B vitamin status, dietary intake and length of stay in a sample of elderly rehabilitation patients

Factors influencing vitamin B6 status in domestic cats: age, disease, and body condition score

Limited studies are available on vitamin B6 status in domestic cats. To this end, we evaluated glutamate-oxaloacetate transaminase (GOT) activity in hemolysates with and without pyridoxal 5'-phosphate addition in two feline populations: a cohort of 60 healthy, domestic (sexually intact and specific pathogen-free) cats maintained under strictly controlled conditions with appropriate diets housed at the Feline Nutrition and Pet Care Center, and a cohort of 57 cats randomly selected between December 2022 to January 2023 that visited the Veterinary Medicine Teaching Hospital to seek care under different circumstances. The GOT activity expressed as the ratio with and without pyridoxal 5'-phosphate addition (primary activation ratio; PAR) decreased significantly with age in the healthy cohort. The PAR values normalized to age established a cut-off for vitamin B6 deficiency in both cohorts, identifying 17 of 101 animals as vitamin B6 deficient. Using machine learning, a partition-based model (decision tree) was built to identify the most important factors that predicted vitamin B6 deficiency while using the resulting tree to make predictions for new observations. This analysis, performed with all 101 cats, revealed that the diagnosis of an infectious, chronic or acute condition (0.55) was the main contributor, followed by age (0.26), and body condition score (optimal-overweight; 0.19). Thus, our study supports that vitamin B6 supplementation may be indicated in junior to adult animals diagnosed with an infectious, chronic, or acute conditions or healthy cats with body weight ranging from optimal to overweight. In older cats, even if healthy, underweight to optimal cats appear to be at risk of vitamin B6 deficiency.

Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review

Malnutrition is a common condition in geriatric rehabilitation settings; however, the accuracy and predictive validity of the measures to identify malnutrition have not been established. The current scoping review followed the Joanna Briggs Institute's evidence synthesis manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Literature published through September 2023 was searched using MEDLINE and CINAHL. The inclusion criteria selected studies reporting malnutrition measures, which include static body weight and weight loss. Identified tools were classified as nutritional screening tools, nutritional assessment tools, or diagnostic criteria. The domains of each tool/criterion and their accuracy and predictive validity were extracted. Fifty-six articles fulfilled the inclusion criteria, and six nutritional screening tools, three nutritional assessment tools, and three diagnostic criteria for malnutrition were identified. These measures consisted of various phenotypes, e.g., weight loss, causes such as inflammation/disease, and risk factors of malnutrition, e.g., functional impairment. The predictive validity of nutritional screening tools (n = 6) and malnutrition diagnostic criteria (n = 5) were inconsistently reported, whereas those for nutritional assessment tools were scarce (n = 1). These findings highlight the need to distinguish the functional impairment of nutritional origin from that of non-nutritional origin in nutritional assessment procedures, and the need to study the accuracy and the predictive validity of these measures in geriatric rehabilitation patients.

Analysis of the Impact of Selected Vitamins Deficiencies on the Risk of Disability in Older People

Vitamin deficiencies have a serious impact on healthy aging in older people. Many age-related disorders have a direct or indirect impact on nutrition, both in terms of nutrient assimilation and food access, which may result in vitamin deficiencies and may lead to or worsen disabilities. Frailty is characterized by reduced functional abilities, with a key role of malnutrition in its pathogenesis. Aging is associated with various changes in body composition that lead to sarcopenia. Frailty, aging, and sarcopenia all favor malnutrition, and poor nutritional status is a major cause of geriatric morbidity and mortality. In the present narrative review, we focused on vitamins with a significant risk of deficiency in high-income countries: D, C, and B (B6/B9/B12). We also focused on vitamin E as the main lipophilic antioxidant, synergistic to vitamin C. We first discuss the role and needs of these vitamins, the prevalence of deficiencies, and their causes and consequences. We then look at how these vitamins are involved in the biological pathways associated with sarcopenia and frailty. Lastly, we discuss the critical early diagnosis and management of these deficiencies and summarize potential ways of screening malnutrition. A focused nutritional approach might improve the diagnosis of nutritional deficiencies and the initiation of appropriate clinical interventions for reducing the risk of frailty. Further comprehensive research programs on nutritional interventions are needed, with a view to lowering deficiencies in older people and thus decreasing the risk of frailty and sarcopenia.

