exudates and Protein-Energy-Malnutrition

Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predicting protein-energy wasting (PEW) among Malaysian dialysis patients.. A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.. MIS cut-off score of >=5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r2=0.552, p<0.001) and PD (r2=0.466, p<0.001) patients. DMS and MIS had higher sensitivity values in PD (81% and 82%, respectively) compared to HD (59% and 60%, respectively) patients.. The MIS cut-off scores for malnutrition classification were established (score >=5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutrition screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more practical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers.. 背景与目的：在马来西亚透析患者中，营养不良的发生率很高，需要一种能够 早期识别和管理患者的有效的筛查工具。本横断面研究目的是在马来西亚透析 患者中探讨透析营养不良评分工具（DMS）和营养不良炎症评分工具（MIS） 预测蛋白质能量消耗（PEW）的敏感度。方法与研究设计：用DMS 和MIS 筛 查155 名血液透析（HD）和90 名腹膜透析（PD）患者营养不良的风险，并与 国际肾脏营养与代谢协会（ISRNM）已经制定的PEW 指南进行比较。结果： MIS 截点得分>=5 表示所有的患者存在营养不良。根据ISRNM 标准，59%的HD 和83%的PD 患者有PEW。基于DMS，73%的HD 和71%的PD 患者存在中度 营养不良，而使用MIS，分别有88%和90%的患者为营养不良。在HD（R2 =0.552，p<0.001）和PD（R2=0.466，p<0.001）患者中，DMS 和MIS 显著相 关。与HD 患者相比（分别为59%和60%），PD 患者对DMS 和MIS 有较高的 灵敏度值（分别为81%和82%）。结论：在马来西亚透析患者中，确定了MIS 区分营养不良的截点值（得分>=5）。对于透析患者，尤其是接受腹膜透析的患 者，DMS 和MIS 是有效的营养筛查工具。DMS 可能是用在马来西亚透析装置 中更实用更简单的工具，因为它不需要实验室指标。.

Topics: Adult; Aged; Anthropometry; Body Mass Index; Diet; Female; Humans; Inflammation; Iron; Malaysia; Male; Middle Aged; Peritoneal Dialysis; Protein-Energy Malnutrition; Renal Dialysis; Reproducibility of Results; Risk Factors; ROC Curve; Serum Albumin; Wasting Syndrome

Poor appetite could be indicative of protein energy wasting (PEW) and experts recommend assessing appetite in dialysis patients. Our study aims to determine the relationship between PEW and appetite in haemodialysis (HD) patients.. HD patients (n=205) self-rated their appetite on a scale of 1 to 5 as very good (1), good (2), fair (3), poor (4) or very poor (5). Nutritional markers were compared against appetite ratings. Using logistic regression analysis associations between dichotomized appetite with PEW diagnosis were determined as per the International Society of Renal Nutrition and Metabolism (ISRNM) criteria and alternate objective measures. Data was adjusted for socioeconomic and demographic characteristics.. Poorer appetite ratings were significantly associated with lower income (P = 0.021), lower measurements (P < 0.05) for mid-arm muscle circumference, mid-arm muscle area and lean tissue mass (LTM), serum urea (P = 0.007) and creatinine (P = 0.005). The highest hsCRP (P = 0.016) levels occurred in patients reporting the poorest appetite. Serum albumin did not differ significantly across appetite ratings. Poor oral intake represented by underreporting (EI/BMR < 1.2) was evident for all appetite ratings. PEW was prevalent irrespective of appetite ratings (very good: 17.6 %, good: 40.2 %, fair: 42.3 % and poor: 83.3 %). After dichotomizing appetite ratings into normal and diminished categories, there was a marginal positive association between diminished appetite and overall PEW diagnosis (OR adj: 1.71; 95 % CI: 0.94-3.10, P = 0.079). Amongst individual ISRNM criteria, only BMI < 23 kg/m2 was positively associated with diminished appetite (OR adj: 2.17; 95 % CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (OR adj: 2.86; 95 % CI: 1.31-6.24) and fat mass (OR adj: 1.91; 95 % CI: 1.03-3.53), lower levels of serum urea (OR adj: 2.74; 95 % CI: 1.49-5.06) and creatinine (OR adj: 1.99; 95 % CI: 1.01-3.92), higher Dialysis Malnutrition Score (OR adj: 2.75; 95 % CI: 1.50-5.03), Malnutrition Inflammation Score (OR adj: 2.15; 95 % CI: 1.17-3.94), and poorer physical (OR adj: 3.49; 95 % CI: 1.89-6.47) and mental (OR adj: 5.75; 95 % CI: 3.02-10.95) scores.. A graded but non-significant increase in the proportion of PEW patients occurred as appetite became poorer. However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.

