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Dogan O, Sahinli H, Yazilitas D. Assessment of malnutrition in cancer patients: a geriatric approach with the mini nutritional assessment. Front Nutr 2025; 12:1590137. [PMID: 40416373 PMCID: PMC12101082 DOI: 10.3389/fnut.2025.1590137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Accepted: 04/01/2025] [Indexed: 05/27/2025] Open
Abstract
Background and objectives Malnutrition is a common problem among cancer patients, significantly impacting clinical outcomes and quality of life. This study aimed to evaluate the prevalence of malnutrition and its associated factors in geriatric cancer patients undergoing chemotherapy. Materials and methods This prospective study included 471 patients aged 65 years and older, conducted at Ankara Etlik City Hospital between January and December 2023. Patients' demographic, clinical, and nutritional statuses were assessed using the Mini Nutritional Assessment (MNA). Nutritional status was classified as normal (MNA ≥ 24), at risk of malnutrition (MNA 17-23.5), and malnourished (MNA < 17). Depression and insomnia were evaluated using the Geriatric Depression Scale (GDS) and the Insomnia Severity Index (ISI), respectively. Factors associated with malnutrition were analyzed statistically. Results Malnutrition was identified in 20.5% of the patients. Malnutrition was significantly associated with radiotherapy (p = 0.001), surgical history (p = 0.001), adjuvant therapy (p = 0.002), metastatic disease (p = 0.011), low BMI (p < 0.001), high depression scores (p < 0.001), moderate-to-severe insomnia (p < 0.001), and the presence of comorbidities (p = 0.022). However, no significant association was found between pain and malnutrition (p = 0.07). Conclusion This study highlights the multifactorial nature of malnutrition in geriatric cancer patients and emphasizes the importance of regular nutritional assessments using validated tools like MNA. Early detection and intervention can improve clinical outcomes and quality of life. However, the study has certain limitations, including being single-center, the use of self-reported measures, and the exclusion of palliative patients, which may affect the generalizability of the results.
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Affiliation(s)
- Ozlem Dogan
- Adiyaman University Training and Research Hospital, Department of Medical Oncology, Adıyaman, Türkiye
| | - Hayriye Sahinli
- Ankara Etlik City Hospital, Department of Medical Oncology, Ankara, Türkiye
| | - Dogan Yazilitas
- Ankara Etlik City Hospital, Department of Medical Oncology, Ankara, Türkiye
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Furuya H, Kikutani T, Yokota Y, Ozeki M, Tamura F. Temporal relationship between malnutrition and oral function impairment in older adults with dysphagia: A cross-lagged panel model. J Nutr Health Aging 2025; 29:100577. [PMID: 40334363 DOI: 10.1016/j.jnha.2025.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/09/2025]
Abstract
OBJECTIVES This study aimed to longitudinally investigate the temporal relationship between tongue pressure and malnutrition in older adults with dysphagia and to determine the antecedent factors. DESIGN This is a retrospective cohort study. SETTING AND PARTICIPANTS In total, 177 participants aged ≥65 years with dysphagia who visited a specialized dysphagia rehabilitation clinic between 2014 and 2018 were enrolled. MEASUREMENTS Malnutrition was assessed based on the phenotypic criteria (unintentional weight loss, low body mass index, and reduced skeletal muscle mass) from the Global Leadership Initiative on Malnutrition framework. Tongue pressure was measured using a tongue pressure measuring device. The bidirectional association between tongue pressure and malnutrition was examined, adjusting for age, sex, cognitive function, occlusal support status, and comorbidities. RESULTS In the Cross-Lagged Panel Model, a significant cross-lagged effect was observed from tongue pressure to malnutrition at 6 months (β = -0.135, p < 0.001) and 12 months (β = -0.112, p = 0.028). However, the pathway from malnutrition to tongue pressure was not significant. Logistic regression analysis also revealed that baseline tongue pressure was significantly associated with malnutrition at 6 months (odds ratio [OR] = 0.91, 95% confidence interval [CI]: 0.86-0.95) and 12 months (OR = 0.89, 95% CI: 0.84-0.94). During the follow-up period, tongue pressure improved; however, the prevalence of malnutrition increased. CONCLUSIONS Decreased tongue pressure may precede malnutrition in older adults with dysphagia; however, a reverse relationship was not observed. The findings suggest the importance of incorporating oral function assessment as part of the risk assessment for malnutrition.
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Affiliation(s)
- Hiroyasu Furuya
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, 4-44-19 Higashi-cho, Koganei-shi, Tokyo 184-0011, Japan; Division of Rehabilitation for Speech and Swallowing Disorder, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-ku, Tokyo 102-8158, Japan.
| | - Takeshi Kikutani
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, 4-44-19 Higashi-cho, Koganei-shi, Tokyo 184-0011, Japan; Division of Rehabilitation for Speech and Swallowing Disorder, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-ku, Tokyo 102-8158, Japan
| | - Yuri Yokota
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, 4-44-19 Higashi-cho, Koganei-shi, Tokyo 184-0011, Japan; Division of Rehabilitation for Speech and Swallowing Disorder, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-ku, Tokyo 102-8158, Japan
| | - Maiko Ozeki
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, 4-44-19 Higashi-cho, Koganei-shi, Tokyo 184-0011, Japan
| | - Fumiyo Tamura
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, 4-44-19 Higashi-cho, Koganei-shi, Tokyo 184-0011, Japan; Division of Rehabilitation for Speech and Swallowing Disorder, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-ku, Tokyo 102-8158, Japan
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Siegmund LA, Siedlecki SL. Avoiding Functional Decline and Minimizing the Effects of Frailty in Hospitalized Older Adults. CLIN NURSE SPEC 2025; 39:140-146. [PMID: 40233232 DOI: 10.1097/nur.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2025]
Abstract
PURPOSE/OBJECTIVES The purpose of this article is to introduce the clinical nurse specialist to the Frailty Care Model. This model can be used by the clinical nurse specialist as a framework to guide nurses as they provide care to older adults predisposed to frailty progression while hospitalized. DESCRIPTION The Frailty Care Model is used as a framework to plan the care of the hospitalized older adult. Examples of frailty screening tools are presented to inform the clinical nurse specialist of the older adult's needs for intervention while hospitalized, and a case study is used. Known targets for frailty interventions include low physical activity, malnutrition, and depression, and recommendations for each are given. OUTCOME The clinical nurse specialist can use and support specific interventions to improve mobility and physical activity, address depression, and improve nutritional intake in hospitalized older adults. CONCLUSION The clinical nurse specialist is essential to the care of the hospitalized older adult who has frailty or is at risk for frailty. Frailty screening and an awareness of risks as well as modifiable factors can set the stage for supportive care that can help to prevent or stabilize frailty in the hospitalized older adult.
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Affiliation(s)
- Lee Anne Siegmund
- Author Affiliation: Senior Nurse Scientists, Office of Nursing Research and Innovation, Cleveland Clinic, Ohio
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Nitschke I, Moede C, Koenig A, Sobotta BAJ, Hopfenmüller W, Jockusch J. An Evaluation of Reference Bite Force Values: Investigating the Relationship Between Dental Prosthetic Restoration and Bite Force in a Cross-Sectional Study. J Clin Med 2025; 14:2723. [PMID: 40283551 PMCID: PMC12027650 DOI: 10.3390/jcm14082723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Revised: 04/07/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
Objectives: This study aimed to establish reference values for bite force in individuals with various prosthetic restorations and to examine the relationship between prosthetic treatment groups (PTGs) and bite force as an indicator of masticatory muscle function. Materials and Methods: In a cross-sectional study from November 2021 to March 2023, 198 participants aged 18 to 95 years were recruited from multiple dental and geriatric centers. The participants were assigned to seven PTGs based on their dental and prosthetic statuses. Bite force was measured using the Occlusal Force Meter GM10, with three recordings on each side of the jaw, and analyzed using ANOVA. Results: The bite force decreased with fewer teeth and the transition from fixed to removable dentures. Fully dentate participants exhibited the highest bite forces, differing significantly from the other groups (p < 0.001). For the fully dentate individuals (547 ± 240 N), the bite force decreased progressively with the extent of prosthetic restoration, reaching 55 ± 45 N in edentulous individuals with complete dentures in both jaws. However, edentulous participants with two interforaminal implants demonstrated higher bite forces than those with partial dentures. Conclusions: Bite force is significantly impacted by prosthetic restoration type. Fully dentate individuals have the highest bite forces, while edentulous patients with implant-supported dentures also show considerable bite forces, similar to those with partial dentures.
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Affiliation(s)
- Ina Nitschke
- Gerodontology Section, Department of Prosthetic Dentistry and Materials Science, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (C.M.); (B.A.J.S.)
| | - Celine Moede
- Gerodontology Section, Department of Prosthetic Dentistry and Materials Science, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (C.M.); (B.A.J.S.)
| | - Andreas Koenig
- Materials Science Section, Department of Prosthetic Dentistry and Materials Science, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany
| | - Bernhard A. J. Sobotta
- Gerodontology Section, Department of Prosthetic Dentistry and Materials Science, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (C.M.); (B.A.J.S.)
| | - Werner Hopfenmüller
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Julia Jockusch
- Gerodontology Section, Department of Prosthetic Dentistry and Materials Science, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (C.M.); (B.A.J.S.)
- Department of Prosthetic Dentistry and Senior Dentistry, Brandenburg Medical School (Theodor Fontane), 14776 Brandenburg an der Havel, Germany
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Ushida K, Wakabayashi H, Kinoshita S, Tohara H, Isowa T, Sakai K, Tohyama M, Shirai Y, Momosaki R. Association between bed-rest time, food intake, and constipation in older nursing home residents. Geriatr Gerontol Int 2025; 25:583-587. [PMID: 40019003 PMCID: PMC11973017 DOI: 10.1111/ggi.70025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 01/18/2025] [Accepted: 02/18/2025] [Indexed: 03/01/2025]
Abstract
AIM This study aimed to investigate the associations between bed-rest time and food intake and between bed-rest time and constipation in older nursing home residents. METHODS We conducted a cross-sectional study using data from the Long-term Care Information System for Evidence (LIFE) database. We used data collected from older nursing home residents registered in the LIFE database between April 2022 and March 2023. We compared outcome data between the short-bed-rest group (≥9 h out of bed per day) and the long-bed-rest group (<9 h out of bed per day). The outcomes were the percentage of food intake provided in the last 3 days, the percentage of energy sufficiency (the percentage of energy intake to energy requirements), and the incidence of constipation. RESULTS The short-bed-rest group consisted of 265 people (53.9%). The short-bed-rest group showed a significantly higher percentage of food intake (93.1 ± 12.3 vs. 85.2 ± 21.6), a higher percentage of energy sufficiency (104.8 ± 19.4 vs. 92.2 ± 26.2), and a lower incidence of constipation (6.0% vs. 18.5%) than the long bed-rest group. Multivariable analyses revealed that shorter bed-rest time was independently and significantly associated with the percentage of food intake (standardized coefficient: 0.28, P < 0.001), the percentage of energy sufficiency (standardized coefficient 0.30, p < 0.001), and incidence of constipation (odds ratio: 0.12, P < 0.001). CONCLUSION Bed-rest time is associated with food intake and constipation in older nursing home residents. Geriatr Gerontol Int 2025; 25: 583-587.
