1
|
Zhao J, Lu Q, Zhang X. Associations of serum vitamin B12 and its biomarkers with musculoskeletal health in middle-aged and older adults. Front Endocrinol (Lausanne) 2024; 15:1387035. [PMID: 38808112 PMCID: PMC11130390 DOI: 10.3389/fendo.2024.1387035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction The effects of vitamin B12 metabolism on musculoskeletal health and the exact mechanism have not been fully determined. Our study aimed to assess the association of vitamin B12 and its biomarkers with musculoskeletal health in middle-aged and older adults. Methods The data from the National Health and Nutrition Examination Survey 2001-2002 were used to investigate the effects of serum vitamin B12 and its biomarkers (homocysteine and methylmalonic acid) on skeletal muscle health. Bone mineral density (BMD), lean mass, gait speed and knee extensor strength were used as indicators for musculoskeletal health. Results Serum vitamin B12 level was positively correlated with the total and appendicular lean mass (β = 584.83, P = 0.044; β = 291.65, P = 0.043) in older adults over 65 years of age. In the full population, plasma homocysteine was associated with total lean mass, appendicular lean mass, gait speed, and knee extensor strength (all P < 0.05). Among older adults over 65 years of age, homocysteine level was significantly negatively correlated with gait speed and knee extensor strength (β = -12.75, P = 0.019; β = -0.06, P <0.001). Plasma methylmalonic acid was negatively associated with total BMD and femur BMD in the full population (β = -0.01, P = 0.018; β = -0.01, P = 0.004). In older adults, methylmalonic acid significantly affected total BMD, femur BMD and knee extensor strength (β = -0.01, P = 0.048; β = -0.01, P = 0.025; β = -7.53, P = 0.015). Conclusions Vitamin B12 and its biomarkers are closely related to BMD, body composition, muscle strength and physical function in middle-aged and older adults. Vitamin B12 may be an important indicator of musculoskeletal health in the elderly.
Collapse
Affiliation(s)
- Jiao Zhao
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Lu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xianfeng Zhang
- Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Liu Y, Han Y, Gao Y, Yao N, Wang Y, Wang F, Wu Z, Dong Y, Wang S, Li B. The association between oxidative balance score and frailty in adults across a wide age spectrum: NHANES 2007-2018. Food Funct 2024; 15:5041-5049. [PMID: 38651948 DOI: 10.1039/d4fo00870g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background: Frailty has been one of the most serious global public health challenges we will ever face. Oxidative stress is associated with the pathogenesis of frailty, and may be accurately reflected by the oxidative balance score (OBS). However, there have been no studies examining the effect of OBS on frailty. Therefore, we aimed to explore the association between OBS and frailty and whether there was an interaction between the outcomes. Methods: 22 914 participants aged over 20 years taking part in the National Health and Nutrition Examination Survey (NHANES) in 2007-2018 were involved in the study. Sixteen dietary factors and four lifestyle factors were selected to score the OBS. A modified 36-item deficit cumulative frailty index (FI) was used to assess the degree of frailty. The association between OBS and frailty was analyzed using binary logistic regression. Subgroup analysis and interaction tests were used to investigate whether this association was stable across populations. Results: A negative association between OBS and the prevalence of frailty was found in this study. There was also an interaction between OBS and age in their association with frailty. High OBS was significantly and negatively associated with the prevalence of frailty in the 20-39 and 40-64 age groups. In addition, higher OBS combined with a population in the 20-39 age group resulted in a stronger negative association with frailty. Conclusion: High OBS was significantly associated with lower odds of frailty. An interaction existed between OBS and age. Individuals, especially in relatively young populations, are advised to increase OBS through greater intake of antioxidant nutrients and healthier lifestyles, thereby reducing the adverse effects of frailty.
Collapse
Affiliation(s)
- Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Yu Han
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Yuqi Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Yuxiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Fengdan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Zibo Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Yibo Dong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Sizhe Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, P. R. China.
| |
Collapse
|
3
|
O'Connor D, Molloy AM, Laird E, Kenny RA, O'Halloran AM. Sustaining an ageing population: the role of micronutrients in frailty and cognitive impairment. Proc Nutr Soc 2023; 82:315-328. [PMID: 36938798 DOI: 10.1017/s0029665123002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Age-related frailty and cognitive decline are complex multidimensional conditions that significantly impact the ability of older adults to sustain functional capacity and independence. While underlying causes remain poorly understood, nutrition continually emerges as one associated risk element. Many studies have addressed the importance of adequate nutrition in delaying the onset of these conditions, but the specific role of micronutrients is not well established. The consideration of pre-frailty as an outcome variable is also limited in the current literature. In this review, we focus on the potential value of maintaining micronutrient sufficiency to sustaining the health of the ageing population. Using data from the Irish longitudinal study on ageing, we consider several vitamins known to have a high prevalence of low status in older adults and their impact on pre-frailty, frailty and cognitive impairment. They include vitamin B12 and folate, both of which are associated with multiple biological mechanisms involved in long-term health, in particular in cognitive function; vitamin D, which has been associated with increased risk of musculoskeletal disorders, depression and other chronic diseases; and the carotenoids, lutein and zeaxanthin, that may help mitigate the risk of frailty and cognitive decline via their antioxidant and anti-inflammatory properties. We show that low concentrations of folate and carotenoids are implicated in poorer cognitive health and that the co-occurrence of multiple nutrient deficiencies confers greatest risk for frailty and pre-frailty in the Irish longitudinal study on ageing cohort. These health associations contribute to evidence needed to optimise micronutrient status for health in the older adult population.
Collapse
Affiliation(s)
- Deirdre O'Connor
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Eamon Laird
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Physical Education and Sport, University of Limerick, Limerick, Ireland
| | - Rose Anne Kenny
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aisling M O'Halloran
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
4
|
Impact of Vitamin B12 Insufficiency on the Incidence of Sarcopenia in Korean Community-Dwelling Older Adults: A Two-Year Longitudinal Study. Nutrients 2023; 15:nu15040936. [PMID: 36839293 PMCID: PMC9967932 DOI: 10.3390/nu15040936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
The longitudinal effect of B12 insufficiency on sarcopenia has not yet been investigated in older adults. We aimed to study the impact of B12 levels on alterations in muscle mass, function and strength over two years. Non-sarcopenic older adults (n = 926) aged 70-84 were included. Using the Korean Frailty and Aging Cohort Study, this two-year longitudinal study used data across South Korea. The tools used for assessing muscle criteria were based on the Asian Working Group for Sarcopenia guidelines. Participants were divided into the insufficiency (initial serum B12 concentration < 350 pg/mL) and sufficiency groups (≥350 pg/mL). Logistic regression analyses were performed to evaluate the effect of initial B12 concentration on sarcopenia parameters over a two-year period. In women, multivariate analysis showed that the B12 insufficiency group had a significantly higher incidence of low SPPB scores (odds ratio [OR] = 3.28, 95% confidence interval [CI] = 1.59-6.76) and sarcopenia (OR = 3.72, 95% CI = 1.10-12.62). However, the B12 insufficiency group did not have a greater incidence of sarcopenia or other parameters in men. Our findings suggest B12 insufficiency negatively impacts physical performance and increases the incidence of sarcopenia only in women.
Collapse
|
5
|
Wan Z, Zheng J, Zhu Z, Sang L, Zhu J, Luo S, Zhao Y, Wang R, Zhang Y, Hao K, Chen L, Du J, Kan J, He H. Intermediate role of gut microbiota in vitamin B nutrition and its influences on human health. Front Nutr 2022; 9:1031502. [PMID: 36583209 PMCID: PMC9792504 DOI: 10.3389/fnut.2022.1031502] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Vitamin B consists of a group of water-soluble micronutrients that are mainly derived from the daily diet. They serve as cofactors, mediating multiple metabolic pathways in humans. As an integrated part of human health, gut microbiota could produce, consume, and even compete for vitamin B with the host. The interplay between gut microbiota and the host might be a crucial factor affecting the absorbing processes of vitamin B. On the other hand, vitamin B supplementation or deficiency might impact the growth of specific bacteria, resulting in changes in the composition and function of gut microbiota. Together, the interplay between vitamin B and gut microbiota might systemically contribute to human health. In this review, we summarized the interactions between vitamin B and gut microbiota and tried to reveal the underlying mechanism so that we can have a better understanding of its role in human health.
Collapse
Affiliation(s)
- Zhijie Wan
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | | | | | - Lan Sang
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Jinwei Zhu
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Shizheng Luo
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Yixin Zhao
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Ruirui Wang
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Yicui Zhang
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Kun Hao
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Liang Chen
- Nutrilite Health Institute, Shanghai, China
| | - Jun Du
- Nutrilite Health Institute, Shanghai, China
| | - Juntao Kan
- Nutrilite Health Institute, Shanghai, China
| | - Hua He
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| |
Collapse
|
6
|
Salmon T, Essa H, Tajik B, Isanejad M, Akpan A, Sankaranarayanan R. The Impact of Frailty and Comorbidities on Heart Failure Outcomes. Card Fail Rev 2022; 8:e07. [PMID: 35399550 PMCID: PMC8977991 DOI: 10.15420/cfr.2021.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
Frailty is a multisystemic process leading to reduction of physiological reserve and a reduction in physical activity. Heart failure (HF) is recognised as a global cause of morbidity and mortality, increasing in prevalence over recent decades. Because of shared phenotypes and comorbidities, there is significant overlap and a bidirectional relationship, with frail patients being at increased risk of developing HF and vice versa. Despite this, frailty is not routinely assessed in patients with HF. Identification of these patients to direct multidisciplinary care is key, and the development of a frailty assessment tool validated in a large HF population is also an unmet need that would be of considerable benefit in directing multidisciplinary-team management. Non-pharmacological treatment should be included, as exercise and physical rehabilitation programmes offer dual benefit in frail HF patients, by treating both conditions simultaneously. The evidence for nutritional supplementation is mixed, but there is evidence that a personalised approach to nutritional support in frail HF patients can improve outcomes.
