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Mostafapour E, Shahsavan M, Shahmiri SS, Jawhar N, Ghanem OM, Kermansaravi M. Prevention of malnutrition after one anastomosis gastric bypass: value of the common channel limb length. BMC Surg 2024; 24:156. [PMID: 38755612 PMCID: PMC11097460 DOI: 10.1186/s12893-024-02438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Hypoalbuminemia and anemia are commonly observed indications for one anastomosis gastric bypass (OAGB) reversal and remain significant concerns following the procedure. Sufficient common channel limb length (CCLL) is crucial to minimize nutritional complications. However, limited literature exists regarding the impact of CCLL on OAGB outcomes. This study aimed to assess the effect of CCLL on weight loss and nutritional status in patients who underwent OAGB. METHODS A prospective cohort study was conducted from August 2021 to July 2022, involving 64 patients with a body mass index of 40-50 kg/m2. The standardized length of the biliopancreatic limb (BPLL) for all patients in this study was set at 175 cm. Additionally, the measurement of the common channel limb length (CCLL) was performed consistently by the same surgeon for all included patients. RESULTS The mean age and BMI of the patients were 39.91 ± 10.03 years and 43.13 ± 2.43 kg/m2, respectively, at the time of surgery. There was a statistically significant negative correlation between CCLL and percent total weight loss (%TWL) at the 12-month mark after OAGB (P = 0.02). Hypoalbuminemia was observed in one patient (1.6%), while anemia was present in 17 patients (26.6%) at the one-year follow-up. Statistical analysis revealed no significant difference in the incidence of anemia and hypoalbuminemia between patients with CCLL < 4 m and those with CCLL ≥ 4 m. CONCLUSION A CCLL of 4 m does not appear to completely prevent nutritional complications following OAGB. However, maintaining a CCLL of at least 4 m may be associated with a reduced risk of postoperative nutritional deficiencies.
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Affiliation(s)
- Elyas Mostafapour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Rasool Hospital, Tehran, Iran.
| | - Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Rasool Hospital, Tehran, Iran.
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2
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Vishak MS, Ramasamy K. Swallowing Rehabilitation: Tracing the Evolution of Assessment and Intervention Approaches for Dysphagia over 30 Years. Indian J Otolaryngol Head Neck Surg 2024; 76:2171-2175. [PMID: 38566735 PMCID: PMC10982211 DOI: 10.1007/s12070-023-04325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 04/04/2024] Open
Abstract
Dysphagia or difficulty in swallowing is a common condition affecting millions worldwide. It can occur due to structural problems, neurological disorders, cancer treatment, aging, etc. Swallowing rehabilitation aims to help patients regain safe and efficient swallowing function through compensatory strategies and exercises. This literature review examines the recent advancements in swallowing rehabilitation techniques over the past three decades, with a focus on innovations in diagnostics, personalized medicine, and patient care.
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Affiliation(s)
- M. S. Vishak
- Department of Otorhinolaryngology, JIPMER, Puducherry, Karaikal India
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3
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Costanzo G, Sambugaro G, Mandis G, Vassallo S, Scuteri A. Pancytopenia Secondary to Vitamin B12 Deficiency in Older Subjects. J Clin Med 2023; 12:jcm12052059. [PMID: 36902847 PMCID: PMC10003837 DOI: 10.3390/jcm12052059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Vitamin B12 (cobalamin CBL) is a water-soluble vitamin required to form hematopoietic cells (red blood cells, white blood cells, and platelets). It is involved in the process of synthesizing DNA and myelin sheath. Deficiencies of vitamin B12 and/or folate can cause megaloblastic anemia (macrocytic anemia with other features due to impaired cell division). Pancytopenia is a less frequent exordium of severe vitamin B12 deficiency. Vitamin B12 deficiency can also cause neuropsychiatric findings. In addition to correcting the deficiency, an essential aspect of management is determining the underlying cause because the need for additional testing, the duration of therapy, and the route of administration may differ depending on the underlying cause. METHODS Here, we present a series of four patients hospitalized for megaloblastic anemia (MA) in pancytopenia. All patients diagnosed with MA were studied for a clinic-hematological and etiological profile. RESULTS All the patients presented with pancytopenia and megaloblastic anemia. Vitamin B12 deficiency was documented in 100% of cases. There was no correlation between the severity of anemia and deficiency of the vitamin. Overt clinical neuropathy was present in none of the cases of MA, while subclinical neuropathy was seen in one case. The etiology of vitamin B12 deficiency was pernicious anemia in two cases and low food intake in the remaining cases. CONCLUSION This case study emphasizes the role of vitamin B12 deficiency as a leading cause of pancytopenia among adults.
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Affiliation(s)
- Giulia Costanzo
- S.C. di Medicina Interna, Policlinico Universitario Monserrato “Duilio Casula”—AOU di Cagliari, 09123 Cagliari, Italy
| | - Giada Sambugaro
- Scuola Specializzazione Allergologia e Immunologia Clinica, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Giulia Mandis
- Scuola Specializzazione Medicina Interna, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Sofia Vassallo
- Scuola Specializzazione Allergologia e Immunologia Clinica, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Angelo Scuteri
- S.C. di Medicina Interna, Policlinico Universitario Monserrato “Duilio Casula”—AOU di Cagliari, 09123 Cagliari, Italy
- Dipartimento Scienze Mediche e Sanita’ Pubblica, Universita’ di Cagliari, 09124 Cagliari, Italy
- Correspondence:
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Miyamori D, Yoshida S, Kashima S, Koike S, Ishii S, Okazaki Y, Ikeda K, Matsumoto M. How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database. J Am Med Dir Assoc 2023; 24:368-375.e1. [PMID: 36587929 DOI: 10.1016/j.jamda.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES As disasters become more frequent because of global warming, countries across the world are seeking ways to protect vulnerable older populations. Although these conditions may increase nursing home admission (NHA) rates for older persons, we know of no studies that have directly tested this hypothesis. DESIGN This was a retrospective cohort study. SETTING AND PARTICIPANTS We analyzed data from long-term care insurance (LTCI) users in 3 Japanese prefectures that incurred heavy damage from the 2018 Japan Floods, which is the largest recorded flooding disaster in national history. Specifically, we extracted NHA data from the LTCI comprehensive database, both for disaster-affected and unaffected individuals. METHODS We employed the Cox proportional hazards model to calculate multivariate-adjusted hazard ratios (HRs) for NHAs within a 6-month period following the 2018 Japan Floods, with adjustments for potential confounding factors. RESULTS Of the 187,861 individuals who used LTCI services during the investigated period, we identified 2156 (1.1%) as disaster affected. The HR for NHA was significantly higher for disaster-affected (vs unaffected) individuals (adjusted HR 3.23: 95% CI 2.88‒3.64), and also higher than the HRs for older age (90-94 years vs 65-69 years: 2.29, CI 1.93‒2.70), cognitive impairment (severe impairment vs normal: 1.40, CI 1.25‒1.57), and physical function (bedridden vs independent: 2.27, CI 1.83‒2.70). According to our subgroup analyses, the adjusted HR for disaster-affected individuals unable to feed themselves was 6.00 (CI 3.68‒9.79), with a significant interaction between the 2 variables (P = .01). CONCLUSIONS AND IMPLICATIONS Natural disasters increase the risk of NHA for older persons, especially those who are unable to feed themselves. Health care providers and policymakers should understand and prepare for this emerging risk factor.
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Affiliation(s)
- Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shuhei Yoshida
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Okazaki
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kotaro Ikeda
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Laura T, Melvin C, Yoong DY. Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study. BMC Geriatr 2022; 22:634. [PMID: 35918652 PMCID: PMC9344637 DOI: 10.1186/s12877-022-03343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions - depressive symptoms and malnutrition - relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. METHODS Consecutive admissions of patients ≥ 65 years to a general medical department were recruited over 16 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital's electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. RESULTS We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) of 1,507 patients with follow-up data. Depressive symptoms, malnutrition, higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P < 0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR = 1.62, 95% CI 1.22-2.16), had poor oral intake (OR = 1.35, 95% CI 1.02-1.79) and functional decline during admission (OR = 1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty (OR = 1.53, 95% CI 1.07-2.19), delirium (OR = 2.33, 95% CI 1.60-3.39) cognitive impairment (OR = 1.88, 95% CI 1.39-2.54) and poor oral intake during hospitalization (OR = 2.70, 95% CI 2.01-3.64). In minimal adjustment set identified by DAG, depressive symptoms (OR = 1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was no longer statistically significant after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR = 1.40, 95% CI 0.99-1.98). CONCLUSION The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.
