Protein intake protects against weight loss in healthy community-dwelling older adults.

Weight loss is prevalent in the elderly population, with deleterious health consequences, notably loss of lean body mass and subsequent functional decline. Protein intake below the current RDA [0.8 g/(kg · d)] is also common in older adults; however, the link between the 2 has received little attention. Our objective was to assess the relation between protein intake and incident 1-y weight loss ≥5% in community-dwelling older adults. We conducted a nested, prospective, case-control study in 1793 community-living elderly participants of the Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge). We studied 211 incident cases of 1-y weight loss (≥5%) and 211 weight-stable controls (±2%) matched by sex and age category (70 ± 2, 75 ± 2, and 80 ± 2 y). Diet was measured by 3 nonconsecutive 24-h recalls. ORs (95% CIs) for the association between protein intake and weight loss were computed by using conditional logistic regression. After adjustment for body mass index, energy intake, appetite, smoking status, physical activity level, physical function, chronic diseases and medications, depressive symptoms, and serum albumin and ultrasensitive C-reactive protein, the ORs of weight loss in participants with low protein intakes [<0.8 g/(kg · d)] were 2.56 (95% CI: 1.01, 6.50) compared with participants with very high protein intakes [≥1.2 g/(kg · d)]. Corresponding numbers were 2.15 (95% CI: 1.02, 4.56) in participants with moderate protein intakes [0.8-<1.0 g/(kg · d)] and 1.33 (95% CI: 0.77, 2.28) in participants with high protein intakes [1.0-1.2 g/(kg · d)]. Our results suggest that protein intakes >1.0 g/(kg · d) are protective against weight loss in healthy older adults. These findings add epidemiologic evidence in support of higher optimal protein intakes than the current guidelines for healthy older adults.

Low physical function predicts either 2-year weight loss or weight gain in healthy community-dwelling older adults. the NuAge Longitudinal Study.

OBJECTIVES: Weight change in older adults affects physical function (PF). However, data suggest that, conversely, PF may be a determinant of weight change. Our objective was to assess the role of baseline PF as a predictor of 2-year weight loss (WL) and weight gain (WG) ≥ 5% among healthy well-functioning community-dwelling older adults. METHODS: The NuAge cohort (67-84 years) was classified into three groups according to the percent weight change over a 2-year follow-up: weight stable (weight change ≤ 2%; n = 629), WL ≥ 5% (n = 189), and WG ≥ 5% (n = 111). A summary measure of baseline PF was computed (sum of biceps, quadriceps, and grip strength, timed up and go, chair stand, normal and maximal gait speed, and balance performance scores [individual test score range = 0-4]; PF score range = 0-32). Multivariable logistic regression models separately assessed the relationships between baseline PF and 2-year WL and WG ≥ 5%. RESULTS: Baseline PF was worse in both the WL (p < .001) and the WG (p = .001) groups compared with the weight stable group. In models adjusting for sex, age, body mass index, energy intake, depressive symptoms, and other significantly associated covariates, each 1-unit increase in standard deviation of PF was associated with decreased risk of either 2-year WL (odds ratio = 0.79, 95% CI = 0.63-0.99, p = .043) or WG (odds ratio = 0.74, 95% CI = 0.55-0.99, p = .041). CONCLUSIONS: Low baseline PF was an independent common predictor of 2-year WL and WG ≥ 5% in the healthy well-functioning community-dwelling elderly population. Whether PF is an early cause or marker of weight change in this population remains to be determined.

More than just not being alone: the number, nature, and complementarity of meal-time social interactions influence food intake in hospitalized elderly patients.

