Malnutrition (MN) is widespread in nursing homes. Sometimes, but not always, nutritional interventions (NIs) are made, and the reasons for or against NIs are unknown. The aim of this cross-sectional ...study was to describe these reasons for residents with and without MN according to nurses’ subjective judgement and according to objective signs of MN. The nutritional status of 246 nursing home residents was subjectively judged by nurses (MN, at risk of MN, no MN) and objectively assessed by body mass index (BMI), weight loss (WL), and low food intake. NIs (enriched meals and/or oral nutritional supplements) were recorded using a standardized questionnaire, and nurses’ main reasons for (not) giving NIs were obtained in an open question. Of the residents, 11.0% were subjectively malnourished, and 25.6% were at risk of MN; 32.9% were malnourished according to objective criteria. Overall, 29.7% of the residents received NIs, 70.4% of those with MN as assessed by the nurses, 53.0% of those with objective MN, and 11.0% and 18.0% of non-malnourished residents, respectively. Reasons for NIs most often stated were low intake (47.9%), WL (23.3%), and low BMI (13.7%). Reasons against NIs mostly mentioned were adequate BMI (32.9%) and sufficient intake (24.3%). The lack of NIs for residents with MN was partially—but not always—explained by valid reasons. As residents without MN frequently received NIs, criteria for both MN rating and providing NIs, require closer scrutiny.
Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this ...regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 95% CI 0.5–9.7, IC-LO 1.4 0.3–6.6, IC-LA 1.4 0.3–6.6) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.
Dietary intake and requirements in nursing home (NH) residents vary individually, but concepts for individualised interventions are currently lacking. Therefore, we present an individualised modular ...nutritional intervention concept for NH residents with (risk of) malnutrition and describe its application and acceptability. Three enrichment modules-a sweet and a savoury protein cream (40 g, 125 kcal, 10 g protein) and a protein-energy drink (250 mL, 220 kcal, 22 g protein)-were offered to residents of two German NHs single or in combination in five levels of enrichment from level 0 (no enrichment) to 4 (all enrichment modules) to compensate for individual energy and protein deficiencies. Residents with chewing and/or swallowing difficulties received reshaped instead of usual texture-modified meals. The intervention concept was applied to 55 residents (Mean age of 84 ± 8 years, 76.0% female, 25.5% malnutrition). Despite (risk of) malnutrition, 18.2% received no enrichment (level 0). Level 1 was allocated to 10.9%, level 2 to 27.3%, level 3 to 20.0% and level 4 to 23.6% of the residents. 32.7% received reshaped texture-modified meals (RTMM). Participants consuming RTMM were more often assigned to level 4 than residents receiving usual meals (38.8% vs 16.2%). We proposed and successfully applied an individualised modular nutritional intervention concept to NH residents with (risk of) malnutrition. In the next step, the effects of the concept and its transferability to other NHs need to be demonstrated.
Reducing the intake of total fat, saturated fatty acids (SFA) and dietary cholesterol was a cornerstone of dietary guidance in past decades. This emphasis shifted recently from lowering the intake of ...total fat to focusing on the quality of dietary fat intake, the avoidance of industrial trans-fatty acids (TFA), and the substitution of SFA with unsaturated fatty acids. There is also a trend towards investigating diet-disease associations of fatty foods rather than nutrients.
We aimed to summarize comprehensively the currently available evidence for total dietary fat, fat quality, and fatty foods such as butter, vegetable oils, nuts and seeds on risk of non-communicable diseases including cardiovascular disease (and its risk factors), cancer, type 2 diabetes, and neurodegenerative diseases.
The findings from systematic reviews of prospective observational studies, which often compared extreme intake categories, found mainly no association of total fat, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and SFA with risk of non-communicable diseases. Systematic reviews of randomized controlled trials indicate that SFA and/or TFA substitution with MUFA and/or PUFA improves blood lipids and markers of glycemic control (observed only for SFA replacement), with the effect of PUFA being more pronounced. A higher intake of total TFA was associated increased risk of cardiovascular disease. In line with current dietary guidelines, the available published evidence deems it reasonable to recommend replacement of SFA with MUFA and PUFA and avoidance of consumption of industrial TFA.
•Reducing the intake of total fat, saturated fatty acids and dietary cholesterol was a cornerstone of dietary guidance in past decades.•Findings from systematic reviews of observational studies found mainly no association of total fat and fatty acids with risk of non-communicable diseases.•Systematic reviews of randomized trials indicate that saturated fatty acids and/or trans fatty acids substitution with monounsaturated fatty acids and/or polyunsaturated fatty acids improves blood lipids.•A higher intake of total trans-fatty acids was associated increased risk of cardiovascular disease.•The available evidence deems it reasonable to recommend replacement of saturated fatty acids with unsaturated fatty acids and avoidance of consumption of industrial trans-fat.
Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in ...counteracting these key health threats.
To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.
This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.
We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.
A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
Reducing the intake of total fat, saturated fatty acids (SFA) and dietary cholesterol was a cornerstone of dietary guidance in past decades. This emphasis shifted recently from lowering the intake of ...total fat to focusing on the quality of dietary fat intake, the avoidance of industrial trans-fatty acids (TFA), and the substitution of SFA with unsaturated fatty acids. There is also a trend towards investigating diet-disease associations of fatty foods rather than nutrients.
