Nutritional status of Irish older people in receipt of meals-on-wheels and the nutritional content of meals provided

Transcriptome analysis reveals the main metabolic pathway of c-GMP induced by salt stress in tomato (Solanum lycopersicum) seedlings

Tomato (Solanum lycopersicum L.) is a model crop as well as an important food worldwide. In arid areas, increasing soil salinity has limited higher yields in tomato production. As a second messenger molecule, cyclic guanosine monophosphate (c-GMP) plays an indispensable role in plant response to salt stress by regulating cell processes to promote plant growth and development. However, this mechanism has not been fully explored in tomato seedlings. In this experiment, tomato seeds were cultured in four treatments: (1) distilled water (CK); (2) 20μM c-GMP (T1); (3) 50mM NaCl (T2); and (4) 20μM c-GMP+50mM NaCl (T3). The results show that 20μM c-GMP effectively alleviated the inhibitory effect of 50mM NaCl on growth and development, and induced the expression of 1580 differentially expressed genes (DEGs). Seedlings in the CK vs T1 shared 95 upregulated and 442 downregulated DEGs, whereas T2 vs T3 shared 271 upregulated and 772 downregulated DEGs. Based on KEGG (Kyoto Encyclopaedia of Genes and Genomes) analysis, the majority of DEGs were involved in metabolism; exogenous c-GMP induced significant enrichment of pathways associated with carbohydrates, phenylpropanoids and fatty acid metabolism. Most PMEs , acCoA , PAL , PODs , FADs , and AD were upregulated, and GAPDHs , PL , PG , BXL4 , and β-G were downregulated, which reduced susceptibility of tomato seedlings to salt and promoted their salt tolerance. The application of c-GMP increased soluble sugar, flavonoid and lignin contents, reduced accumulation of malondialdehyde (MDA), and enhanced the activity of peroxidase (POD). Thus, our results provide insights into the molecular mechanisms associated with salt tolerance of tomato seedlings.

Prevalence of malnutrition risk among older French adults with culinary dependence

OBJECTIVE

The term 'culinary dependence' denotes a situation in which someone delegates all or part of their daily meal-related activities to a third party. The present study aimed to explore nutritional risk among older people (≥65 years) with culinary dependence.

METHOD

The first survey included 559 people either living at home without help, with help unrelated to food activities, with help related to food activities or living in nursing home. The second survey included 319 people with food help provided by a caregiver, by meals-on-wheels or by a nursing home. Nutritional status was assessed with the Mini-Nutritional Assessment. Sociological background and wellness variables (health, cognitive and mental status) were collected.

RESULTS

The first survey found a strong association between culinary dependence and nutritional risk. About half of the people who delegated their food-related activities were malnourished or at risk of malnutrition compared with only 4% for people with no help and 12% for people with help unrelated to food activity. According to the second survey, this prevalence varied slightly depending on who the tasks were delegated to (46% for those who had the support of a caregiver; 60% for those who used a meals-on-wheels service; 69% for those living in nursing home). According to multivariate analyses, dependence categories, depressive symptoms and cognitive status were identified as independent determinants of malnutrition.

CONCLUSION

Without inferring a causal relationship between dependence and malnutrition, there is a strong need for care structures to take into account the issue of malnutrition when developing services targeting older people.

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review

Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.

The views, experiences and expectations of Australian Meals on Wheels customers: A national survey

OBJECTIVE

To investigate views and expectations of Australian Meals on Wheels (MOW) customers to inform the development of National Meal Guidelines and improve current services.

METHODS

A survey was designed through literature review and consultations with key stakeholders. National convenience sampling returned  337 surveys. Descriptive statistics and chi-squared analyses were applied to the survey data.

RESULTS

Meals on Wheels customers reported satisfaction with their current service, with the meal itself found to be the most valuable aspect. People living in small country towns were more likely to value the social contact provided by MOW than those in major cities (P = .001). Delivery of pantry items was the most popular additional option for future services.

CONCLUSION

Valuable information for inclusion in the development of the National Meal Guidelines was provided: nutritional content of meals, meal variety, packaging and presentation, opportunities for nourishing snacks and pantry items, and social contact.

Tracking and treating malnutrition: a retrospective observational study of the nutritional status of vulnerable people accessing a meals-on-wheels (MOW) service

AIM

The aims of the study were to describe the characteristics of meals-on-wheels (MOW) recipients, including prevalence of malnutrition amongst those who have received input from the Nutrition and Wellbeing Service (NWS) and to explore whether the NWS had an impact on the nutritional status (malnutrition risk) of recipients over time.

