Susanne Hengstermann

Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission

OBJECTIVE This prospective, controlled, and multicentric study evaluated nutritional status, body composition, muscle strength, and quality of life in patients with inflammatory bowel disease in clinical remission. In addition, possible effects of gender, malnutrition, inflammation, and previous prednisolone therapy were investigated. METHODS Nutritional status (subjective global assessment [SGA], body mass index, albumin, trace elements), body composition (bioelectrical impedance analysis, anthropometry), handgrip strength, and quality of life were assessed in 94 patients with Crohns disease (CD; 61 female and 33 male, Crohns Disease Activity Index 71 +/- 47), 50 patients with ulcerative colitis (UC; 33 female and 17 male, Ulcerative Colitis Activity Index 3.1 +/- 1.5), and 61 healthy control subjects (41 female and 20 male) from centers in Berlin, Vienna, and Bari. For further analysis of body composition, 47 well-nourished patients with inflammatory bowel disease were pair-matched by body mass index, sex, and age to healthy controls. Data are presented as median (25th-75th percentile). RESULTS Most patients with inflammatory bowel disease (74%) were well nourished according to the SGA, body mass index, and serum albumin. However, body composition analysis demonstrated a decrease in body cell mass (BCM) in patients with CD (23.1 kg, 20.8-28.7, P = 0.021) and UC (22.6 kg, 21.0-28.0, P = 0.041) compared with controls (25.0 kg, 22.0-32.5). Handgrip strength correlated with BCM (r = 0.703, P = 0.001) and was decreased in patients with CD (32.8 kg, 26.0-41.1, P = 0.005) and UC (31.0 kg, 27.3-37.8, P = 0.001) compared with controls (36.0 kg, 31.0-52.0). The alterations were seen even in patients classified as well nourished. BCM was lower in patients with moderately increased serum C-reactive protein levels compared with patients with normal levels. CONCLUSION In CD and UC, selected micronutrient deficits and loss of BCM and muscle strength are frequent in remission and cannot be detected by standard malnutrition screening.

Circulating adipokines and the protective effects of hyperinsulinemia in inflammatory bowel disease.

OBJECTIVE Adipokines are fat-derived hormones and cytokines with immune-modulating and metabolic properties. Most of them are associated with insulin resistance. The aim of the present investigation was to evaluate circulating levels of adipokines and glucose homeostasis in patients with inflammatory bowel disease (IBD) and to evaluate possible associations with the course and characteristics of the disease. METHODS Serum leptin, resistin, visfatin, retinol-binding protein-4, adiponectin, glucose, insulin, and inflammatory parameters were analyzed in 93 patients with inactive IBD (49 with Crohns disease [CD], 44 with ulcerative colitis [UC]), 35 patients with active IBD (18 with CD, 17 with UC), and 37 age- and body mass index-matched healthy controls. Ninety-two patients were followed for 6 mo. RESULTS Leptin was similar in patients with IBD and controls, whereas resistin and visfatin were increased in patients with active disease but not in those in remission. In active and inactive disease, adiponectin was decreased (P < 0.001) and retinol-binding protein-4 was increased (P < 0.001) compared with controls. About 60% of patients with IBD showed increased levels of insulin, whereas serum glucose remained normal, resulting in increased homeostasis model assessment values in most patients. Hyperinsulinemia was associated with the decrease in adiponectin (r = -0.572, P < 0.001) and proved to be an independent protective factor for 6-mo maintenance of remission (P = 0.016). CONCLUSION IBD led to largely similar alterations in circulating adipokines and hyperinsulinemia in patients with CD and those with UC. The unexpected protective effect of hyperinsulinemia on relapse rate denotes the role of the metabolic-inflammatory response as a modulator in IBD.

