Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Malnutrition Frequency and its Relationship with the Disease Severity in Geriatric Psoriasis Patients: A Cross Sectional Study
Psöriyazis Hastalarında Geriatrik Yaş Grubunda Malnütrisyon Sıklığı ve Hastalık Şiddeti ile İlişkisi: Kesitsel Bir Çalışma
Didem AYTİMURa , Selahattin Fehmi AKÇİÇEKb , İlgen ERTAM SAĞDUYUc , Zeliha Fulden SARAÇb
aDepartment of Public Health, Ege University Faculty of Medicine, İzmir, Türkiye
bDivision of Geriatrics, Ege University Health Application and Research Center, İzmir, Türkiye
cDepartment of Dermatology, Ege University Health Application and Research Center, İzmir, Türkiye
Turkiye Klinikleri J Dermatol. 2024;34(1):8-15
doi: 10.5336/dermato.2023-99854
Article Language: EN
Full Text
ABSTRACT
 Objective: Whether psoriasis increases the frequency of malnutrition in the geriatric age group and whether malnutrition's frequency or severity and disease severity is related, remains unclear. This study aims to determine the frequency of malnutrition in geriatric psoriasis patients and identify associated factors. Material and Methods: Thirty two patients aged sixty and above treated at Psoriasis Clinic of Ege University Hospital between July 2019 and May 2021 were included in the study, administered survey forms, mini nutritional assessment (MNA), and Psoriasis Area Severity Index (PASI) were reported. MNA score of 24 and above indicate no malnutrition risk, 17-23.5 points suggest risk of malnutrition, and below 17 points indicate malnutrition. PASI score 10 and above categorize the disease as moderate-severe. SPSS 21.0 software was used. Chi-square test, Fisher's exact test for correlation analysis, multivariate logistic regression analysis were used to determine factors associated with malnutrition risk. Results: The average age of thirty-two psoriasis patients is 67.4 and 84.4% are male. Among the patients, analysis showed no statistically significant relationship between sociodemographic factors and MNA score, clinical findings and MNA score, or PASI values. According to PASI values, 15.6% of patients had a PASI of 10 or higher, 4 at risk of malnutrition had PASI below 10. Twenty three patients in normal MNA group had PASI below 10. Only normal patients and patients who were at risk of malnutrition were detected. Regression analysis showed that risk of malnutrition was 52.51 times higher in alcohol users (odds ratio: 52.5) (confidence interval=2.514-1096.76, p=0.011). Conclusion: No malnutrition cases were detected. As risk of malnutrition is found to be higher among alcohol users of geriatric psoriasis patients, further evaluation of its association with malnutrition will increase awareness for elder health.

Keywords: Elderly; psoriasis; malnutrition; disease severity
ÖZET
 Amaç: Bu çalışmada, psöriyazisin geriatrik yaş grubunda malnütrisyon sıklığını artırıp artırmadığı ve hastalık şiddetiyle malnütrisyonun sıklığının ya da şiddetinin artırıp artırmadığı henüz aydınlatılmadığından; geriatrik psöriyazis hastalarında malnütrisyon sıklığının belirlenmesi, ilişkili faktörlerin tespit edilmesi amaçlanmıştır. Gereç ve Yöntemler: Ege Üniversitesi Hastanesi Psöriyazis Polikliniğinde Temmuz 2019-Mayıs 2021 tarihlerinde izlenen 60 yaş ve üstü 32 hasta dâhil edilmiş olup hastalar anket formu, mini nütrisyonel değerlendirme [mini nutritional assessment (MNA)] testi, Psöriyazis Alan Şiddet İndeksi (PAŞİ) ile değerlendirilmiştir. Malnütrisyon açısından MNA puanı 24 ve üzeriyse risk bulunmamaktadır. 17-23,5 puan riski olduğunu; 17 puan altı ise malnütrisyonu olduğunu gösterir. PAŞİ'den 10 ve üzeri puan alınması hastalığın orta-şiddetli olduğunu göstermektedir. SPSS 21.0 istatistik programı kullanılmıştır. Malnütrisyon riski ile ilişkili faktörleri belirlemek için öncelikle ki-kare testi, Fisher exact test ve korelasyon, çok değişkenli karşılaştırmada lojistik regresyon analizi kullanılmıştır. Bulgular: Otuz iki psöriyazis hastasının yaş ortalaması 67,4 olup, %84,4'ü erkektir. Malnütrisyonla, sosyodemografik ve klinik faktörleri arasındaki ilişkiyi değerlendirmek için yapılan korelasyon analizine göre sosyodemografik faktörler, klinik bulgular ile MNA skoru ve PAŞİ değerleri arasında istatistiksel açıdan ilişki anlamlı değildir. Hastaların %15,6'sının PAŞİ değeri 10 ve üstüdür. Malnütrisyon yönünden risk altında olan 4 hasta, MNA'ya göre normal grupta olan hastaların 23'ü, 10 altında PAŞİ değerine sahiptir. Yalnızca normal ve risk altında hasta saptanmıştır. Regresyon analizine göre geriatrik psöriyazis hastalarında malnütrisyon durumuna etki edebilecek faktörler değerlendirildiğinde; alkol kullananlarda malnütrisyon riski 52,51 kat daha yüksek bulunmuştur (göreceli olasılıklar oranı: 52,5) (güven aralığı=2,514-1096,76, p=0,011). Sonuç: Çalışmamızda, malnütrisyonlu hasta bulunamamıştır. Alkol kullananlarda kullanmayanlara göre malnütrisyon riski oldukça yüksek bulunduğundan; alkol tüketiminin sorgulanması ve malnütrisyonla ilişkisinin daha ayrıntılı değerlendirilmesi ve hastaların bu konudaki farkındalığının artırılması yaşlı sağlığı açısından önem taşıyacaktır.