Topics: Adult; Aged; Anorexia; Appetite; Arm; C-Reactive Protein; Cross-Sectional Studies; Dietary Proteins; Female; Hand Strength; Humans; Income; Kidney Failure, Chronic; Malaysia; Male; Middle Aged; Muscle, Skeletal; Organ Size; Protein-Energy Malnutrition; Renal Dialysis; Self Report; Serum Albumin; Thinness; Wasting Syndrome

A cross-sectional study was carried out to determine the current prevalence of protein-energy malnutrition (PEM) among Orang Asli schoolchildren and to investigate the potential predictors of malnutrition. A total of 241 (120 males and 121 females) Orang Asli schoolchildren age 7-12 years living in remote areas of Pos Betau, Pahang participated voluntarily in this study. Anthropometric and socioeconomic data were collected and the children were screened for intestinal parasitic infections. The overall prevalences of mild and significant underweight conditions were 52.3% and 37.3%, respectively, and the prevalences of mild stunting and wasting were 43.6% and 43.1%, respectively, while the prevalences of significant stunting and wasting were 43.6% and 5.6%, respectively. There was a significant association between gender (male) and malnutrition (p = 0.029). The results also showed a higher prevalence of stunting among children age < or = 10 years than in older children (p = 0.001). Other independent variables, including socioeconomic status and intestinal parasitic infections, had no significant associations with malnutrition indices. PEM is prevalent among schoolchildren in rural Malaysia and therefore of public health concern since PEM diminishes immune function and impairs cognitive function and educational performance. School-based programs of prevention through health education and interventions should be considered as an essential part of measures to improve the quality of life of schoolchildren in rural Malaysia.

Topics: Age Factors; Animals; Body Weights and Measures; Child; Child Nutrition Disorders; Cross-Sectional Studies; Female; Humans; Intestinal Diseases, Parasitic; Malaysia; Male; Prevalence; Protein-Energy Malnutrition; Rural Population; Sex Factors; Socioeconomic Factors

We conducted a cross sectional study to examine the association of intestinal parasitic infections and protein energy malnutrition (PEM) with iron-status indicators and anaemia among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2 - 15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis for blood and faecal samples. All children were infected either by A. lumbricoides, T. trichiura or hookworm and almost 19%, 26% and 3% of the children had severe infection of ascariasis, trichuriasis and hookworm infection respectively. The prevalence of giardiasis among them was 24.9%. Overall, 41.5% of the children were anaemic (haemoglobin < 11.0 g/dL). Of these 61.0% of the children had iron deficiency and 36.5% had iron deficiency anaemia (IDA), which accounted for 88.0% of anaemia in this population. Severe trichuriasis had the most significant correlation with anaemia and iron deficiency in this population. It contributed to low concentrations of haemoglobin, serum iron and serum ferritin and high total iron binding capacity (TIBC). Significant underweight and stunting were associated with low concentrations of haemoglobin and serum iron while significant wasting was significantly associated with low concentration of serum ferritin. Logistic regression analysis confirmed that severe trichuriasis was a strong predictor of IDA. It also confirmed that children who were significantly underweight and whose mother was working were independent predictors of IDA in this population.

