A computational model to analyze the impact of birth weight-nutritional status pair on disease development and disease recovery

Purpose

The purpose of this work is to analyse the combined impacts of birth weight and nutritional status on development and recovery of various types of diseases. This work aims to computationally establish the facts about the effects of individual birth weight-nutritional status pairs on disease development and disease recovery.

Methods

This work designs a computational model to analyze the impact of birth weight-nutritional status pairs on disease development and disease recovery. Our model works in two phases. The first phase finds the best machine learning model to predict birth weight from "Child Birth Weight Dataset" available at IEEE Dataport (https://dx.doi.org/10.21227/dvd4-3232). The second phase combines the predicted birth weight labels with nutritional status labels and establishes the effects using differential equations.

Results

The experimental results find Gradient boosting (GB) to work the best with Information gain (IGT) and Support Vector Machine (SVM) with Chi-square test (CST) for predicting the birth weights. The simulated results establish that "normal birth weight and normal nutritional status" is the best pair for resisting disease development as well as enhancing disease recovery. The results also depict that "low birth weight and malnutrition" is the worst pair for disease development while "high birth weight and malnutrition" is the worst combination for disease recovery.

Conclusion

The findings computationally establish the facts about the effects of birth weight-nutritional status pairs on disease development and disease recovery. As a social implication, this study can spread awareness about the importance of birth weight and nutritional status. The outcome can be helpful for the concerned authority in making decisions on healthcare cost and expenditure.

Associations between eating alone, its transition and depressive symptoms among Chinese middle-aged and older adults: evidence from two national cohorts

BACKGROUND

Few studies have explored the longitudinal association between eating alone and depressive symptoms, and have focused on the effect of eating alone transition. This study aims to explore the longitudinal association between eating alone, its transition and depressive symptoms among two national surveys using a cohort study design.

METHODS

The participants aged ≥ 45 years were recruited for the 2016 to 2018 waves China Family Panel Data (CFPS) and 2015 to 2018 waves China Health and Retirement Longitudinal Study (CHARLS). Eating alone was assessed by self-reported. Depressive symptoms were evaluated by Center for Epidemiologic Studies Depression Scale. Cox hazard regression was used to explore the associations between eating alone, its transition and depressive symptoms after adjusting for covariates.

RESULTS

A total of 21,476 participants were included in this study. The Cox model showed that compared with commensality, eating alone was associated with a higher risk of depressive symptoms, both in the CFPS, CHARLS and pooled analysis. In addition, compared with commensality consistently, the transition from commensality to alone and eating alone consistently were associated with a higher risk of depressive symptoms. The sensitivity analyses showed that the association remained robust.

CONCLUSIONS

Eating alone and a change from commensality to eating alone were associated with higher risks of depressive symptoms among Chinese middle-aged and older adults in two cohorts. This study suggested that providing eating partners may be an effective intervention method to prevent depressive symptoms in middle-aged and older adults.

Nutritional Risk, Depression, and Physical Function in Older People Living Alone

This study investigated depression and physical function as factors associated with nutritional risk in older adults living alone. The study included 2896 people 65 years or older who lived alone. Data were collected in South Korea between September and November 2020. Descriptive statistics, a chi-squared test, independent samples t-test, weighted multiple regression analysis, and binary logistic regression analysis were performed using IBM SPSS for Windows ver. 23.0. In this study, 44.8% of participants were in the nutritional risk group. Furthermore, 60.9% of those at risk for depression, 75.1% of those with instrumental activities of daily living (IADLs) dependency, and 59.1% of those with chewing limitations were at nutritional risk. The factors that increased nutritional risk in the weighted multiple regression analysis were depression (β = 0.27, p < 0.001), chewing limitations (β = 0.12, p < 0.001), IADL dependency (β = 0.09, p < 0.001), and basic physical movement (β = 0.04, p = 0.020). Binary logistic regression analysis showed that those with IADL dependency had a 2.59 times higher nutritional risk than those with IADL non-dependency (p < 0.001). The nutritional risk group had a higher risk of depression (2.01 times higher [p < 0.001]), chewing limitations (1.76 times higher [p < 0.001]), and basic physical movement limitations (1.35 times higher [p = 0.009]) than the good nutritional group. Therefore, nutritional screening is required of older individuals living alone. To mitigate nutritional risks, it is necessary to assess depression and physical function, including IADL dependency.

The role of comprehensive geriatric assessment in the identification of different nutritional status in geriatric patients: a real-world, cross-sectional study

Background

Malnutrition is an often unrecognized problem, but it is common in older patients and leads to adverse outcomes.

Aims

The purpose of this study is to analyze the prevalence of the risk of undernutrition in elderly patients and the correlation between CGA and nutritional status, and to determine the nutritional status of elderly patients.

