Mini Nutritional Assessment Short Form Research Articles

Nutritional status of the older adults in nursing homes: A cross-sectional study.

To investigate the nutritional status of older adults in nursing homes in Chongqing, China, compare and analyse the differences in the physical condition, cognitive function and social-related factors of older adults with different nutritional statuses. Malnurtition in the older people has become a priority concer, and the incidence and factors associated with malnutrition vary somewhat by healthcare setting. In Chongqing ,China, there is lack of research on malnutrition of the older people in nursing homes. Here, we investigated the incidence of malnutrition and analysed the associated factors. A cross-sectional study. From January to April 2023, a cross-sectional survey was conducted in three nursing homes in Chongqing, China. Participants completed a series of questionnaires, including the Demographic Information Questionnaire which included age, gender, education level, previous occupation, marital status and other information. The survey also included validated non-demographic instruments [Short-Form Mini-Nutritional Assessment (MNA-SF), Barthel Index (BI) and Mini-mental State Examination (MMSE)] to identify related impact factors. The Guidelines for cross-sectional studies were used in this study (Data S1). 209 older adults aged 60 and over participated in this study, of whom 121 were women and 88 were men. The average (SD) age of the participants was 84.7 (6.3) years. Of the participants, 46.4% were classified as well nourished. About 39.2% were at risk of malnutrition and 14.4% were malnourished. Compared to those who were well nourished, those who were malnourished or at risk of becoming malnourished were more likely to suffer from comorbidities, polypharmacy, a higher risk of falling, ADL dependence and to receive more nutritional interventions. However, there are no significant differences after adjustment for age, education level, previous occupation, marital status, length of stay, and type of health care payment. Malnutrition is a common problem among older adults innursing homes in Chongqing, China. There are certain differences in physical conditions and nutritional interventions among older adults withdifferent nutritional status. This study suggests that the problem of malnutrition is very prominent in nursing homes in Chongqing, China. Cognitive impairment, impaired activities of daily living, fall risk and nutritional intervention need to be prevalent in older adults with (risk of) malnutrition.

Nutrition and Isolation in a Rural US Population over 80 Years Old: A Descriptive Analysis of a Vulnerable Population

Factors allowing rural, community-dwelling 80+ year-olds to thrive remain unexplored. Isolation can impact this vulnerable population. In this study, patients were prospectively surveyed for age, gender, cohabitation (self, spouse, family) and location (suburban, rural, and isolated). Mini-nutritional assessment short form (MNA-SF) and BMI were obtained. A p < 0.05 represented statistical significance. Patients (n = 167) were mostly female (120; 71.9%) with an average overweight BMI (26.5) and low-normal MNA-SF scores (11.8). Most live alone (49.7%), followed by spousal (31.7%) and family (18.6%) cohabitation. Over 80% are rural (71) or rural-isolated (67), and of these, 83% had normal nutrition. Self-habitation correlated with lower MNA-SF scores (p = 0.02). Normal BMIs correlated with family cohabitation (OR = 0.90 [CI: 0.82-0.99]) and nourished MNA-SF scores with spousal cohabitation (OR = 1.69; CI: 1.15-2.47) rather than living alone. Self-habitation increases vulnerability to obesity and malnutrition. Interventions should aim to maintain independence while improving the effects of habitation on nutrition.

A Simple Scale That Can Be Used to Screen Visceral Obesity

A possible relationship between the Mini Nutritional Assessment Short Form (MNA-SF) and visceral fat thickness (VFT) in 390 participants 60 years and older was investigated. VFT was measured by ultrasonography as the distance between the inner wall of the rectus abdominis and the anterior abdominal aortic wall. The risk of visceral obesity increased with the increase in MNA-SF values independent of age, gender, diabetes mellitus, and alcohol history (odds ratio = 1.534, 95% CI 1.176–2.002, P = .002). The optimal cut-off point of the MNA-SF to predict visceral obesity was measured as 12.5 (area under the curve = 0.617, 95% CI 0.558–0.676). Our findings suggest that the MNA-SF may be useful in visceral obesity screening.

Association between oral health and nutritional status among older patients requiring long-term care who received home-visit dental care.

