Nutritional assessment interpretation on 22 007 Spanish community-dwelling elders through the Mini Nutritional Assessment test

Evaluation of the Iranian Mini Nutritional Assessment Short-Form in Community-dwelling Elderly

BACKGROUND

This study was aimed to assess agreement and diagnostic accuracy of the Iranian version of Mini Nutritional Assessment short-form (MNA-SF) against the original MNA, as a gold standard in community-dwelling elderly.

METHODS

The full MNA and 9-item MNA-SF comprising questions regarding clinical status, dietary assessment and self-perception of health status and nutri-tion together with mid-arm and calf circumference measurements without in-cluding the body mass index (BMI) were completed for 205 volunteers aged 65 or older recruited from all over Markazi Province (Iran). Correlation, diagnostic accuracy and agreement between the MNA-SF and full MNA were calculated.

RESULTS

The MNA and the MNA-SF classified 45.4% and 64.4% of the sub-jects as malnourished or at risk of malnutrition, respectively. Substantial agree-ment between the MNA-SF and full MNA was observed (Kappa=0.633). The MNA-SF correlated strongly with the full MNA (r=0.868, P<0.001). The MNA-SF showed high sensitivity (96.77%) and negative predictive values (95.89%), relatively high specificity (62.5%) and positive predictive values (68.18%) and fair accuracy (Area under curve =0.796).

CONCLUSION

Iranian MNA-SF seems to be an applicable screening tool for quick detection of malnutrition or at risk of malnutrition in community-dwelling elderly especially when BMI is unavailable.

Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale

OBJECTIVES

The purpose of this study was to develop a new brief, comprehensive geriatric assessment scale for older patients diagnosed with different hematological malignancies, the Geriatric Assessment in Hematology (GAH scale), and to determine its psychometric properties.

MATERIALS AND METHODS

The 30-item GAH scale was designed through a multi-step process to cover 8 relevant dimensions. This is an observational study conducted in 363 patients aged≥65years, newly diagnosed with different hematological malignancies (myelodysplasic syndrome/acute myeloblastic leukemia, multiple myeloma, or chronic lymphocytic leukemia), and treatment-naïve. The scale psychometric validation process included the analyses of feasibility, floor and ceiling effect, validity and reliability criteria.

RESULTS

Mean time taken to complete the GAH scale was 11.9±4.7min that improved through a learning-curve effect. Almost 90% of patients completed all items, and no floor or ceiling effects were identified. Criterion validity was supported by reasonable correlations between the GAH scale dimensions and three contrast variables (global health visual analogue scale, ECOG and Karnofsky), except for comorbidities. Factor analysis (supported by the scree plot) revealed nine factors that explained almost 60% of the total variance. Moderate internal consistency reliability was found (Cronbach's α: 0.610), and test-retest was excellent (ICC coefficients, 0.695-0.928).

CONCLUSION

Our study suggests that the GAH scale is a valid, internally reliable and a consistent tool to assess health status in older patients with different hematological malignancies. Future large studies should confirm whether the GAH scale may be a tool to improve clinical decision-making in older patients with hematological malignancies.

Muscle and bone, two interconnected tissues

As bones are levers for skeletal muscle to exert forces, both are complementary and essential for locomotion and individual autonomy. In the past decades, the idea of a bone-muscle unit has emerged. Numerous studies have confirmed this hypothesis from in utero to aging works. Space flight, bed rest as well as osteoporosis and sarcopenia experimentations have allowed to accumulate considerable evidence. Mechanical loading is a key mechanism linking both tissues with a central promoting role of physical activity. Moreover, the skeletal muscle secretome accounts various molecules that affect bone including insulin-like growth factor-1 (IGF-1), basic fibroblast growth factor (FGF-2), interleukin-6 (IL-6), IL-15, myostatin, osteoglycin (OGN), FAM5C, Tmem119 and osteoactivin. Even though studies on the potential effects of bone on muscle metabolism are sparse, few osteokines have been identified. Prostaglandin E2 (PGE2) and Wnt3a, which are secreted by osteocytes, osteocalcin (OCN) and IGF-1, which are produced by osteoblasts and sclerostin which is secreted by both cell types, might impact skeletal muscle cells. Cartilage and adipose tissue are also likely to participate to this control loop and should not be set aside. Indeed, chondrocytes are known to secrete Dickkopf-1 (DKK-1) and Indian hedgehog (Ihh) and adipocytes produce leptin, adiponectin and IL-6, which potentially modulate bone and muscle metabolisms. The understanding of this system will enable to define new levers to prevent/treat sarcopenia and osteoporosis at the same time. These strategies might include nutritional interventions and physical exercise.

Social and economic correlates of malnutrition in Polish elderly population: the results of PolSenior study

OBJECTIVES

The aim of this study was to evaluate the prevalence of malnutrition in Polish elderly population and analyse its social and economic correlates based on the data from the PolSenior project, the first large-scale study of a representative group of Polish seniors.

DESIGN

A cross-sectional population-based study.

SETTING

All territorial provinces in Poland.

PARTICIPANTS

4482 community-dwelling respondents aged 65 years or above (women: n=2142, age=79.0±8.4 years; men: n=2340, age= 78.3±8.6 years).

