Objectives: We examined if individually-adapted nutritional counselling could prevent > 5% weight loss among elderly patients 3 months after discharge from a rehabilitation institution. In addition we assessed quality of life (QoL) and appetite. Design: An open, randomized trial. Setting: Godthaab Health and Rehabilitation Institution in Bærum, Norway. Participants: Patients identified as being undernourished or at risk of disease-related malnutrition using the Nutritional Risk Screening tool NRS-2002. Intervention: Shortly before discharge, patients in the intervention group received an individually-tailored nutrition plan. During the subsequent 3 months these patients were contacted 3 times via telephone calls and they received one visit at their homes, for nutrition counselling. Focus on this counselling was on optimizing meal environment, improving appetite, increasing food intake, advice on food preparation, and motivation and support. Measurements: In addition to weight, QoL and appetite were assessed using the EQ-5D questionnaire and a modified version of the Disease-Related Appetite Questionnaire, respectively. Results: Among 115 considered eligible for the study, 100 were enrolled (72 women and 28 men), with a mean age of 75 years and a mean body mass index of 20 kg/m^2. Two in the intervention group (n = 52) and 5 in the control group (n = 48) lost > 5% of their body weight, giving an odds ratio of 0.34 (95% CI: 0.064 – 1.86; p = 0.22). We did not detect any significant differences in the QoL- or appetite scores between the two study groups after three months. Conclusion: An individually-adapted nutritional counselling did not improve body mass among elderly patients 3 months after discharge from a rehabilitation institution. Neither quality of life nor appetite measures were improved. Possibly, nutritional counselling should be accompanied with nutritional supplementation to be effective in this vulnerable group of elderly. The trial is registered in Clinical Trials (ID: NCT01632072).

Året inleddes med en ny organisation för Högskolan Kristianstad och bildandetav fyra nya fakulteter. Avdelningen för Mat- och måltidsvetenskapingår numera i Fakulteten för Naturvetenskap tillsammans med avdelningenför Datavetenskap och avdelningen för Miljö och biologi. Det varinte bara för HKR som det gångna året innebar organisatoriska förändringarutan även för vår avdelning.Bitte Müller Hansen gick i pension efter nästan tio år som programansvarigför Gastronomiprogrammet och avdelningschef. Bitte har betytt oerhörtmycket för utveckling av programmet och har lagt ner stort engagemangi såväl utbildningen, som i sina kontakter med studenter och medarbetsmarknaden.

Under året som gått har mycket hänt och vi utvecklas vidare! Denna upplaga av Mat- och måltidsvetenskaps verksamhetsberättelse sammanfattar händelser och utveckling av ämnesområdet vid Högskolan Kristianstad under 2019. Ett år där alla medarbetare på avdelningen bidragit till att arbeta för visionen att vi ska ha en ledande position för framtidens mat och måltider genom attraktiva utbildningar, framgångsrik forskning och aktiv samverkan.

Approximately 40 per cent of older adults living at home are at risk of malnutrition. To detect this condition, body mass index is often used as a tool. The standard way of measuring body height is in a standing position. Height decreases with age and further, many older adults are not physically capable to undergo standing height measures. As height is one of the components in BMI it can be affected by body height decrease which in turn will affect the estimated prevalence of malnutrition risk. There are many different ways to estimate height by proxy measures. The aim of this study was to investigate whether proxy measurements could prove to be useful when estimating height in Swedish community-dwelling older adults. Home visits were made to 51 men and 51 women, who had participated in the randomized, single-blinded health-promoting intervention study, Elderly in the Risk Zone, living in the urban district Örgryte-Härlanda in Gothenburg, Sweden. Body weight, standing height, recumbent height, knee-height and demi-span was measured. An interview was also conducted, retrieving information regarding e.g. height around 20 years of age. T-test and Wilcoxon rank tests were performed and to further examine the results regression analyses and Bland & Altman-plots were conducted. The result showed that between 20 years of age to present age the men had decreased, in body height, on average 3,8 cm and the women 4,9 cm. In both the regression analysis and in the Bland & Altman plots, recumbent height and youth height seem to best conform to standing measured height. In the men, a negative correlation was found between the difference standing and knee-height measure of body height compared to mean values of the two measures in the Bland & Altman plots, though it was the only measurement that did not show any group mean statistical significant difference from standing height by t-test. No negative or positive correlation was seen in the women by the Bland & Altman plots. Demi-span gave an underestimation of body height in both genders. The present results show that body height seems to decrease with age and that besides standing, the best proxy measure is recumbent height otherwise that right knee-height could be used. Different height measurements could affect the BMI classification. Though we need to learn more about what affects the height decrease with age and what proxy measures are reliable. It would be desirable that a larger study would be conducted.

Sarcopenia, defined as loss of skeletal muscle mass and function, is associated with adverse outcomes such as physical disability, impaired quality of life and increased mortality. Several mechanisms are involved in the development of sarcopenia. Potentially modifiable factors include nutrition and physical activity. Protein metabolism is central to the nutritional issues, along with other potentially modifying nutritional factors as energy balance and vitamin D status. An increasing but still incomplete knowledge base has generated recent recommendations on an increased protein intake in the elderly. Several factors beyond the total amount of protein consumed emerge as potentially important in this context. A recent summit examined three hypotheses: (1) A meal threshold; habitually consuming 25-30 g protein at breakfast, lunch and dinner provides sufficient protein to effectively stimulate muscle protein anabolism; (2) Protein quality; including high-quality protein at each meal improves postprandial muscle protein synthesis; and (3) performing physical activity in close temporal proximity to a high-quality protein meal enhances muscle anabolism. Optimising the potential for muscle protein anabolism by consuming an adequate amount of high-quality protein at each meal, in combination with physical activity, appears as a promising strategy to prevent or delay the onset of sarcopenia. However, results of interventions are inconsistent, and well-designed, standardised studies evaluating exercise or nutrition interventions are needed before guidelines can be developed for the prevention and treatment of age-related sarcopenia.

