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Silverii GA. Optimizing metformin therapy in practice: Tailoring therapy in specific patient groups to improve tolerability, efficacy and outcomes. Diabetes Obes Metab 2024; 26 Suppl 3:42-54. [PMID: 38987983 DOI: 10.1111/dom.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 07/12/2024]
Abstract
Metformin is the first-line medication for type 2 diabetes. It is effective and safe, provided some caution is taken in specific populations. In patients with chronic kidney disease, metformin may provide long-term benefits, and it is a first-line therapy for diabetes, but the estimated glomerular filtration rate (eGFR) must be assessed regularly, to minimize the risk for metformin accumulation. When eGFR is 30-60 mL/min/1.73m2, the dose should be reconsidered, and sick-days education provided. Metformin should be discontinued when eGFR falls below 30 mL/min/1.73m2. Metformin accumulation may increase the risk for lactic acidosis if concomitant risk factors for hyperlactataemia (liver or respiratory insufficiency, sepsis, acute heart failure) are present; in these conditions, metformin is contraindicated, even although the available evidence is reassuring. Patients on metformin often complain of gastrointestinal side effects (mainly diarrhoea and nausea) during therapy initiation, but they may sometimes occur after years of stable therapy. These usually resolve if the dose is carefully titrated, or by switching to the extended-release formulation. Patients with obesity may benefit from the significant, although modest, metformin-associated weight loss and appetite reduction. During pregnancy, metformin is associated with a reduction of pregnancy complications, especially in obese women, but some concern remains, because metformin crosses the placenta, and it is associated with a significantly lower mean birth weight than insulin. In the elderly, gastrointestinal tolerability and renal function must be reassessed more often. Vitamin B-12 should be screened regularly in long-time metformin users because metformin may induce clinical vitamin B-12 deficiency.
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Affiliation(s)
- Giovanni Antonio Silverii
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Florence, Italy
- Diabetology Unit, Central Tuscany Local Health Unit, Florence, Italy
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2
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Nielsen RL, Bornæs O, Iversen E, Strejby Christensen LW, Kallemose T, Jawad B, Rasmussen HH, Munk T, Lund TM, Andersen O, Houlind MB, Leegaard Andersen A, Tavenier J. Growth differentiation factor 15 (GDF15) levels are associated with malnutrition in acutely admitted older adults. Clin Nutr 2024; 43:1685-1693. [PMID: 38879915 DOI: 10.1016/j.clnu.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND AIMS The aging process is often accompanied by high risk of malnutrition and elevated levels of growth differentiation factor 15 (GDF15). GDF15 is an increasingly recognized biomarker for regulation of metabolism, but few studies have investigated the connection between GDF15 and malnutrition in older age and how it relates to other features of aging such as decreased appetite and physical function. Therefore, we investigated the associations between GDF15 levels and nutritional status, appetite, and physical function in acutely admitted older adults. METHODS Plasma GDF15 levels were measured using immunoassays in 302 older adults (≥65 years) admitted to the emergency department (ED). Nutritional status was evaluated with the Mini Nutritional Assessment Short-Form (MNA®-SF), appetite was evaluated with the Simplified Nutritional Appetite Questionnaire (SNAQ), and physical function was evaluated with handgrip strength (HGS), 30-s chair stand test (30s-RSS), and gait speed (GS). Associations between GDF15 and each outcome was determined by logistic regression adjusted for age, sex, and C-reactive protein (CRP). RESULTS Each doubling in plasma GDF15 level was associated with an adjusted odds ratio (OR) (95% confidence interval) of 1.59 (1.10-2.29, P = 0.01) for risk of malnutrition compared to normal nutrition and 1.19 (0.85-1.69, P = 0.3)) for malnutrition compared to risk of malnutrition. Each doubling in GDF15 was associated with an adjusted OR of 1.63 (1.21-2.23)) for having poor appetite, 1.46 (1.07-1.99) for having low HGS, 1.74 (1.23-2.51) for having low 30s-RSS, and 1.99 (1.39-2.94) for having low GS. CONCLUSION Among older adults admitted to the ED, higher GDF15 levels were significantly associated with malnutrition, poor appetite, and low physical function independent of age, sex, and CRP.
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Affiliation(s)
- Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Olivia Bornæs
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Louise Westberg Strejby Christensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Baker Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, 9220 Aalborg, Denmark; The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev and Gentofte, 2100 Copenhagen, Denmark.
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev and Gentofte, 2100 Copenhagen, Denmark.
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark.
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark.
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark.
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
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Taheri N, Choi EL, Nguyen VTT, Zhang Y, Huynh NM, Kellogg TA, van Wijnen AJ, Ordog T, Hayashi Y. Inhibition of EZH2 Reduces Aging-Related Decline in Interstitial Cells of Cajal of the Mouse Stomach. Cell Mol Gastroenterol Hepatol 2024:101376. [PMID: 38969206 DOI: 10.1016/j.jcmgh.2024.101376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND & AIMS Restricted gastric motor functions contribute to aging-associated undernutrition, sarcopenia, and frailty. We previously identified a decline in interstitial cells of Cajal (ICC; gastrointestinal pacemaker and neuromodulator cells) and their stem cells (ICC-SC) as a key factor of gastric aging. Altered functionality of the histone methyltransferase enhancer of zeste homolog 2 (EZH2) is central to organismal aging. Here, we investigated the role of EZH2 in the aging-related loss of ICC/ICC-SC. METHODS klotho mice, a model of accelerated aging, were treated with the most clinically advanced EZH2 inhibitor, EPZ6438 (tazemetostat; 160 mg/kg intraperitoneally twice a day for 3 weeks). Gastric ICC were analyzed by Western blotting and immunohistochemistry. ICC and ICC-SC were quantified by flow cytometry. Gastric slow wave activity was assessed by intracellular electrophysiology. Ezh2 was deactivated in ICC by treating KitcreERT2/+;Ezh2fl/fl mice with tamoxifen. TRP53, a key mediator of aging-related ICC loss, was induced with nutlin 3a in gastric muscle organotypic cultures and an ICC-SC line. RESULTS In klotho mice, EPZ6438 treatment mitigated the decline in the ICC growth factor KIT ligand/stem cell factor and gastric ICC. EPZ6438 also improved gastric slow wave activity and mitigated the reduced food intake and impaired body weight gain characteristic of this strain. Conditional genomic deletion of Ezh2 in Kit-expressing cells also prevented ICC loss. In organotypic cultures and ICC-SC, EZH2 inhibition prevented the aging-like effects of TRP53 stabilization on ICC/ICC-SC. CONCLUSIONS Inhibition of EZH2 with EPZ6438 mitigates aging-related ICC/ICC-SC loss and gastric motor dysfunction, improving slow wave activity and food intake in klotho mice.
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Affiliation(s)
- Negar Taheri
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Egan L Choi
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Vy Truong Thuy Nguyen
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Yuebo Zhang
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Nick M Huynh
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Tamas Ordog
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Yujiro Hayashi
- Enteric Neuroscience Program and Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
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4
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Vieira RA, Nunes DP, Lima DB, Rocha GDS, Corona LP, Santos-Orlandi AAD, Sampaio EDS, Rodrigues PCDOG, de Brito TRP. Association between telomere length and anorexia of ageing: a cross-sectional study conducted with community-dwelling older people. J Hum Nutr Diet 2024. [PMID: 38856709 DOI: 10.1111/jhn.13338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND To verify whether shorter telomere length is associated with anorexia of ageing in community-dwelling older people. METHODS Conducted as a cross-sectional investigation, the study enrolled 448 participants residing in an urban area of a municipality in Brazil. Relative telomere length in blood samples was measured using quantitative polymerase chain reaction (qPCR), whereas the presence of anorexia of ageing was determined using the Simplified Appetite Nutritional Questionnaire. Data analysis employed multiple logistic regression. RESULTS Among the 448 older individuals surveyed, 70.69% were female, and the predominant age bracket ranged from 60 to 69 years (45.08%). Approximately 25% exhibited the shortest telomeric length, with a corresponding anorexia of ageing prevalence of 41.16%. Older individuals with diminished telomere lengths displayed an increased likelihood of experiencing anorexia of ageing (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.12-3.29), independent of factors such as gender, age group, depressive symptoms, pain and performance in basic daily life activities. CONCLUSIONS The observed association between anorexia of ageing and a telomeric biomarker underscores the imperative to meticulously evaluate the nutritional dimensions of older people, with a view to implementing interventions that may enhance their overall health status.
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Dericioglu D, Methven L, Clegg ME. Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population. Proc Nutr Soc 2024:1-13. [PMID: 38557431 DOI: 10.1017/s0029665124002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein's high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult's appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.
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Affiliation(s)
- Dilara Dericioglu
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6DZ, UK
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
| | - Lisa Methven
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
- Food Research Group, Department of Food and Nutritional Sciences, University of Reading,Whiteknights, Reading RG6 6DZ, UK
| | - Miriam E Clegg
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6DZ, UK
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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6
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Calcaterra L, Abellan van Kan G, Steinmeyer Z, Angioni D, Proietti M, Sourdet S. Sarcopenia and poor nutritional status in older adults. Clin Nutr 2024; 43:701-707. [PMID: 38320461 DOI: 10.1016/j.clnu.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND & AIMS The association between sarcopenia and malnutrition has been poorly studied in the older population. The purpose of this study is to address the association between sarcopenia, according to different validated definitions, and nutritional status in a large population of community-dwelling older adults. METHODS Observational, cross-sectional study of the Geriatric Frailty Clinic (GFC) for Assessment of Frailty and Prevention of Disability, held by the "Gérontopôle" of the Toulouse University Hospital. Patients aged above 65 years who benefitted from a Dual X-ray Densitometry (DXA) during their assessment at the GFC from June 5th 2013 to January 28th 2020 were included. Sarcopenia was defined according to proposed validated definitions. The Mini Nutritional Assessment (MNA) was used to stratify nutritional status, and identify patients with a poor nutritional status (at risk of malnutrition or malnourished, MNA <24). Multiple logistic regression analyses were performed between MNA and each sarcopenia definition adjusted for confounders. RESULTS Among the 938 patients with DXA data, a total of 809 (86.2 %) subjects were included in the analysis (mean age 81.8 ± 6.9 years, 527 females (65.1 %)). Prevalence of sarcopenia ranged from 12.6 % to 44.9 %, according to various definitions. Overall 244 (30.2 %) of the patients had a poor nutritional status (MNA-score <24), Baumgartner and Newman definitions of sarcopenia were both associated with low MNA-scores (OR = 4.69, CI 3.15-6.98 and OR = 2.30, CI 1.55-3.14, respectively), EWGSOP2 "confirmed sarcopenia" definition was also associated with low MNA-scores (OR = 3.68, CI 2.30-5.89), as well as for the lean mass definition according EWGSOP2 cut-off (OR 5.22 CI 3.52-7.73). Both FNIH and EWGSOP2 "probable sarcopenia" definitions were not associated with the risk of malnutrition. CONCLUSIONS In this study, the prevalence of sarcopenia ranged from 12.6 to 44.9 % according to various definitions. A score of MNA under 24, was associated with almost all of the sarcopenia definitions. This study reinforces the concept that malnutrition and sarcopenia are strictly related. When facing malnutrition in daily clinical practice, body composition should be assessed and the proposed nutritional intervention should be tailored by these results in order to prevent the onset of late-life disability.