MEASUREMENTS

The nutritional status of participants was assessed through the Mini Nutritional Assessment Short Form (the revised MNA-SF). Out of social and economic correlates we evaluated age, sex, level of education, marital status, place of residence, living conditions and economic status. Economic status of the respondents was determined on the basis of questions on how well they could manage their own budgets. Those who could afford only the cheapest food or clothes were considered the group of self-reported poverty.

RESULTS

Frequency of malnutrition in the PolSenior population accounted for 7.5% (in 5.0% men and 9.0% women; p<0.001). The risk of malnutrition was present in 38.9% (33.3% men and 42.4% women; p<0.001). In our study female sex, older age, unmarried status, living in a rural area and self-reported poverty were independent correlates of malnutrition.

CONCLUSIONS

Our data showed high prevalence of malnutrition and the risk of its development among the community-dwelling elderly people in Poland. Screening with MNA-SF should focus in particular on unmarried, poorly educated individuals, in late old age, living in rural areas and self-reporting a poor financial state, especially women.

Oral health in the elderly patient and its impact on general well-being: a nonsystematic review

Data on the oral health of the elderly depict a worrying situation, with an elevated prevalence of caries and moderate periodontal disease, frequent edentulism, and numerous cases of dry mouth and oral cancer. There is wide evidence that periodontitis is a risk factor for certain systemic diseases, and impaired oral health has been associated with mastication and nutritional problems, especially among the elderly, with highly negative effects on their quality of life. In this nonsystematic review, the authors discuss the importance of evaluating the oral health of the geriatric population in a comprehensive manner, beyond simple clinical assessments.

Protein malnutrition attenuates bone anabolic response to PTH in female rats

PTH is indicated for the treatment of severe osteoporosis. Elderly osteoporotic patients frequently suffer from protein malnutrition, which may contribute to bone loss. It is unknown whether this malnutrition may affect the response to PTH. Therefore, the aim of the present study was to assess whether an isocaloric low-protein (LP) diet may influence the bone anabolic response to intermittent PTH in 6-month-old female rats. Six-month-old female rats were either pair fed an isocaloric LP diet (2.5% casein) or a normal-protein (NP) diet (15% casein) for 2 weeks. The rats continued on their respective diet while being treated with 5- or 40-μg/kg recombinant human PTH amino-terminal fragment 1-34 (PTH-[1-34]) daily, or with vehicle for 4 weeks. At the end of this period, areal bone mineral density, bone mineral content, microstructure, and bone strength in axial compression of proximal tibia or 3-point bending for midshaft tibia tests were measured. Blood was collected for the determination of IGF-I and osteocalcin. After 4 weeks of PTH-(1-34), the dose-dependent increase of proximal tibia bone mineral density, trabecular microstructure variables, and bone strength was attenuated in rats fed a LP diet as compared with rats on a NP intake. At the level of midshaft tibia cortical bone, PTH-(1-34) exerted an anabolic effect only in the NP but not in the LP diet group. Protein malnutrition was associated with lower IGF-I levels. Protein malnutrition attenuates the bone anabolic effects of PTH-(1-34) in rats. These results suggest that a sufficient protein intake should be recommended for osteoporotic patients undergoing PTH therapy.

Malnutrition in older adults on financial assistance in an urban Asian country: a mixed methods study

OBJECTIVE

The objectives of the present study were to assess the nutritional status, identify factors for malnutrition risk and evaluate barriers to adequate nutrition among recipients of the Public Assistance (PA) scheme for socio-economically disadvantaged Singaporeans.

DESIGN

Using a cross-sectional study design, we assessed PA recipients' malnutrition risk using the DETERMINE Nutritional Health checklist and the full Mini-Nutritional Assessment (MNA), as well as their nutritional knowledge, co-morbidity burden, depression risk, instrumental and basic activities of daily living (IADL and BADL), and awareness and utilization of available food services. In-depth interviews were also conducted on malnourished individuals (MNA score < 17) to understand barriers to adequate nutrition.

SETTING

Homes of community-living older adults and nursing homes of institutionalized older adults.

SUBJECTS

All PA recipients aged ≥55 years in Central Singapore District.

RESULTS

Four hundred and sixty-five of 511 (91·0 %) eligible PA recipients participated in the study. The prevalence of malnutrition in the study population was 2·8 %. However, 50·3 % were at risk of malnutrition. Among community-dwelling respondents, the risk of malnutrition was independently associated with age >75 years, currently unmarried, BADL impairment, depression risk and BMI < 19·0 kg/m2. Qualitative analysis revealed that financial, social and physical barriers and lack of knowledge were the main contributors to poor nutritional status. Only half were aware of subsidized food services and education increased interest in utilizing food services. Among nursing home respondents, those who were BADL impaired were more likely to be at risk of malnutrition.

CONCLUSIONS

Among PA recipients, the prevalence of malnutrition is low but the risk of malnutrition is high. Education on adequate nutrition and food services are recommended.

Management of osteoporosis of the oldest old

This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement.

INTRODUCTION

This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent.

METHODS

This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months.

RESULTS

The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed.

CONCLUSION

These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.

