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02/2012 journal articles

EFFECT OF AGAVE FRUCTANS ON SELECTED PARAMETERS OF CALCIUM METABOLISM AND BONE CONDITION IN RATS

E. Cieslik, K. Topolska, W. Praznik, J.M. Cruz Rubio

J Aging Res Clin Practice 2012;1(2):103-108

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Objective: A prevalence of chronic diseases such as osteoporosis is observed because of the increasing life expectancy coming with a backlog of elderly (especially women). In this regard, functional foods containing fructans might play an outstanding role. The aim of the study was to assess the effects of agave fructans on selected parameters of calcium metabolism and bone condition in rats. Design: 28 days, 6 rats for each feeding group. Setting: University of Agriculture in Krakow, Poland. Subjects: 36 male Wistar rats, weighing about 120 g. Intervention: The current work studies the development of Wistar rats (experiment duration: 28 days) by Ca-modulated diet (Ca 100 – recommended doses, Ca 50 – 50% deficiency of doses, Ca 25 – 75% deficiency of doses) with/without agave fructan. The commercial product “Metlin” (Nekutli) - organic fructan from agave was used. After an adaptation period, the rats were distributed into six groups and kept in steel cages under controlled conditions. Finally, the rats were anaesthetized; blood and femora were sampled. Measurements: The levels of Ca2+, inorganic phosphorous, and the activity of alkaline phosphatase in rat blood serum were performed. BMC as well as BMD of femora were determined. Right femora were also scanned with peripheral quantitative computed tomography. The following parameters were determined: cortical thickness, periosteal and endoosteal circumferences as well as polar strength strain index. Statistical analysis was carried out. The Tukey’s-test was used to determine differences between the experimental groups. Results: The level of calcium- and phosphate ions and the biochemical parameters (ICTP, ALP) in the blood are relatively constant with positive trend to higher availability of Ca2+ with agave fructan. The content of calcium in the femur increases clearly in the groups with agave fructan. Additionally the results of femora analysis show a higher stability and density of rat bone with agave fructan, particularly in the Ca 50 group. Conclusion: The results support the assumption that intake of agave fructan could provide the prevention of bone mass loss and bone weakening, what in turn could improve quality of life, by helping prevent osteoporosis.

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INFLUENCE OF AGGREGATION OF VASCULAR RISK FACTORS ON NEUROPSYCHOLOGICAL PERFORMANCE AND WHITE MATTER LESIONS IN EARLY ALZHEIMER’S DISEASE

L.B.G.Tay, M.S. Chong, P.C.M. Chan, Y.Y. Sitoh, W.S. Lim

J Aging Res Clin Practice 2012;1(2):109-114

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Objective: To determine the influence of aggregation of vascular risk factors independent of cerebral infarcts on neuropsychological test performance in individuals with early Alzheimer’s disease (AD), and the mechanisms underlying this association. Methods: This is a cross-sectional study of 67 AD and 32 vascular dementia (VaD) subjects of mild severity, excluding Alzheimer’s disease subjects with a past history of stroke or transient ischemic attack, or who had radiological evidence of infarcts. Subjects with Alzheimer’s disease were stratified into 2 groups based on the number of vascular risk factors: i) AD-RF- (n=45) with 0-2 risk factors, and ii) AD-RF+ (n=22) with 3-5 risk factors. All subjects had undergone neuroimaging, and white matter lesions were graded using the age-related white matter changes (ARWMC) rating scale. We compared the neuropsychological test performance between AD-RF-, AD-RF+ and VaD groups, adjusting for the influence of white matter lesions. Results: AD-RF+ subjects displayed a trend towards greater impairment in amnestic domains relative to AD-RF- and VaD. In addition, AD-RF+ subjects were significantly more impaired than AD-RF- in the non-amnestic domains, being intermediate to VaD in category fluency (p=0.05) and block design (p=0.03), and more impaired than VaD in confrontational naming (p=0.05). There was incremental white matter lesion burden across AD-RF-, AD-RF+ and VaD (p<0.01), with a significant effect on non-amnestic domains. Conclusions: This study has shown that an aggregation of vascular risk factors aggravates impairment in both amnestic and non-amnestic domains in early Alzheimer’s disease, independent of the presence of cerebral infarcts. White matter lesions, especially those in the frontal regions, represent one mechanism underlying this relation.

