title: Malnutrition in community-dwelling adults with dementia (NutriAlz Trial).
abstract: OBJECTIVE
  The objective of this study is to assess the nutritional status, measured by the MNA, in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition.
  
  
  METHODS
  Cross-sectional analysis of a cluster randomized clinical trial (Nutrialz).
  
  
  METHODS
  Community-dwelling individuals attending dementia clinics.
  
  
  METHODS
  940 individuals.
  
  
  METHODS
  The clinical scales assessed were Mini Nutritional Assessment (MNA), Eating Behaviour Scale (EBS), Charlson comorbidity index, Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL) score, Instrumental Activities of Daily Living (IADL) score, Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell depression scale and Zarit Caregiver Burden Interview.
  
  
  RESULTS
  5.2% of participants were classified as being malnourished, 42.6% as being at risk of malnutrition and 52.2% as well nourished. Malnutrition by type of dementia was more frequent in Lewy bodies dementia (18.2%) than in the other types. Worse nutritional status is significantly related to more advanced age and worse cognitive, functional and behavioural profile, as well as increased burden for caregivers. Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression, exaltation, lack of inhibition and irritability. The items more strongly related to malnutrition are appetite/feeding and hallucinations. Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition. Dependence on feeding is a strongly related risk factor, while food preparation is only a moderate one. A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS (Odds Ratio (OR) 0.84, 95%CI 0.78 to 0.91), Cornell (OR 1.12, 95%CI 1.09 to 1.16), the number of dependent BADL (OR 1.29, 95%CI 1.17 to 1.42), age (OR 1.04, 95%CI 1.02-1.06), MMSE (OR 0.95, 95%CI 0.92 to 0.98) and Charlson (OR 1.18, 95%CI 1.05 to 1.34). A similar model built for prediction of malnutrition retained as significant covariables only EBS, Cornell and the number of dependent BADL.
  
  
  CONCLUSIONS
  These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.
authors.affiliation: Institut de l'Envelliment, Universitat Autònoma de Barcelona, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. marta.roque@uab.cat
authors.forename: M
authors.initials: M
authors.lastname: Roqué
authors.forename: A
authors.initials: A
authors.lastname: Salvà
authors.forename: B
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003704:Dementia / Q000503:physiopathology* / Q000523:psychology; D003863:Depression / Q000503:physiopathology / Q000523:psychology; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000517:prevention & control; D009483:Neuropsychological Tests; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D011795:Surveys and Questionnaires
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Med Clin (Barc). 1993 May 8;100(18):692-8
references.pmid: 8492597
references.citation: J Nutr Health Aging. 1998;2(2):119-21
references.pmid: 10993581
references.citation: Gerontologist. 1969 Autumn;9(3):179-86
references.pmid: 5349366
references.citation: Eur J Public Health. 2013 Jun;23(3):405-9
references.pmid: 22539629
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: J Nutr Health Aging. 2005;9(2):81-4
references.pmid: 15791350
references.citation: J Nutr Health Aging. 2009 Nov;13(9):782-8
references.pmid: 19812868
references.citation: Nutrition. 1999 Feb;15(2):116-22
references.pmid: 9990575
references.citation: Neurologia. 2002 Jun-Jul;17(6):317-23
references.pmid: 12084358
references.citation: J Nutr Health Aging. 2001;5(4):295-9
references.pmid: 11753499
references.citation: J Alzheimers Dis. 2012;28(3):647-54
references.pmid: 22045479
references.citation: J Clin Nurs. 2008 Sep;17(17):2266-74
references.pmid: 18705703
references.citation: J Nutr Health Aging. 2006 Nov-Dec;10(6):466-85; discussion 485-7
references.pmid: 17183419
references.citation: J Nutr Health Aging. 2009 Jun;13(6):529-37
references.pmid: 19536421
references.citation: J Nutr Health Aging. 2003;7(2):91-6
references.pmid: 12679828
references.citation: JAMA. 1963 Sep 21;185:914-9
references.pmid: 14044222
references.citation: J Nutr Health Aging. 2005;9(2):117-20
references.pmid: 15791356
references.citation: Public Health Nutr. 2009 Jan;12(1):82-90
references.pmid: 18413012
references.citation: Biol Psychiatry. 1988 Feb 1;23(3):271-84
references.pmid: 3337862
references.citation: J Nutr Health Aging. 2007 Jan-Feb;11(1):38-48
references.pmid: 17315079
references.citation: J Am Geriatr Soc. 1998 Oct;46(10):1223-7
references.pmid: 9777903
references.citation: Int Psychogeriatr. 2009 Jun;21(3):520-5
references.pmid: 19257916
references.citation: J Gerontol Nurs. 1997 Jul;23(7):9-15; quiz 54-5
references.pmid: 9287601
references.citation: J Nutr Health Aging. 2011 Dec;15(10):822-30
references.pmid: 22159768
references.citation: J Nutr Health Aging. 2001;5(2):113-7
references.pmid: 11426292
references.citation: Age Ageing. 2008 Jan;37(1):83-9
references.pmid: 17971391
references.citation: J Gerontol A Biol Sci Med Sci. 2001 Jun;56(6):M366-72
references.pmid: 11382797
references.citation: Gerontologist. 1986 Jun;26(3):260-6
references.pmid: 3721233
references.citation: J Am Geriatr Soc. 2010 Sep;58(9):1734-8
references.pmid: 20863332
references.citation: Neurology. 1993 Nov;43(11):2412-4
references.pmid: 8232972
references.citation: J Neuropsychiatry Clin Neurosci. 2000 Spring;12(2):233-9
references.pmid: 11001602
references.citation: Arch Gerontol Geriatr. 2009 May-Jun;48(3):356-60
references.pmid: 18448178
references.citation: Arch Gerontol Geriatr. 2011 Nov-Dec;53(3):249-51
references.pmid: 21236503
references.citation: J Am Med Dir Assoc. 2004 Mar-Apr;5(2):89-97
references.pmid: 14984619