BACKGROUND & AIMS: There is increasing interest in estimating skeletal muscle mass (SMM) in clinical practice. We aimed to validate a bioelectrical impedance analysis (BIA) prediction equation for SMM, developed in a different healthy elderly population, in a population of hospital patients aged 70 and over, by comparison with dual-energy X-ray absorptiometry (DXA) SMM estimates. Comparison was also made with two other previously published BIA muscle prediction equations.

METHODS: Muscle measurements by BIA and DXA were compared in 117 patients with a range of clinical conditions (45 female, 72 male, mean age 75 years).

RESULTS: The BIA equation used yielded an accurate estimate of DXA-derived SMM. Mean (SD) difference was 0.26(1.79) kg (ns). The two other BIA equations over-estimated SMM compared to DXA (both p < 0.001), but all equations were highly correlated.

CONCLUSIONS: The BIA equation used, developed in a different healthy elderly population, gave an accurate estimate of DXA-derived SMM in a population with various clinical disorders. BIA appears potentially capable to estimate SMM in clinical disorders, but the optimal approach to its use for this purpose requires further investigation.

Objective: The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.

Design: Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.

Participants: A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.

Methods: One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).

Results: Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.

Conclusions: Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Background

A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

Objective

This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

Methods

The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

Results

Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

Conclusion

An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

Kunskaper och vetenskapligt förankrade insikter kring matens betydelse för människans hälsa tilltar samtidigt som intresset för kost och hälsa ökar hos både patienter och allmänhet. Personal inom vård och omsorg upplever därför ofta svårigheter att orientera sig i flödet av hälsobudskap där buden dessutom kan vara motstridiga. Läkare, sjuksköterskor och annan vårdpersonal har ett kontinuerligt behov av att uppdatera sina kunskaper om mat, nutrition och hälsa. 


Bokens första del ger råd om nutritionshandläggning vid speciella sjukdomar, t.ex. hjärt–kärlsjukdomar, diabetes och fetma.Dessutom fokuseras nutritionens betydelse vid vanliga kroniska sjukdomar såsom mag-tarm-, njur- och demenssjukdom.Åldrandet, mat och nutrition diskuteras i flera kapitel.Vårdprocessen vid utredning och behandling belyses. Bokens andra del ger kliniskt relevant kunskap om näringslära och kostrekommendationer. T.ex. avhandlas hälsoeffekter och behov av fett, kolhydrater och protein, omega-3-fettsyror och vitamin D,hälsoeffekter av traditionell medelhavskost, och dess nordiska motsvarighet, liksom olika typer av populära koster.


I den här boken samlas kunskapen hos tjugosex av Sveriges främsta forskare inom nutritionsområdet på ett lättillgängligt sätt för att ge evidensbaserade svar på många av de frågor som möter sjukvårdspersonal.

Background & aims

Long-term effects of total gastrectomy on nutritional status are not well known, neither is the role of nutritional support. Dietary counselling is usually individualized, but generally not well defined. We aimed to evaluate effects of individualized oral nutritional support long time after total gastrectomy.

Methods

Dietary advice was given, aiming for an energy and protein rich diet, using ordinary food and liquid supplements tailored to individual needs and preferences. Counselling was repeated monthly. Body weight and a 4-day food record were obtained at baseline, and thereafter—at month 1, 3, 6 and 12. Body composition, resting and total energy expenditure were measured at baseline and at 12 months.

Results

Thirteen of 15 included patients completed the study. Though a trend of weight gain was seen after 1 month, there was no significant weight change at 12 months as weight development was quite heterogeneous. Six patients who remained healthy during the study (all with BMI<25) gained weight (p<0.05), while five patients with intercurrent co-morbidity and two with initial BMI>25 lost weight or remained stable.

Conclusions

Nutritional intervention long time after total gastrectomy did not change body weight, body composition or energy metabolism. Intercurrent co-morbidity appeared to have a major impact on outcome, as the nutritional support was more effective in patients who remained healthy and had a BMI<25.

BACKGROUND & AIMS: Malnutrition is common after total gastrectomy. There is a need for clinically useful methods to assess energy requirements. We aimed to validate measurements of energy expenditure by an activity monitor (ActiReg) and a physical activity interview (HPAQ(modified)), in long-term survivors after gastrectomy for gastric carcinoma, using doubly labelled water as reference method.

METHODS: Total energy expenditure (TEE) was estimated by DLW (14 days), ActiReg (3 days) and HPAQ(modified) (7 days) in 15 patients. Measurements were repeated after 12 months. Basal metabolic rate was measured with indirect calorimetry.

RESULTS: ActiReg and HPAQ(modified) both underestimated TEE by 180 (+/-254 SD) and 130 (+/-326 SD)kcalday(-1), i.e. 14% vs. 12%, respectively. However, this was evident only at higher levels of physical activity (PAL(DLW)> or =1.65), whereas at lower levels (PAL<1.65) no difference was found. There were no changes in TEE over time independent of the method used. DLW and ActiReg had approximately the same width of the 95% confidence interval of this estimate, while it was 2.4 times larger by HPAQ(modified).

