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O'Brien L, Wilkinson TJ, Frampton C, Gearry RB, Wall C. A systematic review and meta-analysis of the dietary fiber menu provision and consumption for older adults living in residential care facilities. Am J Clin Nutr 2024; 120:431-441. [PMID: 38851635 DOI: 10.1016/j.ajcnut.2024.05.026] [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: 12/03/2023] [Revised: 05/12/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Older adults living in residential care facilities are commonly given laxatives to treat constipation; however, these may not always provide full relief, and side effects include diarrhea. Dietary fiber effectively prevents constipation, and international guidelines recommend 25 g/d for optimal laxation. Older adults in residential care rely on the facility menu to provide their nutritional requirements, including adequate dietary fiber. Little is known about how much dietary fiber is provided and consumed. OBJECTIVES We aimed to determine the provision and consumption of dietary fiber for older adults living in residential care facilities. METHODS We systematically searched available literature for studies reporting the analysis of residential care menus and meals consumed by residents aged over 65 y. A meta-analysis was performed on the studies that provided the mean amount of dietary fiber provided and consumed by residents. A random effect model was applied due to the heterogeneity of study methodologies. RESULTS The literature search yielded 4406 publications, but only 28 studies were eligible for our meta-analysis. The study sample comprised 4817 residents. The mean amount of fiber provided to residents was 21.4 g/d [standard error (SE): 1.2; 95% confidence interval: 18.8, 24.2 g/d], the mean amount of fiber consumed by residents was 15.8 g/d (SE: 0.6; 95% confidence interval: 14.7, 16.9 g/d). CONCLUSIONS Older adults living in care facilities are provided with dietary fiber below the recommended guidelines. Compounding this is that residents consume much less than what is provided and do not meet the recommendations for dietary fiber consumption. There is scope to improve dietary fiber provision, promote consumption to residents to aid laxation, and potentially reduce laxative use and the unwanted side effects of diarrhea. This trial was registered at PROSPERO as CRD42023427265.
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Affiliation(s)
- Leigh O'Brien
- Department of Medicine, University of Otago, Christchurch, New Zealand.
| | - Tim J Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Catherine Wall
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Kusama T, Takeuchi K, Kiuchi S, Aida J, Hikichi H, Sasaki S, Kondo K, Osaka K. Dental prosthesis use is associated with higher protein intake among older adults with tooth loss. J Oral Rehabil 2023; 50:1229-1238. [PMID: 37394871 PMCID: PMC10699889 DOI: 10.1111/joor.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/28/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Tooth loss is associated with reduced protein intake, which leads to sarcopenia and frailty in older adults. OBJECTIVE To evaluate the protective effect of dental prostheses on decreased protein intake in older adults with tooth loss. METHODS This cross-sectional study was based on a self-reported questionnaire targeting older adults. Data were obtained from the Iwanuma Survey of the Japan Gerontological Evaluation Study. We used % energy intake (%E) of total protein as the outcome and the use of dental prostheses and number of remaining teeth as explanatory variables. We estimated the controlled direct effects of tooth loss by fixing the use/non-use of dental prostheses based on a causal mediation analysis, including possible confounders. RESULTS Among 2095 participants, the mean age was 81.1 years (1SD = 5.1), and 43.9% were men. The average protein intake was 17.4%E (1SD = 3.4) of the total energy intake. Among participants with ≥20, 10-19 and 0-9 remaining teeth, the average protein intake was 17.7%E, 17.2%E/17.4%E and 17.0%E/15.4%E (with/without a dental prosthesis), respectively. Compared to participants with ≥20 remaining teeth, those with 10-19 remaining teeth without a dental prosthesis did not have a significantly different total protein intake (p > .05). Among those with 0-9 remaining teeth without a dental prosthesis, total protein intake was significantly low (-2.31%, p < .001); however, the use of dental prostheses mitigated the association by 79.4% (p < .001). CONCLUSION Our results suggest that prosthodontic treatment could contribute to maintaining protein intake in older adults with severe tooth loss.
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Affiliation(s)
- Taro Kusama
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Kenji Takeuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Sakura Kiuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Hikichi
- Division of Public Health, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Sorimachi K, Moriyama N, Hatashita S, Miyajima H, Shigemoto S, Takagi K, Hirano H, Ito M, Iseki K, Yasumura S. Association of the Number of Teeth With Physical Function and Length of Hospital Stay After Hip Fracture Surgery: A Prospective Observational Study at a Tertiary Hospital in Japan. Cureus 2023; 15:e47297. [PMID: 38022003 PMCID: PMC10656494 DOI: 10.7759/cureus.47297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Although lower-extremity muscle strength is associated with physical function, there are challenges in assessing the muscle strength of patients after hip surgery due to pain or limited cognitive function. The number of teeth is a characteristic that can be easily examined. Although the relationship between the number of teeth and physical function has been reported in recent years, there are no reports examining the relationship with prognosis in patients with hip fractures. Therefore, this study aimed to investigate the relationship between the number of teeth and physical function and length of hospital stay after hip fracture surgery and to evaluate the predictive efficacy of the number of teeth on postoperative prognosis. METHODS This prospective cohort study was conducted in a tertiary clinical care facility. Patients aged ≥65 years who underwent hip surgery were included. A total of 101 patients (mean age: 85.1±8.0 years) were included. The factor analyzed was the number of teeth at admission. Patients were divided into two groups according to the number of teeth: those with ≥20 and those with ≤19 teeth. The outcomes were knee extension muscle strength-to-weight ratio at two weeks postoperatively and the length of hospital stay. A multiple regression analysis was performed to determine the association between the two groups. RESULTS Of 101 patients, 79 (78.2%) had ≤19 teeth, whereas 22 (21.8%) had ≥20 teeth. The mean muscle strength-to-weight ratio and length of hospital stay were 0.26±0.11 kgf/kg and 57.5±31.4 days, respectively. Multiple regression analysis revealed that the number of teeth was significantly associated with the muscle strength-to-weight ratio (β=-0.26, p=0.04) but not with the duration of hospitalization (β=0.17, p=0.09). CONCLUSIONS We suggest that assessment of the number of teeth at admission may be a useful predictor of patient physical function.
