foi de 32%. As variáveis do primeiro nível não foram associadas ao desfecho, porém a classe econômica foi mantida até o modelo final. As variáveis do segundo e do terceiro níveis não foram significativas. No quarto nível, peso para altura aos 12 meses não foi significativo, porém foi mantido até o modelo final. No último nível, os níveis de Alb não foram associados ao desfecho e a gravidade da doença cárie foi positivamente associada com desnutrição proteico-calórica em pré-escolares. A associação da gravidade da cárie com déficit antropométrico sinaliza que a saúde bucal deva ser parte importante nas políticas públicas de atenção à infância.

An analysis was conducted to evaluate if the severity of caries is associated with protein-calorie malnutrition in preschool children. The cross-sectional study was performed on a retrospective cohort of 625 children aged 24-71 months attending daycare centers in São Luís, Maranhão. A hierarchical model was evaluated at five levels: 1.) Socio-economic variables (economic group, mother's educational level and skin color); 2) Access variables; 3) Low birth weight (LBW) and exclusive breastfeeding; 4) Weight per height at 12 months; and 5) Severity of caries and albumin (Alb) levels. The outcome was protein-calorie malnourishment (weight per height z score < -2). The prevalence of outcome was 5.0% and the prevalence of caries was 32%. At the first level, the variables were not associated with the outcome, but the economic group was maintained until the final model. The variables in the second and third levels were not significant. At the fourth level, weight for height at 12 months was not significant, but was maintained until the final model. In the last level, severity of caries was positively associated with malnourishment. The association between severity of caries and malnourishment suggest that oral health should be integrated with public health care policies for children.

Modelo de atención a la malnutrición crónica infantil en la región de Upper River, Gambia, según el marco Innovative Care for Chronic Conditions / Attention Model to chronic child malnutrition in the region of Upper River, Gambia, according to the Innovative framework Care for Chronic Conditions / Modelo de atenção à malnutrição crônica infantil na região de Upper River, Gâmbia, segundo o quadro Innovative Care for Chronic Conditions

La malnutrición es uno de los principales problemas de salud pública en la República de Gambia,con un 18 % de la población menor de cinco años afectada. El objetivo de este trabajo esofrecer una descripción y un análisis del conjunto de actores e instituciones y de sus políticase intervenciones involucradas en el abordaje de la malnutrición crónica infantil en la región deUpper River, Gambia. El mapa de atención a la malnutrición infantil se ha realizado a partirde una evaluación del modelo de atención vigente, siguiendo la herramienta Innovative Carefor Chronic Conditions Framework Situation Assessment de la Organización Mundial de laSalud, guiando el análisis por la experiencia profesional en este contexto del autor, y con elapoyo de la bibliografía consultada. Basado en los resultados, a modo de discusión se ofreceuna serie de intervenciones y estrategias de mejora del modelo en sus tres niveles de atencióna la malnutrición infantil...

Malnutrition is a major public health problem in the Republic of Gambia, with 18% of the populationunder five affected. The purpose of this paper is to provide a description and analysis of theset of actors and institutions, their policies and interventions involved in tackling child chronicmalnutrition in the region of Upper River, Gambia. The map of attention to child malnutritionhas been made from an assessment of the current care model, following the tool InnovativeCare for Chronic Conditions Framework Situation Assessment of the World Health Organization,guiding the analysis by professional experience in this context of the author, and with thesupport of the consulted bibliography. Based on the results, a series of interventions and strategiesfor improvement of the model in its three levels of care to child malnutrition is discussed...

