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Bice EM, Galek KE, Ward M. Dysphagia and Diets in Skilled Nursing Facilities When Patient's Health Status Changes: The Role of Imaging. J Am Med Dir Assoc 2024; 25:381-386. [PMID: 38109943 DOI: 10.1016/j.jamda.2023.11.008] [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: 07/26/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Research suggests that clinical decision making for assessing and treating patients with swallowing dysfunction varies significantly, and decisions may harm patients. The study aimed to investigate clinical practice of speech-language pathologists (SLPs) assessing and treating swallowing in skilled nursing facilities (SNFs). DESIGN Retrospective review of 120 medical records of patients recommended for a flexible endoscopic evaluation of swallowing (FEES). SETTING AND PARTICIPANTS 120 SNF patients. METHODS Records from 25 SNFs were reviewed to determine which patients were receiving swallowing therapy, their diet level pre- and post-FEES, and if they received prior imaging studies. Recordings of FEES were assigned severity ratings based on the Dynamic Imaging Grade of Swallowing Toxicity-FEES scores to determine the relationship between diet and liquid recommendations before and after FEES, how often patients consume a modified diet in the absence of dysphagia, percentage of patients without dysphagia receiving swallowing treatment, percentage of patients receiving alternative means of nutrition without dysphagia, and the percentage of patients with a feeding tube without an imaging assessment. RESULTS Chi-square tests revealed no agreement between pre- and postimaging diet levels. Ordinal regressions indicated preimaging diets did not fit the DIGEST severity rating model; however, investigators found a good fit with postimaging diet recommendations. Descriptive statistics indicated that 67% of the patients receiving a modified solid and/or liquid did not have dysphagia. Treatment was provided to 100% of the patients without dysphagia. Sixty-one percent of patients with feeding tubes had no dysphagia. Forty-five percent of NPO (nothing by mouth) patients had imaging during their acute stay. CONCLUSIONS AND IMPLICATIONS The results strongly suggest that the practice of continuing acute care diet recommendations in a SNF increases cost and may negatively impact patient quality of life. The practice may also lead to negative health consequences. A new imaging assessment is required to inform treatment when medical status changes.
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Affiliation(s)
- Ed M Bice
- IOPI Medical, LLC, Woodinville, WA, USA.
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Somers A, Perkisas S, Bastijns S, Ariën F, De Cock AM. Clinical approach to the older person with anorexia. Acta Clin Belg 2023; 78:486-496. [PMID: 37345458 DOI: 10.1080/17843286.2023.2228037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Anorexia is a challenging problem among older people. Apart from being the consequence of normal ageing, it can also be a symptom of underlying disease. Despite the high prevalence of anorexia, only few recommendations exist on the evaluation in older people. The objective of this study is to summarize evidence and provide guidance through creating a flowchart. METHODS A systematic literature search was performed through combining following keywords: older people (aged, geriatrics, older adult), anorexia (also loss of appetite, unintentional weight loss) and diagnosis. After removal of duplicates and case-reports, articles were selected based on title and abstract by two reviewers. Guidelines, reviews, studies and relevant publications discussing anorexia or unintentional weight loss were included. Relevant data were extracted and processed into a flowchart. RESULTS Out of 619 hits, 25 articles were included discussing either the evaluation of anorexia or unintentional weight loss. Consensus in the work-up of unintentional weight loss is to start with a detailed history and physical examination followed by full bloodwork, urinalysis, chest x-ray and a faecal occult blood test. In certain cases, ultrasound and upper endoscopy are further recommended. In the work-up of anorexia, medication, social, psychological, logopaedic and neurocognitive aspects need to be taken into consideration. CONCLUSIONS One of the main challenges of the evaluation of anorexia in older people is the lack of guidance in existing literature. Therefore, we investigated what is currently known about the management of anorexia and unintentional weight loss as well and combined best practices to form a flowchart.
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Affiliation(s)
- Annelies Somers
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Stany Perkisas
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Sophie Bastijns
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Femke Ariën
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Anne-Marie De Cock
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
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3
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Dufe Turkson RK, Ngounda J, Nel R, Walsh CM. The nutritional status of community-dwelling elderly in Lesotho and factors associated with malnutrition. Nutr Health 2023; 29:513-522. [PMID: 35195475 PMCID: PMC10503240 DOI: 10.1177/02601060221082368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The elderly living in Africa are prone to malnutrition which is complicated by the high prevalence of poverty. This study assessed the nutritional status of the elderly and factors associated with malnutrition. Method: In a cross-sectional survey, the nutritional status of 300 participants aged 65 years and older was determined using the Mini Nutritional Assessment (MNA) questionnaire consisting of 18 questions. Socio-demographic data was obtained using a questionnaire. Results: Sixty-six percent were at risk of malnutrition, while 14.6% (n = 44) were malnourished. Participants that did not use electricity as a fuel for cooking versus those that did, had higher odds of being malnourished/ at risk of malnutrition (OR = 1.85 [1.04; 3.31]). Those that did not experience psychological stress or acute disease versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.33 [0.12; 0.90]). Participants that did not perceive nutritional problems versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.18 [0.09; 0.34]). Similarly, those that did not perceive their health status as poor versus those that did, had lower odds of being malnourished/at risk of malnutrition (OR = 0.17 [0.08; 0.34]). Discussion: The findings indicate that the elderly with more resources, less stress, and better actual and perceived health were less likely to be malnourished. In such communities, routine screening in the elderly is required to identify those with compromised health and nutritional status.
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Affiliation(s)
- Rose Kokui Dufe Turkson
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Jennifer Ngounda
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Riette Nel
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
| | - Corinna May Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
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4
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Bernchou TE, Rasmussen LB, Gaarde P, Færgeman K, Voltelen B, Larsen P. Home-delivered between-meal snacks for fragile older adults – A pilot study. AGING AND HEALTH RESEARCH 2023. [DOI: 10.1016/j.ahr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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5
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Niu CC, Bao WJ, Jiang HX, Yu J. The Effect of Nighttime Snacking on Cognitive Function in Older Adults: Evidence from Observational and Experimental Studies. Nutrients 2022; 14:nu14224900. [PMID: 36432586 PMCID: PMC9692411 DOI: 10.3390/nu14224900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Evidence shows that supplementary snacking could provide older adults with nutrients that cannot be obtained through three meals a day. However, whether and how supplementary snacking, especially nighttime snacking, affects older adults' cognitive function remain unclear. The present study examined the effect of nighttime snacking on cognitive function for older adults. In study 1, we investigated the association between nighttime snacking and cognitive function based on data from 2618 community-dwelling older adults from the China health and nutrition survey (CHNS). In study 2, we conducted an experiment (n = 50) to explore how nighttime acute energy intake influences older adults' performance on cognitive tasks (immediate recall, short-term delayed recall, and long-term delayed recall). Both the observational and experimental studies suggested that nighttime snacking facilitated older adults' cognitive abilities, such as memory and mathematical ability, as indicated by subjective measures (study 1) and objective measures (studies 1 and 2). Moreover, this beneficial effect was moderated by cognitive load. These findings bridge the gap in the literature on the relationships between older adults' nighttime snacking and cognitive function, providing insight into how to improve older adults' dietary behaviors and cognitive function.
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Affiliation(s)
- Cheng-Cheng Niu
- Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Wei-Jie Bao
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Hai-Xin Jiang
- Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Jing Yu
- Faculty of Psychology, Southwest University, Chongqing 400715, China
- Correspondence:
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The Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA): concurrent, construct and predictive validity in an external evaluation cohort of community-dwelling older persons. Br J Nutr 2022; 128:509-520. [PMID: 34486958 DOI: 10.1017/s0007114521003433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We previously developed a malnutrition risk index, the Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) with good predictive accuracy for mortality risk in an original population cohort (SLAS1). Herein, we further evaluate the concurrent and predictive validity of the ENIGMA construct in an external validation cohort (SLAS-2) of 2824 community-dwelling older adults aged 55+ years. They were assessed on the ENIGMA index, Mini Nutritional Assessment-Short Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI), known correlates of malnutrition, and baseline and follow-up functional dependency and 10-year mortality risk. Higher ENIGMA risk categories were significantly associated (P < 0·001) with lower education, living alone, smoking, low physical activity, BMI < 18·5 kg/m2, poorer muscle strength and functional mobility, exhaustion, physical frailty, homocysteine, glomerular filtration rate, Hb, red and white blood cell counts, platelets, systemic inflammation indexes, metabolic syndrome, CVD, cognitive impairment and depressive symptoms (Geriatric Depression Scale ≥ 5). ENIGMA scores showed statistically significant (P < 0·001) correlations but low-to-moderate concordance with MNA-SF (r = 0·148, agreement = 45·9 %, kappa = 0·085) and GNRI scores (r = 0·156, agreement = 45·8 %, kappa = 0·096). Controlling for known correlates of malnutrition, only high-risk ENIGMA among the indexes significantly predicted baseline functional dependency (OR = 1·64, 95 % CI 1·01, 2·65) and mortality (hazard ratio = 1·65 (95 % CI 1·04, 2·62). ENIGMA marginally out-performed MNA-SF and GNRI in predicting baseline functional dependency (AUC: 0·625 v. 0·584 v. 0·526), follow-up functional dependency (AUC: 0·594 v. 0·525 v. 0·479) and 10-year mortality risk (AUC: 0·641 v. 0·596 v. 0·595). The concurrent and predictive validity of the ENIGMA construct is replicated in an external evaluation study of community-dwelling older persons.
