Nutritional assessment and nutritional status of centenarians (based on the materials of the study “Centenary citizen” in Moscow)

Abstract

BACKGROUND: Malnutrition and micro- and macronutrient deficiencies are common in people aged 95 years and older. For timely detection of nutritional disorders, it is crucial to regularly examine centenarians and, if necessary, correct an individual patient management plan. A well-balanced diet is one of the fundamental factors for the normal functioning of the human body throughout its life. With age, for various reasons, the risk of malnutrition increases, however, the nutritional status of centenarians is currently not fully understood due to the difficulties of diagnosis.

AIM: To evaluate nutritional status and its impact on life expectancy in patients aged 95 years and older, to identify the main determinants that affect the development of malnutrition, and to assess their impact on three-year survival of centenarians.

MATERIALS AND METHODS: Analyzed the results of a Mini Nutritional Assessment, general and biochemical blood tests (including such parameters as hemoglobin levels, iron levels, total protein, albumin, vitamin B12, vitamin D, folic acid) in non-institutionalized people aged 95 and older living in Moscow. All studies were conducted at home in the presence of relatives and/or social workers after signing a voluntary informed consent.

RESULTS: The study included 82 people, mean age (98.3±1.89) years; 87.8% were women. Of all the study participants, 56.1% (n=46) were at risk of developing malnutrition, and 11% (n=9) had malnutrition syndrome. Among the 64 participants who took the blood test, anemia was diagnosed in 71.9% (n=46), with macrocytic in 10.9% (n=5), normocytic in 84.8% (n=39), and microcytic in 4.3% (n=2) of patients. Hypoalbuminemia was identified in 16.9% (n=11 of 65) of participants. Of the 50 people who were screened for vitamin D levels, vitamin D deficiency was found in 98% (n=49 out of 50). The following factors influenced survival: a Mini Nutritional Assessment score of more than 24 reduces the risk of 3-year death by 72% (odds ratio (OR) — 0.28, confidence interval (CI) — 0.1–0.8), anemia increases the adverse risk by 3 times (OR=3.1, CI 1.1–8.9). The main clinical conditions associated with a higher risk of developing malnutrition were anemia (OR=3.1, CI 1.1–8.9) and chewing problems (OR=2.8, CI 0.9–7.8).

CONCLUSIONS: Conducting a nutrition assessment and drawing up a program for the prevention of malnutrition syndrome in centenarians will improve the quality of life and increase life expectancy.

Keywords

geriatric syndrome / centenarians / nutrition / malnutrition / anemia

References

[1] Kehoe L, Walton J, Flynn A. Nutritional challenges for older adults in Europe: current status and future directions. Proceedings of the Nutrition Society. 2019;78(2):221–233. doi: 10.1017/S0029665118002744

[2] Kehoe L., Walton J., Flynn A. Nutritional challenges for older adults in Europe: current status and future directions // Proceedings of the Nutrition Society. 2019. Vol. 78, N 2. P. 221–233. doi: 10.1017/S0029665118002744

[3] Malnutrition in older adults. Clinical guidelines. ID 615. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. 2020. Available from: https://cr.minzdrav.gov.ru/recomend/615_2 (In Russ)

[4] Клинические рекомендации — Недостаточность питания (мальнутриция) у пациентов пожилого и старческого возраста. ID 615. Одобрено Научно-практическим Советом Минздрава РФ. 2020. Режим доступа: https://cr.minzdrav.gov.ru/recomend/615_2 Дата обращения: 15.07.2023

[5] Tkacheva ON, Kotovskaya YuV, Krylov KYu, et al. Malnutrition as a factor aggravating the heart failure course in the elderly and senile age. Russian Journal of Cardiology. 2022;27(1S):25–32. (In Russ) doi: 10.15829/1560-4071-2022-4583

[6] Ткачева О.Н., Котовская Ю.В., Крылов К.Ю., Ерусланова К.А., Федин М.А. Мальнутриция как фактор, усугубляющий течение хронической сердечной недостаточности в пожилом и старческом возрасте // Российский кардиологический журнал. 2022. Т. 27, №1S. С. 25–32. doi: 10.15829/1560-4071-2022-4583

[7] Sharashkina NV, Tkacheva ON, Runikhina NK, et al. Comprehensive geriatric assessment — the main tool for the work of a geriatrician. Russian Journal of Geriatric Medicine. 2022;(4): 210–227. (In Russ) doi: 10.37586/2686-8636-4-2022-210-227

[8] Шарашкина Н.В., Ткачева О.Н., Рунихина Н.К., и др. Комплексная гериатрическая оценка — основной инструмент работы врача-гериатра // Российский журнал гериатрической медицины. 2022. №4. С. 210–227. doi: 10.37586/2686-8636-4-2022-210-227

[9] Corish CA, Bardon LA. Malnutrition in older adults: Screening and determinants. Proceedings of the Nutrition Society. 2018;78(3): 372–379. doi: 10.1017/s0029665118002628

[10] Corish C.A., Bardon L.A. Malnutrition in older adults: Screening and determinants // Proceedings of the Nutrition Society. 2018. Vol. 78, N 3. P. 372–379. doi: 10.1017/s0029665118002628

[11] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA: The Journal of the American Medical Association. 2001;285(19): 2486–2497. doi: 10.1001/jama.285.19.2486

[12] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) // JAMA: The Journal of the American Medical Association. 2001. Vol. 285, N 19. P. 2486–2497. doi: 10.1001/jama.285.19.2486

