Nutritional predictors of mortality after discharge in elderly patients on a medical ward.

BACKGROUND: Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. MATERIALS AND METHODS: This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. RESULTS: Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004). CONCLUSIONS: The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.

Impact of lifestyle on metabolic syndrome in apparently healthy people.

Parallel to the increase in obesity, the prevalence of metabolic syndrome (MetS) is continually increasing, with increased risk of diabetes and cardiovascular atherosclerosis diseases. Despite the importance of this public health problem, the relative impact of diet and physical activity on MetS prevalence has yet to be established. We investigated the association between lifestyle, in terms of both habitual dietary pattern and physical activity, and MetS in a cohort of adults without known diabetes and atherosclerotic cardiovascular disease. Four hundred seventy-seven randomly selected adult participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire and a questionnaire on physical activity, and underwent routine laboratory blood measurements. MetS was identified in 24.7% of the cohort. Dietary patterns were not significantly different (P = 0.31) between the groups (with or without MetS). The habitual physical activity level was significantly lower (P = 0.011) in the group with MetS. In particular, the prevalence of sedentary participants was 58.1% in the group with MetS, and 43.9% in the group without MetS. Multivariate analysis revealed that MetS was associated with age (OR = 1.06, 95% CI 1.03-1.08) and physical activity level (light vs. sedentary: OR = 0.53, 95% CI 0.32-0.87; moderate/heavy vs. sedentary: OR = 0.31, 95% CI 0.13-0.75). This study suggests that inadequate physical activity level is associated with MetS. Our results are therefore consonant with the notion of healthier lifestyle changes to counteract the epidemic of diabetes and cardiovascular disease, though adequate interventional trials will be needed in high-risk populations.

Habitual street food intake and subclinical carotid atherosclerosis.

Street food (SF) is defined as out-of-home food consumption, and generally consists of energy-dense meals rich in saturated fats and poor in fibers, vitamins and antioxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with atherosclerosis has not been considered. The association between habitual SF consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, was therefore investigated. One thousand thirty-five randomly selected adult participants without known diabetes and atherosclerotic cardiovascular diseases were cross-sectionally investigated in Palermo, Italy. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 541 participants. A score of SF consumption was obtained by categorizing each of ten SFs consumed more or less than once a month. Participants were divided into three classes based on the tertiles of SF score distribution. Age, gender distribution, body mass index (BMI), prevalence of hypertension and of clinically silent carotid atherosclerosis (I tertile 20.8 %, II tertile 19.7 %, III tertile 19.0 %; P = 0.85) were not significantly different among the three groups. Clinically silent carotid atherosclerosis was independently associated with age, gender and hypertension. The score of SF consumption was significantly correlated with BMI (r = 0.10; P = 0.04), uric acid (r = 0.16; P = 0.002) and high-density lipoproteins-cholesterol (r = -0.13; P = 0.009) blood concentrations. In conclusion, this study suggests that SF consumption is not associated with clinically silent carotid atherosclerosis. However, given the association of SF consumption with other cardiovascular risk factors, caution requires that this category of food should be limited in patients at high cardiovascular risk.

Impact of chronic diuretic treatment on glucose homeostasis.

BACKGROUND: The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory. METHODS: This study investigated whether diuretic use is associated with markers of metabolic and cardiovascular risk, such as insulin-resistance and uric acid, in a cohort of adults without known diabetes and/or atherosclerotic cardiovascular disease. Nine hundred sixty-nine randomly selected participants answered a questionnaire on clinical history and dietary habits. Laboratory blood measurements were obtained in 507 participants. RESULTS: Previously undiagnosed type 2 diabetes was recognized in 4.2% of participants who were on diuretics (n = 71), and in 2% of those who were not (n = 890; P = 0.53). Pre-diabetes was diagnosed in 38% of patients who were on diuretics, and in 17.4% (P < 0.001) of those who were not. Multivariate analysis showed that insulin-resistance (HOMA-IR) was associated with the use of diuretics (P = 0.002) independent of other well-known predisposing factors, such as diet, physical activity, body mass index, and waist circumference. The use of diuretics was also independently associated with fasting plasma glucose concentrations (P = 0.001) and uric acid concentrations (P = 0.01). CONCLUSIONS: The use of diuretics is associated with insulin-resistance and serum uric acid levels and may contribute to abnormal glucose tolerance.