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7
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Aida J, Takeuchi K, Furuta M, Ito K, Kabasawa Y, Tsakos G. Burden of Oral Diseases and Access to Oral Care in an Ageing Society. Int Dent J 2022; 72:S5-S11. [PMID: 36031325 PMCID: PMC9437805 DOI: 10.1016/j.identj.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/05/2022] [Accepted: 06/17/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society. Methods We selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature. Results The rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs. Conclusions To address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.
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Affiliation(s)
- Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kenji Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan; Division of Regional Community Development, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Kyushu University Faculty of Dental Science, Fukuoka, Japan
| | - Kanade Ito
- Department of Oral Care for Systemic Health Support, Health Sciences and Biomedical Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Kabasawa
- Department of Oral Care for Systemic Health Support, Health Sciences and Biomedical Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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8
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van Hamersveld-Kramer M, Perry SIB, Lodewijks E, Vasse E, de van der Schueren MAE. Decision-making regarding oral nutritional supplements for nursing home residents with advanced dementia: A cross-sectional pilot study. J Hum Nutr Diet 2021; 35:58-67. [PMID: 34694055 DOI: 10.1111/jhn.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surrogate decision-making regarding oral nutritional supplements (ONS) for nursing home residents with advanced dementia is a complex process. In this cross-sectional study, we assessed whether Dutch dietitians, elderly care physicians (physicians) and surrogate decision-makers (SDMs) differ in the factors that they regard important when considering ONS. We also investigated differences in opinion regarding whether or not ONS is a life-prolonging measure. METHODS Through an online survey, 90 dietitians, 53 physicians and 70 SDMs of nursing home residents (all aged ≥ 65 years old with advanced dementia) rated the level of perceived influence of 11 pre-defined factors on their decision-making, ranked factors in order of importance and stated whether they considered ONS a life-prolonging measure or not. By statistical analysis, we tested differences in the mean sum of ranks for perceived influence differing between groups. We also tested differences in proportions between groups of those who considered ONS a life-prolonging measure. RESULTS Rating of perceived influence significantly differed for six factors. Quality of life was ranked as the most influential factor by all groups. Dietitians significantly differed in their opinion on the life-prolonging effect of ONS from physicians (odds ratio = 0.29, 95% confidence interval = 0.13-0.65), as well as from SDMs (odds ratio = 0.22, 95% confidence interval = 0.10-0.45). CONCLUSIONS Although all groups proclaimed quality of life to be first priority in decision-making, we found that Dutch dietitians, physicians and SDMs differed in what they regarded important when considering ONS for nursing home residents with advanced dementia. Regarding the life-prolonging effect of ONS, dietitians differed in opinion from physicians, as well as from SDMs.
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Affiliation(s)
| | - Sander I B Perry
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Lodewijks
- Department of Dietetics, Florence Healthcare, Rijswijk, The Netherlands.,University Network for the Care Sector Zuid Holland, Leiden, The Netherlands
| | - Emmelyne Vasse
- Department of Dietetics, Gelderse Vallei Hospital, Ede, The Netherlands.,Dutch Malnutrition Steering Group, Amsterdam, The Netherlands
| | - Marian A E de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Wilfred SA, Becker CB, Kanzler KE, Musi N, Espinoza SE, Kilpela LS. Binge eating among older women: prevalence rates and health correlates across three independent samples. J Eat Disord 2021; 9:132. [PMID: 34666821 PMCID: PMC8524882 DOI: 10.1186/s40337-021-00484-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emerging research indicates that binge eating (BE; consuming unusually large amounts of food in one siting while feeling a loss of control) is prevalent among older women. Yet, health correlates of BE in older adult populations are poorly understood. The original study aimed to investigate BE prevalence, frequency, and health correlates in a sample of older adult women. Based on results from this first study, we then sought to replicate findings in two additional samples of older adult women from separate studies. METHOD Using self-reported frequencies of BE from three separate samples of older women with very different demographics, we compared BE prevalence, frequency, and health correlates among older women. Study 1 (N = 185) includes data collected online (86% White; 59% overweight/obese status). Study 2 (N = 64) was conducted in person at a local food pantry (65% Hispanic; 47% household income < $10,000/year). Study 3 (N = 100) comprises data collected online (72% White; 50% Masters/Doctoral Degree). RESULTS Per DSM-5 frequency criterion of BE at least weekly, we found prevalence rates ranging from 19 to 26% across the three samples. Correlates of BE frequency included elevated negative mood, worry, BMI, and less nutritious food consumption. CONCLUSIONS Across three very different samples in terms of race/ethnicity, education, food security status, measurements, and sampling methodology, we found fairly consistent rates of self-reported BE at least weekly (19-26%). Results suggest that BE is related to negative health indices among older women and support the need for more research in this population.
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Affiliation(s)
| | | | | | - Nicolas Musi
- Barshop Institute, UT Health San Antonio, San Antonio, TX, USA
- South Texas VA Health System, Audie Murphy Veterans Hospital, San Antonio, TX, USA
| | - Sara E Espinoza
- Barshop Institute, UT Health San Antonio, San Antonio, TX, USA
- South Texas VA Health System, Audie Murphy Veterans Hospital, San Antonio, TX, USA
| | - Lisa Smith Kilpela
- ReACH Center, UT Health San Antonio, San Antonio, TX, USA.
- Barshop Institute, UT Health San Antonio, San Antonio, TX, USA.
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10
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Minagawa Y, Saito Y. The Role of Underweight in Active Life Expectancy Among Older Adults in Japan. J Gerontol B Psychol Sci Soc Sci 2021; 76:756-765. [PMID: 32016426 DOI: 10.1093/geronb/gbaa013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES It is underweight, rather than overweight or obesity, that has been a pressing public health concern in Japan. This study examines the impact of being underweight on the health of older Japanese men and women, measured by active life expectancy at age 65. Following the Japanese government's guideline, underweight in this study is defined using the body mass index (BMI) value of 20. METHOD Data came from five waves (1999-2009) of the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA). We used the Interpolation of Markov Chain approach to estimate the number of years underweight (BMI < 20), normal weight (20 < BMI < 25), and overweight (25 < BMI) individuals were expected to live without difficulty in activities of daily living (ADLs) or instrumental ADLs. RESULTS We found differences in life and health expectancies across the three weight categories. Underweight people were expected to live the shortest lives and spend the fewest years in an active state compared with normal and overweight individuals. Results remained unchanged even when accounting for educational attainment, smoking history, and a count of existing chronic conditions. DISCUSSION Being underweight is associated with poor quality of life lived among Japanese older adults. This finding suggests the importance of maintaining proper weight and avoids nutritional risks at advanced ages.
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Affiliation(s)
- Yuka Minagawa
- Faculty of Liberal Arts, Sophia University, Tokyo, Japan
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11
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França VF, Barbosa AR, d’Orsi E. Vitamin B12, Folate and Cognitive Function in Older Adults from Southern Brazil. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-020-09389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Hai S, Gao Q, Gwee X, Chua DQL, Yap KB, Ng TP. Malnutrition Risk, Physical Function Decline and Disability in Middle-Aged and Older Adults Followed Up in the Singapore Longitudinal Ageing Study. Clin Interv Aging 2021; 16:1527-1539. [PMID: 34447244 PMCID: PMC8384148 DOI: 10.2147/cia.s322696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Malnutrition and population ageing are doubly global healthcare challenges. It is widely recognized that disability is a major contributor to malnutrition among older people, but the importance of reducing malnutrition risk (MR) for disability prevention is given little attention. We investigated the association between MR and risk of incident disability and functional decline among community-dwelling older persons. Materials and Methods Prospective cohort study of community-dwelling older adults aged 55 and above (Singapore Longitudinal Ageing Study) with 3–5 years follow-up. MR was measured at baseline using an appropriate and validated index (ENIGMA); physical and functional measures at baseline and follow-up included instrumental and basic activity of daily living (ADL), knee extension (KES), gait velocity (GV), timed up-and-go (TUG). Results Compared to low MR, mild-moderate MR (OR = 1.43, 95% CI = 1.02–2.01) and severe MR (OR=1.74, 95% CI=1.10–2.74) were associated with higher risks of incident disability. Severe MR was associated with functional decline (OR = 1.69, 95% CI = 1.11–2.57). Estimates were adjusted for demographic, social, lifestyle behaviour and health variables. In particular, eating difficulty was associated with incident disability and functional decline, and low lymphocyte with functional decline. Severe MR and low albumin were associated with 37% worse GV and 126% worse TUG declines; consuming few vegetables or fruits with 34% worse KES decline; polypharmacy with 56% worse TUG decline. Conclusion Malnutrition risk increased the risk of incident disability and functional decline in non-disabled persons, it worsened physical performance declines. Further studies should investigate the effectiveness of nutritional interventions in reducing the risk of disability among older people.
