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Cristina NM, Lucia D. Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases. Nutrients 2021; 13:4337. [PMID: 34959889 PMCID: PMC8706789 DOI: 10.3390/nu13124337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 12/16/2022] Open
Abstract
Nutritional well-being is a fundamental aspect for the health, autonomy and, therefore, the quality of life of all people, but especially of the elderly. It is estimated that at least half of non-institutionalized elderly people need nutritional intervention to improve their health and that 85% have one or more chronic diseases that could improve with correct nutrition. Although prevalence estimates are highly variable, depending on the population considered and the tool used for its assessment, malnutrition in the elderly has been reported up to 50%. Older patients are particularly at risk of malnutrition, due to multiple etiopathogenetic factors which can lead to a reduction or utilization in the intake of nutrients, a progressive loss of functional autonomy with dependence on food, and psychological problems related to economic or social isolation, e.g., linked to poverty or loneliness. Changes in the aging gut involve the mechanical disintegration of food, gastrointestinal motor function, food transit, intestinal wall function, and chemical digestion of food. These alterations progressively lead to the reduced ability to supply the body with adequate levels of nutrients, with the consequent development of malnutrition. Furthermore, studies have shown that the quality of life is impaired both in gastrointestinal diseases, but especially in malnutrition. A better understanding of the pathophysiology of malnutrition in elderly people is necessary to promote the knowledge of age-related changes in appetite, food intake, homeostasis, and body composition in order to better develop effective prevention and intervention strategies to achieve healthy aging.
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Affiliation(s)
- Neri Maria Cristina
- Division of Gastroenterology, Geriatric Institute Pio Albergo Trivulzio, 20146 Milan, Italy
| | - d’Alba Lucia
- Department of Gastroenterology and Endoscopy, San Camillo Forlanini Hospital, 00149 Rome, Italy;
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Hiltunen K, Saarela RKT, Kautiainen H, Roitto HM, Pitkälä KH, Mäntylä P. Relationship between Fried's frailty phenotype and oral frailty in long-term care residents. Age Ageing 2021; 50:2133-2139. [PMID: 34473831 PMCID: PMC8581380 DOI: 10.1093/ageing/afab177] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND oral frailty (OFr) may be called a syndrome lacking a consensus on its definition. OBJECTIVE the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care. DESIGN the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition. SETTING participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs). SUBJECTS the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland. METHODS frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination. RESULTS a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties. CONCLUSIONS OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.
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Affiliation(s)
- Kaija Hiltunen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Riitta K T Saarela
- City of Helsinki, Department of Social Services and Health Care, Oral Health Care, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Folkhälsan, Helsinki, Finland
| | - Hanna-Maria Roitto
- City of Helsinki, Department of Social Services and Health Care, Oral Health Care, Helsinki, Finland
- Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Päivi Mäntylä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
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Cuvelier N, Bartell SM. Shrinkage estimation of long-term water ingestion rates. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:990-998. [PMID: 33603092 DOI: 10.1038/s41370-021-00300-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Water consumption is a necessity for human life, though it also presents an opportunity for exposure to harmful chemicals and toxins. In order to gain a better understanding of the potential levels of chronic exposure, accurate estimates of long-term water consumption are needed. OBJECTIVE The objective of this study is to estimate long-term water consumption using a nationally representative sample of the US population. METHODS In this study, we use a random effects model to obtain shrinkage estimates of average daily water consumption for National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2010, and compare to their empirical 2-day averages. RESULTS Our results demonstrate that the shrinkage estimates yielded a reduction in estimated mean water consumption. The 95th percentile was reduced from 3292 to 2529 ml/day. In addition, standard deviation of water consumption for this group decreased from 1052 to 688 ml/day. Similar reductions in the mean and variance were observed stratifying by age and race. SIGNIFICANCE Random effects models may provide a more accurate measure of daily water consumption and could be utilized for future exposure and risk assessments.
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Affiliation(s)
- Nicholas Cuvelier
- Program in Public Health, University of California, Irvine, CA, USA.
| | - Scott M Bartell
- Program in Public Health, University of California, Irvine, CA, USA
- Department of Environmental and Occupational Health, University of California, Irvine, CA, USA
- Department of Statistics, University of California, Irvine, CA, USA
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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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Microwave Hydration Monitoring: System Assessment Using Fasting Volunteers. SENSORS 2021; 21:s21216949. [PMID: 34770259 PMCID: PMC8587514 DOI: 10.3390/s21216949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 12/03/2022]
Abstract
Hydration is an important aspect of human health, as water is a critical nutrient used in many physiological processes. However, there is currently no clinical gold standard for non-invasively assessing hydration status. Recent work has suggested that permittivity in the microwave frequency range provides a physiologically meaningful metric for hydration monitoring. Using a simple time of flight technique for estimating permittivity, this study investigates microwave-based hydration assessment using a population of volunteers fasting during Ramadan. Volunteers are measured throughout the day while fasting during Ramadan and while not fasting after Ramadan. Comparing the estimated changes in permittivity to changes in weight and the time s fails to establish a clear relationship between permittivity and hydration. Assessing the subtle changes in hydration found in a population of sedentary, healthy adults proves difficult and more work is required to determine approaches suitable for tracking subtle changes in hydration over time with microwave-based hydration assessment techniques.
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Bruno C, Collier A, Holyday M, Lambert K. Interventions to Improve Hydration in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13103640. [PMID: 34684642 PMCID: PMC8537864 DOI: 10.3390/nu13103640] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/13/2021] [Indexed: 01/23/2023] Open
Abstract
Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I2 = 0%, p < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.
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Affiliation(s)
- Chevonne Bruno
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Annaleise Collier
- Nutrition and Dietetics Department, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (A.C.); (M.H.)
| | - Margaret Holyday
- Nutrition and Dietetics Department, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (A.C.); (M.H.)
| | - Kelly Lambert
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia;
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Correspondence:
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Uršulin-Trstenjak N, Dodlek Šarkanj I, Sajko M, Vitez D, Živoder I. Determination of the Personal Nutritional Status of Elderly Populations Based on Basic Foodomics Elements. Foods 2021; 10:2391. [PMID: 34681440 PMCID: PMC8535163 DOI: 10.3390/foods10102391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
Nutritional status is a series of related parameters collected using different available methods. In order to determine the nutritional status of elderly populations and ensure nutritional support based on an individual approach, the implementation of the increasingly used foodomics approach is available; this approach plays a key role in personalized diets and in the optimization of diets for a population group, such as an elderly population. The Mini Nutritional Assessment (MNA) method and the Nottingham Screening Tool (NST) form were used on 50 users in a home for the elderly in northwest Croatia. A loss of body mass (BM) was statistically significantly higher for those who had the following: decreased food intake in the last week and users who had complete and partial feeding autonomy. Additionally, the obtained data on drug intake, fluid, individual nutrients, and physical activity are based on an individual approach. The available documentation provides insight into nutritional values and food preparation in an attempt to satisfy a holistic approach in the evaluation of exposure while trying to achieve as many elements of foodomics as possible.
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Affiliation(s)
- Natalija Uršulin-Trstenjak
- Department of Food Technology, University Center Koprivnica, University North, Trg dr. Žarka Dolinara 1, 48000 Koprivnica, Croatia;
- Department of Nursing, University Center Varaždin, University North, Jurja Križanića 31b, 42000 Varaždin, Croatia; (M.S.); (I.Ž.)
| | - Ivana Dodlek Šarkanj
- Department of Food Technology, University Center Koprivnica, University North, Trg dr. Žarka Dolinara 1, 48000 Koprivnica, Croatia;
| | - Melita Sajko
- Department of Nursing, University Center Varaždin, University North, Jurja Križanića 31b, 42000 Varaždin, Croatia; (M.S.); (I.Ž.)
| | - David Vitez
- County Hospital Čakovec, I.G.Kovačića 1e, 40000 Čakovec, Croatia;
| | - Ivana Živoder
- Department of Nursing, University Center Varaždin, University North, Jurja Križanića 31b, 42000 Varaždin, Croatia; (M.S.); (I.Ž.)
