| 1. |
- Burman, Maria, 1983-
(författare)
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Malnutrition and obesity among older adults, assessed by Mini Nutritional Assessment and the body mass index, respectively : prevalence and associations with mortality and urinary tract infection
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- INTRODUCTION: Malnutrition and obesity are health concerns among older (aged ≥ 65 years) adults, but the combination of them have not been studied thoroughly nor have they been thoroughly investigated in very old (aged ≥ 85 years) adults. The aims of this thesis were to investigate the prevalence, trends in prevalence and associations with mortality of malnutrition and obesity, assessed by Mini Nutritional Assessment (MNA) and the body mass index (BMI), respectively, and to examine the combined effects of these conditions on mortality. Malnutrition as a risk factor for urinary tract infection (UTI) was also investigated. MATERIAL AND METHODS: The studies reported on in papers I and II were conducted with data from the Umeå85+/Gerontological Regional Database study, a population-based study of cohorts of very old adults. Data from all four Swedish cohorts (2000–2002, 2005–2007, 2010–2012 and 2015–2017), and from the 2000–2002 and 2005–2007 Swedish cohorts and a 2005–2006 Finnish cohort, respectively, were used. In the paper I study, trends in the prevalence of malnutrition (by MNA score) and obesity (by BMI) were investigated across cohorts. In the paper II study, the associations of MNA scores and BMI with 5-year mortality were investigated. The study reported on in paper III was conducted with data from the Senior Alert national quality registry; associations of Mini Nutritional Assessment–Short Form (MNA-SF) scores, BMI and 2-year mortality in older adults living in residential care facilities in Sweden were investigated. The study reported on in paper IV was conducted with data from the Frail Older People–Activity and Nutrition and Umeå Dementia and Exercise studies; risk factors for UTI among older adults in residential care facilities were investigated. RESULTS: In the paper I study, mean BMI increased between 2000–2002 and 2015–2017 and the prevalence of obesity were 13.4% and 18.3%, respectively; the prevalences of underweight were 7.6% and 3.0%, respectively. Mean MNA scores increased between 2000–2002 and 2010–2012 and were slightly lower in 2015–2017. The prevalence of malnutrition according to MNA scores in the four cohorts were 12.2%, 6.4%, 5.1% and 8.7%, respectively, and the prevalence of at risk thereof were 31.8%–37.2%. In the paper II study, 13.3% of participants were malnourished, and 40.3% at risk thereof according to MNA scores, and malnutrition was more common among women than men. Twenty-five percent of the population had BMIs ≥28.0 kg/m2. Of those with malnutrition according to MNA scores, 17.4% had BMIs ≥ 24.7 kg/m2; of those with good nutritional status according to MNA scores, 13.8% had BMIs < 22.2 kg/m2. Compared to malnutrition according to MNA, lesser mortality was found in individuals with good nutritional status. Compared to individuals with BMI <22.2 kg/m2, lesser mortality was found in those with BMI ≥28.0 kg/m2. In the paper III study, 14.6% of the population was malnourished, and 45.0% at risk of malnutrition according to MNA-SF scores and 16.0% were obese. Compared to individuals with good nutritional status, greater mortality was found in those with malnutrition according to MNA-SF. Mortality was greater among underweight than among normal-weight participants and lesser among participants with obesity, including severe obesity. Higher BMIs were also associated with reduced mortality in subgroups defined by MNA-SF scores. In the paper IV study, malnutrition according to MNA scores was not a risk factor for UTI in the whole sample or in women. In men, the MNA score was associated with UTI in univariate analysis. CONCLUSIONS: The results of this thesis highlight the importance of nutritional screening in older adults in residential care facilities and in very old adults, since malnutrition risk was common and associated with greater mortality among these populations. Malnutrition according to MNA was not a clear risk factor for UTI in older adults living in residential care facilities. Time trends indicated an increasing prevalence of obesity whereas no change in nutritional status according to MNA was observed among very old adults, although these trends need further investigation. The results also confirmed that higher BMIs were beneficial for survival in these populations, and in the residential care population this seems to apply also for BMIs reflecting severe obesity. Finally, in the residential care population, regardless of nutritional status according to MNA-SF, higher BMIs were associated with better survival.
