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Rationale: Over 400,000 people are supported by tube feeding in Japan. Excess protein raise BUN and lead to renal failure. Lack of protein lower albumin concentration and lead to dysfunction. But optimal protein concentration is disputable. Methods: We changed protein concentration at one time from 1.25 g/kg body weight to 1.00 g/kg body weight without calorie change (25 kcal/kg body weight). And measured body weight, albumin, BUN, Cr, e-GFR before change, 1, 2, 6, 12 months after change. At first sixty two patients. One year after, forty one individuals were in hospital (m:f 19:22, age 80.9±10.8). We evaluated these patients’ data. Results: Body weight 40.9±7.7, 41.0±7.8, 41.2±8.1, 41.2 ±8.1, 41.3±8.6, no change. Alb 3.06±0.33, 3.02±0.34, 3.07±0.37, 3.05±0.35, 2.89±0.37, decrease in 12 months after. BUN 23.2±10.3, 17.6±7.3, 17.2±5.7, 17.5±7.1, 19.2±11.1, decrease in 1 month after. Cr 0.630±0.33, 0.615±0.3, 0.586±0.32, 0.623±0.33, 0.711±0.40, increase in 12 months after. e-GFR 97.6±43.3, 98.9±41.0, 99.3±40.0, 96.9±40.2, 87.5±41.3, decrease in 12 months after. Conclusion: Decreasing protein concentration in formula (from 1.25 g/kg body weight to 1.00 g/kg body weight) could reduce albumin concentration in elder Japanese people.

Background Objectives The regulation of cytokine production on the level of the gene transcription may involve several types of polymorphisms in promoter/enhancer region. The aim of this study was to evaluate if polymorphism in several genes could associate with the responsiveness to TNF blocking therapy with etanercept (Enbrel®) in patients with rheumatoid arthritis from Eastern Sweden. Methods 124 patients with active RA were treated with subcutaneous etanercept 25 mg twice a week. The efficacy measures included ACR and DAS28 response rates after treatment for 3 months. The ?308 TNFA, -1082 IL10 and codon 25 TGFB1 gene polymorphisms were detected by combination of PCR and restriction endonuclease mapping. VNTRs in intron 2 of IL1RN gene were detected by PCR and HLA-DQB1 and HLA-DRB1 were typed and subtyped by PCR-SSP. Results 24 patients (19%) were non-responders according to both ACR and DAS28 criteria. We found significant association of one group, composite of TNF1/TNF1 and G/G genotypes, with positive responsiveness to etanercept (p Conclusion We find strong evidence for association of certain genetic markers with efficacy of etanercept treatment in RA patients. Combined ?308 TNFA and ?1082 IL10 genotype may predispose for the response to etanercept therapy, while ?308 TNFA genotype in combination with ESR may be used for the selection of potential non-responders. These results may provide information for future improvement of treatment of RA.

Background: In 1992, local municipalities in Sweden took over full responsibility for the long-term care of elderly. This has led to an increased care burden for the various assisted accommodation services run by the municipalities. Objective: Since ageing and chronic diseases are risk factors for protein-energy malnutrition, we evaluated the nutritional status of all individuals in assisted accommodation, i.e., service flats (SF), old people’s homes (OPH), group living for the demented (GLD), and nursing homes (NH), in three Swedish municipalities. Methods: Of 994 eligible subjects, 872 were examined; the average age was 84.5 ± 8 years, and 69% were female. The Mini Nutritional Assessment (MNA) scale (0–30 points) was used, consisting of 18 point-weighted questions in four categories, i.e., anthropometry, global and dietary issues, and self-assessment. Results: MNA Conclusions: Based on the MNA, one third of the study subjects living in assisted accommodation, and more than half of those living in NH, appeared to be malnourished. Further studies are necessary to assess to what extent these nutritional disturbances are reversible.