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Affiliation(s)
- Kenta Ushida
- Department of Rehabilitation MedicineMie University Graduate School of MedicineTsuJapan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Shoji Kinoshita
- Department of Rehabilitation MedicineJikei University School of MedicineTokyoJapan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Tokiko Isowa
- Department of Nursing, Graduate School of MedicineMie UniversityTsuJapan
| | - Kotomi Sakai
- Department of ResearchHeisei Medical Welfare Group Research InstituteTokyoJapan
| | - Momoko Tohyama
- Department of Rehabilitation MedicineMie University Graduate School of MedicineTsuJapan
| | - Yuka Shirai
- Department of Rehabilitation MedicineMie University Graduate School of MedicineTsuJapan
| | - Ryo Momosaki
- Department of Rehabilitation MedicineMie University Graduate School of MedicineTsuJapan
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Xu P, Shi S, Yu Z, Li D, Zhang C. Case report: A case report and literature review on spontaneous bacterial peritonitis induced by intestinal barrier damage in a colorectal cancer patient with malnutrition. Front Oncol 2025; 15:1444149. [PMID: 40034595 PMCID: PMC11872932 DOI: 10.3389/fonc.2025.1444149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 01/28/2025] [Indexed: 03/05/2025] Open
Abstract
Background Spontaneous bacterial peritonitis (SBP) is an infectious condition characterizing the presence of bacterial infection in the peritoneal fluid with no apparent source of infection within the abdomen. It is extremely rare for patients with malnutrition after colorectal cancer (CRC) surgery to develop SBP. This is the first ever case reported case of SBP resulting from intestinal barrier compromise in a patient with colorectal cancer with malnutrition. Case summary A 72-year-old woman with malnutrition was diagnosed with CRC, and following brief nutritional support, she underwent the laparoscopic-assisted radical right hemicolectomy. The patient was then diagnosed with peritonitis after the operation. An emergency laparotomy was performed, and the patient was finally diagnosed with SBP. The patient ultimately recovered following a series of appropriate postoperative supportive treatments. Conclusion This case highlights the poor outcomes of short preoperative nutritional therapy in CRC patients with malnutrition. Further studies should investigate the role of the intestinal barrier function in the recovery of patients with CRC after surgery.
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Affiliation(s)
| | | | | | - Da Li
- Department of General Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Cheng Zhang
- Department of General Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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Gortan Cappellari G, Calcagnile M, Pennisi R, Castiglia G, Concollato E, Sanson G, Barazzoni R, De Colle P, Zanetti M. A simplified multidimensional scale approach is effective in predicting mortality in hospitalized older adults and highlights the role of nutrition. Clin Nutr 2025; 45:1-9. [PMID: 39729734 DOI: 10.1016/j.clnu.2024.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 11/14/2024] [Accepted: 12/15/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND & AIMS Malnutrition and cognitive impairment are among the major contributors to frailty, that significantly increases the risk of mortality of older hospitalized patients. Multidimensional frailty assessment tools, such as the multidimensional prognostic index-MPI, a tool based on a standard comprehensive geriatric assessment (CGA), have proven valuable for predicting adverse outcomes, including mortality of older adults following acute illness but its application in everyday clinical practice is limited. We hypothesized that removing parameters not closely associated with mortality and sorting the patient population according to the presence or not of cognitive impairment with possible integration of common laboratory markers, could provide a simplified approach that could improve practicability in all settings with at least comparable 1-year mortality predictive value. METHODS A retrospective cohort study was conducted in patients consecutively admitted to the Geriatric Clinic of the Maggiore University Hospital in Trieste, Italy from January 1st 2018 to December 31st 2019. Their demographics, functional, clinical, laboratory parameters and 1-year mortality were recorded. In a development cohort of 1032 consecutive patients, best predictors of mortality were selected via systematic analysis and included in simplified prognostic models and algorithms and subsequently compared for prediction of 1-year mortality. The predictive relevance of the best algorithms was then validated, in comparison to MPI, in a separate cohort of 575 consecutive patients. RESULTS While all demographic and tested laboratory parameters as well as MPI domains correlated with 1-year mortality, exclusion from MPI calculation of Short Portable Mental Status Questionnaire (SPSMQ), Exton Smith scale (ESS) and Mini Nutritional Assessment (MNA) significantly reduced MPI mortality predictivity, suggesting that not all MPI domains have the same weight. Further analysis showed that in the whole study cohort and in subgroups according to cognitive function, selected models including up to 3 parameters were superior to MPI in predicting 1-year mortality. In particular, models including MNA and albumin, or Exton Smith scale proved to better predict mortality in patients without or with severe cognitive impairment, respectively. A derived diagnostic algorithm applying different models according to cognitive status showed improved predictive value compared to MPI while requiring shorter estimated assessment time. Internal validation confirmed these results [HR: 4.37 (3.02-6.31) vs 3.16 (2.18-4.61), p < 0.0001]. CONCLUSIONS In older acutely ill patients, a simplified multidimensional algorithm approach based on the assessment of cognitive function followed by nutritional status with the addition of plasma albumin or of functional status in patients without or with severe cognitive impairment respectively, may significantly improve 1-year mortality prediction while reducing assessment time. Moreover, these results highlight the prognostic value of MNA in association with albumin for 1-year mortality risk screening in the hospital setting and, for the first time, demonstrate its differential performance according to the presence or not of cognitive impairment.
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Affiliation(s)
- Gianluca Gortan Cappellari
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy; School of Dietetics, University of Trieste - Pordenone branch, Pordenone, Italy.
| | - Marta Calcagnile
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Renata Pennisi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Giuseppe Castiglia
- Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Emanuele Concollato
- Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; School of Nursing, University of Trieste, Trieste, Italy
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo De Colle
- Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Geriatric Clinic, Maggiore University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy; School of Dietetics, University of Trieste - Pordenone branch, Pordenone, Italy
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Huang P, Wu L, Zhang R, Chen S, Zhang Y, Chen Y. Systematic review and meta-analysis on the prevalence and risk factors of oral frailty among older adults. Front Med (Lausanne) 2025; 12:1512927. [PMID: 39911869 PMCID: PMC11794213 DOI: 10.3389/fmed.2025.1512927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 01/06/2025] [Indexed: 02/07/2025] Open
Abstract
Objectives The present study aim to systematically review the prevalence and influencing factors of oral frailty in older people. Methods A search strategy was developed and implemented to systematically review literature across PubMed, Embase, Web of Science, MEDLINE (via EBSCOhost), CINAHL, the Cochrane Library, Scopus, China Knowledge Resource Integrated Database (CNKI), Wanfang Data, Chinese Biomedical Database (CBM), and Weipu Database (VIP), in accordance with the PRISMA 2020 guidelines. Our search encompassed studies published up to June 28, 2024, that investigated the prevalence or risk factors of oral frailty among older adults. Literature screening, data extraction, and quality assessment were independently performed by two researchers, followed by data analysis using Stata 17 software. This study has been registered with PROSPERO. Results A total of 35 studies involving 202,864 participants were analyzed. The overall prevalence of oral frailty among older adults was 34.0% (95% CI: 27.9-40.1%, I 2 = 99.7%, p < 0.001). Subgroup analyses revealed statistically significant differences in the prevalence of oral frailty among different assessment tools and age groups (p < 0.05). Univariate meta-regression analysis indicated that the age was related to heterogeneity in the study (p < 0.05). Factors such as age, gender, physical frailty, pre-frailty, and unattached were identified as key risk factors for oral frailty in older adults (all p < 0.05). Conclusion The incidence of oral frailty among older adults is notably high and influenced by a variety of factors. Healthcare professionals are encouraged to actively implement preventive and treatment measures addressing the controllable factors associated with oral frailty. Such proactive efforts are essential for early identification of high-risk individuals, which can help reduce the prevalence of oral frailty among older adults and enhance their quality of life. Systematic Review Registration PROSPERO (CRD42023488653: https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Pingping Huang
- Department of Nursing, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Linjing Wu
- Department of Nursing, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Rongxiang Zhang
- Department of Nursing, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shiqi Chen
- Department of Nursing, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yu Zhang
- Department of Nursing, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Yuan Chen
- Department of Nursing, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Miyata H, Matsumura K, Takase T, Sugimoto K, Funauchi Y, Yagi E, Yoshida A, Kajihara K, Iwanaga T, Amagai T, Nakazawa G. Clinical Importance of Protein Intake in Hospitalized Elderly Patients With Heart Failure. Circ Rep 2025; 7:47-54. [PMID: 39802127 PMCID: PMC11711637 DOI: 10.1253/circrep.cr-24-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 10/10/2024] [Accepted: 10/26/2024] [Indexed: 01/16/2025] Open
Abstract
Background The relationship between protein intake and the long-term prognosis of elderly patients with heart failure remains poorly understood. We investigated the association between predischarge protein intake and long-term prognosis in hospitalized elderly patients with heart failure. Methods and Results A single-center, retrospective analysis of hospitalized patients aged ≥65 years with heart failure and reduced ejection fraction was conducted. Protein intake was evaluated by nutritionists based on visual measurements of the percentage of dietary intake obtained for 7 days before discharge by a nurse. A cutoff of 1.2 g/kg/day protein intake was used to compare the incidence of a composite endpoint, including all-cause mortality and heart failure rehospitalization within 1 year. Among the 100 patients (median age 79 years; 47% male), 56% had low protein intake (<1.2 g/kg/day). Patients with low protein intake had a significantly higher rate of composite endpoints than those with high protein intake (50% vs. 20%; log-rank test P=0.03). Multivariable Cox proportional hazards model revealed that low protein intake was independently associated with long-term prognosis with a hazard ratio of 2.73 and a 95% confidence interval of 1.10-6.80 (P=0.03). Conclusions Low protein intake in the predischarge phase was associated with long-term prognosis in hospitalized elderly patients with heart failure and reduced ejection fraction.
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Affiliation(s)
- Hiroyo Miyata
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University Hyogo Japan
- Department of Clinical Nutrition, Kindai University Hospital Osaka Japan
| | - Koichiro Matsumura
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
| | - Toru Takase
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
| | - Keishiro Sugimoto
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
| | - Yohei Funauchi
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
| | - Eijiro Yagi
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
| | - Ayano Yoshida
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
| | - Katsumi Kajihara
- Department of Clinical Nutrition, Kindai University Hospital Osaka Japan
| | - Takashi Iwanaga
- Department of Clinical Nutrition, Kindai University Hospital Osaka Japan
| | - Teruyoshi Amagai
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University Hyogo Japan
- Faculty of Health Care Sciences, Department of Clinical Engineering, Jikei University of Health Care Sciences Osaka Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine Osaka Japan
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Kaluźniak-Szymanowska A, Deskur-Śmielecka E, Krzymińska-Siemaszko R, Styszyński A, Tobis S, Lewandowicz M, Chudek J, Kostka T, Mossakowska M, Piotrowicz K, Kujawska-Danecka H, Wieczorowska-Tobis K. Health status correlates of malnutrition diagnosed based on the GLIM criteria in older Polish adults-Results of the PolSenior 2 study. PLoS One 2025; 20:e0317011. [PMID: 39775236 PMCID: PMC11706504 DOI: 10.1371/journal.pone.0317011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/19/2024] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION Older individuals are at risk of malnutrition resulting from chronic diseases-related body and muscle mass reduction. In turn, nutritional deficiencies may enhance catabolic processes, leading to accelerated aging and comorbidity, thus creating a vicious cycle. Our study aimed to assess the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to determine the health correlates of malnutrition in a representative sample of community-dwelling older adults. METHODS We used the GLIM criteria to diagnose malnutrition in 5,614 participants of the PolSenior2 study. The PolSenior2 study was a population-based survey designed to assess the medical, psychological, social, and economic characteristics of community-dwelling older adults. RESULTS Malnutrition was diagnosed in 13.4% of the participants using the GLIM criteria. Results of multiple logistic regression showed that the risk of depression [OR 4.18, p<0.001], peptic ulcer disease [OR 2.73, p<0.001], past stroke [OR 1.71, p<0.001], cognitive impairment [OR 1.34, p = 0.015], and chronic pain [OR 1.23, p = 0.046] were independent correlates of malnutrition. CONCLUSION Due to the high risk of malnutrition, special attention should be paid to individuals in late old age. Suspected malnutrition should also be considered in people at risk of depression, with peptic ulcer disease, past stroke, and cognitive impairment. Chronic pain should also prompt the diagnosis for malnutrition.