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Affiliation(s)
- L Calcaterra
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France; Division of Subacute Care, IRCCS, Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - G Abellan van Kan
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France.
| | - Z Steinmeyer
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France
| | - D Angioni
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France
| | - M Proietti
- Division of Subacute Care, IRCCS, Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - S Sourdet
- IHU HealthAge, Frailty Clinic, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, Toulouse 31059, France
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Noritake K, Fujii K, Kubo Y, Yorozuya K, Hayashi T, Goto F, Watanabe H, Yoshida A, Tsubouchi Y, Nakashima D. Appetite and family and friends network among community-dwelling older adults: A cross-sectional study. Nutrition 2024; 119:112321. [PMID: 38199033 DOI: 10.1016/j.nut.2023.112321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the stronger correlate of appetite-family or friend networks-in community-dwelling older adults, given that undernutrition can impair physical function, increase mortality, and be influenced by social networks. METHODS A cross-sectional study was conducted in Kasugai City, Aichi Prefecture, and Nara City, Nara Prefecture, Japan, between August 2019 and March 2023. The analysis included 119 participants (women: 79%, mean age: 76.5 ± 5.6 y). A multiple regression analysis was performed, using the scores from the Japanese version of the Simplified Nutritional Appetite Questionnaire (SNAQ-J) as the dependent variable and family network and friend network as the independent variables. The analysis included social participation, living alone status, sex, age, body mass index, skeletal muscle mass index, grip strength, walking speed, and the Japanese version of the 15 Geriatric Depression Scale score as covariates to examine their relationship with appetite. RESULTS The mean value of the SNAQ-J score of the participants was 15.4 ± 1.2. Seven participants (6%) had a loss of appetite. Family network was significantly associated with appetite (B = 0.121, β = 0.266, P <0.05; 95% condidence interval [CI], 0.030-0.212). In the single regression analysis, the friend network was significantly associated with the total score of the SNAQ-J (B = 0.115, P <0.001; 95% CI, 0.052-0.177); however, this association was not observed in the multiple regression analysis (B = 0.002, β = 0.006, P = 0.954; 95% CI, -0.074-0.078). CONCLUSION Appetite was associated with family networks. Among social networks, focusing on family networks may help prevent the loss of appetite in older adults in Japan.
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Affiliation(s)
- Kento Noritake
- Faculty of Health Sciences, Nihon Fukushi University, Handa, Japan
| | - Keisuke Fujii
- Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Yuta Kubo
- Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Kyosuke Yorozuya
- Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Takahiro Hayashi
- Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Fumihiko Goto
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | - Hidehiro Watanabe
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | - Akihiro Yoshida
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | | | - Daiki Nakashima
- Faculty of Health Science, Naragakuen University, Nara, Japan
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Koya Y, Shibata M, Maruno Y, Sakamoto Y, Oe S, Miyagawa K, Honma Y, Harada M. Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management: A propensity score-matched cohort study. Hepatobiliary Pancreat Dis Int 2024; 23:64-70. [PMID: 37516589 DOI: 10.1016/j.hbpd.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Recurrent acute cholecystitis (RAC) can occur after non-surgical treatment for acute cholecystitis (AC), and can be more severe in comparison to the first episode of AC. Low skeletal muscle mass or adiposity have various effects in several diseases. We aimed to clarify the relationship between RAC and body parameters. METHODS Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled. The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC. The areas were divided by height to obtain the psoas muscle mass index (PMI) and subcutaneous/visceral adipose tissue index (SATI/VATI). According to median VATI, SATI and PMI values by sex, patients were divided into the high and low PMI groups. We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC. RESULTS The entire cohort was divided into the high PMI (n = 81) and low PMI (n = 80) groups. In the propensity score-matched cohort there were 57 patients in each group. In Kaplan-Meier analysis, the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts (log-rank P = 0.001 and 0.015, respectively). In a multivariate Cox regression analysis, the hazard ratios of low PMI and low VATI for RAC were 5.250 (95% confidence interval 1.083-25.450, P = 0.039) and 0.158 (95% confidence interval: 0.026-0.937, P = 0.042), respectively. CONCLUSIONS Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.
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Affiliation(s)
- Yudai Koya
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, 3-1 Higashiminatomachi, Moji-ku, Kitakyushu 801-8502, Japan; Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.
| | - Michihiko Shibata
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Yuki Maruno
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, 3-1 Higashiminatomachi, Moji-ku, Kitakyushu 801-8502, Japan; Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Yoshitaka Sakamoto
- Department of Surgery, Kyushu Rosai Hospital Moji Medical Center, Kitakyushu 801-8502, Japan
| | - Shinji Oe
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Koichiro Miyagawa
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Yuichi Honma
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
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9
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Ishimoto T, Fujimoto T, Matsudaira N, Yamamoto N, Hayashi H, Hisamatsu K, Toyota Y, Akazawa N. Association between anorexia as assessed by simplified nutritional appetite questionnaire and sarcopenia in community-dwelling older adults using outpatient rehabilitation: A cross-sectional study. Clin Nutr ESPEN 2024; 59:176-180. [PMID: 38220373 DOI: 10.1016/j.clnesp.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE A previous study reported an association between sarcopenia and anorexia determined by the simplified nutritional appetite questionnaire (SNAQ) in community-dwelling older adults. However, it is unclear in the community-dwelling older adults who are using outpatient rehabilitation. The purpose of this study was to investigate the relationship between anorexia and sarcopenia as judged by SNAQ in community-dwelling older adults using outpatient rehabilitation. METHODS This study included 120 older adults (72.5% female). Subjects were provided outpatient rehabilitation one to three times a week. The main outcome was sarcopenia as determined using the Asian working group for sarcopenia 2019. The simplified nutritional appetite questionnaire (SNAQ) was used to assess anorexia. The SNAQ total score range from 4 (worst) to 20 (best), with 13 score and lower considered to indicate anorexia. Statistical analysis was performed by forced-entry logistic regression analysis with sarcopenia as the dependent variable, body mass index (BMI), food intake level scale, anorexia, and propensity score calculated using age, sex, number of medications, updated Charlson comorbidity index as the independent variable. RESULTS Sarcopenia was observed in 79 of 120 subjects (65.8%). Anorexia was observed in 28 subjects (23.3%). Logistic regression analysis revealed BMI (odds ratio: 0.71 [95% CI: 0.61-0.84]), anorexia (odds ratio: 5.35 [95% CI: 1.24-23.2]) were extracted as a significant variable. CONCLUSIONS The results of this study show that anorexia as determined by the SNAQ is associated with sarcopenia in community-dwelling older adults using outpatient rehabilitation. This indicates the importance of understanding anorexia in assessing sarcopenia in community-dwelling older adults who are using outpatient rehabilitation.
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Affiliation(s)
- Taisei Ishimoto
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Takehiro Fujimoto
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Nozomi Matsudaira
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Natsuki Yamamoto
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Hikaru Hayashi
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Ken Hisamatsu
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Yoshio Toyota
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Naoki Akazawa
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan.
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Aprahamian I, Coats AJ, Morley JE, Klompenhouwer T, Anker SD. Anorexia of aging: An international assessment of healthcare providers' knowledge and practice gaps. J Cachexia Sarcopenia Muscle 2023; 14:2779-2792. [PMID: 37897129 PMCID: PMC10751437 DOI: 10.1002/jcsm.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of 'normal' aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes. METHODS This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations. RESULTS A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n = 1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%). CONCLUSIONS Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.
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Affiliation(s)
- Ivan Aprahamian
- Division of Geriatrics, Department of Internal MedicineJundiaí Medical SchoolJundiaíBrazil
| | | | - John E. Morley
- Division of Geriatrics, Department of MedicineSaint Louis UniversitySt. LouisMissouriUSA
| | | | - Stefan D. Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT)German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité UniversitätsmedizinBerlinGermany
- Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
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11
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Liu X, Wang Y, Shen L, Sun Y, Zeng B, Zhu B, Dai F. Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey. BMC Geriatr 2023; 23:745. [PMID: 37968629 PMCID: PMC10647084 DOI: 10.1186/s12877-023-04438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND This study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans. METHODS This cross-sectional study selected a total of 4241 community-dwelling individuals aged 60 years and older from the 2005-2010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index > 0.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the "usual or most common type of stool" by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency. RESULTS Frailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools/week. CONCLUSION Negative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.
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Affiliation(s)
- Xuna Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Yiwen Wang
- Xi'an International Medical Center Hospital Affiliated To Northwest University, Xi'an, 710119, China
| | - Lin Shen
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Yating Sun
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Beibei Zeng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Boxu Zhu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Fei Dai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
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12
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Catikkas NM, Binay Safer V. Biceps brachii muscle cross-sectional area measured by ultrasonography is independently associated with one-month mortality: A prospective observational study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1512-1521. [PMID: 37787651 DOI: 10.1002/jcu.23571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Studies examining mortality in palliative care units are limited. We aimed to investigate the mortality and associated factors including ultrasonographic muscle parameters in hospitalized palliative patients with a subgroup analysis of older patients. METHODS A prospective-observational study. We recorded the demographics, number of diseases, diagnoses, and the Charlson comorbidity index (CCI), palliative performance scale (PPS), and nutritional risk screening-2002 (NRS-2002) scores. We noted the nutritional parameters and mortality. We measured the subcutaneous fat thickness (SFT), muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris and biceps brachii using ultrasonography. RESULTS We enrolled 100 patients (mean age: 73.2 ± 16.4 years, 53%: female). One-month mortality was 42%. The non-survivors had significantly higher malignancy, increased CCI and NRS-2002 scores, lower required energy intake, calorie sufficiency rate, and biceps brachii SFT, MT, and CSA than the survivors. The independent mortality predictors were malignancy and biceps brachii CSA while the PPS score and malignancy were significantly associated with mortality in the older subgroup. CONCLUSION The malignancy and biceps brachii CSA might have prognostic value in predicting mortality in palliative patients. This was the first study investigating the mortality-associated factors including ultrasonographic muscle measurements of both the lower and upper limbs in a palliative care center.
