Nutritional Impairments Research Articles

Predicting frailty domain impairments and mortality with the Hospital Frailty Risk Score among older adults with cancer: the ELCAPA-EDS cohort study.

Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark. This retrospective, linkage-based study included patients aged ≥70years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016-2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10days, 30-day readmission, and mortality. Among 587 patients included (median age 82years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS>5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment. Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains.

Association of intrinsic capacity and medication non-adherence among older adults with non-communicable diseases in Taiwan

ObjectivesMedication non-adherence among older adults with non-communicable diseases (NCDs) remains prevalent worldwide, which causes hospitalization and mortality. Our study aimed to examine the association of medication non-adherence with level of overall intrinsic capacity (IC), pattern of IC, and specific IC component among older adults with NCDs. MethodsA cross-sectional questionnaire-based survey of 1268 older adults aged 60 years and above was conducted in 2022 in southern Taiwan. Among them, 894 suffered from 1 more NCD were included in this study. The Integrated Care for Older People Screening Tool for Taiwanese and the Adherence to Refills and Medication Scale were used to assess IC and medication non-adherence, respectively. Latent class analysis (LCA) was used to identify patterns of IC impairment, and binary logistic regression was used to assess the association between medication non-adherence and IC. ResultsOlder adults in the moderate (score: 1–2) or low (score≧3) overall IC groups were more likely to experience medication non-adherence (moderate: adjusted odds ratio (aOR) 1.57 [95% CI: 1.05–2.36]; low: 2.26 [1.40–3.67]). The “physical and nutritional impairments accompanied by depressive symptoms” group was associated with statistically higher odds of medication non-adherence (aOR 1.66 [1.01–2.73]). Older adults with cognitive impairment, hearing loss, or depressive symptoms showed greater likelihood of medication non-adherence (cognitive impairment: aOR 1.53 [1.03–2.27]; hearing loss: aOR 1.57 [1.03–2.37]; depressive symptoms: aOR 1.81 [1.17–2.80]). ConclusionsIntervention for improving medication non-adherence among older adults with NCDs should consider IC.

Supplementation of Micro- and Macronutrients-A Role of Nutritional Status in Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is a condition in which the pathological cumulation of fat with coexisting inflammation and damage of hepatic cells leads to progressive dysfunctions of the liver. Except for the commonly well-known major causes of NAFLD such as obesity, dyslipidemia, insulin resistance, or diabetes, an unbalanced diet and imbalanced nutritional status should also be taken into consideration. In this narrative review, we summarized the current knowledge regarding the micro- and macronutrient status of patients suffering from NAFLD considering various diets and supplementation of chosen supplements. We aimed to summarize the knowledge indicating which nutritional impairments may be associated with the onset and progression of NAFLD at the same time evaluating the potential therapy targets that could facilitate the healing process. Except for the above-mentioned objectives, one of the most important aspects of this review was to highlight the possible strategies for taking care of NAFLD patients taking into account the challenges and opportunities associated with the micronutrient status of the patients. The current research indicates that a supplementation of chosen vitamins (e.g., vitamin A, B complex, C, or D) as well as chosen elements such as zinc may alleviate the symptoms of NAFLD. However, there is still a lack of sufficient data regarding healthy ranges of dosages; thus, further research is of high importance in this matter.

Forecasting Seasonal Acute Malnutrition: Setting the Framework.

