Identifying the elderly at risk for malnutrition: The Mini Nutritional Assessment

Sarcopenic obesity (SO) is a clinical condition in which sarcopenia and obesity occur together, and is associated with more poor clinical outcomes, increased mortality, and morbidity than sarcopenia. Phase angle (PhA), a parameter derived from bioimpedance analysis (BIA), provides data on cellular health, membrane integrity, and cellular function. This study aimed to evaluate the relationship between SO and PhA among older adults with type 2 diabetes mellitus (DM).

We performed a cross-sectional study in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment, the hand-grip strength test (HGST), the chair stand test (CST) for muscle strength evaluation, the 4-meter walking test, and the timed up-and-go (TUG) test for physical performance assessment. The diagnosis of SO was made according to the ESPEN/EASO criteria. The PhA was determined automatically by the BIA using resistance and reactance at 50 kHz for each participant.

A total of 322 participants were included in the study. The mean age of the participants was 72.5 ±5.8, and 203 (63%) of them were female; 63 (19.6%) of them were sarcopenic obese. In multivariable logistic regression analyses, a significant relationship was found when the model was adjusted for age, female gender, MNA-sf scores, HbA1c level, and CCI scores (OR: 0.53, 95%CI: 0.29–0.98, P = 0.04). In ROC analyses, for PhA in predicting SO diagnosis, the AUC was 0.586 (95%CI: 0.505–0.678, P = 0.033). At the cut-off score 4.4, sensitivity was 57.1% and specificity was 61.4%; positive predictive value (PPV) was 26.5%; negative predictive value (NPV) was 85.5%.

The study identified a significant relationship between SO and PhA among older adults with type 2 DM. However, larger prospective studies are needed to confirm the potential utility of PhA as a biomarker for SO.

Emerging studies indicate that time-restricted eating (TRE) may protect against cardiovascular disease (CVD); however, studies performed in elderly adults are limited. This study aimed to analyze the association of TRE with arterial stiffness (AS) in community-dwelling elderly Chinese individuals.

This cross-sectional study recruited 3487 participants aged ≥60 y from Shanghai, China. TRE was determined by calculating the end time of the last meal minus the start time of the first meal of the average day. Participants were then categorized into those with a time-restricted window lasting ≤11 h (TRE) and >11 h (non-TRE). The mean age of the sample was 71.78 ± 5.75 y, and 41.2 % were men. Having a TRE pattern was 72.2 %. In the logistic analysis, TRE was associated with borderline arterial stiffness (OR = 1.419; 95 % CI = 1.077–1.869) and elevated arterial stiffness (OR = 1.699; 95 % CI = 1.276–2.263). In a subgroup analysis, the significance remained in the group at risk of malnutrition (with borderline arterial stiffness: OR = 2.270; 95 % CI = 1.229–4.190; with elevated arterial stiffness: OR = 2.459; 95 % CI = 1.287–4.700), while in well-nourished participants, the association only remained with elevated arterial stiffness (OR = 1.530; 95 % CI = 1.107–2.115) and not with borderline arterial stiffness.

TRE is a risk factor for both borderline and elevated arterial stiffness in community-dwelling Chinese individuals and varies by nutritional status. (Protocol code 2019-WJWXM-04-310108196508064467.)

Despite significant evidence supporting the benefits of comprehensive oncogeriatric assessment in the management of older patients with cancer, the adoption of specialised geriatric oncology programs in the United Kingdom remains limited. Descriptions of clinic structure and models, patient demographics and baseline characteristics, resource utilisation, and predictors of resource utilisation are lacking in this population, which may complicate or impede the planning, resourcing, and development of further services in this subspecialty on a national and regional basis.

Between November 2021 and April 2023, 244 patients commencing systemic anticancer treatment at the Royal Marsden Hospital, London underwent geriatric screening using the Senior Adult Oncology Programme-3 (SAOP3) screening tool. Baseline clinical factors (sex, age, Charlson Comorbidity Index score, Cumulative Illness Rating Scale-Geriatric [CIRS-G] score, Katz Index score, Barthel Index score, treatment intent, and Eastern Cooperative Oncology Group Performance Status [ECOG-PS]) were assessed as predictors of geriatric impairments and need for multidisciplinary referral and intervention using a negative binomial regression analysis. Referral rates to multidisciplinary teams were assessed against ECOG-PS score using point-biserial correlation, as well as against a historical control using descriptive statistics.

The median age of participants was 77; 75.8% were female. Breast cancer was the most prevalent diagnosis (61.9%). Most patients (67.6%) were undergoing treatment in the palliative setting. Two hundred eleven (86.5%) patients were identified as having at least one geriatric impairment. Six hundred forty-nine multidisciplinary referrals were made, of which 583 (86.7%) were accepted by the referred patient. Higher ECOG PS was positively associated with geriatric impairments in physiotherapy, occupational therapy, dietetics, pharmacy, and welfare rights domains, as well as with the overall number of geriatric impairments.

