Minerals and Sarcopenia; The Role of Calcium, Iron, Magnesium, Phosphorus, Potassium, Selenium, Sodium, and Zinc on Muscle Mass, Muscle Strength, and Physical Performance in Older Adults: A Systematic Review

Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes

Magnesium (Mg²⁺) deficiency is probably the most underestimated electrolyte imbalance in Western countries. It is frequent in obese patients, subjects with type-2 diabetes and metabolic syndrome, both in adulthood and in childhood. This narrative review aims to offer insights into the pathophysiological mechanisms linking Mg²⁺ deficiency with obesity and the risk of developing metabolic syndrome and type 2 diabetes. Literature highlights critical issues about the treatment of Mg²⁺ deficiency, such as the lack of a clear definition of Mg²⁺ nutritional status, the use of different Mg²⁺ salts and dosage and the different duration of the Mg²⁺ supplementation. Despite the lack of agreement, an appropriate dietary pattern, including the right intake of Mg²⁺, improves metabolic syndrome by reducing blood pressure, hyperglycemia, and hypertriglyceridemia. This occurs through the modulation of gene expression and proteomic profile as well as through a positive influence on the composition of the intestinal microbiota and the metabolism of vitamins B1 and D.

Association of nutrient-derived dietary patterns with sarcopenia and its components in community-dwelling older Japanese: a cross-sectional study

Background

Diet is a modifiable factor affecting sarcopenia, and accumulating evidence links dietary factors to muscle mass, strength, and function in older adults. However, few studies have examined the association of dietary patterns with sarcopenia. This study examined the association of dietary patterns derived by reduced-rank regression (RRR) with sarcopenia and its components in community-dwelling older Japanese.

Methods

We conducted a cross-sectional study of 1606 community-dwelling adults aged 65 years or older. Dietary intake was assessed by a validated, self-administered diet history questionnaire. Nutrient-derived dietary patterns were identified by using RRR, with sarcopenia-related nutrients (protein, vitamin D, vitamin C, vitamin E, folate, vitamin K, magnesium, iron, and calcium intakes) as response variables. Sarcopenia was defined by using the algorithm of the Asian Working Group for Sarcopenia 2019. Multivariate regression and logistic regression were used to examine the association of dietary patterns with sarcopenia and its components.

Results

The first RRR dietary pattern was characterized by high intakes of fish, soybean products, potatoes, most vegetables, mushrooms, seaweeds, and fruit and a low intake of rice and was associated with decreased prevalence of sarcopenia: the multivariable-adjusted odds ratio of sarcopenia was 0.57 (95% confidence interval, 0.34–0.94; p for trend=0.022) in the highest versus the lowest tertile of dietary pattern. This dietary pattern was also significantly positively associated with usual gait speed (β: 0.02, p=0.024).

Conclusions

A dietary pattern characterized by high intakes of fish, soybean products, potatoes, most vegetables, mushrooms, seaweeds, and fruits and low rice intake was inversely associated with sarcopenia in community-dwelling older Japanese.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00665-w.

Interactions between gut microbiota and skeletal muscle

The gut microbiota is now recognized as a major contributor to the host’s nutrition, metabolism, immunity, and neurological functions. Imbalanced microbiota (ie, dysbiosis) is linked to undernutrition-induced stunting, inflammatory and metabolic diseases, and cancers. Skeletal muscle also takes part in the interorgan crosstalk regulating substrate metabolism, immunity, and health. Here, we review the reciprocal influence of gut microbiota and skeletal muscle in relation to juvenile growth, performance, aging, and chronic diseases. Several routes involving the vascular system and organs such as the liver and adipose tissue connect the gut microbiota and skeletal muscle, with effects on fitness and health. Therapeutic perspectives arise from the health benefits observed with changes in gut microbiota and muscle activity, further encouraging multimodal therapeutic strategies.

Effects of Nutrient Intake on Diagnostic Measures of Sarcopenia among Arab Men: A Cross-Sectional Study

Sarcopenia is a major public health condition and is, therefore, of great clinical interest. However, the role of nutrient intake in sarcopenia is unclear. We examined the associations between nutrient intake and diagnostic measures of sarcopenia, including low muscle mass (appendicular lean mass (ALM) divided by height squared, ALM/h²) and strength (hand-grip strength, HGS) among Arab men. This cross-sectional study included 441 men aged 46.8 ± 15.98 years. Habitual nutrient intake was assessed using a food frequency questionnaire (FFQ). Participants were classified according to different ALM/h² and HGS reference values. Participants with normal muscle mass, defined by an ALM/h² cutoff of <8.68 kg/m² (−1 standard deviation (SD) <reference values Arab men), had greater daily energy, protein and fat intake, and percentage of energy from protein and fat (p < 0.01). Conversely, normal muscle mass was associated with a lower percentage of energy from carbohydrates (CHO) (p < 0.001). Regarding muscle strength, participants with HGS above 42 kg (median HGS of Arab men) had higher daily energy and protein and fat intake, but a lower percentage of energy from CHO and a lower intake of total omega-3 fatty acids (p < 0.05). Individuals with normal muscle mass and high HGS have greater daily energy, protein, and fat intake and a lower percentage of energy from CHO compared to sarcopenic individuals.

Selenium accumulation, speciation, and its effect on nutritive value of Flammulina velutipes (Golden needle mushroom)

Flammulina velutipes is one of the most popular edible mushrooms worldwide. A selenium-biofortification method for its fruiting body was developed using selenite. This study investigated the selenium content, distribution, speciation and the effect of selenium on mushroom growth, nutritive value, and mineral accumulation. Results showed that F. velutipes accumulated nearly 108 μg/g of organic selenium under treatment with 20 μg/g selenite, which accounts for over 97% of total selenium. Most (60-74%) of selenium combined with the protein fraction, whereas 15-21% combined with the polysaccharide fraction. Selenomethionine (56.8%), selenocysteine (22.8%), and methylselenocysteine (17.3%) were the main organic selenium compounds in the fruiting body. Selenium biofortification increased the biomass yield of fruiting body and elevated the content of polysaccharides, proteins, total amino acids, essential amino acids, and several minerals, including iron, calcium, and copper. F. velutipes might become a suitable selenium supplement.

Mechanical ventilation restores blood gas homeostasis and diaphragm muscle strength in ketamine/medetomidine-anaesthetized rats

NEW FINDINGS

What is the central question of the study? Does respiratory support ensure blood gas homeostasis and the relevance of experimental outcomes? What is the main finding and its importance? Spontaneous breathing during surgical intervention under anaesthesia results in impaired gas exchange and loss of diaphragm muscle strength in rats. Subsequent short-term mechanical ventilation restored blood gas homeostasis and diaphragm muscle strength. Blood gas homeostasis interferes substantially with experimental conditions and may alter study results. Monitoring and maintenance of blood gas balance is required to ensure quality and relevance of physiological animal experiments.

ABSTRACT

In pre-clinical small animal studies with surgical interventions under general anaesthesia, animals are often left to breathe spontaneously. However, anaesthesia may impair respiratory functions and result in disturbed blood gas homeostasis. In turn, the disturbed blood gas homeostasis can affect physiological functions and thus unintentionally impact the experimental results. We hypothesized that short-term mechanical ventilation restores blood gas balance and physiological functions despite anaesthesia and surgical interventions. Therefore, we investigated variables of blood gas analyses and diaphragm muscle strength in rats anaesthetized with ketamine/medetomidine after tracheotomy and catheterization of the carotid artery under spontaneous breathing and after 20 min of mechanical ventilation following the same surgical intervention. Spontaneous breathing during general anaesthesia and surgical intervention resulted in unphysiological blood oxygen partial pressure (<65 mmHg) and carbon dioxide partial pressure (>55 mmHg). After subsequent short-term mechanical ventilation, blood gas partial pressures were restored to their physiological ranges. Additionally, diaphragm muscle strength of animals breathing spontaneously was lower compared to animals that received subsequent mechanical ventilation (P = 0.0063). We conclude that spontaneous breathing of rats under ketamine/medetomidine anaesthesia is not sufficient to maintain a physiological blood gas balance. Disturbed blood gas balance is related to reduced diaphragm muscle strength. Mechanical ventilation for only 20 min restores blood gas homeostasis and muscle strength. Therefore, monitoring and maintenance of blood gas balance should be conducted to ensure quality and relevance of small animal experiments.