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Affiliation(s)
- Tay Laura
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore, Singapore. .,Geriatric Education and Research Institute, Singapore, Singapore.
| | - Chua Melvin
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore, Singapore
| | - Ding Yew Yoong
- Geriatric Education and Research Institute, Singapore, Singapore.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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Abstract
Nutrition plays a critical role in the definition of the individual's wellbeing. Nutritional interventions have been repeatedly advocated as of potential interest for preventing or delaying the cognitive decline, also in the context of neurodegenerative conditions. The idea of targeting the initial phases of dementia, when the process is theoretically still amenable of correction, via lifestyle modifications (including healthy diet or supplementation of specific micro-/macro-nutrients) is extremely appealing. In this perspective paper, we describe the most recent evidence on the topic and discuss how the nutritional assessment should be nested within a comprehensive approach to the aging person with initial signs of dementia for promoting his/her optimal management.
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Affiliation(s)
- M Cesari
- Matteo Cesari, MD, PhD. IRCCS Istituti Clinici Scientifici Maugeri; Via Camaldoli 64 - 20138 Milan, Italy. Phone: +39 02 50725136. . Twitter: @macesari
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7
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Prognostic utility of dynapenia in patients with cardiovascular disease. Clin Nutr 2020; 40:2210-2218. [PMID: 33873266 DOI: 10.1016/j.clnu.2020.09.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dynapenia, defined as age-associated loss of skeletal muscle strength, is associated with increased mortality rate, poor activities of daily living, and reduced quality of life. Therefore, dynapenia appears to be a better independent predictor of mortality than sarcopenia in the elderly. However, the prognostic utility of dynapenia in patients with cardiovascular disease (CVD) is not clear. This study was performed to examine the prognostic utility of dynapenia defined by the criteria of Manini et al. in patients with CVD. METHODS The findings of 4192 consecutive patients ≥30 years old (median [interquartile range (IQR)] age 69 [60-76] years, 2874 males) with CVD were reviewed. Grip strength and quadriceps isometric strength (QIS) were measured just before hospital discharge, and low grip strength (<26 kg in males and <18 kg in females), low QIS (<45.0% body mass [BM] and <35.0% BM in males and females, respectively) were considered to indicate dynapenia. The endpoint was all-cause mortality. RESULTS A total of 507 deaths occurred during follow-up (median 2.0 years, IQR 0.8-4.4 years). The overall prevalence of dynapenia was 33.6% and increased with age (p for trend < 0.01). Females showed a significantly higher prevalence rate of dynapenia than males (43.3% vs. 29.2%, respectively; p < 0.01). Patients with dynapenia showed higher all-cause mortality rate than non-dynapenia patients (adjusted hazard ratio: 1.84; 95% confidence interval: 1.51-2.23; p < 0.01). CONCLUSIONS Dynapenia has a high prevalence among patients with CVD and is associated with increased mortality rate.
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8
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Aging and nutrition. Paving the way to better health. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2020; 58:55-68. [PMID: 32134741 DOI: 10.2478/rjim-2020-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 01/04/2023] Open
Abstract
Sufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques such as anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the 'Mini Nutritional Assessment' measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition.
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9
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Combined usage of monosaccharides with polysaccharides may decelerate tumor growth and malignance versus solely using a certain kind of saccharide. Biochem Biophys Res Commun 2020; 525:800-805. [PMID: 32156410 DOI: 10.1016/j.bbrc.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/14/2020] [Indexed: 12/30/2022]
Abstract
Saccharides used in clinical nutrients and the hyperglycemia status may facilitate tumor growth and aggravate cancer patients' outcome. As glucose, fructose and maltodextrin are widely used in clinical practice, various effects on tumor progress among them remain unknown. Six kinds of tumor cell lines were included in this study. We evaluated the discrepant effects of sugars on tumor growth by nude mice xenograft model, wound-healing assay and cell counting kit-8 test were for measuring the migration and proliferation capability in vitro, and oral gavage on C57BL/6 N mice was applied to assess the fluctuation of blood glucose level. Results showed that though tumor cells presented discrepant sensitivity to different saccharides, the combined usage of glucose, fructose with maltodextrin has milder effect on tumor progression and moderate effect on blood glucose fluctuation, which may indicate a brighter option on saccharides selection for tumor patients.
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10
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Cho JM, Choi HS, Cho YS, Park SY, Kim DY, Lee JH. Effect of immune-enhancing enteral nutrition formula enriched with plant-derived n-3 fatty acids on natural killer cell activity in rehabilitation patients. Nutr Res Pract 2019; 13:384-392. [PMID: 31583057 PMCID: PMC6760982 DOI: 10.4162/nrp.2019.13.5.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 06/17/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES Enteral nutrition formulas with immune-enhancing nutrients, such as n-3 fatty acids, may manage patients' nutritional status and pathophysiological processes. The aim of our study was to investigate natural killer (NK) cell activity alterations and related cytokine changes resulting from feeding with soybean oil-containing enteral nutrition formula (control group) and plant-derived n-3 fatty acid-enriched enteral nutrition formula. SUBJECTS/METHODS Subjects participated for 14 consecutive days and consumed enteral formula containing canola and flaxseed oil (n3EN, test group) in nonsurgical patients hospitalized for rehabilitation. Blood samples were collected on the first day and 14 days after the consumption of each formula daily, and anthropometric parameters were collected. Hematology and biochemical values were analyzed, and NK cell activities and serum cytokine concentration were measured. A total of sixty subjects were included in the analysis, excluding dropouts. RESULTS No significant differences were found in biochemical parameters. The n3EN group's NK cell activities at effector:tumor cell ratios of 10:1, 5:1, 2.5:1 and 0.625:1 were significantly higher than those of the control group after two weeks (P < 0.05). However, there were no statistically significant differences in serum cytokine interleukin (IL)-12, interferon-γ, IL-1β, IL-6 and tumor necrosis factor-α values between the two groups. CONCLUSIONS In conclusion, this study elucidates the beneficial effects of plant-derived n-3 fatty acid supplementation in enteral formula on NK cell activity.
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Affiliation(s)
- Jung Min Cho
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University, Seoul 03722, Republic of Korea.,Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul 03722, Republic of Korea
| | - Hyo Seon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Youn Soo Cho
- Department of Nutrition and Dietetics, Yonsei University Severance Hospital, Seoul 03722, Republic of Korea
| | - So Young Park
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Deog Young Kim
- Department & Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jong Ho Lee
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University, Seoul 03722, Republic of Korea.,Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul 03722, Republic of Korea
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11
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Batchelor-Murphy M, Kennerly SM, Horn SD, Barrett R, Bergstrom N, Boss L, Yap TL. Impact of Cognition and Handfeeding Assistance on Nutritional Intake for Nursing Home Residents. J Nutr Gerontol Geriatr 2019; 38:262-276. [PMID: 31124418 PMCID: PMC7187960 DOI: 10.1080/21551197.2019.1617221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In nursing homes (NHs), residents are at risk for malnutrition and weight loss. The purpose of this secondary data analysis was to examine the impact of resident cognitive status and level of feeding assistance provided by NH staff on resident's daily nutritional intake and body weight. As part of a large, multisite clinical trial (N = 786), residents with and without dementia were examined according to level of feeding assistance required during mealtimes (independent, set-up only, needs help eating) over a 21-day period. Outcomes analyzed were percent of meal intake by meal type (breakfast, lunch, dinner) and overall daily intake (meals + snacks/supplements). Residents with dementia who required meal set-up assistance had significantly lower meal intake for all three meals. Residents without dementia requiring meal set-up assistance experienced significantly lower intake for breakfast and dinner, but not lunch. When snacks and supplements were offered between meals, residents with dementia consumed approximately 163 additional calories/day, and residents without dementia consumed approximately 156 additional calories/day. This study adds new evidence that residents at greatest risk for low intake are those who are only provided set-up assistance for meals and/or have cognitive impairment.
