Nutrition and Aging: Changes in the Regulation of Energy Metabolism With Aging

Regulation of skeletal muscle transcriptome in elderly men after 6 weeks of endurance training at lactate threshold intensity

A compromised muscle function due to aging, sarcopenia and reduced level of physical activity can lead to metabolic complications and chronic diseases. Endurance exercise counters these diseases by inducing beneficial adaptations whose molecular mechanisms remain unclear. We have investigated the transcriptomic changes following mild-intensity endurance training in skeletal muscle of elderly men. Seven healthy subjects followed an exercise program of cycle ergometer training at lactate threshold (LT) level for 60 min/day, five times/week during six weeks. Physiological and transcriptomic changes were analyzed before and after training. LT training decreased percentage body fat and fasting levels of plasma glucose, while increasing high-density lipoprotein cholesterol and lecithin-cholesterol acyltransferase levels. Transcriptomic analysis revealed fast-to-slow fiber type transition, increased amount of mtDNA encoded transcripts and modulation of 12 transcripts notably related to extracellular matrix (ECM), oxidative phosphorylation (OXPHOS), as well as partially characterized and novel transcripts. The training simultaneously induced the expression of genes related to slow fiber type transition, OXPHOS and ECM, which might contribute to the improvement of glucose and lipid metabolisms and whole body aerobic capacity.

Food insecurity, food and nutrition programs, and aging: experiences from Georgia

Food insecurity and hunger are real and growing problems in the United States. Among older adults, the prevalence of food insecurity is at a 14-year high and occurred in more than 8% of households with older adults in 2008 according to USDA. However, the rate is at least 10% higher when less severe degrees of food insecurity are considered. Emerging research suggests that several segments of the older adult population are particularly vulnerable to food insecurity, including those receiving or requesting congregate meals, home-delivered meals, and other community-based services. Thus, national and state estimates of food insecurity may obscure problems in specific subgroups of older adults. Older adults are at high risk of chronic health problems that can be exacerbated by food insecurity, poor nutritional status, and low physical activity. To help improve targeting of food and nutrition programs to those most in need because of food insecurity and/or nutrition-related chronic health problems, the purposes of this review are (1) to define the prevalence and consequences of food insecurity; (2) to discuss the outcomes of some food, nutrition, disease prevention, and health promotion programs targeted to older adults in Georgia, the state with the 3rd highest prevalence of food insecurity; and (3) to make recommendations for research, service, and advocacy related to monitoring and alleviating food insecurity and related health problems in older adults.

Community covariates of malnutrition based mortality among older adults

PURPOSE

The purpose of this study was to identify community level covariates of malnutrition-based mortality among older adults. A community level framework was delineated which explains rates of malnutrition-related mortality among older adults as a function of community levels of socioeconomic disadvantage, disability, and social isolation among members of this group.

METHODS

County level data on malnutrition mortality of people 65 years of age and older for the period 2000-2003 were drawn from the CDC WONDER system databases. County level measures of older adult socioeconomic disadvantage, disability, and social isolation were derived from the 2000 US Census of Population and Housing. Negative binomial regression models adjusting for the size of the population at risk, racial composition, urbanism, and region were estimated to assess the relationships among these indicators.

RESULTS

Results from negative binomial regression analysis yielded the following: a standard deviation increase in socioeconomic/physical disadvantage was associated with a 12% increase in the rate of malnutrition mortality among older adults (p < 0.001), whereas a standard deviation increase in social isolation was associated with a 5% increase in malnutrition mortality among older adults (p < 0.05).

CONCLUSIONS

Community patterns of malnutrition based mortality among older adults are partly a function of levels of socioeconomic and physical disadvantage and social isolation among older adults.

The role of functional foods, nutraceuticals, and food supplements in intestinal health

New eating habits, actual trends in production and consumption have a health, environmental and social impact. The European Union is fighting diseases characteristic of a modern age, such as obesity, osteoporosis, cancer, diabetes, allergies and dental problems. Developed countries are also faced with problems relating to aging populations, high energy foods, and unbalanced diets. The potential of nutraceuticals/functional foods/food supplements in mitigating health problems, especially in the gastrointestinal (GI) tract, is discussed. Certain members of gut microflora (e.g., probiotic/protective strains) play a role in the host health due to its involvement in nutritional, immunologic and physiological functions. The potential mechanisms by which nutraceuticals/functional foods/food supplements may alter a host's health are also highlighted in this paper. The establishment of novel functional cell models of the GI and analytical tools that allow tests in controlled experiments are highly desired for gut research.

Resting metabolic rate can vary with age independently from body mass changes in the Colorado potato beetle, Leptinotarsa decemlineata

Temperature and mass dependency of insect metabolic rates are well known, while less attention has been given to other factors, such as age. Among insect species that experience seasonal variation in environmental conditions, such as in temperate latitudes, age may also have indirect effects on the metabolic rate. We examined the effect of age on the resting metabolic rate of Leptinotarsa decemlineata during 11 days after adult emergence by using flow-through respirometry. Age had a significant mass-independent effect on metabolic rate of beetles. A twofold increase in metabolic rate occurred during the first 2 days of adult life after which metabolic rate decreased with age relatively slowly. Ten day-old adult beetles had a metabolic rate similar to newly emerged beetles. The beetles have to be able to complete their development and prepare for overwintering during the relatively short favourable summer periods. Therefore, the observed pattern in metabolic rate may reflect physiological changes in the pre-diapause beetles adapted to temperate latitudes.

