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Zupo R, Castellana F, Guerra V, Donghia R, Bortone I, Griseta C, Lampignano L, Dibello V, Lozupone M, Coelho-Júnior HJ, Solfrizzi V, Giannelli G, De Pergola G, Boeing H, Sardone R, Panza F. Associations between nutritional frailty and 8-year all-cause mortality in older adults: The Salus in Apulia Study. J Intern Med 2021; 290:1071-1082. [PMID: 34437740 DOI: 10.1111/joim.13384] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Preventive nutritional management of frailty, a multidimensional intermediate status in the ageing process, may reduce the risk of adverse health-related outcomes. We investigated the ability of a measure combining physical frailty with nutritional imbalance, defined as nutritional frailty, to predict all-cause mortality over a period of up to 8 years. METHODS We analysed data on 1,943 older adults from the population-based 'Salus in Apulia Study'. Physical frailty was operationalized using Cardiovascular Health Study criteria and cognitive frailty by combining physical frailty with cognitive impairment. A novel five-item construct was built to assess the extent of nutritional imbalance identified with a machine learning algorithm. Cox models and Kaplan-Meier survival probability analyses of physical frailty, nutritional imbalance (two or more of the following: low body mass index, low skeletal muscle index, ≥2.3 g/day sodium intake, <3.35 g/day potassium intake and <9.9 g/day iron intake), cognitive frailty and the novel nutritional frailty phenotype (physical frailty plus nutritional imbalance) were applied to assess all-cause mortality risk, adjusted for age, sex, education and multimorbidity. RESULTS The overall prevalence of nutritional frailty was 4.52% (95% confidence interval, CI:3.55-5.44), being more frequent in males. Subjects with nutritional frailty were at higher risk for all-cause mortality [hazard ratio (HR):2.31; 95%CI:1.41-3.79] than those with physical frailty (HR:1.45,95% CI:1.0-2.02), nutritional imbalance (HR:1.39; 95%CI:1.05-1.83) and cognitive frailty (HR:1.06; 95%CI:0.56-2.01). CONCLUSIONS Efforts to identify, manage and prevent frailty should include the nutritional domain. The nutritional frailty phenotype may highlight major nutritional determinants that could drive survival and health trajectories in older adults.
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Affiliation(s)
- Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Vito Guerra
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Rossella Donghia
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Ilaria Bortone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Chiara Griseta
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Luisa Lampignano
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Madia Lozupone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Vincenzo Solfrizzi
- "C. Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, Research Hospital, National Institute of Gastroenterology "Saverio de Bellis", Castellana Grotte, Bari, Italy
| | - Giovanni De Pergola
- Scientific Direction, Research Hospital, National Institute of Gastroenterology "Saverio de Bellis", Castellana Grotte, Bari, Italy
| | - Heiner Boeing
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.,German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Francesco Panza
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
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Endocrinological and Nutritional Implications of Anorexia of Aging. ENDOCRINES 2021. [DOI: 10.3390/endocrines2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor appetite—known as anorexia—is a common condition in aging and is associated with poor outcomes, including reduced survival and impaired quality of life. The anorexia of aging is mainly the result of several complex endocrinological, metabolic, and nutritional changes occurring with later age. The modulation of different peptides and hormones has been identified as an important determinant for the development of low appetite; in particular, an altered imbalance of plasma ghrelin, leptin, and cholecystokinin and increased inflammatory markers are implicated in its pathophysiology, and robust evidence of their involvement in anorexia of aging has been produced in the clinical setting. More recently, researchers identified that the gut microbiome composition significantly varies according to the appetite status. Other important clinical factors may worsen the symptoms of the anorexia in the elderly, in particular the potential concomitant presence of chronic catabolic comorbidities. Importantly, data indicate that anorexia is prevalent in frail older adults, negatively impacting body composition and specifically in altering muscle mass and function. For all these reasons, a prompt and early diagnosis of anorexia in the elderly is crucial to implement personalized metabolic and nutrition interventions to improve the outcomes and ameliorate quality of life.
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Kadam I, Neupane S, Wei J, Fullington LA, Li T, An R, Zhao L, Ellithorpe A, Jiang X, Wang L. A Systematic Review of Diet Quality Index and Obesity among Chinese Adults. Nutrients 2021; 13:3555. [PMID: 34684556 PMCID: PMC8538294 DOI: 10.3390/nu13103555] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/17/2021] [Accepted: 10/09/2021] [Indexed: 12/21/2022] Open
Abstract
Diet quality scores are designed mainly based on Western-style dietary patterns. They were demonstrated to be good indicators of obesity in developed but not developing countries. Several diet quality scores were developed based on the Chinese dietary guidelines, yet no systematic review exists regarding how they were related to obesity. We searched research articles published between 2000 and 2021 in PubMed, CINAHL, and Scopus databases. Both cross-sectional and prospective studies that examined the relationship between a diet quality score and weight, body mass index, obesity, or waist circumference conducted in a Chinese population were selected. From the 602 articles searched, 20 articles were selected (12 are cross-sectional studies and 8 are prospective cohort studies). The relationship between internationally used scores and obesity was inconsistent among studies. Scores tailored to the Chinese diet demonstrated a strong relationship with both being underweight and obesity. The heterogeneity of the populations and the major nutrition transition in China may partially explain the discrepancies among studies. In conclusion, diet quality scores tailored to the Chinese diet may be associated with both undernutrition and overnutrition, as well as being underweight and obesity outcomes.
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Affiliation(s)
- Isma’il Kadam
- Program in Biochemistry, Graduate Center of the City University of New York, New York, NY 10016, USA;
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA;
| | - Sudeep Neupane
- Department of Public Health, Robbins College of Human Health and Sciences, Baylor University, Waco, TX 76711, USA; (S.N.); (T.L.)
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Lee Ann Fullington
- Library Department, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA;
| | - Tricia Li
- Department of Public Health, Robbins College of Human Health and Sciences, Baylor University, Waco, TX 76711, USA; (S.N.); (T.L.)
| | - Ruopeng An
- Brown School, Washington University, St. Louis, MO 63130, USA;
| | - Li Zhao
- West China Fourth Hospital, West China School of Public Health, Sichuan University, Chengdu 610041, China;
| | - Amy Ellithorpe
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA;
| | - Xinyin Jiang
- Program in Biochemistry, Graduate Center of the City University of New York, New York, NY 10016, USA;
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA;
| | - Liang Wang
- Department of Public Health, Robbins College of Human Health and Sciences, Baylor University, Waco, TX 76711, USA; (S.N.); (T.L.)
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Hegendörfer E, VanAcker V, Vaes B, Degryse JM. Malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged 80 years and over. Acta Clin Belg 2021; 76:351-358. [PMID: 32134709 DOI: 10.1080/17843286.2020.1737779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: To investigate the prevalence of malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged ≥80 years, a worldwide growing age-group.Methods: In the BELFRAIL cohort, malnutrition risk was evaluated with the Mini Nutritional Assessment (MNA total score <24) and prealbumin levels (<20 mg/dl). Agreement between them was assessed with Kohen's kappa coefficient. Association with first unplanned hospitalization (3.0 ± 0.25 years follow-up) and mortality (5.1 ± 0.25 years follow-up) was investigated with survival analysis and Cox multivariate regression.Results: Out of 567 BELFRAIL participants, 556 (98.1%) had MNA and 545 (96.1%) prealbumin levels. Sixty-eight (12.2%) were at risk of malnutrition based on MNA and 69 (12.7%) based on prealbumin, with very poor agreement between them (Kappa = 0.024, 95% CI -0.064, 0.112). For both MNA and prealbumin, participants with malnutrition risk had lower physical and cognitive performance tests' scores. They had no higher risk for first hospitalization compared to those without malnutrition risk, but higher risk for all-cause mortality even after adjustment for multimorbidity, inflammation, physical and mental functioning (HR 1.35 95%CI 0.92-1.97 for MNA; HR 1.46; 95%CI 1.01-2.12 for prealbumin).Conclusion: Malnutrition risk based on MNA or prealbumin was low in a Belgian cohort of community-dwelling adults aged ≥80 years. Physical and cognitive performance was lower in those with malnutrition risk, but malnutrition risk was not independently associated with hospitalization and mortality (except for malnutrition risk by prealbumin). Further research needs to investigate the best tool to assess malnutrition risk in this age group.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (Uclouvain), Louvain, Belgium
| | - Veronika VanAcker
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (Uclouvain), Louvain, Belgium
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Sánchez-Sánchez JL, Rolland Y, Cesari M, de Souto Barreto P. Associations Between Intrinsic Capacity and Adverse Events Among Nursing Home Residents: The INCUR Study. J Am Med Dir Assoc 2021; 23:872-876.e4. [PMID: 34571043 DOI: 10.1016/j.jamda.2021.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The predictive ability of the novel intrinsic capacity (IC) construct has been scarcely investigated in the nursing home setting. The objective of this study was to investigate the associations of IC and its individual domains with mortality, hospitalization, pneumonia onset, and functional status decline in a population of nursing home residents (NHRs). DESIGN We undertook an analysis using data from the INCUR study, a prospective observational study. Data were collected at baseline, at 6 and 12 months by trained staff. SETTING AND PARTICIPANTS A total of 371 NHRs (mean age 85.91 ± 7.34) dwelling in Southern France. METHODS A baseline IC composite score was constructed from scores in the Short Physical Performance Battery, Abbreviated Mental Test, 10-item Geriatric Depression Scale, The Short Form of the Mini-Nutritional Assessment, and self-reported hearing and vision impairments. Adverse outcomes were registered by medical records checking. Functional status evolution was evaluated through changes in the Katz Index. Cox regression was used for associations between IC and its domains and adverse outcomes. Linear mixed models were used in the case of functional status evolution. RESULTS Our analysis revealed associations between a composite score of IC and death [hazard ratio 0.33; 95% confidence interval (CI) 0.15-0.73] and functional status evolution (β = 0.14; 95% CI 0.018-0.29) in our population. Although greater values in IC vitality/nutrition domain were associated with survival (HR 0.84; 95% CI 0.70-0.99), IC cognitive domain was associated with decreased odds of hospitalization (HR 0.91; 95% CI 0.84-0.99) and lower declines in functional status (β = 0.04; 95% CI 0.01-0.07), whereas the IC locomotion domain was inversely associated with pneumonia incidence (HR 0.84; 95% CI 0.72-0.98). CONCLUSIONS AND IMPLICATIONS Our results contribute to preliminary evidence linking greater IC levels and lower risk of late-life adverse outcomes.
