A Cross-Sectional Study on the Association between 24-h Urine Osmolality and Weight Status in Older Adults.

Data on the association between hydration and body weight in the elderly are scarce. The objective of this work was to quantify the association between 24-h urine osmolality and weight status in the elderly. A cross-sectional study was conducted within the Nutrition UP 65 study. A quota sampling was implemented to achieve a nationally representative sample of Portuguese older adults (≥65 years) according to age, sex, education and region. From a sample size of 1500 participants, 1315 were eligible for the present analysis, 57.3% were women and 23.5% were aged ≥80 years. Participants were grouped using tertiles of 24-h urine osmolality by sex. World Health Organization cutoffs were used to classify participants according to weight status. Multinomial multivariable logistic regression models were conducted to evaluate the association of tertiles of osmolality with weight status, adjusting for confounders. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Being in the 3rd urine osmolality tertile (highest) was associated with a higher risk of being obese in men, OR = 1.97, 95% CI = 1.06, 3.66. No such association was found in women. These results highlight the need for implementing studies in order to clarify the association between hydration and weight status in the elderly.

Vitamin D status and associated factors among Portuguese older adults: results from the Nutrition UP 65 cross-sectional study.

OBJECTIVES: To evaluate vitamin D status and its associated factors in Portuguese older adults from the Nutrition UP 65 study. DESIGN: Cross-sectional observational study. PARTICIPANTS AND METHODS: Nationwide cluster sample of 1500 Portuguese subjects ≥65 years old. Participants were classified, according to US Institute of Medicine cut-offs, as presenting normal 25-hydroxyvitamin D (25(OH)D) levels (≥50.0 nmol/L), at risk of inadequacy (30.0-49.9 nmol/L) or at risk of deficiency (<30 nmol/L). The association between individuals' characteristics and 25(OH)D levels was analysed through multinomial logistic regression analysis. RESULTS: Median 25(OH)D serum value was 36.1 (interquartile range (IQR): 35.5) nmol/L. According to the used cut-offs, 39.6% of participants were at risk of 25(OH)D deficiency and 29.4% were at risk of 25(OH)D inadequacy. In the adjusted model, having higher skin pigmentation and waist circumference >88 cm for women and >102 cm for men were associated with higher odds of 25(OH)D deficiency. Otherwise, living in Lisbon Metropolitan Area and in Madeira, 1-12 years of schooling, being married or in a common-law marriage, monthly income ≥€1000, alcohol consumption, medication or supplements with vitamin D supplement use, and blood samples collected in spring or summer were associated with lower odds of being at risk of 25(OH)D deficiency. In this model, season of blood sample collection, medication or supplements use, and waist circumference were the factors more strongly associated with 25(OH)D levels. CONCLUSIONS: Despite using the conservative Institute of Medicine cut-offs, over two-thirds of these study participants presented inadequate 25(OH)D levels, warranting the implementation of corrective measures. Potentially modifiable factors were strongly associated with 25(OH)D levels in this study. These findings may be particularly relevant to the development of public health policies in southern European countries.

Nutritional Strategies Facing an Older Demographic: The Nutrition UP 65 Study Protocol.

BACKGROUND: The population of Portugal is aging. The lack of data on older adults' nutritional status and the lack of nutrition knowledge amongst health professionals, caregivers, and older adults themselves, remains a challenge. OBJECTIVE: The Nutrition UP 65 study aims to reduce nutritional inequalities in the older Portuguese adult population and improve knowledge regarding older Portuguese adults' nutritional status, specifically relating to undernutrition, obesity, sarcopenia, frailty, hydration, sodium, and vitamin D statuses. METHODS: A representative sample of older Portuguese adults was selected. Sociodemographic, lifestyle, anthropometric, functional, and clinical data were collected. Sodium excretion, hydration, and vitamin D statuses were assessed. RESULTS: Data collection (n=1500) took place between December, 2015 and June, 2016. Results will be disseminated in national and international scientific journals, and via Portuguese media. CONCLUSIONS: Nutrition UP 65 results will provide evidence for the design and implementation of effective preventive public health strategies regarding the elderly. These insights may represent relevant health gains and costs savings.