Nutrition Status and Pressure Ulcer: What We Need for Nutrition Screening

BACKGROUND Pressure ulcers (PU) and malnutrition exist in elderly hospitalized patients as a significant and costly problem. The aim of the study was to compare different screening tools to assess nutrition status and to verify them for usage in clinical routine. METHODS Nutrition status (body mass index [BMI], Mini Nutritional Assessment [MNA], weight loss) was determined in 484 (326 female/158 male) multimorbid elderly patients with mean age of 79.6 +/- 7.6 (80.9 +/- 7.4 female/76.9 +/- 7.4 male) years. Bioelectrical impedance analysis (BIA; Nutrigard 2,000-M) was used for evaluation of body composition. Activities of daily living (ADL) were measured with the Barthel Index. PUs were divided into stages I-IV (European Pressure Ulcer Advisory Panel [EPUAP]) and were assessed by the Norton scale. RESULTS The prevalence of PU was 16.7%, with a median Norton scale of 20 (range, 17-24). According to MNA, 39.5% of the PU patients were malnourished, and 2.5% were well nourished. By contrast, 16.6% of the non-PU patients were malnourished, and 23.6% were well nourished. BMI decreased significantly in PU patients (p < .008). BIA resulted in no significant resistance and reactance but in a significant reduction of phase angle in PU. According to a significantly reduced body cell mass and lean body mass in PU patients, the ADL decreased in these patients, too. Furthermore, we analyzed a significant effect of age, ADL, MNA, BMI, phase angle, and body cell mass on the Norton scale. CONCLUSIONS The MNA as a screening and assessment tool is easy to use to determine the nutrition status in multimorbid geriatric patients with PU. Further studies are needed to show an improved outcome of PU healing if evaluation of nutrition status is part of routine clinical practice in multimorbid elderly risk patients within the first day after admission.

Altered status of antioxidant vitamins and fatty acids in patients with inactive inflammatory bowel disease

BACKGROUND & AIMS Data regarding the nutritional status, antioxidant compounds and plasma fatty acid (FA) composition in inactive IBD are conflicting. We compared plasma levels of antioxidants and FA of patients with inactive IBD with active IBD and controls. METHODS Plasma levels of vitamin C, vitamin E, carotenoids, saturated, monounsaturated and polyunsaturated FA, inflammatory markers and nutritional status were determined after an overnight fast in 132 patients with quiescent IBD (40.6+/-13.2 years, 87F/45M), 35 patients with active disease (37.9+/-12.1 years, 25F/10M) and 45 age- and BMI-matched healthy controls (38.1+/-10.5 years, 39F/6M). Results are expressed as mean+/-SD or median [25th percentile;75th percentile]. RESULTS Body mass index (BMI) was normal in inactive (23.9+/-4.7 kg/m(2)), active IBD (22.7+/-4.2 kg/m(2)) and controls (22.3+/-1.9 kg/m(2)). Compared with controls patients with quiescent IBD showed significantly decreased plasma levels of carotenoids (1.85 [1.37;2.56] vs 1.39 [0.88;1.87] micromol/L) and vitamin C (62.3 [48.7;75.0] vs 51.0 [36.4;77.6] micromol/L), increased levels of saturated FA (3879 [3380;4420] vs 3410 [3142;3989] micromol/L) and monounsaturated FA (2578 [2258;3089] vs 2044 [1836;2434] micromol/L) and similar levels of vitamin E and polyunsaturated FA. Results in active disease were similar to inactive disease. CONCLUSION This study shows that antioxidant status and FA profile in a larger population of IBD patients are disturbed independently from disease activity and despite normal overall nutritional status.

Which are the most efficient items of mini nutritional assessment in multimorbid patients

