Background Better tools are needed to diagnose and identify children at risk of clinical malnutrition. Objectives We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. Methods This was a prospective study in children 5–18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. Results Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%–17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (−1.38 ± 1.03 compared with −0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. Conclusions LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.

The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.

14Background: Clinical use of bioelectric impedance is limited by variability in hydration. 15 Analysis of raw bioelectric impedance vectors (BIVA), resistance (R), reactance (Xc) 16 and phase angle (PA) may be an alternative for monitoring disease 17 progression/treatment. Clinical experience of BIVA in children is limited. We 18 investigated predictors of BIVA and their ability to predict clinical outcomes in 19 children with complex diagnoses. 20Methods: R, Xc and PA were measured (BODYSTAT Quadscan 4000) on admission in 21 108 patients (4.6-16.8 years, mean 10.0). R and Xc were indexed by height (H) and 22BIVA-SDS for age and sex calculated using data from healthy children. Potential 23 predictors and clinical outcomes (greater-than-expected length-of-stay (LOS), 24 complications) were recorded. 25Results: Mean R/H-SDS was significantly higher (0.99 (SD 1.32)) and PA-SDS lower (-26 1.22 (1.68))) than expected, with a wide range for all parameters. In multivariate 27 models, the Strongkids risk category predicted R/H-SDS (adjusted mean for low, 28 medium and high risk = 0.49, 1.28, 2.17, p=0.009) and PA-SDS (adjusted mean -0.52, -29

Introduction: Overload can impact multiple aspects in the life of primary caregivers of patients with advanced disease. Characterizing its frequency and associated factors could help develop strategies to mitigate it.Objective: To assess overload levels and associated factors in informal primary caregivers of adult patients in the palliative care unit of a public hospital in Mexico.Method: A descriptive cross-sectional study with consecutive sampling was carried out between January and April 2019. Informal primary caregivers of adult patients in palliative care participated. Those who were in a hurry or did not want to participate were excluded. Overload (primary outcome variable) was evaluated using the Zarit Burden Interview; additionally, a questionnaire of sociodemographic data and other variables related to caregiver interests and the characteristics of the care provided was completed by the participants. A descriptive analysis of the variables and their associations with the presence of overload was conducted. Results:The study enrolled 141 caregivers, 24.11% of which were diagnosed with overload. The variables that showed a significant association with overload (p < 0.05), increasing the probability of occurrence, were perception of the severity of the patient's condition, and negative impact on different areas of the caregiver's life (family, partner, economy). Caregivers with a lower potential for overload included those who took on the role of caregiver for affective reasons, who indulged in pleasant activities, who were good at self-care (physical activity, food, hygiene, and health), and who had a good relation with the patient. The variables of a "negative impact on the family", "relationship with the patient" and "self-care in physical activity" combined showed the greatest association with the risk of overload. Conclusions:The prevalence of overload was lower than that reported in other studies. The variables associated with overload suggest that interventions focused on self-care, problemsolving training, promotion of pleasant activities, and favoring an adequate relationship between caregiver and patient would be beneficial. The main limitations of our research were the type of study and how the sample was selected.

There is a controversy in the modulation of hepatic lipid metabolism by the type of fatty acid in the diet. Thus, the purpose of the present work was to evaluate the effect of short‐ and long‐term consumption of different type and amount of dietary fat on hepatic lipogenesis and oxidation in rat. Short‐term consumption for seven days showed that fatty acid oxidation was increased by soybean oil (SO) and coconut oil (CO) by increasing CPT1 via PPARα coactivated by PGC1β, and the presence of cholesterol in the SO diet reduced fatty acid oxidation. The lipogenic activity mediated by SREBP‐1 and FAS was higher in the group fed CO + cholesterol and the increase in the amount of SO decreased lipogenic activity mediated by SREBP‐1 and FAS. Long‐term consumption showed that the higher the amount of fat in the diet the higher the inhibition in lipogenic and oxidation gene expression independently of the type of fat. SO with a ω3/ω6 ratio 8.4 produced a higher oxidation and lower lipogenesis than the groups fed butter or chia oil with ω3/ω6 ratio of 3 and 0.2 respectively. Thus fatty acid insaturation and amount of fat modulate hepatic fatty acid oxidation and lipogenesis.Supported by INCMNSZ.