CONCLUSION: Both simple methods underestimated total energy expenditure at higher, but not at lower physical activity levels. The ActiReg method appears useful to estimate changes in TEE over time.

Background & aims

Nutritional therapy has traditionally been evaluated by changes in weight and in food intake, while body composition and function may be of greater clinical significance. We investigated relationships between total body skeletal muscle mass (TBSMM), energy balance and exercise capacity in 41 patients before, 6 and 12 months after curatively intended major upper gastrointestinal surgery.

Methods

TBSMM and body energy content were assessed by DXA. Exercise capacity was measured on a treadmill. Energy balance was defined as the difference in body energy content at two points in time.

Results

During the first postoperative year average weight loss was 7% although 1 our of 3 patients remained weight stable (WS). Average TBSMM decreased significantly at 6 months (0.9 kg, p < 0.01), but was regained at 12 months, as was exercise capacity. 72% of weight losing patients (WL) lost TBSMM compared to 17% of WS patients, p < 0.01. Both TBSMM and changes in TBSMM, but not changes in energy content, were correlated to exercise capacity, r2 = 0.49, p < 0.001 and r2 = 0.15, p < 0.05 respectively.

Conclusions

TBSMM and exercise capacity were clearly related in cancer patients after major upper gastrointestinal surgery, as were changes in TBSMM and exercise capacity. Energy balance was not directly correlated to exercise capacity, but more WS than WL patients increased their TBSMM indicating a possible influence by energy balance.

Objective: The purpose of this study was to compare dietary practices among different birth cohorts of 70-year-old Swedes, who were examined between 1971 and 2000.

Setting: Göteborg, Sweden.

Design: Four population-based samples of 1360 70-year-olds, born in 1901, 1911, 1922 and 1930, have undergone health examinations and dietary assessments over a period of almost three decades. One-hour diet history (DH) interviews were conducted in 1971, 1981, 1992 and 2000 with a total of 758 women and 602 women. The formats and contents of the dietary examinations were similar over the years. Statistical analysis of linear trends was conducted, using year of examination as the independent variable, to detect secular trends in food and nutrient intakes across cohorts.

Results: At the 2000 examination, the majority of 70-year-olds consumed nutritionally adequate diets. Later-born cohorts consumed more yoghurt, breakfast cereals, fruit, vegetables, chicken, rice and pasta than earlier-born cohorts. Consumption of low-fat spread and milk also increased, along with that of wine, light beer and candy. In contrast, potatoes, cakes and sugar were consumed less in 2000 than in 1971. The ratio of reported energy intake to estimated basal metabolic rate did not show any systematic trend over time in women, but showed a significant upward trend in men.

Conclusions: The diet history method has captured changes in food selections in the elderly without changing in general format over three decades. Dietary quality has improved in a number of ways, and these findings in the elderly are consistent with national food consumption trends in the general population.

OBJECTIVE:

Secular increases in obesity have been widely reported in middle-aged adults, but less is known about such trends among the elderly. The primary purpose of this paper is to document the most recent wave of the obesity epidemic in population-based samples of 70-y-old men and women from Göteborg. Additionally, we will investigate the influences of physical activity, smoking and education on these secular trends.

POPULATIONS AND METHODS:

Five population-based samples of 3702 70-y-olds (1669 men and 2033 women) in Göteborg, Sweden, born between 1901 and 1930, were examined in the Gerontological and Geriatric Population Studies (H70) between 1971 and 2000. Cohort differences in anthropometric measures were the main outcomes studied. Physical activity, smoking habits and education were assessed by comparable methods in all cohorts. Subsamples of the women in the latest two cohorts (birth years 1922 and 1930) were also part of the Prospective Population Study of Women in Göteborg. In these women, it was possible to examine body mass index (BMI) and waist-to-hip circumference ratio (WHR) longitudinally since 1968.

RESULTS AND CONCLUSIONS:

Significant upward trends were found for height, weight, BMI, waist circumference (WC), WHR, prevalence of overweight (BMI25 kg/m²) and obesity (BMI30 kg/m²) across cohorts in both sexes. In 2000, 20% of the 70-y-old men born in 1930 were obese, and the largest increment (almost doubling) had occurred between the early 1980s and the early 1990s. In 70-y-old women the prevalence of obesity was 24% in 2000, a 50% increase compared to the cohort born 8 y earlier. BMI increased over time in all physical activity, smoking and education groups, with the exception of never-smoking men. Although 70-y-old women in 2000 were heavier than cohorts examined 8 y previously, data from the women studied longitudinally revealed that these differences were already present in earlier adulthood. In conclusion, the elderly population is very much part of the obesity epidemic, although secular trends in BMI were detected slightly earlier in men than in women. The health implications of these secular trends should be focused on in future gerontological research

Undernäring är en dold epidemi. Trots att det är ett stort folkhälsoproblem talar nästan ingen om den. Men det finns i hemmen, på sjukhus och på äldreboenden. En ny rapport, som har kartlagt dess omfattning, visar att uppskattningsvis 400 000 svenskar befinner sig i riskzonen.

