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Background/Objectives Poor food intake is a major etiological factor of malnutrition. This research aims to describe the prevalence of recent and current low food intake (LIRC) and to identify factors associated with LIRC in adult hospital patients from different medical specialities. Subject/Methods 1865 patients participating in the nutritionDay survey 2016–2020 in Germany were included. LIRC was defined by decreased eating both on nutritionDay and in the week before hospitalisation. Multivariate binary logistic regression was used to identify factors associated with LIRC overall and in different specialities. Results LIRC was observed in 21.1% of all patients, with the highest prevalence in Gastroenterology (26.6%) and the lowest in Neurology (11.2%). Weight loss within three months before nutritionDay (OR 2.62 [95% CI 1.93–3.56]), (very) poor self-rated health (2.17 [1.62–2.91]), female sex (1.98 [1.50–2.61]), uncertain weight loss (1.90 [1.03–3.51]), digestive disease (1.90 [1.40–2.56]), inability to walk without assistance (1.55 [1.14–2.12]) and emergency admission (1.38 [1.02–1.86]) were associated with increased risk, cardiac insufficiency (0.55 [0.37–0.83]) and being in a neurological ward (0.51 [0.28–0.92]) with decreased risk in the total sample. In Gastroenterology and Oncology, estimates were higher than in the entire sample; no significant associations were found in Neurology and Geriatrics, presumably due to the low prevalence of LIRC in Neurology and limited data quality in Geriatrics. Conclusion LIRC is common in German hospital patients and associated with female sex, poor health and decreased functional status. Interdisciplinary differences suggest a discipline-specific approach to dealing with malnutrition.

Adipositas im Alter wird, genauso wie bei Jüngeren, durch einen erhöhten Body-Mass-Index, Bauchumfang oder Körperfettanteil definiert. Aufgrund steigender Prävalenzzahlen und zahlreicher negativer Konsequenzen auf die körperliche und psychische Gesundheit erlangen Adipositas und speziell auch sarkopene Adipositas – eine Kombination aus erhöhtem Fettanteil und niedriger Muskelmasse sowie Muskelfunktion – bei älteren Menschen zunehmend an Bedeutung. Therapieoptionen bei Adipositas sind Lebensstilinterventionen, medikamentöse Begleitbehandlungen und chirurgische Eingriffe mit entsprechender Nachsorge, wobei letztere Optionen bei älteren Menschen bisher eine untergeordnete Rolle spielen. Bei Therapieentscheidungen sollten der Erhalt von Selbstständigkeit und Lebensqualität im Vordergrund stehen. Da Gewichtsreduktionen eine Abnahme von Muskelund Knochenmasse induzieren, sind der gesundheitliche Nutzen und die möglichen funktionellen Risiken sorgfältig gegeneinander abzuwägen. Lebensstilinterventionen, die Ernährungs-, Bewegungsund Verhaltenskomponenten kombinieren und einen langsamen Gewichtsverlust fokussieren, haben sich bei jüngeren Senior*innen mit Adipositas als effektiv und sicher erwiesen. Die Übertragbarkeit auf hochbetagte Menschen mit funktionellen Einschränkungen ist noch zu klären.

Aging is associated with reduced appetite as well as a slight increase in pro-inflammatory status, which both might contribute to the development of malnutrition. We aimed to evaluate the association between inflammation based on serum C-reactive protein (CRP), and appetite in healthy community-dwelling older adults. In this cross-sectional study of 158 healthy and non-smoking persons (aged 75–85 years), appetite was assessed in personal interviews by a single question with five answer categories. As nobody reported (very) poor appetite, the remaining three categories were dichotomised into “(very) good” and “moderate” appetite. Fasting serum CRP was analysed according to standard procedures, values ≥ 5.0 mg/L were considered as inflammation. The association between inflammation and appetite was examined by binary logistic regression, unadjusted and adjusted for age, sex, waist circumference, leptin, depressive mood, number of medications, interleukin-6 and tumor necrosis factor-α. Appetite was very good in 27.8%, good in 58.9%, and moderate in 13.3% of participants. Inflammation was present in 10.8% overall, in 8.8% of those with (very) good and in 23.8% of those with moderate appetite (p = 0.038). In the unadjusted model, participants with inflammation were 3.2 times more likely to have moderate appetite (95%CI: 1.01–10.44, p = 0.047). In the adjusted model, the odds of having moderate appetite was 3.7 times higher in participants with inflammation, but no longer significant (95%CI: 0.77–18.55, p = 0.102). In healthy older people, we found hints for a potential association between increased levels of CRP and a slightly reduced appetite. More studies in larger samples are needed.

Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) p Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

Background Studies focusing on self-perception of nutritional status in older hospitalized patients are lacking. We aimed to examine the self-perception of body weight and nutritional status among older hospitalized patients compared to their actual body weight and nutritional status based on medical assessment. Materials and methods This observational cross-sectional study investigated 197 older participants (mean age 82.2±6.8 years, 61% women) who were consecutively admitted to the geriatric acute care ward. Body weight status and nutritional status were assessed using WHO-BMI classification and Mini Nutritional Assessment-Short Form (MNA-SF), respectively. Self-perceived body weight status and nutritional status were assessed with a standardized questionnaire. A follow-up was performed with a short telephone interview after three months. Results According to MNA-SF, 49% and 35% were at risk of malnutrition and malnourished, respectively. There was no agreement between self-perceived nutritional status and objective nutritional status according to MNA-SF (Kappa: 0.06). A slight agreement was found between subjective body weight status and objective body weight status according to WHO-BMI classification (Kappa: 0.19). A total of 184 patients completed the 3 months follow-up and additional 9 patients died during this time, of which 7 and 2 were malnourished and at risk of malnutrition according to MNA-SF, respectively. Of those who were malnourished and at risk of malnutrition based on MNA-SF and died during follow-up, 67.7% did not realize their malnutrition. Compared to the patients with normal nutritional status during hospitalization, malnourished patients based on MNA-SF had higher rates of unplanned hospital readmission and further weight loss and more often reported health deterioration and experienced death within three months after discharge. Conclusion No agreement between self-perceived nutritional status and objective nutritional status among older hospitalized patients was found. Our study highlights the need to raise knowledge about the issue of malnutrition and increase awareness of health risks associated with malnutrition among older hospitalized patients.

