Patients with neuroendocrine tumours located in the gastroenteropancreatic tract (GEP-NETs) and treatment with somatostatin analogues (SSA's) are at risk of malnutrition which has been reported... Show morePatients with neuroendocrine tumours located in the gastroenteropancreatic tract (GEP-NETs) and treatment with somatostatin analogues (SSA's) are at risk of malnutrition which has been reported previously evaluating weight loss or body mass index (BMI) only. The global leadership into malnutrition (GLIM) criteria include weight loss, BMI, and sarcopenia, for diagnosing malnutrition. These GLIM criteria have not been assessed in patients with GEP-NETs on SSA. The effect of malnutrition on overall survival has not been explored before. The aim of this study is to describe the presence of malnutrition in patients with GEP-NET on SSA based on the GLIM criteria and associate this with overall survival. Cross-sectional study screening all patients with GEP-NETs on SSA's for malnutrition using the GLIM criteria. Body composition analysis for sarcopenia diagnosis were performed. Bloods including vitamins, minerals, and lipid profile were collected. Overall survival since the date of nutrition screening was calculated. Uni- and multivariate Cox regression analysis were performed to identify malnutrition as risk factor for overall survival. A total of 118 patients, 47% male, with median age 67 years (IQR 56.8–75.0) were included. Overall, malnutrition was present in 88 patients (75%); based on low BMI in 26 (22%) patients, based on weight loss in 35 (30%) patients, and based on sarcopenia in 83 (70%) patients. Vitamin deficiencies were present for vitamin D in 64 patients (54%), and vitamin A in 29 patients (25%). The presence of malnutrition demonstrated a significantly worse overall survival (p-value = .01). In multivariate analysis meeting 2 or 3 GLIM criteria was significantly associated with worse overall survival (HR 2.16 95% CI 1.34–3.48, p-value = .002). Weight loss was the most important risk factor out of the 3 GLIM criteria (HR 3.5 95% CI 1.14–10.85, p-value = .03) for worse overall survival. A high percentage (75%) of patients with GEP-NETs using a SSA meet the GLIM criteria for malnutrition. Meeting more than 1 GLIM criterium, especially if there is weight loss these are risk factors for worse overall survival. Show less
Wahyuni, S.; Dorst, M.M.A.R. van; Amaruddin, A.I.; Muhammad, M.; Yazdanbakhsh, M.; Hamid, F.; ... ; Sartono, E. 2020
Objective The burden of underweight remains a major problem in Indonesia, and at the same time, the prevalence of overweight is increasing. Malnutrition is a major determinant of health and has... Show moreObjective The burden of underweight remains a major problem in Indonesia, and at the same time, the prevalence of overweight is increasing. Malnutrition is a major determinant of health and has been linked to allergic disorders in children. We examined the relationship between malnutrition and T(H)2 immune markers in school-aged children in Makassar, Indonesia.Methods A cross-sectional study was performed in five schools where socio-demographic characteristics were recorded. Children's standardised z-scores of body mass index (z-BMI) and age-standardised z-scores of height (z-HA) were assessed using WHO child growth standards. Skin prick test (SPT) reactivity was determined to house dust mite allergens. Helminth infection status, (growth) hormones including insulin-like growth factor (IGF-1) and T(H)2 immune markers were measured.Results In total, 954 children were included of whom 21.6% were underweight and 14.8% overweight. After controlling for confounders, overweight was positively associated with leptin (GMR 3.55, 95% CI: 2.99-4.23) and IGF-1 (GMR 1.45, 95% CI: 1.15-1.82), whereas underweight was negatively associated (respectively GMR 0.57, 95% CI: 0.49-0.66 and GMR 0.78, 95% CI: 0.63-0.97). Underweight was associated with a lower eosinophil count (GMR 0.79, 95% CI: 0.64-0.97) but not with total IgE levels or SPT reactivity. Overweight was positively associated with SPT reactivity (adjusted OR 2.68, 95% CI: 1.50-4.78) but no relationship was found with the other T(H)2 immune markers.Conclusion Malnutrition is prominent in school-aged children in Makassar, with overweight associated with increased SPT reactivity. Therefore, interventions should focus on undernutrition, but also on overweight to prevent the increase of allergic disorders in Indonesia. Show less
This volume attempts to dig deeper into what is currently happening in Africa's agricultural and rural sector and to convince policymakers and others that it is important to look at the current... Show moreThis volume attempts to dig deeper into what is currently happening in Africa's agricultural and rural sector and to convince policymakers and others that it is important to look at the current African rural dynamics in ways that connect metropolitan demands for food with value chain improvements and agro-food cluster innovations. It is essential to go beyond a 'development bureaucracy' and a state-based approach to rural transformation, such as the one that often dominates policy debate in African government circles, organizations like the African Union and the UN, and donor agencies. Show less
