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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Svendsen JA, Beck AM, Sigersted Frederiksen AK, Knudsen AW, Munk T. Development of an electronic food ordering system and a la carte menu: Enhancing patient involvement in nutritional care. Clin Nutr ESPEN 2024; 60:86-94. [PMID: 38479944 DOI: 10.1016/j.clnesp.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Malnutrition is a significant issue in hospitals, leading to weight loss and reduced quality of life for patients. Hospital food plays a crucial role in preventing malnutrition, especially for patients with high nutritional risk or malnourishment. However, barriers to providing adequate nutritional care include a lack of tools to record patients' nutritional intake and a limited understanding of energy and protein content in hospital menus. OBJECTIVE The study aimed to develop an electronic patient-centered food ordering system and an à la carte menu to improve patients' nutritional care and involvement in their dietary choices. METHODS The study was conducted in two parts. Part 1 involved a questionnaire survey among hospitalized patients to determine their food preferences, self-assessed ability to use an electronic food ordering system, and preferences for different types of cuisine. The survey also investigated patients' meal choices for a full day, including portion sizes. Part 2 comprised usability tests of the electronic food ordering system prototype, conducted on hospitalized patients to identify interface issues and assess overall satisfaction. RESULTS A total of 99 patients participated in the questionnaire survey. The majority (78.7 %) found the selection of dishes appropriate. Patients' preferences were used to adjust the à la carte menu to reflect their meal choices. In the usability tests, the electronic food ordering system prototype showed positive results, and the System Usability Score was above the threshold for minor adjustments. CONCLUSION The study successfully developed an electronic patient-centered food ordering system and an à la carte menu that aligned with patients' preferences and needs. The system demonstrated usability and potential to improve patients' nutritional care and involvement in their dietary decisions. By addressing the barriers to nutritional care, this system offers a feasible solution to prevent and treat malnutrition in hospitalized patients.
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Affiliation(s)
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | | | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
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Hansen SS, Munk T, Knudsen AW, Beck AM. Concordance between changes in calf circumference and muscle mass exists: A narrative literature review. Clin Nutr ESPEN 2024; 59:171-175. [PMID: 38220372 DOI: 10.1016/j.clnesp.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
Technological methods such as BIA or DXA are not always accessible in clinical practice, thus GLIM supports the use of calf circumference measurements to examine muscle mass. However, it has not been described if measurements of calf circumference can detect a change in muscle mass to the same degree as the technological methods. The aim of this study was to assess, whether changes in calf circumference can be used as a valid proxy for changes in muscle mass. 10 studies including measurements of muscle mass by calf circumference and technological methods at baseline and follow-up were identified through a narrative literature review. Results were used to determine concordance between measurements. Predominantly concordance between changes in calf circumference and muscle mass assessed by BIA or DXA was reviled. However, the results were not uniform for hospitalized patients or older adults as groups. Thus, uncertainty whether changes in calf circumference can be used as a valid proxy for changes in muscle mass in these groups still exist.
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Affiliation(s)
- Signe Skovgaard Hansen
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
| | - Tina Munk
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
| | - Anne Wilkens Knudsen
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
| | - Anne Marie Beck
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
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Beck AM, Ovesen L, Schroll M. A six months' prospective follow-up of 65+-y-old patients from general practice classified according to nutritional risk by the Mini Nutritional Assessment. Eur J Clin Nutr 2024. [DOI: 10.1038/sj/ejcn/1601266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jespersen JB, Beck AM, Munk T, Jensen HO, Knudsen AW. Low-intake dehydration and nutrition impact symptoms in older medical patients - A retrospective study. Clin Nutr ESPEN 2023; 57:190-196. [PMID: 37739655 DOI: 10.1016/j.clnesp.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Malnutrition and low-intake dehydration both increase complications and mortality in hospitalized older medical patients. Nutrition Impact Symptoms (NIS) are barriers for obtaining an adequate nutritional intake and possibly adequate fluid. Therefore, we aimed to assess the prevalence of low-intake dehydration and specific NIS, and the relation between low-intake dehydration and specific NIS. METHODS A retrospective cohort study among older patients (≥65 years) from the Medical Department at Herlev-Gentofte Hospital and referred to a clinical dietitian. Data about sex, age, BMI, prevalence of nutritional risk (NRS-2002), low-intake dehydration (calculated osmolarity >295 mmol/L), and NIS (the EATEN-questionnaire, comprising 16 NIS-questions and whether these were respectively present and limiting nutritional intake) were collected from the hospital records. RESULTS We included 99 patients (61% women), mean age 81 years (±7.9), median BMI 21.8 kg/m2 (IQR:19.5-25.4). Nutritional risk was found in 74%, and low-intake dehydration in 40% of the included patients. The three most frequent NIS-present were: Early satiety (84%), no appetite (82%), and tiredness (72%). The three most frequent NIS-limiting intake were: No appetite (73%), early satiety (69%), and dry mouth (42%). We found low-intake dehydration to be related to a lower prevalence of the following NIS-present; dry mouth (58% vs.80%, p = 0.0210), and breathlessness (24% vs.49%, p = 0.0179). Among the NIS-limiting intake a lower prevalence of other pains was related to low-intake dehydration (7% vs.29%, p = 0.0233). CONCLUSION NIS and low-intake dehydration are highly prevalent in older patients. There is limited association between low-intake dehydration and specific NIS.
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Affiliation(s)
- Jacob Bækgaard Jespersen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Helena Osbæck Jensen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
| | - Anne Wilkens Knudsen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
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Bech CB, Svendsen JA, Knudsen AW, Munk T, Beck AM. The association between malnutrition and dehydration in older adults admitted to a geriatric unit: An observational study. Clin Nutr ESPEN 2023; 57:598-605. [PMID: 37739711 DOI: 10.1016/j.clnesp.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIM There is an overlap between the risk factors causing low intake of water and low intake of nutrients, respectively. This study aims to explore the agreement between the assessment of malnutrition and the outcome of low-intake dehydration in a population of older hospitalized patients. METHODS Patients ≥65 years old and hospitalized at the geriatric hospital ward were screened for eligibility within 96 h of admission. Dehydration was assessed with the calculated serum osmolarity ≥295 mmol/L (1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14), and (risk of) malnutrition was assessed with NRS-2002 ≥ 3 points, MNA-SF ≤ 7 points, MNA-LF < 17, MUST ≥ 2 points, and GLIM after screening with NRS-2002 and MNA-LF. Follow-up data regarding exercise rehabilitation, readmissions, and mortality was collected 30 days after discharge. Statistics used were the Chi-squared test, Fishers-exact test, and Wilcoxon signed rank test. RESULTS A total of 114 patients (57% females) were included. Median age 85.5 (IQR 80; 89.25) years. A total of 49 (43%) were dehydrated. Fewer females were dehydrated (F: 42.9% vs. M: 67.7%, p = 0.013). The patients with osmolarity ≥295 mmol/L had a higher median weight (68.3 (IQR 58.5; 78.4) vs. 62 (IQR 51.8; 72.1), p = 0.021) and mid-up-arm circumference (27 (IQR 26; 30) vs. 25.5 (IQR 22.9; 28.3), p = 0.004). No significant difference was found in the prevalence of malnutrition between those with or without dehydration (NRS-2002; 70% vs. 81%, p = 0.174; MNA-SF: 23.1 vs. 23.2%, p = 1.0; MNA-LF: 37.1 vs. 30.2%, p = 0.644; MUST: 24.5 vs. 33.8%, p = 0.308; GLIM after screening with NRS-2002: 84.4 vs. 74.5%, p = 0.405, GLIM after screening with MNA-LF: 74.1 vs. 75.6%, p = 0.438). Kappa values varied around 0 and reflected low agreement. There were no differences in the follow-up data, between those who were normohydrated and those who were dehydrated. CONCLUSION We found low agreement between the assessment of malnutrition and low-intake dehydration in a population of older hospitalized patients. All geriatric patients should therefore be assessed for both conditions.
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Affiliation(s)
- Camilla Balle Bech
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | | | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark.
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Engelstrup E, Beck AM, Munk T, Bardal P, Knudsen AW. The association between nutrition impact symptoms, nutritional risk, and risk of reduced overall survival in patients with head and neck cancer. A retrospective study. Clin Nutr ESPEN 2023; 57:239-245. [PMID: 37739663 DOI: 10.1016/j.clnesp.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS To examine which nutritional impact symptoms (NIS) were most prevalent at the initial state of treatment in outpatients with head and neck cancer (HNC). Secondly, to examine whether there is a potential relation between risk of reduced overall survival to NIS or nutritional risk. METHODS Retrospective data collection from outpatients with HNC undergoing radiotherapy and/or systemic therapy. A clinical dietitian consulted all patients with the inclusion of a nutritional risk screening according to the Nutritional Risk Screening tool (NRS 2002) and Eastern Cooperative Oncology Group performance status (ECOG), and an assessment of NIS collected with a structured questionnaire, with the prevalence of 16 symptoms and to what degree they were nutritionally limiting. Weight loss at two months follow-up was calculated and patients were categorized as either at low or high risk of reduced overall survival in accordance with a BMI-adjusted weight loss grading system (high, score 0-2; low, score 3-4). RESULTS A total of 110 patients were included (male, 77%; age, 66 (59-71)). The mean weight loss was 4.5 kg at two months follow-up, increasing with higher BMI. Eighty-six percentage of the patients experienced 3 or more of the present NIS (P-NIS), and 44% of the patients experienced 3 or more of the nutritionally limiting NIS (L-NIS). Patients who have a high risk of reduced overall survival accounted for 45% and consisted of patients with low BMI and high percentual weight loss. No significant difference was found between the two groups in terms of NIS. CONCLUSION We found NIS to be highly prevalent among patients with head and neck cancer. Women experienced more NIS than men. Half of the patients were categorized as being at high risk of reduced overall survival, but no relation between the risk of reduced overall survival to NIS or nutritional risk was found in this study.