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Affiliation(s)
- Juan Luis Sánchez-Sánchez
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France; CERPOP UMR1295, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | - Philipe de Souto Barreto
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France; CERPOP UMR1295, Université de Toulouse, Inserm, UPS, Toulouse, France
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Wong A, Huang Y, Sowa PM, Banks MD, Bauer JD. Adult malnutrition, nutritional interventions and outcomes in Singapore: a scoping review of local studies for the past 20 years. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105820964829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is currently no review published on the prevalence and incidence of malnutrition in Singapore across various populations, or what interventions or policies are in place for preventing/treating malnutrition. Objectives: This review aims to determine the: (a) incidence and prevalence of malnutrition in the community, and in acute, intermediate and long-term care facilities; (b) interventions implemented for screening, assessing and treating/preventing malnutrition; (c) specific clinical populations investigated for malnutrition or nutritional therapy; and (d) implications of malnutrition and effectiveness of treating malnutrition or using nutritional therapy in Singapore. Methods: A structured search strategy was applied to available electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, the Cochrane Library and Google Scholar) using selected search terms, with additional reports and grey literature identified using iterative searches. Results: Forty-two articles were found, with the majority of research performed in the community and acute care settings. Malnutrition screening and assessment is the most common nutritional research performed in Singapore. Approximately 14.7% to 65.0% of acute care and 2.8% to 31.5% of community populations are found to be malnourished. Limited interventional and economic-related studies are available. Conclusion: Malnutrition rates in Singapore appear to be similar to other developed countries. Future studies will need to focus on nutritional intervention, cost-effectiveness analyses and specific populations such as the underprivileged, chronically ill and those dependent on nutritional support.
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Affiliation(s)
- Alvin Wong
- Department of Dietetic and Food Services, Changi General Hospital, Singapore
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
| | - Yingxiao Huang
- Department of Dietetic and Food Services, Changi General Hospital, Singapore
| | - Przemyslaw M Sowa
- Centre for the Business and Economics of Health, University of Queensland, Australia
| | - Merrilyn D Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Australia
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
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Nakamura T, Haraguchi Y, Matsumoto M, Ishida T, Momomura SI. Prognostic impact of malnutrition in elderly patients with acute myocardial infarction. Heart Vessels 2021; 37:385-391. [PMID: 34405259 DOI: 10.1007/s00380-021-01922-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
We aimed to investigate the prevalence and the prognostic impact of malnutrition using the geriatric nutritional risk index (GNRI) in elderly patients with acute myocardial infarction (AMI). We investigated 130 consecutive patients aged ≥ 75 years who were discharged following successful primary coronary intervention between March 2009 and December 2016. The mean age of the patients was 81.5 ± 5.0 years, and 55.4% of them were male. At discharge, the patients' nutritional statuses were evaluated using the GNRI, which were calculated as follows: 14.89 × serum albumin (g/dL) + 41.7 × body mass index/22. The patients were divided into two groups, a low GNRI group (GNRI < 92) with nutrition-related risk and a high GNRI group (GNRI ≥ 92) without nutrition-related risk. The mean GNRI score of all patients was 95.2 ± 11.0, and 46 patients (35.4%) had a low GNRI score. During the mean follow-up of 1030 ± 850 days, the all-cause mortality was significantly higher in the low GNRI group than in the high GNRI group (32.6% vs. 13.1%, p < 0.001), while the event rates of AMI recurrence and hospitalization due to heart failure did not differ significantly between the two groups. Multivariate Cox proportional analysis revealed that low GNRI was a modest but independent predictor of mortality (hazard ratio, 0.94; 95% confidence interval 0.90-0.98; p = 0.01). Among elderly patients with AMI, malnutrition assessed using the GNRI was often encountered and was an independent predictor of long-term mortality.
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Affiliation(s)
- Tomohiro Nakamura
- Department of Medicine, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan.
| | - Yumiko Haraguchi
- Department of Medicine, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan
| | - Mitsunari Matsumoto
- Department of Medicine, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan
| | - Takeshi Ishida
- Department of Medicine, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan
| | - Shin-Ichi Momomura
- Department of Medicine, Saitama Citizens Medical Center, 299-1 Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan
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Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients 2021; 13:nu13082764. [PMID: 34444924 PMCID: PMC8399049 DOI: 10.3390/nu13082764] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.
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Ernährung im Alter – ein wesentlicher Schlüssel zum Erhalt der Funktionalität und Lebensqualität. DER GASTROENTEROLOGE 2021; 16:324-331. [PMID: 34341672 PMCID: PMC8320417 DOI: 10.1007/s11377-021-00546-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Jenseits des 70. Lebensjahrs ist bei älteren Menschen regelhaft eine Abnahme der Muskelmasse sowie eine Zunahme der Fettmasse zu beobachten. Diese Veränderungen der Körperzusammensetzung stellen eine wesentliche Prädisposition für den im Alter drohenden Verlust an Funktionalität und Selbständigkeit dar. In diesem Kontext kommt der richtigen Ernährung sowie insbesondere dem Vermeiden einer Mangelernährung große Relevanz zu. Da die ältere Bevölkerung hinsichtlich der Geschwindigkeit und Ausprägung der Alterungsvorgänge sowie ihrer Komorbiditäten als äußerst heterogen zu betrachten ist, müssen Ernährungsempfehlungen individualisiert erfolgen. Mit Hinblick auf eine potenzielle Gefährdung durch eine Sarkopenie ist selbst eine beabsichtigte Gewichtsabnahme im Alter kritisch zu sehen. Fastenepisoden sollten generell vermieden werden. Dies betrifft insbesondere eine unzureichende Kalorienzufuhr im Kontext von akuten oder chronischen Erkrankungen. Im höheren Lebensalter sollten daher regelmäßige Gewichtskontrollen erfolgen, um das Auftreten einer Mangelernährung frühzeitig zu erkennen und entsprechende Maßnahmen einleiten zu können. Zum Erhalt der Muskelmasse und -funktion sollte eine gegenüber jüngeren Menschen erhöhte Eiweißzufuhr von 1,0 g/kgKG angestrebt werden. Bei älteren Menschen mit Sarkopenie wird dieses Ziel auf 1,2 g/kgKG angehoben. Während sich im Alter restriktive Diäten als nachteilig erweisen können, scheinen gesunde Ernährungsformen wie z. B. die mediterrane Ernährung den Erhalt der muskulären und kognitiven Funktion zu fördern.
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Naganuma M, Kudo Y, Suzuki N, Masuda S, Nagaya K. Effect of malnutrition and frailty status on surgical aortic valve replacement. Gen Thorac Cardiovasc Surg 2021; 70:24-32. [PMID: 34132999 DOI: 10.1007/s11748-021-01667-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To date, assessment of nutritional and frailty status in patients undergoing surgical aortic valve replacement remains unclear. This study aimed to assess the effect of geriatric nutritional risk index (GNRI) and Rockwood clinical frailty scale (CFS) on short-term and mid-term survival in patients who underwent surgical aortic valve replacement for aortic stenosis. METHODS In total, 219 patients who underwent aortic valve replacement for aortic stenosis between Jan 1 2011 and Dec 31 2018 were retrospectively monitored in a single center. Mid-term survival was assessed using Kaplan-Meier analysis. Logistic and Cox regression analyses were performed to detect independent predictors for early and mid-term mortality. Follow-up was 97.7% complete, and a GNRI score ≤ 98 denoted malnutrition. RESULTS In the univariable analysis, GNRI [odds ratio (OR) 0.91, 95% confidence interval (CI), 0.86-0.96, p < 0.001] and CFS (OR 2.00 95% CI 1.38-2.94, p < 0.001) were identified as significant risk factors for in-hospital mortality. Mid-term survival was significantly decreased in patients with malnutrition (3 and 5 year survival rates 83.9 and 76.9%, respectively, p < 0.001). Mid-term freedom from major cardiac and cerebrovascular events was significantly decreased in patients with malnutrition (p = 0.039). The CFS (hazard ratio 1.78) and GNRI (hazard ratio 0.95) were independent risk factors for mid-term survival in the univariable and multivariable analyses, respectively. CONCLUSIONS A lower GNRI is associated with poor mid-term mortality and major cardiac and cerebrovascular events after surgical aortic valve replacement. A lower CFS score is associated with unfavorable mid-term outcomes.
