Model of nutritional care in older adults: improving the identification and management of malnutrition using the Mini Nutritional Assessment–Short Form (MNA®-SF) in general practice.

Despite clinical guidelines recommending routine nutrition screening, malnutrition in community-living older adults remains under-recognised. This study evaluated the uptake of a model of nutritional care in older adults designed to improve the identification and management of malnutrition. A pragmatic quasi-experimental study was conducted in eight general practices in regional New South Wales between January 2017 and June 2018. Study participants comprised GPs and practice nurses who participated in a training event on the identification and management of malnutrition and patients (aged >65 years) attending the practices recruited to the study. Nutritional screening was conducted using the Mini Nutritional Assessment-Short Form. The specific objectives of the study were to: (1) evaluate the effects of the intervention on knowledge, attitudes and practices of staff related to malnutrition screening using questionnaires and in-depth interviews; and (2) identify patients' experiences and outcome measures following malnutrition screening through self-completed surveys. Across the eight practices, 11 healthcare professionals completed in-depth interviews. Post-training knowledge surveys (n = 25) identified that knowledge increased in 96% of staff (P < 0.001). Fifty-five older adults who were screened (two malnourished, 10 'at risk of malnutrition') reported an increased awareness of risk factors for malnutrition. This study provides proof-of-concept that a model of care that includes routine malnutrition screening and accompanying pathways for management is acceptable to general practice staff and has promising effects on patient outcomes. However, the low number of patients screened suggests that additional processes are required to improve feasibility (e.g. incorporation into Medicare-funded nurse-led consultations such as the 75+ Health Assessment).

Nutritional screening and intervention of older adults living in the community referred by the My Aged Care online portal.

OBJECTIVE: To assess whether nutritional screening and intervention improve the nutritional status of older adults living in the community. METHODS: The Kiama MOW service performed nutrition screening, after being trained by the research team and maintained the dataset. De-identified data was provided to the research team for analysis. Meals on Wheels staff also kept detailed notes during the nutrition screening process and in discussions with clients. These notes were provided to the research team along with the de-identified quantitative data, a summary of the measures taken following screening, including interventions that were recommended to clients by MOW staff. Staff were not formally interviewed about their experiences in conducting nutrition screening but their open-ended text comments were retrospectively summarised, as well as anecdotal comments made to the research team who were involved in training and supporting the MOW team during the intervention period. RESULTS: Forty-one individuals (25 women, mean age = 79.8 ± 8.9 years) were referred (21 well-nourished, 16 at risk of malnutrition and 4 malnourished). After reassessment (n = 19), nutritional status had significantly improved (P = .008 for all referrals and P < .001 for those at risk of malnutrition or malnourished). The main interventions provided were as follows: nutrition education (100%), home-delivered meals (78%) and social outings including meals (17%). CONCLUSION: The My Aged Care portal may be a feasible source of referral of this population to perform routine nutrition screening for appropriate intervention.

The Postprandial Effect of Anthocyanins on Cardiovascular Disease Risk Factors: a Systematic Literature Review of High-Fat Meal Challenge Studies.

PURPOSE OF REVIEW: Recurrent post-prandial metabolic imbalances are important contributing factors to the development of cardiovascular disease (CVD). This study evaluated whether anthocyanin consumption attenuates the deleterious postprandial response of high-fat meals on CVD risk factors including blood pressure, vascular endothelial function, lipid profile and biomarkers related to oxidative stress, antioxidant status and immune response. RECENT FINDINGS: Five electronic databases were searched up to the period of 1 February 2020, yielding 13 eligible studies, including randomised or cross-over clinical trials (18-59 years of age), using PRISMA guidelines (PROSPERO registration: CRD42019126265). Potential bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials. Beneficial effects of anthocyanins were reported in biomarkers of oxidative stress and antioxidant status in 6 out of 9 studies, and in 3 out of 6 studies for inflammatory response. Two positive results were found concerning attenuation of post-prandial endothelial dysfunction, increased triacylglycerol and total cholesterol exerted by the high fat meal. Blood pressure and lipoproteins were the parameters with least beneficial results. Our systematic literature review revealed beneficial effects of dietary anthocyanin interventions on CVD risk factors following a HFM challenge; however, heterogeneity in results exists. The most promising results were for the attenuation of deleterious postprandial effects on oxidative stress and antioxidant status, triacylglycerol and total cholesterol concentrations, vascular endothelial function and inflammatory biomarkers. Post-prandial changes in blood pressure and lipoproteins were least affected by anthocyanins. Further studies are required in order to better elucidate the post-prandial effects of anthocyanins and CVD risk factors.