J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 13, Number 6, June 2021, pages 334-342

Nutritional Intake by Meal Time Zone in Geriatric Patients Is Related to Nutritional Assessment Index

**Table 1.** Numerical Notations of Nursing Care Level
Grade defined by the long-term care insurance act	Mild ← Breakdown → Severe
Grade assigned in this study	1	2	3	4	5	6	7

Table 1. Numerical Notations of Nursing Care Level

Grade defined by the long-term care insurance act

Mild ← Breakdown → Severe

Assistance required 1

Assistance required 2

Nursing care required 1

Nursing care required 2

Nursing care required 3

Nursing care required 4

Nursing care required 5

Grade assigned in this study

**Table 2.** Demographics
Data are expressed as mean ± standard deviation. Inside is quartile. The main diseases for admission included chronic heart failure, bronchial pneumonia, chronic obstructive pulmonary disease, and type 2 diabetes; however, these conditions had been treated in the acute care hospital, and thus, patients’ condition became stable. Alb: serum albumin; FPG: fasting plasma glucose; BUN: blood urea nitrogen; Cr: creatinine; eGFR: estimated glomerular filtration rate; BW: body weight. GNRI: geriatric nutritional risk index; PNI: prognostic nutritional index; CONUT: controlling nutritional status; NPC/N: nonprotein caloric/nitrogen.
Number of patients (male/female)	52 (33/19)
Age (years)	79.7 ± 8.7	(75.0 - 86.0)
Body mass index (kg/m²)	21.2 ± 4.0	(17.8 - 24.4)
Charlson Comorbidity Index (score)	2.4 ± 1.3	(2.0 - 3.0)
Duration of hospitalization (days)	52.6 ± 36.7	(27.8 - 64.8)
Alb (g/dL)	3.4 ± 0.5	(3.0 - 3.8)
FPG (mg/dL)	101.1 ± 24.1	(89 - 106)
BUN (mg/dL)	20.2 ± 11.8	(13.0 - 22.5)
Cr (mg/dL)	1.0 ± 0.6	(0.67 - 1.18)
eGFR (mL/min/1.73 m²)	60.9 ± 24.7	(42.4 - 72.4)
GNRI (score)	91.0 ± 12.5	(84.1 - 97.9)
PNI (score)	41.6 ± 5.9	(38.7 - 45.8)
CONUT (score)	3.7 ± 2.2	(2.8 - 4.5)
Not approved for nursing care service, n	7
Approved for nursing care service, n	45
Breakdown
Assistance required 1, n	1
Assistance required 2, n	3
Nursing care required 1, n	7
Nursing care required 2, n	16
Nursing care required 3, n	6
Nursing care required 4, n	6
Nursing care required 5, n	6
Nutrient intake
Energy intake (kcal/BW kg/day)	33.0 ± 8.4	(26.1 - 37.2)
Breakfast (kcal/BW kg/day)	10.3 ± 2.6	(8.4 - 12.4)
Lunch (kcal/BW kg/day)	11.5 ± 3.1	(9.3 - 12.8)
Dinner (kcal/BW kg/day)	11.1 ± 3.0	(8.6 - 13.5)
Protein intake (g/BW kg/day)	1.2 ± 0.3	(1.0 - 1.4)
Breakfast (g/BW kg/day)	0.3 ± 0.1	(0.3 - 0.4)
Lunch (g/BW kg/day)	0.4 ± 0.1	(0.4 - 0.5)
Dinner (g/BW kg/day)	0.5 ± 0.1	(0.4 - 0.6)
Fat intake (g/BW kg/day)	0.9 ± 0.3	(0.7 - 1.1)
Breakfast (g/BW kg/day)	0.3 ± 0.1	(0.2 - 0.4)
Lunch (g/BW kg/day)	0.3 ± 0.1	(0.2 - 0.3)
Dinner (g/BW kg/day)	0.3 ± 0.1	(0.2 - 0.4)
Carbohydrate intake (g/BW kg/day)	5.0 ± 1.3	(4.0 - 5.7)
Breakfast (g/BW kg/day)	1.5 ± 0.4	(1.2 - 1.7)
Lunch (g/BW kg/day)	1.8 ± 0.5	(1.4 - 2.1)
Dinner (g/BW kg/day)	1.7 ± 0.5	(1.3 - 2.0)
NPC/N mean	140.6 ± 10.6	(135.2 - 148.3)
Breakfast	163.6 ± 16.1	(150.6 - 177.2)
Lunch	139.1 ± 16.7	(129.1 - 152.8)
Dinner	126.1 ± 10.8	(121.4 - 131.4)

Table 2. Demographics

Data are expressed as mean ± standard deviation. Inside is quartile. The main diseases for admission included chronic heart failure, bronchial pneumonia, chronic obstructive pulmonary disease, and type 2 diabetes; however, these conditions had been treated in the acute care hospital, and thus, patients’ condition became stable. Alb: serum albumin; FPG: fasting plasma glucose; BUN: blood urea nitrogen; Cr: creatinine; eGFR: estimated glomerular filtration rate; BW: body weight. GNRI: geriatric nutritional risk index; PNI: prognostic nutritional index; CONUT: controlling nutritional status; NPC/N: nonprotein caloric/nitrogen.

