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Muñoz-Fernandez SS, Garcez FB, Alencar JCG, Bastos AA, Morley JE, Cederholm T, Aprahamian I, de Souza HP, Avelino-Silva TJ, Bindels LB, Ribeiro SML. Gut microbiota disturbances in hospitalized older adults with malnutrition and clinical outcomes. Nutrition 2024; 122:112369. [PMID: 38422755 DOI: 10.1016/j.nut.2024.112369] [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: 11/03/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Malnutrition is one of the most threatening conditions in geriatric populations. The gut microbiota has an important role in the host's metabolic and muscular health: however, its interplay with disease-related malnutrition is not well understood. We aimed to identify the association of malnutrition with the gut microbiota and predict clinical outcomes in hospitalized acutely ill older adults. METHODS We performed a secondary longitudinal analysis in 108 geriatric patients from a prospective cohort evaluated at admission and 72 h of hospitalization. We collected clinical, demographic, nutritional, and 16S rRNA gene-sequenced gut microbiota data. Microbiota diversity, overall composition, and differential abundance were calculated and compared between patients with and without malnutrition. Microbiota features associated with malnutrition were used to predict clinical outcomes. RESULTS Patients with malnutrition (51%) had a different microbiota composition compared to those who were well-nourished during hospitalization (ANOSIM R = 0.079, P = 0.003). Patients with severe malnutrition showed poorer α-diversity at admission (Shannon P = 0.012, Simpson P = 0.018) and follow-up (Shannon P = 0.023, Chao1 P = 0.008). Differential abundance of Lachnospiraceae NK4A136 group, Subdoligranulum, and Faecalibacterium prausnitzii were significantly lower and inversely associated with malnutrition, while Corynebacterium, Ruminococcaceae Incertae Sedis, and Fusobacterium were significantly increased and positively associated with malnutrition. Corynebacterium, Ruminococcaceae Incertae Sedis, and the overall composition were important predictors of critical care in patients with malnutrition during hospitalization. CONCLUSION Older adults with malnutrition, especially in a severe stage, may be subject to substantial gut microbial disturbances during hospitalization. The gut microbiota profile of patients with malnutrition might help us to predict worse clinical outcomes.
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Affiliation(s)
- Shirley S Muñoz-Fernandez
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil.
| | - Flavia B Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil; Departamento de Medicina, Hospital Universitario, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - Julio C G Alencar
- Disciplina de Emergencias Clínicas, Departamento de Clínica Medica, Faculty of Medicine, University of São Paulo, São Paulo, Sao Paulo, Brazil
| | - Amália A Bastos
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil
| | - John E Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Sao Paulo, Brazil
| | - Heraldo P de Souza
- Disciplina de Emergencias Clínicas, Departamento de Clínica Medica, Faculty of Medicine, University of São Paulo, São Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil
| | - Laure B Bindels
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Sandra M L Ribeiro
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil; School of Arts, Science, and Humanity, University of São Paulo, São Paulo, Sao Paulo, Brazil
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Wu X, Xu Y, Liu Y, Ma A, Zhong F, Gao T, Cai J, Chen Y, Wang Y, Zhou W, Ma Y. Relationships between oral function, dietary intake and nutritional status in older adults aged 75 years and above: a cross-sectional study. BMC Public Health 2024; 24:1465. [PMID: 38822295 PMCID: PMC11143706 DOI: 10.1186/s12889-024-18906-y] [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: 10/13/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Malnutrition is related to impaired oral health and function that causes poor dietary intake, declining the general health of older adults. The role of dietary intake in the association between oral function and nutritional status of Chinese older adults (aged 75 and above) was examined in this cross-sectional study. METHODS Through the randomized cluster sampling method, 267 older adults living in rural areas of Qingdao, Shandong (aged 81.4 ± 4.3, 75-94 years) were chosen as the primary research participants. A Mini Nutritional Assessment - Short Form was used to determine nutritional status, and Food Frequency Questionnaire and 24-hour Food Intake Recall were used to assess dietary intake. The oral function was evaluated by analyzing the teeth, oral problems, bite force, tongue pressure, lip sealing pressure, chewing function questionnaire, whole saliva flow rate, 10-Item Eating Assessment Tool, and water swallow test. RESULTS Based on the MNA-SF score, it was divided into a well-nourished group and a malnutrition group, with the malnutrition group comprising 40.6% of participants. The participants in the malnutrition group showed a higher rate of xerostomia, lower bite force, tongue pressure, and lip sealing pressure, and higher Chewing Function Questionnaire and 10-Item Eating Assessment Tool scores. Furthermore, their plant fat, iron, cereals and potatoes, vegetables, fruits, and seafood intake were relatively low. The regression model indicated that exercise frequency, stroke, chewing and swallowing function, intake of vegetables and fruits were risk factors for nutritional status of older adults. CONCLUSION Malnutrition was relatively common among the Chinese older adults aged 75 and above, and it was significantly correlated with exercise frequency, stroke, chewing and swallowing function, and intake of vegetables and fruits. Therefore, nutrition management should be carried out under the understanding and guidance of the oral function and dietary intake of the older adults.
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Affiliation(s)
- Xiaoqing Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yanqiu Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yajun Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Aiguo Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Feng Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Tianlin Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Jing Cai
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yong Chen
- School of Food Science and Biotechnology, Food Oral Processing Laboratory, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Yali Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Wenkai Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yan Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
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Mendez I, Strassle PD, Ponce S, Le R, Stewart AL, Nápoles AM. Age-related differences in the association between financial hardship and weight change during the COVID-19 pandemic. Heliyon 2024; 10:e30917. [PMID: 38779010 PMCID: PMC11108839 DOI: 10.1016/j.heliyon.2024.e30917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To examine the association of financial hardship with weight changes in the US during the COVID-19 pandemic. Methods We used data from the COVID-19's Unequal Racial Burden survey, a nationally representative, cross-sectional, online survey of diverse adults living in the US, 12/2020-2/2021. This study included 1000 Asian, Black, Latino (half Spanish-speaking), and White adults and 500 American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and multiracial adults (5500 total). Age-specific (18-39, 40-59, ≥60) associations between financial hardship domains and weight change were estimated using multinomial logistic regression, adjusted for demographic and health characteristics. Results Financial hardship during the COVID-19 pandemic was prevalent across all age groups (18-39: 76.2 %; 40-59: 75.6 %; ≥60: 50.6 %). Among adults aged 18-39 and ≥ 60 years old, food insecurity was significantly associated with weight loss (18-39: aOR = 1.42, 95 % CI = 1.04, 1.95; ≥60: aOR = 3.67, 95 % CI = 1.50, 8.98). Among all age groups, unmet healthcare expenses was also associated with weight loss (18-39: aOR = 1.31, 95 % CI = 1.01, 1.70; 40-59: aOR = 1.49, 95 % CI = 1.06, 2.08; ≥60: aOR = 1.73, 95 % CI = 1.03, 2.91). Among adults aged 18-39 and ≥ 60 years old, lost income was significantly associated with weight gain (18-39: aOR = 1.36, 95 % CI = 1.09-1.69; ≥60: aOR = 1.46, 95 % CI = 1.04, 2.06), and among adults 40-59 years old, experiencing increased debt was significantly associated with weight gain (aOR = 1.50, 95 % CI = 1.13, 1.99). Conclusions For those aged 18-39 and ≥ 60 years old experiencing financial hardship during the COVID-19 pandemic was associated with both weight loss and weight gain. Less correlation was observed among adults aged 40-59.
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Affiliation(s)
- Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, USA
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, USA
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Xu Z, Gu Y, Xu X, Topaz M, Guo Z, Kang H, Sun L, Li J. Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study. JMIR Form Res 2024; 8:e52170. [PMID: 38814702 DOI: 10.2196/52170] [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: 08/25/2023] [Revised: 12/21/2023] [Accepted: 03/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND China's older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph-based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. OBJECTIVE This study aims to develop a knowledge graph-based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. METHODS We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo's effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. RESULTS Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo's meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults' own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo's ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual's health profile and dietary requirements. CONCLUSIONS ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo's performance in real-world settings, emphasizing the robust management of complex health data. The system's scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults.
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Affiliation(s)
- Zidu Xu
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Nursing, Columbia University, New York, NY, United States
| | - Yaowen Gu
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Chemistry, New York University, New York, NY, United States
| | - Xiaowei Xu
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, NY, United States
| | - Zhen Guo
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyu Kang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lianglong Sun
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Maxson SL, Grini IS, Ueland Ø, Terragni L. Eating preferences and behaviors of older immigrants in Oslo: A qualitative study. Appetite 2024; 200:107531. [PMID: 38815690 DOI: 10.1016/j.appet.2024.107531] [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: 03/19/2024] [Revised: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
Norway's population of older, first-generation immigrants is expected to almost triple by the year 2060 due to decreased mortality and continued immigration. Studies indicate that older immigrants in Norway have a higher rate of non-communicable disease than older non-immigrants. Eating a health-supporting diet is important for reducing disease risk and maintaining independence in older adults. The purpose of this study was to increase understanding of the eating preferences and behaviors of older, home-dwelling, first-generation immigrants in Oslo, and to identify influences on their eating preferences and behaviors. This qualitative study took a phenomenological approach to understand older immigrants' shared experience of changing eating behaviors with aging. Fourteen home-dwelling, older immigrants were recruited using a combination of purposeful random sampling and snowball sampling. In-depth interviews were conducted then analyzed according to reflexive thematic analysis. Study findings indicate that older immigrants eat a bi-cultural diet pattern. In addition, they seek out information about nutrition, and incorporate many health-supporting eating habits for disease management and prevention. In this way, older immigrants in Oslo share much in common with older non-immigrants. Hopes and worries for the future motivate older immigrants to eat more healthfully in order to maintain independence and cultural identity as long as possible. These results can be useful for designing culturally tailored programs which support eating habits for health maintenance and disease prevention among older immigrants.
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Affiliation(s)
- Stephanie L Maxson
- Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
| | | | | | - Laura Terragni
- Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
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Borda MG, Lafuente Sanchis P, Patricio Baldera J, Tarazona-Santabalbina FJ, Chavarro-Carvajal DA, Salazar-Londoño S, Bocharova M, Aarsland D, Martín-Marco A. Assessing Neutrophil-to-Lymphocyte Ratio as a Nutritional Indicator in Community-Dwelling Older Adults. Arch Med Res 2024; 55:103003. [PMID: 38795422 DOI: 10.1016/j.arcmed.2024.103003] [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: 01/09/2024] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND In an aging population, there is an increasing need for easily accessible nutritional markers. AIMS To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as an effective nutritional indicator compared to the Mini-Nutritional Assessment Short Form (MNA-SF) or other common markers such as albumin and body mass index (BMI). METHODS Data were obtained from the SABE study in Ecuador, which included participants aged 60 years or older. This cross-sectional study collected comprehensive data, including demographics, health-related factors, and physical assessments. Neutrophil and lymphocyte counts were measured by complete blood count. Nutritional status was assessed by MNA-SF, and BMI was calculated. Several physical tests were performed to evaluate the participants' functional status. Confounding variables such as age, sex, and comorbidities were considered. RESULTS The final sample consisted of 1790 subjects (48.9% male). The overall median age was 68 years (IQR 64,76). BMI and lymphocytes were higher in females, while NLR was higher in males. MNA-SF showed a negative association with NLR. Similarly, lymphocyte count shows a positive association with MNA-SF. Physical tests, such as the Romberg test and the Five Times Sit-to-Stand test, also showed correlations with NLR and lymphocyte count, respectively. CONCLUSION The study results suggest a significant relationship between NLR and lymphocytes, and nutritional status. The correlation with albumin is stronger with NLR than with BMI. The simplicity and affordability of NLR may make it suitable for routine use in several medical fields, improving our understanding of the complex relationship between nutrition, inflammation, and overall health.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine, Stavanger University Hospital. Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet. Stockholm, Sweden; Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain.
