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Subclinical Vitamin B12 Deficiency and Functional Disability in Older Age
SUNDAY, NOVEMBER 7
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Zinc Deficiency in a Patient with Intestinal Failure on Parenteral Nutrition
Subclinical Vitamin B12 Deficiency and Functional Disability in Older Age
Author(s): J. Wolff, K. Rhoda, E. Steiger, N. Parekh; Intestinal Rehabilitation and Transplantation, Cleveland Clinic Foundation, Cleveland, OH
Author(s): B. S. Oberlin, C. Tangney, H. Rasmussen, K. Gustashaw; Clinical Nutrition, Rush University Medical Center, Chicago, IL
Learning Outcome: The learner will identify factors that may contribute to the development of zinc deficiency. Background: Zinc deficiency has been associated with skin manifestations. Patients receiving Parenteral Nutrition (PN) receive 3-5 mg of zinc per day in a standard multi-trace element solution (MTE). This should prevent deficiency unless the patient has increased gastrointestinal losses or other factors effecting absorption. Methods: A 50 year old female with Zollinger- Ellison Syndrome presented with erythematous areas around her eyes, nose and mouth and blisters on her fingers. She had undergone a gastrectomy and roux-en-y gastrojejunostomy complicated by bowel obstructions and malabsorption, requiring PN since 1986. A full laboratory investigation was conducted. Medications included ferrous sulfate, magnesium oxide, lactulose, omeprazole, and loperamide. Nutritional Intake: PN provided 25 kcal/kg, 1.4 g protein/kg, a standard dosage of multivitamin and MTE. She consumed a limited diet due to excessive diarrhea when eating and drank 3 cans of nutritional supplement per day. The patient was referred to a dermatologist for evaluation. Results: Patient was diagnosed with necrolytic acral erythema related to zinc deficiency. Plasma Zinc was 26 ug/dl (55-85ug/dl) and 10 mg of zinc was added to the PN solution. Serum levels normalized within one week to 71 ug/dl and the lesions improved within two weeks. Conclusion: This case illustrates the importance of monitoring vitamin and mineral levels in individuals on PN while considering medications that may contribute to deficiency. The laxative effect of the lactulose and oral magnesium may have worsened the malabsorption. Oral iron may have inhibited the absorption of oral zinc and worsened the deficiency. Funding Disclosure: None
Learning Outcome: To examine the association of vitamin B12 deficiency with symptoms and functional measures historically associated with vitamin B12 deficiency. Background: Prevalence of vitamin B12 deficiency (VB12DEF) increases with age with greater risks of sensory disturbances, neurological abnormalities, and cognitive decline in the elderly. Because measurement of serum vitamin B12 (B12) levels has low diagnostic accuracy, use of costlier yet specific biochemical markers is often needed but not performed. The objective was to examine the association of VB12DEF with symptoms and functional measures historically associated with VB12DEF. Methods: Participants in the 1999-2002 National Health and Nutrition Examination Survey aged 60-89 years were included if the following were available: serum concentrations of B12, methylmalonic acid (MMA), homocysteine, creatinine, ferritin, folate and examination data for peripheral neuropathy, cognitive function, gait speed, muscle strength, and dimensions of disability. VB12DEF was defined in four ways using serum levels: 1) B12 less than (LT)258pmol/L; 2)MMA greater than (GT)0.21 mol/L; 3) B12 LT 258pmol/L OR MMA GT 0.21 mol/L (liberal) and; 4) B12 LT 258pmol/L AND MMA GT 0.21 mol/L (conservative). Results: Among 3706 adults (mean age, 69 years; BMI 27.4, 57% female, 81% nonHispanic white), the prevalence of liberal B12 deficiency was 39.1%, and conservative B12 deficiency, 10.5%. Peripheral neuropathy, reduced lower leg muscular strength, impaired cognitive performance and increased disability were significantly associated with odds of being B12 deficient (OR⫽1.31 (1.01, 1.69); OR⫽0.99 (0.99, 1.00); OR⫽0.99 (0.98, 1.00); OR⫽1.36 (1.01, 1.83), respectively). Conclusions: In a nationwide probability survey, small but potentially important deficits in functional ability among older adults are associated with VB12DEF. Further study of vitamin B12 nutriture in this population is needed. Funding Disclosure: None
