Nutrition Screening Initiative Research Articles

Adequacy of Nutrient Intake and Malnutrition Risk in Older Adults: Findings from the Diet and Healthy Aging Cohort Study.

There is a lack of data on the adequacy of nutrient intake and prevalence of malnutrition risk in Asian populations. The aim was to report on the nutrient intake and prevalence of malnutrition risk in a community sample of older adults in Singapore. Analysis was performed on 738 (n = 206 male, n = 532 male, aged 67.6 ± 6.0 years) adults 60 years and above. Intakes of macro- and micronutrients were evaluated against the Recommended Dietary Allowances (RDAs). Malnutrition risk was assessed using the Nutrition Screening Initiative Determine Your Nutritional Health checklist. It was found that 90.5% older adults exceeded the sugar intake, 68.5% males and 57.1% females exceeded the intake limit for saturated fat, and 33% males had inadequate dietary fiber intake when compared to the RDAs. Inadequate dietary calcium intake was found in 49.5% males and 55.3% females. There were 22.3% of older adults at moderate to high malnutrition risk. Singaporean older adults need to reduce their dietary intakes of sugar and saturated fat and increase their intakes in dietary fiber and calcium. Current findings provide public health awareness on the importance of healthy eating and will facilitate decision making by health promotors to deliver targeted nutrition care programs.

Investigation on the 3-Step Procedure of Nutritional Screening, Evaluation, and GLIM Diagnosis for Elderly Inpatients

This study investigated a 3-step procedure of nutritional risk screening, evaluation, and Global Leadership Initiative on Malnutrition (GLIM) diagnosis for Chinese elderly inpatients. Nutritional risk screening was performed as the first step using the Nutritional Risk Screening 2002 (NRS2002). Nutritional status evaluation was performed as the second step using the Mini-Nutritional Assessment Short Form (MNA-SF). Malnutrition diagnosis was performed as the third step using the GLIM criteria. The consistency of these tools and the validity of the GLIM criteria were proven. Fewer patients met the GLIM criteria compared with the NRS2002. Good correlations between malnutrition and frailty or sarcopenia were discovered.

Nutritional Screening and Physical Activity Status Assessment in Elderly: Comparison of Nutritional Screening Initiative (NSI), Short Nutritional Assessment Questionnaire (SNAQ), the Mini Nutritional Assessment (MNA)

Nutritional Screening and Physical Activity Status Assessment in Elderly: Comparison of Nutritional Screening Initiative (NSI), Short Nutritional Assessment Questionnaire (SNAQ), the Mini Nutritional Assessment (MNA)

Associations of Inflammatory, Metabolic, Malnutrition, and Frailty Indexes with Multimorbidity Incidence and Progression, and Mortality Impact: Singapore Longitudinal Aging Study

