The study evaluated the association between consumption frequencies of the major food categories and the risk of new depression four years later in older Taiwanese.
A prospective cohort study with ...multistage random sampling. Logistic regression analysis evaluated the significance of the longitudinal associations of intake frequencies of the major food categories with future (4 years later) risk of new depression, controlled for possible confounding factors with or without adjustment for cognitive status.
Population-based free-living elderly.
Men and women (n 1609) ≥65 years of age.
In a regression model that controlled for demographic, socio-economic, lifestyle and disease/health-related variables but not cognitive status, both fruits (OR = 0·66, 95 % CI 0·45, 0·98, P = 0·038) and vegetables (OR = 0·38, 95 % CI 0·17, 0·86, P = 0·021) were protective against depressive symptoms 4 years later. However, when the same regression model was also adjusted for cognitive status, only vegetables (OR = 0·40, 95 % CI 0·17, 0·95, P = 0·039) were protective against depressive symptoms. Higher consumption of eggs was close to being significant in both regression models (P = 0·087 and 0·069, respectively). Other food categories including meat/poultry, fish, seafood, dairy, legumes, grains and tea showed no significant associations.
Results suggest that although confounding factors cannot be totally ruled out, more frequent consumption of vegetables seems to be protective against depressive symptoms in the elderly. Further studies are needed to elucidate the causal role and the mechanism of the association.
BMI, mid-arm circumference (MAC) and calf circumference (CC) are anthropometric indicators often included in geriatric health measurement scales. However, their relative effectiveness in predicting ...long-term mortality risk has not been extensively examined. The present study aimed to evaluate the relative effectiveness of these anthropometrics in predicting long-term mortality risk in older adults. The study prospectively analysed the ability of these indicators in predicting 4-year follow-up mortality risk of a population-representative sample of 4191 men and women, 53 years of age or older in the 'Survey of Health and Living Status of the Elderly in Taiwan'. Cox regression analyses were performed to evaluate the association of follow-up mortality risk with low ( < 21 kg/m2) or high ( ≥ 27 kg/m2) BMI, low MAC ( < 23·5/22 cm for men/women) and low CC ( < 30/27 cm) respectively, according to Taiwanese-specific cut-off points. Results showed that low CC and low MAC were more effective than low BMI in predicting follow-up mortality risk in 65-74-year-old elderly. But low CC and low BMI were more effective than low MAC in ≥ 75-year-old elderly, and low BMI was more effective than low MAC or low CC in 53-64-year-old persons. High BMI was not effective in predicting mortality risk in any of these age ranges. These results suggest that in elderly adults, CC is more effective than BMI in predicting long-term mortality risk. Thus, more consideration to CC and MAC in designing geriatric health or nutritional measurement scales is recommended.
This study aimed to test the mediating and moderating effects of sleep hygiene practice on the relationship between anxiety and insomnia severity in hospital nurses. A cross‐sectional survey was ...employed, and a convenience sample was recruited from one regional hospital in Taiwan. Participants completed the following self‐report questionnaires over a 3‐month period in 2009: the Insomnia Severity Index, the Beck Anxiety Inventory, and Sleep Hygiene Awareness and Practice Scale. The results indicated that nurses with more anxiety tended to have higher insomnia severity. Further, nurses with poor sleep hygiene practice had more insomnia. Sleep hygiene practice partially mediated the effects of anxiety on insomnia severity. Also, sleep hygiene practice was a moderator in the relationship between anxiety and insomnia severity with age and work units as covariates. Sleep hygiene practice mediated and moderated the relationship between anxiety and insomnia severity after controlling the variables of age and work units. Continuing to learn and train sleep hygiene practice might promote nurses' sleep hygiene, and thereby ameliorate anxiety and reduce the risk of insomnia.
Abstract The study was to compare the ability of BMI, MAC and CC in predicting nutritional status, functional ability and follow-up mortality risk of older adults. The study purposively recruited 160 ...of 320 residents of a nursing home in Central Taiwan to serve as subjects. Residents who were ≥65 years old, cognitively normal, without acute conditions and non-hospitalized were qualified to participate. All subjects signed an informed consent. Each was interviewed with a structured questionnaire for sociodemographic, lifestyle and health-related information; evaluated with the Mini Nutritional Assessment (MNA) and the Activities of Daily Living (ADL) scales; measured for weight, height, MAC and CC; and assayed for nutrition-related biochemical values. Results showed that CC was the best, followed by MAC and then BMI in predicting the nutritional status and health conditions. CC and MAC were also more effective than BMI in predicting 12-month follow-up mortality. Overall, CC is the most capable in predicting nutritional status, functional activity and general health conditions; MAC is the most capable in predicting 12-month follow-up mortality risk whereas BMI is the weakest in all functions. These results should have practical implication in geriatric health measurements.
