Determinants of Nutritional Risk among Community-Dwelling Older Adults with Social Support

BACKGROUND

It is well established that older adults are at risk for malnutrition due to several social and non-social determinants, namely physiological, psychosocial, dietary and environmental determinants. The progression to malnutrition is often insidious and undetected. Thus, nutritional assessment should consider a complex web of factors that can impact nutritional status (NS). The primary objective of this study was to assess the NS of older adults attending senior centres (SCs) and to identify its predictors.

METHODS

This cross-sectional study enrolled a sample of community-dwelling older adults in Lisbon. NS was assessed using Mini Nutritional Assessment (MNA^®). Malnutrition or malnutrition risk (recategorised into a single group) was predicted using binary logistic regression models, considering those participants classified as having a normal NS as the reference group. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures.

RESULTS

A sample of 337 older adults, with an average age of 78.4 years old (range 66-99), mostly women (n = 210; 62.3%), were enrolled. Older adults at risk of malnutrition accounted for 40.7% of the sample. Being older (OR = 1.045, CI 95% [1.003-1.089], p = 0.037), having a worse perception of health status (OR = 3.395, CI 95% [1.182-9.746], p = 0.023), having or having had depression (OR = 5.138, CI 95% [2.869-9.201], p < 0.001), and not having or having had respiratory tract problems (OR = 0.477, CI 95% [0.246-0.925], p = 0.028) were independent predictors of malnutrition or malnutrition risk. An intermediate time of SC attendance was associated with a lower probability of malnutrition or risk (OR = 0.367, CI 95% [0.191-0.705], p = 0.003).

CONCLUSIONS

NS among older adults has a multifactorial aetiology, with a strongly social component and is related to health circumstances. Further research is needed to timely identify and understand nutritional risk among this population.

Dietary parameters in patients with drug allergy: Assessing dietary inflammatory index

Background

Research on the increasing incidence of allergic diseases evidenced the role of diet as a potential key factor. Diet can modulate the low-grade systemic inflammation related to obesity and several diseases. There are no published data on drug allergy.

Aim

To investigate a potential association between diet, including dietary inflammatory index (DII), and drug allergy. Also, to evaluate correlations between diet and obesity, inflammatory and metabolic parameters in patients with drug allergy.

Methods

Ninety consecutive patients studied for suspected drug allergy were evaluated in terms of dietary parameters, anthropometric measurements, bioimpedance and biochemical analysis. DII was calculated based on information collected from a food frequency questionnaire.

Results

After diagnostic work-up, 39 patients had confirmed drug allergy and 45 excluded, representing the study group and the control group, respectively. The majority (79%) were female, with mean age of 39.58±13.3 years. The 84 subjects revealed an anti-inflammatory diet pattern. No significative difference was found in DII scores between drug allergic patients and controls (-3.37±0.95 vs -3.39±0.86, p = 0.985). However, the patients with drug allergy revealed higher obesity and inflammatory parameters. A significative negative correlation was found between DII and adiponectin levels, in the control group (r = -0.311, p = 0.040). In the patient group, a significative positive correlation was observed between DII and triglycerides (r = 0.359, p = 0.032). No other correlations were found between DII and the assessed parameters. Patients with drug allergy presented a significative higher intake of mono-unsaturated fatty-acids comparing to controls (19.8±3.7 vs 17.8 ± 4.0, p = 0.021). No other statistically significant differences were achieved in dietary parameters, between patients and controls.

Conclusion

The population assessed in this study revealed an anti-inflammatory diet profile. Although we have found in a previous work that the same patients with drug allergy revealed higher obesity and inflammatory parameters, the DII did not allow to distinguish between patients with drug allergy or controls. The DII scores correlated with triglycerides levels in the drug allergy patients and inversely with adiponectin levels in the control group. Larger studies are needed to clarify the potential role of the diet in drug allergy and its outcomes.

Obesity markers in patients with drug allergy and body fat as a predictor

BACKGROUND

Obesity is a chronic low-grade inflammation state associated with several diseases.

OBJECTIVE

To investigate a potential link between drug allergy and obesity, exploring whether the association depends on the type (immediate vs nonimmediate) or the severity of the reaction.

METHODS

Anthropometric measurements, bioimpedance, and biochemical analysis, including serum adipokines, were performed in 90 consecutive adult patients studied for suspected drug allergy. Logistic regression models were developed to identify predictors of drug allergy.

