Search

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

Contains fulltext : 88987.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Development and validation of a quick and easy screening tool for the early detection of undernourished residents in nursing homes and residential homes. DESIGN: Multi-center, cross sectional observational study. SETTING: Nursing homes and residential homes. PARTICIPANTS: The screening tool was developed in a total of 308 residents (development sample; sample A) and cross validated in a new sample of 720 residents (validation sample) consisting of 476 nursing home residents (Sample B1) and 244 residential home residents (sample B2). MEASUREMENTS: Patients were defined severely undernourished when they met at least one of the following criteria: BMI or= 5% unintentional weight loss in the past month and/or >or= 10% unintentional weight loss in the past 6 months. Patients were defined as moderately undernourished if they met the following criteria: BMI 20.1-22 kg/m2 and/or 5-10% unintentional weight loss in the past six months. The most predictive questions (originally derived from previously developed screening instruments) of undernourishment were selected in sample A and cross validated in sample B. In a second stage BMI was added to the SNAQRC in sample B. The diagnostic accuracy of the screening tool in the development and validation samples was expressed in sensitivity, specificity, and the negative and positive predictive value. RESULTS: The four most predictive questions for undernutrition related to: unintentional weight loss more than 6 kg during the past 6 months and more than 3 kg in the past month, capability of eating and drinking with help, and decreased appetite during the past month. The diagnostic accuracy of these questions alone was insufficient (Se=45%, Sp=87%, PPV=50% and NPV=84%). However, combining the questions with measured BMI sufficiently improved the diagnostic accuracy (Se=87%, Sp=82%, PPV=59% and NPV=95%). CONCLUSION: Early detection of undernourished nursing- and residential home residents is possible using four screening questions and measured BMI. 01 februari 2010

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.

Summary Background & aims Malnutrition continues to be an important problem in health care which is still under recognized and underrated in developed countries. This study aims to describe current practice in diagnosing and treating malnutrition by medical doctors, medical students and nurses prior, during and after hospitalisation. Methods Prospective analysis of current practice in assessing nutritional status and prescribing treatment by medical and nursing staff in a cohort of hospitalised patients from the general medical wards of the VU University Medical Center, Amsterdam. Comparison of objective identification of malnutrition by an independent observer with subjective identification by the medical and nursing staff. Quantification of diagnosing, treating and communicating malnutrition before, during and following hospital stay by medical doctors, medical students and nurses by evaluating the written information in medical and nursing charts, and referral and discharge letters. Results Three hundred and ninety-five women and men, aged 19–96 years, were included from June to September 2005. The prevalence of malnutrition was 31.9%. Nutritional information was not mentioned in written referrals. Medical doctors performed nutritional assessment in 15.3%, medical students in 52.8%, and nurses in 29.9% of their patients. Medical doctors were the most capable of differentiating between malnourished and well-nourished patients as a basis for undertaking nutritional assessment, although this was still inadequate. Little nutritional intervention was applied during hospital stay. Information on nutritional status was lacking in most discharge letters. Nutritional follow-up was appointed in 1.2%. Conclusions Nutritional assessment and intervention were not sufficiently applied by any professional at any stage of the pre-, actual and post-hospitalisation period.

Objectives To investigate the effects of protein enriched bread and drinking yoghurt, substituting regular products, on the total protein intake and the distribution of protein intake over the day in older adults. Design A single blind randomised controlled trial. Setting Rehabilitation centre. Participants Older adults (≥ 55 years) admitted to a rehabilitation centre after hospital discharge (n=34). Intervention Participants received a high protein diet (protein enriched bread and protein enriched drinking yoghurt; n=17) or a regular diet (regular bread and regular drinking yoghurt; n=17) for three consecutive weeks. Measurements Total protein intake and protein intake per meal, measured twice weekly over a three weeks period (six measurements per participant). Results Compared with controls, patients who received the protein enriched products had a significantly higher protein intake (115.3 g/d vs 72.5 g/d, P

