Nutritional status in a multicenter study among institutionalized patients in Spain.

INTRODUCTION: The aim of our study was to investigate and evaluate, in a multicenter study, the prevalence of malnutrition as well as the relationship between different anthropometric and biochemical markers with Mininutritional assessment (MNA) scores. SUBJECTS AND METHODS: A representative sample of the institutionalized Spanish population aged 65 and older (stricly speaking, born in 1942 or earlier), is covered in this cross-sectional survey. Anthropometric variables, MNA test and biochemical evaluation were performed by Geriatrics Units specialists. RESULTS: The percentage of patients classified as well nourished (27.8%) was larger in the 85-94 (39.4%) range than in the 65-74 (26.2%), 75-84 (24%) and > 95 (14.8%) age ranges. A population of 254 patients (49.6%) were at risk of undernutrition, a number which was larger in 75-84 (52%), 65-74 (53.8%) and > 95 (53.7%) than in the 85-94 (44.1%) ones. On the other hand, undernourishment (22.5%) was larger in those of 95 and older (31.5%) than in 85-94 (16.5%), 75-84 (24%) and 65-74 (20%) patients. According to our investigation females are worse nourished (Odd's Ratio 0.51 CI 95%: 0.33-0.79) and, consequently, more undernourished (Odd's Ratio 2.36 CI 95%: 1.48-3.74) than males. No significant differences in the "at risk of undernutrition category" (Odd's Ratio 0.76 CI 95%: 0.52-1.10) were observed but, in transferrin, iron, haemoglobin and total cholesterol, statistical differences among MNA classification were detected. MNA scores were correlated with iron, total cholesterol, albumin, transferrin, age and haemoglobin. CONCLUSION: In this multicenter study, institutionalized patients have a high prevalence of undernutrition or are at-risk, as well as females are more undernourished than males.

Evaluation of the mini-nutritional assessment short-form (MNA-SF) among institutionalized older patients in Spain.

INTRODUCTION: In the present study, we evaluated a short form version of MNA test in a multicenter study and the relationship of different biochemical markers with MNASF scores. MATERIAL AND METHODS: This was a cross-sectional survey covering a sample of representative of the older institutionalized Spanish population aged above 65 years (n = 873). A Mini nutritional assessment short form test (MNA-SF) was used. RESULTS: The number of patients classified as well nourished (42.1%) was larger in the 65-74 (52.6%) range than in the 75-84 (40.2%), 85-94 (43.8%) and > 95 (24%) age ranges. Risk of undernutrition occurred in a total of 506 patients (57.9%), risk of undernutrition was larger in > 95 (76%) range than in 65-74 (47.4%), 75-84 (59.8%) and 85-94 range (56.2%). No differences were detected between males and females at risk of undernutrition (odds ratio: 0.85 CI 95%: 0.64-1.12). CONCLUSION: In this multicenter study, institutionalized patients have a high prevalence of at risk of malnutrition assessed by MNA-SF test.

Glycaemic control with liraglutide: the phase 3 trial programme.

AIMS: To review the efficacy and safety of liraglutide from the phase 3 trials, focusing primarily on glycaemic control. KEY FINDINGS: Liraglutide was shown to reduce glycated haemoglobin (HbA(1c) ) levels by up to 1.5% from baseline, significantly more than the comparators sitagliptin (-0.9%), glimepiride (-0.5%), rosiglitazone (-0.4%), insulin glargine (-1.1%) and exenatide (-0.8%). Both fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels were shown to be significantly reduced from baseline [up to -2.4 mmol/l (-43.2 mg/dl) and -2.7 mmol/l (-48.6 mg/dl) for FPG and PPG in the liraglutide 1.8 mg group, respectively]. Changes in HbA(1c) , FPG and PPG levels were sustained for the duration of the studies (up to 52 weeks). The glycaemic control offered by liraglutide was not associated with an increased rate of minor hypoglycaemic events compared with comparator treatments, with rates significantly lower than those of glimepiride and exenatide. Major hypoglycaemic events were rare and only occurred in combination with a sulfonylurea. Nausea was the most frequent adverse event, but subsided within the first few weeks. CONCLUSIONS: Liraglutide has been shown to offer effective glycaemic control for patients with type 2 diabetes and is appropriate for use across the conventional continuum of care. Despite the sustained reductions in HbA(1c) , FPG and PPG levels achieved with liraglutide, rates of minor hypoglycaemia were generally low, although the risk increased when combined with a sulfonylurea. Liraglutide is therefore a promising new option for the treatment of type 2 diabetes.

Prevalence of metabolic syndrome with International Diabetes Federation Criteria and ATP III Program in patients 65 years of age or older.

BACKGROUND: The relationship between cardiovascular factors and death can vary with age, very few studies have examined metabolic syndrome in the elderly. OBJECTIVE: The aim of this study is to assess the prevalence of the MS in a sample of elderly institutionalized patients (> 65 years) using ATPIII and IDF definitions. DESIGN: This was a cross-sectional survey covering a sample of representative of the institutionalized Spanish population aged above 65 years. The final sample study consisted of 862 patients, 556 females and 306 males. ATPIII and IDF definitions were used to classify the patients. RESULTS: Prevalence of MS was different according to the two definitions used. When the IDF definition was applied, total prevalence was 48.91% (CI 95%:43.47-50.25), while prevalence according to ATPIII criteria was 46.80% (CI = 43.47-50.25). a higher prevalence of MS was found in females as compared to males. Using IDF criteria, odds ratio was 1.9 (CI 95%:1.4-2.6) and 1.7 (CI 95%:1.2-2.2) according to ATPIII criteria. a steady decrease is seen in MS prevalence as the age of patients increases (the last two groups (85-94 ys and > 95 ys), both for the ATP III and the IDF definitions. CONCLUSION: A higher prevalence of MS in this elderly population as compared to general population was observed. A decrease of this prevalence above 95 years was detected.

Insulin requirements in lipodystrophic diabetes.

A ten-fold increase in daily insulin requirements during the administration of total parenteral nutrition (TPN) is described in a patient with congenital generalized lipodystrophy, insulin-requiring diabetes mellitus, and acanthosis nigricans during an episode of acute pancreatitis secondary to hypertriglyceridaemia. After a period of 13 days on TPN, insulin requirements increased dramatically to an average of 1428 units per day for a period of 12 days, to achieve a mean blood glucose level of 10.9 mmol l-1. When the patient resumed feeding and the TPN was discontinued, the average daily insulin requirement was 104 units with a mean 24 h blood glucose of 11.8 mmol l-1. Parenteral administration of energy substrates in a rare case of diabetes mellitus and congenital lipodystrophy complicated by acute pancreatitis resulted in a severe insulin insensitive state due to the combination of the hypermetabolism conferred by the pancreatitis plus transient impairments of the glucose disposal mechanism by the energy substrates provided.