Unintended Weight Loss in Older Adults

UWL: Screening and Assessment Methods (2009)

Citation:

Suominen M, Laine A, Routasalo P, Pitkala KH, Rasanen L. Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finnish nursing home. J Nutr Health Aging. 2004; 8 (4): 234-238.

PubMed ID: 15316587
 
Study Design:
Descriptive study
Class:
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
The purpose of the study was to measure and compare the energy and nutrient content of the served food to the recommendations, to assess the energy and nutrient intake and to determine the nutritional status of the elderly demented residents in one nursing home.
Inclusion Criteria:
Residence in one of two wards of a Helsinki nursing home.
Exclusion Criteria:
None mentioned. 
Description of Study Protocol:
  • Recruitment: Not described
  • Design: Descriptive study. Nutrient content of food served was calculated from recipes, food served was weighed and the amount left uneaten was weighed and subtracted from food service for a 14-day period. 
  • Blinding used: Not described
  • Intervention: None
  • Statistical analysis: None.
Data Collection Summary:

Timing of Measurements

Nutrient content of food served was calculated from recipes, food served was weighed and the amount left uneaten was weighed and subtracted from food service for a 14-day period.

Dependent Variables

Food and nutrient intake.

Independent Variables

  • Food served
  • Patients were evaluated using the Mini Nutrition Assessment.
Description of Actual Data Sample:
  • Initial N: 23 subjects, all female
  • Attrition (final N): 23
  • Age: Mean of 82 years (range of 69 to 89)
  • Ethnicity: Not discussed
  • Other relevant demographics: All were female with moderate to severe dementia, according to the Mini Mental Status Evaluation

Anthropometrics

  • Average height: 159cm (range, 146cm to 170cm)
  • Average weight: 63kg (range, 44kg to 90kg)
  • Less than half had a BMI of 23 or greater
  • More than half (57%) had not lost weight during the previous three months
  • All were able to get out of bed, but they did not go outdoors. 

Location

Helsinki, Finland.

Summary of Results:

 

Supply

 

Intake

 

Recommendation

 

Energy (kcal)
1,665
1,205
1,570 to 1,850

Energy (kJ)

7,411

5,400

6,500 to 7,700

Protein (E%)

19.3

19.5

10 to 15 (-20)

Fat (E%)

34.7

28.2

<30

Saturated Fatty Acids (E%)
16.3
12.4
<10
Monounsaturated Fatty Acids (E%)
10.3
8.6
10 to 15
Polyunsaturated Fatty Acids (E%)
3.9
3.9
5 to 10
Carbohydrates (E%)
46.0
52.3
>55

Other Findings

  • Most residents ate independently, but 20 residents were at risk of malnutrition and three were malnourished, according to the MNA
  • Food served was deficient in Vitamin D, Vitamin E and folic acid.
Author Conclusion:

It may be possible to get enough nutrients from food served, but many residents did not eat enough. 

Funding Source:
Reviewer Comments:
  • Inclusion or exclusion criteria and recruitment methods were not described
  • Authors note limitation of a small number of assessed subjects
  • Statistical analysis not performed.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? N/A
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? N/A
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? ???
  2.2. Were criteria applied equally to all study groups? ???
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? ???
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) ???
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? N/A
  8.1. Were statistical analyses adequately described and the results reported appropriately? N/A
  8.2. Were correct statistical tests used and assumptions of test not violated? N/A
  8.3. Were statistics reported with levels of significance and/or confidence intervals? N/A
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? N/A
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes