Maternal nutrition in rural Kenya: health and socio-demographic determinants and its association with child nutrition

High levels of food insecurity and human immunodeficiency virus (HIV) infection place most breastfeeding mothers in Kenya at high risk of malnutrition. We examined the role of selected socio-economic, demographic and health factors as determinants of nutritional status among HIV-infected and HIV-uninfected mothers in rural Kenya and further examined the interrelationship between maternal nutritional and child nutritional status within this population. A cross-sectional design was used to collect data from non-pregnant mothers with children ages 4-24 months in Kisumu District, Kenya. Over 80% of the mothers were breastfeeding at the time of the study. Mean maternal body mass index (BMI) (21.60 ± 3.15) and percent body fat (22.29 ± 4.86) values were lower than among lactating mothers in other Sub-Sahara African countries. Maternal HIV status was not significantly associated with any of the maternal nutritional indicators assessed in the study. Breastfeeding, recent severe illness and having multiple children below 2 years of age were negatively associated with maternal nutritional status, while higher maternal age, socio-economic status and household food security were each positively associated with maternal nutritional status. Significant positive association was reported between maternal weight, height, BMI, mid-upper arm circumference (MUAC), body fat and fat-free mass estimates, and children's height-for-age, weight-for-age, weight-for-height and MUAC-for-age z-score. This analysis identifies determinants of maternal nutritional status in rural Kenya and highlights the importance of interventions that address malnutrition in both HIV-infected and HIV-uninfected mothers in rural Kenya. Significant association between maternal and child nutritional status stresses the importance of addressing maternal and young child nutritional status as interrelated factors.     

A behavioral approach to increasing calorie consumption in children with cystic fibrosis

To increase calorie consumption of 5 mildly malnourished children with cystic fibrosis (CF), intervention was implemented in multiple baseline fashion across snack and three meals. Intervention involved nutritional education establishing gradually increasing calories goals, teaching parents contingency management strategies, and a reward system for achieving calorie goals. Following 6 treatment sessions, the children's calorie intake increased across meals and total calorie intake was 25 to 43% above baseline. The calorie increase was maintained at 9-month follow-up. Significant changes in weight and height were made during treatment and the year following intervention. The results suggest that the long-term oral intake of children with CF can be modified by a short-term behavioral intervention.     

Amelioration of neurobehavioral and cognitive abilities of F1 progeny following dietary supplementation with Spirulina to protein malnourished mothers

Early life adversities (stress, infection and mal/undernutrition) can affect neurocognitive, hippocampal and immunological functioning of the brain throughout life. Substantial evidence suggests that maternal protein malnutrition contributes to the progression of neurocognitive abnormalities and psychopathologies in adolescence and adulthood in offspring. Maternal malnutrition is prevalent in low and middle resource populations. The present study was therefore undertaken to evaluate the effects of dietary Spirulina supplementation of protein malnourished mothers during pregnancy and lactation on their offspring’s reflex, neurobehavioral and cognitive development. Spirulina is a Cyanobacterium and a major source of protein and is being used extensively as a dynamic nutraceutical against aging and neurodegeneration. Sprague Dawley rats were switched to low protein (8% protein) or normal protein (20% protein) diet for 15 days before conception. Spirulina was orally administered (400 mg/kg/b.wt.) to subgroups of pregnant females from the day of conception throughout the lactational period. We examined several parameters including reproductive performance of dams, physical development, postnatal reflex ontogeny, locomotor behavior, neuromuscular strength, anxiety, anhedonic behavior, cognitive abilities and microglia populations in the F1 progeny. The study showed improved reproductive performance of Spirulina supplemented protein malnourished dams, accelerated acquisition of neurological reflexes, better physical appearance, enhanced neuromuscular strength, improved spatial learning and memory and partly normalized PMN induced hyperactivity, anxiolytic and anhedonic behavior in offspring. These beneficial effects of Spirulina consumption were also accompanied by reduced microglial activation which might assist in restoring the behavioral and cognitive skills in protein malnourished F1 rats. Maternal Spirulina supplementation is therefore proposed as an economical nutraceutical/supplement to combat malnutrition associated behavioral and cognitive deficits.     

Rare association of central pontine myelinolysis with infantile tremor syndrome

Central pontine myelinolysis (CPM) is an acute demyelination within the central basis pontis. Though exact mechanism is not known it is seen commonly with rapid correction of hyponatremia and also with pontine ischemia or infarction, demyelinating diseases, pontine neoplasm and different metabolic diseases. We report a rare association of CPM in a patient of Infantile Tremor Syndrom (ITS). ITS is a syndrome of tremor, mental and physical retardation, pigmentary changes of hair and skin and anemia in malnourished children. Though first reported in Indian subcontinent many identical cases were reported from around the world. Our case is a 15 month old child with generalized tremor, mild hepatosplenomegaly with features of grade II malnutrition including skin and hair changes. All the signs and symtoms of tremor improved after treatment with the World Health Organization (WHO) protocol for protein energy malnutrition (PEM) and administration of propranolol without any side effects.     

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.     

