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  1. Article ; Online: The Value of an Ecological Approach to Improve the Precision of Nutritional Assessment: Addressing Contributors and Implications of the "Multiple Burdens of Malnutrition".

    Raiten, Daniel J / Steiber, Alison L / Dary, Omar / Bremer, Andrew A

    Nutrients

    2024  Volume 16, Issue 3

    Abstract: Globally, children are exposed to multiple health risks associated with diet and nutrition. Rather than simply being a condition of having too much or too little food, malnutrition is more a syndrome comprising multiple burdens of coexisting and ... ...

    Abstract Globally, children are exposed to multiple health risks associated with diet and nutrition. Rather than simply being a condition of having too much or too little food, malnutrition is more a syndrome comprising multiple burdens of coexisting and reciprocal malnutrition, infection, or other conditions. Importantly, children with such syndromes (e.g., stunting and anemia, which are neither specific nor necessarily sensitive to nutritional status) are more likely to also have irreversible functional outcomes such as poor growth, impaired immune function, or cognitive delays. The global health community has identified nutrition-related targets (e.g., Sustainable Development Goals (SDGs) and World Health Organization (WHO) Global Nutrition Targets) that, for multiple reasons, are difficult to address. Moreover, as the complexity of the global health context increases with persistent pandemics of infectious diseases and the rising prevalence of noncommunicable diseases, there is a growing appreciation that conditions selected as nutrition/health targets indeed represent syndromes for which nutritional status serves as both an input and outcome. In recognition of the impact of these combined challenges and the role of the multiple manifestations of malnutrition, we suggest an approach to nutritional assessment that is intended to improve the precision of context-specific, equitable approaches to health promotion, disease prevention, and treatment.
    MeSH term(s) Child ; Humans ; Malnutrition/diagnosis ; Malnutrition/epidemiology ; Malnutrition/prevention & control ; Nutritional Status ; Diet ; Growth Disorders/epidemiology ; Nutrition Assessment ; Syndrome
    Language English
    Publishing date 2024-01-31
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2518386-2
    ISSN 2072-6643 ; 2072-6643
    ISSN (online) 2072-6643
    ISSN 2072-6643
    DOI 10.3390/nu16030421
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Chronic kidney disease: considerations for nutrition interventions.

    Steiber, Alison L

    JPEN. Journal of parenteral and enteral nutrition

    2014  Volume 38, Issue 4, Page(s) 418–426

    Abstract: Chronic kidney disease (CKD) is highly prevalent and has major health consequences for patients. Caring for patients with CKD requires knowledge of the food supply, renal pathophysiology, and nutrition-related medications used to work synergistically ... ...

    Abstract Chronic kidney disease (CKD) is highly prevalent and has major health consequences for patients. Caring for patients with CKD requires knowledge of the food supply, renal pathophysiology, and nutrition-related medications used to work synergistically with diet to control the signs and symptoms of the disease. The nutrition care process and International Dietetic and Nutrition Terminology allow for systematic, holistic, quality care of patients with this complex, progressive disease. Nutrition interventions must be designed with the individual patients needs in mind while prioritizing factors with the largest negative impact on health outcomes and mortality risk. New areas of nutrition treatment are emerging that involve a greater focus on micronutrient needs, the microbiome, and vegetarian-style diets. These interventions may improve outcomes by decreasing inflammation, improving energy and protein delivery, and lowering phosphorus, electrolytes, and fluid retention.
    MeSH term(s) Humans ; Nutrition Therapy ; Nutritional Requirements ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/diet therapy
    Language English
    Publishing date 2014-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 800861-9
    ISSN 0148-6071
    ISSN 0148-6071
    DOI 10.1177/0148607114527315
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  3. Article ; Online: Perspective: Nutritional Status as a Biological Variable (NABV): Integrating Nutrition Science into Basic and Clinical Research and Care.

    Raiten, Daniel J / Combs, Gerald F / Steiber, Alison L / Bremer, Andrew A

    Advances in nutrition (Bethesda, Md.)

    2021  Volume 12, Issue 5, Page(s) 1599–1609

    Abstract: The field of nutrition has evolved from one focused primarily on discovery of the identities, metabolic functions, and requirements for essential nutrients to one focused on the application of that knowledge to the development and implementation of ... ...

