Mini Nutritional Assessment-Short Form Score Research Articles

Impact of Energy intake at One Week after Hospitalization on Prognosis for Older Adults with Pneumonia.

This study objectives to investigate the influence of average energy intake at 1 week of hospitalization on prognosis for older adults with pneumonia. Retrospective observational cohort study. The Japan Rehabilitation Nutrition Database comprise those with pneumonia in acute care hospitals. The study included 329 pneumonia patients (aged over 65 years) who entered into the Japan Rehabilitation Nutrition Database (JRND) from November 2015 to March 2018. Logistic regression analysis was performed to confirm the relationship of energy intake with the rate of mortality, discharge home, and pneumonia recurrence during hospitalization. Variables included in the multiple regression analysis model were age, sex, Mini Nutritional Assessment-Short Form score (MNA-SF) at hospitalization, A-DROP, Charlson comorbidity index (CCI), and presence or absence of rehabilitation. Of 315 patients with pneumonia (median age 85 years), 63.8% were men. 57.7% were assigned to the lack of energy intake (LEI) at 1 week after admission. Patients in the LEI group were older (p = 0.033), had higher A-DROP score (p < 0.001), and showed higher malnutrition rate in MNA-SF at hospitalization (p < 0.001) than those in the control group. Mortality, pneumonia recurrence (p = 0.001), median body mass index (p = 0.012), and low malnutrition in MNA-SF (p < 0.001) at discharge were significantly higher in the LEI group than in the control group. Logistic regression analysis showed that LEI was an independent risk factor for mortality (Odds ratio: 5.07, p = 0.002), discharge home (Odds ratio: 0.33, p = 0.007), and pneumonia recurrence (Odds ratio: 3.26, p = 0.007). LEI at 1 week after hospitalization in older adults with pneumonia was an independent risk factor for mortality, difficult at-home recovery, and pneumonia recurrence. These findings suggest the importance of adequate energy intake from the early days of hospitalization.

P1538Low energy intake predicts readmission of elderly heart failure patients independently of nutritional status

Abstract Background Malnutrition is frequently present and closely associated with poor clinical outcomes in elderly heart failure (HF) patients. Our previous study showed that low energy intake (EI) is associated with worse functional status in elderly HF inpatients after cardiac rehabilitation, but significance of EI in prediction of hospital readmission has not been elucidated fully. Purpose We examined whether low EI is a predictor of readmission for cardiac events in elderly HF patients. Methods We retrospectively retrieved data for 298 HF patients aged ≥65 years (median age of 77 years, interquartile range [IQR]: 71 - 82, female: 53%) who admitted to our institute for diagnosis and treatment of HF. Medical records were reviewed with regard to demography, medical history, comorbidities, medications, laboratory data, echocardiograms, functional status, nutritional status and total energy intake. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and total EI per day were calculated at discharge by a registered dietitian and a trained physical therapist. The primary endpoint was readmission due to cardiovascular events including worsening HF, arrhythmia, angina pectoris and myocardial infarction during a 1-year follow-up period. Results The median period of follow-up was 235 days (IQR: 78–365 days). The 1-year readmission rate for cardiovascular events was 54.4%. The cutoff values of MNA-SF score and EI, calculated by ROC curve analysis to predict the primary endpoint, were 7 points (area under the curve [AUC]: 0.59, sensitivity: 0.65, specificity: 0.50) and 31.8 kcal/kg/day (AUC: 0.59, sensitivity: 0.83, specificity: 0.35), respectively. Patients with low MNF-SF score (≤7) or low EI (≤31.8 kcal/kg/day) had significantly higher readmission rate during a 1-year follow-up period than did the patients with high MNF-SF score or EI (MNA-SF: 60.7% vs. 45.6%, p&lt;0.01, EI: 60.4% vs. 36.8%, p&lt;0.01), respectively. When patients were classified into four groups using cutoff values of MNA-SF score and EI, 1-year readmission rate was significantly higher in patients with low EI than in those with high EI regardless of MNF-SF scores. In multivariate Cox proportional hazard analyses adjusted for known prognostic factors in addition to age and gender, hazard ratios (HR) were significantly higher in patients with high MNA-SF score and low EI (adjusted HR: 2.81, 95% confidential interval [CI]: 1.15 - 9.32, p=0.02) and low MNA-SF score (≤7) and low EI (adjusted HR: 4.16, 95% CI: 1.72 - 13.72, p&lt;0.01) than those with high MNA-SF score and high EI. Kaplan-Meier curves of readmission rates Conclusions Low energy intake is a nutritional status-independent predictor of 1-year readmission rate in elderly HF patients.

