Satu K. Jyväkorpi

Nutritional guidelines for older people in Finland

BackgroundAgeing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people’s health, functional capacity and quality of life.ObjectiveTo identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland.DesignA review of the existing literature on older people’s nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland.ResultsThe heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4.The use of a vitamin D supplement (20 μg per day) recommended. 5.The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted.ConclusionsOwing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

Nutritional treatment of aged individuals with Alzheimer disease living at home with their spouses: study protocol for a randomized controlled trial

BackgroundNutritional status often deteriorates in Alzheimer’s disease (AD). Less is known about whether nutritional care reverses malnutrition and its harmful consequences in AD. The aim of this study is to examine whether individualized nutritional care has an effect on weight, nutrition, health, physical functioning, and quality of life in older individuals with AD and their spouses living at home.MethodsAD patients and their spouses (aged >65 years) living at home (n = 202, 102 AD patients) were recruited using central AD registers in Finland. The couples were randomized into intervention and control groups. A trained nutritionist visited intervention couples 4–8 times at their homes and the couples received tailored nutritional care. When necessary, the couples were given protein and nutrient-enriched complementary drinks. All intervention couples were advised to take vitamin D 20 μg/day. The intervention lasted for one year. The couples of the control group received a written guide on nutrition of older people. Participants in the intervention group were assessed every three months. The primary outcome measure is weight change. Secondary measures are the intake of energy, protein, and other nutrients, nutritional status, cognition, caregiver’s burden, depression, health related quality of life and grip strength.DiscussionThis study provides data on whether tailored nutritional care is beneficial to home-dwelling AD patients and their spouses.Trial registrationACTRN 12611000018910

Nutritional guidance improves nutrient intake and quality of life, and may prevent falls in aged persons with Alzheimer disease living with a spouse (NuAD trial)

ObjectiveThe aim was to examine the effect of tailored nutritional guidance on nutrition, health-related quality of life (HRQoL) and falls in persons with Alzheimer disease (AD).DesignRandomised controlled trial.Setting and ParticipantsPersons with AD living with a spouse.InterventionTailored nutritional guidance with home visits during one year. The control group received a written guide about nutrition in older adults and all community-provided normal care.MeasurementsThe primary outcome measure was weight change, and secondary outcomes included changes in protein and micronutrient intakes from three-day food records, HRQoL (15D) and rate of falls.ResultsOf the participants (n = 78) with AD (mean age 77.4, 69% males), 40% were at risk for malnutrition, 77% received < 1.2 g/bodyweight (kg) of protein at baseline. We found no difference in weight change between the groups. At 12 months, the mean change in protein intake was 0.05 g/bodyweight (kg) (95% CI −0.06 to 0.15) in the intervention group (IG), and −0.06 g/kg (95% CI −0.12 to 0.02) in the control group (CG) (p = 0.031, adjusted for baseline value, age, sex, MMSE and BMI). Participants’ HRQoL improved by 0.006 (95% CI −0.016 to 0.028) in the IG, but declined by −0.036 (95% CI −0.059 to 0.013) in the CG (p = 0.007, adjusted for baseline value, age, sex, MMSE and BMI). Dimensions that differed included mental functioning, breathing, usual activities and depression. The fall rate was 0.55 falls/person per year (95% CI 0.34 to 0.83) in the IG, and 1.39 falls/person per year (95% CI 1.04 to 1.82) in the CG (IRR 0.55; 95% CI 2.16 to 6.46; p < 0.001 adjusted for age, sex and MMSE).ConclusionsTailored nutritional guidance improves nutrition and HRQoL, and may prevent falls among AD people living with a spouse.

Low protein and micronutrient intakes in heterogeneous older population samples.