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A COMPARISON OF ANTHROPOMETRICS, BIOCHEMICAL VARIABLES AND NUTRIENT INTAKE BETWEEN YOUNG AND ELDERLY RURAL PAKISTANI MEN

I. Alam, A. Larbi, G. Pawelec, P. Iqbal Paracha

J Aging Res Clin Practice 2012;1(2):116-124

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Aging health is associated with nutritional changes which are not well understood or investigated in developing countries, and were therefore evaluated in this study by comparing the nutritional status of elderly with young subjects in Peshawar, Pakistan. Subjects: The participants in this study were young and elderly men (n=50 each), represented by each of the four BMI categories (obese, overweight, normal weight, underweight). Methods: Anthropometrics (height, weight, body mass index (BMI), percent body fat (%BF) were measured; nutrient intake was assessed by 24 hr Dietary Recall (24-hr DR); clinical chemistry variables (albumin, total protein, triglycerides, CRP, ferritin) in plasma were analyzed on a Modular Analytics SWA automated analyzer. Results: Our results show no significant differences in mean weight, waist circumference (WC) and waist to hip ratio (WHR) between young and elderly (p ≥0.005). Mean %BF of elderly was significantly (p=0.02) higher than young. Of the sample, 10% and 34%, respectively, of the elderly fall either in high risk categories of WC (HR-WC) or WHR (HR-WHR). Intake of almost all nutrients studied was significantly higher in young compared to elderly (p <0.005). There were differences in plasma factors but only the mean plasma CRP level was significantly higher in the elderly (p=0.0376). With increasing age, there was a significant increase in % BF and CRP (p=0.0160 and 0.0222, respectively) but decrease in energy intake (p= 0.0001). BMI decreased with age but not significantly (p=0.5821). Conclusions: The elderly had relatively poor nutritional status as compared to the young. Great variations existed in WC, WHR, %BF and nutrient intake within different BMI categories of young and elderly. These results suggest almost the same poor nutritional status of elderly as reported in most developed and developing countries.

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PREDICTORS OF 4-YEAR MORTALITY AMONG NONAGENARIANS AND CENTENARIANS IN DUJIANGYAN, CHINA

J.H. Flaherty, B. Dong, H. Wu, G. Liu, Q. Yuan, J. Deng, Y. Zhang, J. Wu, G. Zeng, X. Ren, J. Hu, W. Wu, T. K. Malmstrom

J Aging Res Clin Practice 2012;1(2):125-130

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Objectives: To identify predictors of mortality in a long-lived Chinese population. Design: Four-year follow up mortality data of a previously performed cross-sectional observational study. Setting: Dujiangyan, China. Participants: Eight-hundred eight Han Chinese aged 90-108 years. Measurements: Trained researchers performed face-to-face interviews and physical and geriatric assessments to obtain information on sociodemographic factors, self-reported medical diseases, geriatric-specific conditions, number of hospitalizations and biomedical measurements (systolic/diastolic blood pressure, body mass index (BMI) and blood tests for albumin, fasting glucose, creatinine clearance, hemoglobin and lipid panel). Results: Of 808 participants, 424 (52.5%) died during the 4-year period. In univariate analyses, age, 3 out of 10 medical diseases (osteoarthritis, respiratory illnesses and diabetes), increasing number of medical diseases (comorbidities), 4 out of 8 geriatric-specific conditions (ADL impairment, hearing problems, cognitive impairment and weight loss), and two biomedical measurements (albumin <40.0 g/L; creatinine clearance <1200 mL/s) were significantly associated with mortality. In multivariate Cox regression analysis, none of the medical diseases that were significant in the univariate analyses, nor comorbidities, were associated with mortality. Three geriatric conditions were significant: ADL impairment [hazard ratio (HR) = 1.42, 95% confidence interval (CI) = 1.14-1.78, P=.002], cognitive impairment (HR = 1.51, 95% CI = 1.18-1.92, P=.001) and weight loss (HR = 1.41, 95% CI = 1.05-1.90, P=.022). Female gender (HR =.75, 95% CI =.59-.95, P=.018) also reached statistical significance. Two biomedical measures were significantly associated with mortality: albumin <40.0 g/L (HR=1.39, 95% CI=1.02-1.88) and CrCl <1200 mL/s (HR=1.41, 95% CI=1.06-1.88). Conclusion: Among a long-lived cohort of Chinese, several geriatric conditions (functional disability, cognitive impairment and weight loss) predict mortality. Comorbidities and specific medical diseases do not. Adding objective biomedical measures does not seem to add substantial information to the risk profile for mortality.

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HOSPITAL TO HOME OUTREACH FOR MALNOURISHED ELDERS (HHOME): A FEASIBILITY PILOT

A.M. Mudge, A.M. Young, L.J. Ross, E.A. Isenring, R.A. Scott, A.N. Scott, L. Daniels, M.D Banks

J Aging Res Clin Practice 2012;1(2):131-134

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Objectives: Malnutrition is common in older hospitalised patients, and barriers to adequate intake in hospital limit the effectiveness of hospital-based nutrition interventions. This pilot study was undertaken to determine whether nutrition-focussed care at discharge and in the early post-hospital period is feasible and acceptable to patients and carers, and improves nutritional status. Design: Prospective cohort study. Setting: Internal medicine wards of a tertiary teaching hospital in Brisbane, Australia. Participants: Patients aged 65 and older admitted for at least 3 days, identified as malnourished or at risk of malnutrition using Mini Nutritional Assessment (MNA). Interventions: An interdisciplinary discharge team (specialist discharge planning nurse and accredited practicing dietitian) provided nutrition-focussed education, advice, service coordination and follow-up (home visits and telephone) for 6 weeks following hospitalisation. Measurements: Nutritional intake, weight, functional status and MNA were recorded 6 and 12 weeks after discharge. Service intensity and changes to care were noted, and hospital readmissions recorded. Service feedback from patients and carers was sought using a brief questionnaire. Results: 12 participants were enrolled during the 6 week pilot (mean age 82 years, 50% male). All received 1-2 home visits, and 3-8 telephone calls. Four participants had new community services arranged, 4 were commenced on oral nutritional supplements, and 7 were referred to community dietetics services for follow-up. Two participants had a decline in MNA score of more than 10% at 12 week follow-up, while the remainder improved by at least 10%. Individualised care including community service coordination was valued by participants. Conclusion: The proposed model of care for older adults was feasible, acceptable to patients and carers, and associated with improved nutritional status at 12 weeks for most participants. The pilot data will be useful for design of intervention trials.

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IS MEASURING GRIP STRENGTH ACCEPTABLE TO OLDER PEOPLE? THE SOUTHAMPTON GRIP STRENGTH STUDY

H.C. Roberts, J. Sparkes, H. Syddall, J. Butchart, J. Ritchie, C. Cooper, A.A. Sayer

J Aging Res Clin Practice 2012;1(2):135-140

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Objectives: To evaluate the acceptability of grip strength measurement among older people in different healthcare settings. Design: A cross-sectional study with quantitative and qualitative data collection. Setting: Four healthcare settings in one town in southern England. Participants: 101 community hospital rehabilitation inpatients, 47 community physiotherapy referrals, 57 patients attending a Parkinson’s clinic at the hospital and 100 residents in care homes. Measurements: Grip strength, Barthel score, Mini Mental State Examination and outline questions on the grip measurement process were assessed on all participants. In-depth semi-structured interviews ascertained the views of a sub-sample of 20 participants on grip strength measurement. Results: The instructions were easily understood, most participants did not find the measurement painful or tiring, and almost all were prepared to repeat the assessment. Participants felt that this could be a useful and acceptable routine assessment, which some thought could be an opportunity to improve their health, while others were uncertain whether it would be helpful to be told that they were becoming weaker. Participants were generally accepting of medical assessments and felt that grip measurement was easy, unless there was a problem with an individual’s hand. Conclusions: This is the first study to demonstrate that grip strength measurement is acceptable to older people undergoing rehabilitation, living with a chronic neurological condition or resident in care homes. The high level of acceptability found among older people in different healthcare settings in this study supports the use of grip strength measurement in routine clinical practice.