ZusammenfassungMalnutrition und Dehydration zählen zu den häufigsten geriatrischen Syndromen mit weitreichenden klinischen Folgen. Zudem gewinnt die Problematik der Adipositas auch im hohen Alter zunehmend an Bedeutung. Dieser Beitrag präsentiert zentrale evidenzbasierte Empfehlungen zur Prävention und Therapie der genannten Ernährungsprobleme aus der aktuellen europäischen ESPEN-Leitlinie.

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 75% of requirements (P 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.

ZusammenfassungDer Leitfaden Ernährungstherapie in Klinik und Praxis (LEKuP) stellt eine grundlegende Überarbeitung des zuletzt im Jahr 2004 von der Deutschen Akademie für Ernährungsmedizin e. V. (DAEM) herausgegebenen Rationalisierungsschemas dar. Dabei erfolgte die Erstellung des LEKuP in enger Zusammenarbeit der verschiedenen Fachgesellschaften: Deutsche Gesellschaft für Ernährung e. V. (DGE) und die Deutsche Akademie für Ernährungsmedizin e. V. (DAEM) mit der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM), dem Berufsverband Deutscher Ernährungsmediziner e. V. (BDEM), der Deutschen Adipositas-Gesellschaft e. V. (DAG), dem Verband der Diätassistenten – Deutscher Bundesverband e. V. (VDD) und dem Berufsverband Oecotrophologie e. V. (VDOE).Gemeinsames Ziel der beteiligten Fachgesellschaften und -verbände war es, auf Grundlage evidenzbasierter Leitlinien einen aktuellen und konsensbasierten Leitfaden für die praktische Ernährungstherapie in Klinik und Praxis zu verfassen. Ein weiteres Ziel der Überarbeitung war es, damit eine Vorlage zu schaffen, aus der ein Kostformenkatalog für stationäre und ambulante medizinische Einrichtungen nach den lokalen Bedürfnissen abgeleitet werden kann.Die dem LEKuP zugrunde liegenden Empfehlungen basieren auf den D-A-CH-Referenzwerten für die Nährstoffzufuhr der Deutschen Gesellschaft für Ernährung e. V. (DGE) für Erwachsene und entsprechen einer vollwertigen und gesundheitsförderlichen Ernährung. Mittelmeerkost und vegetarische Ernährung werden als gleichwertig betrachtet. Abhängig von krankheitsspezifischen Erfordernissen werden Abweichungen und Ergänzungen vorgenommen, sodass eine Ernährungstherapie umgesetzt werden kann, die alle ernährungsbezogenen Maßnahmen zur Wiederherstellung von Gesundheit und Wiedererlangung des Handlungsvermögens von Patienten darstellt. Der vorliegende Leitfaden beschränkt sich auf die Darstellung der Prinzipien der Ernährungstherapie und deren praktische Umsetzung.

International audience; Older adults with poor appetite are at higher risk of undernutrition due to the role of appetite as a key driver of food intake. Dietary protein and fibre are critical nutrients in this population, and enhancing their intake is vital to preventing undernutrition and maintaining organ function and health. In APPETITE, a transdisciplinary consortium of experts from eight institutions in six European countries will collaborate to design potentially effective interventions to enhance protein and fibre consumption of community-dwelling older adults with poor appetite, thereby addressing undernutrition through a targeted nutrition- and physical activity-based strategy. Older adults with poor appetite will first be evaluated using a mixed-methods approach to gain insights into their nutritional and behavioural preferences. Working with this target group, innovative, acceptable and affordable food products will be developed that combine several domestic plant proteins and dietary fibres. Mechanistic insights will be gained by examining the impact of selected products and physical activity on digestibility, amino acid bioavailability and whole-body protein metabolism. In a multi-country, randomised controlled intervention trial, the impact of two new food products, provided as part of a personalised diet, a physical activity programme, and their combination will be determined. APPETITE will improve our understanding about plant-based protein and fibre products and their metabolic and clinical effects. It will create new knowledge about how these products can be combined in a whole-diet approach, together with physical activity and regular social contacts, to overcome undernutrition and to contribute to a better quality of life for older Europeans.

Purpose Individualised interventions are recommended to tackle malnutrition in older adults, but approaches for nursing home (NH) residents are scarce. This study investigated the effects of an individualised nutritional intervention in NH residents with (risk of) malnutrition. Methods In a pre-post study, 6 weeks (w) of usual care were followed by 6w of intervention. The intervention consisted of up to three supplement modules (sweet and savoury protein creams and protein-energy drink, single or combined) and, if required, reshaped texture-modified meals (RTMM). Results Fifty residents completed the study (84 ± 8 years, 74% female). One-third (32%) received RTMM. Additional 258 ± 167 kcal/day and 23 ± 15 g protein/day were offered. Mean daily energy intake increased by 207 (95%CI 47–368, p = 0.005) kcal and protein intake by 14 (7–21, p p = 0.002, w12 vs w6). Body weight, handgrip strength, and other QoL subscales did not change. Conclusion Our intervention improved dietary intake and one QoL subscale in NH residents with (risk of) malnutrition. As a next step, randomized controlled trials are needed to investigate the impact of individualised interventions more comprehensively.

