Malnutrition, fertility and family planning.

Data derived primarily from published reports is used to assess the relationship between malnutrition and reproductive capacity in India. Findings of numerous studies support the conclusion that improvements in nutritional status are associated with increased fertility in the absence of contraception. Nutritional programs should therefore be provided in conjunction with family planning services in order to avoid an increase in population growth. Improvements in the nutritional status of members of a community may help motivate the community toward family planning. A recent Indian study demonstrates that higher caloric intake is associated with smaller family size, and other studies reveal a relationship between malnutrition and pregnancy failure, stillbirth, and infant mortality. The high infant mortality rate in India at the present time may serve to increase family size since couples tend to over produce in order to insure that some of their children will survive. The hypothesis that an inadequate diet is compensated for by an increase in sexual appetite, and hence, in fertility is not substantiated by recent investigations. For example, Indian states with higher protein intake/person have higher birth rates than those states with lower protein intake/person. Tables provide data on 1) birth rates, death rates, infant mortality rates, % of population increase, and sex ratios for each decade from 1921-1970 for India; 2) the relationship between diet and birth rates in several countries; 3) the relationship between various dietary factors and birth, death, and infant mortality rates forIndia; 4) fertility rates observed in several populations where contraception was not practiced; and 5) the relationship between family size and diet in India.     

Malnutrition and the heart.

Earlier concepts that the heart is spared in malnutrition have been shown to be incorrect. Inadequate intake of protein and energy results in proportional loss of skeletal and myocardial muscle. As myocardial mass decreases, so does the ability to generate cardiac output; however, various compensatory factors come into play. Nutritional supplementation for malnourished patients reverses the compensatory factors and may increase the short-term potential for heart failure. Severe cardiac debility results in poor nutrition, which may in turn produce unsuspected but clinically significant myocardial atrophy. Nutritional support may play a role in improving cardiac function in selected patients with cardiac cachexia who are being prepared for cardiac surgery and in patients with rapid weight loss who are at risk for sudden death due to arrhythmias. Malnutrition is common in hospitalized patients, and many patients in hospital now receive nutritional supplementation; both facts have important cardiac implications.     

Malnutrition and ageing

This article aims to provide an overview of the problems that exist in relation to malnutrition and the elderly population. The changes that occur in body composition during ageing are described and how this may affect disease risk. The possible metabolic processes behind weight loss are discussed and the numerous factors that affect nutritional status in the older age group are described. Prevention of malnutrition in this group is important and so the roles of nutrition screening and assessment are examined.     

Malnutrition, measles, mortality, and the humanitarian response during a famine in Ehiopia

CONTEXT: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. OBJECTIVES: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. DESIGN AND SETTING: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. PARTICIPANTS: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. MAIN OUTCOME MEASURES: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m(2) among adults and older persons. RESULTS: Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/10 000 per day (95% confidence interval [CI], 2.4-3.8/10 000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10 000 per day (95% CI, 5.4-8.2/10 000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% CI, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m(2)) among adults aged 18 to 59 years was 22.7% (95% CI, 17.9%-27.5%). CONCLUSIONS: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.     

人脑发育过程中髓鞘碱性蛋白基因的表达

为探索人脑髓鞘碱性蛋白（ＭＢＰ）基因表达的时空秩序与髓鞘发生和形成之间关系，采用３２Ｐ－和生物素标记鼠ＭＢＰｃＤＮＡ和地高辛标记人ＭＢＰｃＲＮＡ探针，对发育过程中人脑进行Ｎｏｒｔｈｅｒｎ斑点杂交和原位杂交研究。Ｎｏｒｔｈｅｒｎ斑点分析结果显示：１６周胎龄脑ＭＢＰｍＲＮＡ表达已明显，Ａ５９０值近２．０／μｇＲＮＡ，随发育逐渐增加，至成年其表达增至９倍（Ａ５９０值为１８／μｇＲＮＡ）。８～２５周胎龄脊髓和延脑切片以及２０、２２和２５周胎龄桥脑、中脑、丘脑、小脑和大脑切片原位杂交结果表明：在８～９周胎龄人脑脊髓前角和近延脑第四脑室底区域中，其散在细胞的核周胞浆内有ＭＢＰｍＲＮＡ表达信号，该阳性细胞比少突细胞大，而且胞浆丰富，它们究竟是神经元或胶质前体仍待鉴定。在２０周胎龄期，ＭＢＰｍＲＮＡ表达在脊髓和延脑区骤增，并沿少突细胞突起延伸呈网状；此期桥脑该基因表达已明显，在其他脑区该表达信号也有散在分布     

Malnutrition and mortality in Kohistan District, Afghanistan, April 2001.