RESULTS

A total of 84 patients completed the diagnostic workup (78.6% women; mean age 39.58 ± 13.3 years). Drug allergy was confirmed in 39 patients and excluded in 45 (controls). Regarding body mass index, 42.2% had normal weight and 55.3% were overweight/obese. A total of 58% of women and 41% of men fulfilled the criteria for central obesity. Patients with drug allergy exhibited considerably higher body mass index, waist and hip circumferences, waist-hip ratio, fat mass, body fat percentage (BFP), trunk fat mass, leptin levels, and leptin-adiponectin ratio than controls. Similar results were obtained in the subgroup with immediate reactions, compared with the nonimmediate or unknown reactions. The higher the BFP and the number of reactions, the greater the odds of drug allergy (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.14 and OR, 2.82; 95% CI, 1.31-6.10, respectively). An immediate reaction was also a predictor of drug allergy (OR, 3.81; 95% CI, 1.30-11.14, P = .02), compared with nonimmediate or unknown reactions. In patients with drug allergy, BFP was a predictor of having an immediate reaction (OR, 1.12; 95% CI, 1.02-1.24, P = .02).

CONCLUSION

Our study illustrates, for the first time, evidence of a link between obesity and drug allergy, particularly immediate reactions. The BFP emerged as a potential predictor of drug allergy.

Eating behaviour among nutrition students and social desirability as a confounder

INTRODUCTION

The study of eating behaviour should consider the presence of potential sources of bias, including social desirability. This is particularly relevant among students of Nutrition Sciences, since they have a higher risk of eating disorders.

OBJECTIVE

To analyse the effect of social desirability in the assessment of eating behaviour dimensions among nutrition students.

METHODS

In this cross-sectional study, we analysed data from 149 students of Nutrition Sciences. Participants completed a questionnaire assessing social desirability and eating behaviour dimensions (emotional, external and binge eating, flexible and rigid control, and eating self-efficacy).

RESULTS

Among males, social desirability had a negative association with binge eating, while among women it had a negative association with emotional, external and binge eating and a positive association with eating self-efficacy. In both subsamples, social desirability showed no significant association with any of the two types of dietary restraint (rigid and flexible control).

DISCUSSION

Overall, the association between social desirability and eating behaviour dimensions among students of Nutrition Sciences occurs in the same direction as found in students from other areas. However, alongside these similarities, there is a stronger association between social desirability and binge eating among male students of Nutrition Sciences. We hypothesize that this may be related with the different knowledge of students from different areas, and the way they perceive and face the treatment of eating disorders.

CONCLUSION

Our study shows that social desirability should be considered while assessing eating behaviour among nutrition students, particularly when studying external eating, binge eating and eating self-efficacy. Moreover, when tailoring interventions to reduce the possible effects of eating behaviour on nutritionists and dieticians' practice, we should consider the influence of social desirability.

[Social desirability and barriers to the accomplishment of the dietary treatment in overweight women]

INTRODUCTION

There are several barriers related to the non-accomplishment of the dietary treatment of overweight. Social desirability (SD), defined as the tendency to transmit a culturally accepted image, may bias parameters evaluated in scientific studies.

AIMS

(1) To evaluate SD in overweight women; (2) To evaluate the association between SD and other characteristics; (3) To compare the level of SD between patients evaluated in their first appointment or in subsequent appointments; (4) To evaluate the differences in the level of SD between patients who mention or not each barrier to the accomplishment of the dietary treatment; (5) To evaluate the effect of SD in the frequency of each statement pointed out as a barrier to the accomplishment of the dietary treatment.

SAMPLE AND METHODS

Sixty-seven women with BMI over 25,0 kg/m2 (mean BMI = 40,0 kg/m2; sd= 5,7) and mean age of 40 years (sd = 11) were evaluated on age, education, height, present and desired weights, perception of heath condition, weight and body image (Likert scale from 1 feels very well to 5 very bad). BMI, weight they desired to loose and corresponding BMI were calculated. The number of previous appointments and the date of the first appointment were registered and the time since the first appointment was calculated. Psychopathologic characteristics were studied with the Psychological General Well-Being Index. Barriers to the accomplishment of the dietary treatment were evaluated by pointing, from a list of 34 sentences mentioning obstacles to its accomplishment, those which patients identified themselves with. SD was evaluated with the Marlowe-Crowne Social Desirability Scale (MC-SDS).

RESULTS

Mean score on the MC-SDS was 20,9 (sd = 4,0). Positive and weak correlations were found between SD and the number of previous appointments and time since the first appointment. Patients with previous appointments show significantly higher levels of SD than those who were evaluated in their first appointment (means of 21,7 and 18,8; p = 0,005). There weren't found significant differences on the level of SD of patients who pointed or not each sentence and it wasn't found a significant effect of SD in the frequency of any sentence.

DISCUSSION

The mean score on the MC-SDS was higher than values found in the majority of studies, which may result from the higher age, lower education and the presence of pathology. Previous contact with the patients seems to influence SD and may bias and make difficult the interpretation of parameters measured by self-report. The identification of barriers to the accomplishment of the dietary treatment seems to be independent from SD.