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Affiliation(s)
- Masaaki Naganuma
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan.
| | - Yasushi Kudo
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan
| | - Nobuaki Suzuki
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan
| | - Shinya Masuda
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan
| | - Koichi Nagaya
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan
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Zhao J, Liu X, Wan L, Gao Y, Huang M, Zha F, Long J, Li D, Nie G, Wang Y. A novel Longshi Scale measured activity of daily living disability in elderly patients affected by neurological diseases: a multi-center cross-sectional study in China. BMC Geriatr 2021; 21:348. [PMID: 34090363 PMCID: PMC8180129 DOI: 10.1186/s12877-021-02296-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background Ability in the activities of daily life is often impaired in the older adults with a neurological disease. The Barthel Index is an instrument used worldwide to assess such ability. The Longshi Scale is a picture-based alternative, but its effectiveness has not been evaluated with older adult subjects. This study was to determine whether the Longshi Scale can effectively quantify the ability of older adults in the activities of daily living by comparing its ratings with those using the Barthel Index. Methods A multi-center cross-sectional study was conducted among patients over 65 years. A total of 2438 patients were divided into three groups, including bedridden, domestic, or community group based on their ability to go out of bed, move outdoors, and return indoors. Their ability in the activities of daily living among three groups was evaluated using both the Longshi Scale and the Barthel Index, and the results were compared. Results There was a significant difference in the average Barthel Index scores of three groups classified using the Longshi Scale. The average Longshi Scale scores also showed significant differences between the four groups classified using the Barthel Index. Spearman correlation coefficients showed strong correlation(>0.83) between the Longshi Scale and Barthel Index scores. Conclusions The Longshi Scale can efficiently distinguish the ability in the activities of daily living of people with a neurological disease. Its rating correlate well with those using the Barthel Index.
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Affiliation(s)
- Jingpu Zhao
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiangxiang Liu
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Li Wan
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yan Gao
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Meiling Huang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fubing Zha
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Dongxia Li
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Guohui Nie
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
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Chew STH, Kayambu G, Lew CCH, Ng TP, Ong F, Tan J, Tan NC, Tham SL. Singapore multidisciplinary consensus recommendations on muscle health in older adults: assessment and multimodal targeted intervention across the continuum of care. BMC Geriatr 2021; 21:314. [PMID: 34001023 PMCID: PMC8127264 DOI: 10.1186/s12877-021-02240-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care. METHODS The recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings. RESULTS The panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment. Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described. CONCLUSIONS Reviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.
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Affiliation(s)
- Samuel T H Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
- Society for Geriatric Medicine Singapore, Singapore, Singapore.
| | - Geetha Kayambu
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | | | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fangyi Ong
- Singapore Nutrition and Dietetics Association, Singapore, Singapore
| | - Jonathan Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
| | - Shuen-Loong Tham
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Society of Rehabilitation Medicine, Singapore, Singapore
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Jiao J, Guo N, Xie L, Ying Q, Zhu C, Guo X, Wen X, Jin J, Wang H, Lv D, Zhao S, Wu X, Xu T. Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study. Gerontology 2021; 68:8-16. [PMID: 33915544 DOI: 10.1159/000514948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. METHODS We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. RESULTS We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59-6.38), readmission (OR 1.45; 95% CI 1.25-1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10-5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09-4.01), readmission (OR 1.38; 95% CI 1.21-1.57), and mortality (OR 6.50; 95% CI 4.00-7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. CONCLUSIONS Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.
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Affiliation(s)
- Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Guo
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingli Xie
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiaoyan Ying
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinying Guo
- Department of Geriatric, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
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Setiati S, Soejono CH, Harimurti K, Dwimartutie N, Aryana IGPS, Sunarti S, Budiningsih F, Mulyana R, Dwipa L, Sudarso A, Rensa R, Istanti R, Azwar MK, Marsigit J. Frailty and Its Associated Risk Factors: First Phase Analysis of Multicentre Indonesia Longitudinal Aging Study. Front Med (Lausanne) 2021; 8:658580. [PMID: 33996862 PMCID: PMC8116892 DOI: 10.3389/fmed.2021.658580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Abstract
Background: National long-term care development requires updated epidemiological data related to frailty. We aimed to find the prevalence of frailty and its associated factors among Indonesian elderly. Methods: We conducted first-phase cross-sectional analysis of Indonesia Longitudinal Aging Study (INALAS) data collected from community-dwelling outpatients aged 60 years and older without acute illness in nine geriatric service care centres. Descriptive, bivariate and multivariate analyses were conducted. Results: Among 908 elderly in this study, 15.10% were robust, 66.20% were pre-frail, and 18.70% were frail. Functional dependence was associated with frailty among Indonesian elderly (OR 5.97, 95% CI 4.04–8.80). Being depressed and at risk for malnutrition were also associated with frailty with OR 2.54, 95% CI 1.56–4.12, and OR 2.56, 95% CI 1.68–3.90, respectively. Prior history of fall (OR 1.77, 95% CI 1.16–2.72) and hospitalization (OR 1.46, 95% CI 0.97–2.20) in the previous 12 months were associated with frailty. There is also significant association between poly pharmacy and frailty (OR 2.42, 95% CI 1.50–3.91). Conclusion: Approximately one in five Indonesian community-dwelling elderly was frail. Frailty is associated with functional dependence, being at risk for malnutrition or being malnourished, depression, history of fall, history of hospitalization, and poly pharmacy. There may be bidirectional relationships between the risk factors and frailty. The development of long-term care in Indonesia should be considered, without forcing the elderly who need it.
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Affiliation(s)
- Siti Setiati
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.,Clinical Epidemiology and Evidence-Based Medicine Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Czeresna Heriawan Soejono
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.,Clinical Epidemiology and Evidence-Based Medicine Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Noto Dwimartutie
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - I G P Suka Aryana
- Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
| | - Sri Sunarti
- Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Fatichati Budiningsih
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret, Solo, Indonesia
| | - Roza Mulyana
- Department of Internal Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
| | - Lazuardhi Dwipa
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Agus Sudarso
- Department of Internal Medicine, Faculty of Medicine, Universitas Hasanuddin, Makasar, Indonesia
| | - Rensa Rensa
- Department of Internal Medicine, Faculty of Medicine, Universitas Atma Jaya, Jakarta, Indonesia
| | - Rahmi Istanti
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Khifzhon Azwar
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Jessica Marsigit
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
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Ozer NT, Akin S, Gunes Sahin G, Sahin S. Prevalence of malnutrition diagnosed by the Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment in older adult outpatients and comparison between the Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment energy-protein intake: A cross-sectional study. JPEN J Parenter Enteral Nutr 2021; 46:367-377. [PMID: 33893657 DOI: 10.1002/jpen.2123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) published malnutrition identification criteria. The Mini Nutritional Assessment (MNA) is malnutrition assessment tool commonly used in older adults. This study aimed to determine prevalence of malnutrition and the relationship between the GLIM and the MNA long form (MNA-LF) and short form (MNA-SF) and energy-protein intake. METHODS A total of 252 older adult outpatients (aged 68.0 years, 61% females) were included. Malnutrition was defined according to the GLIM, MNA-LF, and MNA-SF. Food intake was assessed using the 24-h dietary recall. We analyzed the cutoff value on the MNA-LF score, MNA-SF score, and energy-protein intake for GLIM criteria-defined malnutrition severity with receiver operating characteristic analysis. RESULTS Malnutrition was present in 32.2%, 12.7%, and 13.1% of patients according to the GLIM criteria, MNA-LF, and MNA-SF, respectively. It was determined that 92.7% and 89.0% of patients, based on GLIM criteria, had malnutrition with the MNA-LF and MNA-SF, respectively. The daily energy-protein intake was less in patients with malnutrition according to GLIM, as in the MNA-LF and MNA-SF classifications (p < .05). For the MNA-LF and MNA-SF score, the cutoff value of 11 and 9 points for severe malnutrition (area under curve [AUC] 0.92; p < .001 and 0.90; p < .001), 22 and 11 points for moderate malnutrition (AUC 0.79; p < .001 and 0.76; p < .001) were determined. CONCLUSION According to GLIM criteria, one-third of outpatient older adults were malnourished, whereas the prevalence was much lower applying both the MNA-LF and the MNA-SF.