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Affiliation(s)
- Shan Hai
- Gerontology and Geriatrics Centre, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Qi Gao
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xinyi Gwee
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Denise Qian Ling Chua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Bee Yap
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chen O, Mah E, Dioum E, Marwaha A, Shanmugam S, Malleshi N, Sudha V, Gayathri R, Unnikrishnan R, Anjana RM, Krishnaswamy K, Mohan V, Chu Y. The Role of Oat Nutrients in the Immune System: A Narrative Review. Nutrients 2021; 13:nu13041048. [PMID: 33804909 PMCID: PMC8063794 DOI: 10.3390/nu13041048] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022] Open
Abstract
Optimal nutrition is the foundation for the development and maintenance of a healthy immune system. An optimal supply of nutrients is required for biosynthesis of immune factors and immune cell proliferation. Nutrient deficiency/inadequacy and hidden hunger, which manifests as depleted nutrients reserves, increase the risk of infectious diseases and aggravate disease severity. Therefore, an adequate and balanced diet containing an abundant diversity of foods, nutrients, and non-nutrient chemicals is paramount for an optimal immune defense against infectious diseases, including cold/flu and non-communicable diseases. Some nutrients and foods play a larger role than others in the support of the immune system. Oats are a nutritious whole grain and contain several immunomodulating nutrients. In this narrative review, we discuss the contribution of oat nutrients, including dietary fiber (β-glucans), copper, iron, selenium, and zinc, polyphenolics (ferulic acid and avenanthramides), and proteins (glutamine) in optimizing the innate and adaptive immune system's response to infections directly by modulating the innate and adaptive immunity and indirectly by eliciting changes in the gut microbiota and related metabolites.
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Affiliation(s)
- Oliver Chen
- Biofortis Research, Mérieux NutriSciences, Addison, IL 60101, USA;
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
- Correspondence: or
| | - Eunice Mah
- Biofortis Research, Mérieux NutriSciences, Addison, IL 60101, USA;
| | - ElHadji Dioum
- Quaker Oats Center of Excellence, PepsiCo Health & Nutrition Sciences, Barrington, IL 60010, USA; (E.D.); (Y.C.)
| | - Ankita Marwaha
- PepsiCo Health & Nutrition Sciences, AMESA, Gurgaon 122101, India;
| | - Shobana Shanmugam
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Nagappa Malleshi
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Vasudevan Sudha
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Rajagopal Gayathri
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Kamala Krishnaswamy
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu 600086, India; (S.S.); (N.M.); (V.S.); (R.G.); (R.U.); (R.M.A.); (K.K.); (V.M.)
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo Health & Nutrition Sciences, Barrington, IL 60010, USA; (E.D.); (Y.C.)
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14
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Mertens E, Peñalvo JL. The Burden of Malnutrition and Fatal COVID-19: A Global Burden of Disease Analysis. Front Nutr 2021; 7:619850. [PMID: 33553234 PMCID: PMC7858665 DOI: 10.3389/fnut.2020.619850] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Although reasonable to assume, it is not yet clear whether malnourished countries are at higher risk for severe or fatal coronavirus disease 2019 (COVID-19). This study aims to identify the countries where prevalent malnutrition may be a driving factor for fatal disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: Using estimates from the Global Burden of Disease 2019, country-level burden of malnutrition was quantified using four indicators: death rates for child growth failure (underweight, stunting, and/or wasting) and years lived with disability (YLD) attributed to iron and vitamin A deficiencies and high body mass index (BMI). Global mortality descriptors of the ongoing COVID-19 pandemic were extracted from the European Centre for Disease Prevention and Control, and case fatality ratios (CFRs) were calculated introducing a lag time of 10 weeks after the first death of a confirmed case. Bivariate analyses for 172 countries were carried out for malnutrition indicators and fatal COVID-19. Correlations between burden indicators were characterized by Spearman's rank correlation coefficients (ρ) and visually by scatterplots. Restricted cubic splines and underlying negative binomial regressions adjusted for countries' age-structure, prevalent chronic comorbidities related to COVID-19, population density, and income group were used to explore non-linear relationships. Results: Stratified by the World Bank income group, a moderate positive association between YLD rates for iron deficiency and CFRs for COVID-19 was observed for low-income countries (ρ = 0.60, p = 0.027), whereas no clear indications for the association with child growth failure, vitamin A deficiency, or high BMI were found (ρ < 0.30). Countries ranking high on at least three malnutrition indicators and presenting also an elevated CFR for COVID-19 are sub-Saharan African countries, namely, Angola, Burkina Faso, Chad, Liberia, Mali, Niger, Sudan, and Tanzania, as well as Yemen and Guyana. Conclusions: Population-level malnutrition appears to be related to increased rates of fatal COVID-19 in areas with an elevated burden of undernutrition, such as countries in the Sahel strip. COVID-19 response plans in malnourished countries, vulnerable to fatal COVID-19, should incorporate food security, nutrition, and social protection as a priority component in order to reduce COVID-19 fatality.
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Affiliation(s)
- Elly Mertens
- Unit of Noncommunicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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15
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Moskalev A, Stambler I, Caruso C. Innate and Adaptive Immunity in Aging and Longevity: The Foundation of Resilience. Aging Dis 2020; 11:1363-1373. [PMID: 33269094 PMCID: PMC7673842 DOI: 10.14336/ad.2020.0603] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
The interrelation of the processes of immunity and senescence now receives an unprecedented emphasis during the COVID-19 pandemic, which brings to the fore the critical need to combat immunosenescence and improve the immune function and resilience of older persons. Here we review the historical origins and the current state of the science of innate and adaptive immunity in aging and longevity. From the modern point of view, innate and adaptive immunity are not only affected by aging but also are important parts of its underlying mechanisms. Excessive levels or activity of antimicrobial peptides, C-reactive protein, complement system, TLR/NF-κB, cGAS/STING/IFN 1,3 and AGEs/RAGE pathways, myeloid cells and NLRP3 inflammasome, declined levels of NK cells in innate immunity, thymus involution and decreased amount of naive T-cells in adaptive immunity, are biomarkers of aging and predisposition factors for cellular senescence and aging-related pathologies. Long-living species, human centenarians, and women are characterized by less inflamm-aging and decelerated immunosenescence. Despite recent progress in understanding, the harmonious theory of immunosenescence is still developing. Geroprotectors targeting these mechanisms are just emerging and are comprehensively discussed in this article.
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Affiliation(s)
- Alexey Moskalev
- Institute of Biology of FRC of Komi Scientific Center of Ural Branch of Russian Academy of Sciences, Syktyvkar, 167982, Russia.
| | - Ilia Stambler
- Vetek (Seniority), The Movement for Longevity and Quality of Life, Israel.
| | - Calogero Caruso
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
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16
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Molina-Luque R, Muñoz Díaz B, Romero-Saldaña M, Martínez de la Iglesia J, Aguilera-López MD, Molina-Recio G. Sex-bias in the diagnosis of malnutrition in the elderly: a pilot study. Women Health 2020; 61:121-132. [PMID: 33108992 DOI: 10.1080/03630242.2020.1834057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This research aimed to show that using different cutoff points for women and men in nutritional assessment through the Mini Nutritional Assessment (MNA) and different anthropometric variables, improves the diagnostic accuracy of malnutrition among people over 65 years. A cross-sectional study was carried out in a sample of 240 patients of 65 to 104 years in Córdoba (Spain) between 2013 and 2015. Excluded were those with disabling diseases that prevented informed consent. We assessed Nutritional status using the MNA and the Chang Method (Gold Standard). Global cut points per sex were determined for each independent variable using Receiver Operating Characteristic curves, choosing the best of each according to the highest Youden´s index (J). None of the variables studied showed high precision in the diagnosis of malnutrition in the elderly. Different cutoff points were found for all variables by sex, as well as variations in their validity indexes. The number of lymphocytes was more accurate in women (J = 0.58), being the muscular circumference of the arm the best in men (J = 0.8). Regarding MNA, the Long Form version showed higher sensitivity (S) in women (S = 76%) and short versions in men (S = 71% and 59%) at different cutoff points. The introduction of the sex variable seems determinant to achieve a more accurate diagnostic of malnutrition, avoiding biases derivate from a global study without considering its effect in the development of diseases.
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Affiliation(s)
- Rafael Molina-Luque
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba , Córdoba, Spain
| | | | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba , Córdoba, Spain
| | | | | | - Guillermo Molina-Recio
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba , Córdoba, Spain
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17
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Nurses’ knowledge about malnutrition in older people: A multicenter cross-sectional study. Nutrition 2020; 78:110947. [DOI: 10.1016/j.nut.2020.110947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 01/06/2023]
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18
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Nutritional Status Plays More Important Role in Determining Functional State in Older People Living in the Community than in Nursing Home Residents. Nutrients 2020; 12:nu12072042. [PMID: 32660012 PMCID: PMC7400166 DOI: 10.3390/nu12072042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to verify whether the relationship between nutritional and functional status differs between seniors in the community and those in long-term care institutions. One hundred nursing home (NH) residents aged 60 years and above and 100 sex- and age-matched community-dwelling (CD) older adults were examined. Functional status was assessed using the Comprehensive Geriatric Assessment (CGA) and nutritional status using anthropometric measures, the Mini Nutritional Assessment questionnaire (MNA) and bioimpedance analysis (BIA). Significant environmental interactions were observed with resting metabolic rate (RMR), extracellular water (ECW) and intracellular water (ICW) ratio, skeletal muscle mass (SMM), skeletal muscle index (SMI) and impedance (Z) and resistance (R) to the results of the Timed Up and Go (TUG) test. The two groups demonstrated different relationships between Z and R and handgrip strength and between Geriatric Depression Scale (GDS) score and fat free mass (FFM), body density, total body water (TBW) and phase angle (PhA). Nutritional status seems to be more important for functional state in CD older people than in NH residents. Therefore, to ensure the functional independence of seniors living in the community, it is crucial to maintain the correct nutritional parameters. Further studies are necessary to account for the fact that this relationship is less significant among NH residents and to identify other factors that may contribute to these discrepancies between community and institutional environments.
