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3.
Adv Nutr ; 10(suppl_2): S105-S119, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31089731

RESUMO

Nutrition is a modifiable factor potentially related to aging. Milk and other dairy products may contribute to the prevention of physical and cognitive impairment. We conducted a systematic review to investigate the effectiveness of dairy product intake for preventing cognitive decline, sarcopenia, and frailty in the elderly population. A systematic search for publications in electronic databases [MEDLINE via PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] from 2009 to 2018 identified observational and interventional studies in English and Spanish that tested the relation between dairy product consumption and cognitive decline, sarcopenia, and frailty in community-dwelling older people. We assessed the participants, the type of exposure or intervention, the outcomes, and the quality of evidence. We screened a total of 661 records and included 6 studies (5 observational prospective cohort studies and 1 randomized controlled trial). Regarding cognitive impairment, the relation cannot be firmly established. Consumption of milk at midlife may be negatively associated with verbal memory performance. In older women, high intakes of dairy desserts and ice cream were associated with cognitive decline. On the other hand, 1 study demonstrated a significant inverse relation between dairy intake and development of Alzheimer disease among older Japanese subjects. The consumption of dairy products by older people may reduce the risk of frailty, especially with high consumption of low-fat milk and yogurt, and may also reduce the risk of sarcopenia by improving skeletal muscle mass through the addition of nutrient-rich dairy proteins (ricotta cheese) to the habitual diet. Despite the scarcity of evidence on the topic, our systematic review shows that there are some positive effects of dairy products on frailty and sarcopenia, whereas studies concerning cognitive decline have contradictory findings.


Assuntos
Cognição/efeitos dos fármacos , Laticínios , Dieta , Comportamento Alimentar , Fragilidade/prevenção & controle , Músculo Esquelético/efeitos dos fármacos , Sarcopenia/prevenção & controle , Idoso , Envelhecimento , Animais , Demência/prevenção & controle , Gorduras na Dieta/administração & dosagem , Proteínas na Dieta/farmacologia , Humanos , Leite , Músculo Esquelético/metabolismo , Sarcopenia/metabolismo
4.
Adv Nutr ; 10(suppl_2): S120-S143, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31089740

RESUMO

Nutrition plays an important role in bone health. The aim of our study was to update the evidence regarding dairy intake, osteoporotic fracture (OF) risk, and prospective bone mass density (BMD) evolution assessed by dual-energy X-ray absorptiometry in Europeans and non-Hispanic whites from North America. A systematic search was conducted in MEDLINE, EMBASE, and Scopus for papers published from 1 January, 2000 to 30 April, 2018. The eligibility criteria were as follows: healthy adults; measurable dairy exposure; hip, vertebral, wrist or OF as outcomes; and cohort or case-control studies. Two independent investigators conducted the search and the data extraction. A pooled analysis was conducted with random-effects models. Publication bias and meta-regression were considered. Ten cohort studies relating to OF risk were selected for meta-analysis. Three papers reporting BMD changes associated with dairy intake could not be aggregated in the meta-analysis. The pooled HRs of the highest compared with the lowest levels of dairy intake were 0.95 (95% CI: 0.87, 1.03; I2 = 82.9%; P-heterogeneity < 0.001) for OF at any site; 0.87 (95% CI: 0.75, 1.01; I2 = 86.7%; P-heterogeneity < 0.001) for hip fractures; and 0.82 (95% CI: 0.68, 0.99; I2 = 0.0%; P-heterogeneity = 0.512) for vertebral fractures. Concerning BMD, the selected studies described a 1.7-3% lower hip BMD in young and postmenopausal women with poor intake of milk in their youth, a positive relationship between baseline milk ingestion and the percentage of trochanter BMD change in elderly people, and a positive correlation between milk consumption and BMD change at the radius in women aged >65 y. In conclusion, in the studied population, the highest consumption of dairy products did not show a clear association with the total OF or hip fracture risks; however, a diminished risk of vertebral fracture could be described. The results regarding BMD change were heterogeneous and did not allow for a definitive conclusion.