Collapse
Affiliation(s)
- Thomas Salmon
- Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool UK
| | - Hani Essa
- Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool UK; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK
| | | | - Masoud Isanejad
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK; Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool UK
| | - Asangaedem Akpan
- Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool UK; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Rajiv Sankaranarayanan
- Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool UK; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK; National Institute for Health Research, UK
| |
Collapse
|
7
|
Guaita A, Brunelli L, Davin A, Poloni TE, Vaccaro R, Gagliardi S, Pansarasa O, Cereda C. Homocysteine, Folic Acid, Cyanocobalamin, and Frailty in Older People: Findings From the “Invece. Ab” Study. Front Physiol 2021; 12:775803. [PMID: 34975530 PMCID: PMC8717775 DOI: 10.3389/fphys.2021.775803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Frailty is an important age-related syndrome associated with several adverse health outcomes. Its biological basis is undefined. Raised plasma homocysteine (HOcy) is an established risk factor for cardiovascular disease, dementia, cognitive impairment, and mortality, but little is known about the possible role of plasma HOcy, cyanocobalamin (B12), and folate (FO levels in the development of frailty. Our first aim was to explore the possible association between frailty and plasma concentrations of HOcy, FO, and B12 in a cohort of community-dwelling older people. The second was to assess the influence of these metabolic factors on six-year incidence of frailty in the 875 individuals eligible for inclusion in this study (those with a full follow-up dataset). This research is based on data from three waves – 2012 (herein taken as baseline), 2014, and 2018 – of a longitudinal study (InveCe.Ab) in which non-frail men and women born between 1935 and 1939 underwent multidimensional assessments. Frailty was estimated using a deficit accumulation-based frailty index (FI). HOcy concentration was significantly positively correlated with FI at all timepoints, while B12 and FO levels were not. Plasma concentration of HOcy emerged as a predictor of six-year cumulative incidence of frailty, independent of age, sex, and education, while B12 and FO levels showed no relationship with frailty incidence. Individuals with plasma HOcy in the top quintile showed five months less frailty-free survival (HR 1.487; 95% CI: 1.063–2.078), regardless of age, sex, and education. These results demonstrate that higher HOcy is a risk factor for frailty onset in older adults.
Collapse
Affiliation(s)
- Antonio Guaita
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
- *Correspondence: Antonio Guaita,
| | - Laura Brunelli
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Annalisa Davin
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Tino Emanuele Poloni
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Roberta Vaccaro
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Stella Gagliardi
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Orietta Pansarasa
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Cereda
- Epidemiological and Neuropathological Laboratories, Golgi Cenci Foundation, Abbiategrasso, Italy
- Department of Woman, Mother and Newborn, ASST Fatebenefratelli Sacco, “V. Buzzi” Children Hospital, Milan, Italy
| |
Collapse
|
8
|
Chae SA, Kim HS, Lee JH, Yun DH, Chon J, Yoo MC, Yun Y, Yoo SD, Kim DH, Lee SA, Chung SJ, Soh Y, Won CW. Impact of Vitamin B12 Insufficiency on Sarcopenia in Community-Dwelling Older Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312433. [PMID: 34886159 PMCID: PMC8656801 DOI: 10.3390/ijerph182312433] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 10/31/2022]
Abstract
Vitamin B12 (B12) is involved as a cofactor in the synthesis of myelin. A lack of B12 impairs peripheral nerve production, which can contribute to sarcopenia. In this cross-sectional study, we aimed to investigate the relationship between B12 insufficiency and sarcopenia in community-dwelling older Korean adults. A total of 2325 (1112 men; 1213 women) adults aged 70-84 years were recruited. The tools used for sarcopenia were based on the Asian Working Group for Sarcopenia (AWGS) guidelines. Individuals with low appendicular skeletal muscle mass index (ASMI) (<7.0 kg/m2 for men; <5.4 kg/m2 for women) and low hand grip strength (HGS) (<28 kg for men; <18 kg for women) were defined as the sarcopenia group. Among this group, those who showed low physical performance (≤9 points on the Short Physical Performance Battery (SPPB)) were defined as the severe sarcopenia group. B12 concentrations were classified into insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Univariate and multivariate logistic regression analyses were used to evaluate the relationship between sarcopenia and B12 levels. Low ASMI showed a high incidence in the B12-insufficient group. However, HGS, SPPB, and the severity of sarcopenia showed no correlation with B12. Further, insufficient B12 may affect muscle quantity rather than muscle strength or physical performance.
Collapse
Affiliation(s)
- Seon A Chae
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Hee-Sang Kim
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Jong Ha Lee
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Dong Hwan Yun
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Jinmann Chon
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Myung Chul Yoo
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Yeocheon Yun
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Sung Joon Chung
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea; (S.D.Y.); (D.H.K.); (S.A.L.); (S.J.C.)
| | - Yunsoo Soh
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea; (S.A.C.); (H.-S.K.); (J.H.L.); (D.H.Y.); (J.C.); (M.C.Y.); (Y.Y.)
- Correspondence: (Y.S.); (C.W.W.)
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul 02447, Korea
- Correspondence: (Y.S.); (C.W.W.)
| |
Collapse
|
9
|
Alqahtani BA, Alenazi AM, Alshehri MM, Osailan AM, Alsubaie SF, Alqahtani MA. Prevalence of frailty and associated factors among Saudi community-dwelling older adults: a cross-sectional study. BMC Geriatr 2021; 21:185. [PMID: 33731034 PMCID: PMC7972196 DOI: 10.1186/s12877-021-02142-9] [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] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background Prevalence of frailty has been previously established in different Western countries; however, the prevalence and the burden of in the aging populations of Saudi Arabia has not been examined. Therefore, the aim of this study was to examine the prevalence of frailty, and associated factors among Saudi older population. Methods The study included a total of 486 community-dwelling elderly adults aged 60 years and over living in the Riyadh area. This study took place from August 2019 to June 2020. The prevalence of frailty was determined using the Fried’s frailty phenotype. Association between sociodemographic features and clinical factors and frailty was estimated by Odds Ratio and confidence intervals (OR, IC 95%) using a multinomial logistic regression model. Results The overall prevalence of pre-frailty and frailty were 47.3 and 21.4%, respectively. The following factors were associated with being frail: age (OR: 6.92; 95%CI 3.11–15.41); living alone (OR: 2.50; 95%CI: 1.12–5.59); had more chronic conditions (OR: 1.96; 95%CI: 1.16–3.30); and cognitive impairment (OR: 7.07; 95%CI: 3.92–12.74). Conclusions The Compared with other populations, the prevalence of frailty and pre-frailty in the Riyadh region of Saudi Arabia was high. The implications of frailty in this population should be discussed in future study.
Collapse
Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia.
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia
| | - Mohammed M Alshehri
- Physical Therapy Department, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed M Osailan
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia
| | - Saud F Alsubaie
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia
| | | |
Collapse
|
10
|
Abstract
Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.
Collapse
Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| |
Collapse
|
11
|
Sargent L, Nalls M, Amella EJ, Slattum PW, Mueller M, Bandinelli S, Tian Q, Swift‐Scanlan T, Lageman SK, Singleton A. Shared mechanisms for cognitive impairment and physical frailty: A model for complex systems. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12027. [PMID: 32685657 PMCID: PMC7362211 DOI: 10.1002/trc2.12027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION We describe findings from a large study that provide empirical support for the emerging construct of cognitive frailty and put forth a theoretical framework that may advance the future study of complex aging conditions. While cognitive impairment and physical frailty have long been studied as separate constructs, recent studies suggest they share common etiologies. We aimed to create a population predictive model to gain an understanding of the underlying biological mechanisms for the relationship between physical frailty and cognitive impairment. METHODS Data were obtained from the longitudinal "Invecchaiare in Chianti" (Aging in Chianti, InCHIANTI Study) with a representative sample (n = 1453) of older adults from two small towns in Tuscany, Italy. Our previous work informed the candidate 132 single nucleotide polymorphisms (SNPs) and 155 protein biomarkers we tested in association with clinical outcomes using a tree boosting, machine learning (ML) technique for supervised learning analysis. RESULTS We developed two highly accurate predictive models, with a Model I area under the curve (AUC) of 0.88 (95% confidence interval [CI] 0.83-0.90) and a Model II AUC of 0.86 (95% CI 0.80-0.90). These models indicate cognitive frailty is driven by dysregulation across multiple cellular processes including genetic alterations, nutrient and lipid metabolism, and elevated levels of circulating pro-inflammatory proteins. DISCUSSION While our results establish a foundation for understanding the underlying biological mechanisms for the relationship between cognitive decline and physical frailty, further examination of the molecular pathways associated with our predictive biomarkers is warranted. Our framework is in alignment with other proposed biological underpinnings of Alzheimer's disease such as genetic alterations, immune system dysfunction, and neuroinflammation.
Collapse
Affiliation(s)
- Lana Sargent
- Laboratory of NeurogeneticsNational Institute on AgingNational Institutes of HealthBethesdaMarylandUSA
- Virginia Commonwealth University School of NursingRichmondVirginiaUSA
- Medical University of South Carolina School of NursingCharlestonNorth CarolinaUSA
| | - Mike Nalls
- Laboratory of NeurogeneticsNational Institute on AgingNational Institutes of HealthBethesdaMarylandUSA
- Data Tecnica InternationalGlen EchoMarylandUSA
| | - Elaine J. Amella
- Medical University of South Carolina School of NursingCharlestonNorth CarolinaUSA
| | - Patricia W. Slattum
- Department of Pharmacotherapy & Outcomes ScienceGeriatric Pharmacotherapy Program, School of PharmacyVirginia Commonwealth UniversityRichmondVAUSA
| | - Martina Mueller
- Medical University of South Carolina School of NursingCharlestonNorth CarolinaUSA
| | - Stefania Bandinelli
- Laboratory of Clinical EpidemiologyInCHIANTI Study GroupLocal Health Unit Tuscany CenterFlorenceItaly
| | - Qu Tian
- Longitudinal Studies SectionTranslational Gerontology BranchNational Institute on AgingBaltimoreMarylandUSA
| | | | - Sarah K. Lageman
- Department of NeurologyVirginia Commonwealth School of MedicineRichmondVirginiaUSA
| | - Andrew Singleton
- Laboratory of NeurogeneticsNational Institute on AgingNational Institutes of HealthBethesdaMarylandUSA
| |
Collapse
|
12
|
Satake S, Arai H. Chapter 1 Frailty: Definition, diagnosis, epidemiology. Geriatr Gerontol Int 2020; 20 Suppl 1:7-13. [PMID: 32050303 DOI: 10.1111/ggi.13830] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| |
Collapse
|
13
|
Jungert A, Zenke-Philippi C, Neuhäuser-Berthold M. Dynamics and interactions of cobalamin and folate status during advanced aging - a longitudinal study in a community-dwelling cohort with multiple follow-ups. Nutr J 2020; 19:64. [PMID: 32615974 PMCID: PMC7333253 DOI: 10.1186/s12937-020-00576-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Older people are reported to be prone to imbalances between cobalamin and folate status with possible adverse effects on health. This longitudinal study investigates dynamics and interactions of cobalamin and folate status in a cohort of community-dwelling older adults by considering possible influencing factors. METHODS In total, 332 subjects ≥ 60 years were investigated over a mean observation period of 12 years. Data collection included serum cobalamin, folate and creatinine, dietary intakes of cobalamin, folate and alcohol, use of supplements, body composition, smoking behavior, and diseases. Linear mixed-effects models with repeated measurements were used to investigate the influence of variables on serum cobalamin and folate. RESULTS At baseline, median cobalamin intake exceeded the dietary reference value (DRV), while median folate intake was considerably below DRV. In most subjects, serum concentrations of both vitamins were within reference ranges. For serum cobalamin, apart from supplement use (Parameter estimate [95% confidence interval]: 130.17 [53.32, 207.01]), the main positive predictor was serum folate (4.63 [2.64, 6.62]). For serum folate, serum creatinine (10.85 [4.85, 16.86]), use of supplements (7.86 [5.05, 10.67]), serum cobalamin (0.01 [< 0.01, 0.01]), and dietary folate intake (0.02 [0.01, 0.03]) were positive predictors. No main effects of age, sex, body composition, alcohol intake or smoking were found after adjusting for simultaneous inference. CONCLUSIONS Advancing age, per se, is no risk factor for a decline in serum concentrations of cobalamin or folate in subjects ≥ 60 years. Suboptimal folate intake may limit the function of folate regarding the supply of methyl groups for methylation of cobalamin and subsequent creatine biosynthesis. The positive association of serum creatinine with folate deserves further exploration with regard to its possible relevance for maintaining energy dependent functional integrity in the course of ageing.