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19
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Wang YC, Liang CK, Hsu YH, Peng LN, Chu CS, Liao MC, Shen HC, Chou MY, Lin YT. Synergistic effect of low handgrip strength and malnutrition on 4-year all-cause mortality in older males: A prospective longitudinal cohort study. Arch Gerontol Geriatr 2019; 83:217-222. [DOI: 10.1016/j.archger.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
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20
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Borkent JW, Naumann E, Vasse E, van der Heijden E, de van der Schueren MAE. Prevalence and Determinants of Undernutrition in A Sample of Dutch Community-Dwelling Older Adults: Results from Two Online Screening Tools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091562. [PMID: 31060212 PMCID: PMC6539798 DOI: 10.3390/ijerph16091562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/18/2019] [Accepted: 05/01/2019] [Indexed: 12/20/2022]
Abstract
To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65-74, 75-84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.
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Affiliation(s)
- Jos W Borkent
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
| | - Elke Naumann
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
| | - Emmelyne Vasse
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Department of Dietetics, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Ellen van der Heijden
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
| | - Marian A E de van der Schueren
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117; 1081 HV Amsterdam, The Netherlands.
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21
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Pisprasert V, Shantavasinkul PC, Rattanachaiwong S, Lepananon T, Komindr S. Moderately high-protein enteral formula improved retinol-binding protein in tube-fed patients: A multicentre open study. Nutr Health 2019; 23:203-209. [PMID: 28929948 PMCID: PMC5761720 DOI: 10.1177/0260106017729959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Long-term inadequate dietary consumption may increase the possibility of malnutrition, morbidity and mortality. Enteral nutrition (EN) is a beneficial support that could help to maintain nutritional status and gut function. Aim: Our aim was to evaluate the effect of moderately high-protein enteral formula containing fibre on nutritional status, and its safety. Method: A total of 23 tube-feeding-dependent adult patients were included in this multicentre, open-label study. The patients were fed with the study formula for 7–12 days or equal to the required nutritional support period, during which we performed physical examinations and assessed nutritional status. The primary endpoint was the statistical difference in nutritional status after the treatment, and the secondary outcome was the desirable safety profile. Results: A significant improvement in cumulative energy balance after intervention was observed (p = 0.008). However, the differences in nutritional status, weight and BMI before and after the intervention do not reach statistical significance. Retinol-binding protein (RBP), a marker for nutritional status, increased from baseline levels. Few cases of diarrhoea and constipation had been reported during the study as a safety concern. Conclusions: This study investigated the efficacy and safety of an enteral feed formulation containing fibre. The patients were nourished with the studied formulation via tube feeding for a short period without serious adverse events. After the intervention, the significant increase in cumulative energy balance was observed. However, an extended period of the intervention may be required to attain the significance in other indicators for nutritional status.
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Affiliation(s)
- Veeradej Pisprasert
- 1 Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | | | - Sornwichate Rattanachaiwong
- 1 Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Tanarat Lepananon
- 2 Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surat Komindr
- 2 Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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22
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Hsu YH, Chou MY, Chu CS, Liao MC, Wang YC, Lin YT, Chen LK, Liang CK. Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study. J Nutr Health Aging 2019; 23:876-882. [PMID: 31641739 DOI: 10.1007/s12603-019-1246-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. DESIGN Prospectively longitudinal cohort study. SETTING AND PARTICIPANTS The study recruited 354 men aged 65 years and older in the veteran's retirement community. MEASURES Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. RESULTS According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). CONCLUSIONS Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.
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Affiliation(s)
- Y-H Hsu
- Chih-Kuang Liang, Address: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.), Phone: 886-7-3422526, E-mail:
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23
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Buckinx F, Paquot N, Fadeur M, Bacus L, Reginster JY, Allepaerts S, Petermans J, Biquet S, Bruyère O. Assessment of the energy expenditure of Belgian nursing home residents using indirect calorimetry. Nutrition 2018; 57:12-16. [PMID: 30099232 DOI: 10.1016/j.nut.2018.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 04/24/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the energy expenditure of Belgian nursing home residents using indirect calorimetry and compare the energy expenditure with energy intake. METHODS Indirect calorimetry was performed in nursing home residents to estimate their basal metabolism. The basal metabolism was multiplied by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. In this way, we obtained the total energy expenditure of each nursing home resident. The nutritional intake of each resident was calculated using the precise food-weighing method over a 3-d period. The difference between energy expenditure and consumption was calculated for each patient and the mean of the difference in the population was calculated. These quantitative variables were compared by means of analysis of variance. RESULTS A total of 25 subjects were included in this study (88.1 ± 5.8 y; 84% women). The estimated mean basal metabolism was 1087.2 ± 163.2 kcal. The physical activity level was 1.29 ± 0.1 on average and the energy expenditure due to thermogenesis was 163.1 ± 28.9 kcal. Thus, the mean daily energy expenditure was 1575.2 ± 210.6 kcal, which was within the range of the actual calculated energy intake of the residents (1631.5 ± 289.3 kcal; P = 0.33). CONCLUSIONS The estimated energy intake of Belgian nursing home residents seems appropriate for their energy expenditure.
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Affiliation(s)
- Fanny Buckinx
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; Department of Public Health, Support Unit in Epidemiology and Biostatistics, University of Liège, Belgium.
| | - Nicolas Paquot
- Diabetes, Nutrition, and Metabolic Diseases, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Marjorie Fadeur
- Diabetes, Nutrition, and Metabolic Diseases, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Lucas Bacus
- Nutrition and Dietetics, Haute Ecole de la Province de Liège, Liège, Belgium
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; Department of Public Health, Support Unit in Epidemiology and Biostatistics, University of Liège, Belgium
| | - Sophie Allepaerts
- Geriatrics Department, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Jean Petermans
- Geriatrics Department, Centre Hospitalier Universitaire of Liège, Liège, Belgium
| | - Sabine Biquet
- Nutrition and Dietetics, Haute Ecole de la Province de Liège, Liège, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; Department of Public Health, Support Unit in Epidemiology and Biostatistics, University of Liège, Belgium; Diabetes, Nutrition, and Metabolic Diseases, Centre Hospitalier Universitaire of Liège, Liège, Belgium
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24
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Sjögren Forss K, Nilsson J, Borglin G. Registered nurses' and older people's experiences of participation in nutritional care in nursing homes: a descriptive qualitative study. BMC Nurs 2018; 17:19. [PMID: 29760582 PMCID: PMC5946464 DOI: 10.1186/s12912-018-0289-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/03/2018] [Indexed: 12/18/2022] Open
Abstract
Background The evaluation and treatment of older people’s nutritional care is generally viewed as a low priority by nurses. However, given that eating and drinking are fundamental human activities, the support and enhancement of an optimal nutritional status should be regarded as a vital part of nursing. Registered nurses must therefore be viewed as having an important role in assessing and evaluating the nutritional needs of older people as well as the ability to intervene in cases of malnutrition. This study aimed to illuminate the experience of participating in nutritional care from the perspectives of older people and registered nurses. A further aim is to illuminate the latter’s experience of nutritional care per se. Methods A qualitative, descriptive design was adopted. Data were collected through semi-structured interviews (n = 12) with eight registered nurses and four older persons (mean age 85.7 years) in a city in the southern part of Sweden. The subsequent analysis was conducted by content analysis. Result The analysis reflected three themes: ‘participation in nutritional care equals information’, ‘nutritional care out of remit and competence’ and ‘nutritional care more than just choosing a flavour’. They were interpreted to illuminate the experience of participation in nutritional care from the perspective of older people and RNs, and the latter’s experience of nutritional care in particular per se. Conclusions Our findings indicate that a paternalistic attitude in care as well as asymmetry in the nurse-patient relationship are still common characteristics of modern clinical nursing practice for older people. Considering that participation should be central to nursing care, and despite the RN’s awareness of the importance of involving the older persons in their nutritional care this was not reflected in reality. Strategies to involve older persons in their nutritional care in a nursing home context need to take into account that for this population participation might not always be experienced as an important part of nursing care.
