Cranial MRI findings in children with protein energy malnutrition

In this study, cranial magnetic resonance imaging (MRI) findings were investigated in children with moderate and severe protein energy malnutrition (PEM) to determine cerebral abnormalities in malnutrition in childhood. A total of 20 children aged 3 months to 36 months were included in the study. Thirteen (65%) children had severe malnutrition and seven (35%) children had moderate malnutrition. Fifteen (75%) children had abnormal MRI findings: all of them had cerebral atrophy, and 10 (75%) children had cerebral atrophy plus ventricular dilatation. None of the children had abnormality in the brain stem or cerebellum. The authors did not find statistically significant differences between the groups when comparing the MRI findings for degree of malnutrition, head circumference, iron deficiency anemia, and serum albumin levels. In conclusion, the findings showed that most (75%) children with moderate/severe PEM had abnormal MRI findings. Therefore, it is suggested that children with PEM should be evaluated for cerebral atrophy.     

住院癌症患者衰弱风险预测模型的构建与验证

目的 调查住院癌症患者发生衰弱的危险因素，构建风险预测模型并检验预测效果。方法 选取广州市2所三级甲等医院住院癌症患者570例，分为建模集422例和验证集148例。采用一般资料调查表、Fried衰弱表型、安德森症状评估量表、医院焦虑抑郁量表、中文版失志量表、营养风险筛查2002、Barthel指数量表进行调查，同期收集患者的白细胞介素-6、C-反应蛋白等实验室指标，应用logistic回归分析筛选衰弱的独立危险因素，构建风险预测模型。结果 住院癌症患者衰弱发生率为33.7%,衰弱的影响因素分别为：造口、营养状况、抑郁、神经心理症状群、消化道症状群、D-二聚体、白细胞介素-6。建模集和验证集ROC曲线下面积为0.788、0.735;Brier得分为0.205,校准斜率为0.625,决策曲线分析表明模型具有一定的临床可用性。结论 住院癌症患者衰弱发生率较高，构建的列线图预测模型具有较好的风险预测价值，可有效识别和筛选住院癌症衰弱高危人群。     

Vitamin and mineral status in elderly patients with chronic obstructive pulmonary disease

Introduction: Eating problems are common in patients with chronic obstructive pulmonary disease (COPD), and intake of micronutrients might be lower than recommended. Objective: To study dietary intake, serum and urinary concentration of trace elements and vitamins in elderly underweight patients with established severe COPD. Methods: Outpatients at a university clinic for lung medicine, with COPD, 70–85 years old, with no other serious disease, and with a body mass index (BMI) of ≤20 kg/m² and an FEV₁of <50 % predicted were recruited. Body composition and bone density were evaluated with dual energy X‐ray absorptiometry. Dietary intake was studied by a trained dietitian using diet‐history interview. Blood and urine samples were analysed for various vitamins and trace elements. Results: Seventeen of 30 recruited patients took part. Osteoporosis or osteopaenia was found in 16 patients. Dietary intake of energy and macronutrients was in line with recommendations for healthy individuals. Intake of protein did not meet recommendations for COPD patients. Intake of polyunsaturated fatty acids was lower than recommended and intake of saturated fatty acids was higher than recommended. Mean intake of vitamin D and folic acid was far below recommendations. Serum concentrations for folic acid and methylmalonate and plasma concentrations for homocysteine were below normal in several patients. Conclusion: Intake of vitamin D and calcium is often low in older COPD patients, which might contribute to osteoporosis. Low intake of folic acid might also be a problem. The results support prophylaxis with calcium, vitamin D and folic acid. Please cite this paper as: Andersson I, Grönberg A, Slinde F, Bosaeus I and Larsson S. Vitamin and mineral status in elderly patients with chronic obstructive pulmonary disease. The Clinical Respiratory Journal 2007;1:23–29.     

