| 1. |
- Björnwall, Amanda, et al.
(författare)
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Eating Alone or Together among Community-Living Older People : A Scoping Review
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:7
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Forskningsöversikt (refereegranskat)abstract
- Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples’ life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.
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| 2. |
- Björnwall, Amanda, et al.
(författare)
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Perceptions and experiences of eating alone among community-living retired Swedes : Loss, routine and independence
- 2023
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Ingår i: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 186
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Tidskriftsartikel (refereegranskat)abstract
- The practice of eating together, commensality, is often considered as something positive in later life, particularly regarding peoples' nutritional status and psychosocial well-being. Eating alone, in contrast, is treated as a risk factor, although literature indicates that it is not necessarily something negative. Still, analyses that specifically target older peoples' varied experiences and notions of eating alone are scarce. This study has explored perceptions and experiences of eating alone among older people in Sweden, a country considered highly individualistic, yet with relatively low levels of loneliness in the older population. Semi-structured interviews were conducted with 20 community-living and retired Swedes, 70-90 years of age. A thematic analysis identified three themes: i) 'Eating alone as a manifestation of loss'; ii) 'Eating alone as an everyday routine'; and iii) 'Eating alone as independence and contentment'. General perceptions of eating alone were often related to the current living situation (e.g., cohabiting or single-living). One key finding was an identified tension between the idea of eating alone as something problematic among those living and eating with a partner and the practical experience of an uncomplicated routine among those living and eating alone. Eating together is discussed as a possible social need for many, but perhaps not for all. Some can feel content with eating alone or even enjoy it. Future studies should approach potential disadvantages of eating alone among older people as an open empirical question that is likely to depend on both the individual and the cultural context.
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| 3. |
- Englund, Davis A., et al.
(författare)
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Nutritional Supplementation With Physical Activity Improves Muscle Composition in Mobility-Limited Older Adults, The VIVE2 Study : A Randomized, Double-Blind, Placebo-Controlled Trial
- 2018
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Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 73:1, s. 95-101
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nutritional supplementation and physical activity have been shown to positively influence muscle mass and strength in older adults. The efficacy of long-term nutritional supplementation in combination with physical activity in older adults remains unclear.Methods: Mobility-limited (short physical performance battery [SPPB] ≤9) and vitamin D insufficient (serum 25(OH) D 9–24 ng/mL) older adults were recruited for this study. All subjects participated in a physical activity program. Subjects were randomized to consume a daily nutritional supplement (150 kcal, 20 g whey protein, 800 IU vitamin D, 119 mL beverage) or placebo (30 kcal, nonnutritive, 119 mL). In a prespecified secondary analysis, we examined total-body composition (dual energy X-ray absorptiometry), thigh composition (computed tomography), and muscle strength, power, and quality before and after the 6-month intervention.Results: One hundred and forty-nine subjects were randomized into the study [mean (standard deviation, SD) age 78.5 (5.4) years; 46.3% female; mean (SD) short physical performance battery 7.9 (1.2); mean (SD) vitamin D 18.7 (6.4) ng/mL]. After the intervention period both groups demonstrated improvements in muscle strength, body composition, and thigh composition. Nutritional supplementation lead to further losses of intermuscular fat (p = .049) and increased normal muscle density (p = .018).Conclusions: Six months of physical activity resulted in improvements in body composition, subcutaneous fat, intermuscular fat, and strength measures. The addition of nutritional supplementation resulted in further declines in intermuscular fat and improved muscle density compared to placebo. These results suggest nutritional supplementation provides additional benefits to mobility-limited older adults undergoing exercise training.
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| 4. |
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| 5. |
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| 6. |
- Grosicki, Gregory J., et al.
