Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention.

BACKGROUND: Population strategies to increase physical activity are an essential part of cardiovascular disease prevention. However, little data exist on lifestyle interventions that are easy to integrate into everyday life such as using stairs instead of elevators at the workplace. DESIGN: Pre and postintervention study. METHODS: A 12-week promotional campaign for stair use consisting in posters and floor stickers at the point of choice between stairs and elevators at each hospital floor was organized in a university hospital building. In 77 selected employees with an inactive lifestyle, physical activity, aerobic fitness, anthropometrics, blood pressure, lipids, insulin sensitivity, and C-reactive protein were assessed at baseline, 12 weeks, and 6 months. RESULTS: During the intervention median daily number of ascended and descended one-story staircase units was 20.6/day (14.2-28.1) compared with 4.5/day (1.8-7.2) at baseline (P<0.001). At 12 weeks, estimated maximal aerobic capacity had increased by 9.2±15.1% (P<0.001) corresponding with approximately 1 MET. There were significant declines in waist circumference (-1.7±2.9%), weight (-0.7±2.6%), fat mass (-1.5±8.4%), diastolic blood pressure (-1.8±8.9%), and low-density lipoprotein cholesterol (-3.0±13.5%). At 6 months, the median daily number of ascended and descended one-story staircase units had decreased to 7.2 (3.5-14.0). Benefits on estimated maximal aerobic capacity (+5.9±12.2%, P=0.001) and fat mass (-1.4±8.4%, P=0.038) persisted. CONCLUSION: Encouraging stair use at work is effective for improving fitness, body composition, blood pressure, and lipid profile in asymptomatic individuals with an inactive lifestyle and thus may be a simple way to significantly reduce cardiovascular disease risk at the population level.

Reduction of missed appointments at an urban primary care clinic: a randomised controlled study.

BACKGROUND: Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments. METHODS: We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded. RESULTS: 2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1 year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09). CONCLUSION: A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.

Severity of pain is associated with insufficient energy coverage in hospitalised patients: A cross-sectional study.

BACKGROUND & AIMS: The severity of pain is routinely assessed in hospitalised patients but the impact of pain and pain control on energy coverage has been poorly studied. This One-day cross-sectional observational study assessed the association between severity of pain and coverage of energy needs in hospitalised patients. METHODS: Foods provided and consumed were assessed on one day by dedicated dieticians for unselected hospitalised patients receiving three meals per day. Severity of pain was evaluated by a visual analogue scale at the mealtimes, averaged over the study day, and categorized as no pain, slight, moderate or severe pain. The coverage of energy needs was expressed in percentage of predicted needs. RESULTS: Among the 755 included patients, 63% reported having pain. Severe pain was associated with a lower energy coverage than no pain (p = 0.001) or slight pain (p = 0.001). Insufficient energy coverage, defined as ≤70% of predicted needs, occurred in 13% of the patients. In univariate logistic regressions, predictors of insufficient energy coverage were severe pain as compared to no pain (OR 2.38; 95% CI 1.21, 4.64) and treatment with opioid drugs as compared to no pain killer (OR 1.73; 95% CI 1.07, 2.79). When including sex, age, body mass index, treatment with analgesics and severity of pain in a multivariate logistic regression, severe pain more than doubled the risk of insufficient energy coverage (OR 2.32; CI 1.15, 4.66). CONCLUSIONS: Patients experiencing severe pain have a high risk of insufficient energy coverage. Optimal pain control is probably critical to prevent underfeeding in the hospital. TRIAL REGISTRATION: Identifier no NCT02463565 on www.ClinicalTrials.gov.

A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility.

