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Vaduva P, Esvan M, Thibault R. Characteristics and outcome of patients referred to a specialized outpatient clinic for the management of malnutrition: A retrospective audit. Clin Nutr ESPEN 2024; 61:266-273. [PMID: 38777442 DOI: 10.1016/j.clnesp.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Insufficient screening and management of malnutrition leads to increase morbidity and mortality. AIMS to evaluate the characteristics and clinical outcomes of malnourished patients referred to a specialized outpatient clinic for the management of malnutrition (primary); to compare the latter according to malnutrition severity; to determine the factors associated with severe malnutrition and mortality; to compare the consistency of the decided medical nutrition therapy with the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines (secondary). METHODS This retrospective, observational study included malnourished adults referred for the first time to the specialized nutrition consultation of a teaching University Hospital during 50 months. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria, including body composition assessment by bioimpedance analysis. STATISTICS Chi2 or Fisher, Student or Wilcoxon rank-sum tests; multivariable logistic regression to assess the factors associated with severe malnutrition and mortality. RESULTS 108 malnourished adults were included: 74% had severe malnutrition. The main secondary diagnosis was digestive cancer (48.2%). During the follow-up (median = 70 days) after the first nutritional consultation, 11% of patients were admitted at hospital, 19% had infections and 23.1% died, without any difference according to malnutrition severity. Severely malnourished patients had lower body mass index, a smaller fat mass index (FMI) (4.6 ± 1.8 vs 6.0 ± 2.5 kg/m2; p = 0.01), and a higher level of total body water (64.7 ± 7.1 vs 60.6 ± 5.4%; p = 0.02), compared to moderately malnourished individuals. A low FMI (odds ratio = 0.72 [0.54-0.96]) was the only factor significantly associated with severe malnutrition. We did not find any factor associated with mortality. There was a moderate consistency (47.1%) between the decided medical nutrition therapy and the ESPEN guidelines of nutritional care. CONCLUSIONS Adults referred for the first time to a specialized nutritional consultation present mostly with severe malnutrition and are at risk for significant complications, leading to a high mortality rate. In this population, a low FMI is associated with severe malnutrition. An earlier diagnosis and care of malnutrition and an earlier referral to clinical nutrition units would improve outcomes.
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Affiliation(s)
- Patricia Vaduva
- Department of Endocrinology Diabetology Nutrition, Nutrition Support Team, Home Parenteral Nutrition Centre, CHU Rennes, Rennes, France.
| | - Maxime Esvan
- Clinical Investigation Center - CIC Inserm 1414, CHU Rennes, Rennes, France.
| | - Ronan Thibault
- Department of Endocrinology Diabetology Nutrition, Nutrition Support Team, Home Parenteral Nutrition Centre, CHU Rennes, Rennes, France; Nutrition Metabolism Cancer Institute (NuMeCan), Univ Rennes, INSERM, INRAE, Rennes, France.
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Modified Body Mass Index as a Novel Nutritional and Prognostic Marker in Patients with Cardiac Amyloidosis. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The nutritional assessment is gaining clinical relevance since cardiac cachexia and malnutrition are emerging as novel markers of functional status and prognosis in many cardiovascular disorders, including cardiac amyloidosis (CA). This study aimed to evaluate the prognostic role of different nutritional indices for cardiovascular mortality in patients with CA and subgroups. Fifty CA patients (26 AL and 24 ATTR wild-type) were retrospectively analyzed. All patients underwent a comprehensive clinical and laboratory evaluation. Conventional body mass index (cBMI), modified BMI (mBMI), new BMI (nBMI) and prognostic nutritional index (PNI) were analyzed. Multivariate regression analysis was performed to identify the association between nutritional and other clinical-laboratory parameters with cardiovascular death. Compared to ATTRwt patients, those with AL showed lower mBMI values. No significant difference was observed for the other nutritional indices. During a median follow-up of 11.2 months, a lower mBMI quartile was associated with worse survival, in both groups. In multivariate analysis, mBMI emerged as an independent predictor for cardiovascular death. This study showed that mBMI is a novel index of malnutrition and an independent risk factor for cardiovascular mortality in patients with CA in both AL and ATTRwt form.
