Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study Park Y, Subar AF, et al: The Archives of Internal Medicine. Published online February 14, 2011
Background: Dietary fiber has been hypothesized to lower the risk of coronary heart disease, diabetes, and some cancers. However, little is known of the effect of dietary fiber intake on total death and cause-specific deaths.
Methods: We examined dietary fiber intake in relation to total mortality and death from specific causes in the NIH (National Institutes of Health)-AARP Diet and Health Study, a prospective cohort study. Diet was assessed using a food-frequency questionnaire at baseline. Cause of death was identified using the National Death Index Plus. Cox proportional hazard models were used to estimate relative risks and 2-sided 95% confidence intervals (CIs).
Results: During an average of 9 years of follow-up, we identified 20,126 deaths in men and 11,330 deaths in women. Dietary fiber intake was associated with a significantly lowered risk of total death in both men and women. Dietary fiber intake also lowered the risk of death from cardiovascular, infectious, and respiratory diseases by 24% to 56% in men and by 34% to 59% in women. Inverse association between dietary fiber intake and cancer death was observed in men but not in women. Dietary fiber from grains, but not from other sources, was significantly inversely related to total and cause-specific death in both men and women.
Conclusions: Dietary fiber may reduce the risk of death from cardiovascular, infectious, and respiratory diseases. Making fiber-rich food choices more often may provide significant health benefits.
Kevin’s Comments: After this study was released, I closely checked the food label on my breakfast cereal and to my chagrin it only contained 3 grams of fiber per serving. The new recommendations suggest we ingest 14 grams of fiber per 1000 calories consumed. For the average American this will amount to about 25-28 grams consumed (based on a daily intake of 1800-2000 calories). This study confirms the significant benefit of a high fiber diet on the reduction of risk for heart disease, infections, and respiratory diseases. Interestingly, such a diet reduces the risk of cancer in men but not in women. The authors note that the observed sex difference may, in part, be explained by the differences in leading organ sites for cancer death between men and women and that cancer at these sites may be more influenced by dietary factors. So check those food labels and make sure you are getting the recommended amount of fiber in your diet.
Oral Feeding Options for People With Dementia: A Systematic Review. Hanson LC, Ersek M, et al: The Journal of the American Geriatrics Society 2011; 59 (March): 463-472
Background: As people age, there is a diminished sense of taste and smell. In advanced stage dementia, apraxia (inability to perform tasks even when understood) combined with increasing cognitive impairment leads to a further decrease in food intake.
Objective: To review the oral feeding options in dementia patients and, specifically, to determine if high-calorie supplements, appetite stimulants, modified diets, and assisted feedings improve clinical outcome.
Methods: The authors searched PubMed, CINAHL, EMBASE, and Cochrane using the PICOT framework. This framework designates Population, Intervention, Comparison groups, Outcomes, and Time frame for outcomes. The authors included randomized and nonrandomized studies with participants in hospital, community, and long-term care settings. Study end points varied, including hospitalization, pneumonia, quality of life, weight gain, wound healing, and mortality. Length of follow-up had to be at least 1 month. Three investigators read all the articles and rated their strength of evidence based on the Cochrane rating approach.
Results: 25 articles were included in the review. High-calorie supplements, regardless of the severity of cognitive impairment, improved weight gain; a few studies also showed improved wound healing. The average amount of weight gain was 0.5 to 2.0 kg. The use of appetite stimulants showed mixed results. The use of megestrol showed minimal benefit in those with mild impairment and none in those with severe impairment unless combined with feeding assistance; furthermore, participants reported side effects such as fatigue, loss of strength, and lower extremity edema. Dronabinol showed benefit in improving weight as well as the behavioral disorders that sometimes accompany dementia. However, this was a small study, and participants reported increased somnolence and bouts of euphoria; one participant had a seizure.
Additionally, chocolate, exercise, dietary education, lyophilized food, and feeding assistance showed a minimal, albeit positive effect on weight. Relaxing music during meals also showed benefit, but this was a poorly done study according to the authors. Other techniques evaluated that were of no benefit included buffet-style dining and swallowing education with thickened liquids at all times. None of these interventions improved function, cognition, or mortality. Lastly, the authors recommend that the above techniques be used in combination to improve nutrition in older patients with dementia.
Conclusions: Nutritional supplements are the only option that show benefit in the treatment of malnutrition in cognitively impaired persons; the authors recommend that the above techniques be tried in combination with nutritional supplement to improve weight gain in these patients.
Kevin’s Comments: Although there are limitations to this study, it reinforces that appetite stimulants have little benefit in persons with dementia. It would be interesting to see further quality studies done looking at the role of non-pharmacologic interventions (such a relaxing music and exercise which appears to have some benefit).
Managing Xerostomia in Nursing Homes: Pilot Testing of the Sorbet Increases Salivation Intervention. Crogan NL: The Journal of the American Medical Directors Association 2011; 12 (March): 212-216
Objective: The purpose of this article was to describe the pilot testing of the Sorbet Increases Salivation (SIS) intervention and describe its impact on salivation and subsequent resident food intake.
Methods: Using a repeated treatment design with each elder serving as his or her own control, 12 elders were served 2 ounces of sugar-free lemon-lime sorbet just before the lunch meal for two 3-week periods separated by a 6-week observation (no treatment) period. A plate waste protocol was used to determine actual food intake. Before the initiation of the intervention, salivation was measured (using a Modified Schirmer Test [MST] strip) at baseline and then at 1, 2, and 3 minutes of consuming 2 oz of sugar-free lemon-lime sorbet or 2 oz of water. Summary statistics (means, standard deviations, proportions) were used to describe the study sample. Bivariate statistics determined whether there were significant differences between MST measures or food intake within subjects.
Results: Salivation significantly increased after consuming sorbet or water. Most importantly, residents who consumed sorbet salivated more on average in comparison with residents who consumed water. During pilot testing, most residents consumed more food on average during treatment weeks in comparison with observation weeks.
Conclusion: The intervention has the potential to increase salivation, decrease complaints of xerostomia, and increase food intake in institutionalized elders with drug-induced xerostomia. The new knowledge gained from this study will lead to further research and testing of the intervention with the long-term goal of transforming the "care-as-usual" approach to meal service in nursing homes.
Kevin’s Comments: Xerostomia (dry mouth) is a very common condition in older adults and may contribute to poor food intake and malnutrition. There are many medical conditions that can cause dry mouth such as diabetes, an underactive thyroid, head and neck irradiation, and Sjogren’s Syndrome (also associated with dry eyes). However, many medications can cause dry mouth such as antihistamines, diuretics, tricyclic antidepressants, and bladder control drugs. If treating the underlying condition or removing the offending drug does not resolve the problem, perhaps a simple intervention such as providing sorbet at mealtime can increase saliva and improve food intake.
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