Length of hospital stay among oldest-old patients in acute geriatric ward

PURPOSE

To examine risk factors for prolonged hospital length of stay (LOS) in the oldest-old inpatients aged ≥ 90.

METHODS

This retrospective cross-sectional study was performed in acute Geriatrics Department at Kaplan Medical Center. The target population was the oldest-old inpatients aged ≥ 90 hospitalized with acute illness. In total 1536 admissions of 987 patients admitted between January 2007 and December 2010 from the emergency room were included in the study. We retrieved from the electronic hospital records the following data: demographics, admission diagnosis, comorbidities, laboratory tests, drugs, functional and cognitive status, Charlson Comorbidity Index (CCI) score and age-adjusted CCI score.

RESULTS

The risk factors for a prolonged LOS were tube-feeding, consumption of ≥ 5 drugs, non-independent functional status, diagnosis of urinary tract infection (UTI), pneumonia and malignancy on admission, and comorbidities of congestive heart failure (CHF) and hypoalbuminemia. Multiple linear regression analysis found that UTI, hypoalbuminemia, elevated troponin, pneumonia, number of drugs, malignancy, CHF and number of comorbidities explain a higher risk for a longer LOS.

CONCLUSION

Hospital LOS in the oldest-old patients in acute geriatric ward was associated with admission diagnosis and comorbidities. Awareness of the risk factors for a longer LOS might contribute to reducing hospitalization stay and its related negative consequences. Accurate prediction of prolonged LOS in this age group of patients may be more challenging and require variables that were not included in our study. Future research is warranted.

Association between frailty and vitamin B12 in the older Korean population

Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.

Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

PURPOSE

Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality.

METHODS

Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed.

RESULTS

62 out of 1717 references were eligible for inclusion. Pooled prevalence [95% confidence interval (CI)] of malnutrition and risk of malnutrition were 13 (5-20) % and 47 (40-54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2-24.5) kg/m². Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40-76% in this population.

CONCLUSIONS

Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.

Prevalence of Hyperhomocysteinaemia and Associated Factors among Ethiopian Adult Population in a 2015 National Survey

Hyperhomocysteinaemia (HHcy) is an independent risk factor for major cardiovascular diseases, but data on the prevalence and predictors of HHcy in low- and middle-income countries like Ethiopia are scant. The aim of this study was to estimate the prevalence of HHcy and associated risk factors in the Ethiopian adult population. A cross-sectional survey on risks of noncommunicable diseases (NCDs) using the STEPwise approach to surveillance (STEPS) survey was conducted between April and June 2015. A total of 4,175 study participants were surveyed. Serum homocysteine (Hcy) and metabolic profile were determined using Cobas Integra 400 Plus and CardioChek PA analyzer, respectively. Factors associated with HHcy were determined using logistic regression. The mean serum tHcy concentration was 14.6 μmol/L, with 16.4 μmol/L in males and 13.4 μmol/L in females. Overall, 38% had HHcy, with figures in males (49%) higher than females (30%). Increased age, being male, and high blood pressure and/or taking blood pressure medication, as well as low consumption of fruit and/or vegetables, were independent risk factors for HHcy. In conclusion, the prevalence of HHcy among the adult Ethiopian population is alarmingly high. Improving diets through the promotion of fruit and vegetable consumption is needed to reduce the risk of NCDs.

