BACKGROUND & AIMS: :Acute and chronic malnutrition and micronutrient deficiencies have been found in refugee camp populations. In southeastern Nepal, despite consistent access by refugees to general rations, certain micronutrient deficiencies have posed a substantial health burden to the approximately 100,000 Bhutanese residing in seven refugee camps. Limited food diversity, frequent illness, and poor feeding practices have been cited as underlying causes of poor nutritional status in this population. Annual surveys to assess levels of acute malnutrition (i.e., wasting) and chronic malnutrition (i.e., stunting) have been conducted in these camps by the Association of Medical Doctors of Asia (AMDA) and United Nations High Commissioner for Refugees (UNHCR); however, the capacity to reliably evaluate micronutrient deficiencies has not existed locally in the camps. In January 2007, AMDA and CDC, at the request of UNHCR and the World Food Programme (WFP), conducted a nutritional survey of children aged 6-59 months, assessing 1) the prevalence of acute malnutrition, chronic malnutrition, underweight, anemia, and angular stomatitis (i.e., riboflavin deficiency); 2) the cumulative incidence of diarrhea and acute respiratory illness (ARI); and 3) the feeding practices of the children's mothers. This report describes the results of that survey, which indicated that, although acute malnutrition was found in only 4.2% of the children, chronic malnutrition was found in 26.9% and anemia in 43.3%. These findings underscore the importance of monitoring both malnutrition and micronutrient deficiencies and addressing the underlying causes of nutritional deficits.

背景与目标： : 在难民营人口中发现了急性和慢性营养不良和微量营养素缺乏症。在尼泊尔东南部，尽管难民不断获得普通口粮，但某些微量营养素缺乏给居住在七个难民营中的大约100,000名不丹人带来了沉重的健康负担。食物多样性有限，疾病频发和饮食习惯不佳被认为是该人群营养状况不佳的根本原因。亚洲医生协会 (AMDA) 和联合国难民事务高级专员 (难民署) 在这些营地进行了年度调查，以评估急性营养不良 (即消瘦) 和慢性营养不良 (即发育迟缓) 的水平; 然而，营地当地不存在可靠评估微量营养素缺乏的能力。在2007年1月，AMDA和CDC应难民署和世界粮食计划署 (WFP) 的要求，对6-59个月大的儿童进行了营养调查，评估1) 急性营养不良，慢性营养不良，体重不足，贫血和口角炎 (即，核黄素缺乏); 2) 腹泻和急性呼吸道疾病 (ARI) 的累积发生率; 3) 儿童母亲的喂养习惯。该报告描述了该调查的结果，该结果表明，尽管仅在4.2% 儿童中发现了急性营养不良，但在26.9% 中发现了慢性营养不良，在43.3% 中发现了贫血。这些发现强调了监测营养不良和微量营养素缺乏症以及解决营养不足的根本原因的重要性。

BACKGROUND & AIMS: :Appropriate recognition of malnutrition in adults requires knowledge of screening and assessment methodologies. An appreciation for the contributions of inflammation has resulted in a new etiology-based approach to defining malnutrition syndromes. The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have published a consensus document that extends this approach to describe characteristics for the identification and documentation of malnutrition in adults. Nutrition screening tools are used to identify patients at nutrition risk and those who are likely to benefit from further assessment and intervention. Nutrition assessment serves to guide appropriate intervention. A systematic approach to nutrition assessment that supports the new diagnostic scheme and criteria from the Academy and A.S.P.E.N. has recently been presented. Since screening delays and failures in the diagnosis and management of malnutrition are all too common, a multidisciplinary team approach is recommended to promote improved communication and quality of care.

背景与目标： : 适当承认成年人营养不良需要了解筛查和评估方法。对炎症的贡献的赞赏导致了一种基于病因的新方法来定义营养不良综合征。营养与营养学学会和美国肠外和肠内营养学会 (a.s.p.E.N.) 发布了一份共识文件，该文件扩展了这种方法，以描述识别和记录成人营养不良的特征。营养筛查工具用于识别存在营养风险的患者以及可能从进一步评估和干预中受益的患者。营养评估有助于指导适当的干预。一种系统的营养评估方法，支持学院和a.s.p.e.N.的新诊断方案和标准。最近提出了。由于筛查延误和营养不良的诊断和管理失败非常普遍，因此建议采用多学科团队方法来促进改善沟通和护理质量。