| | - Pablo Lafuente Sanchis
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain
| | - Jonathan Patricio Baldera
- Centre for Age-Related Medicine, Stavanger University Hospital. Stavanger, Norway; Escuela de Estadística de la Universidad Autónoma de Santo Domingo. Santo Domingo, República Dominicana
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Alzira, Spain; Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Madrid, Spain; Medical School, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Diego Andrés Chavarro-Carvajal
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Salomón Salazar-Londoño
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Mariia Bocharova
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London. London, UK
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital. Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London. London, UK
| | - Antonio Martín-Marco
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain
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Kuang M, Qiu J, Yang R, Wang C, Huang X, Xie G, Sheng G, Zou Y. Prognostic value of geriatric nutritional risk index in patients with stable coronary artery disease undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2024; 24:264. [PMID: 38773437 PMCID: PMC11106886 DOI: 10.1186/s12872-024-03940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Malnutrition increases the risk of poor prognosis in patients with cardiovascular disease, and our current research was designed to assess the predictive performance of the Geriatric Nutrition Risk Index (GNRI) for the occurrence of poor prognosis after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (SCAD) and to explore possible thresholds for nutritional intervention. METHODS This study retrospectively enrolled newly diagnosed SCAD patients treated with elective PCI from 2014 to 2017 at Shinonoi General Hospital, with all-cause death as the main follow-up endpoint. Cox regression analysis and restricted cubic spline (RCS) regression analysis were used to explore the association of GNRI with all-cause death risk and its shape. Receiver operating characteristic curve (ROC) analysis and piecewise linear regression analysis were used to evaluate the predictive performance of GNRI level at admission on all-cause death in SCAD patients after PCI and to explore possible nutritional intervention threshold points. RESULTS The incidence of all-cause death was 40.47/1000 person-years after a mean follow-up of 2.18 years for 204 subjects. Kaplan-Meier curves revealed that subjects at risk of malnutrition had a higher all-cause death risk. In multivariate Cox regression analysis, each unit increase in GNRI reduced the all-cause death risk by 14% (HR 0.86, 95% CI 0.77, 0.95), and subjects in the GNRI > 98 group had a significantly lower risk of death compared to those in the GNRI < 98 group (HR 0.04, 95% CI 0.00, 0.89). ROC analysis showed that the baseline GNRI had a very high predictive performance for all-cause death (AUC = 0.8844), and the predictive threshold was 98.62; additionally, in the RCS regression analysis and piecewise linear regression analysis we found that the threshold point for the GNRI-related all-cause death risk was 98.28 and the risk will be significantly reduced when the subjects' baseline GNRI was greater than 98.28. CONCLUSIONS GNRI level at admission was an independent predictor of all-cause death in SCAD patients after PCI, and GNRI equal to 98.28 may be a useful threshold for nutritional intervention in SCAD patients treated with PCI.
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Affiliation(s)
- Maobin Kuang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Provincial, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
| | - Jiajun Qiu
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Provincial, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
| | - Ruijuan Yang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Provincial, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
| | - Chao Wang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Provincial, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
| | - Xin Huang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Provincial, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
| | - Guobo Xie
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China
| | - Guotai Sheng
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China.
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi Provincial, China.
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Li TC, Li CI, Liu CS, Lin CH, Yang SY, Lin CC. Comparison of Mini Nutritional Assessment Tool and Geriatric Nutrition Risk Index in Predicting 12-Y Mortality Among Community-Dwelling Older Persons. J Nutr 2024:S0022-3166(24)00287-6. [PMID: 38763266 DOI: 10.1016/j.tjnut.2024.05.010] [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: 03/04/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Malnutrition is a common and dangerous condition in older adults, which has been associated with increased risk of mortality. OBJECTIVES This study aimed to evaluate and compare the abilities of Mini Nutritional Assessment short form (MNA-SF), MNA full form (MNA-FF), and geriatric nutritional risk index (GNRI) to predict all-cause and expanded cardiovascular disease (CVD)-related mortality in community-dwelling older adults. METHODS This research was an observational cohort study conducted in a community setting, with a 12-y follow-up involving 1001 community-living older adults aged 65 y or older who were enrolled in 2009 and followed up until 2021. Nutritional status assessment was carried out in 2009 using MNA-SF, MNA-FF, and GNRI. Multivariate Cox proportional hazards regression was applied to determine adjusted hazard ratios of mortality with 95% CIs. RESULTS A total of 368 deaths (36.76%) and 122 expanded CVD-related deaths (12.19%) were observed after a median follow-up of 12 y. Compared with normal nutritional status, poor nutritional status assessed by the MNA-SF, MNA-FF, and GNRI was found to be associated with an increased all-cause mortality in older persons. MNA-SF and MNA-FF, but not GNRI, were associated with expanded CVD-related mortality. The MNA-FF showed better discriminatory accuracy for all-cause (C-statistics: 0.77; 95% CI: 0.63, 0.79) and expanded CVD-related mortality (C-statistics: 0.79; 95% CI: 0.70, 0.83) than MNA-SF (C-statistics: 0.76; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.81, respectively) and GNRI (C-statistics: 0.75; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.80, respectively). CONCLUSIONS Our findings indicate that MNA-SF, MNA-FF, and GNRI were all independent predictors of all-cause mortality. In particular, the MNA-FF may be the best nutritional assessment tool for predicting all-cause and CVD-related mortality among older persons residing in community, compared with MNA-SF and GNRI.
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Affiliation(s)
- Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Audiology and Speech-Language Pathology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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9
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Marche C, Baourakis G, Fakotakis E, Nieddu A, Errigo A, Pes GM. The impact of nutrition on psycho-affective status in an older Cretan population: a cross-sectional study. Eur J Nutr 2024:10.1007/s00394-024-03395-x. [PMID: 38744756 DOI: 10.1007/s00394-024-03395-x] [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: 12/06/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Cognitive and mood status influence both personal and social daily activities, with great impact on life quality, particularly among the elderly population. AIM This cross-sectional study aimed to investigate the psycho-affective status concerning eating habits within an elderly population of the Chania area in Crete, Greece. METHODS Cognitive status was assessed in 101 elderly subjects through the Mini-Mental State Examination (MMSE), and mood was evaluated using the Hospital Anxiety and Depression Scale (HADS). Nutritional status was assessed using a validated food frequency questionnaire. RESULTS Multivariable statistical analysis, after adjustment for age, marital status, education, and comorbidity, highlighted among males a positive association of the MMSE score with vegetable consumption (RR 1.18; 95%CI 1.03‒1.34) and a negative association with potato consumption (RR 0.83; 95%CI 0.72‒0.95). Conversely, among females, no statistically significant association was observed for any food. Further, among males, a protective effect on affective status was identified for chicken meat (RR 0.45; 95%CI 0.27‒0.77), fish (RR 0.41; 95%CI 0.21‒0.82), fruit (RR 0.70; 95%CI 0.52‒0.94), cereals (RR 0.67; 95%CI 0.53‒0.87), and cheese (RR 0.78; 95%CI 0.63‒0.97) consumption. Among females, the adjusted model showed a significant detrimental effect of vegetable consumption (RR 1.33; 95%CI 1.02‒1.73). CONCLUSION A predominantly vegetable-based diet-with the notable exception of fruits and legumes-was associated with better cognitive status in males, albeit not in females. A higher intake of fruit, as well as fish, chicken meat, and cheese among males was associated with a better affective status, indicating that adequate protein supply may play a role in maintaining emotional balance.
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Affiliation(s)
- Chiara Marche
- Department of Biomedical Science, University of Sassari, Viale San Pietro No. 43B, 07100, Sassari, Italy.
| | - George Baourakis
- CIHEAM-Mediterranean Agronomic Institute of Chania, P.O. Box 85, 73100, Chania, Crete, Greece
| | - Eleftherios Fakotakis
- CIHEAM-Mediterranean Agronomic Institute of Chania, P.O. Box 85, 73100, Chania, Crete, Greece
| | - Alessandra Nieddu
- Department of Biomedical Science, University of Sassari, Viale San Pietro No. 43B, 07100, Sassari, Italy
| | - Alessandra Errigo
- Department of Medicine, Surgery and Pharmacy, Viale San Pietro 8, 07100, Sassari, Italy
| | - Giovanni Mario Pes
- Department of Medicine, Surgery and Pharmacy, Viale San Pietro 8, 07100, Sassari, Italy
- Sardinia Blue Zone Longevity Observatory, 08040, Ogliastra, Italy
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10
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Thaenpramun R, Komolsuradej N, Buathong N, Srikrajang S. Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study. Br J Nutr 2024; 131:1497-1505. [PMID: 38239007 PMCID: PMC11043908 DOI: 10.1017/s0007114524000175] [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: 08/29/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61-70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118-355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.
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Affiliation(s)
- Rattiyaphon Thaenpramun
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Narucha Komolsuradej
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Napakkawat Buathong
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Siwaluk Srikrajang
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich road, Hat Yai, Songkhla90110, Thailand
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11
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Xu F, Zhong X. Clinical Significance of the Prognostic Nutritional Index in Predicting Delirium among Critically Ill Patients: A Retrospective Cohort Study. Crit Care Res Pract 2024; 2024:3807532. [PMID: 38766547 PMCID: PMC11102111 DOI: 10.1155/2024/3807532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/15/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Delirium is a serious and complex problem facing critically ill patients. This retrospective study aimed to explore the association between prognostic nutrition index (PNI) and delirium in critically ill patients in the intensive care unit (ICU). This study was based on the Medical Information Mart Intensive Care IV (MIMIC IV) database. Patients over 18 years of age were enrolled. Univariate and multivariate logistic regression analyses were performed to explore the association between PNI and delirium. Tendency analysis, subgroups analysis, and restricted cubic spline (RCS) were selected to further certify the association. The receiver operating characteristic curve (ROC) was adopted to assess the predictability of PNI to delirium. Propensity score matching (PSM) was used to reduce the interference of confounders. A total of 3,105 patients participated in this study. As the grade of malnutrition increases, the incidence of delirium increases in all models. The odds ratios (OR) of delirium in the fully adjusted model were 1.00 (reference), 1.04 (0.80, 1.36), 1.53 (1.17, 1.99), and 1.93 (1.44, 2.59). Strong U-shaped curves were found with RCS analysis between delirium and PNI in the subgroups of patients over 60 years of age and patients with chronic obstructive pulmonary disease (COPD). After PSM, the ORs of delirium were 1.44 (1.16, 1.79) and 1.53 (1.22, 1.93), respectively, in the univariate and multivariate logistic regression models. PNI is negatively associated with the prevalence of delirium in critically ill adults in the ICU. PNI is an independent risk factor for the incidence of delirium in adults in the ICU.
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Affiliation(s)
- Feifei Xu
- Department of Intensive Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xi Zhong
- Department of Intensive Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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12
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McEvoy CT, McClure CD. Nutrition resilience for healthy ageing. Age Ageing 2024; 53:ii1-ii3. [PMID: 38745487 DOI: 10.1093/ageing/afae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Claire T McEvoy
- Queen's University Belfast, School of Medicine Dentistry and Biomedical Sciences, Institute for Global Food Security, Centre for Public Health, Belfast BT12 6BJ, UK
| | - Colin D McClure
- Queen's University Belfast, School of Biological Sciences, Institute for Global Food Security, Belfast BT9 5DL, UK
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13
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Ning K, Sun X, Liu L, He L. Prevalence and contributing factors of anemia in patients with gynecological cancer: a retrospective cohort study. Sci Rep 2024; 14:10628. [PMID: 38724572 PMCID: PMC11082243 DOI: 10.1038/s41598-024-61015-4] [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: 10/18/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
This retrospective cohort study aimed to determine the prevalence of anemia among patients with gynecological cancer prior to any treatment and to identify contributing factors associated with anemia in this group. We retrospectively analyzed data from female patients aged 18 and above, diagnosed with various forms of gynecological cancer at The Affiliated Hospital of Southwest Medical University between February 2016 and March 2021. Anemia was assessed based on the most recent CBC results before any cancer treatment. Eligibility was based on a definitive histopathological diagnosis. Key variables included demographic details, clinical characteristics, and blood counts, focusing on hemoglobin levels. Statistical analysis was conducted using logistic regression models, and anemia was defined as hemoglobin levels below 12 g/dL for women, according to WHO criteria. Of the 320 participants, a significant prevalence of anemia was found. Correlations between anemia and factors like age, educational level, and biological markers (iron, folic acid, and vitamin B12 levels) were identified. In our study, we found that the prevalence of anemia among patients with gynecological cancer prior to any treatment was 59.06%, indicating a significant health concern within this population. The study highlights a significant prevalence of anemia in patients with gynecological cancer, emphasizing the need for regular hemoglobin screening and individualized management. These findings suggest the importance of considering various characteristics and clinical variables in anemia management among this patient group. Further studies are needed to explore the long-term effects of these factors on patient outcomes and to develop targeted interventions.
