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Inflammation markers and malnutrition as risk factors for infections and impaired health-related quality of life among older nursing home residents.
Kuikka LK, Salminen S, Ouwehand A, Gueimonde M, Strandberg TE, Finne-Soveri UH, Sintonen H & Pitkala KH
J Am Med Dir Assoc.
OBJECTIVES: To explore malnutrition and inflammation markers as risk factors for poor outcome such as infections and impaired health-related quality-of-life (HRQoL) among nursing home residents. DESIGN: Prospective study lasting 8 months. SETTING: Three nursing homes in Helsinki, Finland, in 2003. PARTICIPANTS: Sample 1 included 199 residents whose Mini Nutritional Assessment (MNA) scores and complete follow-up records concerning infections and mortality were available, and Sample 2 included 55 patients (subsample) whose data concerning laboratory values, HRQoL, and infections during the 8 months follow-up period were available. MEASUREMENTS: At baseline all residents were interviewed with a structured questionnaire consisting of demographic characteristics, activities of daily living (ADL), MNA, and 15D HRQoL instrument. Blood samples were drawn at baseline (hsCRP, IL-10, TNF-alfa,TGF-beta 1,WBC) and during follow-up if infections arose (CRP). Data concerning infections and mortality during the 8-month follow-up were collected. RESULTS: In the whole study group (N=199), malnutrition according to the MNA (<17, n=79) was associated with poor outcome (a serious infection and/or death) during 8 months follow-up compared with those not malnourished according to the MNA (>17, n=120) (30.4% versus 14.2%, P=.006). However, MNA score below 17 did not predict infections in the subsample (n=55). The mean age of residents in subsample was 83 years, 44 (80%) were women. Those with MNA below 17 (n=18) did not differ from others (MNA>17, n=37) with respect to age, gender, ADL-functioning, cognition, or inflammatory markers. The group with MNA below 17 had significantly lower HRQoL according to the 15D both at baseline and at 8 months. During the 8-month follow-up, subsample residents in the highest quartile of hsCRP at baseline (>4.38 mg/L, n=13) had more infections than residents in lower quartiles (<4.38 mg/L, n=42). None of the other inflammation markers were associated with the number of infections or with HRQoL. CONCLUSION: Malnutrition according to the MNA and hsCRP may be used as markers to flag nursing home residents at risk for poor outcome
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