serum vitamin-D levels and the likelihood of independent walking recovery in the year after hip fracture surgery. Methods.–Multicenter prospective study of 603 patients aged≥70 years, admitted to four ItalianHospitals forhip fracturewhowalked independently before the fracture. At admission, patients underwent multidimensional geriatric evaluation. They were evaluated after surgery at 3, 6, and 12 months by telephone interview. Probability of walking recovery (ability to walk independently) was evaluated as a function of serum vitamin-D distribution (tertiles), using multivariable logistic regression. Results.– The mean age was 85.4±0.2, and 75% were women. Median vitamin-D level was 9ng/ml (IQR 10.2ng/ml), 40% of patients had vitamin-D insufficiency, and 54% had deficiency. Vitamin-D level was inversely related to age (P=0.025), BADL difficulty (P=0.002), depressive symptoms (P

To assess the impact of protein-energy malnutrition (PEM) on mortality and the long-term variations in the nutritional status of subjects admitted as emergency cases in a 9-month prospective follow-up study.The study comprised 205 patients without cancer aged 75 years (+/- 1). Malnourished subjects were identified as having at least three nutritional variables (which included weight index, triceps skinfold thickness, arm muscle circumference, serum albumin, and delayed cutaneous hypersensitivity reaction) below the reference range.The mortality was 44% in the 41 malnourished patients and 18% in the 164 nonmalnourished subjects (P0.001). Among malnourished patients with congestive heart failure the mortality was 80%. Multivariate analysis revealed congestive heart failure, multiple organ disease, and PEM to be predictors of death. When the interaction between these disorders and PEM was considered, the prognostic relevance of PEM remained among the patients with cardiac congestion. Of the surviving subjects, 125 were reexamined after 9 months. At admission, more than half of the patients had displayed elevated levels of serum acid glycoprotein as evidence of an ongoing inflammation and subnormal recordings for serum albumin and delayed cutaneous hypersensitivity. At the reexamination, these variables had normalized in the well-nourished patients and in the 9 patients who had recovered from PEM, but remained unchanged in the 10 patients with persistent PEM. The latter patients were severely malnourished, commonly infected, and often hospitalized.Protein-energy malnutrition in noncancer medical patients is associated with an excess mortality in those with congestive heart failure. Improvement of PEM is accompanied by a decline in inflammatory activity.

Background A sedentary lifestyle predisposes to cardiometabolic diseases. Lifestyle changes such as increased physical activity improve a range of cardiometabolic risk factors. The objective of this study was to examine whether functional changes in adipose tissue were related to these improvements. Methods Seventy-three sedentary, overweight (mean BMI 29.9 ± 3.2 kg/m2) and abdominally obese, but otherwise healthy men and women (67.6 ± 0.5 years) from a randomised controlled trial of physical activity on prescription over a 6-month period were included (control n = 43, intervention n = 30). Detailed examinations were carried out at baseline and at follow-up, including fasting blood samples, a comprehensive questionnaire and subcutaneous adipose tissue biopsies for fatty acid composition analysis (n = 73) and quantification of mRNA expression levels of 13 candidate genes (n = 51), including adiponectin, leptin and inflammatory cytokines. Results At follow-up, the intervention group had a greater increase in exercise time (+137 min/week) and a greater decrease in body fat mass (−1.5 kg) compared to the control subjects (changes of 0 min/week and −0.5 kg respectively). Circulating concentrations of adiponectin were unchanged, but those of leptin decreased significantly more in the intervention group (−1.8 vs −1.1 ng/mL for intervention vs control, P P P Conclusions After a 6-month period of increased physical activity in overweight elderly individuals, circulating leptin concentrations decreased despite increased levels of leptin mRNA in adipose tissue. Otherwise, only minor changes occurred in adipose tissue, although several improvements in metabolic parameters accompanied the modest increase in physical activity.

Weight index (WI), triceps skinfold (TSF), serum albumin and delayed cutaneous hypersensitivity reaction (DCH) were measured in 96 hospitalized elderly patients and in 100 age- and sex-matched free-living controls. Using the 10th percentile of data obtained in the controls, WI was subnormal in 35% of the patients. Corresponding findings with regard to TSF, serum albumin and DCH were 32, 50 and 31%, respectively. The findings in the controls were mainly within the range observed in national reference groups. Patients were considered malnourished if they showed at least two variables (of which one was required to be anthropometric) below the cut-off limits used. When these limits were set at the 10th percentile of the recordings in the controls, the occurrence of undernutrition in the patients was 39%. By using the 5th percentile the corresponding figure was 16%. Malnourishment was most pronounced in patients with multiple organ disease and malignancy. It is concluded that low nutritional indices are a common occurrence in elderly subjects admitted to hospital and that undernutrition is related to the nature of the disease rather than age.

