I.Factors Associated with Low Reported Energy Intake in the Elderly

D.Shahar,I.Shai,H.Vardi,D.Fraser (The S.Daniel Abraham International Center for Health and Nutrition,Ben-Gurion University of the Negev,Beer-Sheva,Israel) (1)

 

Background:Underreporting of dietary intake can be estimated by the Energy Ratio (ER) between reported energy intake (EI) and calculated total energy expenditure (TEE).The gap between EI and TEE is usually attributed to underreporting.In elderly populations,compromised dietary intake and health status may offer alternative explanations to this gap.Objective:This study aimed to characterize “underreporting” of dietary intake and low energy reporters (LER) among the elderly.Design:Participants aged 65 years and over,were recruited using random population sampling of the Negev population.Data were collected using the 24-h recall method with additional demographic and age-specific health questionnaires.ER was calculated using the ratio between reported energy intake and calculated TEE computed by the Schofield formula.LER were defined as those with reported energy intake of less than 0.8* calculated BMR using the Schofield formula.Results:We restricted our analysis to 191 elderly aged 65-74y and 177 aged 75y and older who reported their diet to be “as usual.” In univariate analyses,BMI<22,better health status,use of fewer than four medications and good reported appetite were significantly related to higher ER.No difference was shown in ER by gender,level of education,and family status.Weight loss >5 kg was associated with low ER (p=0.049).In a linear regression model,low ER (indicating "underreporting") was significantly associated with higher activity level and use of over four medications.Using a dichotomous approach,Low Energy Reporters (LER) used a higher number of medications,ate fewer food items per day and suffered from poorer appetite.Conclusions:In the elderly,ER<1 may indicate underreporting in dietary intake,and indeed,is frequent among the obese.Nonetheless,among the elderly,ER<1 may reflect truly low caloric intake.Our results suggest that,to some degree,health status variables are associated with decreased ER,supporting a true caloric deprivation state.

 

(1) The Journal of Nutrition,Health and Aging vol.9,n° 5,2005,p 300-304.Serdi Publisher,France

 

II.Elderly patients compliance and elderly patients and health professional's,views,and attitudes TOWARDS prescribed sip-feed supplements

H.Lad,M.Gott,S.Gariballa (Sheffield Institute For Studies on Ageing,Community Sciences Centre,Northern General Hospital,Sheffield,United Kingdom) (1)

 

Background:Although nutritional supplements are widely prescribed in hospital and community settings compliance with supplements and factors affecting compliance are not well understood.Aims:The aims of this study were therefore to examine compliance,factors that influence compliance,views and attitudes of elderly patients and their health professionals on prescribed oral nutritional supplements.Methods:Forty medically stable hospitalised elderly patients prescribed nutritional supplements by a hospital dietician after nutritional screening had their compliance with supplement intake measured.Sixteen patients prescribed nutritional supplements and their health professionals had their views and attitudes on the factors that influence compliance with supplements intake explored using qualitative face-to-face interviews and postal questionnaires respectively.Qualitative data analysis adhered to the principles of grounded theory and followed the ‘Framework' approach.Quantitative data were entered on to a standard spreadsheet and simple descriptive statistics was examined.Results:A total of 40 hospitalised elderly patient (Age range 60-91yrs;mean age 78 years;20 female);24 doctors,13 dietician and 33 nurses were recruited.The main finding of this study was that compliance with prescribed nutritional supplements was low in hospital and in the community.Only 43% of the study population consumed more than 80% of the prescribed amount.Factors that affected compliance included flavour,taste,texture and predictability of the supplements as well as personal preferences and life style.Health professionals dealing with elderly patients have wide-range and different views on the criteria used to prescribe nutritional supplements and factors affecting their subsequent intake.Conclusion:Compliance with prescribed nutritional supplements was low in hospital and in the community.Elderly patients and their health professionals have wide-range and different views on factors that influence compliance with nutritional supplements.

 

(1) The Journal of Nutrition,Health and Aging vol.9,n° 5,2005,p 310-314.Serdi Publisher,France

 

III.DOES THE MANAGEMENT OF OLDER PATIENTS WITH DIABETES MELLITUS MEET RECOMMENDED GUIDELINES?

J Balami (Radcliffe Infirmary Hospital.Department of Clinical Geratology,Radcliffe Infirmary.Oxford,UK) (1)

 

Introduction Diabetes mellitus is a growing health problem for elderly patients who are at particular risk of developing the complications of diabetes,in particular hypoglycaemia,ocular complications and foot ulcers.National Service Framework for diabetes mellitus and National Institute for Clinical Excellence recommends targeting those with the highest risk of complications.It is recommended that all diabetic patients should undergo a review at least once a year,with as a minimum;fundoscopy and foot inspection.The aim of this study was to evaluate the degree of diabetic care and adherence to guidelines,especially annual fundoscopy and foot examination.Methodology A prospective analysis of patients >=65 years with diabetes admitted to both acute and rehabilitation wards,between June 2004 and March 2005.Patients were identified by case note review and by nursing staff.Results A total of 84 patients (77 pre-hospital diagnosis,7 diagnosed during admission).100% Type 11 diabetes.The mean age was 81.6 years.Mean HbAIc 6.9 (range 5.5-11.5) 21% (18) had diabetes controlled by diet alone,63%(53) controlled by oral hypoglycaemic agents,11% (9) on insulin,and 5%(4) on insulin and oral hypoglycaemic agent.Supervision of diabetes by General practitioners in 58% (49) of patients;by diabetic outpatient clinic in 16% (4) cases and 17% (14) patients received no specific supervision.Only 45% (38) and 43% (36) of patients had fundoscopy and foot examination respectively within the preceeding 12 months.Conclusion In this study,a large proportion of older diabetic patients were receiving less than ideal supervision with poor adherence to the guidelines.Hence the need for strategy to optimise the care of older diabetic patients,with easy access to chiropody and ophthalmic services.