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| 2. |
- Ferdous, Tamanna, 1974-
(författare)
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Determinants and Functional Impact of Nutritional Status Among Older Persons in Rural Bangladesh
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Malnutrition is a major problem in Bangladesh. One third of the population in Bangladesh is malnourished, but figures for older persons specifically are scant. Aims: This thesis describes the nutritional status of individuals aged 60+ years, living in a rural community in Bangladesh, with particular focus on the impact of demographic, health and social factors on nutritional status. A main aim is to examine the magnitude of malnutrition in this population. Second, the thesis focuses on the impact of demographic, health and social factors on nutritional status. Third, this thesis also aims to investigate the influence of nutritional status on functional abilities. Methods: A cross-sectional study of people aged 60+ years was conducted in Matlab, a rural area in Bangladesh during 2003-2004. Data were obtained through home interviews, clinical examination and cognitive tests. Nutritional status was assessed using a modified form of the Mini Nutritional Assessment. Physical function was measured by self-reported and performance-based instruments. Cognitive function was assessed using general and specific cognitive tasks. A total of 850 individuals were randomly selected for the purpose of the study, of which 625 participated in the home interviews and 473 underwent clinical examinations and cognitive tests. Information on complete nutritional status was available for 457 individuals. Results: About 26% of older people living in a rural community in Bangladesh were malnourished and 62% were at risk of malnutrition (Studies I-IV). Self-reported health problems (Study I), physician’s diagnoses (Study II), food expenditure (Study I), literacy (Studies I, II), personal income (Study II), female gender (Studies I, II) and financial support (Study II) were significantly associated with nutritional status. Health indicators accounted for the largest variations in nutritional status compared to demographic and socio-economic indicators (Studies I, II). Nutritional status was directly associated with self-reported and performance-based physical functions (Study III), as well as general and specific cognitive functions (Study IV). Conclusion: In low income countries, nutritional status of older persons needs to be addressed both from a health and a socio-economic perspective. Good nutritional status is essential for older persons to be functionally active, both physically and cognitively.
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| 3. |
- Linge, Jennifer, 1990-
(författare)
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Adverse Muscle Composition : Revisiting Sarcopenia in General Population and Liver Disease using Magnetic Resonance Imaging
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sarcopenia - from the Greek words 'sarx' (flesh) and 'penia' (loss) - was, when coined in 1989, a term denoting the decline in muscle mass and strength that occurs with aging. Such definition implies everyone suffers from sarcopenia to varying degrees, which naturally makes studying sarcopenia challenging. Early (practical) definitions of sarcopenia focused on identification of low muscle mass, while later definitions also include criteria of low muscle strength. Use of such definitions to study sarcopenia has shown that wasting is intensified in those suffering from metabolic diseases, and even more rapid in end-stage diseases. Although it is unknown whether sarcopenia accelerate disease or the other way around, detection of sarcopenia concurrent with other diseases clearly identifies a vulnerable subgroup of patients who may need more extensive care.In severe stages of liver disease, poor muscle health has been linked to higher morbidity and mortality, and may affect the outcome of liver transplantation. Sarcopenia is therefore recognized as an important factor that should affect both clinical decision-making and intervention in patients being evaluated for liver transplantation. However, sarcopenia is poorly understood (and commonly overlooked) in earlier stages of disease, where the potential of preventative care is greater. One challenge has been the prevalence of obesity in diseases that may precede more advanced disease, such as non-alcoholic fatty liver disease (NAFLD). Due to their larger body size, individuals with obesity need more muscle mass to maintain mobility function. Therefore, the threshold for what is considered ‘low muscle mass’ needs to be higher, or somehow adjusted for body size.This thesis started by applying the European definition of sarcopenia in 10,000 individuals aged 44-78 years volunteering for the UK Biobank imaging study. It was identified that current body size adjustments used to detect 'low muscle mass' were ineffective. The consequence of this was underdiagnosis of sarcopenia in individuals with overweight and obesity.Therefore, a more personalized muscle volume assessment, that was independent of body size, was developed with the aim to describe how much an individual is deviating from what is expected and address whether they have an 'adequate' amount of muscle volume - muscle volume z-score.Muscle volume was measured using magnetic resonance imaging and from the same images, muscle fat infiltration (indicating muscle quality) was also quantified. The first results indicated that muscle volume z-score and muscle fat infiltration were independently associated with mobility function and hospitalization, and that a combination of the two may identify the most vulnerable individuals. Therefore, thresholds were suggested to identify an adverse muscle composition (low muscle volume z-score combined with high muscle fat infiltration).Following studies investigated associations of adverse muscle composition with metabolic diseases, mobility function, and mortality in general population and NAFLD. Overall, the studies showed that adverse muscle composition was associated with increased morbidity and mortality independent of mobility function, and indicated that muscle composition assessment could provide clinically relevant information that may be useful in risk-stratification of heterogeneous disease populations like NAFLD.Today, the relevance of adverse muscle composition and potential clinical use cases are evaluated in the liver transplant setting through both European and American clinical studies.
