Diagnosis of Sarcopenia in Long-Term Care Homes for the Elderly: the Sensitivity and Specificity of Two Simplified Algorithms with Respect to the EWGSOP Consensus.

OBJECTIVE: To analyze the prevalence of sarcopenia in elderly care homes using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP) and to evaluate the applicability, sensitivity, and specificity of two simplified algorithms that do not include gait speed measurement. DESIGN: Cross-sectional study. SETTING: Long-term care homes. PARTICIPANTS: 249 residents (187 females and 62 males) with a mean age of 84.9 ± 6.7 years (range, 70-106 yrs). MEASUREMENTS: Cognitive impairment was evaluated with the Pfeiffer test, functional capacity with the Barthel index, walking ability by the Functional Ambulation Classification, muscle mass by bioelectrical impedance analysis, muscle strength by handgrip dynamometry and, gait speed over a distance of 4 m. Sarcopenia was assessed using the EWGSOP-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the EWGSOP algorithm using the MacNemar test and obtaining the sensitivity and specificity, kappa coefficient, and area under the receiver operating characteristic curve (AUC). RESULTS: Total or severe dependence was recorded in 67% of the 249 residents, severe or moderate cognitive impairment in 64%, inability to walk in 49%, and capacity to walk only with the aid of an ambulator or two people in 21%. The prevalence of sarcopenia was 63.0% by the EWGSOP algorithm, 62.9% by algorithm A and 63.2% by algorithm B (P = 1.000); 143 participants were diagnosed with sarcopenia by all three methods (P =1.000, K = 1.000). CONCLUSION: Further studies that include residents with functional and/or cognitive impairment are required to validate these results, comparing the diagnostic performance of the EGWSOP algorithm with that of the simplified algorithms validated in the present report.

Nutritional status in chronically-ill elderly patients. Is it related to quality of life?

OBJECTIVE: The aim of this study is to assess the quality of life in chronically-ill elderly patients and its relationship with parameters concerning the patients' nutritional status. DESIGN: A cross-sectional study. SETTING: Primary health-care centres in Jaen, Spain. PARTICIPANTS: A total of 168 chronically-ill elderly outpatients aged from 65 to 89 years. MEASUREMENTS: Quality of life was measured using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. A nutritional assessment was undertaken including socio-demographic variables, anthropometric measurements (body-mass index and calf circumference), functional evaluation (Barthel index and Folstein mini-mental status test) and a dietetic questionnaire. The mini-nutritional assessment test was used as an assessment tool to detect nutritional risk. RESULTS: Quality of life in chronically-ill elderly subjects, as determined by the WHOQOL-BREF questionnaire, which diminishes with age, is independent of anthropometric parameters and a statistically significant difference was found between gender, socio-demographic characteristics, functional capacity, nutritional status and the kind of chronic disease (p<0.05). CONCLUSION: The relationship between the quality of life with the patients' socio-demographic characteristics, functional capacity and nutritional status underlines the importance of taking these factors into account in the management of chronically ill patients, especially women.

[Nutritional status in elderly patients with a hip fracture]. / Estado nutricional en ancianos con fractura de cadera.

BACKGROUND AND OBJECTIVE: Undernutrition is very common in elderly patients with a hip fracture. Malnutrition is associated with increased risk of complications after surgery. Few data exist about the presence of nutritional risk in these patients. The aim of this study was to evaluate the prevalence of undernutrition and the nutritional risk in elderly patients with a hip fracture admitted to a hospital. PATIENTS AND METHOD: A cross sectional study assessing the nutritional status of 80 patients with hip fracture (mean age 80 years) was carried out. Functional capacity, anthropometric measurements, biochemical markers and dietary intake were evaluated. The Mini Nutritional Assessment test has been used to detect nutritional risk. RESULTS: 8.8% of patients were undernourished. 43.7% at risk of malnutrition and 47.5% well-nourished according to MNA test. If only BMI was considered the prevalence of malnutrition was 5%. Energy and micronutrient intake was low and could contribute to the development of complications after surgery. CONCLUSIONS: Our study shows a high prevalence of nutritional risk in elderly patients with a hip fracture. The inclusion of MNA in the preoperative evaluation could contribute to a better nutritional intervention during their stay in the hospital and to provide specific dietary advices to avoid malnutrition after surgery.