Introduction: The detection of systemic risk factors aids in the formulation of strategies to prevent multimorbidity and its associated mortality impact. We aimed to determine the associations of inflammatory, metabolic, malnutrition, and frailty indexes with multimorbidity onset and progression and their predictions of multimorbidity-associated mortality risk. Methods: A prospective cohort study (Singapore Longitudinal Aging Study [SLAS]) of 5,089 community-dwelling older adults aged ≥55 years in two waves of recruitment (SLAS-1: March 2005-September 2007, SLAS-2: January 2013-August 2018). Baseline variables included inflammatory (neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR)) and metabolic profiles (atherogenic index of plasma (AIP), triglyceride-glucose index of insulin resistance (TyG)), physical frailty, and nutritional risk (Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Screening Initiative (NSI), Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA)). At follow-up, 3–5 years after the baseline interview, incident multimorbidity (≥2 chronic diseases) was determined among multimorbidity-free participants (N = 1,657) and worsening multimorbidity (increase of ≥2 chronic diseases) among participants with baseline multimorbidity (N = 1,207). Mortality in all participants and those with multimorbidity (N = 2,291) was determined up to 31 December, 2016. Odds ratio (OR), hazard ratio (HR), and 95% confidence intervals (95% CI) were estimated in multivariate logistic and Cox regression models, in base model adjustments for age, sex, ethnicity, housing type, smoking, and a number of comorbidities, and further stepwise selection adjustment for other systemic risk indexes. Results: At baseline, NLR, LMR, AIP, TyG, physical frailty, ENIGMA, NSI, and MNA-SF were significantly associated with prevalent multimorbidity (p < 0.001). Among multimorbidity-free participants, LMR, TyG, and ENIGMA were significantly associated with incident multimorbidity in both the base model and further stepwise selection models: LMR (OR = 0.87, 95% CI: 0.81–0.94), TyG (OR = 1.36, 95% CI: 1.06–1.75), and ENIGMA (OR = 1.15, 95% CI: 1.02–1.30). Among participants with baseline multimorbidity, NLR, LMR, and TyG significantly predicted worsened multimorbidity at follow-up in base model analysis, and LMR (OR = 0.72, 95% CI: 0.60–0.86) and TyG (OR = 1.96, 95% CI: 1.24–3.09) remained as independent predictors in further stepwise selection models. Among participants with prevalent multimorbidity, NLR, TyG, frailty, MNA, and ENIGMA were significantly associated with mortality risk with base model adjustments and further stepwise selection models: NLR (HR = 1.20, 95% CI: 1.10–1.32), TyG (HR = 1.27, 95% CI: 1.04–1.54), frailty (HR = 1.22, 95% CI: 1.10–1.36), ENIGMA (HR = 1.13, 95% CI: 1.05–1.22), MNA (HR = 0.91, 95% CI: 0.85–0.97). A combined systemic risk index shows increasing quartiles, adjusted for age, sex, housing, and smoking status, significantly predicting mortality risk. Discussion/Conclusion: The onset and progression of multimorbidity and its mortality impact are driven by systemic factors, including inflammation, metabolic dysfunction (insulin resistance), malnutrition, and frailty. The measurement of these systemic factors using simple, inexpensive clinical and blood chemistry tools can help in strategies to prevent and reduce its mortality impact.

Nutritional risk and its relationship with physical function in community-dwelling older adults

BackgroundMalnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist (‘Determine Your Nutritional Health’, also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).MethodsParticipants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0–21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.ResultsIn the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5–85.7) years, were assessed. Almost half (47%) scored either ‘moderate’ (score 3–5) or ‘high’ (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: − 0.36, 95% CI (− 0.60, − 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.ConclusionCross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.

Effects of Nutritional Health Risk and Physical Activity on Depressive Symptoms in Older Adults

PURPOSE: This cross-sectional study examined the combined effects of nutritional health risk and physical activity on depressive symptoms in a representative sample of older adults aged 65 years and older (4,116 men and 5,154 women) from the 2020 Korea Longitudinal Study of Aging.METHODS: Nutritional health risk was categorized as good, moderate, and high according to the Nutrition Screening Initiative. Physical activity was assessed using a questionnaire. Depression was assessed using the Short Form of Geriatric Depression Scale (SGDS).RESULTS: There were significant age differences (p&lt;.001), education level (p&lt;.001), marital status (p&lt;.001), and SDGS (p&lt;.001) according to nutritional health risk or physical activity status. In particular, a general linear model (GLM) showed a significant interaction (R2=.239, F(2,9849)=5.582, p&lt;.004) between nutritional health risk and physical activity on SGDS-based depressive symptoms. The antidepressant effect of regular physical activity was observed in individuals with good or moderate nutritional health risks. However, such beneficial effects of physical activity were not observed in individuals with high nutritional health risks.CONCLUSIONS: The current findings of this study suggest that both good nutrition and physical activity for mental health should be emphasized in older adults, with a greater focus on nutrition for those with a high nutritional health risk.

