H. Heseker

Energy and nutrient intake of young-old, old-old and very-old elderly in Germany

Background: Reliable information about the nutritional status of elderly people in Germany is lacking.Objective: To describe energy and nutrient intake of elderly people living in private households in Germany with special focus on age-related differences in the elderly.Design: Descriptive nationwide cross-sectional study.Setting: Germany, 1998.Subjects: A random sample of 4020 elderly men and women living independently in private households stratified in three age groups (65–74, 75–84, 85+ y), of which 1550 participated and 1372 (789 female subjects) provided reliable 3-day estimated dietary records.Results: The median daily energy intake was 2207 kcal (9.2 MJ) in men and 1994 kcal (8.3 MJ) in women without difference between the age groups. Protein intake amounted to 91 and 81 g/day, respectively, corresponding to 1.2 g/kg body weight per day. The median intake was well above the recommended amount for all nutrients except dietary fibre, calcium, vitamin D and folate, where 38, 35, 75 and 37% did not reach two-thirds of the recommended amount. An age-related decline was observed for calcium intake in male and for dietary fibre, water, calcium, magnesium, iron, vitamins A, E, C and thiamin intake in female participants; however, the overall picture was unaffected by these differences.Conclusions: Dietary intake in these independently living elderly, including the very-old, is adequate for most of the evaluated nutrients. Increased intake of foods rich in dietary fibre, calcium, vitamin D and folate as well as regular sunlight exposure is recommended in order to optimize nutrient supply in this population group.Sponsorship: German Ministry of Health.

EsKiMo – Das Ernährungsmodul im Kinder- und Jugendgesundheitssurvey (KiGGS)

In a module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the dietary behaviour of 6-17-year-olds was assessed from January to December 2006. The study, named EsKiMo (Eating Study as a KiGGS Module), was performed by the Robert Koch Institute together with the division of nutrition and consumer education at the University of Paderborn. It was funded by the Federal Ministry of Food, Agriculture and Consumer Protection. Parents of participants younger than 12 years were asked to conduct a 3-day dietary record. Participants of 12 years and older were personally interviewed about their eating behaviour during the last four weeks using DISHES (Dietary Interview Software for Health Examination Studies). In addition, they were asked to fill in the KiGGS food frequency questionnaire a second time. Furthermore, all participants were asked about their socio-demographic background, leisure time activities, supplement use, meals at school, body weight and height. The study will provide up-to-date, representative data on the nutrition of children and adolescents in Germany. The analyses will include the amounts of foods and food groups consumed as well as the nutrient intake. By connecting these nutrition data with other health data from KiGGS, comprehensive analyses of relationships between nutrition and health are possible.ZusammenfassungIm Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) wurde von Januar bis Dezember 2006 in einem Modul das Ernährungsverhalten von 6- bis 17-Jährigen erfasst. Die Studie mit dem Namen EsKiMo (Ernährungsstudie als KiGGS-Modul) wurde vom Robert Koch-Institut (RKI) gemeinsam mit der Universität Paderborn, Fachgruppe Ernährung und Verbraucherbildung, durchgeführt und vom Bundesministerium für Ernährung, Lebensmittel und Verbraucherschutz finanziert. Die Eltern der teilnehmenden Kinder unter 12 Jahren wurden gebeten, gemeinsam mit ihrem Kind ein 3-Tage-Verzehrsprotokoll zu führen. Die älteren Kinder wurden persönlich mit Hilfe von DISHES (Dietary Interview Software for Health Examination Studies) zu ihrer Ernährung in den letzten 4 Wochen befragt. Außerdem sollten sie einen bereits im KiGGS eingesetzten Ernährungsfragebogen (Food Frequency Questionnaire) ein zweites Mal ausfüllen. Zusätzlich kam bei allen Teilnehmern ein Kurzfragebogen zum Einsatz, in dem unter anderem soziodemographische Daten, Aspekte der Freizeitgestaltung, Supplementeinnahme, Verpflegung in der Schule sowie Körpergröße und -gewicht erhoben wurden. Die Studie wird aktuelle, repräsentative Daten zur Ernährung von Kindern und Jugendlichen in Deutschland liefern. Diese werden sowohl hinsichtlich der Lebensmittelverzehrsmengen als auch Nährstoffversorgung ausgewertet. Durch die Verbindung der Ernährungsdaten mit den im KiGGS erhobenen Gesundheitsdaten sind außerdem umfangreiche Analysen zum Zusammenhang zwischen Ernährung und Gesundheit möglich.AbstractIn a module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the dietary behaviour of 6–17-year-olds was assessed from January to December 2006. The study, named EsKiMo (Eating Study as a KiGGS Module), was performed by the Robert Koch Institute together with the division of nutrition and consumer education at the University of Paderborn. It was funded by the Federal Ministry of Food, Agriculture and Consumer Protection. Parents of participants younger than 12 years were asked to conduct a 3-day dietary record. Participants of 12 years and older were personally interviewed about their eating behaviour during the last four weeks using DISHES (Dietary Interview Software for Health Examination Studies). In addition, they were asked to fill in the KiGGS food frequency questionnaire a second time. Furthermore, all participants were asked about their socio-demographic background, leisure time activities, supplement use, meals at school, body weight and height. The study will provide up-to-date, representative data on the nutrition of children and adolescents in Germany. The analyses will include the amounts of foods and food groups consumed as well as the nutrient intake. By connecting these nutrition data with other health data from KiGGS, comprehensive analyses of relationships between nutrition and health are possible.