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Aprahamian I, Romanini CV, Lima NA, An VN, Aguirre BN, Galdeano JR, da Costa DL, Petrella M, Ribeiro SML, Borges MK, Morley JE, Voshaar RCO. The concept of anorexia of aging in late life depression: A cross-sectional analysis of a cohort study. Arch Gerontol Geriatr 2021; 95:104410. [PMID: 33823473 DOI: 10.1016/j.archger.2021.104410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. METHODS We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. RESULTS Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). CONCLUSIONS Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Carla Vasconcellos Romanini
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Natália Almeida Lima
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Vinicius Nakajima An
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Bianca Nobre Aguirre
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Júlia Riccetto Galdeano
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Daniela Lima da Costa
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Marina Petrella
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Sandra Maria Lima Ribeiro
- Universidade de São Paulo, Faculdade de Saúde Pública, São Paulo, SP, Brasil; Universidade de São Paulo, Escola de Artes Ciências e Humanidades, São Paulo, SP, Brasil
| | - Marcus K Borges
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - John E Morley
- Geriatrics Division, Saint Louis University, Saint Louis, USA
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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Dellière S, Pouga L, Neveux N, Hernvann A, De Bandt JP, Cynober L. Assessment of transthyretin cut-off values for a better screening of malnutrition: Retrospective determination and prospective validation. Clin Nutr 2020; 40:907-911. [PMID: 32665102 DOI: 10.1016/j.clnu.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Abstract
The use of transthyretin (TTR, prealbumin) as a marker of malnutrition and the definition of associated cut-offs are a matter of debate. In order to clarify this issue, we performed a retrospective study and then a prospective validation one. In the first study, data from 23,617 consecutive patients from our University hospital were analysed. Using the 0.11 and 0.05 g/L cut-off values defined by the French Health Authority, only 3.13% and 0.49% appeared malnourished or severely malnourished indicating that these cut-off values are clearly inappropriate. In the prospective study, consecutive patients were stratified for normal (≥0.2 g/L) or low (<0.2 g/L) TTR, and normal (<15 mg/L) or high (≥15 mg/L) C-reactive protein, hence defining 4 groups (n = 50 to 57/group), and data were analysed according to nutritional status estimated from patient files. Receiver operating characteristic (ROC) curve of TTR level associated with malnutrition allowed setting cut-off values at 0.17 and 0.12 g/L for malnutrition and severe malnutrition respectively.
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Affiliation(s)
- Sarah Dellière
- Service de Biochimie, Hôpital Cochin, APHP, Paris, France
| | - Lydia Pouga
- Service de Biochimie, Hôpital Cochin, APHP, Paris, France
| | - Nathalie Neveux
- Service de Biochimie, Hôpital Cochin, APHP, Paris, France; Laboratoire de Biologie de la Nutrition, EA4466 PRETRAM, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - Alain Hernvann
- Service de Biochimie, Hôpital Cochin, APHP, Paris, France
| | - Jean-Pascal De Bandt
- Service de Biochimie, Hôpital Cochin, APHP, Paris, France; Laboratoire de Biologie de la Nutrition, EA4466 PRETRAM, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - Luc Cynober
- Service de Biochimie, Hôpital Cochin, APHP, Paris, France; Laboratoire de Biologie de la Nutrition, EA4466 PRETRAM, Faculté de Pharmacie de Paris, Université de Paris, Paris, France.
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Aging and nutrition. Paving the way to better health. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2020; 58:55-68. [PMID: 32134741 DOI: 10.2478/rjim-2020-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 01/04/2023] Open
Abstract
Sufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques such as anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the 'Mini Nutritional Assessment' measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition.
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Hiramatsu M, Momoki C, Oide Y, Kaneishi C, Yasui Y, Shoji K, Fukuda T, Habu D. Association Between Risk Factors and Intensive Nutritional Intervention Outcomes in Elderly Individuals. J Clin Med Res 2019; 11:472-479. [PMID: 31236164 PMCID: PMC6575122 DOI: 10.14740/jocmr3738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background The purpose of this study was to identify risk factors for intensive nutritional intervention outcomes in elderly undernourished patients to help reduce the number of patients with prolonged hospital stay or without recuperation of previous activities of daily living and quality of life. Methods In total, 230 patients who received interventions from a nutrition support team (NST) between January 2016 and July 2018 were included. Patients were classified into two groups based on NST intervention outcomes: patients with improved nutritional status were included in the successful group, whereas those whose nutritional status did not improve, as defined by progressive illness or death, were classified into the non-successful group. We assessed patient characteristics, laboratory data, and nutrition support methods. Results Our multivariate Cox proportional hazard analysis showed that: 1) The presence of peripheral parenteral nutrition (hazard ratio (HR): 1.80; 95% confidence interval (CI): 1.13 - 2.88) was identified as an independent risk factor for NST intervention outcomes; 2) The energy fill rate to total energy expenditure was < 66.0% (HR: 1.61; 95% CI: 0.98 - 2.66); and 3) A geriatric nutritional risk index score < 70.0 (HR: 1.54; 95% CI: 0.92 - 2.56) tended to be negatively associated with NST intervention outcomes. Conclusions In addition to the nutrition therapy provided by a traditional NST, patients with the risk factors require nutritional intervention. Elderly individuals should also receive nutrition care because they have been recuperating at their home or in long-term care facilities, to prevent experiencing adverse conditions.
