Meta-analysis and moderator analysis of the prevalence of malnutrition and malnutrition risk among older adults with dementia

Evaluating dietary quality and dietary inflammatory potential in cognitive impairment patients in China

INTRODUCTION

Diet plays a critical role in the prevention and treatment of cognitive impairment, yet dietary intake in patients with cognitive impairment in China remains insufficiently studied.

METHODS

A 25-item semi-quantitative food frequency questionnaire was used in a national online survey in China. The Dietary Inflammatory Index was calculated, and principal component analysis was used to identify dietary patterns.

RESULTS

The average daily energy intake was 1131.59 ± 486.30 kcal, below recommended levels. Patients in the pro-inflammatory diet group had lower intakes of nutrients than those in the anti-inflammatory group. Ordinal logistic regression indicated that adherence to a high-quality protein dietary pattern was associated with lower cognitive impairment severity, whereas the high cereal and snack dietary pattern was associated with increased severity.

CONCLUSION

Inadequate intake of essential nutrients, particularly energy and protein, exacerbates cognitive decline. Promoting high-quality protein intake while reducing low-quality carbohydrates may mitigate cognitive deterioration and improve patient health outcomes.

HIGHLIGHTS

Cognitive impairment patients in China show significantly low intake of energy, protein, and essential nutrients, which contributes to malnutrition and exacerbates cognitive decline. The study finds a link between inadequate nutrient intake and increased dietary inflammatory potential, which may accelerate cognitive decline. The pro-inflammatory deit with higher Dietary Inflammatory Index resulted from an overall insufficient intake of nutrients rather that the comsumption of excessively high levels of "pro-inflammatory" foods in patients. Dietary patterns with higher high-quality protein and lower low-quality carbohydrate intake may benefit nutritional status and cognitive health in cognitively impaired patients.

Current Status of Nursing Home Distribution in China: A National Cross-Sectional Study

AIMS

Population aging is a challenge that the whole world is facing, especially in China. This study aims to investigate the current distribution status of nursing homes in China using spatial epidemiology methods.

DESIGN

Cross-sectional study in China.

METHODS

The data were obtained from the Integrated Civil Affairs Government Service Platform 'China County Statistical Yearbook' for 2020 and the 'China City Statistical Yearbook' for 2020. Using global Moran's index to test the clustering of nursing homes, inter-group and intra-group Theil index was utilised to differentiate the sources of differences. The coupling coordination analysis was conducted to explore the coordination. Geographically weighted regression was utilised to investigate the impact of economic development and aging on nursing home resources. All analyses were conducted by Arcgis 10.8 and R Studio 4.3.2.

RESULTS

Global Moran's index indicated that the distribution of nursing homes in China exhibited clustering. The Theil index values for institutions and beds at the national county were 0.32450 and 0.30675. However, upon comparing provinces and regions, it was found that the differences across the country mainly stem from within provinces (contribution rate: institutions 65.0%; beds 73.0%) and within regions (contribution rate: institutions 99.0%; beds 91.0%). The majority of districts and counties had a coupling coordination index of institutions and bed numbers, both of which were < 0.5.

CONCLUSION

The development of nursing home resources in China has been rapid, generally presenting a balanced state, but further optimisation is needed. This study established a foundation for the targeted distribution of essential public services, focusing on nursing home healthcare resources tailored to the needs of older persons.

IMPLICATIONS

The study underscored the urgent need for targeted elderly care policies, emphasising the optimisation of resource distribution to enhance the overall quality of care provided to the aging population.

NO PATIENTS OR PUBLIC CONTRIBUTION

The study did not involve humans.