[EsKiMo - the nutrition module in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)].

In a module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the dietary behaviour of 6-17-year-olds was assessed from January to December 2006. The study, named EsKiMo (Eating Study as a KiGGS Module), was performed by the Robert Koch Institute together with the division of nutrition and consumer education at the University of Paderborn. It was funded by the Federal Ministry of Food, Agriculture and Consumer Protection. Parents of participants younger than 12 years were asked to conduct a 3-day dietary record. Participants of 12 years and older were personally interviewed about their eating behaviour during the last four weeks using DISHES (Dietary Interview Software for Health Examination Studies). In addition, they were asked to fill in the KiGGS food frequency questionnaire a second time. Furthermore, all participants were asked about their socio-demographic background, leisure time activities, supplement use, meals at school, body weight and height. The study will provide up-to-date, representative data on the nutrition of children and adolescents in Germany. The analyses will include the amounts of foods and food groups consumed as well as the nutrient intake. By connecting these nutrition data with other health data from KiGGS, comprehensive analyses of relationships between nutrition and health are possible.ZusammenfassungIm Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) wurde von Januar bis Dezember 2006 in einem Modul das Ernährungsverhalten von 6- bis 17-Jährigen erfasst. Die Studie mit dem Namen EsKiMo (Ernährungsstudie als KiGGS-Modul) wurde vom Robert Koch-Institut (RKI) gemeinsam mit der Universität Paderborn, Fachgruppe Ernährung und Verbraucherbildung, durchgeführt und vom Bundesministerium für Ernährung, Lebensmittel und Verbraucherschutz finanziert. Die Eltern der teilnehmenden Kinder unter 12 Jahren wurden gebeten, gemeinsam mit ihrem Kind ein 3-Tage-Verzehrsprotokoll zu führen. Die älteren Kinder wurden persönlich mit Hilfe von DISHES (Dietary Interview Software for Health Examination Studies) zu ihrer Ernährung in den letzten 4 Wochen befragt. Außerdem sollten sie einen bereits im KiGGS eingesetzten Ernährungsfragebogen (Food Frequency Questionnaire) ein zweites Mal ausfüllen. Zusätzlich kam bei allen Teilnehmern ein Kurzfragebogen zum Einsatz, in dem unter anderem soziodemographische Daten, Aspekte der Freizeitgestaltung, Supplementeinnahme, Verpflegung in der Schule sowie Körpergröße und -gewicht erhoben wurden. Die Studie wird aktuelle, repräsentative Daten zur Ernährung von Kindern und Jugendlichen in Deutschland liefern. Diese werden sowohl hinsichtlich der Lebensmittelverzehrsmengen als auch Nährstoffversorgung ausgewertet. Durch die Verbindung der Ernährungsdaten mit den im KiGGS erhobenen Gesundheitsdaten sind außerdem umfangreiche Analysen zum Zusammenhang zwischen Ernährung und Gesundheit möglich.AbstractIn a module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the dietary behaviour of 6–17-year-olds was assessed from January to December 2006. The study, named EsKiMo (Eating Study as a KiGGS Module), was performed by the Robert Koch Institute together with the division of nutrition and consumer education at the University of Paderborn. It was funded by the Federal Ministry of Food, Agriculture and Consumer Protection. Parents of participants younger than 12 years were asked to conduct a 3-day dietary record. Participants of 12 years and older were personally interviewed about their eating behaviour during the last four weeks using DISHES (Dietary Interview Software for Health Examination Studies). In addition, they were asked to fill in the KiGGS food frequency questionnaire a second time. Furthermore, all participants were asked about their socio-demographic background, leisure time activities, supplement use, meals at school, body weight and height. The study will provide up-to-date, representative data on the nutrition of children and adolescents in Germany. The analyses will include the amounts of foods and food groups consumed as well as the nutrient intake. By connecting these nutrition data with other health data from KiGGS, comprehensive analyses of relationships between nutrition and health are possible.

