Screening for Malnutrition in Community Dwelling Older Japanese: Preliminary Development and Evaluation of the Japanese Nutritional Risk Screening Tool (NRST)

Development of a Brief Assessment Tool to Evaluate Early Low Nutrition Risk in Community Elderly. Creation of the tool and examination of its reliability and criterion-related validity

BACKGROUND

To date simple assessment tool to evaluate early low nutrition risk in general older population has not been available. This study aimed to create such tool and examined its reliability and criterion-related validity.

METHODS

1,192 community elderly with a mean age of 74.7(5.8) years responded to a questionnaire consisting of 48 (Hatoyama) or 34 items (Kusatsu), which have been reported to be associated with nutritional state in older people. Item analysis was conducted on the 34 common items, and items were selected based on the following criteria: adequate pass rates and discriminative power, no gender and regional differences, and a certain level of commonality based on factor analysis. Next, the factor structure of the candidate items was examined through exploratory factor analysis, and confirmatory factor analysis was conducted as the final scale structure. Furthermore, Spearman's partial rank correlation coefficients (sex- and age-adjusted) between the created index and important health indicators were examined to determine the criterion-related validity.

RESULTS

Finally, we obtained a semantic coherence of 4 factors (named health beliefs, dietary status, physical activity, and food-related quality of life) totaling 13 items; confirmatory factor analysis of the 4-factor solution yielded good model fit values, χ2 (59) =275.4 (p<0.001), CFI=0.930, and RMSEA=0.056. The factor loadings for each factor ranged from 0.43 to 0.82, indicating adequate loadings. The reliability of the index was shown to be high by Good-Poor analysis and Cronbach's α. The index showed statistically significant correlations with all health indicators.

CONCLUSIONS

We have developed a simple assessment tool to evaluate early low nutrition risk in general older population.

Effect of psoas muscle index on early postoperative outcomes in surgically treated spinal tumours in an Asian population

BACKGROUND

Sarcopenia has been purported to be a pre-operative risk factor that affects patient outcomes in oncological surgery, but no study as of yet has investigated the effect of sarcopenia in patients with spinal tumours. Psoas muscle measurements, including the psoas muscle index (PMI), are an objective way to determine sarcopenia.

OBJECTIVES

We investigated if PMI could predict post-operative outcomes (length of hospital stay and post-operative complications) in surgically treated spinal tumour patients in a multi-ethnic Asian population.

METHODS

We conducted a retrospective cohort study of patients with spinal tumours who underwent surgery at our tertiary institution from January 2016 to January 2020. PMI was measured on T2-weighted MRI sequences, at the middle of the L3 vertebral body and measurements were collected by 2 independent raters. The primary outcome was length of hospital stay (LOS), and the secondary outcome was post-operative complications. ROC curve was used to attain the cut-off value for PMI and the population was then stratified into 2 groups; sarcopenic if PMI was less than 1.22 and non-sarcopenic if the PMI value was more than or equal to 1.22. Multivariable linear regression was used for LOS, while multivariate logistic regression was used for complications.

RESULTS

57 patients were included with a mean length of stay of 17.8 days (SD 25.1) and the total number of patients with complications were 20 (35.1 %). Mean LOS was significantly higher in the sarcopenic group compared to the non-sarcopenic group. Univariate analysis confirmed the association of lower psoas muscle index corresponding with longer lengths of stay and this was corroborated in a multivariable linear regression model. There were no significant associations between PMI and postoperative complications.

CONCLUSIONS

Lower PMI values were significantly associated with a longer LOS. PMI may be warranted for risk stratifying Asian spinal tumour patients undergoing surgery.

Korean Nationwide Exploration of Sarcopenia Prevalence and Risk Factors in Late Middle-Aged Women

This study examined specific clinical risk factors for age-related loss of skeletal muscle mass in late middle-aged women with sarcopenia. This Korean nationwide cross-sectional study analyzed data from 2814 community-dwelling women aged from 50 to 64 years old and screened them for sarcopenia. This study examined various risk factors such as age; height; weight; body mass index; waist circumference; skeletal muscle mass index; systolic and diastolic blood pressure; smoking and drinking habits; fasting glucose levels; triglyceride; and cholesterol levels. Complex sampling analysis was used for the data set. Prevalence of sarcopenia with a weighted prevalence of 13.43% (95% confidence interval: 2.15-15.78). The risk factors for sarcopenia were height, body mass index, waist circumference, skeletal muscle mass index, systolic blood pressure, diastolic blood pressure, triglyceride level, and total cholesterol level (p < 0.05). Weight, fasting glucose level, drinking status, and smoking status were not significant (p > 0.05). These results are expected to contribute to the existing literature on sarcopenia and identify potential risk factors associated with the development of sarcopenia in late middle-aged females. By acknowledging prevalence and recognized risk factors, healthcare professionals may augment their proficiency in recognizing and discerning potential instances of sarcopenia in female patients.

