Risk For Protein-energy Malnutrition Research Articles

Effects of different levels of egg protein replacement in weaned diets on hematology, kidney functions, and immunity biomarkers.

Eggs are good sources of nutrients essential for the growth and development of infants. Introducing eggs as a weaning food can improve dietary adequacy in infants at risk for protein energy malnutrition (PEM). To evaluate the current objective, 72 pups (36 males and 36 females) were used to calculate the impact of various egg protein levels on blood parameters. Nonisonitrogenous and isocaloric pellet diets were offered to pups for 28 days using nine pups with three replicates according to a completely randomized design (CRD). The water intake and ad libitum diet were offered to weaned pups. The pups were randomly assigned to different concentrations of diet, which contained WF0, control diet, 14% of soybean protein; WF1, 14% of egg protein; WF2, 16% of egg protein; and WF3, 18% of egg protein, respectively. After weaning, the intraperitoneal injection with the drug (xylazine with ketamine) was used to anesthetize before killing on the 28th day. Blood samples were used to measure the blood metabolites. The results indicated that the concentration of red blood cells, white blood cells, serum triglycerides, and serum protein was significantly (p ≤ .05) increased in pups fed with high egg protein levels compared to the control. The highest platelet count was observed in the pups fed WF3 diet. In contrast, the amount of alanine aminotransferase and aspartate aminotransferase was significantly (p ≤ .05) reduced with increasing the level of egg protein in the diets of weaned pups. Immunity biomarkers (immunoglobulin A, immunoglobulin G, and immunoglobulin M) and kidney functions (creatinine and blood urine nitrogen) were nonsignificantly (p ≤ .05) increased in the pups fed a high level of protein due to a high biological value of soybean protein. Moreover, the concentration of immunoglobulin E in all pups remained unchanged. Egg protein in infant formula feed can be used for the growth and development of infants.

Effect of individually tailored nutritional counselling on protein and energy intake among older people receiving home care at risk of or having malnutrition: a non-randomised intervention study

BackgroundWith ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home care clients with PEM or at risk of developing PEM. The secondary aim was to study the intake of energy and other nutrients.MethodsThis intervention study is part of the non-randomised population-based multidisciplinary Nutrition, Oral Health and Medication study (NutOrMed study). The intervention group comprised 112 and the control group 87 home care clients (≥75 years) with PEM or risk of PEM. PEM was defined by Mini Nutritional Assessment score < 24 and/or plasma albumin < 35 g/L. The nutrients intake was assessed from 24-hour dietary recall at the baseline and after the six-month intervention. The intervention consisted of an individually tailored dietary counseling; the persons were instructed to increase their food intake with protein and energy dense food items, the number of meals and consumption of protein-, energy- and nutrient-rich snacks for six months.ResultsAfter the six-month nutritional intervention, the mean change in protein intake increased 0.04 g/kgBW (95% CI 0.05 to 0.2), fibre 0.8 g (95% CI 0.2 to 4.3), vitamin D 8.5 μg (95% CI 0.7 to 4.4), E 0.6 mg (95% CI 0.4 to 2.2), B12 0.7 μg (95% CI 0.02 to 2.6), folate 8.7 μg (95% CI 1.5 to 46.5), iron 0.4 mg 95% CI 0.6 to 2.4), and zinc 0.5 mg (95% CI 0.6 to 2.2) in the intervention group compared with the control group. The proportion of those receiving less than 1.0 g/kg/BW protein decreased from 67 to 51% in the intervention group and from 84 to 76% in the control group. Among home care clients with a cognitive decline (MMSE< 18), protein intake increased in the intervention group by 0.2 g/kg/BW (p = 0.048) but there was no change in the control group.ConclusionAn individual tailored nutritional intervention improves the intake of protein and other nutrients among vulnerable home care clients with PEM or its risk and in persons with cognitive decline.Trial registrationClinicalTrials.gov: NCT02214758. Date of trial registration: 12/08/2014.

Developing a nursing diagnosis for the risk for malnutrition: a mixed-method study.