Food insecurity and associated factors in the Portuguese population.

BACKGROUND: The burden of food insecurity in Portugal, and the socioeconomic and demographic factors that are related to this condition, are unknown. OBJECTIVE: To evaluate the frequency of food insecurity and to identify its associated characteristics in the Portuguese population. METHODS: Data from 3,552 heads of family respondents of the 2005/06 Portuguese National Health Survey were analyzed in a cross-sectional study. Food insecurity was evaluated with the use of the US Department of Agriculture Household Food Security Survey Module 6-Item Short Form. Chi-square tests and multivariate logistic regression models were conducted. Significance was indicated at p < .05. RESULTS: Among the respondents, 16.5% were food insecure and 3.5% had very low food security. The odds of being food insecure were highest for women (OR, 1.51; 95% CI, 1.20 to 1.91), smokers (OR, 1.56; 95% CI, 1.20 to 2.02), younger people (OR, 2.54; 95% CI, 1.69 to 3.80), unemployed people (OR, 3.04; 95% CI, 2.01 to 4.60), those with lower education (OR, 7.98; 95% CI, 4.73 to 13.49), and those with lower income (OR, 6.27; 95% CI, 4.23 to 9.30). CONCLUSIONS: The present study explored for the first time the burden of food insecurity in Portugal, revealing that it was highly prevalent, affecting one in six Portuguese citizens. Low education and low income were the main factors associated with food insecurity.

Survival and cost comparison of kyphoplasty and percutaneous vertebroplasty using German claims data.

STUDY DESIGN: Observational study. OBJECTIVE: Examine the overall survival and treatment costs from a third-party-payer perspective for patients with osteoporotic vertebral compression fractures (OVCFs) treated by vertebral augmentation or conservative treatment in Germany. SUMMARY OF BACKGROUND DATA: OVCFs are associated with increased morbidity, mortality and thus reduced quality of life. Vertebral augmentation has been shown to be effective in these fractures. The association between treatment and survivorship as well as cost per life year gained for balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PVP) was analyzed in the Medicare population. Replication of these analyses is warranted for confidence in findings. METHODS: Claims data from a major health insurance fund were used. Mortality risk differences between operated (BKP, PVP) and nonoperated cohorts were assessed by Cox regression. Operated patient groups were established by propensity score matching adjusting for covariates. For the matched operated patients with OVCF, (2006-2010) survival was estimated by Kaplan-Meier method. RESULTS: A total of 598 newly diagnosed patients with OVCF were operated of 3607 patients with OVCF. The operated cohort was 43% less likely to die than the nonoperated one in the 5-year study period (hazard ratio = 0.57; P < 0.001). Patients who received BKP had higher 60-month adjusted survival rate (66.7%) than those who received PVP (58.7%) (P = 0.68). Cumulative 4-year mean overall costs after first diagnosis were lower for the BKP cohort (PVP: €42,510 vs. BKP: €39,014). Initial upfront higher costs driven by surgical treatment for patients who received BKP are offset by considerable pharmacy costs in patients who received PVP. There were differences between the values of painkiller consumption (PVP: €3321 vs. BKP: €2224). CONCLUSION: Results suggest a higher overall survival rate for operated than nonoperated patients with OVCF and indicate a potential survival benefit for patients who received BKP compared with patients who received PVP. The reasons merit further investigation. Total costs were lower after 4 years for patients who received BKP versus PVP due to less consumption of pharmaceuticals. LEVEL OF EVIDENCE: 3.

Undernutrition and associated factors among hospitalized patients.