Food form and portion size affect postprandial appetite sensations and hormonal responses in healthy, nonobese, older adults

Data are limited concerning the dietary factors that influence appetite control in older adults. This study examined the effects of food form and portion size on appetite in 43 older adults (age: 72 +/- 1 years; BMI: 25.6 +/- 0.3 kg/m(2)). Subjects were assigned to groups based on portion size of the test meal (12.5% (n = 18) vs. 25% (n = 25) of estimated energy need). Subjects randomly consumed, on two separate days, the respective solid or beverage test meal. Appetite sensations and hormonal responses were measured over 4 h. Main effects of food form (P < 0.05) and/or portion size (P < 0.05) were observed for each appetite sensation. Postprandial hunger and desire to eat were greater following beverage vs. solid meal (between 12.5% vs. 25%), whereas fullness was lower after beverage vs. solid meal (P < 0.05). Main effects of food form and/or portion size were observed for glucose, insulin, and ghrelin. Postprandial glucose and insulin concentrations were lower after beverage vs. solid meal (between 12.5% vs. 25%; all comparisons, P < 0.05) whereas beverage meal led to greater 4-h ghrelin vs. solid meal (P = 0.09). No main effects were observed for glucagon-like peptide-1 (GLP-1) or cholecystokinin (CCK). When adjusting for age, food form remained significant for postprandial hunger and fullness; portion size remained significant for postprandial glucose. Greater hunger and reduced satiety with accompanying glucose, insulin, and ghrelin following the beverage vs. solid meals, and to some extent, in smaller vs. larger portions suggest that appetite control is influenced by food form and portion size in older adults. These findings may enhance the development of appropriate dietary strategies that help to regulate energy balance.

The effect of exercise training on resting metabolic rate in type 2 diabetes mellitus

PURPOSE

Exercise is a possible means to increase resting energy expenditure, which could offset age-related metabolic declines and facilitate weight management, both of which are particularly important for people who have type 2 diabetes mellitus. We sought to determine the effects of aerobic exercise training and resistance exercise training and the incremental effect of combined aerobic and resistance exercise training on resting metabolic rate (RMR) in previously sedentary individuals with type 2 diabetes.

METHODS

After a 4-wk run-in period, 103 participants (72 male, 31 female, 39-70 yr, mean +/- SD body mass index = 32.9 +/- 5.7 kg x m(-2)) were randomly assigned to four groups for 22 wk: aerobic training, resistance training, combined aerobic and resistance exercise training, or waiting-list control. Exercise training was performed three times per week at community-based gym facilities. RMR was measured by indirect calorimetry for 30 min after an overnight fast. Body composition was assessed using bioelectrical impedance. These measurements were taken at baseline, at 3 months, and at 6 months of the intervention.

RESULTS

RMR did not change significantly in any group after accounting for multiple comparisons despite significant improvements in peak oxygen consumption and muscular strength in the exercising groups. Adjusting RMR for age, sex, fat mass, and fat-free mass in various combinations did not alter these results.

CONCLUSION

These results suggest that RMR was not significantly changed after a 6-month exercise program, regardless of modality, in this sample of adults with type 2 diabetes.

Prohibitin couples diapause signalling to mitochondrial metabolism during ageing in C. elegans

Marked alterations in cellular energy metabolism are a universal hallmark of the ageing process. The biogenesis and function of mitochondria, the energy-generating organelles in eukaryotic cells, are primary longevity determinants. Genetic or pharmacological manipulations of mitochondrial activity profoundly affect the lifespan of diverse organisms. However, the molecular mechanisms regulating mitochondrial biogenesis and energy metabolism during ageing are poorly understood. Prohibitins are ubiquitous, evolutionarily conserved proteins, which form a ring-like, high-molecular-mass complex at the inner membrane of mitochondria. Here, we show that the mitochondrial prohibitin complex promotes longevity by modulating mitochondrial function and fat metabolism in the nematode Caenorhabditis elegans. We found that prohibitin deficiency shortens the lifespan of otherwise wild-type animals. Notably, knockdown of prohibitin promotes longevity in diapause mutants or under conditions of dietary restriction. In addition, prohibitin deficiency extends the lifespan of animals with compromised mitochondrial function or fat metabolism. Depletion of prohibitin influences ATP levels, animal fat content and mitochondrial proliferation in a genetic-background- and age-specific manner. Together, these findings reveal a novel mechanism regulating mitochondrial biogenesis and function, with opposing effects on energy metabolism, fat utilization and ageing in C. elegans. Prohibitin may have a similar key role in modulating energy metabolism during ageing in mammals.

Telomere shortening and survival in free-living corvids

Evidence accumulates that telomere shortening reflects lifestyle and predicts remaining lifespan, but little is known of telomere dynamics and their relation to survival under natural conditions. We present longitudinal telomere data in free-living jackdaws (Corvus monedula) and test hypotheses on telomere shortening and survival. Telomeres in erythrocytes were measured using pulsed-field gel electrophoresis. Telomere shortening rates within individuals were twice as high as the population level slope, demonstrating that individuals with short telomeres are less likely to survive. Further analysis showed that shortening rate in particular predicted survival, because telomere shortening was much accelerated during a bird's last year in the colony. Telomere shortening was also faster early in life, even after growth was completed. It was previously shown that the lengths of the shortest telomeres best predict cellular senescence, suggesting that shorter telomeres should be better protected. We test the latter hypothesis and show that, within individuals, long telomeres shorten faster than short telomeres in adults and nestlings, a result not previously shown in vivo. Moreover, survival selection in adults was most conspicuous on relatively long telomeres. In conclusion, our longitudinal data indicate that the shortening rate of long telomeres may be a measure of 'life stress' and hence holds promise as a biomarker of remaining lifespan.