 

(1) The Journal of Nutrition,Health and Aging vol.9,n° 5,2005,p366;EUGMS Symposium Geriatric Cardiology,abstract (Madrid,21-22 October 2005 ).Serdi Publisher

 

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IV.Roles of unsaturated fatty acids (especially omega-3 fatty acids) in the brain at various ages and during ageing

J.M.BOURRE (Member of the French Academy of Medicine.INSERM Research Director.Director of Unit U26 Neuro-pharmaco-nutrition.Hopital Fernand Widal,Paris) (1)

 

Among various organs,in the brain,the fatty acids most extensively studied are omega-3 fatty acids.Alpha-linolenic acid (18:3w3) deficiency alters the structure and function of membranes and induces minor cerebral dysfunctions,as demonstrated in animal models and subsequently in human infants.Even though the brain is materially an organ like any other,that is to say elaborated from substances present in the diet (sometimes exclusively),for long it was not accepted that food can have an influence on brain structure,and thus on its function.Lipids,and especially omega-3 fatty acids,provided the first coherent experimental demonstration of the effect of diet (nutrients) on the structure and function of the brain.In fact the brain,after adipose tissue,is the organ richest in lipids,whose only role is to participate in membrane structure.First it was shown that the differentiation and functioning of cultured brain cells requires not only alpha-linolenic acid (the major component of the omega-3,w3 family),but also the very long omega-3 and omega-6 carbon chains (1).It was then demonstrated that alpha-linolenic acid deficiency alters the course of brain development,perturbs the composition and physicochemical properties of brain cell membranes,neurones,oligodendrocytes,and astrocytes (2).This leads to physicochemical modifications,induces biochemical and physiological perturbations,and results in neurosensory and behavioural upset (3).Consequently,the nature of polyunsaturated fatty acids (in particular omega-3) present in formula milks for infants (premature and term) conditions the visual and cerebral abilities,including intellectual.Moreover,dietary omega-3 fatty acids are certainly involved in the prevention of some aspects of cardiovascular disease (including at the level of cerebral vascularization),and in some neuropsychiatric disorders,particularly depression,as well as in dementia,notably Alzheimer's disease.Recent results have shown that dietary alpha-linolenic acid deficiency induces more marked abnormalities in certain cerebral structures than in others,as the frontal cortex and pituitary gland are more severely affected.These selective lesions are accompanied by behavioural disorders more particularly affecting certain tests (habituation,adaptation to new situations).Biochemical and behavioural abnormalities are partially reversed by a dietary phospholipid supplement,especially omega-3-rich egg yolk extracts or pig brain.A dose-effect study showed that animal phospholipids are more effective than plant phospholipids to reverse the consequences of alpha-linolenic acid deficiency,partly because they provide very long preformed chains.Alpha-linolenic acid deficiency decreases the perception of pleasure,by slightly altering the efficacy of sensory organs and by affecting certain cerebral structures.Age-related impairment of hearing,vision and smell is due to both decreased efficacy of the parts of the brain concerned and disorders of sensory receptors,particularly of the inner ear or retina.For example,a given level of perception of a sweet taste requires a larger quantity of sugar in subjects with alpha-linolenic acid deficiency.In view of occidental eating habits,as omega-6 fatty acid deficiency has never been observed,its impact on the brain has not been studied.In contrast,omega-9 fatty acid deficiency,specifically oleic acid deficiency,induces a reduction of this fatty acid in many tissues,except the brain (but the sciatic nerve is affected).This fatty acid is therefore not synthesized in sufficient quantities,at least during pregnancy-lactation,implying a need for dietary intake.It must be remembered that organization of the neurons is almost complete several weeks before birth,and that these neurons remain for the subject's life time.Consequently,any disturbance of these neurons,an alteration of their connections,and impaired turnover of their constituents at any stage of life,will tend to accelerate ageing.The enzymatic activities of synthesis of long-chain polyunsaturated fatty acids from linoleic and alpha-linolenic acids are very limited in the brain:this organ therefore depends on an exogenous supply.Consequently,fatty acids that are essential for the brain are arachidonic acid and cervonic acid,derived from the diet,unless they are synthesized by the liver from linoleic acid and alpha-linolenic acid.The age-related reduction of hepatic desaturase activities (which participate in the synthesis of long chains,together with elongases) can impair turnover of cerebral membranes.In many structures,especially in the frontal cortex,a reduction of cervonic and arachidonic acids is observed during ageing,predominantly associated with a reduction of phosphatidylethanolamines (mainly in the form of plasmalogens).Peroxisomal oxidation of polyunsaturated fatty acids decreases in the brain during ageing,participating in decreased turnover of membrane fatty acids,which are also less effectively protected against peroxidation by free radicals.

 

(1) Nutrition Cognitive Decline and Aging,2005,p87-114,Serdi Publisher,France

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