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Affiliation(s)
- Emilie Engelstrup
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Pernille Bardal
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Anne Wilkens Knudsen
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Folven KI, Tangvik RJ, Nilsen RM, Beck AM, Hetlevik Ø, Biringer E. Nutritional risk, nutrition plan and risk of death in older health care service users with chronic diseases: A register-based cohort study. Clin Nutr ESPEN 2023; 55:440-446. [PMID: 37202082 DOI: 10.1016/j.clnesp.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/15/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Nutritional risk in older health care service users is a well-known challenge. Nutritional risk screening and individualised nutrition plans are common strategies for preventing and treating malnutrition. The aim of the current study was to investigate whether nutritional risk is associated with an increased risk of death and whether a nutrition plan to those at nutritional risk could reduce this potential risk of death in community health care service users over 65 years of age. METHODS We conducted a register-based, prospective cohort study on older health care service users with chronic diseases. The study included persons ≥65 years of age receiving health care services from all municipalities in Norway from 2017 to 2018 (n = 45,656). Data on diagnoses, nutritional risk, nutrition plan and death were obtained from the Norwegian Registry for Primary Health Care (NRPHC) and the Norwegian Patient Registry (NPR). We used Cox regression models to estimate the associations of nutritional risk and use of a nutrition plan with the risk of death within three and six months. Analyses were performed within the following diagnostic strata: chronic obstructive pulmonary disease (COPD), dementia, type 2 diabetes, stroke, osteoporosis and heart failure. The analyses were adjusted for age, gender, living situation and comorbidity. RESULTS Of the 45,656 health care service users, 27,160 (60%) were at nutritional risk, and 4437 (10%) and 7262 (16%) died within three and six months, respectively. Among those at nutritional risk, 82% received a nutrition plan. Health care service users at nutritional risk had an increased risk of death compared to health care service users not at nutritional risk (13% vs 5% and 20% vs 10% at three and six months). Adjusted hazard ratios (HRs) for death within six months were 2.26 (95% confidence interval (CI): 1.95, 2.61) for health care service users with COPD, 2.15 (1.93, 2.41) for those with heart failure, 2.37 (1.99, 2.84) for those with osteoporosis, 2.07 (1.80, 2.38) for those with stroke, 2.65 (2.30, 3.06) for those with type 2 diabetes and 1.94 (1.74, 2.16) for those with dementia. The adjusted HRs were larger for death within three months than death within six months for all diagnoses. Nutrition plans were not associated with the risk of death for health care service users at nutritional risk with COPD, dementia or stroke. For health care service users at nutritional risk with type 2 diabetes, osteoporosis or heart failure, nutrition plans were associated with an increased risk of death within both three and six months (adjusted HR 1.56 (95% CI: 1.10, 2.21) and 1.45 (1.11, 1.88) for type 2 diabetes; 2.20 (1.38, 3.51) and 1.71 (1.25, 2.36) for osteoporosis and 1.37 (1.05, 1.78) and 1.39 (1.13, 1.72) for heart failure). CONCLUSIONS Nutritional risk was associated with the risk of earlier death in older health care service users with common chronic diseases in the community. Nutrition plans were associated with a higher risk of death in some groups in our study. This may be because we could not control sufficiently for disease severity, the indication for providing a nutrition plan or the degree of implementation of nutrition plans in community health care.
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Affiliation(s)
- Kristin I Folven
- Department of Research and Innovation, Helse Fonna Local Health Authority, P.O. Box 2170, NO-5504 Haugesund, Norway; Centre for Nutrition, Department of Clinical Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway.
| | - Randi J Tangvik
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway; Mohn Nutrition Research Laboratory, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, NO-5020 Bergen, Norway
| | - Anne Marie Beck
- Unit for Dieticians and Nutrition Research, Herlev and Gentofte University Hospital, DK-2730 Herlev, Denmark
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway
| | - Eva Biringer
- Department of Research and Innovation, Helse Fonna Local Health Authority, P.O. Box 2170, NO-5504 Haugesund, Norway
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van Zwienen-Pot JI, Reinders I, de Groot LCPGM, Beck AM, Feldblum I, Jobse I, Neelemaat F, de van der Schueren MAE, Shahar DR, Smeets ETHC, Tieland M, Wijnhoven HAH, Volkert D, Visser M. Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs. Nutrients 2023; 15:2025. [PMID: 37432139 DOI: 10.3390/nu15092025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
Nutritional intervention studies in older adults with malnutrition aim to improve nutritional status. Although these studies show a significant gain in body weight, there is inconsistent evidence of clinical effectiveness on muscle strength and mortality. This study aimed to examine the effects of nutritional interventions on muscle strength and risk of mortality in older adults (malnourished or at risk) and explore whether these effects are influenced by participant characteristics. Individual participant data were used from nine RCTs (community setting, hospital and long-term care; duration 12-24 weeks and included oral nutritional supplements, dietary counseling, or both). Handgrip strength (HGS) was measured in seven RCTs and six RCTs obtained mortality data. A ≥3 kg increase in HGS was considered clinically relevant. Logistic generalized estimating equations analyses (GEE) were used to test intervention effectiveness. GEE showed no overall treatment effect (OR 1.11, 95% CI 0.78-1.59) on HGS. A greater, but not statistically significant, effect on HGS was observed for older (>80 years) versus younger participants. No significant treatment effect was observed for mortality (OR 0.78, 95% CI 0.42-1.46). The treatment effect on mortality was greater but remained non-significant for women and those with higher baseline energy or protein intake. In conclusion, no effects of nutritional interventions were observed on HGS and mortality in older adults (malnourished or at risk). While the treatment effect was modified by some baseline participant characteristics, the treatment also lacked an effect in most subgroups.
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Affiliation(s)
- Judith I van Zwienen-Pot
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lisette C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Herlev and Gentofte Hospital, DK-2730 Herlev, Denmark
| | - Ilana Feldblum
- The Daniel Abraham International Center for Health Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 84105, Israel
| | - Inken Jobse
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Floor Neelemaat
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
| | - Danit R Shahar
- The Daniel Abraham International Center for Health Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 84105, Israel
| | - Ellen T H C Smeets
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Amsterdam University of Applied Science, 1067 SM Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
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Beck AM, Volkert D. Proper nutrition and hydration are human rights: also and especially for older patients. Eur Geriatr Med 2023:10.1007/s41999-023-00771-4. [PMID: 37000400 DOI: 10.1007/s41999-023-00771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Anne Marie Beck
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev Gentofte, Borgmester Ib Juuls Vej 1, 2720, Herlev, Denmark
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany.
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Blondal BS, Geirsdottir OG, Beck AM, Halldorsson TI, Jonsson PV, Sveinsdottir K, Ramel A. HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge. Eur J Clin Nutr 2023; 77:45-54. [PMID: 36028775 PMCID: PMC9876791 DOI: 10.1038/s41430-022-01195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. METHODS A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. RESULTS Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (-815 kcal/day and -3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls. CONCLUSIONS Most Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status. STUDY REGISTRATION This study was registered at ClinicalTrials.gov ( NCT03995303 ).
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Affiliation(s)
- B S Blondal
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland.
| | - O G Geirsdottir
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - A M Beck
- University College Copenhagen, Institute of Nursing and Nutrition, Sigurdsgade 26, 2200, Copenhagen, Denmark
- The Dietetic and Nutritional Research Unit, EFFECT, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
| | - T I Halldorsson
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - P V Jonsson
- The Icelandic Gerontological Research Institute, Tungata 26, 101, Reykjavik, Iceland
- Faculty of Medicine, School of Health, University of Iceland, Reykjavík, Iceland
- Department of Geriatrics, The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - A Ramel
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
- Matís ohf, Vinlandsleið 12, 113, Reykjavik, Iceland
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Blondal BS, Geirsdottir OG, Halldorsson TI, Beck AM, Jonsson PV, Ramel A. HOMEFOOD Randomised Trial - Six-Month Nutrition Therapy in Discharged Older Adults Reduces Hospital Readmissions and Length of Stay at Hospital Up to 18 Months of Follow-Up. J Nutr Health Aging 2023; 27:632-640. [PMID: 37702336 DOI: 10.1007/s12603-023-1962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Malnutrition is frequently observed in older adults and is associated with hospital readmissions, length of stay (LOS), and mortality in discharged patients. OBJECTIVE The aim of this study was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence 1-, 6-, 12- and 18-months post-discharge in older Icelandic adults. DESIGN Secondary analysis of a randomized controlled trial. PARTICIPANTS Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. INTERVENTION The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. MEASUREMENTS The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. RESULTS The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions per participant (1 month: 0.02 vs 0.19, P=0.015; 6 month: 0.33 vs 0.77, P=0.014; 0.62 vs 1.12, P=0.044) and a shorter LOS (1 month: 0.02 vs 0.92, P=0.013; 6 months: 2.44 vs 13.21; P=0.006; 12 months: 5.83 vs 19.40, P=0.034; 18 months: 10.42 vs 26.00, P=0.033) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. CONCLUSION A six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge. However, it did neither affect mortality, ER, nor need of long-term care residence in this group.
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Affiliation(s)
- B S Blondal
- Berglind Soffia Blondal, Faculty of Food Science and Nutrition, University of Iceland, Aragata 14, 101 Reykjavik, Iceland, Telephone: +354 842 0242,
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Mortensen C, Tetens I, Kristensen M, Beck AM. Vitamin D and Calcium Supplementation in Nursing Homes-A Quality Improvement Study. Nutrients 2022; 14:nu14245360. [PMID: 36558519 PMCID: PMC9780874 DOI: 10.3390/nu14245360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Even though dietary supplements with vitamin D and calcium are recommended to nursing home residents, we recently reported a low adherence to this recommendation. The objective of this 20-week quality improvement study was to use the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles to improve adherence in Danish nursing homes. We included two nursing homes with 109 residents at baseline. An information sheet including the rationale for the recommendation was developed for the nurses to urge residents to take the supplements and seek approval by the general practitioner afterwards (PDSA cycle 1). Moreover, it was included in admission meetings with new residents to address supplementation (PDSA cycle 2). A nurse reviewed patient records for number of residents prescribed adequate doses of vitamin D (≥20 µg) and calcium (≥800 mg) before, during and after the intervention. At baseline, 32% (n = 35) of the residents had adequate doses of vitamin D and calcium. After implementation of the information sheet and adjustment to admission meetings, this increased to 65% (n = 71) at endpoint (p < 0.001). In conclusion, in this quality improvement study, we improved the number of prescriptions of adequate doses of vitamin D and calcium over 20 weeks using the Model for Improvement and PDSA experiments.
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Affiliation(s)
- Charlotte Mortensen
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-51380364
| | - Inge Tetens
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Michael Kristensen
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, 2200 Copenhagen, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, 2730 Herlev, Denmark
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Christoffersen T, Beck AM, Tetens I, Dynesen AW, Aaslyng MD. Development of an approach for identifying overnutrition among older adults in community health care settings: - an opinion paper. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Pedersen M, Bennich B, Boateng T, Beck AM, Sibilitz K, Andersen I, Overgaard D. Peer-mentor support for older vulnerable myocardial infarction patients referred to cardiac rehabilitation: single-arm feasibility study. Pilot Feasibility Stud 2022; 8:172. [PMID: 35945611 PMCID: PMC9360730 DOI: 10.1186/s40814-022-01141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The positive effects of cardiac rehabilitation are well established. However, it has an inherent challenge, namely the low attendance rate among older vulnerable patients, which illustrates the need for effective interventions. Peer mentoring is a low-cost intervention that has the potential to improve cardiac rehabilitation attendance and improve physical and psychological outcomes among older patients. The aim of this study was to test the feasibility and acceptability of a peer-mentor intervention among older vulnerable myocardial infarction patients referred to cardiac rehabilitation. Methods The study was conducted as a single-arm feasibility study and designed as a mixed methods intervention study. Patients admitted to a university hospital in Denmark between September 2020 and December 2020 received a 24-week peer-mentor intervention. The feasibility of the intervention was evaluated based on five criteria by Orsmond and Cohn: (a) recruitment capability, (b) data-collection procedures, (c) intervention acceptability, (d) available resources, and (e) participant responses to the intervention. Data were collected through self-administrated questionnaires, closed-ended telephone interviews, semi-structured interviews, and document sheets. Results Twenty patients were offered the peer-mentor intervention. The intervention proved feasible, with a low dropout rate and high acceptability. However, the original inclusion criteria only involved vulnerable women, and this proved not to be feasible, and were therefore revised to also include vulnerable male patients. Peer mentors (n = 17) were monitored during the intervention period, and the findings indicate that their mentoring role did not cause any harm. The peer-mentor intervention showed signs of effectiveness, as a high rate of cardiac rehabilitation attendance was achieved among patients. Quality of life also increased among patients. This was the case for emotional, physical, and global quality of life measures at 24-week follow-up. Conclusion The peer-mentor intervention is a feasible and acceptable intervention that holds the potential to increase both cardiac rehabilitation attendance and quality of life in older vulnerable patients. This finding paves the way for peer-mentor interventions to be tested in randomized controlled trials, with a view toward reducing inequality in cardiac rehabilitation attendance. However, some of the original study procedures were not feasible, and as such was revised. Trial registration The feasibility study was registered at ClinicalTrials.gov (ClinicalTrials.gov identification number: NCT04507529), August 11, 2020.
