A practical approach to estimate resting energy expenditure in frail elderly people

Objectives: Some prediction equations of resting energy expenditure (REE) are available and can be used in clinical wards to determine energy requirements of patients. The aim of the present study was to assess the accuracy of those equations in sick elderly patients, using the Bland & Altman methods with our database of 187 REE measurements.Design: The 3 equations tested were Harris & Benedict equation of 1919, WHO/FAO/UNU equation of 1985 and Fredrix et al. equation of 1990. In addition, three models developed from the present data were tested.Results: The present study shows that the Fredrix et al equation gave an accurate prediction of REE without significant bias along the whole range of REE. It also shows that under-weight sick elderly patients (BMI ≤ 21 kg/m2) had a greater weight-adjusted REE than their normal weight counterparts.Conclusion: A simple formula using a factor multiplying body weight, i.e. 22 kcal/kg/d in under-weight and 19 kcal/kg/d in normal weight sick elderly was accurate to predicting REE and bias was not influenced by the level of REE. This model included half of the group in the range of ±10% of the difference between predicted REE and measured REE, but the confidence interval of the bias was ±400 kcal/d. Conversely, the Harris & Benedict and WHO formulae did accurately predict REE

Treating the Gibbs phenomenon in barycentric rational interpolation and approximation via the S-Gibbs algorithm

In this work, we extend the so-called mapped bases or fake nodes approach to the barycentric rational interpolation of Floater-Hormann and to AAA approximants. More precisely, we focus on the reconstruction of discontinuous functions by the S-Gibbs algorithm introduced in [12]. Numerical tests show that it yields an accurate approximation of discontinuous functions

Prevalence of sarcopenia in the French senior population

Introduction A muscle mass normalized for height2 (MMI) or for body weight (SMI) below 2SD under the mean for a young population defines sarcopenia. This study aimed at setting the cutoffs and the prevalence of sarcopenia in the French elderly population. Another objective was to compare the results obtained with SMI and MMI.Methods: Muscle mass was assessed by bioelectrical impedance analysis in 782 healthy adults (<40 years) to determine skeletal mass index (SMI, muscle mass*100/weight) and muscle mass index (MMI, muscle mass/height2). Prevalence was estimated in 888 middle aged (40–59 years) and 218 seniors (60–78 years). All were healthy people.Results: For women mean-2SD were 6.2 kg/m2 (MMI) and 26.6% (SMI); for men limits were 8.6 kg/m2 (MMI) and 34.4% (SMI). In middle aged persons a small number of them were identified as sarcopenic. In healthy seniors, 2.8% of women and 3.6% of men were sarcopenic (MMI). The prevalence was 23.6% in women and 12.5% in men with SMI. MMI and SMI identified different sarcopenic populations, leaner subjects for MMI while fatter subjects for SMI.Conclusion: Cutoff values for the French population were defined. Prevalence of sarcopenia was different from that in the US population

Rigidité artérielle mesurée par pOpmètre® chez les patients à risque cardiovasculaire, lien aux plaques d’athérome carotidien