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Affiliation(s)
- Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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13
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Ferreira RP, Alves LM, Mangilli LD. Association between risk of dysphagia and signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in hospitalized elderly. Codas 2023; 36:e20220232. [PMID: 37820239 DOI: 10.1590/2317-1782/20232022232pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/13/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To identify the risk of dysphagia and its association with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in the hospitalized elderly. METHODS This is an analytical cross-sectional study with the participation of 52 elderly patients admitted to a medical clinic at a public hospital in the Federal District, Brazil. The Eating Assessment Tool, Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls + Calf Circumference and the Mini Nutritional Assessment shortform were applied, in addition to the collection of sociodemographic data and health conditions. RESULTS Among the elderly participants, 30.8% were at risk of self-reported dysphagia. The factors associated with the risk of dysphagia were: signs suggestive of sarcopenia (p=0.04), nutritional status (p<0.001) and oral hygiene frequency (p=0.03). CONCLUSION In the geriatric population of the present study, with the majority of the participants having tested positive for Covid-19, the risk of dysphagia was associated with signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene.
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Affiliation(s)
- Ronivaldo Pinto Ferreira
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil
| | - Luana Marsicano Alves
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil
| | - Laura Davison Mangilli
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil
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14
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Zhang H, Hu W, Yuan M, Lu D, Gao Y, Dai Q. The association between erector spinae muscle content and chronic heart failure and its severity. ESC Heart Fail 2023; 10:2982-2989. [PMID: 37522384 PMCID: PMC10567664 DOI: 10.1002/ehf2.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/11/2022] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF. METHODS AND RESULTS A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626-0.811, P < 0.001). Compared with the HFpEF group, the HFrEF group has a lower prevalence of CHD, LVEF decreased significantly, the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly, also patients in the HFrEF group had significantly lower ESM content compared with patients in the HFpEF group, and ESM is an independent predictor of the severity of heart failure, with an odds ratio of 0.514 (HFrEF group vs. HFpEF group, 95% confidence interval (0.418-0.633, P < 0.05). The results of receiver operating curve analysis showed that the sensitivity and specificity of ESM content for the diagnosis of CHF were 65.6% and 71.6%, respectively, while the sensitivity and specificity of ESM content for predicting the severity of CHF were 47.1% and 89.1%, respectively. CONCLUSIONS The ESM is of great value in predicting the onset and severity of CHF.
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Affiliation(s)
- Hao Zhang
- Department of CardiologyZhongda Hospital, School of Medicine, Southeast UniversityNanjingPR China
| | - Weiwei Hu
- Department of CardiologyZhongda Hospital, School of Medicine, Southeast UniversityNanjingPR China
| | - Mengxuan Yuan
- Department of CardiologyAffiliated Hospital of Yangzhou UniversityYangzhouPR China
| | - Dasheng Lu
- Department of CardiologyThe Second Affiliated Hospital of Wannan Medical CollegeWuhuPR China
| | - Yang Gao
- Department of CardiologyAffiliated Hospital of Yangzhou UniversityYangzhouPR China
| | - Qiming Dai
- Department of CardiologyZhongda Hospital, School of Medicine, Southeast UniversityNanjingPR China
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15
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Mhalhel K, Briglia M, Aragona M, Porcino C, Abbate F, Guerrera MC, Laurà R, Krichen Y, Guerbej H, Germanà A, Levanti M, Montalbano G. Nothobranchius as a model for anorexia of aging research: an evolutionary, anatomical, histological, immunohistochemical, and molecular study. Ann Anat 2023; 250:152116. [PMID: 37302430 DOI: 10.1016/j.aanat.2023.152116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Anorexia of aging, defined as a decrease in appetite and a preponderant loss of body weight occurring in late life, is one of the most common diseases affecting older people. The peptide hormone cholecystokinin (Cck) is known to play a key role in regulating food intake and satiety in higher vertebrates. In humans as well as in rats, an increased concentration of Cck was described as the basis of appetite loss in elderly. However, the role of increased plasma Cck concentrations in mediating the age-related decrease in appetite remains to be established. Although in vitro studies are an excellent resource for investigating aging, the use of a model organism that shares and imitates the human physiological processes guarantees a better understanding of the in vivo mechanisms. African annual fishes from the genus Nothobranchius are emerging as a prominent model organism in biogerontology and developmental biology due to their short captive lifespan. Therefore, in the current study, we aimed to investigate the possibility of using the genus Nothobranchius to model the anorexia of aging and their potential contribution to better understanding the pathway by which Cck induce appetite loss in older people providing a comparative/evolutionary localization of the current study model among the aging canonicals models, the morphology of its gastrointestinal tract and its Cck expression pattern. METHODS The comparative/evolutionary investigation was conducted using the NCBI blastp (protein-protein BLAST) and NCBI Tree Viewer. The macroscopic morphology, histological features, ultrastructural organization of Nothobranchius rachovii gastrointestinal tract were investigated using stereomicroscope, Masson's trichrome and alcian blue-PAS staining, and transmission electron microscopy, respectively. The cck expression pattern was studied through immunofluorescence labeling, western blotting, and quantitative RT-PCR. RESULTS The intestine was folded into different segments divided into an anterior intestine made of a rostral intestinal bulb and an intestinal annex of lower diameter, mid and posterior intestine. The gradual transition from the rostral intestinal bulb to the posterior intestine sections's epithelium is characterized by a gradual reduction in the striated muscular bundles, villi height, and goblet mucous cells count. The lining epithelium of the intestinal villi was characterized by a typical brush border enterocytes full of mitochondria. Moreover, Cck expression was detected in scattered intraepithelial cells concentrated in the anterior tract of the intestine. CONCLUSIONS Our study introduces Nothobranchius rachovii as a model for anorexia of aging, giving the first bases on the gastrointestinal tract morphology and cck expression pattern. Future studies on young and elderly Notobranchius can divulge the contribution of cck in the mechanisms of anorexia associated with aging.
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Affiliation(s)
- Kamel Mhalhel
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy.
| | - Marilena Briglia
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Marialuisa Aragona
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Caterina Porcino
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Francesco Abbate
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Maria Cristina Guerrera
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Rosaria Laurà
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | | | - Hamadi Guerbej
- National Institute of Marine Sciences and Technologies, 5000 Monastir, Tunisia
| | - Antonino Germanà
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Maria Levanti
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
| | - Giuseppe Montalbano
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Via G. Palatucci snc, 98168 Messina, Italy
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Kojima K, Ishikawa H, Watanabe S, Nosaka N, Mutoh T. A Randomized, Double-Blind, Controlled Trial Assessing If Medium-Chain Triglycerides in Combination with Moderate-Intensity Exercise Increase Muscle Strength in Healthy Middle-Aged and Older Adults. Nutrients 2023; 15:3275. [PMID: 37513691 PMCID: PMC10383836 DOI: 10.3390/nu15143275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
An adequate nutritional intake is recommended for the prevention of physical frailty and sarcopenia. In particular, medium-chain fatty acids (MCFAs) are reportedly important for muscle strength in nursing home residents. However, the effects of MCFAs on healthy adults at risk for frailty remain unknown. Hence, a randomized, placebo-controlled study was conducted to investigate the effects of 12 weeks of medium-chain triglycerides (MCTs) intake and walking on muscle mass and function in healthy, sedentary, middle-aged and older adults with a low body mass index. Three MCT intake groups with different amounts of octanoic and decanoic acid intake were compared with a control group. After 12 weeks, knee extension strength increased in all groups, with the increases in all MCT intake groups being significantly higher than those in the control group (p < 0.05). Grip strength significantly increased from baseline in the MCT 6 g/day intake group (p < 0.05). The combination of aerobic exercise and MCT intake may be effective in preventing decline in muscle strength and promoting increase in muscle strength as they can improve muscle energy production, thereby contributing to the maintenance of good health for middle-aged and older adults at high risk for frailty and sarcopenia.
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Affiliation(s)
- Keiichi Kojima
- Central Research Laboratory, The Nisshin OilliO Group, Ltd., Yokohama 235-8558, Kanagawa, Japan
| | - Haruna Ishikawa
- Central Research Laboratory, The Nisshin OilliO Group, Ltd., Yokohama 235-8558, Kanagawa, Japan
| | - Shinji Watanabe
- Central Research Laboratory, The Nisshin OilliO Group, Ltd., Yokohama 235-8558, Kanagawa, Japan
| | - Naohisa Nosaka
- Central Research Laboratory, The Nisshin OilliO Group, Ltd., Yokohama 235-8558, Kanagawa, Japan
| | - Tatsushi Mutoh
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8574, Miyagi, Japan
- Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita-City 010-0874, Akita, Japan
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Chen LK. Unveiling the hidden epidemic: Anorexia of aging and nutritional decline in older adults. Arch Gerontol Geriatr 2023; 111:105064. [PMID: 37210787 DOI: 10.1016/j.archger.2023.105064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Wang X, Yang F, Zhu M, Cui H, Wei J, Li J, Chen W. Development and Assessment of Assisted Diagnosis Models Using Machine Learning for Identifying Elderly Patients With Malnutrition: Cohort Study. J Med Internet Res 2023; 25:e42435. [PMID: 36917167 PMCID: PMC10131894 DOI: 10.2196/42435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older patients are at an increased risk of malnutrition due to many factors related to poor clinical outcomes. OBJECTIVE This study aims to develop an assisted diagnosis model using machine learning (ML) for identifying older patients with malnutrition and providing the focus of individualized treatment. METHODS We reanalyzed a multicenter, observational cohort study including 2660 older patients. Baseline malnutrition was defined using the global leadership initiative on malnutrition (GLIM) criteria, and the study population was randomly divided into a derivation group (2128/2660, 80%) and a validation group (532/2660, 20%). We applied 5 ML algorithms and further explored the relationship between features and the risk of malnutrition by using the Shapley additive explanations visualization method. RESULTS The proposed ML models were capable to identify older patients with malnutrition. In the external validation cohort, the top 3 models by the area under the receiver operating characteristic curve were light gradient boosting machine (92.1%), extreme gradient boosting (91.9%), and the random forest model (91.5%). Additionally, the analysis of the importance of features revealed that BMI, weight loss, and calf circumference were the strongest predictors to affect GLIM. A BMI of below 21 kg/m2 was associated with a higher risk of GLIM in older people. CONCLUSIONS We developed ML models for assisting diagnosis of malnutrition based on the GLIM criteria. The cutoff values of laboratory tests generated by Shapley additive explanations could provide references for the identification of malnutrition. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-EPC-14005253; https://www.chictr.org.cn/showproj.aspx?proj=9542.
