Nutrition includes the theory of energy metabolism and nutrients, and their function in the body. The Dieticians' Working Group is part of the Division of Clinical Geriatrics and is also a separate clinic at the Karolinska University Hospital. Nutrition is regarded as a part of medical treatment, in which the dieticians specialist knowledge of food and nutrients forms the cornerstone in the treatment of diseases such as cardiovascular conditions, diabetes, cancer, renal diseases and COPD.
Ongoing research projects
Nutrition and dementia - OmegAD-study group
Member of the "OmegAD study-group" (omega-3 fatty acids to patients with AD) with focus on diet and nutrition related effects. A daily supplement of omega-3 fatty acids (n-3 FA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) during 6 months did not slow down the disease progression in people with mild to moderate Alzheimer's disease (AD) except in a subgroup of patients with very mild AD (MMT> 27p). Supplementation with n-3 FA resulted in improved appetite and weight gain in the intervention group and also in the control group when they received treatment with n-3 FA after 6 months. The treatment resulted in increased plasma levels of transthyretin (TTR), which is interesting because TTR possibly influence the deposition of beta-amyloid in the brain, a pathological finding of AD. Focus group interviews with relatives to the patients in the study showed how the food situation was affected and how some of the relatives had to find a new role as "food provider".
Multimodal preventive trials for Alzheimer´s disease (AD MIND-MINI)
Several studies show that lifestyle-related vascular and metabolic risk factors (ie hypertension, diabetes, smoking, obesity, inactive lifestyle) increase the risk of dementia /AD. The purpose of the MIND-AD project is to implement a lifestyle intervention containing physical exercise, education about nutrition and diet counseling, cognitive training as well as careful management of vascular and metabolic risk factors. In the first instance, a pilot study with Germany, France, Finland and Sweden will be performed. Responsible for the project: Miia Kivipelto. My role in the project is to plan and work with the nutrition intervention.
Impact of nutritional status and diet on cognitive decline and survival
A PhD project at ARC (Aging Research Center (ARC). Supervising Behnaz Shakersain who will defend her thesis in November 2016. Her research aims are to investigate nutritional status and nutrition in older persons living at Kungsholmen and to study the association between dietary patterns and the onset of dementia.
OPEN-study (Older Person´s Exercise and Nutrition Study-OPEN
The aim of this study is to examine the effects of a daily exercise combined with an oral protein-rich nutritional supplement on functional and nutritional status, health-related quality of life and in older persons living in nursing homes. Our hypothesis is that a simple exercise i.e. "sit-to-stand" performed several times daily in combination with a protein-rich supplement will improve physical function and increase independence in daily activities and increase health-related quality of life in elderly people. Study start is planned to October 2016. Researchers from several of NVS’s divisions (nursing, physiotherapy, occupational therapy, clinical geriatrics, neurodegeneration) are engaged in the study.
In Sweden about 19,000 hip fractures occur yearly. It has been shown that a sparse trabeculation can be associated to a higher prevalence of low energy fractures. Low energy fractures are a clinical parameter associated with frailty in elderly and can be a sign of hidden illness. To perform a risk assessment for frailty in addition to the regular dental protocol is beneficial and enables early treatment and preventive perspective in the primary care units. The study aim is to clarify the correlation between different risk factors and event of fractures. The project also suggests a new strategy for collaboration of between several professions keeping the patient in focus. Individuals assessed as being at risk for malnutrition will be given individual consulting. Those who are physically inactive or have high risk of frailty fractures are given advice for physical activity. The frailty group is a multiprofessional group, including academic primary care units (PCU), primary rehabilitation units (PVR), Karolinska institutet (KI) and Folktandvården Stockholms län AB (FTV). Project not started yet.
Objective and subjective chewing ability
Co-supervisor of a PhD project (dentist Per Stjernfeldt-Elgestad registered 2015-09-15), ACT. The importance of masticatory ability increases with increasing age. Understanding which factors affect an older individual’s masticatory function is a complicated process. The aim of this project is to understand which factors that affect an older individual’s objective and subjective masticatory ability and how they can be measured. The following issues are addressed: 1) To identify valid and reliable instruments for assessing objective masticatory ability. 2) To explore older individuals’ experience of their masticatory ability and factors related to this ability. 3) To examine relationships between objective and subjective assessments on masticatory ability and oral status including prosthetic therapy. 4) To examine relationships between objective and subjective assessments on masticatory ability, texture modification food and nutritional status.
Supervisor to Karin Windahl, RD dietician at Danderyd Hospital (registered 2015-10-27). A PhD project where the EQUAL study will be included. EQUAL is a prospective multicenter study (Germany, Netherlands, England, Italy, Poland and Sweden) studying how symptoms of uremia correlate with different measures of renal function and to examine the best time for starting dialysis in patients> 65 years (Chronic Kidney Disease) CKD and eGFR ≤20 mL / min /1.73 not started dialysis.
Together with researchers from Sahlgrenska University, Baxter Novum created the SWEBIS group. The main aims are: to develop and implement procedures for measurements of body composition in patients with chronic renal failure and to critically evaluate existing methods and research in the field. The group has conducted two training programs for health professionals in the renal clinics (2014, 2016) and has regularly meetings once a year.
Co-author of the ESPEN guidelines for nutrition in Dementia (november 2015), (European Society for Clinical Nutrition and Metabolism).
- ”Alzheimers sjukdom”, 2013. Editor: Agneta Nordberg
- "Stroke. Patienters, närståendes och vårdares perspektiv", 2012. Editor: Ann-Cathrin Jönsson
- ”Geriatrisk nutrition” 2010
- "Kost och Hälsa med inriktning mot primärvård", 2014. Editors: Tommy Cederholm, Elisabet Rothenberg