Cynthia J. Heiss

Hydration in older adults: The contribution of bioelectrical impedance analysis

Abstract The sensory and gastrointestinal changes that occur with ageing affect older adults’ food and liquid intake. Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of bioelectrical impedance analysis to measure hydration in 19 older women in residential care: 13 who viewed themselves as healthy and six with dysphagia. Mann-Whitney U analyses documented no significant between-group differences for Total Body Water (TBW), Fat Free Mass (FFM), Fat Mass (FM), and percentage Body Fat (%BF). However, when compared to previously published data for age-matched women, the TBW and FFM values of the two participant groups were notably less, and FM and %BF values were notably greater than expected. If results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.

Postprandial Light Exercise Attenuates the Glycemic Effect of a Candy Bar

This study investigated the ability of healthy young adults to walk 30 minutes postprandially to attenuate the glycemic response to a candy bar. Seventeen volunteers had blood glucose measured at baseline, 30 minutes, and 60 minutes on 3 days. Participants walked lightly for 30 minutes postprandially on day 3. Without postprandial exercise, there was a blood glucose spike; the differences between baseline, 30-minute, and 60-minute values were significantly different (P < .01). With postprandial exercise, baseline and 30-minute values were not significantly different. In conclusion, light walking for 30 minutes postprandially can blunt the spike in blood glucose.

Associations among Visceral Obesity, Type 2 Diabetes, and Dementia

Obesity is a recognized global epidemic. Obese individuals are at increased risk for type 2 diabetes mellitus (T2DM), and both obesity and diabetes are known risk factors for dementia, another global public health issue. This paper reviews research on the link between obesity, (T2DM), and dementia, with an emphasis on visceral obesity. Some obese individuals, the metabolically healthy obese, do not appear to be at increased risk from excess body fat, but most eventually become metabolically unhealthy over time. Accumulation of visceral fat appears to be particularly problematic. Visceral obesity results in increased free fatty acid delivery to the liver, which, in turn, increases insulin resistance. Visceral obesity is associated with increased inflammatory adipokines which can promote cardiovascular disease and dementia. In addition, a long term complication of T2DM is dementia, due to the vascular complications and increased inflammatory status associated with the disease. These issues highlight the need for health professionals to work to prevent and treat obesity, especially visceral obesity, to optimize health and decrease the likelihood of developing debilitating chronic diseases such as T2DM and dementia. The Mediterranean diet may be useful in decreasing inflammation and dementia risk. Other dietary factors that reduce inflammation, insulin resistance, and cardiovascular risk (and thus dementia) independent of weight loss are addressed.

Post-Meal Exercise may Attenuate the Glycemic Response to a Carbohydrate Load: Important Implications for Adults who are Obese, with Pre-Diabetes or Diabetes, and/or At-Risk for Dementia

Obese individuals are at risk for insulin resistance and type 2 diabetes. Both obesity and diabetes are known risk factors for dementia, already a recognized global public health issue. Up to one-third of Alzheimer-type dementia may be attributed to potentially-modifiable risk factors such as the prevention of obesity and diabetes; physical exercise, particularly postmeal exercise, can play an important role in such prevention. This paper reviews research on the link between obesity and insulin resistance related to the conditions of pre-diabetes and diabetes, the consequences of elevated blood glucose (hyperglycemia) that result from a carbohydrate-rich diet and insulin resistance, the potential short and long term health consequences of elevated blood glucose, and the promising effects of post-meal exercise to stabilize blood glucose levels after consuming a carbohydrate load. Mitigating elevated blood glucose after consumption of snacks and meals in obese adults who are at-risk for, or who have diabetes, could improve glycemic control, decrease the need for medication (or decrease the dosages needed), delay the onset of long term complications of the diabetes, and decrease dementia risk. Further, facilitating stable levels of blood glucose in adults diagnosed with dementia through regular post-meal light exercise may positively affect mood and behavior, important aspects of dementia management, as well as physical health. If post-meal exercise does prove to effectively blunt the blood glucose spike after a meal, it could be a low-cost convenient method to prevent the damaging consequences of elevated blood glucose.

Methamphetamine Exposure, Iron Deficiency, and Implications for Cognitive-Communicative Function: A Case Study

Methamphetamine (meth) exposure during fetal development has the potential to adversely affect the development of multiple organ systems. An interdisciplinary case study of a 4-year 11-month-old child born to a mother addicted to meth revealed significant cognitive and communicative delays. Possible meth-related consequences for these delays included stroke in utero with associated hemiparesis and epilepsy, congenital eye dysfunction, recurrent middle ear infections, attention-deficit/hyperactivity disorder (ADHD), social adjustment problems, and parental neglect. An important additional finding was the child’s nondietary iron deficiency anemia, which could contribute to or compound meth-related behavioral problems. The influence of chronic iron deficiency anemia on cognitive-communicative function speaks to the importance of including dietitians in the interdisciplinary team assessment of children exposed to meth.