Use of the mini nutritional assessment tool in elderly people from long-term institutions of southeast of Brazil

Background: the Mini Nutritional Assessment (MNA) is a multidimensional method of nutritional evaluation that allows the diagnosis of malnutrition and risk of malnutrition in elderly people, it is important to mention that this method has not been well studied in Brazil. Objective: to verify the use of the MNA in elderly people that has been living in long term institutions for elderly people. Design: transversal study. Participants: 89 people (>= 60 years), being 64.0% men. The average of age for both genders was 73.7 +/- 9.1 years old, being 72.8 +/- 8.9 years old for men, and 75.3 +/- 9.3 years old for women. Setting: long-term institutions for elderly people located in the Southeast of Brazil. Methods: it was calculated the sensibility, specificity, and positive and negative predictive values. It was data to set up a ROC curve to verify the accuracy of the MNA. The variable used as a ""standard"" for the nutritional diagnosis of the elderly people was the corrected arm muscle area because it is able to provide information or an estimative of the muscle reserve of a person being considered a good indicator of malnutrition in elderly people. Results: the sensibility was 84.0%, the specificity was 36.0%, the positive predictive value was 77.0%, and the negative predictive value was 47.0%; the area of the ROC curve was 0.71 (71.0%). Conclusion: the MNA method has showed accuracy, and sensibility when dealing with the diagnosis of malnutrition and risk of malnutrition in institutionalized elderly groups of the Southeastern region of Brazil, however, it presented a low specificity.

Atrophy and Neuron Loss: Effects of a Protein-Deficient Diet on Sympathetic Neurons

Protein deficiency is one of the biggest public health problems in the world, accounting for about 30-40% of hospital admissions in developing countries. Nutritional deficiencies lead to alterations in the peripheral nervous system and in the digestive system. Most studies have focused on the effects of protein-deficient diets on the enteric neurons, but not on sympathetic ganglia, which supply extrinsic sympathetic input to the digestive system. Hence, in this study, we investigated whether a protein-restricted diet would affect the quantitative structure of rat coeliac ganglion neurons. Five male Wistar rats (undernourished group) were given a pre- and postnatal hypoproteinic diet receiving 5% casein, whereas the nourished group (n = 5) was fed with 20% casein (normoproteinic diet). Blood tests were carried out on the animals, e.g., glucose, leptin, and triglyceride plasma concentrations. The main structural findings in this study were that a protein-deficient diet (5% casein) caused coeliac ganglion (78%) and coeliac ganglion neurons (24%) to atrophy and led to neuron loss (63%). Therefore, the fall in the total number of coeliac ganglion neurons in protein-restricted rats contrasts strongly with no neuron losses previously described for the enteric neurons of animals subjected to similar protein-restriction diets. Discrepancies between our figures and the data for enteric neurons (using very similar protein-restriction protocols) may be attributable to the counting method used. In light of this, further systematic investigations comparing 2-D and 3-D quantitative methods are warranted to provide even more advanced data on the effects that a protein-deficient diet may exert on sympathetic neurons. (C) 2009 Wiley-Liss, Inc.

Can physical exercise during gestation attenuate the effects of a maternal perinatal low-protein diet on oxygen consumption in rats?

