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PubMed2003

Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women.

Malnutrition, a risk factor for osteoporotic fractures, is frequent in elderly people and, is underdiagnosed and undertreated. There are only few studies on the nutritional status of elderly people in Europe. The Mini Nutritional Assessment (MNA) is a non invasive and validated questionnaire to evaluate nutritional status in elderly people, classified in three groups: 1 degree score < 17: malnourished, 2 degrees score >17 and < 24: at risk of malnutrition, 3 degrees score >24: well-nourished, with a maximum of 30 points. Quantitative ultrasound of bone (QUS) is a method for assessing quality of bone which can be easily performed in nursing homes. Therefore, these two tests allowed to study the relationships between nutritional status and ultrasonic parameters of bone in 78 institutionalized women aged 86 +/- 6 years, living in 11 nursing homes around Lausanne (Switzerland). All were assessed by the MNA, had a measurement of the tricipital skin fold and of the grip strength. Functional status was evaluated by the scale "Activity of Daily Living" (ADL), and serum albumin level was measured when permitted. All had QUS of the calcaneus (with an Achilles, GE Lunar). The measured parameters are the Broadband Ultrasound Attenuation (BUA), attenuation of a band of ultrasonic frequencies through the medium, expressed in dB/MHz, and the Speed of Sound (SOS), speed of the ultrasounds through the medium, expressed in m/s. A third parameter, the stiffness index (SI), expressed as a percentage of the values obtained by the manufacturer in a young population and derived from BUA and SOS, was calculated automatically : SI = (0.67xBUA) + (0.28xSOS) - 420, expressed in percent compared to a young adult population (%YA). Fifteen percent of the women were undernourished and 58% were at risk of malnutrition. As expected, compared with the well-nourished minority, undernourished subjects had significant lower body mass index (BMI), tricipital skin fold (TSF), ADL score and albumin level (p < 0,01). The subjects "at risk of malnutrition" had significant lower BMI, ADL score (p < 0.01), tricipital skin fold and serum albumin (p < 0.05). Ultrasound parameters were low independently of the nutritional status. MNA score correlated significantly with tricipital skin fold (r = 0.508, p < 0.01), ADL (r = 0.538, p < 0.01) and albumin serum level (r = 0.409, p = 0.01). There was a trend for a correlation between the MNA and the ultrasound parameter BUA (r = 0.207, p = 0.07), whereas no correlation was found with SOS and SI. A multivariate analysis showed that tricipital skin fold and ADL explained 61% of the variance of the MNA. In conclusion, using simple and non invasive methods, this study showed that malnutrition and osteoporosis are frequent in institutionalized elderly persons in our country, and the ultrasound parameters are influenced by many others factors in addition to nutrition, especially at this age and in elderly residents of nursing homes.

Activities of Daily Living↗
PubMed1991

Plasma sex steroid-binding protein in mature heifers: effects of reproductive status, nutritional level, and porcine growth hormone, and estradiol-17 beta treatments.

In heifers, the specific 5 alpha-dihydrotestosterone (5 alpha-DHT) binding to sex steroid-binding protein (SBP) was 53 nM in midluteal phase and was 20% lower (p less than 0.05) in early luteal phase. In ovariectomized heifers on a high (H) or a low (L) energy diet, SBP bound testosterone with high specificity and estradiol-17 beta (E2) with a lower specificity; the affinity constant with 5 alpha-DHT was similar in the two groups independent of diet (Ka = 1.0 and 1.3 x 10(9) x M-1 for H and L heifers, respectively). Electrophoretic mobility of SBP was not affected by undernutrition. The specific 5 alpha-DHT binding to SBP in anestrous heifers compared to heifers in early luteal phase was 17% lower 18 days after cessation of ovarian activity (p less than 0.05) and 35% lower after 78 days of anestrus (p less than 0.001). Specific 5 alpha-DHT binding to SBP was 33% lower (p less than 0.001) in L heifers than in H heifers (40 nM). Porcine growth hormone (pGH) and E2 injections increased specific 5 alpha-DHT binding to SBP in both H and L heifers, but the effect depended on diet. Simultaneous injections of pGH and E2 increased specific binding in H heifers (p less than 0.02), whereas it had no effect in L heifers. We conclude that SBP binding capacity varies with ovarian activity in heifers and that nutritional status is one factor of regulation of SBP binding capacity because it affects binding and modifies the SBP response to stimulating factors such as pGH and E2.

