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Item Campylobacter colonization and undernutrition in infants in rural eastern Ethiopia - a longitudinal community-based birth cohort study.(Frontiers Media S.A., 2025-01-07) Chen D; McKune SL; Yang Y; Usmane IA; Ahmed IA; Amin JK; Ibrahim AM; Seran AJ; Shaik N; Ojeda A; Hassen BM; Deblais L; Ahmedo BU; Hassen KA; Bhrane M; Li X; Singh N; Roba KT; French NP; Rajashekara G; Manary MJ; Hassen JY; Havelaar AH; CAGED Research TeamBackground: Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a linchpin between livestock fecal exposure and health outcomes in low-resource smallholder settings. Methods: We followed a birth cohort of 106 infants in rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed sociodemographic determinants, and collected stool and urine samples. A short survey was conducted during monthly visits, infant stool samples were collected, and Campylobacter spp. was quantified using genus-specific qPCR. In month 13, we collected stool and urine samples to assay for EED biomarkers. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering. Results: The Campylobacter load in infant stools increased with age. The mean length-for-age Z-score (LAZ) decreased from −0.45 at 3–4 months of age to −2.06 at 13 months, while the prevalence of stunting increased from 3 to 51%. The prevalence of EED at 13 months of age was 56%. A higher Campylobacter load was associated with more frequent diarrhea. Prelacteal feeding significantly increased Campylobacter load in the first month of life. Over the whole follow-up period, Campylobacter load was increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers’ handwashing with soap. Longitudinally, Campylobacter load was positively associated with food insecurity, introduction of complementary foods, and raw milk consumption. There were no significant associations between Campylobacter load, EED, and LAZ. Conclusion: This study found that most determinants associated with increased Campylobacter infection were related to suboptimal feeding practices and hygiene. The findings related to livestock-associated risks were inconclusive. Although stunting, EED, and Campylobacter prevalence rates all increased to high levels by the end of the first year of life, no significant association between them was identified. While additional research is needed to investigate whether findings from this study are replicable in other populations, community efforts to improve infant and young child feeding practices and food hygiene, and water, sanitation, and hygiene (WaSH) at the household level, could reduce (cross-)contamination at the point of exposure.Item Loss of body weight and lean mass in long-stay, hospitalized canine patients(Wiley‐VCH GmbH, 2023-11-01) Leung YB; Cave N; Wester TJA high prevalence of malnutrition occurs in human hospitals and has been associated with detrimental consequences. By comparison, much less is known in hospitalized veterinary patients. The aims of this study were to evaluate the prevalence of malnutrition and body composition changes in long-stay hospitalised patients using an isotopic dilution technique. An additional objective was to compare the changes in composition with commonly used methods measuring body fat and lean mass. The dogs consumed on average 77.5% of their estimated resting energy requirements during their stay. The majority (78.3%) of dogs lost body weight, of which a greater proportion was lean mass (61.8%) than fat mass (FM) (38.2%). There was a moderate correlation between body condition score and percentage FM measured at admission (Kendall's τ = 0.51; p = 0.002), and at discharge (Kendall's τ = 0.55; p = 0.001). However, there was no correlation between muscle condition score and fat-free mass at either admission or discharge (p > 0.1). Duration of stay was positively associated with loss of body weight (p < 0.001), but was not associated with changes in either lean or FM expressed as a percentage of body weight or in absolute terms (p > 0.1), which was presumed to be explained by small sample size and variation. Food intake was not found to a significant factor for lean or FM loss (p > 0.1). These findings indicate that weight loss is common in hospitalized canine patients, which is not explained by simple under-eating. Other factors such as inflammation and inactivity should be evaluated in future studies to determine their role in influencing muscle and FM changes in hospitalized canine patients.Item The nutritional status of long-term Home Enteral Nutrition (HEN) patients of Te Whatu Ora Counties Manukau : a focus on energy, macronutrients, vitamin D, and selenium : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2024) Soljan, EmmaBackground: Good nutritional status is important for well-being and reduced morbidity and mortality risk and pressure on healthcare systems. Despite being under the care of dietitians, home enteral nutrition (HEN) patients may be at risk of malnutrition and macro- and micronutrient deficiencies. It is important to understand the nutritional status of these patients to recommend appropriate feeding and nutrient monitoring practices. Aim: To investigate the nutritional status (energy, macronutrients, vitamin D, selenium) of long-term home enteral nutrition (HEN) patients in Counties Manukau, New Zealand to determine