El nuevo grado en farmacia ¿cubre las necesidades formativas en el ámbito de la nutrición? / The new degree in pharmacy. Is it enough for the formative needs in the nutrition area?

La importancia de la alimentación en la consecución de la salud y en la prevención de la enfermedad y la necesidad de un buen control de la dieta para alcanzar resultados satisfactorios en la reducción del riesgo, tratamiento y control de muchas de las enfermedades crónicas, es un hecho documentado científicamente y de gran relevancia en la sociedad actual. La Orden CIN/2137/2008, de 3 de julio establece los requisitos para la verificación de los títulos universitarios oficiales que habiliten para el ejercicio de la profesión farmacéutica, abarcando diversas competencias que aluden directamente a la formación del farmacéutico en el campo de la nutrición. Entre ellas se incluyen 1) Prestar consejo terapéutico en farmacoterapia y dietoterapia, así como consejo nutricional y alimentario a los usuarios de los establecimientos en los que presten servicio. 2) Conocer la relación existente entre la alimentación y salud, y la importancia de la dieta en el tratamiento y prevención de las enfermedades. 3) Desarrollar análisis higiénico-sanitarios (bioquímico, bromatológico, microbiológicos, parasitológicos) relacionados con la salud en general y con los alimentos y medio ambiente en particular. 4) Conocer las técnicas analíticas relacionadas con el diagnóstico de laboratorio de tóxicos, alimentos y medioambiente. En este sentido, el nuevo Grado en Farmacia aprobado por el Consejo de Gobierno de la Universidad de Granada incluye la asignatura troncal “Nutrición y Bromatología” de 6 créditos. Sin embargo los créditos obligatorios aprobados por la ANECA para esta materia en 8 Universidades Españolas oscilan entre 7,5 para Sevilla y 12 créditos para Madrid con una media de 9,4 créditos. De esta forma ¿Es posible cubrir con los 6 créditos asignados a esta materia una formación mínima para que el farmacéutico pueda realizar adecuadamente las competencias que se le han asignado?(AU)

The importance of nutrition on human health and on illness prevention, and the need for a good control of the diet to reach satisfactory results in the reduction of the risk, treatment and control of many of the chronic diseases, is a scientifically documented fact quite relevant in the current society(AU)

Does bariatric surgery improve the patient's quality of life?

OBJECTIVE: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS) on the quality of life (QoL), applying the Nottingham Health Profile (NHP) and the bariatric analysis and reporting outcome system (BAROS). DESIGN: A prospective cohort study was performed in 100 adult patients (> 18 years) undergoing bariatric surgery by malabsorptive technique for one year. RESEARCH METHODS AND PROCEDURES: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI) was 50.7 kg/m². RESULTS: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p < 0.001) with respect to baseline values. According to the BAROS test, 48% of patients lost 25-49% of weight excess and 80.8% had resolved major comorbidities at 1 yr. According to the Moorehead-Ardelt QoL score, there were major improvements in employment and self-esteem in 89% and 87% of patients, respectively, and improvements in physical activity, sexual and social relationships. According to the total mean BAROS score, the outcome was considered "very good". CONCLUSION: NHP and BAROS questionnaires appear to be useful and easily applicable tools to assess the QoL of obese patients.