Malnutrition is an umbrella term that refers to an impairment in nutrition indicative of subsequently compromised human well-being. The term covers the full spectrum of nutritional impairments from a small yet detectable departure from a "norm" to a terminal stage when severe malnutrition could result in death. This broad spectrum of nutritional departures from "the optimum" dictates the need for an ensemble of metrics to capture the complexity of involved mechanisms, risk factors, precipitating events, short-term, and long-term consequences. Ideally, these metrics should be universally applicable to vulnerable populations, settings, ages, and times when people are most susceptible to malnutrition. We should be able to characterize and intervene to minimize the risk of malnutrition, especially child acute malnutrition that could be assessed by anthropometric measurements. The main challenge in reaching such an ambitious goal is the complexity of measuring, characterizing, explaining, predicting, and preventing malnutrition at any dimension: temporal or spatial and at any scale: a person or a group. The expansive body of literature has been accumulated on many temporal aspects of malnutrition and seasonal changes in nutritional (anthropometric) status. The research community is now shifting their attention to predictive modeling of child malnutrition and its importance for clinical and public health interventions. This communication aims to provide an overview of challenges for understanding child malnutrition from a perspective of predictive modeling focusing on well-documented seasonal variations in nutritional outcomes and exploring "the systems approach" to tackle underlining conceptual and practical complexities to forecast seasonal malnutrition in an accurate and timely manner. This generalized approach to forecasting seasonal malnutrition is then applied specifically to child acute malnutrition.

FTP5.2 Functional deficits in older patients undergoing major gastrointestinal surgery

Abstract Aim Gastrointestinal surgeons face an increasingly complex patient population. Patients are older, often with co-morbidities, frailty, nutritional, functional, and cognitive impairments. The aim of this study was to compare functional outcomes of a cohort of older patients following emergency and elective major gastrointestinal surgery. Methods A prospective cohort study in 3 NHS trusts was performed (NCT04545125). Baseline comprehensive assessment including quality of life, physical activity levels, functional, nutritional, and cognitive status was performed. Functional status (WHODAS v2, & Activities of Daily living questionnaire) and quality of life (EQ-5D-5L) were assessed at baseline, 6 weeks, 3 months, and 6 months following surgery. Results Ninety-eight patients were recruited; median age 74 years, 56% male. Eighty-two patients underwent elective surgery and 16 underwent emergency surgery. At baseline, 13.9% elective vs 68.8% emergency patients were considered vulnerable or frail on frailty testing; 35.9% elective vs 62.5% emergency were identified as malnourished or at risk of malnutrition. Emergency patients had lower Independent Activities of Daily Living score median 6 versus 8 (p=0.007). Baseline activity was lower in emergency patients compared to elective; 1,386 vs 3,882 MET minutes per week (p=0.06). Functional status and quality of life appeared to recover in elective patients by three months, however this was lower at baseline in emergency patients and this persisted over follow-up. Conclusion High levels of baseline functional, cognitive and nutritional deficits were found in this study. Whilst elective patients appear to recover within 3 months, emergency patients have persistent deficits in functional capacity and quality of life.

Hypoparathyroidism – management, information needs, and impact on daily living from the patients’ perspective: results from a population-based survey

PurposeHypoparathyriodism (hypoPT) is a rare endocrine disorder. It is not known how hypoPT is managed in Germany or whether patients have unmet information needs or impairments in their daily living.MethodsHypoPT patients at a minimum of 6 months’ post-diagnosis were invited to participate in an online survey through their treating physician or through patient organizations. An extensive questionnaire, which was developed and pilot-tested with hypoPT patients, was administered.ResultsA total of 264 patients with a mean age of 54.5 years (SD: 13.3), 85.2% female and 92% with postsurgical hypoPT, participated in the study. In total, 74% of the patients reported regular monitoring of serum calcium at least every 6 months, with lower control frequencies for phosphate (47%), magnesium (36%), creatinine (54%), and parathyroid hormone (50%), and 24-h urine calcium excretion (36%) on a yearly basis. Information on symptoms of hypo- and hypercalcemia was available in 72 and 45% of the patients. Information needs were related to the disease and its treatment as well as to nutrition, physical activities/sports, and support opportunities. Statistically significant differences for all information needs in association with symptom burden were observed. Hospitalization for hypocalcemia was reported by 32%, nutritional impairments (38%) or impact on work ability (52%) was available among patients with hypoPT.ConclusionHypoPT patients experience impairments in daily living and report unmet information needs. Patient and physician education regarding hypoPT is one of the key concepts for improving the management of patients with hypoPT.

