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Effects of nutritional intervention on immune markers in malnourished elderly
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
sion to the hospital. Possible prognostic characteristics predicting life-expectancy data were collected. Results.– A cohort of 116 malnourished, cognitively impaired, older, hospitalized patients is described. Forty-nine patients were described to have dementia, 48 delirium and 19 a combination of dementia and delirium. Mean age was 81.6 years (SD 8.3, range 60–99 years). Fifty-five patients (47.4%) died within one year after hospital admission, 36 of them (31%) died within 3 months after hospital admission. There were no significant differences in survival between the three groups (P = 0.672). Patients with a malignancy or vascular disease were more likely to die within three months after discharge. Conclusion.– Almost half of a cohort of malnourished, cognitive impaired, older, hospitalized patients died within one year after hospital admission. Patients with a malignancy or vascular disease were more likely to die early after discharge. It could be defended that in these patients, extra nutritional support should no longer be offered as a standard. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.168 P168
Effects of nutritional intervention on immune markers in malnourished elderly F. Neelemaat a,∗ , M. Van Bokhorst-De Van Der Schueren a , H. Bontkes b , J. Seidell c , S. Hougee d , A. Thijs e a Nutrition And Dietetics/Internal Medicine, VU University Medical Center, Amsterdam, Netherlands b Pathology, Unit Medical Immunology, VU University Medical Center, MB, Netherlands c Health Sciences, Faculty Of Earth And Life Sciences, VU University, Amsterdam, Netherlands d Centre For Specialised Nutrition, Nutricia Advanced Medical Nutrition, Danone Research, Wageningen, Netherlands e Internal Medicine, VU University Medical Center, Amsterdam, Netherlands Introduction.– Both malnutrition and advanced age are known to negatively impact the immune system. This exploratory RCT studied the effects of a composed nutritional intervention on immune markers, endocrine markers and a selection of micronutrients in malnourished ill elderly patients. Methods.– Malnourished elderly patients (> 60) newly admitted to a university medical center were randomised to receive either usual care plus nutritional intervention (energy and protein enriched diet, comprising oral nutritional support, Ca-vitD supplement, dietetary counselling) commencing in the hospital and continued for 3 months post-discharge or usual care alone. Immune markers (interleukins, complement, C-reactive protein, albumin, TNF-␣), endocrine markers (growth factors) and micronutrients (iron, ferritin, vitamin A, E, D), were measured at baseline and 3 months following discharge. Results.– Two hundred and ten patients were included. For 89 patients (46 intervention, 43 control), both measurements were available. This selection of patients was in a better health status compared to the total group. At baseline, most of the analysed immune markers, endocrine markers and micronutrients showed values within the normal range, with no statistically significant differences between groups. The majority of immune markers, endocrine markers and micronutrients tended to improve over time, without statistically significant differences between groups, except for vitamin D (P = 0.008), confirming the supplementation in the intervention group. Conclusion.– A 3 months nutritional intervention in malnourished ill elderly patients could not demonstrate measurable additional influence on measured immune markers, endocrine markers and selected micronutrients at three months compared to baseline.
S83
The improved outcomes were presumably caused by patients’ improved health status during time. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.169 P169
Prevalence of malnutrition in patients with Alzheimer’s dementia at a memory clinic D. Van Asselt a , E. Droogsma a,∗ , C. Schölzel-Dorenbos b , T. Schuur a , P. Van Walderveen a , J. Van Steijn a a Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands b Geriatric Medicine, Slingeland Ziekenhuiis, Doetinchem, Netherlands Introduction.– Involuntary weight loss, a sign of malnutrition, occurs in 40% of patients with Alzheimer’s disease (AD). Given the negative effects of weight loss and malnutrition in AD patients, it is important to establish the prevalence of malnutrition and the impact of various factors on nutritional status of AD patients. Little is known about the prevalence of malnutrition in AD patients at memory clinics. Text.– This was a retrospective cross-sectional study at a Dutch memory clinic. AD patients, aged 65 years or older, who lived at home or in residential care, were included. At the time the diagnosis AD was made, various data were recorded. Nutritional status was operationalized with the Mini Nutritional Assessment. Linear regression analysis was performed to assess the impact of various factors on nutritional status. Three hundred and twelve patients (mean age ± SD = 77.6 ± 5.7 yrs, mean MMSE ± SD = 20.6 ± 3.8) were enrolled. The prevalence of malnutrition was 0% and 13.5% was at risk of malnutrition. The degree of impairment in basic and complex daily functioning, operationalized with the Interview for Deterioration in Daily Living Activities in Dementia was an independent predictor of nutritional status (P = 0.001, B = -0.062). One in seven elderly patients, with recent diagnosis of AD at a memory clinic, is at risk of malnutrition. The degree of impairment in daily functioning is an independent predictor of nutritional status. Physicians and other caregivers should particularly be alert on, and pay extra attention to, the nutritional status in AD patients with increasing care dependency. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.170 P170
Are oral nutritional supplements effective in undernourished community-dwelling Alzheimer patients? A critically appraised topic
D. Van Asselt , E. Droogsma ∗ Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
Introduction.– Involuntary weight loss occurs in 40% of patients with Alzheimer’s disease (AD) and is associated with negative health outcomes. Studies among institutionalized AD patients showed that oral nutritional supplements (ONS) improved patients’ body weight. However, two thirds of patients with dementia live at home. Our aim was to critically assess current evidence regarding the effect of ONS in undernourished community-dwelling AD patients. Text.– The objective was addressed through the development of a critically appraised topic (CAT). A CAT is a standardized, one page summary of research evidence, organized around a clinical question. CATs provide both a critique of the research and a statement of the clinical relevance of the results. It includes a clinical scenario, structured question, literature search strategy, critical appraisal,
