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PubMed1993

Intestinal absorption and malnutrition in patients with the acquired immunodeficiency syndrome (AIDS).

The relation of small intestinal dysfunction and malnutrition (body composition and serum index parameters of nutrition) was investigated in 36 male patients with AIDS. Mucosal absorptive capacity was assessed by the 25 g D-xylose test. D-xylose absorption (2 h - serum profile and 5 h - urine) classified 17 patients as having impaired and 19 patients as having normal absorption. In both groups body weight, body mass index as well as body composition analysis indicated malnutrition when compared to healthy male controls (n = 340) or asymptomatic HIV-infected patients (n = 26). Patients with abnormal D-xylose test had more severe malnutrition indicated by a lower body cell mass (17.7 +/- 5.4 vs. 22.5 +/- 4.5 kg; p < 0.01) and an increased ratio of extracellular mass to body cell mass (1.99 +/- 0.82 vs. 1.45 +/- 0.46 p < 0.01). Total serum protein, albumin, cholinesterase activity, cholesterol and LDL were significantly diminished in AIDS-patients with abnormal D-xylose test compared to those with normal D-xylose absorption. Intestinal dysfunction indicated by decreased D-xylose Intestinal dysfunction indicated by decreased D-xylose absorption thus represents an important feature of malnutrition and wasting, and patients with abnormal D-xylose absorption have more profound impairment of body composition, visceral proteins and lipids reflecting malnutrition than patients with unaffected intestinal absorption.

AIDS-Related Opportunistic Infections↗
PubMed1996

Maternal risk factors for childhood malnutrition in the Mazowe District of Zimbabwe.

OBJECTIVE: To determine the maternal risk factors associated with childhood malnutrition. DESIGN: An unmatched case control study of 327 children < 5 years of age. SETTING: Primary health care clinics on the communal lands and commercial farms in the Mazowe District of Zimbabwe. MAIN OUTCOME MEASURES: The relationship between maternal risk factors and childhood malnutrition was analysed. To correct for confounding variables a forward stepwise logistic regression was performed. RESULTS: Odds ratio (95pc confidence limits) for childhood malnutrition were a working mother 5.69 (2.37 to 3.66) and lack of decision making power 2.86 (1.1 to 7.45) on the communal lands, and lack of extra income generating projects 3.92 (1.64 to 9.54) and previous death of a child 2.17 (1.08 to 4.39) on the commercial farms. In both areas malnutrition was associated with < or = 1 acre of land 3.66 (1.4 to 9.53) and p < 0.01 (Fisher's exact test) for the communal lands and commercial farms respectively), and father's income < or = Z$150/month 12.5 (2.5 to 100) and 5.56 (1.4 to 25.0) for the communal lands and commercial farms respectively. CONCLUSIONS: To reduce childhood malnutrition in the rural areas reduced maternal work load and increased decision making power, better access to health care plus more access to land and higher income are all critical issues.

Case-Control Studies↗
PubMed1995

[Evaluation of the effective levels of vegetable mixture for the recovery of animals with early or late protein-calorie malnutrition].

The efficiency of a wheat:soy mixture (85:15 ratio) with and without supplementation of the limitant amino acids (methionine and lysine), was evaluated for: a. Supporting the normal rat growth previously fed with a casein diet (control group). b. The rat recovering with early and later protein-calorie malnutrition, and c. The animals ability (control and malnourished groups) in the self-selection for the limitant amino acids given. It was shown that the test diet, with and without supplementation, was adequate to sustain a normal body nitrogen content increase of the control groups animals. The principal changes in rat weight of the experimental animals during the recovering period were dependent on the nutritional state and the quantity of both, diet and amino acids intakes. As the age of rats increased, the diet intake (expressed as g of diet intake/100 g of rat) decreased in all experimental groups; this effect being more noticeable in malnourished groups. The self-selected intake of lysine and methionine, depends on: the previous nutritional state and the period of undernutrition of the animals; higher intake than the standard required values (Rogers and Harper) was observed in the three experimental groups. It was shown that the amount of methionine (gr met intake/100 g of wheat mixture) was directly related to lysine intake, expressed in similar units; significant correlation was observed: r = 0.816 (control group) and r = 0.789 (later malnutrition group) and highly significative r = 0.996 (early malnutrition group). The increase of the ratio between total body nitrogen and its initial value, was significative in all the cases. However the effect was more pronounced when the results obtained with early-malnutrition group are analyzed. The experiments performed with later malnutrition groups revealed that the increase of body nitrogen content was higher for supplemented diets than for animals fed with no-supplemented mixtures (the observed difference was highly significative p < 0.01). The analysis of body lipid content showed that the relative increase was much more significative for early malnourished groups. However in all the cases the effect of amino acid supplementation is almost negligible.