BACKGROUND: Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time. METHODS: We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital. We developed logistic regression models predicting discharge to a PAC facility, based on patient variables measured on admission (day 1) and on day 3. The value of each model was assessed by its area under the receiver operating characteristics curve (AUC). A simple numerical score was derived from the best model, and was validated in a separate cohort. RESULTS: Prediction of discharge to a PAC facility was as accurate on day 1 (AUC: 0.81) as on day 3 (AUC: 0.82). The day-3 model was more parsimonious, with 5 variables: patient's partner inability to provide home help (4 pts); inability to self-manage drug regimen (4 pts); number of active medical problems on admission (1 pt per problem); dependency in bathing (4 pts) and in transfers from bed to chair (4 pts) on day 3. A score > or = 8 points predicted discharge to a PAC facility with a sensitivity of 87% and a specificity of 63%, and was significantly associated with inappropriate hospital days due to discharge delays. Internal and external validations confirmed these results. CONCLUSION: A simple score computed on the 3rd hospital day predicted discharge to a PAC facility with good accuracy. A score > 8 points should prompt early discharge planning.

Comparison of equations for estimating resting metabolic rate in healthy subjects over 70 years of age.

INTRODUCTION: There is a lack of validation studies of formulas for estimating resting metabolic rate (RMR) in healthy subjects over 70 years of age. Indirect calorimetry allows measuring RMR (RMRm), but is time consuming and costly and therefore formula are generally used to estimate RMR (RMRe). We assessed the degree of agreement between RMRm and RMRe predicted by five popular equations: Harris-Benedict (HB), Mifflin-St Jeor (MJ), Owen (OW), World Health Organization (WHO/FAO/UNU) and Lührmann (LM) in a cohort of elderly subjects. METHODS: In 119 healthy subjects, aged 70-98 yr, RMRm was obtained by indirect calorimetry and RMRe by the HB, MJ, OW, WHO/FAO/UNU and LM equations. Means were compared by paired t-test. The Bland and Altman method was used to assess agreement between RMRm and RMRe. Accuracy was defined as the % of individuals whose RMRe was within +/-10% of RMRm. RESULTS: The HB showed the lowest mean RMRe-RMRm difference (-40.9 kcal/day), followed by LM (+44.8 kcal/day) and WHO/FAO/UNU (+53 kcal/day). The HB performed the best of the five equations, having 72.4% of the cases within+/-10% of RMRm. In 18.7% of male subjects and 20% of female subjects HB underestimated the measured values. CONCLUSIONS: Large discrepancies exist between RMRm and RMRe in subjects above 70 years of age. HB performs best, but still tends to underestimate in both sexes. In order to develop more accurate equations to estimate RMR in elderly subjects it would be worthwhile to examine whether additionally specific markers of body composition should be taken into consideration.

Managing postacute hospital care: a case for biopsychosocial needs.

OBJECTIVE: This study aimed to investigate whether, for an identical diagnosis, patients who were transferred to a postacute care (PAC) facility had a higher biopsychosocial complexity than patients who were discharged home. METHODS: This prospective study employed group comparison that included 166 patients who were consecutively admitted to an acute care internal medicine ward for acute congestive heart failure, pneumonia or exacerbation of chronic obstructive pulmonary disease, and malaise or fall. Patients were evaluated within their first 48 h of stay. Biomedical, functional, quality of life, and case complexity data were collected. Factors associated with a transfer to the PAC facility were identified through logistic regression modeling. RESULTS: Fifty-eight patients (34.9%) were transferred. In the multivariate analyses, case complexity score [per point: odds ratio (OR)=1.29; 95% CI=1.18-1.41] and nursing workload (OR=1.06; 95% CI=1.01-1.12) were associated with the transfer. At a cutoff point of > or =33, the case complexity score predicted transfer to the PAC facility with a sensitivity of 79% and a specificity of 84% (positive predictive value=73.0%; negative predictive value=88.4%) and correctly classified 83% of the cases. CONCLUSIONS: Biomedical characteristics alone did not differentiate patients who were transferred versus those who were discharged home, nor did it predict PAC use. This was also true for specific severity scores of cardiac failure and pneumonia as well as for the comorbidity index. Psychosocial parameters were significantly associated to this process as well as a higher nursing workload.

