Lower dietary variety is a relevant factor for malnutrition in older Japanese home-care recipients: a cross-sectional study

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Abstract

Background

Nutritional status of the older people is affected by various life-style factors. Although dietary habit is one of the life-style factors, it is unknown which of older home-care recipients’ dietary habits are associated with malnutrition.

The purpose of this study was to examine the association of dietary variety, as an evaluation index for dietary habits, with malnutrition in Japanese older home-care recipients.

Methods

This cross-sectional study was conducted in a single city, Hyogo Prefecture, Japan between July and October 2016. Three hundred thirty-three community-dwelling older care recipients (aged 65 years or older who were receiving home-visit nursing care services) were enrolled. Their nutritional status (Mini Nutritional Assessment®-short form: MNA®-SF), dietary variety (Food frequency score [FFS]), socio-demographic characteristics (age, sex, marital status, etc.), health indicators (comorbidity [Charlson Comorbidity Index] and dysphagia status [Dysphagia Severity Scale]) were assessed. The participants were classified into two groups: malnourished (0–7 points) and non-malnourished (8–14 points), according to their MNA®-SF scores. Multivariate logistic regression analysis was used to examine the factors associated with malnutrition.

Results

A total of 317 participants were analyzed (118 men, 199 women, median age: 84 years). Compared to the fourth (highest) quartile of FFS, odds ratios (OR) (95% confidence intervals [CI]) of the third, second, and first (lowest) quartiles of FFS were 1.08 (0.42–2.80), 1.29 (0.56–2.98), and 2.30 (1.02–5.19), respectively (p for trend = 0.049). Higher Charlson Comorbidity Index score and the presence of dysphagia were also significantly associated with malnutrition (OR: 2.08, 95% CI: 1.08–4.00 and OR: 3.86, 95% CI: 2.08–7.17, respectively).

Conclusion

Lower dietary variety was significantly associated with malnutrition in Japanese older home-care recipients.

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Most cited references 35

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The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us?

Y Guigoz (2015)

To review the literature on the MNA to Spring 2006, we searched MEDLINE, Web of Science and Scopus, and did a manual search in J Nutr Health Aging, Clin Nutr, Eur J Clin Nutr and free online available publications. The MNA was validated against two principal criteria, clinical status and comprehensive nutrition assessment using principal component and discriminant analysis. The MNA shortform (MNA-SF) was developed and validated to allow a 2-step screening process. The MNA and MNA-SF are sensitive, specific, and accurate in identifying nutrition risk. The prevalence of malnutrition in community-dwelling elderly (21 studies, n = 14149 elderly) is 2 +/- 0.1% (mean +/- SE, range 0- 8%) and risk of malnutrition is 24 +/- 0.4% (range 8-76%). A similar pattern is seen in out-patient and home care elderly (25 studies, n = 3119 elderly) with prevalence of undernutrition 9 +/- 0.5% (mean +/- SE, range 0-30%) and risk of malnutrition 45 +/- 0.9% (range 8-65%). A high prevalence of undernutrition has been reported in hospitalized and institutionalized elderly patients: prevalence of malnutrition is 23 +/- 0.5% (mean +/- SE, range 1- 74%) in hospitals (35 studies, n = 8596) and 21 +/- 0.5% (mean +/- SE, range 5-71%) in institutions (32 studies, n = 6821 elderly). An even higher prevalence of risk of malnutrition was observed in the same populations, with 46 +/- 0.5% (range 8-63%) and 51 +/- 0.6% (range 27-70%), respectively. In cognitively impaired elderly subjects (10 studies, n = 2051 elderly subjects), detection using the MNA, prevalence of malnutrition was 15 +/- 0.8% (mean +/- SE, range 0-62%), and 44 +/- 1.1% (range 19-87%) of risk of malnutrition. The large variability is due to differences in level of dependence and health status among the elderly. In hospital settings, a low MNA score is associated with an increase in mortality, prolonged length of stay and greater likelihood of discharge to nursing homes. Malnutrition is associated with functional and cognitive impairment and difficulties eating. The MNA(R) detects risk of malnutrition before severe change in weight or serum proteins occurs. Intervention studies demonstrate that timely intervention can stop weight loss in elderly at risk of malnutrition or undernourished and is associated with improvements in MNA scores. The MNA can also be used as a follow up assessment tool. The MNA is a screening and assessment tool with a reliable scale and clearly defined thresholds, usable by health care professionals. It should be included in the geriatric assessment and is proposed in the minimum data set for nutritional interventions.

