Objective: To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. Design: An observation study assessing the nutritional status of female orthopaedic patients. Setting: The orthopaedic wards of the Royal Surrey County Hospital. Subjects: Forty-nine female patients aged 60 ± 103 y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. Major outcome methods: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. Results: The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as`malnourished' (scored`17 points), 47% as at risk' (scored 17.5 ± 23.5) and 37% as`well nourished' (scored b23.5). Signi®cant differences were found between the malnourished and well nourished groups for body weight (P`0.001), body mass index (BMI) (P`0.001), demiquet (P`0.001) and mindex (P`0.001). Mean values for energy and nutrient intakes showed a clear stepwise increase across the three groups for all nutrients except sodium, with signi®cant differences for protein (P`0.05), carbohydrate (P`0.05), ribo¯avin (P`0.05) niacin (P`0.05), pyridoxine (P`0.05), folate (P`0.05), calcium (P`0.05), selenium (P`0.05), iron (P`0.05) and NSP (P`0.05) intakes. Stepwise multiple regression analysis indicated that anthropometric assessments were the most predictive factors in the total MNA score. The sensitivity and speci®city of the MNA was assessed in comparison with albumin levels, energy intake and mindex. The sensitivity of the MNA classi®cation of those scoring less than 17 points in comparison with albumin levels, energy intake and mindex varied from 27 to 57% and the speci®city was 66 ± 100%. This was compared with the sensitivity and speci®city of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the speci®city declined to between 37 and 50%. Conclusions: The results suggest that the MNA is a useful diagnostic tool in the identi®cation of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting.

The objectives of the present study were to determine the feasibility of using manufactured foods, enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as a means of increasing the intake of these n-3 polyunsaturated fatty acids (PUFA), and to determine the effect of the consumption of these foods on postprandial lipaemia and other metabolic responses to a high-fat mixed test meal. Nine healthy, normotriacylglycerolaemic, free-living male volunteers (aged 3 5 4 0 years) completed the randomized, controlled, single-blind, crossover study. The study consisted of two periods (each of 22 d) of dietary intervention, separated by a 5-month washout period. During these two periods the subjects were provided with the manufactured foods enriched with EPA and DHA (n-3 enriched) or identical but unenriched foods (control). A mixed test meal containing 82 g fat was given to the fasted subjects on day 22 of each dietary intervention period. Two fasting, and thereafter hourly, blood samples were collected from the subjects for an 8 h period postprandially. Plasma triacylglycerol, total and HDL-cholesterol, non-esterified fatty acids (NEFA), glucose and immunoreactive insulin levels, post-heparin lipoprotein lipase (EC 3.1.1.34) activity and the plasma free fatty acid and phospholipid fatty acid compositions were measured. A mean daily intake of 1.4 g EPA + DHA (0.9 g EPA, 0.5 g DHA) was ingested during the n-3-enriched dietary period, which was significantly higher than the intake during the habitual and control periods (P < 0401) assessed by a 3 d weighed food intake. A significantly higher level of EPA + DHA enrichment of the plasma fatty acids and phospholipids (P < 0.001) after the n-3-enriched compared with the control intervention periods was also found. The energy intake on both of the dietary intervention periods was found to be significantly higher than on the habitual diet (P < 0.001), with an increase in body weight of the subjects, which reached significance during the n-3 PUFA-enriched dietary intervention period (P < 0.04). The palatability of the enriched foods was not significantly different from that of the control foods. Significantly higher fasting plasma HDL-cholesterol and glucose concentrations were found after the n-3 PUFA-enriched compared with the control intervention period (P < 0.02 and P < 0.05 respectively). No significant differences were found for the postprandial lipid and hormone measurements, except for significantly lower levels of NEFA at 60min after the n-3-enriched intervention period (P < 0.04). Enriched manufactured foods were a feasible vehicle for increasing n-3 PUFA intake. However the nature of the foods provided as the n-3 vehicle may have contributed to the increased body weight and higher energy intakes which were adverse consequences of the intervention. These factors, together with the short duration of the study may have been reponsible for the failure to observe significant plasma triacylglycerol reductions in response to daily intakes of n-3 Polyunsaturat...

Objective: To examine the effects of the consumption of ®sh oils on the gene expression of lipoprotein lipase (LPL, EC 3.1.1.34) in human adipose tissue. In order to measure LPL mRNA in adipose tissue samples obtained by needle biopsy from human volunteers a competitive, reverse transcriptase PCR (RT-PCR) protocol was developed. Design: A randomised controlled, single blind cross over dietary study which compared the effects of a low level n-3 polyunsaturated fatty acids (PUFA) using normal foods enriched with eicosapentaenoic (EPA) and docosahexaenoic (DHA) (test diet), with non-enriched but otherwise identical foods (control). The diets were consumed for a period of 22 d with a wash out period of 5 months between the diets. Setting: Free-living individuals associated with the University of Surrey. Subjects: Six male subjects with a mean ( AE sd) age of 51.2 AE 3.6 y were recruited. Major Outcome Measures: Pre-and postprandial blood samples were taken for the measurement of triacylglycerol (TAG), postheparin LPL activity and adipose tissue samples for the measurement of LPL mRNA levels. Results: Mean LPL expression values were 4.12 6 10 5 molecules of LPL mRNA per ng total RNA on the control diet and 4.60 6 10 5 molecules of LPL mRNA per ng total RNA on the n-3 PUFA enriched (test) diet. There was no signi®cant difference between the levels of LPL expression following each diet, consistent with the lack of change in TAG levels in response to increased dietary n-3 PUFA intake. However, the change in LPL expression (Test ± Control diet) correlated signi®cantly with the change in fasting TAG levels (P 0.03, R À0.87 and R 2 0.75) and with the total area under the TAG-time response curve (P 0.003, R À0.96 and R 2 0.92) in individuals. Conclusions: These ®ndings, although based on a small number of subjects, suggest that LPL expression may be a determinant of plasma TAG levels. The development of this methodology should allow further elucidation of the effects of dietary manipulation and disease processes on lipid clearance and regulation in human subjects. Sponsorship: This work was funded by BBSRC.

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