Short-term effect of a protein load on appetite and food intake in diseased mildly undernourished elderly people

BACKGROUND & AIMS: Malnutrition is a risk factor for mortality and various morbidities in the elderly. A low-energy intake often prevails and therapeutic interventions include the administration of dietary supplements, sometimes rich in proteins. We have tested the hypothesis that a protein-rich supplement inhibits appetite and decreases voluntary food intake. METHODS: Twelve mildly undernourished (BMI 21.3 +/- 2.4 kg/m2) elderly (84 +/- 7.8 yr) diseased persons were each studied under 3 conditions, in which they were given in random order at breakfast, and on consecutive days: either no supplement, a 250 kcal, 20 g protein supplement or a 250 kcal, 3.5 g protein supplement. Hunger, fullness, and desire to eat sensations were monitored half-hourly from before breakfast until lunch, and hourly from lunch until dinner. Food intake was assessed by weighing food before and after meals. Total energy and macronutrient intakes were calculated over 24 h. RESULTS: Both supplements increased energy intake (+185 kcal protein supplement, +176 kcal). Protein supplementation induced a net 17 g increase in protein intake (P < or = 0.0003). Neither supplement affected spontaneous food intake at lunch, dinner, or over the 24 h. Protein supplementation significantly depressed appetite in the breakfast to lunch period. CONCLUSION: A 250 kcal, 20 g protein supplement depresses hunger without affecting food intake in elderly diseased mildly undernourished persons.     

Lack of meal intake compensation following nutritional supplements in hospitalised elderly women

Undernutrition contributes to poor clinical outcomes in hospitalised elderly patients but the potential impact of oral nutritional supplements may be reduced by suppressing subsequent food intake. We investigated this possibility in elderly female patients recovering mainly from hip fracture by studying the effect of oral supplements on subsequent food intake during an ad libitum buffet luncheon meal. We tested the effect in seven women by giving the supplement 90 min before the meal and compared energy and macronutrient intake with a control water pre-load condition. A similar study was carried out in another seven women with the supplement or water drink given 30 min beforehand. Both self-rated appetite and energy intake were low in these women. The nutritional supplement did not alter ratings of hunger, fullness or prospective consumption or subsequent energy and macronutrient consumption whether given 90 or 30 min before the meal. There were significant independent correlations between the lack of adequate compensation of energy intake at meals and chronic undernutrition (as assessed by skinfold thickness) and energy intake during the control meal. We conclude that elderly women during the recovery phase after major fractures have low appetites and energy intakes and markedly impaired adjustment of energy intake following liquid oral nutritional supplements. The reasons for this are unknown but are related to anorexia and undernutrition. The consumption of liquid oral supplements given up to 30 min before a meal does not suppress subsequent energy intake from meals.     

Nutrient intake from habitual oral diet in patients with severe short bowel syndrome living in the southeastern United States

OBJECTIVES: Little data are published on the habitual home oral diet of patients with short bowel syndrome (SBS). METHODS: We assessed nutrient intake from oral food and beverages in 19 stable patients with severe SBS who live in the southeastern United States. Intestinal absorption of energy, fat, nitrogen (N), and carbohydrate (CHO) was determined in a metabolic ward. RESULTS: We studied 12 women and 7 men, age 48 +/- 3 y of age (mean +/- SE) receiving parenteral nutrition for 31 +/- 8 mo following massive small bowel resection (118 +/- 25 cm residual small bowel). The patients demonstrated severe malabsorption of energy (59 +/- 3% of oral intake), fat (41 +/- 5%), N (42 +/- 5%) and CHO (76 +/- 3%). Oral energy intake was 2656 +/- 242 kcal/d (39 +/- 3 kcal/kg/d) and oral protein intake was 1.4 +/- 0.1 g/kg/d. Food/beverage intake constituted 49 +/- 4% of total (enteral plus parenteral) daily fluid intake, 66 +/- 4% of total daily kcal and 58 +/- 5% of total daily N intake. Oral fat intake averaged 92 +/- 11 g/day ( approximately 35% of total oral energy). Oral fluid intake averaged 2712 +/- 240 ml/d, primarily from water, soft drinks, sweet tea and coffee. Simple sugars comprised 42 +/- 3% of oral CHO intake. Usual dietary intake of multiple micronutrients were below the Recommended Dietary Allowances (RDA) in a large percentage of patients: vitamin A (47%), vitamin D (79%), vitamin E (79%), vitamin K (63%), thiamine (42%), vitamin B6 (68%), vitamin B12 (11%), vitamin C (58%), folate (37%), iron (37%), calcium (63%), magnesium (79%) and zinc (68%). Only seven patients (37%) were taking oral multivitamin-mineral supplements and only six subjects (32%) were taking oral iron and calcium supplements, respectively. CONCLUSION: In these SBS patients, an oral diet provided a significant proportion of daily nutrient intake. The types of foods and fluids consumed are likely to worsen malabsorption and thus increase PN requirements. Oral intake of essential micronutrients was very low in a significant proportion of these individuals.     

