Search

Zusammenfassung: Mangelernährung ist unter älteren Menschen weitverbreitet und führt aufgrund von Veränderungen der Körperzusammensetzung und -funktion zu zahlreichen negativen klinischen Konsequenzen. Voraussetzung für eine erfolgreiche Prävention oder Therapie ist die frühzeitige Erkennung älterer Personen, die gefährdet sind, eine Mangelernährung zu entwickeln, oder schon davon betroffen sind. In geriatrischen Einrichtungen wird daher ein Mangelernährungsscreening mit einem validierten Instrument (z.B. Mini Nutritional Assessment oder Nutritional Risk Screening) routinemässig und in regelmässigen Abständen empfohlen. Im Falle eines positiven Befunds wird ein anschliessendes Ernährungs-Assessment zur Diagnosebestätigung, zur Ursachenabklärung und zur Bestimmung des Energie- und Proteindefizits durchgeführt, um zielgerichtete ernährungstherapeutische Massnahmen einleiten zu können und dadurch den Ernährungszustand der älteren Personen und damit verbunden die Gesamtprognose zu verbessern.

Background/Objectives The Protein Screener 55 + (Pro55 + ) is a brief food questionnaire to screen older community-dwelling adults for low protein intake. The result is the predicted probability of protein intake Subjects/Methods After translation and pilot-testing, the Pro55+ and the reference standard (3-day dietary record) were completed by 144 participants (81.6 ± 3.9 years, 61.8% female). Discriminative properties were tested by receiver operating characteristic curves and by calculating sensitivity and specificity for different cut-offs of predicted probability (>0.3/>0.5/>0.7) using Results Protein intake was Conclusion The overall discriminative accuracy of the German Pro55+ to identify older community-dwelling people with low protein intake was poor. However, applying different probability cut-offs allows increasing specificity and sensitivity for 0.8 g/kg aBW/d to levels justifying the use for certain purposes e.g. excluding individuals with adequate protein intake. Further validation is needed.

Zusammenfassung Ziel der Studie Subjektive Gründe, Barrieren sowie Unterstützungsbedarfe älterer Menschen mit Adipositas hinsichtlich einer Gewichtsreduktion sind bisher wenig bekannt und wurden daher in einer qualitativen Studie untersucht. Methodik Leitfadengestützte, problemzentrierte Interviews wurden mit 13 Teilnehmenden (selbständig,≥65 Jahre, BMI≥30 kg/m²) geführt und mittels strukturierender und zusammenfassender Inhaltsanalyse nach Mayring ausgewertet. Ergebnisse Fast alle Teilnehmenden nannten sowohl Gründe für (n=5 Kategorien) als auch gegen eine Gewichtsreduktion (n=6 Kategorien). Soziale Einflüsse und Gesundheitsprobleme wurden beiden Bereichen zugeordnet. Weitere Gründe für eine Gewichtsreduktion waren Ästhetik, innerer Druck und Partizipation, weitere Gründe dagegen eine geringere Lebensqualität während der Gewichtsreduktion, Zufriedenheit mit dem aktuellen Gewicht, das Alter sowie Frustration/Resignation aufgrund „gescheiterter“ Gewichtsreduktionen. Als Barrieren wurden physiologische, intrinsische, umweltbezogene und hedonische Aspekte genannt. Hinsichtlich der Gestaltung von Gewichtsreduktionsprogrammen präferierten die Teilnehmenden Gruppenangebote, einfache Maßnahmen und Angebote, die eine Tagesstrukturierung unterstützen. Neben den inhaltliche Komponenten Ernährung, Bewegung und Verhalten wurden Beratung durch Fachkräfte und medizinische Betreuung als wichtig angesehen. Schlussfolgerung Die Berücksichtigung der identifizierten komplexen Gründe, Barrieren und Unterstützungsbedarfe, als Schlüsselkomponenten für Motivation und Adhärenz, könnte zum Erfolg von Lebensstilinterventionen bei älteren Menschen mit Adipositas beitragen und die Wahl patientenzentrierter Zielgrößen unterstützen.

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.

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess in hospitalised older people with (risk of) malnutrition the effects of different nutrition interventions (e.g. supportive interventions, nutritional counselling, food modifications, oral nutritional supplements, comprehensive individualised nutritional interventions or combined approaches) compared to control groups (usual care, placebo or health education materials) on patient-relevant outcomes, and to rank the effects of the different treatments by using a network meta-analysis with individual participant data.