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.

Longitudinal Association Between Sodium and Potassium Intake and Physical Performance in Older Adults

BACKGROUND

Aging is associated with a progressive difficulty to maintain ion regulation, which might impair the capacity for muscle contraction. Thus, the aim of this study was to examine the association between 5-year changes in dietary intake of sodium and potassium and changes in physical performance among older adults.

METHODS

We performed a prospective study with 868 participants from the Seniors-ENRICA cohort. Diet was measured with a validated diet history and physical performance was measured with the Short Physical Performance Battery (SPPB), both in 2012 and 2017. Analyses were performed with linear regression models adjusted for sociodemographic variables, lifestyle, and morbidity, using changes in the intake of sodium and potassium and changes in the sodium/potassium ratio during follow-up as independent variables, and the continuous change in the SPPB score as the dependent variable.

RESULTS

Over 5 years of follow-up, a 1 SD increase in sodium intake (ie, 0.73 g/d) was associated with a 0.13 (95% confidence interval [CI]: 0.26-0.01) points reduction in the SPPB score, while a 1 SD increase in potassium intake (ie, 0.70 g/d) was associated with a 0.19 (0.05-0.34) points increment in the score. In addition, a 1 SD increase in the sodium-to-potassium ratio (ie, 0.30) was associated with worse SPPB (-0.58 [-0.95 to -0.21]). Participants who adhered to dietary recommendations for minerals at baseline but became noncompliant during follow-up decreased their result in the SPPB.

CONCLUSION

An increase of dietary sodium intake, a decrease of potassium intake and the resulting increment in the sodium-to-potassium ratio were prospectively associated with worse physical performance in older adults.

Sarcopenic obesity and 10-year cardiovascular disease risk scores in cancer survivors and non-cancer participants using a nationwide survey

OBJECTIVE

To evaluate the associations of combinations of sarcopenia and adiposity phenotypes with 10-year cardiovascular disease (CVD) risk scores in cancer survivors and non-cancer participants.

METHODS

In 19,019 individuals including 1023 cancer survivors free of CVD who were aged ≥30 years from the Korea National Health and Nutrition Examination Survey, combination groups of sarcopenia, obesity and abdominal obesity based on handgrip strength, BMI and waist circumference, respectively, were generated and 10-year CVD risk scores based on Framingham risk model were determined.

RESULTS AND CONCLUSION

After adjusting for socio-demographic factors, health behaviours, dietary intake of nutrients and time since cancer diagnosis and current cancer therapy (in cancer survivors), cancer survivors with sarcopenic non-obesity, non-sarcopenic abdominal obesity or sarcopenic abdominal obesity had, respectively, 84%, 85% and 3.61-fold higher odds for ≥10% CVD risk scores compared with cancer survivors without those phenotypes. In non-cancer participants, sarcopenia, obesity, abdominal obesity and combinations of those phenotypes had higher odds from 1.37 (in those with obesity) to 4.24 (in those with sarcopenic abdominal obesity) for ≥10% CVD risk scores compared with reference phenotypes. In conclusion, cancer survivors and non-cancer participants with sarcopenia, obesity, abdominal obesity or combination of those phenotypes had increased 10-year CVD risk scores.

Associations between nutrient intakes and dietary patterns with different sarcopenia definitions in older Australian men: the concord health and ageing in men project

Objective:

To assess the associations between nutrient intake and dietary patterns with different sarcopenia definitions in older men.

Design:

Cross-sectional study.

Setting:

Sarcopenia was defined using the Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Dietary adequacy of fourteen nutrients was assessed by comparing participants’ intakes with the Nutrient Reference Values (NRV). Attainment of NRV for nutrients was incorporated into a variable ‘poor’ (meeting ≤ 9) v. ‘good’ (meeting ≥ 10) using the cut-point method. Also, two different dietary patterns, monounsaturated:saturated fat and n-6:n-3 fatty acids ratio and individual nutrients were used as predictor variables.

Participants:

A total of 794 men aged ≥75 years participated in this study.

Results:

The prevalence of sarcopenia by the FNIH, EWGSOP and EWGSOP2 definitions was 12·9 %, 12·9 % and 19·6 %, respectively. With the adjustment, poor nutrient intake was significantly associated with FNIH-defined sarcopenia (OR: 2·07 (95 % CI 1·16, 3·67)), but not with EWGSOP and EWGSPOP2 definitions. The lowest and second-lowest quartiles of protein, Mg and Ca and the lowest quartiles of n-6 PUFA and n-3 PUFA intakes were significantly associated with FNIH-defined sarcopenia. Each unit decrease in n-6:n-3 ratio was significantly associated with a 9 % increased risk of FNIH-defined sarcopenia (OR: 1·09 (95 % CI 1·04, 1·16)).

Conclusions:

Inadequate intakes of nutrients are associated with FNIH-defined sarcopenia in older men, but not with the other two sarcopenia definitions. Further studies are required to understand these relationships.

Longitudinal Observation of Muscle Mass over 10 Years According to Serum Calcium Levels and Calcium Intake among Korean Adults Aged 50 and Older: The Korean Genome and Epidemiology Study

The aim of this study was to investigate the longitudinal change in muscle mass over 10 years according to serum calcium levels and calcium intake. A total of 1497 men and 1845 women aged 50 years and older were included. Significant muscle loss (SML) was defined as a 5% or greater loss from baseline, while time-dependent development of SML was assessed according to quartiles for corrected calcium level and daily calcium intake using Cox regression models. The incidence of SML was 6.7 and 7.7 per 100-person-years among men and women, respectively. Groups with the lowest corrected calcium levels had more prominent SML than those with higher calcium levels, regardless of sex. The relationship between SML and calcium intake was significant only among women. The hazard ratio for SML per 1 mmol/L increase in corrected calcium level was 0.236 and 0.237 for men and women, respectively. In conclusion, low serum calcium levels may predict SML among adults aged ≥ 50 years, while low calcium intake may be a predictor for muscle loss among women. Therefore, encouraging dietary calcium intake among middle-aged and older adults for preservation of muscle mass should be considered.

A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK

Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg-1·d-1), calcium (1000 mg·d-1), folate (400 μg·d-1), vitamin B-12 (2.4 μg·d-1), and fluid (1.6 L·d-1 women, 2.0 L·d-1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.

Potassium intake, skeletal muscle mass, and effect modification by sex: data from the 2008-2011 KNHANES

BACKGROUND

A loss of muscle mass may be influenced by multiple factors. Insulin sensitivity and metabolic acidosis are associated with muscle wasting and may be improved with potassium intake. This study evaluated the association between dietary potassium intake and skeletal muscle mass.

METHODS

We performed a cross-sectional study with data obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) (2008-2011). Participant's daily food intake was assessed using a 24-h recall method. Appendicular skeletal muscle mass (ASM) was calculated as the sum of muscle mass in both arms and legs, measured using dual energy X-ray absorptiometry. The skeletal muscle index (SMI) was calculated as ASM divided by height2 (kg/m2). Low muscle mass was defined as a SMI < 7.0 kg/m2 for men and < 5.4 kg/m2 for women.

