Bibliografias temáticas / Older people Nutrition

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Literatura científica selecionada sobre o tema "Older people Nutrition"

Autor: Grafiati
Publicado: 4 de junho de 2021
Última modificação: 31 de julho de 2024

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Artigos de revistas sobre o assunto "Older people Nutrition"

1

Gandy, J. "Nutrition in older people". Journal of Human Nutrition and Dietetics 22, n.º 6 (dezembro de 2009): 491–92. http://dx.doi.org/10.1111/j.1365-277x.2009.01014.x.

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Wynne, Amanda. "Nutrition in older people". Nutrition & Food Science 99, n.º 5 (outubro de 1999): 219–24. http://dx.doi.org/10.1108/00346659910277641.

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Murray, Carla. "Improving nutrition for older people". Nursing Older People 18, n.º 6 (1 de julho de 2006): 18–22. http://dx.doi.org/10.7748/nop.18.6.18.s11.

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Clegg, Miriam E., e Elizabeth A. Williams. "Optimizing nutrition in older people". Maturitas 112 (junho de 2018): 34–38. http://dx.doi.org/10.1016/j.maturitas.2018.04.001.

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Kokura, Yoji, e Ryo Momosaki. "Rehabilitation Nutrition in Older People". Nutrients 15, n.º 8 (14 de abril de 2023): 1893. http://dx.doi.org/10.3390/nu15081893.

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McElnay, Caroline, Bob Marshall, Jessica O’Sullivan, Lisa Jones, Tracy Ashworth, Karen Hicks e Rachel Forrest. "Nutritional risk amongst community-living Maori and non-Maori older people in Hawke’s Bay". Journal of Primary Health Care 4, n.º 4 (2012): 299. http://dx.doi.org/10.1071/hc12299.

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INTRODUCTION: Maintaining good nutrition is vital for healthy ageing. Poor nutrition increases the risk of hospitalisation, disability and mortality. Research shows clinical malnutrition is preceded by a state of nutritional risk and screening can identify older people at risk of poor nutrition or who currently have impaired nutritional status. AIM: To assess the population prevalence of nutritional risk amongst community-living Maori and non-Maori older people in Hawke’s Bay. METHODS: A postal survey of 1268 people aged 65 years or older on the electoral roll for Hawke’s Bay was conducted. Nutritional risk was measured using the SCREEN II questionnaire. RESULTS: Responses from 473 people were received (43.8% male, 49.9% female, 6.3% unspecified) with an estimated average age of 74 years. Nutritional risk was present amongst 56.5% of older people with 23.7% at risk and 32.8% at high risk. Maori were 5.2 times more likely to be at nutritional risk than non-Maori. Older people living alone were 3.5 times more likely to be at nutritional risk than those living with others. The most frequent risk factors were low milk-product intake, perception of own weight being more or less than it should be, and low meat and alternatives intake. Skipping meals and low fruit and vegetable intake were additional frequent risk factors for Maori. DISCUSSION: Both living situation and ethnicity are associated with nutritional risk. Further investigation is needed to confirm these findings and to determine issues specific for older Maori, including barriers to good nutrition and opportunities for nutritional improvement. KEYWORDS: Maori; nutritional status; older people
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Leslie, W. S. "Improving the dietary intake of frail older people". Proceedings of the Nutrition Society 70, n.º 2 (24 de fevereiro de 2011): 263–67. http://dx.doi.org/10.1017/s0029665111000036.

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As a population subgroup, older people are more vulnerable to malnutrition especially those who are institutionalised. Recognition of deteriorating or poor nutritional status is key in reversing the effects of undernutrition and reinforces the value of regular weight checks and/or the use of screening tools. Commercially produced supplements are often the first option used to address undernutrition in both acute and community settings. They can be expensive and, although regularly prescribed, have undergone only limited evaluation of their effectiveness in community settings. An alternative but less researched approach to improve the nutritional status of undernourished people is food fortification. This approach may be particularly useful for older people, given their often small appetites. The ability to eat independently has been significantly related to decreased risk of undernutrition. Assisting people who have difficulty feeding themselves independently should become a designated duty and may be crucial in optimising nutritional status. Lack of nutrition knowledge has been identified as the greatest barrier to the provision of good nutritional care. Education and training of care staff are pivotal for the success of any intervention to address undernutrition. The development of undernutrition is a multi-factorial process and a package of approaches may be required to prevent or treat undernutrition. Nutrition must be at the forefront of care if national care standards are to be met.
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Fatmah, Fatmah, Suyud Warno Utomo e Fatma Lestari. "Broccoli-Soybean-Mangrove Food Bar as an Emergency Food for Older People during Natural Disaster". International Journal of Environmental Research and Public Health 18, n.º 7 (1 de abril de 2021): 3686. http://dx.doi.org/10.3390/ijerph18073686.