Interaction between muscle temperature and contraction velocity affects mechanical efficiency during moderate-intensity cycling exercise in young and older women

The effect of elevated muscle temperature on mechanical efficiency was investigated during exercise at different pedal frequencies in young and older women. Eight young (24 +/- 3 yr) and eight older (70 +/- 4 yr) women performed 6-min periods of cycling at 75% ventilatory threshold at pedal frequencies of 45, 60, 75, and 90 rpm under control and passively elevated local muscle temperature conditions. Mechanical efficiency was calculated from the ratio of energy turnover (pulmonary O(2) uptake) and mechanical power output. Overall, elevating muscle temperature increased (P < 0.05) mechanical efficiency in young (32.0 +/- 3.1 to 34.0 +/- 5.5%) and decreased (P < 0.05) efficiency in older women (30.2 +/- 5.6 to 27.9 +/- 4.1%). The different effect of elevated muscle temperature in young and older women reflects a shift in the efficiency-velocity relationship of skeletal muscle. These effects may be due to differences in recruitment patterns, as well as sarcopenic and fiber-type changes with age.

Physical activity, energy requirements, and adequacy of dietary intakes of older persons in a rural Filipino community

Background

Aging is a process associated with physiological changes such as in body composition, energy expenditure and physical activity. Data on energy and nutrient intake adequacy among elderly is important for disease prevention, health maintenance and program development.

Methods

This descriptive cross-sectional study was designed to determine the energy requirements and adequacy of energy and nutrient intakes of older persons living in private households in a rural Filipino community. Study participants were generally-healthy, ambulatory, and community living elderly aged 60–100 y (n = 98), 88 of whom provided dietary information in three nonconsecutive 24-hour food-recall interviews.

Results

There was a decrease in both physical activity and food intake with increasing years. Based on total energy expenditure and controlling for age, gender and socio-economic status, the average energy requirement for near-old (≥ 60 to < 65 y) males was 2074 kcal/d, with lower requirements, 1919 and 1699 kcal/d for the young-old (≥ 65 to < 75 y) and the old-old (≥ 75 y), respectively. Among females, the average energy requirements for the 3 age categories were 1712, 1662, and 1398 kcal/d, respectively. Actual energy intakes, however, were only ~65% adequate for all subjects as compared to energy expenditure. Protein, fat, and micronutrients (vitamins A and C, thiamin, riboflavin, iron and calcium) intakes were only ~24–51% of the recommended daily intake. Among this population, there was a weight decrease of 100 g (p = 0.012) and a BMI decrease of 0.04 kg/m² (p = 0.003) for every 1% decrease in total caloric intake as percentage of the total energy expenditure requirements.

Conclusion

These community living elderly suffer from lack of both macronutrient intake as compared with energy requirements, and micronutrient intake as compared with the standard dietary recommendations. Their energy intakes are ~65% of the amounts required based on their total energy expenditure. Though their intakes decrease with increasing age, so do their energy expenditure, making their relative insufficiency of food intake stable with age.

Metabolic ageing in individual zebra finches

Oxidative stress is suggested as a contributor to the ageing process. Knowledge of the relationship between age and energy expenditure may contribute to our understanding of ageing patterns, due to the link between oxygen consumption and free radical production. However, studies on basal metabolic rate (BMR) and age have generally been cross-sectional, which may confound estimates of the age effect due to disproportionate mortality (also known as 'selective disappearance'). We therefore performed a longitudinal study of BMR using captive zebra finches (Taeniopygia guttata) up to 5 years of age. BMR declined with age in individuals of both sexes when body mass was controlled for. Males gained mass with age while females did not. There was no evidence for disproportionate mortality with respect to BMR in either sex. To our knowledge, this is the first longitudinal study of avian BMR over such a long proportion of the lifespan of the study species.

Nutritional considerations for older adults with type 2 diabetes

As Western populations age, the burden of associated chronic diseases, including diabetes, cardiovascular disease (CVD), and cancer will increase dramatically. In the United States in the next 50 years, it is projected that the percentage of adults with type 2 diabetes will exceed 30%, with the vast majority older than 65 years. It is therefore important to determine the best possible dietary and lifestyle modifications to prevent and control this disease and its associated complications. Although few data are available regarding the optimal nutritional regimen for the elderly with type 2 diabetes, as a general rule, the use of nutrient-dense, low glycemic index, high-dietary fiber foods with possibly higher protein intake is recommended.

Which physicians are best prepared to advise seniors about nutrition? A pilot survey in Israel

Physicians' knowledge and attitudes can profoundly impact the quality of nutritional care provided to older patients. We assessed physicians' knowledge and attitudes concerning nutritional care for older adults and its correlates. Questionnaires were mailed to 898 physicians in the second largest HMO in Israel: the response rate was 26.5%. Questionnaires assessed aspects of geriatric nutrition, such as food choices, functioning, and medical conditions. Results indicated highest knowledge of nutritional issues for family physicians and for those who were younger (<50 age) and female. Although 68% believed it is important for physicians to explain nutritional issues to older patients, this role was also deemed important for dietitians (83%) and nurses (59%). A variety of factors influencing geriatric nutrition, especially functional and medical conditions, were identified; likewise, nutrition was perceived as influencing various health conditions. Although the low response rate limits generalizability, it appears that physicians in this survey recognized the impact of proper nutrition health and take responsibility for explaining nutrition to their older patients.