Background: To prevent involuntary weight loss in older people, the knowledge about factors affecting body weight (BW) is essential. Therefore, we aimed to investigate the longitudinal associations of multiple oral health aspects with BW in community-dwelling older adults. Methods: This analysis is based on prospective data with a 10-year follow-up of 657 Dutch community-dwelling older adults (age 66.4 ± 5.8 years, 54% female) from the Longitudinal Aging Study Amsterdam. Participants’ characteristics, BW, and 12 oral health variables (teeth, dentures, nine oral problems, self-rated oral health) were assessed in 2005/07 and 2015/16. The association between oral health and BW was analyzed by mixed models and adjusted for demographic, socio-economic, smoking, health, and functional aspects considering data of both assessments. Results: Mean BW was 79.1 ± 13.3 kg at baseline (B) and 77.6 ± 13.8 kg at follow-up (FU). At baseline, 29.6% of the participants reported being edentulous (FU:34.4%) and 55.8% to wear dentures (FU:62.3%). Dental pain while chewing was the oral problem with the lowest (B:5.2%, FU:6.6%) and xerostomia with the highest prevalence at both examinations (B:24.3%, FU:30.0%). Most participants rated their oral status as healthy (B:65.2%, FU:66.9%). Neither edentulism and denture use nor oral problems showed a longitudinal association with BW. In contrast, self-rated oral health was associated with BW (b = 0.724, SE = 0.296, p = 0.015) after adjusting for multiple confounders. Conclusions: In community-dwelling older adults self-rated oral health may indicate changes in body weight in the long term. Therefore, this simple measure could serve to identify a risk for weight loss and to initiate oral interventions in clinical practice. © 2019, The Author(s), under exclusive licence to Springer Nature Limited.

Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.

Objective:The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.Design:Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.Setting:Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).Participants:CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.Results:Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.Conclusions:The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.

This proof-of-concept study investigated the effects of an innovative nutrition concept, comprising texture modification, enrichment, and reshaping, on dietary intake and nutritional status of 16 nursing home residents with chewing and/or swallowing problems (mean age 86.5 ± 7.4 years) in a pre-test post-test design. During 6 weeks with usual texture-modified diet (P1) energy and protein intake were constant. After the implementation of the innovative diet, daily energy intake increased by 204.2 (median) [interquartile range 95.8-444.4] kcal (

Purpose: Malnutrition is a condition which is highly prevalent, especially in older persons. Physicians play an important role in multidisciplinary nutritional management, but often feel inadequately prepared to provide nutritional information/therapy to their patients. The aim of this study was to gather information on curricular content on malnutrition in older persons in basic study programs for medical doctors. Methods: We selected a cross-sectional study design and used a Web-based online survey. We emailed the Web link to those persons responsible for curriculum development at 310 medical schools in 31 European countries. Results: A total of 26 (8.4%) medical schools in 12 European countries completed the questionnaire. The topic of malnutrition in older adults was included as part of the medical students’ curricula at 50.0% (13 out of 26) of the participating institutions. Most commonly topics taught in the institutions were causes of malnutrition (13, 50%), assessment of malnutrition (13, 50%) and consequences of malnutrition (12, 46.2%). The topic of malnutrition screening was addressed in nine (35%) of the institutions. Conclusions: Based on our results, we strongly recommend including the topic of malnutrition in older adults in the undergraduate curricula of medical students in Europe. A special focus should be placed on multidisciplinary cooperation. Integrative teaching that targets all professional groups could be one option. Initiatives need to be carried out to create a higher level of awareness and promote improvements in nutrition education for medical doctors.

Introduction: We aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. Methods: PubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs were included. Quality assessment was undertaken using Cochrane and GRADE criteria. Results: Eighteen primary studies from seventeen SRs were included. Eleven RCTs compared oral nutritional supplementation (ONS) with usual care. No beneficial effects of ONS treatment, after performing two meta-analysis in body weight changes (six studies), mean difference: 0.59 (95%CI -0.08, 1.96) kg, and in body mass index changes (two studies), mean difference: 0.31 (95%CI -0.17, 0.79) kg/m2 were found. Neither in MNA scores, muscle strength, activities of daily living, timed Up&Go, quality of life and mortality. Results of other intervention studies (dietary counselling and ONS, ONS combined with exercise, nutrition delivery systems) were inconsistent. The overall quality of the evidence was very low due to risk of bias and small sample size. Conclusions: This review has highlighted the lack of high quality evidence to indicate which interventions are effective in treating malnutrition in older people. High quality research studies are urgently needed in this area.

Background: Following a timely update process, the nutrition societies of Germany, Austria, and Switzerland (D-A-CH) revised the reference values for the intake of protein in 2017. The Working Group conducted a structured literature search in PubMed considering newly published papers (2000– 2017). Summary: For infants < 4 months, the estimated values were set based on the protein intake via breast milk. Reference values for infants > 4 months, children, adolescents, pregnant, and lactating women were calculated using the factorial method considering both requirement for growth and maintenance. For adults, reference values were derived from nitrogen balance studies; for seniors (> 65 years), reports on metabolic and functional parameters under various protein intakes were additionally considered. Reference ­values (g protein/kg body weight per day) were set as follows: infants < 4 months: 2.5–1.4, children: 1.3–0.8, adults < 65 years: 0.8, adults > 65 years: 1.0. Key Messages: The reference values for infants, children, adolescents, and adults < 65 years are essentially unchanged compared to recently published values. Scientifically reliable data published between 2000 and 2017 guided the D-A-CH Working Group to set a higher estimated value for adults > 65 years. Since the energy consumption continuously decreases with age, this new estimated protein intake value might be a challenge for the introduction of food-based nutrition concepts for older people.