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Affiliation(s)
- Xue Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengchun Yang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hongyuan Cui
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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20
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Nishioka S, Wakabayashi H. Interaction between malnutrition and physical disability in older adults: is there a malnutrition-disability cycle? Nutr Rev 2023; 81:191-205. [PMID: 35831980 DOI: 10.1093/nutrit/nuac047] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Malnutrition and physical disability are urgent issues in super-aging societies and the 2 phenomena are closely linked in older adults. Both conditions have common underlying causes, including physiological changes due to aging and burdens imposed by disease or injury. Accordingly, a concept of the malnutrition-disability cycle was generated and a comprehensive literature search was performed. There was insufficient evidence to prove an interrelationship between malnutrition and physical disabilities, because of the study design and poor quality, among other factors. However, some evidence exists for the interaction between low body mass index and swallowing disorders, and the effects of some malnutrition and disability components. This review provides the rationale for this interaction, the concept of a malnutrition-disability cycle is proposed, and the available evidence is critically appraise.
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Affiliation(s)
- Shinta Nishioka
- is with the Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki City, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- is with the Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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21
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Paez HG, Pitzer CR, Alway SE. Age-Related Dysfunction in Proteostasis and Cellular Quality Control in the Development of Sarcopenia. Cells 2023; 12:cells12020249. [PMID: 36672183 PMCID: PMC9856405 DOI: 10.3390/cells12020249] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Sarcopenia is a debilitating skeletal muscle disease that accelerates in the last decades of life and is characterized by marked deficits in muscle strength, mass, quality, and metabolic health. The multifactorial causes of sarcopenia have proven difficult to treat and involve a complex interplay between environmental factors and intrinsic age-associated changes. It is generally accepted that sarcopenia results in a progressive loss of skeletal muscle function that exceeds the loss of mass, indicating that while loss of muscle mass is important, loss of muscle quality is the primary defect with advanced age. Furthermore, preclinical models have suggested that aged skeletal muscle exhibits defects in cellular quality control such as the degradation of damaged mitochondria. Recent evidence suggests that a dysregulation of proteostasis, an important regulator of cellular quality control, is a significant contributor to the aging-associated declines in muscle quality, function, and mass. Although skeletal muscle mammalian target of rapamycin complex 1 (mTORC1) plays a critical role in cellular control, including skeletal muscle hypertrophy, paradoxically, sustained activation of mTORC1 recapitulates several characteristics of sarcopenia. Pharmaceutical inhibition of mTORC1 as well as caloric restriction significantly improves muscle quality in aged animals, however, the mechanisms controlling cellular proteostasis are not fully known. This information is important for developing effective therapeutic strategies that mitigate or prevent sarcopenia and associated disability. This review identifies recent and historical understanding of the molecular mechanisms of proteostasis driving age-associated muscle loss and suggests potential therapeutic interventions to slow or prevent sarcopenia.
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Affiliation(s)
- Hector G. Paez
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Integrated Biomedical Sciences Graduate Program, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Laboratory of Muscle Biology and Sarcopenia, Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Center for Muscle, Metabolism and Neuropathology, Division of Regenerative and Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Christopher R. Pitzer
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Integrated Biomedical Sciences Graduate Program, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Laboratory of Muscle Biology and Sarcopenia, Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Center for Muscle, Metabolism and Neuropathology, Division of Regenerative and Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Stephen E. Alway
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Integrated Biomedical Sciences Graduate Program, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Laboratory of Muscle Biology and Sarcopenia, Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Center for Muscle, Metabolism and Neuropathology, Division of Regenerative and Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- The Tennessee Institute of Regenerative Medicine, Memphis, TN 38163, USA
- Correspondence:
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22
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Sánchez-Sánchez JL, Guyonnet S, Lucas A, Parini A, Rolland Y, de Souto Barreto P. Plasma Inflammatory Biomarkers and Anorexia of Ageing among Community-Dwelling Older Adults: An Exploratory Analysis of the MAPT Study. J Nutr Health Aging 2023; 27:1127-1131. [PMID: 37997735 DOI: 10.1007/s12603-023-2024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
Anorexia of aging and biological aging might share physiological underpinnings. The aim of this secondary analysis was to investigate the associations between circulating inflammation-related markers and anorexia of aging in community-dwelling older adults. C-reactive protein (CRP), tumor necrosis factor receptor-1 (TNFR-1), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and growth/differentiation factor-15 (GDF-15) were measured in plasma. Anorexia of aging was defined by the response "severe/moderate decrease in food intake" to the first item of the Mini-Nutritional Assessment. We included 463 subjects (median age=74y, IQR=71-78; 63.1% women). 33 subjects (7.1%) presented with anorexia at baseline, whereas 25 out of 363 (6.9%) developed it along 1-year follow-up. We found that TNFR1 (OR=1.74, 95%CI=1.27-2.39) and GDF-15 (OR=1.38, 95%CI=1.01-1.89) were associated with a significant increase in the odds of presenting with anorexia of aging cross-sectionally. No further significant associations were found. Biological aging mechanisms might be involved in the pathogenesis of anorexia of aging.
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Affiliation(s)
- J L Sánchez-Sánchez
- Juan Luis Sánchez-Sánchez, CHU Toulouse Gérontopôle: Centre Hospitalier Universitaire de Toulouse Gerontopole, France,
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Plotnikov G, Sharif S, Buturlin G, Segal I, Gorelik O, Kagansky N. Factors Associated with In-Hospital Mortality in Elderly Internal Medicine Patients with Nasogastric Tube Feeding. Clin Interv Aging 2023; 18:729-735. [PMID: 37193340 PMCID: PMC10182769 DOI: 10.2147/cia.s408207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
Purpose To evaluate demographic, clinical, and laboratory variables, and their associations with in-hospital mortality, among elderly internal medicine patients with nasogastric tube (NGT) feeding. Patients and Methods Demographic, clinical, and laboratory data were collected retrospectively for 129 patients aged ≥80 years who initiated NGT feeding during their hospitalization in internal medicine wards. The data were compared between survivors and non-survivors. Multivariate logistic regressions were performed to identify the variables most significantly associated with in-hospital mortality. Results The in-hospital mortality rate was 60.5%. Compared to survivors, non-survivors more often presented with pressure sores (P=0.005) and lymphopenia (P<0.001), were more often treated with invasive mechanical ventilation (P<0.001), and less often underwent geriatric assessment (P<0.001). Non-survivors demonstrated higher mean levels of C-reactive protein, and lower mean values of serum cholesterol, triglycerides, total protein, and albumin (P<0.001 for all comparisons). On multivariate analysis, the following variables were most significantly associated with in-hospital mortality in the entire cohort: the presence of pressure sores (odds ratio [OR], 4.34; 95% confidence interval [CI], 1.68-11.48; P=0.003) and lymphopenia (OR, 4.09; 95% CI, 1.51-11.08; P=0.006), and serum cholesterol (OR, 0.98; 95% CI, 0.96-0.99; P=0.003). Conclusion Among elderly acutely ill patients who initiated NGT feeding during hospitalization, in-hospital mortality was extremely high. The factors most strongly associated with in-hospital mortality were the presence of pressure sores and lymphopenia, and lower serum cholesterol levels. These findings may provide useful prognostic information for decision-making regarding initiation of NGT feeding in elderly hospitalized patients.
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Affiliation(s)
- Galina Plotnikov
- Geriatric Assessment Unit, Yitzhak Shamir Medical Center, Zerifin, 7033001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- Correspondence: Galina Plotnikov, Geriatric Assessment Unit, Yitzhak Shamir Medical Center, Zerifin, 7033001, Israel, Tel +972-8-9542271, Fax +972-8-9779597, Email
| | - Saleh Sharif
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- Department of Internal Medicine C, Yitzhak Shamir Medical Center, Zerifin, 7033001, Israel
| | - Gleb Buturlin
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Inbal Segal
- Geriatric Assessment Unit, Yitzhak Shamir Medical Center, Zerifin, 7033001, Israel
| | - Oleg Gorelik
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Nadya Kagansky
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- Shmuel Harofe Geriatric Medical Center, Beer Yaakov, Israel
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Kawase F, Masaki Y, Ozawa H, Imanaka M, Sugiyama A, Wada H, Goto R, Kobayashi S, Tsukahara T. Resting Energy Expenditure in Older Inpatients: A Comparison of Prediction Equations and Measurements. Nutrients 2022; 14:nu14245210. [PMID: 36558367 PMCID: PMC9784286 DOI: 10.3390/nu14245210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Determining energy requirements are an important component of nutritional support for patients with malnutrition; however, the validity of prediction equations for resting energy expenditure (REE) is disputed in older hospitalized patients. We aimed to assess the validity of these equations in older hospitalized patients in Japan. This was a single-center, cross-sectional study of 100 patients aged ≥70 years, hospitalized between January 2020 and December 2021. REE was measured using an indirect calorimeter and was compared to the predicted values calculated from five REE prediction equations. The mean (95% confidence interval) measured REE was 968.1 (931.0, 1005.3) kcal/day, and the mean predicted REE was higher for the FAO/WHO/UNU (1014.3 [987.1, 1041.6] kcal/day, p = 0.164) and Schofield (1066.0 [1045.8, 1086.2] kcal/day, p < 0.001) equations and lower for the Harris-Benedict (898.6 [873.1, 924.1] kcal/day, p = 0.011), Ganpule (830.1 [790.3, 869.9] kcal/day, p < 0.001), and body weight (kg) × 20 (857.7 [821.9, 893.5] kcal/day, p < 0.001) equations. In the age group analysis, none of the predicted values were within a 10% error for more than 80% of patients aged 70−89 years and ≥90 years. The five REE prediction equations did not provide accurate estimates. Validated REE prediction equations need to be developed for older hospitalized patients.