Nutritional status and dietary diversity of pregnant and nonpregnant reproductive-age Rohingya women.

There are no data on the nutritional status and dietary diversity of the pregnant and nonpregnant reproductive-age Rohingya women who have recently shifted to the Bhasan Char Relocation Camp located on an island in the Bay of Bengal. A cross-sectional survey was conducted in November-December, 2021 to assess the nutritional status and evaluate the dietary diversity of two vulnerable groups of the forcibly displaced Rohingya population: nonpregnant reproductive-age women and pregnant mothers. Multivariable logistic regression was applied to identify the factors associated with nutritional impairments. Overall, 7.6% of the nonpregnant reproductive-age women were underweight (Body Mass Index [BMI] < 18.5 kg/m2), and nearly one-third of them had a BMI ≥ 25 kg/m2. However, 26.7% of the pregnant mothers were undernourished (BMI < 20.0 kg/m2) and almost one-fourth of them were either overweight or obese (BMI ≥ 25.0 kg/m2). The prevalence of thinness (Mid Upper Arm Circumference [MUAC] < 23 cm) was 34.5% among pregnant mothers, and 10.1% of them were severely thin (MUAC < 21 cm). The mean (±SD) of the Women's Dietary Diversity Score (WDDS) was 3.3 (±1.1) for nonpregnant reproductive-age women and 3.7 (±1.3) for pregnant mothers enrolled in this study. Overall, 63.8% of the nonpregnant women of childbearing age and 46% of the pregnant mothers had a low WDDS (WDDS < 4). The WDDS was found to be protective against thinness among nonpregnant reproductive-age women (AOR = 0.61; 95% CI = 0.37, 0.93; p-value = .03) and low BMI in pregnant mothers (AOR = 0.71; 95% CI = 0.55, 0.91; p-value = .01). The results of this survey will assist in early recognition of the nutritional demands, and act as a guide to planning nutrition-based programs among Rohingya reproductive-age women relocated to the Bhasan Char Island.

Malnutrition in Head and Neck Cancer: A Patient-reported Outcome Study.

Head and neck cancer (HNC) is associated with a high risk of malnutrition. Malnutrition is defined as acute weight loss greater than 5% and increases mortality 1.7-fold for HNC patients. The aim of the study was to investigate the social and nutritional impairments that patients face throughout cancer-survivorship. The study was conducted nationwide via the self-help network and in a single oncological center. We analysed 134 patient reported outcome (PRO) questionnaires with a mean age of 65.5±9.4 years, including 88 males, 36 females, and ten participants of undisclosed sex. The questionnaire contained 47 items enquiring about demography, weight development, and how treatment impaired nutrition. The patient data showed a weight loss of 8% after surgery, 13% after (chemo)radiotherapy [(C)RT] and a return to baseline weight in convalescence. However, patients with a baseline weight >100 kilogram (kg), had a 22% weight loss after (C)RT (p<0.0001) and this remained permanent at 11% (p=0.0041). Treatment-associated side-effects gradually decreased in the course compared to the time of treatment: loss of taste (55% to 21%), xerostomia (56% to 42%), dysphagia (57% to 43%), and dental problems (33%/ to 21%). (C)RT immediately led to more loss of taste (p=0.0461) and dysphagia (p=0.0334), and surgery as a singular modality scored the lowest odds ratio for side-effects. Social Impact: mood, supporting networks, and supplement satisfaction were rated "good" (Likert Scale). Malnutrition is common among HNC patients. High baseline weight and extensive multimodal treatment are important risk factors that require enhanced stewardship.

Evident lower blood levels of multiple nutritional compounds and highly prevalent malnutrition in sub-acute stroke patients with or without dysphagia.

