1
|
Kurik G, Kelly-Bissue C, Lõhmus A, Muhhamedjanov K, Ilves N, Forbes A. Standardising and simplifying the Global Leadership Initiative on Malnutrition (GLIM) for its more general application. Clin Nutr ESPEN 2024; 62:120-127. [PMID: 38901933 DOI: 10.1016/j.clnesp.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass. AIMS To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application. METHODS (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies. RESULTS (1) Participants' mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m2. In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST "1" were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST "2", 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST "1". (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST "1", by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST "2". CONCLUSIONS Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; "gold standard" muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening.
Collapse
Affiliation(s)
- G Kurik
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - C Kelly-Bissue
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - A Lõhmus
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - K Muhhamedjanov
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - N Ilves
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - A Forbes
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.
| |
Collapse
|
2
|
Fielding RA, Landi F, Smoyer KE, Tarasenko L, Groarke J. Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review. J Cachexia Sarcopenia Muscle 2023; 14:706-729. [PMID: 36807868 PMCID: PMC10067499 DOI: 10.1002/jcsm.13186] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011 to 31 July 2021) in PubMed, Embase® and Cochrane databases to identify English language studies of adults aged ≥ 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts and full text of identified records against pre-defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality and other outcomes of interest. Of 146 studies that underwent full-text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes) and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n = 14) and subject-reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs. without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 3, other n = 2). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged ≥ 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality and other negative outcomes across community, care home and hospital settings. Such associations warrant efforts to improve and standardize screening, detection, assessment and management of anorexia/appetite loss in older adults.
Collapse
Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | | | | | | |
Collapse
|
3
|
El Osta N, Wehbe A, Sleiman N, Drancourt N, El Osta L, Hennequin M. Dental Criteria Could Alert for Malnutrition Risk and Inappropriate Choice of Food Texture in Older Subjects with Dementia: An Analytical Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15086. [PMID: 36429816 PMCID: PMC9690132 DOI: 10.3390/ijerph192215086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Oral health indicators are usually collected to alert for the presence of infectious diseases, but the impact of poor oral health on the nutritional status of older people with dementia is often neglected. This study aims to explore the relationship between the number of posterior dental functional units (PFUs) and the anthropometric measure of malnutrition, the mid-upper arm circumference (MUAC), in older people with dementia while controlling for other variables, and to analyze whether the number of PFUs is considered when adjusting the texture of the food provided at mealtimes. A total of 103 individuals who were 70 years or older with dementia were recruited from seven institutions. Cognitive impairment was assessed using the Mini Mental State Examination. Data were collected from medical records (sociodemographic characteristics, presence of chronic diseases, prescribed medications, results of serum albumin level), as well as questionnaires (type of feeding routes, type of food texture, supplements intake, Activity of Daily Living index), clinical examinations (MUAC), and oral health parameters (PFUs, oral dryness, oral hygiene). MUAC was the dependent outcome variable. MUAC was associated with the number of PFUs (p = 0.032); participants with PFU ≤ 4 were 7.5 times more likely to have MUAC < 21 cm than others. Other associations were found between MUAC and albumin level (OR = 12.5; p = 0.001), modified food texture (OR = 4.2; p = 0.035), and length of institutional stay (OR = 5.2; p = 0.033); however, the type of oral feeding was not significantly related to the number of PFUs (p = 0.487) so there is an inadequate correlation between food texture and oral health status. Similar to MUAC, the number of PFUs could be an oral anthropometric criterion that is recorded during routine hygiene care to alert for the risk of malnutrition and the inappropriate choice of food texture in older individuals with dementia.
