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PubMed2006

The nutritional status of frail elderly with care needs according to the mini-nutritional assessment.

BACKGROUND AND AIMS: Although malnutrition is common in the geriatric population, the relationship between frail elderly with various care needs and nutritional status remains unknown. The purpose of this study was to analyze the association between subjects with higher care needs and poorer nutritional status in the Japanese community-dwelling frail elderly. METHODS: A total of 281 community-dwelling elderly subjects from day-care centers (81.9+/-7.2yr of age mean+/-SD; 72 men and 209 women) who were eligible for Long-Term Care Insurance were enrolled in this study to evaluate their nutritional status using the mini-nutritional assessment. The levels of care needs of participants were classified into six levels according to the Long-Term Care Insurance program. RESULTS: According to the mini-nutritional assessment classification, 39.9%, 51.2%, and 8.9% of the participants were assessed as well-nourished, at-risk of malnutrition, and malnourished, respectively. There were significant differences among the six groups with regard to the nutritional status; subjects with higher care needs were associated with poorer nutritional status. In the higher care needs group, more than half of the subjects did not know their weight change during 3-month intervals. CONCLUSIONS: The population of elderly with higher care needs in the community is associated with a higher prevalence of malnutrition.

Aged, 80 and over↗
PubMed2001

Association between nutrition knowledge and nutritional intake in middle-aged men from Northern France.

OBJECTIVE: The way in which nutrition knowledge transforms into dietary behaviour and nutrient intake may vary among populations. Therefore, the goal of the study was to examine whether nutrition knowledge is associated with nutritional intake in middle-aged men who are at major risk of cardiovascular disease. DESIGN: Cross-sectional population study aimed at comparing the response to a nutrition quiz with food habits and nutrient intake determined by a 3-day food record. SETTING: Men of the Urban Community of Lille (France) examined at home. SUBJECTS: 361 men aged 45-64 y, randomly selected from the electoral rolls. RESULTS: Subjects were separated in a high-score and a low-score group according to their responses to the nutrition quiz. Subjects in the high-score group had better educational and higher income levels than those from the low-score group. Multivariate analysis, adjusting on educational and socio-economic levels and other confounding variables - such as age, body mass index, cigarette smoking, physical activity and energy intake underreporting - showed that subjects in the high-score group were more often consumers of olive oil (36 vs. 12%; ), cheese (85 vs. 76%; or cereals (27 vs. 15%; and less often consumers of sunflower oil (51 vs. 68%; or dry vegetables (12 vs. 22%; than those in the low-score group. Subjects in the high-score group had lower intakes of fat vs. and especially of monounsaturated fat of animal origin vs. than individuals in the low-score group. CONCLUSION: Nutrition quiz score is associated with specific patterns of food choices and nutrient intake suggesting that nutrition knowledge influences dietary behaviour in middle-aged men from Northern France.

Cross-Sectional Studies↗
PubMedDate not supplied

Effect of total parenteral nutrition, constant rate enteral nutrition, and discontinuous oral feeding on plasma cholecystokinin immunoreactivity in children.

Plasma cholecystokinin (CCK) levels were measured by radioimmunoassay in 100 children (mean age: 20 months) on various types of artificial nutrition. Of the 81 children given total parenteral nutrition (TPN), 32 were studied while on cyclic TPN (cTPN), 66 while on partial fractioned feeding completed by parenteral nutrition, 25 while on constant rate enteral nutrition, and 18 while on total discontinuous oral feeding. The remaining 19 control cases were on normal alimentation. Plasma CCK levels during TPN (21.4 +/- 1.6 pg/ml), cTPN (21.8 +/- 2.7 pg/ml), and constant rate enteral nutrition (26.4 +/- 2.8 pg/ml) were not significantly different from each other and were similar to preprandial total discontinuous feeding (21 +/- 2 pg/ml) and control (22.6 +/- 3.5 pg/ml) levels. The postprandial CCK level increased significantly in partial fractionated feeding (33.6 +/- 3.3 pg/ml, p less than 0.02) but remained half that of postprandial total discontinuous oral feeding (75.6 +/- 6.6 pg/ml, p less than 0.001) and postprandial controls (75 +/- 7 pg/ml, p less than 0.001). Thus, basal and stimulated CCK levels are similar in children and adults, and the use of long-term artificial nutritional techniques does not modify the feeding stimulation of CCK. Plasma CCK levels during TPN and constant rate enteral nutrition are similar to fasting values, indicating a possible role for CCK in the biliary sludge.

Child, Preschool↗
PubMedDate not supplied

Effects of parenteral nutrition supplemented with alanyl-glutamine on nutrition status in rats.