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Affiliation(s)
| | - Susan M Kennerly
- b College of Nursing, East Carolina University , Greenville , NC , USA
| | - Susan D Horn
- c School of Medicine, University of Utah , Salt Lake City , UT , USA
| | - Ryan Barrett
- d International Severity Information Systems and the Institute for Clinical Outcomes Research , Salt Lake City , UT , USA
| | - Nancy Bergstrom
- e School of Nursing, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Lisa Boss
- f Memorial Hermann Northeast Medical Center , Humble , TX , USA
| | - Tracey L Yap
- g School of Nursing, Duke University , Durham , NC , USA
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12
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Pfisterer KJ, Boger J, Wong A. Prototyping the Automated Food Imaging and Nutrient Intake Tracking System: Modified Participatory Iterative Design Sprint. JMIR Hum Factors 2019; 6:e13017. [PMID: 31094336 PMCID: PMC6532336 DOI: 10.2196/13017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/27/2019] [Accepted: 04/06/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A total of 45% of older adults living in long-term care (LTC) have some form of malnutrition. Several methods of tracking food and fluid intake exist, but they are limited in terms of their accuracy and ease of application. An easy-to-use, objective, accurate, and comprehensive food intake system designed with LTC in mind may provide additional insights regarding nutritional support systems and nutritional interventions. OBJECTIVE The aim of this study was to conduct a multistage participatory iterative design sprint of a Goldilocks quality horizontal prototype for the Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) system. Specific design objectives included the following: (1) identify practice-relevant problems and solutions through user-centered participatory design, (2) mitigate feasibility-related barriers to uptake, and (3) employ user-centered technology development. METHODS A 6-stage iterative participatory design sprint was developed and executed. A total of 38 participants and advisors representing 15 distinct roles (eg, personal support worker, nurse, and dietitian) were engaged in the design sprint. Subjective workload (Raw Task Load Index), subjective usability scales, and a modified Ravden checklist were used to assess project advisors' perceptions of the AFINI-T system prototype compared with the current method of food and fluid intake charting. RESULTS The top priorities for this system were identified as the following: ease of use, high accuracy, system reliability, ease of maintenance, and requirement of integrating with the current PointClickCare system. Data from project advisors informed design decisions leading to a Goldilocks quality horizontal prototype of the AFINI-T system. Compared with the current food and fluid intake charting system, AFINI-T was perceived to have the following: less time demands (t10.8=4.89; P<.001), less effort (t13.5=5.55; P<.001), and less frustration (t13.0=3.80; P=.002). Usability ratings of the AFINI-T prototype were high, with a subjective usability score mean of 89.2 and the highest ratings on a modified Ravden usability checklist of "very satisfactory" for 7 out of 8 sections. CONCLUSIONS The AFINI-T concept system appears to have good practice relevance as a tool for an intelligent food and fluid intake tracking system in LTC. The AFINI-T concept system may provide improvement over the current system, and advisors are keen to try the AFINI-T system. This research gives tangible examples of how the sprint method can be adapted and applied to the development of novel needs-based application-driven technology.
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Affiliation(s)
- Kaylen J Pfisterer
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - Alexander Wong
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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13
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Ramírez-Vélez R, Correa-Bautista JE, García-Hermoso A, Cano CA, Izquierdo M. Reference values for handgrip strength and their association with intrinsic capacity domains among older adults. J Cachexia Sarcopenia Muscle 2019; 10:278-286. [PMID: 30843369 PMCID: PMC6463468 DOI: 10.1002/jcsm.12373] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/03/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The purposes of this study were three-fold: (i) to describe handgrip strength in older individuals aged ≥60 years in Colombia; (ii) to identify sex-specific and age-specific muscle weakness cut-off points in older adults; and (iii) to determine the odds of adverse events for each of the intrinsic capacity domains for individuals with handgrip strength greater than the muscle weakness cut-off points, as compared with their weaker counterparts. METHODS A cross-sectional study was conducted in Colombia, among 5237 older adults aged ≥60 years old (58.5% women, 70.5 ± 7.8 years), according to 'SABE Survey 2015'. Handgrip strength data were obtained with a Takei dynamometer. Sociodemographic variables, five domains of intrinsic capacity (i.e. locomotion, vitality, cognition, psychological, and sensory), and medical conditions were assessed and analyzed. Adjustments variables were age, ethnicity, socio-economic status, urbanicity, body mass index, smoking status, alcohol intake, drug use, physical activity, and co-morbid chronic diseases. Sex-stratified analyses were conducted with logistic regression models. RESULTS Handgrip strength was greater among men than among women (26.7 ± 8.5 vs. 16.7 ± 5.7 kg, respectively, P < 0.001) at all ages. Weak handgrip strength cut-off points ranged from 17.4 to 8.6 and from 10.1 to 4.9 in men and women, respectively. Overall, participants with optimal handgrip strength had better intrinsic capacity [in men, odds ratio (OR) = 0.62, 95% confidence interval (CI) 0.53 to 0.71; P < 0.001; and in women, OR = 0.79, 95% CI 0.68 to 0.92; P = 0.002] than their weaker counterparts. Also, men with optimal handgrip strength had a lower risk of hospitalization (OR = 0.47, 95% CI 0.29 to 0.78; P = 0.004) than their weaker counterparts. CONCLUSIONS This study is the first to describe handgrip strength values and cut-off points for muscle weakness among a nationally representative sample of Colombian older adults by age and sex. After categorizing older adults as weak or not weak based on the handgrip cut-off points, non-weakness was associated with a decreased odds of intrinsic capacity impairments. These cut-off points may be good candidates for clinical assessment of risks to physical and mental health in older Colombian adults.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Jorge Enrique Correa-Bautista
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Antonio García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - Carlos Alberto Cano
- Instituto de Envejecimiento, Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Mikel Izquierdo
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia.,Department of Health Sciences, Navarrabiomed, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Pamplona, Public University of Navarre, Navarre, Spain
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Johnson S, Nasser R, Rustad K, Chan J, Wist C, Siddique A, Tulloch H. Review of Nutrition Screening and Assessment Practices for Long-Term Care Residents. J Nutr Gerontol Geriatr 2018; 37:169-182. [PMID: 29952730 DOI: 10.1080/21551197.2018.1482811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents.
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Affiliation(s)
- Shanthi Johnson
- a Department of Kinesiology, Faculty of Kinesiology and Health Studies , University of Regina , Regina , SK , Canada.,b Saskatchewan Population Health Evaluation Research Unit (SPHERU) , University of Regina , SK , Canada
| | - Roseann Nasser
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Kayla Rustad
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Jennifer Chan
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Christina Wist
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Aisha Siddique
- b Saskatchewan Population Health Evaluation Research Unit (SPHERU) , University of Regina , SK , Canada
| | - Heather Tulloch
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
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15
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 630] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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16
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Abstract
With the focus of care shifting from the hospital to the community, supportive nutritional care to old people is to become an important issue to address in the community, since undernutrition has serious consequences, both for the quality of life and for the health care costs. Several modifiable nutritional risk factors relate to undernutrition. Unfortunately, the problem with (risk of) undernutrition is aggravated due to a lack of alertness among e.g. health care staff, leading to insufficient attention for systemic screening and nutritional care. Only a few of the existing screening tools have been validated among old people receiving support at home. Few studies have assessed the beneficial effect of nutritional support among old people in their own home, and recently, it was concluded that such have shown limited effects. One reason may be that the nutritional interventions performed have not taken the multiple nutritional risk factors afore-mentioned into consideration when formulating the action/treatment plan and hence not used a multidisciplinary approach. Another reason may be that the intervention studies have not used validated screening tools to identify those old people most likely to benefit from the nutritional support. However, three recent studies have used a multidisciplinary approach and two have proven a beneficial effect on the quality of life of the old people and the health care costs. These findings suggest that when planning nutritional intervention studies for old people receiving support at home, modifiable nutritional risk factors should be taken into consideration, and a multidisciplinary approach considered.
