Five year changes in mental health and associations with vitamin B12/folate status of elderly Europeans.

OBJECTIVE: To describe 5-year changes of mental health in SENECA participants, and to examine whether mental health is associated with the status of vitamin B12 and folate. DESIGN: A longitudinal, multicentre study including a Baseline study, a Follow-up study, and a Finale study. SUBJECTS: Inhabitants of 11 European towns, born between 1913 and 1918, were randomly selected at baseline to participate in the SENECA study. Of the 1099 enrolled subjects in the Follow-up study, 586 participated in the Finale study. INTERVENTION: Mental health status was assessed by the Mini-Mental State Examination (MMSE, cognitive impairment defined as MMSE<23) and the 15-item Geriatric Depression Scale (GDS, depression defined as GDS>5). RESULTS: In the Finale study, mean overall MMSE score was 26.1 for men and 25.6 for women, while mean overall GDS score was 3.1 for men and 4.1 for women. Among subjects that participated in both the Follow-up and the Finale study, MMSE scores decreased with 0.9 points (P<0.0001) and 1.0 points (P<0.0001) among men and women respectively. The GDS scores decreased with 0.7 points (P<0.0001) for men and 0.8 points (P<0.0001) for women. Among subjects that participated in the Finale study, no significant correlations have been observed between mental health and vitamin B12/folate status. CONCLUSION: In the Finale study, mental health of the majority of the SENECA participants remained intact. In contrast to the Follow-up study, no associations between mental health and vitamin B12/folate status were emerged.

Assessment of adolescent food habits in Switzerland.

Several physical, psychological and behavioural changes may affect food habits during adolescence and have long-term consequences on adult health status. Also, as food habits are related to lifestyle and physical activity, all should be assessed together. This paper describes a self-administered food frequency questionnaire (FFQ) designed to assess semi-quantitatively food habits of adolescents, and evaluates its use in a study of lifestyle and physical activity. A FFQ was developed, tested in 20 adolescents and compared with a modified version of the diet history method (a combination of a 3-day dietary record and an interview with a dietitian). This validated semi-quantitative questionnaire was later included in a larger questionnaire on lifestyle and physical activity in a study of 3540 adolescents aged 9-19 years. In the validation study with 20 adolescents, the FFQ showed a good agreement with the modified version of the diet history. During the survey several consumption frequencies were found to be low. In the group of adolescents aged 14-19 years old, dairy products were consumed daily by less than 50% of the sample. About 53% girls but only 33% boys consumed one fruit daily. For one vegetable portion, these proportions were 17 and 8%, respectively. The self-administered food frequency questionnaire correctly describes food consumption in adolescents. Moreover, it was well accepted by the target group, easily understood and completed with very few problems. The results show that a significant proportion of adolescents didn>>t consume milk, fruit and vegetable on a daily basis.

[Swiss Survey in Europe on Nutrition and the Elderly: nutritional status of a Yverdon population aged 74 to 79 years old over a period of four years]. / SENECA Suisse: état nutritionnel d'une population yverdonnoise âgée de 74 à 79 ans, et son évolution sur une période de quatre ans.

In Switzerland the longitudinal SENECA study (Survey in Europe on Nutrition and the Elderly, a Concerted Action of the 3rd European Framework Programme) was implemented in the city of Yverdon-les-Bains. The study investigated the nutritional and health status of 70 to 75-year old elderly living at home, in relation with their food habits, life style, social network and physical activity with a follow-up study 4 years later. Results of the follow-up study, with the subjects aged 74 to 79 years, and changes observed over the 4 years are presented here. The participants reported a rather good self-assessed health and were quite independent in their daily activities. Food and nutrient intakes decreased over the 4-year follow-up, as did physical activity, independence in daily activities and height. However, biological markers (haemoglobin, haematocrit, albumin, lipids and vitamins) of nutritional status showed little change and remained mostly in the normal range. Low energy intake was measured in 21% of the men (< 1500 kcal/d) and in 24% of the women (< 1200 kcal). This is a source of concern since such low energy intakes make it difficult to cover micronutrient requirements. It is therefore important to find ways to maintain or increase the quality of the diet and adequate nutrient intakes.

Effect of dietary phytic acid on zinc absorption in the healthy elderly, as assessed by serum concentration curve tests.

