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PP020-SUN BODY MASS INDEX AND MORTALITY IN INSTITUTIONALISED ELDERLY
30 of postures, sensory and compensatory interventions. The examination leads to recommendations regarding the optimum delivery and maintenance of nutrition and hydration (e.g. per oral, non-oral or combination of the two, special preparation of food). Methods: A retrospective study was undertaken to investigate differences between FEES and clinical examination in determining adequate nutrition and diet modifications. Patients with dysphagia were examined clinically by speech-language therapists to assess swallowing function. Additionally all patients with pharyngeal disorders of swallowing were tested with FEES. The oral intake was evaluated using the Functional Oral Intake Scale (FOIS) (Crary et al., 2004). These data were collected in the clinical examination and FEES. Laryngeal penetration and aspiration of saliva, food and liquid were identified with FEES. The Penetration-Aspiration-Scale (PAS) (Rosenbek et al., 1988) was used to determine the risk of aspiration. Results: Preliminary analysis (N = 19) shows no significant differences in feeding status but the mean-score of FOIS tends to be higher after FEES. Furthermore there is a high significant negative correlation between FOIS and PAS (r = 0.75; p < 0.001). Conclusion: These preliminary findings suggest that FEES is a useful aid to evaluate the swallowing safety and to specify nutritional recommendations for patients with dysphagia. Disclosure of Interest: None Declared
PP019-SUN Outstanding abstract NUTRITIONAL SCREENING AND MORTALITY IN NEWLY INSTITUTIONALISED ELDERLY: A COMPARISON BETWEEN THE GERIATRIC NUTRITIONAL RISK INDEX AND THE MINI NUTRITIONAL ASSESSMENT E. Cereda1 , C. Pedrolli2 , A. Zagami3 , A. Vanotti4 , S. Piffer5 , A. Opizzi6 , M. Rondanelli6 , R. Caccialanza1 . 1 Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, 2 Unit` a Operativa di Dietetica e Nutrizione Clinica, Ospedale “S. Chiara”, Azienda Provinciale per i Servizi Sanitari, Trento, 3 Fondazione Bellaria Onlus, Appiano Gentile, Como, 4 Servizio di Dietetica e Nutrizione Clinica, ASL Como, Como, 5 Servizio Osservatorio Epidemiologico, Direzione per la Promozione e l’Educazione alla Salute, Azienda Provinciale per i Servizi Sanitari, Trento, 6 Servizio Endocrino-nutrizionale, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Nutrizione, Azienda di Servizi alla Persona di Pavia, Universit` a degli Studi di Pavia, Pavia, Italy Rationale: Several nutritional screening tools are now available and their use should be considered according to the association with outcome. We evaluated the risk of mortality associated with the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) in newly institutionalised elderly. Methods: A prospective observational study involving 358 elderly newly admitted to a long-term care setting. Hazard ratios (HR) for mortality among GNRI categories and MNA classes were estimated by the Cox’s regression adjusted for several confounders.
