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- ArticleLewis SM, Mayhugh MA, Freni SC, Cardoso SS, Buffington C, Jairaj K, Turturro A, Feuers RJ.J Nutr Health Aging. 2003;7(2):78-83.Energy intake patterns that may impact health status among non-affluent southern U.S. women from small urban communities have not been evaluated extensively. Usual intake estimates are confounded by factors such as validity of intake methods and socioeconomic status. Typical 24-h energy intakes were reported by Caucasian (CA, n=149) and African-American (AA, n=110) women; at 43% of this sub-population, AA women are appropriately and proportionately represented. Daily energy intake was examined for these non-pregnant females, 24 to 93 y of age, to define typical energy, carbohydrate, protein, and fat intake. Study groups were: 24-29 y, 30-39 y, 40-49 y, 50-59 y, 60-69 y, 70-79 y, and 80-93 y. Statistical comparisons of nutrient variables by age were made by least squares means between groups. Body mass index (BMI) calculations accounted for differences in height and relative body mass. Both races reported similar energy intakes and significant (P<0.05) decreases with age were noted. Energy intakes were 15-40% below recommended levels, similar to reported values; senior lunch programs ameliorated declines among some women >60 y. More daily calories (52-62%) were provided by carbohydrates, followed by fat (26-35%) and protein (14-17%) findings in close agreement with health recommendations. Time-of-day intake patterns suggest women >59 y consume larger noon meals. BMI for AA women was greater (P<0.05) than that of CA women between 30-59 y. At 24-29 y, AA women had lowest BMI values; BMI decreases occurred in CA women after 80 y. These factors may impact the health of non-affluent southern AA and CA women, particularly the elderly who may require guidance for diet planning and intake intervention programs.
- ArticleEckert GP, Kirsch C, Müller WE.J Nutr Health Aging. 2003;7(1):18-23.Cholesterol represents an important determinant of the physical state of biological membranes. Growing evidence indicate that changes in brain cholesterol and variations in neuronal membrane structure are involved in the development of Alzheimer's disease (AD). Cholesterol modulates the cleavage of the amyloid precursor protein and thus affect cellular production of beta-amyloid peptides (Ab). On the other hand, cholesterol seems to be protective against the neurotoxic and membrane disordering properties of Ab. Present review summarizes reports focusing on brain membrane changes in AD and the effects of Ab on these structures. Since it has been shown that these Ab effects are cholesterol dependent, recent findings are presented indicating that the modulation of membrane cholesterol refers to different cholesterol pools within the membranes. Further, consequences thereof for possible pharmacological strategies are discussed.
- ArticleArias-Merino ED, Orozco-Mares I, Garabito-Esparza LC, Fernandez-Cruz L, Arias-Merino MJ, Celis de la Rosa A, Cabrera-Pivaral C, Gonzalez-P Rez GJ.J Nutr Health Aging. 2003;7(2):97-101.AIM: To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes.
DESIGN: Cross-sectional.
SETTING: Fourteen nursing homes in Guadalajara.
PARTICIPANTS: Data were drawn from a random sample of 451 elderly, aged 60-104 years.
MEASUREMENTS: The Spanish versions of MMSE (Folstein), ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained.
RESULTS: The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression.
CONCLUSION: The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression. - ArticleNydhal M, Andersson J, Sidenvall B, Gustafsson K, Fjellström C.J Nutr Health Aging. 2003;7(2):67-74.BACKGROUND: With the increasing numbers of elderly women living at home, there is an interest to investigate the dietary intake of this group.
OBJECTIVE: To investigate the food and nutrient intake in a group of self-managing elderly women in Sweden.
DESIGN: A 3-day self-reported food diary and a repeated 24-h dietary recall were used. The study comprised 135 single-living or married/cohabiting women (mean age 79.5 8.0 years).