Collapse
Affiliation(s)
- Alexandra Jungert
- Institute of Nutritional Science, Justus Liebig University, Goethestrasse 55, D-35390 Giessen, Germany
- Present address: Interdisciplinary Research Center for Biosystems, Land Use and Nutrition (IFZ), Justus Liebig University, Heinrich-Buff-Ring 26-32, D-35392 Giessen, Germany
| | - Carola Zenke-Philippi
- Biometry and Population Genetics, Institute of Agronomy and Plant Breeding II, Interdisciplinary Research Center for Biosystems, Land Use and Nutrition (IFZ), Justus Liebig University, Heinrich-Buff-Ring 26-32, D-35392 Giessen, Germany
| | - Monika Neuhäuser-Berthold
- Institute of Nutritional Science, Justus Liebig University, Goethestrasse 55, D-35390 Giessen, Germany
| |
Collapse
|
14
|
Kuzuya M, Arao T, Takehisa Y, Satake S, Arai H. Chapter 3 Frailty prevention. Geriatr Gerontol Int 2020; 20 Suppl 1:20-24. [DOI: 10.1111/ggi.13832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Masafumi Kuzuya
- Department of Community Healthcare and GeriatricsNagoya University Graduate School of Medicine Nagoya Japan
| | | | - Yozo Takehisa
- Japan Association of Medical and Care Facilities Tokyo Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social ScienceNational Center for Geriatrics and Gerontology Obu Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology Obu Japan
| |
Collapse
|
15
|
Cheong CY, Nyunt MSZ, Gao Q, Gwee X, Choo RWM, Yap KB, Wee SL, Ng TP. Risk Factors of Progression to Frailty: Findings from the Singapore Longitudinal Ageing Study. J Nutr Health Aging 2020; 24:98-106. [PMID: 31886815 DOI: 10.1007/s12603-019-1277-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate risk factors of incident physical frailty. DESIGN A population-based observational longitudinal study. SETTING Community-dwelling elderly with age 55 years and above recruited from 2009 through 2011 in the second wave Singapore Longitudinal Ageing Study-2 (SLAS-2) were followed up 3-5 years later. PARTICIPANTS A total of 1297 participants, mean age of 65.6 ±0.19, who were free of physical frailty. MEASUREMENTS Incident frailty defined by three or more criteria of the physical phenotype used in the Cardiovascular Health Study was determined at follow-up. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological factors, and biochemical markers. RESULTS A total of 204 (15.7%) participants, including 81 (10.87%) of the robust and 123 (22.28%) of the prefrail transited to frailty at follow-up. Age, no education, MMSE score, diabetes, prediabetes and diabetes, arthritis, ≥5 medications, fair and poor self-rated health, moderate to high nutritional risk (NSI ≥3), Hb (g/dL), CRP (mg/L), low B12, low folate, albumin (g/L), low total cholesterol, adjusted for sex, age and education, were significantly associated (p<0.05) with incident frailty. In stepwise selection models, age (year) (OR=1.07, 95%CI=1.03-1.10, p<0.001), albumin (g/L) (OR=0.85, 95%CI=0.77-0.94, p=0.002), MMSE score (OR=0.88, 95%CI=0.78-0.98, p=0.02), low folate (OR=3.72, 95%CI=1.17-11.86, p=0.03, and previous hospitalization (OR=2.26, 95%CI=1.01-5.04,p=0.05) were significantly associated with incident frailty. CONCLUSIONS The study revealed multiple modifiable risk factors, especially related to poor nutrition, for which preventive measures and early management could potentially halt or delay the development of frailty.
Collapse
Affiliation(s)
- C Y Cheong
- Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478,
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Ma T, Sun XH, Yao S, Chen ZK, Zhang JF, Xu WD, Jiang XY, Wang XF. Genetic Variants of Homocysteine Metabolism, Homocysteine, and Frailty - Rugao Longevity and Ageing Study. J Nutr Health Aging 2020; 24:198-204. [PMID: 32003411 DOI: 10.1007/s12603-019-1304-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Recently, elevated homocysteine was reported to be associated with frailty in cross-sectional studies. However, whether homocysteine is causally associated with frailty is unknown. Here, we explore the inter-relationships between five non-synonymous genetic variants of homocysteine metabolic four genes, plasma homocysteine levels, and frailty. METHOD Data of 1480 individuals aged 70-87 years from the ageing arm of Rugao Longevity and Ageing Study were used. Five variants of the four homocysteine metabolic enzyme genes were genotyped. Frailty was defined using Fried's phenotype criteria. RESULTS The percentage of high homocysteine (>15μmol/L) is 33.3%. Two functional variants that decrease methylenetetrahydrofolate reductase (MTHFR) activities, C677T (Ala222Val, rs1801133) and A1298C (Glu429Ala, rs1801131), were significantly associated with increased homocysteine levels (β=-1.16, p=0.01; and β=1.46, p<0.001, respectively). In addition, homocysteine increase gradually from CC-CC, CC-AC, CT-AC, CT-AA, CC-AA, to TT-AA genotypes of the C677T-A1298C combinations. The five polymorphisms in the homocysteine metabolic gene was not associated with frailty. However, homocysteine was significantly associated with frailty with an OR of 2.27 (95% 1.36-3.78) for high homocysteine after adjusting for multiple confounding factors. CONCLUSION Elevated homocysteine is not a causal factor but a biomarker that manifests greater possibility of frailty in high risk elderly individuals for prevention.
Collapse
Affiliation(s)
- T Ma
- Professor Xiao-Feng Wang, Unit of epidemiology, MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai 200433, China; E-mail address: . Xiao-Yan Jiang, Key laboratory of Arrhythmias of the Ministry of education of China, Tongji University school of Medicine, shanghai 200092, People's republic of China; E-mail address:
| | | | | | | | | | | | | | | |
Collapse
|
17
|
O'Halloran AM, Laird EJ, Feeney J, Healy M, Moran R, Beatty S, Nolan JM, Molloy AM, Kenny RA. Circulating Micronutrient Biomarkers Are Associated With 3 Measures of Frailty: Evidence From the Irish Longitudinal Study on Ageing. J Am Med Dir Assoc 2019; 21:240-247.e5. [PMID: 31401047 DOI: 10.1016/j.jamda.2019.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the associations between 3 frailty instruments and circulating micronutrients in a large representative sample of older adults. DESIGN Cross-sectional data from a nationally representative cohort study conducted between October 2009 and July 2011. PARTICIPANTS AND SETTING Adults age ≥50 years (n = 4068) living in the community in Ireland. MEASUREMENTS Circulating micronutrients (lutein, zeaxanthin, folate, vitamin B-12, and vitamin D) were measured, transformed, and standardized. Frailty was assessed using the Frailty Phenotype, the Frailty Index, and the FRAIL Scale (fatigue, resistance, ambulation, illnesses, and loss of weight), instruments. Multinomial logistic regression determined associations between micronutrients and prefrailty or frailty. Models were adjusted for sociodemographic, lifestyle, health, and seasonal factors. RESULTS Adjusting for age, sex, and educational attainment, all 3 measures of frailty were associated with lower levels of lutein [relative risk ratios (RRRs): 0.43‒0.63], zeaxanthin (RRRs: 0.49‒0.63), and vitamin D (RRRs: 0.51‒0.75), and with the accumulation of micronutrient insufficiencies (RRRs: 1.42‒1.90). Attenuated but significant associations were also observed with all measures of prefrailty for lutein, vitamin D, and number of micronutrient insufficiencies. The associations with frailty persisted following additional adjustment for social, lifestyle, and health and seasonal factors, and following multiple test correction. CONCLUSIONS AND IMPLICATIONS We have presented the most consistent evidence in the largest study to date that micronutrient concentrations are associated with prefrailty and frailty in older adults. Our data suggest that low micronutrient status has potential as an easily modifiable marker and intervention target for frailty and supports further investigation into micronutrient supplementation and fortification to prevent frailty and disability among older adults.
Collapse
Affiliation(s)
- Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland.
| | - Eamon J Laird
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, Laboratory Medicine and Molecular Pathology, St James's Hospital, Dublin, Ireland
| | - Rachel Moran
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - John M Nolan
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | | | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| |
Collapse
|
18
|
Bentov I, Kaplan SJ, Pham TN, Reed MJ. Frailty assessment: from clinical to radiological tools. Br J Anaesth 2019; 123:37-50. [PMID: 31056240 DOI: 10.1016/j.bja.2019.03.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022] Open
Abstract
Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning. Numerous clinical tools to diagnose frailty exist, but none has emerged as the standard tool to be used in clinical practice. Radiological modalities, such as computed tomography and ultrasonography, are widely performed before surgery, and are therefore available to be used opportunistically to objectively evaluate surrogate markers of frailty. This review presents the importance of frailty assessment by anaesthesiologists; lists common clinical tools that have been applied; and proposes that utilising radiological imaging as an objective surrogate measure of frailty is a novel, expanding approach for which anaesthesiologists can significantly contribute to broad implementation.
