Nutritional Management in Dementia

With the increase in lifespan, and consequent increase in the elderly population, the prevalence of dementia is also increasing. The prevalence of dementia in the elderly over 65 in Korea was 10.3% in 2020 and is expected to increase to 16.1% by 2050.Dementia is a cognitive decline that affects eating behavior, leading to weight loss and malnutrition. In fact, the prevalence of malnutrition has been rising, and has been reported to be 58.9% among dementia patients in community facilities. Dementia requires the intake of sufficient calories and protein to prevent weight loss. On the other hand, intake of certain nutrients, such as omega-3 fatty acids, thiamine, vitamin E, selenium, and copper, helps prevent dementia in healthy people but has no effect on patients with advanced dementia. As dementia worsens, if food intake is reduced, oral nutritional supplements and enteral nutrition should be initiated to prevent weight loss and malnutrition. Dementia patients are very vulnerable to malnutrition, and hence require more active nutritional support.

Nutritional Management in Dementia

With the increase in lifespan, and consequent increase in the elderly population, the prevalence of dementia is also increasing. The prevalence of dementia in the elderly over 65 in Korea was 10.3% in 2020 and is expected to increase to 16.1% by 2050.Dementia is a cognitive decline that affects eating behavior, leading to weight loss and malnutrition. In fact, the prevalence of malnutrition has been rising, and has been reported to be 58.9% among dementia patients in community facilities. Dementia requires the intake of sufficient calories and protein to prevent weight loss. On the other hand, intake of certain nutrients, such as omega-3 fatty acids, thiamine, vitamin E, selenium, and copper, helps prevent dementia in healthy people but has no effect on patients with advanced dementia. As dementia worsens, if food intake is reduced, oral nutritional supplements and enteral nutrition should be initiated to prevent weight loss and malnutrition. Dementia patients are very vulnerable to malnutrition, and hence require more active nutritional support.

Lifestyle, Diet, Self-care, and Diabetes Fatalism of Diabetic Patients with and without Diabetic Foot / 대한지역사회영양학회지

OBJECTIVES: This study was to determine diabetes fatalism of diabetic patients with and without diabetic foot and its association with lifestyle, diet, and self-care. METHODS: The subjects were diabetic patients with (male/female 48/21) and without diabetic foot (male/female 33/26). We administered the questionnaires which were designed to determine diabetes fatalism, lifestyle, diet, and self-care. Diabetes fatalism was determined by Diabetes fatalism scale (DFS), which consisted of total 12 items in three subscales namely, emotional stress, religiou.spiritual coping, and perceived self-efficacy. RESULTS: The patients with diabetic foot had undesirable diets more frequently (1.37 and 0.91 days/week respectively) and their desirable diets (2.74 and 3.61 days/week respectively) and foot care (4.61 and 5.53 days/week respectively) were less frequent than those without diabetic foot (p < 0.05). An item analysis of the 12 DFS items revealed a Chronbach' alpha of 0.614 and 0.869, respectively in diabetic patients with and without diabetic foot. Perceived self-efficacy related DFS of subjects without diabetic foot was positively associated with smoking (r = 0.350, p < 0.01), undesirable diet (r = 0.295, p < 0.05), and drinking (r = 0.257, p < 0.05), while its negative association with exercise (r = -0.224, p < 0.088) and foot care (r = -0.247, p < 0.059) did not reach to statistical significance. CONCLUSIONS: This work was the first study reporting the potential usefulness of DFS, especially perceived self-efficacy related subscale as a predictor of lifestyle, diet and self-care on the Korean diabetic patients, at least those without severe diabetic foot to screen those who should be the first target for diabetes education.

