Age as a determinant of nutritional status: A cross sectional study

Background Undenutrition is known to be prevalent and largely unrecognised in older patients; however, aberrations in indicators of nutritional status may simply reflect effects of age and/or functional disability. Objective The aim of this study was to measure the effect, if any of age on nutritional status in older patients. Design 445 randomly selected hospitalised patients consented to nutritional status assessment derived from anthropometric, haematological, and biochemical data within 72 hours of admission. Nutritional status was compared between those age < 75 years and those aged 75 years or more. Using multiple regression models, we measured the association between age and nutritional assessment variables after adjusting for disability, chronic illness, medications, smoking and tissue inflammation. Results Body weight, body mass index, mid-upper arm circumference, haemoglobin, serum albumin and plasma ascorbic acid were all significantly lower in people aged ≥ 75 years compared with those < 75 years of age. Although riboflavin (vitamin B2), 25OH VitD3, red-cell folate and vitamin B12 concentrations were lower in those aged ≥ 75 years, differences were not statistically significant. After adjusting for disability and co-morbidity in a multivariate analysis, age alone had a significant and independent effect on important anthropometric and biochemical nutritional assessment variables. Conclusion Increasing age is independently associated with poor nutritional status. This may partly explain the poor clinical outcome in older patients

DELINEATING THE CELLULAR MECHANISMS OF ENDOPLASMIC RETICULUM-RETAINED ENDOGLIN MUTANTS CAUSING HEREDITARY HEMORRHAGIC TELANGIECTASIA TYPE 1

Endoglin, also known as cluster of differentiation 105 (CD105), is an auxiliary receptor in the TGFβ signaling pathway. It is predominantly expressed in endothelial cells as a component of the heterotetrameric receptor dimers comprising type I, type II receptors and the binding ligands. Mutations in ENG, the gene encoding endoglin, have been associated with Hereditary Hemorrhagic Telangiectasia type 1 (HHT1), a rare autosomal dominant inherited disorder affecting about 1 in 5000-8000 individuals, which is generally characterized by vascular malformations. Secretory and many endomembrane proteins synthesized in the Endoplasmic Reticulum (ER) are subjected to a highly stringent protein folding and assembly quality control mechanisms to ensure that only properly folded and assembled proteins are transported forward through the secretory pathway to their final destinations. We have previously demonstrated that some endoglin variants causing HHT1 are retained in the ER and failed to traffic to their normal localization at the plasma membrane, which suggested the possible involvement of the ER Associated protein Degradation (ERAD) in their molecular pathology. In this study, we have investigated the detailed degradation routes of endoglin wild type and two ER-retained mutant variants, P165L and V105D. Stably transfected HEK293 cells expressing Wild Type (WT) and the two mutants were treated with proteasomal and lysosomal inhibitors to elucidate their cellular degradation pathways and the molecular mechanisms underlying the loss of function phenotype associated with the diseasecausing variants. Our results show that WT endoglin has a relatively short half-life of less than 2 hours and degrades through both the lysosomal and proteasomal pathways, whereas the two disease-causing mutant variants (P165L and V105D) are relatively stable with half-life of more than 16 hours and predominantly degrade through the proteasomal ubiquitin pathway. Furthermore, we have demonstrated that endoglin variants P165L and V105D are significantly accumulated in the CRISPR-Cas9-generated HEK293 cells deficient in HRD1 E3 ubiquitin ligase; a major ERAD component. Therefore, our results conclusively confirm the involvement of ERAD in the cellular mechanisms of some HHT1 disease-causing missense variants. These findings might pave the way for more in-depth research studies that could open new windows for future therapeutic interventions for patients with HHT1. We have also investigated if ER-retained HHT1-causing endoglin variants L32R, C53R, V105D, I271N, P165L and C363Y would exert dominant negative effects by hijacking the wild type allele in the ER. Our results show that these ER- retained endoglin mutant variants are able to form heterodimers with the wild type protein. Crucially, they exhibit considerable dominant negative effects manifested in significant entrapment of wild type endoglin within the ER leading to reduced maturation. This suggest that in addition to haploinsufficiency due to mutations in one allele, heterozygous carriers of these ER-retained variants are likely to lose part of the function of the WT allele. These findings may help explain some of the phenotypic heterogeneity amongst HTT1 patients

