One in three hospitalised adults in the US is at risk for malnutrition, a major analysis has found. And patients’ poor food intake is having a significant impact on their healing and recovery, compounding their risk of death.
“Nutrition is easily overlooked as healthcare professionals often focus on a patient’s primary diagnosis,” lead author Abby Sauer told NutritionInsight.
“It may come as a surprise to some that when patients don’t get proper nutrition, it can significantly put their health and lives at risk,” she adds, explaining that nutrition is more important than ever when someone is sick or injured.
The researchers screened around 10,000 patients from 2009 to 2015 to assess malnutrition risk and links with mortality.
They found around one in two patients were eating half or less of their meals. This low food intake was linked to higher risk of mortality, and those who ate none of their food had a nearly six-fold higher risk of dying than those who ate at least some.
The findings support previous studies that have identified hospital malnutrition as a global public health problem, including Australian research which also found that this “silent epidemic” affects one in three hospitalised patients.
Despite this growing awareness, it is still not given the attention it deserves.
“Malnutrition can be invisible to the eye and is rampant in US hospitals because it’s not always top of mind,” said Gail Gerwitz, president of nutritionDay, an organisation which was involved in the study.
Loss of muscle mass and strength takes the brunt of poor nutrition, leading to sarcopenia, an age-related disease of accelerated muscle wasting that results in a downward spiral of poor health and mortality.
Some Australian hospitals are taking action by implementing basic malnutrition and sarcopenia screening tools. Relatives can also look for key signs of malnutrition.
These include unexpected weight loss, tiredness, low mood, poor appetite, unhealthy teeth and gums, listless hair and brittle nails, constipation and poor wound healing.
Hospitals and aged care facilities can take several measures to boost patients’ food intake, by using patient-centred service models, introducing mandatory nutrition standards, addressing obstacles to eating like poor dentition, and providing a choice of meals that are tasty and appealing.
High protein, high energy meals are the first line of defence to prevent or address malnutrition and promote healing. This can be achieved by adding extra cream or butter to food. Where necessary – especially with poor appetite – supplements can be used between meals to boost protein and calorie intake.
Posted by ProPortion Foods Blog on Nov 23, 2018 in Research
The number of people with food allergies is rising dramatically around the world. In fact, data suggest that peanut allergies have tripled over the past couple of decades.
Food allergy – an abnormal immune response to specific proteins – affects around 1 in 20 children. The most common triggers are egg, cow’s milk, peanut, tree nuts, seafood, soy, fish and wheat.
Most reactions aren’t severe, and many children will outgrow them. But peanut, tree nut, seed and seafood allergies are more likely to cause lifelong problems. And it is possible to develop an allergic reaction to a food that was previously safe to eat.
By adulthood, around 2 in 100 people suffer from food allergies. Symptoms can include swelling around the face, hives or skin rash, stomach pain and vomiting. In some they can cause anaphylaxis, a life-threatening reaction to suspect foods.
Not everyone with an allergy reacts to the common foods. More than 160 different foods have caused allergic reactions, including meat, sesame seeds, avocados, marshmallows (gelatin), corn, mango, dried fruit, and hot dogs.
Many less common food allergies are caused by oral allergy syndrome (OAS) or pollen-food allergy syndrome. People with OAS react to inhaled allergens like pollen from trees, weeds or grasses, and can develop “cross-reactivity” to foods with similar proteins.
For instance, many people with an allergy to birch and mugwort pollen also react to raw apple, and citrus fruit allergy can cross over to other citrus fruits, grass pollens, Timothy grass, birch and mugwort pollen.
Allergic reactions can impact quality of life. And because of serious and potentially fatal reactions in rare cases, common allergens must be listed on all foods.
Failure to list all ingredients can be tragic, like in the case of 15-year old Natasha Ednan-Laperouse, who died from an allergic reaction to a baguette in 2016. The culprit was sesame seeds, which was not on the ingredient list.
Hospitals and aged care facilities also need to be aware of new laws.
People who are allergic to peanuts (which are legumes, not nuts) might also be allergic to lupin, another type of high protein legume.
Australia’s food standards body, FSANZ, recently changed food labelling laws to require that lupin be declared as an ingredient – even if the food isn’t packaged.
Although lupin is not ordinarily used in Australian foods, it can be found in a range of common food items like bread, bakery products, pasta, sauces, beverages and even meat-based products like burgers and sausages.
Experts are not sure why food allergies are rising, but environmental influences are most likely.
A probable factor is the human microbiome – the 100 trillion bacteria and other microbes that coexist with us, mainly in our gut. These microbes play crucially important roles in immunity.
A host of modern practices has diluted our microbial diversity, including excessive use of antibiotics and disinfectants, and replacing diverse plant food diets with highly processed foods.
Another intriguing link is the higher incidence of food allergies in areas with less sunlight, suggesting a possible role for vitamin D.
Drawing from these observations, experts advise that we increase our exposure to green spaces, natural environments and sunlight, and regularly eat a broad range of plant foods.
Note that food allergies are different to food sensitivities.
Food sensitivities or intolerances are more prevalent than food allergy. They are not caused by an immune response, so the only way to identify them is by eliminating suspect foods then challenging to see if they produce a reaction.
Chronic diseases, impaired mobility and diminished quality of life with aging seem inevitable to most. Although healthy lifestyle habits protect us, researchers say they may have found another way to reverse the aging process.
Aging cells stop working well for several reasons. Researchers have turned the spotlight to ‘senescent cells’ – cells that stop dividing. This process is thought to have several benefits like suppressing tumours, wound healing and more.
