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01/2019 journal articles

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MID-UPPER ARM CIRCUMFERENCE AS AN INDICATOR OF UNDERNUTRITION AMONG OLD AGE HOME AND COMMUNITY BASED ELDERLY IN PUNJAB, INDIA

Kulvir Singh, Swinderpal Singh , Ginjinder Kaur, Kaushik Bose

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Objective: To use mid upper arm circumference (MUAC) as a proxy measure of undernutrition in elderly males of Punjab, India. Design and measurements: Male participants in old age homes (n=215) and community based (n=239) were measured for standing height, weight and mid upper arm circumference (MUAC) during … from different areas of Punjab. Chronic energy deficiency (CED) was determined using the WHO international guidelines as BMI<18.5 kg/m2 and normal as BMI≥18.5 kg/m2. Descriptive statistics and percentiles were calculated and multiple linear regression analysis was undertaken to assess the associations between age, MUAC and BMI. Receiver-operating characteristic curve (ROC) analysis was performed to determine the best MUAC cut-off values to identify CED status. The χ2 test was used to assess significance of the difference in CED prevalence across MUAC categories. Setting: Old age homes and selected community based elderly of Punjab State, India. Participants: Elderly males in old age homes (n=215) and community based (n=239) were chosen after obtaining the informed consent. Results: MUAC cut-off value of 22.9 cm among the elderly in old age home and 23.4 cm among the community based elderly were the best cut-off points to differentiate between CED and non-CED individuals. Conclusions: The present study proposes the MUAC of 23.5 cm to differentiate between CED and non-CED male elderly individuals. There is a greater need to establish statistically appropriate MUAC cutoff values to predict undernutrition and morbidity in elderly across different ethnic groups.

CITATION:
Kulvir Singh ; Swinderpal Singh ; Ginjinder Kaur ; Kaushik Bose (2019): Mid-Upper Arm Circumference as an Indicator of Undernutrition among Old Age Home and Community Based Elderly in Punjab, India. Care Weekly. http://dx.doi.org/10.14283/cw.2019.5

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THE NUTRITIONAL NEEDS OF MIDDLE-AGED AND OLDER ADULTS: THE EUROPEAN UNION PERSPECTIVE

Susanne Bügel, Balz Frei

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This narrative review describes the distinct nutritional needs of middle-aged and older adults in the European Union. Literature reviews were conducted to identify sources evaluating nutritional status and interventions relevant to these populations. Emphasis was placed on dietary guidelines, systematic reviews, and meta-analyses examining relevant macronutrients and micronutrients and important diseases or conditions related to aging (e.g. cardiovascular disease, infections, osteoporosis, cognition, immunity). Middle-aged and older adults in the European Union frequently do not obtain recommended amounts of key macronutrients and micronutrients necessary for maintaining health. In addition to the nutritional benefits of a healthful diet and contact with professionals to identify nutritional barriers, problem-solving techniques and micronutrient and macronutrient goals can improve the outcomes of dietary interventions in these individuals. Nutrition education programs, particularly those with specific recommendations, are effective for improving the nutritional status of these populations. For those who do not obtain adequate amounts of macronutrients and micronutrients from their diets, adhering to dietary guidelines and, when warranted, supplementation should be considered to improve nutritional status. The findings from randomized, controlled trials suggest that dietary interventions and supplementation can correct nutritional deficiencies and inadequacies that are important to the health of middle-aged and older adults. However, it is important to evaluate nutrient intake from the diet, supplementation, and fortified food to avoid exceeding tolerable upper intake levels of certain nutrients and limit potential adverse outcomes. Medical histories, medication use, dietary patterns, and other risk factors should be considered when recommending dietary improvements and supplements in these populations.

CITATION:
Susanne Bügel ; Balz Frei (2019): The Nutritional Needs of Middle-Aged and Older Adults: The European Union Perspective. Care Weekly. http://dx.doi.org/10.14283/cw.2019.4

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EDITORIAL: BRAIN HEALTH AND FRAILTY: WHERE DO WE GO NEXT?