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Affiliation(s)
- Kotaro Sorimachi
- Department of Public Health/Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Fukushima, JPN
- Department of Traumatology and Reconstructive Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, JPN
| | - Satoshi Hatashita
- Department of Traumatology and Reconstructive Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University, Fukushima, JPN
| | - Hisashi Miyajima
- Clinical Unit of Dentistry and Oral Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Shimpei Shigemoto
- Clinical Unit of Dentistry and Oral Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Kaori Takagi
- Rehabilitation Center, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Hiroko Hirano
- Department of Nursing, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Masayuki Ito
- Department of Traumatology and Reconstructive Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University, Fukushima, JPN
| | - Ken Iseki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Fukushima, JPN
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, JPN
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Gupte R, Shetty M, Hegde C. Influence of wearing complete denture on the glycemic control, serum lipid, and proteins in patients with diabetes. J Indian Prosthodont Soc 2023; 23:259-265. [PMID: 37929365 PMCID: PMC10467312 DOI: 10.4103/jips.jips_284_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 10/05/2023] Open
Abstract
Aims The aim of this study was to assess the impact of prosthodontic rehabilitation on glycemic and lipid control in functionally and completely edentulous patients with diabetes. Setting and Design An in vivo study conducted with the intention of studying the potential link between edentulism and impaired masticatory efficiency with the nutritional status in diabetic patients. Materials and Methods A total of 20 diabetic patients based on the inclusion criteria were selected. They were rehabilitated using a removable prosthesis, and observations were made across three parameters - glycosylated hemoglobin (HbA1C), serum cholesterol (S col), and serum protein (SP) at three stages - baseline, 3 months, and 6 months posttreatment. This was done to gauge the impact of the prosthetic rehabilitation on their health due to an increased masticatory efficiency potentially causing changes in dietary patterns. Statistical Analysis Used •Inter group comparison (>2 groups) was done using one way ANOVA followed by pair wise comparison using post hoc test. •Intra group comparison was done using repeated measures ANOVA (for>2 observations) followed by post Hoc test. For all the statistical tests, P < 0.05 was considered to be statistically significant, keeping α error at 5% and β error ati20%, thus giving a power to the study as 80%. Results Hba1c at the baseline had a mean value of 8.04%, which reduced to 7.87% at the 3-month stage and 7.38% at the 6-month stage. S col at the baseline had a mean of 151.6 mg/dL; at the 3-month follow-up, it was 166.5 mg/dL, and at the 6-month follow-up, it was 173.95 mg/dL. SP had a mean baseline value of 6.38 mg/dL, which progressed to 6.67 mg/dL at the 3-month stage and 6.97 at the 6-month stage. Conclusion Within the limitations of this study, it can be concluded that after 6 months of prosthetic rehabilitation in edentulous/functionally edentulous patients: There was a reduction in HbA1c (8.04%-7.38%); however, it was found to be statistically insignificant at that stage There was an increase in S col (151.6 mg/dL-173.95 mg/dL); it was found to be statistically significant There was an increase in SP (6.38 mg/dL-6.97 mg/dL); however, it was found to be statistically insignificant at that stage.
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Affiliation(s)
- Rishabh Gupte
- Department of Prosthodontics and Crown and Bridge, AB Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Mangalore, Karnataka, India
| | - Manoj Shetty
- Department of Oral Implantology, AB Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Mangalore, Karnataka, India
| | - Chethan Hegde
- Department of Prosthodontics and Crown and Bridge, AB Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Mangalore, Karnataka, India
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Genç FZ, Cingil D, Hisar F. Development of the Turkish version of the oral health assessment tool: Methodological study. SPECIAL CARE IN DENTISTRY 2022. [PMID: 36038964 DOI: 10.1111/scd.12775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
AIM This research aimed to assess the validity and reliability of the "Oral Health Assessment Tool for the Elderly" Turkish form. METHODS A total of 262 elderly individuals > 65 years of age were included in the study. These individuals were selected from community-dwelling elderly and nursing home residents in the Konya province of Turkey. A data form containing sociodemographic information and oral health behavior was used to collect the data. In addition, the Geriatric Oral Health Assessment Index and the Oral Health Assessment Tool for the Elderly were used. To create the Turkish version of the tool, the form was translated and back-translated for content validity. Expert opinion was obtained for criterion validity. Last, confirmatory factor analysis and exploratory factor analysis were performed to evaluate construct validity. Test-retest reliability, interobserver reliability, and Cronbach's alpha reliability coefficients were calculated. RESULTS The Tool Turkish form consisted of 10 items and two factors. The Cronbach's alpha reliability coefficient was 0.86. The total variance explained by the items was 60.19%, and the test-retest reliability coefficient was 0.95. The content validity index was 0.90, and Kendall's coefficient of concordance was 0.97. The correlation coefficient between the scales is 0.719. The mean Oral Health Assessment Tool for the Elderly score obtained by the participants was 5.4 ± 4.32 (median 5, min-max: 0-17). CONCLUSION The Turkish version of the tool is a valid and reliable tool to assess oral health in community-dwelling elderly individuals and those living in nursing homes.