Early detection of Alzheimer's disease using the MEMORIES mnemonic

The rising incidence and death rates linked to Alzheimer's disease (AD) highlight an urgent issue. Genetic screening is celebrated as a significant advancement for its early detection capabilities, pinpointing those at risk before the emergence of symptoms. Yet, the limited availability of these technologies highlights a critical gap in widespread application. This review pivots to the potential of presymptomatic clinical assessments as a readily available, economical, and simple strategy for early detection. Traditionally, AD diagnosis relies on the late-stage identification of cognitive deterioration, functional impairments, and neuropsychiatric symptoms, coinciding with advanced brain degeneration. Conversely, emerging research identifies early indicators preceding significant degeneration, manifesting years before clinical symptoms. We introduce a mnemonic, MEMORIES, to categorize these prodromal: Metabolism changes, Eye/visual impairments, March (refer to gait disturbances), Olfactory dysfunction, Rhythm (blood pressure and heart rate), Insensitivity of the tongue, Ears (hearing loss), and Stool alterations. Recognizing these prodromal through clinical examinations provides a valuable strategy for initiating preventative actions against brain degeneration. This approach advocates for broadening the screening lens beyond genetic screening to encompass clinical evaluations, enhancing early detection and intervention opportunities for AD.

Frailty, malnutrition, healthcare utilization, and mortality in patients with dementia and cognitive impairment obtained from hospital administrative data

Introduction

With aging populations, the prevalence of dementia, frailty and malnutrition will increase. The aim of this study is twofold (a) to determine the demographic data, including frailty and malnutrition prevalence in older patients with diagnosis of dementia and/or cognitive impairment and (b) to determine its impact on outcomes such as length of stay (LOS), readmission and mortality stratified by frailty status.

Methods

Retrospective single-center cohort study conducted using hospital database on older patients ≥65 yrs. admitted to a tertiary hospital between March 2022 and Dec 2023 and discharged with either primary or secondary diagnosis of dementia or cognitive impairment. Data on age, gender, ethnicity, comorbidities, discharge diagnoses, Hospital Frailty Risk Score (HFRS), Clinical Frailty Scale (CFS), activity of daily living (ADL), 3-Minute Nutrition Screening and outcomes such as LOS, readmission, mortality and cost of hospitalization were extracted. Those aged between 65 to 74 years old were categorized as "young-old," and ≥75 years old as "old-old."

Results

Dementia or cognitive impairment diagnosis was prevalent in 8.6% (3090) older patients, and 33.7% were malnourished. 54.5% were female with a mean age of 82.0 years. Almost one fourth were dependent on ADL. Based on frailty defined by (i) HFRS-26.0% had intermediate and 18.2% high frailty (ii) CFS-41.0% were mild/moderately frail, and 32.2% severely frail. Median LOS was 8 days. 30 and 90-days readmission rates were 23.2 and 35.4%, respectively. In-hospital mortality was 7.8% and 30-day mortality 14.0%. High HFRS (aOR 1.511, 95% CI: 1.089-2.097; p = 0.013), severe frailty (aOR 4.325, 95% CI: 0.960-2.684; p < 0.001) and terminal frailty (aOR 39.762, 95% CI: 18.311-86.344; p < 0.001) were significantly associated with inpatient mortality. Intermediate HFRS (aOR 1.682, 95% CI: 1.380-2.050; p < 0.001), mild/moderate frailty (1.609, 95% CI: 1.254-2.065; p < 0.01), high HFRS (aOR 2.178, 95% CI: 1.756-2.702; p < 0.001) and severe frailty (2.333, 95% CI: 1.804-3.017; p < 0.01) were significantly associated with 30-days readmission. The impact of malnutrition on healthcare utilization was highest in the old-old with high HFRS and severe frailty.

Conclusion

Frailty and malnutrition have significant impact on healthcare utilization, readmission rates, and mortality among older adults with dementia and/or cognitive impairment.

Global prevalence and moderating factors of malnutrition in colorectal cancer survivors: A meta-analysis

PURPOSE

This meta-analysis aims to estimate the global prevalence of severe, moderate, overall malnutrition and moderating factors of malnutrition in colorectal cancer (CRC) survivors.

