Nutritional Status and Sarcopenia in Nursing Home Residents: A Cross-Sectional Study

Nan Hua, Yifan Zhang, Xiangmin Tan, Li Liu, Yihan Mo, Xuemei Yao, Xiuhua Wang, James Wiley, Xiaoqing Wang, Nan Hua, Yifan Zhang, Xiangmin Tan, Li Liu, Yihan Mo, Xuemei Yao, Xiuhua Wang, James Wiley, Xiaoqing Wang

Abstract

Objective: This study aimed to assess the nutritional status and sarcopenia in older people living in nursing homes.

Methods: This cross-sectional study enrolled 386 older adults in nursing homes in Hunan Province, China. Assessments included the Mini Nutritional Assessment Short Form for nutrition risk, Dietary Diversity Score for dietary diversity and Mini Mental State Examination for cognitive status. Sociodemographic (e.g., age, sex and educational level), health-related characteristics (e.g., food intake, self-care status and medication), body composition (e.g., body mass index [BMI], protein, body fat mass [BFM], percent body fat [PBF], skeletal muscle index [SMI] and total body water [TBW]) and anthropometric parameters data (e.g., calf circumference [CC], upper arm circumference [UAC], handgrip and gait speed) were also collected. Malnutrition and their associated risk were analyzed by multivariable Poisson regression analysis.

Results: In total, 32.4% of participants (n = 125) were at risk of malnutrition and 49.7% (n = 192) suffered from sarcopenia. Nutritional status was positively associated with age (risk ratio [RR] = 1.03), sarcopenia (RR = 1.88), tooth loss affecting food intake (RR = 1.45), low self-care status (RR = 1.82) and moderate/inadequate dietary diversity (RR = 2.04) and negatively associated with one child (RR = 0.27), BMI (RR = 0.82), protein (RR = 0.76), BFM (RR = 0.91), PBF (RR = 0.94), SMI (RR = 0.65), TBW (RR = 0.94), CC (RR = 0.89) and UAC (RR = 0.86).

Conclusions: Age, number of children, sarcopenia, food intake, self-care status, dietary diversity and body composition were associated with malnutrition among nursing home residents. For vulnerable groups, researchers should focus on raising the body composition indicators, such as BMI, protein, BFM, SMI and TBW and measuring CC and UAC for initial screening.