Immune receptor signaling, aging and autoimmunity

Aging is associated with a myriad of changes including alterations in glucose metabolism, brain function, hormonal regulation, muscle homeostasis and the immune system. Aged dividuals, generally still defined as over 65 years old, differ from middle-aged or young donors in many features of the immune system. The major observation is that the elderly population is not able to cope with infections as well as younger adults and recovery generally takes longer. Moreover, some diseases first appear with advancing age and are likely associated with dysfunction of the immune system. Thus, Alzheimer's disease, atherosclerosis, type II diabetes and some autoimmune disorders are linked to changes in immune function. One major immune cell population implicated as being responsible for the initiation and chronicity of immune dysfunction leading to diseases or immunosuppression is the T-cell. Although many changes in B-cell and innate immune function in aging are associated with the appearance of disease, they are not as well studied and clearly demarcated as changes in the T-cell compartment. The adaptive immune system is coordinated by T-cells, the activation of which is required for the initiation, maintenance and termination of responses against pathogens. Changes in the expression and functions of the T-cell receptor (TCR) for antigen and its co-receptors are closely associated with immunosenescence. Certain similar changes have also been found in some other disease states, e.g., rheumatoid arthritis, systemic lupus erythematosus and cancer. In this chapter, we will summarize our knowledge about multichain immune recognition receptor signaling, mainly the TCR, in aging and autoimmune diseases.

Interaction of age and specific saliva component output on caries

BACKGROUND AND AIMS

The purpose of this study was to explore the relationship between individual salivary components, dental caries and age, utilizing the data from the Oral Health: San Antonio Longitudinal Study of Aging (OH:SALSA).

METHODS

The study population comprised a well-defined stratified sample of 811 dentate men and women. Subjects were divided into four age groups from 35 to 75+ years old. Unstimulated and stimulated submandibular/sublingual saliva flow rates, unstimulated and stimulated parotid saliva flow rates, total protein, 6 individual proteins and 4 inorganic constituents were measured. Specific salivary components were lactoferrin, secretory IgA, albumin, lysozyme, mucin, cystatin, K+, Ca2+, Na+ and Cl-. Caries measurements were the DMFT Index for crowns and for roots, Tooth Health Index for crowns and roots, Tooth caries, Root caries and Tooth restoration. The data on saliva components were square root transformed for linearity prior to analysis. Analysis was carried out in two stages. Partial correlation was performed, in order to identify significant relationships between specific salivary components and caries measurements, controlling for age group. In the second stage, using caries measurement as the dependant variable, the effects of age, flow rate and specific salivary component output (product of flow rate and concentration) were examined.

RESULTS

Significant associations were found between caries, age and specific individual submandibular/sublingual salivary proteins (lactoferrin, albumin, lysozyme, mucin and cystatin) and specific inorganic constituents (K+, Ca2+, Na+ and Cl-).

CONCLUSIONS

Changes in submandibular/ sublingual salivary component output during aging are correlated with high caries prevalence. These changes in saliva components over age may represent caries risk indicators.

Need states based on eating occasions experienced by midlife women

OBJECTIVE

To identify a comprehensive set of distinct "need states" based on the eating occasions experienced by midlife women.

DESIGN

Series of 7 focus group interviews.

SETTING

Meeting room on a university campus.

PARTICIPANTS

A convenience sample of 34 multi-ethnic women (mean age = 46 years).

PHENOMENON OF INTEREST

Descriptions of eating occasions by "need states," specific patterns of needs for the occasion.

ANALYSIS

Interviews were audiotaped, transcribed verbatim, and analyzed for common themes using qualitative data analysis procedures.

FINDINGS

Eight need states suggested a hypothetical framework reflecting a wide range in emotional gratification. Need states with a low level of emotional gratification were dominated by sets of functional needs, such as coping with stress, balancing intake across occasions, meeting external demands of time and effort, and maintaining a routine. Food was a means for reinforcing family identity, social expression, and celebration in need states with high levels of emotional gratification. Occurrence of need states varied by day and meal/snack occasion, with food type and amount dependent on need state.

CONCLUSIONS AND IMPLICATIONS

Eating occasions are driven by specific sets of needs ranging from physical/functional to more emotional/social needs. Addressing need states may improve weight intervention programs for midlife women.

Differences in eating behaviors between nonobese, weight stable young and older adults

Habitual dietary intake, dietary cognitive restraint (CR), disinhibition and hunger are eating behaviors that influence energy balance in both young and older adults. Since the prevalence of overweight and obesity in older adults is steadily rising, it is important to identify eating behavior adaptations that allow individuals to maintain a healthy body weight with advancing age. The association of age with habitual dietary intake, dietary CR, dishinhibition and hunger was examined in 30 older (60-72 years) and 30 younger (18-25 years) nonobese, weight stable, nondieting healthy adults pair-matched by age group for sex, physical activity level (active >150 min of physical activity per week, sedentary <150 min of physical activity per week) and BMI. Dietary CR was significantly greater and hunger was significantly less in older compared to young adults (both P<0.05). Disinhibition scores, habitual energy and macronutrient intake did not differ between age groups. These results indicate that weight management in older, nonobese adults may be facilitated by increased dietary CR and decreased susceptibility to hunger with age. Additionally, changes in energy and macronutrient intake may not be necessary for successful weight management with advancing age.

The epidemiology of obesity: the size of the problem

The epidemic of obesity took off from about 1980 and in almost all countries has been rising inexorably ever since. Only in 1997 did WHO accept that this was a major public health problem and, even then, there was no accepted method for monitoring the problem in children. It was soon evident, however, that the optimum population body mass index is about 21 and this is particularly true in Asia and Latin America where the populations are very prone to developing abdominal obesity, type 2 diabetes and hypertension. These features are now being increasingly linked to epigenetic programming of gene expression and body composition in utero and early childhood, both in terms of fat/lean tissue ratios and also in terms of organ size and metabolic pathway regulation. New Indian evidence suggests that insulin resistance at birth seems linked to low birth weight and a higher proportion of body fat with selective B12 deficiency and abnormalities of one carbon pool metabolism potentially responsible and affecting 75% of Indians and many populations in the developing world. Biologically there are also adaptive biological mechanisms which limit weight loss after weight gain and thereby in part account for the continuing epidemic despite the widespread desire to slim. Logically, the burden of disease induced by inappropriate diets and widespread physical inactivity can be addressed by increasing physical activity (PA), but simply advocating more leisure time activity is unrealistic. Substantial changes in urban planning and diet are needed to counter the removal of any every day need for PA and the decades of misdirected food policies which with free market forces have induced our current 'toxic environment'. Counteracting this requires unusual policy initiatives.

The fundamental drivers of the obesity epidemic

Most policy makers do not yet understand that the obesity epidemic is a normal population response to the dramatic reduction in the demand for physical activity and the major changes in the food supply of countries over the last 40 years. A national focus on individual behaviour reflects a failure to confront the facts. Thus, the changes in food supply and physical environment are socioeconomically driven, and the health sector simply picks up the consequences. Urbanization alone in China has reduced daily energy expenditure by about 300-400 kcal d(-1) and cycling/bussing or going to work by car determines another variation of 200 kcal d(-1). Thus, energy demands may have dropped with additional TV/media, mechanization and computerized changes by 400-800 kcal d(-1), so weight gain and obesity are inevitable for most or all the population. Food intake should have fallen substantially despite the community's focus on the value of food after all the food crises of the past. Yet, Chinese fat and sugar intakes are escalating, and these policy-mediated features are amplified by the primeval biological drive for those commodities with specialized taste buds for fatty acids, meat, sugar and salt. Yet, traditionally, Chinese diets had negligible sugar, and 25-year-old data show that the optimum diet for Chinese contains 15% fat. Policies relating to food imports, agriculture, food quality standards, appropriate food traffic light labelling, price adjustments and controlled access to unhealthy foods are all within the grasp of the Chinese government. China has traditionally been far more responsive to the value of policies which limit inequalities and establish standards of care than many western governments, who have yet to recognize that the individualistic free-market approach to obesity prevention is guaranteed to fail. China could therefore lead the way: if it follows western approaches, the health and economic burden will become unsustainable.

A biometeorological procedure for weather forecast to assess the optimal outdoor clothing insulation

Clothing insulation represents an important parameter strongly dependent on climate/weather variability and directly involved in the assessment of the human energy balance. Few studies tried to explore the influence of climate changes on the optimal clothing insulation for outdoor spaces. For this reason, the aim of this work was to investigate mainly the optimal outdoor minimum clothing insulation value required to reach the thermal neutrality (min_clo) related to climate change on a seasonal basis. Subsequently, we developed an example of operational biometeorological procedure to provide 72-hour forecast maps concerning the min_clo. Hourly meteorological data were provided by three Italian weather stations located in Turin, Rome and Palermo, for the period 1951-1995. Environmental variables and subjective characteristics referred to an average adult young male at rest and at a very high metabolic rate were used as input variables to calculate the min_clo by using a thermal index based on the human energy balance. Trends of min_clo were assessed by a non-parametric statistical method. Results showed a lower magnitude of trends in a subject at a very high metabolic rate than at rest. Turin always showed a decrease of min_clo during the study period and prevalently negative trends were also observed in Palermo. On the other hand, an opposite situation was observed in Rome, especially during the morning in all seasons. The development of a daily operational procedure to forecast customized min_clo could provide useful information for the outdoor clothing fitting that might help to reduce the weather-related human health risk.

Adverse renal consequences of obesity

Emerging evidence indicates that obesity, even in the absence of diabetes, contributes significantly to the development and progression of chronic kidney disease (CKD). Glomerular hyperfiltration/hypertrophy in response to the increased metabolic needs of obesity are postulated to lead to the development of glomerulosclerosis (GS) in a manner analogous to that in reduced renal mass states. Nevertheless, the individual risk for developing GS with obesity is very low. It is proposed that glomerular hyperfiltration/hypertrophy are per se not pathogenic in the absence of an enhanced glomerular blood pressure (BP) transmission, and the modest preglomerular vasodilation that is likely present in the large majority of obese individuals is not sufficient to result in such increased BP transmission. However, in the small subset of obese individuals who are also born with a substantially reduced nephron number, there is a greater risk of enhanced glomerular BP transmission due to the substantially greater preglomerular vasodilation. Of perhaps greater clinical importance, similar additive deleterious effects of obesity on BP transmission would be expected in individuals with reduced renal mass, either congenital or acquired, or with concurrent renal disease, leading to accelerated progression. Of note, a low birth weight may be a risk factor for not only reduced nephron numbers at birth, but also for obesity and hypertension, resulting in a clustering of risk factors for progressive GS. Therefore, even though the individual risk for developing obesity GS is low, the cumulative impact of obesity on the public health burden of CKD is likely to be large because of its huge prevalence.