Poster presentations Results: At baseline, 32.4% and 37.4% of the patients were classified as being malnourished (MNA < 17) and at severe nutritional risk (GNRI < 92), respectively, whereas 57.5% and 35.2%, respectively, were classified as being at risk for malnutrition (MNA 17 23.5) and having low nutritional risk (GNRI 92 98). During a median follow-up of 6.5 years [25th -75th percentile, 5.9 8.6], 297 (83%) elderly died. Risk for all-cause mortality was significantly associated with nutritional risk by the GNRI tool (GNRI < 92 HR = 1.99 [95% CI, 1.38 2.88], P < 0.001; GNRI 92 98 HR = 1.51 [95% CI, 1.04 2.18], P = 0.029) but not with nutritional status by the MNA. A significant association was also found with cardiovascular mortality (GNRI < 92 HR = 1.79 [95% CI, 1.23 2.61], P = 0.003). Conclusion: Nutritional risk by GNRI but not nutritional status by MNA was associated with higher mortality risk. Present data suggest that in the the nutritonal screening of newly institutionalised elderly the use of the GNRI should be preferred to that of the MNA. Disclosure of Interest: None Declared
PP020-SUN BODY MASS INDEX AND MORTALITY IN INSTITUTIONALISED ELDERLY E. Cereda1 , C. Pedrolli2 , A. Zagami3 , A. Vanotti4 , S. Piffer5 , A. Opizzi6 , M. Rondanelli6 , R. Caccialanza1 . 1 Nutrition and Dietetics Service, Fondazione IRCCS a Operativa di Policlinico San Matteo, Pavia, 2 Unit` Dietetica e Nutrizione Clinica, Ospedale “S. Chiara”, Trento, 3 Casa di Riposo Bellaria, 4 Nutrition and Dietetics Service, ASL Como, Como, 5 Servizio Osservatorio Epidemiologico, Azienda Provinciale per i Servizi Sanitari, Trento, 6 Servizio Endocrino-nutrizionale, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Nutrizione, Azienda di Servizi alla Persona di Pavia, Universit` a degli Studi di Pavia, Pavia, Italy Rationale: Malnutrition and sarcopenia in institutions are very common and significantly affect the prognosis. Accordingly, in elderly patients, body mass index (BMI) is considered a marker of protein stores rather than of adiposity. Current guidelines suggest a BMI 21 kg/m2 as major trigger for nutritional support. We evaluated the association between BMI and mortality in institutionalised elderly. Methods: A multi-centric prospective cohort study involving 519 long-term care resident elderly. Risk for mortality accross BMI terziles was estimated by the Cox hazards regression model adjusted for potential confounders recorded at inclusion and collected during the follow-up. Results: During a median follow-up of 5.7 years [25th -75th percentile, 5.2 8.2], 409 (78.8%) elderly died. In primary analyses, based on variables collected at inclusion, patients in the first terzile of BMI (21 kg/m2 ) were at higher risk for all-cause (hazard ratio [HR] 1.38; 95% confidence interval [95% CI, 1.04 1.84]; P = 0.025) and cardiovascular mortality (HR = 1.49 [95% CI, 1.00 2.08], P = 0.045). Increased risk was confirmed even after adjusting for nutritional support during the follow-up (all-cause HR = 1.53 [95% CI, 1.13 2.06], P = 0.006; cardiovascular HR = 1.62 [95% CI, 1.09 2.40], P = 0.018) which in turn
Geriatrics I was associated with a reduced risk (all-cause HR = 0.74 [95% CI, 0.55 0.97], P = 0.035; cardiovascular HR = 0.62 [95% CI, 0.42 0.91], P = 0.016). Conclusion: BMI is significantly associated with all-cause and cardiovascular mortality in institutionalised elderly. A value of 21 kg/m2 can be considered a useful trigger for nutritional support. These results support intending BMI as nutritional reserve in institutionalised elderly. Disclosure of Interest: None Declared