Keywords: nursing homes; nutrition; older adults; risk factors; sarcopenia.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. WHO Aging and Health. [(accessed on 1 September 2022)]. Available online: .
    1. Ge Y.F., Wang L.J., Feng W.M., Zhang B.Z., Liu S.L., Ke Y.H. Challenges and Strategic Options for Healthy Aging in China. J. Manag. World. 2020;7:2002611. doi: 10.19744/j.cnki.11-1235/f.2020.0055.
    1. Shimoda T., Suzuki T., Takahashi N., Tsutsumi K., Samukawa M., Yoshimachi S., Goto T., Enomoto H., Kise N., Ogasawara K., et al. Nutritional Status and Body Composition of Independently Living Older Adults in a Snowy Region of Japan. Gerontol. Geriatr. Med. 2017;3:2333721417706854. doi: 10.1177/2333721417706854.
    1. Park Y.S., Hong H.P., Ryu S.R., Lee S., Shin W.S. Effects of textured food masticatory performance in older people with different dental conditions. BMC Geriatr. 2022;22:384. doi: 10.1186/s12877-022-03064-w.
    1. Hägglund P., Gustafsson M., Lövheim H. Oropharyngeal dysphagia and associated factors among individuals living in nursing homes in northern Sweden in 2007 and 2013. BMC Geriatr. 2022;22:421. doi: 10.1186/s12877-022-03114-3.
    1. Park H.S., Kim D.K., Lee S.Y., Park K.H. The effect of aging on mastication and swallowing parameters according to the hardness change of solid food. J. Texture Stud. 2017;48:362–369. doi: 10.1111/jtxs.12249.
    1. Chen X., Yang S., Zhao H., Li R., Luo W., Zhang X. Self-Efficacy, Exercise Anticipation and Physical Activity in Elderly: Using Bayesian Networks to Elucidate Complex Relationships. Patient Prefer Adher. 2022;16:1819–1829. doi: 10.2147/PPA.S369380.
    1. Beck A.M., Dent E., Baldwin C. Nutritional intervention as part of functional rehabilitation in older people with reduced functional ability: A systematic review and meta-analysis of randomised controlled studies. J. Hum. Nutr. Diet. 2016;29:733–745. doi: 10.1111/jhn.12382.
    1. Gordon A.L., Franklin M., Bradshaw L., Logan P., Elliott R., Gladman J.R. Health status of UK care home residents: A cohort study. Age Ageing. 2014;43:97–103. doi: 10.1093/ageing/aft077.
    1. O’Shea E., Trawley S., Manning E., Barrett A., Browne V., Timmons S. Malnutrition in Hospitalised Older Adults: A Multicentre Observational Study of Prevalence, Associations and Outcomes. J. Nutr. Health Ageing. 2017;21:830–836. doi: 10.1007/s12603-016-0831-x.
    1. Lutz M., Petzold G., Albala C. Considerations for the Development of Innovative Foods to Improve Nutrition in Older Adults. Nutrients. 2019;11:1275. doi: 10.3390/nu11061275.
    1. Volkert D., Beck A.M., Cederholm T., Cereda E., Cruz-Jentoft A., Goisser S., de Groot L., Großhauser F., Kiesswetter E., Norman K., et al. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J. Clin. Med. 2019;8:974. doi: 10.3390/jcm8070974.
    1. Kruizenga H., van Keeken S., Weijs P., Bastiaanse L., Beijer S., Huisman-de Waal G., Jager-Wittenaar H., Jonkers-Schuitema C., Klos M., Remijnse-Meester W., et al. Undernutrition screening survey in 564,063 patients: Patients with a positive undernutrition screening score stay in hospital 1.4 d longer. Am. J. Clin. Nutr. 2016;103:1026–1032. doi: 10.3945/ajcn.115.126615.
    1. Chai P.P., Zhang Y.H., Wan Q., Wang X.F., Fang Z.D., Zhang M. The economic burden of disease in malnutrition in the elderly in China. Chin. Health Econ. 2016;27:407–417. doi: 10.7664/CHE20160303.
    1. Zhang Y.H., Fan L.L., Chai P.P., Partridge J., Xu L., Li X.Q., Goates S. Analysis of the impact of geriatric malnutrition on treatment service utilization and costs. Chin. Health Econ. 2017;6:e000471.
    1. Rasheed S., Woods R.T. An investigation into the association between nutritional status and quality of life in older people admitted to hospital. J. Hum. Nutr. Diet. 2014;27:142–151. doi: 10.1111/jhn.12072.
    1. Leslie W., Hankey C. Aging, Nutritional Status and Health. Healthcare. 2015;3:648–658. doi: 10.3390/healthcare3030648.
