ObjectivesBody weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients.DesignRESORT is an observational, longitudinal cohort.Setting and ParticipantsGeriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital, Melbourne, Australia (N = 1006).MethodsChanges in body weight and body composition [fat mass (FM), appendicular lean mass (ALM)] from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ.ResultsA total of 1006 patients [median age: 83.2 (77.7–88.8) years, 58.5% female] were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia.Conclusions and ImplicationsIn geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients’ nutritional risk.
OBJECTIVE: To study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD).METHODS: We performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change.RESULTS: Intervention patients (n=280) lost significantly more weight than control patients (n=257) (-2.4±7.1 kg vs -0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59).CONCLUSION: The comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight.TRIAL REGISTRATION NUMBER: NTR3937.
Objective: To study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD). Methods: We performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change. Results: Intervention patients (n=280) lost significantly more weight than control patients (n=257) (-2.4±7.1 kg vs -0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59). Conclusion: The comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight.
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In de voorschool worden pedagogisch medewerkers (PMers) steeds vaker geconfronteerd met overgewicht bij kinderen van 2,5 tot 4 jaar. De PMer is getraind in het ondersteunen van de ontwikkeling en opvoeding van het kind. PMers zijn niet opgeleid voor leefstijladvisering. Ongezonde voeding en inactiviteit zijn de belangrijkste oorzaken van overgewicht. Overgewicht komt op jonge leeftijd al meer voor bij lagere sociaaleconomische en etnische groepen. De gezondheidsverschillen nemen hierdoor toe. PMers geven aan dat zij zich niet bekwaam voelen om verantwoordelijk te zijn voor de gezonde keuzes op de voorschool als ook in de advisering naar ouders toe. De centrale vragen in dit project zijn: Wat heeft de PMer in de voorschool nodig in kennis, vaardigheden en attitude om het handelingsrepertoire tav leefstijladvisering aan alle kinderen van 2,5 tot 4 jaar en ouders met diverse sociaaleconomische en cultureel-etnische achtergronden te professionaliseren. Wat is het effect van het handelen van de PMer op de gezonde (gewichts)ontwikkeling van het kind? Het onderzoek is een gerichte interventiestudie met voor- en nametingen bij PMers, kinderen en ouders. De interventie wordt bij een deel van de PMers uitgevoerd en vergeleken met een controlegroep. Bij kinderen worden fysieke- en gedragsmetingen uitgevoerd. Eindpunten zijn het vertrouwen in leefstijladvisering door PMers en ontwikkelingstrends in gewicht bij kinderen. Fases van het projectplan: I. nulmeting en interventie bij PMers; II. nulmeting bij kinderen en interventie door PMers; III. effectmeting interventie bij PMers en kinderen; IV. ontwikkeling competentieprofiel leefstijladvisering voor PMers. Het PS@HW consortium olv de Hogeschool van Amsterdam, Impuls Kinderopvang, Brancheorganisatie Kinderopvang Amsterdam, Nederlands Jeugdinstituut, RIVM Centrum voor Gezond Leven, VU medisch centrum, HvA-Speerpunt Urban Vitality en Sarphati Amsterdam pakt dit op. Dit project beoogt het ontwikkelen van de HBO competentie leefstijladvisering voor PMers van de voorscholen die kinderen bereiken met een achterstand, voor een gezonde (gewichts)ontwikkeling en het terugdringen van gezondheidsverschillen.
