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Nutritional Screening of Older Adults: Risk Factors for 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, Clinical Nutrition and Metabolism.ORCID iD: 0000-0002-8367-1189
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims The overall aim of this thesis was to extend current knowledge about the prevalence of malnutrition, to identify possible risk factors for development of malnutrition, and to describe the consequences of malnutrition in relation to all-cause and cause-specific mortality among older adults admitted to hospital.

Methods The prevalence of malnutrition was estimated in a cohort of 1771 older adults (≥65 years) who were admitted to a Swedish hospital during 2008–2009 (15 months) and screened for malnutrition using the Mini Nutritional Assessment (MNA) instrument. Possible risk factors for malnutrition were recorded during the hospital stay (Study I). Dietary intake 10 years earlier (in 1997) was collected for 725 of these older adults (Study II). All-cause (Study III) and cause-specific (Study IV) mortality were followed up after medians of 3.5 and 5.1 years, respectively, for 1767 of the participants.

Results The prevalence of malnutrition was 9.4% while 55.1% were at risk of malnutrition. Risk factors for malnutrition was an overnight fast >11 hours, <4 eating episodes a day, and not cooking independently. In middle-aged and older adults with a body mass index <25 kg/m2 in 1997, the risk of malnutrition increased for each additional percentage point of energy from total, saturated and monounsaturated fat at follow-up after 10 years. Malnourished older adults had almost four times higher risk of death during follow-up, while those at risk of malnutrition had a 56% higher risk, compared to well-nourished. Furthermore, well-nourished older adults had consistently lower risk of death, regardless of the cause of death.

Conclusions Only 35.5% of older adults admitted to hospital were well-nourished. The identified risk factors could be used in interventions aimed at preventing malnutrition. Normal-weight and underweight middle-aged and older adults should consider limiting the intake of total fat and/or improve the quality of the fat in the diet in order to decrease the risk of becoming malnourished later in life. Malnutrition and risk of malnutrition were associated with increased overall and cause-specific mortality. These relationships emphasize the need for nutritional screening to identify individuals who may require nutritional support in order to avoid preterm death.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 83 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1167
Keyword [en]
Epidemiology, Malnutrition, Mortality, Older adults, Prevalence, Risk factors
National Category
Medical and Health Sciences Geriatrics
Research subject
Nutrition; Geriatrics
Identifiers
URN: urn:nbn:se:uu:diva-267564ISBN: 978-91-554-9435-3 (print)OAI: oai:DiVA.org:uu-267564DiVA: diva2:876410
Public defence
2016-02-26, Vårdskolans aula, ing. 21, Västmanlands sjukhus Västerås, Västerås, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-01-15 Created: 2015-11-24 Last updated: 2016-02-12
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. A high energy intake from dietary fat among middle-aged and older adults is associated with increased risk of malnutrition 10 years later
Open this publication in new window or tab >>A high energy intake from dietary fat among middle-aged and older adults is associated with increased risk of malnutrition 10 years later
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2015 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 114, no 6, 915-923 p.Article in journal (Refereed) Published
Abstract [en]

A higher fat content in the diet could be an advantage for preventing malnutrition among older adults. However, there is sparse scientific evidence to determine the optimal fat intake among older adults. This prospective cohort study examined whether a high energy intake of dietary fat among middle-aged and older adults is associated with the risk of malnutrition 10 years later. The study population comprised 725 Swedish men and women aged 53-80 years who had completed a questionnaire about dietary intake and lifestyle factors in 1997 (baseline) and whose nutritional status was assessed when admitted to the hospital in 2008-2009 (follow-up). At the follow-up, 383 (52.8 %) participants were identified as being at risk of malnutrition and fifty-two (7.2 %) were identified as malnourished. Multinomial logistic regression models were used to analyse the association between previous dietary fat intake and nutritional status later in life. Contrary to what was expected, a high energy intake from total fat, saturated fat and monounsaturated fat among middle-aged and older adults increased the risk of exhibiting malnutrition 10 years later. However, this applied only to individuals with a BMI<25 kg/m(2) at the baseline. In conclusion, these findings suggest that preventive actions to counteract malnutrition in older adults should focus on limiting the intake of total fat in the diet by reducing consumption of food with a high content of saturated and monounsaturated fat.

Keyword
Cohort studies, Dietary fat, Epidemiology, Malnutrition, Mini Nutritional Assessment
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-264619 (URN)10.1017/S0007114515002317 (DOI)000361380600010 ()
Funder
Swedish Research Council, E0639401Forte, Swedish Research Council for Health, Working Life and Welfare, 11132/2011
Available from: 2015-10-26 Created: 2015-10-15 Last updated: 2017-12-01Bibliographically approved
3. 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
4. Malnutrition is associated with increased mortality in older adults regardless of the cause of death
Open this publication in new window or tab >>Malnutrition is associated with increased mortality in older adults regardless of the cause of death
2017 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 117, no 4, 532-540 p.Article in journal (Refereed) Published
Abstract [en]

Malnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged >= 65 years admitted to hospital in 2008-2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24-30), at risk of malnutrition (score 17-23.5) or malnourished (score < 17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55.1% were at risk of malnutrition, and 9.4% of the participants were malnourished. During a median follow-up of 5.1 years, 839 participants (47.5%) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2.43 and 1.32); mental or behavioural disorders (HR 5.73 and 5.44); diseases of the nervous (HR 4.39 and 2.08), circulatory (HR 1.95 and 1.57) or respiratory system (HR 2.19 and 1.49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2.23 and 1.43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.

Keyword
cause-specific mortality, malnutrition, Mini Nutritional Assessment, malnutrition, older adults, survival analysis
National Category
Nutrition and Dietetics
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-267556 (URN)10.1017/S0007114517000435 (DOI)000399336800006 ()28290264 (PubMedID)
Funder
Swedish National Board of Health and Welfare, 11132/2011
Available from: 2015-11-24 Created: 2015-11-24 Last updated: 2017-05-15Bibliographically approved

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