IntroductionAs the population ages, the number of injured elderly is increasing. We sought to determine if low skeletal muscle mass adversely affected outcome in elderly patients following trauma.MethodsPatients ≥ 65 years of age with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay at a Level I trauma center in 2009–2010 were reviewed. Muscle cross-sectional area at the 3rd lumbar vertebra was quantified and muscle index, a normalized measure of muscle mass, was calculated and related to clinical parameters including ventilator-free days, ICU-free days, and mortality. Using previously established sex-specific, muscle index cut-points, patients were then categorized as sarcopenic or non-sarcopenic and differences in clinical outcomes between these two groups were also compared. We also examined muscle index as a continuous variable relative to the same clinical outcomes.ResultsThere were 149 severely injured elderly patients (median age 79 years) enrolled in this study of which 71% were sarcopenic. Of the patients who were sarcopenic, 9% were underweight, 44% normal weight, and 47% overweight/obese as per body mass index (BMI) classifications. The overall mortality rate was 27% and univariate analysis demonstrated higher mortality among those who were sarcopenic (32% vs. 14%, P = 0.018). After controlling for age, sex, and injury severity, multiple logistic regression demonstrated that increased muscle index was significantly associated with decreased mortality (OR per unit muscle index = 0.93, 95% CI: 0.875-0.997, P = 0.025). In addition, multivariate linear regression showed that sarcopenia, but not muscle index, was associated with decreased ventilator-free (P = 0.004) and ICU-free days (P = 0.002). Neither BMI, serum albumin nor total adipose tissue on admission were indicative of survival, ventilator-free or ICU-free days.ConclusionsSarcopenia is highly prevalent in the elderly population with traumatic injuries. Traditional measures of nutritional assessment, such as BMI and serum albumin, do not accurately predict outcome in the injured elderly. Sarcopenia, however, represents a potential new predictor for mortality, discharge disposition, and ICU utilization. Measurement of muscularity allows for the early identification of at-risk patients who may benefit from aggressive and multidisciplinary nutritional and rehabilitative strategies.

Our results suggest that QMLT alone with our current protocol may not accurately identify patients with low muscle mass.

The ingestion of CC with either a high or low GI meal significantly impairs acute blood glucose management and insulin sensitivity compared with ingestion of DC. Future investigations are warranted to determine whether CC is a risk factor for insulin resistance.

A digital ruler can reliably predict L3 muscle CSA, and these linear measures may be used to identify critically ill patients with low muscularity who are at risk for worse clinical outcomes.

Caffeine and caffeinated coffee (CC) elicit acute insulin insensitivity when ingested before a carbohydrate load. The effects of CC on glucose tolerance and insulin sensitivity when co-ingested with a high carbohydrate meal and on postprandial metabolism of a subsequent (second) carbohydrate load have not been studied. In a randomised, crossover design, ten healthy males ingested either CC (5 mg caffeine/kg body weight), decaffeinated coffee (DC) or water (W; equal volume) co-ingested with a high glycaemic index cereal followed 3 h later by a 75 g oral glucose tolerance test. After the initial meal, insulin area under the curve (AUC) and insulin sensitivity index did not differ between treatments, although glucose AUC for CC (107 (SEM 18) mmol/l £ 3 h) and DC (74 (SEM 15) mmol/l £ 3 h) was greater than W (2 0·2 (SEM 29) mmol/l £ 3 h, P,0·05). After the second carbohydrate load, insulin AUC for CC was 49 % and 57 % greater (P,0·01) than for DC and W, respectively. Despite the greater insulin response, glucose AUC for CC (217 (SEM 24) mmol/l £ 2 h) was greater than both DC (126 (SEM 11) mmol/l £ 2 h, P¼ 0·01) and W (55 (SEM 34) mmol/l £ 2 h, P,0·001). Insulin sensitivity index after the second meal was lower after CC (8·2 (SEM 0·9)) compared with both DC (12·4 (SEM 1·2), P, 0·01) and W (13·4 (SEM 1·4), P,0·001). Co-ingestion of CC with one meal resulted in insulin insensitivity during the postprandial phase of a second meal in the absence of further CC ingestion. Thus, CC may play a role in daily glycaemic management.

Background Studies examining nutrition intake of critically ill patients following liberation from mechanical ventilation (LMV) are scarce. The objectives of this prospective, observational feasibility study were to quantify and assess protein and energy intake in hospitalized, critically ill patients following LMV, to determine barriers to optimal intake, and to report on the feasibility of recruiting and retaining patients into this study. Methods Adult patients requiring MV for >72 hours in a medical/surgical intensive care unit (ICU) were recruited. Protein and energy intakes were quantified up to 14 days following LMV. Patients also identified barriers to eating. Results Nineteen patients (mean age, 60 years [SD, 12 years]) were studied over 125 days. Over all study days, the median amounts of protein and energy consumed in comparison with amounts prescribed by dietitians were 46% (interquartile range [IQR], 26–100) and 71% (IQR, 38–100), respectively. When stratified by route of nutrition delivery, on days (n = 54) when patients consumed an oral diet as the sole nutrition source, median amounts of protein and energy consumed in comparison with those prescribed were only 27% (IQR, 15–41) and 47% (IQR, 29–66), respectively. The most frequently reported barriers to eating were poor appetite, early satiety, and taste changes. Conclusions Protein and calorie intake is below prescribed amounts for patients whose enteral nutrition is discontinued and an oral diet prescribed as sole nutrition source following LMV. Acceptable strategies to enhance nutrition intake in post‐ICU patients during the recovery stages of critical illness are needed.

Applied health research methods are evolving to meet the demands of increasingly complex health research needs. Qualitative health research, focused on individual perspectives of health, wellness, illness and recovery, has emerged as a unique discipline of this field. With distinct foci, methods and rules, qualitative health research has the potential to answer applied health research questions to inform practice, education and policy. Despite this potential, there are challenges to the application of qualitative health research methods in nutrition and dietetics research. These include limited training and mentorship availability for the rigorous application of these methods, as well as misaligned goals between the traditional social science‐based qualitative approaches and emerging applied nutrition science needs. Recognising these limitations, this review aims to provide guidance to the nutrition scientist conducting applied qualitative health research. Using nutrition and dietetic examples from the literature, this review defines qualitative health research and advances the Emphasis‐Purposeful sample‐Phenomenon of interest‐Context (EPPiC) framework as a tool for constructing structured overarching research questions and introduces four qualitative health research designs (qualitative description, interpretive description, case study and focused ethnography) relevant to applied nutrition science. This includes guidance on defining the sample, identifying strategies for data collection, analytic techniques and data reporting.

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