BACKGROUND: Glutamine, a nonessential amino acid, has received increasing attention because it becomes essential during stress and catabolic conditions. Many investigations have shown that during severe stress, the consumption of glutamine exceeds glutamine synthesis, resulting in depletion of glutamine stores. The aim of this study was to evaluate the effects of supplementing parenteral diets with a glutamine-containing dipeptide, L-alanyl-L-glutamine, on rat nutrition status. METHODS: Male Wistar rats were used. Animals (n = 36) were centrally catheterized and randomly assigned to 1 of the following groups based on method of parenteral nutrition (PN): control group with oral nutrition and IV infusion of a saline solution; standard parenteral nutrition (SPN) group; or alanyl-glutamine-supplemented PN (ALA-GLN PN) group (20 g/L). Parenteral nutrition was isocaloric and isonitrogenous. Infusions were administered at a rate of 2.0 mL/h over 5 days. Nutrition status was assessed by body weight change, plasma proteins, accumulated urinary creatinine, and nitrogen balance. RESULTS: Accumulated urinary creatinine increased significantly after day 4 in the ALA-GLN PN group, compared with the SPN group and the controls. Body weight change significantly differed on day 5 between the ALA-GLN PN and SPN groups. After 3 days, nitrogen balance was significantly lower and nitrogen retention higher in the ALA-GLN PN group when compared with the SPN group. Albumin and transferrin concentrations decreased significantly in the SPN group, but did not differ from the controls in the ALA-GLN PN group. CONCLUSIONS: Weight, plasma proteins, urinary accumulated creatinine, and nitrogen retention showed a better evolution in the group supplemented with the glutamine dipeptide when compared with the SPN group. Our results suggest a more suitable nutrition support in animals receiving L-alanyl-L-glutamine.

Animals↗
PubMedDate not supplied

Effect of parenteral nutrition on nutrition status after bariatric surgery for morbid obesity.

BACKGROUND: To evaluate the influence of nutrition support (parenteral nutrition [PN] vs no parenteral nutrition [nPN]) on nutrition outcome, complications, and hospital stay after bariatric surgery (BS). METHODS: Sixty-seven consecutive BS patients (17 gastric bypass and 50 biliopancreatic diversion). The first 38 received PN and the next 29 did not (nPN) during the fasting postoperative (PO) period. In both groups, after fasting, a progressive oral diet was introduced. Data related to nutrition status, perioperative complications, and postsurgical hospital stay were compared. RESULTS: Sixty-seven patients (58 women), mean age 39.4 +/- 11.0 years, body mass index (BMI) 50.7 +/- 6.1 kg/m(2), were included. Thirty-eight patients received PN during 8.7 +/- 2.6 days. Ingestion was initiated at a median 8 PO days in PN vs 6.5 PO days in nPN (p < .04). No significant differences between groups were found in age, final fasting serum albumin (SA), and 30 days postoperative SA, with a similar weight loss. Nonsignificant differences were found in non-catheter-related infectious complications, being mainly urinary tract infections. Catheter-related infections were present in 21.1% in the PN group and 13.8% in the nPN (p = .33). Median hospital stay after surgery was 14 +/- 10 days in PN and 12 +/- 10 days in nPN (p = .003). CONCLUSIONS: (1) Nutrition status after BS PO and 30 days postsurgery was no different between PN and nPN. (2) Postsurgery hospital stay was significantly decreased in the nPN group, without a greater incidence of complications. (3) According to nutrition outcome, PN seems unnecessary at the perioperative period in BS unless there are other postsurgical complications.

Adult↗
PubMedDate not supplied

Enteral nutrition and oral nutrition supplements: a review of the economics literature.

BACKGROUND: We sought to review the economics literature on enteral nutrition (EN) and oral nutrition supplements (ONS) against the background of an ongoing clinical guideline development. METHODS: We searched the Health Economic Evaluations Database, the NHS Economic Evaluation Database, and the Cochrane Database of Systematic Reviews. RESULTS: Enteral vs parenteral nutrition was found to be the most common comparison undertaken. The randomized trial evidence suggests that, in some groups of patients, EN is better in terms of clinical endpoints and/or length of hospital stay. This should translate into a lower mean cost for EN, given the reduced daily cost. These studies should be treated with caution because of their small sample size and poor quality. Costing was often crude and poorly reported, tending to focus on the narrow costs of the nutrition supplements. Only 1 study of a nutrition supplement in the community setting was found. CONCLUSIONS: There is some evidence to indicate economic advantages of enteral over parenteral nutrition and of immune-enhancing supplements relative to control diet. There is a lack of well-designed studies taking a broad view of relevant comparators, costs, and outcomes. The cost-effectiveness of different forms of nutrition in different patient groups remains to be established.