This study examined the association between oral health and nutritional status among older patients receiving home-visit dental care. This study enrolled 110 older patients (age ≥65 years) requiring long-term care who received home-visit dental care. The oral health indicators evaluated included number of teeth, occlusal support, number of functional teeth, tongue pressure, tongue coating index (TCI), and rinsing ability. Nutritional indicators included skeletal muscle mass index (SMI) and the mini-nutritional assessment short-form (MNA-SF). A multivariate modified Poisson regression analysis (adjusted for age, sex, medical history, care level, and housing type) was used to calculate prevalence ratios and 95% confidence intervals (CIs). The prevalence ratio for low SMI was not significantly higher for patients with ≥20 teeth than for those with 1-19 or no teeth. Number of teeth was not significantly associated with MNA-SF score. A high TCI score (2.15, 95% CI: 1.07-4.32) and poor rinsing ability (2.32, 95% CI: 1.25-4.30) were significantly associated with low SMI. High TCI scores were associated with low scores in MNA-SF categories (1.25, 95% CI: 1.01-1.55). TCI and rinsing ability, rather than number of teeth, were associated with nutritional status in older patients requiring long-term care.

Monitorovanie funkčného stavu ako prostriedok prevencie komplikácií u geriatrických pacientov

Introduction: The geriatric patient is included in the category of patients with the highest risk of complications. In the case of institutional treatment, his nutritional status and self-sufficiency may deteriorate, he may decompensate for a chronic disease, he may develop geriatric frailty syndrome, sarcopenia, etc. Therefore, it is necessary to identify health problems and functional limitations of seniors as soon as possible, ideally at the time of their reversibility. Areas that require special attention because they affect the overall health and psychological state of the patient include nutrition, physical fitness and the ability to perform activities of daily living. Objective: The main goal of the research was to point out the benefit of regular monitoring of the functional status of geriatric patients in institutional treatment. The partial goal was to find out the current state of nutrition, physical activity and self-sufficiency in geriatric patients. To find out how the state of nutrition, physical activity and self-sufficiency changes after the intervention by members of the interdisciplinary team. Methodology: The research methods were nutritional anamnesis, standardized measuring tools Mini Nutritional assessment (MNA), MNA-Short-Form (MNA-SF), Barthel test (ADL), Physical fitness test (SARS-F), Hand-grip test and additional methods - analysis of health documentation, anthropometric measurements and physical examination. the research set were geriatric patients in institutional health and social facilities (SF). The total number was 368, of which 114 were men, 254 were women. of that number, 132 respondents were hospitalized in the health care facilities (HCF) and 236 in SSF in the Slovak and czech Republics. Research results: We identified risk factors for malnutrition during the nutritional anamnesis. The most common were difficulties with swallowing (n 46), reduced appetite (n 30), a feeling of fullness (n 29), but also problems with excretion- constipation (n 64). Other risk factors were polypharmacy - 105 patients, use of risky medication (n 67), oncological treatment. The average values of the screening tools were: BMI- 26.74, MNA- 23, MNA-SF- 6.3, SARS-F- 3.38, ADL- 74.5, Hand grip test 8.3. Patients in the HcF had worse nutritional status - 41 had malnutrition and 75 patients were at risk of malnutrition. A very negative result was the average value of Hand grip and physical fitness test. Patients had presarcopenia and sarcopenia. Statistical data processing confirmed the relationship between MNA and ADL, SARS-F values (correlation 0.01, 0.05). MNA values had an impact on patients‘ level of self-sufficiency and physical fitness. After the identification of the problem, 356 patients had implemented appropriate interventions - dietary modification, sipping, education, enteral and partially parenteral nutrition, rehabilitation, nursing rehabilitation. After repeated monitoring, the values were adjusted. However, the SARS-F values were not adjusted, nor was the grip strength of seniors in SSF. Conclusion: Regular monitoring of the functional status of geriatric patients has its justification. Thanks to the screening tools, we identified patients at risk of malnutrition and sarcopenia and subsequently eliminated the complications related to them. The research results are part of the KEGA project no. 009 KU-4/2022 Nutrition and physical activity as basic pillars of care for patients at risk.