Methods

This is a real-world cross-sectional study of continuously enrolled elderly patients aged 65 years or older with a complete CGA database. CGA inventory was prepared by compiling and screening general information, body composition and blood biochemical results. MNA was also conducted for each elderly patient to screen for malnutrition. A multivariable logistic regression analysis was used to determine the association between the CGA and nutritional assessment.

Result

The average age of the 211 selected elderly patients (160 men and 51 women) was 79.60 ± 9.24 years, and their ages ranged from 65 to 96 years. After controlling for confounders, patients with a history of PUD (OR = 2.353, p = 0.044), increased ADLs & IADLs scores (OR = 1.051, p = 0.042) or GDS scores (OR = 6.078, p < 0.001) may increase the incidence of the risk of undernutrition respectively, while an increase in BMI (OR = 0.858, p = 0.032) may lower the incidence of malnutrition risk. In addition, increased ADLs & IADLs scores (OR = 1.096, p = 0.002) or GDS scores (OR = 11.228, p < 0.001) may increase the incidence of undernutrition. However, increased MMSE (OR = 0.705, p < 0.001), BMI (OR = 0.762, p = 0.034), UAC (OR = 0.765, p = 0.048) and CC (OR = 0.721, p = 0.003) may decrease the incidence of undernutrition, respectively.

Conclusion

The study found that the prevalence of risk of undernutrition in elderly patients was the highest. Risk of undernutrition was independently associated with peptic ulcer disease, ADLs & IADLs, GDS and BMI. However, we found that when the nutritional status reached the level of undernutrition, it was related to more factors, including ADLs & IADLs, MMSE, GDS, BMI, UAC and CC. Determining the level of malnutrition through CGA may help to prevent and intervene malnutrition as early as possible.

The longitudinal bidirectional association between sarcopenia and cognitive function in community-dwelling older adults: Findings from the China Health and Retirement Longitudinal Study

Background

Although an association between sarcopenia and cognitive function has been demonstrated, the directional association remains unclear. The present study aimed to evaluate the longitudinal reciprocal relationship and identify the possible temporal sequence between sarcopenia and cognitive function in older Chinese adults.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey in 2011 and the follow-up survey in 2015. Cognitive function was measured by episodic memory and executive function. Sarcopenia status (non-sarcopenia, possible sarcopenia and sarcopenia) was defined based on the Asian Working Group for Sarcopenia 2019 criteria. Linear regression analysis and ordinal logistic regression analysis were employed to investigate the relationship between baseline sarcopenia status and follow-up cognition, as well as the association of baseline cognition with follow-up sarcopenia status, respectively. A cross-lagged panel analysis was performed to simultaneously evaluate the bidirectional association and the strength of the temporal relationship.

Results

Of 2689 participants, the median age was 65.0 years and 1249 (46.5%) were female. After adjusting for potential confounders and baseline measurements, baseline sarcopenia status was dose-dependently associated with subsequent cognitive scores (β = -0.45; P for trend = 0.001), and baseline cognitive scores (in tertiles) were also dose-dependently associated with subsequent sarcopenia status (odds ratio (OR) = 0.86; P for trend = 0.017). The cross-lagged panel analysis indicated that the standardised effect size of sarcopenia status on cognitive function (β = -0.09; P < 0.001) is larger relative to the effect of cognitive function on sarcopenia status (β = -0.05; P = 0.019).

Conclusions

There is a longitudinal, bidirectional relationship between sarcopenia status and cognitive function in older Chinese adults. Sarcopenia is likely the driving force in these dynamic associations. These findings imply that interventions in either sarcopenia or cognitive decline may have the ability to generate reciprocal benefits over time. More research is warranted to confirm these findings and to further elucidate underlying causal pathways.

Sarcopenia with Depression Presents a More Severe Disability Than Only Sarcopenia among Japanese Older Adults in Need of Long-Term Care

Background and objectives: The combination of depression and sarcopenia, a condition prevalent worldwide, may cause dis-tinct problems that should not be underestimated. However, to the best of our knowledge, no reports have investigated the combined effects of depression and sarcopenia. In this study, we compared physical function, nutritional status, and daily functioning among older adults with only depression (OD), those with only sarcopenia (OS), and those with sarcopenia with depression (SD) to examine the effects of the combination of depression and sarcopenia. Materials and Methods: The participants were 186 communi-ty-dwelling older individuals who required support or care. The participants were classified into four groups based on the presence or absence of sarcopenia and depression: Control, OD, OS, and SD. The following parameters were evaluated in the four groups: grip strength, walking speed, skeletal muscle mass index (SMI), Mini Nutritional Assessment Short-Form (MNA-sf), and long-term care certification level. In addition, univariate and multivariate analyses of the survey results were performed to identify risk factors leading from OS to SD. Results: We found that 31.2% of older participants who needed support or nursing care had SD, which had more pronounced adverse effects on grip strength, walking speed, SMI, MNA-sf, and level of nursing care than OD or OS. Furthermore, multivariate analysis of SD vs. OS showed that decreased grip strength and worsening MNA-sf were independent risk factors. Conclusions: SD is common among older individuals living in the community. Patients with SD require support and care, and the condition has a greater impact on physical function, nutritional status, and decline in life function compared to OD and OS. Therefore, it is desirable to elucidate the process leading to SD and investigate the risk factors and prognosis. It is expected that sarcopenia with depression will be investigated worldwide in the future.