A malnutrição é um dos principais problemas de saúde pública na República de Gâmbia, com um18 % da população menor de cinco anos afetada. O objetivo deste trabalho é oferecer descriçãoe análise do conjunto de atores e instituições e das suas políticas e intervenções envolvidasna abordagem da malnutrição crônica infantil na região de Upper River, Gâmbia. O mapa deatenção à malnutrição infantil realizou-se a partir de uma avaliação do modelo de atençãovigente, seguindo a ferramenta Innovative Care for Chronic Conditions Framework SituationAssessment da Organização Mundial da Saúde, guiando a análise pela experiência profissionalneste contexto do autor, e com apoio da bibliografia consultada. Baseado nos resultados, a modode discussão oferece-se uma série de intervenções e estratégias de melhoramento do modeloem seus três níveis de atenção à malnutrição infantil...

Impact of prenatal protein-calorie malnutrition on the odontogenesis of wistar rats / Impacto da desnutrição protéico-calórica pré-natal sobre a odontogênese de ratos wistar

Objetivo: Este trabalho teve por objetivo determinar alterações na odontogênese decorrentes da desnutrição protéico-calórica pré e pós-natal. Foram selecionados 12 ratos Wistar adultos, 8 fêmeas e 4 machos. As fêmeas foram divididas em dois grupos, sendo que um deles recebeu dieta normoprotéica (G1) e o outro recebeu dieta hipoprotéica (G2). Material e Métodos: Após o nascimento das ninhadas, foram separados aleatoriamente 24 filhotes de cada grupo. Os animais foram sacrificados, 12 aos 5 dias de vida e 12 aos 8, e suas mandíbulas submetidas à preparação histológica para a obtenção de cortes dos germes dentários. Foram selecionadas 48 lâminas que apresentavam os germes adequadamente cortados (24 de cada grupo), as quais foram analisadas em microscópio e medidas por um examinador calibrado utilizando-se o software Image Pro Plus for Windows, versão 6.0. As diferenças entre as médias foram verificadas mediante o teste não paramétrico de Mann Whitney. Resultados: Os resultados obtidos demonstram que, aos 5 dias, as diferenças de espessura de esmalte e dentina foram estatisticamente significantes entre G1 (84,08 ± 28,9 e 141,51 ± 33,2; p = 0,026) e G2 (47,26 ± 43,8 e 91,19 ± 54,7; p = 0,006). Aos 8 dias de vida não foram identificadas diferenças significativas entre os grupos. Conclusão: Os resultados demonstraram indícios de impacto da desnutrição sobre a espessura dos tecidos dentários. Sugere-se o aprofundamento desta linha de investigação com delineamentos mais complexos.

Objective: This study aimed to determine changes in odontogenesis arising from prenatal and postnatal protein-calorie malnutrition. Material and Methods: Twelve adult Wistar rats were selected; 8 females and 4 males. The females were divided into two groups, one of which received a normoproteic diet (NG) and the other received a hypoproteic diet (HG). After the birth of the litters, 24 pups were randomly separated from each group. The animals were sacrificed, 12 at five-days old and 12 at eight-days old, and their jaws were subjected to histological preparation to obtain cuts of tooth germs. Forty-eight slides were selected that presented the germs properly cut (24 from each group), which were analyzed by microscopy and measured by a calibrated examiner. The differences between means were verified by the nonparametric Mann-Whitney test. Results: The results showed that at 5 days the differences in thickness of enamel and dentin were statistically significant between NG (84.08 ± 28.9 and 141.51 ± 33.2; p = 0.026) and HG (47.26 ± 43.8 and 91.19 ± 54.7; p = 0.006). At 8 days of life there were no significant differences between the groups. Conclusion: The results showed evidence of the impact of malnutrition on the thickness of dental tissues. It is suggested that further work should be carried out in this line of research with more complex designs.