RESULTS

Data from 16,558 participants (age ≥ 19 years) were analyzed. Participants were categorized into quintiles according to their potassium intake. Sex-specific differences were found in the association between potassium intake and muscle mass (PInteraction < 0.001). In men, higher potassium intake was associated with lower odds for low muscle mass; the fully adjusted odds ratios (95% confidence intervals) were 0.78 (0.60-1.03), 0.71 (0.54-0.93), 0.68 (0.51-0.90), and 0.71 (0.51-0.98) for the top four quintiles (referenced against the lowest quintile), respectively. However, this association was attenuated in women after adjusting for total energy intake. Higher potassium intakes were also associated with a greater SMI.

CONCLUSIONS

Higher dietary potassium intake decreased the odds of low muscle mass in men but not in women.

Displacing Sedentary Behaviour with Light Intensity Physical Activity Spontaneously Alters Habitual Macronutrient Intake and Enhances Dietary Quality in Older Females

Displacing Sedentary Behaviour (SB) with light intensity physical activity (LIPA) is increasingly viewed as a viable means of health enhancement. It is, however, unclear whether any behavioural compensations accompany such an intervention. Therefore, the aim of this study was to identify any dietary changes that accompany SB displacement. We hypothesised that SB displacement would improve dietary quality. Thirty-five elderly females (73 ± 5 years) were randomly allocated to one of three groups: (1) sedentary behaviour fragmentation (SBF) (n = 14), (2) continuous LIPA (n = 14), or (3) control (n = 7). Habitual diet (four-day food diary) and physical behaviour (accelerometery) were assessed at weeks 0 and 8. Out of 45 nutrients examined, only glucose exhibited a group × time interaction (p = 0.03), mediated by an exclusive reduction following SBF (-31%). SBF was also the sole experimental group to increase nutrients promoting bone health (SBF: 17%, LIPA: -34%. control: 21%), whereas both experimental groups consumed more nutrients promoting anabolism (SBF: 13%, LIPA: 4%, control: -34%) (z-scores). New ambulators (n = 8) also consumed more nutrients promoting bone health (16%)/anabolism (2%) (z-scores), including significantly increased Zinc intake (p = 0.05, 29%). Displacing SB with LIPA improves dietary quality in older females. Furthermore, SB fragmentation appears advantageous for various dietary outcomes.

Mineral Intake and Clinical Symptoms in Adult Patients with Hypophosphatasia

BACKGROUND

Hypophosphatasia (HPP) is a rare inherited metabolic disorder characterized by deficient activity of the tissue-nonspecific alkaline phosphatase entailing impaired turnover of phosphorus metabolites. Dietary mineral intake is suspected to influence clinical symptoms of HPP, but scientific evidence is missing.

METHODS

Cross-sectional matched-pairs study collecting comprehensive data on nutrient intake in 20 HPP patients and 20 unaffected, age- and gender-matched controls. Dietary information and clinical symptoms were documented in detail over 7 consecutive days using structured diaries.

RESULTS

Baseline data and type of energy-supplying nutrients were balanced between both groups. Median nutritional intake of phosphorus and calcium were significantly lower in HPP patients versus controls, which is partially attributable to lower energy consumption in HPP patients. Differences regarding phosphorus and calcium (Ca/P) ratio and uptake of magnesium, zinc, and vitamin B6 were not statistically significant. Both high (≥ 1375 mg/d) and low intakes (< 1100 mg/d) of phosphorus were significantly associated with an increased frequency of neuropsychiatric symptoms (P = 0.02). Similarly, very high and very low intake of calcium was significantly associated with musculoskeletal (P < 0.01), gastrointestinal (P = 0.02), and neuropsychiatric (P < 0.001) symptoms. An increased Ca/P ratio was associated with increased tiredness/fatigue (P < 0.01), whereas a decreased Ca/P was associated with gastrointestinal issues (P = 0.01).

CONCLUSION

Phosphorus and calcium intake seem reduced in HPP patients along with reduced total energy consumption. Particularly high as well as very low absolute or unbalanced phosphorus and calcium intake are associated with an increased frequency of clinical symptoms.

Current Trends of Essential Trace Elements in Patients with Chronic Liver Diseases

Essential trace elements play crucial roles in the maintenance of health, since they are involved in many metabolic pathways. A deficiency or an excess of some trace elements, including zinc, selenium, iron, and copper, frequently causes these metabolic disorders such as impaired glucose tolerance and dyslipidemia. The liver largely regulates most of the metabolism of trace elements, and accordingly, an impairment of liver functions can result in numerous metabolic disorders. The administration or depletion of these trace elements can improve such metabolic disorders and liver dysfunction. Recent advances in molecular biological techniques have helped to elucidate the putative mechanisms by which liver disorders evoke metabolic abnormalities that are due to deficiencies or excesses of these trace elements. A genome-wide association study revealed that a genetic polymorphism affected the metabolism of a specific trace element. Gut dysbiosis was also responsible for impairment of the metabolism of a trace element. This review focuses on the current trends of four trace elements in chronic liver diseases, including chronic hepatitis, liver cirrhosis, nonalcoholic fatty liver disease, and autoimmune liver diseases. The novel mechanisms by which the trace elements participated in the pathogenesis of the chronic liver diseases are also mentioned.

Biomarkers Profile of People With Sarcopenia: A Cross-sectional Analysis From UK Biobank

OBJECTIVE

This study aimed to characterize the biomarker profile of sarcopenic vs nonsarcopenic men and women, using the current European Working Group on Sarcopenia in Older People (EWGSOP2) definition in the UK Biobank study.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 396,707 (68.8% women, age 38 to 73) participants from UK Biobank.

MEASURES

Thirty-three biomarkers, standardized to sex-specific z-scores, were included in the analysis. Associations between these biomarkers and sarcopenia, defined using EWGSOP2 criteria, were examined using multiple linear regression.

RESULTS

Higher concentrations of rheumatoid factor, C-reactive protein, cystatin C, sex hormone-binding globulin, gamma-glutamyltransferase, alkaline phosphatase, and total protein, as well as lower concentrations of insulin-like growth factor-1, albumin, creatinine, sodium, and systolic blood pressure, were associated with sarcopenia in both men and women. However, some of the associations differed by sex. Sarcopenia was associated with higher concentrations of phosphate, lipoprotein A, and lower of diastolic blood pressure, HbA1c, urea, glucose, total bilirubin, and testosterone in women only, and with higher concentrations of high-density lipoprotein, aspartate aminotransferase, and direct bilirubin and lower values of apolipoprotein A, vitamin D, and apolipoprotein B in men only.

CONCLUSIONS AND IMPLICATIONS

Several biomarkers were associated with sarcopenia in men and women using the new EWGSOP2 statement. However, some of these associations and their magnitude differed between men and women. Considering the EWGSOP2 updated its statement on the definition of sarcopenia in 2019, this study enables us to update the study of the biomarkers profile of people with sarcopenia.

Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health

Supplementation with calcium (Ca) and/or vitamin D (vitD) is key to the management of osteoporosis. Other supplements like vitamin K2 (VitK2) and magnesium (Mg) could contribute to the maintenance of skeletal health. This narrative review summarizes the most recent data on Ca, vitD, vitK2 and Mg supplementation and age-related bone and muscle loss. Ca supplementation alone is not recommended for fracture prevention in the general postmenopausal population. Patients at risk of fracture with insufficient dietary intake and absorption could benefit from calcium supplementation, but it needs to be customized, taking into account possible side-effects and degree of adherence. VitD supplementation is essential in patients at risk of fracture and/or vitD deficiency. VitK2 and Mg both appear to be involved in bone metabolism. Data suggest that VitK2 supplementation might improve bone quality and reduce fracture risk in osteoporotic patients, potentially enhancing the efficacy of Ca ± vitD. Mg deficiency could negatively influence bone and muscle health. However, data regarding the efficacy of vitK2 and Mg supplementation on bone are inconclusive.