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Affiliation(s)
- Maria Pedersen
- Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, 2200, Copenhagen N, Denmark.
| | - Birgitte Bennich
- Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, 2200, Copenhagen N, Denmark
| | - Takyiwa Boateng
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark.,The Dietetic and Nutritional Research Unit, EFFECT, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
| | - Kirstine Sibilitz
- Department of Cardiology, Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Dorthe Overgaard
- Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, 2200, Copenhagen N, Denmark
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16
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Folven K, Tangvik RJ, Nilsen RM, Beck AM, Hetlevik Ø, Biringer E. Nutritional Risk Is Associated with Earlier Death in Older Service Users with Common Chronic Diseases. Curr Dev Nutr 2022. [PMCID: PMC9193744 DOI: 10.1093/cdn/nzac047.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives The objective of the study was to investigate associations of nutritional risk with mortality in older service users with common chronic diseases. Methods We used data from 2017–2018 in national registries in Norway (KPR and NPR) to investigate associations of nutritional risk with six months mortality in a cohort of service users ≥65 years (n = 45,701, mean age 83 years(range 63–106)) with common chronic diseases (COPD, heart failure, osteoporosis, stroke, type 2 diabetes or dementia). Nutritional risk status of the service users was assessed using validated screening tools recommended in the Norwegian guideline on prevention and treatment of malnutrition (either MNA or MUST). We applied Cox regression models to analyse associations of nutritional risk with death in service users with the six chronic diseases. The analyses were done on diagnose specific strata, and adjusted for age, gender and living situation (i.e., living with others vs living alone). Results Of the 45,701 service users, 27,160 (59%) were at nutritional risk and 7,269 (16%) died within six months. Service users that were at nutritional risk had increased risk of death compared to service users not at nutritional risk (20% vs 10%). Adjusted Hazard Ratios (HR) were 2.26 (95% confidence interval: 1.95, 2.61) for service users with COPD, 2.15(1.93, 2.41) for heart failure, 2.37(1.99, 2.84) for osteoporosis, 2.07(1.80, 2.38) for stroke, 2.65(2.30, 3.06) for type 2 diabetes and 1.94(1.74, 2.16) for service users with dementia. Conclusions Nutritional risk in older service users with common chronic diseases was strongly associated with earlier death. The finding warrant increased attention to prevention and treatment of malnutrition in community health services. Funding Sources The project was funded by Helse Fonna Local Health Authority, Norway.
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Due A, Beck AM, Birk CB, Justesen L, Majgaard M, Lei M, Langsted S SK, Jensen TS. Innovative rehabilitating meal service programs for old people living at home: A randomized controlled pilot study. Clin Rehabil 2022; 36:926-939. [PMID: 35521825 DOI: 10.1177/02692155221088777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test the feasibility of a pilot study for a future definitive trial investigating the effect of different meal service programs for old people living at home. DESIGN An 8-week randomized controlled trial was performed. SETTING Three municipalities in the Nordic country, Denmark. SUBJECTS Danish participants (≥65y) with reduced functionality. INTERVENTION Three different meal service programs 1) 24-h meals service, 2) Protein-rich meal service, and 3) Rehabilitation meal service, were developed and compared to standard care. MAIN MEASURES The main outcome was study feasibility. Dietary intake, anthropometry, physical function, quality of life, readmissions and adverse events were also evaluated. Comparisons between participants receiving a meal service program and standard care were done by one-way ANOVA, chi-square test and Fishers exact test. RESULTS A total of 592 subjects were assessed for eligibility and 13% (76/592) were recruited. Final analysis included 75% (57/76) of participants. The outcome measures seemed acceptable and feasible though eligibility, inclusion, and completion of the intervention were lower than expected. The 24-h meal service program managed to significantly increase the intake of protein (p = 0.049) and energy (p = 0.038) compared to the control group where reductions were seen. No other significant differences were found. CONCLUSIONS The pilot study was feasible and several benefits for completers were seen. However, in a future definitive trial, inclusion criteria should be wider, more effort should be put on the time, training and focus of the personal in close contact to the older subjects and the intervention should be less comprehensive and more flexible.
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Affiliation(s)
- Anette Due
- Nutrition and Health Education, 386475University College Copenhagen
| | - Anne Marie Beck
- Research Unit for Nutrition and Dietetics, 53176Herlev and Gentofte Hospital
| | | | - Lise Justesen
- Nutrition and Health Education, 386475University College Copenhagen
| | - Maj Majgaard
- Staff for Health and Care, 114283Municipality of Silkeborg
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Frederiksen AK, Beck AM, Luiking YC, Hofstede JM, Knudsen AW, Munk T. Protein intake in hospitalized older patients after hip fracture: Pilot feasibility study evaluating ESPEN guidelines for geriatrics. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mortensen C, Tetens I, Kristensen M, Snitkjaer P, Beck AM. Adherence and barriers to the vitamin D and calcium supplement recommendation at Danish nursing homes: a cross-sectional study. BMC Geriatr 2022; 22:27. [PMID: 34991498 PMCID: PMC8733751 DOI: 10.1186/s12877-021-02719-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Nursing home residents are in high risk of vitamin D deficiency, which negatively affects bone health. Vitamin D and calcium supplements haves shown to increase bone density and reduce fracture risk. Therefore, The Danish Health Authority recommends all nursing home residents a daily supplement of 20 μg vitamin D and 800–1000 mg calcium. However, adherence to the recommendation and knowledge of it is unknown. The aims of this study were to investigate adherence, knowledge, and potential barriers to this recommendation in Denmark. Methods A cross-sectional electronic survey was conducted in May–June 2020 among 50 randomly selected nursing homes widely distributed in Denmark. Questions included degree of adherence to the recommendation at each nursing home as well as respondent’s knowledge and attitudes towards it, and experienced barriers in relation to adherence. Results Respondents from 41 nursing homes answered the questionnaire, and these were mainly nurses (63%) or nursing home leaders (20%). Low adherence (≤ 40% of residents receiving both supplements) was reported at 35% of nursing homes, and only 8% of the nursing homes had a high adherence (> 80% of residents receiving both supplements). Most respondents (88%) had knowledge of the recommendation and 62% rated importance of increased implementation as high. Common explanations of low implementation were a lack of prescription by the general practitioner in the central electronic database (60%), resident-refusal to eat tablets (43%), chewing-swallowing difficulties (40%), and a high number of tablets given to the residents daily (34%). Conclusions The recommendation of daily vitamin D and calcium supplements to Danish nursing home residents is poorly implemented even though knowledge of the recommendation is relatively high. Barriers relate to an ambiguity of responsibility between the general practitioners and the nursing home staff, as well as the high number of tablets to be consumed in total by the residents. These barriers must be targeted to improve adherence in this vulnerable group of institutionalized older adults.
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Affiliation(s)
- Charlotte Mortensen
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark.
| | - Inge Tetens
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Noerre Allé 51, 2200, Copenhagen N, Denmark
| | - Michael Kristensen
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark
| | - Pia Snitkjaer
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark.,Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
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Lassen AD, Nordman M, Christensen LM, Beck AM, Trolle E. Guidance for Healthy and More Climate-Friendly Diets in Nursing Homes-Scenario Analysis Based on a Municipality's Food Procurement. Nutrients 2021; 13:4525. [PMID: 34960075 PMCID: PMC8704465 DOI: 10.3390/nu13124525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 12/27/2022] Open
Abstract
Reducing the climate impact of food provided for residents in nursing homes is challenging, as the diets for older, frail adults must be high in protein content and energy density while at the same time ensuring that the meals are palatable and recognizable. This study aimed at providing guidance on healthy and more climate-friendly diets for nursing homes in the City of Copenhagen. The goal was to decrease greenhouse gas emissions (GHGE) by at least 25% while at the same time providing nutritionally adequate and recognizable menus. First, food purchase data were compiled with datasets matching each food item to a proxy food item and then to databases containing GHGE and nutrient information. Secondly, two diet scenarios were modelled based on current procurement practices, i.e., an energy- and protein-dense diet and a standard protein-dense diet, and converted into guidelines for menu planning. The diets contained less total meat, especially beef, and significantly more pulses, nuts and seeds in order to increase protein content according to recommendations for older adults. Finally, a combined scenario was calculated to reflect the joint climate impact reduction. This kind of innovation in food procurement is required in order to achieve the necessary transition to a sustainable food system.
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Affiliation(s)
- Anne Dahl Lassen
- Division of Food Technology, National Food Institute, Technical University of Denmark, DK-2800 Kgs, Denmark; (M.N.); (L.M.C.); (E.T.)
| | - Matilda Nordman
- Division of Food Technology, National Food Institute, Technical University of Denmark, DK-2800 Kgs, Denmark; (M.N.); (L.M.C.); (E.T.)
| | - Lene Møller Christensen
- Division of Food Technology, National Food Institute, Technical University of Denmark, DK-2800 Kgs, Denmark; (M.N.); (L.M.C.); (E.T.)
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, DK-2730 Herlev, Denmark;
- Faculty of Health, Institute of Nutrition and Nursing, University College Copenhagen, DK-1799 Copenhagen, Denmark
| | - Ellen Trolle
- Division of Food Technology, National Food Institute, Technical University of Denmark, DK-2800 Kgs, Denmark; (M.N.); (L.M.C.); (E.T.)
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Cramon MØ, Raben I, Beck AM, Andersen JR. Individual nutritional intervention for prevention of readmission among geriatric patients-a randomized controlled pilot trial. Pilot Feasibility Stud 2021; 7:206. [PMID: 34782015 PMCID: PMC8591855 DOI: 10.1186/s40814-021-00926-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 20% of older people are readmitted to the hospital within 30 days of discharge. Even a short hospital stay decreases the ability to cope with the activities of daily living. The aims of this study were to (1) assess the feasibility of recruitment, (2) assess the acceptability of the intervention, and (3) investigate if an individual nutritional intervention could reduce the readmission rate of geriatric patients within 30 days of being discharged to their own homes. Methods The unblinded, randomized, controlled pilot trial includes geriatric patients discharged to their own homes. Forty patients were recruited from a medical ward and randomized to standard treatment (n = 19) or individualized nutritional intervention (n = 21). The intervention was dietary counseling and a nutrition plan before discharge, combined with two home visits performed by an educated nutritionist over a period of 4 weeks. Outcomes were readmission (primary), mortality, protein and energy intake, body weight, activity of daily living, handgrip strength, number of chair stands, and quality of life. Intention-to-treat analysis, per-protocol analysis, and post hoc analysis of readmissions were carried out. Results Recruitment was feasible, and there was high compliance to the intervention. There was no difference in readmission between the intervention group and control group 30 days after discharge (29% vs 11%). The individual nutritional intervention had a positive impact on achieving 75% of energy requirements at 30 days for the intervention group compared to the control group (93% vs 47%, p = 0.01). No other differences were found between the groups. Conclusion The individual nutritional intervention did not prevent readmission among geriatric patients in this trial. Recruitment procedures functioned well, and the intervention was well accepted by the patients. Trial registration ClinicalTrial.gov, NCT03519139. Retrospectively registered on 8 May 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00926-9.