(författare)
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Circulating Interleukin-6 is Associated with Skeletal Muscle Strength, Quality, and Functional Adaptation with Exercise Training in Mobility-Limited Older Adults
- 2020
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Ingår i: Journal of Frailty & Aging. - : EDITIONS SERDI. - 2260-1341 .- 2273-4309. ; 9:1, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- Background: Human aging is characterized by a chronic, low-grade inflammation suspected to contribute to reductions in skeletal muscle size, strength, and function. Inflammatory cytokines, such as interleukin-6 (IL-6), may play a role in the reduced skeletal muscle adaptive response seen in older individuals.Objectives: To investigate relationships between circulating IL-6, skeletal muscle health and exercise adaptation in mobility-limited older adults.Design: Randomized controlled trial.Setting: Exercise laboratory on the Health Sciences campus of an urban university.Participants: 99 mobility-limited (Short Physical Performance Battery (SPPB) <= 9) older adults.Intervention: 6-month structured physical activity with or without a protein and vitamin D nutritional supplement.Measurements: Circulating IL-6, skeletal muscle size, composition (percent normal density muscle tissue), strength, power, and specific force (strength/CSA) as well as physical function (gait speed, stair climb time, SPPB-score) were measured pre- and post-intervention.Results: At baseline, Spearman's correlations demonstrated an inverse relationship (P<0.05) between circulating IL-6 and thigh muscle composition (r = -0.201), strength (r = -0.311), power (r = -0.210), and specific force (r = -0.248), and positive association between IL-6 and stair climb time (r = 0.256; P<0.05). Although the training program did not affect circulating IL-6 levels (P=0.69), reductions in IL-6 were associated with gait speed improvements (r = -0.487; P<0.05) in "higher" IL-6 individuals (>1.36 pg/ml). Moreover, baseline IL-6 was inversely associated (P<0.05) with gains in appendicular lean mass and improvements in SPPB score (r = -0.211 and -0.237, respectively).Conclusions: These findings implicate age-related increases in circulating IL-6 as an important contributor to declines in skeletal muscle strength, quality, function, and training-mediated adaptation. Given the pervasive nature of inflammation among older adults, novel therapeutic strategies to reduce IL-6 as a means of preserving skeletal muscle health are enticing.
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| 7. |
- Hagström, Naima, et al.
(författare)
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A qualitative evaluation of the specific carbohydrate diet for juvenile idiopathic arthritis based on children's and parents' experiences
- 2023
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Ingår i: Pediatric Rheumatology. - : BioMed Central (BMC). - 1546-0096. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInsights into the immunological role of the gastrointestinal tract in autoimmune conditions have led to the investigation of diet as a potential adjunctive treatment option for juvenile idiopathic arthritis (JIA). The specific carbohydrate diet (SCD) has shown promising results. However, studies on participants’ experiences of dietary interventions in JIA are rare. In this study we investigated the experiences of children and parents’ who had participated in a four-week intervention with SCD aiming to examine the potential anti-inflammatory effects.ObjectivesTo conduct a qualitative evaluation exploring children’s and parents’ experiences of the dietary intervention, how they navigated challenges, and their support requirements.MethodsSemi-structured interviews were conducted with 12 children and 15 parents from 13 families, who were interviewed individually and together. The transcripts were analysed using systematic text condensation.ResultsMost participants interviewed found the intervention beneficial, with 12 out of 13 reporting positive effects, such as reduced pain and morning stiffness, and improved gastrointestinal function. Many participants reported being willing to repeat the intervention in the current form. Despite facing challenges, all children followed the diet for one to three months, with some continuing to follow a modified version. Facing the socio-emotional consequences of adhering to the diet was challenging for children. These were handled by focusing on the positive aspects and by relying on the supportive environment available. Parents struggled with practical issues since the diet required hard work, time, and money. Areas identified as requiring additional support include finding simple, quick, and child-friendly solutions, strengthening organizational food skills such as meal planning, and preparation prior to starting the intervention regarding socio-emotional aspects.ConclusionNavigating the dietary treatment was considered challenging, practically for the parents and socio-emotionally for the children. Based on the reported challenges and participants’ suggestions the intervention could be optimised by providing support and solutions in relation to the practical issues and better preparation regarding dealing with the socio-emotional consequences. Despite the difficulties, the participants reported overall positive experiences of, and attitudes towards, the current setup. Consequently, dietary interventions, such as the SCD, may be regarded as suitable targets for further research.
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| 8. |
- Kirn, Dylan R., et al.
