Nutritional status and functional capacity of hospitalized elderly

Background: The nutritional status of the aging individual results from a complex interaction between personal and environmental factors. A disease influences and is influenced by the nutritional status and the functional capacity of the individual. We asses the relationship between nutritional status and indicators of functional capacity among recently hospitalized elderly in a general hospital.Methods: A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%.Results: Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition.Conclusion: There is an interrelationship between the nutritional status of the elderly and reduced functional capacity.

Effects of intrauterine malnutrition on brain free amino acids of young rats, after nutritional recovery during lactation period

The effect of protein-calorie malnutrition during gestation on the brain amino acids of rat pups was studied following nutritional recovery during lactation. The brain amino acids of rat pups born to dam rats malnourished during gestation were studied after these rat pups received proper nutrition during lactation. Pregnant rats were fed a 1% protein diet with total caloric intake restricted to half that of controls. After birth, the offspring of rats fed on deficient diets were nurtured up to the 28th day postpartum by foster mothers receiving adequate diets. At this time, the offspring were killed. The control group consisted of offspring from pregnant rats fed a diet with adequate protein (21%) and calories during the entire gestation and lactation period. Quantitation of brain amino acids in the pups at 28 days postpartum showed lower concentrations of essential and nonessential amino acids in the rats malnourished during gestation. Concentrations of histidine, glycine, and α-aminobutyric acids were all reduced. These findings demonstrate that the brains of rat pups malnourished during gestation show persistent decreases in specific brain amino acids after adequate postpartum nutrition.

Nutritional management and weight changes during hospitalization of Brazilian infants with diarrhoea: Primary reliance on oral feeding or continuous nasogastric drip with locally made, modulated minced chicken formula

The nutritional management of infants admitted with diarrhoea to the University Hospital of Botucatu includes a change from bolus feeding of a modulated minced-chicken formula to a continuous nasogastric drip (NGD) feeding, whenever the required calorie intake is not achieved or the diarrhoea does not subside. To evaluate this approach, the clinical course and weight changes of 63 children, aged 1-20 months, were reviewed; most (81 per cent) were below the third percentile for weight at admission and 76 per cent had a total duration of diarrhoea ≥10 days. Associated infections, mainly systemic, were present at or after admission in 70 per cent of them. Twenty-five survivors needed nutritional support (NS), predominantly NGD, for a median duration of 30 per cent of their admission time, and were compared to 31 survivors managed without NS. Those who necessitated NS lost weight for a significantly longer median time (12x4 days, p<0.005), but their total weight loss was similar (5x4 per cent) as well as diarrhoea's duration (8x7 days). There was a tendency for a longer hospitalization (21x16 days 0.05nutritional insult for the survivors. The NGD can be safely employed and should be valued, provided weight losses are carefully monitored in order to detect infants at highest risk.

Protein deficiency and nutritional recovery modulate insulin secretion and the early steps of insulin action in rats

Maternal malnutrition was shown to affect early growth and leads to permanent alterations in insulin secretion and sensitivity of offspring. In addition, epidemiological studies showed an association between low birth weight and glucose intolerance in adult life. To understand these interactions better, we investigated the insulin secretion by isolated islets and the early events related to insulin action in the hind-limb muscle of adult rats fed a diet of 17% protein (control) or 6% protein [low (LP) protein] during fetal life, suckling and after weaning, and in rats receiving 6% protein during fetal life and suckling followed by a 17% protein diet after weaning (recovered). The basal and maximal insulin secretion by islets from rats fed LP diet and the basal release by islets from recovered rats were significantly lower than that of control rats. The dose-response curves to glucose of islets from LP and recovered groups were shifted to the right compared to control islets, with the half-maximal response (EC 50) occurring at 16.9 ± 1.3, 12.4 ± 0.5 and 8.4 ± 0.1 mmol/L, respectively. The levels of insulin receptor, as well as insulin receptor substrate-1 and phosphorylation and the association between insulin receptor substrate-1 and phosphatidylinositol 3-kinase were greater in rats fed a LP diet than in control rats. In recovered rats, these variables were not significantly different from those of the other two groups. These results suggest that glucose homeostasis is maintained in LP and recovered rats by an increased sensitivity to insulin as a result of alterations in the early steps of the insulin signal transduction pathway.