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Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, Cooper C, Martin FC, Reginster JY, Vellas B, Beard JR. Evidence for the Domains Supporting the Construct of Intrinsic Capacity. J Gerontol A Biol Sci Med Sci 2018; 73:1653-1660. [DOI: 10.1093/gerona/gly011] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
- Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France
- Université de Toulouse III Paul Sabatier, France
- Geriatric Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, Università di Milano, Italy
| | | | | | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, United Kingdom
| | - Finbarr C Martin
- Division of Health and Social Care Research, King’s College, London, United Kingdom
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liege, Belgium
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, France
- Université de Toulouse III Paul Sabatier, France
| | - John R Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
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18
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Vucea V, Keller HH, Morrison JM, Duizer LM, Duncan AM, Carrier N, Lengyel CO, Slaughter SE, Steele CM. Modified Texture Food Use is Associated with Malnutrition in Long Term Care: An Analysis of Making the Most of Mealtimes (M3) Project. J Nutr Health Aging 2018; 22:916-922. [PMID: 30272093 DOI: 10.1007/s12603-018-1016-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Modified texture food (MTF), especially pureed is associated with a high prevalence of under-nutrition and weight loss among older adults in long term care (LTC); however, this may be confounded by other factors such as dependence in eating. This study examined if the prescription of MTF as compared to regular texture food is associated with malnutrition risk in residents of LTC homes when diverse relevant resident and home-level covariates are considered. DESIGN Making the Most of Mealtimes (M3) is a cross-sectional multi-site study. SETTING 32 LTC homes in four Canadian provinces. PARTICIPANTS Regular (n= 337) and modified texture food consumers (minced n= 139; pureed n= 68). MEASUREMENTS Malnutrition risk was determined using the Mini Nutritional Assessment short-form (MNA-SF) score. The use of MTFs, and resident and site characteristics were identified from health records, observations, and standardized assessments. Hierarchical linear regression analyses, accounting for clustering, were performed to determine if the prescription of MTFs is associated with malnutrition risk while controlling for important covariates, such as eating assistance. RESULTS Prescription of minced food [F(1, 382)=5.01, p=0.03], as well as pureed food [F(1, 279)=4.95, p=0.03], were both significantly associated with malnutrition risk among residents. After adjusting for age and sex, other significant covariates were: use of oral nutritional supplements, eating challenges (e.g., spitting food out of mouth), poor oral health, and cognitive impairment. CONCLUSIONS Prescription of minced or pureed foods was significantly associated with the risk of malnutrition among residents living in LTC facilities while adjusting for other covariates. Further work needs to consider improving the nutrient density and sensory appeal of MTFs and target modifiable covariates.
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Affiliation(s)
- V Vucea
- Heather H. Keller, PhD, RD, Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON, N2J 0E2,
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19
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Corona LP, de Oliveira Duarte YA, Lebrão ML. Markers of nutritional status and mortality in older adults: The role of anemia and hypoalbuminemia. Geriatr Gerontol Int 2017; 18:177-182. [PMID: 28782162 DOI: 10.1111/ggi.13137] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/27/2017] [Accepted: 06/13/2017] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to analyze the impact of anemia and hypoalbuminemia on mortality in a 5-year period. METHODS This was longitudinal population-based observational survey part of the Saúde, Bem-Estar e Envelhecimento study (Health, Well-being and Aging), carried out with 1256 older adults from the third wave of the cohort, followed for 5 years, when they were contacted for the fourth wave, in Sao Paulo, Brazil. Anemia was defined when hemoglobin was <12 g/dL for women and <13 g/dL for men, and hypoalbuminemia when serum albumin was <3.5 g/dL. Survival functions were estimated according to nutritional status in four groups: (i) without nutritional alteration; (ii) anemia only; (iii) hypoalbuminemia only; and (iv) anemia and hypoalbuminemia. Hazard ratios were calculated, following the Cox proportional hazards model, controlling for baseline covariates. All analyses considered sample weights, and were carried out using the Stata 12. RESULTS After the 5-year period, 12.3% of the participants died, and 8.2% were lost to follow up. Those who died had lower hemoglobin and albumin concentrations (13.4 g/dL and 3.7 g/dL) compared with survivors (14.3d/dL and 3.9 g/dL; P < 0.001). The crude death rate was 27.6/1000 person-years for participants in group i, 124.3 in group ii, 116.0 in group iii and 222.8 in group iv (P < 0.001). In the final Cox models, group 2 and 3 had a similar effect (hazard ratio 2.23, P = 0.020; 2.53, P = 0.005; respectively) and group 4 had a higher risk (hazard ratio 3.36; P = 0.004). CONCLUSIONS Anemia and hypoalbuminemia are important markers for death in older adults, and have an additive effect on mortality. Because they are common and cost-effective biomarkers, their use should be encouraged in geriatric evaluation for all health professionals and in population settings, such as primary care. Geriatr Gerontol Int 2018; 18: 177-182.
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Affiliation(s)
| | | | - Maria Lúcia Lebrão
- Department of Epidemiology, School of Public Health, University of Sao Paulo, São Paulo, SP, Brazil
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20
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How Swallow Pressures and Dysphagia Affect Malnutrition and Mealtime Outcomes in Long-Term Care. Dysphagia 2017; 32:785-796. [PMID: 28733775 DOI: 10.1007/s00455-017-9825-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/14/2017] [Indexed: 02/07/2023]
Abstract
Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62-102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29-37) and MSPs were 26 kPa (95% CI 23-29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.
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21
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Prevalence of anemia and malnutrition and their association in elderly nursing home residents. Aging Clin Exp Res 2016; 28:857-62. [PMID: 26572155 DOI: 10.1007/s40520-015-0490-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents. MATERIALS AND METHODS Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the χ (2) test and logistic regression analysis. RESULTS The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively). CONCLUSION The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.
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22
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Clinical insights: Understanding the link between nutrition and pressure ulcer prevention. Geriatr Nurs 2015; 36:477-81. [DOI: 10.1016/j.gerinurse.2015.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Veronese N, Cereda E, Solmi M, Fowler SA, Manzato E, Maggi S, Manu P, Abe E, Hayashi K, Allard JP, Arendt BM, Beck A, Chan M, Audrey YJP, Lin WY, Hsu HS, Lin CC, Diekmann R, Kimyagarov S, Miller M, Cameron ID, Pitkälä KH, Lee J, Woo J, Nakamura K, Smiley D, Umpierrez G, Rondanelli M, Sund-Levander M, Valentini L, Schindler K, Törmä J, Volpato S, Zuliani G, Wong M, Lok K, Kane JM, Sergi G, Correll CU. Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects. Obes Rev 2015; 16:1001-15. [PMID: 26252230 DOI: 10.1111/obr.12309] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/13/2022]
Abstract
Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26-1.58) for underweight, 0.85 (95% CI = 0.73-0.99) for overweight and 0.74 (95% CI = 0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.
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Affiliation(s)
- N Veronese
- Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - E Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - S A Fowler
- Becker Medical Library, Washington University, St. Louis, MO, USA
| | - E Manzato
- Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy.,National Research Council, Institute of Neuroscience, Padova, Italy
| | - S Maggi
- National Research Council, Institute of Neuroscience, Padova, Italy
| | - P Manu
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.,Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - E Abe
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - K Hayashi
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - J P Allard
- Toronto General Hospital, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - B M Arendt
- Toronto General Hospital, University Health Network, Toronto, Canada
| | - A Beck
- Research Unit for Nutrition (EFFECT), Herlev University Hospital, Herlev, Denmark
| | - M Chan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Y J P Audrey
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - W-Y Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - H-S Hsu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - C-C Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - R Diekmann
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | | | - M Miller
- Nutrition and Dietetics, Flinders University, Adelaide, Australia
| | - I D Cameron
- Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | - K H Pitkälä
- Unit of Primary Health Care, Department of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - J Lee
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - J Woo
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - K Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - D Smiley
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - G Umpierrez
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - M Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy
| | - M Sund-Levander
- Faculty of Health Sciences, University of Linköping, Linköping, Sweden
| | - L Valentini
- Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany
| | - K Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - J Törmä
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - S Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Zuliani
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M Wong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - K Lok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - J M Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.,Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - G Sergi
- Department of Medicine - DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - C U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA.,Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
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Pezzana A, Cereda E, Avagnina P, Malfi G, Paiola E, Frighi Z, Capizzi I, Sgnaolin E, Amerio ML. Nutritional Care Needs in Elderly Residents of Long-Term Care Institutions: Potential Implications for Policies. J Nutr Health Aging 2015; 19:947-54. [PMID: 26482698 DOI: 10.1007/s12603-015-0537-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To collect information on actual nutritional intervention requirements in long-term care institutions and on the role of institutional factors in nutritional care. DESIGN A cross-sectional analysis of baseline data (collected between September 2011 and September 2013) within the context of a multicenter prospective cohort study. SETTING Nineteen long-term care institutions. PARTICIPANTS Thirteen hundred and ninety-four resident elderly (age ≥60 years). MEASUREMENTS The prevalence of nutritional derangements (MNA-Short Form) and the need to introduce nutritional interventions on the residents. RESULTS Prevalence of malnutrition and risk of malnutrition were 35.2% [95%CI, 32.8-37.8] and 52.6% [95%CI, 50.0-55.2], respectively. Malnutrition was more frequent upon admission and in larger institutions (≥50 beds). Overall, 50% of the residents requiring an individualized nutritional care plan (any type) were not receiving it. Oral diet, the use of fluid thickeners and oral nutritional supplements had to be introduced in 306 (22.5%), 201 (15%) and 175 (13%) residents, respectively. The need to implement the oral diet was mainly due to inadequacy of texture according to chewing and swallowing capabilities. In gender and age-adjusted multivariable logistic regression models, nutritional interventions were associated with worse nutritional status (P<0.001 for all). Moreover, while the duration of stay was unrelated to the need for nutritional interventions, we observed that residents living in larger long-term care institutions (≥50 beds) were more likely to require improvement in nutrition care. CONCLUSIONS In long-term care elderly residents nutritional derangements are very common, underdiagnosed and undertreated. Nutritional screening should be part of routine care. However, also the systematic involvement of a nutritional care specialist appears to be an urgent need, particularly in larger institutions where the standards of care are likely to be lower.
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Affiliation(s)
- A Pezzana
- Emanuele Cereda M.D., Ph.D. Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. Tel.: +39 0382 501615 ; Fax: + 39 0382 502801, E-mail:
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Dupuy C, de Souto Barreto P, Ghisolfi A, Guyonnet S, Dorigny B, Vellas B, Rolland Y. Indicators of oral nutritional supplements prescription in nursing home residents: A cross-sectional study. Clin Nutr 2015; 35:1047-52. [PMID: 26243061 DOI: 10.1016/j.clnu.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/21/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Identifying factors associated with oral nutritional supplement (ONS) prescription in nursing homes (NH) may help to treat malnutrition in this very old and vulnerable population. OBJECTIVES The aim of the study was to investigate if resident-related and NH-related characteristics were associated with ONS prescription. DESIGN Cross-sectional study using medical and demographic data from 6275 NH residents and data on the structure and organization (e.g., presence of a dietitian, organization of the meal) of 175 NHs in southwestern France. The main outcome measure was ONS prescription (dichotomous variable: yes/no). RESULTS ONS were prescribed for 7.8% (n = 489) of NH residents. In a multivariate binary logistic regression, resident-related factors associated with the prescription of ONS were age, clinical markers of undernutrition (body mass index and weight loss), disability in activities of daily living, pain, pressure sores, and hospitalization in the last 12 months. NH-related factors associated with ONS prescription were: presence of a dietitian (Odds Ratio (OR): 1.46, 95% Confidence Interval: 1.18-1.88), NH coordinating physician with specific training in geriatrics (OR: 2.58, 95% CI: 1.48-4.49), organization of evening snack (OR: 1.63, 95% CI: 1.28-2.07), number of general practitioners per NH bed (OR: 0.49, 95% CI: 0.38-0.64 intermediate tertile; OR:0.77, 95% CI:0.59-1.06 highest tertile. Reference category: lowest tertile) and number of drug prescriptions (OR: 0.97, 95% CI: 0.94-0.99). CONCLUSIONS Both resident's characteristics and NH characteristics were associated with ONS prescription independently of each other. Our results showed that NH organizational aspects are associated with ONS prescribing, suggesting that modifiable aspects may contribute to achieve optimal nutritional status in the NH setting.
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Affiliation(s)
- Charlotte Dupuy
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France.
| | - Philipe de Souto Barreto
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Anne Ghisolfi
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Sophie Guyonnet
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Béatrice Dorigny
- Nutricia Advanced Medical Nutrition, Danone Research, Saint-Ouen, France
| | - Bruno Vellas
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
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Jobse I, Liao Y, Bartram M, Delantonio K, Uter W, Stehle P, Sieber CC, Volkert D. Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status. J Nutr Health Aging 2015; 19:356-64. [PMID: 25732222 DOI: 10.1007/s12603-014-0544-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrient- and energy-dense ONS on nutritional status and to identify residents' characteristics associated with compliance. DESIGN AND SETTING Randomized, controlled trial in nursing homes. PARTICIPANTS AND INTERVENTION 87 nursing home residents (87 ± 6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2 x 125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care. MEASUREMENTS ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤ 30% and ≥ 80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents' characteristics were analysed. RESULTS Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (-0.2 (-2.2;+1.6) kg, n=12) and CG (-0.1 (-1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05). CONCLUSIONS A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents' characteristics.
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Affiliation(s)
- I Jobse
- Dr. Inken Jobse, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Koberger Str. 60, D-90408 Nürnberg, Germany, Tel. +49 911 5302 96150, Fax + 49 911 5302 96151, E-mail:
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Suominen MH, Jyvakorpi SK, Pitkala KH, Finne-Soveri H, Hakala P, Mannisto S, Soini H, Sarlio-Lahteenkorva S. Nutritional guidelines for older people in Finland. J Nutr Health Aging 2014; 18:861-7. [PMID: 25470800 DOI: 10.1007/s12603-014-0509-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. OBJECTIVE To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. DESIGN A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. RESULTS The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 μg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. CONCLUSIONS Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.
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Affiliation(s)
- M H Suominen
- MH Suominen, Unit of General Practice, Helsinki University Central Hospital and Department of General Practice and Primary Health Care, University of Helsinki, Finland,
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Oh SI, Kwak CS, Yon M, Lee MS. A Study on the Blood Health Status and Nutrient Intake in Elderly Women Dwelling in Longevity Region in Jeonla Province according to Family Arrangement. ACTA ACUST UNITED AC 2014. [DOI: 10.9799/ksfan.2014.27.5.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dunn H, Moore T. ‘You can’t be forcing food down ‘em’: Nursing home carers’ perceptions of residents’ dining needs. J Health Psychol 2014; 21:619-27. [DOI: 10.1177/1359105314532971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Malnutrition is a life-threatening condition among older people living in nursing care homes. This qualitative analysis of interview data from five care staff aimed to understand their perceptions of ‘caring for’ residents’ nutritional needs. Tensions in the delivery of care and institutionalisation and disempowerment were identified. Despite carers’ good intentions, they often failed to recognise the importance of the psychosocial aspects of mealtimes. Staff shortages, routine-driven, medically based working practices and residents’ resistance to institutionalisation emerged as barriers to quality caregiving. The findings indicate that the relational aspects of care are constrained by social, structural and ideological contexts.