营养不良大鼠左心功能的改变与克山病病因关系的探讨

以左室收缩压峰值LVSP、左室内压最大上升速率dp/dt_(max)、E_(max)等指标测定了饲以克山病区(山东邹县)地瓜干煎饼三个月的营养不良大鼠的左心收缩功能及心脏容量负荷耐受性。结果:28只营养不良大鼠的心率HR、LVSP、dp/dt_(max)、E_(max)分别为295±59beats/min、12.4±3.8Kpa、279.3±104.9Kpa/sec、13.4±4.7Kpa/mm。皆明显低于正常对照 P<0.01。大剂量生理盐水快速静脉注射后上述指标明显低于注射前。P<0.01,而正常大鼠无明显改变 P>0.05。结果表明:营养不良大鼠左心收缩功能降低,容量负荷耐受性减弱。从而从心肌功能水平为营养不良因素在克山病发病中的作用提供了实验依据。     

Feasibility of Accessing Data in Hospitalized Patients to Support Diagnosis of Malnutrition by the Academy‐A.S.P.E.N. Malnutrition Consensus Recommended Clinical Characteristics

Background: The feasibility of accessing data in hospitalized patients to support a malnutrition diagnosis using the new Academy of Nutrition and Dietetics–American Society for Parenteral and Enteral Nutrition (AND‐A.S.P.E.N.) consensus recommended clinical characteristics of malnutrition is largely unknown. We sought to characterize baseline practice to guide the development of appropriate interventions for implementation of the recommended approach. Materials and Methods: A cross‐sectional survey was conducted of 262 consecutive adults who were referred for dietitian or nutrition support team assessments at 2 tertiary teaching hospitals in Pennsylvania. The availability of data to support the proposed AND‐A.S.P.E.N. approach and the resulting malnutrition diagnoses were examined. Results: Mean ± SD age was 58.2 ± 17.1 years, and half were female. Food intake history was available for 76%, weight history for 67%, and physical examination for loss of fat and muscle mass for 94% and for edema for 84%. Hand‐grip strength was not available. The prevalence of malnutrition among the patients referred for nutrition assessment was 6.7% moderate, 7.6% severe with acute illness; 12.2% moderate, 11% severe with chronic illness; and 0.8% moderate, 0.4% severe with social circumstances. Decline in typical food intake and weight loss were the most commonly used clinical characteristics. Conclusion: Data could generally be accessed to support the AND‐A.S.P.E.N. consensus clinical characteristics for malnutrition diagnosis, but further testing in multiple care settings is needed before these observations may be generalized. Training in assessment methods and dissemination of the necessary tools will be necessary for full implementation.     

昆山市2013年学龄前期儿童营养不良和贫血状况调查

目的 调查分析昆山市学龄前期儿童营养不良和贫血的状况,为提高学龄前期儿童的健康水平提供科学依据。方法 通过搜集2013年4-6月学龄前期儿童43 406例入学体检的相关资料,采用一般描述性分析、χ²检验来探究学龄前期儿童营养不良和贫血的状况。结果 本次调查发现学龄前期儿童营养不良1 347例,检出率为3.15%;贫血655例,检出率为1.53%。乡镇学龄前期儿童营养不良和贫血检出率均高于城区(P值均<0.05)。私立幼儿园儿童贫血检出率显著高于公立幼儿园儿童(P<0.05)。结论 昆山市学龄前期儿童营养不良和贫血的状况有待进一步改善。     

学龄前脑性瘫痪儿童149例营养状况调查分析

目的 探讨学龄前脑性瘫痪儿童的营养不良状况及其与临床分型、分级之间的关系。方法 测量149例0～6岁脑性瘫痪住院患儿的身高、体重、血红蛋白值,计算其低体重、发育迟滞、消瘦及贫血率;并分析营养不良各项指标与脑瘫类型、临床分型、粗大运动功能分级(Gross Motor Function Classification System,GMFCS)之间的关系。与正常学龄前儿童的营养不良状况进行对比。结果 学龄前脑性瘫痪儿童低体重、发育迟滞、消瘦及贫血率分别为:31.54%、33.55%、41.28%、28.85%,其营养不良发生率均明显较正常儿童高。在不随意运动型脑瘫及痉挛型进行比较中,低体重及消瘦组差异存在统计学意义(P<0.05),发育迟缓与贫血在这两个组比较差异无统计学意义(P>0.05)。105例痉挛型脑性瘫痪儿童,其低体重、发育迟缓、消瘦、贫血的发生率分别为:26.6%、31.43%、24.76%、28.57%。营养不良与脑性瘫痪的分级在低体重、发育迟缓及消瘦分组中差异都有统计学意义(P<0.05)。结论 脑性瘫痪儿童的营养不良比正常学龄前儿童明显高。加强其营养不良的干预力度是非常有意义及势在必行的。