Nutritional status, physical activity and associated nutrition knowledge of primary school learners.

BACKGROUND: Nutrition education has the potential to improve eating habits, physical activity and nutritional status of schoolchildren. AIM: This study aimed to determine the nutritional status, physical activity levels and the associated nutrition knowledge of primary school learners aged 9-14 years in Harare, Zimbabwe. METHODS: A cross-sectional survey was conducted among learners (n = 368) from eight primary schools. A self-administered questionnaire was used to collect sociodemographic, nutrition knowledge and physical activity data. The weights and heights were measured using World Health Organization (WHO) standards. Pearson chi-square and Fisher's exact tests were used to assess association between categorical variables. Binary logistic regression was used to explore the determinants of wasting and overweight. The level of significance was set at p < 0.05. RESULTS: Overweight, wasting and stunting affected 25.8%, 6.3% and 3% of the learners, respectively. Only 52.7% of the learners achieved the WHO recommended 60 minutes of physical activity. The mean±standard deviation nutrition knowledge score of the learners was 70.3±10.9%. Stunted children were more likely to be wasted (odds ratio (OR) = 4.38; 95% confidence interval (CI) 1.07-17.8; p = 0.039). Inadequate dietary diversity score (OR = 0.44; 95% CI 0.22-0.87; p = 0.018) and using non-active forms of transportation (OR = 2.69; 95% CI 1.52-4.76; p = 0.001) were a significant predictor of overweight among the learners. CONCLUSIONS: Overweight was the leading form of malnutrition, coexisting with undernutrition, reflecting the presence of a 'double burden of malnutrition'. Therefore, comprehensive and multi-sectoral interventions to improve healthy eating and physical activity are warranted.

[Glucocorticoids and androgens for treatment of tiredness and weakness in palliative care patients : a systematic review]. / Glukokortikoide und androgene zur behandlung von müdigkeit und schwäche bei palliativpatienten : eine systematische übersichtsarbeit.

BACKGROUND: The therapy of tiredness, weakness and fatigue in palliative care patients is of growing interest. Glucocorticoids and androgens are habitually mentioned drugs for treatment. In this review evidence for glucocorticoids and androgens for these indications in palliative care patients are presented. MATERIALS AND METHODS: A systematic search of PubMed and Embase for studies on glucocorticoids and androgens for fatigue, asthenia, sedation, tiredness, weakness, exhaustion, cachexia, drowsiness and wasting in palliative care was carried out in August 2011. Furthermore, the Cochrane Library, references from the literature and leading textbooks were also searched. Study information was entered in a standardized extraction sheet. By a categorization of studies five endpoints were distinguished: fatigue, strength/weakness, tiredness, well being/quality of life and energy/activity/performance. RESULTS: A total of 11 controlled studies with glucocorticoids and 13 controlled studies with androgens were included. In addition four uncontrolled studies, two case series and two surveys with glucocorticoids as well as six uncontrolled studies and one case series with androgen treatment were analyzed. All controlled trials of glucocorticoids were performed in cancer patients and all but one controlled trial of androgens in patients with HIV/AIDS. Glucocorticoids improved quality of life but results for changes of fatigue and weakness were inconsistent. Tiredness and energy were not improved. Androgens had a positive effect on fatigue and quality of life and showed variable effects on weakness. Androgens did not improve energy. Side effects were frequently documented but only rarely resulted in discontinuation of therapy. CONCLUSION: With the existing evidence no general recommendation for glucocorticoid and androgen use in tiredness and weakness in palliative care patients can be given; however, glucocorticoids in cancer patients and androgens in HIV positive-patients can be used in an individual trial for improving patient quality of life. The use in patients suffering from other disease entities should be evaluated in randomized controlled trials with a similar setting. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").

The complexity of treating wasting in ambulatory rehabilitation: Is it starvation, sarcopenia, cachexia or a combination of these conditions?

Nutritional status is often impaired in ambulatory rehabilitation patients. Wasting conditions can be classified as starvation, sarcopenia or cachexia but differences between these are not well defined, and misdiagnosis may lead to inappropriate intervention. A secondary analysis of data from 187 ambulatory rehabilitation patients aged >=60 years aimed to identify patients with one or more wasting condition, and investigate the impact on common rehabilitation outcomes. Starvation was defined by fat-free mass index and the Council on Nutrition Appetite Questionnaire score; sarcopenia by fat-free mass index and quadriceps strength; and cachexia by fat-free mass index and serum C-reactive protein. Selected rehabilitation outcomes were compared for those who were, and those who were not, identified as having one or more wasting condition. Of those identified with starvation (n=30), all were also identified as sarcopenic and 20 as cachectic; of those identified as sarcopenic (n=75), 30 had starvation and 37 were cachectic; and of those identified as cachectic (n=37), 20 had starvation and all were sarcopenic. Twenty participants were identified as having all three conditions. Those with starvation had higher level of depression (p=0.003), lower self-rated health (p=0.032), and lower levels of physical function (motor p=0.006; process p=0.004) than those with no evidence of a wasting condition. Those who had sarcopenia had lower physical function (motor p=0.012; process p=0.003) as did those with cachexia (motor p=0.025; process p=0.042). Results suggest problems in operationalising definitions in an ambulatory clinical setting. The overlap identified in this analysis suggests that up to 40% (75/187) of patients could be misidentified and prescribed inappropriate nutritional support.