BACKGROUND & AIMS: At the Unit of Nutritional Rehabilitation of La Plata Children's Hospital "Sor María Ludovica" an inventory was designed to observe in outpatient clinics certain behaviors allowing an early detection of disorders in mother-child link. We evaluate a sample of 50 mothers with their children between 1 and 24 months presenting moderate or severe undernutrition of primary cause, as well as 50 mothers with their children of the same age, sex, social and economical level of the experimental group who never presented undernutrition. This inventory, which has the following parts, was applied1) verbal maternal behaviour, 2) affective maternal behavior, 3) child's hygiene, 4) stimulation of development, 5) participation of other persons in child's care, 6) consistency between mother's discourse and attitudes. The inventory has been sensitive to the proposed objective, showing a highly significant difference when correlate mother-well nourished child and mother-undernourished child.

背景与目标： 在拉普拉塔儿童医院 “Sor 3月 í aludovica” 的营养康复部门，设计了一份清单，以在门诊中观察某些行为，从而可以及早发现母婴联系中的疾病。我们评估了50名母亲的样本，其子女在1至24个月之间表现出主要原因的中度或严重营养不良，以及实验组中50名母亲的年龄，性别，社会和经济水平相同的孩子从未表现出营养不良。该清单包括以下部分: 1) 口头母亲行为，2) 情感母亲行为，3) 儿童卫生，4) 刺激发展，5) 其他人参与儿童照料，6) 母亲话语和态度之间的一致性。该清单对拟议的目标很敏感，在将母亲营养丰富的孩子与母亲营养不足的孩子相关联时显示出非常显着的差异。

BACKGROUND & AIMS: BACKGROUND:Children with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID. AIM:This study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID. METHODS:Forty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than -2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated. RESULTS:Thirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age. CONCLUSIONS:Malnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To identify and compare the sociodemographic determinants of stunting, wasting and overweight among infants of urban and rural areas in the Ecuadorian highlands. DESIGN:Cross-sectional study. SETTING:Nabon (rural) and Cuenca (urban) cantons, Azuay Province, Ecuador. SUBJECTS:A total of 703 children aged 0-24 months and their caregivers (227 rural and 476 urban) recruited during the period from June to September 2008. RESULTS:Stunting prevalence was significantly higher in the rural area (37·4 % v. 17·7 %; P < 0·001) while wasting (7·1 %) and overweight (17·1 %) prevalence were more similar between areas. Determinants of stunting for the pooled sample were male gender (OR = 1·43; 95 % CI 1·06, 1·92; P = 0·02), preterm delivery (OR = 1·65; 95 % CI 1·14, 2·38; P = 0·008), child's age (OR = 1·04; 95 % CI 1·01, 1·07; P = 0·011), maternal education (OR = 0·95; 95 % CI 0·92, 0·99; P = 0·025) and facility-based delivery (OR = 0·57; 95 % CI 0·45, 0·74; P < 0·001). The latter was also a determinant of overweight (OR = 0·39; 95 % CI 0·25, 0·62; P < 0·001). Rural determinants of stunting were maternal height (OR = 0·004; 95 % CI 0·00004, 0·39; P = 0·018), diarrhoea prevalence (OR = 2·18; 95 % CI 1·13, 4·21; P = 0·02), socio-economic status (OR = 0·79; 95 % CI 0·64, 0·98; P = 0·030) and child's age (OR = 1·07; 95 % CI 1·02, 1·11; P = 0·005). Urban determinants were: maternal BMI for stunting (OR = 0·91; 95 % CI 0·84, 0·99; P = 0·027), cough prevalence (OR = 0·57; 95 % CI 0·34, 0·96; P = 0·036) and facility-based delivery (OR = 0·25; 95 % CI 0·09, 0·73; P = 0·011) for overweight, and hygiene for wasting (OR = 0·57; 95 % CI 0·36, 0·89; P = 0·013). CONCLUSIONS:Infant malnutrition was associated with different sociodemographic determinants between urban and rural areas in the Ecuadorian highlands, a finding which contributes to prioritize the determinants to be assessed in nutritional interventions.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD), and has been associated with increased risk of death, cardiovascular events and hospitalization in a substantial proportion of patients. Impaired quality of life (QoL) has been reported in dialysis patients and is a marker of poor outcome. We aimed to assess the prevalence of depression and QoL status among chronic hemodialysis patients. We explored the relationship between depressive symptoms and poor QoL on the one hand and sociodemographic profile, dialysis adequacy, serum chemistry, malnutrition-inflammation score (MIS) and symptom burden on the other hand. PATIENTS AND METHODS:60 chronic hemodialysis patients participated in the study between June and August 2007. They were on thrice-weekly dialysis at the Kasr El-Aini Nephrology and Dialysis Center, Cairo University Hospital. Clinical and sociodemographic data were obtained and their case records were reviewed to obtain laboratory results including hemoglobin, urea reduction ratio, serum albumin, calcium, phosphorus, creatinine and total iron-binding capacity. We used the Beck Depression Inventory (BDI) to assess the severity of depression, and the SF-36 questionnaire to assess QoL in the study group. MIS was used to assess the extent of malnutrition and inflammation complex and total symptom burden was evaluated using the dialysis symptom index (DSI). RESULTS:Mean age was 46.13 +/- 16.55 years, with a range of 22-77 years. 20 patients (33.33%) had a BDI score of >or=15. Two patients (3.33%) had a QoL total score of <50, 8 (13.33%) had scores in the range of 50-60, 30 (50%) had scores in the range of 60-70, 12 (20%) had scores of 70-80, and 8 patients (13.3%) had scores in the range of 80-90. Employment was found to significantly affect BDI scores; all patients with BDI scores >or=15 were unemployed. The mean BDI score of unemployed patients was significantly higher than employed patients (13.03 +/- 6.27 vs. 8.50 +/- 3.51, p = 0.03). Widowed patients had significantly higher BDI and lower F-36 scores compared to single, married and divorced patients (p < 0.05). DSI and MIS showed significant positive correlations with BDI scores (p < 0.05) and significant negative correlations with F-36 scores (p < 0.05). CONCLUSIONS:Our results showed a high prevalence of depressive symptoms among the study group that was linked to poor QoL, total symptom burden and malnutrition-inflammation complex.