Patients' knowledge of drug treatments after hospitalisation: the key role of information.

QUESTION UNDER STUDY: Patients often do not know the reasons for taking their medications after hospital discharge. We investigated whether lack of such knowledge was associated with patients' report of not having received information about their medications while hospitalised. METHODS: Patients with at least one long-term drug (ie, prescribed for more than 30 days) discharged from the wards of general internal medicine of a teaching hospital were included in the study. Patients' knowledge of the reasons for taking these drugs and their report of having received information while hospitalised were assessed by phone one week after discharge. RESULTS: 362 (98.6%) of 367 enrolled patients could be interviewed and provided data on 1693/1871 (90.5%) long-term drugs prescribed at discharge. Patients knew the reasons for taking 1382 (81.6%) drugs and reported having received information about 259 (15.3%) of them. In the adjusted analysis, the reason for taking a drug was less likely to be known when introduced during hospitalisation (OR: 0.7; 95%CI: 0.5 to 0.9), among older patients (OR for > or =80 years of age v/s 20-59: 0.41; 95%CI: 0.22 to 0.76) and among those staying longer (OR per additional hospital day: 0.96; 95%CI: 0.94 to 0.99); such knowledge was strongly and positively associated with the report of having received information during hospitalisation (OR: 7.3; 95%CI: 3.2 to 16.1). CONCLUSION: Patients' report of having received information about their long-term drugs during hospitalisation was associated with a significantly higher knowledge of the reasons for taking them. However, receipt of such information was only infrequently reported.

Comparison of tools for nutritional assessment and screening at hospital admission: a population study.

INTRODUCTION: This population study aimed to test the sensitivity and specificity of nutritional risk index (NRI), malnutrition universal screening tool (MUST) and nutritional risk screening tool 2002 (NRS-2002) compared to subjective global assessment (SGA) and to evaluate the association between nutritional risk determined by these screening tools and length of hospital stay (LOS). METHODS: Patients (n=995) were assessed at hospital admission by four screening tools (SGA, NRI, MUST and NRS-2002). Sensitivity, specificity and predictive values were calculated to evaluate NRI, MUST and NRS-2002 compared to SGA. Multiple logistic regressions, adjusted for age, were used to estimate odds ratios (OR) and confidence interval (CI) for medium and high, compared to low risk in patients hospitalized >11, compared to 1-10 days LOS. RESULTS: The sensitivity was 62%, 61% and 43% and specificity was 93%, 76% and 89% with the NRS-2002, MUST and NRI, respectively. NRS-2002 had higher positive (85%) and negative predictive values (79%) than the MUST (65% and 76%) or NRI (76% and 66%, respectively). Patients who were severely malnourished or at high nutritional risk by SGA (OR 2.4, CI 1.5-3.9), MUST (OR 3.1, CI 2.1-4.7) and NRS-2002 (OR 2.9, CI 1.7-4.9) were significantly more likely to be hospitalized >11 days, compared to 1-10 days, than patients assessed as low risk. CONCLUSION: NRS-2002 had higher sensitivity and specificity than the MUST and NRI, compared to SGA. There was a significant association between LOS and nutritional status and risk by SGA, NRS-2002, MUST and NRI. Nutritional status and risk can be assessed by SGA, NRS-2002 and MUST in patients at hospital admission.

Omega-3 polyunsaturated fatty acids and ionizing radiation: combined cytotoxicity on human colorectal adenocarcinoma cells.

