Nutritional Status and Nutritional Management Implementation for Residents with Disabilities in Welfare Facilities: A Nationwide Survey in Japan.

In Japan, fees for nutritional management (NM) was introduced in April 2009 to improve nutritional care for persons with disabilities residing in welfare facilities. The present study aimed to clarify (1) the nutritional status as well as eating-related functions and behaviors of such residents and (2) status of incorporating claim fees for NM and oral maintenance in facilities supporting persons with disabilities. This cross-sectional study approached 2,510 welfare facilities for persons with disabilities across Japan. Anonymous questionnaire surveys were conducted in August 2018. Among the 1,543 responses, 1,538 (61.3%) were valid for analysis. The median number of residents in a facility was 50. Among all residents (n=80,322), 16.9% were underweight (body mass index [BMI]<18.5) and 14.5% were obese (BMI≥25.0). Of the residents, 38.9% adjusted food form and 15.2% had eating behavior-related problems. In total, 723 (47.0%) and 54 (3.5%) facilities, claimed the fees for NM and oral maintenance, respectively. The main reasons for not implementing the claim fees for NM was the lack of time for nutritional care and management (NCM; 30.2%), absence of a registered dietitian (29.3%), and difficulty in assessing swallowing function (24.1%). Our results revealed that the implementation rates of claim fees for NM and oral maintenance were low despite most respondents having problems with the double burden of malnutrition and necessity of oral care, suggesting the importance of securing time for NCM, appointing registered dietitians, and evaluating swallowing function.

Total energy expenditure among children with motor, intellectual, visual, and hearing disabilities: a doubly labeled water method.

OBJECTIVE: Few studies have evaluated the total energy expenditure (TEE) of children with disabilities using the doubly labeled water (DLW) method; however, none have compared it by disability type. Furthermore, no large-scale studies have focused on the severity of motor disability (MD). We aimed to compare TEE in children with disabilities by disability type. METHODS: In a cross-sectional study design, TEE was measured using the DLW method, anthropometry, and weighted food records. The following comparisons were made: (1) TEEs among four disability types and (2) TEEs of three subgroups classified by MD based on the Gross Motor Function Classification System (GMFCS). RESULTS: In total, 256 children (138 boys; ages 6-15 years) were studied. The comparison between the four disability types for boys in all age categories revealed that TEE (kJ/d) was lowest in MD, followed by intellectual disability (ID), visual disability, and hearing disability (HD), in that order. TEE/fat-free mass (FFM) (kJ/FFMkg/d) was also lowest in MD and highest in HD. TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were also lowest in MD and highest in HD in girls. For both boys and girls, TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were higher in the MD subtype GMFCS I-II than in GMFCS III-IV and GMFCS V. CONCLUSIONS: TEE differed, depending on the disability type, and was the lowest in MD and highest in HD for both boys and girls. Analysis by GMFCS classification revealed that greater severity of motor dysfunction resulted in lower TEE.

Serum albumin levels and their correlates among individuals with motor disorders at five institutions in Japan.

BACKGROUND/OBJECTIVES: The level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders. SUBJECTS/METHODS: A cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey. RESULTS: The mean serum albumin levels were 4.0 ± 0.4 g/dL for men and 3.8 ± 0.5 g/dL for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ≤ 3.5 g/dL); these proportions were greater than those among healthy Japanese adults (≤ 1%). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low HbA1c, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels. CONCLUSIONS: These results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.

Predictors, including blood, urine, anthropometry, and nutritional indices, of all-cause mortality among institutionalized individuals with intellectual disability.