Malnutrition is prevalent after stroke, particularly if post-stroke oropharyngeal dysphagia (OD) reduces nutritional intake. To further understand stroke-related malnutrition, a thorough nutritional assessment was performed in ischemic stroke patients with or without OD during sub-acute inpatient rehabilitation. In this exploratory, observational, cross-sectional, multi-center study in Germany (NTR6802), ischemic stroke patients with (N = 36) or without (N = 49) OD were age- and sex-matched to healthy reference subjects. Presence of (risk of) malnutrition (MNA-SF), blood concentration of stroke-relevant nutritional compounds and metabolites, nutritional intake, quality of life (EQ-5D-5L), and activities of daily living (Barthel index) were assessed. More than half of the stroke patients displayed (risk of) malnutrition, with higher prevalence in patient with OD vs. without OD. Fasted blood concentrations of vitamins B1, B2, B6, A, D, and E, selenium, choline, coenzyme Q10, albumin, pre-albumin, transferrin, docosahexaenoic acid, and eicosapentaenoic acid were all lower in stroke patients compared to their matched healthy reference subjects, irrespective of OD status. Reported energy, macronutrient, and water intake were lower in stroke patients vs. healthy reference subjects. As expected, quality of life and activities of daily living scores were lower in stroke vs. healthy reference subjects, with OD scoring worse than non-OD patients. This study shows that malnutrition is highly prevalent in sub-acute stroke patients during rehabilitation. Even though patients with OD were more likely to be malnourished, blood levels of specific nutritional compounds were similarly lower in stroke patients with or without OD compared to healthy reference subjects. Furthermore, subgroup analysis showed similarly lower blood levels of specific nutritional compounds in patients that are normal nourished vs. patients with (risk of) malnutrition. This might imply disease-specific changes in blood levels on top of overall protein-energy malnutrition. The results of the current study underline that it is important to screen for nutritional impairments in every stroke patient, either with or without OD.

The Role of Exercise Before Cancer Treatment

We aim to describe on the role of exercise in preparation for cancer treatments (prehabilitation) that include surgery and neoadjuvant or nonsurgical approaches. We discuss the evidence for the role of exercise and provide guidelines to exercise prescription and examples of the structure of prehabilitation exercise programs. We use peer-reviewed articles obtained through PubMed searches with search terms: exercise, oncology, cancer surgery, exercise physiology, respiratory exercises, prehabilitation, and behavior change. The emergence of prehabilitation in preparing patients for cancer care has followed a rapidly upward trajectory over the past 20 years. Exercise prehabilitation remains the cornerstone of management, particularly in patients attending for major surgery. Multimodal approaches to supporting patients before cancer treatment are now well accepted and include screening and individualized treatments of functional, nutritional, and psychological impairments. Respiratory training before surgery and the addition of behavior change strategies to improve adherence to interventions and promote improved longer-term outcomes are now included in many prehabilitation programs. For exercise to be an effective treatment in improving fitness and strength, supervised aerobic and resistance exercises at moderate intensity are recommended. There remains debate regarding the use of higher-intensity exercise, the appropriate outcome to measure efficacy, and the mechanisms driving the efficacy of exercise. We provide background evidence and knowledge pertaining to the role and provision of exercise prehabilitation. Understanding screening, risk factors, and potential efficacy assists in knowing who to refer for prehabilitation and what the programs include. This enables more effective com munication with patients attending for cancer treatments.

Novel protein-truncating variant in the APOB gene may protect from coronary artery disease and adverse cardiovascular events