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Affiliation(s)
- Fatma Zehra Genç
- Department of Public Health Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Dilek Cingil
- Department of Public Health Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Hisar
- Department of Public Health Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey
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Hussein S, Kantawalla RF, Dickie S, Suarez-Durall P, Enciso R, Mulligan R. Association of Oral Health and Mini Nutritional Assessment in Older Adults: A Systematic Review with Meta-analyses. J Prosthodont Res 2022; 66:208-220. [PMID: 34261845 DOI: 10.2186/jpr.jpr_d_20_00207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults. STUDY SELECTION For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale. RESULTS A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p<0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p<0.05). CONCLUSION These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.
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Affiliation(s)
- Sahar Hussein
- Herman Ostrow School of Dentistry of University of Southern California Los Angeles, California, USA
| | - Rifat Falak Kantawalla
- Herman Ostrow School of Dentistry of University of Southern California Los Angeles, California, USA
| | - Stephenie Dickie
- Herman Ostrow School of Dentistry of University of Southern California Los Angeles, California, USA
| | - Piedad Suarez-Durall
- Herman Ostrow School of Dentistry of University of Southern California Los Angeles, California, USA
| | - Reyes Enciso
- Herman Ostrow School of Dentistry of University of Southern California Los Angeles, California, USA
| | - Roseann Mulligan
- Herman Ostrow School of Dentistry of University of Southern California Los Angeles, California, USA
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Honeywell S, Samavat H, Touger-Decker R, Parrott JS, Hoskin E, Zelig R. Associations between Dentition Status and Nutritional Status in Community-Dwelling Older Adults. JDR Clin Trans Res 2022; 8:23800844211063859. [PMID: 35000489 DOI: 10.1177/23800844211063859] [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: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE Older adults are at higher risk of malnutrition. The aim of this study was to explore associations between nutritional status and dentition status among older adults seeking care in a dental clinic. METHODS This was a cross-sectional study of data from older adults (65-89 y) who received care at a northeastern US urban dental school clinic between June 2015 and June 2020 (N = 305). Clinical and demographic data were obtained from the electronic health record; nutritional status was determined using the Self-Mini Nutritional Assessment (Self-MNA), and odontograms and digital radiography were used to determine dental data. Adjusted multivariable models were used to explore associations between variables. RESULTS The sample was 53.8% female with a median age of 72.0 y. The median Self-MNA score was 13, reflective of normal nutritional status; 29.5% were at risk of or had malnutrition. Median numbers of teeth and posterior and anterior occluding pairs of teeth (POP, AOP) were 18.0, 2.0, and 5.0, respectively. Those with normal nutritional status had significantly more teeth, POPs, and AOPs than those at risk of or with malnutrition (P = 0.015, P = 0.015, and P = 0.039, respectively). Every additional unit increase in the number of natural or restored teeth or POP was associated with significantly lower odds of being at risk of or with malnutrition (3% and 13%, respectively). Having functional dentition was associated with 46% lower odds of being at risk of or with malnutrition. CONCLUSION This study demonstrated that older adults who had more teeth, better occlusion, and functional dentition were more likely to be of normal nutritional status than those who had less teeth, had poorer occlusion, and lacked functional dentition. Further research with larger, more diverse samples and varied measures of dentition are needed to better understand the associations between nutritional status and dentition status. KNOWLEDGE TRANSFER STATEMENT The findings from this study suggest that older adults with fewer teeth and therefore less efficient occlusion are at higher risk for malnutrition than those with more teeth and better occlusion. Health care professionals should include screening for dentition and malnutrition as part of their routine practice to identify patients who may have tooth loss and be at risk of malnutrition and refer them accordingly for interventions to optimize oral health and nutritional status.
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Affiliation(s)
- S Honeywell
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - H Samavat
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - R Touger-Decker
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
- Department of Diagnostic Sciences, School of Dental Medicine, Rutgers University, Newark, NJ, USA
| | - J S Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - E Hoskin
- Division of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - R Zelig
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
- Department of Diagnostic Sciences, School of Dental Medicine, Rutgers University, Newark, NJ, USA
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Haran JP, Ward DV, Bhattarai SK, Loew E, Dutta P, Higgins A, McCormick BA, Bucci V. The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome. Gut Microbes 2022; 13:1-15. [PMID: 33764826 PMCID: PMC8007149 DOI: 10.1080/19490976.2021.1897209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization.We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history.We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22-0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence.C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH.
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Affiliation(s)
- John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA,Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA,CONTACT John P. Haran Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA01655
| | - Doyle V. Ward
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Shakti K. Bhattarai
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ethan Loew
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amanda Higgins
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Beth A. McCormick
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vanni Bucci
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, USA
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Gennai S, Izzetti R, Pioli MC, Music L, Graziani F. Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: A systematic review and meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:328-358. [PMID: 34761419 DOI: 10.1111/jcpe.13526] [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: 02/04/2021] [Revised: 05/27/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
AIM To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health. MATERIALS AND METHODS A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data. RESULTS The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution. CONCLUSIONS Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.
