Malnutrition and Laboratory Markers in Geriatric Patients. A Comparison of Neurologic-psychiatric, Internal and Trauma Surgical Diseases.

OBJECTIVES: There is minimal information on malnutrition in neurologic-psychiatric patients compared to internal and trauma-surgical patients. The aim of the present study was to explore if there is a correlation of these different disease groups with the nutritional assessment and biochemical markers. DESIGN: Cross - sectional study. SETTING AND PARTICIPANTS: The study was done in a department of geriatric medicine with subspecialisation in neurologic diseases and stroke unit. 338 patients (m / f = 136 / 202, mean age 81.4 ± 7.3 years) were evaluated. MEASUREMENTS: The nutritional status was evaluated by using the short form of the Mini Nutritional Assessment (MNA-SF) and seven biochemical markers (hemoglobin, iron, ferritin, vitamin B 12, folic acid, albumin and cholinesterase) were measured. RESULTS: There were 74 (22%) patients with MNA ≤ 7 points (malnutrition), 148 (44%) patients with an MNA 8 - 11 points (risk of malnutrition) and 116 (34%) patients with an MNA ≥ 12 points (good nutritional status). The mean MNA score of the three major disease groups trauma-surgery, internal medicine and neurology-psychiatry was 9.1 ± 3.2 vs. 9.9 ± 3.1 vs. 10.0 ± 2.8 (p=0.236). There were significant differences of laboratory markers between the disease groups. A deficit of albumin, cholinesterase and hemoglobin was found more often in trauma-surgical and internal patients than in neurological-psychiatric patients (albumin: 21.4%, 15.7%, 5.3%; p=0.001; cholinesterase 16.7%, 16.9%, 6.3%; p=0.007; hemoglobin 78.6%, 61.4%, 50.0%; p=0.002). CONCLUSIONS: Following Mini Nutritional Assessment, the additional measurement of albumin, cholinesterase and hemoglobin allowed a more precise grading of malnutrition. There were significant differences between the disease groups. A deficit of albumin, cholinesterase and hemoglobin was found more often in multimorbid trauma-surgical and internal patients than in neurologic-psychiatric patients.

[Atypical celiac disease in a patient with type 1 diabetes mellitus and Hashimoto's thyreoiditis]. / Atypische Sprue bei einem Patienten mit Diabetes mellitus Typ 1 und Hashimoto-Thyreoiditis.

HISTORY AND ADMISSION FINDINGS: A 49-year-old man presented with a four-week history of fatigue and physical weakness. He was of slender build (BMI 19,5 kg/m (2)) and pale. He also had vitiligo. Diabetes mellitus type 1 and Hashimoto thyreoiditis had been previously diagnosed. INVESTIGATIONS: Laboratory tests revealed iron deficiency anemia with depleted iron reserves (hemoglobin 5,9 g/dl; normal range 14,0 - 18,0). Vitamin B (12) and folic acid were also low. A probable cause was thought to be malabsorption. Antibodies against endomysium and tissue transglutaminase were elevated. Esophagogastroduodenoscopy and videocapsule endoscopy showed villous atrophy in the duodenum and jejunum. Histomorphological findings were compatible with celiac disease (Marsh stage 3a). Osteodensitometry showed significantly lowered bone density. DIAGNOSIS, TREATMENT AND COURSE: These investigations indicated atypical celiac disease with malabsorption, anemia and osteoporosis. The patient received nutritional counseling and was put on a gluten-free diet. Supplementary iron, folic acid and vitamin B (12) were prescribed. A bloodtransfusion was given for the symptomatic anemia. The osteoporosis was treated with calcium and vitamin D3. A follow-up examination after four months revealed complete remission of the abnormal clinical and laboratory findings with partial remission of endoscopic and histologic changes (reduced to Marsh stage 2). CONCLUSION: Because of the lack of gastrointestinal symptoms, the diagnosis of atypical celiac disease is often made only at an advanced stage and advanced age. The disease is often associated with other autoimmune disorders.