Journal of Aging Research & Clinical Practice© Volume 2, Number 2, 2013 NUTRITIONAL STATUS BUT NOT VITAMIN DEFICIENCIES ARE ASSOCIATED WITH LOW FUNCTIONAL SCORES F. O’Leary 1 , M. Allman-Farinelli 1 , P. Petocz 2 , S. Samman 1 Introduction Geriatric rehabilitation patients are at high risk of malnutrition (1-3), muscle wasting and difficulties with activities of daily living (3-5). Undernourished geriatric hospital patients have poor function on admission (3, 4, 6, 7), increased functional decline (4, 6, 7), delayed functional recovery (3) and require greater support (3, 5). One of the most widely used functional assessment tools is the Functional Independence Measure (FIM) (8). Undernutrition is related to inadequate energy and vitamin intake and can result in subclinical deficiencies (1). Deficiencies of B vitamins may affect cellular and disease processes (9), with vitamins B12 and folate essential for one-carbon metabolism, DNA methylation and nucleotide synthesis. Low vitamin B12 status is linked to mitochondrial dysfunction and inflammation (9, 10). Frailty and disability are associated with poor B vitamin status (11) and hyperhomocysteinaemia, a marker of inadequate status is linked to poorer physical function (12). Vitamin D is required for cellular growth and for central nervous system and muscle function (13). Little, however, is known of effects of subclinical vitamin deficiencies and whether specific nutrient inadequacies affect function and health. This study explores the relationship between the selected nutrients, vitamins D, B12 and folate, nutritional status and the functional capacity of elderly rehabilitation patients as measured by FIM. Methods The study was conducted in a 48 bed sub-acute geriatric rehabilitation unit. Newly admitted subjects were recruited in 2, six week periods in August and September of 2005 and 2006. Patients with inadequate English or diagnosed dementia without a carer were excluded. The study protocol was approved by the Calvary Health Care Sydney Ethics Committee, and patients or caregivers provided consent. Potential confounders assessed included medical history, cognitive status, serum albumin, creatinine and urea. Subjects who returned to an acute hospital or those with missing FIM data were removed from analysis. The Charlson co-morbidity index was calculated (14). 1. Discipline of Nutrition and Metabolism, School of Molecular Bioscience, University of Sydney, NSW 2006, Australia; 2. Department of Statistics, Macquarie University, NSW 2109 Australia. Corresponding Author: Samir Samman PhD, Discipline of Nutrition and Metabolism, School of Molecular Bioscience, G08, University of Sydney, NSW 2006 Australia, Fax: 9351 6022, Ph: 9351-2476, email: samir.samman@sydney.edu.au 216 Abstract: Objectives: To investigate relationships between selected vitamins, nutritional status and functional outcomes. Design: Cross-sectional study. Setting: Sub-acute geriatric rehabilitation hospital. Participants: 146 newly admitted rehabilitation patients. Measurements: Nutritional assessment using the Mini Nutritional Assessment (MNA) tool, vitamins B12, D and folate concentrations. Length of stay and Functional Independence Measure data were collected from discharge medical records. Results: Age was 83 ± 7 (mean ± sd) years and BMI 25 ± 6 kg/m 2 . The majority (80%) of subjects were malnourished or at risk of malnutrition and 20% of them had 2 or more vitamin concentrations below the reference range. Vitamin D < 50 nmol/L was found in 55%, vitamin B12 < 221 pmol/L in 34% and serum folate < 6.8 nmol/L in 6% of subjects. Function was related to nutritional status determined by the MNA tool but not related to vitamin concentrations. The assessment component of the MNA score predicted 10% of admission function (β = 0.36, p<0.0005), and subjects with poorer functional scores (< 95) had lower mean MNA scores (19 versus 21, p=0.028). Conclusion: Nutritional status was associated with low functional scores. Low concentrations of vitamins D and B12 were common but were not related to function. More research is needed to investigate the relationship between nutritional status and function. Key words: Nutrition assessment, avitaminosis, activities of daily living, rehabilitation assessment, geriatric assessment. Received November 21, 2012 Accepted for publication January 4, 2013 14 SAMMAN_04 LORD_c 06/06/13 16:13 Page216