Nutrition and Inflammation in Older Individuals: Focus on Vitamin D, n-3 Polyunsaturated Fatty Acids and Whey Proteins

Chronic activation of the inflammatory response, defined as inflammaging, is the key physio-pathological substrate for anabolic resistance, sarcopenia and frailty in older individuals. Nutrients can theoretically modulate this phenomenon. The underlying molecular mechanisms reducing the synthesis of pro-inflammatory mediators have been elucidated, particularly for vitamin D, n-3 polyunsaturated fatty acids (PUFA) and whey proteins. In this paper, we review the current evidence emerging from observational and intervention studies, performed in older individuals, either community-dwelling or hospitalized with acute disease, and evaluating the effects of intake of vitamin D, n-3 PUFA and whey proteins on inflammatory markers, such as C-Reactive Protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor \u3b1 (TNF-\u3b1). After the analysis, we conclude that there is sufficient evidence for an anti-inflammatory effect in aging only for n-3 PUFA intake, while the few existing intervention studies do not support a similar activity for vitamin D and whey supplements. There is need in the future of large, high-quality studies testing the effects of combined dietary interventions including the above mentioned nutrients on inflammation and health-related outcomes

Nutritional risk, functional status and mortality in newly institutionalised elderly

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI,92) and low (GNRI 92-98) nutritional risk were 36.1 and 30.6 %, respectively. At multivariable linear regression, functional status was independently associated with age (P=0.045), arm muscle area (P=0.048), the number of co-morbidities (P=0.027) and mainly with the GNRI (P<0.001). During a median follow-up of 4.7 years (25th-75th percentile 3.7-6.2), 230 (66.5 %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1.86, 95% CI 1.32, 2.63; P<0.001) and low nutritional risk (HR 1.52, 95% CI 1.08, 2.14; P=0.016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI,92) also showed an increased rate of cardiovascular mortality (HR 1.93, 95% CI 1.28, 2.91; P<0.001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly

Nutritional care routines in Italy, results from the PIMAI (Project: latrogenic MAInutrition in Italy) study

Background/Objectives: Disease-related malnutrition is a common comorbidity at hospital admission. The purpose of the present report was to describe the data on nutritional care routines collected during the Project: Iatrogenic MAlnutrition in Italy (PIMAI) study, as these may be helpful to avoid iatrogenic malnutrition and improve nutritional policies.Subjects/Methods: Standards of nutritional care were assessed on the basis of (1) adherence to study protocol (completeness of data collected); (2) attitude in assessing the nutritional status; (3) prescription of nutritional therapy (within 3 days) at least in patients presenting with overt malnutrition (body mass index (BMI) <18.5 kg/m2 or significant weight loss (10% in 3 months and/or 5% in the last month)), regardless of its adequacy, and adherence to current guidelines and (4) attitude in monitoring nutritional status during the stay (number of weight measurements performed compared with those expected).Results: In total, 1583 subjects were assessed. A minimum data set for performing the Nutritional Risk Screening 2002 tool was available in 1284 patients (81.1%), but nutritional screening was possible in every patient by alternative analytical criteria related to food intake, anthropometry and biochemistry. However, several missing values were recorded, particularly in biochemical parameters due to lack of prescription by admission wards. According to ward practices, only 38.2% of the patients had the BMI calculated. A nutritional support was prescribed only to 26/191 patients (13.6%) presenting with overt malnutrition. Finally, we recorded that only 21.6% of the patients (207/960 were randomly selected) had their weight monitored on a scheduled basis. This reality was worse in surgical rather than medical departments (17 vs 26%; P<0.001).Conclusion: Present results confirm that in Italy, nutritional care routines are still poor and need improvements

Fluid intake and nutritional risk in non-critically ill patients at hospital referral.