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Affiliation(s)
| | - Ewa Deskur-Śmielecka
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Arkadiusz Styszyński
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Lewandowicz
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Kostka
- Department of Geriatrics Medical University of Lodz Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - Małgorzata Mossakowska
- Study on Aging and Longevity, International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Hanna Kujawska-Danecka
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical Univeristy of Gdansk, Gdansk, Poland
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11
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Bonilla-Barrera CH, Bea Berges L, Seco-Calvo J. [Malnutrition and obesity in self-sufficient elderly and health determinants related to both nutritional disorders]. Aten Primaria 2025; 57:103078. [PMID: 39288540 PMCID: PMC11422051 DOI: 10.1016/j.aprim.2024.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/20/2024] [Accepted: 07/08/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE Evaluate the nutritional status in older adults in the community, to determine malnutrition, obesity and their risks and to identify determinants related to both clinical situations. DESIGN Cross-sectional study. SITE: 3 Primary care health centers in La Rioja in urban, semiurban and rural areas. PARTICIPANTS 409 people ≥ 65 years old who came to receive consultation, with 3 abandonments. INTERVENTIONS Nutritional assessment by tools screening and anthropometric measurements. MAIN MEASUREMENT The MNA SF® was used to determine the prevalence of malnutrition and the BMI for obesity. Sociodemographic, socioeconomic, health-disease variables, lifestyle habits, metabolic status, and anthropometric measurements were included. Binary logistic regression was performed to predict dichotomous dependent variables. RESULTS The prevalence of malnutrition and its risk (DR) were 18.7% and obesity and its risk were 66,5%. The multivariate model for malnutrition and DR includes polypharmacy, dyslipidemia, sedentary lifestyle, and having mental pathology (OR=3.09, 2.01, 2.12, 1.72, respectively). On the other hand, the probability of presenting obesity is associated with cardiovascular risk, age, excessive-moderate alcohol consumption, hypertension and low adherence to the Mediterranean diet (OR=2.73, 4.27, 2.03, 1.97, 1.81 respectively). CONCLUSION This results stand out that the study population has a poor nutritional status, detecting a risk of malnutrition, obesity and overweight. The identified predictors related to lifestyle habits, presence of diseases, psychosocial problems, metabolic alterations, etc. They can guide the selection of those people who would benefit from screening to detect and approach the risk of malnutrition early.
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Affiliation(s)
| | - Laura Bea Berges
- Gerencia de Atención Primaria, Servicio Riojano de Salud, La Rioja, España
| | - Jesús Seco-Calvo
- Departamento de Enfermería y Fisioterapia, Instituto de Biomedicina (IBIOMED), Universidad de León, León, España; Departamento de Fisiología, Universidad del País Vasco, Vizcaya, España
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12
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Asrullah M, Maula AW, Dewi SL, Helmyati S, Melse-Boonstra A. Food insecurity and BMI are associated with depressive symptoms among adolescents in Yogyakarta province, Indonesia, during the COVID-19 pandemic: a 1-year longitudinal study. Br J Nutr 2024:1-10. [PMID: 39704447 DOI: 10.1017/s0007114524003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
The COVID-19 pandemic has presented multifaceted challenges globally, impacting adolescent health. Among these, food security and nutrition are intertwined closely with mental health outcomes. In Indonesia, with its diverse socio-economic landscape, these interconnections may have been exacerbated by the pandemic. This study investigated the relationship between food security, nutrition and adolescent mental health in Indonesia during COVID-19. Longitudinal data were collected from 511 adolescent boys and girls in 2021-2022 in Gunungkidul district, Yogyakarta. Food security was measured using the Household Food Insecurity Access Scale (HFIAS), and the validated Kessler-10 Psychological Distress Scale (K10) was used to measure adolescent depression. Multivariate linear regression and linear mixed-effects regression were employed to explore associations between these variables, while adjusting for sex, age, pubertal status and household income. Overall, food insecurity score was positively associated with depressive symptoms (β: 0·72, 95 % CI 0·52, 0·92), while BMI z-score was inversely associated (β: -0·31, 95 % CI 0·68, -0·03). We found an increase in strength of association between food insecurity and depressive symptoms over time (moderately food-insecure: β: 1·36 (95 % CI -0·10, 2·83) to 4·63 (95 % CI 2·17, 7·09); severely food-insecure: β: 1·89 (95 % CI 0·36, 3·41) to 3·30 (95 % CI 1·50, 5·10). Enhancing food access, improving nutritional status and providing mental health support are crucial components of adolescent health.
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Affiliation(s)
- Muhammad Asrullah
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Centre for Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ahmad Watsiq Maula
- Biostatistic, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Shita Listya Dewi
- Centre for Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Siti Helmyati
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
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13
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Hollaar V, de van der Schueren M, Haverkort E, Everaars B, Borkent J, Jerković-Ćosić K, van Hout H, Everink I, Naumann E. Associations Between Problems in Oral Health, Oral Function and Malnutrition in Older People: Results From Three Databases. Int J Dent Hyg 2024. [PMID: 39673108 DOI: 10.1111/idh.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/13/2024] [Accepted: 12/03/2024] [Indexed: 12/16/2024]
Abstract
INTRODUCTION Poor oral health can influence an individual's dietary intake, which may result in malnutrition. Both problems in oral health and function and malnutrition are common in older people. The aim of the present study was to explore the associations between oral health and oral function and malnutrition in community-dwelling older people within three different databases. METHODS Data analyses were performed on three existing Dutch databases (Interrai: n = 3876, LPZ: n = 966, PRIMa mouth CARE: n = 975). Logistic regressions (adjusted for age and gender) tested the relation between oral health and oral function (independent variable) and malnutrition (dependent variable). RESULTS Problems in oral health and oral function such as broken teeth (OR: 1.43 [95%CI: 1.12-1.81]), oral pain and discomfort (OR: 2.58 [95%CI: 1.52-4.39]), chewing difficulties (OR: 1.99 [95%CI: 1.54-2.57]), swallowing problems (OR: 6.63 [95%CI: 2.85-15.42]), coughing (OR: 6.05 [95%CI: 2.08-17.61]) and food adaptations (OR: 5.46 [95%CI: 2.60-11.4]) were found to be significantly associated with malnutrition in older people. CONCLUSIONS This study demonstrated a significant link between oral health problems and oral function with malnutrition in community-dwelling older people. Oral health care and healthcare professionals need to consider oral health and oral function in relation to nutritional status and vice versa in community-dwelling older people.
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Affiliation(s)
- Vanessa Hollaar
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Research Group Innovations in Preventive Health Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Elizabeth Haverkort
- Research Group Innovations in Preventive Health Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Babette Everaars
- Research Group Innovations in Preventive Health Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jos Borkent
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Katarina Jerković-Ćosić
- Research Group Innovations in Preventive Health Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Hein van Hout
- Department General Practice and Medicine for Older Persons, Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Amsterdam, The Netherlands
| | - Irma Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Elke Naumann
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
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14
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Spiro A, Hill Z, Stanner S. Meat and the future of sustainable diets-Challenges and opportunities. NUTR BULL 2024; 49:572-598. [PMID: 39526859 DOI: 10.1111/nbu.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/20/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024]
Abstract
The British Nutrition Foundation convened a roundtable event in January 2024 entitled 'Meat and the Future of Sustainable Diets: Turning Challenges into Opportunities', bringing together multi-sector stakeholders to discuss the social, nutritional, public health and environmental aspects of meat consumption within a sustainable food system. Participants explored the challenge of the complexity of balancing nutrition and planetary goals, emphasising the need to navigate trade-offs between various dimensions of sustainability. Whilst recognising the global nature of the issue, the roundtable primarily focussed on a UK perspective. The discussion highlighted the urgency of transforming the food system to achieve net zero, whilst ensuring broader environmental benefits, nutritional adequacy and dietary and health equity across all life stages. Concerns about poor dietary patterns, particularly among vulnerable groups were raised, with participants stressing the need for policies that promote healthy, sustainable and equitable diets without worsening inequalities. These policies should also enhance livelihoods and community wellbeing, foster resilience and support local economies. On the supply side, participants called for better data within the agri-food system, particularly at the farm level. They advocated for a multidimensional, holistic approach that goes beyond greenhouse gas emissions to encompass wider environmental impacts and whole-farm benefits, such as enhancing soil health, promoting biodiversity, improving water management, supporting nutrient cycling and boosting farm-level resilience through diversified cropping systems. Roundtable participants acknowledged existing recommendations to reduce meat consumption for both environmental reasons, such as land use and greenhouse gas emissions, and health concerns, as evidence links red, particularly processed, meat consumption with increased colorectal cancer risk. Given the variation in meat consumption globally and even locally between individuals, the discussion explored the potential of targeted campaigns to reduce high meat intake, along with the role of public food procurement and the food industry in decreasing processed meat consumption. The consensus was that dietary changes must be framed within the context of a balanced diet and broader sustainability concerns. Despite some differing viewpoints on implementation, participants agreed that transitioning to healthier, more sustainable diets is a priority. Collaboration across the entire food chain, from farm to fork, with investment in innovation, robust data collection and research, alongside policy support, was emphasised as essential to achieving this goal.
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Affiliation(s)
- A Spiro
- British Nutrition Foundation, London, UK
| | - Z Hill
- British Nutrition Foundation, London, UK
| | - S Stanner
- British Nutrition Foundation, London, UK
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15
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Papoutsakis C, Sundar C, Woodcock L, Abram JK, Lamers-Johnson E. Translating malnutrition care from the hospital to the community setting. Nutr Clin Pract 2024; 39:1292-1298. [PMID: 39105676 DOI: 10.1002/ncp.11197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Constantina Papoutsakis
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Charanya Sundar
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Lindsay Woodcock
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Jenica K Abram
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Erin Lamers-Johnson
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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16
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Huang Y, Wang H. Comment on 'Overall Mortality for Community-Dwelling Adults Over 50 Years at Risk of Malnutrition' by Gittins et al. J Cachexia Sarcopenia Muscle 2024; 15:2891-2892. [PMID: 39501910 PMCID: PMC11634522 DOI: 10.1002/jcsm.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/23/2024] [Indexed: 12/13/2024] Open
Affiliation(s)
- Yizhuan Huang
- Affiliated Sport Hospital of Chengdu Sport UniversityChengduChina
| | - Han Wang
- Affiliated Sport Hospital of Chengdu Sport UniversityChengduChina
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17
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Leira J, Maseda A, López-López R, Lorenzo-López L, Cibeira N, Lodeiro-Fernández L, Millán-Calenti JC. Determinants of Malnourishment in the Institutionalized Older Population: The FRAGILESS Study. Nutrients 2024; 16:4114. [PMID: 39683508 DOI: 10.3390/nu16234114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 11/15/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES Malnutrition is a very common condition among older people and strongly affects their quality of life. The current literature relates the presence of nutritional deficiencies to several health-related factors that usually emerge at advanced stages of life. This study aimed to assess the associations between malnutrition and its determinants in a group of institutionalized older people via the Mini Nutritional Assessment-Short Form (MNA-SF) and the full MNA. METHODS The MNA-SF was compared with the full MNA to evaluate the nutritional status of 207 older people. A multinomial logistic regression analysis was performed. RESULTS The data revealed that institutionalized older people with cognitive impairment, frailty syndrome, dysphagia, a low BMI, a high duration of institutionalization, and a low educational level are more likely to be malnourished or at risk of malnutrition. CONCLUSIONS The results reveal that the MNA or MNA-SF may not identify common determinants of malnutrition or nutritional risk. The identified determinants depend on the test. Therefore, the data obtained determine the need to use adequate nutritional screening tools to control the presence of malnutrition. Nutritional screening is essential to decrease public costs, hospitalizations, rates of disability, dependence, morbidity, and even mortality among institutionalized older people.
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Affiliation(s)
- Julia Leira
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
| | - Ana Maseda
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
| | - Rocío López-López
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
| | - Laura Lorenzo-López
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
| | - Nuria Cibeira
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
| | - Leire Lodeiro-Fernández
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
| | - José C Millán-Calenti
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain
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18
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Sarier C, Conneely M, Bowers S, Dore L, Galvin R, Griffin A. What is the level of nutrition care provided to older adults attending emergency departments? A scoping review. BMC Geriatr 2024; 24:921. [PMID: 39511468 PMCID: PMC11542468 DOI: 10.1186/s12877-024-05478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 10/16/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND Older adults often experience adverse health outcomes including malnutrition following discharge from emergency departments (ED). Discharge to community care is a transitionary time where nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways in ED settings. AIMS AND OBJECTIVES This scoping review aimed to establish and describe the level of nutrition care provided to older adults admitted and subsequently discharged from EDs. RESEARCH DESIGN Systematic searches of nine academic and grey literature databases (Medline (Ovid), Pubmed, CINAHL Complete (EBSCOhost), EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and four websites (Google, Google Scholar, NICE and LENUS) for relevant professional and organisational publications of research, policy, practice, and guidelines between January 2011 to 2023 were completed. Eligible studies included a population of older adults (≥ 65 years) with an ED attendance and subsequent community discharge, and where nutrition screening had identified malnutrition. Data were extracted on the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model and summarised descriptively. RESULTS Overall, 22 studies were included in the review. Nutrition status was screened on admission to the ED using validated tools: Mini Nutritional Assessment-Short Form (n = 13), Malnutrition Universal Screening Tool (n = 2), Short Nutritional Assessment Questionnaire (n = 2), NRS-2002 (n = 1) and the Mini Nutritional Assessment - Full Form (n = 1). A full nutrition assessment was reported by 5 studies. Only one study referred to documentation of malnutrition in healthcare records. Subsequent nutrition intervention after discharge from the ED for older adults was not described in any study. CONCLUSION While there is evidence to support malnutrition screening is taking place in EDs, there is a lack of information about subsequent nutrition care including assessment and therapy interventions. This points to the need for comprehensive exploration of nutrition care pathways, practice, policy, and research to inform models of integrated care for older persons.