The association of depressive symptoms and body weight change in midlife - Results from the Gutenberg Health Study in Germany

BACKGROUND

The present study aimed to investigate how depressive symptoms affect bodyweight change (gain and loss), and how this association is intertwined with other psychosocial and biomedical factors in the adult general population.

METHODS

In a population-based, prospective, observational single-center cohort study in the Rhine-Main-Region, Germany (Gutenberg Health Study GHS) with N = 12,220 participants, we analyzed baseline and five year follow-up data with logistic regressions separately for bodyweight gain and loss (vs. stable bodyweight).

RESULTS

Overall, 19.8 % of participants gained bodyweight of at least 5 %. More female participants were affected than male participants (23.3 % vs. 16.6 %). Regarding weight loss, overall, 12.4 % lost >5 % of bodyweight; participants were more often female than male (13.0 % vs. 11.8 %). Depressive symptoms at baseline were associated with weight gain (OR = 1.03, 95 % CI = 1.02-1.05). In models controlling for psychosocial and biomedical factors, female gender, younger age, lower socioeconomic status and smoking cessation were associated with weight gain. In weight loss, there was no overall significant effect of depressive symptoms (OR = 1.01 [0.99; 1.03]). Weight loss was associated with female gender, diabetes, less physical activity, and higher BMI at baseline. Only in women, smoking and cancer were associated with weight loss.

LIMITATIONS

Depressive symptoms were assessed via self-report. Voluntary weight loss cannot be determined.

CONCLUSIONS

Significant weight change frequently occurs in middle to old adulthood resulting from a complex interplay of psychosocial and biomedical factors. Associations with age, gender, somatic illness and health behavior (e.g. smoking cessation) provide important information for the prevention of unfavorable weight change.

Factors Related to Nutritional Status of Single Older Residents in Semi-Mountainous Rural Regions of Japan: A Cross-Sectional Study

Japan's notably high aging rate presents the risk of malnutrition. This study aimed to clarify the nutritional status and factors related to the nutritional status of single older residents in a semi-mountainous rural region of Japan. Using a cross-sectional study design, surveys were administered to older adults in the semi-mountainous rural region in the area of Kochi Prefecture, Japan. Factors associated with a risk of malnutrition were identified using binomial logistic regression analysis. In addition, nutritional status was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF). Among 53 participants, the MNA-SF score was 12.1 ± 1.5 (mean ± standard deviation), and 71.7% had a normal nutritional status. We observed that participation in local residents' association gatherings (odds ratio [OR]: 7.42, 95% confidence interval [CI]: 1.17-47.01) and risk of depression/anxiety (OR: 12.77, 95% CI: 1.99-81.94) were associated with an increased risk of malnutrition, whereas social interaction with friends (OR: 0.11, 95% CI: 0.02-0.76) were associated with a decreased risk. The nutritional status was normal overall. Community health workers should share information on the health of residents and promote social events to enable older residents living alone to continue leading healthy lifestyles.

Major depressive disorders in patients with inflammatory bowel disease and rheumatoid arthritis

BACKGROUND

Various immune-mediated inflammatory diseases consisting of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA), are found to have a substantial societal burden, increased healthcare costs, and progressive disability. Studies suggest that patients with vs without comorbid depression have a more significant disability, a lower likelihood of remission, and reduced adherence to therapy. Elevated interleukin (IL)-1β, tumor necrosis factor-α, and IL-6 contribute to developing depression by the impaired physiological responses to stress, resulting in increased pain, fever, fatigue, and lack thereof of interest, and thus poor long-term outcomes. This study emphasizes the timely recognition of the prevalence of major depressive disorder (MDD) in patients with RA and IBD combined, thus preventing disability.

AIM

To identify the prevalence level and temporal trends of depression in hospitalized IBD-RA patients.

METHODS

All adult hospitalized patients from January 2000 to December 2019 in the nationwide inpatient sample (NIS) were captured. The study population included all patients with a primary or secondary IBD-RA overlap disease using corresponding international classification of diseases (ICD)-9 and ICD-10 codes. IBD includes Crohn’s disease and ulcerative colitis. The study population was divided into IBD-RA without MDD (controls) and IBD-RA with MDD (cases). For group comparison between MDD vs no MDD, we used Student's t-test for continuous variables and Rao-Scott Chi-square tests for categorical variables. For univariate analyses, we used logistic regression, and for multivariate analysis, we used a weighted multi-level mixed-effects model. We attested all hypotheses with two-tailed significance level of 0.05 (P < 0.05 was considered significant). The outcome is to examine the temporal trends and prevalence of depression in patients with IBD-RA by gender, race, and age.

