Special Issue "Nutrition Disorders in Older Adults"

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: 30 April 2021.

Special Issue Editor

Dr. Shinta Nishioka
Website
Guest Editor
Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Interests: clinical nutrition; rehabilitation nutrition; malnutrition in older adults; nutritional screening and assessment; nutrition care process; guideline development; sarcopenia

Special Issue Information

Dear Colleagues.

Older adults often experience nutrition disorders such as malnutrition (undernutrition), micronutrient abnormalities, and obesity/overweight. These problems can be caused by multiple factors, including physiological changes in taste and smell, delayed gastric excretion, inflammation from acute/chronic disease or trauma, polypharmacy, lack of exercise, and unnecessary/inappropriate dietary restrictions. Lack of awareness of nutritional disorders among the individual, caregivers, and healthcare providers can exacerbate these conditions.

Numerous studies have shown that malnutrition is associated with mortality, overall complications, incidence of pressure ulcers, physical and cognitive decline, reduced ability to perform activities of daily living, and reduced quality of life in older adults. Therefore, how to screen, evaluate, and treat malnutrition in the older adults has become an urgent issue in an aging society. However, studies reported to date are inconsistent as to whether obesity/overweight has a positive or negative impact on outcomes in older adults. More research is needed to examine the impact of overweight/obesity on the health of older adults and the optimal assessment and intervention strategies for weight management.

This Special Issue focuses on 1) the association between nutrition disorders and health, functioning, quality of life, and socio-economic burden in older adults in all settings (e.g., hospital, institutional, and community); 2) appropriate methods to screen and assess nutrition disorders; and 3) the effectiveness and efficiency of nutritional interventions for nutritional disorders, with or without other interventions (e.g., rehabilitation therapy, medication, social support). Issues related to sarcopenia, sarcopenic obesity, cachexia, and frailty in the context of nutrition are also welcome.

Dr. Shinta Nishioka
Guest Editor

Manuscript Submission Information

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Keywords

  • older adults
  • malnutrition (undernutrition)
  • overweight/obesity
  • micronutrient abnormalities
  • sarcopenia
  • sarcopenic obesity
  • frailty
  • cachexia

Published Papers (7 papers)