Is chronic hypoxemia in patients with chronic obstructive pulmonary disease associated with more marked nutritional deficiency?: A study of the fat-free mass evaluated by anthropometry and bioelectrical impedance methods

In order to determine wheter blood gases abnormalities, specially hypoxemia, are associated with more marked changes in fat-free mass in patients with chronic obstructive pulmonary disease (CPOD), nutritional assessment was performed on 16 normoxemic (PaO 2 > 55 mm Hg) and 16 hypoxemic (PaO 2 < 55 mm Hg) COPD patients in stable clinical condition. Body weight was expressed as percentage of the ideal body weight. Fat-free mass was estimated by anthropometry (FFM-Anthr) and by bioelectrical impedance (FFM- BI). Handgrip-strength was assessed as a measure of peripheral skeletal muscle strength. Patients were age-matched and presented similar degree of airway obstruction. Malnutrition, defined as body weight less than 90% of the ideal, was observed in 19% of the normoxemic patients and in 25% of the hypoxemic patients (p>0,05). FFM values in hypoxemic patients, estimated by both methods, were not different from those observed in normoxemic patients. No significant difference was observed on handgrip values between the two groups. No correlation was found between nutritional indices and pulmonary function and gases exchange parameters. FFM correlated positively with values of peripheral muscle function in normoxemic and hypoxemic patients. These data add further evidence to the hypothesis that hypoxemia is not a primary cause of the nutritional deficiency observed in COPD patients.

Minerals in the nutrition of extremely low birth weight infants

Objective: To review the literature on the role of calcium, phosphorus and trace elements in the nutrition of extremely low birth weight infants, considering their importance for metabolism, bone mineralization and as dietary components. Sources of data: MEDLINE, the Cochrane Database of Systematic Reviews and books on nutrition were searched between 1994 and 2004. Original research studies and reviews were selected. Summary of the findings: Extremely preterm infants are frequently growth-restricted at hospital discharge as a consequence of difficulties in the provision of adequate nutrition. The long-term effects of this growth restriction need to be determined. There is a paucity of studies about the role of minerals, especially micronutrients, in the nutrition of extremely preterm infants. The principal focus of this review was on calcium and phosphorus metabolism, bone mineralization and parenteral and enteral supplementation. A critical evaluation of post-discharge nutrition and its influence upon growth and bone mineralization was presented. Selenium and zinc requirements and the role of selenium as an antioxidant with possible effects on free radical diseases of the preterm infant were discussed. Conclusions: Extremely preterm infants have low mineral reserves and, as a consequence, may have deficiencies in the postnatal period if they do not receive parenteral or enteral supplementation. More studies are needed to elucidate the actual requirements and the appropriate supplementation of micronutrients. There are controversies about the outcome and the influence of post-discharge nutrition on bone disease of prematurity. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Nutritional support and outcome in hospitalized dogs and cats

This study investigated the effect of assisted nutritional support on the outcome and time of hospitalization (TH) of dogs and cats. The study compared two groups of 400 hospitalized animals. The animals in group 1 did not receive assisted nutritional support because they were hospitalized before the clinical nutrition service was implemented; animals in group 2 were nutritionally managed. Animals in group 1 received a low-cost diet with no consumption control. Group 2 animals had their maintenance energy requirement (MER) calculated, received a high-protein and high-energy super-premium diet, had their caloric intake (CI) monitored, and received enteral and parenteral nutritional support when necessary. The statistical analysis of the results included the standard T test (group 1 versus group 2) and chisquare and Spearman's correlation to evaluate group 2 (CI and outcome, body condition score (BCS) and outcome, BCS and CI). For group 2, favorable outcome (FO), defined as the percent responding to therapy and dis-charged from the hospital, was 83%, and the TH was 8.59 days. These values were lower (P < .001) for group 1 (63.2% FO and TH of 5.7 days). For group 2, 65.5% of the animals received voluntary consumption (93.1% outcome), 14.5% received enterai support (67.9% FO), 6.5% received parenteral support (68% FO), and 6.17% did not eat (38.5% FO), demonstrating an association between the type of nutritional support and outcome (P < .01). Group 2 animals that received 0% to 33% of their MER had 62.9% FO, and those receiving more than 67% had 94.3% FO, which shows that lower mortality rates are associated with higher CI (P < .001). TH was higher for animals with higher CI (P < .001). The BCS did not correlate with Cl (P > .05) but did correlate with outcome (P < .01). FO was 68.7% for animals with low BCS, 85.7% for animals with ideal BCS, and 86.6% for overweight animals. Nutritional support could allow for longer therapies, thus increasing the TH and FO rate.