A 3-year prospective cohort study of dietary patterns and frailty risk among community-dwelling older adults

BACKGROUND & AIMS

The association between dietary patterns and frailty is less investigated in Asia. We aimed to investigate the prospective associations between dietary patterns and frailty index (FI) in community-dwelling Japanese older adults aged 60 years or older.

METHODS

A 3-year cohort collected the data on sociodemographic information, lifestyle behaviors, comorbidities, medication history, depression status, nutrition, and physical function from 2014 to 2017. Five dietary patterns including "Mediterranean-style," "sugar and fat," "salt and pickles," "noodle and alcohol," and "protein-rich" dietary patterns were identified using principal component analysis from 20 food groups obtained using a validated food frequency questionnaire. A 54-item FI was constructed on the basis of a deficit accumulation model. This project aimed to investigate the longitudinal association between dietary pattern and frailty trajectories with annual measurements over a 3-year period using a generalized estimating equation.

RESULT

After excluding 108 participants with incomplete data at baseline, 666 participants (56.5% female, 69.4 ± 4.4 years) were included for longitudinal analysis. Our results demonstrated that adherence score to "sugar and fat" dietary pattern" (Q4 vs. Q1: mean difference [0.017], 95% CI [0.006 to 0.029]) and "salt and pickles" dietary pattern (Q3 vs. Q1: mean difference [0.010], 95% CI [0.001 to 0.020]; Q4 vs. Q1: mean difference [0.014], 95% CI [0.003 to 0.025]) were positively associated with change in FI. Adherence score to a "protein-rich" dietary pattern was negatively associated with change in FI (Q4 vs. Q1: mean difference [-0.013], 95% CI [-0.025 to -0.002]).

CONCLUSIONS

"Salt and pickles" dietary pattern and "sugar and fat" dietary pattern were positively associated with frailty. In contrast, "protein-rich" dietary pattern was negatively associated with frailty.

Effects of Dietary or Supplementary Micronutrients on Sex Hormones and IGF-1 in Middle and Older Age: A Systematic Review and Meta-Analysis

Observational research suggests that micronutrients may be protective for sarcopenia, a key health issue during ageing, potentially via effects on hormone synthesis and metabolism. We aimed to carry out a systematic review of RCTs investigating effects of increasing dietary or supplemental micronutrient intake on sex hormones and IGF-1 in individuals aged 45 years or older. We searched MEDLINE, EMBASE and Cochrane databases for RCTs reporting the effects of different micronutrients (vitamins A, C, D, or E; carotenoids; iron; copper; zinc; magnesium; selenium; and potassium) on sex hormones or IGF-1. Of the 26 RCTs identified, nine examined effects of vitamin D, nine of multi-nutrients, four of carotenoids, two of selenium, one of zinc, and one of vitamin E. For IGF-1 increasing vitamin D (MD: -0.53 nmol/L, 95% CI: -1.58, 0.52), multi-nutrients (MD: 0.60 nmol/L, 95% CI -1.12 to 2.33) and carotenoids (MD -1.32 nmol/L; 95% CI -2.76 to 0.11) had no significant effect on circulating concentrations. No significant effects on sex hormones of other micronutrients were found, but data were very limited. All trials had significant methodological limitations making effects of micronutrient supplementation on sex hormones unclear. Further high quality RCTs with physiological doses of micronutrients in people with low baseline intakes or circulating concentrations, using robust methodology, are required to assess effects of supplementation adequately.

Factors associated with sarcopenia: A cross-sectional analysis using UK Biobank

INTRODUCTION

The critical sociodemographic, lifestyle and diseases factors influencing sarcopenia, defined by the current European Working Group on Sarcopenia 2 (EWGSOP2) classification and cut-off points, have not yet been fully elucidated. This study aimed, therefore, to determine sociodemographic, anthropometric, lifestyle and health-related factors associated with sarcopenia using the new EWGSOP2 definition.

STUDY DESIGN

396,283 participants (52.8 % women, age 38-73 years) were included in this cross-sectional study. The potential factors associated with sarcopenia were allocated to four categories: sociodemographic (sex, age, education, income and professional qualification), anthropometric (nutritional status, abdominal obesity, body fat and birth weight), lifestyle (physical activity, smoking, sleeping, sitting time, TV viewing, alcohol, and dietary intakes) and health status (self-reported prevalent diseases). P-values were corrected for multiple testing using the Bonferroni method.

RESULTS

Age, women, lower education, higher deprivation, underweight, lower birth weight, and chronic diseases such as rheumatoid arthritis, chronic bronchitis and osteoporosis were associated with a higher likelihood of sarcopenia. Conversely, overweight, obesity, as well as a self-reported higher intake of energy, protein, vitamins (B12 and B9) and minerals (potassium, calcium and magnesium) were associated with lower odds of sarcopenia.

CONCLUSION

Women, people aged over 65 years, underweight people and those with rheumatoid arthritis were most likely to have sarcopenia. Considering the increase in the ageing population, sarcopenia is likely to become more prevalent. Identifying factors associated with sarcopenia could inform future strategies for early identification of individuals at high risk of sarcopenia and therefore the implementation of preventive strategies against the disease.

The Use of Proton Pump Inhibitors May Increase Symptoms of Muscle Function Loss in Patients with Chronic Illnesses

Long-term use of proton pump inhibitors (PPIs) is common in patients with muscle wasting-related chronic diseases. We explored the hypothesis that the use of PPIs may contribute to a reduction in muscle mass and function in these patients. Literature indicates that a PPI-induced reduction in acidity of the gastrointestinal tract can decrease the absorption of, amongst others, magnesium. Low levels of magnesium are associated with impaired muscle function. This unwanted side-effect of PPIs on muscle function has been described in different disease backgrounds. Furthermore, magnesium is necessary for activation of vitamin D. Low vitamin D and magnesium levels together can lead to increased inflammation involved in muscle wasting. In addition, PPI use has been described to alter the microbiota’s composition in the gut, which might lead to increased inflammation. However, PPIs are often provided together with nonsteroidal anti-inflammatory drugs (NSAIDs), which are anti-inflammatory. In the presence of obesity, additional mechanisms could further contribute to muscle alterations. In conclusion, use of PPIs has been reported to contribute to muscle function loss. Whether this will add to the risk factor for development of muscle function loss in patients with chronic disease needs further investigation.

Changing from a Western to a Mediterranean-style diet does not affect iron or selenium status: results of the New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE) 1-year randomized clinical trial in elderly Europeans

BACKGROUND

Mediterranean diets limit red meat consumption and increase intakes of high-phytate foods, a combination that could reduce iron status. Conversely, higher intakes of fish, a good source of selenium, could increase selenium status.

OBJECTIVES

A 1-y randomized controlled trial [New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE)] was carried out in older Europeans to investigate the effects of consuming a Mediterranean-style diet on indices of inflammation and changes in nutritional status.

METHODS

Selenium and iron intakes and status biomarkers were measured at baseline and after 1 y in 1294 people aged 65-79 y from 5 European countries (France, Italy, the Netherlands, Poland, and the United Kingdom) who had been randomly allocated either to a Mediterranean-style diet or to remain on their habitual, Western diet.