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A DAIRY-BASED PROTEIN, CALCIUM AND VITAMIN D SUPPLEMENT REDUCES FALLS AND FEMORAL NECK BONE LOSS IN AGED CARE RESIDENTS: A CLUSTER RANDOMISED TRIAL

S. Iuliano-Burns, J. Woods, K. King, A. Ghasem Zadeh, X.-F. Wang, Q. Wang, E. Seeman

J Aging Res Clin Practice 2012;1(2):141-146

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Objectives: To test if a dairy-based protein (9g/d), calcium (600mg/d) and vitamin D (960IU/d) supplement formulated to increase intakes to recommended levels would reduce falls and fracture risk in ambulatory low-level aged care residents. Design: Cluster-randomised, single-blind intervention. Setting: 16 low-level aged care facilities in Melbourne, Australia. Participants: 813 residents (mean age 86.1 ± 5.9 years, 76% female). Intervention: 12 months of observation in all facilities followed by 8 months of food-based supplementation (intervention) or usual intake (controls). Measurments: Number of fallers, and non-vertebral fractures, serum 25(OH)D, PTH, osteocalcin, bone mineral density (BMD), bone structure and volumetric BMD at the distal radius and tibia using high-resolution pQCT, balance (Lord’s balance test) and functionality (timed up and go, walking velocity). Repeated measures ANOVA and logistic regression models were used to compare cases and controls. Results: Among the whole sample, supplementation reduced the number of fallers by 42% (OR = 0.58, 95% CI: 0.44 – 0.78, p < 0.001), Among the 58 participants with follow up data, supplementation prevented bone loss at the proximal femur, maintained serum 25(OH)D and reduced PTH by 16% ± 8%, p < 0.03. Conclusion: Fortifying foods with protein, calcium and vitamin D reduced falls in ambulatory aged care residents and is a widely accessible, and inexpensive approach to potentially reduce falls and slow the progression of bone fragility in the elderly.

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THERAPEUTIC LIGHT AND SLEEPINESS AT MEALS IN WOMEN WITH ALZHEIMER\'S DISEASE

L.A. Etcher, J.E. Davis, H. Yarandi

J Aging Res Clin Practice 2012;1(2):147-150

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Objective: The objective of this study was to determine the effect of therapeutic light on excessive daytime sleepiness (EDS) during meal times in females with Alzheimer's disease (AD) associated dementia. Design: The study employed a two-group experimental design with repeated measures on one of the factors. Participants were randomly assigned to either the experimental group receiving blue-green light (BGL) or the control group receiving dim red light (DRL). Setting: The study was conducted in a long-term care facilities where the study participants were residents. Participants: The sample consisted of 20 females mean age 85.9 (+ 6.24) with AD who were residents in a nursing home for at least six months. Intervention: Timed BGL at 12,000 lux was the experimental condition and timed DRL at 5 lux was the control condition. Light in both conditions was delivered for 30 minutes per day between 6 am - 7 am for 14 consecutive days. Measurements: EDS was measured using the Stanford Sleepiness Scale at mealtimes. Results: Reductions in EDS were' demonstrated in the experimental group post-intervention. Conclusion: Replication studies are needed to support pilot findings. Reducing EDS in AD has the potential to reduce weight loss and maintain nutrition.

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PREDICTORS AND PROGNOSIS OF MALNUTRITION IN OLD PATIENTS IN THE REGION OF MONASTIR (TUNISIA)

S. El Mhamdi, M. Mahjoub, A. Sriha, R. Klai, S. Mahjoub, M. So. Soltanio

J Aging Res Clin Practice 2012;1(2):151-155

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Objective: To identify risk factors associated with malnutrition in old patients and to assess the prognosis of malnourished ones in the region of Monastir (Tunisia). Methods: a cross sectional study was done with 662 elderly (225 inpatients and 437 outpatients). The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The prognosis of malnourished patients was evaluated using the pronostic inflammatory and nutritional index (PINI), and the Geriatric nutritional risk index (GNRI). Results: Among the assessed elderly, 33 (14.7%) inpatients and 11 outpatients (2.5%) were malnourished with a prevalence of 6.7% (CI95% = 4.8 - 8.6). The multivariate analysis showed that inpatients, singles and with comorbidities were significantly more likely to develop a malnutrition (adjusted odds ratio ranged from 2.18 to 7.25). Results of the prognosis scores showed that 35.2 and 25% of malnourished patients were at higher risk of complications according to PINI and GNRI respectively. Conclusion: We suggested that nutritional status should ideally be assessed in every patient. Screening systematically for malnutrition at high risk in-and outpatient departments should be considered. We also feel that our findings highlight the need for a nutritional intervention trial among at risk and malnourished hospitalized patients.