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Affiliation(s)
- Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, 57, Iwasaki-cho, Nisshin 470-0196, Aichi, Japan
- Correspondence:
| | - Yoshiyuki Masaki
- Department of Internal Medicine, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
- Department of Community-Based Medical Education, Graduate School of Medical Sciences, Nagoya City University, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Hiroko Ozawa
- Department of Nursing, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Manami Imanaka
- Department of Nursing, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Aoi Sugiyama
- Department of Nursing, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Hironari Wada
- Department of Rehabilitation Therapy, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Ryokichi Goto
- Department of Rehabilitation Therapy, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Shinya Kobayashi
- Department of Internal Medicine, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota 444-2351, Aichi, Japan
| | - Takayoshi Tsukahara
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, 57, Iwasaki-cho, Nisshin 470-0196, Aichi, Japan
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25
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Cox NJ, Howson F, Ibrahim K, Morrison L, Sayer AA, Roberts HC, Robinson SM. Mood and physical activity are associated with appetite in hospitalised older men and women. Age Ageing 2022; 51:6964929. [PMID: 36580556 DOI: 10.1093/ageing/afac297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies. DESIGN Cross sectional observational study. SETTING Eleven wards in one large hospital in England. SUBJECTS Older inpatients aged ≥70 years, admitted non-electively. METHODS Appetite was assessed using the four-item Simplified Nutritional Appetite Questionnaire (SNAQ). Associations between SNAQ score and appetite-related factors present in the dataset were assessed in continuous analyses, including habitual physical activity, mood, medication, cognition and living circumstances. RESULTS 200 participants, mean age of 80.7 years (SD 6.9); 40% were women. Prevalence of poor appetite was 43%. In univariate analyses, lower medication count, higher habitual physical activity and better mood were associated with higher SNAQ scores during admission. In a multivariate analysis, independent associations of higher habitual physical activity and better mood with higher SNAQ scores during hospital admission remained. CONCLUSION In this group of older adults, better mood and higher habitual physical activity were independently associated with better appetite during hospital admission. These are potentially modifiable factors and could be targets for future research into interventions for the anorexia of ageing in the hospitalised older population.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fiona Howson
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Social, Human, and Mathematical Sciences, University of Southampton, Southampton, UK.,Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Sian M Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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26
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Picca A, Calvani R, Coelho-Júnior HJ, Landi F, Marzetti E. Anorexia of Aging: Metabolic Changes and Biomarker Discovery. Clin Interv Aging 2022; 17:1761-1767. [PMID: 36483084 PMCID: PMC9726216 DOI: 10.2147/cia.s325008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/24/2022] [Indexed: 08/04/2023] Open
Abstract
The age-associated decrease in appetite and food intake is referred to as "anorexia of aging". Older adults with anorexia show changes in the quantity/quality of energy supplied to the organism which eventually may cause a mismatch between ingested calories and physiological energy demands. Therefore, a state of malnutrition and impaired metabolism may ensue which renders older people more vulnerable to stressors and more prone to incur negative health outcomes. These latter cover a wide range of conditions including sarcopenia, low engagement in physical activity, and more severe consequences such as disability, loss of independence, hospitalization, nursing home placement, and mortality. Malnutrition has been recognized by the European Society of Clinical Nutrition (ESPEN) among the chief risk factors for the development of frailty. Frailty refers to a state of increased vulnerability to stressors stemming from reduced physiologic reserve, and according to ESPEN, is also nutrition-based. Alike frailty, anorexia is highly prevalent among older adults, and its multifactorial nature includes metabolic changes that develop in older age and possibly underly the condition. Circulating factors, including hormones (eg, cholecystokinin, ghrelin, leptin, and inflammatory and microbial mediators of gut dysbiosis), have been proposed as biomarkers for this condition to support early identification and develop personalized nutritional interventions. Additional studies are needed to untangle the interrelationship between gut microbiota and appetite regulation in older adults operating through brain-gut crosstalk. Furthermore, the contribution of the genetic background to appetite regulation and specific nutritional needs warrants investigation. Here, we provide an overview on anorexia of aging in the context of age-related metabolic changes. A special focus is placed on candidate biomarkers that may be used to assist in the early identification of anorexia of aging and in the development of personalized nutritional counseling.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | | | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
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27
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Ruan GT, Xie HL, Deng L, Ge YZ, Zhang Q, Wang ZW, Zhang X, Zhang HY, Tang M, Song MM, Zhang XW, Yang M, Pan L, Wang KH, Cong MH, Gong YZ, Wang MY, Shi HP. A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer. Front Nutr 2022; 9:893753. [PMID: 35866083 PMCID: PMC9294408 DOI: 10.3389/fnut.2022.893753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundElderly patients with cancer face the challenge of systemic inflammation, which can lead to a poor prognosis. Existing inflammatory indices cannot fully reflect the immune-inflammatory status of patients. This study aimed to develop a new scoring system to predict the survival of elderly patients with cancer using inflammatory indices, namely, the systemic inflammation prognostic score (SIPS).Materials and MethodsThis prospective multicenter study included a total of 1,767 patients with cancer, with a mean age of 70.97 ± 5.49 years, of whom 1,170 (66.2%) were men. We performed the least absolute shrinkage and selection operator (LASSO) regression to screen inflammatory indicators to include in constructing SIPS. Prognostic analysis of SIPS was performed using univariate and multivariate survival analyzes. The prognostic value of SIPS and its components were compared using the prognostic receiver operating characteristic curve and concordance index. The population was divided into the training cohort and the validation cohort in a 7:3 ratio and a SIPS prognostic analysis was performed.ResultsThe LASSO regression selected C-reactive protein (CRP) (≤ 9.81, “0”; > 9.81, “1”), geriatric nutritional risk index (GNRI) (≤ 93.85, “1”; 93.85, “0”), advanced lung cancer inflammation index (ALI) (≤ 23.49, “1”; > 23.49, “0”), and lymphocyte to C-reactive protein ratio (LCR) (≤ 2523.81, “1”; > 2523.81, “0”) to develop SIPS. Patients were divided into the three groups based on the total SIPS: low-risk (0), moderate-risk (1–2), and high-risk (3–4). On the multivariate survival analysis, patients in the moderate-risk [P < 0.001, hazard ratio (HR) = 1.79, 95% CI: 1.47–2.17] and high-risk groups (P < 0.001, HR = 2.40, 95% CI: 1.98–2.92) showed a worse prognosis than those in the low-risk group. The total cohort, training cohort, and validation cohort all showed that SIPS had better survival prediction than CRP, GNRI, ALI, and LCR. The HRs were 2.81 times higher in patients in the high-risk group with malnutrition than in patients in the low-risk group without malnutrition.ConclusionSIPS was an independent prognostic indicator in elderly patients with cancer. Malnutrition in the high-risk group increased the mortality risk.
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Affiliation(s)
- Guo-Tian Ruan
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Hai-Lun Xie
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Li Deng
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Yi-Zhong Ge
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Zi-Wen Wang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xi Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - He-Yang Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Meng Tang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Meng-Meng Song
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xiao-Wei Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Ming Yang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kun-Hua Wang
- Yunnan University, Kunming, China
- General Surgery Clinical Medical Center of Yunnan Province, Kunming, China
| | - Ming-Hua Cong
- Comprehensive Oncology Department, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Zhen Gong
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, China
- *Correspondence: Yi-Zhen Gong,
| | - Meng-Yan Wang
- Department of General Surgery, The 906th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Ningbo, China
- Meng-Yan Wang,
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Han-Ping Shi,
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28
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Cheung NC, Noviasky JA, Ulen KR, Brangman SA. Efficacy and Safety of Megestrol in the Hospitalized Older Person. Sr Care Pharm 2022; 37:284-292. [DOI: 10.4140/tcp.n.2022.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives To evaluate the efficacy and safety of megestrol for off-label use in older patients with weight loss. Design Retrospective, nonblinded cohort study. Setting Upstate University Hospital is a 420-bed facility and academic
medical center with a level 1 trauma center. Upstate Community Hospital is a 314-bed acute care/hospital/ambulatory care center and long-term care hospital that also provides teaching services. Participants Patients 65 years of age and older without malignancy or acquired
immunodeficiency syndrome who were initiated and continued megestrol therapy at the Upstate University hospitals for at least two weeks were included. Of the 1,290 patients initially screened, 16 patients on megestrol were evaluated. An age- and gender-matched control group of 16 patients
was utilized for comparison of changes in weight and other variables. Interventions Patients in the megestrol group have received daily doses of megestrol between 160 mg to 800 mg for an average duration of 19 days. Patients in the control group had no history or current
use of megestrol utilization. Main Outcome Measurements The primary outcome was an increase in weight. Secondary outcome measures included albumin and thromboembolic events. Changes in weight and albumin were also compared with the control group. Results
At a mean duration of 19 days, there was no significant difference in weight gain (0.95 kg, OR = 1.33 [95% CI -1.615-3.527]). Albumin decreased by (0.4 g/dL OR = 0.916 [95% CI 0.12-0.78]) and none of the patients developed a thromboembolic event. Conclusion In older
hospitalized patients, megestrol did not increase weight, and did not improve albumin. No thromboembolic events were observed, but this may be because of a limited duration of observation of therapy and the routine use of anticoagulation prophylaxis in the inpatient setting.
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Affiliation(s)
- Nicole C. Cheung
- 1Florida Agricultural and Mechanical University, Tallahassee, Florida
| | - John A. Noviasky
- 2Upstate Community Hospital, Department of Pharmacy, Syracuse, New York
| | | | - Sharon A. Brangman
- 4SUNY Upstate Medical University Department of Geriatrics, Syracuse, New York
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Huang HH, Wang TY, Yao SF, Lin PY, Chang JCY, Peng LN, Chen LK, Yen DHT. Gastric Mobility and Gastrointestinal Hormones in Older Patients with Sarcopenia. Nutrients 2022; 14:nu14091897. [PMID: 35565864 PMCID: PMC9103579 DOI: 10.3390/nu14091897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Sarcopenia has serious clinical consequences and poses a major threat to older people. Gastrointestinal environmental factors are believed to be the main cause. The aim of this study was to describe the relationship between sarcopenia and gastric mobility and to investigate the relationship between sarcopenia and the concentration of gastrointestinal hormones in older patients. Patients aged ≥ 75 years were recruited for this prospective study from August 2018 to February 2019 at the emergency department. The enrolled patients were tested for sarcopenia. Gastric emptying scintigraphy was conducted, and laboratory tests for cholecystokinin(CCK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY), nesfatin, and ghrelin were performed during the fasting period. We enrolled 52 patients with mean age of 86.9 years, including 17 (32.7%) patients in the non-sarcopenia group, 17 (32.7%) patients in the pre-sarcopenia group, and 18 (34.6%) in the sarcopenia group. The mean gastric emptying half-time had no significant difference among three groups. The sarcopenia group had significantly higher fasting plasma concentrations of CCK, GLP-1, and PYY. We concluded that the older people with sarcopenia had significantly higher plasma concentrations of CCK, GLP-1, and PYY. In the elderly population, anorexigenic gastrointestinal hormones might have more important relationships with sarcopenia than orexigenic gastrointestinal hormones.
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Affiliation(s)
- Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-H.H.); (T.-Y.W.); (P.-Y.L.); (J.C.-Y.C.)
