Lower Mini Nutritional Assessment Scores Research Articles

CUMULATIVE EFFECTS OF COGNITIVE IMPAIRMENT AND FRAILTY ON GERIATRIC SYNDROMES IN A GERIATRIC OUTPATIENT SETTING

Abstract Aim With underlying geriatric syndromes, only few studies emphasized on the aspect of co-occurrence of frailty and cognitive impairment, though they are independently associated with several geriatric syndromes. Methods The participants were recruited from the outpatient clinic of geriatric department in a medical center. Frailty was assessed by a modified version of Fried’s criteria, while cognitive impairment was defined by cutoff scores of the Mini Mental State Examination. Demographic characteristics, self-assessed health status, and geriatric assessment were collected. Polytomous logistic regression model was used to evaluate factors correlated with frailty alone, cognitive impairment alone, and co-occurrence of frailty and cognitive impairment. Results The mean age of the 323 participants (60.1% women) was 80.4 ± 7.3 years. The prevalence of non-frailty, frailty alone, cognitive impairment alone and co-occurrence were 34.4%, 16.7%, 23.8% and 25.1%, respectively. When compared to the not-frail group, the odds ratios (OR) of having activity of daily living impairment (aOR 1.44, 95% CI 1.28-1.63), instrumental activities of daily living impairment (aOR 1.61, 95% CI 1.45-1.81), urinary incontinence (aOR 1.61, 95% CI 1.45-1.81) and with lower mini-nutritional assessment score (aOR 148, 95% CI 1.30-1.69) were significantly higher in the co-occurrence group after adjusted with demographic variables and Charlson comorbidity index. Conclusions Co-occurrence of frailty and cognitive impairment was associated with higher prevalence of disability, incontinence and malnutrition. It is crucial to approach frailty and cognitive impairment simultaneously in daily geriatric clinical practice due to the correlations of several geriatric syndromes to the co-occurrence of physical frailty and cognitive impairment.

The nutritional risk in patients with neuromyelitis optica spectrum disorder.

The effect of nutrition on chronic autoimmune diseases is well known. This study is the first to assess the nutritional status of patients with neuromyelitis optica spectrum disorder (NMOSD) by administering the Mini Nutritional Assessment (MNA), to explore the impacts of nutrition on patients' quality of life and to identify the factors associated with the nutritional status of NMOSD patients. Our study enrolled 70 NMOSD patients and 66 healthy controls. The following data were assessed: demographic information, disease features, and composite evaluations of life status, including nutrition, sleep, anxiety/depression, fatigue, and quality of life. Then, statistical analysis was performed. The MNA score of NMOSD patients was 20.4±3.3, which was significantly lower than that of HCs (23.3±2.5, P=0.002), especially for the dimensions of global evaluation and anthropometric assessment. Nearly 85% of patients were at risk of malnutrition or had definite malnutrition. The total MNA score was positively correlated with the patient's quality of life (P<0.01). Lower MNA scores were correlated with gender (P=0.02), longer disease duration (P<0.001), more severe anxiety (P=0.004), more severe depression (P=0.003), more severe sleep disturbances (P<0.001), and more severe fatigue (P=0.01). Sleep disturbance was revealed to be a significant independent factor for the NMOSD patients' malnutritional risk (P=0.001). These results suggest that the risk of malnutrition is very high in NMOSD patients and that malnutrition is closely related to their quality of life. Malnutrition among NMOSD patients is caused by a combination of various physiological and psychological factors. A multifaceted and personalized intervention is required to improve the prognosis of NMOSD.

