Nutritional and Functional Status in Newly Hospitalized Older Patients Who are Not Underweight

Although malnutrition is commonly associated with being underweight, it occurs whenever nutrient intakes are inadequate, regardless of current body weight. The aim of the study was to determine nutritional status as a predictor of functional status among older patients without underweight according to body mass index (BMI) at hospital admission. This cross-sectional study enrolled 90 patients aged ≥65 years (mean age 78.1?±?6.4). Assessments included basic and Instrumental Activities of Daily Living (bADL, IADL), Mini Nutritional Assessment (MNA), and BMI. Most of respondents were at risk of malnutrition (46%) or malnutrition (17%) according to MNA. Patients with/at risk of malnutrition had lower scores in bADL (p?=?0.020), IADL (p?=?0.010) and MNA (p?r?=?0.34, r?=?0.42, respectively) and negatively with age (r?=??0.33, r?=??0.21). MNA scores were also significant predictors of staying independence in bADL (β?=?0.53, p?β?=?0.45, p?相似文献   

Mini Nutritional Assessment in elderly subjects receiving home nursing care

Background: Old age and disease are risk factors for malnutrition. We assessed the nutritional status in elderly receiving home nursing care. Methods: Eighty people (86% women) over the ages of 70 years (mean±SD 84±6) were investigated. One-third had lung and/or cardiovascular disease, 10% had diabetes mellitus and the remainder had miscellaneous disorders. The Mini Nutritional Assessment (MNA) scale (0–30 points), consisting of 18 point-weighted questions, including anthropometry, e.g. body mass index (BMI, kg m^?2), was used. Results: Fifty patients (62%) were assessed as having suspected malnutrition (MNA 17–23.5 points), while two were assessed as being malnourished (MNA < 17 points). The mean BMI was 22.7±5. One third of the subjects had BMI values <20 and 64% had BMI ≤ 23. Patients with cardiac failure and/or lung disease had the lowest MNA values (20.9±3.3 points) and 85% of these patients were assessed as being at risk for malnourishment. More than half drank ≤1 L of fluid per day. Over half of those who were malnourished or were suspected to be malnourished did not have meal support, whereas almost half of the well-nourished patients had meal support. Conclusion: Two-thirds of the patients receiving home nursing care were assessed as having suspected or confirmed malnutrition, or were underweight. Nutritional routines may need more focus within home nursing care services.     

Nutritional status in intensive care unit patients: a prospective clinical cohort pilot study

Previous researches have shown that the nutritional status of patients in the intensive care unit (ICU) was poor on admission and appears to decline during their stay in the ICU. Critically ill patients are prone to malnutrition because their hypermetabolic disorders lead to an increase in nutritional requirements that are not often met with the nutrition supplied. The aim of this study was to assess the nutritional status and hs-CRP of ICU patients on admission and discharge from the hospital. Twenty-nine neurological ICU patients (20–87 years old) underwent fasting blood sample collections, anthropometric measurements and impedance analysis on admission and discharge at Ghaem Teaching Hospital. NRS 2002 was used to determine malnutrition in ICU patients. Markers of nutritional status changed from admission into the ICU until discharge as follows: weight, BMI and triceps skinfold thickness decreased (p < 0.001, p < 0.001 and p < 0.005, respectively). hs-CRP was decreased over the stay in the hospital (admission = 19.4 ± 16.3, discharge = 13.8 ± 14.5, p value = 0.11). The percent of patients at risk of malnutrition decreased during stay in ICU (not significant). Prevalence of malnutrition was as high as 47.6% on admission. The nutritional status of patients was slightly improved over the period of their stay in hospital using NRS 2002 method.     