the prevalence of malnutrition. Methods: Data were collected from 42 long-term (≥4 weeks) HEN patients (18+ years) under the care of Te Whatu Ora Counties Manukau. Enteral and oral intake were collected through 5 x 24-hour recalls and compared against patients’ prescriptions and estimated requirements (energy, macronutrients, vitamin D, selenium). Clinical signs of deficiency were assessed with a physical assessment (n=40), and nutritional biomarkers from a blood sample (n=22). Body composition was measured with bioelectrical impedance analysis (BIA) (n=29). Malnutrition prevalence was determined by the Global Initiative on Malnutrition (GLIM) criteria. Data were described by mean ± SD, geometric mean (95% confidence intervals), median (interquartile range), and frequencies. Independent t-tests, Mann-Whitney, and Chi-square tests were used to compare data by feeding route and prescription adherence. Results: Malnutrition prevalence was 62.5% (n=25). Prevalence of low BMI and fat free mass index (FFMI) was 47.5% and 44.8% respectively. Mean body mass index (BMI) (21.1 ± 3.6 kg/m²) was low but normal. Fat and/or muscle wasting occurred in at least 35%. Energy and/or protein intake was inadequate in 20% (n=8). Mean plasma vitamin D (143.55 ± 55.35 nmol/L) and selenium (1.37 ± 0.19 µmol/L) were within range with no evidence of deficiency, serum/plasma concentrations were high in 40% and 38.1% respectively. Mean vitamin D intake (13.2 ± 5.3 µg) was low in 26.2% (n=11) but met requirements for all age groups except ≥70 years. Mean selenium intake (95.0 ± 28.1 µg) was low in 7.1% (n=3) but met requirements for all. There were significant differences in nutritional status measures by feeding route and/or prescription adherence. Conclusions: Many HEN patients had poor energy and protein status but maintained good vitamin D and selenium status. Adjustments to feeding practices regarding energy and protein, and more frequent monitoring of malnutrition may be beneficial for prevention of morbidity and mortality.Item Unravelling the reservoirs for colonisation of infants with Campylobacter spp. in rural Ethiopia: protocol for a longitudinal study during a global pandemic and political tensions.(BMJ Publishing Group Ltd, 2022-10-05) Havelaar AH; Brhane M; Ahmed IA; Kedir J; Chen D; Deblais L; French N; Gebreyes WA; Hassen JY; Li X; Manary MJ; Mekuria Z; Ibrahim AM; Mummed B; Ojeda A; Rajashekara G; Roba KT; Saleem C; Singh N; Usmane IA; Yang Y; Yimer G; McKune SINTRODUCTION: Undernutrition is an underlying cause of mortality in children under five (CU5) years of age. Animal-source foods have been shown to decrease malnutrition in CU5. Livestock are important reservoirs for Campylobacter bacteria, which are recognised as risk factors for child malnutrition. Increasing livestock production may be beneficial for improving nutrition of children but these benefits may be negated by increased exposure to Campylobacter and research is needed to evaluate the complex pathways of Campylobacter exposure and infection applicable to low-income and middle-income countries. We aim to identify reservoirs of infection with Campylobacter spp. of infants in rural Eastern Ethiopia and evaluate interactions with child health (environmental enteric dysfunction and stunting) in the context of their sociodemographic environment. METHODS AND ANALYSIS: This longitudinal study involves 115 infants who are followed from birth to 12 months of age and are selected randomly from 10 kebeles of Haramaya woreda, East Hararghe zone, Oromia region, Ethiopia. Questionnaire-based information is obtained on demographics, livelihoods, wealth, health, nutrition and women empowerment; animal ownership/management and diseases; and water, sanitation and hygiene. Faecal samples are collected from infants, mothers, siblings and livestock, drinking water and soil. These samples are analysed by a range of phenotypic and genotypic microbiological methods to characterise the genetic structure of the Campylobacter population in each of these reservoirs, which will support inference about the main sources of exposure for infants. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Florida Internal Review Board (IRB201903141), the Haramaya University Institutional Health Research Ethics Committee (COHMS/1010/3796/20) and the Ethiopia National Research Ethics Review Committee (SM/14.1/1059/20). Written informed consent is obtained from all participating households. Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals and through the Feed the Future Innovation Lab for Livestock Systems.Item Sarcopenia Prevalence and Risk Factors among Residents in Aged Care(MDPI (Basel, Switzerland), 2022-05-01) Darroch P; O'Brien WJ; Mazahery H; Wham CThe aim of this study was to investigate the prevalence of sarcopenia and associated risk factors among older adults living in three residential aged care (RAC) facilities within Auckland, New Zealand. A total of 91 older adults (63% women, mean age ± SD; 86.0 ± 8.3 years) were recruited. Using the European Working Group on Sarcopenia in Older People criteria, sarcopenia was diagnosed from the assessment of: appendicular skeletal muscle mass/height2, using an InBody S10 body composition analyser and a SECA portable stadiometer or ulna length to estimate standing height; grip strength using a JAMAR handheld dynamometer; and