Does dietary iron intake influence the iron status in hospitalised elderly patients?

PURPOSE: To investigate whether there is a relationship between dietary iron intake and body iron store in hospitalised elderly. METHODS: During a three months period, 163 consecutive patients older than 70 years and irrespective of their medical diagnosis participated in this study. Eight patients were excluded because of a lack of co-operation or a too bad general condition. Total food intake data were collected at admission by using a 7 days food-intake and nutrient-supplement record. The average daily dietary intake of each of the nutrients (total energy intake and potential inhibiting or enhancing factors such as calcium, dietary fibres and vitamin C) were calculated. Serum levels of ferritin, iron, transferrin, haemoglobin and mean corpuscular volume were also measured in the 155 study patients. RESULTS: A depleted iron store, defined as a serum ferritin level < 50 microg/L, was found in 23 patients (15%) of whom 17 were anaemic. The mean daily intake of iron (9.5 mg for the total group, 10 mg and 9.2 mg for men and women, respectively), vitamin C, calcium an dietary fibre was not significantly different between patients with depleted and adequate iron stores. The serum iron, transferrin, MCV, haemoglobin and ferritin levels were comparable between patients with a low (< 9 mg, n = 64) and normal (> or = 9 mg, n = 91) iron intake. We found no correlation between the dietary iron intake and the serum ferritin level (r = 0.06, p = 0.45), even not after exclusion of the patients with a serum ferritin level > 300 microg/L (r = 0.005, p = 0.95). CONCLUSION: We found no relationship between the dietary iron intake and biochemical indicators of the iron status in an elderly population. If no gastrointestinal or another organ-related cause might be found, iron deficiency can hardly be attributed to an impaired iron intake without a nutritional investigation. Other parameters may also play an important role in its multifactorial pathogenesis.

The effect of different diagnostic criteria on the prevalence of malnutrition in a hospitalized geriatric population.

Malnutrition is considered an important clinical problem in geriatric hospitalized patients, but no standard diagnostic criteria are available. The aim of this study was to investigate the effect of 7 different sets of diagnostic criteria (6 in hospitalized elderly and 1 in healthy elderly) from nutritional research studies on the prevalence of malnutrition in 151 elderly patients (49 men, 102 women, mean age 82.8 years) consecutively admitted to an acute geriatric ward. Nutritional status was assessed using anthropometric (body mass index, triceps skinfold thickness, mid arm circumference, arm muscle circumference), and laboratory (serum albumin) parameters, and 1 nutritional questionnaire (Mini Nutritional Assessment). The proportion of patients with malnutrition varied between 6.5 and 85%. It is important to assess the nutritional status in elderly patients because the prevalence of malnutrition in hospitalized elderly patients is substantial whatever criteria are used. However, the criteria for the diagnosis can differ by a factor of more than 10 in the number of patients classified as malnourished. A major goal for further research on malnutrition is to define more standardized and validated criteria in order to make comparisons of prevalence and outcome more meaningful, and ensure that all those who will benefit from a nutritional intervention are identified and treated.

Serological analysis of human tuberculosis by an ELISA with mycobacterial antigen 60.

An ELISA method for detecting serum antibodies against A60, an antigen prepared from the cytoplasm of Mycobacterium bovis BCG, has been applied to 385 subjects, namely 197 controls (neonates, healthy adults, and tuberculin negative, nontuberculous patients), and 188 subjects at various stages of tuberculous infection and disease. Most IgM determinations gave negative results. While the neonates and normal adults had titers of IgG anti-A60 antibodies below the cut off value, wide variations in antibody titers were observed among the various types of subjects infected by M. tuberculosis. The results obtained with nontuberculous subjects were: 100% negative IgG in neonates and healthy adult individuals and 6.4% "false positive" cases among 124 non-tuberculous patients. The percentage of serologically positive cases of tuberculosis was: 5.9% in latent active primary forms, 42.8% in patent active primary forms, and 82.8% in active postprimary forms. Tuberculous infections had a positively rate of 14.7%, while inactive postprimary tuberculosis had a positivity rate of 50%. The results obtained with A60 can favourably be compared with other serum ELISA tests for tuberculous antibodies against purified or semipurified mycobacterial antigens. Anti-A60 ELISA IgG antibody test can be useful to monitor the kinetics of humoral immunological response during tuberculous infection, disease and chemotherapy. A positive IgG ELISA test may support the diagnosis of active tuberculous disease.

[Tubular involvement during non-oliguric rhabdomyolysis. (Apropos of 2 cases)]. / Atteinte tubulaire au cours des rhabdomyolyses non oliguriques. (A propos de deux cas).

The authors report two cases of severe rhabdomyolysis in a 23-year-old woman following a toxic coma with muscular compression and in a 34-year-old man after a febrile state. Despite clinical and biological signs of marked muscular necrosis, oliguric acute renal failure did not occur. However, repetitive urinary dosage of N-acetyl-glucosaminidase (NAG), of retinol-binding-protein (RBP) and of beta-2-microglobulin (beta-2-m) revealed an early and long-standing tubular dysfunction not suggested by conventional laboratory data.