Nutrition Status of Elderly Female Patients in Long-term Care Hospital according to Meal Types and Eating Ability / 대한지역사회영양학회지

OBJECTIVES: This study was carried out to determine nutritional status of elderly patients in a long-term care hospital according to meal type and eating ability. METHODS: Subjects were 47 female patients aged over 65 (79.3 +/- 7.1 years) who resided in a long-term care hospital in Seoul. Thirty seven patients who ate diet orally were grouped according to meal type (27 general diet and 10 soft diet) and eating ability (26 eating by oneself and 11 eaten with help) and 10 were on tube feeding. Nutritional status was determined by food consumption and mid-arm circumference. RESULTS: The mean adequacy ratios (MARs) of 12 nutrients (protein, calcium, phosphorus, zinc, vitamin A, vitamin B1, vitamin B2, vitamin B6, niacin, folic acid, vitamin C) were 0.687 for general diet, 0.565 for soft diet, 0.680 for eating by oneself and 0.677 for eaten with help, which were significantly lower than 0.982 for tube feeding (p < 0.05 or p < 0.01). The patients on tube feeding had significantly lower % arm circumference compared to those who ate general diet (84.0% vs. 95.4%, respectively, p < 0.05). Nutrients intakes, nutrient adequacy ratio (NAR) and index of nutritional quality (INQ) were not different between meal types as well as eating ability. The most insufficiently consumed nutrients by the patients on diet were folic acid, vitamin B2, and calcium (NAR 0.334~0.453, 0.515~0.539, and 0.516~0.533, respectively). CONCLUSIONS: The results suggested that regardless of meal type or eating ability, the subjects who were on diets in this study might have inadequate intake of folic acid as well as vitamin B2, and calcium, which need to be reflected on menu planning. The measurement of mid-arm circumference presented more risk of malnutrition of patients on tube feeding than those on diets, despite apparently better nutrient consumption.

The Impact of the Amount of Intracellular SPIO on MR Signal Intensity during In Vivo Tracking of Macrophage Homing

PURPOSE: To determine whether the amount of intracellular superparamagnetic iron oxide (SPIO) in macrophages influences MR signal intensity during in vivo celluar tracking. MATERIALS AND METHODS: Peritoneal macrophages harvested from thioglycolate-treated mice were labeled with SPIO using concentrations of 112, 56, and 28 microgramFe/ml, and different incubation times of 3h, 6h, 12h, 24h and 48 h, respectively. The iron concentration was quantified with the use of absorption spectrophotometry. Each group of macrophages labeled with different concentrations of SPIO was intravenously injected into 18 mice, after inoculation with S. aureus to the thigh. The relative signal intensity (SI) of the abscess wall (SI of the abscess wall/SI of muscle) was measured on MR and was analyzed by the use of the Kruskal-Wallis test. RESULTS: A higher concentration of SPIO in the labeling solution and a longer incubation time resulted in a higher concentration of SPIO in the macrophages. The relative SI of the abscess wall (0.63 for 112 microgramFe/mL; 0.67 for 56 microgramFe/ml; 0.89 for 28 microgramFe/mL) significantly decreased with an increase of SPIO concentration (k2=10.53, p < 0.005). CONCLUSION: The amount of intracellular SPIO influences the MR signal intensity by the susceptibility effect, and it is recommended to use sufficient iron-oxide label as long as it does not affect cellular function and viability.

Relationship between the Number of SPIO-labeled Macrophage and MR Signal Intensity

PURPOSE: For the in vivo imaging of macrophages using MRI, the feasibility of labeling macrophages with iron oxide and the number of SPIO-labeled macrophage detected in 1.5 T MR, were assessed. MATERIALS AND METHODS: The MR signal intensity was measured with variable concentrations of iron oxide, ranging from 112 to 2.384x10-7 μgFe/mL. The macrophages were incubated in SPIO solution (112 μgFe/mL) for 24 hours. The MR signal intensity was measured in variable numbers of SPIO-labeled macrophages. RESULTS: The MR image signal intensity gradually increased with decreasing SPIO concentration, and reached a plateau at a concentration of 0.219 μgFe/mL. After incubation with iron oxide, the compact uptake of SPIO was detected in the cytoplasm of the macrophages using Prussian blue staining. No susceptibility effect was detected in the tubes of more than 122 macrophages. CONCLUSION: The MR signal intensity was dependent on the number of macrophages. No susceptibility effect due to a cluster of SPIO-labeled macrophages was detected in more than 488 cells.