Dietary intake of people with dementia on acute hospital wards

The aim of this service evaluation was to understand the factors affecting meal provision on a dementia ward and assess whether meals-based dietary intake met estimated mean energy requirement and reference nutrient intake (RNI). A mixed-methods approach was adopted: 1. Mapping the dietary intake for a cohort ( n =6) of inpatients with advanced dementia over a period of four consecutive days. 2. Semi-structured interviews to explore the experiences of the professionals ( n =5) involved. Two of the participants' four-day mean intakes did not meet their estimated energy requirement based on meal provision. All participants apart from one met the target of 0.75g of protein per kg body weight per day for the general population. Several of the nutrients consumed were at or exceeded the RNI for adults of this age, although participants' mean dietary vitamin D intake was substantially below the RNI for the general population. The themes included communication, time pressure and the continuity of service provision. The meals provided were nutritionally sound. Individuals' nutritional status was improved through staff supporting them with eating. The contribution of drinks and snacks to nutrient intake warrants further exploration. Effective communication between food providers and ward areas is important. Mealtimes should reflect patient need - for example, having the main meal in the evening and a lighter option at lunch. This does not clash with the benefits of a flexible breakfast time.

Mining the Age-Dependent Reference Intervals of B Vitamins from Routine Laboratory Test Results

Objective

To describe the reference intervals of folate, vitamin B12, vitamin B6, and vitamin B1 by sex and age.

Methods

The study was performed by gathering data on 55,811 subjects from 57 medical centers. Groups were categorized based on age and grouped according to statistical significance values. The reference values for the different groups were determined using the Bhattacharya and Hoffmann methods.

Results

Vitamin B1 and B6 values and folate (vitamin B9) levels between the sexes were statistically significantly increased in the group aged 0 to 10 years. Likewise, we witnessed a similar increase in vitamin B12 levels in the group aged 0 to 5 years. However, low vitamin B6 levels (P <.001) were detected in nongeriatric patients (aged 0-60 years), and the reference intervals (3.4-41.9 µg/L) also were significantly different from those in the geriatric group (aged 61-100 years; 2.0-29.4 µg/L).

Conclusion

A lower vitamin B6 reference limit allows detection of subclinical vitamin deficiency more precisely in the geriatric group; respective reference intervals should be revised accordingly.

Selected B vitamins and their possible link to the aetiology of age-related sarcopenia: relevance of UK dietary recommendations

The possible roles of selected B vitamins in the development and progression of sarcopenia are reviewed. Age-related declines in muscle mass and function are associated with huge and increasing costs to healthcare providers. Falls and loss of mobility and independence due to declining muscle mass/function are associated with poor clinical outcomes and their prevention and management are attractive research targets. Nutritional status appears a key modifiable and affordable intervention. There is emerging evidence of sarcopenia being the result not only of diminished anabolic activity but also of declining neurological integrity in older age, which is emerging as an important aspect of the development of age-related decline in muscle mass/function. In this connection, several B vitamins can be viewed as not only cofactors in muscle synthetic processes, but also as neurotrophic agents with involvements in both bioenergetic and trophic pathways. The B vitamins thus selected are examined with respect to their relevance to multiple aspects of neuromuscular function and evidence is considered that requirements, intakes or absorption may be altered in the elderly. In addition, the evidence base for recommended intakes (UK recommended daily allowance) is examined with particular reference to original datasets and their relevance to older individuals. It is possible that inconsistencies in the literature with respect to the nutritional management of sarcopenia may, in part at least, be the result of compromised micronutrient status in some study participants. It is suggested that in order, for example, for intervention with amino acids to be successful, underlying micronutrient deficiencies must first be addressed/eliminated.

Prevalence of hyperhomocysteinemia during routine physical examination in Guangxi Province, China and related risk factors

BACKGROUND

Studies on homocysteine (Hcy) have mainly focused on the correlation between the homocysteine concentration and disease development. Few epidemiological investigations have been performed. This study was conducted to investigate the prevalence of hyperhomocysteinemia (HHcy) during routine physical examination in Guangxi Province, China and the correlation of serum Hcy with gender, age, serum uric acid (UA), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and blood glucose (GLU) to provide evidence for preventing and treating HHcy.

METHODS

Data of 8043 patients who underwent physical examinations at the First Affiliated Hospital of Guangxi Medical University, China from 2015 to 2016 were collected. These data included gender, age, and the serum Hcy, UA, GLU, TC, TG, HDL-C, and LDL-C concentrations.