Animals↗
PubMed1997

Cytokines and the malnutrition of chronic renal failure.

Malnutrition in uremic patients remains one of the major causes of morbidity and mortality. Its mediators remain largely unknown. Uremia is characterized by changes in circulating levels of catabolic cytokines and anabolic growth factors. The aim of this study was to investigate whether these changes are associated with the malnutrition of patients with chronic renal failure (CRF). We have studied the prevalence of malnutrition in a small group of patients (n = 20) with CRF (serum creatinine = 551 +/- 105 mumol/l, mean +/- SD) and 25 age-matched controls. Nutritional status was assessed by dietary diaries, subjective global assessment (SGA), and by measurement of anthropometric parameters. Regression analysis was applied to examine the relationship between biochemical and anthropometric parameters. Simultaneously, we have investigated changes in the circulating levels of catabolic cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1 beta and IL-6] and an anabolic growth factor [insulin-like growth factor-I (IGF-I)]. We observed a high prevalence of malnutrition as judged initially by SGA: 50% moderately malnourished and 15% severely malnourished. This was confirmed by anthropometric measurements. We noted a significant reduction in both triceps skinfold thickness (TST; 35% of patients < 25th centile) and midarm muscle circumference (MAMC, 65% of patients < 25th centile). We also noted a reduction in serum IGF-I in malnourished patients (IGF-I in well-nourished patients = 207 +/- 48 micrograms/l, in malnourished patients = 133 +/- 33 micrograms/l, p < 0.01). IGF-I correlated with TST (r = 0.71, p < 0.001) and MAMC (r = 0.47, p < 0.05). IGF-I had a high predictive value for TST (R2 = 51%, p < 0.001). In contrast, TNF-alpha levels were higher in malnourished patients: 19.5 +/- 30 pg/ml compared to 3.9 +/- 8 pg/ml in healthy patients (p < 0.001) and TNF-alpha showed a negative correlation with MAMC (r = -0.69, p < 0.01; R2 = 47%, p < 0.01). IL-1 beta levels were higher in CRF than in controls but did not correlate with nutritional parameters. No significant changes could be detected in serum IL-6. A significant percentage of predialysis patients with CRF suffer from some degree of malnutrition. This may be attributed in part to a fall in circulating anabolic growth factors and an increase in catabolic cytokines.

Adult↗
PubMed2003

Malnutrition at age 3 years and lower cognitive ability at age 11 years: independence from psychosocial adversity.

BACKGROUND: Early malnutrition is linked to poor cognition, but long-term effects have not been extensively examined and psychosocial confounds have not always been controlled. OBJECTIVE: To test the hypothesis that malnutrition at age 3 years will be associated with poorer cognitive ability at age 11 years independent of psychosocial confounds. DESIGN: A prospective, longitudinal study of a birth cohort of 1559 children originally assessed at age 3 years for malnutrition (low hemoglobin level, angular stomatitis, kwashiorkor, and sparse, thin hair) and followed up to age 11 years. SETTING AND PARTICIPANTS: A community sample of 1559 children (51.4% boys and 48.6% girls) born between September 1, 1969, and August 31, 1970, in 2 towns in the island of Mauritius, with 68.7% Indians and 25.7% Creoles (African origin). MAIN OUTCOME MEASURES: Verbal and spatial ability measured at ages 3 and 11 years and reading, scholastic ability, and neuropsychologic performance measured at age 11 years. RESULTS: Malnourished children had poorer cognition at both ages. Deficits were stable across time, applied to all sex and ethnic groups, and remained after controlling for multiple measures of psychosocial adversity. Children with 3 indicators of malnutrition had a 15.3-point deficit in IQ at age 11 years. CONCLUSIONS: Malnutrition at age 3 years is associated with poor cognition at age 11 years independent of psychosocial adversity. Promoting early childhood nutrition could enhance long-term cognitive development and school performance, especially in children with multiple nutritional deficits.

Anemia↗
PubMed1997

Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications.

