Background: Although diagnosing and treating malnutrition, sarcopenia and underweight are recommended to be embedded and sustained within nutritional care, it is unknown if that is facilitated in geriatric rehabilitation. This study determined the proportion of geriatric rehabilitation inpatients with malnutrition, sarcopenia or underweight receiving dietetic interventions as part of routine clinical care and if these patients have greater improvements in body weight and composition compared to patients not receiving dietetic interventions.Methods: Geriatric rehabilitation inpatients from the observational REStORing health of acutely unwell adulTs (RESORT) cohort were included (n=971, median age 83.2 [77.7-88.8] years, 58.5% (n=568) females). Malnutrition, sarcopenia and underweight were defined by the Global Leadership Initiative of Malnutrition, European Working Group on Sarcopenia in Older People 2 and age-specific body mass index cut-offs. Data on dietetic interventions initiated by dietitians as part of clinical care was extracted from the centralised hospital database. Changes in body weight (kg), skeletal muscle mass (kg, %), and fat mass (kg, %) from admission to discharge were determined using linear mixed models.Results: Dietetic interventions were received by 306 (62.0%), 138 (71.5%) and 153 (76.9%) of patients with malnutrition (n=493), sarcopenia (n=193) and underweight (n=199). Duration and frequency of dietetic interventions were higher in patients with malnutrition, sarcopenia or underweight compared to patients without those conditions. There were no differences in body weight/composition changes in patients with malnutrition, sarcopenia or underweight receiving dietetic interventions compared to those not receiving interventions.Conclusions: One-third of geriatric rehabilitation inpatients with malnutrition, sarcopenia or underweight are not receiving dietetic interventions and therefore the referral and diagnostic process require improvements. Patients with malnutrition, sarcopenia or underweight receiving dietetic interventions had no greater improvements in body weight/composition compared to those who did not receive interventions. Tailoring dietetic interventions for malnutrition, sarcopenia and underweight diagnosis may improve patient outcomes.
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From PLoS website: In general, dietary antigens are tolerated by the gut associated immune system. Impairment of this so-called oral tolerance is a serious health risk. We have previously shown that activation of the ligand-dependent transcription factor aryl hydrocarbon receptor (AhR) by the environmental pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) affects both oral tolerance and food allergy. In this study, we determine whether a common plant-derived, dietary AhR-ligand modulates oral tolerance as well. We therefore fed mice with indole-3-carbinole (I3C), an AhR ligand that is abundant in cruciferous plants. We show that several I3C metabolites were detectable in the serum after feeding, including the high-affinity ligand 3,3´-diindolylmethane (DIM). I3C feeding robustly induced the AhR-target gene CYP4501A1 in the intestine; I3C feeding also induced the aldh1 gene, whose product catalyzes the formation of retinoic acid (RA), an inducer of regulatory T cells. We then measured parameters indicating oral tolerance and severity of peanut-induced food allergy. In contrast to the tolerance-breaking effect of TCDD, feeding mice with chow containing 2 g/kg I3C lowered the serum anti-ovalbumin IgG1 response in an experimental oral tolerance protocol. Moreover, I3C feeding attenuated symptoms of peanut allergy. In conclusion, the dietary compound I3C can positively influence a vital immune function of the gut.
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