Zn absorption was investigated in healthy elderly subjects aged 71-78 years and in young subjects aged 23-43 years using serum concentration curve (SCC) tests. Both groups had similar Zn and protein status. The increase in serum Zn was monitored for 180 min after ingestion of 200 ml of soya milk enriched with 50 mg of Zn. Three levels of phytic acid were used: 0 g/200 ml (totally dephytinized soya milk), 0.13 g/200 ml (half dephytinized), and 0.26 g/200 ml (natural phytic acid content). In a first study the effect of 0 v. 0.26 g/200 ml phytic acid was compared in 10 elderly and 10 young subjects, each subject receiving both treatments. In a second study soya milks with 0 and 0.13 g/200 ml were tested in nine elderly and ten young subjects, again receiving both treatments. Mean areas under the curve of the SCC tests conducted with the 0 g/200 ml soya milk were found to be the same in both studies. Phytic acid strongly depressed Zn absorption in both studies (P < or = 0.05), but to a greater extent at the 0.26 g/200 ml level. No difference was found between the groups of young and elderly subjects. Therefore, no significant effect of aging on Zn absorption, as evaluated by the SCC test, or on the inhibitory effect of phytic acid was detected.

Longitudinal changes in iron and protein status of elderly Europeans. SENECA Investigators.

OBJECTIVE: Describe the iron and protein status of European elderly people studied in 1993, together with changes observed in the previous four years. DESIGN: Two optional designs: (1) A transversal study from a randomly selected group of female and male elderly subjects born between 1913 and 1914. (2) A longitudinal study including base-line measurements in 1988/1989 in subjects born in 1913-1918, which were repeated and extended in 1993. SETTING: Nineteen towns in 12 European countries participated in the baseline study in 1988/ 1989. Eleven centres in nine countries completed the follow-up study in 1993, and two new towns joined in 1993. The study included blood sampling for analysis of markers of nutritional status. RESULTS: The mean haemoglobin (Hb) values during the follow-up study for the different town populations ranged from 142 to 159 g/l for men and from 129 to 146 g/l for women. Prevalences of anaemia, based on WHO criteria (Hb < 130 g/l for men, and Hb < 120 g/l for women), amounted to 6.0% and 5.0% for men and women, respectively, and were very close to the baseline prevalences of 5.6% and 5.5%. A small decrease in Hb was observed after 4y in men. The mean haematocrit (Hct) values for the different towns ranged from 42% to 48% in men and from 39% to 44% in women. For both sexes, a decrease in Hct was observed. White blood cell (WBC) counts and differentials were measured in the follow-up study only. Mean WBC counts ranged from 5.8 x 10(3)/microliter to 7.1 x 10(3)/microliter in men and from 5.6 x 10(3)/microliter to 6.7 x 10(3)/microliter in women. Mean lymphocyte counts ranged from 1.6 x 10(3)/microliter to 2.4 x 10(3)/microliter in men and from 1.7 x 10(3)/microliter to 2.3 x 10(3)/microliter in women and mean neutrophile counts ranged from 3.4 x 10(3)/microliter to 4.4 x 10(3)/microliter and from 3.1 x 10(3)/microliter to 4.0 x 10(3)/microliter, respectively. The mean serum albumin values for the different towns varied from 39.9 g/l to 43.2 g/l for men, and from 39.3 g/l to 42.4 g/l for women, quite similar to the baseline study. In 25 subjects (2.2%) only serum albumin level was below 35 g/l and five subjects (0.4%) had a serum albumin level below 30 g/l. No albumin changes were detected for either sex over the four year period. The group of survivors in the follow-up study had higher mean albumin concentrations at baseline than the group of subjects who had died between the baseline and the follow-up study. CONCLUSION: In this population of elderly subjects in their seventies, Hb, Hct and albumin showed little change over the 4 year follow-up period. The prevalence of anaemia and low serum albumin values was relatively low, which is indicative of a relatively good health.

Summary and conclusions of the report on the second data collection period and longitudinal analyses of the SENECA Study.