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Affiliation(s)
- Katarina Sjögren Forss
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Jane Nilsson
- Malmö Town, Borough Administration West, SE-214 66 Malmö, Sweden
| | - Gunilla Borglin
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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25
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Terp R, Jacobsen KO, Kannegaard P, Larsen AM, Madsen OR, Noiesen E. A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk—a randomized controlled trial. Clin Rehabil 2018; 32:930-941. [DOI: 10.1177/0269215518765912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To investigate the effect of a nutrition intervention program for geriatric nutritional at-risk patients. Design: A randomized controlled trial. Setting: Department of geriatric medicine in a university hospital and in the primary healthcare sector, Copenhagen. Subjects: Geriatric patients ( N = 144) at nutritional risk. Intervention: The intervention consisted of an individual dietary plan for home, including pre-discharge advice on nutritional intake, combined with three follow-up visits after discharge (one, four, and eight weeks). Main measures: Change in body weight, Barthel Index, hand-grip strength and self-rated health from baseline (discharge) to three months after discharge, readmission, and mortality (90 and 120 days). Results: The mean (SD) age in total sample was 87.2 (6.2) years. Sample size in the intervention group (IG) was N = 72, and in the control group (CG), N = 72. IG had a mean (SD) weight gain of 0.9 (4.2) kg compared to a weight loss of 0.8 (3.6) kg in the CG ( P = 0.032). In addition, an improvement in self-rated health was seen in the IG compared to CG (IG: 23 (47%) vs. CG: 12 (24%); P = 0.021). No significant difference between groups was found in functional status, mortality, or readmission rates. Conclusion: An individual dietary plan based on everyday food, combined with three follow-up visits (one, four, and eight weeks) after discharge, led to an improvement in nutritional status and self-rated health in geriatric patients.
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Affiliation(s)
- Rikke Terp
- Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Kim Otto Jacobsen
- Department of Geriatric Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Pia Kannegaard
- Department of Geriatric Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne-Mette Larsen
- Nutritional Unit, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Eline Noiesen
- Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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26
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Weger-Lucarelli J, Auerswald H, Vignuzzi M, Dussart P, Karlsson EA. Taking a bite out of nutrition and arbovirus infection. PLoS Negl Trop Dis 2018; 12:e0006247. [PMID: 29596427 PMCID: PMC5875747 DOI: 10.1371/journal.pntd.0006247] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Nutrition is a key factor in host–pathogen defense. Malnutrition can increase both host susceptibility and severity of infection through a number of pathways, and infection itself can promote nutritional deterioration and further susceptibility. Nutritional status can also strongly influence response to vaccination or therapeutic pharmaceuticals. Arthropod-borne viruses (arboviruses) have a long history of infecting humans, resulting in regular pandemics as well as an increasing frequency of autochthonous transmission. Interestingly, aside from host-related factors, nutrition could also play a role in the competence of vectors required for transmission of these viruses. Nutritional status of the host and vector could even influence viral evolution itself. Therefore, it is vital to understand the role of nutrition in the arbovirus lifecycle. This Review will focus on nutritional factors that could influence susceptibility and severity of infection in the host, response to prophylactic and therapeutic strategies, vector competence, and viral evolution. As the old adage goes, you are what you eat. Proper nutrition is a cornerstone of health, and malnutrition can seriously impair the function of the immune system, resulting in increased infections or a more severe disease. Imbalanced or inadequate nutrition can also affect responses to vaccines or drugs that are vital for protection and treatment against viruses. A mosquito is also a product of what it eats. Nutrition during development and adult lifecycle can affect the feeding behavior of mosquitoes, thereby affecting transmission of viral diseases. Arthropod-borne viruses (arboviruses) are a major global health concern, especially in areas impacted by malnutrition. Understanding how nutrition can affect both humans and mosquitoes in the context of these viruses is vital to combating these diseases.
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Affiliation(s)
- James Weger-Lucarelli
- Viral Populations and Pathogenesis Unit, Institut Pasteur, Centre National de la Recherche Scientifique, Paris, France
| | - Heidi Auerswald
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Marco Vignuzzi
- Viral Populations and Pathogenesis Unit, Institut Pasteur, Centre National de la Recherche Scientifique, Paris, France
| | - Phillipe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Erik A. Karlsson
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
- * E-mail:
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How Swallow Pressures and Dysphagia Affect Malnutrition and Mealtime Outcomes in Long-Term Care. Dysphagia 2017; 32:785-796. [PMID: 28733775 DOI: 10.1007/s00455-017-9825-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/14/2017] [Indexed: 02/07/2023]
Abstract
Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62-102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29-37) and MSPs were 26 kPa (95% CI 23-29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.
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Nutritional assessment of community-dwelling older adults in rural Nepal. PLoS One 2017; 12:e0172052. [PMID: 28196115 PMCID: PMC5308814 DOI: 10.1371/journal.pone.0172052] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
Background Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal’s health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool. Methods A cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated. Results 111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts. Conclusions The MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention.
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Miller GD, Beavers DP, Hamm D, Mihalko SL, Messier SP. Nutrient Intake During Diet-Induced Weight Loss and Exercise Interventions in a Randomized Trial in Older Overweight and Obese Adults. J Nutr Health Aging 2017; 21:1216-1224. [PMID: 29188882 DOI: 10.1007/s12603-017-0892-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Dietary restriction in obese older adults undergoing weight loss may exacerbate nutrient deficiencies common in this group; the nutritional health of older adults is a factor in their quality of life, disability, and mortality. This study examined the effect of an 18-month weight loss program based in social cognitive theory incorporating partial meal replacements, on nutrient intake in older overweight and obese adults. DESIGN The following analysis is from the Intensive Diet and Exercise for Arthritis (IDEA) trial, a single-blind, randomized controlled trial. Individuals were randomized into one of three 18-month interventions: exercise (E); intensive diet-induced weight loss (D); or intensive diet-induced weight loss plus exercise (D+E). SETTING The study setting was at a university research facility. PARTICIPANTS Overweight and obese older adults (n=388; BMI=33.7±3.8 kg/m2; 65.8±6.1 years) were recruited. INTERVENTIONS The D and D+E interventions (group mean goal of ≥10% loss by 18-months) utilized partial meal replacements (2 meal replacement shakes/day for 6-months). Exercise training for E and D+E was 3 days/week, 60 minutes/day. MEASUREMENTS Three day food records were collected at baseline, 6-months, and 18-months and analyzed for total energy and macro- and micronutrient intake. Comparisons of dietary intake among treatment groups were performed at 6 and 18 months using mixed linear models. RESULTS Weight loss at 18-months was 11.3±8.3% (D), 10.3±6.8% (D+E), and 1.2±4.2% (E). Meal replacements were used by more than 60% (6-months) and 50% (18-months) of D and D+E participants, compared to ≤15% for E. Both D and D+E consumed less energy and fat, and more carbohydrates and selected micronutrients than E during follow-up. More than 50% of all participants consumed less than the recommended intake of particular vitamins and minerals. CONCLUSIONS The diet intervention improved intakes of several nutrients. However, inadequate intake of several vitamins and minerals of concern for older adults suggests they need further guidance to assure adequate intake.
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Affiliation(s)
- G D Miller
- Gary D. Miller, PhD, Box 7868 Reynolda Station, Department Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109-7868, ; 336-758-1901; 336-758-4680 (fax)
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Cipriani G, Carlesi C, Lucetti C, Danti S, Nuti A. Eating Behaviors and Dietary Changes in Patients With Dementia. Am J Alzheimers Dis Other Demen 2016; 31:706-716. [PMID: 27756815 PMCID: PMC10852764 DOI: 10.1177/1533317516673155] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Eating problems and dietary changes have been reported in patients with dementia. OBJECTIVES The aim of this article is to explore the generalized problems with nutrition, diet, feeding, and eating reported among patients with dementia. METHODS Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2016. Search terms used included behavioral and psychological symptoms of dementia, dementia, dietary changes, eating behavior. Publications found through this indexed search were reviewed for further relevant references. RESULTS Abnormal eating behaviors, eating problems, and dietary changes are present in most people with dementia, especially in the later stages of the condition. CONCLUSION Individuals with dementia frequently develop serious feeding difficulties and changes in eating and dietary habits. The changes may be secondary to cognitive impairment or apraxia, or the result of insufficient caregiving, or the consequence of metabolic or neurochemical abnormalities occurring as part of the dementing process.
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Affiliation(s)
| | | | | | - Sabrina Danti
- Department of Neurology, Versilia Hospital, Lucca, Italy
| | - Angelo Nuti
- Department of Neurology, Versilia Hospital, Lucca, Italy
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Macronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ). Br J Nutr 2016; 116:1103-15. [PMID: 27546175 DOI: 10.1017/s0007114516003020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand. The median BMI was higher for Māori (28·3 kg/m2) than for non-Māori (26·2 kg/m2) P=0·007. For Māori, median energy intake was 7·44 MJ/d for men and 6·06 MJ/d for women with 16·3 % energy derived from protein, 43·3 % from carbohydrate and 38·5 % from fat. Median energy intake was 7·91 and 6·26 MJ/d for non-Māori men and women, respectively, with 15·4 % of energy derived from protein, 45 % from carbohydrate and 36·7 % from fat. For both ethnic groups, bread was the top contributor to energy and carbohydrate intakes. Protein came from beef and veal, fish and seafood, bread, milk and poultry with the order differing by ethnic groups and sex. Fat came mainly from butter and margarine. Energy-adjusted protein was higher for Māori than non-Māori (P=0·049). For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.
