Neck circumference of the elderly is associated with their nutritional status

by Plataforma SINC

Researchers have discovered that the circumference of the neck serves as a reference to detect possible cases of malnutrition. Credit: Beatriz Lardiés

Researchers at the Miguel Servet University Hospital in Zaragoza (Spain) have analysed the ratio between the perimeter of the neck of people living in old people's homes and the probability of malnutrition. Values below 37.8 cm in males and 35.2 cm in females indicate risk.

29 oct 2019--Professionals working in nursing homes often detect possible cases of malnutrition by measuring certain body circumferences of the elderly, such as the arm or calf. Now, a team of researchers from Zaragoza has found another part of the body that can serve as a reference: the neck.

To carry out their study, the authors cross-checked the anthropometric data of 352 elderly people from five public homes in Zaragoza and with an average age of 83, with their results in a questionnaire called Mini Nutritional Assessment (MNA). This assessment tool is commonly used to identify malnourished elderly people or those at risk of being malnourished.

Statistical methods were then applied to find the association between these two parameters, and the results, published in the journal Nutrition, confirm that the circumference of the neck -together with that of the calf- presents the best predictive value when diagnosing the risk of malnutrition among residents.

"In our study, the cut-off point for detecting the risk of malnutrition was 37.8 cm in men and 35.2 cm in women, a limit to be taken into account by the staff of the homes," says Beatriz Lardiés, a researcher at the Miguel Servet University Hospital and co-author of the study.

Once the risk of malnutrition—which affected 48.3% of the women and 45.5% of the men analysed—is detected, it is necessary to carry out a complete nutritional assessment and to consider other clinical and analytical parameters in order to check whether a patient is really malnourished. If this turns out to be the case, the necessary measures to reverse this situation should be taken immediately.

"The diagnosis of malnutrition cannot be made with a single anthropometric parameter, like the perimeter of the calf or the circumference of the arm, but it can help identify it," Lardiés says.

The researcher points out that, as this study has been carried out in nursing homes, "its results can be extrapolated to populations with similar characteristics, but we cannot ensure that the cut-off points detected are valid in other population groups."

In any case, the authors conclude that anthropometry is an easy and non-invasive method for rapidly assessing the nutritional status of older people, a group that is growing all over the world.

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More information: Beatriz Lardiés-Sánchez et al. Neck circumference is associated with nutritional status in elderly nursing home residents, Nutrition (2019). DOI: 10.1016/j.nut.2019.01.015

Provided by Plataforma SINC 

Strategies needed to prevent malnutrition in older people

A pilot study led by Associate Professor Carol Wham, is the first in a series to investigate the prevalence of malnutrition risk in older people across three settings in Auckland.

New research from Massey University shows concerning levels of malnutrition among older people living independently in the community or newly admitted to hospital or a residential care facility.
Associate Professor Carol Wham led the study, investigating the prevalence of malnutrition risk in older people across three accommodation settings. The study was conducted within the Waitemata District Health Board region in Auckland, including North Shore City, Waitakere City and the Rodney District, in 2014.

27 may 2017--Of the 167 participants, 23 per cent were malnourished, and 35 per cent were at high risk of malnutrition. Those recently admitted to residential care had a higher prevalence of malnourishment – 47 per cent, compared to 23 per cent in hospital, and two per cent living in the community.
The pilot study, a first of its kind in New Zealand, is the first in a series to screen for risk of malnutrition in community and early admission to hospital and residential care. The research is currently being followed up, using a larger group of 250 people in each of the three settings. Researchers are now analysing these results.
Dr Wham says older people are known to be at disproportionate risk of malnutrition, with health conditions both contributing to having an inadequate food and nutrition intake and occurring as a consequence of inadequate intake. "Maintaining good nutritional status is important for remaining independent, yet far too often key aspects of food provision for older people are disregarded or taken for granted, especially among those with health disparities."
She says elimination of particular foods or food groups from the diet, due to chewing and swallowing difficulties, aggravates the risk of malnutrition. "Reduced food intake can contribute to dysphagia [difficulty swallowing], and can compromise the integrity of the swallow, which initiates a vicious cycle further decreasing food intake and further exacerbating poor swallowing function."
The risk of malnutrition is a burden on older people and health-care facilities, Dr Wham says. "In community-living older New Zealanders, high malnutrition risk has been shown to impact health-related quality of life. It's associated with higher infection rates, loss of muscle mass, strength and function, longer length of hospital stays, as well as increasing morbidity and mortality."
This study highlights the need for mandatory screening for malnutrition risk in all settings, Dr Wham says.
"We discovered marked differences in nutritional risk and the prevalence of dysphagia between older adults living in the three different social settings. Independently living older adults demonstrated the best nutritional profiles with nutrition risk and prevalence of dysphagia significantly lower than those recently admitted to hospital or residential care facilities. We expected these results. However, this data revealed the stark delineation between well older adults, and those experiencing a slide in their health status and profile.
"Malnutrition and swallowing difficulties significantly affect quality of life and are costly to individuals, families and the community. Simple intervention measures to manage under-nutrition, can make a substantial difference. However, given the differences we have identified between each setting, a more targeted approach should be used to identify the optimum nutrition intervention for each setting," Dr Wham says.
She would like to see awareness around malnutrition in older people, given a higher profile. "This issue should not be considered a 'normal' part of ageing. It needs to be higher up the political agenda," Dr Wham says.

