Case Study: The nutritional management of a patient with acute myeloid leukaemia

No Abstract

Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition

Objectives: This study aimed to expand on the limited South African malnutrition prevalence data and investigate the feasibility of mid-upper-arm circumference (MUAC) as a malnutrition screening tool. Design: A cross-sectional, multi-centre, descriptive design was adopted. Setting: The study was undertaken in three tertiary public hospitals in the same urban area within the Eastern Cape of South Africa. Subjects: Adult hospitalised patients volunteered to participate (n = 266). Methods: Data were collected using interviewer-administered questionnaires; obtaining anthropometric measurements; and consulting medical files. For maximum accuracy of various MUAC cut-off points, receiver operating characteristic curves were generated and area under the curve determined. Results: Both body mass index (BMI) and MUAC identified 21% of participants as underweight or malnourished, and 39% as overweight or obese. The Malnutrition Universal Screening Tool (MUST) found 23% at increased malnutrition risk. Nurses or doctors detected and referred only 19% of underweight patients (BMI < 18.5 kg/m2), to dietetics services. Direct measurements of BMI and MUST were unobtainable in 38% and 43% of patients respectively, whilst MUAC was obtainable in 100%. A statistically significant relationship (p < 0.001) exists between MUAC, BMI and MUST to detect malnutrition or malnutrition risk. MUAC cut-offs for undernutrition were determined at < 23 cm (BMI < 16 kg/m2) and < 24 cm (BMI < 18.5 kg/m2), respectively, for the study’s population groups. Conclusion: Malnutrition prevalence was high in this study, but often unidentified, with only a fifth referred to dietetic services. MUAC is a feasible method to identify adult malnutrition and should be considered as a malnutrition screening tool and key nutritional status indicator in South African public hospitals

Manipulation of starch bioaccessibility in wheat endosperm to regulate starch digestion, postprandial glycemia, insulinemia, and gut hormone responses: a randomized controlled trial in healthy ileostomy participants

Background: Cereal crops, particularly wheat, are a major dietary source of starch, and the bioaccessibility of starch has implications for postprandial glycemia. The structure and properties of plant foods have been identified as critical factors in influencing nutrient bioaccessibility; however, the physical and biochemical disassembly of cereal food during digestion has not been widely studied. Objectives: The aims of this study were to compare the effects of 2 porridge meals prepared from wheat endosperm with different degrees of starch bioaccessibility on postprandial metabolism (e.g., glycemia) and to gain insight into the structural and biochemical breakdown of the test meals during gastroileal transit. Design: A randomized crossover trial in 9 healthy ileostomy participants was designed to compare the effects of 55 g starch, provided as coarse (2-mm particles) or smooth (0.2-mm particles) wheat porridge, on postprandial changes in blood glucose, insulin, C-peptide, lipids, and gut hormones and on the resistant starch (RS) content of ileal effluent. Undigested food in the ileal output was examined microscopically to identify cell walls and encapsulated starch. Results: Blood glucose, insulin, C-peptide, and glucose-dependent insulinotropic polypeptide concentrations were significantly lower (i.e., 33%, 43%, 40%, and 50% lower 120-min incremental AUC, respectively) after consumption of the coarse porridge than after the smooth porridge (P , 0.01). In vitro, starch digestion was slower in the coarse porridge than in the smooth porridge (33% less starch digested at 90 min, P , 0.05, paired t test). In vivo, the structural integrity of coarse particles (~2 mm) of wheat endosperm was retained during gastroileal transit. Microscopic examination revealed a progressive loss of starch from the periphery toward the particle core. The structure of the test meal had no effect on the amount or pattern of RS output. Conclusion: The structural integrity of wheat endosperm is largely retained during gastroileal digestion and has a primary role in influencing the rate of starch amylolysis and, consequently, postprandial metabolism. This trial was registered at isrctn.org as ISRCTN40517475

Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition

Objectives: This study aimed to expand on the limited South African malnutrition prevalence data and investigate the feasibility of mid-upper-arm circumference (MUAC) as a malnutrition screening tool. Design: A cross-sectional, multi-centre, descriptive design was adopted. Setting: The study was undertaken in three tertiary public hospitals in the same urban area within the Eastern Cape of South Africa. Subjects: Adult hospitalised patients volunteered to participate (n = 266). Methods: Data were collected using interviewer-administered questionnaires; obtaining anthropometric measurements; and consulting medical files. For maximum accuracy of various MUAC cut-off points, receiver operating characteristic curves were generated and area under the curve determined. Results: Both body mass index (BMI) and MUAC identified 21% of participants as underweight or malnourished, and 39% as overweight or obese. The Malnutrition Universal Screening Tool (MUST) found 23% at increased malnutrition risk. Nurses or doctors detected and referred only 19% of underweight patients (BMI < 18.5 kg/m2), to dietetics services. Direct measurements of BMI and MUST were unobtainable in 38% and 43% of patients respectively, whilst MUAC was obtainable in 100%. A statistically significant relationship (p < 0.001) exists between MUAC, BMI and MUST to detect malnutrition or malnutrition risk. MUAC cut-offs for undernutrition were determined at < 23 cm (BMI < 16 kg/m2) and < 24 cm (BMI < 18.5 kg/m2), respectively, for the study’s population groups. Conclusion: Malnutrition prevalence was high in this study, but often unidentified, with only a fifth referred to dietetic services. MUAC is a feasible method to identify adult malnutrition and should be considered as a malnutrition screening tool and key nutritional status indicator in South African public hospitals

British III done: recent work on Shakespeare and British, English, Irish, Scottish and Welsh identities

This contribution to &lt;i&gt;Literature Compass&lt;/i&gt; has a three-fold purpose. First, it aims to do what it says in the title, and flag up recent approaches to British identities in Shakespeare studies. Secondly, it seeks to remind readers of an earlier and now largely forgotten tradition of nationalist criticism and scholarship preoccupied with the place of Britain – nation, state and empire – that flourished in the 1920s and 1930s. Thirdly, it endeavours to excavate some of the more obscure material on the subject that, because of its place of publication, may have been overlooked. The material collected here covers issues of borders, colonialism, culture, genre, identity, invasion, language, mapping, monarchy, plantation, union, and the matter of Britain, especially in the histories, though as will be seen this work encompasses most of Shakespeare's corpus. The short introductions to each section and the accompanying bibliography of over 300 items, ranging from notes and queries to substantial essays, is divided into six sections, beginning with a brief overview of the historical debate, then focusing on criticism dealing broadly with Britain, then embracing material ordered by constituent nation: England, Ireland, Scotland and Wales. That there is an even spread of material under this handful of headings suggests that each and every nation within this multi-nation state, as well as the problematic and often contested whole, has attracted its fair share of critical concern