New values anthropometry for classification of nutritional status in the elderly

Anthropometry provides information on the physical status of the individual and can be associated with aspects of health including nutritional status. Currently, the stratification of the arm and calf circumferences is classified into only two situations: “malnourished” and “well-nourished”. A total of 513 interviews were conducted, and 391 elderly people (≥65 years) completed the assessment using the Mini Nutritional Assessment (MNA) and anthropometry of selected samples of the population of Cuiabá-MT. The body mass index (BMI, kg/m2) was calculated for the elderly people, establishing five new reference values for circumferences, arm relaxed (RAC), abdomen (AC), and calf (CC) in centimeters (cm). The median age was 71 years (64% women and 36% men) and was correlated to the RAC (r=?0.180, p<0.001) and CC (r=?0.202, p<0.001). the BMI obtained the median of 27 (15% malnourished, risk of malnutrition 13%, eutrophic 24%; overweight 33%, obese 16%), and it was correlated to the RAC (r=0.798, p<0.001), AC (r=0.823 p <0.001) and CC (r=0.605, p<0.001). The MNA was 26 (malnourished 13.8%, risk of malnutrition 12.3%, well-nourished, 73.9%). The BMI stratification by morbidity vs no morbidity was 27.50 (n=287) and 24.4 (n=104) to total sample respectively (p<0,05). The RAC × AC (r=0.798, p<0.001), RAC × CC (r=0.648, p<0.001), and CC × AC (r=0.496, p<0.001) were correlated between themselves. The eutrophic classification by circumference for both genders: RAC=27.1–29.00 cm, AC=88.1–95.00 cm, CC=32.60–33.00 cm. There are more overweight and obese than malnourished, which is a risk factor for morbidity and MNA only identifies malnutrition. Circumferences showed good association with BMI and are easy to apply. Therefore, the proposal of the circumferences can simplify and expand the nutritional assessment.     

Agreement between different versions of MNA

Abstract

Malnutrition occurs frequently in the elderly with important clinical and functional consequences. Moreover, the treatment of malnutrition in the elderly may be effective if clinical and nutritional interventions are performed in the early stages. Therefore the early identification of the risk of malnutrition using validated and handy tools plays a pivotal role in terms of clinical outcome. Mini Nutritional Assessment (MNA) was validated for this purpose since many years but it is still ongoing the debate over whether the use of different items in certain clinical conditions can be effective without affecting the validity of the nutritional status evaluation. The aim of this study was to assess the agreement between different versions of MNA in the evaluation of nutritional risk in elderly subjects.

Methods

522 subjects, 345 women and 177 men, were recruited from nursing homes or were free living in three different regions in Italy. All subjects underwent a multidimensional geriatric evaluation, addressed especially to nutritional status. We compared three different versions of MNA: the “original” version; a “proportional” MNA (MNA-P) in which the total MNA score was replaced by the ratio between the maximum score that each subject could obtain without including the body mass index (BMI) and the total original MNA score; and a third version in which calf circumference (CC) and mid-upper arm circumference (MAC) were used instead of BMI.

Results

According to the original MNA, a high prevalence of malnutrition was found out in both genders (26% of women and 16.3% of men); both the versions of MNA, in which BMI was not considered, showed a good predictive value compared to original MNA. In particular, the MNA-P. showed an overall efficiency equal to 89,1% with specificity and positive predictive value respectively equal to 97.5% and 95.2%. MNA-CC-MAC showed even better results in terms of overall efficiency (91.4%), sensitivity (81.1%), specificity (97.1%), positive and negative predictive values (94.2% and 94.4%, respectively).

Conclusion

The different versions of MNA gave similar results in the classifications of subjects and in comparison with nutritional and biochemical parameters. Moreover MNA versions that did not considered BMI seem to be more effective in singling out subjects with risk factors related to malnutrition (disability, reduced strength and calf circumference, anaemia).     

Managing Malnutrition in Older Persons Residing in Care Homes: Nutritional and Clinical Outcomes Following a Screening and Intervention Program

This study aimed to establish prevalence of malnutrition in older adult care home residents and investigate whether a nutritional screening and intervention program could improve nutritional and clinical outcomes. A community-based cohort study was conducted in five Newcastle care homes. 205 participants entered; 175 were followed up. Residents already taking oral nutritional supplements (ONS) were excluded from interventions. Those with Malnutrition Universal Screening Tool (MUST) score of 1 received dietetic advice and ≥2 received dietetic advice and were prescribed ONS (220 ml, 1.5 kcal/ml) twice daily for 12 weeks. Body mass index (BMI), MUST, mini nutritional assessment score (MNA)®, mid upper arm muscle circumference (MAMC), and Geriatric Depression Scale (GDS) were recorded at baseline and 12 weeks. Malnutrition prevalence was 36.6% ± 6.6 (95% CI). A higher MUST was associated with greater mortality (p = 0.004). Type of intervention received was significantly associated with change in MUST score (p < 0.001); dietetic advice resulting in the greatest improvement. There were no significant changes in BMI (p = 0.445), MAMC (p = 0.256), or GDS (p = 0.385) following the interventions. Dietitian advice may slow the progression of nutritional decline. In this study oral nutritional supplements over a 3-month period did not significantly improve nutritional status in malnourished care home residents.     

