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Validation of the photography method for nutritional intake assessment in hospitalized elderly subjects

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The journal of nutrition, health & aging

Abstract

Objective

The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients.

Design

this is a prospective observational study.

Setting

hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy).

Participants

255 consecutive elderly hospitalized patients. Measurements: assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation).

Results

The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; p<0.001) as well as a significant positive correlation between the indirect photographic method and the food caloric estimation calculated by the direct method (n=255; r= 0.6489, p<0.001). Intraclass coefficient (ICC), showed a highly significant degree of agreement between the gold standard and the indirect photographic method (ICC: 0.69; p<0.0001). Additionally, the results showed a good inter rater agreement of the indirect photographic method (kappa-statistic measure of interrater agreement: (Z=13.04; p<0.001); agreement 70.29% e Kappa=0.5965) and a good specificity of the indirect method as it was independent on the single food item.

Conclusions

The study originally provided the validation of the indirect photographic method for the assessment of nutritional intake in a vast cohort of hospitalized elderly subjects. The present results moved a step forward in the appropriate assessment of nutrition intake in frail elderly, providing an easy to use tool that may be incorporate in routine clinical practice for early and targeted therapeutic interventions.

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References

  1. Wilson MM, Vaswani S, Liu D, Morley JE, Miller DK. Prevalence and causes of undernutrition in medical outpatients. The American journal of medicine. 1998;104(1): 56–63.

    Article  CAS  PubMed  Google Scholar 

  2. de Groot CP, van Staveren WA, Survey in Europe on N, the Elderly aCA. European SENECA studies. Clinics in geriatric medicine. 2002;18(4): 699–708, vi.

    Article  PubMed  Google Scholar 

  3. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013;76(4): 296–302.

    Article  CAS  PubMed  Google Scholar 

  4. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. Journal of the American Geriatrics Society. 2010;58(9): 1734–1738.

    Article  PubMed  Google Scholar 

  5. Arvanitakis M, Coppens P, Doughan L, van Gossum A. Nutrition in care homes and home care: recommendations -a summary based on the report approved by the Council of Europe. Clinical nutrition. 2009;28(5): 492–496.

    Article  CAS  PubMed  Google Scholar 

  6. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868): 752–762.

    Article  PubMed  Google Scholar 

  7. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, et al. Frailty in older adults: evidence for a phenotype. The journals of gerontology Series A, Biological sciences and medical sciences. 2001;56(3): M146–156.

    Article  CAS  PubMed  Google Scholar 

  8. Rockwood K, Mitnitski A, Song X, Steen B, Skoog I. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. Journal of the American Geriatrics Society. 2006;54(6): 975–979.

    Article  PubMed  Google Scholar 

  9. Evans SJ, Sayers M, Mitnitski A, Rockwood K. The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age and ageing. 2014;43(1): 127–132.

    Article  PubMed  Google Scholar 

  10. Naseer M, Forssell H, Fagerstrom C. Malnutrition, functional ability and mortality among older people aged 60 years: a 7-year longitudinal study. European journal of clinical nutrition. 2016;70(3): 399–404.

    Article  CAS  PubMed  Google Scholar 

  11. de Boissieu P, Mahmoudi R, Hentzien M, Toquet S, Novella JL, Blanchard F, Jolly D, Drame M. The SAFES Cohort. The journal of nutrition, health & aging. 2015;19(6): 702–707.

    Article  Google Scholar 

  12. Keshavarzi S, Ahmadi SM, Lankarani KB. The impact of depression and malnutrition on health-related quality of life among the elderly Iranians. Global journal of health science. 2015;7(3): 161–170.

    Google Scholar 

  13. Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. International journal of nursing studies. 2007;44(6): 1036–1054.

    Article  PubMed  Google Scholar 

  14. Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. The American journal of clinical nutrition. 2005;82(4): 784–791; quiz 913-784.

    CAS  PubMed  Google Scholar 

  15. Rasheed S, Woods RT. Malnutrition and associated clinical outcomes in hospitalized patients aged 60 and older: an observational study in rural Wales. Journal of nutrition in gerontology and geriatrics. 2013;32(1): 71–80.

    Article  PubMed  Google Scholar 

  16. Naithani S, Whelan K, Thomas JE, Gulliford MC. Multiple morbidity is associated with increased problems of food access in hospital: a cross-sectional survey utilising the Cumulative Illness Rating Scale. Journal of human nutrition and dietetics: the official journal of the British Dietetic Association. 2010;23(6): 575–582.

    Article  CAS  Google Scholar 

  17. Poulsen I, Rahm Hallberg I, Schroll M. Nutritional status and associated factors on geriatric admission. The journal of nutrition, health & aging. 2006;10(2): 84–90.

    CAS  Google Scholar 

  18. Giner M, Laviano A, Meguid MM, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition. 1996;12(1): 23–29.

    Article  CAS  PubMed  Google Scholar 

  19. Gariballa S, Forster S. Malnutrition is an independent predictor of 1-year mortality following acute illness. The British journal of nutrition. 2007;98(2): 332–336.

