Limited compensation at the following meal for protein and energy intake at a lunch meal in healthy free-living older adults.

Various interventions have previously been found to increase protein intakes in older adults, but in free-living individuals, compensation for increased intakes at one meal may easily negate these effects resulting in limited long term benefit. This study investigated the impact of adding sauce to an older person's lunch meal on intakes at that meal, at the following meal and overall (lunch + evening meal). Using a repeated measures design, 52 participants consumed both a lunch meal with sauce and the same lunch meal without sauce on two separate occasions, and intake at this meal and at the following meal were measured. In all participants analysed together, the addition of sauce resulted in increased protein intakes at the lunch meal. Individual differences were also found, where for some individuals (n = 26), the addition of sauce resulted in significantly higher protein and energy intakes at the lunch meal (12.3 g protein, 381 kJ) and overall (11 g protein, 420 kJ), compared to the no-sauce condition, while for some individuals (n = 19), the sauce manipulation resulted in lower protein and energy intakes (lunch: 7 g protein, 297 kJ; overall: 7 g protein, 350 kJ). Compensation for earlier intakes was low (0-17%) for both groups. These findings demonstrate the possible value of adding sauce to an older person's meal for increasing intakes, and demonstrate a need for attention to individual differences. This study also confirms previous findings of limited compensation in older adults, but extends earlier studies to demonstrate limited compensation for the protein consumed in a complete meal in healthy older adults

Perspectives on the causes of undernutrition of community-dwelling older adults: A qualitative study

Objectives: Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults. Design: Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed. Setting: Community-dwelling. Participants: Older adults. Measurements: A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition. Results: 33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food & appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization. Conclusions: This study provides guidance to better understand the underlying causes of undernutrition from an older adult’s perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members

Factors associated with (risk of) undernutrition in community-dwelling older adults receiving home care: a cross-sectional study in the Netherlands

OBJECTIVE: It is generally thought that causes of undernutrition are multifactorial, but there are limited quantitative studies performed. We therefore examined a wide range of potential factors associated with undernutrition in community-dwelling older adults. DESIGN: Cross-sectional study. SETTING: Community-dwelling older adults (≥65 years) receiving home care in the Netherlands. SUBJECTS: Data on potential factors associated with (risk of) undernutrition were collected among 300 older adults. Nutritional status was assessed by the SNAQ65+ instrument. Undernutrition was defined as mid-upper arm circumference <25 cm or unintentional weight loss of ≥4 kg in 6 months. Being at risk of undernutrition was defined as having poor appetite and inability to walk up and down stairs of fifteen steps, without resting. RESULTS: Of all participants, ninety-two (31·7 %) were undernourished and twenty-four (8·0 %) were at risk of undernutrition. Based on multivariate logistic regression analyses, the statistically significant factors associated with (risk of) undernutrition (P<0·05) were: unable to go outside (OR=5·39), intestinal problems (OR=2·88), smoking (OR=2·56), osteoporosis (OR=2·46), eating fewer than three snacks daily (OR=2·61), dependency in activities of daily living (OR=1·21), physical inactivity (OR=2·01), nausea (OR=2·50) and cancer (OR=2·84); a borderline significant factor was depression symptoms (OR=1·83, P=0·053). CONCLUSIONS: The study suggests that (risk of) undernutrition is a multifactorial problem and that associated factors can be found in several domains. These findings may support the development of intervention trials for the prevention and treatment of undernutrition in community-dwelling older adults

Factors associated with (risk of) undernutrition in communitydwelling older adults receiving home care: a cross-sectional study in the Netherlands: Public Health Nutrition

Objective: It is generally thought that causes of undernutrition are multifactorial, but there are limited quantitative studies performed. We therefore examined a wide range of potential factors associated with undernutrition in communitydwelling older adults. Design: Cross-sectional study. Setting: Community-dwelling older adults (>= 65 years) receiving home care in the Netherlands. Subjects: Data on potential factors associated with (risk of) undernutrition were collected among 300 older adults. Nutritional status was assessed by the SNAQ(65+) instrument. Undernutrition was defined as mid-upper arm circumference = 4 kg in 6 months. Being at risk of undernutrition was defined as having poor appetite and inability to walk up and down stairs of fifteen steps, without resting. Results: Of all participants, ninety-two (31.7%) were undernourished and twentyfour (8.0%) were at risk of undernutrition. Based on multivariate logistic regression analyses, the statistically significant factors associated with (risk of) undernutrition (P <0.05) were: unable to go outside (OR=5.39), intestinal problems (OR=2.88), smoking (OR =2.56), osteoporosis (OR=2.46), eating fewer than three snacks daily (OR=2.61), dependency in activities of daily living (OR=1.21), physical inactivity (OR=2.01), nausea (OR=2.50) and cancer (OR=2.84); a borderline significant factor was depression symptoms (OR =1.83, P=0.053). Conclusions: The study suggests that (risk of) undernutrition is a multifactorial problem and that associated factors can be found in several domains. These findings may support the development of intervention trials for the prevention and treatment of undernutrition in community-dwelling older adults

