Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study

Hua Tsen Hsiao, Jun Jun Lee, Hsiu Hui Chen, Ming Kung Wu, Chi Wei Huang, Ya Ting Chang, Chia Yi Lien, Jing-Jy Wang, Hsin I. Chang, Chiung Chih Chang

Research output: Contribution to journalArticle

Abstract

Background & aims: Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. Methods: A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. Results: There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = −.06, P < 0.001) and MNA (β = −.1, P < 0.001). A BMI of 22–23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. Conclusions: In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.

Original languageEnglish
Pages (from-to)2187-2194
Number of pages8
JournalClinical Nutrition
Volume38
Issue number5
DOIs
Publication statusPublished - 2019 Oct 1

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Nutrition Assessment
Cognition
Dementia
Body Weight
Body Mass Index
Comorbidity
Obesity
Hypertension
Diabetes Mellitus
Equipment and Supplies
Body Weight Changes
Feeding Behavior
Appetite
Deglutition
Nutritional Status
Malnutrition
Caregivers
Statistical Factor Analysis
Alzheimer Disease
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

Cite this

Hsiao, H. T., Lee, J. J., Chen, H. H., Wu, M. K., Huang, C. W., Chang, Y. T., ... Chang, C. C. (2019). Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study. Clinical Nutrition, 38(5), 2187-2194. https://doi.org/10.1016/j.clnu.2018.09.017
Hsiao, Hua Tsen ; Lee, Jun Jun ; Chen, Hsiu Hui ; Wu, Ming Kung ; Huang, Chi Wei ; Chang, Ya Ting ; Lien, Chia Yi ; Wang, Jing-Jy ; Chang, Hsin I. ; Chang, Chiung Chih. / Adequacy of nutrition and body weight in patients with early stage dementia : The cognition and aging study. In: Clinical Nutrition. 2019 ; Vol. 38, No. 5. pp. 2187-2194.
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abstract = "Background & aims: Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. Methods: A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. Results: There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24{\%} mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = −.06, P < 0.001) and MNA (β = −.1, P < 0.001). A BMI of 22–23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. Conclusions: In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.",
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Hsiao, HT, Lee, JJ, Chen, HH, Wu, MK, Huang, CW, Chang, YT, Lien, CY, Wang, J-J, Chang, HI & Chang, CC 2019, 'Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study', Clinical Nutrition, vol. 38, no. 5, pp. 2187-2194. https://doi.org/10.1016/j.clnu.2018.09.017

Adequacy of nutrition and body weight in patients with early stage dementia : The cognition and aging study. / Hsiao, Hua Tsen; Lee, Jun Jun; Chen, Hsiu Hui; Wu, Ming Kung; Huang, Chi Wei; Chang, Ya Ting; Lien, Chia Yi; Wang, Jing-Jy; Chang, Hsin I.; Chang, Chiung Chih.

In: Clinical Nutrition, Vol. 38, No. 5, 01.10.2019, p. 2187-2194.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adequacy of nutrition and body weight in patients with early stage dementia

T2 - The cognition and aging study

AU - Hsiao, Hua Tsen

AU - Lee, Jun Jun

AU - Chen, Hsiu Hui

AU - Wu, Ming Kung

AU - Huang, Chi Wei

AU - Chang, Ya Ting

AU - Lien, Chia Yi

AU - Wang, Jing-Jy

AU - Chang, Hsin I.

AU - Chang, Chiung Chih

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background & aims: Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. Methods: A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. Results: There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = −.06, P < 0.001) and MNA (β = −.1, P < 0.001). A BMI of 22–23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. Conclusions: In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.

AB - Background & aims: Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. Methods: A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. Results: There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = −.06, P < 0.001) and MNA (β = −.1, P < 0.001). A BMI of 22–23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. Conclusions: In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.

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