Evaluación del estado nutricional en pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis / Nutritional assessment in patients with chronic renal failure under hemodialysis

Introduction: Several factors involved in the development of malnutrition in Hemodialysis patients, given the impact of malnutrition in the forecast, it is extremely important to monitor the protein energy status of these patients. Objective: 10 assess the nutritional status of patients with chronic kidney disease (ERC5) stage 5 on hemodialysis (HD). Methods: Patients over 18 years, of both sexes, tri-weekly dialysis. Nutritional diagnosis was used as the Subjective Global Assessment (SGA), body mass index (BMI), triceps skinfold (PT), arm muscle circumference (AMC), and biochemical parameters (alburnin, cholesterol, protein catabolic rate, phosphorus). Results: According to SGA, 5% of patients had reiterate malnutrition by BMI 28% had malnutrition, according to the PT showed 12% depletion of their fat mass and was significantly higher in females (p = 0.015). According to the AMC showed 42% depletion of their muscle mass and was significantly higher in males (p = 0.029). According to the values of albumin, 41% were at nutritional risk and cholesterol levels by 55%. The 75% had inadequate protein intake. AMC depletion was significantly correlated with low protein intake (p = 0.02). 62% of the population showed altered phosphorus values. Conclusions: From this study it appears that no single method of nutritional assessment and need a combination of subjective and objective methods in order to identify those patients who require specific nutritional interventions.

Introducción: Varios son los factores implicados en el desarrollo de la mal nutrición de los pacientes en hemodiálisis, dado el impacto de la desnutrición en el pronóstico, es de suma importancia supervisar el estado energético proteico de estos pacientes. Objetivo: Valorar el estado nutricional de los pacientes con enfermedad renal crónica (ERC5) estadio 5 en tratamiento de hemodiálisis (HD). Metodología: Se incluyeron pacientes mayores de 18 años, de ambos sexos, que realizaran diálisis trisemanal. Como diagnóstico nutricional se utilizó la Valoración Global Subjetiva (VGS modificada por kalantar), Indice de Masa Corporal (IMC), el pliegue tricipital (PT), Circunferencia muscular del brazo (CMB), y parámetros bioquímicos (albúmina, colesterol, índice de catabolismo proteico, fósforo). Resultados: Según la VGS, el 5% de los pacientes presentó desnutrición moderada, según el IMC el 28 % presentó desnutrición, según el PT un 12 % presentó depleción de su masa grasa, siendo significativamente mayor en el sexo femenino (p=0.015). Según la CMB el 42% presentó depleción de su masa muscular, siendo significativamente mayor en el sexo masculino (p=0.029). Según los valores de albúmina el 41% presentó riesgo nutricional y según los valores de colesterol el 55%. El 75% presentó ingesta proteica inadecuada. La depleción de la CMB se correlacionó significativamente con la baja ingesta proteica (p=0.02). El 62 % de la población presentó valores de fósforo alterados. Conclusiones: Del presente estudio se infiere que no existe un único método de valoración nutricional y es necesaria una combinación de métodos subjetivos y objetivos para lograr identificar a aquellos pacientes que requieran de intervenciones nutricionales específicas.

Uso da Spirulina platensis na recuperação de ratos submetidos à dieta de restrição proteica / Use of Spirulina platensis for recovering rats under protein restriction diet feeding

O presente estudo avaliou a ação da espirulina como fonte protéica na recuperação do estado nutricional de ratos machos adultos. Foram estudados 48 animais, divididos em quatro grupos de acordo com a dieta: grupo controle de caseína (CC) e grupo controle de espirulina (CE), que receberam dieta equilibrada durante todo o experimento; grupo recuperado de caseína (RC) e grupo recuperado de espirulina (RE), que consumiram dieta com restrição protéica durante 60 dias e, a seguir, receberam a dieta equilibrada à base de caseína e espirulina, respectivamente, durante 90 dias. Foram analisadas a composição centesimal e a microbiológica da Spirulina platensis, bem como o ganho em peso dos animais. Após o sacrifício dos animais, foram realizadas as análises para determinação do peso do fígado e do aspecto histopatológico, da gordura corporal e dos constituintes sanguíneos. A espirulina utilizada continha 59,65% de proteína, 3,72% de lipídios, 17,53% de resíduo mineral fixo e 7,81 de umidade, e não apresentou contaminação por microrganismos. Não houve diferenças significativas quanto à gordura corporal e constituintes protéicos séricos entre os quatro grupos de animais. Em relação ao ganho de peso não foi constatada diferença entre os grupos CC e CE, nas diferentes semanas de números 1, 5, 6, 7 e de 10 a 18, contudo esta ocorrência não foi observada nos grupos RC e RE. O peso relativo do fígado diminuiu nos animais com restrição protéica, principalmente no grupo RC, porém sem alterações histopatológicas, e os constituintes lipídios tiveram valores diminuídos. Conclui-se que o uso da Spirulina platensis na recuperação de ratos com dieta de restrição protéica reduz a lipemia.

