María Paz Redondo del Río

Bioimpedance vector analysis and conventional bioimpedance to assess body composition in older adults with dementia

OBJECTIVE Although dementia and nutritional status have been shown to be strongly associated, differences in body composition (BC) among older people with dementia have not yet been firmly established. The aim of this study was to assess BC through conventional and vector bioimpedance analysis (BIA and BIVA, respectively) in a sample of institutionalized older men with and without dementia, in order to detect dementia-related BC changes. METHODS Forty-one institutionalized men ages ≥ 65 y (23 without dementia [CG] and 18 with dementia [DG]) were measured with BIA and interpreted with BIVA and predictive equations. RESULTS Age (74.4 and 75.7 y) and body mass index (22.5 and 23.6 kg/m(2)) were similar for DG and CG, respectively. Resistance and ratio of resistance to height did not differ significantly between the two groups. Reactance and ratio of reactance to height were 21.2% and 20.4% lower in DG than in CG. Phase angle was significantly lower in DG (mean = 4.0; 95% confidence interval [CI], 3.6°-4.3°) than in CG (mean = 4.7; 95% CI, 4.3°-5.1°). Mean fat mass index (6 and 7 kg/m(2)), and mean fat-free mass index (16.4 and 16.6 kg/m(2)) were similar in both groups. BIVA showed a significant downward migration of the ellipse in DG with respect to CG (T(2) = 15.1; P < 0.01). CONCLUSION Conventional BIA showed no significant differences in BC between DG and CG, although reactance and ratio of reactance to height were about 21% lower in DG. Nevertheless, a body cell mass depletion and an increase in the ratio of extracellular to intracellular water were identified in DG using BIVA. BIVA reflects dementia-related changes in BC better than BIA.

Nutritional approach of inpatients with anorexia nervosa

Anorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way.

The Importance of Nutritional Assessment in Institutionalized Elderly with Dementia: Malnutrition, Early Detection

Malnutrition is a highly prevalent geriatric syndrome in the elderly with dementia, especially in institutionalized patients and in subjects in advanced stages of the illness. In order to both diagnose and treat it correctly, it is necessary to make a two-phase nutritional assessment: first, nutritional screening and, second, a complete nutritional assessment, which will be carried out when risk of malnutrition or malnutrition itself is detected by the former. Nutritional screening should be systematically included in the comprehensive nutritional assessment. It also should be periodically repeated as part of the follow-up of geriatric patients, both institutionalized individuals and outpatients. Comprehensive nutritional assessment is the basis for nutritional diagnosis and also the starting point for dietary and nutritional interventions adapted to patient needs. This type of assessment must include a clinical and nutritional history, a physical examination focused on the detection of signs and symptoms of nutritional alterations, an anthropometric and body composition assessment, as well as laboratory tests and suitable complementary examinations in each case. No single nutritional measure is considered a gold standard to make nutritional diagnoses, so all the parameters of the nutritional assessment should be interpreted jointly.