Dietary and health profiles of Spanish women in preconception, pregnancy and lactation

The nutritional status and lifestyle of women in preconception, pregnancy and lactation determine maternal, fetal and child health. The aim of this cross-sectional study was to evaluate dietary patterns and lifestyles according the perinatal physiological status in a large sample of Spanish women. Community pharmacists that were previously trained to collect the data recruited 13,845 women. General information, anthropometric measurements, physical activity, unhealthy habits and dietary data were assessed using a validated questionnaire. Mean values and percentages were used as descriptive statistics. The t-test, ANOVA or chi-squared test were used to compare groups. A score that included dietary and behavioral characteristics was generated to compare lifestyles in the three physiological situations. The analysis revealed that diet quality should be improved in the three stages, but in a different manner. While women seeking a pregnancy only met dairy recommendations, those who were pregnant only fulfilled fresh fruits servings and lactating women only covered protein group requirements. In all cases, the consumption allowances of sausages, buns and pastries were exceeded. Food patterns and unhealthy behaviors of Spanish women in preconception, pregnancy and lactation should be improved, particularly in preconception. This information might be useful in order to implement educational programs for each population group.

Nutritional status in community-dwelling elderly in France in urban and rural areas

Malnutrition is a frequent condition in elderly people, especially in nursing homes and geriatric wards. Its frequency is less well known among elderly living at home. The objective of this study was to describe the nutritional status evaluated by the Mini Nutritional Assessment (MNA) of elderly community-dwellers living in rural and urban areas in France and to investigate its associated factors.

Methods

Subjects aged 65 years and over from the Approche Multidisciplinaire Intégrée (AMI) cohort (692 subjects living in a rural area) and the Three-City (3C) cohort (8,691 subjects living in three large urban zones) were included. A proxy version of the MNA was reconstructed using available data from the AMI cohort. Sensitivity and specificity were used to evaluate the agreement between the proxy version and the standard version in AMI. The proxy MNA was computed in both cohorts to evaluate the frequency of poor nutritional status. Factors associated with this state were investigated in each cohort separately.

Results

In the rural sample, 38.0% were females and the mean age was 75.5 years. In the urban sample, 60.3% were females and the mean age was 74.1 years. Among subjects in living in the rural sample, 7.4% were in poor nutritional status while the proportion was 18.5% in the urban sample. Female gender, older age, being widowed, a low educational level, low income, low body mass index, being demented, having a depressive symptomatology, a loss of autonomy and an intake of more than 3 drugs appeared to be independently associated with poor nutritional status.

Conclusion

Poor nutritional status was commonly observed among elderly people living at home in both rural and urban areas. The associated factors should be further considered for targeting particularly vulnerable individuals.

Preoperative serum albumin level as a predictor of postoperative complication after spine fusion

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To investigate the association between preoperative baseline serum albumin and postoperative surgical complication.

SUMMARY OF BACKGROUND DATA

The prevalence of malnutrition in the hospitalized patient population has only been recently recognized. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) has been shown to be associated with increased morbidity and mortality rates. The prognostic implications and significance of hypoalbuminemia after spine fusion surgery remain unknown. In this study, we assess the predictive value of preoperative nutritional status (serum albumin level) on postoperative complication rates.

METHODS

The medical records of 136 consecutive patients undergoing spine fusion at Duke University Medical Center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized as hypoalbuminemia (malnourished). Patient demographics, comorbidities, and postoperative complication rates were collected. Patients were also stratified into 2 groups based on their cause, namely elective degenerative/deformity versus nonelective cases. The association between preoperative serum albumin level and postoperative complication was assessed via logistic regression analysis.

RESULTS

Overall, 40 (29.4%) patients experience at least 1 postoperative complication. Patients undergoing elective surgery had more complications based on preoperative albumin levels (malnourished patients: 35.7% vs. nourished patients: 11.7%, P = 0.03), whereas those undergoing nonelective surgery had similar complication rates (malnourished patients: 46.5% vs. nourished patients: 42.1%, P = 0.75). For patients undergoing elective spinal surgery, logistic regression with and without propensity score adjustment for risk factors, demonstrated that preoperative serum albumin level was a significant predictor of postoperative complications (OR: 4.21; 95% CI: 1.09-16.19; P = 0.04) and (OR: 4.54; 95% CI: 1.17-19.32; P = 0.04), respectively.

CONCLUSION

Preoperative hypoalbuminemia is an independent risk factor for postoperative complications after elective spine surgery for degenerative and deformity causes, and should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.

LEVEL OF EVIDENCE

2.

Comorbidities, polypharmacy, functionality and nutritional status in Turkish community-dwelling female elderly

BACKGROUND AND AIMS

Most elderly persons live in developing countries where current geriatric epidemiological data are scarce. We aimed to study major comorbidities, polypharmacy, functional and nutritional status in a Turkish community-dwelling female elderly clinic population.

METHODS

Female geriatrics outpatient clinic patients were assessed cross-sectionally. Patients underwent comprehensive geriatric cassessment, including identification of chronic diseases, drugs, functionality, and nutrition. Comorbidities and drugs were defined by the review of patients' self-reports and current medications. Geriatric depression and cognition were assessed by 30-item geriatric depression scale and Folstein mini-mental-state-examination. Functional status was assessed by the evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutritional assessment was performed by mini-nutritional-assessment-short form.