CONTEXT: The humanitarian situation in Afghanistan has been deteriorating for more than 3 years because of civil war and severe drought. Because of recent events, the international community is predicting a severe worsening of the country's current situation. OBJECTIVE: To assess the magnitude and causes of mortality and prevalence of malnutrition in Kohistan district, Faryab province, Afghanistan. DESIGN: Two-stage, 30-cluster household survey conducted April 4 through 10, 2001, which included anthropometric measurements, assessment of food coping mechanisms, and retrospective mortality data collection for November 26, 2000, through April 4, 2001. SETTING AND PARTICIPANTS: A total of 378 households comprising 3165 people living in Kohistan district, Faryab province, Afghanistan. MAIN OUTCOME MEASURES: Crude mortality rate, mortality rate among children younger than 5 years, causes of death, prevalence of wasting and stunting among children aged 6 to 59 months (weight-for-height and height-for-age z scores <-2, respectively), and food coping mechanisms. RESULTS: The crude mortality rate among the 3165 persons surveyed during the period of interest was 2.6 (95% confidence interval [CI], 1.7-3.5) per 10 000 per day and the mortality rate among 763 children younger than 5 years was 5.9 (95% CI, 2.0-8.8) per 10 000 per day. Diarrhea (25.0%), respiratory tract infections (19.4%), measles (15.7%), and scurvy (6.5%) caused most of the 108 deaths. The prevalences of wasting and stunting among 708 children aged 6 to 59 months were 7.0% (95% CI, 5.9%-9.0%) and 63.7% (95% CI, 58.6%-68.8%), respectively. Evidence of late-stage food coping mechanisms and prefamine indicators existed among the population. CONCLUSIONS: These data indicate that, by April 2001, a humanitarian crisis already existed in Kohistan. Essential humanitarian services, including food aid and public health programs, are urgently required in such regions of Afghanistan and will be crucial if a worsening humanitarian crisis is to be avoided. For these services and programs to be implemented, the international community needs to create adequate humanitarian space (ie, a secure and accessible location where humanitarian organizations can provide services to emergency-affected populations) to ensure that humanitarian organizations have access to populations within Afghanistan as well as to refugees who flee to surrounding countries.     

建立早产儿脑损伤的随访与早期干预体系

随着早产儿存活率的提高,尤其是早早产儿存活增多,早产儿相关神经系统后遗症越来越受到关注和重视。除脑性瘫痪外,伴随发育过程,早产儿有较高的学习、社会交往等神经心理行为障碍,甚至成年期的生活质量也受到影响。有关早产儿脑损伤及神经系统后遗症的发生机制,如何对早产儿进行随访、怎样进行早期干预,是目前医学研究的热点和难题。本专题对早产儿脑损伤及其远期神经后遗症的发生机制、评价手段、早期干预方法等相关问题进行了探讨,以期为早产儿脑损伤的随访与早期干预体系的正确合理建立奠定基础。     

确立"脑主神明"是藏象学说发展的必然--兼论藏象学说的利与弊

阐述了藏象学说的科学性，指出了藏象学说的欠缺之处，认为确立和发展“脑主神明”说是正本清源，也是藏象学说发展的必然，阐明了在脑主神明基础上的脏腑关系，并提出脑主神明说应该完善的假说。     

七氟醚对发育期大脑神经损伤的药物干预研究进展

七氟醚是产科和儿科全身麻醉中最常用的吸入麻醉药物之一,其对发育期大脑的神经损伤是目前医学研究热点。通过查阅相关基础文献,本文将动物实验中七氟醚神经毒性的髓鞘形成受损、细胞凋亡、神经炎症、氧化应激、组蛋白乙酰化抑制及神经突触和受体改变等主要潜在机制进行归纳,进一步探究了相应的抗贫血药、植物提取物类药物、α₂受体激动剂和其他类型药物干预效果与机制,为妊娠期胎儿和婴幼儿提供围手术期脑保护措施的理论依据。     

Malnutrition, and anthropometric and biochemical abnormalities in end-stage renal disease patients

OBJECTIVE: To detect and compare the degree of malnutrition as well as the anthropometric and biochemical abnormalities among male and female patients with end-stage renal disease (ESRD). METHODS: A cross-sectional study was carried out at hemodialysis units in 7 Jordanian hospitals, between 2004 - 2005. Two hundred and seventeen ESRD outpatients who underwent hemodialysis were recruited using the convenience-sampling technique. A subjective global assessment (SGA) was used to assess the degree of malnutrition in both male and female patients. Anthropometric and biochemical measurements were also assessed in all patients. RESULTS: The SGA suggested that 50% of females were well nourished while 75% of the males were moderately to severely malnourished. The measured anthropometric variables showed a significant decrease in both male and female patients, except for triceps skinfold thickness. The hemoglobin as well as blood creatinine level were lower among females. In the biochemical parameters, there was a significant decrease in hemoglobin, albumin, and total protein blood levels in male patients. However, a significant decrease in hemoglobin only was detected in female patients with advanced malnutrition. CONCLUSION: The nutritional status determined by SGA indicated a higher proportion of male patients with moderate to severe malnutrition as compared to female patients. Most of the anthropometric parameters could be used to assess the nutritional status of hemodialysis patients. The noticeable hemoglobin reduction, which increased with malnutrition degree, was significant in both male and female patients, while serum albumin and total protein reduction was significant among male patients only.     

Malnutrition and health in developing countries

MALNUTRITION, WITH ITS 2 CONSTITUENTS of protein–energy malnutrition and micronutrient deficiencies, continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor (the 2 forms of protein– energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries. In these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein– energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently. To be effective, all such interventions require accompanying nutrition-education campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium Development Goals, we need to address poverty, which is clearly associated with the insecure supply of food and nutrition.     

Malnutrition in Relation with Dietary,Geographical, and Socioeconomic Factors among Older Chinese

Objective Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary, geographical, and socioeconomic factors. Methods A total of 13,987 ≥ 60-year-old persons from the 2010–2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight, overweight or obesity, and micronutrient inadequacy. Results Overall, the prevalence of obesity, overweight, and underweight was 12.4％, 34.8％, and 5.7％, respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old (≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75％ of the elderly do not meet the Dietary Reference Intakes for vitamins A, B1, B2, and E, folate, calcium, selenium, potassium, biotin, and choline, with the prevalence of inadequate intake increasing with age for most nutrients. At the population level, the mean intakes of numerous food groups did not meet the recommendations by the Chinese Dietary Guideline. Conclusions Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China.