Nutritional Status in Patients Undergoing Phase II Cardiac Rehabilitation by Mini Nutritional Assessment

Malnutrition impairs quality of life and prognosis of patients with cardiovascular disease. The Mini Nutritional Assessment (MNA) is a screening tool developed for the nutritional assessment of older adults. However, usefulness of MNA for patients undergoing cardiac rehabilitation (CR) has not been fully investigated. From March 2017 to September 2019, the MNA-short form (MNA-SF) and the MNA total score in patients undergoing phase II CR at the Juntendo University Hospital were evaluated. A total of 336 patients (mean age 70.1 ± 11.4 years; males: 209) were analyzed. In the MNA-SF, 157 patients (47%) were found to be malnourished or at risk of malnutrition. In MNA total score, 168 patients (50%) were found to be malnourished or at risk of malnutrition. The MNA-SF < 12 group had significantly lower body mass index (BMI), hemoglobin level, low MNA scores for protein/water intake, self-evaluation of nutrition and health, and upper arm and calf circumferences compared to the MNA-SF ≥ 12 group. Assuming BMI < 18.5 as malnutrition, the sensitivity and specificity for malnutrition were 100% and 58.9% for MNA-SF, and 96.9% and 54.9% for MNA total score, respectively. MNA is useful in screening for malnutrition in patients undergoing CR. Approximately 50% of them were determined to be malnourished or at risk of malnutrition, suggesting the need for detailed evaluation regarding their food intake and dietary intervention.

Impact of sarcopenia and phase angle on mortality of the very elderly.

Sarcopenia is a major component of geriatric syndrome and associated with poor clinical outcomes and mortality. However, diagnosing sarcopenia in the very elderly is difficult, and data on its epidemiology and devastating effects in this group are scarce. Phase angle (PA) is measured using bioimpedance spectroscopy and known to reflect cellular integrity and health. This study aimed to clarify the impact of sarcopenia and PA on mortality risk in very elderly people living in long-term care facilities. This prospective cohort study enrolled elderly residents living in nine long-term care facilities. We collected the participants' data, such as body mass index (BMI), comorbidities and laboratory data, from September to October 2017 and mortality data until October 2019. Nutritional status was evaluated using the Mini Nutritional Assessment (MNA) score, and multifrequency bioimpedance spectroscopy was used to assess body composition including PA. Appendicular skeletal muscle mass was calculated using the body composition monitor-derived equation of Taiwan's researchers. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) definition (sarcopenia vs. normal group). We divided the participants into two groups according to the median PA value of 3.65° (high vs. low group) and performed multivariate regression analyses to verify the association with mortality risk according to sarcopenia diagnosis or PA group. A total of 279 elderly participants were enrolled; of them, 238 (85.3%) were diagnosed with sarcopenia according to EWGSOP2 guidelines. The median patient age was 83years, 211 (75.6%) were female and the median BMI was 20.4kg/m2 . The sarcopenia group was older than the normal group (84 vs. 81years; P=0.002), had a lower mean BMI (19.8 vs. 26.6kg/m2 , P<0.001) and had a lower MNA score (9 vs. 12 points, P<0.001). Sarcopenia was associated with a higher mortality risk after the adjustment for age, sex and diabetes mellitus (hazard ratio [HR], 3.744; 95% confidence interval [CI], 1.155-12.134; P=0.028). A low PA was associated with sarcopenia, older age, female sex, low MNA score and overhydration volume; it was also a significant predictor of mortality after the adjustment for age, sex, diabetes mellitus and MNA score (HR, 0.593; 95% CI, 0.420-0.837; P=0.003). Sarcopenia is prevalent among the very elderly patients in long-term care facilities. Sarcopenia and low PA are significantly associated with higher mortality risk.

Mini Nutritional Assessment Score and Visceral Proteins as Potential Predictors of Pressure Injuries in Home Care Patients With Stroke

This study aimed to determine the presence of pressure injuries and their severity based on Mini Nutritional Assessment (MNA) score and visceral protein levels in stroke patients receiving home care services. A case-control study was conducted in a case group with pressure injury (n = 54) and in a control group with no pressure injury (n = 54). The MNA scores and serum albumin and prealbumin values were significantly lower in the case group than in the control group (P &lt; .001). There were also significant differences according to the pressure injury stages. Lower MNA score and low levels of serum albumin and prealbumin are associated with the presence of pressure injuries and increased severity of pressure injuries.