Aims and objectives
To improve the short‐form Mini‐Nutritional Assessment (MNA) to ameliorate under‐rating the risk of malnutrition in patients on haemodialysis.
Background
The full MNA was found to ...be appropriate for rating the risk of malnutrition in persons undergoing haemodialysis but the short‐form under‐rated the risk.
Design
A cross‐sectional study with purposive sampling.
Methods
The study recruited 152 adult ambulatory patients on maintenance haemodialysis from one dialysis centre in Taiwan. Each subject was rated with the Subjective Global Assessment (SGA), the original and selected alternative short‐forms (by replacing better performing nonshort‐form items for lesser performing short‐form items) of a Taiwanese‐specific MNA (T1). Serum albumin and creatinine concentrations and the SGA were also used as referents. Results were evaluated with Pearson's correlation analysis, binary classification test and receiver operating characteristic (ROC) curves.
Results
The full MNA showed good consistency with the SGA, but the original short‐form rated fewer patients at risk of malnutrition compared with the full MNA. Exchanging item O (self‐rated nutritional status) with item E (neuropsychological problems) produced the best results and restored the predictive ability of the short‐form. Replacing item P for E produced the next best results.
Conclusion
Results suggest that the predictive ability of the short‐form can be greatly restored by rearranging the component items of the short‐form without affecting the performance of the full MNA. The study is probably the first example of a disease‐specific version of the MNA.
Relevance to clinical practice
The revision makes short‐form MNA suitable for rating the risk of malnutrition in patients on haemodialysis in clinical practice.
The present study was aimed to validate two normalised short-form (SF) Mini-Nutritional Assessments (MNA) that contained either BMI (Taiwan version 1, T1) or calf circumference (CC; Taiwan version 2, ...T2) for rating the nutritional status of elderly Taiwanese. Both versions adopted Taiwanese anthropometric cut-offs, but T2 further had the BMI item replaced by CC. We compared the ability of the two SF in rating the nutritional status of 2674 elderly Taiwanese in the 1999 ‘Taiwan Longitudinal Survey on Aging’ with their respective full versions. We evaluated the agreement between the SF and full scales with weighted κ and performed Cox regression analysis for the follow-up 4-year mortality according to nutritional status rated at baseline. The results showed that the agreements between the respective SF and the full MNA were good (weighted κ: 0·679 for T1 and 0·667 for T2). Both SF performed well in predicting follow-up 4-year mortality relative to the full MNA. In conclusion, MNA-T1-SF and -T2-SF have good consistency with the full MNA and have quite comparable abilities in rating the nutritional status of elderly Taiwanese. Both SF versions appear appropriate for functioning as stand-alone units for rating the nutritional status of the elderly in community-living settings or the general population.
The full Mini Nutritional Assessment (full-MNA) and short-form MNA (MNA-SF) are simple and effective nutrition screening scales, but their usefulness for identifying patients with peritoneal dialysis ...(PD) at risk of protein-calorie malnutrition (PEM) has not been investigated.
This study was aimed to investigate the convergent validity of the full-MNA and MNA-SF for identifying patients with PD at risk of PEM.
A cross-sectional study.
A hospital-managed dialysis center.
80 adult ambulatory PD patients.
Patients were interviewed for personal data and rated with the full-MNA, MNA-SF and the Subjective Global Assessment (SGA) for nutritional status. The consistency among the scales was assessed with kappa coefficients. The ability of each scale to differentiate undernutrition was evaluated with external standards including serum albumin and creatinine concentrations, mid-arm and calf circumferences, and dialysis-related indicators. Statistical significance was evaluated with Wilcoxon rank-sum test.
The full-MNA and MNA-SF showed low agreements with the SGA (kappa=0.346 and 0.185, respectively). The full-MNA and MNA-SF performed better than the SGA in differentiating undernutrition according to the external standards. However, contrary to general expectation, MNA-SF rated a significantly smaller proportion of subjects at risk of undernutrition.
The full-MNA and MNA-SF are more able than the SGA in identifying PD patients at risk of PEM. However, MNA-SF rates a smaller proportion of PD patients at risk of undernutrition than the full-MNA. The use of MNA-SF as a stand-alone unit requires further confirmation.
Aim. The study was aimed to examine the appropriateness of using the Mini Nutritional Assessment to screen for risk of under‐ and over‐nutrition in adults with intellectual disabilities.
Background. ... Persons with intellectual disabilities are at increased risk of malnutrition, but routine monitoring of their nutritional conditions are not widely done.