[13] Iron deficiency anemia. Clinical guidelines. ID 669. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. 2021. Available from: https://cr.minzdrav.gov.ru/recomend/669_1 (In Russ)

[14] Клинические рекомендации — Железодефицитная анемия. ID 669. Одобрено Научно-практическим Советом Минздрава РФ. 2021. Режим доступа: https://cr.minzdrav.gov.ru/recomend/669_1 Дата обращения: 15.07.2023

[15] Type 2 diabetes mellitus in adults. Clinical guidelines. ID 290. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. 2022. Available from: https://cr.minzdrav.gov.ru/recomend/290_2 (In Russ)

[16] Клинические рекомендации — Сахарный диабет 2 типа у взрослых. ID 290. Одобрено Научно-практическим Советом Минздрава РФ. 2022. Режим доступа: https://cr.minzdrav.gov.ru/recomend/290_2 Дата обращения: 15.07.2023

[17] Donini LM, Poggiogalle E, Molfino A, et al. Mini-nutritional assessment, malnutrition universal screening tool, and nutrition risk screening tool for the nutritional evaluation of older nursing home residents. Journal of the American Medical Directors Association. 2016;17(10):959.e11–959.e18. doi: 10.1016/j.jamda.2016.06.028

[18] Donini L.M., Poggiogalle E., Molfino A., et al. Mini-nutritional assessment, malnutrition universal screening tool, and nutrition risk screening tool for the nutritional evaluation of older nursing home residents // Journal of the American Medical Directors Association. 2016. Vol. 17, N 10. P. 959.e11–959.e18. doi: 10.1016/j.jamda.2016.06.028

[19] Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition — An ESPEN Consensus Statement. Clinical Nutrition. 2015;34(3):335–340. doi: 10.1016/j.clnu.2015.03.001

[20] Cederholm T., Bosaeus I., Barazzoni R., et al. Diagnostic criteria for malnutrition — An ESPEN Consensus Statement // Clinical Nutrition. 2015. Vol. 34, N 3. P. 335–340. doi: 10.1016/j.clnu.2015.03.001

[21] Population Structure and Ageing [Internet]. Eurostat: Statistics Explained. — [cited: 2023 Jul 15]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing

[22] Population Structure and Ageing [Internet]. Eurostat: Statistics Explained. — [дата обращения: 15.07.2023]. Доступ по ссылке: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing

[23] Özsürekci C, Kara M, Güngör AE, et al. Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults. Nutrition in Clinical Practice. 2022;37(6):1409–1417. doi: 10.1002/ncp.10877

[24] Özsürekci C., Kara M., Güngör A.E., et al. Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults // Nutrition in Clinical Practice. 2022. Vol. 37, N 6. P. 1409–1417. doi: 10.1002/ncp.10877

[25] Khovasova NO, Vorobyeva NM, Tkacheva ON, et al. The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT. Terapevticheskii arkhiv. 2022;94(1):24–31. (In Russ) doi: 10.26442/00403660.2022.01.201316

[26] Ховасова Н.О., Воробьева Н.М., Ткачева О.Н., и др. Распространенность анемии и ее ассоциации с другими гериатрическими синдромами у лиц старше 65 лет: данные российского эпидемиологического исследования ЭВКАЛИПТ // Терапевтический архив. 2022. Т. 94, №1. С. 24–31. doi: 10.26442/00403660.2022.01.201316

[27] Nikitin IG, Brutskaya LA, Gultiaeva NA, Podkhvatilina AS. Issues of diagnostics and treatment of vitamin D deficiency in older patients. Clinical nutrition and metabolism. 2022;3(4):230–245. (In Russ) doi: 10.17816/clinutr115028

[28] Никитин И.Г., Бруцкая Л.А., Гультяева Н.А., Подхватилина А.С. Проблемные вопросы диагностики и лечения дефицита витамина D у пожилых больных // Клиническое питание и метаболизм. 2022. Т. 3, №4. C. 230–245. doi: 10.17816/clinutr115028

[29] Langan RC, Goodbred AJ. Vitamin B12 Deficiency: Recognition and Management. Am Fam Physician. 2017;96(6):384–389.

[30] Langan R.C., Goodbred A.J. Vitamin B12 Deficiency: Recognition and Management // Am Fam Physician. 2017. Vol. 96, N 6. P. 384–389.

[31] Soini H, Suominen M, Muurinen S, Pitkälä K. Long-term care and oral health. Journal of the American Medical Directors Association. 2009;10(7):512–514. doi: 10.1016/j.jamda.2009.05.007

[32] Soini H., Suominen M., Muurinen S., Pitkälä K. Long-term care and oral health // Journal of the American Medical Directors Association. 2009. Vol. 10, N 7. P. 512–514. doi: 10.1016/j.jamda.2009.05.007

[33] Ivanova AS, Obukhova OA, Kurmukov IA, Volf LYa. Review of ESPEN-2021 Practice Guidelines for Patients with Cancer. Part 2: Interventions Relevant to Specific Patient Categories. Clinical nutrition and metabolism. 2022;3(4):193–206. (In Russ) doi: 10.17816/clinutr119059.

[34] Иванова А.С., Обухова О.A., Курмуков И.А., Вольф Л.Я. Обзор практических рекомендаций ESPEN-2021 для онкологических больных. Часть 2: частные вопросы нутритивной поддержки // Клиническое питание и метаболизм. 2022. Т. 3, №4. C. 193–206. doi: 10.17816/clinutr119059.

RIGHTS & PERMISSIONS

Eco-Vector