Nutrition and Immune Function in the Geriatric Population

Effect of Calorie Restriction and Exercise on Type 2 Diabetes

Type-2 diabetes (T2D) is a chronic condition, generally regarded as an irreversible, that is among the top 10 causes of death globally. The hallmark of T2D is hyperglycemia, which results from disturbances in insulin sensitivity, insulin secretion, β-cell dysfunction and insulin resistance. Several clinical and lifestyle factors are involved in the progression of T2D, such as obesity and physical inactivity. A high-calorie diet is the main contributor to the development of obesity, which results in T2D, as obesity or increased intra-abdominal adipose tissue is related to insulin resistance. Technological advances have contributed to individuals having a more sedentary lifestyle, leading to obesity and T2D. T2D can be treated with lifestyle interventions, such as diet and exercise. Herein, we highlight the positive impact of a very low-calorie diet (VLCD) and lifestyle modalities in the treatment and prevention of T2D. An inclusion of VLCD 400-800 kcal/day for 8 weeks and ≥ 150 minutes exercise 5 times a week as lifestyle interventions can decrease glucose levels to normal, reduce HbA1c and improve insulin resistance and sensitivity. Therefore, a potential mechanism in maintaining glucose homeostasis and remission of T2D by VLCD and exercise reduces body weight.

Inhibitory Effects of Pentobarbital and Phenobarbital on Human Neutrophil Functions

Neutrophils are important components of the immune system which protects the host from bacterial invasion. Phenobarbital and pentobarbital are used to treat seizures/convulsions in critically ill patients who are sometimes immunocompromised hosts. In the current study we examined the effect of pentobarbital and phenobarbital at clinically relevant concentrations and at 10 and 100 times these concentrations on several aspects of human neutrophil functions using ex vivo system. The two barbiturates impaired neutrophil chemotaxis but failed to suppress phagocytosis. Pentobarbital and phenobarbital also inhibited production of superoxide (O2), hydrogen peroxide (H2O2), and hydroxyl radical (OH·) by neutrophils in a dose-dependent manner. These drugs did not scavenge the reactive oxygen species (ROS) generated by the xanthine-xanthine oxidase system. Elevation of intracellular calcium concentrations ([Ca2+]i) in neutrophils by a stimulant was dose-dependently attenuated with pentobarbital and phenobarbital. The two anesthetics also decreased protein kinase C (PKC) activity. These effects on [Ca2+]i and PKC activity may represent a part of mechanisms responsible for inhibition of neutrophil functions. Further studies using in vivo systems are required to elucidate inhibitory effects of pentobarbital or phenobarbital on ROS production and chemotaxis in clinical settings.

Is it possible to increase weight and maintain the protein status of debilitated elderly residents of nursing homes?

BACKGROUND

The care of elderly persons in chronic care nursing wards is generally complicated by nutritional problems such as weight loss and worsening protein status. An inability or refusal of the patient to consume enough food often necessitates the use of expensive commercial formulas for nutritional support. The purpose of this study was to determine whether the use of an in-house (high-protein, milk-based) low-cost formula with added minerals and vitamins for total nutritional support would be effective in maintaining weight and protein status of patients in the long term.

METHODS

Participants were recruited from five nursing care units of a single geriatric facility. All residents who required formula feeding were followed prospectively. The formula was provided either as a pudding or a milkshake for oral feeding or as a liquid for tube feeding and served as the sole source of nutrition. Data were collected regarding the participants' weight (monthly), serum albumin level (periodically), and the manner of formula administration (oral, nasogastric, or gastrostomy tube).

RESULTS

One hundred forty-three participants who received this formula were followed for a maximum period of 6 years. Mean weight increased by 5 kg during the first year and remained stable thereafter. Those participants who died within 6 months had no increase in weight. The long-term mean serum albumin level of all participants was an acceptable 4 g/dL.

CONCLUSION

The long-term use of an inexpensive in-house formula for total nutritional support increased weight and maintained serum albumin levels in most of the chronically ill elderly nursing care patients who participated in the study.