BACKGROUND Malnutrition is associated with comorbidities and functional decline among older people. Less is known about nutrient intakes across heterogeneous older populations. OBJECTIVE We examined nutritional status and nutrient intakes in different samples of older people representing broad spectrum of healthy and frail populations. We evaluated adequacy of their energy, protein and micronutrient intakes in comparison to recommendations. DESIGN AND PARTICIPANTS Cross-sectional study combined five datasets: home-dwelling older people participating in nutrition education and cooking classes (NC) [n=54], participants from Helsinki Businessmen Study [n=68], home-dwelling people with Alzheimer disease (AD) [n=99] and their spousal caregivers (n=97), participants from Porvoo Sarcopenia and Nutrition Trial (n=208), and residents of Helsinki assisted living facilities (ALF) [n=374]. Nutritional status was assessed using Mini Nutritional Assessment and nutrient intakes retrieved from 1 to 3 day food records. RESULTS Those suffering most from mobility limitation and cognitive decline had the poorest nutritional status (p<0.001; adjusted for age, sex, comorbidities). However, low intakes of energy, protein, and micronutrients were observed in high proportion in all groups, inadequate intakes of vitamins D, E, folate, and thiamine being most common. Protein intakes did not differ between the groups, but 77% of all participants had lower than recommended protein intake. In general, the NC group had highest micronutrient intakes and the ALF group the lowest. However, AD females had the lowest energy, protein, and vitamin C intakes. CONCLUSIONS Our study provides a detailed picture of risks related to nutrient intakes in various groups of older people. These findings could be used in planning tailored nutrition interventions.

High proportions of older people with normal nutritional status have poor protein intake and low diet quality.

INTRODUCTION The Mini Nutritional Assessment (MNA) is a well-validated instrument examining the nutritional status of older people. The aim of this study was to examine how older peoples energy and nutrient intakes are associated with the MNA and to determine how sensitive and specific MNA is in identifying those having low energy and protein intakes. MATERIALS AND METHODS This cross-sectional study combined data from five nutritional studies (N=900): both home-dwelling and institutionalized older people without and with disabilities. Their nutritional status was assessed with MNA, and nutrient intakes were retrieved from 1 to 3day food diaries. Nutrient intakes were divided according to MNA status (normal nutritional status, at-risk of malnutrition, malnourished). Sensitivity, specificity, and likelihood ratios of MNA of various cut-off points were tested with recommended protein and energy intakes. ROC curves was constructed. RESULTS Energy, protein and most nutrient intakes showed logical linear trends according to MNA classes. However, more than three-fourths of the participants with MNA>23.5 had lower than recommended protein intakes. Sensitivity of MNA ranged from 0.32 to 0.82 for recommended energy (F:1570kcal/d/M:2070kcal/d) and protein intakes (1.0g/kg BW or 1.2g/kgBW) cut-off points, and specificity from 0.75 to 0.25, respectively. AUC values were low (0.52-0.53). CONCLUSIONS MNA status was consistently associated with nutrient intakes and diet quality. However, a high proportion of older people even with normal nutritional status had poor energy and protein intakes. Thus, MNA does not identify all those with poor nutrient intakes who may be at risk of developing malnutrition.

Iron Nutrition in Schoolchildren of Western Mexico: The Effect of Iron Fortification

In Mexico, food fortification is used as a strategy to combat micronutrient deficiencies. However, little is known about the effects of food fortification in vulnerable populations. This study was carried out in a population of school children believed to be at risk of various micronutrient deficiencies, including iron. The study aimed at determining iron status of children, and identifying and quantifying the sources of iron intake and the presence of relevant enhancers and inhibitors of iron absorption in the diet. The iron status and dietary iron intake was assessed of schoolchildren aged 3–14 years in western Mexico. Hemoglobin, serum ferritin, and transferrin saturation percentages were used to evaluate the iron status in a school-based sample of 762 children. Dietary data were collected from 607 children using semi-quantitative food frequency questionnaires. The overall prevalence of anemia and iron deficiency was 3.7% and 4%, respectively. Iron intake ranged from 1.9 to 3.3 times the recommended daily allowance, with fortified iron accounting for 72% of the total iron intake. Although iron fortification of staples such as maize flour in Mexico for more than a decade most likely contributed to reducing the prevalence of anemia and iron deficiency, the relatively large amounts of iron consumed could eventually lead to problems related to excessive iron intake in some children. Nutritional guidelines for iron fortification in Mexico should be defined and put into practice.