Quality of life, physical performance and nutritional status in older patients hospitalized in a cardiology department.

ObjectivesQuality of life (QoL) is a priority outcome in older adults suffering from cardiovascular diseases. Frailty and poor nutritional status may affect the QoL through mobility disorders and exhaustion. The objective of this study was to determine if physical frailty and nutritional status were associated with QoL, in older cardiology patients.MethodsCross sectional, observational study conducted in a cardiology department from a university hospital. Participants (n = 100) were aged 70 and older. Collected data included age, sex, cardiac diseases, New York Heart Association (NYHA) classification, comorbidities (Charlson Index) and disability. A Short Physical Performance Battery (SPPB), including walking speed assessment was performed; handgrip strength were measured as well as Fried's frailty phenotype. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and Body Mass Index (BMI), inflammation by C-reactive protein (CRP). QoL was assessed using the EORTC–QLQ questionnaire. Univariate and multivariate analyses were performed to study the associations between all recorded parameters and QoL.ResultsIn participants (mean age: 79.3 ± 6.7 years; male: 59%), Charlson index, arrhythmia, heart failure, NYHA classⅢ-Ⅳ, MNA, disability, walking speed, SPPB score, frailty and CRP were significantly associated with QoL in univariate analysis. Multivariate analysis showed that NYHA classⅢ-Ⅳ (P < 0.001), lower MNA score (P = 0.03), frailty (P < 0.0001), and higher CRP (P < 0.001) were independently associated with decreased QoL.ConclusionsFrailty, nutritional status and inflammation were independently associated with poor QoL. Further studies are needed to assess the efficacy of nutritional and physical interventions on QoL in this population.

THE ASSESSMENT OF HOSPITAL MALNUTRITION IN GERIATRIC POPULATION

Poor nutritional status can occur at any age, but older people, especially because of frailty, are the most vulnerable. In elderly patient malnutrition has been associated with an increase of mortality and costs of health care. The aim of our study is to evaluate the nutritional status of hospitalized patients and other risk items. This is a retrospective study conducted at Geriatrics Division of Trieste from 01/01/2012 to 01/08/2019. Data of patients over 65 years were collected by the Mini Nutritional Assessment (MNA), the Activity of Daily Living scale (ADL), blood values such as albumin, lymphocytes and ferritin, the number of hospitalization drugs and other items included in a geriatric Multidimensional Prognostic Index (MPI). The overall number of patients included in this study was 3457 and the mean age was 84,16 +/- 7,38 years. The mean MNA score was 20,47 +/- 5,76. The percentage of malnourished people was 26,44% and 39,10% was at risk. Malnutrition was significantly associated with low level of ADL (p<0,001). Polypharmacy at the hospital admission was not associated with a low MNA score. Undiagnosed and untreated malnutrition is known to be a cause of mortality in the elderly hospitalized people. Especially for frailty old patients with low ADL and high MPI should be a priority to submit the screening for nutritional issue in order to improve the outcome for each patient.

Mini Nutritional Assessment Score as a Potential Predictor of Pressure Ulcers in Elderly Nursing Home Patients With Dementia

This retrospective study compared the presence and severity of pressure ulcers in long-term care residents with dementia based on Mini Nutritional Assessment (MNA) scores. Participants included 50 older adults with pressure ulcers and 50 matched controls. MNA scores for subjects with and without ulcers were significantly different (8.34 ± 2.67 vs 9.98 ± 2.32, P = .001). Scores based on ulcer stage did not follow a linear pattern; however, subjects with stage 4 ulcers had significantly lower scores (6.33 ± 2.55) than subjects with stages 1 to 3 ulcers (8.90 ± 2.70, P = .009; 9.64 ± 2.16, P = .001; and 9.08 ± 2.02, P = .004, respectively). Results show a relationship between low MNA scores and pressure ulcers. Thus, MNA has the potential for use in implementation of preventive measures and mitigation of ulcer progression.