Cost-Benefit Analysis↗
PubMed2002

Nutrition as a mediator in the relation between oral and systemic disease: associations between specific measures of adult oral health and nutrition outcomes.

Recent associations between oral health and systemic disease have led to renewed interest in the mouth and its contribution to health outcomes. Many pathways for this relationship have been postulated, among them the potential mediating role of nutrition. The link between various nutrients and systemic disease has been established, but relatively little work has been done in relating oral conditions with nutrition. We searched MEDLINE, from 1966 to July, 2001, to identify articles relating specific oral measures to nutrition outcomes. We included original articles written in English with a sample size greater than 30 that used objective oral health measures. We reviewed a total of 56 articles. Only a small proportion of these studies were methodologically sound. Although many studies were small and cross-sectional, the literature suggests that tooth loss affects dietary quality and nutrient intake in a manner that may increase the risk for several systemic diseases. The impact of tooth loss on diet may be only partially compensated for by prostheses. To date, there is little information relating periodontal disease and oral pain and nutrition. A few studies suggest poorer nutrition among individuals with xerostomia and altered taste. Further, impaired dentition may contribute to weight change, depending on age and other population characteristics. There is a paucity of well-designed studies addressing oral health and nutrition. Before we can acquire a better understanding of how nutrition and oral health interrelate, however, more studies will be required to confirm these associations-preferably longitudinal studies with larger sample sizes and better control of important confounders.

Adult↗
PubMed1991

Effects of a nutrition workshop on paraprofessional assignment of geriatric nutrition services.

The use of dietary assessment techniques by non-nutrition professionals is necessary if the nutrition component of elderly assistance programs is to be fully utilized to the client's advantage. This study examined the impact of a one day nutrition education workshop on community based assessor's evaluation of nutrition needs and services in the home-bound elderly. At the beginning and end of the workshop, changes in a case study nutrition assessment and assignment of services were evaluated. This same procedure was also followed before and three months after the workshop, using client charts from the field. In both the workshop case study and the field chart review there was a significant increase in the detection of nutrition related problems and assignment of services for these problems after the nutrition education workshop.

Aged↗
PubMed1993

Nutrition and health risks in the elderly: the nutrition screening initiative.

OBJECTIVES: The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons. METHODS: A 14-item checklist of characteristics associated with nutritional status was administered to a random sample of Medicare beneficiaries, aged 70 years and older, in New England. Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status. Sensitivity and specificity values were reviewed to define low, moderate, and high nutritional risk scores. RESULTS: A revised checklist containing 10 yes/no items was adopted. Scores of 6 or more points defined persons at high nutritional risk. Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist. Among those in the high-risk group, 56% perceived their health to be "fair" or "poor" and 38% had dietary intakes below 75% of the recommended dietary allowances for three or more nutrients. CONCLUSIONS: The Nutrition Screening Initiative Checklist is a brief, easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems.

Aged↗
PubMed1999

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): bloodwork requirements. Food and Nutrition Service, USDA. Final rule.

This final rule amends regulations governing the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to allow State agencies the option to defer the collection of blood test data for up to 90 days after the date of certification, so long as the applicant is determined to have at least one qualifying nutrition risk factor at the time of certification. In addition, this final rule will expand the current regulatory standard of the maximum age of blood test data used to assess nutritional risk for WIC certification. Although blood tests may no longer be a mandatory part of each WIC applicant's certification intake process, such tests are still required for the purposes of assessing nutritional status, nutrition surveillance, providing nutrition education, further tailoring food packages to meet nutritional needs, and referring to appropriate health and social services in the community.

Blood Chemical Analysis↗
PubMed2000

Nutrition-related cardiovascular risk factors in older people: results from the Third National Health and Nutrition Examination Survey.

SETTING: In view of the recognized potential benefits of nutritional therapy in older persons, Congress is evaluating the coverage of nutritional services for Medicare beneficiaries. OBJECTIVE: To estimate the number of older persons in the US who have one or more cardiovascular risk factors (hypertension, increased low density lipoprotein (LDL) cholesterol, and diabetes mellitus), for which nutritional therapy is recommended. DESIGN: Cross-sectional analysis of adults, aged > or = 65, participating in the Third National Health and Nutrition Examination Survey (NHANES III). MAIN OUTCOMES: The authors estimated the proportion of adults, aged > or = 65, with diabetes mellitus, increased LDL cholesterol, and/or hypertension. Efforts were made to assess whether obesity status, gender, race, and/or socioeconomic factors were associated with the prevalence of any or all three conditions. RESULTS: Approximately 86% (20 million persons) in the US, aged > or = 65, have at least one of the index conditions. Whereas a higher body mass index (BMI) increased the likelihood of having any or all three conditions, 81% of persons of average body weight (BMI <25 kg/m2) had at least one condition. After adjusting for age, gender, BMI, marital status, and poverty index, blacks were more likely than whites to have any one condition (odds ratio (OR) = 3.0, P < .01) or all three conditions (OR = 2.3, P = .05). CONCLUSIONS: Almost 90% of Americans aged > or = 65 have one or more nutrition-related cardiovascular risk factors. Improved nutritional interventions may be valuable especially for blacks, who have a higher prevalence of conditions requiring nutritional therapy.

Aged↗
PubMed2004

[Nutritional support in various disease states. B. Nutritional support in severe infection].

Within one decade the concept of clinical nutritional support has changed. It was once thought that total parenteral nutrition was an all-purpose panacea, and then that role was played by enteral nutrition. Recently, however, immunonutrition has emerged as a new methodology for nutritional support. Because of the pathologic complexity, numerous problems remain in nutritional support for surgical patients with severe infection. The best route of nutrition in the acute phase, actual efficacy of immune system-enhancing diets, and the prevention of bacterial translocation (BT) and Ventilator-associated pneumonia (VAP) should be resolved. This paper describes concerns in the clinical nutritional management of patients with severe infection and examines how the remaining questions are being resolved.

Adjuvants, Immunologic↗
PubMed1992

[Insulin-like growth factor I (somatomedin C) in premature infants on total parenteral nutrition. Relations with nutritional status and protein-energy intakes].

Insulin-like growth factor I (IGF I) is like prealbumin and transferrin a marker of nutritional status. Its level increases with gestational age. The levels of IGF I (96 times), transferrin (86 times) and prealbumin (69 times) were measured in blood samples from 26 premature infants aged 8 to 78 days (gestational age: 28 to 34 weeks, birth weight: 840 to 1,800 g). At the time of sampling, all the infants were on total parenteral nutrition (360 +/- 42 kJ/kg/day and 2.5 +/- 0.3 g of proteins/kg/day). The results were analysed with reference to anthropometric parameters (weight, height, head circumference, skinfolds and arm circumference). There was no correlation between plasma IGF I and anthropometric measurements. There were significant correlations between IGF I and transferrin (p less than 0.01), prealbumin (p less than 0.05), protein intake (p less than 0.01) an energy intake (p less than 0.05). Plasma IGF I increased at the end of the first week of parenteral nutrition in all the 5 infants having initial low values. The plasma IGF I was not correlated with the duration of parenteral nutrition in the 26 infants after the second week of nutrition. IGF I measurement is useful for evaluating the protein nutritional status of premature infants on total parenteral nutrition.

Energy Intake↗
PubMedDate not supplied

Nutritional follow-up of cystic fibrosis patients: the role of nutrition education.

OBJECTIVE: To evaluate the nutritional status of a group of cystic fibrosis patients and establish the role of nutrition education addressed to them in a comparative study before and after intervention. METHODS: All cystic fibrosis patients in regular follow-up in the pulmonology clinic of Instituto da Crianca during 1996-99 were prospectively monitored for 3.5 years. Measurements of weight, height, mid upper arm circumference, skinfolds and calculations of weight/age, height/age, weight/height, mid upper arm circumference and triceps z scores, percentage of ideal weight for height, percentage of body fat, check of the use of enzymes with meals and of the use of nutritional supplements were performed at four points in time: initial (I), 7 (II), 13 (III) and 43 (IV) months after the first evaluation. Nutritional counseling was given both verbally and in writing (booklet) to all patients. RESULTS: Seventy-four patients, 38F/36M, age range 6 months to 18.4 years were evaluated. At study entry the anthropometric data showed: percentage of ideal weight for height = 94+/-13, percentage of body fat = 15+/-7.1, z scores for weight/age = -1.13+/-1.3, z scores for height/age = -0.94+/-1.2, z scores for weight/height = -0.69+/-1.1, z scores for mid upper arm circumference = -1.35+/-1.3, triceps z scores = -0.74+/-0.9. Compliance with enzyme therapy and use of high-calorie supplements improved during the study period. There was a significant increase in weight/height and triceps z scores and percentage of body fat throughout the study period. After stratifying patients into three age groups the anthropometric improvement was only significant among children under 5 years of age CONCLUSIONS: Mild malnutrition was present in this group of cystic fibrosis patients. The nutrition education led to an improvement in compliance with enzyme therapy, use of nutritional supplements and in nutritional status, mostly among the younger patients.