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Affiliation(s)
- Nurhayat Tugra Ozer
- Department of Clinical Nutrition, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Sibel Akin
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Gulsah Gunes Sahin
- Department of Clinical Nutrition, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
| | - Serap Sahin
- Department of Clinical Nutrition, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
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Dwyer JT, Gahche JJ, Weiler M, Arensberg MB. Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. J Community Health 2021; 45:640-660. [PMID: 31571022 PMCID: PMC7188699 DOI: 10.1007/s10900-019-00739-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, 02111, USA
- Department of Medicine and Community Health, School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Mary Weiler
- Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA
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Kadosaka T, Nagai T, Suzuki S, Sakuma I, Akao M, Yamashita T, Anzai T, Okumura K. Association of Low Body Weight with Clinical Outcomes in Elderly Atrial Fibrillation Patients Receiving Apixaban-J-ELD AF Registry Subanalysis. Cardiovasc Drugs Ther 2021; 36:691-703. [PMID: 33830400 DOI: 10.1007/s10557-021-07180-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Although direct oral anticoagulants are effective and safe in preventing stroke in atrial fibrillation (AF) patients with low body weight, data remain limited in AF patients with extremely low body weight (<50 kg). We aimed to investigate the association of this body weight category with clinical outcomes in elderly AF patients receiving apixaban. METHODS The J-ELD AF Registry is a large-scale, multicenter prospective observational study of Japanese non-valvular AF patients aged ≥ 75 years taking on-label doses of apixaban. The entire cohort (3025 patients from 110 institutions) was divided into three body weight subgroups: >60 kg (n = 1019, 33.7%), 50-60 kg (n = 1126, 37.2%), and <50 kg (n = 880, 29.1%). RESULTS The event incidence rates (/100 person years) were 1.69, 1.82, and 1.23 for stroke or systemic embolism (P = 0.60); 1.37, 1.73, and 2.73 for bleeding requiring hospitalization (P = 0.154); 2.02, 2.67, and 4.92 for total death (P = 0.003); and 0.73, 0.95, and 1.23 for cardiovascular death (P = 0.57), respectively. After adjusting for confounders by Cox regression analysis, body weight <50 kg was not an independent risk for stroke or systemic embolism, bleeding requiring hospitalization, total death, or cardiovascular death. CONCLUSIONS The incidence of events in each body weight group was comparable for stroke or systemic embolism and bleeding requiring hospitalization, and body weight <50 kg might not be an independent risk for death in Japanese non-valvular AF patients aged ≥ 75 years taking on-label doses of apixaban.
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Affiliation(s)
- Takahide Kadosaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Ichiro Sakuma
- Department of Cardiovascular Medicine, Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Efthymiou A, Hersberger L, Reber E, Schönenberger KA, Kägi-Braun N, Tribolet P, Mueller B, Schuetz P, Stanga Z. Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial. Clin Nutr 2021; 40:1546-1554. [PMID: 33743290 DOI: 10.1016/j.clnu.2021.02.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The nutritional risk screening (NRS 2002) is a validated screening tool for malnutrition. This study aims to investigate the prognostic value of the NRS 2002 and its individual components regarding long-term mortality and adverse outcomes in a well-characterized cohort of medical inpatients. METHODS We performed a 5-year follow-up investigation of patients included in the investigator-initiated, prospective, randomized controlled multicenter EFFORT trial that evaluated the effects of individualized nutritional intervention vs. standard hospital food. We used multivariable cox regression analyses adjusted for randomisation arm, study centre, comorbidities and main admission diagnosis to investigate associations between NRS 2002 total scores at time of hospital admission and several long-term outcomes. RESULTS We had confirmed mortality data over the mean follow-up time of 3.2 years in 1874 from the initial cohort of 2028 EFFORT patients. Mortality showed a step-wise increase in patients with NRS 3 (289/565 [51.2%]) and NRS 4 (355/717 [49.6%]) to 59.5% (353/593) in patient with NRS≥5 corresponding to an adjusted Hazard Ratio (HR) of 1.28 (95%CI 1.15 to 1.42, p ≤ 0.001) for mortality after one year and 1.13 (95%CI 1.05 to 1.23, p = 0.002) for the overall time period. All individual components of NRS including disease severity, food intake, weight loss and BMI provided prognostic information regarding long-term mortality risk. CONCLUSION Nutritional risk mirrored by a NRS 2002 total score is a strong and independent predictor of long-term mortality and morbidity in polymorbid medical inpatients particularly in patients with high nutritional risk with an NRS ≥5 points.
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Affiliation(s)
- Andriana Efthymiou
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emilie Reber
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | | | | | | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Nishida T, Yamabe K, Honda S. The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults. Nutrients 2021; 13:nu13020512. [PMID: 33557341 PMCID: PMC7915146 DOI: 10.3390/nu13020512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9-8.2) and frailty status (OR: 2.3; 95% CI: 1.0-5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo 859-6305, Japan;
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
- Correspondence: ; Tel.: +81-95-819-7945
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Wahyuni S, Effendy C, Kusumaningrum FM, Dewi FST. Factors Associated with Independence for Elderly People in Their Activities of Daily Living. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i12021.44-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Health in the elderly does not merely refer to a condition free from disease but should also have elements regarding functionality and independence. Purpose: This study aimed to measure Activities of Daily Living (ADLs) and to identify the factors affecting ADLs among the elderly population in Sleman District. Methods: A cross-sectional study was carried out using secondary data from the Multidimensional Elderly Care project, nested on the Health Demographic and Surveillance System in Sleman, involving 549 elderly participants. The independence of these elderly people was measured using an Activities of Daily Living Scale questionnaire. Factors measured were cognitive (using the Mini-Mental State Examination questionnaire), psychological (using the Geriatric Depression Scale or Cornell Scale for Depression in Dementia questionnaires), economic (using the Financial Management Behavior Scale questionnaire), and nutritional status (using the Mini Nutritional Assessment questionnaire). The data were analyzed using the chi-square test, Fisher test, and Poisson test for bivariate analysis, while multivariate analysis using a logistic regression test. Results: The prevalence of elderly dependence was 14.03%. Elderly dependence was significantly related to age, job, residence, financial management, dementia, depression, malnutrition, and stroke disease in the bivariate analysis. However, after multivariate analysis, only age (>86 years) (PR = 4.31; 95% CI = 1.91–9.72), malnutrition (PR = 6.62; 95% CI = 3.79–11.57), and stroke (PR = 3.06; 95% CI = 2.03–4.61) were still shown to be related to elderly dependence. Conclusion: Increasing age, malnutrition, and stroke in elderly people lead to higher dependency in their ADLs.
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Chiang GSH, Nyunt MSZ, Gao Q, Wee SL, Yap KB, Tan BY, Ng TP. Primary Care Prognostic (PCP) Index of 11-Year Mortality Risk: Development and Validation of a Brief Prognostic Tool. J Gen Intern Med 2021; 36:62-68. [PMID: 32820420 PMCID: PMC7858716 DOI: 10.1007/s11606-020-06132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Healthcare providers use a life expectancy of at least 5 to 10 years in shared clinical decision-making with older adults about cancer screening, major surgeries, and disease prevention interventions. At present, few prognostic indexes predict long-term mortality beyond 10 years or are suited for use in primary care settings. OBJECTIVE We developed and validated an 8-item multidimensional index predicting 11-year mortality for use in primary care. DESIGN, SETTING, AND PARTICIPANTS Using data from the Singapore Longitudinal Ageing Studies (SLAS), we developed a Primary Care Prognostic (PCP) Index for predicting 11-year mortality risk in a development cohort (n = 1550) and validated it in a geographically different cohort (n = 928). MAIN MEASURES The PCP Index was derived from eight indicators (body mass loss, weakness, slow gait, comorbidity, polypharmacy, IADL/BADL dependency, low albumin, low total cholesterol, out of 25 candidate indicators) using stepwise Cox proportional hazard models. KEY RESULTS In the developmental cohort, the mortality hazard ratio increased by 53% per PCP point score increase, independent of age and sex. Across risk categories, absolute risks of mortality increased from 5% (score 0) to 67.9% (scores 7-9), with area under curve (AUC = 0.77 (95% CI 0.73-0.80)). The PCP Index also predicted mortality in the validation cohort, with AUC = 0.70 (95% CI 0.64-0.75). CONCLUSIONS The PCP Index using simple clinical assessments and point scoring is a potentially useful prognostic tool for predicting long-term mortality and is well suited for risk stratification and shared clinical decision-making with older adults in primary care.
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Affiliation(s)
| | | | - Qi Gao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Keng Bee Yap
- Department of Geriatric Medicine, Ng Teng Fong Hospital, Singapore, Singapore
| | - Boon Yeow Tan
- Department of Medicine, St Luke's Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute, Singapore, Singapore.
- Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.