Collapse
Affiliation(s)
- Nada El Osta
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Amine Wehbe
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Nelly Sleiman
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Noemie Drancourt
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, 63003 Clermont-Ferrand, France
| | - Lana El Osta
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, 63003 Clermont-Ferrand, France
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Strube-Lahmann S, Müller-Werdan U, Norman K, Skarabis H, Lahmann NA. Underweight in Nursing Homes: Differences between Men and Women. Gerontology 2021; 67:211-219. [PMID: 33472200 DOI: 10.1159/000512459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In Germany, there is an ongoing concern about the high prevalence of underweight on admission to health-care institutions. In order to assess possible sex-specific differences, the aim of this study is to provide valid figures about the prevalence and risk factors of underweight of men and women in German nursing homes. MATERIAL AND METHODS A secondary data analysis of 8 annual consecutive cross-sectional studies of 19,686 residents from 280 nursing homes was conducted from 2009 to 2016. Underweight was defined as BMI < 18.5 (<20) for individuals <65 years (≥65 years). For statistical modeling, we used classification and regression trees (CRTs) and random forest in "R." RESULTS Average prevalence of underweight in nursing home residents was 13.7% (13.2-14.2). Initial descriptive results showed that the prevalence of underweight among women was 15.6% (15.0-16.2) and the prevalence of underweight among men was 7.5% (6.7-8.2). The CRT-based modeling indicated that "loss of appetite" as the most important indicator for low BMI. If "loss of appetite" was present, prevalence of underweight increased from 13.5 to 39.1%. Other important indicators were "very large institutions" and the "resident/nurse ratio." The random forest analysis confirmed the importance of the CRT approach. DISCUSSION/CONCLUSION The multivariate approach revealed that the role of sex for being underweight in nursing homes is marginal. To avoid higher morbidity and mortality in this group, nutritional intervention by clinical practitioners to increase appetite should be given high priority, especially in large long-term care institutions.
Collapse
Affiliation(s)
- Sandra Strube-Lahmann
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ursula Müller-Werdan
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristina Norman
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal, Potsdam, Germany
| | - Horst Skarabis
- Emeritus Professor for Statistics at the Freie Universität Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| |
Collapse
|
6
|
Lampmann L, Hannink A, Kiesswetter E, Emberger-Klein A, Volkert D, Menrad K. Protein for Community-Dwelling Older People: Aspects That Influence the Perception of Commercially Available Protein Drinks. Front Nutr 2020; 7:100. [PMID: 32850932 PMCID: PMC7401965 DOI: 10.3389/fnut.2020.00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/05/2020] [Indexed: 01/16/2023] Open
Abstract
In an aging population, support for independent living is increasingly critical for older generations. Currently, sarcopenia is a major cause of frailty, which increases the risk of decreased mobility, falls, morbidity, and mortality and leads to dependence on third parties. Sarcopenia is preventable by consumption of adequate protein. However, many older people do not meet the recommended daily allowance of protein, thereby supporting dependence rather than independent living. Current literature indicates that a protein drink could be an appropriate product for older peoples' protein consumption. We were interested in autonomous persons whose nutritional decisions were still self-determined and thus could preventively influence their personal health. This study evaluated three commercially available protein drinks in three focus groups (n = 25) to gain insight into which aspects influence the perception of commercial protein drinks on community-dwelling older people (age, 76.8 ± 4.9). Findings from the focus groups revealed only aspects, which influenced the perception of commercial protein drinks negatively. Most importantly, the drinks did not comply with relevant aspects when buying (healthy) foods, which where naturalness, freshness, locally grown ingredients, and trust. Furthermore, the target group did not see a need for additional protein consumption. Thus, we identify important aspects to be considered for the development of a target-group-specific protein drink as well as more suitable communication to prevent distrust in order to support independent living for community-dwelling older people.
