Background: The worldwide ageing demographic trend has resulted in a growing number of frail elderly who are in the last stages of autonomous living. Oral nutritional interventions for the frail elderly address the body’s natural weight loss, sometimes reversing weight loss, though the literature is not of one accord. No review of nutritional interventions has been conducted for community-dwelling frail elderly, who are most likely to benefit from these interventions and delay adverse outcomes. Objective: (i) This systematic review analyzes results from randomized controlled trials of oral nutrition interventions for the community-dwelling frail elderly to determine their efficacy in making gains in nutritional and functional status. (ii) The secondary objective is to analyze the quality of the studies in this review and draw conclusions for further areas of development in the field of nutrition in elderly care. Methods: Randomized controlled trials of oral nutritional supplements were searched in The Cochrane Library and PubMed, and hand searched in reference lists of systematic reviews. These interventions targeted protein-energy deficiency and included oral supplementation or supplementation paired with exercise compared to a placebo or usual practice. Community-dwelling frail elderly not institutionalized or hospitalized were eligible. Studies targeting disease-specific elderly were excluded. Results: Out of 120 search results, six trials were included in this review. A small weight gain from oral nutritional interventions among frail community-dwelling elderly was reported in five out of six studies. Functional status did not improve significantly with the interventions. Studies used unstandardized definitions and different ways to measure outcomes, resulting in heterogeneity. Conclusions: The few and poor quality of studies demonstrates the need for more studies of better quality and homogeneity assessing oral nutritional interventions for nutritional and functional gain in frail elderly who are not yet suffering from adverse outcomes. / published_or_final_version / Public Health / Master / Master of Public Health

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Hypothesis. We hypothesized that contrary to "normal aging," frail elderly women would have a heightened resting energy expenditure per kg fat free mass (REE/kg FFM) and thermic effect of food (TEF) response. / Methods. 13 healthy (H) [X +/- SEM: 81.4 +/- 1.1 yr] and 9 frail elderly women (F) [84.7 +/- 1.6 yr], free from acute conditions underwent REE and TEF measurements (liquid standard mixed meal: 720 kcal, 58% carbohydrate, 14% protein, 28% fat) using ventilated hood indirect calorimetry. Anthropometric and body composition measurements, thyroid hormones, cortisol, cytokines and catecholamine concentrations, and physical activity (PASE) and mobility ("time up and go" TUG) scores were related to the results obtained. / Results. H had a faster TUG: 10.2 +/- 1.6 vs. 21.0 +/- 9.3 s (p=0.001), greater PASE score: 179.2 +/- 116.1 vs. 47.1 +/- 26.2 (p=0.003), greater triiodothyronine [T3]: 5.1 +/- 0.6 vs. 4.3 +/- 0.4 rhomol/L (p=0.003) and lower cortisol concentrations: 351.1 +/- 19.9 vs. 474.5 +/- 43.6 nmol/L (p=0.011). In H vs. F: REE/kg FFM was 1044 +/- 20.4, 1021 +/- 23.7 kcal/day (NS) and TEF response as expressed as % of REE was 18.4 +/- 5.6, 19.5 +/- 4.2 (NS). The time course of glucose (p=0.043) and insulin from 90 minutes onwards (P=0.013) suggested insulin resistance in F. REE was positively correlated with FFM, percent body fat and [T3] (r>0.499, p<0.021). / Conclusion. REE/kg FFM and TEF response was not different between H and F and thus the greater prevalence of malnutrition in F, cannot be explained by these parameters.