RESULTS: Mean energy intake for the whole group was 6.8 1.9 MJ, and low energy figures were obtained in all age groups indicating some possible under-reporting with a calculated EIrep/BMRest of 1.24 0.36 for the whole group. Overall, energy and nutrient intake was similar in the different age groups (64-68 yrs, 74-78 yrs and 84-88 yrs). Reported intakes of vitamin D (4.8 2.7 mg), tocopherol (5.9 2.2 mg), iron (8.5 2.9 mg), folate (200 8.7 mg) and selenium (29 11 mg) were low compared to recommended intakes. Only minor differences between women in different household types were found. The women reported a variety of food items in their diet.
CONCLUSIONS: Overall, the results from this study indicate that self-managing elderly women report low energy figures, but have a sufficient intake of most nutrients. However, there is a tendency that the oldest women, i.e. 84-88 yrs have lower intakes. - ArticleChin A Paw MJ, de Groot LC, van Gend SV, Schoterman MH, Schouten EG, Schroll M, van Staveren WA.J Nutr Health Aging. 2003;7(1):55-60.The effectiveness was examined of inactivity and weight loss as criteria to identify a frail subgroup within independently living elderly persons participating in the SENECA study (Survey in Europe on Nutrition and the Elderly, a Concerted Action). Eight-hundred-forty-nine participants (aged 75 to 80) from nine countries were classified in four subgroups: 1) inactive elderly (lowest tertile activity score: n = 204); 2) weight losing elderly (lowest quintile: * 6.3% weight loss over 4-5 years: n = 108); 3) both inactive and weight losing (n = 54); 4) neither inactive nor weight losing: reference (n = 483). Differences in health, physical functioning and nutritional characteristics between groups 1, 2 and 3 respectively, and the reference group were evaluated. Compared to the weight-stable, active reference group, both inactive, weight losing (group 3) and inactive subjects (group 1) reported significantly more chronic diseases (2.2 and 1.8 vs. 1.1), disabilities (81 and 80 vs. 43%), use of medications (both 2.3 vs. 1.1) and care services (26 and 21 vs. 6%), and a lower self-rated health (2.8 and 3.1 vs. 3.8), relative health (1.9 and 2.1 vs. 2.6), and physical performance score (17 and 18 vs. 22). In addition, inadequate micronutrient intake and biochemical deficiencies were more prevalent. Weight-losing elderly were not significantly different from the reference group with respect to these characteristics. Therefore, physical inactivity alone or in combination with weight loss seems to be a practical and inexpensive screening criterion for identifying a subgroup of elderly with less favourable health and nutritional characteristics and poorer physical functioning among non-institutionalised elderly.
- ArticleAkner G, Flöistrup H.J Nutr Health Aging. 2003;7(1):1-12.PURPOSE: Examination of the individual intake of energy, nutrients and water in clinically stable multidiseased nursing-home residents.
METHODS: Comprehensive clinical assessment of 54 elderly nursing-home residents (80 +/- 10 years, mean +/- SD). The intake of food and beverages was measured by the weighed food intake method during five consecutive week days followed by computerized transformation to energy, 21 different nutrients, dietary fiber, alcohol and water. The resting energy expenditure was determined by indirect calorimetry.
RESULTS: There was at least 2-3-fold, variation in intake of energy, nutrients and water, present also when expressed per kg body weight. For some micronutrients the relative intake variation was more than 8-fold. The results are compared with the present swedish recommended dietary allowances as well as with seven other studies of dietary intake in elderly using the weighed food intake method. The residents had on average 14.1 (range 6-31) different current clinical problems and were treated with a mean of 9.5 different drugs. The nursing staff spent 40 % of the total daytime working hours (7 am to 7 pm) on nutrition related issues.
CONCLUSIONS: The nursing-home residents exhibited a large interindividual heterogeneity regarding intake of energy, nutrients and water. More emphasis should be given to individualized nutrition assessment in clinical geriatric care as a more solid base for nutrition treatment programmes integrated with the regular medical management and evaluation. - ArticleIshikawa-Takata K, Ohta T.J Nutr Health Aging. 2003;7(1):44-53.BACKGROUND: Japanese women have a lower bone mass and smaller calcium intake than Caucasians.
OBJECTIVE: To investigate the differences in the relationship between bone mass and lifestyle among Japanese women of different life stages.