The Royal Marsden Senior Adult Oncology Programme represents the first geriatric oncology service in a tertiary cancer centre in the United Kingdom. Following implementation of SAOP3 screening, we observed a substantial increase in referrals to all multidisciplinary teams, suggestive of previously underrecognized needs among this population. The need for multidisciplinary intervention was strongly correlated with baseline ECOG-PS score, but not with other measured clinical variables, including comorbidity or functional indices.

This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple readily available measure of malnutrition risk, and 30-day postoperative complications following total shoulder arthroplasty (TSA).

The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2021. The study population was divided into 3 groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Logistic regression analysis was conducted to investigate the connection between preoperative GNRI and postoperative complications.

Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of any complications (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.54-1.96; P < .001), blood transfusions (OR: 1.52, 95% CI: 1.09-2.11; P = .013), failure to wean off a ventilator within 48 hours (OR: 3.84, 95% CI: 1.26-11.72; P = .018), wound dehiscence (OR: 15.80, 95% CI: 1.61-155.28; P = .018), nonhome discharge (OR: 1.90, 95% CI: 1.63-2.22; P < .001), readmission (OR: 1.54, 95% CI: 1.19-1.99; P = .001), unplanned reoperation (OR: 1.87, 95% CI: 1.27-2.74; P = .001), length of stay > 2 days (OR: 1.85, 95% CI: 1.63-2.12; P < .001), and mortality (OR: 3.38, 95% CI: 1.32-8.71; P = .011). Severe malnutrition was independently significantly associated with a greater likelihood of any complication (OR: 3.33, 95% CI: 2.80-3.97; P < .001), sepsis (OR: 9.83, 95% CI: 2.94-32.85; P < .001), pneumonia (OR: 3.30, 95% CI: 1.71-6.38; P < .001), unplanned reintubation (OR: 5.77, 95% CI: 2.47-13.51; P < .001), urinary tract infection (OR: 2.15, 95% CI: 1.19-3.87; P = .011), stroke (OR: 3.57, 95% CI: 1.18-10.84; P = .024), blood transfusions (OR: 5.27, 95% CI: 3.86-7.20; P < .001), failure to wean off a ventilator within 48 hours (OR: 7.64, 95% CI: 2.29-25.55; P < .001), Clostridioides difficile infection (OR: 4.17, 95% CI: 1.21-14.32; P = .023), nonhome discharge (OR: 3.56, 95% CI: 2.92-4.34; P < .001), readmission (OR: 2.05, 95% CI: 1.46-2.89; P < .001), length of stay > 2 days (OR: 3.27, 95% CI: 2.73-3.92; P < .001), and mortality (OR: 4.61, 95% CI: 1.51-14.04; P = .007).

Malnutrition based on GNRI is a strong predictor of complications following TSA, with increasing severity related to an increased rate of complications.

This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire.

This cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment – Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes.

Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13–16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R² = 0.662).

This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.

Adequate patient selection is crucial within the treatment of older patients with colorectal cancer (CRC). While previous studies report increased morbidity and mortality in older patients screened positive for frailty, improvements in the perioperative care and postoperative outcomes have raised the question of whether older patients screened positive for frailty still face worse outcomes. This study aimed to investigate the postoperative outcomes of older patients with CRC screened positive for frailty, and to evaluate changes in treatment after frailty screening and geriatric assessment.

Patients ≥70 years with primary CRC who underwent frailty screening between 1 January 2019 and 31 October 2021 were included. Frailty screening was performed by the Geriatric-8 (G8) screening tool. If the G8 indicated frailty (G8 ≤ 14), patients were referred for a comprehensive geriatric assessment (CGA). Postoperative outcomes and changes in treatment based on frailty screening and CGA were evaluated.

A total of 170 patients were included, of whom 74 (43.5%) screened positive for frailty (G8 ≤ 14). Based on the CGA, the initially proposed treatment plan was altered to a less intensive regimen in five (8.9%) patients, and to a more intensive regimen in one (1.8%) patient. Surgery was performed in 87.8% of patients with G8 ≤ 14 and 96.9% of patients with G8 > 14 (p = 0.03). Overall postoperative complications were similar between patients with G8 ≤ 14 and G8 > 14 (46.2% vs. 47.3%, p = 0.89). Postoperative delirium was observed in 7.7% of patients with G8 ≤ 14 and 1.1% of patients with G8 > 14 (p = 0.08). No differences in 30-day mortality (1.1% vs. 1.5%, p > 0.99) or one-year and two-year survival rates were observed (log rank, p = 0.26).

Although patients screened positive for frailty underwent CRC surgery less often, those considered eligible for surgery can safely undergo CRC resection within current clinical care pathways, without increased morbidity and mortality. Efforts to optimise perioperative care and minimise the risk of postoperative complications, in particular delirium, seem warranted. A multidisciplinary onco-geriatric pathway may support tailored decision-making in patients at risk of frailty.