Nutritional risk among Oklahoma congregate meal participants

OBJECTIVE: To determine if there were differences by demographic variables in response rates to Nutrition Screening Initiative (NSI) Checklist statements reported by over 50% of Oklahoma Older Americans Act Nutrition Program (OAANP) congregate meal participants categorized at high nutritional risk based on cumulative NSI Checklist scores. DESIGN: This study evaluated Oklahoma State Unit on Aging statewide archival demographic and NSI Checklist data from 8892 OAANP congregate participants. ANALYSIS: Data were analyzed using chi-square analyses. RESULTS: Eighteen percent of congregate participants were categorized at high nutritional risk. Over 50% of participants categorized at high nutritional risk reported "yes" to having an illness or condition that affected food eaten; eating alone; taking 3 or more medications; and inability to shop, cook, and feed themselves. Significant differences were observed in participant "yes" response rates to these NSI Checklist statements by demographic variables. Participants responded "yes" more to these statements if they were female, of advanced age, and living alone or in rural areas. CONCLUSIONS AND IMPLICATIONS: The results of this study indicate problem areas and population groups for targeting nutrition education programs and services among Oklahoma OAANP congregate meal participants.     

Nutritional status of institutionalized and free-living elderly in Alexandria

Because of an increase in the number of elderly and the problems of nutrition associated with them, it is of interest to study the nutritional status of elderly persons in Alexandria City. The purpose of this study was to assess the nutritional status of elderly population and to compare between the nutritional status of those institutionalized and those living free. The study was conducted on 240 elderly persons (120 institutionalized and 120 free living) selected randomly from institutions and from different sites. The basic data, weight, height, body mass index (BMI) of each were recorded. Dietary intake study was done by using 24 hours recall for 3 consecutive days and food frequency were used to obtain the best estimate of food intake. Energy and nutrient intakes were obtained and compared with the recommended dietary allowance (RDAs). The main findings of the study revealed that the mean age of the institutionalized elderly was greater than those living free. Percent of obesity among females was 71.7% among free living and 45% among institutionalized. Under-nutrition was present in 11.7% and 8.3% of institutionalized males and females respectively. Food habits showed that institutionalized subjects consume more amounts of many food items than free-living. Total daily energy intake was found to be below the recommendation for all subjects, with higher intake among institutionalized than free living. Nutrient intakes among institutionalized and free living elderly were inadequate except thiamin, riboflavin, vitamin C and iron. The nutrients least adequately supplied in the diets of elderly are vitamin A and calcium along with energy deficits. In conclusion both institutionalized and free living are at risk for developing nutrient deficiencies. Deficient energy, calcium and vitamin A are common problems among most subjects. The composition of the diet among free living subjects seem to be also poor in some micronutrients. We recommended a nutrition intervention program and nutrition education to improve nutritional status of elderly people.     

Nutritional evaluation and prevalence of not transmissible chronic disease in elderly participating in an assistance program

The purpose of this study was to evaluate the nutritional state and the prevalence of not transmissible chronic disease in elderly, who were participating in an assistance program of the Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil. Socio-economical, anthropometric and biochemical variables, as well as systemic blood pressure were collected from 82 individuals between 60 and 87 years of age, 90,2 % of them female. According to the body mass index (BMI) 52,4% of the studied sample were overweight, 28,0% eutrophic and 19,5% underweight; 37,8% presented high body fat percentage (BF%). With regard to the relation BMI/BF%, 63,4% of the elderly with overweight, 12,5% of the eutrophic and 11,8% of the underweight presented high BF%. The waist-to-hip ratio revealed 40,2% at high risk and 12,2% at very high risk of developing cardiovascular disease. In addition, 22,0% had high blood pressure. The biochemical tests revealed that 39,3%, 39,3% and 3,3% presented higher plasma cholesterol, triglyceride and glucose levels respectively. There is a need for continuous nutritional education programs and monitoring of the nutritional and health status for improving the quality of life of the studied individuals.     

Measures of body composition and risk of heart failure in the elderly: The Rotterdam study

Objectives  

The incidence of heart failure increases with aging. Aim of the present, study was to determine whether measures body composition predict incident heart failure in older adults.     