Assessment of the Food and Eating Environment on College Campuses Using a Modified Version of the Nutrition Environment Measures Survey for Restaurants (NEMS-R) Author(s): M. B. Erdman,1 T. Horacek,1 B. Phillips,2 W. Guo,3 S. Colby,4 A. White,5 T. Kidd,6 M. Koenings,7 J. Walsh,5 V. Quick,8 G. Greene9; 1Syracuse University, Syracuse, NY, 2Tuskegee University, Tuskegee, AL, 3Michigan State University, East Lansing, MI, 4East Carolina University, Greenville, NC, 5 University of Maine, Orono, ME, 6Kansas State University, Manhattan, KS, 7 University of Wisconsin, Madison, Madison, WI, 8Rutgers University, New Brunswick, NJ, 9University of Rhode Island, Kingston, RI Learning Outcome: Participants will be able to understand strategies used to measure food/eating environments of dining venues on eleven campuses of higher education using a modified assessment tool. The food/eating environment is an important determinant of eating behaviors. However, no tool exists to assess college nutrition environments. This study modified the Nutrition Environment Measures Survey - Restaurants (NEMS-R) (Saelans et al) for on-campus food-courts (SU), snack bars (SB), and dining halls (DH). The NEMS-R assesses enhancers and barriers to healthful eating and the availability of nutrition information (NI), salad bars, healthy entrees, fresh fruits/vegetables (F/V), whole grain (WG) breads, and low fat milk. Modifications included availability of healthful cereals, vegan/vegetarian items, low-fat beverages, labeled 100% juices, WG options, low-fat dressings and protein sources. On 11 campuses, 48 dining venues were assessed - 22 DH, 12 SU, and 14 SB - with a mean (⫾ standard deviation) total score of 34.5 ⫾ 12.9 out of 100. The range was [6-72]. DH scored significantly higher, 41.2 ⫾10.3, than SU, 30.6 ⫾ 15.6, and SB, 27.4 ⫾ 8.8 (p⬍0.05). There were few differences between states, however, between venues enhancers and/or barriers of NI, pricing and portion size were significantly different (p⬍0.01). NI was available online for 74% yet on the menu for only 32% of venues. There was a significant difference in the number of fresh fruits but not non-fried vegetables available by venue. Most venues had at least one WG option, but DH had significantly more (p⬍0.05). DH had significantly more (p⬍0.01) salad bars than SU, which had more than SB. Students may have more difficulty choosing nutritious foods at SU and SB than DH, but all venues need improvement. Funding Disclosure: Syracuse University, State Agricultural Experiment Stations participating in USDA/NIFA North Central Research Project NC1028
The Influence of Dietary Restraint and Social Desirability on Accuracy of Reported Dietary Intake Author(s): A. H. Schoch, H. A. Raynor; Nutrition, University of Tennessee, Knoxville, TN Learning Outcome: After reviewing this abstract, the learner will understand that social desirability can influence accuracy of reporting energy intake of a laboratory meal. Underreporting in self-reported dietary intake has been linked to dietary restraint (DR) and social desirability (SD). As few investigations have examined both DR and SD in accuracy of reported intake, this study investigated accuracy of reporting consumption of a laboratory meal during a 24-hour dietary recall (24HR) in 38 healthy, college-aged (20.3 ⫾ 1.7 years), normalweight women (22.4 ⫾ 1.8 kg/m2), categorized as high or low in DR and SD. Participants consumed a meal of four foods (sandwich wrap, chips, fruit, and ice cream) and completed a telephone 24HR. Accuracy of reported energy intake of the meal ⫽ ((reported intake - measured intake)/measured intake) x 100 (positive numbers ⫽ overreporting). Overreporting of energy intake occurred in all groups (overall accuracy rate ⫽ 43.1 ⫾ 49.9%). Mixed factorial analysis of co-variance found an interaction of SD x individual foods (p ⬍ 0.05). SD-High as compared to SD-Low more accurately reported energy intake of chips (19.8 ⫾ 56.2% vs. 117.1 ⫾ 141.3%, p ⬍ 0.05) and ice cream (17.2 ⫾ 78.2% vs. 71.6 ⫾ 82.7%, p ⬍ 0.05). An effect of SD was found, where SD-High as compared to SD-Low more accurately reported energy intake of the overall meal (29.8 ⫾ 48.2% vs. 58.0 ⫾ 48.8%, p ⬍ 0.05). Overreporting intake from a laboratory meal was prevalent. However, those high in SD were more accurate in reporting intake, particularly of high-fat foods. Future research is needed to investigate factors that contribute to overreporting. Funding Disclosure: None