背景与目标：

BACKGROUND & AIMS: A total of 1,053 cirrhotic patients were included in a prospective study to determine whether malnutrition is a risk factor for mortality in cirrhotic patients. Child-Pugh classification as well as clinical and biochemical variables were used to assess the severity of cirrhosis. Nutritional status was evaluated both by anthropometric and clinical measurements. Patients were defined as malnourished when midarm muscle area (MAMA) and/or midarm fat area (MAFA) were below the 5th percentile of an age- and sex-matched population. During follow-up, 419 patients died. The estimated survival rate was 82.7% at 1 year, 65.1% at 3 years, and 50.7% at 5 years. The presence of muscle depletion and/or of a steep reduction in fat deposits was associated with a higher risk of mortality (midarm muscle area, < 5th percentile, relative risk = 1.79; midarm fat area, < 5th percentile, relative risk = 1.35). When patients were stratified according to the Child-Pugh classification, cumulative survival was lower in patients with a reduction in muscle mass in Child-Pugh classes A and B (log rankP = .027; P = .022, respectively) but not in class C. Conversely, a significant reduction in adipose tissue deposits appeared to have no independent impact on survival in any Child-Pugh class. When examined using a multivariate Cox proportional hazard analysis, age, sex, bilirubin, cholinesterase, ascites, and esophageal varices were selected, whereas the parameters of nutritional status were not. This suggests that malnutrition, while strongly associated with the deterioration of liver function, cannot be considered an independent risk factor for mortality in a general population of cirrhotic patients.

背景与目标： 一项前瞻性研究共纳入了1,053例肝硬化患者，以确定营养不良是否是肝硬化患者死亡的危险因素。Child-Pugh分类以及临床和生化变量用于评估肝硬化的严重程度。通过人体测量和临床测量评估营养状况。当中臂肌肉区域 (MAMA) 和/或中臂脂肪区域 (MAFA) 低于年龄和性别匹配人群的第5个百分位数时，患者被定义为营养不良。在随访期间，有419名患者死亡。估计生存率在1年时82.7%，3年时65.1%，5年时50.7%。肌肉耗竭和/或脂肪沉积急剧减少的存在与较高的死亡率风险相关 (中臂肌肉面积，<第5百分位，相对风险 = 1.79; 中臂脂肪面积，<第5百分位，相对风险 = 1.35)。当根据Child-Pugh分类对患者进行分层时，Child-Pugh a级和B级肌肉质量减少的患者的累积生存率较低 (log rankP = .027; P = .022)，但C级则没有。相反，在任何Child-Pugh类别中，脂肪组织沉积物的显着减少似乎对生存率没有独立影响。当使用多变量Cox比例风险分析进行检查时，选择了年龄，性别，胆红素，胆碱酯酶，腹水和食管静脉曲张，而营养状况的参数则没有。这表明，营养不良虽然与肝功能恶化密切相关，但不能被视为肝硬化患者一般人群死亡的独立危险因素。

BACKGROUND & AIMS: OBJECTIVE:To assess if malnutrition influences the response to the hepatitis B virus vaccine in haemodialysis patients and whether this correlates with morbidity and mortality in these patients.

