Development of a protein energy malnutrition screening tool for older Thais in public residential homes

2021 ◽  
pp. 1-30
Author(s):  
Thitima Phodhichai ◽  
Warapone Satheannoppakao ◽  
Mathuros Tipayamongkholgul ◽  
Carol Hutchinson ◽  
Siriphan Sasat
Keyword(s):  
Logistic Regression ◽  
Serum Albumin ◽  
Performance Test ◽  
Screening Tool ◽  
Phase 1 ◽  
Protein Energy Malnutrition ◽  
Multiple Logistic Regression ◽  
Cross Sectional ◽  
Residential Homes ◽  
Protein Energy

Abstract Objective: This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and test its practicality. Design: This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-hour recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analyzed by Chi-square test, Fisher’s exact test, t-test, Mann-Whitney U test, and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model. Setting: Four public residential homes in central region, Thailand. Participants: 249 older residents residing in public residential homes and eight intended users. Results: 26∙9% had PEM (serum albumin <3∙5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥9 types of medicine daily. These predictors were included in PEM screening tool. Regarding tool performance test, area under the ROC curve was 0∙8 (P<0∙001) with sensitivity and specificity of 83∙9 and 45∙5%, respectively. For its practicality, eight intended users reported that it was useful and easy to use. Conclusions: New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.

scholarly journals Aflatoxins in body fluids and food of Nigeria children with protein-energy malnutrition

2012 ◽  
Vol 12 (53) ◽  
pp. 6553-6566
Author(s):  
GC Onyemelukwe ◽  
◽  
D Ogoina ◽  
GE Ibiam ◽  
GH Ogbadu
Keyword(s):  
Protein Energy Malnutrition ◽  
Cross Sectional Study ◽  
Body Fluids ◽  
The Body ◽  
Healthy Controls ◽  
Cross Sectional ◽  
Detection Rates ◽  
Nigerian Children ◽  
Protein Energy ◽  
Patient Groups

Aflatoxins are natural contaminants of food crops implicated in the pathogenesis of various human diseases. This study aimed to determine the associations between aflatoxins and protein- energy malnutrition ( PEM) by measurements of aflatoxins in serum, urine and food on plate of Nigerian children with PEM. A cross - sectional study was undertaken in 3 agro - ecological regions of Nigeria (Guinea savannah, Sudan savannah and Rain forest), where aflatoxins B1 , B2, G1, G2, M1, and M2 were measured in sera, urine and food on plate of 79 children with PEM (kwashiorkor n=36, marasmic kwashiorkor n=29 and marasmus n=13) and 33 healthy controls, matched for age and sex. Among healthy controls, aflatoxin detection rates were higher in the Guinea Savannah (72.2%) than in the Sudan Savannah (53.8%), albeit statistically insignificant. In relation to nutritional groups, the rates of detection of aflatoxins were higher in marasmic kwashiorkor (93.1%) and kwashiorkor patients (88.9%) , compared to marasmus (76.9%) and controls (63.6%, p=0.013). The rates of detection of B1 aflatoxin followed a similar trend viz. marasmic kwashiorkor (82.4%), kwashiorkor (69.4%), marasmus (53.8%) and controls (42.4%, p=0.007). Of all types of aflatoxins detected in serum, M2 had the highest rates of detection in all patient groups and controls. The median concentrations of aflatoxins detected in sera of each PEM group were significantly higher than those of controls, but comparisons between PEM groups were not statistically significant. The frequency and concentration of aflatoxins detected in urine and food of PEM groups and controls were not statistically different. However, controls had the lowest serum / urine aflatoxin ratio as well as lowest median aflatoxins concentrations in their food as compared to PEM patient s. In conclusion, aflatoxins are commonly detected in the body fluids and food of Nigerian children , but more frequently and at higher concentrations in children with PEM , possibly due to decreased excretion or increased exposure. Future prospective studies are desirable to determine if aflatoxins contribute to the pathogenesis of all types of PEM and not necessarily kwashiorkor alone.

scholarly journals Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older

2015 ◽  
Author(s):  
Robert Robinson
Keyword(s):  
Risk Factor ◽  
Serum Albumin ◽  
Hospital Readmission ◽  
Lymphocyte Count ◽  
Protein Energy Malnutrition ◽  
Total Lymphocyte Count ◽  
Total Lymphocyte ◽  
Protein Energy ◽  
Patients At Risk ◽  
Low Serum