MALNUTRITON AND MORTALITY IN FRAIL AND NON-FRAIL OLDER ADULTS UNDERGOING INTERVENTIONS FOR PERIPHERAL ARTERIAL DISEASE

Older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. This study sought to determine the association between preprocedural nutritional status and all-cause mortality. This was a post-hoc analysis of the Frailty Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort including 2 centers recruiting patients between October 1, 2015 and August 1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled. The Mini Nutritional Assessment (MNA)-Short Form was assessed by trained observers preprocedure, with scores ≤7 of 14 considered malnourished and scores 8 to 11 of 14 considered at risk for malnutrition. The modified Essential Frailty Toolset (mEFT) was simultaneously assessed to measure frailty, with scores ≥3 of 5 considered frail. The primary endpoint was all-cause mortality at 12 months after the procedure. Multivariable logistic regression was used to adjust for potential confounders. There were 148 subjects with 39.2% females, a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. In the cohort, 59 (40%) had claudication and 89 (60%) had chronic limb threatening ischemia (CLTI) with 98 (66%) undergoing endovascular revascularization and 50 (34%) undergoing open or hybrid revascularization. Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12-months. Mini Nutritional Assessment-Short Form scores were modestly correlated with the mEFT scores (Pearson’s R=-0.48, P < 0.001). Patients with malnourishment or at risk of malnourishment had 2.5-fold higher crude 1-year mortality compared with those with normal nutritional status. In frail patients with mEFT scores ≥3 (41%), malnutrition was associated with all-cause mortality (adjusted OR: 2.08 per point decrease in MNA scores; 95% CI: 1.03 to 4.35); whereas in nonfrail patients with mEFT scores < 3 (59%), MNA scores had no effect on mortality (adjusted OR: 1.05; 95% CI: 0.56 to 2.00). Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals.

Impact of Multiple Texture-Modified Diets on Oral Intake and Nutritional Status in Older Patients with Pneumonia: A Retrospective Cohort Study.

Texture-modified diets (TMD) is often used in clinical practices for the treatment and prevention of pneumonia. However, it is unclear how stages of TMD affect the swallowing ability and nutritional status in patients with pneumonia. This study aimed to investigate the relationship between the various stages of TMD and swallowing ability and nutritional status in older inpatients with pneumonia. In this retrospective cohort study, data for patients aged ≥ 65years with pneumonia were obtained from the Japan Rehabilitation Nutrition Database. We performed coarsened exact matching with Mini Nutritional Assessment Short Form (MNA-SF) on admission. Ultimately, 218 patients (mean age 82.9 ± 9.8years) were included and divided into two groups based on the stages of TMD in the facility: multiple TMD (M-TMD) group (stages of TMD ≥ 6) and control group (stages of TMD < 6). The main outcome was the rate of improvement in the Food Intake Level Scale (FILS) and the maintenance or improvement in the MNA-SF score. We used the within-hospital correction with generalized estimation equations that are commonly used to analyze clustered data while correcting for confounding factors by clustering. Multivariate multiple logistic analysis showed that M-TMD was independently associated with FILS improvement rate and the maintenance or improvement in the MNA-SF score (odds ratio [OR] 3.252; 95% confidence interval [CI] 1.602-6.601; p = 0.001 and OR 1.873; 95% CI 1.054-3.330; p = 0.032, respectively). M-TMD in the facility was associated with the maintenance or improvement in swallowing ability and the nutritional status of patients with pneumonia.