Physiologic determinants of the anorexia of aging: insights from animal studies

The anorexia of aging is a syndrome characterized by unexplained losses in food intake and body weight that occur near the end of life. Proposed etiologies cover a wide range of biological and psychological conditions. The observation of this phenomenon in older laboratory animals suggests that physiological changes play a significant causal role. Research on the neurochemical control of energy balance has received much attention in recent years, and age-related alterations in the neuropeptidergic effectors of food intake have been implicated in the anorexia of aging. This review provides an update on putative mechanisms underlying this dysregulation of feeding during advanced age.

Severe dementia and adverse outcomes of nursing home-acquired pneumonia: evidence for mediation by functional and pathophysiological decline

OBJECTIVES

To assess whether the severity of dementia is related to unfavorable outcomes of nursing home-acquired pneumonia and how this relationship is mediated.

DESIGN

Prospective cohort study.

SETTING

Psychogeriatric wards of 61 nursing homes in the Netherlands.

MEASUREMENTS

Dementia severity and the possible mediators swallowing disturbance, aspiration, insufficient food intake, weight loss, and dehydration were measured and related to the following outcomes: death (rate), cure rate, and increase in discomfort at the onset of pneumonia.

PARTICIPANTS

Demented patients (n = 374) treated with antibiotics for pneumonia.

RESULTS

Dementia severity was independently related to death rate within the first week after pneumonia (hazard rate ratio = 3.0 for the most severely demented quartile versus the least demented quartile, 95% confidence interval (CI) = 1.1-8.3) and to 3-month mortality (odds ratio (OR) 2.5, 95% CI = 1.1-5.4). The latter relation was in part mediated by aspiration and weight loss (OR dementia severity adjusted for these mediators declined from 2.5 to 1.9, 95% Cl = 0.8-4.3). Dementia severity was not related to cure rate within 2 weeks nor to an in-crease in discomfort after 3 days compared with before the pneumonia.

CONCLUSION

The functional and pathophysiological consequences of progressive dementia account in part for increased 3-month mortality after pneumonia. Mid-term mortality is expected to be high only in the most severely demented patients and in less severely demented patients who aspirated or who lost weight. Implications for end-of-life decision-making and effectiveness of preventive and curative interventions are discussed.

[Malnutrition prevalence in institutionalized elderly people in Valencia Community, Spain]

BACKGROUND

The goal of this study was to know the prevalence of malnutrition in an institutionalized elderly population according to age and sex.

PATIENTS AND METHOD

We studied 615 institutionalized patients, with a mean age (SD) of 79.33 (9.07) years. Anthropometric parameters included weight, height, knee-heel length, tricipital and subescapular skin folds, arm perimeter and fat mass. Biochemical parameters included: total cholesterol, triglycerides, albumin, prealbumin, transferrin,retinol-binding protein, C3 and lymphocyte count. Malnutrition prevalence was 26.87% (CI 95%, 23.15-30.86), 29.08% (CI 95%, 22.82-35.97) in men and 25.59% (CI 95%, 25.01-30.61) in women. Anthropometric parameters were found to be decreased in all malnourished patients. Significant decreases in albumin and retinol-binding protein concentrations were observed in some age groups of malnourished patients. We also found a decrease in the total cholesterol level in parallel to an age increase in both sexes, regardless of the nutritional status. Triglyceride levels were significantly decreased in both males and females with malnutrition.

CONCLUSIONS

We detected a high prevalence of malnutrition, yet lower than reported in other studies with similar age groups.

Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools

Protein-energy malnutrition is a prevalent problem in older persons. Its relation to increased morbidity and mortality has been well documented. Early recognition of malnutrition allows for a timely intervention. A large proportion of chronic diseases affecting older persons can be either prevented or significantly improved by improving nutrition, which underscores the importance of developing a screening system that can trigger a more comprehensive evaluation when indicated. Screening for malnutrition in older persons can be difficult because of the normal age-related changes in many of the commonly used parameters. A comprehensive nutritional evaluation includes a complete history and physical examination in addition to a more specific nutrition-oriented assessment. Specific nutritional assessment includes estimating food intake, anthropometric measurements, and evaluation of several biochemical parameters commonly affected by changes in nutritional status. In this article, we review the commonly used tools for nutritional assessment in older persons. The goal is to promote disease-free, active, and successful aging.

