Download or read book Disease and Mortality in Sub Saharan Africa written by Dean T. Jamison and published by World Bank Publications. This book was released on 2006-01-01 with total page 414 pages. Available in PDF, EPUB and Kindle. Book excerpt: Current data and trends in morbidity and mortality for the sub-Saharan Region as presented in this new edition reflect the heavy toll that HIV/AIDS has had on health indicators, leading to either a stalling or reversal of the gains made, not just for communicable disorders, but for cancers, as well as mental and neurological disorders.

Download or read book Social Factors in the Incidence of Malnutrition written by J. M. Olenja and published by . This book was released on 1984 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Pocket Book of Hospital Care for Children written by World Health Organization and published by World Health Organization. This book was released on 2013 with total page 442 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem.

Download or read book Sustainable healthy diets written by Food and Agriculture Organization of the United Nations and published by Food & Agriculture Org.. This book was released on 2019-10-15 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: Considering the detrimental environmental impact of current food systems, and the concerns raised about their sustainability, there is an urgent need to promote diets that are healthy and have low environmental impacts. These diets also need to be socio-culturally acceptable and economically accessible for all. Acknowledging the existence of diverging views on the concepts of sustainable diets and healthy diets, countries have requested guidance from the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) on what constitutes sustainable healthy diets. These guiding principles take a holistic approach to diets; they consider international nutrition recommendations; the environmental cost of food production and consumption; and the adaptability to local social, cultural and economic contexts. This publication aims to support the efforts of countries as they work to transform food systems to deliver on sustainable healthy diets, contributing to the achievement of the SDGs at country level, especially Goals 1 (No Poverty), 2 (Zero Hunger), 3 (Good Health and Well-Being), 4 (Quality Education), 5 (Gender Equality) and 12 (Responsible Consumption and Production) and 13 (Climate Action).

Download or read book Malnutrition written by Azizur Rahman and published by Nova Science Publishers. This book was released on 2020 with total page 222 pages. Available in PDF, EPUB and Kindle. Book excerpt: "This book brings together a range of contemporary research contributions of the malnutrition field. Written by leading international experts in the field of socioeconomic, demographic, clinical, and environmental and policy related malnutrition. This book explores the theme of the prevalence, risk factors and outcomes of malnutrition lifecycle and burden of the 21st century's world"--

Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Download or read book Social Isolation and Loneliness in Older Adults written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-05-14 with total page 317 pages. Available in PDF, EPUB and Kindle. Book excerpt: Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Download or read book Social Determinants of Health in Non communicable Diseases written by Katsunori Kondo and published by Springer. This book was released on 2021-11-04 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is open access under a CC BY-NC-ND 4.0 license. This open access book is the first compilation that reviews a wide range of social determinants of health (SDHs) for non-communicable diseases (NCDs) and healthy ageing in Japan. With the highest life expectancy and the largest elderly population in the world, Japan has witnessed health inequality by region and social class becoming more prevalent since the 2000s. The first half of this volume describes in detail major NCDs, such as cancers, heart and kidney diseases, diabetes, stroke, and metabolic syndrome. The second half, on the other hand, explores various SDHs relating to healthy ageing. All chapters review and focus on SDHs, particularly health inequality associated with socio-economic status and social capital, which are widely addressed in the field of social epidemiology. The book makes the argument that “Health for All” advocated by the WHO should be implemented based on social justice and benefits for the greater society. Public health researchers and policymakers, both in Japan and other nations, will gain scientific evidence from this book to prepare for the coming era as ageing becomes a global issue.

Download or read book Improving Child Nutrition written by and published by UN. This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: "UNICEF's 2009 report Tracking Progress on Child and Maternal Nutrition drew attention to the impact of high levels of undernutrition on child survival, growth and development and their social and economic toll on nations. It described the state of nutrition programmes worldwide and argued for improving and expanding delivery of key nutrition interventions during the critical 1,000-day window covering a woman's pregnancy and the first two years of her child's life, when rapid physical and mental development occurs. This report builds on those earlier findings by highlighting new developments and demonstrating that efforts to scale up nutrition programmes are working, benefiting children in many countries."--Page 1.

