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Body composition in Swedish old people aged 65-99 years, living in residential care facilities
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2009 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, no 1, 98-107 p.Article in journal (Refereed) Published
Abstract [en]

It is important to evaluate body composition changes in subjects with an existing multi-system reduction in capacity, as a small decrease in fat-free mass (FFM) can cause serious impairments. The aim of the study was to describe body composition in old people living in institutions. Body composition data were collected within a study of 173 subjects with functional and cognitive impairment, aged 65-99 years, and living in residential care facilities. A bioelectrical impedance spectrometer (BIS) (Xitron Hydra 4200; 5-1000 kHz) was used to assess the amount of both FFM and fat mass (FM) which where adjusted for height. The Harpenden caliper and a tape measure were used to assess body fat, arm-muscle and arm-fat area (mm(2)). A large proportion of the old and functionally impaired population was at risk of malnutrition or already malnourished (63.4% vs. 17.4%) according to Mini-Nutritional Assessment (MNA). Women had significantly lower fat-free mass index (FFMI) and higher FMI, inversely related to age, than men. Bioelectrical impedance spectroscopy and anthropometrical measurements correlated but on different levels. In addition the FM% differed between the two methods (46.3% vs. 33.4%).

Place, publisher, year, edition, pages
Elsevier , 2009. Vol. 49, no 1, 98-107 p.
Keyword [en]
Anthropometry, Bioelectrical impedance spectroscopy, Body composition, Cognitive impairment, Functional decline and old age, Sweden
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-35689DOI: 10.1016/j.archger.2008.05.012PubMedID: 18703240OAI: oai:DiVA.org:umu-35689DiVA: diva2:346298
Available from: 2010-08-31 Created: 2010-08-31 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Nutritional status, body composition and physical activity among older people living in residential care facilities
Open this publication in new window or tab >>Nutritional status, body composition and physical activity among older people living in residential care facilities
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main purpose of this thesis was to study, whether drinkable yoghurt enriched with probiotic bacteria could have any effect on constipation and body weight (BW) among older people with dementia. Further, it concerns poor nutritional status among older people with physical and cognitive impairments and its relationship with factors commonly occur in older people living in residential care facilities. It also discusses how body composition changes with ageing and the associations between changes in muscle mass and functional balance after a high-intensity weight-bearing exercise program (the HIFE program) and the ingestion of an additional milk-based protein-enriched energy supplement.

A six-month feasibility study that included a probiotic drink was performed among 15 old people who were living in special units for people with dementia and who all had constipation. The effects of the probiotic drink on stool habits, and BW were studied. The outcome measures were followed daily for bowel movements and at three and six months for BW. The staff found the study easy to carry out and that the drink was well accepted by the participants. No convincing beneficial effects on stool habits were observed. In addition, a mean BW loss of 0.65 kg/month was registered. A poor nutritional intake, low physical activity level, and an over-night fast of almost 15 hours, 4 hours longer than recommended were also observed.

As a part of the FOPANU Study (Frail Older People-Activity and Nutrition Study), a randomized controlled trial was carried out in Umeå - the associations between nutritional status and factors common among old people with physical and cognitive impairments living in residential care facilities was studied. Assessments were made of nutritional status using the Mini Nutritional Assessment (MNA) scale, fat-free mass (FFM) and fat mass (FM) using both bioelectrical impedance spectroscopy (BIS) and skinfold thickness measurements. The effects of a high- intensity functional exercise program with an additional protein-enriched milk drink on ability to build muscle mass were evaluated. Analyses were made to investigate whether nutritional status, assessed using the MNA scale, was associated with medical conditions, drugs, activities of daily living (Barthel ADL index), cognitive impairment (Mini Mental State Examination (MMSE)), and depressive symptoms (Geriatric Depression Scale (GDS)) at baseline. The associations were assessed with multiple linear regression analyses with additional interaction analyses.

An independent association was found between poor nutritional status and having had a urinary tract infection (UTI) during the preceding year and being dependent in feeding for both women and men, and having lower MMSE scores for women. A large proportion of the participants, were at risk of malnutrition or were already malnourished. Women, but not men, had significantly lower Fat-Free Mass Index (FFMI) and Fat Mass Index (FMI) with age.

Bioelectrical impedance spectroscopy results correlated with skinfold thickness measurements, but on different levels on value for FM%.

Despite the high-intensity exercise had long-term effects (at six months, three months after the exercise) on functional balance, walking ability and leg strength. No effects on muscle mass and no additional effects from the protein-enriched drink could be observed after the three months of high intensity exercise. A negative, long-term effect on the amount of muscle mass and BW was revealed at six months (three months after the intervention had ended). The effects from the exercise did not differ for participants who were malnourished. No statistical interactions were observed between sex, depression, dementia disorder, and nutritional status, and the level of functional balance capacity on the outcome at three or six months.

In summary, the majority of the included older people with dementia had a low dietary intake, low physical activity level, and lost BW despite receiving a probiotic drink supplement every day for six months. The supplementation had no detectable effect on constipation. Among the participants in the FOPANU Study, UTI during the preceding year was independently associated with poor nutritional status. Being dependent in feeding was associated with poor nutritional status as were lower MMSE scores for women but not for men. Despite the high-intensity exercise program had long-term effects on the fysical function was no effect on the amount of muscle mass at three months observed. The FFM and FM expressed as indexes of body height were inversely related to age for women, but not for men. A high-intensity exercise program did not have any effect on the amount of muscle mass. The ingestion of a protein-enriched drink immediately after exercise produced no additional effect on the outcome and the results did not differ for participants who were malnourished. The negative long-term effect on amount of muscle mass, and BW, indicate that it is necessary to compensate for increased energy demands during a high-intensity exercise program. High age, female sex, depression, mild to moderate dementia syndrome, malnutrition, and severe physical impairment do not seem to have a negative impact on the effect of a high-intensity functional weight-bearing exercise program. Consequently, people with these characteristics in residential care facilities should not be excluded from training and rehabilitation including nutrition. More research is needed in large randomized controlled trials to further explore the association between energy balance and malnutrition among frail old people, with a special focus on UTI and constipation, but also to study how physical exercise affects older people’s nutritional status.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 90 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1428
Keyword
Nutritional status, constipation, BW loss, UTI, body composition, exercise, muscle mass, functional balance
National Category
Nutrition and Dietetics
Research subject
Nutrition
Identifiers
urn:nbn:se:umu:diva-43780 (URN)978-91-7459-229-0 (ISBN)
Public defence
2011-06-11, Aulan, Vårdvetarhuset, Umeå, 10:00 (English)
Opponent
Supervisors
Note
EmbargoAvailable from: 2011-05-13 Created: 2011-05-09 Last updated: 2011-05-13Bibliographically approved

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