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Affiliation(s)
- Mai Østerø Cramon
- Department of Medicine, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark. .,Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg, Denmark.
| | - Ines Raben
- Department of Medicine, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg, Denmark
| | - Anne Marie Beck
- Institute for Nursing and Nutrition, Faculty of Health, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen, Denmark.,Nutrition Research Unit, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg, Denmark
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Munk T, Svendsen JA, Knudsen AW, Østergaard TB, Thomsen T, Olesen SS, Rasmussen HH, Beck AM. A multimodal nutritional intervention after discharge improves quality of life and physical function in older patients - a randomized controlled trial. Clin Nutr 2021; 40:5500-5510. [PMID: 34656032 DOI: 10.1016/j.clnu.2021.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many older hospitalized patients are at nutritional risk or malnourished and the nutritional condition is often further impaired during hospitalization. When discharged to own home, a "Nutrition Gap" often occurs, causing inadequate dietary intake, and potentially impeded recovery. Previously, cross-sectorial studies of single component nutritional intervention have shown a limited effect on clinically relevant outcomes. We hypothesized that a multimodal nutritional intervention is necessary to elicit a beneficial effect on clinically relevant outcomes. METHODS A randomized controlled trial was performed for a period of 16 weeks. At discharge, the intervention group (IG) received dietetic counselling including a recommendation of daily training, an individual nutrition plan and a package containing foods and drinks covering dietary requirements for the next 24 h. Further, a goodie-bag containing samples of protein-rich milk-based drinks were provided. Information regarding recommendations of nutritional therapy after discharge was systematically and electronically communicated to the municipality. The dietician performed telephone follow-ups on day 4 and 30 and a home visit at 16 weeks. The control group (CG) received standard treatment. The primary outcome was readmissions within 6 month, secondary outcomes were Length of Stay (LOS), Health Related Quality of Life (EQ-5D-3L), nutritional status, physical function (30s-CST) and mortality. This trial was registered under ClinicalTrials.gov Identifier no. NCT03488329. RESULTS We included 191 patients (IG: n = 93). No significant difference was seen in readmissions within 6 month (IG: 45% vs. CG: 45%, Risk Ratio (RR): 0.96 0.71-1.31, p = 0.885). At the 16-weeks follow-up more patients in the IG reached at least 75% of energy and protein requirements (82% vs. CG: 61%, p = 0,007). The energy (kcal) and protein intake (g) per kg was significantly higher in the IG (26.4 kcal/kg (±7.4) vs. 22.6 (±7.4), p = 0.0248) (1.1 g/kg (±0.3) vs. 0.9 g/kg (±0.3). Furthermore, significant lower weight loss was seen in IG (0.7 (±4.3) vs. -1.4 (±3.6), p = 0.002). A significant and clinically relevant difference was found in the EQ-5D-3L VAS-score (IG: mean 61.6 ± 16.2 vs. CG: 53.3 ± 19.3, p = 0.011) (Δ14.3 (±15.5) vs. Δ5.6 (±17.2), p = 0.002). A significant difference in mean 30s-CST in IG was also found (7.2 (±4.3) vs. 5.3 (±4.1), p = 0.010). The improvements in physical function were of clinical relevance in both groups, but significantly higher in the IG (Δ4.2 (±4.4) vs. Δ2.2 (±2.5), p = 0.008). In fact, 86% in IG experienced improvements in the 30s-CST compared with 68% in the CG (p = 0.022). LOS was found to be lower at all time points, however not significant (30 days: -3 (-8.5 to 2.5), p = 0.276, 16 weeks: -4 (-10.2 to 2.2, p = 0.204), 6 months: -3 (-9.3 to 3.3, p = 0346)). All-cause mortality was not different between groups, however RR showed a non-significantly 47% reduction at day 30 (0.53 (0.14-2.05, p = 0.499)) and a 17% reduction at 16 weeks (0.83 (0.40-1.73, p = 1.000)) in IG. Per protocol (PP) analysis revealed a non-significant decrease of 32% in readmission at 6 months (RR: 0.68 (0.42-1.08), p = 0.105). CONCLUSION The present study, using a multimodal nutritional approach, revealed no significant effect on readmissions however a significant positive effect on nutritional status, quality of life and physical function was found. The improvements in quality of life and physical function were of clinical relevance. No significant effect was found on LOS and mortality.
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Affiliation(s)
- Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark.
| | - Jonas Anias Svendsen
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark
| | - Anne Wilkens Knudsen
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark
| | - Tanja Bak Østergaard
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark
| | - Thordis Thomsen
- Research Unit, Department of Anesthesiology, Herlev Gentofte University Hospital, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Clinical Institute, Aalborg University Hospital, Denmark
| | - Henrik Højgaard Rasmussen
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Centre for Nutrition and Bowel Disease & Danish Nutrition Science Centre, Aalborg University Hospital, Clinical Institute, Aalborg University, Denmark
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Herlev Gentofte Hospital, University of Copenhagen, Denmark; University College Copenhagen, Faculty of Health, Institute of Nursing and Nutrition, Copenhagen, Denmark
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Andersen AL, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J. Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study. Nutrients 2021; 13:nu13082757. [PMID: 34444917 PMCID: PMC8398199 DOI: 10.3390/nu13082757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59-98%) and follow-up (30-88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18-0.44) to 0.57 (95%CI 0.42-0.72)). Prevalence of risk factors ranged from 17-68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally.
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Affiliation(s)
- Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Correspondence: ; Tel.: +45-24-61-61-08
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
| | - Line J. H. Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Psychology & Neuroscience, Duke University, 2020 W Main St., Suite 201, Durham, NC 27707, USA
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
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Hansen T, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J, Andersen AL. Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data. Geriatrics (Basel) 2021; 6:geriatrics6020046. [PMID: 33926079 PMCID: PMC8167602 DOI: 10.3390/geriatrics6020046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.
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Affiliation(s)
- Tina Hansen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Correspondence: ; Tel.: +45-29243586
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Psychology and Neuroscience, Duke University, 2020 W Main St, Durham, NC 27705, USA
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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Affiliation(s)
- Jonas Anias Svendsen
- Dietetic and Nutritional Research Unit Herlev‐Gentofte University Hospital Herlev Denmark
| | - Signe Loftager Okkels
- Dietetic and Nutritional Research Unit Herlev‐Gentofte University Hospital Herlev Denmark
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit Herlev‐Gentofte University Hospital Herlev Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit Herlev‐Gentofte University Hospital Herlev Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit Herlev‐Gentofte University Hospital Herlev Denmark
- University College Copenhagen, Faculty of Health Institute of Nursing and Nutrition Copenhagen Denmark
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Okkels SL, Dybdal DR, Pedersen RJ, Klausen TW, Olsen A, Beck AM, Bügel S. A culinary twist of a two-course meals-on-wheels menu in a cluster-randomized controlled trial influencing health-related quality of life in nursing home residents. Clin Nutr ESPEN 2021; 43:137-147. [PMID: 34024505 DOI: 10.1016/j.clnesp.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Meals-on-wheels in nursing homes are sensory diminished because of the packaging and reheating of the food, which creates less appetite stimulation and an impaired meal experience for nursing home residents. This background is crucial since nursing home residents are a frail and often malnourished group that is physiologically affected by sensory, physical and mental alterations. The study aimed to increase health-related quality of life in nursing home residents receiving meals-on-wheels using an intervention menu with favourite meals that added a culinary twist and were sensory improved by chefs. METHODS A double-blinded cluster-randomized controlled trial with two arms, one group receives an intervention menu, and the other group receives a non-optimized menu. The intervention menu included popular meals-on-wheels (a main meal for dinner and a starter/dessert before or after dinner with culinary improvements). The participants received the same meals without culinary improvements in the control group. Health-related quality of life (EQ5D3L) was the primary outcome of the study. Secondary outcomes were mental and nutritional status and muscle strength. The measurements were assessed at a baseline and end visit (12 weeks after baseline visit). RESULTS Fifty-two nursing home residents were included in the study (There are 20 in the intervention group and 32 in the control group). Following the principle of intention-to-treat, a significant decreasing effect (p-value 0.026) was found between the groups on health-related quality of life. The treated group experienced the largest decrease from the baseline to the end visit. The intervention group had a significant decrease in the second item on Satisfaction With Food-related Life (SWFL2) (I am very pleased with my food). No changes were found either within or between the groups, on the rest of the measured parameters. CONCLUSIONS Nursing home residents are a target group experiencing natural aggravation, why the health-related quality of life might be difficult to improve using a culinary meal intervention. The decreasing effect of Satisfaction With Food-related Life found in the intervention group could be related to these older adults being too unfamiliar with the culinary twist added to the intervention menu. The study was registered on ClinTrials.gov (Identifier NCT03133364).
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Affiliation(s)
- Signe Loftager Okkels
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
| | - Ditte Rokkjær Dybdal
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark.
| | - Rie Johanne Pedersen
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark.
| | | | - Annemarie Olsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark; University College Copenhagen, Institute of Nutrition and Nursing, Faculty of Health, Copenhagen, Denmark.
| | - Susanne Bügel
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
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Beck AM, Nielsen SB, Bjørnsbo KS. Grandchildren's food workshop: Impact of an intergenerational cooking program on dietary habits, food courage, cooking skills and two-way interaction in Danish children and their grandparents. Nutr Health 2021; 27:413-421. [PMID: 33631082 DOI: 10.1177/0260106021991637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Good nutrition is a key aspect of health. Cooking activities can improve dietary habits, cooking skills and food courage in terms of courage to cook and taste new foods, in individuals of all ages. However, targeting both grandchildren and grandparents at the same time through intergenerational cooking activities, is new. AIM This paper aims to present the impact of intergenerational cooking activities on dietary habits, food courage, cooking skills and two-way interaction between young and old participants in The Grandchildren's Food Workshop. METHODS In this observational pilot study, the Danish Heart Foundation's experimental cooking program for grandchildren and grandparents was developed and tested. The influence of the food workshop on the participants' dietary habits, food courage, cooking skills and two-way interaction was assessed by a before and after questionnaire. McNemar's and chi-squared tests were used to evaluate the effects. RESULTS A total of 180 grandchildren (10 to 12 years) and 183 grandparents participated in The Grandchildren's Food Workshop. A total of 82 (46%) grandchildren (71% of which were girls) and 125 (68%) grandparents (83% of which were women) responded to the baseline and follow-up questionnaires. The impact on dietary habits and food courage was limited, while there was an impact on cooking skills in the grandchildren. The already good two-way interaction was unaltered. CONCLUSIONS The findings indicate an impact on cooking skills among grandchildren participating in The Grandchildren's Food Workshop, while the impact on dietary habits, food courage and two-way interaction between age groups was limited. Further research, including more detailed dietary data, should explore the significance of an intergenerational approach.