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Affiliation(s)
- Cerenay Sarier
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sheila Bowers
- Department of Clinical Nutrition & Dietetics, University of Limerick Hospital Group, Dooradoyle, Limerick, Ireland
| | - Liz Dore
- Health Research Methods, Glucksman Library, University of Limerick, Librarian, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
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Isaia G, Presta R, Brunetti E, Cacciatore CM, Carbonara F, Berardo E, Villosio C, Cicerchia F, Mulatero P, Bo S, Bo M. Nutritional screening on hospital admission and one-year clinical outcomes in a prospective cohort of older patients. Clin Nutr ESPEN 2024; 64:221-228. [PMID: 39396703 DOI: 10.1016/j.clnesp.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND & AIMS Malnutrition negatively affects the prognosis and quality of life of hospitalized patients. However, there are several gaps between evidence-based knowledge and current clinical practice. Our primary aim was to describe the prevalence of malnutrition risk in a cohort of in a cohort of older inpatients; secondly, we explored its predictors and its independent impact on 12-month survival. METHODS Prospective study focused on patients aged 65 years and older consecutively admitted for any reason to the acute geriatric and general medical units of an Italian university hospital. Comprehensive geriatric assessment data, including the short form of the Mini Nutritional Assessment (MNA-SF), were collected within 48 hours of admission. The prevalence of malnutrition and risk of malnutrition according to the MNA-SF represented the main outcome. Correlations among clinical variables, nutritional status, and one-year survival were analyzed using multivariable and Cox models. RESULTS Among 594 patients (median age: 84 years, 49.5 % female), mostly living at home with moderate functional autonomy, 82.3 % were identified as probably malnourished or at risk of malnutrition according to MNA-SF (39.9 % and 42.4 %, respectively). Malnutrition and the risk of malnutrition were positively associated with living alone at home (OR 2.803, 95%CI 1.567-5.177, p < 0.001), and negatively associated with autonomy in IADL (OR 0.765, 95%CI 0.688-0.846, p < 0.001) and the best performance at HST (OR 0.901, 95%CI 0.865-0.936; p < 0.001). After 12 months, 31.8 % of patients was dead and mortality was positively correlated with malnutrition according to MNA-SF (OR 2.493, 95%CI 1.345-4.751, p = 0.004), institutionalization (OR 2.815, 95%CI 1.423-5.693, p = 0.003) and severe cognitive impairment (OR 1.701, 95%CI 1.031-2.803, p = 0.036). CONCLUSION Malnutrition is common among older inpatients upon admission, primarily influenced by their functional and cognitive status, and it is linked to a worse prognosis. Early incorporation of thorough nutritional and functional assessments into clinical practice is crucial to improve prognosis prediction and enable timely, focused interventions targeting modifiable causal factors in a patient-centered approach.
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Affiliation(s)
- Gianluca Isaia
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Roberto Presta
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Enrico Brunetti
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Clelia Maria Cacciatore
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Francesca Carbonara
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Eleonora Berardo
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Cristina Villosio
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Francesca Cicerchia
- Department of Medical Sciences, University of Turin, Turin, Italy; Section of Internal Medicine 3, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Paolo Mulatero
- Department of Medical Sciences, University of Turin, Turin, Italy; Section of Internal Medicine 3, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Simona Bo
- Department of Medical Sciences, University of Turin, Turin, Italy; Section of Dietetic and Clinical Nutrition, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
| | - Mario Bo
- Section of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
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Karam G, Abbas N, El Korh L, Abi Saad A, Nasreddine L, Ouaijan K. The Association of Cognitive Impairment and Depression with Malnutrition among Vulnerable, Community-Dwelling Older Adults: A Large Cross-Sectional Study. Geriatrics (Basel) 2024; 9:122. [PMID: 39311247 PMCID: PMC11417916 DOI: 10.3390/geriatrics9050122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/26/2024] Open
Abstract
(1) Background: Mental health issues in older adults, particularly cognitive impairment and depression, can affect nutritional status. This study investigates the prevalence of malnutrition among community-dwelling older adults at risk of social exclusion and dependency in Lebanon and its association with cognitive impairment and depression. (2) Methods: This cross-sectional study used secondary data from the TEC-MED project, involving 1410 older adults aged 60 and above in Beirut. Nutritional status was assessed with the Mini Nutritional Assessment _Short Form (MNA_SF), cognitive impairment with the AD8 Dementia Screening Interview, and depression with the Geriatric Depression Scale (GDS-15). (3) Results: 87.2% of participants were at risk of malnutrition, and 2.5% were malnourished. Cognitive impairment was present in 82.2% of the sample and 45% experienced moderate to severe depression. Malnourished individuals had significantly higher rates of cognitive impairment (96.7% vs. 57.8%) and depression (85.7% vs. 23.2%). Significant associations were found between the risk of malnutrition, decreased food intake, cognitive impairment, and depression; however, no significant association was found with BMI. Logistic regression analysis indicated that older age, cognitive impairment, and depression were significant predictors of malnutrition, while having a caregiver was protective. (4) Conclusions: The high prevalence of risk of malnutrition among vulnerable older adults with cognitive impairment and depression underscores the need for policies integrating nutritional screening into routine health check-ups for older adults.
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Affiliation(s)
- George Karam
- Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut 11002807, Lebanon; (G.K.)
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut 11002110, Lebanon
- Faculty of Medicine, Saint George University of Beirut, Beirut 11002807, Lebanon
| | - Nada Abbas
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut 11002110, Lebanon
| | - Lea El Korh
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut 11002110, Lebanon
| | - Alexander Abi Saad
- Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut 11002807, Lebanon; (G.K.)
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11072020, Lebanon
| | - Krystel Ouaijan
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11072020, Lebanon
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Bodelon C, Sung H, Mitchell EL, Deubler EL, Newton CC, Jemal A, Teras LR, Patel AV. Excess Body Weight and the Risk of Second Primary Cancers Among Cancer Survivors. JAMA Netw Open 2024; 7:e2433132. [PMID: 39287946 PMCID: PMC11409156 DOI: 10.1001/jamanetworkopen.2024.33132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Importance Little is known about the causes of second primary cancers among individuals with a history of cancer. Descriptive studies have suggested that lifestyle factors, including excess body weight, may be important. Objective To investigate whether excess body weight is associated with the risk of a second primary malignant neoplasm among cancer survivors. Design, Setting, and Participants This cohort study of adults in 21 states in the US used data from the Cancer Prevention Study II Nutrition cohort, a large prospective study that invited participants to respond to a survey in 1992 and biennial surveys starting in 1997, and who were followed-up through 2017. Eligible participants included those who received a diagnosis of a first primary nonmetastatic invasive cancer between 1992 and 2015. Data analysis occurred from September 2023 to March 2024. Exposure Body mass index (BMI), computed from self-reported height and weight at the time of the first primary cancer diagnosis (mean [SD] years to diagnosis, 1.7 [1.5] years). Main Outcome and Measures Main outcomes included a second primary cancer or an obesity-related second cancer. Cancer diagnoses were reported on biennial surveys and verified through medical record abstraction or linkage with state cancer registries. Results This cohort included 26 894 participants who received a diagnosis of a first nonmetastatic primary cancer (mean [SD] age at first cancer diagnosis, 72.2 [6.5] years; 15 920 male [59.2%]). At the time of first diagnosis, 11 497 participants (42.8%) had overweight and 4684 (17.2%) had obesity. During a median (IQR) follow-up time of 7.9 (3.4-13.6) years, 3749 (13.9%) participants received a diagnosis of a second primary cancer, of which 1243 (33.2%) were obesity-related second primary cancers. Compared with cancer survivors whose BMI was in the normal range (18.5 to <25), there was 15% increased risk of any second primary cancer for those who had overweight (25 to <30; adjusted hazard ratio [aHR], 1.15; 95% CI, 1.07-1.25) and a 34% increased risk for those who had obesity (BMI ≥30; aHR, 1.34; 95% CI, 1.21-1.48), with greater risk for obesity-related second primary cancers, including a 40% increased risk for those with overweight (aHR, 1.40; 95% CI, 1.22,-1.61) and a 78% increased risk for those with obesity (aHR, 1.78; 95% CI, 1.51-2.11). Conclusions and Relevance In this cohort study of older survivors of nonmetastatic cancer, those who had overweight or obesity at the time of their first cancer diagnosis were at higher risk of developing a second cancer, especially an obesity-related second cancer. Given the high prevalence of overweight and obesity among cancer survivors, it is important to promote survivorship care guidelines recommending weight management and increase awareness of second cancers among physicians and cancer survivors.
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Affiliation(s)
- Clara Bodelon
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Hyuna Sung
- Department of Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Ellen L Mitchell
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Emily L Deubler
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Christina C Newton
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Lauren R Teras
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
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Sanchez-Garcia E, Cruz-Jentoft AJ, Ravasco P, Suominen M, Pitkälä PK. Nutritional care in older adults: are we doing everything? An expert opinion review. Curr Med Res Opin 2024; 40:1563-1576. [PMID: 39044672 DOI: 10.1080/03007995.2024.2380007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality-of-life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.
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Affiliation(s)
- Elisabet Sanchez-Garcia
- Consultant in Geriatric Medicine, Mater Private Network, Cork, Ireland
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paula Ravasco
- Universidade Católica Portuguesa, Faculty of Medicine and Centre for Interdisciplinary Research in Health, Centre for Interdisciplinary Research Egas Moniz (CiiEM), Lisbon, Portugal
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Prof Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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23
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Struijk EA, Fung TT, Bischoff‐Ferrari HA, Willett WC, Lopez‐Garcia E. Total magnesium intake and risk of frailty in older women. J Cachexia Sarcopenia Muscle 2024; 15:1275-1282. [PMID: 38845194 PMCID: PMC11294045 DOI: 10.1002/jcsm.13450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND An adequate magnesium intake might lower the risk of frailty through its role in muscle function. METHODS We analysed data from 81 524 women aged ≥60 years participating in the Nurses' Health Study. Total magnesium intake was obtained from repeated food frequency questionnaires administered between 1984 and 2010 and self-reported information on supplementation. Frailty was defined as having at least three of the following five FRAIL scale criteria: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses and weight loss ≥ 5%. The occurrence of frailty was assessed every 4 years from 1992 to 2018. Cox proportional hazards models adjusted for lifestyle factors, medication use and dietary factors were used to assess the association between magnesium intake and frailty. RESULTS During a median follow-up of 16 years, we identified 15 477 incident cases of frailty. Women with a higher intake of total energy-adjusted magnesium had a decreased risk of frailty after adjustment for lifestyle factors, medication use and dietary factors. The relative risk (95% confidence interval) for Quintile 5 (Q5) versus Quintile 1 (Q1) was 0.88 (0.82, 0.94) (P-trend < 0.001). When only energy-adjusted magnesium from the diet was considered, the inverse association was stronger (Q5 vs. Q1: 0.68 [0.56, 0.82]; P-trend < 0.001). Those reaching the recommended daily allowance (RDA) of magnesium through diet had a 14% (9%, 19%) lower risk of frailty compared with those not meeting the RDA. CONCLUSIONS Increased intake of foods rich in magnesium was associated with a decreased risk of frailty.