(författare)
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The Vitality, Independence, and Vigor in the Elderly 2 Study (VIVE2) : Design and methods
- 2015
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Ingår i: Contemporary Clinical Trials. - : Elsevier BV. - 1551-7144 .- 1559-2030. ; 43, s. 164-171
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nutritional supplementation may potentiate the increase in skeletal muscle protein synthesis following exercise in healthy older individuals. Whether exercise and nutrition act synergistically to produce sustained changes in physical functioning and body composition has not been well studied, particularly in mobility-limited older adults. Methods: The VIVE2 study was a multi-center, randomized controlled trial, conducted in the United States and Sweden. This study was designed to compare the effects of a 6-month intervention with a once daily, experimental, 4 fl. oz. liquid nutritional supplement providing 150 kcal, whey protein (20 g), and vitamin D (800 IU) (Nestle Health Science, Vevey, Switzerland), to a low calorie placebo drink (30 kcal, non-nutritive; identical format) when combined with group-based exercise in 150 community-dwelling, mobility-limited older adults. All participants participated in a structured exercise program (3 sessions/week for 6 months), which included aerobic, strength, flexibility, and balance exercises. Results: The primary outcome was 6-month change in 400 m walk performance (m/s) between supplement and placebo groups. Secondary outcomes included 6 month change in: body composition, muscle cross-sectional area, leg strength, grip strength, stair climb time, quality of life, physical performance, mood/depressive symptoms and nutritional status. These outcomes were selected based on their applicability to the health and wellbeing of older adults. Conclusions: The results of this study will further define the role of nutritional supplementation on physical functioning and restoration of skeletal muscle mass in older adults. Additionally, these results will help refine the current physical activity and nutritional recommendations for mobility-limited older adults.
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| 9. |
- Koochek, Afsaneh, et al.
(författare)
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Dietary differences between elderly Iranians living in Sweden and Iran a cross-sectional comparative study
- 2011
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11, s. 411-
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Tidskriftsartikel (refereegranskat)abstract
- Background: During the last decades, global migration has increased and many immigrant groups have a higher prevalence than the native born population of several cardiovascular disease risk factors, including poor dietary habits. However, it is uncertain if dietary habits in immigrant populations reflect dietary habits in their country of origin or if the current diet is a consequence of the migration and possible change of dietary habits. The aim of this study was to examine possible dietary differences between elderly Iranians living in Stockholm, Sweden with elderly Iranians living in Tehran, Iran, taking into account sex, age, marital status, and education. Methods: Dietary intakes were assessed by semi - quantitative food frequency questionnaire in a cross-sectional study of 121 Iranians living in Stockholm and 52 Iranians living in Tehran, aged 60-80. Differences in dietary habits between the two groups was analysed by bootstrapped regression analyses with 1000 replications. Results: Iranians living in Sweden had significantly higher intake of protein, total fat, fiber than Iranians living in Iran, but lower consumption of carbohydrates. The observed differences in intake of macronutrients were reflected in consumed amount of all food items, which were higher among Iranians living in Iran with the exception of bread and grain consumption which was lower. Conclusions: There are general differences in dietary habits between Iranians living in Iran and Iranians living in Sweden. Parts of observed differences in dietary habits may reflect a favourable adoption process to the Swedish dietary habits after migration. Meanwhile other differences are point of concern in light of the high prevalence of overweight, among Iranians living in Sweden and can have unfavourable impact in particular in the context of cardiovascular health.
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| 10. |
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| 11. |
- Koochek, Afsaneh
(författare)
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Elderly Iranians in Sweden : the impact of migration on risk factors for cardiovascular disease
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To analyze determinants of and differences in risk factors for cardiovascular disease (CVD) among elderly Iranians in Sweden, elderly Swedes, and elderly Iranians in Iran. Method: A total of 1212 men and women aged 60 84 were studied. Study I included 167 Iranianborn and 235 Swedish-born residing in Stockholm, Sweden. The outcome variables, body mass index (BMI) and self-reported leisure-time physical activity were analyzed by linear regression and unconditional logistic regression. Study II included 176 Iranians in Stockholm and 300 Iranians in Tehran and was designed to determine the prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes. Unconditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for outcome variables. In Study III, the Short Form Health Survey (SF-36) was administered to collect information about health-related quality of life in elderly Iranians in Sweden (n=176), elderly Iranians in Iran (n=298), and an elderly Swedish control group (n = 151) randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age and education. In Study IV, dietary intakes were assessed by administering a semi-quantitative food frequency questionnaire to 121 Iranians living in Stockholm and 52 Iranians living in Tehran. Differences in dietary habits between the two groups and association of dietary habits with prevalence of overweight, general obesity, and central obesity were analyzed by linear and unconditional logistic regression. Results: In Study I, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference group) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher average BMI than the reference group after adjustment for age, education, and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later. Iranians and Swedes had almost the same odds of >= once-weekly leisure-time physical activity. In Study II, the risks of hypertension and smoking were higher in Iranian women and men in Sweden than in Iran in the age-adjusted model and remained significant after adjusting for all other independent variables. Abdominal obesity was found in nearly 80% of the women in both groups. In Study III, Iranian women in Sweden with shorter times of residence scored lower vitality than other women in this study. Among elderly Iranian women, more than 15 years of residence in Sweden was positively associated with social functioning and role limitation due to emotional problems. In general, the Swedish women scored higher in all dimensions of the SF-36 than the women in the other two subsamples. The Swedish men scored higher in six of eight dimensions than the men in the other two subsamples. Study IV, Iranians living in Sweden consumed more protein, total fat, fiber, and all food groups than Iranians living in Iran, with the exception of bread and grain. The only association found between diet and prevalence of overweight, general obesity, and central obesity was an inverse association between fruit consumption and central obesity in Iranians who had lived in Sweden >15 years. Conclusions: There is a strong association between migration status and the prevalence of cardiovascular disease among elderly Iranians living in Sweden. However, length of time since migration to Sweden is not associated with poorer health-related quality of life among elderly Iranians. In fact, the partial adoption of favorable dietary habits may be associated with increasing number of years in Sweden. The adoption of such favorable habits may lead to increased healthrelated quality of life, decreased CVD risk factors, and increased life expectancy. Health promotion in the public health care system and interventions aimed at the prevention and treatment of overweight and obesity should include a special focus on recent elderly female immigrants, who exhibited the largest difference in BMI and lowest score of health-related quality of life compared to the reference groups. Such resources could empower individuals to achieve a lifestyle that includes more physical activity and healthier dietary habits. This could increase health-related quality of life and decrease risk of obesity and CVD, especially as regular physical activity clearly attenuates many of the health risks associated with overweight or obesity. Treatments and prevention programs that focus on lifestyle changes, carried out by dieticians, physiotherapists, district nurses and physicians in primary health care are therefore recommended.
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| 12. |
- Koochek, Afsaneh, et al.
(författare)
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Is migration to Sweden associated with increased prevalence of risk factors for cardiovascular disease?
- 2008
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Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - : Sage Publications. - 1741-8267 .- 1741-8275. ; 15:1, s. 78-82
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: [corrected] The proportion of elderly immigrants in Sweden is increasing. This is an important issue considering that the prevalence of cardiovascular disease (CVD) is a global health problem and that CVD is one of the main causes of morbidity among the elderly. The aim of this study is to analyze whether there is an association between migration status, that is being an elderly Iranian immigrant in Sweden, as compared with being an elderly Iranian in Iran, and the prevalence of risk factors for CVD. DESIGN: Population-based cross-sectional study with face-to-face interviews. PARTICIPANTS AND SETTING: A total of 176 Iranians in Stockholm and 300 Iranians in Tehran, aged 60-84 years. METHODS: The prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes was determined. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes. RESULTS: The age-adjusted risk of hypertension and smoking was higher in Iranian women and men in Sweden. OR for hypertension was 1.9 (95% CI: 1.1-3.2) for women and 3.1 (95% CI: 1.5-6.3) for men and OR for smoking was 6.9 (95% CI: 2.2-21.6) for women and 4.7 (95% CI: 2.0-11.0) for men. The higher risk for hypertension and smoking remained significant after accounting for age, socioeconomic status, and marital status. Abdominal obesity was found in nearly 80% of the women in both groups. CONCLUSION: The findings show a strong association between migration status and the prevalence of hypertension and smoking. Major recommendation for public health is increased awareness of CVD risk factors among elderly immigrants.
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| 13. |
- Lövestam, Elin, et al.
(författare)
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Evaluating Documentation of Dietetic Care in Swedish Medical Records
- 2013
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Ingår i: MEDINFO 2013. - 9781614992899 - 9781614992882 ; 192, s. 1078-
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Konferensbidrag (refereegranskat)abstract
- An adequate documentation in medical records is essential for patient safety and high quality care. The aim of this study was to evaluate documentation by dietitians in Swedish medical records. A retrospective audit of 147 dietetic notes in electronic medical records was performed. The audit focused at documentation of essential parts of the dietetic care, as well as other quality aspects such as lingual clarity and structure of the documentation. The nutrition intervention showed to be the most documented part of dietetic care. However, the audit showed that several important parts of nutrition care were poorly documented, for instance nearly half of the audited records had no clear nutrition problem documented, and in most of the records, the goal of nutrition intervention was missing. The study shows that Swedish dietitians need to improve documentation in medical records, as a suggestion by implementing a more structured documentation model.
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| 14. |
- Lövestam, Elin, 1983-, et al.