RESULTS

Estimated selenium intakes increased significantly with the intervention group (P < 0.01), but were not accompanied by changes in serum selenium concentrations. Iron intakes also increased (P < 0.001), but there was no change in iron status. However, when stratified by study center, there were positive effects of the intervention on iron status for serum ferritin for participants in Italy (P = 0.04) and France (P = 0.04) and on soluble transferrin receptor (sTfR) for participants in Poland (P < 0.01). Meat intake decreased and fish intake increased to a greater degree in the intervention group, relative to the controls (P < 0.01 for both), but the overall effects of the intervention on meat and fish intakes were mainly driven by data from Poland and France. Changes in serum selenium in the intervention group were associated with greater changes in serum ferritin (P = 0.01) and body iron (P = 0.01), but not sTfR (P = 0.73); there were no study center × selenium status interactions for the iron biomarkers.

CONCLUSIONS

Consuming a Mediterranean-style diet for 1 y had no overall effect on iron or selenium status, although there were positive effects on biomarkers of iron status in some countries. The NU-AGE trial was registered at clinicaltrials.gov as NCT01754012.

Nutrition and Muscle Strength, As the Key Component of Sarcopenia: An Overview of Current Evidence

Much has been achieved by recent research to increase understanding of the links between nutrition and muscle health. Focusing on muscle strength as the key component of sarcopenia, the aim of this overview was to evaluate its links to nutrition, both to variation in habitual diets in older populations, as well as considering supplementation effects in trials. A main message from the reviewed studies is that while many provide suggestive evidence of benefits of higher nutrient intakes and diets of higher quality, findings are inconsistent, and data on muscle strength are often lacking. To assess the potential of optimising diets as a strategy to promote and maintain muscle strength, gaps in current evidence need to be addressed. These include the need for (i) better understanding of individual differences in responsiveness to dietary change, and the need for targeted nutritional support; (ii) clearer distinction between protective and therapeutic actions of diet; and (iii) definition of the role of dietary patterns and their influence on muscle strength, to allow effects of changes in food consumption to be evaluated—particularly when combined with physical activity. Development of this evidence is needed to enable translation into appropriate dietary recommendations for older populations.

The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes

Skeletal muscle is integral to the metabolism and utilisation of macronutrients; however, substantial muscle loss and morphological changes occur with ageing. These are associated with loss of muscle function and accelerate rapidly from the age of 60 years, leading to the conditions of sarcopenia and frailty. As the relationship between muscle ageing and macronutrient metabolism and utilisation has seen limited research to date, this review focuses on the interactions between skeletal muscle changes during ageing, metabolism and utilisation of fat, carbohydrates and overall energy expenditure.Skeletal muscle contributes less to resting energy expenditure during ageing, potentially contributing to onset of obesity from middle age. Age-related changes to skeletal muscle lead to glucose dysregulation, with consequent reduction in glycaemic control, increased insulin resistance and ultimately onset of type-2 diabetes. Recent studies indicate that high total fat and SFA intake are detrimental to skeletal muscle, while higher intakes of PUFA are protective. Age-associated changes in skeletal muscle may also reduce total fatty acid utilisation.In conclusion, further research is needed to understand the relationships between macronutrient metabolism and utilisation and age-related changes to skeletal muscle. No dietary recommendations exist specifically for skeletal muscle health during ageing, but we advise individuals to follow healthy eating guidelines, by consuming sufficient protein, fruit and vegetables, and limited SFA and to maintain physically active lifestyles. Clinicians responsible for managing type-2 diabetes need to be aware of growing evidence relating age-related skeletal muscle changes to diabetes onset and progression.

Cross talk between mineral metabolism and meat quality: a systems biology overview

Meat quality has an inherent complexity because of the multiple interrelated causative factors and layers of feedback regulation. Understanding the key factors and their interactions has been challenging, despite the availability of remarkable high-throughput tools and techniques that have provided insights on muscle metabolism and the genetic basis of meat quality. Likewise, we have deepened our knowledge about mineral metabolism and its role in cell functioning. Regardless of these facts, complex traits like mineral content and meat quality have been studied under reductionist approaches. However, as these phenotypes arise from complex interactions among different biological layers (genome, transcriptome, proteome, epigenome, etc.), along with environmental effects, a holistic view and systemic-level understanding of the genetic basis of complex phenotypes are in demand. Based on the state of the art, we addressed some of the questions regarding the interdependence of meat quality traits and mineral content. Furthermore, we sought to highlight potential regulatory mechanisms arising from the genes, miRNAs, and mineral interactions, as well as the pathways modulated by this interplay affecting muscle, mineral metabolism, and meat quality. By answering these questions, we did not intend to give an exhaustive review but to identify the key biological points, the challenges, and benefits of integrative genomic approaches.

Physical activity, dietary calcium to magnesium intake and mortality in the National Health and Examination Survey 1999-2006 cohort

Calcium and magnesium affect muscle mass and function. Magnesium and calcium are also important for optimal vitamin D status. Vitamin D status modifies the associations between physical activity and risk of incident cardiovascular disease (CVD) and CVD mortality. However, no study examined whether levels of magnesium and calcium and the ratio of dietary calcium to magnesium (Ca:Mg) intake modify the relationship between physical activity and mortality. We included 20,295 National Health and Nutrition Examination Survey participants (1999-2006) aged >20 years with complete dietary, physical activity and mortality data (2,663 deaths). We assessed physical activity based on public health guidelines and sex-specific tertiles of MET-minutes/week. We used Cox proportional hazards models adjusted for potential confounding factors and stratified by the intakes of magnesium, calcium, Ca:Mg ratio. We found higher physical activity was significantly associated with reduced risk of total mortality and cause-specific mortality, regardless of Ca:Mg ratio, magnesium or calcium intake. In contrast, both moderate and high physical activity were significantly associated with substantially reduced risks of mortality due to cancer when magnesium intake was above the RDA level. We also found higher physical activity was significantly associated with a reduced risk of mortality due to cancer only when Ca:Mg ratios were between 1.7 and 2.6, although the interaction was not significant. Overall, dietary magnesium and, potentially, the Ca:Mg ratio modify the relationship between physical activity and cause-specific mortality. Further study is important to understand the modifying effects of the balance between calcium and magnesium intake on physical activity for chronic disease prevention.

Handgrip Strength and Its Association With Hydration Status and Urinary Sodium-to-Potassium Ratio in Older Adults

Objective: Older adults present higher risk of functional disability detected by handgrip strength and an increased risk of poor health conditions, such as dehydration and low values of the sodium-to-potassium (Na/K) ratio. This study aimed to quantify the association of hydration status and Na/K ratio with handgrip strength, based on the urinary excretion of older adults.Methods: A cross-sectional study was conducted in 735 older adults ≥ 65 years old. Handgrip strength was measured with a Jamar Dynamometer and low values were defined according to body mass index and to sex-specific cutoff points. The hydration status was evaluated based on free water reserve. Sodium and potassium intake were evaluated after converting 24-hour urinary sodium and potassium excretion, respectively. A logistic regression model was used to estimate the probability of presenting low handgrip strength, according to risk of hypohydration and to quartiles of Na/K, stratified by sex and adjusted for potential confounders.Results: The adjusted odds ratio (OR) for presenting low handgrip strength was higher in women at risk of hypohydration, but this association was not found in men. Both women and men with the highest values of Na/K ratio presented higher adjusted OR for low handgrip strength (OR in women was 2.03; 95% confidence interval [CI]: 1.12-3.68, and in men was 2.19; 95% CI: 1.11-4.29).Conclusions: The risk of hypohydration was directly associated with low handgrip strength in older women. In older adults, higher values of urinary Na/K ratio were also directly associated with low handgrip strength.