More information: Carol Wham et al. Malnutrition risk of older people across district health board community, hospital and residential care settings in New Zealand, Australasian Journal on Ageing (2017). DOI: 10.1111/ajag.12410


Provided by Massey University

Malnutrition may be common among older adults

NEW YORK, 22 may 2009- Up to one in six older adults living on their own may not be getting adequate nutrition, a study from Sweden suggests.

Researchers found that among 579 adults ages 75 to 80 years, nearly 15 percent were at risk of malnutrition, based on their diet, weight and recent weight loss, and physical and mental well-being.

Women were more likely to be undernourished than men; nearly 19 percent were at risk of malnutrition, compared with almost 11 percent of men.

In addition, men and women who were depressed or described themselves as unhealthy were more likely than others to become at risk of malnutrition over the next two to four years.

Dr. Yvonne Johansson and her colleagues at Linkoping University report the findings in the Journal of Clinical Nursing.

Malnutrition and dehydration are common in nursing homes, but older adults living at home can also be at risk, for various reasons -- such as poor appetite and mobility problems that limit their ability to shop and cook.

The current findings suggest that doctors should regularly assess older adults' nutritional status, symptoms of depression and their perceptions of their own health, according to Johansson.

"This makes it possible to individualize the care of older home-living people in cooperation with different professionals in health and medical care and home-care services," she told Reuters Health.

Older adults can also take steps to ensure they are adequately nourished, according to Johansson. She suggested eating several smaller meals and snacks throughout the day; people's appetites often wane as they age, and many older adults may not be able to manage large meals.

But even though older adults' calorie needs may not be what they used to be, Johansson said, their nutrient needs stay the same -- or may increase. So it's important, she noted, to keep this in mind in meal planning, and choose foods rich in nutrients like protein, fiber, "good" fats, vitamins and minerals.

SOURCE: Journal of Clinical Nursing, May 2009.

Malnutrition may be common among older adults

NEW YORK , 20 may 2009- Up to one in six older adults living on their own may not be getting adequate nutrition, a study from Sweden suggests.

Researchers found that among 579 adults ages 75 to 80 years, nearly 15 percent were at risk of malnutrition, based on their diet, weight and recent weight loss, and physical and mental well-being.

Women were more likely to be undernourished than men; nearly 19 percent were at risk of malnutrition, compared with almost 11 percent of men.

In addition, men and women who were depressed or described themselves as unhealthy were more likely than others to become at risk of malnutrition over the next two to four years.

Dr. Yvonne Johansson and her colleagues at Linkoping University report the findings in the Journal of Clinical Nursing.

Malnutrition and dehydration are common in nursing homes, but older adults living at home can also be at risk, for various reasons -- such as poor appetite and mobility problems that limit their ability to shop and cook.

The current findings suggest that doctors should regularly assess older adults' nutritional status, symptoms of depression and their perceptions of their own health, according to Johansson.

"This makes it possible to individualize the care of older home-living people in cooperation with different professionals in health and medical care and home-care services," she told Reuters Health.