AimAs the risk for malnutrition in older people in hospitals is often underreported, we aimed to develop a risk nursing diagnosis, including label, definition and risk factors.DesignA convergent parallel mixed‐methods design was employed.MethodsA literature review led to risk factors, validated by 22 hospitalized older people's perspectives and observations, including their nursing records. Per participant, one interview (qualitative), one non‐participatory observation of three meals (198 hr; qualitative) and one nursing record evaluation (quantitative) were conducted.FindingsAccording to the classification system of NANDA International, the risk for protein–energy malnutrition is defined with 18 risk factors, including associated conditions. Content validated risk factors are presented from three participants with the most, medium and least coherent nursing record, measured with the Quality of Diagnosis, Intervention and Outcomes tool.ConclusionThis new nursing diagnosis supports nurses to manage the risk for malnutrition and optimize older people's nutrition.

S0058 The Prevalence and Burden of Protein Energy Malnutrition Among Patients Hospitalized for Chronic Pancreatitis in the United States

INTRODUCTION: Chronic pancreatitis (CP) is associated with inflammatory destruction of the pancreas, suboptimal digestion, and absorption of nutrients, resulting in an elevated risk of Protein Energy Malnutrition (PEM). We sought to provide a national estimate of the prevalence, trends, characteristics, and the burden of PEM among patients hospitalized for CP. METHODS: Adult (age ≥18 years) hospital records were selected from the Nationwide Inpatient Sample (2007–2014). The prevalence and trends of PEM was calculated, stratified by concomitant presence of CP, and the impact of CP on the trends of PEM was measured. Among patients hospitalized for CP (Nationwide Inpatient Sample, 2012–2014), those with concomitant PEM and its associated factors (demographic, hospital, and co-morbid) were identified. CP patients with PEM were propensity-matched (1:1) to those without PEM, and the impact of PEM on clinical outcomes were estimated (SAS 9.4). RESULTS: From 2007–2014 (Figure 1A), the average prevalence of PEM was 506 per 10,000 hospitalizations, increasing from 337/10,000 (2007) to 626/10,000 (2014). The annual rate of increase in PEM was steeper (2.3x higher, Figure 1B) among patients with CP vs. no-CP (93/10,000 vs. 41/10,000 hospitalization/year). From 2012–2014, 11.5% (3,694 of 32,024) of CP hospitalizations had concomitant PEM, which was higher than patients without CP (5%) or with cirrhosis (6.1%). Odds for PEM was higher among Whites, advanced age, Medicare-insured, low-income earners, non-Northeastern regions, and patients with multiple co-morbidities such as alcohol and tobacco use, biliary stones, malignancies, and chronic diseases of the lung, heart, liver, and kidney. After propensity-matching, concomitant PEM was associated with very poor outcomes (Figure 2), including: mortality (AOR: 3.55 [95% CI: 1.73–7.31], P < 0.0001), acute kidney injury (AOR: 1.48 [95% CI: 1.28–1.70], P < 0.0001), parenteral nutrition (AOR: 5.58 [95% CI: 4.47–6.97], P < 0.0001), longer hospital stay (PEM: 8.3- vs. no-PEM: 4.8-days P < 0.0001), higher charges (PEM: US$59,334 vs. no-PEM: US$33,249 P < 0.0001) and higher discharge to secondary facilities (AOR: 1.74 [95% CI: 1.53–1.97], P < 0.0001). CONCLUSION: In conclusion, there is a higher prevalence and steeper increase of PEM among patients with CP than the general population. PEM is associated with higher mortality and poorer outcomes. Prevention, early recognition, and treatment of PEM among the high-risk categories may curb these dismal outcomes.Figure 1.: A: Increasing trend in the rate of PEM among Hospitalized Patients in the US (2007 to 2014). B: Among hospitalized patients, frequency and rate of increase in PEM is higher among patients with chronic pancreatitis (2007 to 2014).Figure 2.: Impact of Protein Energy Malnutrition on Outcomes of Hospitalizations for Chronic Pancreatitis.

What do screening tools measure? Lessons learned from SCREEN II and SNAQ65.

Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice. Dutch community-dwelling older adults (n=200, 78.2±6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ65+ (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score <54 out of 64). Chi-square tests were used to test associations between demographic, health, physical and social factors and outcome of SNAQ65+ and SCREEN II. Of all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQ65+). Agreement between the two tools was poor (kappa<0.20). Gender, BMI, living status, income, activity level and protein/energy intake were associated with SCREEN II; age, BMI, comorbidities, medication use, help at home, activity level and low basic mobility were associated with SNAQ65+. SCREEN II and SNAQ65+ measure different concepts of malnutrition and therefore identify different persons at risk. SCREEN II is more inclusive and comprises both undernutrition and overnutrition as well as different determinants that can impact on food intake, while SNAQ65+ is solely focused on protein-energy malnutrition.