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Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
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Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
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Nomura Y, Shimada M, Kakuta E, Okada A, Otsuka R, Tomizawa Y, Taguchi C, Arikawa K, Daikoku H, Sato T, Hanada N. Mortality-and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249584. [PMID: 33371399 PMCID: PMC7768389 DOI: 10.3390/ijerph17249584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
Mortality is obviously intended for epidemiological studies of community-dwelling older adults. There are several health-related factors associated with nutritional status and mortality. The aim of this study was to elucidate the risk factor for mortality in community-dwelling oldest-older adults at the age of 90 and clarify the structure of health-related factors associated with mortality. A 10-year follow-up study was performed for 93 subjects at the age of 90. The mean and median of their survival days were 2373 and 2581 days for women, and 1694 and 1793 days for men. By Cox's proportional hazards model, health-related factors associated with mortality were self-assessed for chewing ability, activities of daily living (ADLs), serum albumin, total cholesterol, serum creatinine, and gripping power for women but not for men. These factors interacted with each other, and the association of these factors was different in women and men. Self-assessed chewing ability was a powerful risk factor for mortality in women at the age of 90. It acted independently from nutritional status. For older adults, addressing healthy food choices together with improved oral functions is useful. However, risk factors for mortality may depend on the life stage of subjects. To investigate the risk factor for the mortality, the life course approach is necessary.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
- Correspondence: ; Tel.: +81-45-580-8462
| | - Mieko Shimada
- Department of Dental Hygiene, Chiba Prefectural University of Health Sciences, Chiba 261-0014, Japan;
| | - Erika Kakuta
- Department of Oral Bacteriology, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan;
| | - Ayako Okada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
| | - Ryoko Otsuka
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
| | - Yasuko Tomizawa
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Chieko Taguchi
- Department of Preventive and Public Oral Health, School of Dentistry at Matsudo, Nihon University, Matsudo 470-2101, Japan; (C.T.); (K.A.)
| | - Kazumune Arikawa
- Department of Preventive and Public Oral Health, School of Dentistry at Matsudo, Nihon University, Matsudo 470-2101, Japan; (C.T.); (K.A.)
| | - Hideki Daikoku
- Iwate Dental Association, Morioka 020-0045, Japan; (H.D.); (T.S.)
| | - Tamotsu Sato
- Iwate Dental Association, Morioka 020-0045, Japan; (H.D.); (T.S.)
| | - Nobuhiro Hanada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
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Lai X, Zhu H, Du H, Huo X, Yu K. Nutritional status of Chinese oldest-old adults (≥80 years of age): a cross-sectional study in Beijing. Eur J Clin Nutr 2020; 75:1040-1046. [PMID: 33323962 DOI: 10.1038/s41430-020-00826-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/29/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nutrition is associated with frailty, functional impairments, and mortality in elderly people. Only a few studies focused on oldest-old hospitalized patients with worse health and more comorbidities compared with the general older adults in China. OBJECTIVE This study aimed to investigate the nutritional risk, malnutrition, and nutritional support status of oldest-old hospitalized patients (≥80 years of age) in China, and to provide a basis for implementing an effective nutritional intervention. METHODS This study involved 358 oldest-old patients of Peking Union Medical College Hospital in China. The Nutrition Risk Screening 2002 scale was used to assess nutritional risk. Malnutrition was defined as body mass index (BMI) < 18.5 kg/m2; or unwanted weight loss >10% at any time, or unwanted weight loss >5% in recent 3 months and BMI < 22 kg/m2. Logistic regression analysis was used to identify factors associated with nutritional risk. RESULTS The overall frequency of nutritional risk and malnutrition was 50.3% (180/358) and 36.0% (129/358), respectively. Also, 134 (37.3%) patients received nutritional support; the ratio of parenteral nutrition (PN) to enteral nutrition (EN) was 1.35:1. Further, 106 (58.9%) patients with nutritional risk received nutritional support. The number of chronic diseases and age were protective factors, and activities of daily living (ADL) were risk factors. CONCLUSIONS The overall frequencies of nutritional risk and malnutrition of oldest-old hospitalized patients were high, and the rates of EN and PN were low. Nutritional risk was associated with the number of chronic diseases, age, and ADL.
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Affiliation(s)
- Xiaoxing Lai
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China.
| | - Hongwei Zhu
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Hongdi Du
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Xiaopeng Huo
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China.
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, 100730, Beijing, China
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Chew STH, Tan NC, Cheong M, Oliver J, Baggs G, Choe Y, How CH, Chow WL, Tan CYL, Kwan SC, Husain FS, Low YL, Huynh DTT, Tey SL. Impact of specialized oral nutritional supplement on clinical, nutritional, and functional outcomes: A randomized, placebo-controlled trial in community-dwelling older adults at risk of malnutrition. Clin Nutr 2020; 40:1879-1892. [PMID: 33268143 DOI: 10.1016/j.clnu.2020.10.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS The world's over-65 population is expanding rapidly, and the risk of malnutrition is prevalent in this population. Meeting nutritional needs is a recognized strategy to reduce and address multiple debilitating adverse health outcomes associated with malnutrition. The objective of this randomized, controlled trial was to determine the effects of oral nutritional supplement (ONS) containing beta-hydroxy-beta-methylbutyrate (HMB), along with dietary counseling, on health outcomes in community-dwelling older adults at risk of malnutrition. METHODS Strengthening Health In ELDerly through nutrition (SHIELD) studied adults aged ≥ 65 years in Singapore who were recruited between August 2017 and March 2019. Participants were community ambulant and classified as medium or high risk for malnutrition using Malnutrition Universal Screening Tool (MUST). Participants (n = 811) were randomly assigned to one of two study treatments for 180 days: (i) two servings/day of ONS containing HMB with dietary counseling (n = 405) or (ii) two servings/day of placebo supplement with dietary counseling (n = 406). The primary composite outcome was 'survival without hospital (re)admission and with at least 5% weight gain to day 180'. Dietary intakes, nutritional and functional outcomes were measured at baseline, 30, 90, and 180 days. RESULTS A higher proportion in intervention group met the 180-day primary composite outcome compared to placebo (33.4% vs. 8.7%, P < 0.001), largely driven by body weight component (36.2% vs. 9.4%, P < 0.001). Survival and hospital (re)admission rate were not significantly different between the groups. Weight, BMI, and mid upper arm circumference were significantly greater in the intervention group compared to placebo during the study (all P < 0.001), and at days 30, 90, and 180 (all P < 0.05). The odds of having better nutritional status during the study were also significantly higher in the intervention group compared to placebo, as measured using MUST risk (OR = 2.68, P < 0.001) and vitamin D status (OR = 4.23, P < 0.001). Intervention group had significantly higher energy, protein, fat, and carbohydrate intakes than the placebo group (all P ≤ 0.017). Leg strength at day 90 was significantly greater for the intervention group than for the placebo group (LSM ± SE: 12.85 ± 0.22 vs. 12.17 ± 0.22; P = 0.030). Handgrip strength for females was significantly higher at day 180 for the intervention group compared to placebo (LSM ± SE: 14.18 ± 0.17 vs. 13.70 ± 0.17; P = 0.048). Within the low appendicular skeletal muscle mass index (ASMI) subgroup, the intervention group had significantly greater calf circumference at days 90 and 180 compared to placebo (both P ≤ 0.0289). CONCLUSIONS For community-dwelling older adults at risk of malnutrition, daily consumption of specialized ONS containing HMB and vitamin D for six months, along with dietary counseling, significantly improved nutritional and functional outcomes compared to placebo supplement with dietary counseling. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.govNCT03245047.
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Affiliation(s)
- Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore; SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore
| | - Magdalin Cheong
- Department of Dietetic & Food Services, Changi General Hospital, Singapore
| | - Jeffery Oliver
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | - Geraldine Baggs
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | - Yong Choe
- Abbott Nutrition Research and Development, Columbus, OH, USA
| | - Choon How How
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore; Care and Health Integration, Changi General Hospital, Singapore
| | - Wai Leng Chow
- Health Services Research, Changi General Hospital, Singapore
| | | | | | | | - Yen Ling Low
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore
| | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore
| | - Siew Ling Tey
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore
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Shinohara M, Wada R, Yano K, Akitsu K, Koike H, Kinoshita T, Fujino T, Ikeda T. Relationship between the nutritional status and safety and efficacy outcomes in atrial fibrillation patients aged 80 years and over receiving oral anticoagulants. J Cardiol 2020; 77:147-153. [PMID: 33371946 DOI: 10.1016/j.jjcc.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/30/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malnutrition has been reported to be associated with worse clinical outcomes in various cardiovascular diseases. We aimed to investigate the clinical significance of the nutritional status in atrial fibrillation (AF) patients aged 80 years and over receiving oral anticoagulants (OACs), focusing on the difference between direct OACs (DOACs) and warfarin treatment. METHODS This was a retrospective and observational study. We enrolled 332 consecutive AF patients aged 80 years and over who were treated with OACs: DOACs (n = 256) and warfarin (n = 76). A controlling nutritional status (CONUT) score was used to evaluate the nutritional status. The enrolled patients were divided into two groups based on the CONUT score: CONUT score <5 (n = 239) and CONUT score ≥5 (n = 93) groups. We investigated the relationship between the nutritional status and clinical outcomes. RESULTS The CONUT score ≥5 group had significantly higher incidence of major bleeding (MB) compared to the CONUT score <5 group (4.6/100 person-years vs. 0.7/100 person-years, p < 0.01). On Cox hazard analysis, CONUT score ≥5 group was significantly associated with increased MB compared with the CONUT score <5 group (hazard ratio: 5.80, 95% confidence interval: 1.44-23.33, p = 0.013). In the DOAC group, the incidence of MB did not differ between the CONUT score ≥5 and CONUT score <5 groups (p = 0.54). In the warfarin group, MB occurred more frequently in the CONUT score ≥5 group than CONUT score <5 group (p < 0.01). There was no significant difference in the incidence of thromboembolic events between the CONUT score ≥5 and CONUT score <5 groups in both the DOAC and warfarin groups. CONCLUSIONS The prognostic values of the nutritional status based on the CONUT score for MB differed between AF patients aged 80 years and over receiving DOACs and those receiving warfarin. It may be favorable to use DOACs to avoid bleeding events in those with malnutrition.