Oscillations in total body fat content through life: an evolutionary perspective

Adipose tissue is considered an efficient system in which to store energy. Throughout life, the total amount of body fat exhibits some oscillations. Typically, there are three specific periods in which there are notable increases in fat mass, specifically early in life, during pregnancy and lactation, and with ageing. The existence of the first two peaks in fat mass has been interpreted, from an evolutionary point of view, as a beneficial manoeuvre to protect against the scarcity of energy to the offspring of the species. Nevertheless, the role of increasing body fat with ageing is more dubious. However, recent evidence suggests that the gain in adiposity in senescence may also be interpreted in the same evolutionary context. The aim of this review is to focus on the age-related changes in fat depots. In addition, an evolutionary explanation to the observed changes has been emphasized.

Energy, macronutrient and fatty acid intake of French elderly community dwellers and association with socio-demographic characteristics: data from the Bordeaux sample of the Three-City Study

Few data are available regarding dietary habits of the elderly, in particular about fatty acid consumption, whereas these are major risk or protective factors of several age-related diseases. The aim of the present study was to characterise the dietary intake of a French elderly population in terms of energy, macronutrients and fatty acids based on their socio-demographic characteristics. The study population (age range 67·7–94·9 years) consisted of 1786 subjects from Bordeaux (France), included in the Three-City cohort. Dietary assessment was performed by a 24 h recall, allowing the estimation of energy, protein, carbohydrate, total fat, SFA, MUFA and PUFA intakes. Socio-demographic characteristics (age, sex, marital status, educational level and income), practice of sports and BMI were registered. Total energy intake (EI) was lower in women and in older participants ( ≥ 85 years) but higher in single subjects. Higher EI was associated with higher income, but not with educational level. Mean contribution of macronutrients to EI (protein 18 %, carbohydrate 46 % and total fat 31 %) was higher in women than men, except for alcohol. The oldest individuals consumed less protein and more mono- and disaccharides. Excess saturated fat intake (43 % of total fat), associated with a relative deficit in MUFA consumption (36 % of total fat), was observed. The mean 18 : 2n-6 : 18 : 3n-3 ratio was 9.9 and decreased with higher educational level. The present results suggest that being female, older age, being widowed and low income level could be considered as risk factors of inadequate dietary intake.

Short-term overfeeding increases resting energy expenditure in patients with HIV lipodystrophy

BACKGROUND

HIV lipodystrophy and other lipodystrophy syndromes are characterized by extensive loss of subcutaneous adipose tissue. Lipodystrophy syndromes are also associated with increased resting energy expenditure (REE). This hypermetabolism may be an adaptive response to an inability to store triacylglycerol fuel in a normal manner.

OBJECTIVE

This study was done to determine whether REE increases significantly after short-term overfeeding in patients with HIV lipodystrophy.

DESIGN

REE was measured in HIV-infected patients with lipodystrophy (n = 9) and in HIV-infected (n = 10) and healthy (n = 9) controls after 3 d on a eucaloric diet and again after 3 d on a diet of similar composition but increased in calories by 50%.

RESULTS

After 3 d of eucaloric feeding, REE was significantly higher in patients with HIV lipodystrophy [33.2 +/- 0.27 kcal/kg lean body mass (LBM)] than for both HIV-infected and healthy controls (29.9 +/- 0.26 and 29.6 +/- 0.27 kcal/kg LBM, respectively; P < 0.01). Furthermore, after 3 d of overfeeding, REE increased significantly in patients with HIV lipodystrophy but not in the control groups (33.2 +/- 0.27 vs 34.7 +/- 0.27 kcal/kg LBM; P < 0.01). Finally, postprandial thermogenesis did not differ among the groups after a "normal" test meal but tended to be higher in patients with HIV lipodystrophy than in healthy controls after a large test meal.

CONCLUSIONS

Adaptive thermogenesis in the resting component of total daily energy expenditure and in the postprandial period may be a feature of the HIV lipodystrophy syndrome and may be due to an inability to store triacylglycerol fuel in a normal manner.

Inadequate dietary protein increases hunger and desire to eat in younger and older men

Many older people experience changes in appetite and consume marginal or inadequate dietary protein. This study was designed to examine the appetitive responses to habitual protein intakes that span the range of adequacy in younger and older men. Twenty-two men (12 younger, aged 21-43 y and 10 older, aged 63-79 y) completed, in random order, three 18-d trials that involved consumption of individualized, isoenergetic menus providing 1.00, 0.75, and 0.50 g protein . kg BW(-1). d(-1), which were 125% (trial P125), 94% (trial P94), and 63% (trial P63) of the Recommended Dietary Allowance for protein. Near the end of each trial, the subjects recorded appetitive sensations hourly throughout one day using a visual analogue scale. Independent of age, ratings of hunger were lower for P125 (1.3 +/- 0.5 cm) than P94 (1.8 +/- 0.8 cm) and P63 (1.8 +/- 0.6 cm) (P = 0.037), and desire to eat was lower during the P125 trial (1.4 +/- 0.5 cm), compared with the P63 trial (2.1 +/- 0.7 cm) (P = 0.003), and P94 (1.8 +/- 0.7 cm) was not different when compared with P63 and P125. Protein intake did not influence fullness. These results show that younger and older men who consume inadequate protein experience appetite changes that may promote increased food intake.