Letter to a New Nurse

Letter to a New Nurse

Impact of Elderly Masticatory Performance on Nutritional Status: An Observational Study.

Background and Objectives: Masticatory limitations on the dietary habits of edentulous subjects restrict their access to adequate nutrition, exposing them to a greater risk of protein energy malnutrition. The aim of this study is to verify the existence of an association between Masticatory Performance (MP) and nutritional changes in the elderly. Materials and Methods: 76 participants were enrolled. MP testing was performed using the two-color chewing gum mixing test. The system used reveals the extent to which the two differently colored chewing gums mix, and allows discrimination between different MPs. The assessment of the participants’ nutritional statuses was carried out through a food interview. Anthropometric parameters were collected, and bioimpedance analysis was performed. Results: Mean MP was 0.448 ± 0.188. No statistically significant differences were detected between male and female subjects (p > 0.05). According to the Body Mass Index (BMI), obese patients had a lower MP than overweight and normal weight subjects (0.408 ± 0.225, 0.453 ± 0.169 and 0.486 ± 0.181, respectively). MP values were lower both in male and female subjects with a waist circumference above the threshold than those below it (0.455 ± 0.205 vs. 0.476 ± 0.110, respectively, in males and 0.447 ± 0.171 vs. 0.501 ± 0.138, respectively, in females). No relationship was noticed between MP and bioimpedance parameters (p > 0.05). Conclusions: A statistically significant relation was observed between MP and the number of missing teeth. A reduced MP could worsen nutritional parameters. A reduced MP did not seem to negatively affect bioimpedance parameters.

Identifying Malnutrition in PALTC Communities

Identifying Malnutrition in PALTC Communities

Relationships between Changes in Posterior Occlusal Support Status and Risk of Protein-energy Malnutrition among the Japanese Community-dwelling Elderly

Objective: Protein-Energy Malnutrition (PEM) among the elderly limits the daily activities and leads to a bedridden state. Oral health status in the elderly can be one of the PEM indicators. We aimed to assess the correlation between changes in posterior occlusal support status and the incidence of PEM over a 5-year period in the Japanese community-dwelling elderly. Materials and Methods: Two hundred and seventy-two subjects aged 75 years in 2003 were followed up in 2008. Posterior occlusal support without dentures in 2003 and 2008 was categorized into one of three groups based on the number of occlusal support zones (OSZ) present. According to the Eichner’s Index and changes in the values over 5 years, five groups were defined for the main exposure variables: 1) Complete: four OSZ remaining, 2) Moderate: one to three OSZ remaining, 3) Lost support: no OSZ remaining, 4) Early change: change from four to one to three OSZ, and 5) Late change: change from one to three to no OSZ. For the outcome variables, the rates of changes in protein intake, total energy intake, and BMI over 5 years were calculated and divided into two groups. The nutrition status for malnutrition was defined as A) IPE: the rates of changes in protein and total energy intake were less than or equal to the median and B) IPEB: the rates of changes in the three items were less than or equal to the median. Results: Male subjects whose posterior OSZ decreased from four to one to three over 5 years had a significantly higher risk of IPE and IPEB than those in other groups (odds ratio: 4.0 for IPE and 4.3 for IPEB). Conclusion: Male elderly participants who lost posterior occlusal support zones over 5 years experienced a decrease in protein intake and had an increased risk of PEM.

Predominance of Gastrointestinal Protozoan Parasites in Children: A Brief Review

Intestinal parasitic infections are among the major diseases of concern to public health throughout the world [1]. About 25% of world’s population suffers from one or more kinds of intestinal parasitic infections (helminthes/protozoa). Children because of their complex nutritional requirements and less developed immune systems are observed to be the principal sufferers of these parasitic infections [2]. Moreover, they have an extremely delicate physiology which can result in severe upsetting of their biochemical and physiological processes associated with these infections. Intestinal protozoan parasites can affect children in a variety of ways; they cause mal-absorption, reduced growth, increased risk for protein energy malnutrition, reduced psychomotor development and anemia. This report addresses Cryptosporidium, Giardia, and Entamoeba as the main parasitic protozoa of concern among children worldwide.