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Affiliation(s)
- Kexue Ning
- College of Agroforestry and Health, The Open University of Sichuan, Chengdu, China
| | - Xingyu Sun
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ling Liu
- Department of Reproductive Medicine Center, The Affiliated Hospital, Southwest Medical University, 25 Taiping Street, Luzhou, China
| | - Lijuan He
- Department of Health Management Center, The Affiliated Hospital, Southwest Medical University, 25 Taiping Street, Luzhou, China.
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14
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Furulund E, Druckrey-Fiskaaen KT, Carlsen SEL, Madebo T, Fadnes LT, Lid TG. Healthy eating among people on opioid agonist therapy: a qualitative study of patients' experiences and perspectives. BMC Nutr 2024; 10:70. [PMID: 38705977 PMCID: PMC11071228 DOI: 10.1186/s40795-024-00880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024] Open
Abstract
People with substance use disorders often have unhealthy diets, high in sweets and processed foods but low in nutritious items like fruits and vegetables, increasing noncommunicable disease risks. This study investigates healthy eating perceptions and barriers among individuals with opioid use disorder undergoing opioid agonist therapy. Interviews with 14 participants at opioid agonist therapy clinics in Western Norway, using a semi-structured guide and systematic text condensation for analysis, reveal that most participants view their diet as inadequate and express a desire to improve for better health. Barriers to healthy eating included oral health problems, smoking habits, and limited social relations, while economic factors were less of a concern for the participants. Participants did find healthy eating easier when they were in social settings. This study underscores the importance of understanding and addressing these barriers and facilitators to foster healthier eating patterns in this population, potentially enhancing overall health and well-being.
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Affiliation(s)
- Einar Furulund
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Karl Trygve Druckrey-Fiskaaen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siv-Elin Leirvåg Carlsen
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tesfaye Madebo
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lars T Fadnes
- Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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15
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Do KN, Le LTT, Dang SC, Nguyen HTT, Nguyen GT, Ngo HVT, Nguyen HLT, Nguyen LTT, Dang AK, Le HT. An Assessment of Physical Activity and Risk Factors in People Living with Dementia: Findings from a Cross-Sectional Study in a Long-Term Care Facility in Vietnam. Geriatrics (Basel) 2024; 9:57. [PMID: 38804314 PMCID: PMC11130955 DOI: 10.3390/geriatrics9030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND People living with dementia (PLWD) may experience substantial cognitive decline as the disease progresses, which interferes with their daily activities. This study aimed to assess physical activity (PA) performance and care dependency (CD) and identify factors related to PA among PLWD. METHODS We conducted a cross-sectional study in 63 PLWD from National Geriatrics Hospital, Vietnam, from 2021 to 2023. We used the Mini Nutritional Assessment (MNA), International Physical Activity Questionnaire (IPAQ), and Care Dependency Scale (CDS) to assess the nutritional status and the levels of PA and CD, respectively. We used the Mann-Whitney test to compare the differences in the PA types and CD levels between dementia levels and a multivariable logistics regression model to analyze factors related to PA. RESULTS More than half of the subjects had mild dementia. In total, 35% of the PLWD had a low level of PA, and 46.3% were completely independent of care. The mean score in each CDS aspect of the subjects with moderate/severe dementia was statistically significantly lower than that of those with mild dementia (p ≤ 0.05). Lower dependency (OR = 0.9; 95% CI = 0.88-0.99) and malnutrition (OR = 15.4; 95% CI = 1.18-20.21) were associated with insufficient PA in the PLWD. CONCLUSION Formal caregivers and healthcare workers should encourage PLWD to perform physical activities at any level and personalize the development of tailored and nutritional care strategies for each individual.
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Affiliation(s)
- Khanh Nam Do
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Linh Thao Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Son Cong Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Ha Thu Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Giang Thu Nguyen
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Tyne NE2 4HH, UK;
| | - Hang Van Thi Ngo
- VinUniversity Medical Simulation Center, College of Health Sciences, VinUniversity, Hanoi 100000, Vietnam;
| | - Huong Lan Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Department of Nutrition, Saint Paul General Hospital, Hanoi 100000, Vietnam
| | - Lieu Thu Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Department of Nutrition, National Hospital of Obstetrics and Gynecology, Hanoi 100000, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane 4102, Australia
| | - Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Department of Nutrition and Dietetics, Hanoi Medical University Hospital, Hanoi 100000, Vietnam
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16
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Soós R, Bakó C, Gyebrovszki Á, Gordos M, Csala D, Ádám Z, Wilhelm M. Nutritional Habits of Hungarian Older Adults. Nutrients 2024; 16:1203. [PMID: 38674893 PMCID: PMC11053580 DOI: 10.3390/nu16081203] [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: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
There are many nutritional changes that come with aging, mostly as consequences of health regression. Malnutrition and overweight often start with inadequate food consumption, followed by alterations in biochemical indices and body composition. In our study, we aimed to analyze the feeding habits and energy and nutrient intake of a Hungarian elderly population, focusing on macronutrient, water, fruit, and vegetable consumption while searching for possible nutritional factors leading to NCD and many other chronic diseases in this population. Two questionnaires were used. These were the Mini Nutritional Assessment (MNA) and one asking about nutritional habits, and a 3-day feeding diary was also filled. Subjects (n = 179, 111; females (F), 68 males (M), older than 50 years were recruited. Based on MNA results, 78 adults (43.57% of the studied population) were malnourished or at risk of malnutrition, although, according to BMI categories, 69% were overweight and 7.3% were obese among M, while 42.3% were overweight among F. The average daily meal number was diverse. The amount of people consuming fruit (11.7%) and vegetables (8.93%) several times a day was extremely low (15.3% of F and 4.4% of M). Daily fruit consumption in the whole sample was 79.3%. Overall, 36.3% consumed 1 L of liquid and 0.5 L of consumption was found in 15.1% of participants. A significant gender difference was found in water consumption, with F drinking more than M (p ≤ 0.01). In our sample, 27.93% of the respondents took dietary supplements. Further analysis and research are needed to explore the specific health implications of and reasons behind these findings.
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Affiliation(s)
- Rita Soós
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Csilla Bakó
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
| | - Ádám Gyebrovszki
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Mónika Gordos
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Dávid Csala
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Zoltán Ádám
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, University of Pécs, 7624 Pécs, Hungary;
- Wnt-Signaling Research Group, Szentagothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Márta Wilhelm
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
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Wang P, Huang J, Xue F, Abuduaini M, Tao Y, Liu H. Associations of serum vitamin B6 status with the risks of cardiovascular, cancer, and all-cause mortality in the elderly. Front Immunol 2024; 15:1354958. [PMID: 38698865 PMCID: PMC11064647 DOI: 10.3389/fimmu.2024.1354958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Background There are few studies investigating the relationship between serum vitamin B6 and mortality risk in the elderly. This study hereby evaluated the associations between biomarkers of serum vitamin B6 status and cardiovascular, cancer, and all-cause mortality risks in the elderly. Methods Our study included a total of 4,881 participants aged 60 years or older from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Serum vitamin B6 status was estimated based on levels of pyridoxal 5'-phosphate (PLP), 4-pyridoxic acid (4-PA), and vitamin B6 turnover rate (4-PA/PLP) detected by high-performance liquid chromatography. Survival status and corresponding causes of death were matched through the National Death Index records through December 31, 2019. Multivariate Cox regression model was adopted to assess the relationships between serum vitamin B6 status and the risk of mortality. Results During a median follow-up period of 10.33 years, 507 cardiovascular deaths, 426 cancer deaths, and 1995 all-cause deaths were recorded, respectively. In the multivariate-adjusted Cox model, the hazard ratios (HRs) and 95% confidence intervals (CIs) for the highest versus the lowest quartiles of PLP, 4-PA, and 4-PA/PLP were 0.70(0.54-0.90), 1.33(0.88-2.02), and 2.01(1.41-2.79) for cardiovascular mortality, 0.73(0.52-1.02), 1.05(0.71-1.57), and 1.95(1.25-3.05) for cancer mortality, and 0.62(0.53-0.74), 1.05(0.82-1.34), and 2.29(1.87-2.79) for all-cause mortality, respectively. Conclusion Our study found that lower serum PLP levels were associated with increased risks of cardiovascular and all-cause mortality among the elderly population. And higher vitamin B6 turnover rate was associated with increased risks of cardiovascular, cancer, and all-cause mortality.
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Affiliation(s)
- Pengxi Wang
- Department of Medical Genetics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jia Huang
- Department of Medical Genetics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Feng Xue
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Munire Abuduaini
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuchang Tao
- Department of Medical Genetics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hongyan Liu
- Department of Medical Genetics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Zhao X, Meng L, Wang D, Shi J, Wu W, Fan G, Shi H, Dong J, Yu P, Yang R. Targeted metabolomic profiles of serum amino acids are independently correlated with malnutrition in older adults. BMC Geriatr 2024; 24:341. [PMID: 38622502 PMCID: PMC11020810 DOI: 10.1186/s12877-024-04937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/31/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Malnutrition is a common geriatric syndrome that is closely associated with adverse clinical outcomes and poses significant harm to older adults. Early assessment of nutritional status plays a crucial role in preventing and intervening in cases of malnutrition. However, there is currently a lack of measurable methods and biomarkers to evaluate malnutrition in older adults accurately. The aim of this study is to investigate the independent correlation between serum levels of amino acids and malnutrition in older adults, and to identify effective metabolomics biomarkers that can aid in the early detection of geriatric malnutrition. METHODS A total of 254 geriatric medical examination participants from Beijing Hospital were included in the study, consisting of 182 individuals with normal nutritional status (Normal group) and 72 patients at risk of malnutrition or already malnourished (MN group). Malnutrition was assessed using the Mini-Nutritional Assessment Short-Form (MNA-SF). Demographic data were collected, and muscle-related and lipid indexes were determined. Serum amino acid concentrations were measured using isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS). The correlation between serum amino acid levels and malnutrition was analyzed using non-parametric tests, partial correlation analysis, linear regression, and logistic regression. RESULTS The geriatric MN group exhibited significantly lower serum aromatic amino acid levels (P < 0.05) compared to the normal group. A positive correlation was observed between serum aromatic amino acid levels and the MNA-SF score (P = 0.002), as well as with known biomarkers of malnutrition such as body mass index (BMI) (P < 0.001) and hemoglobin (HGB) (P = 0.005). Multivariable logistic or linear regression analyses showed that aromatic amino acid levels were negatively correlated with MN and positively correlated with the MNA-SF score, after adjusting for some confounding factors, such as age, gender, BMI, smoking status, history of dyslipidemia, diabetes mellitus and frailty. Stratified analyses revealed that these trends were more pronounced in individuals without a history of frailty compared to those with a history of frailty, and there was an interaction between aromatic amino acid levels and frailty history (P = 0.004). CONCLUSION Our study suggests that serum aromatic amino acids are independently associated with malnutrition in older adults. These results have important implications for identifying potential biomarkers to predict geriatric malnutrition or monitor its progression and severity, as malnutrition can result in poor clinical outcomes.
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Affiliation(s)
- Xianghui Zhao
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, 100730, Beijing, China
| | - Li Meng
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, 100730, Beijing, China
| | - Daguang Wang
- Department of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Jing Shi
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, 100730, Beijing, China
| | - Wenbin Wu
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, National Clinical Research Center for Geriatrics, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Guoqing Fan
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, National Clinical Research Center for Geriatrics, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Hong Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, National Clinical Research Center for Geriatrics, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Jun Dong
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, 100730, Beijing, China
| | - Pulin Yu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, 100730, Beijing, China.
| | - Ruiyue Yang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, 100730, Beijing, China.
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Borda MG, Salazar-Londoño S, Lafuente-Sanchis P, Patricio Baldera J, Venegas LC, Tarazona-Santabalbina FJ, Aarsland D, Martín-Marco A, Pérez-Zepeda MU. Neutrophil-to-lymphocyte ratio and lymphocyte count as an alternative to body mass index for screening malnutrition in older adults living in the community. Eur J Nutr 2024:10.1007/s00394-024-03392-0. [PMID: 38613694 DOI: 10.1007/s00394-024-03392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults. METHODS This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables. RESULTS In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI. CONCLUSION The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway.
