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Nutrition Disorders in Older Adults

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 41259

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Special Issue Editor

Dr. Shinta Nishioka

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Guest Editor

Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan
Interests: clinical nutrition; rehabilitation nutrition; malnutrition in older adults; nutritional screening and assessment; nutrition care process; guideline development; sarcopenia

Special Issue Information

Dear Colleagues.

Older adults often experience nutrition disorders such as malnutrition (undernutrition), micronutrient abnormalities, and obesity/overweight. These problems can be caused by multiple factors, including physiological changes in taste and smell, delayed gastric excretion, inflammation from acute/chronic disease or trauma, polypharmacy, lack of exercise, and unnecessary/inappropriate dietary restrictions. Lack of awareness of nutritional disorders among the individual, caregivers, and healthcare providers can exacerbate these conditions.

Numerous studies have shown that malnutrition is associated with mortality, overall complications, incidence of pressure ulcers, physical and cognitive decline, reduced ability to perform activities of daily living, and reduced quality of life in older adults. Therefore, how to screen, evaluate, and treat malnutrition in the older adults has become an urgent issue in an aging society. However, studies reported to date are inconsistent as to whether obesity/overweight has a positive or negative impact on outcomes in older adults. More research is needed to examine the impact of overweight/obesity on the health of older adults and the optimal assessment and intervention strategies for weight management.

This Special Issue focuses on 1) the association between nutrition disorders and health, functioning, quality of life, and socio-economic burden in older adults in all settings (e.g., hospital, institutional, and community); 2) appropriate methods to screen and assess nutrition disorders; and 3) the effectiveness and efficiency of nutritional interventions for nutritional disorders, with or without other interventions (e.g., rehabilitation therapy, medication, social support). Issues related to sarcopenia, sarcopenic obesity, cachexia, and frailty in the context of nutrition are also welcome.

Dr. Shinta Nishioka
Guest Editor

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Keywords

older adults
malnutrition (undernutrition)
overweight/obesity
micronutrient abnormalities
sarcopenia
sarcopenic obesity
frailty
cachexia

Published Papers (11 papers)

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Research

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12 pages, 591 KiB

Open AccessArticle

Risk of Weight Loss in Adult Patients and the Effect of Staffing Registered Dietitians in Kaifukuki (Convalescent) Rehabilitation Wards: A Retrospective Analysis of a Nationwide Survey

by Shinta Nishioka, Yoji Kokura, Takatsugu Okamoto, Masako Takayama and Ichiro Miyai

Healthcare 2021, 9(6), 753; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060753 - 18 Jun 2021

Cited by 3 | Viewed by 2293

Abstract

There is scarce evidence regarding the risk of weight loss and the effect of having registered dietitians (RDs) on staff in rehabilitation wards on weight loss. We aimed to examine the effects of RDs in Kaifukuki (convalescent) rehabilitation wards (KRWs) on the prevention of weight loss in adult patients. Data from 2-year nationwide annual surveys on KRWs in Japan were retrospectively analysed. Weight loss was defined as loss of ≥5% weight during the KRW stay. Risk of weight loss in class 1 KRWs (obligated to provide nutrition care) was compared with that in class 2–6 KRWs (not obligated). Risk of weight loss in class 2–6 KRWs with RDs was compared to those without. Overall, 17.7% of 39,417 patients lost weight. Class 1 KRWs showed a lower risk of weight loss than class 2–6 KRWs (17.3% vs. 18.5%, p = 0.003). KRWs with RDs showed a significantly lower incidence of weight loss than those without RDs (16.1% vs. 18.8%, p = 0.015). Class 1 KRWs and exclusively staffed RDs were independently associated with lower odds of weight loss (odds ratio = 0.915 and 0.810, respectively). Approximately 18% of KRW patients lost weight, and having RDs on staff can lower the risk of weight loss. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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8 pages, 436 KiB

Open AccessArticle

Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

by Yusuke Ito, Hidetaka Wakabayashi, Shinta Nishioka, Shin Nomura and Ryo Momosaki

Healthcare 2021, 9(6), 722; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060722 - 12 Jun 2021

Cited by 2 | Viewed by 3247

Abstract

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form^® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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16 pages, 1233 KiB

Open AccessArticle

Harnessing Stakeholder Perspectives and Experience to Address Nutrition Risk in Community-Dwelling Older Adults

by Catherine B. Chan, Naomi Popeski, Leah Gramlich, Marlis Atkins, Carlota Basualdo-Hammond, Janet Stadnyk and Heather Keller

Healthcare 2021, 9(4), 477; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9040477 - 16 Apr 2021