血液透析患者颈-股动脉脉搏波速度改变及其影响因素

背景：维持性血液透析患者颈-股动脉脉搏波速度改变受多种因素影响。 目的：探讨维持性血液透析患者颈-股动脉脉搏波速度改变及其相关因素分析。 设计、时间及地点：相关性分析,交叉对照实验,于2006-01/08北京大学第三医院肾脏内科完成。 对象：北京大学第三医院临床情况稳定的66例维持性血液透析患者。 方法：收集患者一般情况、生化学指标、颈-股动脉脉搏波速度和主观综合营养状态的评估等4个方面资料。根据SGA营养评分将患者分为营养正常组49例、营养不良组17例。比较两组脉搏波速度的差异,采用单因素相关和多因素回归分析探讨脉搏波速度的相关因素。 主要观察指标：患者颈-股动脉脉搏波速度,血白蛋白和甲状旁腺激素。 结果：血液透析患者颈-股动脉脉搏波速度与年龄(r=0.284,P=0.021)、收缩压(r=0.468,P < 0.001)、脉压(r=0.451,P < 0.001)存在显著正相关,与透前血清肌酐(r=-0.347,P=0.004)、转铁蛋白(r=-0.284,P < 0.05)、血前蛋白 (r=-0.318,P < 0.05)、血浆白蛋白(r=-0.263,P < 0.05)和甲状旁腺激素(r=-0.167,P < 0.05)存在负相关。多元逐步回归分析显示脉压和甲状旁腺激素是颈-股动脉脉搏波速度的独立影响因素。采用SGA营养评估营养状态,营养不良组颈-股动脉脉搏波速度明显增快,与营养正常组比较差异有显著性意义(P < 0.05)。 结论：脉压是维持性血液透析患者颈-股动脉脉搏波速度独立的影响因素。营养不良与动脉粥样硬化是维持性血液透析常见的并发症,两者关系密切,营养不良者脉搏波速度值增高。     

Pathologic ultrasound findings and risk for congenital anomalies in teenage pregnancies

Objective: To detect the number and diagnosis of fetal malformations in teenage pregnancies and to evaluate whether low maternal age or epigenetic factors have an influence on this issue. Materials and methods: We performed a retrospective analysis in a single center for prenatal diagnostics in Northern Germany. We searched our electronic databank for all pregnancies with maternal age under 20 years. Pregnancy outcome and fetal malformations are described. Results: The incidence of teenage pregnancies in our study was 638 patients (4.4%). The total of fetal malformations in teenage pregnancies was 51(8.3%). Chromosomal aberrations were found in 5 cases (0.9%). 9 cases of fetal gastroschisis as one of the most frequent malformations were followed up and neonatal outcome was uneventful. Furthermore we found 16 cases with different heart defects and 30 cases with other malformations. Patients’ body mass indices showed an increase over the years and nicotine consumption was testified in more than 50% of the patients. Conclusions: Teenage pregnancies are at risk for fetal non-chromosomal and chromosomal abnormalities. As these might be detected by first-trimester-screening prenatal care in teenage pregnancies should include at least early ultrasound examination. Epigenetic factors may play a key role in certain fetal malformations.     

呼吸功能不全病人代谢特点及围手术期营养治疗

呼吸功能不全病人的病理生理特点决定其在疾病的不同阶段会发生不同程度的营养问题。在围手术期治疗中,及时合理的营养治疗是救治病人的重要环节,运用得当会明显改善预后,否则会导致病情恶化。合理的营养治疗是提高呼吸功能不全病人手术耐受性和成功率的重要方面。     

维持性血液透析病人营养与预防临床研究

目的：通过较简便可行的生化检查，对维持血液透析病人的预防观察，并发症的发生情况，了解此类病人长期存活的影响因素，从而在日常工作中给予指导，减少营养不良的发生。提高生存质量和存活时间。方法：对46例患者透析前各项指标的检测，其中营养不良较重者28例、轻者13例．全部采用碳酸盐血液透析治疗，对于透后12周、镐周分析做白蛋白、Hb、HCT等检查，了解病人的营养状况，根据营状不良的程度判断预后。结果：白蛋白、胆固醇明显降低者，心血管并发症及感染等并发症明显增多，死亡率增高。结论：对于维持性血液透析病人，要综合治疗要定期复查Hb、HCT、白蛋白、胆固醇等较常见的实验室指标，保证其生存质量。     

单吻合口胃旁路术治疗病态肥胖症56例疗效分析

目的 探讨单吻合口胃旁路术（OAGB）治疗病态肥胖症及其相关合并症的有效性与安全性。方法 回顾性分析2018年9月至2019年10月首都医科大学附属北京友谊医院普通外科中心实施OAGB的56例肥胖病人的临床资料。结果 56例均顺利完成手术,无中转开腹病例。手术时间为78~262（131.7±30.6）min,术中失血量为20~200（45.2±50.9）mL,术后住院时间为3~7（4.4±1.1）d,每台手术所需钉仓数为5~8（6.7±0.7）个。术后6周内12例（21.4%）发生并发症,其中Clavien-Dindo分级Ⅰ级7例、Ⅱ级4例、Ⅲb级1例。术后3、6、12个月的总体重减少百分比（%TWL）分别为20.0%、26.5%及33.5%。完成术后12个月随访的25例病人中,2型糖尿病、高血压病、高脂血症及高尿酸血症的缓解率分别为100%、83.3%、91.7%及44.4%。结论 OAGB治疗病态肥胖症及其相关合并症安全且有效,术后随访应密切关注胆汁反流和营养不良风险。