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain.
| | - Salomón Salazar-Londoño
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Lafuente-Sanchis
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain
| | - Jonathan Patricio Baldera
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway
- Escuela de Estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Luis Carlos Venegas
- Hospital Universitario Mayor-Méderi, Universidad del Rosario, Bogotá, Colombia
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, 28029, Spain
- Medical School, Universidad Católica de Valencia San Vicente Mártir, Valencia, 46001, Spain
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Antonio Martín-Marco
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Ciudad de México, México
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Huixquilucan Edo, México
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20
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Mills CM, Boyar L, O'Flaherty JA, Keller HH. Social Factors Associated with Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review. JMIR Res Protoc 2024. [PMID: 38696645 DOI: 10.2196/56714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND In high-income countries, between 65 and 70 percent of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors' knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. OBJECTIVE The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in high-income countries (HIC) and to identify social interventions that address nutrition risk in community-dwelling older adults in HIC. METHODS This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE, CINAHL, PsychInfo, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote and Covidence will be used for reference management and removal of duplicate studies. Articles will be screened, and data extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and details of social interventions designed to address nutrition risk. RESULTS The scoping review was started in October 2023 and will be finalized by August 2024. Findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. CONCLUSIONS Given the high prevalence of nutrition risk in community-dwelling older adults in high-income countries and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk. CLINICALTRIAL
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Affiliation(s)
- Christine Marie Mills
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, CA
- School of Public Health Sciences, University of Waterloo, Waterloo, CA
| | - Liza Boyar
- School of Public Health Sciences, University of Waterloo, Waterloo, CA
| | | | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, CA
- Schlegel-UW Research Institute for Aging, Waterloo, CA
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21
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García-Fuente I, Corral-Gudino L, Gabella-Martín M, Olivet-de-la-Fuente VE, Pérez-Nieto J, Miramontes-González P. How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk. Rev Clin Esp 2024; 224:217-224. [PMID: 38490479 DOI: 10.1016/j.rceng.2024.03.003] [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: 01/02/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. OBJECTIVE To assess the concordance of different nutritional scales in hospitalized patients. METHODS Prospective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. RESULTS Eighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87-98) and MUST the most specific (91%; CI 85-99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR- 0.17; 95% CI 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. CONCLUSIONS A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.
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Affiliation(s)
- I García-Fuente
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain
| | - L Corral-Gudino
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain.
| | - M Gabella-Martín
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - J Pérez-Nieto
- Enfermería, Hospital Universitario Río Hortega, Valladolid, Spain
| | - P Miramontes-González
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain
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22
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Rothenberg E, Tsagari A, Erickson N, Katsagoni CN, Malone A, de van der Schueren M, Shaw C, Steiber A, Vranesic Bender D, Jager-Wittenaar H. Global Leadership Initiative on Malnutrition (GLIM) for the diagnosis of malnutrition - a framework for consistent dietetic practice. Clin Nutr ESPEN 2024; 60:261-265. [PMID: 38479920 DOI: 10.1016/j.clnesp.2024.02.009] [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: 09/28/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 04/13/2024]
Abstract
Malnutrition is an alarming and ongoing healthcare problem globally. Malnutrition has a negative impact on the individual patient, leading to poorer clinical outcomes and increased mortality, but also poses an economic burden on society. Proper identification and diagnostics are prerequisites for initiation of treatment. In 2019, the Global Leadership Initiative on Malnutrition, a consensus-based global framework to uniformly diagnose malnutrition across populations, healthcare settings, and countries was published. Identifying and treating malnutrition is an interdisciplinary team effort. Nonetheless, the nutrition and dietetics profession is specifically trained for diagnosing and treating nutrition(-related) conditions, and therefore has a key role in the interdisciplinary team in implementing the GLIM framework in clinical practice. For the nutrition and dietetics profession, GLIM offers a great opportunity for moving both the scientific and clinical knowledge of malnutrition management forward. While the GLIM framework has been extensively studied since its launch, various knowledge gaps still remain. For the nutrition and dietetics profession, these knowledge gaps mainly relate to the GLIM implementation process, to the role of GLIM in relation to the nutrition care process, and to treatment strategies for various nutrition-related conditions. In this opinion paper, we aimed to describe the rationale for implementing the GLIM framework in clinical dietetic practice, and propose a research agenda based on knowledge gaps regarding GLIM in relation to nutrition care from a dietetic point of view.
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Affiliation(s)
- Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Amalia Tsagari
- Department of Clinical Nutrition, "KAT'' Hospital, Athens, Greece; Healthcare Faculty, BSc Dietetics, Aegean College, Athens, Greece
| | - Nicole Erickson
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilian University Hospital Munich, Munich, Germany
| | | | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Springs, MD, United States
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Clare Shaw
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Alison Steiber
- Research, International, and Scientific Affairs Team, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Darija Vranesic Bender
- Clinical Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Zagreb, Croatia
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Physical Education and Physiotherapy, Department Physiotherapy and Human Anatomy, Research Unit Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
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23
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Wu Z, Owen A, Woods RL, Cribb L, Alharbi T, Zhou Z, Chong TTJ, Orchard SG, Shah RC, Wolfe R, Torres D, McNeil JJ, Sheets KM, Murray AM, Ryan J. Associations of body habitus and its changes with incident dementia in older adults. J Am Geriatr Soc 2024; 72:1023-1034. [PMID: 38243627 PMCID: PMC11018504 DOI: 10.1111/jgs.18757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND This study examined the associations of body mass index (BMI) and waist circumference (WC), as well as their short- and long-term changes over time, with incident dementia in older individuals. METHODS Data came from 18,837 community-dwelling individuals aged 65+ years from Australia and the United States, who were relatively healthy without major cognitive impairment at enrolment. Anthropometric measures were prospectively assessed at baseline, as well as change and variability from baseline to year two (three time-points). In a subgroup (n = 11,176), self-reported weight at age 18 and 70+ years was investigated. Dementia cases satisfied DSM-IV criteria. Cox regression was used to examine the associations between anthropometric measures and incident risk of dementia. RESULTS Compared to normal weight, an overweight (HR: 0.67, 95%CI: 0.57-0.79, p < 0.001) or obese BMI (HR: 0.73, 95%CI: 0.60-0.89, p = 0.002), or a larger WC (elevated, HR: 0.71, 95%CI: 0.58-0.86, p < 0.001; highly elevated, HR: 0.65, 95%CI: 0.55-0.78, p < 0.001; relative to low) at baseline was associated with lower dementia risk. In contrast, substantial increases in BMI (>5%) over 2 years after baseline were associated with higher dementia risk (HR: 1.49, 95% CI: 1.17-1.91, p = 0.001). Increased dementia risk was also seen with an underweight BMI at baseline and a 2-year BMI decrease (>5%), but these associations appeared only in the first 4 years of follow-up. Compared to normal weight at both age 18 and 70+ years, being obese at both times was associated with increased dementia risk (HR: 2.27, 95%CI: 1.22-4.24, p = 0.01), while obesity only at age 70+ years was associated with decreased risk (HR: 0.70, 95%CI: 0.51-0.95, p = 0.02). CONCLUSIONS Our findings suggest that long-term obesity and weight gain in later life may be risk factors for dementia. Being underweight or having substantial weight loss in old age may be early markers of pre-clinical dementia.
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Affiliation(s)
- Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Lachlan Cribb
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Tagrid Alharbi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Trevor T.-J. Chong
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia, 3800
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia, 3181
- Department of Clinical Neurosciences, St Vincent’s Hospital, Melbourne, VIC, Australia, 3065
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Raj C. Shah
- Department of Family & Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL USA 60612
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Daniel Torres
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
| | - Kerry M. Sheets
- Division of Geriatric and Palliative Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA, 55415
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis, MN, USA, 55404
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, 3004
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24
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Enge M, Peelen FO, Nielsen RL, Beck AM, Olin AÖ, Cederholm T, Boström AM, Paur I. Malnutrition prevalence according to GLIM and its feasibility in geriatric patients: a prospective cross-sectional study. Eur J Nutr 2024; 63:927-938. [PMID: 38240774 PMCID: PMC10948466 DOI: 10.1007/s00394-023-03323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/29/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE In 2019, the Global Leadership Initiative on Malnutrition (GLIM) suggested a 2-step diagnostic format for malnutrition including screening and diagnosis. Prospective validation and feasibility studies, using the complete set of the five GLIM criteria, are needed. The aims of this study were to determine the prevalence of malnutrition, and investigate how the prevalence varied with mode of screening. Furthermore, we assessed the feasibility of GLIM in geriatric patients. METHODS Consecutive patients from two acute geriatric wards were included. For screening risk of malnutrition, the Mini Nutritional Assessment-Short Form (MNA-SF) or Malnutrition Screening Tool (MST) were used. In accordance with GLIM, a combination of phenotypic and etiologic criteria were required for the diagnosis of malnutrition. Feasibility was determined based on % data completeness, and above 80% completeness was considered feasible. RESULTS One hundred patients (mean age 82 years, 58% women) were included. After screening with MNA-SF malnutrition was confirmed by GLIM in 51%, as compared with 35% after screening with MST (p = 0.039). Corresponding prevalence was 58% with no prior screening. Using hand grip strength as a supportive measure for reduced muscle mass, 69% of the patients were malnourished. Feasibility varied between 70 and 100% for the different GLIM criteria, with calf circumference as a proxy for reduced muscle mass having the lowest feasibility. CONCLUSION In acute geriatric patients, the prevalence of malnutrition according to GLIM varied depending on the screening tool used. In this setting, GLIM appears feasible, besides for the criterion of reduced muscle mass.
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Affiliation(s)
- Maria Enge
- Department of Geriatric Medicine, Jakobsbergsgeriatriken, Stockholm, Sweden
| | - Frida Ostonen Peelen
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit EATEN, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Ann Ödlund Olin
- Department of Quality and Patient Safety, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Tommy Cederholm
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Ingvild Paur
- Norwegian Advisory Unit On Disease-Related Undernutrition, Oslo, Norway.
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway.
- Institute for Clinical Medicine, Clinical Nutrition Research Group, UiT the Arctic University of Norway, Tromsø, Norway.
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Chen B, Zhao H, Li M, Zhao T, Liao R, Lu J, Zou Y, Tu J, Teng X, Huang Y, Liu J, Huang P, Wu J. Effect of multicomponent intervention on malnutrition in older adults: A multicenter randomized clinical trial. Clin Nutr ESPEN 2024; 60:31-40. [PMID: 38479928 DOI: 10.1016/j.clnesp.2024.01.004] [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: 08/15/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND & AIMS Malnutrition is a significant geriatric syndrome (GS) prevalent in older adults and seriously affects patient prognosis and quality of life. We assessed the impact of the multicomponent intervention of health education, dietary advice, and exercise with oral nutritional supplementation (ONS) on nutritional status, body composition, physical functions, and quality of life. METHODS This multicenter randomized clinical trial (RCT) was performed from April 2021 to April 2022. The intervention lasted for 12 weeks, and 99 older adults with malnutrition or at risk of malnutrition were enrolled in six nursing homes. All participants were randomly assigned to the control (health education plus standard diet plus exercise) or research (health education plus standard diet plus exercise plus ONS) group. The research group consumed ONS (244 kcal, 9.8g protein, and 9.6g fat per time) twice a day between meals. The primary outcomes were changes in the nutritional status and body composition from baseline to 12 weeks. The secondary outcomes were changes in physical function, quality of life and nutritional associated other blood markers. RESULTS For primary outcomes, after 12 weeks, body weight increased similarly in both treatment arms (time × treatment effect, P > 0.05). There were no between-group differences in body mass index (BMI) or mini nutritional assessment tool-short form (MNA-SF) scores (time × treatment effects, P > 0.05). The MNA-SF score from 11.0 (10.5, 12.0) to 13.0 (11.0, 13.0) in the research group and from 11.0 (10.0, 12.0) to 12.0 (11.0, 13.0) in the control group (both P < 0.05). There were no between-group differences in the skeletal muscle mass index (SMI), fat-free mass index (FFMI), appendicular skeletal muscle mass (ASMM), fat mass (FAT), or leg muscle mass (LMM) (time × treatment effects, P > 0.05). Both groups showed similar and highly significant increases in SMI, FFMI, and LMM after (P < 0.05). The research group showed an increase in fat-free mass (FFM) and ASMM and a decrease in the percent of body fat (PBF) and waist circumference (WC) (P < 0.05). For secondary outcomes, There were no between-group differences in grip strength, short physical performance battery (SPPB), 6-min walking distance (6MWD), activities of daily living (ADL), instrumental activities of daily living (IADL), frailty status (FRAIL), mini-mental state examination (MMSE), Tinetti, geriatric depression scale-15 (GDS-15), or 12-item short form survey (SF-12) (time × treatment effects, P > 0.05). Although there was no significant difference, the 6MWD changed differentially between the two treatment arms during the study period in favor of the research group. Although not significant, SF-12 scores improved after 12 weeks in both groups. No between-group differences were observed in prealbumin (PRE), c-reactive protein (CRP), vitamin D (VIT-D), insulin-like growth factor 1 (IGF-1), alanine transaminase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), insulin, and adiponectin levels (time × treatment effects, P > 0.05). Insulin and adiponectin levels were significantly higher in the control group (P < 0.05). CONCLUSION The twelve-week multicomponent intervention improved the nutritional status of older people in China at risk of malnutrition. ONS may enhance the effects of exercise on muscle mass. This clinical trial was registered (https://www. CLINICALTRIALS gov). The trial number is ChiCTR2000040343.
