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Soós R, Bakó C, Gyebrovszki Á, Gordos M, Csala D, Ádám Z, Wilhelm M. Nutritional Habits of Hungarian Older Adults. Nutrients 2024; 16:1203. [PMID: 38674893 PMCID: PMC11053580 DOI: 10.3390/nu16081203] [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: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
There are many nutritional changes that come with aging, mostly as consequences of health regression. Malnutrition and overweight often start with inadequate food consumption, followed by alterations in biochemical indices and body composition. In our study, we aimed to analyze the feeding habits and energy and nutrient intake of a Hungarian elderly population, focusing on macronutrient, water, fruit, and vegetable consumption while searching for possible nutritional factors leading to NCD and many other chronic diseases in this population. Two questionnaires were used. These were the Mini Nutritional Assessment (MNA) and one asking about nutritional habits, and a 3-day feeding diary was also filled. Subjects (n = 179, 111; females (F), 68 males (M), older than 50 years were recruited. Based on MNA results, 78 adults (43.57% of the studied population) were malnourished or at risk of malnutrition, although, according to BMI categories, 69% were overweight and 7.3% were obese among M, while 42.3% were overweight among F. The average daily meal number was diverse. The amount of people consuming fruit (11.7%) and vegetables (8.93%) several times a day was extremely low (15.3% of F and 4.4% of M). Daily fruit consumption in the whole sample was 79.3%. Overall, 36.3% consumed 1 L of liquid and 0.5 L of consumption was found in 15.1% of participants. A significant gender difference was found in water consumption, with F drinking more than M (p ≤ 0.01). In our sample, 27.93% of the respondents took dietary supplements. Further analysis and research are needed to explore the specific health implications of and reasons behind these findings.
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Affiliation(s)
- Rita Soós
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Csilla Bakó
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
| | - Ádám Gyebrovszki
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Mónika Gordos
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Dávid Csala
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Zoltán Ádám
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, University of Pécs, 7624 Pécs, Hungary;
- Wnt-Signaling Research Group, Szentagothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Márta Wilhelm
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
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Vivian GK, da Silva RO, Santos ACA, Hastreiter AA, Dias CC, Makiyama EN, Borelli P, de Oliveira Rodrigues C, Fock RA. The interaction between aging and protein malnutrition modulates peritoneal macrophage function: An experimental study in male mice. Exp Gerontol 2023; 171:112025. [PMID: 36372284 DOI: 10.1016/j.exger.2022.112025] [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: 06/09/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Malnutrition is considered one of the most common problems in the elderly population worldwide and can significantly interfere in health evolution in these individuals, predisposing them to increased infection susceptibility. The immune response triggered by infections comprises several mechanisms, and macrophages play important roles in this response. This study aimed to evaluate mechanisms related to macrophage function in a model of protein malnutrition in the elderly. Two age groups (young: 3-5 months and elderly: 18-19 months) male C57BL/6NTac mice were subjected to protein malnutrition with a low-protein diet (2 %). The nutritional status, hemogram and number of peritoneal cells were affected by both age and nutritional status. Additionally, the spreading capacity as well as the phagocytic and fungicidal activity of peritoneal macrophages were affected by the nutritional status and age of the animal. Interestingly, the percentages of F4/80+/CD11b+ and CD86+ cells were reduced mostly in elderly animals, while the TLR-4+ population was more affected by nutritional status than by age. The production of pro-inflammatory cytokines such as TNF-α, IL-1α, and IL-6 was also influenced by nutritional status and/or by age, and malnourished animals of advanced age produced higher amounts of the anti-inflammatory cytokine IL-10. Furthermore, the phosphorylation ratio of the transcription factor NFκB (pNFκB/NFκB) was directly affected by the nutritional status, independently of age. Thus, these results allow us to conclude that aging and protein malnutrition compromise macrophage function, likely affecting their immune function, and in aged protein-malnourished animals, this impairment tends to be more pronounced.
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Affiliation(s)
- Gabriela Kodja Vivian
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Renaira Oliveira da Silva
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Andressa Cristina Antunes Santos
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Araceli Aparecida Hastreiter
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Carolina Carvalho Dias
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Edson Naoto Makiyama
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Primavera Borelli
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Ricardo Ambrósio Fock
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
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Abstract
Older adults are vulnerable to nutrition-related health problems due to health and psychosocial changes that accompany aging. Those in rural communities face additional problems. This study characterizes the nutritional risk of rural older adults using the Nutritional Risk Index (NRI), paying particular attention to gender differences in risk. Data come from face-to-face interviews with a random sample of 638 White rural adults aged 55 and older. Women scored significantly higher on the NRI, indicating greater nutritional risk. Women were more likely to report NRI items related to oral health, special diets, disease interference with eating, gastrointestinal problems, and anemia, whereas men were more likely to report smoking regularly. A comparison with the application of the NRI in other populations indicates that it is sensitive to nutrition-related health conditions that may be more prevalent in rural populations, making it a useful tool for measuring nutritional risk.
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Randall Simpson J, Gumbley J, Whyte K, Lac J, Morra C, Rysdale L, Turfryer M, McGibbon K, Beyers J, Keller H. Development, reliability, and validity testing of Toddler NutriSTEP: a nutrition risk screening questionnaire for children 18–35 months of age. Appl Physiol Nutr Metab 2015; 40:877-86. [DOI: 10.1139/apnm-2015-0048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nutrition is vital for optimal growth and development of young children. Nutrition risk screening can facilitate early intervention when followed by nutritional assessment and treatment. NutriSTEP (Nutrition Screening Tool for Every Preschooler) is a valid and reliable nutrition risk screening questionnaire for preschoolers (aged 3–5 years). A need was identified for a similar questionnaire for toddlers (aged 18–35 months). The purpose was to develop a reliable and valid Toddler NutriSTEP. Toddler NutriSTEP was developed in 4 phases. Content and face validity were determined with a literature review, parent focus groups (n = 6; 48 participants), and experts (n = 13) (phase A). A draft questionnaire was refined with key intercept interviews of 107 parents/caregivers (phase B). Test–retest reliability (phase C), based on intra-class correlations (ICC), Kappa (κ) statistics, and Wilcoxon tests was assessed with 133 parents/caregivers. Criterion validity (phase D) was assessed using Receiver Operating Characteristic (ROC) curves by comparing scores on the Toddler NutriSTEP to a comprehensive nutritional assessment of 200 toddlers with a registered dietitian (RD). The Toddler NutriSTEP was reliable between 2 administrations (ICC = 0.951, F = 20.53, p < 0.001); most questions had moderate (κ ≥ 0.6) or excellent (κ ≥ 0.8) agreement. Scores on the RD nutrition risk rating and the Toddler NutriSTEP were correlated (r = 0.67, p < 0.000). The area under the ROC curve for moderate and high RD risk ratings were 84.6% and 82.7%, respectively. Cut-points of ≥21 (sensitivity 86%; specificity 61%) (moderate risk) and ≥26 (sensitivity 95%; specificity 63%) (high risk) were determined. The Toddler NutriSTEP questionnaire is both reliable and valid for screening for nutritional risk in toddlers.