Mathieu Maltais

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CITATION:
Mathieu Maltais (2019): Editorial: Brain Health and Frailty: Where Do We Go Next?. Care Weekly. http://dx.doi.org/10.14283/cw.2019.3

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ASSOCIATIONS OF DEMOGRAPHICS, SMOKING, AND WEIGHT STATUS WITH INTENTIONALITY OF WEIGHT LOSS: NHANES 1999- 2016

Zhaohui Cui, June Stevens, Jianwen Cai

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Background: Intentional weight loss has been shown to have health benefits, whereas, unintentional weight loss is a strong risk factor for morbidity and mortality. The prevalence of unintentional weight loss in an American national sample has not been described in the past quarter century. Objectives: To describe the distribution of unintentional and intentional weight loss and its associations with demographics, smoking, and weight status. Design: A nationally representative population-based cross-sectional study. Setting: The National Health and Nutrition Examination Survey (NHANES 1999-2016). Participants: 41,603 adults who aged ≥21 years and were not pregnant during the year prior to the survey. Measurements: Participants reported their current body weight, their weight one year earlier, and if they tried to lose weight in the past year. A weight loss was defined as a ≥5% of reduction in weight. Demographics, smoking, and weight status were determined for the beginning of the weight change interval. We used survey frequency analysis to examine prevalences and survey multinomial logistic regression analysis to compare odds ratios in subgroups. Results: Over a one year period, 18.2% of American adults lost weight, and 6.2% lost weight unintentionally. The prevalence of unintentional weight loss was stable over the 18-year period studied. Adults who were older were more likely to subsequently lose weight unintentionally than their younger counterparts, and the highest risk was in those who were 79 years or older. Other risk factors included lower education level (vs. college educated) and smoking (vs. nonsmoking). Adults who were overweight or obese were more likely to report unintentional weight loss than normal weight. Conclusion: Studies examining weight loss need to assess and carefully consider the distribution and correlates of intentionality, and expect that even elderly cohorts will exhibit both unintentional and intentional weight loss.

CITATION:
Zhaohui Cui ; June Stevens ; Jianwen Cai (2019): Associations of Demographics, Smoking, and Weight Status with Intentionality of Weight Loss: NHANES 1999-2016. Care Weekly. http://dx.doi.org/10.14283/cw.2019.2

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THE EFFECT OF VITAMIN D SUPPLEMENTATION ON COGNITION IN A ROBUSTLY AGING POPULATION: DOUBLE-BLIND, RANDOMIZED PILOT STUDY

Rosario Sakamoto, Barbara J Cherry , Stephanie Vaughn

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Objectives: Explore the effects of vitamin D supplementation on global cognition, executive function and episodic memory among older community dwellers. Design: Parallel group, double-blind pretest-posttest placebo-controlled randomized pilot study. Setting/Participants: Robustly aging older community dwellers: Osher Lifelong Institute members of the California State University, Fullerton. Sample size: 61, 12 with intervention. Intervention: Vitamin D3 5000 IU administered orally daily for six months. Baseline serum 25OHD and post six-month supplementation measured likewise, cognitive testing done. Measurements: Chemiluminescence LIASON® assay was used for determination of serum 25OHD levels. Mini-Mental State Exam (MMSE) assessed global cognition, executive function with Letter-Number Sequencing and Stroop Color-Word tests, episodic memory with immediate and delayed Logical Memory tests. Randomization/Blinding: The twelve participants were randomly assigned to treatment or placebo groups (7 with active pills, 5 with placebo). Both participants and clinic nurses were blinded to results of randomization. Results: The demographics revealed the following: Age 60 – 88 years, mean =70 years, BMI mean = 26, with more females (78%) than males (22%). Individuals were predominantly White (62%), highly educated with post-college education (56%), and physically, moderately active. Serum vitamin D levels increased significantly from baseline mean 24ng/ml (60nmol/L) to 60ng/ml (150nmol/L). Six months’ vitamin D supplementation showed significant improvement in global cognition for the treatment versus placebo groups, p = 0.04, with a trend for improvement in Stroop measures, p’s = .097; .093. No adverse events or side effects, high compliance with taking pills and well tolerated. Conclusion: Healthy older individuals who had intact cognition, supplemented with a high dose of vitamin D3 (cholecalciferol) and followed for six months showed improvement on the global mental status and trended towards improvement in executive function. Vitamin D3 (cholecalciferol) 5000 IU daily increases serum vitamin D levels that reduced vitamin D deficiency, and may improve global cognition but not executive function or memory.

CITATION:
Rosario Sakamoto ; Barbara J Cherry ; Stephanie Vaughn (2019): The Effect of Vitamin D Supplementation on Cognition in a Robustly Aging Population: Double-Blind, Randomized Pilot Study. Care Weekly. http://dx.doi.org/10.14283/cw.2019.1

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