Effects of acute and chronic protein intake on metabolism, appetite, and ghrelin during weight loss

OBJECTIVE

This study evaluated the effects of acute and chronic consumption of higher dietary protein on energy expenditure, macronutrient use, appetite, and appetite-regulating hormones during weight loss in women.

RESEARCH METHODS AND PROCEDURES

Thirty-eight women chronically consuming a 750 kcal/d energy-deficit diet with a protein content of 30% (higher protein-chronic diet, HP-CD, n = 21) or 18% (normal protein-chronic diet, NP-CD, n = 17) for 9 weeks were tested. On separate days, metabolic, appetite, and hormonal responses were measured over 4 hours when the women consumed a higher protein-acute meal (HP-AM) (30% of energy as protein) or a normal protein-acute meal (NP-AM) (18% of energy as protein).

RESULTS

With chronic diet groups combined, HP-AM led to lower respiratory exchange ratio (0.829 +/- 0.005 vs. 0.843 +/- 0.008; p < 0.05), lower carbohydrate oxidation (p < 0.05), and higher fat oxidation (p < 0.05) compared with NP-AM. HP-AM also led to reduced self-reported postprandial hunger (p < 0.001) and desire to eat (p < 0.001) and lower postprandial ghrelin (252 +/- 16 vs. 274 +/- 18 ng/mL x 240 minutes, p < 0.05) compared with NP-AM. No differences in postprandial energy expenditure (PPEE) occurred between meals. When combining acute meals, respiratory exchange ratio was lower (p < 0.05) and protein oxidation (p < 0.001) was higher in the HP-CD vs. NP-CD. An acute meal-by-chronic diet interaction was observed with PPEE such that HP-AM led to greater PPEE in the HP-CD vs. NP-CD (28.7 +/- 2.7 vs. 19.9 +/- 2.7 kcal/min for 195 minutes; p < 0.05).

CONCLUSIONS

During weight loss, thermogenesis and protein use appear to be influenced by chronic protein intake, while appetite and ghrelin are more responsive to acute protein intake.

Prediction of air temperature for thermal comfort of people in outdoor environments

Current thermal comfort indices do not take into account the effects of wind and body movement on the thermal resistance and vapor resistance of clothing. This may cause public health problem, e.g. cold-related mortality. Based on the energy balance equation and heat exchanges between a clothed body and the outdoor environment, a mathematical model was developed to determine the air temperature at which an average adult, wearing a specific outdoor clothing and engaging in a given activity, attains thermal comfort under outdoor environment condition. The results indicated low clothing insulation, less physical activity and high wind speed lead to high air temperature prediction for thermal comfort. More accurate air temperature prediction is able to prevent wearers from hypothermia under cold conditions.

Habitual physical activity differentially affects acute and short-term energy intake regulation in young and older adults

BACKGROUND

Energy intake (EI) regulation is impaired in older adults, but it is not known if habitual physical activity affects accuracy of EI regulation in older compared with young adults.

OBJECTIVE

We hypothesized that the ability to compensate for a high-energy yogurt preload beverage at a subsequent ad libitum meal (i.e. acute compensation) and over the course of the testing day (i.e. short-term compensation) would decrease with age, but the magnitude of the decline would be smaller in physically active compared with sedentary older adults.

DESIGN

On two occasions, young active (n=15), young sedentary (n=14), older active (n=14) and older sedentary (n=11) subjects consumed either a high-energy yogurt preload beverage (YP: 500 ml, 1988 kJ, men; 375 ml, 1507 kJ, women), or no preload (NP), 30 min before an ad libitum test meal. EI at both ad libitum meals was measured, and total daily EI was determined on both testing days. Percent EI compensation for the YP was calculated for the test meal and testing day to determine acute and short-term compensation.

RESULTS

Percent EI compensation at the test meal was significantly lower in the older compared with the young subjects (65+/-4 vs 81+/-4%, P=0.005). There was no effect of habitual physical activity level on acute compensation, and no age by physical activity level interaction (P=0.60). In contrast, short-term compensation was not different with age (87+/-5 vs 93+/-6%, older vs young, P=0.45), but was more accurate in active vs sedentary subjects (100+/-5 vs 79+/-6%, P=0.01). As with acute compensation, there was no age by physical activity interaction (P=0.39).

CONCLUSION

Acute EI regulation is impaired in older adults, which is not attenuated by physical activity status. However, EI regulation over the course of a day is more accurate in active vs sedentary adults, which may facilitate long-term energy balance. Future work is needed to determine if higher energy expenditure in older active vs older sedentary adults improves long-term EI regulation.

