This research was conducted to test the hypothesis that parenteralarginine supplementation is effective in enhancing birth weights of intrauterinegrowth restricted (IUGR) fetuses. Underfed and prolific ewes were used asexperimental models. The first study characterized the pharmacokinetics ofarginine and citrulline and assessed the potential of citrulline to serve as aprecursor for enhancing arginine availability in fetal and maternal plasma. Sixlate pregnant ewes and their fetuses were instrumented to access arterial andvenous circulations. Intravenous boluses of 155 mol of L-arginine-HCl or Lcitrullineper kg body weight were administered to each ewe. Administration ofcitrulline was more effective than arginine in achieving a sustained increase inconcentrations of arginine in maternal and fetal blood. Accordingly, theclearance rate of citrulline was lower and its biological half-life in maternal bloodgreater, when compared with arginine. The second experiment determined ifadministration of arginine to underfed ewes is effective in ameliorating orpreventing IUGR. Ewes were fed either 100% or 50% of the National ResearchCouncil recommended nutrient requirements for pregnant sheep. Between Day60 of pregnancy and parturition control-fed ewes received saline solution and underfed ewes received either saline solution or L-arginine-HCl solution (155mol of arginine/kg body weight) intravenously three times daily (n=5 / treatmentgroup). Birth weights of lambs were lower in saline-infused underfed ewes.There was no difference in birth weights of lambs from control-fed and argininetreatedunderfed ewes. The third experiment determined whether administrationof arginine could improve survival rates of lambs and enhance fetal growth inewes carrying multiple fetuses. Between Days 100 and 121 of pregnancy, ewesreceived an intravenous infusion of either saline solution (n= 14) or L-arginine-HCl solution (345 mol of arginine/kg body weight, n=20) three times daily.Parenteral administration of arginine increased the percentage of lambs bornalive and enhanced the birth weights of quadruplets. Collectively, these resultsindicate that 1) parenteral administration of arginine improves pregnancyoutcomes in underfed and prolific ewes; and 2) the use of arginine or citrullinemay have important implications for the design of an effective treatment forpreventing or ameliorating IUGR in mammals.

Mer än 25 % av äldre patienter lider av undernäring under sin sjukhusvistelse. Detta problem har varit känt i ett flertal år. Syftet med studien var att beskriva sjuksköterskors bedömning och hantering av undernutrition hos äldre patienter som vårdas på sjukhus. Metoden som valdes till studien var en kvalitativ enkätstudie och dess svar bearbetades genom en kvalitativ innehållsanalys. Resultaten presenterades i sju olika teman: Den kliniska blicken, Samlad bedömning, Bedömningshjälpmedel, Registrering av kostintag, Psykisk hälsa, Undersköterskans roll och Tidsbrist. Konklusionen är att sjuksköterskor har tillräcklig kunskap och hjälpmedel för att kunna bedöma ett adekvat nutritionsstatus på sina patienter. Det som dock hindrar dem är den ständiga tidsbristen som gör att nutritionsfrågor prioriteras lägre. Undersköterskorna tar ofta på sig ansvaret för nutritionsbedömningen. / In spite of the fact the situation has been well known for several years, more than 25 percent of elderly patients suffer from malnutrition during hospital care. The aim of this study was to describe the nurse's assessment of nutrition status among elderly patients treated in hospital. The chosen method was a qualitative questionnaire and by using a qualitative content analysis, the answers were processed. The results were presented in seven themes; The clinical eye, Resources, Raised assessment, Registration of food intake, Mental health, Assistant nurse´s role and Lack of time. Our conclusion is that nurses have enough knowledge and aid to appraise an adequate nutrition status on their patients, but is prevented by constant lack of time resulting in nutrition questions being lower prioritized. Instead, the assistant nurse takes more responsibility for the nutrition assessment.

Undernutrition is a major public health problem, contributing to 33% of deaths in infants and young children globally. In Kygryzstan, Central Asia, Mercy Corps provided 6 metric tons of rice, flour and oil as well as nutrition education to kindergartens in 40 rural regions, serving 41,000 children, for one year. Anthropometric measurements were collected at the beginning and end of the program (10 months later). Children, who were stunted, wasted and underweight at baseline, recovered by follow-up, with rates of recovery of 50%, 65% and 50%, respectively. The prevalence of stunting, wasting and underweight in the population decreased from 13.8%, 3.4% and 3.2%, respectively, to 8.6%, 2.1% and 2.3%, respectively. These results are particularly significant as the dearth of research on pre-school feeding’s impact on growth and nutrition has led to this particular intervention being deemed ineffective for improvement of nutritional outcome.