RESULTS

The overall prevalence of HHcy was 50.8% (52.3% in males, 48.1% in females). Age, UA, TC, TG, and LDL-C were significantly higher and HDL-C was significantly lower in patients with than without HHcy, regardless of gender (all P<.05). The Hcy level was positively correlated with UA, TC, TG, and LDL-C but negatively correlated with HDL-C. Gender, age, UA, TC, and TG were independent risk factors for HHcy.

CONCLUSION

The prevalence of HHcy was very high during routine physical examination in Guangxi Province, China. HHcy was related to gender, age, high concentrations of UA, TC, TG, and LDL-C; and low concentrations of HDL-C. Strengthening early intervention of HHcy can reduce the risk of cardiovascular disease.

Vitamin B12 Deficiency Induced by the Use of Gastric Acid Inhibitors: Calcium Supplements as a Potential Effect Modifier

OBJECTIVE

Use of gastric acid inhibitors has emerged as a risk factor of vitamin B12 deficiency, especially in older adults. Calcium supplements could be an effect modifier of this relationship by its role in the absorption process of vitamin B12. The aim of this study is to examine whether the use of calcium supplements could be an effect modifier of the association between gastric acid inhibitors and vitamin B12 deficiency.

DESIGN

Cross-sectional study based on medical chart reviews.

SETTING

Geriatric Assessment Unit (GAU) of a university-affiliated hospital.

PARTICIPANTS

The study included 172 patients discharged from the GAU between 2008 and 2012.

MEASUREMENTS

Cases of vitamin B12 deficiency were identified as those who had received a diagnosis of vitamin B12 deficiency, and/or were receiving a treatment for vitamin B12 deficiency. Use of gastric acid inhibitors and calcium supplements at admission was determined from the pharmacist report. Associations between medications and vitamin B12 status were investigated using logistic regression models.

RESULTS

Seventy-one patients (41%) had vitamin B12 deficiency. At admission, 42% were taking gastric acid inhibitors and 45% calcium supplements. After adjustment for covariates, analyses revealed that vitamin B12 deficiency was more likely among users of gastric acid inhibitors who did not concomitantly received calcium supplements [OR=3.12; P=0.01]. Conversely, no significant association was observed in patients using both, gastric acid inhibitors and calcium supplements [OR=1.30; P=0.59].

CONCLUSIONS

The present study provides the very first evidence that the use of calcium supplements could be an effect modifier of the association between gastric acid inhibitors and vitamin B12 deficiency. Failure to consider calcium supplements as an effect modifier could have led to biased risk estimates in previous published studies.

Cheese 'refinement' with whey B-vitamin removal during precipitation potentially induces temporal 'functional' dietary shortage: homocysteine as a biomarker

Cottage cheese 'refinement' with massive B-vitamin losses (≈70-84%) through whey removal during precipitation may potentially induce an acute imbalance between protein/methionine load and temporal inadequacy/shortage of nutrients critical for their metabolism, i.e. B6 and B12. The temporal effect of cottage cheese consumption was evaluated using increased plasma homocysteine as a B-vitamin shortage marker. In a double-blind study, healthy, normal-weight (BMI = 22-27), premenopausal women aged 25-45 years were first given a methionine load (100 mg kg(-1), n = 15), then cottage cheese alone (500 g, ≈50 g protein, ≈1200 mg methionine, n = 49) at breakfast, and then with added B6 (2 mg, n = 8) and/or B6 + folate (1 mg + 200 mcg, n = 7). Plasma homocysteine was measured preprandially (t0) and then postprandially 5 h (t5) and ≥6-24 h. Cheese-induced homocysteine increased 28.7% (p ≤ 0.001), ≈60% of the free methionine response, remaining higher through ≥6-8 h. Co-supplementation with B6 reduced the Hcy increase by 45.0% (to 14.9%, p = 0.025), and that with B6 + folate reduced the Hcy increase by 72.3% (to 7.5%, p = 0.556, NS). Homocysteine increased more in participants with lower baselines (<5 μM vs. ≥5 μM, p ≤ 0.001) following cheese, ≈3-fold (54.8% vs. 18.5%) or methionine, 47.3% (266.7% vs. 181.1%). Cheese B-vitamin depletion - i.e. to B6 ≈ 2.0-4.0 μg g(-1) protein, far below women's metabolic requirement (15-20 μg g(-1)) - appeared to induce acute relative shortage compared to methionine/protein loads, exemplified by greater homocysteine increases than with other animal proteins (previous data), more so with lower baseline homocysteine. Smaller increases following re-supplementation demonstrated potential for 'functional fortification'/co-supplementation. Unnoted cheese 'refinement', like white bread, potentially induces episodic vitamin shortage effects, warranting consideration for acute/cumulative implications, alternative processing/supplementation technologies, and food combinations, especially for at-risk populations (i.e. with genetic, hormonal/gender, or aging-related predispositions), and for cardiovascular, bone, and brain health.