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58
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Mukherjee U, Napier C, Oldewage-Theron W. ‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1947037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Upasana Mukherjee
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein, South Africa
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Paulis SJC, Everink IHJ, Halfens RJG, Lohrmann C, Schols JMGA. Dehydration in the nursing home: Recognition and interventions taken by Dutch nursing staff. J Adv Nurs 2021; 78:1044-1054. [PMID: 34462958 PMCID: PMC9290809 DOI: 10.1111/jan.15032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 08/07/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
Aims To examine which signs/symptoms registered nurses (RNs) and certified nurse assistants (CNAs) (nursing staff) in Dutch nursing homes associate with dehydration, if they observe these signs/symptoms themselves and what they do after observing them. Design A cross‐sectional study. Methods In February 2020, using an online questionnaire based on a diagnostic strategy to diagnose dehydration, nursing staff was asked: (1) which signs/symptoms they associate with dehydration; (2) if they observe these signs/symptoms themselves; and (3) which actions they take after observing these signs/symptoms in a resident. Descriptive statistics and Chi‐square statistics were used to describe the answers and explore significant differences between groups. Results In total, 250 RNs and 226 CNAs participated. Among RNs, 67%–99% associated the signs/symptoms of the strategy to dehydration compared with 45%–98% of the CNAs. RNs and CNAs often indicated to observe signs/symptoms from the strategy themselves (80.1% and 92.6%), but they also often relied on information given by other care professionals and the informal caregiver. Interventions taken were mainly focused on communicating findings to colleagues. Conclusion Many signs/symptoms from the diagnostic strategy trigger nursing staff to think of dehydration. Results also show that a variety of formal and informal caregivers are involved in dehydration care. As RNs and CNAs did often not receive dehydration training after entering workforce, this could have limited their ability to recognize signs/symptoms related to dehydration. To ensure timely recognition of dehydration, a clear description of roles and responsibilities about dehydration care in, and between, formal and informal caregivers is essential with structurally embedded dehydration training in the nursing home. Impact Tackling dehydration in the nursing home requires interdisciplinary collaboration and communication with family members. Without clear roles and responsibilities, a risk of dehydration can be left unattended.
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Affiliation(s)
- Simone J C Paulis
- Department of Health Services Research, Care Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Irma H J Everink
- Department of Health Services Research, Care Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ruud J G Halfens
- Department of Health Services Research, Care Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Jos M G A Schols
- Department of Health Services Research, Care Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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60
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Abdul Wahab P, Mohd Yusoff D, Abdul Kadir A, Ali SH, Yeong Yeh L. Prevalence, Symptoms, and Associated Factors of Chronic Constipation Among Older Adults in North-East of Peninsular Malaysia. Clin Nurs Res 2021; 31:348-355. [PMID: 34340590 DOI: 10.1177/10547738211033934] [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: 12/31/2022]
Abstract
This study aimed to determine the prevalence, symptoms, and associated factors of chronic constipation among older adults in the North-East of Peninsular Malaysia. A cross-sectional study was conducted among older patients from four health clinics. A total of 400 older patients participated, with a mean age of 68.7 (SD = 6.4) years. The prevalence of chronic constipation was 14.8%. The highest symptom reported was the inability to pass stool (98.3%). Chronic constipation was significantly associated with older age (OR = 2.97; 95% CI [1.17, 7.54]; p = .022), inadequate plain water intake per day (OR = 2.13; 95% CI [1.13, 4.02]; p = .020), hypertension (OR = 2.22; 95% CI [1.07, 4.61]; p = .033), and hyperlipidemia (OR = 2.52; 95% CI [1.24, 5.11]; p = .010). Identification of chronic constipation should be done as part of routine clinic visits, especially for older patients with cardiovascular disease.
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Affiliation(s)
| | | | | | - Siti Hawa Ali
- Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Lee Yeong Yeh
- Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia
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Maintaining oral hydration in older adults in surgical wards: a best practice implementation project. JBI Evid Implement 2021; 20:63-71. [PMID: 34282093 DOI: 10.1097/xeb.0000000000000289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM Oral hydration is essential in older adults as poor hydration can complicate existing medical conditions and increase morbidity. Older adults in surgical wards are at risk of dehydration due to insufficient fluid consumption. The aim of this project is to ensure patients aged 65 years and above are adequately hydrated. METHODS The current project was conducted over 7 months from February to August 2019 and involved pre and postimplementation audits to ensure compliance with best practice. The Joanna Briggs Institute Practical Application of Clinical Evidence System and the Getting Research into Practice tools were used as a guide. Audits were conducted at four surgical wards with a sample of 42 patients at each audit. The measures implemented include educating nurses on the importance of oral hydration in older adult patients and labelling water jugs to encourage fluid intake among these patients. RESULTS Nurses' compliance in monitoring older adult patients' daily fluid intake increased from 5 to 76% at follow-up audit (P < 0.05). In addition, the average amount of fluid consumed over 3 days increased from 858.23 to 1037.50 ml. CONCLUSION This project demonstrated a significant increase in oral fluid intake among older adult patients during hospitalization and their understanding of adequate fluid intake. Nurses play an important role in ensuring adequate amounts of daily fluid intake by these patients.
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A Portable Biodevice to Monitor Salivary Conductivity for the Rapid Assessment of Fluid Status. J Pers Med 2021; 11:jpm11060577. [PMID: 34205354 PMCID: PMC8235451 DOI: 10.3390/jpm11060577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 01/29/2023] Open
Abstract
The evaluation of fluid status can save adults from life-threatening conditions, but the current methods are invasive or time-consuming. Therefore, we developed a portable device for measuring salivary conductivity. This prospective observational study enrolled 20 volunteers with no history of systemic diseases. Participants were observed for 13 h, including water restriction for 12 h followed by rehydration with 1000 mL water within 1 h. Serum and urine biomarkers for fluid status, thirst scales, and salivary conductivity were collected during dehydration and rehydration. No significant differences in age, body mass index, glycohemoglobin, and estimated glomerular filtration rate were noted between sexes. Salivary conductivity increased after water restriction and decreased after rehydration. Similarly, urine osmolality, urine specific gravity, thirst intensity scales, and body weight followed the same trend and were statistically significant. The angiotensin-converting enzyme and aldosterone levels showed the same trend, without reaching statistical significance. The red blood cell count and hemoglobin concentration also followed the same trend. Analyzing the receiver operating characteristic curves, the area under the curve was 0.707 (95% confidence interval 0.542–0.873, p = 0.025). Using the Youden index, the optimal cutoff determined as 2678.09 μs/cm (sensitivity: 90%, specificity: 55%). This biodevice effectively screened dehydration among healthy adults.
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Hoen L, Pfeffer D, Zapf R, Raabe A, Hildebrand J, Kraft J, Kalkhof S. Association of Drug Application and Hydration Status in Elderly Patients. Nutrients 2021; 13:1929. [PMID: 34199738 PMCID: PMC8226953 DOI: 10.3390/nu13061929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Due to multifactorial reasons, such as decreased thirst and decreased total body water, elderly patients are vulnerable to dehydration. Mild cognitive impairment (MCI) or dementia increase the risk of dehydration and, in turn, dehydration decreases cognitive performance. The study aims to identify and assess differences in hydration status, taking into account patients' drug treatment and diseases, using bioelectrical impedance vector analysis (BIVA), thereby revealing unfavorable aspects of prognosis. 447 geriatric patients (241 women, 206 men) including information on medication and bioelectrical impedance analysis (BIA) were investigated, which allowed studying the association between 40 drugs and the hydration status. First, patients were divided into disease groups. Renal disease and diuretic treatment were significantly different in both sexes, whereas cardiovascular patients differed exclusively for females. Next, drug enrichment was examined in either hyperhydrated or dehydrated patients. Simvastatin, candesartan, bisoprolol, amlodipine, olmesartan, furosemide, torasemide, allopurinol, mirtazapine, pantoprazole, cholecalciferol, and resveratrol showed enrichment depending on hydration status. This study demonstrated that patients can be differentiated and stratified by BIVA, taking into account medication and disease associated with hydration status. Although patients diagnosed with MCI and therefore treated with resveratrol, BIVA still showed evaluated dehydration. This is unfavorable in terms of prognosis and requires special attention.
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Affiliation(s)
- Laura Hoen
- Institute for Bioanalysis, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, D-96450 Coburg, Germany; (L.H.); (D.P.); (R.Z.); (J.H.)
| | - Daniel Pfeffer
- Institute for Bioanalysis, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, D-96450 Coburg, Germany; (L.H.); (D.P.); (R.Z.); (J.H.)
- Division of Geriatrics, Klinikum Coburg GmbH, Ketschendorfer Str. 33, D-96450 Coburg, Germany;
| | - Rico Zapf
- Institute for Bioanalysis, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, D-96450 Coburg, Germany; (L.H.); (D.P.); (R.Z.); (J.H.)
- Division of Geriatrics, Klinikum Coburg GmbH, Ketschendorfer Str. 33, D-96450 Coburg, Germany;
| | - Andrea Raabe
- Division of Nephrology, Klinikum Coburg GmbH, Ketschendorfer Str. 33, D-96450 Coburg, Germany;
| | - Janosch Hildebrand
- Institute for Bioanalysis, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, D-96450 Coburg, Germany; (L.H.); (D.P.); (R.Z.); (J.H.)
| | - Johannes Kraft
- Division of Geriatrics, Klinikum Coburg GmbH, Ketschendorfer Str. 33, D-96450 Coburg, Germany;
| | - Stefan Kalkhof
- Institute for Bioanalysis, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, D-96450 Coburg, Germany; (L.H.); (D.P.); (R.Z.); (J.H.)