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Visvanathan R, Piantadosi C, Lange K, Naganathan V, Hunter P, Cameron ID, Chapman I. The Randomized Control Trial of the Effects of Testosterone and a Nutritional Supplement On Hospital Admissions in Undernourished, Community Dwelling, Older People. J Nutr Health Aging 2016; 20:769-79. [PMID: 27499311 DOI: 10.1007/s12603-016-0689-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In a pilot single centre study we found that treatment of undernourished older, community dwelling people for one year with oral testosterone (placebo-controlled) and a nutritional supplement (no control) was associated with a significant reduction in hospitalizations. A larger, multicentre study was conducted to investigate further this potentially important finding. DESIGN One year, randomized, placebo-controlled, multi-centre, double-blind, trial. SETTING Community. PARTICIPANTS 53 undernourished men and women aged 65 years and older. INTERVENTION Oral testosterone undecanoate (40 mg/day women, 160 mg/day men) and high energy oral nutritional supplement (2108-2416 kJ/day) or placebo medication and low energy (142-191 kJ/day) "placebo" oral nutritional supplementation. MEASUREMENTS Hospital admissions, falls and other variables were assessed. RESULTS 53 subjects were recruited (64% male and mean age 77 years), which was substantially less than planned. Sixteen subjects (30%) were admitted to hospital at least once, with a total of 29 admissions. Eight subjects (32%) in the placebo arm were admitted to hospital, whilst in the intervention group also there were eight (29%) subjects admitted to hospital during the study period. There was no difference in the number of hospitalisations (P = 0.842), length of hospitalization (P=0.645) or quality of life [mental health P=0.195 and physical health P=0.451) between the treatment arms. CONCLUSIONS In undernourished older people, treatment with testosterone and a nutritional supplementation did not reduce the number and length of hospitalisations or improve quality of life.
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Affiliation(s)
- R Visvanathan
- Professor Renuka Visvanathan, University of Adelaide and The Queen Elizabeth Hospital, Department of Medicine and The Aged and Extended Care Services, Address: Level 8B, The Queen Elizabeth Hospital, Woodville South, SA 5011, Telephone No: 08-82226887, Fax No: 08-82228593, e-mail:
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Brooke J, Ojo O. Oral and enteral nutrition in dementia: an overview. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:624-628. [PMID: 26110853 DOI: 10.12968/bjon.2015.24.12.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The number of people currently living with dementia in the UK is estimated to be 850 000 and this is expected to rise to over 1 million by the year 2025. Dementia is a progressive terminal disease and the rate of decline is unique to each person; however, cognitive deterioration can be accelerated by undernutrition. This article discusses evidence-based approaches in the use of oral and enteral nutrition interventions for people living with dementia and ways to support their caregivers. The discussion of interventions to improve oral nutrition includes changes to the environment, support with feeding difficulties, nutritional supplements and education and training for caregivers.
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Affiliation(s)
- Joanne Brooke
- Associate Professor, College of Nursing, Midwifery and Healthcare, University of West London
| | - Omorogieva Ojo
- Senior Lecturer in Primary Care, Adult Nursing and Paramedic Science, Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London
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Schultz AR, Neves-Souza RD, Costa VDSP, Meneses-Barriviera CL, Franco PPR, Marchiori LLDM. Is There a Possible Association between Dietary Habits and Benign Paroxysmal Positional Vertigo in the Elderly? The Importance of Diet and Counseling. Int Arch Otorhinolaryngol 2015; 19:293-7. [PMID: 26491473 PMCID: PMC4593901 DOI: 10.1055/s-0035-1551551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/29/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Poor diet habits and inadequate intake of nutrients are a concern in the elderly. Nutritional education with guidance may improve the results of the treatment of vertigo. Objective Evaluate the presence of benign paroxysmal positional vertigo (BPPV) associated with feeding habits. Methods Cross-sectional study with elderly people living independently. We evaluated nutritional habits through the method of dietary 24-hour recall and manipulation of Dix-Hallpike. Results Based on a sample of 487 individuals, 117 had BPPV. Among the 117 elderly patients with BPPV, 37 (31.62%) had inadequate feeding. From those 370 individuals without BPPV, 97 (26.21%) had inappropriate feeding. No significant association between nutritional habits and BPPV in the total population was observed (p = 0.3064). However, there was significant relation between BPPV and inadequate carbohydrate intake (p = 0.0419) and insufficient fiber intake (p = 0.03), and the diet of these subjects was rich in polyunsaturated fatty acids (p = 0.0084). Conclusion These data correlate with the dyslipidemia and hypertriglyceridemia status, making it extremely important to reduce the intake of fats and carbohydrates and increase the fiber intake to stabilize triglycerides and thus minimize harmful effects on the inner ear. Food readjustment is suggested in patients with BPPV, along with the work of a multidisciplinary team to improve the quality of the elderly.
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Affiliation(s)
| | | | - Viviane de Souza Pinho Costa
- Department of Health Sciences, Centre of Biological and Health Sciences (CCBS), Universidade Norte do Paraná (UNOPAR), Londrina, Paraná, Brazil
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Keshavarzi S, Ahmadi SM, Lankarani KB. The impact of depression and malnutrition on health-related quality of life among the elderly Iranians. Glob J Health Sci 2014; 7:161-70. [PMID: 25948441 PMCID: PMC4802080 DOI: 10.5539/gjhs.v7n3p161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/26/2014] [Accepted: 09/24/2014] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The present study aimed to assess the association between nutritional status and depressive symptoms among elderly Iranians and to explore their impact on their Health-Related Quality of Life (HRQoL). METHODS In this cross-sectional study, 447 elders aging from 55 to 85 years were randomly selected and completed the Iranian version of Geriatric Depression Scale-15 (GDS), Mini Nutritional Assessment (MNA), and the Iranian version of Short Form Health Survey (SF-36). RESULTS Out of the 447 elderly, 72.1% were female with the mean age of 65.99 ± 7.89 years. The prevalence of depression was 38.1%. In addition, the SF-36 sub-scores tended to be lower among the elders with depressive symptoms according to GDS. The Physical Functioning (PF), Bodily Pain (BP), Role Physical (RP), Role Emotional (RE), and Mental Health (MH) dimensions of the SF-36 were also statistically poorer in the elders with depression. The mean MNA score was 24.6 ± 2.7; 35.4% of the participants were malnourished or at risk of malnutrition and 64.6% were adequately nourished. The sub scores of SF-36 were significantly lower in the elders with impaired nutritional status. CONCLUSIONS Considering the importance of the association among psychological and nutritional problems and HRQoL in caring for and promoting the welfare of the elders, this study provided fundamental information and a basis for further evaluation of this issue in developing and undeveloped countries.
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Affiliation(s)
| | - Seyed Mehdi Ahmadi
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
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Fereshtehnejad SM, Ghazi L, Shafieesabet M, Shahidi GA, Delbari A, Lökk J. Motor, psychiatric and fatigue features associated with nutritional status and its effects on quality of life in Parkinson's disease patients. PLoS One 2014; 9:e91153. [PMID: 24608130 PMCID: PMC3946796 DOI: 10.1371/journal.pone.0091153] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/10/2014] [Indexed: 12/16/2022] Open
Abstract
Objectives Parkinson’s disease (PD) patients are more likely to develop impaired nutritional status because of the symptoms, medications and complications of the disease. However, little is known about the determinants and consequences of malnutrition in PD. This study aimed to investigate the association of motor, psychiatric and fatigue features with nutritional status as well as the effects of malnutrition on different aspects of quality of life (QoL) in PD patients. Methods One hundred and fifty patients with idiopathic PD (IPD) were recruited in this study. A demographic checklist, the Unified Parkinson’s Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS) were completed through face-to-face interviews and clinical examinations. The health-related QoL (HRQoL) was also evaluated by means of the Parkinson’s Disease Questionnaire (PDQ-39). For evaluation of nutritional status, the Mini Nutritional Assessment (MNA) questionnaire was applied together with anthropometric measurements. Results Thirty seven (25.3%) patients were at risk of malnutrition and another 3 (2.1%) were malnourished. The total score of the UPDRS scale (r = −0.613, P<0.001) and PD duration (r = −0.284, P = 0.002) had a significant inverse correlation with the total MNA score. The median score of the Hoehn and Yahr stage was significantly higher in PD patients with abnormal nutritional status [2.5 vs. 2.0; P<0.001]. More severe anxiety [8.8 vs. 5.9; P = 0.002], depression [9.0 vs. 3.6; P<0.001] and fatigue [5.4 vs. 4.2; P<0.001] were observed in PD patients with abnormal nutritional status. Except for stigma, all other domains of the PDQ-39 were significantly correlated with the total score of the MNA. Conclusion Our study demonstrates that disease duration, severity of motor and psychiatric symptoms (depression, anxiety) and fatigue are associated with nutritional status in PD. Different aspects of the HRQoL were affected by patients’ nutritional status especially the emotional well-being and mobility domains.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Firoozgar Clinical Research Development Center (FCRDC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Ladan Ghazi
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Mahdiyeh Shafieesabet
- Medical Students Research Committee (MSRC), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Ali Shahidi
- Movement Disorders Clinic, Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Delbari
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Sabzevar University of Medical Sciences, Sabzevar, Khorasan, Iran
| | - Johan Lökk
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
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Chan TC, Luk JKH, Chu LW, Chan FHW. Association between body mass index and cause-specific mortality as well as hospitalization in frail Chinese older adults. Geriatr Gerontol Int 2014; 15:72-9. [PMID: 24418288 DOI: 10.1111/ggi.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/29/2022]
Abstract
AIM A U-shaped relationship between body mass index (BMI) and all-cause mortality has been reported, but there are few studies examining the association between BMI and cause-specific mortality and hospitalization. We carried out a longitudinal study to examine these associations in Chinese older adults with multiple comorbidities, which could provide a reference for the recommended BMI in this population. METHODS From 2004 to 2013, a retrospective cohort of Chinese older adults was selected from a geriatric day hospital in Hong Kong. They were divided into groups according to their BMI: BMI <16; BMI 16-18; BMI 18.1-20; BMI 20.1-22; BMI 22.1-24; BMI 24.1-26; BMI 26.1-28; BMI 28.1-30 and BMI >30. Other assessments included medical, functional, cognitive, social and nutritional assessment. RESULTS A total of 1747 older adults (mean age 80.8 ± 7.1 years, 44.1% male, 46.1% living in nursing homes, Charlson Comorbidity Index 2.0 ± 1.6) with a median follow up of 3.5 years were included. Older adults with BMI 24-28 had the lowest all-cause, infection-related and cardiovascular mortality (P < 0.001). Multivariate analysis showed that there was an inverted J-shaped association between BMI and hazard ratio for all-cause and infection-related mortality in both nursing home and community-dwelling older adults. The rate of all-cause hospitalization was lower in older adults with BMI 22-28 (P = 0.002). Multivariate analysis showed that there was an inverted J-shaped association between the odds ratio of recurrent hospitalization and BMI. CONCLUSION Chinese older adults with BMI 24-28 had lower all-cause mortality, infection-related mortality, cardiovascular-related mortality and all-cause hospitalization. This study provides a reference for the recommended BMI in this population.