Malnutrition Risk and Kidney Function and Decline in Community-Dwelling Older Adults

The association of malnutrition with chronic kidney disease (CKD) is well established. However, there is a paucity of studies of the effect of malnutrition risk (MR) on kidney function decline among older persons who do not have end-stage or dialyzable CKD. This study aimed to examine the association between MR status and kidney function, and future risks of kidney function decline and CKD progression in community-dwelling older adults. Nutrition Screening Initiative's DETERMINE Your Nutritional Health Checklist and estimated glomerular filtration rate (eGFR) were assessed at baseline among 5,122 participants free of end-stage renal failure or dialyzed CKD in the Singapore Longitudinal Aging Studies (SLAS-1 and SLAS-2). Follow-up eGFR was assessed in a subcohort of SLAS-2 participants without CKD (eGFR > 60mL/min/1.73m2) at baseline (N=786) who were followed up at 3-5years. In baseline cross-sectional analyses adjusting for other risk factors, low, moderate, and high MR was significantly associated with decreasing eGFR coefficients of -1.5, -3.3, and -5.0mL/min/1.73m2 respectively, and increasing CKD odds ratios of 1.81, 2.18, and 3.11 respectively. In longitudinal analysis, low, moderate, and high MR was significantly associated with increased risk of eGFR (>25%) decline (odds ratio of 2.37, 3.34, and 2.18 respectively). Among older adults without advanced kidney disease, MR is associated with poor kidney function and increased risk of kidney function decline and CKD. Preventive interventions to modify MR may help to reduce the deterioration of renal function in older people.

Functional health index of intrinsic capacity: multi-domain operationalisation and validation in the Singapore Longitudinal Ageing Study (SLAS2).

ad hoc approaches are used to create composite indexes of intrinsic capacity (IC) based on five domains recommended by the World Health Organization for healthy ageing. We examined how combinations of domain-specific measures determine measurement performances of composite IC indexes. in this population-based prospective cohort study, community-dwelling older persons (N = 2,906) aged 55 years and above were recruited. We used 12 domain-specific measures: cognition (Mini-Mental State Examination, MMSE), psychological (Geriatric Depression Scale, GDS), locomotion (Timed Up-and Go [TUG], GV, Knee Extension Strength, Performance Orientated Mobility Assessment), sensory (logarithm of the Minimum Angle of Resolution [LogMAR] vision and Whisper Test hearing) and vitality (forced expiratory volume in 1second pulmonary function, Elderly Nutritional Indicators for Geriatric Malnutrition Assessment [ENIGMA], Nutritional Screening Initiative) to derive 144 composite 2- to 5-domain functional health indexes (FHI), and evaluated their abilities to predict 9-year mortality and their associations with health determinants. with 5-domain FHI, TUG, logMAR and MMSE showed the largest factor loadings (0.65-0.75). All single-domain FHI were significantly associated with mortality risks. Area under the receiver operating characteristic curve (AUC) values of mortality prediction increased with the number of domains (from mean 0.615 for single-domain FHI to mean 0.705 for 5-domain FHI), but the difference between 3-domain versus 4-domain FHI (P = 0.082) or versus 5-domain FHI (P = 0.109) was not statistically significant. Highest AUCs (P < 0.001) of best performing FHI were single-domain TUG: 0.735; 2-domain TUG + ENIGMA: 0.743; 3-domain TUG + LogMAR + ENIGMA: 0.762; 4-domain TUG + MMSE + LogMAR + ENIGMA: 0.757; 5-domain TUG + MMSE + GDS + LogMAR + ENIGMA: 0.751. FHI showed excellent construct validity based on correlations with known health determinants. among Singaporean older adults, cognition, sensory and locomotion are predominant IC domains. A multi-domain IC index performs better with more domain measures, but a minimalist 3-domain index performs just as robustly as a 4- or 5-domain index.