Collapse
Affiliation(s)
- Lyn Lampmann
- Chair of Marketing and Management of Biogenic Resources, Weihenstephan-Triesdorf University of Applied Sciences, Technical University of Munich Straubing for Biotechnology and Sustainability, Straubing, Germany
| | - Anne Hannink
- Institute for Biomedicine of Aging, Friedrich-Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Agnes Emberger-Klein
- Chair of Marketing and Management of Biogenic Resources, Weihenstephan-Triesdorf University of Applied Sciences, Technical University of Munich Straubing for Biotechnology and Sustainability, Straubing, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Klaus Menrad
- Chair of Marketing and Management of Biogenic Resources, Weihenstephan-Triesdorf University of Applied Sciences, Technical University of Munich Straubing for Biotechnology and Sustainability, Straubing, Germany
| |
Collapse
|
7
|
Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care. Healthcare (Basel) 2020; 8:healthcare8030296. [PMID: 32854303 PMCID: PMC7551165 DOI: 10.3390/healthcare8030296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 [95% CI 0.5–9.7], IC-LO 1.4 [0.3–6.6], IC-LA 1.4 [0.3–6.6]) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.
Collapse
|
8
|
Nutritional Status is Associated With Severe Dementia and Mortality: The Cache County Dementia Progression Study. Alzheimer Dis Assoc Disord 2019; 32:298-304. [PMID: 30188355 DOI: 10.1097/wad.0000000000000274] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Studies have reported faster cognitive/functional decline in persons with dementia (PWD) with malnutrition. We investigated whether baseline nutritional status predicted severe dementia and mortality in a population-based sample. PATIENTS A maximum of 300 PWD were assessed annually for up to 8.6 years. METHODS Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA). Severe dementia was defined as: "severe" rating on the Clinical Dementia Rating or Mini-Mental State Examination score ≤10. Using Cox proportional hazards models, we examined the association between baseline mMNA score (or its subcomponents) with each outcome. Covariates included demographics; dementia onset age, type, and duration; APOE genotype; and residency with caregiver. RESULTS Compared with "well-nourished," "malnourished" PWD had 3-4 times the hazard of severe dementia [hazard ratio (HR), 4.31; P=0.014] and death (HR, 3.04; P<0.001). Those "at risk for malnutrition" had twice the hazard of severe dementia (HR, 1.98; P=0.064) and 1.5 times the hazard of death (HR, 1.46; P=0.015). mMNA subcomponents of food group intake, weight loss, body mass index, mobility, health status, protein consumption, and mid-arm circumference predicted one or both outcomes. CONCLUSIONS Nutritional status is an important predictor of clinical outcomes in dementia and may provide an avenue for intervention.
Collapse
|
9
|
Malnutrition and related risk factors in older adults from different health-care settings: an enable study. Public Health Nutr 2019; 23:446-456. [PMID: 31453792 PMCID: PMC7025158 DOI: 10.1017/s1368980019002271] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition. Design: Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression. Setting: Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH). Participants: CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years. Results: Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors. Conclusions: The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
Collapse
|
10
|
Tsuji T, Yamamoto K, Yamasaki K, Hayashi F, Momoki C, Yasui Y, Ohfuji S, Fukushima W, Habu D. Lower dietary variety is a relevant factor for malnutrition in older Japanese home-care recipients: a cross-sectional study. BMC Geriatr 2019; 19:197. [PMID: 31349800 PMCID: PMC6659217 DOI: 10.1186/s12877-019-1206-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 07/09/2019] [Indexed: 01/10/2023] Open
Abstract
Background Nutritional status of the older people is affected by various life-style factors. Although dietary habit is one of the life-style factors, it is unknown which of older home-care recipients’ dietary habits are associated with malnutrition. The purpose of this study was to examine the association of dietary variety, as an evaluation index for dietary habits, with malnutrition in Japanese older home-care recipients. Methods This cross-sectional study was conducted in a single city, Hyogo Prefecture, Japan between July and October 2016. Three hundred thirty-three community-dwelling older care recipients (aged 65 years or older who were receiving home-visit nursing care services) were enrolled. Their nutritional status (Mini Nutritional Assessment®-short form: MNA®-SF), dietary variety (Food frequency score [FFS]), socio-demographic characteristics (age, sex, marital status, etc.), health indicators (comorbidity [Charlson Comorbidity Index] and dysphagia status [Dysphagia Severity Scale]) were assessed. The participants were classified into two groups: malnourished (0–7 points) and non-malnourished (8–14 points), according to their MNA®-SF scores. Multivariate logistic regression analysis was used to examine the factors associated with malnutrition. Results A total of 317 participants were analyzed (118 men, 199 women, median age: 84 years). Compared to the fourth (highest) quartile of FFS, odds ratios (OR) (95% confidence intervals [CI]) of the third, second, and first (lowest) quartiles of FFS were 1.08 (0.42–2.80), 1.29 (0.56–2.98), and 2.30 (1.02–5.19), respectively (p for trend = 0.049). Higher Charlson Comorbidity Index score and the presence of dysphagia were also significantly associated with malnutrition (OR: 2.08, 95% CI: 1.08–4.00 and OR: 3.86, 95% CI: 2.08–7.17, respectively). Conclusion Lower dietary variety was significantly associated with malnutrition in Japanese older home-care recipients.