- Protein Biomarker Unit, Fraunhofer Institute for Cell Therapy and Immunology, Perlickstr. 1, D-04103 Leipzig, Germany
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Kim JS. Fine Wrinkle Treatment and Hydration on the Facial Dermis Using HydroToxin Mixture of MicroBotox and MicroHyaluronic Acid. Aesthet Surg J 2021; 41:NP538-NP549. [PMID: 32779694 PMCID: PMC8240748 DOI: 10.1093/asj/sjaa231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hyaluronic acid (HA) is a key contributor to skin moisture (hydration), and MicroBotox demonstrates improvements for fine wrinkles of the face. OBJECTIVES The author sought to evaluate the safety and efficacy of intradermal injection of hydrotoxin (combined mixture of MicroHA and MicroBotox) for the treatment of skin roughness and dryness on facial dermis. METHODS Fifty women who had thin, dry skin with fine wrinkles throughout the whole face, especially in the crow's feet and forehead areas, were enrolled in the study. Two cc stabilized-HA filler and 1 cc (40 U) of botulinumtoxinA were mixed in the novel combined hydrotoxin mixture. Intended to hydrate the dermis and treat fine wrinkles of the face, the mixture was injected into the real dermal layer of the face. The volume of HA per site was 0.002 cc and toxin was 0.04 U. Skin roughness and stratum corneum hydration were measured at 1, 2, 3, and 6 months. RESULTS One month post-treatment, skin roughness was reduced to 50.19% in topographic computer analysis utilizing 10× dermascope photos. Stratum corneum hydration on crow's feet improved to 81.34% at 1 month and 56.12% at 2 months from pre-treatment baseline (P < 0.0001). Global Aesthetic improvement scale of Skin hydration and fine wrinkle improved. CONCLUSIONS The combination injection method of MicroHA and MicroBotox is not associated with side effects and showed significant synergic effect in improvement of skin roughness and moisturizing. Neuramix-hydrotoxin injection method is an easy and reproducible procedure to make constant injection depth and amount. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jong Seo Kim
- Corresponding Author: Dr Jong Seo Kim, Kim-JongSeo Plastic Surgery Clinic, 2F Apgujung BD. 842 NonHyun-ro, GangNam-gu, Seoul, Korea 06025. E-mail: ; Instagram: @reteenage
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Keser I, Cvijetić S, Ilić A, Colić Barić I, Boschiero D, Ilich JZ. Assessment of Body Composition and Dietary Intake in Nursing-Home Residents: Could Lessons Learned from the COVID-19 Pandemic Be Used to Prevent Future Casualties in Older Individuals? Nutrients 2021; 13:1510. [PMID: 33947099 PMCID: PMC8146998 DOI: 10.3390/nu13051510] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022] Open
Abstract
The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3-95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC® and dietary intake was assessed via 24-h recall and analyzed using "Nutrition" software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (>50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.
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Affiliation(s)
- Irena Keser
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia; (I.K.); (A.I.); (I.C.B.)
| | - Selma Cvijetić
- Department of Occupational and Environmental Medicine, Institute for Medical Research and Occupational Health, Ksaverska Cesta 2, 10000 Zagreb, Croatia;
| | - Ana Ilić
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia; (I.K.); (A.I.); (I.C.B.)
| | - Irena Colić Barić
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia; (I.K.); (A.I.); (I.C.B.)
| | | | - Jasminka Z. Ilich
- Institute for Successful Longevity, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
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Buaprasert P, Piyapaisarn S, Vanichkulbodee A, Kamsom A, Sri-On J. Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross-sectional study. Geriatr Gerontol Int 2021; 21:485-491. [PMID: 33847031 DOI: 10.1111/ggi.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/23/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
AIM The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED. METHODS This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates. RESULTS In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively. CONCLUSIONS One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction. Geriatr Gerontol Int 2021; 21: 485-491.
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Affiliation(s)
- Phudit Buaprasert
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sawangwarach Piyapaisarn
- Department of Emergency Medicine, Srinagarind Hospital, Khon Kaen University, Khonkaen, Thailand
| | - Alissara Vanichkulbodee
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anucha Kamsom
- The Department of Biostatistic, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jiraporn Sri-On
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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67
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Munk T, Bech CB, Klausen TW, Rønholt F, Suetta C, Knudsen AW. Accuracy of the calculated serum osmolarity to screen for hyperosmolar dehydration in older hospitalised medical patients. Clin Nutr ESPEN 2021; 43:415-419. [PMID: 34024549 DOI: 10.1016/j.clnesp.2021.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/04/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Simple hyperosmolar dehydration, also termed water-loss dehydration (HD), is common in older hospitalised patients, thus increasing the risk of morbidity and mortality. Directly measured serum osmolality is the reference standard to determine HD; however, it is not a routine test due to its complexity and cost. Thus, a simple valid objective diagnostic tool to detect HD is needed. Consequently, we aimed to validate the agreement between measured s-osmolality (mOsm/kg) and calculated s-osmolarity (mOsm/L). METHODS Patients aged >65 were included from the emergency medical department at Herlev Hospital, Copenhagen, Denmark. Exclusion criteria were: eGFR< 30 mmol/L, severe heart failure, decompensated cirrhosis, alcohol intake or initiated rehydration treatment. We obtained data for measured s-osmolality as well as calculated osmolarity, using the by ESPEN recommended equation [1.86x (Na+ + K+)+1.15 ∗glucose + urea+14]. To determine accuracy, we used cut-off values of >295 mOsm/L versus >300 mOsm/kg. RESULTS A total of 90 patients (female 53%), age median 78 yrs (72-86 yrs) were included. According to the measured mOsm/kg, impending HD was evident in 32% (n = 10), of these 11% (n = 10) had current HD. There was a significant association between calculated mOsm/L and measured Osm/kg (r2 = 0.7513, p < 0.0001). A sensitivity of 90% (95% CL: 56%-100%), a specificity of 68% (95% CL: 56%-78%), Positive predictive value (PPV) of 26% (95% CL: 12%-43%), and Negative predictive value (NPV) of 98% (95% CL: 90%-100%) were observed. Notably, only 20% (n = 2) of the patients who were dehydrated according to the measured Osm/kg were correctly clinically diagnosed with dehydration. CONCLUSIONS The equation recommended by ESPEN to calculate osmolarity was found to be an accurate objective diagnostic tool to assess HD in older hospitalised medical patients. The method is markedly superior to the current clinical practice.
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Affiliation(s)
- Tina Munk
- Dietetic and Nutritional Research Unit (EFFECT), Herlev Gentofte University Hospital, Herlev, Denmark.
| | - Camilla Balle Bech
- Dietetic and Nutritional Research Unit (EFFECT), Herlev Gentofte University Hospital, Herlev, Denmark
| | | | - Finn Rønholt
- Geriatric Research Unit, Medical Department, Herlev Gentofte University Hospital, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Medical Department, Herlev Gentofte University Hospital, Denmark; Geriatric Research Unit, Geriatric and Palliative Department, Bispebjerg and Frederiksberg Hospitals, Denmark; Copenhagen Centre for Clinical Age Research, University of Copenhagen, Denmark
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit (EFFECT), Herlev Gentofte University Hospital, Herlev, Denmark
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68
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Lord LM. Fluid Needs in the Older Adult Receiving Tube Feedings. Nutr Clin Pract 2021; 36:360-368. [PMID: 33666945 DOI: 10.1002/ncp.10634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Fluid imbalance can occur quickly in older adults and in others who cannot express thirst or are in a setting where fluid status is not closely monitored. In tube-fed individuals receiving inadequate calories, severe malnutrition may occur in weeks to months, but improper water intake may lead to critical fluid imbalances in a matter of days. Simplistic equations frequently used to determine fluid needs in adults include milliliters per kilogram of body weight and milliliters per energy (kilocalories) consumed or per energy (kilocalories) need and variations of the Holliday-Segar formula. None of these fluid-requirement equations have been validated through evidenced-based science, and research investigations have revealed that they can grossly overestimate or underestimate fluid needs in the older adult. Clinicians need guidance to better estimate initial fluid needs for the older adult receiving tube feedings and to provide proper close monitoring afterward to avert preventable fluid imbalance-related hospital readmissions, morbidities, and mortalities in this patient population.
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Affiliation(s)
- Linda M Lord
- University of Rochester Medical Center, Rochester, New York, USA
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69
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Varanoske AN, Coker NA, Johnson BADI, Belity T, Wells AJ. Muscle Quality, Measured by Ultrasound-Derived Corrected Echo Intensity, Does not Affect Changes in Cross-sectional Area of the Vastus Lateralis Following Recumbent Rest. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320967277] [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]
Abstract
Objective: Recumbent rest elicits a decrease in muscle size of the lower extremity, but the extent of decrease may be related to differences in muscle quality. This could have implications for ultrasound-derived measures of muscle size, particularly in individuals with a large proportion of intramuscular contractile elements. The research objective was to determine whether decreases in muscle size following recumbent rest are related to ultrasound-derived corrected echo intensity in resistance-trained males. Methods: Cross-sectional area (CSA), echo intensity (EI), subcutaneous fat thickness (SFT), and EI corrected for SFT (EICor) of the vastus lateralis (VL) were measured via ultrasonography in 30 resistance-trained males. Measures were obtained immediately following recumbency (T0) and 15 minutes after recumbency (T15). The association between EICor and percentage change in CSA (%ΔCSA) from T0 to T15 was examined. Comparisons of morphological characteristics were examined between a subset of participants with the lowest (LO; n = 10; <33rd percentile) and highest (HI; n = 10; >66th percentile) EICor. Results: EICor was not correlated with %ΔCSA ( P = .151), and the decrease in CSA from T0 to T15 did not differ between the LO and HI groups. Conclusions: Muscle quality (EICor) is not related to the decrease in CSA of the VL following recumbent rest among resistance-trained, young males. The time frame of muscle CSA acquisition should not differ based solely on differences in muscle quality.
