Psychometric properties of the Persian version of the nutritional form for the elderly (NUFFE) in nursing home residents.

Background: The Nutritional Form for the Elderly (NUFFE) is a newly developed tool. This study aimed to carry out a psychometric evaluation of the Persian version of NUFFE (NUFFE-P) among nursing home residents. Methods: Nursing home participant's aged ≥ 60 years (n=97) were enrolled. The inclusion criteria were residency for at least 6 months in the nursing home, and ability to communicate. Exclusion criteria included cognitive impairment, having depressed mood, severe hearing loss, problems in upper and lower extremities also, history of hospital admission during 6 months before enrollment. Anthropometric measures, laboratory tests, three-day food intake, NUFFE-P version, Mini Nutritional Assessment (MNA), Barthel Index (BI) and Geriatric Depression Scale (GDS-15) were assessed. The relationship between the NUFFE-P and MNA scores was considered as concurrent validity. Results: The Cronbach's alpha coefficient of NUFFE-P tool was 0.76. The intraclass correlation coefficient for the total score between two raters obtained 0.98 (CI 0.97-0.99). The correlation coefficient between the NUFFE-P and the MNA scores was -0.75 (p<0.01). Four factors were extracted for the NUFFE-P in an exploratory factor analyses. Sensitivity 69.8% and 100% and specificity 75.7% and 85.6% were achieved to detect elderly at medium risk (cutoff=6), and at high risk of under-nutrition (cutoff=11) respectively. Conclusion: The NUFFE-P has sufficient psychometric properties in nutritional status screening among the Iranian elderly nursing homes residents.

The effect of low-dose omega 3 fatty acids on the treatment of mild to moderate depression in the elderly: a double-blind, randomized, placebo-controlled study.

Due to the rise in the social and economic costs of depression, new antidepressant medication with fewer side effects should be found. Several studies have shown that an association exists between ω-3 polyunsaturated fatty acids (ω-3 PUFAs) and depression. However, this association has not been clear enough in the elderly with mild to moderate depression. Sixty-six inhabitants of Kahrizak Charity Foundation participated in this double-blind, randomized, placebo-controlled study. Each participant was ≥ 65 years of age, had a Mini Mental State Exam of ≥ 22, and had scores ranging from 5 to 11 on the Geriatric Depression Scale-15 (GDS-15). During the 6 months, the drug group was treated daily with one gram of fish oil capsule containing 300 mg of both eicosapentaenoic acid and docosahexaenoic acid. No significant differences were noted between the groups in regard to level of education, use of antidepressant drugs, alcohol, tobacco use, history of chronic diseases, age, body mass index (BMI), high-sensitive C-reactive protein (hs-CRP), total cholesterol, and GDS-15 scores at baseline. After adjusting for cholesterol, BMI, and history of thyroid dysfunctions, a statistically significant difference was seen in GDS-15 scores between both groups. Furthermore, treatment with ω-3 PUFAs was clinically more effective in treating depression in comparison with the placebo. In this study, low-dose ω-3 PUFAs had some efficacy in the treatment of mild to moderate depression in elderly participants.

Evaluation of the Mini Nutritional Assessment in the elderly, Tehran, Iran.

OBJECTIVE: To determine whether the Mini Nutritional Assessment (MNA) can screen and diagnose for malnutrition in the Iranian elderly. DESIGN: The MNA was administered to all volunteers. Each patient underwent anthropometric and serum albumin measurements. Reliability, validity, sensitivity, specificity, positive- and negative-predictive values were estimated. To identify optimal threshold values for predicting malnutrition, receiver-operating characteristic curve analysis was performed for MNA scores. SETTING: Kahrizak Charity Foundation (Tehran, Iran). SUBJECTS: Two hundred and twenty-one consecutive elderly patients entered into the cross-sectional study. Amputees and patients with liver or renal disorders, oedema or any end-stage diseases were excluded. RESULTS: According to MNA score, 3.2 % were malnourished, 43.4 % were at risk of malnutrition and 53.4 % were well nourished. The proportions in these categories according to ideal body weight and serum albumin were 2.3 %, 17.1 % and 80.6 %, respectively. Cronbach's alpha coefficient (reliability) was 0.61. The correlations between total MNA score, anthropometric values and serum albumin (criterion-related validity) were all significant. There were significant differences in total MNA score between two BMI groups but not between two categories according to serum albumin and skin ulcers (construct validity). The sensitivity and specificity of the MNA according to its established cut-off points were 82 % and 63 %, respectively. Positive-predictive value was 35 % and negative-predictive value was 93 %. By using the best cut-off point (MNA score of 22 according to Youden index), the sensitivity, specificity, positive-predictive value and negative-predictive value were 88 %, 62 %, 57 % and 89 %, respectively. CONCLUSIONS: The MNA with its established cut-off points may not be a good fit for Asian populations, including Iranian elderly.