Background and aimsGenetic testing is still rarely used for the diagnosis of dyslipidemia, even though gene variants determining plasma lipids levels are not uncommon. MethodsStarting from a a pilot-analysis of targeted Next Generation Sequencing (NGS) of 5 genes related to familial hypercholesterolemia (LDLR, APOB, PCSK9, HMGCR, APOE) within a cardiovascular cohort in subjects with extreme plasma concentrations of low-density lipoprotein (LDL) cholesterol, we discovered and characterized a novel point mutation in the APOB gene, which was associated with very low levels of apolipoprotein B (ApoB) and LDL cholesterol. ResultsAPOB c.6943 G > T induces a premature stop codon at the level of exon 26 in the APOB gene and generates a protein which has the 51% of the mass of the wild type ApoB-100 (ApoB-51), with a truncation at the level of residue 2315. The premature stop codon occurs after the one needed for the synthesis of ApoB-48, allowing chylomicron production at intestinal level and thus avoiding potential nutritional impairments. The heterozygous carrier of APOB c.6943G > T, despite a very high-risk profile encompassing all the traditional risk factors except for dyslipidemia, had normal coronary arteries by angiography and did not report any major adverse cardiovascular event during a 20-years follow-up, thereby obtaining advantage from the gene variant as regards protection against atherosclerosis, apparently without any metabolic retaliation. ConclusionsOur data support the use of targeted NGS in well-characterized clinical settings, as well as they indicate that.a partial block of ApoB production may be well tolerated and improve cardiovascular outcomes.

Effects of simulated nitrogen deposition on the nutritional and physiological status of beech forests at two climatic contrasting sites in Italy

Anthropogenic activities have resulted in a significant increase of reactive nitrogen (N)compounds in the atmosphere and a rise in N deposition on forest ecosystems. Increasing N loads impact forest productivity and health, altering tree physiological status and nutrient balance with possible beneficial and detrimental consequences. The impact of N deposition has received considerable attention by scientific research, covering medium and high latitudes, while experimental studies in the Mediterranean area are almost absent. The present study used a manipulative approach, through replicated N additions (background deposition, 30, 60 kg N ha−1yr−1) to simulate the cumulative effects of N deposition in two beech (Fagus sylvaticaL.) forests located in contrasting climatic regions of Italy. Leaf nutrients and photosynthetic pigments were tested as monitoring indicators after four years of N fertilization. Foliar N and pigment concentrations indicated not limiting N conditions at both forest sites, although changes in chlorophylls and carotenoids showed an early response of the canopy to N additions. N-to-phosphorus (P) and sulfur (S) ratios increased under elevated N fertilization, which could be partly related to the relative enhancement of foliar N concentration, and partly associated with the reduction of foliar P and S. The two eutrophic beech forests monitored were not severely affected by chronic N addition, not showing critical nutritional and physiological impairments over the short to medium period. However, the modifications in leaf nutrient and pigment compositions showed an incipient stress response and accentuated the differences induced by climatic and soil characteristics at the two sites. The potential use of nutrients and photosynthetic pigments in monitoring forest N deposition under contrasting climatic conditions and the eventual limits of manipulative experiments are discussed.

Geriatric impairments were directly and indirectly associated with mortality in older patients with cancer: a structural equation analysis

ObjectivesWe assessed the direct and indirect effects between six geriatric domains and 6- and 12-month mortality in older cancer patients. Study Design and SettingWe included cancer patients aged ≥70 years from the Elderly Cancer Patients cohort, referred for geriatric assessment between 2007 and 2016. We used structural equation modelling to examine the interrelationships between six geriatric domains (function and mobility, nutrition, cognition, mood, comorbidities and polypharmacy, and social support) and the direct and indirect relationships between these domains, the cancer stage, site, and treatment on the one hand and mortality on the other. ResultsThe analysis included 1,434 patients (mean age: 80 ± 5.6 years; women: 48%; main cancer sites: digestive tract [36.2%], urinary tract and prostate [26.6%], and breast [16.5%]; metastatic cancer: 48%). Direct relationships to 6- and 12-month mortality were identified for functional impairment (standardized coefficient [SC]: 0.37 [P < 0.001] and 0.32 [P < 0.001], respectively), poor nutritional status (SC: 0.11 [P = 0.005] and 0.14 [P = 0.001]), poor social support (SC = 0.07 [P = 0.08] and 0.09 [P = 0.02]), cancer site, stage, and treatment. The effects of comorbidities, cognitive impairment, and depression on mortality were mediated by functional and nutritional status. ConclusionIn older cancer patients, functional and nutritional impairments were the strongest direct prognostic geriatric factors for mortality.