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Affiliation(s)
- Alyssa N. Varanoske
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Nicholas A. Coker
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Bri-Ana D. I. Johnson
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Tal Belity
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adam J. Wells
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Exercise Physiology Intervention and Collaboration (EPIC) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
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Vickram S, Rohini K, Srinivasan S, Veenakumari DN, Archana K, Anbarasu K, Jeyanthi P, Thanigaivel S, Gulothungan G, Rajendiran N, Srikumar PS. Role of Zinc (Zn) in Human Reproduction: A Journey from Initial Spermatogenesis to Childbirth. Int J Mol Sci 2021; 22:2188. [PMID: 33671837 PMCID: PMC7926410 DOI: 10.3390/ijms22042188] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023] Open
Abstract
Zinc (Zn), the second-most necessary trace element, is abundant in the human body. The human body lacks the capacity to store Zn; hence, the dietary intake of Zn is essential for various functions and metabolism. The uptake of Zn during its transport through the body is important for proper development of the three major accessory sex glands: the testis, epididymis, and prostate. It plays key roles in the initial stages of germ cell development and spermatogenesis, sperm cell development and maturation, ejaculation, liquefaction, the binding of spermatozoa and prostasomes, capacitation, and fertilization. The prostate releases more Zn into the seminal plasma during ejaculation, and it plays a significant role in sperm release and motility. During the maternal, labor, perinatal, and neonatal periods, the part of Zn is vital. The average dietary intake of Zn is in the range of 8-12 mg/day in developing countries during the maternal period. Globally, the dietary intake of Zn varies for pregnant and lactating mothers, but the average Zn intake is in the range of 9.6-11.2 mg/day. The absence of Zn and the consequences of this have been discussed using critical evidence. The events and functions of Zn related to successful fertilization have been summarized in detail. Briefly, our current review emphasizes the role of Zn at each stage of human reproduction, from the spermatogenesis process to childbirth. The role of Zn and its supplementation in in vitro fertilization (IVF) opens opportunities for future studies on reproductive biology.
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Affiliation(s)
- Sundaram Vickram
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India; (S.V.); (S.T.)
| | - Karunakaran Rohini
- Unit of Biochemistry, Faculty of Medicine, AIMST University, Semeling, Bedong 08100, Kedah, Malaysia
| | - Subramanian Srinivasan
- Department of Biomedical Engineering, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India; (S.S.); (G.G.); (N.R.)
| | | | - Kumar Archana
- Department of Agriculture Engineering, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India;
| | - Krishnan Anbarasu
- Department of Bioinformatics, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India;
| | - Palanivelu Jeyanthi
- Department of Biotechnology, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai, Tamil Nadu 600062, India;
| | - Sundaram Thanigaivel
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India; (S.V.); (S.T.)
| | - Govindarajan Gulothungan
- Department of Biomedical Engineering, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India; (S.S.); (G.G.); (N.R.)
| | - Nanmaran Rajendiran
- Department of Biomedical Engineering, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India; (S.S.); (G.G.); (N.R.)
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Wham C, Smithers A, Kruger R, Mazahery H, Richter M. Factors associated with low-intake dehydration among older inpatients: A pilot study. Australas J Ageing 2020; 40:e163-e172. [PMID: 33295084 DOI: 10.1111/ajag.12894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess fluid intake among older inpatients and factors associated with low-intake dehydration. METHODS Daily fluid intake and access were assessed within the 24-hour period, and blood was drawn to measure serum osmolality. RESULTS Of 89 patients, 16% and 27% had serum osmolality ≥ 300 (dehydrated) and 295-299 mOsm/kg (impending dehydration), respectively. Median (IQR) total fluid intake was 1.7 (1.6, 1.9) L/day. Fluid intake from beverages (P = .06) and water (P = .02) was higher in hydrated than impending/dehydrated patients. Of all fluid sources, only water intake was associated with hydration status (P = .02). The adjusted odds of serum osmolality ≥ 295 were increased for patients in the first (<0.3 L, P = .007) and second (0.3-0.8 L, P = .04) tertiles of water intake than those in the third tertile (≥0.8 L). Bladder control difficulty was associated with lower water intake (P = .03). CONCLUSION Monitoring water intake and assisting patients with bladder control difficulty may be key strategies to maintain hydration.
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Affiliation(s)
- Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Allie Smithers
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Rozanne Kruger
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Hajar Mazahery
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Marilize Richter
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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Tarteret P, Strazzulla A, Rouyer M, Gore C, Bardin G, Noel C, Benguerdi ZE, Berthaud J, Hommel M, Aufaure S, Jochmans S, Diamantis S. Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak. Int J Infect Dis 2020; 104:125-131. [PMID: 33301993 PMCID: PMC7721348 DOI: 10.1016/j.ijid.2020.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives This study aimed to identify demographic, clinical and medical care factors associated with mortality in three nursing homes in France. Methods Two nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. A third nursing home had no direct connection with a general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. Results During the first 3 months of the outbreak, 224 of 375 (59.7%) residents were classified as COVID-19 cases and 57 of 375 (15.2%) died. The hospital-dependent nursing homes had lower COVID-19 case fatality rates in comparison with the non-hospital-dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11–0.38], p = 0.001). During the first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had a daily clinical examination (OR: 0.09 [0.03–0.35], p = 0.01), three vital signs measurement per day (OR: 0.06 [0.01–0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00–0.24], p = 0.001). Conclusions This study suggested that high mortality rates in some nursing homes during the COVID-19 outbreak might have been contributed by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing a connection with general hospitals should be considered to deal with present and future health disasters in nursing homes.
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Affiliation(s)
- Paul Tarteret
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France.
| | - Alessio Strazzulla
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France; Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Maxence Rouyer
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France; Intensive Care Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Cecile Gore
- Geriatrics Department, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Guillaume Bardin
- Emergency Department, Centre Hospitalier Sud Essonne, Etampes, France
| | - Coralie Noel
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | | | | | - Manuel Hommel
- Geriatrics Department, Hopital Leon Binet, Provins, France
| | - Sylvie Aufaure
- Geriatrics Department, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Sebastien Jochmans
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Sylvain Diamantis
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France; Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France
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Logozzi M, Mizzoni D, Di Raimo R, Andreotti M, Macchia D, Spada M, Fais S. In vivo antiaging effects of alkaline water supplementation. J Enzyme Inhib Med Chem 2020; 35:657-664. [PMID: 32106720 PMCID: PMC7054916 DOI: 10.1080/14756366.2020.1733547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
Telomeres length and telomerase activity are currently considered aging molecular stigmata. Water is a major requirement for our body and water should be alkaline. Recent reports have shown that aging is related to a reduced water intake. We wanted to investigate the effect of the daily intake of alkaline water on the molecular hallmark of aging and the anti-oxidant response. We watered a mouse model of aging with or without alkaline supplementation. After 10 months, we obtained the blood, the bone marrow and the ovaries from both groups. In the blood, we measured the levels of ROS, SOD-1, GSH, and the telomerase activity and analysed the bone marrow and the ovaries for the telomeres length. We found reduced ROS levels and increased SOD-1, GSH, telomerase activity and telomeres length in alkaline supplemented mice. We show here that watering by using alkaline water supplementation highly improves aging at the molecular level.
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Affiliation(s)
- Mariantonia Logozzi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Davide Mizzoni
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Rossella Di Raimo
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Macchia
- Center of Animal research and Welfare, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Spada
- Center of Animal research and Welfare, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Fais
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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Chronic Dehydration in Nursing Home Residents. Nutrients 2020; 12:nu12113562. [PMID: 33233662 PMCID: PMC7709028 DOI: 10.3390/nu12113562] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/12/2023] Open
Abstract
Chronic dehydration mainly occurs due to insufficient fluid intake over a lengthy period of time, and nursing home residents are thought to be at high risk for chronic dehydration. However, few studies have investigated chronic dehydration, and new diagnostic methods are needed. Therefore, in this study, we aimed to identify risk factors for chronic dehydration by measuring serum osmolality in nursing home residents and also to evaluate whether examining the inferior vena cava (IVC) and determining the IVC collapsibility index (IVC-CI) by ultrasound can be helpful in the diagnosis of chronic dehydration. A total of 108 Japanese nursing home residents aged ≥65 years were recruited. IVC measurement was performed using a portable handheld ultrasound device. Fifteen residents (16.9%) were classified as having chronic dehydration (serum osmolality ≥295 mOsm/kg). Multivariate logistic regression analysis showed that chronic dehydration was associated with dementia (odds ratio (OR), 6.290; 95% confidential interval (CI), 1.270–31.154) and higher BMI (OR, 1.471; 95% CI, 1.105–1.958) but not with IVC or IVC-CI. Cognitive function and body weight of residents should be considered when establishing a strategy for preventing chronic dehydration in nursing homes.