    Abstract The field of nutrition has evolved from one focused primarily on discovery of the identities, metabolic functions, and requirements for essential nutrients to one focused on the application of that knowledge to the development and implementation of dietary recommendations to promote health and prevent disease. This evolution has produced a deeper appreciation of not only the roles of nutrients, but also factors affecting their functions in increasingly complex global health contexts. The intersection of nutrition with an increasingly more complex global health context necessitates a view of nutritional status as a biological variable (NABV), the study of which includes an appreciation that nutritional status is: 1) not limited to dietary exposure; 2) intimately and inextricably involved in all aspects of human health promotion, disease prevention, and treatment; and 3) both an input and an outcome of health and disease. This expanded view of nutrition will inform future research by facilitating considerations of the contexts and variability associated with the many interacting factors affecting and affected by nutritional status. It will also demand new tools to study multifactorial relations to the end of increasing precision and the development of evidence-based, safe, and effective standards of health care, dietary interventions, and public health programs.
    MeSH term(s) Diet ; Global Health ; Health Promotion ; Humans ; Nutritional Sciences ; Nutritional Status
    Language English
    Publishing date 2021-05-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2583634-1
    ISSN 2156-5376 ; 2156-5376
    ISSN (online) 2156-5376
    ISSN 2156-5376
    DOI 10.1093/advances/nmab046
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  4. Article ; Online: Factors Associated with IRB Review Time in a Non-Federally Funded Study Using an sIRB of Record.

    Lamers-Johnson, Erin / Will, Vanessa K / Long, Julie M / Woodcock, Lindsay / Kelley, Kathryn / Steiber, Alison L / Jimenez, Elizabeth Yakes

    Ethics & human research

    2023  Volume 45, Issue 4, Page(s) 16–29

    Abstract: From 2018 to 2020, U.S. federal mandates began requiring the use of a single institutional review board (sIRB) of record for federally funded, multisite studies. With an interest in the efficiency of site activation, we compared the frequency with which ... ...

    Abstract From 2018 to 2020, U.S. federal mandates began requiring the use of a single institutional review board (sIRB) of record for federally funded, multisite studies. With an interest in the efficiency of site activation, we compared the frequency with which local review and approval and three different reliance options (ways to establish a reliance agreement between the sIRB and the relying institution) were used during this period in a multisite, non-federally funded study (ClinicalTrials.gov identifier: NCT03928548). Using general linear models, we analyzed the relationships between local reliance or approval and sIRB of record approval times and (a) the regulatory option selected and (b) relying-site and process characteristics. Eighty-five sites received sIRB approval through 72 submissions (40% using local review, 46% using the SMART IRB agreement, 10% using an IRB authorization agreement, and 4% using a letter of support). Median time to establish a local reliance or study approval and sIRB approval were longest for sites using a SMART IRB agreement. Study-site region and the time of submission were significantly associated with local reliance or approval time, which averaged 129 and 107 days faster for Midwestern (p = 0.03) or Western (p = 0.02) sites, respectively, and 70 days slower for Northeastern sites (p = 0.42) compared with sites in the South, and 91 days slower when regulatory communication was initiated during or after February 2019 compared with before (p = 0.02). Similar relationships between sIRB approval time and region and time frame were observed; in addition, approval time was 103 days slower for sites affiliated with a research 1 (R1) university versus not (p = 0.02). Region of the country, time frame, and R1 university affiliation were associated with variations in study-site activation in a non-federally funded, multisite study.
    MeSH term(s) Humans ; Communication ; Ethics Committees, Research ; Health Facilities
    Language English
    Publishing date 2023-05-29
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ISSN 2578-2363
    ISSN (online) 2578-2363
    DOI 10.1002/eahr.500173
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Project - executive summary.

    Raiten, Daniel J / Steiber, Alison L / Papoutsakis, Constantina / Rozga, Mary / Handu, Deepa / Proaño, Gabriela V / Moloney, Lisa / Bremer, Andrew A

    The American journal of clinical nutrition

    2023  Volume 117 Suppl 1, Page(s) S1–S10

    Abstract: The public health community has come to appreciate that a deeper understanding of the biology of human milk is essential to address ongoing and emerging questions about infant feeding practices. The critical pieces of that understanding are that 1) human ...