METHODS

A comprehensive search was conducted in Embase, CINAHL, Medline-OVID, PubMed, Scopus, and Web of Science from inception to February 8, 2024, without language, region, or publication date restrictions. A generalized linear mixed model and random-effects model were used to examine the pooled prevalence, and moderator analyses were implemented to investigate variations in the pooled prevalence.

RESULTS

In 35 studies involving 9,278 colorectal cancer survivors, the global prevalence was 12.10% for severe malnutrition (95% confidence interval (CI): 7.28-16.92; n = 507), 33.13% for moderate malnutrition (95% CI: 28.93-37.34; n: 2,192), and 47.78% for overall malnutrition (95% CI: 41.60-53.96; n: 3,812). Asia showed higher rates of severe malnutrition 16.67% (95% CI: 4.66-28.68, n: 232) and overall malnutrition 53.17% (95% CI: 39.66-66.69, n: 1,913), whereas low-middle income countries demonstrated higher rates of overall malnutrition 67.46% (95% CI: 30.25-100.00, n: 82). Male sex, colon cancer, advanced stage, metastasis, chemotherapy, surgery, adjuvant treatment, smoking, alcohol consumption, hypertension, and diabetes significantly moderated overall malnutrition prevalence.

CONCLUSIONS

This meta-analysis reports detailed data on the global prevalence of CRC survivors experience malnutrition, highlighting that health-care professionals should consider the identified moderating factors.

IMPLICATIONS FOR CANCER SURVIVORS

Addressing malnutrition in CRC survivors is critical, as early and proactive nutritional management can enhance recovery, improve quality of life, and potentially reduce cancer-related complications associated with malnutrition.

Health status correlates of malnutrition diagnosed based on the GLIM criteria in older Polish adults-Results of the PolSenior 2 study

INTRODUCTION

Older individuals are at risk of malnutrition resulting from chronic diseases-related body and muscle mass reduction. In turn, nutritional deficiencies may enhance catabolic processes, leading to accelerated aging and comorbidity, thus creating a vicious cycle. Our study aimed to assess the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to determine the health correlates of malnutrition in a representative sample of community-dwelling older adults.

METHODS

We used the GLIM criteria to diagnose malnutrition in 5,614 participants of the PolSenior2 study. The PolSenior2 study was a population-based survey designed to assess the medical, psychological, social, and economic characteristics of community-dwelling older adults.

RESULTS

Malnutrition was diagnosed in 13.4% of the participants using the GLIM criteria. Results of multiple logistic regression showed that the risk of depression [OR 4.18, p<0.001], peptic ulcer disease [OR 2.73, p<0.001], past stroke [OR 1.71, p<0.001], cognitive impairment [OR 1.34, p = 0.015], and chronic pain [OR 1.23, p = 0.046] were independent correlates of malnutrition.

CONCLUSION

Due to the high risk of malnutrition, special attention should be paid to individuals in late old age. Suspected malnutrition should also be considered in people at risk of depression, with peptic ulcer disease, past stroke, and cognitive impairment. Chronic pain should also prompt the diagnosis for malnutrition.

Addressing Inflammaging and Disease-Related Malnutrition: Adequacy of Oral Nutritional Supplements in Clinical Care

BACKGROUND

Disease-related malnutrition, with or without inflammation, in older adults is currently emerging as a public health priority. The use of Foods for Special Medical Purposes, including Oral Nutritional Supplements, and supplements is crucial to support patients in achieving their nutritional needs. Therefore, this article aims to comprehensively provide an analysis of the adequacy of FSMPs in meeting the nutritional requirements of different age-related diseases and takes into account the emerging role of inflammation. Moreover, it provides an identikit of the ideal products, following the pathology-specific guidelines.

METHODS

Data on 132 products were gathered through face-to-face meetings with companies' consultants. Specifically, information on energy, macronutrient, and micronutrient contents were collected, as well as on texture and flavors, osmolarity, cost, and packaging.