Huisman, E.J.; Trip, E.J.; Siersema, P.D.; Hoek, B. van; Erpecum, K.J. van 2011
The main objective of this thesis was to study the association between nutritional status and survival in end-stage renal disease patients who are maintained on a chronic dialysis treatment. Where... Show moreThe main objective of this thesis was to study the association between nutritional status and survival in end-stage renal disease patients who are maintained on a chronic dialysis treatment. Where as obesity is an established risk factor for morbidity and mortality in the general population, many survival studies in hemodialysis patients have indicated reverse associations of obesity with mortality. We showed, however, that the association between BMI and mortality in the hemodialysis population was similar, and not reversed compared with the general population of equal baseline age and duration of follow-up. Independent from BMI, weight loss and muscle mass depletion were both associated with an increased mortality risk in hemodialysis patients. Furthermore, we observed an interaction effect between protein-energy wasting, inflammation and cardiovascular disease, resulting in excess mortality in chronic dialysis patients. Finally, compared with a normal nutritional status, the short-term impact of protein-energy wasting on mortality appeared more important than the long-term effect. The results of this thesis emphasize the importance of maintaining a good nutritional status in chronic dialysis patients. The nutritional status of dialysis patients should be assessed regularly, at least every 6 months. In clinical practice, the 7-point Subjective global assessment can be used for this. Show less
Chronic malnutrition has been consistently high in Kilifi District, Kenya, despite efforts to improve nutrition. This report presents an alternative approach to nutrition planning in Kilifi... Show moreChronic malnutrition has been consistently high in Kilifi District, Kenya, despite efforts to improve nutrition. This report presents an alternative approach to nutrition planning in Kilifi District, taking into account the multidimensional and multidisciplinary nature of nutrition. This approach incorporates the following processes: intersectoral collaboration and a participatory approach to solving nutritional problems; use of existing structures to implement food security and nutrition surveillance to provide information for district nutrition planning. Show less
Three groups of Ugandan children (20 in each group) and one comparison group of 20 children were examined between 11 and 17 years of age. The children in the first three groups had suffered from... Show moreThree groups of Ugandan children (20 in each group) and one comparison group of 20 children were examined between 11 and 17 years of age. The children in the first three groups had suffered from energy-protein malnutrition 10 to 16 years previously when they were hospitalised at different ages (between 8-15) months, 16-21 months, 22-27 months). The comparison group consist of children who had not suffered from clinical malnutrition during infancy. All the children came from one tribe and were individually matched for sex, age, education and home environment. The three groups malnourished in infancy fell significantly below the comparison group in tests performance at the later age. Further analysis showed that the deficit is not related to the severity of acute malnutrition, but rather to the degree of chronic undernutrition at admission. No evidence was found for a relationship between impairment and the age at admission. Show less
This study is concerned with the relation between protein-energy malnutrition and the intellectual abilities of children in Uganda. The findings are based on the investigation of a group of 60... Show moreThis study is concerned with the relation between protein-energy malnutrition and the intellectual abilities of children in Uganda. The findings are based on the investigation of a group of 60 Ugandan boys and girls who became severely malnourished during the first 27 months of their life, resulting in their admission to the hospital in Kampala. At the time of the study, in 1970-1971, the children were between 11 and 17 years old. The relation between malnutrition and intellectual abilities is explored in two ways: by comparison with a matched group of children who were not severely malnourished during the first years of their life; and by relating the present intellectual abilities of each child to its condition on admission to the hospital. The findings are discussed against the evidence from other psychological studies Show less