physical performance with a 2.4-m gait speed test. Malnutrition risk was assessed using the Mini Nutrition Assessment–Short Form (MNA-SF). Most (83%) of residents were malnourished or at risk of malnutrition, and 41% were sarcopenic. Multivariate regression analysis showed lower body mass index (Odds Ratio (OR) = 1.4, 95% CI: 1.1, 1.7, ρ = 0.003) and lower MNA-SF score (OR = 1.6, 95% CI: 1.0, 2.4, ρ = 0.047) were predictive of sarcopenia after controlling for age, level of care, depression, and number of medications. Findings highlight the need for regular malnutrition screening in RAC to prevent the development of sarcopenia, where low weight or unintentional weight loss should prompt sarcopenia screening and assessment.Item Tackling malnutrition with a new compact oral nutrient supplement among residents in aged care: a pilot study(CSIRO Publishing, 2022) O'Brien WJ; Jellicoe J; Mazahery H; Wham CIntroduction: There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim: To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods: Residents (n = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April–June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results: Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion: Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation.Item Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018(MDPI (Basel, Switzerland), 2022-05-26) Wham C; Curnow J; Towers AThis study aimed to determine four-year outcomes of community-living older adults identified at 'nutrition risk' in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49-87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.Item Is the Utility of the GLIM Criteria Used to Diagnose Malnutrition Suitable for Bicultural Populations? Findings from Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ)(Springer Nature, 2023-01) MacDonell SO; Moyes SA; Teh R; Dyall L; Kerse N; Wham CObjectives To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age. Design A longitudinal cohort study. Setting Bay of Plenty and Lakes regions of New Zealand. Participants 255 Māori; 400 non-Māori octogenarians. Measurements All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. Results 56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. Conclusion Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework.Item Frailty, nutrition & healthy ageing : evaluating nutrition risk in support of healthy ageing : the enrich study towards enriching life in older age : thesis submitted in partial fulfilment of the requirements of Doctor of Philosophy in Nutritional Sciences, Massey University, New Zealand(Massey University, 2020) Chatindiara, IdahBackground: New Zealand is one of the countries experiencing a significant change in the population pyramid, characterised by an increase in the number of older adults (≥65 years old) compared to younger age groups. Worldwide, increases in the number of older adults is associated with increases in national health costs, and currently nearly half (42%) of the New Zealand’s district health board expenses are being used for support services of older adults. This begs the question whether healthy ageing is being attained; and which strategies can be employed to prevent health loss with advancing age. The evidenced based literature presents an undebatable association between malnutrition (undernutrition) and adverse health outcomes among older adults, which calls for research to identify ways to prevent malnutrition. Aim and objectives: The overarching aim of this research was to obtain evidence-based data that will help inform policy and practice on the importance of routine screening for malnutrition (risk); and to inform intervention planning towards preventing malnutrition and associated adverse health outcomes among older adults. After identifying research gaps in New Zealand, specific objectives of this thesis were 1) To investigate the associations between malnutrition risk status, body composition and physical performance among community-dwelling older New Zealanders – [study 1]; 2) To investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission – [study 2]. 3) To report the overlapping prevalence of malnutrition and frailty at admission to Residential Aged Care (RAC), and to evaluate the prevalence and factors associated with malnutrition and frailty – [study 3]. 4) To explore older adults’ perspectives and experiences of food and nutrition intake, to gain new insights to factors that influence vulnerability to malnutrition risk– [study 4]. The findings of the four studies were then synthesised to inform recommended intervention strategies to prevent malnutrition with advancing age [discussion]. Methods: This research used a mixed methodology design including three cross-sectional quantitative studies and one qualitative. The three quantitative studies involved assessment of malnutrition status using the Mini Nutritional Assessment Short Form (MNA®SF) and several potential risk factors (Assessment procedure) for malnutrition including body composition (Bio-impedance analysis scale), upper body muscle strength (Hand grip strength), lower body muscle strength and mobility (Five times sit to stand test and Gait speed), Frailty status (Fried phenotype model), dental status (Dentate, non-dentate or use of dental appliances), dysphagia risk (Eating Assessment Tool