Background: Dietary calcium intake is assumed to be important for prevention and treatment of osteoporosis. However, people in countries with high calcium intake from commodities such as milk and milk products have a high incidence of hip fracture. The effect and influence of calcium intake to prevent osteoporotic fracture vary from different studies. Objective: To investigate premorbid daily calcium intake in patients with low energy hip fractures during four consecutive years. Design: In total 120 patients (mean age 78±8,5 (SD) years) were included between 2002 and 2005. The patients answered a structured food frequency questionnaire (FFQ) interviews on patients' daily calcium intake from food and supplements took place during a 6-month period before the fracture. Dual energy X-ray absorptiometry (DEXA) was performed in a subgroup of 15 patients. Results: The mean daily calcium intake from food and supplementation was 970±500 mg. However, 38% had an intake below recommended 800 mg/d. There were no significant relationship between calcium intake and age, gender, bone mineral density, serum calcium or albumin, type of fracture or body mass index. The mean free plasma calcium concentration was 2.3±0.1, i.e. within the reference limit. In 2005, 80% of the patients who underwent DEXA had manifest osteoporosis. There was a trend towards decreased calcium intake over the observation period, with a mean calcium intake below 800 mg/day in 2005. Conclusion: Hip fracture patients had a mean calcium intake above the recommended daily intake, as assessed by a FFQ. However, more than one-third of patients had an intake below the recommended 800mg/day. The intake appeared to decrease over the investigated years. The relationship between calcium intake and fracture susceptibility is complex. Keywords: calcium intake, dairy products, osteoporosis, hip fracture, bone mineral density. (Published online: 2 April, 2008) Citation: Food & Nutrition Research 2008. DOI: 10.3402/fnr.v52i0.1654

Background: Epidemiologic and animal studies have suggested that dietary fish or fish oil rich in-3 fatty acids, for example, docosahexaenoic acid and eicosapentaenoic acid, may prevent Alzheimer disease (AD). Objective: To determine effects of dietary-3 fatty acid supplementation on cognitive functions in patients with mild to moderate AD. Design: Randomized, double-blind, placebo-controlled clinical trial. Participants: Two hundred four patients with AD (age range [mean±SD], 74±9 years) whose conditions were stable while receiving acetylcholine esterase inhibitor treatment and who had a Mini-Mental State Examination (MMSE) score of 15 points or more were randomized to daily intake of 1.7 g of docosahexaenoic acid and 0.6 g of eicosapentaenoic acid (-3 fatty acid–treated group) or placebo for 6 months, after which all received-3 fatty acid supplementation for 6 months more. Main Outcome Measures: The primary outcome was cognition measured with the MMSE and the cognitive portion of the Alzheimer Disease Assessment Scale. The secondary outcome was global function as assessed with the Clinical Dementia Rating Scale; safety and tolerability of -3 fatty acid supplementation; and blood pressure determinations. Results: One hundred seventy-four patients fulfilled the trial. At baseline, mean values for the Clinical Dementia Rating Scale, MMSE, and cognitive portion of the Alzheimer Disease Assessment Scale in the 2 randomized groups were similar. At 6 months, the decline in cognitive functions as assessed by the latter 2 scales did not differ between the groups. However, in a subgroup (n=32) with very mild cognitive dysfunction (MMSE 27 points), a significant (P.05) reduction in MMSE decline rate was observed in the-3 fatty acid–treated group compared with the placebo group. A similar arrest in decline rate was observed between 6 and 12 months in this placebo subgroup when receiving-3 fatty acid supplementation. The -3 fatty acid treatment was safe and well tolerated. Conclusions: Administration of -3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline according to the MMSE or the cognitive portion of the Alzheimer Disease Assessment Scale. However, positive effects were observed in a small group of patients with very mild AD (MMSE 27 points). Trial Registration: clinicaltrials.gov Identifier: NCT00211159

© 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Background: Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability. Objective: To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia. Design: A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention. Results: Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045. Conclusions: This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.