Selenium, aging and aging-related diseases

Selenium is an essential trace element in the human body and plays an important role in the body via selenoprotein, which contains selenium. Selenoproteins (glutathione peroxidase, thioredoxin reductase, methionine sulfoxide reductase1 and endoplasmic reticulum-selenoproteins, etc.) have antioxidant effects and are involved in regulating antioxidant activities. Aging is an inevitable process and is always accompanied by aging-related diseases. Reactive oxygen species are important initial factors in aging and aging-related diseases. Selenium contributes to the alleviation of reduced reactive oxygen species-mediated inflammation, reduced DNA damage and prolonged telomere length and thereby plays roles in fighting aging and preventing aging-related diseases. In the elderly, aging-related diseases include neuropsychiatric diseases, tumors, cardiovascular diseases, and skin aging, among others. Selenium supplementation is an important strategy for anti-aging and the prevention of aging-related diseases and is of great significance for the elderly. However, with the accumulation of related research, selenium supplementation does not necessarily contribute to the prevention of aging and aging-related diseases. It is believed that a low level of selenium is beneficial to the human body. Thus, the effect of selenium on human aging and aging-related diseases is still controversial. This paper reviews the research progress and objective role of selenium in aging and aging-related diseases.

Gut Microbiota, Muscle Mass and Function in Aging: A Focus on Physical Frailty and Sarcopenia

Human gut microbiota is able to influence the host physiology by regulating multiple processes, including nutrient absorption, inflammation, oxidative stress, immune function, and anabolic balance. Aging is associated with reduced microbiota biodiversity, increased inter-individual variability, and over-representation of pathobionts, and these phenomena may have great relevance for skeletal muscle mass and function. For this reason, the presence of a gut-muscle axis regulating the onset and progression of age-related physical frailty and sarcopenia has been recently hypothesized. In this narrative review, we summarize the studies supporting a possible association between gut microbiota-related parameters with measures of muscle mass, muscle function, and physical performance in animal models and humans. Reduced muscle mass has been associated with distinct microbiota composition and reduced fermentative capacity in mice, and the administration of probiotics or butyrate to mouse models of muscle wasting has been associated with improved muscle mass. However, no studies have targeted the human microbiome associated with sarcopenia. Limited evidence from human studies shows an association between microbiota composition, involving key taxa such as Faecalibacterium and Bifidobacterium, and grip strength. Similarly, few studies conducted on patients with parkinsonism showed a trend towards a different microbiota composition in those with reduced gait speed. No studies have assessed the association of fecal microbiota with other measures of physical performance. However, several studies, mainly with a cross-sectional design, suggest an association between microbiota composition and frailty, mostly assessed according to the deficit accumulation model. Namely, frailty was associated with reduced microbiota biodiversity, and lower representation of butyrate-producing bacteria. Therefore, we conclude that the causal link between microbiota and physical fitness is still uncertain due to the lack of targeted studies and the influence of a large number of covariates, including diet, exercise, multimorbidity, and polypharmacy, on both microbiota composition and physical function in older age. However, the relationship between gut microbiota and physical function remains a very promising area of research for the future.

Association between dietary nutrient intake and sarcopenia in the SarcoPhAge study

BACKGROUND

It has been suggested that a balanced nutritional intake may be useful in preventing or even reversing sarcopenia.

AIM

To describe cross-sectional associations between dietary nutrient intake and sarcopenia.

METHODS

Subjects recruited from the SarcoPhAge study population completed a food frequency questionnaire. The micronutrient and macronutrient intake was evaluated in both sarcopenic and non-sarcopenic participants. The Nutritional Belgian Recommendations of 2016 were used, i.e., adequate intake and estimated average requirement (EAR). For micronutrients, the prevalence of insufficient intake was estimated as the proportion of subjects whose intake was below the EAR.

RESULTS

A total of 331 subjects (mean age of 74.8 ± 5.9 years, 58.9% women) had complete data and were included in this study. Among them, 51 were diagnosed with sarcopenia (15.4%). In the fully adjusted model, analyses revealed that sarcopenic subjects consumed significantly lower amounts of two macronutrients (proteins, lipids) and five micronutrients (potassium, magnesium, phosphorus, iron, and vitamin K) than non-sarcopenic subjects (all p values < 0.005). A significantly increased prevalence of insufficiency was found for sarcopenic subjects compared to non-sarcopenic subjects for potassium, magnesium, iron, calcium and vitamins E and C (all p values < 0.005). The prevalence of sarcopenic subjects who were also below the Nutritional Belgian Recommendations for protein and lipids was significantly higher than that of non-sarcopenic subjects.

DISCUSSION AND CONCLUSIONS

Sarcopenic subjects seem to consume significantly reduced amounts of many micronutrients and macronutrients compared to non-sarcopenic subjects. These results suggest that a poorly balanced diet may be associated with sarcopenia and poor musculoskeletal health, although prospective studies are needed to confirm these findings.

New insights into the pathogenesis and treatment of sarcopenia in chronic heart failure

Sarcopenia is an age-related geriatric syndrome that is characterized by a progressive loss of muscle mass, strength and function. Chronic heart failure (CHF), the final stage of various cardiovascular diseases, may be closely correlated with the occurrence of sarcopenia. Accumulating evidence has demonstrated that CHF can promote the development of sarcopenia through multiple pathophysiological mechanisms, including malnutrition, inflammation, hormonal changes, oxidative stress, autophagy, and apoptosis. Additionally, CHF can aggravate the adverse outcomes associated with sarcopenia, including falls, osteoporosis, frailty, cachexia, hospitalization, and mortality. Sarcopenia and CHF are mutually interacting clinical syndromes. Patients with these two syndromes seem to endure a double burden, with no particularly effective way to hinder their progression. However, the combination of physical exercise, nutritional supplements, and drug therapy may counteract the development of these maladies. In this review, we will summarize the latest progress in the pathogenesis and treatment of sarcopenia in patients with CHF.

Role of Calcium and Low-Fat Dairy Foods in Weight-Loss Outcomes Revisited: Results from the Randomized Trial of Effects on Bone and Body Composition in Overweight/Obese Postmenopausal Women

Several studies have investigated the possibility of dairy foods and calcium (Ca) mediating weight and body composition, but a consensus has not been reached. We aimed to investigate weight-loss-related outcomes during intervention with low-fat dairy foods or Ca + vitamin D supplements, both as complements to hypocaloric diets. Overweight/obese Caucasian, early-postmenopausal women (n = 135) were recruited for a 6 month energy-restricted weight loss study complemented with either low-fat dairy foods (D; 4–5 servings/day), or Ca + vitamin D supplements (S); both to amount a total of ~1500 mg/day and 600 IU/day of Ca and vitamin D, respectively, or placebo pills (C). Bone mineral density (BMD) and lean and fat tissue were measured by Lunar iDXA. Serum and urinary markers of bone turnover were analyzed. Diet and physical activity were assessed with 3-day records. Participants on average lost ~4%, ~3%, and ~2% of body weight, fat, and lean tissue, respectively. The significantly better outcomes were noticed in participants in the D group regarding body composition (fat loss/lean tissue preservation) and in participants in the S group regarding the BMD outcomes, compared to those in the C group. Therefore, increasing low-fat dairy foods to 4–5 servings/day and/or increasing Ca & vitamin D intake by supplements (in those who are at the borderline dietary intake) may be beneficial for weight loss/maintenance and may lead to more favorable bone and body composition outcomes in postmenopausal women during moderate weight loss.