The association between hyporexia/anorexia, reduced food intake and disease-related malnutrition at hospital admission is well established. However, information on fluid intake according to nutritional risk has never been provided. Thus, we assessed the attitude and adequacy of fluid intake among case-mix hospitalised patients according to nutritional risk. A sample of 559 non-critically ill patients randomly taken from medical and surgical wards was evaluated. Nutritional risk was diagnosed by the Nutritional Risk Screening 2002. Usual fluid consumption the week before admission was assessed and categorised as /= 5 cups/d (1 cup = 240 ml), with the acceptable intake being >/= 5 cups/d. Prevalence of nutritional risk was 57.2 %, and 46.2 % of the patients reported a fluid intake /= 65 years (OR: 1.88 (95 % CI: 1.03, 3.43); P < 0.04), energy intake (for every 25 % increase in food intake compared with estimated requirements, OR: 0.37 (95 % CI: 0.25, 0.55); P < 0.001) and the number of drugs taken (every three-drug increase, OR: 0.63 (95 % CI: 0.44, 0.90); P < 0.02) were independently associated with inadequate fluid intake ( < 5 cups/d). A significant independent association was also found with nutritional risk (OR: 0.64 (95 % CI: 0.43, 0.95); P < 0.03). Nutritional risk appears to be positively associated with greater fluid intake in non-acute hospitalised patients, but both the reasons and the consequences of this relationship, as well as the impact on clinical practice, need to be explored. However, water replacement by oral nutritional support should take advantage of the patients' attitude to assuming a greater fluid intake, limiting at the same time fluid overload during the refeeding phase

Fluid intake and nutritional risck in non-critically ill patients at hospital referral

The association between hyporexia/anorexia, reduced food intake and disease-related malnutrition at hospital admission is well established. However, information on fluid intake according to nutritional risk has never been provided. Thus, we assessed the attitude and adequacy of fluid intake among case-mix hospitalised patients according to nutritional risk. A sample of 559 non-critically ill patients randomly taken from medical and surgical wards was evaluated. Nutritional risk was diagnosed by the Nutritional Risk Screening 2002. Usual fluid consumption the week before admission was assessed and categorised as /= 5 cups/d (1 cup = 240 ml), with the acceptable intake being >/= 5 cups/d. Prevalence of nutritional risk was 57.2 %, and 46.2 % of the patients reported a fluid intake /= 65 years (OR: 1.88 (95 % CI: 1.03, 3.43); P < 0.04), energy intake (for every 25 % increase in food intake compared with estimated requirements, OR: 0.37 (95 % CI: 0.25, 0.55); P < 0.001) and the number of drugs taken (every three-drug increase, OR: 0.63 (95 % CI: 0.44, 0.90); P < 0.02) were independently associated with inadequate fluid intake ( < 5 cups/d). A significant independent association was also found with nutritional risk (OR: 0.64 (95 % CI: 0.43, 0.95); P < 0.03). Nutritional risk appears to be positively associated with greater fluid intake in non-acute hospitalised patients, but both the reasons and the consequences of this relationship, as well as the impact on clinical practice, need to be explored. However, water replacement by oral nutritional support should take advantage of the patients' attitude to assuming a greater fluid intake, limiting at the same time fluid overload during the refeeding phase

Maintaining the gluten-free diet: The key to improve glycemic metrics in youths with type 1 diabetes and celiac disease

Aims: Gluten-free diets (GFD) were considered as high glycemic index and/or high content of saturated fats; this could affect keeping good metabolic control in individuals with both type 1 diabetes (T1D) and celiac disease (CD). Our objective was to analyze time in range and other continuous glucose monitoring (CGM) metrics with real-time CGM systems, in youths with T1D and CD, compared to those with T1D only. Methods: An observational case-control study, comparing youths aged 8-18&nbsp;years with T1D and CD, with people with T1D only was performed. The degree of maintaining GFD was assessed through anti-tissue transglutaminase antibodies and dietary interview, and maintaining Mediterranean diet through the KIDMED questionnaire. Results: 86 youths with T1D and CD, 167 controls with T1D only, were included in the study and the two groups reported similar real-time CGM metrics. Among the first group, 29&nbsp;% were not completely maintaining GFD and compared to people with T1D only they showed higher hyperglycemia rates (% time above range: 38.72&nbsp;±&nbsp;20.94 vs 34.34&nbsp;±&nbsp;20.94; P&nbsp;=&nbsp;0.039). Conclusions: Individuals with T1D and CD who maintain GFD presented similar glucose metrics compared to youths with T1D only. Individuals not strictly maintaining GFD presented higher hyperglycemia rates