Purpose A poor appetite affects up to 27% of community-dwelling older adults in Europe and is an early predictor of malnutrition. Little is known about the factors associated with poor appetite. The present study, therefore, aims to characterise older adults with poor appetite. Methods As part of the European JPI project APPETITE, data from 850 participants, aged ≥ 70 years of the Longitudinal Ageing Study Amsterdam (LASA) from 2015/16 were analysed. Appetite during the last week was assessed with a five-point scale and dichotomised into "normal" and "poor". Binary logistic regression was used to examine associations between 25 characteristics from 5 domains—physiological, emotional, cognitive, social, and lifestyle—and appetite. First, domain-specific models were calculated using stepwise backward selection. Second, all variables contributing to poor appetite were combined in a multi-domain model. Results The prevalence of self-reported poor appetite was 15.6%. Fourteen parameters from all five single-domain models contributed to poor appetite and were entered into the multi-domain model. Here, female sex (total prevalence: 56.1%, odds ratio: 1.95 [95% confidence interval 1.10–3.44]), self-reported chewing problems (2.4%, 5.69 [1.88–17.20]), any unintended weight loss in the last 6 months (6.7%, 3.07 [1.36–6.94]), polypharmacy defined as ≥ 5 medications in the past 2 weeks (38.4%, 1.87 [1.04–3.39]), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale without appetite item) (1.12 [1.04–1.21]) were associated with an increased likelihood of having poor appetite. Conclusion According to this analysis, older people with the characteristics described above are more likely to have a poor appetite.

Frailty is common in nursing home (NH) residents, but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (1) obtain the prevalence of frailty, (2) investigate the agreement between both instruments, and (3) evaluate their predictive validity for adverse health events in German NH residents.Prospective cohort study.German NH residents (n = 246, age 84 ± 8 years, 67% female).Frailty status was categorized according to FRAIL-NH (nonfrail, frail, most frail) and CFS (not frail, mild to moderately frail, severely frail). Agreement between instruments was examined by Spearman correlation, an area under the receiver operating characteristic curve (AUC) with 95% CI, and sensitivity and specificity using the "most frail" category of FRAIL-NH as reference standard. Adverse health events (death, hospital admissions, falls) were recorded for 12 months, and multivariate cox and logistic regression models calculated.According to FRAIL-NH, 71.1% were most frail, 26.4% frail, and 2.5% nonfrail. According to CFS, 66.3% were severely frail, 26.8% mild to moderately frail, and 6.9% not frail. Both scales correlated significantly (r = 0.78; RFrailty is highly prevalent in German NH residents. Both instruments show good agreement despite different approaches and are able to predict adverse health outcomes. Based on our findings and because of its simple administration, CFS may be an alternative to FRAIL-NH for assessing frailty in NHs.

Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.

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.

Malnutrition is widespread in older people and if not treated leads to numerous negative clinical consequences, such as functional decline and in-hospital complications as well as increased health care costs. Prerequisites for a successful prevention and therapy of malnutrition are the early identification of persons at risk or those affected and a detailed assessment of their nutritional situation. Based on the current literature, this article provides an overview of important aspects considered in the screening and assessment of malnutrition in older people, such as the use of malnutrition screening tools, the application of diagnostic criteria, the quantification of energy and protein deficiencies, the identification of potential causes of malnutrition and the determination of individual preferences and resources.

The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) 27 kg/m2), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m2) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.

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 counteracting 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 modification 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-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. Conclusion: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

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 (

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.

Effective policies to address poor food choices and dietary patterns need to consider the complex set of motives affecting eating behavior. This study examined how different eating motives are associated with anthropometry, body composition, and dietary intake. Our analysis is based on a cross-sectional sample with 429 healthy adults in three different age groups collected in Germany from 2016 to 2018. Dietary intake, Body Mass Index (BMI), waist circumference (WC), and fat-free mass (FFM) were measured by standardized methods. Eating motives were measured using The Eating Motivation Scale (TEMS). Regressing dietary intakes and anthropometric indicators on TEMS motives, we identify the main sources of variation in diet and nutritional status separately for men and women. Results indicated the Health motive to be positively associated with FFM (B±SE=1.72±0.44) and negatively with WC (B±SE=-3.23±0.81) for men. For women, the Need & Hunger motive was positively associated with FFM (B±SE=1.63±0.44) and negatively with WC (B±SE=-2.46±0.81). While Liking and Habits were the most frequently stated eating motives, we did not find them to be significantly related to the nutritional status. Other motives were associated with dietary intake but not anthropometry or body composition. The Price motive was positively and the Convenience motive was negatively associated with energy (B±SE=63.77±19.98;B±SE=-46.96±17.12) and carbohydrate intake (B±SE=7.15±2.65;B±SE=-5.98±2.27) for men. The results highlight the need for more differentiated analyses of eating motives, beyond comparing the relative importance of motives based on mean values, towards the association of motives with dietary intake and nutritional status.

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.

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.

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.

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.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/mOf 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.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.

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.

Malnutrition is widespread in older people and if not treated leads to numerous negative clinical consequences, such as functional decline and in-hospital complications as well as increased health care costs. Prerequisites for a successful prevention and therapy of malnutrition are the early identification of persons at risk or those affected and a detailed assessment of their nutritional situation. Based on the current literature, this article provides an overview of important aspects considered in the screening and assessment of malnutrition in older people, such as the use of malnutrition screening tools, the application of diagnostic criteria, the quantification of energy and protein deficiencies, the identification of potential causes of malnutrition and the determination of individual preferences and resources.

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.