DESIGN: Cross-sectional and longitudinal investigations of the relationship between bone mass and lifestyle in Japanese women aged 15-69 years.
RESULTS: In both cross-sectional and longitudinal investigations of high school students, exercise was shown to effectively increase bone mass. In the longitudinal investigation, bone mass was generally greater with high or increased milk consumption. In the cross-sectional investigation of nonparous women and women more than 36 months post partum, those who exercised had significantly higher bone mass. Twelve to 35 months post partum, bone mass was greater in women with higher calcium or milk intake. The effects of parity were not investigated longitudinally, but women who continuously exercised or started exercise had greater bone mass. Non-exercising women with a higher or increased frequency of intake of dairy products, small fish, and soy products had increased bone mass. The longitudinal investigations suggest that exercise increases bone mass in pre-menopausal women. In women just after menopause, it was shown cross-sectionally that bone mass was greater with a higher calcium intake, and longitudinally that exercise resulted in a slower decrease in bone mass. Among women more than 6-7 years past menopause, exercise inhibited the decrease in bone mass.
CONCLUSION: The relationship between these lifestyle factors and bone mass differs according to pregnancy status and time since menopause. - ArticleKölsch H, Lütjohann D, von Bergmann K, Heun R.J Nutr Health Aging. 2003;7(1):37-41.Studies on Alzheimer's disease (AD) revealed that cholesterol metabolism might be involved in the pathogenesis of this neurodegenerative disorder. The apolipoprotein E4 genotype is a known risk factor in AD. Elevated serum cholesterol concentrations are detected in patients with AD and two recent epidemiological studies have indicated that treatment with inhibitors of cholesterol synthesis (statins) decrease the incidence of AD. 24R- and 24S-hydroxycholesterol, the major cholesterol elimination product of the brain, possess neurotoxic effects in vitro, and increased concentrations of 24S-hydroxycholesterol have been detected in patients from our department, suggesting a role for this oxysterol in the pathogenesis of AD. This review will give a brief overview on the relevance of 24S-hydroxycholesterol as a possible risk factor and diagnostic state marker for AD.
- ArticleJ Nutr Health Aging. 2003;7(4):200-40.
- ArticleSavina C, Donini LM, Anzivino R, De Felice MR, De Bernardini L, Cannella C.J Nutr Health Aging. 2003;7(6):385-9.BACKGROUND: Frail elderly people, living in nursing homes, usually show a malnutrition state caused by an increased need of energy or an inadequate food intake. Among the causes leading to reduction of food intake in elderly people and consequently to malnutrition, is the loss of appetite, often marker of depression and alterations of taste and smell perception.
OBJECTIVE: The aim of this research is to verify the application of the AHSP Questionnaire and relate its score to nutritional state of a frail elderly population hospitalized in a geriatric rehabilitation care.
SETTING AND SUBJECTS: All patients of the "3rd Rehabilitation Department" of the Istituto Geriatrico "Villa delle Querce" Nemi (Rome-Italy).
METHODS: Informations, number and type of medical conditions, prescribed drugs, other parameters that can affect taste, smell, hunger and nutritional status, mood, cognitive and nutritional status have been collected from the clinical folders. To assess appetite, hunger smell and taste perception had been submitted the AHSP Questionnaire.
RESULTS: The AHSP Questionnaire had been administered only to 44 of the 103 patients present at the survey because of the high prevalence of cognitive impairment. AHSP score is lower in presence of malnutrition assessed with MNA (Mini Nutritional Assessment). MNA, expressed as proportional score, seems to present a clear correlation with AHSP's (r=0.59; p=0.000).