Olika synsätt präglar den svenska njursjukvården vad gäller det nutritionella omhändertagandet av patienter med njursvikt utan dialys. En majoritet av Sveriges njurmedicinska kliniker använder proteinreducerad kost vid njursviktsbehandling före dialys. Den lägsta proteinnivån vid proteinreducerad kost (0,3 g/kg kroppsvikt/dag) är inte längre i bruk. Den proteinreducerade kosten har »moderniserats« under de senaste 10 åren. Ordination av fasta proteinnivåer har minskat, medan individuellt beräknade proteinnivåer har ökat, vilket överensstämmer med riktlinjerna från Svensk njurmedicinsk förening. Njursvikt leder ofta till malnutrition. Oberoende av synen på proteinreducerad kost bör njursviktspatienter erbjudas kontakt med legitimerad dietist för optimering av näringsintaget i syfte att förebygga malnutrition.

Geriatrisk nutrition utkom första gången 2010. Denna bok är en reviderad upplaga, som har förändrats på flera sätt både avseendeinnehåll, struktur och lay-out. Boken riktar sig både till studenter inom olika vårdutbildningar och till yrkesverksamma inomvård och omsorg av äldre. Den har ambitionen att ge en förståelse för hur åldrandet påverkar kroppens funktioner och hälsan.Fokus i boken ligger på mat, näring och nutrition och de specifika nutritionsproblem som följer med åldrandet. Boken vill ävenge en medicinsk bakgrund till olika sjukdomar som är vanliga hos äldre, vilket är förutsättningen för att förstå sjukdomsspecifiknutritionsbehandling. Boken tar också upp regelverk, organisation och kvalitet samt etiska och kulturella aspekter på nutritionsomhändertagandeav äldre. Helt nytt är ett kapitel om centrala begrepp och termer samt ett separat kapitel om kulturella aspekteroch ett utökat avsnitt som behandlar D vitamin. Boken är faktagranskad av personer med specifika kompetenser inom olikaområden som boken tar upp.

In Europe, as in much of the Western world, the number of citizens aged 65 and over has grown at an unprecedented rate and is expected to account for over 30% of the total population by 2060. Coupled with a steady increase in life expectancy, this massive demographic change calls for a major effort to ensure quality of life in our older population. A thorough understanding of the elderly as food consumers, their nutritional needs, and their food perception and preferences is increasingly recognized as key areas for future research.

Food perception change at a later age as a result of the psychophysiological changes that occur with aging, such as decreased appetite and chemosensory acuity. The latter generally decrease food intake and the pleasure that the elderly derive from their meals, making the identification of possible compensation strategies (e.g., flavor enhancement, textural changes, etc.) essential to food producers interested in developing products for this increasingly important segment. Promoting food satisfaction among the elderly is also paramount to ensuring adequate nutritional intake. This aspect has major public health implications, such as preventing malnutrition and sarcopenia, which are leading causes of decreased independence and lower quality of life. Additionally, the importance of social and psychological factors is increasingly recognized. Many conditions related to aging (e.g., tiredness, loneliness) may prevent elderly people from preparing and enjoying meals, calling for alternative vehicles – such as tailor-made distribution channels, social food preparation and eating situations – for promoting healthy eating.

In this workshop, a range of international speakers with relevant professional experience will present their latest work. More generally, it is our intention with this workshop to raise awareness of how sensory and consumer research can contribute to promote well-being among the elderly, and ultimately to expand the number of healthy life years as we age.

Background  Overweight and obesity are epidemic in Western societies and constitute a major public health problem because of adverse effects on vascular health. Vascular factors may play a role in the development of a rapidly growing disease of late life, Alzheimer disease (AD). Using body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), we examined whether overweight is a risk factor for dementia and AD.

Methods  The relationship between BMI and dementia risk was investigated in a representative cohort of 392 nondemented Swedish adults who were followed up from age 70 to 88 years, with the use of neuropsychiatric, anthropometric, and other measurements. Multivariate Cox proportional hazards regression analyses included BMI, blood pressure, cardiovascular disease, cigarette smoking, socioeconomic status, and treatment for hypertension.

Results:  During the 18-year follow-up (4184.8 risk-years), 93 participants were diagnosed as having dementia. Women who developed dementia between ages 79 and 88 years were overweight, with a higher average BMI at age 70 years (27.7 vs 25.7; P = .007), 75 years (27.9 vs 25.0; P<.001), and 79 years (26.9 vs 25.1; P = .02) compared with nondemented women. A higher degree of overweight was observed in women who developed AD at 70 years (29.3; P = .009), 75 years (29.6; P<.001), and 79 years (28.2; P = .003) compared with nondemented women. For every 1.0 increase in BMI at age 70 years, AD risk increased by 36%. These associations were not found in men.

Conclusions  Overweight is epidemic in Western societies. Our data suggest that overweight at high ages is a risk factor for dementia, particularly AD, in women. This may have profound implications for dementia prevention.

OBJECTIVES: To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living (ADLs) at 3-month follow-up.

DESIGN: Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011.

SETTING: Two urban districts of Gothenburg, Sweden.

PARTICIPANTS: Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service.

INTERVENTION: A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit.

MEASUREMENTS: Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up.

RESULTS: Both interventions delayed deterioration of self-rated health (odds ratio (OR) = 1.99, 95% confidence interval (CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs (OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated.

CONCLUSION: Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts.

Introduction: Due to good living conditions, the population of older adults is growing. Increased age increases prevalence of diseases and thereby also the risk of disease related malnutrition (DRM) increases. Appetizing and nutritious food products are needed to counteract DRM. One possible way to enable increased nutritional intake for older people with poor appetite is to offer energy/protein rich snacks between meals. In Sweden, afternoon coffee is an appreciated part of the day. It has also been shown that different varieties of muffins are a popular choice to eat with the coffee among older adults. Developing muffins to suit older adults’ nutritional needs along with their sensory cravings may contribute to decreased DRM. The aim of this study was to investigate added nutritional content along with the sensorial effects of increased fat/protein content in muffins.