Objectives: To identify determinants of incident malnutrition in community-dwelling older adults. Design: Meta-analysis of 6 community-based longitudinal datasets with follow-up of 1 to 3 years. Setting: Datasets from MaNuEL (MalNutrition in the Elderly) partners were included: 3 studies from Germany and 1 each from Ireland, the Netherlands, and New Zealand. Participants: community-dwelling adults aged 65 and older (N=4,844). Measurement: The same definition of incident malnutrition was used for all cohorts (body mass index < 20.0 kg/m2 at follow-up or weight loss ≥10 % between baseline and follow-up). Twenty-one potential baseline determinants from 7 domains (demographic, nutritional, lifestyle, social, psychological, physical functioning, medical) and 2 follow-up variables (hospitalization, falls) were harmonized for all studies. Binary logistic regression analyses were performed to assess the association between each variable, adjusted for specific confounders, and incident malnutrition. Combined odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. Results: Studies included between 209 and 1,841 participants without malnutrition at baseline; mean age ranged from 71.7 to 84.6. Incidence of malnutrition varied from 5.1% and 17.2%. Meta-analyses identified 6 variables as independent determinants of incident malnutrition; with increasing age, the risk of developing malnutrition increased continuously. Unmarried, separated, or divorced participants were more likely to develop malnutrition than married participants, whereas no association was found for widowed participants. Participants with difficulty walking (OR=1.41, 95% CI=1.06–1.89) or difficulty climbing stairs (OR=1.45, 95% CI=1.14–1.85) and those who were hospitalized before baseline (OR=1.49, 95% CI=1.25–1.76) and during follow-up (OR=2.02, 95% CI=1.41–2.88) had higher odds of incident malnutrition. Conclusion: In this harmonized meta-analysis based on prospective data of older, community-dwelling adults, age, marital status, limitations with walking and climbing stairs, and hospitalization were identified as determinants of incident malnutrition. J Am Geriatr Soc 66:2335–2343, 2018.

International audience; Objectives: Knowledge of factors determining dietary intake is important to develop targeted strategies to prevent malnutrition and age-related diseases. The aim of the present systematic review was to analyze the state of the art regarding the role of social status, cultural aspects, and psychological distress on dietary intake in community-dwelling older adults. Methods: A systematic search was performed per the Preferred Reporting Items for Systematic Reviews and Meta- Analyses procedure. Titles, abstracts, and full textswere screened for predefined inclusion and exclusion criteria. Results: Thirty-nine studies were included. Seven different groups of psychosocial and cultural determinants were associated with dietary intake. Family structure and living situation (e.g., loneliness, marital status), educational level, and income were the most important determinants associated with dietary choices and eating behavior. Less frequently, social assets, demographic parameters, psychosocial status, and awareness of current dietary recommendations were associated with the quality of the eating pattern. Conclusions: The results of our review indicate heterogeneity of the studies in the field of social and psychological determinants of dietary patterns in older adults, but some important conclusions can be drawn. Further research harmonizing and integrating approaches and methodologies are required to better understand the determinants of dietary intake and the complexity of their interactions.

IntroductionIn Germany, an efficient and feasible transition from hospital to home for older patients, ensuring continuous care across healthcare settings, has not yet been applied and evaluated. Based on the transitional care model (TCM), this study aims to reduce preventable readmissions of patients ≥75 years of age with a transitional care intervention performed by geriatric-experienced care professionals. The study investigates whether the intervention ensures continuous care during transition and stabilises the care situation of patients at home.Methods and analysesRandomised controlled clinical trial, recruiting between 25 April 2018 and 31 December 2019 in one German hospital in the city of Regensburg. The intervention group is supported by care professionals in the transition process from hospital to home for up to 12 months. Based on TCM, the intervention includes an individual care plan according to a patient’s symptoms, risks, needs and values. The plan is advanced in the domestic situation via personal visits and telephone contacts. All necessary care actions regarding, for example, mobility, residence adjustments, or nutrition, are initiated to be executed by ambulant care services, and are monitored, evaluated and adapted if necessary. In supervising the care plan, the care professionals do not administer active care services themselves but coordinate them. Patients and their caregivers are actively engaged in the care planning and execution. In contrast, the control group receives only usual discharge planning in the hospital and usual ambulatory care.The primary outcome is the all-cause readmission rate assessed using health insurance data within a follow-up of up to 12 months after hospital discharge. Secondary outcomes include care quality, mobility, nutritional and wound situation, and health-related quality of life. They are assessed at baseline, after 1 month, 3 months, 6 months, and at the end of study visit. Additionally, the economic efficiency of the intervention will be evaluated.Ethics and disseminationEthics approval for the trial was obtained from the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg. Results will be published in peer-reviewed, open-access scientific journals and disseminated at national and international research conferences and through public presentations in the geriatric and healthcare community.Trial registrationClinicalTrials.gov identifier:NCT03513159.

Introduction Obesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity.Methods and analyses Six databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention.Ethics and dissemination We will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups.PROSPERO registration number CRD42019147286.

Plate diagrams (PDs) are commonly used to monitor dietary intake in nursing homes (NHs). PD intake estimation of texture-modified diet (TMD) is reliable, but only if the offered portion is determined by weighing records (WRs). Offered portion size is usually individualized in NHs and WRs are impractical for NH routine. Thus, an estimation of offered portion size by PDs seems to be appropriate but its validity is unknown. Further, validity of PDs for intake estimation based on estimated offer (instead of WRs) is unknown.Main meal dietary offer and intake were assessed via PDs and WRs.Seventeen NH residents receiving TMD regularly.Offered portion size and intake of breakfast, lunch, and dinner at 42 days were estimated by nursing personnel via PDs (answer options offered portion size:standard, standard, ¾, ½, ¼, nothing, I do not know; answer options intake: all plus second helping, all, ¾, ½, ¼, nothing, I do not know). In parallel, scientific personnel weighed all offered food items and leftovers. PD estimation of offered portion size was multiplied by energy and protein content of predefined standard portions. Afterward, PD estimation of intake was multiplied by PD determined energy and protein offer to determine the estimated energy and protein intake. PD determined offer and intake were compared with weighed offer and intake.Seventeen residents (14 female) with a mean [±standard deviation (SD)] age of 87.1 (±7.5) years participated in the study. Nursing personnel overestimated offer and intake. Mean daily differences (±SD) between WR and PD determined offer were -349.0 (±315.7) kcal, P .001, (-36.3% of mean weighed energy offer) and -15.0 (±12.8) g protein, P .001, (-42.2% of mean weighed protein offer). Mean daily differences (±SD) between WR and PD determined intake were -283.0 (±299.8) kcal, P .001, (-35.1% of mean weighed energy intake) and -12.6 (±12.7)g protein, P .001, (-43.1% of mean weighed protein intake).PD estimation of individualized offered portion size of TMD by nursing staff is not valid and can, thus, not be recommended. The mistake in estimation of offered portion size is continued on intake estimation but does not become larger, which supports the use of PDs for intake estimation but just in case of a WR determined offer.

