Malnourished Adults Research Articles

Navigating nutrition care for hospitalised malnourished older adults transitioning home: Insights from clinical dietitians

Navigating nutrition care for hospitalised malnourished older adults transitioning home: Insights from clinical dietitians

Impact of an oral nutritional supplement on nutritional status in older adults with malnutrition: A randomized controlled trial

Background: The aging population is expanding at an unprecedented rate, leading to a significant increase in the prevalence of malnutrition among older adults. Oral Nutritional Supplements (ONS) have emerged as a widely accepted strategy to address the nutritional needs of this demographic. Objective: This study aimed to evaluate the impact of an ONS on the nutritional status of malnourished older adults. Methods: This was an open-label, randomized-controlled, parallel-group, single-centered study. Recruitment criteria were age ≥60 years, and mini nutrition assessment-short form (MNA-SF) score ≤11. A total of 50 participants were randomly assigned to the intervention (IG) and control (CG) groups (1:1 ratio). The IG received 200 mL of ONS as a bedtime drink for 12 weeks, while the CG received 200 mL of water. Nutrition status, biochemical analysis, and dietary assessment were performed at the beginning and end of the study. Results: Forty-two participants (IG: n=20, and CG: n=22) completed the study. After 12 weeks, the IG showed a significant improvement in the MNA-SF score (p<0.001) compared to the CG (p=0.118). The IG experienced a substantial increment in the vitamin D level (p=0.002). No significant improvements were found in the serum albumin and haemoglobin levels in either group. The intervention led to significant increases in daily intake of energy (p<0.001), carbohydrate (p=0.013), protein (p<0.001), and fat (p<0.001) in comparison to the control group. Conclusion: Supplementing with an ONS, along with a regular diet, significantly improved nutritional status, some biochemical parameters, and daily intake of energy and macronutrients in older adults with malnutrition.

Lost in Transition: Insights from a Retrospective Chart Audit on Nutrition Care Practices for Older Australians with Malnutrition Transitioning from Hospital to Home.

Care transitions from hospital to home for older adults with malnutrition present a period of elevated risk; however, minimal data exist describing the existing practice. This study aimed to describe the transition of nutrition care processes provided to older adults in a public tertiary hospital in Australia. A retrospective chart audit conducted between July and October 2022 included older (≥65 years), malnourished adults discharged to independent living. Dietetic care practices (from inpatient to six-months post-discharge) were reported descriptively. Of 3466 consecutive admissions, 345 (10%) had a diagnosis of malnutrition documented by the dietitian and were included in the analysis. The median number of dietetic visits per admission was 2.0 (IQR 1.0-4.0). Nutrition-focused discharge plans were inconsistently developed and documented. Only 10% of patients had nutrition care recommendations documented in the electronic discharge summary. Post-discharge oral nutrition supplementation was offered to 46% and accepted by 34% of the patients, while only 23% attended a follow-up appointment with dietetics within six months of hospital discharge. Most patients who are seen by dietitians and diagnosed with malnutrition appear lost in transition from hospital to home. Ongoing work is required to explore determinants of post-discharge nutrition care in this vulnerable population.

Enhancing physical function and activity level in malnourished older adults through oral nutrition supplements: a randomized controlled trial

BackgroundMalnutrition of older individuals, leads to significant functional decline, reducing their quality of life. Lifestyle interventions; dietary improvements and supplementation are explored to enhance the physical function of older adults. The current study aimed to assess the impact of oral nutritional supplements (ONS) on the functional and activity levels of Sri Lankan older adults.MethodsThis randomized controlled trial included; an intervention group (IG) receiving 200 mL of ONS providing 247 kcal per serving, for 12 weeks and a control group (CG) receiving an equivalent volume of water. Changes in handgrip strength, knee extension strength, gait speed, functional and activity levels were assessed.ResultsThe IG showed significant improvements in handgrip strength (43.96 ± 18.61 kg vs. 32.81 ± 17.92 kg; p < 0.001) and knee extension strength (23.45 ± 2.29 kg vs. 16.41 ± 2.09 kg; p < 0.001) following 12 weeks compared to the CG. The IG also exhibited significant improvements in gait speed (1.31 ± 0.52 m/s vs. 0.87 ± 0.26 m/s), Barthel index score, (0.30 ± 0.47 vs. -0.18 ± 0.66), PASE score (0.52 ± 17.79 vs. -1.60 ± 21.77) and IPAQ categories.ConclusionsONS was found to be effective in improving the functional and physical activity levels of malnourished older adults.Trial registration.Sri Lanka Clinical Trial Registry SLCTR/2022/021. Registered on 06/10/2022.