CONCLUSION: The results achieved show the scarce adaptability of the AHSP Questionnaire to frail elderly people living in geriatric rehabilitation care. MNA is at the moment the most reliable tool to single out dietary deficiency on geriatrics population. - ArticleHigh KP, Sinclair J, Easter LH, Case D, Chilton FH.J Nutr Health Aging. 2003;7(6):378-84.Unknown factors present in the serum of older adults impair lymphocyte function and may be responsible for anergy (absence of delayed-type hypersensitivity (DTH)) present in many older adults. Polyunsaturated fatty acids (PUFAs) and their metabolites are immunomodulatory and may play a role in clinical conditions of advanced age, including immune dysfunction. We hypothesized that PUFAs could be the factor(s) present in serum that contribute to impaired immune responses in older adults. Prior studies of serum PUFAs in older adults neither adequately control dietary PUFA intake, nor investigated the relationship of PUFAs and DTH responses. We determined serum PUFA concentrations in young adults with normal immune responses, and older adults with impaired (anergic elderly) or normal immunity (nonanergic elderly) before and after administering a standardized diet. After controlling for dietary intake, advancing age was associated with markedly higher serum concentrations of arachidonic acid (AA), dihomo-gamma-linoleic acid (DGLA), and eicosapentaenoic acid (EPA) and a lower AA:EPA ratio. Other serum PUFAs and the AA:DGLA ratio were unaffected by age. However, there was no difference between older adults with or without anergy. These data suggest advanced age is associated with marked alterations of serum PUFAs that are only apparent after strictly controlling dietary intake. However, there was no association of serum PUFA concentrations with DTH status among older adults.
- ArticleBirlouez-Aragon I, Tessier FJ.J Nutr Health Aging. 2003;7(2):103-9.In this review we describe how tissues are protected against free radicals and we detail the mechanisms by which the insufficient reduction of ascorbate is involved in glycation and oxidation processes on proteins.
- ArticleBarone L, Milosavljevic M, Gazibarich B.J Nutr Health Aging. 2003;7(1):13-7.OBJECTIVES: A study was undertaken to determine which nutritional assessment tool would be better in assessing changes in nutritional status over time in hospitalised older patients. The two tools used were the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA).
DESIGN: Single blind, prospective study conducted over a 60-day period.
SETTING: Five regional hospitals within Southern New South Wales, Australia.
SUBJECTS: There were 43 patients at the commencement of the study, then 28 patients at day 30 and 20 patients at day 60.
METHODS: All patients over 65 years of age admitted to the five hospitals during May 2001 were eligible. The only exclusions were those patients admitted to palliative care or with severe dementia. Two dietitians saw each patient. Each dietitian assessed the patient using his or her assigned nutritional assessment tool either the SGA or the MNA. All dietitians were randomly assigned the tool at the commencement of the study. They were familiarised with the use of the tool by participating in a workshop prior to the start of the study.
RESULT: The MNA was able to detect greater numbers of malnourished subjects when compared to the SGA. This finding was consistent across Day 0, 30 and 60 and statistically significant (p<0.05) at all time periods.
CONCLUSIONS: This study has shown the MNA to be a more appropriate nutrition assessment tool for older patients when compared to the SGA. The MNA is better able to identify severely malnourished patients. This study illustrated the potential use of the MNA as an ongoing monitor of nutritional status and hence a measure of the impact of nutrition intervention. - ArticleLewis SM, Mayhugh MA, Freni SC, Thorn B, Cardoso S, Buffington C, Jairaj K, Feuers RJ.J Nutr Health Aging. 2003;7(2):121-8.Antioxidant nutrient intervention strategies to ameliorate negative health factors are of notable research interest. Central to the thesis that antioxidant nutrients improve biological defense systems and provide health benefits is an accurate indication of daily antioxidant nutrient intake. Little information is available concerning these nutrient intakes among non-affluent women of the southern U.S. This study examines the 24-h intake of vitamins: A, E, C, -carotene, a-tocopherol, riboflavin, and minerals: zinc, selenium, copper, manganese, iron, and molybdenum among 259 Caucasian (CA) and African-American (AA) women from small urban communities. Women were non-pregnant females, 19-93 y of age. Statistical comparisons of nutrient intake were made by least squares means within age groups. Intakes were compared to various Dietary Reference Intakes including Recommended Daily Allowance (RDA) and Estimated Average Requirement (EAR) values as established by the U.S. National Research Council. Numerous dietary deficiencies in important antioxidant nutrients associated with metabolic antioxidant systems were identified. Few race-related differences were detected. Intake of vitamin A was generally within recommended levels while vitamin E intake was below the EAR. The vitamin precursors, -carotene and a-tocopherol, were significantly (P<0.05) below customary intakes at all ages. More than 60% of this population reported dietary copper, zinc, and selenium intakes below recommended levels. A lack of race differences for most nutrient intakes suggests similar socioeconomic or endogeneous regional factors. All women in this population reported dietary intakes of antioxidant vitamins and minerals below recommended values, conditions that could contribute to subsequent health risks unless nutrient-dense food choices and antioxidant supplementation are considered in their overall nutritional support.