Determinants of protein–energy malnutrition in community-dwelling older adults: A systematic review of observational studies

Protein-energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein-energy malnutrition in community-dwelling older adults.A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein-energy malnutrition were selected and a best evidence synthesis was performed to summarize the results.In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein-energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications.This review shows that protein-energy malnutrition is a multi-factorial problem and that different domains likely play a role in the pathway of developing protein-energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein-energy malnutrition in community-dwelling older adults

Targeting the underlying causes of undernutrition. Cost-effectiveness of a multifactorial personalized intervention in community-dwelling older adults: A randomized controlled trial

Background & aims: Undernutrition in old age is associated with increased morbidity, mortality and health care costs. Treatment by caloric supplementation results in weight gain, but compliance is poor in the long run. Few studies targeted underlying causes of undernutrition in community-dwelling older adults. This study aimed to evaluate the cost-effectiveness of a multifactorial personalized intervention focused on eliminating or managing the underlying causes of undernutrition to prevent and reduce undernutrition in comparison with usual care. Methods: A randomized controlled trial was performed among 155 community-dwelling older adults receiving home care with or at risk of undernutrition. The intervention included a personalized action plan and 6 months support. The control group received usual care. Body weight, and secondary outcomes were measured in both groups at baseline and 6 months follow-up. Multiple imputation, linear regression and generalized estimating equation analyses were used to analyze intervention effects. In the cost-effectiveness analyses regression models were bootstrapped to estimate statistical uncertainty. Results: This intervention showed no statistically significant effects on body weight, mid-upper arm circumference, grip strength, gait speed and 12-Item Short-Form Health Survey physical component scale as compared to usual care, but there was an effect on the 12-Item Short-Form Health Survey mental component scale (0-100) (β = 8.940, p. =0.001). Borderline significant intervention effects were found for both objective and subjective physical function measures, Short Physical Performance Battery (0-12) (β = 0.56, p. =0.08) and ADL-Barthel score (0-20) (β = 0.69, p. =0.09). Societal costs in the intervention group were statistically non-significantly lower than in the control group (mean difference -274; 95% CI -1111; 782). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 0.72 at a willingness-to-pay of 1000 €/kg weight gain and 0.80 at a willingness-to-pay of 20,000 €/quality-adjusted life year gained. Conclusions: This multifactorial personalized intervention showed a statistically non-significant effect and was not cost-effective on body-weight compared to usual care. We observed consistently beneficial treatment effects in the intervention group on all outcomes measures. Clinical trial registry number and website: NTR5184 (www.trialregister.nl)

Symptom burden and its association with change in glucose metabolism status over a 7-year period: the Hoorn Study

Aims To study symptom burden among older people and its associations with change in glucose metabolism status over a 7‐year period. Methods We conducted a prospective population‐based cohort study among 397 older people. We used the revised Diabetes Symptom Checklist to assess symptom burden. Glucose metabolism status was determined using an oral glucose tolerance test. Analyses were adjusted for multiple confounders, including cardiovascular risk and risk of depression (Center for Epidemiological Studies Depression Scale score ≥ 16). Results Revised Diabetes Symptom Checklist total scores (range 0–100) increased slightly over time among people with normal glucose metabolism (mean difference β1.04; P = 0.04) and those with impaired glucose metabolism (β1.96; P = 0.01), but not among people with Type 2 diabetes (β0.46; P = 0.55). These associations between symptom burden and glucose status were attenuated after full adjustment for multiple confounders and remained statistically significant for those with impaired glucose status. Linear mixed models showed significant mean differences in revised Diabetes Symptom Checklist total scores over time when comparing people with Type 2 diabetes with those with normal or impaired glucose metabolism, but not when comparing subjects with impaired vs normal glucose metabolism; these results did not alter after full adjustment. Conclusions Symptom burden increased gradually over time in the people with impaired glucose metabolism and those with normal glucose metabolism, but not in patients with Type 2 diabetes over a 7‐year follow‐up period

Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub

In order to tackle the increasing problem of malnutrition (i.e. protein-energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNuEL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence-based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNuEL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web-based questionnaires, MaNuEL will provide insight into current clinical practice, policies and health professionals' education on malnutrition and will make recommendations for improvement. MaNuEL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies