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    Is the Utility of the GLIM Criteria Used to Diagnose Malnutrition Suitable for Bicultural Populations? Findings from Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ)
    (Springer Nature, 2023-01) MacDonell SO; Moyes SA; Teh R; Dyall L; Kerse N; Wham C
    Objectives To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age. Design A longitudinal cohort study. Setting Bay of Plenty and Lakes regions of New Zealand. Participants 255 Māori; 400 non-Māori octogenarians. Measurements All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. Results 56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. Conclusion Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework.
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    The relationship between nutritional adequacy and 24-month fracture occurence in Māori and non-Māori of advanced age : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand
    (Massey University, 2015) Towgood, Alice
    Abstract Background The life expectancy of both Māori and non-Māori is continually increasing with more New Zealanders expected to live into advanced age. Adults over the age of 80 experience greater health loss than any other age group, with chronic disease and associated disability increasing substantially with age. Osteoporosis and the morbidity associated with fractures, particularly hip fracture, are of critical concern for an ageing population and may diminish quality of life and independence for older people, thus placing an increased burden on health and disability support services. The role of nutrition in the maintenance of bone mineral density (BMD), bone integrity, and subsequent fracture prevention, particularly in octogenarians is unclear. The ability to meet adequate energy requirements decrease with increasing age and may compromise intake of nutrients related to bone health. Nutrients necessary for bone health including: protein, calcium, vitamin D, phosphorous, magnesium and potassium are modifiable factors. Achieving optimal bone nutrient intakes may influence potential for maintenance of good bone health in adults of advanced age. This study aims firstly to investigate food and nutrient intakes of Māori and Non-Māori octogenarians to establish an understanding of nutrient adequacy. Secondly, to investigate the energy and nutrient intakes of participants who experience a fracture compared with those non-fractured to identify nutrient specific risk factors for fracture in adults of advanced age. Method Comprehensive nutritional parameters were collected using two separate 24-hour multi-pass recalls. FOOD files were used to analyse food sources and nutrient intake. Face to face interviews were conducted to ascertain specific social, demographic, health and fracture information. Fracture occurrence was measured over a 24 month period following the 2 x 24-hour Multi Pass Recall’s and included self-reported and hospitalised fracture occurrences. Hospitalisation data was obtained with permission from the participants. National Health Index New Zealand (NHI) numbers were used to identify fractures. Results There were 317 participants (113 Māori and 204 non-Māori), aged 80-90 years in this study. For men and women respectively the median energy intakes were 6,943kJ vs. 5,603kJ for Māori; and 8,203kJ vs. 6,225kJ for non-Māori; protein as a percentage of energy was 15.5% vs. 15.9% for Māori and 15.7% vs. 15.5% for non-Māori. The top foods contributing to energy were bread, butter and margarine for all Maori and non-Maori with beef and veal contributed the most protein for Māori men, bread for Māori women and milk for non-Māori, men and women. Compared to the Estimated Average Requirement (EAR) intakes of calcium, vitamin D, magnesium and potassium were inadequate for all participants. Compared to an EAR of 1100mg for men and women, median calcium intakes were low, 559mg vs. 539mg for Māori and 748mg vs. 672mg for non-Māori, men and women respectively. The primary food groups contributing to calcium were milk, cheese and bread. Compared to the EAR (15 μg/day in men and women) and vitamin D intake from food was low (≤ 4 μg) for all participants. Compared to the EAR (350mg/day men and 265mg/day women), median magnesium intakes were 259 mg/day vs. 204mg/day for Māori and 271 mg/day vs. 238 mg/day for non-Māori, men and women respectively. The primary food groups contributing to magnesium were bread, breakfast cereals and fruit. A total of 18.6% of Māori and 20.6% of non-Māori sustained a fracture over a 24 month period. One in five Māori and non-Māori women sustained fractures. Among non-Māori women those who fractured were 1.1 times more likely to be financially insecure than non-fractured women (p=0.033). For Māori women who were fractured, inability to afford to eat properly was 3.3 times more likely (p=0.012), and previous fractures were 1.5 times (p=0.015) more likely than for non-fractured women. Fractured Māori women consumed significantly less vitamin D (2.0μg vs 3.0μg) (P=0.01) and magnesium (143.0mg vs 211mg) (P=0.033) compared to non-fractured Māori women. Conclusion Energy intakes were low for all participants and may have manifested the suboptimal intakes of calcium, vitamin D, potassium and magnesium prevalent in Māori and non-Māori, men and women. Fractures were more frequent in women than men, and both Māori and non-Māori sustained similar rates of fracture over the 24 month period. Magnesium and vitamin D intakes were significantly related to fracture occurrence in Māori women; this relationship diminished with further regression analysis. Increased intake of energy in adults of advanced age, with a focus on protein rich and nutrient dense foods, particularly calcium and magnesium, should be encouraged through consuming a variety of foods from the major food groups. Greater intakes of calcium can be achieved through higher consumption of milk and dairy products including yoghurt and cheese; and magnesium through increased green leafy vegetables, seafood, dairy, mushrooms, avocado, beans and bananas. Vitamin D intakes were minimal from food; however it is possible participants were receiving supplementary vitamin D and further investigation is warranted. For fractured Māori women, magnesium intake was significantly lower than those with no fractures. Promoting increased intakes of culturally acceptable foods such as vegetables and seafood may be advantageous to increase magnesium intakes.
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    Validation of the nutrition screening tool 'Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II' among people in advanced age : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Human Nutrition at Massey University, Albany, New Zealand
    (Massey University, 2013) Redwood, Kristy Maree
    Background: This study aims to determine the validity of the nutrition screening tool ‘Seniors in the Community: Risk Evaluation for Eating and Nutrition’ (SCREEN II) among adults of advanced age in Life and Living in Advanced Age: a cohort study in New Zealand (LiLACS NZ). SCREEN II is widely used in Canada and has been found to be valid and reliable amongst well community living older people. As the LiLACS NZ participants are considerably older than those recruited in Canada it was important to validate the SCREEN II tool among participants in advanced age and in the New Zealand setting. Methods: Forty–five people, 85-86 years, were recruited on the basis of their baseline nutrition risk score. SCREEN II consists of 14 items with a total summed score ranging from 0 to 64. Equal proportions of participants were recruited at low (>54), medium (50-53) and high risk (<50). One year later participants completed a follow up SCREEN II assessment and underwent a dietitian’s nutrition risk rating assessment. The assessment included a medical history, anthropometric measures and a dietary assessment using three 24 hour multiple pass recalls. Using clinical judgement the dietitian ranked participants from low risk (score of 1) to high risk (score of 10). A Spearman’s correlation determined the association between the SCREEN II score and the dietitian’s risk score. Receiver operating characteristic (ROC) curves were completed to determine sensitivity and specificity of cut-offs. Results: There was no change in nutrition risk over the year. Participants who lived alone (p=0.02), were women (p=0.03), widowed (p=0.01), former or current smokers (p=0.03), took multiple medications (polypharmacy) (p=0.03), had depressive symptoms (p=0.02) were significantly more likely to be at nutrition risk. SCREEN II was significantly correlated with the dietitian’s risk rating (r= -0.73, p<0.01). A new cut-off of <49 was established for high nutrition risk based on ROC curves and was associated with high sensitivity 90% and specificity 86%. Conclusion: SCREEN II appears to be a valid tool for the identification of nutrition risk in community-living older adults 85 years and older using a cut-off of <49 for high nutrition risk. Key Words: SCREEN II, nutrition, screening tool, advanced age, older adults