scholarly journals BASELINE FINDINGS OF CARENUTRITION INTERVENTION (RCT) AMONG OLDER CAREGIVERS - RISK OF MALNUTRITION AND INSUFFICIENT PROTEIN INTAKE

Author(s):  
S. Kunvik ◽  
R. Valve ◽  
K. Salminen ◽  
M. Salonoja ◽  
M.H. Suominen

Objectives: Older caregivers are vulnerable to nutritional problems, but only a few studies have examined their nutrition. The purpose of this study was to determine the associations between nutritional status and nutrient intake among older caregivers. Design: Cross-sectional analysis of baseline data from the CareNutrition randomized controlled trial (RCT). Setting: Community-dwelling caregivers from the Western part of Finland in two different clusters. Participants: A total of 79 caregivers aged ≥65 with normal cognition were recruited for the study, all of whom had officially approved caregiver status by The Social Insurance Institution of Finland. Measurement: Nutritional status was assessed by the Mini Nutritional Assessment (MNA), nutrient intake by a three-day food diary, nutrition-related blood markers by laboratory tests, cognition by the Mini Mental State Examination (MMSE), and other baseline characteristics were also evaluated using validated methods. Results: The majority of the caregivers (79.7%) had a good nutritional status (MNA points >23.5), 19% were at risk of malnutrition (MNA points 17-23.5) and one person (1.3%) already suffered from malnutrition (MNA points <17). The female caregivers were at a higher risk of malnutrition than the males (26.5% vs. 6.7%, p=0.026). Depressive symptoms and medication were associated with decreased nutritional status, and good health-related quality of life with better nutritional status. Mean protein intake was 1.0 g/kg IBW/d and 79.7% of the caregivers (77.6% female, 83.3% male) did not consume the recommended protein intake of 1.2 g/kg IBW/d. Their intake of dietary fibre, folate and vitamin D was also insufficient. Conclusion: Every fifth caregiver was at risk of malnutrition. The females were at a higher risk than the males. Most of the caregivers had insufficient protein intakes. These findings confirm the importance of investigating the nutritional status of older caregivers and indicate a need for preventive nutritional guidance.

2013 ◽  
Vol 17 (12) ◽  
pp. 2834-2843 ◽  
Author(s):  
Yu Xuan Koo ◽  
Min Li Kang ◽  
Angie Auyong ◽  
Glen Zq Liau ◽  
Jeremy Hoe ◽  
...  

AbstractObjectiveThe objectives of the present study were to assess the nutritional status, identify factors for malnutrition risk and evaluate barriers to adequate nutrition among recipients of the Public Assistance (PA) scheme for socio-economically disadvantaged Singaporeans.DesignUsing a cross-sectional study design, we assessed PA recipients’ malnutrition risk using the DETERMINE Nutritional Health checklist and the full Mini-Nutritional Assessment (MNA), as well as their nutritional knowledge, co-morbidity burden, depression risk, instrumental and basic activities of daily living (IADL and BADL), and awareness and utilization of available food services. In-depth interviews were also conducted on malnourished individuals (MNA score < 17) to understand barriers to adequate nutrition.SettingHomes of community-living older adults and nursing homes of institutionalized older adults.SubjectsAll PA recipients aged ≥55 years in Central Singapore District.ResultsFour hundred and sixty-five of 511 (91·0 %) eligible PA recipients participated in the study. The prevalence of malnutrition in the study population was 2·8 %. However, 50·3 % were at risk of malnutrition. Among community-dwelling respondents, the risk of malnutrition was independently associated with age >75 years, currently unmarried, BADL impairment, depression risk and BMI < 19·0 kg/m2. Qualitative analysis revealed that financial, social and physical barriers and lack of knowledge were the main contributors to poor nutritional status. Only half were aware of subsidized food services and education increased interest in utilizing food services. Among nursing home respondents, those who were BADL impaired were more likely to be at risk of malnutrition.ConclusionsAmong PA recipients, the prevalence of malnutrition is low but the risk of malnutrition is high. Education on adequate nutrition and food services are recommended.


2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Teresa Madeira ◽  
Catarina Peixoto-Plácido ◽  
Nuno Sousa-Santos ◽  
Nuno Mendonça ◽  
Osvaldo Santos ◽  
...  