Number of patients (male/female)

52 (33/19)

Age (years)

79.7 ± 8.7

(75.0 - 86.0)

Body mass index (kg/m²)

21.2 ± 4.0

(17.8 - 24.4)

Charlson Comorbidity Index (score)

2.4 ± 1.3

(2.0 - 3.0)

Duration of hospitalization (days)

52.6 ± 36.7

(27.8 - 64.8)

Alb (g/dL)

3.4 ± 0.5

(3.0 - 3.8)

FPG (mg/dL)

101.1 ± 24.1

(89 - 106)

BUN (mg/dL)

20.2 ± 11.8

(13.0 - 22.5)

Cr (mg/dL)

1.0 ± 0.6

(0.67 - 1.18)

eGFR (mL/min/1.73 m²)

60.9 ± 24.7

(42.4 - 72.4)

GNRI (score)

91.0 ± 12.5

(84.1 - 97.9)

PNI (score)

41.6 ± 5.9

(38.7 - 45.8)

CONUT (score)

3.7 ± 2.2

(2.8 - 4.5)

Not approved for nursing care service, n

Approved for nursing care service, n

Breakdown

Assistance required 1, n

Assistance required 2, n

Nursing care required 1, n

Nursing care required 2, n

Nursing care required 3, n

Nursing care required 4, n

Nursing care required 5, n

Nutrient intake

Energy intake (kcal/BW kg/day)

33.0 ± 8.4

(26.1 - 37.2)

Breakfast (kcal/BW kg/day)

10.3 ± 2.6

(8.4 - 12.4)

Lunch (kcal/BW kg/day)

11.5 ± 3.1

(9.3 - 12.8)

Dinner (kcal/BW kg/day)

11.1 ± 3.0

(8.6 - 13.5)

Protein intake (g/BW kg/day)

1.2 ± 0.3

(1.0 - 1.4)

Breakfast (g/BW kg/day)

0.3 ± 0.1

(0.3 - 0.4)

Lunch (g/BW kg/day)

0.4 ± 0.1

(0.4 - 0.5)

Dinner (g/BW kg/day)

0.5 ± 0.1

(0.4 - 0.6)

Fat intake (g/BW kg/day)

0.9 ± 0.3

(0.7 - 1.1)

Breakfast (g/BW kg/day)

0.3 ± 0.1

(0.2 - 0.4)

Lunch (g/BW kg/day)

0.3 ± 0.1

(0.2 - 0.3)

Dinner (g/BW kg/day)

0.3 ± 0.1

(0.2 - 0.4)

Carbohydrate intake (g/BW kg/day)

5.0 ± 1.3

(4.0 - 5.7)

Breakfast (g/BW kg/day)

1.5 ± 0.4

(1.2 - 1.7)

Lunch (g/BW kg/day)

1.8 ± 0.5

(1.4 - 2.1)

Dinner (g/BW kg/day)

1.7 ± 0.5

(1.3 - 2.0)

NPC/N mean

140.6 ± 10.6

(135.2 - 148.3)

Breakfast

163.6 ± 16.1

(150.6 - 177.2)

Lunch

139.1 ± 16.7

(129.1 - 152.8)

Dinner

126.1 ± 10.8

(121.4 - 131.4)

**Table 3.** Nutritional Composition of the Hospital Meal Menu
	Breakfast	Lunch	Dinner	Mean
Data are expressed as mean ± standard deviation.
Ratio to daily intake of each nutrient (%)
Energy intake	31.3 ± 2.7	34.9 ± 1.8	33.8 ± 2.3	-
Protein intake	27.6 ± 2.7	35.4 ± 2.4	37.0 ± 2.6	-
Fat intake	34.5 ± 5.4	32.2 ± 4.3	33.3 ± 4.3	-
Carbohydrate intake	30.9 ± 3.0	36.0 ± 2.0	33.1 ± 2.2	-
Energy ratio of each nutrient (%)
Protein/energy ratio	13.5 ± 2.0	16.3 ± 2.0	17.5 ± 2.1	15.8 ± 1.5
Fat/energy ratio	27.7 ± 6.0	24.3 ± 4.7	26.3 ± 4.2	25.8 ± 3.7
Carbohydrate/energy ratio	59.7 ± 6.9	59.3 ± 5.7	56.2 ± 5.7	58.5 ± 4.4
Menu characteristics	The main staple provided is bread or porridge, the side dishes provided are milk, fruits (fresh or canned food/jelly) and sides (vegetable dishes). In addition, bread comes with jam and butter, and porridge comes with seaweed/pickled plum paste.	Set menu of rice or porridge as the main staple, and a main dish with 2 - 3 sides as the side dishes. Eggs/fish/meat, soy products and vegetables/fruits are used as the ingredients. Noodles or special menu are provided at lunch.