Assuntos
Osso e Ossos , Laticínios , Dieta , Grupo com Ancestrais do Continente Europeu , Comportamento Alimentar , Fraturas Ósseas/prevenção & controle , Osteoporose/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Densidade Óssea , Osso e Ossos/lesões , Osso e Ossos/metabolismo , Europa (Continente) , Feminino , Fraturas do Quadril/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Leite , América do Norte , Fraturas por Osteoporose/prevenção & controle , Fraturas da Coluna Vertebral/prevenção & controle , Adulto Jovem
5.
Eur J Intern Med ; 65: 69-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076345

RESUMO

BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

6.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 27-35, feb. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182433

RESUMO

Objetivos: Demostrar la eficacia de una intervención integral en la transición de cuidados (Plan de Alta Guiado Multinivel, PAGM) para disminuir eventos adversos a 30 días en ancianos frágiles con insuficiencia cardiaca aguda (ICA) dados de alta desde servicios de urgencias (SU) y validar los resultados de dicha intervención en condiciones reales. Método: Se seleccionarán pacientes mayores de 70 años frágiles con diagnóstico principal de ICA dados del alta a su domicilio desde SU. La intervención consistirá en aplicar un PAGM: 1) lista de verificación sobre recomendaciones clínicas y activación de recursos; 2) programación de visita precoz; 3) transmisión de información a atención primaria; 4) hoja de instrucciones al paciente por escrito. Fase 1: ensayo clínico con asignación al azar por conglomerados emparejado. Se asignará de forma aleatoria 10 SU (N = 480) al grupo de intervención y 10 SU (N = 480) al grupo de control. Se compararán los resultados entre grupo de intervención y control. Fase 2: estudio cuasi-experimental. Se realizará la intervención en los 20 SU (N = 300). Se comparará los resultados entre la fase 1 y 2 del grupo de intervención y entre la fase 1 y 2 del grupo de control. La variable principal de resultado es compuesta (revisita a urgencias u hospitalización por ICA o mortalidad de origen cardiovascular) a los 30 días del alta. Conclusiones: El estudio valorará la eficacia y factibilidad de una intervención integral en la transición de cuidados para reducir resultados adversos a 30 días en ancianos frágiles con ICA dados de alta desde los SU


Objectives: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. Method: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. Conclusions: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home


Assuntos
Humanos , Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Transferência de Pacientes , Alta do Paciente , Doença Aguda , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
7.
Emergencias ; 31(1): 27-35, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656870

RESUMO

OBJECTIVES: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. MATERIAL AND METHODS: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. CONCLUSION: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.


Assuntos
Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Alta do Paciente , Transferência de Pacientes , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
8.
Nutr Hosp ; 34(5): 1267-1274, 2017 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-29280638

RESUMO

BACKGROUND: Enteral nutrition (EN) is an effective nutritional intervention for patients at risk of malnutrition or malnourished. However, complications such as gastrointestinal intolerance, hyperglycemia or refeeding syndrome can be triggered by EN. AIM: To investigate the effects of a tube feeding formula (TFF) on patients' nutritional status, biochemical status, bowel habits and safety. METHODOLOGY: Observational, prospective and multicenter study. Patients ≥ 18 years, undernourished or at nutritional risk, who were prescribed a high-calorie, high-protein, fiber-fortified TFF were included. Patients were evaluated over a period of eight weeks (baseline [V1], four weeks [V2] and eight weeks [V3]). RESULTS: A statistically significant increase in weight (1.5 kg), body mass index (0.6 kg/m2) and nutritional intake (59.7 kcal/day) was observed between V1 and V2. Between V1 and V3, there was a statistically significant decrease in the percentage of individuals with abnormal biochemical markers for glucose, potassium, total protein and albumin. The number of patients' bowel movements remained stable throughout the study with a mean of 1.1 daily bowel movements. CONCLUSION: The TFF was safe and well tolerated, improving patients' nutritional status without altering patients' bowel habits.


