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- 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. |
- 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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| 3. |
- 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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