Selenium and zinc status are suboptimal in a sample of older New Zealand women in a community-based study

The importance of selenium and zinc in the immune functioning of the aged is widely recognized. Seniors in New Zealand are at particularly high risk of low selenium status because of the low selenium soil environment. The zinc status of the New Zealand elderly has never been assessed. In this cross-sectional study, the biochemical selenium, zinc and lipid levels, physical functional capacity and dietary intakes of 103 randomly selected free-living New Zealand women (mean age +/- SD, 75 +/- 3 y) were assessed. Among nonusers of selenium supplements (n = 80), 80% [95% confidence interval (CI): 70; 88%] had plasma selenium levels (0.85 +/- 0.23 micromol/L) below 1.00 micromol/L [ approximately 10% below mean plasma selenium necessary for full expression of glutathione peroxidase (GPx) activity in New Zealand subjects]. Plasma selenium was strongly correlated with GPx: r = 0.56; P < 0.0001. For nonusers of zinc supplements (n = 88), serum zinc concentrations were 12.4 +/- 1.4 micromol/L, with 12% (95% CI: 6; 21%) having levels below the cut-off value (10.7 micromol/L). Estimated mean daily selenium and zinc intakes were 34 +/- 10 microg and 8.7 +/- 2.0 mg, respectively. Subjects in the highest tertile of a functional capacity index had higher biochemical zinc and selenium values than those in the lowest tertile (P < 0.05). The correlation between plasma selenium and GPx indicates that selenium intake in these women is still insufficient for full expression of GPx activity. Lower serum zinc levels also appear to be prevalent. Because a suboptimal trace element status may be more common among those with a poor physical functioning, promotion of the consumption of nutrient dense foods or supplements to improve selenium and zinc status of elderly women in New Zealand may be beneficial.     

Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial

AIMS:To compare nutritional counseling with and without oral supplements in HIV-infected patients with recent weight loss. DESIGN: Randomized non-blinded controlled trial, stratified for change in antiretroviral treatment at baseline. PATIENTS: HIV-infected patients with recent weight loss (> 5% of total, and >3% in the last month). INTERVENTION: Nutritional counseling to increase dietary intake by 600 kcal/day over 8 weeks; in group A (n=24) by normal food, and in group B (n=26) by a range of fortified drink supplements with a calorific value of 0.6 to 1.5 kcal/ml. METHODS: Body composition by bioelectrical impedance analysis, dietary intake by 24 h recall. RESULTS: Fat free mass increased from baseline to week 8 (P<0.05) with no difference between groups A and B (P=0.97). Body cell mass and weight gain were not significant and equal between groups. Assessed at weeks 2 and 4, group B patients consumed 11 +/- 6 kcal/kg as supplements, and their total energy intake was 6 kcal/kg higher than in group A (P<0.01). Total energy intake was not different between groups at weeks 6 and 8. DISCUSSION: Nutritional counseling and oral supplements are both feasible methods to restore food energy intake in malnourished HIV-infected patients. Although normal food intake is partially replaced, oral supplements may improve the adherence to a weight gain regimen.     

