Muhammet Cemal Kizilarslanoglu

Proton Pump Inhibitors and Risk of Pneumonia in Individuals with Dementia

To the Editor: I have read the article of Ho and colleagues with great interest. They found that individuals with dementia are more prone to develop pneumonia when using long-term proton pump inhibitors (PPIs) than those not using PPIs. One of the major long-term complications of prolonged use of PPIs is pneumonia, and it is seen not only in individuals with dementia but also in all populations using long-term PPIs. I have carefully read the article, and I wonder if it is possible to add or explain some points to enhance the findings of the article. First, one of the most-common reasons for pneumonia in individuals with dementia is related to difficulty swallowing. Although dysphagia rates of individuals using PPIs and controls are available and seem to be similar between groups in a recent study, it is not clearly described whether participants’ swallowing problems were investigated using a validated swallowing test. The other point that should be considered when evaluating respiratory infections is pneumococcus and influenza vaccination rates in the study population. I wonder if the mentioned vaccines rates in the study population are available according to group. Lastly, we encounter the problem in daily clinical practice of long-term use of PPIs that, in most individuals using PPIs, there is no absolute risk for gastric protection, so I wonder if it is possible to know the indications for using PPIs in recent study populations and whether the indications are similar between patient groups.

Is it possible using handgrip strength instead of body mass index in MNA-SF test to assess the nutritional status of geriatric patients?

OBJECTIVE To explore the relationships among ethnicity/race, gender, demographics, age-group and dietary health in a nationally representative sample of older adults. DESIGN Cross-sectional study. SETTING Data for this study were collected by interview in the mobile examination centers from the National Health and Nutrition Examination Surveys, 2011 - 2012. PARTICIPANTS U.S. representative sample of adults aged 55 years and older (N = 1860) from five ethnic/racial groups. All participants read, understood, and signed informed consent forms under data collection procedures by trained individuals. MEASUREMENTS Sociodemographics were collected by trained interviewers using a general questionnaire. Food groups were determined by 24-hour recall using the validated USDA Automated Multiple-Pass Method. Data were presented by cross-tabulation and logistic regression to investigate relationships among race/ethnicity, gender, and age groups. RESULTS Over 70% of older adults failed to consume 2.75 cups of combined fruits and vegetables. Other Hispanics (Hispanics excluding Mexican Americans) had higher Odds of sugar-containing food consumption compared to non-Hispanic Whites (adjusted model). Being older and female were protective factors for over-consumption of sugar. CONCLUSION Older Americans are not meeting dietary guidelines and there are differences by gender and ethnicity. Since diet has been associated with quality of life and medical costs, public health interventions can benefit by knowing age-, gender- and racial/ethnic- specific dietary behaviors.IntroductionIn Mini-Nutritional Assessment-Short Form (MNA-SF) test, a practical and reliable alternative parameter is still necessary for patients with difficult body mass index evaluation. We aimed to show whether or not handgrip strength may be used instead of body mass index (BMI) in MNA-SF test.Materials and MethodsMNA-SF test scores, calf circumferences (CC), handgrip strength (HGS), and BMI of 191 patients were evaluated. The first one of calculated MNA-SF tests was with BMI, the second one with CC, and the last one with HGS. Zero point was given if CC was <31 cm and 3 points were given if CC was ≥31 cm. Zero, 1, 2, and 3 points were given if the loss of HGS when compared to expected HGS were ≥%60, from ≥%30 to <%60, from ≥%10 to <%30, and <%10 or greater than expected HGS, respectively. MNA-SF scores and nutritional status according to these three measures were compared.ResultsMean age and median MNA-SF scores of the patients were 75±7.6 years and 12 points (min-max: 0-14) respectively. There were strongly positive correlations between MNA-SF scores with BMI and CC, with BMI and HGS, and with CC and HGS (r=0.938 p<0.001, r=0.938 p<0.001, r=0.914 p<0.001, respectively). Substantial agreement in nutritional status of the patients were seen between MNA-SF groups with BMI and CC, with CC and HGS, and with BMI and HGS (kappa: 0.795 p<0.001, kappa: 0.709 p<0.001, and kappa: 0.760 p<0.001, respectively).ConclusionsHGS might be considered instead of BMI in MNA-SF test to assess nutritional status of geriatric patients.