This research was conducted to test the hypothesis that parenteralarginine supplementation is effective in enhancing birth weights of intrauterinegrowth restricted (IUGR) fetuses. Underfed and prolific ewes were used asexperimental models. The first study characterized the pharmacokinetics ofarginine and citrulline and assessed the potential of citrulline to serve as aprecursor for enhancing arginine availability in fetal and maternal plasma. Sixlate pregnant ewes and their fetuses were instrumented to access arterial andvenous circulations. Intravenous boluses of 155 mol of L-arginine-HCl or Lcitrullineper kg body weight were administered to each ewe. Administration ofcitrulline was more effective than arginine in achieving a sustained increase inconcentrations of arginine in maternal and fetal blood. Accordingly, theclearance rate of citrulline was lower and its biological half-life in maternal bloodgreater, when compared with arginine. The second experiment determined ifadministration of arginine to underfed ewes is effective in ameliorating orpreventing IUGR. Ewes were fed either 100% or 50% of the National ResearchCouncil recommended nutrient requirements for pregnant sheep. Between Day60 of pregnancy and parturition control-fed ewes received saline solution and underfed ewes received either saline solution or L-arginine-HCl solution (155mol of arginine/kg body weight) intravenously three times daily (n=5 / treatmentgroup). Birth weights of lambs were lower in saline-infused underfed ewes.There was no difference in birth weights of lambs from control-fed and argininetreatedunderfed ewes. The third experiment determined whether administrationof arginine could improve survival rates of lambs and enhance fetal growth inewes carrying multiple fetuses. Between Days 100 and 121 of pregnancy, ewesreceived an intravenous infusion of either saline solution (n= 14) or L-arginine-HCl solution (345 mol of arginine/kg body weight, n=20) three times daily.Parenteral administration of arginine increased the percentage of lambs bornalive and enhanced the birth weights of quadruplets. Collectively, these resultsindicate that 1) parenteral administration of arginine improves pregnancyoutcomes in underfed and prolific ewes; and 2) the use of arginine or citrullinemay have important implications for the design of an effective treatment forpreventing or ameliorating IUGR in mammals.

Severe acute malnutrition (SAM) threatens the lives of millions of children globally. In developing countries, 15% of the population is undernourished; and half of the mortality for children younger than 5 years old is associated to undernutrition (UNICEF, 2008), the most vulnerable population to malnutrition. Overall, Haiti reports 19.2% of children are undernourished, 11.4% are underweight, and 10.3% are wasted (Lutter et al., 2011; DHS, 2005, CWW-proposal, 2007). The treatment for the management of SAM has evolved over the decades (Lancet, 2006). The Community Management of Acute Malnutrition (CMAM) is an evidence-based intervention with proven effectiveness for treating children with SAM (Collins, 2007). The CMAM intervention reduces infant mortality related to SAM (Lancet, 2006, Collins, 2007; WHO, 2001; UNICEF, 2009). The CMAM intervention was validated in 2007 through the United Nations agencies for the management of SAM. Nevertheless, it has had limited reach and poor public health impact in some of the developing countries (e.g.; Haiti) where it was implemented. Concern Worldwide is a non-profit humanitarian organization, which pioneered in the creation of the CMAM intervention. Concern introduced the CMAM interventions in Haiti in October 2007 as a pilot program. The program was implemented in close to 20 health institutions in the metropolitan Port-au-Prince. As is the case with any other public health program, there were many challenges to the CMAM intervention implementation in Haiti. Concern’s CMAM intervention was not sustainable after it retracted the technical support in 2012 (UNICEF-Haiti country report, 2014). The purpose of this paper is to first review the Concern Worldwide CMAM program implementation in five communes of Port-au-Prince. Then, a suggested plan is outlined for the revitalization of the intervention’s activities and long-term sustainability once revitalized.