PURPOSE: This study evaluated the social facilitation of elderly patients' food intake beyond the presence of mealtime companions by assessing various relationships. The study examined the relationships between patients' intake and (a) the number of interpersonal exchanges with mealtime fellows, (b) the nature of behaviors expressed by the patients themselves and their fellows, and (c) the degree of complementarity between these. DESIGN AND METHODS: Interpersonal exchanges and intake were observed on repeated mealtime occasions (n = 1,477) nested within 32 geriatric patients (21 women, 11 men; age, M = 78.8 years). Participants' intake was estimated from plate leftovers. Interpersonal behaviors were examined for both participants and patients with whom they interacted in terms of agency and communion dimensions, following the interpersonal circumplex model of human interaction. With the use of multilevel regression analyses, the number, nature, and complementarity of behaviors that participants engaged in and were exposed to on a given meal were computed to test their impact on intake. RESULTS: The total amount of interaction between patients was positively related to intake. The effect was significant for both participants' own behaviors and those to which they were exposed, and it varied with the nature of the interaction; effects were significant in terms of frequency and complementarity for communal behaviors, and complementarity only for agentic behaviors. Effects could only partly be explained by meal duration effects. IMPLICATIONS: The results provide support for the effect of the number, nature, and complementarity of mealtime interpersonal behaviors on the food intake of elderly patients, and they may inspire new approaches to ensure adequate intake in this malnutrition-prone population.

Hunger and aversion: drives that influence food intake of hospitalized geriatric patients.

BACKGROUND: Diminished appetite occurs frequently with aging and is considered an important clinical symptom of malnutrition, a condition associated with negative clinical outcome, decreased quality of life, and increased health care costs in hospitalized geriatric patients. Yet, in this population, research is scant on hunger and aversion, the two underlying drives that shape appetite, or on their influence on food intake. This study aimed (a) to examine their interrelationship and respective contribution to food intake; (b) to determine how each relate to other health-related contemporaneous subjective states preceding the meal (good physical health, positive mood, pain); and (c) to explore clinical variables as moderators of the drives-intake relationships to identify population segments for which these relationships are the strongest. METHODS: 32 patients (21 women, 11 men; age range, 65-92 years) were observed during repeated meals in a geriatric rehabilitation unit (for a total of 1477 meals). Perceived hunger, aversion, and contemporaneous subjective states were reported before each meal. Protein and energy consumption was calculated from plate leftovers. Clinical measures were obtained from participants' medical charts. RESULTS: The hunger-aversion relationship had a low inverse correlation (p =.001), with each uniquely contributing to protein intake (positive and negative effects, respectively; all p <.05). Hunger was positively associated with the perception of physical health and with mood (all p =.001). Aversion was associated with pain (p =.001). Furthermore, aversion-intake relationships were influenced by moderators, whereas hunger-intake relationships remained constant. CONCLUSIONS: From a clinical perspective, these results suggest that nutritional interventions aimed at bolstering hunger and curbing aversion may be necessary to ensure optimal food intake. Subgroups of patients who would particularly benefit from these interventions are suggested.

A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly.

Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service "blueprints" were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients' meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and opportunities for improvement put forth, while considering services' resources and priorities. By providing a precise, objective, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients.

Direct and indirect effects of everyday emotions on food intake of elderly patients in institutions.

BACKGROUND: Decreased food intake is an important risk factor for malnutrition, which is highly prevalent among geriatric patients. The emotional nature of the hospitalization experience and the complex organizational setting involved in meal production and delivery services in institutions increase the risk for decreased food intake. Everyday emotions are known to have a particularly strong influence on decision-making and behavior in the elderly, and have also been shown, in younger populations, to influence food intake and its psychological antecedents, such as quality perception and satisfaction judgments. The objective of this paper is to study the direct impact of elderly patients' everyday emotions on food intake and their indirect effects mediated by quality perceptions and satisfaction judgments. METHODS: Thirty patients (20 women, 10 men, 65-92 age range) in a geriatric rehabilitation unit were observed on repeated meal episodes (average of 46 care episodes per patient) where they provided self-reports for emotions (positive emotions, anger, anxiety, and mild depressed feelings), perceived meal quality, and satisfaction. Food intake was measured in terms of energy and protein content. RESULTS: The impact on food intake was favorable, and both direct and indirect for positive emotions, direct and negative for anxiety, direct and positive for mild depressed feelings, and indirect and negative for anger. Indirect effects were mediated by quality perception judgments but not by satisfaction, which was not significantly related to food intake. CONCLUSION: Results suggest that, given their impact on food intake, measuring and monitoring patients' everyday emotions may be an important innovative strategy to improve food intake of elderly patients in institutions.