Impact evaluation of positive deviance hearth in Migori county, Kenya

A Positive Deviance (PD) Hearth intervention is a home and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in a low resource community. The intervention uses the ‘Positive Deviance’ approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and transfers such positive practices to other mothers who are equally disadvantaged economically. Positive Deviance Hearth intervention is designed to treat malnourished children, enable the families to sustain their rehabilitation at home on their own and to prevent malnutrition in younger siblings. However, PD Hearth intervention monitoring system in Migori only assesses a program’s ability to treat, one of the three PD Hearth objectives. Thus, there was need for impact evaluation to measure outcomes of the PD Hearth intervention to sustain rehabilitation and prevent malnutrition in younger siblings. The objectives of the study were to determine the level to which PD Hearth enables families to sustain rehabilitation at home on their own and to identify the practices which influence PD Hearth outcomes. The study was designed as a pipeline quasi-experimental and mixed method was used to collect data and perform statistical analyses. Single stage cluster sampling was used to identify 53 and 54 children on the intervention and comparison group in five communities. Weight measurements of the children on the intervention aged 6 to 59 months at the entry, exit and graduation stages were retrieved from Kenya Medical Research Institute Family AIDS Care and Education Services programme activities reports. Anthropometry (height measurements) for the children on the intervention and comparison children was taken. Caregivers filled in a questionnaire, assisted by the researchers as necessary. At entry, 18.9% children on the intervention had moderate underweight while 43.4% had mild underweight. At current status though, 3.8% and 34.0% had moderate and mild underweight respectively. The regression model predicted that Weight-for-Height (WAZ) of the children on the intervention at current status lied on 51.5 percentile, thus, normal for underweight. Increased feeding frequency made the largest contribution to weight gain than other caregiver practices. Therefore, the Migori County government in collaboration with the Ministry of Health needs to scale up PD Hearth intervention to reverse cases of Moderate Acute Malnutrition (MAM) and prevent Severe Acute Malnutrition (SAM) in the County.

Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture

IntroductionOne percent of falls in over-75years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75years old. ObjectiveThe principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution. Materials and methodsA prospective observational epidemiological study included 50 patients aged over 75years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNA<17/30. Assessment systematically comprised associated comorbidity (Cumulative Illness Rating Scale-Geriatric [CIRS-G]), cognitive status on the Mini Mental State Examination (MMSE), functional status on activities of daily life (ADL), and mean hospital stay (MHS). Scores were compared on quantitative tests (Student t) with the significance threshold set at P<0.05. ResultsMean age for the 50 patients was 86.1years (range, 77–94years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (P<0.006), greater numbers of severe comorbidities (P=0.006), more severe cognitive disorder (P=0.005) and functional dependence (P=0.002), and 8 days’ longer MHS (P=0.012). DiscussionThe present study confirmed the high prevalence of PEM in HF patients aged over 75years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients’ hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects. Level of evidenceLevel IV; prospective cohort study.

Socioeconomic determinants of protein and calorie consumption and potential risk of protein-energy malnutrition among households in South-West Nigeria

Purpose – The study aimed to investigate the problem of malnutrition among Nigerian households with emphasis on protein and calorie intake. Design/methodology/approach – Multi-stage random sampling approach was used to select 321 household members drawn from a total of 80 households. A combination of descriptive and inferential statistics was applied in analysing the data. Findings – The study revealed that household income, dependency ratio, education and gender of household head, among others, are factors that would significantly influence per capita daily calorie and protein intake of households. Protein-energy malnutrition is more of inadequate calorie than protein intake. There was confirmatory evidence of inadequate consumption of calorie among pre-school and school age children, while adult male members seemed to consume the above requirements with the possibility of being at the risk of obesity. Though children were undernourished, they are unlikely to be marasmic. Originality/value – The study examined the problem of malnutrition among Nigerian households with emphasis on protein and calorie intake. Socio-economic factors influencing per capita calorie and protein intakes as well as the possible risks of protein-energy malnutrition among household members were also examined. The patterns of intake of calorie and protein consumption among household members indicated the possibility of over-nutrition and under-nutrition coexisting among members of the households with over-nutrition and potential risks of obesity in adult males and under-nutrition among pre-school and school age children.

THE RISK OF THE DEVELOPMENT OF PROTEIN-ENERGY MALNUTRITION AND COMPETENCE ON A HEALTHY DIET OF ELDERLY PATIENTS

The article presents the data collected during the study of awareness of older patients with risk of protein-energy malnutrition. The quality of diet of free-living 106 patients older than 65 years with the risk of prote-inenergy malnutrition was analyzed. The relationship between the presence of depression, cognitive impairment and dependence in daily living and quality of diet was examined. The main causes of malnutrition in these patients were identified.

