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Lukas Funk, Ulrike Sonja Trampisch, Maryam Pourhassan, Rainer Wirth Department of Geriatric Medicine, Marien Hospital Herne, Herne, GermanyCorrespondence: Lukas Funk Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Hölkeskampring, 4044629, Deutschland, Tel +49 (0) 2323 499 5822, Email Lukas.Funk@rub.dePurpose: Vitamin D deficiency is a common finding in geriatric patients. The ESPEN micronutrient guideline states that vitamin D serum levels significantly decrease in the presence of inflammation and should be interpreted with caution. This is of great interest for hospital care and would imply a significant change to the current approach to hospitalized patients with suspected vitamin D deficiency.Patients and methods: To evaluate the association of vitamin D and inflammation, we reanalyzed the data set of serum 25(OH)D-Levels of 687 consecutive geriatric hospitalized patients of a previously published study.Results: We found that vitamin D deficiency (< 20 ng/dl) was prevalent in 78.0% and vitamin D insufficiency (20– 30 ng/dl) in 9.9% of patients. Sperman’s correlation showed a significant but very weak correlation (R = − 0.100, P < 0.01) of serum vitamin D and C-reactive protein. However, linear regression with the inclusion of age and gender revealed no significant association (beta-coefficient − 0.070; p=0.067).Conclusion: In this study, we could not confirm a significant and clinically relevant association between serum vitamin D levels and inflammation, contrasting with a previous study. However, longitudinal studies need to be performed to draw a final conclusion.Keywords: Vitamin D, 25-hydroxyvitamin D, inflammation, older, C-reactive protein, geriatric

Under continuous human disturbance, regeneration is the basis for biodiversity persistence and ecosystem service provision. In tropical dry forests, edaphic ecosystem engineering by biological soil crusts (biocrusts) could impact regeneration by influencing erosion control and soil water and nutrient fluxes, which impact landscape hydrology, geomorphology, and ecosystem functioning. This study investigated the effect of cyanobacteria-dominated biocrusts on water infiltration and aggregate stability in a human-modified landscape of the Caatinga dry forest (NE Brazil), a system characterized by high levels of forest degradation and increasing aridity. By trapping dust and swelling of cyanobacterial filaments, biocrusts can seal soil surfaces and slow down infiltration, which potentially induces erosion. To quantify hydraulic properties and erosion control, we used minidisc-infiltrometry, raindrop-simulation, and wet sieving at two sites with contrasting disturbance levels: an active cashew plantation and an abandoned field experiencing forest regeneration, both characterized by sandy soils. Under disturbance, biocrusts had a stronger negative impact on infiltration (reduction by 42% vs. 37% during regeneration), although biocrusts under regenerating conditions had the lowest absolute sorptivity (0.042 ± 0.02 cm s−1/2) and unsaturated hydraulic conductivity (0.0015 ± 0.0008 cm s−1), with a doubled water repellency. Biocrusts provided high soil aggregate stability although stability increased considerably with progression of biocrust succession (raindrop simulation disturbed: 0.19 ± 0.22 J vs. regenerating: 0.54 ± 0.22 J). The formation of stable aggregates by early successional biocrusts on sandy soils suggests protection of dry forest soils even on the worst land use/soil degradation scenario with a high soil erosion risk. Our results confirm that biocrusts covering bare interspaces between vascular plants in human-modified landscapes play an important role in surface

The extent to which inflammation impacts food intake remains unclear, serving as a key risk factor for malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). To address this, we analyzed a large, merged dataset of geriatric hospitalized patients across Europe. The study included 1650 consecutive patients aged & GE;65 year from Germany, Italy, Finland, Denmark, and Poland. Nutritional intake was assessed using the first item of the Mini Nutritional Assessment Short Form; C-reactive protein (CRP) levels were measured using standard procedures. In total (age 79.6 & PLUSMN; 7.4 year, 1047 females), 23% exhibited moderate to severe inflammation, and 12% showed severe inflammation; 35% showed moderate reductions in food intake, and 28% were considered malnourished. Median CRP levels differed significantly between patients with severe, moderate, and no decrease in food intake. Among patients with a CRP level of 3.0-4.99 mg/dL, 19% experienced a severe decrease in food intake, while 66% experienced moderate to severe decreases. Regression analysis revealed that inflammation was the most prominent risk factor for low food intake and malnutrition, surpassing other factors such as age, gender, infection, and comorbidity. A CRP level of & GE;3.0 mg/dL is associated with reduced food intake during last 3 months in two thirds of hospitalized geriatric patients and therefore indicative for a high risk of malnutrition.

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Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counter-acting these key health threats. Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modifica-tion and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-in

BACKGROUND/OBJECTIVES: In the recently introduced GLIM diagnosis of malnutrition (Global Leadership Initiative on Malnutrition), details of how to classify inflammation as an etiologic criterion are lacking. This study aimed to determine at what level of serum C-reactive protein (CRP) the risk of low food intake increases in acutely ill older hospitalized patients. SUBJECTS/METHODS: A total of 377 patients, who were consecutively admitted to a geriatric acute care ward, were analyzed. Nutritional intake was determined using the food intake item of Nutritional Risk Screening and the plate diagram method and patients were grouped into three categories as >75%, 50-75% and ≤50% of requirements. CRP was analyzed according to standard procedures and patients were classified into different CRP groups as follows: 0.0-0.99 mg/dl, 1.0-1.99 mg/dl, 2.0-2.99 mg/dl, 3.0-4.99 mg/dl, 5.0-9.99 mg/dl and ≥10.0 mg/dl. RESULTS: Of the total population (mean age of 82.2 ± 6.6 years; 241 females), 82 (22%) had intake <50% of requirements and 126 (33%) demonstrated moderate to severe inflammation. Patients with food intake <50% of requirements had a significantly higher median CRP level compared to patients with food intake >75% of requirements (P < 0.001). The group with serum-CRP levels above 3.0 mg/dl had a markedly higher proportion of patients with low food intake; i.e., <50% and <75% of the requirements. CONCLUSION: A serum-CRP of 3.0 mg/dl appears to be a reasonable threshold of acute inflammation leading to reduced food intake to serve as an orientation with regard to the inflammation criterion of the GLIM diagnosis in acutely ill older patients.