Assuntos
Fibras na Dieta , Ingestão de Energia , Nutrição Enteral/métodos , Alimentos Formulados , Idoso , Idoso de 80 Anos ou mais , Defecação , Nutrição Enteral/efeitos adversos , Feminino , Alimentos Formulados/efeitos adversos , Humanos , Masculino , Estado Nutricional , Oligossacarídeos , Estudos Prospectivos , Espanha
9.
Nutr. hosp ; 34(6): 1267-1274, nov.-dic. 2017. tab, graf
Artigo em Inglês | IBECS | ID: ibc-168962

RESUMO

Background: Enteral nutrition (EN) is an effective nutritional intervention for patients at risk of malnutrition or malnourished. However, complications such as gastrointestinal intolerance, hyperglycemia or refeeding syndrome can be triggered by EN. Aim: To investigate the effects of a tube feeding formula (TFF) on patients' nutritional status, biochemical status, bowel habits and safety. Methodology: Observational, prospective and multicenter study. Patients ≥ 18 years, undernourished or at nutritional risk, who were prescribed a high-calorie, high-protein, fiber-fortified TFF were included. Patients were evaluated over a period of eight weeks (baseline [V1], four weeks [V2] and eight weeks [V3]). Results: A statistically significant increase in weight (1.5 kg), body mass index (0.6 kg/m2) and nutritional intake (59.7 kcal/day) was observed between V1 and V2. Between V1 and V3, there was a statistically significant decrease in the percentage of individuals with abnormal biochemical markers for glucose, potassium, total protein and albumin. The number of patients’ bowel movements remained stable throughout the study with a mean of 1.1 daily bowel movements. Conclusion: The TFF was safe and well tolerated, improving patients’ nutritional status without altering patients' bowel habits (AU)


Introducción: la nutrición enteral es una intervención efectiva para pacientes desnutridos o en riesgo de sufrir desnutrición. Sin embargo, puede desencadenar complicaciones como intolerancia gastrointestinal, hiperglicemia o síndrome de realimentación. Objetivo: investigar los efectos de una fórmula de nutrición enteral por sonda en el estado nutricional y bioquímico, hábitos gastrointestinales y seguridad de los pacientes. Metodología: estudio observacional, prospectivo y multicéntrico. Se incluyeron pacientes ≥ 18 años, desnutridos o en riesgo de desnutrición, tributarios de recibir una fórmula de nutrición enteral hipercalórica, hiperproteica, y rica en fibra y fructooligosacáridos. Los pacientes fueron evaluados durante 8 semanas en 3 visitas (V1, inicial; V2, 4 semanas; V3, 8 semanas). Resultados: entre V1 y V2 se observó un incremento estadísticamente significativo en peso (1,5 kg), índice de masa corporal (0,6 kg/m2) e ingesta calórica (59,7 kcal/día). Entre V1 y V3, existió un descenso en el porcentaje de pacientes con valores anormales de glucosa, potasio, proteína total y albúmina. Los hábitos intestinales se mantuvieron estables durante el estudio (1,1 deposiciones diarias de media). Conclusión: la fórmula fue segura, tolerada, y mejoró el estado nutricional del paciente sin alterar los hábitos intestinales (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional/fisiologia , Nutrição Enteral/métodos , Deficiência de Proteína/dietoterapia , Deficiência de Proteína/epidemiologia , Desnutrição Proteico-Calórica/dietoterapia , Oligossacarídeos/uso terapêutico , Estudos Prospectivos , Análise Estatística
10.
Nutr. hosp., Supl ; 6(separata 1): 49-59, mayo 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-120649

RESUMO

El abordaje de la nutrición en el paciente anciano requiere entender la desnutrición desde un punto de vista general. A los cambios fisiológicos que acompañan al envejecimiento se añaden con frecuencia comorbilidades que modulan y complican cualquier tipo de intervención. Es por ello que en Geriatría se acepta de forma universal una aproximación global, que considera tanto los aspectos médicos como aquellas vertientes funcionales y sociales que sin duda intervienen en el soporte nutricional. Igualmente interesa destacar la heterogeneidad de la población anciana en relación con la situación funcional y cognitiva, lo que hace que el estudio del anciano se realice en los diferentes niveles asistenciales: domicilio, residencias de ancianos y hospitales, tanto de agudos como demedia y larga estancia. Este dato es fundamental, pues las cifras de prevalencia de desnutrición varían en función del contexto de estudio, con un incremento relacionado con el grado de institucionalización. Se sabe que la situación general del individuo, en términos de comorbilidad, situación cognitiva, independencia funcional y situación nutricional predice con exactitud el pronóstico en unida desde larga estancia, especialmente en lo relacionado con la mortalidad (AU)