RESULTS

Five-hundred and fifteen patients were included in this study over an 8-year period. Mean age was 73.4 ± 6.9 years. Mean number of chronic diseases was 2.8. 61.1 % had >3 chronic diseases. Most common 3 diagnoses were hypertension (75.3 %), depression (45.5 %) and dementia (39.4 %). Mean number of drugs was 4.8. Polypharmacy was noted as 63.2 and 47.6 % by definitions as >4 or >5 chronic drug use, respectively. Subjects with at least one dependency of ADL and IADL were 23.4 and 64.0 %. Prevalence of poor nutrition was 39.1 %. In patients with at least one ADL or IADL dependency, undernutrition (p < 0.001), dementia (p < 0.001), cerebrovascular accident, Parkinson's disease, diabetes were more prevalent (p < 0.05) and were taking higher number of drugs (p < 0.01).

CONCLUSIONS

Polypharmacy and functional dependency seem to be prevalent among female elders in our country. Nutritional status was worse than the other reported urban area of Turkey and also than among males of same region but better than among Iranian counterparts. This study illustrates geographical differences in and between the individual countries and supports the continued need for comprehensive geriatric assessment worldwide.

Oral health-related quality of life and malnutrition in patients treated for oral cancer

Purpose

This study examined whether oral health-related quality of life (OHRQoL) is associated with nutritional status in patients treated for oral cancer.

Methods

A cross-sectional study was carried out on with patients treated for oral cancer at least 6 months after treatment. OHRQoL was measured using two questionnaires: Oral Impacts on Daily Performances (OIDP) and Oral Health Impact Profile (OHIP-14); malnutrition risk was assessed through the Mini Nutritional Assessment (MNA). Multivariable regression models assessed the association between the outcomes (OIDP and OHIP-14) and the exposure (MNA), adjusting for sex, age, clinical stage, social class, date of treatment completion, and functional tooth units.

Results

The final simple included 133 patients, 22.6 % of which were malnourished or at risk of malnutrition. More than 95 % of patients reported a negative impact on the OHRQoL for both measures used. Patients with malnutrition or risk of malnutrition had significantly worse OHRQoL than those with no malnutrition, even after adjusting for clinical and socioeconomic data (ß-coefficient = 8.37 (95 % confidence interval (CI) 1.42–15.32) with the OIDP and ß-coefficient = 2.08 (95 % CI 0.70–3.46) with the OHIP-14).

Conclusion

Being malnourished or at risk of malnutrition is an important longer-term determinant of worse OHRQoL among patients treated for oral cancer.

Risk of being undernourished in a cohort of community-dwelling 85-year-olds: the Octabaix study

OBJECTIVES

To describe the prevalence of the risk of being undernourished in a community-dwelling population of 85-year-olds, and to study associated factors.

METHODS

A cross-sectional community-based survey of 328 inhabitants assigned to seven primary healthcare teams was carried out. Geriatric assessment was based on sociodemographic variables, the Barthel Index (BI), the Lawton Index (LI), the Spanish version of the Mini-Mental State Examination, the Charlson Comorbidity Index, chronic diseases, social risk measured by Gijon's Social-Familial Evaluation Scale, prescriptions and blood tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Participants were defined as being at risk of undernourishment when they had a MNA score above or equal to 23.5. A comparative analysis was carried out between patients with and without risk of being undernourished, and a multiple logistic regression analysis was carried out.

RESULTS

The prevalence risk of being undernourished was 34.5%. A statistically significant association was found with being female (OR 2.44, 95% CI 1.28-4.54), LI (OR 1.47, 95% CI 1.29-1.66), social risk (OR 1.15, 95% CI 1.02-1.29) and prescription drugs taken (OR 5.58, 95% CI 2.09-14.92). Cardiovascular prescription showed a protective association (OR 4.34, 95% CI 1.78-10.0). No statistical differences between the risks of being undernourished were found in the laboratory analysis.

CONCLUSIONS

There is a high risk of being undernourished in 85-year-old subjects. This nutritional status was positively associated with being female, disability, increased social risk and a high number of prescription drugs, whereas there was a protective relationship with cardiovascular prescription. In evaluations of nutritional status in the community, a multidisciplinary assessment is more valid than analytical findings.

Malnutrition in an elderly population without cognitive impairment living in nursing homes in Spain: study of prevalence using the Mini Nutritional Assessment test

BACKGROUND

The prevalence of malnutrition in institutionalized elderly people is generally high. A good nutritional status is related to a decrease in mortality and costs of morbidity treatments. Therefore, it is essential to know the nutritional status in order to establish action policies. However, there are not enough studies about malnutrition in institutionalized elderly in Spain.

OBJECTIVES

The objectives of this survey were to assess the prevalence of malnutrition and risk of malnutrition in elderly people living in nursing homes in the province of Albacete (Spain) using the Mini Nutritional Assessment (MNA®) test, to analyze their distribution according to age, gender and different nursing home features, and to identify the MNA items that best predict the MNA total score.