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Affiliation(s)
- Anne Marie Beck
- 87011University College Copenhagen, Institute of Nursing and Nutrition, Denmark.,Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Denmark
| | | | - Kirsten S Bjørnsbo
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Denmark
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Beck AM, Knudsen AW, Østergaard TB, Rasmussen HH, Munk T. Poor performance in nutrition risk screening may have serious consequences for hospitalized patients. Clin Nutr ESPEN 2021; 41:365-370. [PMID: 33487291 DOI: 10.1016/j.clnesp.2020.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Finding patients at nutrition risk and securing sufficient nutritional intake, is vital to decrease risk of adverse outcomes and all-cause mortality. The aims of this study were therefore to investigate the prevalence of patients being screened for nutrition risk, to determine nutritional coverage in at-risk patients and assess the prevalence of readmissions and mortality within 30 days. METHODS A one-day cross-sectional study was performed at Herlev Hospital, Denmark in June 2019. Patients >18 y and hospitalized for ≥4 days were enrolled. Exclusion criteria were admission to the intensive, palliative, acute medical or maternal ward. If a patient was not screened by the ward a clinical dietitian screened the patient. Patients found to be at nutrition-risk underwent a 24-h dietary recall to assess energy and protein intake. Data on length of stay, readmissions, and mortality within 30 days were collected from the hospital patient register. RESULTS In total 197 (F:52%) patients were included. Median (IQR) age 74y (65-81). At the audit day n = 76 (39%) had a primary screening, and n = 42 (21%) were screened within 24 h. A NRS-2002-score ≥ 3 was found in 111 patients (63%). At-risk patients were more likely to be readmitted within 30 days (45% vs. 27%, p = 0.024) and had a higher mortality within 30 days after discharge (23% vs. 10%., p = 0.0285). In patients at nutrition risk 23% covered ≥75% of their energy- and protein requirement the last 24 h. More patients covered their energy- and protein-need if they were supplemented with enteral and/or parenteral nutrition fully or partly (63% vs. 15%, p < 0.001 or had been in contact with a clinical dietitian during the admission (33% vs. 15%, p = 0.0337. There were no differences in prevalence of readmissions and mortality between those patients at nutrition risk, who covered their energy and protein need and those who did not. CONCLUSIONS The results demonstrate that the current nutritional care process is inadequate and may have serious consequences for hospitalized patients. Further effort is needed on the awareness of screening patients and how to fulfil their requirements during hospitalization. An abstract with part of the results has been accepted as a poster to ESPEN 2020.
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Affiliation(s)
- Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark.
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Tanja Bak Østergaard
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Henrik Højgaard Rasmussen
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark; Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, Herlev Gentofte Hospital, Herlev, Denmark
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Beck AM, Husted MM, Weekes CE, Baldwin C. Interventions to Support Older People's Involvement in Activities Related to Meals. A Systematic Review. J Nutr Gerontol Geriatr 2020; 39:155-191. [PMID: 33079642 DOI: 10.1080/21551197.2020.1834484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this systematic review is to assess whether old people should be actively involved in activities related to meals to support quality of life, nutritional status and functional abilities related to meals. Two electronic databases Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness were searched, supported by PubMed citation, snowball searches. Eleven primary studies were included. The quality was low. No studies assessed the effect on health-related quality of life. Three types of interventions to support activities related to meals were identified: Meal-related activities to facilitate improved autonomy seemed to overall improve nutritional intake, physical and social function related to meals, plus mealtime coping. Interventions of encouragement and reinforcement by staff to facilitate independence in eating seemed to have beneficial effect on nutritional intake and physical function related to meals. Interventions using food preparation and cooking to support participation seemed to have beneficial effects on social function related to meals and mealtime coping. There is an urgent need for good quality, adequately powered studies in this area and among old people in all health care settings.
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Affiliation(s)
- Anne Marie Beck
- Faculty of Health, University College Copenhagen, Copenhagen, Denmark.,Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - C Elizabeth Weekes
- Department of Nutrition and Dietetics, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
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Kristensen MB, Wessel I, Ustrup KS, Dieperink KB, Zwisler AD, Beck AM. Nutrition screening and assessment tools for patients with cancer and survivors of cancer: a systematic review protocol. BMJ Open 2020; 10:e037844. [PMID: 33004394 PMCID: PMC7534678 DOI: 10.1136/bmjopen-2020-037844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Nutritional challenges are common consequences of cancer, and they do not only occur in the hospital setting. They are also frequent after completion of treatment, and nutritional interventions in community-based post-treatment rehabilitation services are important. The first step towards initiating any nutritional intervention is to identify the individual in need hereof, but evidence is limited on the applicability of different nutrition screening and assessment tools in the post-treatment rehabilitation services. The aim is to systematically review and identify nutrition screening and assessment tools appropriate for use in patients with cancer and survivors of cancer in hospital or community-based healthcare settings. METHODS AND ANALYSIS In this systematic review, the electronic databases PubMed, CINAHL Complete and Embase were searched systematically using comprehensive search strategies. Primary searches were carried out in August 2018 with updated searches performed in November 2019. Clinicaltrials.gov and PROSPERO International Prospective Register of Systematic Reviews will be searched for additional relevant studies. Studies will be included if they validate a nutrition screening or assessment tool in adult patients with cancer or survivors of cancer. No restriction on publication date will be applied, and full-text articles in English, Danish, Norwegian and Swedish are eligible for inclusion. Two reviewers will independently conduct screening of search results, study selection, data extraction and quality assessment. Data will be synthesised narratively. ETHICS AND DISSEMINATION No ethical approval is required. Results will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and published in an international peer-reviewed journal. Furthermore, results will be presented in relevant research and clinical fora to facilitate transfer of results to clinical practice in benefit of patients. PROSPERO REGISTRATION NUMBER CRD42018096678.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Kim Skov Ustrup
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Karin B Dieperink
- Research Unit of Oncology, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Herlev, Denmark
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Kristensen MB, Wessel I, Beck AM, Dieperink KB, Mikkelsen TB, Møller JJK, Zwisler AD. Effects of a Multidisciplinary Residential Nutritional Rehabilitation Program in Head and Neck Cancer Survivors-Results from the NUTRI-HAB Randomized Controlled Trial. Nutrients 2020; 12:nu12072117. [PMID: 32708864 PMCID: PMC7400860 DOI: 10.3390/nu12072117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer survivors frequently experience nutritional challenges, and proper rehabilitation should be offered. The trial objective was to test the effect of a multidisciplinary residential nutritional rehabilitation programme addressing physical, psychological, and social aspects of eating problems after treatment. In a randomized controlled trial, 71 head and neck cancer survivors recruited through a nationwide survey were randomized to the program or a wait-list control group. Inclusion was based on self-reported interest in participation. The primary outcome was change in body weight. Secondary outcomes included physical function, quality of life, and symptoms of anxiety and depression. Differences between groups at the 3-month follow-up were tested. No significant differences were seen in body weight change, but there were overall trends towards greater improvements in physical function (hand grip strength: p = 0.042; maximal mouth opening: p = 0.072) and quality of life ("Role functioning": p = 0.041; "Speech problems": p = 0.040; "Pain": p = 0.048) in the intervention group. To conclude, a multidisciplinary residential nutritional rehabilitation program had no effect on body weight in head and neck cancer survivors with self-reported interest in participation, but it may have effect on physical function and quality of life. Further research on relevant outcomes, inclusion criteria, and the program's effect in different subgroups is needed.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
- Correspondence: ; Tel.: +45-2429-6329
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark;
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 50, 4. 2730 Herlev, Denmark
| | - Karin B. Dieperink
- Research Unit of Oncology, Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark;
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000 Odense C, Denmark
| | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
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Gade J, Quick AA, Beck AM, Rønholt F, Vinther A. SARC-F in hospitalized, geriatric medical patients - Feasibility, prevalence of risk of sarcopenia, and characteristics of the risk group, including one-year follow-up. Clin Nutr ESPEN 2020; 37:80-86. [PMID: 32359760 DOI: 10.1016/j.clnesp.2020.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES SARC-F is an interview-based screening-tool recommended to rapidly screen for risk of sarcopenia - the loss of muscle mass and strength. Not previously investigated, this observational study aimed to assess the feasibility of the SARC-F screening tool in Danish geriatric medical patients, estimate the prevalence of risk, and investigate associations to predefined variables. METHODS This was an observational cohort study with a one-year follow-up. All non-isolated patients ≥65 years, understanding Danish and admitted to a Danish geriatric medical ward in the capital region of Denmark, were recruited. If readmitted during the study period, they were not included again. The following data were collected upon recruitment; demographics, nutritional risk screening (NRS-2002), BMI, calf-circumference, Barthel-index, health-related Quality of life (QoL), hand-grip strength (HGS), and length of hospital admission. Additionally, the one-year follow-up included mortality, admission(s) to hospital, and visits to the emergency-room. RESULTS From September 2017 to February 2018, 461 patients were admitted, 377 eligible, and 301 included. Study feasibility was 80%, and estimated feasibility if implemented in daily clinical practice was 85%, as some patients had to be excluded from screening due to cognitive impairment. The prevalence of the risk of sarcopenia upon admission for participants were 64.5%. Being at risk were characterized by significantly lower HGS, Barthel-index, and QoL, as well as longer admissions (men only), and one-year mortality (female only) (P ≤ 0.05). CONCLUSION Use of SARC-F is feasible in a geriatric setting, but only in older adults without severe cognitive problems. Risk of sarcopenia among geriatric patients ≥65 years is high, and the risk group is characterized by lower strength, functional- and QoL measurements, longer hospitalization (men only), and increased mortality (women only).
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Affiliation(s)
- Josephine Gade
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte University Hospital, Denmark; Department of Nutrition, Exercise and Sports, Copenhagen University, Denmark.
| | | | - Anne Marie Beck
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte University Hospital, Denmark; University College Copenhagen, Denmark
| | - Finn Rønholt
- Medical Department, Herlev and Gentofte University Hospital, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte University Hospital, Denmark; QD-Research Unit, Herlev and Gentofte University Hospital, Denmark
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Munk T, Svendsen JA, Knudsen AW, Østergaard TB, Beck AM. Effect of nutritional interventions on discharged older patients: study protocol for a randomized controlled trial. Trials 2020; 21:365. [PMID: 32345358 PMCID: PMC7189460 DOI: 10.1186/s13063-020-04301-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/01/2020] [Indexed: 01/04/2023] Open
Abstract
Background During hospitalization, many older patients are at nutritional risk or malnourished, and their nutritional condition is often further impaired during hospitalization. After discharge, a “nutrition gap” often occurs in which the patient does not receive enough nutrition to ensure an optimal recovery. Methods The study is a randomized controlled study ongoing over 112 days. At discharge, the intervention group receives guidance from a clinical dietitian, and an individualized nutrition plan is made. The dietitian will perform telephone follow-up after 4 and 30 days. It will also be possible for the participant, the participant’s relatives, or the participant’s municipality to contact the dietitian if nutritional questions arise. At the time of discharge, the intervention group will receive a package containing foods and drinks that will cover their nutritional needs on the first day after discharge. They will also receive a goodie bag containing samples of protein-rich, milk-based drinks. Data are collected on quality of life, appetite, physical function, dietary intake, weight, height, energy and protein needs, and experience of discharge and cooperation with the municipality. Information about nutrition status will be sent to the municipality so that the municipality can take over nutritional treatment. The control group receives a standard treatment. Discussion This study is the first to combine previously successful single nutritional interventions into a multimodal intervention whose aim is to obtain an effect on patient-related outcomes. We hope that the results will prove beneficial and help to ensure the cross-sector quality of nutritional support to older patients. Trial registration ClinicalTrials.gov, NCT03488329. April 5, 2018.
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Affiliation(s)
- Tina Munk
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Jonas Anias Svendsen
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Tanja Bak Østergaard
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, Denmark. .,University College Copenhagen, Faculty of Health, Institute of Nursing and Nutrition, Copenhagen, Denmark.
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Kristensen MB, Wessel I, Beck AM, Dieperink KB, Mikkelsen TB, Møller JJK, Zwisler AD. Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial). Nutr J 2020; 19:21. [PMID: 32183835 PMCID: PMC7079410 DOI: 10.1186/s12937-020-00539-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background Eating problems frequently affect quality of life and physical, psychological and social function in patients treated for head and neck cancer (HNC). Residential rehabilitation programmes may ameliorate these adverse effects but are not indicated for all individuals. Systematic assessment of rehabilitation needs may optimise the use of resources while ensuring referral to rehabilitation for those in need. Yet, evidence lacks on which nutrition screening and assessment tools to use. The trial objectives are: 1) To test the effect of a multidisciplinary residential nutritional rehabilitation programme compared to standard care on the primary outcome body weight and secondary outcomes health-related quality of life, physical function and symptoms of anxiety and depression in patients curatively treated for HNC and 2) To test for correlations between participants’ development in outcome scores during their participation in the programme and their baseline scores in Nutritional Risk Screening 2002 (NRS 2002), the Scored Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and M. D. Anderson Dysphagia Inventory (MDADI) and to assess sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores. Methods In a randomised controlled trial, 72 patients treated for HNC recruited through a nationwide survey will be randomised to a multidisciplinary residential nutritional rehabilitation programme or to a wait-list control group. Data are collected at baseline, three and six months. Primary outcome is change in body weight, and secondary outcomes include changes in quality of life, physical function and symptoms of anxiety and depression. Potential correlations between intervention effect and baseline scores in NRS 2002, PG-SGA-SF and MDADI will be tested, and sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores will be assessed. Discussion This is the first randomised controlled trial to test the effect of a multidisciplinary residential nutritional rehabilitation programme in patients treated for HNC. Recruitment through a nationwide survey gives a unique possibility to describe the trial population and to identify potential selection bias. As the trial will explore the potential of different nutrition screening and assessment tools in the assessment of rehabilitation needs in patients treated for HNC, the trial will create knowledge about how selection and prioritisation of nutritional rehabilitation aimed at patients treated for HNC should be offered. The results may contribute to a better organisation and use of existing resources in benefit of patients treated for HNC. Trial registration The trial is registered by The Danish Data Protection Agency (registration 2012-58-0018, approval number 18/14847) and the Regional Committees on Health Research Ethics for Southern Denmark (journal number 20182000–165). ClinicalTrials.gov Identifier: NCT03909256. Registered April 9, 2019.
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Affiliation(s)
- Marianne Boll Kristensen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark. .,Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, J.B. Winsløws Vej 9A, DK-5000, Odense C, Denmark.
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark.,Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 50, 4, DK- 2730, Herlev, Denmark
| | - Karin B Dieperink
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark.,Research Unit of Oncology, Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000, Odense C, Denmark
| | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Odense University Hospital, Vestergade 17, Nyborg, DK-5800, Denmark
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Gade J, Beck AM, Rønholt F, Andersen HE, Munk T, Vinther A. Validation of the Danish SARC-F in Hospitalized, Geriatric Medical Patients. J Nutr Health Aging 2020; 24:1120-1127. [PMID: 33244571 DOI: 10.1007/s12603-020-1453-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Validation of the Danish version of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) for hospitalized geriatric medical patients, compared against the original EWGSOP (European Working Group on Sarcopenia in Older People) and revised EWGSOP2 definition for sarcopenia. Additionally, investigation of the ability of SARC-F to individually identify low strength/function and muscle mass. DESIGN Cross-sectional analysis of data from an RCT. SETTING Hospital, Medical Department. PARTICIPANTS 122 geriatric medical patients (65.6% women) ≥ 70 years of age with mixed medical conditions. MEASUREMENTS SARC-F screening, diagnostic assessment of sarcopenia (hand-grip strength, muscle mass measured by dual-frequency bio-impedance analysis, and 4-m usual gait speed). RESULTS The prevalence of risk of sarcopenia (SARC-F ≥ 4) was 48.3%, while it was diagnosed in 65.8% and 21.7%, with EWGSOP and EWGSOP2, respectively. The sensitivity, specificity, positive predictive value, negative predictive value according to EWGSOP were 50.0 %, 53.7 %, 67.2% and 36.1%, while they were 53.8 %, 53.2 %, 24.1% and 80.6%, according to EWGSOP2 (all participants). The ability of SARC-F to predict reduced strength, function, and muscle mass was modest. There was a significant negative linear, yet weak, relationship between total SARC-F score and hand-grip strength (R2=0.033) and 4-m gait speed (R2=0.111), but not muscle mass (R2=0.004). CONCLUSION SARC-F does not seem to be a suitable screening tool for identifying and excluding non-sarcopenic geriatric patients. Furthermore, the SARC-F score was more strongly correlated with reduced muscle strength and physical function than with low muscle mass.
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Affiliation(s)
- J Gade
- Anders Vinther, Dept. Physiotherapy and Occupational therapy, Borgmester Ib Juuls Vej 29, DK-2730 Herlev, Denmark, Phone: +45-26808710 and E-mail:
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Justesen L, Walter U, Kristensen NH, Beck AM. The Breakfast Club – co-creational meal practices as rehabilitation strategies in nursing homes. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A growing aging population demands new welfare public health activities in nursing homes. Involving residents in meal activity through a co-creational approach as part of a rehabilitation strategy has been suggested as a solution, but knowledge is limited. This project explore how co-creational meal practices in a breakfast club might improve residents’ food related functionality and quality of life.
Methods
The project is designed as a three-year complex intervention study in a Danish nursing home. A breakfast club is held with 4-5 residents (16 all together) and 2-6 staff members on a weekly basis during a period of 10 month. Residents are on shift hosting the club and all members are preparing the meal together. The degree of food related functionality is assessed after each club and is analyzed through paired t-test on mean values. Semi-structured interviews in combination with Research Driven Photo-Elicitation is conducted with 16 residents and 8-10 staff members before, during and after holding the clubs in order to evaluate quality of life and potentials for implementing meal practices to everyday practices. A hermeneutic analysis strategy is applied.
Results
Preliminary results from 12 breakfast clubs finds an increase in residents food related functionality. Data will be presented in November 2019. All residents express impact on quality of life independent of physical or mental state. Improved functionality is not the main value for participation in the breakfast club. Staff became aware of utilizing residents food related functionality.
Conclusions
The study will contribute with new knowledge about whether co-creational meal activities could have a positive effect on functional abilities and improve health-related quality of life in residents in nursing homes. A meal practice based on co-creation has potential to become implemented as a public health activity in nursing homes and increase residents’ quality of life and food related functionality.
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Affiliation(s)
- L Justesen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - U Walter
- School of Hospitality, Culinary Arts and Meal Science, Orebro University, Örebro, Sweden
| | - N H Kristensen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - A M Beck
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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Volkert D, Beck AM, Cederholm T, Cereda E, Cruz-Jentoft A, Goisser S, de Groot L, Großhauser F, Kiesswetter E, Norman K, Pourhassan M, Reinders I, Roberts HC, Rolland Y, Schneider SM, Sieber CC, Thiem U, Visser M, Wijnhoven HAH, Wirth R. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J Clin Med 2019; 8:E974. [PMID: 31277488 PMCID: PMC6678789 DOI: 10.3390/jcm8070974] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany.
| | - Anne Marie Beck
- Department Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Herlev and Gentofte University Hospital, 2703 Herlev, Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 701 05 Uppsala, Sweden
- Theme Ageing, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Sabine Goisser
- Heidelberg University Centre for Geriatric Medicine and Network Aging Research (NAR), University of Heidelberg, 69126 Heidelberg, Germany
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - Franz Großhauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Kristina Norman
- German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany
- Research Group on Geriatrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Maryam Pourhassan
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Helen C Roberts
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06200 Nice, France
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Ulrich Thiem
- Centre of Geriatrics and Gerontology, Albertinen-Haus, Hamburg, and Chair of Geriatrics and Gerontology, University Medical Centre Eppendorf, 20246 Hamburg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
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Ingadottir AR, Bjorgvinsdottir EB, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Birgisdottir BE, Gislason T, Gunnarsdottir I. Effect of two different nutritional supplements on postprandial glucose response and energy- and protein intake in hospitalised patients with COPD: A randomised cross-over study. Clin Nutr 2019; 39:1085-1091. [PMID: 31064666 DOI: 10.1016/j.clnu.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/08/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Oral nutrition support is frequently used in treatment of malnutrition in patients with chronic obstructive pulmonary disease (COPD). Considering the use of corticoidsteroids in patients with COPD, little is known about the effect on postprandial glucose response and if they might interfere with glucose control. Our aims were to compare the effect of a liquid oral nutritional supplement (ONS) and semi solid inbetween meal snack (snack) on postprandial glucose and energy- and protein intake, and to compare the effect of timing of each intervention on postprandial glucose and energy- and protein intake. METHODS Patients with COPD (n = 17) admitted to the Department of Pulmonary Medicine, Iceland and defined as at low or medium nutritional risk (score 0-3) were recruited. In a randomised cross-over design, subjects consumed ONS or snack either in a fasting state (study 1) or following breakfast (study 2) and postprandial glucose responses were assessed at regular intervals for two hours (t = 15, t = 30, t = 45, t = 60, t = 90, t = 120 min). Energy- and protein intake was estimated using a validated plate diagram sheet. Wilcoxon Signed-Rank test was used to compare the two interventions. RESULTS In study 2, following breakfast, postprandial glucose was significantly higher after consuming ONS than the snack after 60 min (9.7 ± 2.4 mmol/L vs. 8.2 ± 3.2 mmol/L, p = 0.013 and 120 min 9.2 ± 3.2 mmol/L vs. 7.9 ± 2.4 mmol/L, p = 0.021, respectively). No difference was found in postprandial glucose concentrations between ONS and the snack when consumed after overnight fasting (study 1). No difference in energy or protein intake from hospital food was seen between supplement types neither in study 1 or 2. CONCLUSION Lower postprandial glucose concentrations were associated with the snack compared to ONS when taken after a meal compared to either type directly after overnight fasting. The clinical relevance of higher postprandial blood glucose after consuming a liquid ONS after breakfast compared with a semi solid snack needs to be studied further.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland.