Mercurio en aguas del sureste de España: posibles fuentes de contaminación / Mercury in Waters from South-eastern Spain: possible sources of Pollution

Se determinaron los niveles de mercurio en aguas potables, aguas de riego y aguas residuales de distintos lugares de la provincia de Granada (sureste de España). Se analizaron un total de 74 muestras mediante espectrometría de absorción atómica de vapor frío, y se verifi caron la sensibilidad, la exactitud y la precisión del método. No se detectó mercurio en las muestras de agua potable, pero los valores detectados en el agua de riego oscilaron entre valores indetectables y 0,12 μg/l. Aunque estos valores no son motivo de alarma general, algunos puntos de muestreo presentaron signos evidentes de contaminación. Sin embargo, no se pudo identifi car con certeza el origen de dicha contaminación. Dado que la concentración de base de mercurio en la tierra es, por lo general, bastante baja, los valores superiores registrados parecen ser atribuibles a la actividad antropogénica (uso intensivo de productos fi tosanitarios, residuos industriales y urbanos, etc.) Los niveles de mercurio en aguas residuales fueron ligeramente más elevados, entre 2,83 y 3,95 μg/l, lo que indica que es necesario vigilar y controlar de manera periódica dicho nivel de contaminación

We determined Hg levels in drinking, irrigation and waste waters from different locations in the province of Granada (South-east Spain). A total of 74 samples were analysed using cold-vapour atomic-absorption spectrometry, and the sensitivity, accuracy and precision of the method were verifi ed. Hg was not detected in drinking water samples but values in irrigation water were found to range from undetectable to 0.12 μg/l. Although these values do not give cause for general alarm, some sampling points showed clear evidence of contamination. However, the origins of such could not be identifi ed with any certainty. In the light of the fact that background Hg levels in soil are in general fairly low, the higher values recorded seem to be attributable to anthropogenic activity (extensive use of phytosanitory products, urban and industrial waste,…). Hg levels in wastewater were somewhat higher, ranging from 2.83 to 3.95 μg/l, indicating that such a degree of contamination requires surveillance and periodic controls

Evolución de la capacidad funcional en ancianos institucionalizados tras una intervención nutricional / Evolution of functional capacity in elderly before nutritional intervention

Este trabajo forma parte de un amplio estudio, realizado con el propósito de conocer la influencia del enriquecimiento en calcio de la dieta, a partir de la utilización de leche semidesnatada enriquecida en calcio, sobre la calidad de vida y el estado óseo de una población mayor institucionalizada, que participa en un programa de intervención nutricional de 18 meses de duración. El objetivo de este trabajo es conocer la evolución de la capacidad funcional, física y mental, de dicha población. Se estableció un grupo control, cuya ingesta media de calcio fue de 921ñ128 mg/día y un grupo problema con una dieta similar pero con un aporte mayor de calcio, 1.056ñ 256 mg/día, por la incorporación de leche enriquecida en este mineral. La capacidad física se evaluó mediante el Indice de Katz, que mide el grado de independencia para la realización de las actividades básicas de la vida diaria (ABVD). Para la valoración de la capacidad mental se utilizó la Escala de Cruz Roja. Al inicio del estudio, los resultados de la valoración de capacidad funcional, tanto física como mental, fueron bastante similares en los dos grupos. Tras la intervención nutricional, se observó que la pérdida de capacidad física fue significativamente menor en el grupo problema que en el control (P<0,05), ya que el 91,8 por ciento de los individuos del grupo problema no desciende de categoría, frente al 74,6 por ciento del control. La pérdida de capacidad mental ha sido considerable en ambos grupos, aunque sin diferencias significativas entre ellos. (AU)

Dietary intake of calcium, magnesium and phosphorus in an elderly population using duplicate diet sampling vs food composition tables.

The aim of this study was to estimate the dietary intake of calcium, magnesium and phosphorus in the elderly institutionalised population using duplicate diet sampling and to establish any related difference with the results obtained using food composition tables. The study was carried out on a sample group of 112 subjects in Granada (Spain). 1-week food duplicate samples offered by the elderly were studied. Calcium and magnesium were determined by AAS and phosphorus was determined by spectrophotometry. Anova showed significant differences (p<0.05) in all the minerals analyzed. These results suggest that the use of food composition tables is not suitable to evaluate the calcium, magnesium and phosphorus in nutritional trials. Moreover, the results show clearly that it is essential to consider these differences to establish the adequate intakes of calcium, magnesium and phosphorus for the elderly population in relation to the mineral bone status.