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Affiliation(s)
- Masakazu Hiramatsu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi, Osaka 558-8585, Japan
| | - Chika Momoki
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, 3-1-3 Gakuennminami, Nara-shi, Nara 631-8585, Japan
| | - Yumi Oide
- Department of Nutrition, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-ku, Osaka-shi, Osaka 559-0012, Japan
| | - Chiduko Kaneishi
- Department of Nutrition, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-ku, Osaka-shi, Osaka 559-0012, Japan
| | - Yoko Yasui
- Department of Clinical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi, Osaka 558-8585, Japan
| | - Kumiko Shoji
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi, Osaka 558-8585, Japan
| | - Takashi Fukuda
- Department of Gastroenterological Medicine, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-ku, Osaka-shi, Osaka 559-0012, Japan
| | - Daiki Habu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi, Osaka 558-8585, Japan
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Monacelli F, Sartini M, Bassoli V, Becchetti D, Biagini AL, Nencioni A, Cea M, Borghi R, Torre F, Odetti P. Validation of the Photography Method for Nutritional Intake Assessment in Hospitalized Elderly Subjects. J Nutr Health Aging 2017; 21:614-621. [PMID: 28537324 DOI: 10.1007/s12603-016-0814-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients. DESIGN this is a prospective observational study. SETTING hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy). PARTICIPANTS 255 consecutive elderly hospitalized patients. MEASUREMENTS assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation). RESULTS The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; p<0.001) as well as a significant positive correlation between the indirect photographic method and the food caloric estimation calculated by the direct method (n=255; r= 0.6489, p<0.001). Intraclass coefficient (ICC), showed a highly significant degree of agreement between the gold standard and the indirect photographic method (ICC: 0.69; p<0.0001). Additionally, the results showed a good inter rater agreement of the indirect photographic method (kappa-statistic measure of interrater agreement: (Z=13.04; p<0.001); agreement 70.29% e Kappa=0.5965) and a good specificity of the indirect method as it was independent on the single food item. CONCLUSIONS The study originally provided the validation of the indirect photographic method for the assessment of nutritional intake in a vast cohort of hospitalized elderly subjects. The present results moved a step forward in the appropriate assessment of nutrition intake in frail elderly, providing an easy to use tool that may be incorporate in routine clinical practice for early and targeted therapeutic interventions.
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Affiliation(s)
- F Monacelli
- Dr. Fiammetta Monacelli, MD, PhD, Researcher Assistant in Geriatrics, Dept of Internal Medicine and Medical Specialties (DIMI), Viale Benedetto XV, 6, 16132 Genoa, Italy, Phone/fax+390103537545, e-mail
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Presley CJ, Dotan E, Soto-Perez-de-Celis E, Jatoi A, Mohile SG, Won E, Alibhai S, Kilari D, Harrison R, Klepin HD, Wildes TM, Mustian K, Demark-Wahnefried W. Gaps in nutritional research among older adults with cancer. J Geriatr Oncol 2016; 7:281-92. [PMID: 27197919 PMCID: PMC4969118 DOI: 10.1016/j.jgo.2016.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/03/2016] [Accepted: 04/18/2016] [Indexed: 01/01/2023]
Abstract
Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research.
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Affiliation(s)
- Carolyn J Presley
- Yale Cancer Center/Yale University School of Medicine, New Haven, CT, USA.
| | - Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Enrique Soto-Perez-de-Celis
- Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Supriya G Mohile
- James Wilmot Cancer Center at the University of Rochester, Rochester, NY, USA
| | - Elizabeth Won
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shabbir Alibhai
- Department of Medicine,University Health Network and University of Toronto,Canada
| | - Deepak Kilari
- Froedtert Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert Harrison
- SCOREboard,University of Rochester Medical Center, Rochester, NY, USA
| | - Heidi D Klepin
- Wake Forrest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Tanya M Wildes
- Washington University School of Medicine, St. Louis, MO, USA
| | - Karen Mustian
- James Wilmot Cancer Center at the University of Rochester, Rochester, NY, USA
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Kim SE. [Nutritional Screening and Assessment in Hospitalized Patients]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 65:336-41. [PMID: 26087687 DOI: 10.4166/kjg.2015.65.6.336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nutritional screening and assessment in patients with malnutrition is the critical first step for nutritional care. Although nutritional assessment is a rigorous process that includes obtaining diet and medical history, current clinical status, physical examination, anthropometric data, laboratory data, and often functional and economic information, it is a very effective and worthy practice in terms of reducing various complications, morbidity, mortality and total medical costs. Systematic approaches with appropriate tools for nutritional screening and assessment are needed based on the clinical situations in each institute.
