Tea and toast syndrome

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Tea and toast syndrome is a form of malnutrition commonly experienced by elderly people who are unable to prepare meals and tend to themselves. The term is not intrinsic to tea or bread products only; rather, it describes limited dietary patterns which lead to reduced calories resulting in a deficiency of vitamins and other nutrients. This can contribute to a gradual loss of wellness and muscle due to poor protein intake. [1] In elderly individuals with a low GFR, the syndrome may manifest itself as hyponatremia, a low concentration of the electrolyte sodium in the bloodstream. This is attributed to drinking a large amount of water while consuming a diet poor in salt and protein. [2] Hyponatremia can lead to various neurological problems ranging from headaches and a decreased ability to think, to seizures and coma in the most severe cases. [3]

Contents

Signs and symptoms

Some signs and symptoms of malnutrition in older adults may include: unintended weight loss, tiredness and fatigue, muscle weakness or loss of strength, constipation, dizziness, syncope, gastritis, peptic ulcers, paleness of the skin, poor wound healing, depression, problems with memory, a weak immune system, and anemia. [4]

Causes

The syndrome often occurs once children have moved away, and a partner has died or is dying. An elderly person with nobody left to cook for, or without the skills to cook, will revert to a diet of simple foods such as bread, cheese and crackers, and canned foods. While the sodium content is variable in such foods, they are among the top contributors of sodium in the average American's diet. [5] However, if portion sizes are inadequate, a person may not be consuming enough protein and salt. When combined with excessive water intake, this results insufficient solute concentration. Patients with poor kidney function, or low glomerular filtration rate, are at even higher risk of hyponatremia due to increased water retention. [2] According to the New York Times, as many as 60% of seniors living at home are either malnourished or at risk of becoming malnourished. In addition to the problems lack of nutrients will cause, this state also means that the complications of other illnesses, even the common cold, can be much more severe. [6] [7]

Factors that lead to the syndrome include poverty, social isolation, psychological issues such as depression, loss of taste and smell, chronic illnesses that cause a lack of appetite, dental problems that result in difficulty chewing and swallowing foods, a decline in cognitive functioning, alcoholism, and physical disabilities and limitations. [4] [8] Though less of a factor than psychological issues, the increased number of medications often taken by elderly people can also affect eating habits. These medications may suppress appetite, make food taste different, or affect how nutrients are absorbed, making it even less likely seniors will get the required nutrients. 8% of seniors suffer from hyponatremia, although it is unclear how much of that is due to "tea and toast" diets. [8] The prevalence of hyponatremia in the elderly population may be even higher in health care settings. [2] The hyponatremia is believed to arise as a result of a diet poor in salt and protein with large water intake in combination with a low glomerular filtration rate (GFR). The low GFR causes a lowered rate of osmole excretion, and an increase in the amount of water reabsorbed; thus, the hyponatremia occurs when the amount of water intake exceeds the renal water excretion capacity. [2] Medications, such as thiazides and antidepressants, may exacerbate symptoms of hyponatremia. [2]

Diagnosis

Potential signs and symptoms of "tea and toast syndrome" can include those of malnutrition such as general weakness and cognitive impairment. [9] In general, hyponatremia is usually asymptomatic until severe. [10]

Typical laboratory findings for tea and toast syndrome include a low serum osmolality (hypotonicity) with a normal urine osmolality since antidiuretic hormone levels are normal. A common laboratory finding for the tea and toast phenomenon is manifestation as hyponatremia. This laboratory finding is not commonly symptomatic when paired with other abnormal electrolyte findings seen in the elderly such as hyperglycemia. [11] Other laboratory tests to identify the cause of hyponatremia as being due to low solute intake include identifying a patient's protein intake through measures of urine urea content and through a history of their regular dietary intake. [12] Upon determination of the cause of hyponatremia as being due to low dietary intake, effective treatment measures can be taken on an individual patient basis.

Prevention

Cara Myer, the author of "The Tea and Toast Syndrome: Psychosocial Aspects of Congregate Dining" suggests that congregate dining for older adults may be an excellent strategy to prevent tea and toast syndrome. Myer mentions that social service interventions for malnutrition, including congregate dining, are often under-utilitized and could provide a stimulating environment that may improve the quality of life of many older adults. [8]

Further, general preventative measures focus on evaluating the nutrition of older adults, including keeping record of weight patterns, helping with meal plans that focus on nutrient rich roods and using local services such as a meal delivery program. [13]

Additional strategies include: [4]

Treatment

Treatment of tea and toast syndrome is centered primarily around resolving hyponatremia. Treatment choice depends on the type of hyponatremia. [2]

Traditional treatment for hyponatremia depends on the volume load in the person. For those who are euvolemic (normal body volume load), fluid intake should be restricted. In those that are hypovolemic (low body volume load), give isotonic saline. In those that are hypervolemic (high body volume load), diuresis should be induced. [14] Elderly patients may present in any of these volume states. However, "tea and toast" syndrome patients typically present euvolemic hyponatremia since their hyponatremia is caused by low solute intake. It is critical that these patients receive proper nutrition that is higher in protein and electrolyte intake. [15]