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Affiliation(s)
- Bo Chen
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Jiangsu Provincial Key Laboratory of Gerontology & Geriatrics, Nanjing 210029, China; Jiangsu Provincial Innovation Center of Gerontology & Geriatrics, Nanjing 210029, China
| | - Hongye Zhao
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, China
| | - Min Li
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ting Zhao
- Department of Nutrition, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruoqi Liao
- Rehabilitation Medical Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Lu
- Rehabilitation Medical Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzheng Zou
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinran Teng
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yaxuan Huang
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin Liu
- Clinical Medicine Research Institution, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jianqing Wu
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Jiangsu Provincial Key Laboratory of Gerontology & Geriatrics, Nanjing 210029, China; Jiangsu Provincial Innovation Center of Gerontology & Geriatrics, Nanjing 210029, China.
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Chee SY. "Savoring the Past, Nourishing the Present": Uncovering the Essence of Multicultural Mealtime Experiences in Senior Living Facilities. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:322-348. [PMID: 37786389 DOI: 10.1080/01634372.2023.2264894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Mealtimes are crucial markers of daily schedules and hold significant meaning for older adults in senior living facilities worldwide, extending beyond the food served. Utilizing Moustakas' transcendental phenomenological approach, this study explores the lived experiences and multifaceted meanings of mealtimes for older adults from multicultural backgrounds in senior living facilities in Malaysia. In six urban senior living facilities, 28 older adults from Malaysia's three major ethnic groups, namely Bumiputera Malays, Chinese, and Indians were interviewed through semi-structured one-on-one interviews. Five discernible themes beyond tangible aspects emerged: mealtimes as cultural bridges, memories and palate, emotional bonds through food, quality control and consumption, and comfort through personalized dining experience. This study raises awareness among senior-living facilitators, family caregivers, academics, and policymakers to acknowledge the evident complexities of mealtimes for older adults living away from the comfort of familiarity. Future research should consider the active involvement of all stakeholders in co-creating and implementing interventions that enhance older adults' mealtime experiences in senior-friendly establishments.
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Affiliation(s)
- Shi Yin Chee
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- Active Ageing Impact Lab, Taylor's University, Subang Jaya, Malaysia
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Wong A, Huang Y, Banks MD, Sowa PM, Bauer JD. A Conceptual Study on Characterizing the Complexity of Nutritional Interventions for Malnourished Older Adults in Hospital Settings: An Umbrella Review Approach. Healthcare (Basel) 2024; 12:765. [PMID: 38610187 PMCID: PMC11011329 DOI: 10.3390/healthcare12070765] [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: 01/23/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Malnutrition is a widespread and intricate issue among hospitalized adults, necessitating a wide variety of nutritional strategies to address its root causes and repercussions. The primary objective of this study is to systematically categorize nutritional interventions into simple or complex, based on their resource allocation, strategies employed, and predictors of intervention complexity in the context of adult malnutrition in hospital settings. METHODS A conceptual evaluation of 100 nutritional intervention studies for adult malnutrition was conducted based on data from a recent umbrella review (patient population of mean age > 60 years). The complexity of interventions was categorized using the Medical Research Council 2021 Framework for Complex Interventions. A logistic regression analysis was employed to recognize variables predicting the complexity of interventions. RESULTS Interventions were divided into three principal categories: education and training (ET), exogenous nutrient provision (EN), and environment and services (ES). Most interventions (66%) addressed two or more of these areas. A majority of interventions were delivered in a hospital (n = 75) or a hospital-to-community setting (n = 25), with 64 studies being classified as complex interventions. The logistic regression analysis revealed three variables associated with intervention complexity: the number of strategies utilized, the targeted areas, and the involvement of healthcare professionals. Complex interventions were more likely to be tailored to individual needs and engage multiple healthcare providers. CONCLUSIONS The study underlines the importance of considering intervention complexity in addressing adult malnutrition. Findings advocate for a comprehensive approach to characterizing and evaluating nutritional interventions in future research. Subsequent investigations should explore optimal balances between intervention complexity and resource allocation, and assess the effectiveness of complex interventions across various settings, while considering novel approaches like telehealth.
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Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Yingxiao Huang
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Merrilyn D. Banks
- Centre for the Business and Economics of Health, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - P. Marcin Sowa
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - Judy D. Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia
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28
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Wang P, Huang X, Liu Y, Xue L, Ning C, Jiang L, Liu J. Risk factors and the nomogram model for malnutrition in patients with nasopharyngeal carcinoma. Support Care Cancer 2024; 32:256. [PMID: 38546900 DOI: 10.1007/s00520-024-08459-6] [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: 12/01/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For patients with nasopharyngeal carcinoma (NPC), the incidence of malnutrition is quite high, and malnutrition has severe effects on NPC patients. However, there is currently no recognized gold standard or specific nutritional assessment tool available to assess malnutrition in NPC patients. Our objective was to develop and verify a new nomogram model for NPC patients. METHODS Data were collected from NPC patients. To evaluate risk factors for malnutrition, univariate and multivariate logistic regression analyses were used. Based on the risk factors, a new nomogram model was developed. The efficacy of the model was evaluated and validated. RESULTS Logistic regression analysis showed that age ≥ 65 years, the number of chemotherapy cycles completed ≥ 1, a high total radiation dose received, low body mass index (BMI), low albumin, and low chloride were the risk factors. The assessment effect of the new model was good by evaluation and validation; it can be used as an assessment tool for malnutrition in NPC patients. CONCLUSIONS Age ≥ 65 years, completing ≥ 1 chemotherapy cycles, a high total radiation dose received, low BMI, low albumin, and low chloride levels are risk factors for malnutrition in NPC patients. The assessment effect of the new model, developed based on these risk factors, is good, and it can be used as an assessment tool for malnutrition in NPC patients.
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Affiliation(s)
- Pengpeng Wang
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Xueling Huang
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Yuanhang Liu
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Li Xue
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Chuanyi Ning
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Li Jiang
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Jieying Liu
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Gao D, Su Y, Zhang X, Li H, Luo H. The application of virtual reality meditation and mind-body exercises among older adults. Front Psychol 2024; 15:1303880. [PMID: 38566950 PMCID: PMC10985321 DOI: 10.3389/fpsyg.2024.1303880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Virtual reality (VR)-based mindfulness is a promising method to improve the health of older adults. Therefore, many attempts have been made to explore the application of VR-based mindfulness, such as VR meditation and mind-body exercises, in older adults. Generally, current studies indicate the heavy reliance on apparatus for implementing VR-based mindfulness interventions. In VR meditation, the crucial apparatus is VR headsets. In VR mind-body exercises, three essential components are required: motion capture sensors, main consoles, and display screens. In the aspect of health promotion, VR meditation is an effective method for improving mental health, pain, and quality of life in older adults. VR mind-body exercises contribute to increasing the mental health and physical function of older adults. Furthermore, VR mind-body exercises may be combined with other forms of exercise as a mixed method to promote the health of older adults. VR-based mindfulness interventions enhance the meditation and mind-body exercises experience for older adults while improving accessibility. However, their implementation still encounters a series of challenges, such as cost, technical anxiety, and apparatus-related issues. Additionally, we recommend future research to examine the optimal exercise dose for VR mind-body exercises to maximize their health benefits.
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Affiliation(s)
- Dong Gao
- College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yuqin Su
- Institute of Sports Science, College of Physical Education, Southwest University, Chongqing, China
| | - Xing Zhang
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Hansen Li
- Institute of Sports Science, College of Physical Education, Southwest University, Chongqing, China
| | - Hongcheng Luo
- School of Physical Education, Xichang University, Xichang, China
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30
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Fonseca SCF, Barroso SC, Santos MCT. Enhancing Elderly Nutrition: A Qualitative Evaluation of Menus in a Social Solidarity Institution in the North of Portugal. Nutrients 2024; 16:753. [PMID: 38474881 DOI: 10.3390/nu16050753] [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: 01/18/2024] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
This work addresses the importance of food and nutrition in promoting the health of the elderly population, with a specific focus on the qualitative evaluation of menus provided by a social solidarity institution in Portugal. The aim of this study is to conduct a qualitative evaluation of menus furnished by a social solidarity institution situated in the northern region of Portugal in order to prevent and/or treat malnutrition in the elderly. The methodology involves the evaluation of four weekly menus, totaling 28 complete daily menus for the elderly, using the "Avaliação Qualitativa de Ementas Destinadas a Idosos" (AQEDI) tool. This assessment tool comprises six domains: general items, soup, protein suppliers, carbohydrate suppliers, vegetable suppliers, and dessert, each consisting of various parameters. The findings reveal that all menus were classified as "acceptable," with percentages ranging from 60.73% to 68.84%, and suggest that there exists room for improvement. This study emphasizes the necessity for coordinated efforts within the institution to enhance menu planning, taking into account both nutritional guidelines and sensory aspects of food. Effective coordination within the institution is crucial for maintaining positive aspects and rectifying inadequacies in menu planning.
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Affiliation(s)
- Sandra Celina Fernandes Fonseca
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Suzanne Carvalho Barroso
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Maria Cristina Teixeira Santos
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- ProNutri Group-CINTESIS@RISE, Center for Health Technology and Services Research (CINTESIS), Associate Laboratory RISE-Health Research Network, University of Porto, 4200-450 Porto, Portugal
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31
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Wilson N, Mullaney W. Frailty and nutrition. Br J Community Nurs 2024; 29:118-123. [PMID: 38421891 DOI: 10.12968/bjcn.2024.29.3.118] [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] [Indexed: 03/02/2024]
Abstract
As the ageing population grows and forms a significant category of over 65s in many societies, along with it comes the risk of developing physical and psychological degenerative changes. This presents many challenges for health and social care services in not only identifying those at risk but also managing that risk to try to preserve health and independence for as long as possible. Screening for frailty has supported services to identify those that may be at risk of hospitalisation, requiring long term care or support services at home in older age. Frailty can be exacerbated by the risk of nutritional deficiencies and more severe malnutrition. Therefore, screening for frailty should also include a nutritional assessment, which can be supported by a recognition of the need for nutritional support along with other holistic frailty management.
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Affiliation(s)
- Neil Wilson
- Senior Lecturer in Nursing, Manchester Metropolitan University
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32
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Calcaterra L, Abellan van Kan G, Steinmeyer Z, Angioni D, Proietti M, Sourdet S. Sarcopenia and poor nutritional status in older adults. Clin Nutr 2024; 43:701-707. [PMID: 38320461 DOI: 10.1016/j.clnu.2024.01.028] [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: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND & AIMS The association between sarcopenia and malnutrition has been poorly studied in the older population. The purpose of this study is to address the association between sarcopenia, according to different validated definitions, and nutritional status in a large population of community-dwelling older adults. METHODS Observational, cross-sectional study of the Geriatric Frailty Clinic (GFC) for Assessment of Frailty and Prevention of Disability, held by the "Gérontopôle" of the Toulouse University Hospital. Patients aged above 65 years who benefitted from a Dual X-ray Densitometry (DXA) during their assessment at the GFC from June 5th 2013 to January 28th 2020 were included. Sarcopenia was defined according to proposed validated definitions. The Mini Nutritional Assessment (MNA) was used to stratify nutritional status, and identify patients with a poor nutritional status (at risk of malnutrition or malnourished, MNA <24). Multiple logistic regression analyses were performed between MNA and each sarcopenia definition adjusted for confounders. RESULTS Among the 938 patients with DXA data, a total of 809 (86.2 %) subjects were included in the analysis (mean age 81.8 ± 6.9 years, 527 females (65.1 %)). Prevalence of sarcopenia ranged from 12.6 % to 44.9 %, according to various definitions. Overall 244 (30.2 %) of the patients had a poor nutritional status (MNA-score <24), Baumgartner and Newman definitions of sarcopenia were both associated with low MNA-scores (OR = 4.69, CI 3.15-6.98 and OR = 2.30, CI 1.55-3.14, respectively), EWGSOP2 "confirmed sarcopenia" definition was also associated with low MNA-scores (OR = 3.68, CI 2.30-5.89), as well as for the lean mass definition according EWGSOP2 cut-off (OR 5.22 CI 3.52-7.73). Both FNIH and EWGSOP2 "probable sarcopenia" definitions were not associated with the risk of malnutrition. CONCLUSIONS In this study, the prevalence of sarcopenia ranged from 12.6 to 44.9 % according to various definitions. A score of MNA under 24, was associated with almost all of the sarcopenia definitions. This study reinforces the concept that malnutrition and sarcopenia are strictly related. When facing malnutrition in daily clinical practice, body composition should be assessed and the proposed nutritional intervention should be tailored by these results in order to prevent the onset of late-life disability.
