Objective: To analyze the clinical characteristics and risk factors of protein energy wasting (PEW) in children with chronic kidney disease (CKD). Methods: Clinical data of 231 children with chronic kidney disease hospitalized in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to January 2023 were retrospectively analyzed to explore the incidence of PEW. According to the diagnostic criteria of CKDPEW, they were divided into a CKDPEW group and a non PEW group. The comparison between the groups was performed by independent-sample t test and Chi-squared test, and the risk factors were analyzed by multivariate Logistic regression. Results: Among the 231 children, there were 138 males and 93 females, with a visiting age of 9.9 (7.9, 16.0) years; 6 cases were in stage 1, 14 cases in stage 2, 51 cases in stage 3, 36 cases in stage 4, and 124 cases in stage 5. A total of 30 children (13.0%) with CKD PEW were diagnosed at the age of 7. 1 (3.8, 13.2) years, including 1 case in stage 1, 1 case in stage 2, 5 cases in stage 3, 5 cases in stage 4, and 18 cases in stage 5. There were a total of 201 cases (87.0%) in the non PEW group, diagnosed at the age of 11.8 (8.5, 12.2) years, including 5 cases in stage 1, 13 cases in stage 2, 46 cases in stage 3, 31 cases in stage 4, and 106 cases in stage 5. The Chi-squared test and t test showed that the systolic blood pressure, diastolic blood pressure, birth weight and carbon dioxide binding capacity of the CKD PEW group were lower than those of the non PEW group ((109±22) vs. (120±20) mmHg (1 mmHg=0.133 kPa), (72±19) vs. (79±16) mmHg, (2.9±0.5) vs. (3.2±0.6) kg, (17±4) vs. (19±4) mmol/L,t=2.85, 2.14, 0.67, 2.63, all P<0.05). Multivariate logistic regression analysis showed that carbon dioxide binding capacity and birth weight were independent protective factors of CKDPEW in children (OR=0.81 and 0.36, 95%CI=0.73-0.90 and 0.17-0.77, respectively; both P<0.01); the risk of PEW in CKD children decreased by 0.187 times for every 1 mmol/L increment in carbon dioxide binding capacity, and 0.638 times for every 1 kg increment in birth weight. Conclusions: The incidence of protein energy expenditure in children with chronic kidney disease is lower than that in the previous researches. PEW can appear in CKD 1-2 stage, and attention should be paid to it in the early stage of CKD in clinical practice. Low birth weight CKD children are susceptible to PEW, and actively correcting metabolic acidosis can reduce the risk of CKDPEW.
Renal Insufficiency, Chronic/epidemiology* ; Humans ; Child ; Energy Metabolism ; Protein-Energy Malnutrition/epidemiology* ; Risk Factors ; Adolescent ; Male ; Female ; Proteins/metabolism* ; China/epidemiology*

The number of patients is increasing and their mean age is also increasing. Proper dietary adjustments are necessary to prevent protein-calorie malnutrition or complications but it is difficult for dialysis patients to adapt to diet therapy due to stress or anorexia. Education does not consider the individual characteristics, knowledge, dietary inhabit education demands, and initial education. The purpose of this study was to identify dialysis patient's nutrition knowledge and, dietary practice and compare those with nutrition education or counseling demands for providing basic data of desirable nutrition management. The data were collected by a survey consisting of the general characteristics, disease related characteristics, nutrition education and counsel characteristics, level of nutrition knowledge, diet therapy, and nutrition education and counsel demands from the 28th March to 22th July 2017. The total number of subjects were 33 patients among dialysis patients at two tertiary medical institutions and an artificial kidney room at a private hospital in Incheon·Gyeonggi. The data collected were analyzed statistically using the SPSS program 23.0, followed by further analyses using frequency analysis, one-way ANOVA, cross analysis, and correlation analysis. The results of the dialysis patients showed that younger (P < 0.05), female (P < 0.05), abnormal high school diploma (P < 0.001) groups had high nutrition scores. In addition, dietary practice and nutrition education and counsel demands showed a positive correlation (P < 0.05, P < 0.01). In particular, females were higher than males in nutrition knowledge, dietary practice, nutrition education, and counseling demand scores.
Anorexia ; Counseling ; Dialysis ; Diet Therapy ; Diet ; Education ; Female ; Hospitals, Private ; Humans ; Kidney Failure, Chronic ; Kidneys, Artificial ; Male ; Protein-Energy Malnutrition

