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December 7th 2018
By: Sarah Bedford, M.S.
University of Wisconsin-Green Bay |Dietetic Intern
Malnutrition & Sarcopenia
in Geriatrics
What to expect:
Introduction to Malnutrition & Sarcopenia
A Look at Current Research
My thoughts
A Take Away Message for Your
Professional Practice
TODAYonline (2017). [photograph]. Retrieved from: https://www.todayonline.com/singapore/half-spores-
elderly-found-be-frail-mostly-due-malnutrition
Why I chose this topic
Images: Bedford, S. Malnutrition and sarcopenia in Geriatrics. (2018)
Review of Terminology
Risk Factors
High Risk Score on
AssessmentMalnutrition
Review of Terminology
Risk Factors
High Risk Score on
AssessmentSarcopenia
Definition = clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or physical performance
Malnutrition and sarcopenia are accelerated in hospitalized older adults:
increase length of stay & re-hospitalization rates
Increases frequency & severity of complications
Overview of Malnutrition Sarcopenia Syndrome (MSS)
President’s Council on Bioethics. (2002). Illustrating progressive age-related loss of muscle tissue. Retrieved from:
https://bioethicsarchive.georgetown.edu/pcbe/background/strong_muscles.html
Normal muscle Sarcopenia
Vandewoud et al. (2012)
Hu, X., Zhang, L., Wang, H., Hao, Q., Dong, B., & Yang, M.
Scientific Reports | 2017
Malnutrition-sarcopenia syndrome
predicts mortality in hospitalized
older patients
Study #1
Study #1 : Objective & Subjects
Aimed to Identify:
• prevalence of malnutrition, sarcopenia, & MSS
• association between MSS & long-term mortality
Sample Population:
• Hospitalized adults 60+ years old (n = 414)
• Exclusion Criteria: acute life threatening diseases, severe cognitive impairment, delirium, & edema
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Hu, X. et al. Scientific Reports. (2017)
1. Interviews to gather
demographics and take
anthropometric measurements
2. Sarcopenia Screening
3. Nutritional Assessment via MNA
4. Follow up completed 12, 24, 36
months to assess survival rate
Study #1: Research Methods
Amazon. (2018). CAMRY Digital Hand Held Dynamometer [photograph].
Retrieved from: https://www.amazon.com/CAMRY-Dynamometer-
Strength-Measurement-Capturing/dp/B00A8K4L84
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients.
Hu, X. et al. Scientific Reports. (2017)
Study #1 Results
Figure 2. Venn diagram
illustrating the overlap
between malnutrition
risk, malnutrition, and
sarcopenia
4.9% individuals had MSS
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Hu, X. et al. Scientific Reports. (2017)
Study #1 Results
Figure 3. Survival curves
of the study population
according to sarcopenia
and nutritional status at
baseline
Red Line: MSS
Purple Line: Malnutrition
risk & sarcopenia
Survival curves
significantly
differed
(p<0.001)
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Hu, X. et al. Scientific Reports. (2017)
Study #1: Strengths & Limitations
Strengths
• Factoring MNA results with & without BMI
• Utilization of standardized assessments
Limitation
• Diagnosis of MSS is new and still evolving
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Hu, X. et al. Scientific Reports. (2017)
Article #1Final Conclusion
Statement
“Older inpatients with MSS or with a combination of
malnutrition risk & sarcopenia are at increased risk of long term all cause
mortality”
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized
older patients. Hu, X. et al. Scientific Reports. (2017)
Research Quality Rating = Positive
Rodriguez, D., Marco, E., Moreno, N., Miralles, R., Ibar, O., Escalada, F., Muniesa, J.
Journal of Clinical Nutrition | 2016
Prevalence of malnutrition and
sarcopenia in a post-acute care geriatric
unit: Applying new ESPEN definition
and EWGSOP criteria
Article #2
Study #2: Objective & Subjects
Aimed to Determine:
• prevalence of malnutrition and sarcopenia
• the potential relationship between the syndromes
Sample Population:
• Patients in post-acute geriatric rehab in Spain (n=88)
• Exclusion Criteria: general and/or cognitive condition prevented administering diagnosis tests
Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit: Applying new ESPEN definition and EWGSOP criteria. Rodriguez et al.Journal of Clinical Nutrition. (2016).
1. Interviews gathered information on unintentional weight loss
2. Nutritional Assessment via MNA Short Form
3. Sarcopenia Screening
4. Evaluation of lab values (albumin, iron profile, total protein, urea levels)
Study #2: Research Methods
Nestle Nutrition Institute. (2009). Mini Nutritional Assessment MNA [PDF].
Retrieved from: https://www.mna-elderly.com/forms/mini/mna_mini_english.pdf
Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit: Applying new ESPEN definition and
EWGSOP criteria. Rodriguez et al.Journal of Clinical Nutrition. (2016).
Study #2 Results
Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit: Applying new ESPEN definition and EWGSOP criteria. Rodriguez et al.Journal of Clinical Nutrition. (2016).
Study #2: Strengths & Limitations
Strengths
• Followed standard assessment guidelines
• Acknowledged limitation in lab values
Limitations
• Can be a challenge to gather information in this population
• Observation study design vs longitudinal
Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit: Applying new ESPEN definition and EWGSOP criteria. Rodriguez et al.Journal of Clinical Nutrition. (2016).