DESIGN:A 4-year prospective open study.

SETTING:Haemodialysis unit of a 434-bed University Hospital.

PATIENTS:Sixty-four patients with end-stage chronic renal failure on maintenance haemodialysis.

INTERVENTIONS:Three-dose vaccination series with recombinant hepatitis B virus vaccine.

MEASUREMENTS:Antibody formation against the vaccine, predialysis serum urea, serum albumin and prealbumin, dialysis efficacy (Kt/V), protein catabolic rate (PCR), arm muscle circumference, triceps skinfold, serum parathyroid hormone concentration, mortality and morbidity (hospital days per year of dialysis).

RESULTS:Increase in age negatively influences the formation of antibodies (P = 0.01), whereas serum albumin (P = 0.008) and predialysis blood urea concentration (P = 0.004) are positively correlated with the formation of antibodies. Responders had significantly higher levels of serum albumin and prealbumin and predialysis blood urea than non-responders. The percentage of non-responders was higher (70%) in the group with predialysis blood urea concentration between 90 and 125 mg/dl than in those with predialysis blood urea concentrations between 176 and 225 mg/dl (14.2%). Patients with serum albumin levels between 3 and 3.5 g/dl were non-responders in a higher percentage (87.5%) than those with serum albumin levels between 4.5 and 5 g/dl (18.8%). After a 4-year follow-up, survival was 20% higher in the responder group (P < 0.05). Morbidity, expressed as hospital days per year of haemodialysis, was markedly lower in the responder group (10.4 +/- 2 versus 32 +/- 14 days, P = 0.03).

CONCLUSIONS:Malnutrition negatively influences the response to the hepatitis B virus vaccine in haemodialysis patients. Non-responders have higher morbidity and mortality than responders, and therefore the absence of response to the hepatitis B vaccine can be considered as a risk factor in the haemodialysis population.

背景与目标： 目的 : 评估营养不良是否影响血液透析患者对乙型肝炎病毒疫苗的反应，以及这是否与这些患者的发病率和死亡率相关。
设计 : 一项为期4年的前瞻性开放研究。
设置 : 拥有434张床位的大学医院的血液透析单元。
患者 : 维持血液透析的64例终末期慢性肾衰竭患者。
干预 : 重组乙型肝炎病毒疫苗的三剂量疫苗接种系列。
测量 : 疫苗抗体形成、透析前血清尿素、血清白蛋白和前白蛋白、透析功效 (Kt/V) 、蛋白质分解代谢率 (PCR) 、臂肌围、肱三头肌皮褶、血清甲状旁腺激素浓度、死亡率和发病率 (每年透析的住院天数)。
结果 : 年龄的增加对抗体的形成产生负面影响 (P = 0.01)，而血清白蛋白 (P = 0.008) 和透析前血尿素浓度 (P = 0.004) 与抗体的形成呈正相关。应答者的血清白蛋白，前白蛋白和透析前尿素水平明显高于无应答者。透析前血尿素浓度在90至125 mg/dl之间的组的无反应者百分比 (70%) 高于透析前血尿素浓度在176至225 mg/dl之间的组 (14.2%)。血清白蛋白水平在3至3.5g/dl之间的患者的无反应百分比 (87.5%) 高于血清白蛋白水平在4.5至5g/dl之间的患者 (18.8%)。经过4年的随访，应答组的生存率20% 更高 (P <0.05)。在应答组中，发病率以每年血液透析的住院天数表示，显着降低 (10.4/- 2对32/- 14天，P = 0.03)。
结论 : 营养不良对血液透析患者对乙型肝炎病毒疫苗的反应产生负面影响。无应答者的发病率和死亡率高于应答者，因此对乙型肝炎疫苗无应答可被视为血液透析人群的危险因素。