RESULTS

A total of 133315 records were identified with IBD-RA overlap, of which 26155 patients (19.62%) had MDD. Among the IBD-RA patients, those who had MDD were younger [mean age of 56 years (SD ± 15)] to IBD-RA without MDD patients with a P < 0.0001, more females (80% among cases vs 73% among controls) than males with a P < 0.0001, frequent in the white race (79% among cases vs 73% among controls) than black race. Over the 19 years, the number of patients with MDD in IBD-RA increased from 153 (the year 2000) to 2880 (the year 2019) in weighted NIS, representing a 1782% increase compared to the year 2000 with a P < 0.001. Factors associated with higher MDD included younger age, female gender, white race, alcohol, opioids, esophageal disorders, peptic ulcer disease, chronic pancreatitis, paralysis, dementia, menopausal disorders, obesity, nutritional deficiencies, diabetes mellitus with chronic complications, and osteoarthritis.

CONCLUSION

There is a rise in the prevalence of depression in younger patients with IBD-RA combined compared to their counterparts. These patients are also at higher risk for the increased cost of care and poor treatment compliance. It is crucial to educate the involved clinicians to identify the early signs and symptoms of depression in patients with IBD or RA or IBD-RA combined and treat them to have a better overall prognosis.

Dietary factors, risk of developing depression, and severity of its symptoms in older adults-A narrative review of current knowledge

Depression is one of the most common diseases in the older population. Difficulties in recognizing its etiology and recurrence make depression a major challenge for health care professionals. The risk of developing depression is influenced by many factors, including lifestyle and diet. Research studies have shown a relationship between the consumption of specific macro- and microelements and depression. However, so far, no nutritional recommendations on how to reduce the risk of the disease and its relapses in older adults have been developed. This review outlines research results of conducted studies and focuses on both basic and potentially promising elements of diet, such as proteins, carbohydrates, fats, dietary fiber, vitamins (D, E, C, and B), and microelements such as magnesium, zinc, selenium, or iron.

Social support and nutritional status: Positive psychological capital as a mediator

Nutrition is a critical public health concern for older adults and could be influenced by psychosocial factors. We explored the relationships of social support, positive psychological capital, and nutritional status among older adults from the perspective of positive psychology. We used random sampling to recruit 151 community-dwelling older adults aged 60 and over, and they took part in face-to-face or telephone interviews using a standardized questionnaire. Hierarchical linear regression and bootstrapping analyses were applied to examine mediation effects. The results show that there were significant positive correlations between the participants' social support, positive psychological capital, and nutritional status. Furthermore, we found a significant mediating effect of positive psychological capital in the relationship between social support and nutritional status. These findings are of significance for adopting positive psychology interventions to maintain and improve older adults' nutritional status.

Muscle Strength Moderates the Relationship between Nutritional Health Risk and Depression in Korean Older Adults

Background: Little is known about the relationships between muscle strength and nutritional health risk with late-in-life depression. This study aimed to investigate the moderating effect of lower-extremity muscle strength on the relationship between nutritional health risk and depression in Korean older adults. Methods: Data obtained from 5949 women and 3971 men aged ≥ 65 years in the 2020 Korea Longitudinal Study on Aging were used in this study. Exposures included lower-extremity muscle strength and nutritional health risk. Lower-extremity muscle strength was measured with a modified sit-to-stand test. The nutritional health risk was assessed using a screening tool. Depression was defined as a score ≥ 8 points on the Geriatric Depression Scale (GDS). Results: Logistic regression analyses showed that depression was positively associated with nutritional health risk (p < 0.001) and inversely associated with lower-extremity muscle strength (p < 0.001). A moderation analysis with Andrew Hayes’ PROCESS macro showed a significant moderating effect of lower-extremity muscle strength (β = −0.119; 95% confidence interval, −0.172 to −0.066; p < 0.001) on the relationship between nutritional health risk and depression; the weaker was the muscle strength, the steeper was the slope of the GDS score for nutritional health risk. Conclusions: The current findings suggest the need for an intervention targeting both high nutritional risk and weak muscle strength as a therapeutic strategy against depression in Korean older adults.

Clarifying the relationship between sarcopenia and depression in geriatric outpatients

OBJECTIVE

We investigate the relationship between sarcopenia components and depression in geriatric outpatients, considering the effects of potential confounding factors.

METHODS

Adults ≥60 years of age were selected from outpatient clinics. Muscle strength was assessed using handgrip strength (HGS) measured using a hydraulic hand dynamometer and chair stand test (CSST). Physical performance was evaluated by usual gait speed (UGS), nutritional status, and frailty were screened by mini-nutritional assessment (MNA) questionnaire and FRAIL scale. Depression was diagnosed through a psychiatric interview and the administration of the Geriatric Depression Scale (GDS).