Compliance with an oral hyperproteic supplement with fibre in nursing home residents

Background: Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake. Oral supplements may improve the health status in this population, but their use may be limited by compliance and side effects.Objectives To evaluate effects of an oral supplement of protein and fibre on compliance, on nutritional status, and on intestinal habits in nursing home residents.Method: A prospective observational study was carried out in 66 Spanish nursing homes. 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements. After informed consent was given, subjects received 2 daily cartons (400 ml) of a liquid oral supplement rich in protein and fibre along 3 months. Supplement intake compliance was measured at baseline and after 6 and 12 weeks. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA), weight, and Body Mass Index (BMI). Changes in intestinal habits and digestive symptoms were also recorded, as well as subject’s supplement acceptance.Results: Compliance with the supplement intake was 97.46% at 6 weeks and 96% at 12 weeks of follow-up. Significant changes (p<0.0001) were found in nutritional status: mean value of MNA improved from baseline (MNA=14.0±3.9) after 12 weeks (MNA=17.0±4.0), as well as weight (+2.1 kg, a 4.1% increase). The BMI did not change significantly (BMI=21.43 at baseline; BMI= 21.78 at 12 weeks). Undernutrition prevalence (MNA<17) decreased from 76.4 to 46.6% (p<0.0001). Intestinal habits showed a significant improvement in defecation frequency (from 4.7 to 6.1 stools per week, p<0.0001) and faeces consistency (from 53.2% to 74.5% reporting formed soft stools, p<0.0001). 48.9% of the subjects considered to have better intestinal habits after 6 weeks and 50.5% after 3 months of supplementary food intake, the rest reporting no change. Vomits and flatulence were also significantly reduced (p<0.0001). Conclusion: The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance. Supplements improve their nutritional status and their intestinal habits.     

Mini Nutritional Assessment (MNA) and nutritional risk in elderly. A proposal of nutritional surveillance system for the Department of Public Health

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.     

Body Mass Index as a Predictor of All-Cause Mortality in Nursing Home Residents During a 5-Year Follow-up

BackgroundBody mass index (BMI) is considered a short-term mortality predictor, but a consensus has not been reached on its role and that of other nutritional parameters in predicting long-term mortality in nursing home residents.ObjectivesTo correlate BMI, Mini Nutritional Assessment scores, and serum albumin levels with the 5-year mortality rate in institutionalized elderly subjects.MethodsA total of 181 nursing home residents aged ≥70 years were included in a 5-year longitudinal study. Data were collected on all participants’ nutritional, health, cognitive, and functional status by means of a comprehensive geriatric assessment. Data on the participants’ vital status were obtained 5 years after beginning the study, and a survival analysis was conducted using Kaplan–Meier curves and multivariate Cox proportional hazards models.ResultsThe 5-year mortality rate was 63%. The deceased subjects (n = 115) had a lower BMI (24.7 ± 4.6 vs 26.6 ± 5.0 kg/m²; P = .03) and Mini Nutritional Assessment score (18.6 ± 3.7 vs 20.1 ± 3.6; P = .02) than those still alive. Serum albumin levels did not differ between the two groups. Among the three indicators of nutritional status considered in this study, only BMI ≥ 30 kg/m² was significantly associated with a lower mortality risk at 5 years (hazard ratio = 0.432; 95% CI 0.20-0.70; P = .04), the risk for death being greater the lower the BMI class (log-rank test: P < .001).ConclusionsOur findings suggest that BMI is the best of the three parameters considered as a nutritional predictor of nursing home residents’ mortality in the longer term, and indicate that a lower mortality risk coincides with a higher BMI.     

