Drugs and nutrition in old age

Glucuronidation and sulphation of paracetamol in HIV-positive patients and patients with AIDS

AIMS

To gauge the effect of disease state and disease progression on the glucuronidation and sulphation of paracetamol (APAP) among HIV-positive patients and patients with AIDS.

METHODS

The extent of APAP glucuronidation and APAP sulphation was assessed using a spot urine sample collected 4 h after the oral administration of 500 mg of APAP to 108 patients with AIDS or HIV infection. The molar concentrations of APAP and its glucuronide and sulphate metabolites were determined using a validated h.p.l.c. method and glucuronidation and sulphation indices were constructed using APAP metabolite/APAP molar concentration ratios.

RESULTS

No effect of disease state, AIDS vs asymptomatic HIV positive vs control, on APAP glucuronidation or sulphation was observed. The patient population was studied over time and disease progression also did not significantly alter the calculated glucuronidation and sulphation indices. The effect of the concomitant administration of other therapeutic agents was assessed and in the cross sectional portion of the study dapsone appeared to significantly decrease APAP sulphation as did lamivudine. In the longitudinal portion of the study the latter effect was not observed but zidovudine was seen to increase APAP glucuronidation. The data also indicates that APAP glucuronidation may be reduced in patients who are >10% below their ideal body weight.

Social cognitive predictors of nutritional risk in rural elderly adults

According to Social Cognitive Theory (Bandura, 1997), nutritional risk would be predicted by perceptions of nutrition efficacy, which in turn would be predicted from four sources: modeling, verbal support, physiological conditions, and nutrition habits. In telephone interviews with 154 rural elderly adults (44 men, 110 women; mean age = 74.4 years), nutritional risk was measured with Nutritional Risk Index (NRI), Nutritional Screening Initiative (NSI), and seven-high-risk-nutrients consumed less than 50 percent of RDA (Diet Plus Analysis). Nutrition-efficacy was measured with a new twenty-five-item scale of Perceived Nutrition Barriers (PNB). Sources of nutrition-efficacy included: mealtime modeling--shared meals, household size; verbal support--people talk to each day, hours talked, number of confidants; physiological conditions that may affect nutrition--age, body mass, medications, disability, negative affect, and nutrition habits--daily food variety, use of meal services. Path analysis was performed with each measure of nutritional risk (NRI, NSI, 7-high-risk-nutrients) as a criterion variable, nutrition-efficacy (PNB) as a possible mediating variable, and sources of nutrition-efficacy as predictor variables. Social Cognitive variables accounted for 58 percent of variance in NRI, 49 percent of variance in NSI, and 29 percent of variance in seven-high-risk-nutrients. Nutritional risk was directly predicted by large households, few shared meals, few confidants, high body mass, many medications, and few daily foods; it was indirectly predicted (via PNB) by high levels of negative affect. Perceived Nutrition Barriers (PNB) most often mentioned were food cost, eating alone, food tastelessness, transportation to the store, and chewing difficulty.