Nutritional Guidance Improves Nutrient Intake and Quality of Life, and May Prevent Falls in Aged Persons with Alzheimer Disease Living with a Spouse (NuAD Trial).

OBJECTIVE: The aim was to examine the effect of tailored nutritional guidance on nutrition, health-related quality of life (HRQoL) and falls in persons with Alzheimer disease (AD). DESIGN: Randomised controlled trial. SETTING AND PARTICIPANTS: Persons with AD living with a spouse. INTERVENTION: Tailored nutritional guidance with home visits during one year. The control group received a written guide about nutrition in older adults and all community-provided normal care. MEASUREMENTS: The primary outcome measure was weight change, and secondary outcomes included changes in protein and micronutrient intakes from three-day food records, HRQoL (15D) and rate of falls. RESULTS: Of the participants (n = 78) with AD (mean age 77.4, 69% males), 40% were at risk for malnutrition, 77% received < 1.2 g/bodyweight (kg) of protein at baseline. We found no difference in weight change between the groups. At 12 months, the mean change in protein intake was 0.05 g/bodyweight (kg) (95% CI -0.06 to 0.15) in the intervention group (IG), and -0.06 g/kg (95% CI -0.12 to 0.02) in the control group (CG) (p = 0.031, adjusted for baseline value, age, sex, MMSE and BMI). Participants' HRQoL improved by 0.006 (95% CI -0.016 to 0.028) in the IG, but declined by -0.036 (95% CI -0.059 to 0.013) in the CG (p = 0.007, adjusted for baseline value, age, sex, MMSE and BMI). Dimensions that differed included mental functioning, breathing, usual activities and depression. The fall rate was 0.55 falls/person per year (95% CI 0.34 to 0.83) in the IG, and 1.39 falls/person per year (95% CI 1.04 to 1.82) in the CG (IRR 0.55; 95% CI 2.16 to 6.46; p < 0.001 adjusted for age, sex and MMSE). CONCLUSIONS: Tailored nutritional guidance improves nutrition and HRQoL, and may prevent falls among AD people living with a spouse.

Treatment of hypertension in obese patients: efficacy and feasibility of weight and salt reduction programs.

The effect of three different nutrition counselling programs on well established hypertension was studied in 64 obese patients regularly attending a hypertension clinic. The 12-month program of weekly-monthly group sessions focused on weight reduction (W group, n = 24), salt restriction (S group, n = 17) or both (WS group, n = 23). The mean (+/-SEM) weight decreased by 6.9 +/- 0.7 kg in the W group (p less than 0.001) and by 5.0 +/- 0.6 kg (p less than 0.001) in the WS group during the first three months of the study and levelled off thereafter. The weight changes in the S group were small during the trial. The mean 24-hour urinary sodium excretion in the WS and S groups was reduced by about 35 and 50 mmol, respectively, during the first months of the study, and fell thereafter somewhat in the S group but not in the WS group. Sodium excretion remained unchanged in the W group. Systolic and diastolic blood pressure (BP) fell significantly in the W and WS groups during the first months of the study. BP remained thereafter stable in most patients but declined further in one fifth of them. BP changed little during the trial in the S group. By 12 months, BP control was improved in 67, 61 and 12% of the patients in the W, WS and S groups, respectively. Improved BP control was strongly related to weight loss but not to reduced sodium excretion. Weight reduction programs with even modest success help most obese patients with established hypertension, whereas moderate salt intake restriction gives little added benefit.