Use of the mini nutritional assessment tool in elderly people from long-term institutions of Southeast of Brazil

Background: the Mini Nutritional Assessment (MNA) is a multidimensional method of nutritional evaluation that allows the diagnosis of malnutrition and risk of malnutrition in elderly people, it is important to mention that this method has not been well studied in Brazil.Objective: to verify the use of the MNA in elderly people that has been living in long term institutions for elderly people.Design: transversal study.Participants: 89 people (≥ 60 years), being 64.0% men. The average of age for both genders was 73.7±9.1 years old, being 72.8±8.9 years old for men, and 75.3±9.3 years old for women.Setting: long-term institutions for elderly people located in the Southeast of Brazil.Methods: it was calculated the sensibility, specificity, and positive and negative predictive values. It was data to set up a ROC curve to verify the accuracy of the MNA. The variable used as a “standard” for the nutritional diagnosis of the elderly people was the corrected arm muscle area because it is able to provide information or an estimative of the muscle reserve of a person being considered a good indicator of malnutrition in elderly people.Results: the sensibility was 84.0%, the specificity was 36.0%, the positive predictive value was 77.0%, and the negative predictive value was 47.0%; the area of the ROC curve was 0.71 (71.0%).Conclusion: the MNA method has showed accuracy, and sensibility when dealing with the diagnosis of malnutrition and risk of malnutrition in institutionalized elderly groups of the Southeastern region of Brazil, however, it presented a low specificity.     

A Prospective Study on Malnutrition and Duration of Hospitalisation among Hospitalised Geriatric Patients Admitted to Surgical and Medical Wards of Hospital Universiti Kebangsaan Malaysia

Elderly people are known to be at a greater risk of malnutrition, particularly those having diseases or illnesses. A prospective study was undertaken on 92 hospitalised geriatric patients (45.6% males), aged 60 to 89 years old, admitted to surgical and medical wards at Hospital Universiti Kebangsaan Malaysia (HUKM). The study aimed to assess malnutrition at admission, day 3 and day 7 of hospitalisation, and its relation with length of stay in the wards. Malnutrition was assessed using anthropometrics and biochemical indicators. Although the majority of subjects had a normal Body Mass Index (BMI), 10.9% had Chronic Energy Deficiency (CED) and 38% were overweight. A total of 10% subjects had muscle wasting as assessed by Mid-upper Arm Circumference (MUAC). Biochemical tests indicated that women subjects were more likely to have hypoalbuminaemia (p <0.05) whilst, men were at risk of anaemia (p < 0.05). Throughout hospitalisation, there was a significant reduction in body weight, biceps skinfold thickness, calf circumference, MUAC, percentage of body fat and body mass index (BMI) in both males and females (p < 0.05 for all parameters). Biochemical tests on a sub sample of subjects indicated that 71.4% had hypoalbuminaemia and 39.6% were anaemic. Subjects diagnosed with cancer, had loss of appetite or had poor nutritional status as assessed by BMI or MUAC on admission were more likely to be hospitalised longer than or equal to 7 days (p < 0.05 for all parameters). Serum albumin levels at admission correlated positively with MUAC values both on admission (r = 0.608, p <0.01) and at clay seven of hospitalisation (r = 0.906, p < 0.05). There is a need to screen elderly patients at high risk of malnutrition at admission in order to reduce the length of stay and increase their health and nutritional status.     

Evaluation of malnutrition status and related risk factors in geriatric outpatient clinic

BACKGROUND/OBJECTIVESMalnutrition risk and malnutrition among the elderly is a public health concern. In combating this health-related problem, it is critically important to evaluate the risk factors in a multidimensional way and to apply appropriate nutrition intervention based on the results.SUBJECTS/METHODSA cross-sectional study was conducted on 215 elderly patients (32.6% male, 67.4% female) in a geriatric outpatient clinic of a hospital in Turkey. Nutritional questionnaires that incorporated the 24-h recall method were applied to determine general characteristics of patients, their health status, nutritional habits, and daily energy and nutrient intakes. Mini Nutritional Assessment was used to determine nutritional status. Relevant anthropometric measurements were obtained.RESULTSThe subjects'' mean age was 76.1 ± 7.0 years, and the prevalence of malnutrition (n = 7) and risk of malnutrition (n = 53) among the 215 subjects was 3.2% and 24.7%, respectively. Patients with malnutrition or risk of malnutrition were found to be single, have a depression diagnosis, in an older age group, have less appetite, more tooth loss, have more frequent swallowing/chewing difficulty, and have more frequent meal skipping. In addition, mean daily energy, carbohydrate, fat, fiber, vitamin E, vitamin B1, vitamin B2, vitamin B6, vitamin C, folates, potassium, magnesium, phosphorus, iron intake, and water consumption were found to be statistically significantly low in subjects with malnutrition or risk of malnutrition. After performing regression analysis to determine confounding factors, malnutrition risk was significantly associated with marital status, loss of teeth, appetite status, and depression.CONCLUSIONSRoutine nutritional screening and assessment of the elderly should be performed. If nutritional deficiencies cannot be diagnosed early and treated, self-sufficiency in the elderly may deteriorate, resulting in increased institutionalization.     

