Nutritional status, chewing function and vitamin deficiency in geriatric inpatients

The aim of this study was to investigate the correlation of vitamin and trace element deficiencies with the cognitive function, the Activities of Daily Living, the nutritional status and the chewing function in a population of geriatric hospitalized patients.IntroductionAll patients aged 70 years and over admitted to a geriatric department because of an acute disease were included into the study. Assessments of Activities of Daily Living (Barthel's Index), cognition (MMST) and chewing function (Carrot test) were done for every patient included. The nutritional status was assessed by the MNA, the BMI and by measurements of skinfold thickness. In addition to routine laboratory investigations the following laboratory investigations were done for every patient: Osteocalcin, Transketolase-Activity, Thiamin, Glutathion-Reductase-Activity, Niacin, Vitamin C, Vitamin A, Vitamin E and Selenium.ResultsThirty-one patients (18 female and 13 male) were included into the study. No patient refused participation. The mean age was 78, 2 years. The mean BMI was 26.87 kg/m2, the mean Barthel index was 60 points. The average score in the Mini-Mental-Status-Test was 20.7 points. Only 26% of the patients had a good nutritional status according to the Mini Nutritional Assessment (MNA). Forty-five percent of the patients had no own teeth. Eighty-one percent of the patients stated that they have no problems with chewing. However, objective testing revealed a higher prevalence of chewing dysfunction: 42% were not able to grind a carrot slice sufficiently in the carrot test. 55% of the patients had Vitamin C concentrations below the normal range, Selenium concentrations were below normal range in 52% of the patients investigated. Patients with a bad chewing function (index 6 in the carrot test) had a tendency to lower serum levels of Vitamin B1, Niacin, Vitamin C, Vitamin A and Selenium. There was a significant positive correlation of selenium levels with vitamin B 12 levels and lymphocyte count. The concentrations of Vitamin C and Vitamin A were significantly higher in patients taking many medications. No significant correlation was found between micronutrient deficiencies and BMI or the MNA score.ConclusionsElderly patients with acute illness have frequently micronutrient deficiencies, Vitamin C and Selenium being deficient in more than half of the patients. These deficiencies were not restricted to underweight patients: Patients with a normal BMI and even overweight patients showed micronutrient deficiencies. Geriatric and nutritional assessments alone are not suitable to identify the patients with these deficiencies.