Evolución de salud percibida durante una intervención nutricional en una población anciana institucionalizada / Health evolution perceived during a nutritional intervention in an elderly population institucionalized

El objetivo de este estudio es conocer la evolución de la autopercepción de salud de una población anciana institucionalizada, que participa en un programa de intervención nutricional de 18 meses de duración, cuya finalidad es estudiar la influencia del enriquecimiento en calcio de la dieta sobre el estado óseo de esta población. Se estableción un grupo control, cuya ingesta media de calcio fue de 921 +/- 128 mg/día, y un grupo problema con una dieta similar pero con un aporte mayor de calcio, 1056 +/- 256 mg/día, por la incorporación de leche enriquecida en este mineral. Las cuestines planteadas a los ancianos, al inicio y al final de la intervención, fueron: 1: ¿Se siente limitado en su movilidad? 2: ¿Considera su fuerza muscular normal para su edad?; 3: ¿Tiene dolores "de huesos"?. Los resultados obtenidos indican que la autopercepción de salud de la población anciana estudiada es independiente de la edad, y mejor en los hombres que en las mujeres. Tras la intervención mutricional, se observó que la salud percibida disminuyó menos en el grupo problema que en el control, por lo que al final del estudio, en el grupo problema la autopercepción de salud ósea era mejor que en el grupo control. No obstante, son necesarios estudios más amplios que permitan confirmar estos resultados (AU)

Serum copper concentration in HIV-infection patients and relationships with other biochemical indices.

We have determined the degree of abnormalities in serum copper concentrations in HIV-seropositive individuals. The study was conducted at the Virgen de las Nieves Universitary Hospital in Granada (Spain). A total of 142 HIV-infected individuals and 84 control subjects were included in the study. The HIV-infected subjects were divided into three groups following the 1993 criteria of the Center for Disease Control and Prevention (Atlanta, USA). Serum copper levels in HIV-infected subjects were significantly higher than those found in control individuals (P < 0.001). Moreover, there were no statistically significant (P > 0.05) differences in serum Cu levels among the three groups considered although serum Cu enhancement occurred at the beginning of the infection process (group A). This increase then remains constant in advanced stages of HIV infection (groups B and C). The mean serum Cu concentration in women (1.41 mg/l) was not significantly higher than that found in men (1.39 mg/l) (P > 0.05). Linear regression analyses between serum copper concentrations and nutritional or biochemical indices (prealbumin, albumin, transferrin, lymphocytes CD4, body mass index, weight) were not statistically correlated (P > 0.05). These data suggest that copper which is an acute phase reactant, may be a useful marker of HIV activity and progression to AIDS as in other chronic infective diseases.

[Nutritional state of iron in the institutionalized aged: study of intake and hematological indices]. / Estado nutricional en hierro en ancianos institucionalizados: estudio de la ingesta e índices hematológicos.

In this study we determined the nutritional state of iron in 93 elderly people who were institutionalized in Granada, by means of a determination of their ingested iron, as well as the determination of the serum iron, hematologic parameters (hemoglobin and hematocrit), and the corpuscular indexes (mean corpuscular volume and mean corpuscular hemoglobin). The elderly people had an iron intake that was considered to be adequate (10.2 +/- 2.1 mg/day), and this is not related to the hematological parameters studied. 4% of the men, and 22% of the women showed hemoglobin values that were considered to be low.

Body composition in institutionalized elderly people in Granada (Spain). Relation with other nutritional parameters.

Anthropometric characteristics and body composition were assessed in a group of 93 institutionalized elderly people, mean age 80.9 +/- 7.6 years, in Granada (Spain). The body composition was measured by the bioelectrical impedance technique. The influence of dietary energy intake, lifestyle, physical activity and health data were studied. Forty-five per cent of the women and 17% of the men were obese (BMI > 30 kg/m2) and 78% of the women and 54% of the men were overweight (BMI > 25 kg/m2). Only 12% of men and 4% of women suffered from undernutrition (BMI < 20 kg/m2). No significant correlations (P > 0.05) were found between BMI or body fat percentage and energy intake. Lifestyle and health data do not affect the BMI or body composition, but a significant negative correlation (P < 0.05) was found between the physical handicap level and the energy intake in all the sample (r = -0.26) and in the women (r = -0.16).

