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Bouillanne O.,Service de Gerontologie 2 | Bouillanne O.,University of Paris Descartes | Curis E.,University of Paris Descartes | Hamon-Vilcot B.,Service de Gerontologie 2 | And 8 more authors.
Clinical Nutrition | Year: 2013

Background & aims: Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding. Methods: This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score. Results: Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m2; 95% confidence interval (CI), [0; 0.60]; for SD group: -0.21 kg/m2; 95% CI, [-0.61; 0.20]; p = 0.005 between the two groups), ASMM index (+0.21 kg/m2; 95% CI, [0; 0.34] and -0.11 kg/m2; 95% CI, [-0.20; 0.09]; p = 0.022), BCM index (+0.44 kg/m2; 95% CI, [0.08; 0.52] and -0.04 kg/m2; 95% CI, [-0.09; 0.10]; p = 0.004). There was no significant effect for hand-grip strength or ADL score. Conclusions: This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Bouillanne O.,Service de Gerontologie 2 | Bouillanne O.,University of Paris Descartes | Hay P.,Service de Gerontologie 2 | Liabaud B.,Service de Gerontologie 2 | And 4 more authors.
Nutrition | Year: 2011

Objective: Serum albumin has long been used in clinical practice as a marker of protein-energy undernutrition, but very few studies have focused on its relation with dual-energy X-ray absorptiometry-assessed lean mass measurements, which is the current reference method in routine for body composition-related nutritional status. Serum albumin concentration is also affected by non-nutrition-related factors, and there is published evidence on the relation between serum albumin concentration and morbidity/mortality in the elderly. This study was designed to examine the relationship between serum albumin and lean mass and nutrition-related risk of morbidity/mortality in geriatric patients. Our objective was to clarify whether serum albumin in geriatric patients is a marker of body composition-related nutritional status, risk of morbidity/mortality, neither, or both. Methods: This prospective study enrolled 125 elderly patients hospitalized in a rehabilitation unit [83.8 (SD 7.7) y]. Subjects were evaluated for serum albumin concentration and nutritional status at admission [body mass index, lean mass, appendicular skeletal muscle mass index, and body cell mass index (calculated as the ratio of the mass to the square of the height), evaluated by dual-energy X-ray absorptiometry combined with bioelectrical impedance analysis]. Outcome scores were assessed 6 mo later, taking into account complications (pressure ulcers and/or infections) and 6-mo mortality. Results: Serum albumin concentration was not correlated with the lean mass, appendicular skeletal muscle mass, or body cell mass indexes. Serum albumin concentration was, however, correlated with outcome score (r = 0.22, P = 0.02). Conclusion: This study clearly demonstrates that albumin is not suitable as a marker of body composition in elderly patients. © 2011 Elsevier Inc.


Rakotoarisoa L.,Service de Gerontologie 2 | De Rozier Rakotoarisoa A.,Service de Gerontologie 2 | Guidez L.,Hopital Georges Clemenceau | Baptiste N.,Service de Gerontologie 2
Revue de Geriatrie | Year: 2014

The Dandy-Walker syndrome is a rare congenital malformation of the hindbrain usually diagnosed during pregnancy or early in the course of life. We report a case in an elderly diagnosed during Geriatric assessment. Cerebral scan revealed an agenesis of the cerebellar vermis. The clinical issue was complicated with loss of walking. © La Revue de Gériatrie.


Rigaud A.-S.,Service de gerontologie 2 | Rigaud A.-S.,University of Paris Descartes | Simonnet T.,University Paris Est Creteil | Rialle V.,French National Center for Scientific Research | And 23 more authors.
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2010

Multi interventional aids have a major role in the caring of disability in elderly people suffering from Alzheimer's disease. In this article, we report the preliminary data of the TANDEM project who's final aim is to test the technical feasibility and acceptability of a telecare system for patients and their families at home, in order to provide various services in daily life including drug taking, memory aids, family and social contacts, cognitive stimulation and nutritional interventions tailored to the patients' needs, as well as detection of situations with risks such as falls and wandering using weared sensors. The project encompasses the implementation of the telecare system. The services are being set up and added in a progressive and collaborative way, and are appropriately tailored to patients' needs by iterative process, including testing by patients, families and professionals. This multi-disciplinary approach, which integrates human, medical, psychological, ethical and social issues, aims at improving patients and families' daily life as well as alleviating the growing burden of this disease on social and health services. © 2010 Elsevier Masson SAS. All rights reserved.


Blonde-Cynober F.,Laboratoire Of Biologie | Cassereau C.,Laboratoire Of Biologie | Morineau G.,Laboratoire Of Biologie | Etienne S.,Service de Gerontologie 1 | And 4 more authors.
Annales de Biologie Clinique | Year: 2010

Diagnosis of iron deficiency is not easily performed in inflammatory situation as usually encountered in elderly hospitalized patients (> 70 years old). At first, we determined serum soluble receptor transferrin (RsTf), RsTf/serurn ferritin ratio (RsTf-F index.) and biochemical and haematological values used to evaluate iron status, in iron-depleted subjects (ferritinemia < 50 ug/L) (group 2) (n = 22, 82 ± 7 years) or not (group 1, reference group) (n = 1.8, 82 ± 6 years), without inflammatory diseases. Relevance of the biological parameters to diagnose iron deficiency was evaluated (ROC curve) and a cut-off value of RsTf-F (> 1.85) was established. Then, we selected 60 patients (group 3) suspect of iron deficiency as previously validated with an inflammatory syndrome (CRP > 12 rag/L). Almost all patients (95%) presented at least one risk factor of iron deficiency (anticoagulant: drugs, nutritional or gastrointestinal diseases). In group 3, index. RsTf-F values were increased. (RsTf-F: 2.69 ± 0.82 versus group 1: 1.25 ± 0.34, p<0.05), in anemic patients (women Hb < 120 g/L, men Hb < 130 g/L) (n = 42) and in non-anemic patients (n = 18) (respectively RsTf-F: 2.84 ± 0.87 versus 2.35 ± 0.58, p < 0.05). Thus, in elderly patients with inflammatory disorders, RsTf-F index could suspect iron deficiency before appearance of biological anemia.


de Sant'Anna M.,Service de gerontologie 2 | de Sant'Anna M.,University of Paris Descartes | de Rotrou J.,Service de gerontologie 2 | de Rotrou J.,University of Paris Descartes | And 30 more authors.
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2010

Cognitive stimulation is a therapeutic non-pharmacological intervention, which may be provided to both healthy and cognitively impaired people. It encompasses a set of psychoeducational methods including practical applications, gathered in sessions and corresponding to ecological situations in daily life. Cognitive stimulation represents training in cognitive, psychological and social functions. The recent progress in assistant technology has lead to the development of computerized cognitive stimulation programmes that represent a promising means for delivery and dissemination of this non-pharmacological intervention. In the present paper, we describe the principles of cognitive stimulation, the methods of delivery and the advantages of computerized cognitive stimulation, and the necessary conditions for its implementation. We insist on the need to tailor human-machine interfaces to the needs and disabilities of elderly people, in particular those who suffer from cognitive disorders. © 2009 Elsevier Masson SAS. All rights reserved.


Bouillanne O.,Service de Gerontologie 2 | Bouillanne O.,University of Paris Descartes | Neveux N.,University of Paris Descartes | Neveux N.,Service Interhospitalier Of Biochimie | And 5 more authors.
Nutrition | Year: 2014

Objective: Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. Splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. The aim of this study was to explore whether protein pulse feeding increased postprandial AA concentrations, and if so whether this increase persisted after 6 wk of dietary treatment. Methods: This prospective randomized study enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 wk. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n=30), 72% of dietary protein (averaging 1.31 g/kg body weight daily) was consumed in one meal at noon. The patients were evaluated on day 1 and at 6 wk for plasma postprandial (five times from 0 to +180 min) AA concentrations (expressed as area under the curve above baseline). Results: Protein pulse feeding was more efficient than protein spread feeding at increasing plasma postprandial AA concentrations, notably of essential AAs. This increased postprandial AA bioavailability was maintained after 6 wk. Conclusions: This study demonstrates that increased postprandial AA bioavailability induced by protein pulse feeding persists after 6 wk (i.e., that there is no metabolic adaptation blunting AA bioavailability). © 2014 Elsevier Inc.


PubMed | Service de Gerontologie 2
Type: Journal Article | Journal: Clinical nutrition (Edinburgh, Scotland) | Year: 2013

Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding.This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n=36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n=30), 72% of dietary protein (1.31g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score.Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group:+0.38kg/m(2); 95% confidence interval (CI), [0; 0.60]; for SD group:-0.21kg/m(2); 95% CI, [-0.61; 0.20]; p=0.005 between the two groups), ASMM index (+0.21kg/m(2); 95% CI, [0; 0.34] and-0.11kg/m(2); 95% CI, [-0.20; 0.09]; p=0.022), BCM index (+0.44kg/m(2); 95% CI, [0.08; 0.52] and-0.04kg/m(2); 95% CI, [-0.09; 0.10]; p=0.004). There was no significant effect for hand-grip strength or ADL score.This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients.

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