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Norman K.,Charite - Medical University of Berlin | Wirth R.,St. Marien Hospital Borken | Wirth R.,IBA University | Neubauer M.,Charite - Medical University of Berlin | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2015

Objectives: We investigated the impact of low phase angle (PhA) values on muscle strength, quality of life, symptom severity, and 1-year mortality in older cancer patients. Design: Prospective study with 1-year follow-up. Participants: Cancer patients aged >60years. Methods: PhA was derived from whole body impedance analysis. The fifth percentile of age-, sex-, and body mass index-stratified reference values were used as cut-off. Quality of life was determined with the European Organization of Research and Treatment in Cancer questionnaire, reflecting both several function scales and symptom severity. Muscle strength was assessed by hand grip strength, knee extension strength, and peak expiratory flow. Results: 433 cancer patients, aged 60-95years, were recruited. Patients with low PhA (n=197) exhibited decreased muscle strength compared with patients with normal PhA (hand grip strength: 22±8.6 vs 28.9±8.9kg, knee extension strength: 20.8±11.8 vs 28.1±14.9kg, and peak expiratory flow: 301.1±118 vs 401.7±142.6L/min, P<.001). Physical function, global health status, and role function from the European Organization of Research and Treatment in Cancer questionnaire were reduced, and most symptoms (fatigue, anorexia, pain, and dyspnea) increased in patients with low PhA (P<.001). In a risk-factor adjusted regression analysis, PhA emerged as independent predictor of physical function (ß:-0.538, P=023), hand grip strength (ß:-4.684, P<.0001), knee extension strength (ß:-4.548, P=035), and peak expiratory flow (ß:-66.836, P<.0001). Low PhA moreover predicted 1-year mortality in the Cox proportional hazards regression model, whereas grip strength was no longer significant. Conclusions: PhA below the fifth reference percentile is highly predictive of decreased muscle strength, impaired quality of life, and increased mortality in old patients with cancer and should be evaluated in routine assessment. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Source

Most organ systems display a normal aging process where the intestinal system due to its high regeneration potential does not usually lead to functional impairments. It is therefore a mistake to interpret gastrointestinal complaints as only being age-related as this can lead to an underuse of diagnostic procedures. The heavy burden of malnutrition in the elderly will be discussed in more detail which leads to loss of fat-free mass (sarcopenia) with the subsequent development of frailty leading to a high burden for both the persons affected and the health system as a whole. Due to the demographic shift, nutritional medicine will also impact more and more the daily work of gastroenterologists. © Springer-Verlag 2012. Source

Stange I.,IBA University | Bartram M.,University of Bonn | Liao Y.,University of Bonn | Poeschl K.,University of Bonn | And 5 more authors.
Journal of the American Medical Directors Association | Year: 2013

Objectives: Although oral nutritional supplements (ONS) are known to be effective to treat malnutrition in the elderly, evidence from nursing home populations, including individuals with dementia, is rare, especially with regard to functionality and well-being. A known barrier for ONS use among elderly is the volume that needs to be consumed, resulting in low compliance and thus reduced effectiveness. This study aimed to investigate the effects of a low-volume, energy- and nutrient-dense ONS on nutritional status, functionality, and quality of life (QoL) of nursing home residents. Design: Randomized controlled intervention trial. Setting: Six nursing homes in Nürnberg and Fuerth, Germany. Participants: Nursing home residents affected by malnutrition or at risk of malnutrition. Intervention: Random assignment to intervention (IG) and control group (CG), receiving 2×125mL ONS (600kcal, 24g protein) per day and routine care, respectively, for 12weeks. Measurements: Nutritional (weight, body mass index [BMI], upper arm and calf circumferences, MNA-SF) and functional parameters (handgrip strength, gait speed, depressive mood [GDS], cognition [MMSE], activities of daily living [Barthel ADL]) as well as QoL (QUALIDEM) were assessed at baseline (T1) and after 12weeks (T2). ONS intake was registered daily and compliance calculated. Results: A total of 77 residents (87±6y, 91% female) completed the study; 78% had dementia (MMSE<17) and 55% were fully dependent (ADL ≤30). Median compliance was 73% (IQR 23.5%-86.5%) with median intake of 438 (141-519) kcal per day. Body weight, BMI, and arm and calf circumferences increased in the IG (n=42) and did not change in the CG (n=35). Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG (P<.05). GDS, handgrip strength, and gait speed could not be assessed in 46%, 38%, and 49% of participants at T1 and/or T2, because of immobility and cognitive impairment. In residents able to perform the test at both times, functionality remained stable in IG and CG, except for ADLs, deteriorating in both groups. From 10 QoL categories, "positive self-perception" increased in IG (78 [33-100] to 83 [56-100]; P<.05) and tendedtodecrease in CG (100 [78-100] to 89 [56-100]; P=06), "being busy" significantly dropped in CG (33 [0-50] to 0 [0-50]; P<.05). Conclusion: Low-volume, nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and resulted in significant improvements of nutritional status and, thus, were effective to support treatment of malnutrition. Assessment of function was hampered by dementia and immobility, limiting the assessment of functionality, and highlighting the need for better tools for elderly with functional impairments. ONS may positively affect QoL but this requires further research. © 2013 American Medical Directors Association, Inc. Source