Malnutrition is related to functional impairment in older adults receiving home care

ObjectivesThe aims of this work were (a) to provide a detailed description of the association between nutritional (Mini Nutritional Assessment; MNA®) and functional status in a sample of older adults receiving home care, using both questionnaire- and performance-based functional methods, and (b) to investigate the impact of different MNA subscales on this association.DesignMulti-centre, cross-sectional.SettingHome care.Participants296 persons ≥65 years in need of care (80.7±7.7 y).MeasurementsNutritional status was determined by the MNA and functional status by two questionnaires (Instrumental and Basic Activities of Daily Living; IADL, ADL) and three performance tests (handgrip strength, HGS; Short Physical Performance Battery, SPPB; Timed ‘Up and Go’ Test, TUG). A categorical and a covariance analytical approach were used to test for differences in functional status between MNA groups (well nourished, risk of malnutrition, malnourished). In addition, functional parameters were correlated with total MNA, a modified MNA version (modMNA), where functional items were excluded, and MNA subscales (‘functionality’, ‘general assessment’, ‘anthropometry’, ‘dietary assessment’, and ‘subjective assessment’).Results57% of the participants were at risk of malnutrition and 12% malnourished. 35% reported severe limitations in IADL, 18% in ADL. 40%, 39% and 35% had severe limitations in HGS, SPPB and TUG; 9%, 28% and 34% were not able to perform the tests. Functional status deteriorated significantly from the well nourished to the malnourished group in all functional measures. The modMNA was weak but still significantly related to all functional parameters except TUG. The subscale ‘functionality’ revealed strongest correlations with functional measures. All other MNA subscales showed only weak or no associations.ConclusionMore than one half of the seniors receiving home care were at nutritional risk and poor functional level, respectively. Malnutrition according to MNA was significantly associated to both questionnaire- and performance-based functional measures even after exclusion of functional MNA items.

Institutional factors associated with the nutritional status of residents from 10 German nursing homes (ErnSTES study).

ObjectivesIn nursing homes malnutrition among residents is widespread. Because residents place part of their personal freedom of choice into institutional hands, institution-specific factors may influence nutritional status of residents.DesignMulti-centre cross-sectional study.Setting10 nation-wide German nursing homes.Participants714 exclusively orally fed residents (aged 65 years and older, not in final weeks of life).MeasurementsParticipants’ characteristics (e. g. gender, age, level of care, dementia diagnosis), body mass index (BMI), mini nutritional assessment (MNA), energy intake (3-day dietary record, BLS II.3), and selected institution-specific factors (size of institution, daily rate for food supply, number of residents per care staff member). Metric data are given as median (P25, P75).Results11 % of residents (81 % female, 85 (81, 91) years) had a BMI <20 kg/m2 (n=658). According to MNA, 10 % of the residents were malnourished (n=650). Capacity of institutions was 116 (56, 139) beds, care staff ratio was 4.1 (3.5, 4.2) residents per care person (mean over all care levels), and daily food budget was 4.45 (4.10, 4.71) Euro/d. Low daily food budget was associated with a higher risk for a BMI <20 kg/m2 (OR 3.30 [95 %CI 1.70–6.42]). Higher food budget also decreased malnutrition risk (OR 0.66 [0.46–0.95]) according to MNA. Residents’ mean energy intake was 6.1 (5.2, 7.1; n=565) MJ/day in women and 7.1 (6.2, 8.2; n=132) MJ/day in men. Intake was higher with small facility size, higher food budget, and lower care staff ratio (P <0.05).ConclusionThe institutional environment affects the nutritional status of nursing home residents as an independent risk factor. The results suggest promotion of small facilities and the provision of more care staff and more financial resources for food in the structural design of residential homes.

Revised D-A-CH intake recommendations for folate: how much is needed?

The D-A-CH reference value (D-A-CH arises from the initial letters of the common country identification for the countries Germany (D), Austria (A) and Switzerland (CH)) for folate equivalents had been set at 400 μg/d for adults in the year 2000. By that time, the prevention of cardiovascular diseases through reduction of homocysteine was considered an important target of the reference value. Since that time a number of research papers revealed that in spite of an inverse association between folate-rich diet and chronic diseases, a preventive effect of folic acid intake on cardiovascular events was not supported by randomized controlled trials, and the reduction of plasma homocysteine levels to around 10–12 μmol/l did not reduce the risk for thromboembolic and cardiovascular diseases in persons already affected by these diseases. These results together with the observation that folate intakes below 400 μg/d result in a sufficient folate status justified a review of the current literature and—consequently—a reduction of the reference value to 300 μg/d for adults. This reference value is expressed as dietary folate equivalents that take into account the difference in bioavailability between folic acid and all types of folates in food. The recommendation to take a daily supplement of 400 μg of synthetic folic acid for women who intend to get pregnant and until the end of the first trimester of pregnancy is maintained.