Methods: Design of four different muffins were developed and produced according to a processing scheme where fat and proteins were added. Sensory evaluation and nutritional calculations were performed. Further moisture content, water activity, weight loss and size of the muffins were measured.

Results: The fat and protein additions affected the sensory properties and nutritional value of the muffins:

Muffin type

Content (g/100g   muffin)

Sensory properties

fat

protein

Reference

27

4,9

soft, smooth

With added fat

42

3,8

flat, moist, fatty mouth

With added protein (whey)

23

12,4

feel hard, compact, pointy, low

flavors

With added fat and protein

37

10,2

a bit hard, compact, fatty mouth feel   effects of protein are dominant

Discussion: It can be concluded that muffins with added nutrients and sensorialy designed for older adults’ is promising.  However, further recipe/process development in order to increase appetizing sensory properties may be achieved.

Background: The population of older adults is growing and many are at risk of disease-related malnutrition.This is a serious condition which increases the risk for other diseases and distress, human suffering and puts ahigh load on health care costs. Meal concepts tailored to suit the needs of older adults are required to decreasethe incidence of disease-related malnutrition.

Objective: To evaluate sensory perception regarding a concept of small, protein and energy-enriched multicomponentmeals designed according to the nutritional needs of older adults.

Design: A meal concept of small main courses with complementary desserts and protein and energy-enrichedproducts was evaluated using triangle tests, hedonic evaluation and focus group discussion. Enriched saucesand meals were compared to corresponding commercial products regarding appearance, taste, consistency andoverall acceptance.

Results: The concept of a small main course with a complementary dessert was generally perceived as positiveby the target group. The acceptance scores for the enriched meals were generally lower than for the commercialmeals, mainly owing to the packaging of the enriched meals which required covering the food in sauce.Enriched sauces contained approximately 90% more protein than the commercial sauces. However, proteinenrichment affected the sensory properties of the sauces and they were perceived as thicker, creamier and lessflavour-intensive.

Conclusions: A concept based on small, protein and energy-enriched meals supplemented with a dessert wasconsidered suitable for increasing the energy and protein intakes of older adults provided that the method ofenrichment ensures attractive sensorial properties.

Disease related malnutrition is a common problem among older adults which results in human suffering and high health care costs. One way to counteract this condition is to offer appetizing and nutritious food products adapted to the needs of older adults. However, macronutrient enrichment of food products is not straight forward as it affects flavour and texture properties. In this study, muffins were fortified with rape seed oil and whey powder to reach increased fat and/or protein content and the nutritional value, sensory properties and physical parameters were investigated. The results showed that ingredients could be added to significantly increase the energy and protein density, but enrichment affected on appearance and other sensory properties. Extra fat made the muffins flat and moist with a smooth and fatty mouth feel, while whey powder addition resulted in high/pointy muffins with shiny appearance, hard texture and altered flavours. For co-addition of fat and protein the effects of added protein dominated. The specific role of muffin/cake batter compounds, and their transformation during the baking process, needs to be further investigated. Hence, more research is needed in order to offer older adult appealing foods with high energy and nutrient density.

The world is facing a number of challenges related to food consumption. These are, on the one hand, health effects and, on the other hand, the environmental impact of food production. Radical changes are needed to achieve a sustainable and healthy food production and consumption. Public and institutional meals play a vital role in promoting health and sustainability, since they are responsible for a significant part of food consumption, as well as their “normative influence” on peoples’ food habits. The aim of this paper is to provide an explorative review of the scientific literature, focusing on European research including both concepts of health and sustainability in studies of public meals. Of >3000 papers, 20 were found to satisfy these criteria and were thus included in the review. The results showed that schools and hospitals are the most dominant arenas where both health and sustainability have been addressed. Three different approaches in combining health and sustainability have been found, these are: “Health as embracing sustainability”, “Sustainability as embracing health” and “Health and sustainability as separate concepts”. However, a clear motivation for addressing both health and sustainability is most often missing

Aims: With an ageing population worldwide,pressure on health and social care systems grows. Strategies to preventage-related conditions as malnutrition, sarcopenia, and frailtyare therefore of ultimate importance, to enable older adults remainingphysically and mentally active and independent as long aspossible. Good nutrition plays a significant role in maintainingand improving functioning. The aim of the conference session wasto 1) elucidate and discuss nutritional challenges faced and strategiesto improve nutritional intake and nutritional status amongolder adults, and 2) to share knowledge and best practices gainedfrom both national and international (research) projects on nutritionand ageing conducted in Europe.

Methods: In this conference session, three presentations about different aspects of malnutrition in older persons were given. Firstly,an overview of current practices in different European Countriesto prevent malnutrition in older adults were presented anddiscussed. Data were collected via the European Specialist Dietetic Network for Older Adults who reported on the most recent statistics,guidelines and practice for screening, prevalence and interventions for identifying, preventing and treating malnutrition. Secondly, the relationship between dietary intake, physical performance(gait speed and hand grip strength) and body composition(dual energy x-ray absorptiometry) in two cohorts from the GothenburgH70 Birth Cohort Studies, i.e., one Swedish cohort at age70 (born in 1944) and one Swedish cohort at age 85 (born in 1930)[1] were discussed. Thirdly, a range of strategies to support adequate nutrition in older adults were discussed.