    Article  CAS  PubMed  Google Scholar 

  20. Volkert D, Saeglitz C, Gueldenzoph H, Sieber CC, Stehle P. Undiagnosed malnutrition and nutrition-related problems in geriatric patients. The journal of nutrition, health & aging. 2010;14(5): 387–392.

    Article  CAS  Google Scholar 

  21. Neyens J, Halfens R, Spreeuwenberg M, Meijers J, Luiking Y, Verlaan G, Schols J. Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care (LTC): a cross-sectional study. Archives of gerontology and geriatrics. 2013;56(1): 265–269.

    Article  PubMed  Google Scholar 

  22. Chen LY, Liu LK, Hwang AC, Lin MH, Peng LN, Chen LK, Lan CF, Chang PL. Set: A Prospective Cohort Study in Taiwan. The journal of nutrition, health & aging. 2016;20(1): 41–47.

    Article  Google Scholar 

  23. Rentero Redondo L, Iniesta Navalon C, Gascon Canovas JJ, Tomas Jimenez C, Sanchez Alvarez C. [Malnutrition in the Elderly Patient to Hospital Admission, an Old Problem Unsolved]. Nutricion hospitalaria. 2015;32(5): 2169–2177.

    PubMed  Google Scholar 

  24. Bien B, Bien-Barkowska K, Wojskowicz A, Kasiukiewicz A, Wojszel ZB. Prognostic factors of long-term survival in geriatric inpatients. Should we change the recommendations for the oldest people? The journal of nutrition, health & aging. 2015;19(4): 481–488.

    CAS  Google Scholar 

  25. Zhang J, Zhao X, Wang A, Zhou Y, Yang B, Wei N, Yu D, Lu J, Chen S, et al. Emerging malnutrition during hospitalisation independently predicts poor 3-month outcomes after acute stroke: data from a Chinese cohort. Asia Pacific journal of clinical nutrition. 2015;24(3): 379–386.

    CAS  PubMed  Google Scholar 

  26. Feldblum I, German L, Castel H, Harman-Boehm I, Bilenko N, Eisinger M, Fraser D, Shahar DR. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutrition journal. 2007;6(37.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Carrion S, Cabre M, Monteis R, Roca M, Palomera E, Serra-Prat M, Rofes L, Clave P. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clinical nutrition. 2015;34(3): 436–442.

    Article  PubMed  Google Scholar 

  28. Felton DA. Complete Edentulism and Comorbid Diseases: An Update. Journal of prosthodontics: official journal of the American College of Prosthodontists. 2016;25(1): 5–20.

    Article  Google Scholar 

  29. Yildiz D, Buyukkoyuncu Pekel N, Kilic AK, Tolgay EN, Tufan F. Malnutrition is associated with dementia severity and geriatric syndromes in patients with Alzheimer disease. Turkish journal of medical sciences. 2015;45(5): 1078–1081.

    Article  CAS  PubMed  Google Scholar 

  30. Omidvari AH, Vali Y, Murray SM, Wonderling D, Rashidian A. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. The Cochrane database of systematic reviews. 2013;6(CD005539.

    Google Scholar 

  31. Eide HD, Halvorsen K, Almendingen K. Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses. Journal of clinical nursing. 2015;24(5-6): 696–706.

    Article  PubMed  Google Scholar 

  32. Meijers JM, Halfens RJ, van Bokhorst-de van der Schueren MA, Dassen T, Schols JM. Malnutrition in Dutch health care: prevalence, prevention, treatment, and quality indicators. Nutrition. 2009;25(5): 512–519.

    Article  PubMed  Google Scholar 

  33. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2): 116–122.

    Article  CAS  PubMed  Google Scholar 

  34. Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clinics in geriatric medicine. 2002;18(4): 737–757.

    Article  PubMed  Google Scholar 

  35. Baek MH, Heo YR. Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital. Nutrition research and practice. 2015;9(6): 637–643.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Simmons SF, Reuben D. Nutritional intake monitoring for nursing home residents: a comparison of staff documentation, direct observation, and photography methods. Journal of the American Geriatrics Society. 2000;48(2): 209–213.

    Article  CAS  PubMed  Google Scholar 

  37. Pouyet V, Cuvelier G, Benattar L, Giboreau A. A photographic method to measure food item intake. Validation in geriatric institutions. Appetite. 2015;84: 11–19.

    PubMed  Google Scholar 

  38. Guigoz Y, Vellas B. The mini nutritional assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme. 1999;1: 3–11.

    Article  CAS  PubMed  Google Scholar 

  39. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975;23: 433–441.

    Article  CAS  PubMed  Google Scholar 

  40. Mahoney FI, Barthel DW. Functional evaluation: The Barthel index. Md State Med J. 1965;14: 61–65.

    CAS  PubMed  Google Scholar 

  41. Salvi, M.D. Miller, A. Grilli, R. Giorgi, A.L. Towers, V. Morichi. A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. Am Geriatr Soc. 2008;56(10): 1926–1931.