BACKGROUND: Malnutrition is reported frequently in head and neck cancer patients. The impact of malnutrition on surgical outcome is not clearly understood. The purpose of this study was to define the usefulness of six different parameters in scoring malnutrition and to determine the nutritional parameter primarily related to postoperative complications. METHODS: Sixty-four patients undergoing major surgery for advanced head and neck cancer were studied prospectively, and six different parameters were used to define malnutrition. Logistic regression was used to relate nutritional parameters to postoperative complications. RESULTS: The parameters applied all identified different aspects of the nutritional status, as malnutrition varied between 20% and 67%. Logistic regression analysis identified a weight loss of more than 10% to be the most prominent predictive parameter for the occurrence of major postoperative complications. CONCLUSIONS: Patients with weight loss more than 10% during the six months before surgery are at a great risk for the occurrence of major postoperative complications.

Carcinoma, Squamous Cell↗
PubMed1998

Electrophysiological properties of rat hippocampal principal cells are unaltered by prenatal protein malnutrition.

There is growing evidence that prenatal protein malnutrition alters the development of the hippocampal formation in rats (Morgane et al., 1993; Galler et al., 1996; Almeida et al., 1996, for reviews). Little is known, however, of the possible functional consequences of prenatal malnutrition on the physiology of principal cells in the hippocampus. We have addressed this issue by comparing the electrophysiological properties of hippocampal neurons (dentate granule cells and CA1 pyramidal cells) in slices prepared from control and from prenatally protein malnourished adult male and female Sprague-Dawley rats. We found no significant effect of the prenatal protein malnutrition insult upon a number of intrinsic membrane properties measured with whole-cell current clamp recordings, including: resting membrane potential, input resistance, and membrane time constant, or on action potential characteristics such as threshold, amplitude, and/or firing frequency. Additionally, we saw no effect of prenatal malnutrition upon extracellular measures of glutamatergic synaptic transmission such as the presynaptic fiber volley, excitatory postsynaptic potential or population spike amplitude at the perforant path to dentate granule cell synapse or at the Schaffer collateral to CA1 pyramidal cell synapse. In conclusion, we have demonstrated that prenatal protein malnutrition does not result in significant alterations of the cellular physiological properties of these two types of principal neurons in the adult rat hippocampus.

Aging↗
PubMed1986

Variations in sexual dimorphism in the skulls of rats subjected to malnutrition, castration, and treatment with gonadal hormones.

Two groups of weanling rats were subjected to malnutrition, one with periodic injections of testosterone (males) and the other with estradiol (females). Two other groups (castrated males or castrated females) received normal feedings. In control animals, the relative weights (mg/gm body weight) of testes, seminal vesicles, and ovaries were greater than in malnourished rats. However, relative weights of those organs in hormone-treated, malnourished animals were greater than in those subjected to malnutrition alone and still greater than in controls. Normal sexual cranial dimorphism (SCD) was decreased 16% by male castration, 23% by malnutrition, and 83% by estradiol treatment in malnourished females. On the other hand, normal SCD was increased 20% by female castration and more than 200% by testosterone treatment in malnourished males. All monosexual comparisons corroborated the bisexual range of distances found. Testicular but not ovarian secretions seemed to influence sexual cranial dimorphism. Malnutrition delayed SCD because of a deficiency of testosterone level in stressed males. It is suggested that estradiol in females may counteract sexual cranial development and that its inhibitory effect may be additive to the testosterone deficit evoked by malnutrition.

Animals↗
PubMed1980

Home-orienting behavior in rat pups surviving postnatal or intergenerational malnutrition.

Growth and home-orienting behavior were studied during the 1st 12 days of life in 3 groups of rat pups: (1) those with intergenerational malnutrition; (2) those with postnatal malnutrition produced by cross-fostering pups born of well-nourished mothers to lactating females maintained on a low-protein diet; and (3) well-nourished control pups. Growth of pups was impaired in both malnourished groups, and eye-opening was similarly delayed. On tests of homing behavior, both malnourished groups were impaired to a similar extent and were less likely to find their way to the nest than were control pups. However, survival rates were significantly lower (50%) in the postnatally malnourished group but not in the intergenerationally malnourished group (73%), as compared with controls (100%). These findings suggest that adaptation occurs in long-term malnutrition with increased survival. However, physical characteristics and homing behavior in early life are not distinguishable in those surviving short- or long-term malnutrition. This is in contrast to the finding of more severe behavioral deficits in later life among rats subjected to many generations of malnutrition than among those malnourished for only 1 generation.

Animals↗
PubMedDate not supplied

Role of parenteral nutrition in preventing malnutrition and decreasing bacterial translocation to liver in obstructive jaundice.