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Affiliation(s)
- Janis Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jillian Gumbley
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Kylie Whyte
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jane Lac
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Crystal Morra
- Noojmowin Teg Health Centre, Little Current, ON P0P 1K0, Canada
| | - Lee Rysdale
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Mary Turfryer
- York Region Public Health, Newmarket, ON L3Y 6Z1, Canada
| | - Kim McGibbon
- Thunder Bay District Health Unit, ON P7B 6E7, Canada
| | - Joanne Beyers
- Sudbury & District Health Unit, Sudbury, ON P3E 6H3, Canada
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Carducci B, Reesor M, Haresign H, Rysdale L, Keller H, Beyers J, Paquette-Duhaime S, O'Connor A, Simpson JR. NutriSTEP®is Reliable for Internet and Onscreen Use. CAN J DIET PRACT RES 2015; 76:9-14. [DOI: 10.3148/cjdpr-2014-029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Bianca Carducci
- Human Health and Nutritional Sciences, University of Guelph, Guelph, ON
| | - Maria Reesor
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | | | - Lee Rysdale
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | | | | | | | - Amy O'Connor
- Medical and Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
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Nutritional and functional assessment of hospitalized elderly: impact of sociodemographic variables. J Aging Res 2013; 2013:101725. [PMID: 24222851 PMCID: PMC3810317 DOI: 10.1155/2013/101725] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/20/2013] [Accepted: 07/21/2013] [Indexed: 11/26/2022] Open
Abstract
Background. This work was constructed in order to assess the nutritional and functional status in hospitalized elderly and to study the associations between them and sociodemographic variables. Methods. 200 elderly patients (>65 years old) admitted to Internal Medicine and Neurology Departments in nonemergency conditions were included. Comprehensive geriatric assessments, including nutritional and functional assessments, were done according to nutritional checklist and Barthel index, respectively. Information was gathered from the patients, from the ward nurse responsible for the patient, and from family members who were reviewed. Results. According to the nutritional checklist, 56% of participants were at high risk, 18% were at moderate risk of malnutrition, and 26% had good nutrition. There was a high nutritional risk in patients with low income and good nutrition in patients with moderate income. Also, there was a high nutritional risk in rural residents (61.9%) in comparison with urban residents (25%). Barthel index score was significantly lower in those at high risk of malnutrition compared to those at moderate risk and those with good nutrition. Conclusions. Hospitalized elderly are exposed to malnutrition, and malnourished hospitalized patients are candidates for functional impairment. Significant associations are noticed between both nutritional and functional status and specific sociodemographic variables.
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Rambousková J, Slavíková M, Krsková A, Procházka B, Anděl M, Dlouhý P. Nutritional status assessment of institutionalized elderly in Prague, Czech Republic. ANNALS OF NUTRITION AND METABOLISM 2013; 62:201-6. [PMID: 23485785 DOI: 10.1159/000346038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are few studies in the Czech Republic describing and evaluating the nutritional status of institutionalized elderly. METHODS Data were collected from 659 women and 156 men aged 65 years and older and living in retirement homes in and around Prague. Data included: a Mini-Nutritional Assessment (MNA questionnaire), anthropometric measurements and biochemical evaluations. RESULTS According to the MNA questionnaire, 10.2% of these elderly individuals were malnourished and 39.4% were at risk of malnutrition. More women than men were malnourished (OR = 0.59 and 95% CI 0.42-0.86). Mean BMI values were 25.5 for females and 27.5 for males. MNA was positively correlated mostly with immobility (r = 0.63; p < 0.001), BMI (r = 0.57; p < 0.001) and mid-arm circumference (r = 0.56; p < 0.001). Serum albumin levels were <28 g/l in 1.3% (1.3% of the women and 1.36% of the men) and between 29.0 - 34.0 g/l in 21% (22.5% of the women and 14.4% of the men). Statistically significant differences between groups according to MNA scores were found for albumin, prealbumin, transferrin and creatinine. Prevalence of smoking was significantly higher among males. CONCLUSION The study results confirmed that institutionalized elderly, especially women, should be considered a nutritionally vulnerable population group that needs attention.
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Affiliation(s)
- Jolana Rambousková
- Centre for Research of Diabetes, Metabolism and Nutrition, Department of Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Vieira Ribeiro RS, Rosa MI, Bozzetti MC. Malnutrition and associated variables in an elderly population of Criciúma, SC. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000100017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Malnutrition and associated variables in an elderly population of Criciúma, SC. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70017-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lee JS, Sinnett S, Bengle R, Johnson MA, Brown A. Unmet Needs for the Older Americans Act Nutrition Program. J Appl Gerontol 2010. [DOI: 10.1177/0733464810376512] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study documents the size of unmet needs for Older Americans Act Nutrition Program (OAANP) and characteristics of program participants and waitlisted people based on the data from the Georgia client database systems. About 60% of those who requested the OAANP service between July and early November, 2008 ( n = 4,952) were on waitlists. Waitlisted people, especially those on the Home-Delivered Meals (HDM) waitlist, were more likely to report poorer sociodemographic characteristics, poorer self-reported health status, food insecurity, and nutritional risk. Requesting HDM was the foremost significant factor associated with unmet needs. Other race/not disclosing race information and living alone also increased the odds of being on the waitlists. There is a critical unmet need for the OAANP in Georgia, especially among those targeted by the Older Americans Act and requesting HDM. Federal and state policy makers, administrators, and program providers should better understand and meet the need of nutritionally vulnerable older Georgians.