Download or read book Energy Balance and Obesity written by Isabelle Romieu and published by IARC Working Group Report. This book was released on 2018-01-12 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding the relationship between energy balance and obesity is essential to develop effective prevention programs and policies. The International Agency for Research on Cancer convened a Working Group of world-leading experts in December 2015 to review the evidence regarding energy balance and obesity, with a focus on low- and middle-income countries, and to consider the following scientific questions: (i) Are the drivers of the obesity epidemic related only to energy excess and/or do specific foods or nutrients play a major role in this epidemic? (ii) What are the factors that modulate these associations? (iii) Which types of data and/or studies will further improve our understanding? This book provides summaries of the evidence from the literature as well as the Working Group's conclusions and recommendations to tackle the global epidemic of obesity.

Download or read book Disease Control Priorities Third Edition Volume 8 written by Donald A. P. Bundy and published by World Bank Publications. This book was released on 2017-11-20 with total page 977 pages. Available in PDF, EPUB and Kindle. Book excerpt: More children born today will survive to adulthood than at any time in history. It is now time to emphasize health and development in middle childhood and adolescence--developmental phases that are critical to health in adulthood and the next generation. Child and Adolescent Health and Development explores the benefits that accrue from sustained and targeted interventions across the first two decades of life. The volume outlines the investment case for effective, costed, and scalable interventions for low-resource settings, emphasizing the cross-sectoral role of education. This evidence base can guide policy makers in prioritizing actions to promote survival, health, cognition, and physical growth throughout childhood and adolescence.

Download or read book Progress for Children written by UNICEF. and published by UNICEF. This book was released on 2006 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: Undernutrition contributes to the deaths of about 5.6 million children under five in the developing world each year. It can lead to poor school performance and dropout, it threatens girls' future ability to bear healthy children and it perpetuates a generational cycle of poverty. This volume of Progress for Children reports on the world's performance in improving nutrition in young children, a crucial step towards meeting the Millennium Development Goals.

Download or read book Contemporary Issues in Childhood Malnutrition written by Jyoti Ratan Ghosh and published by Nova Science Publishers. This book was released on 2020-04-30 with total page 229 pages. Available in PDF, EPUB and Kindle. Book excerpt: Malnutrition refers to deficiencies, excesses, or imbalances in a person''s intake of energy and/or nutrients. Child malnutrition, in all its forms, includes undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age), micronutrient-related malnutrition (a lack of important vitamins and minerals) or micronutrient excess, overweight, obesity, and resulting diet-related non-communicable diseases. Malnutrition is one of the most important factors for improper physical and mental development of children. One in every five children in the developing world is malnourished, and poor nutrition is associated with half of all child deaths worldwide. The problem of low or excessive body weight concerns countries with different levels of socio-economic development. This is a medical, social, and economic issue. Every country in the world is affected by one or more forms of malnutrition. Combating malnutrition in all its forms is one of the greatest global health challenges. Infants, children and adolescents are at particular risk of malnutrition. In children, malnutrition has particularly significant health consequences during both early development and adulthood. Malnutrition endangers children''s survival, health, growth and development, slows national progress towards the developmental goals and thus diminishes the strength and capacity of nation. Malnutrition in terms of undernutrition is substantially higher in rural than in urban areas and children from indigenous populations often have the poorest nutritional status. The developmental, economic, social, and medical impacts of the global burden of malnutrition are serious and lasting for all involved including individuals and their families, communities and countries. Poor nutrition during the early years of life can also have severe consequences for subsequent skeletal and immunological development. Studies have demonstrated that undernutrition is not caused by food insecurity alone. Other factors range from the length of the breastfeeding period and the availability of milk oligosaccharides, pathogen exposure, and enteric dysfunction marked by villus atrophy and loss of gut barrier function. Differences in the succession of microbial establishment and maturity might contribute to family discordances in nutritional status. Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. Its prevalence has increased at an alarming rate. Globally, in 2016, the number of overweight children under the age of five is estimated to be over 41 million. Almost half of all overweight children under 5 lived in Asia. Overweight and obesity have been linked to adverse psychological and physical outcomes during childhood and continuing into adolescence and adulthood. The association between overweight and obesity with psychosocial problems (anxiety, depression and negative self-image), health problems (diabetes and cardiovascular events) and impaired social, educational and economic productivity has been well documented. Moreover, the negative impact of being underweight, overweight, or obese on the health and development of children and adolescents can also extend into adulthood, increasing the risk of chronic non-communicable diseases and disability. Overweight and obesity, as well as their related diseases, are largely preventable. Therefore prevention of childhood obesity is a high priority. The mechanism of development of obesity is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the result of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Nutritional assessmentis the interpretation of anthropometric, biochemical, clinical and dietary data to determine whether a person or groups of people are well nourished or malnourished (over-nourished or under-nourished). Research can be aimed at identifying the various social, cultural, political, and economic factors of nutrition in order to fully understand the underlying causes of malnutrition. The social determinants of malnutrition can be explored through both qualitative and quantitative research methods. Furthermore, exploring the issues of food security, dietary diversity, and infant-feeding practices can provide a comprehensive understanding of a population''s nutritional status.