Collapse
Affiliation(s)
- Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
| | - Stephen J Kaplan
- Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| |
Collapse
|
19
|
Cuesta-Triana F, Verdejo-Bravo C, Fernández-Pérez C, Martín-Sánchez FJ. Effect of Milk and Other Dairy Products on the Risk of Frailty, Sarcopenia, and Cognitive Performance Decline in the Elderly: A Systematic Review. Adv Nutr 2019; 10:S105-S119. [PMID: 31089731 PMCID: PMC6518150 DOI: 10.1093/advances/nmy105] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022] Open
Abstract
Nutrition is a modifiable factor potentially related to aging. Milk and other dairy products may contribute to the prevention of physical and cognitive impairment. We conducted a systematic review to investigate the effectiveness of dairy product intake for preventing cognitive decline, sarcopenia, and frailty in the elderly population. A systematic search for publications in electronic databases [MEDLINE via PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] from 2009 to 2018 identified observational and interventional studies in English and Spanish that tested the relation between dairy product consumption and cognitive decline, sarcopenia, and frailty in community-dwelling older people. We assessed the participants, the type of exposure or intervention, the outcomes, and the quality of evidence. We screened a total of 661 records and included 6 studies (5 observational prospective cohort studies and 1 randomized controlled trial). Regarding cognitive impairment, the relation cannot be firmly established. Consumption of milk at midlife may be negatively associated with verbal memory performance. In older women, high intakes of dairy desserts and ice cream were associated with cognitive decline. On the other hand, 1 study demonstrated a significant inverse relation between dairy intake and development of Alzheimer disease among older Japanese subjects. The consumption of dairy products by older people may reduce the risk of frailty, especially with high consumption of low-fat milk and yogurt, and may also reduce the risk of sarcopenia by improving skeletal muscle mass through the addition of nutrient-rich dairy proteins (ricotta cheese) to the habitual diet. Despite the scarcity of evidence on the topic, our systematic review shows that there are some positive effects of dairy products on frailty and sarcopenia, whereas studies concerning cognitive decline have contradictory findings.
Collapse
Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Department of Preventive Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Escuela de Enfermería de Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Medicina de Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
20
|
Pourhassan M, Angersbach B, Lueg G, Klimek CN, Wirth R. Blood Thiamine Level and Cognitive Function in Older Hospitalized Patients. J Geriatr Psychiatry Neurol 2019; 32:90-96. [PMID: 30572755 DOI: 10.1177/0891988718819862] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM We sought to identify any association between whole blood thiamine level and functional status in older hospitalized patients. METHODS This cross-sectional study retrospectively analyzed the results of routine measurements of whole blood thiamine levels of 233 older patients who were consecutively hospitalized to a geriatric acute care ward. Nutritional status, depression, and the participants' cognitive impairment were evaluated using the Mini Nutritional Assessment-Short Form, Depression in Old Age Scale, and Montreal Cognitive Assessment, respectively. Activities of daily living were determined using Barthel Index (BI) on admission and at the time of discharge. Diagnoses of dementia and delirium were derived from the patients' medical records. RESULTS Of 233 participants (mean age 82.1 [7.1]), 47.0% and 39.0% were at risk of malnutrition and malnourished, respectively. There was no thiamine deficiency (<20 ng/mL) in total population. Nearly all patients (95%) were screened with impaired cognitive function, in which 36% and 9% had the diagnosis of dementia and delirium, respectively. Patients with dementia (P = .040) and delirium (P = .002) demonstrated lower mean thiamine blood levels compared to patients without. Mean blood vitamin B1 was higher in patients with functional recovery (change in BI ≥5 points during hospitalization; P = .018). In a binary logistic regression analysis, blood vitamin B1, weight loss, and female gender were the major independent risk factors for delirium but not for dementia. CONCLUSION Despite the absence of thiamine deficiency, whole blood thiamine was lower in patients with dementia and delirium compared to those without. Higher thiamine levels were significantly associated with functional recovery during hospitalization.
Collapse
Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Bjoern Angersbach
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Gero Lueg
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Christiane Nicola Klimek
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
21
|
Balboa-Castillo T, Struijk EA, Lopez-Garcia E, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillon P. Low vitamin intake is associated with risk of frailty in older adults. Age Ageing 2018; 47:872-879. [PMID: 30052701 DOI: 10.1093/ageing/afy105] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/03/2018] [Indexed: 01/07/2023] Open
Abstract
Background the association between vitamin intake and frailty has hardly been studied. The objective was to assess the association of dietary vitamin intake with incident frailty in older adults from Spain. Methods data came from a cohort of 1,643 community-dwelling individuals aged ≥65, recruited in 2008-10 and followed up prospectively throughout 2012. At baseline, 10 vitamins were assessed (vitamin A, thiamine, riboflavin, niacin, vitamins B6, B12, C, D, E and folates) using a validated face-to-face diet history. Incident frailty was identified using Fried's definition as having ≥3 of the following five criteria: unintentional weight loss of ≥4.5 kg, exhaustion, weakness, slow walking speed and low physical activity. Nonadherence to the recommended dietary allowances (RDA) was considered when the intake of a vitamin was below the recommendation. Analyses were performed with logistic regression and adjusted for main confounders. Results during a 3.5-year follow-up, 89 (5.4%) participants developed frailty. The odds ratios (95% confidence interval) of frailty for those in the lowest versus the highest tertile of vitamin intake were 2.80 (1.38-5.67), P-trend: 0.004, for vitamin B6; 1.65 (0.93-2.95), P-trend: 0.007, for vitamin C; 1.93 (0.99-3.83), P-trend: 0.06, for vitamin E and 2.34 (1.21-4.52), P-trend: 0.01, for folates. Nonadherence to the RDAs of vitamins was related to frailty for thiamine odds ratio (OR): 2.09 (1.03-4.23); niacin OR: 2.80 (1.46-5.38) and vitamin B6; 2.23 (1.30-3.83). When considering tertiles of RDAs for the 10 vitamins those who met <5 RDAs had a higher risk of frailty, OR: 2.84 (1.34-6.03); P-trend: <0.001, compared to those who met >7. Conclusion a lower intake of vitamins B6, C, E and folates was associated with a higher risk of frailty. Not meeting RDAs for vitamins was also strongly associated.
Collapse
Affiliation(s)
- Teresa Balboa-Castillo
- Department of Public Health—EPICYN Research Center, School of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillon
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
- Johns Hopkins Bloomerg School of Public Health, Baltimore, USA
| |
Collapse
|
22
|
Tomlinson DJ, Erskine RM, Morse CI, Onambélé GL. Impact of Above-Average Proanabolic Nutrients Is Overridden by High Protein and Energy Intake in the Muscle-Tendon Unit Characteristics of Middle- to Older-Aged Adults. J Nutr 2018; 148:1776-1785. [PMID: 30247586 PMCID: PMC6209810 DOI: 10.1093/jn/nxy185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/19/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background The impact, within a single cohort, of independent modulators of skeletal muscle quality, including age, adiposity and obesity, habitual nutritional intake, and physical activity (PA), is unclear. Objective We examined the bivariate associations between age, adiposity, habitual nutritional intake, and PA against 11 key intrinsic muscle-tendon unit (MTU) characteristics to identify the strongest predictors. We also compared overall profile differences between MTU categories with the use of z scores shown in radar graphs. Methods Fifty untrained independently living men (n = 15) and women (n = 35) aged 43-80 y (mean ± SD: 64 ±9 y) were categorized by adiposity [men: normal adiposity (NA) <28%, high adiposity (HA) ≥28%; women: NA <40%, HA ≥40%] and body mass index [BMI (in kg/m2); normal: 18 to <25; overweight: ≥25 to <30; and obese: ≥30]. Group differences were examined by body composition assessed with the use of dual-energy X-ray absorptiometry, habitual nutritional intake through a 3-d food diary, PA (work, leisure, sport) using the Baecke questionnaire, 14 serum cytokine concentrations using multiplex luminometry, and 11 MTU characteristics of the gastrocnemius medialis using a combination of isokinetic dynamometry, electromyography, and ultrasonography. Results Interestingly, classification by BMI highlighted differences between normal and obese individuals in 6 of 11 MTU characteristics (P < 0.001 to P = 0.043). No significant differences were reported in serum cytokine concentrations between adiposity and BMI classifications. BMI predicted 8 of 11 (r = 0.62-0.31, P < 0.001 to P = 0.032), daily energy intake predicted 7 of 11 (r = 0.45-0.34, P = 0.002-0.036), age predicted 5 of 11 (r = -0.49-0.32, P < 0.001 to P = 0.032), work-based PA predicted 5 of 11 (r = 0.43-0.32, P = 0.003-0.048), and adiposity predicted 4 of 11 (r = 0.51-0.33, P < 0.001 to P = 0.022) MTU characteristics. Mathematical z scores and radar graphs showed how endocrine and dietary profiles, but not PA, differed between the top and bottom ∼20% of muscle unit size and specific force. Conclusions Given the number of factors associated with MTU, education should be targeted to both adequate food quantity and quality (especially protein intake) and increasing habitual moderate to vigorous PA while decreasing sedentary behavior. Specific endocrine variables are also proposed as key pharmaceutical targets.
Collapse
Affiliation(s)
- David J Tomlinson
- Health, Exercise, and Active Living Research Center, Manchester Metropolitan University, Crewe, United Kingdom
| | - Robert M Erskine
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Institute of Sport, Exercise, and Health, University College London, London, United Kingdom
| | - Christopher I Morse
- Health, Exercise, and Active Living Research Center, Manchester Metropolitan University, Crewe, United Kingdom
| | - Gladys L Onambélé
- Health, Exercise, and Active Living Research Center, Manchester Metropolitan University, Crewe, United Kingdom
| |
Collapse
|
23
|
Wang J, Maxwell CA, Yu F. Biological Processes and Biomarkers Related to Frailty in Older Adults: A State-of-the-Science Literature Review. Biol Res Nurs 2018; 21:80-106. [DOI: 10.1177/1099800418798047] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The objectives of this literature review were to (1) synthesize biological processes linked to frailty and their corresponding biomarkers and (2) identify potential associations among these processes and biomarkers. In September 2016, PubMed, Cumulative Index to Nursing and Allied Health, Cochrane Library, and Embase were searched. Studies examining biological processes related to frailty in older adults (≥60 years) were included. Studies were excluded if they did not employ specific measures of frailty, did not report the association between biomarkers and frailty, or focused on nonelderly samples (average age < 60). Review articles, commentaries, editorials, and non-English articles were also excluded. Fifty-two articles were reviewed, reporting six biological processes related to frailty and multiple associated biomarkers. The processes (biomarkers) include brain changes (neurotrophic factor, gray matter volume), endocrine dysregulation (growth hormones [insulin-like growth factor-1 and binding proteins], hormones related to glucose and insulin, the vitamin D axis, thyroid function, reproductive axis, and hypothalamic–pituitary–adrenal axis), enhanced inflammation (C-reactive protein, interleukin-6), immune dysfunction (neutrophils, monocytes, neopterin, CD8+CD28−T cells, albumin), metabolic imbalance (micronutrients, metabolites, enzyme-activity indices, metabolic end products), and oxidative stress (antioxidants, telomere length, glutathione/oxidized glutathione ratio). Bidirectional interrelationships exist within and between these processes. Biomarkers were associated with frailty in varied strengths, and the causality remains unclear. In conclusion, frailty is related to multisystem physiological changes. Future research should examine the dynamic interactions among these processes to inform causality of frailty. Given the multifactorial nature of frailty, a composite index of multisystem biomarkers would likely be more informative than single biomarkers in early detection of frailty.