| | - Eva Bjorg Bjorgvinsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Anne Marie Beck
- Faculty of Health and Copenhagen University College, Copenhagen N, Denmark; Research Unit for Nutrition, Herlev and Gentofte Hospital, DK-2820, Gentofte, Denmark
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | - C Elizabeth Weekes
- Department of Nutrition & Dietetics, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; The Icelandic Gerontological Research Institute, Landspitali University Hospital & University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Bryndis Eva Birgisdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Husted MM, Beck AM, Ulrikkeholm LK. Involving community-dwelling older adults in activities related to meals as part of a rehabilitation program: a single-blinded cluster-controlled study. Clin Rehabil 2019; 33:1185-1196. [PMID: 30955358 DOI: 10.1177/0269215519837742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To understand if older adults have improvement in health-related quality of life, muscle strength, and nutritional status when involved in own meals as part of a rehabilitation program. DESIGN The study was single-blinded cluster-controlled consisting of two groups: intervention and control. SUBJECTS Intervention consisted of 62 participants and control of 61 recruited from, respectively, three and two aged care areas. Age was, respectively, 82.9 (±7.5) vs. 83.5 (±7.7) years. The proportion of female participants was, respectively, 42 (68 %) vs. 41 (67 %). INTERVENTIONS The healthcare staff had education related to food, meals, and nutrition, and older adults participated in an eight weeks rehabilitation program. Focus was on shopping, cooking, social context, and ability to eat and included collaborative goal setting with a case manager. Controls received usual community aged care. MAIN MEASURES The main outcomes were health-related quality of life measured by EuroQol-5D-3L (EQ-5D-3L), muscle strength (30 seconds chair-stand), and body weight. Data were analyzed with non-parametric and parametric statistics as appropriate. RESULTS There was a significant (P = 0.01) improvement of health-related quality of life (converted EQ-5D-3L score) in intervention (0.570 vs. 0.668) compared to the control (0.666 vs. 0.580) from baseline to follow-up. There was no difference in muscle strength between intervention and control: 15 (31 %) vs. 16 (32 %) improved 30 seconds chair-stand. There was no difference in weight change between the groups (-1 vs. -2.4 kg) (P = 0.261). CONCLUSIONS Improvement in health-related quality of life was seen when older adults were involved in activities related to meals.
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Affiliation(s)
| | - Anne Marie Beck
- 2 Research Unit for Nutrition, Herlev and Gentofte University Hospital, Gentofte, Denmark.,3 Institute for Nursing and Nutrition, University College, Copenhagen N, Denmark
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Ingadottir AR, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Gislason T, Gunnarsdottir I. Oral nutrition supplements and between-meal snacks for nutrition therapy in patients with COPD identified as at nutritional risk: a randomised feasibility trial. BMJ Open Respir Res 2019; 6:e000349. [PMID: 30687503 PMCID: PMC6326325 DOI: 10.1136/bmjresp-2018-000349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 11/27/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction Intervention studies have mainly used oral nutritional supplements (ONS) for the management of patients with chronic obstructive pulmonary disease (COPD) identified as at nutritional risk. In this 12-month randomised feasibility trial, we assessed the (1) feasibility of the recruitment, retention and provision of two interventions: ONS and between-meal snacks (snacks) and (2) the potential impact of the provision of snacks and ONS on body weight and quality of life in patients with COPD. Methods Hospitalised patients with COPD, at nutritional risk, were randomised to ONS (n=19) or snacks (n=15) providing 600 kcal and 22 g protein a day in addition to regular daily diet. The intervention started in hospital and was continued for 12 months after discharge from the hospital. Results Study recruitment rate was n=34 (45%) and retention rate at 12 months was similar for both groups: n=13 (68%) in the ONS group and n=10 (67%) in the Snacks group. Both groups gained weight from baseline to 12 months (2.3±4.6 kg (p=0.060) in the ONS group and 4.4±6.4 kg (p=0.030) in the Snacks group). The St George’s Respiratory Questionnaire total score improved from baseline to 12 months in both groups (score 3.9±11.0 (p=0.176) in the ONS group and score 8.9±14.1 (p=0.041) in the Snacks group). Discussion In patients with COPD who are at nutritional risk snacks are at least as feasible and effective as ONS, however, adequately powered trials that take account of the difficulties in recruiting this patient group are required to confirm this effect.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
| | - Anne Marie Beck
- Faculty of Health, Copenhagen University College, Copenhagen, Denmark.,Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,The Icelandic Gerontological Research Institute, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Pohju A, Beck AM, Belqaid K, Rasmussen HH. Changes in nutritional routines at discharge in Scandinavia during a 10-year period: A follow-up survey. Clin Nutr ESPEN 2018; 28:148-152. [PMID: 30390873 DOI: 10.1016/j.clnesp.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Time to treat malnutrition during hospital admission is limited due to short hospital stays. Therefore, nutritional care often needs to be continued after discharge from hospital. However, health care professionals' attitudes and discharge routines may not always support continuity of good nutritional practice. The aim of this study was to investigate changes in nutritional discharge routines and related attitudes in Scandinavia (Denmark, Norway, Sweden) over a 10-year period. METHODS A survey among doctors and nurses in Scandinavian hospitals was conducted in 2012/2014 and results were compared with an identical survey from 2004. Differences between countries were also studied. RESULTS Response rate in 2012/2014 survey was 25% with 2733 questionnaires returned. There was a statistically significant difference between the countries regarding proportions of respondents reporting routinely measuring patients' weight at discharge (Denmark 14% vs. Norway 4% vs. Sweden 22%, p < 0.0005). However, these proportions had increased since the 2004 survey in all countries. In Denmark and Sweden, evaluation of nutritional status at discharge was more often stated to be a standard procedure in 2012/2014 compared to 2004 (10% vs. 18%, p < 0.0005; 8% vs. 15%, p < 0.0005, respectively). A statistically significant increase was found in the proportion of Danish and Swedish participants responding that the nutritional regimens initiated during hospital stay are always included in discharge summaries (35% vs 41%, p < 0.004; 51% vs. 63%, p < 0.0005, respectively). CONCLUSIONS The results suggest a positive development in the nutritional discharge routines. Nevertheless, there appears to be room for improvement. Differences in the nutritional practices still exist between the Scandinavian countries.
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Affiliation(s)
- Anne Pohju
- Clinical Nutrition Unit, Helsinki University Hospital, Helsinki, Finland.
| | - Anne Marie Beck
- Department of Nutrition and Health, Metropolitan University College, and Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Kerstin Belqaid
- Function Area Clinical Nutrition, Karolinska University Hospital, and Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Aalborg University Hospital, Clinical Institute, Aalborg University, Aalborg, Denmark
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Husted MM, Beck AM, Ulrikkeholm LK. A cluster randomised feasibility pilot trial evaluating involving community-dwelling older adults in activities in relation to meals in a rehabilitation program; recruitment, data collection and protocol. Pilot Feasibility Stud 2018; 4:134. [PMID: 30123525 PMCID: PMC6091176 DOI: 10.1186/s40814-018-0323-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/20/2018] [Indexed: 11/18/2022] Open
Abstract
Background Community-dwelling older adults receiving support at home such as meals-on-wheels may lose the ability to preserve social, cognitive, and functional abilities, when becoming accustomed to and dependent of community aged care. When still able to cook older adults often hold some control over the foods that are prepared and which they eat, and which helps to foster identity. The purpose of this study is to assess feasibility of outcome measurements and sample size when conducting a pilot cluster randomized trial to evaluate community-dwelling older adults being involved in activities in relation to meals in a rehabilitation program. Methods This cluster randomized controlled study will consist of two clusters of a total of 5 community aged care areas; the intervention cluster, which hold 3 community aged care areas and the control cluster which hold 2 areas. The 130 community-dwelling older adults, receiving meals-on-wheels, will randomly be allocated to either the intervention cluster consisting of 8 weeks of participation in a rehabilitation program led by a Case Manager or the control cluster receiving usual community aged care. The primary outcome will be assessment of data collection (ratio between completed- and non-completed data) and assessment of sample size. The secondary clinical outcomes will be health-related quality of life (EQ-5D-3 L), muscle strength (chair stand), nutritional status (weight/BMI), loneliness (UCLA scale), mental well-being (Warwich-Edinburgh scale), self-efficacy (General Self-Efficacy scale), satisfaction with food-related life (SWFL scale) and refrigerator content. Discussion This study evaluates community-dwelling older adults receiving support at home, using involvement in activities related to meals with a rehabilitation approach, and this is a new area of research and will therefore be contributing in developing and refining consistent practices of rehabilitation programs. Trial registration ClinicalTrials.gov (registration no: NCT03289598). The protocol has been sent to the Danish Ethical Board which has concluded that approval is not needed and that the study can be carried on as described. Approval by The Danish Data Protection Agency has been giving through general approval for use of data in The City of Odense and will follow rules for obtaining the data accordingly.
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Affiliation(s)
- M M Husted
- The Danish Dietetic Association, Skt. Annæ Plads 6, K 1250 Copenhagen, Denmark
| | - A M Beck
- 2Copenhagen University College, Sigurdsgade 26, N 2200 Copenhagen, Denmark
| | - L K Ulrikkeholm
- The Department of the Elderly and Disabled, Ørbækvej 100, SØ 5220 Odense, Denmark
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Krogh LH, Beck AM, Kristensen NH, Hansen MW. Handling the inpatient's hospital 'Career' - Are nurses laying the groundwork for healthy meal and nutritional care transitions? Nurs Inq 2018; 26:e12262. [PMID: 30123979 DOI: 10.1111/nin.12262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
This qualitative study examined hospital nurses' methods in handling meal and nutrition care during inpatient time, with an underlying focus on undernourished older adult. Observations and interviews were used to document nurses' methods through the span of a transition (defined by an entry, passage, and exit). The study finds inconsistencies in care methods due to institutional processes restricting both mealtime care and nutritional logging of information throughout hospitalization. It is concluded that the consequences of these inconsistencies must be recognized and that new approaches to meals and nutritional care should be introduced in order to provide greater flexibility. Based on the assumption that mobilizing patient resources is pivotal for meal and nutritional care, it is argued that it may be important to mobilize patient resources during mealtime and in nutritional logging of information in order to increase the visibility of meal and nutritional care in patient transitions within the institution and across settings. Both nurses' methods and institutions developmental initiatives regarding meal and nutritional care need to accommodate the differences between what in this paper is defined as social-bodily care and text-based care. This could be met through care methods that take place with, more than for the patient.