Vitamin B12 absorption: mammalian physiology and acquired and inherited disorders

BACKGROUND

Vitamin B12 (cobalamin) is a cobalt-containing compound synthesized by bacteria and an essential nutrient in mammals, which take it up from diet. The absorption and distribution of dietary vitamin B12 to the organism is a complex process involving several gene products including carrier proteins, plasma membrane receptors and transporters. Disturbed cellular entry, transit or egress of vitamin B12 may lead to low vitamin B12 status or deficiency and eventually hematological and neurological disorders.

OBJECTIVE

The aim of this review is to summarize the causes leading to vitamin B12 deficiency including decreased intake, impaired absorption and increased requirements. Under physiological conditions, vitamin B12 bound to the gastric intrinsic factor is internalized in the ileum by a highly specific receptor complex composed by Cubilin (Cubn) and Amnionless (Amn). Following exit of vitamin B12 from the ileum, general cellular uptake from the circulation requires the transcobalamin receptor CD320 whereas kidney reabsorption of cobalamin depends on Megalin (Lrp2). Whereas malabsorption of vitamin B12 is most commonly seen in the elderly, selective pediatric, nondietary-induced B12 deficiency is generally due to inherited disorders including the Imerslund-Gräsbeck syndrome and the much rarer intrinsic factor deficiency. Biochemical, clinical and genetic research on these disorders considerably improved our knowledge of vitamin B12 absorption. This review describes basic and recent findings on the intestinal handling of vitamin B12 and its importance in health and disease.

Mini nutritional assessment

PURPOSE OF REVIEW

To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA).

RECENT FINDINGS

Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving.

SUMMARY

The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.

Prediction of all-cause mortality by B group vitamin status in the elderly

BACKGROUND & AIMS

Little is known about the direct relationship of B vitamins to mortality in the elderly. All-cause mortality by vitamin B status, using dietary (B-1, B-2, niacin, B-6) or biochemical data (erythrocyte transketolase reductase, erythrocyte glutathione reductase, plasma pyridoxal-phosphate, folate and serum B-12) was evaluated.

METHODS

The Taiwanese Elderly Nutrition and Health Survey (1999-2000) provided 1747 participants 65 years and over. Dietary and biochemical data were collected at baseline. Survivorship was determined until December 31, 2008.

RESULTS

Survivors had higher vitamin B-1 and niacin intakes and pyridoxal-phosphate and folate concentrations. Controlled for confounders, and relative to the lowest tertile of vitamin B-1 or B-6 intakes, the hazard ratios (95% confidence interval) for tertile 3 were 0.74 (0.58-0.95) and 0.74 (0.57-0.97); both p for trend values were <0.05. Further adjustment for dietary diversity led to insignificant findings. For pyridoxal-phosphate, compared to those with deficiency levels, the multivariable-adjusted hazard ratios (95% confidence interval) for adequacy was 0.52 (0.38-0.71) with p for trend <0.0001 and unchanged with dietary diversity adjustment.

CONCLUSIONS

Higher vitamin B-1 and B-6 intakes and plasma pyridoxal-phosphate were associated with lower risk of mortality up to 10 years and could be achieved by increased dietary diversity.