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Affiliation(s)
| | | | | | | | - Arvine Brown
- Georgia Department of Human Services Division of Aging Services, Atlanta, GA, USA
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Neupane B, Walter SD, Krueger P, Loeb M. Community controls were preferred to hospital controls in a case–control study where the cases are derived from the hospital. J Clin Epidemiol 2010; 63:926-31. [DOI: 10.1016/j.jclinepi.2009.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 11/09/2009] [Accepted: 08/15/2009] [Indexed: 11/17/2022]
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Association between serum copper, zinc and hospital admissions among care home residents. Arch Gerontol Geriatr 2010; 51:e24-7. [DOI: 10.1016/j.archger.2009.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 08/03/2009] [Accepted: 08/05/2009] [Indexed: 11/24/2022]
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Neupane B, Walter SD, Krueger P, Marrie T, Loeb M. Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study. BMC Geriatr 2010; 10:22. [PMID: 20459844 PMCID: PMC2888820 DOI: 10.1186/1471-2318-10-22] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 05/11/2010] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A better understanding of potentially modifiable predictors of in-hospital mortality and re-admission to the hospital following discharge may help to improve management of community-acquired pneumonia in older adults. We aimed to assess the associations of potentially modifiable factors with mortality and re-hospitalization in older adults hospitalized with community-acquired pneumonia. METHODS A prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization. RESULTS Of 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8%) died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2%) were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR) = 4.00, 95% confidence interval (CI) = (1.46, 10.96), P = .007), chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50), P = .014), cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31), P = .040) were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85), P = .022) was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90), P = .028). Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization. CONCLUSION Chronic comorbidities appear to be the most important predictors of death and re-hospitalization in older adults hospitalized with community-acquired pneumonia while vitamin E supplementation was protective.
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Affiliation(s)
- Binod Neupane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Capturing the data: nutrition risk screening of adults in hospital. Nutrients 2010; 2:438-48. [PMID: 22254032 PMCID: PMC3257654 DOI: 10.3390/nu2040438] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 03/25/2010] [Accepted: 03/30/2010] [Indexed: 12/19/2022] Open
Abstract
This study aims to explore limitations with the Malnutrition Screening Tool in identifyingmalnutrition risk, in a cohort of 3,033 adult Australian medical and surgical hospital inpatients. Seventy-two percent of patients were screened; illness and medical care limited access to others. Malnutrition risk (16.5%; n = 501) was found in all age groups with a trend to higher risk in medical wards; 10% (n = 300) of patients with communication barriers were excluded. Systematic screening increased dietitians’ referrals by 39%. Further research is required to enable screening of all patients, including those with communication issues with an easy to use valid tool.
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Bocock MA, Keller HH, Brauer PM. Defining malnutrition risk for older home care clients. CAN J DIET PRACT RES 2009; 69:171-6. [PMID: 19063806 DOI: 10.3148/69.4.2008.171] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The Resident Assessment Instrument-Home Care (RAI-HC) is widely used to assess needs of home care clients and includes five items used to screen for malnutrition. This study involved defining malnutrition risk and identifying other items within the RAI-HC that might improve malnutrition screening among adults aged 65 or older receiving home care. METHODS A literature review, three focus groups of community care access centre case managers (n=29), and five key informant interviews with registered dietitians were used to identify malnutrition risk factors and indicators. A nominal group (n=5) was used to rank RAI-HC malnutrition risk items. Data were charted and integrated to create the final list of potential risk factors. RESULTS Seven malnutrition indicators (dietary intake, appetite, dysphagia, nutrition support, end-stage disease, weight status, and fluid intake) and seven risk factors (health status, functional ability, self-reported poor health, mood status, social function, cognitive performance, and trade-offs) were considered important concepts in the construct of malnutrition for older home care clients. CONCLUSIONS These items identified through divergent methods form the basis for developing a screening-for-malnutrition-risk tool for home care.
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Affiliation(s)
- Mary Ann Bocock
- Department of Family Relations and Applied Human Nutrition, University of Guelph, Guelph, Ontario, Canada
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Abstract
Prevention of premature chronic diseases is an important component of healthy aging. Nutrition education can help to reduce the risk of premature chronic diseases in some older adults. Home delivered meals and congregate dining services assist vulnerable elderly persons by providing opportunities for nutritional and social support. Screening and assessment tools identify factors affecting nutritional health and can also provide specific directions for planning, implementation, and evaluation of tailored interventions. Dietitians and allied health professionals are well positioned to assist a heterogeneous population of older adults in securing nutritional adequacy.
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Affiliation(s)
- Magdalena Krondl
- Department of Nutritional Sciences, Faculty of Medicine, Institute for Human Development, Life Courses and Aging, University of Toronto, Ontario, Canada.
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Beck A, Holst M, Rasmussen H. Efficacy of the Mini Nutritional Assessment to predict the risk of developing malnutrition or adverse health outcomes for old people. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eclnm.2008.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Keller HH. Promoting food intake in older adults living in the community: a review. Appl Physiol Nutr Metab 2008; 32:991-1000. [PMID: 18059571 DOI: 10.1139/h07-067] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Older adults (>65 y) living in the community have the potential to have significant nutrition concerns and deficits owing to the physiological, social, and psychological changes that occur with ageing. However, poor nutrition should not be considered an inevitable consequence of ageing. Older adults are quite heterogenous, including those ageing "successfully", "usually", and at "accelerated" rates. By improving the nutritional status of older adults, significant health and quality of life gains can be realized. These three subgroups of older adults have different concerns and risk factors and thus need different interventions. A substantial amount of research on older adult nutrition needs, determinants of food intake, risk of poor nutrition, and interventions has occurred in the past decade in Canada. The purpose of this review is to summarize this research and identify how nutrition promotion for older adults can be improved. Research to date indicates that the need for nutrition promotion is substantial. A variety of interventions have improved food intake and health of participants, although most programs are provided at a tertiary prevention level. Nutrition screening can help to identify in a timely manner those older adults who may benefit from limited services and which secondary prevention activities need to be increased. Nutrition promotion policy is currently lacking for older adults in Canada and is an important barrier to improving food intake in this growing segment of the population.