METHODS

A cross-sectional study was conducted with data collected from 895 elders living in 34 nursing homes all over the province of Albacete, including facilities located in the main city, towns and villages. Prevalence of malnutrition and risk of malnutrition were assessed using the MNA full form test. Groups of malnutrition were compared by using mean MNA scores. Stepwise linear regression analyses were used to identify the items in the MNA which best predicted the MNA total scores.

RESULTS

According to the MNA, the prevalence of malnutrition among elderly people staying in Albacete province nursing homes was 2.8%, and the prevalence of being at risk of malnutrition was 37.3%. MNA total score was significantly higher in men (24.3 ± 2.9) than in women (23.7 ± 3.3) and significantly higher in residents living in nursing homes located in towns and villages (24.2 ± 2.8) than in those who were living in institutions placed in the main city (23.7 ± 3.4). The MNA score was found to decrease with increasing age, except for individuals aged 90 years or older.

CONCLUSIONS

The prevalence of malnutrition and risk of malnutrition was 40.1%. Female gender and living in institutions located in the main city were identified as malnutrition risk factors. In general, an increase in malnutrition with age was detected, except for people in the last years of their lives. The MNA questions that best predicted the nutritional status were the ones relating to the anthropometrical and self-assessments.

Quality of life in sarcopenia and frailty

The reduced muscle mass and impaired muscle performance that define sarcopenia in older individuals are associated with increased risk of physical limitation and a variety of chronic diseases. They may also contribute to clinical frailty. A gradual erosion of quality of life (QoL) has been evidenced in these individuals, although much of this research has been done using generic QoL instruments, particularly the SF-36, which may not be ideal in older populations with significant comorbidities. This review and report of an expert meeting presents the current definitions of these geriatric syndromes (sarcopenia and frailty). It then briefly summarizes QoL concepts and specificities in older populations and examines the relevant domains of QoL and what is known concerning QoL decline with these conditions. It calls for a clearer definition of the construct of disability, argues that a disease-specific QoL instrument for sarcopenia/frailty would be an asset for future research, and discusses whether there are available and validated components that could be used to this end and whether the psychometric properties of these instruments are sufficiently tested. It calls also for an approach using utility weighting to provide some cost estimates and suggests that a time trade-off study could be appropriate.

Association of the oral health impact profile with malnutrition risk in Spanish elders

The objective of this study was to determine any relationship between oral health-related quality of life (OHR-QoL) and malnutrition risk in the elderly using the oral health impact profile (OHIP). We studied 250 institutionalized elderly people, 162 females and 88 males, with and without teeth. Data were gathered on: general health; oral health; malnutrition risk, measured with the Mini Nutritional Assessment (MNA); and OHR-QoL, evaluated with the OHIP. A multivariate binary logistic regression model was constructed with malnutrition presence/risk as dependent variable. Mean age was 82.7 ± 8.2 years. Malnutrition or malnutrition risk was shown by 36.8% of the sample. OHIP was associated with malnutrition/risk after adjustment for age, sex, functional status, and mild dementia diagnosis. Malnutrition/risk was 3.43-fold more likely in participants with OHIP-reported "problems" than in those with none. The conclusion of the study was that OHIP-measured OHR-QoL is associated with malnutrition risk.

Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly

Functionality, comorbidities, polypharmacy, nutritional status and sarcopenia affect the prognosis of elderly excessively. These parameters are influenced by the population, living settings and age. We aimed to study these parameters in Turkish community-dwelling male elderly. We studied 274 male elderly ≥60 years of age admitted to our Geriatrics outpatient clinics. Mean age was 74.4 ± 7.1 years; 47.4% of the subjects were ≥75 years, 24.1% were ≥80 years. Mean activities-of-daily-living (ADL) and instrumental ADL (IADL) scores were 9.4 and 11.1, respectively. Patients with at least one-dependence at ADL-IADL were 22.6%-47.2%, and more than half-dependence at ADL-IADL were 2.8%-17.9%, respectively. Mean number of comorbidities were 2.6. Most common diagnosis was hypertension with 65%; mean number of drugs were 4.5; 55.3% were using ≥4 chronic drugs. Prevalences of malnutrition were 3.7%-6.9%, malnutrition risk were 23.5%-26.7% by the mini nutritional assessment test-long form and short form, respectively. Calf circumference was measured <31 cm in 10.5%. Our findings suggest that Turkish community-dwelling male elderly may have greater prevalences of functional dependence, sarcopenia but lower rates of malnutrition and similar rates of polypharmacy compared with the western developing countries and developed countries. This study emphasized the geographical differences in and/or between the individual countries highlighting the need for studies both country- and world-wide.

Malnutrition in community-dwelling adults with dementia (NutriAlz Trial)

OBJECTIVES

The objective of this study is to assess the nutritional status, measured by the MNA, in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition.

DESIGN

Cross-sectional analysis of a cluster randomized clinical trial (Nutrialz).

SETTING

Community-dwelling individuals attending dementia clinics.

PARTICIPANTS

940 individuals.

MEASUREMENTS

The clinical scales assessed were Mini Nutritional Assessment (MNA), Eating Behaviour Scale (EBS), Charlson comorbidity index, Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL) score, Instrumental Activities of Daily Living (IADL) score, Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell depression scale and Zarit Caregiver Burden Interview.