RESULTS

Participants with depression were similar to participants without depression regarding age (p = .055), education (p = .095), frailty (p = .857), and HGS scores (p = .053). The group with depression had longer CSST duration (p = .023), slower UGS (p =  .027), and more malnutrition (p = .001). Multivariate regression analysis revealed that only the malnutrition was independently associated factor with depression after adjusting for confounding factors.

CONCLUSIONS

Depression is associated with malnutrition and some components of sarcopenia in geriatric outpatients. Our results revealed that sarcopenia might be associated with depression through malnutrition. If malnutrition lasts for a long time, sarcopenia may become evident in the later stages of depression.

Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

A Data-Driven Analysis of Sociocultural, Ecological, and Economic Correlates of Depression Across Nations

The prevalence of depression varies widely across nations, but we do not yet understand what underlies this variation. Here we use estimates from the Global Burden of Disease study to analyze the correlates of depression across 195 countries and territories. We begin by identifying potential cross-correlates of depression using past clinical and cultural psychology literature. We then take a data-driven approach to modeling which factors correlate with depression in zero-order analyses, and in a multiple regression model that controls for covariation between factors. Our findings reveal several potential correlates of depression, including cultural individualism, daylight hours, divorce rate, and GDP per capita. Cultural individualism is the only factor that remains significant across all our models, even when adjusting for spatial autocorrelation, mental healthcare workers per capita, multicollinearity, and outliers. These findings shed light on how depression varies around the world, the sociocultural and environmental factors that underlie this variation, and potential future directions for the study of culture and mental illness.

Patients with higher vitamin D levels show stronger improvement of self-reported depressive symptoms in psychogeriatric day-care setting

Depression is a common psychiatric disorder among geriatric patients that decreases the quality of life and increases morbidity and mortality. Vitamin D as a neuro-steroid hormone might play a role in the onset and treatment of depression. In the present study, the association between depressive symptoms and vitamin D concentration in serum was evaluated. 140 patients of a psychogeriatric day-care unit were included. The geriatric depression scale (GDS) and the Hamilton depression rating scale (HDRS) were assessed at the beginning and end of treatment, GDS scores additionally 6 weeks after discharge from the day-care unit. Vitamin D levels were measured at the beginning of the treatment, routinely. Patients with levels below 30 µg/L were treated with 1000 IU vitamin D per day. There was no association between the severity of depressive symptoms and the concentration of vitamin D at the beginning of the treatment. Patients with higher vitamin D levels showed a stronger decline of depressive symptoms measured by the GDS during their stay in the day-care unit. We provide evidence that vitamin D serum levels might influence antidepressant therapy response in a geriatric population. Prospective studies are necessary to determine which patients may profit from add-on vitamin D therapy.

The Role of Micronutrients in Ageing Asia: What Can Be Implemented with the Existing Insights

Life expectancy as a measure of population health does not reflect years of healthy life. The average life expectancy in the Asia-Pacific region has more than doubled since 1900 and is now above 70 years. In the Asia-Pacific region, the proportion of aged people in the population is expected to double between 2017 and 2050. Increased life expectancy leads to an increase in non-communicable diseases, which consequently affects quality of life. Suboptimal nutritional status is a contributing factor to the prevalence and severity of non-communicable diseases, including cardiovascular, cognitive, musculoskeletal, immune, metabolic and ophthalmological functions. We have reviewed the published literature on nutrition and healthy ageing as it applies to the Asia-Pacific region, focusing on vitamins, minerals/trace elements and omega-3 fatty acids. Optimal nutritional status needs to start before a senior age is reached and before the consequences of the disease process are irreversible. Based on the nutritional status and health issues in the senior age in the region, micronutrients of particular importance are vitamins A, D, E, C, B-12, zinc and omega-3 fatty acids. The present paper substantiates the creation of micronutrient guidelines and proposes actions to support the achievement of optimal nutritional status as contribution to healthy ageing for Asia-Pacific populations.

[Risk factors associated with malnutrition of community-dwelling older adults: A rapid review]

The aim of this review was to determine the most important risk factors (RF) in the development of malnutrition in people over 65 years living in the community. A rapid review has been conducted by applying the PRISMA methodology (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) and using the Medline database (PubMed). A search strategy was drawn up, up to 13 January 2020. A total of 24 articles published in the last 5years were included in this review. Assuming the methodological limitations of the present review, it is possible to conclude that undernutrition is a multifactorial problem whose most significant RF are: age, economic status, alterations in the digestive system, comorbidity, polymedication, dependence on the performance of daily life activities, physical inactivity, food insecurity, depression, social isolation, and the field of self-perceptions. Early identification of geriatric patients exposed to these RF can allow a preventive approach in the development of malnutrition from primary care.