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Affiliation(s)
- L Calcaterra
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France; Division of Subacute Care, IRCCS, Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - G Abellan van Kan
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France.
| | - Z Steinmeyer
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France
| | - D Angioni
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France
| | - M Proietti
- Division of Subacute Care, IRCCS, Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - S Sourdet
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France
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Ogawa N, Yun S, Izutsu M, Yuki M. Sarcopenia and risk factors among Japanese community-dwelling older adults during the COVID-19 pandemic: A cross-sectional study. Nurs Health Sci 2024; 26:e13094. [PMID: 38356044 DOI: 10.1111/nhs.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/15/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
The COVID-19 pandemic exposed older adults to high risk of sarcopenia. This study aimed to investigate the prevalence of sarcopenia and its risk factors among Japanese community-dwelling older adults during the COVID-19 pandemic. We collected data through questionnaires and physical measurements among 242 older adults. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019 criteria. The results revealed that 14.5% had sarcopenia, which was significantly associated with age, nutritional status, number of prescription medications, body mass index, and self-rated health. On multivariate analysis, the risk of malnutrition was independently significantly associated with sarcopenia. Approximately 70% of participants reported decreased social interaction and going outside, but with no significant association with sarcopenia. In addition, approximately 65% of the participants had an exercise habit and went outside at least once a week, thus maintaining a good level of activity. These findings suggest that prevention of sarcopenia during the pandemic required provision of opportunities for older adults to remain active and positive assessment of nutritional status and well-being.
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Affiliation(s)
- Natsuka Ogawa
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shan Yun
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Miku Izutsu
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Michiko Yuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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Pereira DFC, Parron Fernandes KB, Aguiar AF, Casonatto J. The Impact of Undernutrition Risk on Rehabilitation Outcomes in Ischemic Stroke Survivors: A Hospital-Based Study. BRAIN & NEUROREHABILITATION 2024; 17:e7. [PMID: 38585033 PMCID: PMC10990841 DOI: 10.12786/bn.2024.17.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Patients experiencing a cerebrovascular event are vulnerable to declining nutritional status, hindering rehabilitation. This study aims to analyze the association between malnutrition risk and hospital rehabilitation indicators in ischemic stroke survivors (ISS). This analytical study examined medical records of 160 adult patients (69.3 ± 13 years). Undernutrition risk (UR; independent variable) and rehabilitation indicators (dependent variables) like hospital stay, clinical outcome, functionality, stroke severity, food intake, mobility (bedridden), mechanical ventilation, and enteral nutrition were assessed. Data were dichotomized, and the chi-square test identified associations (p ≤ 0.05), followed by Poisson regression for prevalence ratios. Patients at UR had 2-fold higher risk of death (95% confidence interval [CI], 0.99-4.79), 1.8-fold higher risk of high stroke severity (95% CI, 1.06-3.11), 76% higher chance of being bedridden (95% CI, 1.28-2.44), and 3-fold higher risk of mechanical ventilation (95% CI, 1.20-9.52). UR in hospitalized ISS is associated with deteriorating rehabilitation indicators, including mobility, decreased food intake, mechanical ventilation use, and neurological deficit, indicating an increased mortality risk post-stroke.
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Affiliation(s)
- Daniela Figueiredo Corrêa Pereira
- Research Group in Physiology and Physical Activity, University Pitágoras UNOPAR Anhanguera, Londrina, Brazil
- Department of Medicine, Pontifical Catholic University, Londrina, Brazil
| | | | - Andreo Fernando Aguiar
- Research Laboratory in Muscular System and Physical Exercise, University Pitágoras UNOPAR Anhanguera, Londrina, Brazil
| | - Juliano Casonatto
- Research Group in Physiology and Physical Activity, University Pitágoras UNOPAR Anhanguera, Londrina, Brazil
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Jimenez EY, Lamers-Johnson E, Long JM, McCabe G, Ma X, Woodcock L, Bliss C, Abram JK, Steiber AL. Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study. Am J Clin Nutr 2024; 119:779-787. [PMID: 38432715 DOI: 10.1016/j.ajcnut.2023.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment. OBJECTIVES This study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified. METHODS A prospective cohort study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes. RESULTS After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake. CONCLUSIONS Findings from this multihospital study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This trial was registered at clinicaltrials.gov as NCT03928548 (https://classic. CLINICALTRIALS gov/ct2/show/NCT03928548).
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States; Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; College of Population Health, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - George McCabe
- Department of Statistics, Purdue University, West Lafayette, IN, United States
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States
| | - Lindsay Woodcock
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Courtney Bliss
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Jenica K Abram
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Alison L Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States.
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Mohamad Ishak NS, Kikuchi M, Ikemoto K. Dietary pyrroloquinoline quinone hinders aging progression in male mice and D-galactose-induced cells. FRONTIERS IN AGING 2024; 5:1351860. [PMID: 38487591 PMCID: PMC10938241 DOI: 10.3389/fragi.2024.1351860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024]
Abstract
Background: Understanding and promoting healthy aging has become a necessity in the modern world, where life expectancy is rising. The prospective benefits of the antioxidant pyrroloquinoline quinone (PQQ) in healthy aging are promising. However, its role in aging remains unclear. Thus, this study aimed to investigate the effect of PQQ on preventing the progression of aging and to explore its underlying molecular mechanisms. Methods: Naturally aged C57BL/6J male mice were fed a normal diet with or without PQQ (20 mg/kg/day) for 10 weeks. Body composition was measured by bioimpedance at weeks 0 and 8. The integument conditions were evaluated at weeks 0, 4, and 8. Muscle strength and function were examined at week 8. At the ninth week, computed tomography images of the mice were captured, and blood and tissue samples were collected. The levels of inflammatory cytokines in the gastrocnemius muscle were measured, and the muscle fiber cross-sectional area in the soleus muscle was examined. Additionally, a D-galactose (D-gal)-induced cell aging model was used to study the effects of PQQ intervention on cell proliferation, senescence, differentiation, ROS levels, and mitochondrial function in myoblasts (C2C12). Cell proliferation and monolayer permeability of D-gal-induced intestinal epithelial cells (IEC6) were also examined. Results: Aged mice suffered from malnutrition; however, PQQ supplementation ameliorated this effect, possibly by improving metabolic dysfunction and small intestinal performance. PQQ prevented rapid loss of body fat and body fluid accumulation, attenuated muscle atrophy and weakening, reduced chronic inflammation in skeletal muscles, and improved skin and coating conditions in aged mice. Furthermore, PQQ intervention in D-gal-treated C2C12 cells improved mitochondrial function, reduced cellular reactive oxygen species (ROS) levels and senescence, and enhanced cell differentiation, consequently preventing age-related muscle atrophy. In addition, PQQ increased cell proliferation in D-gal-treated IEC6 cells and consequently improved intestinal barrier function. Conclusion: PQQ could hinder the aging process and particularly attenuate muscle atrophy, and muscle weakness by improving mitochondrial function, leading to reduced age-related oxidative stress and inflammation in muscles. PQQ may also ameliorate malnutrition caused by intestinal barrier dysfunction by enhancing IEC proliferation. This study provides evidence for the role of PQQ in aging and suggests that PQQ may be a potential nutritional supplementation that can be included in healthy aging strategies.
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Shaharom NFM, Yusoff A, Mutalib SRA, Seow EK. Assessing Impact of Cooking Methods on the Physicochemical and Sensory Properties of Instant Fortified Rice Congee for the Elderly. Foods 2024; 13:723. [PMID: 38472836 DOI: 10.3390/foods13050723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Instant rice congee (IRC) fortified with functional ingredients is designed for supplementation in nourishing the elderly. In this study, collagen peptide and curcumin were fortified in IRC to improve antioxidant and protein content. Different cooking methods were used to prepare rice congee in order to retain the nutritional content of instant fortified rice congee (IFRC). The effect of cooking methods on IFRC were investigated in this study using field emission scanning electron microscopy (FESEM) and Fourier transform infrared spectroscopy (FTIR). As for cooking methods, the steaming method (IFRC-S) exhibited the highest total phenolic content (TPC) at 36.13 ± 5.63 mg GAE/g sample; a ferric reducing antioxidant power (FRAP) value of 6.39 ± 0.24 mg TE/g sample and protein content at 52.20 ± 6.48%. There were no significant differences (p > 0.05) in the texture analysis of hardness, cohesiveness and viscosity between the different cooking methods. However, the boiling method (IFRC-B) showed the highest adhesiveness, at -58.78 ± 11.55 g/s. IFRC with different cooking methods also had no significant differences (p > 0.05) in bulk density, volume expansion and the water absorption index. In sensory analysis, it was found that there were no significant differences (p > 0.05) detected in attribute colour, odour, taste, texture and overall acceptability between each cooking method. This study is particularly useful for gaining a preliminary understanding of the development of IRC focused on the elderly.
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Affiliation(s)
- Noor Farisya Mohd Shaharom
- Department of Food Science and Technology, School of Industrial Technology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | - Anida Yusoff
- Department of Food Science and Technology, School of Industrial Technology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
- Food Science Research Group, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | - Siti Roha Ab Mutalib
- Department of Food Science and Technology, School of Industrial Technology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
- Food Science Research Group, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | - Eng-Keng Seow
- Department of Food Science and Technology, School of Industrial Technology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
- Food Science Research Group, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA, Selangor Branch, Bandar Puncak Alam 42300, Selangor, Malaysia
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Low E, D’Cunha NM, Georgousopoulou E, Naumovski N, Bacon R, Isbel S, Brocklehurst M, Reynolds M, Ryan D, Kellett J. Risk of Social Isolation as a Contributing Factor to Diet Quality in Community-Dwelling Older Persons Living in the Australian Capital Territory-A Pilot Study. Healthcare (Basel) 2024; 12:539. [PMID: 38470650 PMCID: PMC10930706 DOI: 10.3390/healthcare12050539] [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: 01/10/2024] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES Social isolation is recognised as a risk factor in the inflammatory process. This study explored the association between social isolation and the Dietary Inflammatory Index (DII) in community-dwelling older persons. METHODS This cross-sectional pilot study recruited 107 community-dwelling people aged over 55 years living in the Australian Capital Territory. Participants completed an extensive food frequency questionnaire and provided anthropometric and sociodemographic data. Social isolation was evaluated using the Lubben Social Network Scale (LSNS). Diet quality was assessed using DII. RESULTS Average age was 70.1 (±8.61) years and 62.8% were female. The average DII score was -1.10 (±1.21), indicating an anti-inflammatory diet. Higher LSNS was associated with lower DII (b (95% CI) = -0.041 (-0.066, -0.17); p < 0.01) and was positively influenced by the number of people in household (b (95% CI) = 5.731 (2.336, 9.127); p = 0.001). CONCLUSION Increased risk of social isolation was associated with an increased tendency towards a more inflammatory diet. Reducing social isolation may decrease the inflammatory component of dietary intake for older persons living independently in the community.