Topics: Adolescent; Anemia, Iron-Deficiency; Anthropometry; Child; Child, Preschool; Cross-Sectional Studies; Feces; Female; Health Surveys; Helminthiasis; Humans; Intestinal Diseases, Parasitic; Iron; Iron Deficiencies; Malaysia; Male; Odds Ratio; Prevalence; Protein-Energy Malnutrition; Risk Factors; Surveys and Questionnaires

This study aims to determine the prevalence of protein-energy malnutrition and its association with soil-transmitted helminthiases in Orang Asli (Aborigine) children in Selangor, Malaysia. The results obtained from 368 children aged 2-15 years showed that the overall prevalence of mild and significant underweight was 32.1% and 56.5% respectively. The prevalence of mild stunting was 25.6% while another 61.3% had significant stunting. The overall prevalence of mild and significant wasting was 39.0% and 19.5% respectively. The overall prevalence of ascariasis, trichuriasis and hookworm infection were 61.9%, 98.2% and 37.0% respectively and of these 18.9%, 23.5% and 2.5% of the children had severe infection of the respective helminthes. The overall prevalence of giardiasis was 24.9%. The present study vividly shows that stunting and underweight are highly prevalent among Orang Asli children and therefore of concern in this community. In this population intestinal parasitic infections, especially severe trichuriasis and giardiasis, were identified as the main predictors of stunting and wasting respectively, in addition to age between 2 to 6 years.

Topics: Adolescent; Age Distribution; Ascariasis; Child; Child, Preschool; Female; Giardiasis; Helminthiasis; Hookworm Infections; Humans; Malaysia; Male; Prevalence; Protein-Energy Malnutrition; Risk Factors; Severity of Illness Index; Soil; Trichuriasis

A cross-sectional study to examine the association of giardiasis with protein-energy malnutrition, vitamin A deficiency and iron deficiency anaemia was conducted among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2-15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and faecal samples. The results showed that 24.9% of the children were infected with Giardia duodenalis, while 56.5, 61.3 and 15.1% had significant underweight, stunting and wasting, respectively. Giardiasis was statistically identified as a strong predictor of significant wasting in this study population.

Topics: Adolescent; Anemia, Iron-Deficiency; Child; Child, Preschool; Cross-Sectional Studies; Female; Giardiasis; Humans; Malaysia; Male; Prevalence; Protein-Energy Malnutrition; Surveys and Questionnaires; Vitamin A Deficiency

A study to determine the prevalence of goitre and abnormal thyroid status during pregnancy in Malaysian women was conducted. Two hundred and three women (Malay = 85, Chinese = 47 and Indian = 71) in the third trimester and with no known thyroid disease were studied. There was a marked racial disparity in the prevalence of goitre: Indian 61%, Malay 28% and Chinese 29% (p = 0.001). The serum thyrotropic hormone (TSH) was significantly higher in Indians (median: 1.36 uIU/ml) compared to Malays (1.14 uIU/ml, p = 0.009). The serum albumin was also significantly lower in Indians (mean +/- sd; 36.12 +/- 3.9 mmol/l) compared to Malays (39.3 +/- 4.8 mmol/l) or Chinese (39.1 +/- 5.2) (p < 0.001). Thyroid antibody was detected in 14.6% of these women with no significant racial difference in its prevalence. Three women were found to be thyrotoxic but none were hypothyroid. This study found a high prevalence of goitre among the pregnant Indian women, probably related to the protein malnutrition state. The high prevalence of positive thyroid antibody in our population indicates that a high percentage of women are at risk of developing postpartum thyroiditis.