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Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.

(2002)

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Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study.

Denise K. Houston, Jingzhong Ding, Richard Harris … (2007)

Dietary surveys suggest that many older, community-dwelling adults consume insufficient dietary protein, which may contribute to the age-related loss of lean mass (LM). The objective of the study was to determine the association between dietary protein and changes in total LM and nonbone appendicular LM (aLM) in older, community-dwelling men and women. Dietary protein intake was assessed by using an interviewer-administered 108-item food-frequency questionnaire in men and women aged 70-79 y who were participating in the Health, Aging, and Body Composition study (n=2066). Changes in LM and aLM over 3 y were measured by using dual-energy X-ray absorptiometry. The association between protein intake and 3-y changes in LM and aLM was examined by using multiple linear regression analysis adjusted for potential confounders. After adjustment for potential confounders, energy-adjusted protein intake was associated with 3-y changes in LM [beta (SE): 8.76 (3.00), P=0.004] and aLM [beta (SE): 5.31 (1.64), P=0.001]. Participants in the highest quintile of protein intake lost approximately 40% less LM and aLM than did those in the lowest quintile of protein intake (x+/-SE: -0.501+/-0.106 kg compared with -0.883+/-0.104 kg for LM; -0.400+/-0.058 kg compared with -0.661+/-0.057 kg for aLM; P for trend<0.01). The associations were attenuated slightly after adjustment for change in fat mass, but the results remained significant. Dietary protein may be a modifiable risk factor for sarcopenia in older adults and should be studied further to determine its effects on preserving LM in this population.

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Author and article information

Contributors

Taeko Tsuji: taeko.t1110@gmail.com

Kaoru Yamamoto: kaoru.3462@gmail.com

Kazuyo Yamasaki: yamasaki-k@nishinomiya-fukushi.or.jp

Fumikazu Hayashi: fhayashi@fmu.ac.jp

Chika Momoki: momoki@tezukayama-u.ac.jp

Yoko Yasui: yasui@life.osaka-cu.ac.jp

Satoko Ohfuji: satop@med.osaka-cu.ac.jp

Wakaba Fukushima: wakaba@med.osaka-cu.ac.jp

Daiki Habu: +81-(0)6-6605-2892 , habu@life.osaka-cu.ac.jp

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 26 July 2019

Publication date PMC-release: 26 July 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 197

Affiliations

[1 ]ISNI 0000 0001 1009 6411, GRID grid.261445.0, Department of Medical Nutrition, Graduate School of Human Life Science, , Osaka City University, ; 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585 Japan

[2 ]Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Hyogo, Japan

[3 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Office of Epidemiology, Radiation Medical Science Center for the Fukushima Health Management Survey, , Fukushima Medical University, ; Fukushima, Japan

[4 ]GRID grid.444443.7, Department of Food and Nutrition, Faculty of Contemporary Human Life Science, , Tezukayama University, ; Nara, Japan

[5 ]ISNI 0000 0001 1009 6411, GRID grid.261445.0, Department of Clinical Nutrition, Graduate School of Human Life Science, , Osaka City University, ; Osaka, Japan

[6 ]ISNI 0000 0001 1009 6411, GRID grid.261445.0, Department of Public Health, , Osaka City University Graduate School of Medicine, ; Osaka, Japan

Article

Publisher ID: 1206

DOI: 10.1186/s12877-019-1206-z

PMC ID: 6659217

PubMed ID: 31349800

SO-VID: 7c00fd52-19fd-4447-845d-b52df7a2f848

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 September 2018

Date accepted : 9 July 2019

Funding

Funded by: The Japan Academy of Home Care

Award ID: No.16-001

Award Recipient : Taeko Tsuji

Funded by: Osaka City University Support office for Female Researchers

Award ID: No.4

Award Recipient : Taeko Tsuji

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: malnutrition,older people,home care,dietary variety,dietary habits,dysphagia,comorbidity

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ScienceOpen disciplines: Geriatric medicine

Keywords: malnutrition, older people, home care, dietary variety, dietary habits, dysphagia, comorbidity

Lower dietary variety is a relevant factor for malnutrition in older Japanese home-care recipients: a cross-sectional study

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Hearing Loss and Restoration

Most cited references 35

The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us?

Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.

Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study.

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