- ArticleJohnson CS.J Nutr Health Aging. 2003;7(4):247-50.PURPOSE: To examine the association between nutritional risk and falls among frail older adults.
METHODS: This study involved 98 frail older adults with a mean age of 82 years. Measures included background questionnaire, falls profile, a nutritional risk assessment checklist, physical parameters such as balance, lower extremity strength, and functional mobility and endurance, and psychological variables.
RESULTS: Approximately 31% of participants had suffered falls. Fallers and non-fallers were similar in age, prevalence of self-reported health problems and medications use. However, fallers had a higher level of nutritional risk and poorer physical and psychological well-being compared to non-fallers. Regression analysis showed that the level of nutritional risk is a significant determinant of falls along with leg strength and balance.
CONCLUSION: Although the level of nutritional risk is associated with falls, further research is necessary to establish the causal link and to explore the effectiveness of nutritional intervention as a falls prevention strategy. - ArticleGalan P, de Bree A, Mennen L, Potier de Courcy G, Preziozi P, Bertrais S, Castetbon K, Hercberg S.J Nutr Health Aging. 2003;7(6):428-35.Cardiovascular diseases are the primary cause of mortality in France. Many epidemiological studies have shown that the total homocysteine concentration is a risk indicator for cardiovascular disease. Furthermore, it has been shown that the homocysteine concentration can be effectively lowered by supplementation with folic acid, vitamin B6 and B12. However, it is not yet known whether a reduction of the homocysteine concentration by such a supplementation indeed leads to a decreased risk of cardiovascular disease. Another possible dietary factor that may lower the risk of cardiovascular disease is fish-oil, which is rich in omega-3 fatty acids. These fatty acids lower platelet aggregation and triglyceride rich lipoproteins and may have antiarrhythmic effects. Some trials have investigated the effect of fish or fish-oil on cardiovascular mortality, and the results, although not conclusive, suggest a protective effect of a higher intake. In the SU.FOL.OM3 study we will evaluate the effect of supplementation at nutritional doses of folate (in the natural 5-methyl-tetrahydrofolate form) in combination with vitamin B6 and B12 and/or omega-3 fatty acids and/or placebo on recurrent ischemic diseases in a factorial design. The supplements will be randomly allocated to the participants in a double-blind fashion. In total 3,000 patients aged between 45 and 80 years who had a past history of myocardial infarction or unstable angina pectoris or an ischemic stroke will be included. The participants will be supplemented and followed up for a period of five years.
- ArticleMitchell D, Haan MN, Steinberg FM, Visser M.J Nutr Health Aging. 2003;7(3):130-9.BACKGROUND: Controversy exists regarding the relative contribution of diet and exercise to body composition. Few studies have examined these associations in the elderly, where changes occur in the body fat to muscle ratio.
OBJECTIVE: The primary objective of this paper is to determine whether energy intake or physical activity are associated with body composition. Secondly, to investigate whether specific macronutrients are associated with fat or lean tissue.
DESIGN: Data (n= 1404) for this cross-sectional analysis were collected from a population-based sub-sample of elderly enrollees in the Cardiovascular Health Study (CHS). Dietary intake and physical activity were assessed by questionnaires. Body composition was measured by Dual Energy X-ray Absorptiometry (DEXA). Linear regression models were used to assess the associations of diet and activity with body composition.