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75
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Bruno RR, Masyuk M, Muessig JM, Binneboessel S, Bernhard M, Bäz L, Franz M, Kelm M, Jung C. Sublingual microcirculation detects impaired perfusion in dehydrated older patients. Clin Hemorheol Microcirc 2020; 75:475-487. [DOI: 10.3233/ch-200859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD (“acceptable”)). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maryna Masyuk
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Johanna M. Muessig
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Laura Bäz
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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Patel AI, Hecht CE, Cradock A, Edwards MA, Ritchie LD. Drinking Water in the United States: Implications of Water Safety, Access, and Consumption. Annu Rev Nutr 2020; 40:345-373. [PMID: 32966189 DOI: 10.1146/annurev-nutr-122319-035707] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.
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Affiliation(s)
- Anisha I Patel
- Division of General Pediatrics, Stanford University, Palo Alto, California 94305, USA
| | - Christina E Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
| | - Angie Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Marc A Edwards
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
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Volkert D. [Current ESPEN Guideline Clinical Nutrition and Hydration in Geriatrics]. Dtsch Med Wochenschr 2020; 145:1306-1314. [PMID: 32906183 DOI: 10.1055/a-0986-2892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Malnutrition, dehydration and obesity are relevant health problems with far-reaching consequences for older people. Routine screening for malnutrition and dehydration should be carried out in order to identify vulnerable and affected persons at an early stage and to be able to take timely countermeasures. In many cases, adequate nutrition and hydration can be supported by simple nursing measures and optimisation of the food and drink supply. Nutritional advice, sip feed, enteral and parenteral nutrition are further effective measures for the prevention and therapy of malnutrition. An ingestion deficiency dehydration should be diagnosed on the basis of serum osmolality and requires a rapid compensation of the deficit by hypotonic fluids - depending on the severity, in the form of drinks, subcutaneously or intravenously. Weight loss in old age should only be considered in cases of obesity with associated health problems and should be achieved by moderate energy reduction in combination with physical exercise.
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Sciama DS, Goulart RMM, Villela VHL. Active ageing: social representations of health professionals in Elderly Health Reference Units. Rev Esc Enferm USP 2020; 54:e03605. [PMID: 32901658 DOI: 10.1590/s1980-220x2018056503605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify social representations of health professionals providing elderly care in seven Elderly Health Reference Units in São Paulo city regarding health necessities, their role in care and promotion of active ageing. METHOD Qualitative research, based on directives from the document "Active ageing: a policy framework" by the World Health Organization. The Discourse of the Collective Subject is employed to systematize social representations, whose central ideas were categorized using the QualiQuantiSoft® program. Four reference situations were elaborated and the one related to iatrogenesis and elder vulnerability was selected. RESULTS Twenty-nine professionals took part in this study (sixteen physicians, seven nutritionists and six nurses). Seven categories emerged from the central ideas, with higher frequency for medical conduct disagreement on referring the patient to the Basic Health Unit and the polypharmacy issue. CONCLUSION Discourse by professionals point out the necessity of creating care that overcomes the fragmentation of the work process.
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Affiliation(s)
- Debora Sipukow Sciama
- Secretaria Municipal da Saúde, Coordenadoria de Vigilância em Saúde, Divisão de Vigilância Epidemiológica, Núcleo de Doenças e Agravos Não Transmissíveis, São Paulo, SP, Brasil
| | - Rita Maria Monteiro Goulart
- Universidade São Judas Tadeu, Programa de Pós-graduação em Ciências do Envelhecimento, São Paulo, SP, Brasil
| | - Vera Helena Lessa Villela
- Secretaria Municipal da Saúde, Coordenadoria de Vigilância em Saúde, Divisão de Vigilância Epidemiológica, Núcleo de Doenças e Agravos Não Transmissíveis, São Paulo, SP, Brasil
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Tanaka S, Fujishiro M, Watanabe K, Imatake K, Suzuki Y, Abe M, Ishihara H, Tani S. Seasonal variation in hydration status among community-dwelling elderly in Japan. Geriatr Gerontol Int 2020; 20:904-910. [PMID: 32827223 DOI: 10.1111/ggi.14010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
AIM While the heat during the summer season may dehydrate the elderly, little is known about the seasonal variation in dehydration. This study aimed to investigate the seasonal variation in hydration status among the community-dwelling elderly in Japan. METHODS We retrospectively analyzed the data collected after an overnight fast of adults aged ≥65 years who had no advanced kidney disease and underwent an annual health checkup at Nihon University Hospital between January and December 2019. Participants were classified according to their checkup date, whether summer (n = 265) or not summer (n = 638). The not summer group was subdivided into spring (n = 235), autumn (n = 213) and winter (n = 190). RESULTS Among the four seasons, the spring group showed the highest levels of plasma osmolality (306.1 ± 3.9 mOsm/L), urine specific gravity (1.0172 ± 0.0058) and prevalence rates of urine specific gravity ≥1.020 (34.0%). However, seasonal differences were clinically mild, and >90% of participants showed plasma osmolality ≥300 mOsm/L, indicating dehydration, in all four seasons. The summer group showed lower urine specific gravity levels (1.0150 ± 0.0062 vs. 1.0165 ± 0.0064, P < 0.001) and prevalence rates of urine specific gravity ≥1.020 (22.6% vs. 30.4%, P = 0.023) than did the not summer group. The summer season was associated with low urine specific gravity levels even after adjusting for the multiple linear regression model. CONCLUSION Japanese elderly after overnight fast are more dehydrated during the spring rather than the summer. Geriatr Gerontol Int 2020; 20: 904-910.
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Affiliation(s)
- Sho Tanaka
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan
| | - Midori Fujishiro
- Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan.,Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Watanabe
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhiro Imatake
- Department of Health Planning Center, Nihon University Hospital, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Health Planning Center, Nihon University Hospital, Tokyo, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hisamitsu Ishihara
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shigemasa Tani
- Department of Health Planning Center, Nihon University Hospital, Tokyo, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Bethancourt HJ, Swanson ZS, Nzunza R, Huanca T, Conde E, Kenney WL, Young SL, Ndiema E, Braun D, Pontzer H, Rosinger AY. Hydration in relation to water insecurity, heat index, and lactation status in two small-scale populations in hot-humid and hot-arid environments. Am J Hum Biol 2020; 33:e23447. [PMID: 32583580 DOI: 10.1002/ajhb.23447] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study compared the prevalence of concentrated urine (urine specific gravity ≥1.021), an indicator of hypohydration, across Tsimane' hunter-forager-horticulturalists living in hot-humid lowland Bolivia and Daasanach agropastoralists living in hot-arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. METHODS This study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane' households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). RESULTS The prevalence of hypohydration among Tsimane' men (50.0%) and women (54.0%) was substantially higher (P < .001) than for Daasanach men (15.9%) and women (17.5%); the prevalence of hypohydration among Tsimane' (37.0%) and Daasanach (31.4%) children was not significantly different (P = .33). Multiple logistic regression models suggested positive but not statistically significant trends between household water insecurity and odds of hypohydration within populations, yet some significant joint effects of water and food insecurity were observed. Heat index (2°C) was associated with a 23% (95% confidence interval [CI]: 1.09-1.40, P = .001), 34% (95% CI: 1.18-1.53, P < .0005), and 23% (95% CI: 1.04-1.44, P = .01) higher odds of hypohydration among Tsimane' men, women, and children, respectively, and a 48% (95% CI: 1.02-2.15, P = .04) increase in the odds among Daasanach women. Lactation status was also associated with hypohydration among Tsimane' women (odds ratio = 3.35, 95% CI: 1.62-6.95, P = .001). CONCLUSION These results suggest that heat stress and reproductive status may have a greater impact on hydration status than water insecurity across diverse ecological contexts.
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Affiliation(s)
- Hilary J Bethancourt
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Zane S Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA
| | | | - Tomas Huanca
- Centro Boliviano de Investigacion y Desarrollo Socio Integral (CBIDSI), San Borja, Bolivia
| | - Esther Conde
- Centro Boliviano de Investigacion y Desarrollo Socio Integral (CBIDSI), San Borja, Bolivia
| | - W Larry Kenney
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Emmanuel Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - David Braun
- Department of Anthropology, Center for the Advanced Study of Human Paleobiology, The George Washington University, Washington, District of Columbia, USA.,Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, Leipzig, Germany
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA.,Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Asher Y Rosinger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of Anthropology, The Pennsylvania State University, Pennsylvania, USA
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Borkent JW, Keller H, Wham C, Wijers F, de van der Schueren MAE. Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults. Healthcare (Basel) 2020; 8:E151. [PMID: 32498433 PMCID: PMC7349548 DOI: 10.3390/healthcare8020151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country.