Older adults can also take steps to ensure they are adequately nourished, according to Johansson. She suggested eating several smaller meals and snacks throughout the day; people's appetites often wane as they age, and many older adults may not be able to manage large meals.

But even though older adults' calorie needs may not be what they used to be, Johansson said, their nutrient needs stay the same -- or may increase. So it's important, she noted, to keep this in mind in meal planning, and choose foods rich in nutrients like protein, fiber, "good" fats, vitamins and minerals.

SOURCE: Journal of Clinical Nursing, May 2009.

Mealtime interaction encourages hospitalized seniors to eat more

Universite de Montreal study highlights importance of socializing over food

07 may 2009--Sharing a meal in good company can stimulate the appetite – particularly among hospitalized seniors – according to a new Université de Montréalstudy published in The Gerontologist.

"The more social interaction occurs at mealtimes in hospital geriatric re-adaptation units the better food intake will be," says Danielle St-Arnaud McKenzie.

A graduate of the Université de Montréal Department of Nutrition, St-Arnaud McKenzie conducted the study with Professor Marie-Jeanne Kergoat of the Faculty of Medicine, Professor Guylaine Ferland of the Department of Nutrition, as well as Laurette Dubé of McGill University.

Research has shown that a majority of patients suffer from nutritional deterioration during hospitalization. "Approximately 35 percent of elderly people suffer from malnutrition," says Marie-Jeanne Kergoat. "That's a scary estimate when we consider that nutrition tends to deteriorate during hospitalization."

St-Arnaud McKenzie observed some 30 patients during mealtimes at the re-adaptation unit of the Institut universitaire de gériatrie de Montréal (IUGM), which is affiliated to the Université de Montréal. Using an evaluation grid, she measured their verbal and non-verbal behaviors. By observing these patients at mealtimes she calculated the level of conviviality. She then measured food intake by looking at the quantity of food leftover after the meal.

Results were clear – there was a correlation between food intake and social interaction. What's more, patients ate more when social interactions were friendly and lively. The research team also found that nutritional deficiencies mostly occur when patients eat alone in their rooms.

As the population ages, the number of seniors will rise and researchers must find solutions to elderly malnutrition. "By eating poorly, elderly patients risk developing other age-related health problems," says St-Arnaud McKenzie.

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About the Université de Montréal: www.umontreal.ca/english/index.htm

3 out of 4 hospital patients suffer from malnutrition regardless of their pathology


A study of 817 patients conducted in the Department of Nutrition and Bromatology at the University of Granada (UGR), in collaboration with the Unit of Nutrition and Dietetics at the hospital Virgen de las Nieves (Granada, Spain) of 817 patients, showed that 75% of hospitalised patients suffer from malnutrition regardless of their pathology. The study, which was carried out in patients older than 18 in all the departments of the hospital except Psychiatry and Ophthalmology, showed that, although hospitals have enough resources to prevent malnutrition, it is caused due to the poor administration of resources and the lack of importance given to nutrition.
The study, which was carried out by Gabriela Lobo Támer and led by researchers Mª Dolores Ruiz López and Antonio Pérez de la Cruz, analysed a series of biochemical parameters defining the nutritional status, such as albumin — a protein found in blood plasma that synthesizes in the liver. Thus, 75% of patients analysed had less than 3.5 grams of this protein per volume of blood (milliliter) — the minimum to consider that patients are well nourished.
Lobo Támer highlighted that her study showed that 75% of patients “are already undernourished when admitted,” although 40-50% of analysed subjects’ condition worsened while staying at the hospital, depending on the department they were admitted to.
Hospital stay and treatment costs
This study also revealed, for the first time, how much it costs to the Public Administration both hospital stay and treatment for each patient. The average is “between 3,500 € and 6,000 €” (only for food and medication) . Hospital staff, diagnoses, fungibles, etc. are not taken into account). Oncology and Hematology being the most resource-consuming services. “Patients who undergo heart surgery and those who have a bone marrow transplant cost the most to the health system, as sometimes these operations cost more than 35,000 €.”
The study concluded that the times at which food is served in Spanish hospitals “are not the most appropriate”, and contribute to malnutrition. “It would be advisable to adapt eating hours to better suit the Spanish lifestyle. In Spain lunch and dinner is later than in the rest of Europe and patients have to change their eating habits during their hospital stay.”