Nutrition and the Geriatric Rehabilitation Patient: Challenges and Solutions

Characterization of Metallic Off-Flavors in Drinking Water: Health, Consumption, and Sensory Perception

Characterization of taste- and flavor-producing metals, namely iron and copper, in drinking water is a multifaceted subject. Both metals are essential nutrients, can be toxic, and are known to produce unpleasant tastes and flavor sensations in drinking water. Ingestion of trace metal contaminants through drinking water is a probable source of human exposure. Biochemical mechanisms of metallic flavor perception have been previously described; however, less is known about how variations in salivary constituents might impact individuals' sensitivities to metallic flavors and beverage consumption behaviors. This research presents findings from in vitro experiments, using artificial human saliva, to better understand the role of salivary lipids and proteins on metallic flavor production as measured by biomarkers of metal-induced oxidative stress. The results indicate that metal-induced lipid oxidation, as measured by thiobarbituric acid reactive substances (TBARS), is dominated by salivary proteins, is slightly inhibited in the presence of salivary nitrite, and is detectable by the TBARS method at and above respective concentrations of 9 µM (0.5 mg/L) and 90 µM (5 mg/L), which are both above the aesthetic standards for iron (0.3 mg/L) and copper (1.0 mg/L) in drinking water. Preliminary study with human subjects indicated that reduction in metallic flavor sensitivity, as measured by the best estimate flavor threshold for ferrous iron among 33 healthy adults aged 19-84 years old (22 females), corresponded with reduced drinking water consumption and increased caloric beverage intake among older subjects (>60 years), as determined by a validated self-reported beverage intake questionnaire. These findings provide insights for further research to examine how salivary constituents can impact humans' sensory abilities in detecting metallic off-flavors in water, and how reduced metallic flavor sensitivity may influence beverage choices and drinking water consumption.

Acuidade olfatória e qualidade de vida após a laringectomia total

RESUMO: Objetivo: identificar a prevalência e os fatores associados às alterações do olfato e descrever a qualidade de vida após a laringectomia total. Métodos: estudo transversal para avaliar a acuidade olfatória e a qualidade de vida de laringectomizados totais no Instituto Nacional de Câncer por meio da aplicação do Teste de Identificação do Olfato da Universidade da Pensilvânia, do Questionário de Qualidade de Vida da Universidade de Washington e do Questionário sobre a Acuidade Olfatória Pré-Reabilitação do Olfato. Resultados: foram avaliados 48 laringectomizados totais, sendo 39 do sexo masculino e 9 do sexo feminino, com idade média de 62 anos e tempo médio de 5,6 anos desde a laringectomia total. No Teste de Identificação do Olfato a pontuação média foi de 17,9. De acordo com a classificação do olfato no teste, a maioria dos participantes apresentou algum grau de alteração, sendo que apenas 2 indivíduos tiveram o olfato considerado dentro da normalidade. No Questionário de Qualidade de vida da Universidade de Washington, o escore composto foi 80,47. Os domínios que apresentaram as médias de pontos mais baixas foram paladar, saliva e fala. No questionário sobre a acuidade olfatória pré-reabilitação do olfato, a maioria dos participantes consideraram seu olfato de ruim a razoável. 21 indivíduos relataram apresentar algum grau de dificuldade em suas atividades de vida diária em decorrência de alterações do olfato. Conclusão: os laringectomizados totais apresentaram alta prevalência de alterações do olfato, com comprometimentos relacionados às suas atividades de vida diária.

Nursing's role in nutrition

There are not enough dietitians and nutritionists available to serve the entire healthcare industry. That means that nurses often fill the role of nutrition counselors. Nurses do not receive extensive education about nutrition, but there are great opportunities for nurses in nutrition, both as educators and researchers. One way this can happen is through the use of nutrition assessment tools. This article introduces a freeware nutritional assessment tool for use on Windows-based computers (available at http://nursing.jmu.edu). Unlike currently available tools, the Nutrition Analyzer is a stand-alone, Web-independent product, which builds a database of client data that can be manipulated for analysis and research.

High rate of deficiency in the amino acids tryptophan and histidine in people with wounds: implication for nutrient targeting in wound management--a pilot study

BACKGROUND

Malnutrition resulting from inadequate protein, energy, or micronutrient intake has been identified as an independent risk factor for the development of pressure ulcers in older adult patients and is associated with increased morbidity and death.

OBJECTIVE

To assess the relationship between albumin, the standard biochemical marker of nutritional adequacy, and amino acid status in people with wounds.

METHODS

The authors performed tests for serum albumin, prealbumin, and amino acid profiles on 18 consecutive hospital patients with wounds and 7 patients without wounds.

RESULTS

A low level of the essential amino acids tryptophan and histidine was a common finding in older people with wounds. Of the 18 consecutive wound cases, 16 (88.9%) were found to be deficient in tryptophan, histidine, or both. Moreover, levels were generally found to be lower than those in the group without wounds. The levels of all other amino acids were essentially normal for all patients. Finally, although serum albumin is often used as a surrogate marker of amino acid adequacy or nutritional status, clinically abnormal albumin had poor specificity (63.2%), poor sensitivity (60.7%), and low positive predictive value (70.8%) for the identification of a low tryptophan or histidine level.

CONCLUSIONS

People with wounds are a relatively at-risk group and are likely to be overlooked in terms of micronutrient deficiencies, and these findings have important implications in terms of potential specific targeting of nutrient supplementation.