Background: Thyroid hormone metabolism is modulated by starvation and overfeeding but also by dietary composition. Unfortunately, little is known about the effect of malnutrition on disease-induced nonthyroidal illness (NTI). In this study, we investigated whether the degree of NTI after surgery differed between severely malnourished and well-fed patients with head and neck cancer. Methods: Plasma levels of the thyroid hormones 3',5-triiodothyronine (T 3), reverse T3 (rT3), free T4 (FT4), and thyrotropin (TSH) were measured on the first day before the operation and on the first, fourth, and seventh day after the operation in 16 malnourished patients who were admitted for intentional curative surgery of T1-T4 carcinomas of the head and neck. Six well-fed head and neck cancer patients eligible for surgical treatment served as a control group. Results: In the malnourished group, rT3 showed a significant increase, whereas T3and FT4 decreased significantly due to the operation. TSH showed no significant change. During the postoperative course, it took 7 days until rT3 and 4 days until T3 and FT4were restored to their preoperative value. In contrast, well-fed patients did not develop NTI. Conclusions: This study shows that peri- and postoperative rT 3, T3, and FT4 levels change significantly in malnourished patients compared with well-fed patients. Therefore, it can be concluded that nutrition status of patients undergoing major head and neck surgery should be optimized in order to prevent the development of NTI.

Background: This article describes the characteristics of patients identified as malnourished using the Short Nutritional Assessment Questionnaire (SNAQ) in terms of health status (quality of life, functional capacity, and body composition) and care complexity. We expected that by using the quick and easy SNAQ method of screening on malnutrition, inferences could be made about general health status and care complexity. This information can be used for optimal multi-disciplinary treatment of the malnourished patient.Methods: The research population consisted of a group of 588 patients admitted to internal medicine and surgery wards of the VU university medical center. Patients with a SNAQ score of at least 3 points were considered malnourished. The SNAQ score was compared to the health status, which was determined by serum albumin, hand grip strength, quality of life, body composition, and estimated care complexity.Results: At admission, 172 patients (29%) had a SNAQ score of at least 3 points. These patients had a significantly poorer quality of life, poorer physical functioning, a lower fat free mass index, and higher care complexity.Conclusion: These findings confirm our assumption that a considerable proportion of malnourished patients should be considered as complex patients and that malnutrition is an important aspect and indicator of overall health status of the patients. The SNAQ is a simple malnutrition screening tool, applicable in the current complex hospital situation, to identify these complex, malnourished patients. (C) 2006 European Federation of Internal Medicine. Published by Elsevier B.V All rights reserved.

OBJECTIVE: For the early detection and treatment of malnourished hospital patients no valid screening instrument for the Dutch language exists. Calculation of percentage weight loss and body mass index (BMI) by the nurse at admission to the hospital appeared to be not feasible. Therefore, the short, nutritional assessment questionnaire (SNAQ), was developed.RESEARCH, DESIGN AND METHODS: Two hundred and ninety one patients on the mixed internal and surgery/oncology wards of the VU University medical center were screened on nutritional status and classified as well nourished (18.5), moderately malnourished (5-10% weight loss in the last 6 months and BMI>18.5) or severely malnourished (>10% weight loss in the last 6 months or >5% in the last month or BMIRESULTS: The questions 'Did you lose weight unintentionally?'. 'Did you experience a decreased appetite over the last month?' and 'Did you use supplemental drinks or tube feeding over the last month?' were most predictive of malnutrition. The instrument proved to be valid and reproducible.CONCLUSION: SNAQ is an easy, short, valid and reproducible questionnaire for early detection of hospital malnutrition.

Ten minste een op de tien patienten in de huisartsenpraktijk is ondervoed. Ouderen, patienten met multimorbiditeit en chronisch zieken hebben een verhoogd risico. De prevalentie van (risico op) ondervoeding bij thuiswonende geriatrische patienten bedraagt zelfs meer dan 50%. Een huisarts moet rekening houden met minimaal 250 ondervoede patienten in zijn praktijk. We onderscheiden drie vormen van ondervoeding: anorexie, sarcopenie en cachexie. Ondervoeding leidt tot een toename van de zorgbehoefte en een toename van de zorgkosten. Een vroege herkenning en behandeling van ondervoeding zijn gewenst. Screening van risicogroepen kan daarbij worden overwogen. Er zijn nog geen eenduidige diagnostische criteria vastgesteld. De huisarts kan een eenvoudige gevalideerde vragenlijst de SNAQ 65+ gebruiken. De behandeling van ondervoeding in de eerste lijn wordt vaak multidisciplinair uitgevoerd, onder regie van de huisarts. Een effectieve voedingsbehandeling duurt ten minste drie maanden. De belangrijkste taak van huisartsen is misschien wel het aan ondervoeding denken bij hoogrisicogroepen. Vroege herkenning en behandeling kunnen bijdragen aan herstel van ziekte, (behoud van) kwaliteit van leven, en vermindering van zorgkosten.