Indices of malnutrition in patients admitted to general medical and chest medicine wards of an Iranian teaching hospital on admission and discharge

The nutritional status of hospitalised patients is generally poor on admission and in some cases declines during their stay in hospital. The aim of this study was to assess the nutritional status of a group of hospitalised patients on admission and at discharge from a large teaching hospital in Northwestern Iran. Male and female patients, who were anticipated to stay in hospital for more than 1 week on the general medical or chest medicine ward, gave informed consent to take part in the study. One hundred and fourteen patients (53.6 ± 17.2 years, body mass index (BMI) 21.0 ± 5.7 kg/m² (mean ± standard error of the mean) were recruited to evaluate the nutritional status. Changes in bioimpedance and anthropometric markers of nutritional status were recorded. The NRS 2002 (nutritional risk screening) method was used to assess nutritional status in patients on admission and prior to discharge. Malnutrition, as assessed using NRS 2002 method, decreased during the stay of patients in hospital (2.8 ± 1.0 versus 1.8 ± 1.0, p < 0.001). This study showed that prevalence of malnutrition was as high as 63.1 % on admission to the general medical and chest wards. The nutritional status of patients was significantly changed over the period of their stay in hospital, as assessed using the NRS 2002 method, although patients lost weight due to the acute care situation.     

Nutrition screening of older people in a community general practice, using the MNA-SF

Background: Objective

The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition.

Design

Cross-sectional study of nutritional risk screen conducted over a six month period.

Participants and setting

Patients attending a general practice clinic in Victoria, Australia, who attended for the “75 plus” health assessment check.

Measurements

The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded.

Results

Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category.

Conclusion

In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.     

Nutritional predictors of cognitive impairment severity in demented elderly patients: The key role of BMI

Introduction

The body mass index (BMI) is commonly used to assess nutritional status and the Mini Mental State Examination (MMSE) is a validated tool for assessing cognitive status in elderly people. Nutritional and cognitive aspects are closely related in dementia.

Objectives

To establish whether BMI predicts cognitive decline in demented patients and whether an ??alarm?? BMI cut-off exists for declining MMSE scores.

Subjects and methods

82 elderly demented patients underwent clinical, bio-chemical and functional assessment.

Design

Transversal study.

Results

The mean BMI was 26.08±4.48 kg/m₂ and the mean MMSE 18.68±5.38. Patients with BMI<25 kg/m₂ had significantly lower MMSE scores (16.5±5.53 vs 20.38±4.64; p 0.001), fat-free mass (FFM; 27.76±8.99 vs 37.38±10.58 kg; p<0.001), fat-free mass index (FFMI; 11.52±3.03 vs 14.67±2.89 kg/m₂; p<0.001), and fat mass (FM; 24.90±6.89 vs 36.86±6.77 kg; p<0.001), as well as lower Mini Nutritional Assessment (MNA) scores (23.80±2.50 vs 25.00±2.29; p=0.03) and higher vitamin B12 levels (460.95±289.80 vs 332.43±82.07 pg/ml; p=0.01). In the sample as a whole, MMSE scores significantly correlated with scores for MNA (r=0.27, p=0.01), FFM (r=0.27, p=0.01), BMI (r=0.19, p=0.05), ADL (r=0.28, p=0.01) and instrumental activities of daily living (IADL; r=0.34, p=0.002). On multiple logistic regression, BMI<25 kg/m₂ was independently associated with the risk of moderate-severe cognitive impairment (OR=2.96; 95% CI; 1.16?C7.55) and female gender was independently associated with severity of dementia (OR=3.14; 95% CI; 1.09?C9.03).

