Fluid intake of elderly Europeans

Dehydration is a common fluid disorder which occurs in residents, hospitalised and community-dwelling elderly people. In this study the intake of water and fluids of community-dwelling elderly Europeans is presented in relation to risk factors of dehydration: mental state, ability to perform activities of daily living (ADL), medicine use and body composition. As part of the SENECA-study of 1993, data were collected from a random age-stratified sample (birth cohorts 1913-1918) of inhabitants of small traditional towns in Europe. Food intake data were collected by using the dietary history method. The study population consisted of 629 men and 696 women of the following towns: Hamme/Belgium, Roskilde/Denmark, Haguenau/France, Romans/France, Padua/Italy, Culemborg/the Netherlands, Lisbon/Portugal, Yverdon/Switzerland, Marki/Poland and Ballymoney-Limavady-Portstewart/Northern Ireland/United Kingdom. Fluid intake of elderly people varied between the towns of Europe and between men and women. A high percentage of the female population had a water intake below the cut-off value of 1,700 g. In most towns about 70 percent of daily water intake came from the food groups 'Milk products', 'Alcoholic drinks', 'Juices' and 'Other non-alcoholic drinks'. The consumption of 'Other non-alcoholic drinks' contributed most to daily fluid intake. In the total female population, women with the lowest water intake (first tertile) scored negatively on factors influencing fluid intake (mental state, ADL) in comparison to women of the second and third tertile. However, in the distinct towns no unequivocal relationship emerged between those factors and fluid intake. Yet, women were found to be at higher risk of dehydration because of much lower water intakes than men and because of the overall relationship between a low fluid intake and a poor mental state and ADL problems.     

Design and prospective validation of a dosing instrument for continuous infusion of vancomycin: a within-population approach

Introduction

The clinical application of continuous infusion (CoI) of vancomycin has gained interest in recent years. Since no international guidelines on initial dosing of vancomycin CoI exist, there is a need for methods to facilitate the switch from intermittent to continuous vancomycin dosing algorithms in clinically infected populations. Therefore, the aim of this study was to design and validate an a priori dosing schedule for CoI of vancomycin in clinical practice.

Methods

A dosing table for CoI of vancomycin based on estimated glomerular filtration rate (eGFR) was developed by simulation of continuous infusion of vancomycin using pharmacokinetic (PK) software and a PK population model designed from historical within-population data in intermittently dosed patients. The target range for the first vancomycin serum concentrations drawn approximately 24 h after start of infusion’ (C24) was set at 15–20 mg/L corresponding with an area under the curve (AUC) of at least 350 mg·h·L^?1. The performance of the dosing schedule was primarily assessed by describing the percentages of patients attaining the predefined target.

Results

An eGFR-derived dosing schedule for CoI of vancomycin was established and implemented in clinical practice. Prospective assessment in 35 general ward and 45 intensive care unit patients showed that the C24 target was reached in 69 and 63 % and the AUC target was attained in 80 and 72 % of patients, respectively.

Conclusions

An easy method to design and validate an eGFR-derived dosing algorithm for the continuous infusion of vancomycin to switch from intermittent to continuous dosing of vancomycin was developed.     

Energy expenditure at rest and during activities: A comparison between young and elderly women

Energy expenditure at rest (resting metabolic rate, RMR) and during several activities was measured in 20 young (age 19–27 years) and 19 elderly (age 65–78 years) females. Fat-free mass (FFM) was estimated by means of a four compartment model which accounted for variability in water and bone mineral in the FFM. RMR was lower (P < 0.05) in the elderly (mean ± SE 3.55 ± 0.05 kJ/min) compared to the younger females (3.92 ± 0.09 kJ/min). However, after correction for differences in FFM between the groups, RMR was 3.71 ± 0.07 kJ/min and 3.77 ± 0.06 kJ/min for the elderly and young, respectively, and the difference was not significant. Energy expenditure (EE) during several activities, standing with arm movement, bicycling at 25 Watts, and walking at 3 km/h, were not different between the two groups. However, the physical activity ratios (PAR) for the activities were higher (P < 0.05) in the elderly (1.61 ± 0.03, 3.29 ± 0.07, 4.11 ± 0.16, respectively) than in the young (1.47 ± 0.03, 2.93 ± 0.05, 3.58 ± 0.14, respectively). EE due to physical activity alone (total EE minus RMR) was significantly higher for all activities in the elderly, except for walking at fixed speed of 3 km/h. After correction for the lower relative FFM in the elderly, differences between age groups disappeared. EE for walking 500 m at an individually selected speed was higher in the elderly, although they selected a lower walking speed. Differences between young and elderly decreased when step frequency was taken into account. It is concluded that EE due to physical activity in elderly women is higher than in younger females, but that the differences in EE due to physical activity are largely attributable to differences in body composition. © 1996 Wiley-Liss, Inc.     

