Clinical nutrition and metabolism

BACKGROUND: Malnutrition and micro- and macronutrient deficiencies are common in people aged 95 years and older. For timely detection of nutritional disorders, it is crucial to regularly examine centenarians and, if necessary, correct an individual patient management plan. A well-balanced diet is one of the fundamental factors for the normal functioning of the human body throughout its life. With age, for various reasons, the risk of malnutrition increases, however, the nutritional status of centenarians is currently not fully understood due to the difficulties of diagnosis.

AIM: To evaluate nutritional status and its impact on life expectancy in patients aged 95 years and older, to identify the main determinants that affect the development of malnutrition, and to assess their impact on three-year survival of centenarians.

MATERIALS AND METHODS: Analyzed the results of a Mini Nutritional Assessment, general and biochemical blood tests (including such parameters as hemoglobin levels, iron levels, total protein, albumin, vitamin B12, vitamin D, folic acid) in non-institutionalized people aged 95 and older living in Moscow. All studies were conducted at home in the presence of relatives and/or social workers after signing a voluntary informed consent.

RESULTS: The study included 82 people, mean age (98.3±1.89) years; 87.8% were women. Of all the study participants, 56.1% (n=46) were at risk of developing malnutrition, and 11% (n=9) had malnutrition syndrome. Among the 64 participants who took the blood test, anemia was diagnosed in 71.9% (n=46), with macrocytic in 10.9% (n=5), normocytic in 84.8% (n=39), and microcytic in 4.3% (n=2) of patients. Hypoalbuminemia was identified in 16.9% (n=11 of 65) of participants. Of the 50 people who were screened for vitamin D levels, vitamin D deficiency was found in 98% (n=49 out of 50). The following factors influenced survival: a Mini Nutritional Assessment score of more than 24 reduces the risk of 3-year death by 72% (odds ratio (OR) — 0.28, confidence interval (CI) — 0.1–0.8), anemia increases the adverse risk by 3 times (OR=3.1, CI 1.1–8.9). The main clinical conditions associated with a higher risk of developing malnutrition were anemia (OR=3.1, CI 1.1–8.9) and chewing problems (OR=2.8, CI 0.9–7.8).

CONCLUSIONS: Conducting a nutrition assessment and drawing up a program for the prevention of malnutrition syndrome in centenarians will improve the quality of life and increase life expectancy.

Cachexia, mediated by the multiligand receptor RAGE (receptor for advanced glycation end products) and its ligands HMGB1, S100B, and S100A1, is a formidable multifactorial complication of the severe course of a number of somatic and malignant diseases. One of the most visualized symptoms of cachexia is a significant decrease in body weight, but the main one is the systemic shutdown of a number of regulatory centers that control the maintenance of homeostasis. Activation of these markers contributes to the launch and intensification of the destructive processes of cachexia, and blocking, in some cases, can reduce their intensity. Among known drugs from various therapeutic groups, there are blockers of one or more markers. For example, Papaverine antispasmodic as well as the nootropic anxiolytic Tenoten, antibacterial Pentamidine and antidepressant Duloxetine. This review describes in detail the significance of the listed markers in the pathogenesis of cachexia, especially in malignant pathology. An assumption was made about the possible control of cachectic progression with the help of such blockers to improve the quality of life of patients.

This article presents the tactics of nutritional support in a patient with pseudomembranous colitis after repeated consecutive operations on the abdominal organs, which led to significant violations of the nutritional status. Competent, individually selected correction of protein-energy deficiency in patients with pseudomembranous colitis allows achieving an effective treatment result, avoiding severe complications such as perforation, toxic dilatation, and bleeding. The peculiarity of this clinical case is that a patient with perforation of Meckel’s diverticulum and abdominal abscess developed a complication — secondary widespread peritonitis, phlegmon, which required repeated surgical interventions. Surgical treatment and massive antibiotic therapy led to the development of Clostridium difficile infection: during the treatment the patient developed multiple loose stools and C. difficile toxins A and B were detected. Severe pseudomembranous colitis was accompanied by protein-energy deficiency (hypoproteinemia, hypoalbuminemia), severe dehydration, hypokalemia, hyponatremia, and moderately severe anemia of complex genesis. When selecting nutritional support for patients with clostridial infection, it is important to take into account severe systemic inflammation, which affects the absorption and absorption of the intestinal wall, which in turn determines the route of introduction of nutrient substrates. In this case we needed to choose the right method for correcting the patient’s nutritional status.