172 Sarcopenia, Frailty and Malnutrition in the Older Adults in the Emergency Department Setting

Abstract Background The physical phenotype of frailty shows significant overlap with sarcopenia, and sarcopenia phenotype is associated with malnutrition. Integrating screening of these interrelated conditions, could help identify those most vulnerable in the Emergency Department (ED) setting. Methods Patients ≥75 were screened in the Emergency department (ED) by an interdisciplinary Gerontological ED team using a standardised assessment tool, incorporating the Clinical Frailty Scale (CFS) and the mini-nutritional assessment short form (MNA-SF). Patients at risk of malnutrition ( MNA-SF &lt;12) were referred for Dietetics assessment and screened for sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm for case finding, followed by grip strength and calf muscle measurement. Results In a convenience sample of patients referred to dietetics following initial screen in ED, 57% were female (25/44) and the mean age was 83 years (range 75-94). Eighty-eight percent (39/44) were at risk of malnutrition/malnourished and 25% (11/44) were diagnosed with malnutrition (MNA-SF score 0-7). Seventy-three percent (32/44) scored ≥4 on the CFS. Fifty-two percent of all patients (23/44) had a Sarc-F ≥ 4, suggestive of sarcopenia, while 45% (20/44) had a probable diagnosis of sarcopenia and 39% (17/44) met diagnostic criteria for sarcopenia. Risk of malnutrition was more commonly observed in those patients with a CFS score ≥4 (94% vs. 75%), as was risk of sarcopenia (81% vs. 17%). Fifty percent (22/44) of all patients screened positive for suspicion of both frailty and sarcopenia (frailty score≥4 and Sarc-F score≥4). Patients with a probable diagnosis of sarcopenia and concomitant frailty had more ED attendances, falls and longer lengths of stay. Conclusion Frailty, malnutrition and sarcopenia are frequently observed in older patients in the acute setting. The integration of screening measures for malnutrition, frailty and sarcopenia in clinical practice can facilitate the identification of patients for multi-component targeted interventions.

Association between Dysphagia and Frailty in Community Dwelling Older Adults.

Dysphagia is described as a geriatric syndrome that occurs more frequently with aging. It is associated with the deterioration in functionality however, it is usually ignored. Frailty is a geriatric syndrome that is recognized more with its well-known adverse consequences. Very recently, dysphagia has been suggested to accompany frailty in older adults. We aimed to investigate the association between dysphagia and frailty in the community dwelling older adults. Prospective, cross-sectional study. Geriatric outpatient clinic. Older adults aged ≥60 years. Dysphagia was evaluated by EAT-10 questionnaire and frailty by FRAIL scale. Handgrip strength (HGS) was evaluated by hand-dynamometer. Gait speed was evaluated by 4-meter usual gait speed (UGS). Nutritional status was assessed by mini-nutritional assessment-short form (MNA-SF). 1138 patients were enrolled. Mean age was 74.1±7.3 years. EAT-10 questionnaire was answered by all and FRAIL-scale by 851 subjects. EAT-10 score >15 points was regarded as significant dysphagia risk. The participants with EAT-10>15 points were older when compared to the participants with EAT-10<=15 points (p=0.002). Among participants with EAT-10>15 points, women gender and neurodegenerative diseases were more prevalent (p=0.04, p=0.002; respectively); number of chronic diseases, number of drugs and FRAIL score were higher (p=0.001 for each), and HGS, UGS, MNA-SF scores were lower (p=0.002, p=0.01, p<0.001; respectively). In multivariate analyses, the factors independently associated with presence of EAT-10 score>15 were FRAIL score and the number of drugs. Dysphagia is associated with frailty irrespective to age, presence of neurodegenerative diseases, number of chronic diseases and drugs. To our knowledge, this is the largest serie in the literature providing data on independent association of dysphagia with frailty.