sion to the hospital. Possible prognostic characteristics predicting life-expectancy data were collected. Results.– A cohort of 116 malnourished, cognitively impaired, older, hospitalized patients is described. Forty-nine patients were described to have dementia, 48 delirium and 19 a combination of dementia and delirium. Mean age was 81.6 years (SD 8.3, range 60–99 years). Fifty-five patients (47.4%) died within one year after hospital admission, 36 of them (31%) died within 3 months after hospital admission. There were no significant differences in survival between the three groups (P = 0.672). Patients with a malignancy or vascular disease were more likely to die within three months after discharge. Conclusion.– Almost half of a cohort of malnourished, cognitive impaired, older, hospitalized patients died within one year after hospital admission. Patients with a malignancy or vascular disease were more likely to die early after discharge. It could be defended that in these patients, extra nutritional support should no longer be offered as a standard. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.168 P168
Effects of nutritional intervention on immune markers in malnourished elderly F. Neelemaat a,∗ , M. Van Bokhorst-De Van Der Schueren a , H. Bontkes b , J. Seidell c , S. Hougee d , A. Thijs e a Nutrition And Dietetics/Internal Medicine, VU University Medical Center, Amsterdam, Netherlands b Pathology, Unit Medical Immunology, VU University Medical Center, MB, Netherlands c Health Sciences, Faculty Of Earth And Life Sciences, VU University, Amsterdam, Netherlands d Centre For Specialised Nutrition, Nutricia Advanced Medical Nutrition, Danone Research, Wageningen, Netherlands e Internal Medicine, VU University Medical Center, Amsterdam, Netherlands Introduction.– Both malnutrition and advanced age are known to negatively impact the immune system. This exploratory RCT studied the effects of a composed nutritional intervention on immune markers, endocrine markers and a selection of micronutrients in malnourished ill elderly patients. Methods.– Malnourished elderly patients (> 60) newly admitted to a university medical center were randomised to receive either usual care plus nutritional intervention (energy and protein enriched diet, comprising oral nutritional support, Ca-vitD supplement, dietetary counselling) commencing in the hospital and continued for 3 months post-discharge or usual care alone. Immune markers (interleukins, complement, C-reactive protein, albumin, TNF-␣), endocrine markers (growth factors) and micronutrients (iron, ferritin, vitamin A, E, D), were measured at baseline and 3 months following discharge. Results.– Two hundred and ten patients were included. For 89 patients (46 intervention, 43 control), both measurements were available. This selection of patients was in a better health status compared to the total group. At baseline, most of the analysed immune markers, endocrine markers and micronutrients showed values within the normal range, with no statistically significant differences between groups. The majority of immune markers, endocrine markers and micronutrients tended to improve over time, without statistically significant differences between groups, except for vitamin D (P = 0.008), confirming the supplementation in the intervention group. Conclusion.– A 3 months nutritional intervention in malnourished ill elderly patients could not demonstrate measurable additional influence on measured immune markers, endocrine markers and selected micronutrients at three months compared to baseline.
S83
The improved outcomes were presumably caused by patients’ improved health status during time. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.169 P169
Prevalence of malnutrition in patients with Alzheimer’s dementia at a memory clinic D. Van Asselt a , E. Droogsma a,∗ , C. Schölzel-Dorenbos b , T. Schuur a , P. Van Walderveen a , J. Van Steijn a a Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands b Geriatric Medicine, Slingeland Ziekenhuiis, Doetinchem, Netherlands Introduction.– Involuntary weight loss, a sign of malnutrition, occurs in 40% of patients with Alzheimer’s disease (AD). Given the negative effects of weight loss and malnutrition in AD patients, it is important to establish the prevalence of malnutrition and the impact of various factors on nutritional status of AD patients. Little is known about the prevalence of malnutrition in AD patients at memory clinics. Text.– This was a retrospective cross-sectional study at a Dutch memory clinic. AD patients, aged 65 years or older, who lived at home or in residential care, were included. At the time the diagnosis AD was made, various data were recorded. Nutritional status was operationalized with the Mini Nutritional Assessment. Linear regression analysis was performed to assess the impact of various factors on nutritional status. Three hundred and twelve patients (mean age ± SD = 77.6 ± 5.7 yrs, mean MMSE ± SD = 20.6 ± 3.8) were enrolled. The prevalence of malnutrition was 0% and 13.5% was at risk of malnutrition. The degree of impairment in basic and complex daily functioning, operationalized with the Interview for Deterioration in Daily Living Activities in Dementia was an independent predictor of nutritional status (P = 0.001, B = -0.062). One in seven elderly patients, with recent diagnosis of AD at a memory clinic, is at risk of malnutrition. The degree of impairment in daily functioning is an independent predictor of nutritional status. Physicians and other caregivers should particularly be alert on, and pay extra attention to, the nutritional status in AD patients with increasing care dependency. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.170 P170
Are oral nutritional supplements effective in undernourished community-dwelling Alzheimer patients? A critically appraised topic
D. Van Asselt , E. Droogsma ∗ Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
Introduction.– Involuntary weight loss occurs in 40% of patients with Alzheimer’s disease (AD) and is associated with negative health outcomes. Studies among institutionalized AD patients showed that oral nutritional supplements (ONS) improved patients’ body weight. However, two thirds of patients with dementia live at home. Our aim was to critically assess current evidence regarding the effect of ONS in undernourished community-dwelling AD patients. Text.– The objective was addressed through the development of a critically appraised topic (CAT). A CAT is a standardized, one page summary of research evidence, organized around a clinical question. CATs provide both a critique of the research and a statement of the clinical relevance of the results. It includes a clinical scenario, structured question, literature search strategy, critical appraisal,