AbstractBoth malnutrition (which here refers to undernutrition) and obesity are prevalent in older adults, but they are frequently seen as mutually exclusive. In fact, a low body mass index (BMI) is one of the aetiological diagnostic criteria for malnutrition. On the contrary, the concomitant presence of malnutrition and obesity has been less studied. The aim of this study was to characterise the nutritional status of community-dwelling older adults (≥ 65 years old) living in Portugal. The study included a nationally representative sample of randomly selected community-dwelling older adults. Trained nutritionists collected data through face-to-face structured interviews regarding sociodemographic characteristics, nutritional status and anthropometric measures (namely, weight and height), among other variables of the PEN-3S study. Nutritional status was assessed by the 18-item Mini Nutritional Assessment (full MNA®), in which a lower score indicates worse nutritional status. The World Health Organisation's (WHO) BMI cut-offs for adults were followed (obesity: BMI ≥ 30Kg/m2). MNA and BMI categories estimates (95% CI) were obtained using Complex Samples analysis (SPSS® 24.0). Non-difference between sexes was analysed with Chi-square tests. Complete information was available for 1110 community-dwelling participants (mean age: 75.9 ± 8.1 years; 48.9% women; 71.4% attended school for < 5 years). According to the MNA, 0.5% (95%CI: 0.2–1.7) were classified as malnourished and 16.0% (12.9–19.7) were at risk of malnutrition. Following WHO's BMI criteria, 0.6% (0.2–1.5) had a BMI ≤ 18.5Kg/m2, 41.9% (37.9–46.0) had a BMI between 25–30Kg/m2, and 36.7% (32.8–40.9) presented a BMI ≥ 30Kg/m2. The prevalence of risk of malnutrition was significantly higher for women (20.1%, 95%CI: 15.4–25.9) than men (10.4%, 7.6–14.1; p < 0.001). The prevalence of obesity was also significantly higher for women (42.2%, 35.9–48.7 versus 29.3%, 24.8–34.2; p = 0.007). Moreover, 13.9% (9.2–20.4) were simultaneously at risk of malnutrition and had a BMI ≥ 30Kg/m2, while no one in this BMI category was classified as malnourished. Although appropriate BMI cut-offs for older adults are still uncertain, these results highlight that a high BMI does not exclude the risk of malnutrition, particularly in women. Therefore, health professionals should routinely screen for malnutrition using multi-component, validated screening tools, irrespective of the BMI. In fact, malnutrition is preventable if detected on time and effective interventions exist. The concomitant presence of malnutrition and obesity may pose additional challenges to the treatment.


2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 19-19
Author(s):  
Samantha Honeywell ◽  
Hamed Samavat ◽  
EIleen Hoskin ◽  
Riva E. Touger-Decker ◽  
Rena Zelig

Abstract Objectives Older adults in the United States are at greater risk for tooth loss and malnutrition than those younger than 65 years. Prior research regarding associations between dentition status and nutritional status in older adults is heterogeneous. The primary aim of this study was to explore associations between dentition status and nutritional status in older adults. Methods This was a retrospective, cross-sectional study of data from older adults (65–89 years) who received care at the Rutgers School of Dental Medicine clinics between June 1, 2015 and June 1, 2020. Nutritional status was determined using Self Mini Nutritional Assessment (Self-MNA). Records were included if they had complete odontogram and Self-MNA data. Spearman rank correlation was performed to analyze the relationships between Self-MNA scores and number of teeth. Chi-square, Fisher's Exact, and Kruskal-Wallis tests were used to examine the associations between nutritional status category, number of remaining teeth categories, and presence of functional dentition defined as ≥21 teeth. Results Of the 305 records available, 53.8% were female. The median Self-MNA score was 13, indicative of normal nutritional status; 93.1% of the sample had some tooth loss (mean ± SD = 16.7 ± 8.8 teeth). Those who were at risk for or who had malnutrition had fewer teeth (P = 0.02) than those with normal nutritional status. Those with 20–28 teeth or functional dentition were significantly more likely to be of normal nutritional status (P = 0.02 and P = 0.03, respectively) than to be at risk of or have malnutrition, compared to those with fewer teeth. Those with fewer than 20 teeth had significantly lower Self-MNA scores than those with 20 or more teeth (P = 0.02). Conclusions Older adults who were at risk of or who had malnutrition had fewer teeth than those with normal nutritional status. Those with functional dentition were more likely to have a normal nutritional status than those without functional dentition. Future research in larger more diverse samples is needed to better understand the associations between dentition status and nutritional status. Funding Sources None