Background: Intestinal absorption capacity is considered to be the best method for assessing overall digestive intestinal function. Earlier reference values for intestinal function in healthy Dutch adults were based on a study that was conducted in an inpatient metabolic unit setting in a relatively small series. The present study aimed to readdress and describe the intestinal absorption capacity of healthy adults, who were consuming their usual (Western European) food and beverage diet, in a standard ambulatory setting. Methods: Twenty-three healthy subjects (aged 22–60 years) were included in the analyses. Nutritional intake (energy and macronutrients) was determined with a 4-day nutritional diary. Subsequently, mean faecal losses of energy (by bomb calorimetry), fat, protein and carbohydrate were determined following a 3-day faecal collection. Finally, intestinal absorption capacity was calculated from the differences between intake and losses. Results: Mean (SD) daily faeces production was 141 (49) g (29% dry weight), containing 891 (276) kJ [10.7 (1.3) kJ g 1 wet faeces; 22.6 (2.5) kJ g 1 dry faeces], 5.2 (2.2) g fat, 10.0 (3.8) g protein and 29.7 (11.7) g carbohydrates. Mean (SD) intestinal absorption capacity of healthy subjects was 89.4% (3.8%) for energy, 92.5% (3.7%) for fat, 86.9% (6.4%) for protein and 87.3% (6.6%) for carbohydrates. Conclusions: The present study provides normative values for both stool nutrient composition and intestinal energy and macronutrient absorption in healthy adults on a regular Dutch diet in an ambulatory setting. Intestinal energy absorption was found to be approximately 90%.

Objectives: To examine differences between the assessment of body composition by body mass index (BMI) and bioelectrical impedance analysis (BIA) in patients with rheumatoid arthritis (RA). Method: The body composition of RA patients was assessed during their visit to the outpatient department of a Dutch academic hospital using BMI, fat-free mass index (FFMI), and fat mass index (FMI). FFMI and FMI were determined by single-frequency BIA. Results: Sixty-five consecutive RA patients (83% women, mean age 58 years, median disease duration 7 years) with moderately active disease [mean Disease Activity Score using 28 joint counts (DAS28) = 3.40; mean Rheumatoid Arthritis Disease Activity Index (RADAI) score = 3.49] and moderate disability [mean Health Assessment Questionnaire (HAQ) score = 0.87] were included. Based on BMI, 2% of our study population were underweight, 45% had a healthy body composition, and 54% were overweight or obese. Based on BIA, 18% of the patients showed a low FFMI and 74% had a high or very high FMI. Low FFMI was found in 44% of the women with a normal BMI, and high FMI was found in 40% of the women and 75% of the men with a normal BMI. Conclusions: A high frequency of unfavourable body composition, predominantly reduced FFMI and elevated FMI, was found in a cohort of RA patients with moderately active disease, turning BMI into an unreliable method for assessment of body composition in RA. BIA, however, might be the preferred method to assess FFMI and FMI in RA patients in clinical practice, as it is easy to use and relatively inexpensive. [ABSTRACT FROM AUTHOR]

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.

BACKGROUND/OBJECTIVES: The majority of hospital outpatients with undernutrition is unrecognized, and therefore untreated. There is a need for an easy and valid screening tool to detect undernutrition in this setting. The aim of this study was to determine the diagnostic accuracy of the MUST (Malnutrition Universal Screening Tool) and SNAQ (Short Nutritional Assessment Questionnaire) tools for undernutrition screening in hospital outpatients.METHODS: In a large multicenter-hospital-outpatient population, patients were classified as: severely undernourished (body mass index (BMI) 5% in the last month or >10% in the last 6 months), moderately undernourished (BMI 18.5-20 (RESULTS: Out of the 2236 outpatients, 6% were severely and 7% were moderately undernourished according to the reference method. MUST and SNAQ identified 9% and 3% as severely undernourished, respectively. MUST had a low PPV (Se=75, Sp=95, PPV=43, NPV=98), whereas SNAQ had a low Se (Se=43, Sp=99, PPV=78, NPV=96).CONCLUSIONS: The validity of MUST and SNAQ is insufficient for hospital outpatients. While SNAQ identifies too few patients as undernourished, MUST identifies too many patients as undernourished. We advise to measure body weight, height and weight loss, in order to define undernutrition in hospital outpatients.