Collapse
Affiliation(s)
- Taeko Tsuji
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Kaoru Yamamoto
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Hyogo, Japan
| | - Fumikazu Hayashi
- Office of Epidemiology, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Chika Momoki
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, Nara, Japan
| | - Yoko Yasui
- Department of Clinical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daiki Habu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan.
| |
Collapse
|
11
|
Considerations for the Development of Innovative Foods to Improve Nutrition in Older Adults. Nutrients 2019; 11:nu11061275. [PMID: 31195630 PMCID: PMC6627386 DOI: 10.3390/nu11061275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/15/2019] [Accepted: 05/27/2019] [Indexed: 12/21/2022] Open
Abstract
The population of older adults is growing globally. This increase has led to an accumulation of chronic illnesses, so-called age-related diseases. Diet and nutrition are considered the main drivers of the global burden of diseases, and this situation applies especially to this population segment. It relates directly to the development of coronary heart disease, hypertension, some types of cancer, and type 2 diabetes, among other diseases, while age-associated changes in body composition (bone and muscle mass, fat, sarcopenia) constitute risk factors for functional limitations affecting health status and the quality of life. Older adults present eating and swallowing problems, dry mouth, taste loss, and anorexia among other problems causing “anorexia of aging” that affects their nutritional status. The strategies to overcome these situations are described in this study. The impact of oral food processing on nutrition is discussed, as well as approaches to improve food acceptance through the design of innovative foods. These foods should supply a growing demand as this group represents an increasing segment of the consumer market globally, whose needs must be fulfilled.
Collapse
|
12
|
High relative consumption of vegetable protein is associated with faster walking speed in well-functioning older adults. Aging Clin Exp Res 2019; 31:837-844. [PMID: 31115875 DOI: 10.1007/s40520-019-01216-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/04/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adequate nutrition and, especially, optimal protein intake are necessary to preserve physical function during aging. Increased consumption of animal-derived protein is often advocated as a strategy to support physical performance in old age. However, there is a lack of empirical evidence to support this claim. AIMS To assess the relationship of protein consumption and specific protein sources with physical function in older adults. METHODS Participants were community dwellers aged 60 years and older recruited in São Paulo, Brazil. Enrollees had their medical books reviewed and were evaluated for anthropometry, physical performance, and diet. Physical performance was evaluated by isometric handgrip strength and walking speed (WS) tests. Diet was assessed using a 24-h recall diary. RESULTS Ninety older adults were recruited (mean age: 68.0 ± 6.7 years; 87.0% women). Body weight-adjusted protein consumption was significantly associated with upper-limb muscle strength (r = 0.21; p < 0.05), but not with usual (r = 0.09; p > 0.05) or fast WS (r = 0.08; p > 0.05). Conversely, relative protein consumption was correlated with usual WS (r = 0.13; p < 0.05), while fast WS was negatively associated with relative animal protein intake (r = - 0.18; p < 0.05) and positively associated with relative plant-based protein ingestion (r = 0.15; p < 0.05). DISCUSSION Findings of the present study indicate that different measures of protein intake are associated with distinct components of physical function. In addition, high relative ingestion of vegetable protein is associated with faster WS. CONCLUSIONS A comprehensive dietary evaluation is necessary to appreciate the impact of specific nutrients on physical performance in older people. Future interventional studies are needed to establish the optimal blend of protein sources to support physical performance in old age.