    Abstract The public health community has come to appreciate that a deeper understanding of the biology of human milk is essential to address ongoing and emerging questions about infant feeding practices. The critical pieces of that understanding are that 1) human milk is a complex biological system, a matrix of many interacting parts that is more than the sum of those parts, and 2) human milk production needs to be studied as an ecology that consists of inputs from the lactating parent, their breastfed baby, and their respective environments. The "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Project was designed to examine this ecology as well as its functional implications for both the parent and infant and to explore ways in which this emerging knowledge can be expanded via a targeted research agenda and translated to support the community's efforts to ensure safe, efficacious, and context-specific infant feeding practices in the United States and globally. The five working groups of the BEGIN Project addressed the following themes: 1) parental inputs to human milk production and composition; 2) the components of human milk and the interactions of those components within this complex biological system; 3) infant inputs to the matrix, emphasizing the bidirectional relationships associated with the breastfeeding dyad; 4) the application of existing and new technologies and methodologies to study human milk as a complex biological system; and 5) approaches to translation and implementation of new knowledge to support safe and efficacious infant feeding practices.
    MeSH term(s) Female ; Infant ; Humans ; Milk, Human ; Lactation ; Infant Nutritional Physiological Phenomena ; Breast Feeding ; Mothers
    Language English
    Publishing date 2023-05-11
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 280048-2
    ISSN 1938-3207 ; 0002-9165
    ISSN (online) 1938-3207
    ISSN 0002-9165
    DOI 10.1016/j.ajcnut.2022.12.020
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  6. Article ; Online: Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study.

    Jimenez, Elizabeth Yakes / Lamers-Johnson, Erin / Long, Julie M / McCabe, George / Ma, Xingya / Woodcock, Lindsay / Bliss, Courtney / Abram, Jenica K / Steiber, Alison L

    The American journal of clinical nutrition

    2024  Volume 119, Issue 3, Page(s) 779–787

    Abstract: Background: The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment.: Objectives: ...

    Abstract Background: The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment.
    Objectives: This study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified.
    Methods: A prospective cohort study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes.
    Results: After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake.
    Conclusions: Findings from this multihospital study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This trial was registered at clinicaltrials.gov as NCT03928548 (https://classic.
    Clinicaltrials: gov/ct2/show/NCT03928548).
    MeSH term(s) Aged ; Adult ; Humans ; United States ; Dietetics ; Cohort Studies ; Enteral Nutrition ; Aftercare ; Hand Strength ; Prospective Studies ; Medicare ; Patient Discharge ; Malnutrition/diagnosis ; Malnutrition/therapy ; Weight Loss
    Language English
    Publishing date 2024-02-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 280048-2
    ISSN 1938-3207 ; 0002-9165
    ISSN (online) 1938-3207
    ISSN 0002-9165
    DOI 10.1016/j.ajcnut.2023.12.012
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  7. Article ; Online: Subjective global assessment remains an important nutrition assessment tool: response to Marcelli, DiBenedetto, Ciotola, Grassmann, and Canaud.

    Hand, Rosa K / Steiber, Alison L

    Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation

    2015  Volume 25, Issue 2, Page(s) 135

    MeSH term(s) Female ; Humans ; Kidney Failure, Chronic/blood ; Male ; Obesity/blood ; Renal Dialysis ; Serum Albumin/metabolism
    Chemical Substances Serum Albumin
    Language English
    Publishing date 2015-03
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 1080003-7
    ISSN 1532-8503 ; 1051-2276
    ISSN (online) 1532-8503
    ISSN 1051-2276
    DOI 10.1053/j.jrn.2014.09.004
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  8. Article: A new breed of evidence and the tools to generate it: introducing ANDHII.

    Murphy, William J / Steiber, Alison L

    Journal of the Academy of Nutrition and Dietetics

    2015  Volume 115, Issue 1, Page(s) 19–22

    MeSH term(s) Databases, Factual ; Dietetics/methods ; Dietetics/standards ; Evidence-Based Practice ; Health Knowledge, Attitudes, Practice ; Humans ; Medical Informatics Applications ; Nutritionists/standards ; Societies, Scientific/standards
    Language English
    Publishing date 2015-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2646718-5
    ISSN 2212-2672
    ISSN 2212-2672
    DOI 10.1016/j.jand.2014.10.025
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  9. Article ; Online: Evidence for human milk as a biological system and recommendations for study design-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 4.

    Donovan, Sharon M / Aghaeepour, Nima / Andres, Aline / Azad, Meghan B / Becker, Martin / Carlson, Susan E / Järvinen, Kirsi M / Lin, Weili / Lönnerdal, Bo / Slupsky, Carolyn M / Steiber, Alison L / Raiten, Daniel J

    The American journal of clinical nutrition

    2023  Volume 117 Suppl 1, Page(s) S61–S86

    Abstract: Human milk contains all of the essential nutrients required by the infant within a complex matrix that enhances the bioavailability of many of those nutrients. In addition, human milk is a source of bioactive components, living cells and microbes that ... ...

