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Lavriša Ž, Pravst I. Nutritional Challenges in Nursing Homes: Pilot Study on Macronutrient Intake and Status of Vitamins D and B12. Nutrients 2024; 16:1495. [PMID: 38794733 PMCID: PMC11124101 DOI: 10.3390/nu16101495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Older adults living in nursing homes (NH) are considered a population group that could be at risk in terms of nutrition, even more so than their community-dwelling peers. Evidence on the nutritional status of NH residents is scarce, as they are commonly excluded from population-based dietary studies. This is also the case in Slovenia. In the presented pilot study, we assessed the intake of macronutrients as well as the intake and status of vitamin D and vitamin B12 on a sample of NH and NH daycare center users to explore the need for a larger representative study. The pilot study included 37 participants from three Slovenian NH (20 participants) and their daycare centers (17 participants). Daycare centers offer daytime care services for older adults, where users are also provided with major meals during their stay. Intakes of energy and nutrients were estimated by three 24 h dietary records. Fasting blood samples were collected for the assessment of vitamin D and vitamin B12 status. Over 90% of the participants had daily energy and protein intakes below recommendations (reference values: energy intake: males 2100 kcal and females 1700 kcal; protein intake > 1 g/kg body mass). The males' median daily intakes of vitamin D were 1.7 µg (1.5 µg females), and 2.3 µg for vitamin B12 (2.0 µg females). None of the participants had adequate vitamin D intake (>20 µg), and 92.3% males and 87.5% females had inadequate vitamin B12 intake (<4 µg). The prevalence of vitamin D deficiency (serum 25-OH-D conc. < 30 nmol/L) was 100% among NH residents and 53% among NH daycare center users. The prevalence of vitamin B12 deficiency was found in 20% of NH residents. The study results highlighted that certain nutrients might be critical in this population, especially among NH residents; however, a more thorough investigation with the inclusion of other important markers of nutritional status should be performed on a larger, representative sample to support the development and implementation of appropriate public health interventions.
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Affiliation(s)
- Živa Lavriša
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia;
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - Igor Pravst
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska ulica 98, SI-1000 Ljubljana, Slovenia;
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
- VIST–Faculty of Applied Sciences, Gerbičeva cesta 51A, SI-1000 Ljubljana, Slovenia
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Zittermann A, Schmidt A, Haardt J, Kalotai N, Lehmann A, Egert S, Ellinger S, Kroke A, Lorkowski S, Louis S, Schulze MB, Schwingshackl L, Siener R, Stangl GI, Volkert D, Watzl B, Bischoff-Ferrari HA. Protein intake and bone health: an umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society. Osteoporos Int 2023:10.1007/s00198-023-06709-7. [PMID: 37126148 PMCID: PMC10382330 DOI: 10.1007/s00198-023-06709-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/13/2023] [Indexed: 05/02/2023]
Abstract
This umbrella review aimed at assessing whether a protein intake exceeding the current recommendation for younger (0.8 g/kg body weight [BW]/day) and older (1.0 g/kg BW/day) adults affects bone mineral density and fracture risk. Moreover, the effect of animal or plant protein was evaluated. A systematic literature search was conducted in PubMed, Embase, and Cochrane Database of Systematic Reviews for systematic reviews (SRs) with or without meta-analysis of prospective studies published between 11/2008 and 08/2021. Methodological quality, outcome-specific certainty of evidence, and overall certainty of evidence of the retrieved SRs were assessed using established tools and predefined criteria. Eleven SRs of randomized controlled trials (RCTs) and/or cohort studies were included. In SRs of cohort studies and RCTs, protein intake/kg BW/day ranged between 0.21-0.95 g (low intake) and > 1.24 g (high intake), respectively, and between 0.67-1.1 g (control groups) and 1.01-1.69 g (intervention groups), respectively. The vast majority of outcome-specific certainty of evidence was rated "low" or "very low." The overall certainty of evidence for an association (cohort studies) or effect (RCTs) of total, animal or plant protein intake on each of the investigated outcomes was rated "insufficient," with the exception of possible evidence for a reduced hip fracture risk by high vs. low protein intake. Since protein intakes in low/control and high/intervention groups were very heterogeneous and with low certainty of evidence, it remains unclear whether a dose above the current recommendation or type of protein intake (animal or plant protein) affects bone health overall. However, there is possible evidence for reduced hip fracture risk with high versus low protein intake.