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Affiliation(s)
- Line H Krogh
- Department of Planning, Aalborg University, Copenhagen, Denmark
| | | | | | - Mette W Hansen
- Department of Planning, Aalborg University, Copenhagen, Denmark
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Gade J, Pedersen RJ, Beck AM. Effect of Protein or Essential Amino Acid Supplementation During Prolonged Resistance Exercise Training in Older Adults on Body Composition, Muscle Strength, and Physical Performance Parameters: A Systematic Review. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718765760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: Loss of muscle mass and strength with aging, sarcopenia, burdens many older adults, making identification of strategies on how to counteract it very relevant—especially to health care providers working in rehabilitation. The aim of this systematic review was to determine the effect of protein or essential amino acid (EAA) supplementation during prolonged resistance exercise training (RT) in older adults. No known stimulants of muscle protein synthesis, or ingredients with an effect on muscle strength/physical function, were allowed with the supplementation, differentiating this systematic review from others. Data sources and methods: In January 2017, 4 electronic databases and reference lists were searched for randomized controlled trials investigating the effect of protein or EAA supplementation during RT in older adults (mean age >60 years) on outcomes of body composition, muscle strength, and physical performance. Study selection and data extraction were performed by 2 independent reviewers. Results Sixteen studies (1107 participants) fulfilled the eligibility criteria. Methodologic differences between the studies disallowed a meta-analysis. Of the 16 studies, 6 found significant effects on body composition (3 studies), muscle strength (3 studies), and physical performance (2 studies) measures. Conclusions The evidence is weak and inconsistent, as benefit of protein or EAA supplementation during RT in older adults is only shown in some studies. The findings indicate that frail/sarcopenic older adults might benefit more than healthy older adults. Further research is needed to allow an interpretation on the importance of study population and design. Trial registration: PROSPERO, Reg. no.: CRD42017063808. Registered April 14, 2017.
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Affiliation(s)
- Josephine Gade
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark
| | - Rie Johanne Pedersen
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark
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Okkels SL, Saxosen M, Bügel S, Olsen A, Klausen TW, Beck AM. Acceptance of texture-modified in-between-meals among old adults with dysphagia. Clin Nutr ESPEN 2018; 25:126-132. [PMID: 29779807 DOI: 10.1016/j.clnesp.2018.03.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS Old adults suffering from dysphagia have difficulties swallowing, chewing and/or eating, and are therefore at high risk of undernutrition. In-between-meals that are texture modified are of particular importance for people suffering from dysphagia. To meet their adequate daily amount of food intake they are recommended to eat 3-5 in-between-meals daily. The aim of the current pilot study was to identify the most liked in-between-meals for old adults based on flavour and describe the basic sensory properties of these in-between-meals. Following, the equality between flavour and appearance-based preferences was investigated. METHODS From three nursing homes 30 old adults aged 70 years or older suffering from dysphagia were recruited. They were assessing 20 texture modified in-between-meals based on their flavour and appearance on a 3 point hedonic scale. RESULTS When participants were asked to assign liking based on flavour, the most liked in-between-meals were frozen, cold and sweet (vanilla ice cream, strawberry parfait and panna cotta). These meals were among the in-between-meals richest in fat and energy. Liking based on flavour and appearance was equal in 18 out of 20 samples. Furthermore, nutritional and sensory characteristics of the preferred meals were described. CONCLUSION Flavour and sensory-based ranking of in-between-meals opens the possibility to design new in-between-meals to old adults with dysphagia, by choosing the most liked in-between-meals to offer the target group.
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Affiliation(s)
- S L Okkels
- Dietetic and Nutritional Research Unit, Gentofte University Hospital, Gentofte, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
| | - M Saxosen
- Dietetic and Nutritional Research Unit, Gentofte University Hospital, Gentofte, Denmark
| | - S Bügel
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark
| | - A Olsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark
| | - T W Klausen
- Department of Hematology, Herlev University Hospital, Herlev, Denmark
| | - A M Beck
- Dietetic and Nutritional Research Unit, Gentofte University Hospital, Gentofte, Denmark; Metropolitan University, Faculty of Health and Technology, Department of Nutrition and Midwifery, Copenhagen, Denmark
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Gade J, Beck AM, Bitz C, Christensen B, Klausen TW, Vinther A, Astrup A. Protein-enriched, milk-based supplement to counteract sarcopenia in acutely ill geriatric patients offered resistance exercise training during and after hospitalisation: study protocol for a randomised, double-blind, multicentre trial. BMJ Open 2018; 8:e019210. [PMID: 29391380 PMCID: PMC5829859 DOI: 10.1136/bmjopen-2017-019210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Age-related loss of muscle mass and strength, sarcopaenia, burdens many older adults. The process is accelerated with bed rest, protein intakes below requirements and the catabolic effect of certain illnesses. Thus, acutely ill, hospitalised older adults are particularly vulnerable. Protein supplementation can preserve muscle mass and/or strength and, combining this with resistance exercise training (RT), may have additional benefits. Therefore, this study investigates the effect of protein supplementation as an addition to offering RT among older adults while admitted to the geriatric ward and after discharge. This has not previously been investigated. METHODS AND ANALYSIS In a block-randomised, double-blind, multicentre intervention study, 165 older adults above 70 years, fulfilling the eligibility criteria, will be included consecutively from three medical departments (blocks of n=20, stratified by recruitment site). After inclusion, participants will be randomly allocated (1:1) to receive either ready-to-drink, protein-enriched, milk-based supplements (a total of 27.5 g whey protein/day) or isoenergetic placebo products (<1.5 g protein/day), twice daily as a supplement to their habitual diet. Both groups will be offered a standardised RT programme for lower extremity muscle strength (daily while hospitalised and 4×/week after discharge). The study period starts during their hospital stay and continues 12 weeks after discharge. The primary endpoint is lower extremity muscle strength and function (30 s chair-stand-test). Secondary endpoints include muscle mass, measures of physical function and measures related to cost-effectiveness. ETHICS AND DISSEMINATION Approval is given by the Research Ethic Committee of the Capital Region of Denmark (reference no. H-16018240) and the Danish Data Protection Agency (reference no. HGH-2016-050). There are no expected risks associated with participation, and each participant is expected to benefit from the RT. Results will be published in peer-reviewed international journals and presented at national and international congresses and symposiums. TRIAL REGISTRATION NUMBER NCT02717819 (9 March 2016).
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Affiliation(s)
- Josephine Gade
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Anne Marie Beck
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Christian Bitz
- Kitchen Unit, Bispebjerg and Frederiksberg Hospital, København, Denmark
| | | | | | - Anders Vinther
- Department of Rehabilitation, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Arne Astrup
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Hansen T, Kjaersgaard A, Beck AM, Poulsen I. Letter to the editor: Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study. J Nutr Health Aging 2018; 22:1018. [PMID: 30272108 DOI: 10.1007/s12603-018-1092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T Hansen
- T. Hansen, Division of Physical and Occupational Therapy, Faculty of Health and Technology, Copenhagen University College, Copenhagen, Denmark
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Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia - An updated clinical guideline. Clin Nutr 2017; 37:1980-1991. [PMID: 28939270 DOI: 10.1016/j.clnu.2017.09.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/24/2017] [Accepted: 09/02/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Oropharyngeal dysphagia (OD) has significant consequences for both the person with dysphagia and the society. An often-used treatment for OD is the recommendation of the texture of food and liquids. This recommendation seems to be based more on best practice than on evidence from a systematic review of existing scientific evidence. The aim of this paper was to report the result of an up-date of an original national guideline focussing on whether thickened liquids (review question 1) and modified foods (review question 2) are beneficial for adults above 17 years with OD in relation to three critical outcomes (aspiration, pneumonia and death) and seven important outcomes (dehydration, weight loss, mealtime performance, patient preferences, intervention adherence and quality of life). METHODS Three steps were used. First: An updated systematic literature search. Second: An assessment of the quality of the evidence for each review question by means of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Third: Development of clinical recommendations based on the evidence, assessment of the risk benefit ratio, and perceived patient preferences. RESULTS The body of evidence consisted of two RCTs for review question 1 both using nectar thickened liquids or honey-thickened liquids. No evidence was found for two important outcomes, mealtime performance and quality of life. With regard to risk of pneumonia, death, aspiration, dehydration, weight loss and intervention adherence no significant differences were found. The outcome addressing patient preferences, found a non-significant increased dissatisfaction with nectar thickened liquids (RR 1.11; 95% CI 0.95-1.30) and a significant increased dissatisfaction with honey thickened liquids compared to thin liquids/chin down (RR 1.18; 95% CI 1.01-1.37). No evidence was identified for review question 2. CONCLUSIONS Based on the quality of the evidence, assessment of the risk benefit ratio, and perceived patient preferences a weak recommendation against the use of texture modified liquids and good clinical practice pointing for the use of texture modified foods in patients with OD were made.
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Affiliation(s)
- Anne Marie Beck
- Division of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark; Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark.
| | - Annette Kjaersgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark
| | - Tina Hansen
- Division of Physical and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Ingrid Poulsen
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Denmark; Health, Arhus University, Denmark
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Ingadottir AR, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Gislason T, Gunnarsdottir I. Two components of the new ESPEN diagnostic criteria for malnutrition are independent predictors of lung function in hospitalized patients with chronic obstructive pulmonary disease (COPD). Clin Nutr 2017. [PMID: 28641831 DOI: 10.1016/j.clnu.2017.05.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Low fat free mass index (FFMI) is a component of the ESPEN diagnosis criteria of malnutrition, that only when accompanied with weight loss is considered to be a determinant of malnutrition. Our aims were to assess the prevalence of malnutrition in patients with chronic obstructive pulmonary disease (COPD) applying the ESPEN criteria, and to examine the ability of different components of the criteria to predict COPD severity, length of stay (LOS), hospital readmissions within 30 days and mortality. METHODS Subjects were COPD patients (n = 121) admitted to Landspitali University Hospital from March 2015 to March 2016. Patients were screened for nutritional risk using Icelandic screening tool (ISS) and NRS-2002. Body composition was measured by bioelectrical impedance analysis (BIA). Lung function was measured by spirometry. RESULTS The prevalence of malnutrition according to the ESPEN criteria was 21%. The association between nutritional assessment, applying different components of the ESPEN criteria, and COPD severity was highly significant, with the highest risk being associated with low FFMI OR (95% CI) 4.77 (2.03, 11.20; p < 0.001). There was a trend towards higher risk of hospitalization for >7 days in subjects with low FFMI (OR 2.46 95% CI 0.92, 6.59; p = 0.074) and increased risk of 6 and 9 months' mortality (OR 2.72 95% CI 0.88, 8.39, P = 0.082 and OR 2.72 95% CI 0.94, 7.87, P = 0.065, respectively) in subjects diagnosed as malnourished by the ESPEN criteria. CONCLUSION This study describes the prevalence of malnutrition in hospitalized COPD patients using the ESPEN criteria from 2015. Our findings suggest that FFMI could be used independently of weight loss for the diagnosis of malnutrition in COPD patients, although there remain some problems associated with its measurement in the clinical setting.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland.
| | - Anne Marie Beck
- Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen N, Denmark; Research Unit for Nutrition, Herlev and Gentofte Hospital, DK-2820 Gentofte, Denmark
| | - Christine Baldwin
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - C Elizabeth Weekes
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; The Icelandic Gerontological Research Center, Landspitali University Hospital & University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Beck AM, Hansen BS. [Focus on nutrition improves the effect of rehabilitation in geriatric patients]. Ugeskr Laeger 2017; 179:V10160708. [PMID: 28397676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As a consequence of the loss of physical function more than half of the geriatric patients are discharged with a physical rehabilitation plan. Only a few patients are, however, discharged with a nutritional rehabilitation plan. Data suggest that about 60% of the geriatric patients who are discharged with a physical rehabilitation plan never start the rehabilitation, often due to readmissions. Presumably, this figure could be lowered if a nutritional intervention was initiated. Hence, geriatric patients discharged with a physical rehabilitation plan should simultaneously be discharged with a nutritional rehabilitation plan.
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