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Affiliation(s)
- Seong Eun Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Frangos E, Trombetti A, Graf CE, Lachat V, Samaras N, Vischer UM, Zekry D, Rizzoli R, Herrmann FR. Malnutrition in Very Old Hospitalized Patients: A New Etiologic Factor of Anemia? J Nutr Health Aging 2016; 20:705-13. [PMID: 27499303 DOI: 10.1007/s12603-015-0641-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anemia and malnutrition are highly prevalent, frequently concomitant and associated with negative outcomes and mortality in the elderly. OBJECTIVES To evaluate the association between these two entities, and test the hypothesis that protein-energy deficit could be etiology of anemia. DESIGN Prospective case-control study. SETTING Geriatric and Rehabilitation Hospital, Geneva University Hospitals, Switzerland. PARTICIPANTS 392 patients (mean age 84.8 years old, 68.6% female). MAIN OUTCOME MEASURES Hematological (hemoglobin (Hb)), chemical (iron work up, cyanocobalamin, folates, renal function, C-Reactive Protein (CRP)) and nutrition (albumin, prealbumin) parameters, and mini nutritional assessment short form (MNA-SF). RESULTS The prevalence of anemia (defined as Hb<120 g/l) was 39.3%. Anemic patients were more frequently malnourished or at risk of malnutrition according to the MNA-SF (p=0.047), with lower serum albumin (p <0.001) and prealbumin (p <0.001) levels. Thirty-eight percent of these patients had multiple causes and 14.3% had no cause found for anemia. Among the latter 90.9% of patients with unexplained anemia had albumin levels lower than 35g/l. After exclusion of iron,vitamin B12 and folic acid deficits, anemic patients had lower albumin (p<0.001) and prealbumin (p 0.007) levels. Albumin level explained 84.5% of the variance in anemia. In multivariate analysis albumin levels remain associated with Hb only in anemic patients, explaining 6.4% of Hb variance (adj R2) and 14.7% (adj R2) after excluding inflammatory parameters (CRP>10). CONCLUSIONS Albumin levels are strongly associated with anemia in the elderly. Screening for undernutrition should be included in anemia assessment in those patients. Further prospective studies are warranted in order to explore the effect of protein and energy supplementation on hemoglobin level.
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Affiliation(s)
- E Frangos
- Dr. Emilia Frangos, Clinique de Joli-Mont, 45 avenue Trembley, 1211 Genève 19, E-mail: Phone : +41.22.717.03.30; Fax : +41.22.788.00.79
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11
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Impact of Serum Albumin on Functional Status and Hospital Outcome in Oldest-Old Inpatients. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2014.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bailly N, Maître I, Wymelbeke VV. Relationships between nutritional status, depression and pleasure of eating in aging men and women. Arch Gerontol Geriatr 2015; 61:330-6. [DOI: 10.1016/j.archger.2015.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
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Baylis D, Syddall H, Jameson K, Cooper C, Lord J, Roberts H, Sayer A. Cachexia, sarcopenia, inflammaging and outcomes in hospitalised older people (the CaSIO study): Study protocol and preliminary results. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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van der Meij BS, Wijnhoven HA, Finlayson GS, Oosten BS, Visser M. Specific food preferences of older adults with a poor appetite. A forced-choice test conducted in various care settings. Appetite 2015; 90:168-75. [DOI: 10.1016/j.appet.2015.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 12/16/2014] [Accepted: 03/07/2015] [Indexed: 01/04/2023]
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Schlitzkus LL, Melin AA, Johanning JM, Schenarts PJ. Perioperative management of elderly patients. Surg Clin North Am 2015; 95:391-415. [PMID: 25814114 DOI: 10.1016/j.suc.2014.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The older population only represents 13.7% of the US population but has grown by 21% since 2002. The centenarian population is growing at a faster rate than the total US population. This unprecedented growth has significantly increased surgical demand. The establishment of quality and performance improvement data has allowed researchers to focus attention on the older patient population, resulting in an exponential increase in studies. Although there is still much work to be done in this field, overlying themes regarding the perioperative management of elderly patients are presented in this article based on a thorough literature review.
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Affiliation(s)
- Lisa L Schlitzkus
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Alyson A Melin
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Paul J Schenarts
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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16
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Affiliation(s)
- Jong Lull Yoon
- Department of Family Medicine and Geriatrics, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Dongtan, Korea
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17
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Pereira GF, Bulik CM, Weaver MA, Holland WC, Platts-Mills TF. Malnutrition among cognitively intact, noncritically ill older adults in the emergency department. Ann Emerg Med 2014; 65:85-91. [PMID: 25129819 DOI: 10.1016/j.annemergmed.2014.07.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/20/2014] [Accepted: 07/14/2014] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE We estimate the prevalence of malnutrition among older patients presenting to an emergency department (ED) in the southeastern United States and identify subgroups at increased risk. METHODS We conducted a cross-sectional study with random time block sampling of cognitively intact patients aged 65 years and older. Nutrition was assessed with the Mini Nutritional Assessment Short-Form (0 to 14 scale), with malnutrition defined as a score of 7 or less and at risk for malnutrition defined as a score of 8 to 11. The presence of depressive symptoms was defined as a Center for Epidemiological Studies Depression-10 score of 4 or more (0 to 10 scale). RESULTS Among 138 older adults, 16% (95% confidence interval [CI] 11% to 23%) were malnourished and 60% (95% CI 52% to 68%) were either malnourished or at risk for malnutrition. Seventeen of the 22 malnourished patients (77%) denied previously receiving a diagnosis of malnutrition. The prevalence of malnutrition was not appreciably different between men and women, across levels of patient education, or between those living in urban and rural areas. However, the prevalence of malnutrition was higher among patients with depressive symptoms (52%), those residing in assisted living (44%), those with difficulty eating (38%), and those reporting difficulty buying groceries (33%). CONCLUSION Among a random sample of cognitively intact older ED patients, more than half were malnourished or at risk for malnutrition, and the majority of malnourished patients had not previously received a diagnosis. Higher rates of malnutrition among individuals with depression, difficulty eating, and difficulty buying groceries suggest the need to explore multifaceted interventions.