Collapse
|
13
|
Wolters M, Volkert D, Streicher M, Kiesswetter E, Torbahn G, O'Connor EM, O'Keeffe M, Kelly M, O'Herlihy E, O'Toole PW, Timmons S, O'Shea E, Kearney P, van Zwienen-Pot J, Visser M, Maitre I, Van Wymelbeke V, Sulmont-Rossé C, Nagel G, Flechtner-Mors M, Goisser S, Teh R, Hebestreit A. Prevalence of malnutrition using harmonized definitions in older adults from different settings - A MaNuEL study. Clin Nutr 2018; 38:2389-2398. [PMID: 30448194 DOI: 10.1016/j.clnu.2018.10.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. METHODS Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m2; age-specific BMI <20 if age 65-<70 and <22 kg/m2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20 kg/m2 and/or WL in participants aged ≥65 years. RESULTS Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m2, 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. CONCLUSIONS Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.
Collapse
Affiliation(s)
- Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Eibhlís M O'Connor
- Dept Biological Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Mary O'Keeffe
- Dept Biological Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Mary Kelly
- Dept Biological Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Eileen O'Herlihy
- School of Microbiology and APC Microbiome Ireland, University College Cork, Cork, T12 Y337, Ireland
| | - Paul W O'Toole
- School of Microbiology and APC Microbiome Ireland, University College Cork, Cork, T12 Y337, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Emma O'Shea
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Patricia Kearney
- Dept Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Judith van Zwienen-Pot
- Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Isabelle Maitre
- USC 1422 GRAPPE, Ecole Supérieure d'Agricultures (ESA), SFR 4207 QUASAV, INRA, 55 Rue Rabelais, F-49007 Angers, France
| | - Virginie Van Wymelbeke
- Centre Hospitalier Universitaire Dijon Bourgogne, Centre Champmaillot, Unité de Recherche Pôle Personnes Âgées, 2 Rue Jules Violle, F-21000 Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, 9(E) Boulevard Jeanne d'Arc, F-21000 Dijon, France
| | - Claire Sulmont-Rossé
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, 9(E) Boulevard Jeanne d'Arc, F-21000 Dijon, France
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Marion Flechtner-Mors
- Medical Center, Division of Sports and Rehabilitation Medicine, University of Ulm, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Sabine Goisser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany; Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Ruth Teh
- General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
| | | |
Collapse
|
14
|
Tak YJ, Lee JG, Yi YH, Kim YJ, Lee S, Cho BM, Cho YH. Association of Handgrip Strength with Dietary Intake in the Korean Population: Findings Based on the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-1), 2016. Nutrients 2018; 10:nu10091180. [PMID: 30154371 PMCID: PMC6165190 DOI: 10.3390/nu10091180] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/15/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
To evaluate associations between handgrip strength (HGS) and dietary nutrients, this study of a representative Korean population of 1553 adults aged ≥60 years (706 men and 847 women) analyzed data from the Korea National Health and Nutrition Examination Survey (2016). HGS was measured in both hands three times using a digital grip strength dynamometer. Dietary intake data were collected by the 24-h recall method through computer-assisted personal interviews. The study population had a mean age of 70.1 years, body mass index (BMI) of 24.2 kg/m2, and HGS of 35.7 kg in men, 21.2 kg in women. Total energy (r = 0.411), protein (r = 0.217), polyunsaturated fatty acid (PUFA) (r = 0.269), fiber (r = 0.272), and vitamin C (r = 0.098) were positively correlated with HGS. In multivariable regression analysis, PUFA (β = 0.083) and vitamin C (β = 0.003) were positively associated with HGS among women. Fiber (β = 0.071) and vitamin C (β = 0.006) showed a positive association with HGS among men. Community-dwelling older men and women with higher levels of PUFA, fiber, and vitamin C in their diet were more likely to have greater HGS even after adjusting for age, total calorie intake, BMI, chronic diseases and health-related habits.
