Summary
Body mass index (BMI) and mortality in old adults from the general population have been related in a U‐shaped or J‐shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5–24.9, 25–29.9, ≥30 kg/m2), the most adjusted hazard ratios (HRs) according to a pre‐defined list of covariates were obtained from authors and pooled by random‐effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow‐up were meta‐analysed. Compared with normal weight, all‐cause mortality HRs were 1.41 (95% CI = 1.26–1.58) for underweight, 0.85 (95% CI = 0.73–0.99) for overweight and 0.74 (95% CI = 0.57–0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13–2.40]). RR results corroborated primary HR results, with additionally lower infection‐related mortality in overweight and obese than in normal‐weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.
There was a high prevalence of malnutrition and poor intake in this sample of patients who had fallen in hospital. Nutrition assessment and intervention for patients who have fallen in the acute care setting should be considered.
An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy.
Objective:
To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a cardiovascular disease (CVD) prevention program and a county (Norrbotten) without such a program.
Design:
Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009, 2014). Dietary habits were assessed by a semi-quantitative food frequency questionnaire.
Setting:
Counties of Norrbotten and Västerbotten, Northern Sweden.
Participants:
Five thousand four hundred Swedish adults (mean age 56.9 years; 51.2% women) from Västerbotten (47%) and Norrbotten (53%).
Results:
No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein, and alcohol were observed between the counties (p for interaction ≥0.33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; p for interaction = 0.36). Nor were there any between-county differences for intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (p for interaction ≥ 0.09). Consumption of meat (p for interaction = 0.05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, p for interaction = 0.04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (p for interaction <0.01).
Conclusions:
Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favor of a county with a CVD prevention program compared to a county without such a program.
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