Food habits and appetite of elderly women at the time of a femoral neck fracture and after nutritional and anabolic support

OBJECTIVE: To study appetite and food choices in lean elderly women at the time of a femoral neck fracture and after 6 months of nutritional and anabolic intervention. SUBJECTS AND METHODS: Forty-five nondemented women >70 years of age (mean +/- SD: 83 +/- 5 years) with a recent hip fracture and body mass index <24 kg/m2 (mean: 20.5 +/- 2.3) were interviewed about their appetite and dietary habits prior to fracture. The patients were randomized to treatment with a protein-rich liquid supplement (PR; 200 kcal and 20 g protein day(-1)) alone or in combination with nandrolone decanoate injections (PR/N) 25 mg i.m. every third week or to a control group (C). A second interview was conducted 6 months later. RESULTS: Reduced appetite before the fracture was reported by 60%. Half of the patients did not have dessert with any of their daily meals, one-third used low-fat margarines and one-third drank water with their meals. The estimated mean daily energy intake was 6.4 +/- 1.2 MJ (1541 +/- 304 kcal) indicating that three of four subjects did not meet their energy needs. At 6 months, 40% reported reduced appetite. There was no difference in the change of appetite between the three randomized groups. Still, half of the subjects appeared to not meet their energy needs. Protein intake increased in the PR and PR/N groups, in contrast to the controls (P = 0.002). CONCLUSION: Reduced appetite and insufficient energy intake was recorded in lean elderly women with a femoral neck fracture. Nutritional supplementation alone or in combination with an anabolic steroid increased protein intake without adversely affecting appetite.     

Assessment of macronutrient and micronutrient intake in women with anorexia nervosa

OBJECTIVE: The purpose of this study is to evaluate the accuracy of diet history compared to observed food intake in the nutritional assessment of women with anorexia nervosa (AN) and healthy age-matched controls. METHOD: One-month diet history was compared to 1-day observed food intake in 30 women with AN and 28 control subjects. RESULTS: Reported intake by diet history was similar to observed intake for macronutrient composition and fat intake for patients with AN. Reported energy intake was higher than observed intake (1,602 +/- 200 kcal vs. 1,289 +/- 150 kcal, p <.05), but was in agreement with predicted energy expenditure by the Harris-Benedict equation (1,594 +/- 18 kcal, p =.97) in patients with AN. Micronutrient intake by diet history was highly correlated with observed intake in patients with AN. More than one half of the patients with AN failed to meet the recommended dietary allowance (RDA) for vitamin D, calcium, folate, vitamin B12, zinc, magnesium, and copper when assessed by diet history. In contrast to patients with AN, diet history did not correlate with observed intake of energy, macronutrients, or most micronutrients among the controls. DISCUSSION: Diet history is an accurate tool to assess fat intake and macronutrient composition in patients with AN and demonstrates significant micronutrient deficiencies in this population. The agreement between total energy intake and predicted energy expenditure supports the overall utility of the diet history in the nutritional assessment of patients with AN.     

Compliance of orthopaedic patients with postoperative oral nutritional supplementation

BACKGROUND: Studies have shown clinical benefits of nutritional supplementation in orthopaedic and elderly patients in both under and well nourished groups. However, patient compliance with the supplementation has not been reported. AIM: To assess level of patient compliance with nutritional supplementation when prescribed postoperatively to unselected orthopaedic patients as part of a large controlled trial researching the clinical benefits of non-targeted nutritional supplementation. METHODS: Patients in the intervention group were prescribed two oral supplements each day of their hospital stay, in addition to usual meals. Information describing the supplements was given by the dietitian. Supplements were issued on drug rounds and the proportion of each drink consumed was recorded and collated. Patients could choose to change the type of drink or to discontinue the supplements completely at any time. Twenty-four hour food intake was analysed for a random sub-sample of 48 patients. RESULTS: Eighty-four patients (27 men, 57 women; mean age, 72 years) were prescribed supplements. Median length of stay was 14.4 days. Supplements were taken for a mean of 6.7 days. Median compliance was 14.9%. Despite this, median energy intake in the study group was 1523 kcal/day and 1289 kcal/day in the control (P= 0. 0214). CONCLUSION: Compliance with non-targeted, postoperative nutritional supplementation is poor in unselected orthopaedic patients but even low levels of supplementation significantly increase energy intake.     