Collapse
Affiliation(s)
- Young Jin Tak
- Department of Family Medicine, Pusan National University Hospital, Busan 602-739, Korea.
- Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea.
- Department of Family Medicine, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University Hospital, Busan 602-739, Korea.
- Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea.
- Department of Family Medicine, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
- Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea.
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University Hospital, Busan 602-739, Korea.
- Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea.
- Department of Family Medicine, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
- Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea.
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University Hospital, Busan 602-739, Korea.
- Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea.
- Department of Family Medicine, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
| | - Sangyeoup Lee
- Department of Medical Education, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
- Family Medicine Clinic, Pusan National University Yangsan Hospital, Geumo-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
| | - Byung Mann Cho
- Department of Preventive Medicine and Occupational Medicine, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University School of Medicine, Busandaehak-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
- Family Medicine Clinic, Pusan National University Yangsan Hospital, Geumo-ro, Mulgeum-eup, Yangsan-si 50612, Korea.
| |
Collapse
|
15
|
Abstract
With the focus of care shifting from the hospital to the community, supportive nutritional care to old people is to become an important issue to address in the community, since undernutrition has serious consequences, both for the quality of life and for the health care costs. Several modifiable nutritional risk factors relate to undernutrition. Unfortunately, the problem with (risk of) undernutrition is aggravated due to a lack of alertness among e.g. health care staff, leading to insufficient attention for systemic screening and nutritional care. Only a few of the existing screening tools have been validated among old people receiving support at home. Few studies have assessed the beneficial effect of nutritional support among old people in their own home, and recently, it was concluded that such have shown limited effects. One reason may be that the nutritional interventions performed have not taken the multiple nutritional risk factors afore-mentioned into consideration when formulating the action/treatment plan and hence not used a multidisciplinary approach. Another reason may be that the intervention studies have not used validated screening tools to identify those old people most likely to benefit from the nutritional support. However, three recent studies have used a multidisciplinary approach and two have proven a beneficial effect on the quality of life of the old people and the health care costs. These findings suggest that when planning nutritional intervention studies for old people receiving support at home, modifiable nutritional risk factors should be taken into consideration, and a multidisciplinary approach considered.
Collapse
|
16
|
Fanelli Kuczmarski M, Pohlig RT, Stave Shupe E, Zonderman AB, Evans MK. Dietary Protein Intake and Overall Diet Quality Are Associated with Handgrip Strength in African American and White Adults. J Nutr Health Aging 2018; 22:700-709. [PMID: 29806859 PMCID: PMC5984956 DOI: 10.1007/s12603-018-1006-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the association of handgrip strength (HS) with protein intake, diet quality, and nutritional and cardiovascular biomarkers in African American and White adults. DESIGN Cross-sectional wave 3 (2009-2013) of the cohort Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. PARTICIPANTS Socioeconomically diverse urban population of 2,468 persons aged 33 to 71 years. MEASUREMENTS Socio-demographic correlates, dietary intakes and biomarkers, HS, physical performance measures were collected. HS was measured using a dynamometer with the dominant hand. Functional measures included chair, tandem, and single leg stands. Two 24-hour recalls were collected using the