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Affiliation(s)
- Ellen A. Struijk
- Department of Preventive Medicine and Public Health, School of MedicineUniversidad Autónoma de Madrid‐IdiPazMadridSpain
- CIBERESP (CIBER of Epidemiology and Public Health)MadridSpain
| | - Teresa T. Fung
- Department of NutritionSimmons UniversityBostonMAUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Heike A. Bischoff‐Ferrari
- Department of Geriatrics and Aging ResearchUniversity Hospital Zürich and University of ZürichZürichSwitzerland
- Centre on Aging and MobilityUniversity Hospital Zürich and Waid City HospitalZürichSwitzerland
| | - Walter C. Willett
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMAUSA
- Channing Division of Network Medicine, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMAUSA
| | - Esther Lopez‐Garcia
- Department of Preventive Medicine and Public Health, School of MedicineUniversidad Autónoma de Madrid‐IdiPazMadridSpain
- CIBERESP (CIBER of Epidemiology and Public Health)MadridSpain
- IMDEA/Food Institute, CEI UAM + CSICMadridSpain
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Tabue Teguo M, Letchimy L, Rinaldo L, Bonnet M, Tchero H, Simo-Tabue N, Boucaud-Maitre D. Malnutrition and Its Determinants among Older Adults Living in French Caribbean Nursing Homes: A Cross-Sectional Study. Nutrients 2024; 16:2208. [PMID: 39064650 PMCID: PMC11280315 DOI: 10.3390/nu16142208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in French Caribbean nursing homes. METHODS This cross-sectional study was taken from the KASEHAD (Karukera Study of Ageing in EHPAD) study. Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies-Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted were performed to test the association between nutritional status and both socio-demographic variables and geriatric scales. RESULTS A total of 332 older adults from six nursing homes were included in the KASEHPAD study. Among the participants, 319 had an MNA-SF score. The mean age was 81.3 ± 10.6 years, and half of the participants were men. The frequency of malnutrition (MNA-SF ≤ 7) was 27.6% (95% confidence interval (CI): 22.0-32.5) (n = 88). Based on the multivariable analysis, a low MMSE was associated with malnutrition (OR: 0.81 (0.68-0.92); p = 0.015) and there was a borderline significant link between a higher CESD score and malnutrition (OR: 1.05 (1.00-1.12); p = 0.07). CONCLUSIONS Cognitive decline and a tendency toward depression were associated with malnutrition in nursing homes in the French West Indies. Although this study cannot establish causal relationships, the identification of these three geriatric syndromes in nursing homes is crucial for preventing adverse health events.
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Affiliation(s)
- Maturin Tabue Teguo
- Equipe EPICLIV, Université des Antilles, 97233 Fort-de-France, France; (N.S.-T.); (D.B.-M.)
- Centre Hospitalo-Universitaire de Martinique, 97261 Fort-de-France, France; (L.L.); (M.B.)
- Inserm U1219 Bordeaux Population Health Center, University of Bordeaux, 33405 Talence, France
| | - Laurys Letchimy
- Centre Hospitalo-Universitaire de Martinique, 97261 Fort-de-France, France; (L.L.); (M.B.)
| | - Leila Rinaldo
- Centre Hospitalo-Universitaire de Guadeloupe, 97110 Pointe-à-Pitre, France;
| | - Michel Bonnet
- Centre Hospitalo-Universitaire de Martinique, 97261 Fort-de-France, France; (L.L.); (M.B.)
| | - Huidi Tchero
- Centre Hospitalier Louis Constant Fleming, 97150 Saint Martin, France;
| | - Nadine Simo-Tabue
- Equipe EPICLIV, Université des Antilles, 97233 Fort-de-France, France; (N.S.-T.); (D.B.-M.)
- Centre Hospitalo-Universitaire de Martinique, 97261 Fort-de-France, France; (L.L.); (M.B.)
| | - Denis Boucaud-Maitre
- Equipe EPICLIV, Université des Antilles, 97233 Fort-de-France, France; (N.S.-T.); (D.B.-M.)
- Centre Hospitalier Le Vinatier, 69500 Bron, France
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25
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Kubo Y, Fujii K, Noguchi T, Hayashi T, Tomiyama N, Ochi A, Hayashi H. Longitudinal association between oral function and underweight onset among community-dwelling older adults: Role of regular self-weighing. SPECIAL CARE IN DENTISTRY 2024; 44:1090-1096. [PMID: 38192111 DOI: 10.1111/scd.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024]
Abstract
AIMS Regular self-weighing is effective in weight management and may help to mitigate the risk of underweight among older adults. We examined which factors of oral function are associated with a risk for underweight among community-dwelling older adults and whether regular self-weighing can mitigate that risk. METHODS This was a cohort study. Self-administered questionnaires were mailed to 7665 older adults in March 2019 (response rate 74.3%) and 7591 in March 2020 (response rate 74.7%). Among those who responded to both surveys, 3594 older adults who were not underweight in March 2019 were included (follow-up rate: 59.2%). We examined the association between dysphagia, poor masticatory function, and dry mouth and the development of underweight, and whether regular self-weighing reduced the risk for underweight. RESULTS The average age ± standard deviation of participants was 71.1 ± 3.4 years. There was a significant association between swallowing difficulty and the occurrence of underweight (odds ratio = 1.65, p = .012). However, this relationship did not differ significantly with regular self-weighing (p = .477). CONCLUSIONS These study findings suggest that to prevent underweight among community-dwelling older adults, it is important to focus on those with poor swallowing function.
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Affiliation(s)
- Yuta Kubo
- Division of Occupational Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Keisuke Fujii
- Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
- Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Naoki Tomiyama
- Division of Occupational Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Akira Ochi
- Division of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Hiroyuki Hayashi
- Division of Occupational Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
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Chen Q, Shen J, Gao Y, Wang XX, Jia QY, Li M. Nutritional status of the older adults in nursing homes: A cross-sectional study. J Clin Nurs 2024; 33:2640-2648. [PMID: 38185924 DOI: 10.1111/jocn.16978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
AIM AND OBJECTIVES To investigate the nutritional status of older adults in nursing homes in Chongqing, China, compare and analyse the differences in the physical condition, cognitive function and social-related factors of older adults with different nutritional statuses. BACKGROUND Malnurtition in the older people has become a priority concer, and the incidence and factors associated with malnutrition vary somewhat by healthcare setting. In Chongqing ,China, there is lack of research on malnutrition of the older people in nursing homes. Here, we investigated the incidence of malnutrition and analysed the associated factors. DESIGN A cross-sectional study. METHODS From January to April 2023, a cross-sectional survey was conducted in three nursing homes in Chongqing, China. Participants completed a series of questionnaires, including the Demographic Information Questionnaire which included age, gender, education level, previous occupation, marital status and other information. The survey also included validated non-demographic instruments [Short-Form Mini-Nutritional Assessment (MNA-SF), Barthel Index (BI) and Mini-mental State Examination (MMSE)] to identify related impact factors. The Guidelines for cross-sectional studies were used in this study (Data S1). RESULTS 209 older adults aged 60 and over participated in this study, of whom 121 were women and 88 were men. The average (SD) age of the participants was 84.7 (6.3) years. Of the participants, 46.4% were classified as well nourished. About 39.2% were at risk of malnutrition and 14.4% were malnourished. Compared to those who were well nourished, those who were malnourished or at risk of becoming malnourished were more likely to suffer from comorbidities, polypharmacy, a higher risk of falling, ADL dependence and to receive more nutritional interventions. However, there are no significant differences after adjustment for age, education level, previous occupation, marital status, length of stay, and type of health care payment. CONCLUSION Malnutrition is a common problem among older adults innursing homes in Chongqing, China. There are certain differences in physical conditions and nutritional interventions among older adults withdifferent nutritional status. PUBLIC CONTRIBUTION This study suggests that the problem of malnutrition is very prominent in nursing homes in Chongqing, China. Cognitive impairment, impaired activities of daily living, fall risk and nutritional intervention need to be prevalent in older adults with (risk of) malnutrition.
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Affiliation(s)
- Qiu Chen
- Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Jun Shen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Gao
- Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Xin Xia Wang
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Qian Ying Jia
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Miao Li
- Chongqing Medical University, Chongqing, China
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Boucaud-Maitre D, Simo-Tabue N, Mounsamy L, Rambhojan C, Letchimy L, Rinaldo L, Dartigues JF, Amieva H, Dramé M, Tabué-Teguo M. Malnutrition and its determinants among older adults living in foster families in Guadeloupe (French West Indies). A cross-sectional study. PLoS One 2024; 19:e0304998. [PMID: 38905295 PMCID: PMC11192354 DOI: 10.1371/journal.pone.0304998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). METHODS This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. RESULTS Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers'rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult's rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. CONCLUSION Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Nadine Simo-Tabue
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Ludwig Mounsamy
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | | | - Laurys Letchimy
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Leila Rinaldo
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | | | - Hélène Amieva
- Inserm U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Moustapha Dramé
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Maturin Tabué-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Lindqvist S, Olai L, Hägglund P. Factors associated with malnutrition among older people in Swedish short-term care: Poor oral health, dysphagia and mortality. Int J Dent Hyg 2024. [PMID: 38825769 DOI: 10.1111/idh.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES To investigate the relationship between malnutrition and potential contributing factors such as poor oral health, dysphagia and mortality among older people in short-term care. METHODS This cross-sectional study is a part of the multidisciplinary multicentre project SOFIA (Swallowing function, Oral health and Food Intake in old Age), which includes older people (≥65 years) in 36 short-term care units in five regions of Sweden. Nutritional status was measured with version II of the Minimal Eating Observation and Nutrition Form (MEONF-II), oral health with the Revised Oral Assessment Guide (ROAG), dysphagia with a water swallow test, and the mortality rate was followed for 1 year. Data were analysed using descriptive analysis and logistic regression models to calculate odds ratios for the association between malnutrition and these factors. RESULTS Among the 391 participants, the median age was 84 years and 53.3% were women. Mortality rate was 25.1% within 1 year in the total group, and was higher among malnourished participants than among their well-nourished counterparts. Severe dysphagia (OR: 6.51, 95% CI: 2.40-17.68), poor oral health (OR: 5.73, 95% CI: 2.33-14.09) and female gender (OR: 2.2, 95% CI: 1.24-3.93) were independently associated with malnutrition. CONCLUSION Mortality rate was higher among malnourished people than those who were well nourished. Severe dysphagia, poor oral health and female gender was predictors of malnutrition among older people in short-term care. These health risks should be given more attention in short-term care with early identification.
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Affiliation(s)
- Susanne Lindqvist
- Department of Odontology, Dental Hygienist Education, Umeå University, Umeå, Sweden
| | - Lena Olai
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Patricia Hägglund
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umea, Sweden
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Wu X, Shen J, Zhang X, Liu B, Liu M, Shi J, Qian S, Zong G, Lai H, Yuan C, Tonetti MS. The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function. J Clin Periodontol 2024; 51:691-701. [PMID: 38348766 DOI: 10.1111/jcpe.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 05/16/2024]
Abstract
AIM Emerging evidence points to a two-way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause-effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis. MATERIALS AND METHODS A single calibrated examiner determined the periodontitis stage of a consecutive sample of 241 Chinese subjects reporting for tooth replacement. Their masticatory function was quantified by the mixing ability of a two-colour chewing gum. Validated food frequency questionnaires were used to calculate the intake of 33 food group items by an experienced calibrated rater. After verification of assumptions, visual structural equation modeling was performed with Amos 23. The consistency of results and the potential modifying effect of age were assessed in 9043 subjects from the NHANES database. RESULTS Highly significant models were constructed using periodontitis stage and age as exogenous factors. Periodontitis stage diagnosis significantly affected the number of posterior FTUs and oral health-related quality of life (OHRQoL, path coefficient [PC] = -0.55 and -0.20, p < .05, respectively). In the model, FTUs also had an independent effect on OHRQoL (PC = 0.23, p < .05). FTUs determined the level of masticatory function (PC = -0.38, p < .05), which in turn affected vegetable intake but not fruit or meat intake (PC = -0.18, p < .0.5, PC = 0.06, NS and PC = 0.11, NS, respectively). The effect of age was significant for vegetable and meat intake and was also correlated with periodontitis stage diagnosis. Analysis of the NHANES database confirmed the negative impact of periodontitis on the number of occluding pairs and vegetable consumption for the 18-44, 45-60 and >60 age groups. CONCLUSIONS Periodontitis showed a potential cause-effect pathway affecting vegetable intake across cultures and age groups. The size of the effect is potentially of clinical and public health significance. Additional studies, including intervention trials, are required to test this potential mechanism linking oral health to nutrition.