2018 ◽  
Vol 52 (3) ◽  
Author(s):  
Ernani R. Bullecer ◽  
Maribel M. Develos

Objective. This study has been conducted to determine the prevalence of malnutrition and nutritionally-at-risk community-dwelling older adults in an urban setting through the use of Mini Nutritional Assessment (MNA®). Methods. A cross-sectional survey was done among older adults in Barangay Sto. Niño, an urban poor community in Pasay City, Metro Manila to determine the prevalence of malnutrition and older adults using the short and full form of the Mini Nutritional Assessment (MNA®). Anthropometric assessment was done to determine body mass index as well as physical examination to determine presence of nutrient deficiencies. Results. Using the Asia Pacific cut-off for BMI, it can be noted that 16.5% were classified as underweight. On the other hand, results of the MNA® short form screening showed that less than half (42.6%) of the study respondents have normal nutritional status. Majority of the respondents were either malnourished (14.8%) or at risk of malnutrition (42.6%). Moreover, results of the Full MNA® form showed that almost half of the study respondents were either malnourished (8.2%) or at risk of malnutrition (39.3%). The rest of the study respondents were classified as having normal nutritional status (52.5%). Conclusion. As compared to Body Mass Index, which can only identify prevalence of malnutrition, the MNA®, both short and full form, was not only able to identify malnourished and nutritionally-at-risk older adult as well as provide variables that may screen for possible causes of malnutrition. This is necessary and relevant for timely nutrition intervention for improved nutritional outcome among older adults.


Author(s):  
R. Zelig ◽  
L. Byham-Gray ◽  
S.R. Singer ◽  
E.R. Hoskin ◽  
A. Fleisch Marcus ◽  
...  

Background and Objective: Older adults are at risk for both impaired oral health and suboptimal nutritional status. The objective of this study was to explore the relationships between malnutrition risk and missing teeth in community-dwelling older adults. Design: This was a retrospective cross-sectional analysis of data obtained from the electronic health records of 107 patients aged 65 and older who attended an urban northeast US dental school clinic between June 1, 2015 and July 15, 2016. Odontograms and radiographs were used to identify teeth numbers and locations; malnutrition risk was calculated using the Self-Mini Nutritional Assessment (Self-MNA). Relationships between numbers of teeth and malnutrition risk were assessed using bivariate logistic regression. Results: Participants (N=107) were 72.6 years (SD=5.6) of age; 50.5% were female. Mean Self-MNA score was 12.3 (SD=2.0) reflective of normal nutrition status; 20.6% were at risk for malnutrition, 4.7% were malnourished. Greater than 87% were partially or completely edentulous. Those with 10-19 teeth had lower Self-MNA scores (mean=11.6, SD=2.5) than those with 0-9 teeth (mean=12.7, SD=1.3) or 20 or more teeth (mean=12.6, SD=1.8) and had an increased risk for malnutrition (OR=2.5, p=0.076). Conclusion: The majority of this sample of older adults were partially edentulous and of normal nutritional status. Those with 10-19 teeth were more likely to be at risk for malnutrition. Further studies are needed to examine relationships between tooth loss and malnutrition risk and the impact of impaired dentition on the eating experience in a larger sample and to inform clinical practice.