- Institute of Emergency and Critical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Tse-Yao Wang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-H.H.); (T.-Y.W.); (P.-Y.L.); (J.C.-Y.C.)
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Shan-Fan Yao
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Pei-Ying Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-H.H.); (T.-Y.W.); (P.-Y.L.); (J.C.-Y.C.)
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Julia Chia-Yu Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-H.H.); (T.-Y.W.); (P.-Y.L.); (J.C.-Y.C.)
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (L.-N.P.); (L.-K.C.)
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (L.-N.P.); (L.-K.C.)
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei 112020, Taiwan
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-H.H.); (T.-Y.W.); (P.-Y.L.); (J.C.-Y.C.)
- Institute of Emergency and Critical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Emergency Medicine, National Defense Medical Center, Taipei 114202, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 300102, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7371
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de Souto Barreto P, Cesari M, Morley JE, Roberts S, Landi F, Cederholm T, Rolland Y, Vellas B, Fielding R. Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report. J Frailty Aging 2022; 11:129-134. [PMID: 35441188 PMCID: PMC8898654 DOI: 10.14283/jfa.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Appetite loss/anorexia of aging is a highly prevalent and burdensome geriatric syndrome that strongly impairs the quality of life of older adults. Loss of appetite is associated with several clinical conditions, including comorbidities and other geriatric syndromes, such as frailty. Despite its importance, appetite loss has been under-evaluated and, consequently, under-diagnosed and under-treated in routine clinical care. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually on September 27th 2021 to debate issues related to appetite loss/anorexia of aging. In particular, topics related to the implementation and management of appetite loss in at-risk older adult populations, energy balance during aging, and the design of future clinical trials on this topic were discussed. Future actions in this field should focus on the systematic assessment of appetite in the care pathway of older people, such as the Integrated Care for Older People (ICOPE) program recommended by the World Health Organization. Moreover, clinical care should move from the assessment to the treatment of appetite loss/anorexia. Researchers continue to pursue their efforts to find out effective pharmacologic and non-pharmacologic interventions with a favorable risk/benefit ratio.
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Affiliation(s)
- P de Souto Barreto
- Philipe de Souto Barreto, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesde, 31000 Toulouse, France, +33 561 145 636,
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Recognising undernutrition in a community hospital: the nursing judgement is insufficient. Eur J Clin Nutr 2022; 76:1611-1614. [PMID: 35444266 PMCID: PMC9019789 DOI: 10.1038/s41430-022-01145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Introduction Standardised nutritional screening methods improve the rate of recognising older patients with undernutrition, which is strongly encouraged in hospitals and residential settings. Therefore, our study compared the rates of identifying undernutrition before and after introducing the Mini Nutritional Assessment (MNA®) in a community hospital. Methods This was a single-centre, retrospective, observational before–after study. Participants were subjects aged 65 years or older, admitted to a community hospital from May 2018 to December 2020. The nursing assessment at admission included the MNA® from January 2020. The prevalence of undernutrition gathered by nursing diagnoses from 2018 to 2019 was compared with data obtained using the MNA® in 2020. Then, a confirmatory analysis was conducted to compare the prevalence of undernutrition in 2020 when both nursing diagnoses and the MNA® were used. Results We analysed data of approximately 316 patients (238 before and 78 after introducing the MNA®). Overall, results showed that 47.1% (n = 149) of the patients were undernourished. As observed, the prevalence of undernutrition was 38.6% (n = 92) in 2018–2019 and 73.1% (n = 57) in 2020 (p < 0.001). In 2020, however, 38.5% of patients (n = 30) were identified as undernourished using the MNA® but not using nursing diagnoses. Therefore, the correlation between these two methods was poor (Pearson’s correlation 0.169, p = 0.14). Conclusion Identifying elderly patients with undernutrition significantly increased after introducing the MNA®. Undernutrition is a common condition that should be systematically screened using a validated tool to activate personalised nutritional interventions promptly.
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review. J Pers Med 2022; 12:jpm12030372. [PMID: 35330372 PMCID: PMC8950250 DOI: 10.3390/jpm12030372] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Dental health is often neglected among the elderly because of the numerous comorbidities in this population, such as cardiovascular diseases. However, dental health influences general health and quality of life by impacting both the general health and the psychological state of the individual. The present review highlights the main dental comorbidities in the elderly population, their impact on the quality of life, the barriers towards access to dental care in the elderly and methods to improve their dental health. Information related to dental care and its importance must be provided both to older individuals and their caregivers in order to detect dental pathology and treat it adequately. Ensuring dental health involves the whole society of elders, caregivers, dental care providers, the public sector, health policymakers, and the private sector.
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Vijewardane SC, Balasuriya A, Myint PK, Johnstone AM. Determinants of Undernutrition and Associated Factors of Low Muscle Mass and High Fat Mass among Older Men and Women in the Colombo District of Sri Lanka. Geriatrics (Basel) 2022; 7:geriatrics7020026. [PMID: 35314598 PMCID: PMC8938783 DOI: 10.3390/geriatrics7020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Undernutrition is a health challenge due to an expanding older population. The aims of the study were to assess the prevalence and determinants of undernutrition and, associated factors of low muscle and high fat mass among older men and women in the Colombo district of Sri Lanka. A cross sectional study was conducted using a multistage cluster sampling technique. Undernutrition was defined based on anthropometry and body composition assessed using bio-electrical impedance. Sex-specific multivariable logistic regression analyses were conducted. Of 800 participants (30.6% men), 35.3% were undernourished. The factors significantly associated with undernutrition among older women were hypertension with an adjusted odds ratio (aOR) (1.97; 1.36–2.88) and musculoskeletal disabilities aOR (2.19; 1.36–3.53). Among women, age ≥ 70 (1.79; 1.18–3.34) and diabetes (1.77; 1.10–2.84) were associated with low muscle mass and age ≥ 70 (2.05; 1.21–3.47), diabetes (2.20; 1.35–3.59) and disability in chewing (2.39; 1.30–4.40) were associated with high fat mass. Among men, age ≥ 70 years, no/up to grade 5 education, diabetes, visual disability, little/no responsibility in food shopping and not getting nutritional advice from media were associated with reduced odds of low muscle mass and no/up to grade 5 school education, disability in chewing and little/no responsibility in food shopping were associated with reduced odds of high fat mass. Undernutrition among older people is common in Sri Lanka. We have identified key factors associated with low muscle mass and high fat mass in this setting. Given the potential consequences of these conditions, our study provides potential targets for prevention of undernutrition and sarcopenic obesity.
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Affiliation(s)
- Samantha Chandrika Vijewardane
- Nutrition Division, Ministry of Health, Colombo 00600, Sri Lanka
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK;
- Correspondence: ; Tel.: +44-78-6925-6729
| | - Aindralal Balasuriya
- Department of Public Health and Family Medicine, Faculty of Medicine, General Sir John Kotelawala Defense University, Dehiwala-Mount Lavinia 10390, Sri Lanka;
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK;
| | - Alexandra M. Johnstone
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK;
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35
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Oliveira-Junior G, Pinto RS, Shirley MK, Longman DP, Koehler K, Saunders B, Roschel H, Dolan E. The Skeletal Muscle Response to Energy Deficiency: A Life History Perspective. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022. [DOI: 10.1007/s40750-021-00182-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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36
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Merchant RA, Woo J, Morley JE. Editorial: Anorexia of Ageing: Pathway to Frailty and Sarcopenia. J Nutr Health Aging 2022; 26:3-5. [PMID: 35067696 DOI: 10.1007/s12603-021-1703-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Reshma A Merchant
- Dr Reshma A Merchant, Division of Geriatric Medicine. Department of Medicine, 1E Kent Ridge Road, NUHS Tower Block, Singapore 119228,
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Dent E, Woo J, Scott D, Hoogendijk EO. Toward the recognition and management of sarcopenia in routine clinical care. NATURE AGING 2021; 1:982-990. [PMID: 37118343 DOI: 10.1038/s43587-021-00136-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/06/2021] [Indexed: 04/30/2023]
Abstract
Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease's adoption into routine care.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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38
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Endocrinological and Nutritional Implications of Anorexia of Aging. ENDOCRINES 2021. [DOI: 10.3390/endocrines2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor appetite—known as anorexia—is a common condition in aging and is associated with poor outcomes, including reduced survival and impaired quality of life. The anorexia of aging is mainly the result of several complex endocrinological, metabolic, and nutritional changes occurring with later age. The modulation of different peptides and hormones has been identified as an important determinant for the development of low appetite; in particular, an altered imbalance of plasma ghrelin, leptin, and cholecystokinin and increased inflammatory markers are implicated in its pathophysiology, and robust evidence of their involvement in anorexia of aging has been produced in the clinical setting. More recently, researchers identified that the gut microbiome composition significantly varies according to the appetite status. Other important clinical factors may worsen the symptoms of the anorexia in the elderly, in particular the potential concomitant presence of chronic catabolic comorbidities. Importantly, data indicate that anorexia is prevalent in frail older adults, negatively impacting body composition and specifically in altering muscle mass and function. For all these reasons, a prompt and early diagnosis of anorexia in the elderly is crucial to implement personalized metabolic and nutrition interventions to improve the outcomes and ameliorate quality of life.
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Lin B, Bai L, Wang S, Lin H. The Association of Systemic Interleukin 6 and Interleukin 10 Levels with Sarcopenia in Elderly Patients with Chronic Obstructive Pulmonary Disease. Int J Gen Med 2021; 14:5893-5902. [PMID: 34566428 PMCID: PMC8457863 DOI: 10.2147/ijgm.s321229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 01/07/2023] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is often associated with sarcopenia, and systemic inflammation is an underlying pathogenesis of COPD. In this study, the effects of interleukin (IL)- 6 and IL-10 levels on sarcopenia in patients with COPD were investigated. Methods Seventy-three patients (59 males and 14 females), aged 60–93 years old, who had stable COPD (not including patients with advanced lung decline) were enrolled in this study. The patients were classified according to four stages of lung function, based on the Global Initiative for Chronic Obstructive Lung Disease 2018, and their symptoms were evaluated using the COPD assessment test and mMRC dyspnea Scale. The skeletal muscle index (SMI) was evaluated using a dual-energy X-ray absorptiometry test, and walking pace and handgrip strength were measured to reflect muscle mass and function. The diagnosis of sarcopenia was made according to the Asian Working Group for Sarcopenia and China guide recommendations. The inflammation biomarkers IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay. Albumin (Alb) was measured using the bromocresol green method. Results Twenty-eight patients (38.36%) were diagnosed with sarcopenia. IL-6 (r = −0.38, P = 0.001) and IL-10 (r = −0.38, P = 0.001) were negatively correlated with the SMI, while the IL-10/IL-6 ratio had no correlation with sarcopenia. Multiple regression analysis showed that age (OR = 1.11, P = 0.02) and IL-6 (OR = 1.07, P<0.05), had a strong correlation with sarcopenia, while IL-10 was not statistically significant in sarcopenia. However, body mass index (OR = 0.54, P = 0.002) had an opposite effect on muscle reduction. Conclusion The increase of IL-6 might be a factor associated with sarcopenia. However, the relationship between IL-10 and sarcopenia is unclear.