Download or read book Disease Control Priorities Third Edition Volume 2 written by Robert Black and published by World Bank Publications. This book was released on 2016-04-11 with total page 419 pages. Available in PDF, EPUB and Kindle. Book excerpt: The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.

Download or read book Explaining Child Malnutrition in Developing Countries written by Lisa C. Smith and published by Intl Food Policy Res Inst. This book was released on 2000 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt: One in three preschool children in developing countries is undernourished. Consequently, they are likely to have impaired immune systems, poor cognitive development, low productivity as adults, and susceptibility to diet-related chronic diseases such as hypertension and coronary heart disease later in life. Undernourished female preschoolers are likely to grow into undernourished young women who are more likely to give birth to babies who are undernourished even before they are born, thus perpetuating the intergenerational transmission of deprivation. This report sheds light on some of the main causes of child malnutrition, projects how many children are likely to be malnourished in the year 2020 given current trends, and identifies priority actions for reducing malnutrition most quickly in the coming decades.

Download or read book What Can We Learn from Nutrition Impact Evaluations written by The World Bank and published by World Bank Publications. This book was released on 2010-08-27 with total page 102 pages. Available in PDF, EPUB and Kindle. Book excerpt: Evaluation Summary What Can We Learn from Nutrition Impact Evaluations? High levels of child malnutrition in developing countries contribute to mortality and have long-term consequences for children s cognitive development and earnings as adults. Recent impact evaluations show that many different interventions have had an impact on children s anthropometric outcomes (height, weight, and birth weight), but there is no simple answer to the question What works? to address the problem. Similar interventions have widely different results in different settings, owing to differences in local context, the causes and severity of malnutrition, and the capacity for program implementation. Impact evaluations of programs supported by the Bank, which are generally large-scale, complex inter-ventions in low-capacity settings, show equally variable results. The findings confirm that it should not be assumed that an intervention found effective in a randomized medical setting will have the same effects when implemented under field conditions. There are many robust experimental and quasi-experimental methods for assessing impact under difficult circumstances often found in field settings. The relevance and impact of nutrition impact evaluations could be enhanced by collecting data on service delivery, demand-side behavioral outcomes, and implementation processes to better understand the causal chain and what part of the chain is weak, in parallel with impact evaluations. It is also important to understand better the distribution of impacts, particularly among the poor, and to document better the costs and effectiveness of interventions. High levels of child malnutrition in developing countries are contributing to mortality and present long-term consequences for the survivors. An estimated 178 million children under age 5 in developing countries are stunted (low height for age) and 55 million are wasted (low weight for height). Malnutrition makes children more susceptible to illness and strongly affects child mortality. Beyond the mortality risk in the short run, the developmental delays caused by undernutrition affect children s cognitive outcomes and productive potential as adults. Micronutrient deficiencies vitamin A, iron, zinc, iodine, for example are also common and have significant consequences. Progress in reducing malnutrition has been slow: More than half of countries are not on track to achieve the Millennium Development Goal of halving the share of children who are malnou-rished (low weight for age) by 2015. The food price and financial crises are making achievement of this goal even more elusive. The World Bank has recently taken steps to ex-pand its support for nutrition in response to the underlying need and the increased urgency due to the crises. WHAT DO WE KNOW ABOUT REDUCING MALNUTRITION? The increased interest and resources focused on the problem of high and potentially increasing rates of undernutrition raises the question, what do we know about the causes of malnutrition and the in-terventions most likely to reduce it? The medical literature points to the need to inter-vene during gestation and the first two years of life to prevent child malnutrition and its consequences. It suggests that investments in interventions during this window of opportunity among children under 2 are likely to have the greatest benefits. Recently published meta-analyses of the impact evaluation literature point to several interventions found effective for reducing undernutrition in spe-cific settings. However, there are limitations to the generalizability of those reviews findings, particularly in the context of large-scale government programs most likely to be supported by the World Bank. The reviews tend to disproportionately draw on the findings of smaller, controlled experiments; there are few examples of evaluations of large-scale programs, over which there is less control in implementation. In reviewing a large number of studies, interventions, and outcomes, they tend to focus on average impacts. They generally do not explain the magnitude or variability of impacts across or within studies. Very few address the programmatic reasons why some interventions work or don t work, nor do they assess the cost-effectiveness of interventions. Objectives of the Review This paper reviews recent impact evaluations of interventions and programs to improve child anth-ropometric outcomes height, weight, and birth weight with an emphasis on both the findings and limitations of the literature and on understanding what might happen in a non-research setting. It further reviews in greater detail the experience and lessons from evaluations of the impact of World Bank-supported programs on nutrition outcomes. Specifically, the review addresses four questions. First, what can be said about the impact of different interventions on children s anthropometric outcomes? Second, how do these findings vary across settings and within target groups, and what accounts for this variability? Third, what is the evidence of the cost-effectiveness of these interventions? Finally, what have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? While there are different dimensions of child nutri-tion that could be explored, the report focuses on child anthropometric outcomes -- weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the MDGs. Methodology and Scope Forty-six nutrition impact evaluations published since 2000 were systematically reviewed. These evaluations assessed the impact of diverse interven-tions community nutrition programs, conditional and unconditional cash transfers, early child devel-opment programs, food aid, integrated health and nutrition services, and de-worming. All of the evaluations