Energy expenditure of acutely ill hospitalised patients

OBJECTIVE: To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. DESIGN: Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community RESULTS: Men had higher basal energy expenditure (BMR) values compared to women however the difference was not statistically significant [Men, mean (SD) 1405 (321) Kcal, women 1238 (322) kcal; mean difference (95% CI) 166 kcal (-17 to 531), p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP), concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p < 0.05"; r = -0.29, "p < 0.05" respectively). However, in a multivariate analysis for all 63 subjects combined CRP explained most of the variance in BMR in hospital. The Harris Benedict equation predicted within ± 10% measured BMR in only 47% of individuals in hospital. CONCLUSION: Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients

Effect of folic acid and metformin on insulin resistance and inflammatory factors of obese children and adolescents

Background: Considering the increasing trend of obesity, especially in developing countries such as Iran, and the role of inflammatory factors and insulin resistance (IR) in the occurrence of obesity-related complications as well as the safety of some agents such as folic acid and metformin, this clinical trial was designed to investigate the effect of metformin and folic acid on inflammatory factors and IR among obese children. Materials and Methods: In this randomized, double-blind, controlled clinical trial study, sixty obese children aged 6-12 years were enrolled. Selected obese children were randomly allocated in two interventional (1 mg/daily folic acid or 1000 mg metformin for 8 weeks) groups. Biochemical measurements including homeostasis model assessment of IR (HOMA-IR), homocysteine (Hcy), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured between and within the groups before and after trial. Results: In each group, thirty obese children were studied. The groups were age- and sex-matched. After folic acid and metformin administration, mean of Hcy, HOMA-IR, TNF-α, and IL-8 decreased significantly (P < 0.05). IL-6 decreased significantly after folic acid use (P < 0.05). Conclusion: The findings of this trial indicated that both metformin and folic acid could decrease IR and level of Hcy in obese children and adolescents. The effectiveness of metformin on IR was more significant than folic acid. Regarding the effectiveness of the two studied agents on inflammatory factors, it is suggested that the role of folic acid was superior to metformin. It is suggested that metformin is a proper agent for obese children with IR and folic acid is an appropriate supplement for obese children with increased inflammatory factors. © 2016 Journal of Research in Medical Sciences

Significantly elevated levels of plasma nicotinamide, pyridoxal, and pyridoxamine phosphate levels in obese Emirati population : a cross-sectional study

Water-soluble vitamins like B3 (nicotinamide), B6 (pyridoxine), and B9 (folic acid) are of utmost importance in human health and disease, as they are involved in numerous critical metabolic reactions. Not surprisingly, deficiencies of these vitamins have been linked to various disease states. Unfortunately, not much is known about the physiological levels of B6 vitamers and vitamin B3 in an ethnically isolated group (such as an Emirati population), as well as their relationship with obesity. The aim of the present study was to quantify various B6 vitamers, as well as B3, in the plasma of obese and healthy Emirati populations and to examine their correlation with obesity. A sensitive and robust HPLC-MS/MS-based method was developed for the simultaneous quantitation of five physiologically relevant forms of vitamin B6, namely pyridoxal, pyridoxine, pyridoxamine, pyridoxamine phosphate, and pyridoxal phosphate, as well as nicotinamide, in human plasma. This method was used to quantify the concentrations of these vitamers in the plasma of 57 healthy and 57 obese Emirati volunteers. Our analysis showed that the plasma concentrations of nicotinamide, pyridoxal, and pyridoxamine phosphate in the obese Emirati population were significantly higher than those in healthy volunteers (p < 0.0001, p = 0.0006, and p = 0.002, respectively). No significant differences were observed for the plasma concentrations of pyridoxine and pyridoxal phosphate. Furthermore, the concentrations of some of these vitamers in healthy Emirati volunteers were significantly different than those published in the literature for Western populations, such as American and European volunteers. This initial study underscores the need to quantify micronutrients in distinct ethnic groups, as well as people suffering from chronic metabolic disorders