Collapse
Affiliation(s)
- Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, NY, USA
| | | | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
24
|
Al-Batayneh KM, Zoubi MSA, Shehab M, Al-Trad B, Bodoor K, Khateeb WA, Aljabali AAA, Hamad MA, Eaton G. Association between MTHFR 677C>T Polymorphism and Vitamin B12 Deficiency: A Case-control Study. J Med Biochem 2018; 37:141-147. [PMID: 30581350 PMCID: PMC6294092 DOI: 10.1515/jomb-2017-0051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/10/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Vitamin B12 (cobalamin) deficiency is a prevalent worldwide health concern. Several factors are associated with vitamin B12 deficiency including lifestyle, genetic predisposition, and malfunctions in the absorption and transport of vitamin B12. In the current case-control study, we aimed at investigating the association between MTHFR polymorphisms and vitamin B12 deficiency in a Jordanian population. METHODS Two polymorphic sites of the MTHFR gene (c.677C>T, rs1801133 and c.1286A>C, rs1801131) were analyzed using RFLP and DNA sequencing in a group of vitamin B12 deficient individuals (45 males and 55 females). As a control, 100 matching individuals (age and sex) with vitamin B12 levels > 200 ng/mL were also recruited for this study. RESULTS The MTHFR c.677C>T variant was significantly associated with vitamin B12 deficiency in individuals from northern Jordan. The frequency of the homozygous MTHFR c.677C>T genotype was significantly higher in B12 deficient individuals in comparison with the control group (X2 = 8.397, p = 0.0150). The T allele frequency showed significant association with vitamin B12 deficiency in the study population (OR= 1.684, 95% CI: 1.116 to 2.542, p = 0.017). On the other hand, the MTHFR c.1286A>C variant did not show significant association with vitamin B12 deficiency in the selected population. CONCLUSIONS Our results showed a significant association between homozygous MTHFR c.677C>T variant and T allele frequencies and vitamin B12 deficiency in the Jordanian population.
Collapse
Affiliation(s)
- Khalid M. Al-Batayneh
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | - Mazhar Salim Al Zoubi
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Murad Shehab
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | - Bahaa Al-Trad
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | - Khaldon Bodoor
- Department of Applied Biology, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Wesam Al Khateeb
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | | | - Mohammad Al Hamad
- Department of Pathology, Faculty of Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Greg Eaton
- Department of Biology, Rowan University, New Jersey, USA
| |
Collapse
|
25
|
Selected B vitamins and their possible link to the aetiology of age-related sarcopenia: relevance of UK dietary recommendations. Nutr Res Rev 2018; 31:204-224. [DOI: 10.1017/s0954422418000045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractThe possible roles of selected B vitamins in the development and progression of sarcopenia are reviewed. Age-related declines in muscle mass and function are associated with huge and increasing costs to healthcare providers. Falls and loss of mobility and independence due to declining muscle mass/function are associated with poor clinical outcomes and their prevention and management are attractive research targets. Nutritional status appears a key modifiable and affordable intervention. There is emerging evidence of sarcopenia being the result not only of diminished anabolic activity but also of declining neurological integrity in older age, which is emerging as an important aspect of the development of age-related decline in muscle mass/function. In this connection, several B vitamins can be viewed as not only cofactors in muscle synthetic processes, but also as neurotrophic agents with involvements in both bioenergetic and trophic pathways. The B vitamins thus selected are examined with respect to their relevance to multiple aspects of neuromuscular function and evidence is considered that requirements, intakes or absorption may be altered in the elderly. In addition, the evidence base for recommended intakes (UK recommended daily allowance) is examined with particular reference to original datasets and their relevance to older individuals. It is possible that inconsistencies in the literature with respect to the nutritional management of sarcopenia may, in part at least, be the result of compromised micronutrient status in some study participants. It is suggested that in order, for example, for intervention with amino acids to be successful, underlying micronutrient deficiencies must first be addressed/eliminated.
Collapse
|
26
|
van Dijk M, Dijk FJ, Hartog A, van Norren K, Verlaan S, van Helvoort A, Jaspers RT, Luiking Y. Reduced dietary intake of micronutrients with antioxidant properties negatively impacts muscle health in aged mice. J Cachexia Sarcopenia Muscle 2018; 9:146-159. [PMID: 29045021 PMCID: PMC5803605 DOI: 10.1002/jcsm.12237] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 06/06/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inadequate intake of micronutrients with antioxidant properties is common among older adults and has been associated with higher risk of frailty, adverse functional outcome, and impaired muscle health. However, a causal relationship is less well known. The aim was to determine in old mice the impact of reduced dietary intake of vitamins A/E/B6/B12/folate, selenium, and zinc on muscle mass, oxidative capacity, strength, and physical activity (PA) over time. METHODS Twenty-one-month-old male mice were fed either AIN-93-M (control) or a diet low in micronutrients with antioxidant properties (=LOWOX-B: 50% of mouse recommended daily intake of vitamins A, E, B6, and B12, folate, selenium, and zinc) for 4 months. Muscle mass, grip strength, physical activity (PA), and general oxidative status were assessed. Moreover, muscle fatigue was measured of m. extensor digitorum longus (EDL) during an ex vivo moderate exercise protocol. Effects on oxidative capacity [succinate dehydrogenase (SDH) activity], muscle fibre type, number, and fibre cross-sectional area (fCSA) were assessed on m. plantaris (PL) using histochemistry. RESULTS After 2 months on the diet, bodyweight of LOWOX-B mice was lower compared with control (P < 0.0001), mainly due to lower fat mass (P < 0.0001), without significant differences in food intake. After 4 months, oxidative status of LOWOX-B mice was lower, demonstrated by decreased vitamin E plasma levels (P < 0.05) and increased liver malondialdehyde levels (P = 0.018). PA was lower in LOWOX-B mice (P < 0.001 vs. control). Muscle mass was not affected, although PL-fCSA was decreased (~16%; P = 0.028 vs. control). SDH activity and muscle fibre type distribution remained unaffected. In LOWOX-B mice, EDL force production was decreased by 49.7% at lower stimulation frequencies (P = 0.038), and fatigue resistance was diminished (P = 0.023) compared with control. CONCLUSIONS Reduced dietary intake of vitamins A, E, B6, and B12, folate, selenium, and zinc resulted in a lower oxidative capacity and has major impact on muscle health as shown by decreased force production and PA, without effects on muscle mass. The reduced fCSA in combination with similar SDH activity per fibre might explain the reduced oxidative capacity resulting in the increased fatigue after exercise in LOWOX-B mice.
Collapse
Affiliation(s)
- Miriam van Dijk
- Nutricia Research, Nutricia Advanced Medical Nutrition, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands
| | - Francina J Dijk
- Nutricia Research, Nutricia Advanced Medical Nutrition, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands
| | - Anita Hartog
- Nutricia Research, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands
| | - Klaske van Norren
- Nutrition and Pharmacology, Wageningen University, Stippeneng 4, 6708 WE, Wageningen, the Netherlands
| | - Sjors Verlaan
- Nutricia Research, Nutricia Advanced Medical Nutrition, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands.,Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Ardy van Helvoort
- Nutricia Research, Nutricia Advanced Medical Nutrition, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
| | - Richard T Jaspers
- Laboratory for Myology, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, De Boelelaan 1108, 1081 HZ, Amsterdam, the Netherlands
| | - Yvette Luiking
- Nutricia Research, Nutricia Advanced Medical Nutrition, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands
| |
Collapse
|
27
|
Laird E, Molloy AM, McNulty H, Ward M, McCarroll K, Hoey L, Hughes CF, Cunningham C, Strain JJ, Casey MC. Greater yogurt consumption is associated with increased bone mineral density and physical function in older adults. Osteoporos Int 2017; 28:2409-2419. [PMID: 28462469 DOI: 10.1007/s00198-017-4049-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/10/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED In this cohort of community dwelling older adults (>60 years), we observed significant positive associations between the frequencies of yogurt intake with measures of bone density, bone biomarkers, and indicators of physical function. Improving yogurt intakes could be a valuable health strategy for maintaining bone health in older adults. INTRODUCTION The associations of yogurt intakes with bone health and frailty in older adults are not well documented. The aim was to investigate the association of yogurt intakes with bone mineral density (BMD), bone biomarkers, and physical function in 4310 Irish adults from the Trinity, Ulster, Department of Agriculture aging cohort study (TUDA). METHODS Bone measures included total hip, femoral neck, and vertebral BMD with bone biochemical markers. Physical function measures included Timed Up and Go (TUG), Instrumental Activities of Daily Living Scale, and Physical Self-Maintenance Scale. RESULTS Total hip and femoral neck BMD in females were 3.1-3.9% higher among those with the highest yogurt intakes (n = 970) compared to the lowest (n = 1109; P < 0.05) as were the TUG scores (-6.7%; P = 0.013). In males, tartrate-resistant acid phosphatase (TRAP 5b) concentrations were significantly lower in those with the highest yogurt intakes (-9.5%; P < 0.0001). In females, yogurt intake was a significant positive predictor of BMD at all regions. Each unit increase in yogurt intake in females was associated with a 31% lower risk of osteopenia (OR 0.69; 95% CI 0.49-0.96; P = 0.032) and a 39% lower risk of osteoporosis (OR 0.61; 95% CI 0.42-0.89; P = 0.012) and in males, a 52% lower risk of osteoporosis (OR 0.48; 95% CI 0.24-0.96; P = 0.038). CONCLUSION In this cohort, higher yogurt intake was associated with increased BMD and physical function scores. These results suggest that improving yogurt intakes could be a valuable public health strategy for maintaining bone health in older adults.
Collapse
Affiliation(s)
- E Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - A M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H McNulty
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - M Ward
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - K McCarroll
- St James's Hospital, The Mercers Institute for Research on Ageing, Dublin, Ireland
| | - L Hoey
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - C F Hughes
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - C Cunningham
- St James's Hospital, The Mercers Institute for Research on Ageing, Dublin, Ireland
| | - J J Strain
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - M C Casey
- St James's Hospital, The Mercers Institute for Research on Ageing, Dublin, Ireland
| |
Collapse
|
28
|
Lorenzo-López L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodríguez-Villamil JL, Millán-Calenti JC. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr 2017; 17:108. [PMID: 28506216 PMCID: PMC5433026 DOI: 10.1186/s12877-017-0496-2] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that affects multiple domains of human functioning. A variety of problems contributes to the development of this syndrome; poor nutritional status is an important determinant of this condition. The purpose of this systematic review was to examine recent evidence regarding the association between nutritional status and frailty syndrome in older adults. METHODS PubMed, Web of Science, and Scopus electronic databases were searched using specific key words, for observational papers that were published during the period from 2005 to February 2017 and that studied the association or relationship between nutritional status and frailty in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed to assess the quality of the included articles. RESULTS Of the 2042 studies found, nineteen met the inclusion criteria. Of these studies, five provided data on micronutrients and frailty, and reported that frailty syndrome is associated with low intakes of specific micronutrients. Five studies provided data on macronutrients and frailty, and among those studies, four revealed that a higher protein intake was associated with a lower risk of frailty. Three studies examined the relationship between diet quality and frailty, and showed that the quality of the diet is inversely associated with the risk of being frail. Two studies provided data on the antioxidant capacity of the diet and frailty, and reported that a high dietary antioxidant capacity is associated with a lower risk of developing frailty. Finally, seven studies evaluated the relationship between scores on both the Mini Nutritional Assessment (MNA) and the MNA-SF (Short Form) and frailty, and revealed an association between malnutrition and/or the risk of malnutrition and frailty. CONCLUSIONS This systematic review confirms the importance of both quantitative (energy intake) and qualitative (nutrient quality) factors of nutrition in the development of frailty syndrome in older adults. However, more longitudinal studies on this topic are required to further understand the potential role of nutrition in the prevention, postponement, or even reversion of frailty syndrome.