Analysis of anthropometric indicators used in the nutritional assessment of active elderly in the city of Macaé, Rio de Janeiro, Brazil

Introduction: Body composition changes related to aging alter the capacity of predicting risk through anthropometric parameters. Objective: To discuss methodological aspects of anthropometry in active elderly based on associations between Body Mass Index (BMI) and other nutritional indicators. Methods: Cross-sectional study with active elderly from Macaé, Rio de Janeiro, Brazil (2014/2015). Nutritional status was described according to the BMI (Nutritional Screening Initiative, 1994). Linear regression analysis was performed: the outcome variable was BMI and the dependent ones were circumferences of waist, hip, neck, calf, arm and waist-to-hip ratio (WHR). Results: We assessed 173 people (55.5% female; median 71 years old). Calf and neck circumferences and WHR presented low R2 value. Among women, hip (R2=0.825) and waist circumferences (R2=0.729) individually explained much of the variation in BMI; and among men, waist (R2=0.759) and arm circumferences (R2=0.741) performed better. The cut-off points for waist circumference corresponding to the critical BMI value (27 kg/m2) were 87.9 and 96.8 cm, respectively for women and men. In multiple analysis, the association of waist, hip and arm circumferences with BMI remained significant. Conclusion: Circumferences traditionally used to assess adults had higher linear association with BMI than specific indicators for elderly people. The body composition of active elderly can be more similar to adults’ than that of elderly with other profiles. The waist circumference cut-off points established for adults may not be suitable for elderly populations. We suggest testing the cut-off points obtained by this study on other groups of active elderly.

Angiotensin receptor blockers use and changes in frailty, muscle mass, and function indexes: Singapore Longitudinal Ageing Study

AbstractBackgroundPre‐clinical studies suggest that renin–angiotensin system blockade may improve muscle function. Clinical reports of the effect of angiotensin converting enzyme inhibitors (ACEIs) on physical functioning are inconsistent. There are no reports of the effect of angiotensin receptor blockers (ARBs) treatment in older adults.MethodsWe analysed data of 1268 participants in the Singapore Longitudinal Ageing Study (SLAS‐2) who provided information on the use of ACEI, ARB, and other antihypertensive drugs at baseline and follow‐up (mean 4.5 years later). Baseline and follow‐up outcome measures were cumulated deficits frailty index (CD‐FI), physical phenotype frailty index (PP‐FI), calf circumference (CC), knee extension strength, composite muscle mass and strength (MMS) z‐score, and gait speed (GS). In primary analyses, we compared the use and non‐use of an anti‐hypertensive drug class among participants with hypertensive and cardiac disease, and secondarily with participants having other chronic diseases, and those who reported no chronic diseases. Multi‐variable analyses adjusted for socioeconomic status, body mass index ≥30, ≥5 comorbidities, ≥5 drugs use, other non‐ARB or non‐ACEI drugs (calcium channel blockers, beta blockers, or hydrochlorothiazide), MMSE &lt;23, Geriatric Depression Scale score, Nutrition Screening Initiative nutritional risk, physical activities, baseline frailty, and physical performance.ResultsAmong study participants, 7.8% (N = 99) were ARB users (62% used losartan), 11.7% (N = 148) were ACEI users (53% used enalapril), and 34.2% (N = 434) were users of other anti‐hypertensive drug classes. The cohort participants overall showed increases in the mean levels and changes in CD‐FI and PP‐FI and decreases in knee extension strength, GS, CC, and MMS. However, among groups, ARB users showed decreasing trends in CD‐FI and increasing trends of CC and MMS. Among participants with hypertensive and cardiovascular disease, there were significant differences in CD‐FI and PP‐FI changes, adjusted for confounding variables: ARB users compared with non‐users showed lesser declines in CD‐FI (0.013 vs. 0.028, P = 0.018) and PP‐FI (0.924 vs. 1.170, P = 0.017). ARB users also showed statistically significantly greater gains in MMS z‐scores: 0.329 vs. 0.076, P = 0.022. There was no association of ACEI or other anti‐hypertensive class use with changes in frailty, MMS, or GS.ConclusionsThe use of ARBs is associated with a reduction in frailty and age‐related loss of muscle mass and strength.

Eating Alone and Cognitive Decline in Korean Older Adults: A 3-Year Prospective Study.