A modified Mini Nutritional Assessment without BMI can effectively assess the nutritional status of neuropsychiatric patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72790/1/j.1365-2702.2008.02686.x.pd

Dietary analysis and nutritional behaviour in people with and without age-related macular disease

Background and Aims: Consumption of antioxidant nutrients can reduce the risk of progression of age-related macular degeneration (AMD) - the leading cause of visual impairment in adults over the age of 50 years in the UK. Lutein and zeaxanthin (L&Z) are of particular interest because they are selectively absorbed by the central retina. The objectives of this study were to analyse the dietary intake of a group of AMD patients, assess their ability to prepare and cook healthy food, and to make comparisons with people not affected by AMD. Methods: 158 participants with AMD were recruited via the UK charity The Macular Society, and fifty participants without AMD were recruited from optometric practice. A telephone interview was conducted by trained workers where participants completed a 24 hour food diary, and answered questions about cooking and shopping capabilities. Results: In the AMD group, the average L&Z intake was low in for both males and females. Those able to cook a hot meal consumed significantly more L&Z than those who were not able. Most participants were not consuming the recommended dietary allowance of fibre, calcium, vitamin D and E, and calorific intake was also lower than recommendations for their age-group. The non-AMD group consumed more kilocalories and more nutrients than the AMD group, but the L&Z intake was similar to those with AMD. The main factor that influenced participant’s food choices was personal preference. Conclusion: For an ‘informed’ population, many AMD participants were under-consuming nutrients considered to be useful for their condition. Participants without AMD were more likely to reach recommended daily allowance values for energy and a range of nutrients. It is therefore essential to design more effective dietary education and dissemination methods for people with, and at risk of, AMD

Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital

<p>Abstract</p> <p>Background</p> <p>Individualized, nutritional support reduced undernutrition among older stroke patients and improved quality of life in our recent randomized, controlled trial. Weight control thus seems to be important after stroke, and methods for monitoring nutritional status need to be simple and non-invasive. Here we aimed to assess if the nutritional intervention altered body composition in men and women in this study cohort, and also to examine the correlation between the methods for assessing body-, fat- and fat-free mass.</p> <p>Methods</p> <p>Acute stroke patients > 65 years at nutritional risk were randomized to either individualized, nutritional treatment with energy- and protein rich supplementation (intervention, n = 58) or routine, nutritional care (control, n = 66) while in hospital. Body composition was assessed with anthropometry and bioelectrical impedance. The follow-up period was three months.</p> <p>Results</p> <p>During the first week while in hospital, weight loss was smaller in the intervention group compared with the controls (P = 0.013). After three months weight- and fat loss were significant in both men and women. Whereas no significant differences were found in changes in body composition between the male study groups, in the women both weight loss (P = 0.022) and fat loss (P = 0.005) was smaller in the intervention group compared with the controls. A high correlation (r = 0.87) between mid upper arm circumference (MUAC) and body mass index (BMI) was found.</p> <p>Conclusions</p> <p>Individualized nutritional support to older stroke patients in hospital was beneficial for maintaining an adequate body mass and body composition the first week and seemed to have a preventive effect on fat loss among women, but not among men after three months. Measurement of MUAC may be used in the assessment of nutritional status when BMI cannot be obtained.</p> <p>Trial registration</p> <p>This trial is registered with ClinicalTrials.gov, number NCT00163007.</p