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Affiliation(s)
- Xinyu Wu
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jie Shen
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Zhang
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Beilei Liu
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Min Liu
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junyu Shi
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shujiao Qian
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Hongchang Lai
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maurizio S Tonetti
- Shanghai Perio-Implant Innovation Center, Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- European Research Group on Periodontology, Genova, Italy
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Kim G, Hwang M, Lee S, Park YH. Malnutrition and its associated factors among community-dwelling older men living alone. Nutr Res Pract 2024; 18:400-411. [PMID: 38854473 PMCID: PMC11156769 DOI: 10.4162/nrp.2024.18.3.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND/OBJECTIVES Older men who live alone are more vulnerable to poor nutrition. However, little attention has been paid to malnutrition among this population. This study aimed to examine malnutrition and its associated factors among community-dwelling older men living alone. SUBJECTS/METHODS This cross-sectional descriptive study used cohort data of community-dwelling older adults living alone in South Korea. A total of 230 older men aged 65 and over were included in this study. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form. Multidimensional factors (sociodemographic, health-related, psychosocial, and lifestyle characteristics) were evaluated. Hierarchical logistic regression analyses were conducted to identify the malnutrition-related factors. RESULTS The prevalence of malnutrition was 32.2% in older men living alone. Low income (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.01-5.90), polypharmacy (OR, 2.23; 95% CI, 1.16-4.28), suicidal ideation (OR, 2.13; 95% CI, 1.02-4.45), meal skipping (OR, 3.26; 95% CI, 1.60-6.64), and smoking (OR, 2.86; 95% CI, 1.43-5.73) were significantly associated with malnutrition. CONCLUSION Malnutrition is a severe health problem in older men living alone. This study highlights the importance of comprehensive and tailored interventions to mitigate malnutrition among older men living alone.
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Affiliation(s)
- Gahye Kim
- College of Nursing, Seoul National University, Seoul 03080, Korea
| | - Minhwa Hwang
- College of Nursing, Seoul National University, Seoul 03080, Korea
| | - Seonghyeon Lee
- College of Nursing, Seoul National University, Seoul 03080, Korea
| | - Yeon-Hwan Park
- College of Nursing, Seoul National University, Seoul 03080, Korea
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea
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Javorszky SM, Palli C, Domkar S, Iglseder B. Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review. BMC Geriatr 2024; 24:445. [PMID: 38773449 PMCID: PMC11110417 DOI: 10.1186/s12877-024-05070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.
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Affiliation(s)
- Susanne M Javorszky
- Institute of Nursing Science and Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria.
| | - Christoph Palli
- FH Joanneum, Institute of Health and Nursing, Alte Post Straße 149, 8020, Graz, Austria
| | - Susanne Domkar
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
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French C, Burden S, Stanmore E. Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e50922. [PMID: 38687981 PMCID: PMC11094602 DOI: 10.2196/50922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. OBJECTIVE This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). METHODS This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). RESULTS Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants' self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. CONCLUSIONS The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. TRIAL REGISTRATION ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50922.
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Affiliation(s)
- Chloe French
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sorrel Burden
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Emma Stanmore
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Zhong W, Zhao A, Wei X, Mao S, Li P, Shen Q, Zhang H, Jiang H, Wang P, Zhang Y. The Effect of Sn-2 Palmitate on Blood Glucose, Lipids and Body Composition in Middle-Aged and Elderly Adults: A Randomized, Double-Blinded Controlled Trial. Nutrients 2024; 16:973. [PMID: 38613008 PMCID: PMC11013204 DOI: 10.3390/nu16070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Sn-2 palmitate is widely used in infant formula. However, little is known about its effects on metabolism and body composition in middle-aged and elderly adults. In a double-blinded, randomized controlled trial, we enrolled Chinese adults aged 45-75 years with self-reported constipation. Individuals were randomly assigned in a 1:1 ratio to a 1,3-dioleoyl-2-palmitoyl-glycerol (OPO)-enriched oil (66% palmitic acid in the sn-2 position) or a control vegetable oil (24% palmitic acid in the sn-2 position) daily for 24 weeks. Skim milk powder was used as the carrier for both fats. Interviews and body composition were performed at baseline, week 4, week 12 and week 24. A fasting blood draw was taken except at week 4. This study was a secondary analysis and considered exploratory. A total of 111 adults (83 women and 28 men, mean age 64.2 ± 7.0 years) were enrolled, of whom 53 were assigned to the OPO group and 57 to the control group. During the intervention, blood glucose, triglyceride, the triglyceride-glucose index, total cholesterol, low-density lipoprotein cholesterol and remnant cholesterol remained stable, while high-density lipoprotein cholesterol decreased in both groups (p = 0.003). No differences in change were observed between the groups (all p > 0.05). From baseline to week 24, the level of visceral fat increased slightly (p = 0.017), while body weight, total body water, protein, soft lean mass, fat-free mass, skeletal muscle and skeletal muscle mass index (SMI) decreased in two groups (p < 0.01). At weeks 4, 12 and 24, the SMI decreased less in the OPO group than in the control group, with a trend towards significance (p = 0.090). A 24-week daily intake of sn-2-palmitate-enriched oil had no adverse impact on fasting blood glucose, lipids and body composition compared with the control vegetable oil in Chinese adults (funded by Chinese Nutrition Society National Nutrition Science Research Grant, National Key Research and Development Program of China and Wilmar (Shanghai) Biotechnology Research & Development Center Co., Ltd.; ChiCTR1900026480).
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Affiliation(s)
- Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (W.Z.); (S.M.); (P.L.); (Q.S.)
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Xuetao Wei
- Department of Toxicology, School of Public Health, Peking University, Beijing 100191, China;
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (W.Z.); (S.M.); (P.L.); (Q.S.)
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (W.Z.); (S.M.); (P.L.); (Q.S.)
| | - Qianqian Shen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (W.Z.); (S.M.); (P.L.); (Q.S.)
| | - Hong Zhang
- Wilmar (Shanghai) Biotechnology Research & Development Center Co., Ltd., Shanghai 200137, China;
| | - Hua Jiang
- School of Nursing, Peking University, Beijing 100191, China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (W.Z.); (S.M.); (P.L.); (Q.S.)
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Qing H, Zhang XD, Yang E, Li HX, Wei YL, Chen W, Guo SY, Tang SF. Nutritional status and nutritional intervention of older inpatients in China. J Nutr Health Aging 2024; 28:100169. [PMID: 38308922 DOI: 10.1016/j.jnha.2024.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Malnutrition is a critical issue among older inpatients, yet limited large-scale research related to this issue has been conducted in China. This study aimed to examine the nutritional status and support of older inpatients in China, assess the associations between disease categories and malnutrition on admission, and explore effective nutritional intervention. METHODS A total of 24,139 older participants from the China Nutrition Fundamental Data 2020 Project were included. Malnutrition was measured by the Global Leadership Initiative on Malnutrition criteria. Adjusted odds ratios (aORs) were calculated using logistic analysis. RESULTS The overall frequency of malnutrition on admission was 18.9%. Participants with infections were more likely to have malnutrition (aOR = 1.929, 95% CI 1.486-2.504). Risks that were also noted for malnutrition included neoplasms (aOR = 1.822, 95% CI 1.697-1.957), hemic and lymphatic diseases (aOR = 1.671, 95% CI 1.361-2.051), nervous system diseases (aOR = 1.222, 95% CI 1.126-1.326), respiratory diseases (aOR = 1.613, 95% CI 1.490-1.746), and digestive system diseases (aOR = 1.462, 95% CI 1.357-1.577). Further, 32.26% inpatients with malnutrition during hospitalization didn't receive nutritional support. Oral nutrition supplements, enteral tube feeding, and parenteral nutrition were associated with stable or improved nutritional status. CONCLUSIONS Older inpatients were at a high risk for malnutrition but did not receive adequate nutritional intervention. More resources and attention need to be devoted to the nutritional status of older inpatients and targeted nutritional support.
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Affiliation(s)
- Hua Qing
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xu-Dong Zhang
- National Institute of Hospital Administration, National Health Commission, Beijing 100048, China
| | - En Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui-Xin Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yi-Lin Wei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Yan Guo
- National Institute of Hospital Administration, National Health Commission, Beijing 100048, China.
| | - Shang-Feng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Ruiz-Rosso R, Moreno-Cámara S, Gutiérrez-Sánchez B, da-Silva-Domingues H, Del-Pino-Casado R, Palomino-Moral PÁ. Factors Influencing Nutritional Status in Hospitalized Individuals Aged 70 and Above. Nutrients 2024; 16:645. [PMID: 38474773 PMCID: PMC10934742 DOI: 10.3390/nu16050645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Older adults are vulnerable to malnutrition due to physical, psychological, and social factors. Malnutrition, a prevalent and modifiable issue in this population, is associated with an elevated risk of adverse clinical outcomes. The purpose of the study is to assess the nutritional status of older adult individuals admitted to a general hospital and examine its correlation with socio-health and demographic variables. METHODS The study included 239 individuals aged 70 and above, employing a cross-sectional descriptive observational approach with a convenience sampling method. Sociodemographic information was gathered, and variables such as cognitive impairment, functional capacity, comorbidities, medication consumption, and nutritional status were evaluated. Statistical analysis involved descriptive calculations, bivariate analysis, and multivariate analysis, utilizing binary logistic regression. RESULTS Approximately half of the sample were at risk of malnutrition, with a more notable prevalence among women. Factors such as age (OR = 1.04), cognitive impairment (OR = 1.06), functional dependence (OR = 0.96), and comorbidities (OR = 1.08) were linked to an elevated risk of malnutrition. In our regression model, age, cognitive impairment, and drug consumption emerged as significant predictors of malnutrition risk. CONCLUSIONS Individuals aged 70 and above have a notably high prevalence of malnutrition risk, particularly among those experiencing functional dependence and cognitive impairment. In our sample, cognitive impairment in older adults, coupled with above-median drug consumption, emerges as the primary predictor for malnutrition risk.
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Affiliation(s)
| | | | | | - Henrique da-Silva-Domingues
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.R.-R.); (S.M.-C.); (B.G.-S.); (R.D.-P.-C.); (P.Á.P.-M.)
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Wijnhoven HAH, Kok AAL, Schaap LA, Hoekstra T, van Stralen MM, Twisk JWR, Visser M. The associations between sleep quality, mood, pain and appetite in community dwelling older adults: a daily experience study. J Nutr Health Aging 2024; 28:100028. [PMID: 38388106 DOI: 10.1016/j.jnha.2023.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/29/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To investigate the daily life experiences of sleep, mood, and pain in relation to appetite in community-dwelling older adults aged 75 years and older, stratified by sex. DESIGN Existing data from a daily experience study embedded in the Longitudinal Aging Study Amsterdam (LASA) among the oldest-old (≥75 years). SETTING LASA is an ongoing cohort study of a nationally representative sample of older adults aged ≥55 years from three culturally distinct regions in the Netherlands. PARTICIPANTS 434 community-dwelling older adults aged ≥75 years. MEASUREMENTS Participants filled-out a one-week diary on daily experience of pain, mood, last night sleep (10-point Likert scale), and appetite (5-point Likert scale) on five measurement occasions between 2016 and 2021. (Hybrid) linear mixed models were used to investigate overall, within-subject and between-subject association between mood, sleep, and pain (independent variables) and appetite (dependent variable), while correcting between-subject associations for season, age, educational level, partner status, body mass index, alcohol consumption, physical activity level, smoking status, chronic diseases and use of nervous system medication, stratified by sex. RESULTS Averaged over all days, males reported a poor appetite on 12% of the days and females on 19% of the days. Statistically significant between-subject associations with a poorer appetite were found for lower mood (unstandardized b = 0.084 [95% CI 0.043-0.126] (males), (b = 0.126 [95% CI 0.082-0.170] (females)), poorer sleep (b = 0.045 [95% CI 0.007-0.083] (males), (b = 0.51 [95% CI 0.017-0.085] (females)) and more severe pain in males only (b = 0.026 [95% CI 0.002-0.051]). Except for pain, within-subject associations were somewhat weaker: mood: b = 0.038 [95% CI 0.016-0.060] (males), (b = 0.082 [95% CI 0.061-0.104] (females)); sleep: b = 0.029 [95% CI 0.008-0.050] (males), (b = 0.15 [95% CI 0.005-0.025] (females)); and pain (b = 0.032 [95% CI 0.004-0.059] (males)). CONCLUSIONS This study found that poor sleep, low mood (more strongly in females) and more severe pain (males only) are associated with poor appetite in older adults on a daily level both within and between persons. Sex differences in factors related to poor appetite should be considered in future research.