RESULTS: Total energy intake was not associated with any of the body composition measures. Higher dietary saturated fat was associated with higher percent body mass as fat and trunk fat in both sexes (p<0.01), and in men other dietary fats were associated with body fat. In women, distance walked was inversely associated with fat masses even after adjustment for pace of walking. In both sexes, faster pace of walking was associated with lower body and fat mass (p<0.01). Lean muscle mass was not associated with physical activity or dietary intakes.
CONCLUSION: Physical activity and dietary fat intake in this the elderly population were more closely associated with body fat mass than was total energy intake. - ArticlePaillard T, Lafont C, Costes-Salon MC, Dupui P.J Nutr Health Aging. 2003;7(2):117-9.The effects of three strength development methods (during 6 weeks) were assessed on the body composition in 32 women, 62 to 75 years old and randomised in 3 groups. The first group (SC) has climbed and come down 300 stairs per session. The second group (ES) followed an electrostimulation programme on quadriceps muscles. The third group (SC+ES) has combined the stairs climbing with electrostimulation. Body composition and bone mineral density (BMD) was assessed using Absorptiometry machine before and after the programmes. None of the programmes has increased significantly BMD. Nevertheless, the SC+ES group BMD enhanced more on the trochanter (p<0,05) and the two legs (p<0,05) than the SC and ES groups BMD (interaction group/time). The combined activity (SC+ES) would deserve to be tested on a longer period.
- ArticleGil Gregorio P, Ramirez Diaz SP, Ribera Casado JM, DEMENU group.J Nutr Health Aging. 2003;7(5):304-8.OBJECTIVES: To know nutritional status of a group of institutionalized patients with moderate Alzheimer's Disease (AD), and to ascertain the effects of an intervention with nutritional supplements on morbidity and mortality after one year follow-up.
PATIENTS AND METHODS: 99 patients (mean age: 86.5 years), 80 women, with a diagnosis of AD according with NINCDS/ADRDA criteria, were recruited from 8 nursing-homes. 25 were included in an intervention group and received a nutritional supplements along 12 months. Evolution was evaluated according to the Functional Assessment Staging Test (FAST). Patients with FAST levels 5-6 were included. General clinical variables as well as variables reflecting cognitive state and nutritional status: anthropometric, biochemical data and Mini Nutritional Assessment (MNA) were analysed. Statistical analysis was carry out with the SPSS 10.0 package.
RESULTS: Mean time since diagnosis was 49 months, with a 20.2 months duration of institutionalization. Mean value of MNA was 20.1 3.5. 16.5% of patients had a BMI equal o lower than 21. After one year the intervention group showed higher levels of albumin (P=05), pre-albumin (P=05), iron (P=01), zinc (P=05), and beta-carotene (P=05) than the control group. The same response in BMI (P=05), MNA (P=05), and triceps skinfold (P=01). Mortality was lower (16% vs. 22.7%), without statistical significance, in the intervention group, as it was the number of infectious events (47% vs. 66% P=05), and the days in bed (7.5 2.1 vs. 17.3 5.6 P=05).
CONCLUSION: Nutritional supplements applied to a group of patients with AD living in nursing-homes can reduce morbidity and mortality after one year follow-up. - ArticleTurchet P, Laurenzano M, Auboiron S, Antoine JM.J Nutr Health Aging. 2003;7(2):75-7.Probiotics are being increasingly studied for their ability to enhance host resistance to, and recovery from, infection. The probiotic strain Lactobacillus casei DN-114001 has previously been shown to reduce the incidence and duration of episodes of diarrhoea in children. Our controlled pilot study aimed to evaluate the effect of supplementation for 3 weeks with milk fermented with yoghurt cultures and L. casei DN-114001 on the incidence and severity of winter infections (gastrointestinal and respiratory) in elderly people. We found no difference in the incidence of winter infections between groups. However, duration of all pathologies was significantly lower in the treatment group (7.0 3.2 days, n=180) than in the control group (8.7 3.7 days; n=180) (p=0.024), as was maximal temperature (38.3 0.5 C treatment group vs. 38.5 0.6 C control; p=0.01). The potential for a 20% reduction in the duration of winter infections that we have found warrants further investigation on a larger scale.