Topics: Adult; China; Cross-Cultural Comparison; Cross-Sectional Studies; Female; Goiter, Endemic; Humans; Incidence; India; Malaysia; Pregnancy; Pregnancy Complications; Protein-Energy Malnutrition; Serum Albumin; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones; Thyroiditis, Autoimmune; Thyrotropin

Kuala Lumpur is the capital city of Malaysia with an estimated population of 1.55 million. Approximately 12% of the population live in squatter settlements occupying about 7% of the city total area. The squatter settlements generally are provided with basic amenities such as piped water, toilet facilities and electricity. Health indicators for the overall population of Kuala Lumpur are better off than for the rest of the country; however, intra-city differentials prevail along ethnic and socio-economic lines. Malays and Indians have higher rates for stillbirths, and neonatal, infant and toddler mortality than the Chinese. The wide disparity in the socio-economic status between the advantaged and the poor groups in the city is reflected in the dietary practices and nutritional status of young children from these communities. The percentage of preschool children from urban poor households with inadequate intakes of calories and nutrients is two to three times higher than those from the advantaged group. Compared to rural infants, a lower percentage of urban infants are breastfed. A lower percentage of Malays from the urban advantaged group breastfed, compared with the urban poor group. The reversed trend is found for the Chinese community. Growth attainment of young children from the urban poor is worse than the urban advantaged, though better than the rural poor. Health and nutritional practices implications related to both undernutrition and overnutrition are discussed, to illustrate the twin challenges of malnutrition in the city.

Topics: Adolescent; Adult; Breast Feeding; Child; Child, Preschool; Cross-Sectional Studies; Deficiency Diseases; Developing Countries; Female; Humans; Hypercholesterolemia; Ill-Housed Persons; Incidence; Infant, Newborn; Malaysia; Male; Maternal-Child Health Centers; Nutrition Disorders; Nutritional Requirements; Nutritional Sciences; Obesity; Population Growth; Poverty; Pregnancy; Protein-Energy Malnutrition; Socioeconomic Factors; Transients and Migrants; Urban Population

Anthropometric and parasitological data from cross-sectional studies of two groups of primary school children (Group I of Indian origin, 325 boys and 259 girls, age = 7 years; Group II of Malay origin, 284 boys and 335 girls, age = 7-9 years) from two different ecological settings in Peninsular Malaysia were examined for epidemiological evidence of an association between hookworm infection and protein-energy malnutrition. In both ecological groups, significant weight, height and haemoglobin deficits were observed in children with hookworm infection after adjustment for covariables including Ascaris and Trichuris infection intensities and other child and family characteristics. The deficits were related to the intensity of infection based on egg counts. These findings suggest that hookworm may be an important determinant of chronic protein-energy malnutrition, as well as anaemia, in areas where diets are generally inadequate in protein, energy, and iron. Well-controlled intervention studies are needed to confirm these observations.

Topics: Anthropometry; Ascariasis; Child; Child Nutrition Disorders; Chronic Disease; Cross-Sectional Studies; Feces; Female; Hookworm Infections; Humans; India; Malaysia; Male; Parasite Egg Count; Protein-Energy Malnutrition; Regression Analysis; Trichuriasis

From the start of the school milk feeding programme in February 1985 to October 1986, a total of 2,766 children aged six to nine years from 12 primary schools in Ulu Selangor were followed-up for about two years. The children's weight and height were monitored at the beginning, in the middle and at the end of the study. The study shows that there is a reduction in the prevalence of protein-energy malnutrition in terms of underweight (15.3% to 8.6%), stunting (16.3% to 8.3%) and wasting (2.6% to 1.7%) from the start of the school feeding programme to two years later. Associated with this there was an improvement in the attendance rate of the children during the same period. As there was no major developmental change in Ulu Selangor during that period, it is likely that the reduction in the prevalence of protein-energy malnutrition and the improvement of the attendance rate among the children are due to the impact of the school milk feeding programme.

Topics: Animals; Child; Female; Food Services; Humans; Malaysia; Male; Milk; Nutritional Status; Program Evaluation; Protein-Energy Malnutrition; School Health Services

An anthropometric assessment was conducted on a sample of 309 children, aged twelve years and below, from an urban squatter community in Kuala Lumpur, Malaysia. The community consists mainly of Malays and Indians and is fairly established with a mean length of residence of about fifteen years. There was not much difference between the two ethnic groups with regard to educational status or income. Most of the residents were unskilled or semiskilled workers employed in factories and government agencies. About 40 percent of the infants and toddlers were found to be wasted, while about one-third of the older children were stunted. There appears to be some association between income per capita and nutritional status.