Serum concentration and dietary intake of Zn in healthy institutionalized elderly subjects.

We determined the serum concentrations and dietary intake of zinc, as indicators of Zn status, in 44 healthy institutionalized elderly subjects in Granada (Spain) (mean age 81.4 +/- 7.9 years). Determination of Zn in serum was carried out by electrothermal atomic absorption spectrophotometry. Serum samples had a mean Zn concentration of 10.49 +/- 3.5 mumol/1. No significant differences were found in the serum levels of Zn as regards the sex of the subjects. However, concerning Zn intake, determined by a 7-day weighted food record, a significant statistical difference (P < 0.001) was found between men and women, with mean values of 10.01 +/- 1.76 mg/day and 7.33 +/- 1.33 mg/day, respectively. Application of regression analysis to the serum concentration of Zn and other nutritional parameters shows a statistically significant correlation (P < 0.05) between serum levels of Zn and the body mass index. The lack of statistical correlation between the serum concentration of zinc and its intake indicates that this index cannot be used as an indicator of zinc status in the elderly.

Serum concentration and dietary intake of Mg and Ca in institutionalized elderly people.

We determined the serum levels and the dietary intake of Mg and Ca in 93 institutionalized elderly people (24 men and 69 women) in Granada (Spain). The serum samples had mean concentrations of 21.39 +/- 2.08 mg/l magnesium and 93.39 +/- 9.24 mg/l calcium. No significant differences were found in the serum levels of the two minerals as regards the sex of the subjects. Application of linear regression analysis to the serum Mg and Ca levels showed a statistically significant positive correlation (P < 0.05). A low vitamin D intake of these subjects (51.8% of the recommended dietary allowance) was observed. The intakes of Ca and Mg correlated positively together, as well as with the intakes of energy, protein, fibre (in the case of Mg only), iron and phosphorus (P < 0.05). The Ca and energy intake were adequate to their current recommendations, as too was the Ca:P ratio, whereas the diet had a poor supply of fibre, vitamin D and Mg.

Serum copper in institutionalized elderly subjects: relations with dietary intake of energy, specific nutrients and haematological parameters.

The concentrations of serum copper were determined as an indicator of corporal status of Cu and its relation to aging in 93 institutionalized elderly subjects (24 men and 69 women) in Granada (Spain). We found that aging does not affect serum Cu levels in the two age groups included in the study: Group I < 80 years and Group II > or = 80 years. Application of linear regression analysis to the serum Cu levels and the intake of energy, fibre, iron and magnesium showed a statistically significant negative correlation (P < 0.05) among them in all the subjects. However, no correlation was observed when the serum Cu levels were related to the intake of zinc or vitamin C. Therefore, at the daily intake levels of these two nutrients, they do not interfere in the absorption of copper and hence do not affect the corporal status of this element in the elderly. Blood erythrocyte and haemoglobin concentrations do not show any significant correlation with the serum Cu concentrations (P > 0.05).

[Magnesium deficiency in patients with HIV-AIDS]. / Deficiencia de magnesio en pacientes VIH-SIDA.

