Wielokulturowość jako wyzwanie dla dietetyka

Praca dietetyka z pacjentem dotyczy głównie jego nawyków i zwyczajów żywieniowych. Najczęściej wynikają one z tradycji rodzinnych bądź uwarunkowań kulturowych. Zalecenia żywieniowe oraz zasady dietoterapii, z którymi dietetyk zapoznaje się podczas procesu kształcenia, są zwyczajowo dostosowane do tradycyjnego profilu Polaka. Tymczasem rozwijająca się mobilność społeczeństw sprawia, że coraz częściej w gabinecie dietetycznym pojawiają się osoby, które mają zróżnicowane uwarunkowania kulturowe, światopoglądowe, religijne, a także fizjologiczne. Tego typu wyzwania są coraz powszechniej spotykane. Mogą one dotyczyć na przykład zaleceń dla pacjenta z anemią, który jest wegetarianinem. Powiększa się także dostępność w polskich sklepach produktów spożywczych z całego świata, co z jednej strony pozwala obcokrajowcom na wykonywanie tradycyjnych potraw, z drugiej natomiast stanowi inspirację dla mieszkańców naszego kraju. Wyzwania te wskazują na potrzebę włączenia do procesu kształcenia dietetyków modułu obejmującego wiedzę o wielokulturowości, kuchniach świata i zasadach religijnych wpływających na sposób odżywiania się. Ułatwi to tworzenie alternatywnych zaleceń dla pacjentów reprezentujących odmienne środowiska kulturowe, przy uwzględnieniu ich zwyczajów żywieniowych. Warto również położyć nacisk na naukę języków obcych oraz na pogłębienie umiejętności tworzenia zaleceń żywieniowych dla pacjentów z innych państw. Pozwoli to zniwelować trudności wynikające z wielokulturowości

Gonadotropins and steroid hormones in older people: their mutual connections and relations to body mass indices

Introduction: Aging in mammals, including man, is accompanied by deep changes in hormone secretion. In the majority of cases, hormone secretion (mostly of gonadal steroids and adrenocortical hormone dehydroepiandrosterone — DHEA) undergoes pronounced decrease. This decrease is thought to contribute to the progression of aging. In contrast, the secretion of gonadotropins is sharply increased in older adults, as a result of gonadal deficiency. Recent data indicate that gonadotropin excess may also, by itself, influence the aging process. The aim of the present study was to investigate the mutual relation between steroid hormones and gonadotropins and their effect on body mass indices in older people. Material and methods: In a group of 100 patients (61 women and 39 men) aged over 75 years, blood serum concentrations of folliclestimulating hormone (FSH), luteinising hormone (LH), oestradiol (E2), testosterone, dehydroepiandrosterone sulphate (DHEAs), and cortisol were measured. All the patients were measured for the following: body weight (kg), body mass index (BMI) (kg/m2), and waist-to-height ratio (WtHR). The differences of the numerical data were evaluated by Student’s t-test and the correlations between them by means of Pearson’s test. Results and conclusions: The most interesting finding of this study was to show that FSH and LH are negatively correlated with body mass and indices such as BMI and WtHR in older women. Because in older women the mediation of ovary is unlikely, we conclude that gonadotropins may influence the body mass by their direct extra-gonadal action

Serum testosterone level correlates with left ventricular hypertrophy in older women

IntroductionSex hormones may play an important role in age-related cardiac remodeling. However, their impact on cardiac structure and function in females of advanced age still remains unclear. The aim of this study is to evaluate the relationship between sex hormones level and echocardiographic parameters in older women with concomitant cardiovascular diseases.Materials and MethodsThe study group included 52 community-dwelling women with mean age 79.5 ± 2.8 years, consecutive patients of an outpatient geriatric clinic. In all the subjects, a transthoracic echocardiogram was performed and serum testosterone, estradiol, follicle-stimulating hormone, luteinising hormone, dehydroepiandrosterone sulphate, and cortisol levels were determined.ResultsTestosterone level correlated positively with interventricular septum diastolic dimension (IVSd) (rS=0.293, p<0.05), left ventricular mass index (rS=0.285, p<0.05), E/E’ ratio (rS=0.301, p<0.05), and negatively with E’ (rS=-0.301, p<0.05). Estradiol level showed a positive correlation with the posterior wall dimension (rS=0.28, p<0.05). Besides, no significant correlations between clinical or echocardiographic parameters and other hormones were observed. Female subjects with diagnosed left ventricular hypertrophy (LVH) (n=34) were characterized by a significantly higher rate of hypertension (p=0.011), higher waist-to-height ratio (p=0.009), higher testosterone level (0.82 vs. 0.48 nmol/L, p=0.024), higher testosterone/estradiol ratio (16.4 vs. 9.9, p=0.021), and received more anti-hypertensive drugs (p=0.030). In a multiple stepwise logistic regression, the best determinants of LVH were the presence of hypertension (OR=6.51; 95% CI 1.62-26.1), and testosterone level (OR= 6.6; 95% CI 1.19-36.6).ConclusionsHigher serum testosterone levels may contribute to pathological cardiac remodeling, especially in hypertensive women. Estradiol, gonadotropins, DHEAS, and cortisol were not related to echocardiographic parameters