OBJECTIVE: This study evaluated whether omega-3 polyunsaturated fatty acids (PUFAs) could enhance the radiosensitivity of three different human colorectal adenocarcinoma cell lines. To understand the underlying mechanisms, the effects of omega-3 PUFAs on the cell growth, survival, and apoptosis were evaluated alone or in combination with an antioxidant (vitamin E) and compared with the effects of omega-6 PUFAs. METHODS: LS174T, CO112, and Caco-2 cell survival was assessed by clonogenic assay after a 3-d pretreatment with omega-3/omega-6 PUFAs and/or vitamin E before a single X-ray exposure to 4 Gy. Cell growth and viability were measured by double fluorescence-activated cell sorter analyses using propidium iodide and fluorescein isothiocyanate-conjugated annexin V. Student's t test or multivariable linear regression analyses were used for comparison. RESULTS: Preincubation with 30 to 100 micromol/L of omega-3 PUFAs induced a dose-dependent additive decrease in cell survival after irradiation (P < 0.05). Evaluation of the underlying mechanisms indicated that omega-3 PUFAs mainly decreased the cell number via apoptosis induction. Moreover, formation of lipid peroxidation products and modulation of cyclooxygenase II activity seemed to be involved, because coincubation with 10 micromol/L vitamin E abolished the effect of 50 micromol/L of omega-3 PUFAs (P < 0.05), whereas omega-6 PUFAs could partly mimic omega-3 PUFA effects. CONCLUSION: These observations suggest that omega-3 PUFAs may be potential candidates as nutritional adjuvants to enhance the efficacy of human colorectal cancer radiotherapy.

Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study.

BACKGROUND: Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population. METHODS AND FINDINGS: Dietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis. CONCLUSION: Measured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention.

Effects of a structured patient-centered discharge interview on patients' knowledge about their medications.

PURPOSE: Many recently hospitalized patients lack knowledge about important aspects of their medications. We evaluated whether a structured discharge interview could improve medication knowledge. METHODS: Patients discharged with at least one discharge medication were recruited from two general internal medicine services (one experimental and one control) of a teaching hospital. During a 3-month baseline period, usual care at discharge was provided in both services. During the ensuing 3-month period, observation was continued in the control service; residents in the experimental service implemented the intervention, which consisted of a structured patient-centered discharge interview during which a computer-generated individualized treatment card was discussed with and provided to patients. One week after discharge, patients' knowledge about their medications was assessed by telephone. RESULTS: We enrolled a total of 809 patients. After adjustment for patients' characteristics and for the effect of time, the intervention significantly increased the percentage of medications for which patients correctly knew the purposes (adjusted difference = 6%; 95% confidence interval [CI]: 3% to 8%; P <0.001), possible side effects (adjusted difference = 19%; 95% CI: 9% to 29%; P <0.001), and precautions to observe (adjusted difference = 9%; 95% CI: 2% to 19%; P <0.001). However, the number of medications that patients discontinued after discharge was not modified. Patients with a better knowledge of side effects of their active treatment were less likely to discontinue their medications, but there were no associations with other types of knowledge. CONCLUSION: A structured patient-centered discharge interview, performed by residents using a standardized treatment card, significantly increased patients' knowledge about their medications. Its effects on compliance require further study.

Impaired baroreflex sensitivity and the risks of new-onset ambulatory hypertension, in an elderly population-based study.

BACKGROUND: Impairment of the autonomic nervous system activity may be involved in the development of hypertension. Yet the prognostic values of heart rate variability and baroreflex sensitivity in the risk of new-onset ambulatory hypertension have not been investigated. We sought to assess the relationship between heart rate variability and baroreflex sensitivity parameters and ambulatory hypertension in a community-dwelling elderly cohort. METHODS: Normotensive subjects were selected from the PROOF study cohort, including 1011 subjects aged 65 years at baseline. The autonomic nervous system activity was assessed through 24-hour heart rate variability and 15-minute spontaneous baroreflex sensitivity at baseline. Incident hypertension was defined with the 24-hour, day-time and night-time ambulatory blood pressure measurements and antihypertensive treatment use, at two-years of follow-up. RESULTS: At baseline, 13.7% of subjects developed day-time hypertension, 18.2% developed night-time hypertension and 13.6% developed 24-hour hypertension. Reduced baroreflex sensitivity at baseline was associated with onset of hypertension after adjustment for blood pressure level, C-reactive protein levels and depression score (OR = 0.45 [0.23-0.86]). Indices of heart rate variability were not associated with hypertension onset. CONCLUSION: Baroreflex sensitivity may represent an intermediate goal for prevention of ambulatory hypertension at early stage.