used research designs that compared the outcomes among those affected by the project to the counterfactual that is, what would have happened to a similar group of people in the absence of the intervention. About half used randomized assignment to create treatment and control groups, while the remainder used matching and various econometric techniques to construct a counterfactual. Among the 46 evaluations, twelve assessed the im-pact of World Bank-supported programs on nutri-tion outcomes in eight countries. While the broader review relies on the analysis of the published impact evaluations as the main source of data, for these twelve evaluations project documents and research outputs were reviewed and World Bank staff, country officials and the evaluators and re-searchers who conducted the studies were interviewed. Findings A wide range of interventions had a positive impact on indicators related to height, weight, wasting, and low birth weight. There were a total of 10 different outcome indica-tors for the four main anthropometric outcomes. A little more than half of the evaluations addressing a height-related indicator found program impacts on at least one group of children, and this was true for about the same share of interventions aimed at improving weight-related and wasting (low weight for height)-related indicators. About three-quarters of the 11 evaluations of interventions that aimed at improving birth weight indicators registered an impact in at least one specification, including five out of seven micronutrient interven-tions. There was no clear pattern of impacts across interventions in every intervention group there were examples of programs that did and did not have an impact on a given indicator, and with varying magnitude. Evaluations of the nutritional impact of programs supported by the World Bank, which are generally large-scale, complex, and implemented in low-capacity settings, show equally variable results. Even controlling for the specific outcome indicator, studies often targeted children of different age groups that might be more or less susceptible to the interventions. It is thus difficult to point to inter-ventions that are systematically more effective than others in reducing malnutrition across diverse set-tings and age groups. Differences in local context, variation in the age of the children studied, the length of exposure to the intervention, and differing methodologies of the studies account for much of the variability in results. Context includes factors like the level and local determinants of malnutrition, differences in the characteristics of beneficiaries (including their age), the availability of service infrastructure, and the implementation capacity of government. Outside of a research setting in the context of a large government program there are many things that can go wrong in either service delivery or the demand response that can compromise impact. Beyond this, there are social factors like the status of women or the presence of civil unrest that can affect outcomes. These findings underscore the conclusion that it should not be assumed that an intervention found effective in a randomized controlled trial in a re-search setting will have the same effects when im-plemented under field conditions in a different set-ting. They also point to the need to understand the prevailing underlying causes of malnutrition in a given setting and the age groups most likely to benefit in selecting an intervention. Further, impact evaluations need to supplement data measuring impact with data on service delivery and demand-side behavioral outcomes to demonstrate the plausibility of the findings, to understand what part of a program works, and to address weak links in the results chain to improve performance. There is scant evidence on the distribution of nutrition impacts who is benefiting and who is not or on the cost-effectiveness of interventions Just because malnutrition is more common among the poor does not mean that they will disproportio-nately benefit from an intervention, particularly if acting on new knowledge or different incentives relies on access to education or quality services. Only a third of the 46 evaluations looked at the distribution of impacts by gender, mother s education, poverty status, or availability of complementary health services. Only nine assessed the impacts on nutritional outcomes of the poor compared with the non-poor. Among the evaluations that did examine variation in results, several found that the children of more educated mothers or in better-off communities are be-nefitting the most. Bank-supported cash transfers, community nutrition, and early child development programs in six of eight countries had some impact on child anthropometric outcomes. Of the 12 impact evaluations of Bank support, all but one were of large-scale government programs with multiple interventions and a long results chain. Three-quarters found a positive impact on anthro-pometric outcomes of children in at least one age group, although the magnitude was in some cases not large or applied to a narrow age group. Most of the impact evaluations involved assessment of completely new programs and involved World Bank researchers. Most used quasi-experimental evaluation designs and two-thirds assessed impact after at most 3 years of program implementation. Only half of the evaluations documented the distribution of impacts and only a third presented information on the costs of the intervention (falling short of cost-effectiveness analysis). In two of the countries (Colombia and the Philippines) the evaluations likely had an impact on government policy or programs. Lessons A number of lessons for development practi-tioners and evaluators arose from the review of impact evaluations of World Bank nutrition support. For task managers: Impact evaluations of interventions that are clearly beyond the means of the government to sustain are of limited relevance. The complexity, costs, and fiscal sustainability of the intervention should figure into the decision as to whether an impact evaluation is warranted. Impact evaluations are often launched for the purpose of evaluating completely new pro-grams, but they may be equally or even more useful in improving the effectiveness of ongo-ing programs. There are methods for obtaining reliable impact evaluation results when randomized assignment of interventions is not possible for political, ethical, or practical reasons. For evaluators: In light of the challenges of evaluating large-scale programs with a long results chain, it is well worth the effort to assess the risks to disruption of the impact evaluation ahead of time and identify mitigation measures. The design and analysis of nutrition impact evaluations need to take into account the likely sensitivity of children of different ages to the intervention. For the purposes of correctly gauging im-pact, it is important to know exactly when delivery of an intervention took place in the field (as opposed to the official start of the program). Evaluations need to be designed to provide evidence for timely decision-making, but with sufficient elapsed time for a plausible impact to have occurred. The relevance of impact evaluations for po-licymakers would be greatly enhanced if im-pact evaluations were to document both the

