Screening and Assessment for an Early Identification of Malnutrition in Older People
Malnutrition is common among older people and leads to numerous negative clinical consequences due to changes in ...body composition and body function. A prerequisite for successful prevention and treatment is the early identification of older persons with (risk of) malnutrition. Therefore, in geriatric settings, routine malnutrition screening with a validated tool (e.g., Mini Nutritional Assessment or Nutritional Risk Screening) is recommended at regular intervals. In case of a positive screening result, a subsequent nutritional assessment is performed to confirm the diagnosis, to clarify the causes and to determine the energy and protein deficit, in order to initiate a targeted nutritional therapy and to improve the nutritional status of the older persons and thereby the overall prognosis.
Objectives
To compare the prognostic value of the revised Mini Nutritional Assessment short form (MNA‐SF) classification with that of the long form (MNA‐LF) in relation to mortality and functional ...change in community‐dwelling older adults receiving home care in Germany.
Design
Multicenter, 1‐year prospective observational study.
Setting
Community.
Participants
Older adults (≥65) receiving home care (n = 309).
Measurements
Nutritional status (well nourished, at risk of malnutrition, malnourished) was classified using the MNA‐SF and MNA‐LF at baseline. Functional status was determined according to the Barthel Index of activities of daily living (ADLs) at baseline and after 1 year. Hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality were calculated for MNA‐SF and MNA‐LF categories using stepwise Cox regression analyses. Repeated‐measurements analysis of covariance was used to examine changes in ADL scores over time for MNA‐SF and MNA‐LF categories.
Results
MNA‐SF classified 15% of the sample as malnourished and 41% as being at risk of malnutrition, whereas the MNA‐LF classified 14% and 58%, respectively. During the follow‐up year, 15% of participants died. The estimated hazard ratios (HR) for 1‐year mortality were lower for MNA‐SF than for MNA‐LF categories (at risk of malnutrition: HR = 2.21, 95% confidence interval (CI) = 1.02−4.75 vs HR = 5.05, 95% CI = 1.53−16.58; malnourished: HR = 3.27, 95% CI = 1.34−8.02 vs HR = 8.75, 95% CI = 2.45−31.18). For MNA‐SF categories, no differences in functional change were found. According to the MNA‐LF, ADL decline tended to be greater in those at risk of malnutrition (7.1 ± 10.1 points) than in those who were well nourished (3.7 ± 10.1 points) and malnourished (4.9 ± 10.1 points).
Conclusion
In this sample of older adults receiving home care, the MNA‐LF was superior to the MNA‐SF in predicting mortality and differentiating functional decline during 1 year of follow‐up.
Malnutrition (i.e., protein-energy malnutrition) in older adults has severe negative clinical consequences, emphasizing the need for effective treatments. Many, often small, randomized controlled ...trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and a need for meta-analyses and data pooling has been expressed. However, evidence synthesis is hampered by the wide variety of outcomes and their method of assessment in previous RCTs. This paper describes the protocol for developing a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk.
The project consists of five phases. The first phase consists of a scoping review to identify frequently used outcomes in published RCTs and select additional patient-reported outcomes. The second phase includes a modified Delphi Survey involving experienced researchers and health care professionals working in the field of malnutrition in older adults, followed by the third phase consisting of a consensus meeting to discuss and agree what critical outcomes need to be included in the COS. The fourth phase will determine how each COS outcome should be measured based on a systematic literature review and a second consensus meeting. This will be followed by a dissemination and implementation phase. Patient and Public Involvement (PPI) representatives will contribute to study design, oversight, consensus, and dissemination.
The result of this project is a COS that should be included in any RCT evaluating the effect of nutritional interventions in older adults with malnutrition and those at risk. This COS will facilitate comparison of RCT results, will increase efficient use of research resources and will reduce bias due to measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.
•Older patients with cancer have a higher risk for cachexia.•Older patients with and without cachexia differ in body composition.•Older patients with cachexia have a higher risk of death.•Assessment ...of weight loss can identify older patients with cachexia.
