Nutritional status of the elderly in rural North China: a cross-sectional study.

OBJECTIVES: This study aimed to describe the nutritional status of elderly people living in a rural area of North China. DESIGN: Community-based, cross-sectional prevalence survey. SETTING: 3 rural towns of Lvliang City, Shanxi Province, China. PARTICIPANTS: A sample of 1845 community residents (29.1% of those eligible) 55 years or older (birth before 1958-01-01). MEASUREMENTS: The participants were assessed regarding demographic characteristics, height, weight, as well as having a physical examination and blood sampling for serum cholesterol, total homocysteine (tHcy), folate, and vitamin B12 levels. RESULTS: 991 (53.7%) were female and 139 (7.5%) did not complete the anthropometric measurement. Prevalence of underweight and obesity was 3.5% and 24.9% in men and 6.7% and 31.0% in women (P = 0.003, P = 0.005, respectively). Prevalence of hypercholesterolemia and hypocholesterolemia was 13.5% and 52.6% in men and 25.0% and 34.3% in women (P < 0.001, P < 0.001, respectively). Prevalence of high LDL-c concentrations was 8.8% in men and 16.8% in women (P < 0.001). The mean serum tHcy in men (28.8 ± 20.1 µmmol/l) was significantly higher than in women (21.0 ± 15.1 µmmol/L, P < 0.001). Prevalence of hyperhomocysteinemia (defined as > 15µmmol/L) was 79.7% in men and 65.5% in women (P < 0.001). Prevalence of low folate (defined as < 11 nmol/L) and vitamin B12 levels (defiend as < 185 pmol/L) was 70.8 % and 76.8% in men and 56.5% and 72.6% in women (P < 0.001, P = 0.036, respectively). Correlation coefficients between tHcy, folate, and vitamin B12 indicated an inverse linear correlation (r = -0.21, P < 0.001, r = -0.35, P < 0.001, respectively). CONCLUSIONS: As China's economic climate has developed, the nutritional status of elderly people in the rural parts of the country has improved in some aspects. However, the trend toward obesity will lead to a shift in the burden of obesity-related chronic diseases. In addition, rurally-located elderly people are at high risk of death that may be associated with abnormal serum cholesterol. The data also suggest that severe deficiencies in folate and vitamin B12 levels exist, as well as there being a high prevalence of hyperhomocysteinemia. Folate and vitamin B12 supplementation are necessary to prevent related diseases.

Rhytidectomy for treatment of the aging face.

Rhytidectomy or face-lift is an operation designed to remove facial wrinkles. Most often, it is performed in conjunction with other facial procedures, such as brow-lifts, blepharoplasty, and submental liposuction, for complete rejuvenation of the aging face. The recent surge of interest in cosmetic surgery has prompted more patients to inquire about and undergo a face-lift operation. Careful preoperative selection of patients is extremely important in achieving a successful outcome. At the Mayo Clinic, most facial cosmetic surgical procedures performed by the Department of Otorhinolaryngology are done on an outpatient basis. A combination of local anesthesia and intravenous sedation provides excellent patient tolerance and comfort both intraoperatively and postoperatively. Treatment involving the superficial musculoaponeurotic system is used for those patients who require additional underlying support and definition of the facial contour. Postoperative recovery is routinely uneventful. Complications of face-lift surgery are rarely encountered. Case reports are presented to illustrate the representative postoperative results.

Hypoparathyroidism following total laryngopharyngectomy and gastric pull-up.

We have used the gastric pull-up technique for closure of large pharyngoesophageal defects after radical oncological surgery since 1979. The management of severe hypocalcemia and hypovitaminosis D seemed more difficult in patients undergoing pull-up reconstruction than in patients undergoing the same extirpative surgery, but reconstructed with more traditional methods. To determine if hypocalcemia and hypovitaminosis D were more common in gastric pull-up patients, and if postoperative management of these conditions is more problematic in this group, we retrospectively compared three groups of head and neck surgery patients. Group 1 consisted of 17 patients undergoing total laryngectomy with thyroid complex preservation. Group 2 consisted of 7 patients undergoing mediastinal dissection with total laryngectomy-thyroidectomy previously or concurrently. Group 3 consisted of 30 patients undergoing total laryngopharyngoesophagectomy-thyroidectomy and gastric pull-up reconstruction. The incidences of hypocalcemia requiring therapy were 12%, 50%, and 73%, respectively, with an overall incidence of 51%. The average amounts of supplemental calcium and vitamin D in the three groups were compared. A significant between the three groups was noted. Finally, the dietary calcium and vitamin D requirements for one problematic patient were prospectively recorded and summarized graphically. We conclude that any patient should be carefully monitored for the signs and symptoms of hypocalcemia after major head and neck surgery. In the special instance of the gastric pull-up patient, calcium requirements and the range of serum calcium fluctuation are greatly increased compared to patients undergoing more traditional methods of reconstruction.