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Ilhamto N, Anciado K, Keller HH, Duizer LM. In-house pureed food production in long-term care: perspectives of dietary staff and implications for improvement. J Nutr Gerontol Geriatr 2014; 33:210-228. [PMID: 25105716 DOI: 10.1080/21551197.2014.927306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Texture modification of foods to a pureed consistency is a common management approach for older adults with dysphagia. Long-term care (LTC) facilities commonly produce some pureed food in-house. This study investigated challenges and preferred practices associated with the production of pureed food in LTC facilities. Nutrition Managers (n = 27) and cooks (n = 26) from 25 Ontario LTC facilities were recruited for one-on-one, semistructured interviews. Interviews were digitally recorded, transcribed, and analyzed using inductive thematic analysis. Four themes arose from the data to exemplify challenges in production, including (a) difficulty in using standardized recipes, (b) varied interpretation of governmental guidelines, (c) lack of consistency in terminology and texture, and (d) wanting to improve the visual appeal. These challenges were reported to reduce the quality of in-house produced pureed food. Preferred practices to overcome these challenges were also provided by participants, such as involving cooks in pureed recipe improvements and tailoring to the specific needs of residents. Incorporation of these practices into pureed food production may help to shape and improve future practice and pureed food products.
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Affiliation(s)
- Nila Ilhamto
- a Elmira Pet Products , Elmira , Ontario , Canada
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Ilhamto N, Keller HH, Duizer LM. The effect of varying ingredient composition on the sensory and nutritional properties of a pureed meat and vegetable. J Nutr Gerontol Geriatr 2014; 33:229-248. [PMID: 25105717 DOI: 10.1080/21551197.2014.927307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of this research was to investigate the effects of ingredients and preparation methods on the sensory and nutritional properties of pureed turkey and carrots. Turkey samples varying in added liquid and muscle composition were developed. Seasoning application methods were also studied. Pureed carrots were formulated with no added thickener, added modified corn starch, rice cereal, or skim milk powder. Small changes in added liquid and seasoning application altered the perceived texture of the turkey. Pureed carrots with added modified corn starch were more slippery and firm than other samples. The addition of skim milk powder or rice cereal did not alter sensory properties but led to higher protein contents when compared to unthickened carrots. In-house formulations did not differ in sensory ratings of appearance and flavor when compared to commercial products but contained more carbohydrates. Modest changes in recipes for pureed products can improve sensory appeal and nutrient density; quality in-house products are feasible with only minor alterations.
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Affiliation(s)
- Nila Ilhamto
- a Elmira Pet Products, Elmira , Ontario , Canada
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Savikko N, Pitkälä KH, Laurila JV, Suominen MH, Tilvis RS, Kautiainen H, Strandberg TE. Secular trends in the use of vitamins, minerals and fish-oil products in two cohorts of community-dwelling older people in Helsinki--population-based surveys in 1999 and 2009. J Nutr Health Aging 2014; 18:150-4. [PMID: 24522466 DOI: 10.1007/s12603-013-0381-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine and compare the prevalence of use of vitamins, minerals, and fish-oil products (VMFO) in Finnish community-dwelling older people at two time points over a decade, and to explore the associated factors with the VMFO use. METHODS A postal survey was sent to people aged 75, 80, 85, 90, and 95 years living in Helsinki, Finland in 1999 (N=3219) and in 2009 (N=2247). The response rates were 78% (n=2511) and 73% (n=1637), respectively. The surveys included items on demographic and health related factors, used medication and self-reported supplemental use of vitamins or minerals, and natural products. RESULTS The proportion of respondents using at least one VMFO was 49.8% in 1999 and 66.8% in 2009 (p<0.001). The proportion using vitamin D (RR 4.58, 95% CI 3.89 to 5.40; p<0.001), calcium (RR 2.47, 95% CI 2.18 to 2.80; p<0.001), magnesium (RR 1.47, 95% CI 1.17 to 1.85; p<0.001), and fish-oil/omega3 products (RR 3.66, 95% CI 2.41 to 5.55; <0.001) was higher in 2009 than in 1999, even when adjusted for age, gender, living conditions, education and comorbidities, whereas that of other vitamins and fish-liver-oil products was lower. At both time points the use of VMFO was associated with female gender and higher number of used medications. In 1999, higher education was associated with VMFO-use while age and comorbidities was not. In 2009 higher age and comorbidities was associated with VMFO-use. CONCLUSIONS The use of VMFO is common among community-dwelling older people and it has significantly increased over ten years. The increase was mainly due to the use of vitamin D and calcium. The consumption of other vitamin supplements has decreased. Education was no longer associated with use of VFMO in 2009 where as age and comorbidities were.
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Affiliation(s)
- N Savikko
- Niina Savikko, Add: P.O. Box 20, 00014 University of Helsinki, Tel: +358 50 5371126, Fax: +358 9 191 27536, E-mail:
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Cankurtaran M, Saka B, Sahin S, Varlı M, Doventas A, Yavuz B, Halil M, Curgunlu A, Ulger Z, Tekin N, Akcicek F, Karan M, Atli T, Beger T, Erdincler D, Ariogul S. Turkish nursing homes and care homes nutritional status assessment project (THN-malnutrition). Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Prevalence of food insecurity and malnutrition, factors related to malnutrition in the elderly: A community-based, cross-sectional study from Turkey. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wright ORL, Connelly LB, Capra S, Hendrikz J. Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care. Health Expect 2013; 16:251-65. [PMID: 21923814 PMCID: PMC5060661 DOI: 10.1111/j.1369-7625.2011.00711.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor satisfaction with institutional food is a significant moderator of food intake in geriatrics/rehabilitation and residential aged care. PURPOSE To quantify the relationship between foodservice satisfaction, foodservice characteristics, demographic and contextual variables in geriatrics/rehabilitation and residential aged care. METHODS The Resident Foodservice Satisfaction Questionnaire was administered to 103 patients of 2 geriatrics/rehabilitation units and 210 residents of nine residential aged care facilities in Brisbane, Australia. Ordered probit regression analysis measured the association of age, gender, ethnicity and appetite, timing and amount of meal choice, menu selectivity, menu cycle, production system, meal delivery system and therapeutic diets with foodservice satisfaction. RESULTS Patient and resident appetite (P < 0.01), the amount and timing of meal choice (P < 0.01), self-rated health (P < 0.01), accommodation style (P < 0.05) and age (P < 0.10) significantly moderated foodservice satisfaction. High protein/high energy therapeutic diets (P < 0.01), foodservice production (P < 0.01) and delivery systems (P > 0.01) were significant moderators for those with 'fair' self-rated health. CONCLUSIONS Patient and resident characteristics and structural and systems-related foodservice variables were more important for influencing foodservice satisfaction than characteristics of food quality. The results suggest modifications to current menu planning and foodservice delivery methods: reducing the time-lapse between meal choice and consumption, augmenting the number of meals at which choice is offered, and revising food production and delivery systems.It is important that residents in poorer health who are a high risk of under-nutrition are provided with sufficient high protein/high energy therapeutic diets. Diets that restrict macro- and micro-nutrients should be minimized for all patients and residents.
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Affiliation(s)
- Olivia R L Wright
- School of Human Movement Studies, The University of Queensland, St Lucia, Qld, Australia.