(författare)
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Evaluation of a Nutrition Care Process-based audit instrument, the Diet-NCP-Audit, for documentation of dietetic care in medical records
- 2014
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 28:2, s. 390-397
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Tidskriftsartikel (refereegranskat)abstract
- Adequate documentation in medical records is important for high-quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four-step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0-1 or 0-2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet-NCP-Audit. Firstly, the content validity of the Diet-NCP-Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter-rater agreement with Krippendorff's α = 0.65-0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra-rater reliability test-retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic care.
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| 15. |
- Lövestam, Elin, et al.
(författare)
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Evaluation of Nutrition Care Process documentation in electronic patient records : Need of improvement
- 2015
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Ingår i: Nutrition & Dietetics. - : Wiley. - 1446-6368 .- 1747-0080. ; 72:1, s. 74-80
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Tidskriftsartikel (refereegranskat)abstract
- AimHigh-quality documentation in patient records is essential for patient safety and plays a prominent role in the delivery and evaluation of dietetic/nutrition care. We aimed to evaluate dietitians' documentation in patient records according to the four steps in the Nutrition Care Process: assessment, diagnosis, intervention and monitoring/evaluation.MethodsA retrospective audit of 147 systematically collected outpatient dietetic notes from primary care centres and hospitals in central Sweden was performed using a validated audit instrument. The instrument was used to assess the documentation of 14 items: 10 items focusing on the Nutrition Care Process steps and four items on language clarity and structure, with a maximum total score of 26 for each dietetic note. The notes were divided into three different quality levels, A (high score), B (medium score) or C (low score). Comparisons were made between notes from primary care and hospitals.ResultsThe audit showed that the majority of the notes were placed at level B, scoring 13.5–19.5. Only 3% of the notes scored higher than 19.5. The most frequently documented items were intervention (90%), evaluation (70%) and nutrition problem (56%), whereas the least documented items were nutrition prescription (15%), goal of intervention (9%) and connection of problem-etiology-symptom (5%). Flaws in lingual clarity were common (72%). Primary care notes received higher scores than those from hospitals.ConclusionsThe audit shows that Swedish dietetic documentation needs to be improved, for example, by further training and education in the Nutrition Care Process and its standardised terminology.
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| 16. |
- Lövestam, Elin, et al.
(författare)
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The power of language on patient‐centredness : linguistic devices in the dietetic notes of patient records
- 2015
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Ingår i: International Journal of Applied Linguistics. - : Wiley. - 0802-6106 .- 1473-4192. ; 25:2, s. 225-245
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Tidskriftsartikel (refereegranskat)abstract
- n this paper, 30 notes written by Swedish dietitians in patient records are analysed, inspired by Critical Linguistics and Critical Discourse Analysis. Focusing on linguistic devices such as agency sources and evidential markers, we describe how patients are constantly referred to only in terms of the institutional patient role, or not referred to at all, through different techniques such as nominalization and passive verbs. The dietitians writing the notes are even more absent from the text, as they almost never refer to themselves as persons in the dietetic notes. There is a stated ambition in health care to provide patient-centred care and a collaborative patient-clinician relationship. However, we suggest that there might be a need for more person-centred language in dietetics.
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| 17. |
- Lövestam, Elin, et al.
(författare)
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The struggle to balance system and lifeworld : Swedish dietitians’ experiences of a standardised nutrition care process and terminology
- 2016
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Ingår i: Health Sociology Review. - : Informa UK Limited. - 1446-1242 .- 1839-3551. ; 25:3, s. 240-255
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Tidskriftsartikel (refereegranskat)abstract
- In this study, we explored Swedish dietitians’ experiences of a standardised Nutrition Care Process (NCP) and terminology from the perspective of Habermas’ concepts of system and lifeworld. Seven focus group discussions were analysed thematically. In thispaper, we argue that dietitians seem to mainly connect the NCP with a system perspective, highlighting aspects such as professionalism, measurability and clarity of the patient record as helpful outcomes from the NCP standardisation. We also see a tension between system and lifeworld, as dietitians emphasised the importance of the dietitian–patient relationship, stating that a patient’s complex situation does not always fit into the pre-defined NCP terms and measurements. Several approaches were identified whereby dietitians tried to reach a balance between the system and lifeworld. We argue that strategies for achieving this balance need more attention in the education and implementation of standardised care processes and terminologies.
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| 18. |
- Odlund Olin, A, et al.