Status of Geriatrics in 22 Countries

ObjectivesThe aim of this article is to describe the current status of geriatrics and position of geriatricians in 22 countries of three continents, and to portray their attitudes towards and resources allocated to geriatrics.MethodsAn electronic survey was delivered to a convenience sample of 22 geriatricians in leading positions of their countries.ResultsThe time required in post graduation specialist training to become a geriatrician varied from one year (subspecialty in the USA) to six years (independent specialty in Belgium). The number in the population aged 80+ per geriatrician varied from 450 (Austria) to 25,000 (Turkey). Of respondents, 55% reported that geriatrics is not a popular specialty in their country. Acute geriatric wards, rehabilitation and outpatient clinics were the most common working places for geriatricians. Nearly half of the respondents had an opinion that older patients who were acutely ill, were receiving subacute rehabilitation or had dementia should be cared for by geriatricians whereas half of the respondents would place geriatricians also in charge of nursing home and orthogeriatric patients. The biggest problems affecting older people’s clinical care in their countries were: lack of geriatric knowledge, lack of geriatricians, and attitudes towards older people. Half of respondents thought that older people’s health promotion and comprehensive geriatric assessment were not well implemented in their countries, although a majority felt that they could promote good geriatric care in their present position as a geriatrician.ConclusionThe position of geriatric, geriatricians’ training and contents of work has wide international variety.

Self-Perception of Economic Means is Associated with Dietary Choices, Diet Quality and Physical Health in the Oldest Old Men from the Highest Socioeconomic Group

IntroductionSelf-perception of economic means may affect dietary choices, diet quality, and health behavior. We examined these associations in the oldest-old men from the highest socioeconomic class.MethodsThe participants in this cross-sectional analysis were the oldest- old home-dwelling men (n = 314, mean age 87 years, range 82–97 years) from the longitudinal Helsinki Businessmen Study cohort. They responded to a postal health and nutrition questionnaire, whereupon dietary intakes were assessed using 3–day food diaries and two diet quality indices. The questionnaire also included items about health, exercise, falls, and economic means.ResultsHigher self-perception of economic means was linearly associated with higher fish intake (p = 0.021), fruit and vegetable intakes (p = 0.027), use of alcohol (p = 0.003), overall diet quality according to IDQ (p = 0.008), self-perceived physical condition (p = 0.002) and inversely associated with body weight (p = 0.011), weight loss (p = 0.008), blood glucose levels (p = 0.020), and falls (p = 0.029).ConclusionSelf-perception of economic means was associated with dietary choices and physical health even among affluent older men. This information is important, because self-perception of economic means, however real, may affect health and nutrition behavior of older people.

Higher Polyunsaturated Fatty Acid to Saturated Fatty Acid Ratio Is Associated With Cognition, Mobility, Nutrient Intakes, and Higher Diet Quality in Heterogeneous Older Populations

To the Editor: Longitudinal studies suggest that nutrition plays an important role in healthy aging.1 As people age, eventually they become less active, theirmetabolism slows, and energy requirement and dietary intake decrease.2 At the same time, nutrient requirementsmayeven increase as the ability to absorb and utilizemany nutrients becomes less efficient, thus maintaining a nutrient-dense and high-quality diet is very important for the health of older individuals.2 Research has demonstrated that sufficient nutrient intake and diet quality has a huge effect on physical and cognitive functioning, cardiovascular, and immune systems.2 For the prevention of coronary heart disease, a diet with high polyunsaturated fatty acids to saturated fatty acids (PUFA/SFA) ratio has been recommended.3 How fat quality is associated with mobility, cognition, nutrient intake, and overall diet quality in older people has not been thoroughly studied. Therefore, we analyzed PUFA/SFA ratio and its associations with mobility, nutrition, and cognition in heterogeneous groups (home-dwelling and institutionalized) of older people.