Fondaparinux versus enoxaprin in the management of acute coronary syndromes in Switzerland: A cost comparison analysis.

QUESTION UNDER STUDY: Anticoagulation therapy is routinely used in cases of non ST-segment elevation acute coronary syndromes (NSTE-ACS). The most commonly used drug in such events is enoxaparin, a low molecular weight heparin. Fondaparinux, a synthetic pentasaccharide, is as effective as enoxaparin in terms of survival or residual angina pectoris and significantly reduces bleeding complications. The purpose of this study was to assess the magnitude of cost reductions if enoxaparin were replaced by fondaparinux in Switzerland. METHODS: Costs of hospital stay for NSTE-ACS with or without bleeding complications at the Geneva University Hospitals were determined for patients admitted between July 1st, 2007 and June 30th, 2008. These costs were applied to subjects recruited in the AMIS Plus registry, which gathers information on ACS in Swiss hospitals, using three scenarios. Firstly, using the baseline incidence of bleeding episodes observed in the AMIS plus registry. Secondly, using the baseline incidence of haemorrhagic episodes observed in the Geneva University Hospitals sample and thirdly, using the incidence of haemorrhagic episodes observed in the OASIS-5 study. These results and costs were then extrapolated to the national level. RESULTS: At the Swiss national level, replacement of enoxaparin by fondaparinux would generate annual savings ranging from 854,000 Swiss Francs (scenario 1) to 3,400,000 Swiss Francs (scenario 2) and 2,845,000 Swiss Francs (scenario 3). Estimated savings accounted for 55 to 63% of total hospital costs. CONCLUSIONS: Use of fondaparinux instead of enoxaparin in patients with NSTE-ACS could yield substantial savings at the local as well as the national level in Switzerland.

Depressive symptoms and autonomic nervous system dysfunction in an elderly population-based study: the PROOF study.

BACKGROUND: To assess the relationship between depressive symptoms, evaluated through self-reported history as well as current depressive symptoms, and impaired autonomic nervous system activity, evaluated by long-term heart rate variability and baroreflex sensitivity among elderly community residents, aged 65 years. METHODS: Subjects from the Proof cohort Study were evaluated for depressive symptoms and self-reported history of depression at inclusion. Autonomic nervous system activity was assessed through 24-h heart rate variability and baroreflex sensitivity. Cross-sectional analyses were performed to study the relationship between the different status of depression and autonomic nervous system activity. RESULTS: Among the 1011 Proof study participants, 823 subjects were included in the analyses. Current depressive symptoms were present among 67 subjects; history of depression was reported by 228 subjects. Psychoactive drugs were used by 59 subjects. Low frequency (p=0.02), very low frequency (p<0.01) and Low/High frequency ratio (p<0.001) were lower among subjects with depressive symptoms and history of depression, independently of antidepressant treatment. The association remained significant for Low/High frequency ratio after adjustment for gender and physical activity (p=0.004). CONCLUSION: Current depressive symptoms may be linked to autonomic nervous system lower performances. A possible long-term effect of depressive symptoms at middle-age may influence later-life autonomic nervous system activity. Our results highlight the importance of taking into account the depressive symptoms in the cardiovascular risk, even in the elderly.

Assessment of food intake in hospitalised patients: a 10-year comparative study of a prospective hospital survey.