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Affiliation(s)
- Tuen-Ching Chan
- Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong; Division of Geriatric Medicine, Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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El Zoghbi M, Boulos C, Amal AH, Saleh N, Awada S, Rachidi S, Bawab W, Salameh P. Association between cognitive function and nutritional status in elderly: A cross-sectional study in three institutions of Beirut—Lebanon. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.gmhc.2013.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bonetti L, Bagnasco A, Aleo G, Sasso L. Validation of the Staff Attitudes to Nutritional Nursing Care Geriatric scale in Italian. Int Nurs Rev 2013; 60:389-96. [DOI: 10.1111/inr.12033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Loris Bonetti
- Department of Health Sciences; University of Genoa; Genoa; Italy
| | | | - Giuseppe Aleo
- Department of Health Sciences; University of Genoa; Genoa; Italy
| | - Loredana Sasso
- Department of Health Sciences; University of Genoa; Genoa; Italy
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Ng IS, Cheung KC, Chou KL. Correlates of Eating Disorder in Middle-Aged and Older Adults. J Aging Health 2013; 25:1106-20. [DOI: 10.1177/0898264313494798] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study aims to investigate: (a) the association of eating disorders with childhood sexual abuse and recent stressful life events; (b) the coexistence of eating disorders and other common psychiatric disorders; and (c) the impact of eating disorders on obesity, medical conditions, and health service utilization. Method: We conducted secondary data analyses based on population-based study, which consists of a nationally representative sample of 2,870 community-dwelling adults aged 50 and above, interviewed in 2006 to 2007. Results and conclusion: The 12-month prevalence of eating disorders was 2.61%. Multivariate analyses revealed that eating disorders were more common among younger age groups, women, and those who reported stressful life events. In addition, eating disorders were significantly related to anxiety disorders, agoraphobia, panic disorder, obesity, and cancer. Discussion: This study supports the notion that eating disorders in older adults are associated with a number of psychosocial, psychiatric, and medical conditions.
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Affiliation(s)
- Isabella S.F. Ng
- Department of Asian and Policy Studies, The Hong Kong Institute of Education, Hong Kong, China
| | - Kelvin C.K. Cheung
- Department of Asian and Policy Studies, The Hong Kong Institute of Education, Hong Kong, China
| | - Kee-Lee Chou
- Department of Asian and Policy Studies, The Hong Kong Institute of Education, Hong Kong, China
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Bell J, Bauer J, Capra S, Pulle CR. Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine? Can J Physiol Pharmacol 2013; 91:489-95. [DOI: 10.1139/cjpp-2012-0301] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Inadequate energy and protein intake leads to malnutrition; a clinical disease not without consequence post acute hip fracture. Data detailing malnutrition prevalence, incidence, and intake adequacy varies widely in this patient population. The limited success of reported interventional strategies may result from poorly defined diagnostic criteria, failure to address root causes of inadequate intake, or errors associated with selection bias. This pragmatic study used a sequential, explanatory mixed methods design to identify malnutrition aetiology, prevalence, incidence, intake adequacy, and barriers to intake in a representative sample of 44 acute hip fracture patients (73% female; mean age, 81.7 ± 10.8 years). On admission, malnutrition prevalence was 52.2%. Energy and protein requirements were only met twice in 58 weighed 24 h food records. Mean daily patient energy intake was 2957 kJ (50.9 ± 36.1 kJ·kg–1) and mean protein intake was 22.8 g (0.6 ± 0.46 g·kg–1). This contributed to a further in-patient malnutrition incidence of 11%. Barriers to intake included patient perceptions that malnutrition and (or) inadequate intake were not a problem, as well as patient and clinician perceptions that treatment for malnutrition was not a priority. Malnutrition needs to be treated as a disease not without consequence, and food should be considered as a medicine after acute hip fracture.
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Affiliation(s)
- Jack Bell
- The Prince Charles Hospital, Rode Rd, Chermside, Queensland Health 4035, Australia
- Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Australia
| | - Judith Bauer
- Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Australia
| | - Sandra Capra
- Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Australia
| | - Chrys Ranjeev Pulle
- The Prince Charles Hospital, Rode Rd, Chermside, Queensland Health 4035, Australia
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Ucak S, Basat O, Karatemiz G. Functional and Nutritional State in Elderly Men With Compensated Hypogonadism. J Am Med Dir Assoc 2013; 14:433-6. [DOI: 10.1016/j.jamda.2013.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
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Vitamin B12 and folic acid levels are not related to length of stay in elderly inpatients. Nutrition 2013; 29:757-9. [DOI: 10.1016/j.nut.2012.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 09/07/2012] [Accepted: 10/10/2012] [Indexed: 11/23/2022]
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Serra-Prat M, Mans E, Palomera E, Clavé P. Gastrointestinal peptides, gastrointestinal motility, and anorexia of aging in frail elderly persons. Neurogastroenterol Motil 2013; 25:291-e245. [PMID: 23240772 DOI: 10.1111/nmo.12055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The mechanisms involved in anorexia in frail elderly people remain unclear. The objective of this study was to establish whether fasting and postprandial levels of gastrointestinal peptides, gastrointestinal motility, and hunger are modified by age and frailty. METHODS Three groups of subjects were studied: (a) frail elderly (>70 years) persons, (b) non-frail elderly (>70 years) persons, and (c) healthy adults (aged 25-65 years). After an overnight fast, participants ingested a 400 Kcal liquid meal and appetite, hormonal, and gastrointestinal responses were monitored during early (0-60 min) and late (60-240 min) postprandial periods. KEY RESULTS Frail persons showed poor nutritional status, sarcopenia, and almost absence of hunger during fasting and postprandial periods. Older persons presented higher levels of glucose and insulin during fasting, enhanced postprandial CCK release in early postprandial period and postprandial hyperglycemia and hyperinsulinemia, but similar ghrelin levels than younger adults. Ultrasound scan showed that the fasting antral area was higher and antral compliance lower in old persons. The paracetamol absorption test showed enhanced postprandial gastric emptying in the frail. Non-gallbladder contractors showed no CCK peak in younger and non-frail groups, but the same high CCK peak as contractors in the frail. CONCLUSIONS & INFERENCES Frailty was associated with anorexia, risk of malnutrition, and sarcopenia. Frail persons showed impaired gastric motility (larger antral area at rest, impaired antral compliance, and enhanced postprandial emptying), impaired gallbladder motility, and fasting and/or postprandial alterations in CCK, glucose, and insulin release. Further studies are needed to determine if these factors may contribute to anorexia of aging in frail persons.
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Affiliation(s)
- M Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
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Gagne DA, Von Holle A, Brownley KA, Runfola CD, Hofmeier S, Branch KE, Bulik CM. Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: results of the Gender and Body Image (GABI) study. Int J Eat Disord 2012; 45:832-44. [PMID: 22729743 PMCID: PMC3459309 DOI: 10.1002/eat.22030] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Limited research exists on eating disorder symptoms and attitudes and weight and shape concerns in women in midlife to older adulthood. We conducted an online survey to characterize these behaviors and concerns in women ages 50 and above. METHOD Participants (n = 1,849) were recruited via the Internet and convenience sampling. RESULTS Eating disorder symptoms, dieting and body checking behaviors, and weight and shape concerns were widely endorsed. Younger age and higher body mass index (BMI) were associated with greater endorsement of eating disorder symptoms, behaviors, and concerns. DISCUSSION Weight and shape concerns and disordered eating behaviors occur in women over 50 and vary by age and BMI. Focused research on disordered eating patterns in this age group is necessary to develop age-appropriate interventions and to meet the developmental needs of an important, growing, and underserved population.