Prognostic Differences of the Mini Nutritional Assessment Short Form and Long Form in Relation to 1-Year Functional Decline and Mortality in Community-Dwelling Older Adults Receiving Home Care

To compare the prognostic value of the revised Mini Nutritional Assessment short form (MNA‐SF) classification with that of the long form (MNA‐LF) in relation to mortality and functional change in community‐dwelling older adults receiving home care in Germany.

Folic Acid and Other Potential Measures in the Prevention of Neural Tube Defects

Neural tube defects (NTD) are common congenital malformations leading to severe disability or even death. The causes of NTD are multifactorial, including genetic predisposition, nutritional and environmental risk factors, and other maternal conditions. Some countries have introduced mandatory or at least voluntary folic acid fortification as an effective measure to reduce NTD, whereas others support periconceptional supplementation of women of childbearing age. Countries with mandatory fortification achieved a significant increase in folate intake and a significant decline in the prevalence of NTD. This was also true for supplementation trials. However, the magnitude of the decline depends on the initial NTD rate. This review clearly shows that not all cases of NTD can be prevented by increasing the folate intake. Other relevant causes of NTD, which are largely disregarded, have also to be taken into account in research and consultation to reduce the risk and economic burden of NTD.

Abschätzung der Aufnahme von Pflanzenschutzmittel-Rückständen in der Nahrung mit neuenVerzehrsmengen für Kinder

ZusammenfassungDie Abschätzung der Aufnahme von Pflanzenschutzmittel-Rückständen über die Nahrung stellt die Grundlage der Risikobewertung von Rückständen für die Verbraucher dar. Auf der Basis einer bundesweiten Verzehrsstudie wurden neue Modelle zur Abschätzung von Lang- und Kurzzeitaufnahmemengen für Kinder von 2 bis unter 5 Jahren entwickelt, um die Risikobewertung von Rückständen realistisch und aktuell zu gestalten. Die empfohlenen Methoden werden vorgestellt und an Beispielen erläutert. Die Modelle sollen die bisherigen Abschätzungsverfahren auf nationaler Ebene ersetzten.AbstractThe risk assessment of pesticide residues is based on the estimation of their dietary intake. Models based on a new national consumption survey were developed to estimate the short- and long-term dietary intake of pesticide residues for children from 2 to under 5 years, allowing a realistic risk assessment to be made. The recommended methods are described. At the national level, the new models shall replace the previous methods for evaluating dietary intake.

Energy and Protein Intake, Anthropometrics, and Disease Burden in Elderly Home-care Receivers--A Cross-sectional Study in Germany (ErnSIPP Study).

ObjectiveTo date, no study has examined the nutritional status and disease burden of elderly home-care receivers living in Germany. Aim of this cross-sectional study was, first, to assess disease burden and nutritional status, denoted in anthropometrics, and, second, to investigate associations between anthropometrics and disease burden.DesignCross-sectional multi-centre study.SettingHome-care receivers living in three urban areas of Germany in 2010.Participants353 elderly (>64 years) in home care (128 males aged 79.1 ±7.8 years, 225 females aged 82.0 ±7.5 years).MeasurementsNutritional status was assessed by body mass index (BMI), mid upper arm circumference (MUAC) and calf circumference (CC). Medical conditions were assessed in personal interviews. A 3-day prospective nutrition diary was kept. Metric data are reported as mean±SD or median (interquartile range), p<0.05 was considered significant.ResultsMost participants were substantially (59%), and 11% severest in need of care. The seniors suffered from 5 (4–7) chronic diseases; dementia, depression, stroke, and respiratory illness were most prevalent (each 20–40%). More than one-third of participants had only moderate or poor appetite, nearly half were unable to eat independently. Chewing problems were reported for 52% of study participants, and more than one quarter of elderly had swallowing problems. Daily mean energy intake was 2017±528 kcal in men (n=123) and 1731±451 kcal in women (n=216; p<0.001). Mean protein intake amounted to 1.0 g/kg body weight. Mean BMI was 28.2±6.2 kg/m2 (n=341), 14% of seniors had a BMI <22 kg/m2 (including 4% with BMI <20 kg/m2). Critical MUAC (<22 cm) was indicated in 6% of subjects; and CC <31 cm in 11% of men, 21% of women (p<0.05). After adjusting for sex and age, BMI, MUAC and CC were negatively associated with high care level, hospitalization in the previous year, nausea/vomiting, prevalence of dementia, poor appetite, and eating difficulties like dependency, chewing and swallowing problems.ConclusionWe recommend to pay special attention to the nutritional status of elderly persons in home-care exhibiting named disease burden.