Collapse
Affiliation(s)
- Laura Lorenzo-López
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071, A Coruña, Spain
| | - Ana Maseda
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071, A Coruña, Spain
| | - Carmen de Labra
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071, A Coruña, Spain
| | - Laura Regueiro-Folgueira
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071, A Coruña, Spain
| | - José L Rodríguez-Villamil
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071, A Coruña, Spain
| | - José C Millán-Calenti
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071, A Coruña, Spain. .,Gerontology Research Group, Department of Biomedical Sciences, Medicine and Physiotherapy, Faculty of Health Sciences, Universidade da Coruña, Campus de Oza, 15071, A Coruña, Spain.
| |
Collapse
|
29
|
Vidoni ML, Pettee Gabriel K, Luo ST, Simonsick EM, Day RS. Vitamin B12 and Homocysteine Associations with Gait Speed in Older Adults: The Baltimore Longitudinal Study of Aging. J Nutr Health Aging 2017; 21:1321-1328. [PMID: 29188896 PMCID: PMC5726303 DOI: 10.1007/s12603-017-0893-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to assess the independent associations of serum levels of vitamin B12 and plasma concentrations of homocysteine with gait speed decline. DESIGN, SETTING, PARTICIPANTS This study utilized longitudinal analysis of participants 50 years or older from The Baltimore Longitudinal Study of Aging, N=774. MEASUREMENTS Gait speed (m/s) was assessed using the 6-meter usual pace test. Vitamin B12 and homocysteine concentrations were collected using standard clinical protocols. Linear mixed effects regression was stratified by baseline age category (50-69, 70-79, and ≥80 years old). RESULTS Mean follow-up time for the total study sample was 5.4 ± 2.0 years. No association between vitamin B12 and gait speed decline over the follow-up time for any age group was found. Elevated homocysteine concentrations were associated with decline in gait speed after adjustment for covariates (50-69: β= -0.005, p=.057; 70-79: β= -0.013, p<.001, ≥80: β= -0.007, p=.054). CONCLUSION Homocysteine and vitamin B12 are inversely related, yet only homocysteine was associated with gait speed decline in this population of healthy older adults. Given these results, future research should be directed towards investigating the relationship in populations with greater variation in vitamin B12 concentrations and other mechanisms influencing homocysteine concentrations.
Collapse
Affiliation(s)
- M L Vidoni
- R. Sue Day, University of Texas Health Science Center at Houston School of Public Health, Division of Epidemiology, Human Genetics, and Environmental Science, Michael and Susan Dell Center for Healthy Living, Houston, TX, USA,
| | | | | | | | | |
Collapse
|
30
|
Ng TP, Nyunt MSZ, Feng L, Feng L, Niti M, Tan BY, Chan G, Khoo SA, Chan SM, Yap P, Yap KB. Multi-Domains Lifestyle Interventions Reduces Depressive Symptoms among Frail and Pre-Frail Older Persons: Randomized Controlled Trial. J Nutr Health Aging 2017; 21:918-926. [PMID: 28972245 DOI: 10.1007/s12603-016-0867-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms. METHOD Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M). RESULTS Mean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (∆=change) at 6M for cognitive versus control (∆=-0.39, p=0.021, group*time interaction p=0.14); physical versus control (∆ =-0.37, p=0.026, group*time interaction p=0.13), and at 12M for nutrition versus control (∆ =-0.46, p=0.016, group*time interaction p=0.15). The effect for combination versus control was significant at 6M (∆ =-0.43, p=0.020) and 12M (∆ =-0.51, p=0.005, group*time interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time. CONCLUSION Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.
Collapse
Affiliation(s)
- T P Ng
- A/P Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Wee AKH. Serum folate predicts muscle strength: a pilot cross-sectional study of the association between serum vitamin levels and muscle strength and gait measures in patients >65 years old with diabetes mellitus in a primary care setting. Nutr J 2016; 15:89. [PMID: 27756315 PMCID: PMC5070191 DOI: 10.1186/s12937-016-0208-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/06/2016] [Indexed: 12/27/2022] Open
Abstract
Background Old age and diabetes mellitus are risk factors for vitamin deficiencies, weakness and falls. Deficiencies of vitamin D, and possibly vitamin B12 and folate (which are associated with hyperhomocysteinaemia), contribute to sarcopenia. Determination of the physical effects of vitamin deficiencies in specific groups of people can help to guide public health policy with regard to vitamin supplementation. Methods A pilot cross-sectional study was conducted to determine the association of levels of vitamin D, vitamin B12, folate and homocysteine with muscle strength, gait and fall history in 56 patients >65 years old with diabetes mellitus in primary care in Singapore. Hand-grip and leg-quadriceps strength measures were obtained and divided by body mass index (BMI). The timed up-and-go and Tinetti tests were used to measure gait. A history of “at least one fall in the preceding year” was obtained. Results Vitamin B12 deficiency (<150 pmol/l) was present in 43 % of patients, folate deficiency (<13.5 mmol/l) in 20 %, hyperhomocysteinaemia (≥15.0 μmol/l) in 52 % and vitamin D deficiency (<49.9 nmol/l) in 25 %. Levels of vitamin D, vitamin B12 and homocysteine did not significantly predict muscle strength in regression analyses. Folate (B = 0.010, P < 0.01) and gender (B = 0.356, P < 0.001) predicted average grip strength corrected for BMI (F(2,53) = 17.74, P < 0.001, R2 = 0.40) Folate (B = 0.011, P < 0.05) and gender (B = 0.367, P < 0.001) also predicted average leg quadriceps strength corrected for BMI (F(2,53) = 9.79, P < 0.001, R2 = 0.27). Average leg strength and average leg strength corrected for BMI were both negatively associated with the risk of having fallen in the preceding year (odds ratio (OR) = 0.89, 95 % CI 0.80–0.98, P < 0.05 and OR = 0.12, 95 % CI 0.02–0.92, P < 0.05, respectively). Conclusions The prevalence of vitamin deficiency was very high in our sample of patients >65 years old with diabetes mellitus. Folate levels were significantly correlated with grip and leg strength (with correction for BMI). Leg strength was positively correlated with gait measures and negatively correlated with a history of falls. The role of folate in muscle weakness and falls warrants further study.
Collapse
Affiliation(s)
- Andrew Kien Han Wee
- SingHealth Polyclinics, Marine Parade Polyclinic, Blk 80 Marine Parade Central, #01-792, Singapore, 440080, Singapore.
| |
Collapse
|
32
|
VNTR polymorphisms of the IL-4 and IL-1RN genes and their relationship with frailty syndrome in Mexican community-dwelling elderly. Aging Clin Exp Res 2016; 28:823-32. [PMID: 26646252 DOI: 10.1007/s40520-015-0503-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/13/2015] [Indexed: 01/26/2023]
Abstract
Inflammation is a key event that is closely associated with the pathophysiology of frailty. The relationship of genetic polymorphisms into inflammatory cytokines with frailty remains poorly understood. The aim of this study was to investigate the association between VNTR polymorphisms of the IL-4 and IL-1RN genes with the risk of frailty. We included a sample of 630 community-dwelling elderly aged 70 and older. Both IL-4 and IL-1RN VNTR polymorphisms were genotyped by the polymerase chain reaction (PCR) method. Mean age was 77.7 years (SD = 6.0) and 52.5 % were women. The participants classified as frail were more likely to be older, had lower MMSE score (p < 0.001), and had more disability for IADL (p < 0.001) and ADL (p < 0.001). Genotypic and allelic frequencies for the IL-4 VNTR polymorphism did not show significant differences between study groups (p > 0.05). However, we just observed a significant difference in the allelic frequencies for the A2 allele of the IL-1RN VNTR polymorphism between frail and nonfrail groups (OR 1.84, 95 % CI 1.08-3.12, p = 0.02). In addition, we analyzed the combined effect of the IL-4 and IL-1RN VNTR polymorphisms and their possible association with frailty, where the combined IL-4 (low) -IL-1Ra (high) genotype was identified as a marker of risk to frailty syndrome (OR 7.86, 95 % CI 1.83-33.69, p = 0.006). Our results suggest that both A2 allele and the combined IL-4 (low) -IL-1Ra (high) genotype might be genetic markers of susceptibility to frailty in Mexican elderly.
Collapse
|
33
|
Pfisterer KJ, Sharratt MT, Heckman GG, Keller HH. Vitamin B12 status in older adults living in Ontario long-term care homes: prevalence and incidence of deficiency with supplementation as a protective factor. Appl Physiol Nutr Metab 2016; 41:219-22. [PMID: 26781161 DOI: 10.1139/apnm-2015-0565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vitamin B12 (B12) deficiency, although treatable, impacts up to 43% of community-living older adults; long-term care (LTC) residents may be at greater risk. Recommendations for screening require further evidence on prevalence and incidence in LTC. Small, ungeneralizable samples provide a limited perspective on these issues. The purposes of this study were to report prevalence of B12 deficiency at admission to LTC, incidence 1 year post-admission, and identify subgroups with differential risk. This multi-site (8), retrospective prevalence study used random proportionate sampling of resident charts (n = 412). Data at admission extracted included demographics, B12 status, B12 supplementation, medications, diagnoses, functional independence, cognitive performance, and nutrition. Prevalence at admission of B12 deficiency (<156 pmol/L) was 13.8%; 47.6% had normal B12 (>300 pmol/L). One year post-admission incidence was 4%. Better B12 status was significantly associated with supplementation use prior to LTC admission. Other characteristics were not associated with status. This work provides a better estimate of B12 deficiency prevalence than previously available for LTC, upon which to base protocols and policy. Prospective studies are needed to establish treatment efficacy and effect on health related outcomes.
