[Gender aspects of malnutrition and associated sequelae. Prevention and therapy]

Sex differences in clinical presentation, treatment response, and side effects of nutritional therapy among patients at nutritional risk: a secondary analysis of the randomized clinical trial EFFORT

BACKGROUND

Considering sex-specific factors has become an increasingly recognized area for research and practice, in the field of clinical nutrition, there is insufficient evidence regarding differences in clinical presentation, treatment response, and side effects of nutritional therapy among female and male patients.

OBJECTIVES

We hypothesized that the clinical presentation, response to nutritional therapy, and side effects from the intervention would differ in the two sexes.

METHODS

This secondary analysis investigated differences among female and male patients at risk for malnutrition regarding initial presentation, clinical outcomes, and treatment response in patients included in the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial comparing individualized nutritional support to usual care.

RESULTS

Of 2028 patients included in the trial, 964 were females and 1064 were males. The nutritional history and clinical presentation of female patients was different: they consumed less food and had a greater loss of appetite than the male population. Male patients had higher risk for mortality at 180 d [27% compared with 19%; adjusted hazards ratio (HR): 1.35; 95% CI: 1.12, 1.63] and further adverse clinical outcomes. However, there was no difference in the effect of nutritional support on mortality among female and male patients (HR: 0.76; 95% CI: 0.45, 1.27, compared with HR: 0.81; 95% CI: 0.54, 1.21, respectively; P-interaction = 0.939).

CONCLUSIONS

Results of this multicenter randomized trial suggest that multimorbid female inpatients have a different clinical presentation and are more prone to loss of appetite and reduced daily dietary intake than male inpatients. Importantly, the favorable response to nutritional interventions was similar in both sexes. This trial was registered at clinicaltrials.gov as NCT02517476.

The state of nutrition and the self-assessment of symptoms of depression in the group of seniors living in the countryside of Lublin province - preliminary report

INTRODUCTION

The incidence of malnutrition increases together with the number of chronic diseases and medications taken daily. There are also other factors causing changes in the nutrition of the elderly, raising the risk of undernourishment. Such factors include difficulties with daily shopping, meal preparation and other everyday activities, hindering access to food with proper quantitative and qualitative properties. The nutritional state of the elderly is influenced not only by somatic disorders, but also by mental disorders such as depression.

AIM

To define the relationship between the nutritional state of the elderly living in their home environment and the incidence of depression.

MATERIAL AND METHODS

The described sample consisted of 116 (100%) elderly persons living in the Lubelskie Voivodeship, using the services carried out within primary healthcare. The nutritional state of the elderly was assessed with the use of the full version of the Mini Nutritional Assessment (MNA) questionnaire. In order to determine the intensity of depression symptoms, the Geriatric Depression Scale (GDS) (the 15-item version by Yesavage) was applied.

RESULTS

During analysis of the impact of depression on malnutrition risk, a correlation with a high statistical significance level was found. Malnutrition was significantly more often identified in people in whom the GDS scale revealed severe depression (p = 0.00002). The risk of depression has a substantial impact on nutritional state. The nutritional state of the elderly deteriorates together with the increase of the risk of depression.

CONCLUSIONS

In over 48% of respondents, including those living with their families, an intensification of depression symptoms was found.