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Malnutrition and Risk of Structural Brain Changes Seen on Magnetic Resonance Imaging in Older Adults
Author(s) -
Schueren Marian A. E.,
LontermanMonasch Sabine,
Flier Wiesje M.,
Kramer Mark H.,
Maier Andrea B.,
Muller Majon
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14385
Subject(s) - medicine , malnutrition , odds ratio , micronutrient , atrophy , hyperintensity , magnetic resonance imaging , cross sectional study , vitamin b12 , confidence interval , pediatrics , pathology , radiology
Objectives To study the associations between protein energy malnutrition, micronutrient malnutrition, brain atrophy, and cerebrovascular lesions. Design Cross‐sectional. Setting Geriatric outpatient clinic. Participants Older adults (N = 475; mean age 80 ± 7). Measurements Nutritional status was assessed using the Mini Nutritional Assessment ( MNA ) and according to serum micronutrient levels (vitamins B1, B6, B12, D; folic acid). White matter hyperintensities ( WMH s), global cortical brain atrophy, and medial temporal lobe atrophy on magnetic resonance imaging ( MRI ) were rated using visual rating scales. Logistic regression analyses were performed to assess associations between the three MNA categories (<17, 17–23.5, ≥23.5) and micronutrients (per SD decrease) and WMH s and measures of brain atrophy. Results Included were 359 participants. Forty‐eight participants (13%) were malnourished ( MNA <17), and 197 (55%) were at risk of malnutrition ( MNA = 17–23.5). Participants at risk of malnutrition (odds ratio ( OR ) = 1.93, 95% confidence interval ( CI ) = 1.01–3.71) or who were malnourished ( OR = 2.80, 95% CI = 1.19–6.60) had a greater probability of having severe WMH s independent of age and sex than those with adequate nutritional status. Results remained significant after further adjustments for cognitive function, depressive symptoms, cardiovascular risk factors, history of cardiovascular disease, smoking and alcohol use, and micronutrient levels. Lower vitamin B1 ( OR = 1.51, 95% CI = 1.11–2.08) and B12 ( OR = 1.45, 95% CI = 1.02–2.04) levels were also related to greater risk of severe WMH s, independent of age and sex. Results remained significant after additional adjustments. MNA and vitamin levels were not associated with measures of brain atrophy. Conclusion Malnutrition and lower vitamin B1 and B12 levels were independently associated with greater risk of WMH s. Underlying mechanisms need to be further clarified, and whether nutritional interventions can modify these findings also needs to be studied.