PREVALENCE AND ASSOCIATED FACTORS OF MALNUTRITION AMONG ELDERLY PATIENTS AT AN OUTPATIENT CLINIC, COMMUNITY HOSPITAL IN THAILAND: A CROSS-SECTIONAL STUDY
Background: The number of Thais aged 60 and older has increased dramatically, and this trend will continue, making Thailand an increasingly aging society in the coming decades. The nutritional state of the elderly should be a major priority because it harms mortality and quality of life.
Methods: From August to September 2022, the prevalence and associated determinants of malnutrition were determined based on a survey and hospital records using the Mini Nutritional Assessment (MNA®) as a screening tool for malnutrition among the elderly attending the outpatient department at Bangkhla Hospital. Multinomial regression analysis accounted for any confounding factors yielding an adjusted odds ratio (aOR) and 95% confidence intervals (95%CI).
Results: This study enrolled a total of 91 individuals. Of these, 4.40% (95%CI= 0.01-0.11) of the participants were malnourished, while 18.70% (95%CI=0.11-0.28) were at risk of malnutrition. After controlling for potential confounding factors, a history of Covid-19 was associated with malnutrition (aOR=55.00, 95%CI= 2.70 to 1110.30), cancer (aOR= 25.80, 95%CI= 1.60-409.40) and gouty arthritis (aOR= 8.80, 95%CI= 1.20-59.60) was similarly associated with at risk of malnutrition. However, the protective effect of exercise was associated with malnutrition and risk of malnutrition, respectively (aOR= 0.04, 0.13, 95%CI= 0.00-0.80, 0.00-0.50).
Conclusion: Overall, the study emphasized the significance of addressing malnutrition which was on the rise among the elderly in community hospitals in Thailand, especially in light of the aging population. Health professionals and policymakers should be aware of the various factors associated with malnutrition and strive to implement appropriate interventions to improve the nutritional status and quality of life of the elderly.
Lorthanavanich D, Narathron N, Teerakapibal S, Rompho N,Tanvisuth A, Komazawa O. Population Aging in Thailand vol 1 Economic Research Institute for ASEAN and East Asia. 2021. https://econpapers.repec.org/bookchap/eraeriabk/2021-rpr-06
Teerawichitchainan B, Pothisiri W, Knodel J, Prachuabmoh V. Thailand’s Older Persons and Their Well-being An Update based on the 2017 Survey of Older Persons in Thailand. Angew Chemie Int Ed 2017; 6: 951-52.
Saunders J, Smith T. Malnutrition: Causes and consequences. Clin Med J R Coll Physicians London 2010; 10: 624–7. DOI: https://doi.org/10.7861/clinmedicine.10-6-624
Elia M. Defining, recognizing, and reporting malnutrition. Int J Low Extrem Wounds 2017; 16: 230–7. DOI: https://doi.org/10.1177/1534734617733902
França TGD, Ishikawa LLW, Zorzella-Pezavento SFG, Chiuso-Minicucci F, Da Cunha MLRSM, Sartori A. Impact of malnutrition on immunity and infection. J Venom Anim Toxins Incl Trop Dis 2009; 15: 374–90. DOI: https://doi.org/10.1590/S1678-91992009000300003
Bourke CD, Berkley JA, Prendergast AJ. Immune Dysfunction as a Cause and Consequence of Malnutrition. Trends Immunol [Internet] 2016; 37: 386–98. Available from: http://dx.doi.org/10.1016/j.it.2016.04.003 DOI: https://doi.org/10.1016/j.it.2016.04.003
Kupisz-Urbanska M, Marcinowska-Suchowierska E. Malnutrition in Older Adults—Effect on Falls and Fractures: A Narrative Review. Nutrients 2022; 14: 1–11. DOI: https://doi.org/10.3390/nu14153123
Bórikova I, Tomagova M, Ziakova K, Miertova M. Pharmacotherapy as a fall risk factor. Cent Eur J Nurs Midwifery 2018; 9: 832–9. DOI: https://doi.org/10.15452/CEJNM.2018.09.0012
Chuansangeam M, Wuthikraikun C, Supapueng O, Muangpaisan W. Prevalence and risk for malnutrition in older Thai people: A systematic review and meta-analysis. Asia Pac J Clin Nutr 2022; 31: 128–41.