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Affiliation(s)
- Masaya Shinohara
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
| | - Ryo Wada
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kensuke Yano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Katsuya Akitsu
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hideki Koike
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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Lau S, Pek K, Chew J, Lim JP, Ismail NH, Ding YY, Cesari M, Lim WS. The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults. Nutrients 2020; 12:nu12092885. [PMID: 32967354 PMCID: PMC7551805 DOI: 10.3390/nu12092885] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research.
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Affiliation(s)
- Sabrina Lau
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
- Correspondence: ; Tel.: +65-6359-6474
| | - Kalene Pek
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Noor Hafizah Ismail
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20122 Milan, Italy
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
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Bakhtiari A, Pourali M, Omidvar S. Nutrition assessment and geriatric associated conditions among community dwelling Iranian elderly people. BMC Geriatr 2020; 20:278. [PMID: 32762725 PMCID: PMC7409695 DOI: 10.1186/s12877-020-01668-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although malnutrition risk is well documented in elderly care institutions, few studies have been conducted to address concerns regarding community-dwelling elderly people. This study has been aimed to describe the nutritional status and its related socioeconomic and geriatric factors in community-dwelling elders with malnutrition. Method For this study, a randomized sampling among people aged 60 has been done (n = 326). Information on nutrition status (full MNA) and health information, like cognitive status (MMSE), daily functional status (ADL and IADL scales) and frailty was obtained. Multiple logistic regression analyses have been carried out, in order to identify the association of demographical and clinical factors with malnutrition. Results 28.1% of the participants suffered from poor nutrition. In the binary analysis, low MNA scores were associated with increasing age, female gender, lower education level, financial dependence, solitary life, poor self-rated health, multiple physical disabilities and chronic disease, polypharmacy, smoking, functional and cognitive decrease and frailty. In the final model of the multivariate analysis, living alone (OR:1.249,CI:1.105–2.620), multiple physical disabilities (OR:2.183,CI:1.246 ± 3..250) and chronic disease (OR: 2.148,CI:1.167–2.879) were independently associated with malnutrition. Also financial independency (OR:0.625,CI:0.233–0.938), functional ability on ADL (OR:0.536,CI:0.327–0.976) and IADL (OR:0.319,CI:0.194–0.856), normal cognitive (OR:0.456,CI:0.293–0.934) and no frailty (OR:0.253,CI:0.117–0.729) independently were inversely associated with malnutrition. The model was adjusted for all socio- demographic and health variables that were significantly related in the previous models. Conclusions Our results indicated a strong correlation between malnutrition and health status. Identifying predictive factors can potentially improve prevention and management strategies used for malnutrition in elderly.
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Affiliation(s)
- Afsaneh Bakhtiari
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran
| | - Mahbobeh Pourali
- Department of Nursing, Babol School of Midwifery Nursing, Babol University of Medical Sciences, Babol, Iran
| | - Shabnam Omidvar
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran.
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A narrative review of healthcare financing and reimbursement of nutritional support for patients in Singapore. Health Policy 2020; 124:1146-1154. [PMID: 32624248 DOI: 10.1016/j.healthpol.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
AIMS Nutritional support is used frequently in Singapore's healthcare settings, but limited research has been published on how it is financed. This paper aims to provide a narrative review on the financing of nutritional support in Singapore for acute care, step-down care, intermediate and long-term care (ILTC), community and home settings. METHODS A structured search strategy was applied to available electronic databases using selected search terms, with additional reports and grey literature identified using iterative searches. RESULTS A limited number of publications were found via electronic databases. The majority of publications were from governmental reports/ press releases, and healthcare organizations' websites. While funds are available via MediSave, MediShield Life, MediFund, and various other schemes, they may not be sufficient for individuals on long-term nutritional support. CONCLUSIONS More funding sources for nutritional support are urgently required for patients in ILTC. Means-testing mechanism and targeting may need to improve to ensure access to financial assistance for nutritional support and prevent poorer outcomes and higher medical costs. Medical providers, dietitians, pharmacists and social workers play a role in determining need, prescribing and accessing nutritional support for optimal care of individuals in hospitals and ILTC. Future policies will need to address the issues of access to nutritional support in the elderly and low-income populations.
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Bouëtté G, Esvan M, Apel K, Thibault R. A visual analogue scale for food intake as a screening test for malnutrition in the primary care setting: Prospective non-interventional study. Clin Nutr 2020; 40:174-180. [PMID: 32430249 DOI: 10.1016/j.clnu.2020.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS The Self-Evaluation of Food Intake (SEFI®) is a simple tool to assess food intake that correlates well with the diagnosis of malnutrition in the hospital setting. AIMS to evaluate the validity of SEFI® for the diagnosis of malnutrition among adults in the primary care setting (primary aim); to assess the prevalence of malnutrition, the feasibility of the SEFI® and the variables associated with malnutrition (secondary aims). METHODS A non-interventional prospective study on consecutive patients at three primary care practices. Primary endpoint: confrontation of a SEFI® visual analogue scale score <7/10 with the diagnosis of malnutrition as defined by the Global Leadership Initiative on Malnutrition criteria. Secondary endpoints: the proportion of patients for whom a SEFI® score was collected. Multivariate analysis: threshold α = 0.20 in univariate analyses, step-by-step logistic regression. RESULTS Among 747 eligible patients, 505 were included: mean age (±SD) 56 ± 19 yrs, 61% female, 49% presenting with acute medical problems, 15.8% (n = 80) with SEFI® score <7/10, and 4.2% (n = 21) with malnutrition. The predictive performance of the SEFI® score <7 for the diagnosis of malnutrition was good (AUC = 0.82 [95% confidence interval (CI), 0.72-0.92]): sensitivity 76.2% (n = 16/21, [58.0-94.4]), specificity 86.8% (n = 420/484, [83.8-89.8]), positive predictive value 20.0% (n = 16/80, [11.2-28.8]), and negative predictive value 98.8% (n = 420/425, [97.8-99.8]). The feasibility of the SEFI® 10-point visual analogue scale was 100% (505/505). The variables independently associated with malnutrition were: female gender (odds ratio 4.9 [95% CI, 1.7-14.2], P = 0.003), cancer (4.8 [1.4-15.9], P = 0.011) and chronic alcohol consumption (7.4 [1.3-41.4], P = 0.023). CONCLUSIONS The prevalence of malnutrition was 4.2% in this primary care setting. The SEFI® visual analogue scale for food intake is feasible and could be helpful for the diagnosis of malnutrition in this setting.
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Affiliation(s)
| | - Maxime Esvan
- Centre d'Investigation clinique, INSERM 1414, CHU Rennes, Univ Rennes, Rennes, France
| | - Katharina Apel
- Département de Médecine Générale, Univ Rennes, Rennes, France
| | - Ronan Thibault
- Unité de Nutrition, CHU Rennes, INRA, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France.
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Sebastião E. Activity behavior and cognitive performance in older adults living in a senior housing facility: the impact of frailty status. Aging Clin Exp Res 2020; 32:703-709. [PMID: 31243743 DOI: 10.1007/s40520-019-01254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Frailty, a condition characterized by a reduced physiological reserve and resilience, is highly prevalent among older adults. AIMS This study examined differences in physical activity (PA) level, sedentary behavior (SB) time, and cognitive performance in older adults living in a senior housing facility (SHF) as a function of frailty status. METHODS This study assessed 100 older adults from a SHF in the Midwest area of the United States. Participants were categorized as frail or non-frail according to scores observed in the short physical performance battery (SPPB), using the cutoff of nine previously stated in the literature. PA level and SB time were self-reportedly assessed using the physical activity scale for the elderly (PASE) and SB using a specific questionnaire developed for the older adult population. Cognitive performance was assessed using a collection of tests measuring cognitive processing speed, verbal learning, visuospatial memory, and verbal fluency. RESULTS Frail and non-frail older adults reported similar PA level and SB time (P > .05). Frail older adults performed significantly (P < .05) worse than their counterparts, non-frail in all measures of cognitive function. However, after controlling the analysis for age, only processing speed (SDMT scores) remained statistically different (P < .05) between groups. DISCUSSION/CONCLUSION Older adults living in a SHF with different frailty status (i.e., frail vs. non-frail) report similar levels of PA level and SB time; but our findings suggest that non-frail older adults appear to have better cognitive function in terms of processing speed compared to the frail group.