PURPOSE: Wasting and underweight are the 2 main indicators of children’s undernutrition. We aimed to estimate the prevalence of undernutrition at the national level in Iran. METHODS: We performed a search for original articles published in international and Iranian databases including MEDLINE, Web of Science, Google Scholar, Scopus, CINHAL (Cumulative Index to Nursing and Allied Health Literature), Scientific Information Database, Irandoc, Iranmedex, and Magiran during January 1989–August 2017. Seven keywords, in English and Persian, including malnutrition, protein energy malnutrition, growth disorders, underweight wasting, weight loss, children below 5 years old, and children, were used to search the databases. RESULTS: Finally, 17 articles were included in the meta-analysis, based on which the prevalence of underweight and wasting in Iranian children were estimated to be 11% and 5%, respectively. The prevalence rates of underweight among children in the central, western, southern, and northern parts of Iran and at the national level were 24%, 5%, 20%, 17%, and 6%, respectively. The prevalence rates of wasting in the central, western, southern, and northern parts of Iran and at the national level were 9%, 4%, 11%, 5%, and 4%, respectively. CONCLUSION: Although the prevalence of underweight and wasting in Iran was low, some parts of the country showed high prevalence. The main reason behind this difference in the prevalence of malnutrition may be due to the level of development in different regions.
Child* ; Growth Disorders ; Humans ; Iran ; Malnutrition ; Nursing ; Prevalence* ; Protein-Energy Malnutrition ; Thinness* ; Weight Loss

This study set out to evaluate the impact of personalized nutritional counseling (PNC) on the nutritional status of hemodialysis (HD) patients. This was an intervention study for 10 months at 2 hospitals. Anthropometric, biochemical, dietary, and body composition parameters were measured at baseline and after 3 and 6 months of PNC. A total of 42 patients (23 men and 19 women) were included. Intake of dietary protein, serum albumin, and cholesterol levels had increased significantly from baseline to month 6 (p < 0.05). Among the bioelectrical impedance analysis (BIA) parameters, both the body cell mass (BCM) and the fat free mass (FFM) had significantly reduced at month 3 compared to baseline (p < 0.05). However, there was no difference between baseline and month 6. We assessed the nutritional status of the subjects using the malnutrition inflammation score (MIS), and divided them into an adequately nourished (AN) and a malnourished (MN) group at baseline. In the subgroup analysis, serum levels of albumin and cholesterol had increased significantly, particularly from baseline to month 6 in the MN group (p < 0.05). This study suggests that consecutive PNC contributed to the improvement of the protein intake, serum levels of albumin, cholesterol and to the delay of muscle wasting, which could also have a positive impact on the nutritional status, particularly in malnourished patients receiving HD treatment.
Body Composition ; Cholesterol ; Counseling* ; Diet Therapy ; Dietary Proteins ; Electric Impedance ; Humans ; Inflammation ; Male ; Malnutrition ; Nutrition Assessment ; Nutritional Status* ; Protein-Energy Malnutrition ; Renal Dialysis* ; Serum Albumin

OBJECTIVES: This study compared the nutritional status of child-bearing age women between the Democratic People's Republic of Korea (North Korea) and the Republic of Korea (South Korea). METHODS: The data presented in the DPRK Final Report of the National Nutrition Survey 2012 was utilized for the nutritional status and food intake of North Korean women. To produce the South Korean women's data comparable to those of North Korean women, the data from the 2012 National Health and Nutrition Survey were analyzed and the data presented in the 2010 Report of the Korean Agency for Technology and Standards were utilized. RESULTS: The prevalence of maternal anemia (blood hemoglobin < 12.0 g/dL) was over 30% in all the age groups of North Korean women and 8.9%, 14.2%, 16.4% in 20-29, 30-39, 40-49 year old South Korean women, respectively. The prevalence of maternal protein-energy malnutrition (Mid-Upper Arm Circumference < 22.5 cm) was 25.2%, 21.4%, 21.8% in 20-29, 30-39, 40-49 year old North Korean women, respectively and less than 10% in all the age groups of South Korean women. Result of dietary diversity comparison showed that North Korean women consumed less food than South Korean women at all food groups: grains, fruits, vegetables, meat, and dairy. Percentage of North Korean women having consumed protein rich foods-meat and fish, eggs or dairy products-were much lower than those of South Korean women. CONCLUSIONS: The striking disparity of nutritional status between South and North Korean women indicates that nutrition support for North Korean women is essential in the process of preparation for a unified nation.
Anemia ; Arm ; Democratic People's Republic of Korea* ; Eating ; Eggs ; Female ; Fruit ; Humans ; Meat ; Nutrition Surveys ; Nutritional Status ; Ovum ; Prevalence ; Protein-Energy Malnutrition ; Republic of Korea ; Strikes, Employee ; Vegetables

To develop a live vaccine strain against fowl typhoid and paratyphoid caused by Salmonella serovar Gallinarum biovar Gallinarum (Salmonella Gallinarum) and Salmonella serovar Enteritidis (Salmonella Enteritidis), respectively, several nalidixic acid resistant mutants were selected from lipopolysaccharide (LPS) rough strains of Salmonella Gallinarum that escaped from fatal infection of a LPS-binding lytic bacteriophage. A non-virulent and immunogenic vaccine strain of Salmonella Gallinarum, SR2-N6, was established through in vivo pathogenicity and protection efficacy tests. SR2-N6 was highly protective against Salmonella Gallinarum and Salmonella Enteritidis and safer than Salmonella Gallinarum vaccine strain SG 9R in the condition of protein-energy malnutrition. Thus, SR2-N6 may be a safe and efficacious vaccine strain to prevent both fowl typhoid and paratyphoid.
Bacteriophages ; Nalidixic Acid ; Protein-Energy Malnutrition ; Salmonella ; Salmonella enteritidis ; Typhoid Fever* ; United Nations ; Virulence

