1
|
Calmarza-Chueca F, Cristina-Sánchez-Gimeno A, Perez-Nogueras J, Caverni-Muñoz A, Sanz-Arque A, Arbones-Mainar JM, Sanz-Paris A. Institutionalized elderly are able to detect small viscosity variations in thickened water with gum-based thickeners: should texture classifications be reviewed? BMC Geriatr 2021; 21:647. [PMID: 34798812 PMCID: PMC8603478 DOI: 10.1186/s12877-021-02599-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of dysphagia is very high in institutionalized elderly. Knowledge of the rheological and sensory characteristics of the various thickeners in elderly is limited, although it has been seen that there are differences between the rheological behaviors of gum-based thickeners with different composition. Moreover, we have not found sensory studies of viscosity in institutionalized elderly. Our hypothesis was that viscosity ranges established by the scientific societies, such as the National Dysphagia Diet Task Force (NDD), seem to be very wide and individuals might be able to detect small differences within the same texture range. The objectives of our study were 1) comparing the rheological characteristics of two commercial gum-based thickeners with different composition, dissolved in water under standard conditions, and 2) perform a sensory analysis (with both adults and institutionalized elderly) to detect different viscosities within the same texture (nectar and honey). METHODS Two commercial thickeners based on gums (NC and RC) were studied analyzing their viscosity in water with different concentrations (shear rate: 50 s- 1; temperature: 22-25 °C). A sensory analysis involving 26 elderly and 29 adult controls was carried out to evaluate whether differences within nectar and honey textures among gum-based thickeners could be distinguished. RESULTS As the shear rate increases, viscosity decreases (non-Newtonian and pseudoplastic behavior). At the same concentration, each thickener produces a different viscosity (p < 0.05). Institutionalized elderly detected viscosity differences in nectar range of 49.9 (2.5) mPa·s (p < 0.05) and 102.2 (4.7) mPa·s (p < 0.0001). They also detected viscosity differences in honey texture range of 134.6 (9.7) mPa·s (p < 0.05) y 199.3 (9.2) mPa·s (p < 0.0001). Their caregivers also detected viscosity differences in both viscosity ranges (p < 0.0001) and with greater intensity than the elderly in honey texture (p: 0.016). CONCLUSIONS Our results suggest that the accepted viscosity ranges by NDD for the different textures might be too wide because institutionalized elderly and their caregivers are able to discern small differences in viscosity in nectar and honey textures. Gum-based thickeners with different composition showed differences in viscosity capacity, so they are not interchangeable.
Collapse
Affiliation(s)
| | - Ana Cristina-Sánchez-Gimeno
- Food Technology, Faculty of Veterinary, Zaragoza University, AgriFood Institute of Aragon (IA2), C/ Miguel Servet, 177, 50013, Zaragoza, Spain
| | | | | | - Alejandro Sanz-Arque
- Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - José Miguel Arbones-Mainar
- Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain.,Center for Biomedical Research in Network Physiopathology Obesity and Nutrition (CIBERObn), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, Zaragoza, Spain. .,Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.
| |
Collapse
|
2
|
González-Fernández M, Perez-Nogueras J, Serrano-Oliver A, Torres-Anoro E, Sanz-Arque A, Arbones-Mainar JM, Sanz-Paris A. Masseter Muscle Thickness Measured by Ultrasound as a Possible Link with Sarcopenia, Malnutrition and Dependence in Nursing Homes. Diagnostics (Basel) 2021; 11:1587. [PMID: 34573928 PMCID: PMC8469670 DOI: 10.3390/diagnostics11091587] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 01/13/2023] Open
Abstract
Sarcopenia is a progressive and generalized loss of skeletal muscle mass and strength. It is frequently associated with malnutrition and dependence in nursing homes. Masticatory muscle strength could be the link between sarcopenia, malnutrition and dependence. We aimed to study the relation between sarcopenia, malnutrition and dependence with masseter muscle thickness measured by ultrasound. A cross-sectional study was realized, with 464 patients from 3 public nursing homes in Zaragoza (Spain). The diagnosis of sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People 2 criteria, malnutrition by the Mini Nutritional Assessment (MNA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria and functional capacity by the Barhel Index and the texture diet. Masseter muscle thickness (MMT) was measured by ultrasound. The median age was 84.7 years, and 70% of the participants were women. Sarcopenia was confirmed in 39.2% of patients, malnutrition in 26.5% (risk 47.8%), total dependence in 37.9% and diet texture was modified in 44.6%. By logistic regression, once the model was adjusted for age, sex, Barthel index and texture diet, our analyses indicated that each 1 mm decrease in MMT increased the risk of sarcopenia by ~57% (OR: 0.43), the risk of malnutrition by MNA by ~63% (OR: 0.37) and the risk of malnutrition by GLIM by ~34% (OR: 0.66). We found that MMT was reduced in sarcopenic, malnourished and dependent patients, and it could be the common point of a vicious cycle between sarcopenia and malnutrition. Further studies are needed to establish causality.
