Agathe Raynaud-Simon Service de Gériatrie, H ôpital Bichat APHP, Paris Faculté de Médecine Denis Diderot, Paris 7 Laborato...
Malnutrition
Malnutrition and mortality <ul><li>EURONUT-SENECA STUDY </li></ul><ul><ul><li>I  (1988 - 1989)   2600 subjects, aged 70-75...
Assessment of malnutrition <ul><li>Risk factors  </li></ul><ul><li>Appetite and food intake </li></ul><ul><li>Nutritional ...
Risk factors for malnutrition Cancer Cardiac Respiratory Liver Renal Chronic infections Chronic inflammation Malabsorption...
Risk factors for malnutrition Cancer Cardiac Respiratory Liver Renal Chronic infections Chronic inflammation Malabsorption...
Evaluation of food intake
Nutritional parameters and life-threatening complications in geriatric patients   Sullivan DH et al, J Gen Intern Med  200...
Malnutrition « Marasmus » Progressiv weight loss Protein and energy deficiency Muscle and fat loss Normal albuminemia No e...
Volkert D et al. Aktuel Ernaehr Med 2004; 29: 190-197 40 % 82    5 215 acute care, mixt Volkert (1992) 33 % 79    6 110 ...
Malnutrition criteria <ul><li>Malnutrition : one or more of the following criteria </li></ul><ul><ul><li>Weight loss  ≥  5...
Mini- MNA - risk factors - appetite - nutritional criteria  NEW ! Kaiser, JNHA 2009
<ul><li>GNRI = (1,489 x albumin g/L) + 41,7 x  actual weight </li></ul><ul><li>  ideal weight </li></ul><ul><li>Ideal weig...
Assessment  of nutritional status Body storage Weight, BMI How much fat? How much muscle? Metabolic homeostasis Albuminemi...
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Malnutrition & Sarcopenia

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  • The prevalence rates in the different studies therefore differs widely as a consequence of the different parameters used for the diagnosis of malnutrition . For example these are some the data for the BMI. The rates differ according to different cut off values. Look at the data provided by Volkert and collegues. The chose a population of patients from acute care. The prevalence if they use a cut off value of 18 or 22.
  • Raynaud

