Mini-Nutritional-Assessment (MNA) without body mass index (BMI) predicts functional disability in elderly Taiwanese.

Nutritional status and functional ability are mutually dependent especially in the elderly. This study examined the functional status-predictive ability of the MNA in a cross-sectional study. We analyzed the dataset of the "Survey of Health and Living Status of the Elderly in Taiwan" (SHLSET). Subjects were 2948≥65 year-old persons who were rated with the long-form (LF) and short-form (SF) MNA with or without BMI for the risk of malnutrition, and with the Activities of Daily Living (ADL) and the Instrument Activities of Daily Living (IADL) for functional status. The ADL and IADL scores were calculated according to rated nutritional status. Receiver Operating Characteristic (ROC) curves were generated for ADL and IADL status predicted by the MNA. Logistic regression was performed to evaluate the association of rated MNA scores with ADL or IADL status. Results showed that both SF and LF of MNA-T1 and T2 were able to predict ADL and IADL disabilities. Those who were rated malnourished or at risk of malnutrition had drastically higher risk of ADL or IADL dependency compared to those who were rated normal. The SF versions performed well in rating nutritional status and predicting ADL and IADL status. Overall, MNA-T2-SF performed at least equally well as MNA-T1-SF in rating functional decline. These results suggest the MNA is able to predict functional decline of the elderly. MNA-T2, especially the SF, a version without BMI should be particularly useful in clinical, long-term care and community settings.

Quality issues of self-report of hypertension: analysis of a population representative sample of older adults in Taiwan.

The study was to evaluate the quality of self-report of hypertension and examine the factors associated with under- and over-reporting of hypertension in older Taiwanese. Data for this analysis were from the Social Environment and Biomarkers Study in Taiwan 2000, which involved a national sample of 1021 Taiwanese over 54 years of age. We performed binary classification tests to compare the prevalence rates of self-reported vs. clinically measured hypertension according to World Health Organization (WHO) (blood pressure ≥ 160/95 mm Hg or on hypertension medication) and JNC-6 (140/90 mm Hg or on hypertension medication) definitions. Logistic regression analysis was performed to analyze the potential factors associated with under- or over-reporting of blood pressure status. Results showed the test characteristics of self-reports were: sensitivity 73%, specificity 93%, and kappa = 0.68 (p < 0.001) based on the WHO definition; and sensitivity 51%, specificity 95% and kappa = 0.43 (p < 0.001) based on the JNC-6 definition. Old age was associated with over-reporting whereas having no health checkup during the past 12 months was associated with under-reporting. The relatively low agreement between self-reports and clinically measured hypertension (JNC-6 definition) was mainly due to the lack of a well-defined hypertension practice guideline and the failure of clinicians to clearly inform patients of their diagnoses. The consistency of hypertension practice guidelines and the effectiveness of informing the patients of their diagnoses are two main factors impacting the quality of self-report of hypertension in elderly Taiwanese. Better self-reports of health data can improve the efficiency of public health surveillance efforts.

The association of body mass index (BMI) with all-cause mortality in older Taiwanese: results of a national cohort study.

In older adults, underweight has been shown to be associated with increased all-cause mortality, but the association with excessive weight is inconclusive. The study aimed to determine the association of weight status with subsequent all-cause mortality risk in older Taiwanese. The study analyzed the dataset of the "Survey of Health and Living Status of the Elderly in Taiwan", a nationally representative longitudinal cohort study. Baseline BMI calculated from self-reported weight and height (kg/m(2)) was used to predict all-cause mortality risk during subsequent four years in 2462 ≥ 53 years old Taiwanese. Cox-regression analysis was performed to determine the significance of the association of weight status with all-cause mortality during follow-up four-years controlled for demographic, lifestyle and health-related variables. Results showed that underweight was associated with increased risk of mortality risk in all age ranges examined, but excessive weight was not significantly associated with increased risk of mortality. Results suggest that the association between BMI status and all-cause mortality is "L-shaped" and "obesity paradox" may indeed exist in these specific age groups in Taiwanese over 65 years old. However, some uncertainty remains because confounding factors could not be totally controlled. Large scale prospective studies with better control of confounding factors are needed to resolve this important public health issue.

