Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-28T22:35:58.227Z Has data issue: false hasContentIssue false

Oral candidiasis and nutritional deficiencies in elderly hospitalised patients

Published online by Cambridge University Press:  09 March 2007

Elena Paillaud
Affiliation:
Departement de Médecine Interne et Gériatrie, Hôpital Albert Chenevier, AP-HP, 40 rue Mesly, 94010 Creteil Cedex, France
Isabelle Merlier
Affiliation:
Departement de Médecine Interne et Gériatrie, Hôpital Albert Chenevier, AP-HP, 40 rue Mesly, 94010 Creteil Cedex, France
Catherine Dupeyron
Affiliation:
Laboratoire de Biologie, Hôpital Albert Chenevier, 40 rue Mesly, 94010, Creteil, Cedex, France
Elisabeth Scherman
Affiliation:
Laboratoire de Biologie, Hôpital Albert Chenevier, 40 rue Mesly, 94010, Creteil, Cedex, France
Joël Poupon
Affiliation:
Laboratoire de Biochimie-Toxicologie, Hôpital Fernand Widal, AP-HP, Paris, France
Phuong-Nhi Bories*
Affiliation:
Laboratoire de Biologie, Hôpital Albert Chenevier, 40 rue Mesly, 94010, Creteil, Cedex, France Laboratoire de Biochimie, Hôpital Hôtel-Dieu, AP-HP, Paris, France
*
*Corresponding author: Dr Phuong Nhi Bories, fax +33 1 49 81 31 19, email, phuong-nhi.bories@ach.ap-hop-paris.fr
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The prevalence of oral candidiasis and its association with malnutrition in terms of protein–energy malnutrition and mineral and vitamin depletion were evaluated in ninety-seven hospitalised older adults aged 82·1 (SD 8·6) years. Patients underwent a complete oral examination with microbiological investigation on admission to our geriatric rehabilitation unit. Patients were assessed nutritionally by evaluation of dietary intake and measurement of anthropometric variables, serum nutritional proteins, ferritin, Zn, folate, vitamins B12 and C. The prevalence of oral candidiasis was 37% (n 36); the proportion of patients with BMI <20 kg/m2 was 32% (n 31). The nutritional status of the population was studied by comparing two groups defined according to the absence (group I; n 61) or presence (group II; n 36) of oral candidiasis. The two groups did not differ on the basis of BMI and mid-arm circumference. However, group II had a smaller leg circumference, lower daily energy and protein intakes, lower albumin and transthyretin levels. Patients successfully treated with fluconazole increased their intake on day 30. The proportion of patients with hypozincaemia (<12·5 μmol/l) and vitamin C deficiency (<0·7 mg/l) was higher in group II. Treatment with antibiotics, poor oral hygiene, denture wearing, and vitamin C deficiency appeared as the most significant independent risk factors associated with oral candidiasis. The present findings show that oral candidiasis appears to be related to malnutrition and results in mucosal lesions that have a negative impact on energy intake, which may subsequently worsen nutritional status.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2004

