Predictors of incident malnutrition-a nutritionDay analysis in 11,923 nursing home residents.
Journal
European journal of clinical nutrition
ISSN: 1476-5640
Titre abrégé: Eur J Clin Nutr
Pays: England
ID NLM: 8804070
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
07
01
2021
accepted:
18
06
2021
revised:
30
05
2021
pubmed:
10
7
2021
medline:
1
4
2022
entrez:
9
7
2021
Statut:
ppublish
Résumé
Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56-4.98]), a quarter (2.15 [1.56-2.97]) or half of the meal eaten (1.72 [1.40-2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0-23.0) (1.86 [1.44-2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65-74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00-1.62]) (vs. mobile) predicted incident MN in the final model. 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
Sections du résumé
BACKGROUND/OBJECTIVES
Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents.
SUBJECTS/METHODS
NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m
RESULTS
Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56-4.98]), a quarter (2.15 [1.56-2.97]) or half of the meal eaten (1.72 [1.40-2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0-23.0) (1.86 [1.44-2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65-74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00-1.62]) (vs. mobile) predicted incident MN in the final model.
CONCLUSION
10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
Identifiants
pubmed: 34239065
doi: 10.1038/s41430-021-00964-9
pii: 10.1038/s41430-021-00964-9
pmc: PMC8907076
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
382-388Informations de copyright
© 2021. The Author(s).
Références
OECD. Long-Term Care Rescources and Utilisation: Beds in residential long-term care facilities. Available at https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_LTCR# . Accessed January 07, 2021.
Cereda E, Pedrolli C, Klersy C, Bonardi C, Quarleri L, Cappello S, et al. Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA((R)). Clin Nutr. 2016;35:1282–90. https://doi.org/10.1016/j.clnu.2016.03.008 . e-pub ahead of print 2016/04/18
doi: 10.1016/j.clnu.2016.03.008
pubmed: 27086194
Kiesswetter E, Colombo MG, Meisinger C, Peters A, Thorand B, Holle R et al. Malnutrition and related risk factors in older adults from different health-care settings: an enable study. Public Health Nutr 2019: 1–11. e-pub ahead of print 2019/08/28; https://doi.org/10.1017/s1368980019002271
Namasivayam AM, Steele CM. Malnutrition and Dysphagia in long-term care: a systematic review. J Nutr Gerontol Geriatr. 2015;34:1–21. https://doi.org/10.1080/21551197.2014.1002656 . e-pub ahead of print 2015/03/25
doi: 10.1080/21551197.2014.1002656
pubmed: 25803601
Wolters M, Volkert D, Streicher M, Kiesswetter E, Torbahn G, O’Connor EM, et al. Prevalence of malnutrition using harmonized definitions in older adults from different settings - A MaNuEL study. Clin Nutr. 2019;38:2389–98. https://doi.org/10.1016/j.clnu.2018.10.020 . e-pub ahead of print 2018/11/19
doi: 10.1016/j.clnu.2018.10.020
pubmed: 30448194
Abizanda P, Sinclair A, Barcons N, Lizan L, Rodriguez-Manas L. Costs of malnutrition in institutionalized and community-dwelling older adults: a systematic review. J Am Med Dir Assoc. 2016;17:17–23. https://doi.org/10.1016/j.jamda.2015.07.005 . e-pub ahead of print 2015/12/30
doi: 10.1016/j.jamda.2015.07.005
pubmed: 26712488
Chen LY, Liu LK, Hwang AC, Lin MH, Peng LN, Chen LK, et al. Impact of malnutrition on physical, cognitive function and mortality among older men living in veteran homes by minimum data set: a prospective cohort study in Taiwan. J Nutr Health Aging. 2016;20:41–47. https://doi.org/10.1007/s12603-015-0646-1 . e-pub ahead of print 2016/01/06
doi: 10.1007/s12603-015-0646-1
pubmed: 26728932
