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Nutritional status among older people: Risk factors and consequences of malnutrition
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2013 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Despite the high frequency and serious consequences of protein–energy malnutrition, prevention and treatment of malnutrition do not currently receive appropriate attention. Increased awareness of the importance of nutritional screening among older people is needed. The overall aim of this thesis was to extend our current knowledge about malnutrition and the consequences of a poor nutritional status in relation to preterm death, and to identify possible risk factors for developing malnutrition among older people. The aim of Paper I was to estimate the prevalence of malnutrition and to examine the associations between mealtime habits, meal provision, and malnutrition among older people admitted to a Swedish hospital. The aim of Paper II was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in older people.

The baseline survey was a cross-sectional study of 1771 patients aged ³65 years who were admitted to hospital. Nutritional status was assessed using the MNA instrument, and possible risk factors associated with malnutrition were recorded during the hospital stay (Paper I). Overall survival was followed up after 35–50 months in a cohort study of 1767 participants (Paper II).

Of the 1771 participants, 35.5% were well-nourished, 55.1% were at risk of malnutrition, and 9.4% were malnourished at baseline. An overnight fast >11 hours was associated with risk of malnutrition (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.14–1.87) and being malnourished (OR 1.67; 95% CI 1.04–2.69). Fewer than four eating episodes a day was associated with both risk of malnutrition (OR 1.88, 95% CI 1.52–2.32) and being malnourished (OR 3.10; 95% CI 2.14–4.49). Not cooking independently was also associated with both risk of malnutrition (OR 1.9; 95% CI 1.30–2.93) and being malnourished (OR 5.04; 95% CI 2.95–8.61). At the 50-month follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants. After adjusting for confounders, the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18–2.07) in the group at risk of malnutrition and 3.71 (2.28–6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicted preterm death in people aged 65 years and older.

This thesis provides additional knowledge of the current nutritional situation among older people admitted to hospital. The high prevalence and serious consequences of malnutrition demonstrated in this thesis underline the importance of screening and taking actions to counteract malnutrition among older people. The data showing that the length of overnight fasting and number of eating episodes per day are possible risk factors for malnutrition are consistent with the current nutritional recommendations. This knowledge may stimulate care providers to decrease the length of overnight fasting and increase the number of eating episodes per day among older people at risk of malnutrition.

Place, publisher, year, edition, pages
Kopieringen vid Västmanlans sjukhus Västerås , 2013. , 23 p.
National Category
Medical and Health Sciences
Research subject
Medical Science; Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-207486ISBN: 978-91-506-2345-1 (print)OAI: oai:DiVA.org:uu-207486DiVA: diva2:648433
Opponent
Supervisors
Available from: 2013-10-16 Created: 2013-09-16 Last updated: 2017-01-25Bibliographically approved
List of papers
1. Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital
Open this publication in new window or tab >>Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital
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2013 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 32, no 2, 281-288 p.Article in journal (Refereed) Published
Abstract [en]

Background & aims: Large-scale studies performed in hospitals with the validated Mini Nutritional Assessment tool (MNA) are scarce. However, factors associated with malnutrition are important for identifying individuals at risk. The aims of the present study were to estimate the prevalence of malnutrition and to examine the association between mealtime habits, meal provision, and malnutrition among elderly patients admitted to hospital.

Methods: This cross-sectional study included patients aged ≥ 65 years admitted to internal medicine, surgical or orthopaedic wards. The MNA was used for their nutritional assessment, and factors potentially associated with malnutrition were recorded.

Results: Of 1771 patients (mean age 78 years), 35.5% were well-nourished, 55.1% were at risk of malnutrition and 9.4% were malnourished. Overnight fasts exceeding 11 hours, fewer than four eating episodes a day, and not cooking independently were associated with both malnutrition and risk of malnutrition.

Conclusions: The risk of malnutrition was high among elderly patients admitted to hospital, whereas the proportion with fully developed malnutrition was lower than expected. A long overnight fast, few eating episodes, and not cooking independently were associated with an increased risk of malnutrition. Knowledge of these factors when providing care to the elderly may assist health-care professionals to prevent malnutrition.

Keyword
Malnutrition, Prevalence, Elderly, Hospital, MNA, Risk factor
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-197104 (URN)10.1016/j.clnu.2012.07.013 (DOI)000316838300018 ()22898590 (PubMedID)
Conference
Abstract of this manuscript was presented by poster in the 32nd ESPEN Congress in Nice on Sep 5th 2010.
Available from: 2013-03-19 Created: 2013-03-18 Last updated: 2017-12-06Bibliographically approved
2. Nutritional status predicts preterm death in older people: a prospective cohort study
Open this publication in new window or tab >>Nutritional status predicts preterm death in older people: a prospective cohort study
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2014 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 2, 354-359 p.Article in journal (Refereed) Published
Abstract [en]

Background & aims: There is an association between malnutrition and mortality. However, it is uncertain whether this association is independent of confounders. The aim of the present study was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in people 65 years and older. Methods: This prospective cohort study included individuals aged >= 65 years who were admitted to hospital between March 2008 and May 2009 and followed-up after 50 months (n = 1767). Nutritional status was assessed with the MNA, and possible risk factors associated with malnutrition were recorded during participants hospital stay. Main outcome measure was overall survival. Results: Based on the MNA definitions, 628 (35.5%) were well-nourished, 973 (55.1%) were at risk of malnutrition, and 166 (9.4%) of the participants were malnourished at baseline. During the follow-up period 655 (37.1%) participants died. At follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants (p < 0.001). After adjusting for confounders the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18-2.07) in the group at risk of malnutrition and 3.71 (2.28-6.04) in the malnourished group. Conclusions: Nutritional status defined according to the three categories in the full MNA independently predicts preterm death in people aged 65 years and older. These findings are clinically important and emphasise the usefulness of the MNA for screening of nutritional status.

Keyword
nutritional status, malnutrition, Mini Nutritional Assessment, survival analysis
National Category
Nutrition and Dietetics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-207484 (URN)10.1016/j.clnu.2013.06.004 (DOI)000334985500027 ()
Available from: 2013-09-16 Created: 2013-09-16 Last updated: 2017-12-06Bibliographically approved

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