Introduction Existing guidelines on nutrition support in patients with cancer cachexia state limited evidence for the beneficial effects of n-3 polyunsaturated fatty acids (PUFAs) on clinical outcome. In order to report on the latest evidence for n-3 PUFAs in cancer cachexia, we conducted a systematic literature review of randomized controlled trials (RCTs), comparing the effects on clinical outcome parameters of oral or enteral supplementation of n-3 PUFAs in cancer patients receiving chemotherapy, radiotherapy, surgery or palliative care. Materials and methods In PubMed, EMBASE and the Cochrane Library, search terms on cancer, n-3 PUFAs and clinical outcome parameters (nutritional status, morbidity, mortality and quality of life) were entered on 1 April 2013, using limits for adults, humans and English language. The quality and evidence of the retrieved publications were appraised by an expert team of Australian and Dutch dieticians and nutritionists, using the ADA grading system. Fifteen RCTs were retrieved. Results Nine RCTs were of positive quality, five of neutral quality and one of negative quality and were performed in patients with various types of cancer. Fair evidence shows that supplementation of n-3 PUFAs appears to be safe and may improve the quality of life and physical activity in patients with cancer. However, supplementation of n-3 PUFAs does not improve energy or protein intake, appetite or survival and does not reduce postoperative complications. The evidence for the effect on body weight, fatfree mass and performance status remains inconclusive. Conclusion Supplementation of n-3 PUFAs may have some positive effects in patients with cancer. Introduction Cancer cachexia, a complex metabolic syndrome associated with underlying illness, characterized by an increased inflammatory status and loss of muscle mass with or without loss of fat mass, is highly prevalent among patients with cancer1–7. This syndrome is a result of complex alterations in carbohydrate, lipid and protein metabolism8,9, caused by inflammatory mediators such as cytokines and tumour-derived catabolic drivers10. Proteolysis-inducing factor (PIF) is produced by the tumour and induces protein catabolism11. As a result of the acute-phase response, the liver shows an increased protein turnover for the production of inflammatory mediators, using muscle mass to release amino acids9,10. Changes in lipid metabolism in cancer include a reduction of lipogenesis, with unchanged whole-body lipolysis and mobilization of fatty acids from fat tissue. Alterations in glucose metabolism are reflected by glucose intolerance and insulin resistance8,9,11. Thus far, conventional nutritional support has been limited in its ability to stabilize body weight and maintain fat-free mass in patients with cachexia. Pharmaceutical interventions sometimes improved appetite, body weight and quality of life, but weight gain mostly consisted of fat mass12–15. n-3 Polyunsaturated fatty acids (PUFAs), especially eicosapentaenoic acid (EPA), seem to be promising agents to treat cancer cachexia. A dose of around 2 g of EPA per day (alone or combined with docosahexaenoic acid, DHA) appears to decrease the production of proinflammatory cytokines16,17 and PIF and is associated with stabilization of body weight and probably fat-free mass13,18. This has been shown in animal studies and in nonrandomized human trials in pancreatic cancer patients19,20. However, randomized controlled trials (RCTs) show contradictory results21–26. This may be due to issues related to study limitations, such as the disease severity, confounding factors and nonadherence with n-3 PUFA supplements. Also, study designs and outcome parameters differ in terms of supplementation dosage, * Corresponding author Email: b.vandermeij@vumc.nl 1 Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, the Netherlands 2 Centre for Dietetics Research, School of Human Movement Studies, University of Queensland, Brisbane, Australia 3 Department of Nutrition and Dietetics, Royal Brisbane & Women’s Hospital, Brisbane, Australia 4 Department of Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Australia 5 Department of Surgery, VU University Medical Center Amsterdam, the Netherlands