Collapse
Affiliation(s)
- Kaylen J Pfisterer
- a University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.,b Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - Mike T Sharratt
- a University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.,b Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - George G Heckman
- a University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.,b Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - Heather H Keller
- a University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.,b Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| |
Collapse
|
34
|
Kurnat-Thoma EL, Pangilinan F, Matteini AM, Wong B, Pepper GA, Stabler SP, Guralnik JM, Brody LC. Association of Transcobalamin II (TCN2) and Transcobalamin II-Receptor (TCblR) Genetic Variations With Cobalamin Deficiency Parameters in Elderly Women. Biol Res Nurs 2015; 17:444-54. [DOI: 10.1177/1099800415569506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cobalamin (vitamin B12) deficiency is a subtle progressive clinical disorder, affecting nearly 1 in 5 individuals > 60 years old. This deficiency is produced by age-related decreases in nutrient absorption, medications that interfere with vitamin B12 absorption, and other comorbidities. Clinical heterogeneity confounds symptom detection for elderly adults, as deficiency sequelae range from mild fatigue and weakness to debilitating megaloblastic anemia and permanent neuropathic injury. A better understanding of genetic factors that contribute to cobalamin deficiency in the elderly would allow for targeted nursing care and preventive interventions. We tested for associations of common variants in genes involved in cobalamin transport and homeostasis with metabolic indicators of cobalamin deficiency (homocysteine and methylmalonic acid) as well as hematologic, neurologic, and functional performance features of cobalamin deficiency in 789 participants of the Women’s Health and Aging Studies. Although not significant when corrected for multiple testing, eight single nucleotide polymorphisms (SNPs) in two genes, transcobalamin II ( TCN2) and the transcobalamin II-receptor ( TCblR), were found to influence several clinical traits of cobalamin deficiency. The three most significant findings were the identified associations involving missense coding SNPs, namely, TCblR G220R (rs2336573) with serum cobalamin, TCN2 S348F (rs9621049) with homocysteine, and TCN2 P259R (rs1801198) with red blood cell mean corpuscular volume. These SNPs may modify the phenotype in older adults who are more likely to develop symptoms of vitamin B12 malabsorption.
Collapse
Affiliation(s)
- Emma L. Kurnat-Thoma
- Genome Technology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- University of Utah, College of Nursing, Salt Lake City, UT, USA
| | - Faith Pangilinan
- Genome Technology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy M. Matteini
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Bob Wong
- University of Utah, College of Nursing, Salt Lake City, UT, USA
| | | | - Sally P. Stabler
- University of Colorado, School of Medicine, Division of Hematology, Denver, CO, USA
| | | | - Lawrence C. Brody
- Genome Technology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
35
|
Abstract
The prevalence of vitamin B12 deficiency increases with age. Patients with dementia and spouses of patients with dementia are at special risk for the development of vitamin B12 deficiency. In a normal diet this vitamin is present only in animal source foods; therefore, vegans frequently develop vitamin B12 deficiency if not using supplements or foods fortified with cobalamin. Apart from dementia, most of these manifestations are completely reversible under correct therapy; therefore it is crucial to identify and to treat even atypical presentations of vitamin B12 deficiency as early as possible. This article deals with the physiology and pathophysiology of vitamin B12 metabolism. A practice-oriented algorithm which also considers health economic aspects for a rational laboratory diagnosis of vitamin B12 deficiency is presented. In cases with severe neurological symptoms, therapy should be parenteral, especially initially. For parenteral treatment, hydroxocobalamin is the drug of choice.
Collapse
Affiliation(s)
- A H Leischker
- Klinik für Allgemeine Innere Medizin und Altersmedizin, Alexianer Krefeld GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland,
| | | |
Collapse
|
36
|
Valentini L, Pinto A, Bourdel-Marchasson I, Ostan R, Brigidi P, Turroni S, Hrelia S, Hrelia P, Bereswill S, Fischer A, Leoncini E, Malaguti M, Blanc-Bisson C, Durrieu J, Spazzafumo L, Buccolini F, Pryen F, Donini LM, Franceschi C, Lochs H. Impact of personalized diet and probiotic supplementation on inflammation, nutritional parameters and intestinal microbiota - The "RISTOMED project": Randomized controlled trial in healthy older people. Clin Nutr 2014; 34:593-602. [PMID: 25453395 DOI: 10.1016/j.clnu.2014.09.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/23/2014] [Accepted: 09/29/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the impact of a personalized diet, with or without addition of VSL#3 preparation, on biomarkers of inflammation, nutrition, oxidative stress and intestinal microbiota in 62 healthy persons aged 65-85 years. DESIGN Open label, randomized, multicenter study. PRIMARY ENDPOINT High-sensitivity C-reactive protein. SETTING Community. INTERVENTIONS Eight week web-based dietary advice (RISTOMED platform) alone or with supplementation of VSL#3 (2 capsules per day). The RISTOMED diet was optimized to reduce inflammation and oxidative stress. MEASUREMENTS Blood and stool samples were collected on days 1 and 56. RESULTS Diet alone reduced ESR (p = 0.02), plasma levels of cholesterol (p < 0.01) and glucose (p = 0.03). Addition of VSL#3 reduced ESR (p = 0.05) and improved folate (p = 0.007), vitamin B12 (p = 0.001) and homocysteine (p < 0.001) plasma levels. Neither intervention demonstrated any further effects on inflammation. Subgroup analysis showed 40 participants without signs of low-grade inflammation (hsCRP<3 mg/l, subgroup 1) and 21 participants with low-grade inflammation at baseline (hsCRP≥3 mg/l, subgroup 2). In subgroup 2 addition of VSL#3 increased bifidobacteria (p = 0.005) in more participants and improved both folate (p = 0.015) and vitamin B12 (p = 0.035) levels compared with subgroup 1. The increases were positively correlated to the change in the bifidobacteria concentration for folate (p = 0.023) and vitamin B12 (p = 0.001). As expected change in homocysteine correlated negatively to change in folate (r = -0.629, p = 0.002) and vitamin B12 (r = -0.482, p = 0.026). CONCLUSIONS Addition of VSL#3 increased bifidobacteria and supported adequate folate and vitamin B12 concentrations in subjects with low-grade inflammation. Decrease in homocysteine with VSL#3 was clinically relevant. suggesting protective potentials for aging-associated conditions, e.g. cardiovascular or neurological diseases. ClinicalTrials.gov: NCT01069445-NCT01179789.
Collapse
Affiliation(s)
- Luzia Valentini
- Dept Gastroenterology and Hepatology, Charité-Universitätsmedizin Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany.
| | - Alessandro Pinto
- Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Isabelle Bourdel-Marchasson
- CHU Bordeaux, Clinical Gerontology, France; CNRS, RMSB, UMR 5536, France; University Bordeaux, RMSB, UMR 5536, Bordeaux, France
| | - Rita Ostan
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 12, 40126 Bologna, Italy
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Silvia Turroni
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Silvana Hrelia
- Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Stefan Bereswill
- Dept Microbiology and Hygiene, Charité-Universitätsmedizin Berlin, CBF, Hindenburgdamm 27, 12203 Berlin, Germany
| | - André Fischer
- Dept Microbiology and Hygiene, Charité-Universitätsmedizin Berlin, CBF, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Emanuela Leoncini
- Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | - Marco Malaguti
- Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | | | | | - Liana Spazzafumo
- Biostatistical Center INRCA, Via S. Margherita 5, 60100 Ancona, Italy
| | - Fabio Buccolini
- R&D, VoxNet CEO, Via Giovanni Paisiello 32, 00198 Rome, Italy
| | - Florence Pryen
- Actial Farmaceutica Lda, Praca Severiano Ferraz 258, 09000 082 Funchal, Portugal
| | - Lorenzo Maria Donini
- Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 12, 40126 Bologna, Italy
| | - Herbert Lochs
- Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| |
Collapse
|
37
|
Mohler MJ, Fain MJ, Wertheimer AM, Najafi B, Nikolich-Žugich J. The Frailty Syndrome: Clinical measurements and basic underpinnings in humans and animals. Exp Gerontol 2014; 54:6-13. [DOI: 10.1016/j.exger.2014.01.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 01/10/2023]
|
38
|
Vitamin B12 deficiency in relation to functional disabilities. Nutrients 2013; 5:4462-75. [PMID: 24225845 PMCID: PMC3847742 DOI: 10.3390/nu5114462] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/16/2013] [Accepted: 11/04/2013] [Indexed: 11/16/2022] Open
Abstract
This study was designed to assess whether symptoms, functional measures, and reported disabilities were associated with vitamin B12 (B12) deficiency when defined in three ways. Participants, aged 60 or more years of age, in 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were categorized in relation to three previously used definitions of B12 deficiency: (1) serum B12 < 148 pmol/L; (2) serum B12 < 200 pmol/L and serum homocysteine > 20 μmol/L; and (3) serum B12 < 258 pmol/L or serum methylmalonic acid > 0.21 μmol/L. Functional measures of peripheral neuropathy, balance, cognitive function, gait speed, along with self-reported disability (including activities of daily living) were examined with standardized instruments by trained NHANES interviewers and technicians. Individuals identified as B12 deficient by definition 2 were more likely to manifest peripheral neuropathy OR (odds) (95% confidence intervals), p value: 9.70 (2.24, 42.07), 0.004 and report greater total disability, 19.61 (6.22, 61.86) 0.0001 after adjustments for age, sex, race, serum creatinine, and ferritin concentrations, smoking, diabetes, and peripheral artery disease. Smaller, but significantly increased, odds of peripheral neuropathy and total disability were also observed when definition 3 was applied. Functional measures and reported disabilities were associated with B12 deficiency definitions that include B12 biomarkers (homocysteine or methylmalonic acid). Further study of these definitions is needed to alert clinicians of possible subclinical B12 deficiency because functional decline amongst older adults may be correctable if the individual is B12 replete.
Collapse
|
39
|
Bouillon K, Kivimaki M, Hamer M, Sabia S, Fransson EI, Singh-Manoux A, Gale CR, Batty GD. Measures of frailty in population-based studies: an overview. BMC Geriatr 2013; 13:64. [PMID: 23786540 PMCID: PMC3710231 DOI: 10.1186/1471-2318-13-64] [Citation(s) in RCA: 303] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/06/2013] [Indexed: 12/12/2022] Open
Abstract
Background Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use. Methods In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators. Results Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments. Conclusions Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.