Evidence is accumulating that vitamin D may have beneficial effects on respiratory tract, autoimmune, neuro-degenerative, and mental diseases. The present umbrella review of systematic reviews (SRs) of cohort studies and randomised controlled trials (RCTs), plus single Mendelian randomisation studies aims to update current knowledge on the potential role of vitamin D in preventing and treating these extraskeletal diseases. Altogether, 73 SRs were identified. Observational data on primary prevention suggest an inverse association between vitamin D status and the risk of acute respiratory tract infections (ARI), dementia and cognitive decline, and depression, whereas studies regarding asthma, multiple sclerosis (MS), and type 1 diabetes mellitus (T1DM) are scarce. SRs of RCTs support observational data only for the risk of ARI. No respective RCTs are available for the prevention of chronic obstructive pulmonary disease (COPD), MS, and T1DM. SRs of RCTs indicate beneficial therapeutic effects in vitamin D-deficient patients with asthma and COPD, while effects on major depression and T1DM need to be further elucidated. Mendelian randomisation studies do not consistently support the results of SRs. Since several limitations of the included SRs and existing RCTs do not permit definitive conclusions regarding vitamin D and the selected diseases, further high-quality RCTs are warranted.

Older adults are at increased risk of malnutrition, which is associated with poorer health, quality of life, and worse disease outcomes. This study identifies predictors of incident malnutrition using data from a subsample (n = 1,841) of The Irish Longitudinal Study on Ageing. Participants were excluded if they were less than 65 years, missing body mass index data at baseline or follow-up, missing baseline weight loss data or malnourished at baseline (body mass index 10% over follow-up) as the dependent variable. Factors showing significant (p < .05) univariate associations with incident malnutrition were entered into a multivariate model. The analysis was then repeated, stratified by sex. The 2-year incidence of malnutrition was 10.7%. Unmarried/separated/divorced status (vs married but not widowed), hospitalization in the previous year, difficulties walking 100 m, or climbing stairs independently predicted incident malnutrition at follow-up. When examined by sex, hospitalization in the previous year, falls during follow-up, and self-reported difficulties climbing stairs predicted malnutrition in males. Receiving social support and cognitive impairment predicted malnutrition in females. The development of malnutrition has a range of predictors. These can be assessed using simple questions to identify vulnerable persons.

The protein intake of older people has gained increasing scientific interest as a potential factor to delay the age-associated decline in muscle mass and consequently to counteract the development of sarcopenia. The skeletal muscle of older people seems less responsive to the anabolic stimulus of protein intake. Therefore, higher protein needs are discussed to overcome this anabolic resistance and to maintain muscle mass as far as possible. Besides the total amount of protein consumed, the distribution, quality and timing in relation to physical exercise are considered relevant; however, deriving clear recommendations for clinical practice is still difficult as positive results of protein intake on muscle metabolism found in experimental trials cannot simply be transferred to everyday conditions and randomized controlled trials often failed to show improvements in muscular outcomes related to protein supplementation. The effectiveness of protein supplementation may depend on functional resources of the older persons and the habitual protein intake. There is still a need for studies with well-defined protocols and populations to further elucidate the role of protein in the prevention and treatment of sarcopenia.

Purpose The Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established to extend scientific knowledge, strengthen evidence-based practice, build a sustainable, transnational network of experts and harmonize research and clinical practice in the field of protein-energy malnutrition in older persons. This paper aims to summarize the main scientific results achieved during the 2-year project and to outline the recommendations derived. Methods 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) worked together on 6 relevant domains of malnutrition-i.e. prevalence, screening, determinants, treatment, policy measures and education for health care professionals-making use of existing datasets, evidence and expert knowledge. Results Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework on the aetiology of malnutrition in older persons were developed. Based on these activities and taking existing evidence into consideration, 13 clinical practice, 9 research and 4 policy recommendations were developed. The MaNuEL Toolbox was created and made available to effectively distribute and disseminate the MaNuEL results and recommendations. Conclusions The MaNuEL Knowledge Hub successfully achieved its aims. Results and recommendations will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein-energy malnutrition in the older population. Key summary pointsAim To summarize the main scientific results achieved during the 2-year Joint Action Malnutrition in the Elderly (MaNuEL) project and to outline the recommendations derived. Findings Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework (DoMAP) on the aetiology of malnutrition in older persons were developed. Message The MaNuEL Toolbox was made available to effectively distribute and disseminate the MaNuEL results and recommendations, which will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein-energy malnutrition in the older population.

Background The lack of sufficient knowledge of health care professionals is one main barrier to implementing adequate nutritional interventions. Until now, it is not known to which extent European nurses are exposed to the topic of malnutrition in older adults during their education. Objective To determine whether formal nursing degree programs in Europe address the topic of nutrition and, specifically, malnutrition in older adults. Design A cross-sectional study was conducted using an online-survey. Participants The online-survey link was e-mailed to 926 nursing education institutions in 31 European countries. Methods This study was conducted as part of the Healthy Diet for Healthy Life Joint Programming Initiative, Malnutrition in the Elderly Knowledge Hub (MaNuEL) project. Descriptive analyses were performed using SPSS. Associations were calculated using the chi-square tests and Fisher's exact test. Results The response rate of our survey was 14.2% (131 institutions). Of these, 113 (86.3%) addressed the topic of nutrition in their educational programs, and 73.7% addressed the topic of malnutrition in older adults. Malnutrition screening (70.8%), causes (67.2%) and consequences (68.7%) of malnutrition were frequently-addressed topics of content. Topics that were rarely addressed included nutritional support in intensive care units (ICU) (23.7%), cooperation in multidisciplinary nutrition teams (28.2%), dietary counselling (32.1%) and the responsibilities of various professions in nutritional support (35.1%). The topic of malnutrition in older adults is taught by nurses in 52.7%, by dietitians in 23.7%, by nutritional scientists in 18.3%, and physicians in 19.8% of the institutions. Conclusions The topics of malnutrition and malnutrition screening are currently not included in the content of nutrition courses taught at nearly 30% of the European educational institutions for nurses. Nursing educators urgently need to improve curriculum content with respect to the topic of malnutrition in older adults to enable nurses to provide high-quality nutritional care of older persons.

open access article; International audience; [u]Background & Aims[/u] Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. [u]Methods[/u] A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. [u]Results[/u] Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. [u]Conclusion[/u] There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly aging population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.