The effects of low dose n-3 fatty acids on serum lipid profiles and insulin resistance of the elderly: a randomized controlled clinical trial.

INTRODUCTION: N-3 fatty acids have several beneficial effects on dyslipidemia and diabetes, conditions which are prevalent in the elderly. This study assessed the effects of low-dose n-3 fatty acids on serum lipid profile, lipoprotein(a), apolipoprotein B, fasting glucose, insulin, and insulin resistance in a group of elderly Iranians. MATERIALS AND METHODS: A 6-month randomized, double-blind placebo-controlled clinical trial was carried out in 124 elderly residents of Kahrizak Charity Foundation aged >or= 65. The intervention group was supplemented with 1 g/day fish oil capsule (with 180 mg eicosapentaenoic acid, EPA; and 120 mg docosahexaenoic acid, DHA; a total of 300 mg n-3 fatty acids as effective constituents). Fasting blood samples were collected at baseline and after 6 months of the trial. RESULTS: There were no significant effects of fish oil on the studied variables in the intervention group. In the placebo group, serum triglyceride significantly increased and high-density lipoprotein cholesterol significantly decreased (p = 0.01 and p = 0.009, respectively). By repeated measurement analysis after adjustments, the overall decrease in serum triglycerides compared with placebo was significant (p = 0.04). CONCLUSION: Supplementation with low dose n-3 fatty acids for 6 months could significantly protect elderly Iranians from a rise in serum triglycerides.

Increased risk of chronic kidney disease in elderly with metabolic syndrome and high levels of C-reactive protein: Kahrizak Elderly Study.

BACKGROUND: To explore the interrelationship between metabolic syndrome (MS), chronic kidney disease (CKD) and C-reactive protein (CRP) in an elderly Iranian cohort. METHODS: 122 residents of Kahrizak Charity Foundation aged >or= 60 years were enrolled in this survey. MS was defined according to the NCEP-ATPIII criteria. CKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2. CRP levels >or= 3 mg/dl were determined as a high CRP. RESULTS: The multivariate-adjusted odds ratio (OR) for CKD in MS was 5.81 (95% confidence interval (CI) 1.72-19.58) compared to those without MS. High blood pressure and high triglyceride levels were significantly associated with an increased risk of CKD (OR 4.01, 95% CI 1.55-10.37 and OR 3.27, 95% CI 1.25-8.53, respectively). Subjects with MS and high CRP levels had a 1.71-fold greater risk of having CKD compared to those without MS and low CRP levels (95% CI 1.02-2.84). CONCLUSION: There was a strong and independent relation between MS and risk of CKD in these elderly people. High blood pressure and hypertriglyceridemia increased the risk of CKD. Combination of high CRP and MS was strongly associated with an increased risk of CKD.

Effect of metabolic control on oxidative stress, subclinical atherosclerosis and peripheral artery disease in diabetic patients.