Relationship Between Nutritional Status and Insomnia Severity in Older Adults

ObjectivesBoth insomnia and malnutrition are quite common and can cause similar negative consequences, such as falls, depression, and cognitive impairment in older adults, but there is no study investigating the relationship between the 2. The aims were to investigate relationships between insomnia/insomnia severity and Mini Nutritional Assessment (MNA) score and serum nutrient levels. Setting and participantsAged 65 years or older, 575 outpatients were included. MethodsMNA scores >23.5, 17-23.5, and <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. Insomnia Severity Index (ISI) with scores of 8 and higher indicated insomnia, which was further stratified as mild (8-14), moderate (15-21), or severe (22-28). ResultsThe mean age was 73.1 ± 7.7 years, with 73.2% being female. The prevalence of patients with no insomnia, mild insomnia, moderate insomnia, and severe insomnia were 34.4%, 20.9%, 30.1%, and 14.6%, respectively. After adjusting for gender, education, number of drugs, Charlson Comorbidity Index, presence of depression, and Mini-Mental State Examination scores, patients with insomnia had lower MNA scores than those without insomnia (OR = 0.84, 95% CI: 0.7-0.9, P < .001). There were significant relationships between moderate/severe insomnia and the presence of malnutrition and risk of malnutrition (OR = 1.6, 95% CI: 1.0-2.5, P = .046; OR = 1.6, 95% CI: 1.0-2.7, P = .042) and MNA scores (OR = 0.83, 95% CI: 0.7-0.9, P < .001)/OR = 0.82, 95% CI: 0.7-0.9, P < .001). There was no significant difference between insomnia severity status and serum vitamin D, vitamin B12, folate levels, or classification of these nutrients (P > .05). Conclusions/ImplicationsThere is a close relationship between MNA scores and insomnia or insomnia severity in older adults. Therefore, when evaluating an older patient with insomnia, malnutrition should be evaluated, or insomnia should also be questioned in an older patient with malnutrition. Thus, more effective management of the 2 can be possible.

Systemic and Metabolic Signature of Sarcopenia in Community-Dwelling Older Adults.

Evidence suggests the pivotal contribution of nutrition as a modifiable risk factor for sarcopenia. The present cross-sectional study characterized the nutritional and metabolic profile of sarcopenia through an extensive exploration of a wide array of blood biomarkers related to muscle protein metabolism and transcriptomic signatures in community-dwelling elderly adults. Among 189 older individuals with a mean age of 73.2 years, sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria based on appendicular lean mass measured by dual-energy X-ray absorptiometry scan, muscle strength, and gait speed. Nutritional status was evaluated using the mini-nutritional assessment (MNA). In addition, we assessed specific blood biomarkers of nutritional status (plasma essential amino acids [EAAs], vitamins), nicotine-derived metabolites, and an extensive microarray analysis from peripheral blood mononuclear cells. Malnutrition defined by low MNA score was independently associated with sarcopenia (p < .001). Sarcopenic elderly showed lower body mass index and leptin and higher adiponectin and high-density lipoproteins. Levels of EAAs including lysine, methionine, phenylalanine, threonine, as well as branched-chain AAs and choline, were inversely associated with sarcopenia. Furthermore, nicotine metabolites (cotinine and trans-3'-hydroxycotine) and vitamin B6 status were linked to one or more clinical and functional measures of sarcopenia. Differentially expressed genes and ingenuity pathway analysis supported the association of nutrition with sarcopenia. Herein, the characterization of a nutritional and metabolic signature of sarcopenia provides a firm basis and potential identification of specific targets and directions for the nutritional approach to the prevention and treatment of sarcopenia in aging populations.

Self-reported exhaustion, physical activity, and grip strength predict frailty transitions in older outpatients with chronic diseases.