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Affiliation(s)
- Greg F Pereira
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Cynthia M Bulik
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, NC; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark A Weaver
- Departments of Medicine and Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Wesley C Holland
- Department of Biology, University of North Carolina, Chapel Hill, NC
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Messinger-Rapport BJ, Gammack JK, Thomas DR, Morley JE. Clinical update on nursing home medicine: 2013. J Am Med Dir Assoc 2014; 14:860-76. [PMID: 24286710 DOI: 10.1016/j.jamda.2013.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 12/18/2022]
Abstract
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
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Hotchandani A. Loss of appetite and strength in the geriatric population: diagnostic symptoms for dengue. Trop Doct 2014; 44:182-5. [PMID: 24504142 DOI: 10.1177/0049475514522225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In dengue endemic regions, a chief complaint of nocturnal fever often is a pathognomic phrase that triggers an investigation for dengue. This article looks at cases of patients who were tested for dengue based on their symptoms of weakness and loss of appetite, without fever as fever was absent in most cases. The article also examines the changes in weight that occur after diagnosis of dengue and compares it to weight loss (if any) that occurred prior to the diagnosis. Dealing with the anorexia and weight loss is challenging for physicians, patients and family members.
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Affiliation(s)
- Ajay Hotchandani
- Head Physician, Department of Geriatrics, Mercy Clinic, Belize City, Belize
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20
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Yoshimura K, Yamada M, Kajiwara Y, Nishiguchi S, Aoyama T. Relationship between depression and risk of malnutrition among community-dwelling young-old and old-old elderly people. Aging Ment Health 2013; 17:456-60. [PMID: 23176659 DOI: 10.1080/13607863.2012.743961] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study explores the association between nutritional status and depression among healthy community-dwelling young-old (aged 65-74) and old-old elderly (aged 75 and older). METHOD A cross-sectional design was implemented. A total of 274 community-dwelling older individuals (142 young-old; 132 old-old) were assessed using the Geriatric Depression Scale (GDS), Mini-Nutritional Assessment Short-Form (MNA-SF) and Life-Space Assessment. Logistic regression analysis was used to determine if depression was independently associated with risk of malnutrition, stratified by age (young-old vs. old-old). RESULTS In the logistic regression model for young-old, being at risk of malnutrition (MNA-SF (≦11) was strongly associated with depression (GDS (≧5;) (likelihood ratio ν = 6.26; 95% confidence interval [CI]: 1.91-20.49). In contrast, in the old-old group, the model was not statistically significant. CONCLUSION Depression and nutritional status were strongly correlated in young-old but not in old-old community-dwelling elderly. This study reveals that not only the factors correlated with but also the symptoms of depression may vary among different age stratifications of the elderly.
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Affiliation(s)
- Kazuya Yoshimura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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John BK, Bullock M, Brenner L, McGaw C, Scolapio JS. Nutrition in the elderly. Frequently asked questions. Am J Gastroenterol 2013; 108:1252-66; quiz 1267. [PMID: 23711624 DOI: 10.1038/ajg.2013.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 04/02/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Bijo K John
- Division of Gastroenterology, Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, USA
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22
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Leistra E, Langius JAE, Evers AM, van Bokhorst-de van der Schueren MAE, Visser M, de Vet HCW, Kruizenga HM. Validity of nutritional screening with MUST and SNAQ in hospital outpatients. Eur J Clin Nutr 2013; 67:738-42. [PMID: 23632750 DOI: 10.1038/ejcn.2013.85] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/14/2013] [Accepted: 03/25/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES The majority of hospital outpatients with undernutrition is unrecognized, and therefore untreated. There is a need for an easy and valid screening tool to detect undernutrition in this setting. The aim of this study was to determine the diagnostic accuracy of the MUST (Malnutrition Universal Screening Tool) and SNAQ (Short Nutritional Assessment Questionnaire) tools for undernutrition screening in hospital outpatients. METHODS In a large multicenter-hospital-outpatient population, patients were classified as: severely undernourished (body mass index (BMI) <18.5 (<65 years) or <20 ( ≥ 65 years) and/or unintentional weight loss >5% in the last month or >10% in the last 6 months), moderately undernourished (BMI 18.5-20 (<65 years) or 20-22 ( ≥ 65 years) and/or 5-10% unintentional weight loss in the last 6 months) or not undernourished. Diagnostic accuracy of the screening tools versus the reference method was expressed as sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). RESULTS Out of the 2236 outpatients, 6% were severely and 7% were moderately undernourished according to the reference method. MUST and SNAQ identified 9% and 3% as severely undernourished, respectively. MUST had a low PPV (Se=75, Sp=95, PPV=43, NPV=98), whereas SNAQ had a low Se (Se=43, Sp=99, PPV=78, NPV=96). CONCLUSIONS The validity of MUST and SNAQ is insufficient for hospital outpatients. While SNAQ identifies too few patients as undernourished, MUST identifies too many patients as undernourished. We advise to measure body weight, height and weight loss, in order to define undernutrition in hospital outpatients.