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Research

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Open AccessArticle
The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults
Healthcare 2021, 9(1), 32; https://doi.org/10.3390/healthcare9010032 - 01 Jan 2021
Viewed by 513
Abstract
The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food [...] Read more.
The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried’s component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84–0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60–7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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Open AccessArticle
Prevalence and Associated Factors of Malnutrition and Sarcopenia in a Daycare Facility: A Cross-Sectional Study
Healthcare 2020, 8(4), 576; https://doi.org/10.3390/healthcare8040576 - 18 Dec 2020
Viewed by 742
Abstract
Malnutrition and sarcopenia are prevalent and growing health issues in older populations. Early detection is important to implement proper interventions. However, little is known about malnutrition and sarcopenia in daycare facilities, the most dominant long-term care service. In this study, the prevalence of [...] Read more.
Malnutrition and sarcopenia are prevalent and growing health issues in older populations. Early detection is important to implement proper interventions. However, little is known about malnutrition and sarcopenia in daycare facilities, the most dominant long-term care service. In this study, the prevalence of and factors associated with malnutrition and sarcopenia in older individuals who commute to community daycare facilities were evaluated. The cross-sectional study included 62 older individuals screened for malnutrition and sarcopenia on their first day in a daycare facility in Japan. Daily physical activity and basal diseases were also evaluated. According to Global Leadership Initiative on Malnutrition (GLIM) criteria, 40.3% (25/62) of patients were malnourished and 59.7% (37/62) were well nourished. The Asian Working Group for Sarcopenia 2019 evaluation found that 12.9% (8/62) of patients showed no sarcopenia, whereas 87.1% (54/62) had sarcopenia. The prevalence of well-nourished sarcopenic individuals was the highest (45.2% (28/62)), followed by malnourished sarcopenia individuals (40.3% (25/62)). All malnourished individuals were sarcopenic and 14.5% (9/62) were well nourished and nonsarcopenic. Daily physical activity was significantly lower among sarcopenic individuals. Subgroups showed no significant difference in comorbidities. The prevalence of malnutrition and sarcopenia was relatively high. Activity-related sarcopenia seemed to precede malnutrition. Early detection of malnutrition and sarcopenia in daycare facilities should be encouraged for early intervention. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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Open AccessArticle
High Visceral Fat Area Attenuated the Negative Association between High Body Mass Index and Sarcopenia in Community-Dwelling Older Chinese People
Healthcare 2020, 8(4), 479; https://doi.org/10.3390/healthcare8040479 - 12 Nov 2020
Viewed by 306
Abstract
The association between obesity and sarcopenia remains controversial. The present study was conducted to explore the associations among body mass index (BMI), visceral fat area (VFA), and sarcopenia in older people and analyze their potential mechanisms. This cross-sectional study included 861 community-dwelling older [...] Read more.
The association between obesity and sarcopenia remains controversial. The present study was conducted to explore the associations among body mass index (BMI), visceral fat area (VFA), and sarcopenia in older people and analyze their potential mechanisms. This cross-sectional study included 861 community-dwelling older Chinese people from three regions of China. BMI, VFA, muscle mass, muscle strength, physical performance, body composition, and metabolic markers were measured. Muscle mass and muscle strength were positively correlated with BMI, but were negatively correlated with VFA. Simple overweight/obesity was negatively associated with sarcopenia (OR = 0.07, 95% CI = 0.03~0.18), and the OR value was lower than combined obesity (OR = 0.16, 95% CI = 0.09~0.28). Fat free mass and total body protein were positively associated with high BMI but negatively associated with high VFA. Furthermore, high VFA was adversely associated with some metabolic risk factors of sarcopenia. Combination of BMI and VFA increased diagnostic efficiency of low muscle mass and sarcopenia. In conclusion, high BMI was negatively associated with sarcopenia, while high VFA attenuated the negative association between high BMI and sarcopenia. The opposite association may partially be attributed to their different associations with body composition and metabolic risk factors of sarcopenia. Therefore, bedsides BMI, VFA and its interaction with BMI should be considered in sarcopenia prevention. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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Open AccessArticle
Impact of Body Mass Index on Activities of Daily Living in Patients with Idiopathic Interstitial Pneumonias
Healthcare 2020, 8(4), 385; https://doi.org/10.3390/healthcare8040385 - 05 Oct 2020
Viewed by 811
Abstract
In patients with idiopathic interstitial pneumonias, undernutrition has a profound effect on prognosis. However, whether body mass index affects the ability to perform activities of daily living as measured by the Barthel index in patients with idiopathic interstitial pneumonias remains unknown. Therefore, we [...] Read more.
In patients with idiopathic interstitial pneumonias, undernutrition has a profound effect on prognosis. However, whether body mass index affects the ability to perform activities of daily living as measured by the Barthel index in patients with idiopathic interstitial pneumonias remains unknown. Therefore, we examined the impact of body mass index on the activities of daily living in inpatients with idiopathic interstitial pneumonia. We used a database constructed by the Japan Medical Data Center. Data were extracted from 2774 inpatients from participating hospitals with a diagnosis of idiopathic interstitial pneumonia. Multiple regression analysis adjusted for confounding factors was performed to determine whether body mass index classification would be independently related to change in Barthel index during hospitalization. Underweight, normal weight, overweight, and obesity numbered 473 (19%), 1037 (41), 795 (31%), and 235 (9%), respectively. Multivariable analysis showed that being underweight was independently associated with a change in Barthel index during hospitalization of −2.95 (95% confidence interval −4.82 to −1.07) points lower than being normal weight. Approximately 20% of the patients with idiopathic interstitial pneumonias were underweight. Those who were underweight had decreased independence in activities of daily living during hospitalization. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
Open AccessArticle
Sarcopenic Obesity and Activities of Daily Living in Stroke Rehabilitation Patients: A Cross-Sectional Study
Healthcare 2020, 8(3), 255; https://doi.org/10.3390/healthcare8030255 - 06 Aug 2020
Cited by 2 | Viewed by 1388
Abstract
Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent [...] Read more.
Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent rehabilitation wards. This study was performed in older post-stroke patients admitted to convalescent rehabilitation wards between January 2017 and March 2019. Sarcopenia was diagnosed based on the skeletal muscle mass index and hand grip strength according to the criteria of the 2019 Asian Working Group for Sarcopenia. Obesity was diagnosed according to the body fat percentage; ≥27% in men, ≥38% in women. The primary outcome was the Functional Independence Measure (FIM) score upon admission, which was analyzed using multiple linear regression. In total, 376 participants (women 44%; mean age 77.5 years) were analyzed and classified as normal (22%), simple obesity (17%), sarcopenia without obesity (32%), and sarcopenic obesity (28%). The presence of sarcopenic obesity was independently associated with the FIM score (95% CI, −16.157 to −5.353), whereas simple obesity and sarcopenia without obesity were not. In conclusion, sarcopenic obesity was independently associated with lower activities of daily living capability in older patients with stroke. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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Open AccessArticle
Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults
Healthcare 2020, 8(2), 151; https://doi.org/10.3390/healthcare8020151 - 02 Jun 2020
Viewed by 1173
Abstract
Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different [...] Read more.
Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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Review

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Open AccessReview
Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis
Healthcare 2020, 8(4), 579; https://doi.org/10.3390/healthcare8040579 - 21 Dec 2020
Viewed by 627
Abstract
Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is [...] Read more.
Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (−273.8 kJ/d; 95%CI: −419.1 to −128.6, p = 0.0002) and protein (−12.4 g/d; 95%CI: −17.9 to −6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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