A-24 / September 2010 Suppl 2—Abstracts Volume 110 Number 9
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Zinc Deficiency in a Patient with Intestinal Failure on Parenteral Nutrition
Subclinical Vitamin B12 Deficiency and Functional Disability in Older Age
Author(s): J. Wolff, K. Rhoda, E. Steiger, N. Parekh; Intestinal Rehabilitation and Transplantation, Cleveland Clinic Foundation, Cleveland, OH
Author(s): B. S. Oberlin, C. Tangney, H. Rasmussen, K. Gustashaw; Clinical Nutrition, Rush University Medical Center, Chicago, IL
Learning Outcome: The learner will identify factors that may contribute to the development of zinc deficiency. Background: Zinc deficiency has been associated with skin manifestations. Patients receiving Parenteral Nutrition (PN) receive 3-5 mg of zinc per day in a standard multi-trace element solution (MTE). This should prevent deficiency unless the patient has increased gastrointestinal losses or other factors effecting absorption. Methods: A 50 year old female with Zollinger- Ellison Syndrome presented with erythematous areas around her eyes, nose and mouth and blisters on her fingers. She had undergone a gastrectomy and roux-en-y gastrojejunostomy complicated by bowel obstructions and malabsorption, requiring PN since 1986. A full laboratory investigation was conducted. Medications included ferrous sulfate, magnesium oxide, lactulose, omeprazole, and loperamide. Nutritional Intake: PN provided 25 kcal/kg, 1.4 g protein/kg, a standard dosage of multivitamin and MTE. She consumed a limited diet due to excessive diarrhea when eating and drank 3 cans of nutritional supplement per day. The patient was referred to a dermatologist for evaluation. Results: Patient was diagnosed with necrolytic acral erythema related to zinc deficiency. Plasma Zinc was 26 ug/dl (55-85ug/dl) and 10 mg of zinc was added to the PN solution. Serum levels normalized within one week to 71 ug/dl and the lesions improved within two weeks. Conclusion: This case illustrates the importance of monitoring vitamin and mineral levels in individuals on PN while considering medications that may contribute to deficiency. The laxative effect of the lactulose and oral magnesium may have worsened the malabsorption. Oral iron may have inhibited the absorption of oral zinc and worsened the deficiency. Funding Disclosure: None
Learning Outcome: To examine the association of vitamin B12 deficiency with symptoms and functional measures historically associated with vitamin B12 deficiency. Background: Prevalence of vitamin B12 deficiency (VB12DEF) increases with age with greater risks of sensory disturbances, neurological abnormalities, and cognitive decline in the elderly. Because measurement of serum vitamin B12 (B12) levels has low diagnostic accuracy, use of costlier yet specific biochemical markers is often needed but not performed. The objective was to examine the association of VB12DEF with symptoms and functional measures historically associated with VB12DEF. Methods: Participants in the 1999-2002 National Health and Nutrition Examination Survey aged 60-89 years were included if the following were available: serum concentrations of B12, methylmalonic acid (MMA), homocysteine, creatinine, ferritin, folate and examination data for peripheral neuropathy, cognitive function, gait speed, muscle strength, and dimensions of disability. VB12DEF was defined in four ways using serum levels: 1) B12 less than (LT)258pmol/L; 2)MMA greater than (GT)0.21 mol/L; 3) B12 LT 258pmol/L OR MMA GT 0.21 mol/L (liberal) and; 4) B12 LT 258pmol/L AND MMA GT 0.21 mol/L (conservative). Results: Among 3706 adults (mean age, 69 years; BMI 27.4, 57% female, 81% nonHispanic white), the prevalence of liberal B12 deficiency was 39.1%, and conservative B12 deficiency, 10.5%. Peripheral neuropathy, reduced lower leg muscular strength, impaired cognitive performance and increased disability were significantly associated with odds of being B12 deficient (OR⫽1.31 (1.01, 1.69); OR⫽0.99 (0.99, 1.00); OR⫽0.99 (0.98, 1.00); OR⫽1.36 (1.01, 1.83), respectively). Conclusions: In a nationwide probability survey, small but potentially important deficits in functional ability among older adults are associated with VB12DEF. Further study of vitamin B12 nutriture in this population is needed. Funding Disclosure: None