We assessed the nutritional status and physical function of 121 women (79.4 +/- 6.6 y, 26.8 +/- 5.6 kg/m2) and 61 men (78.6 +/- 8.3 y, 26.6 +/- 4.7 kg/m2) participating in the Geriatric Day Hospital. According to a composite index of malnutrition, 19% of them were found malnourished whereas the Mini-Nutritional Assessment, a validated nutritional screening tool, found that 56% of the elderly were malnourished or at risk for malnutrition. Malnourished persons, as determined by the composite index, had a lower lean body mass (LBM) by bioelectrical impedance analysis compared with the well-nourished group (40.5 +/- 9.7 vs. 42.0 +/- 8.7 kg, p = 0.0001). LBM correlated significantly with handgrip strength (r = 0.34, p = 0.0001) but not with gait speed (r = 0.04, p = 0.27). There were no significant differences between nutritional states for any of the two tests of physical function. The score of the MNA, correlated with gait speed (r = 0.24, p = 0.02) but the performance at the physical tests was not different according to the nutritional status defined by this tool. We conclude that malnutrition is relatively prevalent among frail persons participating in the Geriatric Day Hospital and that malnutrition is one among many other factors that contribute to their low level of physical performance. As such, a nutritional intervention may be of benefit in improving the physical function of frail elderly persons who are malnourished.

Orientadores: Valdemiro Carlos Sgarbieri, Maria Elena Guariento / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-08T15:09:44Z (GMT). No. of bitstreams: 1 CaselatodeSousa_ValeriaMaria_M.pdf: 1055288 bytes, checksum: 2463027d9dc5134cb93d00176b97879b (MD5) Previous issue date: 2007 / Resumo: Os idosos constituem-se em um grupo de risco para deficiências nutricionais, devido às dificuldades na manutenção da adequada ingestão energética e de nutrientes por meio de uma alimentação balanceada. O desenvolvimento de meios para a recuperação do estado nutricional e o estímulo de uma resposta positiva na saúde dos idosos é de fundamental importância. A suplementação alimentar é um meio válido e eficaz para a recuperação e manutenção do estado nutricional em idosos. Com o objetivo de avaliar os efeitos de um produto dietético sobre o estado nutricional de idosos desnutridos ou em risco de desnutrição, particularmente nos parâmetros de consumo alimentar, antropométricos e bioquímicos, foi realizado o estudo de caso. Este estudo de caso foi prospectivo, com 14 idosos, entre 68 e 95 anos de idade, que receberam um produto dietético oral, desenvolvido na Faculdade de Engenharia de Alimentos ¿ UNICAMP, composto de proteína do soro do leite, hidrolisado de colágeno, carboidratos, inulina e frutooligossacarídeos, vitaminas e minerais, ao longo de três meses. Para a seleção dos idosos foi aplicada a escala Mini-Avaliação Nutricional (MAN) e selecionados quando apresentaram desnutrição ou risco de desnutrição. A avaliação do estado nutricional foi determinada por parâmetros dietéticos, antropométricos e bioquímicos coletadas no tempo 0 e tempo 2. Os parâmetros dietéticos foram obtidos através do registro alimentar de três dias, onde foram analisados a energia e os nutrientes carboidratos, proteínas, lipídios, vitamina B12, ácido fólico, cálcio, magnésio e zinco. Os parâmetros antropométricos mensurados foram peso (P), altura (A), prega cutânea tricipital (PCT), circunferência do braço (CB), circunferência da panturrilha (CP), circunferência da coxa (CCx), área muscular do braço corrigida (AMBc), circunferência da cintura (CC), circunferência do quadril (CQ), índice de massa corpórea (IMC), a composição corporal e a massa livre de gordura (MLG) foram avaliadas por bioimpedância elétrica (BIA). Os parâmetros bioquímicos mensurados foram as dosagens de glicemia de jejum e perfil renal (uréia e creatinina), proteínas séricas (proteínas totais e albumina), perfil lipídico (colesterol total, LDL-c, HDL-c, triglicérides), Vitamina B12, ácido fólico, cálcio, magnésio e zinco. Os dados obtidos foram submetidos à análise estatística. Como resposta à ingestão do produto dietético foram observadas evidências nos seguintes parâmetros: na avaliação do consumo alimentar houve influência nos valores de ácido fólico, cálcio e magnésio; nos parâmetros antropométricos, embora não fossem observadas diferenças estatísticas, o ganho de peso médio em encontrado nos idosos foi de 1,88 kg; nos parâmetros bioquímicos, constatou-se que houve um aumento significativo