Rita Guerra

Hand length as an alternative measurement of height

Background/objectives:Despite the utmost importance of body height in evaluating nutritional status, it is not always possible to obtain its measurement and height may have to be estimated. The objective of the study was to formulate and cross-validate a regression equation to predict height using hand length measurement and also to determine if predicted height (PH) will lead to significant errors when used in body mass index (BMI) calculation.Subjects/methods:A cross-sectional study was conducted using a consecutive sample of 465 inpatients (19–91 years), from a university hospital. Participants were randomly divided into a development sample of 311 individuals and a cross-validation one. A linear regression model was used to formulate the equation. Intraclass correlation coefficients (ICCs) for single measures and differences between measured height (MH) and PH and between BMI calculated with MH (BMIMH) and with PH (BMIPH) were determined.Results:The regression equation for PH is: PH (cm)=80.400+5.122 × hand length (cm)—0.195 × age (years)+6.383 × gender (gender: women 0, men 1) (R=0.87, s.e. of the estimate=4.98 cm). MH and PH were strongly correlated, ICCs: 0.67-0.74 (P<0.001). Differences were small, mean difference±s.d., ⩽−0.6±4.4 cm (P⩾0.24). BMIMH and BMIPH were strongly correlated, ICCs: 0.94-0.96 (P<0.001). Differences were small, ⩽0.3±1.7 kg/m2 (P⩾0.10).Conclusions:The formulated regression equation using hand length, age and gender provides a valid estimation of height and is useful in the clinical context. PH from this regression equation can be used in BMI calculations as misclassification is small.

Financial impact of sarcopenia on hospitalization costs

Background/Objectives:This study aims to increase knowledge regarding the association of sarcopenia with hospitalization costs among a wide-ranging sample of adult hospitalized patients.Subjects/Methods:A prospective study was conducted among hospitalized adult patients. Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People, as low muscle mass, assessed by bioelectrical impedance analysis and low muscle function evaluated by handgrip strength. Hospitalization cost was calculated for each patient based on discharge diagnosis-related group codes and determined on the basis of a relative weight value. Costs were defined as the percentage of deviation from the cost of a patient with a relative weight equal to one. Multivariable linear regression models were performed to identify the factors independently associated with hospitalization costs.Results:A total of 656 hospitalized patients aged ⩾18 years (24.2% sarcopenic) composed the study sample. Sarcopenia increased hospitalization costs by [euro ]1240 (95% confidence interval (CI): [euro ]596–1887) for patients aged <65 years and [euro ]721 (95% CI: [euro ]13–1429) for patients aged ⩾65 years. Sarcopenic overweight was related to an increase in hospitalization costs of [euro ]884 (95% CI: [euro ]295–1476).Conclusions:Sarcopenia is independently related to hospitalization costs. This condition is estimated to increase hospitalization costs by 58.5% for patients aged <65 years and 34% for patients aged ⩾65 years.

Sarcopenia among hospitalized patients – A cross-sectional study

BACKGROUND & AIMS Data on the prevalence of sarcopenia among hospitalized older patients are scarce and there is no available information on the burden of sarcopenia among younger patients. The present study aims to increase the knowledge about the frequency of sarcopenia among hospitalized patients and to evaluate the influence of different diagnostic criteria in these estimates. METHODS A cross-sectional study was conducted in hospitalized adult patients. Sarcopenia was defined, according to the European Working Group on Sarcopenia in Older People (EWGSOP), as the presence of both low muscle mass, assessed by Bioelectrical Impedance Analysis (BIA), adjusted for height, and low muscle function (hand grip strength). Two other criteria were applied, also using hand grip strength for evaluating muscle function, one that also assessed muscle mass by BIA, but adjusted for weight, and another which estimated muscle mass based on mid-arm muscle circumference. Nutritional status was evaluated by Patient-Generated Subjective Global Assessment. The degree of agreement between the different diagnostic criteria was assessed using kappa. Multivariable logistic regression models were used in order to identify factors associated with sarcopenia. RESULTS 608 hospitalized adult patients aged ≥18 years composed the study sample. According to EWGSOPs criteria, 25.3% patients were sarcopenic. However, depending on age and on the applied criteria, frequency of sarcopenia varied from 5% to 41.1% for men and from 4.9% to 38.3% for women. There was 95.7% (k = 0.89) agreement between criteria that estimated muscle mass by BIA. According to EWGSOP criteria approximately 20% of the non-undernourished patients were sarcopenic. Furthermore, 29.5% of overweight and 18.7% of obese patients were sarcopenic. Factors associated with sarcopenia were male gender, age ≥65 years, moderate or severe dependence, being undernourished and admitted to a medical ward. CONCLUSIONS Sarcopenia is frequent among hospitalized patients and varies widely depending on the applied diagnostic criteria. Sarcopenia was identified in a considerable proportion of patients aged under ≥65 years and in non-undernourished, namely among overweight and obese.

ESPEN diagnostic criteria for malnutrition - A validation study in hospitalized patients.