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Affiliation(s)
- Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Maria C Pioli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Larisa Music
- Department of Periodontology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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10
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Moynihan P, Varghese R. Impact of Wearing Dentures on Dietary Intake, Nutritional Status, and Eating: A Systematic Review. JDR Clin Trans Res 2021; 7:334-351. [PMID: 34210202 DOI: 10.1177/23800844211026608] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION A key purpose of denture provision is to enable eating, yet the body of evidence pertaining to the impact of dentures on wide-ranging nutritional outcomes has not been systematically reviewed. OBJECTIVES To systematically review published evidence pertaining to the effect of wearing removable dental prosthesis on dietary intake, nutritional status, eating function, and eating related-quality of life (ERQoL). METHODS Eight questions relating to the impact of wearing dentures on nutritional outcomes were addressed. The target population was healthy adults aged ≥18 y. Data sources included Medline, Embase, CINAHL, and PubMed. Included were all human epidemiologic studies. The Newcastle-Ottawa score was used for appraisal of study quality. Harvest plots, vote counting, and accompanying narrative provided the basis for synthesis. RESULTS Of the 1,245 records identified, 134 were retrieved and eligibility assessed by 2 reviewers, and 41 studies were included in the synthesis (14 rated good quality, 20 fair, and 7 poor). The balance of data supported a positive impact of wearing full (5/7 studies) or partial (3/3 studies) dentures (vs. no dentures) on nutritional status, though no clear direction of effect was detected for the impact of dentures on dietary intake. The balance of data clearly showed that objective measures of eating function were compromised in full (14/15 studies) and partial (6/7 studies) denture wearers as compared with the dentate. Data showed that ERQoL was also compromised in denture wearers as compared with the dentate (3/3 studies). However, data showed a positive impact of wearing dentures on ERQoL (5/5 studies) as opposed to wearing no dentures. CONCLUSION The balance of evidence shows that despite no clear pattern on impact of wearing dentures on measured dietary intake, in those with tooth loss, wearing dentures can have a positive impact on nutritional status and enjoyment of eating. KNOWLEDGE TRANSFER STATEMENT The results of this systematic review can be used to advocate for health care services to address prosthodontic need to benefit nutritional outcomes. The findings will be of use in educating health care professionals on the impact of wearing dentures and not addressing prosthodontic need on nutritional outcomes.
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Affiliation(s)
- P Moynihan
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - R Varghese
- Glaxosmithkline Consumer Healthcare, Weybridge, UK
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11
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Suma S, Furuta M, Takeuchi K, Tomioka M, Iwasa Y, Yamashita Y. Number of teeth, denture wearing and cognitive function in relation to nutritional status in residents of nursing homes. Gerodontology 2021; 39:197-203. [PMID: 34047382 DOI: 10.1111/ger.12554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although statistical associations between tooth loss and cognitive decline have been reported, there are few previous studies on denture wearing. Additionally, it remains unclear whether nutritional status mediates this association. OBJECTIVE Our purpose was to test for the hypothesis that the association between the number of teeth and denture wearing with cognitive function is mediated by nutritional status in residents of nursing homes. MATERIALS AND METHODS We enrolled 162 participants who required long-term care (mean age: 87.7 ± 7.5 years, 26 men and 136 women) and were admitted to eight nursing homes in Fukuoka city, from September 2013 to March 2014. A trained dentist conducted dental and swallowing examinations, and the care-staff assessed nutritional status, comorbid conditions and cognitive function using the Clinical Dementia Rating (CDR). RESULTS Poisson regression analysis showed that 0-19 teeth without dentures were associated with severe cognitive impairment (CDR 3) (prevalence ratio = 2.00; 95% confidence interval: 1.13-3.55) after adjustment for sex, age, suspected swallowing dysfunction and comorbid conditions. Mediation analysis confirmed that the nutritional status as a mediator of this association (the percentage mediated effect through nutritional status was 23.1%). CONCLUSION There is an association between dental status and cognitive impairment in elder individuals, and dentures and poor nutrition are involved in this association. However, due to the cross-sectional design of this study, there is a possibility that this association is bidirectional.
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Affiliation(s)
- Shino Suma
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kenji Takeuchi
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mikiko Tomioka
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka, Japan
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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12
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[Dental treatment in old age-When and what is indicated?]. Z Gerontol Geriatr 2021; 54:517-528. [PMID: 33900419 DOI: 10.1007/s00391-021-01893-9] [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: 12/23/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
In the past few years the oral health of seniors has improved and more seniors retain their natural teeth until old age; however, the prevalence of oral diseases among seniors is still very high and a serious problem. Good oral health is, however, relevant for seniors as it influences the chewing function, the nutritional status and general satisfaction. In addition, diseases of the oral cavity show interactions with general health. The current article therefore provides an evidence-based overview of the oral health of seniors and highlights important relationships (nutritional status, oral health-related quality of life, general health). It also gives advice on when dental treatment may be indicated. Furthermore, instruments for assessing oral health, chewing function and oral health-related quality of life are presented and explained.