INTRODUCTION: By rising diabetes mellitus prevalence, the prevalence of its most complication; cardiovascular disease (CVD) is also increasing. Moreover, oxidative stress has important role in pathogenesis of diabetes and its complications. We investigated relationship between total antioxidant status (TAS) and surrogate measures of subclinical atherosclerosis (SA) with glycemic status in diabetics. METHODS & MATERIALS: In a cross-sectional study, we recorded height, weight, waist circumference (WC) and blood pressure of 267 subjects. Blood samples were collected to measure fasting blood sugar (FBS), glycated hemoglobin (HbA1c), lipid profiles and TAS. The surrogate measures of SA were Carotid Intima Media Thickness (CIMT), and Ankle Brachial Index (ABI). RESULTS: We found significantly lower TAS leves and ABI values and higher CIMT in diabetic patients especially in poor glycemic group. There was a nonsignificant, weak correlation between TAS, ABI and CIMT with glycemic status (r = -0.10, -0.16, and +0.09, respectively). Multivariate regression analysis showed a significant influence of increasing age and diabetes duration on worsening CIMT in poor glycemic group. CONCLUSIONS: Our study showed poor glycemic control leads to worse CIMT by increasing age and duration of diabetes. However we did not find a significan correlation between glycemic status and TAS levels. We suggest CIMT measurement along with other SA markers in poor glycemic diabetics, especially in older patients with longer duration of diabetes, to identify high risk CVD patients.

Relationship between insulin resistance and subclinical atherosclerosis in individuals with and without type 2 diabetes mellitus.

BACKGROUND: Insulin resistance is of utmost importance as an underlying mechanism for increased risk of cardiovascular disease (CVD). We assessed the association between Homeostatic Model Assessment (HOMA-IR) and two surrogate subclinical atherosclerosis markers (SCA) among individuals with and without type 2 diabetes (DM), those who did not have any clinical presentation of the CVD. METHODS: In a cross-sectional study, 208 participants (105 diabetics and 103 non-diabetics) were enrolled from referred patients with diabetes to an academic outpatient clinic and their non-diabetic relatives in-law. Fasting serum levels of insulin, blood glucose and lipid profile, were measured. Anthropometric and blood pressure were measuremented standardly. Body Mass Index (BMI) and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) index were calculated. Coronary Artery Calcium Score(CACS) was measured using a Multi-Detctor CT scanner. Flow mediated dilation (FMD) was measured using bimode ultrasonography (with linear transducer 13,000 MHZ). Univariate and multivariate logistic regression models were used to evaluate the association between these SCA markers and HOMA index in adjusting models. RESULTS: CACS and HOMA-IR were higher and FMD was lower in diabetic participants than non-diabetic ones (P < 0.01) In a stepwise logistic regression model, CACS and FMD were associated with HOMA-IR (odds ratio = 1.778; 95 % confidence interval (CI): 1.211-2.726 and odds ratio = 1.557; 95 % CI: 1.601-2.275, respectively) in non-diabetics but not among diabetic participants. CONCLUSIONS: CACS and FMD are related to insulin resistance among non-diabetic individuals, but we could not find this relationship among diabetic patients.

Impact of hypertension on various markers of subclinical atherosclerosis in early type 2 diabetes.

BACKGROUND: Presence of Diabetes Mellitus increases the risk of subclinical atherosclerosis. In this study was aimed to determine the influence of hypertension (HTN) on surrogate markers of atherosclerosis in a population of patients with early type 2 diabetes. METHODS: 125 diabetic subjects drawn from Dr. Shariati outpatient's clinic list and 153 non- diabetic subjects who were the relatives in law of diabetic participants were recruited. Participants with type 2 diabetes were free of clinical evidence of cardiovascular disease and renal involvement. Two groups of diabetic and control were further divided into two subgroups of hypertensive (known case of HTN or blood pressure ≥140/90 mmHg) and normotensive, and anthropometric characteristics, metabolic biomarkers as well as markers of subclinical atherosclerosis including Carotid intima media thickness (CIMT), flow mediated dilation (FMD) and Ankle Brachial Index (ABI) were measured. RESULTS: Diabetic group with a mean age of 49.9 ± 7.5 years had significantly higher CIMT (0.64 ± 0.14 vs 0.76 ± 0.19, p = 0.001) and lower FMD (16.5 ± 8.1 vs 13.3 ± 7.1, p = 0.003) and ABI (1.2 ± 0.1 vs 1.1 ± 0.1, p = 0.01) than control with mean age of 52.9 ± 10.1 years. 34% of control and 59.2% of diabetic were hypertensive. Fasting blood sugar, insulin levels and calculated insulin resistance index of HOMA IR. of hypertensive subjects were higher than normotensive subjects in both groups of diabetic and non-diabetic. Similar pattern was presented for measured inflammatory mediators of hs-CRP and IL-6. Among subclinical atherosclerosis markers, only CIMT was significantly different between hypertensive and normotensive subjects in both groups. In adjusted linear regression analysis, a constant significant association existed between age and CIMT, ABI and FMD in non-diabetic, while in diabetic, age only correlated with CIMT and not the other two markers. In multiple regression model, HTN was recognized as a risk factor for increasing CIMT (OR = 2.93, 95% CI = 1.03-8.33, p = 0.04) but not attenuating FMD or ABI. CONCLUSIONS: Since FMD and CIMT may measure a different stage of subclinical atherosclerosis in diabetic patients, influence of HTN on these markers might be different.