Surgery in patients with obstructive jaundice is associated with significant infectious complications probably due to impaired immune function and malnutrition. Total parenteral nutrition (TPN) may alleviate malnutrition but may also promote bacterial translocation (BT) from the gut. To elucidate if TPN can prevent malnutrition without promotion of BT in obstructive jaundice, 40 dogs underwent laparotomy for tissue sampling and placement of a central venous line and were allocated into one of four groups: I (PO-control) received dog chow and water ad libitum; II (PO-CBDL) underwent ligation of common bile duct (CBDL) and was fed dog chow; III (TPN-control) received TPN; and IV (TPN-CBDL) underwent CBDL and received TPN. Body weight, blood samples for liver function tests and bacterial culture, and tissues from liver and mesenteric lymph nodes (MLN) for quantitative bacterial culture and for histology were obtained prior to and 2 weeks after the experiment. The incidence of BT to MLN was 40% in the PO-CBDL and TPN-CBDL animals, which was significantly different from the other two groups (0%; p < 0.05). The incidence of BT to liver was 70% (7/10) in the PO-CBDL animals, which was significantly higher than that in groups I, III, and IV (0%, 20%, 20%, respectively) (p < 0.05). The PO-CBDL animals showed a significant decrease in body weight and prealbumin compatible with malnutrition, whereas the TPN-CBDL animals showed a significant increase in alkaline phosphatase and a consistent cholestasis on histology. The data suggest that TPN can prevent jaundice-associated malnutrition and decrease BT to liver but should be administered cautiously because it may precipitate cholestasis.

Animals↗
PubMed1999

The effect of different diagnostic criteria on the prevalence of malnutrition in a hospitalized geriatric population.

Malnutrition is considered an important clinical problem in geriatric hospitalized patients, but no standard diagnostic criteria are available. The aim of this study was to investigate the effect of 7 different sets of diagnostic criteria (6 in hospitalized elderly and 1 in healthy elderly) from nutritional research studies on the prevalence of malnutrition in 151 elderly patients (49 men, 102 women, mean age 82.8 years) consecutively admitted to an acute geriatric ward. Nutritional status was assessed using anthropometric (body mass index, triceps skinfold thickness, mid arm circumference, arm muscle circumference), and laboratory (serum albumin) parameters, and 1 nutritional questionnaire (Mini Nutritional Assessment). The proportion of patients with malnutrition varied between 6.5 and 85%. It is important to assess the nutritional status in elderly patients because the prevalence of malnutrition in hospitalized elderly patients is substantial whatever criteria are used. However, the criteria for the diagnosis can differ by a factor of more than 10 in the number of patients classified as malnourished. A major goal for further research on malnutrition is to define more standardized and validated criteria in order to make comparisons of prevalence and outcome more meaningful, and ensure that all those who will benefit from a nutritional intervention are identified and treated.

Aged↗
PubMed2006

Skeletal muscle expression of LDH and monocarboxylate transporters in growing rats submitted to protein malnutrition.

BACKGROUND: In different circumstances such as infant malnutrition, old age or chronic disease, decline of muscular strength, particularly anaerobic power, is shown. In this context, our laboratory, has demonstrated a decrease in anaerobic glycolytic power in pre-pubertal Bolivian children living at low and high altitude and suffering from marginal protein malnutrition. AIM OF THE STUDY: To bring molecular support to the relationship between protein malnutrition and anaerobic glycolytic metabolism, we studied the impact of prolonged protein malnutrition on lactate metabolism in different muscles of growing rats. Lactate dehydrogenase (LDH), monocarboxylate transporters (MCT1, MCT4) and membrane protein CD147 were chosen as specific markers of anaerobic glycolytic metabolism. METHODS: Two groups of 10 weaning male rats were fed for 10 weeks either ad libitum with a well-balanced diet containing 18% protein or an isocaloric-diet containing 8% protein. LDH activity and mRNA amounts of LDH isoforms, MCT, CD147 were measured. RESULTS: Protein deprivation during rat growth induced a decrease of LDH specific activity in skeletal muscles (mean value of -41%), accompanied by isoform distribution modifications in soleus, but not in glycolytic muscles (extensor digitorum longus (EDL) or plantaris). A reduction in mRNA amounts encoding the LDH A and B subunits was observed in EDL. A decrease in LDH B mRNA amounts was monitored in plantaris, whereas no modification in both LDH isoform mRNA quantities was observed in soleus. MCT1 mRNA quantities were decreased in EDL but MCT4 mRNA quantities remained stable. CD147 mRNA amounts were unchanged except for EDL with a 42% increase. CONCLUSIONS: The global decreases of LDH activity, LDH and MCT gene expressions in growing rat skeletal muscles support the observed alterations of lactate metabolism associated with lowered muscular anaerobic performances in protein malnutrition.

