European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Introduction: The aim of this study was to assess the energy
expenditure of nursing home residents with indirect calorimetry
and then to compare it with the calculated energy intake of the
residents.
Methods: An indirect calorimetry was performed for each nursing
home resident included in this study to estimate their basal
metabolism. Then, the basal metabolismwas multiplied by a physical
activity level (PAL) coefficient. Finally, energy expenditure related to
thermogenesis (i.e. 10% of the basal metabolism) was added. In this
way, we obtained the total energy expenditure of each nursing home
resident. Nutritional intake of each resident was calculated by the
precise weighing food method, over a 3-day period.
Results: A total of 29 subjects, all residing in one nursing home
in Liège, Belgium, and meeting the selection criteria (i.e. to be
oriented, stable condition and able to walk, with or without technical
assistance) were included in this study. The mean age of this
population was 88.1 ± 5.8 years and 84% of them were women. The
mean basal metabolism estimated was 1087.2 ± 163.2 kcal. When
multiplied by the PAL (1.29 ± 0.1) and added to the energy expenditure
due to thermogenesis (155.7 ± 24.7 kcal), we obtained the mean
energy expenditure of 1557.3 ± 247.1 kcal, which was similar to the
calculated energy intake of the residents (1631.5 ± 289.3 kcal). Indeed,
the difference was not statistically significant (p = 0.33)
Conclusion: The estimated energy intake of nursing home residents
seems appropriate for their energy expenditure.
P-629
Graves’ Disease – an atypical presentation
A. Canelas1, C. Machado 2, P. Tavares2, C. Silva1, G. Rocha2, L. Andrade1,
V. Dias1. 1Internal Medicine Department, Centro Hospitalar Vila Nova de
Gaia/Espinho, 2Endocrinology Department, Centro Hospitalar Vila Nova
de Gaia / Espinho, Porto, Portugal
Introduction: Graves’ Disease (GD) its responsible for 80% of
hyperthyroidism cases. Usually has distinctive signs and symptoms
(goiter, oftalmopathy, palpitations) [1]. Thyroid disorders are very
common in the elderly, and correlatewith high morbidity if untreated.
The typical symptoms may be absent, or mistakenly associated to the
age or comorbidities [2,3].
Methods: We report on an elderly woman with an atypical
presentation of GD. The relevant literature was reviewed.
Case report: 81 year-old, female, with a 2-month history of proximal
muscle weakness, depressed humor, lethargy and constipation.
Admitted for fever of unknown origin. On physical: lethargic,
dehydrated, pale and feverish. Laboratory findings: Hemoglobin
9.8 g/dL; white blood count 16.69X10^3, 85% neutrophils; C-reactive
protein 45.53 mg/dL; Sodium 127 mmol/L; Sedimentation velocity
rate 120 mms. Excluded respiratory, urinary, abdominal, orthopedic,
neurological, spondylodiscitis or endocarditis, as cause. Endoscopic
studies: esophagi candidiasis. Virology, serology and tuberculosis were
negative. Thyroid study: TSH 0.11 microiU/mL, free T4 2.46 pmol/mL;
Echography: enlarged, heterogeneous, multiple nodules; Positive
Anti-TSH antibodies. Therefore, diagnosed with GD, but without
criteria for thyrotoxicotic storm, initiating tiamazole. On the 11th day,
deteriorated and was admitted in the Intermediary Care Unit for
Severe Sepsis with multiple organ dysfunction, caused by intestinal
occlusion with megacolon and RCD aggravated by tubular necrosis.
There wasn’ t surgical treatment to be offered. The patient ultimately
died, regardless of all the efforts.
Conclusion: In 1931, Lahey, described a form of hyperthyroidism in
which the patients were “apathetic”, showing few, or none of the
typical symptoms [4,5]. The pathogeny is unknown, but seems to
be related with brain defiance of catecholamines [6]. This alerts us
for the fact that in cases of clinical stress, they can rapidly
deteriorate.
P-630
Comparison of nutritional status among elderly in hospital and in
community environments
M. Cebola, A. Mahendra, M. Pombo, B. Marques, H. Pinto, E. Carolino,
L. Mendes. Licnciatura em Dietética e Nutrição, Escola Superior de
Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa
Introduction: The elderly is considered vulnerable population by the
senescence process, which puts them at high risk of morbidity and
mortality. Several studies indicate a high prevalence of malnutrition in
the elderly in community and in hospital admissions, so the main
purpose of this study is to compare the nutritional status of the elderly
persons in both settings, located in Lisbon.
Methods: The screening tool Mini Nutritional Assessment (MNA®),
body mass index (BMI), arm circumference (AC), arm muscle area
(AMA) and C-reactive protein (CRP) were used to assess nutritional
status. Based on MNA® questions, food and water intake were
evaluated.
Results: A total of 99 elderly were evaluated (57.6% in hospital and
42.4% in the community). A higher level of inflammationwas observed
in hospital, according to CRP levels. It was reported a lower intake in
the hospital for: number of meals (15% less), portions of fruit and
vegetables (10.5% less), protein intake (33.4% less) and water intake
(44.3% less). In hospital, BMI indicated that 26.7% of the elderly were
malnourished whilst in community it was observed to be 20%. 43.9%
had a form of malnutrition in hospital and 45% in community,
when AMA was evaluated. MNA® detected 63.1% of patients were
malnourished or at risk of malnutrition in hospital and 62% in
community. Overall the elderly revealed worse nutritional status is in
hospital. The results suggest the need to regularly assess nutritional
status allowing to identify and decrease complications associated with
malnutrition, regardless of where the elderly are to remain.
P-631
Nutritional assessment of an elderly population by application of
24-hour recall and the Mini Nutritional Assessment
M. Cebola, M. Pombo, H. Pinto, E. Carolino, L. Mendes. Licenciatura em
Dietética e Nutrição, Escola Superior de Tecnologia da Saúde de Lisboa,
Instituto Politecnico de Lisboa
Introduction: Aging is characterized by physiological, social and
psychological changes that compromise food intake and nutritional
status. To ensure good nutritional status it’s crucial to assess the
nutritional status through a validated tool and evaluate the food
intake, which is the purpose of this study.
Methods: An analytical, observational, transversal, correlational and
quantitative study was conducted. The elderly’ s assessment and
characterization was done by the application of Mini Nutritional
Assessment (MNA), arm circumference (AC), laboratory parameters
and 24 hours recall.
Results: In the study, 42 elderly people were assessed, from which 26
women. By applying the MNA_Long Form® (MNA_LF®) 0 were
undernourished, 26 (62%) at risk of desnutrition and 16 (38%)
eutrophic. By applying the body mass index (BMI) 2 (5%) undernour-
ished, 6 (15%) at risk of desnutrition, 7 (17%) eutrophic e 26 (63%)
overweight. By the AC 19 (45%) exhibit depletion of lean body mass, 20
(48%) good nutritional state and 3 (7%) excess of body fat. The 24 hours
recall indicated low intake of macronutrients and of some micro-
nutrients (vitamins A, D and E, folate, potassium, calcium and
magnesium) and high intake of sodium and phosphorus. The AC
correlated with IMC (r = 0,61; p = 0) and MNA_LF (r = 0,45; p = 0,003).
The IMC correlated with the presence of dyslipidemia (r = 0,41;
p = 0,01), diabetes mellitus (r = 0,45; p = 0,003) and arterial hyperten-
sion (r = 0,375; p = 0,02).
Key conclusions: The population being studied showed high
prevalence of malnutrition, similar percentage of risk of desnutrition
and overnutrition, and deficit of food intake, as seen in other
Portuguese studies about the elderly in community.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S195