Smaller but energy and protein-enriched meals improve energy and nutrient intakes in elderly patients

The purpose of the present study was to investigate if smaller but energy and protein enriched meals could improve energy and nutrient intakes in elderly geriatric patients. Ten patients, between 77 and 87 years of age were included in the study, performed at a Geriatric rehabilitation ward. The first week after inclusion, the patients were offered a three days' standard hospital menu and the second week, a three days' energy and protein-enriched menu. The consumption of food and the fluid intake were recorded using a pre-coded food record book during both the menus and analysed by the Swedish National Food Administration. The patients' energy requirements were calculated according to the Nordic Nutrition Recommendation for elderly subjects. When the standard hospital menu was offered, six patients had lower energy intake, -67 to -674 kcal/day, than the calculated energy requirements. The daily energy intake increased by 37 %, with the energy and protein-enriched menu compared with the standard hospital menu. Furthermore, the daily intake of protein, fat, carbohydrate, certain vitamins and minerals was significantly higher with the energy and protein-enriched menu compared with the standard hospital menu. CONCLUSION: This study showed that the intake of energy and nutrients increased with the energy and protein-enriched menu in elderly patients on a geriatric rehabilitation ward.     

Energy and nutrient intake of elderly hospitalized patients in a steady metabolic status versus catabolic status

Protein undernutrition enhances frailty and aggravates intercurrent diseases generally observed in elderly patients. Undernutrition results from insufficient food intake and catabolic status. Daily nutrient intakes were explored for hospitalized geriatric patients. Nutrient intake (carbohydrates, lipids, proteins, and calcium) was determined in randomly selected geriatric patients (n=49) over five consecutive days by weighting food in the plate before and after meals. For each geriatric patient, catabolic status and risk factors of undernutrition were considered. Results were compared between patients in a steady status or catabolic status. In steady status patients, protein, lipid and carbohydrate intake but not calcium intake, met recommended dietary allowances (total caloric intake:1535 +/- 370 Cal/day ; protein:1+/- 0.4 g/kg/day ; carbohydrates:55 +/- 7.7 % ; lipids: 30 +/- 6.3 % ; calcium:918 +/- 341 mg/day) . Patients in catabolic status (cardiopulmonary deficiency , neurologic disease , inflammatory process) had lower total caloric intake, lower protein intake and dramatically lower calcium intake (total caloric intake : 1375 +/- 500 Cal/day ; protein :0.9 +/- 0.4 g/kg/day ; carbohydrates : 54 +/- 8.3 % ; lipids : 31 +/-6.2 % ; calcium : 866 +/- 379 mg/day). Nutrient intake was lower in elderly patients hospitalized in short stay care units, perhaps due to failure to recognize suitable nutrient requirements. Protein-caloric undernutrition should be diagnosed early during hospitalization in order to allow appropriate dietary supplementation. However the incidence of protein undernutrition among elderly patients as a cause or a consequence of adverse pathophysiological processes remains a cause of debate.     

Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial

BACKGROUND & AIMS: Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting. METHODS: Sixteen inpatients with a stage 2, 3 or 4 pressure ulcer randomised to receive daily a standard hospital diet; a standard diet plus two high-protein/energy supplements; or a standard diet plus two high-protein/energy supplements containing additional arginine (9 g), vitamin C (500 mg) and zinc (30 mg). Nutritional status measurements (dietary, anthropometric and biochemical) and pressure ulcer size and severity (by PUSH tool; Pressure Ulcer Scale for Healing; 0=completely healed, 17=greatest severity) were measured weekly for 3 weeks. RESULTS: Patients' age and BMI ranges were 37-92 years and 16.4-28.1 k g/m2) respectively. Baseline PUSH scores were similar between groups (8.7+/-0.5). Only patients receiving additional arginine, vitamin C and zinc demonstrated a clinically significant improvement in pressure ulcer healing (9.4+/-1.2 vs. 2.6+/-0.6; baseline and week 3, respectively; P<0.01). All patient groups presented with low serum albumin and zinc and elevated C-reactive protein. There were no significant changes in biochemical markers, oral dietary intake or weight in any group. CONCLUSIONS: In this small set of patients, supplementary arginine, vitamin C and zinc significantly improved the rate of pressure ulcer healing. The results need to be confirmed in a larger study.     