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Affiliation(s)
- Heather H Keller
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada.
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The ability of the DETERMINE checklist to predict continued community-dwelling in rural, white women. JOURNAL OF NUTRITION FOR THE ELDERLY 2007; 25:41-59. [PMID: 18032215 DOI: 10.1300/j052v25n03_04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study evaluated the ability of the DETERMINE checklist to predict continued community-dwelling in rural elderly women. Using a stratified random sample (N = 249) of white women aged 65-94, in-home interviews were completed at baseline and a telephone interview at 3 years. Overall higher total DETERMINE checklist scores negatively predicted continued community-dwelling (p = 0.0005). Lower risk scores indicated continued community-dwelling, while mid-range scores were inconclusive. Regression analysis for each age bracket showed that total DETERMINE checklist scores was most predictive of those aged 75-84 (p = 0.0037). The DETERMINE checklist may be a useful tool to identify those with increased risk of losing independence.
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Keller HH, Haresign H, Brockest B. Process Evaluation of Bringing Nutrition Screening to Seniors in Canada (BNSS). CAN J DIET PRACT RES 2007; 68:86-91. [PMID: 17553194 DOI: 10.3148/68.2.2007.86] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although nutrition risk is prevalent in Canadian older adults, the process of screening must be considered before nationwide programs can be recommended. A process evaluation of the Bringing Nutrition Screening to Seniors in Canada demonstration project was completed. Through the use of the 15-item Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN©) questionnaire, risk was identified in convenience samples of 1,196 community-living older adults recruited from five Canadian communities. All at-risk participants were offered referrals to community resources. Telephone follow-up of at-risk participants occurred after screening. Telephone interviews with screening administrators and older adults revealed screening benefits and challenges. Nutrition risk occurred in 38.9% of the sample. Most participants found screening helpful. Among the at-risk group (n=465), 39% accepted referrals for additional services. Older adults provided several reasons for refusing referrals, including denial of risk. Dietitian services were an identified gap, as were prevention-level resources. Nutrition risk is prevalent and older adults can benefit from screening. Training, ongoing support, and prioritization (policy, time, and money) are needed for sustainable screening programs. Before implementation of a nationwide screening program, sufficient and appropriate community resources are required, as is a national strategy for screening older adults.
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Affiliation(s)
- Heather H Keller
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
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Charlton KE, Kolbe-Alexander TL, Nel JH. The MNA, but not the DETERMINE, screening tool is a valid indicator of nutritional status in elderly Africans. Nutrition 2007; 23:533-42. [PMID: 17570641 DOI: 10.1016/j.nut.2007.04.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Revised: 03/26/2007] [Accepted: 04/30/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We compared the validity of existing nutrition screening tools for use in older South Africans. METHODS This was a cross-sectional study in 283 free-living and institutionalized black South Africans > or = 60 y of age. Trained fieldworkers administered a 24-h recall, the DETERMINE and Mini-Nutritional Assessment (MNA) screening tools, and performed anthropometric measurements and physical function tests. Biochemical indicators assessed included serum albumin, hemoglobin, ferritin, vitamin B12, red blood cell folate, cholesterol, and vitamin C. The six-item Cognitive Impairment Test was used to assess cognitive function. RESULTS The MNA score was positively and significantly associated with anthropometric measurements, cognitive function, instrumental activities of daily living and, in women only, percentage of body fat, handgrip strength, and activities of daily living. Compared with the MNA, the DETERMINE instrument had a low positive predictive value (55.6%) and specificity (11.2%), resulting in a high rate of false positives classified as being malnourished. CONCLUSION The MNA, but not the DETERMINE, screening tool is appropriate for use in identifying older black South Africans who are malnourished or at risk of malnutrition.
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Affiliation(s)
- Karen E Charlton
- Smart Foods Centre, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
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Randall Simpson JA, Keller HH, Rysdale LA, Beyers JE. Nutrition Screening Tool for Every Preschooler (NutriSTEP): validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur J Clin Nutr 2007; 62:770-80. [PMID: 17554250 DOI: 10.1038/sj.ejcn.1602780] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Study 1: To establish the validity of scores on Nutrition Screening Tool for Every Preschooler (NutriSTEP), a community-based parent-administered screening tool for assessing nutrition risk, by comparing scores to an expert rating. Study 2: To demonstrate test-retest reliability of NutriSTEP. SUBJECTS/METHODS Study 1: Parents of 269 preschoolers (of 294 parents recruited from the community), completed the NutriSTEP questionnaire; a registered dietitian (RD) assessed the nutritional status (based on medical and nutritional history, 3 days of dietary recall and anthropometric measurements) of these preschoolers and rated their nutritional risk (1 (low) to 10 (high risk)). Receiver operating characteristic (ROC) curves were used to establish validity and determine appropriate cut points based on sensitivity and specificity. Study 2: Parents of 140 preschoolers (of 161 recruited) completed NutriSTEP on two occasions. Intraclass correlation (ICC) and kappa were used to assess reliability. RESULTS Study 1: Scores on NutriSTEP and the RD rating were correlated (r=0.48, P=0.01). Area under the ROC curve for the high risk RD rating (score 8+) and the moderate risk rating (score 5+) were 81.5 and 73.8%, respectively. A moderate risk cut point of >20 and high risk cut point of >25 were identified for the NutriSTEP scores. Study 2: The NutriSTEP score was reliable between administrations (ICC=0.89, F=16.7, P<0.001). Most items on the questionnaire had adequate (kappa>0.5) or excellent (kappa>0.75) agreement. CONCLUSIONS The NutriSTEP questionnaire is both valid and reliable for determining nutritional risk in preschoolers.
