malnutrition & sarcopenia in geriatrics · 1. interviews to gather demographics and take...

December 7th 2018

By: Sarah Bedford, M.S.

University of Wisconsin-Green Bay |Dietetic Intern

Malnutrition & Sarcopenia

in Geriatrics

What to expect:

Introduction to Malnutrition & Sarcopenia

A Look at Current Research

My thoughts

A Take Away Message for Your

Professional Practice

TODAYonline (2017). [photograph]. Retrieved from: https://www.todayonline.com/singapore/half-spores-

elderly-found-be-frail-mostly-due-malnutrition

Why I chose this topic

Images: Bedford, S. Malnutrition and sarcopenia in Geriatrics. (2018)

Review of Terminology

Risk Factors

High Risk Score on

AssessmentMalnutrition

Review of Terminology

Risk Factors

High Risk Score on

AssessmentSarcopenia

Definition = clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or physical performance

Malnutrition and sarcopenia are accelerated in hospitalized older adults:

increase length of stay & re-hospitalization rates

Increases frequency & severity of complications

Overview of Malnutrition Sarcopenia Syndrome (MSS)

President’s Council on Bioethics. (2002). Illustrating progressive age-related loss of muscle tissue. Retrieved from:

https://bioethicsarchive.georgetown.edu/pcbe/background/strong_muscles.html

Normal muscle Sarcopenia

Vandewoud et al. (2012)

Hu, X., Zhang, L., Wang, H., Hao, Q., Dong, B., & Yang, M.

Scientific Reports | 2017

Malnutrition-sarcopenia syndrome

predicts mortality in hospitalized

older patients

Study #1

Study #1 : Objective & Subjects

Aimed to Identify:

• prevalence of malnutrition, sarcopenia, & MSS

• association between MSS & long-term mortality

Sample Population:

• Hospitalized adults 60+ years old (n = 414)

• Exclusion Criteria: acute life threatening diseases, severe cognitive impairment, delirium, & edema

Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Hu, X. et al. Scientific Reports. (2017)

1. Interviews to gather

demographics and take

anthropometric measurements

2. Sarcopenia Screening

3. Nutritional Assessment via MNA

4. Follow up completed 12, 24, 36

months to assess survival rate

Study #1: Research Methods

Amazon. (2018). CAMRY Digital Hand Held Dynamometer [photograph].

Retrieved from: https://www.amazon.com/CAMRY-Dynamometer-

Strength-Measurement-Capturing/dp/B00A8K4L84

Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients.

Hu, X. et al. Scientific Reports. (2017)

Study #1 Results

Figure 2. Venn diagram

illustrating the overlap

between malnutrition

risk, malnutrition, and

sarcopenia

4.9% individuals had MSS


Study #1 Results

Figure 3. Survival curves

of the study population

according to sarcopenia

and nutritional status at

baseline

Red Line: MSS

Purple Line: Malnutrition

risk & sarcopenia

Survival curves

significantly

differed

(p<0.001)


Study #1: Strengths & Limitations

Strengths

• Factoring MNA results with & without BMI

• Utilization of standardized assessments

Limitation

• Diagnosis of MSS is new and still evolving


Article #1Final Conclusion

Statement

“Older inpatients with MSS or with a combination of

malnutrition risk & sarcopenia are at increased risk of long term all cause

mortality”

Malnutrition-sarcopenia syndrome predicts mortality in hospitalized

older patients. Hu, X. et al. Scientific Reports. (2017)

Research Quality Rating = Positive

Rodriguez, D., Marco, E., Moreno, N., Miralles, R., Ibar, O., Escalada, F., Muniesa, J.

Journal of Clinical Nutrition | 2016

Prevalence of malnutrition and

sarcopenia in a post-acute care geriatric

unit: Applying new ESPEN definition

and EWGSOP criteria

Article #2

Study #2: Objective & Subjects

Aimed to Determine:

• prevalence of malnutrition and sarcopenia

• the potential relationship between the syndromes

Sample Population:

• Patients in post-acute geriatric rehab in Spain (n=88)

• Exclusion Criteria: general and/or cognitive condition prevented administering diagnosis tests

Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit: Applying new ESPEN definition and EWGSOP criteria. Rodriguez et al.Journal of Clinical Nutrition. (2016).

1. Interviews gathered information on unintentional weight loss

2. Nutritional Assessment via MNA Short Form

3. Sarcopenia Screening

4. Evaluation of lab values (albumin, iron profile, total protein, urea levels)


Nestle Nutrition Institute. (2009). Mini Nutritional Assessment MNA [PDF].

Retrieved from: https://www.mna-elderly.com/forms/mini/mna_mini_english.pdf

Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit: Applying new ESPEN definition and

EWGSOP criteria. Rodriguez et al.Journal of Clinical Nutrition. (2016).

Study #2 Results


Study #2: Strengths & Limitations

Strengths

• Followed standard assessment guidelines

• Acknowledged limitation in lab values

Limitations

• Can be a challenge to gather information in this population

• Observation study design vs longitudinal


Article #2 Final Conclusion

Statement

Sarcopenia is more prevalent in malnourished

post-acute geriatric patients. More research is needed to evaluate if the

combination of syndromes

Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit:

Applying new ESPEN definition and EWGSOP criteria. Rodriguez et al.