Anahtar Kelimeler: Yaşlı; psöriyazis; malnütrisyon; hastalığın şiddeti
REFERENCES:
  1. Koç E. Türkiye Psoriasis Tedavi Kılavuzu-2016. İstanbul: Galenos Yayınevi; 2016. [Link] 
  2. Alper S, Atakan N, Gurer MA, Onsun N, Ozarmagan G. Güncellenmiş Türkiye psoriasis biyolojik ajan kullanım kılavuzu [Updated Turkish guidelines for the management of psoriasis with biologic agents]. Turkderm. 2010;44:105-12. [Crossref] 
  3. Pathirana D, Nast A, Ormerod AD, Reytan N, Saiag P, Smith CH, et al. On the development of the European S3 guidelines on the systemic treatment of psoriasis vulgaris: structure and challenges. J Eur Acad Dermatol Venereol. 2010;24(12):1458-67. [Crossref]  [PubMed] 
  4. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377-85. [Crossref]  [PubMed] 
  5. Barker JN. Genetic aspects of psoriasis. Clin Exp Dermatol. 2001;26(4):321-5. [Crossref]  [PubMed] 
  6. Çelik Tığlı R. Psoriasisli Hastalarda Metabolik Sendrom Sıklığı [Uzmanlık tezi]. İstanbul: T.C. Sağlık Bakanlığı Haseki Eğitim ve Araştırma Hastanesi; 2009. Erişim tarihi: 04.10.2023 [Link] 
  7. Gündoğdu H. Malnütrisyon [Malnutrition]. İç Hastalıkları Dergisi. 2010;17:189-202. [Link] 
  8. Bozoğlu E, Öztürk A. Malnütrisyonun tanımı, sıklığı ve etiyolojik faktörler [Definition, prevalence and etiological factors of malnutrition]. Turkiye Klinikleri Journal of Geriatrics-Special Topics. 2016;2(1):7-15. [Link] 
  9. Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, et al; Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734-8. [Crossref]  [PubMed] 
  10. Çavuşoğlu Ç, Demirkol ME. Yaşlılarda bağımlılık [Dependence in the elderly]. Journal of Dependence. 2018;19(3):59-69. [Link] 
  11. Royal College of Psychiatrists. Our Invisible Addicts. 2nd ed. London: The Royal College of Psychiatrists; 2018. [Link] 
  12. Sarıkaya D. Geriatrik hastalarda mini nütrisyonel değerlendirme (MNA) testinin uzun ve kısa (MNA-SF) formunun geçerlilik çalışması [Uzmanlık tezi]. Ankara: Hacettepe Üniversitesi; 2013. Erişim tarihi: 04.10.2023 Erişim linki: [Link] 
  13. Bilaç C, Şahin MT, Öztürkcan S: Dermatolojide hastalık şiddeti skorlama sistemleri [Disease severity scoring systems in dermatology]. Turkderm-Arch Turk Dermatol Venerology. 2016;50:42-53 [Crossref] 
  14. Yildizhan IK, Sürgün E. Epidemiological and clinical characteristics, treatments, and comorbidities in elderly patients with psoriasis and the evaluation of patients according to the age of onset. Turkish Journal of Geriatrics. 2020;23(2):216-23. [Crossref] 
  15. van Winden MEC, ter Haar ELM, Groenewoud HMM, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Disease and treatment characteristics in geriatric psoriasis: a patient survey comparing age groups. Acta Derm Venereol. 2020;100(14):adv00215. [Crossref]  [PubMed]  [PMC] 
  16. Tseng IL, Yang CC, Lai EC, Lee CN. Psoriasis in the geriatric population: A retrospective study in Asians. J Dermatol. 2021;48(6):818-24. [Crossref]  [PubMed] 
  17. Chen K, Wang G, Jin H, Xu J, Zhu X, Zheng M, et al. Clinic characteristics of psoriasis in China: a nationwide survey in over 12000 patients. Oncotarget. 2017;8(28):46381-9. [Crossref]  [PubMed]  [PMC] 
  18. Gottlieb AB, Langley RG, Strober BE, Papp KA, Klekotka P, Creamer K, et al. A randomized, double-blind, placebo-controlled study to evaluate the addition of methotrexate to etanercept in patients with moderate to severe plaque psoriasis. Br J Dermatol. 2012;167(3):649-57. [Crossref]  [PubMed]  [PMC] 
  19. Alakbarov H. Psoriasis hastalarında yaşa bağlı klinik ve epidemiyolojik özelliklerin karşılaştırmalı değerlendirilmesi [Uzmanlık tezi]. İzmir: Ege Üniversitesi; 2017. Erişim tarihi: 04.10.2023 [Link] 