nas dosagens de proteínas totais e albumina, colesterol total, ácido fólico, magnésio. Conclui-se que o produto dietético teve um efeito positivo em alguns parâmetros avaliados, melhorando o estado nutricional dos idosos, proporcionando um aumento no peso corporal / Abstract: The elderly is considered to be a risk group for nutritional deficiencies due to difficulties in maintining an adequate energy and nutrient intake through a balanced diet. It is extremely important to create ways to recover the nutritional status and promote a positive response in the health of elderly individuals. Food supplementation is a valid and viable way for recovering and maintaining the nutritional status of the elderly. This case study was carried out with the objective of evaluating the effect of a dietetic product on the nutritional status, particurlarly on the dietetic, anthropometric and biochemical parameters of malnourished elderly or elderly at risk of malnutrition. This was a prospective case study, with 14 elderly individuals aged between 68 and 95, who received an oral dietetic product, developt in the Faculdade de Engenharia de Alimentos ¿ UNICAMP, that it composes of whey protein isolated and a bovine collagen hydrolysate, carbohydrates, inuline, frutooligosaccharides, vitamins and minerals, for three months. For the selection of the elderly, the Mini Nutritional Assessemnt (MAN) scale was applied to choose those who presented malnutrition or risk of malnutrition. The assessment of the nutritional status was dertermined by dietetic, anthropometric and biochemical parameters estimated at time 0 and time 2. The dietetic parameters were obtained from recording the food intake of the individuals for three days and then analyzing nutrients such as carbohydrates, proteins, lipids, Vitamin B12, folic acid, calcium, magnesium and zinc. The measured anthropometric parameters were weight (W), height (H), triceps skinfold thickness (TST), arm circumference (AC), calf circumference (CC), thigh circumference (TC), corrected arm muscle area (CAMA), waist circumference (WC), hip circumference (HC), body mass index (BMI), and the body composition and fat-free mass (FFM) were evaluated by of the bioelectrical impedance analysis (BIA). The measured biochemical parameters were the dosages of fasting glycemia and renal function, serum proteins (total proteins and albumin), lipidic profile (total cholesterol, LDL-c, HDL-c, triglycerides), Vitamin B12, folic acid, calcium, magnesium and zinc. The collected data was submitted to statistical analysis. The responses to the diet product intake we as follows: for the dietary intake, the product had influence on the values of folic acid, calcium and magnesium; for anthropometric parameters, though statistical differences were not observed, there was an average 1.88-kg weight gain in the elderly; for biochemical parameters, a significant increase in the dosage of serum proteins and albumin, total cholesterol, folic acid and magnesium was observed. The data suggested that the diet product had a positive effect on some of the evaluated parameters, improving the nutritional status of the elderly and promoting a gain of body weight / Mestrado / Nutrição Basica e Experimental / Mestre em Alimentos e Nutrição

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Submitted in fulfillment of the requirements of the degree of Master of Applied Science in Food and Nutrition, Durban University of Technology, Durban, South Africa, 2016. / Rational and Objectives The objective of this study was to determine socio-demographic, socio-economic, health status, dietary diversity, nutrition adequacy, food consumption patterns, coping strategies, and agricultural practices in relation to food insecurity and nutritional status of elderly population in Mpharane. Methodology The sample size was n=260 participants with 75 men and 185 women. A variety of variables were used to measure the objectives and different types of questionnaires were used as measuring instruments for all the variables of the study. Socio-demographic questionnaires determined household indicators like age, employment status, and number of dependents, living conditions and assets. Anthropometrics measurements that were conducted included height, weight and blood pressure. Health status questionnaires included indictors such as consumption of alcohol, smoking, food allergies and affected parts of the body. Food frequency score, dietary intake and nutrition adequacy were established. Coping