(författare)
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Minimal effect on energy intake by additional evening meal for frail elderly service flat residents : a pilot study
- 2008
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Ingår i: The Journal of Nutrition, Health & Aging. - Paris, France : Springer. - 1279-7707 .- 1760-4788. ; 12:5, s. 295-301
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nutritional problems are common in frail elderly individuals receiving municipal care. OBJECTIVE: To evaluate if an additional evening meal could improve total daily food intake, nutritional status, and health-related quality of life (HRQOL) in frail elderly service flat (SF) residents. DESIGN: Out of 122 residents in two SF complexes, 60 subjects agreed to participate, of which 49 subjects (median 84 (79-90) years, (25th-75th percentile)) completed the study. For six months 23 residents in one SF complex were served 530 kcal in addition to their regular meals, i.e. intervention group (I-group). Twenty-six residents in the other SF building were controls (C-group). Nutritional status, energy and nutrient intake, length of night time fast, cognitive function and HRQOL was assessed before and after the intervention. RESULTS: At the start, the Mini Nutritional Assessment classified 27% as malnourished and 63% as at risk for malnutrition, with no difference between the groups. After six months the median body weight was unchanged in the I-group, +0.6 (-1.7-+1.6) kg (p=0.72) and the C-group -0.6 (-2.0-+0.5) kg (p=0.15). Weight change ranged from -13% to +15%. The evening meal improved the protein and carbohydrate intake (p<0.01) but the energy intake increased by only 180 kcal/day (p=0.15). The night time fast decreased in the I-group from 15.0 (13.0-16.0) to 13.0 (12.0-14.0) hours (p<0.05). There was no significant difference in cognitive function or HRQOL between the groups. CONCLUSION: Nine out of ten frail elderly SF residents had nutritional problems. Serving an additional evening meal increased the protein and carbohydrate intake, but the meal had no significant effect on energy intake, body weight or HRQOL. The variation in outcome within each study group was large.
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| 19. |
- Odlund Olin, A, et al.
(författare)
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Nutritional status, well-being and functional ability in frail elderly service flat residents
- 2005
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Ingår i: European Journal of Clinical Nutrition. - London, United Kingdom : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 59:2, s. 263-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate nutritional status and its relationship to cognition, well-being, functional ability and energy intake in frail elderly service flat residents.DESIGN: Cross-sectional and prospective study.SETTING: Two municipal service flat complexes.SUBJECTS: A total of 80 residents (median age 85.5 (79-90) y) with regular home care assistance participated. A subgroup of 35 residents took part in a re-examination 1 y later.METHODS: Mini Nutritional Assessment (MNA), Short Portable Mental Status Questionnaire, Barthel Index and Health Index were used for the evaluation of nutritional, cognitive and ADL function and well-being, respectively.RESULTS: In all, 30% of the frail and chronically ill service flat residents were assessed as malnourished and 59% were at risk of malnutrition. The malnourished residents had worse cognitive conditions (P<0.001) and well-being (P<0.05), lower functional ability (P<0.01) and they had a greater need for daily assistance (P<0.05) than the other residents. The median night fast period was 14.0 (12.5-15.0) h. Five subjects classified as malnourished at baseline had lost a median of -9.6 kg (range -11.0 to +7.3 kg) (P<0.05) in body weight at the 1-y follow-up, which contrasted significantly from the weight stability in residents classified as at risk for malnutrition or well-nourished.CONCLUSION: Out of 10 residents, nine were assessed to have impending nutritional problems that related to impaired well-being, cognition, and functional ability. Malnourished residents had a significant weight loss over one year. Studies are needed to determine whether weight loss and nutrition-related dysfunction in service flat residents are preventable or treatable.
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| 20. |
- Sjöström, Sara, et al.
(författare)
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Factors influencing the choice of oral nutritional supplements prescribed by Swedish dietitians
- 2016
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Ingår i: ABSTRACT BOOK, Complete. The 11th NORDIC NUTRITION CONFERENCE NNC2016. - : SNF Swedish Nutrition Foundation.