Animals↗
PubMed1991

Iron status, energy intake, and nutritional status of healthy young Asian children.

The iron status, dietary intake, and protein energy nutritional status of healthy Asian children ranging in age from 4 to 40 months was investigated. The serum ferritin, erythrocyte zinc protoporphyrin, haemoglobin and mean corpuscular haemoglobin concentrations, and mean corpuscular volume were determined in a community study of 138 children. Protein energy nutritional status was estimated by anthropometry and a four or five day weighed dietary inventory was completed by 97 children. Concentrations of the serum ferritin, haemoglobin, and mean corpuscular haemoglobin, and the mean corpuscular volume decreased progressively with increasing age. The mean values for these four indices were significantly lower in toddlers between 21 and 23 months age than in infants less than 6 months old. The mean erythrocyte zinc protoporphyrin was high in the first six months, later falling and rising again to peak in the 21 to 23 month age group. Thirty five per cent of children were iron deficient (serum ferritin concentration less than 10 micrograms/l) and low values for the mean corpuscular volume and mean corpuscular haemoglobin were observed in 33% and 35% respectively and 17% were anaemic (haemoglobin concentration less than 110 g/l). No association was observed between biochemical iron status and the dietary intake of energy or iron. Nor was there an association between protein energy nutritional status and iron status. Screening for iron deficiency in communities at risk is recommended and nutrition education using trained link workers is preferred to prophylactic iron treatment.

Age Factors↗
PubMed1980

Association of participation in a nutritional program for the elderly with nutritional status.

The nutritional status of 547 participants of the Title VII Nutrition Program for the Elderly was assessed by anthropometric, biochemical, and dietary means. The nutriture for vitamins A and C was positively associated with frequency of participation in the program using biochemical and dietary methods of assessment. A significant smaller percentage of persons who participated in the program on a regular basis had inadequate intakes of riboflavin and thiamin. Fewer persons had anemia and low serum iron concentrations than was reported in an earlier baseline study. However, in this group of persons frequency of participation was not associated with anemia or serum iron-concentrations. Participation in the program was not significantly related to the dietary intake of energy, saturated fat, and cholesterol or to the incidence of obesity when assessed using triceps skinfold thickness, ponderal index, body mass index, and percentage of desirable weight. It can be concluded that the Title VII Nutrition Program for the Elderly is associated with improvement in the nutritional status of the participants.

Aged↗
PubMed2002

Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool.

In patients suffering from advanced neoplastic disease, malnutrition is a common complication affecting both the survival and quality of life. In order to monitor early dietary interventions, an assessment of patients' nutritional status is essential. We assessed the nutritional status of 46 patients using two different methods: 1) an objective method of nutritional assessment and 2) the subjective global assessment (SGA) technique. It was found that 28 patients were characterized as malnourished by means of the objective method and 30 patients according to the SGA. The correlation of the results of the assessments between the two methods was high and a validation test of the SGA gave a sensitivity of 96% and specificity of 83%. The most frequent symptoms affecting food intake were anorexia, early satiety, dry mouth, pain and nausea. The results show that the SGA represents an easy method for assessment of the nutritional status in such cancer patients and that it can therefore be used as a screening tool. The high incidence of malnutrition in this group of patients, and their rare use of nutrient supplements, both indicate the importance of early nutritional assessment, and nutritional intervention when appropriate.

Adult↗
PubMed2002

Oral health and nutritional status in a group of geriatric rehabilitation patients.

The aims of this study were to evaluate the oral health status and nutritional status in a group of geriatric rehabilitation patients, and to analyse the relationship between these two parameters. Nurses at the ward performed structured assessments of oral and nutritional status using the Revised Oral Assessment Guide and the Subjective Global Assessment form in 223 newly admitted patients. Most oral health problems were found among patients who stayed longer at the hospital and were more dependent on help as compared with the healthier patients. Thirty-four per cent of the patients were either severely undernourished, at risk or suspected to be undernourished (UN). Oral health problems were more common among UN patients (p < 0.0005) compared with well-nourished patients. The most frequent oral health problem was found on teeth or dentures (48%). Problems related to the tongue and lips were also common among UN patients (56 and 44%, respectively). Oral health status was correlated (r = 0.32) to nutritional status. Problems with swallowing had the strongest association to the nutritional status (OR 6.05; 95% CI 2.41-15.18). This study demonstrated that poor oral health status was related to undernourishment.