Short-term energy restriction reduces resting energy expenditure in patients with HIV lipodystrophy and hypermetabolism

We have previously shown that resting energy expenditure (REE) is increased in patients with HIV lipodystrophy. This hypermetabolism could be the result of an inadequate storage capacity for lipid fuel secondary to atrophy of the subcutaneous adipose tissue depot. Therefore, energy restriction may be able to alleviate this hypermetabolism. To test this hypothesis, we measured REE in HIV-infected patients with lipodystrophy and hypermetabolism and in HIV-infected and healthy controls. Measurements were taken during the overnight fasted state after 3 days on a eu-energetic diet and again after 3 days on a diet of similar composition but reduced in energy by 50%. After 3 days of eu-energetic feeding, REE was significantly higher in HIV-infected patients with lipodystrophy compared with healthy controls (139.5 +/- 1.3 vs 117.2 +/- 1.3 kJ/kg lean body mass, P < .001) and tended to be higher compared with HIV-infected subjects without lipodystrophy (139.5 +/- 13 vs 127.3 +/- 1.4 kJ/kg lean body mass, P = .06). Furthermore, energy restriction caused a significant decline in REE in patients with HIV lipodystrophy (P < .001). This dietary manipulation did not lead to a significant reduction in REE in either HIV-infected or healthy controls. This suggests that energy intake and REE may be uniquely coupled in patients with lipodystrophy as a means to dissipate energy that cannot be stored in a normal manner. A better understanding of this coupling would have important implications for weight regulation in general.

Ghrelin, anthropometry and nutritional assessment in geriatric hospital patients

Loss of appetite is an important causal factor for malnutrition in the elderly, and age-associated changes of hormone levels seem to be of great relevance in this regard. At present there has been no study exploring the role of the appetite stimulating hormone ghrelin in geriatric hospital patients.

STUDY POPULATION

121 (f 82, m 39) patients from two geriatric wards of our hospital. Mean age was 80.2+/-7.7 years.

RESULTS

The basal ghrelin level (mean 158.43+/-144.02 pg/ml) showed no gender difference. No association with the age of the patients could be demonstrated. There was an inverse correlation of basal ghrelin with BMI, upper arm circumference, triceps skin fold, basal leptin and insulin. No correlation between established screening/assessment tools for malnutrition - Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Nutritional Risk Screening (NRS) - could be shown. Even after grouping the ghrelin levels into six different disease categories, no significant difference could be shown between them.

CONCLUSION

For our patients aged 67 to 94, no correlation with age could be shown. Nevertheless the basal level of ghrelin is substantially lower when compared to a younger population with similar BMI, while the anorectic hormone leptin shows no substantial difference. This causes a more anorectic hormonal constellation which may contribute to the loss of appetite in geriatric patients.

The anorexia of aging

Malnutrition in the elderly is one of the greatest threats to health, well-being and autonomy, it is therefore crucial to understand and to contrast the causal factors of inadequate energy intake. This review focuses on the mechanisms of the so-called 'anorexia of aging'. In recent years, it has been shown that elderly subjects have abnormal peripheral signal patterns and alterations in central hypothalamic control relays. Negative feedback from impaired gastric motility, exaggerated long-term adiposity signals (leptin, insulin) and postprandial anorexigenic signals (CCK, PYY) seem to prevail over the central feeding drive. If nutritional strategies of intervention are to be improved, these data need to be taken into account.

Tube feeding in advanced dementia: the metabolic perspective

Problems with the procedure do not fully explain its ineffectiveness

Factors Associated with Impaired Appetite in Well-Functioning Community-Dwelling Older Adults

Poor appetite in older adults is a common problem in clinical practice, but prevalence of this symptom and its risk factors in community-dwelling older adults are not well understood. As part of the Health, Aging and Body Composition Study, we ascertained self-reported impaired appetite and related factors in 2,169 older adults aged 70-79 years. About 12% of participants reported impaired appetite. Those reporting impaired appetite were more likely to be older, female, and black and to report having illness or physical conditions interfering with appetite than those not reporting impaired appetite. Hierarchical logistic regression suggested that multiple factors contributed to impaired appetite. In particular, symptomatic depression (OR (95% CI) = 2.5 (1.6- 4.1)), poor self-reported health (2.4 (1.7-3.2)), current smoking, chewing problems, reported visual impairment, weight loss since age 50, and log (TNF-alpha) were significantly related to impaired appetite.

The anorexia of aging in humans

Energy intake is reduced in older individuals, with several lines of evidence suggesting that both physiological impairment of food intake regulation and non-physiological mechanisms are important. Non-physiological causes of the anorexia of aging include social (e.g. poverty, isolation), psychological (e.g. depression, dementia), medical (e.g. edentulism, dysphagia), and pharmacological factors. Physiological factors include changes in taste and smell, diminished sensory-specific satiety, delayed gastric emptying, altered digestion-related hormone secretion and hormonal responsiveness, as well as food intake-related regulatory impairments for which specific mechanisms remain largely unknown. Studies in healthy elderly individuals have shown that men who consume diets over several weeks providing either too few or too many calories relative to dietary energy needs subsequently do not compensate for the resulting energy deficit or surplus when provided an ad libitum diet. Healthy elders have also been shown to be less hungry at meal initiation and to become more rapidly satiated during a standard meal compared to younger adults. Studies in animal models are required to investigate potential mechanisms underlying these observations, while human studies should focus on examining the potential consequences of this phenomenon and practical therapeutic strategies for the maintenance of appropriate energy intake with increasing age. In light of this need, we have recently demonstrated that low reported hunger assessed using a simple questionnaire predicts unintentional weight loss in a sample of healthy older women, and thus may provide a clinically useful tool for identifying older individuals at risk for undesirable weight change and therefore at high priority for intervention.