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Aim To identify factors that predict the 62–69 years old Taiwanese to be healthy octogenarians. Methods We analyzed the 1989 (baseline), and 2003 and 2007 (end-point) datasets of the Taiwan Longitudinal Survey on Aging, a national cohort study. A total of 1977 participants aged 62–69 years at baseline were tracked for 14–18 years. The outcome measure was “being healthy octogenarians”, defined as participants who were aged ≥80 years, free from activities of daily living dependency, depressive symptoms or cognitive impairment, and able to provide social support. A logistic regression model was used to identify the predictors. Results The results showed that higher educational level, conjugal living, absence of smoking or betel quid chewing, moderate alcohol drinking, routine physical activity, more leisure activities, no hypertension, no diabetes, sleeping well and satisfied with economic condition were the positive predictors for becoming a healthy octogenarian. Conclusions Using a multidimensional criterion, the present study identified a list of factors in predicting older Taiwanese becoming healthy octogenarians. The findings highlight the need to identify potential factors for various populations. Many of the predictors are modifiable factors. The present results would be valuable for planning effective health promotion strategies to achieve healthy aging for older adults. Geriatr Gerontol Int 2017; ••: ••–••.

AIM To determine the characteristics associated with developing a new need for long-term care among older Taiwanese adults. METHODS We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging. A total of 1986 persons who were aged ≥70 years and had no disability in activities of daily living or need for long-term care at the baseline served as the study participants. We first identified the potential variables associated with developing a need for long-term care in demographic, socioeconomic, anthropometric, functional status, mental health, medical and global domains based on the literature and our earlier studies. We then carried out univariable logistic regression analyses to identify the variables most strongly associated with developing a new need for long-term care within each domain. Variables showing the strongest association were further analyzed in a forward stepwise multivariable logistic regression model to determine the significant predictors. RESULTS The multivariable model identified age, sex, doing heavy housework, walking 200 m, carrying out calculation, appetite status, frequency of hospitalizations during the past 12 months, living arrangement and weight loss as significant (P

Summary Background & aims The usefulness of body mass index (BMI) and calf circumference (CC) for predicting emerging care-need of older adults has not been carefully evaluated. We attempted to compare the abilities of these two anthropometrics in predicting emerging care-need in older adults. Methods We analyzed the 1999 (baseline) and 2003 (end-point) datasets of the Taiwan Longitudinal Survey on Aging. Participants were 2521 ≥ 65-year old adults without care at baseline. To derive proper cut-offs of BMI and CC, we first drew a plot to show the relationship between the risk of care-need and the cumulative distribution of BMI or CC. We then divided the risk into three levels and calculated the corresponding percentiles of BMI and CC. Multivariable logistic regression was used to build up predictive models. Akaike Information Criterion (AIC) and net reclassification improvement (NRI) were performed to compare the models as well as the predictive abilities of BMI and CC. Results After controlled other independent variables, CC was significantly associated with emerging care-need in the subsequent 4 years, but BMI was not. The AIC value of the model with CC (1956.3) was remarkably lower than BMI (1968.7). The NRI was 4.8% (p = 0.007) which quantified the improvement of the model with inclusion of CC instead of BMI to predict emerging care-need. Conclusions All indices we performed suggest that CC has better ability to predict emerging care-need in older Taiwanese compared to BMI. The potential application of anthropometric indicators, especially CC, for predicting emerging care-need deserves further investigation.

Background Nutritional status is associated with physical functioning in older people. Protein–energy malnutrition can limit functional performance. Objectives This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes. Design A 24-week randomized, double-blind, controlled trial. Settings A privately managed geriatric nursing home in Taiwan. Participants Ninety-two persons who were ≥65 years old, ≤25kg/m 2 , >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. Methods Qualified participants were stratified by gender and then randomly assigned to either the control group ( n =45) or the intervention group ( n =47). Each participant in the intervention group would receive a 50g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24kg/m 2 . The supplement contained 9.5g protein, 250kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t -test and by the Generalized Estimating Equations controlled for nutritional status. Results The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p Conclusions "Need-based intervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage.

Aims To determine the independent and combined associations of leisure-time physical activity (LTPA) and fruit and vegetable consumption with subsequent new depressive symptoms in Taiwanese aged ≥53 years. Methods We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging and used the Center for Epidemiologic Studies Depression scale (score 0–30) to rate depressive symptoms. We excluded those who had depressive symptoms (Center for Epidemiologic Studies Depression scale ≥10) at baseline, and carried out logistic regression analysis to determine the associations of LTPA and fruit and vegetable consumption, independently or in combination, with new depressive symptoms 4 years later (n = 2630). Results Independently, high LTPA was associated with reduced new depressive symptoms (OR 0.75, 95% CI 0.57–0.99); higher fruit and vegetable consumption showed the same trend, but was not significant. Combining high fruit (OR 0.61, 95% CI 0.41–0.89), vegetable (OR 0.49, 95% CI 0.26–0.93) or fruit and vegetable (OR 0.39, 95% CI 0.20–0.77) consumption with high LTPA all further reduced the likelihood of developing subsequent new depressive symptoms beyond LPTA alone. Conclusion The simultaneous presence of several good lifestyle habits increases the beneficial effect of reducing the risk of developing depressive symptoms in older adults. Thus, older adults are encouraged to have as many good lifestyle habits as possible to reduce the risk of depressive symptoms. Geriatr Gerontol Int 2015; ●●: ●●–●●.

Summary Background & aims Falling is a major issue in geriatric health. Tools that identify individuals at risk of falling can help reduce the risk of falling. The study aimed to determine whether the full and short-form Mini Nutritional Assessment (MNAs) have the ability to predict the risk of falling in older adults. Methods Subjects were 3118 ≥ 53-year old Taiwanese who completed both the 1999 and 2003 “Taiwan Longitudinal Study on Aging” surveys. We rated these subjects with normalized versions of the MNA and applied the standard cut-offs to define under-nutrition (≤23.5 and ≤11 points, respectively). We used multivariate logistic regression analysis and receiver operating characteristics to evaluate the ability of these tools in predicting the risk of falling three years later. Results Older adults rated as at risk of malnutrition with the full MNA (OR = 1.87, 95% confidence interval = 1.33–2.63, p p = 0.014) were associated with increased risk of falling three years later. Both versions significantly predicted the risk of falling and performed slightly better in ≥65-year old persons than in younger (53–64-year old) persons. The short-form performed relatively well compared to the full scale. Conclusions Results suggest that the full and short-form MNAs, in addition to rating the risk of malnutrition, also predict the risk of falling in older adults. Although the short-form is slightly less effective than the full scale in predicting the future risk of falling, its simplicity, effectiveness and efficiency make it ideal as a multipurpose screening tool in clinical settings.

Aims We determined the association of perceived stress with depressive symptoms in older Taiwanese. Methods We analyzed the 2007 dataset of the Taiwan Longitudinal Survey on Aging, a population-based survey of 4534 persons aged ≥54 years. Perceived stress was based on respondents' reports of whether each of the five situations (own health, financial status, job, getting along with family members and family members' problems) “makes you feel stressed or anxious”. Participants were rated with the 10-item Center for Epidemiologic Studies Depression scale (score 0–30; ≥10 as having depressive symptoms). Multivariate logistic regression analysis was carried out to determine the association of each perceived stress situation with depressive symptoms in persons aged 54–64 years (middle-aged), 65–74 years (young-old) and ≥75 years (old-old). Results Over one-third of respondents were stressed over their own health. The middle-aged respondents who were stressed were 2.0–10.9-fold as likely to have depressive symptoms, the young-old were 3.1–8.1-fold as likely and the old-old were 4.3–12.6-fold as likely compared with the non-stressed respondents (all P