US Department of Agriculture Automated Multiple Pass Method. The total protein intake and diet quality, evaluated by adherence to the DASH eating plan and Healthy Eating Index-2010, were calculated. Biomarkers included nutritional anemia, and serum levels of albumin, cholesterol, magnesium, and glucose. RESULTS The mean ±SE age of the sample was 52.3±0.2 years. Approximately 61% were African American and 57% were women. The mean ±SE HS of women was 29.1±0.2kg and for men was 45.9±0.4 kg. Protein, gm, per kg body weight for the women was 0.94±0.02 compared to 1.16 ±0.02 for men. After adjusting for socio-demographic factors, hypertension, and diabetes, HS/BMI ratio was significantly associated with protein intake per kg body weight (p<0.001) and diet quality, assessed by either the DASH adherence (p=0.009) or Health Eating Index-2010 (p=0.031) scores. For both men and women, participants in the upper tertile of HS maintained a single leg and tandem stances longer and completed 5 and 10 chair stands in shorter time compared to individuals in the lower HS tertile. Of the nutritional status indicators, the percent of men in the upper HS tertile with low serum magnesium and albumin, was significantly lower than those in the lower HS tertile [magnesium,7.4% vs 16.1%; albumin, 0.4% vs 4.5%]. The only difference observed for women was a lower percent of diabetes (14.4% for the upper HS tertile compared to 20.5% for the lower HS tertile. CONCLUSIONS The findings confirm the role of protein and a healthful diet in the maintenance of muscle strength. In this community sample, HS was significantly associated with other physical performance measures but did not appear to be strongly associated with indicators of nutritional risk. These findings support the use of HS as a proxy for functional status and indicate the need for research to explore its role as a predictor of nutritional risk.
Collapse
Affiliation(s)
- M Fanelli Kuczmarski
- Marie Fanelli Kuczmarskia, University of Delaware, Department of Behavioral Health and Nutrition, 206C McDowell Hall, Newark, DE 19716, United States, , Ph: +1-302-831-8765; Fax: +1-302-831-4261,
| | | | | | | | | |
Collapse
|
17
|
Landi F, Calvani R, Tosato M, Martone AM, Picca A, Ortolani E, Savera G, Salini S, Ramaschi M, Bernabei R, Marzetti E. Animal-Derived Protein Consumption Is Associated with Muscle Mass and Strength in Community-Dwellers: Results from the Milan EXPO Survey. J Nutr Health Aging 2017; 21:1050-1056. [PMID: 29083447 DOI: 10.1007/s12603-017-0974-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Behavioral factors, including protein intake, influence the quantity and quality of skeletal muscle. The aim of this study was to explore the relationship between animal-derived protein intake and muscle mass and function in a large sample of unselected community-dwellers. MATERIAL AND METHODS The VIP (Very Important Protein) study, conducted during Expo 2015 in Milan, was a population survey aimed at assessing major health metrics in a population outside of the research setting, with a special focus on the relation between animal-derived protein intake and muscle mass and function. A brief questionnaire exploring lifestyle habits, dietary preferences and the consumption of selected foods was administered. Muscle mass was estimated by calf circumference (CC) and mid-arm muscle circumference (MAMC) of the dominant side. Muscle strength of upper and lower extremities was assessed through handgrip strength testing and repeated chair stand test, respectively. RESULTS The mean age of the 1,853 participants was 50.3 years (standard deviation: 15.7; range: 18-98 years), of whom 959 (51.7%) were women. Participants in the highest tertile of protein consumption showed better performance at both the handgrip strength (p <0.001) and chair stand tests than those in the lowest tertile (p <0.01). The same results were found for CC (p <0.001) and MAMC (p <0.001). Participants with high protein intake and engaged in regular physical activity showed the higher scores in all the assessed domains. CONCLUSIONS The results of the VIP survey suggest an association between animal-derived protein intake and muscle mass and strength across ages. Our findings also indicate a synergistic effect of animal-derived protein intake and physical activity on muscle-related parameters.