Association of Lower Nutritional Status and Education Level with the Severity of Depression Symptoms in Older Adults-A Cross Sectional Survey

The study analyzes the relationship between nutritional status and depression symptoms severity in the older population. A total of 1975 older outpatients (1457 women and 518 men, median age 75) were included in the study. Depression symptoms severity was assessed using the Geriatric Depression Scale (GDS). Participants were divided into two subgroups according to GDS score. Group A: 0–5 points—without depression symptoms (1237, W:898, M:339), and group B: 6–15 points—with depression symptoms (738, W:559, M:179). The nutritional status of the patients was assessed with Mini Nutritional Assessment (MNA) and basic anthropometric variables (waist, hips, calf circumferences, body mass index (BMI), waist to hip ratio (WHR), and waist to height ratio (WHtR)). Education years and chronic diseases were also noted. Women with higher depression symptoms severity had significantly lower MNA scores [A: 26.5 (24–28) (median (25%−75% quartiles)) vs. B:23 (20.5–26)], shorter education time [A:12 (8–16) vs. B:7 (7–12)], smaller calf circumference [A:36 (33–38) vs. B: 34 (32–37)], and higher WHtR score [A:57.4 (52.3–62.9) vs. B:58.8 (52.1–65.6)]. Men with depression symptoms had lower MNA scores [A:26.5 (24.5–28) vs. B:24 (20.5–26.5)], shorter education [A:12 (9.5–16), B:10 (7–12)], and smaller calf circumference [A:37 (34–39), B:36 (33–38)]. In the model of stepwise multiple regression including age, years of education, anthropometric variables, MNA and concomitant diseases nutritional assessment, and education years were the only independent variables predicting severity of depression symptoms both in women and men. Additionally, in the female group, odds were higher with higher WHtR. Results obtained in the study indicate a strong relationship between proper nutritional status and education level with depression symptoms severity in older women and men.

Evaluation of malnutrition risk of inpatients in a research and training hospital: A cross-sectional study

BACKGROUND & AIMS

Malnutrition is one of the most important factors affecting the prognosis of inpatients. The aim of this study is to determine the malnutrition risk of hospitalized patients and to examine the relationship between the presence of malnutrition and other parameters.

METHODS

The study included 162 inpatients over the age of 25 who were staying in the hospital's internal medicine service for 7 days or more and who volunteered to participate in the study. A demographic-information questionnaire, consisting of 5 sections, a 24-h food recall record, NRS-2002, NRI and Beck Depression Inventory was given to patients during bedside interviews. After obtaining the necessary permission, the anthropometric measurements and biochemical parameter values of the patients were taken from their files. All statistical analyzes were performed by researchers with the SPSS package program.

RESULTS

Of 162 patients (48.8% female, 51.2% male), 24.7% were at risk for malnutrition according to NRS-2002 and 66.7% of the patients were not depressive, based on the Beck Depression Inventory scale. The malnutrition risk was higher (60.0%) in patients who had been hospitalized for more than 15 days (p = 0.010). The majority of those with malnutrition had no problems preventing them from eating (32.5%), were found to be not depressive (52.5%) and were in the normal range of body mass index (57.5%) (p = 0.002, p = 0.034, p = 0.001; respectively). Nutrient intake was lower in patients with a higher malnutrition risk, but the difference was insignificant (p > 0.05). Albumin levels (p = 0.028) and total protein levels (p = 0.015) were significantly lower in patients who were at risk of malnutrition. While overweight patients showed higher levels of serum albumin (p < 0.001), CRP levels were found to be lower in overweight patients (p < 0.001).

CONCLUSIONS

It was found that the majority of patients with malnutrition were in the normal range for BMI. Nutritional intake and biochemical parameters should be followed closely in patients who are at risk of malnutrition. Depression can be a cause for insufficient nutrition and should be evaluated, particularly in patients whose length of hospital stay is greater than 7 days.

Associations between depression, nutrition, and outcomes among individuals with coronary artery disease

OBJECTIVES

Depression and malnutrition are prevalent among people with coronary artery disease (CAD) and can affect their prognosis, but the relationship between depression and malnutrition and its co-effect on prognosis is not clear. We sought to explore that relationship and its effects.

METHODS

In this study, the nutritional and emotional statuses of 547 people with CAD were assessed using the Controlling Nutritional Status (CONUT) score and the Patient Health Questionnaire-9. The average follow-up period was 2.1 y, after which we explored the relationship between depression and nutrition and prognosis.

RESULTS

A total of 41% of the participants were found to have mild malnutrition, 10% moderate to severe malnutrition, 26% had mild depression, and 11% had moderate to severe depression. A total of 20.6% of the participants were found to have comorbidities of depression and malnutrition; and both moderate to severe depression (adjusted hazard ratio [HR], 1.674; 95% confidence interval [CI], 1.098-2.551) and moderate to severe malnutrition (adjusted HR, 1.686; 95% CI, 1.073-2.648) were observed to be risk factors for the composite end point. Participants with comorbidities of depression and malnutrition were found to have increased risk of cardiovascular death (HR, 5.390; 95% CI, 1.483-19.589) and composite end point (adjusted HR, 1.791; 95% CI, 1.133-2.833) compared to those without both depression and malnutrition.

