Abstract
Dietary protein and/or calorie insufficiencies represent an important problem in elderly patients. The biological and clinical implications, and particularly the influence on bone mass of undernutrition in the elderly, have not been completely defined, although several studies have demonstrated a high prevalence of dietary insufficiencies in patients with a recent fracture of the proximal femur. In the present study the relationship between dietary intakes, physical performance and bone mineral density (BMD) was examined in hospitalized elderly patients. The study comprised 74 patients (48 women, mean age 82 years; and 26 men, mean age 80 years) who were hospitalized for various medical indications. They were divided into two groups according to their dietary protein intakes, evaluated during the first 28 days in hospital while on a regular diet. The first group consisted of 26 patients (14 women and 12 men) whose protein intake was equal to or greater than 1 g per kilogram of ideal body weight. The second group consisted of 48 patients (34 women and 14 men) who consumed less than 1 g of protein per kilogram of ideal body weight. The two groups differed also in their energy, carbohydrate, lipid and calcium intakes. Patients in the group with the higher protein intake displayed higher BMD at the level of the femoral neck as measured by dual-photon absorptiometry. The men in this group also had higher lumbar spine BMD. After 4 weeks in hospital the women with a higher protein intake had significantly enhanced bicipital and quadricipital muscle strength and better performance as indicated by the increased capacity to climb stairs. These results indicate that lower dietary intakes in hospitalized elderly patients without fractures are associated with lower physical performance and lower femoral neck BMD. Thus, the role of dietary factors, including protein, in the risk of proximal femoral fractures deserves further investigation.
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References
Weir DR, Houser HB, Davis M, Schenk E. Recognition and management of nutrition problems of the elderly. In: Reichel W, editor. Clinical aspects of aging. Baltimore: Williams & Wilkins, 1978:183–98.
Burr ML, Milband JE, Gibbs D. The nutritional status of the elderly. Age Ageing 1982;11:89–96.
Mitchell CO, Lipschitz DA. Detection of protein-calorie malnutrition in the elderly. Am J Clin Nutr 1982;35:389–406.
Seeman E, Riggs BL. Dietary prevention of bone loss in the elderly. Geriatrics 1981;36:71–9.
Parfitt AM. Dietary risk factors for age-related bone loss and fractures. Lancet 1983;2:1181–5.
Schaafsma G, Van Beresteyn ECH, Raymakers JA, et al. Nutritional aspects of osteoporosis. World Rev Nutr Diet 1987;49:121–59.
Adams P, Berridge FR. Effects of kwashiokor on cortical and trabecular bone. Arch Dis Child 1969;44:705–9.
Garn SM, Guzman MA, Wagner B. Subperiosteal gain and endosteal loss in protein-calorie malnutrition. Am J Phys Anthropol 1969;30:153–5.
Garn SM, Kanzas J. Protein intake, bone mass, and bone loss. In: de Luca HF, Frost H, Jee W, Johnston C, Parfitt AM, editors. Osteoporosis: recent advances in pathogenesis and treatment. Baltimore: University Park Press, 1981:257–63.
Parfitt AM, Miller MJ, Frame B, et al. Metabolic bone disease after intestinal bypass for treatment of obesity. Ann Intern Med 1978;89:193–200.
Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ. Nutrition in orthopedic surgery. J Bone Joint Surg [Am] 1982;64:1263–72.
Older MWJ, Delyth E, Dickerson JWT. A nutrient survey in elderly women with femoral neck fracture. Br J Surg 1980;67:884–6.
Young GA, Chem C, Hill GL. Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometric measurements. Am J Clin Nutr 1978;31:429–35.
Bastow MD, Rawlings J, Allison SP. Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism? Lancet 1983;1:143–6.
Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990;335:1013–6.
Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA 1976;235:1567–70.
Chevalley T, Rizzoli R, Nydegger V, et al. Preferential low bone mineral density of the femoral neck in patients with a recent fracture of the proximal femur. Osteoporosis Int 1991;1:147–54.
Souci S, Fachmann W, Kraut H. Composition des aliments: tableaux des valeurs nutritives. Stuttgart: Wissenschaftliche Verlagsgesellschaft, 1981/1982.
Paul AA, MacCance RA, Widdowson EM. The composition of foods. 4th ed. Amsterdam: Elsevier, 1978.
Ingenbleek Y, Carpentier YA. A prognostic inflammatory and nutritional index scoring critically ill patients. Int J Vitam Nutr Res 1985;55:91–101.
Slosman DO, Rizzoli R, Buchs B, Piana F, Donath A, Bonjour JP. Comparative study of the performance of X-ray and Gd bone densitometers at the level of the spine, femoral neck and femoral shaft. Eur J Nucl Med 1990;17:9–13.
Buchs B, Rizzoli R, Slosman DO, Nydegger V, Bonjour JP. Densité minérale osseuse de la colonne lombaire, du col et de la diaphyse fémoraux, d'unéchantillon de la population genevoise. Schweiz Med Wochenschr 1992;122:1129–36.
National Research Council: Food and Nutrition Board. Recommended dietary allowances. Washington: National Academy of Sciences, 1980.
Tkatch L, Rapin CH, Rizzoli R, et al. Benefits of oral protein supplement in elderly patients with hip fracture. J Am Coll Nutr 1992:11:519–25.
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Geinoz, G., Rapin, C.H., Rizzoli, R. et al. Relationship between bone mineral density and dietary intakes in the elderly. Osteoporosis Int 3, 242–248 (1993). https://doi.org/10.1007/BF01623827
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DOI: https://doi.org/10.1007/BF01623827