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Affiliation(s)
- Jos W. Borkent
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, Department of Kinesiology, University of Waterloo, Waterloo, ON N2G 0E2, Canada;
| | - Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand;
| | - Fleur Wijers
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
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Serra-Prat M, Lorenzo I, Papiol M, Palomera E, Bartolomé M, Pleguezuelos E, Burdoy E. Intracellular Water Content in Lean Mass as an Indicator of Muscle Quality in an Older Obese Population. J Clin Med 2020; 9:jcm9051580. [PMID: 32455974 PMCID: PMC7290582 DOI: 10.3390/jcm9051580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background: In aged populations, muscle strength depends more on muscle quality than on muscle quantity, while all three are criteria for the diagnosis of sarcopenia. Intracellular water content (ICW) in lean mass (LM) has been proposed as an indicator of muscle quality related to muscle strength in older people. Objectives: To evaluate the relationship between the ICW/LM ratio, muscle strength and indicators of functional performance in obese older adults, and to assess the value of the ICW/LM ratio as an indicator of muscle quality. Methodology: Design: cross-sectional study. Population: persons aged 65–75 years with a body mass index of 30–39 kg/m2. ICW and LM were estimated by bioelectrical impedance. Hand grip, gait speed, unipedal stance test, timed up-and-go (TUG) test, Barthel score and frailty (Fried criteria) were assessed. Sarcopenia was established according to EWGSOP2 criteria. Results: Recruited were 305 subjects (66% women), mean age 68 years. The ICW/LM ratio correlated with the TUG test, gait speed and grip strength, and was also associated with sex, the unipedal stance test and frailty. Independently of age, sex and muscle mass, the ICW/LM ratio was related with gait speed, the TUG test and unipedal stance capacity. One person (0.3%) had sarcopenia defined as low muscle strength and low muscle mass, while 25 people (8.2%) had sarcopenia defined as low muscle strength and poor muscle quality (ICW/LM). With this last definition, sarcopenia was related to frailty, gait speed and the TUG test. Conclusions: ICW content in LM could be a useful muscle quality indicator for defining sarcopenia. However, more studies are required to confirm our findings for other populations.
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Affiliation(s)
- Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, 08304 Barcelona, Spain; (I.L.); (E.P.)
- Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, 08916 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), ISCIII, 08304 Barcelona, Spain
- Correspondence: ; Tel.: +34-(93)-741-7730
| | - Isabel Lorenzo
- Research Unit, Consorci Sanitari del Maresme, Mataró, 08304 Barcelona, Spain; (I.L.); (E.P.)
- Universitat de Vic-Universitat Central de Catalunya, 08500 Barcelona, Spain
| | - Mònica Papiol
- ABS Argentona, Consorci Sanitari del Maresme, Argentona, 08310 Barcelona, Spain; (M.P.); (E.B.)
| | - Elisabet Palomera
- Research Unit, Consorci Sanitari del Maresme, Mataró, 08304 Barcelona, Spain; (I.L.); (E.P.)
| | - Maria Bartolomé
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró, 08304 Barcelona, Spain;
| | - Eulogio Pleguezuelos
- Rehabilitation Service, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, 08304 Barcelona, Spain;
| | - Emili Burdoy
- ABS Argentona, Consorci Sanitari del Maresme, Argentona, 08310 Barcelona, Spain; (M.P.); (E.B.)
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró, 08304 Barcelona, Spain;
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A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103590. [PMID: 32443789 PMCID: PMC7277589 DOI: 10.3390/ijerph17103590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 12/19/2022]
Abstract
Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk among older adults and the high prevalence of falls among Americans age 65 years and older each year, a brief intervention was created. Stepping Up Your Nutrition (SUYN) is a 2.5 h workshop developed through a public/private partnership to motivate older adults to reduce their malnutrition risk. The purposes of this naturalistic workshop dissemination were to: (1) describe the SUYN brief intervention; (2) identify participant characteristics associated with malnutrition risk; and (3) identify participant characteristics associated with subsequent participation in Stepping On (SO), an evidence-based fall prevention program. Data were analyzed from 429 SUYN participants, of which 38% (n = 163) subsequently attended SO. As measured by the SCREEN II®, high and moderate malnutrition risk scores were reported among approximately 71% and 20% of SUYN participants, respectively. Of the SUYN participants with high malnutrition risk, a significantly larger proportion attended a subsequent SO workshop (79.1%) compared to SUYN participants who did not proceed to SO (65.8%) (χ2 = 8.73, p = 0.013). Findings suggest SUYN may help to identify malnutrition risk among community-dwelling older adults and link them to needed services like evidence-based programs. Efforts are needed to expand the delivery infrastructure of SUYN to reach more at-risk older adults.
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Effect of Increased Daily Water Intake and Hydration on Health in Japanese Adults. Nutrients 2020; 12:nu12041191. [PMID: 32340375 PMCID: PMC7231288 DOI: 10.3390/nu12041191] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022] Open
Abstract
Increased hydration is recommended as healthy habit with several merits. However, supportive data are sparse. To assess the efficacy of increased daily water intake, we tested the effect of water supplementation on biomarkers in blood, urine, and saliva. Twenty-four healthy Japanese men and 31 healthy Japanese women with fasting blood glucose levels ranging from 90–125 mg/dL were included. An open-label, two-arm, randomized controlled trial was conducted for 12 weeks. Two additional 550 mL bottles of water on top of habitual fluid intake were consumed in the intervention group. The subjects drank one bottle of water (550 mL) within 2 h of waking, and one bottle (550 mL) 2 h before bedtime. Subjects increased mean fluid intake from 1.3 L/day to 2.0 L/day, without changes in total energy intake. Total body water rate increased with associated water supplementation. There were no significant changes in fasting blood glucose and arginine vasopressin levels, but systolic blood pressure was significantly decreased in the intervention group. Furthermore, water supplementation increased body temperature, reduced blood urea nitrogen concentration, and suppressed estimated glomerular filtration rate reduction. Additionally, existence of an intestinal microbiome correlated with decreased systolic blood pressure and increased body temperature. Habitual water supplementation after waking up and before bedtime in healthy subjects with slightly elevated fasting blood glucose levels is not effective in lowering these levels. However, it represents a safe and promising intervention with the potential for lowering blood pressure, increasing body temperature, diluting blood waste materials, and protecting kidney function. Thus, increasing daily water intake could provide several health benefits.
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85
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Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study. Eur Geriatr Med 2020; 11:393-402. [PMID: 32297264 PMCID: PMC7280358 DOI: 10.1007/s41999-020-00304-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 11/17/2022]
Abstract
Aim To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents. Findings International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests). Message This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home. Electronic supplementary material The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users. Purpose Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. Methods Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (≥ 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. Results After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. Conclusion This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account. Electronic supplementary material The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users.
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87
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Abstract
Anorexia, weight loss and muscle wasting commonly affect people approaching the end of life. It is critical that clinicians caring for people with advanced illness and progressive frailty can assess the nutritional and hydration needs of these people, engage them in shared decision making and support them to plan ahead regarding their nutritional care preferences as their health deteriorates.
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Affiliation(s)
- Adam Hurlow
- Consultant in Palliative Medicine, Department of Palliative Medicine, Robert Ogden Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF
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88
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Bhanu C, Avgerinou C, Kharicha K, Bauernfreund Y, Croker H, Liljas A, Rea J, Kirby-Barr M, Hopkins J, Walters K. 'I've never drunk very much water and I still don't, and I see no reason to do so': a qualitative study of the views of community-dwelling older people and carers on hydration in later life. Age Ageing 2019; 49:111-118. [PMID: 31819953 PMCID: PMC6911653 DOI: 10.1093/ageing/afz141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background dehydration is associated with significant adverse outcomes in older people despite being largely preventable and treatable. Little research has focused on the views of community-dwelling older people on hydration, healthy drinking and the perceived importance of drinking well in later life. Objectives to understand community-dwelling older people and informal carers’ views on hydration in later life and how older people can be supported to drink well. Methods qualitative study using interviews and a focus group exploring hydration and nutrition in later life (24 older people at risk of malnutrition and dehydration, 9 informal carers) and thematic analysis. Results this article presents the findings on hydration alone. Four themes are presented: perceptions of healthy drinking, barriers to and facilitators of drinking in later life and supporting older people to drink well. The perceived importance of adequate hydration in later life was polarised. Concerns about urinary incontinence and knowledge gaps were significant barriers. Consideration of individual taste preference and functional capacity acted as facilitators. Distinct habitual drinking patterns with medications and meals exist within individuals. Many relied on thirst at other times or when fluid demands are greater (such as hot weather), a known unreliable prompt in later life. Conclusions older people could be supported to drink well by building upon existing habitual drinking patterns. Primary care and public health should consider individual barriers, facilitators and tailored education. A multidisciplinary approach to promote hydration should be incorporated into care for older people with more complex needs.