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Affiliation(s)
- E Leistra
- Dutch Malnutrition Steering Group, Amsterdam, The Netherlands.
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Abstract
Numerous alterations in hormonal secretion occur with aging. In general, these tend towards a disintegration of the normal cyclic secretory patterns resulting in lower total circulating levels. In addition, declines in receptors and postreceptor function further decreases the ability of the hormonal orchestra to maintain coordinated function throughout the organism. Clues to some of these age-related changes in humans may come from the study of simpler organisms where regulatory systems are known to modulate the aging process. In particular, the interactions among the environment, hormones, and insulin receptor genes have led to new insights into the genetic control of longevity and the development of syndrome X.
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Affiliation(s)
- W A Banks
- Division of Geriatric Medicine, Saint Louis University Medical School, 915 N. Grand Blvd., St. Louis, MO 63106 ; Geriatric Research, Education and Clinical Center, St. Louis VAMC, St. Louis, MO 63125
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Haverkort EB, Binnekade JM, de Haan RJ, van Bokhorst - de van der Schueren MA. Handgrip strength by dynamometry does not identify malnutrition in individual preoperative outpatients. Clin Nutr 2012; 31:647-51. [DOI: 10.1016/j.clnu.2012.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/16/2011] [Accepted: 01/27/2012] [Indexed: 11/28/2022]
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Haverkort EB, de Haan RJ, Binnekade JM, van Bokhorst–de van der Schueren MA. Self-reporting of height and weight: valid and reliable identification of malnutrition in preoperative patients. Am J Surg 2012; 203:700-7. [DOI: 10.1016/j.amjsurg.2011.06.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/17/2011] [Accepted: 06/17/2011] [Indexed: 11/17/2022]
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Abstract
Undernutrition in older persons usually presents as weight loss and is predominantly due to protein energy wasting. The presentation of undernutrition is often subtle in older persons and there is a need to utilize screening tools and increasing physician awareness. There are multiple treatable causes of undernutrition in older persons. The major causes are anorexia, cachexia, sarcopenia, dehydration, malabsorption and hypermetabolism. This article also provides an overview of the use of nutritional supplements and an approach to managing protein energy wasting.
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Affiliation(s)
- John E Morley
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, St Louis, MO 63104, USA.
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Kshetrimayum N, Reddy CVK, Siddhana S, Manjunath M, Rudraswamy S, Sulavai S. Oral health-related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City, India. Gerodontology 2012; 30:119-25. [PMID: 22364560 DOI: 10.1111/j.1741-2358.2012.00651.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether oral health-related quality of life (OHRQoL) is associated with nutritional status in the institutionalised elderly population of Mysore. BACKGROUND Malnutrition in the elderly has an evident impact on their general health and quality of life. Analysis of data of the Geriatric Oral Health Assessment Index (GOHAI) and their association with the Mini Nutritional Assessment (MNA) results improves our understanding of the complex relationship between oral health and malnutrition. MATERIALS AND METHODS The study was conducted among the institutionalised elderly population in Mysore city, Karnataka. Data on socio-demographic, oral health status were gathered. OHRQoL was evaluated using GOHAI, and malnutrition risk using MNA. RESULTS Out of 141 elderly, 41.1% were men and 58.9% were women with mean age of 72.2 ±7.5 years. Mean GOHAI score was 47.03 ± 9.2, with 69.5% had low perception of oral health. Mean MNA score was 9.91 ± 2.4, 15.6% were malnourished, 52.5% were at risk of malnutrition and 31.9% were adequately nourished. A strong association was found between the mean GOHAI and MNA scores. CONCLUSION Oral health-related quality of life was associated with nutritional deficit, and it requires a greater integration between dentistry and nutrition in the health promotion of older adults.
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Affiliation(s)
- Nandita Kshetrimayum
- Department of Public Health Dentistry, JSS Dental College and Hospital, A constituent college of JSS University, Mysore- 570015, Karnataka, India.
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Vischer UM, Frangos E, Graf C, Gold G, Weiss L, Herrmann FR, Zekry D. The prognostic significance of malnutrition as assessed by the Mini Nutritional Assessment (MNA) in older hospitalized patients with a heavy disease burden. Clin Nutr 2012; 31:113-7. [DOI: 10.1016/j.clnu.2011.09.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 08/31/2011] [Accepted: 09/18/2011] [Indexed: 10/16/2022]
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Samuel LJ, Szanton SL, Weiss CO, Thorpe RJ, Semba RD, Fried LP. Financial Strain Is Associated with Malnutrition Risk in Community-Dwelling Older Women. EPIDEMIOLOGY RESEARCH INTERNATIONAL 2012; 2012:696518. [PMID: 24163772 PMCID: PMC3806140 DOI: 10.1155/2012/696518] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the relationship between financial strain, or difficulty acquiring necessities, and malnutrition risk in a community dwelling sample of frail and nonfrail women aged 70-79 in the Women's Health and Aging Study (n = 679). Malnutrition risk was measured with a modified version of the Mini-Nutritional Assessment Short Form (MNA-SF) and defined as a score <11, financial strain was measured by (1) sufficiency of money on a monthly basis and (2) adequacy of income for food, and income was measured by ordinal categories. Mean (SD) modified MNA-SF score was 12.2 (1.80), and 14.7% of women had malnutrition risk. Women who usually did not have enough money to make ends meet had more than four-fold increased odds of malnutrition risk (OR = 4.54; 95% CI: 2.26, 9.14) compared to their counterparts who had some money left over each month. This was only slightly attenuated after control for income and education, (OR = 4.08; 95% CI: 1.95, 8.52) remaining robust. These results show an association between financial strain and malnutrition risk, independent of income, in older women. Self-reported financial strain may be preferable to income as a screener for malnutrition risk in older adults in clinical and research settings.