Impact of an oral nutritional supplement on the body composition of older adults with or at risk of malnutrition in an institutionalised setting: A randomised controlled trial.

Malnutrition often manifests as a body weight (BW) reduction and unhealthy alteration in body composition. The present study aimed to assess the efficacy of an oral nutritional supplement (ONS) in improving BW and body composition among older adults with malnutrition. An open-label randomised controlled, parallel-group study was conducted among older adults (age ≥ 60 years) with/at risk of malnutrition (mini nutrition assessment-short form score ≤ 11). In total, 50 participants were randomly assigned to the intervention (IG) and control (CG) groups (1:1 ratio). The IG received the ONS (57 g/day; 247 kcal/serving, 12 g protein) before bedtime for 12 weeks. CG received 200 mL of water. Anthropometric measurements, body composition analysis, and dietary and physical activity assessments were performed at the beginning and end of the study. Forty-two participants (IG: 20, CG: 22) completed the study. The mean ± SD ages of the IG and CG were 75.4 ± 6.1 and 74.8 ± 5.2 years, respectively (p = 0.73). The IG had a significant increase in BW (+1.68 ± 1.16 vs. -0.46 ± 0.95 kg; p < 0.001), lean mass (+1.23 ± 0.93 vs. -0.45 ± 0.90 kg; p < 0.001) and fat mass (+0.54 ± 0.82 vs. -0.06 ± 0.82 kg; p = 0.02) compared to the CG. One-quarter of the IG (n = 5) achieved a weight gain > 5% of BW, whereas none in the CG did (p = 0.01). No significant changes were observed in bone mineral content in either group. For malnourished older adults, supplementing with an ONS, along with regular food intake, significantly increased BW, lean mass and fat mass compared to control following the regular diet without supplementation.

A Conceptual Study on Characterizing the Complexity of Nutritional Interventions for Malnourished Older Adults in Hospital Settings: An Umbrella Review Approach.

Malnutrition is a widespread and intricate issue among hospitalized adults, necessitating a wide variety of nutritional strategies to address its root causes and repercussions. The primary objective of this study is to systematically categorize nutritional interventions into simple or complex, based on their resource allocation, strategies employed, and predictors of intervention complexity in the context of adult malnutrition in hospital settings. A conceptual evaluation of 100 nutritional intervention studies for adult malnutrition was conducted based on data from a recent umbrella review (patient population of mean age > 60 years). The complexity of interventions was categorized using the Medical Research Council 2021 Framework for Complex Interventions. A logistic regression analysis was employed to recognize variables predicting the complexity of interventions. Interventions were divided into three principal categories: education and training (ET), exogenous nutrient provision (EN), and environment and services (ES). Most interventions (66%) addressed two or more of these areas. A majority of interventions were delivered in a hospital (n = 75) or a hospital-to-community setting (n = 25), with 64 studies being classified as complex interventions. The logistic regression analysis revealed three variables associated with intervention complexity: the number of strategies utilized, the targeted areas, and the involvement of healthcare professionals. Complex interventions were more likely to be tailored to individual needs and engage multiple healthcare providers. The study underlines the importance of considering intervention complexity in addressing adult malnutrition. Findings advocate for a comprehensive approach to characterizing and evaluating nutritional interventions in future research. Subsequent investigations should explore optimal balances between intervention complexity and resource allocation, and assess the effectiveness of complex interventions across various settings, while considering novel approaches like telehealth.

Predicting COVID-19 Re-Positive Cases in Malnourished Older Adults: A Clinical Model Development and Validation.