Summary Background & aims Despite the high prevalence of malnutrition among older hospitalized persons, it is unknown how many of these malnourished patients are at risk of developing the refeeding syndrome (RFS). In this study, we sought to compare the prevalence and severity of malnutrition among older hospitalized patients with prevalence of known risk factors of RFS. Methods This cross-sectional multicenter-study investigated older participants who were consecutively admitted to the geriatric acute care ward. Malnutrition screening was conducted using Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment-Short Form (MNA-SF). The National Institute for Health and Clinical Excellence (NICE) criteria were applied for assessing patients at risk of RFS. Weight and height were measured. Degree of weight loss (WL) was obtained by interview. Serum phosphate, magnesium, potassium, sodium, calcium, creatinine and urea were analyzed according to standard procedures. Results The study group comprised 342 participants (222 females) with a mean age of 83.1 ± 6.8 and BMI range of 14.7–43.6 kg/m 2 . More participants were assessed at risk of malnutrition using NRS-2002 (n = 253, 74.0%) compared to MUST (n = 170, 49.7%) and MNA-SF (n = 191, 55.8%). Of total participants, 239 (69.9%; 157 females) were considered to be at risk of RFS. Based on NRS-2002, 75.9% (n = 192) of patients at risk of malnutrition are at risk of RFS whereas according to MUST and MNA-SF, 85.9% (n = 146) and 69.1% (n = 132) of patients at risk of malnutrition are exposed to high risk of RFS, respectively. In addition, the prevalence of risk of RFS is significantly increased with higher score of NRS-2002 and MUST and lower score of MNA-SF. In a stepwise multiple regression analysis, disease severity (38.2%), WL in 3 months (20.3%) and BMI (33.3%) mainly explained variance in NRS-2002, MUST and MNA-SF scores, respectively, in patients with risk of RFS. Conclusion Nearly three-quarters of geriatric hospitalized patients with risk of malnutrition demonstrated significant risk of RFS. Therefore, additional screening for risk of RFS in patients screened for malnutrition appears to be abdicable among this population.

Background and aims: Research in malnutrition in older people is limited by the lack of consensus on relevant outcomes. Researchers of two European initiatives, the ‘Malnutrition in the Elderly (MaNuEL) Knowledge Hub’ (mostly experts in nutrition) and the Optimal Evidence-Based Non-drug Therapies in Older People (ONTOP) project (geriatricians) agreed to merge forces performing a systematic review of the effectiveness of nutritional interventions for the prevention and treatment of malnutrition in older persons. In a first step, we aimed to identify relevant outcomes for this review using a systematic approach and to explore if the rating of relevant outcomes differed depending on the researchers’ professional background. Methods: Following the ONTOP protocol, we searched all outcomes used in research of nutritional interventions for the prevention and treatment of malnutrition in older people. We carried out a web-based Delphi survey using a standardized list of 13 potentially relevant outcomes among 41 experts in geriatrics and nutrition who were asked to rate each outcome from 1 to 9 points: low importance (score 1–3), important but non-critical (score 4–6), and critical (score 7–9). Participants were informed that only those outcomes rated as critical (7–9 points) would be used in the literature review. After two rounds consultation, we compared the results from each group of experts: the ONTOP group formed by 13 geriatricians and the MaNuEL group formed by 28 experts in nutrition. Mean values were used for overall rating and the Mann–Whitney U test was used to see the differences on ratings between both groups. Results: Mortality, morbidity, functional status, nutritional status and quality of life were considered critical outcomes by the whole group of experts. However, by analysing the ratings by the experts’ professional background, geriatricians only rated mortality, morbidity and functional status as critical, while experts in nutrition (MaNuEL group) rated nutritional status, changes in dietary intake, compliance with the intervention, quality of life, and frailty status outcomes as critical too. Two outcomes, changes in dietary intake and compliance with the intervention, were rated with a significant different between the two professional groups (p

Refeeding syndrome is a life-threatening complication that may occur after initiation of nutritional therapy in malnourished patients, as well as after periods of fasting and hunger. Refeeding syndrome can be effectively prevented and treated if its risk factors and pathophysiology are known. The initial measurement of thiamine level and serum electrolytes, including phosphate and magnesium, their supplementation if necessary, and a slow increase in nutritional intake along with close monitoring of serum electrolytes play an important role. Since refeeding syndrome is not well known and the symptoms can be extremely heterogeneous, this complication is poorly recognized, especially against the background of severe disease and multimorbidity. This overview aims to summarize the current knowledge and increase awareness about refeeding syndrome.

Nursing home (NH) residents with (risk of) malnutrition are at particular risk of low protein intake (PI). The aim of the present analysis was (1) to characterize usual PI (total amount/day (d) and meal, sources/d and meal) of NH residents with (risk of) malnutrition and (2) to evaluate the effects of an individualized nutritional intervention on usual PI. Forty residents (75% female, 85 ± 8 years) with (risk of) malnutrition and inadequate dietary intake received 6 weeks of usual care followed by 6 weeks of intervention. During the intervention phase, an additional 29 ± 11 g/d from a protein-energy drink and/or 2 protein creams were offered to compensate for individual energy and/or protein deficiencies. PI was assessed with two 3-day-weighing records in each phase and assigned to 4 meals and 12 sources. During the usual care phase, mean PI was 41 ± 10 g/d. Lunch and dinner contributed 31 ± 11% and 32 ± 9% to daily intake, respectively. Dairy products (median 9 (interquartile range 6–14) g/d), starchy foods (7 (5–10) g/d) and meat/meat products (6 (3–9) g/d) were the main protein sources in usual PI. During the intervention phase, an additional 18 ± 10 g/d were consumed. Daily PI from usual sources did not differ between usual care and intervention phase (41 ± 10 g/d vs. 42 ± 11 g/d, p = 0.434). In conclusion, daily and per meal PI were very low in NH residents with (risk of) malnutrition, highlighting the importance of adequate intervention strategies. An individualized intervention successfully increased PI without affecting protein intake from usual sources.