Effect of Milk and Other Dairy Products on the Risk of Frailty, Sarcopenia, and Cognitive Performance Decline in the Elderly: A Systematic Review

Nutrition is a modifiable factor potentially related to aging. Milk and other dairy products may contribute to the prevention of physical and cognitive impairment. We conducted a systematic review to investigate the effectiveness of dairy product intake for preventing cognitive decline, sarcopenia, and frailty in the elderly population. A systematic search for publications in electronic databases [MEDLINE via PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] from 2009 to 2018 identified observational and interventional studies in English and Spanish that tested the relation between dairy product consumption and cognitive decline, sarcopenia, and frailty in community-dwelling older people. We assessed the participants, the type of exposure or intervention, the outcomes, and the quality of evidence. We screened a total of 661 records and included 6 studies (5 observational prospective cohort studies and 1 randomized controlled trial). Regarding cognitive impairment, the relation cannot be firmly established. Consumption of milk at midlife may be negatively associated with verbal memory performance. In older women, high intakes of dairy desserts and ice cream were associated with cognitive decline. On the other hand, 1 study demonstrated a significant inverse relation between dairy intake and development of Alzheimer disease among older Japanese subjects. The consumption of dairy products by older people may reduce the risk of frailty, especially with high consumption of low-fat milk and yogurt, and may also reduce the risk of sarcopenia by improving skeletal muscle mass through the addition of nutrient-rich dairy proteins (ricotta cheese) to the habitual diet. Despite the scarcity of evidence on the topic, our systematic review shows that there are some positive effects of dairy products on frailty and sarcopenia, whereas studies concerning cognitive decline have contradictory findings.

Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial

Background

Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease (COPD) is not fully reversed by exercise training. Antioxidants are critical for muscle homeostasis and adaptation to training. However, COPD patients experience antioxidant deficits that worsen after training and might impact their muscle response to training. Nutritional antioxidant supplementation in combination with pulmonary rehabilitation (PR) would further improve muscle function, oxidative stress, and PR outcomes in COPD patients.

Methods

Sixty-four COPD patients admitted to inpatient PR were randomized to receive 28 days of oral antioxidant supplementation targeting the previously observed deficits (PR antioxidant group; α-tocopherol: 30 mg/day, ascorbate: 180 mg/day, zinc gluconate: 15 mg/day, selenomethionine: 50 μg/day) or placebo (PR placebo group). PR consisted of 24 sessions of moderate-intensity exercise training. Changes in muscle endurance (primary outcome), oxidative stress, and PR outcomes were assessed.

Results

Eighty-one percent of the patients (FEV₁ = 58.9 ± 20.0%pred) showed at least one nutritional antioxidant deficit. Training improved muscle endurance in the PR placebo group (+37.4 ± 45.1%, p < 0.001), without additional increase in the PR antioxidant group (-6.6 ± 11.3%; p = 0.56). Nevertheless, supplementation increased the α-tocopherol/γ-tocopherol ratio and selenium (+58 ± 20%, p < 0.001, and +16 ± 5%, p < 0.01, respectively), muscle strength (+11 ± 3%, p < 0.001), and serum total proteins (+7 ± 2%, p < 0.001), and it tended to increase the type I fiber proportion (+32 ± 17%, p = 0.07). The prevalence of muscle weakness decreased in the PR antioxidant group only, from 30.0 to 10.7% (p < 0.05).

Conclusions

While the primary outcome was not significantly improved, COPD patients demonstrate significant improvements of secondary outcomes (muscle strength and other training-refractory outcomes), suggesting a potential “add-on” effect of the nutritional antioxidant supplementation (vitamins C and E, zinc, and selenium) during PR. This trial is registered with NCT01942889.

Dietary Patterns, Skeletal Muscle Health, and Sarcopenia in Older Adults

In recent decades, the significance of diet and dietary patterns (DPs) for skeletal muscle health has been gaining attention in ageing and nutritional research. Sarcopenia, a muscle disease characterised by low muscle strength, mass, and function is associated with an increased risk of functional decline, frailty, hospitalization, and death. The prevalence of sarcopenia increases with age and leads to high personal, social, and economic costs. Finding adequate nutritional measures to maintain muscle health, preserve function, and independence for the growing population of older adults would have important scientific and societal implications. Two main approaches have been employed to study the role of diet/DPs as a modifiable lifestyle factor in sarcopenia. An a priori or hypothesis-driven approach examines the adherence to pre-defined dietary indices such as the Mediterranean diet (MED) and Healthy Eating Index (HEI)—measures of diet quality—in relation to muscle health outcomes. A posteriori or data-driven approaches have used statistical tools—dimension reduction methods or clustering—to study DP-muscle health relationships. Both approaches recognise the importance of the whole diet and potential cumulative, synergistic, and antagonistic effects of foods and nutrients on ageing muscle. In this review, we have aimed to (i) summarise nutritional epidemiology evidence from four recent systematic reviews with updates from new primary studies about the role of DPs in muscle health, sarcopenia, and its components; (ii) hypothesise about the potential mechanisms of ‘myoprotective’ diets, with the MED as an example, and (iii) discuss the challenges facing nutritional epidemiology to produce the higher level evidence needed to understand the relationships between whole diets and healthy muscle ageing.

[Osteosarcopenia: A narrative review]

Osteosarcopenia is a phenotype resulting from the combination of sarcopenia and low bone mineral density. Based on the relationship between bone and muscle, this phenotype is associated with a higher risk of falls, fractures, dependence, and health care costs than its individual components. Given its characteristics, it can be considered as a new geriatric syndrome. Therefore, understanding its pathophysiology and diagnosis, as well as its non-pharmacological and pharmacological management is a task of great importance. The problem in addressing this phenotype arises from the tradition of managing sarcopenia and osteoporosis separately. There is also a lack of consensus on what to call it (sarco-osteopenia, sarco-osteoporosis, osteosarcopenia). The aim of this review is to outline the epidemiology, pathophysiology, diagnoses, adverse events, and management of osteosarcopenia.

Sarcopenic obesity can be negatively associated with active physical activity and adequate intake of some nutrients in Korean elderly: Findings from the Korea National Health and Nutrition Examination Survey (2008-2011)

BACKGROUND/OBJECTIVES

The aim of this study was to analyze the factors related to sarcopenic obesity among the elderly in South Korea.

SUBJECTS/METHODS

A total of 3,367 elderly (≥ 65 years) from the Korea National Health and Nutrition Examination Survey (2008–2011) were included in this analysis. The subjects were assessed to determine their sarcopenia and obesity status. Sarcopenia was assessed by determining their appendicular skeletal muscle mass (ASM). Obesity was defined by the waist circumference. An association of sarcopenic obesity and the related factors was analyzed using multiple logistic regression models.

RESULTS

The risk of sarcopenic obesity of the subjects was decreased by active physical activity. After adjusting for age, smoking, and alcohol consumption, the risk of sarcopenic obesity in men of the highest level group (Q4) decreased by 45% (OR = 0.550, 95% CI = 0.334–0.905, P trend 0.018) compared to that in the reference group (Q1). Among the women, the risk of sarcopenic obesity in the Q3 and Q4 groups decreased by 29.0% (OR = 0.710, 95% CI = 0.512–0,984) and 56.7% (OR = 0.433, 95% CI = 0.281–0.668), respectively, compared to that in the Q1 group (P trend < 0.001). The mean daily energy intake was higher in the non-sarcopenia group than in the sarcopenia group. The risk of sarcopenic obesity in subjects not meeting the recommended intakes of energy, riboflavin, and vitamin C increased significantly by 25.4%, and 36.6%, and 32.6%, respectively, compared to that in the subjects meeting the recommended nutrient intake.

CONCLUSION

Active physical activity as well as an adequate intake of energy and some vitamins might be negatively associated with the development of sarcopenia and sarcopenic obesity in the elderly.