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Affiliation(s)
- Cini Bhanu
- Department of Primary Care and Population Health, University College London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, UK
| | | | - Helen Croker
- Health Behaviour Research Centre, University College London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, UK
| | - Jennifer Rea
- Department of Primary Care and Population Health, University College London, UK
| | - Maggie Kirby-Barr
- Patient and Public Involvement Representative, Department of Primary Care and Population Health, University College London, UK
| | - Jane Hopkins
- Patient and Public Involvement Representative, Department of Primary Care and Population Health, University College London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, UK
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89
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Siegfried F, Rommel F, Rothe M, Brinkmann MP, Sochurek JAM, Freitag J, Grisanti S, Ranjbar M. Evaluating diurnal changes in choroidal sublayer perfusion using optical coherence tomography angiography. Acta Ophthalmol 2019; 97:e1062-e1068. [PMID: 31087516 DOI: 10.1111/aos.14140] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/23/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate diurnal changes of choroidal sublayer perfusion in normal eyes and to identify influencing factors using optical coherence tomography angiography (OCTA). METHODS A prospective study was conducted on healthy volunteers, each of whom underwent repeated measurements of subfoveal choroidal thickness (SFCT) via enhanced depth imaging (EDI) optical coherence tomography (OCT) as well as perfusion of choroidal vascular sublayers using OCTA at 7 a.m., 12 p.m., 4 p.m. and 8 p.m. Possible interactions between diurnal variations and other factors, such as mean arterial pressure (MAP), gender and age, were evaluated. RESULTS A total of 22 eyes from 22 participants were analysed. Mean age of participants was 56 years. A significant pattern of diurnal variation was observed for SFCT (p < 0.001) as well as perfusion of Sattler's layer (SLP; p = 0.009) and Haller's layer (HLP; p = 0.003). SFCT demonstrated a linear decrease, being thicker in the morning (348 μm) and thinner in the evening (310 μm). Both, SLP and HLP showed a quadratic relation to time of day, increasing from morning (64% and 76%) to afternoon (66% and 77%), before decreasing again in the evening (64% and 76%). HLP changes were significantly associated with fluctuations of MAP (B = 0.0007; CI 0.0001-0.0014; p = 0.047). No significant differences with regard to gender were detectable. However, older participants (≥60 years) had fewer diurnal changes (p = 0.042). CONCLUSION Optical coherence tomography angiography-based analysis of choroidal sublayer perfusion demonstrated significant diurnal variations. Therefore, it is important to account for time of day, when comparing longitudinal OCTA data.
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Affiliation(s)
- Fynn Siegfried
- Department of Ophthalmology University of Lübeck Lübeck Germany
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
| | - Felix Rommel
- Department of Ophthalmology University of Lübeck Lübeck Germany
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
| | - Matthias Rothe
- Department of Ophthalmology University of Lübeck Lübeck Germany
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
| | - Max P. Brinkmann
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
| | - Jan A. M. Sochurek
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
| | - Josephine Freitag
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
| | | | - Mahdy Ranjbar
- Department of Ophthalmology University of Lübeck Lübeck Germany
- Laboratory for Angiogenesis & Ocular Cell Transplantation University of Lübeck Lübeck Germany
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90
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Cognitive performance in relation to hydration status and water intake among older adults, NHANES 2011–2014. Eur J Nutr 2019; 59:3133-3148. [DOI: 10.1007/s00394-019-02152-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
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91
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Anjo I, Amaral TF, Afonso C, Borges N, Santos A, Moreira P, Padrão P. Are hypohydrated older adults at increased risk of exhaustion? J Hum Nutr Diet 2019; 33:23-30. [PMID: 31578795 DOI: 10.1111/jhn.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dehydration appears to affect muscle strength and weakness, although its influence on exhaustion remains unclear. The present study aimed to quantify the association between hydration status and exhaustion among older adults. METHODS A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to age, sex, education level and region within the Nutrition UP65 cross-sectional study. A 24-h urine sample was collected to estimate free water reserve (FWR), which was categorised into tertiles according to sex. Subjects with incomplete 24-h urine and renal disease were excluded. From a sample size of 1500 subjects, 1143 were eligible. Exhaustion was self-reported according to the Center for Epidemiologic Studies Depression Scale. A logistic regression model was conducted to evaluate the association between FWR and exhaustion. Odds ratios and the respective 95% confidence intervals were calculated by sex and age. RESULTS Free water reserve median (interquartile range) was 0.52 (0.68) L in women and 0.36 (0.77) L in men. Hypohydration affected 11.6% of women and 25.1% of men, whereas exhaustion was reported by 39.3% of women and 25.1% of men. After adjusting for confounders, women ≥80 years classified in the highest tertile of FWR showed a decreased risk of exhaustion (third tertile: odds ratio = 0.38; 95% confidence interval = 0.15-0.96) compared to women in the lowest FWR tertile. No such significant association was observed in women with <80 years and in men. CONCLUSIONS These results show an association between worse hydration status and exhaustion in older women, highlighting the need to implement further studies clarifying this association.
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Affiliation(s)
- I Anjo
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal
| | - T F Amaral
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,Faculdade de Engenharia, UISPA-IDMEC, Universidade do Porto, Porto, Portugal
| | - C Afonso
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - N Borges
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - A Santos
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - P Moreira
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Centro de Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - P Padrão
- Faculdade de Ciências da Nutrição e Alimentação da, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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92
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Stephens AD, Kaminski Schierle GS. The role of water in amyloid aggregation kinetics. Curr Opin Struct Biol 2019; 58:115-123. [PMID: 31299481 DOI: 10.1016/j.sbi.2019.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022]
Abstract
The role of water in protein function and aggregation is highly important and may hold some answers to understanding initiation of misfolding diseases such as Parkinson's, Alzheimer's and Huntington's where soluble intrinsically disordered proteins (IDPs) aggregate into fibrillar structures. IDPs are highly dynamic and have larger solvent exposed areas compared to globular proteins, meaning they make and break hydrogen bonds with the surrounding water more frequently. The mobility of water can be altered by presence of ions, sugars, osmolytes, proteins and membranes which differ in different cell types, cell compartments and also as cells age. A reduction in water mobility and thus protein mobility enhances the probability that IDPs can associate to form intermolecular bonds and propagate into aggregates. This poses an interesting question as to whether localised water mobility inside cells can influence the propensity of an IDP to aggregate and furthermore whether it can influence fibril polymorphism and disease outcome.
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Affiliation(s)
- Amberley D Stephens
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK
| | - Gabriele S Kaminski Schierle
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, UK.
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93
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Varanoske AN, Coker NA, Johnson BAD, Belity T, Mangine GT, Stout JR, Fukuda DH, Wells AJ. Effects of Rest Position on Morphology of the Vastus Lateralis and Its Relationship with Lower-Body Strength and Power. J Funct Morphol Kinesiol 2019; 4:jfmk4030064. [PMID: 33467379 PMCID: PMC7739298 DOI: 10.3390/jfmk4030064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022] Open
Abstract
Ultrasonography of the lower body typically encompasses supine rest due to fluid shifts affecting tissue size and composition. However, vastus lateralis (VL) examination is completed in the lateral recumbent position, and this positional change may influence morphology and its ability to predict function. This study aimed to examine the effect of position on VL morphology and its relationship with lower-body performance. Cross-sectional area (CSA), muscle thickness (MT), pennation angle (PA), echo intensity (UnCorEI), subcutaneous adipose tissue thickness (SFT), and echo intensity corrected for SFT (CorEI) were assessed in 31 resistance-trained males (23.0 ± 2.1 yrs; 1.79 ± 0.08 m; 87.4 ± 11.7 kg) immediately after transitioning from standing to supine (IP), after 15 min of standing (ST), and after 15 min of rest in three recumbent positions: supine (SUP), dominant lateral recumbent (DLR), non-dominant lateral recumbent (NDLR). Participants also completed unilateral vertical jumps, isometric/isokinetic tests, and a one-repetition maximum leg press. CSA, MT, PA, and SFT were greater in ST compared to NDLR, DLR, and SUP (p < 0.05). CSA, UnCorEI, and CorEI were different between recumbent positions; however no differences were observed for MT, PA, and SFT. Different magnitudes of relationships were observed between muscle morphological characteristics measured after rest in different positions and performance variables. Muscle morphology in IP generally appears to be the best predictor of performance for most variables, although utilizing the NDLR and DLR positions may provide comparable results, whereas morphology measured in ST and SUP provide weaker relationships with physical performance. IP also requires less time and fewer requirements on the technician and subject, thus researchers should consider this positioning for VL examination.
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Affiliation(s)
- Alyssa N. Varanoske
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - Nicholas A. Coker
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - Bri-Ana D.I. Johnson
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - Tal Belity
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - Gerald T. Mangine
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Jeffrey R. Stout
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - David H. Fukuda
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - Adam J. Wells
- Institute of Exercise Physiology and Rehabilitation Science, Division of Kinesiology, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
- Correspondence: ; Tel.: +1-407-823-3906
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94
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The Role of Water Homeostasis in Muscle Function and Frailty: A Review. Nutrients 2019; 11:nu11081857. [PMID: 31405072 PMCID: PMC6723611 DOI: 10.3390/nu11081857] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
Water, the main component of the body, is distributed in the extracellular and intracellular compartments. Water exchange between these compartments is mainly governed by osmotic pressure. Extracellular water osmolarity must remain within very narrow limits to be compatible with life. Older adults lose the thirst sensation and the ability to concentrate urine, and this favours increased extracellular osmolarity (hyperosmotic stress). This situation, in turn, leads to cell dehydration, which has severe consequences for the intracellular protein structure and function and, ultimately, results in cell damage. Moreover, the fact that water determines cell volume may act as a metabolic signal, with cell swelling acting as an anabolic signal and cell shrinkage acting as a catabolic signal. Ageing also leads to a progressive loss in muscle mass and strength. Muscle strength is the main determinant of functional capacity, and, in elderly people, depends more on muscle quality than on muscle quantity (or muscle mass). Intracellular water content in lean mass has been related to muscle strength, functional capacity, and frailty risk, and has been proposed as an indicator of muscle quality and cell hydration. This review aims to assess the role of hyperosmotic stress and cell dehydration on muscle function and frailty.