The present study determined the ability of the Mini Nutritional Assessment (MNA) to predict care need in older people. We analysed the datasets of the Taiwan Longitudinal Study on Aging. The 1999 survey containing the MNA items served as the baseline and the 2003 survey served as the endpoint. Of the 4440 participants, 2890 were aged ≥ 65 years and served as subjects in the present study. After excluding 150 subjects having incomplete data, 2740 were rated for nutritional status with the normalised long-form (LF) and short-form (SF) MNA-Taiwan version 1 (T1) and version 2 (T2) and evaluated with logistic regression analysis for cross-sectional associations of the rated nutritional status with care need, controlled for age, sex, education level, living arrangement and physical activity. Receiver operating characteristic curves were generated for evaluating the ability of the MNA to predict care need. After further excluding 250 subjects who had care need at baseline and seventy-six who were lost to follow-up, 2414 were evaluated for the ability of the MNA to predict subsequent care need with logistic regression analysis. The results demonstrated that all the MNA predicted concurrent and subsequent care need well. The OR for needing subsequent care in the ‘at-risk’ and ‘malnourished’ groups were, respectively, 2·04 and 3·33 for the MNA-T1-LF, 2·10 and 5·35 for the MNA-T2-LF, 1·49 and 2·48 MNA-T1-SF, and 1·80 and 3·44 for the MNA-T2-SF (allPR2values were 0·190, 0·191, 0·184 and 0·192. In conclusion, all the four MNA have the ability to predict future care need, including the MNA-T2-SF, which appears to have great potential for practical applicability.

Background Nutrition is a key element in geriatric health. Protein-energy malnutrition is common in institutionalized persons. Objective This study examined the effectiveness of a need-based "routine screening and timely intervention" strategy in improving the nutritional status of persons living in nursing homes. Design A 24-week randomized, double-blind, controlled trial. Setting A privately managed geriatric nursing home in Taiwan. Participants Ninety-two ≥65-year old persons who were ≤25kg/m 2 , >1 month residence, able to self-feed or receive oral feeding, without acute infection and non-bed-ridden. Methods Prospective participants were stratified by gender and then randomly assigned to either the control group ( n =45) or the intervention group ( n =47). Each subject in the intervention group was given a 50g/day soy-protein-based nutritional supplement if he/she was rated as undernourished according to the Mini Nutritional Assessment (MNA, score ≤24) and BMI ≤24kg/m 2 . The supplement contained 9.5g protein, 250kcal energy and all essential micro-nutrients. The supplementation would be suspended once either one of the "at risk" condition was corrected. Nutritional rating with the MNA took place at baseline and every 4 weeks during the trial. Biochemical indicators were measured at baseline, mid-point (week-12) and end-point (week-24). Results were analyzed with the two-sample t -test, and the generalized estimating equations (GEE) controlled for demographic and health-related variables. Results Of the 92 subjects, 82 completed the trial; 7 withdrew and 3 died during the trial. Results showed that the need-based intervention was an effective and appropriate strategy for improving the nutritional status of persons at risk of undernourishment. The intervention significantly improved body weight, BMI, mid-arm circumference, calf circumference, and serum albumin and cholesterol concentrations at all intervals (all p Conclusions Results suggest that the need-based nutritional intervention can be a practical and useful strategy for improving the nutritional status of persons living in nursing homes and save on healthcare cost. The potential application of this strategy deserves the attention of health planners.

Objective To determine the impact of perceived-stress over one's own health, financial condition, job, and conflict with family members, and family members' problems on depressive symptoms in older adults. Methods We analyzed datasets of the Taiwan Longitudinal Survey on Aging, and used self-reported stress in 2003 and 2007 to represent long-term stress conditions in 4854 ≥ 50-year old persons. The impact of long-term stress on depressive status (evaluated with CES-D10, score range 0–30) was determined with multivariate logistic regression analysis. Persons with proxy interviews, incomplete CES-D data, or cognitive impairment were excluded. Results Perceived-health stress had stronger impacts on depressive symptoms than most other stress situations. Job-related stress showed no impact. Other stress situations showed modest associations in the middle-aged and young-olds. Ongoing stress had stronger impacts than past stress. Excluding health and job stresses, the impact generally decreased with aging. The association with clinically relevant depression generally followed that with depressive symptoms. Conclusion All perceived stresses are not equal in their impacts on subsequent depressive symptoms. Perceived-health stress has stronger impacts under most conditions. Better understanding of the associations of various stressors with depressive symptoms could enhance planning of effective strategies to reduce the risk of depression in older persons.

Aims and objectives To improve the short-form Mini-Nutritional Assessment (MNA) to ameliorate under-rating the risk of malnutrition in patients on haemodialysis. Background The full MNA was found to be appropriate for rating the risk of malnutrition in persons undergoing haemodialysis but the short-form under-rated the risk. Design A cross-sectional study with purposive sampling. Methods The study recruited 152 adult ambulatory patients on maintenance haemodialysis from one dialysis centre in Taiwan. Each subject was rated with the Subjective Global Assessment (SGA), the original and selected alternative short-forms (by replacing better performing nonshort-form items for lesser performing short-form items) of a Taiwanese-specific MNA (T1). Serum albumin and creatinine concentrations and the SGA were also used as referents. Results were evaluated with Pearson's correlation analysis, binary classification test and receiver operating characteristic (ROC) curves. Results The full MNA showed good consistency with the SGA, but the original short-form rated fewer patients at risk of malnutrition compared with the full MNA. Exchanging item O (self-rated nutritional status) with item E (neuropsychological problems) produced the best results and restored the predictive ability of the short-form. Replacing item P for E produced the next best results. Conclusion Results suggest that the predictive ability of the short-form can be greatly restored by rearranging the component items of the short-form without affecting the performance of the full MNA. The study is probably the first example of a disease-specific version of the MNA. Relevance to clinical practice The revision makes short-form MNA suitable for rating the risk of malnutrition in patients on haemodialysis in clinical practice.

To identify factors that predict the 62-69 years old Taiwanese to be healthy octogenarians.We analyzed the 1989 (baseline), and 2003 and 2007 (end-point) datasets of the Taiwan Longitudinal Survey on Aging, a national cohort study. A total of 1977 participants aged 62-69 years at baseline were tracked for 14-18 years. The outcome measure was "being healthy octogenarians", defined as participants who were aged ≥80 years, free from activities of daily living dependency, depressive symptoms or cognitive impairment, and able to provide social support. A logistic regression model was used to identify the predictors.The results showed that higher educational level, conjugal living, absence of smoking or betel quid chewing, moderate alcohol drinking, routine physical activity, more leisure activities, no hypertension, no diabetes, sleeping well and satisfied with economic condition were the positive predictors for becoming a healthy octogenarian.Using a multidimensional criterion, the present study identified a list of factors in predicting older Taiwanese becoming healthy octogenarians. The findings highlight the need to identify potential factors for various populations. Many of the predictors are modifiable factors. The present results would be valuable for planning effective health promotion strategies to achieve healthy aging for older adults. Geriatr Gerontol Int 2017; 17: 2579-2585.

Aim: The present study was conducted to investigate the trends of childhood nephrotic syndrome (NS) admissions and factors associated with childhood NS admissions with major infections in Taiwan. Methods: A retrospective analysis was performed using Taiwan National Health Research Insurance Database (NHIRD) to explore the associated factors and health care burden for childhood NS admissions with major infections in 1997 to 2007. Results: Of 133 927 children, a total of 176 children had NS, which incurred 508 hospital admissions. Nineteen percent of admissions were associated with major infections. Pneumonia was the most common infection (49%), followed by urinary tract infection (UTI), bacteraemia/sepsis, peritonitis and cellulitis. Pneumonia was the most common infection among children age younger than 10 years, whereas UTI was more common among children aged greater than 10 years. NS admission with infections had longer periods of hospital length of stay and higher hospital total costs compared to those without infections. Regression analysis reveals that younger age, regional hospitals, admission hospital located in middle and south areas and admission made in spring were associated with increased risk for developing major infections. Conclusions: While 19% of childhood NS admissions were associated with major infections, young age, admissions made in spring, located in middle and south Taiwan and in regional hospitals were the major associated factors for infection. Age plays an important role in risk and types of infection.