Lilamand M, Kelaiditi E, Demougeot L, Rolland Y, Vellas B, Cesari M. The Mini Nutritional Assessment-Short Form and mortality in nursing home residents-results from the INCUR study. J Nutr Health Aging. 2015;19:383–8. https://doi.org/10.1007/s12603-014-0533-1 . e-pub ahead of print 2015/03/27
doi: 10.1007/s12603-014-0533-1
pubmed: 25809801
Meijers JM, Halfens RJ, Wilson L, Schols JM. Estimating the costs associated with malnutrition in Dutch nursing homes. Clin Nutr. 2012;31:65–68. https://doi.org/10.1016/j.clnu.2011.08.009 . e-pub ahead of print 2011/09/02
doi: 10.1016/j.clnu.2011.08.009
pubmed: 21880401
Torma J, Winblad U, Cederholm T, Saletti A. Does undernutrition still prevail among nursing home residents? Clin Nutr. 2013;32:562–8. https://doi.org/10.1016/j.clnu.2012.10.007 . e-pub ahead of print 2012/11/10
doi: 10.1016/j.clnu.2012.10.007
pubmed: 23137706
Veronese N, Cereda E, Solmi M, Fowler SA, Manzato E, Maggi S, et al. Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects. Obes Rev. 2015;16:1001–15. https://doi.org/10.1111/obr.12309 . e-pub ahead of print 2015/08/08
doi: 10.1111/obr.12309
pubmed: 26252230
Tamura BK, Bell CL, Masaki KH, Amella EJ. Factors associated with weight loss, low BMI, and malnutrition among nursing home patients: a systematic review of the literature. J Am Med Dir Assoc. 2013;14:649–55. https://doi.org/10.1016/j.jamda.2013.02.022 . e-pub ahead of print 2013/05/04
doi: 10.1016/j.jamda.2013.02.022
pubmed: 23639716
Lannering C, Ernsth Bravell M, Midlöv P, Östgren CJ, Mölstad S. Factors related to falls, weight-loss and pressure ulcers-more insight in risk assessment among nursing home residents. J Clin Nurs. 2016;25:940–50. https://doi.org/10.1111/jocn.13154 . e-pub ahead of print 2016/01/28
doi: 10.1111/jocn.13154
pubmed: 26813994
Izawa S, Enoki H, Hasegawa J, Hirose T, Kuzuya M. Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period. J Nutr Health Aging. 2014;18:372–7. https://doi.org/10.1007/s12603-013-0400-5 . e-pub ahead of print 2014/03/29
doi: 10.1007/s12603-013-0400-5
pubmed: 24676317
Knoops KT, Slump E, de Groot LC, Wouters-Wesseling W, Brouwer ML, van Staveren WA. Body weight changes in elderly psychogeriatric nursing home residents. J Gerontol A Biol Sci Med Sci. 2005;60:536–9. https://doi.org/10.1093/gerona/60.4.536 . e-pub ahead of print 2005/06/04
doi: 10.1093/gerona/60.4.536
pubmed: 15933399
Beck AM. Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents-a Danish follow-up study. J Nutr Health Aging. 2015;19:96–101. https://doi.org/10.1007/s12603-015-0439-6 . e-pub ahead of print 2015/01/07
doi: 10.1007/s12603-015-0439-6
pubmed: 25560822
Bauer S, Halfens RJG, Lohrmann C. Changes in nutritional status in nursing home residents and associated factors in nutritional status decline: a secondary data analysis. J Adv Nurs. 2017;73:2420–9. https://doi.org/10.1111/jan.13297
doi: 10.1111/jan.13297
pubmed: 28299828
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4:e297 https://doi.org/10.1371/journal.pmed.0040297 . e-pub ahead of print 2007/10/19
doi: 10.1371/journal.pmed.0040297
pubmed: 17941715
pmcid: 2020496
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9. https://doi.org/10.1016/j.ijsu.2014.07.013 . e-pub ahead of print 2014/07/22
doi: 10.1016/j.ijsu.2014.07.013
O’Keeffe M, Kelly M, O’Herlihy E, O’Toole PW, Kearney PM, Timmons S, et al. Potentially modifiable determinants of malnutrition in older adults: A systematic review. Clin Nutr. 2018. https://doi.org/10.1016/j.clnu.2018.12.007 . e-pub ahead of print 2019/01/28
doi: 10.1016/j.clnu.2018.12.007
pubmed: 30685297
Streicher M, van Zwienen-Pot J, Bardon L, Nagel G, Teh R, Meisinger C, et al. Determinants of incident malnutrition in community-dwelling older adults: a MaNuEL multicohort meta-analysis. J Am Geriatr Soc. 2018;66:2335–43. https://doi.org/10.1111/jgs.15553 . e-pub ahead of print 2018/08/24
doi: 10.1111/jgs.15553
pubmed: 30136728