Predictors of smoking cessation in 50-66-year-old male Taiwanese smokers: a 7-year national cohort study.

The study was aimed to determine the predictors of smoking cessation in 50-66-year-old male Taiwanese smokers. The study analyzed datasets of the "Survey of Health and Living Status of the Elderly in Taiwan" (SHLSET), a population-based longitudinal cohort study conducted by the Bureau of Health Promotion of Taiwan. Binary logistic regression analysis was performed to determine the association of demographic, socioeconomic, lifestyle and health-related variables with changes in smoking status at baseline, or with subsequent changes in smoking status in 50-66-year-old male Taiwanese. Functional impairment was the strongest predictor of quitting smoking for 50-66-year-old Taiwanese men. Other factors including a first hospitalization, emergency visit, or diagnosis of heart disease, quitting drinking, living with a spouse and older age were associated with increased likelihood of quitting smoking. Men with long smoking history, heavy daily cigarette consumption and more formal education were less likely to quit. Results suggest that functional decline is the major cause for quitting smoking for older Taiwanese men. Physical impairment and traumatic diseases that cause physical impairment have the most impact whereas "silent diseases" such as hypertension or diabetes have little impact. These findings should be useful for designing target-specific intervention strategies for older male Taiwanese smokers.

Mid-arm and calf circumferences (MAC and CC) are better than body mass index (BMI) in predicting health status and mortality risk in institutionalized elderly Taiwanese.

The study was to compare the ability of BMI, MAC and CC in predicting nutritional status, functional ability and follow-up mortality risk of older adults. The study purposively recruited 160 of 320 residents of a nursing home in Central Taiwan to serve as subjects. Residents who were ≥65 years old, cognitively normal, without acute conditions and non-hospitalized were qualified to participate. All subjects signed an informed consent. Each was interviewed with a structured questionnaire for sociodemographic, lifestyle and health-related information; evaluated with the Mini Nutritional Assessment (MNA) and the Activities of Daily Living (ADL) scales; measured for weight, height, MAC and CC; and assayed for nutrition-related biochemical values. Results showed that CC was the best, followed by MAC and then BMI in predicting the nutritional status and health conditions. CC and MAC were also more effective than BMI in predicting 12-month follow-up mortality. Overall, CC is the most capable in predicting nutritional status, functional activity and general health conditions; MAC is the most capable in predicting 12-month follow-up mortality risk whereas BMI is the weakest in all functions. These results should have practical implication in geriatric health measurements.

Predicting the need of formal care in Taiwan: analysis of a national random sample.

The study aimed to examine the determinants of needing formal care and the factors impacting care arrangements in elderly Taiwanese by analyzing the 1999 and 2003 data of "The Survey of Health and Living Status of the Elderly in Taiwan", a prospective cohort study of older Taiwanese. For the purpose of this study, only participants 70 years or older were analyzed. The association of sociodemographic, lifestyle and health-related variables with care need and care arrangements at baseline and four years later were analyzed. Results showed that the major predictors of needing formal care in elderly Taiwanese were old age, cognitive impairment and functional disability. Self-perceived poor health and prior nursing-home admission were marginally significant. Results also showed that the traditional culture dictated care arrangement. Most elderly Taiwanese preferred to have private home carers (usually from neighboring countries) over institutionalization. The ratio of private care vs. institutionalization increased from 1:3 in 1999 to 1:1 in 2003 as the government allowed introducing more foreign carers. Results suggest that the major determinants of needing formal care in elderly Taiwanese are old age, and cognitive and functional impairments, similar to that observed in Western countries. However, culture and public policy impact care options.

The association of plasma C-reactive protein levels with anthropometric and lipid parameters in elderly Taiwanese.