PP021-SUN RANDOMIZED CONTROLLED TRIAL IN CARE HOME RESIDENTS SHOWS IMPROVED QUALITY OF LIFE (QOL) WITH ORAL NUTRITIONAL SUPPLEMENTS E.L. Parsons1 , R.J. Stratton1 , A.L. Cawood2 , T.R. Smith3 , H. Warwick3 , M. Elia1 . 1 University of Southampton, Southampton, 2 Nutricia, Trowbridge, 3 Southampton NHS Trust, Southampton, United Kingdom Rationale: As few trials have explored the effect of nutrition support on quality of life (QOL) in care homes, this has become a research priority [1]. This study examined the hypothesis that oral nutritional supplements (ONS) can be more effective than dietary advice (DA) at improving QOL in care home residents. Methods: 104 residents (57 residential, 47 nursing, mean age 88.3±7.7 y, mean BMI 19.1±2.7 kg/m2 , 86% female) at risk of malnutrition (using Malnutrition Universal Screening Tool ‘MUST’) were randomised to receive ONS with guidance on how to use (Nutricia range; mean intake 333kcal±237/d; n = 53) for 12 weeks or written and verbal DA (n = 51). QOL was measured at baseline and at 12 weeks using EuroQol (EQ-5D), including a time trade off (TTO) (range 0.073 to 1) and a visual analogue scale (VAS) (score 0 to 100) for self perceived health. Results were analysed using per-protocol and intention to treat analysis. Results: QOL (adjusted for baseline, malnutrition risk, type of care (nursing, residential)) was significantly higher in the ONS than the DA group. Using per protocol analysis (n = 70) the EQ-5D TTO scores (mean±SD) were 0.60±0.23 vs. 0.56±0.25 (p = 0.004) and VAS scores 67.4±15.2 vs. 57.3±23.1 (p = 0.027) for ONS vs. DA. With intention to treat analysis, EQ-5D TTO (mean±SE) (0.70±0.03 vs. 0.61±0.03; p = 0.009) and VAS (66.4±5.1 vs. 56.5±9.5; p = 0.05) scores remained significant. Conclusion: This is the first study in care homes to indicate that ONS in malnourished residents can improve quality of life more effectively than dietary advice. References [1] NICE (2006) CG32 Nutrition Support for Adults. London. Disclosure of Interest: E. Parsons: None Declared, R. Stratton Other: Nutricia Ltd, A. Cawood: None Declared, T. Smith: None Declared, H. Warwick: None Declared, M. Elia: None Declared
31 PP022-SUN RANDOMIZED CONTROLLED TRIAL SHOWS GREATER TOTAL NUTRITIONAL INTAKES WITH LIQUID SUPPLEMENTS THAN DIETARY ADVICE IN CARE HOME RESIDENTS E.L. Parsons1 , M. Elia1 , A.L. Cawood2 , T.R. Smith3 , H. Warwick3 , R.J. Stratton1 . 1 University of Southampton, Southampton, 2 Nutricia, Trowbridge, 3 Southampton NHS Trust, Southampton, United Kingdom Rationale: Few trials have compared the effectiveness of oral nutritional supplements (ONS) with dietary advice (DA) in care homes [1]. This trial examined the hypothesis that ONS can be more effective at improving nutritional intake than DA in care home residents. Methods: 104 residents (57 residential, 47 nursing, mean age 88.3±7.7 y, mean BMI 19.1±2.7 kg/m2 , 86% female) at risk of malnutrition (using Malnutrition Universal Screening Tool ‘MUST’) were randomised to receive ONS with guidance on how to use (Nutricia range; mean intake 333kcal±237/d; n = 53); or written and verbal DA (n = 51) for 12 weeks. At baseline and 12 weeks, nutritional intake (energy and protein) was measured by a dietitian (24 h recalls; analysed with WISP) and appetite (hunger, desire to eat) assessed with 100 mm visual analogue scales. Results were analysed using perprotocol regression analysis. Results: Total energy and protein intakes (adjusted for baseline, malnutrition risk, type of care (nursing, residential)) were significantly higher in the ONS than the DA group (1655±502 kcal vs 1253±469 kcal, p = 0.001; 62.1±18.4 g vs 49.6±19.9 , p = 0.004). Appetite sensations were not significantly different between the ONS and DA groups (hunger: 39±21 mm vs 33±28 mm, n = 57; desire to eat: 46.6±19 mm vs 49.7±27.3 mm, n = 54). Conclusion: This RCT indicates that ONS can be more effective at increasing total energy and protein intakes than dietary advice with ONS having little effect on the appetite of care home residents. References [1] Parsons EL et al (2011) Systematic review of the effects of oral nutritional interventions in care homes, Proc Nutr Soc (in press). Disclosure of Interest: E. Parsons: None Declared, M. Elia: None Declared, A. Cawood: None Declared, T. Smith: None Declared, H. Warwick: None Declared, R. Stratton Other: Nutricia Ltd
