ESPEN Guideline on Clinical Nutrition and Hydration in Geriatrics

Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. Conclusion: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used

Variations du statut nutritionnel chez 75 patients âgés hospitalisés pour dénutrition

PARIS-BIUP (751062107) / SudocSudocFranceF

Evaluation de l'efficacité d'un outil destiné aux médecins généralistes pour la prise en charge des personnes âgées dénutries au décours d'une hospitalisation en gériatrie aiguë

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Escarres et nutrition (rôle de la nutrition dans la prévention et dans la cicatrisation des escarres)

PARIS-BIUP (751062107) / SudocSudocFranceF

LE SYSTEME DES INSULIN-LIKE GROWTH FACTORS AU COURS DU VIEILLISSEMENT, INFLUENCE DE LA DENUTRITION ET DE L'INFLAMMATION

LE ROLE DE L'INSULIN-LIKE GROWTH FACTOR I (IGF I) DANS LE VIEILLISSEMENT A ETE EVOQUE EN RAISON DE LA DIMINUTION DE SES CONCENTRATIONS PLASMATIQUES AVEC L'AGE ET DE SES PROPRIETES METABOLIQUES ET CELLULAIRES. SES CONCENTRATIONS PLASMATIQUES SONT REGULEES PAR LA NUTRITION. LES CONCENTRATIONS PLASMATIQUES DE DEHYDROEPIANDROSTERONE SULFATE (DHEAS) DIMINUENT AUSSI AVEC L'AGE. NOUS AVONS D'ABORD ETUDIE LES RELATIONS ENTRE LES CONCENTRATIONS D'IGF I, DE DHEAS, ET LA SANTE DES PERSONNES AGEES, DANS UNE POPULATION DE SUJETS AGES VIVANT A DOMICILE, EN BON ETAT NUTRITIONNEL (ETUDE PAQUID). CONTRAIREMENT AU DHEAS, LES CONCENTRATIONS PLASMATIQUES D'IGF I NE SONT PAS CORRELEES AUX PARAMETRES DU QUESTIONNAIRE DE SANTE. D'AUTRE PART, L'ADMINISTRATION DE DHEA A DES SUJETS AGES (ETUDE DHEAGE) N'A PAS ENTRAINE DE VARIATION SIGNIFICATIVE DES CONCENTRATIONS D'IGF I. CES RESULTATS SUGGERENT QUE LES RELATIONS ENTRE LES CONCENTRATIONS DE DHEAS ET LA SANTE NE SONT PAS MEDIEES PAR L'IGF I. PAR AILLEURS, LES CONCENTRATIONS D'IGF I SITUEES DANS LE TERTILE SUPERIEUR SONT ASSOCIEES A UN EXCES DE MORTALITE APRES 2 ANS QUI RESTE INCOMPLETEMENT EXPLIQUE. NOUS AVONS ENSUITE ETUDIE LES VARIATIONS DES CONCENTRATIONS PLASMATIQUES D'IGF I, D'IGFBP3 ET DE GHBP CHEZ DES PATIENTS AGES HOSPITALISES POUR DENUTRITION, ET NOUS LES AVONS COMPAREES A CELLES DE SUJETS AGES SAINS. NOUS AVONS MONTRE QUE L'IGF I POURRAIT REPRESENTER UN OUTIL INTERESSANT POUR LE SUIVI DE L'EFFICACITE DE LA RENUTRITION. L'EVALUATION D'UNE METHODE DE DOSAGE RAPIDE MONTRE QUE L'IGF I PEUT ETRE UTILISE EN PRATIQUE CLINIQUE. D'AUTRE PART, L'AUGMENTATION DES MARQUEURS DE L'INFLAMMATION EST ASSOCIEE A UNE PROTEOLYSE INTENSE DE L'IGFBP3 QUI MODULE LA BIODISPONIBILITE DE L'IGF I, ET QUI POURRAIT AINSI JOUER UN ROLE DANS L'HYPERCATABOLISME. AINSI, CE TRAVAIL CONTRIBUE A UNE MEILLEURE COMPREHENSION DES VARIATIONS DE SYSTEME IGF AU COURS DU VIEILLISSEMENT NORMAL ET DANS LES SITUATIONS DE DENUTRITION AVEC HYPERCATABOLISME.PARIS7-Bibliothèque centrale (751132105) / SudocSudocFranceF

Citrulline stimulates locomotor activity in aged rats: Implication of the dopaminergic pathway