In 1988 SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) was initiated to study cross cultural differences in nutritional issues and life style factors affecting health and performance of elderly Europeans. Nine of the original 19 participating towns in 12 European countries decided to conduct a longitudinal study. This supplement presents the findings of the second data collection period and the first longitudinal analyses of these nine towns. In addition, cross-sectional results are discussed for two towns from which few baseline data were collected, and for two towns which were only involved in the 1993 survey: one from the United Kingdom and one from the United States. Ethical permission for the studies was obtained from local ethical committees.

Nutritional status of institutionalised elderly in Ecuador.

The nutritional status of 111 elderly men and women aged 60 to 99 years in two institutions in the Ecuadorian Andes was evaluated using dietary, anthropometric and biochemical measurements. Mean daily energy intakes of men and women were 1720 and 1650 kcal, respectively (7.2 and 6.9 MJ), corresponding to 1.5 times the calculated basal metabolic rate (BMR). 6% of subjects had intakes less than 1.2 x BMR and 40% less than 1.5 x BMR. Body mass index (BMI) was below 20 kg/m2 in 21% of subjects; 45% were between 20 and 24. Only one subject had a BMI over 29. Intakes of protein, calcium, iron, riboflavin and vitamin C were satisfactory, in contrast to those of zinc, vitamin A, niacin and thiamin. Using sex- and altitude-specific cutoffs for hemoglobin, anemia was observed in 11% of subjects. Nutritional status, evaluated using biochemical indicators, was satisfactory with respect to riboflavin, vitamin A, vitamin E and copper. 14% of subjects had low serum zinc levels and 17% had serum albumin values below 35 g/L. Low physical activity was associated with low energy intake and low serum albumin levels.

Effect of malnutrition on serum and milk antibodies in Zairian women.

Serum and human milk antimicrobial antibody titers were measured longitudinally in 17 malnourished and 14 control Zairian women during 6 to 18 months of lactation to test whether malnutrition is specifically associated with an impaired secretory antibody response. No decreases in total serum and human milk immunoglobulin concentrations, neutralizing antibody titers against rotavirus, or specific enzyme-linked immunosorbent assay antibody titers against rotavirus, respiratory syncytial virus, Escherichia coli, Streptococcus pneumoniae, and Haemophilus influenzae were detected when malnourished women were compared with control women. Malnutrition had no effect on circulating and secretory antibody concentrations in Zairian women. Daily human milk outputs, however, were about 30% lower in malnourished than in control women, resulting in a correspondingly lower ingestion of immunoglobulins by the children of malnourished women.

Copper, selenium, and zinc status and balances after major trauma.

To investigate the trace elements (TE) losses and status after trauma, 11 severely injured patients (Injury Severity Score: 29 +/- 6), admitted to the ICU were studied from the day of injury (D0) until D25. Balance studies were started within 24 hours after injury, until D7. Serum and urine samples were collected from D1 to D7, then on D10, 15, 20, and 25. Intravenous TE supplementation was initiated upon admission. SERUM: Selenium (Se) and zinc (Zn) levels were decreased until D7 and were normal thereafter. LOSSES: TE urinary excretions were higher than reference ranges until D20 in all patients. Fluid losses through drains contained large amounts of TE. BALANCES: Balances were slightly positive for copper (Cu) and Zn, and negative for Se from D5 to D7 despite supplements. Cu status exhibited minor changes compared to those observed with the Zn and Se status: Serum levels were decreased and losses increased. Considering the importance of Se and Zn in free radical scavenging, anabolism, and immunity, current recommendations for TE supplements in severely traumatized patients ought to be revised.

Risk factors associated with the recall of respiratory diseases in the Ecuadorian children.

Risk factors associated with the recall of a recent episode of acute respiratory infection (ARI) were evaluated in 1,553 Ecuadorian preschool children enrolled into a cross-sectional health and nutrition survey. In a univariate analysis, ARI recall was significantly higher in children living in low altitude regions (Relative Risk, RR = 2.4), in younger children (RR = 1.6), in children from larger families (RR = 1.3), in children with diarrhoea recall (RR = 1.9), in children served with poor quality drinking water (RR = 1.3) and in anaemic children (RR = 1.2) than that in the appropriate control groups. After taking into account the confounding effect of altitude, no association was found between ARI recall and low height-for-age values. Stepwise logistic regression analysis identified living in low altitude regions, diarrhoea recall, and younger age as independent factors associated with a higher recall of ARI. In contrast to the recall of acute diarrhoea, no association between ARI recall and nutritional status was found. The impact of nutritional interventions in children from developing countries may be greater on enteric than on respiratory diseases.