RESULTS

5.2% of participants were classified as being malnourished, 42.6% as being at risk of malnutrition and 52.2% as well nourished. Malnutrition by type of dementia was more frequent in Lewy bodies dementia (18.2%) than in the other types. Worse nutritional status is significantly related to more advanced age and worse cognitive, functional and behavioural profile, as well as increased burden for caregivers. Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression, exaltation, lack of inhibition and irritability. The items more strongly related to malnutrition are appetite/feeding and hallucinations. Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition. Dependence on feeding is a strongly related risk factor, while food preparation is only a moderate one. A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS (Odds Ratio (OR) 0.84, 95%CI 0.78 to 0.91), Cornell (OR 1.12, 95%CI 1.09 to 1.16), the number of dependent BADL (OR 1.29, 95%CI 1.17 to 1.42), age (OR 1.04, 95%CI 1.02-1.06), MMSE (OR 0.95, 95%CI 0.92 to 0.98) and Charlson (OR 1.18, 95%CI 1.05 to 1.34). A similar model built for prediction of malnutrition retained as significant covariables only EBS, Cornell and the number of dependent BADL.

CONCLUSION

These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.

Resting energy expenditure in malnourished older patients at hospital admission and three months after discharge: predictive equations versus measurements

BACKGROUND

Predicting resting energy expenditure (REE) in malnourished hospitalized older patients is important for establishing optimal goals for nutritional intake. Measuring REE by indirect calorimetry is hardly feasible in most clinical settings.

OBJECTIVE

To study the most accurate and precise REE predictive equation for malnourished older patients at hospital admission and again three months after discharge.

DESIGN

Twenty-three equations based on weight, height, gender, age, fat free mass (FFM) and/or fat mass (FM) and eleven fixed factors of kcal/kg were compared to measured REE. REE was measured by indirect calorimetry. Accuracy of REE equations was evaluated by the percentage patients predicted within 10% of REE measured, the mean percentage difference between predicted and measured values (bias) and the Root Mean Squared prediction Error (RMSE).

RESULTS

REE was measured in 194 patients at hospital admission (mean 1473 kcal/d) and again three months after hospital discharge in 107 patients (mean 1448 kcal/d). The best equations predicted 40% accuracy at hospital admission (Lazzer, FAO/WHO-wh and Owen) and 63% three months after discharge (FAO/WHO-wh). Equations combined with FFM, height or illness factor predicted slightly better. Fixed factors produce large RMSE's. All predictive equations showed proportional bias, with overestimation of low REE values and underestimation of high REE values. Correction by regression analysis did not improve results.

CONCLUSIONS

The REE predictive equations are not adequate to predict REE in malnourished hospitalized older patients. There is an urgent need for either a new accurate REE predictive equation, or accurate easy-to-use equipment to measure REE in clinical practice.

Nutrition education intervention for dependent patients: protocol of a randomized controlled trial

Background

Malnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions.

The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition.

Methods/Design

Intervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain). These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0–6–12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA), food intake, dentures, degree of dependency (Barthel test), cognitive state (Pfeiffer test), mood status (Yesavage test), and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin.

Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits) up to 6 months. The North American Nursing Diagnosis Association (NANDA) methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient’s nutritional status using the MNA test, diet, anthropometry, and biochemical parameters.

Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention.

The SPSS/PC program will be used for statistical analysis.

Discussion

The nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of view: diet, anthropometry and biochemistry in dependent patients at nutritional risk and to assess the effect of a nutritional education intervention. The design with random allocation, inclusion of all patients, validated methods, caregivers’ education and standardization between nurses allows us to obtain valuable information about nutritional status and prevention.

Trial Registration number

Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360775

The association between malnutrition and oral health status in elderly in long-term care facilities: a systematic review

OBJECTIVES

Malnutrition is a common problem in the elderly. It is not clear if oral health is associated to malnutrition in this population. The aim of this systematic review is to determine whether an association exists between oral health and malnutrition in the elderly in a long-term care facility.

DESIGN

Systematic review.

DATA SOURCE

Medline, Cochrane and Cinahl were systematically searched for to identify articles published between January 1985 and May 2011. Reference lists were checked for additional publications.

REVIEW METHODS

Publications were included if they explored the association between oral health status and malnutrition. As no consensus about terminology was found, a sensitive filter was developed. The methodological quality of the studies was assessed. Two independent reviewers performed all methodological steps.

RESULTS

Sixteen studies met the criteria for inclusion. Eleven studies used a multivariate approach; nine of these found an association between oral health status and malnutrition. Four studies found a relationship between masticatory problems and malnutrition. Five studies found an association between malnutrition and dental condition, number of oral problems, tongue alteration, problems with saliva flow, and candidiasis. Overall, the methodological quality of the studies was medium.

CONCLUSIONS

Tentative evidence indicates an independent association between oral health status and malnutrition in the elderly residing in a long-term care facility. Caution is needed for the interpretation of these results because of the absence of a gold standard to define and assess malnutrition and oral health status and the presence of methodological limitations throughout the studies.