    Abstract Human milk contains all of the essential nutrients required by the infant within a complex matrix that enhances the bioavailability of many of those nutrients. In addition, human milk is a source of bioactive components, living cells and microbes that facilitate the transition to life outside the womb. Our ability to fully appreciate the importance of this matrix relies on the recognition of short- and long-term health benefits and, as highlighted in previous sections of this supplement, its ecology (i.e., interactions among the lactating parent and breastfed infant as well as within the context of the human milk matrix itself). Designing and interpreting studies to address this complexity depends on the availability of new tools and technologies that account for such complexity. Past efforts have often compared human milk to infant formula, which has provided some insight into the bioactivity of human milk, as a whole, or of individual milk components supplemented with formula. However, this experimental approach cannot capture the contributions of the individual components to the human milk ecology, the interaction between these components within the human milk matrix, or the significance of the matrix itself to enhance human milk bioactivity on outcomes of interest. This paper presents approaches to explore human milk as a biological system and the functional implications of that system and its components. Specifically, we discuss study design and data collection considerations and how emerging analytical technologies, bioinformatics, and systems biology approaches could be applied to advance our understanding of this critical aspect of human biology.
    MeSH term(s) Female ; Infant ; Humans ; Milk, Human ; Lactation ; Infant Nutritional Physiological Phenomena ; Breast Feeding ; Infant Formula
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
    ZDB-ID 280048-2
    ISSN 1938-3207 ; 0002-9165
    ISSN (online) 1938-3207
    ISSN 0002-9165
    DOI 10.1016/j.ajcnut.2022.12.021
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  10. Article ; Online: Executive summary: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project.

    Raiten, Daniel J / Steiber, Alison L / Hand, Rosa K

    The American journal of clinical nutrition

    2016  Volume 103, Issue 2, Page(s) 599S–605S

    Abstract: Preterm birth (infants born at <37 wk of gestational age) is a significant clinical and public health challenge in the United States and globally. No universally accepted practice guidelines exist for the nutritional care of preterm infants. To address ... ...

    Abstract Preterm birth (infants born at <37 wk of gestational age) is a significant clinical and public health challenge in the United States and globally. No universally accepted practice guidelines exist for the nutritional care of preterm infants. To address the current state of knowledge and to support systematic reviews that will be used to develop evidence-informed guidance, a consortium consisting of the American Academy of Pediatrics, the ASN, the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, the Food and Drug Administration, the CDC, the USDA/Agricultural Research Service (USDA/ARS), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH initiated the Pre-B Project. The project included the constitution of 4 thematic working groups charged with the following tasks: 1) develop a series of topics/questions for which there is sufficient evidence to support a systematic review process to be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL), leading to the development of new guidelines for nutritional care of preterm infants, and 2) develop a targeted research agenda to address priority gaps in our understanding of the role of nutrition in the health and development of preterm/neonatal intensive care unit infants. This review consists of a project overview including a summary of a workshop hosted by the USDA/ARS Children's Nutrition Research Center and summary reports of the 4 working groups established to address the following themes: 1) nutrient specifications, 2) clinical/practical issues in enteral feeding, 3) gastrointestinal and surgical issues, and 4) current standards for assessing infant feeding outcomes. These reports will serve as the basis for the ultimate guideline development process to be conducted by the Academy of Nutrition and Dietetics' EAL.
    MeSH term(s) Centers for Disease Control and Prevention, U.S. ; Child Nutrition Sciences/trends ; Congresses as Topic ; Enteral Nutrition/trends ; Evidence-Based Medicine ; Food Assistance ; Humans ; Infant Formula/chemistry ; Infant Formula/metabolism ; Infant Formula/standards ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; Milk, Human/chemistry ; Milk, Human/metabolism ; National Institute of Child Health and Human Development (U.S.) ; Parenteral Nutrition/adverse effects ; Parenteral Nutrition/trends ; Pediatrics/trends ; Practice Guidelines as Topic ; Premature Birth/diet therapy ; Premature Birth/metabolism ; Premature Birth/physiopathology ; Premature Birth/therapy ; Societies, Medical ; Societies, Scientific ; United States ; United States Department of Agriculture ; United States Food and Drug Administration
    Language English
    Publishing date 2016-01-20
    Publishing country United States
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 280048-2
    ISSN 1938-3207 ; 0002-9165
    ISSN (online) 1938-3207
    ISSN 0002-9165
    DOI 10.3945/ajcn.115.124222
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