Association between renal insufficiency and malnutrition in older adults: Results from the NHANES III
ABSTRACT The extent to which relevant confounding variables influence the recognized association between renal insufficiency and malnutrition is not known. This study examined whether renal insufficiency was associated with malnutrition, independent of relevant demographic, social, and medical conditions in noninstitutionalized adults 60 years of age and older.
Participants (5248) in the United States Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994), a cross-sectional study, were examined in a multivariate logistic regression model. Participants were stratified into three groups of glomerular filtration rate (GFR) by serum creatinine. Dietary and nutritional factors were estimated from 24-hour dietary recall, biochemistry measurements, anthropometry, and bioelectrical impedance. Participants were malnourished if they demonstrated at least three of the following five criteria: (1) serum albumin < or =37 g/L, (2) male weight < or =63.9 kg, female weight < or =51.8 kg, (3) serum cholesterol <4.1 mmol/L, (4) energy intake <15 kcal/kg/day, and (5) protein intake <0.5 g/kg/day.
A GFR <30 mL/min/1.73 m(2) was present in 2.3% of men and 2.6% of women; these participants demonstrated low energy and protein intake and higher serum markers of inflammation. Thirty-one percent of individuals with malnutrition demonstrated a GFR <60 mL/min/1.73 m(2). In multivariate analysis, a GFR <30 mL/min/1.73 m(2) was independently associated with malnutrition [odds ratio 3.6 (2.0 to 6.6)] after adjustment for relevant demographic, social and medical conditions.
It is probable that renal insufficiency is an important independent risk factor for malnutrition in older adults. Malnutrition should be considered, prevented, and treated as possible in persons with clinically important renal insufficiency. These results should be confirmed in a prospective longitudinal cohort study.
Full-textDOI: · Available from: Catherine M Clase, Mar 21, 2014
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ABSTRACT: ** Diparti- mento di Geriatria, Università Campus Biomedico, Roma Objective. This study aimed at quantify the discrepancy between two formulas commonly used to estimate the glomerular filtration rate (Cockroft-Gault (CG- GFR) and Modification of Diet in Renal Disease (MDRD-GFR) equations) in a pop- ulation of elderly inpatients. Methods. Data come from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA). We used the 95% limits of agreement, the κ κ statistic, and a graphic ap- proach to evaluate the influence of potential confounders on the magnitude of the difference in the GFR estimates. Results. We studied 7,496 persons (51% women, mean age 77.8 (SD: 7.2)). The mean GFR estimated using the CG and MDRD formulas was 50.7 (17.9) and 55.5 (20.5), respectively. At the individual level, the MDRD-GFR can differ by more than 50% compared with the CG-GFR. The agreement between the formulas was moderate in diagnosing moderate renal insufficiency, and a fair in diagnosing severe renal insufficiency. The magnitude of the difference in GFR estimates was influenced by age and weight. Conclusions. The CG and MDRD formulas have a good average agreement, but at the individual level they can give estimates that differ substantially, and cannot be used interchangeably to measure renal function in elderly people.
Article: Nutritional requirements with aging