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicenter cohort study

Background: age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods: our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results: overall, mortality was found to increase starting from eGFR = 30-44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81-5.95) to ACR = 30-300 mg/g (HR = 1.96, 95%CI = 1.23-3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45-59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78-0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71-0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. Conclusions: physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild-moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function

Diabetes, sarcopenia and chronic kidney disease; the screening for CKD among older people across Europe (SCOPE) study

ackground:Sarcopenia may be more present in older adults with diabetes (DM). Accordingly, we evaluated the prevalence of sarcopenia and its associated risk factors among community‑dwelling older adults with DM.Methods:A cross‑sectional analysis of older people living in the community was carried out. Participants (aged 75 years and more) came from an European multicenter prospective cohort (SCOPE study). Global geriatric assess‑ment including short physical performance battery, handgrip strength test and bioelectrical impedance analysis was performed. Sarcopenia was defined by the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Estimated glomerular filtration rate (eGFR) was calculated using Berlin Initiative Study (BIS) to define the stages of chronic kidney disease (CKD). Previous known DM was defined as physician‑diagnosed DM reg‑istered in the patient's medical record or the use of DM‑related medications. Hemoglobin A1c levels and specific DM therapies administered were collected. Time elapsed from the first diagnosis of DM was not collected and, therefore, was not included in the analyses.Results:A total of 1,420 subjects were evaluated with a median age of 79.0 (6.0) years, of which 804 (56.6%) were women and 615 (43.3%) men; 315 (22.2%) participants had prior DM diagnosis, with a median age of 80.0 (6.0), 146 (46.3%) were women. Using EWGSOP2 definition, 150 (10.6%) participants in the SCOPE study met diagnostic criteria for sarcopenia. Participants without diabetes had more often normal results in the 3 sarcopenia components than participants with diabetes [887 (80.31%) vs. 227 (72.1%), p=0.002], highlighting higher percentages of severe sarco‑penia in participants with diabetes [27 (8.6%) vs. 58 (5.2%), p=0.028]. Confirmed or severe sarcopenia was detected in 41 (13%) participants with diabetes and 109 (9.8%) participants without diabetes (p=0.108). According to BIS equa‑tion, sarcopenia was not significantly more prevalent in the more advanced stages of CKD (p=0.845). In multivariate analyses, older age (odds ratios [OR], 1.17; 95% confidence interval [CI], 1.08-1.27), and lower body mass index (OR, 0.79; 95% CI, 0.71-0.89 were associated with the presence of sarcopenia.Conclusions:One tenth of all older community‑dwelling subjects have sarcopenia. Older age and being thinner, but not worse renal function, were associated with higher prevalence of sarcopenia in older older adults with diabetes

Short physical performance battery is not associated with falls and injurious falls in older persons:longitudinal data of the SCOPE project

Introduction: Falls and fall-related injuries in older persons are a major public health problem. Our objective was to study the predictive value of the Short Physical Performance Battery (SPPB) in the cohort of the SCOPE project on falls, injurious falls, and possible difference of prediction between indoors and outdoors falls. Methods: For this sub-study of the SCOPE project participants reporting no falls at baseline, and survey data on falls at the 12-month and 24-month follow-up were included. Participant´s characteristics were assessed during the baseline interview and medical examinations. Falls as well as injurious falls and fall circumstances were obtained self-reported. SPPB and its association with fallers vs. no fallers at 12 and at 24 months were studied with logistic regression models. Results: The 1198 participants had a median age of 79 years (77–82), and a median SPPB of 10 (8–11), with a 52.5% of female. A total of 227 and 277 falls (12- and 24- month visits, respectively) were reported. In the crude model, the SPPB sum scores (p &lt; 0.001) as well as most single item scores were significant different between fallers and non-fallers over time. However, the association was attenuated in models adjusted for age, sex, marital status, number of medications, quality of life, handgrip strength, and muscle mass [e.g., 12 months; OR 0.94 (0.87–1.02)]. While SPPB fails to differentiate between injurious and non-injurious falls (p = 0.48), a lower SPPB score was associated with falls at home (p &lt; 0.01) after 24 months.Conclusion: SBPP was not able to significantly predict the risk of falling as well as experiencing an injurious fall. Trial registration: This study was registered prospectively on 25th February 2016 at clinicaltrials.gov (NCT02691546).</p