Collapse
Affiliation(s)
- F Landi
- Francesco Landi, MD, PhD - Center for Geriatric Medicine [CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy. Phone: +39 (06) 3388546, Fax: +39 (06) 3051-911, e-mail:
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Monacelli F, Sartini M, Bassoli V, Becchetti D, Biagini AL, Nencioni A, Cea M, Borghi R, Torre F, Odetti P. Validation of the Photography Method for Nutritional Intake Assessment in Hospitalized Elderly Subjects. J Nutr Health Aging 2017; 21:614-621. [PMID: 28537324 DOI: 10.1007/s12603-016-0814-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients. DESIGN this is a prospective observational study. SETTING hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy). PARTICIPANTS 255 consecutive elderly hospitalized patients. MEASUREMENTS assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation). RESULTS The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; p<0.001) as well as a significant positive correlation between the indirect photographic method and the food caloric estimation calculated by the direct method (n=255; r= 0.6489, p<0.001). Intraclass coefficient (ICC), showed a highly significant degree of agreement between the gold standard and the indirect photographic method (ICC: 0.69; p<0.0001). Additionally, the results showed a good inter rater agreement of the indirect photographic method (kappa-statistic measure of interrater agreement: (Z=13.04; p<0.001); agreement 70.29% e Kappa=0.5965) and a good specificity of the indirect method as it was independent on the single food item. CONCLUSIONS The study originally provided the validation of the indirect photographic method for the assessment of nutritional intake in a vast cohort of hospitalized elderly subjects. The present results moved a step forward in the appropriate assessment of nutrition intake in frail elderly, providing an easy to use tool that may be incorporate in routine clinical practice for early and targeted therapeutic interventions.
Collapse
Affiliation(s)
- F Monacelli
- Dr. Fiammetta Monacelli, MD, PhD, Researcher Assistant in Geriatrics, Dept of Internal Medicine and Medical Specialties (DIMI), Viale Benedetto XV, 6, 16132 Genoa, Italy, Phone/fax+390103537545, e-mail
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Buckinx F, Allepaerts S, Paquot N, Reginster JY, de Cock C, Petermans J, Bruyère O. Energy and Nutrient Content of Food Served and Consumed by Nursing Home Residents. J Nutr Health Aging 2017; 21:727-732. [PMID: 28537340 DOI: 10.1007/s12603-016-0782-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare energy and protein content of the served food with the actual intake from the food consumed by nursing home residents. This study also aimed to compare food intake and dietary allowances. DESIGN This is a cross sectional study. SETTING This study was performed in nursing homes. PARTICIPANTS Residents of these 2 nursing homes were eligible for the study if they agreed to participate and if they meet the selection criteria (to be older than 65 years and have a regular texture diet). MEASUREMENT Nutrient content of the served food and real food consumption was calculated for all meals during a 5-day period by precise weighting method. Difference between consumed and served dietary content was evaluated by the Chi² test. RESULTS Seventy-four Belgian nursing home residents (75% of women, 85.8 ± 7.04 years on average) were included in this study. These subjects had a mean body mass index of 24.9 ± 4.83 kg/m². The mean energy content of the served food was 1783.3 ± 125.7 kcal per day. However, residents did not eat the whole of the meals and the actual energy content of the consumed food was significantly less (1552.4 ± 342.1 kcal per day; p<.001). The average protein content of the food served was equal to 0.96 ± 0.20 g/kg/day and the average consumption of protein by the residents was 0.88 ± 0.25 g/kg/day. The difference between protein served and consumed was also significant (p=.04). Moreover, people considered as well nourished, eating significantly more energy than the others (p=.04). CONCLUSION Meals served in nursing homes are not entirely consumed by their residents. As expected, the energy consumed are lower in subjects considered as malnourished or at risk of malnutrition.
Collapse
Affiliation(s)
- F Buckinx
- Fanny Buckinx, M.SC., Ph.D., University of Liège, Department of Public Health, Epidemiology and Health Economics, CHU - Sart Tilman, Bât. B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000 Liège, Belgium,Tél : +32 43 66 49 33, Fax : +32 43 66 28 12, E-mail :
| | | | | | | | | | | | | |
Collapse
|
20
|
Vaccaro JA, Huffman FG. Dietary risk factors by race/ethnicity, age-group, and gender in a representative sample of us older adults. J Nutr Health Aging 2016. [DOI: 10.1007/s12603-016-0778-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|