BACKGROUND & AIMS: A food quality control and improvement permanent process was initiated in 1999. To evaluate the food service evolution, protein-energy needs coverage were compared in 1999 and 2008 with the same structure survey in all hospitalized patients receiving 3 meals/day. METHODS: Nutritional values of food provided, consumed and wasted over 24h including non-exclusive nutritional support were calculated individually. Nutritional needs were estimated as 110% of Harris-Benedict formula for energy and 1.2 or 1.0 g protein/kg/day for patients <65 or ≥65 years old, respectively. Multivariate analysis identified factors associated with low nutritional intake in both populations standardized to body mass index (BMI) of 1999's patients. RESULTS: Out of 1677 patients, 1291 were included. Mean BMI was higher in 2008 than 1999 (P<0.001). The proportion of underfed patients was unchanged (69 vs. 70%, NS). The consumption of ≥1 oral nutritional supplements (ONS) daily increased the protein needs coverage from 80% to 115% (P<0.001). The year 1999, high BMI, 1st week of hospital stay, specific diet, ONS absence and low meal quality were associated with low nutritional intakes. CONCLUSION: The nutritional needs coverage could have improved in 2008 if BMI was similar to 1999's. ONS consumption is associated with a lower risk of underfeeding in hospitalized patients.

Body composition changes over 9 years in healthy elderly subjects and impact of physical activity.

BACKGROUND & AIMS: Age-related changes of body composition affect health status. This study aims at clarifying body composition changes in healthy elderly subjects, and evaluating the impact of physical activity on these changes. METHODS: In 1999, 213 subjects ≥ 65 years recruited through advertisements underwent assessment of health state, energy expenditure by physical activity, body composition by bioimpedance analysis and body cell mass by total body potassium. In 2008, 112 of them repeated these assessments with additional determination of Barthel index, Mini Mental State Examination and Geriatric Depression Score. RESULTS: Lean tissues decreased in both genders (p < 0.05). Compared to subjects aged 65-74 years at baseline, those aged ≥75 years lost more body weight (men: -3.7 ± 5.4 vs. 0.4 ± 5.4 kg, women: -3.6 ± 5.5 vs. 0.3 ± 5.2 kg, both p < 0.05), and fat-free mass (men: -3.6 ± 3.3 vs. -0.4 ± 2.7 kg, women: -1.8 ± 2.3 vs. -0.1 ± 2.5 kg, both p < 0.05). Plotting of fat-free mass evolution against age at baseline showed an exponential loss of fat-free mass. Increased physical activity limited lean tissue loss in men but not in women. CONCLUSION: Loss of lean tissues occurs exponentially with aging. Further research should confirm these changes in subjects over 80 years. Increasing physical activity limits fat-free mass loss in men but not women.

Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.

BACKGROUND & AIMS: Small bowel disruption is often complicated by acute intestinal failure and can be corrected by chyme reinfusion (CR). Plasma citrulline ([Cit]) is a biomarker of the enterocyte mass. Our aim was to determine whether [Cit] could be a marker of absorptive intestinal mass or function by assessing whether CR could affect intestinal absorptive function and [Cit]. METHODS: Twenty-six patients with small bowel disruption and double enterostomy were treated with CR. Fecal wet weight, nitrogen and fat absorption, parenteral nutrition delivery and [Cit] were measured before and after the initiation of CR with a median follow-up of 30 days. RESULTS: CR decreased the intestinal wet weight output (median+/-IQ, 2384+/-969 vs. 216+/-242mLd(-1), P<0.0001) and parenteral nutrition dependence (65% vs. 8%, P<0.01). CR was associated with a rise in net nitrogen and fat digestive absorption and [Cit] (17.0+/-10.0 vs. 31.0+/-12.0micromolL(-1), P=0.0001). Before the initiation of CR, [Cit] correlated positively with the absorptive post-duodenal small bowel length (r=0.39, P=0.04), but not with the total post-duodenal small bowel length (r=0.11, P=0.60). CONCLUSION: CR allows for a dramatic improvement of intestinal absorptive function and a near doubling in [Cit] level. [Cit] is not a marker of overall intestinal mass, but of the absorptive small bowel function.

Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern.

