营养不良的胃肠形态和功能

蛋白质－热能营养不良是儿科常见疾病之一，它与胃肠道形态和功能有密切联系。营养不良可引起胃肠形态异常和功能障碍，而胃肠道形态异常又可引起营养物质吸收障碍，从而进一步造成营养不良。我们认为了解营养不良的胃肠形态和功能有助于儿科医师对本病的治疗。     

鞍区肿瘤术后中枢性低钠血症的诊断和治疗

目的:探讨鞍区肿瘤术后中枢性低钠血症的诊断及处理方法。方法:对我科近四年鞍区肿瘤术后并发中枢性低钠血症的58例患者进行回顾性分析,术前、手术当日及术后每日定时检测血钠,观察尿量变化,测定中心静脉压,确定低钠血症的类型并给予相应的处理。结果:56例恢复正常,1例死于严重肺部感染,1例自动出院。结论:鞍区肿瘤易出现抗利尿激素分泌不当综合症和脑性耗盐综合症两种类型。前者需限水治疗,后者应予以充分补钠、补水,根据水、钠检测水平治疗。     

Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial

AIMS:To compare nutritional counseling with and without oral supplements in HIV-infected patients with recent weight loss. DESIGN: Randomized non-blinded controlled trial, stratified for change in antiretroviral treatment at baseline. PATIENTS: HIV-infected patients with recent weight loss (> 5% of total, and >3% in the last month). INTERVENTION: Nutritional counseling to increase dietary intake by 600 kcal/day over 8 weeks; in group A (n=24) by normal food, and in group B (n=26) by a range of fortified drink supplements with a calorific value of 0.6 to 1.5 kcal/ml. METHODS: Body composition by bioelectrical impedance analysis, dietary intake by 24 h recall. RESULTS: Fat free mass increased from baseline to week 8 (P<0.05) with no difference between groups A and B (P=0.97). Body cell mass and weight gain were not significant and equal between groups. Assessed at weeks 2 and 4, group B patients consumed 11 +/- 6 kcal/kg as supplements, and their total energy intake was 6 kcal/kg higher than in group A (P<0.01). Total energy intake was not different between groups at weeks 6 and 8. DISCUSSION: Nutritional counseling and oral supplements are both feasible methods to restore food energy intake in malnourished HIV-infected patients. Although normal food intake is partially replaced, oral supplements may improve the adherence to a weight gain regimen.     

GROWTH STATUS OF CHILDREN IN NORTH WEST SYRIA: A COMPARISON OF THREE RURAL LIVELIHOOD GROUPS

Undernutrition, a multifactorial phenomenon, has severe consequences. A study was conducted in Syria to compare nutritional differences in children from three rural livelihood groups: a “barley-livestock” group in the southeast (Khanasser), and an “olive/fruit tree” group and an “irrigation” group in the northwest of Aleppo province (Afrin). An anthropometric assessment was conducted on 541 rural children from 207 rural households and 199 urban children (2-10 years) from a middle income urban group. Comparisons were made with the 1978 NCHS/WHO (National Center for Health Statistics/ World Health Organization) international growth reference (WHO, 1995) and a -2 SD Z-score was used as a cut-off. Prevalence rates and mean Z-scores were calculated and independent sample t-tests used to compare totals and age-group disaggregated children (both boys and girls). Total stunting prevalence was highest in the barley-livestock group (23%) and lowest in the irrigation group (12.5%). Girls in the barley-livestock group displayed the highest rates of stunting (28.3%), followed by the boys (22%) and the girls (21.08%) in the olive/fruit tree group. The prevalence of underweight children was highest in the barley-livestock and olive/fruit tree livelihood groups (14.29% and 13.25%, respectively). Wasting rates were very low. The rates of stunting and underweight were higher in the barley-livestock and olive/fruit tree groups, as compared with the country-level estimates of 20.8 percent and 12.9 percent respectively, in children under five. A comparison of rates and mean scores indicates that, amongst rural groups, there was considerable variation: the barley-livestock and olive/fruit tree group, belonging to drier and poorer areas, exhibited higher rates and lower mean scores.     

Nutritional Strategies for the Preservation of Fat Free Mass at High Altitude

Exposure to extreme altitude presents many physiological challenges. In addition to impaired physical and cognitive function, energy imbalance invariably occurs resulting in weight loss and body composition changes. Weight loss, and in particular, loss of fat free mass, combined with the inherent risks associated with extreme environments presents potential performance, safety, and health risks for those working, recreating, or conducting military operations at extreme altitude. In this review, contributors to muscle wasting at altitude are highlighted with special emphasis on protein turnover. The article will conclude with nutritional strategies that may potentially attenuate loss of fat free mass during high altitude exposure.     

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Burden and risk factors for wasting in the first 6 months of life among Indian children are not well documented. We used data from India's National Family Health Survey 4 to estimate the prevalence of severe wasting (weight for length < ‐3 SD) among 18,898 infants under 6 months of age. We also examined the association of severe wasting with household, maternal, and child‐related factors using multivariable logistic regression analysis. Prevalence of severe wasting among infants less than 6 months of age was 14.8%, ranging from 3.5 to 21% across states. Low birth weight (<2,500 g; adjusted odds ratio [AOR] 1.40, 95% CI [1.19, 1.65]), nonutilization of supplementary nutrition by mother during lactation (AOR 1.23, 95% CI [1.05, 1.43]), and anthropometric assessment during summer (AOR 1.37, 95% CI [1.13, 1.65]) and monsoon months (AOR 1.53, 95% CI [1.20, 1.95]) were associated with higher odds of severe wasting. Infants aged 2 to 3 months (AOR 0.78, 95% CI [0.66, 0.93]) and 4 to 5 months (AOR 0.65, 95% CI [0.55, 0.73]) had lower odds of severe wasting as compared with the 0‐ to 1‐month category. This analysis reveals a high burden of severe wasting in infants less than 6 months in India. Preventive interventions must be targeted at reducing low birth weight due to fatal growth restriction and prematurity. Appropriate care practices at facilities and postdischarge with extra attention to those born small and sick can prevent further deterioration in nutritional status.