The Eating Experience: Adaptive and Maladaptive Strategies of Older Adults with Tooth Loss.

To explore the eating experience and eating-related quality of life (ERQOL) of community-dwelling older adults with tooth loss. Nineteen older adults from the clinics of a northeast US dental school who met inclusion criteria (>65 y old, <20 teeth, and no dentures) composed the sample. For this mixed methods study, demographic characteristics, number and location of teeth, Mini Nutritional Assessment-Short Form score, and anthropometrics data were collected; semistructured interviews were conducted to collect in-depth information about the eating experience and ERQOL. Thematic analysis was completed with NVivo 12 software (QSR International). Participants' mean age was 71.3 y (SD = 5.2); 52.6% (n = 10) were women; 63.2% (n = 12) were Black or African American. The mean Mini Nutritional Assessment-Short Form score of 12.1 was reflective of normal nutrition status; 31.6% (n = 6) of patients were at risk for malnutrition or were malnourished. Fifteen percent (n = 3) were fully edentulous; 84.2% (n = 16) had 1 to 19 teeth (mean = 10.8, SD = 6.5). The 2 overarching themes identified were adaptive and maladaptive behavioral responses to tooth loss. Adaptive strategies included modification in food preparation and cooking methods, food texture selection, meal timing, and approaches to chewing. Maladaptive behaviors included food avoidance and limiting eating and smiling in front of others. Psychosocial factors, including finances, limited food choices and ERQOL, whereas the support of family and friends enhanced ERQOL according to participants. Older adults with tooth loss exhibit both adaptive and maladaptive behaviors that affect their eating experience, dietary intake, and ERQOL. While many expressed positive adaptive coping strategies, they also described maladaptive behaviors, including avoidance of healthy foods and limiting eating during social interactions, which may affect their nutritional status and overall health and well-being. Further research is needed to explore how duration and severity of tooth loss influence these behaviors and risk of malnutrition. Interprofessional approaches are needed to support positive adaptation and coping with tooth loss. The results of this study can be used by health professionals treating patients with tooth loss in an effort to improve their eating experience and eating-related quality of life. The findings provide data to support further studies and the need for evidence-based guidelines and educational materials to meet the unique needs of older adults with tooth loss.

Influence of Antipsychotics on Functional Prognosis after Geriatric Hip Fracture.

To investigated the effects of antipsychotics on rehabilitation outcomes for geriatric hip fracture inpatients. Retrospective cohort study. The registry data from the Japan Rehabilitation Nutrition Database for analysis. Of the 234 patients in the Japan Rehabilitation Nutrition Database admitted between November 2015 and March 2018, 214 met the eligibility criteria. The antipsychotics were phenothiazine, butyrophenone, benzamide, and atypical antipsychotics. For hip fracture patients, the following information was registered: (a) admission data: age, sex, Charlson Comorbidity Index, Functional Independence Measure (FIM) at admission, medications, height, body weight, and Mini Nutritional Assessment-Short Form score (MNA-SF) and (b) discharge data: discharge destination, FIM at discharge, MNA-SF, and total units of provided rehabilitation therapy (one unit = 20 minutes based on the national healthcare insurance policy). Thirteen patients (6.1%) were prescribed antipsychotics. According to the multiple linear regression analysis, antipsychotics negatively affected FIM efficiency (β=-0.190, 95% confidence interval, -0.652 to -0.104, p=0.007). Furthermore, on logistic regression analysis, fall during hospitalization was correlated with the use of antipsychotics (odds ratio=4.376, 95% confidence interval: 1.153 to 16.612, p=0.030). The use of antipsychotics impaired the improvement of the activities of daily living (ADL) and increased the incidence of fall during hospitalization. Reviewing medication therapies at admission may further improve ADL.