Nutritional and social hierarchy establishment of the primitively eusocial wasp Mischocyttarus cassununga (Hymenoptera, Vespidae, Mischocyttarini) and related aspects

The results on the nutritional influence in the social hierarchy establishment among females from six colonies of Mischocyttarus cassununga show that: - there was no caste determination in the pre-imaginal period concerning ingested food quantities, however, in relation to qualification (proteins and carbohydrate) the Mann-Whitney test applied showed variation among colonies: in two colonics (colony 3, p=0.0209; colony 4, p=0.0090) the larvae which ingested a higher quantity of solid food became adults of hierarchically higher position, however in two other colonies, colony 1 (p=0.6744) and colony 2 (p=0.3367) this difference was not statistically significant; in two experimentally manipulated colonies the caste determination was observed in the imaginal phase (it was verified that the larger the food quantity consumed, the higher the assumed hierarchical position by the individuals); - adult individuals of hierarchically higher position in two colonies ingested a greater amount of solid than liquid food (Mann-Whitney; p ≤ 0.05), however in the other three colonies there was no difference. It can be seen that for all colonies (2, 3, 4, 5 and 6) the high tendency to solid food ingestion occurs. In colony 1, this data was not collected because the observation purpose was different); - inside the colony hierarchy, the older individuals were the ones that occupied higher hierarchical positions; - more than one inseminated female per colony was found in the two experimentally manipulated colonies ; - ovarian development is greater in inseminated females; - the average height of the 3rd tergite was greater for inseminated females, indicating an adaptation to accommodate larger ovary development (t-Student test; p ≤ 0.05).

Clinical and nutritional profile of individuals with Chagas disease

Chagas disease (CD), caused by the protozoan Trypanossoma cruzi, affects approximately 18 million individuals in the Americas, 5 million of which five in Brazil. Most chronic sufferers have either the indeterminate form of the disease, without organic compromise, or the cardiac or digestive forms. Despite the importance of this disease, there is no information on the effect of nutrition on CD evolution. We evaluated the clinical-nutritional profile of individuals with CD treated at the Tropical Diseases Nutrition Out-Patient Clinic of the Botucatu School of Medicine, UNESP.A retrospective cohort study was performed between 2002 and 2006, on 66 patients with serum and parasitological diagnosis of CD. Epidemiological, clinical, nutritional, and biochemical data were collected, including gender, age, skin color, smoking, alcoholism, physical activity, weight, stature, body mass index, abdominal circumference, glycemia, and lipid profile. Fifty-three percent were mate and 47% female; 96% were white skinned. Mean age was 49.6±6.36 years. The predominant form was indeterminate in 71 %; smoking and drinking were recorded in 23% and 17%, respectively. Sedentariness predominated in 83%, and 55% presented increased abdominal circumference. Most, 94%, were overweight or obese. The biochemical exam revealed hyperglycemia in 12% and dyslipidemia in 74%. These findings suggest that the Chagas population presents co-morbidities and risk factors for developing chronic non-transmissible diseases, including cardiovascular diseases, making CD evolution even worse. © 2007 by The Brazilian Journal of Infectious Diseases and Contexto Publishing. All rights reserved.

Dry matter yield and nutritional value of Marandu grass under nitrogen fertilization and irrigation in cerrado in São Paulo

The aim of this study was to evaluate dry matter yield and nutritional value of palisade grass (Brachiaria brizantha cv. Marandu) using nitrogen doses and sprinkler irrigation in two periods of the year, aiming at reducing seasonality of forage production. It was used a randomized block design in a split-plot scheme, with five doses of nitrogen (0, 50, 100, 150, and 200 kg/ha/cut), and the sub-plots were defined by the seasons of the year (wet and dry season), with and without irrigation. During the wet season, in the plots with and without irrigation, doses of 175 and 161 kg/ha/cut promoted the highest dry matter yields. During the dry season, 171 kg ha -1N with irrigation resulted in the highest dry matter yield. During the same season, there was no response to N fertilization in the lack of irrigation. Average contents of CP were 10% with and without irrigation. Contents of neutral detergent fiber decreased with nitrogen doses, while acid detergent fiber was not affected by fertilization. Plots under irrigation reached the maximal acid detergent fiber content at N dose of 60 kg ha -1. Irrigation promotes increase of 15% increase in dry matter yield and it increases contents of neutral detergent fiber. © 2010 Sociedade Brasileira de Zootecnia.

Food intake and nutritional status of hospitalised older people

Background and aims. Disease is influenced by the nutritional status of the individual. We have assessed the relationship between nutritional status and food intake among recently hospitalised older people. Methods. A cross-sectional study was undertaken with 240 older people in a hospital that provides care for the public and private healthcare systems. Nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition. Food intake was estimated by the reported food intake during a typical day. The Kruskal-Wallis test was used to compare the medians and the correlation coefficient of Spearman to verify the relationship between the consumption of energy, protein and vitamin C and MNA scores. Results. 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. The malnourished individuals reported significantly less energy and nutrient intake than those at risk of malnutrition or those without malnutrition (P=0.001). Not all nutrient intake, just some (iron, cholesterol and fibre), were lower in malnourished people. Conclusions and implications for practice. Deterioration of the nutritional status of older people is accompanied by a reduction in energy and some nutrient intake. The investigation of food intake in older people could provide important information about nutritional risk. © 2010 Blackwell Publishing Ltd.

Hunger and malnutrition in the countries of the Association of Caribbean States (ACS)

Includes bibliography