Effect of low dose ω-3 poly unsaturated fatty acids on cognitive status among older people: a double-blind randomized placebo-controlled study.

BACKGROUND: Cognitive impairment is a prevalent health problem in older people and its global prevalence tends to increase parallel to the extended life expectancy in world. The beneficial effect of ω-3 PUFAs on cognitive impairment has been demonstrated in some experimental and cohort studies. In this study we aimed to assess the effect of low dose docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) supplementation on cognitive status in the elderly. METHODS: In a double-blind, randomized placebo-controlled study, 199 individuals aged ≥65 years with normal or mild to moderate cognition impairment were assigned to receive either 180 mg of DHA plus 120 mg of EPA or placebo for 180 days. Cognitive status was assessed using Mini-Mental State Examination (MMSE) and Abbreviated Mental Test (AMT) score. RESULTS: MMSE and AMT scores were not different at the time of allocation [18.84 (5.37), 18.55 (5.12), (P = 0.70) and 4.81 (2.79) and 4.64 (2.77), (P = 0.67) respectively] and over 6 months between the ω-3 PUFA- and placebo- treated groups [18.57 (5.21), 18.39 (5.10), (P = 0.80) and 4.64 (2.77) and 4.48 (2.69) and (P = 0.67)]. The participants were categorized based on MMSE score into normal cognition, mild and moderate cognitive impairment. After multivariate adjustment, there was no significant difference among categorized groups regarding the ω-3 PUFA effect except in normal cognition group, that amount of decline in AMT in ω-3 poly unsaturated fatty acids (PUFAs) was less than placebo group. CONCLUSIONS: It seems that prescription of low dose ω-3 PUFAs for 6 months had no significant beneficial effects on improvement of cognition or prevention of cognitive decline in older people.

Association of metabolic syndrome with inflammatory mediators in women with previous gestational diabetes mellitus.

BACKGROUND: An increased risk of metabolic syndrome (MS) has been observed among women with previous gestational diabetes mellitus (pGDM). Increased inflammatory markers such as C-reactive protein (CRP) and interleukin 6 (IL-6) usually accompany. We performed this survey to examine the relationship between pGDM and MS, CRP and IL-6. METHODS: 77 women with pGDM and 67 randomly sampled women free from GDM participated in this study, 2-3 years after index pregnancy. Laboratory and anthropometric measurements were performed. MS was defined according to ATP III criteria. Statistical analyses were conducted using SPSS 18. RESULTS: CRP were different between groups with and without pGDM [2.69 (2.86 mg/dl and 1.56 (1.39) mg/dl, respectively; p < 0.01]. The presence of each MS component by itself was associated with significantly higher CRP Levels, except for fasting blood glucose. In linear regression models, CRP and IL-6 were significantly associated with BMI (ß =0. 25, 0.23; p < 0.01), waist circumference (ß=0. 27, 0.05; p < 0.01) and HOMA-IR (ß=0. 39, 0.39; p < 0.01). After adjustment for age and BMI the occurrence of pGDM in the group with both high CRP and MS was significantly associated with CRP level (OR= 5.11; CI=1.59-16.43; p < 0.01). CONCLUSION: Since CRP and Il-6 were higher in women with both pGDM and MS it appears that the presence of pGDM with MS components have a synergistic effect on the elevation of serum levels of inflammatory markers which can be partly as a result of visceral obesity. Further long-term studies are necessary to confirm the relationship between CRP, IL-6 and MS in women with pGDM.