Mice (C57BL/6J: B6) exposed to maternal dietary restriction (DR) exhibited fetal growth- restriction and as adults develop symptoms of the metabolic syndrome. We aimed to determine the impact of DR on fetal hepatic gluconeogenic pathway and insulin sensitivity in late gestation. Second, we aimed to determine whether a postweaning diet rich in omega-3 fatty acids would alter the development of glucose intolerance, insulin resistance and obesity in DR male offspring. The reduced rate of fetal glycogen synthesis by DR male offspring and altered hepatic gene expression of enzymes involved in insulin signalling and glucose metabolism suggest abnormal fetal development in response to DR that may contribute to the later development of the metabolic syndrome. The postweaning omega-3 diet improved obesity, glucose intolerance and insulin resistance in both DR and control males. These data suggest that nutrition in pregnancy and postnatal life play important roles in determining life-long metabolic health.

Mice (C57BL/6J: B6) exposed to maternal dietary restriction (DR) exhibited fetal growth- restriction and as adults develop symptoms of the metabolic syndrome. We aimed to determine the impact of DR on fetal hepatic gluconeogenic pathway and insulin sensitivity in late gestation. Second, we aimed to determine whether a postweaning diet rich in omega-3 fatty acids would alter the development of glucose intolerance, insulin resistance and obesity in DR male offspring. The reduced rate of fetal glycogen synthesis by DR male offspring and altered hepatic gene expression of enzymes involved in insulin signalling and glucose metabolism suggest abnormal fetal development in response to DR that may contribute to the later development of the metabolic syndrome. The postweaning omega-3 diet improved obesity, glucose intolerance and insulin resistance in both DR and control males. These data suggest that nutrition in pregnancy and postnatal life play important roles in determining life-long metabolic health.

<p>Mer än 25 % av äldre patienter lider av undernäring under sin sjukhusvistelse. Detta problem har varit känt i ett flertal år. Syftet med studien var att beskriva sjuksköterskors bedömning och hantering av undernutrition hos äldre patienter som vårdas på sjukhus. Metoden som valdes till studien var en kvalitativ enkätstudie och dess svar bearbetades genom en kvalitativ innehållsanalys. Resultaten presenterades i sju olika teman: Den kliniska blicken, Samlad bedömning, Bedömningshjälpmedel, Registrering av kostintag, Psykisk hälsa, Undersköterskans roll och Tidsbrist. Konklusionen är att sjuksköterskor har tillräcklig kunskap och hjälpmedel för att kunna bedöma ett adekvat nutritionsstatus på sina patienter. Det som dock hindrar dem är den ständiga tidsbristen som gör att nutritionsfrågor prioriteras lägre. Undersköterskorna tar ofta på sig ansvaret för nutritionsbedömningen.</p> / <p>In spite of the fact the situation has been well known for several years, more than 25 percent of elderly patients suffer from malnutrition during hospital care. The aim of this study was to describe the nurse's assessment of nutrition status among elderly patients treated in hospital. The chosen method was a qualitative questionnaire and by using a qualitative content analysis, the answers were processed. The results were presented in seven themes; The clinical eye, Resources, Raised assessment, Registration of food intake, Mental health, Assistant nurse´s role and Lack of time. Our conclusion is that nurses have enough knowledge and aid to appraise an adequate nutrition status on their patients, but is prevented by constant lack of time resulting in nutrition questions being lower prioritized. Instead, the assistant nurse takes more responsibility for the nutrition assessment.</p>