Download or read book Malnutrition in the Elderly written by W.O. Seiler and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt: H. B. Stahelin "Under-or malnutrition is a frequent and serious problem in geriatric patients" (8). Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the aged. The immune function is impaired, the risk for falls and fractures increases, in acute illness, recovery is delayed, and complications are frequent. Acute and chronic illnesses lead to a catabolic metabolism and hence increase the signs and symptoms of malnutrition. Cytokines related to inflamma tion block the synthesis of albumin and shift protein synthesis to acute phase pro teins. The activation of the ubiquitine-proteasome pathway leads to a degradation of muscle protein, which leads to an additional loss of muscle mass which occurs as age-dependent sarcopenia, and adds to the already existing frailty (2, 4). It is often difficult to decide to what extent the metabolic alterations result from malnutrition or concomitant illness. Psychological factors contribute as a circulus vitiosus significantly to anorexia and, thus, aggravate the condition. They are the most important causes of failure to thrive in old age (7). It is evident that next to the therapy of the underlying illness, an adequate support with calorie and nutrient intake over weeks becomes essen tial under these conditions. Clear-cut improvements are often only seen after 6 or more weeks. Besides a clinical, clearly visible malnutrition, selective nutrient deficits are much more frequent. Numerous and highly different mechanisms may lead to a marginal or insufficient supply with micronutrients.