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Older people risk poor nutritional status during natural disasters due to low intakes of energy, carbohydrates, protein, and fat. A food bar is a form of emergency food product that contains carbohydrate and protein, and is practical for disaster situations. The study aimed to investigate the effect of a broccoli-soybean-mangrove food bar on older people’s weight following natural disasters. A quasi-experimental pre-post intervention study was designed using 33 subjects at the treatment group of various nutritional status types of older people during two weeks with balanced nutrition education over two weeks. Bivariate analysis with a paired t-test used to test whether weight, macronutrient intakes, and balanced nutrition knowledge were significantly different before and after the study. The study showed broccoli-soybean-mangrove food bar consumption resulted in a significantly increased weight of 0.2 kg, energy (291.9 kcal), protein (6.1 g), carbohydrate (31.1 g), dan fat (15.6 g) intakes. Balanced nutrition education of older people could also substantially increase knowledge of older people regarding nutrition (11.8 points). The proportion of malnourished subjects who gained weight was more remarkable than normal subjects in the first and second weeks of the intervention. However, the proportion of normal nutritional status subjects having increased macronutrients intakes was higher than the malnourished subjects. These findings recommend broccoli-soybean-mangrove food bar consumption to significantly improve weight and macronutrients intakes in older people following a natural disaster. It is necessary to make the broccoli-soybean-mangrove food bar more available, accessible, and affordable to all people in emergencies, mainly for older people.
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Cole, Delwyn. "Optimising nutrition for older people with dementia". Nursing Standard 26, n.º 20 (18 de janeiro de 2012): 41–48. http://dx.doi.org/10.7748/ns2012.01.26.20.41.c8883.

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Watson, Roger. "Editorial: Nutrition and older people with dementia". Journal of Clinical Nursing 20, n.º 3-4 (11 de janeiro de 2011): 303–4. http://dx.doi.org/10.1111/j.1365-2702.2010.03268.x.

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Teses / dissertações sobre o assunto "Older people Nutrition"

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Lin, Jou-Chia. "The nutritional effects of the Elderly Nutrition Program: Title III-C for the Menomonie congregate-site meal program participants". Online version, 1999. http://www.uwstout.edu/lib/thesis/1999/1999lin.pdf.

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Roth, Ruth A. "Differences in nutrition knowledge of the elderly according to nutrition risk levels, levels of education, age and gender". Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/941354.

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The purpose of the study was to examine nutrition knowledge of elderly congregate meal site participants with particular interest directed towards nutrition risk levels and the demographic characteristics of education, age, and gender. The population utilized in this study were 120 elderly, both male and female, over the age of 60 years who attended ten congregate meal sites in Allen County, Indiana and who volunteered to participate. The researcher administered a 25 question nutrition knowledge survey and the 10 question Determine Your Nutritional Health Checklist at the meal sites. The study was designed to determine if there was a significant difference in nutrition knowledge among elderly at congregate meal sites who exhibit varying nutrition risk, education, and age levels and between elderly men and women. The conclusion was that there was a significant difference between nutrition knowledge of men and women with women scoring more correct answers on the survey. Although not shown statistically other preliminary findings suggest the need for further research; a greater proportion of females than males were in the lowest nutrition risk level; the 60-74 years olds had a higher nutrition knowledge average score than did the two older groups. Further, those with 9-11 years of education and in the lowest nutrition risk level (all females) had the highest nutrition knowledge score; and males with less than eight years of education had the lowest nutrition knowledge score and a preponderance of those were in the moderate or high risk level. The researcher also concluded that more nutrition education is needed for these participants, but it must be geared to their learning level to be effective.
Department of Family and Consumer Sciences
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Jia, Xueli. "Nutrition, survival, and cognitive decline in older people". Thesis, University of Aberdeen, 2007. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=186836.

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L'Italien, Matthew R. "Longitudinal Nutrition Risk Assessment of the Elderly". Fogler Library, University of Maine, 2004. http://www.library.umaine.edu/theses/pdf/LItalienMR2004.pdf.