RESULTS

Most FSMPs met the daily recommendations for energy and protein intake. Nonetheless, few products contained β-hydroxy-β-methylbutyrate, optimal Branched-Chain Amino Acids ratios, arginine, glutamine, and omega-3 fatty acids. Furthermore, a marked predominance of FSMPs with a high osmolarity (85.7%), sweet taste (72%), and only animal protein content (79.5%) was observed. Cost analysis of FSMPs revealed a mean cost of EUR 5.35/portion. Products were mostly adequate for cancer, neurodegenerative diseases, diabetes, inflammatory bowel disease, end-stage kidney disease, dysphagiam and chronic obstructive pulmonary disease. However, gaps have been found for sarcopenia and abdominal surgery.

CONCLUSION

In light of the current market landscape, there is a need for a comprehensive regulation that indicates the optimal composition of FSMPs and the production of such products to tackle disease-related malnutrition.

The Concurrent Association of Magnesium and Calcium Deficiencies with Cognitive Function in Older Hospitalized Adults

Background/Objectives: Hypomagnesemia and hypocalcemia are common conditions among older adults that may contribute to cognitive decline. However, most of the existing research has focused primarily on dietary intake rather than the actual serum levels of these nutrients or examined them separately. This study aims to investigate the relationship between hypomagnesemia, hypocalcemia, and the concurrent presence of both deficiencies in relation to cognitive performance among seniors. Methods: A total of 1220 hospitalized patients aged 60 and older were included in the analysis. The participants were categorized into four groups: those with normal serum levels of magnesium and calcium, those with hypomagnesemia, those with hypocalcemia, and those with both serum magnesium and calcium deficiencies. To evaluate the potential influence of age, sex, common comorbidities, and disturbances in magnesium and calcium levels on cognitive performance, two general linear models were employed, using the Mini-Mental State Examination (MMSE) and Clock-Drawing Test (CDT) as dependent variables. Results: After adjusting for age, sex, body mass index, and comorbidities, the mean values for the MMSE and CDT were 23.33 (95%CI: 22.89-23.79) and 5.56 (95%CI: 5.29-5.83) for the group with normomagnesemia and normocalcemia, 22.59 (95%CI: 21.94-23.24) and 5.16 (95%CI: 4.77-5.54) for the group with hypomagnesemia, 19.53 (95%CI: 18.36-20.70) and 4.52 (95%CI: 3.83-5.21) for the group with hypocalcemia, and 21.14 (95%CI 19.99-22.29) and 4.28 (95%CI 3.61-4.95) for the group with both hypomagnesemia and hypocalcemia, respectively. Magnesium and calcium deficiencies contributed to MMSE and CDT variance in the general linear models. Conclusions: Our findings indicate that in addition to age, body mass index, and chronic heart failure, both hypomagnesemia and hypocalcemia are associated with reduced cognitive performance.

The Association of Cognitive Impairment and Depression with Malnutrition among Vulnerable, Community-Dwelling Older Adults: A Large Cross-Sectional Study

(1) Background: Mental health issues in older adults, particularly cognitive impairment and depression, can affect nutritional status. This study investigates the prevalence of malnutrition among community-dwelling older adults at risk of social exclusion and dependency in Lebanon and its association with cognitive impairment and depression. (2) Methods: This cross-sectional study used secondary data from the TEC-MED project, involving 1410 older adults aged 60 and above in Beirut. Nutritional status was assessed with the Mini Nutritional Assessment _Short Form (MNA_SF), cognitive impairment with the AD8 Dementia Screening Interview, and depression with the Geriatric Depression Scale (GDS-15). (3) Results: 87.2% of participants were at risk of malnutrition, and 2.5% were malnourished. Cognitive impairment was present in 82.2% of the sample and 45% experienced moderate to severe depression. Malnourished individuals had significantly higher rates of cognitive impairment (96.7% vs. 57.8%) and depression (85.7% vs. 23.2%). Significant associations were found between the risk of malnutrition, decreased food intake, cognitive impairment, and depression; however, no significant association was found with BMI. Logistic regression analysis indicated that older age, cognitive impairment, and depression were significant predictors of malnutrition, while having a caregiver was protective. (4) Conclusions: The high prevalence of risk of malnutrition among vulnerable older adults with cognitive impairment and depression underscores the need for policies integrating nutritional screening into routine health check-ups for older adults.

