Screening for malnutrition in dwelling elderly

Abstract

For decades it has been postulated that the main environmental factor for coronary heart disease (CHD) was the intake of saturated fatty acids (SFA). Nevertheless, confirmation of the role of SFA in CHD through intervention trials has been disappointing. It was only when the diet was enriched in n-3 fatty acids that CHD was significantly prevented, especially cardiac death. In addition to n-3 fatty acids, many other foodstuffs or nutrients such as fibers, antioxidants, folic acid, calcium and even alcohol contribute to prevent CHD. Thus the relationship between diet and CHD morbidity and mortality appears to be much more complex than formerly suspected considering as key factors only SFA, linoleic acid, cholesterol and atherosclerosis. Some of the mechanisms are briefly described, but many additional nutrients (or non nutrients) may also play an important role in the pathogenesis of CHD. Finally, as a result of the most recent epidemiologic studies the ideal diet may comprise: 8% energy from SFA, 5% from polyunsaturated fatty acids with a ratio 5/1 of linoleic/alpha-linolenic acid+longer chains n-3, oleic acid as desired, large intake of cereals, vegetables, legumes and fruits, fish twice a week, cheese and yogurt as dairy products, rapeseed and olive oils as edible fat. Without side effects, such a diet can be highly palatable, easily enjoyed by many populations and may prevent effectively and rapidly (within a few weeks or months) CHD.

Malnutrition Screening in the Elderly Population

“…The Mini Nutritional Assessment (MNA) was developed to evaluate the risk of malnutrition in the elderly in home-care programmes, nursing homes and hospitals. In theory it should be better at identifying frail elderly patients at risk of undernutrition since it encompasses physical and mental aspects of health; 20,21,31 moreover, it detects risk of malnutrition at a time when albumin levels and BMI are still normal. 32 The score for screening is derived from six components-reduced food intake in the preceding three months; weight loss during the preceding three months; mobility; psychological stress or acute disease in the preceding three months; neuropsychological problems; body mass index.…”

An observational study of screening for malnutrition in elderly people living in sheltered accommodation

“…Biochemical markers such as low albumin, prealbumin, retinol binding protein, haemoglobin, lymphocyte count and cholesterol are nonspecific and are more directly influenced by disease than nutritional status (Seres, 1999 and Salva & Pera, 2001; Thomas et al. , 2002; McKinlay, 2004).…”

Predictors of Nutritional Risk in Community-dwelling Seniors

“…28 Thus, impairment in either basic or instrumental activities of daily living (ADLs or IADLs respectively) could be detrimental to nutritional status. 29,30 Problems can also arise when the gastro-intestinal tract is unable to effectively absorb energy and nutrients from ingested food. There are many medical, psychological (e.g., cognitive decline 27 and depression 28,31 ) and environmental (e.g., social support 3,32,33 ) characteristics that work in consort to compromise (or promote) sufficient dietary intake and absorption through these means.…”