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Affiliation(s)
- J A Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada.
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Chen LK, Lin MH, Hwang SJ, Wang P, Chwang LC. Nutritional status and clinical outcomes among institutionalized elderly Chinese in Taiwan. Arch Gerontol Geriatr 2006; 44:315-23. [PMID: 16949167 DOI: 10.1016/j.archger.2006.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 06/28/2006] [Accepted: 07/04/2006] [Indexed: 10/24/2022]
Abstract
Nutrition is an important issue in institutional care, and is related to clinical outcomes in many aspects. Although Taiwan is marching to an aged society, related studies were lacking. Elderly residents in two long-term care facilities (LTCF) were enrolled for study. Nutritional status including anthropometric measurements and laboratory examinations was assessed every 3 months for 12 months. Age, sex-matched community-dwelling elderly participating in the annual health check-up was randomly selected as the control subjects. In total, 66 subjects in LTCF and 870 age, sex-matched community-dwelling elderly were enrolled. Body mass index, serum levels of albumin, and total cholesterol were significantly poorer in LTCF residents than the community-dwelling elderly. Triceps skinfold thickness, hemoglobin, serum albumin, and total cholesterol were progressively deteriorated among the institutionalized elderly during the 6-month follow-up. Thirteen subjects of the study group had been hospitalized during the follow-up. Body mass index, triceps skinfold thickness, mid-arm circumference, serum albumin at screening were significantly poorer and unintentional weight loss within 6 months was significantly greater in subjects who had been hospitalized. By using multivariate logistic regression model, only weight loss >5% within 6-month follow-up was the significant independent predictive factors to hospitalization. In conclusion, nutritional status of institutionalized elderly Chinese was significantly poorer than the community-dwelling elderly. Nutritional markers were progressively deteriorated in LTCF residents during the follow-up period. Unintentional weight loss >5% within 6 months was the only significantly independent predictive factor for hospitalization among the institutionalized elderly Chinese.
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Affiliation(s)
- Liang-Kung Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Shih Pai Road Sec 2, Taipei 11217, Taiwan
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Abstract
BACKGROUND Urinary tract infections (UTI) are the most common type of infection among residents of long-term care facilities (LTCFs). The presence of asymptomatic bacteriuria among LTCF residents brings challenges to onsite health professionals. The aim of this study was to explore the prevalence and related factors of aymptomatic bacteriuria among the institutionalized elderly in Taiwan. METHODS In 2002, residents of 2 private LTCFs participated in this study. History taking, anthropometric measurements, and urine and blood samplings were performed by experienced research staff. Urine bacterial culture was performed by a standard procedure; subjects with symptoms indicating UTI were excluded. Repeated urine bacterial culture was performed 1 week after screening tests. Bacteriuria was defined as 1 or more organisms isolated from 2 consecutive urine specimens (> or =10(5) CFU [colony-forming units]/mL). Asymptomatic bacteriuria was defined as identical microorganisms isolated from 2 urine culture specimens taken at 1-week intervals from a subject who was free of UTI symptoms. The presence of asymptomatic bacteriuria and its related factors, such as age, sex, nutritional status, and long-term placement of urinary catheter, were evaluated. RESULTS A total of 64 institutionalized Chinese elderly (mean age, 76.2 +/- 9.1 years; male:female, 48:16) were collected. The prevalence of asymptomatic bacteriuria was 57.8% (37/64), and was not associated with age, sex, functional status, long-term foley catheter, or previous UTI history. The most commonly isolated organisms were Escherichia coli (29.7%), Klebsiella pneumoniae (21.6%), Providentia stuartii (16.2%), and Pseudomonas aeruginosa (13.5%). Moreover, 21.6% of them showed multiple organisms. Nutritional status (body mass index, serum levels of albumin, total cholesterol, total lymphocyte count, and hemoglobin) was similar between subjects with or without bacteriuria (p > 0.05). CONCLUSION Asymptomatic bacteriuria is common among Chinese residents in LTCFs. Escherichia coil was the most commonly cultured bacterium. Presence of asymptomatic bacteriuria was not associated with age, sex, functional status, catheter indwelling, previous history of UTI, or nutritional status of residents in LTCFs.
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Affiliation(s)
- Yi-Ting Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taiwan, ROC
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Keller HH, Goy R, Kane SL. Validity and reliability of SCREEN II (Seniors in the Community: Risk evaluation for eating and nutrition, Version II). Eur J Clin Nutr 2005; 59:1149-57. [PMID: 16015256 DOI: 10.1038/sj.ejcn.1602225] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nutrition risk screening for community-living seniors is of great interest in the health arena. However, to be useful, nutrition risk indices need to be valid and reliable. The following three studies describe construct validation, test-retest and inter-rater reliability of SCREEN II. METHODS Study (1) seniors were recruited from the general community and from a geriatrician's clinic to complete a nutritional assessment and SCREEN II. 193 older adults provided medical and nutritional history, 3 days of dietary recall and anthropometric measurements. A dietitian reviewed all information collected and ranked seniors on risk: 1 (low) to 10 (high risk). Receiver operating characteristic curves were completed. An abbreviated SCREEN II was developed through statistical analysis and expert ranking of the 17 items. Studies (2) and (3) seniors were recruited from the community to self-administer (n = 149) or be interviewed (n = 97) using SCREEN II twice within 2 weeks. For self-administration one index was completed via mail. Interviewer administration was completed via telephone with two interviewers. Intra-class correlations were calculated. RESULTS (1) Total and abbreviated SCREEN II have increased sensitivity and specificity as compared to SCREEN I in identifying seniors at nutritional risk. (2) Test-retest reliability was adequate (intra-class correlation (ICC) = 0.83). (3) Inter-rater reliability was adequate (ICC = 0.83). CONCLUSIONS SCREEN II appears to be a valid and reliable tool for the identification of risk for impaired nutritional states in community-living older adults, and is an improvement over SCREEN I.