Patients with chronic inflammatory diseases and malignant tumors have an increased risk of cachexia. No consistent definition exists to rapidly identify cachexia in older patients with and without cancer.
One-hundred patients (53% male) aged 70 + years were included in the study by a university hospital. In addition to the detection of malnutrition and determination of body composition by bioelectrical impedance analysis, cachexia was assessed according to the well-established definitions of Evans (weight loss ≥ 5% within the last 12 months plus additional clinical parameters), Fearon (weight loss > 5% in 6 months) and Bozzetti (weight loss ≥ 10% of habitual weight). After a follow-up of 3.5 years, the mortality rate was recorded.
Thirty-three patients had a malignant tumor disease. The patients with a non-malignant underlying disease did not differ in their mental state, physical condition and state of health compared to patients with cancer. A higher percentage of patients with underlying malignancy had cachexia. There were significant differences in the body composition between the patients with or without cachexia. Cachectic patients exhibited a significantly lower skeletal muscle mass and fat mass. The risk of death was increased in cachectic patients of all three cachexia definitions.
For clinical daily routine, the assessments by a weight loss according to Fearon and Bozzetti are suggested to be practicable methods to detect cachexia in older patients with and without cancer.
Aging is associated with reduced appetite as well as a slight increase in pro-inflammatory status, which both might contribute to the development of malnutrition. We aimed to evaluate the association ...between inflammation based on serum C-reactive protein (CRP), and appetite in healthy community-dwelling older adults. In this cross-sectional study of 158 healthy and non-smoking persons (aged 75–85 years), appetite was assessed in personal interviews by a single question with five answer categories. As nobody reported (very) poor appetite, the remaining three categories were dichotomised into “(very) good” and “moderate” appetite. Fasting serum CRP was analysed according to standard procedures, values ≥ 5.0 mg/L were considered as inflammation. The association between inflammation and appetite was examined by binary logistic regression, unadjusted and adjusted for age, sex, waist circumference, leptin, depressive mood, number of medications, interleukin-6 and tumor necrosis factor-α. Appetite was very good in 27.8%, good in 58.9%, and moderate in 13.3% of participants. Inflammation was present in 10.8% overall, in 8.8% of those with (very) good and in 23.8% of those with moderate appetite (
p
= 0.038). In the unadjusted model, participants with inflammation were 3.2 times more likely to have moderate appetite (95%CI: 1.01–10.44,
p
= 0.047). In the adjusted model, the odds of having moderate appetite was 3.7 times higher in participants with inflammation, but no longer significant (95%CI: 0.77–18.55,
p
= 0.102). In healthy older people, we found hints for a potential association between increased levels of CRP and a slightly reduced appetite. More studies in larger samples are needed.
IntroductionObesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been ...fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity.Methods and analysesSix databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention.Ethics and disseminationWe will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups.PROSPERO registration numberCRD42019147286.
Various aspects of protein intake are thought to be crucial for the prevention of sarcopenia in older adults. Information about the day-to-day variation in these aspects is lacking. Our objective was ...to examine whether daily protein intake, protein distribution across meals, number of meals providing adequate protein, and protein sources vary across the week in healthy community-dwelling older adults. In 140 persons (51% women) that were aged 75⁻85 years, protein intake was assessed by seven-day food records. On average across the week, protein intake (median IQR) was 0.93 0.79⁻1.10 g/kg body weight (BW) and the coefficient of variation across the three main meals was 0.50 0.40⁻0.61. The number of meals per day providing ≥0.4 g protein/kg BW was 0.57 0.43⁻1.00 and 60.0 52.4⁻65.2% of protein intake was animal-based. According to Friedman's test, differences throughout the week were observed in women for daily protein intake (
= 0.038; Sunday: 0.99 0.78⁻1.31 vs. Tuesday: 0.79 0.68⁻1.12 g/kg BW) and number of meals with adequate protein (
= 0.019; ≥1 daily meal: Sunday: 69.4% vs. Tuesday: 41.7%). On Sunday, protein intake was most in agreement with suggestions to prevent sarcopenia. In men, protein intake did not differ throughout the week.