Oral dietary supplements in pre- and postoperative surgical patients: a prospective and randomized clinical trial

It has been suggested that the routine provision of oral dietary supplements (ODS) in postoperative surgical patients is of benefit in terms of morbidity and length of hospital stay. The aim of this study was to evaluate the effects of both pre- and postoperative ODS in patients undergoing an elective laparotomy. Patients requiring elective major gastrointestinal surgery were prospectively randomized into one of four groups: Group I received ODS in addition to normal diet both pre- and postoperatively, Group II were given ODS in the preoperative period only, Group III received ODS only in the postoperative period, and Group IV did not receive any supplements. Assessments of nutritional status, voluntary food intake, weight loss, serum albumin, morbidity and mortality, anxiety and depression, and postoperative activity levels were performed, and comparisons made between the groups. One hundred patients were included in the study. The mean daily energy intake from preoperative ODS was 507 +/- 140 kcal, significantly more than the 252 +/- 195 kcal in the postoperative period (P < 0.001). The postoperative voluntary food intake in patients receiving ODS was not significantly different from that in patients receiving normal diet alone (1090 versus 1268 kcal, 46.2 versus 49.1 g protein, P > 0. 05). All groups demonstrated an overall weight loss, with no significant differences between the groups, and there was no demonstrable effect on clinical outcome. At 6 mo postoperatively there were no differences between the study groups in terms of levels of activity. These results suggest that the routine use of perioperative ODS in well-nourished patients undergoing major gastrointestinal surgery confers no clinical or functional benefit.     

Does a new steam meal catering system meet patient requirements in hospital?

BACKGROUND: It has been consistently observed that a significant proportion of hospital inpatients are malnourished and many actually develop malnutrition in hospital. The NHS provides over 300 million meals each year at a cost of pound 500 million, yet there is relatively little research evaluating how well different catering systems provide for the needs of hospital inpatients. AIM: The aim of the study was to: (i) evaluate whether a new steam meal catering system (Steamplicity) enables patients in theory to meet their energy requirements in hospital and (ii) compare energy and protein intake using Steamplicity with a traditional bulk cook-chill system. METHODS: Patients not at nutritional risk had their food intake at one lunchtime assessed. Energy intake was compared with the patients' energy requirements and energy and protein intake were compared with previous data from a bulk system. RESULTS: Fifty-seven patients had a median daily energy requirement of 7648 kJ (1821 kcal) [inter-quartile range (IQR): 6854-9164 kJ]. Assuming 30% [2293 kJ (546 kcal)] should be supplied by the lunch meal the average intake of 1369 kJ (326 kcal) fell short by 40%. Patients served meals from Steamplicity ate less energy [1369 kJ versus 1562 kJ (326 kcal versus 372 kcal) P = 0.04] but similar protein (18 g versus 19 g P = 0.34) to the bulk system. The largest difference was the energy provided by the dessert since the bulk system served more hot high-calorie desserts. CONCLUSIONS: Patient intakes did not meet their estimated requirements. The patients in this study were eating well and not at nutritional risk, thus patients with a poor appetite will be even less likely to meet their nutritional requirements. Steamplicity meals result in a lower energy intake than meals from a bulk cook-chill system, but similar protein intakes.     

Zinc and acute tropical ulcers in Gambian children and adolescents

28 Gambian children and adolescents with acute tropical leg ulcers entered a double blind trial of oral zinc supplements as an adjunct to standard treatment. Analysis of the area healing of the ulcers resulted in a mathematical expression which showed that for each subject re-epithelialization reduced the ulcer radius at a constant healing rate (k). k was derived from the equation At = pi X (r - k X t)2, where At = residual ulcer area at time "t", r = initial ulcer radius and t = time from start of treatment. In the zinc treated group k was 0.55 +/- 0.39 mm/day, and 0.51 +/- 0.25 mm/day in the placebo group. The initial low plasma zinc of 6.5 +/- 1.9 mumol/L in the ulcerated subjects was not significantly lower than that of 7.5 +/- 3.6 mumol/L in the nonulcerated controls. Oral zinc supplements significantly elevated plasma zinc concentrations by 5.8 +/- 4.8 mumol/L compared to the placebo group's change of 0.4 +/- 2.0 mumol/L (p less than 0.001). Plasma alkaline phosphatase activities and fatty acid profiles did not change with zinc supplementation. Thus unequivocal clinical and biochemical evidence of zinc deficiency in these ulcerated subjects was not established, despite changes in plasma zinc. This study does not indicate any role for zinc supplementation in the management of acute tropical ulcers.     