Nutritional intervention in the elderly means understanding nutrition as a global matter. Not only physiological changes but also added comorbidity complicates any kind of intervention. This is the reason why medical, functional and social peculiarities are studied and considered to assess the elderly patient. It is interesting to point out the heterogeneity of the ageing population indifferent aspects such as functional and cognitive status that motivate an assessment in multiple contexts: community, nursing homes and hospitals (including acute care units and long term care units). This aspect is important taking into account the prevalence according to the assistant level, with increased values depending on the institutionalization degree. Health status of the elderly in terms of comorbidity, cognitive status, functional autonomy and nutritional status predicts long term care prognosis, specially related to mortality (AU)


Assuntos
Humanos , Dinâmica Populacional , Avaliação Nutricional , Nutrição do Idoso , Transtornos Nutricionais/epidemiologia , Impactos na Saúde , Apoio Nutricional , Comorbidade , Avaliação Geriátrica/métodos , Envelhecimento/fisiologia
11.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 46(2): 100-110, mar.-abr. 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-87997

RESUMO

La sarcopenia es un síndrome geriátrico frecuente e importante para la práctica clínica diaria de los profesionales que trabajan con personas mayores. El número de personas mayores afectadas y su relación con la incapacidad, la fragilidad, muchas enfermedades, hábitos de vida y resultados adversos son de gran relevancia para la práctica geriátrica. Además, los cambios biológicos que conducen a la pérdida de fuerza y masa muscular se relacionan intrínsecamente con los mecanismos del envejecimiento. No es, por tanto, sorprendente que la investigación en este campo esté creciendo exponencialmente en los últimos años y que la sarcopenia se haya colocado en los últimos años en el primer plano del interés geriátrico y gerontológico. La Sociedad Española de Geriatría y Gerontología ha creado recientemente un Observatorio de la Sarcopenia, que pretende promover actividades formativas y de investigación en este campo. La primera actividad del Observatorio ha sido poner a disposición de nuestra comunidad científica una revisión de la situación actual de la sarcopenia, que permita unificar conceptos y aumentar el interés en este prometedor campo de la geriatría(AU)


Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology. The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Força Muscular/fisiologia , Sociedades Médicas/ética , Sociedades Médicas/normas , Envelhecimento/patologia , Músculos/fisiopatologia , Fatores de Risco , Terapia por Exercício , Exercício/fisiologia , Contração Muscular/fisiologia , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Síndrome
12.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 41(6): 340-356, nov. 2006. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-050926

RESUMO

La desnutrición calórico-proteica es frecuente en el anciano hospitalizado. La presencia de este diagnóstico condiciona el pronóstico clínico, así que su detección y tratamiento parecen prioritarios en el plan terapéutico del paciente. Todos los hospitales deberían implantar sistemas de cribado sistemático de desnutrición asociado a un plan de cuidados. Algunas estrategias útiles para mejorar la situación nutricional del anciano son: la modificación de la dieta hospitalaria, incluidas las comidas de alta densidad calórico-proteica, y la utilización de medidas de soporte nutricional, como el suplemento oral o enteral, la nutrición enteral y la nutrición parenteral. En el artículo se repasa desde la evidencia disponible hasta los beneficios que pueden esperarse de todas estas alternativas. Son necesarios más estudios de calidad para responder a los interrogantes del efecto sobre episodios importantes, como capacidad funcional y calidad de vida. Las evidencias en diagnósticos específicos llevan a concretar en mayor medida las ventajas atribuibles a cada posibilidad nutricional


Protein-caloric malnutrition is common in hospitalized elderly patients. The presence of this diagnosis affects clinical prognosis and consequently its detection and treatment are a priority. All hospitals should implement systematic malnutrition screening systems associated with a care plan. Useful strategies to improve nutritional status in the elderly are modifying the hospital diet by including meals with a high protein-caloric density, and the use of nutritional support measures such as oral or enteral supplementation and enteral and parenteral nutrition. Based on the available evidence, the present article reviews the benefits that can be expected from all these alternatives. Further, high-quality studies are required to answer questions on the effect of these measures on significant events such as functional capacity and quality of life. The evidence on specific diagnoses allows the advantages of each nutritional modality to be evaluated more precisely


Assuntos
Idoso , Humanos , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/dietoterapia , Suplementos Nutricionais , Nutrição Enteral , Nutrição Parenteral , Estado Nutricional , Hospitalização , Medicina Baseada em Evidências , Protocolos Clínicos , Fatores de Risco , Índice de Gravidade de Doença
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