Effective screening instruments are necessary for evaluating the outcomes of early interventions for the prevention or delay of disability in older persons. This study examined how transitions in frailty items over 1 year and the baseline components of a comprehensive geriatric assessment were associated with improvements in frailty at a 2-year follow-up in a sample of older patients.This was a single-center prospective observational study of older patients aged 65 years and over with chronic diseases (n = 103), who were followed through a hospital-based program over 2 years. Frailty was evaluated via the modified Fried Frailty Index and a comprehensive geriatric assessment.We noted significant improvements in weight loss (P = .016) and self-reported exhaustion (P = .006), and a less decrease in grip strength (P = .009) at the 1-year follow-up. Furthermore, baseline cerebral vascular accident diagnosis (P = .022), high polypharmacy (P = .037), a higher Geriatric Depression Scale score (P = .033), and a lower Mini Nutritional Assessment score (P = .039) were significantly associated with improved frailty at the 2-year follow-up. Furthermore, improvement in self-reported exhaustion (odds ratio [OR]: 4.7, 1.4–16.1, P = .014) and physical activity (OR: 3.8, 1.0–13.7, P = .046), and a less decrease in grip strength (OR: 4.0, 1.3–12.5, P = .017) at the 1-year follow-up were significantly associated with improved frailty at the 2-year follow-up.Self-reported exhaustion, physical activity, and grip strength are easy, quick, and feasible screening tests for improvements in frailty in clinical practice.

High Intake of Nonmilk Extrinsic Sugars Is Associated With Protein and Micronutrient Dilution in Home-Dwelling and Institutionalized Older People

BackgroundHigh dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations. Design and participantsThis cross-sectional study combined five Finnish data sets covering home-dwelling (n = 526) and institutionalized (n = 374) older people. Their nutritional status was assessed using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1- to 3-day food records. The participants were divided into quartiles corresponding to the proportions of energy received from NMES. Energy, nutrient, and fiber intakes were classified according to the NMES quartiles, and the participants were divided according to their places of residence (home, institution). ResultsHigh NMES intakes were associated with older age, female sex, poor cognition, low MNA scores, immobility, and institutionalization. In all, 90% of the participants in the highest NMES quartile (Q4) were institutionalized. In the institutionalized individuals, low protein and micronutrient intakes were observed in both those with low energy intake (Q1) and in those with very high NMES intakes (Q4). In home-dwelling individuals, the nutrient intakes tended to decline linearly with increasing NMES intakes in protein and most micronutrients. ConclusionsInstitutionalized older people consumed diets high in NMES, compared with those living at home, and their low energy and high NMES intakes were associated with low protein and micronutrient intakes.

Associations Between Tooth Loss, With or Without Dental Prostheses, and Malnutrition Risk in Older Adults

A systematic review was conducted to investigate the associations between missing teeth, teeth replaced with dental prostheses, and malnutrition risk, as determined by the Mini Nutritional Assessment (MNA), among community-dwelling older adults. A comprehensive search strategy was designed to identify studies published between 2000 and 2014 that met inclusion criteria. Searches were conducted in Medline, CINAHL, and Cochrane Libraries. Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed and risk-of-bias analyses were performed. Study data were abstracted and synthesized in narrative and summary tables. Of the 8 studies that met inclusion criteria, 5 found significant associations between MNA score and tooth loss. Those with fewer teeth/limited occlusion had lower MNA scores, hence were at greater risk for malnutrition than those with a greater number of teeth and/or more occluding teeth pairs. Provision of dentures to older adults was associated with significant increases in MNA scores. The studies reviewed support associations between tooth loss, replacement with prostheses, and malnutrition risk; individuals with more missing teeth and limited occlusion were at increased risk of malnutrition. Additional high-quality research seems warranted to substantiate a causal relationship between dental and nutritional status. Inadequate oral health and poor nutritional status are associated with increased mortality risk in older adults. Efforts to optimize oral health and nutritional status of older adults are needed.

Nutritional predictors of mortality after discharge in elderly patients on a medical ward.

Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004). The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.

Prevalence and correlates of malnutrition among elderly in an urban area in Coimbatore.