    Article  Google Scholar 

  42. Morley JE. Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment. The journal of nutrition, health & aging. 2011;15(2): 87–90.

    Article  CAS  Google Scholar 

  43. Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, Davidson B, Duerksen D, Jeejeebhoy K, Payette H. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. Journal of human nutrition and dietetics: the official journal of the British Dietetic Association. 2015;28(6): 546–557.

    Article  CAS  Google Scholar 

  44. van Staveren WA, de Groot LC, Blauw YH, van der Wielen RP. Assessing diets of elderly people: problems and approaches. The American journal of clinical nutrition. 1994;59(1 Suppl): 221S–223S.

    PubMed  Google Scholar 

  45. Nelson M, Atkinson M, Darbyshire S. Food photography II: use of food photographs for estimating portion size and the nutrient content of meals. The British journal of nutrition. 1996;76(1): 31–49.

    Article  CAS  PubMed  Google Scholar 

  46. Hinton EC, Brunstrom JM, Fay SH, Wilkinson LL, Ferriday D, Rogers PJ, de Wijk R. Using photography in ‘The Restaurant of the Future’. A useful way to assess portion selection and plate cleaning? Appetite. 2013;63(31–35.

    PubMed  Google Scholar 

  47. Swanson M. Digital photography as a tool to measure school cafeteria consumption. The Journal of school health. 2008;78(8): 432–437.

    Article  PubMed  Google Scholar 

  48. Williamson DA, Allen HR, Martin PD, Alfonso AJ, Gerald B, Hunt A. Comparison of digital photography to weighed and visual estimation of portion sizes. Journal of the American Dietetic Association. 2003;103(9): 1139–1145.

    Article  PubMed  Google Scholar 

  49. Parent M, Niezgoda H, Keller HH, Chambers LW, Daly S. Comparison of visual estimation methods for regular and modified textures: real-time vs digital imaging. Journal of the Academy of Nutrition and Dietetics. 2012;112(10): 1636–1641.

    Article  PubMed  Google Scholar 

  50. Kaiser M, Bandinelli S, Lunenfeld B. Frailty and the role of nutrition in older people. A review of the current literature. Acta bio-medica: Atenei Parmensis. 2010;81 Suppl 1(37–45.

    Google Scholar 

  51. Avila-Funes JA, Medina-Campos RH, Tamez-Rivera O, Navarrete-Reyesb AP, Amieva H, Aguilar-Navarro S. Frailty is associated with disability and recent hospitalization in community-dwelling elderly: the coyocan cohort. J Frailty Aging 2014;3(4): 206–210.

    CAS  PubMed  Google Scholar 

  52. Pohlhausen S, Uhlig K, Kiesswetter E, Diekmann R, Heseker H, Volkert D, Stehle P, Lesser S. Energy and Protein Intake, Anthropometrics, and Disease Burden in Elderly Home-care Receivers-A Cross-sectional Study in Germany (ErnSIPP Study). J Nutr Health Aging. 2016;20(3): 361–8. doi: 10.1007/s12603-015-0586-9.

    Article  CAS  PubMed  Google Scholar 

  53. Zuniga K, McAuley E. Considerations in selection of diet assessment methods for examining the effect of nutrition on cognition. J Nutr Health Aging. 2015 Mar;19(3):333–40. doi: 10.1007/s12603-014-0566-5.

    Article  CAS  PubMed  Google Scholar 

  54. Bonnefoy M, Berrut G, Lesourd B, Ferry M, Gilbert T, Guerin O, Hanon O, Jeandel C, Paillaud E, et al. Frailty and nutrition: searching for evidence. The journal of nutrition, health & aging. 2015;19(3): 250–257.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine and Medical Specialties (DiMI), Section of Geriatrics, University of Genoa, Viale Benedetto XV,6, 16132, Genoa, Italy

    Fiammetta Monacelli, D. Becchetti, A. Nencioni, R. Borghi & P. Odetti

  2. Department of Science and Public Health (DISSAL), University of Genoa, Via Pastore 1, 16132, Genoa, Italy

    M. Sartini & A. L. Biagini

  3. Section of Geriatrics, Galliera Hospital, Via delle Cappuccine, 14, 16132, Genoa, Italy

    V. Bassoli

  4. Department of Internal Medicine and Medical Specialties (DiMI), Section of Hematology, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy

    M. Cea

  5. Department of Internal Medicine and Medical Specialties (DiMI), Section of Internal Medicine University of Genoa, Viale Benedetto XV,6, 16132, Genoa, Italy

    F. Torre

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  1. Fiammetta Monacelli
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  2. M. Sartini
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  3. V. Bassoli
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Correspondence to Fiammetta Monacelli.

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Monacelli, F., Sartini, M., Bassoli, V. et al. Validation of the photography method for nutritional intake assessment in hospitalized elderly subjects. J Nutr Health Aging 21, 614–621 (2017). https://doi.org/10.1007/s12603-016-0814-y

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  • DOI: https://doi.org/10.1007/s12603-016-0814-y

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