Nutritional knowledge, attitude and practice of Iranian households and primary health care staff: NUTRIKAP Survey.

The aim of this study is to determine knowledge, attitude and practice of Iranian households and health staff on nutrition at province level. The sampling method in NUTRIKAP survey for households in each province is single-stage cluster sampling and the size of clusters is equal. The sampling method for health staff in each province is stratified random sampling. Samples are selected from physicians, health experts, health technicians, nutritionists and health assistants (Behvarz). Overall, 14136 people in 57 clusters in each province and 480 health staff over the country participate in this survey. The necessary data will be gathered by the structured questionnaire and the interview with the eligible person in each household. Data gathering from health staff will be carried out by self-administered questionnaire. The results of this study can help the bureau of community nutrition to provide the proper interventions to improve nutritional health of households.

Association of vitamin D receptor with longevity and healthy aging.

Longevity is a multifaceted trait in which variety of genes and environmental factors are involved. Newly, the role of vitamin D has been revived regarding its potential advantage on delaying the aging process. Vitamin D exerts its effect through vitamin D receptor (VDR). VDR-FokI is the only polymorphism which alters the VDR length. We examined the frequency of FokI genotypes in old age population as compared to young adults to determine the discerning genotype of FokI polymorphism leading to longer living. In addition, to highlight the position of FokІ polymorphism in quality of life; a cognitive function assessment was performed. 728 participants participated in this study of which 166 individuals were elderly residents of Kahrizak Charity Foundation. The rest were participants of Iranian Multicenter Osteoporosis Study (IMOS). Genomic DNA was extracted from peripheral blood and VDR genotype was detected by the polymerase chain reaction. The participants in the elderly group underwent a cognitive function assessment. Cognitive function was measured with the mini mental state examination (MMSE). Data were analyzed by SPSS 16.5. The prevalence of ff genotype showed 48% decrease in elderly population as compared to young adults (P=0.06). In addition, F allele was over-represented in the elderly group as compared to controls (P=0.05). Also, "FF" participants of elderly group had higher MMSE as compared to "ff" genotype (18.16Vs17.12). Our data suggest that single nucleotide polymorphisms (SNPs) in FokI may be possibly involved in longevity and cognitive function.

Correlation of serum homocysteine and previous history of gestational diabetes mellitus.

BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy condition. In this study, the risk of having a history of previous GDM (pGDM) on serum homocysteine level was assessed. METHODS: Biomedical parameters, serum homocysteine, Insulin, homeostatic model assessment (HOMA) in women with (n = 52) and without pGDM (n = 51) were assessed. According to their current status of Oral Glucose Tolerance Test (GTT), the participants in each group were divided into two subgroups of normal or impaired GTT. RESULTS: Mean serum homocysteine in normal women was 8.56 ± 3.19 vs 11.44 ± 7.34 µmol/L (p < 0.01) in women with pGDM. Two groups had significant differences in respect to serum insulin levels (8.35 ± 5.12 vs 12.48 ± 5.44, p < 0.002), and HOMA-IR (1.90 ± 1.30 vs 2.91 ± 1.30, p < 0.002). In women without pGDM, serum homocysteine in normal and impaired GTT were 7.60 ± 1.69 and 10.52 ± 3.65 µmol/L (p = 0.03), respectively, while in women with pGDM, the figures were 8.38 ± 2.52 and 14.00 ± 10.17 (p < 0.01), respectively. In multi regression analysis an association between history of GDM and homocysteine levels was presented (OR: 7.71, 95% CI: 1.67-35.42, p < 0.001). CONCLUSION: A trend of elevation of homocysteine is presented in women with pGDM, that is more prominent in women with impaired GTT, and shows a significant correlation with history of GDM. Further studies with larger sample size are suggested.

Gender differences in association between metabolic syndrome and carotid intima media thickness.