PP023-SUN DYSPHAGIA AND COGNITIVE IMPAIRMENT INCREASE THE RISK OF MALNUTRITION IN NURSING HOME RESIDENTS NEW DATA FROM THE NUTRITIONDAY IN EUROPEAN NURSING HOMES E. Kiesswetter1 , K. Schindler2 , R. Diekmann1 , M. Mouhieddine2 , M. Hiesmayr2 , C.C. Sieber1 , D. Volkert1 . 1 Institute for Biomedicine of Aging, University of Erlangen-N¨ urnberg, N¨ urnberg, Germany; 2 Medical University of Vienna, Vienna, Austria Rationale: Dysphagia (Dy) and cognitive impairment (CI) are serious health problems in nursing home (NH) residents; both problems markedly affect adequate nutrition and increase the risk of malnutrition. Presently
PP019-SUN Outstanding abstract NUTRITIONAL SCREENING AND MORTALITY IN NEWLY INSTITUTIONALISED ELDERLY: A COMPARISON BETWEEN THE GERIATRIC NUTRITIONAL RISK INDEX AND THE MINI NUTRITIONAL ASSESSMENT E. Cereda1 , C. Pedrolli2 , A. Zagami3 , A. Vanotti4 , S. Piffer5 , A. Opizzi6 , M. Rondanelli6 , R. Caccialanza1 . 1 Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, 2 Unit` a Operativa di Dietetica e Nutrizione Clinica, Ospedale “S. Chiara”, Azienda Provinciale per i Servizi Sanitari, Trento, 3 Fondazione Bellaria Onlus, Appiano Gentile, Como, 4 Servizio di Dietetica e Nutrizione Clinica, ASL Como, Como, 5 Servizio Osservatorio Epidemiologico, Direzione per la Promozione e l’Educazione alla Salute, Azienda Provinciale per i Servizi Sanitari, Trento, 6 Servizio Endocrino-nutrizionale, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Nutrizione, Azienda di Servizi alla Persona di Pavia, Universit` a degli Studi di Pavia, Pavia, Italy Rationale: Several nutritional screening tools are now available and their use should be considered according to the association with outcome. We evaluated the risk of mortality associated with the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) in newly institutionalised elderly. Methods: A prospective observational study involving 358 elderly newly admitted to a long-term care setting. Hazard ratios (HR) for mortality among GNRI categories and MNA classes were estimated by the Cox’s regression adjusted for several confounders.
Poster presentations Results: At baseline, 32.4% and 37.4% of the patients were classified as being malnourished (MNA < 17) and at severe nutritional risk (GNRI < 92), respectively, whereas 57.5% and 35.2%, respectively, were classified as being at risk for malnutrition (MNA 17 23.5) and having low nutritional risk (GNRI 92 98). During a median follow-up of 6.5 years [25th -75th percentile, 5.9 8.6], 297 (83%) elderly died. Risk for all-cause mortality was significantly associated with nutritional risk by the GNRI tool (GNRI < 92 HR = 1.99 [95% CI, 1.38 2.88], P < 0.001; GNRI 92 98 HR = 1.51 [95% CI, 1.04 2.18], P = 0.029) but not with nutritional status by the MNA. A significant association was also found with cardiovascular mortality (GNRI < 92 HR = 1.79 [95% CI, 1.23 2.61], P = 0.003). Conclusion: Nutritional risk by GNRI but not nutritional status by MNA was associated with higher mortality risk. Present data suggest that in the the nutritonal screening of newly institutionalised elderly the use of the GNRI should be preferred to that of the MNA. Disclosure of Interest: None Declared