BACKGROUND & AIMS: :Breast-feeding policy tends to be an emotive issue. International agencies recommend exclusive breast-feeding for 4-6 months followed by continued partial breast-feeding into the second year of life in order to promote infant and child health and minimize the damage caused by the malnutrition-infection cycle. To what extent are these recommendations supported by the experimental evidence? Are they a simplification for emotional reasons or public health purposes? Breast-feeding is believed to benefit infants because breast milk contains the ideal mix of nutrients for infants, because it contains factors which promote development of the infant's gut and immune system and which prevent pathogen invasion, and because exclusive breast-feeding prevents intake of pathogens in food or water. However, some apparently contradictory evidence exists. First, in environments which are not highly contaminated breast-fed infants tend to growth falter relative to those fed formula. Second, in such environments partial breast-feeding is not associated with significantly increased gut damage relative to exclusive breast-feeding, suggesting that active promotion of gut development by breast-feeding is more important than simple avoidance of pathogens from other foods. Third, many immune factors in breast milk are probably present primarily to protect the mother, not the infant. Finally, breast milk itself may contain bacteria or viruses. This problem has come to the fore with the human immunodeficiency virus epidemic, since it is clear breast-feeding is an important mode of mother-to-child transmission. The present review will examine these challenges to the basis of the international infant feeding recommendations and will suggest that the science does actually support the policy.

背景与目标： : 母乳喂养政策往往是一个情绪化的问题。国际机构建议完全母乳喂养4-6个月，然后继续部分母乳喂养到生命的第二年，以促进婴儿和儿童健康，并最大程度地减少营养不良感染周期造成的损害。这些建议在多大程度上得到实验证据的支持？它们是出于情感原因还是出于公共卫生目的的简化？母乳喂养被认为对婴儿有益，因为母乳中含有婴儿理想的营养成分，因为它含有促进婴儿肠道和免疫系统发育并防止病原体入侵的因素，并且因为纯母乳喂养可以防止摄入食物或水中的病原体。但是，存在一些明显矛盾的证据。首先，在没有受到高度污染的环境中，母乳喂养的婴儿相对于那些喂养的配方奶的婴儿往往会生长迟缓。其次，在这种环境中，相对于纯母乳喂养，部分母乳喂养与肠道损伤的显着增加无关，这表明通过母乳喂养积极促进肠道发育比简单地避免其他食物中的病原体更为重要。第三，母乳中的许多免疫因子可能主要是为了保护母亲而不是婴儿。最后，母乳本身可能含有细菌或病毒。随着人类免疫缺陷病病毒的流行，这个问题已经凸显出来，因为很明显，母乳喂养是母婴传播的重要方式。本次审查将在国际婴儿喂养建议的基础上研究这些挑战，并建议科学确实支持该政策。

BACKGROUND & AIMS: :Cryptosporidium is a protozoan parasite associated with acute and persistent diarrhea that, even in asymptomatic persons, can impair normal growth and potentially cognitive and physical development in young children. The recent availability of the complete gene sequence for Cryptosporidium hominis antigen Cp15 allows examination of innovative vaccine regimens involving intra-nasal antigen priming with live bacterial vectors applicable to human populations. We used a recently described weaned mouse model of cryptosporidiosis, where nourished and malnourished vaccinated mice receive the Cp15 antigen recombinant with cytolysinA on a Salmonella serovar Typhi CVD 908-htr A vector, followed by parenteral exposure to antigen with adjuvant. After challenge with Cryptosporidium oocysts via gavage, parameters of infection and disease (stool shedding of parasites, growth rates) were quantified, and serum/lymphoid tissue harvested to elucidate the Cp15-specific adaptive immune response. In vaccinated nourished mice, the regimen was highly immunogenic, with strong antigen-specific IL-6 and IFN-γ secretion and robust Cp15-specific immunoglobulin titers. In vaccinated malnourished mice, secretion of cytokines, particularly IFN-γ, and antigen-specific humoral immunity were generally undiminished despite protein deprivation and stunted growth. In contrast, after natural (oral) challenge with an identical inoculum of Cryptosporidium oocysts, cytokine and humoral responses to Cp15 were less than one-fourth those in vaccinated mice. Nevertheless, vaccination resulted in only transient reduction in stool shedding of parasites and was not otherwise protective against disease. Overall, immunogenicity for a C. hominis antigen was documented in mice, even in the setting of prolonged malnutrition, using an innovative vaccine regimen involving intra-nasal antigen priming with a live enteric bacterial vector, that has potential applicability to vulnerable human populations irrespective of nutritional status.