This investigation aims at evaluating the effects of spirulin as a protein source for recovering the nutritional status of adult male rats. Forty-eight animals were studied and divided by four groups according to the feed diet: casein control (CC) group and spirulin control (SC) group, which received balanced diet during the whole experiment; recovered casein (RC) group and recovered spirulin (RS) group, which received a protein-restriction diet for 60 days and, afterwards, they were fed with balanced diet based on casein and spirulin, respectively, for 90 days. The centesimal and microbiologicalcomposition of Spirulina platensis and animals weight gains could be evaluated. After being euthanized the animal’s liver weight and its histopathologic aspects were analyzed, besides the body fat and blood components. The spirulinused contained 59.65% of protein, 3.72% of lipids, 17.53 of fixed mineral residue and 7.81% of humidity, and showed no microorganism contamination. Significant differences on body fat and serum protein contents could not be observedamong the four animal groups. Regarding the weight gains, there was no difference among the animals of groups CC and SC in different weeks of experiments numbers 1, 5, 6, 7 and from 10 to 18, but these findings were not observed among the RC and RS groups. The relative liver weight decreased in animals under protein restriction, mainly in the group RC, but no histopathological alterations could be observed, and lipid contents decreased. In conclusion, the useof Spirulina platensis for recovering rat on protein restriction diet induces a reduction of lipemia.

Differential response to gepirone but not to chlordiazepoxide in malnourished rats subjected to learned helplessness

The learned helplessness (LH) paradigm is characterized by learning deficits resulting from inescapable events. The aims of the present study were to determine if protein-calorie malnutrition (PCM) alters learning deficits induced by LH and if the neurochemical changes induced by malnutrition alter the reactivity to treatment with GABA-ergic and serotonergic drugs during LH. Well-nourished (W) and PCM Wistar rats (61 days old) were exposed or not to inescapable shocks (IS) and treated with gepirone (GEP, 0.0-7.5 mg/kg, intraperitoneally, N = 128) or chlordiazepoxide (0.0-7.5 mg/kg, intraperitoneally, N = 128) 72 h later, 30 min before the test session (30 trials of escape learning). The results showed that rats exposed to IS had higher escape latency than non-exposed rats (12.6 ± 2.2 vs 4.4 ± 0.8 s) and that malnutrition increased learning impairment produced by LH. GEP increased the escape latency of W animals exposed or non-exposed to IS, but did not affect the response of PCM animals, while chlordiazepoxide reduced the escape deficit of both W and PCM rats. The data suggest that PCM animals were more sensitive to the impairment produced by LH and that PCM led to neurochemical changes in the serotonergic system, resulting in hyporeactivity to the anxiogenic effects of GEP in the LH paradigm.

Sensibilidade no diagnóstico da desnutrição protéico-calórica realizado pelas equipes de saúde por meio do SIAB e de busca ativa de casos / The sensitivity of malnutrition diagnosis using the SIAB and active search of cases