BACKGROUND & AIMS The European Society for Clinical Nutrition and Metabolism (ESPEN) released a consensus statement for undernutrition diagnosis: ESPEN diagnostic criteria for malnutrition (EDC). The EDC lacks validation and therefore, the present study aims to assess the concurrent and predictive validity of this tool in a cohort of inpatients. METHODS A prospective observational study took place in a university hospital. Concurrent validity of EDC was evaluated using the Patient Generated Subjective Global Assessment (PG-SGA) nutrition status classification as the reference method. Sensitivity, specificity, positive and negative predictive values were determined. The EDC predictive validity was assessed by its independent association with length of hospital stay (LOS), applying Cox proportional hazards ratio method. RESULTS Of the 632 included patients, 455 participants (72%) were nutritionally-at-risk (Nutritional Risk Screening initial screening). For those that had screened positive, 260 (57.1%) and 55 participants (12.1%) were undernourished according to PG-SGA and to EDC, respectively. Compared to PG-SGA, the EDC revealed a sensitivity of 17.1% and a specificity of 98.3%. Positive and negative predictive values were respectively 89.1% and 58.9%. Undernutrition evaluated by EDC was independently associated with lower hazard ratio for being discharged home over time, 0.695 (95% confidence interval: 0.509; 0.950). CONCLUSIONS The EDC could be used in clinical settings to confirm undernutrition suggested by other methods. The independent association of undernutrition by EDC with LOS shows this method is of clinical relevance.

Nutritional Strategies Facing an Older Demographic: The Nutrition UP 65 Study Protocol

Background The population of Portugal is aging. The lack of data on older adults’ nutritional status and the lack of nutrition knowledge amongst health professionals, caregivers, and older adults themselves, remains a challenge. Objective The Nutrition UP 65 study aims to reduce nutritional inequalities in the older Portuguese adult population and improve knowledge regarding older Portuguese adults’ nutritional status, specifically relating to undernutrition, obesity, sarcopenia, frailty, hydration, sodium, and vitamin D statuses. Methods A representative sample of older Portuguese adults was selected. Sociodemographic, lifestyle, anthropometric, functional, and clinical data were collected. Sodium excretion, hydration, and vitamin D statuses were assessed. Results Data collection (n=1500) took place between December, 2015 and June, 2016. Results will be disseminated in national and international scientific journals, and via Portuguese media. Conclusions Nutrition UP 65 results will provide evidence for the design and implementation of effective preventive public health strategies regarding the elderly. These insights may represent relevant health gains and costs savings.

Accuracy of a digital skinfold system for measuring skinfold thickness and estimating body fat.

The use of skinfold thickness measurements to evaluate the distribution of subcutaneous adipose tissue and to predict body fat has recognised advantages. However, the different types of skinfold calliper available present limitations that make them unattractive and perhaps less used in daily practice. The purpose of the present study was to evaluate the accuracy and functionality of a new digital skinfold system, the Liposoft 2008+Adipsmeter V0 (LA), for measuring skinfold thickness and determining body fat proportion (%BF). Skinfold thickness measurements made by the LA were compared with those obtained with a Harpenden (H) calliper from two samples of adults (n 45) and older adults (n 56) in a university-based cross-sectional study. A comparison was also conducted between estimated %BF from skinfolds and dual-energy X-ray absorptiometry. Bland and Altman plots show that skinfolds measured by the LA and H calliper are in high agreement, with a mean difference of 0·3 (95% CI -3·1, 3·4) mm. In regard to the %BF estimated from LA and H skinfolds measurement, the LA produced a similar approximation to dual-energy X-ray absorptiometry %BF, with a mean difference of 0·2 (95% CI -0·8, 1·2) %, compared with %BF obtained with the H calliper. The LA system is an accurate instrumentation and represents an innovation in the evaluation of skinfold thickness and body composition based on anthropometric measurement.

Sarcopenia and length of hospital stay

Background/objectives:We aimed to quantify the association of sarcopenia with length of hospital stay (LOS) and to identify factors associated with sarcopenia among hospitalized patients.Subjects/methods:A total of 655 patients composed the study sample. A longitudinal study was conducted in a University Hospital. Sarcopenia was defined, according to European Consensus criteria, as low muscle mass (bioelectrical impedance analysis) and low muscle function (handgrip strength). Logistic regression, Kaplan–Meier and Cox adjusted proportional hazards methods were used. LOS was determined from the date of hospital admission and discharge home (event of interest).Results:Participants were aged 18 to 90 years (24.3% sarcopenic). Factors associated with sarcopenia were male gender, age ⩾65 years, moderate or severe dependence, undernutrition and being admitted to a medical ward. Sarcopenic patients presented a lower probability of being discharged home (hazard ratio (HR), 95% confidence interval (CI)=0.71, 0.58–0.86). However, after stratifying for age groups, this effect was visible only in patients aged <65 years (HR, 95% CI= 0.66, 0.51–0.86). Moreover, sarcopenic overweight or obese patients presented a higher probability of being discharged home (HR, 95% CI=0.78, 0.61–0.99) than nonoverweight sarcopenic patients (HR, 95% CI=0.63, 0.48–0.83).Conclusions:Being male, age ⩾65 years, presenting dependence, being undernourished and admitted to a medical ward were factors associated with sarcopenia among hospitalized adult patients. Sarcopenia is independently associated with longer LOS, although this association is stronger for patients aged <65 years. Moreover, sarcopenic overweight was associated with a higher probability of discharge home than nonoverweight sarcopenia.