BACKGROUND

Support services, for example, MOW, play an important role in the prevention and treatment of malnutrition in the community. In the UK, MOW services are under threat. However, little is known about how they support the health and well-being of older people. This study reports on the characteristics of MOW recipients and investigates change in nutritional status over time.

METHODS

A retrospective study of MOW recipients of nutritional concern who were offered a check through the NWS was conducted. Demographic, social and health information were gathered at the initial visit. Nutritional status (risk of malnutrition) was obtained using the validated Malnutrition Universal Screening Tool (MUST), at the initial and subsequent visits. Changes over time were investigated for recipients receiving at least two follow-up visits.

FINDINGS

An initial visit was made to 399 MOW recipients, and 148 recipients had two or more follow-up visits. At initial screening, 177 (44%) of recipients were at medium or high risk of malnutrition. Frailty was significantly related to malnutrition risk (P = 0.049). At follow-up, there was a reduction in malnutrition risk.

CONCLUSIONS

The MOW service was associated with a reduction in malnutrition risk. By offering well-being visits within a MOW service, malnutrition can be identified early. Future studies into how MOW services might delay or prevent the need for support from acute health services and social care are warranted.

Evaluating the Effect of a Home-Delivered Meals Service on the Physical and Psychological Wellbeing of a UK Population of Older Adults - A Pilot and Feasibility Study

We evaluated the effectiveness of a 3-week, daily meal provision service by a non-profit provider on the physical and psychological wellbeing of an older adult population. We further examined the feasibility of carrying out such measures in participant's homes. 19 older adult participants (8M, 11F; 78.3 ± 8.7 years) received 3 meals per day for 21 days and supplemented these meals ad libitum. Risk of malnutrition (Mini Nutritional Assessment; MNA) body composition, blood pressure, handgrip strength, balance, mobility, loneliness, social capital, satisfaction with life and mood were evaluated in participant's homes before and after the intervention. Following the intervention, MNA score increased significantly and participants rated themselves as significantly less depressed. We describe a methodology that was largely feasible and outline ways in which it could be improved. We have demonstrated that even short-term, home meal deliveries improve MNA scores and can positively alter some measures of mood.

Serve Size and Estimated Energy and Protein Contents of Meals Prepared by 'Meals on Wheels' South Australia Inc.: Findings from a Meal Audit Study

An audit of ‘standard’ (STD) and ‘energy and protein fortified’ (HEHP) meals from Meals on Wheels (MOW) South Australia’s summer menu was conducted to evaluate the consistency, and serve size and nutrient contents, of their menu items. Twenty soups, 20 mains and 20 desserts from each of the STD and HEHP menus were prepared at the MOW South Australia’s kitchen and delivered to three ‘sham(dummy)-clients’ over a 5-week period. Each meal component was weighed in triplicate, to the nearest gram, the variation within the serve weight was calculated, and the overall energy and protein content of each meal was determined using FoodWorks (Xyris Software, Highgate Hill, Queensland, Australia). On average, the variability for soups and mains was ≤6% and for desserts was ≤10% and although the measured serve sizes of the MOW meals were consistently smaller than prescribed serve size, the differences were minor. As a percentage of recommended daily intakes (RDIs) for adults aged over 60 years, we calculated that the STD meals contained 21–39% for energy and 42–63% for protein while the HEHP meals contained 29–55% for energy and 46–69% for protein. These findings demonstrate that MOW meals currently meet the voluntary meal guidelines for energy and protein.

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review

Participation in home-delivered meals programs may contribute to the health and independence of older adults living in the community, especially those who are food insecure or those who are making transitions from acute, subacute, and chronic care settings to the home. The purpose of this study was to conduct a comprehensive and systematic review of all studies related to home-delivered meals in order to shed light on the state of the science. A complete review of articles appearing in PubMed using the keyword "Meal" was conducted; and titles, abstracts, and full-texts were screened for relevance. Included in this review are 80 articles. Most studies are descriptive and do not report on outcomes. Frequently reported outcomes included nutritional status based on self-reported dietary intake. Additionally, most studies included in this review are cross-sectional, have a small sample size, and/or are limited to a particular setting or participant population. More rigorous research is needed to (1) gain insight into why so few eligible older adults access home-delivered meals programs, (2) support expansion of home-delivered meals to all eligible older adults, (3) better identify what home-delivered meals models alone and in combination with other services works best and for whom, and (4) better target home-delivered meals programs where and when resources are scarce.

Impact of home-delivered meal programs on diet and nutrition among older adults: a review

BACKGROUND

Poor diet quality and insufficient nutrient intake is of particular concern among older adults. The Older Americans Act of 1965 authorizes home-delivered meal services to homebound individuals aged 60 years and older.