A protocol of physical exercise, based on maximal oxygen uptake ((V) over dot(O2max)), for female rats before and during pregnancy was developed to evaluate the impact of a low-protein diet on oxygen consumption during gestation and growth rate of the offspring. Virgin female Wistar rats were divided into four groups as follows: untrained (NT, n = 5); trained (T, n = 5); untrained with low-protein diet (NT+LP, n = 5); and trained with low-protein diet (T+LP, n = 5). Trained rats were submitted to a protocol of moderate physical training on a treadmill over a period of 4 weeks (5 days week(-1) and 60 min day(-1), at 65% of (V) over dot(O2max)). At confirmation of pregnancy, the intensity and duration of the exercise was reduced. Low-protein groups received an 8% casein diet, and their peers received a 17% casein diet. The birthweight and growth rate of the pups up to the 90th day were recorded. Oxygen consumption ((V) over dot(O2)), CO(2) production and respiratory exchange ratio (RER) were determined using an indirect open-circuit calorimeter. Exercise training increased. (V) over dot(O2max) by about 20% when compared with the initial values (45.6 +/- 1.0 ml kg(-1) min(-1)). During gestation, all groups showed a progressive reduction in the resting (V) over dot(O2) values. Dams in the NT+LP group showed lower values of resting (V) over dot(O2) than those in the NT group. The growth rate of pups from low-protein-fed mothers was around 50% lower than that of their respective controls. The T group showed an increase in body weight from the 60th day onwards, while the NT+LP group presented a reduced body weight from weaning onwards. In conclusion, physical training attenuated the impact of the low- protein

Influence of age on the development of immunological lung response in intrauterine undernourishment

Objective: We investigated the effect of intrauterine undernourishment on some features of asthma using a model of allergic lung inflammation in rats. The effects of age at which the rats were challenged (5 and 9 wk) were also evaluated. Methods: Intrauterine undernourished offspring were obtained from dams that were fed 50% of the nourished diet of counterparts and were immunized at 5 and 9 wk of age. They were tested for immunoglobulin E anti-ova titers (by passive cutaneous anaphylaxis), cell count in the bronchoal-veolar fluid, leukotriene concentration, airway reactivity, mucus production, and blood corticosterone and leptin concentrations 21 d, after immunologic challenge. Results: Intrauterine undernourishment significantly reduced the antigen-specific immunoglobulin E production, inflammatory cell infiltration into airways, mucus secretion, and production of leukotrienes B-4/C-4 in the lungs in both age groups compared with respective nourished rats. The increased reactivity to methacholine that follows antigen challenge was not affected by intrauterine undernourishment. Corticosterone levels increased with age in the undernourished rats` offspring, but not in the nourished rats` offspring. Undernourished offspring already presented high levels of corticosterone before inflammatory stimulus and were not modified by antigen challenge. Leptin levels increased with challenge in the nourished rats but not in the undernourished rats and could not be related to corticosterone levels in the. undernourished rats. Conclusion: Intrauterine undernourishment has a striking and age-dependent effect on the off spring, reducing lung allergic inflammation. (C) 2008 Elsevier Inc. All rights reserved.

Malnutrition hos äldre patienter på sjukhus : Metoder för bedömning av nutritionsstatus samt sjuksköterskans rutiner och attityder i samband med prevention

Syftet med studien var att beskriva subjektiva multifaktoriella metoder som sjuksköterskor kan använda för att identifiera äldre patienter med malnutrition och patienter med risk för att utveckla malnutriion. Syftet var vidare att redogöra för vilka undersökningar som sjuksköterskor i kliniskt arbete använder för att bedöma patienters nutrionsstatus med samt att belysa sjuksköterskors attityder till prevention av malnutritionstillstånd. Studien genomfördes som en systematisk litteraturstudie. De vetenskapliga artiklar (n=17) som ingick i studiens resultat söktes i databaserna ELIN@Dalarna och CINAHL. De sökord som användes var malnutrition, nutrition, undernutrition, elderly, screening, assessment, MNA, SGA, nurses och attitudes i olika kombinationer. Genom analys och granskning av de vetenskapliga artiklarna framkom det i resultatet att SGA, MNA, Simplified Model Malnourishment och NUFFE var subjektiva multifaktoriella metoder som sjuksköterskor kan använda för identifiering av äldre patienter med malnutrition eller risk för malnutrition. Den vanligaste undersökningen som sjuksköterskor bedömde patienters nutritionsstatus med var vägning. Andra undersökningar var mätning, BMI, intervju om normal vikt och viktförlust, observation av patienten, kostregistrering samt nutritionsplan i journalen. Sjuksköterskor upplevde att sjukhusledningen inte förväntade sig att bedömning av patienters nutritionsstatus skulle ske vid inskrivning samt att ansvarsfördelningen mellan sjuksköterskor och läkare var oklar. Det förekom att sjuksköterskor var ointresserade av behandling av malnutrition, men majoriteten var mycket intresserade. Många sjuksköterskor kände att deras kunskaper inom nutrition var otillräckliga för arbetet.