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| 4. |
- Adamsson, Viola
(författare)
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A Healthy Nordic Diet and Cardiometabolic Risk Factors : Intervention Studies with Special Emphasis on Plasma Lipoproteins
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A healthy diet is important in the prevention of cardiovascular disease (CVD). Several risk factors, modifiable by diet, are involved in the development of CVD, e.g. hyperlipidaemia, hyperglycaemia, insulin resistance, obesity and hypertension. Little data however exist on diets composed of foods originating from the Nordic countries, and their potential to reduce CVD risk.This thesis aimed to investigate whether an ad libitum healthy Nordic diet (ND), either provided as a whole diet, or as a prudent breakfast (PB) alone, could influence CVD risk factors in healthy, mildly hypercholesterolemic men and women. Another aim was to describe the nutrient and food composition of the ND, both by using self-reported data and serum biomarkers of dietary fat quality.The primary clinical outcome measure was LDL-cholesterol, and other cardiometabolic risk factors were secondary outcomes.Two parallel, randomised, controlled intervention studies were conducted in free-living subjects. Clinical and dietary assessments were performed at baseline and at the end of dietary interventions. All foods were provided to subjects randomised to ND, whereas only breakfast items were supplied to subjects randomised to PB. Control groups followed their habitual diet/breakfast.Compared with controls, ND reduced body weight and improved several CVD risk factors including LDL-cholesterol, insulin sensitivity and blood pressure. Several, but not all effects were probably partly mediated by diet-induced weight loss. ND accorded with Nordic nutrition recommendations and was defined as “a plant-based diet, where animal products are used sparingly as side dishes”. Compared with average Swedish diet, ND was high in dietary fibre, but low in sodium, meat, high-fat dairy products, sweets and alcohol. A decreased intake of saturated fat and increased intake of n-3 PUFA during ND was partly reflected in serum lipids. Eating a PB without other dietary changes did not improve lipid or glucose metabolism, but decreased markers of visceral fat and inflammation, without influencing body weight.This thesis suggests that a whole ND, but not PB alone, promotes weight loss and improves multiple CVD risk factors in healthy subjects after 6 weeks. These results suggest that ND could have a potential role in the prevention of cardiometabolic diseases.
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| 5. |
- Fart, Frida, 1992-
(författare)
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The Ageing Gut, in Health and Disease
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a global ageing phenomenon, which stress the importance for an improved health for the increased population of older adults. One important factor for a good health is a well-functioning gut. Hence, this thesisinvestigates several aspects of gut health for older adults, spanning from overall gut health in community-dwelling older adults, to investigating a gut disease model: inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis. When investigating community-dwelling older adults, gastrointestinal symptoms were found to be common and correlated to a lower experience of well-being. In addition, more than half of the population did not reach the recommended intake of several macronutrients, including protein and fibre. Compared to a group of active older adults, still practising orienteering, i.e., senior orienteers, community-dwelling older adult’s further showed signs of a less healthier gut microbiota, including lower levels of Faecalibacterium prausnitzii.By investigating the disease model of inflammatory bowel disease, later onset of Crohn’s disease seemed to have less hyperresponsive adaptive immune response toward the own gut microbiota, which seems to be due to a less genetic predisposition among later onset individuals. Interestingly, an environmental pollutant, per- and polyfluoroalkyl substances (PFAS), was increased in the serum of late-onset ulcerative colitis patients compared to healthy controls. A higher level of PFAS further correlated to a disturbed bile acid pool. In addition, PFAS induced an increased intestinal permeability across ileal and colonic murine tissue. In conclusion, the work included in this thesis further emphasises the importance of a maintained gut health. In addition, the work highlights diet, an active life-style, gut microbiota and environmental factors, for example PFAS, as targets of future interventions studies with the aim to improve gut health and overall health among older adults.