Aged↗
PubMed1995

Preoperative nutritional status and prognostic nutritional index in patients with benign disease undergoing abdominal operations--Part II.

OBJECTIVES: Part II of this study was undertaken to develop a prognostic nutritional index for the identification of high risk patients with benign disease undergoing abdominal operations at the Universitas Hospital in Bloemfontein. METHODS: To accomplish this goal, 52 consecutive adult non-cancer surgical patients, admitted to the Universitas Hospital for a period of one year, were studied prospectively. The postoperative outcome was monitored until discharge or death. Various discriminant analyses were performed on the obtained data. Four prognostic indexes were compiled, including two nutritional and two mixed models. A short and medium length index were derived for both the nutritional and the mixed models. RESULTS/DISCUSSION: The results suggest that the short nutritional index may be the most practical for the prediction of surgical outcome in this specific set of patients. The short nutritional index included diet risk, serum albumin, body mass index, % ideal body weight, triceps skinfold and grip strength. It is further suggested that these indices be tested in another set of patients and be compared with other available prognostic models.

Abdomen↗
PubMed1993

[Approximation to the nutritional status with a nutrition survey in the health area].

OBJECTIVE: As part of an overall diagnosis of health in our Area we carried out a study of nutritional habits and attitudes, with the aim of altering the negative aspects by health education. DESIGN: A descriptive study of a questionnaire filled in by a sample taken from the electoral roll in our Health Area. SITE. Tonepacheco Health Area (Murcia). PARTICIPANTS: 600 inhabitants. MAIN MEASUREMENTS AND RESULTS: 82.7% consumed milk products once or more a day. 66.3% ate meat, eggs and fish between one and three times a week. 74.8% consumed legumes, potatoes and dried fruits; 95.8% bread, rice and pasta; 77.7% biscuits, sweets and chocolates; and 71.2% consumed fats; the preceding all between one and three times a week. 44.2% ate green and root vegetables between 4 and 6 times a week. 89.4% are fruit once or more a day. 73.4% ate out of the house between 4 and 6 times a week. Of the 2.8% of children who drank alcoholic drinks, 66.3% did so habitually. CONCLUSIONS: We believe it is important to emphasise in health education the need for a balanced diet, with special attention being paid to enolic habits in children.

Adolescent↗
PubMed2003

Assessment of nutritional status on hospital admission: nutritional scores.

Malnutrition is still a largely unrecognized problem in hospitals. Malnutrition in hospitalized patients is generally related to increasing morbidity and mortality, and costs and length of stay. The aim of this study was to assess the nutritional status of patients on admission to a general hospital using different nutritional scores and to test the sensitivity and specificity of these scores. Sample population included 60 patients (55% male; 45% female) selected (aged 65.6+/-15.9 y) at random by using a computer software program. The nutritional state assessment was performed within 48 h of admission, using different nutritional indices (Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Gassull classification, Instant Nutritional Assessment (INA) and a combined index). About 78.3% of patients were found to be malnourished on admission. The frequency of malnutrition degree varied from 63.3% as assessed by the SGA to 90% with the NRI. Malnutrition severity was not related to the diagnosis. However, an elderly population was associated with a higher prevalence of malnutrition. INA was the best single score to identify patients who are malnourished or at risk of malnutrition and who may benefit from nutrition support.

Adult↗
PubMedDate not supplied

Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden.