Mechanical, biochemical, and morphological changes in the heart from chronic food-restricted rats

Food restriction (FR) has been shown to induce important morphological changes in rat myocardium. However, its influence on myocardial performance is not completely defined. We examined the effects of chronic FR on cardiac muscle function and morphology. Sixty-day-old Wistar-Kyoto rats were fed a control (C) or a restricted diet (daily intake reduced to 50% of the amount of food consumed by the control group) for 90 days. Myocardial performance was studied in isolated left ventricular (LV) papillary muscle. Fragments of the LV free wall were analysed by light microscopy, and the ultrastructure of the myocardium was examined in the LV papillary muscle. The myocardial collagen concentration was also evaluated. FR decreased body weight (BW) and LV weight (LVW); the LVW/BW ratio was higher in the restricted group (C, 1.86 +/- 0.17 mg/g; FR, 2.19 +/- 0.31 mg/g; p < 0.01). In the FR animals, the cardiac fibers were polymorphic, some of them were of small diameter and others presented lateral infoldings; the ultrastructural alterations were focal and included reduction of sarcoplasmic content, absence and (or) disorganization of myofilaments and Z line, numerous electron dense and polymorphic mitochondria, and deep infoldings of the plasma membrane. The hydroxyproline concentration was higher in the FR animals (p < 0.01). FR prolonged the contraction and relaxation time of the papillary muscle and did not change its ability to contract and shorten. In conclusion, although a 90-day period of FR caused striking myocardial ultrastructural alterations and increased the collagen concentration, it only minimally affected the mechanical function.

Myocardial remodeling and dysfunction are induced by chronic food restriction in spontaneously hypertensive rats

Several studies have shown alterations in hearts from animals subjected to food restriction (FR). However, few experiments in hearts evaluating pressure overload have been reported. We examined the effects of chronic FR on myocardial function and morphology in spontaneously hypertensive rats (SHR). Sixty-day-old SHR were fed a control (C) or a restricted diet (daily intake reduced to 50% of amount of food consumed by the control group) for 90 days. Myocardial performance was studied in isolated left ventricular (LV) papillary muscle. Food restriction decreased body weight and LV weight; LV weight/body-weight ratio was lower in the food-restricted group (SHR-C, 2.84 +/- 0.21 mg/g; SHR-FR, 2.56 +/- 0.24 mg/g; P <.05). Food restriction did not change arterial systolic blood pressure. Myocyte surface area was lower in the food-restricted group (P <.01). Food restriction induced myocardial ultrastructural alterations including reduced sarcoplasm content, reduced and disorganized myofilaments, disorganized Z line, dilated sarcoplasmic reticulum, and deep infoldings of plasma membrane. Myocardial hydroxyproline concentration was increased in the restricted rats. Peak developed tension (P <.05) and maximum rate of tension development (P <.01) were decreased in the SHR-FR group. In conclusion, myocardium of SHR subjected to chronic FR presents attenuation of hypertrophy development, ultrastructural changes, increased collagen content, and systolic dysfunction. (c) 2006 Elsevier B.V. All rights reserved.