Conclusion

BMI seems to indicate global health status in elderly demented people and a BMI of 25 kg/m² can be considered an ??alarm?? cutoff, lower values coinciding with a worse cognitive status based on MMSE scores.     

Nutritional Risk and Nutritional Status at Admission and Discharge among Chinese Hospitalized Patients: A Prospective,Nationwide, Multicenter Study

Objective: The objective of this study was to assess nutritional risk and status of Chinese hospitalized patients at admission and discharge and relations with clinical outcomes.

Methods: A prospective, nationwide, multicenter study was conducted from June to September 2014 in 34 large hospitals in 18 cities in China. Patients ≥ 18 years with a hospital stay of 7–30 days were recruited. Anthropometric and laboratory indicators, nutritional risk screening, and assessment by Nutritional Risk Screening 2002 (NRS 2002) and subjective global assessment (SGA) were performed within 24 hours of admission and discharge. Clinical data during hospitalization were collected.

Results: A total of 6,638 patients met the criteria with a male: female ratio of 1.39:1 and an average age of 59.72 ± 15.40 years. At admission, the proportion of patients with nutritional risk, body mass index (BMI) < 18.5 kg/m², and moderate to severe malnutrition was 40.12%, 8.92%, and 26.45%, respectively, whereas at discharge, these percentages were 42.28%, 8.91%, and 30.57%, respectively. The values of all of these indicators were higher in patients 65 years of age and older. Patients with nutritional risk at admission had a longer average hospital stay (14.02 ± 6.42 vs 13.09 ± 5.703 days), higher incidence of total complications (6.90% vs 1.52%), and greater total medical expenses (3.39 ± 7.50 vs 3.00 ± 3.38 million RMB; all p < 0.01) than patients without nutritional risk. Similar results were obtained for the patients with nutritional risk at discharge.

Conclusion: The prevalence of nutritional risk and malnutrition, including moderate to severe malnutrition, at discharge is higher than that observed at admission; the clinical outcome of patients with nutritional risk is poor.     

Determinants of Health Related Quality of Life in Home Dwelling Elderly Population: Appetite and Nutritional Status

Objective

The present study aimed to examine nutritional risk factors such as poor appetite, malnutrition or obesity affecting health related quality of life in elderly.

Design and participants

This is a cross-sectional population-based study consisted of 407 elderly (142 men and 265 women) mean aged 71.7±6.54 years.

Measurements

Questionnaire including the demographic and general characteristics, health information, nutritional habits was performed by face-to-face interviews. Daily food consumption was assessed using 24-hour dietary recall. Mini Nutrition Assessment (MNA) and Mini Nutrition Assessment-Short Form (MNA-SF) were used for assessment of nutrition status. Appetite was evaluated using the Simplified Nutritional Appetite Questionnaire (SNAQ). Health related life quality scale (Short Form Health Survey-SF36) was used for evalution health related quality of life.

Results

According to MNA and MNA-SF 6.1%; 4.2% of elderly people were malnutrition and 40.3%; 21.9% of them were at risk of malnutrition respectively. Accordingly, SNAQ 28.7% of elderly were risk at loss of weight. Health related quality of life scores of women were significantly lower than men. Good nutritional (MNA-SF) and good appetite (SNAQ) status, increased 1.69, 1.48 fold in the mental component summary scale scores respectively. SNAQ was the best determinant of physical component summary scale score had the greatest positive effect, good appetite status increased approximately 2.2 fold in physical scores. Polypharmacy and high BMI decreased health related quality of life in elderly.

Conclusion

Determinants of quality of life are preventable and treatable with early and appropriate interventions in elderly.

     