Journal of Clinical Nutrition. (2016).

Research Quality Rating = Positive

Pierik et al. | BioMed Central Geriatrics | 2016

High risk of malnutrition is

associated with low muscle mass in

older hospitalized patients – a

prospective cohort study.

Article #3

Article #3: Objective & Subjects

Aim to Associate the risk of malnutrition with:

1) Muscle strength & mass at admission

2) Change of muscle strength & mass during hospitalization

Sample Population:

• Hospitalized adults of 70+ years from Amsterdam (n=176)

• Exclusion Criteria: expected length of stay <24hrs, Isolation needed or Terminally ill, Did not speak Dutch, Unwillingness to participate

High risk of malnutrition is associated with low muscle mass in older hospitalized patients – a prospective cohort study. Pierik et al. BMC Geriatrics. (2016).

1. Interviews & Medical records to

gather demographics and general

lifestyle information

2. Malnutrition was assessed via SNAQ

3. Muscle Strength assessed using hand

grip strength

4. Muscle Mass was assessed using BIA

with adjustments


36 Questionnaire Examples. (2018). Short Nutritional Assessment Questionnaire

[photograph]. Retrieved from: https://www.examples.com/education/assessment-

questionnaire.html

High risk of malnutrition is associated with low muscle mass in older hospitalized

patients – a prospective cohort study. Pierik et al. BMC Geriatrics. (2016).

34.8% screened as high risk

malnutrition via SNAQ

High malnutrition risk was significantly associated with lower skeletal muscle (odds

ratio 0.90)

No differences in the change of muscle strength and muscle

mass parameters during hospitalization were found

dependent on level of malnutrition risk

Article #3

Results


Article #3: Strengths & Limitations

Strength

• Included a variety of conditions

Limitations

• BIA can be influenced by hydration status

• Small population size

• Observational study design


Article #3Final Conclusion

Statement

“In older hospitalized patients a high risk of malnutrition was

significantly associated with lower absolute skeletal muscle at admission but not muscle

strength.”

High risk of malnutrition is associated with low muscle mass in older

hospitalized patients – a prospective cohort study. Pierik et al. BMC

Geriatrics. (2016).

Research Quality Rating = Neutral

Summary of Article Conclusions

Study #1

• Hospitalized older adults who screened for sarcopenia and malnutrition (& risk) are at increased risk of long term mortality

Study #2

• Sarcopenia was more prevalent in individuals with malnutrition

• 37.5% positively screened for sarcopenia – 90.9% had malnutrition

Study #3

• In hospitalized older adults, high risk malnutrition is associated with lower muscle mass but not muscle strength at admission

(Pierik et al., 2016)

(Rodriguez et al., 2016)

(Hu et al., 2017)

My Opinions & Thoughts

More research is needed. . .

Utilization of Nutrition Focus Physical

Exam to detect the conditions

Importance on strength and overall

physical function in nutrition

interviews

Image: Bedford, S. Malnutrition and sarcopenia in Geriatrics. (2018)

Take Home Messages

1. Malnutrition Sarcopenia Syndrome may be a potential diagnosis in the future.

2. Important to evaluate overall strength & function during nutritional assessments to better understand a

geriatric patient’s whole story

ReferencesStudy References:

(Study #1) Hu, X., Zhang, L., Wang, H., Hao, Q., Dong, B., & Yang, M. (2017). Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Scientific Reports, 7:3171, 1-9. DOI:10.1038/s41598-017-03388-3

(Study #3) Pierik, V., Meskers, C., Ancum, J., Numans, S., Verlaan, S., Scheerman, K., Kruizinga, R., Maier, A. (2017). High risk of malnutrition is associated with low muscle mass in older hospitalized patients – a prospective cohort study. BMC Geriatrics, 17:118, 1-8. DOI 10.1186/s12877-017-0505-5

(Study #2) Rodriguez, D., Marco, E., Moreno, N., Miralles, R., Ibar, O., Escalada, F., Muniesa, J. (2016). Prevalence of malnutrition and sarcopenia in a post-acute care geriatric unit: Applying the new ESPEN definition and EWGSOP criteria. Clinical Nutrition, 36, 1339-1344. http://dx.doi.org/10.1016/j.clnu.2016.08.024

Other References:

◦ Vandewoude, M., Alish, C., Sauer, A., & Hegazi, R. (2012). Malnutrition-Sarcopenia Syndrome: Is This the Future of Nutrition Screening and Assessment for Older Adults. Journal of Aging Research, 2012, 1-8. doi:10.1155/2012/651570

◦ Width, M., Reinhard, T. (2018). The Essential Pocket Guide for Clinical Nutrition Second Edition. Wolters Kluwer.

Malnutrition & Sarcopenia in Geriatrics

By: Sarah Bedford, M.S.

https://uwgbresearchreviews.weebly.com

Thank you!

https://uwgbresearchreviews.weebly.com/

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