Association Between Vitamin B12 Levels and Mortality in Hospitalized Older Adults

OBJECTIVES: To investigate the effect of various medications on vitamin B12 status and the association between vitamin B12 levels and mortality. DESIGN: Retrospective cross‐sectional study. SETTING: Four internal medicine departments and the geriatrics department at Kaplan Medical Center (KMC), Rehovot and Harzfeld Geriatrics Hospital, Gedera, Israel. PARTICIPANTS: One thousand five hundred seventy patients aged 65 and older hospitalized at the KMC and Hartzfeld Hospital in 2007. MEASUREMENTS: Blood vitamin B12 levels and demographic, clinical, and laboratory data obtained from electronic medical records. RESULTS: Vitamin B12 deficiency (≤200 pmol/L) was found in 15% of older hospitalized patients. Fifty percent of the patients had high vitamin B12 levels (≥350 pmol/L), 68.2% of whom were aged 80 and older. Metformin use was clearly associated with lower vitamin B12 levels. In patients aged 65 and older, an inverse correlation was found between vitamin B12 levels and albumin, metformin, and angiotensin‐converting enzyme (ACE) inhibitor use. Age, number of medications, and mortality were linearly correlated with vitamin B12 levels. CONCLUSION: Higher vitamin B12 levels were associated with greater mortality, but it is unclear whether vitamin B12 is a marker or a surrogate marker or even a substance that directly causes death. Further investigation is needed to clarify.     

Nutritional considerations for the pureed diet texture in dysphagic elderly

In long-term care facilities little attention is given to the nutritional density, flavor, and presentation of the pureed diet texture. Use of the food processor to puree food offers opportunities for the development of pureed meals that are flavorful and appealing. This article presents guidelines that foodservice departments can use to transform their traditional pureed meals into “cuisine puree”.     

Plant-based dietary patterns in the control of obesity and cardiovascular risk

Obesity and cardiovascular disease are uncommon in people consuming plant-based diets. In contrast, overweight and obesity are surging in US children and adults, increasing their risk for cardiovascular disease and diabetes. Plant-based diets are primarily comprised of whole plant foods that are rich in fiber and several beneficial phytochemicals and low to moderate in fat. Plant-based dietary patterns have been shown to reduce body weight and cardiovascular risk factors in adults, children, and adolescents. Well-planned plant-based diets are nutritionally adequate, well-accepted, and sustainable for the long term and represent an effective strategy in the control of obesity and cardiovascular disease risk.     

Effects of empagliflozin on cardiorespiratory fitness and significant interaction of loop diuretics

The effects of empagliflozin on cardiorespiratory fitness in patients with type 2 diabetes mellitus (T2DM) and heart failure with reduced ejection fraction (HFrEF) are unknown. In this pilot study we determined the effects of empagliflozin 10 mg/d for 4 weeks on peak oxygen consumption (VO₂) in 15 patients with T2DM and HFrEF. As an exploratory analysis, we assessed whether there was an interaction of the effects of empagliflozin on peak VO₂ of loop diuretics. Empagliflozin reduced body weight (?1.7 kg; P = .031), but did not change peak VO₂ (from 14.5 mL kg^?1 min^?1 [12.6‐17.8] to 15.8 [12.5‐17.4] mL kg^?1 min^?1; P = .95). However, patients using loop diuretics (N = 9) demonstrated an improvement, whereas those without loop diuretics (N = 6) experienced a decrease in peak VO₂ (+0.9 [0.1‐1.4] vs ?0.9 [?2.1 to ?0.3] mL kg^?1 min^?1; P = .001), and peak VO₂ changes correlated with the baseline daily dose of diuretics (R = +0.83; P < .001). Empagliflozin did not improve peak VO₂ in patients with T2DM and HFrEF. However, as a result of exploratory analysis, patients concomitantly treated with loop diuretics experienced a significant improvement in peak VO₂.     

Diet Design for a Multicenter Controlled Feeding Trial: The DELTA Program

Objective To describe the process and results of diet standardization, diet validation, and monitoring of diet composition, which were key components of protocol 1 of Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA-1), the initial protocol in a program of multicenter human feeding studies designed to evaluate the effects of amount and type of fat on lipoproteins and hemostasis parameters in various demographic groups.Design DELTA-1 was based on a randomized, blinded, crossover experimental design. Three diets were fed for 8 weeks to 103 healthy men and women aged 22 to 67 years at 4 field centers. Diet A, an average American diet, was designed to provide 37% of energy from fat, 16% of energy from saturated fatty acids (SFAs); diet B (step 1 diet) was designed to provide 30% of energy from fat, 9% of energy from SFA; and diet C (low SFA diet) was designed to provide 26% of energy from fat, 5% of energy from SFA. Key features of diet standardization included central procurement of fat-containing foods, inclusion of standard ingredients, precision weighing of foods—especially sources of fat and cholesterol—and use of standardized written procedures.Setting For menu validation, a set of 12 menus for each diet was prepared in duplicate and chemically assayed. For monitoring of diet composition during the study, an 8-day diet cycle (6 weekday and 2 weekend menus) was sampled by every field center twice during each of 3 feeding periods.Statistical analyses Means (±standard error) were calculated and compared with target nutrient specifications.Results DELTA-1 was able to provide a standardized diet that met nutrient specifications across 4 field centers over 24 weeks of participant feeding spanning a total of 8 months.Applications Prestudy chemical validation of menus and continuous sampling and assay of diets throughout the study are essential to standardize experimental diets and to ensure that nutrient target goals are met and maintained throughout a controlled multicenter feeding study. J Am Diet Assoc. 1998;98:766–776.