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Affiliation(s)
- Baiyang Lin
- Department of Pneumology, Shanxi Provincial People's Hospital, Taiyuan, 030000, People's Republic of China
| | - Li Bai
- Department of Pneumology, Shanxi Hospital of Integrated Traditional and Western Medicine, Taiyuan, 030000, People's Republic of China
| | - Shenglong Wang
- Department of Pneumology, Shanxi Hospital of Integrated Traditional and Western Medicine, Taiyuan, 030000, People's Republic of China
| | - Hong Lin
- Department of Orthopedics, The Sixth Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
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Accuracy of the Simplified Nutritional Appetite Questionnaire for Malnutrition and Sarcopenia Screening among Older Patients Requiring Rehabilitation. Nutrients 2021; 13:nu13082738. [PMID: 34444898 PMCID: PMC8402148 DOI: 10.3390/nu13082738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/17/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study aimed to examine the accuracy of the Simplified Nutritional Appetite Questionnaire (SNAQ) and the SNAQ for Japanese Elderly (SNAQ-JE) for the Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and sarcopenia screening in older persons. We included 380 inpatients aged ≥65 years (mean age, 79.3 ± 7.9; 60.0% women) and admitted to rehabilitation units. Undernutrition and sarcopenia were diagnosed based on GLIM criteria and the Asian Working Group for Sarcopenia, respectively, using bioimpedance analysis. Poor appetite was defined as an SNAQ score of <14 points and an SNAQ-JE score of ≤14 points. The sensitivity, specificity, and accuracy of these tools for detecting poor appetite for GLIM-defined malnutrition and sarcopenia were assessed. The rates of GLIM-defined malnutrition and sarcopenia were 56.8% and 59.2%, respectively. The number of patients with poor appetite was 94 (24.7%) for the SNAQ and 234 (61.6%) for the SNAQ-JE. The sensitivity and specificity of the SNAQ measured against GLIM-defined malnutrition were 32.9% and 73.1%, respectively, and against sarcopenia were 29.8% and 70.2%, respectively. The sensitivity and specificity of the SNAQ-JE measured against GLIM-defined malnutrition were 82.6% and 51.0%, respectively, and against sarcopenia were 86.0% and 53.7%, respectively. The SNAQ-JE showed fair accuracy for GLIM-defined malnutrition and sarcopenia in older patients admitted to rehabilitation units.
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Dent E, Woo J, Scott D, Hoogendijk EO. Sarcopenia measurement in research and clinical practice. Eur J Intern Med 2021; 90:1-9. [PMID: 34238636 DOI: 10.1016/j.ejim.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 12/15/2022]
Abstract
Sarcopenia is a disease related to accelerated loss of skeletal muscle and subsequent decline in functional capacity. It affects approximately 13% of the world's population aged over 60 years. Sarcopenia is primarily managed and prevented through a combination of exercise prescription combined with appropriate nutritional strategies. This review outlines diagnostic and case finding/screening tools for age-related (primary) sarcopenia used in research and clinical practice. Diagnostic tools critically reviewed include those of the: European Workgroup for Sarcopenia (EWGSOP) versions 1 and 2; Asian Working Group for Sarcopenia (AWGS) versions 1 and 2; Foundation for the National Institutes of Health (FNIH); and the Sarcopenia Definition and Outcomes Consortium (SDOC). Criteria used by diagnostic tools (muscle mass, muscle strength and physical functioning/performance) are also detailed. Case-finding tools include the SARC-F questionnaire, Ishii's formula and Goodman's screening grid. Additionally, this review discusses the strengths and weaknesses of each diagnostic and case-finding tool, and examines their ability to reliably predict adverse clinical outcomes and patient responses to potential therapies.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, 88 Wakefield St, Adelaide SA, 5000 Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne VIC, 3004 Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Central Ave, Hong Kong.
| | - David Scott
- Deakin University, Melbourne VIC, 3004 Australia; Monash University, Wellington Rd, Clayton VIC, 3800 Australia.
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands.
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Nawai A, Phongphanngam S, Khumrungsee M, Leveille SG. Factors associated with nutrition risk among community-dwelling older adults in Thailand. Geriatr Nurs 2021; 42:1048-1055. [PMID: 34256155 DOI: 10.1016/j.gerinurse.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional risk based on the Mini Nutritional Assessment. Multivariate analysis indicated factors significantly associated with nutritional risk were: aged ≥80 years (OR:8.59, 95% CI = 2.94-25.11), low income (OR: 2.35, 95% CI = 1.15-4.78), living alone (OR: 2.02, 95% CI = 0.20-0.78), moderate to severe pain (OR: 5.88, 95% CI = 2.30-15.02), dyslipidemia (OR: 5.12, 95% CI = 2.23-11.77), osteoarthritis (OR: 2.49, 95% CI = 1.14-5.48), poor physical performance (OR: 1.49, 95% CI = 1.70-3.15), and ≥1 fall in the previous year (OR: 2.22, 95% CI = 1.21-4.07). Results point to the need for multifactorial interventions to reduce risk for geriatric nutrition problems. Further studies are needed to determine effective solutions to the problem of malnutrition among older adults.
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Affiliation(s)
- Ampicha Nawai
- Boromarajonani College of Nursing, Chiang Mai, Thailand.
| | | | | | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Cox NJ, Bowyer RCE, Ni Lochlainn M, Wells PM, Roberts HC, Steves CJ. The composition of the gut microbiome differs among community dwelling older people with good and poor appetite. J Cachexia Sarcopenia Muscle 2021; 12:368-377. [PMID: 33580637 PMCID: PMC8061352 DOI: 10.1002/jcsm.12683] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/07/2020] [Accepted: 01/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anorexia of ageing is common and important in the development of sarcopenia in older individuals. Links have been proposed between the gut microbiota and sarcopenia. Disordered gut function is also recognized in anorexia of ageing, but how this may relate to resident gut microbiota is unexplored. Understanding this relationship may provide a basis for novel interventions for anorexia of ageing and sarcopenia. This study explores compositional differences of the gut microbiota between community dwelling healthy older adults with good or poor appetite, and associated differences in sarcopenia. METHODS We assessed appetite by the Simplified Nutritional Appetite Questionnaire (SNAQ) in members of the TwinsUK cohort aged ≥65 years. Using a pool of 776 individuals with existing microbiome data estimated from 16S rRNA sequencing data, we identified 102 cases (SNAQ score < 14) (95% female, mean age 68 years) matched to controls (SNAQ > 14) on body mass index, gender, age, diet, calorie consumption, frailty, antibiotic use, socio-economic status, and technical variables to minimize confounding microbiota associations. Species abundance and diversity, compositional differences, and paired differences in taxa abundance were compared between cases and controls. Additionally, we compared case and controls for sarcopenia as measured by muscle mass (appendicular lean mass/height2 ) and strength (chair stand time in seconds). RESULTS Cases with poor appetite had reduced species richness and diversity of their gut microbiome (adjusted OBSERVED: beta = -0.2, P < 0.001; adjusted SHANNON: beta = -0.17, P = 0.0135), significant compositional differences (adjusted non-parametric multivariate analysis of variance, P = 0.0095), and significant differences in taxa abundance including reduction of genus Lachnospira (logFC = -1.015, q = 0.023). In all-female subgroup analysis, cases with poor appetite demonstrated reduction in muscle strength (11.03 s vs. 9.26 s, P = 0.02). CONCLUSIONS This study is the first to observe differences in the composition of gut microbiota between healthy community dwelling older individuals with good and poor appetite. We found female individuals with reduced muscle strength had poor appetite compared with those with normal strength. These associations require further examination to understand causality and mechanisms of interaction, to inform potential strategies targeting the gut microbiota as a novel intervention for anorexia of ageing and sarcopenia.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ruth C E Bowyer
- Department of Twins Research and Genetic Epidemiology, Kings College London, St Thomas' Hospital, London, UK
| | - Mary Ni Lochlainn
- Department of Twins Research and Genetic Epidemiology, Kings College London, St Thomas' Hospital, London, UK
| | - Philippa M Wells
- Department of Twins Research and Genetic Epidemiology, Kings College London, St Thomas' Hospital, London, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Claire J Steves
- Department of Twins Research and Genetic Epidemiology, Kings College London, St Thomas' Hospital, London, UK.,Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Li M, Zhao S, Wu S, Yang X, Feng H. Effectiveness of Oral Nutritional Supplements on Older People with Anorexia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13030835. [PMID: 33802580 PMCID: PMC8001033 DOI: 10.3390/nu13030835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nutrition plays an important role in maintaining the overall health of older people. Inadequate intake may lead to impaired body function, higher morbidity, and mortality. Oral nutritional supplements (ONS) showed positive effect on the nutritional status of the elderly; however, systematic evidence is currently lacking on the effect of ONS on the elderly with anorexia. AIMS The current systematic review and meta-analysis included randomized controlled trial (RCT) articles to investigate the effectiveness of ONS on the main aspects of anorexia of aging (AA). METHODS By using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, researchers independently searched PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and other gray literature resources for publications that met the inclusion criteria by October 2020. The Cochrane Risk of Bias Tools were used for quality assessment. The inverse-variance method was used for the fixed model (FM) while the DerSimonian-Laird method was used for the random model (RM). Respective 95% confidence intervals (95% CIs), mean difference (MD) or standardized mean difference (SMD) was used for indices in terms of effect size (ES). RESULTS 2497 records were found through the systematic search, while 17 RCTs (n = 1204) were included, with a mean age of 81.9 years (range: 74-87 years). Supplementation occurred in the morning, mid-day, and evening, while the times varied from one to three times a day. The results of meta-analysis showed that, generally, ONS had a positive effect on the overall appetite, MD = 0.18, 95% CI (0.03, 0.33), p = 0.02, and consumption, MD = 1.43, 95% CI (0.01, 2.86), p = 0.05; but not significant in terms of other aspects of appetite: hunger, p = 0.73; fullness, p = 0.60; desire to eat, p = 0.80; preoccupation, p = 0.15. Additionally, it showed an increase in the overall energy intake, SMD = 0.46, 95% CI (0.29, 0.63), p < 0.001, in protein intake, SMD = 0.59, 95% CI (0.16, 1.02), p = 0.007, and in fat intake, MD = 3.47, 95% CI (1.98, 4.97), p < 0.001, while no positive effect was found on carbohydrates intake, p = 0.06. Significance differences were also found in the body weight, SMD = 0.53, 95% CI (0.41, 0.65), p < 0.001, and body mass index (BMI), MD = 0.53, 95% CI (0.12, 0.95), p = 0.01. Moreover, subgroup analyses were conducted according to the nutrient density with no positive results showed except for the low-density ONS on overall energy intake. CONCLUSIONS The results of the present study indicated that ONS had beneficial effects on overall appetite, energy intake, body weight and BMI.