The influence of temporal food restriction on the performance of isolated cardiac muscle

In this study we assessed the mechanical function of isolated left ventricular papillary muscles from 60 day-old male Wistar-Kyoto rats (WKY) subjected to different periods of food restriction (FR). The food-restricted animals (R) were fed 50% of the amount of diet consumed by the ad Libitum-fed rats (C). The cardiac muscles were studied after 30, 60, and 90 days (R-30, R-60 and R-90) of FR. The effect of FR on myocardial collagen concentration was also evaluated. The parameters from the three control groups that were statistically identical were combined and the control pool group (CP) was formed. The left ventricular weight-to-body weight ratio was lower in the R-30 and higher in the R-60 and R-90 in relation to their control groups. Hydroxyproline concentration was higher only in R-90 compared to CP and R-30. Myocardial mechanical function was the same in the C groups. The comparisons between CP and FR groups showed that: the muscles of R-30 presented increased resting tension and maximum rate of tension decline, and decreased velocity of shortening; the muscles of R-60 and R-90 groups showed a prolongation of the time to peak tension (TPT) and the time to peak shortening (TPS); and R-30 had an increased time from peak tension to 50% relaxation (RT1/2). Increases in TPT, TPS, and RT1/2 in groups R-60 and R-90 were significant in relation to R-30. In conclusion, while FR for 30 days produces disparate effects on myocardial performance, FR for 60 and 90 days prolongs the contraction period. The change of relaxation time in R-90 might be related to the increased myocardial collagen content. (C) 2001 Elsevier B.V. All rights reserved.

Food restriction induces in vivo ventricular dysfunction in spontaneously hypertensive rats without impairment of in vitro myocardial contractility

Cardiac structures, function, and myocardial contractility are affected by food restriction (FR). There are few experiments associating undernutrition with hypertension. The aim of the present study was to analyze the effects of FR on the cardiac response to hypertension in a genetic model of hypertension, the spontaneously hypertensive rat (SHR). Five-month-old SHR were fed a control or a calorie-restricted diet for 90 days. Global left ventricle (LV) systolic function was evaluated in vivo by transthoracic echocardiogram and myocardial contractility and diastolic function were assessed in vitro in an isovolumetrically beating isolated heart (Langendorff preparation). FR reduced LV systolic function (control (mean ± SD): 58.9 ± 8.2; FR: 50.8 ± 4.8%, N = 14, P < 0.05). Myocardial contractility was preserved when assessed by the +dP/dt (control: 3493 ± 379; FR: 3555 ± 211 mmHg/s, P > 0.05), and developed pressure (in vitro) at diastolic pressure of zero (control: 152 ± 16; FR: 149 ± 15 mmHg, N = 9, P > 0.05) and 25 mmHg (control: 155 ± 9; FR: 150 ± 10 mmHg, N = 9, P > 0.05). FR also induced eccentric ventricular remodeling, and reduced myocardial elasticity (control: 10.9 ± 1.6; FR: 9.2 ± 0.9%, N = 9, P < 0.05) and LV compliance (control: 82.6 ± 16.5; FR: 68.2 ± 9.1%, N = 9, P < 0.05). We conclude that FR causes systolic ventricular dysfunction without in vitro change in myocardial contractility and diastolic dysfunction probably due to a reduction in myocardial elasticity.

Food restriction impairs myocardial inotropic response to calcium and beta-adrenergic stimulation in spontaneously hypertensive rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Impact of malnutrition on immunity and infection

Malnutrition may be a consequence of energy deficit or micronutrient deficiency. It is considered the most relevant risk factor for illness and death, particularly in developing countries. In this review we described the magnitude of this problem, as well as its direct effect on the immune system and how it results in higher susceptibility to infections. A special emphasis was given to experimental models used to investigate the relationship between undernutrition and immunity. Malnutrition is obviously a challenge that must be addressed to health authorities and the scientific community.

