T.M. Puranen

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.

Tailored nutritional guidance for home-dwelling AD families: The feasibility of and elements promoting positive changes in diet (NuAD-trial)

ObjectivesTo describe the process and feasibility of our randomised, controlled intervention study (NuAD trial) that positively affected the nutrition and quality of life, and prevented falls of home-dwelling persons with Alzheimer disease (AD).Design, setting, participantsThis qualitative study comprised 40 persons with AD and spousal caregivers of our trial. Our intervention during one year involved tailored nutritional guidance for these couples. The nutritionist’s field notes (about 100 pages) and the participant feedback questionnaires (N = 28) served to analyse the feasibility of intervention, factors promoting the application of intervention and challenges hindering it. Thematic content analysis served to analyse our data with the grounded theory approach.ResultsWe identified several positive elements promoting better nutrition: positive attitudes on nutrition to participants including a participant-centred approach, positive feedback, findings of food diaries and practical suggestions. Home visits by the nutritionist were convenient and participants felt that someone cares. Group meetings which included protein-rich snacks strengthened the nutritional message by enabling discussions and socialising. The oral nutritional supplements (ONS) helped participants to regain their energy and to motivate them to exercise and make changes in their diets. Obstacles to making changes in diets included participants’ false ideas about nutrition, especially with regard to weight gain. Health problems and functional limitations hampered food management, and some families had inveterate eating habits. The positive feedback from participants indicated the feasibility of our tailored nutritional guidance.ConclusionsAssessment-based, tailored nutritional guidance implemented with a personal and positive approach may inspire and empower AD families to make positive changes in their diets, leading them to improved nutrition and quality of life.

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.

P365: Tailored nutritional intervention and nurses’ guidance in nutrition improves nutrition among residents with dementia in long-term care

P363 Nutritional guidance improves nutrient intake, quality of life and prevents falls of aged persons with AD living at home: a randomized, controlled trial (NuAD-trial) M.H. Suominen, T.M. Puranen, U. Eloniemi-Sulkava, S.K. Jyvakorpi, H. Kautiainen, U. Siljamaki-Ojansuu, K.H. Pitkala Society for Gerontological Nutrition in Finland, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Central Hospital, Finland, Helsinki, Finland; University of Helsinki, Palmenia Centre for Continuing Education, Helsinki, Finland; Nutrition Unit at Tampere University Hospital, Tampere, Finland