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Affiliation(s)
- Danielle A. Gagne
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | | | - Sara Hofmeier
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, Department of Nutrition, University of North Carolina, Chapel Hill, NC
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Bonetti L, Bagnasco A, Aleo G, Sasso L. 'The transit of the food trolley'- malnutrition in older people and nurses' perception of the problem. Scand J Caring Sci 2012; 27:440-8. [PMID: 22846143 DOI: 10.1111/j.1471-6712.2012.01043.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS To investigate how the issue of malnutrition in institutionalised older people is perceived by nurses in a Teaching Hospital in Italy and how some aspects that can prevent malnutrition are dealt with. BACKGROUND Malnutrition in institutionalised older people is still a significant and unresolved problem. Many studies have been published on the inadequacy of nutritional care. Nurses play a strategic and key role in the prevention of malnutrition. Knowing how nurses perceive the problem of malnutrition and how they deal with aspects that can prevent malnutrition can be an important starting point for implementing strategies that will improve overall nutritional care. METHODS A Focus Group (FGs) study was conducted in a Teaching Hospital in the north-west of Italy with 33 nurses, who were still working or had worked with older people. The FGs were audio-taped and transcribed verbatim. Data collection was stopped when we achieved saturation. Two researchers independently analysed the transcription for content analysis and negotiated the emerging categories. RESULTS Although nurses perceived malnutrition as a significant issue, it was often considered of secondary importance compared with other aspects of care. Food choice, although available, is often limited to very few options, diets are standardised and monotonous and patients must choose 'sight unseen'. Time constraints and understaffing were the obstacles for the identification of the need for nutritional care. Organisational and managerial decision-making did not ensure the provision of high-quality nutritional care. Patients' nutritional status was often not assessed, and tools such as the Mini Nutritional Assessment were not mentioned by the participants. CONCLUSION Our study substantially confirmed what is reported in the literature. However, it is necessary to raise nurses' awareness around poor nutritional care to prevent malnutrition in institutionalised older people.
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Affiliation(s)
- Loris Bonetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Piantadosi C, Visvanathan R, Naganathan V, Hunter P, Cameron ID, Lange K, Karnon J, Chapman IM. The effect of testosterone and a nutritional supplement on hospital admissions in under-nourished, older people. BMC Geriatr 2011; 11:66. [PMID: 22023735 PMCID: PMC3213029 DOI: 10.1186/1471-2318-11-66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/24/2011] [Indexed: 11/27/2022] Open
Abstract
Background Weight loss and under-nutrition are relatively common in older people, and are associated with poor outcomes including increased rates of hospital admissions and death. In a pilot study of 49 undernourished older, community dwelling people we found that daily treatment for one year with a combination of testosterone tablets and a nutritional supplement produced a significant reduction in hospitalizations. We propose a larger, multicentre study to explore and hopefully confirm this exciting, potentially important finding (NHMRC project grant number 627178). Methods/Design One year randomized control trial where subjects are allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. 200 older community-dwelling, undernourished people [Mini Nutritional Assessment score <24 and either: a) low body weight (body mass index, in kg/m2: <22) or b) recent weight loss (>7.5% over 3 months)]. Hospital admissions, quality-adjusted life years, functional status, nutritional health, muscle strength, body composition and other variables will be assessed. Discussion The pilot study showed that combined treatment with an oral testosterone and a supplement drink was well tolerated and safe, and reduced the number of people hospitalised and duration of hospital admissions in undernourished, community dwelling older people. This is an exciting finding, as it identifies a treatment which may be of substantial benefit to many older people in our community. We now propose to conduct a multi-centre study to test these findings in a substantially larger subject group, and to determine the cost effectiveness of this treatment. Trial registration Australian Clinical Trial Registry: ACTRN 12610000356066
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Affiliation(s)
- Cynthia Piantadosi
- The Health Observatory, University of Adelaide, Department of Medicine, Adelaide SA 5005, Australia
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Legrain S, Tubach F, Bonnet-Zamponi D, Lemaire A, Aquino JP, Paillaud E, Taillandier-Heriche E, Thomas C, Verny M, Pasquet B, Moutet AL, Lieberherr D, Lacaille S. A New Multimodal Geriatric Discharge-Planning Intervention to Prevent Emergency Visits and Rehospitalizations of Older Adults: The Optimization of Medication in AGEd Multicenter Randomized Controlled Trial. J Am Geriatr Soc 2011; 59:2017-28. [DOI: 10.1111/j.1532-5415.2011.03628.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Aurélie Lemaire
- Geriatric Unit; L'Assistance Publique-Hôpitaux de Paris; Hôpital Pitié-Salpêtrière; Paris; France
| | | | | | - Elodie Taillandier-Heriche
- Department of Geriatrics and Internal Medicine; L'Assistance Publique-Hôpitaux de Paris; Hôpital Albert Chenevier
| | - Caroline Thomas
- Geriatric Unit; L'Assistance Publique-Hôpitaux de Paris; Hôpital Saint-Antoine
| | | | - Blandine Pasquet
- Department of Epidemiology, Biostatistics, and Clinical Research; L'Assistance Publique-Hôpitaux de Paris; Hôpital Bichat
| | - Aline Lasserre Moutet
- Patient Education Unit for Chronic Patients; Hôpitaux Universitaires de Genève; Geneva; Switzerland
| | | | - Sophie Lacaille
- Geriatric Unit; L'Assistance Publique-Hôpitaux de Paris; Hôpital Bichat
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Valerio A, D'Antona G, Nisoli E. Branched-chain amino acids, mitochondrial biogenesis, and healthspan: an evolutionary perspective. Aging (Albany NY) 2011; 3:464-78. [PMID: 21566257 PMCID: PMC3156598 DOI: 10.18632/aging.100322] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Malnutrition is common among older persons, with important consequences increasing frailty and morbidity and reducing health expectancy. On the contrary, calorie restriction (CR, a low-calorie dietary regimen with adequate nutrition) slows the progression of age-related diseases and extends the lifespan of many species. Identification of strategies mimicking key CR mechanisms – increased mitochondrial respiration and reduced production of oxygen radicals – is a hot topic in gerontology. Dietary supplementation with essential and/or branched chain amino acids (BCAAs) exerts a variety of beneficial effects in experimental animals and humans and has been recently demonstrated to support cardiac and skeletal muscle mitochondrial biogenesis, prevent oxidative damage, and enhance physical endurance in middle-aged mice, resulting in prolonged survival. Here we review recent studies addressing the possible role of BCAAs in energy metabolism and in the longevity of species ranging from unicellular organisms to mammals. We also summarize observations from human studies supporting the exciting hypothesis that dietary BCAA enriched mixture supplementation might be a health-promoting strategy in aged patients at risk.
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Affiliation(s)
- Alessandra Valerio
- Pharmacology Unit, Department of Biomedical Sciences and Biotechnologies, Brescia University, Italy
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Otsuki T, Shimizu K, Iemitsu M, Kono I. Salivary secretory immunoglobulin A secretion increases after 4-weeks ingestion of chlorella-derived multicomponent supplement in humans: a randomized cross over study. Nutr J 2011; 10:91. [PMID: 21906314 PMCID: PMC3182968 DOI: 10.1186/1475-2891-10-91] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 09/09/2011] [Indexed: 12/24/2022] Open
Abstract
Background Chlorella, a unicellular green alga that grows in fresh water, contains high levels of proteins, vitamins, minerals, and dietary fibers. Some studies have reported favorable immune function-related effects on biological secretions such as blood and breast milk in humans who have ingested a chlorella-derived multicomponent supplement. However, the effects of chlorella-derived supplement on mucosal immune functions remain unclear. The purpose of this study was to investigate whether chlorella ingestion increases the salivary secretory immunoglobulin A (SIgA) secretion in humans using a blind, randomized, crossover study design. Methods Fifteen men took 30 placebo and 30 chlorella tablets per day for 4 weeks separated by a 12-week washout period. Before and after each trial, saliva samples were collected from a sterile cotton ball that was chewed after overnight fasting. Salivary SIgA concentrations were measured using ELISA. Results Compliance rates for placebo and chlorella ingestions were 97.0 ± 1.0% and 95.3 ± 1.6%, respectively. No difference was observed in salivary SIgA concentrations before and after placebo ingestion (P = 0.38). However, salivary SIgA concentrations were significantly elevated after chlorella ingestion compared to baseline (P < 0.01). No trial × period interaction was identified for the saliva flow rates. Although the SIgA secretion rate was not affected by placebo ingestion (P = 0.36), it significantly increased after 4-week chlorella ingestion than before intake (P < 0.01). Conclusions These results suggest 4-week ingestion of a chlorella-derived multicomponent supplement increases salivary SIgA secretion and possibly improves mucosal immune function in humans.
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Affiliation(s)
- Takeshi Otsuki
- Faculty of Health and Sport Sciences, Ryutsu Keizai University, Ryugasaki, Ibaraki, Japan.
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