Adolescent↗
PubMed2005

Wholesome nutrition: a suitable diet for the new nutrition science project.

OBJECTIVE: To show that the practice of wholesome nutrition meets the demands of the concept of the new nutrition science, at present and in the future. METHOD: To define 'wholesome nutrition', to describe its origin and to discuss its recommendations; and to cite practical examples showing that wholesome nutrition includes the dimensions and domains that are the basis of the concept of the new nutrition science. CONCLUSION: The recommendations of wholesome nutrition are an effective implementation of the concept of the new nutrition science.

Diet↗
PubMed1996

Methods of nutritional assessment for determining nutritional care at the pre-school level.

Prevalence of malnutrition in pre-school children may be used to determine the need for nutrition surveillance or nutritional care. That prevalence depends on the nutritional classification used. The authors consider that one of the most recommended classifications used for identifying Protein Energy Malnutrition (PEM) was developed by Waterlow. The criteria includes weight-for-height and height-for-age. Frisancho suggested that Arm Muscle Area (AMA), related to height, could provide useful measurements for assessing mass reserve, thus, in beginning stages of PEM it is worth while to determine those who could benefit from nutritional services. The aim of this study was to determine the percentages of pre-school children considered well nourished by Waterlow indicators, but wasted or below average using the AMA for height criteria. Children (881) of either sex, from 48 to 79 months of age, were studied from the Tijuana, Baja California, Mexico pre-school system. Standard anthropometric measurements were taken including weight, height, upper-arm circumference, and triceps skinfold. Arm muscle area was created from those measurements. Using Waterlow indicators, results showed deficit of height-for-age alone was seen in 25.6%; deficit of weight-for-height alone was observed in 1%; deficit of AMC-for-height, but well nourished by Waterlow indicators was seen in 14.9%. If one speculates that children with deficits of AMC-for-height could have different risks of acquiring a disease compared to those apparently normal, then 14.9% of the studied sample would also need nutritional care. Thus, using these criteria, the need for nutritional surveillance and nutritional education is greater for PEM than that established exclusively using Waterlow criteria.

Child↗
PubMed2006

Food supplementation, nutritional intake of recipients and operational aspects: an integrated pilot nutrition initiative of BRAC.

OBJECTIVES: To explore the nutritional quality of supplementary foods and additional energy consumption by the recipients in a pilot nutrition initiative of BRAC. DESIGN: In-depth interviews, observations during feeding at feeding centres, and laboratory analyses of supplementary foods for nutrient contents performed at the Institute of Nutrition and Food Science, University of Dhaka, Bangladesh. SETTING: Muktagacha thana (sub-district) in Mymensingh district, a rural area of Bangladesh. SUBJECTS: Pregnant and lactating mothers and children below 2 years of age. RESULTS: Analysis revealed that supplementary food, if taken completely, could provide daily energy equivalent to 752 kcal to a mother and 212 kcal to a child below 2 years of age. Mothers consumed about 75% of the food provided (approximately 564 kcal day(-1)). The food was shared mostly with young children and husbands. In-depth interview with mothers also suggested that they usually skipped breakfast if the food was given in the morning. The children liked the taste of food, and unless the child was sick or had some food before coming to the centre, she/he ate all the food provided. Although the main purpose of the project was to provide nutrition education, it was observed that activities at feeding centres were limited to food distribution with little time devoted to the communication of nutritional messages. CONCLUSIONS: Training should be given to service providers to communicate nutritional messages effectively as part of understanding the goal of the initiative. It is important to explore whether the regular diets of the recipients are replaced by the food supplementation or not.

Adolescent↗
PubMed1999

Liver cirrhosis: rationale and modalities for nutritional support--the European Society of Parenteral and Enteral Nutrition consensus and beyond.

Evaluation of nutritional status is a major problem in patients with liver cirrhosis this is due to water retention and the effect of liver function on protein synthesis. Despite problems evaluating the patient, malnutrition has been found to be a common complication in liver cirrhosis and is associated with poorer outcome. Nutritional restrictions, like protein restriction, are no longer recommended in most patients with liver cirrhosis but are considered harmful. An intake of 1 to 1.5 g/kg protein and 25 to 40 kcal/kg body weight a day is recommended (depending on the situation of the patient). If adequate intake cannot be achieved by oral nutrition, stepwise nutritional support with the introduction of an additional late evening meal, sip feeding or tube feeding is recommended. Parenteral nutrition should be used as a second line treatment for acutely ill patients. Data indicate that improvement of nutritional status prior to liver transplantation might reduce complications.

Animals↗