Eye movement impairments in children with malnutrition.

Malnutrition is characterised by deficient nutrient ingestion and absorption and is still one of the most important causes of morbidity and mortality in children worldwide. Our main rationale was that protein-energy malnutrition (PEM) may affect eye movement in children with malnutrition. Twenty children without PEM (mean age=10.8; SD=1.0 years) and 18 children with PEM (mean age=10.9; SD=1.2 years) were included in the present study. We applied three types of tests: one that consisted of a maze and two versions of the Spot the Seven Errors test using boats and elephants. Our results indicated that children with PEM exhibited performance deficits in the maze test (p < .001) and Spot the Seven Errors test for both boats (p < .001) and elephants (p < .001). These data suggest that nutritional impairments during the first year of life (i.e., a critical period) can directly impact eye movement. Eye tracking is a reliable technique to investigate higher-order processes, but our results should be interpreted with caution. Our findings highlight the relevance of cognitive development in malnourished children, which can negatively affect their development. Screening, assessment and rehabilitation strategies are essential in this at-risk population.

Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus

Purpose International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool. Materials and Methods A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round. Results Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool. Conclusions Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed. Implications for Rehabilitation Dysphagia is an added complication following cervical spinal cord injury (cSCI) affecting morbidity, mortality and quality of life. Early identification of dysphagia risk allows focused interventions that reduce associated nutritional and respiratory impairments. Best practice recommendations based on expert consensus provide a baseline of appropriate interventions, in the absence of empirical evidence. A multi-professional approach to rehabilitation encourages a consistent and coordinated approach to care across acute and rehabilitation settings.

The nutritional needs of older cancer survivors

Older adults comprise a large proportion of cancer survivors, and older cancer survivors have distinct nutritional needs. Herein, we summarize nutritional needs of older cancer survivors, describe approaches to identify nutritional impairments, and provide guidelines for clinicians to address nutritional needs.

The Relationship between Nutritional Status and Body Composition with Clinical Parameters, Tumor Stage, CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors.

Recent studies have obtained inadequate data on the association between nutritional status, body composition, clinical parameters and tumor stage in patients withpancreatic and periampullary tumors. The purpose of this study was to assess the relationship between nutritional status (NS), body composition (BC) and selected clinical parameters in patients with pancreatic and periampullary cancer, as well as describe the differences between resection and non-resection groups. This is a prospective study of 76 patients with pancreatic and periampullary tumors. We evaluated NS, BMI, body mass loss (BML) and albumin, total protein, CRP, CEA, CA19-9, lipase, amylase, tumor stage, and BC using bioelectrical impedance (BIA). All subjects were divided into resection (n = 59) and non-resection (n = 17) groups. The non-resection group had a worse NS, as well as increased amylase and WBC, compared to the resection. The selected parameters of BC corresponded to BML albumin, TP, NS, age, BMI, Karnofsky, RBC, HCT and HGB. No associations were found between BC with tumor size, CRP, CA19-9, and CEA. We recorded the relationship between metastasis and NRS, as well as tumor size with SGA. The percentage of BML was positively correlated with age and CRP but negatively correlated with RBC, HGB, HCT and anthropometric measurements. We found many statistical correlations with NS and selected parameters, as well as differences between the resection and non-resection group. The detection of early prognostic factors of nutritional impairments would improve the quality of life and reduce the rate of postoperative complications.