The Health and Medicine Division of the National Academies of Science, Engineering, and Medicine recommends that older adults improve their diet by consuming more fish, low-fat dairy products, and whole grains (such as fortified breakfast cereals). Older adults can also improve their diet by snacking on nuts and legumes as well as ensuring that they include fruit and vegetables at the center of their diet. [16]

See also

Related Research Articles

A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures, such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted to smaller molecules in the process of releasing energy, such as for carbohydrates, lipids, proteins, and fermentation products, leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

<span class="mw-page-title-main">Dietary supplement</span> Product providing additional nutrients

A dietary supplement is a manufactured product intended to supplement a person's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources, or that are synthetic. The classes of nutrient compounds in supplements include vitamins, minerals, fiber, fatty acids, and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, and so are not nutrients per se, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients. The European Commission has also established harmonized rules to help insure that food supplements are safe and appropriately labeled.

Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symptoms can be absent, mild or severe. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Severe symptoms include confusion, seizures, and coma; death can ensue.

<span class="mw-page-title-main">Weight loss</span> Reduction of the total body mass

Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat, or lean mass. Weight loss can either occur unintentionally because of malnourishment or an underlying disease, or from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or increase in exercise is called cachexia and may be a symptom of a serious medical condition.

<span class="mw-page-title-main">Thirst</span> Craving for potable fluids experienced by animals

Thirst is the craving for potable fluids, resulting in the basic instinct of animals to drink. It is an essential mechanism involved in fluid balance. It arises from a lack of fluids or an increase in the concentration of certain osmolites, such as sodium. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, structures in the brain detect changes in blood constituents and signal thirst.

<span class="mw-page-title-main">Electrolyte imbalance</span> Medical condition

Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, potassium, and sodium.

Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135–145 mmol/L. Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms typically only occur when levels are above 160 mmol/L.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH), also known as the syndrome of inappropriate antidiuresis (SIAD), is characterized by a physiologically inappropriate release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH causes a physiologically inappropriate increase in solute-free water being reabsorbed by the tubules of the kidney to the venous circulation leading to hypotonic hyponatremia.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Empty calories</span> Calories with no nutritional value

In human nutrition, empty calories are those calories found in beverages and foods composed primarily or solely of sugars and/or certain fats and oils such as cholesterol, saturated or trans fats, that provide little to no useful nutrients such as protein, fibre, vitamins, minerals, essential fatty acids, or antioxidants. Foods composed mostly of empty calories have low nutrient density, meaning few nutrients relative to their energy content. The consumption of large amounts of empty calories can have negative health consequences.

<span class="mw-page-title-main">Protein–energy malnutrition</span> Medical condition

Protein–energy undernutrition (PEU), once called protein-energy malnutrition (PEM), is a form of malnutrition that is defined as a range of conditions arising from coincident lack of dietary protein and/or energy (calories) in varying proportions. The condition has mild, moderate, and severe degrees.

Specific appetite, also known as specific hunger, is a drive to eat foods with specific flavors or other characteristics.

Canadian health claims by Health Canada, the department of the Government of Canada responsible for national health, has allowed five scientifically verified disease risk reduction claims to be used on food labels and on food advertising. Other countries, including the United States and Great Britain, have approved similar health claims on food labels.

Fibre supplements are considered to be a form of a subgroup of functional dietary fibre, and in the United States are defined by the Institute of Medicine (IOM). According to the IOM, functional fibre "consists of isolated, non-digestible carbohydrates that have beneficial physiological effects in humans".

<span class="mw-page-title-main">Weight management</span> Techniques for maintaining body weight

Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify ideal body weights for different individuals.

FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are short-chain carbohydrates that are poorly absorbed in the small intestine and ferment in the colon. They include short-chain oligosaccharide polymers of fructose (fructans) and galactooligosaccharides, disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol, and maltitol. Most FODMAPs are naturally present in food and the human diet, but the polyols may be added artificially in commercially prepared foods and beverages.

<span class="mw-page-title-main">Potomania</span> Medical condition

Potomania is a specific hypo-osmolality syndrome related to massive consumption of beer, which is poor in solutes and electrolytes. With little food or other sources of electrolytes, consumption of large amounts of beer or other dilute alcoholic drinks leads to electrolyte disturbances, where the body does not have enough nutrients known as electrolytes, namely sodium, potassium, and magnesium. The symptoms of potomania are similar to other causes of hyponatremia and include dizziness, muscular weakness, neurological impairment and seizures, all related to hyponatremia and hypokalaemia. While the symptoms of potomania are similar to other causes of hyponatremia and acute water intoxication, it should be considered an independent clinical entity because of its often chronic nature of onset, pathophysiology, and presentation of symptoms.

<span class="mw-page-title-main">Health effects of salt</span> Conditions associated with the consumption of either too much or too little salt

The health effects of salt are the conditions associated with the consumption of either too much or too little salt. Salt is a mineral composed primarily of sodium chloride (NaCl) and is used in food for both preservation and flavor. Sodium ions are needed in small quantities by most living things, as are chloride ions. Salt is involved in regulating the water content of the body. The sodium ion itself is used for electrical signaling in the nervous system.