背景与目标： 隐孢子虫是一种与急性和持续性腹泻相关的原生动物寄生虫，即使在无症状的人中，也会损害幼儿的正常生长以及潜在的认知和身体发育。人隐孢子虫抗原Cp15的完整基因序列的最新可用性允许使用适用于人类的活细菌载体检查涉及鼻内抗原引发的创新疫苗方案。我们使用了最近描述的断奶的隐孢子虫病小鼠模型，其中营养和营养不良的接种疫苗的小鼠在沙门氏菌血清型伤寒CVD 908-htr a载体上接受用细胞溶解素重组的Cp15抗原，然后用佐剂肠胃外暴露于抗原。通过灌胃用隐孢子虫卵囊攻击后，对感染和疾病的参数 (寄生虫的粪便脱落，生长速率) 进行定量，并收集血清/淋巴组织以阐明Cp15-specific的适应性免疫反应。在接种的营养小鼠中，该方案具有高度免疫原性，具有很强的抗原特异性IL-6和IFN-γ 分泌以及强大的Cp15-specific免疫球蛋白滴度。在接种疫苗的营养不良小鼠中，尽管蛋白质缺乏和生长发育迟缓，但细胞因子 (尤其是IFN-γ) 的分泌和抗原特异性体液免疫通常不会减少。相反，在用相同的隐孢子虫卵囊接种物进行自然 (口服) 攻击后，细胞因子和对Cp15的体液反应小于接种疫苗的小鼠中的4分之1。然而，疫苗接种仅导致寄生虫粪便脱落的短暂减少，并且无法预防疾病。总体而言，即使在长期营养不良的情况下，使用创新的疫苗方案，包括用活的肠道细菌载体进行鼻内抗原引发，即使在长期营养不良的情况下，也可以在小鼠中记录人C抗原的免疫原性，该方案对脆弱人群具有潜在的适用性，无论营养状况如何。

BACKGROUND & AIMS: OBJECTIVES:This study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia. DESIGN:An institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016. SETTING:Selected government health institutions in the Amhara region, Ethiopia. PARTICIPANTS:Children treated in therapeutic feeding units for SAM were included. OUTCOME MEASURES:Time to recovery from SAM. RESULTS:One thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11-28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery. CONCLUSIONS:The time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Previous studies have shown alterations in bone marrow cell proliferation in malnourished rats, during lactation. The objective of this study was to determine in vivo effects of moderate and severe malnutrition on spleen cell proliferation in 21-day-old rat pups. MATERIALS AND METHODS:Spleen cell proliferation was determined following administration of bromodeoxyuridine (BrdUrd) over a time course of 2, 4, 6 and 8 h. Incorporation of BrdUrd was detected using FITC-conjugated anti-BrdUrd monoclonal antibodies and total DNA content was detected and evaluated using propidium iodide using flow cytometry. RESULTS:Proportions of cells in S and G2 /M were reduced in the rats with moderate (MN2(nd) ) and severe (MN3(rd) ) malnutrition. BrdUrd incorporation was lower in both groups of malnourished rat. In cells of MN2nd individuals, length of G1 became shorter, while length of S-phase increased. In contrast, fraction of cells in proliferation was significantly lower in both groups of malnourished rat, with MN3rd group having lowest percentage of cell population growth. In this study, severe malnutrition did not significantly affect duration of phases of the cell cycle, although fractions of proliferating cells were dramatically reduced. CONCLUSION:Moderate malnutrition increased time of cells in DNA synthesis and time of total cell cycle and severe malnutrition reduced growth fraction of spleen cells in malnourished rats during lactation.

背景与目标：

BACKGROUND & AIMS: :Hospital case-fatality rates for severe malnutrition in the developing world remain high, particularly in Africa where they have not changed much over recent decades. In an effort to improve case management, WHO has developed treatment guidelines. The aim of this review is to critically appraise the evidence for the guidelines and review important recent advances in the management of severe malnutrition. We conclude that not only is the evidence base deficient, but also the external generalisability of even good-quality studies is seriously compromised by the great variability in clinical practice between regions and types of health facilities in the developing world, which is much greater than between developed countries. The diagnosis of severe wasting is complicated by the dramatic change in reference standards (from CDC/WHO 1978 to CDC 2000 in EpiNut) and also by difficulties in accurate measurement of length. Although following treatment guidelines has resulted in improved outcomes, there is evidence against the statement that case-fatality rates (particularly in African hospitals) can be reduced below 5% and that higher rates are proof of poor practice, because there is wide variation in severity of illness factors. The practice of prolonged hospital treatment of severe malnutrition until wasting and/or oedema has resolved is being replaced by shorter hospital stays combined with outpatient or community follow-up because of advances in dietary management outside of hospital.