This study aimed to determine the possibility of using the Mini-Nutritional Assessment (MNA) to evaluate the quality of life and functional status in patients with hepatocellular carcinoma (HCC). The study recruited 300 outpatients with HCC from a teaching hospital in Central Taiwan to serve as subjects. All subjects were interviewed with a structured questionnaire for rating the nutritional status with the MNA (long-form and short-form), and for evaluating quality of life and functional status with Global Quality of Life (GQL) and Global Functional Status (GFS), respectively, of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version-3. Cancer staging and liver cirrhosis indicators, blood biochemical indicators, and self-rated health status and mobility were used as reference standards. Results showed that based on the strength of the correlation and association with the reference standards, both the long-form and short-form of the MNA performed better than GQL and GFS in predicting quality of life and functional status of patients with HCC. These results suggest that the MNA is suitable for identifying the risk of deteriorating quality of life or functional status, in addition to identifying the risk of malnutrition, in patients with HCC.

This study examined the association of metabolic syndrome, metabolic disorders and functional impairment with depression in older (≥54 years) adults. A cross-sectional study. Setting: Data of this study were from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan (2000). A national representative sample of persons 54 years of age or older in Taiwan (N = 1023). Results showed that the presence of any number of metabolic disorders without functional impairment was not associated with depression. However, the presence of functional impairment regardless of the number of metabolic disorder was associated with a significantly higher risk of depression after adjusting for confounding factors (OR = 5.13, 95% CI = 2.13–12.36) (p

Aim. The study was aimed to examine the appropriateness of using the Mini Nutritional Assessment to screen for risk of under- and over-nutrition in adults with intellectual disabilities. Background. Persons with intellectual disabilities are at increased risk of malnutrition, but routine monitoring of their nutritional conditions are not widely done. Design. The study purposively recruited 104 institutionalised adults (≥19 years old) with intellectual disabilities to serve as participants. Methods. Participants were interviewed with a structured questionnaire to elicit personal data, health-related information and answers to items in the Activities of Daily Living and the Mini Nutritional Assessment scales and measured for anthropometrics. Biochemical data were taken from their routine medical measurements. Each subject was graded with the Mini Nutritional Assessment that adopted Taiwanese-specific anthropometric cut-off points (T1) and an alternative version that omitted the body mass index item (T2). Results. Both Mini Nutritional Assessment versions were able indentifying individuals at risk of malnutrition among adults with intellectual disabilities and rated comparable proportions of patients malnourished (6·7 and 5·8% for Mini Nutritional Assessment-T1 and Mini Nutritional Assessment-T2, respectively) or at risk of malnutrition (14·4 and 17·3%, respectively). Persons with cerebral palsy were at greater risk of malnourishment than persons with other disabilities. Conclusion. The Mini Nutritional Assessment is appropriate for screening for under- and over-nutrition in adults with intellectual disabilities. The Mini Nutritional Assessment (especially the version without body mass index) can make routine monitoring of nutritional status of these patients an easier task. However, further studies are needed to develop subtype-specific versions (tools) as various subtypes of intellectual disability are associated with different nutritional problems. Relevance to clinical practice. The Mini Nutritional Assessment can serve as a tool for routine screening for under- and over-nutrition in persons with intellectual disabilities.

Nutrition is a key element in geriatric health and is important for functional ability. The present study examined the functional status-predictive ability of the Mini-Nutritional Assessment (MNA). We analysed the dataset of the ‘Survey of Health and Living Status of the Elderly in Taiwan’, a population-based study conducted by the Bureau of Health Promotion of Taiwan. Study subjects ( ≥ 65 years old) who completed both the 1999 and 2003 surveys were rated with the long form and short form of the MNA at baseline and with the Activities of Daily Living (ADL) and the Instrument Activities of Daily Living (IADL) scales 4 years later (end-point). The ability of the MNA to predict ADL or IADL dependency was evaluated with logistic regression models. The results showed that the elderly who were rated malnourished or at risk of malnutrition at baseline generally had significantly higher ADL or IADL scores 4 years later. Lower baseline MNA scores also predicted a greater risk of ADL or IADL dependency. These associations exist even among the elderly who were free of ADL or IADL dependency at baseline. The results clearly indicate that the MNA is able to predict ADL and IADL dependency (in addition to rating current nutritional status) of the elderly. The MNA, especially the short form, should be a valuable tool for identifying elderly at risk of functional decline and/or malnutrition in clinical practice or community programmes.

Liver cancer patients are confronted with the additional risk of malnutrition because the disease is often associated with hepatitis, liver cirrhosis, and metabolic disturbances. Nutritional intervention can improve treatment outcome, but early detection is important. This study aimed to determine whether the Mini Nutritional Assessment (MNA) could effectively rate the nutritional status of patients with liver cancer in Taiwan. A total of 300 patients were evaluated for nutritional status with two modified versions of the MNA in short and long forms. MNA-Taiwan Version 1 adopted population-specific anthropometric cutpoints, whereas Version 2 replaced mid-arm and calf circumferences in place of body mass index. Predicted statuses were compared to results predicted by the Council on Nutrition Appetite Questionnaire (CNAQ) and analyzed for correlations with biochemical or cancer status parameters. Results showed that both versions of the MNA were effective in predicting nutritional status, and predictions by the short forms agreed well with those by the long forms. The nutritional scores correlated well with hemoglobin, serum albumin, C-reactive protein, r-glutamyl transpeptidase, TNM (tumor, node, metastasis) staging, and severity of cirrhosis. These results suggest that the MNA can be an effective tool for assessing the nutritional status of patients with liver cancer.

Objective. The study was to evaluate the ability of the Mini Nutritional Assessment in predicting malnutrition in people with three subtypes of mental disorder (schizophrenia, major depression and bipolar disorder) in Taiwan. Design. The study involved a convenience sample of 120 residents of psychiatric wards managed by a hospital in central Taiwan (52 with schizophrenia, 36 with major depression and 32 with bipolar disorder) classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Methods. A structured questionnaire elicited subjects’ personal data, disease history and answers to questions in the Mini Nutritional Assessment. Serum and anthropometrical parameters were measured. Nutritional status was evaluated with a content-equivalent version of the Mini Nutritional Assessment (Taiwan version-1, T1). Results. The Mini Nutritional Assessment-Taiwan version-1 was effective in assessing the nutritional status of people of all three subtypes of disorder. Nutritional statuses predicted with the Mini Nutritional Assessment-Taiwan version-1 agreed well with other nutritional indicators such as BMI, waist circumference and appetite status. According to the Mini Nutritional Assessment-Taiwan version-1, people with major depression were more likely to be at risk of undernutrition, whereas people with schizophrenia or bipolar disorder were more likely to be at risk of overnutrition. Conclusion. The Mini Nutritional Assessment-Taiwan version-1 can effectively grade both undernutrition and overnutrition of people with schizophrenia, major depression or bipolar disorder. Relevance to clinical practice. The Mini Nutritional Assessment enables nurses to monitor emerging nutritional problems in people with psychiatric disorder without relying on subjective judgement. With proper intervention, it can help reduce nutrition-related chronic conditions in these individuals and save on healthcare cost.

OBJECTIVES: To provide pooled data on the prevalence of malnutrition in elderly people as evaluated using the Mini Nutritional Assessment (MNA). DESIGN: Retrospective pooled analysis of previously published datasets. SETTING: Hospital, rehabilitation, nursing home, community. PARTICIPANTS: Four thousand five hundred seven people (75.2% female) with a mean age of 82.3. MEASUREMENTS: The prevalence of malnutrition in the combined database and in the four settings was examined. RESULTS: Twenty-four data sets with information on full MNA classification from researchers from 12 countries were submitted. In the combined database, the prevalence of malnutrition was 22.8%, with considerable differences between the settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). In the combined database, the "at risk" group had a prevalence of 46.2%. Consequently, approximately two-thirds of study participants were at nutritional risk or malnourished. CONCLUSION: The MNA has gained worldwide acceptance and shows a high prevalence of malnutrition in different settings, except for the community. Because of its specific geriatric focus, the MNA should be recommended as the basis for nutritional evaluation in older people.