Beliefs about and usage of vitamin/mineral supplements by elderly participants of rural congregate meal programs in central Iowa

Responses to the belief statements indicated that elderly subjects who used supplements, either appropriately or inappropriately, had more misperceptions about vitamin/mineral supplements than elderly subjects who did not use supplements. These results indicate that the elderly need guidance from dietitians or other qualified health professionals to make informed choices on whether to take vitamin/mineral supplements. Those elderly persons who choose to use supplement products also need guidance in terms of safety and cost.     

Relation of body composition to daily physical activity in free-living Japanese adult women

The objective of the present study was to investigate the relationship between the indices of body size such as BMI, fat-free mass index (FFMI, FFM/height2), fat mass index (FMI, FM/height2), and body fat percentage (%BF), and physical activities assessed by the doubly-labelled water (DLW) method and an accelerometer in free-living Japanese adult women. We conducted a cross-sectional study in 100 female subjects ranging in age from 31 to 69 years. Subjects were classified in quartiles of BMI, FFMI, FMI and %BF. Daily walking steps and the duration of light to vigorous physical activity were simultaneously assessed by an accelerometer for the same period as the DLW experiment. Only physical activity-related energy expenditure (PAEE)/FFM and PAEE/body weight (BW) decreased in the highest quartile of BMI. Physical activity level, PAEE/FFM and PAEE/BW decreased in the highest quartile of FMI and %BF, whereas they were not different among quartiles of FFMI. Daily walking steps and the duration of moderate- and vigorous-intensity physical activities decreased or tended to decrease in the highest quartile of FMI and %BF, but did not differ among quartiles of FFMI and BMI. These results clearly showed that Japanese adult women with higher fat deposition obviously had a low level of physical activities assessed by both the DLW method and accelerometry, but those with larger BMI had lower PAEE/FFM and PAEE/BW only. Our data suggest that the relationship between obesity and daily physical activities should be discussed using not only BMI but also FMI or %BF.     

Nutritional evaluation and supplementation of elderly subjects participating in a "meals on wheels" program

A nutritional assessment of 33 elderly subjects participating in a "meals on wheels" program revealed a high prevalence of nutritional deficiencies. Twelve of these subjects, who were considered to be at high risk for protein calorie malnutrition, received 240 ml of a polymeric dietary supplement three times daily for 16 wk. This resulted in a significant (50%) increase in total caloric and protein intake which was maintained for the entire 16 wk of study. In seven of the 12 subjects a weight gain of greater than 2 kg was found. Modest but significant elevations in serum albumin and highly significant elevations of the total iron binding capacity, serum and red cell folate, leukocyte ascorbate, and serum vitamin B12 provided strong evidence for improved nutritional status. In contrast no improvement in the hemoglobin, total lymphocyte count, T cell number, T suppressor cells, T helper, or B cells was noted. In no anergic subjects was skin test conversion found. In addition no increase in serum trace metals or vitamin B6 levels were noted. Thus this study demonstrates that nutritional supplementation results in significant improvement in selected nutritional parameters. The fact that the hematopoietic and immunological status of these patients was unchanged suggest that the abnormalities may be age rather than nutritionally related or that a critical nutritional deficiency was not corrected.     

老年肝胆外科住院患者的动态营养风险筛查

目的调查老年肝胆外科住院患者营养风险、营养不足发生率以及营养支持应用状况。方法采用定点连续抽样,对156例老年肝胆外科住院患者（≥65岁）人院后第2天早晨和住院2周或出院时进行营养风险筛查2002（NRS 2002）的动态描述性研究。结果NRS 2002的适用率为96．8％（151／156）。患者总的营养风险发生率为36．9％（57／156）,营养不足发生率为26．2％（41／156）。住院时间大于2周的患者营养风险和营养不足发生率分别为49．6％和36．7％,住院时间小于2周的患者营养风险和营养不足发生率分别为37．3％和21．4％,两者相比差异具有统计学意义（P〈0．05）。存在营养风险和无营养风险患者营养支持率分别为64．1％和17．4％。其中,接受大手术患者中有营养风险和无营养风险患者的营养支持率分别为87．9％和36．8％,接受中、小手术患者中有营养风险和无营养风险患者的营养支持率分别为41．3％和9．6％。结论NRS 2002适用于老年肝胆外科住院患者的营养风险筛查。住院时间大于2周老年肝胆外科住院患者营养风险和营养不足发生率反而有所增加。临床营养支持在肝胆外科需要更加重视住院患者的营养问题,临床上存在肠外、肠内营养的不合理应用。     

Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population

Risk factors for institutionalization of frail elderly have been studied but the role of nutritional status has not been addressed. A prospective cohort of 288 frail elderly (81 male; 207 female; mean age: 78.2 +/- 7.6 years) were recruited from the current list of those receiving home help services and followed for 3-5 years. At baseline, height, weight, and arm muscle circumference were measured. Self-reported weight loss prior to baseline, energy, and protein intake were recorded. Covariates included sociodemographic factors, social network variables, functional and health status. Cox's multivariate survival analysis was used to identify independent predictors of institutionalization. Over the period of observation, 46% of subjects were institutionalized. Univariate predictors included weight loss >/=5 kg, functional status, and not living alone. In multivariate analysis, weight loss significantly increased the likelihood of institutionalization [Hazard Ratio (HR) = 1.71 (95% CI: 1.08-2.73)] as did limited functional capacities [HR = 1.26 (95% CI: 1.02-1.55)]. Among the free-living frail elderly, weight loss >/=5 kg is an important predictor of early institutionalization after controlling for social network, health, and functional status.     

Nutritional intakes of 1072 French free-living men with and without diagnosed cardiovascular risk factors

OBJECTIVE: To compare the dietary intakes of free-living people with and without previously diagnosed diet-modifiable cardiovascular risk factors (hypertension, hypercholesterolaemia and diabetes). DESIGN: Cross-sectional survey on cardiovascular risk factors including a three-consecutive-day food record. SETTING: Multicentre setting in Lille (northern France), Strasbourg (north-east) and Toulouse (south-west) areas. SUBJECTS: A total of 1072 middle-aged men randomly selected from the general population: group 1 (504 men without previously diagnosed diet-modifiable risk factor), group 2 (377 men with one previously diagnosed diet-modifiable risk factor) and group 3 (191 men with two or three previously diagnosed diet-modifiable risk factors). INTERVENTIONS: None. RESULTS: Total daily energy intake equalled 10731 kJ/day (standard error: 119), 9991 (138) and 9737 (166) in groups 1, 2 and 3, respectively (P<0.0001 for ANOVA comparing the three groups), and daily energy intake without alcohol equalled 9860 (115), 9096 (132) and 8654 (159) kJ/day (P<0.0001). The proportion of calories from animal proteins (in daily energy intake without alcohol) increased from group 1 to 3 (P<0.0001), whereas the proportion from oligosaccharides decreased (P<0.0001). The proportion of calories from alcohol (in total daily energy intake) increased with the number of risk factors (P<0.0001). These results remained significant after adjustment for confounders. No significant group differences were found in the proportions of energy from polysaccharides, saturated, monounsaturated and polyunsaturated fats. CONCLUSIONS: As compared with subjects without risk factor, significant quantitative and qualitative changes are observed in individuals with diagnosed hypertension, hypercholesterolaemia or diabetes. However, lower consumptions of saturated fats and alcohol are needed.     

Nutritional risk and survival in elderly veterans: A five-year follow-up

The purpose of this study was to identify predictors of survival over five years in a sample of 377 elderly (age 55+) chronically ill men. Subjects were selected at baseline from consecutive appointments at a geriatric clinic and given extensive medical and psychosocial assessment. Five years later, subjects who could be located were interviewed by telephone. Interviews were completed with 194 (51.4%) subjects, 90 others were confirmed as deceased, 29 subjects could not be interviewed, and 64 more were not located although VA records did not show that any were deceased. The predictor variable of interest was the Nutritional Risk Index (NRI), a 16 item index which measures nutritional dimensions of health status. Other variables included functional health status [Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL)], mental health status [Mini-Mental Status Exam (MMSE), morale], health habits (smoking, alcohol use and exercise), use of health services (physician visits, emergency room (ER) visits, hospital stays), and demographic factors (age, income, marital status and living arrangements). Proportional hazard models showed that the variables with statistically significant direct effects on survival time were younger age, higher functional health status on IADL, non-smoking, moderate alcohol use, and perception of adequate income. Nutritional status was indirectly associated with survival.Rodney M. Coe is Professor of Community and Family Medicine, Saint Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center (GRECC), St. Louis VA Medical Center; James C. Romeis is Professor of Public Health, Saint Louis University and Coordinator, Health Services Research & Development (HSR&D), St. Louis VA Medical Center, Douglas K. Miller is Associate Professor of Internal Medicine, Saint Louis University School of Medicine; Fredric D. Wolinsky is Professor of Internal Medicine, Indiana University, Indianapolis; and Katherine S. Virgo is Assistant Professor of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.This project was supported in part by NIH grant R37-AG-09692 to Dr. Wolinsky.     