But in aging, these cells accumulate and may impact the function of surrounding cells. And animal research suggests that removing these deteriorating cells could thwart or delay age-related physical decline.
Researchers propose that DNA damage, inflammation and erosion of telomeres – protective tips at the end of chromosomes – could all explain why cells become senescent with age.
It now appears that gene regulation might also factor in.
Every cell in the body contains all the information that the body needs to function. But different genes are turned on or off according to that cell’s role – explaining for instance why the heart and brain work differently despite containing the same genes.
Genes are activated by environmental messages, facilitated by around 300 proteins called ‘splicing factors’. With aging, the number of splicing factors drops, so that aging cells are less able to respond to changes in the environment.
Researchers from the University of Exeter, UK, have been able to turn these splicing factors back on and revive old cells – in vitro at least – by treating cells with a chemical that produces small amounts of hydrogen sulphide.
Hydrogen sulphide – the gas that smells like rotten eggs – is found naturally in our bodies. But in high doses it can be toxic. The researchers found a way to send the molecule in small doses to the mitochondria – the cell’s energy powerhouse – where they think it acts.
They hope this procedure could eventually be used in living people and treat age-related diseases.
Can death itself be cured so that people can live forever?
Aubrey de Grey thinks so. He founded the organisation, Strategies for Engineered Negligible Senescence (SENS), focussed on finding ways to remove senescent cells and theoretically keep bodies alive forever.
Do people want immortality? A 2013 national survey of Americans found that 56% would not use technologies that would help them live to 120 or longer. Two-thirds of respondents were concerned about the strain on natural resources.
Jake Dunagan, director of the consulting firm Very Nice and researcher in cognitive bias, says the SENS longevity research is selfish. “’I want mine. I always want mine.’ Well what if everyone had this? What would be the long-term implications of that?”
There is a notable distinction between increasing our “health span” – the primary focus of most aging research – and increasing our life span, say other researchers like biochemist and professor of biogerontology, Judy Campisi.
Most people fear death and discussing it is taboo in many cultures. De Grey calls it “the terrible thing that awaits [us],” disparaging people who simply accept their fate.
But ‘The Art of Dying Well’ suggests that coming to terms with death can help us live more fully. “In fact,” they suggest, “consciousness of our mortality can enable us to cherish every moment of the life we have.”
People have long thought that dementia is unavoidable if you carry risky genes. Now research is slowly but surely debunking this fateful thinking as mounting evidence suggests lifestyle changes could help people retain control over their mental faculties.
In fact, a recent study collated the latest research and found that controllable factors could account for around 35% of the dementia burden – larger than that attributed to the genes typically linked with Alzheimer’s disease, the most common form of dementia.
Signposts have long pointed the way – physical conditions like hypertension, inflammation and heart disease confer greater risk of dementia. So it’s really a no-brainer that the benefits of looking after our physical wellbeing extend to better mental health.
In 2013, Spanish researchers allocated 522 people aged 55-80 at high risk for heart disease to a Mediterranean diet or low-fat diet. More than six years later, those in the Mediterranean diet group had less heart disease and scored higher on cognitive tests used for dementia.
Indeed, research has found that people who follow a Mediterranean diet have less brain atrophy and amyloid-ß that is typical of Alzheimer’s. “If you follow a Western diet, your brain ages faster. A Mediterranean diet is protective,” says neuroscientist Lisa Mosconi.
The traditional Mediterranean diet is high in plant foods: vegetables, fruit, legumes, nuts, seeds and wholegrains, and extra virgin olive oil for cooking and salads. It also features moderate consumption of fish, fermented dairy (cheese, yoghurt) and red wine with meals, and very little processed food or meat.
Physical activity has numerous health benefits, from reducing risk of heart disease and diabetes to some cancers. A grouped analysis of 15 studies in 2010 found that across the board, exercise can also protect against cognitive decline.
Other studies have shown that physical activity can enhance blood flow to the brain and increase levels of brain-derived neurotropic factor – a protective protein.
Even if you don’t fancy donning gym gear and sweating it out with aerobics classes and barbells, just taking opportunities each day to walk, move and be active will reap physical and mental rewards.
Keeping the brain active also confers striking protection against Alzheimer’s disease. Staying educated encourages new neural connections that might compensate for cognitive decline with aging. “It future-proofs your brain,” according to researcher Leon Flicker.
Even people who don’t pursue ongoing education can boost their cognitive reserves in other ways, like reading, doing puzzles or attending quiz nights. Quiz nights may have additional benefits – having a strong social network can also keep the brain healthy. Even being married reduces dementia risk dramatically.
In 2017, researchers pooled data from 27 studies on sleep. They found that sleep problems increase risk of cognitive impairment by 65% and could account for up to 15% of Alzheimer’s diagnoses.
Other protective factors include not smoking and maintaining a healthy weight and blood pressure.
Even if you have a genetic predisposition for Alzheimer’s disease, “there are still things you can do,” says Finnish geriatric epidemiologist Tiia Ngandu.
Richard Isaacson has set up a clinic for preventing Alzheimer’s in the US. The clinic offers individualised prevention strategies for people at risk for dementia.
Based on data they have collected, he estimates that 60% of lifestyle recommendations will apply to most people. Beyond that, strategies may vary from person to person, including, for instance, specific treatments for heart conditions or sleep problems.
Researchers are now optimistic that people can prevent their risk of dementia, and current large studies are underway to strengthen the evidence base.