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Shapiro, Sheryl Lynn 1961. "NUTRITION AND HEALTH PRACTICES: A STUDY OF HOW SOURCES OF NUTRITIONAL INFORMATION, NUTRITIONAL KNOWLEDGE, HEALTH LOCUS OF CONTROL, AND MOTIVATING FACTORS TOWARD PREVENTIVE HEALTH CONTRIBUTE TO THE ADEQUACY OF THE HEALTHY ELDERLY DIET". Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/291265.

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Yeh, Mei-Chun Patty. "Nutrition knowledge, health benefits and use of nutrition suppliements among older adults in Northwestern Wisconsin". Online version, 2000. http://www.uwstout.edu/lib/thesis/2000/2000yehm.pdf.

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Rozario, Suzanna R. "Evaluation of Nutrition Risk and Body Mass Index in Maine Seniors". Fogler Library, University of Maine, 2006. http://www.library.umaine.edu/theses/pdf/RozarioSR2006.pdf.

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Barake, Roula. "Correlates and consequences of vitamin D status in older people". Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86736.

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It is well established that vitamin D contributes to bone health. New evidence from cross-sectional and prospective cohort studies and a few clinical trials suggest that vitamin D status may play a role in functional capacity declining with age; however, there are some gaps in these studies yet to be examined. Little is known about vitamin D status in healthy, free-living, older people in North America. Older individuals may be more vulnerable due to low vitamin D intake and limited endogenous synthesis. Thus, the objectives of this thesis were to (i) determine the distribution of serum 25 hydroxy vitamin D [25(OH)D] concentrations in healthy older people living in Québec and determine how season, age, sex and supplement consumption affect this distribution; (ii) determine to what extent vitamin D intake from foods, supplements and proxy measure of sunlight exposure explain the variation in serum 25(OH)D concentrations, controlling for the effects of age and sex; and determine the dietary predictors of optimal concentration of 25(OH)D; and (iii) examine whether vitamin D status can predict change in functional decline capacity over 1 and 2 years, controlling for season and other potential confounders. Data for this study have been obtained from a random sampling of 405 participants from the NuAge cohort study of 1793 independently-living men and women aged 68 to 82 years at baseline. The NuAge sample is a stratified sample of participants in three age categories 70 ± 2 years, 75 ± 2 years and 80 ± 2 years with approximately equivalent numbers of men and women in each group. For objective (i), a cross-sectional design was applied. Serum 25(OH)D was assessed using radioimmunoassay. Data were analyzed controlling for age, sex, season and other potential confounders. For objective (ii), six 24-hour recalls were obtained for the same subjects as the first study also in a cross-sectional design. In addition to nutrient intake, foods were grouped into 6 food group
Il est bien établi que la vitamine D contribue à la santé osseuse. Des données récentes d'études transversales, de cohortes prospectives et d'essais cliniques suggèrent que la vitamine D pourrait jouer un rôle dans la diminution des capacités fonctionnelles avec l'âge; toutefois, certaines lacunes de ces études n'ont toujours pas été étudiées. On sait peu de choses au sujet des niveaux de vitamine D chez les personnes âgées autonomes, en bonne santé, vivant en Amérique du Nord. Ces personnes peuvent être plus vulnérables aux carences d'une part à cause d'un faible apport en vitamine D et, d'autre part, à cause d'une synthèse endogène limitée. Ainsi, les objectifs de cette thèse étaient de (i) déterminer la distribution des concentrations sériques de 25 hydroxy vitamine D [25 (OH) D] chez les personnes âgées en bonne santé, vivant au Québec et de déterminer comment la saison, l'âge, le sexe et la consommation de suppléments affectent cette distribution; (ii) de déterminer dans quelle mesure l'apport alimentaire de vitamine D, l'apport de suppléments et la saison peuvent expliquer les variations des concentrations sériques de 25 (OH) D, en contrôlant pour les effets de l'âge et du sexe, ainsi que de déterminer l'apport alimentaire idéal de vitamine D pour obtenir un niveau optimal de 25 (OH) D; et, finalement (iii) d'évaluer l'effet de l'état nutritionnel en vitamine D sur la diminution des capacités fonctionnelles pendant 1 et 2 ans, tout en prenant en compte la saison et d'autres variables de confusion potentielles. Cette étude repose sur des données obtenues auprès d'un échantillon aléatoire de 405 participants de l'étude de cohorte NuAge, composée de 1793 hommes et femmes âgés entre 68 et 82 ans au départ, vivant de façon indépendante. Cet échantillon est stratifié selon trois catégories d'âge: 70 ± 2 ans, 75 ± 2 ans et 80 ± 2 ans, avec des nombres comparables d'hommes et de femmes dans chaque gr
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Burke, Linda Fiona. "Evaluation of a physical activity and nutrition program for older people". Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/790.