Aim and objectives. The study determined whether a new version of the Mini Nutritional Assessment that adopted population-specific anthropometric cut-points would improve the mortality-predicting ability in institutionalised Taiwanese older people. Background. Routine screening is the key for detecting emerging malnutrition, but the tool must be simple, reliable and easyto-use to be well accepted. The Mini Nutritional Assessment can meet these requirements, but for non-Western populations, modifications based on anthropometric considerations are needed. Design. The study purposively sampled 208 residents, aged >65 years, of a long-term care institution in Central Taiwan. Subjects were free of acute infection/disease and able to communicate. A university human-subject-study ethics committee approved the protocol. Methods. The study included biochemical measurements and a structured questionnaire for eliciting personal data and answers to questions in the Mini Nutritional Assessment. Follow-up survival/mortality was tracked for two consecutive sixmonth periods and analysed according to nutritional statuses graded with the original or a modified Mini Nutritional Assessment. The modified version adopted population-specific anthropometric cut-points and was without body mass index. Results. The modification improved the mortality-predictive ability. Mortality rates for the first six months were 8AE7, 3AE9 and 0% according to the original Mini Nutritional Assessment and 10AE6, 3AE4 and 0% according to the modified version for subjects rated malnourished, at risk of malnutrition and normal, respectively. The mortality-predictive ability of both versions weakened after six months. Conclusion. Both versions can predict follow-up mortality, but the modified version has improved ability. For best results, the tool should be applied every six months or less (shorter for more frail older people) to screen for new cases of at-risk individuals. Relevance to clinical practice. The Mini Nutritional Assessment that adopts population-specific anthropometric cut-points may have improved nutritional-risk and mortality-risk predictive abilities. The tool can help care-workers detect emerging nutritional problems and enable timely intervention. Routine use of the tool may help improve the quality of care.

Background The Mini Nutritional Assessment (MNA) and the Malnutrition Universal Screening Tool (MUST) are two widely used malnutrition screening scales. Objective The study was to compare the grading ability of the two scales, and to determine whether adoption of population-specific anthropometric cut-points could improve the grading ability of these tools and whether calf circumference (CC) could be an acceptable alternative to BMI in these scales. Design Purposive sampling. Settings Outpatients receiving annual physical examination at an area hospital. Participants Community-living elderly who were 65 years or older, able to communicate orally, without acute health conditions and willing to sign a study-consent. Methods Subjects were measured for anthropometrics and blood biochemical indicators, and interviewed for personal data and answers to the MNA and MUST. The risk of malnutrition was evaluated with the short-form MNA (MNA-SF) and the MUST, each in three versions (the original, Taiwan version-1 (T1) which adopted population-specific anthropometric cut-points, and Taiwan version-2 (T2) which replaced BMI with CC). Long-form (LF) MNA versions served as references. Results Results showed that (a) in both scales, patterns of nutritional status rated with the original versions were different from those rated with respective modified versions but ratings made with two modified versions were the same, (b) the T2 versions showed the best grading ability based on agreement with the reference (MNA-LF), and (c) MNA-SF versions rated greater proportions of subjects at risk of malnutrition than the respective MUST versions. Conclusions (a) Adoption of population-specific anthropometric cut-points improves the grading ability of the MNA-SF and the MUST in community-living Taiwanese, (b) CC is an acceptable alternative to BMI for both MNA-SF and MUST, and (c) nutritional assessment tools should be as much population or ethnically specific as possible to account for cultural and anthropometric differences across populations.

Objective We sought to determine whether the MNA (Mininutritional Assessment) would be an effective tool for assessing the nutritional status of patients undergoing hemodialysis. Design Purposive sampling. Setting Two hospital-managed hemodialysis centers in central Taiwan. Patients Subjects were 95 ambulatory patients older than 40 years without acute diseases or infections who had received hemodialysis treatment at the center for longer than 30 days. Methods Each subject was interviewed with a structured questionnaire to elicit basic personal data and health- and lifestyle-related information and answered questions on the Council on Nutrition Appetite Questionnaire and MNA. Serum biochemical data were obtained from their routine measurement. The nutritional status of each subject was graded with two modified MNA versions. MNA-TI adopted population-specific anthropometric cut-points, and MNA-TII further had the body mass index question deleted from the scale and question scores adjusted but maintained the same 30 total points. Results Based on the strength of correlation with the key nutrition-related parameters including appetite status, serum creatinine, percent weight loss, hospital length of stay, number of prescribed drugs, and hemodialysis time, both modified MNA versions reflected the nutritional status of Taiwanese hemodialysis patients better than the Council on Nutrition Appetite Questionnaire. Serum albumin did not reflect nutritional status well in these hemodialysis patients. MNA-TI predicted 26.4% and MNA-TII predicted 29.5% of hemodialysis patients were either malnourished or at risk of malnutrition. Conclusions Both versions of the modified MNA are effective in assessing the nutritional status of hemodialysis patients. MNA-TII without body mass index is a significant improvement for hemodialysis patients because body weights fluctuate significantly between dialysis sessions.

Aims and objectives. To determine whether a modified version of the Mini-Nutritional Assessment without body mass index could effectively assess the nutritional risk status of stroke rehabilitation patients in Taiwan. Background. The Mini-Nutritional Assessment was developed on the basis of clinical data of Western populations. Although widely used, its application to assess stroke rehabilitation patients has been limited. Further, to get best results, population-specific modifications to address anthropometric and lifestyle differences have been suggested, especially for non-Caucasian populations. Design. The study assessed the nutritional status of stroke rehabilitation patients who enrolled in the Long-term Care Service of Taipei. Strokes who were >40 years old, in the program for >1 month and cognitively able to answer the questions were recruited to participate in the study. Methods. An on-site in-person interview with structured questionnaire elicited information on personal data, disease history and healthcare use and answers to the Mini-Mental State Examination, the Activities of Daily Living and the Mini-Nutritional Assessment. Patient’s nutritional status was assessed with the Mini-Nutritional Assessment in three versions: the original, population-specific (MNA-TI) and population-specific, without body mass index (MNA-TII). Results. The original Mini-Nutritional Assessment rated 24% of patients malnourished and 57% at risk of malnutrition. Similar results, 14 and 64%, respectively, for MNA-TI; and 19 and 57%, respectively, for MNA-TII were observed. Conclusion. Both the original and the modified versions of the Mini-Nutritional Assessment can effectively rate the nutritional risk status of stroke rehabilitation patients in Taiwan. Version MNA-TII that adopted population-specific anthropometric cut-values but without body mass index can effectively predict the nutritional status of stroke patients. Relevance to clinical practice. The modified scale (MNA-TII) can enhance the application of the tool and timely detection and intervention of undernutrition among stroke rehabilitation patients. It can also help to improve job efficiency of the primary care professionals.