C-reactive protein (CRP), a plasma inflammation marker, has been known to play a role in the development of cardiovascular diseases. This study aims to evaluate the association of CRP with anthropometric and plasma lipid parameters in elderly Taiwanese 65 years or older. Data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000), a national probability sampling study conducted to gain an understanding of the dietary pattern, and nutritional and health status of elderly Taiwanese were analyzed. Results showed that in men, CRP was positively correlated with age and waist-to-hip ratio (WHR) (both p<0.05) whereas in women, CRP was positively correlated with waist and WHR but negatively correlated with HDL-C (all p<0.05). Linear regression analysis showed that log CRP was positively associated with WHR in both genders (p<0.05) after adjusting for confounders. The correlation of CRP with WHR was stronger than that with both waist circumference and body mass index (BMI). Log CRP was inversely associated with HDL-C in women, but not men. The study suggests that among the anthropometric parameters examined, WHR is a stronger predictor for elevated CRP in elderly Taiwanese men and women. Whereas low HDL-C is a predictor among the plasma lipid parameters for elevated plasma CRP, at least in women. Gender differences exist in the association of CRP with anthropometric and lipid parameters.

Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese.

The objective of this study was to determine the population-specific cut-points of body mass index (BMI), mid-arm circumference (MAC) and calf circumference (CC) for identifying subnormal nutritional status in elderly Taiwanese, and to evaluate the possibility of improving the functionality of the Mini Nutritional Assessment (MNA) by adopting these cut-points. This study analyzed data from 1583 men and 1307 women, 65 years or older, of a national survey. The survey involved in-home, face-to-face, interviews and anthropometric measurements. Results showed that based on the cumulative percentile curves, the fifth percentile values were: BMI, 17 kg/m2 for both men and women; MAC, 22.5 cm for men and 21 cm for women; and CC, 28 cm for men and 25 cm for women. Substitution of these population-specific cut-points for respective values in the MNA screen resulted in lowered proportions of elderly classified malnourished or at risk of malnutrition. The prevalence of malnutrition was reduced from 1.7% to 1.4% in men and from 2.4% to 1.5% in women. The proportions classified at risk of malnutrition were reduced from 10.1% to 8.9% for men and 16.8% to 12.8% for women. In conclusion, results suggest that the MNA is a valuable tool for geriatric nutritional risk assessment. However, in populations where significant differences exist in anthropometric measurements from the Caucasian populations, population-specific cut-points should be used.

Interview to study the determinants of hypertension in older adults in Taiwan: a population based cross-sectional survey.

The aim of the study was to assess the association of socioeconomic, anthropometric and lifestyle factors with self-reported hypertension in older adults in Taiwan. The data were part of the "1999 Survey of Health and Living Status of the Elderly in Taiwan". The survey was conducted in-home, face-to-face, by interviews of 4440 men and women, 53 years or older, in a population-based cross-sectional study. The prevalence of self-reported hypertension was 31.1% for men and 38.0% for women. A logistic regression model showed a higher probability of self-reported hypertension for female gender, older age, and greater BMI, and lower probability for increased consumption of leguminous foods. No association was observed with cigarette smoking, alcohol consumption or physical activity. Current cigarette smokers and alcohol-drinkers underreported their hypertension status. Compared to the medically measured hypertension of a sub-sample study of the same cohort, only about 60% of medically-substantiated hypertensive patients self-reported their hypertensive status, indicating that the interview survey underestimated the prevalence of hypertension in this Taiwanese elderly population. The interview survey appears to identify associations of hypertension with age, gender, BMI and some food patterns, but does not recognize the likely associations with the candidate risk factors of physical inactivity, cigarette smoking, alcohol consumption and limited education, at least in this Taiwanese population. Thus caution must be applied where interview alone categorises individual older Taiwanese as hypertensive or not. A survey which has validation or cross-checking questions about the medical diagnosis of hypertension and the likelihood of its memory and appreciation by the patient (such as method, definition, communication with patient, recall and follow-up, lifestyle advice or pharmaco-therapy, presence of cognitive impairment) may clarify the significance of the discrepancy between self-reporting and medical record. In turn, this would allow a more robust evaluation of blood pressure determinants in such populations. Nevertheless, there is a role for community-based surveys that utilise self-reporting in the identification, prioritization and surveillance of putative contributors to hypertension; this is the case where, as in the Taiwanese elderly, it assumes major importance in the burden of disease and premature mortality.