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Affiliation(s)
- Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum Nordrhein Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | | | - Julia Haardt
- Science Department, German Nutrition Society, Bonn, Germany
| | - Nicole Kalotai
- Science Department, German Nutrition Society, Bonn, Germany
| | | | - Sarah Egert
- Department of Nutrition and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany
| | - Sabine Ellinger
- Department of Nutrition and Food Science, Human Nutrition, University of Bonn, Bonn, Germany
| | - Anja Kroke
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Stefan Lorkowski
- Institute of Nutritionals Sciences, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-, Leipzig, Germany
| | - Sandrine Louis
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Bonn, Germany
| | - Gabriele I Stangl
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Halle, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Bernhard Watzl
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital Zurich, University of Zurich, and City Hospital Zurich, Zurich, Switzerland
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Effects of an increased habitual dietary protein intake followed by resistance training on fitness, muscle quality and body composition of seniors: a randomised controlled trial. Clin Nutr 2022; 41:1034-1045. [DOI: 10.1016/j.clnu.2022.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/08/2021] [Accepted: 02/18/2022] [Indexed: 11/20/2022]
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Tan J, Xu Z, He Y, Zhang L, Xiang S, Xu Q, Xu X, Gong J, Tan C, Tan L. A web-based novel prediction model for predicting depression in elderly patients with coronary heart disease: A multicenter retrospective, propensity-score matched study. Front Psychiatry 2022; 13:949753. [PMID: 36329913 PMCID: PMC9624295 DOI: 10.3389/fpsyt.2022.949753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is associated with an increased risk of death in patients with coronary heart disease (CHD). This study aimed to explore the factors influencing depression in elderly patients with CHD and to construct a prediction model for early identification of depression in this patient population. MATERIALS AND METHODS We used propensity-score matching to identify 1,065 CHD patients aged ≥65 years from four hospitals in Chongqing between January 2015 and December 2021. The patients were divided into a training set (n = 880) and an external validation set (n = 185). Univariate logistic regression, multivariate logistic regression, and least absolute shrinkage and selection operator regression were used to determine the factors influencing depression. A nomogram based on the multivariate logistic regression model was constructed using the selected influencing factors. The discrimination, calibration, and clinical utility of the nomogram were assessed by the area under the curve (AUC) of the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA) and clinical impact curve (CIC), respectively. RESULTS The predictive factors in the multivariate model included the lymphocyte percentage and the blood urea nitrogen and low-density lipoprotein cholesterol levels. The AUC values of the nomogram in the training and external validation sets were 0.762 (95% CI = 0.722-0.803) and 0.679 (95% CI = 0.572-0.786), respectively. The calibration curves indicated that the nomogram had strong calibration. DCA and CIC indicated that the nomogram can be used as an effective tool in clinical practice. For the convenience of clinicians, we used the nomogram to develop a web-based calculator tool (https://cytjt007.shinyapps.io/dynnomapp_depression/). CONCLUSION Reductions in the lymphocyte percentage and blood urea nitrogen and low-density lipoprotein cholesterol levels were reliable predictors of depression in elderly patients with CHD. The nomogram that we developed can help clinicians assess the risk of depression in elderly patients with CHD.
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Affiliation(s)
- Juntao Tan
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengguo Xu
- Department of Teaching and Research, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin He
- Department of Medical Administration, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Lingqin Zhang
- Department of Biomedical Equipment, People's Hospital of Chongqing Bishan District, Chongqing, China
| | - Shoushu Xiang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Qian Xu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China.,Medical Data Science Academy, Chongqing Medical University, Chongqing, China.,Library, Chongqing Medical University, Chongqing, China
| | - Xiaomei Xu
- Department of Gastroenterology, The Fifth People's Hospital of Chengdu, Chengdu, China.,Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Gong
- Department of Information Center, The University Town Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Tan
- Department of Medical Record Management, Chongqing University Cancer Hospital, Chongqing, China
| | - Langmin Tan
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
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Seemer J, Kiesswetter E, Fleckenstein-Sußmann D, Gloning M, Bader-Mittermaier S, Sieber CC, Sixt B, Wurm S, Volkert D. Effects of an individualised nutritional intervention to tackle malnutrition in nursing homes: a pre-post study. Eur Geriatr Med 2021; 13:741-752. [PMID: 34854062 PMCID: PMC9151515 DOI: 10.1007/s41999-021-00597-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Individualised interventions are recommended to tackle malnutrition in older adults, but approaches for nursing home (NH) residents are scarce. This study investigated the effects of an individualised nutritional intervention in NH residents with (risk of) malnutrition. METHODS In a pre-post study, 6 weeks (w) of usual care were followed by 6w of intervention. The intervention consisted of up to three supplement modules (sweet and savoury protein creams and protein-energy drink, single or combined) and, if required, reshaped texture-modified meals (RTMM). RESULTS Fifty residents completed the study (84 ± 8 years, 74% female). One-third (32%) received RTMM. Additional 258 ± 167 kcal/day and 23 ± 15 g protein/day were offered. Mean daily energy intake increased by 207 (95%CI 47-368, p = 0.005) kcal and protein intake by 14 (7-21, p < 0.001) g (w12 vs w1). Quality of life (QoL) increased in the subscale "care relationship" (+ 9 (3-15) points, p = 0.002, w12 vs w6). Body weight, handgrip strength, and other QoL subscales did not change. CONCLUSION Our intervention improved dietary intake and one QoL subscale in NH residents with (risk of) malnutrition. As a next step, randomized controlled trials are needed to investigate the impact of individualised interventions more comprehensively.
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Affiliation(s)
- J Seemer
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - E Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | | | - M Gloning
- Institute of Food Technology, Hochschule Weihenstephan-Triesdorf, Freising, Germany
| | - S Bader-Mittermaier
- Fraunhofer Institute for Process Engineering and Packaging, Freising, Germany
| | - C C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - B Sixt
- Institute of Food Technology, Hochschule Weihenstephan-Triesdorf, Freising, Germany
| | - S Wurm
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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