Animals↗
PubMed1994

Induction of malnutrition in chronic alcoholism: role of gastric emptying.

Epidemiological studies reveal that chronic alcoholics exhibiting liver disease are generally malnourished. Experimental studies unequivocally demonstrate that incidence of malnutrition cannot be avoided in animals fed liquid diets containing high concentrations of alcohol. Furthermore, ingestion of additional amounts of macronutrients by such chronically alcoholic animals prevents or regresses alcohol-induced adverse effects despite a continuous intake of high amounts of alcohol. It is thus apparent that high amounts of alcohol intake and malnutrition are necessary factors to produce adverse effects in chronic alcoholism. The mechanism by which malnutrition manifests in chronic alcoholism is, however, not clear. Recent studies have demonstrated, a) an inverse relationship between alcohol and non-alcohol energy intake and its impact on alcohol-induced effects in chronically alcoholic rats, b) a synergism between malnutrition and high doses of alcohol intake in the induction of alcoholemia, and c) that chronic alcoholemia significantly prolongs the delay in gastric emptying. Data obtained from these studies enable us to hypothesize that abnormal prolongation of gastric emptying in alcoholics with chronic alcoholemia may play a major role in the initiation of macronutrient deficiencies leading eventually to the induction of malnutrition.

Alcoholism↗
PubMed2005

To screen or not to screen for adult malnutrition?

BACKGROUND: There is some controversy about whether all adults receiving healthcare should be routinely screened for nutritional problems. METHODS: (i) A systematic review examined the proposition that malnutrition is under-recognised and under-treated, and that nutritional interventions in malnourished patients, identified through a screening procedure produce clinical benefits (assessed using randomised controlled trials, RCTs). (ii) A systematic review of nutritional screening interventions in populations of malnourished and well-nourished subjects (RCTs and non-RCTs). RESULTS: (i) The prevalence of malnutrition varies according to the criteria used, but is estimated to affect 10-60% of patients in hospital and nursing homes, 10% or more of older free-living subjects, and less than 5% of younger adults. In the absence of formal screening procedures, more than half the patients at risk of malnutrition in various settings do not appear to be recognised and/or are not referred for treatment. RCTs show that nutritional interventions in malnourished patients produce various clinical benefits. (ii) Interventions with nutritional screening in different care settings also generally suggest clinical benefits, but some are limited by small sample sizes and inadequate methodology. Factors that influence outcomes include validity, reliability and ease of using the screening procedure, the 'care gap' that exists between routine and desirable care and the need for other resources, which may increase or decrease following screening. CONCLUSIONS: The frequent failure to recognise and treat malnutrition, especially where it is common, is unacceptable. In such circumstances, the routine use of a simple screening procedure is recommended. Each health care setting should have a transparent policy about nutritional screening, which may vary according to the 'care gap', available resources, and specific populations of patients, in which the prevalence of malnutrition may vary widely.

Humans↗
PubMed1985

Elevated serum immunoreactive pancreatic cationic trypsinogen in acute malnutrition: evidence of pancreatic damage.

We used a sensitive probe of pancreatic dysfunction, serum immunoreactive cationic trypsinogen, to study 50 infants and children with varying degrees of malnutrition. Patients were classified into subgroups according to the severity of malnutrition. Mean serum trypsinogen concentration was significantly elevated in 25 patients with "severe" malnutrition (77.4 +/- 42.0 ng/ml, P less than 0.001) and in 23 with "moderate" malnutrition (55.2 +/- 16.1 ng/ml, P less than 0.02) compared with the mean value (32.5 +/- 10.4 ng/ml) for well-nourished controls. The level of circulating trypsinogen tended to rise with increasing severity of malnutrition. There was no relationship between serum trypsinogen and other variables such as age, specific diagnosis, or mode of feeling. Elevated serum trypsinogen levels could not be attributed to renal disease or cystic fibrosis. In patients who showed an improvement in nutritional status, serum trypsinogen tended to revert toward normal. Elevated serum trypsinogen values in acutely malnourished infants and children may result from pancreatic acinar cell damage or regurgitation of enzymes from obstructed pancreatic ducts.

Acute Disease↗
PubMed1996

Prevalence of malnutrition in patients in general practice.