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The aim of the program was to develop, implement and evaluate a low cost, accessible, sustainable, replicable physical activity and nutrition program that would ultimately reduce chronic disease. The thesis demonstrates the importance of evaluation pre, during and post intervention. The program was successful, data from the intervention group improved in areas of physical activity, dietary behaviours, and anthropometric measures, in comparison to the control group participants.
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AZZOLINO, DOMENICO. "NUTRITION AND FRAILTY: HOW TO CAPTURE THE COMPLEXITY OF OLDER PEOPLE". Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/886598.

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The older population is characterized by a high clinical complexity. Poor nutritional status is highly prevalent in older people and has been repeatedly evoked as a major contributor to several health-related negative outcomes. The aim of this thesis was to evaluate the contribution of nutrition in some age-related conditions, taking into account the older people’s complexity. Study I. We explored the association between lack of energy and malnutrition in nursing home residents. Lack of energy was highly prevalent in our sample (i.e., 43.2%). We found a significant association between malnutrition and lack of energy, independent of potential confounders. Decrease in food intake, reduced mobility, and psychological stress or acute disease in the past 3 months were identified as the items of the Mini Nutritional Assessment contributing the most to the association between malnutrition and lack of energy. Study II. We investigated the association between unintentional weight loss and mortality in a population of older patients undergoing hemodialysis. Older patients experiencing unintentional weight loss during the follow-up period had a 3.4-fold risk of death independently of comorbidities and other risk factors. Study III. We explored the prevalence of frailty and its association with hospitalization and mortality in a population of older patients undergoing haemodialysis. Study III outlined a high prevalence of frailty (i.e., 55.2%) among older patients undergoing haemodialysis. Frailty was significantly associated with a higher risk of hospitalization and all-cause mortality in our sample. Conclusions. Nutritional status is an aspect frequently overlooked, despite it has been repeatedly evoked as a major determinant of health status in all stages of life. Our findings clearly show the role of nutritional status as a mediator of several health-related conditions in older people. Indeed, given the burden it poses in terms of adverse health outcomes, increased (research) efforts should be paid to nutritional status. A multidimensional and multidisciplinary approach is pivotal for the early identification of people presenting nutritional issues in order to prevent the onset of serious complications.
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Livros sobre o assunto "Older people Nutrition"

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Groom, Hilary. Nutrition in older people. London: British Nutrition Foundation, 1996.

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National Eldercare Institute on Health Promotion (American Association of Retired Persons) e United States. Administration on Aging, eds. Nutrition and older adults. Washington, DC (601 E St., N.W., Washington 20049): National Eldercare Institute on Health Promotion, American Association of Retired Persons, 1993.

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Reber, Alta Mae. Nutrition and aging. 2a ed. Denton, Tex: Center for Studies in Aging, University of North Texas, 1988.

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Keller, Heather. Aging well with nutrition. Waterloo, Ontario?]: [Heather H. Keller?], 2013.

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Swarth, Judith. Seniors and nutrition. Danbury, CT: Grolier Educational, 1988.

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Health Media of America (Firm), ed. Cholesterol and nutrition. Danbury, CT: Grolier Educational Corp., 1988.

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A, Horwitz, e World Health Organization, eds. Nutrition in the elderly. Oxford: Published on behalf of the World Health Organization by Oxford University Press, 1989.

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Books, Prevention Health, ed. Seniors guide to good nutrition. Emmaus, Pa: Rodale Press, 2000.

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Canada, Canada Health, ed. Healthy aging. [Ottawa]: Health Canada, 2002.

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Ronni, Chernoff, ed. Geriatric nutrition: The health professional's handbook. Gaithersburg, Md: Aspen Publishers, 1991.

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Capítulos de livros sobre o assunto "Older people Nutrition"

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Carroll, Mary, L. Jane Brue e Brian Booth. "Nutrition". In Caring for Older People, 130–34. London: Macmillan Education UK, 1993. http://dx.doi.org/10.1007/978-1-349-12879-2_14.