Design. The study purposively recruited 104 institutionalised adults (≥19 years old) with intellectual disabilities to serve as participants.
Methods. Participants were interviewed with a structured questionnaire to elicit personal data, health‐related information and answers to items in the Activities of Daily Living and the Mini Nutritional Assessment scales and measured for anthropometrics. Biochemical data were taken from their routine medical measurements. Each subject was graded with the Mini Nutritional Assessment that adopted Taiwanese‐specific anthropometric cut‐off points (T1) and an alternative version that omitted the body mass index item (T2).
Results. Both Mini Nutritional Assessment versions were able indentifying individuals at risk of malnutrition among adults with intellectual disabilities and rated comparable proportions of patients malnourished (6·7 and 5·8% for Mini Nutritional Assessment‐T1 and Mini Nutritional Assessment‐T2, respectively) or at risk of malnutrition (14·4 and 17·3%, respectively). Persons with cerebral palsy were at greater risk of malnourishment than persons with other disabilities.
Conclusion. The Mini Nutritional Assessment is appropriate for screening for under‐ and over‐nutrition in adults with intellectual disabilities. The Mini Nutritional Assessment (especially the version without body mass index) can make routine monitoring of nutritional status of these patients an easier task. However, further studies are needed to develop subtype‐specific versions (tools) as various subtypes of intellectual disability are associated with different nutritional problems.
Relevance to clinical practice. The Mini Nutritional Assessment can serve as a tool for routine screening for under‐ and over‐nutrition in persons with intellectual disabilities.
Objective. The study was to evaluate the ability of the Mini Nutritional Assessment in predicting malnutrition in people with three subtypes of mental disorder (schizophrenia, major depression and ...bipolar disorder) in Taiwan.
Design. The study involved a convenience sample of 120 residents of psychiatric wards managed by a hospital in central Taiwan (52 with schizophrenia, 36 with major depression and 32 with bipolar disorder) classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria.
Methods. A structured questionnaire elicited subjects’ personal data, disease history and answers to questions in the Mini Nutritional Assessment. Serum and anthropometrical parameters were measured. Nutritional status was evaluated with a content‐equivalent version of the Mini Nutritional Assessment (Taiwan version‐1, T1).
Results. The Mini Nutritional Assessment‐Taiwan version‐1 was effective in assessing the nutritional status of people of all three subtypes of disorder. Nutritional statuses predicted with the Mini Nutritional Assessment‐Taiwan version‐1 agreed well with other nutritional indicators such as BMI, waist circumference and appetite status. According to the Mini Nutritional Assessment‐Taiwan version‐1, people with major depression were more likely to be at risk of undernutrition, whereas people with schizophrenia or bipolar disorder were more likely to be at risk of overnutrition.
Conclusion. The Mini Nutritional Assessment‐Taiwan version‐1 can effectively grade both undernutrition and overnutrition of people with schizophrenia, major depression or bipolar disorder.
Relevance to clinical practice. The Mini Nutritional Assessment enables nurses to monitor emerging nutritional problems in people with psychiatric disorder without relying on subjective judgement. With proper intervention, it can help reduce nutrition‐related chronic conditions in these individuals and save on healthcare cost.
Abstract The study was to evaluate the quality of self-report of hypertension and examine the factors associated with under- and over-reporting of hypertension in older Taiwanese. Data for this ...analysis were from the Social Environment and Biomarkers Study in Taiwan 2000, which involved a national sample of 1021 Taiwanese over 54 years of age. We performed binary classification tests to compare the prevalence rates of self-reported vs. clinically measured hypertension according to World Health Organization (WHO) (blood pressure ≥ 160/95 mm Hg or on hypertension medication) and JNC-6 (140/90 mm Hg or on hypertension medication) definitions. Logistic regression analysis was performed to analyze the potential factors associated with under- or over-reporting of blood pressure status. Results showed the test characteristics of self-reports were: sensitivity 73%, specificity 93%, and kappa = 0.68 ( p < 0.001) based on the WHO definition; and sensitivity 51%, specificity 95% and kappa = 0.43 ( p < 0.001) based on the JNC-6 definition. Old age was associated with over-reporting whereas having no health checkup during the past 12 months was associated with under-reporting. The relatively low agreement between self-reports and clinically measured hypertension (JNC-6 definition) was mainly due to the lack of a well-defined hypertension practice guideline and the failure of clinicians to clearly inform patients of their diagnoses. The consistency of hypertension practice guidelines and the effectiveness of informing the patients of their diagnoses are two main factors impacting the quality of self-report of hypertension in elderly Taiwanese. Better self-reports of health data can improve the efficiency of public health surveillance efforts.
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