CONCLUSIONS

Depression and malnutrition were found to be risk factors for adverse outcomes in people with CAD. People with CAD should pay attention to their emotional and nutritional statuses, and interventions must be timely and efficient.

[Impact on the risk of malnutrition and depression of a clinical trial with nutritional educational intervention in non-institutionalized elderly subjects receiving a telecare service in Terrassa (Spain)]

Introduction

Introduction: the elderly are a growing and vulnerable population. Depression and malnutrition are frequent, and there seems to be associated. Objectives: to assess the impact of a nutritional educational intervention on the risk of malnutrition and depression in elderly subjects. Methods: Analytical, experimental, randomized longitudinal study in 38 autonomous, non-institutionalized elderly subjects. Nutritional and depression risk were measured using the Mini Nutritional Assessment (MNA) and the Yesavage Geriatric Depression Scale (GDS-SF), respectively. The impact of the intervention was measured with nutrition and food security questionnaires. Statistics were performed with Spearman's correlation coefficient, and comparisons between means with the Student's t-test. A p-value  0.05 was considered significant. Results: 63.2 % of the sample had a good nutritional status, 28,9 % were at risk of malnutrition, and 7.9 % had malnutrition. Of the total of participants, 28.9 % had depression. A statistically significant, moderate and negative linear relationship was found between depression and nutritional risk (rho = -0.489; p  0.01). The nutritional educational intervention produced a significant increase in knowledge of food security (2.95 ± 2.53 compared to 0.37 ± 1.46; p  0.0005). Conclusions: the risks of malnutrition and depression are significantly associated in older adults. Furthermore, the nutritional educational intervention improved knowledge of food safety, but did not improve nutritional status or in the degree of depression.

Functional status mediates the association of nutritional status with depressive symptoms in patients with heart failure

AIMS

The decline of nutritional status and depressive symptoms are pandemic in heart failure patients and functional status may play a pivotal role between these. This study aimed to determine whether nutritional status is associated with depressive symptoms and whether functional status mediates this relationship in heart failure patients.

DESIGN

This was a secondary analysis of a cross-sectional study.

METHODS

The data were collected from November 2015-April 2016. Heart failure patients (N = 254) being hospitalized were included in this secondary analysis. The Depression Sub-Scale of the Hospital Anxiety and Depression Scale and the Duke Activity Status Index were used to assess patients' depressive symptoms and functional status. The nutritional status of patients was calculated using the Geriatric Nutritional Risk Index.

RESULTS

In this study, the average scores of depressive symptoms, nutritional status and functional status were 4.91 (SD 3.12), 102.38 (SD 6.57) and 20.58 (SD 8.96) respectively. Out of the 254 patients, 46 patients (18.1%) had significant depressive symptoms (the score of Depression Sub-Scale of the Hospital Anxiety and Depression Scale ≥ 8) and 55 (21.7%) suffered from malnutrition (the score of Geriatric Nutritional Risk Index ≤ 98). In the multiple regression analyses, nutritional status was negatively associated with depressive symptoms (β = -0.142, p = .02) and functional status mediated the relationship between nutritional status and depressive symptoms.

CONCLUSIONS

Many patients with heart failure have malnutrition and depressive symptoms. Functional status plays a mediating role in the relationship between nutritional status and depressive symptoms.

IMPACT

To relieve depressive symptoms in patients with heart failure, it is of importance to improve the functional status, especially for those with poor nutritional status.

Combined Depression and Malnutrition As an Effective Predictor of First Fall Onset in a Chinese Community-Dwelling Population: A 2-Year Prospective Cohort Study

This study aims to explore the single and joint effects of depression and malnutrition on the incidence of first fall onset in a Chinese community-dwelling elderly population. This cohort study consisted of 739 residents without a history of falls who were aged 60 years and older (mean age: 67.08 ± 5.79 years, female: 58.2%). Depression was defined with the Geriatric Depression Scale (GDS)-30; a score of ≥11 was considered to be depressed, while malnutrition was defined with the Mini Nutritional Assessment where a score <17 was defined as malnourished. Over a 2-year follow-up period, older adults who experienced at least one fall were allocated to the first fall onset group. The prevalence of baseline falls was 21.36%. During the 2-year follow-up, incidence of first fall onset was 13.13%. After adjusting for all confounders, depression alone (adjusted odds ratio [OR] = 3.545, 95% confidence interval [CI] = 1.318-9.535) and malnutrition alone (adjusted OR = 2.204, 95% CI = 1.183-4.108) were observed to be independent risk factors for first fall onset, while comorbidity of depression and malnutrition showed progressively increased risk of promoting first fall (adjusted OR = 8.161, 95% CI = 3.591-18.545) than those with only depression or malnutrition or without both depression and malnutrition. Malnutrition mediated 56% effects in the association between depression and first fall onset, while depression mediated 76% effects in the promoting role of malnutrition in first fall. Depression and malnutrition were found to be independent causes for promoting first fall, while mental health and nutrition should be treated as commonly prior interventions to delay first fall onset. Meanwhile, for malnourished Chinese community-dwelling older adults, avoidance or treatment of depression should be addressed at first.