Summary Background & aims Oral nutritional supplements (ONS) can be helpful for nursing home (NH) residents to prevent or treat malnutrition. Presently little is known about the use of ONS in NHs and the factors associated with its use. Thus, the aim of this analysis was to describe the use of ONS in NHs participating in the nutritionDay project and to determine characteristics of NH residents receiving ONS. Methods Data from nutritionDay (nD), a cross-sectional multicenter study with standardized questionnaires on resident and NH level were analyzed. NH residents participating between 2007 and 2014 aged 65 years or older were included. Unit characteristics (2 variables), general residents' characteristics (18), residents' nutritional status (3) and residents' nutrition (4) were of interest as potential predictors of the use of ONS (no vs yes). Univariate binary logistic regression (LR) analyses were performed for all variables, and significant predictors (p Results 13.9% of 23,689 NH residents received ONS. Univariate analysis identified all variables as predictors. After multivariate analysis 19 variables remained in the model (Nagelkerke's R2 = 0.319). Odds ratios (OR [95% Confidence Interval]) of receiving ONS were highest in residents receiving supplementary parenteral nutrition (29.05 [14.85–56.81]; however only 1.1% of all participants) and fortified diet (11.91 [8.52–16.64]; 5.7%). The odds ratio of receiving ONS was 3.26 ([2.86–3.71]; 18.3%) for residents being classified as at risk of malnutrition and 4.56 ([3.86–5.40]; 10.0%) for malnourished residents according to NH staff. Low BMI and weight loss in the last year increased the odds of receiving ONS by 2.34 ([1.93–2.84]; 16.0%) and 1.38 ([1.23–1.54]; 32.8%), respectively. Furthermore, increasing age, cognitive and functional impairment, low food intake on nD, neurological disease and cancer were associated with an increased likelihood of the use of ONS. In NH units with a nutritional expert (67.1%) and units performing a nutritional assessment at least once a month (71.6%), the odds of receiving ONS were also significantly increased (1.89 [1.71–2.10] and 1.17 [1.06–1.29]). Conclusion In NHs who participated in the nutritionDay, ONS are used for residents with poor nutritional and functional status and often in combination with other nutritional interventions. Future studies need to clarify the role of NH staff in the prescription and distribution of ONS and focus on the reasons for and adequacy of the use of ONS in NHs.

Despite high prevalence at hospital admission, disease related malnutrition (DRM) remains under recognized and undertreated. DRM is associated with increased morbidity, hospital readmission rate, and burden for the healthcare system. The compelling need to increase awareness and knowledge through an international survey has triggered the launch of the nutritionDay (ND) concept.ND is a worldwide annual systematic collection and analysis of data in hospital wards, intensive care units and nursing homes. ND is based on questionnaires to systematically collect and analyze the patient's characteristics, food intake and nutrition support, as well as the determinants of their environment (facility, health care personal, etc …). Questionnaires, outcome documentation sheets and step-by-step guidance are available as download in 30 languages.ND has described the nutritional status and behavior of over 150,000 hospitalized patients and nursing home's patients in over 56 participating countries. These data allowed a local, regional, national and international benchmarking at different levels (i.e. type of medical pathologies, care facilities, etc.) and over time. Sixteen peer-reviewed publications have already been released and picture the international scene of DRM.This review presents the 10-year of the ND project development and shows how ND serves all health care professionals to optimize nutrition care and nutrition related structures. ND keeps progressing and is likely to become a standard tool for determining the nutritional status and behavior of hospitalized patients and nursing home's population.

The incidence of refeeding syndrome (RFS) in older patients is not well-known. The aim of the study was to determine the prevalence of known risk factors for RFS in older individuals during hospitalization at geriatric hospital departments. 342 consecutive older participants (222 females) who admitted at acute geriatric hospital wards were included in a cross-sectional study. We applied the National Institute for Health and Clinical Excellence (NICE) criteria for determining patients at risk of RFS. In addition, Mini Nutritional Assessment Short Form (MNA®-SF) was used to identify patients at risk of malnutrition. Weight and height were assessed. The degree of weight loss was obtained by interview. Serum phosphate, magnesium, potassium, sodium, calcium, creatinine and urea were analyzed according to standard procedures. Of 342 older participants included in the study (mean age 83.1 ± 6.8, BMI range of 14.7–43.6 kg/m2), 239 (69.9%) were considered to be at risk of RFS, in which 43.5% and 11.7% were at risk of malnutrition and malnourished, respectively, according to MNA-SF. Patients in the risk group had significantly higher weight loss, lower phosphate and magnesium levels. In a multivariate logistic regression analysis, low levels of phosphate and magnesium followed by weight loss were the major risk factors for fulfilling the NICE criteria. The incidence of risk factors for RFS was relatively high in older individuals acutely admitted in geriatric hospital units, suggesting that, RFS maybe more frequent among older persons than we are aware of. Patients with low serum levels of phosphate and magnesium and higher weight loss are at increased risk of RFS. The clinical characteristics of the older participants at risk of RFS indicate that these patients had a relatively poor nutritional status which can help us better understand the potential scale of RFS on admission or during the hospital stay.