PP020-SUN BODY MASS INDEX AND MORTALITY IN INSTITUTIONALISED ELDERLY E. Cereda1 , C. Pedrolli2 , A. Zagami3 , A. Vanotti4 , S. Piffer5 , A. Opizzi6 , M. Rondanelli6 , R. Caccialanza1 . 1 Nutrition and Dietetics Service, Fondazione IRCCS a Operativa di Policlinico San Matteo, Pavia, 2 Unit` Dietetica e Nutrizione Clinica, Ospedale “S. Chiara”, Trento, 3 Casa di Riposo Bellaria, 4 Nutrition and Dietetics Service, ASL Como, Como, 5 Servizio Osservatorio Epidemiologico, Azienda Provinciale per i Servizi Sanitari, Trento, 6 Servizio Endocrino-nutrizionale, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Nutrizione, Azienda di Servizi alla Persona di Pavia, Universit` a degli Studi di Pavia, Pavia, Italy Rationale: Malnutrition and sarcopenia in institutions are very common and significantly affect the prognosis. Accordingly, in elderly patients, body mass index (BMI) is considered a marker of protein stores rather than of adiposity. Current guidelines suggest a BMI 21 kg/m2 as major trigger for nutritional support. We evaluated the association between BMI and mortality in institutionalised elderly. Methods: A multi-centric prospective cohort study involving 519 long-term care resident elderly. Risk for mortality accross BMI terziles was estimated by the Cox hazards regression model adjusted for potential confounders recorded at inclusion and collected during the follow-up. Results: During a median follow-up of 5.7 years [25th -75th percentile, 5.2 8.2], 409 (78.8%) elderly died. In primary analyses, based on variables collected at inclusion, patients in the first terzile of BMI (21 kg/m2 ) were at higher risk for all-cause (hazard ratio [HR] 1.38; 95% confidence interval [95% CI, 1.04 1.84]; P = 0.025) and cardiovascular mortality (HR = 1.49 [95% CI, 1.00 2.08], P = 0.045). Increased risk was confirmed even after adjusting for nutritional support during the follow-up (all-cause HR = 1.53 [95% CI, 1.13 2.06], P = 0.006; cardiovascular HR = 1.62 [95% CI, 1.09 2.40], P = 0.018) which in turn
Geriatrics I was associated with a reduced risk (all-cause HR = 0.74 [95% CI, 0.55 0.97], P = 0.035; cardiovascular HR = 0.62 [95% CI, 0.42 0.91], P = 0.016). Conclusion: BMI is significantly associated with all-cause and cardiovascular mortality in institutionalised elderly. A value of 21 kg/m2 can be considered a useful trigger for nutritional support. These results support intending BMI as nutritional reserve in institutionalised elderly. Disclosure of Interest: None Declared
PP021-SUN RANDOMIZED CONTROLLED TRIAL IN CARE HOME RESIDENTS SHOWS IMPROVED QUALITY OF LIFE (QOL) WITH ORAL NUTRITIONAL SUPPLEMENTS E.L. Parsons1 , R.J. Stratton1 , A.L. Cawood2 , T.R. Smith3 , H. Warwick3 , M. Elia1 . 1 University of Southampton, Southampton, 2 Nutricia, Trowbridge, 3 Southampton NHS Trust, Southampton, United Kingdom Rationale: As few trials have explored the effect of nutrition support on quality of life (QOL) in care homes, this has become a research priority [1]. This study examined the hypothesis that oral nutritional supplements (ONS) can be more effective than dietary advice (DA) at improving QOL in care home residents. Methods: 104 residents (57 residential, 47 nursing, mean age 88.3±7.7 y, mean BMI 19.1±2.7 kg/m2 , 86% female) at risk of malnutrition (using Malnutrition Universal Screening Tool ‘MUST’) were randomised to receive ONS with guidance on how to use (Nutricia range; mean intake 333kcal±237/d; n = 53) for 12 weeks or written and verbal DA (n = 51). QOL was measured at baseline and at 12 weeks using EuroQol (EQ-5D), including a time trade off (TTO) (range 0.073 to 1) and a visual analogue scale (VAS) (score 0 to 100) for self perceived health. Results were analysed using per-protocol and intention to treat