Estimated glomerular filtration rate and functional status among older people: A systematic review

Background: The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive value of different eGFR equations in regard to frailty and disability outcomes. Methods: We searched Pubmed from inception to March 2018 for studies investigating the association between eGFR and self-reported and/or objective measures of frailty or disability. Cross-sectional and longitudinal studies were separately analysed. Results: We included 16 studies, one of which reporting both cross-sectional and longitudinal data. Three out of 7 cross-sectional studies compared different eGFR equations in regard to their association with functional status: two studies showed that cystatin C-based, but not creatinine-based eGFR may be associated with hand-grip strength or frailty; another study showed that two different creatinine-based eGFR equations may be similarly associated with disability. Four out of 10 longitudinal studies provided comparative data: two studies reported similar association with disability for different creatinine-based eGFR equations; one study showed that creatinine-based eGFR was not associated with frailty, but a not significant trend for association was observed with cystatin C-based eGFR; one study showed that cystatin C-based but not creatinine-based eGFR may predict incident mobility disability, while both methods may predict gait speed decline. High heterogeneity was observed in regard to confounders included in reviewed studies. None of them included the most recently published equations. Conclusion: Available data do not support the superiority of one of the eGFR equations in terms of measuring or predicting functional decline

Clinical implications of estimating glomerular filtration rate with three different equations among older people: preliminary results of the project 'Screening for Chronic Kidney Disease Among Older People Across Europe (SCOPE)'

We aimed at investigating to what extent CKD may be staged interchangeably by three different eGFR equations in older people, and evaluating the source of discrepancies among equations in a population of 2257 patients older than 75 years enrolled in a multicenter observational study. eGFR was calculated by CKD-EPI, BIS and FAS equations. Statistical analysis was carried out by Bland-Altman analysis. κ statistic was used to quantify the agreement between equations in classifying CKD stages. The impact of selected variables on the difference among equations was graphically explored. The average difference between BIS and FAS was -0.24 (95% limits of agreement (95%LA = -4.64-4.14) mL/min/1.73 m2. The difference between CKD-EPI and BIS and between CKD-EPI and FAS was 8.97 (95%LA = -2.90-20.84) and 8.72 (95%LA = -2.11-19.56) mL/min/1.73 m2, respectively. As regards CKD stage classification, κ value was 0.47 for both CKD-EPI vs. FAS and CKD-EPI vs. BIS, while BIS and FAS had similar classificatory properties (κ = 0.90). Muscle mass was found related to the difference between CKD-EPI and BIS (R2 = 0.11) or FAS (R2 = 0.14), but not to the difference between BIS and FAS. In conclusion, CKD-EPI and BIS/FAS equations are not interchangeable to assess eGFR among older people. Muscle mass may represent a relevant source of discrepancy among eGFR equations

Quality of life and kidney function in older adults: prospective data of the SCOPE study

Abstract: A longitudinal alteration in health-related quality of life (HRQoL) over a two-year period and its association with early-stage chronic kidney disease (CKD) progression was investigated among 1748 older adults (>75 years). HRQoL was measured by the Euro-Quality of Life Visual Analog Scale (EQ-VAS) at baseline and at one and two years after recruitment. A full comprehensive geriatric assessment was performed, including sociodemographic and clinical characteristics, the Geriatric Depression Scale-Short Form (GDS-SF), Short Physical Performance Baery (SPPB), and estimated glomerular filtration rate (eGFR). The association between EQ-VAS decline and covariates was investigated by multivariable analyses. A total of 41% of the participants showed EQ-VAS decline, and 16.3% showed kidney function decline over the two-year follow-up period. Participants with EQ-VAS decline showed an increase in GDS-SF scores and a greater decline in SPPB scores. The logistic regression analyses showed no contribution of a decrease in kidney function on EQVAS decline in the early stages of CKD. However, older adults with a greater GDS-SF score were more likely to present EQ-VAS decline over time, whereas an increase in the SPPB scores was associated with less EQ-VAS decline. This finding should be considered in clinical practice and when HRQoL is used to evaluate health interventions among older adults