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| 6. |
- von Berens, Åsa
(författare)
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Nutrition, exercise and body composition in community-dwelling older adults : Effects on function, wellbeing and mortality
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The demographic shift in society with more people reaching a high age provides new challenges for both society and the healthcare system.Aim: The overall aim of this thesis was to examine the impact of nutrition, exercise and body composition on function, wellbeing and mortality in community-dwelling older adults.The thesis is based on 1) data from the Vitality, Independence and Vigor in the Elderly 2 study (VIVE2) (Papers I-III), i.e. 149 community-dwelling participants >70 years who took part in an exercise program, and were randomized to take either a protein- and vitamin D-rich supplement or a placebo for 6 months and 2) three cohorts from two Swedish population studies on older adults (Paper IV). Quantitative (Papers I, II and IV) and qualitative methods (Paper III) were used. Results: Paper I reports cross-sectional data showing that there was no clear association between serum levels of serum 25(OH)D and physical performance in mobility-limited adults.In Paper II, the results of the VIVE2 study indicated positive effects on mental health from exercise but no additional effect from supplementation was detected.In Paper III, the qualitative interview investigation indicated that the VIVE2 intervention had positive effects, both psychologically and physically. Another finding was that weight loss was a main reason for participants wanting to take part in the study, whereas the aim of the study was to improve muscle function.Paper IV shows from prospective observational data that 75-year-old women with sarcopenic obesity had an increased mortality risk within 10 years, while a similar result could not be found among 75-year-old or 88-year-old men.Conclusion: The exercise intervention improved the mental status of the participants based on both quantitative and qualitative studies. No effect could be attributed to the protein- and vitamin D-rich nutritional supplement, a finding that needs to be evaluated in light of the participants’ good nutritional status. No clear association was revealed between physical function and serum 25(OH)D. Sarcopenic obesity may be associated with mortality but such associations may depend on age and gender.
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| 7. |
- Bjermo, Helena, 1981-
(författare)
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Dietary Fatty Acids and Inflammation : Observational and Interventional Studies
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dietary fat quality influences the risk of type 2 diabetes and cardiovascular disease. A low-grade inflammation is suggested to contribute to the disease development, often accompanied by obesity. Whereas n-3 polyunsaturated fatty acids (PUFA) have been considered anti-inflammatory, n-6 PUFA have been proposed to act pro-inflammatory. Saturated fatty acids (SFA) act pro-inflammatory in vitro. This thesis aimed to investigate effects of different fatty acids on low-grade inflammation in observational and interventional studies. In Paper I and II, fatty acid composition in serum cholesterol esters was used as objective marker of dietary fat quality and related to serum C-reactive protein (CRP) and other circulating inflammatory markers in two population-based cohorts, conducted in middle-aged men and elderly men and women, respectively. In Paper III and IV, the impact of diets differing in fat quality on inflammation and oxidative stress was investigated in randomised controlled studies, in subjects with metabolic syndrome and abdominal obesity. In Paper I and II, a low proportion of linoleic acid (18:2 n-6) in serum was associated with higher CRP concentrations, indicating that a low intake of vegetable fats may be related to low-grade inflammation. High CRP concentrations were also associated with high proportions of palmitoleic (16:1) and oleic (18:1) acids and high stearoyl coenzymeA desaturase index, possibly reflecting altered fat metabolism and/or high SFA intake in this population. When comparing two high-fat diets rich in either saturated or monounsaturated fat, and two low-fat diets with or without long-chain n-3 PUFA supplementation during 12 weeks (Paper III), no differences in inflammation or oxidative stress markers were observed. Moreover, a 10-week intervention (Paper IV) with high linoleic acid intake showed no adverse effects on inflammation or oxidative stress. Instead, interleukin-1 receptor antagonist and tumor necrosis factor receptor-2 decreased after linoleic acid intake compared with a diet high in SFA. The results in this thesis indicate that dietary n-6 PUFA found in vegetable fats is associated with lower inflammation marker levels, and to some extent reduces systemic inflammation when compared with SFA. Supplementation of n-3 PUFA did not exert any systemic anti-inflammatory effects, maybe due to a relatively low dose.