Background Rheumatoid cachexia (i.e. loss of fat free mass (FFM) and gain in fat mass (FM)) is often observed in chronic rheumatoid arthritis (RA) patients, with deleterious effects on morbidity and functional capacity [1,2]. In addition, the use of glucocorticoids is associated with increase in FM. Therefore, careful assessment of body composition is important in RA patients. Dual-energy X-ray absorptiometry (DXA) is a valid and reliable method to assess body composition, but is also expensive, time-consuming, invasive and thus not feasible for every-day use. Bioelectrical impedance analysis (BIA) is a relatively cheap, rapid, and non-invasive method to assess body composition in clinical practice, however BIA has not been validated in RA patients. Objectives To validate BIA against two different, widely used DXA devices for the assessment of body composition in patients with RA. Methods This cross-sectional validation study was performed in RA patients who visited study center A or B in the context of the COBRA-light extension studyl. Body composition was assessed by DXA (study center A: Hologic Delphi; study center B: GE Lunar IDxa) and BIA (Quadscan 4000) on the same day, and recorded as FM, FM%, FFM and FFM%. Agreement between both methods was assessed by paired t-tests, Bland-Altman plots and intra-class correlation coefficients (ICC), in which DXA was used as reference method. Results Of the 149 extension study patients, 43 patients (63% women, mean age 56 years, mean disease duration 5 years) were assessed by both DXA and BIA at the same day, and were included in this validation study. In study center A (n=25), BIA overestimated FM by 0.2 kg (p=0.71), and significantly underestimated FFM by 2.2 kg (p 0.90) and moderate-to-good agreement in study center B (>0.85). Conclusions This study showed that BIA is an invalid method for the assessment of body composition in RA patients, both at individual and group level, and that errors depend on the DXA device used as reference method. References Walsmith, Int J Cardiol 2002, 85:89–99 Summers, Nat Rev Rheumatol 2010, 6:445–51 Disclosure of Interest None declared

Introduction: In our society offering extra nutritional support is a standard for malnourished patients at admission to hospital. Whether cognitively impaired, older, hospitalized patients at risk of malnutrition would also benefit from this regimen is unknown. This study assesses their 3-months and 1-year survival. Prognostic characteristics predicting life expectancy are also studied. Methods: This prospective cohort included cognitively impaired, older, hospitalized patients at risk of malnutrition (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 1 year after patients' admission to the hospital. Possible prognostic characteristics predicting life expectancy data were collected. Results: A cohort of 116 cognitively impaired, older, hospitalized patients at risk of malnutrition is described. 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). Fifty-five patients (47.4%) died within 1 year after hospital admission, 36 of them (31%) died within 3 months after hospital admission. There were no significant differences in survival between the three groups (P = 0.672). Patients with a malignancy or vascular disease were more likely to die within 3 months after discharge. Multivariate analysis showed malignant neoplasm, vascular disease and age as prognostic factors for mortality. Conclusion: Almost half of a cohort of malnourished, cognitive impaired, older, hospitalized patients died within 1 year after hospital admission. Patients with a malignancy or vascular disease were more likely to die early after discharge. It could be defended that in these patients, extra-nutritional support should no longer be offered as a standard. © 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Ondervoeding is een veelvoorkomend probleem bij kwetsbare ouderen. Ten minste een op de drie geriatrische patienten kan als ondervoed worden beschouwd.

Dear Editor,With great pleasure we read the article by Macdonaldet al., describing the validation of a 23-item question-naire for estimating dietary calcium intake, the CaQ [1].We encourage this initiative as we are in search of aneasy, accurate, and feasible way to estimate the calciumintake of our patients as well.Recently, there has been a lot of attention for thepossible elevated cardiovascular risks of surplus calciumsupplementation on the one hand and calcium deficien-cy on the other hand in patients with osteoporosis. Tobe able to prescribe the adequate amount of calciumsupplementation, a practical tool to validly estimate thedietary intake of calcium is not available to clinicians.Most dietary assessment methods are too time-consuming for clinical practice. The gold standard ofassessing dietary calcium intake is a 7-day food diarywith weighed portion sizes, which is laborious for cli-nicians as well as for patients, and therefore not feasiblein clinical practice. Food frequency questionnaires(FFQ) are far more practical; however, they still consistof many questions and thus are not feasible in clinicalpractice either.Macdonald et al. validated their 23-item CaQ againsttwo “gold standards”: a 7-day food diary (n=33), whichis close to a real gold standard, although portion sizeswere estimated rather than weighed, and a FFQ (n=72),which is similar to the CaQ except for being moreelaborate. The authors conclude that their CaQ is anadequate tool to assess daily calcium intake when scor-ing between 700 and 1,200 mg.Although we were excited to see the work ofMacdonald et al., we missed a detailed report on thenumber of patients that has an estimated calcium intakeoutside a predefined clinically relevant area. Forexample, if an intake of 1,000 mg would be considerednormal, a difference of 250 mg between the goldstandard and the questionnaire would be clinicallyrelevant, as patients below 750 mg would benefit fromsupplementation. From a clinician’s perspective, it isimportant to know how many patients fall within theclinically relevant area, in order to judge the applicabilityof the CaQ for prescription of calcium supplements topatients.We recently validated a calcium intake list with only threeitems, which underestimated calcium intake compared toa dietary history with a clinically relevant difference ofmore than 250 mg in 56 % of patients [2]. Using ourlist to prescribe calcium supplements would mean thattoo many patients would be given too much calcium,possibly resulting in elevated cardiovascular risks.Currently, we are in the process of refining the list inorder to improve sensitivity and specificity for use inclinical practice.We look forward to validation studies of calciumintake lists in other cohorts of osteoporosis patients tosee if these lists are valid across cultures and diets andto decide on clinically relevant cutoff points for theprescription of calcium medication.