BACKGROUND: In 1992, local municipalities in Sweden took over full responsibility for the long-term care of elderly. This has led to an increased care burden for the various assisted accommodation services run by the municipalities. OBJECTIVE: Since ageing and chronic diseases are risk factors for protein-energy malnutrition, we evaluated the nutritional status of all individuals in assisted accommodation, i.e., service flats (SF), old people's homes (OPH), group living for the demented (GLD), and nursing homes (NH), in three Swedish municipalities. METHODS: Of 994 eligible subjects, 872 were examined; the average age was 84.5+/-8 years, and 69% were female. The Mini Nutritional Assessment (MNA) scale (0-30 points) was used, consisting of 18 point-weighted questions in four categories, i.e., anthropometry, global and dietary issues, and self-assessment. RESULTS: MNA <17, i.e., malnutrition, was noted in 36% of the study population. Divided according to accommodation type, the MNA scores were <17 in 21% of individuals in SF, 33% of those in OPH, 38% of those in GLD, and 71% of those in NH. The corresponding values for MNA scores 17-23.5 (risk for malnutrition) were 49, 51, 57, and 29%, respectively. Average body mass index (BMI) values were 24.2+/-5 (SF), 23.6+/-5 (OPH), 23.9+/-4 (GLD), and 22.3+/-4 (NH). BMI values < or =20 were found in 18% of those in SF, in 25% of those in OPH, in 19% of those in GLD, and in 33% of those in NH. Both MNA and BMI correlated with upper arm and calf circumference, with r values ranging from 0.4 to 0.7 (p<0.001). MNA and BMI correlated significantly (r = 0.52, p<0.001). Age correlated with MNA and BMI with r values of 0.1 (p<0.01) and 0.14 (p < 0.001), respectively. Subjects with significant help requirements during meals ate fewer whole meals per day than those who could feed themselves. CONCLUSIONS: Based on the MNA, one third of the study subjects living in assisted accommodation, and more than half of those living in NH, appeared to be malnourished. Further studies are necessary to assess to what extent these nutritional disturbances are reversible.

Aged↗
PubMed1998

Effects of zinc and nutritional status on clinical outcomes in head and neck cancer.

The head and neck cancer patient often presents with both protein malnutrition and trace element deficiencies. Zinc has been found to be deficient in many head and neck cancer patients. In this study, pretreatment zinc status and nutritional status (measured by the Prognostic Nutritional Index [PNI]) were correlated with clinical outcomes in 47 patients. The patients were followed-up for a median of 52 mo from the time of enrollment. Our results showed that the tumor size and overall stage correlated significantly to zinc status whereas no such correlation was seen with PNI, alcohol intake, or smoking in our subjects. The results also showed that impaired zinc status was associated with an increased number of treatment morbidities, unplanned hospitalizations, and treatment delays (P < 0.05). Nutritional status was not associated with any studied outcome variable. The disease-free interval was highest for the group which had both zinc-sufficient and nutrition-sufficient status. Although our data do not prove conclusively, they do suggest that impaired zinc status at presentation may contribute to treatment morbidity, and that for an optimal mean disease-free interval, a sufficient zinc and nutritional status is required.

Aged↗
PubMed2004

Nutritional status of women in Bangladesh: comparison of energy intake and nutritional status of a low income rural group with a high income urban group.

This study evaluated the influence of socio-economic status on energy intake (EI), anthropometric characteristics and body composition (BC) of premenopausal Bangladeshi women in two socio-economic groups. This cross-sectional study measured height, weight, biceps and triceps skinfolds by standard procedures. A three-day dietary record was used to estimate EI. The biceps and triceps skinfolds were used to calculate total body fat (TBF), fat-free mass (FFM) and body fat percentage (BF%) according to Durnin and Womersley. FAO/WHO/UNU equations were used to calculate basal metabolic rates (BMR). Two locations in Bangladesh were studied; the Dhaka city area and the west region of the subdistrict Nandail (Betagair Union) in the district of Mymensingh. Study subjects were premenopausal women (N =191) aged 16(40 years. The high socio-economic group (group H, N =90) consisted of women with high income and educational level. The low socio-economic group (group L, N =101) consisted of rural, low income, illiterate women. Both groups contained three subgroups (non-pregnant, non-lactating =1, pregnant =2, lactating =3). Socio-economic status had a significant effect on body weight, height, biceps and triceps skinfolds, BMI, TBF, FFM and BF% (P<0.001). These variables were significantly higher (P<0.001) in all subgroups of group H than in the corresponding subgroups of group L. The influence of physiological status on most of these variables was not significant. EI was, however, influenced by both socio-economic (P<0.001) and physiological(P<0.05) status. The mean EI was significantly lower (P<0.001) in all subgroups of group L than in the corresponding subgroups of group H. The contributory sources were different in high and low income groups. In both groups, EI was lower than the recommended level. Based on the dietary and anthropometric results, we conclude that malnutrition is a common feature among low income rural women. This contradicts findings in western countries, where obesity is prevalent in low income groups.

