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Ultrasonography is frequently used to measure the rectus femoris muscle cross-section area, and has been suggested to associate with poor health condition. However, no validation studies have been performed to compare rectus femoris muscle ultrasonography (RFMS) with anatomical planimetry when measuring the muscle cross-sectional area (CSA). This validation study compared the two methods of CSA measurement of unfixed (frozen) and fixed (unfrozen) rectus femoris muscle specimens obtained from elderly human cadavers. Agreement between tests was studied by Bland–Altman analysis. We found a significant difference between planimetry and RFMS of unfixed (frozen) muscle specimens (mean difference, -0.389 cm²; 95% CI, -0.144 to -0.634), p = 0.022. No significant difference was observed between the two methods when measuring fixed (unfrozen) muscle specimens (mean difference, 0.032 cm², 95% CI, -0.007 to -0.070), p = 0.107. In fixed specimens, the 95% limit of agreement between the two methods ranged between 0.12 cm² and -0.06 cm² (<10% deviation); while in unfixed muscle specimens, the range was between 0.28 cm² and -1.06 cm² (~50% deviation). In light of the similar results obtained in fixed specimens, ultrasound is a safe and accurate method of rectus femoris muscle size assessment. In clinical practice, RFMS may be used to detect a decrease in rectus femoris muscle mass, typically associated with malnutrition of the elderly, and may therefore be a simple and practical tool for the screening of malnutrition.

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Empowering nutrition via biotechnology

Feeding Asia’s children

This paper determines the risk for cardiovascular diseases (CVDs), and nutrition level in infants aged 0–6 months using Fuzzy Cognitive Maps (FCMs). The aim of this study is to facilitates the medical experts to early detects these diseases with accuracy, so that overall death ratio can be reduced. Firstly, we have introduced the concepts of FCMs and briefly refer to the applications of these methods in medical. After that, two intelligent decision support systems for cardiovascular and malnutrition are developed using FCMs. The proposed cardiovascular risk assessment system takes six inputs: chest pain, cholesterol, heart rate, blood pressure, blood sugar, and old peak and determines CVDs risk. The second decision support system of malnutrition diagnosis takes twelve inputs: breastfeeding, daily income, maternal education, colostrum intake, energy intake, protein intake, vitamin A intake, iron intake, family size, height, weight, head circumference, and skin fold thickness and diagnoses the nutrition level in infants. We have explained the working of both decision support systems using case studies.

Significant nutritional issues facing people with cancer undergoing treatment include weight loss, treatment-related side effects and the presence of nutritional impact symptoms. Appropriate nutritional care is an essential component of a comprehensive cancer care service and all members of the multidisciplinary team should play a proactive role in addressing the nutritional needs of patients. Key aspects include the identification of malnutrition by nutritional screening and assessment, setting of appropriate goals, nutritional intervention (determining the nutritional prescription and implementation of the nutritional care plan), evaluation and monitoring. The success of nutritional care in improving patient outcomes is dependent upon the intensity of the care provided and positive clinical outcomes, such as improvements in dietary intake, maintenance of nutritional status and improvement in quality of life have been demonstrated in recent randomised controlled studies.

Improvements in the peri-operative management of gastrointestinal malignancies allows patients to start eating and walking almost immediately after recovery from anaesthesia, and results in earlier discharge in a better state of health. This is termed fast track surgery and results from the judicious use of minimally invasive procedures or better open surgery, and is enhanced by modern anaesthetic protocols, reducing the use of opiate drugs and is predicated by a team effort. When patients present with advanced cancers and a prolonged period of poor food intake, the risk of suffering complications following surgery is increased. Many different nutritional risk assessment tools have been developed and have been shown to be effective in deciding which patients should undergo peri-operative nutritional therapy.

Artificial nutrition reduces the risk of post-operative complications when used selectively on at risk patients. In low risk patients, the complications of enteral nutrition and parenteral nutrition, lthough uncommon, may be serious and significantly reduce the effectiveness of these therapies. However, in high risk patients significant reductions in mortality and morbidity can be achieved and their benefits can be substantial.

The global climate crisis poses large risks to public health through many exposure pathways, from heat waves and air pollution, to malnutrition, infectious diseases and social dislocation. At the same time, confronting the cause of climate change — reducing greenhouse gas emissions — offers health and financial benefits, especially by reducing chronic diseases. First, according to the World Health Organization (WHO) more than seven million people die prematurely every year from air pollution. Therefore, departing from fossil fuel-based energy can save millions of lives. Second, a diet with less red meat (particularly in wealthy countries) will both mitigate greenhouse gas emissions and reduce saturated fat and the risk of cardiac disease. And third, over five million people are dying annually from lack of exercise due to a growing trend in sedentary lifestyles — caused in large part by overreliance on motorized transportation. Thus, opportunities abound to enhance physical fitness through smart urban design that promotes safe, low-carbon, “active” transportation (via walking and biking) that will reduce the risk of coronary heart disease, strokes, diabetes, depression and colon, and breast cancer.