Anatomical location for waist circumference measurement in older adults; a preliminary study

BACKGROUND AND OBJECTIVE Different anatomical locations for measuring waist circumference are described in the literature but the best anatomical location for measuring waist circumference in older adults has yet to be established. Thus, an exploratory study was developed to examine which waist circumference best explains abdominal fat mass in older adults. METHODS Waist circumference was measured in the ten different anatomical locations from a sample of 51 older adults. The choice of which waist circumference measurement best associated with abdominal fat mass was evaluated with dual-energy X-ray absorptiometry (DXA) measurement of abdominal fat. RESULTS Mean waist circumference values varied from 81.9 (standard deviation (SD): 8.7) cm and 91.5 (SD: 11.2) cm for women and between 95.7 (SD: 8.2) cm and 101.5 (SD: 10.4) cm for men, according to the different anatomical locations. The coefficients of determination of the linear regression model varied from 0.545 to 0.698 (p < 0.001) and the standardised coefficients varied from 0.738 and 0.836 (p < 0.001). The anatomical landmark situated 2.5 cm above the umbilicus was the waist circumference measurement that associated best with abdominal fat mass measured by DXA. CONCLUSION This exploratory study contributes to the recognition that the anatomical location where the waist circumference measurement is taken gives considerably different results. The waist circumference measurement 2.5 cm above the umbilicus was the best surrogate measure of abdominal fat in this older adults sample.

Vitamin D status and associated factors among Portuguese older adults: results from the Nutrition UP 65 cross-sectional study

Objectives To evaluate vitamin D status and its associated factors in Portuguese older adults from the Nutrition UP 65 study. Design Cross-sectional observational study. Participants and methods Nationwide cluster sample of 1500 Portuguese subjects ≥65 years old. Participants were classified, according to US Institute of Medicine cut-offs, as presenting normal 25-hydroxyvitamin D (25(OH)D) levels (≥50.0 nmol/L), at risk of inadequacy (30.0–49.9 nmol/L) or at risk of deficiency (<30 nmol/L). The association between individuals’ characteristics and 25(OH)D levels was analysed through multinomial logistic regression analysis. Results Median 25(OH)D serum value was 36.1 (interquartile range (IQR): 35.5) nmol/L. According to the used cut-offs, 39.6% of participants were at risk of 25(OH)D deficiency and 29.4% were at risk of 25(OH)D inadequacy. In the adjusted model, having higher skin pigmentation and waist circumference >88 cm for women and >102 cm for men were associated with higher odds of 25(OH)D deficiency. Otherwise, living in Lisbon Metropolitan Area and in Madeira, 1–12 years of schooling, being married or in a common-law marriage, monthly income ≥€1000, alcohol consumption, medication or supplements with vitamin D supplement use, and blood samples collected in spring or summer were associated with lower odds of being at risk of 25(OH)D deficiency. In this model, season of blood sample collection, medication or supplements use, and waist circumference were the factors more strongly associated with 25(OH)D levels. Conclusions Despite using the conservative Institute of Medicine cut-offs, over two-thirds of these study participants presented inadequate 25(OH)D levels, warranting the implementation of corrective measures. Potentially modifiable factors were strongly associated with 25(OH)D levels in this study. These findings may be particularly relevant to the development of public health policies in southern European countries.

Impact of Nutritional Supplementation and a Psychomotor Program on Patients With Alzheimer’s Disease:

This study aims to evaluate the impact of oral nutritional supplementation (ONS) and a psychomotor rehabilitation program on nutritional and functional status of community-dwelling patients with Alzheimer’s disease (AD). A 21-day prospective randomized controlled trial was conducted and third intervention group performed a psychomotor rehabilitation program. Patients were followed up for 180 days. Mean (standard deviation) score of Mini Nutritional Assessment (MNA) increased both in the nutritional supplementation group (NSG; n = 25), 0.4 (0.8), and in the nutritional supplementation psychomotor rehabilitation program group (NSPRG; n = 11), 1.5 (1.0), versus −0.1 (1.1) in the control group (CG; n = 43), P < .05. Further improvements at 90-day follow-up for MNA in NSG: 1.3 (1.2) and NSPRG: 1.6 (1.0) versus 0.3 (1.7) in CG (P < .05) were observed. General linear model analysis showed that the NSG and NSPRG ▵MNA score improved after intervention, at 21 days and 90 days, was independent of the MNA and Mini-Mental State Examination scores at baseline (Ps > .05). The ONS and a psychomotor rehabilitation program have a positive impact on long-term nutritional and functional status of patients with AD.