Osteoporotic phenotype of body composition: Relationship with nutritional status and physical condition in women with rheumatoid arthritis

Aim of the study – to assess the relationship of the osteoporotic phenotype of body composition with nutritional and physical status in women with rheumatoid arthritis (RA).Material and methods. 104 women (average age 59.5±8.7 years) with RA were enrolled. The examination included clinical, laboratory and instrumental (dual-energy X-ray absorptiometry) methods. Nutritional status was assessed using the Mini Nutrition Assessment-Short Form (MNA-SF), physical status – using the International Physical Activity Questionnaire (IPAQ), “Chair stand test”, handgrip strength, “Timed Up and Go test” and gait speed.Results. Osteoporotic phenotype was diagnosed in 38.5% of patients. Malnutrition and risk of malnutrition according to MNA-SF had 51.0% of women. Low and moderate level of physical activity according to IPAQ – 51.9% of patients. In multivariate logistic regression analysis, independent factors associated with osteoporotic phenotype were determined: walking &lt;30 minutes a day (odds ratio (OR) – 1.34; 95% confidence interval (95% CI): 0.11–17.32), low muscle strength of the upper extremities (handgrip strength less than 16 kg) (OR=7.12; 95% CI: 1.02–49.57) and lower extremities (“Chair stand test” more than 15 seconds) (OR=4.45; 95% CI: 1.08–18.42), body mass index (BMI) less than 25 kg/m2 (OR=1.39; 95% CI: 1.04–1.85).Conclusion. A high frequency of the osteoporotic phenotype of body composition was revealed in patients with RA, among whom almost half of the examined individuals had insufficient nutrition and/or reduced physical activity. Walking &lt;30 minutes a day, low upper and lower limb muscle strength, and BMI&lt;25 kg/m2 were associated with the osteoporotic phenotype.

DETERMINATION OF MALNUTRITION, FRAILTY, POLYPHARMACY, MULTIMORBIDITY, AND MORTALITY RISK IN HOSPITALIZED ELDERLY COVID-19 PNEUMONIA CASES WITH AND WITHOUT POSSIBLE SARCOPENIA

Introduction: To evaluate elderly COVID-19 pneumonia hospitalizations via the presence of possible sarcopenia, hand grip strength measurements, malnutrition, frailty, polypharmacy, multimorbidity, mortality risk and 30th-day mortality after discharge. Materials and Method: This observational study included geriatric patients in the COVID ward of Gaziosmanpasa Training and Research Hospital between March 1, 2022, and April 30, 2022. SARC-F screening test, hand grip strength measurement, CALL score for mortality risk, KATZ Index of Independence in activities of daily living, Mini Nutritional Assessment-Short Form, BORG dyspnea scale, and Frail scale were administered. 30th-day mortality after discharge was recorded during follow-up using phone calls. Results: Distribution of 75 cases aged 76.6±8.2 years was as follows: 65.3% (n =49) possible sarcopenia, 49.3% (n =37) malnutrition, 49.3% (n =37) polypharmacy,70.7% (n =53) multimorbidities. 30th-day after-discharge mortality was 24.0% (n =18). The length of hospital stay, activities of daily living, frailty, D-dimer level, albumin, and oxygen requirement were significant in the possible sarcopenia group compared to non-sarcopenia group (p =0.003, p = 0.012, p =0.012, p =0.007, p =0.004, and p =0.015, respectively). Impaired hand grip strength was related to a higher CALL risk score (r =-0.343; p =0.003), higher drug use and disease counts (r =-0.387, p =0.001 and r =-0.321; p =0.005), prolonged length of hospital stay (r=-0.315; p=0.006), and higher oxygen requirement (r =-0.240, p =0.038). Conclusion: COVID-19 pneumonia hospitalizations of geriatric patients are significantly accompanied by possible sarcopenia. The measurement of hand grip strength was emphasized to determine associations with the length of hospital stay, malnutrition, and 30th-day discharge mortality of hospitalized COVID-19 pneumonia in the elderly. Keywords: Pneumonia; COVID-19; Sarcopenia; Frail Elderly; Malnutrition; Mortality.