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Affiliation(s)
- Laura J. Samuel
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Sarah L. Szanton
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Carlos O. Weiss
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Medicine, Baltimore, MD 21205, USA
| | - Roland J. Thorpe
- Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Richard D. Semba
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Linda P. Fried
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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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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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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Presence and persistence of nutrition-related symptoms during the first year following esophagectomy with gastric tube reconstruction in clinically disease-free patients. World J Surg 2011; 34:2844-52. [PMID: 20842361 PMCID: PMC2982950 DOI: 10.1007/s00268-010-0786-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Esophagectomy with gastric tube reconstruction results in a variety of postoperative nutrition-related symptoms that may influence the patient's nutritional status. METHODS We developed a 15-item questionnaire, focusing on the nutrition-related complaints the first year after an esophagectomy. The questionnaire was filled out the first week after discharge and 3, 6, and 12 months after surgery. The use of enteral nutrition, meal size and frequency, social aspects related to eating, defecation pattern, and body weight were recorded at the same time points. We analyzed the relationship between the baseline characteristics and the number of nutrition-related symptoms, as well as the relationship between those symptoms and body weight with linear mixed models. RESULTS We found no significant within-patient change for the total number of nutrition-related symptoms (P = 0.67). None of the baseline factors were identified as predictors of the complaint scores. The most frequently experienced complaints were early satiety, postprandial dumping syndrome, inhibited passage due to high viscosity, reflux, and absence of hunger. One year after surgery, meal sizes were still smaller, the social aspects of eating were influenced negatively, and patients experienced an altered stool frequency. Directly after the surgical procedure 78% of the patients lost weight, and the entire postoperative year the mean body weight remained lower (P = 0.47). We observed no association between the complaint scores and body weight (P = 0.15). CONCLUSIONS After an esophagectomy, most patients struggle with nutrition-related symptoms, are confronted with nutrition-related adjustments and a reduced body weight.
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Morley JE. Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment. J Nutr Health Aging 2011; 15:87-90. [PMID: 21365159 DOI: 10.1007/s12603-011-0018-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J E Morley
- GRECC, St. Louis VA Medical Center and Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA.
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Morley JE. Depression in nursing home residents. J Am Med Dir Assoc 2010; 11:301-3. [PMID: 20511093 DOI: 10.1016/j.jamda.2010.03.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
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Abstract
Numerous studies have now found that good nutrition coupled with exercise are key factors to aging successfully. In addition, it is now clear that men who drink 2 shots of alcohol (red wine or other) do better. Women are limited to only 1 drink a day. This article examines some key nutritional factors involved in successful aging and highlights different needs between men and women.
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Affiliation(s)
- John E Morley
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, 1 Jefferson Barracks Drive, Saint Louis, MO 63125, USA.
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Morley JE. Anorexia, weight loss, and frailty. J Am Med Dir Assoc 2010; 11:225-8. [PMID: 20439039 DOI: 10.1016/j.jamda.2010.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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Saka B, Kaya O, Ozturk GB, Erten N, Karan MA. Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr 2010; 29:745-8. [PMID: 20627486 DOI: 10.1016/j.clnu.2010.04.006] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 04/06/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS Age related decline in food intake is associated with various physiological, psychological and social factors. Our aim was to assess the nutritional status of our elderly patients and its association with other geriatric syndromes. METHODS In this cross-sectional population based study, Mini Nutritional Assessment (MNA) test was used to evaluate nutritional status of 413 elderly patients who were admitted to our outpatient clinic in the last 12 months. MNA test results were compared with the laboratory findings and established geriatric syndromes. RESULTS Poor nutritional status was found in 44% of the patients (n=181: 13% malnutrition, 31% malnutrition risk). Malnutrition rate was higher among those with subsequent hospitalization (n=122, 25% vs 8%). Patients with poor nutritional status had lower blood haemoglobin, serum total protein and albumin, and revealed more chronic diseases and geriatric syndromes (6 ± 2 vs 3 ± 2, p<0.0001). Patients with depression, fecal incontinence, decreased cognitive function and functional dependence showed poor nutritional status according to MNA test results. CONCLUSIONS Malnutrition rate of our patients was comparable with the previous data. Malnutrition risk showed positive correlation with the number of existing geriatric syndromes. Depression, dementia, functional dependence and multiple co-morbidities were associated with poor nutritional status.