New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance-and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, >= 1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR

To evaluate nutritional status and its relation to cognitive and physical function and quality of life in elderly female patients with hip fractures.Nutritional status was assessed in 42 women (80+/-7 years old) using the body mass index (BMI), triceps skin fold, arm muscle circumference and serum levels of insulin-like growth factor (IGF-1) and its binding protein (BP) IGFBP-1. Handgrip strength was measured. The Short Portable Mental Status Questionnaire was used to assess cognitive function and the Nottingham Health Profile to asses quality of life.Low BMI (== 20) and reduced IGF-1 and IGFBP-1 levels were detected in 50% of the patients. BMI correlated with IGF-1 (p0.02) and with hand grip strength (P0.001). Hand grip strength correlated with arm muscle circumference (P0.05). Cognitive dysfunction was detected in 18% of the patients, and a correlation was found between cognitive function and BMI (P0.01). The Nottingham Health Profile assessment indicated a lower quality of life in underweight patients as compared to others (P0.05).Half of the elderly women with hip fractures displayed signs of protein-energy malnutrition. Underweight was associated with reduced serum levels of IGF-1, muscle fatigue, cognitive dysfunction and a low quality of life rating, i.e. a cluster of factors which may unfavourably influence the postoperative course in a large proportion of hip fracture patients.

Background: Many diseases striking old adults result in eating difficulties. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG) are unclear and everybody may not benefit from the procedure. Objective: The aim of this study was to evaluate indications for and survival after PEG insertion in patients older than 65 years. Design and Methods: A retrospective analysis including age, gender, diagnosis, indication, and date of death was made in 201 consecutive individuals, 94 male, mean age 79±7 years, who received a nutritional gastrostomy. Results: Dysphagia was present in 86% of the patients and stroke was the most common diagnosis (49%). Overall median survival was 123 days and 30-day mortality was 22%. Patients with dementia and Mb Parkinson had the longest survival (i.e. 244 and 233 days), while those with other neurological diseases, and head and neck malignancy had the shortest (i.e. 75 and 106 days). There was no difference in mortality in patients older or younger than 80 years, except in patients with dementia. Conclusions: Old age should not be a contraindication for PEG. A high 30-day mortality indicates that there is a need of better criteria for selection and timing of PEG insertion in the elderly.Keywords: elderly; enteral nutrition; gastrostomy; mortality; PEG; survival(Published: 20 July 2011)Citation: Food & Nutrition Research 2011. 55 6037 - DOI: 10.3402/fnr.v55i0.6037

BACKGROUND: Desaturase indexes, as markers of endogenous fatty acid desaturation, and a characteristic serum fatty acid (FA) composition are related to cardiovascular and metabolic diseases, but the relation to mortality is poorly investigated. OBJECTIVE: The objective was to evaluate the relation between dietary fat biomarkers, desaturase indexes, and mortality. DESIGN: In this community-based prospective sample, 50-y-old men were followed for a maximum of 33.7 y. Cox proportional hazard analysis was conducted to investigate desaturase indexes (stearoyl-CoA-desaturase and Delta(6)- and Delta(5)-desaturase) and the relation of individual serum esterified fatty acids (FAs) in relation to total and cardiovascular mortality in the total study sample (n = 2009) and in a healthy subsample (n = 1885). Desaturase indexes were estimated as product-to-precursor FA ratios. RESULTS: During follow-up, 1012 men in the total sample died and 931 men in the healthy subsample died. Desaturase indexes predicted both total and cardiovascular mortality. The relations were independent of smoking status, physical activity, BMI, total cholesterol, and hypertension. The adjusted and standardized (per SD) hazard ratios (HRs) and 95% CIs for cardiovascular mortality were 1.15 (1.04, 1.27) for stearoyl-CoA-desaturase, 1.12 (1.0, 1.24) for Delta(6)-desaturase, and 0.88 (0.80, 0.98) for Delta(5)-desaturase, respectively. The proportion of serum linoleic acid was inversely related, whereas serum FAs associated with saturated fat intake (palmitic, palmitoleic, and dihomo-gamma-linolenic acids) were directly related to total and cardiovascular mortality. CONCLUSIONS: Altered endogenous FA desaturation might contribute to mortality risk because we observed independent associations between desaturase activity indexes and mortality. The proportion of linoleic acid was inversely related, and FAs reflecting saturated fat intake were directly related to mortality.