BACKGROUND: Metabolic syndrome (Mets) is a cluster of cardiovascular risk factors which can predicts cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is known as a surrogate measure of subclinical atherosclerosis and predictor of CVD. Although, it has shown the association between Mets and CIMT, this relation regarding sex differences is limited. We aimed to find out whether gender differences in this association. METHODS: In this cross-sectional study, we recorded height, weight, waist circumference (WC), blood pressure, and lipid profiles. We used Mets; defined based on NCEP ATP III definition, and traditional cardiovascular risk factors; age, body mass index (BMI), WC, hyperlipidemia, and hypertension, in multivariate regression models which including;. The CIMT measurement < 0.73 or ≥0.73 mm was considered as low- or high risk to CVD. RESULTS: Overall, 150 subjects were enrolled to study that their ages were 36-75 years. The 47.3% of them (71 subjects) had Mets. CIMT was increased in Mets group compared non-Mets group (P = 0.001). In logistic regression analysis, a significant association was found between Mets and CIMT in women, but not in men (p = 0.002, and p = 0.364, respectively). After adjustment to age, WC, BMI, hypertension and hyperlipidemia, this association was significant just in women (p = 0.011) independent of WC, BMI, hyperlipidemia and hypertension. CONCLUSION: Our data showed that MetS is a stronger risk factor for subclinical atherosclerosis in women than in men. So, we suggest the assessment of CIMT along with definition Mets in middle-aged women could be lead to earlier detection of at risk individuals to CVD.

Cardiac autonomic neuropathy measured by heart rate variability and markers of subclinical atherosclerosis in early type 2 diabetes.

Cardiac autonomic neuropathy (CAN) is a critical complication of type 2 diabetes mellitus (T2DM). Heart rate variability (HRV) is a noninvasive tool to assess cardiac autonomic function. We aimed to evaluate whether CAN is associated with increased risk of atherosclerosis in T2DM. A total of 57 diabetic and 54 nondiabetic subjects, free of coronary heart disease, were recruited. Carotid intima media thickness (CIMT), coronary calcium score (CAC), and brachial Flow Mediated Dilation (FMD) were measured. Heart rate variability and vagal components of autonomic function were determined. Significant reduction of normalized HF power (P < 0.05) and total power (P < 0.01) was observed in T2DM. CIMT and CAC scores were significantly higher while FMD was significantly lower in diabetics (P < 0.01 for all). Median HbA(1c) levels were significantly higher in diabetics. CIMT was inversely and independently associated with total power both in diabetics and controls (P < 0.01 for both groups). There was also an inverse association between total power and median HbA(1c). Autonomic dysfunction, especially parasympathetic neuropathy, was present since early-stage T2DM. This was related to subclinical atherosclerosis. Early detection of cardiac autonomic neuropathy can help us detect the development of atherosclerosis earlier in T2DM to prevent unfavorable outcomes.

Older people's mortality index: development of a practical model for prediction of mortality in nursing homes (Kahrizak Elderly Study).

AIMS: In the elderly, mortality prediction models are important for clinical decision-making and planning of services required. METHODS: A total of 247 Kahrizak Charity Foundation (KCF) residents aged ≥ 65 years were followed up for approximately 39 months. At the baseline, the questionnaires of Barthel Index (BI), Mini-Mental State Examination, Geriatric Depression Scale, Mini Nutritional Assessment and Norton Index was given. Medical history was recorded and anthropometric values were also measured at the baseline. Fasting blood samples were collected at baseline. Mortality and its causes were recorded during the study. RESULTS: A total of 30% (74) of participants died during the study. The variables that had a significant association with mortality in the Cox regression hazard model were entered into the principal components analysis (PCA). The older people's mortality index (OPMI) was developed by four variables extracted from PCA, including BI, age, hemoglobin and mid-arm circumference. Cut-points of these components were calculated using ROC curve analysis. Based on neural network analysis, there was no significant difference in relative importance of OPMI components. OPMI was correlated to mortality (r = -.351, P = 0.000) and survival (r = -0.355, P = 0.000). OPMI score was defined as the number of adverse predictors present. An increasing hazard ratio for mortality was observed from scores 1 to 4 (2.10, 4.56, 7.12 and 13.85, respectively). CONCLUSION: Our suggested model could predict mortality in KCF residents well. The new developed model could be a practical, easy and non-expensive index for mortality prediction in elderly care facilities.