Results: Information was provided by representatives fromSpain, The Netherlands, United Kingdom, Switzerland, Greece,Turkey, and Portugal, which identified commonalities in practiceas well as variations that were specific for each country. Mandatory nutritional risk screening is not in place for every country andfor some countries, even when malnutrition screening is mandatorythe rate of screening uptake remained low. Many countriesreported staffing/dietetic capacity as a limitation, and the need fordietitians to raise awareness of the importance of nutrition amongstother medical and allied health professionals was raised. There isconsensus that dietitians should be regarded as integral membersof the multidisciplinary team and whilst there were some examplesof good practice, there is still room for improvement in this area. A variety of screening tools are used and reported malnutritionprevalence varied between countries, however with the latest GLIM consensus on the diagnosis criteria for malnutrition, thismay encourage consistency in criteria in the future.Data from the Gothenburg H70 Birth Cohort Studies [1]showed good dietary intake in relation to recommendations [2 although intake for some nutrients were somewhat lower in the 85-year olds compared to the 70-year olds. In both cohorts vitaminD was the nutrient with highest proportion of low intakes. Amongthe 70-year olds, alcohol intake had increased significantly indicatingchanges in lifestyle over time. Significant differences werefound in prevalence of low muscle mass, slow self-selected walkingspeed, and hand grip strength, with a higher proportion havingsarcopenia among the 85-year olds compared to the 70-year old(3% vs. 55% respectively) [3]. Differences were also found in mealpatterns among 85 year-olds in risk of malnutrition compared tothose without with lower meal frequency and less snack meals/dayamong those in risk of malnutrition.Strategies to support adequate nutrition range from strategiesto identify those in need of nutritional support to strategies regardingthe provision of nutrition [4]. As an important prerequisite, allolder persons should be routinely screened for malnutrition in regularintervals in order to identify an existing risk early. Various validated screening tools specifically for older persons are availablefor different healthcare settings [5]. Potential risk factors or causesof malnutrition, e.g. chewing or swallowing problems, medicationside effects or depression, need to be identified and eliminated asfar as possible [4]. Direct dietary strategies to support adequateintake include the recommendation or provision of energy andnutrient dense food and enriched meals in an appealing and appetizingway. Particular attention should be paid to sensory characteristics,adequate texture and food variety, always consideringindividual likes and dislikes. Dietary restrictions should generallybe avoided since they may limit food choice and eating pleasureand thus bear the risk of limiting dietary intake [4].Besides regular main meals, snacks should be available as needed.Furthermore, older persons should be encouraged to sharetheir mealtimes with others and eat in a pleasant, relaxed atmosphere. In case of dementia, finger food may help to maintain independenteating and allow for eating while walking for personswho are constantly pacing. Depending on individual resources andneed of assistance for shopping, preparing meals and eating, adequatesupport should be arranged. If oral nutrition is insufficientor impossible despite all these efforts, e.g., in case of dysphagia,enteral and parenteral nutrition should be taken into consideration[4].As often several persons – relatives as well as different healthcare professionals – are involved in nutritional care, communicationand close cooperation of these persons is important to ensureconsistent approaches and avoid double effort.

Conclusions: Older adults are at increased risk of malnutrition,which in turn is related to poor health outcomes. Nutritional interventionsaim to maintain autonomy through physical independence,preventing disability, and to ensure quality of life among older adults. Nutritional care and support of older adults at risk or affected by malnutrition is thus an important public health concern, but adequate structures and strategies to prevent and treat malnutrition are not implemented everywhere. Future efforts should aim to put adequate nutritional care into practice as an integral part of geriatric healthcare in all settings in all countries. 

Objective: To study gender differences in older adults according to practice, knowledge and attitudes regarding food habits and meal patterns. Design: Cross-sectional study. Setting: Two urban districts of Gothenburg, Sweden. Participants: A total of 297 individuals were included, 102 men and 195 women. They were 80 years or older and living in ordinary housing without being dependent upon the municipal home help services or help from another person in Activities of Daily Life, and cognitively intact, defined as having a score of 25 or higher in the Mini Mental State Examination. Measurements: Telephone interviews regarding food habits and meal patterns were conducted. Results: Almost all participants (99%) ate their main meal at home and men preferred company at meals more often (p<0.001). Women had the sole responsibility to shop for food more often (p<0.000), and generally regarded cooking as a routine or something they just had to do. Among men, few (13%) took a great interest in cooking and 36 % of the men stated that cooking was something they were not capable of performing (p<0.000). Men had company at meals every day more often (71% vs 40%). Respondents stated that loneliness took away the enjoyment of cooking and changed their habits when becoming a widow or widower. Conclusion: Women take greater responsibility for the household than men, regardless of marital status. A large proportion of the men thought cooking was something they were not able to do. The findings in this study may indicate a possible gender difference in the need for societal support.

BACKGROUND:: Frailty is considered highly prevalent among the aging population. Fruit and vegetable intake is associated with positive health outcomes across the life-span; however, the relationship with health benefits among older adults has received little attention.

AIM:: The aim was to examine if a relationship exists between meal frequency or frequency of vegetable intake and the development of frailty in a population of older adults.

METHODS:: A total of 371 individuals, 80 years or older, from the study 'Elderly Persons in the Risk Zone' were included. Data was collected in the participants' home by face-to-face interviews up to 24 months after the intervention. Baseline data were calculated using Chi²-test; statistical significance was accepted at the 5% level. Binary logistic regression was used for the relationship between meal frequency or vegetable intake and frailty.