A Study on Nutritional Status during Dialysis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Patients undergoing peritoneal dialysis are at risk for protein-energy malnutrition because of nutrient losses during dialysis. This study determined the nutritional status of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Forty-four patients receiving CAPD were divided into two groups according to dialysis period. We investigated the nutritional status of the patients by measuring anthropometric and biochemical parameters, as well as food intake, self-appetite, dietary habits, a subjective global assessment, and a total nutritional status assessment. Group I subjects (7 males, 13 females) had received dialysis for ＜ 2 years, whereas the group II subjects (18 males, 6 females) received dialysis for ≥ 2 years. Energy intake with added dextrose in the dialysate per kg of body weight was 30.3 ± 5.8 kcal in group I and 29.0 ± 8.1 kcal in group II. The average protein intake per kg of weight was 1.0 ± 0.3 g in group I and 1.0 ± 0.4 g in group II, which were less than the recommended protein intake for patients undergoing CAPD (1.2-1.5 g/kg). Mean serum albumin level was significantly lower in group II than that in group I (p ＜ 0.05). A recent self-appetite score was significantly higher in group II than that in group I (p ＜ 0.01). The dietary habits score was significantly lower in group II than that in group I (p ＜ 0.05). The subjective global assessment was significantly higher in group I (85.0%) than that in group II (54.2%) under normal nutrition status (p ＜ 0.05). The dialysis period was significantly and negatively corre lated with the subjective global assessment (r = -0.502, p ＜ 0.01) and the total nutritional status assessment (r = -0.575, p ＜ 0.01). These results demonstrated that patients undergoing CAPD for ≥ 2 years had worse nutritional status than those who had been undergoing dialysis for ＜ 2 years. Good nutritional status can predict the long-term survival of patients undergoing peritoneal dialysis. Additionally, the exact evaluation of nutritional status before 2 years will be important to maintain long-term dialysis therapy in patients undergoing CAPD. (Korean J Nutr 2012; 45(1): 30 ~ 43)

Usefulness of the Mini‐Nutritional Assessment (MNA) to evaluate the nutritional status of Japanese frail elderly under home care

Background: The Mini‐Nutritional Assessment (MNA) has proved useful in Western countries to predict long‐term mortality of institutionalized elderly patients, as well as the elderly living at home. However, there are few reports on the usefulness of this evaluation in the elderly in Japan. Our objective was to examine the usefulness of the MNA to screen and diagnose malnutrition in the elderly in Japan and investigate the effect of nutritional status on their activities of daily living (ADL) and mortality.Methods: We recruited 181 frail elderly (62 men and 119 women) under home care whose age was 79.8 ± 8.8 years old. We assessed their nutritional status (anthropometric measurements, serum albumin, MNA) and ADL; then we followed up these patients for more than 2 years to see whether the MNA reflected their prognosis.Results: The MNA score correlated with anthropometric measurements, serum albumin and ADL (P &lt; 0.01). The hazard ratio of mortality by all causes was significantly higher in the elderly with protein energy malnutrition (PEM) and risk for PEM, compared with well‐nourished elderly patients.Conclusion: The MNA was useful to screen the elderly for nutritional status because it reflected the ADL and the prognosis, as well as conventional nutritional indexes such as anthropometric values and serum albumin.

Early Brain Growth

After completing this article, readers should be able to: 1. Discuss the roles of macronutrients (protein and energy) in neuronal and glial structure and neurotransmitter synthesis and function. 2. Delineate the neonates at risk for protein-energy malnutrition. 3. Characterize the neurodevelopment handicaps that occur in infants who experience intrauterine growth restriction. 4. Describe the mechanism by which protein and energy malnutrition alter the size of the brain. 5. Explain the effects of mild-to-moderate malnutrition on brain growth. Pediatric clinicians and researchers have long understood the importance of providing adequate nutritional intake to infants and children to promote appropriate neurodevelopmental outcome. Studies describing the untoward effects of nutritional microcephaly in humans date back to the seminal work of Winick and Rosso in the 1960s, ( 1) but the concept of loss of brain growth during periods of malnutrition was well known before that time. In this review, we assess the potential mechanisms by which macronutrients interact with the developing brain, including a discussion of the molecular, biochemical, structural, and behavioral effects of protein-energy malnutrition on the brain. Further, we examine the neurodevelopmental effects of clinical conditions that result in decreased head growth velocity between 24 and 40 weeks postconception, including intrauterine growth restriction (IUGR) and failure to thrive in preterm infants. Finally, we consider nutritional and non-nutritional strategies that have the potential to preserve normal brain growth. The brain is a dynamic structure throughout the lifespan ( 2) that is constantly remodeling itself, guided by the interaction between an intrinsic, apparently experience-independent set of factors and extrinsic experiences. The former frames a basic blueprint of predictable neurobehavioral milestone development that typically developing humans follow. The latter translates into the methods by which daily positive and negative experiences mold and shape the brain, providing variability in the developmental trajectory among humans. Fundamentally, within any developmental time period, …

Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients.

To evaluate the clinical assessment of nutritional status and mortality in geriatric patients. Prospective follow-up study. Acute geriatric inpatient ward. Eighty-three consecutive acute geriatric patients (mean age +/- standard deviation = 83 +/- 7; 68% women). Patients were classified as (1) having protein-energy malnutrition (PEM), (2) having moderate PEM or being at risk for PEM, or (3) being well nourished according to Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MNA). Body mass index ((BMI) kg/m2), arm anthropometry, and handgrip strength were determined. In a subgroup of patients (n = 39), body composition was analyzed using dual energy x-ray absorption and bioelectrical impedance. Three-year mortality data were obtained from the Swedish population records. Twenty percent and 26% of the patients were classified as having PEM based on SGA and MNA, respectively, whereas 43% and 56%, respectively, were classified as having moderate PEM or being at risk for PEM. Objective measures, such as BMI, arm anthropometry, handgrip, and body fat were 20% to 50% lower in the malnourished group than in the well-nourished subjects (P <.05). Moreover, mortality was higher in those classified as being malnourished, ranging from 40% after 1 year to 80% after 3 years, compared with 20% after 1 year (P =.03-0.17) and 50% after 3 years (P <.01) in patients classified as being well nourished. Fewer than one-third of newly admitted geriatric patients had a normal nutritional status according to SGA and MNA. BMI, arm anthropometry, body fat mass, and handgrip strength were reduced, and 1-, 2-, and 3-year mortality was higher in patients classified as malnourished. The present data justify the use of SGA and MNA for the assessment of nutritional status in geriatric patients.

Nutritional status and chewing capacity in nursing home residents.

Chronically ill elderly persons sustain a high risk for protein-energy malnutrition (PEM). In this study we explored some of the complex associations between nutritional status, dental health and cognitive and physical function in 192 nursing home residents (mean age 84+/-8 years, 80% female). Nutrition-related data from the Resident Assessment Instrument (RAI) were compiled into a Nutrition Score (NuSc; 0-1 = non-PEM, 2 = risk for PEM, and 3-7 = PEM). Chewing capacity, according to number and condition of occlusal contacts, was determined by a Clinical Dental Functionality score (CDF). The Cognitive Performance Scale (CPS) and activities of daily living (ADL) were determined according to the RAI. Fifty percent of the residents had NuSc > or = 2, and 25% had NuSc > or = 3. One third did not have the dental prerequisites for chewing. i.e., < 4 occlusal contacts. Almost half of the residents had severe cognitive dysfunction, and over two thirds were severely limited in their ADL activities. Subjects with > or = 4 occlusal contacts, i.e., technical chewing capacity, had better NuSc (1.5+/-1.4) than those not able to chew (2.4+/-1.6, p=0.0005). In univariate logistic regression, the odds for NuSc > or = 2 increased with reduced ADL functions. inability to chew and poor cognition. In multivariate logistic regression, ADL and chewing capacity were significantly related to NuSc > or = 2. When NuSc > or = 3 was chosen as cut-off, only ADL was related to malnutrition. In conclusion, half of this group of nursing home residents appeared to be malnourished, or were at risk for PEM. Reduced physical function was the strongest predictor of PEM, while impaired chewing capacity was associated with risk for PEM.

Malnutrition Awareness Activity

Nutrition professionals are acutely aware of the role of preexisting malnutrition in hospital patients and have developed screening tools for early identification. Given the shorter lengths of stay and increased patient acuity, it is imperative to help expand the skills of other professionals in identifying patients at risk for protein-energy malnutrition before or at admission.