Do positive or negative experiences of social support relate to current and future health? Results from the Doetinchem Cohort Study

Background  

Cross-sectional studies have reported associations between social support and health, but prospective evidence is less conclusive. This study aims to investigate the associations of positive and negative experiences of social support with current and future lifestyle factors, biological risk factors, self-perceived health and mental health over a 10-year period.     

Systolic and Diastolic Strain Measurements Show Left Ventricular Dysfunction in Women with Turner Syndrome

Aim: This study aimed to describe the systolic left ventricular global longitudinal strain (LvGLS) and left ventricular peak early diastolic strain rate (Sre) in adult women with Turner syndrome (TS) and to determine its relationship with exercise capacity and clinical parameters. Methods: In this cross-sectional cohort study, consecutively included adult TS women underwent an electrocardiogram, transthoracic echocardiogram (TTE) and cardiopulmonary exercise test (CPET) on the same day. LvGLS and Sre were measured using 2D speckle tracking analysis (STE) and compared with age-matched healthy female controls. Results: Ninety-four adult women (age 36 ± 13 years) with TS and 32 healthy age-matched female controls were included. Women with TS had a significantly impaired/reduced systolic LvGLS (–17.82 ± 2.98% vs. –21.80 ± 1.85%, p < 0.001) and Sre (0.98 ± 0.32 s-1 vs. 1.27 ± 0.19 s-1, p > 0.001), compared to healthy female controls. Furthermore, TS women had reduced diastolic function as measured by conventional echocardiographic parameters: A higher A-wave (p < 0.001), lower E/A-ratio (p = 0.001), longer deceleration time (p = 0.006), and a higher E/E’-ratio (p < 0.001). Women with TS also had a significantly reduced maximal workload (p = 0.033), reduced oxygen uptake (p < 0.001) and a reduced maximal heart rate (p < 0.001) during exercise. Multivariable linear regression analysis revealed that Age, karyotype and QT-duration were significantly associated with Sre, but not with LvGLS, in the TS population. Conclusion: Systolic and diastolic strain and exercise capacity were significantly reduced in TS women compared to healthy women. No correlation between strain itself and exercise capacity could be demonstrated, but correlations with conventional TTE parameters and baseline characteristics were found.     

Dietary Protein Intake in Older Adults from Ethnic Minorities in the Netherlands,a Mixed Methods Approach

Optimizing protein intake is a novel strategy to prevent age associated loss of muscle mass and strength in older adults. Such a strategy is still missing for older adults from ethnic minority populations. Protein intake in these populations is expected to be different in comparison to the majority of the population due to several socio-cultural factors. Therefore, the present study examined the dietary protein intake and underlying behavioral and environmental factors affecting protein intake among older adults from ethnic minorities in the Netherlands. We analyzed frequency questionnaire (FFQ) data from the Healthy Life in an Urban Setting (HELIUS) cohort using ANCOVA to describe dietary protein intake in older adults from ethnic minorities in the Netherlands (N = 1415, aged >55 years, African Surinamese, South Asian Surinamese, Moroccan, and Turkish). Additionally, we performed focus groups among older adults from the same ethnic minority populations (N = 69) to discover behavioral and environmental factors affecting protein intake; 40–60% of the subjects did not reach minimal dietary protein recommendations needed to maintain muscle mass (1.0 g/kg bodyweight per day (BW/day)), except for Turkish men (where it was 91%). The major sources of protein originated from animal products and were ethnic specific. Participants in the focus groups showed little knowledge and awareness about protein and its role in aging. The amount of dietary protein and irregular eating patterns seemed to be the major concern in these populations. Optimizing protein intake in these groups requires a culturally sensitive approach, which accounts for specific protein product types and sociocultural factors.     

Dietary Patterns,Cognitive Decline,and Dementia: A Systematic Review

Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until now mainly focused on the role of individual nutrients and bioactive components. However, the evidence for combined effects, such as multinutrient approaches, or a healthy dietary pattern, such as the Mediterranean diet, is growing. These approaches incorporate the complexity of the diet and possible interaction and synergy between nutrients. Over the past few years, dietary patterns have increasingly been investigated to better understand the link between diet, cognitive decline, and dementia. In this systematic review we provide an overview of the literature on human studies up to May 2014 that examined the role of dietary patterns (derived both a priori as well as a posteriori) in relation to cognitive decline or dementia. The results suggest that better adherence to a Mediterranean diet is associated with less cognitive decline, dementia, or Alzheimer disease, as shown by 4 of 6 cross-sectional studies, 6 of 12 longitudinal studies, 1 trial, and 3 meta-analyses. Other healthy dietary patterns, derived both a priori (e.g., Healthy Diet Indicator, Healthy Eating Index, and Program National Nutrition Santé guideline score) and a posteriori (e.g., factor analysis, cluster analysis, and reduced rank regression), were shown to be associated with reduced cognitive decline and/or a reduced risk of dementia as shown by all 6 cross-sectional studies and 6 of 8 longitudinal studies. More conclusive evidence is needed to reach more targeted and detailed guidelines to prevent or postpone cognitive decline.