Building and validating a clinical prediction model for novel coronavirus (COVID-19) re-positive cases in malnourished older adults. Malnourished older adults from January to May 2023 were retrospectively collected from the Department of Geriatrics of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. They were divided into a "non-re-positive" group and a "re-positive" group based on the number of COVID-19 infections, and into a training set and a validation set at a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify predictive factors for COVID-19 re-positivity in malnourished older adults, and a nomogram was constructed. Independent influencing factors were screened by multivariate logistic regression. The model's goodness-of-fit, discrimination, calibration, and clinical impact were assessed by Hosmer-Lemeshow test, area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CIC), respectively. We included 347 cases, 243 in the training set, and 104 in the validation set. We screened 10 variables as factors influencing the outcome. By multivariate logistic regression analysis, preliminary identified protective factors, risk factors, and independent influencing factors that affect the re-positive outcome. We constructed a clinical prediction model for COVID-19 re-positivity in malnourished older adults. The Hosmer-Lemeshow test yielded χ2 =5.916, P =0.657; the AUC was 0.881; when the threshold probability was >8%, using this model to predict whether malnourished older adults were re-positive for COVID-19 was more beneficial than implementing intervention programs for all patients; when the threshold was >80%, the positive estimated value was closer to the actual number of cases. This model can help identify the risk of COVID-19 re-positivity in malnourished older adults early, facilitate early clinical decision-making and intervention, and have important implications for improving patient outcomes. We also expect more large-scale, multicenter studies tofurther validate, refine, and update this model.

Prevalence of Poor Nutrition in Knee Osteoarthritis Patients: A Hospital-Based Cohort Study in Indian Population.

Malnourished adults with knee osteoarthritis (OA) have a lower propensity for physical activities, leading to post-surgical stress and poorer clinic-functional outcomes. The study is aimed to propose an integrative screening procedure for patients and to identify a subset of patients who are undernourished or at risk of undernutrition in the Indian population. A hospital-based cross-sectional study was conducted at a tertiary care, a university-level teaching hospital for seven months, which included knee OA patients above the age of 45years, and the following criteria were evaluated anthropometric measurement and blood biochemical parameters and nutritional scoring system. The current study reports a high prevalence of malnutrition (69.5%) in patients with knee OA in the Indian population based on blood biochemical levels, and late presenters are associated with poor nutritional status of an individual. A single gold standard blood biochemical test, serum albumin alone, reports many malnourished individuals in the population, and the remaining blood biochemical parameters may not yield any additional information. Mini nutritional assessment, mid-arm circumference, and mid-calf circumference are poor predictors of malnutrition, and we need a revised cut-off for our group of patients. In the cohort of OA Knee, the prevalence of malnutrition is high (69.5%) in the Indian population. Serum Albumin is the best parameter to detect the presence of malnutrition preoperatively, and MNS is not applicable to detect malnutrition in our subset of patients. The study recommends routinely measuring serum albumin levels in all patients to correct the nutritional abnormality preoperatively, resulting in better surgical outcomes and reduced post-operatively complications. IV.

Predictors of malnutrition among older residents in Qatari long-term care facilities: a retrospective study

BackgroundMalnutrition is a prevalent issue among older adults in long-term care facilities and is associated with adverse health outcomes and increased healthcare costs. Identifying the predictors of malnutrition in this population is crucial for developing effective intervention strategies. This study aimed to explore the factors contributing to malnourishment among older individuals living in long-term care facilities in Qatar.MethodsThis cross-sectional study included 75 older adults from two long-term care facilities (Rumailah Hospital and Enaya Specialized Care Center) in Qatar. Baseline characteristics, including age, sex, length of stay, mortality, weight, body mass index, co-morbidities, and laboratory parameters, were assessed. Data were analyzed using the most recent version of the SPSS software, version 29. Predictors of malnutrition and mortality were identified using logistic regression analysis.ResultsOf the 75 older individuals included in the study, 85% (64) were malnourished. The average age of the participants was 74.89 years, with a standard deviation of 10.21. Of all participants, approximately 61% (46) were males, and 39% (29) were females. Most malnourished older adults were classified as either at “moderate (29.69%)” or “severe risk (37.50%),” according to the Geriatric Nutritional Risk Index. Malnourished participants experienced a significant percentage of weight change within 3 months (14.01 ± 7.89); the only statistically significant predictor of malnutrition was the percentage of weight change within 3 months with an odds ratio (OR) of 4.8 (confidence interval [CI] 1.56–14.75) and p-value of 0.006. Statistically significant predictors of mortality were malnutrition (OR 24.84, CI 1.09–564) and age (OR 1.07, CI 1.00–1.14).ConclusionsA significant predictor of malnutrition in older adults identified in this study was the sudden and recent change in weight, which can be employed to detect individuals at risk early and guide tailored interventions. Malnutrition is a significant predictor of mortality. Employing a multidimensional strategy to tackle malnutrition can improve outcomes for the older individuals.