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Bogden, John D., e Donald B. Louria. "Micronutrients and Immunity in Older People". In Preventive Nutrition, 545–65. Totowa, NJ: Humana Press, 2009. http://dx.doi.org/10.1007/978-1-60327-542-2_22.

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Bogden, John D., e Donald B. Louria. "Micronutrients and Immunity in Older People". In Preventive Nutrition, 551–72. Totowa, NJ: Humana Press, 2005. http://dx.doi.org/10.1007/978-1-59259-880-9_22.

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Bogden, John D., e Donald B. Louria. "Micronutrients and Immunity in Older People". In Preventive Nutrition, 317–36. Totowa, NJ: Humana Press, 1997. http://dx.doi.org/10.1007/978-1-4757-6242-6_17.

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Bogden, John D., e Donald B. Louria. "Micronutrients and Immunity in Older People". In Preventive Nutrition, 531–50. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-22431-2_28.

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Kyriazis, Marios. "Healthy Nutrition for Older People". In Healthy Ageing and Longevity, 549–66. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-83017-5_26.

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Eberhardie, Christine. "Nutrition". In Older People and Mental Health Nursing: A Handbook of Care, 135–42. Oxford, UK: Blackwell Publishing Ltd, 2008. http://dx.doi.org/10.1002/9780470692240.ch11.

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Kydd, Angela B. "Nutritional Issues for Older People and Older People with Dementia in Institutional Environments". In Handbook of Behavior, Food and Nutrition, 2885–94. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-0-387-92271-3_180.

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Gariballa, Salah. "Nutrition and Quality of Life in Older People". In Handbook of Behavior, Food and Nutrition, 3099–113. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-0-387-92271-3_192.

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Roigk, Patrick, Fabian Graeb, Ólöf Guðný Geirsdóttir e Jack Bell. "Nutrition and Hydration". In Perspectives in Nursing Management and Care for Older Adults, 171–89. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-33484-9_11.

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AbstractNutrition and hydration are fundamental aspects of healthcare, especially in the care of older people, particularly those in hospitals or in long-term care facilities. Worldwide, nurses are ‘best-placed’ coordinators of interdisciplinary nutritional management and care processes. Even so, it is essential that nurses collaborate with other healthcare specialists as an interdisciplinary team to provide high-quality care that reflects patients’ needs for assessment, intervention, and health promotion. When an interdisciplinary team work collaboratively, care is more successful, improves patient outcomes, and reduces the risk of in-hospital and long-term mortality.The care process begins with screening and monitoring of the nutritional status and fluid intake of all older people within 24 h of admission. In the case of positive screening, comprehensive assessment and involvement of other team members should undertake to understand the underlying problem. Appropriate food and appealing meals, snacks, and drinks should be available and offered with recommended amounts of energy, protein, vitamins, minerals (particularly calcium), and water. This should be complemented with supplementary drinks if intake is not adequate. The prescription of vitamin D and calcium should be discussed.Patient-centred and evidence-based information should provide and interventions in the case of end-of-life care should be appropriate discussed. Educating, informing, and involving patients and families increases their level of health literacy. Malnutrition and/or dehydration management should be included in the discharge plan.The aim of this chapter is to increase awareness of nurses’ responsibility, within a multidisciplinary team, for assessment and intervention of nutrition and hydration, examine the issues pertaining to nutrition and fluid balance in older people and outline the nature, assessment and interventions relating to malnutrition and dehydration.
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Trabalhos de conferências sobre o assunto "Older people Nutrition"

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Bawadi, Hiba, e Zumin Shi. "Protein Intake among Patients with Diabetes is Linked to Poor Glycemic Control". In Qatar University Annual Research Forum & Exhibition. Qatar University Press, 2020. http://dx.doi.org/10.29117/quarfe.2020.0149.

