Inflammation markers and malnutrition as risk factors for infections and impaired health-related quality of life among older nursing home residents.
OBJECTIVE
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.


METHODS
Prospective study lasting 8 months.


METHODS
Three nursing homes in Helsinki, Finland, in 2003.


METHODS
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.


METHODS
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.


CONCLUSIONS
Malnutrition according to the MNA and hsCRP may be used as markers to flag nursing home residents at risk for poor outcome.
Kuikka
Liisa K
LK
University of Helsinki, Department of General Practice and Helsinki University Hospital, Unit of General Practice, Mannerheimintie 172 PL 41, Helsinki, Finland. liisa.kuikka@helsinki.fi
Salminen
Seppo
S
Ouwehand
Arthur
A
Gueimonde
Miguel
M
Strandberg
Timo E
TE
Finne-Soveri
Ulla H
UH
Sintonen
Harri
H
Pitkälä
Kaisu H
KH
D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000209:etiology*; D016207:Cytokines / Q000097:blood; D005260:Female; D005387:Finland; D006304:Health Status; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis*; D009735:Nursing Homes; D015596:Nutrition Assessment; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
D016207:Cytokines