BackgroundEating alone is a critical factor in nutritional risk screening among older adults. We investigated whether changes in eating status (eating alone or with others) in late-life affected cognitive decline in community-dwelling older adults. MethodsWe used data from the Survey of the Living Conditions and Welfare Needs of Korean Older Persons. Nutritional risk, including eating status, was assessed using seven questions from the Nutrition Screening Initiative checklist, and cognitive function was measured using the Mini-Mental State Examination (MMSE). On the basis of changes in eating status between baseline (2008) and the 3-year follow-up (2011), the subjects were divided into four groups: group 1 (eating with others at both surveys), group 2 (eating alone in 2008 and eating with others in 2011), group 3 (eating with others in 2008 and eating alone in 2011), and group 4 (eating alone at both surveys). Generalized linear models were used to compare the changes in MMSE scores over the 3-year period among the four groups. ResultsAmong older women, group 2 had the least decline in MMSE scores (-0.55±0.46), whereas group 3 had the greatest decline (-1.76±0.37) (p=0.034). We observed no difference in the change in MMSE scores among the four eating groups in older men. Conclusion Deprivation of mealtime partners in late life showed significant cognitive decline compared with gaining mealtime partners. Eating alone may be a risk factor for cognitive impairment; thus, meal programs reinforcing social integration might help preserve cognitive function.

Efficacy of malnutrition screening tools in China for elderly outpatients.

Malnutrition in elderly individuals is extremely common. In China, Nutritional Risk Screening 2002 (NRS-2002) is often used to assess malnutrition in hospitalized elderly patients, although a gold standard for elderly outpatients is lacking. The Nutrition Screening Initiative Checklist (NSI) and Malnutrition Screening Tool (MST) have seldom been validated in elderly outpatients. This open, parallel, multi-center, cross-sectional study evaluated the performance of NRS-2002, the NSI, and the MST in estimating malnutrition risk in elderly outpatients. This study included 986 elderly outpatients, with 53.2% being women, from five clinical teaching hospitals in Beijing. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the tools were estimated using a body mass index (BMI) of <18.5 kg/m2 as a reference. The mean (range) age of the patients was 69.6±6.8 (60-100) years. Overall, 4.3% had BMI <18.5 kg/m2, 16.8% scored ≥3 points in NRS-2002, 9.8% scored ≥2 points in the MST, and 37.0% scored ≥3 points in the NSI. NRS-2002 had the highest sensitivity and the best AUC (0.934 vs. 0.642 for the NSI and 0.660 for the MST, p<0.05), and the MST had the highest specificity. The sensitivity and specificity of the NSI were 0.64 and 0.64, respectively. NRS-2002 had the highest validity, and the MST had the highest specificity in estimating the risk of malnutrition in elderly outpatients. However, the accuracy of the NSI should be further verified with large samples.

Associations between Nutritional Risk and Mental Health in an Elderly Korean Population

Objective：Older adults are at greater risk for malnutrition than younger adults, and malnutrition can be associated with a variety of mental problems. This study was undertaken to investigate differences in mental health indicators according to nutritional risk administered to elderly people living in the community. Methods：Nutritional risk score was assessed using the ‘Determine Your Nutrition Health’ checklist, developed by the Nutritional Screening Initiative. The study enrolled 400 elderly people living in the community. Study subjects were divided into 3 groups based on their nutritional risk score: good nutrition (score ≤2; n=275), moderate nutritional risk (score 3-5; n=63), and high nutritional risk (score ≥6; n=62). The General Health Questionnaire-12 (GHQ-12), suicide risk screening tool, memory decline awareness, sleep disorder questionnaire, and health-related quality of life (EuroQoL-5 dimension, EQ-5D) were used to assess mental health problems. Statistical analyses were performed using chi-square test, analysis of variance, and Pearson correlation analysis. Results：In the high nutrition risk group, GHQ-12 score was highest. In the good nutrition group, subjective memory impairment score and sleep difficulty were lowest, and EQ-5D index was highest. The risk of suicide tended to increase with increasing nutritional risk. Nutritional risk score was significantly correlated with GHQ-12, subjective memory impairment, sleep latency time, total sleep duration, sleep difficulty, and EQ-5D index. Conclusion：This study confirms that nutritional risk in the elderly is related to various psychological symptoms and low quality of life. High nutritional risk in the elderly warrants clinical attention to mental health and quality of life.