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Affiliation(s)
- Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Almar A L Kok
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Methodology Programme, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute, Aging & Later Life Programme, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Methodology Programme, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Rollins CJ, Verdell A. Nutrition in Older Adults. GERIATRIC MEDICINE 2024:249-296. [DOI: 10.1007/978-3-030-74720-6_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Wu XS, Miles A, Braakhuis A. Malnutrition in aged care: interplay between dysphagia and diet. Curr Opin Otolaryngol Head Neck Surg 2023; 31:350-356. [PMID: 37523160 DOI: 10.1097/moo.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW This review aims to deliver expert insights on the current advances and challenges in managing malnutrition in aged care settings, with a specific emphasis on the interaction between dysphagia and diet. RECENT FINDINGS Several reviews identify the high prevalence of dysphagia in aged care facilities and highlight the correlation between dysphagia and malnutrition. Recent studies underscore the importance of nutrition and cancer screening and assessment, yet highlight the lack of consensus on the definitive tools to be used. There is a growth in employing innovative implementations for enhancing swallowing function and optimizing texture-modified foods. SUMMARY Early identification and strategic interventions are vital for managing malnutrition and dysphagia in aged care facilities, as these conditions are widespread and lead to a higher risk of complications. Although nutritional strategies have shown potential in enhancing oral intake for residents requiring texture-modified foods, lack of investigation on functional outcomes and long-term impact have been highlighted, emphasizing the need for continued research and development of effective assessment tools and targeted interventions to optimize the care for this at-risk group.
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Affiliation(s)
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Grafton, Auckland, USA
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Roberts S, Gomes K, Rattray M. Dietitians' perceptions of identifying and managing malnutrition and frailty in the community: A mixed-methods study. Nutr Diet 2023; 80:511-520. [PMID: 36843203 DOI: 10.1111/1747-0080.12799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 02/28/2023]
Abstract
AIM This study aimed to explore dietitians' perceptions of their current practice for identifying and managing malnutrition/frailty in the community, to fill an evidence gap. METHODS This mixed-methods study involved an online survey distributed to dietitians practising in Australia and New Zealand, and semi-structured interviews with a subset of survey participants. The 34-item survey and interviews explored dietitians' practices for identifying/managing malnutrition and frailty, focusing on the community setting. Survey data were analysed descriptively and some simple association tests were conducted using statistical software. Interview data were analysed thematically. RESULTS Of the 186 survey respondents, 18 also participated in an interview. Screening and assessment for malnutrition varied in the community and occurred rarely for frailty. Dietitians reported practising person-centred care by involving clients/carers/family in setting goals and selecting nutrition interventions. Key barriers to providing nutrition care to community-dwelling adults included a lack of awareness/understanding of nutrition by clients and other health professionals (leading to them not participating in or valuing nutrition care), lack of time and resources in the community, and client access to foods/supplements. Enablers included engaging family members/carers and coordinating with other health professionals in nutrition care planning. CONCLUSION Reported practices for identifying malnutrition and frailty vary in the community, suggesting guidance may be needed for health professionals in this setting. Dietitians reported using person-centred care with malnourished and frail clients but encountered barriers in community settings. Engaging family members/carers and multidisciplinary colleagues may help overcome some of these barriers.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kristin Gomes
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Zanetti M, Veronese N, Riso S, Boccardi V, Bolli C, Cintoni M, Francesco VD, Mazza L, Onfiani G, Zenaro D, Pilotto A. Polypharmacy and malnutrition in older people: A narrative review. Nutrition 2023; 115:112134. [PMID: 37453210 DOI: 10.1016/j.nut.2023.112134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Polypharmacy is the simultaneous use of multiple medicines, usually more than five. Polypharmacy is highly prevalent among older individuals and is associated with several adverse health outcomes, including frailty. The role of polypharmacy in nutritional status seems to be crucial: although a clear association between polypharmacy and malnutrition has been widely reported in older people, the magnitude of the effect of increased number of drugs in combination with their type on the risk for malnutrition remains to be largely explored. Therefore, this review aims to discuss the association between polypharmacy and malnutrition in older people and to provide suggestions for its management. Polypharmacy is prevalent among malnourished frail patients, and the relative contribution of comorbidities and polypharmacy to malnutrition is difficult to be determined. Several mechanisms by which commonly used medications have the potential to affect nutritional status have been identified and described. Deprescribing (i.e., a systematic process of identification and discontinuation of drugs or a reduction of drug regimens) could be an essential step for minimizing the effects of polypharmacy on malnutrition. In this regard, the literature suggests that in older patients taking several medications, the best method to solve this problem is the comprehensive geriatric assessment, based on a holistic approach, including drug review, to find potential unnecessary and inappropriate medications. Nutritional and deprescribing interventions must be tailored to patient needs and to the local context to overcome barriers when applied in different settings.
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Affiliation(s)
- Michela Zanetti
- Geriatric Clinic, Maggiore Hospital of Trieste, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carolina Bolli
- Clinical Nutrition Unit, Presidio Ospedaliero "San Filippo Neri", Rome, Italy
| | - Marco Cintoni
- Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Liliana Mazza
- Department of Integration, Azienda USL di Bologna, Bologna, Italy
| | - Giovanna Onfiani
- Clinical Nutrition Unit, Complex Structure of Endocrinology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Zenaro
- Direzione Tecnica Socio Sanitaria Coopselios, Reggio Emilia, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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Tani Y, Yamamoto T, Kusama T, Kinugawa A, Aida J, Fujiwara T, Kondo K. Cooking skills modify the association between oral health and mortality. Age Ageing 2023; 52:afad180. [PMID: 37725969 DOI: 10.1093/ageing/afad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Indexed: 09/21/2023] Open
Abstract
Poor oral health has been linked to an increased risk of mortality. People with good cooking skills may be able to cope with problems caused by oral dysfunction, such as restricted food choice. This study investigated whether cooking skills modified the association between oral health status and mortality. A 3-year follow-up was conducted among participants of the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65-101 years. Oral health assessment comprised number of teeth and three oral functions (awareness of swallowing difficulty, decline in masticatory function, and dry mouth). Cooking skills were assessed using a valid scale adapted for Japanese participants. Mortality from 2016 to 2019 was analysed for 10,121 respondents. Cox regression models were used to estimate hazard ratios for mortality risk adjusting for potential confounders, including sociodemographic factors and health status. During the follow-up, there were 488 deaths (4.8% of all participants). Both fewer teeth and poor oral function were associated with a greater mortality risk. Cooking skills modified the association only for oral function. Stratification by cooking skill score showed that the hazard ratios for ≥2 oral difficulties (vs. none) was 2.06 (95% confidence interval: 1.43-2.96) among those with low cooking skills and 1.25 (95% confidence interval: 0.92-1.71) among those with high cooking skills after adjusting for potential confounders. Improving cooking skills may be key to mitigating health risks owing to poor oral functions.
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Affiliation(s)
- Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takafumi Yamamoto
- Department of Health Promotion, National Institute of Public Health, Wako-shi, Saitama 351-0197, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Taro Kusama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Anna Kinugawa
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Katsunori Kondo
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Scienc, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8672, Japan
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Keller HH, Trinca V. Determinants of a decline in a nutrition risk measure differ by baseline high nutrition risk status: targeting nutrition risk screening for frailty prevention in the Canadian Longitudinal Study on Aging (CLSA). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:593-612. [PMID: 36947396 PMCID: PMC10349003 DOI: 10.17269/s41997-023-00745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Nutrition risk is a key component of frailty and screening, and treatment of nutrition risk is part of frailty management. This study identified the determinants of a 3-year decline in nutrition risk (measured by SCREEN-8) for older adults stratified by risk status at baseline. METHODS Secondary data analysis of the comprehensive cohort sample of the Canadian Longitudinal Study on Aging (CLSA) (n = 5031) with complete data for covariates at baseline and 3-year follow-up. Using a conceptual model to define covariates, determinants of a change in nutrition risk score as measured by SCREEN-8 (lower score indicates greater risk) were identified for those not at risk at baseline and those at high risk at baseline using multivariable regression. RESULTS Models stratified by baseline nutrition risk were significant. Notable factors associated with a decrease in SCREEN-8 for those not at risk at baseline were mental health diagnoses (- 0.83; CI [- 1.44, -0.22]), living alone at follow-up (- 1.98; CI [- 3.40, -0.56]), and lack of dental care at both timepoints (- 0.91; CI [- 1.62, -0.20]) and at follow-up only (- 1.32; CI [- 2.45, -0.19]). For those at high nutrition risk at baseline, decline in activities of daily living (- 2.56; CI [- 4.36, -0.77]) and low chair-rise scores (- 1.98; CI [- 3.33, - 0.63]) were associated with lower SCREEN-8 scores at follow-up. CONCLUSION Determinants of change in SCREEN-8 scores are different for those with no risk and those who are already at high risk, suggesting targeted approaches are needed for screening and treatment of nutrition risk in primary care.
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Affiliation(s)
- Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Gajda R, Jeżewska-Zychowicz M. Relationship between Food Insecurity and Nutritional Risk among Older Adults in Poland-A Preliminary Study. Nutrients 2023; 15:3232. [PMID: 37513650 PMCID: PMC10385899 DOI: 10.3390/nu15143232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Aging populations may be associated with increased nutritional risk, malnutrition, and food insecurity. This study aims to examine the relationship between food insecurity and nutritional risk, taking into account selected characteristics of the study group, and factors describing nutritional risk. It was conducted between May and July 2021, among 417 people aged 60 and older, in two regions of Poland. Questions from the SCREEN-14 questionnaire were used to assess nutritional risk. Selected questions from the HFSS questionnaire (U.S. Household Food Security Survey Module) concerning the elderly were used to assess food insecurity. A K-means cluster analysis was used to separate homogeneous clusters into food security indicators and nutritional risk factors. The Mann-Whitney U test and Kruskal-Wallis test were used to compare mean values between groups, and the Chi-square test was used to verify the differences. Two clusters were distinguished: I-"low food security and high nutritional risk" and II-"high food security and low nutritional risk". Cluster I included people aged 60-65, and over 75, living in urban areas, living alone or with family, with unfavorable economic situations and family relationships. Cluster II was composed of people aged 71-75, who were rural residents, living with a partner, with favorable economic situations and family relations. The vast majority of nutritional risk factors were found in Cluster I and among those at high nutritional risk. The largest number of people were affected by such nutritional risk factors such as difficulty in chewing or biting, loss in appetite, skipping meals, and perceiving one's weight as abnormal. Moreover, the group of people most significantly affected by high nutritional risk were in unfavorable economic situations, had poor family relationships, lived alone or with family, rated their health as worse than their peers, were overweight and obese, had metabolic disease, or impeding mobility. The results obtained can be applied to the planning of social and health policies for the elderly in Poland.