背景与目标： : 发展中国家严重营养不良的医院病死率仍然很高，特别是在非洲，近几十年来变化不大。为了改善病例管理，世卫组织制定了治疗指南。本次审查的目的是严格评估指南的证据，并审查严重营养不良管理方面的重要最新进展。我们得出的结论是，不仅证据基础不足，而且甚至高质量研究的外部可推广性也受到发展中国家区域和卫生设施类型之间临床实践差异的严重损害，这远远大于发达国家之间的差异。严重消瘦的诊断因参考标准的急剧变化 (从CDC/WHO 1978到EpiNut的CDC 2000) 以及精确测量长度的困难而变得复杂。尽管遵循治疗指南的结果有所改善，但有证据表明，病死率 (尤其是在非洲医院) 可以降低到5% 以下，而较高的病死率证明实践不佳，因为疾病的严重程度差异很大。因素。由于医院外饮食管理的进步，长期住院治疗严重营养不良直至消瘦和/或水肿解决的做法被较短的住院时间结合门诊或社区随访所取代。

BACKGROUND & AIMS: BACKGROUND:Nutrition and environmental factors are essential for the education of the neonatal immune system. Epidemiological evidence has shown that malnutrition and allergic diseases that occur during early childhood share similar protective and risk factors. This paper describes the protocol of the Mother and Infant Cohort Study (MICOS), which aims to determine the contribution of early nutrition to the development of malnutrition and allergic diseases in infants' first year of life. METHODS:MICOS is a prospective cohort study conducted at selected government health clinics in two states, namely Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Women in their third trimester of pregnancy are recruited into the study and their infants will be followed-up at 3, 6, and 12 months of age. Information on prenatal factors including socio-demographic characteristics, obstetric history, pre-pregnancy body mass index, gestational weight gain, smoking, family history of allergic diseases, maternal dietary intake and sunlight exposure during pregnancy are obtained through face-to-face interviews. Postnatal factors including dietary intake, sun exposure, and anthropometric measurements of the mothers, as well as feeding practices, dietary intake, anthropometric measurements, and development of allergic diseases of the infants are assessed at each follow-up. Blood samples are collected from the mothers in the third trimester to determine 25-hydroxyvitamin D levels as well as from the infants at age 12 months to determine atopic sensitisation. DISCUSSION:The concept of developmental origins of health and disease (DOHaD) which emphasises on the role of early life environments in shaping future health and disease susceptibility in adulthood has gained a huge interest in recent years. The DOHaD paradigm has influenced many fields of research including malnutrition and allergic diseases. While findings from the developed countries remain controversial, such studies are scarce in developing countries including Malaysia. The present study will determine the cause and effect relationship between early nutrition and the development of malnutrition and allergic diseases in infants' first year of life.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:To assess nutritional status, the prevalence of nutritional risk, and nutritional support in hospitalized patients in Guangzhou, to determine gender or age associated differences in the prevalence of nutritional risk. METHODS:A total of 2550 patients admitted during April to December 2008 from six departments (Gastroenterology, Pulmonology, Neurology, Nephrology, General Surgery and Thoracic Surgery) of four teaching hospitals were screened using the Nutritional Risk Screening 2002 tool. RESULTS:Overall prevalence of undernutrition and nutritional risk was 17.8% and 41.5%, respectively. The department of Pulmonology had the highest prevalence of undernutrition (28.2%) and nutritional risk (55.9%). The prevalence of nutritional risk was significantly higher in patients >=70 years of age than patients <70 years (64.2% vs 32.6%, p<0.001). No gender difference in the prevalence of nutritional risk was observed in general. In total, 47.6% of "at risk" and 19.4% of "not at risk" patients received nutritional support. Parenteral nutrition accounted for 88.8% of the nutritional support. CONCLUSIONS:The present study documented the prevalence of nutritional risk defined by NRS2002 and inappropriate assignment of nutritional interventions in Guangzhou hospitals.

背景与目标：