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Konferensbidrag (refereegranskat)abstract
- Background and aims: Oral Nutritional Supplements (ONS) are commonly used in combination with dietary changes when treating disease-related malnutrition. In Sweden ONS are primarily prescribed by registered dietitians and subsidized by county councils, and there are no standardized guidelines for prescription. The aim of this study was to examine factors influencing the choice of ONS prescriptions.Methods: A newsletter with a link to an online survey was e-mailed to 1480 members of The Swedish Association of Clinical Dietitians (DRF) as well as to other dietitians with contact details on the DRF´s webpage.Results: A total of 133 dietitians, from 17 out of 21 county councils working in various settings, answered the survey. When asked to choose from alternatives of important influencing factors for ONS prescription the three most frequently selected were, patient taste preferences (96 %), nutritional requirements (93%), and medical diagnosis (85 %). Those were followed by, dietitian’s previous experiences of successful ONS (76 %), local procurements (62 %), food allergy and intolerance (53 %), price (23 %), dietitian taste preferences (15 %), and other alternatives (8 %). Over half (52 %) of the dietitians rated patient taste preferences as the single most influential factor when prescribing ONS. Although, 51% stated that patients were seldom or otherwise not provided with the opportunity to taste ONS before prescription. Onethird (35%) of the dietitians stated that representatives from ONS companies impact their choice for prescription.Conclusion: Patient taste preferences and nutritional requirements, were found to be the most important influencing factors for prescribing ONS. In conjunction, it was also found that many patients seldom get the opportunity to try ONS before prescription.
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| 21. |
- Skoglund, Elisabeth, et al.
(författare)
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Functional improvements to 6 months of physical activity are not related to changes in size or density of multiple lower-extremity muscles in mobility-limited older individuals
- 2022
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Ingår i: Experimental Gerontology. - : Elsevier BV. - 0531-5565 .- 1873-6815. ; 157
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Tidskriftsartikel (refereegranskat)abstract
- Older adults are encouraged to engage in multicomponent physical activity, which includes aerobic and muscle-strengthening activities. The current work is an extension of the Vitality, Independence, and Vigor in the Elderly 2 (VIVE2) study - a 6-month multicenter, randomized, placebo-controlled trial of physical activity and nutritional supplementation in community dwelling 70-year-old seniors. Here, we examined whether the magnitude of changes in muscle size and quality differed between major lower-extremity muscle groups and related these changes to functional outcomes. We also examined whether daily vitamin-D-enriched protein supplementation could augment the response to structured physical activity. Forty-nine men and women (77 ± 5 yrs) performed brisk walking, muscle-strengthening exercises for the lower limbs, and balance training 3 times weekly for 6 months. Participants were randomized to daily intake of a nutritional supplement (20 g whey protein + 800 IU vitamin D), or a placebo. Muscle cross-sectional area (CSA) and radiological attenuation (RA) were assessed in 8 different muscle groups using single-slice CT scans of the hip, thigh, and calf at baseline and after the intervention. Walking speed and performance in the Short Physical Performance Battery (SPPB) were also measured. For both CSA and RA, there were muscle group × time interactions (P < 0.01). Significant increases in CSA were observed in 2 of the 8 muscles studied, namely the knee extensors (1.9%) and the hip adductors (2.8%). For RA, increases were observed in 4 of 8 muscle groups, namely the hip flexors (1.1 HU), hip adductors (0.9 HU), knee extensors (1.2 HU), and ankle dorsiflexors (0.8 HU). No additive effect of nutritional supplementation was observed. While walking speed (13%) and SPPB performance (38%) improved markedly, multivariate analysis showed that these changes were not associated with the changes in muscle CSA and RA after the intervention. We conclude that this type of multicomponent physical activity program results in significant improvements in physical function despite relatively small changes in muscle size and quality of some, but not all, of the measured lower extremity muscles involved in locomotion.
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| 22. |
- Taylor, Rachael M., et al.
(författare)
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Diet quality and cardiovascular outcomes : A systematic review and meta-analysis of cohort studies
- 2024
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Ingår i: Nutrition & Dietetics. - : Wiley-Blackwell Publishing Inc.. - 1446-6368 .- 1747-0080.
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo evaluate relationships between diet quality and cardiovascular outcomes.MethodsSix databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta-analyses using a random effects model.ResultsOf the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta-analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82–0.84, p < 0.001) and mortality risk (n = 49 studies, relative risk 0.83, 95% CI 0.82–0.84, p < 0.001) among those with highest versus lowest diet quality. In sensitivity analyses of a high number of pooled studies (≥13 studies) the Mediterranean style diet patterns and adherence to the heart healthy diet guidelines were significantly associated with a risk reduction of 15% and 14% for cardiovascular disease incidence and 17% and 20% for cardiovascular disease mortality respectively (p < 0.05).ConclusionsHigher diet quality is associated with lower incidence and risk of mortality for cardiovascular disease however, significant study heterogeneity was identified for these relationships.