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Affiliation(s)
- Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
| | - Marzena Jeżewska-Zychowicz
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska 159C, 02-776 Warsaw, Poland
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Stahl J, Hauser C, Simon M, Valenta S, Favez L, Zúñiga F. Institutional Factors Associated with Residents' Malnutrition in Nursing Homes: A Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1074-1081. [PMID: 36934773 DOI: 10.1016/j.jamda.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Malnutrition is frequent in older adults, associated with increased morbidity, mortality, and higher costs. Nursing home residents are especially affected, and evidence on institutional factors associated with malnutrition is limited. We calculated the prevalence of malnutrition in Swiss nursing home residents and investigated which structure and process indicators of nursing homes are associated with residents' malnutrition. DESIGN Subanalysis of the Swiss Nursing Homes Human Resources Project 2018, a multicenter, cross-sectional study conducted from 2018 to 2019 in Switzerland. SETTING AND PARTICIPANTS This study included 76 nursing homes with a total of 5047 residents. METHODS Malnutrition was defined as a loss of bodyweight of ≥5% in the last 30 days or ≥10% in the last 180 days. Binomial generalized estimating equations (GEE) were applied to examine the association between malnutrition and structural (staffing ratio, grade mix, presence of a dietician, malnutrition guideline, support during mealtimes) and process indicators (awareness of malnutrition, food administration process). GEE models were adjusted for institutional (profit status, facility size) and specific resident characteristics. RESULTS The prevalence of residents with malnutrition was 5%. A higher percentage of units per nursing home having a guideline on prevention and treatment of malnutrition was significantly associated with more residents with weight loss (OR 2.47, 95% CI 1.31-4.66, P = .005). Not having a dietician in a nursing home was significantly associated with a higher rate of residents with weight loss (OR 1.60, 95% CI 1.09-2.35, P = .016). CONCLUSIONS AND IMPLICATIONS Having a dietician as part of a multidisciplinary team in a nursing home is an important step to address the problem of residents' malnutrition. Further research is needed to clarify the role of a guideline on prevention and treatment of malnutrition to improve the quality of care in nursing homes.
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Affiliation(s)
- Jonathan Stahl
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Nursing Development, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Claudia Hauser
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Breast, Abdomen, Pelvis, University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sabine Valenta
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Lauriane Favez
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.
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Hernández-Olivas E, Muñoz-Pina S, Andrés A, Heredia A. The impact of age-related digestive disorders on in vitro digestibility of macronutrients and bioaccessibility of minor components of chia seeds. Food Res Int 2023; 169:112874. [PMID: 37254324 DOI: 10.1016/j.foodres.2023.112874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023]
Abstract
Gastrointestinal (GI) functions deteriorate with age, primarily affecting protein digestion. The consumption of chia seeds may be helpful for the elderly because they offer a vegetable-based source of proteins, healthy lipids, fibre and micronutrients. The impact of common age-related GI deterioration on chia seed digestibility was assessed using in vitro digestion models. The goal was to study the potential of chia seeds as part of the diet of seniors. Deterioration in the oral, gastric and intestinal stages of digestion was cumulatively assessed in three digestion models: E1 (deterioration in oral conditions), E2 (deterioration in oral and gastric conditions) and E3 (deterioration in oral, gastric and intestinal conditions). Less efficient chewing (E1) decreased proteolysis, lipolysis and antioxidant capacity (p < 0.05). In contrast, deterioration in gastric functions seemed to affect only total polyphenolic content. Finally, in the model simulating the greatest deterioration in digestive functions (E3), all measured variables were negatively affected (proteolysis, lipolysis, amino acid release, total phenolic content, antioxidant capacity and calcium). Calcium bioaccessibility fell by 24 % with a decrease in pancreatic enzymes and bile secretion (E3). Age-related reduced digestive function did not affect the ratio of essential to non-essential amino acids in the digested samples in any case. However, under suboptimal GI conditions (E3), amino acids such as valine, leucine and isoleucine, which are important for sarcopenia prevention in the elderly, fell by 39 %, 49 % and 44 %, respectively. These findings might be helpful for further in vitro studies of chia seeds as a possible food ingredient. They may also be useful for the development of more targeted nutrition strategies in the elderly.
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Affiliation(s)
- Ever Hernández-Olivas
- Instituto Universitario de Ingeniería de Alimentos para el Desarrollo (IUIAD-UPV), Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Sara Muñoz-Pina
- Instituto Universitario de Ingeniería de Alimentos para el Desarrollo (IUIAD-UPV), Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
| | - Ana Andrés
- Instituto Universitario de Ingeniería de Alimentos para el Desarrollo (IUIAD-UPV), Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Ana Heredia
- Instituto Universitario de Ingeniería de Alimentos para el Desarrollo (IUIAD-UPV), Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
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46
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Tsai L, Boyle E, Buhl SF, Kock G, Brønd JC, Visser M, Mendonça N, Shiroma EJ, Caserotti P. Associations between appetite, physical activity and sedentary behaviour from hip- and wrist-worn accelerometers in community-dwelling older adults. Geriatr Gerontol Int 2023; 23:411-417. [PMID: 37098733 PMCID: PMC11503582 DOI: 10.1111/ggi.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/18/2023] [Accepted: 04/10/2023] [Indexed: 04/27/2023]
Abstract
AIM The objective of the current study was to examine whether physical activity and sedentary behavior were associated with appetite among community-dwelling older adults. METHODS Cross-sectional analysis was performed on three cohort studies: the Longitudinal Aging Study Amsterdam (LASA); the Health, Aging and Body Composition Study (HABC Study) and the I'm Still Standing Study (ISS Study); (n = 1173, n = 162, n = 125; age range: 57-99, 85-95, 80-100 years; women: 51%, 56%, 61%, respectively). Physical activity and sedentary behavior were measured using hip-worn (LASA and HABC) and wrist-worn (ISS) accelerometers. Appetite was self-reported. Logistic regression models were fitted by accelerometer placement to explore the association between good appetite and various physical activity metrics (total activity, sedentary behavior, and time spent in different intensities of physical activity). RESULTS Among cohorts using hip-worn accelerometers, those having total activity within the highest tertile had more than double the odds of having good appetite compared with those within the lowest tertile (odds ratio [OR] 2.16 (1.15-4.06)). Each additional percent of daily sedentary behavior decreased the odds for having good appetite by 3% (OR 0.97 (0.95-0.996)), while each additional percent of daily light-intensity physical activity increased the odds for having good appetite by 4% (OR 1.02 (1.01-1.06)). No association was found between either physical activity or sedentary behavior and appetite for measurements with the wrist-worn accelerometers. CONCLUSIONS Among community-dwelling older adults, the associations between appetite, accelerometer-assessed physical activity and sedentary behavior differ by accelerometer placement location. This study highlights the importance of careful interpretation of accelerometer data from different body locations and concurrent health outcomes. Geriatr Gerontol Int 2023; 23: 411-417.
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Affiliation(s)
- Li‐Tang Tsai
- Research Unit for ORL—Head and Neck Surgery and AudiologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Eleanor Boyle
- Clinical Biomechanics Unit, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - Sussi F Buhl
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Gry Kock
- Steno Diabetes Centre OdenseOdense University HospitalOdenseDenmark
| | - Jan C Brønd
- Centre of Research in Childhood Health, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research InstituteVrije University AmsterdamAmsterdamThe Netherlands
- Department of Internal Medicine, Nutrition and DieteticsVU University Medical CenterAmsterdamThe Netherlands
| | - Nuno Mendonça
- EpiDoC Unit, CHRC, NOVA Medical SchoolNOVA University LisbonLisbonPortugal
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population SciencesNational Institute on AgingBaltimoreMarylandUSA
| | - Paolo Caserotti
- Center for Active and Healthy Ageing, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
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Pasini E, Corsetti G, Dioguardi FS. Nutritional Supplementation and Exercise as Essential Allies in the Treatment of Chronic Heart Failure: The Metabolic and Molecular Bases. Nutrients 2023; 15:nu15102337. [PMID: 37242219 DOI: 10.3390/nu15102337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic heart failure (CHF) is one of principal health problems in industrialized countries. Despite therapeutical improvement, based on drugs and exercise training, it is still characterized by elevated mortality and morbidity. Data show that protein energy malnutrition, clinically evident primarily with sarcopenia, is present in more than 50% of CHF patients and is an independent factor of CHF prognosis. Several pathophysiological mechanisms, primarily due to the increase in blood hypercatabolic molecules, have been proposed to explain this phenomenon. Nutritional supplementation with proteins, amino acids, vitamins and antioxidants have all been used to treat malnutrition. However, the success and efficacy of these procedures are often contradictory and not conclusive. Interestingly, data on exercise training show that exercise reduces mortality and increases functional capacity, although it also increases the catabolic state with energy expenditure and nitrogen-providing substrate needs. Therefore, this paper discusses the molecular mechanisms of specific nutritional supplementation and exercise training that may improve anabolic pathways. In our opinion, the relationship between exercise and the mTOR complex subunit as Deptor and/or related signaling proteins, such as AMPK or sestrin, is pivotal. Consequently, concomitantly with traditional medical therapies, we have proposed a combination of personalized and integrated nutritional supplementation, as well as exercise to treat malnutrition, and anthropometric and functional CHF-related disorders.
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Affiliation(s)
- Evasio Pasini
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy
- Italian Association of Functional Medicine, 20855 Lesmo, Italy
| | - Giovanni Corsetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy
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48
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Ouaijan K, Hwalla N, Kandala NB, Abi Kharma J, Kabengele Mpinga E. Analysis of predictors of malnutrition in adult hospitalized patients: social determinants and food security. Front Nutr 2023; 10:1149579. [PMID: 37229465 PMCID: PMC10203390 DOI: 10.3389/fnut.2023.1149579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/07/2023] [Indexed: 05/27/2023] Open
Abstract
Background Malnutrition in hospitalized patients is becoming a priority during the patient care process due to its implications for worsening health outcomes. It can be the result of numerous social factors beyond clinical ones. This study aimed to evaluate the link between these various risk factors considered social determinants of health, food security levels, and malnutrition and to identify potential predictors. Methods A cross-sectional observational study was conducted on a random sample of adult patients in five different hospitals in Lebanon. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were interviewed to collect social and economic characteristics and were categorized into four criteria: (1) area of residence (urbanization level), (2) level of education, (3) employment status, and (4) source of health coverage. The food security level was screened by a validated two-question tool, adapted from the US Department of Agriculture Household Food Security Survey, targeting both quantity and quality. Results In a random sample of 343 patients, the prevalence of malnutrition according to the GLIM criteria was 35.6%. Patients with low levels of food security, mainly low quality of food, had higher odds of being malnourished (OR = 2.93). Unemployed or retired patients and those who have only completed only elementary school had higher odds of being diagnosed with malnutrition as compared to those who were employed or had university degrees, respectively (OR = 4.11 and OR = 2.33, respectively). Employment status, education level, and type of health coverage were identified as predictors of malnutrition in the multiple regression model. Household location (urban vs. rural) was not associated with malnutrition. Conclusion The social determinants of health identified in our study, mainly the level of education and income level, in addition to food security, were identified as predictors of malnutrition in hospitalized patients. These findings should guide healthcare professionals and national policies to adopt a broader perspective in targeting malnutrition by including social determinants in their nutrition care.
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Affiliation(s)
- Krystel Ouaijan
- Department of Clinical Nutrition, Saint George Hospital University Medical Center, Beirut, Lebanon
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Joelle Abi Kharma
- Faculty of Arts and Sciences, Lebanese American University, Beirut, Lebanon
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49
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Mulligan R, Suarez Durall P. Geriatric Phenotypes and Their Impact on Oral Health. Clin Geriatr Med 2023; 39:235-255. [PMID: 37045531 DOI: 10.1016/j.cger.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Older adults have multiple morbidities that can impact oral, systemic, and psychological health. Although each disorder requires consideration from the provider before treatment, by assessing the common phenotypic presentations of older adults, we can better understand, select, and coordinate treatment modifications that would need to be considered and implemented for dental care.
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Affiliation(s)
- Roseann Mulligan
- Herman Ostrow School of Dentistry of the University of Southern California, DEN 4338, Mail Code: 0641, Los Angeles, CA 90089, USA.
| | - Piedad Suarez Durall
- Herman Ostrow School of Dentistry of the University of Southern California, University Park Campus, DEN 4338, Mail Code: 0641, Los Angeles, CA 90089, USA
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50
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Bell JJ, Rushton A, Elmas K, Banks MD, Barnes R, Young AM. Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals. Healthcare (Basel) 2023; 11:healthcare11081172. [PMID: 37108004 PMCID: PMC10138321 DOI: 10.3390/healthcare11081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes. METHODS A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions. RESULTS Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition. CONCLUSIONS Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians.
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Affiliation(s)
- Jack J Bell
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alita Rushton
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Kai Elmas
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Merrilyn D Banks
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Rhiannon Barnes
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4072, Australia
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