A packaged rice-based oral rehydration solution for acute diarrhea.

In a 12-month community study in Ecuadorian preschool children, we compared a packaged rice-based oral rehydration solution (R-ORS) that contained 160 g of rice flour and 12 g of sucrose per liter as well as electrolytes and alpha-amylase, and required cooking before consumption, to the standard glucose-electrolyte oral rehydration solution (G-ORS) for the treatment of acute noncholera diarrhea. The reconstituted R-ORS had energy and protein contents of 620 kcal/L and 12g/L, respectively, and an osmolarity of 230 mosm/L. In all, 156 cases were treated with the R-ORS and 144 with the standard G-ORS. Cases treated with R-ORS had a significantly shorter duration of diarrhea (p < 0.0001; median; 34 h versus 48 h), a lower number of stools (p < 0.001; median; four versus seven), and a greater weight gain after 4 days of treatment (p < 0.05; mean; 1.6% versus-0.2%) than those treated with G-ORS. ORS and total liquid intakes tended to be higher with the R-ORS. The two ORS were equivalent for the correction of mild dehydration and the maintenance of normal hydration status.

Effect of age on concentrations of serum antibodies to viral, bacterial, and food antigens in elderly Swiss people.

Serum antibody concentrations to two viral, five bacterial, and two food antigens were investigated in 307 elderly Swiss subjects, and the hypothesis of whether serum antibody titers decreased with age was tested. The cross-sectional part of the study consisted of 216 unselected consecutive patients hospitalized in one geriatric hospital. The patients were divided into two age groups (65 to 84 and 85 to 102 years old), and their antibody titers were compared. No age-related decreases in antibody titers were observed. The members of the two age groups were well matched for medical diagnosis and nutritional and inflammatory status. The prospective part of the study consisted of 91 healthy elderly subjects living in the community; they were 71 to 76 years old when they were enrolled in the study. Their serum antibody status was measured at the beginning of the study and 4 years later. We observed a significant decrease in diphtheria antitoxin levels and a significant increase in antibody titer to the capsular polysaccharide of Streptococcus pneumoniae. No change in antibody titer to rotavirus, respiratory syncytial virus, lipopolysaccharide of Escherichia coli, C polysaccharide of S. pneumoniae, or the polyribosyl-ribitol phosphate of Haemophilus influenzae was observed. Thus, no signs of B-cell immunosenescence were seen in these two groups of elderly Swiss people.

Effect of malnutrition in Ecuadorian children on titers of serum antibodies to various microbial antigens.

The titers of serum antibodies to natural infection with enteric and respiratory pathogens, to a food antigen and to tetanus and diphtheria toxoid were evaluated by enzyme-linked immunosorbent assay in 1,554 Ecuadorian children younger than 5 years of age. The nutritional status of the children was assessed by anthropometry and measurement of biochemical status indicators. The children were enrolled in a representative national nutrition and health survey. Antibody titers were analyzed as a function of the nutritional status of the children. For 12 of 14 antibody concentrations tested, underweight children showed lower antibody titers than did control children. The difference was statistically significant for antibody to both T-cell-dependent antigens (tetanus toxoid, rotavirus, respiratory syncytial virus) and T-cell-independent antigens (lipopolysaccharide, polyribosyl-ribitol phosphate, capsular polysaccharide). When children with a recent episode of diarrhea were excluded, many of the differences remained significant. When these children were further classified by age, only difference in titers of antibodies to respiratory syncytial virus and tetanus toxoid remained significant. No statistically significant difference was detected between underweight and control children with respect to protective antibody levels to four bacterial antigens. Anemic children showed significantly lower antibody levels to both T-cell-dependent and T-cell-independent antigens than did control children, and a higher proportion of anemic children had diphtheria antitoxin below a conservatively defined protective antibody level. No major differences in antibody titers were seen between children with different retinol and zinc concentrations in serum.

Altitude correction for hemoglobin.