Different Methods to Assess the Nutritional Status of Alzheimer Patients

Objective To assess the body composition and nutritional state of patients with Alzheimer’s (Global Deterioration Scale GDS-4) using different methods and to investigate the correlation among methods. Methods A total of 25 Alzheimer GDS-4 patients participated in this transversal descriptive observational study, which used anthropometry, Mini Nutritional Assessment (MNA), the Nutrition Screening Initiative Check List (NSI) and a 24-hour recall questionnaire (R24h). Results Anthropometric observations pointed to obesity in patients of both sexes. The MNA showed that 76% of the population was “at risk of malnutrition”, and the NSI suggested that 32% had a high nutritional risk, 48% had an “average” nutritional risk, and the remaining 20% a low nutritional risk. The Bland-Alman concordance plot between the NSI and MNA tests pointed to a high degree of agreement, meaning that both tests provided similar results for the group of studied subjects. The nutritional analysis, based on the Kruskal-Wallis test, showed there were significant differences between R24h and MNA in the case of ascorbic acid, iron, zinc and potassium (p < 0.05), and between R24h and NSI in the case of the double unsaturation index and vitamin D3 (p < 0.05). These results suggest that both questionnaires are equally valid for evaluating the nutritional status of Alzheimer patients. Conclusion Although the NSI and MNA tests provide similar results, we recommend an initial nutritional assessment using the NSI since it is short but provides information on any alteration in food intake as a result of restrictions and/or metabolic alterations.

Association between Falls and Nutritional Status of Community-Dwelling Elderly People in Korea.

BackgroundMalnutrition is a well-known risk factor of falls, although studies examining the association between nutritional status and falls are rare. We aimed to investigate the association between nutritional status and falls according to gender among Korean older adults.MethodsThe study included 10,675 participants (4,605 men and 6,070 women) aged 65 years and older and used data from the 2011 Survey of Living Conditions and Welfare Needs of Korean Older Persons. Nutritional status of the participants was assessed using the Nutritional Screening Initiative checklist, and the participants were categorized into the following groups: “good,” “moderate nutritional risk,” and “high nutritional risk.” Odds ratios (OR) of fall risk in the above groups based on gender were evaluated using multivariate logistic regression analyses.ResultsFallers in both genders showed significant association with older age, lower household income, inadequate exercise, and poor nutritional status compared with non-fallers. Considering the good nutritional status group as the reference group, the high nutritional risk group showed a higher risk of falls in men (OR, 1.59; 95% confidence interval [CI], 1.26–1.99); both moderate and high nutritional risk groups showed a higher risk of falls after adjusting for confounding factors in women (OR, 1.39; 95% CI, 1.19–1.62 and OR, 1.90; 95% CI, 1.61–2.24, respectively).ConclusionThe risk of falls was associated with poor nutritional status, and statistical significance of the association between nutritional status and falls was stronger in women than in men.

Assessment of Nutritional Status through Body Mass Index (BMI) among First Year Students of MBBS &amp; BSc Nursing Course of Government Medical Education Institutes in Dhaka

Context: Adequate knowledge about nutritional status of a community is necessary to have a comprehensive idea about its development process, as under-nutrition is one of the major health problems in developing countries. As an individual’s height and weight can be readily and inexpensively measured, body mass index (BMI) has become a popular heuristic approximation for body fatness in epidemiology and clinical practice. The BMI is the most common surrogate measure of obesity as well as nutritional assessment for individual. For this reasons an attempt has been taken to assess the nutritional status through the body mass index (BMI) among first year students of MBBS and B sc nursing course of government medical education institutes in Dhaka.&#x0D; Material and Methods: This descriptive type of analytic study was conducted in the Anatomy Department of Dhaka Medical College, Dhaka. The study sample was 177 individuals of first year students of MBBS and B.Sc nursing course admitted in the session of 2017-2018 in the Dhaka Medical College &amp; Dhaka Nursing College, Dhaka. Body Mass Index (BMI) was calculated as student’s weight in kilograms divided by the square of the student’s height in meters (kg/m2). The warning sign of poor nutritional health was calculated according to the checklist adapted by the Nutrition Screening Initiative, American Academy of Family Physicians July 2001. With the help of statistical software SPSS-20 comparisons between the two groups were done.&#x0D; Result: The mean (±SD) height (meter), weight (kg) and BMI of groups MBBS and B Sc nursing were 1.63±0.09, 61.65±11.22, 23.11±3.53 and 1.56±0.07, 49.05±9.42, 20.15±3.47 respectively. Good nutritional health status was found 61.80% in MBBS and 53.30% in B Sc nursing groups.&#x0D; Conclusion: The present study showed that the BMI of first year students of MBBS course is higher than first year students of B Sc nursing course.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 11-16