Associação entre risco de disfagia e sinais sugestivos de sarcopenia, estado nutricional e frequência de higiene oral em idosos hospitalizados

ABSTRACT Purpose To identify the risk of dysphagia and its association with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in the hospitalized elderly. Methods This is an analytical cross-sectional study with the participation of 52 elderly patients admitted to a medical clinic at a public hospital in the Federal District, Brazil. The Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Calf Circumference and the Mini Nutritional Assessment shortform were applied, in addition to the collection of sociodemographic data and health conditions. Results Among the elderly participants, 30.8% were at risk of self-reported dysphagia. The factors associated with the risk of dysphagia were: signs suggestive of sarcopenia (p=0.04), nutritional status (p&lt;0.001) and oral hygiene frequency (p=0.03). Conclusion In the geriatric population of the present study, with the majority of the participants having tested positive for Covid-19, the risk of dysphagia was associated with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene.

Association between risk of dysphagia and signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in hospitalized elderly.

To identify the risk of dysphagia and its association with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in the hospitalized elderly. This is an analytical cross-sectional study with the participation of 52 elderly patients admitted to a medical clinic at a public hospital in the Federal District, Brazil. The Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Calf Circumference and the Mini Nutritional Assessment shortform were applied, in addition to the collection of sociodemographic data and health conditions. Among the elderly participants, 30.8% were at risk of self-reported dysphagia. The factors associated with the risk of dysphagia were: signs suggestive of sarcopenia (p=0.04), nutritional status (p<0.001) and oral hygiene frequency (p=0.03). In the geriatric population of the present study, with the majority of the participants having tested positive for Covid-19, the risk of dysphagia was associated with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene.

Malnutrition and its determinants among older adults living in foster families in Guadeloupe (French West Indies). A cross-sectional study.

Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers'rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult's rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.

Assessing the link between nutritional status, functional capacity, and morbidity profile in the community-dwelling elderly of Maharashtra, India

BackgroundAgeing challenges elderly individuals, increasing the risk of malnutrition due to physical, psychological, functional, and social changes. Poor nutritional status is directly related to functional capacity and can increase the risk of morbidity and mortality. Early identification of the risk of malnutrition among the elderly can promote independence and well-being with a good quality of life. ObjectivesTo assess the interrelationship between the nutritional status and indicators of functional capacity and morbidity profile among the elderly population from the Pune District of Maharashtra, India. MethodsThe study followed a cross-sectional survey design. The convenience sampling technique was used to recruit participants. Three standardised instruments - the Mini-Nutritional Assessment – Short Form (MNA-SF), the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Cumulative Illness Rating Scale-Geriatric (CIRS-G) – were used to assess the nutritional status, functional capacity and morbidity profile respectively. The data were analysed using Chi-square tests of association, and independent t-test and one-way ANOVA for difference in means. ResultsParticipants were 100 older adults (age range: 60–90 years). 24 % of the sample were malnourished and 33 % were at risk for malnutrition. Dependent participants had a significantly lower MNA-SF score (5.6 ± 3.5) than independent participants (10.4 ± 3.0) (p < 0.001). There was a significant association between poor nutritional status and morbidity profile specific to disability in organ systems like eyes, ears, throat, haematopoietic, musculoskeletal, and upper GI systems, as well as psychiatric illness (p ≤ 0.05). The CIRS-G score was significantly higher for malnourished participants (12.6 ± 6.2) than those at risk of malnutrition (8.9 ± 4.8) and well nourished (6.0 ± 4.0) (p < 0.001). ConclusionNutritional status was associated with functional capacity and indicators of morbidity profile in the elderly. Incorporating routine nutritional risk screening as a component of healthcare can facilitate early identification of at-risk individuals, enabling timely intervention and improving health outcomes. Future research should prioritise investigating routine screening programs to assess the risk of malnutrition and the effectiveness of nutrition interventions such as dietary modifications and supplementation to prevent malnutrition in older adults.

Effect of comorbid heart failure assessed by plasma B-type natriuretic peptide level on the activities of daily living in patients with hospitalization-associated disability after aspiration pneumonia.