Changes in the nutritional statuses of edentulous elderly patients after new denture fabrication with and without providing simple dietary advice

PurposeProviding appropriate dental prostheses and dietary interventions may improve food and nutrient intake in elderly edentulous patients, but evidence to support their use is scarce. In this trial, we aimed to clarify the combined effect, on the nutritional statuses of edentulous elderly patients, of dentists providing complete dentures with dietary advice. MethodsA randomized-controlled trial was performed on a healthy elderly population who required new complete dentures. All participants had new complete dentures fabricated and were randomly divided into an intervention or a control group. The intervention group received simple dietary advice through standardized patient information leaflets and the control group received advice on denture care only. Nutritional status was assessed using the Mini Nutritional Assessment short-form (MNA-SF) before and at 3 and 6months after treatment. At each assessment point, the MNA-SF scores were compared using the Mann–Whitney U test. The within-group differences in the MNA-SF scores were analyzed using the Wilcoxon signed-rank test with Bonferroni correction. ResultsIn total, 59 participants completed all trial steps. At 6months after treatment, the MNA-SF score in the intervention group was significantly higher than that in the control group (p=0.01). Comparing the within-group changes in the MNA-SF score revealed that the score increased significantly from 3 to 6months in the intervention group (p=0.001, Bonferroni correction). ConclusionsNutritional statuses of healthy edentulous elderly population might be improved by fabricating new complete dentures and providing simple dietary advice.

FACTORS ASSOCIATED WITH DIMINISHED COUGH INTENSITY IN COMMUNITY-DWELLING ELDERLY USING DAY CARE SERVICES: A PILOT STUDY

Purpose: We investigated factors affecting diminished cough intensity in community-dwelling elderly using day care services. Participants and Methods: A total of 61 elderly males and females aged ≥65 years who were certified to receive long-term adult day care services were enrolled in this study. Assessments included: Cough intensity (assessed using cough peak flow measurements, as well as possible determinants of cough intensity, lifestyle, and demographic characteristics), nutritional status (using the Mini Nutritional Assessment-Short Form), dietary intake (using the Dietary Variety Score), routine activity (using the Japanese version of the International Physical Activity Questionnaire), care-related factors (including day care services utilization and an oral exercise regimen) as well as age, need for long-term care, gender, sarcopenia status, the Charlson Comorbidity Index, and body mass, limb skeletal mass, and respiratory indices. Results: A reduced cough peak flow (odds ratio 4.46, 95% confidence interval: 1.08–18.43) was associated with sarcopenia and was weakly (not significantly) associated with age, gender, and the Mini Nutritional Assessment-Short Form score. Conclusion: A reduced cough peak flow was independently associated with sarcopenia and associated with age, gender, and nutritional status.

Relating the MNA Mobility Single Item to Usual Walking Speed in Hospitalized and Community-Dwelling Geriatric Patients.

Usual walking speed (WS) is a relatively easy and reproducible tool for detecting mobility impairment. For some reasons, however, geriatric patients might not be able to perform walking tests. Therefore, a subjective assessment could be an alternative method to screen for mobility impairment. In the present paper, we explore the use of the mobility item from the Mini Nutritional Assessment-short form (MNA-sf) to assess mobility and its congruence with walking speed in hospitalized and ambulatory patients. We analyzed retrospective data from 357 patients and found a highly significant correlation between WS and the MNA-sf mobility item. After dichotomization of the MNA-sf mobility score (mobility impairment ≤1 and no impairment >1), AUC for ROC curves showed that the mobility item derived from the MNA-sf reflects fairly well the mobility of geriatric hospitalized patients (AUC = 0.773), while it performs better in ambulatory patients (AUC = 0.838).

Relationship between nutritional status and frailty in hospitalized older patients.