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Yamakawa H, Ohnuma T, Satoh T, Sugiyama K, Harikae M, Iwamoto T. [Establishment of a short-form screening test for malnutrition in a newly developed comprehensive geriatric assessment initiative named 'Dr. SUPERMAN']. Nihon Ronen Igakkai Zasshi 2013; 50:233-42. [PMID: 23979247 DOI: 10.3143/geriatrics.50.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM Assessment of the nutritional state is important in comprehensive geriatric assessment (CGA). Several standardized screening tests for malnutrition are available such as the Mini-Nutritional Assessment (MNA) and MNA-Short Form (MNA-SF). However, it takes more than 10 minutes to perform the MNA-SF alone. We have developed a CGA initiative named 'Dr. SUPERMAN', which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for malnutrition preceding the MNA. METHODS The MNA-SF, which consists of 6 items (A-F), was administered to 163 elderly outpatients (mean age: 83.4 years, 80 men) with various diseases. Using the results of the MNA-SF score (normal ≥ 12 and abnormal ≤ 11) as a gold standard, the sensitivity, specificity, and positive predictive values (PPVs) of each item were calculated and the best combination of 2 items for identifying malnutrition among the elderly outpatients was selected. According to the combination of 2 items (item B: weight loss during the last 3 months; item F: body mass index (BMI)/calf circumference (CC) in cm), they were divided into 2 groups: the normal control (NC) group (neither items B nor F) and the malnutrition/at risk (MN) group (either items B or D, or both). Findings of the clinical feature, anthropometric measurement, and nutritional biomarker between the 2 groups were examined to clarify the characteristics of each. RESULTS The MNA-SF score was distributed as follows: 3-7 in 12 cases, 8-11 in 68 cases, and 12-14 in 83 cases. Based on the MNA-SF score, the combination of items B and F revealed the highest sensitivity (91.3%), specificity (63.9%), and PPV (70.9%), resulting in 103 cases in the MN group and 60 cases in the NC group. A high frequency of anorexia, living alone, hypoprealbuminemia, lymphocytopenia, and dehydration was observed in the MN group, whereas a high frequency of leg edema was observed in the NC group. Cases showing a positive wall-occiput test, which compelled the alternation of CC with BMI, accounted for 24% of all cases. CONCLUSIONS The combination of 'weight loss during the last 3 months' and initial BMI ≥ 23/CC <31 cm along with a positive wall-occiput test was a useful and valuable SF screening test for malnutrition in elderly outpatients.
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Affiliation(s)
- Hiroko Yamakawa
- Department of Geriatric Medicine, Tokyo Medical University Hospital
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Serrano-Urrea R, Garcia-Meseguer MJ. Malnutrition in an elderly population without cognitive impairment living in nursing homes in Spain: study of prevalence using the Mini Nutritional Assessment test. Gerontology 2013; 59:490-8. [PMID: 23949114 DOI: 10.1159/000351763] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of malnutrition in institutionalized elderly people is generally high. A good nutritional status is related to a decrease in mortality and costs of morbidity treatments. Therefore, it is essential to know the nutritional status in order to establish action policies. However, there are not enough studies about malnutrition in institutionalized elderly in Spain. OBJECTIVES The objectives of this survey were to assess the prevalence of malnutrition and risk of malnutrition in elderly people living in nursing homes in the province of Albacete (Spain) using the Mini Nutritional Assessment (MNA®) test, to analyze their distribution according to age, gender and different nursing home features, and to identify the MNA items that best predict the MNA total score. METHODS A cross-sectional study was conducted with data collected from 895 elders living in 34 nursing homes all over the province of Albacete, including facilities located in the main city, towns and villages. Prevalence of malnutrition and risk of malnutrition were assessed using the MNA full form test. Groups of malnutrition were compared by using mean MNA scores. Stepwise linear regression analyses were used to identify the items in the MNA which best predicted the MNA total scores. RESULTS According to the MNA, the prevalence of malnutrition among elderly people staying in Albacete province nursing homes was 2.8%, and the prevalence of being at risk of malnutrition was 37.3%. MNA total score was significantly higher in men (24.3 ± 2.9) than in women (23.7 ± 3.3) and significantly higher in residents living in nursing homes located in towns and villages (24.2 ± 2.8) than in those who were living in institutions placed in the main city (23.7 ± 3.4). The MNA score was found to decrease with increasing age, except for individuals aged 90 years or older. CONCLUSIONS The prevalence of malnutrition and risk of malnutrition was 40.1%. Female gender and living in institutions located in the main city were identified as malnutrition risk factors. In general, an increase in malnutrition with age was detected, except for people in the last years of their lives. The MNA questions that best predicted the nutritional status were the ones relating to the anthropometrical and self-assessments.
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Affiliation(s)
- R Serrano-Urrea
- Department of Mathematics, Faculty of Computer Science Engineering, University of Castilla-La Mancha, Albacete, Spain
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Papparotto C, Bidoli E, Palese A. Risk factors associated with malnutrition in older adults living in Italian nursing homes: a cross-sectional study. Res Gerontol Nurs 2013; 6:187-97. [PMID: 23739882 DOI: 10.3928/19404921-20130528-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/13/2013] [Indexed: 01/08/2023]
Abstract
Malnutrition is a significant problem among older adults living in nursing homes: Malnourished residents are at increased risk of hospitalization and mortality. Multiple factors determine malnutrition, and the extant literature has focused attention on individual factors such as aging, sex, and dependence in activities of daily living. However, little evidence is available on factors influenced by nursing care. Exploring the relationship between the nutritional status of nursing home residents and certain individual factors, including those potentially influenced by nursing care, was the aim of this cross-sectional study. A total of 186 nursing home residents was enrolled in the study; in addition, 18 nurses were involved in the data collection process. Twenty-one percent of the residents had an adequate nutritional status, 43% were at risk of malnutrition, and 36% were malnourished. Multivariate analysis revealed that those independent factors associated with malnutrition, once adjusted for age, sex, and dependence in activities of daily living, were: having had a stroke, being dependent in activities of daily living, eating half or less of food provided at mealtimes, and having their weight checked only every 3 months or longer. Nursing care projects may be effective in reducing the risk of malnutrition among nursing home residents. However, further research is needed to develop knowledge of the factors associated with malnutrition and those influenced by care delivered in nursing homes.
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Aziz NA, Roos RAC. Characteristics, pathophysiology and clinical management of weight loss in Huntington’s disease. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
SUMMARY Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder caused by a CAG repeat expansion in the HTT gene. Clinically, the disease is characterized by motor impairment, cognitive deterioration and behavioral disturbances. Unintended weight loss is also a hallmark of the disease and frequently leads to general weakening and a decline in the quality of life of HD patients. Moreover, a higher BMI has been associated with a slower rate of disease progression. In this review, the authors first delineate the characteristics of weight loss in both HD patients and genetic models of the disease. Subsequently, they discuss the pathophysiological processes underlying weight loss in HD and highlight the implications for management and care of HD patients with, or at risk of, unintended weight loss.
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Affiliation(s)
- N Ahmad Aziz
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Raymund AC Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Suzuki H, Asakawa A, Amitani H, Nakamura N, Inui A. Cancer cachexia--pathophysiology and management. J Gastroenterol 2013; 48:574-94. [PMID: 23512346 PMCID: PMC3698426 DOI: 10.1007/s00535-013-0787-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/20/2013] [Indexed: 02/04/2023]
Abstract
About half of all cancer patients show a syndrome of cachexia, characterized by anorexia and loss of adipose tissue and skeletal muscle mass. Cachexia can have a profound impact on quality of life, symptom burden, and a patient's sense of dignity. It is a very serious complication, as weight loss during cancer treatment is associated with more chemotherapy-related side effects, fewer completed cycles of chemotherapy, and decreased survival rates. Numerous cytokines have been postulated to play a role in the etiology of cancer cachexia. Cytokines can elicit effects that mimic leptin signaling and suppress orexigenic ghrelin and neuropeptide Y (NPY) signaling, inducing sustained anorexia and cachexia not accompanied by the usual compensatory response. Furthermore, cytokines have been implicated in the induction of cancer-related muscle wasting. Cytokine-induced skeletal muscle wasting is probably a multifactorial process, which involves a protein synthesis inhibition, an increase in protein degradation, or a combination of both. The best treatment of the cachectic syndrome is a multifactorial approach. Many drugs including appetite stimulants, thalidomide, cytokine inhibitors, steroids, nonsteroidal anti-inflammatory drugs, branched-chain amino acids, eicosapentaenoic acid, and antiserotoninergic drugs have been proposed and used in clinical trials, while others are still under investigation using experimental animals. There is a growing awareness of the positive impact of supportive care measures and development of promising novel pharmaceutical agents for cachexia. While there has been great progress in understanding the underlying biological mechanisms of cachexia, health care providers must also recognize the psychosocial and biomedical impact cachexia can have.