Effects of binge eating on satiation, satiety, and energy intake of overweight children

BACKGROUND: Children who report episodes of binge eating gain more weight than do children not reporting binge eating. However, how binge eating affects children's food intake at meals is unknown. OBJECTIVE: We compared the energy intake and postmeal satiety of children with and without a history of binge eating during buffet meals. DESIGN: Sixty overweight children aged 6-12 y were categorized into those reporting past binge-eating episodes (n = 10) and those reporting no such episodes (n = 50). Children selected lunch twice from a multiple-item, 9835 kcal, buffet meal: after an overnight fast and after a standardized breakfast. Children ate ad libitum, until they reported they were full. The main outcome measures were energy intake during meals and duration of postmeal satiety, after adjustment for covariates, including age, race, sex, socioeconomic status, and body composition. RESULTS: After the overnight fast, children in the binge-eating group consumed more energy [x (+/-SD): 1748 +/- 581 compared with 1309 +/- 595 kcal; P = 0.04] and exhibited a shorter satiety duration (194 +/- 84 compared with 262 +/- 89 min; P = 0.03) than did children in the non-binge-eating group. After the standardized breakfast, binge-eating children reported a shorter satiety duration (75 +/- 62 compared with 132 +/- 62 min; P = 0.01) and consumed more energy at the postbreakfast meal (1874 +/- 560 compared with 1275 +/- 566 kcal; P = 0.004). CONCLUSION: The ability to consume large quantities of palatable foods, coupled with decreased subsequent satiety, may play a role in the greater weight gain found in binge-eating children.     

Dietary intake and thiamin, iron, and zinc status in elite Nordic skiers during different training periods.

This study evaluated how different training periods affect dietary intake and biochemical indices of thiamin, iron, and zinc status in elite Nordic skiers. Subjects were 17 skiers and 39 controls, ages 18-38 yrs. Dietary data were collected by 7-day food records at 3-month intervals. Coefficient of variation (CV) was used to indicate magnitude of seasonal changes. Energy intake for the year (28 food record days) was 3,802 kcal/day (CV 19.1%) in male skiers, 2,754 kcal/day (CV 3.7%) in male controls, 2,812 kcal/day (CV 9.1%) in female skiers, and 2,013 kcal/day (CV 5.9%) in female controls. CVs for thiamin, riboflavin, vitamin C, calcium, magnesium, iron, and zinc intake were 14.1-23.9% (male skiers), 2.9-15.0% (male controls), 4.8-24.5% (female skiers), and 4.3-11.5% (female controls). Seasonal changes in energy, carbohydrate, and micronutrient intakes reflected energy expenditure in male endurance athletes particularly. Erythrocyte transketolase activation coefficients and serum ferritin and zinc concentrations did not differ between skiers and controls. Seasonal variations in these biochemical indices of nutritional status were of the same magnitude in skiers and controls, despite large changes in skiers' physical activity.     

Blood zinc, copper and magnesium in aging. A study in healthy home-living elderly

BACKGROUND: Blood concentrations of copper, zinc and magnesium were determined in healthy elderly to assess whether aging interferes with mineral and micronutrient status. METHODS: Experimental design: case series. Setting: Internal Medicine and Geriatrics ambulatories in a University Hospital in Pisa, a city of Central Italy. Participants: 143 healthy outpatients of both sexes, who underwent a cardiological examination. Intervention: no treatment and intervention were performed. Measures: copper (Cu), zinc (Zn) and magnesium--both intraerythrocytic (iMg) and extracellular (eMg)--were measured. RESULTS: The concentrations of Cu and eMg were found significantly higher in the elderly: Cu 117.5 +/- 17.0 micrograms/dl in the elderly vs 102.5 +/- 19.6 micrograms/dl in the younger (p < 0.001); eMg 1.8 +/- 0.2 in the elderly vs 1.7 +/- 0.2 mEq/l in the younger (p < 0.05). On the other hand, the levels of Zn and iMg did not differ in the two groups: Zn 113.3 +/- 14.9 micrograms/dl in the elderly vs 118.0 +/- 17.3 micrograms/dl in the younger, p = n.s.; iMg 4.3 +/- 0.4 mEq/l in the elderly vs 4.2 +/- 0.4 mEq/l in the younger, p = n.s. No correlation was found between age and single elements. CONCLUSIONS: These results suggest that the healthy free-living elderly have an adequate mineral intake. Nutrient supplements may by useful in the elderly with chronic diseases, comorbidities, and polypharmacy to prevent further age dysfunctions.     

Chitosan supplementation and fecal fat excretion in men

OBJECTIVE: Few weight loss supplements are clinically tested for efficacy, yet their proliferation continues. Chitosan-based supplements are sold as fat trappers and fat magnets. They purportedly block fat absorption and cause weight loss without food restriction. We quantified the in vivo effect of a chitosan product on fat absorption. RESEARCH METHODS AND PROCEDURES: Participants (n = 15) consumed five meals per day for 12 days. Energy intake was not restricted. Participants consumed no supplements during a 4-day control period and two capsules five times per day (4.5 g chitosan/d), 30 minutes before each meal, during a 4-day supplement period. All feces were collected from days 2 to 12. Oral charcoal markers permitted division of the feces into two periods. The two fecal pools were analyzed for fat content. RESULTS: Participants were male, 26.3 +/- 5.9 years old, BMI of 25.6 +/- 2.3 kg/m(2). Subjects consumed 133 +/- 23 g of fat/d and 12.91 +/- 1.79 MJ/d (3084 +/- 427 kcal/d). Individual meals averaged 26.3 +/- 9.3 g of fat. With chitosan supplementation at 10 capsules/day, fecal fat excretion increased by 1.1 +/- 1.8 g/d (p = 0.02), from 6.1 +/- 1.2 to 7.2 +/- 1.8 g/d. DISCUSSION: The effect of chitosan on fat absorption is clinically negligible. Far from being a fat trapper, at 0.11 +/- 0.18 g of fat trapped per 0.45-g capsule or 1.1 g (9.9 kcal) fat trapped per day, this product would have no significant effect on energy balance. The fat trapping claims associated with chitosan are unsubstantiated.     

Effect of liquid dietary supplements on energy intake in the elderly

BACKGROUND: Undernutrition is a risk factor for increased mortality in older adults. Therapeutic intervention includes the administration of liquid dietary supplements. OBJECTIVE: We investigated the effect of liquid dietary supplements on satiation, satiety, and energy intake in older adults. DESIGN: This study had 2 phases in a within-subject, repeated-measures design. The energy intake of 15 elderly (aged >70 y) and 15 younger (aged 20-40 y) healthy subjects was measured after 4 liquid preloads: water, high fat, high carbohydrate, and high protein. The preloads were administered within 5 min of a test meal in phase 1 and >or=60 min before the test meal in phase 2. Palatability, fullness, and hunger were assessed by using visual analogue scales. RESULTS: Mean energy consumption of the test meals was significantly lower in the older than in the younger subjects (P = 0.001), as was mean macronutrient consumption of fat and carbohydrate (P = 0.002 and 0.001, respectively). Mean energy intake and macronutrient consumption were higher in phase 2 than in phase 1 in both older and younger subjects (P < 0.05). Satiety lasted longer in older than in younger subjects after the high-protein and high-fat preloads (P = 0.001). CONCLUSION: In the elderly, administration of dietary supplements between meals instead of with meals may be more effective in increasing energy consumption.     

Nutrition in the elderly hospital patient Nottingham studies

Forty percent of elderly hospital admissions in the UK are undernourished, half severely so. Most continue to lose weight in hospital. not only because of disease, but also because of failure to identify and treat malnutrition and due to shortcomings in hospital food provision, upon which most patients depend for their nutritional care. Our studies have shown that more than 40% of food set before patients is left, and therefore wasted. This means that elderly patients are taking less than 70% of their energy (30-35 kcal/kg/day), and protein (1 dram/kg/day) requirements. Catering strategies, such as provision of smaller volume, high energy and protein density meals with snacks and, if necessary, proprietary oral supplements, have been shown not only to improve nutritional status of patients, but to result in improved clinical outcome. Our work has shown a relationship between malnutrition and loss of thermoregulation, which is reversed by appropriate feeding. We have also described the beneficial effects of overnight nasogastric tube feeding in undernourished patients with fractured femur. Like others, we have used a percutaneous endoscopic gastrostomy in the management of elderly patients with cerebrovascular and motor neurone disease, and have published audits of outcome in this field.