Relationship between mastication and malnutrition in community-dwelling older adults: a meta-analysis.

To determine the relationship between mastication and malnutrition in community-dwelling older adults. To establish the eligibility criteria, the acronym PECOS was used: Population: non-institutionalized older adults; Exposure: older adults with malnutrition; Control: older adults without malnutrition; Outcome: masticatory problems in malnourished older adults; Study types: observational studies. It selected studies assessing malnutrition and mastication difficulties in non-institutionalized adults over 60 years old, of both sexes. Mastication and malnutrition were evaluated with questionnaires on self-reported symptoms and clinical and instrumental assessments. There were no restrictions on language, year of publication, or ethnicity. The included studies were evaluated for methodological quality with the Joanna Briggs Institute tool for cross-sectional studies. For the cross-sectional studies included, the odds ratio (OR) was calculated with 95% confidence intervals. After searching the databases, 692 references were retrieved, with three studies selected for quantitative and qualitative analysis. The values obtained in the meta-analysis for association show that malnutrition and mastication difficulties were 2.21 times as likely to occur (OR = 2.21; 95%CI = 0.93 - 5.26; I2 = 94%) as individuals without malnutrition (p < 0.001). The assessment of the risk of bias presented a high-risk, a moderate-risk, and a low-risk study. The certainty of evidence was rated very low with the GRADE tool. Individuals at risk of malnutrition are 2.21 times as likely to have mastication difficulties.

Síndrome de realimentação no desnutrido grave: os desafios nutricionais

INTRODUCTION: Refeeding Syndrome (RS) is a set of signs and symptoms that occur in a situation of abrupt nutrient supply in malnourished or starving children and adults. Its incidence in pediatrics is unknown and is underreported due to underdiagnosis or insufficient monitoring. Hypophosphatemia is the most characteristic analytical finding of SR, although it is not always present. Hydro-electrolyte disturbances such as hypokalemia and hypomagnesemia can produce cardiac, muscular, and neurological changes with a risk of serious complications. OBJECTIVE: To warn of the severity of this syndrome and to identify patients at risk. CASE REPORT: A 3-year and 5-month-old patient with chronic nonprogressive encephalopathy (CPE), BMI: 10.9 (Z-score -4.76) sought emergency care due to irresponsiveness and pallor. He was hypotheremic, hypoglycemic, and had isochoric and punctiform pupils. After initial management, the patient evolved with eye movement and limb mobility. Laboratory tests were ordered with mild anemia, hospital admission was requested, and a polymeric diet was started via gastrostomy 180ml every 3/3 hours. The patient evolved with hypokalemia, hypomagnesemia, and severe hypophosphatemia. A diagnosis of SR was made and thiamine replacement, correction of hydroelectrolytic disturbances and reduction of the diet was initiated with slow progression. CONCLUSION: The main tool to avoid SR is to perform an adequate prevention. To do this, one should initially identify patients at risk, perform a biochemical evaluation, and progress the diet carefully and slowly. Vitamin supplementation is necessary, especially thiamine.

Four-week administration of an energy and protein dense oral nutritional supplement on plasma micronutrient concentrations in malnourished older adults living in nursing homes

Four-week administration of an energy and protein dense oral nutritional supplement on plasma micronutrient concentrations in malnourished older adults living in nursing homes

From hospital to home: Does the nutrition care provided to malnourished older adults meet ESPEN guideline recommendations?

From hospital to home: Does the nutrition care provided to malnourished older adults meet ESPEN guideline recommendations?