Dietary Intake and Associated Factors in Long-Term Care Homes in Southeast Spain

Diet is a key modifiable factor in the management of malnutrition and age-related diseases such as sarcopenia, an important issue in long-term care homes. The objectives of this study were to evaluate the dietary intake of residents, define dietary patterns, and analyze their association with sex, diet texture, nutritional status, and the presence of sarcopenia. Intake was assessed by the precise weighing method, dietary patterns were defined a posteriori by cluster analysis, and nutritional status and sarcopenia were evaluated by applying the MNA-SF test and EWGSOP algorithm, respectively. A regular diet was consumed by 63% of participants; 56% were at risk of malnutrition and 63% were diagnosed with sarcopenia. Intake of potassium, magnesium, zinc, iodine, vitamin D, E, folic acid, and fiber was low in >80% of participants. Protein intake was <1 g/kg/day in 56% of participants and <25 g/meal in 100%. Two dietary patterns were identified, but neither fully met recommendations. The risk of a poorer diet was higher in females and residents with sarcopenia and was lower in those consuming regular diets. In conclusion, action is required to improve the inadequate nutritional intake of long-term care residents.

Magnesium and vitamin B2 supplementation is an important nutritional resource of sports medicine

The supply of the with magnesium and vitamin B2 is essential to maintain the energy metabolism of cells, hormonal balance, endurance, immunity, cardiovascular health of athletes. As a result, by increasing the availability of these micronutrients, it is possible to increase maximum aerobic power, achieve better sports results and stimulate adequate recovery after competition or after intensive training. A promising way to increase the supply of athletes with magnesium and vitamin B2 is the use of aqueous solutions of magnesium citrate in combination with riboflavin.

Supplements with purported effects on muscle mass and strength

PURPOSE

Several supplements are purported to promote muscle hypertrophy and strength gains in healthy subjects, or to prevent muscle wasting in atrophying situations (e.g., ageing or disuse periods). However, their effectiveness remains unclear.

METHODS

This review summarizes the available evidence on the beneficial impacts of several popular supplements on muscle mass or strength.

RESULTS

Among the supplements tested, nitrate and caffeine returned sufficient evidence supporting their acute beneficial effects on muscle strength, whereas the long-term consumption of creatine, protein and polyunsaturated fatty acids seems to consistently increase or preserve muscle mass and strength (evidence level A). On the other hand, mixed or unclear evidence was found for several popular supplements including branched-chain amino acids, adenosine triphosphate, citrulline, β-Hydroxy-β-methylbutyrate, minerals, most vitamins, phosphatidic acid or arginine (evidence level B), weak or scarce evidence was found for conjugated linoleic acid, glutamine, resveratrol, tribulus terrestris or ursolic acid (evidence level C), and no evidence was found for other supplements such as ornithine or α-ketoglutarate (evidence D). Of note, although most supplements appear to be safe when consumed at typical doses, some adverse events have been reported for some of them (e.g., caffeine, vitamins, α-ketoglutarate, tribulus terrestris, arginine) after large intakes, and there is insufficient evidence to determine the safety of many frequently used supplements (e.g., ornithine, conjugated linoleic acid, ursolic acid).

CONCLUSION

 In summary, despite their popularity, there is little evidence supporting the use of most supplements, and some of them have been even proven ineffective or potentially associated with adverse effects.

Daily Consumption of Oregon Hazelnuts Affects α-Tocopherol Status in Healthy Older Adults: A Pre-Post Intervention Study

Background

Inadequate vitamin E and magnesium intakes are of concern for older adults owing to the associated incidence of age-related diseases.

Objective

This study was designed to determine the extent to which a 16-wk intervention with hazelnuts alters vitamin E and magnesium status in a group of older men and women, and used a pre-post intervention design without a control group to adjust for temporal changes.

Methods

Participants (n = 32 including 22 women; mean ± SD age: 63 ± 6 y) consumed hazelnuts (∼57 g/d) for 16 wk. Blood and urine samples and anthropomorphic measures were taken at the start and end of the intervention to determine plasma concentrations of α-tocopherol and serum concentrations of magnesium, lipids, glucose, insulin, and high-sensitivity C-reactive protein along with urinary vitamin E metabolites; several other micronutrients were measured by a lymphocyte proliferation assay. There were 3 primary endpoints, calculated as the mean changes in measurements between baseline and the end of the 16-wk intervention for 1) plasma α-tocopherol, 2) urinary α-carboxyethyl hydroxychromanol (α-CEHC; an α-tocopherol metabolite), and 3) serum magnesium.

Results

Hazelnut consumption increased concentrations of the urinary α-tocopherol metabolite α-CEHC (mean ± SD: 0.84 ± 0.45 to 1.14 ± 0.50 µmol/g creatinine; P = 0.0006). In addition, hazelnut consumption increased serum concentrations of magnesium (+2.1%, P = 0.05), decreased concentrations of fasting glucose (-3.4%, P = 0.03) and LDL cholesterol (-6.0%, P = 0.02), and decreased total:HDL cholesterol ratios (-4.5%, P = 0.009). No significant changes were observed in blood pressure, lymphocyte proliferation assays, and serum concentrations of insulin, high-sensitivity C-reactive protein, triglyceride, α-tocopherol, or HDL cholesterol.

Conclusions

Consuming hazelnuts improves a biomarker of vitamin E status in older adults. Vitamin E is a shortfall micronutrient, as identified by the Dietary Guidelines for Americans 2015-2020, which frequently is consumed at levels less than the Estimated Average Requirement of 12 mg/d; thus, hazelnuts should be considered as part of a healthy dietary pattern. This trial was registered at clinicaltrials.gov as NCT03485989.

Prevalence and Associated Factors of Sarcopenia in Nursing Home Residents: A Systematic Review and Meta-analysis

OBJECTIVE

To review the prevalence and associated factors of sarcopenia in nursing homes.

DESIGN

A systematic review and meta-analysis of published studies in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.

SETTING

Nursing homes.

PARTICIPANTS

Older adults aged ≥60 years.

MEASUREMENTS

Sarcopenia was defined according to various validated diagnostic criteria, such as the European Working Group on Sarcopenia in Older People (EWGSOP) criteria and skeletal muscle index (SMI). We performed meta-analyses with random effects models to calculate the pooled prevalence of sarcopenia. The risk of bias of the included studies was evaluated using a 10-item tool explicitly designed for prevalence studies.

RESULTS

We included 16 studies with a total of 3585 participants from 129 nursing homes. The included studies were of low to moderate risk of bias. The pooled prevalences of EWGSOP-defined sarcopenia and SMI-defined sarcopenia were 41% [95% confidence interval (CI) 32%-51%, 12 studies, 2685 cases] and 59% (95% CI 24%-93%, 3 studies, 643 cases), respectively. The pooled prevalences of EWGSOP-defined sarcopenia in women and men were 46% (8 studies, 1332 cases) and 43% (8 studies, 739 cases), respectively. The pooled data showed that malnutrition was an independent associated factor of EWGSOP-defined sarcopenia (odds ratio [OR] 1.74, 95% CI 1.36-2.24; 3 studies, 718 cases), but malnutrition risk (OR 1.01, 95% CI 0.53-1.94; 2 studies, 379 cases) and female gender were not (OR 1.14, 95% CI 0.11-11.66; 3 studies, 827 cases). The association between age and body mass index with sarcopenia was inconsistent across studies. Limited evidence indicated that smoking might be related to sarcopenia.

CONCLUSIONS/IMPLICATIONS

Sarcopenia is highly prevalent in older nursing home residents. Malnutrition may be an associated factor of sarcopenia. More prospective studies are needed to clarify the association between age, gender, malnutrition, and smoking with sarcopenia.