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was due to enrolment of the clinical AD patients without evidence
of amyloid in the brain. Development of passive and active
immunization, beta and gamma-secretase inhibition or RAGE
receptor inhibitors are recently appreciated as the promising future
treatments. Furthermore, novel experimental drug candidates
directing towards alternative targets to amyloid molecule have been
suggested. Compared to amyloid-based approaches, drugs targeting
tau, metabolic actors such as insulin and NGF manipulators,
multitarget anti-inflammatory agents and metal chelators are in
the beginning of clinical development. Anti-tau approaches, in
particular, are promising because clinically investigation of tau
is an unexplored frontier, hitherto there is an evidence that tau
dysfunction has been positively correlated to other neurological
diseases characterized by loss of cognitive function including Pick’s
disease, parkinsonism and frontotemporal dementia.
A broader therapeutic intervention that can operate on multiple
targets would increase the chances of finding a successful
mechanism of action.
Symposium: Metabolism and nutrition
S-08
Impact of nutrition for health of older people: Asian’s
perspective
L.-K. Chen
Taipei Veterans General Hospital, Taipei, Taiwan
Introduction:
Nutrition plays a very important role in healthy
aging and the prevalence of malnutrition became higher when
people getting older. This symposium aimed to report issues
of malnutrition in Asian countries, which includes community-
dwelling older people, older patients in the acute hospitals and
those who lived in the retirement communities.
Role of protein and vitamin D intake for disability and
cardiovascular disease
(Presenter: Dr. Hidenori Arai, National
Center for Geriatrics and Gerontology, Japan): Along with the aging
of the society, the prevalence of sarcopenia and cardiovascular
disease is estimated to be increasing in the future in Asian countries.
For the prevention of these disorders, the role of nutrition should be
more highlighted in the field of geriatrics. However, little evidence
has been provided to address appropriate nutrition focusing on
protein and vitamin D for the prevention and disability and
cardiovascular disease in the elderly. Therefore, we hypothesized
that low protein and vitamin D intake results in sarcopenia without
affecting the development of cardiovascular disease in community-
dwelling elderly in Japan. We studied the protein and vitamin D
intake in community-dwelling elderly through questionnaire. Based
on the questionnaire, we divided the cohort into quartiles and
followed them up for 2 years. We found that the elderly with
lowest intake of protein and vitamin D had a significantly higher
incidence of disability in 2 years. When we divided the cohort into
young old and old old, the difference was only significant in old
old. We also found a significant association between vitamin D
intake and skeletal muscle mass. However, we did not find any
effect on cardiovascular disease. In conclusion, our data indicate
that sufficient protein and vitamin D intake is important for the
prevention of disability in old old.
Malnutrition in hospitalized Malaysian elderly
(Presenter:
Dr. Philip Jun Hua POI, University Malaya Medical Centre, Kuala
Lumpur, Malaysia): Hospitalised elderly are frequently identified
as being malnourished. Malaysia is a fast developing country with
a growing elderly population, and more elderly are now seeking
limited geriatric health services. The prevalence of malnutrition
in hospitalized elderly Malaysians is wholly dependent upon
identification of this condition by the medical and nursing staff.
Due to the heavy clinical workload, this opportunity is often
missed due to the lack of agreement in screening the patients.
A local malnutrition risk screening tool for hospitals (MRST-H) was
developed. This new screening tool was tested for reliability and
was found to have an excellent Kappa index of agreement amongst
the raters (dietitian / nurse). It is hoped that this new screening
tool will help identify malnourished hospitalized Malaysian elderly
more efficiently, and allow early intervention.
Malnutrition and swallowing difficulty among dependent
community-dwelling older people in Japan: prevalence and
consequences
(Presenter: Dr. Masafumi Kuzuya, Department of
Community Healthcare & Geriatrics, Nagoya University Graduate
School of Medicine, Nagoya, Japan): This study aimed to determine
the prevalence of malnutrition and the swallowing difficulty and
to examine the association of these problems with subsequent
mortality or hospitalization during a 1-year follow-up among
community-dwelling dependent older people. The study population
consisted of 1142 community-dwelling dependent older people
(men: 460; women: 682) with physical or mental disability in some
degree. They were eligible for long-term care insurance, lived in
Kanagawa and Aichi prefectures, and were provided various home
care services. Nutritional and swallowing statuses were evaluated
by Mini-Nutritional Assessment-Short Form (MNA-SF), and
Dysphagia severity scale (DSS), respectively. Data also included the
clients’ demographic characteristics. Overall, 16.7% and 55.4% were
diagnosed as malnutrition and at risk for malnutrition, respectively.
The prevalence of dysphagia was 8.6%. The prevalence rate of
malnutrition increased as dysphagia severity increased. Although
the malnutrition was associated with mortality and hospitalization,
no apparent association was observed between the swallowing
difficulty and these events. In conclusion, the results highlight the
need for effective prevention to reduce the poor nutritional status
among community-dwelling dependent older people.
Impact of malnutrition on physical, cognitive function and mor-
tality among older men living in Veteran Homes: A prospective
cohort study in Taiwan
(Presenter: Dr. Liang-Yu Chen, Center for
Geriatrics and Gerontology, Kaohsiung Veterans General Hospital,
Taiwan): This prospective cohort study enrolled 1,248 male
residents aged equal or more than 65 years for study. Malnutrition
was defined based on the MDS RAP trigger. The mean age of
participants is 83.1
±
5.1 years, and the prevalence of malnutrition
was 6.1%. Inadequate dietary content (57.9%) and unintentional
weight loss (31.6%) account for the majority of malnutrition
identified by MDS tool. Higher 18-month mortality rate (25% vs.
14.2%), higher baseline CCI (median 1 vs. 0), and higher baseline
sum of RAP triggers (median 8.5 vs. 5) were noted among residents
with malnutrition. Furthermore, malnutrition was shown predictive
for functional decline (OR: 3.096, 95% CI: 1.715–5.587) and potential
cognitive improvement (OR: 2.469, 95% CI: 1.188–5.128) among
survivors after adjustment for age, body mass index and CCI. In
conclusion, malnutrition among older men living in veteran homes
was associated with multimoridities and higher care complexity,
and was predictive for mortality and functional decline.
Summary:
For community-dwelling older people, vitamin D
supplementation was very important to muscle mass but not
cardiovascular disease. In Japan, the prevalence of dysphagia
reached 8.6% among community-dwelling older people and they
became more malnourished as the dysphagia becoming more
severe. In the retirement communities, malnutrition was associated
with multimorbidity and care complexity, which was predictive
for poorer functional outcome. However, malnutrition may be
protective for cognitive decline, which may be related to the
survivor effects instead of the effect of malnutrition per se.
Financial disclosure:
All authors declare no conflict of interest for
their studies.