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13
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Haran JP, McCormick BA. Aging, Frailty, and the Microbiome-How Dysbiosis Influences Human Aging and Disease. Gastroenterology 2021; 160:507-523. [PMID: 33307030 PMCID: PMC7856216 DOI: 10.1053/j.gastro.2020.09.060] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
The human gut microbiome is a collection of bacteria, protozoa, fungi, and viruses that coexist in our bodies and are essential in protective, metabolic, and physiologic functions of human health. Gut dysbiosis has traditionally been linked to increased risk of infection, but imbalances within the intestinal microbial community structure that correlate with untoward inflammatory responses are increasingly recognized as being involved in disease processes that affect many organ systems in the body. Furthermore, it is becoming more apparent that the connection between gut dysbiosis and age-related diseases may lie in how the gut microbiome communicates with both the intestinal mucosa and the systemic immune system, given that these networks have a common interconnection to frailty. We therefore discuss recent advances in our understanding of the important role the microbiome plays in aging and how this knowledge opens the door for potential novel therapeutics aimed at shaping a less dysbiotic microbiome to prevent or treat age-related diseases.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine; Department of Microbiology and Physiological Systems; Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Beth A McCormick
- Department of Microbiology and Physiological Systems; Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts
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14
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Zelig R, Goldstein S, Touger-Decker R, Firestone E, Golden A, Johnson Z, Kaseta A, Sackey J, Tomesko J, Parrott JS. Tooth Loss and Nutritional Status in Older Adults: A Systematic Review and Meta-analysis. JDR Clin Trans Res 2020; 7:4-15. [PMID: 33345687 DOI: 10.1177/2380084420981016] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/OBJECTIVE Older adults are at risk for tooth loss and compromised nutritional status. Our objective was to conduct a systematic review and meta-analysis to answer the following question: Among adults aged ≥60 y living in developed countries, what are the associations between tooth loss and nutritional status as assessed by a validated nutrition screening or assessment tool? METHODS PRISMA guidelines were followed. PubMed, Scopus, CINAHL, Web of Science, and MEDLINE were searched for studies published in English between 2009 and 2019 that met inclusion criteria. Data extracted included study and participant characteristics, dentition, and nutritional status. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. Random effects meta-analysis was used. RESULTS Of the 588 unduplicated articles identified, 78 were reviewed in full text, and 7 met inclusion criteria. Six studies were combined for a meta-analysis, which revealed that individuals who were completely edentulous or who lacked functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished, as compared with those who were dentulous or had functionally adequate dentition (risk ratio, 1.21; 95% CI, 1.11 to 1.32; I2 = 70%). Whether the article statistically adjusted for medical history explained most of the heterogeneity in the pooled effect. CONCLUSIONS AND IMPLICATIONS Findings suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Use of validated tools to assess risk of malnutrition in older adults with tooth loss is important to promote early intervention and referral to optimize nutrition and oral health status. Findings were limited by heterogeneity, risk of bias, and overall quality of the studies reviewed. Cohort studies that adjust for known confounders and use consistent approaches to assess tooth loss and nutritional status are needed. KNOWLEDGE TRANSFER STATEMENT The results of this study suggest that older adults with tooth loss are at greater risk of malnutrition than those with functionally adequate dentition. Screening of this population for malnutrition by health care professionals, including dentists and dietitians, may result in corresponding referrals to optimize nutrition and oral health status. Further research is needed with consistent approaches to assess tooth loss and nutritional status.
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Affiliation(s)
- R Zelig
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA.,Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - S Goldstein
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - R Touger-Decker
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA.,Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - E Firestone
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - A Golden
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - Z Johnson
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - A Kaseta
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - J Sackey
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - J Tomesko
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - J S Parrott
- Department of Interdisciplinary Studies, Rutgers School of Health Professions, Newark, NJ, USA
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15
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Lee YJ, Lee HKH. The association between oral health and food avoidance among older adults in the United States. PUBLIC HEALTH IN PRACTICE 2020; 1:100011. [PMID: 36101684 PMCID: PMC9461514 DOI: 10.1016/j.puhip.2020.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives This study examines the association between oral health and food avoidance among older adults in the United States. Study design A population-based sample of 1,278 adults aged 51+ from the Health and Retirement Study was used. A logistic regression model was performed to evaluate various oral health conditions and food avoidance behavior among older adults. Results were quantified as odds ratios (OR). Results This study found a significant association between oral health and food avoidance in older adults. Individuals with teeth loss, poor self-rated oral health, and teeth or gum sensitivity experienced more food avoidance. Conclusions Geriatric health care professionals assessing older adults’ well-being can be informed by this study outcome to consider oral health as a potential risk factor for food avoidance. This study can inform policymakers to develop oral health promotion programs and goals for older adults, and also consider nutritional support for older adults with negative oral health conditions. Oral health condition is associated with food avoidance among older adults. Geriatric health care professionals can consider oral health as a potential risk/protective factor for food avoidance. Oral health promotion programs need to consider nutritional support for older adults with negative oral health conditions.
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Affiliation(s)
- Yeonjung Jane Lee
- University of Hawaiʻi at Mānoa, Myron B. Thompson School of Social Work, United States
- Corresponding author.
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16
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Sinclair AJ, Dunning T, Dhatariya K. Clinical guidelines for type 1 diabetes mellitus with an emphasis on older adults: an Executive Summary. Diabet Med 2020; 37:53-70. [PMID: 31498912 DOI: 10.1111/dme.14135] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
Abstract
We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high-quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of 'general' recommendations followed by 'specific' recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self-management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self-management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis.