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Affiliation(s)
- H H Keller
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
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Abstract
AIM This paper reports a literature review describing the range of published tools available for use by nurses to screen or assess nutritional status of patients/clients, and to examine whether the validity, reliability, sensitivity, specificity and acceptability of the tool have been investigated. Tools developed specifically for use with older adults are not considered in this review. A screening/assessment tool is described as a tool that uses a questionnaire-type format, contains more than one risk factor for malnutrition and gives an assessment of risk. BACKGROUND The incidence of malnutrition in people cared for by nurses is high and screening or assessment tools are often used to identify those with, or at risk of, malnutrition. METHODS A comprehensive literature review methodology was employed. A range of electronic databases was searched from 1982 to 2002. Search terms incorporating "nutrition", "screening", assessment, feeding, instrument, tool, validity, reliability, sensitivity and specificity were combined. Manual searches were also conducted. RESULTS Seventy-one nutritional screening/assessment tools were identified of which 35 were reviewed. Tools not reviewed included those which incorporated significant use of biochemical measures (8), included complex anthropometric measures (3), were concerned specifically with ingestion (4) or were designated for use with an older population (21). The tools reviewed use a wide variety of risk factors for malnutrition, varying from anthropometric measurements to socio-cultural aspects of eating behaviour. Some identify an action plan based on the score obtained. Many have not been subjected to validity and/or reliability testing and yet appear to be in use in clinical practice. The sensitivity, specificity and acceptability of the tools are often not investigated. CONCLUSION There are many published nutritional screening/assessment tools available for use by nurses to screen or assess the nutritional status of patients/clients. Many have not been subject to rigorous testing. Future work should consider a more standardized approach to the use of these tools.
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Affiliation(s)
- Sue M Green
- School of Nursing and Midwifery, University of Southampton, Highfield, Southampton SO17 1BJ, Hampshire, UK.
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Ruiz-López MD, Artacho R, Oliva P, Moreno-Torres R, Bolaños J, de Teresa C, López MC. Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: what are the main factors? Nutrition 2003; 19:767-71. [PMID: 12921887 DOI: 10.1016/s0899-9007(03)00125-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed which factors contribute to the high level of nutritional risk detected by the Mini Nutritional Assessment (MNA) test in institutionalized older women. To this end, we undertook a complete nutritional assessment. METHODS A cross-sectional study in 89 older women (age range, 72-98 y) living in two private nursing homes in Granada (Spain) was carried out. The MNA test was used as an assessment tool to detect nutritional risk. The nutritional assessment included anthropometric measurements (body mass index, triceps and subscapular skinfold thicknesses, and mid-arm and calf circumferences), quantification of dietary intake (7-d weighed-food records), clinical and functional evaluations (number of drugs, Katz index, and Red Cross cognitive scale), and biological markers (albumin, prealbumin, transferrin, and lymphocyte counts). RESULTS We found that 7.9% (n = 5) of the older women were malnourished (MNA score, 14.5 +/- 1.4), 61.8% (n = 56) were at risk of malnutrition (MNA score, 20.6 +/- 2.1), and 30.3% (n = 28) were well nourished (MNA score, 25.0 +/- 1.1) according to the MNA test. CONCLUSIONS This high prevalence of risk of malnutrition detected by the MNA test in healthy institutionalized older women was due mainly to risk situations and self-perception of health and did not depend on age. Inadequate micronutrients intake may contribute to the development of malnutrition in this population.
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Affiliation(s)
- M Dolores Ruiz-López
- Departamento de Nutrición y Bromatología, Facultad de Farmacia, Universidad de Granada, Spain.
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Higgins MM, Barkley MC. Tailoring Nutrition Education Intervention Programs to Meet Needs and Interests of Older Adults. ACTA ACUST UNITED AC 2003; 23:59-79. [PMID: 14650553 DOI: 10.1300/j052v23n01_05] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Methods for determining appropriate content of older adult nutrition education intervention programs and strategies for effectively delivering nutrition messages to older learners are presented. Educators can determine the nutrition education needs and interests of their older learners by using results of food intake surveys and assessment screening tools, written surveys, interviews and group discussions. Findings of recent reports using these methods are summarized. Additionally, published experiences with and suggestions for tailoring education intervention programs for older adult audiences, including those of particular racial/ethnic groups, are reviewed. The need for research in this area is presented. This article is one of a series of literature reviews of topics related to nutrition education for older adults.
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Affiliation(s)
- Mary Meck Higgins
- Department of Human Nutrition, Kansas State University. 202 Justin Hall, Manhattan, KS 66506, USA.
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Sharkey JR, Schoenberg NE. Variations in nutritional risk among black and white women who receive home-delivered meals. J Women Aging 2003; 14:99-119. [PMID: 12537078 DOI: 10.1300/j074v14n03_07] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The maintenance of good nutritional status is a cornerstone of health, function, and quality of life. To assess indicators and correlates of high levels of nutritional risk, sociodemographic, functional status, and nutritional data were collected from a diverse sample of 729 older women. Results from ordered logit analysis indicated that being Black, having an income < or = 125% of the federal poverty level, living alone, and being in the younger-old age group (ages 60 to 74 years) were associated with moderately high and very high levels of nutritional risk. An examination of individual and multiple nutritional risk indicators suggested a heightened vulnerability of Black women to inadequate dietary intake, even net of income and other influential variables. With demographic projections of an increasingly numerous and diverse older population who may face health and nutritional challenges, researchers must strengthen efforts to assist policymakers and service providers to properly target nutrition services.
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Affiliation(s)
- Joseph R Sharkey
- UNC Institute on Aging Carolina Program in Healthcare and Aging Research, Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, 27514, USA.