OBJECTIVE

The purpose of this study was to review scientific evidence on the impact of home-delivered meal services on diet and nutrition among recipients.

METHODS

Keyword and reference searches were conducted in Cochrane Library, Google Scholar, PubMed and Web of Science. Inclusion criteria included: study design (randomized controlled trials, cohort studies, pre-post studies, or cross-sectional studies); main outcome (food and nutrient intakes); population (home-delivered meal program participants); country (US); language (articles written in English); and article type (peer-reviewed publications or theses).

RESULTS

Eight studies met the inclusion criteria, including two randomized controlled trial studies (from the same intervention), one cohort study, two pre-post studies, and three cross-sectional studies. All but two studies found home-delivered meal programs to significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Other beneficial outcomes include increased socialization opportunities, improvement in dietary adherence, and higher quality of life.

CONCLUSIONS

Home-delivered meal programs improve diet quality and increase nutrient intakes among participants. These programs are also aligned with the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults maintain independence and remain in their homes and communities as their health and functioning decline.

"It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients

OBJECTIVES

Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia.

PARTICIPANTS

A convenience sample of 12 MOW clients.

INTERVENTION

Participants received snacks five times a week, in addition to their usual MOW order, for four weeks.

MEASUREMENTS

Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients' homes were digitally recorded, transcribed verbatim, and themes identified.

RESULTS

Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477) /day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as 'malnourished' or 'at risk of malnutrition' decreased from 17% to 8%, and 67% to 25%, respectively (P <0.05). Mean body weight increased from 67.1 (±14.3) to 67.8 (±14.8) (P= 0.008), while Body Mass Index (BMI) increased by a mean of 0.78 (±1.16) kg/m2 (P = 0.039). Only half of participants indicated interest in continuing with the program. Reasons included the role of snacks serving as a reminder to eat, as well as their perceived nutritional value. Identified barriers included perceived lack of need for additional food, ability to self-provide such items, and a perceived adequate health status.

CONCLUSION

Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.

Hospital admissions in poorly nourished, compared with well-nourished, older South Australians receiving 'Meals on Wheels': findings from a pilot study

AIM

To evaluate whether 'Meals on Wheels' (MOW) improves health and reduces hospital admissions in poorly nourished (PN) older people.

METHODS

Two hundred and fifty older South Australians were retrospectively classified: (i) PN (MNA score <24) receiving MOW (MOW PN); (ii) PN not receiving MOW (non-MOW PN); and (iii) well-nourished (WN). Data regarding their health were compared.

RESULTS

Health outcomes at baseline for MOW PN and non-MOW PN were not different, but both were worse than the WN. Over 12 months, weight loss was ∼2-3 times greater in both PN than WN groups. Hospital admissions were not different for MOW PN compared with non-MOW PN and WN, but non-MOW PN had 2.9 as many admissions and spent 5 days more in hospital than WN (all Ps < 0.05).

CONCLUSION

Providing MOW to nutritionally vulnerable older people may not prevent age-related decline in health, although a potential reduction in hospital admissions warrants investigation.

The cost associated with disease-related malnutrition in Ireland

Objective

The present study aimed to establish the annual public expenditure arising from the health and social care of patients with diet-related malnutrition (DRM) in the Republic of Ireland.

Design

Costs were calculated by (i) estimating the prevalence of DRM in health-care settings derived from age-standardised comparisons between available Irish data and large-scale UK surveys and (ii) applying relevant costs from official sources to estimates of health-care utilisation by adults with DRM. No attempt has been made to estimate separately the costs of DRM and any associated disease, since each can be a cause or consequence of the other. The methods used are adapted from an evaluation of the cost of malnutrition in the UK by the British Association for Parenteral and Enteral Nutrition (2009).

Settings

Hospitals, nursing homes, out-patient clinics, primary-care clinics and home care.

Subjects

All adult patients receiving hospital in-patient, out-patient or specified community health-care services.

Results

The annual public health and social care cost associated with adult malnourished patients in Ireland is estimated at over €1·4 billion, representing 10 % of the health-care budget. Most of this cost arises in acute hospital or residential care settings (i.e. 70 %), with nutritional support estimated to account for <3 % of spend.

Conclusions

The cost associated with the care of patients with DRM is substantial and may rise as the proportion of older people within the population increases, a group at increased risk of DRM. Despite growing pressure on health-care budgets, little attention has been focused on the economic burden associated with DRM in Ireland or the potential for savings arising from improved detection and treatment of those at risk.

Mini nutritional assessment

PURPOSE OF REVIEW

To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA).

RECENT FINDINGS

Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving.

SUMMARY

The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.