Nutritional screening in a population-based cohort of community-dwelling older people

BACKGROUND

The risk of malnutrition is widely recognized in institutional settings but few studies have been conducted among community-dwelling older people. The objective of this study was to describe the nutritional status and factors associated with possible malnutrition among community-dwelling older people.

METHODS

A randomly selected sample (n = 696) of persons aged ≥ 75 years were included in the study. Baseline information was obtained for nutritional status (mini nutritional assessment short-form MNA-SF), depressive symptoms (15-item geriatric depression scale), cognitive status (mini-mental state examination MMSE) and daily activities (Barthel ADL index and Lawton and Brody IADL scale), self-reported health, oral health and medication use. Univariate and multivariate regression analyses were conducted to identify demographical, clinical and functional factors associated with possible malnutrition.

RESULTS

Of the 696 participants, 15% had possible malnutrition. In the univariate analysis, low MNA-SF scores were associated with advanced age, poor self-rated health, dry mouth/chewing problems, depressive symptoms and an increasing number of drugs in regular use. Higher albumin level, ADL, IADL and MMSE scores, and the ability to walk 400 m independently were inversely associated with possible malnutrition. In the multivariate analysis, dry mouth/chewing problems (OR 2.01, 95% CI: 1.14-3.54), IADL (OR 0.85, 95% CI: 0.75-0.96) and MMSE scores (OR 0.90, 95% 0.85-0.96) were independently associated with possible malnutrition.

CONCLUSION

Being at risk of malnutrition was common among community-dwelling older people. Problems with mouth, IADL and cognitive impairments were linked to possible nutritional risks.

Polypharmacy and nutritional status in elderly people

PURPOSE OF REVIEW

Increasing use of drugs among elderly people has raised concerns about possible negative health outcomes, including malnutrition, associated with polypharmacy. Evidence about the association of polypharmacy with nutritional status is scarce. This review summarizes the relevant evidence regarding polypharmacy and nutritional status in elderly people.

RECENT FINDINGS

The probability of nutritional problems as a consequence of drugs is highest in elderly people suffering from several diseases. Drug treatment may contribute to poor nutritional status by causing loss of appetite, gastrointestinal problems, and other alterations in body function. Some recently published studies add evidence on possible association between increasing number of drugs and malnutrition. Studies indicate also an association between polypharmacy and weight changes. In addition, there are available studies that have shown deficits in the intake of specific macronutrients and micronutrients (e.g. fiber, glucose, and specific vitamins) for those with a high number of drugs in use.

SUMMARY

On the basis of available evidence, the role of polypharmacy on nutritional status among elderly people is unclear. Some diseases promote malnutrition; thus, the independent role of drugs for nutritional status is challenging to determine. Longitudinal studies with careful adjustment for underlying diseases are needed to explore association between polypharmacy and malnutrition. Nutritional evaluation should be a routine part of comprehensive geriatric assessment that is conducted ideally in multiprofessional teams, including physician, pharmacist, and dietitian.

Serum ferritin and nutritional status in older adults at eldercare facilities

OBJECTIVES

To identify serum ferritin levels and their association with nutritional status determined by Body Mass Index in older adults at four eldercare facilities.

METHODS

An exploratory, cross-sectional study was carried out on 100 older adults residing at eldercare facilities in Colima, Mexico. Association between blood serum ferritin levels and nutritional status determined by Body Mass Index was evaluated. Ferritin levels were determined by means of chemiluminescence of blood samples obtained from subjects under control conditions. Descriptive statistics were used to analyze demographic characteristics. Student's t test and chi-square test were used to compare ferritin levels and Body Mass Index, respectively, between sexes. Statistical significance was considered to exist when P≤ 0.05. Pearson's correlation was used to establish the relation between Body Mass Index and serum ferritin levels.

RESULTS

Mean serum ferritin levels were 59.9489 ng/mL in women and 86.9266 ng/mL in men (P= 0.12). In regard to Body Mass Index there was statistical significance between normal vs overweight/obesity (P = 0.008), but not between normal vs underweight (P = 0.34). Body Mass Index/serum ferritin correlation was not statistically significant (Pearson's r = 0.003).

CONCLUSIONS

The quantification of a single serum indicator is insufficient for determining nutritional status in the older adult.

Suitability of the short-form Mini Nutritional Assessment in free-living elderly people in the northwest of Spain

OBJECTIVE

To evaluate the Mini Nutritional Assessment (MNA) test and the short-form MNA (MNA-SF) as screening tools for malnutrition risk and malnutrition in the free-living elderly of northwestern Spain.

DESIGN

transversal study.

SETTING

free-living elderly people of northwestern Spain.

SUBJECTS

728 participants (36.4% men and 63.6% women), the average of age for both genders was 80.7 ± 7.4.

RESULTS

according to MNA screening 12.5% subjects were classified as undernutrition (MNA < 17) and 57.5% were at risk for undernutrition (17 ≤ MNA ≤ 23.5). Significant correlations were found between MNA-SF and the full version (r=0.916; p < 0.000). The sensibility and specificity of the MNA-SF for the full MNA version were 81.4% and 92.7%, respectively. The regression analyses showed that weight loss had more influence on the MNA score, followed by the Body Mass Index (BMI), acute illness or psychological stress, mobility, self-perceived health status and neuropsychological problems.

