Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

Wojzischke, Julia; Wijngaarden, J. van; Berg, C. van den; Cetinyurek-Yavuz, Aysun; Diekmann, Rebecca; Luiking, Yvette C.; Bauer, Jürgen

doi:10.1007/s41999-020-00294-2

Cited by 67 publications

(56 citation statements)

References 92 publications

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“…Geriatric rehabilitation following an acute event aims at functional recovery through multidisciplinary interventions [1]. Onethird of geriatric rehabilitation patients are diagnosed with malnutrition [2], which is a modifiable risk factor of sarcopenia [3], the age-related low muscle strength and muscle mass [4], being present in 56% of geriatric rehabilitation patients [5]. Malnutrition and sarcopenia are independently associated with functional decline [6,7], lower quality of life [8,9] and higher mortality [10,11] in older adults and can negatively impact functional recovery during geriatric rehabilitation [12,13].…”

Section: Introductionmentioning

confidence: 99%

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

et al. 2021

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Background & aims: Malnutrition and sarcopenia coexist in older adults, yet they remain largely undiagnosed and untreated, despite available interventions. This study aimed to assess the prevalence, the coexistence of, and the association between malnutrition and sarcopenia in geriatric rehabilitation inpatients. Methods: REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort of geriatric rehabilitation inpatients. The association between malnutrition, diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2) (no sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia) was determined using multinomial logistic regression analyses, adjusted for age, sex, comorbidities and cognitive impairment. Results: Out of 506 geriatric rehabilitation inpatients, 51% were malnourished, 49% had probable sarcopenia, 0.4% had confirmed sarcopenia (non-severe) and 19% had severe sarcopenia. Malnutrition and probable sarcopenia and malnutrition and confirmed/severe sarcopenia coexisted in 23% and 13% of the 506 patients respectively. Malnutrition was not associated with probable sarcopenia (OR ¼ 0.91, 95% CI ¼ 0.58e1.42, p ¼ 0.674) but with severe sarcopenia (OR ¼ 2.07, 95% CI ¼ 1.13e3.81, p ¼ 0.019). Conclusion:The prevalence, coexistence of, and the association between malnutrition and severe sarcopenia in geriatric rehabilitation inpatients warrant diagnosis at admission. Further research into feasible and effective interventions to counteract both conditions to improve geriatric rehabilitation outcomes is needed.

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Section: Introductionmentioning

confidence: 99%

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

et al. 2021

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“…It has been shown that nutritional status is associated with functional outcomes in geriatric rehabilitation patients [ 1 , 2 ] and malnutrition was associated with a decreased improvement in activities of daily living (ADL) over the course of geriatric rehabilitation [ 2 ]. However, the relevance of obesity for functional outcomes has only rarely been investigated in this setting, although this seems particularly relevant in view of the obesity pandemic in old age.…”

Section: Introductionmentioning

confidence: 99%

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

et al. 2021

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The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥ 70 years. Individual activities of daily living were documented by the Barthel index (BI, 0-100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1 - t2, t2 - t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2 - t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.

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“…The latter point is particularly problematic given that the primary outcome for most prehabilitation trials was identified to be functional and/or clinical. Malnourished patients have lower functional capacity (58,64) and a reduced capacity to gain function through exercise alone (without first correcting malnutrition, which, for malnourished patients, could be the underlying etiology for the compromised function (58,65,66). A failure to correctly identify malnutrition for treatment has the potential to produce misleading findings for the effect of prehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

et al. 2021

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Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge and facilitate the design of future studies, we undertook a scoping review of prehabilitation studies to map the range of work on prehabilitation being carried out in any cancer type and with a particular focus on diet or nutrition interventions.Objectives: Firstly, to describe the type of prehabilitation programs currently being conducted. Secondly, to describe the extent to which prehabilitation studies involved aspects of nutrition, including assessment, interventions, implementation, and outcomes.Eligibility Criteria: Any study of quantitative or qualitative design that employed a formal prehabilitation program before cancer treatment (“prehabilitation” listed in keywords, title, or abstract).Sources of Evidence: Search was conducted in July 2020 using MEDLINE, PubMed, EMBASE, EMCARE, CINAHL, and AMED.Charting Methods: Quantitative data were reported as frequencies. Qualitative nutrition data were charted using a framework analysis that reflects the Nutrition Care Process Model: assessment, intervention, and monitoring/evaluation of the nutrition intervention.Results: Five hundred fifty unique articles were identified: 110 studies met inclusion criteria of a formal prehabilitation study in oncology. prehabilitation studies were mostly cohort studies (41%) or randomized-controlled trials (38%) of multimodal (49%), or exercise-only (44%) interventions that were applied before surgery (94%). Nutrition assessment was inconsistently applied across these studies, and often conducted without validated tools (46%). Of the 110 studies, 37 (34%) included a nutrition treatment component. Half of these studies provided the goal for the nutrition component of their prehabilitation program; of these goals, less than half referenced accepted nutrition guidelines in surgery or oncology. Nutrition interventions largely consisted of counseling with dietary supplementation. The nutrition intervention was indiscernible in 24% of studies. Two-thirds of studies did not monitor the nutrition intervention nor evaluate nutrition outcomes.Conclusion: Prehabilitation literature lacks standardized and validated nutritional assessment, is frequently conducted without evidence-based nutrition interventions, and is typically implemented without monitoring the nutrition intervention or evaluating the intervention's contribution to outcomes. We suggest that the development of a core outcome set could improve the quality of the studies, enable pooling of evidence, and address some of the research gaps identified.

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Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

Cited by 67 publications

References 92 publications

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review

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