Cited by 5 | Viewed by 2456

Abstract

Community-dwelling, older adults have a high prevalence of nutrition risk but strategies to mitigate this risk are not routinely implemented. Our objective was to identify opportunities for the healthcare system and community organizations to combat nutrition risk in this population in the jurisdiction of Alberta, Canada. An intersectoral stakeholder group that included patient representatives was convened to share perspectives and experiences and to identify problems in need of solutions using a design thinking approach. Results: Two main themes emerged from the workshop: (1) lack of awareness and poor communication of the importance of nutrition risk between healthcare providers and from healthcare providers to patients and (2) the necessity to work in partnerships comprised of patients, community organizations, healthcare providers and the health system. Conclusion: Improving awareness, prevention and treatment of malnutrition in community-dwelling older adults requires intersectoral cooperation between patients, healthcare providers and community-based organizations. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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10 pages, 604 KiB

Open AccessArticle

The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults

by Yuto Kiuchi, Hyuma Makizako, Yuki Nakai, Kazutoshi Tomioka, Yoshiaki Taniguchi, Mika Kimura, Hiroaki Kanouchi, Toshihiro Takenaka, Takuro Kubozono and Mitsuru Ohishi

Healthcare 2021, 9(1), 32; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9010032 - 01 Jan 2021

Cited by 13 | Viewed by 3071

Abstract

The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried’s component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84–0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60–7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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13 pages, 901 KiB

Open AccessArticle

Prevalence and Associated Factors of Malnutrition and Sarcopenia in a Daycare Facility: A Cross-Sectional Study

by Aya Shiota, Naomi Nakayama, Yuki Saito, Tamako Maeda, Yukie Maeda and Kentaro Nakayama

Healthcare 2020, 8(4), 576; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8040576 - 18 Dec 2020

Cited by 11 | Viewed by 3333

Abstract

Malnutrition and sarcopenia are prevalent and growing health issues in older populations. Early detection is important to implement proper interventions. However, little is known about malnutrition and sarcopenia in daycare facilities, the most dominant long-term care service. In this study, the prevalence of and factors associated with malnutrition and sarcopenia in older individuals who commute to community daycare facilities were evaluated. The cross-sectional study included 62 older individuals screened for malnutrition and sarcopenia on their first day in a daycare facility in Japan. Daily physical activity and basal diseases were also evaluated. According to Global Leadership Initiative on Malnutrition (GLIM) criteria, 40.3% (25/62) of patients were malnourished and 59.7% (37/62) were well nourished. The Asian Working Group for Sarcopenia 2019 evaluation found that 12.9% (8/62) of patients showed no sarcopenia, whereas 87.1% (54/62) had sarcopenia. The prevalence of well-nourished sarcopenic individuals was the highest (45.2% (28/62)), followed by malnourished sarcopenia individuals (40.3% (25/62)). All malnourished individuals were sarcopenic and 14.5% (9/62) were well nourished and nonsarcopenic. Daily physical activity was significantly lower among sarcopenic individuals. Subgroups showed no significant difference in comorbidities. The prevalence of malnutrition and sarcopenia was relatively high. Activity-related sarcopenia seemed to precede malnutrition. Early detection of malnutrition and sarcopenia in daycare facilities should be encouraged for early intervention. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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15 pages, 2618 KiB

Open AccessArticle

High Visceral Fat Area Attenuated the Negative Association between High Body Mass Index and Sarcopenia in Community-Dwelling Older Chinese People

by Cheng Li, Bingxian Kang, Ting Zhang, Hongru Gu, Qingqing Man, Pengkun Song, Zhen Liu, Jingyi Chen, Xile Wang, Bin Xu, Wenhua Zhao and Jian Zhang

Healthcare 2020, 8(4), 479; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8040479 - 12 Nov 2020

Cited by 5 | Viewed by 1812

Abstract

The association between obesity and sarcopenia remains controversial. The present study was conducted to explore the associations among body mass index (BMI), visceral fat area (VFA), and sarcopenia in older people and analyze their potential mechanisms. This cross-sectional study included 861 community-dwelling older Chinese people from three regions of China. BMI, VFA, muscle mass, muscle strength, physical performance, body composition, and metabolic markers were measured. Muscle mass and muscle strength were positively correlated with BMI, but were negatively correlated with VFA. Simple overweight/obesity was negatively associated with sarcopenia (OR = 0.07, 95% CI = 0.03~0.18), and the OR value was lower than combined obesity (OR = 0.16, 95% CI = 0.09~0.28). Fat free mass and total body protein were positively associated with high BMI but negatively associated with high VFA. Furthermore, high VFA was adversely associated with some metabolic risk factors of sarcopenia. Combination of BMI and VFA increased diagnostic efficiency of low muscle mass and sarcopenia. In conclusion, high BMI was negatively associated with sarcopenia, while high VFA attenuated the negative association between high BMI and sarcopenia. The opposite association may partially be attributed to their different associations with body composition and metabolic risk factors of sarcopenia. Therefore, bedsides BMI, VFA and its interaction with BMI should be considered in sarcopenia prevention. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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8 pages, 237 KiB