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| 23. |
- von Berens, Åsa, et al.
(författare)
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Effect of exercise and nutritional supplementation on health-related quality of life and mood in older adults : the VIVE2 randomized controlled trial
- 2018
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health-related quality of life (HRQoL) and absence of depressive symptoms are of great importance for older people, which may be achieved through lifestyle interventions, e.g., exercise and nutrition interventions. The aim of this investigation was to analyze the effects of a physical activity program in combination with protein supplementation on HRQoL and depressive symptoms in community-dwelling, mobility-limited older adults. Methods: In the Vitality, Independence, and Vigor 2 Study (VIVE2), community-dwelling men and women with an average age of 77.55.4 years, some mobility limitations and low serum vitamin D levels (25(OH)Vit D 22.5-60 nmol/l) from two study sites (Stockholm, Sweden and Boston, USA) were randomized to receive a nutritional supplement or a placebo for 6 months. All took part in a physical activity program 2-3 times/week. The primary outcome examined in VIVE2 was 400 M walk capacity. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Health Survey (SF36), consisting of the Physical Component Summary (PCS) and Mental Component Summary (MCS), and depressive symptoms were measured using The Centre for Epidemiologic Studies Depression Scale (CES-D). In the sensitivity analyses, the sample was divided into sub-groups based on body measures and function (body mass index (BMI), appendicular lean mass index (ALMI), handgrip strength and gait speed). Results: For the whole sample, there was a significant improvement in both MCS, mean (95% CI) 2.68 (0.5, 4.9) (p 0.02), and CES-D -2.7 (-4.5, -0.9) (p 0.003) during the intervention, but no difference was detected between those who received the nutritional supplement and those who received the placebo. The results revealed no significant change in PCS or variation in effects across the sub-categories. Conclusions: This study demonstrates that a six-month intervention using a physical activity program had positive effects on mental status. No additional effects from nutritional supplementation were detected.
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| 24. |
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| 25. |
- 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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| 26. |
- von Berens, Åsa, et al.
(författare)
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Physical performance and serum 25(OH)vitamin D status in community dwelling old mobility limited adults : A cross-sectional study
- 2018
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Ingår i: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 22:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To examine the potential association between serum 25(OH) vitamin D and theperformance on the Short Physical Performance Battery (SPPB) including the sub-components; five repeatedchair stands test, 4 meters walk test and balance in older mobility-limited community-dwelling men and women.Design:A cross sectional study was performed in American and Swedish subjects who were examined forpotential participation in a combined exercise and nutrition intervention trial. Logistic regression analysis andlinear regression analyses were performed to evaluate the association for 25(OH)D with the overall score onthe SBBP, chair stand, gait speed and balance.Participants:Community-dwelling (mean age 77.6 ± 5.3 years)mobility limited American (n=494) and Swedish (n=116) females (59%) and males.Measurements:The SPPB(0-12 points) includes chair stand (s), gait speed (m/s) and a balance test. Mobility limitation i.e., SPPB score ≤9 was an inclusion criterion. A blood sample was obtained to measure serum 25(OH)vitamin D concentrations.Results:No clear association of 25(OH)D with SPPB scores was detected either when 25(OH)D was assessedas a continuous variable or when categorized according to serum concentrations of <50, 50-75 or <75 nmol/L.However, when analyzing the relationship between 25(OH)D and seconds to perform the chair stands, asignificant quadratic relationship was observed. Thus, at serum levels of 25(OH)D above 74 nmol/L, higherconcentrations appeared to be advantageous for the chair stand test, whereas for serum levels below 74 nmol/Lthis association was not observed.Conclusion: This cross- sectional study lacked clear association betweenserum 25(OH)D and physical performance in mobility limited adults. A potentially interesting observation wasthat at higher serum levels of 25(OH)D a better performance on the chair stand test was indicated.
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| 27. |
- von Berens, Åsa, et al.
(författare)
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Sarcopenic obesity and associations with mortality in older women and men – a prospective observational study
- 2020
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components. Methods: Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m2 , fat mass > 30%/ > 42% or waist circumference ≥ 88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively. Results: SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2–8.9)) of dying within 10 years compared to those with a “normal” phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 87 years, obesity was associated with increased survival. Conclusions: SO was observed in 4–11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within 10 years. In 87-year-old men, the results indicated that obesity without sarcopenia was related to a survival benefit over a four-year period.
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