Nutrition Knowledge Determinants among Undergraduate Students in Selected University in Jakarta

Malnutrition problem (under and over nutrition), known as the double burden of malnutrition, was a growing concern in developing countries, including Indonesia. The 2018 Indonesia Basic Health Survey noted a substantial increase in the proportion of these nutritional impairments. As a fundamental factor of malnutrition, nutritional knowledge was expected to be occupied not only by vulnerable groups. A transitional age group like youth, in this case undergraduate students, should also be on the radar since they carried a risk of malnutrition from adolescence into adulthood. This study aimed to assess the nutritional knowledge determinants among undergraduate students in Jakarta. This cross-sectional study was conducted among undergraduate students in Universitas Pembangunan Nasional Veteran Jakarta. The nutritional knowledge regarding the Indonesian Guideline for Balance Diet, as well as participants’ characteristics questionnaire, was self-administered online by 235 participants using Google Form. Chi-Square, Spearman’s rho, and logistics regression tests were used to analyze the data using statistical software. Students who participated in this study were primarily female, aged under 20 years, achieve a GPA above 3.50, and had normal BMI. The bivariate analysis reported a significant association between sex, study field, and parent’s income with nutrition knowledge level. Based on logistic regression, the odds of having an adequate nutrition knowledge level is about 2.76 times higher among students whose parents earned 3-5 million IDR per month than students whose parents earned less than 3 million or more than 5 million IDR. Undergraduate students were also a prominent target group to ensure nutritional knowledge occupancy since they may face adolescent nutritional problems and future risk of adult nutritional problems. This study is fostering targeted nutrition education for youth undergraduate students.

Functional Correlates of Malnutrition Among Older Patients in a Primary Care Clinic in Northern, Nigeria

Context: Nutritional and functional impairments are assumed to be inevitable consequences of aging and they attract little attention in the primary care setting. Aim: To determine the association between malnutrition and functional status of the elderly to advocate for their routine screening in the primary care clinics and similar settings. Settings and Design: A cross-sectional descriptive study involving 352 patients of age ≥60 years who presented at the Family Medicine Clinic. Methods and Materials: The nutritional status was assessed using the Mini Nutritional Assessment tool, whereas functional capacity was assessed using Katz and Lawton index for the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), respectively. Statistical Analysis: Chi-square test and logistic regression analysis were used to determine associations between variables and nutritional status, and determinants of nutritional status, respectively. Results: The mean age of respondents was 67.9 ± 7.6 (60–95) years; 215 (61.1%) were women. The prevalence of malnutrition was 25.9% and of risk of malnutrition 53.1%. Advancing age (odds ratio [OR] = 4.93, 95% confidence interval [CI] =1.42–1.71, P ≤ 0.001), low monthly income (OR = 9.29, 95% CI = 0.20–43.50, P = 0.005) and being functionally dependent (OR = 14.706, 95% CI = 1.26–3.35, P = 0.03 for ADL; OR = 17.51, 95% CI = 5.07–37.31, P = 0.004 for IADL) were the determinants of malnutrition in the elderly patients. Conclusion: The prevalence of malnutrition and those of at-risk of malnutrition was high. Advancing age, low income, and functional dependence were the independent correlates.

Association between nutritional and functional status indicators with caregivers' burden in Alzheimer's disease.

To investigate the association between nutritional and functional status of Alzheimer's disease patients and caregivers' burden. A cross-sectional study was conducted among 79 community-dwelling Alzheimer's disease patients living with their caregivers. Caregivers' burden was assessed using the Zarit Burden-Interview. Multinomial logistic regressions were carried out using caregivers' burden as the dependent variable. Caregivers' severe overload was strongly associated with weight loss of more than 3 kg during the previous 3 months (OR=7.34; 95% CI: 2.02-26.65), lower values of calf girth (OR=3.20; 95% CI: 1.03-9.93), sarcopenia status (OR=3.50; 95% CI: 1.09-11.22), and lower gait speed values (OR=3.83; 95% CI: 1.18-12.47). Otherwise, overweight or obesity (OR=0.21; 95% CI: 0.05-0.83), was related to lower odds of higher caregivers' burden. In community-dwelling older adults with Alzheimer's disease, the nutritional and functional status impairments were strongly associated with increasing caregivers' burden, whereas overweight conferred protection.