Different studies in India have shown that more than 50% of elderly population of India are suffering from malnutrition and more than 90% have less than recommended intake. The aim of this study is to estimate the prevalence and correlates of malnutrition among elderly aged 60 years and above in an urban area in Coimbatore using Mini Nutritional Assessment (MNA). A cross-sectional study was conducted on 154 households and 190 elderly were interviewed. Nutritional status was assessed using the MNA questionnaire. Mean (standard deviation) age of the total population (n = 190) was 71.09 (7.93) years and 30% was male. In this population, 37 (19.47%) was malnourished (MNA <17.0) and 47 (24.73%) were at risk for malnutrition (MNA 17.0-23.5). No significant association was observed between smoking, current alcohol consumption, higher medication use, higher comorbidity, and use of walk aid with malnutrition. Among the social factors studied, lower socioeconomic status compared to higher socioeconomic status (adjusted odds ratio [OR] =5.031, P < 0.001), single/widowed/divorced compared to married (adjusted OR = 3.323, P < 0.05), and no pension compared to those having pension (adjusted OR = 3.239, P < 0.05) were significantly associated with malnutrition. The prevalence of malnutrition observed in the aged people is unacceptably high. The increasing total number of lifestyle, somatic, functional, and social factors was associated with lower MNA scores. The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with sociodemographic, somatic, and functional status. Hence, we recommend that the treatment of malnutrition should be multifactorial, and the treatment team should be multidisciplinary. Further research is needed to develop appropriate guidelines for nutritional screening and interventional programs among geriatric population.

Body mass index, Mini Nutritional Assessment, and their association with five-year mortality in very old people.

to investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people. A prospective cohort study. A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community. Out of 1195 potential participants, 832 were included (mean age 90.2±4.6 years). Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed. The mean BMI value for the whole population was 25.1±4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5±4.6 for the whole sample, and it was lower for women than for men (P<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17-23.5) according to MNA. Also, 34.8% of those with a MNA score <17 still had a BMI value ≥22.2 kg/m2. A BMI value <22.2 kg/m2 and a MNA score<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA. Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women.

Poor nutrition and alcohol consumption are related to high serum homocysteine level at post-stroke.

BACKGROUND/OBJECTIVESIncreased serum homocysteine (Hcy) levels have been reported to be related to the occurrence of cardio- and cerebrovascular diseases. High serum Hcy levels are also related to the development of secondary stroke and all-cause mortality. The purpose of this study was to investigate the prevalence of high serum homocysteine level and relating factors, and the change over the 10 month period post-stroke.SUBJECTS/METHODSConsecutive stroke patients who were admitted to the Asan Medical Center were enrolled. Ten months after the onset of stroke, an interview with a structured questionnaire was performed and blood samples were obtained for the biochemical parameters. Nutritional status was determined using the mini nutritional assessment (MNA) score and dietary nutrient intakes were also obtained using a 24 hour recall method.RESULTSOut of 203 patients, 84% were malnourished or at risk of malnutrition, and 26% had high homocysteine levels at 10 months post-stroke. Using logistic regression, the factors related with high homocysteine levels at 10 months post-stroke included heavy alcohol consumption (P = 0.020), low MNA scores (P = 0.026), low serum vitamin B12 (P = 0.021) and low serum folate levels (P = 0.003). Of the 156 patients who had normal homocysteine levels at admission, 36 patients developed hyperhomocysteinemia 10 months post-stroke, which was related to heavy alcohol consumption (P = 0.013). Persistent hyperhomocysteinemia, observed in 22 patients (11%), was related to male sex (P = 0.031), old age (P = 0.042), low vitamin B6 intake (P = 0.029), and heavy alcohol consumption (P = 0.013).CONCLUSIONHyperhomocysteinemia is common in post-stroke, and is related to malnutrition, heavy alcohol drinking and low serum level of folate and vitamin B12. Strategies to prevent or manage high homocysteine levels should consider these factors.