This study aimed to evaluate the association of body fatness and sedentary status with asthma and respiratory symptoms in schoolchildren in Kaohsiung, Taiwan. A questionnaire study elicited episodes of respiratory symptoms and data on lifestyle and anthropometric parameters in 1329 5th grade schoolchildren. Results showed that 12.4% of boys and 9.5% of girls had physician-diagnosed asthma, whereas 15.1% of boys and 12.4% of girls had suspected asthma. Significantly greater proportions of boys had non-exercise-induced respiratory symptoms than girls (p < 0.05). The number of respiratory symptoms was positively correlated with TV-watching time per day and self-reported sedentary time per weekend-day in girls (p < 0.05). Underweight was positively associated with one of the seven respiratory symptoms in girls (p < 0.05). At risk of overweight was positively associated with two of the seven respiratory symptoms in boys and one of the seven respiratory symptoms in girls (all p < 0.05). The risk of having physician-diagnosed asthma and suspected asthma increased 93% and 72%, respectively, in schoolchildren at risk of overweight (p < 0.05). Overweight was associated with a 78% increase in physician-diagnosed asthma (adjusted odd ratio (aOR) = 1.78, 95% CI = 1.08-2.91, p < 0.05). Higher sedentary time was significantly associated with more occurrences of one of the seven respiratory symptoms in girls (aOR = 1.05, 95% CI = 1.00-1.11, p < 0.05). Higher body mass index (BMI) was significantly correlated with longer TV-watching time per day in girls and longer self-reported sedentary time per weekday in boys (p < 0.05). In summary, schoolchildren who are at risk of overweight or overweight and/or have more sedentary time have increased risk of respiratory symptoms and asthma. Weight and sedentary statuses of schoolchildren can affect their respiratory health.

The aims of this study were to evaluate the impact of aging on body fatness and body muscle status and to assess the association of diet and physical activity with aging-associated anthropometric changes. The study analyzed the data of a 1999 population-based cross-sectional survey in men and women, aged 53 years or older, in Taiwan. In-home, in-person interviews elicited the participants’ sociodemographic status, weight and height, physical activity, and intake frequency of food items and measured their midarm circumference (MAC) and calf circumference (CC). Linear regression analyzed the correlates of these anthropometric parameters. Results based on body mass index (BMI, kg/m 2 ) indicate that the prevalence of overweight-obesity was 31.1% for men and 33.7% for women by the World Health Organization definition (BMI, N25) or 43.1% for men and 45.4% for women by the Taiwanese definition (BMI, N24). Average height losses were 1.0 cm for men and 1.3 cm for women, and weight losses were 2.9 and 3.2 kg per decade for men and women, respectively. Aging was associated with decreasing BMI, MAC, and CC. The female sex was associated with higher BMI but smaller MAC and CC. Physical activity was positively associated with BMI, MAC, and CC. Body mass index was positively associated with fruit consumption but negatively with milk consumption. Midarm circumference was positively associated with fish and fruit but negatively with egg and legume consumptions. Calf circumference was positively associated with vegetable consumption. In conclusion, aging-associated anthropometric changes in older Taiwanese are comparable with those observed in Western populations. Both diet and physical activity can modulate aging-associated anthropometric changes in older individuals.

Objectives: This study investigated the prevalence and determinants of the use of dietary supplements and non-prescription medicines by older adults in Taiwan. Methods: Data are from the 1999 Survey of Health and Living Status of the Elderly in Taiwan. The survey involved a national random sample of 2360 men and 2080 women, 53 years or older. Results: Overall, 32.4% of elderly men and 42.7% of elderly women used at least one kind of dietary supplement during the past 12 months. Approximately 16% of elderly men and 19% of elderly women used multivitamin and mineral supplements, 10.5 and 22% used calcium, and 10 and 14% used vitamin E, respectively. Conclusions: The rates of supplement use are generally lower than those observed in the USA but comparable to that in other industrialised countries. Elderly who are females or who are more highly educated or physically more active are more frequent supplement users.

The objective of this study was to assess food intake patterns and their correlates in men and women in Taiwan 53 years of age or older. The study analyzed data generated in a cross-sectional population-based survey conducted in 1999. An in-home questionnaire interview elicited respondents' sociodemographic status, physical activity, and the consumption frequency of major food categories. Results showed that fish was the most frequently consumed protein-rich food, followed by meat and poultry. More than 50% of older adults consumed milk less than twice per week, whereas more than 40% consumed soy food more than 3 times per week. More than 90% of elderly Taiwanese consumed vegetables everyday or almost everyday, but only 60% consumed fruits everyday or almost everyday. Elderly Taiwanese men consumed meat, fish, seafood, eggs, and tea more often than did elderly women, whereas the opposite was true for dairy, fruits, and vegetables. Advanced aging was associated with a decline in the consumption frequency of most major food categories, a decrease in appetite status and an increase in digestive problems. Higher education and frequent daily physical exercise were associated with an increase in the consumption frequency of most food categories. Results suggest that age, sex, education, and physical activity impact food intake patterns and that risk of malnutrition does exist in some elderly in Taiwan.

To determine the independent and combined associations of leisure-time physical activity (LTPA) and fruit and vegetable consumption with subsequent new depressive symptoms in Taiwanese aged ≥53 years.We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging and used the Center for Epidemiologic Studies Depression scale (score 0-30) to rate depressive symptoms. We excluded those who had depressive symptoms (Center for Epidemiologic Studies Depression scale ≥10) at baseline, and carried out logistic regression analysis to determine the associations of LTPA and fruit and vegetable consumption, independently or in combination, with new depressive symptoms 4 years later (n = 2630).Independently, high LTPA was associated with reduced new depressive symptoms (OR 0.75, 95% CI 0.57-0.99); higher fruit and vegetable consumption showed the same trend, but was not significant. Combining high fruit (OR 0.61, 95% CI 0.41-0.89), vegetable (OR 0.49, 95% CI 0.26-0.93) or fruit and vegetable (OR 0.39, 95% CI 0.20-0.77) consumption with high LTPA all further reduced the likelihood of developing subsequent new depressive symptoms beyond LPTA alone.The simultaneous presence of several good lifestyle habits increases the beneficial effect of reducing the risk of developing depressive symptoms in older adults. Thus, older adults are encouraged to have as many good lifestyle habits as possible to reduce the risk of depressive symptoms.

Objective:The study was conducted to gain an understanding of the status of potential nutrition risks in > 53-year-old men and women in Taiwan.Methods:The study employed a validated nutrition-risk screening questionnaire, the Mini Nutritional Assessment, to assess the potential risk of undernutrition in the elderly population in Taiwan. The questionnaire was translated into the local language, Chinese, and was modified slightly based on cultural considerations. It was administered to 4440 randomly selected subjects by means of face-to-face interviews. The questionnaire included questions on subjective self-evaluations, global parameters, simple dietary assessment and some anthropometric measurements.Results:Results show that the questionnaire can be used effectively as a tool to screen for individuals who are at risk of undernutrition. It showed that the proportion of the elderly population at risk of nutritional inadequacy is relatively low, but does increase with advanced ageing. The proportion of the elderly considered at high risk of undernutrition was found to increase with age, ranging from 0.88% for 53–60-year-old subjects to 1.86% for subjects aged 60–70 years, 3.6% for 70–80-year-olds and 5.3% for >80-year-old subjects.Conclusion:The study showed that a simple questionnaire adopted from the Mini Nutritional Assessment can be employed to provide a preliminary screening and to identify individuals who are potentially at increased risk of nutritional inadequacy in the elderly population in Taiwan.

Background and Purpose. Patients with chronic stroke may benefit from continuing rehabilitation training after hospital discharge. This study examined whether caregiver-mediated, home-based intervention (CHI) could improve physical functioning and social participation in these patients. Methods. A single-blind, randomized, controlled 12-week trial conducted with 51 patients from 3 hospitals in Taiwan who had chronic stroke (>6 months; Brunnstrom recovery stages III-V). Patients and their caregivers in the intervention arm (n = 25) were given weekly personalized CHI trainings designed by a physical therapist. Patients in the control arm (n = 26) received visits from the therapist without intervention. All were evaluated for physical recovery through the Stroke Impact Scale, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Barthel Index at baseline and endpoint. Caregivers were evaluated with the Caregiver Burden Scale. Results were analyzed through Mann-Whitney U test. Results. CHI significantly improved scores of the Stroke Impact Scale: strength (control vs intervention, respectively: 1.4 vs 15.5; P = .002), mobility (–0.5 vs 13.7; P < .001), composite physical (–0.7 vs 11.2; P < .001), and general recovery domain (0.2 vs 17.4; P < .001). CHI also significantly improved free-walking velocity (–1.4 vs 7.5 cm/s; P = .006), 6-minute walk distance (–10.5 vs 15.8 m; P = .003), Berg Balance Scale score (–0.8 vs 4.5; P = .006), and Barthel Index score (0.6 vs 7.2; P = .008). CHI did not significantly increase caregiver burden at endpoint. Conclusion. CHI can improve physical functional recovery and, possibly, social participation in patients with chronic stroke.