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Jensen GL, Friedmann JM, Coleman CD, Smiciklas-Wright H. Screening for hospitalization and nutritional risks among community-dwelling older persons. Am J Clin Nutr 2001; 74:201-5. [PMID: 11470721 DOI: 10.1093/ajcn/74.2.201] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The potential for the use of nutritional screening to identify older persons at risk of hospitalization has not been contrasted with the use of tools developed for predicting hospital admissions. OBJECTIVE Our goal was to compare the associations of items from the Level II Nutrition Screen (LII) and the Probability of Repeated Admissions (P(ra)) questionnaire with the outcome of hospitalization. DESIGN This was a cohort study of participants in a Medicare managed-risk health plan who completed both the LII and P(ra) (n = 386). All hospitalizations within 1 y of screening were recorded. Hierarchical multivariate logistic regression was used to model associations with hospitalization. RESULTS P(ra) items that retained significant associations with hospitalization were self-reported health, hospitalization in the past year, and >6 doctor visits in the past year (positive predictive value: 20%; sensitivity: 53.1; specificity: 69.7). LII items that retained significant associations with hospitalization were eating problems and polypharmacy (positive predictive value: 17.9%; sensitivity: 58.0; specificity: 56.3). Those persons designated by the P(ra) score as being at high risk of hospitalization (P(ra) > or = 0.30, 75th percentile) were also more likely to report weight loss, polypharmacy, consumption of a special diet, and functional limitation on the LII. CONCLUSIONS Retained items from the P(ra) and the LII were comparable in identifying participants at risk of hospitalization. These observations suggest that nutritional risk factors such as eating problems, weight loss, and consumption of special diets should be considered in the management of older persons at risk of hospitalization, irrespective of the screening approach selected.
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Affiliation(s)
- G L Jensen
- Vanderbilt Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
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Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56:M366-72. [PMID: 11382797 DOI: 10.1093/gerona/56.6.m366] [Citation(s) in RCA: 1467] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Mini-Nutritional Assessment (MNA) is a validated assessment instrument for nutritional problems, but its length limits its usefulness for screening. We sought to develop a screening version of this instrument, the MNA-SF, that retains good diagnostic accuracy. METHODS We reanalyzed data from France that were used to develop the original MNA and combined these with data collected in Spain and New MEXICO: Of the 881 subjects with complete MNA data, 151 were from France, 400 were from Spain, and 330 were from New MEXICO: Independent ratings of clinical nutritional status were available for 142 of the French subjects. Overall, 73.8% were community dwelling, and mean age was 76.4 years. Items were chosen for the MNA-SF on the basis of item correlation with the total MNA score and with clinical nutritional status, internal consistency, reliability, completeness, and ease of administration. RESULTS After testing multiple versions, we identified an optimal six-item MNA-SF total score ranging from 0 to 14. The cut-point score for MNA-SF was calculated using clinical nutritional status as the gold standard (n = 142) and using the total MNA score (n = 881). The MNA-SF was strongly correlated with the total MNA score (r = .945). Using an MNA-SF score of > or = 11 as normal, sensitivity was 97.9%, specificity was 100%, and diagnostic accuracy was 98.7% for predicting undernutrition. CONCLUSIONS The MNA-SF can identify persons with undernutrition and can be used in a two-step screening process in which persons, identified as "at risk" on the MNA-SF, would receive additional assessment to confirm the diagnosis and plan interventions.
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Affiliation(s)
- L Z Rubenstein
- University of California at Los Angeles School of Medicine.
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Abstract
Nutrition is a prime concern for the optimal health of older persons. Nutritional requirements for older persons must take into account the physiologic changes that occur with aging. The gastrointestinal tract is the site of key structural and functional changes that affect nutrient intake and assimilation. A working knowledge of nutritional screening, assessment, and interventions can assist the practitioner in providing quality care for the older patient.
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Affiliation(s)
- G L Jensen
- Vanderbilt Center for Human Nutrition, Vanderbilt, University Medical Center, Nashville, Tennessee, USA.
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Lee JS, Frongillo EA. Nutritional and health consequences are associated with food insecurity among U.S. elderly persons. J Nutr 2001; 131:1503-9. [PMID: 11340107 DOI: 10.1093/jn/131.5.1503] [Citation(s) in RCA: 247] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to examine the consequences associated with food insecurity for the nutritional and health status of the elderly in the United STATES: The data analyzed were from the Third National Health and Nutrition Examination Survey (1988-1994) and the Nutrition Survey of the Elderly in New York State (1994). Multiple logistic and linear regression analyses were used to assess the extent to which food-insecure elderly were likely to have lower nutrient intake, skinfold thickness, self-reported health status and higher nutritional risk. Regardless of food insecurity status, older people consumed less than the recommended dietary allowance for eight nutrients. Food-insecure elderly persons had significantly lower intakes of energy, protein, carbohydrate, saturated fat, niacin, riboflavin, vitamins B-6 and B-12, magnesium, iron and zinc, as well as lower skinfold thickness. In addition, food-insecure elderly persons were 2.33 (95% confidence interval: 1.73-3.14) times more likely to report fair/poor health status and had higher nutritional risk. These results indicate that food-insecure elderly persons have poorer dietary intake, nutritional status and health status than do food-secure elderly persons. It is necessary to ensure the nutritional well-being of all elderly persons who are at nutritional and health risk, including those who are food insecure and have even poorer nutritional and health status than those who are food secure.
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Affiliation(s)
- J S Lee
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
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Lee JS, Frongillo EA. Understanding needs is important for assessing the impact of food assistance program participation on nutritional and health status in U.S. elderly persons. J Nutr 2001; 131:765-73. [PMID: 11238757 DOI: 10.1093/jn/131.3.765] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to assess the impact of food assistance programs on nutritional and health status of nutritionally needy elderly persons. Two cross-sectional and one longitudinal data sets were used: Third National Health and Nutrition Examination Survey (1988-94), Nutrition Survey of the Elderly in New York State (1994) and Longitudinal Study of Aging (1984-1990). Multiple logistic and linear regression analyses were used to examine whether food assistance participants among food insecure elderly (i.e., those whose needs for food assistance programs are met) have better nutrient intake, skinfold thickness and self-reported health status and less nutritional risk, hospitalization and mortality than nonparticipants (i.e., those whose needs are unmet) and whether the benefit is larger than that among food secure elderly persons. Across three data sets, food insecure elderly persons had poorer nutritional and health status than food secure elderly persons. Contrary to the hypotheses, among food insecure elderly persons, food assistance participants had similar or poorer nutrient intakes, skinfold thickness, nutritional risk, self-reported health status, hospitalization and mortality than nonparticipants. Food secure participants had similar nutritional and health status as food secure nonparticipants. Lack of information on the dynamic nature and changes in needs with program participation in the three data sets likely did not allow accurate estimation of the impact of food assistance participation. Different study designs, as well as theory and knowledge of needs that clarifies need status and its change within each older individual across an appropriate time interval, are necessary to accurately assess impacts of food assistance programs.