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Affiliation(s)
- Hajime Suzuki
- />Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
- />Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8520 Japan
| | - Akihiro Asakawa
- />Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Haruka Amitani
- />Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Norifumi Nakamura
- />Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8520 Japan
| | - Akio Inui
- />Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
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Beattie E, O'Reilly M, Strange E, Franklin S, Isenring E. How much do residential aged care staff members know about the nutritional needs of residents? Int J Older People Nurs 2013; 9:54-64. [DOI: 10.1111/opn.12016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 11/21/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Elizabeth Beattie
- Dementia Collaborative Research Centre: Carers & Consumers; Queensland University of Technology; Brisbane Australia
- Dementia Training Studies Centre; Queensland University of Technology; Brisbane Australia
- School of Nursing; Queensland University of Technology; Brisbane Australia
| | - Maria O'Reilly
- School of Nursing; Queensland University of Technology; Brisbane Australia
| | - Elise Strange
- Dietetics Department; School of Human Movement Studies; The University of Queensland; Brisbane Australia
| | - Sara Franklin
- Dementia Collaborative Research Centre: Carers & Consumers; Queensland University of Technology; Brisbane Australia
| | - Elisabeth Isenring
- Princess Alexandra Hospital; School of Human Movement Studies; The University of Queensland; Brisbane Australia
- Master of Dietetic Studies Program; School of Human Movement Studies; The University of Queensland; Brisbane Australia
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Volkert D. Malnutrition in older adults - urgent need for action: a plea for improving the nutritional situation of older adults. Gerontology 2013; 59:328-33. [PMID: 23406648 DOI: 10.1159/000346142] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/28/2012] [Indexed: 12/19/2022] Open
Abstract
During the past decades, malnutrition has attracted increasing scientific attention and is by now regarded as a true geriatric syndrome characterized by multifactorial causality, identified by symptoms and accompanied by frailty, disability and poor outcome. This viewpoint summarizes our present knowledge and the usual current handling of malnutrition in older people and highlights the urgent need for action in this field. Age-related changes in the complex system of appetite regulation, resulting in the so-called anorexia of aging, predispose older adults to a decrease in food intake which may lead to malnutrition, if additional risk factors like health or social problems occur. Consequently, malnutrition is widespread in the older population, notably in those who are institutionalized. Despite the fact that effective interventions are available, prevention and treatment of malnutrition do not currently receive appropriate attention. As an important first step towards better awareness, screening for malnutrition should become a mandatory integral part of the comprehensive geriatric assessment. Furthermore, practical local guidelines should be implemented in all geriatric hospital wards and nursing homes in order to improve nutritional care in the daily routine. Important to note is that reasonable nutritional management is not possible without qualified staff in adequate numbers allowing appropriate individual nutritional care. Regarding future research, studies at the cellular, metabolic and clinical levels and the linking of information from different research approaches are required to better understand the transition from good nutritional health and independence of old people to malnutrition, functional impairment and poor health. In parallel to well-designed observational and intervention studies, standardized documentation of nutritional information in daily routine would enable the uniform collection of data for research as well as for political decisions. In summary, the time is ripe for better inclusion of nutrition in geriatric health care. This will not only bring about improved nutritional status and outcome, and thus individual benefit for the affected person, but also economic benefits both for the institution and the health-care system.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
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Dillon EL. Nutritionally essential amino acids and metabolic signaling in aging. Amino Acids 2012; 45:431-41. [PMID: 23239011 DOI: 10.1007/s00726-012-1438-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 11/28/2012] [Indexed: 02/07/2023]
Abstract
Aging is associated with a gradual decline in skeletal muscle mass and strength leading to increased risk for functional impairments. Although basal rates of protein synthesis and degradation are largely unaffected with age, the sensitivity of older muscle cells to the anabolic actions of essential amino acids appears to decline. The major pathway through which essential amino acids induce anabolic responses involves the mammalian target of rapamycin (mTOR) Complex 1, a signaling pathway that is especially sensitive to regulation by the branched chain amino acid leucine. Recent evidence suggests that muscle of older individuals require increasing concentrations of leucine to maintain robust anabolic responses through the mTOR pathway. While the exact mechanisms for the age-related alterations in nutritional signaling through the mTOR pathway remain elusive, there is increasing evidence that decreased sensitivity to insulin action, reductions in endothelial function, and increased oxidative stress may be underlying factors in this decrease in anabolic sensitivity. Ensuring adequate nutrition, including sources of high quality protein, and promoting regular physical activity will remain among the frontline defenses against the onset of sarcopenia in older individuals.
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Affiliation(s)
- E Lichar Dillon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
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Yoshimatsu T, Yoshida D, Shimada H, Komatsu T, Harada A, Suzuki T. Relationship between near-infrared spectroscopy, and subcutaneous fat and muscle thickness measured by ultrasonography in Japanese community-dwelling elderly. Geriatr Gerontol Int 2012; 13:351-7. [PMID: 22762795 DOI: 10.1111/j.1447-0594.2012.00906.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Near-infrared spectroscopy (NIRS) allows estimation of the percentage of body fat (%BF) regardless of the patient's posture; thus, it is useful for assessment of elderly patients with severe decline of basic activity who cannot hold a standing position. However, the accuracy by which the near-infrared light emitted from NIRS reflects subcutaneous tissue is unknown. The aim of this study was to assess how correctly NIRS reflects the subcutaneous fat and muscle thickness derived from ultrasonography in community-dwelling elderly. METHODS A total of 93 community-dwelling older adults aged 65 years and older were enrolled in this study (mean 75.8 years, 6.7 SD). Participants were assessed according to optical density (OD) measurements by NIRS, subcutaneous fat and muscle thickness by ultrasonography, and muscle strength. Pearson's correlation coefficients were calculated for each sex. Stepwise multiple regression analysis was used to identify factors that contributed to OD for each sex. RESULTS OD measured at the forearm and thigh were significantly correlated with subcutaneous fat thickness. In stepwise multiple regression analyses, subcutaneous fat thickness was found to be a significant determinant of OD in men (forearm β = -0.37, P = 0.01; thigh β = -0.63, P < 0.001) and women (forearm β = -0.50, P < 0.001; thigh: β = -0.52, P < 0.001). CONCLUSIONS These results suggest that NIRS can appropriately estimate fat-free mass. By adding other variables to OD as the predictive variable, skeletal muscle mass might be estimated in the elderly population.
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Affiliation(s)
- Tatsuki Yoshimatsu
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Ota, Tokyo, Japan.
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High Technology Coming to a Nursing Home Near You. J Am Med Dir Assoc 2012; 13:409-12. [DOI: 10.1016/j.jamda.2012.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 12/22/2022]
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Abstract
Undernutrition in older persons usually presents as weight loss and is predominantly due to protein energy wasting. The presentation of undernutrition is often subtle in older persons and there is a need to utilize screening tools and increasing physician awareness. There are multiple treatable causes of undernutrition in older persons. The major causes are anorexia, cachexia, sarcopenia, dehydration, malabsorption and hypermetabolism. This article also provides an overview of the use of nutritional supplements and an approach to managing protein energy wasting.
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Affiliation(s)
- John E Morley
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, St Louis, MO 63104, USA.
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Increasing Awareness of the Factors Producing Falls: The Mini Falls Assessment. J Am Med Dir Assoc 2012; 13:87-90. [DOI: 10.1016/j.jamda.2011.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 11/21/2022]
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Morley JE. Anemia in the nursing homes: a complex issue. J Am Med Dir Assoc 2012; 13:191-4. [PMID: 22261540 DOI: 10.1016/j.jamda.2011.12.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 01/17/2023]
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Geriatric Principles: Evidence-Based Medicine at Its Best. J Am Med Dir Assoc 2012; 13:1-2.e1-2. [DOI: 10.1016/j.jamda.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 11/20/2022]
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical Update on Nursing Home Medicine: 2011. J Am Med Dir Assoc 2011; 12:615-626.e6. [DOI: 10.1016/j.jamda.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022]
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