Sustainable Eating Pattern to Limit Malnutrition in Older Adults

The SENIOR cross-sectional study is a multicenter study conducted in three North Italian Scientific Hospitalization and Treatment Institutions in Pavia and Monza on older adults (≥ 65 years old). The estimated duration is 36 months with an preferred starting date on November 2023.

The primary objective of the SENIOR cross-sectional is the evaluation of the nutritional status in at least a total of 200 free-living and hospitalized older adults. Therefore, the primary endpoint is to define the malnutrition prevalence in free-living and hospitalized older adults with GLIM criteria, which is the most update recent international consent.

As secondary objectives, the definition of the prevalence of sarcopenia (according to EWGSOP2 diagnosis) and a mapping of other relevant factors potentially associated with malnutrition will be carried out on the population target: lifestyle, socioeconomic status, anthropometric measures, clinical condition including medical treatment and blood analysis. In addition, the impact of these factors on health status of the target population will be investigated, potentially leading to the identification of new malnutrition risk factors.

To the over 65 older adults, admitted at the three hospitals for medical visits or recovery, will be proposed to participate to the SENIOR cross-sectional study. After the participants' signature of the informed consent, the clinical and pathological information will be gathered to assess the eligibility.

On eligible subject different variables will be measured. Dietary habits will be evaluated through a Mediterranean diet questionnaire (MEDI-LITE) and the MIND diet questionnaire. Physical activity will be evaluated with the Physical Activity Scale for the Elderly (PASE) questionnaire and activities of daily living will be assessed through Barthel Index. Sleep quality will be investigated with Pittsburgh questionnaire. Emotional status of participants will be examined with the Geriatric Depression Scale 15 item (GDS-15). Quality of life will be measured with SF-12 questionnaire. Ending, vitamin D deficiency will be evaluated with the Evidence Q questionnaire.

Anthropometric variables will include weight, height (knee height and demi-span), circumferences (waist, mid-arm, calf and medium tight), and body composition (bioimpedance analysis, BIA). In addition, muscle strength (handgrip) and physical performance (4-meter gait speed) will be evaluated.

Malnutrition will be diagnosed according to the 2019 GLIM criteria using a two-step approach. Participants will be first screened with Malnutrition Universal Screening Tool (MUST), followed by diagnostic assessment requiring at least one phenotypic criterion (weight loss, low BMI, or reduced appendicular skeletal muscle mass derived from BIA) and one etiologic criterion (reduced intake or inflammation/disease burden). Severity grading will be also performed.

Muscle strength (handgrip), Appendicular Skeletal Mass (ASM, derived from BIA) and locomotion (gait speed) will be used to diagnose sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus.

Intrinsic capacity, a marker of healthy aging promoted by the World Health Organisation (WHO), will be also assessed, exploring the following domains: locomotion, vitality, cognition, psychological status, and sensory function.

Blood analysis will be carried out on a subgroup to evaluate the participants' inflammatory, nutritional and clinical status.

Data from medical records will be used to calculate the Cumulative Illness Rating Scale (CIRS) score, a gold-standard measure of overall disease burden. The CIRS-based comorbidity and severity indices quantify an individual's health status, with lower scores indicating lower burden and higher scores indicating greater severity and comorbidity.

Finally, information on medication use at hospital admission (number and active substances) and hospitalizations in the previous year (yes/no) will be retrieved from medical records, based on prior structured interviews. Length of stay will be obtained from discharge letters and defined as the number of days spent in the hospital for each inpatient.

Inclusion criteria

• Age ≥ 65 years old
• Admission to U.O. of General Medicine and to U.O.S.D. of Endocrinology and Metabolic diseases of ICS Maugeri IRCCS Hospital; to the Division and Specialist Gastroenterology Clinic of the IRCCS Policlinico San Matteo Foundation, Pavia, Italy; to the Department of Neurology and Geriatrics of the IRCCS San Gerardo dei Tintori Foundation, Monza, Italy
• Informed consent written and signed

Exclusion criteria

• Dysphagia
• Terminal disease
• History of bariatric surgery
• Dementia or cognitive decline (MMSE score <20/30)
• Eating disorder
• Patients with tumor diagnosis not in remission and currently not treated with oncological therapy
• Advanced liver failure (CHILD ≥ B)
• Advanced renal failure (eGFR < 15 mL/min/1.73m ^2 )
• Advanced chronic or acute respiratory failure (pO2 < 60 mmHg or PCO2 > 45 mmHg)