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Affiliation(s)
- A J Sinclair
- Kings College, London, UK
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
| | | | - K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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17
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Wong FMF, Ng YTY, Leung WK. Oral Health and Its Associated Factors Among Older Institutionalized Residents-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214132. [PMID: 31717812 PMCID: PMC6861909 DOI: 10.3390/ijerph16214132] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
The oral health of an ageing population, especially that of the institutionalized elderly population, constitutes a significant concern because it is closely linked to general health and the quality of life. Shared common risk factors drive the development and worsening of poor oral health and non-communicable diseases, which eventually lead to self-care inability. Several studies have reported on the poor oral health of the institutionalized elderly population. However, few comprehensive reports exist regarding the relationship between poor oral health, the oral health-related quality of life (OHRQoL) and the associated factors in this specific population. Objective: The objective is to describe recently reported oral health levels, the OHRQoL and the associated factors among older institutional residents. Methods: Studies published between July 2009 and June 2019 in MEDLINE, EMBASE and CINAHL were searched. The population, intervention, comparison and outcome (PICO) strategy was used as a guide. The reported factors related to poor oral health were identified (i.e., age, gender, educational level, acquired systemic conditions or dementia/cognitive impairment). Results: Twenty-five surveys (or study series) from 19 countries were included. The level of evidence reported by these studies was generally moderate to strong. The reported oral cleanliness and health of the surveyed institutionalized elderly were poor (>50% of residents had calculus; denture hygiene index > 80%). Gum (approximately 30% of dentate residents had moderate to severe periodontitis), teeth (decayed, missing or filled teeth >20), mucosa (>10% had mucosal lesions) and denture problems (up to 40%) were prevalent and were associated with a poor OHRQoL, especially in females, socially deprived residents or those with mild or above cognitive impairment. Those with a poor OHRQoL might show signs of poor nutrition. Conclusions: This report reviewed evidence-based knowledge on oral health, the OHRQoL and the associated factors among elderly institutional residents. Further research is needed to confirm these observations. For improved oral health, a better OHRQoL and the general well-being of older residents, clinical trials are needed, targeting modifiable factors, such as social inequality, oral healthcare accessibility, and/or nursing home service quality. The relationship between oral health, the OHRQoL and nutrition in this at-risk population also warrants exploration.
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Affiliation(s)
- Florence M. F. Wong
- School of Nursing, Tung Wah College, Hong Kong SAR, China
- Correspondence: ; Tel.: +852-3468-6838
| | - Yannies T. Y. Ng
- North District Hospital, Hospital Authority, Hong Kong SAR, China;
| | - W. Keung Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China;
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18
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Alzheimer's Disease Microbiome Is Associated with Dysregulation of the Anti-Inflammatory P-Glycoprotein Pathway. mBio 2019; 10:mBio.00632-19. [PMID: 31064831 PMCID: PMC6509190 DOI: 10.1128/mbio.00632-19] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies of the intestinal microbiome and AD have demonstrated associations with microbiome composition at the genus level among matched cohorts. We move this body of literature forward by more deeply investigating microbiome composition via metagenomics and by comparing AD patients against those without dementia and with other dementia types. We also exploit machine learning approaches that combine both metagenomic and clinical data. Finally, our functional studies using stool samples from elders demonstrate how the c microbiome of AD elders can affect intestinal health via dysregulation of the P-glycoprotein pathway. P-glycoprotein dysregulation contributes directly to inflammatory disorders of the intestine. Since AD has been long thought to be linked to chronic bacterial infections as a possible etiology, our findings therefore fill a gap in knowledge in the field of AD research by identifying a nexus between the microbiome, loss of intestinal homeostasis, and inflammation that may underlie this neurodegenerative disorder. The microbiota-gut-brain axis is a bidirectional communication system that is poorly understood. Alzheimer’s disease (AD), the most common cause of dementia, has long been associated with bacterial infections and inflammation-causing immunosenescence. Recent studies examining the intestinal microbiota of AD patients revealed that their microbiome differs from that of subjects without dementia. In this work, we prospectively enrolled 108 nursing home elders and followed each for up to 5 months, collecting longitudinal stool samples from which we performed metagenomic sequencing and in vitro T84 intestinal epithelial cell functional assays for P-glycoprotein (P-gp) expression, a critical mediator of intestinal homeostasis. Our analysis identified clinical parameters as well as numerous microbial taxa and functional genes that act as predictors of AD dementia in comparison to elders without dementia or with other dementia types. We further demonstrate that stool samples from elders with AD can induce lower P-gp expression levels in vitro those samples from elders without dementia or with other dementia types. We also paired functional studies with machine learning approaches to identify bacterial species differentiating the microbiome of AD elders from that of elders without dementia, which in turn are accurate predictors of the loss of dysregulation of the P-gp pathway. We observed that the microbiome of AD elders shows a lower proportion and prevalence of bacteria with the potential to synthesize butyrate, as well as higher abundances of taxa that are known to cause proinflammatory states. Therefore, a potential nexus between the intestinal microbiome and AD is the modulation of intestinal homeostasis by increases in inflammatory, and decreases in anti-inflammatory, microbial metabolism.