RESULTS:: Mean meal frequency was 4.2 ± 0.9 meals per day; women seem to have a somewhat higher meal frequency than men (p=0.02); 57% of the participants had vegetables with at least one meal per day. No significant relationship was found between meal frequency or vegetable intake and frailty at 12 or 24 months follow-ups.

CONCLUSIONS:: Among this group of older adults (80+), meal frequency was slightly higher among women than men, and just over half of the participants had vegetables with at least one meal a day. The risk of developing frailty was not associated with meal frequency or vegetable intake. The questions in this study were meant as indicators for healthy food habits.

Sjukdomsrelaterad undernäring har beskrivits i Europa sedan ett tiotal år. Problemet har föranlett Europarådet att 2003 anta en resolution med rekommendationer till medlemsländerna om nutritionsbehandling på sjukhus.

I en enkätstudie genomförd bland svenska läkare, sjuksköterskor och dietister undersöktes attityder till och rutiner för nutritionsbehandling inom slutenvården – i relation till Europarådets rekommendationer.

Totalt 1 656 personer (38 procent) svarade på enkäten. Av dessa ansåg 88 procent att nutritionsstatus ska screenas vid inläggning, medan endast 22 procent beskrev att så verkligen sker. Nästan hälften ansåg att utbildningen i klinisk nutrition för vårdpersonal var otillräcklig. En otydlighet i ansvarsfördelningen beskrevs av majoriteten av dem som svarat.

Undersökningen visar att svensk slutenvård inte lever upp till Europarådets rekommendationer om nutritionsbehandling. Brister har också definierats vad gäller riktlinjer och organisation.

För framtiden efterlyses en nationell handlingsplan för att implementera Europarådets resolution i svensk hälso- och sjukvård.

Sjukdomsrelaterad under­näring har beskrivits i Europa under flera decennier.Europarådet antog år 2003 en resolution med rekommendationer till medlemsländerna kring nutritionsbehandling på sjukhus.En tidigare studie visar att rekommendationerna inte efterlevs inom svensk slutenvård, där flertalet patienter är äldre.Den aktuella enkätstudien, riktad till sjuksköterskor inom särskilda boenden, påvisar sjuksköterskornas ansvar för nutritionsprocessen men även brister i både kunskap och utbildning.Brister har även beskrivits i ansvarsfördelning mellan yrkesgrupper, riktlinjer för nutritionsbehandling och övergripande organisation.En förändrad struktur efter­lyses inom hälso -och sjukvårdsorganisationen. Såväl läkare, dietister, sjuksköterskor som undersköterskor bör vara aktiva i nutritionsprocessen vid särskilda boenden.

Background: Limited data are available on body composition (BC) and physical function in healthy adults >80 y, potentially hampering development of reference values. We aimed to study 1) BC and physical function and 2) changes in hand-grip strength over a 4-year period in a community dwelling elderly Swedish population.

Methods: Apparently healthy, community-dwelling men (n=51) and women (n=51) aged >83y were measured by Sit to Stand-test, hand grip strength, body height, body weight and BC using a Bioimpedance Spectroscopy (Impedimed). The study was approved by the Regional Ethical Review Board in Gothenburg as an addition to Elderly Persons in the Risk Zone (T176-12).

Results: Mean age 86.5 y, no age difference between sexes. Men and women performed equally well at the Sit to Stand-test. Men were significantly stronger with a mean HGS of 34.1 kg compared to women of 19.5 kg. 15 % had a BMI below 22 kg/m2. According to skeletal muscle index (SMI) 64 % were assessed as having severe sarcopenia (Cruz-Jentoft et al 2010).

Conclusion: In this healthy elderly population BC and physical function was well preserved compared to previous studies, although many were classified as sarcopenic according to current cut-offs. Results from this study can be used as reference values for healthy community-dwelling elderly in high age.

Background: The expression older adult refers to a person who is 65 years and older. This part of the population has increased over the past decades, and is expected to increase further, by almost 70 % over the next 90 years. Muscle mass decreases with increasing age which affects physical function and nutritional status. Age also result in increased risk of diseases that can affect the muscle mass negatively. Measurement of body composition provides information of nutritional status and indications of physical function. Reference values from healthy older adults are required as a comparison when assessing body composition, nutritional status & physical function in different groups of older adults. Objective: To study physical function in relation to body composition in an apparently healthy elderly Swedish population. Methods: One hundred community-dwelling men and women were visited. The study population was part of the project Elderly in the Risk Zone, conducted in Gothenburg with people 80 years and older within the city district Örgryte-Härlanda. Inclusion criteria in this study were those remaining after two years of follow-up, still living within the area in their own home. Exclusion criteria were pacemaker, fractures, amputation, paralysis, dementia and recent or ongoing influenza or calici. The participants answered a few questions and preformed a series of tests to determine physical function and autonomy. Height and weight were measured, as well as body composition using a bioelectrical impedance spectroscopy (BIS). The main study Elderly in the Risk Zone was approved by the Regional Ethical Review Board in Gothenburg (Dnr 650-07). This study was approved as an addition to Elderly Persons in the Risk Zone (T176-12). Results: Mean age was 86.5 years. Men and women performed equally well at the Standing-up-test and there were no difference in BMI between sexes. Men were significantly heavier, taller, stronger, and had more TBW, ECW, ICW and FFM than women. Out of the whole population, nineteen percent had low FFMI, no one with concurrent low FMI, although three men had low FFMI with high FMI. Fifteen percent were underweight according to BMI. Conclusion: The older adults in Örgryte-Härlanda show adequate physical function indicated by FFM and better hand grip strength in comparison to previous studies. Physical function appears to be more associated with body composition than chronological age. Combined measurements of body composition and hand grip strength seem to be efficient methods for assessing physical function in community-dwelling older adults.