As the life expectancy of people with intellectual disability (ID) increases, it is becoming necessary to understand factors affecting survival. However, predictors that are typically assessed among healthy people have not been examined. Predictors of all-cause mortality, including blood, urine, anthropometry, and nutritional indices, were examined among institutionalized people with ID. This retrospective cohort study involved 316 participants (191 males, 125 females; mean age, 36.5 ± 10.5 years) at a public facility for people with ID in Ibaraki Prefecture, Japan. During the follow-up from the examination day in 1984-1992 through December 31, 2007 (mean follow-up, 18.6 years), 44 deaths occurred. Mean age at death was 47.1 ± 10.0 years (range, 22.3-65.3 years). Early deaths within three years (n = 4) were treated as censored cases. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality. Sex- and age-adjusted analysis (p<0.15) revealed positive associations with mortality for high serum cholesterol, high thymol turbidity test (TTT), and glucosuria and negative associations with mortality for high serum albumin, high uric acid, high potassium, high calcium, and high systolic blood pressure. Multivariate analysis revealed that male sex (HR, 4.11; 95% CI, 1.59-10.59), high serum cholesterol (1.01; 1.00-1.02), high serum TTT (1.21; 1.03-1.41), and epilepsy significantly increased the mortality risk. The results indicate that the predictors of life expectancy for people with ID included both factors that are shared with healthy people (male sex, high serum cholesterol) and factors specific to people with disabilities (high serum TTT and epilepsy).

The distributions and correlates of serum albumin levels in institutionalised individuals with intellectual and/or motor disabilities.

The serum albumin level is a widely accepted indicator of nutritional status in healthy adults and elderly individuals. However, there are few data regarding the distribution and correlates of serum albumin levels in individuals with intellectual and/or motor disabilities. We conducted a cross-sectional study at a public facility for individuals with intellectual and/or motor disabilities in Ibaraki prefecture, Japan. Health check-up data obtained in 2001 from 477 individuals with intellectual disability (286 males, average age 40.6 (SD 12.3) years; 191 females, average age 45.1 (SD 11.6) years) were retrospectively reviewed. With the exception of men with cerebral palsy, the serum albumin level was nearly normally distributed. The mean was 44 (SD 3.6) g/l for males and 44 (SD 3.6) g/l for females with intellectual disability, 43 (SD 3.2) g/l in males and 44 (SD 2.6) g/l for females with cerebral palsy, 41 (SD 2.7) g/l for males and 42 (SD 3.7) g/l for females with Down's syndrome, and 42 (SD 4.5) g/l for males and 41 (SD 3.2) g/l for females with severe motor and intellectual disabilities. Only six of 474 individuals (1.3 %) had a serum albumin

Survey on the implementation of blood and urine examinations at Japanese institutions and schools for individuals with intellectual disabilities and/or motor disabilities in 1998.

OBJECTIVES: Few national surveys have been conducted on the health and nutrition of disabled people in Japan, and as a result, the actual health and nutritional status of this population group has not been clarified. The aim of the present study is to clarify the following hypotheses: nutritional assessment is not carried out at institutions and schools for individuals with intellectual disabilities (ID) and/or motor disabilities (MD), and there are marked differences in implementation rates and assessment methods (i) between institutions and schools and (ii) among the disability categories. METHODS: Questionnaires were sent to 1,080 selected institutions and schools for individuals with ID and/or MD. For each disability category, the implementation rate of blood and urine tests (14 items) was calculated separately for the institutions and schools. RESULTS: A total of 826 responses were obtained (response rate: 76.5%); of these, 822 were valid. For all investigated items, implementation rate was significantly higher for the institutions (0-90.3%) when compared to the schools (0-10.2%). The implementation rate of 13 items at institutions for patients with severe intellectual and motor disabilities (4.8-90.3%) was higher than that for institutions for those with intellectual disabilities (0.4-57.0%) or institutions for those with motor disabilities (0-80.0%). The implementation rate of creatinine urinary excretion/24 h and creatinine height index was lower than that for other examinations. CONCLUSIONS: Large differences in implementation rates were apparent between the institutions and schools. The implementation rate of blood and urine laboratory examinations varied considerably among the disability categories.

An epidemiological study on anemia among institutionalized people with intellectual and/or motor disability with special reference to its frequency, severity and predictors.