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Affiliation(s)
| | | | | | | | - Hui Feng
- Correspondence: ; Tel.: +86-151-7312-1969
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Lin YC, Chang YH. Poor Appetite and Eating Difficulties Can Predict the Long-Term Risk of Falling: A Longitudinal Study in Middle-Aged and Older Adults. J Appl Gerontol 2020; 40:1465-1474. [PMID: 33267709 DOI: 10.1177/0733464820976439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study investigates whether self-reported nutritional status affects falling among middle-aged and older adults. METHOD We used 8-year follow-up data from the Taiwan Longitudinal Study on Aging. At baseline, respondents' appetite, changes in amount of food intake, and eating difficulties were assessed in a questionnaire-based survey in addition to anthropometric measurements (body mass index, mid-arm circumferences, and involuntary body weight loss). Their associations with falls in the follow-up were examined using multivariable log-binomial regression. RESULTS The study included 2,519 respondents aged 50 years and older. Poor appetite (prevalence ratio [PR] = 1.25, 95% confidence interval [CI] = [1.07, 1.46]) and eating difficulties (PR = 1.16, 95% CI = [1.02, 1.32]) significantly predicted falling 8 years later with adjustments for sociodemographics, health behaviors, comorbidities, and anthropometric measures by taking into account probabilities of follow-up. CONCLUSION Poor appetite and eating difficulties can predict falling in the long-term independent of anthropometric measurements among middle-aged and older adults.
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Affiliation(s)
- Yu-Chun Lin
- China Medical University Hospital, Taichung City, Taiwan
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46
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Anker MS, Springer J, Coats AJ, von Haehling S. The 10th year of the Journal of Cachexia, Sarcopenia and Muscle. J Cachexia Sarcopenia Muscle 2020; 11:1390-1395. [PMID: 33340288 PMCID: PMC7749579 DOI: 10.1002/jcsm.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine Berlin, Berlin, Germany
| | - Jochen Springer
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Andrew Js Coats
- Department of Cardiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
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47
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Tsutsumimoto K, Doi T, Nakakubo S, Kim M, Kurita S, Ishii H, Shimada H. Association between anorexia of ageing and sarcopenia among Japanese older adults. J Cachexia Sarcopenia Muscle 2020; 11:1250-1257. [PMID: 32190984 PMCID: PMC7567148 DOI: 10.1002/jcsm.12571] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Malnutrition plays an essential role in the mechanism of pathogenesis for sarcopenia. In late life, both food consumption and energy intakes decline. One of key factors for reduced energy intakes is anorexia of ageing. The aim of this study is to examine the association between anorexia of ageing and sarcopenia among community-dwelling elderly Japanese individuals. METHODS This uses population-based, cross-sectional cohort study of elderly Japanese individuals. Anorexia of ageing was assessed via a simplified nutritional appetite questionnaire. Handgrip strength and walking speed were tested, and skeletal muscle mass was assessed using a bio-impedance analysis device. Subjects with sarcopenia were defined as those who met the criteria of the Asian Working Group for Sarcopenia. The association between anorexia of ageing and sarcopenia was then analysed via multiple regression analysis. RESULTS In total, 9,496 elderly Japanese individuals were evaluated (mean age 74.1 ± 5.4 years; male, 47.0%). The prevalence of anorexia of ageing was 9.8% (n = 927) in the present study. The prevalence of sarcopenia in men was 1.1%, 1.8%, 6.1%, 10.1%, and 21.2% and was 1.6%, 3.3%, 3.6%, 4.8%, and 7.4% in women aged 65-69, 70-74, 75-79, 80-84, and 85 years and older, respectively. The prevalence of anorexia also showed an age-dependent increase in both sexes (P < 0.001, respectively). The prevalence of anorexia in men was 8.3%, 6.3%, 9.8%, 13.6%, and 12.9% and was 7.9%, 9.4%, 10.5%, 17.6%, and 17.1% in women aged 65-69, 70-74, 75-79, 80-84, and 85 years and older, respectively. In multivariable logistic regression model adjusted for the covariates except for albumin, anorexia of ageing was independently associated with sarcopenia (OR: 1.45, 95% CI: 1.07 to 1.95; P = 0.015). This significant association remained even after adjusting for all covariates including nutritional status (OR: 1.42, 95% CI: 1.06 to 1.92, P = 0.020). CONCLUSIONS Anorexia of ageing is associated with sarcopenia among Japanese elderly individuals. Further studies are needed to determine whether a causal association exists between anorexia and sarcopenia.
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Affiliation(s)
- Kota Tsutsumimoto
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Takehiko Doi
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Sho Nakakubo
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Minji Kim
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Satoshi Kurita
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hideaki Ishii
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hiroyuki Shimada
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
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48
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Volkert D. [Current ESPEN Guideline Clinical Nutrition and Hydration in Geriatrics]. Dtsch Med Wochenschr 2020; 145:1306-1314. [PMID: 32906183 DOI: 10.1055/a-0986-2892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Malnutrition, dehydration and obesity are relevant health problems with far-reaching consequences for older people. Routine screening for malnutrition and dehydration should be carried out in order to identify vulnerable and affected persons at an early stage and to be able to take timely countermeasures. In many cases, adequate nutrition and hydration can be supported by simple nursing measures and optimisation of the food and drink supply. Nutritional advice, sip feed, enteral and parenteral nutrition are further effective measures for the prevention and therapy of malnutrition. An ingestion deficiency dehydration should be diagnosed on the basis of serum osmolality and requires a rapid compensation of the deficit by hypotonic fluids - depending on the severity, in the form of drinks, subcutaneously or intravenously. Weight loss in old age should only be considered in cases of obesity with associated health problems and should be achieved by moderate energy reduction in combination with physical exercise.
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49
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Hakeem FF, Bernabé E, Sabbah W. Association Between Oral Health and Frailty Among American Older Adults. J Am Med Dir Assoc 2020; 22:559-563.e2. [PMID: 32859517 DOI: 10.1016/j.jamda.2020.07.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We examined the association between tooth loss, periodontal diseases, and frailty among older American adults. DESIGNS, SETTINGS, AND PARTICIPANTS Data from the National Health and Nutrition Examination Surveys (NHANES) 2011-2014 was used. We included 2368 community-dwelling adults aged 60 years and older. Frailty was measured with the 49-item frailty index. Oral health indicators included number of teeth and periodontal disease. A composite nutritional intake variable based on 13 micronutrients from the dietary assessment was created. Negative binomial regression was used to test the association between oral health and frailty. The first model was adjusted for age and gender, the second model was additionally adjusted for nutritional intake, and the third model was additionally adjusted for other covariates. RESULTS For each additional tooth, the rate ratio (RR) for frailty was 0.99 [95% confidence interval (CI) 0.98-0.99] in the fully adjusted model. Similarly, participants with moderate-severe periodontitis had 1.08 RR (95% CI 1.02-1.14) for frailty index compared with participants with no periodontitis after adjusting for age, gender, and poor nutritional intake. The association lost significance in the fully adjusted model. CONCLUSIONS AND IMPLICATIONS Oral health is associated with the frailty index, and nutritional intake appears to have a modest effect on the association. Periodontal disease has a weaker association with frailty compared with number of teeth. The findings highlight the importance of maintaining good oral health at older age and incorporating oral health indicators in routine geriatric assessments. Future research should investigate the role of potential mediating factors in this association.
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Affiliation(s)
- Faisal F Hakeem
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom; College of Dentistry, Department of Preventive Dental Sciences, Taibah University Dental College & Hospital, Madinah, Saudi Arabia.
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Wael Sabbah
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
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50
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Semba RD, Gonzalez-Freire M, Tanaka T, Biancotto A, Zhang P, Shardell M, Moaddel R, Ferrucci L. Elevated Plasma Growth and Differentiation Factor 15 Is Associated With Slower Gait Speed and Lower Physical Performance in Healthy Community-Dwelling Adults. J Gerontol A Biol Sci Med Sci 2020; 75:175-180. [PMID: 30874790 DOI: 10.1093/gerona/glz071] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Growth and differentiation factor 15 (GDF-15) has been associated with obesity, muscle wasting, and cachexia. The receptor for GDF-15 was recently identified in the brainstem and regulates food intake and metabolism. The relationship of plasma GDF-15 with the age-associated decline of muscle mass and strength, gait speed, and physical performance in adults has not been well characterized. METHODS Plasma GDF-15, grip strength, 6-m gait speed, 400-m walking test time, lower extremity physical performance score, appendicular lean mass, and fat mass were measured in 194 healthy adult participants, aged 22-93 years, of the Baltimore Longitudinal Study of Aging. RESULTS Plasma GDF-15 concentrations increased with age (p < .001) and were higher in whites compared with blacks and Asians (p = .04). Adults with higher plasma GDF-15 had slower 6-m gait speed, longer 400-m walking time, and lower physical performance score in multivariable analyses adjusting for age and race. Plasma GDF-15 was not associated with grip strength, appendicular lean mass, or fat mass. CONCLUSIONS Elevated plasma GDF-15 is associated with slower gait speed, higher 400-m walking time, and lower physical performance in very healthy community-dwelling adults. The relationship between plasma GDF-15 and sarcopenia-related outcomes may be stronger in the population not selected to be healthy, and this hypothesis should be tested in a representative population.
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Affiliation(s)
- Richard D Semba
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Toshiko Tanaka
- National Institute on Aging, National Institutes of Health, Baltimore
| | - Angelique Biancotto
- Trans-NIH Center for Human Immunology, Autoimmunity, and Inflammation, National Institutes of Health, Bethesda, Maryland
| | - Pingbo Zhang
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Shardell
- National Institute on Aging, National Institutes of Health, Baltimore
| | - Ruin Moaddel
- National Institute on Aging, National Institutes of Health, Baltimore
| | | | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore
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