Assessment of nutritional status among elderly population in a rural area of West Bengal, India

Background: Geriatric population is a potentially vulnerable group for malnutrition as per 2002 census of the World Health Organization. Objectives: To estimate the prevalence of malnutrition and risk of malnutrition among elderly population in Arkhali village, North 24 Parganas, West Bengal, India. Materials and Methods: This community-based cross-sectional study was carried out in Arkhali village, Amdanga Block, rural field practice area of Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India, among 235 elderly individuals aged ≥ 60 years during February to March 2014 by applying Mini Nutritional Assessment (MNA) questionnaire. Elderly individuals were interviewed after obtaining informed verbal consent. Results: MNA showed 29.4% elderly had malnutrition and 60.4% were at risk of malnutrition. Females (59.4%) were significantly more malnourished than males (40.6%). Older age (p < 0.001), lower income of family (p < 0.001), low literacy level (p < 0.001), decreased food intake (p < 0.001), and fewer consumption of meals (p < 0.001) were independently associated with lower MNA scores. Conclusion: Nutritional status of elderly subjects is very poor as detected in this study. There is need and scope for geriatric nutritional interventions in rural population.

Comparing Cognition, Mealtime Performance, and Nutritional Status in People With Dementia With or Without Ideational Apraxia

To describe the prevalence rate of ideational apraxia (IA) affecting self-feeding in people with dementia, confirm the stage of dementia at which IA most commonly occurs, and compare mealtime performance and nutritional status between people with dementia (PWD) with and without IA. A cross-sectional design with between-subject comparison was used. Among the 395 potential participants recruited from dementia special care units at nine long-term care facilities in central and northern Taiwan, 98 met the operational definition of IA and were included in the PWD with IA group. From the remaining pool, 98 participants, matched for age and sex with the PWD with IA group, were randomly allocated to the PWD without IA group. Eating Behavior Scale (EBS) scores, food intake, total eating time, meal assistance, body mass index, Mini-Nutritional Assessment (MNA), and Mini-Mental State Examination scores were collected. The prevalence rate of IA affecting self-feeding in our study population of PWD was 24.8%. PWD with IA had significantly lower EBS scores, had more food intake (p < .001), spent more time being fed by caregivers, needed more verbal and feeding assistance, and had lower MNA scores than PWD without IA. Decline in the self-feeding ability of PWD affected by IA most commonly occurred in the severe stage of dementia. When dementia progresses to the late stage, staff should pay special attention to residents' mealtime performance and nutritional status. For PWD with IA, reassigning staff at mealtimes based on eating ability and providing memory training are recommended.

Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities.

To investigate factors associated with poor nutritional status in older people living in residential care facilities. 188 residents (136 women, 52 men) with physical and cognitive impairments participated. Mean age was 84.7 y (range 65-100). The Mini Nutritional Assessment (MNA), Barthel ADL Index, Mini Mental State Examination (MMSE), and Geriatric Depression Scale were used to evaluate nutritional status, activities of daily living, cognitive status and depressive symptoms. Medical conditions, clinical characteristics and prescribed drugs were recorded. Univariate and multivariate regressions were used to investigate associations with MNA scores. The mean MNA score was 20.5 ± 3.7 (range 5.5-27) and the median was 21 (interquartile range (IQR) 18.8-23.0). Fifteen per cent of participants were classified as malnourished and 66% at risk of malnutrition. Lower MNA scores were independently associated with urinary tract infection (UTI) during the preceding year (β = - 0.21, P = 0.006), lower MMSE scores (β = 0.16, P = 0.030), and dependent in feeding (β = - 0.14, P = 0.040). The majority of participants were at risk of or suffering from malnutrition. Urinary tract infection during the preceding year was independently associated with poor nutritional status. Dependence in feeding was also associated with poor nutritional status as were low MMSE scores for women. Prospective observations and randomized controlled trials are necessary to gain an understanding of a causal association between malnutrition and UTI.