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Fujiwara A, Minakuchi H, Uehara J, Miki H, Inoue‐Minakuchi M, Kimura‐Ono A, Nawachi K, Maekawa K, Kuboki T. Loss of oral self‐care ability results in a higher risk of pneumonia in older inpatients: A prospective cohort study in a Japanese rural hospital. Gerodontology 2019; 36:236-243. [DOI: 10.1111/ger.12402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/01/2019] [Accepted: 02/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Aya Fujiwara
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Hajime Minakuchi
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | | | - Haruna Miki
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Mami Inoue‐Minakuchi
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Aya Kimura‐Ono
- Center for Innovative Clinical Medicine Okayama University Hospital Okayama Japan
| | - Kumiko Nawachi
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kenji Maekawa
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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Madeira T, Peixoto-Plácido C, Sousa-Santos N, Santos O, Alarcão V, Goulão B, Mendonça N, Nicola PJ, Yngve A, Bye A, Bergland A, Amaral TF, Lopes C, Gorjão Clara J. Malnutrition among older adults living in Portuguese nursing homes: the PEN-3S study. Public Health Nutr 2018; 22:1-12. [PMID: 30319081 PMCID: PMC10260583 DOI: 10.1017/s1368980018002318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/30/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes. DESIGN Cross-sectional study. Data on demographic and socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, loneliness feelings and functional status were collected by trained nutritionists through a computer-assisted face-to-face structured interview followed by standardised anthropometric measurements. Logistic regression was used to identify factors associated with being at risk of malnutrition/malnourished. SETTING Portuguese nursing homes. SUBJECTS Nationally representative sample of the Portuguese population aged 65 years or over living in nursing homes. RESULTS A total of 1186 individuals (mean age 83·4 years; 72·8 % women) accepted to participate. According to the Mini Nutritional Assessment, 4·8 (95 % CI 3·2, 7·3) % were identified as malnourished and 38·7 (95 % CI 33·5, 44·2) % were at risk of malnutrition. These percentages increased with age and were significantly higher for women. Logistic regression showed (OR; 95 % CI) that older adults reporting no or little appetite (6·5; 2·7, 15·3), those revealing symptoms of depression (2·6; 1·6, 4·2) and those who were more dependent in their daily living activities (4·7; 2·0, 11·1) were also at higher odds of being malnourished or at risk of malnutrition. CONCLUSIONS Malnutrition and risk of malnutrition are prevalent among nursing home residents in Portugal. It is crucial to routinely screen for nutritional disorders, as well as risk factors such as symptoms of depression and lower functional status, to prevent and treat malnutrition.
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Affiliation(s)
- Teresa Madeira
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Peixoto-Plácido
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Nuno Sousa-Santos
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Osvaldo Santos
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Violeta Alarcão
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Beatriz Goulão
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nuno Mendonça
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Paulo Jorge Nicola
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Agneta Yngve
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Asta Bye
- OsloMet – Oslo Metropolitan University, Oslo, Norway
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Teresa F Amaral
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Carla Lopes
- EPIUnit – Institute of Public Health, University of Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Gorjão Clara
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Chatindiara I, Allen J, Popman A, Patel D, Richter M, Kruger M, Wham C. Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission. BMC Geriatr 2018; 18:78. [PMID: 29562879 PMCID: PMC5863453 DOI: 10.1186/s12877-018-0771-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/16/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Malnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission. METHODS A cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool. RESULTS Among 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97-0.99)], low body mass index [kg/m2: 1.02 (1.02-1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00-1.02)] and decline in cognition [MoCA score: 1.01 (1.00-1.02)] as significant predictors of malnutrition risk in older adults at hospital admission. CONCLUSION Among older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.
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Affiliation(s)
- Idah Chatindiara
- School of Food and Nutrition, Massey University, Auckland, New Zealand.
| | - Jacqueline Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Amy Popman
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Darshan Patel
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Marilize Richter
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Marlena Kruger
- School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Carol Wham
- School of Food and Nutrition, Massey University, Auckland, New Zealand
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22
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Yamaguchi K, Tohara H, Hara K, Nakane A, Kajisa E, Yoshimi K, Minakuchi S. Relationship of aging, skeletal muscle mass, and tooth loss with masseter muscle thickness. BMC Geriatr 2018. [PMID: 29519234 PMCID: PMC5844127 DOI: 10.1186/s12877-018-0753-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Previous studies have reported a relationship between masseter muscle thickness and tooth loss or limb muscle thickness. However, it is not yet known whether masseter muscle thickness is related to appendicular skeletal muscle mass, and grip strength. The purpose of this study was to determine which of the two variables—tooth loss or appendicular skeletal muscle mass index—is more strongly related to masseter muscle thickness, and to identify a suitable indicator of decreasing masseter muscle thickness in healthy elderly individuals. Methods Grip strength, walking speed, body weight, skeletal muscle mass index, tooth loss, and masseter muscle thickness at rest and during contraction were determined in 97 community-dwelling elderly individuals aged ≥65 years (men: 44, women: 53). Masseter muscle thickness was chosen as the dependent variable, while age, skeletal muscle mass index, body weight, grip strength, and tooth loss were chosen as the independent variables. Multiple regression analysis was conducted using the stepwise regression method. Results In men, grip strength was the only independent predictor of masseter muscle thickness at rest. Tooth loss and grip strength were independent predictor of masseter muscle thickness during contraction. In women, tooth loss was the independent predictor of masseter muscle thickness both at rest and during contraction, while grip strength and body weight were the independent predictor of masseter muscle thickness at rest only. Conclusions We confirmed that in healthy elderly individuals, tooth loss has a stronger relationship with masseter muscle thickness than aging and skeletal muscle mass index do. Masseter muscle thickness in both elderly men and women is also associated with grip strength, suggesting that grip strength can be used as an indicator of masseter muscle thickness in this population.