    1. Cruz-Jentoft A.J., Baeyens J.P., Bauer J.M., Boirie Y., Cederholm T., Landi F., Martin F.C., Michel J.P., Rolland Y., Schneider S.M., et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–423. doi: 10.1093/ageing/afq034.
    1. Dhillon R.J., Hasni S. Pathogenesis and Management of Sarcopenia. Clin. Geriatr. Med. 2017;33:17–26. doi: 10.1016/j.cger.2016.08.002.
    1. Donini L.M., Busetto L., Bauer J.M., Bischoff S., Boirie Y., Cederholm T., Cruz-Jentoft A.J., Dicker D., Frühbeck G., Giustina A., et al. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clin. Nutr. 2020;39:2368–2388. doi: 10.1016/j.clnu.2019.11.024.
    1. Government C. Aging Career Development and Elderly Service System Planning. [(accessed on 1 September 2022)]; Available online: .
    1. Kaiser M.J., Bauer J.M., Rämsch C., Uter W., Guigoz Y., Cederholm T., Thomas D.R., Anthony P.S., Charlton K.E., Maggio M., et al. Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment. J. Am. Geriatr. Soc. 2010;58:1734–1738. doi: 10.1111/j.1532-5415.2010.03016.x.
    1. Mao Y.J., Wu J.Q., Liu G.X., Hu S., Chen B., Liu J., Wang J.Y., Yu P.L., Zhang C.T., Wu J.H. Chinese expert consensus on prevention and intervention for theelderly with malnutrition (2022) Chin. J. Geriatr. 2022;5:191–203. doi: 10.3760/cma.j.issn.0254-9026.2022.07.001.
    1. Huppertz V.A.L., Halfens R.J.G., van Helvoort A., de Groot L., Baijens L.W.J., Schols J. Association between Oropharyngeal Dysphagia and Malnutrition in Dutch Nursing Home Residents: Results of the National Prevalence Measurement of Quality of Care. J. Nutr. Health Ageing. 2018;22:1246–1252. doi: 10.1007/s12603-018-1103-8.
    1. Sahin S., Tasar P.T., Simsek H., Çicek Z., Eskiizmirli H., Aykar F.S., Sahin F., Akcicek F. Prevalence of anemia and malnutrition and their association in elderly nursing home residents. Ag. Clin. Exp. Res. 2016;28:857–862. doi: 10.1007/s40520-015-0490-5.
    1. Hickson M. Malnutrition and ageing. Postgrad Med. J. 2006;82:2–8. doi: 10.1136/pgmj.2005.037564.
    1. Davidson J., Getz M. Nutritional risk and body composition in free-living elderly participating in congregate meal-site programs. J. Nutr. Elder. 2004;24:53–68. doi: 10.1300/J052v24n01_04.
    1. Guigoz Y., Vellas B., Garry P.J. Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr. Rev. 1996;54:S59–S65. doi: 10.1111/j.1753-4887.1996.tb03793.x.
    1. Group C.M.A.G.N.S. Guidelines for the application of parenteral and enteral nutrition in elderly Chinese patients. Chin. J. Geriatr. 2020;24:336–346. doi: 10.3760/cma.j.issn.0254-9026.2020.02.002.
    1. Rubenstein L.Z., Harker J.O., Salvà A., Guigoz Y., Vellas B. Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF) J. Gerontol. Biol. Sci. Med. Sci. 2001;56:M366–M372. doi: 10.1093/gerona/56.6.M366.
    1. He X.Y., Liu X.Q. Reliability and validity evaluation of the Mini-Nutrition Assessment Form and the Nutrition Screening Form. Milit. Nurs. 2010;21:691–697.
    1. Chen L.K., Woo J., Assantachai P., Auyeung T.W., Chou M.Y., Iijima K., Jang H.C., Kang L., Kim M., Kim S., et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J. Am. Med. Dir. Assoc. 2020;21:300–307.e302. doi: 10.1016/j.jamda.2019.12.012.
    1. Rathnayake K.M., Madushani P., Silva K. Use of dietary diversity score as a proxy indicator of nutrient adequacy of rural elderly people in Sri Lanka. BMC Res. Notes. 2012;5:469. doi: 10.1186/1756-0500-5-469.
    1. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E.M. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34:939–944. doi: 10.1212/WNL.34.7.939.
    1. Li G., Shen Y.C., Chen C.H., Li S.R., Zhang W.X., Liu M. A pilot study of the Simple Mental State Checklist in different populations. Chin. Ment. Health J. 1989;5:e23432.
    1. Zhang X., Edwards B.J. Malnutrition in Older Adults with Cancer. Curr. Oncol. Rep. 2019;21:80. doi: 10.1007/s11912-019-0829-8.