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Affiliation(s)
- Elizabeth Low
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
- Centre for Ageing, Research and Translation, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia;
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Nathan M. D’Cunha
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
- Centre for Ageing, Research and Translation, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia;
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Ekavi Georgousopoulou
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
| | - Nenad Naumovski
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, ACT 2601, Australia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Kallithea, 17671 Athens, Greece
| | - Rachel Bacon
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
| | - Stephen Isbel
- Centre for Ageing, Research and Translation, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia;
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
| | - Megan Brocklehurst
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
| | - Matthew Reynolds
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
| | - Daena Ryan
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
| | - Jane Kellett
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; (N.M.D.); (E.G.); (N.N.); (R.B.); (J.K.)
- Centre for Ageing, Research and Translation, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia;
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, ACT 2617, Australia
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Lo Buglio A, Bellanti F, Carmignano DFP, Serviddio G, Vendemiale G. Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients. Nutrients 2024; 16:576. [PMID: 38474705 DOI: 10.3390/nu16050576] [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: 01/25/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
The Controlling Nutritional Status (CONUT) score has demonstrated its ability to identify patients with poor nutritional status and predict various clinical outcomes. Our objective was to assess the association between the CONUT score, inflammatory status, and body composition, as well as its ability to identify patients at risk of frailty in hospitalized elderly patients. METHODS a total of 361 patients were retrospectively recruited and divided into three groups based on the CONUT score. RESULTS patients with a score ≥5 exhibited significantly higher levels of inflammatory markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Neutrophil/Lymphocytes ratio (NLR), main platelet volume (MPV), and ferritin, compared to those with a lower score. Furthermore, these patients showed unfavorable changes in body composition, including a lower percentage of skeletal muscle mass (MM) and fat-free mass (FFM) and a higher percentage of fatty mass (FM). A positive correlation was found between the CONUT score and inflammatory markers, Geriatric Depression Scale Short Form (GDS-SF), and FM. Conversely, the Mini Nutritional Assessment (MNA), Mini-Mental Status Examination, activity daily living (ADL), instrumental activity daily living (IADL), Barthel index, FFM, and MM showed a negative correlation. Frailty was highly prevalent among patients with a higher CONUT score. The receiver operating characteristic (ROC) curve demonstrated high accuracy in identifying frail patients (sensitivity). CONCLUSIONS a high CONUT score is associated with a pro-inflammatory status as well as with unfavorable body composition. Additionally, it is a good tool to identify frailty among hospitalized elderly patients.
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Affiliation(s)
- Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | | | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
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Tan S, Jiang J, Qiu L, Liang Y, Meng J, Tan N, Xiang B. Prevalence of Malnutrition in Patients with Hepatocellular Carcinoma: A Comparative Study of GLIM Criteria, NRS2002, and PG-SGA, and Identification of Independent Risk Factors. Nutr Cancer 2024; 76:335-344. [PMID: 38379140 DOI: 10.1080/01635581.2024.2314317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM Malnutrition is prevalent in hepatocellular carcinoma (HCC) patients, linked to poor outcomes, necessitating early intervention. This study aimed to investigate malnutrition in HCC patients, assess Nutrition Risk Screening 2002 (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA) vs. Global Leadership Initiative on Malnutrition (GLIM) criteria, and identify independent risk factors. METHOD A cross-sectional retrospective study was conducted on 207 patients with HCC. Nutritional screening/assessment results and blood samples were collected within 72 h of admission. This study assessed the prevalence of malnutrition using the NRS-2002 and PG-SGA and retrospectively using the GLIM criteria. The performance of the screening tools was evaluated using kappa (K) values. Logistic regression analyses were performed to determine whether laboratory parameters were associated with malnutrition as identified by the GLIM criteria. RESULTS Of the participants, 30.4% were at risk of malnutrition according to NRS-2002. The agreement between the NRS-2002 and GLIM criteria was substantial. The GLIM criteria and PG-SGA diagnosed malnutrition in 43 and 54.6% of the participants, respectively. Age, anemia, and ascites correlated with malnutrition in regression. CONCLUSION The GLIM criteria, along with NRS-2002 and PG-SGA, aid in diagnosing malnutrition in HCC patients. Recognizing risk factors improves accuracy, enabling timely interventions for better outcomes.
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Affiliation(s)
- Shengqiang Tan
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Jie Jiang
- Department of Clinical Nutrition, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Liulin Qiu
- Department of Clinical Nutrition, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Yaohao Liang
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Jianyi Meng
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Ning Tan
- College of Basic Medical Sciences, Guilin Medical University, Guilin, China
| | - Bangde Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
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Duval A, Sayd T, Bourillon S, Aubry L, Mosconi V, Ferraro V, Santé-Lhoutellier V. Utilizing the influence of protein enrichment of meal components as a strategy to possibly prevent undernutrition in the elderly: an in vitro approach. Food Funct 2024; 15:2078-2089. [PMID: 38303670 DOI: 10.1039/d3fo03659f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Nutritional strategies are required to limit the prevalence of denutrition in the elderly. With this in mind, fortified meals can provide more protein, but their digestibility must be ensured. Using a dynamic in vitro digester, DIDGI®, programmed with the digestion conditions of the elderly, we evaluated the supplementation of each component of a meal and assessed protein digestibility, amino acid profile, micro-nutrients and vitamins bioaccessibility for a full course meal. Higher protein digestibility was evidenced for the fortified meal, with higher release of essential amino acids. Moreover the large increase of leucine released was comparable to the range advocated for the elderly to favour protein anabolism. This in vitro study underlines the interest of using dish formulations to meet the nutritional needs of seniors, which is why this work will be completed by a clinical study in nursing home.
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Affiliation(s)
- Angeline Duval
- INRAE, QuaPA, UR 370, 63122 Saint Genes Champanelle, France.
| | - Thierry Sayd
- INRAE, QuaPA, UR 370, 63122 Saint Genes Champanelle, France.
| | | | - Laurent Aubry
- INRAE, QuaPA, UR 370, 63122 Saint Genes Champanelle, France.
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Vettoretti S, Molinari P, Armelloni S, Castellano G, Caldiroli L. Spontaneous low-protein intake in older CKD patients: one diet may not fit all. Front Nutr 2024; 11:1328939. [PMID: 38419850 PMCID: PMC10899392 DOI: 10.3389/fnut.2024.1328939] [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: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
BackgroundProtein restriction has been extended to stage 3 chronic kidney disease (CKD) regardless of age in the latest K-DOQI guidelines for the dietary management of patients with CKD. However, in elderly CKD patients there is a tendency to a spontaneous reduction in protein and energy intake that may impair the overall nutritional status. The aim of our study is to assess whether there are differences in malnutrition, exercise capacity and inflammatory status in elderly CKD patients with spontaneously low protein intake (sLPI) compared with patients with normal protein intake (NPI).MethodsWe performed a cross-sectional analysis of 123 incident patients. Malnutrition was assessed using Malnutrition Inflammation Score (MIS) and serum markers; As for physical performance, we used Short Physical Performance Battery (SPPB) and handgrip strength.ResultsWe found that in older patients with advanced CKD, as many as 68% had low spontaneous protein intake, and they were more malnourished evaluated with MIS (25% vs. 10%, p = 0.033), protein-energy wasting (PEW) (43% vs. 14%, p = 0.002) and nPCR (0.63[0.51–0.69] vs. 0.95[0.87–1.1], p < 0.0001). They also had worse body composition, in terms of lower mid-arm muscular circumference (MAMC), fat tissue index (FTI) and higher overhydration (OH). sLPI patients also had higher levels of IL6 (4.6[2.9–8.9] vs. 2.8[0.8–5.1], p = 0.002). Moreover, sLPI patients were frailer (33% vs. 24%, p = 0.037) and had poorer physical performance especially when assessed with (SPPB) (7[5–9] vs. 9[7–10], p = 0.004) and gait test time (6.08 + 2 vs. 7.22 + 2.7, p = 0.04). sLPI was associated with lower physical performance [SPPB OR, 0.79 (0.46–0.97), p = 0.046] and malnutrition [MIS 1.6 (1.05–3.5), p = 0.041] independently from patients’ age and eGFR.ConclusionWe found that in older patients with advanced CKD, up to 68% had low spontaneous protein intake and were frailer, more malnourished and with lower physical performance. These findings emphasize the importance of assessing patients’ needs, and personalized approaches with individual risk–benefit assessments should be sought. To achieve the best possible outcomes, targeted interventions should use all available tools.
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Affiliation(s)
- Simone Vettoretti
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Paolo Molinari
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Silvia Armelloni
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giuseppe Castellano
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lara Caldiroli
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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Husejko J, Gackowski M, Wojtasik J, Strzała D, Pesta M, Mądra-Gackowska K, Nuszkiewicz J, Woźniak A, Kozakiewicz M, Kędziora-Kornatowska K. Preliminary Report on the Influence of Acute Inflammation on Adiponectin Levels in Older Inpatients with Different Nutritional Status. Int J Mol Sci 2024; 25:2016. [PMID: 38396693 PMCID: PMC10889142 DOI: 10.3390/ijms25042016] [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: 12/31/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Inflammation can be triggered by a variety of factors, including pathogens, damaged cells, and toxic compounds. It is a biological response of the immune system, which can be successfully assessed in clinical practice using some molecular substances. Because adiponectin, a hormone released by adipose tissue, influences the development of inflammation, its evaluation as a potential measure of inflammation in clinical practice is justified. In the present contribution, statistical comparison of adiponectin concentration and selected molecular substances recognized in clinical practice as measures of inflammation were utilized to demonstrate whether adipose tissue hormones, as exemplified by adiponectin, have the potential to act as a measure of rapidly changing inflammation when monitoring older hospitalized patients in the course of bacterial infection. The study showed no statistically significant differences in adiponectin levels depending on the rapidly changing inflammatory response in its early stage. Interestingly, the concentration of adiponectin is statistically significantly higher in malnourished patients than in people with normal nutritional levels, assessed based on the MNA. According to the results obtained, adiponectin is not an effective measure of acute inflammation in clinical practice. However, it may serve as a biomarker of malnutrition in senile individuals.
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Affiliation(s)
- Jakub Husejko
- Department of Geriatrics, Faculty of Health Science, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowska-Curie 9 Street, 85-094 Bydgoszcz, Poland; (J.H.); (D.S.); (M.P.); (K.M.-G.); (M.K.); (K.K.-K.)
| | - Marcin Gackowski
- Department of Toxicology and Bromatology, Faculty of Pharmacy, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, A. Jurasza 2 Street, 85-089 Bydgoszcz, Poland;
| | - Jakub Wojtasik
- Centre for Statistical Analysis, Nicolaus Copernicus University in Toruń, Chopina 12/18 Street, 87-100 Toruń, Poland;
| | - Dominika Strzała
- Department of Geriatrics, Faculty of Health Science, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowska-Curie 9 Street, 85-094 Bydgoszcz, Poland; (J.H.); (D.S.); (M.P.); (K.M.-G.); (M.K.); (K.K.-K.)
| | - Maciej Pesta
- Department of Geriatrics, Faculty of Health Science, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowska-Curie 9 Street, 85-094 Bydgoszcz, Poland; (J.H.); (D.S.); (M.P.); (K.M.-G.); (M.K.); (K.K.-K.)
| | - Katarzyna Mądra-Gackowska
- Department of Geriatrics, Faculty of Health Science, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowska-Curie 9 Street, 85-094 Bydgoszcz, Poland; (J.H.); (D.S.); (M.P.); (K.M.-G.); (M.K.); (K.K.-K.)
| | - Jarosław Nuszkiewicz
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24 Street, 85-092 Bydgoszcz, Poland;
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Karłowicza 24 Street, 85-092 Bydgoszcz, Poland;
| | - Mariusz Kozakiewicz
- Department of Geriatrics, Faculty of Health Science, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowska-Curie 9 Street, 85-094 Bydgoszcz, Poland; (J.H.); (D.S.); (M.P.); (K.M.-G.); (M.K.); (K.K.-K.)
| | - Kornelia Kędziora-Kornatowska
- Department of Geriatrics, Faculty of Health Science, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowska-Curie 9 Street, 85-094 Bydgoszcz, Poland; (J.H.); (D.S.); (M.P.); (K.M.-G.); (M.K.); (K.K.-K.)