Introduction: Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission. Materials and Methods: All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge. Results: The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan-Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI: 2.30-4.63) and higher DRG weight (Hazard Ratio 1.19, 95% CI: 1.03-1.38) to be significant independent predictors of hospital readmission within 30 days. Discussion: This study investigated the relationship of PEM to the rate of hospital readmission within 30 days of discharge in patients 65 years of age or older. These results indicate that laboratory markers of PEM can identify patients at risk of hospital readmission within 30 days of discharge. This risk determination is simple and identifies a potentially modifiable risk factor for readmission: protein energy malnutrition.

scholarly journals Prevalence of nutritional deficiencies among school going adolescents of Vadodara, Gujarat, India: a cross sectional study

2019 ◽  
Vol 6 (6) ◽  
pp. 1767
Author(s):  
Ashish Shamjibhai Bhalsod ◽  
Nisarg N. Dave ◽  
Nilesh Thakor
Keyword(s):  
Vitamin A Deficiency ◽  
Protein Energy Malnutrition ◽  
Cross Sectional Study ◽  
Nutritional Deficiencies ◽  
Growth Spurt ◽  
Cross Sectional ◽  
Male Adolescents ◽  
Protein Energy ◽  
Complex Deficiency ◽  
Fatty Acid Deficiency

Background: Adolescent constitutes over 23% of the population in India. Critical development occurs during adolescence period. Growth spurt and increase in physical activity during adolescent period increases the nutrition and health needs of the adolescent. Objective was to study prevalence of nutritional deficiencies among school going adolescents of Vadodara city, Gujarat.Methods: The study was carried during period from September 2018 to August 2019. After taking the permission of principals of 3 schools and consent of the parents of adolescents, 511 adolescents from 3 schools of Vadodara city were examined for signs of various nutritional deficiencies. The data was collected by predesign, pretested proforma and analyzed using SPSS 17.0 (Trial Version).Results: Out of total 511 adolescents 253(49.5%) were female. Mean age of the study adolescents was 15.6±1.81 years. Maximum numbers of the adolescents were in the age group of 10-14 years (60.3%). Mean age of female and male adolescents was 15.2±1.71 years and 15.6±2.01 years respectively. The study revealed that vitamin A deficiency was present in 38(7.4%) adolescents. Vitamin B complex deficiency signs were seen in 112(21.9%) adolescents. Vitamin C deficiency signs were seen in 43(8.4%) adolescents. Protein Energy Malnutrition was observed in 52(10.1%) adolescents. Essential fatty acid deficiency was observed in 56(10.9%) adolescents.Conclusions: High prevalence of nutritional deficiencies among these adolescents needs great attention and health education.

MO510OLFACTORY AND GUSTATORY DYSFUNCTION AMONG PATIENTS WITH KIDNEY IMPAIRMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Api Chewcharat ◽  
Elizabeth Phipps ◽  
Khushboo Bhatai ◽  
Sagar Nigwekar
Keyword(s):  
Serum Albumin ◽  
Grip Strength ◽  
Kidney Function ◽  
Protein Energy Malnutrition ◽  
Cross Sectional Study ◽  
Olfactory Dysfunction ◽  
Food Aversion ◽  
Lower Serum ◽  
Cross Sectional ◽  
Poor Appetite