strategies in the household were determined for the period of food insecurity. Agricultural practices questionnaires were to determined household indictors like land, types of crops and livestock. The completed Socio-demographic Questionnaires, Health Questionnaires, Food Frequency Questionnaires, Anthropometric Measurements Forms, Coping Strategies Questionnaires and the Agricultural Practices Questionnaire were captured on a Microsoft Excel® Spreadsheet by the researcher and analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.0, with the assistance of a statistician. Results Results indicated that all participants resided with grandchildren. Majority of grandmothers headed the households. All participants were unemployed and 61.20% often had shortage of money to buy food. Nutrient analysis from 24-Hour Food Recall indicated deficient intake in energy, calcium and vitamin A. There were high levels of food insecurity among the participants since all the participants used all 15 coping strategies. The Body Mass Index (BMI) results indicated 65.50% of participants were overweight, 60.70% obese and 13.60% were underweight. Majority of participants had access to land for plantation. All Participants suffered from various health aliments. The history of health associated with diseases indicating that 24.60% (n=64) of the participants had reported skin diseases, 71.20% (n=185) of the participants suffered from diseases of skeleton or joints and 81.90% (n=213) of the participants indicated affected eyes, ears, nose and teeth. Diseases of the chest or respiratory system were experienced by 50.80% (n=132) of the participants. The total fat intake of all the groups was slightly below the recommended goal by the World Health Organization WHO (15-30%), with men obtaining 13.33% and women 12.55% of energy from fat. Carbohydrates contributed 75.12% for men and 75.41% for women of the daily energy needs in the groups, slightly above the levels recommended by the WHO (55-75%). The contribution of protein to total daily energy intake for all the groups was within the recommendation of 10-15%, men (11.56%) and women (12.07%). As a result this proves that the average participant consumed a balanced diet in terms of the macronutrient intake. Carbohydrates were the main source of food consumption. The highest number of individual foods consumed by the majority of the participants was between 6-10 individual foods (53.46%, n=139) followed by 11-15 individual foods (39.23%, n=102). The mean Food Variety Score (FVS) (±SD) for all the foods consumed from the food groups during seven days was 10.06 (±6.726), which indicated a low food variety score. The food group with the most variety was the cereal group. Seven different cereals were consumed by (1.53%, n=4) participants, a large number of the participants (31.15%, n=81) only consumed 3 different cereals within seven day period and (23.46%, n=61) of the participants consumed 4 different cereals. Conclusion The grandparents were the principle providers for the grandchildren and the demographic pressures, unemployment and old age increased the financial strains which contributed to high levels of poverty resulting in food and nutrition insecurity and poor nutritional status of the elderly people. / M

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Contexte : La détérioration de l’état nutritionnel liée à la perte d’autonomie qui accompagne l’évolution de la démence du type Alzheimer (DTA) peut être limitée par un proche aidant efficace. À long terme, le rôle soignant du proche aidant peut affecter sa propre santé physique et psychologique. Objectifs : (1) décrire les caractéristiques sociodémographiques des patients et de leurs proches aidants; (2) examiner l’évolution de la maladie et des variables à l’étude au cours de la période de suivi; (3) explorer la relation possible entre le fardeau perçu du proche aidant, l’état nutritionnel des patients et la stabilité du poids corporel du proche aidant. Hypothèses : L’absence du fardeau chez l’aidant est associée à un meilleur état nutritionnel chez le patient; la détérioration de la fonction cognitive chez le patient s’accompagne d’une augmentation du fardeau perçu par l’aidant; la dégradation du fardeau chez l’aidant conduit à sa perte de poids. Méthode : Les données analysées proviennent de l’étude « Nutrition-mémoire » menée entre 2003 et 2006 dans les trois cliniques de cognition situées dans des hôpitaux universitaires à Montréal. Quarante-deux patients