Collapse
Affiliation(s)
- Kim Bouillon
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Ng TP, Aung KCY, Feng L, Scherer SC, Yap KB. Homocysteine, folate, vitamin B-12, and physical function in older adults: cross-sectional findings from the Singapore Longitudinal Ageing Study. Am J Clin Nutr 2012; 96:1362-8. [PMID: 23134883 DOI: 10.3945/ajcn.112.035741] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a paucity of studies, as well as inconsistent findings, on the associations of homocysteine, folate, and vitamin B-12 with physical function and decline in older persons. OBJECTIVE We investigated the independent associations of homocysteine, folate, and vitamin B-12 with gait and balance performance and Instrumental Activities of Daily Living (IADL) in community-living older persons. DESIGN We performed cross-sectional analyses on baseline data of 796 respondents in the Singapore Longitudinal Ageing Study who had laboratory measurements of fasting homocysteine folate and vitamin B-12 and completed Performance Oriented Mobility Assessment (POMA) of gait and balance and self-reports of IADLs. RESULTS In multivariate analyses in which sex, age, education, housing type, comorbidities, hospitalization, depression and global cognitive scores, BMI, creatinine, arthritis and hip fracture, serum albumin and hemoglobin, and physical activities were controlled for, we showed that homocysteine, independently of folate and vitamin B-12, showed significant negative associations with POMA balance (P = 0.02), POMA gait scores (P < 0.01), and IADL (P < 0.01). Serum folate showed a significant positive association only with POMA balance scores (P < 0.045). No significant independent associations for vitamin B-12 were observed. CONCLUSIONS The independent association of elevated homocysteine and low folate, but not vitamin B-12, on physical and functional decline was supported in this study. Interventional studies of the physical functional effects of folate and vitamin B-12 status in different populations are needed.
Collapse
Affiliation(s)
- Tze-Pin Ng
- Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | | | | | | |
Collapse
|
41
|
Wong YYE, Almeida OP, McCaul KA, Yeap BB, Hankey GJ, Flicker L. Homocysteine, Frailty, and All-Cause Mortality in Older Men: The Health in Men Study. J Gerontol A Biol Sci Med Sci 2012; 68:590-8. [DOI: 10.1093/gerona/gls211] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
Collapse
Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
| |
Collapse
|
43
|
Chang SS, Weiss CO, Xue QL, Fried LP. Association between inflammatory-related disease burden and frailty: results from the Women's Health and Aging Studies (WHAS) I and II. Arch Gerontol Geriatr 2012; 54:9-15. [PMID: 21763008 PMCID: PMC3197795 DOI: 10.1016/j.archger.2011.05.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 05/16/2011] [Accepted: 05/17/2011] [Indexed: 01/07/2023]
Abstract
Frailty is associated with a pro-inflammatory state, which has been characterized by elevated levels of systemic inflammatory biomarkers, but has not been related to the number of co-existing chronic diseases associated with inflammation. We sought to determine the extent to which a higher number of inflammatory-related diseases is associated with frailty and to identify the most common disease patterns associated with being frail in older adults. We performed binomial regression analyses to assess whether a higher count of inflammatory-related diseases increases the probability of frailty using data from the WHAS I and II, companion cohorts composed of 70-79-year-old community-dwelling older women in Baltimore, Maryland (n=620). An increase of one inflammatory-related disease was associated log-linearly with frailty (Prevalence Ratio (PR)=2.28, 95% Confidence Interval (CI)=1.81-2.87). After adjusting for age, race, education, and smoking status, the probability of frailty remained significant (PR=1.97, 95%CI=1.52-2.55). In the frail population, chronic kidney disease (CKD) and depressive symptoms (Prevalence=22.9%, 95%CI=14.2-34.8%); CVD and depressive symptoms (21.7%, 95%CI=13.2-33.5%); CKD and anemia (18.7%, 95%CI=11.1-29.7%); cardiovascular disease (CVD), CKD, and pulmonary disease (10.7%, 95%CI=5.2-21.0%); CKD, anemia, and depressive symptoms (8.7%, 95%CI=3.9-18.2%); and CVD, anemia, pulmonary disease, and depressive symptoms (5.0%, 95%CI=1.6-14.4%) were among the most frequent disease combinations. Their prevalence percentages were significantly higher in the frail versus non-frail women. A higher inflammatory-related disease count, perhaps reflecting a greater pro-inflammatory burden, increases the likelihood of frailty. Shared mechanisms among specific disease combinations may further contribute to this risk.
Collapse
Affiliation(s)
- Sandy S. Chang
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208025, New Haven, CT, 06520, USA
| | - Carlos O. Weiss
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, John R. Burton Pavillion, 5505 Hopkins Bayview Circle, Baltimore, MD, 21224 USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, John R. Burton Pavillion, 5505 Hopkins Bayview Circle, Baltimore, MD, 21224 USA
| | - Linda P. Fried
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 Street, R1048, New York, NY, 10048 USA
| |
Collapse
|
44
|
Swart KMA, van Schoor NM, Blom HJ, Smulders YM, Lips P. Homocysteine and the risk of nursing home admission and mortality in older persons. Eur J Clin Nutr 2011; 66:188-95. [DOI: 10.1038/ejcn.2011.186] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
45
|
O'Leary F, Flood VM, Petocz P, Allman-Farinelli M, Samman S. B vitamin status, dietary intake and length of stay in a sample of elderly rehabilitation patients. J Nutr Health Aging 2011; 15:485-9. [PMID: 21623471 DOI: 10.1007/s12603-010-0330-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the relationships between previous diet, biomarkers of selected B vitamins, nutritional status and length of stay. DESIGN Cross sectional study. SETTING Geriatric rehabilitation patients, Sydney, Australia. PARTICIPANTS Fifty two consenting patients with normal serum creatinine levels and no dementia. MEASUREMENTS Serum vitamin B12, plasma vitamin B6, serum and erythrocyte folate, homocysteine and methylmalonic acid (MMA) concentrations; dietary intake using a validated semi-quantitative food frequency questionnaire and nutritional assessment using the Mini Nutritional Assessment (MNA). Length of stay data were collected from medical records after discharge. RESULTS The age was 80 ± 8 year (mean ± SD), BMI 26.4 ± 6.8 kg/m2 and MNA score 22 ± 3 indicating some risk of malnutrition. Deficiencies of vitamins B6, B12 and folate were found in 30, 22 and 5 subjects respectively. Length of stay was positively correlated with age and MMA (Spearman's correlation 0.4, p<0.01 and 0.28, p<0.05 respectively) and negatively correlated with albumin, vitamin B6 and MNA score (Spearman's correlation -0.35, -0.33 and -0.29, p<0.05). After adjustment for age and sex, ln vitamin B6 and ln MMA concentrations were significant in predicting ln LOS (p=0.006 and p=0.014 respectively). CONCLUSION The study indicates a high risk of vitamin B deficiencies in the elderly and suggests that deficiencies of vitamins B6 and B12 are associated with length of stay. This is concerning as B vitamin status is rarely fully assessed.
Collapse
Affiliation(s)
- F O'Leary
- Discipline of Nutrition and Metabolism, School of Molecular Bioscience, University of Sydney, NSW 2006, Australia
| | | | | | | | | |
Collapse
|
46
|
Pedersen TL, Keyes WR, Shahab-Ferdows S, Allen LH, Newman JW. Methylmalonic acid quantification in low serum volumes by UPLC–MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2011; 879:1502-6. [DOI: 10.1016/j.jchromb.2011.03.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 03/16/2011] [Accepted: 03/18/2011] [Indexed: 01/14/2023]
|
47
|
Robinson DJ, O'Luanaigh C, Tehee E, O'Connell H, Hamilton F, Chin AV, Coen R, Molloy AM, Scott J, Lawlor BA, Cunningham CJ. Vitamin B12 status, homocysteine and mortality amongst community-dwelling Irish elders. Ir J Med Sci 2010; 180:451-5. [PMID: 21072617 DOI: 10.1007/s11845-010-0639-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 10/28/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vitamin B12 deficiency is associated with hyperhomocysteinaemia, which is associated with atherosclerosis and increased mortality. High levels of vitamin B12 have also been associated with increased mortality in certain patient populations. AIMS We examined vitamin B12 and homocysteine status and mortality rates in a population of Irish community-dwelling elders over a 3-year period. METHODS Prospective, community-based observational cohort study. RESULTS Subjects in the highest quartile of homocysteine had increased mortality rates (14.68 vs. 7.32%, relative risk 2.09). This relationship was attenuated when controlled for the presence or absence of a history of stroke or myocardial infarction. There was no relationship between vitamin B12 status and mortality during the observation period. CONCLUSION Vitamin B12 levels are not associated with death rates in Irish community-dwelling elders. Homocysteine levels are associated with mortality and may act via the mechanism of atherosclerotic disease.
Collapse
Affiliation(s)
- D J Robinson
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin 8, Ireland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
SummaryFrailty is a central concept in geriatric medicine, but without a clear definition. Many regard it as a syndrome with its own clinical manifestations and pathophysiology, whilst others consider it to be the result of the accumulation of age-related deficits that predict adverse changes in health. We analysed, through a systematic review, the definitions and markers of the frailty syndrome. Twenty-five articles were included and divided, according to design, into observational, intervention, review and qualitative studies. There was a predominance of operational definitions that used only physical markers to identify frailty. The only qualitative study found that health professionals chose a multidimensional definition that took into account factors other than just the physical. We conclude that there is still no standard definition or agreement about markers of the frailty syndrome.
Collapse
|
49
|
Abstract
BACKGROUND Fatigue is common, disabling yet underappreciated, in patients with chronic diseases, including inflammatory bowel disease (IBD). AIMS To examine the literature and determine the prevalence and patterns of fatigue in IBD patients, to identify opportunities and directions for future research in this area. METHODS A systematic review using PubMed and Ovid Medline databases was conducted using search terms 'fatigue', 'Crohn', 'colitis' and 'inflammatory bowel disease'. A review of fatigue in other similar chronic diseases was also performed. RESULTS Ten studies were found to include data on fatigue in IBD patients; all were conducted between 1999 and 2009. However, only one study (in children) measured fatigue in IBD patients as a primary outcome. In patients in remission, the prevalence of fatigue in IBD patients ranges from 41 to 48%. Data are sparse and conflicting on whether fatigue severity is proportional to disease severity/activity. CONCLUSIONS Despite the clinical reality of fatigue, there are few published studies examining fatigue in IBD as a primary outcome. More data are needed on the prevalence, correlation between disease activity and fatigue severity, and putative pathogenic pathways involved in fatigue pathogenesis, before ultimately elucidating targeted therapies for fatigue in IBD patients.
Collapse
Affiliation(s)
- D R van Langenberg
- Monash University Department of Gastroenterology & Hepatology, Medicine, Box Hill Hospital, Box Hill, Melbourne, Vic., Australia.
| | | |
Collapse
|
50
|
Abstract
Vitamin B(12) deficiency is a common but underrecognized problem in older adults. Historically, B(12) deficiency was diagnosed once a severe pernicious anemia developed. Scientific developments have led to a new understanding of a broader spectrum of B(12) deficiency and identification of a milder form of deficiency associated with food/vitamin B(12) malabsorption. Using an individual example, this article describes the functional impact of vitamin B(12) deficiency and highlights modern approaches to diagnosis and treatment.
Collapse
Affiliation(s)
- Mary P Cadogan
- University of California, Los Angeles, School of Nursing, Los Angeles, CA, USA.
| |
Collapse
|