ObjectiveThe definition of frailty still lacks quantitative biomarkers. This study aimed to investigate the relationship between nutrition-related biomarkers and frailty in hospitalized older patients.Materials and methodsThis is a cross-sectional study including 380 hospitalized older patients. The patients were categorized as nonfrail (n=140), prefrail (n=81), and frail (n=159) by the criteria of frailty phenotype. The nutritional status was assessed using the mini nutritional assessment-short form (MNA-SF), levels of serum transferrin (TNF), prealbumin (PA), total protein (TP), albumin (ALB), retinol-binding protein (RBP), and hemoglobin (Hb).ResultsThe grip strength, levels of serum TFN, TP, ALB, Hb, and MNA-SF scores all decreased significantly in the order of nonfrail, prefrail, and frail groups (P<0.01). Older ages, more fall incidents, and higher polypharmacy ratio were observed in the frail and prefrail groups than in the nonfrail group (P<0.05). Univariate logistic regression analysis showed that frailty was positively related to age, polypharmacy, fall history, nutritional status, levels of TFN, PA, TP, ALB, RBP, and Hb, but was negatively related to grip strength. Ordinal logistic regression analysis showed that older patients who were well nourished, with higher levels of TFN, TP, and ALB were less likely to develop into frailty.ConclusionHospitalized older patients with better nutritional status and higher levels of TFN, TP, and ALB were less likely to develop into frailty. These nutrition-related biomarkers may be used for the evaluation of nutritional status and frailty in older patients.

Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients.

The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA). To verify the association of SPPB and POMA scores with falls in older outpatients. 451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller. 245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores. SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.

Malnutrition risk and perception on dietary practices among elderly living in agricultural settlements

PurposeThis research aims to identify malnutrition risk and perception of malnourished and at-risk elderly individuals on their dietary practices.Design/methodology/approachIn Phase 1, a cross-sectional study was conducted among 413 elderly individuals aged 60 years and above in agricultural settlements in Kuantan, Pahang, Malaysia. Malnutrition risk was assessed using the Mini Nutritional Assessment Short-Form (MNA-SF). In Phase 2, in-depth semi-structured interviews were conducted among 21 elderly individuals identified in Phase 1. The interviews ceased when data saturation was achieved.Findings25.7 per cent (n = 106) of elderly individuals were identified as malnourished and at-risk (MNA-SF score = <12). Age, smoking, income and living status were significantly associated with malnutrition risk (p < 0.05). Thematic analysis revealed four themes that represent elderly individuals’ perception on their dietary practices: the impact of aging on dietary intake; food restriction according to health condition; poor dietary intake due to feeling of loneliness; and perceived benefits of foods for health.Research limitations/implicationsStrategies from multidisciplinary healthcare professionals to eliminate improper dietary practice are required for the maintenance of health, functional independence and quality of life among the elderly.Originality/valueThis research is at the forefront in reporting the elderly individuals’ perception on dietary practice in agricultural settlement. Attention to individual’s health issues and the associated factors that may influence their dietary practices is essential to provide appropriate interventions to achieve optimum nutritional status and healthy aging.

Malnutrition and Mortality in Frail and Non-Frail Older Adults Undergoing Aortic Valve Replacement.