Author(s):  
S. Kunvik ◽  
R. Valve ◽  
M. Salonoja ◽  
M.H. Suominen

Background: Older caregivers, males especially, are vulnerable to nutritional problems. Low intake of protein is common and can affect their nutrition and health. Objectives: The aim in this RCT was to investigate the effect of tailored nutritional guidance on protein intake among caregivers aged ≥65 years with protein intake under recommendations (≤1.2 g/kgBW/d). Subgroup analysis were made with male caregivers. Design: Data from the CareNutrition randomized controlled trial (RCT). Setting: Community-dwelling caregivers from the Western part of Finland. Participants: Total of 55 caregivers (n=28 intervention group (IG), n=27 control group (CG)) with protein intake of under 1.2 g/kgBW/d at baseline. 45.5% were male (n=12 male intervention group (MIG), n=13 male control group (MCG)). Intervention: During the six-month intervention tailored nutritional guidance was given to the intervention group during home visit (once) and in group meetings (2-4 times), complemented with written material. Written material was offered to control group. Measurements: Protein intake was assessed with three-day food diary at baseline and final measurements. Main outcome measure was change in protein intake (g/kg bodyweight (BW)/d), analysed among participants with protein intake under 1.2 g/kgBW/d at baseline. Participant characteristics were evaluated with validated methods. Results: Mean protein intake was 0.86 g/kgBW/d in IG and 0.85 g/kgBW/d in CG and among males, 0.89 g/kgBW/d in MIG and 0.79 g/kgBW/d in MCG. There was no significant difference in the change in protein intake between IG and CG. Protein intake increased among MIG by 0.11 g/kgBW/d and decreased in MCG group by -0.07 g/kgBW/d, p=0.007. There was also a significant increase in protein intake within the IG (+0.10 g/kgBW/d, p=0.038). Conclusions: Tailored nutritional guidance resulted in improved protein intake among older male caregivers. Group-based nutritional guidance may boost nutrition among older caregivers, especially males.


2022 ◽  
pp. 238008442110638
Author(s):  
S. Honeywell ◽  
H. Samavat ◽  
R. Touger-Decker ◽  
J.S. Parrott ◽  
E. Hoskin ◽  
...  

Background/Objective: Older adults are at higher risk of malnutrition. The aim of this study was to explore associations between nutritional status and dentition status among older adults seeking care in a dental clinic. Methods: This was a cross-sectional study of data from older adults (65–89 y) who received care at a northeastern US urban dental school clinic between June 2015 and June 2020 (N = 305). Clinical and demographic data were obtained from the electronic health record; nutritional status was determined using the Self–Mini Nutritional Assessment (Self-MNA), and odontograms and digital radiography were used to determine dental data. Adjusted multivariable models were used to explore associations between variables. Results: The sample was 53.8% female with a median age of 72.0 y. The median Self-MNA score was 13, reflective of normal nutritional status; 29.5% were at risk of or had malnutrition. Median numbers of teeth and posterior and anterior occluding pairs of teeth (POP, AOP) were 18.0, 2.0, and 5.0, respectively. Those with normal nutritional status had significantly more teeth, POPs, and AOPs than those at risk of or with malnutrition (P = 0.015, P = 0.015, and P = 0.039, respectively). Every additional unit increase in the number of natural or restored teeth or POP was associated with significantly lower odds of being at risk of or with malnutrition (3% and 13%, respectively). Having functional dentition was associated with 46% lower odds of being at risk of or with malnutrition. Conclusion: This study demonstrated that older adults who had more teeth, better occlusion, and functional dentition were more likely to be of normal nutritional status than those who had less teeth, had poorer occlusion, and lacked functional dentition. Further research with larger, more diverse samples and varied measures of dentition are needed to better understand the associations between nutritional status and dentition status. Knowledge Transfer Statement: The findings from this study suggest that older adults with fewer teeth and therefore less efficient occlusion are at higher risk for malnutrition than those with more teeth and better occlusion. Health care professionals should include screening for dentition and malnutrition as part of their routine practice to identify patients who may have tooth loss and be at risk of malnutrition and refer them accordingly for interventions to optimize oral health and nutritional status.


Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2183
Author(s):  
Aleksandra Kaluźniak-Szymanowska ◽  
Roma Krzymińska-Siemaszko ◽  
Marta Lewandowicz ◽  
Ewa Deskur-Śmielecka ◽  
Katarzyna Stachnik ◽  
...  