BACKGROUND: To examine the type, frequency, severity, and predictors of anemia and its relationship with co-morbid conditions among institutionalized people with intellectual and/or motor disability. METHODS: We conducted a cross-sectional study at a public facility for people with intellectual and/or motor disability in Ibaraki prefecture, Japan. Health checkup data obtained in 2001 from 477 people with intellectual disability (male: 286, average age 40.6 +/- 12.3; female: 191, average age 45.1 +/- 11.6) were retrospectively reviewed. RESULTS: The prevalence of anemia among male participants was higher than in female participants for each disability category (intellectual disability, 41.1%, 4.2%; cerebral palsy, 37.5%, 4.8%; Down's syndrome, 15.0%, 0%; severe motor and intellectual disabilities, 61.9%, 16.7%). Most participants with anemia (93.8 - 100%) showed a normocytic normochromic anemia pattern. Multivariate analysis revealed that factors related to an increase in frequency included sex (male), low body mass index (BMI), use of anticonvulsants or major tranquilizers, and a high zinc sulfate turbidity test (ZTT) value. No clinically diagnosed co-morbid condition was found to be related to the presence of anemia. CONCLUSION: A high frequency of mild normocytic normochromic anemia in institutionalized people with intellectual and/or motor disability was observed, particularly among males. Medications and chronic inflammation may increase the risk of anemia.

Energy expenditure in males with mental retardation.

Previously, we reported that males with mental retardation (MR) (MR group) expended more energy than males without MR (control group) at a given work load. The precise physiological mechanisms for this difference remain unclear. Using the same set of subjects (23 age-, height-, and weight-matched male pairs, mean age: 36.3 y), we examined possible causes for the observed metabolic difference by monitoring physical movements and evaluating the metabolic capability of the skeletal muscles. In the supine position when no body movements were detected for any subjects, oxygen consumption (VO2) and heart rate (HR) were not markedly different between the MR and the control groups. By contrast, in the sitting and standing positions and during walking at 30 and 50 m/min, when significantly larger body movements were monitored in the MR group, VO2 and HR were significantly higher in this group than in the control group. Linear regression analyses, performed separately in the MR and control groups, revealed that the slope of the regression line of HR on relative exercise intensity (%VO2max) during walking, that of VO2 on walking speeds, and that of VO2 on the number of steps in the MR group were almost identical with those in the control group. These results suggest that the capability of skeletal muscles was not so different between the two groups. Thus, the high energy expenditure in the MR group was suggested to be a result of excessive body movements rather than an intrinsic incapability of skeletal muscles.

The utility of anthropometric assessment at institutions and schools for individuals with intellectual disabilities and/or motor disabilities: a nation-wide survey in Japan.

OBJECTIVES: To obtain information regarding the actual methods used for nutritional assessment at institutions and schools in order to establish a nutritional assessment method for individuals with disabilities. METHODS: Questionnaires were sent to 1,080 selected institutions and schools for individuals with intellectual disabilities (ID) and/or motor disabilities (MD). The response rate was 76.5%. RESULTS: The implementation rates for height and weight measurements were generally very high at both institutions and schools for individuals with ID and/or MD (85.5-100%), but those for other items were very low and varied among different disability types. The implementation rate for BMI was 17.9-71.9%, demonstrating that BMI was not widely used among institutions and schools for individuals with ID and/or MD. As for the methods for calculating percent body fat, a high percentage of institutions and schools for individuals with ID and/or MD indicated the use of bioelectrical impedance analysis for most disability types (60 - 77.9%). CONCLUSIONS: The percentages of institutions for individuals with ID and/or MD and of schools for individuals with ID and/or MD that implement nutritional assessment are very low, with variations among different disability types.

Smoking patterns of university woman students in Miyagi, Japan: the Miyagaku Study.

BACKGROUND: The increase in the smoking rate among young women is a worldwide problem. However, few reports have focused on female students, in particular, with detailed accounts of their smoking behavior. The aim of this study was to clarify the smoking patterns of Japanese women of approximately 20 years of age. METHODS: Smoking behavior, age at initiation, favorite brand and related attitudes were examined using a cross-sectional anonymous questionnaire administered to students at a women's university in Miyagi, Japan in 2000. RESULTS: Of 2,984 subjects (response rate: 96%), 16% said that they smoke (95% confidence interval 15-18%): 7% of freshmen, 16% of sophomores, 22% of juniors and 20% of seniors. While music majors were most likely to smoke (21%), domestic science majors had the lowest rate of smoking (10%). Among the smokers, 27% started the habit at age 20 years, the legal age in Japan, and 25% started at age 18. The favorite brand was Marlboro (39%), followed by Mild Seven (16%), a domestic brand. One-third of the smokers had no plans to quit. CONCLUSIONS: Reaching the legal age and entering university may prompt young women to start smoking habitually. In contrast to its overall market share in Japan, a US brand is now favored by current young female smokers.