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Introduction.- In former research we showed that 19% of home living geriatric patients suffered from malnutrition. Fifty-one percent were at risk for malnutrition. Aim of this study is to define determinants related to malnutrition. Methods.- Cross-sectional data from 173 patients was obtained at first hospital visit. Nutritional status was assessed by means of the Mini Nutritional Assessment (MNA 23.5 indicative of satisfactory nutritional status). Possible determinants of malnutrition were categorized into somatic factors (medication use, co morbidity), social factors (children, marital status), psychological factors (Mini Mental State Examination [MMSE] and Geriatric Depression Scale [GDS]) and functional status (Activities of Daily Life (ADL) and Instrumental Activities of Daily Life [IADL]). Both linear regression (with MNA as a dependent parameter) and logistic regression (MNA

BACKGROUND & AIMS: It is known from earlier studies that only 15% of the malnourished hospital outpatient population is recognized and receives nutritional treatment. To increase this number, a quick and easy malnutrition screening tool would be helpful. Because such a tool is lacking, we developed one by using the SNAQ (Short Nutritional Assessment Questionnaire) as a basis. The aim of this study was to develop a quick and easy malnutrition screening tool and to measure its diagnostic accuracy in malnourished hospital outpatients.METHODS: First, an optimal set of questions was selected for the preoperative outpatient population. Secondly, the diagnostic accuracy for the preoperative outpatients was determined (979 patients) and finally, the diagnostic accuracy for general hospital outpatients was established (705 patients).RESULTS: The three original SNAQ questions proved to be the best set of questions for the outpatient population as well. In the preoperative and general outpatient population the diagnostic accuracy resulted respectively in a sensitivity of 53% and 67%, a specificity of 97% and 98%, a positive predictive value of 69% and 72% and a negative predictive value of 94% and 97%.CONCLUSIONS: With an acceptable diagnostic accuracy it may be concluded that the original SNAQ malnutrition screening tool is valid for the hospital outpatient population.

Background and aims: This study evaluated the use of perioperative nutritional support on Quality of Life (QOL) in malnourished head and neck cancer patients undergoing surgery. Methods: 49 Malnourished (weight loss > 10%) head and neck cancer patients who were included in a nutrition intervention trial were randomized to receive either no preoperative and standard postoperative tube-feeding (group I), standard preoperative and postoperative tube-feeding (group II) or arginine-supplemented preoperative and postoperative tube-feeding (group III). Of these patients, 31 completed a full QOL assessment on the first day of preoperative nutritional support, one day before surgery, and 6 months after surgery. Both a disease-specific (EORTC QLQ-C30) and a generic questionnaire (COOP-WONCA) were used. One way analysis of variance (ANOVA) and the Kruskal-Wallis test were applied for testing differences in scores between groups. Results: Between baseline and the day before surgery, both preoperatively fed groups revealed a positive change for the dimensions physical and emotional functioning and dyspnea (with significance in group II, P = 0.050, 0.031, 0.045 respectively). Group III showed a negative change in appetite (P = 0.049). Between baseline and 6 months after surgery, there were no differences between group I and both pre-fed groups. There were no differences in favour of group III compared to group II. Conclusion: Enteral nutrition improves QOL of severely malnourished head and neck cancer patients in the period preceding surgery. No benefit of preoperative enteral feeding on QOL could be demonstrated 6 months after surgery. (C) 2000 Harcourt Publishers Ltd.

Rationale: In our society, offering extra nutritional support is a standard for malnourished patients at admission to hospital. Whether malnourished cognitively impaired older hospitalized patients would also benefit from this regimen is unknown. This prospective study assesses their 3 months and one-year overall survival. Prognostic characteristics predicting survival are also studied. Methods: This cohort included malnourished cognitively impaired older (60+) hospitalized patients (group 1: dementia, 2: delirium and 3: combination dementia/ delirium), newly admitted to an acute hospital and receiving usual nutritional care. Data on survival was completed until one year after patients' admission to the hospital. Possible prognostic characteristics predicting life-expectancy data were collected. Cox regression analyses were carried out. Results: Out of 3291 older patients, 575 patients (6%) were identified as malnourished. Of which 116 (20%) were cognitively impaired. Forty-nine patients were described to have dementia, 48 delirium and 19 a combination of dementia and delirium. Mean age was 81.6 years (SD 8.3, range 60 99 years). Thirty-six of them (31%) died within three months after hospital admission and 55 patients (47%) died within one year. Survival was not significant different between the three groups (p = 0.672, log-rank=0.672). The only prognostic characteristic was disease. Patients with a malignancy (p = 0.018) or vascular disease (p = 0.003) were more likely to die within three months after discharge (80%). Conclusion: Almost half of a cohort of malnourished cognitively impaired older, hospitalized patients died within one year after hospital admission. Patients with a malignancy or vascular disease were more likely to die early after discharge. It could be debated if extra nutritional support should be offered as a standard in patients with these diagnoses.