Is the BCG Vaccine Safe for Undernourished Individuals?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Expression of renin-angiotensin system signalling compounds in maternal protein-restricted rats: effect on renal sodium excretion and blood pressure

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Grade of esophageal cancer and nutritional status impact on postsurgery outcomes

CONTEXTO: A desnutrição protéico-energética constitui causa previsível para o desenvolvimento de complicações pós-operatórias e pior prognóstico de pacientes cirúrgicos. OBJETIVO: Estudar a associação de indicadores de estado nutricional com estádio da doença e as principais complicações e mortalidade pós-operatória de pacientes com câncer de esôfago. MÉTODO: Foram avaliados retrospectivamente 100 prontuários de pacientes com câncer de esôfago (38-81 anos) de ambos os sexos (85% masculino e 15% feminino) submetidos a esofagectomia (n = 25) e gastrojejunostomia (n = 75), no período de 1995 a 2004. Os dados coletados foram: história clínica, exame endoscópico, estádio (TNM-UICC), estado nutricional (índice de massa corporal, percentual de perda de peso - %PP, albuminemia e contagem de linfócitos total) e evolução clínica pós-operatória. Houve composição dos grupos de acordo com o porte da cirurgia (grande x pequeno). Foi realizada a associação entre as complicações pós-operatórias e a mortalidade (após pós-operatório de 30 dias). As comparações entre médias dos dois grupos foram feitas pelo teste t de Student e a existência de associações entre variáveis testadas pelos testes de χ2 ou exato de Fisher com P = 0,05. RESULTADOS: Houve predomínio dos tumores avançados (estádio III e IV), com a presença de disfagia em 95% dos pacientes e perda ponderal >10%, anterior ao diagnóstico, em 78%. A obstrução esofágica, presente em 77 pacientes, foi associada (P = 0,0021) com o baixo índice de massa corporal (desnutrição protéico-energética). A %PP e a hipoalbuminemia associaram-se estatisticamente (P<0,05) com o estádio avançado da doença. As complicações pós-operatórias precoces ocorreram em 69,2% e 30,7% dos pacientes submetidos a esofagectomia e ostomias, respectivamente, com predomínio das infecciosas nas ostomias (80%) e as pleuropulmonares nas esofagectomias (61%). A albuminemia foi menor nos pacientes submetidos as ostomias, tendo sido a hipoalbuminemia associada (P<0,05) com a ocorrência de complicações pós-operatórias e mortalidade. A %PP e a contagem de linfócitos total associaram-se com as complicações pós-operatórias precoces e infeccionas nas ostomias e a contagem de linfócitos total, com a mortalidade operatória nas esofagectomias. CONCLUSÕES: O estado de DPE esteve associado às complicações pós-operatórias apenas nos pacientes submetidos a ostomias, sem presença destas associações nas esofagectomias.

Crescimento pulmonar compensatório (CPC): massa corpórea, conteúdo protéico e massa pulmonares em ratos subnutridos trilobectomizados

OBJETIVO:Avaliar o comportamento bioquímico do CPC após trilobectomia no rato adulto jovem subnutrido. MÉTODOS: Foram utilizados 137 ratos Wistar, machos, subnutridos pela oferta de 33% da ingestão diária normal na fase de adaptação e durante o experimento, distribuídos por sorteio, em 9 grupos experimentais, submetidos a três tratamentos (Controle, Toracotomia, Trilobectomia) e sacrificados em três momentos (7, 30 e 90 dias). Na Trilobectomia foram extirpados os lobos médio, acessório e caudal direitos, que representavam 55% do tecido pulmonar. Estudou-se os seguintes atributos e variáveis: massa corpórea e pulmonar, relação entre massa pulmonar e corpórea e conteúdos protéicos pulmonares. RESULTADOS: No lobo cranial e no pulmão esquerdo, tanto a massa quanto os conteúdos protéicos, nos trilobectomizados, foram maiores em todos os momentos do estudo quando comparados aos demais, sendo este aumento suficiente para compensar a perda dos três lobos. Os conteúdos protéicos do lobo cranial e do pulmão esquerdo, nos trilobectomizados, tiveram o mesmo comportamento da massa pulmonar, mas este aumento não foi suficiente para compensar a perda dos três lobos. CONCLUSÕES: Nos ratos adultos subnutridos trilobectomizados ocorre CPC. A recuperação da massa pulmonar é total, mas o conteúdo protéico pulmonar apesar de aumentar, não chega aos valores dos ratos não trilobectomizados.