É atribuição da Atenção Primária á Saúde e da Estratégia de Saúde da Família (ESF) atuar na promoção e na manutenção do estado de saúde da população infantil por meio do atendimento e acompanhamento integrais. Para a atuação das equipes de saúde é fundamental a análise de saúde das populações cobertas. Para esse fim o Sistema de Informação da Atenção Básica (SIAB) é instrumento de valor inestimável. O objetivo deste estudo foi demonstrar a sensibilidade no diagnóstico da desnutrição protéico-calórica realizado pelas equipes de Saúde da Família, quando são utilizados apenas dados primários como instrumentos de busca da adequação e posterior informação destes, via SIAB, e por meio da busca ativa de crianças de 0 a 23 meses e 29 dias e obtenção de seus dados antropométricos delas. Trata-se de estudo seccional, realizado no município de Patos de Minas (MG), de janeiro a abril de 2005. As prevalências de desnutrição protéico-calórica informadas no SIAB foram 2,35% e 2,5%, nas equipes A e B, respectivamente. As prevalências de desnutrição encontradas a partir da busca ativa, dos dados antropométricos e do cálculo dos índices peso-idade foram 14,12% e 13,75% nas equipes A e B, respectivamente. Essas foram superiores à prevalência descrita pela Pesquisa Nacional de Demografia e Saúde, cuja prevalência foi 5,7%. As prevalências de desnutrição protéico-calórica com base no índice peso-idade, mediante exclusivamente a utilização do SIAB como fonte de dados, levam ao subdiagnóstico do problema. Tratando-se o SIAB de um sistema de informação "territorializado", cujos dados possibilitam a construção de indicadores populacionais referentes a áreas de abrangência bem-delimitadas, propomos a avaliação crítica e constante desses dados.

Both the Primary Care System and the Family Health Program are responsible for promoting and maintaining the health of the child population by providing full care and follow-up. For enabling the health teams to carry out their work it is fundamental to analyze the health status of the population covered by the system. The Primary Care Information System (SIAB) is a priceless instrument for this purpose. The goal of this study is to demonstrate the sensitivity of protein-calorie malnutrition diagnosis performed by the Family Health Teams when only using the SIAB as data source and when performing active search of children from 0-23 months and 29 days of age, taking their anthropometric data. This cross-sectional study was carried out in the municipality of Patos de Minas (State of Minas Gerais), from January to April 2005. The prevalence of protein-calorie malnutrition informed by the SIAB found by teams A and B was of 2.35% and 2.5% respectively. The prevalence of malnutrition found by teams A and B through active search, collection of anthropometric data and weight/age ratio calculation were 14.12% and 13.75% respectively. This prevalence rate was higher than that described by the National Demographic and Health Survey, which was 5.7%. The prevalence of protein-calorie malnutrition based on weight/age ratio exclusively using the SIAB as a data source results in an underdiagnosis of this health problem. Seen that the SIAB is a territorialized information system designed for allowing elaboration of population indicators in well defined areas of coverage, the authors propose a critical and constant evaluation of these data. The authors also suggest active search of all cases, involving the entire health team.

A study of Nutritional Improvement in the Patients with Neurologic Disorders by Changing Enteral Feeding Methods

Protein-calories malnutrition is common among patients in the hospital. In particular, elderly patients with neurologic disorders has more risk of nutritional deficiency due to swallowing difficulty. Enteral tube feeding is more economical, physiological and immunological than parenteral nutrition for patients who have adequate gastrointestinal function. This study was conducted patients with neurologic disorders who received enteral nutrition at Asan Medical Center from February 1 to October 10, 2002. The control group (48 patients) were given traditional feeding methods 4 times a day while the treatment group (45 patients) were given improved feeding methods 3 times a day. We assessed nutritional status of patients and compared to both groups. We investigated body weight, serum albumin, hemoglobin, total lymphocyte count by means of nutrition markers. The objectives of this study is to reduce the time needed for nutritional requirement of patients without an increase in gastrointestinal intolerances. The results of this study are as follows: 1. Nutritional status of many patients in both groups were either malnourished or at risk for malnutrition. 2. The time to arrive to the nutritional requirements were 6.21 +/- 0.35 days for the control group and 4.24 +/- 0.52 days for the treatment group. The treatment group showed a significantly shorter amount of time. 3. The changes of the nutritional marker in the control group showed a significant drop in body weight, serum albumin and serum hemoglobin while the treatment group experienced a significant increase in body weight, serum albumin and total lymphocyte count. 4. Feeding intolerane such as diarrhea, high residual volume, ileus, nausea and vomiting were investigated. Diarrhea found in 25.1% (12 patients) of the control group and 22.2% (10 patients) of the treatment group and these findings are not significant.

