Quality of diet and level of physical performance related to inflammatory markers in community-dwelling frail, elderly people

OBJECTIVE

The aim of this study was to assess whether diet quality and functional status were associated with serum levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in frail, elderly, community-dwelling individuals.

METHODS

Seventy-eight frail, elderly individuals (age ≥65 y, usual gait speed <0.6 m/s and Mini Nutritional Assessment <24) participated in this cross-sectional study from the National Home Healthcare Services in Gangbuk-gu, Seoul, South Korea. Diet quality was assessed using mean adequacy ratio (MAR) of the diet, which was calculated by averaging the sum of the nutrient adequacy ratios (NAR) for the intakes of energy, protein, and 11 micronutrients. Grip strength was measured as an indicator of muscle strength, and short physical performance battery (SPPB) was measured as an indicator of physical performance. The levels of the inflammatory markers IL-6 and TNF-α were obtained from serum samples.

RESULTS

MAR and NAR scores for phosphorus; vitamins A, B₁, and B₆; and niacin were negatively associated with IL-6 (β = -0.006, -0.004, -0.004, -0.007, -0.004, and -0.005, respectively; P < 0.05). SPPB score, as well as NAR scores for vitamin B₆, niacin, and vitamin C, were negatively associated with TNF-α (β = -0.098, -0.006, -0.006, and -0.004, respectively; P < 0.05).

CONCLUSION

MAR of the diet was inversely associated with IL-6 concentration in frail elderly individuals, and higher SPPB score was associated with lower levels of TNF-α. Results from the present study suggest that improving diet quality and physical performance might lower levels of inflammation in this frail, elderly population.

Effectiveness of a nutrition education program for the prevention and treatment of malnutrition in end-stage renal disease

OBJECTIVE

In end-stage renal disease (ESRD) patients, malnutrition is mainly addressed from a pharmacological but not educational point of view. Therefore, the objective of this study was to implement a nutritional education program (NEP) and to evaluate and compare its effectiveness in the treatment and prevention of malnutrition with oral supplementation (OS)-the standard treatment in these patients.

DESIGN

This study was a longitudinal, 4-month prospective study.

SETTINGS

The study was conducted from January to May 2012 in the Hemodialysis Fresenius Medical Care Clinic of Murcia.

SUBJECTS

One hundred twenty patients with ESRD undergoing hemodialysis were randomly assigned to a NEP or to OS.

INTERVENTION

Patients assigned to the NEP group followed an educational program for 4 months that aimed to improve general nutritional knowledge and included culinary recommendations and an elaboration of balanced menus. The OS group received a nutritional supplement during the hemodialysis procedure.

MAIN OUTCOME MEASURE

The main outcome measure was certain biochemical markers of nutritional and metabolic status. Nutrition knowledge was also evaluated.

RESULTS

After 4 months of intervention, nutritional knowledge was increased in all patients (P < .050) after the NEP, which was reflected in a decrease in the prevalence of malnutrition, especially in this group. Creatinine clearance, total protein serum values, and other biochemical parameters improved significantly in both groups (P < .050 in all cases), although other parameters such as C-reactive protein were impaired only in the NEP group.

CONCLUSION

The NEP was at least as effective as OS for preventing and even treating malnutrition in patients with chronic renal failure on hemodialysis, improving their nutritional status, which may result in a long-term decrease in the mortality and morbidity of these patients.