Im Verlauf einer Demenzerkrankung treten fruher oder spater Ernahrungsprobleme auf und es stellt sich die Frage, welche Masnahmen effektiv sind, um eine bedarfsgerechte Ernahrung zu gewahrleisten und so zum Erhalt von Gesundheit, Funktionalitat und Selbststandigkeit beizutragen. Dieser Beitrag soll einen Uberblick uber den aktuellen Kenntnisstand zur Ernahrung bei Demenzerkrankungen bieten. Die Arbeit basiert auf der aktuellen Leitlinie der European Society for Clinical Nutrition and Metabolism (ESPEN) zur Ernahrung bei Demenz, in der die verfugbare Evidenz systematisch untersucht wurde. Ernahrungsmasnahmen sollten fester Bestandteil der Behandlung von Demenzpatienten sein. Voraussetzungen dafur sind ein routinemasiges Screening auf Mangelernahrung, ggf. mit nachfolgendem Assessment, und eine regelmasige Kontrolle des Korpergewichts, um vorhandene Probleme fruhzeitig zu erkennen. Eine ausreichende orale Ernahrung kann in allen Stadien der Demenz durch ein hochwertiges und ansprechendes, bedurfnisgerechtes Essensangebot in entspannter Atmosphare, durch individuell benotigte Unterstutzung und durch Beseitigung moglicher Ursachen von Mangelernahrung gefordert werden. Reichen ubliche und angereicherte Nahrungsmittel nicht aus, um den Energie- und Nahrstoffbedarf zu decken, wird Trinknahrung zur Verbesserung des Ernahrungszustands empfohlen. Positive Effekte einer Energie- und/oder Nahrstoffsupplementierung auf die kognitiven Fahigkeiten sind nicht belegt. Eine kunstliche Ernahrung sollte nur ausnahmsweise zum Einsatz kommen, und zwar nach sorgfaltiger Nutzen-Risiko-Abwagung unter Berucksichtigung des (mutmaslichen) Patientenwillens. Fur Patienten mit schwerer Demenz oder am Lebensende wird kunstliche Ernahrung generell nicht empfohlen.

Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population.One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007.A total of 507 NH units from 15 countries.NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index20 kg/mData on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents' nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents' nutritional status, general residents' characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P .01) included in a multivariate analysis.Six-month mortality rate of the included 4857 NH residents was 20.3%. Univariate analysis identified residents' diet, use of ONS, intake at lunch, and 14 confounders as predictors of mortality. Intake at lunch and 7 confounders remained in the multivariate model [area under the receiver operating curve = 0.687; 95% confidence interval (CI) 0.669-0.706; P .001]. The less residents ate for lunch, the higher was the risk of mortality, with the highest odds ratio (OR) for residents who ate nothing (OR 3.38; 95% CI 2.58-4.42). Mortality risk was OR 2.36; 95% CI 1.91-2.92, and OR 1.64; 95% CI 1.29-2.07 times higher for immobile and partially mobile compared with mobile residents. Cancer, dysphagia, weight loss5 kg in the last year, body mass index20 kg/mPoor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.

The refeeding syndrome is a life-threatening complication that can occur after initiation of a nutrition therapy in malnourished patients. If the risk factors and pathophysiology are known, the refeeding syndrome can effectively be prevented and treated, if recognized early. A slow increase of food intake and the close monitoring of serum electrolyte levels play an important role. Because the refeeding syndrome is not well known and the symptoms may vary extremely, this complication is poorly recognized, especially against the background of geriatric multimorbidity. This overview is intended to increase the awareness of the refeeding syndrome in the risk group of geriatric patients.

The relationship between hypophosphatemia (HP) and malnutrition in older hospitalized patients has received little attention. We sought to investigate this association among this population. The study participants were consecutively admitted to a geriatric acute care ward in six hospitals. Malnutrition screening was conducted by Mini Nutritional Assessment-Short Form. Patients were divided into two groups according to serum phosphate: HP (0.68 mmol/l) and non-HP groups (0.68 mmol/l). Of 335 participants, 7% of subjects had HP. Malnutrition or nutritional risk was present in 86 and 56% of participants with and without HP, respectively (P = 0.003). The analysis indicated 9.8, 86.4, 97.9 and 44.0% sensitivity, positive predictive value, specificity and negative predictive value of HP with regard to malnutrition, respectively. This study demonstrated that HP in older hospitalized patients is associated with malnutrition and may be used as an indicator of nutritional risk. Contrary, normal serum phosphate does not exclude being at nutritional risk.

Objectives Nursing home (NH) residents receiving texture-modified diet (TMD) are at risk of inadequate nutritional intake and subsequent malnutrition. It is essential to monitor dietary intake to take corrective actions, if necessary. Plate diagrams (PDs) are widely used to assess dietary intake in institutions but little is known about their validity for TMD. Design Dietary intake at main meals was assessed by nursing personnel via PDs and scientific personnel via weighing records (WRs). Setting and Participants 17 NH residents receiving TMD on a regular basis. Methods Intake from main meals (breakfast, lunch, and dinner) at 48 days was estimated by nursing personnel in quarters of the offered amount [nothing, ¼, ½, ¾, all, all plus second helping ( 5 4 ), or I do not know] and by scientific personnel via WRs. PD estimation was multiplied by the energy and protein content of the offered meal determined by WR and compared to WR intake results. Sums of daily PD quarters were drawn against WR intake results. Results Energy and protein intake from main meals separately and in total per day were highly correlated (r > 0.854, all P .05). Mean differences [±standard deviation (SD)] between PD and WR were 13.9 (±68.6) kcal, which is 1.7% of the mean weighed caloric intake, and 0.2 (±3.3) g protein, which is 0.5% of the mean weighed protein intake per day. Daily energy and protein intake from main meals determined by WR varies widely within each category of summed daily intake quarters; for example, a sum of PD quarters of 12 (ie, “all eaten at all meals”) showed corresponding WR intake levels from 394.6 to 1368.9 kcal and 16.3 to 63.0 g protein. Conclusions and Implications Energy and protein intake from TMD estimated by PD corresponds very well to WR-determined intake, if the energy and protein content of the offered meals is known.