Van Bokhorst-de van der Schueren MAE, Lonterman-Monasch S, de Vries OJ, Danner SA, Kramer MHH, Muller M. Prevalence and determinants for malnutrition in geriatric outpatients. Clin Nutr [Internet] 2013; 32: 1007–11. Available from: http://dx.doi.org/10.1016/j.clnu.2013.05.007 DOI: https://doi.org/10.1016/j.clnu.2013.05.007
Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr 2010; 29: 507–11. DOI: https://doi.org/10.1016/j.clnu.2010.01.006
Chalermsri C, Assantachai P, Pramyothin P, Pengsorn N, Muangpaisan W. Prevalence of and factors associated with undernutrition in a geriatric outpatient setting: Results from a multidimensional nutritional assessment. Siriraj Med J 2018; 70: 413–8.
Bellanti F, Buglio A lo, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients : Screening and. Nutrients 2022; 14: 1–16. DOI: https://doi.org/10.3390/nu14040910
Kang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, et al. Prevalence of malnutrition in hospitalized patients: A multicenter cross-sectional study. J Korean Med Sci 2018; 33: 1–10. DOI: https://doi.org/10.3346/jkms.2018.33.e10
Prevalence of hospital-acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: A systematic review of the evidence J Hum Nutr Diet 2022; 35: 1043-58. doi: 10.1111/ jhn.13009. Epub 2022 Apr 26. DOI: https://doi.org/10.1111/jhn.13009
Barker LA, Gout BS, Crowe TC. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011; 8: 514–27. DOI: https://doi.org/10.3390/ijerph8020514
Roubenoff R, Roubenoff RA, Preto J, Balke CW. Malnutrition Among Hospitalized Patients: A Problem of Physician Awareness. Arch Intern Med 1987;147:1462–5. DOI: https://doi.org/10.1001/archinte.147.8.1462
Dadachov M, Lambrecht RM, Hetheringtion E. An improved tungsten-188/rhenium-188 gel generator based on zirconium tungstate. J Radioanal Nucl Chem Lett 1994; 188: 267–78. DOI: https://doi.org/10.1007/BF02164887
Musa IR, Omar SM, Adam I. Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan. BMC Public Health [Internet] 2022; 22: 1–8. Available from: https://doi.org/10.1186/s12889-022-14536-4 DOI: https://doi.org/10.1186/s12889-022-14536-4
Piodena-Aportadera MRB, Lau S, Chew J, Lim JP, Ismail NH, Ding YY, et al. Calf Circumference Measurement Protocols for Sarcopenia Screening: Differences in Agreement, Convergent Validity and Diagnostic Performance. Ann Geriatr Med Res 2022; 26: 215–24. DOI: https://doi.org/10.4235/agmr.22.0057
Uccioli L, Monticone G, Russo F, Mormile F, Durola L, Mennuni G, et al. Autonomic neuropathy and transcutaneous oxymetry in diabetic lower extremities. Diabetologia 1994; 37: 1051–5. DOI: https://doi.org/10.1007/BF00400469
Vellas B, Guigoz Y, Gary PJ, Nourhashemi F, Bennahum D, Lauque S, et al, The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutr 1999; 15: 987–92. DOI: https://doi.org/10.1016/S0899-9007(98)00171-3
Nawai A, Phongphanngam S, Khumrungsee M, Leveille SG. Factors associated with nutrition risk among community-dwelling older adults in Thailand. Geriatr Nurs (Minneap) [Internet] 2021; 42: 1048–55. Available from: https://doi.org/10.1016/j.gerinurse.2021.06.005 DOI: https://doi.org/10.1016/j.gerinurse.2021.06.005
Morgan PT, Breen L. The role of protein hydrolysates for exercise-induced skeletal muscle recovery and adaptation: a current perspective. Nutr Metab [Internet] 2021; 18: 1–18. Available from: https://doi.org/10.1186/s12986-021-00574-z DOI: https://doi.org/10.1186/s12986-021-00574-z