BACKGROUND/OBJECTS: When the functions involved in the ingestion of food occurs failure, not only loss of enjoyment of eating, it will be faced with protein-energy malnutrition. Dysmasesis and difficulty of swallowing occurs in various diseases, but it may be a major cause of aging, and elderly people with authoring and dysmasesis and difficulty of swallowing in the aging society is expected to increase rapidly. SUBJECTS/METHODS: In this study, we carried out a survey targeting nutritionists who work in elderly care facilities, and examined characteristics of offering of foods for elderly and the degree of demand of development of easily chewable and swallowable foods for the elderly who can crush foods and take that by their own tongues, and sometimes have difficulty in drinking water and tea. RESULTS: In elderly care facilities, it was found to provide a finely chopped food or ground food that was ground with water in a blender for elderly with dysmasesis. Elderly satisfaction of provided foods is appeared overall low. Results of investigating the applicability of foods for elderly and the reflection will of menus, were showed the highest response rate in a gelification method in molecular gastronomic science technics, and results of investigating the frequent food of the elderly; representative menu of beef, pork, white fish, anchovies and spinach, were showed Korean barbecue beef, hot pepper paste stir fried pork, pan fried white fish, stir fried anchovy, seasoned spinach were the highest offer frequency. CONCLUSIONS: This study will provide the fundamentals of the development of easily chewable and swallowable foods, gelification, for the elderly. The study will also illustrate that, in the elderly, food undergone gelification will reduce the risk of swallowing down to the wrong pipe and improve overall food preference.
Aged* ; Aging ; Deglutition ; Drinking Water ; Eating ; Food Preferences ; Humans ; Nutritionists ; Protein-Energy Malnutrition ; Seasons ; Spinacia oleracea ; Tea ; Tongue ; Water

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.
Adult ; APACHE ; Body Mass Index ; Critical Illness* ; Electronic Health Records ; Enteral Nutrition ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Nitrogen* ; Nutritional Support ; Parenteral Nutrition* ; Physiology ; Protein-Energy Malnutrition ; Respiration, Artificial ; Retrospective Studies ; Ventilation

Patients with diabetes undergo bariatric surgery to improve sugar metabolism and to achieve weight loss. However, possible complications after bariatric surgery must be carefully considered. We report a case of uncontrolled blood sugar after bariatric surgery despite weight loss in a severely obese patient with diabetes. The patient underwent bariatric surgery in 2009 in order to lose weight and improve glycemic control. Six months after the surgery, the patient experienced dumping syndrome. The patient did actually lose weight; however, as the visceral fat/subcutaneous fat+visceral fat ratio increased, insulin resistance was not improved, and glycemic control was aggravated. The patient received proper medication for dumping syndrome including nutritional support and exercise education. Due to these efforts, the patient has maintained her weight loss, and her blood sugar level was controlled within the target range.
Bariatric Surgery ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Dumping Syndrome ; Education ; Humans ; Insulin Resistance ; Insulin ; Intra-Abdominal Fat ; Metabolism ; Nutritional Support ; Protein-Energy Malnutrition ; Weight Loss

Nutrition therapy is challenging in critically ill patients. Critical illness is associated with a state of catabolic stress, in which stress hormones and inflammatory mediators are activated, resulting in proteolysis. The aim of nutrition therapy in critically ill patients is to preserve lean body mass, to preserve immune function, and to avoid metabolic complications. Enteral nutrition is preferred over parenteral nutrition. Enteral nutrition should be initiated within 24 to48 hours of intensive care unit admission. However, enteral nutrition should be withheld until the patient is fully resuscitated. If enteral nutrition is not feasible within several days, supplementary parenteral nutrition is necessary. In the acute phase, energy requirements should not be over 20 to 25 kcal/kg/d, and protein should be supplemented in the range of 1.2 to 2.0 g/kg/day. Monitoring tolerance is very important in critically ill patients with artificial nutrition to avoid complications. Immunonutrition such as glutamine and omega-3 fatty acid is helpful to modulate effects on the immune system in critically ill patients. Implementation of a feeding protocol and the involvement of a nutrition support team can systemize nutrition therapy. Together, these steps will hopefully enable the integration of evidence-based guidelines into practice, leading to improvements in nutrition performance so that patients' chances of a good outcome are optimized.
Critical Illness ; Enteral Nutrition ; Glutamine ; Humans ; Immune System ; Intensive Care Units* ; Nutrition Therapy* ; Parenteral Nutrition ; Protein-Energy Malnutrition ; Proteolysis