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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.

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The purpose of this study was to explore utility of handgrip strength measured by the hand-grip dynamometer for assessment of nutritional status in protein-calorie malnutrition. The first study included six subjects (all right-handed), who had grip strength measured daily for five days, then weekly for three weeks. Intra-individual variability was approximately 10%. No learning or training effect was observed. Change in leg position from feet on the floor to elevation of feet made no significant difference in grip-strength measurement. In Phase Two, 43 healthy adult subjects (three left-handed) prior to elective surgery, height was significantly related to handgrip strength (r = 0.82, p < 0.001). Males were stronger than females. After surgery, the non-dominant hand lost significant strength (2.68 kilograms) and recovered more quickly than the dominant hand. Multiple regression analyses provided predictive equations for pre-surgery left hand-grip strength using age, sex, and height (R² = 0.77); from age, sex, hand measured, and grip strength two days after surgery or three days after surgery (R² = 0.89 for each). Ten sequential grip-strength measurements analyzed by repeated measures analysis of variance with orthogonal comparisons showed a difference in measurements between hands as well as before and after surgery. The slope of the measurement line was more linear before and three days after surgery, but more quadratic in shape two days after surgery. The effects seen by type of surgery were inversion of the slope of right hand sequential measurements two days after knee surgery and before-surgery drop and increase from trial five to trial seven in left hand sequential measurements of knee and vaginal hysterectomy subjects. In a six-month-long case study, grip-strength measurements were followed in a seriously-ill 68-year-old patient hospitalized for surgical repair of hiatal hernia and mucous fistula who underwent several periods of nutritional depletion. Grip strength varied throughout the period (although not differently from healthy subjects), but did not directly parallel changes in serum albumin or prealbumin. The conclusion was that hand strength measured by the handgrip dynamometer did not change enough with fasting and surgery from normal day-to-day variability to be useful for nutritional assessment.

Dietary intake for female college students representing both athletic and nonathletic groups was studied using 3-day food records to determine whether there was difference in nutrient intake between groups. Body composition and nutritional beliefs were evaluated. Groups included: repertory dance (n = 4), gymnastics (n = 6), basketball (n = 6), cross-country runners (n = 5), volleyball (n = 4), and softball (n = 8). All groups had adequate calorie, high protein, low iron, zinc intake. All groups except volleyball had high vitamin C intake. Body composition ranged from 13.6%-21.7% fat. Eighty-six percent considered themselves over their optimal weight. A majority wanted more information on nutrition (75%) and on weight control (82%). I conclude there is no significant difference between dietary intake of athletic college women as compared to a nonathletic group, there is no significant difference in dietary intake among groups of athletic women, and athletic women consider dietary intake and nutrition knowledge to be important factors in training and competition.

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Malnutrition, as evidenced by low weight for height, low triceps skinfold thickness and low midarm muscle circumference, is prevalent among COPD patients. A stepped decline in nutritional status has been postulated as a mechanism for malnutrition wherein patients progressively suffer weight loss with each COPD exacerbation. A randomized clinical trial of continuous enteral nutrition could not successfully address whether or not the stepped decline in weight can be prevented. Despite this, sixteen patients admitted for a COPD exacerbation, participated in an observational prospective study wherein anthropometric, biochemical, dynamometric, respiratory, general well-being and energy consumption measures were obtained. Twelve patients had body weights below 90% of ideal weight. The mean energy intake was 107% $ pm$ 30 of estimated resting energy expenditure. Measures were repeated to assess changes during hospitalization. Weight change was a poor indicator of nutritional status. Midarm muscle circumference and handgrip strength appear to be useful as nutritional status indicators among unstable hospitalized COPD patients. Changes in handgrip strength and midarm muscle circumference were closely linked (r =.78, p $<$ 0.0005) and tended to decrease over the course of hospitalization despite clinical improvement. In the absence of adequate nutrition, COPD patients have at least as much risk of developing iatrogenic malnutrition as are other hospitalized medical patients.

Despite the acknowledged importance of nutritional support for COPD patients, it is difficult to accomplish in acutely stressed individuals. A randomized trial of nutritional supplementation during an acute exacerbation was carried out in 16 hospitalized patients for a 2 week period. Six control patients consumed a standard diet supplying 1,951 $ pm$ 130 (mean $ pm$ SEM) kcal and 80 $ pm$ 6 g protein/d, while ten treatment patients, in addition to the usual diet received oral supplements (Ensure) or snacks, resulting in an intake of 2,516 $ pm$ 129 kcal (p = 0.012) and 99 $ pm$ 6 g protein/d (p = 0.059). Although the treatment subjects improved their intake over the control group, no significant improvement in nutritional status occurred in either group. / Forced vital capacity (FVC % predicted) improved significantly over the study period in treated vs control subjects (+11.10 $ pm$ 4.63 vs $-$4.50 $ pm$ 2.14; p = 0.026). Nitrogen balances were calculated for 9 subjects, and all were in negative balance ($-$8.42 $ pm$ 1.74 g nitrogen/d) with no difference between groups. / Because of the high doses of methylprednisolone administered (69.6 $ pm$ 8.3 mg/d), and their known catabolic effects, we examined whether the dose affected nitrogen balance and muscle strength. Both nitrogen balance (r = $-$0.73; p = 0.025) and grip strength (r = $-$0.76; p $<$ 0.001) worsened with higher doses of steroids. The catabolic process may have resulted from elevated energy requirements, inadequate intake of protein and energy or been induced by high doses of steroids. / Hospitalized COPD patients are highly stressed and catabolic, and the means to preventing protein wasting during an acute exacerbation of their disease remains to be established. (Abstract shortened by UMI.)

In this study two methods of nutritional assessment were compared by evaluating the attitudes of health professionals concerning usefulness of the procedure and by determining the accuracy of diagnoses and time involved using the methods. The two procedures of assessment were the traditional "eye-ball" or observation method and a written method involving laboratory and anthropometric measurements. Thirty-eight persons, including physicians, nurses, dietitians, a medical school instructor, and students of related disciplines, were the subjects of this study.In addition to being more up to date, the subjects felt the written method was significantly more useful than the traditional method in terms of accuracy, organization, logical order, preciseness, value, understandability, use of form, and completeness. The traditional method was found to be more appealing to the subjects in terms of time saved, ease of use, and simplicity. The traditional method was found to be much quicker to complete but the written method was found to give significantly more correct diagnoses. In conclusion, the written method was found to be significantly more useful due to its logical approach to diagnosing the nutritional status of the hospitalized patients; however, its use would be curtailed due to the amount of time required to complete the procedure unless protocol were established whereby some other member of the health care team could take the responsibility for completing the procedure, thus relieving thephysician of the duty.