Table 3. Nutritional Composition of the Hospital Meal Menu

Breakfast

Lunch

Dinner

Mean

Data are expressed as mean ± standard deviation.

Ratio to daily intake of each nutrient (%)

Energy intake

31.3 ± 2.7

34.9 ± 1.8

33.8 ± 2.3

Protein intake

27.6 ± 2.7

35.4 ± 2.4

37.0 ± 2.6

Fat intake

34.5 ± 5.4

32.2 ± 4.3

33.3 ± 4.3

Carbohydrate intake

30.9 ± 3.0

36.0 ± 2.0

33.1 ± 2.2

Energy ratio of each nutrient (%)

Protein/energy ratio

13.5 ± 2.0

16.3 ± 2.0

17.5 ± 2.1

15.8 ± 1.5

Fat/energy ratio

27.7 ± 6.0

24.3 ± 4.7

26.3 ± 4.2

25.8 ± 3.7

Carbohydrate/energy ratio

59.7 ± 6.9

59.3 ± 5.7

56.2 ± 5.7

58.5 ± 4.4

Menu characteristics

The main staple provided is bread or porridge, the side dishes provided are milk, fruits (fresh or canned food/jelly) and sides (vegetable dishes). In addition, bread comes with jam and butter, and porridge comes with seaweed/pickled plum paste.

Set menu of rice or porridge as the main staple, and a main dish with 2 - 3 sides as the side dishes. Eggs/fish/meat, soy products and vegetables/fruits are used as the ingredients. Noodles or special menu are provided at lunch.

**Table 4.** Dietary Pattern
Nutrient intake ratio	Dietary pattern
*\|load\| > 0.300 were considered as an important factor (in module). En: energy; Pro: protein; Carb: carbohydrate.
Breakfast
En ratio	-0.425*	-0.074	0.127
Pro ratio	-0.338*	0.171	-0.249
Fat ratio	-0.323*	0.134	-0.367*
Carb ratio	-0.303*	-0.201	0.417*
Lunch
En ratio	0.327*	-0.327*	-0.211
Pro ratio	0.200	-0.435*	-0.046
Fat ratio	0.224	-0.343*	0.170
Carb ratio	0.270	-0.156	-0.432*
Dinner
En ratio	0.287	0.430*	0.026
Pro ratio	0.235	0.264	0.394*
Fat ratio	0.236	0.200	0.368*
Carb ratio	0.213	0.417*	-0.244
Variance explained by each factor (eigenvalue)	2.278	1.733	1.512
Proportion of variance (%)	43.2	25.0	19.1
Cumulative proportion (%)	43.2	68.2	87.3

Table 4. Dietary Pattern

Nutrient intake ratio

Dietary pattern

First factor

Second factor

Third factor

*|load| > 0.300 were considered as an important factor (in module). En: energy; Pro: protein; Carb: carbohydrate.

Breakfast

En ratio

-0.425*

-0.074

0.127

Pro ratio

-0.338*

0.171

-0.249

Fat ratio

-0.323*

0.134

-0.367*

Carb ratio

-0.303*

-0.201

0.417*

Lunch

En ratio

0.327*

-0.327*

-0.211

Pro ratio

0.200

-0.435*

-0.046

Fat ratio

0.224

-0.343*

0.170

Carb ratio

0.270

-0.156

-0.432*

Dinner

En ratio

0.287

0.430*

0.026

Pro ratio

0.235

0.264

0.394*

Fat ratio

0.236

0.200

0.368*

Carb ratio

0.213

0.417*

-0.244

Variance explained by each factor (eigenvalue)

2.278

1.733

1.512

Proportion of variance (%)

43.2

25.0

19.1

Cumulative proportion (%)

43.2

68.2

87.3

**Table 5.** Multiple Regression Models of Serum Albumin
	Regression coefficient	Standard error	t value	P value
*P < 0.05 (n = 52).
Age	-0.010	0.012	-0.833	0.410
Sex	0.162	0.165	0.984	0.331
Grade assigned in this study	-0.040	0.046	-0.860	0.395
First factor	-0.048	0.036	-1.320	0.194
Second factor	-0.100	0.045	-2.228	0.032*
Third factor	-0.014	0.051	-0.274	0.786

Table 5. Multiple Regression Models of Serum Albumin

Regression coefficient

Standard error

t value

P value

*P < 0.05 (n = 52).

Age

-0.010

0.012

-0.833

0.410

Sex

0.162

0.165

0.984

0.331

Grade assigned in this study

-0.040

0.046

-0.860

0.395

First factor

-0.048

0.036

-1.320

0.194

Second factor

-0.100

0.045

-2.228

0.032*

Third factor

-0.014

0.051

-0.274

0.786