  20. Aykol C, Mevlitoglu I, Özdemir M, Ünal M. Konya yöresindeki psoriasis hastalarının klinik ve sosyodemografik özelliklerinin değerlendirilmesi [Evalution of clinical and sociodemograpic features of patients with psoriasis in the Konya region]. Turk Dermatoloji Dergisi. 2011;5(3):71-4. [Crossref] 
  21. Kundakci N, Türsen U, Babiker MO, Gürgey E. The evaluation of the sociodemographic and clinical features of Turkish psoriasis patients. Int J Dermatol. 2002;41(4):220-4. [Crossref]  [PubMed] 
  22. Polo TCF, Corrente JE, Miot LDB, Papini SJ, Miot HA. Dietary patterns of patients with psoriasis at a public healthcare institution in Brazil. An Bras Dermatol. 2020;95(4):452-8. [Crossref]  [PubMed]  [PMC] 
  23. De La Montana J, Miguez M. Suitability of the short-form Mini Nutritional Assessment in free-living elderly people in the northwest of Spain. J Nutr Health Aging. 2011;15(3):187-91. [Crossref]  [PubMed] 
  24. Krzymińska-Siemaszko R, Mossakowska M, Skalska A, Klich-Rączka A, Tobis S, Szybalska A, et al. Social and economic correlates of malnutrition in Polish elderly population: the results of PolSenior study. J Nutr Health Aging. 2015;19(4):397-402. [Crossref]  [PubMed] 
  25. Cuervo M, García A, Ansorena D, Sánchez-Villegas A, Martínez-González M, Astiasarán I, et al. Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test. Public Health Nutr. 2009;12(1):82-90. Erratum in: Public Health Nutr. 2009;12(1):136. [Crossref]  [PubMed] 
  26. Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr. 2010;29(4):507-11. [Crossref]  [PubMed] 
  27. Tüzün S, Hacıağaoğlu N, Dabak MR. Malnutrition in home care patients. TJFMPC. 2019;13(2):159-66. [Crossref] 
  28. Bayrak F, Ersoy S, Pala E. Ümraniye Durmuş Tanış Aile Sağlığı Merkezine başvuran 65 yaş üzeri hastalarda malnütrisyon sıklığı ve ilişkili durumlar [Prevalence of malnutrition and related conditions in patients over 65 years of age admitted to Ümraniye Durmuş Tanis Family Health Center]. Abant Tıp Dergisi. 2021;10(1):93-103. [Crossref] 
  29. Eken K, Uyar M. Yaşlı bireylerde malnütrisyon/malnütrisyon riski sıklığı ve etkileyen faktörler [Prevalence of malnutrition/malnutrition risk and relevant factors among older adults]. ESTÜDAM Halk Sağlığı Dergisi. 2021;6(3):200-8. [Crossref] 
  30. Johansson L, Sidenvall B, Malmberg B, Christensson L. Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home. J Nutr Health Aging. 2009;13(10):855-61. [Crossref]  [PubMed] 
  31. Nykänen I, Lönnroos E, Kautiainen H, Sulkava R, Hartikainen S. Nutritional screening in a population-based cohort of community-dwelling older people. Eur J Public Health. 2013;23(3):405-9. [Crossref]  [PubMed] 
  32. Ijaz S, Jackson J, Thorley H, Porter K, Fleming C, Richards A, et al. Nutritional deficiencies in homeless persons with problematic drinking: a systematic review. Int J Equity Health. 2017;16(1):71. [Crossref]  [PubMed]  [PMC] 
  33. Fares D, Barbosa AR, Borgatto AF, Coqueiro Rda S, Fernandes MH. Factors associated with nutritional status of the elderly in two regions of Brazil. Rev Assoc Med Bras (1992). 2012;58(4):434-41. English, Portuguese. [Crossref]  [PubMed] 
  34. Tian HY, Qiu R, Jing LP, Chen ZY, Chen GD, Chen YM. Alternate Mediterranean diet score is positively associated with skeletal muscle mass index in middle-aged adults. Br J Nutr. 2017;117(8):1181-8. [Crossref]  [PubMed] 
  35. Mathew AC, Das D, Sampath S, Vijayakumar M, Ramakrishnan N, Ravishankar SL. Prevalence and correlates of malnutrition among elderly in an urban area in Coimbatore. Indian J Public Health. 2016;60(2):112-7. [Crossref]  [PubMed] 

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-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

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