Formulation and evaluation of novel nutraceuticals rich in protein, vitamins, minerals, natural flavors, and steviol glycosides for improving quality of life

For a wide range of people, including malnourished adults (12+) with non-communicable diseases (NCDs), micronutrient deficiency, underweight and overweight, pregnant and lactating women, the current study aimed to present novel nutraceuticals structured according to the Standards of Protein-Rich Concentrated Nutrient Supplementary Foods with Daily Value (DV) on the New Nutrition and Supplement Facts Labels of Food and Drug Administration (FDA), for improving quality of life (QoL). Whey protein concentrate, skim milk powder, vitamins (folic acid, B12, C), minerals (iron, zinc), natural flavors (vanilla, cinnamon, coffee, chocolate), and stevia leaves extract were mixed to provide per serving; 10 g protein (20% DV), 25% DV of elemental iron and zinc, vitamin C, folic acid, vitamin B12, with elemental calcium (25% DV) emerged from milk derivatives. The novel nutraceuticals were subjected to the physicochemical, microbiological, and sensory evaluation. Results showed significant differences (P&lt;0.05) among formulations with natural flavors added in different amounts. The serving sizes of the four formulations were different according to the difference in the amount of natural flavor while keeping the same amounts of the other ingredients. Following the chocolate-flavored formulation as the first in order of overall acceptability, were coffee, cinnamon, and vanilla-flavored formulation, according to the sensory evaluation.

Impact of an oral nutritional supplement on improving body composition in older adults with malnutrition : A randomized controlled trial

The consequences of malnutrition in the elderly often manifest as weight loss and altered body composition. The aim of this study was to assess the efficacy of an oral nutritional supplement (ONS) on body composition in malnourished older adults.

Four-week administration of an energy and protein dense oral nutritional supplement improves micronutrient concentrations but does not completely correct deficiencies in institutionalized malnourished older adults.

Poor food intake is common among elderly living in nursing homes, leading to micronutrient deficiency (MD). There are no recommendations for the management of MD in malnourished older adults. We conducted a single arm, open-label, multicenter interventional study in institutionalized malnourished older adults to describe the effect of a 4-week daily energy and protein dense oral nutritional supplementation (ONS, 600 kcal, 30 g protein per unit) containing 50% of the recommended daily micronutrient intake on micronutrient status. Plasma concentrations of vitamins (A, B9, B12, C, E), magnesium (Mg), selenium (Se) and zinc (Zn), and erythrocyte vitamin B9 were measured at baseline and after 4 weeks. Forty-six participants completed the study (age 87.4 ± 6.6). At baseline, the most frequent MD were Se (48%), Zn (35%), Mg (24%) and vitamin C (24%). Plasma concentrations of vitamins B9, B12, C and E, Mg, Se and Zn significantly increased and the proportion of subjects with at least one MD decreased (p = 0.006). However, after 4 weeks, 40% of subjects still had at least one MD. ONS consumption improved micronutrient status but did not correct MD in all participants. Our data suggest that the prescription of vitamin, mineral and trace element supplementation should be considered in institutionalized malnourished older adults in addition to high energy and high protein ONS.

Impact of a specialized oral nutritional supplement on quality of life in older adults following hospitalization: Post-hoc analysis of the NOURISH trial