Visser M, Volkert D, Corish C, Geisler C, de Groot LC, Cruz-Jentoft AJ, et al. Tackling the increasing problem of malnutrition in older persons: the Malnutrition in the Elderly (MaNuEL) Knowledge Hub. Nutr Bull. 2017;42:178–86. https://doi.org/10.1111/nbu.12268
doi: 10.1111/nbu.12268
Volkert D, Kiesswetter E, Cederholm T, Donini LM, Eglseer D, Norman K, et al. Development of a model on determinants of malnutrition in aged persons: a MaNuEL project. Gerontol Geriatr Med. 2019;5:2333721419858438 https://doi.org/10.1177/2333721419858438 . e-pub ahead of print 2019/07/02
doi: 10.1177/2333721419858438
pubmed: 31259204
pmcid: 6589946
Volkert D, Visser M, Corish CA, Geisler C, de Groot L, Cruz-Jentoft AJ, et al. Joint action malnutrition in the elderly (MaNuEL) knowledge hub: summary of project findings. Eur Geriatr Med. 2020;11:169–77. https://doi.org/10.1007/s41999-019-00264-3 . e-pub ahead of print 2020/04/17
doi: 10.1007/s41999-019-00264-3
pubmed: 32297234
Hiesmayr M, Schindler K, Pernicka E, Schuh C, Schoeniger-Hekele A, Bauer P, et al. Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006. Clin Nutr. 2009;28:484–91. https://doi.org/10.1016/j.clnu.2009.05.013 . e-pub ahead of print 2009/07/01
doi: 10.1016/j.clnu.2009.05.013
pubmed: 19573957
Schindler K, Pichard C, Sulz I, Volkert D, Streicher M, Singer P, et al. nutritionDay: 10 years of growth. Clin Nutr. 2017;36:1207–14. https://doi.org/10.1016/j.clnu.2016.11.004 . e-pub ahead of print 2016/12/06
doi: 10.1016/j.clnu.2016.11.004
pubmed: 27916337
Valentini L, Schindler K, Schlaffer R, Bucher H, Mouhieddine M, Steininger K, et al. The first nutritionDay in nursing homes: participation may improve malnutrition awareness. Clin Nutr. 2009;28:109–16. https://doi.org/10.1016/j.clnu.2009.01.021 . e-pub ahead of print 2009/03/07
doi: 10.1016/j.clnu.2009.01.021
pubmed: 19264381
Ribbe MW, Ljunggren G, Steel K, Topinkova E, Hawes C, Ikegami N, et al. Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing. 1997;26(Suppl 2):3–12. https://doi.org/10.1093/ageing/26.suppl_2.3 . e-pub ahead of print 1998/02/17
doi: 10.1093/ageing/26.suppl_2.3
pubmed: 9464548
WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63. https://doi.org/10.1016/s0140-6736(03)15268-3 . e-pub ahead of print 2004/01/17
doi: 10.1016/s0140-6736(03)15268-3
Porta M Incidence. In: A dictionary of epidemiology: Oxford university press, 2014.
Ioannidis JPA. The proposal to lower P value Thresholds to .005. JAMA. 2018;319:1429–30. https://doi.org/10.1001/jama.2018.1536 . e-pub ahead of print 2018/03/23
doi: 10.1001/jama.2018.1536
pubmed: 29566133
Benjamin DJ, Berger JO, Johannesson M, Nosek BA, Wagenmakers EJ, Berk R, et al. Redefine statistical significance. Nat Hum Behav. 2018;2:6–10. https://doi.org/10.1038/s41562-017-0189-z
doi: 10.1038/s41562-017-0189-z
pubmed: 30980045
Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38:1–9. https://doi.org/10.1016/j.clnu.2018.08.002 . e-pub ahead of print 2018/09/03
doi: 10.1016/j.clnu.2018.08.002
pubmed: 30181091
Mamhidir AG, Ljunggren G, Kihlgren M, Kihlgren A, Wimo A. Underweight, weight loss and related risk factors among older adults in sheltered housing-a Swedish follow-up study. J Nutr Health Aging. 2006;10:255–62. e-pub ahead of print 2006/08/04
pubmed: 16886095
Volicer L, Frijters DH, van der Steen JT. Apathy and weight loss in nursing home residents: longitudinal study. J Am Med Dir Assoc. 2013;14:417–20. https://doi.org/10.1016/j.jamda.2012.12.004 . e-pub ahead of print 2013/01/29
doi: 10.1016/j.jamda.2012.12.004
pubmed: 23352355
Watkins R, Goodwin VA, Abbott RA, Hall A, Tarrant M. Exploring residents’ experiences of mealtimes in care homes: a qualitative interview study. BMC geriatrics. 2017;17:141–141. https://doi.org/10.1186/s12877-017-0540-2
doi: 10.1186/s12877-017-0540-2
pubmed: 28697747
pmcid: 5506571
Milte R, Ratcliffe J, Chen G, Miller M, Crotty M. Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes. Nurs Health Sci. 2018;20:116–24. https://doi.org/10.1111/nhs.12394 . e-pub ahead of print 2018/01/10