Adolescent↗
PubMed2003

[Nutritional status of patients in hospitals in Poland. More thorough assessment of nutritional status of adult patients].

The purpose of the study was a more thorough assessment of the nutrition state of patients admitted to hospitals in Poland. The study was carried out in four hospitals at teaching centre level, in four hospitals at province level, and in four county hospitals. The patients for the study were selected randomly from 3310 adult patients (every 10th patient admitted to these hospitals). For the study 210 patients (122 women and 88 men) were qualified. Their mean age was 54 +/- 16 years (range 15-82 years). The patients were subjected to various biochemical tests including determination of antioxidant vitamins (vitamins A, E and C), vitamin B12, folic acid, ferritin, and homocysteine and blood lipids. Vitamin deficiency accepted as vitamin malnutrition was found in the case of vitamin C in 51.8% of the patients, folic acid in 32%, vitamin E in 10%, vitamin B12 in 6.8%, vitamin A in 1.4%. Vitamin deficiency was equally frequent in patients with malnutrition, overweight or with obesity. Lipid profile disturbances were found in 51% and high homocysteine level in 63% of the studied patients.

Adolescent↗
PubMed2003

The relationship between dental status, food selection, nutrient intake, nutritional status, and body mass index in older people.

This paper reviewed the findings from a national survey in Great Britain which assessed whether dental status affected older people's food selection, nutrient intake, and nutritional status. The survey analyzed national random samples of free-living and institution subjects for dental examination, interview, and four-day food diary as well as blood and urine tests In the free-living sample, intakes of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C were significantly lower in edentulous as compared to dentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly non-starch polysaccharides. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and retinol were the only analytes significantly associated with dental status. Having 21 or more teeth increased the likelihood of having an acceptable body mass index (BMI). Thus, maintaining a natural and functional dentition defined as having more than twenty teeth into old age plays an important role in having a healthy diet rich in fruits and vegetables, a satisfactory nutritional status, and an acceptable BMI.

Aged↗
PubMed1995

Nutritional status and food security: winter nutrition monitoring in Sarajevo 1993-1994.

OBJECTIVE: To monitor nutritional status and food security throughout the winter of 1993-1994 in order to provide early warning of any deterioration, identify the nutritionally vulnerable and so enable humanitarian agencies to respond appropriately. DESIGN: Four different household groups were prospectively followed: residents, refugees in collective centres, refugees in private accommodation and elderly living alone (either residents or refugees). Four local communities were purposively selected and two collective centres were randomly selected. Households were randomly selected within each community and collective centre. An additional sample of all elderly inhabitants of the old people's home were nutritionally assessed only. SETTING: Monitoring was implemented in the besieged city of Sarajevo. SUBJECTS: 143 households with 90 children (< 18 years), 230 adults (18-59 years), and 94 elderly (60 + years) members, and 40 elderly inhabitants of the old people's home were monitored. INTERVENTIONS: Every month from December 1993 to March 1994, information on household food security was collected through structured questionnaires. All subjects were weighed and their heights measured. Weight for age Z scores in children (six months to 12 years) and body mass index (BMI) in adults and the elderly were calculated. RESULTS: While the nutritional status of adults and children consistently remained normal, high levels of undernutrition were detected among the elderly ranging from 16% to 21% (BMI < 18.5). Between December 1993 and February 1994, adults lost an average of 260 grams in weight (paired t test p = 0.005). Indicators of household food security (food stocks per person, market food prices and access to food aid) showed negative trends during the same time period. CONCLUSIONS: Whilst there was no nutritional disaster in Sarajevo over the winter 1993-1994, there were signs that capacity to cope was weakening in some groups. The elderly were identified as the most nutritionally vulnerable due to sickness, cold, stress and problems related to food preparation. The most food insecure group were refugees in collective centres who were highly dependent on food aid, were less likely to have relatives outside Sarajevo to support them, had fewer possessions to sell and were least likely to have gardens.

Adolescent↗
PubMedDate not supplied

Oral and nutritional status--Is the MNA a useful tool for dental clinics.

OBJECTIVES: To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents. DESIGN: Descriptive, cross-sectional study. SETTING: All elderly residents in all NH and LT in Helsinki, the capital of Finland. PARTICIPANTS: The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53). MEASUREMENTS: A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management. RESULTS: 11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia). CONCLUSION: In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.

Aged↗