We determined the association of perceived stress with depressive symptoms in older Taiwanese.We analyzed the 2007 dataset of the Taiwan Longitudinal Survey on Aging, a population-based survey of 4534 persons aged ≥54 years. Perceived stress was based on respondents' reports of whether each of the five situations (own health, financial status, job, getting along with family members and family members' problems) "makes you feel stressed or anxious". Participants were rated with the 10-item Center for Epidemiologic Studies Depression scale (score 0-30; ≥10 as having depressive symptoms). Multivariate logistic regression analysis was carried out to determine the association of each perceived stress situation with depressive symptoms in persons aged 54-64 years (middle-aged), 65-74 years (young-old) and ≥75 years (old-old).Over one-third of respondents were stressed over their own health. The middle-aged respondents who were stressed were 2.0-10.9-fold as likely to have depressive symptoms, the young-old were 3.1-8.1-fold as likely and the old-old were 4.3-12.6-fold as likely compared with the non-stressed respondents (all P 0.001). Financial stress and its association with depressive symptoms deceased with increasing age. Nearly half of the Taiwanese older adults had concerns over family members' problems and the concern was associated with depressive symptoms in the younger age groups. Relationship strain with family members existed in10% of older Taiwanese, but the association with depressive symptoms was strong. Job-related stress was not associated with depressive symptoms.Perceived stress and its association with depressive symptoms vary according to stress situations and age. The present findings should be useful for developing appropriate strategies to reduce the risk of depression in older adults.

To determine the effectiveness of a pragmatic health promotion program to improve the metabolic disorders in older workers in Taiwan, we conducted a 24-week quasi-experiment in three worksites in southern Taiwan in 2010. Among 1,245 workers, 108 met the inclusion criteria (full-time workers aged over 50 years) and agreed to participate in the study. They were assigned to either the intervention ( n = 58) or the reference group ( n = 50) according to their availability to participate in health-promoting activities. The intervention group received training in behavioral modifications to improve diet, time-use, stress management and physical activity. Motivational lectures, group activities, and team competitions were used to improve participants’ knowledge and skills in managing own health. Subjects in the reference group received no intervention. Lifestyle, anthropometric and biochemical indicators were measured at baseline and end-point. Mixed effects linear models were used to determine the intervention effects. The intervention significantly lowered body weight (intervention vs. reference = −1.22 vs. –0.30kg, p = 0.026), BMI (–0.46 vs. –0.02kg/m2, p = 0.006), and waist circumference (–2.68 vs. +0.79cm, p

Malnutrition is prevalent in patients with chronic obstructive pulmonary disease (COPD) but is often neglected in clinical practice. This study examined the usefulness of the Mini Nutritional Assessment (MNA) for assessing the nutritional status of patients with COPD. We recruited 83 patients with COPD in stable condition from the pulmonary rehabilitation unit of a medical center in northern Taiwan. Each patient was interviewed with a structured questionnaire to elicit personal and health-related data, and measured for anthropometric and blood biochemical indicators. Nutritional status was rated with two Taiwanese-specific versions of the MNA, MNA-T1 and MNA-T2. Fat-free mass was measured with bioelectrical impedance analysis (BIA), and exercise capacity indicators with the 6-Minute Walk Test. The two MNA versions showed high agreement (kappa = 0.949) in predicting the nutritional risk, and both versions predicted the FFMI well (area under the curve of the Receiver Operating Characteristics = 0.804, p0.001 for MNA-T1; and 0.813, p0.001 for MNA-T2). MNA scores decreased with increasing disease severity and were highly correlated with FFMI, BMI, mid-arm circumference, calf circumference, and oxygen saturation at rest and during exercise (all p0.01). The MNA score was positively correlated with FEV1, FVC and 6-minute walking distance, and negatively correlated with GOLD stages (all p0.05). However, the MNA score was not significantly correlated with blood biochemical indicators, perhaps due to inflammatory status associated with COPD. The MNA appears appropriate for rating the nutritional risk of patients with COPD. Routine use of the MNA may help reduce the risk of malnutrition in patients with COPD.

summary Background & aims: Diabetes mellitus is prevalent in many countries around the world, but the potential causal factors are not clearly known. We attempted to determine the risk factors for new-onset diabetes in � 53-year old Taiwanese. Methods: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). We performed logistic regression analyses to determine the cross-sectional and longitudinal (1999 e2003) associations of the sociodemographic, lifestyle, and health-related variables with diabetes and new-onset diabetes, respectively. We excluded those who were diabetic at baseline in the longitudinal analysis. Results: Results of the cross-sectional analysis showed that higher weight, past betel-quid chewing, IADL dependency, hypertension, heart disease, chronic kidney disease and depressive symptoms were positively associated with diabetes while alcohol drinking was negatively associated with diabetes. Longitudinal analysis showed that excessive weight, physical inactivity, depressive symptoms, and hypertension were associated with increased likelihood of new-onset diabetes while higher physical activity was associated with reduced likelihood of new-onset diabetes. Cigarette-smoking and moderate alcohol drinking showed no clear impacts on new-onset diabetes in older Taiwanese. Conclusions: Results show that excessive weight, physical inactivity, hypertension and depressive symptoms are the major risk factors for new-onset diabetes for both Eastern and Western populations, whereas smoking and alcohol drinking have varying impacts among these populations. Better understanding of these relationships should be helpful for planning effective health promotion strategies for reducing the risk of new-onset diabetes in older adults.

Objective:To compare the mortality-predictive ability of the full- and short-form (SF) Mini Nutritional Assessment (MNA). Design:A prospective cohort study. Setting:Population-representative sample. Participants: 2872 ≥65-year old men and women. Measurements:The study analyzed 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). Subjects were graded for nutritional status with the full- MNA and MNA-SF of a Taiwanese-specific version (T2, containing calf circumference instead of BMI) at baseline (1999) and tracked their survival status for 4 years. Mortality-predictive abilities of the full-MNA and MNA-SF were compared using Cox regression analysis and Net Reclassification Improvement (NRI). Results: The full-MNA and MNA-SF have comparable abilities in predicting follow-up 4-year mortality risk according to the hazard ratios (all p

The aim of this study was to compare the effectiveness of IDF (International Diabetes Federation) and ATP-III (National Cholesterol Education Program-Adult Treatment Panel III) for predicting metabolic syndrome, and to evaluate the usefulness of these definitions for health promotion.A cross-sectional study.A national random sample.A population representative sample of 1021 54-91 year-old Taiwanese.Subjects were measured for anthropometric and biochemical indicators and rated for the presence of metabolic syndrome using the two definitions. We evaluated the effectiveness of the two definitions in predicting MetS among those who had specific metabolic disorders. Results were analyzed with Student t-test and McNemar's test.Among the 918 subjects who had one or more MetS-item disorders, ATP-III rated greater proportions of subjects as having MetS than IDF, but both definitions predicted less than 50% (37.7% and 45.4%, respectively) as having MetS.Compared to IDF, ATP-III rated a greater proportion of subjects as having MetS, but both definitions missed more than 50% of subjects who had metabolic disorder(s). Since those who are missed have as much need for lifestyle intervention, the definitions appear not appropriate for health promotion.