The serum magnesium concentrations are compared between the three clinical classification categories established in 1993 by the Centers for Disease Control (CDC) (infection) by the human immunodeficiency virus) in adults, and its relation with the CD4 lymphocyte count, albumin, and pre-albumin. The serum magnesium concentration is part of the broad analytical screening and it is determined by atomic absorption spectroscopy. The data obtained were analyzed by the statistical program SPSS. The comparisons of the serum magnesium concentrations between the three clinical categories of the CDC were evaluated by an analysis of variance (ANOVA test). Afterwards, and using a regression analysis, the relations between the different variables were evaluated. 35 patients affected by HIV-AIDS were studied, 22 belonging to category A, 3 to category B, and 10 to category C, 29.4% of the patients studied presented hypomagnesemia, with an average serum magnesium level of 17.6 +/- 10.3 mg/l. There is a quadratic relation between the serum magnesium level and the number of CD4 lymphocytes in HIV-AIDS patients studied. A larger number of cases would allow us to conclude whether hypomagnesemia is a factor belonging to the disease, as well showing the possible differences in the magnesium state between the three diagnostic groups studied. Future studies will be necessary to clarify the role of magnesium in the clinical progression of patients infected by HIV.

Nutritional status of vitamin A and E in institutionalized elderly people in Granada (Spain).

A study has been carried out on the nutritional status of vitamin A and E in 93 institutionalized elderly people in Granada (Spain) by studying their vitamin intake and the serum values of retinol and alpha-tocopherol. The influence of lipid intake and lipids in plasma has been also discussed. The vitamin A intake is higher than the recommended amount and represent 209% DR in men and 217% DR in women. The vitamin E intake is deficient in 33% of the men and 27% of the women. The serum values of retinol indicate that 11% of the women have a deficiency (< 0.7 microM), and that 39% of the men and 32% of the women have low values (0.7-1.22 microM). As for the serum values of alpha-tocopherol, 6% of the women have deficient values, and 82% of the men and 37% of the women have low values (11.6-23.2 microM).

Development of a marker of estrogenic exposure in human serum.

The deleterious, disruptive effects of estrogen mimics on the endocrine system were discovered after the compounds were released into the environment. Their chemical structure does not obviously resemble that of steroid hormones; hence, their estrogenic effects were totally unexpected. In addition to occupational exposures, environmental estrogens may have played a role in decreasing the quantity and quality of human semen during the last 50 years and in increasing the incidences of testicular cancer and cryptorchidism in men and breast cancer in women and men in industrialized countries. Testing the environmental estrogen hypothesis will require developing appropriate biomarkers of exposure and measuring these biomarkers at developmental points where exposure is critical. We report the ongoing development of a method to extract and separate xenoestrogens from ovarian estrogens with human serum as a source, followed by determination of xenoestrogen concentration by a bioassay. We also critically assess bioassays currently available to measure the cumulative effect of xenoestrogens, e.g., (a) the E-SCREEN assay, which measures the proliferative effect of estrogens on their target cells, and (b) the induction by estrogens of specific gene products, such as progesterone receptor and pS2.

Intake of iodine and major nutrients in an area of endemic goitre.

We surveyed the diet of a group of inhabitants in a mountainous area where goitre was endemic. The amount of iodine supplied by the diet was determined by analyzing foods with gas chromatography with electron-capture detection. The mean daily intake of iodine per person was between 286.4 and 1,134.4 micrograms. These values are within acceptable ranges recommended by several authors. The dietary supplies of proteins, fats and carbohydrates were also all within the ranges recommended by the FAO/WHO. Although goitre was endemic in the area studied, no dietary deficiency in iodine supply was found in any of the families investigated. Thus the ultimate cause of the endemic will have to be sought in other etiologic factors.

High-performance liquid chromatographic determination of ochratoxin A and its 4R-4-hydroxy metabolite in human urine.

One of the metabolites of ochratoxin A (OA) is 4R-4-hydroxyochratoxin A (4-OH-OA), and the ratio of 4-OH-OA to OA excreted in urine can be linked to the carcinogenic potential of this compound. As further support to the hypothesis that OA can be involved in Balkan endemic nephropathy and the associated urinary system tumours, it was decided to investigate the presence of these two compounds in the urine of affected populations. A sensitive method is described for the determination of the compounds at the 10 ng l-1 level. It involves extraction, two purification steps by column chromatography and high-performance liquid chromatography (HPLC), an analysis by HPLC and a confirmatory test by HPLC after derivatisation.