Objective: The aim of the study was to identify the most significant MNA-items to accelerate the determination of nutritional risk of elderly patients in routine clinical practice in a geriatric hospital. Since MNA requires 10–15 min it is hardly applicable to clinical routine.Design: The study was a cross-sectional study. Setting: The study centre was an acute geriatric hospital. Participants: In total 808 multimorbid elderly patients were recruited. Methods: We applied the MNA in 808 (528f/280m) geriatric multimorbid patients (78.5 ± 8.7f / 74.6 ± 9m yrs) without cognitive impairment 48h after hospital admission. Admission diagnoses covered orthopaedical (40%), internal (34%) and cerebrovascular (24%) diseases. According to analysis of reliability the consistency of the MNA scale for multimorbid patients has been verified. In preparation for scale reduction a factor analysis was applied. A reduced scale with selected cutoffs was configured and compared with MNA.Results: According to MNA, 15% of patients were well-nourished, 65% at risk of malnutrition and 20% were malnourished. The reliability analyses showed a Cronbach’s Alpha of 0.60 that represented a satisfactory result. By means of factor analysis the MNA-items were reduced from 18 to 7 items (weight loss, mobility, BMI, number of full meals, fluid consumption, mode of feeding, health status), with new cutoffs (12.5–15 well-nourished, 9–12 at risk of malnutrition, <9 malnourished). According to the modified MNA (m-MNA) 21.7% of the patients were well-nourished, 54.5% at risk of malnutrition and 21.7% were malnourished. The score of the MNA and m-MNA correlated with r=0.910. Furthermore, there was a strong correlation between MNA and m-MNA group classification of 83%.Conclusion: The m-MNA enables a rapid (3min) and efficient screening of malnutrition in multimorbid geriatric patients. The m-MNA is easy to apply and may also be suitable in multimorbid patients with cognitive dysfunction. Due to the variety of items the m-MNA seems to be superior to other screening tools.

Association between intestinal tight junction permeability and whole-body electrical resistance in healthy individuals: a hypothesis.

OBJECTIVE Intestinal permeability describes non-carrier-mediated modes of transport through the intestinal epithelium. Wrist-ankle bioimpedance analysis (BIA) is a standard method to determine body composition based on the measurements of whole-body electrical resistance and reactance values. The present report deals with the coincidentally observed associations between permeability results and electrical raw values of BIA and their subsequent reproduction in a larger group of individuals. METHODS Tetrapolar wrist-ankle BIA was performed on day 1 in the initial sample (12 women, 36 +/- 11 y of age) and the validation sample (36 healthy subjects, 26 women and 10 men, 35 +/- 14 y of age). Intestinal permeability tests (lactulose and mannitol) were implemented within 1 wk thereafter. Wrist-ankle electrical resistance plus electrical resistance between current-conducting electrodes and voltage-sensing electrodes (Rtotal) was measured at 5 kHz and 100 kHz. RESULTS Permeability and bioimpedance raw values were normal, indicating normal tight junction permeability and normal hydration. Lactulose correlated to R(50total) in the initial sample (rho = 0.639, P = 0.025) and in the validation sample (rho = 0.673, P < 0.001). Weaker associations to R(50total) were observed with mannitol (rho = 0.381, P = 0.008) and lactulose/mannitol (rho = 0.369, P = 0.010) in the total group of individuals. Regression analyses demonstrated that R(50total) alone accounted for 41.3% of the variance in lactulose permeability. CONCLUSION The nature of the observed positive association between intestinal tight junction permeability and whole-body electrical resistance is unclear. We hypothesize that regulation involving submolecular mechanisms based on the principles of quantum physics might have caused the observed association. Such coherent mechanisms might possibly play a role in basal physiologic regulation in humans.

Total serum homocysteine levels do not identify cognitive dysfunction in multimorbid elderly patients

ObjectivesTotal blood homocysteine (Hcys) and folate levels have been investigated in association with cognitive dysfunction in healthy but not in multimorbid elderly patients. We hypothesized that total serum Hcys is an adequate marker to identify multimorbid elderly patients with cognitive dysfunction assessed by the Short Cognitive Performance Test (SKT) and Mini-Mental State Examination (MMSE).DesignCross-sectional study.SettingThe study center was an acute geriatric hospital.ParticipantsA total of 189 multimorbid elderly patients were recruited.MethodsCognitive dysfunction was determined according to the SKT and MMSE. Biochemical parameters (Hcys, folate, vitamin B12, hemoglobin), nutritional status (BMI, Mini Nutritional Assessment, nutritional intake), and activities of daily living were assessed.ResultsAccording to the SKT, 25.4% of patients showed no cerebral cognitive dysfunction, 21.2% had suspected incipient cognitive dysfunction, 12.7% showed mild cognitive dysfunction, 9.0% had moderate cognitive dysfunction, and 31.7% of patients were demented. The median plasma Hcys value was elevated by ∼20% in multimorbid elderly patients, independent of cognitive dysfunction. Serum folate and vitamin B12 concentrations were within normal ranges. We did not find significant differences in nutritional status, activities of daily living, numbers of diseases or medications, or selected biochemical parameters between the SKT groups.ConclusionElevated serum Hcys levels with normal plasma folate and vitamin B12 concentrations were observed in multimorbid elderly patients. The plasma Hcys level did not appear to be an important biological risk factor for cognitive dysfunction in multimorbid geriatric patients.