Physical frailty and body composition in obese elderly men and women

OBJECTIVE: To evaluate the prevalence of frailty and interrelationships among body composition, physical function, and quality of life in community-dwelling obese elderly (OE) persons. RESEARCH METHODS AND PROCEDURES: Fifty-two OE, 52 nonobese frail, and 52 nonobese nonfrail subjects, matched for age and sex, were studied. Subjective and objective measures of functional status were evaluated by using the physical performance test, exercise stress test, lower extremity (LE) strength, gait speed, static and dynamic balance, functional status questionnaires, and health-related quality-of-life questionnaire (Medical Outcomes Short Form). Body composition was evaluated by using DXA, and muscle quality was evaluated by determining the ratio of LE strength to LE lean mass. RESULTS: Among OE subjects, 96% met our standard criteria for mild to moderate frailty. Compared with the nonobese nonfrail group, the OE and nonobese frail groups had lower and similar scores in physical performance test, peak aerobic power, and functional status questionnaire, and exhibited similar impairments in strength, walking speed, balance, and health-related quality of life. Although absolute fat-free mass (FFM) was greater, the percentage body weight as FFM and muscle quality was lower in the OE group than in the other two groups. DISCUSSION: Physical frailty, which predisposes to loss of independence, is common in community-living OE men and women. Physical frailty in OE subjects was associated with low percentage FFM, poor muscle quality, and decreased quality of life. These findings suggest that weight loss therapy may be particularly important in OE persons to improve physical function, in addition to improving the medical complications associated with obesity.     

Body composition in the elderly: Total body water and anthropometry

Body composition measured with isotopic dilution was compared with anthropometric measurements. The study was carried out in 47 subjects from both sexes, 65 to 92 years old. Total body water (TBW), anthropometric measurements, and dynamometry were assessed. TBW was significatively higher in men than women and decreased with age. Dynamometry and fatfree mass were well correlated (r=0.73 in males and r=0.58 in females) and significantly different between sexes. A negative correlation was found for dynamometry with age, being significant for women. Linear regression equations to predict TBW from anthropometric measurements in males and females were obtained: Males: TBW(I)=19.349+0.617 weight(kg) — 0.931 mid-arm circumference(cm)+0.122 dynamometry (kg) Females: TBW(l)=−5.531+0.343 weight(kg)-0.213 triceps skinfold (mm)+ 0.148 dynamometry(kg) + 3.424 wrist diameter (cm). This simple model is proposed for use in epidemiological and field studies where other more sophisticated methods can not be applied.     

Nutritional status of adults participating in ambulatory rehabilitation

AIMS: To assess the overall nutritional status of older adults participating in ambulatory rehabilitation and determine its association with relevant outcomes including physical function and quality of life. DESIGN: Cross-sectional. SETTING: Ambulatory rehabilitation service in the Southern region of Adelaide, Australia. SUBJECTS: A total of 229 participants recruited as part of a RCT between June 2005 and June 2006, stroke (n=83), elective orthopedic procedure (n=44) and other medical condition (n=102). METHODS: Nutritional status was measured using Mini Nutritional Assessment (MNA), Simplified Nutrition Appetite Questionnaire (SNAQ) and Body Mass Index. Functional performance was assessed using the Modified Barthel Index (MBI) and quality of life was measured using the Short Form-36 (SF-36). RESULTS: Sixty-three percent of participants were malnourished or at risk of malnutrition according to the MNA and a third had a risk of >or= 5% weight loss in the subsequent six months, according to the SNAQ. Participants with a diagnosis other than stroke or elective orthopedic procedure were the most vulnerable, with 53% (n=74/140) classified as at risk of malnutrition or malnourished and a longer length of stay in hospital. Functional performance was no different for participants assessed as at risk of malnutrition or malnourished compared to the well nourished, but the SF-36 mental component score was significantly higher for those who were well nourished (p=0.003). CONCLUSION: Findings emphasise the magnitude of the malnutrition problem in ambulatory rehabilitation settings. Further research is required to evaluate the resource implications against expected benefits of providing nutrition interventions at this point.