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Taburee W, Sirilak S, Khotcharrat R, Anekpunyakul P, Dilokthornsakul P, Lukkahatai N, Boongird C. Health-Related Problems and Drivers of Health-Related Quality of Life Among Community-Dwelling Older Adults. J Prim Care Community Health 2020; 11:2150132720913724. [PMID: 32189548 PMCID: PMC7082868 DOI: 10.1177/2150132720913724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The aims of this study were to explore prevalence of health-related problems and identify factors associated with health-related quality of life (HRQOL) among community-dwelling older adults (CDOAs) in rural Thailand. Methods: A total of 384 CDOAs with mean age of 71 years (SD = 7.6) were recruited. The Thai Ministry of Public Health’s comprehensive geriatric assessment (CGA) was used to measure the CDOAs’ health conditions in the primary care unit of community hospitals. HRQOL of the participants was assessed by using the EQ-5D questionnaire. Results: The results showed that the most common health-related problems were risk of glaucoma (89.6%) and hypertension (64.6%). The HRQOL were predicted by the incidence of falls (β = −0.076, P < .001), Timed Up and Go Test (β = −0.087, P < .001), and age (β = −0.667, P = .002). Discussion: This study highlighted the need to incorporate CGA in family practice, which included risk of falls assessment by measuring TUG test, fall prevention, and to provide resources for caring older adults at home which ultimately will improve CDOAs’ quality of life.
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Predictive value of the geriatric nutritional risk index in percutaneous coronary intervention with rotational atherectomy. Heart Vessels 2020; 35:887-893. [PMID: 31970508 DOI: 10.1007/s00380-020-01558-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
The prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing percutaneous coronary intervention (PCI) with rotational atherectomy (RA) remains unknown. Therefore, we aimed to clarify whether the GNRI could predict major adverse cardiac events (MACE) in patients undergoing PCI with RA. A total of 206 patients who underwent PCI with RA from January 2009 to December 2017 were retrospectively tracked. The patients were divided into 2 groups based on the GNRI value on admission. MACE comprised all-cause death, target lesion revascularization (TLR), target vessel revascularization (TVR), and myocardial infarction. One year of follow up was completed in 95.6% of patients. During this period, 50 cases of MACE were observed (all-cause death, 32 cases; TLR, 21 cases; and TVR, 2 cases). Patients with a low GNRI (< 98) had a significantly higher incidence of MACE than did patients with a high GNRI (≥ 98) (37.9% vs. 15.5%, log-rank p < 0.05). The GNRI was an independent predictor of MACE (hazard ratio, 0.94; 95% confidence interval [CI], 0.92-0.97). Furthermore, the GNRI had better predictive power than did its components alone (i.e. body mass index and serum albumin level) (net-reclassification improvement, 0.39; 95% CI, 0.07-0.71; p = 0.01; integrated discrimination improvement, 0.02; 95% CI, - 0.01-0.04; p = 0.07). The GNRI on admission is a predictor of MACE after PCI with RA. Further studies are required to determine whether intensive medical therapy could improve clinical events, particularly cardiovascular death and revascularization, in this population.
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85
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Cheong CY, Nyunt MSZ, Gao Q, Gwee X, Choo RWM, Yap KB, Wee SL, Ng TP. Risk Factors of Progression to Frailty: Findings from the Singapore Longitudinal Ageing Study. J Nutr Health Aging 2020; 24:98-106. [PMID: 31886815 DOI: 10.1007/s12603-019-1277-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate risk factors of incident physical frailty. DESIGN A population-based observational longitudinal study. SETTING Community-dwelling elderly with age 55 years and above recruited from 2009 through 2011 in the second wave Singapore Longitudinal Ageing Study-2 (SLAS-2) were followed up 3-5 years later. PARTICIPANTS A total of 1297 participants, mean age of 65.6 ±0.19, who were free of physical frailty. MEASUREMENTS Incident frailty defined by three or more criteria of the physical phenotype used in the Cardiovascular Health Study was determined at follow-up. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological factors, and biochemical markers. RESULTS A total of 204 (15.7%) participants, including 81 (10.87%) of the robust and 123 (22.28%) of the prefrail transited to frailty at follow-up. Age, no education, MMSE score, diabetes, prediabetes and diabetes, arthritis, ≥5 medications, fair and poor self-rated health, moderate to high nutritional risk (NSI ≥3), Hb (g/dL), CRP (mg/L), low B12, low folate, albumin (g/L), low total cholesterol, adjusted for sex, age and education, were significantly associated (p<0.05) with incident frailty. In stepwise selection models, age (year) (OR=1.07, 95%CI=1.03-1.10, p<0.001), albumin (g/L) (OR=0.85, 95%CI=0.77-0.94, p=0.002), MMSE score (OR=0.88, 95%CI=0.78-0.98, p=0.02), low folate (OR=3.72, 95%CI=1.17-11.86, p=0.03, and previous hospitalization (OR=2.26, 95%CI=1.01-5.04,p=0.05) were significantly associated with incident frailty. CONCLUSIONS The study revealed multiple modifiable risk factors, especially related to poor nutrition, for which preventive measures and early management could potentially halt or delay the development of frailty.
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Affiliation(s)
- C Y Cheong
- Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478,
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de Sousa OV, Mendes J, Amaral TF. Nutritional and Functional Indicators and Their Association With Mortality Among Older Adults With Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2020; 35:1533317520907168. [PMID: 32088972 PMCID: PMC10624010 DOI: 10.1177/1533317520907168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
This study investigated how different nutritional and functional status indicators are associated with mortality in patients with Alzheimer's disease (AD). A prospective cohort study was conducted among 79 community-dwelling older adults with AD. Follow-up was 60 months. Undernutrition status was evaluated by Mini Nutritional Assessment (MNA), body mass index, mid-arm muscle circumference (MAMC), calf circumference, and phase angle. Functional status was assessed by handgrip strength, and usual gait speed. Twenty-two participants died (27.8%). Results show that undernutrition (hazard ratio [HR] 5.69, 95% confidence interval [CI] 2.21-14.61), weight loss (HR 3.82, 95% CI 1.37-10.63), underweight (HR 3.24, 95% CI 1.18-8.82), low MAMC (HR 4.54, 95% CI 1.65-12.48), calf circumference ≤ 31 (HR 4.27, 95% CI 1.63-11.16), low HGS (HR 3.11, 95% CI 1.18-8.17), and low gait speed (HR 4.73, 95% CI 1.68-13.27) were all associated with mortality. In conclusion, a poor nutritional and functional status was associated with a higher risk of mortality, regardless of sex, age, marital status, education, and cognitive function.
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Affiliation(s)
- O. Vicente de Sousa
- Psychogeriatrics Unit of Hospital de Magalhães Lemos E.P.E., Porto, Portugal
- UNIFAI/ICBAS (Research and Education Unit on Aging), Department of Behavioral Sciences, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - J. Mendes
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Department of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Porto, Portugal
- I3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - T. F. Amaral
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- UISPA-IDMEC, Faculty of Engineering, University of Porto, Porto, Portugal
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Liu W, Chen S, Jiang F, Zhou C, Tang S. Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China. J Nutr Health Aging 2020; 24:500-506. [PMID: 32346688 DOI: 10.1007/s12603-020-1348-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the association between malnutrition and physical frailty among nursing home older adults in China. DESIGN AND SETTING A cross-sectional study in 15 nursing homes in Changsha, China. PARTICIPANTS A total of 705 nursing home residents who were aged 60 and older. MEASUREMENTS Physical frailty was identified based on the following five components: slow gait speed, low physical activity, weight loss, exhaustion, and low grip strength. Nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression models were used to analyze the association between nutritional status and physical frailty. RESULTS The mean (SD) age of the participants was 82.5 (8.1) years old (range, 60-106 years), and 226 (32%) was men. Of those participants, 5.1% and 55.6% were malnourished and at risk of malnutrition, respectively; 60.3% and 36.2% were identified as being frail and prefrail, respectively. Compared with participants who were well-nourished, those who were at risk of malnutrition or malnourished were two times more likely to be physically frail (adjusted odds ratio 2.66, 95% confidence interval 1.01 to 7.00), after adjustment for age, education level, cognitive status, depressive symptoms, and disability in activities of daily living. No significant association was observed between malnutrition and physical prefrailty. CONCLUSION Our findings suggest that poor nutritional status and physical frailty are highly prevalent in nursing home older adults in China, and that poor nutritional status is associated with increased odds of physical frailty.