Abstract Background and Aims Poor appetite and food aversion are common in chronic kidney disease patients. Olfactory and gustatory function changes might be attributed to poor appetite among this population. Nevertheless, the associations between impaired kidney function and olfactory and gustatory dysfunction are less clear. Moreover, the prevalences of olfactory and gustatory dysfunction among patients with impaired kidney function have not been reported. Method We conducted a cross-sectional study among 3,529 US adults aged ≥ 40 years old in the National Health and Nutrition Examination Survey (NHANES) 2013-2014. We calculated the prevalences of olfactory and gustatory dysfunction among patients with impaired kidney function aged ≥ 40 years old by using analytic survey weights and design factors. We also examined the association between impaired kidney function and olfactory and gustatory dysfunction as well as the association between olfactory and gustatory dysfunction and nutritional markers among patients with impaired kidney function using weighted multivariable linear regression and logistic regression. Results The prevalences of olfactory impairment and gustatory dysfunction among impaired kidney function participants were 25% and 14%, respectively. After adjusting for confounders, impaired kidney function was significantly associated with higher odds of olfactory dysfunction (OR = 1.29, 95% CI [1.03, 1.60]; p=0.04) but not gustatory dysfunction (OR = 1.41, 95%CI [0.96, 2.09]; p=0.08). Among impaired kidney function population, olfactory dysfunction was significantly associated with lower serum albumin and grip strength but not serum total cholesterol, LDL-cholesterol or protein-energy malnutrition. However, gustatory dysfunction was not significantly associated with any nutritional markers among the impaired kidney function population. (Figure 1) Conclusion Impaired kidney function was associated with higher odds of olfactory but not gustatory dysfunction. Among those with impaired kidney function, only olfactory but not gustatory dysfunction was associated with lower serum albumin and grip strength.

scholarly journals Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

2019 ◽  
Vol 45 (3) ◽  
pp. 640-660 ◽  
Author(s):  
Johanna T. Dwyer ◽  
Jaime J. Gahche ◽  
Mary Weiler ◽  
Mary Beth Arensberg
Keyword(s):  
Older Adults ◽  
Predictive Validity ◽  
Screening Tool ◽  
Protein Energy Malnutrition ◽  
The United States ◽  
Community Dwelling ◽  
Screening Tools ◽  
World Health ◽  
Community Settings ◽  
Protein Energy

Abstract Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

scholarly journals Midnight salivary cortisol secretion and the use of antidepressants were associated with abdominal obesity in women with type 1 diabetes: a cross sectional study

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Eva Olga Melin ◽  
Magnus Hillman ◽  
Maria Thunander ◽  
Mona Landin-Olsson
Keyword(s):  
Type 1 Diabetes ◽  
Logistic Regression ◽  
Abdominal Obesity ◽  
Salivary Cortisol ◽  
Cross Sectional Study ◽  
Cortisol Secretion ◽  
Multiple Logistic Regression ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background Abdominal obesity is a risk factor for cardiovascular disease. The aim was to explore the influence of midnight salivary cortisol (MSC), antidepressants and sex on abdominal obesity in type 1 diabetes (T1D). We controlled for physical inactivity, smoking, depression and alexithymia. Methods Cross sectional study of 190 T1D patients (86 women/104 men, 18–59 years, diabetes duration 1–55 years), consecutively recruited from one specialist diabetes outpatient clinic. Anthropometrics, blood pressure, saliva and blood samples were collected, supplemented with data from electronic medical records. Depression and alexithymia were assessed by self-report instruments. MSC (nmol/l) was categorised into 3 levels: high MSC: (≥ 6.7) (n = 64); intermediate MSC: ≥ 3.7− < 6.7) (n = 64); low MSC (< 3.7) (n = 62). Abdominal obesity was defined as waist circumference (meters) ≥ 0.88 for women and as ≥ 1.02 for men. Multiple logistic regression analyses (Backward: Wald) were performed. The Hosmer and Lemeshow test for goodness-of-fit and Nagelkerke R2 were used to evaluate each multiple logistic regression analysis model. Results The prevalence of abdominal obesity was three times higher in the women than in the men (24% versus 8%) (p = 0.002). Antidepressants were used by 10% of the women and by 4% of the men (p = 0.09). The prevalence of high MSC was 1.7 times higher in the women (43% versus 26%); the prevalence of both intermediate MSC (28% versus 38%) and low MSC (29% versus 36%) were lower in the women (p = 0.048). Significant associations with abdominal obesity were for all 190 patients: female sex (adjusted odds ratio (AOR) 3.4 (confidence interval (CI) 1.4–8.2)) and the use of antidepressants (AOR 4.3 (CI 1.2–14.8)); for the 86 women: high MSC (AOR 18.4 (CI 1.9–181)) and use of antidepressants (AOR 12.2 (CI 2.0–73.6)); and for the 104 men: alexithymia (AOR 5.2 (CI 1.1–24.9)). Conclusions Clear sex differences were demonstrated with a distinct higher prevalence of abdominal obesity, as well as a distinct higher prevalence of high midnight salivary cortisol in the women with type 1 diabetes. High midnight salivary cortisol secretion and the use of antidepressants were independent risk factors for abdominal obesity in the women.