This paper presents a comprehensive empirical analysis of the factors affecting growth and psychological development of over 100 infants from birth to age 6 months in the Embu region of Kenya. The analysis was divided into four parts. First, infants' birth weight, and length and head circumference as measured few days after birth, were modeled using multiple regression models. Maternal prepregnancy body mass index (BMI), gestation period, and parity were associated with infants' anthropometric measurements (P < 0.05). Second, the scores on seven clusters of the Brazelton Neonatal Behavioral Assessment Scale were explained by health and socioeconomic indicators. While the models had poor predictive power, the scores were comparable to those reported in the literature for Puerto Rican and African American infants. The third part of the analysis modeled infant growth between 1–6 months by analyzing longitudinal data on length, head circumference, and weight. Dynamic models were postulated for the effects of nutritional, socioeconomic, and environmental factors and morbidity on anthropometric variables. The results showed that infants' calcium intakes were positively associated with length (P < 0.05). Maternal BMI and hemoglobin concentration were positively associated with infant weight (P < 0.05); infant morbidity was negatively associated with weight (P < 0.05). Lastly, the infants' scores at 6 months on the Bayley Motor Scale and on eight items from the Bayley Infant Behavior Record were explained using anthropometric, socioeconomic, and psychological variables. The infants' arm circumference and intake of protein were significant predictors of scores on the Bayley Motor Scale. In addition, time spent by the mother talking to the infant was positively associated with the scores on the Bayley Infant Behavior Record. The empirical results have implications for identifying vulnerable children in developing countries.

Agriculture is the primary livelihood of a majority of the population in South Asia. The region also houses a large population of undernourished people. The farming system for nutrition (FSN) model envisages developing and demonstrating a sustainable framework of farming to improve nutritional outcomes that can be used for upscaling and wider adoption. Agricultural intervention and farming systems research in India has been largely focused on enhancing production, productivity and profitability of crop and animal resources without much emphasis on better nutritional outcomes. The FSN model has been conceptualized to develop location-specific inclusive models to address the nutritional needs of farm and non-farm families based on their resource endowments and surrounding environment. The main components of the model are as follows: (1) survey to identify the major nutritional problems, (2) design suitable agricultural interventions to address the problems, (3) include specific nutritional criteria in the design, (4) improve small farm productivity and profitability, (5) undertake nutrition awareness programmes and (6) introduce monitoring systems for assessing impact on nutrition outcomes. The objective is to demonstrate feasibility of nutrition-sensitive agriculture. The proposed model is being tested in two select locations to demonstrate improvement in nutrition status through improved agricultural production system, dietary diversification, income enhancement, greater nutrition awareness and changed behaviour patterns, to be evaluated through a set of objective indicators.

China has achieved huge success in alleviating nutrient deprivation over the past four decades. The prevalence of child undernutrition in terms of stunting, underweight and infant mortality has dropped well below the world average. This chapter reviews China’s successful experiences in improving health and nutrition, and points out the challenge of overnutrition in terms of child overweight and obesity. Income growth increases diet adequacy, while the westernized dietary transition during fast urbanization, preferences towards meat and oil, and the traditional social norm highlighting a fat body shape for children give rise to overnutrition. Children of rural or migrant families have higher prevalence of overnutrition than that of their urban counterparts. It is worth addressing dual malnutrition — remaining nutrient deprived as well as overweight and obesity — if China aims to realize its national blueprint “Healthy China 2030”.

Malnutrition poses risks regarding cognitive, behavioral, and physical well-being. The aim of this study was to investigate the prevalent health issues associated with malnutrition by utilizing electronic health records (EHR) data. The IBM Watson Health, Explorys platform was used to access the EHR data. Two cohorts were created by two queries; patients with a history of malnutrition (n=5180) and patients without a history of malnutrition diagnosis (n= 413890). The log odds ratio and χ2 statistic were used to identify the statistically significant differences between these two cohorts. We found that there were 35 terms that were more common among the cohort with the malnutrition diagnosis. These terms were categorized under developmental anomalies, infectious agents, respiratory system issues, digestive system issues, pregnancy/prenatal problems, mental, behavioral, or neurodevelopmental disorders, diseases of the ear or mastoid process, diseases of the visual system, and chromosomal anomalies. The management of malnutrition in children is a complex problem that can be addressed with a multifactorial approach. Based on the key themes emerging from among the commonly prevalent terms identified in our study, infection prevention, education in appropriate nutritional solutions for digestive health issues, supportive services to address neurodevelopmental needs, and quality prenatal healthcare would constitute beneficial prevention efforts. Improving our understanding of malnutrition is necessary to develop new interventions for prevention and treatment.