Collapse
Affiliation(s)
| | | | | | | | | | - Jose M. Arbones-Mainar
- Instituto de Investigación Sanitaria Aragon (IIS-Aragon), 50007 Zaragoza, Spain;
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50007 Zaragoza, Spain
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Alejandro Sanz-Paris
- Nutrition Department, University Hospital Miguel Servet, 50007 Zaragoza, Spain;
- Instituto de Investigación Sanitaria Aragon (IIS-Aragon), 50007 Zaragoza, Spain;
| |
Collapse
|
3
|
González-Fernández M, Arbones-Mainar JM, Ferrer-Lahuerta E, Perez-Nogueras J, Serrano-Oliver A, Torres-Anoro E, Sanz-Paris A. Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals. Dysphagia 2021; 36:1031-1039. [PMID: 33462765 DOI: 10.1007/s00455-020-10234-8] [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: 05/20/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia. METHODS Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume-viscosity swallow test (V-VST). RESULTS 469 patients (69% women, mean age 84.7 yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1 mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST. CONCLUSIONS The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings.
Collapse
Affiliation(s)
| | - Jose M Arbones-Mainar
- Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain. .,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain. .,Centro de Investigacion Biomedica en Red Fisiopatología Obesidad Y Nutricion (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.
| | | | | | | | | | - Alejandro Sanz-Paris
- Department of Nutrition, University Hospital Miguel Servet, Zaragoza, Spain.,Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain
| |
Collapse
|
4
|
Sanz-Paris A, Perez-Nogueras J, Torres-Anoro E, Blasco-Solana M, Losfablos-Callau F, Gonzalez-Fernandez M, Sanz-Arque A, Arbones-Mainar JM. SUN-PO181: Comparison of Two Formulas for Muscle Mass Calculation According to the European Consensus of Sarcopenia and Malnutrition in Institutionalized Elderly Population. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32813-4] [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: 10/26/2022]
|
5
|
Lardiés-Sánchez B, Arbones-Mainar JM, Perez-Nogueras J, Serrano-Oliver A, Torres-Anoro E, Sanz-Paris A. Neck circumference is associated with nutritional status in elderly nursing home residents. Nutrition 2019; 62:153-157. [PMID: 30913519 DOI: 10.1016/j.nut.2019.01.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Anthropometry is an easy and noninvasive method to evaluate nutritional status in institutionalized elderly people who are often bedridden. The aim of this study was to investigate the relationship between the neck circumference (NC) and nutritional status of elderly nursing home residents and to find cutoff points for NC size to identify individuals at risk of malnutrition. METHODS A cross-sectional study was developed with data collected from 352 elderly people living in five public nursing homes. Different anthropometric measures and the Mini Nutritional Assessment (MNA) were used to determine nutritional status. Receiver operating characteristic (ROC) curves were built for each anthropometric variable to determine their sensitivity and specificity for predicting the risk of malnutrition according to the MNA. RESULTS The mean age of the participants (59% females) was 83 years old. In total, 48.3% of women and 45.5% of men were at risk of malnutrition according to their MNA scores. All anthropometric measurements were highly intercorrelated in both men and women, indicating a high degree of collinearity. Bootstrapped linear regression was used to assess the strength of the association between an individuals' nutritional status and their anthropometric parameters. Calf circumference and NC presented the best predictive value with the highest sensitivity for diagnosing the risk of malnutrition in both institutionalized elderly men and women. The best cutoff points of NC to identify elderly nursing home residents at risk of malnutrition were 35.2 cm for females and 37.8 cm for males. CONCLUSIONS NC is associated with other classical anthropometric parameters and malnutrition status in elderly people living in nursing homes.
Collapse
Affiliation(s)
- Beatriz Lardiés-Sánchez
- Nutrition Department of University Hospital Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, Spain.
| | - Jose M Arbones-Mainar
- Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, Spain; Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain; Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutricion (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | | | | | | | - Alejandro Sanz-Paris
- Nutrition Department of University Hospital Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, Spain
| |
Collapse
|
6
|
Sanz-Paris A, Coque-Rubio J, Perez-Gimeno G, Hernandez-Alcaine L, Boj-Carceller D, Lardies-Sanchez B, Perez-Nogueras J, Serrano-Oliver A, Puzo J, Perez-Fernandez L, Azcona I. MON-PP134: Relationship between Abdominal Circumference in Decubitus and other Anthropometric Parameters. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30566-5] [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: 11/30/2022]
|
7
|
Sanz-Paris A, Boj D, Perez-Nogueras J, Gascon J, Corrales T. PP117-MON EXPERIENCE WITH A NEW SPECIFIC AND HYPERCALORIC DIABETES ENTERAL FORMULA: GLYCAEMIC AND NUTRITIONAL RESULTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60428-8] [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: 11/29/2022]
|