We investigated the effects of comorbid heart failure on rehabilitation outcomes in patients with hospitalization-associated disability after aspiration pneumonia(AP). This study included 134 patients with hospitalization-associated disability after AP. Patients were classified into heart failure (B-type natriuretic peptide (BNP) ≧100pg/ml, n = 39) and non-heart failure (BNP < 100pg/ml, n = 95) groups, and the rehabilitation outcomes of both groups were compared. Rehabilitation effectiveness was lower in heart failure group than in non-heart failure group (21.1 ± 22.6% vs 36.2 ± 30.8, p < 0.01). The rate of independent walking at discharge in heart failure group (28.2%) was significantly lower than in non-heart failure group (53.7%). Multiple linear regression analysis revealed that age, male, handgrip strength, quadriceps strength, functional oral intake scale, Mini Nutritional Assessment Short Form, and BNP were significantly associated with rehabilitation effectiveness. Results suggest that comorbid heart failure has a negative impact on rehabilitation outcomes in patients with hospital-associated disability after AP.

Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study

ObjectiveWe studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs). DesignCross-sectional study. Setting and ParticipantsTwo Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years. MethodsInclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants’ age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment–Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used. ResultsOf the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status. Conclusions and ImplicationsTwo-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts.

The association between sarcopenia, defined by a simplified screening tool, and long-term outcomes.

Sarcopenia and frailty are frequently observed in older adult patients and linked to unfavorable postoperative outcomes. Identifying low muscle mass and function is primary for diagnosing sarcopenia. The simpler screening, which excludes muscle mass measurement, exhibited strong predictive capabilities in identifying sarcopenia. This research explored the association between sarcopenia, as defined by the C3 formula, and long-term outcomes in older adult cancer patients who underwent surgery. Surgical cancer patients aged 60 and older were enrolled. Sarcopenia was identified using the C3 formula, assessing muscle strength through handgrip strength, physical performance via a 6-m walk test, and nutrition status via the Mini Nutritional Assessment-Short Form. Long-term outcomes were evaluated with the Barthel Index for activities of daily living (B-ADL) at 3 months, as well as 1-year mortality rates. The study enrolled 251 patients, with 130 classified as sarcopenic according to the C3 formula. Compared with nonsarcopenic patients, patients with sarcopenia exhibited a higher frequency of moderate to severe disability (B-ADL ≤70) 3 months postdischarge (19.5% vs 5.2%; P = 0.001) and elevated 1-year mortality rates (29.5% vs 14.9%; P = 0.006). No significant differences were observed in infection rates, hospital stay duration, or in-hospital mortality. Distant organ metastasis (HR = 3.99; 95% CI = 2.25-7.07) and sarcopenia defined by the C3 formula (HR = 1.78; 95% CI = 1.01-3.15) were identified as independent risk factors for 1-year mortality. The simplified sarcopenia screening tool was associated with increased rates of moderate to severe disability 3 months postdischarge and higher 1-year mortality rates compared with nonsarcopenic patients.

TUMOR NECROSIS FACTOR-Α, INTERLUKIN-6, AND VISFATIN LEVELS IN OLDER PATIENTS WITH MALNUTRITION

Abstract Introduction Proinflammatory cytokine is associated with malnutrition status. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were pro-inflammatory cytokines stimulated by nutritional deficiency. Visfatin is an adipokine with a strong correlation with inflammation. The relationships of TNF-α, IL-6 and visfatin are not consistent, and no study have investigated them in the older patients with malnutrition. Methods This prospective study included patients aged ≥ 75 years at the emergency department and all patients underwent Mini-Nutritional Assessment-Short Form (MNA-SF) and blood tests for fasting plasma TNF-α, IL-6 and visfatin levels. Results We enrolled 106 older patients with a mean age of 87.3 years, including 43 (40.5%) patients in at risk of malnutrition group (MNA-SF between 8 to 11), 24 (22.6%) patients in the malnutrition group (MNA-SF &amp;lt; 8), and 39 (36.7%) patients in normal group. Compared to the normal group, both at risk of malnutrition and malnutrition group had significantly lower Mini-Mental State Examination (MMSE). Furthermore, TNF-α was significantly higher in at risk of malnutrition group. In contrast, IL-6 was significantly higher in malnutrition group. Visfatin levels was not correlated to the malnutrition status. Both TNF-α and IL-6 negatively correlated with Barthel index and MMSE. Backward and stepwise multiple logistic regression analyses showed that the independent predictor for both at risk of malnutrition and malnutrition was MMSE. Conclusion The nutrition deficit status was correlated with proinflammatory cytokines, serum TNF-α and IL-6. The independent predictor of both at risk of malnutrition and malnutrition group was MMSE in older patients.

