Elsevier

European Geriatric Medicine

Volume 1, Issue 4, September 2010, Pages 207-212
European Geriatric Medicine

Research paper
Nutritional status, chewing function and vitamin deficiency in geriatric inpatients

https://doi.org/10.1016/j.eurger.2010.06.006Get rights and content

Abstract

The aim of this study was to investigate the correlation of vitamin and trace element deficiencies with the cognitive function, the Activities of Daily Living, the nutritional status and the chewing function in a population of geriatric hospitalized patients.

Introduction

All patients aged 70 years and over admitted to a geriatric department because of an acute disease were included into the study. Assessments of Activities of Daily Living (Barthel's Index), cognition (MMST) and chewing function (Carrot test) were done for every patient included. The nutritional status was assessed by the MNA, the BMI and by measurements of skinfold thickness. In addition to routine laboratory investigations the following laboratory investigations were done for every patient: Osteocalcin, Transketolase-Activity, Thiamin, Glutathion-Reductase-Activity, Niacin, Vitamin C, Vitamin A, Vitamin E and Selenium.

Results

Thirty-one patients (18 female and 13 male) were included into the study. No patient refused participation. The mean age was 78, 2 years. The mean BMI was 26.87 kg/m2, the mean Barthel index was 60 points. The average score in the Mini-Mental-Status-Test was 20.7 points. Only 26% of the patients had a good nutritional status according to the Mini Nutritional Assessment (MNA). Forty-five percent of the patients had no own teeth. Eighty-one percent of the patients stated that they have no problems with chewing. However, objective testing revealed a higher prevalence of chewing dysfunction: 42% were not able to grind a carrot slice sufficiently in the carrot test. 55% of the patients had Vitamin C concentrations below the normal range, Selenium concentrations were below normal range in 52% of the patients investigated. Patients with a bad chewing function (index 6 in the carrot test) had a tendency to lower serum levels of Vitamin B1, Niacin, Vitamin C, Vitamin A and Selenium. There was a significant positive correlation of selenium levels with vitamin B 12 levels and lymphocyte count. The concentrations of Vitamin C and Vitamin A were significantly higher in patients taking many medications. No significant correlation was found between micronutrient deficiencies and BMI or the MNA score.

Conclusions

Elderly patients with acute illness have frequently micronutrient deficiencies, Vitamin C and Selenium being deficient in more than half of the patients. These deficiencies were not restricted to underweight patients: Patients with a normal BMI and even overweight patients showed micronutrient deficiencies. Geriatric and nutritional assessments alone are not suitable to identify the patients with these deficiencies.

Introduction

Undernutrition and malnutrition have a paramount negative impact on morbidity and mortality of elderly persons. Even patients with obesity aged 65 years and older show an increased mortality when losing more than 5% of their actual body weight [27]. Due to decreased physical activity, the energy requirements decrease with age in most persons. Energy intake of older men (40–74 years old) is nearly a third less (2100–2300 calories/day) compared to the intake of men aged 24–34 years old (2700 calories/day) [18], [24]. In contrast, the requirements for vitamins and trace elements do not decrease with age [26].

When assessed by the Mini Nutritional Assessment (MNA), only 20% of elderly community dwelling people have no risk of malnutrition whereas 71% are at risk and 9% suffer from severe malnutrition [28].

In German hospitals, the prevalence of malnutrition in geriatric inpatients is exceeding 50% [33]. Caloric supplementation improves outcomes in malnourished hospital patients and malnourished older persons [25]. Maintenance of nutritional status has the potential to reduce morbidity and delay the transition to high-level care [45]. For hospitalized elderly patients, fat mass is associated with a decreased risk of adverse events [3].

Depression is the most common cause for malnutrition (30% of cases), followed by malignant diseases (9% of cases) [44]. Difficulties in purchasing and preparing food can also contribute to the development of malnutrition [38]. Handgrip strength and Barthel's Index show an association with the assessment by MNA [28].

The chewing function has an influence on the nutritional status too. Publications focused on this topic are rare [42], [46]. In Japanese edentulous outpatients, the self-evaluation of the masticatory function improved after the switch from old to new dentures [17].

The aim of this study is to find out if the levels of relevant vitamins and the levels of Selenium are decreased in patients defined malnourished or at risk of malnutrition by the MNA and if decreased levels of Selenium or Vitamin C are associated with decreased scores in the Basic Activities of Daily Living (BADLs). Furthermore, it is aimed to find out if patients with poor chewing function, defined by the carrot test have decreased levels of micronutrients.

Section snippets

Materials and methods

All patients aged 70 years and older admitted with an acute illness to the Department of Geriatrics of the Bonifatius-Hospital Lingen (Ems) between February and March 2003 were included into the study. Patients aged 70 years and older that were admitted to another department of the hospital were not included into the study. The Bonifatius Hospital Lingen is an Academic Teaching Hospital of the Medical School of Hannover in Niedersachsen (Germany) with 416 beds for acute care. The study protocol

Results

Thirty-one patients (18 female, 13 male) were included into the study. The patients had an age between 70 and 91 years. The mean age was 78.2 years.

Only two patients had less than three diagnoses, 13 (42%) had more than six diagnoses.

Only one patient did not take any medication. Four (13%) took more than 10 medications. Two patients (6.4%) were taking multivitamin preparations. Fourteen patients (45%) reported involuntary weight loss. Fifteen patients (48%) were cared for by relatives, 15

Discussion

This study recruited older patients, most of them with significant restrictions in their Activities of Daily Living (ADL): The mean Barthel's Index was 60 points. Most patients had restricted cognitive function.

The mean BMI was 26.78 kg/m2. According to the WHO definition, 19 patients (61%) were overweight. Only one patient had a BMI of < 18.5 kg/m2, which is defined as underweight. However, the WHO definition of normal ranges of BMI is not accepted in older people [29]. In contrast to the

Conclusions

Many geriatric inpatients have deficiencies in vitamins and trace elements. Vitamin C and selenium are particularly low with serum levels below normal limits in more than half of the patients investigated. Vitamin and trace element deficiencies are not restricted to underweight patients but are also of concern in patients with normal BMI and even in overweight patients. Even through geriatric (Barthel's Index, MMST) and nutritional (MNA, Carrot test) assessments cannot predict which patient

Conflict of interest statement

The study was supported by a grant from the German Society for Geriatrics (Deutsche Gesellschaft für Geriatrie, DGG).

Acknowledgements

The authors thank Petra Landwehr, Secretary at Bonifatius Hospital, for her excellent technical assistance.

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