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| 8. |
- Farooqi, Nighat, 1969-
(författare)
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Nutrition and energy expenditure in women with chronic obstructive pulmonary disease
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AimThe overall objective of this thesis was to increase the knowledge and validate methods for assessment of total daily energy expenditure (TEE), energy requirement and energy intake (EI) in women with COPD. We also investigated the relationship of BMI with clinical characteristics of COPD in a population-based study. Due to the substantial and increasing morbidity in women with COPD, special attention was given to this group.MethodsResting metabolic rate (RMR) was measured by indirect calorimetry (IC). TEE was measured by criterion method, doubly labeled water (DLW) (Paper I-III) during a 14-day period. TEE was simultaneously assessed by SenseWear Armband, software version 5.1 and 6.1 (SWA5 respectively SWA6), and ActiHeart (paper I). EI was assessed by diet history interview and 7-day food diary (paper II), and energy requirement was predicted using pedometer-determined physical activity level (paper III). Energy requirement data was also acquired from studies concerning TEE measured by DLW in patients with COPD (paper IV). BMI and other characteristics in subjects with COPD were compared with non-COPD subjects in a population-based study, Obstructive Lung disease in Norrbotten study (OLIN) (paper V).ResultsThere was a large variation in RMR and TEE measured by DLW in this group of women with COPD. The results of energy expenditure study showed that the SWA5 assessed TEE with good accuracy over a 14-day period in free-living women with COPD. However, the SWA6 and ActiHeart methods tend to underestimate TEE. A higher proportion of women were within ± 5% of the TEE individually measured with the DLW method using SWA5 than SWA6 and AH (63%, 47%, 37% respectively). The agreement between the TEE measured by DLW and SWA5 was strong, and with SWA6 and ActiHeart it was lesser. Bland-Altman plots revealed no systematic bias for TEE. The reported EI was underestimated by 28% respectively 20 % when assessed by diet, and the 7-day food diary compared with the criterion method, DLW. More women were identified as valid-reporters based on their 7- day food diaries than on their diet histories (63% vs 32%). The accuracy of reported EI was only related to BMI. The agreement between the DLW and the EI methods was weak. The Bland-Altman plots revealed a slight systematic bias for both methods. The energy requirement predicted by pedometer-determined PAL multiplied by six different RMR equations was within a reasonable accuracy (±10%) of the measured TEE for all equations except one. The agreement between the DLW and four of six predicted TEE methods was strong. The Bland– Altman plots revealed no systematic bias for predicted energy requirement except for one. Estimated PAL from the pedometer was lower by 14 % than the measured criterion PAL. The energy requirement calculation based on available TEE data measured by DLW varied by BW and FFM. Compared to men, women had a lower RMR and TEE/kg BW/day, and higher RMR and TEE/kg FFM/day. The correlates of RMR/kg BW were gender and forced expiratory volume in 1st second (FEV1) % of predicted value, of TEE/ kg BW the correlates were age and gender, and of TEE/kg FFM were age and FEV1 % predicted. BMI decreased significantly with increase in disease severity and correlated significantly to forced expiratory volume in 1st second % predicted. In the population-based study (OLIN), subjects with COPD had lower BMI and a higher prevalence of underweight than in non-COPD, and its sub-groups namely, normal lung function and restrictive spirometry pattern subjects. There was an independent association between COPD and low BMI. Fewer COPD subjects were obese than in the non-COPD, normal lung function and restrictive spirometry pattern groups. Among the subjects with COPD, women had a lower mean BMI and a higher proportion were under-weight than men. In COPD women with under-weight, FEV1 % predicted values increased with an increase in BMI.ConclusionCompared with the gold standard DLW method, the total daily energy expenditure can be assessed reliably by SenseWear Armband 5 in women with COPD, while other devices underestimated TEE. The energy intake was underestimated by diet history and 7-day food diary methods, and energy requirement was predicted with reasonable accuracy using pedometer-determined PAL and common RMR equations, compared with DLW. Furthermore, the energy requirement was determined per kg BW/day and per kg FFM/day, using DLW based TEE data in patients with COPD. In the population-based study (OLIN), subjects with COPD had lower BMI and higher prevalence of under-weight than subjects without COPD. There was a gender difference, which was particularly significant in COPD, for women to have lower mean BMI and a higher prevalence of under-weight. The present findings indicate that low BMI is common in COPD and needs to be intervened. For a successful nutritional treatment, it is imperative to assess the patient’s ener
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| 9. |
- Iggman, David
(författare)
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Dietary Fatty Acids and Cardiometabolic Risk : Influence on Lipoproteins, Insulin Resistance and Liver Fat
