Economic Challenges in Nutritional Management

Obesity in European nursing homes participating in nutritionDay 2016-2021-Prevalence and resident characteristics

The objective of this study is to assess obesity prevalence and characterize European nursing home (NH) residents with obesity comprehensively. Cross-sectional nutritionDay data from 2016 to 2021. Descriptive characterization of European NH residents ≥65 years with and without obesity. Binomial logistic regression to identify factors associated with obesity. A total of 11 327 residents (73.8% female, 86.4 ± 7.9 years, mean body mass index 25.3 ± 5.4 kg/m2) from 12 countries were analysed. Obesity prevalence was 17.7%, mostly class I (13.0%). Taking ≥5 drugs/day (OR 1.633; 95% confidence intervals 1.358-1.972), female sex (1.591; 1.385-1.832), being bed/chair-bound (1.357; 1.146-1.606), and having heart/circulation/lung disease (1.276; 1.124-1.448) was associated with increased obesity risk, older age (0.951; 0.944-0.958), mild (0.696; 0.601-0.805) and severe (0.591; 0.488-0.715) dementia, eating less than ¾ of lunch on nutritionDay (0.669; 0.563-0.793), needing assistance for eating (0.686; 0.569-0.825), and being identified by NH staff at risk for (0.312; 0.255-0.380) or with malnutrition (0.392; 0.236-0.619) decreased obesity risk. Almost one in five residents in European NH participating in nutritionDay is affected by obesity. Through a wide exploratory analysis, including data from 12 European countries, we confirmed previous findings and identified additional factors associated with obesity that should be considered in the daily care of affected residents.

Intermittent fasting versus continuous energy-restricted diet for patients with type 2 diabetes mellitus and metabolic syndrome for glycemic control: A systematic review and meta-analysis of randomized controlled trials

AIMS

To compare the safety of intermittent fasting (IF) with that of continuous energy-restricted diets (CERD) in patients with T2DM and metabolic syndrome who were overweight or obese and assess their effects on glycemic control and weight loss.

MATERIALS AND METHODS

We searched MEDLINE (Ovid), Embase, and SINOMED databases up to September 13, 2020. The major outcome was glycemic control and secondary outcomes were change in weight, fasting insulin, and lipid profile.

RESULTS

Of 84 retrieved studies, 5 met our inclusion criteria. Of these, four studies comprising 355 participants were included in the meta-analysis. Based on changes in HbA1c (-0.06, 95% confidence interval [CI] -0.27 to 0.16) and fasting plasma glucose (-0.27, 95% CI -0.76 to 0.22), IF and CERD had similar effects on glycemic control. Moreover, IF had a better effect on weight loss (-1.70, 95% CI -3.28 to -0.11 kg). Patients in both groups experienced similar improvements in fasting insulin and lipid profile as well as similar hypoglycemic events.

CONCLUSIONS

IF is a safe diet pattern and could be implemented for patients with T2DM or metabolic syndrome. Further studies with a larger sample size are needed to verify the effectiveness and safety of IF in patients with T2DM.

The quality of nutritional care in hospitals: Austria, Switzerland, and Turkey compared

OBJECTIVE

The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey.

METHODS

This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed.

RESULTS

Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention.

CONCLUSIONS

The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.

Insufficiency of B vitamins with its possible clinical implications

Vitamin deficiency causes classical deficiency diseases such as beriberi and rickets. Vitamin insufficiency, which is milder than deficiency, is a risk for various chronic diseases, but its significance has not been recognized in Japan. Vitamin D insufficiency is quite common in Japan, and a serious risk for osteoporotic fracture through its unbeneficial effect on bone and muscle. Insufficiency of B vitamins has been little studied. However, hyperhomocysteinemia caused by the insufficiency of vitamin B12 or folate is a risk for cardiovascular disease, osteoporotic fracture, and cognitive impairment. Additionally, we have recently reported that vitamin B1 insufficiency is a risk for heart failure in the elderly. The effect of improvement of nutritional status including vitamins is less marked compared to drug treatment, but it costs far less, and is suited for the primary prevention of diseases. Randomized controlled trial is considered the study with the most robust evidence in the evaluation of drug treatment, but more emphasis should be put on the well-designed cohort studies in evaluating the role of nutrients. Vitamin insufficiency is quite prevalent, and vitamin requirement is much higher for its prevention than for the prevention of deficiency.

Hospital Malnutrition, a Call for Political Action: A Public Health and NutritionDay Perspective

Disease-related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analysed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical, surgical, long-term care and other patients (n = 153,470). In 59,126 medical patients included between 2006 and 2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. A similar pattern is found in all four patient groups. Nutrition care processes increase slightly with the presence of risk factors but are never done in more than 50% of the patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.