Infections and antibiotic resistance in nursing homes

Infections occur frequently in nursing home residents. The most common infections are pneumonia, urinary tract infection, and skin and soft tissue infection. Aging-associated physiologic and pathologic changes, functional disability, institutionalization, and invasive devices all contribute to the high occurrence of infection. Antimicrobial agent use in nursing homes is intense and usually empiric. All of these factors contribute to the increasing frequency of antimicrobial agent-resistant organisms in nursing homes. Programs that will limit the emergence and impact of antimicrobial resistance and infections in nursing homes need to be developed.

Leukocyte migration inhibition studies and neutrophil cell function during aging in Nigerians

In this study, in vitro cell-mediated immune response was analysed in 150 healthy Nigerians between 6 and 95 years old by the leukocyte migration inhibitory factor (L-MIF) test. Lymphocytes were activated with the mitogen concanavalin A and candida, measles virus and mycobacterial antigens. Nonspecific cellular immune capacity was studied by the Nitroblue tetrazolium (NBT) test. Numerical estimates of leukocytes and lymphocyte subpopulations were done. Mean L-MIF activity obtained with the four lymphocyte activators decreased with rising age indicating a progressive decline in cellular immune function with age. There was no significant age-related change in formazan positivity rate for both unstimulated and stimulated NBT tests. No age-related change in number was observed for any of the leucocyte and lymphocyte subpopulations. These results show that cell-mediaging response in Nigerians immunity declines, but phagocyte function is unchanged during aging. Lymphocyte depletion or numerical alteration in resting T cell subsets could not be demonstrated to be responsible for depressed cell-mediated immunity in aging Nigerians.

Nutrition education: the older adult with diabetes

The dietitian, working with other members of the health care team, plays a very important role in developing a care plan for the older person with diabetes. Often individuals in this age group have so many health care needs that nutrition intervention may be low on the priority list. Optimum nutrition is essential to maintain health and well-being as well as to keep blood glucose levels in the target range. The dietitian who works with this population must be very skilled at multifaceted assessment. He or she must be able to correlate all the information gained to creatively design, with the patient and caregivers, a workable dietary intervention, and be able to adapt instruction techniques and tools for a wide variety of educational needs and abilities. Knowledge, skill, experience, confidence in judgment and, most important, sincere caring are all important to the process. Nutrition education should be individually tailored and incorporate patience, kindness, humor, understanding, and above all a respect for the differences that make each older person an individual.

Prognostic role of serum albumin and prealbumin levels in elderly patients at admission to a geriatric hospital

The incidence of biological malnutrition is very high in geriatric hospitalized patients. The aim of the present study was to investigate the nutritional status of elderly patients at the time of hospital admission in an effort to identify variables which influence the outcome of hospital stay. Forty-six percent (244/552) of the admitted patients had a serum albumin level less than 35 g/l. Cancer patients had a significantly (p < 0.0001) lower serum albumin and prealbumin values than other patients. The patients, who died, had even lower albumin values as compared to the cancer patients. None of the studied nutritional and social parameters showed correlation with the length of hospital stay in any group of patients. No significant correlation could be found between age and nutritional values. No significant correlation could be established between the social parameters and nutritional variables. By using variance analysis statistically significant association was found between cancer and serum albumin (p < 0.0001) as well as between the death occurring during the hospital stay and nutritional values (p < 0.0001). By the discriminant analysis model, the mortality during hospital stay could be predicted with 78.8% certainty when the presence of cancer, the albumin and prealbumin values were known. In addition, cancer status may be suspected in the case of low nutritional values at admission in these elderly patients. Our results indicate that by the measurement of these simple parameters an accurate prediction can be achieved in the prognosis of hospitalized geriatric patients already at the time of admission.

Effect of aging on serum albumin

Some studies have shown a negative association between age and serum albumin. Several of these studies included older people with known disease. Disease may reduce albumin in any age group. Other studies have shown no association between age and albumin. To investigate the association of age and albumin, albumin levels were determined in 241 apparently healthy subjects aged 55 to 101. A small but consistent negative regression slope of about 4% per decade was found for those aged over 70. Because the relationship to age was small, the finding of hypoalbuminemia in an elderly patient generally should be attributed to disease rather than age alone.