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to investigate how dietary fatty acids affect the risk for cardiometabolic disease, i.e. cardiovascular disease (CVD), type 2 diabetes and obesity. The overall hypothesis was that unsaturated fatty acids and especially the predominant polyunsaturated fatty acid (PUFA) linoleic acid (LA), 18:2n-6, would decrease cardiometabolic risk compared with saturated fatty acids (SFAs), in line with current recommendations to partly replace dietary SFA with PUFA.Papers I and V were observational studies based on the community-based cohort Uppsala Longitudinal Study of Adult Men (ULSAM). Adipose tissue fatty acid composition was determined as biomarker for dietary fat intake. Studies II, III and IV were randomised short-term interventions on human volunteers, in which different dietary fats were provided to the participants.In 71-year-old men, adipose tissue LA and α-linolenic acid (18:3n-3) were associated with insulin sensitivity (euglycaemic clamp), although this association was diminished for LA after adjusting for lifestyle variables. Different SFA displayed divergent associations; only palmitic acid (16:0) was inversely associated with insulin sensitivity (Paper I). In Cox regression analyses, LA was modestly associated with decreased all-cause mortality, but not CVD mortality during 15 years follow-up (Paper V).In a 3+3-week cross-over study on 20 weight-stable volunteers with dyslipidaemia, all foods were provided. A rapeseed oil-based diet distinctly lowered low-density lipoprotein cholesterol and triglycerides compared with a dairy-fat based diet (butter, cream and fatty cheese). Insulin sensitivity or coagulation factors were not affected (Paper II).In a 10-week randomised trial on 67 abdominally obese participants, PUFA (mostly sunflower oil) decreased liver fat compared with SFA (mostly butter) under isocaloric conditions. In individuals considered highly compliant to study diets, lipoproteins were also decreased during the PUFA diet (Paper III).In a 7-week double-blind randomised trial on 41 healthy volunteers, PUFA (sunflower oil) decreased the total:HDL cholesterol ratio compared with SFA (palm oil) during moderate weight gain (1.5 kg) (Paper IV).In conclusion, LA (PUFA) intake is associated with decreased cardiometabolic risk compared with higher SFA intake, overall supporting a beneficial role of non-tropical vegetable oils in place of solid fats in preventing fatty liver and cardiometabolic disorders.
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| 10. |
- Johansson, Yvonne, 1956-
(författare)
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Self-Perceived Health and Nutritional Status among Home-Living Older People : A Prospective Study
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to follow the development of nutritional status and its significance for general health status using an epiemiologic method in a representative population‐based selection of older individuals in two cohorts. The main focus was to prospectively examine the significance of demographic, social and medical factors and to establish a basis to investigate the possibilities of preventive measures.Methods: Five hundred and eighty‐three individuals (278 women and 305 men), 75 and 80 years old, when included, living in a municipality in Östergötland in Sweden, participated in this study. Data collection took place 2001‐2006 with one examination yearly. The examination included a single question regarding self‐perceived health demographical questions, different questionnaires in the areas of nutritional status, symptoms of depression, cognitive function, health‐related quality of life and well being and objective assessments such as anthropometrical, physical and biochemical measurements.Results: Fifty percent of the women (I) and 58% of the men (II) perceived themselves as healthy. Important factors for women’s health (I) at baseline were no or few symptoms of depression, better physical mobility and better physical health. Among men who perceived themselves as healthy (II) at baseline, important factors were better physical health, maintaining a social network and the ability to walk outdoors. After one year 69% of the women and 75% of the men still perceived themselves as healthy. Among those women (I) who perceived themselves as healthy after one year, better physical mobility and better physical health were still important, with the addition of less or no pain. Important predictors for preserving health among men (II) were no symptoms of depression and the ability to walk up and down stairs. The prevalence of risk for malnutrition (III) was 14.5% (n=84), among women 18.8% and men 10.6%. Risk factors for malnutrition at baseline were a lower TSF, lower handgrip strength and worse physical health according to the PGC MAI. The incidence was 7.6%‐16.2%, and was distributed equally among women and men over time. Predictors for developing malnutrition were lower self‐perceived health, increased number of symptoms of depression. Especially men with symptoms of depression ran a higher risk. Reported energy intake (IV) was low in relation to the estimated requirement, on average 74% among women and 67% among men. Intake of vitamins A, D, E and folate was below the recommended intake and the same pattern was found over time. A smaller weight loss was found among women and men from baseline to Follow‐up 2.Conclusions: The experience of a good physical health was the only common factor for a good self‐perceived health among women and men. The highest risk for developing malnutrition was a combination of impaired self‐perceived health and increased number of symptoms of depression.Clinical implications: A combination of nutritional status, self‐perceived health and symptoms of depression can be a base for clinical judgement and can be used by different professionals in ealth and medical care and in home care service.
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