Topics: Anthropometry; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Nutritional Status; Protein-Energy Malnutrition; Socioeconomic Factors; Urban Health

Topics: Adolescent; Adult; Anemia, Hypochromic; Child; Child, Preschool; Eating; Female; Humans; Infant; Infant, Newborn; Malaria; Malaysia; Middle Aged; Nutrition Disorders; Protein-Energy Malnutrition

Topics: Anthropometry; Child; Child, Preschool; Female; Humans; Infant; Malaysia; Male; Nutrition Surveys; Protein-Energy Malnutrition

Recent trends in population indicators that relate to food, nutrition, and nutritionally related health situations in Malaysia are reviewed. The overview is supplemented when possible with data obtained from recent community level nutrition assessment surveys. The death rate of children 1-4 years has for many years been accepted as a rough indicator of protein calorie malnutrition. Along ethnic lines, the Malays suffer the highest toddler mortality, being 2.91/1000 compared to 2.38 for Indians and 1.18 for the Chinese for 1978. There is also considerable variation in total mortality rate (TMR) from state to state. If one examines the annual percentage rate of decline of TMR over the 1957-1967 and 1968-1978 periods, one finds that while the average annual percentage decline in TMR was higher for the predominantly urban Chinese during the 1st decade after Merdeka, this is now reversed in favor of the predominantly rural Malay population. During 1978, the national incidence for low birth weight was 17.5% in Indians, 10.8% in Malays, and 7.9% in Chinese. Calorie availability per capita daily has increased from a mean of 2453 during 1961-1970 to 2550 during 1971-1978. Similarly, protein availability has also increased, albeit marginally, from 50 g to 52 g for the corresponding periods. Expressed as % of requirement, calorie avilability now stands at around 123%; protein availabiltiy is at 108%. The food balance sheet analysis gives no indication of the unequal distribution of food between the various socioeconomic groups. Segments of the community with extreme availabilties of calorie and protein, associated with inadequacies or excesses are bound to exist. For the purposes of national planning, the per capita daily availability of calories and protein should be aimed at levels that well exceed their estimated requirements in order to allow for unequal distribution and plate waste. The community nutritional assessments showed that although the prevalence of acute malnutrition in the form of moderate "wasting" was low (1-3%), the moderate forms of chronic malnutrition as manifested by "underweight" (12-37%) or "stunting" (5-36%) were relatively common. There was also a moderate prevalence of anemia (16-33%). In rural Malaysia and the urban squatter areas, the presence of helminthic parasites such as ascaris and trichuris is ubiquitous. Continued efforts should be directed to the improvement of the nutritional health of both rural and urban pover

Topics: Anemia; Child, Preschool; Female; Food Supply; Health Status Indicators; Humans; Infant; Infant Mortality; Malaysia; Male; Nutritional Physiological Phenomena; Protein-Energy Malnutrition; Socioeconomic Factors

Topics: Anthropometry; Child; Child, Preschool; Female; Humans; Infant; Malaysia; Male; Protein-Energy Malnutrition

Topics: Child; Female; Humans; Malaysia; Male; Protein-Energy Malnutrition

Topics: Adolescent; Adult; Age Factors; Ascorbic Acid Deficiency; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Nutrition Disorders; Protein-Energy Malnutrition; Riboflavin Deficiency; Rural Health; Thiamine Deficiency; Vitamin A Deficiency

Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.

Topics: Anemia; Body Weight; Child, Preschool; Developing Countries; Diarrhea, Infantile; Family Characteristics; Hospitalization; Humans; Immunization Schedule; Infant; Infant Mortality; Infant Nutritional Physiological Phenomena; Life Style; Malaysia; Pneumonia; Protein-Energy Malnutrition; Socioeconomic Factors

Topics: Culture; Diet; Environmental Health; Female; Health Education; Humans; Infant; Infant Nutritional Physiological Phenomena; Lung Abscess; Malaysia; Parity; Protein-Energy Malnutrition; Public Health