Poor nutritional status but not cognitive or functional impairment per se independently predict 1 year mortality in elderly patients with hip-fracture

Zanetti, Michela; Cappellari, Gianluca Gortan; Ratti, Chiara; Ceschia, Giuliano; Murena, Luigi; Colle, Paolo De; Barazzoni, Rocco

doi:10.1016/j.clnu.2018.08.030

Cited by 30 publications

(15 citation statements)

References 38 publications

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“…In addition, older people with femoral fractures are often malnourished at the time of fracture, and subsequently have poor food intakes. Malnutrition is frequently underdiagnosed in geriatric patients [8] and is considered to be a contributing factor for worse outcomes during hospitalization [9][10][11] or after fracture surgery [12,13]. Therefore, a screening tool to identify patients with a high risk of malnutrition is important while caring for elderly patients with femoral fractures.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Huang

et al. 2020

IJERPH

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Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI < 82; group 1, n = 127), moderate-risk group (GNRI 82–92; group 2, n = 179), low-risk group (GNRI 92–98; group 3, n = 123), and no-risk group (GNRI > 98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. Results: The patients in groups 1–3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34–29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.

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Section: Introductionmentioning

confidence: 99%

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Huang

et al. 2020

IJERPH

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“…On the other hand, malnutrition is common among older people and often poorly recognized and underdiagnosed [229]. Insufficient dietary intake is not only related to the development of sarcopenia [86], but is also a major risk factor for cognitive or functional impairments and mortality in older patients [230,231].…”

Section: Obesity and Weight Lossmentioning

confidence: 99%

The Effects of Lifestyle and Diet on Gut Microbiota Composition, Inflammation and Muscle Performance in Our Aging Society

et al. 2021

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Living longer is associated with an increased risk of chronic diseases, including impairments of the musculoskeletal and immune system as well as metabolic disorders and certain cancers, each of which can negatively affect the relationship between host and microbiota up to the occurrence of dysbiosis. On the other hand, lifestyle factors, including regular physical exercise and a healthy diet, can affect skeletal muscle and immune aging positively at all ages. Accordingly, health benefits could partly depend on the effect of such interventions that influence the biodiversity and functionality of intestinal microbiota. In the present review, we first discuss the physiological effects of aging on the gut microbiota, immune system, and skeletal muscle. Secondly, we describe human epidemiological evidence about the associations between physical activity and fitness and the gut microbiota composition in older adults. The third part highlights the relevance and restorative mechanisms of immune protection through physical activity and specific exercise interventions during aging. Fourth, we present important research findings on the effects of exercise and protein as well as other nutrients on skeletal muscle performance in older adults. Finally, we provide nutritional recommendations to prevent malnutrition and support healthy active aging with a focus on gut microbiota. Key nutrition-related concerns include the need for adequate energy and protein intake for preventing low muscle mass and a higher demand for specific nutrients (e.g., dietary fiber, polyphenols and polyunsaturated fatty acids) that can modify the composition, diversity, and metabolic capacity of the gut microbiota, and may thus provide a practical means of enhancing gut and systemic immune function.

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“…Poor nutrition status (as defined by MNA score <23.5) was associated with increased 3-, 6-, and 12-month mortality and cognitive and functional deficits; logistic regression demonstrated that the mortality association in malnourished patients was independent of age, gender, comorbidities, type of surgery, and even postoperative complications. 13 This conclusion seems straightforward, but it is also important to note that nutrition screening took place up to 72 h after admission, which raises the question of whether the disease itself is causing the malnutrition screening results and implying a reverse causality that could confound the association. Moreover, it is well known that perfect markers for malnutrition do not exist, yet the results are similar when other imperfect markers are studied as well.…”

Section: Introductionmentioning

confidence: 98%

For you were hungry and I gave you food: The prevalence and treatment of malnutrition in patients with acute hip fracture

Morrison

2021

Nut in Clin Prac

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Hip fractures are a common clinical problem with substantial morbidity and difficult recovery. Preexisting malnutrition has been shown to be common in those patients and a substantial risk factor for poorer outcomes, increased length of stay, and mortality. Additionally, great variability exists in reported malnutrition prevalence rates owing to the variety of nutrition screening and assessment tools utilized globally to identify malnutrition in these patients. Although previous data and a recent Cochrane review have not proven the value of nutrition supplements, we highlight several articles that show an opportunity for improvement in the nutrition care of patients sustaining hip fractures along with a multicenter randomized trial demonstrating the value of carefully designed nutrition intervention. There is also evidence that malnourished patients with hip fracture are still being undertreated. Current guidelines are reviewed, and continued efforts on the part of the clinicians to follow the guidelines as well as lowering the barriers to high-quality nutrition research is discussed.

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Poor nutritional status but not cognitive or functional impairment per se independently predict 1 year mortality in elderly patients with hip-fracture

Cited by 30 publications

References 38 publications

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures—A Retrospective Study in a Level I Trauma Center

The Effects of Lifestyle and Diet on Gut Microbiota Composition, Inflammation and Muscle Performance in Our Aging Society

For you were hungry and I gave you food: The prevalence and treatment of malnutrition in patients with acute hip fracture

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