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Background: Nutrition therapy is considered a key component of diabetes management. Highprotein diets are recently gaining more popularity. Knowledge regarding the potential glycemic effect of protein in people with type 2 diabetes has been a particular interest. Methods: This study is a cross-sectional study based on NHANES data collected on participants aged 40 years and older who attended the surveys cohorts of 2011–2012 and 2013–2014. Data on 1058 participants were included in the analysis. Glycemic control was measured as HbA1c level and patients were categorized into quartiles of daily protein intake. Analysis adjusted for age, gender, race and energy intake muscle strength (quartile), sedentary activity, income to poverty ratio, education, smoking, alcohol drinking and BMI. Logistic regression models were produced to investigate the impact of high protein intakes on odds of poor glycemic control (HbA1c ≥ 7). Results: After controlling for muscle strength (quartile), sedentary activity, income to poverty ratio, education, smoking, alcohol drinking and BMI; patients in Quartile 4 for protein intake had 260% increased risk for poor glycemic control as compared to those in quartile 1. These results are limited because the analysis did not consider the source of protein (animal vs plant). Further studies are needed.
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Caragiuli, Manila, Agnese Brunzini, Alessandra Papetti, Michele Germani, Pietro Scendoni e Chiara Mazzoni. "Multidimensional assessment of elderly people’s health for the development of a fall risk index". In 8th International Conference on Human Interaction and Emerging Technologies. AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002791.

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As life expectancy increases, the likelihood of more falls and fall-related hospitalizations increases with a significant impact on the health system. Given the high incidence of falls in healthy elderly people, in order to prevent them, it is necessary to identify predisposing risk factors, analyze the specific needs of the subjects and use a targeted preventive strategy. This paper investigates the influence of multidimensional health parameters on the fall risk of community-dwelling older people, living in inner areas of Marche Region (Italy). Multidimensional data on the global health of each individual has been collected among several health domains (i.e., mobility, psychological, nutritional, cardiological, social). Statistical analysis has been applied for the assessment of the relationship among the defined health variables and the influence on the fall risk. The binary logistical regression analysis has produced a statistical model with good characteristics of fit and good predictability. The following features have been proven to be strong predictors of fall: female (OR for Gender, 5.526; 95% CI, 1.49–20.53), limited range of movement (OR 3.278; 95% CI, 1.01-10.68), diabetes (OR 4.487; 95% CI, 1.02-19.80), previous syncope (OR 7.686; 95% CI, 1.01-58.55), and body mass index (OR 1.176; 95% CI, 1.03-1.35). Future work will allow the development of a fall prediction index to have a framework of the elder’s global health status and to define a personalized intervention strategy for any adverse event prevention.
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Josaphat, A., AM Saldanha, JP Mwanga e A. Simon. "TB or not TB? A spontaneous tubercular enterocutaneous fistula in a severely acutely malnourished child". In MSF Paediatric Days 2022. NYC: MSF-USA, 2022. http://dx.doi.org/10.57740/ttb5-d359.

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INTRODUCTION Tuberculosis (TB) and severe acute malnutrition (SAM) are major health problems in east Democratic Republic Congo (DRC), a setting with persistent armed conflict and population displacement. Diagnosis of TB in children is difficult as symptoms are non-specific and diagnostic sensitivity is low, especially in SAM. CASE DESCRIPTION (Download PDF for photos accompanying this description) A 4-year old girl was referred for a 2-week history of fever, cough, weight loss, and swelling of the limbs and face. On examination she was febrile and tachycardic, with pedal edema up to the knee, facial puffiness, and bilateral crepitations on auscultation. She lived in an overcrowded camp for internally displaced people. Her older brother had similar symptoms and neighbours had recently started TB treatment. She was admitted with a working diagnosis of SAM-Kwashiorkor type, acute pneumonia, and suspicion of TB. At day 5, her fevers continued despite IV broad-spectrum antibiotics. Chest x-ray was insignificant. Sputum microscopy and GeneXpert on gastric aspirate were both negative for TB. She developed abdominal distension and a spontaneous fistula at the umbilicus (photo), discharging milky fluid that was thought to be digested nutritional milk. Anti-tuberculosis treatment was started based on strong clinical suspicion of extra-pulmonary TB (EPTB). Within 2 weeks she improved clinically and nutritionally, the fistula spontaneously closed eliminating the need for surgery, and she could be discharged. DISCUSSION This case highlights the difficulties of diagnosing EPTB in children with SAM. Diagnosis relies heavily on clinical suspicion and epidemiological information. Negative sputum microscopy and GeneXpert gastric aspirate analysis do not rule out TB. Early initiation of treatment is the most important factor affecting mortality, thus empirically starting treatment should be considered. Spontaneous enterocutaneous fistulas caused by TB are rare, and there is limited literature describing their presentation or treatment. In our case, an empiric conservative treatment approach was very successful and even eliminated the need for surgery.
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Enriched food and snacks can increase nutritional intake in older people in hospital. National Institute for Health Research, março de 2018. http://dx.doi.org/10.3310/signal-00573.

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