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Affiliation(s)
- Bulent Saka
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Millet Cad., Capa, Fatih, Istanbul 34093, Turkey.
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Aging male. Clin Geriatr Med 2010; 26:171-84. [PMID: 20497839 DOI: 10.1016/j.cger.2010.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There are several special issues that confront the physician when dealing with the older male. Physicians need to pay attention to these issues and recognize their importance to their patients. This article briefly reviews these unique challenges.
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&NA;. Consider the cause of anorexia when treating elderly patients. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11204280-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Morley JE. Hypertension: Is It Overtreated in the Elderly? J Am Med Dir Assoc 2010; 11:147-52. [DOI: 10.1016/j.jamda.2009.12.081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 02/07/2023]
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Abstract
PURPOSE OF REVIEW Anorexia and weight loss are associated with increased mortality in cachectic patients. The role of caloric supplementation is controversial. The purpose of this review is to examine the role of calorie supplementation in cachexia. RECENT FINDINGS Caloric supplementation improves outcomes in malnourished hospital patients and malnourished older persons. It may improve the quality of life in cancer patients and for those persons receiving palliative care. Caloric supplementation should include a balanced essential amino acid supplement given at least twice a day. The role of eicosapentanoic acid as a supplement is controversial. All caloric supplements should be given between and not with meals. SUMMARY Caloric supplementation rich in protein and with adequate vitamin D should be given between meals to all patients with cachexia.
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Affiliation(s)
- John E Morley
- GRECC, VA Medical Center and Division of Geriatric Medicine, Saint Louis University, School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA.
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Leistra E, Neelemaat F, Evers AM, van Zandvoort MHWM, Weijs PJM, van Bokhorst-de van der Schueren MAE, Visser M, Kruizenga HM. Prevalence of undernutrition in Dutch hospital outpatients. Eur J Intern Med 2009; 20:509-13. [PMID: 19712855 DOI: 10.1016/j.ejim.2009.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 03/06/2009] [Accepted: 03/23/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence of undernutrition in hospital inpatients is high. Earlier detection and treatment in the hospital outpatient clinic may help to reduce these numbers. The purpose of this study was to assess the prevalence of undernutrition in hospital outpatients in the Netherlands, to determine high risk departments, and to determine the percentage of patients receiving dietetic treatment. METHODS This cross-sectional multicenter study was conducted in nine hospitals. Patients who visited the outpatient clinic on one of the screening days in the period March-May 2008 received a short questionnaire and were weighed. Patients were classified as severely undernourished, moderately undernourished or not undernourished. RESULTS 2288 patients were included in the study, of which 5% were severely undernourished and 2% were moderately undernourished. The prevalence of severe undernutrition was highest in the outpatient departments of oral maxillofacial surgery (17%), oncology (10%), rehabilitation (8%), gastroenterology (7%) and pulmonology (7%). Only 17% of all severely undernourished and 4% of all moderately undernourished patients reported to receive dietetic treatment. CONCLUSION The prevalence of undernutrition in hospital outpatients is generally low but largely undertreated. Future screening should focus on high risk departments.
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Affiliation(s)
- Eva Leistra
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands.
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48
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, Saint Louis, Missouri 63104, USA.
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49
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Lifestyle Risk Factors and Utilization of Preventive Services in Disabled Elderly Adults in the Community. J Community Health 2009; 34:440-8. [DOI: 10.1007/s10900-009-9166-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Christensson L, Bachrach-Lindström M. Adapting "the Staff Attitudes to Nutritional Nursing Care scale" to geriatric nursing care. J Nutr Health Aging 2009; 13:102-7. [PMID: 19214337 DOI: 10.1007/s12603-009-0015-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A positive attitude is assumed to be important in nursing staff's help and support of elderly people during meals. As there is no specific tool for measuring staff's attitudes regarding important issues within eating and nutrition, the SANN (Staff Attitudes to Nutritional Nursing Care) scale was developed. The scale was developed and tested in nursing staff working at resident homes, and the number of items was reduced from 63 to 19 with five underlying factors. The aim of this study was to describe how the SANN scale was adapted and tested in nursing staff working in different types of elderly care. DESIGN The raw 63-item version went through minor changes, and one unclear worded item was excluded. The changed raw 62-item version was answered by 188 nursing staff working at six hospital care clinics and 64 staff working at one resident home. RESULTS The analysis reduced the 62 items to 18, and the adapted scale was named the SANN-G scale, G standing for "geriatric care". A rotated factor analysis gave a five-factor solution, explaining 54% of the variance. The scale achieved good internal reliability, with a Cronbach's alpha of 0.83. Fourteen items fulfilled inclusion criteria in both the SANN and the SANN-G scales. CONCLUSION The SANN-G scale is practicable for use in staff working in different types of elderly care. It can be used to explore existing attitudes and identify areas with a low degree of prevailing positive attitudes as well as to evaluate whether and how attitudes change after nutritional education and intervention.
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Affiliation(s)
- L Christensson
- Department of Nursing Science, University College of Health Sciences, Jönköping, Sweden.
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