Older adults undergoing aortic valve replacement (AVR) are at risk for malnutrition. The association between preprocedural nutritional status and midterm mortality has yet to be determined. The FRAILTY-AVR (Frailty in Aortic Valve Replacement) prospective multicenter cohort study was conducted between 2012 and 2017 in 14 centers in 3 countries. Patients ≥70 years of age who underwent transcatheter or surgical AVR were eligible. The Mini Nutritional Assessment-Short Form was assessed by trained observers preprocedure, with scores ≤7 of 14 considered malnourished and 8 to 11 of 14 considered at risk for malnutrition. The Short Performance Physical Battery was simultaneously assessed to measure physical frailty, with scores ≤5 of 12 considered severely frail and 6 to 8 of 12 considered mildly frail. The primary outcome was 1-year all-cause mortality, and the secondary outcome was 30-day composite mortality or major morbidity. Multivariable regression models were used to adjust for potential confounders. There were 1158 patients (727 transcatheter AVR and 431 surgical AVR), with 41.5% females, a mean age of 81.3 years, a mean body mass index of 27.5 kg/m2, and a mean Society of Thoracic Surgeons-Predicted Risk of Mortality of 5.1%. Overall, 8.7% of patients were classified as malnourished and 32.8% were at risk for malnutrition. Mini Nutritional Assessment-Short Form scores were modestly correlated with Short Performance Physical Battery scores (Spearman R=0.31, P<0.001). There were 126 deaths in the transcatheter AVR group (19.1 per 100 patient-years) and 30 deaths in the surgical AVR group (7.5 per 100 patient-years). Malnourished patients had a nearly 3-fold higher crude risk of 1-year mortality compared with those with normal nutritional status (28% versus 10%, P<0.001). After adjustment for frailty, Society of Thoracic Surgeons-Predicted Risk of Mortality, and procedure type, preprocedural nutritional status was a significant predictor of 1-year mortality (odds ratio, 1.08 per Mini Nutritional Assessment-Short Form point; 95% CI, 1.01-1.16) and of the 30-day composite safety end point (odds ratio, 1.06 per Mini Nutritional Assessment-Short Form point; 95% CI, 1.001-1.12). Preprocedural nutritional status is associated with mortality in older adults undergoing AVR. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable patients.

The impact of malnutrition on efficacy of resistance training in community-dwelling older adults.

Few studies have focused on the effect of resistance training under conditions of malnutrition in older adults requiring long-term care. The purpose of this study was to investigate the influence of nutritional status in older adults on resistance training-induced changes in physical performance. A total of 91 community-dwelling older adults participated in 24weeks of resistance training. Participants used the 60% of one repetition maximum for three sets of 10 repetitions for resistance training. Short Physical Performance Battery (SPPB), Mini Nutritional Assessment Short Form (MNA-SF), Barthel Index, and grip strength were measured before and after the resistance training. The participants were classified into three groups according to the MNA-SF score at baseline (0 to 7 as malnutrition group, 8 to 11 as at risk group, and 12 to 14 as well-nourished group). In comparing the preintervention and postintervention changes in functional fitness of the groups, there was a significant Group×Time interaction for SPPB scores (F=11.59, p<0.01), 4-m walk speed (F=5.87, p<0.01), and grip strength (F=3.27, p<0.05). Multivariate logistic regression analysis showed that well-nourished group was significantly more likely to improvement of physical function (odds ratio 3.08, 95% confidence interval [1.54, 6.15], p<0.01). The results of study revealed that malnutrition was an independent negative factor of effects of resistance training in older adults. These results suggested that effects of resistance training may be affected by the nutritional state.

Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis

Objectives: Sarcopenia is characterized by loss of muscle strength and mass, leading to falls and adverse health outcomes. Our aim was to determine the prevalence of sarcopenia in patients with rheumatoid arthritis (RA) and to identify factors associated with sarcopenia in these patients.Methods: A cross-sectional study of 388 consecutive women with RA was conducted, assessing muscle mass and strength, and walking speed. Falls and bone fractures sustained over the prior year were evaluated. The association between sarcopenia and RA characteristics, falls, and bone fractures was evaluated using logistic regression analyses.Results: The prevalence of sarcopenia was 37.1% (14.7%, severe sarcopenia; 22.4%, sarcopenia), with 49.0% classified as having low muscle mass. The incidence of falls, fractures, and lower bone mineral density was higher in patients with than without sarcopenia. Age, RA duration, Steinbrocker’s stage, the high Mini-Nutritional Assessment-Short Form score and the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) were independent factors associated with sarcopenia.Conclusion: We confirmed that sarcopenia develops in a significant proportion of patients with RA. Age, longer disease duration, joint destruction and malnutrition were positively associated with sarcopenia, with the use of bDMARDs being negatively associated.