Introdução: Alterações no neurodesenvolvimento podem estar associadas à subnutrição. As consequências da subnutrição dependerão da idade da criança, do tipo, duração e grau da subnutrição. As possíveis alterações ocasionadas pela subnutrição são variáveis, porém, dentre essas alterações, a linguagem que é considerada uma das atividades cognitivas humanas mais elaboradas, apresenta grandes riscos. Objetivo: Caracterizar e analisar a linguagem oral e processamento fonológico de crianças que foram diagnosticadas com subnutrição em idade precoce adotando como referencial o desempenho de crianças na mesma faixa etária com bom e mau desempenho de linguagem receptiva e expressiva nas diferentes tarefas de memória de trabalho, consciência fonológica, fonologia e vocabulário. Método: Crianças com histórico de subnutrição em idade precoce (antes dos três anos de idade) e recuperadas nutricionalmente, foram avaliadas quanto à linguagem receptiva e expressiva, seu componente fonológico, vocabulário, consciência fonológica, memória de trabalho fonológica e memória visuo-espacial. Para possibilitar a análise desses componentes nessas crianças e se estabelecer parâmetro de comparação, foi realizada a avaliação de crianças eutróficas (sem histórico de subnutrição) na mesma faixa etária, pelos mesmos testes, e divididas em dois grupos (G1 crianças que apresentavam bom desempenho de linguagem e G2 - crianças que apresentavam mau desempenho de linguagem). O desempenho dos grupos foi comparado utilizando-se para inferência estatística dos resultados os testes t-student e Kruskal-Wallis. Para verificar possíveis associações entre os componentes avaliados foi utilizado o teste Exato de Fisher. Resultados: Nas crianças com histórico de subnutrição, observou-se que a criança que apresentou o quadro de subnutrição com menor idade, maior tempo de duração do diagnóstico e pior grau apresentou mau desempenho de linguagem e pior desempenho em todas as provas avaliadas no estudo quando comparada aos dois grupos de crianças eutróficas. Esse resultado sugere que essas variáveis (idade, duração e tipo) da subnutrição podem ser determinantes para os efeitos sobre a linguagem e processamento fonológico. As demais crianças que apresentaram variações na idade, duração e tipo de subnutrição assemelharam-se em algumas provas ao grupo G1 e em outras com o G2. Esse resultado reforça a suposição de que essas variáveis levam a diferentes prejuízos em linguagem e/ou processamento fonológico. Em relação à comparação de desempenho entre G1 e G2, os grupos apresentaram diferença significativa nas provas de memória de trabalho, tanto a fonológica quanto a visuo-espacial, não houve diferença para consciência fonológica. Os resultados não apontaram a existência de associação entre desempenho de linguagem, alteração fonológica e de vocabulário. Conclusões: Este estudo sugere que crianças que tiveram subnutrição no período crítico do desenvolvimento cerebral, mesmo após recuperação nutricional, apresentaram alterações cognitivas duradouras e importantes. / Introduction: Changes in the neurodevelopmental process may be related to undernutrition condition. The consequences of undernutrition appear to be dependent of childrens age, type, duration and degree of undernutrition. Undernutrition related alterations are diversified and the language that is considered to be one of the most relevant human cognitive skills may represent important risks. Objective: The aim of this study was to characterize and analyze the oral language and phonological processing of children diagnosed with undernutrition at early age using as standard of comparison the childrens performance in the same range age. Methods: Children presenting undernutrition at early age (diagnosed before reaching 3 years of age) with nutritional recovery were enrolled in this study and assessed for receptive and emissive language, phonology, vocabulary, phonological awareness, visuospatial and phonological working memories. Data obtained from these children were correlated with results collected from eutrophic children in the same range of age without undernutrition condition which were randomly divided in 2 groups (G1- children without language deficit and G2 children with language deficit) and submitted to the same tests. Data obtained from each group were averaged and compared using t-student and Kruskal-Wallis. Possible association between different language components was assessed by Fishers Exact tests. Results: In the children diagnosed with udernutrition, the infant with the highest level of disease (detected with the lower age and with the high long duration) shows significant language deficit and lower performance in all of the applied tests when compared with G1 and G2. This result suggests that age and duration and type of undernutrition may be determinant on the effects of language and phonological awareness. No significant differences were found between groups concerning phonological awareness. No association was found between language deficit and changes in phonology or vocabulary. Conclusions: Data obtained from this study suggest that children diagnosed with undernutrion during the critical period of brain development may present relevant and long-lasting cognitive alterations, even after nutritional recovering. In addition, data suggest that low performance may compromise working memories phonological and visuospatial.

This diploma thesis deals with the topic of malnutrition, its causes and prevention. The aim of this thesis is to find out, wheter the respondetns of the questionnaire survey prevent by their habits the development of malnutrition. The number of participants of this survey is 347 in productive age, women are 212 and men are 135. In the theoretical part of this thesis, there is a desription of the importance of nutritents (macronutrients and micronutrients), there are also desription od nutrition intake disorder and their causes (health, psychical, social, lifestyle factors) and prevention, especially nutritional recommendations. The practical part of this thesis analyzes data obtained by the survey using quantitative method. The questionnare is devided into three parts: anthropometric, factors of life-style, factors of health status. Based on the results of analysis of questionare, it was found that most of the respondents neither men nor women do prevent the development of malnutrtion by behavioral habits, women are better in terms of lifestyle factors. Key words Nutrition, malnutrition, obesity, undernutrition, prevention