Assessment of the Food and Eating Environment on College Campuses Using a Modified Version of the Nutrition Environment Measures Survey for Restaurants (NEMS-R) Author(s): M. B. Erdman,1 T. Horacek,1 B. Phillips,2 W. Guo,3 S. Colby,4 A. White,5 T. Kidd,6 M. Koenings,7 J. Walsh,5 V. Quick,8 G. Greene9; 1Syracuse University, Syracuse, NY, 2Tuskegee University, Tuskegee, AL, 3Michigan State University, East Lansing, MI, 4East Carolina University, Greenville, NC, 5 University of Maine, Orono, ME, 6Kansas State University, Manhattan, KS, 7 University of Wisconsin, Madison, Madison, WI, 8Rutgers University, New Brunswick, NJ, 9University of Rhode Island, Kingston, RI Learning Outcome: Participants will be able to understand strategies used to measure food/eating environments of dining venues on eleven campuses of higher education using a modified assessment tool. The food/eating environment is an important determinant of eating behaviors. However, no tool exists to assess college nutrition environments. This study modified the Nutrition Environment Measures Survey - Restaurants (NEMS-R) (Saelans et al) for on-campus food-courts (SU), snack bars (SB), and dining halls (DH). The NEMS-R assesses enhancers and barriers to healthful eating and the availability of nutrition information (NI), salad bars, healthy entrees, fresh fruits/vegetables (F/V), whole grain (WG) breads, and low fat milk. Modifications included availability of healthful cereals, vegan/vegetarian items, low-fat beverages, labeled 100% juices, WG options, low-fat dressings and protein sources. On 11 campuses, 48 dining venues were assessed - 22 DH, 12 SU, and 14 SB - with a mean (⫾ standard deviation) total score of 34.5 ⫾ 12.9 out of 100. The range was [6-72]. DH scored significantly higher, 41.2 ⫾10.3, than SU, 30.6 ⫾ 15.6, and SB, 27.4 ⫾ 8.8 (p⬍0.05). There were few differences between states, however, between venues enhancers and/or barriers of NI, pricing and portion size were significantly different (p⬍0.01). NI was available online for 74% yet on the menu for only 32% of venues. There was a significant difference in the number of fresh fruits but not non-fried vegetables available by venue. Most venues had at least one WG option, but DH had significantly more (p⬍0.05). DH had significantly more (p⬍0.01) salad bars than SU, which had more than SB. Students may have more difficulty choosing nutritious foods at SU and SB than DH, but all venues need improvement. Funding Disclosure: Syracuse University, State Agricultural Experiment Stations participating in USDA/NIFA North Central Research Project NC1028
The Influence of Dietary Restraint and Social Desirability on Accuracy of Reported Dietary Intake Author(s): A. H. Schoch, H. A. Raynor; Nutrition, University of Tennessee, Knoxville, TN Learning Outcome: After reviewing this abstract, the learner will understand that social desirability can influence accuracy of reporting energy intake of a laboratory meal. Underreporting in self-reported dietary intake has been linked to dietary restraint (DR) and social desirability (SD). As few investigations have examined both DR and SD in accuracy of reported intake, this study investigated accuracy of reporting consumption of a laboratory meal during a 24-hour dietary recall (24HR) in 38 healthy, college-aged (20.3 ⫾ 1.7 years), normalweight women (22.4 ⫾ 1.8 kg/m2), categorized as high or low in DR and SD. Participants consumed a meal of four foods (sandwich wrap, chips, fruit, and ice cream) and completed a telephone 24HR. Accuracy of reported energy intake of the meal ⫽ ((reported intake - measured intake)/measured intake) x 100 (positive numbers ⫽ overreporting). Overreporting of energy intake occurred in all groups (overall accuracy rate ⫽ 43.1 ⫾ 49.9%). Mixed factorial analysis of co-variance found an interaction of SD x individual foods (p ⬍ 0.05). SD-High as compared to SD-Low more accurately reported energy intake of chips (19.8 ⫾ 56.2% vs. 117.1 ⫾ 141.3%, p ⬍ 0.05) and ice cream (17.2 ⫾ 78.2% vs. 71.6 ⫾ 82.7%, p ⬍ 0.05). An effect of SD was found, where SD-High as compared to SD-Low more accurately reported energy intake of the overall meal (29.8 ⫾ 48.2% vs. 58.0 ⫾ 48.8%, p ⬍ 0.05). Overreporting intake from a laboratory meal was prevalent. However, those high in SD were more accurate in reporting intake, particularly of high-fat foods. Future research is needed to investigate factors that contribute to overreporting. Funding Disclosure: None
A-24 / September 2010 Suppl 2—Abstracts Volume 110 Number 9