An insufficient decrease in nocturnal blood pressure (BP) is a known factor in cardiovascular mortality. We aimed to determine whether autonomic nervous system (ANS) activity and its change over 2 years were associated with a shift to non-dipper status, independently of initial BP, in a general elderly population. From participants in the PROOF study, 600 subjects untreated for hypertension were selected (age at baseline: 65 years, men: 41.5%). Dipper/non-dipper status was defined using repeated measures of 24-h ambulatory BP at baseline and 2 years later. ANS activity was evaluated on the basis of 24-h heart rate variability at both examinations. Among the 454 dipper subjects at baseline, 26.2% became non-dippers. Multivariate analysis showed that a +1 between-subject s.d. increase in the very low frequency at baseline was associated with a decreased odds ratio for the shift to non-dipper status 2 years later (OR=0.61 [0.41-0.91], P=0.02). The within-subject change between the two measurements of day and night systolic BP and day diastolic BP also contributed significantly to the risk of shift to non-dipper status. Our results suggest that impaired ANS activity precedes an insufficient decrease in nocturnal BP independent of hypertension status.

C-reactive protein implications in new-onset hypertension in a healthy population initially aged 65 years: the Proof study.

BACKGROUND: Because inflammation is known to be related with several cardiovascular diseases, we sought to determine whether C-reactive protein (CRP) might precede the onset of hypertension. METHODS: The study population was selected from the Proof study cohort including 1011 individuals initially aged 65 years at baseline and followed for 7 years. CRP, ambulatory blood pressure measurement (ABPM) and casual blood pressure were repeatedly measured during examination. Normotensive individuals were selected according to different measurements of blood pressure, self-reported history of hypertension and use of antihypertensive treatment. RESULTS: Among 335 individuals, considered normotensive at baseline with ABPM (threshold 135/85 mmHg), with no history of hypertension and no use of antihypertensive treatment, the incidence of hypertension was 9.9% 2 years later. The 2-year risk for new-onset hypertension was 18% greater for 1 mg/l increment of CRP (odds ratio, 1.18; 95% confidence interval, 1.01-1.39). This relationship remained after adjustment for low-density lipoprotein cholesterol, BMI and change in CRP between the two examinations but not after adjustment for 24-h systolic ABPM. Among the 160 individuals considered normotensive at baseline with an additional criterion (casual blood pressure below 140/90 mmHg), the incidence of hypertension was 26.9% 2 years later. The 2-year risk for new-onset hypertension was 52% greater for 1 mg/l increment of CRP (odds ratio, 1.52; 95% confidence interval, 1.17-1.96) after adjustment for systolic ABPM, change in CRP and BMI. CONCLUSION: An elevated baseline CRP value precedes new-onset hypertension at an early stage among an elderly healthy population. Whether CRP measurement can ease the detection of patients likely to develop clinical hypertension remains to be determined.

Clinical relevance of parenteral nutrition prescription and administration in 200 hospitalized patients: a quality control study.

BACKGROUND & AIMS: Optimal implementation of parenteral nutrition (PN) is required to promote clinical outcome and costs control. This prospective quality control study examined if PN prescription was justified and PN administration was adequate to cover the nutritional needs of patients hospitalized in the Geneva University Hospital. METHODS: Two-hundred consecutive patients receiving PN were included from Medicine, Intensive Care or Surgery Units. PN prescription was considered justified if oral feeding or enteral nutrition were contraindicated or provided less than 40% of the energy target after 5 days. PN was considered adequate if it covered 90%-110% of the recommended need for energy (i.e., 110% of the Harris-Benedict formula) and proteins (i.e., 1.2 or 1.0 g protein/kg body weight/day for patients < or = or >65 years, respectively), and was supplemented with vitamins and trace elements. RESULTS: PN prescription was justified in all but 14 patients (7%). However, PN administration was frequently inadequate: overfeeding (62%) was more often observed than underfeeding (14%), particularly among thin, elderly and female patients (P<0.01). Moreover, PN was not supplemented with vitamins and/or trace elements in 47 patients (24%). CONCLUSION: PN prescription is generally justified but PN administration is often inadequate. Further teaching of medical teams and quality control surveys are warranted to optimize PN practices.