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Affiliation(s)
- W Liu
- Dr. Siyuan Tang, Xiangya Nursing School of Central South University, 172 Tongzipo Road, YueLu District, Changsha, Hunan 41000, China, Tel.: +86 73182650263; Fax: +86 73182650263, E-mail: ; Dr. Sanmei Chen, Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi Ward, Fukuoka 812-8582, Japan, Phone: +81 92 642 6151; Fax: +81 92 642 4854, E-mail:
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Myostatin dysfunction is associated with lower physical activity and reduced improvements in glucose tolerance in response to caloric restriction in Berlin high mice. Exp Gerontol 2019; 128:110751. [DOI: 10.1016/j.exger.2019.110751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/06/2019] [Accepted: 10/13/2019] [Indexed: 12/16/2022]
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Banning LBD, Ter Beek L, El Moumni M, Visser L, Zeebregts CJ, Jager-Wittenaar H, Pol RA. Vascular Surgery Patients at Risk for Malnutrition Are at an Increased Risk of Developing Postoperative Complications. Ann Vasc Surg 2019; 64:213-220. [PMID: 31634605 DOI: 10.1016/j.avsg.2019.10.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malnutrition is an important risk factor for adverse postoperative outcomes such as infection and delayed wound healing, often resulting in longer hospital stay and higher readmission and mortality rates. The aim of this study is to assess the relationship between the risk for malnutrition prior to elective vascular surgery and postoperative complications. METHODS In this observational cross-sectional study, elective vascular surgery patients were included from January 2015 until November 2018. Included were percutaneous, carotid, endovascular, peripheral bypass, abdominal, lower extremity amputation, and other interventions. The patients were assessed for risk for malnutrition using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), whereby <4 points was defined as low risk, 4-8 points as medium risk, and ≥9 points as high risk for malnutrition. Postoperative complications were registered using the Comprehensive Complication Index. Univariate and multivariate analyses were performed to evaluate the relationship between risk for malnutrition and postoperative complications. RESULTS Of 468 patients, 113 (24.1%) were found to be at risk for malnutrition (PG-SGA SF ≥4 points). Occurrence of postoperative complications (23.9% in the low risk vs. 51.9% in the high risk group, P = 0.006), length of hospital stay (5.5 ± 4.3 days in the low risk vs. 8.2 ± 5.1 in the high risk group, P = 0.005), 30-day readmission (4.7% in the low risk vs. 19.2% in the high risk group, P = 0.009), and Comprehensive Complication Index (median score of 0 in the low risk vs. 8.7 in the high risk group, P = 0.018) varied significantly between the 3 PG-SGA SF groups. After multivariate analysis, the medium risk for malnutrition group had a 1.39 (95% confidence interval 1.05-1.84) times higher Comprehensive Complication Index than the low risk for malnutrition group (P = 0.02). CONCLUSIONS Electively operated vascular surgery patients at risk for malnutrition are more likely to develop postoperative complications. This finding suggests that improving the nutritional status of vascular surgery patients prior to surgery has the potential to reduce the risk of complications.
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Affiliation(s)
- Louise B D Banning
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lies Ter Beek
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Linda Visser
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Roberts PS, Aronow HU, Parker J, Riggs RV. Measuring Frailty in Inpatient Rehabilitation. PM R 2019; 12:356-362. [PMID: 31622049 DOI: 10.1002/pmrj.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 10/07/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND In response to the global aging population, there has been increasing research on frailty. How frailty is conceptualized is shifting with the development of frailty models, especially in the acute care arena. OBJECTIVE To explore frailty/vulnerability risk factors available at admission that were associated with salient patient outcomes within the context of inpatient rehabilitation. DESIGN Methodologies in acute care are not easily adapted for a typical admission evaluation or a rehabilitation patient. In this study, the concept of frailty among patients admitted to rehabilitation was developed from risk factors available at admission that were associated with two patient outcomes, adverse hospital outcomes and 30-day hospital readmissions. SETTING Inpatient rehabilitation. PATIENTS Data were included on all patients (n = 768) discharged from an inpatient rehabilitation unit of an academic medical center from 1 January 2012 through 31 December 2012. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Adverse events within the inpatient rehabilitation stay and 30-day hospital readmissions. RESULTS Significant independent factors associated with adverse events in the rehabilitation unit included African American (1.77 OR; 95% CI 1.06-2.96), Hispanic (3.17 OR; 95% CI 1.13-8.94), having >9 total comorbid conditions (1.44 OR; 95% CI 1.244-1.66), and sphincter control domain (including bladder and bowel management) ≤ 9 FIM (0.92 OR; 95% CI 0.86-0.98). For 30-day readmission three variables were found to be significant: onset ≥7 days (2.31 OR; 95% CI 1.28-4.22), requiring a tube for feeding (3.45 OR; 95% CI 1.433-11.12), and being obese (4.72 OR; 95% CI 1.433-15.58). CONCLUSIONS The findings highlight the need for early admission screening and identification of risk factors which can provide the time in the rehabilitation setting for the clinical team to treat and prevent the potential for poor outcomes.
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Affiliation(s)
- Pamela S Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA.,Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, CA
| | - Harriet U Aronow
- Department of Nursing Research and Performance Improvement, Cedars-Sinai, Los Angeles, CA
| | - Jordan Parker
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA
| | - Richard V Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA.,Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, CA
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Association between Food Store Availability and the Incidence of Functional Disability among Community-Dwelling Older Adults: Results from the Japanese Gerontological Evaluation Cohort Study. Nutrients 2019; 11:nu11102369. [PMID: 31590318 PMCID: PMC6835243 DOI: 10.3390/nu11102369] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
This study sought to clarify the association between food store availability and the incidence of disability in older adults. This study utilized a population-based cohort study of independent Japanese adults aged ≥65 years, which was a 6 year follow-up of participants in the Japan Gerontological Evaluation Study. A total of 31,273 respondents were extracted. Food store availability was evaluated based on the existence of food stores within 500/1000 m of the home. We utilized participant-reported subjective measurement as well as geographic information system-based objective measurement for the evaluation. The incidence of disability was determined using municipal data on eligibility for long-term care insurance benefits. There were 7643 (24.4%) community-dwelling participants with low subjective food store availability and 5673 (18.1%) with low objective food store availability. During the follow-up period of 6 years, the cumulative incidence of disability was 20.9%, with a significant association between low subjective food store availability and increased disability. Participants who reported low subjective food store availability had a significantly higher likelihood of developing disability (hazard ratio = 1.18, 95% confidence interval: 1.11-1.25) than those who reported high subjective food store availability after adjusting for age, sex, sociodemographic status, environmental status, walking and going out, dietary food intake, body mass index, and comorbidities. Low subjective food store availability was associated with early onset of disability. Accessibility of food stores might contribute to maintaining a disability-free life.
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92
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Wang YC, Liang CK, Hsu YH, Peng LN, Chu CS, Liao MC, Shen HC, Chou MY, Lin YT. Synergistic effect of low handgrip strength and malnutrition on 4-year all-cause mortality in older males: A prospective longitudinal cohort study. Arch Gerontol Geriatr 2019; 83:217-222. [DOI: 10.1016/j.archger.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
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Versteeg AL, van Tol FR, Lehr AM, Oner FC, Verlaan JJ. Malnutrition in patients who underwent surgery for spinal metastases. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:213. [PMID: 31297378 DOI: 10.21037/atm.2019.04.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Malnutrition is common among cancer patients and has been associated with increased morbidity and mortality. The primary objective of this study was to evaluate the nutritional status of patients who underwent surgical treatment for spinal metastases. In addition, the association between nutritional status and length of stay, health related quality of life (HRQOL), the occurrence of adverse events and survival was investigated. Methods A single center prospective observational cohort study including patients with spinal metastases who underwent surgical treatment was performed. Demographic, diagnostic, treatment, and HRQOL (SOSGOQ2.0 and EQ-5D-3L) data were prospectively collected at baseline and 12 weeks post-treatment. Nutritional status was evaluated with the Patient-Generated Subjective Global Assessment (PG-SGA). Results A total of 39 patients were included. Malnutrition as determined by the PG-SGA was present in 36 (92%) of the patients, of whom 32 (82%) were moderately malnourished and 4 (10%) were severely malnourished. Malnourishment was associated with lower baseline SOSGOQ2.0 total scores, SOSGOQ2.0 physical function, mental health and social functioning scores, EQ-5D total scores and EQ-5D mobility scores. No association between malnutrition and survival could be determined. Conclusions The prevalence of malnutrition among surgically treated patients with spinal metastases is high. Malnutrition demonstrated to be associated with lower baseline HRQOL scores. Future larger studies are needed to further investigate the prognostic significance of malnutrition.
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Affiliation(s)
- Anne L Versteeg
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris R van Tol
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Mechteld Lehr
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Cumhur Oner
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Update on Interventions to Prevent or Reduce Frailty in Community-Dwelling Older Adults: a Scoping Review and Community Translation. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0277-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Background Recently frailty has drawn significant interest as an important predictor of several clinically relevant outcomes. There is no widely accepted instrument for the assessment of frailty and most of the current ones evaluate only physical features. The Tilburg Frailty Indicator (TFI) is a valid and reliable instrument which enables multidimensional assessment of frailty. We aimed to adapt and evaluate the Turkish version of the TFI. Methods We translated and culturally adapted the English version of the TFI into Turkish using standard guidelines. We enrolled consecutive patients who were 70 years old or older and were admitted to our outpatient geriatrics clinic. We used Cronbach’s alpha values to evaluate the internal consistency and also assessed inter-observer and test–retest variability using intraclass correlation coefficient (ICC). Results The Cronbach’s alpha reliability coefficients of the instrument ranged from 0.65 to 0.72 and item-total correlation ranged between −0.05 and 0.57. There was a good agreement between two assessments (ICC=0.99) and between two observers (ICC=0.99). Conclusion We have shown the reliability of the Turkish version of the TFI as a tool to evaluate frailty in a multidimensional manner among the Turkish outpatient population.
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Affiliation(s)
- Yildiray Topcu
- Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey,
| | - Fatih Tufan
- Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey,
| | - Cihan Kilic
- Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey,
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