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Affiliation(s)
- Kohei Yamaguchi
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Haruka Tohara
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Koji Hara
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Ayako Nakane
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Eriko Kajisa
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kanako Yoshimi
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Tokyo Medical and Dental University, 1-5-45 yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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23
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Nykänen I, Törrönen R, Schwab U. Dairy-Based and Energy-Enriched Berry-Based Snacks Improve or Maintain Nutritional and Functional Status in Older People in Home Care. J Nutr Health Aging 2018; 22:1205-1210. [PMID: 30498827 DOI: 10.1007/s12603-018-1076-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Consumption of energy- and nutrient-dense snacks are recommended for older people to maintain adequate nutrition. We evaluated the effects of dairy-based and energy-enriched berry products consumed as snacks on nutritional and functional status among vulnerable older people receiving home care services. DESIGN Randomised controlled study. SETTING AND PARTICIPANTS The study sample consisted of 85 home care clients, with mean age of 81.9 (SD 7.1) years in the intervention group (n=50) and 83.7 (SD 8.1) years in the control group (n=35), and 72% women in both groups. INTERVENTION In the intervention group, the participants consumed both high-protein dairy-based products and energy-enriched berry purées for three months. The snack products provided nearly 300 kcal and 14 g protein per day. MEASUREMENTS The Mini Nutritional Assessment (MNA), body mass index (BMI), mid-arm muscular area (MAMA) and concentrations of plasma albumin and prealbumin and blood haemoglobin were used to determine nutritional status, and handgrip strength was used to determine functional status at baseline and after the intervention. RESULTS After adjustment for age and gender, the intervention showed a significant effect on MNA scores (2.1, 95% [CI]: 1.0 to 3.3) (p=0.003), albumin concentration (2.0 g/L, 95% [CI]: 1.1 to 3.2) (p=0.006) and handgrip strength of the right hand in women (2.4 kg, 95% [CI]: 1.2 to 3.3) (p=0.007). The MNA scores improved in the intervention group, while albumin concentration and handgrip strength decreased in the control group. CONCLUSIONS Regular use of dairy- and energy-enriched berry-based snacks may improve or maintain nutritional and functional status among older people in home care.
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Affiliation(s)
- I Nykänen
- Irma Nykänen, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland Phone: +358 40 355 2991, Fax: +358 17 162 131, E-mail:
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24
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Haran JP, Bucci V, Dutta P, Ward D, McCormick B. The nursing home elder microbiome stability and associations with age, frailty, nutrition and physical location. J Med Microbiol 2017; 67:40-51. [PMID: 29134939 DOI: 10.1099/jmm.0.000640] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The microbiome from nursing home (NH) residents is marked by a loss in diversity that is associated with increased frailty. Our objective was to explore the associations of NH environment, frailty, nutritional status and residents' age to microbiome composition and potential metabolic function. METHODOLOGY We conducted a prospective longitudinal cohort study of 23 residents, 65 years or older, from one NH that had four floors: two separate medical intensive floors and two floors with active elders. Residents were assessed using the mini nutritional assessment tool and clinical frailty scale. Bacterial composition and metabolic potential of residents' stool samples was determined by metagenomic sequencing. We performed traditional unsupervised correspondence analysis and linear mixed effect modelling regression to assess the bacteria and functional pathways significantly affected by these covariates.Results/Key findings. NH resident microbiomes demonstrated temporal stability (PERMANOVA P=0.001) and differing dysbiotic associations with increasing age, frailty and malnutrition scores. As residents aged, the abundance of microbiota-encoded genes and pathways related to essential amino acid, nitrogenous base and vitamin B production declined. With increasing frailty, residents had lower abundances of butyrate-producing organisms, which are associated with increased health and higher abundances of known dysbiotic species. As residents became malnourished, butyrate-producing organisms declined and dysbiotic bacterial species increased. Finally, the microbiome of residents living in proximity shared similar species and, as demonstrated for Escherichia coli, similar strains. CONCLUSION These findings support the conclusion that a signature 'NH' microbiota may exist that is affected by the residents' age, frailty, nutritional status and physical location.
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Affiliation(s)
- John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vanni Bucci
- Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Biology, University of Massachusetts Dartmouth, Dartmouth, MA, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Doyle Ward
- Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Beth McCormick
- Center for Microbiome Research, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
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25
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Lecerf JM, Dalle B, Padol J, Berthier C, Jaruga A, Jozeau P, Herault S, Deparis F. Une formule de repas du soir contre la sous-nutrition en EHPAD. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.06.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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26
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Abstract
Alterations in nutritional status are common and can be associated with increased morbidity and mortality. However, for healthcare providers, the definition of malnutrition is vague, insensitive, and poorly standardized. In contrast, nutrition risk is more easily defined, and recognizes that both poor nutritional status and disease severity contribute to increased morbidity and mortality. Clinicians need to identify patients who may already have evidence of nutrient deficiencies or have disease processes that affect nutrition risk. This article reviews risk assessment tools and provides practical tips to screen patients and identify those whose nutrition risk warrants specialized nutrition therapy.
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Affiliation(s)
- Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40292, USA
| | - Stephen A McClave
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40292, USA.
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27
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Hurree N, Jeewon R. An Analysis of Contributors to Energy Intake Among Middle Aged and Elderly Adults. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE JOURNAL 2016. [DOI: 10.12944/crnfsj.4.special-issue-elderly-november.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Adulthood and middle age is widely recognized as the time of life when unhealthy eating habits may develop. Data from various studies have demonstrated that changes in eating habits may also occur during old age. It is essential to acknowledge that a high consumption of certain food groups such as sweetened beverages, meat and eggs may contribute to an increased energy intake. This obviously results in high body mass index (BMI) and consequently an increased risk of non-communicable diseases (NCDs) and obesity. Energy intake among middle aged and elderly individuals may be influenced by socio demographic factors (for example: age, gender, socio economic status), social factors (for example: marital status), environmental factors like access to food commodities as well as nutrition knowledge and physical activity level. The present review highlights eating habits, contribution of specific food groups to energy intake and the influence of several factors on energy intake among the middle aged and elderly population.
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Affiliation(s)
- Natasha Hurree
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Rajesh Jeewon
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
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