A study on the provision of TPN for hospitalized patients

In Korea, implementation of nutrition support guidelines has been limited due to strict health insurance reimbursement policies as well as the lack of consensus on the best approach to TPN management. We examined the impact of TPN provision to hospitalized patients where NST (nutrition support team ) consultations were not requested by their primary physicians. The study showed the followings : 1. The median dutation of TPN provision was 8 days, but many patients were on TPN for less than 1 week. 2. The intake of energy and protein were less than the patient's requirements 3. Lipid emulsion was not provided to the most TPN patients. In conclusion, the role of NST should be expanded and studies are needed not only on TPN formulations which are suitable to Koreans but also on the cost-effectiveness of NST activities. TPN policies and protocols should be established based on the needs of each hospital.

The Effect of Oral Nutritional Supplement in Malnourished CAPD Patients / 대한신장학회잡지

Protein-calorie malnutrition is common in CAPD patients and is associated with increased morbidity and mortality. To evaluate the effect of an oral nutritional supplement(Greenbia RDplus, DR. CHUNG'S FOOD CO., LTD, Seoul, Korea) providing 800Cal and 24g of protein daily in addition to their usual diet on the nutritional status, we conducted a prospective study in malnourished CAPD patients (N=26). Subjects were randomised into 2 groups: group I(N=15) taking Greenbia RDplus for 3 months, group II(N=11) as control. In group I, the data of 12 patients who completed the 3-months study period were analyzed. There were no statistically significant changes in biochemical parameters including total protein, serum albumin, prealbumin, transferrin during the study period in both groups, but IGF-I increased significantly in group I(129.2+/-88.8 vs. 174.1+/-109.3ng/mL, P<0.05). Total calorie (1349+/-272 vs. 1720+/-251Cal/day, P<0.05) and protein intake(1.05+/-0.29 vs. 1.24+/-0.25g/kg/day, P<0.05) assessed by 72-hours dietary recall method increased significantly in group I with oral supplement. Body weight(52.4+/-8.3 vs. 54.2+/-8.8kg, P<0.05), body mass index(18.7+/-1.8 vs. 19.5+/-2.0kg/m2, P<0.05), % body fat(13.2+/-4.2 vs. 15.4+/-3.9%, P<0.05), total body muscle(16.8+/-3.7 vs. 18.2+/-3.3kg, P<0.05), midarm circumference(22.8+/-2.1 vs. 23.7+/-2.2cm, P<0.05) and calculated arm muscle area(25.9+/-7.1 vs. 28.9+/-6.1 cm2, P<0.05) increased significantly in group I after 3 months. Biceps and triceps skinfold thickness tended to increase following oral nutritional supplement but there was no statistical significance. Anthropometric parameters remained unchanged in group II. Kt/Vurea, normalized protein catabolic rate and standardized creatinine clearance did not change in both groups. In conclusion, oral nutritional supplement in malnourished CAPD patients well tolerated and was effective in improving the anthropometric parameters.