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NUTRITION MEDPASS IS AN EFFECTIVE APPROACH TO ORAL NUTRITIONAL SUPPLEMENTATION TO INCREASE ELDERLY MALNOURISHED PATIENTS INTAKE AND COMPLIANCE AND IMPROVE NUTRITION STATUS AND OUTCOMES

F. García-Gollarte, R. Muñoz-Fernández, S. Coucheiro-Vilar, V. Herrando-Sanchís, T. Turró-Ribalta, G. Enrich-Pola, M.L. Orera-Peña

J Aging Res Clin Practice 2012;1(2):156-161

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Background: Nutritional problems are common in the elderly population, particularly in institutional settings. Previous studies have shown that the use of a medication Medpass oral nutritional supplement program improves the nutritional status of these patients. Objectives: To assess the beneficial effects of a nutrition MedPass program on body weight and nutritional status in malnourished subjects over 65 years. Design: Prospective, observational, open-label study. Setting: Long-term care hospitals and nursing homes, Spain. Participants: Institutionalized patients who are malnourished or at risk for malnutrition (n = 495). Measurements: Malnutrition was defined by the Malnutrition Screening Tool (MST). The primary endpoints were changes in weight (kg) and body mass index (BMI) (kg/m2) from baseline to 8 weeks. Daily record of oral nutritional supplement (ONS) intake. Secondary endpoints included albumin and total protein. Results: We analyzed 495 evaluable patients valid for intention--to-treat (ITT) analysis and 339 for the per-protocol (PP) analysis. At each weekly study visit and at the end of the study, statistically significant differences (p < 0.001) were found in weight, BMI and secondary variables (albumin and total protein levels) when compared to baseline, both in the ITT and the PP analysis. The average increase in body weight (mean ± SD) increase was 2 ± 2 kg for PP analysis; 76.1% of participants (n = 258) achieved a weight gain exceeding 1 kg in the PP analysis. Conclusions: The use of a MedPass program improved the nutritional status of elderly patients who are malnourished or at risk for malnutrition, as indicated by increased body weight and BMI.

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ENDOMETRIOSIS AND NUTRITION – RECOMMENDING A MEDITERRANEAN DIET DECREASES ENDOMETRIOSIS-ASSOCIATED PAIN: AN EXPERIMENTAL OBSERVATIONAL STUDY

J. Ott, K. Nouri, D. Hrebacka, S. Gutschelhofer, J.C. Huber, R. Wenzl

J Aging Res Clin Practice 2012;1(2):162-166

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Objective: Typical treatments for endometriosis are either medical therapy or surgery. Our objective was to test whether a diet that closely followed Mediterranean nutritional recommendations would affect endometriosis-associated pain. Design: Prospective, experimental, observational study. Setting: Academic research institution. Participants: 68 women with laparoscopically diagnosed endometriosis. Interventions: Patients had to adhere to a nutrition regimen which included fresh vegetables and fruit, white meat, fish rich in fat, soy products, wholemeal products, foods rich in magnesium, and cold pressed oils; sugary drinks, red meat, sweets, and animal fats had to be avoided. Measurements: Change in subjective pain sensation, as measured by a Numeric Rating Scale (NRS; 0=“no pain;” 10=“very strong pain”) after five months of diet. Results: Forty-three patients (63.2%) adhered to the nutrition regimen for over five months. The intention-to-treat analysis that included all patients showed a significant improvement of general pain symptoms based on the NRS (4.2±2.5 to 2.5±2.4; p<0.01). The group of patients who adhered to the study protocol (n=43, 63.2%) experienced a mean improvement in pain, with a NRS score from 4.2±3.0 to 2.0±2.3 (p<0.01). For the intention-to-treat group, a mean improvement was found in general condition, with a NRS score from 6.4±1.9 to 8.2±1.8 (p<0.01). For the study protocol group, NRS declined from 6.7±2.2 to 8.5±1.7 (p<0.01). Patients in the study protocol group also experienced significant improvement in dysmenorrhea, dyspareunia, and dyschezia (p<0.01). Conclusion: Endometriosis-associated pain symptoms may be influenced positively by a Mediterranean diet.