    1. 1. Agathe Raynaud-Simon Service de Gériatrie, H ôpital Bichat APHP, Paris Faculté de Médecine Denis Diderot, Paris 7 Laboratoire de Biologie de la Nutrition, EA4466, Faculté de Pharmacie, Paris 5 Evaluation of malnutrition
    2. 2. Malnutrition
    3. 3. Malnutrition and mortality <ul><li>EURONUT-SENECA STUDY </li></ul><ul><ul><li>I (1988 - 1989) 2600 subjects, aged 70-75 years </li></ul></ul><ul><ul><li>II (1993 - 1994) 1221 subjects aged 75-80 years </li></ul></ul><ul><ul><ul><li>Weight loss > 5 kg : 16 % (men and women) </li></ul></ul></ul><ul><ul><ul><li> Mortality X 2 in the next 5 years </li></ul></ul></ul>
    4. 4. Assessment of malnutrition <ul><li>Risk factors </li></ul><ul><li>Appetite and food intake </li></ul><ul><li>Nutritional criteria </li></ul>
    5. 5. Risk factors for malnutrition Cancer Cardiac Respiratory Liver Renal Chronic infections Chronic inflammation Malabsorption Maldigestion Failure <ul><li>Depression </li></ul><ul><li>Troubles du comportement </li></ul><ul><li>For eating </li></ul><ul><li>For mobility </li></ul><ul><li>Head and neck </li></ul><ul><li>Neurologic or vascular disease </li></ul>Psychiatric disorders Disability Swallowing disorders <ul><li>Alzheimer’s disease </li></ul><ul><li>Other dementia </li></ul><ul><li>Parkinson’s disease </li></ul><ul><li>Low salt </li></ul><ul><li>Weight reducing </li></ul><ul><li>diabetic </li></ul><ul><li>Low fat </li></ul><ul><li>Low fibers </li></ul><ul><li>Poor dental health </li></ul><ul><li>Ill adapted dentures </li></ul><ul><li>Mycosis of the mouth </li></ul><ul><li>Loss of taste </li></ul>Neurologic Restrictive diets Mouth and teeth <ul><li>Multiple drugs </li></ul><ul><li>Dryness of the mouth, abdominal complaints, nausea </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Pain </li></ul><ul><li>infection </li></ul><ul><li>Fracture with limitation of mobility </li></ul><ul><li>Surgery </li></ul><ul><li>Severe constipation </li></ul><ul><li>Pressure sores </li></ul><ul><li>Alone </li></ul><ul><li>Grieving </li></ul><ul><li>Financial problms </li></ul><ul><li>Hospitalization </li></ul><ul><li>Admission to a nursing home </li></ul>Drugs Acute conditions, Worsening of a chronic condition Psychologic, social and environement
    6. 6. Risk factors for malnutrition Cancer Cardiac Respiratory Liver Renal Chronic infections Chronic inflammation Malabsorption Maldigestion Failure <ul><li>Depression </li></ul><ul><li>Troubles du comportement </li></ul><ul><li>For eating </li></ul><ul><li>For mobility </li></ul><ul><li>Head and neck </li></ul><ul><li>Neurologic or vascular disease </li></ul>Psychiatric disorders Disability Swallowing disorders <ul><li>Dementia </li></ul><ul><li>Alzheimer’s disease </li></ul><ul><li>Other dementia </li></ul><ul><li>Parkinson’s disease </li></ul><ul><li>Low salt </li></ul><ul><li>Weight reducing </li></ul><ul><li>diabetic </li></ul><ul><li>Low fat </li></ul><ul><li>Low fibers </li></ul><ul><li>Poor dental health </li></ul><ul><li>Ill adapted dentures </li></ul><ul><li>Mycosis of the mouth </li></ul><ul><li>Loss of taste </li></ul>Neurologic Restrictive diets Mouth and teeth <ul><li>Multiple drugs </li></ul><ul><li>Dryness of the mouth, abdominal complaints, nausea </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Pain </li></ul><ul><li>infection </li></ul><ul><li>Fracture with limitation of mobility </li></ul><ul><li>Surgery </li></ul><ul><li>Severe constipation </li></ul><ul><li>Pressure sores </li></ul><ul><li>Alone </li></ul><ul><li>Grieving </li></ul><ul><li>Financial problms </li></ul><ul><li>Hospitalization </li></ul><ul><li>Admission to a nursing home </li></ul>Drugs Acute conditions, Worsening of a chronic condition Psychologic, social and environement
    7. 7. Evaluation of food intake
    8. 8. Nutritional parameters and life-threatening complications in geriatric patients Sullivan DH et al, J Gen Intern Med 2002; 17: 923 - 932 4,0% ≥ 22 kg/m ² 0,008 15,4% BMI < 22 kg/m ² 4,6% ≥ 18 mg/dL 0,046 10,5% Transthyretin < 18 mg/dL 5,3% ≥ 30 g/L 0,018 13,3% Albumin < 30 g/L 4,5% no <0,001 19% Weight loss > 5 % yes 3,2% > 323 mm 2,4% 286 – 323 mm <0,001 13,8% MAC < 286 mm P-Wert Complication rate Parameter
    9. 9. Malnutrition « Marasmus » Progressiv weight loss Protein and energy deficiency Muscle and fat loss Normal albuminemia No edema « Kwashiorkor » Rapid weight loss Protein deficiency Muscle mass loss Hypoalbuminemia Edema
    10. 10. Volkert D et al. Aktuel Ernaehr Med 2004; 29: 190-197 40 % 82  5 215 acute care, mixt Volkert (1992) 33 % 79  6 110 rehabilitation Sullivan (1994) 22 % 79  6 302 acute care, mixt Incalzi (1996) < 22 52 % 80  7 42 hip fracture Ponzer (1999) 35 % 83  4 99 acute care, mixt Dormenval (1999) 8 % > 70 116 ICU (respirator) Dardaine (2001) < 21 36 % 81  1 337 acute care, mixt Flodin (2000)  20 36 % 80  7 42 hip fracture Ponzer (1999) 31 % 78  9 201 stroke Gariballa (1998) 26 % 62 95 Parkinson Markus (1993) 21 % 82  5 215 acute care, mixt Volkert (1992) < 20 17 %  65 127 acute care, mixt DaCunha (2001) < 18,5 31 % 80  9 119 hip fracture Maffuli (1999) 9 % 82  5 215 acute care, mixt Volkert (1992) < 18 11 % 80  9 119 hip fracture Maffuli (1999) < 16 prevalence age n patients author BMI
    11. 11. Malnutrition criteria <ul><li>Malnutrition : one or more of the following criteria </li></ul><ul><ul><li>Weight loss ≥ 5 % in 1 month ou ≥ 10% in 6 months </li></ul></ul><ul><ul><li>BMI ≤ 21 </li></ul></ul><ul><ul><li>Albuminemia < 35 g/L </li></ul></ul><ul><ul><li>MNA < 17 </li></ul></ul><ul><li>Severe malnutrition : one or more of the following criteria </li></ul><ul><ul><li>Weight loss ≥ 10 % in 1 month or ≥ 15% in 6 months </li></ul></ul><ul><ul><li>BMI < 18 </li></ul></ul><ul><ul><li>Albuminemia < 30 g/L </li></ul></ul>
    12. 12. Mini- MNA - risk factors - appetite - nutritional criteria NEW ! Kaiser, JNHA 2009
    13. 13. <ul><li>GNRI = (1,489 x albumin g/L) + 41,7 x actual weight </li></ul><ul><li> ideal weight </li></ul><ul><li>Ideal weight with Lorentz formulae </li></ul>Geriatric Nutritional Risk Index Bouillanne et al, Am J Clin Nut, 2005
    14. 14. Assessment of nutritional status Body storage Weight, BMI How much fat? How much muscle? Metabolic homeostasis Albuminemia? Glycemia? Ca? P? …

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