The Effect of Peritoneal Membrane Transport Characteristics on the Nutritional Status in Long-Term Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients / 대한신장학회잡지

Protein-calorie malnutrition is common in CAPD patients and is associated with increased morbidity and mortality. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein loss through the peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross-sectional study on clinically stable 110 patients who performed CAPD for more than 2 years, using PET and measuring nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Following results were obtained. 1) The patients were divided into 4 groups according to the PET results: high transporter(n=17, 15.5%), high average transporter(n=32, 29.1%), low average transporter(n=52, 47.3%) and low transporter(n=9, 8.1%). 2) Serum albumin levels(g/dl) in high transporter, high average transporter, low average transporter and low transporter were 3.5+/-0.4, 3.8+/-0.4, 4.1+/-0.4 and 4.3+/-0.3, respectively, and there was a significant difference between high transporter and low transporter(p<0.05). High transporter had significantly lower serum creatinine level(11.5+/-1.8mg/dl) than in low transporter(16.3+/-5.0mg/dl)(p<0.05), prealbumin level(mg/dl) was significantly lower in high transporter(29.8+/-5.1) than low average transporter(41.1+/-9.6) and low transporter(41.4+/-3.6) (p< 0.05). But, there were no significant differences in Hct, BUN, total cholesterol, transferrin and IGF-1 among the 4 groups. 3) Albumin loss through dialysate (g/day) was significantly more in high transporter(5.36+/-1.44) than in low average transporter(4.17+/-1.09) and low transporter(3.88+/-1.35)(p<0.05), and SCCr(L/wk/ 1.73 m2) was higher in high transporter(67.08+/-10.60) than in the others(high average transporter, 63.75+/-17.72; low average transporter, 54.92+/-14.54; low transporter, 49.03+/-8.93) (p<0.05). 4) Malnourished patients assessed by SGA were more in high transporter group (6/17, 35.3%) than in low transporer group (1/9, 11.1%)(p<0.05). 5) There were no statistically significant differences in NPCR, Weekly Kt/Vurea, and anthropometric parameters among the 4 groups. In conclusion, CAPD patients in high transporter group are more malnourished despite of more adequate dialysis with higher SCCr compared to those in low transporter group, which is resulted from large amount of protein and albumin loss through dialysate. Strict management and protein replacement therapy will be indicated in high transport CAPD patients to prevent protein malnutrition related morbidity and mortality.

Prevalencia de desnutrición en preescolar de Tabasco, México / Prevalence of malnutrition in preschool children of Tabasco, Mexico

La desnutrición infantil en Tabasco se percibe, a trevés del contacto cotidiano con los grupos de riesgo, como uno de los principales problemas de salud pública; sin embargo, no existía información local que permitiera aproximarse al problema para manejarlo de acuerdo con su frecuencia y distribución. Ante esta situación, la Secretaría de Salud Pública de Tabasco realizó, en el segundo semestre de 1991, la Primera Encuesta Estatal de Nutrición con el propósito de conocer la situación nutricional y alimentaria de 935 niños de 1 a 4 años de los 17 municipios de la entidad seleccionados en forma aleatoria. El nivel estatal de desnutrición fue del 46 por ciento (29.8 por ciento leve; 12.8 por ciento moderado; y 3.4 por ciento severo). El 90 por ciento de los desnutridos severos se localiza en el medio rural. Los municipios más afectados fueron Tacotalpan, Nacajuca, Jonuta, Macuspana y Centla con índices de 63.6 por ciento, 62.2 por ciento, 60 por ciento, 59.4 por ciento respectivamente. El análisis de los resultados define áreas de alto riesgo y permite la elaboración de propuestas concretas para su atención

Childhood malnutrition is an important and prevailing public health problem in Tabasco, Mexico, where precise information is still lacking. Tabasco Public Health Department has been working on this problem since 1991. The first nutritional survey was carried out to recognize the nutritional level of 935 randomly selected children between 1-4 years of age in 17 municipalities of the state. A proportion of 46% of childhood malnutrition level was found in this Mexican state (29.8 low, 12.8% moderate and 3.4% severe). Ninety percent of severe childhood malnutrition cases were located in the rural municipalities of Tacotalpa, Nacajuca, Jonuta, Macuspana and Centla. These municipalities were more affected, with a malnutrition prevalence of 63%, 62.2%, 60%, 59.5% and 59.4%, respectively. Results from these surveys identify high risk areas and may serve to advance specific proposals for nutrition interventions.