Long-term changes in nutritional status are associated with functional and mortality outcomes among community-living older adults.

Older adults who are malnourished are at high risk for adverse functional and mortality outcomes. The aim of this study was to assess the long-term changes in nutritional status among community-living older adults and their associations with adverse health outcomes. This was a population-based observational cohort study (Singapore Longitudinal Aging Study, SLAS 1), with a 4- to 5-y follow-up of 2075 community-living adults ≥60 y of age. Nutritional status (Mini Nutritional Assessment Short-Form [MNA-SF] and Nutritional Screening Initiative [NSI]), instrumental/basic activities of daily living (IADLs/ADLs) and quality of life (QoL) were assessed at both baseline and at the 4- to 5-y follow-up. The 10-y mortality was assessed from the date of 4- to 5-y follow-up to March 2017. Estimates of associations between changes in nutritional status and adverse health outcomes were analyzed using multinomial logistic regression or Cox proportional hazards regression, and indicated by odds ratios/hazard ratios (ORs/HRs) and 95% confidence intervals (CIs). Nutritional status was dynamic from baseline to the 4- to 5-y follow-up according to both MNA-SF and NSI. Compared with persistent normal nutrition, nutritional deterioration was associated with increased incident IADL/ADL disability (MNA-SF: OR, 3.22; 95% CI, 1.13-9.16), poor QoL (MNA-SF: OR, 4.53; 95% CI 2.13-9.64), and mortality (MNA-SF: HR, 4.76; 95% CI, 2.82-8.03; NSI: HR, 1.99; 95% CI, 1.27-3.14); nutritional improvement was associated with decreased incident IADL/ADL disability (NSI: OR, 0.17; 95% CI, 0.05-0.59); persistent poor nutrition (MNA-SF at risk/malnourished or NSI moderate/high nutritional risk) was associated with elevated incidence of poor QoL (MNA-SF: OR, 1.92,; 95% CI, 1.05-3.52; NSI: OR, 2.31; 95% CI, 1.19-4.49) and mortality (MNA-SF: HR, 2.57; 95% CI, 1.59-4.15; NSI: HR 1.97; 95% CI, 1.17-3.32). Compared with persistent poor nutrition, nutritional improvement was also associated with decreased incidence of mortality (MNA-SF: HR, 0.43; 95% CI, 0.23-0.80). Changes in nutritional status are associated with adverse health outcomes, and should be monitored with simple screening tools to identify older adults at high risk for adverse functional and mortality outcomes for selective nutritional interventions.

Multicenter Cross-sectional Community-based Nutrition Risk Screening in 3885 Chinese Elderly Adults

Objective To evaluate the nutrition risks in Chinese elderly adults in community and provide the basis for malnutrition prevention.Methods The study population comprised of adults aged 60 years or older selected from communities. A stratified multi-stage cluster sampling method was used to investigate older adults in rural and urban areas with structured questionnaire. Nutrition Screening Initiative (NSI) checklist was used to screen nutritional status. Analyses were stratified according to age,gender,different regions,rural and urban areas,and income.Results A total of 3885 older adults with complete information were enrolled for final analyses,among whom 1894 (48.8%) were males and 1991 (51.2%) were females; 56.2% aged 60-69 years,28.8% aged 70-79 years,and 15% aged over 80 years; 1665(42.9%) were urban residents; 1592(41.0%) were in the eastern region,1211(31.2%) in the central region,and 1082(27.8%) in the western region. Up to 48.4% of the elderly adults were at high nutritional risk,and the nutritional risk was significantly higher in females (50.7%) than in males (46.0%),in individuals aged over 80 years (53.0%) than in other age groups,in urban area (41.7%) than in rural area (53.9%),and in eastern region (52.9%) than in other regions. Significant differences were found between nutritional status and the following variables: age (Χ 2=33.7,P=0.000),gender (Χ 2=15.7,P=0.000),different regions (Χ 2=72.0,P=0.000),rural and urban areas (Χ 2=69.4,P=0.000),income (Χ 2=304.9,P=0.000),and living arrangement (Χ 2=128.1,P=0.000).Conclusion Elder adults in community are at high nutritional risk.