Research into food preferences in older adults and seniors considers how people's dietary experiences change with ageing, and helps people understand how taste, nutrition, and food choices can change throughout one's lifetime; particularly when people approach the age of 70, or beyond. Influencing variables can include: social and cultural environment, gender and/or personal habits, and also physical and mental health. Scientific studies have been performed to explain why people like or dislike certain foods and what factors may affect these preferences.

A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium. Calories may also be supplemented if the individual is losing weight undesirably.

References

  1. ↑ "Senior Citizens Suffer From 'Tea and Toast Syndrome'". prnewswire.com. 28 February 2011. Archived from the original on 28 September 2015. Retrieved 28 September 2015.
  2. 1 2 3 4 5 6 Filippatos, Theodosios D; Makri, Andromachi; Elisaf, Moses S; Liamis, George (November 2017). "Hyponatremia in the elderly: challenges and solutions". Clinical Interventions in Aging. 12: 1957–1965. doi: 10.2147/CIA.S138535 . PMC   5694198 . PMID   29180859.
  3. ↑ Babar, Sultan M. (October 2013). "SIADH associated with ciprofloxacin". The Annals of Pharmacotherapy. 47 (10): 1359–1363. doi:10.1177/1060028013502457. ISSN   1542-6270. PMID   24259701. S2CID   36759747. Archived from the original on 2021-08-10. Retrieved 2021-10-27.
  4. 1 2 3 "How to prevent the 'tea and toast syndrome' – and reduce the risk of malnutrition in seniors". Bayshore HealthCare. 12 November 2018. Archived from the original on 2021-09-13. Retrieved 2021-09-13.
  5. ↑ "Simple swaps to eat less salt - Learn the most common sources of sodium in your diet and some easy substitutions you can make". Harvard Health Publishing. 2018-08-01. Retrieved 2022-11-22.
  6. ↑ Nagourney, Eric (April 12, 2005). "HEALTH; Tea and Toast and a Danger That Can Be Hard to Spot". The New York Times . Archived from the original on February 18, 2019. Retrieved January 30, 2018.
  7. ↑ Anderson, Olwen (25 December 2010). "Avoiding the 'tea & toast' syndrome as you age". Archived from the original on 30 August 2019. Retrieved 28 September 2015.
  8. 1 2 3 Myer, Cara (2003). "The Tea and Toast Syndrome: Psychosocial Aspects of Congregate Dining". Generations. 28 (3).
  9. ↑ Corcoran, Clodagh; Murphy, Craig; Culligan, Eamonn P; Walton, Janette; Sleator, Roy D (2019-06-01). "Malnutrition in the elderly". Science Progress. 102 (2): 171–180. doi: 10.1177/0036850419854290 . ISSN   0036-8504. PMC   10424533 . PMID   31829839.
  10. ↑ Kugler, John P.; Hustead, Thomas R. (2000-06-15). "Hyponatremia and Hypernatremia in the Elderly". American Family Physician. 61 (12): 3623–3630. ISSN   0002-838X. PMID   10892634. Archived from the original on 2021-09-13. Retrieved 2021-09-13.
  11. ↑ Liamis, George; Elisaf, Moses S.; Makri, Andromachi; Filippatos, Theodosios D. (2017-11-14). "Hyponatremia in the elderly: challenges and solutions". Clinical Interventions in Aging. 12: 1957–1965. doi: 10.2147/CIA.S138535 . PMC   5694198 . PMID   29180859.
  12. ↑ Yu, Alan S. L.; Jain, Nishank; Budhiraja, Pooja; McGreal, Kerri (2016). "Current Challenges in the Evaluation and Management of Hyponatremia". Kidney Diseases. 2 (2): 56–63. doi:10.1159/000446267. ISSN   2296-9381. PMC   4947691 . PMID   27536693.
  13. ↑ "Senior health: How to prevent and detect malnutrition". Mayo Clinic. Archived from the original on 2021-09-13. Retrieved 2021-09-13.
  14. ↑ Braun, Michael M.; Barstow, Craig H.; Pyzocha, Natasha J. (2015-03-01). "Diagnosis and management of sodium disorders: hyponatremia and hypernatremia". American Family Physician. 91 (5): 299–307. ISSN   1532-0650. PMID   25822386.
  15. ↑ Verbalis, Joseph G.; Goldsmith, Steven R.; Greenberg, Arthur; Korzelius, Cynthia; Schrier, Robert W.; Sterns, Richard H.; Thompson, Christopher J. (October 2013). "Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations". The American Journal of Medicine. 126 (10): S1–S42. doi:10.1016/j.amjmed.2013.07.006. PMID   24074529.
  16. ↑ Food and Nutrition Board; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine. (13 July 2016). Meeting the dietary needs of older adults : exploring the impact of the physical, social, and cultural environment : workshop summary. Washington (DC): National Academies Press (US). ISBN   978-0-309-44227-5.{{cite book}}: CS1 maint: multiple names: authors list (link)
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