References

Abbasi, AA & Rudman, D (1993) Observations on the prevalence of protein-calorie undernutrition in VA nursing homes. J Am Geriatr Soc 41, 117121.CrossRefGoogle ScholarPubMed
Appollonio, I, Carabellese, C, Frattola, A & Trabucchi, M (1997) Influence of dental status on dietary intake and survival in community-dwelling elderly subjects. Age Ageing 26, 445456.CrossRefGoogle ScholarPubMed
Baum, MK, Campa, A, Lai, S, Lai, H & Page, JB (2003) Zinc status in human immunodeficiency virus type 1 infection and illicit drug use. Clin Infect Dis 37, S117S123.CrossRefGoogle ScholarPubMed
Black, RE (2003) Zinc deficiency, infectious disease and mortality in the developing world. J Nutr 133, 1485S1489S.CrossRefGoogle ScholarPubMed
Blaum, CS, Fries, BE & Fiatarone, MA (1995) Factors associated with low body mass index and weight loss in nursing home residents. J Gerontol 50, M162M168.CrossRefGoogle ScholarPubMed
Brocker, P, Bourée, P, De Rekeneire, N, Maugourd, MF, Perillat, A & Moulias, R (2000) Prévalence des candidoses oropharyngées en gériatrie à propos d'une étude nationale multicentrique (A multicentre prevalence study of oropharyngeal candidiasis in geriatric patients) L'Année Gérontologique 2000 133 – 150 Paris Serdi Edition.Google Scholar
Challacombe, SJ (1986) Haematological abnormalities in oral lichen planus, candidiasis, leukoplakia and non-specific stomatitis. Int J Oral Maxillofac Surg 15, 7280.CrossRefGoogle ScholarPubMed
Challacombe, SJ (1994) Immunologic aspects of oral candidiasis. Oral Surg Oral Med Oral Pathol 78, 202210.CrossRefGoogle ScholarPubMed
Dewys, WD, Begg, C & Lavin, PT (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69, 491497.CrossRefGoogle ScholarPubMed
Ertekin, MV, Uslu, H, Karslioglu, I, Ozbek, E & Ozbek, A (2003) Effect of oral zinc supplementation on agents of oropharyngeal infection in patients receiving radiotherapy for head and neck cancer. J Int Med Res 31, 253266.CrossRefGoogle ScholarPubMed
Fain, O, Paries, J & Jacquart, B (2003) Hypovitaminosis C in hospitalized patients. Eur J Int Med 14, 419425.CrossRefGoogle ScholarPubMed
Fidel, PL (2002) Distinct protective host defenses against oral and vaginal candidiasis. J Med Mycol 40, 359375.CrossRefGoogle ScholarPubMed
Fletcher, J, Mather, J, Lewis, MJ & Whiting, G (1975) Mouth lesions in iron-deficient anemia: relationship to Candida albicans in saliva and to impairment of lymphocyte transformation. J Infect Dis 131, 4450.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SE & McHugh, PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12, 189198.CrossRefGoogle Scholar
Jenkins, WM, Macfarlane, TW, Ferguson, MM & Mason, DK (1977) Nutritional deficiency in oral candidosis. Int J Oral Surg 6, 204210.CrossRefGoogle ScholarPubMed
Lamy, M, Mojon, P, Kalykakis, G, Legrand, R, Butz-Jorgensen, E (1999) Oral status and nutrition in the institutionalized elderly. J Dent 27, 443448.CrossRefGoogle ScholarPubMed
Lesourd, B & Mazari, L (1999) Nutrition and immunity in the elderly. Proc Nutr Soc 58, 685695.CrossRefGoogle ScholarPubMed
Lode, H & Hoffken, G (1989) Oral candidosis and its role in immunocompromised patients. Mycoses 32, 3033.CrossRefGoogle ScholarPubMed
Long, CL, Maull, KI, Krishnan, RS, Laws, HL, Geiger, JW, Borghesi, L, Franks, W, Lawson, TC & Sauberlich, HE (2003) Ascorbic acid dynamics in the seriously ill and injured. J Surg Res 109, 144148.CrossRefGoogle ScholarPubMed
Marazzi, MC, Mancinelli, S, Palombi, L, Martinoli, L, D'Alessandro, de, Luca, E, Buonomo, E & Riccardi, F (1990) Vitamin C and nutritional status of institutionalized and noninstitutionalized elderly women in Rome. Int J Vitam Nutr Res 60, 351359.Google ScholarPubMed
Miller, RA (1996) The aging immune system: primer and prospectus. Science 273, 7074.CrossRefGoogle ScholarPubMed
Mocchegiani, E & Muzzioli, M (2000) Therapeutic application of zinc in human immunodeficiency virus against opportunistic infections. J Nutr 130, 1424S1431S.CrossRefGoogle ScholarPubMed
Mojon, P, Budtz-Jorgensen, E & Rapin, CH (1999) Relationship between oral health and nutrition in very old people. Age Ageing 28, 463468.CrossRefGoogle ScholarPubMed
Morley, JE & Kraenzle, D (1994) Causes of weight loss in a community nursing home. J Am Geriatr Soc 42, 583585.CrossRefGoogle Scholar
Palmqvist, S, Unell, L & Lindquist, B (1984) Denture stomatitis in nursing home patients. Swed Dent J 8, 7380.Google ScholarPubMed
Peterson, DE (1992) Oral candidiasis. Clin Geriatr Med 8, 513527.CrossRefGoogle ScholarPubMed
Rothan-Tondeur, M, Lancien, E, Pialleport, T, Meaume, S, Moulias, R, Marzais, M, Cambau, E & Le Blanche, AF (2001) Prevalence of oropharyngeal candidiasis in geriatric inpatients. J Am Geriatr Soc 49, 17411742.CrossRefGoogle ScholarPubMed
Roza, AM & Shizgal, HM (1984) The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass. Am J Clin Nutr 40, 168182.CrossRefGoogle ScholarPubMed
Rudman, D & Feller, AG (1989) Protein-calorie undernutrition in the nursing home. J Am Geriatr Soc 37, 173183.CrossRefGoogle ScholarPubMed
Samaranayake, LP (1986) Nutritional factors and oral candidosis. J Oral Pathol 15, 6165.CrossRefGoogle ScholarPubMed
Samaranayake, LP (1992) Oral mycoses in HIV infection. Oral Surg Oral Med Oral Pathol 73, 171180.CrossRefGoogle ScholarPubMed
Samaranayake, LP & MacFarlane, TW (1981) A retrospective study of patients with recurrent chronic atrophic candidosis. Oral Surg Oral Med Oral Pathol 52, 150153.CrossRefGoogle ScholarPubMed
Samaranayake, LP, Wilkieson, CA, Lamey, PJ & MacFarlane, TW (1995) Oral disease in the elderly in long-term hospital care. Oral Dis 1, 147151.CrossRefGoogle ScholarPubMed
Schorah, CJ, Newill, A, Scott, DL & Morgan, DB (1979) Clinical effects of vitamin C in elderly inpatients with low blood-vitamin-C levels. Lancet i 403405.CrossRefGoogle ScholarPubMed
Schou, L, Wight, C & Cumming, C (1987) Oral hygiene habits, denture plaque, presence of yeasts and stomatitis in institutionalised elderly in Lothian, Scotland. Community Dent Oral Epidemiol 15, 8589.CrossRefGoogle ScholarPubMed
Shay, K, Truhlar, MR & Renner, RP (1997) Oropharyngeal candidosis in the older patient. J Am Geriatr Soc 45, 863870.CrossRefGoogle ScholarPubMed
Sheiham, A (2001) Dietary effects on dental diseases. Public Health Nutr 4, 569591.CrossRefGoogle ScholarPubMed
Sheiham, A & Steele, J (2001) Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people?. Public Health Nutr 4, 797803.CrossRefGoogle ScholarPubMed
Wilkieson, C, Samaranayake, LP, MacFarlane, TW, Lamey, PJ & MacKenzie, D (1991) Oral candidosis in the elderly in long term hospital care. J Oral Pathol Med 20, 1316.CrossRefGoogle ScholarPubMed