The aim of this study is to explore preferences, needs and attitudes regarding food habits and meal patterns among community-dwelling older adults. 164 community-dwelling, 87-100-years old, 73 % women. Cross-sectional questionnaires based survey distributed by postal service. Approved by the Regional Ethical Review board in Gothenburg T231-14, addition to Dnr ref nr: 650-07. Results were, meanage 90.6 ± 2.84 yrs, mean BMI 23.7 ± 3.70 kg/m2, ♀71, ♂31 had no medical difficulties. More women than men lived alone, ♀102 ♂21 (p<0.01). ♀75 ♂28 would not consider home delivered convenience meals and ♀101 ♂23 cooked alone. Top three important practicalities when buying or receiving convenience meals were easy-open package (♀64 ♂23), easy to get food out (♀34 ♂13) and easily read (♀31 ♂16). This very old population shows good health evident by nutritional status and meal patterns. Subject characteristics indicated better condition than average Swedish nonagenarian, a minority reporting medical difficulties. Very few would consider convenience meals home delivered and would never use the computer. The conclusion is that an majority of both sexes preferred and managed planning, acquiring and cooking food independently although gender differences were apparent with women taking a greater responsibility. A great proportion was interested in testing new flavors. An urgent need concerned accessible containers with readable labels showing the importance for industry to acknowledge needs of older adults and accordingly adapt packaging for this age group.

Hälsosamma matvanor och god nutrition har stor betydelse för patientens autonomi, vårdbehov och rehabilitering och är grundläggande för övrig behandling. Att säkerställa att patienten har bästa möjliga nutritionsstatus inför planerad kirurgi, i det akuta efterförloppet och under sin rehabilitering har stor betydelse i omvårdnads- och läkningsprocessen. Rätt mat och näring är en viktig patientsäkerhetsfråga.Undernäring leder till sämre resultat av medicinsk och kirurgisk behandling, förlängd vårdtid och ökad risk för komplikationer, lidande och död. Säker vård avseende nutrition baseras på̊ bedömning av undernäring eller risk för undernäring, utredning av orsak samt adekvat näringsbehandling.God och säker vård är personcentrerad och evidensbaserad. Den bedrivs i team och bygger på kommunikation mellan alla inblandade. Ett strukturerat arbete med ohälsosamma matvanor och nutritionsbehandling inför kirurgi bygger på att olika professioner arbetar tillsammans med patienten i centrum. Dietisten kan erbjuda nutritionsbehandling på̊ individnivå̊.Vi hoppas att denna broschyr kan bidra till ett strukturerat nutritionsarbete inför planerad kirurgi och göra vården kring mat och näring i samband med kirurgi bättre och säkrare för alla som den berör.

BACKGROUND & AIMS: Though a great interest and willingness to nutrition therapy, there is an insufficient practice compared to the proposed ESPEN guidelines for nutrition therapy. The aim of this questionnaire was to study doctors and nurses' self-reported knowledge in nutritional practice, with focus on ESPEN's guidelines in nutritional screening, assessment and treatment.

METHODS: A questionnaire about different aspects of nutritional practice was answered by 4512 doctors and nurses in Denmark, Sweden and Norway.

RESULTS: The most common cause for insufficient nutritional practice was lack of nutritional knowledge. Twenty-five percent found it difficult to identify patient in need of nutritional therapy, 39% lacked techniques for identifying malnourished patients, and 53% found it difficult to calculate the patients' energy requirement and 66% lacked national guidelines for clinical nutrition. Twenty-eight percent answered that insufficient nutrition practice could lead to complications and prolonged hospital stay. Those that answered that their nutritional knowledge was good had also a better nutritional practice.

CONCLUSION: The self-reported nutritional knowledge was inadequate among Scandinavian doctors and nurses. Increased nutritional knowledge seems to improve the nutritional practice. A combination of an integrated nutrition curriculum during the education, together with post-graduated education for both physicians and nurses should be established.

Background/Objectives:

Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat-free mass depletion.

Subjects/Methods:

The results in this cross-sectional study are based on 169 COPD patients (62% female subjects). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires: the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ).

Results:

Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared with men (P<0.05). Thirty-six percent of the patients were depleted (fat-free mass index (FFMI) <15 kg/m(2) for women and FFMI<16 kg/m(2) for men). Depleted patients had more NIS (P<0.05) and also rated appetite and taste of food as worse compared with non-depleted patients (P<0.05).

Conclusions:

NIS are common in patients with COPD, and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and whether NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future.

RATIONALE: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat free mass depletion.

METHODS: The results in this cross-sectional study are based on 169 COPD patients (62 % females). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires; Eating Symptoms Questionnaire (ESQ) and Disease Related Appetite Questionnaire (DRAQ).

RESULTS: Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared to men (p<0.05). Thirty-six percent of the patients were depleted (FFMI < 15 kg/m² for women and FFMI < 16 kg/m² for men). Depleted patients had more NIS (p<0.05), and also rated appetite and taste of food as worse compared to non-depleted (p < 0.05).

CONCLUSION: Nutrition impact symptoms are common in patients with COPD and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and if NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future.