Open AccessArticle

Impact of Body Mass Index on Activities of Daily Living in Patients with Idiopathic Interstitial Pneumonias

by Kengo Shirado, Hidetaka Wakabayashi, Keisuke Maeda and Ryo Momosaki

Healthcare 2020, 8(4), 385; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8040385 - 05 Oct 2020

Cited by 1 | Viewed by 3335

Abstract

In patients with idiopathic interstitial pneumonias, undernutrition has a profound effect on prognosis. However, whether body mass index affects the ability to perform activities of daily living as measured by the Barthel index in patients with idiopathic interstitial pneumonias remains unknown. Therefore, we examined the impact of body mass index on the activities of daily living in inpatients with idiopathic interstitial pneumonia. We used a database constructed by the Japan Medical Data Center. Data were extracted from 2774 inpatients from participating hospitals with a diagnosis of idiopathic interstitial pneumonia. Multiple regression analysis adjusted for confounding factors was performed to determine whether body mass index classification would be independently related to change in Barthel index during hospitalization. Underweight, normal weight, overweight, and obesity numbered 473 (19%), 1037 (41), 795 (31%), and 235 (9%), respectively. Multivariable analysis showed that being underweight was independently associated with a change in Barthel index during hospitalization of −2.95 (95% confidence interval −4.82 to −1.07) points lower than being normal weight. Approximately 20% of the patients with idiopathic interstitial pneumonias were underweight. Those who were underweight had decreased independence in activities of daily living during hospitalization. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

10 pages, 454 KiB

Open AccessArticle

Sarcopenic Obesity and Activities of Daily Living in Stroke Rehabilitation Patients: A Cross-Sectional Study

by Tatsuya Matsushita, Shinta Nishioka, Shiori Taguchi, Anna Yamanouchi, Ryusei Nakashima and Hidetaka Wakabayashi

Healthcare 2020, 8(3), 255; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8030255 - 06 Aug 2020

Cited by 22 | Viewed by 4142

Abstract

Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent rehabilitation wards. This study was performed in older post-stroke patients admitted to convalescent rehabilitation wards between January 2017 and March 2019. Sarcopenia was diagnosed based on the skeletal muscle mass index and hand grip strength according to the criteria of the 2019 Asian Working Group for Sarcopenia. Obesity was diagnosed according to the body fat percentage; ≥27% in men, ≥38% in women. The primary outcome was the Functional Independence Measure (FIM) score upon admission, which was analyzed using multiple linear regression. In total, 376 participants (women 44%; mean age 77.5 years) were analyzed and classified as normal (22%), simple obesity (17%), sarcopenia without obesity (32%), and sarcopenic obesity (28%). The presence of sarcopenic obesity was independently associated with the FIM score (95% CI, −16.157 to −5.353), whereas simple obesity and sarcopenia without obesity were not. In conclusion, sarcopenic obesity was independently associated with lower activities of daily living capability in older patients with stroke. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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16 pages, 865 KiB

Open AccessArticle

Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults

by Jos W. Borkent, Heather Keller, Carol Wham, Fleur Wijers and Marian A. E. de van der Schueren

Healthcare 2020, 8(2), 151; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8020151 - 02 Jun 2020

Cited by 10 | Viewed by 3935

Abstract

Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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Review

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12 pages, 1276 KiB

Open AccessReview

Sarcopenia among the Elderly Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Di-Ya Tu, Fa-Min Kao, Shih-Tzer Tsai and Tao-Hsin Tung

Healthcare 2021, 9(6), 650; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060650 - 31 May 2021

Cited by 8 | Viewed by 4177

Abstract

Purpose. This systematic review and meta-analysis was conducted to explore the effect of protein intake on the prevention and improvement of sarcopenia. Methods. We searched the Cochrane Library, PubMed, and EMBASE from inception to 20 May 2021. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Results. There were 12 studies that met the selection criteria among 53 eligible publications. The results of the study show that the protein intake has no significant effect on the physical performance—4 m gait speed, chair rise test, short physical performance battery, muscle mass—skeletal muscle mass index, and muscle strength—hand grip strength. Conclusion. Protein supplementation had no significant effect on 4 m gait speed and on improving skeletal muscle mass index, hand grip strength, chair rise test, and short physical performance battery. Additional randomized controlled trials are warranted to adequately assess the effect of protein supplementation on elderly sarcopenia. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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24 pages, 413 KiB

Open AccessReview

Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis

by Xiaojing Sharon Wu, Anna Miles and Andrea Braakhuis

Healthcare 2020, 8(4), 579; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8040579 - 21 Dec 2020

Cited by 32 | Viewed by 7894

Abstract

Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (−273.8 kJ/d; 95%CI: −419.1 to −128.6, p = 0.0002) and protein (−12.4 g/d; 95%CI: −17.9 to −6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention. Full article

(This article belongs to the Special Issue Nutrition Disorders in Older Adults)

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