The present study was aimed to validate two normalised short-form (SF) Mini-Nutritional Assessments (MNA) that contained either BMI (Taiwan version 1, T1) or calf circumference (CC; Taiwan version 2, T2) for rating the nutritional status of elderly Taiwanese. Both versions adopted Taiwanese anthropometric cut-offs, but T2 further had the BMI item replaced by CC. We compared the ability of the two SF in rating the nutritional status of 2674 elderly Taiwanese in the 1999 ‘Taiwan Longitudinal Survey on Aging’ with their respective full versions. We evaluated the agreement between the SF and full scales with weighted κ and performed Cox regression analysis for the follow-up 4-year mortality according to nutritional status rated at baseline. The results showed that the agreements between the respective SF and the full MNA were good (weighted κ: 0·679 for T1 and 0·667 for T2). Both SF performed well in predicting follow-up 4-year mortality relative to the full MNA. In conclusion, MNA-T1-SF and -T2-SF have good consistency with the full MNA and have quite comparable abilities in rating the nutritional status of elderly Taiwanese. Both SF versions appear appropriate for functioning as stand-alone units for rating the nutritional status of the elderly in community-living settings or the general population.

Objective The objective of this study is to determine the concurrent and longitudinal associations of lifestyle factors including smoking, alcohol drinking, betel quid chewing, tea ( Camellia sinensis ) drinking and physical activity with depressive symptoms in older Taiwanese. Methods The study analyzed Taiwan Longitudinal Study on Aging (TLSA) datasets to determine the association of lifestyle variables with concurrent depressive symptoms in 4122 ≥ 50-year-old Taiwanese at baseline (1999) and with the new development of depressive symptoms 8 years later. Results Heavy/problem alcohol drinking increased the association with concurrent depressive symptoms (OR = 1.85, 95%CI = 1.02–3.36); frequent tea drinking (OR = 0.63, 95%CI = 0.50–0.79) and frequent physical activity (OR = 0.59, 95%CI = 0.48–0.71) reduced the association; whereas smoking and betel quid chewing showed no significant associations. Smoking (OR = 1.56, 95%CI = 1.06–2.30) increased the development of depressive symptoms 8 years later; past smoking and current betel quid chewing showed similar trends (OR = 1.47, 95%CI = 0.93–2.31); exercising ≥ 3 times/wk reduced the development (OR = 0.77, 95%CI = 0.60–0.99) while alcohol drinking showed no impact. Conclusion Lifestyle variables can impact the mental wellbeing of older Taiwanese. Interventions to reduce the risk of depressive symptoms in older adults should include strategies aimed at improving these modifiable risk factors.

The present study was conducted to investigate the trends of childhood nephrotic syndrome (NS) admissions and factors associated with childhood NS admissions with major infections in Taiwan.A retrospective analysis was performed using Taiwan National Health Research Insurance Database (NHIRD) to explore the associated factors and health care burden for childhood NS admissions with major infections in 1997 to 2007.Of 133,927 children, a total of 176 children had NS, which incurred 508 hospital admissions. Nineteen percent of admissions were associated with major infections. Pneumonia was the most common infection (49%), followed by urinary tract infection (UTI), bacteraemia/sepsis, peritonitis and cellulitis. Pneumonia was the most common infection among children age younger than 10 years, whereas UTI was more common among children aged greater than 10 years. NS admission with infections had longer periods of hospital length of stay and higher hospital total costs compared to those without infections. Regression analysis reveals that younger age, regional hospitals, admission hospital located in middle and south areas and admission made in spring were associated with increased risk for developing major infections.While 19% of childhood NS admissions were associated with major infections, young age, admissions made in spring, located in middle and south Taiwan and in regional hospitals were the major associated factors for infection. Age plays an important role in risk and types of infection.

Physical functional ability and nutritional status are two major indicators for predicting the risk of mortality in older adults. The present study examined the complementarity of the Activities of Daily Living (ADL) and the Mini-Nutritional Assessment (MNA) for predicting follow-up 4-year all-cause mortality risk in elderly Taiwanese. We analysed data of the ‘Survey of Health and Living Status of the Elderly in Taiwan’, a population-based longitudinal cohort study which involved 2872 men and women of ≥ 65 years old at baseline (1999). We rated their functional dependency with the ADL scale and nutritional status with the MNA (both the long form, LF and the short form, SF) at baseline, and analysed the complementarity of the two scales in predicting follow-up 4-year all-cause mortality with Cox regression analysis and the net reclassification improvement (NRI) to quantify the improvement. The results showed that both ADL and MNA offered improvement in predicting follow-up mortality risk beyond that predicted by either one alone according to the Akaike information criterion and the NRI. The MNA-SF was nearly as effective as the MNA-LF in improving the predictive ability of the ADL. The present study suggests that the MNA (especially the SF because of its simplicity and time-saving feature) together with the ADL scale might be of value for predicting the mortality risk of frail elderly living in various settings.

The aging process involves changes in weight, height, body mass index (BMI), muscle mass, and a redistribution of body fat. These anthropometrical measures are closely related to nutrition, functional ability and health. However, most studies conducted on aging-associated anthropometrical changes so far involve Western populations. Knowledge on population-specific changes is necessary for understanding the population-related differences. This article aims to review anthropometrical changes important to geriatric nutritional assessment including weight, height, BMI, and mid arm (MAC) and calf circumferences (CC) in older Taiwanese. BMI is probably the most widely studied anthropometrical indicator but mid arm and CC have also received increasing attention in recent years. The pattern of age-associated anthropometrical changes in Taiwanese generally parallels the Western populations. BMI, an indicator of body weight relative to height, is often considered an indicator of body fatness. Currently, the World Health Organization (WHO) sets a uniform standard of BMI 25–29.9 kg/m2 for overweight and ≥30 for obesity. However, there is evidence that these thresholds may underestimate the prevalence of overweight and obesity in Taiwanese. The Department of Health of Taiwan has adopted modified thresholds of BMI 24–26.9 kg/m2 for overweight and ≥27 for obesity for Taiwanese. Similarly, because of stature differences, elderly Taiwanese appear to have different cut-points of MAC (22.5/21 cm for Taiwanese men/women vs. 21/21 cm for Western men/women) and CC (28/25 cm for Taiwanese men/women vs. 31/31 cm for Western men/women) for undernutrition. Several social, lifestyle and dietary factors have been observed to impact these indicators in older Taiwanese. Age has the strongest impact on BMI, MAC and CC. Routine physical exercise is associated with higher BMI, MAC and CC. Cigarette-smoking is associated with lower BMI and CC but not MAC. Consumption of dairy products is associated with lower BMI and MAC but not CC. Consumption of fruit is associated with greater BMI and CC but not MAC whereas consumption of tea is associated with greater BMI, MAC and CC. These anthropometrical indicators are useful nutritional and health indicators for old persons or hospitalized patients and are included in many major geriatric nutritional assessment tools. MAC and especially CC, in addition to reflecting general nutritional status, also reflect body muscle mass or the functional status in frail elderly. Understanding these aging-associated changes and the implication of these indicators as they relate to health is important to health care and support to elderly individuals.

ObjectiveThe study evaluated the association between consumption frequencies of the major food categories and the risk of new depression four years later in older Taiwanese.DesignA prospective cohort study with multistage random sampling. Logistic regression analysis evaluated the significance of the longitudinal associations of intake frequencies of the major food categories with future (4 years later) risk of new depression, controlled for possible confounding factors with or without adjustment for cognitive status.SettingPopulation-based free-living elderly.SubjectsMen and women (n 1609) ≥65 years of age.ResultsIn a regression model that controlled for demographic, socio-economic, lifestyle and disease/health-related variables but not cognitive status, both fruits (OR = 0·66, 95 % CI 0·45, 0·98, P = 0·038) and vegetables (OR = 0·38, 95 % CI 0·17, 0·86, P = 0·021) were protective against depressive symptoms 4 years later. However, when the same regression model was also adjusted for cognitive status, only vegetables (OR = 0·40, 95 % CI 0·17, 0·95, P = 0·039) were protective against depressive symptoms. Higher consumption of eggs was close to being significant in both regression models (P = 0·087 and 0·069, respectively). Other food categories including meat/poultry, fish, seafood, dairy, legumes, grains and tea showed no significant associations.ConclusionsResults suggest that although confounding factors cannot be totally ruled out, more frequent consumption of vegetables seems to be protective against depressive symptoms in the elderly. Further studies are needed to elucidate the causal role and the mechanism of the association.