In older adults, the relationship between healthy eating motivation (HEM) and protein intake as key component of a healthy diet is poorly understood. Therefore, we investigate the association of HEM ...with (1) total protein intake and (2) intake of different protein sources in older adults with varying functional status. In this cross-sectional study including 250 adults (≥70 years), we assessed HEM with "The Eating Motivation Survey" and protein intake by 7-day food records. In addition, gender, age, Body Mass Index (BMI), energy intake and functional status were considered. Regression analyses revealed that HEM was neither related to total (
= -0.02;
= 0.723) nor to relative protein intake (
= 0.04;
= 0.370). Notwithstanding this, participants with stronger HEM showed lower intake of protein from meat and meat products (
= -0.14
= 0.018), higher intake of overall plant-based protein (
= 0.11
= 0.032), protein from fruit and vegetables (
= 0.20
= 0.002) and from pulses, nuts an seeds (
= 0.16
= 0.016). Our findings suggest HEM as a valuable indicator for intake of distinct protein sources. However, since HEM is not related to total protein intake, the importance of sufficient protein consumption should be emphasized by promoting healthy eating, regardless of self-perceived HEM.
In an aging population, support for independent living is increasingly critical for older generations. Currently, sarcopenia is a major cause of frailty, which increases the risk of decreased ...mobility, falls, morbidity, and mortality and leads to dependence on third parties. Sarcopenia is preventable by consumption of adequate protein. However, many older people do not meet the recommended daily allowance of protein, thereby supporting dependence rather than independent living. Current literature indicates that a protein drink could be an appropriate product for older peoples' protein consumption. We were interested in autonomous persons whose nutritional decisions were still self-determined and thus could preventively influence their personal health. This study evaluated three commercially available protein drinks in three focus groups (
n
= 25) to gain insight into which aspects influence the perception of commercial protein drinks on community-dwelling older people (age, 76.8 ± 4.9). Findings from the focus groups revealed only aspects, which influenced the perception of commercial protein drinks negatively. Most importantly, the drinks did not comply with relevant aspects when buying (healthy) foods, which where naturalness, freshness, locally grown ingredients, and trust. Furthermore, the target group did not see a need for additional protein consumption. Thus, we identify important aspects to be considered for the development of a target-group-specific protein drink as well as more suitable communication to prevent distrust in order to support independent living for community-dwelling older people.
Introduction:
Nutritional habits and requirements are changing over the lifespan, but the dynamics of nutritional issues and the diet-health relationship in the major stages of the human life cycle ...are not sufficiently understood. A human phenotyping research platform for nutrition studies was established to recruit and phenotype selected population groups across different stages of life. The project is the backbone of the highly interdisciplinary
enable
competence cluster of nutrition research aiming to identify dietary determinants of a healthy life throughout the lifespan and to develop healthier and tasty convenience foods with high consumer acceptance.
Methods:
The phenotyping program included anthropometry, body composition analysis, assessment of energy metabolism, health and functional status, multisensory perception, metabolic phenotyping, lifestyle, sociodemography, chronobiology, and assessment of dietary intake including food preferences and aversions.
Results:
In total, 503 healthy volunteers at four defined phases of life including 3–5-year old children (
n
= 44), young adults aged 18–25 years (
n
= 94), adults aged 40–65 years (“middle agers,”
n
= 205), and older adults aged 75–85 years (
n
= 160) were recruited and comprehensively phenotyped. Plasma, serum, buffy coat, urine, feces and saliva samples were collected and stored at −80°C. Significant differences in anthropometric and metabolic parameters between the four groups were found. A major finding was the decrease in fat-free mass and the concomitant increase in % body fat in both sexes across the adult lifespan.
Conclusions:
The dataset will provide novel information on differences in diet-related parameters over the lifespan and is available for targeted analyses. We expect that this novel platform approach will have implications for the development of innovative food products tailored to promote healthy eating throughout life.
Trial registration:
DRKS, DRKS00009797. Registered on 20 January 2016,
https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&_ID=DRKS00009797
.
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