Bollwein J.,IBA University | Diekmann R.,IBA University | Kaiser M.J.,IBA University | Bauer J.M.,Geriatric Center Oldenburg | And 3 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background.The etiology of the geriatric syndrome frailty is multifactorial. Besides hormonal and inflammatory processes, nutritional influences may be of major relevance. In this cross-sectional study, the association between dietary quality and frailty was investigated.Methods.In 192 community-dwelling older volunteers (>75 years), an interview-based food frequency questionnaire was used to assess nutritional data. A Mediterranean diet (MED) score (maximum 9 points) was used to evaluate dietary quality. Frailty was defined as the presence of at least three and prefrailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength, and slow walking speed. Older adults without any of these attributes were defined as "nonfrail" Binomial logistic regression analysis was used to assess the risk of being frail (vs prefrail and nonfrail) in each quartile (vs lowest quartile) of the MED score.Results.The mean (SD) age of the participants was 83 (4) years; 41.1% were prefrail and 15.1% were frail. The risk of being frail was significantly reduced in the highest quartile of the MED score (OR 0.26; 95% CI 0.07-0.98).Conclusions.A healthy dietary pattern is associated with a lower risk of being frail. Larger, prospective and interventional studies are needed to clarify the association between dietary quality and frailty. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. Source

Bollwein J.,IBA University | Diekmann R.,IBA University | Kaiser M.J.,IBA University | Bauer J.M.,Geriatric Center Oldenburg | And 3 more authors.
Nutrition Journal | Year: 2013

Background: To preserve muscle mass and therefore limit the risk of disability in older adults protein intake is seen as important factor. Besides the amount of protein, its distribution over the day is thought to affect protein anabolism. This cross-sectional study investigates the association between the amount and distribution of protein intake and frailty in older adults. Methods. In 194 community-dwelling seniors (≥75 years) amount of protein intake and its distribution over the day (morning, noon, evening) were assessed using a food frequency questionnaire. Unevenness of protein distribution was calculated as coefficient of variation (CV). Frailty was defined as the presence of at least three, pre-frailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Results: 15.4% of the participants were frail, 40.5% were pre-frail. Median (min.-max.) daily protein intake was 77.5 (38.5-131.5) g, 1.07 (0.58-2.27) g/kg body weight (BW) and 15.9 (11.2-21.8) % of energy intake without significant differences between the frailty groups. The risk of frailty did not differ significantly between participants in the higher compared to the lowest quartile of protein intake. Frail participants consumed significantly less protein in the morning (11.9 vs. 14.9 vs. 17.4%, p = 0,007), but more at noon (61.4 vs. 60.8 vs. 55.3%, p = 0.024) than pre-frail and non-frail. The median (min.-max.) CV of protein distribution was highest in frail (0.76 (0.18-1.33)) compared to pre-frail (0.74 (0.07-1.29)) and non-frail (0.68 (0.15-1.24)) subjects (p = 0.024). Conclusions: In this sample of healthy older persons, amount of protein intake was not associated with frailty, but distribution of protein intake was significantly different between frail, pre-frail and non-frail participants. More clinical studies are needed to further clarify the relation between protein intake and frailty. © 2013 Bollwein et al.; licensee BioMed Central Ltd. Source

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