The study was aimed to examine the appropriateness of using the Mini Nutritional Assessment to screen for risk of under- and over-nutrition in adults with intellectual disabilities.Persons with intellectual disabilities are at increased risk of malnutrition, but routine monitoring of their nutritional conditions are not widely done.The study purposively recruited 104 institutionalised adults (≥19 years old) with intellectual disabilities to serve as participants.Participants were interviewed with a structured questionnaire to elicit personal data, health-related information and answers to items in the Activities of Daily Living and the Mini Nutritional Assessment scales and measured for anthropometrics. Biochemical data were taken from their routine medical measurements. Each subject was graded with the Mini Nutritional Assessment that adopted Taiwanese-specific anthropometric cut-off points (T1) and an alternative version that omitted the body mass index item (T2).Both Mini Nutritional Assessment versions were able indentifying individuals at risk of malnutrition among adults with intellectual disabilities and rated comparable proportions of patients malnourished (6·7 and 5·8% for Mini Nutritional Assessment-T1 and Mini Nutritional Assessment-T2, respectively) or at risk of malnutrition (14·4 and 17·3%, respectively). Persons with cerebral palsy were at greater risk of malnourishment than persons with other disabilities.The Mini Nutritional Assessment is appropriate for screening for under- and over-nutrition in adults with intellectual disabilities. The Mini Nutritional Assessment (especially the version without body mass index) can make routine monitoring of nutritional status of these patients an easier task. However, further studies are needed to develop subtype-specific versions (tools) as various subtypes of intellectual disability are associated with different nutritional problems.The Mini Nutritional Assessment can serve as a tool for routine screening for under- and over-nutrition in persons with intellectual disabilities.

To determine the impact of dental prosthetic condition on food consumption, risk of malnutrition and follow-up 4-year mortality risk in elderly Taiwanese. Analyzing the data sets of the 1999 and 2003 “Survey of Health and Living Status of the Elderly in Taiwan”, a longitudinal cohort study. A national probability sample of 2766 men and women 65 years of age or older. Self-reported intake frequencies of major food categories, masticatory ability, food consumption, and the risk of malnutrition assessed with the Mini Nutritional Assessment (short-form) stratified by dental prosthetic condition. Cox regression was used to compare follow-up mortality risk. Non-denture wearers and removable-denture wearers had poorer masticatory ability and greater nutritional risk and consumed fruits and vegetable less often compared to fixed-denture wearers. Removable-denture wearers also had lower self-perceived nutritional status and BMI compared to fixed-denture wearers. Survival analysis showed that nondenture wearers and removable-denture wearers had lower follow-up 4-year survival. Cox regression analysis showed that removable-denture wearers had increased follow-up 4-year mortality risk compared to fixed-denture wearers adjusted for sociodemographic, lifestyle and health-related factors. Based on data of a national sample of a longitudinal cohort study, dental prosthetic condition is a significant factor of nutritional health in the elderly. It can affect food pattern and the risk of malnutrition and mortality of elderly persons. Dental care should be an important part of geriatric health promotion program and fixed-denture is a preferred choice over removable-denture.

BMI, mid-arm circumference (MAC) and calf circumference (CC) are anthropometric indicators often included in geriatric health measurement scales. However, their relative effectiveness in predicting long-term mortality risk has not been extensively examined. The present study aimed to evaluate the relative effectiveness of these anthropometrics in predicting long-term mortality risk in older adults. The study prospectively analysed the ability of these indicators in predicting 4-year follow-up mortality risk of a population-representative sample of 4191 men and women, 53 years of age or older in the ‘Survey of Health and Living Status of the Elderly in Taiwan’. Cox regression analyses were performed to evaluate the association of follow-up mortality risk with low ( 2) or high ( ≥ 27 kg/m2) BMI, low MAC (

Background Routine screening/assessment of protein-energy status is essential for preventing uremic malnutrition in patients on hemodialysis (HD). A simple, low cost, reliable and non-invasive tool is greatly desired. Objective This study aimed to evaluate the appropriateness of using the long-form (LF) and the short-form (SF) Mini Nutritional Assessment (MNA) for grading the risk of protein-energy malnutrition in patients on HD. Design and sampling A cross-sectional study with purposive sampling. Setting A hospital-managed hemodialysis center. Participants 152 adult ambulatory patients on hemodialysis. Methods The nutritional status of each patient was graded with MNA-LF and MNA-SF, each in two versions—a normalized-original (content-equivalent) version (by adopting population-specific anthropometric cut-off points) and an alternative version that replaced calf circumference for BMI in the scale. The SGA, serum albumin and serum creatinine served as references. Cross-tabulation test was used to evaluate the consistency of the versions. Results MNA-SF versions rated fewer HD subjects malnourished or at risk of malnutrition (32.2% and 24.3% for T1 and T2, respectively) compared to MNA-LF versions (40.8% and 36.2%) or the SGA (47.4%). MNA-SF versions (kappa=0.450 and 0.446) also did not perform as well as MNA-LF versions (kappa=0.734 and 0.666) in predicting the risk of malnutrition in HD patients using the SGA as the reference. MNA-SF also did not perform as well as the MNA-LF using serum albumin or serum creatinine as the reference. Conclusions The MNA-LF is appropriate for predicting protein-energy malnutrition in HD patients but MNA-SF may under-rate these patients. Effort should be made to improve the MNA-SF for HD patients since the short-form is more time-efficient and thus, greatly desired in clinical practice.

To provide pooled data on the prevalence of malnutrition in elderly people as evaluated using the Mini Nutritional Assessment (MNA).Retrospective pooled analysis of previously published datasets.Hospital, rehabilitation, nursing home, community.Four thousand five hundred seven people (75.2% female) with a mean age of 82.3.The prevalence of malnutrition in the combined database and in the four settings was examined.Twenty-four data sets with information on full MNA classification from researchers from 12 countries were submitted. In the combined database, the prevalence of malnutrition was 22.8%, with considerable differences between the settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). In the combined database, the "at risk" group had a prevalence of 46.2%. Consequently, approximately two-thirds of study participants were at nutritional risk or malnourished.The MNA has gained worldwide acceptance and shows a high prevalence of malnutrition in different settings, except for the community. Because of its specific geriatric focus, the MNA should be recommended as the basis for nutritional evaluation in older people.

Nutrition is a key element in geriatric health, and nutritional screening/assessment is a key component of comprehensive geriatric evaluation. The study aimed to validate the Mini Nutritional Assessment Taiwan version-1 (MNA-T1) which adopted population-specific anthropometric cut-points, and version-2 (MNA-T2) which replaced BMI with mid-arm and calf circumferences in the scale for predicting the nutritional status of elderly Taiwanese. Using data of a population-representative longitudinal study of 2802 Taiwanese aged 65 years or older, the study graded the nutritional status of each subject with the original and both modified versions at baseline, analysed their hospital length of stay, the Activities of Daily Living (ADL), the Center for Epidemiologic Studies Depression Scale (CES-D) and life-satisfaction scores at baseline and end of 4 years, and tracked their survival during the period. Results showed that both modified versions had superior predictive abilities compared with the original MNA, and their graded scores correlated better with hospital length of stay, and ADL, CES-D and life-satisfaction scores. Both modified versions were effective in predicting follow-up mortality risk. The relative mortality risk was about 7 times for those rated malnourished and 2·5 times for those rated at risk of malnutrition compared with those who were rated normal at baseline by the two modified versions. These results suggest that both of the modified versions are effective in predicting the nutrition and health statuses of Taiwanese elderly and would serve to validate the predictive ability of the two modified versions. The MNA-T2, which requires no BMI, can make routine nutritional screening/assessment an easier task.