Association of Frailty and Malnutrition With Long-term Functional and Mortality Outcomes Among Community-Dwelling Older Adults

Physical frailty and malnutrition are prevalent among older adults and may be associated with functional and mortality outcomes. To assess the health outcomes associated with physical frailty and malnutrition singly and in combination among older adults. Population-based cohort study (Singapore Longitudinal Aging Study 1). Included were 2804 community-dwelling adults in Singapore aged 55 years or older at baseline (September 1, 2003, to December 23, 2005), with 2 follow-ups at 2- to 3-year intervals (from March 7, 2005, to September 10, 2007, and from November 13, 2007, to December 12, 2009) and a 12-year mortality follow-up to March 31, 2017. Data analysis was from July 1 to September 28, 2017. Baseline physical frailty (Fried criteria) with participants categorized according to the total score as frail (3-5 points), prefrail (1-2 points), or robust (0 point), and nutritional status (Nutrition Screening Initiative DETERMINE Your Nutritional Health Checklist and Mini Nutritional Assessment Short-Form [MNA-SF]). Baseline (prevalent) and follow-up (incident) instrumental/basic activities of daily living (IADL/ADL) disability, poor quality of life (QOL), and mortality were measured. Estimates of association were by odds ratios (ORs) and hazard ratios (HRs) and their 95% CIs. The participants (mean [SD] age, 66.0 [7.7] years; 1033 [36.8%] male; 2611 [93.1%] Chinese) included 1021 (37.6%) categorized as robust with MNA-SF normal nutrition (R-NN), 330 (12.2%) robust with MNA-SF at risk/malnourished (R-ARM), 734 (27.0%) prefrail/frail with MNA-SF normal nutrition (PFF-NN), and 631 (23.2%) prefrail/frail with MNA-SF at risk/malnourished (PFF-ARM). Among these 2804 participants, 44 had missing frailty status, and 78 had missing MNA-SF nutritional status; therefore, 88 participants in total had missing frailty-nutritional status. In cross-sectional analyses, the prevalence of IADL/ADL disability was lowest among the R-NN group (169 [16.9%]) and increased substantially only among the PFF-ARM group (249 [40.2%]) (OR, 1.88; 95% CI, 1.40-2.53). Poor QOL prevalence was lowest among the R-NN group (142 [14.1%]), and the increase in other frailty and nutritional status groups was highest in the PFF-ARM group (255 [41.3%]) (OR, 2.61; 95% CI, 1.96-3.49). In longitudinal analyses, significant association with only incident poor QOL across frailty and nutritional status groups was highest in the PFF-ARM group (89 [34.8%]) compared with the R-NN group (132 [19.2%]) (OR, 1.70; 95% CI, 1.17-2.48). The mortality rate was lowest in the R-NN group (0.54 per 100 person-years) and highest in the PFF-ARM group (3.04 per 100 person-years) (HR, 1.72; 95% CI, 1.01-2.92). The results based on the Nutrition Screening Initiative measure of nutritional status were similar. Reported adverse health outcomes attributed to poor nutrition often appear more likely to be associated with physical frailty. Prefrail/frail older persons with poor nutrition might be targeted for interventions to prevent or delay adverse functional and mortality outcomes.

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas.

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months. This study used a pre-posttest study design, with data collected before and after 3 months of HDM services. Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas. Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months. The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month. After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk. Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.