The Role of Muscle Ultrasonography to Diagnose Malnutrition and Sarcopenia in Maintenance Hemodialysis

Sarcopenia and malnutrition are commonly seen and fundamental indicators of prognosis and are directly associated with increased mortality in maintenance hemodialysis (MHD) patients. We aimed to reveal the frequency of malnutrition and sarcopenia in patients undergoing MHD and investigate the role of muscle ultrasound (US) parameters to predict sarcopenia and malnutrition. A total of 45 patients who have undertaken MHD for more than 6months three times a week were evaluated for the present study. The US measurement was performed on gastrocnemius medialis, rectus femoris (RF), and abdominal muscles, including rectus abdominis, external oblique abdominalis, internal oblique abdominalis, and transversus abdominis. Nutritional status of the participants was assessed by mini-nutritional assessment short-form (MNA-SF). The prevalence of probable and confirmed sarcopenia was 51.1% (n=23) and 35.6% (n=16), respectively. The malnutrition and risk of malnutrition were observed in 31.1% of the whole study population (n=14). All muscle US measurements were lower in the sarcopenic group; however, the difference is meaningful only for RF cross-sectional area (CSA) (P=.046). The malnourished group had substantially lower muscle thickness and CSA, except for the gastrocnemius muscle thickness. The value of RFCSA to predict sarcopenia and malnutrition was observed as 4.61cm2, respectively (P<.05). RFCSA was independently associated with sarcopenia (odds ratio: 0.37; 95% confidence interval: 0.17-0.79; P=.011) and malnutrition (odds ratio: 0.45; 95% confidence interval: 0.23-0.87; P=.017). RFCSA may be a useful and simple predictor for predicting patients undergoing hemodialysis who are at risk of sarcopenia and malnutrition.

Early Quality of Life Assessment After Segmental Colorectal Resection for Deep Infiltrating Endometriosis

Endometriosis is a benign condition afflicting women of reproductive age that significantly impacts their quality of life (QoL). Given its debilitating symptoms and prevalence, it is essential to define its proper management. In this study, we have assessed patient-reported outcomes among women having undergone segmental colorectal resection for deep infiltrating endometriosis. Any correlation between preoperative nutritional status and overall postoperative complications has also been analyzed. Prospective observational study. Public medical center. One hundred forty consecutive patients that had undergone segmental colorectal resection for DIE between November 2020 and October 2021 at IRCCS Sacro Cuore Don Calabria Hospital of Negrar of Valpolicella (Verona, Italy). Patient-reported outcomes were measured using data collected from the MD Anderson Symptom Inventory for gastrointestinal surgery patients and Euro-QoL Group EQ-5D-5L (EQ-5Q-5L) questionnaires, which were administered preoperatively (T0), at discharge (T1) and at 4 to 6 weeks after surgery (T2). Nutritional status was examined through the Mini Nutritional Assessment Short form and Prognostic Nutritional Index. A significant improvement in the EQ-5Q-5L and MDASI-GI scores was noted between T0 and T2 (p <. 001 and p <. 001, respectively.) No statistically significant differences were found in scores at T2 between patients who had experienced postoperative complications and those who had not. No statistically significant association was observed between the presence of malnutrition and overall postoperative complications and their severity. This study confirms, through patient-reported outcomes, the pivotal role of surgery in improving the QoL at 4 to 6 weeks of women affected by endometriosis who have previously been unresponsive to medical therapy.

Malnutrition Screening Tools Are Not Sensitive Enough to Identify Older Hospital Patients with Malnutrition.