Article #2 Final Conclusion
Statement
Sarcopenia is more prevalent in malnourished
post-acute geriatric patients. More research is needed to evaluate if the
combination of syndromes
Prevalence of Malnutrition and sarcopenia in a post-acute care geriatric unit:
Applying new ESPEN definition and EWGSOP criteria. Rodriguez et al.
Journal of Clinical Nutrition. (2016).
Research Quality Rating = Positive
Pierik et al. | BioMed Central Geriatrics | 2016
High risk of malnutrition is
associated with low muscle mass in
older hospitalized patients – a
prospective cohort study.
Article #3
Article #3: Objective & Subjects
Aim to Associate the risk of malnutrition with:
1) Muscle strength & mass at admission
2) Change of muscle strength & mass during hospitalization
Sample Population:
• Hospitalized adults of 70+ years from Amsterdam (n=176)
• Exclusion Criteria: expected length of stay <24hrs, Isolation needed or Terminally ill, Did not speak Dutch, Unwillingness to participate
High risk of malnutrition is associated with low muscle mass in older hospitalized patients – a prospective cohort study. Pierik et al. BMC Geriatrics. (2016).
1. Interviews & Medical records to
gather demographics and general
lifestyle information
2. Malnutrition was assessed via SNAQ
3. Muscle Strength assessed using hand
grip strength
4. Muscle Mass was assessed using BIA
with adjustments
Study #3: Research Methods
36 Questionnaire Examples. (2018). Short Nutritional Assessment Questionnaire
[photograph]. Retrieved from: https://www.examples.com/education/assessment-
questionnaire.html
High risk of malnutrition is associated with low muscle mass in older hospitalized
patients – a prospective cohort study. Pierik et al. BMC Geriatrics. (2016).
34.8% screened as high risk
malnutrition via SNAQ
High malnutrition risk was significantly associated with lower skeletal muscle (odds
ratio 0.90)
No differences in the change of muscle strength and muscle
mass parameters during hospitalization were found
dependent on level of malnutrition risk
Article #3
Results
High risk of malnutrition is associated with low muscle mass in older hospitalized patients – a prospective cohort study. Pierik et al. BMC Geriatrics. (2016).
Article #3: Strengths & Limitations
Strength
• Included a variety of conditions
Limitations
• BIA can be influenced by hydration status
• Small population size
• Observational study design
High risk of malnutrition is associated with low muscle mass in older hospitalized patients – a prospective cohort study. Pierik et al. BMC Geriatrics. (2016).
Article #3Final Conclusion
Statement
“In older hospitalized patients a high risk of malnutrition was
significantly associated with lower absolute skeletal muscle at admission but not muscle
strength.”
High risk of malnutrition is associated with low muscle mass in older
hospitalized patients – a prospective cohort study. Pierik et al. BMC
Geriatrics. (2016).
Research Quality Rating = Neutral
Summary of Article Conclusions
Study #1
• Hospitalized older adults who screened for sarcopenia and malnutrition (& risk) are at increased risk of long term mortality
Study #2
• Sarcopenia was more prevalent in individuals with malnutrition
• 37.5% positively screened for sarcopenia – 90.9% had malnutrition
Study #3
• In hospitalized older adults, high risk malnutrition is associated with lower muscle mass but not muscle strength at admission
(Pierik et al., 2016)
(Rodriguez et al., 2016)
(Hu et al., 2017)
My Opinions & Thoughts
More research is needed. . .
Utilization of Nutrition Focus Physical
Exam to detect the conditions
Importance on strength and overall
physical function in nutrition
interviews
Image: Bedford, S. Malnutrition and sarcopenia in Geriatrics. (2018)
Take Home Messages
1. Malnutrition Sarcopenia Syndrome may be a potential diagnosis in the future.
2. Important to evaluate overall strength & function during nutritional assessments to better understand a
geriatric patient’s whole story
ReferencesStudy References:
(Study #1) Hu, X., Zhang, L., Wang, H., Hao, Q., Dong, B., & Yang, M. (2017). Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Scientific Reports, 7:3171, 1-9. DOI:10.1038/s41598-017-03388-3
(Study #3) Pierik, V., Meskers, C., Ancum, J., Numans, S., Verlaan, S., Scheerman, K., Kruizinga, R., Maier, A. (2017). High risk of malnutrition is associated with low muscle mass in older hospitalized patients – a prospective cohort study. BMC Geriatrics, 17:118, 1-8. DOI 10.1186/s12877-017-0505-5
(Study #2) Rodriguez, D., Marco, E., Moreno, N., Miralles, R., Ibar, O., Escalada, F., Muniesa, J. (2016). Prevalence of malnutrition and sarcopenia in a post-acute care geriatric unit: Applying the new ESPEN definition and EWGSOP criteria. Clinical Nutrition, 36, 1339-1344. http://dx.doi.org/10.1016/j.clnu.2016.08.024
Other References:
◦ Vandewoude, M., Alish, C., Sauer, A., & Hegazi, R. (2012). Malnutrition-Sarcopenia Syndrome: Is This the Future of Nutrition Screening and Assessment for Older Adults. Journal of Aging Research, 2012, 1-8. doi:10.1155/2012/651570
◦ Width, M., Reinhard, T. (2018). The Essential Pocket Guide for Clinical Nutrition Second Edition. Wolters Kluwer.
Malnutrition & Sarcopenia in Geriatrics
By: Sarah Bedford, M.S.
https://uwgbresearchreviews.weebly.com
Thank you!