CONCLUSIONS

These data showed a high prevalence of undernutrition risk among the free-living elderly people in northwestern Spain using the MNA test in two steps. The high sensitivity and specificity of MNA-SF might be sufficient for medical practice to identify patients at undernutrition risk or undernutrition. Generally, the full MNA confirmed the diagnosis for persons identified at risk by the MNA-SF, and planning was needed for nutritional interventions.

Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment

OBJECTIVES

To provide pooled data on the prevalence of malnutrition in elderly people as evaluated using the Mini Nutritional Assessment (MNA).

DESIGN

Retrospective pooled analysis of previously published datasets.

SETTING

Hospital, rehabilitation, nursing home, community.

PARTICIPANTS

Four thousand five hundred seven people (75.2% female) with a mean age of 82.3.

MEASUREMENTS

The prevalence of malnutrition in the combined database and in the four settings was examined.

RESULTS

Twenty-four data sets with information on full MNA classification from researchers from 12 countries were submitted. In the combined database, the prevalence of malnutrition was 22.8%, with considerable differences between the settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). In the combined database, the "at risk" group had a prevalence of 46.2%. Consequently, approximately two-thirds of study participants were at nutritional risk or malnourished.

CONCLUSION

The MNA has gained worldwide acceptance and shows a high prevalence of malnutrition in different settings, except for the community. Because of its specific geriatric focus, the MNA should be recommended as the basis for nutritional evaluation in older people.

Nutritional status in the healthy longeval population from Sardinia (Italy)

OBJECTIVES

The aim of this study was to evaluate sex- and age-related variations of the nutritional status in the aged population of central Sardinia, a geographical area with a high frequency of long-lived people, particularly men.

DESIGN

The sample consisted of 200 subjects over 70 years of age (men: N= 100, age= 81.0 +/- 7.0 years; women: N= 100, age= 81.5 +/- 7.3 years).

SETTING

Orroli (central Sardinia, Italy).

MEASUREMENTS

Mini nutritional assessment (MNA) and bioelectrical impedance vector analysis (BIVA) were used to evaluate nutritional status and body composition.

RESULTS

The indicators revealed a generally good nutritional status. The MNA results (men: 24.6 +/- 2.2; women: 23.4 +/- 2.5) showed that 64.1% of the subjects had a normal nutritional status and only a small proportion (1.2%) could be classified as malnourished. BIVA showed that most subjects (74.2%) were normal, while the prevalence of low body cell mass was 10.7% and that of dehydration 11.2%. According to the MNA, the nutritional status was significantly better in the men. Almost three-quarters of the men (73.1%) were well nourished vs. half of the women (50.6%). A worsening of the nutritional status with age was observed. The proportion of malnourished individuals, as assessed by MNA, increased from 0% to 9.1% from 70-79 to > 90 years.

CONCLUSIONS

With respect to their contemporaries from other regions, the elderly of Orroli presented a better nutritional status, a similar worsening with age and generally higher sexual dimorphism.

Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults

BACKGROUND & AIMS

Older adults are poorly assessed for malnutrition risk although malnutrition is not an uncommon problem in this population. The aim of this study was to determine the malnutrition risk and its correlates in geriatric outpatients.

METHOD

The study was performed in 2327 patients > or =65 years old who were admitted to our Geriatric Medicine outpatient clinic. Together with comprehensive geriatric assessment, nutritional assessment with short version of mini nutritional assessment test (MNA-SF) was performed. MNA-SF score < or =11 was determined as malnutrition risk.

RESULTS

Mean age of patients was 72.14+/-6.11 and 1479 (63.6%) were female. Mean MNA-SF score was 12.31+/-2.18. The number of patients with MNA-SF score < or =11 was 651 (28%). Depression, haematocrit, plasma fasting glucose, albumin, erythrocyte sedimentation rate, instrumental activities of daily living scores and bone mineral density measured from total femur were found to be significantly associated with malnutrition risk.

CONCLUSION

In this study malnutrition risk was detected in 651 (28%) patients. This ratio was similar to the literature. In older adults malnutrition risk is found to be increased due to majority of chronic illnesses and physical dependency. In conclusion, nutritional assessment should be a part of comprehensive geriatric assessment.

Malnutrition in free-living elderly in rural south India: prevalence and risk factors

Objective

To estimate the prevalence of malnutrition among free-living elderly in a rural population of south India.

Design

Cross-sectional study. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire, which is an eighteen-item nutritional screening instrument used in the elderly.

Setting

Kaniyambadi block, a rural development block in the state of Tamil Nadu, south India.

Subjects

Community-dwelling elderly (aged 60 years and above).

Results

As evaluated by the MNA, 14 % of the 227 subjects were malnourished and 49 % were at risk of malnourishment. No significant difference was found between men and women. The majority of the elderly were living with their children, had no income and consumed three meals per day. Older age (P < 0·001), decreased food intake (P < 0·001) and consuming fewer meals (P < 0·001) were independently associated with lower MNA scores.

Conclusions

More than 60 % of the subjects had low MNA scores (<23·5) indicating that deficient protein–energy intake is common among rural elderly of south India and requires more attention.