Does an association between increased homocystein levels and cognitive dysfunction also exist in multimorbid geriatric patients

ZusammenfassungHintergrundDer Zusammenhang zwischen Homocystein (Hcys)- bzw. Folsäurespiegeln im Blut und kognitiven Defiziten wurde bisher bei gesunden, nicht aber bei multimorbiden Senioren beschrieben. Die aktuelle Fragestellung ist daher, ob sich dieser Zusammenhang bei multimorbiden geriatrischen Patienten bestätigt.MethodikDer kognitive Status wurde von 189 (131 f/58 m) multimorbiden geriatrischen Patienten im Alter von 78,6 ± 7,3 Jahren mittels Syndrom-Kurztest (SKT) in einer Querschnittserhebung untersucht. Neben biochemischen Parametern (Plasma-Hcys, Serum-Folsäure, Vitamin B12, Blutbild), Ernährungsstatus (BMI, Mini Nutritional Assessment) wurde die Selbstständigkeit der Patienten erfasst. Die Bestimmung der Vitaminzufuhr erfolgte anhand des 3-Tage- Ernährungsprotokolls.ErgebnisseNach SKT zeigten 25,4% keine kognitive Leistungsstörungen, bei 21,2% lag ein Verdacht auf leichte kognitive Defizite vor, 12,7% hatten leichte, 9,0% mäßige und 31,7% schwere kognitive Defizite. Plasma Hcys-Spiegel waren unabhängig von kognitiven Defiziten um 20% erhöht. Folsäure und Vitamin B12 im Serum lagen im Normbereich, obwohl die Folsäurezufuhr um 75% vermindert war. Unterschiede zwischen SKT-Gruppen waren weder hinsichtlich Ernährungsstatus, Selbständigkeit, Anzahl der Diagnosen oder Medikation noch hinsichtlich biochemischer Parameter signifikant.SchlussfolgerungenEs wurden erhöhte Hcys-Spiegel bei multimorbiden geriatrischen Patienten mit kognitiven Defiziten und normalen Folsäure- und Vitamin B12- Konzentrationen analysiert. Hcys im Plasma erscheint als kein geeigneter biologischer Risikofaktor für kognitive Defizite bei multimorbiden geriatrischen Patienten.AbstractBackgroundTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.MethodsAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 ± 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B12, hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.ResultsAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B12 levels were within range, though dietary folate intake (97 [80–128] µg/d) was reduced about 75% (recommendation 400 µg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B12 were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.ConclusionWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B12 concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.BACKGROUND Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD. METHODS According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional. RESULTS According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters. CONCLUSION We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten?@@@Does an association between increased homocystein levels and cognitive dysfunction also exist in multimorbid geriatric patients?