Joanisse S, McKendry J, Lim C, Nunes EA, Stokes T, Mcleod JC, et al. Understanding the effects of nutrition and post-exercise nutrition on skeletal muscle protein turnover: Insights from stable isotope studies. Clin Nutr Open Sci [Internet] 2021; 36: 56–77. Available from: https://doi.org/10.1016/j.nutos.2021.01.005 DOI: https://doi.org/10.1016/j.nutos.2021.01.005
Chen N, He X, Feng Y, Ainsworth BE, Liu Y. Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. Eur Rev Aging Phys Act 2021; 18: 1–19. DOI: https://doi.org/10.1186/s11556-021-00277-7
Mohammed E, Browne LD, Kumar AAU, Adeeb F, Fraser AD, Stack AG. Prevalence and treatment of gout among patients with chronic kidney disease in the Irish health system: A national study. PLoS One 2019; 14: 1–14. DOI: https://doi.org/10.1371/journal.pone.0210487
Haley JE, Urbina EM. Insulin Resistance and Cardiovascular Disease. Contemp Endocrinol 2020; 86: 195–205. DOI: https://doi.org/10.1007/978-3-030-25057-7_12
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. J Parenter Enter Nutr 2019; 43: 181–93. DOI: https://doi.org/10.1002/jpen.1451
Santarpia L, Contaldo F, Pasanisi F. Nutritional screening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle 2011; 2: 27–35. DOI: https://doi.org/10.1007/s13539-011-0022-x
Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 2005; 9 (Suppl.2); S51-63. DOI: https://doi.org/10.1016/j.ejon.2005.09.007
Penninger JM, Grant MB, Sung JJY. The Role of Angiotensin Converting Enzyme 2 in Modulating Gut Microbiota, Intestinal Inflammation, and Coronavirus Infection. Gastroenterology [Internet] 2021; 160: 39–46. Available from: https://doi.org/10.1053/j.gastro.2020.07.067 DOI: https://doi.org/10.1053/j.gastro.2020.07.067
Guo Y, Wang B, Gao H, Gao L, Hua R, Xu JD. ACE2 in the Gut: The Center of the 2019- nCoV Infected Pathology. Front Mol Biosci 2021; 8: 1-11. DOI: https://doi.org/10.3389/fmolb.2021.708336
Damayanthi HDWT, Prabani KIP. Nutritional determinants and COVID-19 outcomes of older patients with COVID-19: A systematic review. Arch Gerontol Geriatr [Internet] 2021; 95(January): 104411. Available from: https:// doi.org/10.1016/j.archger.2021.104411 DOI: https://doi.org/10.1016/j.archger.2021.104411
Sikaroudi MK, Zonooz SR, Ebrahimi Z, Jebraili H, Farsi F, Talebi A, et al. Assessment of anorexia and weight loss during the infection and recovery period of patients with coronavirus disease 2019 (COVID-19). Clin Nutr Open Sci [Internet] 2021; 40: 102–10. Available from: https://doi.org/10.1016/j.nutos.2021.11.001 DOI: https://doi.org/10.1016/j.nutos.2021.11.001
Bartleson JM, Radenkovic D, Covarrubias AJ, Furman D, Winer DA, Verdin E. SARSCoV-2, COVID-19 and the aging immune system. Nat Aging [Internet] 2021; 1: 769–82. Available from: http://dx.doi.org/10.1038/s43587-021-00114-7 DOI: https://doi.org/10.1038/s43587-021-00114-7
De Araújo Morais AH, Aquino JDS, Da Silva-Maia JK, Vale SHDL, MacIel BLL, Passos TS. Nutritional status, diet and viral respiratory infections: Perspectives for severe acute respiratory syndrome coronavirus 2. Br J Nutr 2021; 125: 851–62. DOI: https://doi.org/10.1017/S0007114520003311
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