Non-institutionalized nonagenarians health-related quality of life and nutritional status: is there a link between them?

Introduction: Nonagenarian population, clearly increasing, shows different characteristics from the rest of elderly people. Health-related quality of life is a way to study population health in physical, psychological and social dimensions. Objectives: To examine the relationship between nutritional status and health-related quality of life in a group of free-living nonagenarians. Differences with octogenarians were also studied. Methods: Within Villanueva Older Health Study, 20 non-institutionalised people (92.5±3.5 years; 80% women) make the nonagenarian subsample. Nutritional risk was assessed by Mininutritional Assessment questionnaire, dietary intake by a 24-hour dietary recall and health-related quality of life by EuroQoL-5D questionnaire. SPSS was used for statistical analysis. Results: 40% nonagenarians were at risk of malnutrition. Dietary assessment showed magnesium, zinc, potassium, folic acid, vitamin D and vitamin E deficiencies. Problems in mobility were more frequently reported (80%). EQ-5Dindex was associated with MNA (p<0.05). Self-care dimension was associated with calcium and niacin (p<0.05), retinol and cholesterol (p<0.01) intake. Usual activities dimension was associated with niacin (p<0.01) and cholesterol(p<0.05) intake. Pain/discomfort dimension was associated with protein (p<0.01), energy, selenium and niacin (p<0.05) intake. Anxiety/depression was associated with protein(p<0.01) and selenium (p<0.05) intake. Conclusions: Risk of malnutrition is a factor associated to health-related quality of life. Results suggest that energy and some nutrient intakes could be possibly associated to health-related quality of life but further research on this influence is required.

Nutritional risk among surgery patients and associations with hospital stay and postoperative complications

Introduction and Objectives: Nutritional Risk Screening (NRS 2002) is employed to identify nutritional risk in the hospital setting and determine which patients would benefit from nutritional support. The aim of the present study was to identify nutritional risk in patients admitted to the surgery ward and determine possible associations with hospital stay and postoperative complications. Methods: Three hundred fifteen surgery patients were evaluated in the first 24 hours since admission. Evaluations involved the calculation of the body mass index, the determination of weight loss ≥ 5% in the previous six months and the assessment of nutritional risk using the NRS 2002. Hospital stay (in days) and postoperative complications were also recorded. Results: A total of 31.1% of the patients were classified as being "at risk", among whom 98.3% had food intake 50% lower than habitual intake, 65.9% had weight loss ≥ 5% in the previous six months, 64.7% had a diagnosis of neoplasm, 59.9% were aged ≥ 60 years and 59.9% were candidates for non-elective surgery. Postoperative complications were recorded in 4.4% of the overall sample and were more frequent in patients at nutritional risk (p < 0.000). Hospital stay was also longer among the patients at nutritional risk (p < 0.01). Conclusion: A high percentage of surgery patients were at nutritional risk in the present study and associations were found with age ≥ 60 years, a diagnosis of neoplasm, non-elective surgery of the gastrointestinal tract, a reduction in habitual food intake and weight loss. Patients at nutritional risk had a greater frequency of postoperative complications and a longer hospital stay.

Nutritional assessment of the most frequently consumed dishes in a slum in Iquitos, Peruvian Amazon

Introduction: Large nutritional surveys in Peru have identified the magnitude and location of the different types of malnutrition. The chronic type is the most prevalent one. However, although rates may be considered as alarming (even more in rural areas), only one of these studies contains information about intake characteristics, using 24-hour recalls (R24). That is, it lacks some other systems, adapted to the gastronomical characteristics of their regions and to the bioavailability of food in each area, in order to locate the origin of this situation and, thus, propose truly effective and efficient solutions. Aim: To determine the nutritional value of the main dishes consumed by the residents of a slum in Peruvian Amazon. Methods: Ninety-eight participants completed three 24-h recalls. Based on these data, we selected the 25 most commonly eaten dishes and evaluated their nutritional composition. We took note of the homemade recipes, weights and measures. In addition, we observed preparation and cooking. The mean nutritional composition of each dish was calculated per 100 g using the Nutriplato 4.6. software. We also calculated gains or losses resulting from culinary treatments. Results: Within those which include milk, the highest energy density is the mingado de arroz. In the group of fish, the most energetic is pescado frito, while within meat-based recipes tallarín con pollo, res asada and chancho frito are the most energetic ones. Regarding prepared dishes, the juane is the highest energy density of all recipes. Inside garnish, using bananas as the main ingredient, plátano frito and madurito are the most energetic. Fats are higher in fried dishes and those which contribute most fat ratio. The same thing happens with garnish as 100 grams of plátano frito or madurito contain more than 70% of the RDA. Res asada and juane present the highest sodium level. Conclusions: If we wish to offer healthier dishes, it is necessary to change their composition and/or cooking methods, reducing the consumption of fried foods. Sodium intake should also be reduced. Two foods could be important to that aim: menudencia de pollo, rich in B vitamins and low in fat, and frijol hervido, which is rich in vegetable protein and, with rice dishes ubiquitous in this area, increases the biological value of ingested proteins.

Timing versus caloric goal in nutritional therapy for critically ill patients

Introduction: Enteral nutrition is an important therapy for severely critically ill patients. The timing and amount of energy have been highly debated. Objective: The aim of the present study was to directly compare the timing and the caloric targets in critically ill patients. Methods: Retrospective cohort study conducted at a single center, comparing timing and caloric goal for critically ill patients. Patients were stratified according to the start of nutritional therapy (24, 48, or more than 48 h) and the amount of energy delivered (target adequacy of previously calculated percentage in the first week). Statistical analysis was performed using parametric and non-parametric tests for independent samples and logistic regression. The results were expressed as mean ± standard deviation or incidence and percentage. Results and discussion: There were no differences in major clinical outcomes in relation to the achievement of percentage of caloric goal at the end of the first week of the study. The beginning of caloric intake on the first day of hospitalization was associated with reduced mortality in the intensive care unit, but not with hospital mortality. The strategy of an early and limited amount of calories seems to be associated with a better outcome. Prospective studies evaluating and comparing these strategies are recommended.

Nutritional approach of inpatients with anorexia nervosa

Anorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way.