International audienceObjectives: A citrulline (CIT)-enriched diet improves locomotor activity in aged rats, but the underlying mechanism is unknown. The aim of this study was to determine the effect of CIT administration on locomotor activity and dopamine activity in healthy aged rats.Methods: Sixty adult (3-mo-old) and aged (20-mo-old) rats were divided into four groups (n ¼ 15 each) stratified by age (adult versus old) and diet (control versus CIT; i.e., Ad-Control, Ad-CIT, Old-Control, Old-CIT) and fed for 4 d on either a CIT-enriched diet (5 g/kg daily; Ad-CIT and Old-CIT) or an isonitrogeneous control diet (Ad-Control and Old-Control). Locomotor activity was evaluated in a Y-maze. On day 5, animals were sacrificed and brain (striatum) was removed to determine total and phosphorylated forms of tyrosine hydroxylase (TH) by immunohistochemistry.Results: CIT restored locomotor activity in aged rats (arm visits: Old-CIT 28 ± 1 versus Old-Control 23 ± 1; P < 0.05), associated with an increase in total TH (Old-CIT 668 ± 27 versus Old-Control 529 ± 22; P < 0.05) and phosphorylated forms of TH (Old-CIT 1012 ± 39 versus Old-Control 589 ± 69; P < 0.05).Conclusion: In aged rats, CIT is able to stimulate locomotor activity via the dopaminergic pathway

Serum Leptin Levels, Nutritional Status, and the Risk of Healthcare-Associated Infections in Hospitalized Older Adults

We aimed to determine whether serum leptin levels are predictive of the occurrence of healthcare-associated infections (HAIs) in hospitalized older patients. In a prospective cohort, 232 patients had available data for leptin and were monitored for HAIs for 3 months. Admission data included comorbidities, invasive procedures, the Mini Nutritional Assessment (MNA), BMI, leptin, albumin and C-reactive protein levels, and CD4 and CD8 T-cell counts. Multivariate logistic regression modelling was used to identify predictors of HAIs. Of the 232 patients (median age: 84.8; females: 72.4%), 89 (38.4%) experienced HAIs. The leptin level was associated with the BMI (p &lt; 0.0001) and MNA (p &lt; 0.0001) categories. Women who experienced HAIs had significantly lower leptin levels than those who did not (5.9 &mu;g/L (2.6&ndash;17.7) and 11.8 (4.6&ndash;26.3), respectively; p = 0.01; odds ratio (OR) (95% confidence interval): 0.67 (0.49&ndash;0.90)); no such association was observed for men. In a multivariate analysis of the women, a lower leptin level was significantly associated with HAIs (OR = 0.70 (0.49&ndash;0.97)), independently of comorbidities, invasive medical procedures, and immune status. However, leptin was not significantly associated with HAIs after adjustments for malnutrition (p = 0.26) or albuminemia (p = 0.15)&mdash;suggesting that in older women, the association between serum leptin levels and subsequent HAIs is mediated by nutritional status

Measuring Walking Speed Failed to Predict Early Death and Toxicity in Elderly Patients with Metastatic Non-Small-Cell Lung Cancer (NSCLC) Selected for Undergoing First-Line Systemic Treatment: An Observational Exploratory Study

Walking speed (WS) has emerged as a potential predictor of mortality in elderly cancer patients, yet data involving non-small-cell lung cancer (NSCLC) patients are scarce. Our prospective exploratory study sought to determine whether WS would predict early death or toxicity in patients with advanced NSCLC receiving first-line systemic intravenous treatment. Overall, 145 patients of &ge;70 years were diagnosed with NSCLC over 19 months, 91 of whom displayed locally-advanced or metastatic cancer. As first-line treatment, 21 (23%) patients received best supportive care, 13 (14%) targeted therapy, and 57 (63%) chemotherapy or immunotherapy. Among the latter, 38 consented to participate in the study (median age: 75 years). Median cumulative illness rating scale for geriatrics (CIRS-G) was 10 (IQR: 8&ndash;12), and median WS 1.09 (IQR: 0.9&ndash;1.31) m/s. Older age (p = 0.03) and comorbidities (p = 0.02) were associated with Grade 3&ndash;4 treatment-related adverse events or death within 6 months of accrual. Overall survival was 14.3 (IQR: 6.1-NR) months for patients with WS &lt; 1 m/s versus 17.3 (IQR: 9.2&ndash;26.5) for those with WS &ge; 1 m/s (p = 0.78). This exploratory study revealed WS to be numerically, yet not significantly, associated with early mortality in older metastatic NSCLC patients. Following these hypothesis-generating results, a larger prospective, multicenter study appears to be required to further investigate this outcome