Stephanie Lesser

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.

Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: Resident interviews versus assessment by nursing staff

BACKGROUND When the Mini Nutritional Assessment (MNA) was developed, the authors did not specifically focus on the nursing home setting. Due to a number of particularities of nursing home residents, such as cognitive and linguistic disabilities, a number of uncertainties with regard to its application await clarification. AIMS AND OBJECTIVES The aim of this study was to compare the results of two different modes of MNA application in nursing homes: resident interviews versus assessment by nursing staff. METHOD The MNA was applied to 200 residents of two municipal nursing homes in Nuremberg, Germany. First one-on-one interviews of the residents were conducted by two researchers from our group. Next, the MNA was applied by the attending nursing staff who was blinded to the results of the first MNA. To evaluate the prognostic properties of the two different approaches, data on mortality of the screened residents were collected during a six-month follow-up period. RESULTS Among 200 residents (f 147 m 53, f 86.5 +/- 7.4 y. m 83.0 +/- 8.5 y.), the MNA could be applied to 138 residents (69.0%) by one-on-one interviews and to 188 residents (94.0%) by the nursing staff. 15.2% of the residents were categorised as malnourished by the interviews and 8.7% by the nursing staffs assessment. The agreement of the two forms was low for the MNA short form (weighted kappa = 0.31; 95% CI: 0.14 - 0.47) as well as for the full MNA (weighted kappa = 0.35; 95% CI: 0.27 - 0.44). After exclusion of residents with cognitive impairment (n=89), agreement for the full version increased (weighted kappa = 0.47, 95% CI 0.25 - 0.68). 25 (12.5%) study participants deceased during the follow-up period. Mortality was significantly associated with the mortality for both approaches, while the MNA application by the nursing staff proved to be superior (nursing staff p < 0.001, residents p < 0.05). CONCLUSIONS The results of the MNA in nursing home residents may differ substantially when resident interviews are compared to assessment by nursing staff. The authors recommend that the MNA should be routinely applied by the nursing staff. The application rate is higher and interference with cognitive as well as linguistic deficits is lower. In future studies, the mode of MNA application in nursing home residents should be clearly stated to facilitate comparability of results.

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.

Nutritional situation of the elderly in Eastern/Baltic and Central/Western Europe - the AgeingNutrition project.

Background/Aims: In the AgeingNutrition project, funded by the European Commission, partners from 10 ‘Eastern/Baltic’ (new) European (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Poland, Romania, Slovak Republic, Slovenia, and Turkey) and 5 ‘Central/Western’ (old) European countries (Austria, Belgium, Germany, Greece, and Spain) performed a comparative analysis of existing data on nutritional status, food intake, nutrient intake, dietary habits and lifestyle of the aging population in Europe. Methods: Using predefined inclusion criteria, 36 studies (22 from Eastern/Baltic, 14 from Central/Western countries) were chosen for evaluation. The studies varied in general design, data assessment and parameters and methods applied (especially regarding assessment of nutritional situation, comprising anthropometry, blood lipid profile, dietary nutrient and food intake). Thus, data evaluation by recalculation of raw data had to be restricted to a few distinct, common parameters. Results and Conclusion: Energy intake is too high in both regions, especially in some of the ‘younger old’ and seems not to be adjusted to energy expenditure. Simultaneously, energy intake was considerably lower than recommended in some very old seniors in Eastern/Baltic countries. Interestingly, quantity and quality of available information is similar in ‘new’ and ‘old’ member states. Immense variations in methodology hampered performing reliable comparative evaluation. It is, thus, mandatory to standardize methods for assessment of nutrition and health status for future international multicenter studies.

The fatty acid pattern of dietary fat influences the oral bioavailability of the flavonol quercetin in pigs

We have shown recently that dietary fat content influences the bioavailability of the flavonol quercetin. In the present study, the influence of the fatty acid pattern of dietary fats on the oral bioavailability of quercetin was investigated. Quercetin (30 micromol/kg body weight) was administered to growing pigs (n 6) in test meals consisting either of 200 g of a standard pig diet (2% crude fat) or of the same diet supplemented with 15 g fat/100 g diet using either medium-chain (MCT) or long-chain fatty acid triacylglycerols (LCT). Blood samples were drawn repeatedly over a period of 24 h and analysed by HPLC. In addition, the influence of the different diets on gastric emptying was investigated in rats. In pigs, the bioavailability of quercetin was measured by quantifying its plasma metabolites with an intact flavonol structure. Bioavailability was enhanced by 38% (P<0.05) and 12% (P>0.05) after intake with the MCT and LCT diets, respectively, compared to the standard diet. Maximum plasma concentrations of quercetin were reached significantly later with the MCT diet than with the LCT or the standard diet (P<0.05). No differences in dry matter of the gastric content were observed 60 min after intake of the experimental diets in rats. Thus, administration of quercetin together with a diet containing MCT fat enhances the bioavailability of the flavonol. Absorption of quercetin was delayed significantly with this diet. However, this was probably not due to slower gastric emptying of the MCT diet.

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.

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.