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95
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Mendes J, Padrão P, Moreira P, Santos A, Borges N, Afonso C, Negrão R, Amaral TF. Handgrip Strength and Its Association With Hydration Status and Urinary Sodium-to-Potassium Ratio in Older Adults. J Am Coll Nutr 2019; 39:192-199. [PMID: 31381481 DOI: 10.1080/07315724.2019.1633439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Older adults present higher risk of functional disability detected by handgrip strength and an increased risk of poor health conditions, such as dehydration and low values of the sodium-to-potassium (Na/K) ratio. This study aimed to quantify the association of hydration status and Na/K ratio with handgrip strength, based on the urinary excretion of older adults.Methods: A cross-sectional study was conducted in 735 older adults ≥ 65 years old. Handgrip strength was measured with a Jamar Dynamometer and low values were defined according to body mass index and to sex-specific cutoff points. The hydration status was evaluated based on free water reserve. Sodium and potassium intake were evaluated after converting 24-hour urinary sodium and potassium excretion, respectively. A logistic regression model was used to estimate the probability of presenting low handgrip strength, according to risk of hypohydration and to quartiles of Na/K, stratified by sex and adjusted for potential confounders.Results: The adjusted odds ratio (OR) for presenting low handgrip strength was higher in women at risk of hypohydration, but this association was not found in men. Both women and men with the highest values of Na/K ratio presented higher adjusted OR for low handgrip strength (OR in women was 2.03; 95% confidence interval [CI]: 1.12-3.68, and in men was 2.19; 95% CI: 1.11-4.29).Conclusions: The risk of hypohydration was directly associated with low handgrip strength in older women. In older adults, higher values of urinary Na/K ratio were also directly associated with low handgrip strength.
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Affiliation(s)
- Joana Mendes
- 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
| | - Patrícia Padrão
- Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal.,EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal.,EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal.,The Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
| | - Alejandro Santos
- I3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal.,Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal
| | - Nuno Borges
- Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal.,CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal
| | - Cláudia Afonso
- Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal
| | - Rita Negrão
- 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
| | - Teresa F Amaral
- Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal.,UISPA-IDMEC, Faculty of Engineering, University of Porto, Porto, Portugal
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96
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LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, Hirsch IB, McDonnell ME, Molitch ME, Murad MH, Sinclair AJ. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:1520-1574. [PMID: 30903688 PMCID: PMC7271968 DOI: 10.1210/jc.2019-00198] [Citation(s) in RCA: 268] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. CONCLUSIONS Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.
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Affiliation(s)
- Derek LeRoith
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Susan S Braithwaite
- Presence Saint Francis Hospital, Evanston, Illinois
- Presence Saint Joseph Hospital, Chicago, Illinois
| | - Felipe F Casanueva
- Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatologia Obesidad y Nutricion, Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Boris Draznin
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Jeffrey B Halter
- University of Michigan, Ann Arbor, Michigan
- National University of Singapore, Singapore, Singapore
| | - Irl B Hirsch
- University of Washington Medical Center–Roosevelt, Seattle, Washington
| | - Marie E McDonnell
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark E Molitch
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
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97
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Białecka-Dębek A, Pietruszka B. The association between hydration status and cognitive function among free-living elderly volunteers. Aging Clin Exp Res 2019; 31:695-703. [PMID: 30128663 PMCID: PMC6491399 DOI: 10.1007/s40520-018-1019-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/03/2018] [Indexed: 11/25/2022]
Abstract
Background Ageing is inevitably associated with a progressive cognitive decline. With the rising percentage of the elderly in society, the number of people with dementia and cognitive impairment increases. Water is a vital ingredient that must be included in the diet. The impact of hydration status on cognitive performance has been studied only a little so far. Aims The objective of the study was to investigate the relation between the hydration status and the cognitive function. Methods The study was conducted among 60 free-living volunteers, aged 60–93 years. Data on water consumption were gathered based on 3-day records. The hydration status was assessed in morning urine samples by evaluating urine specific gravity. The cognitive function was tested using the Mini Mental State Examination (MMSE), the Babcock Story Recall Test and the Trail Making Test. Information about depression was gathered by the Geriatric Depression Scale. Results The mean daily total water intake was 2441 ± 622 ml, and 70% of respondents met the reference values for an adequate intake. The mean urine specific gravity (1.013 g/cm3, range of 1.004–1.025 g/cm3) indicated that most of the individuals were in a good hydration state. The average result of MMSE was 27.8, which is connected with mild cognitive impairment. There was no significant relationship between the hydration status and the results of the cognitive function test in the studied population. Discussion/conclusion As the elderly volunteers had a good hydration status, there was no significant relationship between cognitive performance and urine specific gravity. It is necessary to replicate the findings of this study with a larger and more diverse sample of older adults.
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Affiliation(s)
- Agata Białecka-Dębek
- Department of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776, Warsaw, Poland.
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776, Warsaw, Poland
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98
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Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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99
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Fukushima Y, Sano Y, Isozaki Y, Endo M, Tomoda T, Kitamura T, Sato T, Kamijo Y, Haga Y, Yoda T. A pilot clinical evaluation of oral mucosal dryness in dehydrated patients using a moisture-checking device. Clin Exp Dent Res 2019; 5:116-120. [PMID: 31049213 PMCID: PMC6483039 DOI: 10.1002/cre2.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022] Open
Abstract
This study included 30 patients (17 males and 13 females; mean age, 73.7 ± 13.1 years) who were diagnosed with dehydration based on vital signs, skin symptoms, and blood test findings by emergency medicine physicians. First, the attending physician of our department measured oral mucosal dryness. Subsequently, the emergency medicine physician blindly divided the severity of dehydration into three stages according to clinical findings and blood test results. In this study, the oral moisture-checking device (Mucus®; Life Co., Ltd., Saitama, Japan) was used to measure the oral mucosal dryness. We examined the oral moisture level for each dehydration severity level and the correlations of each severity level of dehydration with the measured values. Spearman's correlation coefficient (Medcalc version 11.3 for Windows) was used for statistical analysis. P < 0.05 indicated significant differences. Twenty-six patients were diagnosed with dry mouth, and a moderate negative correlation was found between the severity of dehydration and oral moisture degree (r = -0.686). The correlation coefficient for the relationship between oral moisture degree and severity of dehydration was -0.686, indicating a negative correlation (P < .05). These results suggest that the oral mucosal dryness may be a useful index of dehydration severity.
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Affiliation(s)
- Yosuke Fukushima
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Yoshie Sano
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Yuta Isozaki
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Mao Endo
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Taketo Tomoda
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Tomohisa Kitamura
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Tsuyoshi Sato
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
| | - Yoshito Kamijo
- Emergency Medical Center and Poison CenterSaitama Medical University HospitalJapan
| | - Yoshiyuki Haga
- Emergency Medical Center and Poison CenterSaitama Medical University HospitalJapan
| | - Tetsuya Yoda
- Department of Oral and Maxillofacial SurgeryFaculty of Medicine, Saitama Medical UniversityJapan
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Gaspar PM, Scherb CA, Rivera-Mariani F. Hydration Status of Assisted Living Memory Care Residents. J Gerontol Nurs 2019; 45:21-29. [PMID: 30917202 DOI: 10.3928/00989134-20190213-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/18/2019] [Indexed: 11/20/2022]
Abstract
Water intake and hydration status of assisted living memory care (ALMC) residents were evaluated. Thirty-two residents (eight men; mean age 86.5 years; Global Deterioration Scale [GDS] 3 to 7) from four ALMC units participated. Ingested food and fluid amount, type, and time, and ingestion behaviors were observed from 7:00 a.m. to 7:00 p.m. Related factors were obtained from chart review/participant survey. Mean fluid intake was 1,160.16 mL; mean water intake from food and fluid was 56.55% (SD = 23.4%) of recommended water intake (RWI). Only one participant met 100% RWI. Using osmolality laboratory results (available for 21 participants), five participants were hydrated, whereas eight (38.1%) participants were in impending dehydration and dehydration categories, respectively. Fluid intake, GDS, and level of assistance during meals predicted RWI. Water intake of ALMC residents is inadequate, placing them at risk for dehydration, and justifies development and implementation of care standards for increasing water intake. [Journal of Gerontological Nursing, 45(4), 21-29.].
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