    1. Bamia C., Orfanos P., Juerges H., Schottker B., Brenner H., Lorbeer R., Aadahl M., Matthews C.E., Klinaki E., Katsoulis M., et al. Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium. Maturitas. 2017;103:37–44. doi: 10.1016/j.maturitas.2017.06.023.
    1. Zhu B., Huang Q.M., Liu H., Zhang X.H., Yin X.H., Li Q.C., Huang L.M. Nutritional status and influencing factors of elderly people in nursing institutions in Hangzhou in 2019. J. Hygiene Res. 2020;19:8. doi: 10.19813/j.cnki.weishengyanjiu.2020.06.025.
    1. Azzolino D., Damanti S., Bertagnoli L., Lucchi T., Cesari M. Sarcopenia and swallowing disorders in older people. Ag. Clin. Exp. Res. 2019;31:799–805. doi: 10.1007/s40520-019-01128-3.
    1. de Lima Alvarenga E.H., Dall’Oglio G.P., Murano E.Z., Abrahão M. Continuum theory: Presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur. Arch Otorhinolaryngol. 2018;275:443–449. doi: 10.1007/s00405-017-4801-7.
    1. Kehoe L., Walton J., Flynn A. Nutritional challenges for older adults in Europe: Current status and future directions. Proc. Nutr. Soc. 2019;78:221–233. doi: 10.1017/S0029665118002744.
    1. Jyväkorpi S.K., Lindström M., Suominen M.H., Kautiainen H., Salminen K., Niskanen R.T., Pitkälä K.H., Roitto H.M. Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people. Ageing Clin. Exp. Res. 2022;34:1357–1363. doi: 10.1007/s40520-022-02077-0.
    1. Zhang L., Liao J., Pan X., Liang D., Zeng J., Sun M., Luo X., Ma X., Yin M., Ni J. How to make more people adopt healthy behaviors? Assessing health literacy, health promoting lifestyle and their association of community residents in Shenzhen, China. Front. Public Health. 2022;10:900883. doi: 10.3389/fpubh.2022.900883.
    1. Crichton M., Craven D., Mackay H., Marx W., de van der Schueren M., Marshall S. A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: Associations with geographical region and sex. Age Ageing. 2019;48:38–48. doi: 10.1093/ageing/afy144.
    1. Pereira Machado R.S., Santa Cruz Coelho M.A. Risk of malnutrition among Brazilian institutionalized elderly: A study with the Mini Nutritional Assessment (MNA) questionnaire. J. Nutr. Health Ageing. 2011;15:532–535. doi: 10.1007/s12603-011-0059-8.
    1. Groen W.G., Kuijpers W., Oldenburg H.S., Wouters M.W., Aaronson N.K., van Harten W.H. Empowerment of Cancer Survivors Through Information Technology: An Integrative Review. J. Med. Int. Res. 2015;17:e270. doi: 10.2196/jmir.4818.
    1. Zhao M., Wang S., Li J., Gao J., Huang L.Q., Wang K.F. Nutritional status and influencing factors of older people in nursing homes in Jinan City. Chin. J. Gerontol. 2019;39:5120–5124.
    1. Zgheib E., Ramia E., Hallit S., Boulos C., Salameh P. Factors Associated with Functional Disability Among Lebanese Elderly Living in Rural Areas: Role of Polypharmacy, Alcohol Consumption, and Nutrition-based on the Aging and Malnutrition in Elderly Lebanese (AMEL) Study. J. Epidemiol. Glob. Health. 2018;8:82–90. doi: 10.2991/j.jegh.2018.08.002.
    1. Smoliner C., Norman K., Wagner K.H., Hartig W., Lochs H., Pirlich M. Malnutrition and depression in the institutionalised elderly. Br. J. Nutr. 2009;102:1663–1667. doi: 10.1017/S0007114509990900.
    1. Arimond M., Wiesmann D., Becquey E., Carriquiry A., Daniels M.C., Deitchler M., Fanou-Fogny N., Joseph M.L., Kennedy G., Martin-Prevel Y., et al. Simple food group diversity indicators predict micronutrient adequacy of women’s diets in 5 diverse, resource-poor settings. J. Nutr. 2010;140:2059s–2069s. doi: 10.3945/jn.110.123414.
    1. Chatindiara I., Williams V., Sycamore E., Richter M., Allen J., Wham C. Associations between nutrition risk status, body composition and physical performance among community-dwelling older adults. Aust. N. Z. J. Public Health. 2019;43:56–62. doi: 10.1111/1753-6405.12848.
    1. Roberts H.C., Denison H.J., Martin H.J., Patel H.P., Syddall H., Cooper C., Sayer A.A. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing. 2011;40:423–429. doi: 10.1093/ageing/afr051.

Source: PubMed

3
구독하다