Predictive ability of various nutritional variables for mortality in elderly people

Agarwal, Nanakram; Acevedo, Francisco; Leighton, Linda S.; Cayten, C. Gene; Pitchumoni, C. S.

doi:10.1093/ajcn/48.5.1173

Cited by 127 publications

(75 citation statements)

References 23 publications

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“…14,15 Nutritional status was assessed according to a single anthropometric value (body mass index) and 3 routine laboratory tests (serum albumin, serum cholesterol, lymphocyte count), which are known to be simple parameters associated with nutritional status. 5,[16][17][18][19][20][21][22] Poor nutrition was defined as having at least 3 of the following: body mass index Ͻ 18.5 kg/m 2 , serum albumin Ͻ 3.0 g/dL, serum cholesterol Ͻ 130 mg/dL, and total lymphocyte count Ͻ 1,000/mm 3 . 5,[16][17][18][19][20][21][22] Subjects Ն 90 y of age who were admitted to the ICU and for whom DNR orders were in effect received all indicated medical treatments except for cardiopulmonary resuscitation.…”

Section: Variablesmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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BACKGROUND:We evaluated the clinical characteristics and factors associated with mortality in very elderly patients > 90 y of age admitted to the ICU. METHODS: We evaluated age-specific rates of admission and mortality in 16,935 subjects > 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects > 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward. RESULTS: The mortality rate of ICU subjects > 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose (P ‫؍‬ .006), poor nutrition (P ‫؍‬ .001), high Simplified Acute Physiology Scoring II scores (P < .001), DNR order (P ‫؍‬ .002), and vasopressor treatment (P ‫؍‬ .03) were independent predictive factors of mortality in subjects > 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died. CONCLUSIONS: The very elderly subjects (> 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.

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Section: Variablesmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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“…Serum albumin was analyzed using a nephelometric method (Behring nephelometric analyzer II, Behring Diagnostics GmbH, Marburg, Germany), with a 2% coefficient of variation. Hypoalbuminemia was conventionally diagnosed at serum albumin values below 35 g/l (Agarwal et al, 1988) and this definition was adopted to obtain a prevalence of this condition among elderly people for comparison with other studies. 25-Hydroxyvitamin D was measured using a radioimmunoassay (RIA) analysis (25 OH DiaSorin Stillwater, MN, USA); the reference range was 37.5-175 nmol/l, coefficient of variation, 8-11%.…”

Section: Protocolmentioning

confidence: 99%

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

et al. 2007

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Objectives: The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds. Subjects and methods: Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.575.3 years and 136 men aged 73.975.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry. Results: The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI o22 (OR ¼ 12) and a protein intake o65.7 g/day (OR ¼ 3.7). Women carried some risk already in the BMI 25-30 class (OR ¼ 5), and a much greater risk in the BMI o22 class (OR ¼ 26). Albumin o40 g/l also emerged as an independent risk factor (OR ¼ 2.6). Conclusions: BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values o22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Agerelated sarcopenia does not seem to be involved in bone mass loss.

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“…Porém, a maioria dos autores considera como padrão-ouro as medidas antropométricas e exames laboratoriais (linfócitos totais, albumina, colesterol séri-co, hemoglobina e transferrina) (67,69,72,79,80). …”

Section: Aspectos Peculiares Do Idosounclassified

Avaliação do estado nutricional de adultos e idosos e situação nutricional da população brasileira

Acuña

Cruz

2004

Arq Bras Endocrinol Metab

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RESUMOAs alterações do estado nutricional (desnutrição e obesidade) são relacionadas com sérios agravos para a saúde. O presente trabalho de revisão da literatura tem por objetivo descrever os principais métodos de avaliação do estado nutricional, com finalidade de facilitar o diagnóstico dos problemas nutricionais e acompanhar intervenções dietoterápicas. Descreve o método clínico, detalha aspectos da antropometria e os exames laboratoriais utilizados em avaliação do estado nutricional. Relaciona alguns dos principais índices múltiplos, utilizados tanto com fins diagnósticos e prognósticos. Informa a respeito da impedância bioelétrica, completando abordagem sobre os méto-dos convencionais, além de descrever as principais vantagens e desvantagens dos métodos não-convencionais. Finaliza com revisão sobre a situação nutricional da população brasileira, através da análise de dados obtidos em três inquéritos populacionais (1974, 1989, 1997). Nutritional disorders (undernutrition and obesity) are associated to increases in morbidity and mortality. This paper consists on a review of literature with the purpose of describing the main methods of nutritional assessment, in order to facilitate the diagnosis of nutritional disorders and the follow-up of dietetics interventions. It describes the clinical method, details procedures of anthropometry and laboratory evaluation and enrolls some of the multiple indices used for diagnosis and prognosis. Information about bioelectric impedance is given. Some aspects of non-conventional methods are reminded. Nutritional status of the Brazilian population is discussed, using the analysis of data collected from three populational surveys (1974, 1989, and 1997). (1), para manter a composição e funções adequadas do organismo (2), resultando do equilíbrio entre ingestão e necessidade de nutrientes (1). As alterações do estado nutricional contribuem para aumento da morbi-mortalidade. Assim sendo, a desnutrição predispõe a uma série de complicações graves, incluindo tendência à infecção, deficiência de cicatrização de feridas, falência respi- ratória (3), insuficiência cardíaca, diminuição da sín-tese de proteínas a nível hepático com produção de metabólitos anormais, diminuição da filtração glomerular e da produção de suco gástrico (4). Por outro lado, o sobrepeso e a obesidade são fatores de risco para variado número de agravos à saúde, dos quais os mais freqüentes são doença isquêmica do coração, hipertensão arterial, acidente vascular cerebral, diabetes mellitus tipo 2, colelitíase, osteoartrite (especialmente de joelhos), neoplasia maligna de mama pós-menopausa e de endométrio, esofagite de refluxo, hér-nia de hiato e problemas psicológicos (5,6). AVALIAÇÃO DO ESTADO NUTRICIONALOs objetivos da avaliação do estado nutricional são: a) identificar os pacientes com risco aumentado de apresentar complicações associadas ao estado nutricional (CAN), para que possam receber terapia nutricional adequada (1,7-9); b) monitorizar a eficácia da intervenção dietoterápica (1,9).Esta avaliação pode...

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Predictive ability of various nutritional variables for mortality in elderly people

Cited by 127 publications

References 23 publications

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

Avaliação do estado nutricional de adultos e idosos e situação nutricional da população brasileira

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