analysis. Results: QOL (adjusted for baseline, malnutrition risk, type of care (nursing, residential)) was significantly higher in the ONS than the DA group. Using per protocol analysis (n = 70) the EQ-5D TTO scores (mean±SD) were 0.60±0.23 vs. 0.56±0.25 (p = 0.004) and VAS scores 67.4±15.2 vs. 57.3±23.1 (p = 0.027) for ONS vs. DA. With intention to treat analysis, EQ-5D TTO (mean±SE) (0.70±0.03 vs. 0.61±0.03; p = 0.009) and VAS (66.4±5.1 vs. 56.5±9.5; p = 0.05) scores remained significant. Conclusion: This is the first study in care homes to indicate that ONS in malnourished residents can improve quality of life more effectively than dietary advice. References [1] NICE (2006) CG32 Nutrition Support for Adults. London. Disclosure of Interest: E. Parsons: None Declared, R. Stratton Other: Nutricia Ltd, A. Cawood: None Declared, T. Smith: None Declared, H. Warwick: None Declared, M. Elia: None Declared
31 PP022-SUN RANDOMIZED CONTROLLED TRIAL SHOWS GREATER TOTAL NUTRITIONAL INTAKES WITH LIQUID SUPPLEMENTS THAN DIETARY ADVICE IN CARE HOME RESIDENTS E.L. Parsons1 , M. Elia1 , A.L. Cawood2 , T.R. Smith3 , H. Warwick3 , R.J. Stratton1 . 1 University of Southampton, Southampton, 2 Nutricia, Trowbridge, 3 Southampton NHS Trust, Southampton, United Kingdom Rationale: Few trials have compared the effectiveness of oral nutritional supplements (ONS) with dietary advice (DA) in care homes [1]. This trial examined the hypothesis that ONS can be more effective at improving nutritional intake than DA in care home residents. Methods: 104 residents (57 residential, 47 nursing, mean age 88.3±7.7 y, mean BMI 19.1±2.7 kg/m2 , 86% female) at risk of malnutrition (using Malnutrition Universal Screening Tool ‘MUST’) were randomised to receive ONS with guidance on how to use (Nutricia range; mean intake 333kcal±237/d; n = 53); or written and verbal DA (n = 51) for 12 weeks. At baseline and 12 weeks, nutritional intake (energy and protein) was measured by a dietitian (24 h recalls; analysed with WISP) and appetite (hunger, desire to eat) assessed with 100 mm visual analogue scales. Results were analysed using perprotocol regression analysis. Results: Total energy and protein intakes (adjusted for baseline, malnutrition risk, type of care (nursing, residential)) were significantly higher in the ONS than the DA group (1655±502 kcal vs 1253±469 kcal, p = 0.001; 62.1±18.4 g vs 49.6±19.9 , p = 0.004). Appetite sensations were not significantly different between the ONS and DA groups (hunger: 39±21 mm vs 33±28 mm, n = 57; desire to eat: 46.6±19 mm vs 49.7±27.3 mm, n = 54). Conclusion: This RCT indicates that ONS can be more effective at increasing total energy and protein intakes than dietary advice with ONS having little effect on the appetite of care home residents. References [1] Parsons EL et al (2011) Systematic review of the effects of oral nutritional interventions in care homes, Proc Nutr Soc (in press). Disclosure of Interest: E. Parsons: None Declared, M. Elia: None Declared, A. Cawood: None Declared, T. Smith: None Declared, H. Warwick: None Declared, R. Stratton Other: Nutricia Ltd
PP023-SUN DYSPHAGIA AND COGNITIVE IMPAIRMENT INCREASE THE RISK OF MALNUTRITION IN NURSING HOME RESIDENTS NEW DATA FROM THE NUTRITIONDAY IN EUROPEAN NURSING HOMES E. Kiesswetter1 , K. Schindler2 , R. Diekmann1 , M. Mouhieddine2 , M. Hiesmayr2 , C.C. Sieber1 , D. Volkert1 . 1 Institute for Biomedicine of Aging, University of Erlangen-N¨ urnberg, N¨ urnberg, Germany; 2 Medical University of Vienna, Vienna, Austria Rationale: Dysphagia (Dy) and cognitive impairment (CI) are serious health problems in nursing home (NH) residents; both problems markedly affect adequate nutrition and increase the risk of malnutrition. Presently