BACKGROUND & AIMS: The identification of modifiable risk factors associated with disease-related undernutrition at hospital admission will contribute to the development of integrated intervention and control strategies for a timely primary prevention. This study aim was to quantify the association between functional autonomy and undernutrition. METHODS: A multicentric cross-sectional study was developed in six public hospitals in Portugal. Undernutrition risk was assessed using Nutritional Risk Screening 2002, undernutrition status was classified from anthropometry and functional autonomy was evaluated using the Katz Index. RESULTS: In this sample of 1144 patients, 36% were at undernutrition risk and 9.7% undernourished. In logistic regression analysis, dependent patients were at an increased risk of undernutrition (OR = 1.69, 95% confidence interval (CI) = 1.20-2.39). The following parameters: illiteracy (OR = 2.45, CI = 1.52-3.96), age (one year increment) (OR = 1.03, CI = 1.02-1.04), male (OR = 1.61, CI = 1.19-2.16), single/divorced/widowed (OR = 1.83, CI = 1.34-2.51) and smoker (OR = 1.55, CI = 1.02-2.35) also increased the undernutrition risk. The impaired functional status, being single, divorced or widowed and be a smoker were also associated with anthropometric undernutrition. CONCLUSIONS: Functional impairment is related with undernutrition risk and with anthropometrical undernutrition at hospital admission. We also conclude that little extra information is gained by using anthropometrical indices compared to NRS 2002 when assessing the factors associated with undernutrition.

[Relevance of nutrition knowledge on clinical practice: medical opinion survey]. / Relevância dos conhecimentos sobre nutrição no desempenho clínico: estudo de opinião médica.

Although previous studies show that physicians generally agree that nutrition knowledge is important for their daily clinical practice, several other studies report their poor knowledge of the subject. One of the strongest reasons given for this is the non-incorporation of Nutrition as a compulsory subject for the medical sciences degree. Dietary counselling and assessment of the patients' nutritional status don't seem to be systematic. The aim of this study is to asses how relevant physicians consider Nutrition to be in the successful running of a good practice. The study was undertaken at the general hospital of Vila Real/Peso da Régua (CHVR/PR) by distribution of a self- administered questionnaire to 153 of the physicians of the clinical body. Mean values were compared with the Student's t test and proportions with the Chi-square test. Of the 153 physicians, 108 replies were received (70,6%). Of these 108 replies, 53,3% consider nutrition knowledge important although 29,6% state their knowledge is poor. More than half say that Clinical Nutrition should be a compulsory subject of the Medical Sciences syllabus, and 99,1% deem it important to assess the patient's nutritional status. About 95% stated they provided written or verbal nutritional guidance, and most of the physicians had already sought the assistance of a nutritionist. This study shows that the clinical body of the CHVR/PR is aware of the importance nutrition knowledge has in their daily practice. It must be noted, though, that although almost one third of the physicians rate their nutrition knowledge poor, most of them provide nutritional guidance to their patients.

Contribución al conocimiento del síndrome parapléjico de la ganadería extensiva de los llanos de Venezuela parte I: estrategias diagnósticas / Contribution of the knowledge of the livestock paraplegic syndrome in the Venezuelan plains I: diagnostic strategies

Establecimientos ganaderos fundados en ecosistemas de sabanas en los llanos venezolanos desde la Colonia dieron origen a los tradicionales sistemas de producción extensiva-extractiva (SPE), conocidos como vaca-maute y cría-levante, base de explotación de la ganadería de carne en Venezuela. En estos sistemas de producción, los rebaños quedaron expuestos a la adversidad del ambiente durante siglos frente a depredadores, plagas y enfermedades, así como al ciclo lluvia-sequía, característicos de estas llanuras que abarcan unos 12 millones de hectáreas, donde predominan suelos ácidos y comunidades de pastos del género Trachypogon que sostienen a unos 8 millones de cabezas de mestizo cebú x criollo. Las condiciones ambientales y de manejo para sostener una ganadería de carne eficiente, no son las más idóneas, debido a escasa innovación tecnológica que es necesario incorporar para mejorar la eficiencia de estos sistemas de producción. Por lo que es necesario considerar que en el origen del Síndrome Parapléjico Bovino (SPB) han estado jugando papel fundamental las condiciones ambientales descritas. Con un modelo que implicó integrar varios niveles de investigación: aplicada, básica y operativa; ésta última realizada en fincas de los productores afectados por el SPB y que fue ejecutada por un equipo multidisciplinario e interinstitucional, se evaluó prioritariamente la situación nutricional y el manejo integral de los animales en la cadena ecológica del sistema-suelo-planta-animal. Los resultados confirmaron que el SPB es un trastorno de origen multifactorial y estrechamente vinculado a deficiencia de minerales, especialmente de fósforo.