Malnutrition in community-dwelling adults with dementia (Nutrialz Trial)
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The objective of this study is to assess the nutritional status, measured by the MNA, in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition.
Cross-sectional analysis of a cluster randomized clinical trial (Nutrialz).
Community-dwelling individuals attending dementia clinics.
The clinical scales assessed were Mini Nutritional Assessment (MNA), Eating Behaviour Scale (EBS), Charlson comorbidity index, Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL) score, Instrumental Activities of Daily Living (IADL) score, Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell depression scale and Zarit Caregiver Burden Interview.
5.2% of participants were classified as being malnourished, 42.6% as being at risk of malnutrition and 52.2% as well nourished. Malnutrition by type of dementia was more frequent in Lewy bodies dementia (18.2%) than in the other types. Worse nutritional status is significantly related to more advanced age and worse cognitive, functional and behavioural profile, as well as increased burden for caregivers. Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression, exaltation, lack of inhibition and irritability. The items more strongly related to malnutrition are appetite/feeding and hallucinations. Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition. Dependence on feeding is a strongly related risk factor, while food preparation is only a moderate one. A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS (Odds Ratio (OR) 0.84, 95%CI 0.78 to 0.91), Cornell (OR 1.12, 95%CI 1.09 to 1.16), the number of dependent BADL (OR 1.29, 95%CI 1.17 to 1.42), age (OR 1.04, 95%CI 1.02–1.06), MMSE (OR 0.95, 95%CI 0.92 to 0.98) and Charlson (OR 1.18, 95%CI 1.05 to 1.34). A similar model built for prediction of malnutrition retained as significant covariables only EBS, Cornell and the number of dependent BADL.
These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.
Key wordsDementia elderly malnutrition MNA
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- 1.White H, Pieper C, Schmader K, et al. Weight change in Alzheimer’s disease. J Am Geriatr Soc. 1996;44(3):1232–1234.Google Scholar
- 4.Gillette Guyonnet S, Abellan Van Kan G, Alix E, Andrieu S, Salva A “IANA Expert Group: Weight loss and Alzheimer’s disease”, a Journal of Nutrition, Health and Aging 2007 Jan-Feb;11(1):38–48Google Scholar
- 7.Guigoz Y, Vellas B, Garry PJ. Mini nutritional assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts, Research in Gerontology, 1994;(Suppl 2):15–59Google Scholar
- 8.Rubenstein LZ, Harker JO, Salvà A, Vellas B. Nutritional Screening in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). J Gerontol (MS) 2001;56A(6):356–360.Google Scholar
- 9.Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status.; MNA-International Group. J Nutr Health Aging. 2009 Nov;13(9):782–788.PubMedCrossRefGoogle Scholar
- 24.Esquius M, Schwartz S, López Hellín J, Andreu AL, García E. [Anthropometric reference parameters for the aged population]. [Article in Spanish] Med Clin (Barc). 1993 May 8;100(18):692–698.Google Scholar
- 33.Fallon C, Bruce I, Eustace A, et al. Nutritional status of community dwelling subjects attending a memory clinic. J Nutr Health Aging 2002;6(Supp):21Google Scholar
- 34.Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC; Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010 Sep;58(9):1734–1738. doi: 10.1111/j.1532-5415.2010.03016.x.PubMedCrossRefGoogle Scholar
- 35.Nykänen I, Lönnroos E, Kautiainen H, Sulkava R, Hartikainen S. Nutritional screening in a population-based cohort of community-dwelling older people. Eur J Public Health. 2012 Apr 25. [Epub ahead of print]Google Scholar
- 37.Cuervo M, García A, Ansorena D, Sánchez-Villegas A, Martínez-González M, Astiasarán I, Martínez J. Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test. Public Health Nutr. 2009 Jan;12(1):82–90. Epub 2008 Apr 16.PubMedCrossRefGoogle Scholar