We aimed to summarize comprehensively the currently available evidence for total dietary fat, fat quality, and fatty foods such as butter, vegetable oils, nuts and seeds on risk of non-communicable diseases including cardiovascular disease (and its risk factors), cancer, type 2 diabetes, and neurodegenerative diseases.
The findings from systematic reviews of prospective observational studies, which often compared extreme intake categories, found mainly no association of total fat, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and SFA with risk of non-communicable diseases. Systematic reviews of randomized controlled trials indicate that SFA and/or TFA substitution with MUFA and/or PUFA improves blood lipids and markers of glycemic control (observed only for SFA replacement), with the effect of PUFA being more pronounced. A higher intake of total TFA was associated increased risk of cardiovascular disease. In line with current dietary guidelines, the available published evidence deems it reasonable to recommend replacement of SFA with MUFA and PUFA and avoidance of consumption of industrial TFA.
•Reducing the intake of total fat, saturated fatty acids and dietary cholesterol was a cornerstone of dietary guidance in past decades.•Findings from systematic reviews of observational studies found mainly no association of total fat and fatty acids with risk of non-communicable diseases.•Systematic reviews of randomized trials indicate that saturated fatty acids and/or trans fatty acids substitution with monounsaturated fatty acids and/or polyunsaturated fatty acids improves blood lipids.•A higher intake of total trans-fatty acids was associated increased risk of cardiovascular disease.•The available evidence deems it reasonable to recommend replacement of saturated fatty acids with unsaturated fatty acids and avoidance of consumption of industrial trans-fat.
Poor appetite is considered a key factor in the development of malnutrition, a link that can be explained by alterations in dietary intake. Given the limited data on dietary characteristics in ...community-dwelling older adults with poor appetite, the present study aimed to examine whether poor appetite is associated with lower nutrient intake and more unfavourable food choices.
In 569 participants of the Longitudinal Aging Study Amsterdam aged ≥70 years appetite was assessed using the Simplified Nutritional Appetite Questionnaire and dichotomised into normal (>14) and poor (≤14). Intake of energy, 19 nutrients, 15 food groups, the Dutch Healthy Diet Index 2015 (DHD15) and Mediterranean Diet Score (MDS) were calculated from a food frequency questionnaire. Dietary differences between appetite groups were examined using Mann-Whitney U test and binary logistic regression adjusted for potential confounders.
Mean age was 78 ± 6 years and 52% were female. Appetite was poor in 12.5% of participants. Energy intake was 1951 (median; quartiles 1-3: 1,653-2,384) kcal/day with no difference between appetite groups. Poor appetite was associated with lower intake of protein (OR 0.948, 95%CI 0.922-0.973), folate (0.981, 0.973-0.989), zinc (0.619, 0.454-0.846), vegetables (0.988, 0.982-0.994) and lower scores of DHD15 (0.964, 0.945-0.983) and MDS (0.904, 0.850-0.961), as well as higher intake of carbohydrates (1.015, 1.006-1.023), and vitamins B2 (4.577, 1.650-12.694) and C (1.013, 1.005-1.021).
Community-dwelling older adults with poor appetite showed poorer diet quality with a lower intake of protein, folate, zinc and vegetables, compared with those reporting normal appetite and should be advised accordingly.
Purpose
A poor appetite affects up to 27% of community-dwelling older adults in Europe and is an early predictor of malnutrition. Little is known about the factors associated with poor appetite. The ...present study, therefore, aims to characterise older adults with poor appetite.
Methods
As part of the European JPI project APPETITE, data from 850 participants, aged ≥ 70 years of the Longitudinal Ageing Study Amsterdam (LASA) from 2015/16 were analysed. Appetite during the last week was assessed with a five-point scale and dichotomised into "normal" and "poor". Binary logistic regression was used to examine associations between 25 characteristics from 5 domains—physiological, emotional, cognitive, social, and lifestyle—and appetite. First, domain-specific models were calculated using stepwise backward selection. Second, all variables contributing to poor appetite were combined in a multi-domain model.
Results
The prevalence of self-reported poor appetite was 15.6%. Fourteen parameters from all five single-domain models contributed to poor appetite and were entered into the multi-domain model. Here, female sex (total prevalence: 56.1%, odds ratio: 1.95 95% confidence interval 1.10–3.44), self-reported chewing problems (2.4%, 5.69 1.88–17.20), any unintended weight loss in the last 6 months (6.7%, 3.07 1.36–6.94), polypharmacy defined as ≥ 5 medications in the past 2 weeks (38.4%, 1.87 1.04–3.39), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale without appetite item) (1.12 1.04–1.21) were associated with an increased likelihood of having poor appetite.
Conclusion
According to this analysis, older people with the characteristics described above are more likely to have a poor appetite.
Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in ...counteracting these key health threats.
To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.
This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.
We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.
A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
Comment on Tai Chi for Risk of Falls. A meta‐analysis Schoene, Daniel; Kiesswetter, Eva; Lord, Stephen R
Journal of the American Geriatrics Society,
December 2017, 2017-12-00, 20171201, Volume:
65, Issue:
12
Journal Article
PDF