OBJECTIVE: To propose a correction for the hemoglobin (Hb) increase induced by altitude-associated hypoxia. DESIGN: Part of a national study of nutrition and health of preschool children (0-59 months), based on a stratified, probabilistic, cluster sample. SETTING: Coastal and Andean regions of Ecuador, comprising about 97% of the population, living at altitudes ranging from sea level to 3400 m. SUBJECTS: Subsample of 469 girls and boys, 6-59 months old, with normal iron (Fe) status parameters, i.e serum ferritin > or = 10 micrograms/l, transferrin saturation > or = 12%, zinc protoporphyrin < or = 2.8 micrograms/g Hb. RESULTS: Exponential regression curves are adapted through the Hb values of the children, grouped by altitude ranges, and through the data reported by Hurtado in 1945 for male adults. From these exponential curves, correction factors for Hb are derived for altitudes ranging from sea level to 3400 m. CONCLUSION: The striking parallelism between the hypoxia-induced hemoglobin increase with altitude in young children (girls and boys) and that in male adults strongly suggests that the proposed correction factors for Hb are applicable for all ages and possibly both genders, at least in the Andes.

Influence of large intakes of trace elements on recovery after major burns.

Because Cu, Se, and Zn are involved in immune and antioxidative defense mechanisms and tissue repair, deficiencies might aggravate complications classically observed with burns. After measuring massive cutaneous trace element losses in 10 burn patients, our aim in this study was to determine whether large intravenous intakes of Cu, Zn, and Se can modify serum trace element levels and recovery after major burns. Ten patients, aged 34 +/- 6 yr (mean +/- SD), admitted to the burns center of a Swiss university hospital with thermal burns on 41 +/- 9% of their body surface were studied prospectively, with trace element balance studies from day 1 (D1) to D7 postinjury. Urine and blood samples were also collected on D10, D15, D20, and D25. The patients were divided into two groups of five and received either standard (group 1, control) or greatly increased (group 2, treatment: 4.5 mg Cu, 190 micrograms Se, and 40 mg Zn/day) trace element intakes. Energy and protein intake and wound treatment were similar in both groups. The treatment group was characterized by improved Cu, Se, and Zn status (increase in serum levels and various protein indicators), a much larger leukocyte increase between D4 and D14 (mainly neutrophils), and shorter hospital stay (45 days) compared with the untreated group (57 days). Grafting requirements were more extensive in group 1. Although severity of injury and wound treatment were similar in the groups, the duration of hospitalization was lower in the treated group. Further studies are required to determine whether this is related to trace element supplementation.

Zinc absorption in healthy elderly humans and the effect of diet.

Absorption of a zinc stable isotope was measured on two consecutive occasions in nine young and eight elderly healthy men aged 24-40 and 70-83 y, respectively. A zinc stable-isotope label (0.8 mg 70Zn) was added to a test meal of either high or low zinc bioavailability, depending mainly on phytic acid content. Zinc absorption from the high-bioavailability test meal was not significantly different (P > 0.05) in the young (38.9 +/- 9.8%, mean +/- SD) and elderly (35.0 +/- 10.9%) subjects. Zinc absorption from the low-bioavailability test meal was 40% and 43% lower, at 23.4 +/- 10.2% and 19.8 +/- 6.1% in these young and elderly men, respectively. Again, no significant effect of age was found. These results show that aging does not lead to nutritionally relevant changes in zinc absorption and in the effect of dietary inhibitors on zinc absorption. Thus, zinc absorption ability seems to be preserved in healthy elderly people, at least until the age of 80 y.

Nutritional and environmental risk factors for diarrhoeal diseases in Ecuadorian children.

Risk factors associated with diarrhoea, based on the recall of a recent episode were evaluated from a cross-sectional national nutrition and health study in 1,620 Ecuadorian children less than 5 years old. Prevalence of diarrhoea varied with the age of the children; 6- to 23-months-old children showed the highest prevalence. In this age range the prevalence of diarrhoea was significantly associated with hygienic factors (quality of drinking water, sanitation and refuse system), but not with demographic factors (sex, altitude, population density, family size). The nutritional status of the children was determined by anthropometry and blood chemistry. After stratification for sanitation levels, a low weight-for-age Z-score and low serum retinol and zinc concentrations showed a statistically significant (p < or = 0.06) association with diarrhoea prevalence only in children living under better hygienic conditions. Multivariate analysis revealed significant associations between both sanitation levels and nutritional level as defined by anthropometry, but not by blood chemistry, and diarrhoea prevalence.