PURPOSE: Aortic stiffness is a functional and structural consequence of ageing and arteriosclerosis. Regional arterial stiffness can be easily evaluated using pOpmetre(®) (Axelife SAS, France). This new technique assesses the pulse wave transit time (TT) between the finger (TTf) and the toe (TTt). Based on height chart, regional pulse wave velocity (PWV) between the toe and the finger can be estimated (PWVtf). pOpscore(®) index is also calculated as the ratio between PWVtoe and PWVfinger and can be considered as a peripheral vascular stiffness index. The aim of the study was to evaluate the relationship between pOpmetre(®) indices and the presence of carotid plaques in a population with cardiovascular risk factors. METHODS: In 77 consecutive patients recruited for a vascular screening for atherosclerosis (46 men aged 54 ± 2 years; 31 women aged 49 ± 3 years; ns), the difference between TTt and TTf (called Dt-f), the regional pulse wave velocity between the toe and the finger (PWVtf = constant × height/Dt-fm/s) and pOpscore(®) were measured by pOpmetre(®). Presence of carotid plaques was assessed using ultrasound imaging. The local aortic stiffness (AoStiff) was evaluated by the Physioflow(®) system. RESULTS: No difference was found between patients with or without carotid plaques (n=25 versus 52) for Ankle-Brachial Pressure Index (ABPI: 1.15 ± 0.04 versus 1.12 ± 0.03), nor for diastolic or systolic blood pressure (87 ± 3 versus 82 ± 2; 137 ± 3 versus 132 ± 2 mmHg). The first group was older than the second (59 ± 2 versus 49 ± 2 years, P<0.002) with a larger intimae media thickness (0.69 ± 0.02 versus 0.63 ± 0.01 mm, P<0.004), a higher AoStiff (10.4 ± 0.7 versus 8.2 ± 0.5m/s, P<0.02), and PWVtf (14.3 ± 1.0 versus 10.7 ± 0.7 m/s, P<0.004) and a shorter Dt-f (57.9 ± 5.1 versus 73.5 ± 3.5 ms, P<0.01). PWVtf (r(2)=0.49, P<0.0001) and Dt-f (r(2)=0.54, P<0.0001) correlated with age. A significant difference in pOpscore(®) index was observed between both groups (1.51 ± 0.3 versus 1.41 ± 0.2, P<0.006). CONCLUSION: Our results show a significant arterial stiffness indices measured by pOpmetre(®) in patients with and without carotid plaques

Hypovitaminosis D in geriatric inpatients: a marker of severity of chronic diseases

Background and aims: Hypovitaminosis D is associated with adverse health outcomes including several bone and non-bone chronic diseases. It remains unclear whether hypovitaminosis D leads to more numerous or more severe chronic diseases. Our aim was to determine whether there was an association between serum 25-hydroxyvitamin D deficiency (i.e., 25OHD <= 25 nmol/L) and, respectively, the number and severity of chronic diseases assessed with the Kaplan-Feinstein index (KFI) among geriatric inpatients. Methods: Two hundred and forty older Caucasian adults admitted between December 2008 and September 2009 to the geriatric acute care unit of Angers University Hospital, France (mean 84.6 +/- 0.4 years; 68.8% women) were included in this cross-sectional study. Serum 25OHD, KFI score and number of chronic diseases (i.e., diseases lasting at least 3 months or running a course with minimal change, whatever their nature or site) were assessed. Subjects were divided into 2 groups according to 25OHD concentration (either deficient for 25OHD <= 25 nmol/L, or non-deficient for 25OHD >25 nmol/L). Age, gender, use of vitamin D supplements, number of chronic diseases, serum parathyroid hormone and season tested were used as potential confounders. Results: Mean serum 25OHD concentration was 35.2 +/- 1.7 nmol/L. The 102 (42.5%) subjects with 25OHD deficiency had higher KFI compared with their counterparts (p=0.008). Vitamin D deficiency was not significantly associated with the number of chronic diseases (adjusted beta=-0.37 with p=0.216), but with KFI (unadjusted beta=1.33 with p=0.008; adjusted beta=1.37 with p=0.010). Conclusions: Irrespective of the number of chronic diseases, 25OHD deficiency was associated with the severity of chronic diseases. (C) 2012, Editrice Kurti

Comorbidities and Treatment-Limiting Decisions in Older Adults Dying in the Emergency Department: Is There an Association?

International audienc

Association of angiitis of central nervous system, cerebral amyloid angiopathy, and Alzheimer's disease: Report of an autopsy case

The association of angiitis of central nervous system (ACNS) with cerebral amyloid angiopathy (CAA) suggests a physiopathological relationship between these two affections. Few cases are reported in patients with Alzheimer’s disease (AD). We describe here a clinicopathological case associating ACNS, CAA, and AD. We discuss the aetiology of ACNS and its relationship with cerebral deposition of beta A4 amyloid protein (βA4)