This study evaluates the concurrent validity of five malnutrition screening tools to identify older hospitalized patients against the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria as limited evidence is available. The screening tools Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Mini Nutritional Assessment-Short Form (MNA-SF), and the Patient-Generated Subjective Global Assessment-Short Form (PG-SGA-SF) with cut-offs for both malnutrition (conservative) and moderate malnutrition or risk of malnutrition (liberal) were used. The concurrent validity was determined by the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the level of agreement by Cohen's kappa. In total, 356 patients were included in the analyses (median age 70 y (IQR 63-77); 54% male). The prevalence of malnutrition according to the GLIM criteria without prior screening was 42%. The conservative cut-offs showed a low-to-moderate sensitivity (32-68%) and moderate-to-high specificity (61-98%). The PPV and NPV ranged from 59 to 94% and 67-86%, respectively. The Cohen's kappa showed poor agreement (k = 0.21-0.59). The liberal cut-offs displayed a moderate-to-high sensitivity (66-89%) and a low-to-high specificity (46-95%). The agreement was fair to good (k = 0.33-0.75). The currently used screening tools vary in their capacity to identify hospitalized older patients with malnutrition. The screening process in the GLIM framework requires further consideration.

Frailty Prevention Care Management Program (FPCMP) on Frailty and Health Function in Community-Dwelling Older Adults: A Quasi-Experimental Trial Protocol.

Frailty often results from deteriorating muscle strength and decreased physical function in older adults. Frailty includes not only physical components, but also psychological and social aspects. Previous research has shown that exercise programs, especially resistance exercises combined with nutritional care, can reduce frailty. This study aimed to develop a Frailty Prevention Care Management Program that prevents frailty and improves physical activity and nutrition compared to usual care for community-dwelling older adults. A quasi-experimental and single-blinded trial with a non-equivalent control group using a before-after design will be performed involving Frailty Prevention Care Management Program interventions, taking place both at the communities. Participants will be divided into two different intervention groups and two control groups. All groups will be assessed three times: at baseline, immediately after the intervention, and 3 months post intervention. A total of 72 community-dwelling older adults are recruited. This intervention includes an exercise program (design TRX program) and nutritional education. The control group will not receive any specific exercise training. The primary outcome shall comprise the effect of the Frailty Prevention Care Management Program on frailty using the Taiwanese version of the Tilburg frailty indicator. Secondary outcomes include the effect of physical activity using the Senior Fitness Test and nutrition measures using the Mini Nutritional Assessment-Short Form. A generalized estimating equation is constructed to analyze the effects of the intervention. This trial will provide vital information to guide interventions to improve outcomes (frailty, physical activity, and nutrition) and inform the integration of nutrition and TRX exercises in community-dwelling older adults.

Effects of a low-protein nutritional formula with dietary counseling in older adults with chronic kidney disease stages 3–5: a randomized controlled trial

BackgroundAlthough combining a low-protein diet (LPD) with oral nutritional supplements increases treatment adherence and nutritional status in patients with chronic kidney disease (CKD), the effect of this combination approach in older adults remains unclear. This study examined the impact of a 6% low-protein formula (6% LPF) with diet counseling in older adults with stage 3–5 CKD.MethodsIn this three-month randomized controlled study, 66 patients (eGFR < 60 mL/min/1.73 m2, non-dialysis, over 65 years of age) were randomly assigned to an intervention group (LPD plus a 6% LPF) or control group (LPD alone). The 6% LPF comprised 400 kcal, 6 g of protein, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and various micronutrients. All data were collected at baseline and after three months, including physical performance based on hand grip strength (HGS) and gait speed, nutritional status using Mini Nutritional Assessment-Short Form (MNA-SF) scores, body composition through bioelectrical impedance analysis, and dietary intake from 24-h dietary records.ResultsThis study incorporated 47 participants (median age, 73; median eGFR, 36 ml/min/1.73 m2; intervention group: 24; control group: 23). The intervention group exhibited significant differences in HGS and gait speed, and micronutrient analysis revealed significantly higher monounsaturated fatty acids (MUFA), EPA, DHA, calcium, iron, zinc, copper, thiamine, riboflavin, niacin, B6, B12, and folic acid intake than the control group. MNA-SF scores, macronutrient intake, and body composition did not differ significantly between the two groups.ConclusionsCompared to LPD counseling alone, an LPD prescription with 6% LPF in older adults with CKD stages 3–5 helped relieve physical deterioration and increased micronutrient intake after three months.Trial registrationClinicalTrials.gov NCT05318014 (retrospectively registered on 08/04/2022).