ZusammenfassungHintergrundDer Zusammenhang zwischen Homocystein (Hcys)- bzw. Folsäurespiegeln im Blut und kognitiven Defiziten wurde bisher bei gesunden, nicht aber bei multimorbiden Senioren beschrieben. Die aktuelle Fragestellung ist daher, ob sich dieser Zusammenhang bei multimorbiden geriatrischen Patienten bestätigt.MethodikDer kognitive Status wurde von 189 (131 f/58 m) multimorbiden geriatrischen Patienten im Alter von 78,6 ± 7,3 Jahren mittels Syndrom-Kurztest (SKT) in einer Querschnittserhebung untersucht. Neben biochemischen Parametern (Plasma-Hcys, Serum-Folsäure, Vitamin B12, Blutbild), Ernährungsstatus (BMI, Mini Nutritional Assessment) wurde die Selbstständigkeit der Patienten erfasst. Die Bestimmung der Vitaminzufuhr erfolgte anhand des 3-Tage- Ernährungsprotokolls.ErgebnisseNach SKT zeigten 25,4% keine kognitive Leistungsstörungen, bei 21,2% lag ein Verdacht auf leichte kognitive Defizite vor, 12,7% hatten leichte, 9,0% mäßige und 31,7% schwere kognitive Defizite. Plasma Hcys-Spiegel waren unabhängig von kognitiven Defiziten um 20% erhöht. Folsäure und Vitamin B12 im Serum lagen im Normbereich, obwohl die Folsäurezufuhr um 75% vermindert war. Unterschiede zwischen SKT-Gruppen waren weder hinsichtlich Ernährungsstatus, Selbständigkeit, Anzahl der Diagnosen oder Medikation noch hinsichtlich biochemischer Parameter signifikant.SchlussfolgerungenEs wurden erhöhte Hcys-Spiegel bei multimorbiden geriatrischen Patienten mit kognitiven Defiziten und normalen Folsäure- und Vitamin B12- Konzentrationen analysiert. Hcys im Plasma erscheint als kein geeigneter biologischer Risikofaktor für kognitive Defizite bei multimorbiden geriatrischen Patienten.AbstractBackgroundTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.MethodsAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 ± 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B12, hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.ResultsAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B12 levels were within range, though dietary folate intake (97 [80–128] µg/d) was reduced about 75% (recommendation 400 µg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B12 were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.ConclusionWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B12 concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.BACKGROUND Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD. METHODS According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional. RESULTS According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters. CONCLUSION We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten

ZusammenfassungHintergrundDer Zusammenhang zwischen Homocystein (Hcys)- bzw. Folsäurespiegeln im Blut und kognitiven Defiziten wurde bisher bei gesunden, nicht aber bei multimorbiden Senioren beschrieben. Die aktuelle Fragestellung ist daher, ob sich dieser Zusammenhang bei multimorbiden geriatrischen Patienten bestätigt.MethodikDer kognitive Status wurde von 189 (131 f/58 m) multimorbiden geriatrischen Patienten im Alter von 78,6 ± 7,3 Jahren mittels Syndrom-Kurztest (SKT) in einer Querschnittserhebung untersucht. Neben biochemischen Parametern (Plasma-Hcys, Serum-Folsäure, Vitamin B12, Blutbild), Ernährungsstatus (BMI, Mini Nutritional Assessment) wurde die Selbstständigkeit der Patienten erfasst. Die Bestimmung der Vitaminzufuhr erfolgte anhand des 3-Tage- Ernährungsprotokolls.ErgebnisseNach SKT zeigten 25,4% keine kognitive Leistungsstörungen, bei 21,2% lag ein Verdacht auf leichte kognitive Defizite vor, 12,7% hatten leichte, 9,0% mäßige und 31,7% schwere kognitive Defizite. Plasma Hcys-Spiegel waren unabhängig von kognitiven Defiziten um 20% erhöht. Folsäure und Vitamin B12 im Serum lagen im Normbereich, obwohl die Folsäurezufuhr um 75% vermindert war. Unterschiede zwischen SKT-Gruppen waren weder hinsichtlich Ernährungsstatus, Selbständigkeit, Anzahl der Diagnosen oder Medikation noch hinsichtlich biochemischer Parameter signifikant.SchlussfolgerungenEs wurden erhöhte Hcys-Spiegel bei multimorbiden geriatrischen Patienten mit kognitiven Defiziten und normalen Folsäure- und Vitamin B12- Konzentrationen analysiert. Hcys im Plasma erscheint als kein geeigneter biologischer Risikofaktor für kognitive Defizite bei multimorbiden geriatrischen Patienten.AbstractBackgroundTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.MethodsAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 ± 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B12, hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.ResultsAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B12 levels were within range, though dietary folate intake (97 [80–128] µg/d) was reduced about 75% (recommendation 400 µg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B12 were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.ConclusionWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B12 concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.BACKGROUND Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD. METHODS According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional. RESULTS According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters. CONCLUSION We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.