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Affiliation(s)
- J S Lee
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA
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Vellas B, Lauque S, Andrieu S, Nourhashemi F, Rolland Y, Baumgartner R, Garry P. Nutrition assessment in the elderly. Curr Opin Clin Nutr Metab Care 2001; 4:5-8. [PMID: 11122552 DOI: 10.1097/00075197-200101000-00002] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of malnutrition, which is relatively low in free-living elderly persons (5-10%), is considerably higher (30-60%) in hospitalized or institutionalized elderly persons. As a result, nutritional assessment should be part of routine clinical practice in elderly patients who are frail, sick or hospitalized. A comprehensive screening tool for assessment of nutritional status is needed that is clinically relevant and cost-effective to perform. A number of simple and rapid tests for detecting or diagnosing malnutrition in the elderly have recently been developed. If malnutrition is suggested by such screening tests, then they should be supplemented by conventional nutritional assessment before treatment is planned.
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Affiliation(s)
- B Vellas
- Department of Internal Medicine and Clinical Gerontology, University of Toulouse, France.
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Vellas B, Guigoz Y, Baumgartner M, Garry PJ, Lauque S, Albarede JL. Relationships between nutritional markers and the mini-nutritional assessment in 155 older persons. J Am Geriatr Soc 2000; 48:1300-9. [PMID: 11037019 DOI: 10.1111/j.1532-5415.2000.tb02605.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the relationships between nutritional status measured by a comprehensive nutritional assessment including anthropometric measurements, nutritional biological markers, evaluation of dietary intake, and the Mini-Nutritional Assessment (MNA) nutrition screening tool. DESIGN A prospective study. PARTICIPANTS One hundred fifty-five older subjects (53 men and 102 women; mean age = 78 years; range = 56-97 years). These participants were hospitalized in a geriatric evaluation unit (n = 105) or free living in the community (n = 50). MEASUREMENT Weight, height, knee height, midarm and calf circumferences, triceps and subscapular skinfolds, albumin, transthyretin (prealbumin), transferrin, ceruloplasmin, C-reactive protein, alpha1-acid glycoprotein, cholesterol, vitamins A, D, E, B1, B2, B6, B12, folate, copper, zinc, a 3 day food record combined with a food-frequency questionnaire; the MNA nutritional screening. RESULTS The MNA scores have been found to be significantly correlated to nutritional intake (P < .05 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), anthropometric and biological nutritional parameters (P < .001 for albumin, transthyretin, transferrin, cholesterol, retinol, alpha-tocopherol, 25-OH cholecalciferol zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition in which nutrition intervention may be effective. CONCLUSIONS The MNA is a practical, noninvasive, and cost-effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons.
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Affiliation(s)
- B Vellas
- Department of Internal Medicine and Clinical Gerontology, Toulouse University Hospital, France
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Abstract
Older people are growing in prevalence and their nutrition-related concerns adversely impact upon health, function, and life quality. Changes in body composition and organ system function alter nutrient requirements. The purpose of this review is to examine changes in nutritional requirements with aging and to highlight practical approaches to nutritional screening, assessment, and intervention. A multidisciplinary approach with individualized care is recommended. Health care providers who work with older people must be attentive to nutrition, because appreciable comorbidity and unfavorable outcomes may accompany either under- or overnutrition.
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Affiliation(s)
- M McGee
- Vanderbilt Center for Human Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Arrowsmith H. A critical evaluation of the use of nutrition screening tools by nurses. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1999; 8:1483-90. [PMID: 10887829 DOI: 10.12968/bjon.1999.8.22.6421] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Malnutrition remains a problem in hospital and community patients, the consequences of which have deleterious effects on the sick individual and cost implications for healthcare providers. Provision of nutritional support has been shown to improve patient outcome in those at risk of malnutrition; therefore, the detection and treatment of malnutrition is paramount. Nurses have been identified as being in an ideal position to carry out routine nutritional screening to detect patients at risk of malnutrition and hence refer to the dietitian for detailed nutritional assessment and provision of nutritional support. Therefore, many nutritional screening tools have been developed to guide nurses in basic nutritional screening. However, for a tool to be effective certain criteria must be met including ease of use, cost-effectiveness, the presence of an action plan and prior testing for validity, reliability, sensitivity and specificity. Six such tools are critically evaluated in this article to establish whether they meet these criteria. Surprisingly, none of the screening tools demonstrated a beneficial effect on clinical outcome or met all of the above criteria. It is therefore essential that these tools are refined and retested before becoming part of established nursing practice.
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Abstract
Both undernutrition and overnutrition contribute to increased risk of morbidity and mortality. Marasmus, kwashiorkor, and decreased micronutrient status are types of nutritional deficiencies, whereas obesity and problems resulting from dietary supplements are examples of overnutrition. Screening for malnutrition can be performed in the ambulatory, hospital, and institutional populations, each with methods appropriate for the target population. For patients determined to be at high risk, further nutrition assessment can be performed to help arrive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing morbidity and mortality in the population.
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Affiliation(s)
- D D Hensrud
- Division of Preventive Medicine, Mayo Medical School, Rochester, Minnesota, USA
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41
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Testwerkzeuge für die Ernährungsanamnese bei älteren Personen*. Z Gerontol Geriatr 1999. [DOI: 10.1007/pl00014616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15:116-22. [PMID: 9990575 DOI: 10.1016/s0899-9007(98)00171-3] [Citation(s) in RCA: 1199] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.
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Affiliation(s)
- B Vellas
- Nestlé Research Center, Lausanne, Switzerland
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Salvioli G, Ventura P, Pradelli J. Impact of nutrition on cognition and affectivity in the elderly: A review. Arch Gerontol Geriatr 1998. [DOI: 10.1016/s0167-4943(98)80068-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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