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Nutritional issues in nursing home care.

The most common nutritional problems in nursing home residents are weight loss and concomitant protein energy undernutrition. Although the causes of weight loss in these patients can usually be treated, they are rarely identified in the nursing home. Depression and adverse drug effects are the most common causes of weight loss. We discuss the appropriate use of feeding tubes in the nursing home and the early use of enteral feeding to prevent the development of severe protein energy undernutrition. Vitamin deficiencies, especially folate and pyridoxine deficiencies, frequently develop in nursing home residents. Hip fractures are often associated with vitamin D deficiency. Trace mineral deficiencies (for example, zinc deficiency) can aggravate immune deficiency and slow wound healing. Inadequate fluid intake leads to dehydration, hypotension, and, in persons with diabetes mellitus, hyperosmolarity. Finally, food intake itself can cause postprandial hypotension (which in turn may precipitate falls), produce electrolyte shifts, and result in aspiration pneumonia. Physical activity programs are an important component of nursing home care that may have an effect on nutritional status, and simple, cost-effective programs may be as beneficial as high-technology programs. Careful attention to the nutritional intake of nursing home residents is both a clinical and a quality-of-life issue.

Aged↗

Vital vitamins.

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Adult↗

Hyperhomocysteinemia, atherosclerosis and thrombosis.

High plasma levels of homocysteine are the results of the interplay between congenital and environmental factors. In the last two decades, a growing amount of interest has focused on mild-to-moderate hyperhomocysteinemia as a risk factor of thromboembolic diseases. Case-control and cross-sectional studies clearly indicated that mild-to-moderate hyperhomocysteinemia is associated with heightened risk of both arterial and venous thrombosis. On the other hand, prospective studies did not unequivocally show that hyperhomocysteinemia is associated with a high thrombotic risk. Therefore, additional studies are needed to define whether hyperhomocysteinemia is a risk factor for thrombosis, especially of the venous circulation. Among these, prospective cohort studies will clarify better the temporal relationship between high homocysteine levels and the thrombotic event. Most importantly, however, randomized, placebo-controlled, double-blind trials of the effects of homocysteine-lowering vitamins on the thrombotic risk are urgently needed. Not only will they help in defining whether the relationship between hyperhomocysteinemia and thrombosis is causal, they will also have a potential dramatic impact in the prevention of thromboembolic events.

Adult↗

[Vitamin B 1 deficiency in chronic alcoholics and its clinical correlation].

50 chronic alcoholics reporting to the medical emergency ward of Basle University Hospital with alcohol-related illness were examined with respect to thiamine nutritional status by means of the transketolase activation test of erythrocytes (ETK). 46% of the chronic alcoholics, compared to only 2% of the control population (1152 healthy adults), had transketolase activation quotients indicating a strong probability of thiamine deficiency (alphaETK greater than 1.25). The most important symptoms associated with the biochemical parameters of thiamine deficiency were: anemia, pathologic liver functions (bilirubin, gamma-globulins), low diastolic blood pressure and Wernicke's encephalopathy. There was a statistically significant correlation (p less than 0.05) between these symptoms and the biochemical parameters for thiamine deficiency. Therefore, when treating chronic alcoholics, these symptoms should direct attention to a possible vitamin B1 deficiency. Since the enzymatic vitamin B1 parameters correlate with the patients' hemoglobin, our results would be consistent with anemia influenced by provision of thiamine.

Adult↗

[Effect of rations with a varying content of polyunsaturated fatty acids and vitamins on the state of the small intestine in respect of age].

Groups of young sexually mature and old albino rats were kept for three months on 4 isocaloric rations, viz. balanced, with reduced proportion of essential fatty acids or group 'B' vitamins and with simultaneous curtailment of fatty acids and vitamins. With vitamin deficiency there was a certain derangement in the structure and function of the small intestine, especially in older animals. A shortage of essential fatty acids impaired the condition of the small intestine only in old animals. In cases of concurrent deficiency of vitamins and essential fatty acids maximal changes in both young and old animals were in evidence.

Age Factors↗

[Recommended vitamin intake].

Vitamins intakes cannot be absolutely established; they depend on basic composition of the diet, ecological conditions and physiological status of the subject. Nevertheless, approximate norms can be established, which avoid deficiencies or overdosages. Dietary and epidemiologic surveys, assays on volunteers conducted the commissions of F.A.O./O.M.S. Experts and National Authorities to propose values with a practical consensus for vitamins A, B1, B2, PP, P, C, D, B12 folates and some other factors.

Adolescent↗

[Clinical significance of extra vitamin supplements and enriched food products].

Consumers increasingly use vitamin supplements. Also, since June 1996, foodstuffs enriched with vitamins are available on the Dutch market. These sources of extra vitamins may be useful for groups at risk for marginal vitamin deficiencies. These risk groups include the chronically ill (e.g. diabetics), people using medicaments, older people and pregnant women. Extra vitamins from low-dose supplements or enriched foodstuffs may also constitute a valuable and safe supplement to the diet of children, smokers, people eating unbalanced, people on slimming diets, vegetarians and people engaged in intensive sports. According to the advisory group Nutrition of the Health Council, addition of vitamins to foodstuffs causes no risks of any importance for public health, apart from vitamins A and D and of the trace elements selenium, copper and zinc. Consequently, these should only be added to reconstituted foodstuffs or in a substitution product, not in enriched foodstuffs.

Adolescent↗

Confluent ecchymoses on the lower extremities of a malnourished patient.

Nutritional deficiencies result in many distinctive cutaneous manifestations. Vitamin C deficiency, or scurvy, produces follicular hyperkeratosis, perifollicular hemorrhages, gingival hypertrophy, and bleeding (1). We report here a case of malnutrition who suddenly developed extensive eccymoses on the lower extremities sharing morphological similarities with purpura fulminans. Although the patient did not have the characteristic dermatological features of scurvy, serum levels of vitamins C, K, B12, and E were decreased.

Aged↗

[Clinical vitaminology].

This paper deals with overview on clinical vitaminology including as follows: 1. Historical trends of prevalence of vitamin deficiency in Japan. 2. Recent status of number of patient with vitamin deficiency referred to "patients survey" by Ministry of Health and Welfare. 3. Notion and characteristic of vitamin dependency. 4. Types of vitamin deficiency. i.e. a simple type and a tape caused by disturbance of utilization. 5. Vitamin metabolism of hospitalized elderly patients. 6. Pharmacological role of vitamins.

Adult↗

[Vitamin deficiencies and hypervitaminosis].

There have recently been very few deficiencies with respect to fat soluble and water soluble vitamins in Japan All-trans-retinoic acid as induction or maintenance treatment improves disease free and overall survival against acute promyelocytic leukemia. In the isolated vitamin E deficiencies gene mutation has been cleared for alpha-tocopherol transferprotein. Recently, a relation of nutritional vitamin K intake and senile osteoporosis in women was epidemiologically demonstrated on a prospective study. Thiamin was yet noticed as development of deficiency in alcoholism, while the importance of supplemental folic acid during pregnancy has become especially clear in light of studies showing that folic acid supplements reduce the risk of neural tube defects in the fetus. With respect to hypervitaminosis, the Council for Responsible Nutrition (CRN), USA, has established safe intakes by identifying the NOAEL (No Observed Adverse Effect Level) and LOAEL (Lowest Observed Adverse Effect Level). Summaries of NOAEL and LOAEL for individual vitamins were shown.

Avitaminosis↗