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METABOLIC SYNDROME IN POST-MENOPAUSAL WOMEN FROM AN OTOMI ETHNIC GROUP: PREVALENCE OBTAINED THROUGH THREE CRITERIA

R. Cruz-Lumbreras, F. Luna-Vazquez, J. Rodríguez-Antolín, P. Pacheco, F. Castelán, M. Martínez-Gómez, E. Cuevas

J Aging Res Clin Practice 2012;1(2):167-172

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Objective: To determine the prevalence of metabolic syndrome (MS) in post-menopausal Otomi women from Tlaxcala, México. Design: Cross sectional study. Setting: Non-institutionalized active women living in Ixtenco, Tlaxcala. Participants: 139 women aged 43-93. Measurements: MS was determined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III), the American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (AHA/NHLBI), and the International Diabetes Foundation (IDF) criteria. Fisher's exact tests and logistic regression analyses were done to examine associations of MS and other metabolic illness with the variables of interest. Results: According to ATP III, AHA/NHLBI, and IDF criteria, 58.3%, 73.4%, and 70.5% of participants were identified with MS, respectively. Means of weight, body mass index (IBM), waist circumference (WC), fasting glucose, serum insulin, systolic pressure, and serum triglycerides were significantly high in women with MS, independently of the diagnostic criterion. Logistic regression analyses showed that the risk to have type 2 diabetes (DM) of participants with MS was big using the AHA/NHLBI criterion. Younger had a bigger risk to present DM, insulin resistance, overweight-obesity, and MS using the IDF criterion than older women. Neither the presence of MS nor other metabolic variables were affected by stature of participants. Conclusion: Prevalence of MS in Otomi post-menopausal women was high independently of the diagnostic criterion, although it was low in the oldest women at same time that obesity decreased. Efforts are needed to ensure if genetic and environmental conditions are implicated in this high prevalence.

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THE RELATIONSHIP BETWEEN WEIGHT STATUS AND THE NEED FOR HEALTH CARE ASSISTANCE IN NURSING HOME RESIDENTS

A.M.Beck, K. Damkjær, S.F. Simmons

J Aging Res Clin Practice 2012;1(2):173-177

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Objective: The purpose of this study was to evaluate the relationship between underweight status and weight loss events on the need for health care assistance among a sample of Danish nursing home residents over 12-months. Design: Longitudinal, repeated measures design with three data collection points at baseline (2004) and six and 12 months post baseline. Setting: 11 Danish nursing home facilities. Participants: 441 Danish nursing home residents over the age of 65. Measurements: Resident Assessment Instrument (RAI-NH) data were abstracted for each participant at each of three data collection points. RAI-NH data related to facility staff ratings of residents’ physical functioning (Activities of Daily Living, ADL) status and their need for health care staff assistance related to ADLs were collected at each time point in addition to the resident weight status and experience of weight loss according to three criterion (i.e., > 1%, >5% or >10% of baseline body weight at 6 or 12 months) and Body Mass Index (BMI) values. Results: Low BMI (< 18.5) and weight loss were both significantly associated with the need for staff assistance with ADLs during a 12-month timeframe. Conclusion: The results of this study suggest that elderly nursing home residents with a low BMI or weight loss may add to the substantial and costly burden of nursing home care due to the associated need for higher levels of ADL assistance.

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WERNICKE’S ENCEPHALOPATHY AS A COMPLICATION OF CHAGAS MEGA ESOPHAGUS

F. Magalhães Scoralick, L.L. Louzada, M.A.Toledo, M. Ruback

J Aging Res Clin Practice 2012;1(2):178-180

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he Wernicke-Korsakoff syndrome (WKS) is a potentially lethal disease that is associated with vitamin B1 (thiamin) deficiency. It is characterized by disordered mental status, memory deficits, psychosis, ophtalmoplegia and ataxic gait. The WKS is associated with alcohol use in about 90% of the patients. This report adds the possibility of developing vitamin B1 deficiency and WKS in patients with chagasic mega esophagus. The authors describe a case of a 63 year old man with grade IV chagasic mega esophagus. There was no past use of alcohol. He was admitted to the emergency unit of the Brasilia University Hospital with a history of acute diarrhea, altered mental status, disordered ocular movements, flaccid tetraparesis and abolished deep tendon reflexes. The plasma levels of thiamin were markedly reduced and in the magnetic resonance of the brain there were alterations usually found in acute Wernicke encephalopathy. This report highlights the possibility of considering patients with chagasic mega esophagus as at risk for developing vitamin B1 deficiency and WKS.

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