A multicomponent frailty intervention for socioeconomically vulnerable older adults: a designed-delay study.

PurposeThe primary aim of this study was to evaluate the effectiveness of a 6-month multicomponent intervention on physical function in socioeconomically vulnerable older adults in rural communities. As secondary aims, we evaluated the effectiveness of the intervention on frailty and other geriatric syndromes, sustained benefit at 12 months, and baseline characteristics associated with poor response.Patients and methodsThis designed-delay study was conducted in 187 adults (mean age: 77 years; 75% women) who were living alone or on a low income in three rural regions of Korea. A 24-week multicomponent program that consisted of group exercise, nutritional supplementation, depression management, deprescribing medications, and home hazard reduction was implemented with a planned 6-month interval from August 2015 through January 2017. The primary outcome was physical function, measured using the Short Physical Performance Battery (SPPB) score (range: 0–12; minimum clinically important difference ≥1) at 6 months. Secondary outcomes included frailty phenotype, sarcopenia, Mini Nutritional Assessment-Short Form score (range: 0–14), Center for Epidemiologic Studies-Depression Scale score (range: 0–60), and falls.ResultsAt 6 months, the SPPB score increased by 3.18 points (95% CI: 2.89, 3.48) from baseline. The program improved frailty (odds ratio: 0.06; 95% CI: 0.02, 0.16), sarcopenia (odds ratio: 0.32; 95% CI: 0.15, 0.68), Mini Nutritional Assessment-Short Form score by 1.67 points (95% CI: 1.28, 2.06), and Center for Epidemiologic Studies-Depression Scale score by −3.83 points (95% CI: −5.26, −2.39), except for fall (rate ratio: 0.99; 95% CI: 0.69, 1.43). These beneficial effects were sustained at 12 months. Body mass index ≥27 kg/m2 and instrumental activities of daily living disability at baseline were associated with poor improvement in the SPPB score.ConclusionThis 24-week multicomponent program had sustained beneficial effects up to 1 year on physical function, frailty, sarcopenia, depressive symptoms, and nutritional status in socioeconomically vulnerable older adults in rural communities. (ClinicalTrials.gov, NCT 02554994)

The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients.

One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients' quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD). The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients' data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded. Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001). The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.

Correlation of nutritional status in elderly patients with Alzheimer disease and self-efficacy of their caregivers

Objective To investigate the correlation between nutritional status in elderly patients with Alzheimer disease (AD) and self-efficacy of their caregivers. Methods Ninety-two elderly patients with AD and 92 their caregivers were enrolled from a Peking Union Medical College in Beijing from March to October 2017, who were evaluated by the mini nutritional assessment short form (MNA-SF) and the general self-efficacy scale (GSES) respectively for the nutritional status of the AD patients and the self-efficacy of their caregivers, and the correlation between them was analyzed. Results The average MNA-SF score of the AD patients was 7.8±2.5. The incidence of malnutrition risk and malnutrition were 34.8% and 27.2% respectively. The MNA-SF score of the AD patients decreased (F=4.589, P=0.009), and the incidence of malnutrition risk (χ2=7.319, P=0.026) and malnutrition (χ2=7.080, P=0.032) increased significantly with the aggravation of AD. The average self-efficacy score of the caregivers was 2.20±0.45. With the aggravation of AD, the GSES score of the caregivers decreased significantly (F=3.122, P=0.016). There was a positive correlation between the nutritional status of the AD patients and the self-efficacy of their caregivers (r=0.254, P=0.022). Conclusion The nutritional status in elderly patients with AD is positively correlated with the self-efficacy of their caregivers, that is, the higher GSES score of the caregiver is, the better nutritional status of the AD patient has. Key words: Alzheimer disease; Elderly patient; Nutritional status; Caregiver; Self-efficacy