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Ji S, Jung HW, Baek JY, Jang IY, Lee E. Sarcopenia as the Mobility Phenotype of Aging: Clinical Implications. J Bone Metab 2024; 31:1-12. [PMID: 38485236 PMCID: PMC10940105 DOI: 10.11005/jbm.2024.31.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024] Open
Abstract
Sarcopenia, which is characterized by an age-related decline in muscle mass and function, poses significant challenges to geriatric care. Its definition has evolved from muscle-specific criteria to include muscle mass, muscle function, and physical performance, recognizing sarcopenia as a physical frailty. Sarcopenia is associated with adverse outcomes, including mortality, falls, fractures, cognitive decline, and admission to long-term care facilities. Neuromechanical factors, protein-energy balance, and muscle protein synthesis-breakdown mechanisms contribute to its pathophysiology. The identification of sarcopenia involves screening tests and a comprehensive assessment of muscle mass, strength, and physical function. Clinical approaches aligned with the principles of comprehensive geriatric assessment prioritize patient-centered care. This assessment aids in identifying issues related to activities of daily living, cognition, mood, nutrition, and social support, alongside other aspects. The general approach to factors underlying muscle loss and functional decline in patients with sarcopenia includes managing chronic diseases and evaluating administered medications, with interventions including exercise and nutrition, as well as evolving pharmacological options. Ongoing research targeting pathways, such as myostatin-activin and exercise mimetics, holds promise for pharmacological interventions. In summary, sarcopenia requires a multifaceted approach, acknowledging its complex etiology and tailoring interventions to individual patient needs.
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Affiliation(s)
- Sunghwan Ji
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yilmaz K, Wirth R, Daubert D, Pourhassan M. Prevalence and determinants of micronutrient deficiencies in malnourished older hospitalized patients. J Nutr Health Aging 2024; 28:100039. [PMID: 38280831 DOI: 10.1016/j.jnha.2024.100039] [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: 11/14/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND OBJECTIVE Malnutrition and micronutrient deficiencies represent significant concerns in geriatric care, leading to adverse health outcomes in older adults. The study aimed to investigate the prevalence and determinants of micronutrient deficiencies in malnourished older hospitalized patients. DESIGN AND SETTING This prospective, observational study was conducted in a geriatric acute care unit. PARTICIPANTS The study included 156 malnourished older adults. MEASUREMENTS Malnutrition was identified using the Mini Nutritional Assessment-Short Form. Micronutrient status was assessed through serum analysis of vitamins (A, B1, B6, B12, C, D, E, H, K, folic acid) and minerals (iron, zinc, copper, selenium) within 24 h post-admission. RESULTS The average patient age was 82.3 ± 7.5 years, with 69% female. The results revealed a high prevalence of micronutrient deficiencies, with 90% of patients exhibiting deficiencies in three or more micronutrients. Notably, every patient presented at least one micronutrient deficiency. Common deficiencies were found in vitamins C (75%), D (65%), H (61%), and K (45%), as well as folic acid (37%), iron (31%), zinc (36%) and selenium (35%). In binary regression analysis, the amount of previous weight loss was significantly associated with a higher prevalence of multiple (>2) micronutrient deficiencies (P = 0.045). Other variables such age (P = 0.449), gender (P = 0.252), BMI (P = 0.265) and MNA-SF score (P = 0.200) did not show any significant association with the prevalence multiple micronutrient deficiencies. CONCLUSION The high prevalence of micronutrient deficiencies in malnourished older hospitalized patients underscore the urgent need for targeted interventions to address micronutrient deficiencies in this population, promoting their health status.
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Affiliation(s)
- Kübra Yilmaz
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Diana Daubert
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany.
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Song IA, Lee K, Lee S, Kim K, Oh TK. Implementation of a multidisciplinary nutritional support team and clinical outcomes in critically ill patients with COVID-19. Clin Nutr 2024; 43:315-321. [PMID: 38142476 DOI: 10.1016/j.clnu.2023.12.007] [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: 08/05/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND & AIMS The South Korean government established the multidisciplinary nutritional support teams (NST) system for enhancing the evaluation and adequate supply of nutritional support to patients at high risk of malnutrition. However, the impact of the NST on clinical outcomes in critically ill patients with coronavirus disease 2019 (COVID-19) remains unclear. We aimed to investigate whether NST implementation affects survival outcomes in patients with COVID-19 requiring intensive care unit (ICU) admission. METHODS Using data from the National Health Insurance Service and Korea Disease Control and Prevention Agency in South Korea, adult patients with COVID-19 admitted to the ICU between October 8, 2020, and December 31, 2021, were included. The NST comprised four professional personnel (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). Patients admitted to ICUs with and without the NST system were assigned to the NST and non-NST groups, respectively. RESULTS A total of 13,103 critically ill adult patients were included in the final analysis; among them, 10,103 (77.1 %) and 3,000 (22.9 %) patients were included in the NST and non-NST groups, respectively. In the NST group, 2,803 (27.7 %) critically ill patients with COVID-19 were prescribed enteral or parenteral nutrition by the NST. In a covariate-adjusted multivariable model, the NST group showed a 40 % lower in-hospital mortality rate than the non-NST group (odds ratio: 0.60, 95 % confidence interval: 0.51, 0.71; P < 0.001). In subgroup analyses, compared with the non-NST group, the NST group showed significantly lower in-hospital mortality rates at 2, 3, 4, and 5 points on the World Health Organization clinical progression scale among patients with acute respiratory distress and mechanical ventilatory support. CONCLUSIONS NST implementation was associated with improved survival outcomes in critically ill patients with COVID-19; accordingly, it may be recommended for improving adequate nutritional support and evaluation in critically ill patients.
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Affiliation(s)
- In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, South Korea
| | - Kyunghwa Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, South Korea
| | - Sunghee Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, South Korea
| | - Keonhee Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, South Korea.
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Chen Z, Hao Q, Sun R, Zhang Y, Fu H, Liu S, Luo C, Chen H, Zhang Y. Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery. CNS Neurosci Ther 2024; 30:e14343. [PMID: 37408469 PMCID: PMC10848042 DOI: 10.1111/cns.14343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/07/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD. METHODS The data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS A total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42-2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05). CONCLUSIONS Our results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single-center cohort and will need to be validated in future studies involving multiple centers.
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Affiliation(s)
- Zhiqiang Chen
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Quanshui Hao
- Department of AnesthesiologyHuanggang Central Hospital of Yangtze UniversityHuanggangChina
| | - Rao Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yanjing Zhang
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Hui Fu
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Shile Liu
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Chenglei Luo
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Hanwen Chen
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Yiwen Zhang
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
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Arifin H, Chen R, Banda KJ, Kustanti CY, Chang CY, Lin HC, Liu D, Lee TY, Chou KR. Meta-analysis and moderator analysis of the prevalence of malnutrition and malnutrition risk among older adults with dementia. Int J Nurs Stud 2024; 150:104648. [PMID: 38043486 DOI: 10.1016/j.ijnurstu.2023.104648] [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: 06/02/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Aging and dementia are common and closely related health problems in older adults, affecting their ability to maintain a healthy diet and ultimately resulting in malnutrition. OBJECTIVE In this study, we estimated the global prevalence of malnutrition and malnutrition risk in older adults with dementia. DESIGN Meta-analysis. DATA SOURCES Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus, and Web of Science were comprehensively searched for articles published from database inception to October 2022. METHODS Pooled prevalence analysis was conducted using a generalized linear mixed model and a random-effects model. I2 and Cochran's Q statistics were used for identifying heterogeneity. Publication bias was evaluated using Peters' regression test and a funnel plot. Moderator analyses were conducted to investigate variations in the prevalence estimates of the included studies. All statistical analyses were conducted using R software. RESULTS A total of 16 studies involving a total of 6513 older adults with dementia were included in the analysis. The results indicated that 32.52 % (95 % confidence interval: 19.55-45.49) of all included older adults with dementia had malnutrition, whereas 46.80 % (95 % confidence interval: 38.90-54.70) had a risk of malnutrition. The prevalence of malnutrition was found to be high among older patients living in institutionalized settings (46.59 %) and those with Alzheimer's disease (12.26 %). The factors moderating the prevalence of malnutrition included adequate vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. The prevalence of malnutrition risk was high among women (29.84 %) and patients with Alzheimer's disease (26.29 %). The factors moderating the prevalence of malnutrition risk included total cholesterol level, vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. CONCLUSIONS Approximately one-third of older adults with dementia are malnourished and nearly half of older adults are at a risk of malnutrition. Encouraging collaboration among health-care professionals and ensuring early assessment and effective management of malnutrition are crucial for maintaining a favorable nutritional status in older adults with dementia. REGISTRATION This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022369329). TWEETABLE ABSTRACT Globally, approximately 32.52 % of older adults with dementia are malnourished and approximately 46.80 % are at a risk of malnutrition.
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Affiliation(s)
- Hidayat Arifin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia. https://twitter.com/ha_arifin
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia
| | - Ching-Yi Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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AlFehaidi AAAHZ, Khan SHU, Abdelrahman RA, Ahel NT, Shine P, De Ramos MD, Skairjeh NM, Khan SA, Al-Saadi RK. Predictors of malnutrition among older residents in Qatari long-term care facilities: a retrospective study. BMC Nutr 2024; 10:23. [PMID: 38303045 PMCID: PMC10835922 DOI: 10.1186/s40795-024-00827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Malnutrition is a prevalent issue among older adults in long-term care facilities and is associated with adverse health outcomes and increased healthcare costs. Identifying the predictors of malnutrition in this population is crucial for developing effective intervention strategies. This study aimed to explore the factors contributing to malnourishment among older individuals living in long-term care facilities in Qatar. METHODS This cross-sectional study included 75 older adults from two long-term care facilities (Rumailah Hospital and Enaya Specialized Care Center) in Qatar. Baseline characteristics, including age, sex, length of stay, mortality, weight, body mass index, co-morbidities, and laboratory parameters, were assessed. Data were analyzed using the most recent version of the SPSS software, version 29. Predictors of malnutrition and mortality were identified using logistic regression analysis. RESULTS Of the 75 older individuals included in the study, 85% (64) were malnourished. The average age of the participants was 74.89 years, with a standard deviation of 10.21. Of all participants, approximately 61% (46) were males, and 39% (29) were females. Most malnourished older adults were classified as either at "moderate (29.69%)" or "severe risk (37.50%)," according to the Geriatric Nutritional Risk Index. Malnourished participants experienced a significant percentage of weight change within 3 months (14.01 ± 7.89); the only statistically significant predictor of malnutrition was the percentage of weight change within 3 months with an odds ratio (OR) of 4.8 (confidence interval [CI] 1.56-14.75) and p-value of 0.006. Statistically significant predictors of mortality were malnutrition (OR 24.84, CI 1.09-564) and age (OR 1.07, CI 1.00-1.14). CONCLUSIONS A significant predictor of malnutrition in older adults identified in this study was the sudden and recent change in weight, which can be employed to detect individuals at risk early and guide tailored interventions. Malnutrition is a significant predictor of mortality. Employing a multidimensional strategy to tackle malnutrition can improve outcomes for the older individuals.
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Affiliation(s)
- Al Anoud Ali H Z AlFehaidi
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar.
| | - Shafi Hashmath Ulla Khan
- Department of Geriatrics & Long-Term Care, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rana Albdeljubbar Abdelrahman
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Nesreen Talal Ahel
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Pavithra Shine
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Monica Doroja De Ramos
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Nisreen Mazin Skairjeh
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Shakeel Ahmad Khan
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
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Sato R, Sawaya Y, Ishizaka M, Yin L, Shiba T, Hirose T, Urano T. Neck circumference is a highly reliable anthropometric measure in older adults requiring long-term care. PeerJ 2024; 12:e16816. [PMID: 38313007 PMCID: PMC10838066 DOI: 10.7717/peerj.16816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
The reliability of neck circumference measurement as an assessment tool for older adults requiring long-term care remains unknown. This study aimed to evaluate the reliability of neck circumference measurement in older adults requiring long-term care, and the effect of edema on measurement error. Two physical therapists measured the neck circumference. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to examine the reliability of neck circumference measurement. Correlation analysis was used to evaluate the relationship between edema values (extracellular water/total body water) and neck circumference measurement difference. For inter-rater reliability of neck circumference measurement, the overall ICC (2,1) was 0.98. The upper and lower limits of the difference between examiners ranged from -0.9 to 1.2 cm. There was no association between edema values and neck circumference measurement error. Thus, measurement of the neck circumference in older adults requiring long-term care is a reliable assessment tool, with a low error rate, even in older adults with edema.
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Affiliation(s)
- Ryo Sato
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
| | - Yohei Sawaya
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Lu Yin
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
| | - Takahiro Shiba
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
| | - Tamaki Hirose
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Tomohiko Urano
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
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