Objective: To characterize malnutrition in a nonspecific group of newly admitted hospital patients. Design: A prospective, descriptive study aiming to identify typical symptoms of malnutrition in a heterogeneous population of newly admitted patients to the wards of internal medicine. Setting: The wards of internal medicine of the VU University Medical Center. Subjects: A total of 106 patients were included in the study, 70 patients underwent the full interview. Next to nutritional status, the sociodemographics, underlying disease, estimated care complexity, care situation before admission, journey through the care system, nutritional intervention and nutritional follow-up after discharge were described for each patient. Results: Of 70 patients 24 (34%) were malnourished. Malnourished patients suffered two chronic diseases vs one for well-nourished patients (P =0.05). They also had a higher estimated care complexity (P =0.035) and a trend towards longer length of hospital stay (P =0.09). Malnourished patients did not differ from well-nourished patients in age, sex, partner status and care received at home. In all, 54% of the malnourished patients were identified correctly by the medical staff. The reasons for admission to the hospital were diverse in only four out of 24 patients malnutrition was the primary reason for admission. Discharge letters to the general practitioner (GP) contained only fragmentary information about the patients' nutritional status. At 3 months after discharge, most of the GPs were scarcely aware of any nutritional problems of their patients. Conclusions: Malnutrition is difficult to recognize in a nonspecific hospital population. Patients do not present with unique symptoms indicating malnutrition. To be able to correctly identify all malnourished patients, screening of the nutritional status of all newly admitted patients seems to be necessary.

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

Objective: Development and validation of a quick and easy screening tool for the early detection of undernourished residents in nursing homes and residential homes. Design: Multi-center, cross sectional observational study. Setting: Nursing homes and residential homes. Participants: The screening tool was developed in a total of 308 residents (development sample; sample A) and cross validated in a new sample of 720 residents (validation sample) consisting of 476 nursing home residents (Sample B1) and 244 residential home residents (sample B2). Measurements: Patients were defined severely undernourished when they met at least one of the following criteria: BMI

Malnutrition is reported to occur in approximately 30% of head and neck cancer patients. Also, impaired immunocompetence is described as a common phenomenon in this patient group. The purpose of this study was to assess the possible relationship between malnutrition and some prognostically important immune parameters in head and neck cancer patients. Thirty-two malnourished (recent weight loss ≤ 10%) and 34 well-nourished patients undergoing curative treatment for advanced head and neck cancer were studied prospectively, and six parameters of their immune status (leucocytes, lymphocytes, lymphocyte phenotyping, monocytes, HLA-DR expression on monocytes and serum interleukin-10) were determined on the day of panendoscopy. Reference values for monocytes, HLA-DR expression and interleukin-10 were obtained from 43 healthy controls. Although the number of monocytes was elevated in both patient groups, the HLA-DR expression on these monocytes was significantly lower in the malnourished than in the well-nourished and control groups. Tumor stage, tumor localization, recurrence after initial radiotherapy, age and gender were not correlated to HLA-DR expression. No relationships emerged between nutritional status and lymphocyte subsets. Malnourished head and neck cancer patients show a significantly lower HLA-DR expression on monocytes than well-nourished ones and healthy controls. According to the literature this would imply an increased risk for postoperative complications. Indeed, postoperative complications occur more frequently in malnourished than in well-nourished 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.