scholarly journals Relationship between obesity indices and hypertension among middle-aged and elderly populations in Taiwan: a community-based, cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031660 ◽  
Author(s):  
Yen-An Lin ◽  
Ying-Jen Chen ◽  
Yu-Chung Tsao ◽  
Wei-Chung Yeh ◽  
Wen-Cheng Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Cross Sectional Study ◽  
Multiple Logistic Regression ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Elderly Populations ◽  
Obesity Indices ◽  
Northern Taiwan

ObjectiveObesity and hypertension (HTN) have become increasingly prevalent in Taiwan. People with obesity are more likely to have HTN. In this study, we evaluated several anthropometric measurements for the prediction of HTN in middle-aged and elderly populations in Taiwan.DesignCross-sectional observational study.SettingCommunity-based investigation in Guishan Township of northern Taiwan.ParticipantsA total of 396 people were recruited from a northern Taiwan community for a cross-sectional study. Anthropometrics and blood pressure were measured at the annual health exam. The obesity indices included body mass index (BMI), body fat (BF) percentage and waist circumference (WC).Outcome measuresStatistical analyses, including Pearson’s correlation, multiple logistic regression and the area under ROC curves (AUCs) between HTN and anthropometric measurements, were used in this study.ResultsOf the 396 people recruited, 200 had HTN. The age-adjusted Pearson’s coefficients of BMI, BF percentage and WC were 0.23 (p<0.001), 0.14 (p=0.01) and 0.26 (p<0.001), respectively. Multiple logistic regression of the HTN-related obesity indices showed that the ORs of BMI, BF percentage and WC were 1.15 (95% CI 1.08 to 1.23, p<0.001), 1.07 (95% CI 1.03 to 1.11, p<0.001) and 1.06 (95% CI 1.03 to 1.08, p<0.001), respectively. The AUCs of BMI, BF percentage and WC were 0.626 (95% CI 0.572 to 0.681, p<0.001), 0.556 (95% CI 0.500 to 0.613, p=0.052) and 0.640 (95% CI 0.586 to 0.694, p<0.001), respectively.ConclusionsWC is a more reliable predictor of HTN than BMI or BF percentage. The effect of abdominal fat distribution on blood pressure is greater than that of total BF amount.

scholarly journals Sugar-Containing Beverages Consumption and Obesity in Children Aged 4–5 Years in Spain: the INMA Study

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1772 ◽  
Author(s):  
Sandra Gonzalez-Palacios ◽  
Eva-María Navarrete-Muñoz ◽  
Manoli García-de-la-Hera ◽  
Laura Torres-Collado ◽  
Loreto Santa-Marina ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Preschool Children ◽  
Confidence Interval ◽  
Soft Drinks ◽  
Multiple Logistic Regression ◽  
Obese Children ◽  
Odds Ratios ◽  
Cross Sectional ◽  
Obesity In Children

The consumption of sugar-containing beverages (SCB) has been associated with obesity although the evidence in preschool children is scarce. Cross-sectional analyses were performed to assess the association between obesity and SCB consumption (packaged juices and sugar-sweetened soft drinks) in 1823 children at the age of 4–5 years from the INfancia y Medio Ambiente (INMA) Project. One drink was defined as a glass of 175 mL, and the consumption of SCB was categorized in <1, 1–7 drinks/week and > 1 drink/day. We used multiple logistic regression to estimate odds ratios (OR). The average SCB consumption was 79.1 mL/day, mainly from packaged juices (80.9%). The SCB consumption was lower in non-obese children than in children with obesity, 76.6 vs 118.4 mL/day (p = 0.02). After adjusting for covariates, children who consumed >1 drink/day showed elevated odds of obesity, OR = 3.23 (95% confidence interval (CI): 1.48–6.98) compared to children who consumed <1 SCB drink a week. Each additional SCB drink per day was associated with higher odds of obesity, OR = 1.55 (1.14–2.09). Higher consumption of packaged juices, but not sugar-sweetened soft drinks, was significantly associated with higher odds of obesity, OR = 1.55 (1.09–2.15) and OR = 1.59 (0.76–3.39), respectively. A higher SCB consumption is associated with obesity in preschool children, mainly due to the consumption of packaged juices.

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