EAT-10) and cognitive status (Montreal cognitive assessment tool). In the comprehensive qualitative study, an in-depth interview lasting about an hour per participant was conducted. The in-depth interviews were recorded and transcribed verbatim. Thematic content analysis of the transcripts was conducted using the integrated approach. Results: We found the prevalence of malnutrition and malnutrition risk respectively of 1% and 11% in the community, 26.9% and 46.6% at admission to the hospital, and 48% and 45% at admission to RAC. Nearly half (43%) of the participants were both frail and malnourished at admission to RAC. From the quantitative work [studies 1-3], the key predictors or risk factors identified for malnutrition were related to physiological frailty –Fried phenotype model, low muscle strength, muscle mass, gait speed, dysphagia risk, and psychological frailty – low cognition. From the qualitative work [study 4], thematic analysis of the participants’ perspectives and experiences of food intake identified six main themes which contribute to understanding the increasing vulnerability to malnutrition with advancing age. A synthesis of the six themes indicated that the key factors that potentially increase risk of malnutrition encompasses all the three dimensions of frailty i.e. physiological – low appetite, comorbidities imposing food restrictions and physical challenges restraining food procurement, preparation or eating; psychological & social frailty – loneliness, living alone, carer stress and symptoms of depression, which altogether promote low food intake. Conclusion: The central thesis of this research indicates malnutrition risk is highly prevalent across New Zealand settings, and may be prevented or treated through timely screening and person-centred interventions. Although a lower prevalence of malnutrition is recorded in the community, the quantitative data collected across settings provide evidence that the risk of malnutrition starts in the community, and early intervention is paramount in institutions as several older people enter hospital and RAC when already malnourished or at risk. Analysis of the qualitative data collected from older adults provided unique perspectives on factors that shape older New Zealanders eating habits. These support international recommendations for researchers to pay attention to older adults’ perspectives towards designing appropriate interventions. Overall, the thesis findings indicate that policy and practice interventions should be aimed at preventing or reducing the prevalence of all three dimensions of frailty, in order to attain both optimal nutrition intake and healthy ageing. Mandatory screening for malnutrition (targeted in the community and routinely in institutions) is the first step to ensure timely intervention.Item Nutrition risk in age-related residential care : prevalence and associated factors in adults of advanced age : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2017) Senior, Stacey MarieBackground: The New Zealand population is rapidly ageing. Adults of advanced age (≥85 years) are one of the fastest growing population groups with numbers expected to double by 2036. Increasing longevity is associated with reduced mobility, health loss, cognitive decline, and nutritional vulnerability. This often results in increased care requirements and movement into age-related residential care (ARRC). Overseas research indicates an increased prevalence of malnutrition in ARRC residents. Malnutrition in older adults is associated with increased morbidity and mortality, and consequently increased cost of health care. This study aims to establish the prevalence of nutrition risk and associated factors among adults of advanced age recently admitted to ARRC within the Waitemata District Health Board (WDHB) region of Auckland, New Zealand. Methods: A total of 97 participants aged ≥85 years were recruited within five days of admission to WDHB ARRC facilities. Sociodemographic and health characteristics of participants were determined during a single 60-minute interview. Standardised measures were used to measure body composition, grip strength and gait speed. Nutrition risk was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), dysphagia risk using the 10-Item Eating Assessment Tool (EAT-10) and cognitive status using the Montreal Cognitive Assessment (MoCA). Results: Of the 97 participants (mean age 90.9 ± 3.8 years), half (50.5%) were malnourished, 40.2% at nutrition risk and a third (37.1%) were at dysphagia risk. Malnourished participants were more likely to be ≥90 years (p = 0.019), admitted to ARRC on a permanent basis (p = 0.016), at dysphagia risk (p = 0.015), have a BMI <23 (p = 0.022), lower fat mass (p = 0.005), and fewer comorbidities (p = 0.030). The MNA-SF score was inversely correlated with age (r = -0.225, p = 0.027) and positively correlated with BMI (r = 0.499, p = <0.001) and fat mass (r = 0.765, p = <0.001). Conclusion: A high prevalence of malnutrition and dysphagia risk was discovered within this study population. Residents aged ≥90 years with low BMI are at greatest nutrition risk and are an easily identifiable group. Early screening and intervention is recommended upon admission to ARRC. Key words: Aged, anthropometric measures, deglutition disorders, malnutrition, mini nutritional assessment, rest home