Both during and after hospitalization, nutritional care with daily intake of oral nutritional supplements (ONS) improves health outcomes and decreases risk of mortality in malnourished older adults. In a post-hoc analysis of data from hospitalized older adults with malnutrition risk, we sought to determine whether consuming a specialized ONS (S-ONS) containing high protein and beta-hydroxy-beta-methylbutyrate (HMB) can also improve Quality of Life (QoL). We analyzed data from the NOURISH trial-a randomized, placebo-controlled, multi-center, double-blind study conducted in patients with congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Patients received standard care+S-ONS or placebo beverage (target 2 servings/day) during hospitalization and for 90 days post-discharge. SF-36 and EQ-5D QoL outcomes were assessed at 0-, 30-, 60-, and 90-days post-discharge. To account for the missing QoL observations (27.7%) due to patient dropout, we used multiple imputation. Data represent differences between least squares mean (LSM) values with 95% Confidence Intervals for groups receiving S-ONS or placebo treatments. The study population consisted of 622 patients of mean age ±standard deviation: 77.9±8.4 years and of whom 52.1% were females. Patients consuming placebo had lower (worse) QoL domain scores than did those consuming S-ONS. Specifically for the SF-36 health domain scores, group differences (placebo vs S-ONS) in LSM were significant for the mental component summary at day 90 (-4.23 [-7.75,-0.71]; p=0.019), the domains of mental health at days 60 (-3.76 [-7.40,-0.12]; p=0.043) and 90 (-4.88 [-8.41,-1.34]; p=0.007), vitality at day 90 (-3.33 [-6.65,-0.01]; p=0.049) and social functioning at day 90 (-4.02 [-7.48,-0.55]; p=0.023). Compared to placebo, differences in LSM values for the SF-36 general health domain were significant with improvement in the S-ONS group at hospital discharge and beyond: day 0 (-2.72 [-5.33,-0.11]; p=0.041), day 30 (-3.08 [-6.09,-0.08]; p=0.044), day 60 (-3.95 [-7.13,-0.76]; p=0.015), and day 90 (-4.56 [-7.74,-1.38]; p=0.005). In hospitalized older adults with cardiopulmonary diseases and evidence of poor nutritional status, daily intake of S-ONS compared to placebo improved post-discharge QoL scores for mental health/cognition, vitality, social functioning, and general health. These QoL benefits complement survival benefits found in the original NOURISH trial analysis. NCT01626742.

Plant Versus Animal Protein Intake On Bone Mineral Density In A Combined Cohort Of Frail, Malnourished And Healthy Older Adults

Plant Versus Animal Protein Intake On Bone Mineral Density In A Combined Cohort Of Frail, Malnourished And Healthy Older Adults

Effects of High-protein, Leucine-enriched Oral Nutritional Supplement and Resistance Exercise on Physical Performance among Malnourished Older Adults with Sarcopenia

Background: Malnutrition combined with sarcopenia among older adults has resulted in poor outcomes, diminished quality of life (QoL), and increased mortality rates. Inadequate calorie and protein intake are factors contributing to sarcopenia. Specific nutritional interventions and exercise regimens may improve muscle strength and health outcomes. Aim: To determine the effects of a high-protein, leucine-enriched oral nutritional supplement (ONS) and resistance training (RT) on physical performance, muscle strength, QoL, and other outcomes among adults with sarcopenia. Methods: This was a single arm, open-label, 12-week prospective, multicenter study that involved outpatient malnourished older adults with sarcopenia from four hospitals in Thailand. During the 12-week period, subjects were given two servings of high-protein, leucine-enriched ONS per day with RT four times/week. Accordingly, short physical performance battery (SPPB), hand grip strength, muscle mass by dual-energy x-ray absorptiometry (DXA), QoL, frailty, and functional status of all subjects were assessed. Results: A total of 47 participants were enrolled in this study. After 12 weeks, 5-time chair stand results decreased from 11.59 ± 3.31 to 8.97 ± 1.85 seconds (pConclusions: High-protein, leucine-enriched ONS and RT have benefits for malnourished sarcopenic older adults through improvements in physical performance, muscle strength, muscle mass, recovery rates from malnutrition, frailty, and QoL.

Malnutrition, Quality of Life and Their Relationship among Older Adults: A Scoping Review

Malnutrition and poor quality of life (QoL) in older adults are becoming a public health concern. Therefore, this review article summarised significant studies which investigated the assessment of malnutrition and QoL and its relation. A literature research on academic journals published from 2011 to 2021 was conducted by using electronic databases, which were Google Scholar, PubMed, Science Direct and SCOPUS. A total of 21 studies with 26,569 participants were identified and included in this review. The prevalence of malnutrition ranged from 1.6% to 26.5%, and poor QoL was significant amongst malnourished older adults. In conclusion, malnutrition is associated with poor QoL amongst older adults. Future studies regarding factors that influence malnutrition and its relation towards the QoL amongst older adults are needed as it will help in assisting the healthcare professions to combat these health problems.