SURVIVAL OF MALNOURISHED ELDERLY PATIENTS RECEIVING POST-DISCHARGE NUTRITIONAL SUPPORT; A RANDOMIZED CONTROLLED STUDY Floor Neelemaat* 1, Suzanne van Keeken2, Jacqueline Langius1, Marian de van der Schueren1, Abel Thijs3, Judith Bosmans4 1Nutrition and Dietetics / Internal Medicine, VU University Medical Center, 2Nutrition and Health, VU University, 3Internal Medicine, VU University Medical Center, 4Health Sciences, VU University, Amsterdam, Netherlands Rationale: In malnourished elderly patients, a post-discharge individualized nutritional intervention has shown to have positive effects on body weight, lean body mass, fall incidents and functional limitations1,2. However, the impact on survival is still unclear. Therefore, the aim of this randomized controlled study was to examine the effect of this nutritional intervention on survival in malnourished elderly patients. Methods: 210 malnourished elderly patients, aged ≥60 years, were randomized during hospitalization to a 3months post-discharge nutritional intervention group (protein and energy enriched diet, oral nutritional supplements, vitamin D3/calcium supplement and dietetic telephone counseling) or to a control group (usual care regimen). Survival data was evaluated 1 year and 4 years post-discharge. Survival analyses were performed using intention-to-treat analysis by Cox regression. Results: The study population consisted of 94 men (45%) and 116 women with a mean age of 74.5 (SD 9.5) years. Baseline characteristics were not different between groups. There were no statistically significant differences in survival between groups (Table 1). Table 1: Survival rates at 1 and 4 years following 3-months post-discharge nutritional intervention in malnourished elderly patients

Rationale: Both malnutrition and advanced age are known to negatively impact the immune system. This exploratory randomized controlled trial studied the effects of a composed nutritional intervention on immune markers, endocrine markers and a selection of micronutrients in malnourished ill elderly patients. Methods: Malnourished elderly patients (>60) newly admitted to a university medical center were randomised to receive either usual care plus a nutritional intervention (energy and protein enriched diet, comprising oral nutritional support, calcium-vitamin D supplement, dietetary counselling) commencing in the hospital and continued for 3 months post-discharge or usual care alone. Immune markers (interleukins, complement, C-reactive protein, albumin, TNF-alpha), endocrine markers (growth factors) and micronutrients (iron, ferritin, vitamin A, E and D), were measured at baseline and at 3 months following hospital discharge. Results: 210 patients were included in this study. For 89 patients (46 intervention, 43 control) both measurements were available. This selection of patients were in a better health status compared to the total group. At baseline, most of the analysed immune markers, endocrine markers and micronutrients showed values within the normal range, with no statistically significant differences between groups. The majority of immune markers, endocrine markers and micronutrients tended to improve over time, without statistically significant differences between groups, except for vitamin D (p = 0.008), confirming the supplementation in the intervention group. Conclusion: A 3 months nutritional intervention in malnourished ill elderly patients could not demonstrate measurable additional influence on measured immune markers, endocrine markers and selected micronutrients at three months compared to baseline. The improved outcomes were presumably caused by patients' improved health status during time.

little information is available about nutritional status and outcome of NH residents suffering from one or both of these problems. Methods: Data about Dy (yes vs no), CI (no/moderate vs severe), malnutrition (BMI 5 kg [WL]) were collected in yearly intervals from 2007 until 2010 by local nursing staff of voluntarily participating institutions using standardized questionnaires. Analysis was restricted to units with complete information and residents aged 65 y (7585 residents from 9 European countries). The prevalence of malnutrition and poor outcome in residents without Dy and CI (Dy CI ), with either Dy (Dy+ CI ) or CI (Dy CI+) and those with both problems (Dy+ CI+) was compared. Results: Mean age of the residents was 87±8 y, 82% were female. 15.6% suffered from Dy, 32.6% from CI. 62.0% were free of and 10.1% had both problems. The prevalence of malnutrition according to BMI and staff classification was lowest in Dy CI and highest in Dy+ CI+ (table). Mortality (23.5% vs. 12.2%) was significantly higher and WL> 5 kg after 6 months (19.4% vs. 9.4%) more prevalent in those with Dy compared to those without Dy independent of CI.