The objective of this study was to determine the prevalence and correlates of malnutrition in patients living at home with cancer and chronic diseases. Patients (213) with cancer and 228 patients with chronic diseases were randomly selected from general practice registers. Nutritional status was determined from body mass index (BMI in kg/metre2), triceps skinfold thickness (TST), mid-arm muscle circumference (MAMC) and population centiles. Patients were classified as mildly malnourished if they had a BMI < 20 and TST or MAMC < 15th centile, moderately malnourished if they had a BMI < 18 and TST or MAMC < 5th centile, and severely malnourished if they had a BMI < 16 and TST or MAMC < 5th centile. Using these criteria, nearly 10% of patients were malnourished: 24 (5.4%) mildly, 12 (2.7%) moderately and 4 (0.01%) severely. Malnutrition was more common in patients in social classes 3.2, 4 and 5 than in social classes 1, 2 and 3.1 (P = 0.003), and in patients receiving district nurse care (P < 0.001). Malnutrition was more prevalent in cancer patients who complained of chronic or severe pain (32% vs 12%, P = 0.021) and in patients with chronic disorders who experienced mental apathy (22% vs 5%, P = 0.014). Clinicians need to be aware that malnutrition is common in patients living at home. In this study BMI proved to be a fairly good indicator of malnutrition and routine measurement of BMI would be one simple way of detecting patients who are at risk.

Journal Article↗
PubMed2003

Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola.

This study arises from a general proposition that different levels and types of exposure to war are crucial in shaping health outcomes in a population under war-induced duress. We analyze civil war-related regional and ethnolinguistic differentials in age-adequate immunization (complete vaccination for age) and levels of malnutrition in Angola. Our analysis is based on data from a nationally representative survey conducted in 1996, some 2 years after the end of one of the most destructive periods of hostilities in the history of Angolan civil war. The data show that despite Angola's unique mineral wealth, the nation's levels of child age-adequate immunization is lower and malnutrition rates are higher than in most of sub-Saharan Africa. To examine age-adequate immunization and chronic malnutrition we fit logistic regression models that include the regional degree of war impact and ethnolinguistic group, in addition to rural-urban differences and other conventional sociodemographic characteristics. The tests reveal a significant disadvantage of rural children relative to urban children in both immunization and chronic malnutrition. Net of the rural-urban differences, we also detect a significant disadvantage of children residing in parts of the country that had been most affected by the fighting. The tests also point to a lower level of immunization and higher level of chronic malnutrition among children from the ethnolinguistic group commonly identified with the opposition. These associations tend to be stronger among children who were born and/or grew up during war than among children who were born after peace was re-established.

Africa South of the Sahara↗
PubMed1998

Renal dietitians' perspective: identification, prevalence, and intervention for malnutrition in dialysis patients in Texas.

OBJECTIVE: Determine the prevalence of malnutrition per facility standards; examine interventions used to treat malnutrition; and share experiences, concerns, and solutions to problems in the management of malnutrition in dialysis patients in Texas. DESIGN: Structured survey questionnaires. SETTING: 196 outpatient hemodialysis (HD) and 86 peritoneal dialysis (PD) programs in End-Stage Renal Disease (ESRD) Network of Texas, Inc. PARTICIPANTS: Renal dietitians who worked in Texas dialysis facilities that treated chronic, outpatient adult, and pediatric ESRD patients on HD or PD. MEASIRES: Criteria used to identify malnourished patients, prevalence of malnutrition in dialysis recipients, prevalence and types of interventions used to manage malnourished patients, and participation in quality management activities among renal dietitians. RESULTS: For facilities that treated both HD and PD patients in 1996: (1) a significantly greater proportion of PD patients were identified as malnourished than HD patients; (2) facilities that had a high percentage of malnourished HD patients also had a high percentage of malnourished PD patients; (3) a significantly greater proportion of PD patients received commercial nutrition supplements than HD patients; and (4) use of tube feedings, intradialytic parenteral nutrition, intraperitoneal parenteral nutrition, and total parenteral nutrition among HD and PD patients decreased significantly from the past to the current survey year. Renal dietitians shared their experiences, concerns and solutions to problems in the management of malnutrition in this population. CONCLUSION: Results indicate a need to improve the nutritional status of malnourished dialysis patients, to increase consideration of tube feedings as viable nutrient delivery routes, and to maximize involvement of renal dietitians in the quality management process. With the cooperative effort of staff, care givers, patients, and family, early identification and appropriate interventions may improve the nutritional status and quality of life of dialysis patients. This is a US government work. There are no restrictions on its use.

Adult↗