avec une DTA probable vivant dans la communauté et leurs aidants ont été suivis en dyades pendant une période de dix-huit mois. Les analyses ont porté sur les données colligées du recrutement à douze mois plus tard en raison du nombre restreint des patients interviewés à la dernière mesure. La relation entre le fardeau de l’aidant et les variables caractérisant l’état nutritionnel chez les patients a été évaluée à l’aide des analyses de corrélations, du test khi-carré ou du test de Fisher. L’état cognitif des patients était évalué à l’aide du score au Mini-Mental State Examination, le fardeau de l’aidant était estimé par le score au « Zarit Burden Interview », l’état nutritionnel des patients était défini par la suffisance en énergie et en protéines, le score à l’outil de dépistage nutritionnel des aînés, le poids et l’indice de masse corporelle des patients. Résultats : Le fardeau perçu des aidants était associé à la suffisance en énergie chez les patients. Le nombre de patients ayant des apports insuffisants en énergie était plus important chez les dyades où les aidants percevaient un fardeau plus élevé. Toutefois, aucune association n’a été observée entre le fardeau des aidants et le risque nutritionnel ou la suffisance en protéines chez les patients. La détérioration de la fonction cognitive des patients ne semble pas avoir provoqué une augmentation du fardeau chez leurs aidants. De plus, l’augmentation du fardeau de l’aidant n’était pas accompagnée d’une perte de son poids corporel. Par ailleurs, un fardeau plus important a été observé chez les aidants des patients obèses ou présentant un embonpoint. Conclusion : La réduction du fardeau perçu des aidants permettrait d’améliorer les apports alimentaires des patients et ainsi de limiter ou minimiser le risque de détérioration de leur état nutritionnel et de perte de poids. / Background: The progressive decline in nutritional status related to the loss of autonomy commonly observed in Alzheimer’s disease (AD) may be limited by an effective caregiver. In the long term, the caregiver’s role may affect his own physical and psychological health. Objectives: (1) to describe the demographic characteristics of patients and their caregivers; (2) to examine the evolution of the disease and study variables during the follow-up period; (3) to explore the possible relationship between the caregiver’s perceived burden, the nutritional status of patients and the stability of caregiver’s body weight. Hypotheses: The absence of caregiver burden is associated with better nutritional status in patients; the decline of cognitive function in patients is accompanied by an increase in the caregiver’s perceived burden; and an increased caregiver burden leads to a loss of body weight. Methods: We analysed data from the “Nutrition-memory” study carried out between 2003 and 2006 in the three university hospital memory clinics in Montréal. Forty-two community dwelling patients with probable AD and their informal caregivers were followed as dyads for a period of eighteen months. Analyses focused on data collected from recruitment to twelve months later because of the limited number of patients interviewed at the last measurement. The relation between caregiver burden and the variables characterizing the nutritional status in patients was assessed using correlation analysis, chi-square test or Fisher’s exact test. The patient’s cognitive function was assessed using the Mini-Mental State Examination, caregiver burden was estimated by the Zarit Burden Interview, and the nutritional status of patients was defined by their adequacy in energy and proteins intake, the elderly nutrition screening score, weight and body mass index of patients. Results: The caregiver’s perceived burden was associated with the energy adequacy in patients. The number of patients with inadequate intake of energy was higher among dyads caregivers who perceived a higher burden. No association was found between the caregiver’s burden and the nutritional risk or protein adequacy in patients. The deterioration of patient’s cognitive function does not seem to have led to an increased caregiver burden. In addition, increased caregiver burden was not accompanied by weight loss. Moreover, a greater burden was observed among caregivers of patients who were overweight or obese. Conclusion: Reducing perceived caregiver burden could improve dietary intake of patients and thereby limit or minimize the risk of deterioration of their nutritional status and weight loss.