Up to 28% of elderly residents in Europe are at risk of malnutrition. As uniform diagnostic criteria for malnutrition have not been formulated, in autumn 2018, the Global Leadership Initiative on Malnutrition (GLIM) presented a consensus on its diagnosis. According to the consensus, the diagnosis of malnutrition requires a positive screening test result for the risk of malnutrition, and the presence of at least one etiologic and one phenotypic criterion. This study aimed to assess the diagnostic performance and accuracy of the Mini Nutritional Assessment—Short Form (MNA-SF) against GLIM criteria. The analysis involved 273 community-dwelling volunteers aged ≥ 60 years. All participants were screened for malnutrition with the MNA-SF questionnaire. Next, the GLIM phenotypic and etiologic criteria were assessed in all subjects. Based on the presence of at least one phenotypic and one etiologic criterion, malnutrition was diagnosed in more than one-third of participants (n = 103, 37.7%). According to the MNA-SF, only 7.3% of subjects had malnutrition, and 28.2% were at risk of malnutrition. The agreement between the MNA-SF score and the GLIM criteria were observed in only 22.3% of the population. The sensitivity and specificity of MNA-SF against the GLIM criteria were fair (59.2% and 78.8%, respectively). The area under the curve (AUC) was 0.77, indicating the fair ability of MNA-SF to diagnose malnutrition. Based on the present study results, the best solution may be an optional replacement of the screening tool in the first step of the GLIM algorithm with clinical suspicion of malnutrition.


Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 60 ◽  
Author(s):  
Tony Arjuna ◽  
Michelle Miller ◽  
Tomoko Ueno ◽  
Renuka Visvanathan ◽  
Kylie Lange ◽  
...  

The effects of “standard (STD)” vs. “protein- and energy-enriched (HEHP)” food-service meals on the nutrient intake, nutritional status, functional capacity, and wellbeing of older adults was investigated using a 12 week, double-blinded, parallel group design. All participants received dietetics counseling and either an STD (2.3 MJ and 30 g protein per meal) or a HEHP (4.6 MJ and 60 g protein) hot lunchtime meal for at least 3 days/week; those who did not want food-service meals were included in the control group (CON). Twenty-nine participants completed the study (STD = 7; HEHP = 12; CON = 10). From baseline to week 12, the HEHP subjects increased their mean daily energy intake from 6151 ± 376 kJ to 8228 ± 642 kJ (p = 0.002 for effect of time) and protein intake from 67 ± 4 g to 86 ± 8 g (p = 0.014 for effect of time). The MNA (Mini Nutritional Assessment) score was increased significantly in HEHP by 4.0 ± 1.1 points (p = 0.001), but not in the STD and CON groups (2.8 ± 2.1 points and 1.8 ± 1.1 points, p > 0.05). No difference was found for other clinical outcomes between the groups. The findings indicate that provision of HEHP-fortified food-service meals can increase energy and protein intake and improve the nutritional status of nutritionally at-risk older people.


2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Angel G Hilerio Lopez

Malnutrition in the older adult is an ongoing situation in Mexico and is most apparent in individuals that reside in hospitals, nursing homes, and retirement homes. For that reason, it is necessary to evaluate the nutritional status of these adults by means of the Mini Nutritional Assessment (MNA) and levels of three serum indicators that are commonly ordered when making malnutrition diagnosis. An analytical cross-sectional study was carried out on 100 older adults residing in eldercare facilities. Nutritional status was evaluated by means of the MNA and three serum indicators (albumin, ferritin, and hemoglobin). Descriptive statistics were used to analyze sociodemographic characteristics, and a Student’s t test, based on gender and reference values, was used to compare mean values of the three serum indicators.  A Chi-square test was used to compare proportions in individuals, based on gender, who had normal nutritional status or were malnourished, and who were at-risk of malnutrition.  A One-way ANOVA with Scheffé post hoc test was used to identify the association between serum indicators and nutritional status of older adults. Of the 100 older adults studied, 53% were men and 47% were women. The mean age was 85±0.7 years. According to the MNA, 20% had normal nutritional status, 55% were at-risk of malnutrition, and 25% were malnourished. The mean indicator values were: albumin 4.7±0.04 g/dL, ferritin 74.2±8.7 ng/mL, and hemoglobin 13.0±0.1 g/dL. No significant association was found between serum indicators and each MNA classification; however, when the same indicators were compared between the sexes, hemoglobin showed a significant difference (P=0.037). Women had lower values but those values did not extend beyond the established physiological range for this population. There was a 55% prevalence of risk of malnutrition in the nutritional status of older adults living in Mexican eldercare facilities in a Mexican province and it was even more frequent in women. 


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