Quality of life may be a more valuable prognostic factor than depression in older hemodialysis patients

PURPOSE

Depression and impairment of quality of life (QoL) reduce the survival of individual on hemodialysis (HD). However, few studies evaluated the impact of these conditions on the survival of older patients undergoing HD.

METHODS

A retrospective cohort study was performed including patients aged ≥ 60 years on HD in Recife, Brazil, assessed in 2013 and monitored until 2017. Depression was evaluated with the Mini-International Neuropsychiatric Interview and QoL with the Control, Autonomy, Self-realization, and Pleasure Questionnaire (CASP-16). Survival differences according to the depression and QoL status were measured by Kaplan-Meier analysis and Cox regression. Death Certificates were analyzed to assess the cause of death.

RESULTS

A total of 171 patients were included (mean age 68.7 ± 6.9 years). The mean follow-up time was 3 years (maximum 4.5 years) and there were 98 deaths (57.3% of the sample). In a multivariate model that included depression and QoL, only QoL impairment was associated with a higher risk of death (HR 1.62, p = 0.035). Among CASP domains, only "Control" was associated with survival (HR 0.90, p = 0.014). Depression was unrelated to the cause of death, but there was a trend for death by endocrine diseases if QoL was impaired (p = 0.057).

CONCLUSION

QoL impairment is a key predictor of prognosis in older patients on HD and may be more important than depression. It is important that teams dealing with this population include in protocols an assessment of QoL, in order to offer a range of care according to the needs of these patients.

Depression and quality of life in older adults on hemodialysis

Objective:

Depression is highly prevalent in hemodialysis patients, but few studies have evaluated older hemodialysis patients. The aim of this study was to evaluate the prevalence of depression, its associated factors and its impact on quality of life in an older population on hemodialysis.

Methods:

This was a cross-sectional study including 173 hemodialysis patients aged 60 years or older in Recife, Brazil. Depression was evaluated using the Mini-International Neuropsychiatric Interview when depressive symptoms (according to the 5-item Geriatric Depression Scale) were present. Quality of life was assessed with the Control, Autonomy, Self-realization and Pleasure Questionnaire (CASP-16). Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin, and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics.

Results:

Depression was present in 22.5% of the sample. Depressed patients presented low CASP-16 quality of life scores (31.6 vs. 24.2, p < 0.001), twice the odds of albumin levels < 3.8 g/dL (OR 2.36; 95%CI 1.10-5.07; p = 0.027) and higher parathormone levels (OR 1.06; 95%CI 1.00-1.13; p = 0.05).

Conclusion:

Older hemodialysis patients have a high prevalence of depression. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels. Teams dealing with older hemodialysis patients should include depression and quality of life assessments in care protocols.

Adhering to a vegetarian diet may create a greater risk of depressive symptoms in the elderly male Chinese population

BACKGROUND

A vegetarian diet may be a risk factor for depression, but this relationship was unclear in the elderly Chinese population.

METHODS

Self-report data were gathered from 1051 elderly persons using the Cohort of Elderly Health and Environment Controllable Factors, which was created in West Anhui, China. The depressive symptoms were set as binary, ordinal, and continuous outcomes, respectively, whereas the dietary structures were computed as an ordinal variable and a dummy variable. Multiple logistic regression, ordinal regression, and linear regression were used to assess the relationship by adjusting the potential confounding variables with p-values of <0.1 in univariate analysis.

RESULTS

The elderly participants who had a vegetable-based diet had the highest GDS scores of 8.78 ± 6.894 (p = 0.001) and the highest rate of depression (32.9%, p = 0.003). After adjustment for the potential confounders, elderly men who had a vegetable-based diet had a higher rate of depression (OR[95%CI]: 1.62[1.07-2.46], 4.71[1.38-16.03]), more severe symptoms of depression (OR[95%CI]: 8.85[2.94-34.12]), and higher GDS scores (β[95%CI]: 1.46[0.70-2.22], 2.97[1.28-4.67]) than male participants who had a meat-based diet, but this was not the case in women.

LIMITATIONS

All data were self-reported. The study lacked quantitatively evaluated dietary intake. The duration of the current dietary structures and comorbidities were not reported. The cross-sectional study made the causal role uncertain.

CONCLUSIONS

Vegetarian diets may pose a greater risk of depressive symptoms among the elderly Chinese population, especially elderly men. Given the cross-sectional nature of this study, the causal role was uncertain. Further prospective studies, in particular among elderly women, are needed.