Dual-task training in older adults with cognitive impairment: A meta-analysis and trial sequential analysis of randomized controlled trials

OBJECTIVE

To determine the effects of simultaneous dual-task training on cognitive function, physical function, and depression in older adults with mild cognitive impairment or dementia.

METHODS

Comprehensive database searches were conducted in PubMed, Embase, the Cochrane Library, CINAHL, Ovid-Medline, Web of Science, and Scopus up to December 2022. Randomized controlled trials were included to assess the efficacy of simultaneous dual-task training for older adults with mild cognitive impairment or dementia. The analysis utilized Comprehensive Meta-Analysis version 3.0, presenting Hedges' g and the corresponding 95 % confidence interval (CI) for the pooled effect size and, applying a random-effects model. The I2 and Cochran's Q tests were employed to evaluate heterogeneity. The Cochrane Risk of Bias 2.0 tool was employed to assess study quality. The Copenhagen Trial Unit (version 0.9.5.10 Beta) was employed for trial sequential analysis, providing a rigorous methodology for evaluating cumulative evidence from multiple studies.

RESULTS

Of the 1676 studies identified, 20 studies involving 1477 older adults with cognitive impairment were included. Dual-task training significantly enhanced global cognition (0.477, 95 % CI: 0.282 to 0.671), executive function (-0.310, 95 % CI: -0.586 to -0.035), working memory (0.714, 95 % CI: 0.072 to 1.355), gait (0.418, 95 % CI: 0.252 to 0.583), physical activity (0.586, 95 % CI: 0.012 to 1.16), and depression (-0.703, 95 % CI: -1.253 to -0.153). Trial sequential analyses revealed the robustness of this meta-analysis, which was based on a sufficient sample size from the included studies. Moreover, dual-task training demonstrated beneficial effects on global cognition, executive function, working memory, and gait.

CONCLUSIONS

Dual-task training improved cognition, physical function, and depression among older adults with cognitive impairment. Accordingly, dual-task training should be considered a clinical nonpharmacological intervention for older adults with mild cognitive impairment or dementia. Nevertheless, the trial sequential analysis results were consistent with those of the pairwise meta-analysis but only global cognition reached significance by crossing the trial sequential analysis boundary. Future studies with higher-quality designs and larger sample sizes are required to obtain more conclusive results regarding other outcomes.

REGISTRATION

PROSPERO CRD42023418598.

Prevention, Assessment, and Management of Malnutrition in Older Adults with Early Stages of Cognitive Disorders

Malnutrition is common in older adults, and its risk is greater in those living with dementia. Relative to cognitively healthy peers, the prevalence of malnutrition is also increased in individuals with early stages of cognitive disorders owing to pathophysiological, cognitive, and psychosocial changes related to cognitive impairment. Malnutrition is associated with adverse health outcomes, including faster cognitive and functional decline. Here, we provide an overview of the prevention, assessment, and management of malnutrition in older adults, with a special focus on the aspects that are important to consider in individuals with early stages of cognitive disorders. Strategies to prevent malnutrition include systematic screening for malnourishment using validated tools to detect those at risk. If the screening reveals an increased risk of malnutrition, a detailed assessment including the individual's nutritional, medical, and functional status as well as dietary intake should be performed. The management of malnutrition in the early stages of cognitive disorders should be based on the findings of a comprehensive assessment and be personalized according to the individual's specific characteristics. In the article, we also provide an overview of the evidence on vitamin supplements and specific dietary patterns to prevent cognitive decline or attenuate its progression.

Prevalence of Malnutrition in a Group of Institutionalized Psychogeriatric Patients Using Different Diagnostic Criteria

Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.