doi: 10.1111/nhs.12394
pubmed: 29314590
pmcid: 6635740
Schlettwein-gsell D, Decarli B, de Groot L. Meal patterns in the SENECA study of nutrition and the elderly in Europe: assessment method and preliminary results on the role of the midday meal. Appetite. 1999;32:15–22. https://doi.org/10.1006/appe.1998.0191 . e-pub ahead of print 1999/02/17
doi: 10.1006/appe.1998.0191
pubmed: 9989909
Okkels SL, Dybdal DR, Beck AM, Bügel S, Klausen TW, Olsen A. An investigation of main meal preferences in nursing home residents. J Sens Stud. 2019;34:e12504 https://doi.org/10.1111/joss.12504
doi: 10.1111/joss.12504
Buckinx F, Allepaerts S, Paquot N, Reginster JY, de Cock C, Petermans J, et al. Energy and nutrient content of food served and consumed by nursing home residents. J Nutr Health Aging. 2017;21:727–32. https://doi.org/10.1007/s12603-016-0782-2 . e-pub ahead of print 2017/05/26
doi: 10.1007/s12603-016-0782-2
pubmed: 28537340
Streicher M, Themessl-Huber M, Schindler K, Sieber CC, Hiesmayr M, Volkert D. nutritionDay in Nursing Homes-The Association of nutritional intake and nutritional interventions with 6-month mortality in malnourished residents. J Am Med Dir Assoc. 2017;18:162–8. https://doi.org/10.1016/j.jamda.2016.08.021 . e-pub ahead of print 2016/10/11
doi: 10.1016/j.jamda.2016.08.021
pubmed: 27742584
Wirth R, Streicher M, Smoliner C, Kolb C, Hiesmayr M, Thiem U, et al. The impact of weight loss and low BMI on mortality of nursing home residents - Results from the nutritionDay in nursing homes. Clin Nutr. 2016;35:900–6. https://doi.org/10.1016/j.clnu.2015.06.003 . e-pub ahead of print 2015/07/07
doi: 10.1016/j.clnu.2015.06.003
pubmed: 26143743
Salminen K, Suominen M, Kautiainen H, Roitto H, Pitkala K. Energy intake and severity of dementia are both associated with health-related quality of life among older long-term care residents. Nutrients 2019; 11. e-pub ahead of print 2019/09/25; https://doi.org/10.3390/nu11102261
Batchelor-Murphy M, Kennerly SM, Horn SD, Barrett R, Bergstrom N, Boss L, et al. Impact of cognition and handfeeding assistance on nutritional intake for nursing home residents. J Nutr Gerontol Geriatr. 2019;38:262–76. https://doi.org/10.1080/21551197.2019.1617221 . e-pub ahead of print 2019/05/28
doi: 10.1080/21551197.2019.1617221
pubmed: 31124418
pmcid: 7187960
Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, et al. ESPEN guidelines on nutrition in dementia. Clin Nutr. 2015;34:1052–73. https://doi.org/10.1016/j.clnu.2015.09.004
doi: 10.1016/j.clnu.2015.09.004
pubmed: 26522922
Berkhout AM, Cools HJ, van Houwelingen HC. The relationship between difficulties in feeding oneself and loss of weight in nursing-home patients with dementia. Age Ageing. 1998;27:637–41. https://doi.org/10.1093/ageing/27.5.637 . e-pub ahead of print 2003/04/05
doi: 10.1093/ageing/27.5.637
pubmed: 12675103
Crogan NL, Alvine C, Pasvogel A. Improving nutrition care for nursing home residents using the INRx process. J Nutr Elder. 2006;25:89–103. https://doi.org/10.1300/j052v25n03_07 . e-pub ahead of print 2007/11/23
doi: 10.1300/j052v25n03_07
pubmed: 18032218
pmcid: 2583249
van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. A systematic review of malnutrition screening tools for the nursing home setting. J Am Med Dir Assoc. 2014;15:171–84. https://doi.org/10.1016/j.jamda.2013.10.006 . e-pub ahead of print 2013/12/03
doi: 10.1016/j.jamda.2013.10.006
pubmed: 24290910
Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health. 2014;36:e2014009 https://doi.org/10.4178/epih/e2014009 . e-pub ahead of print 2014/08/01
doi: 10.4178/epih/e2014009
pubmed: 25078382
pmcid: 4154347
Fewell Z, Davey Smith G, Sterne JAC. The impact of residual and unmeasured confounding in epidemiologic studies: a simulation study. Am J Epidemiol. 2007;166:646–55. https://doi.org/10.1093/aje/kwm165 . e-pub ahead of print 2007/07/05
doi: 10.1093/aje/kwm165
pubmed: 17615092