Malnourished elderly people and lipid status

Protein-energy malnutrition is common in the elderly. The relationship between protein-energy malnutrition and lipid status remains uncertain and few studies are available. The aim of this study was to evaluate the lipid status of malnourished elderly subjects recently hospitalized in a geriatric medical care unit. Classical parameters such as total cholesterol, HDL cholesterol, apoproteins A1 et B, vitamins A and E were measured. Particular attention was given to other parameters such as fatty acids. The studied population included 86 elderly subjects. They were divided into two groups, according to serum albumin (alb) and Body Mass Index (BMI). Fifty patients aged 81.5 7.3 years were considered to be well-nourished (WN) with albumin 35 g/l and BMI 21 kg/m2. Thirty six patients aged 84.1 6.6 years were considered to be malnourished (MN) with albumin < 35 g/l and BMI < 21 kg/m2. Our main findings shown significant decrease in all classical lipid parameters : total cholesterol (p< 0.001), HDL cholesterol (p< 0.005), apoproteins A1 (p< 0.001) and B (p< 0.001) in the malnourished group. We found an increase in the rate of v9 fatty acids (p< 0.001 for the oleic acid; p< 0.05 for the eicosatrienoic acid) and also an increase in the triene/tetraene ratio (p< 0.05) as a result of malnutrition. CONCLUSION: Protein-energy malnutrition is accompanied by lipid status alterations.     

Relación entre el estado nutricional y el riesgo de presentar úlceras por presión en pacientes incluidos en el programa de atención domiciliaria

ObjectiveThe objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence, underlying diseases and the nutritional status.ScopePatients in home care program in Primary Health Care.Patients100 home care patients.Main variablesage, sex, caregiver, illness, BMI, haemoglobin, haematocrit, lymphocyte count, albumin, cholesterol, Barthel index, Pfeiffer, nutritional assessment (MNA) and Braden scale.ResultsFourteen percent of the ATDOM patients had malnutrition and 46% a high risk of malnutrition. The degree of dependency, and the level of cognitive impairment increased (P < 001) the risk of pressure ulcers. Furthermore, the nutritional status affected the risk of pressure ulcers (P < 001) with OR 3.73 higher in malnourished patients. Values of 3.76 ± 0.05 g/dL albumin and cholesterol of 176.43 ± 6.38 were associated with an increased risk of ulceration. There was a significant relationship between nutritional status (P < 01) and the degree of dependence. In malnourished patients albumin levels decreased to 3.46 ± 0.098, with averages of 11.41 ± 154.95 mg/dL cholesterol. Finally, a lower BMI was significantly related to malnutrition.ConclusionsThe present study demonstrates that 14 % of the ATDOM patients showed malnutrition, and 46 % a high risk of malnutrition. Malnutrition, the degree of physical dependence and severity of cognitive impairment is associated with an increased risk of ulceration, which justify the need for carrying out some personalised measurements on ATDOM patients.     

The obesity paradox in elderly patients with heart failure: analysis of nutritional status

ObjectiveThe obesity paradox refers to the improved survival of obese compared with non-obese elderly or diseased patients for reasons that are not clear. To assess the relative roles of fat and other factors in this improved survival, we analyzed the prognostic value of overweight and obesity elderly patients with heart failure (HF), controlling for other nutritional data such as midarm anthropometrics, serum proteins, and muscle strength.MethodsTwo hundred forty-four patients (83.2 ± 0.5 y old) hospitalized for HF were included. A nutritional survey was performed in all patients. After discharge, the patients were followed up by telephone.ResultsFourteen patients (5.7%) died during hospitalization. The median survival was 984 d. Patients with better nutritional status as assessed by the body mass index (BMI), subjective score, midarm muscle area, triceps skinfold thickness, handgrip, lymphocyte count, and serum albumin, prealbumin, and cholesterol levels showed better short- and long-term prognoses. Obese patients with a BMI above 30 kg/m² showed a better long-term prognosis than those with a BMI from 25 to 30 kg/m², those with a BMI from 20 to 25 kg/m², and those with a BMI lower than 20 kg/m². However, survival was not significantly related to a triceps skinfold thickness above the 95th percentile. Obese and overweight patients were younger and had better a nutritional status than those with a normal or decreased BMI as shown by the anthropometrics, subjective score, handgrip, lymphocyte count, hemoglobin, and serum albumin, prealbumin, and cholesterol levels. All the nutritional data correlated closely with each other. New York Heart Association class also correlated with nutrition-derived data: as the HF class increased, the nutritional status deteriorated. On multivariate analysis, to predict long-term survival, neither BMI nor triceps skinfold thickness showed an independent predictive value, whereas a larger midarm muscle area did.ConclusionThe obesity paradox was confirmed in this series of elderly patients with HF. Those with a high BMI and improved survival had a better nutritional status and New York Heart Association functional class than those with a lower BMI, which may explain the differences in survival.