Sex Differences of Sarcopenia in an Elderly Asian Population: The Prevalence and Risk Factors

The loss of muscle mass is widespread in age-related health phenomena in the elderly population. This study examined the prevalence of sarcopenia in a community-dwelling elderly population according to gender. The study also identified gender-specific risk factors in older people aged 75-84 years old. One thousand two hundred and ninety-three participants aged between 75 and 84 years from the National Health and Nutrition Examination Surveys in Korea were investigated. The prevalence of sarcopenia in males and females in the weighted-value sample was 41.2% (95%CI: 35.8-46.8) and 37.2% (32.7-41.9), respectively. Gender-specific clinical risk factors in males were height, weight, body mass index, waist circumference, skeletal muscle mass index, fasting glucose, and triglyceride levels. Height, weight, body mass index, waist circumference, skeletal muscle mass index, and total cholesterols were clinical risk factors for females. These outcomes would be crucial to primary care clinicians and health care professionals when patients require a referral for early detection and treatment. Health care professionals and clinicians can quickly identify potential sarcopenic patients by acknowledging the gender-specific prevalence and risk factors.

Gender-Specific Risk Factors and Prevalence for Sarcopenia among Community-Dwelling Young-Old Adults

Sarcopenia in the elderly is a serious global public health problem. Numerous sarcopenia studies classified their subjects into a single group, but health conditions and body composition vary according to age. This study examined the prevalence of sarcopenia according to gender and assessed the gender-specific risk factors in young-old adults. In this study, 2697 participants in Korea aged from 65 to 74 years were analyzed from Korea National Health and Nutrition Examination Surveys. The prevalence of sarcopenia in males and females was 19.2% (CI 95%: 16.4–22.3) and 26.4% (23.7–29.4), respectively. The risk factors in men were age, body mass index (BMI), waist circumference (WC), skeletal muscle index (SMI), fasting glucose (FG), triglyceride, and systolic blood pressure (SBP). Their odd ratios were 1.447, 0.102, 1.494, 0.211, 0.877, 1.012, and 1.347. The risk factors in women were age, height, weight, BMI, WC, SMI, and fasting glucose with values of 1.489, 0.096, 0.079, 0.158, 0.042, and 1.071, respectively. The prevalence of sarcopenia was higher in females than in males. Overall, the clinical risk factors in males were age, height, BMI, WC, SMI, FG, triglyceride, and SBP. Age, height, weight, BMI, WC, SMI, and FG were the risk factors for women.

Malnutrition Is an Independent Risk Factor for Low Health-Related Quality of Life Among Centenarians

Background: To explore the association and understand gender disparities between nutritional status and quality of life among centenarians. Methods: It was a full-sample survey of centenarians conducted in Hainan that included a total of 1,002 eligible centenarians whose age had been verified. The Mini Nutritional Assessment - Short Form (MNA-SF) questionnaire and the EuroQol five dimensions visual analog scale (EQ-5D-VAS) were used to measure participants' nutritional status and quality of life, respectively. Findings: In the 1002 centenarians (822 women and 180 men), 797 (79.5%) (79.5%) reported multimorbidity. The adjusted standardized β estimate association between the MNA-SF and EQ-5D scores was 0.508 in the complete sample. With reference to the normal nutrition group, the standardized β estimate of the association between EQ-5D score and nutritional status were -0.179 and -0.583 for the at risk of malnutrition and malnutrition groups, respectively (both P <0.001). Nutritional status significantly affected the five dimensions of quality of life, particularly mobility and self-care. Compared with the normal nutrition group, the malnutrition group had greater odds of low mobility [Odds ratio (OR)=23.15; 95% CI: 9.81-54.64] and low self-care (OR=24.58; 95% CI: 12.62-47.89). Among males, nutritional status was significantly associated with the usual activities and anxiety/depression dimensions after adjustment. Female participants had results similar to the general population. Interpretation: Malnutrition and being at risk of malnutrition is prevalent among centenarians. Maintaining normal nutritional status is an important protective factor and should receive more attention to improve centenarians' quality of life.

A comparison of the different anthropometric indices for assessing malnutrition among older people in Turkey: a large population-based screening

OBJECTIVE

Due to an increase in aging worldwide, assessment of the nutritional status of older people becomes an important matter. Malnutrition in older people increases the risk of infections, disease period and hospitalization rates. This study aimed to compare the different anthropometric indices for detecting malnutrition among older people and comparing these indices among males and females to explain the possible differences.

METHODS

In this cross-sectional study, 2721 aged 65 years and older in Turkey were enrolled. Anthropometric measurements weight, height, hip circumference (HC), and waist circumference (WC), abdominal circumference (AC), mid-upper arm circumference (MUAC), triceps skinfold thickness (TST), calf circumference (CC)) were measured. Body mass index (BMI), abdominal volume index (AVI), body roundness index (BRI) and body adiposity index (BAI), and waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) indices were calculated using standardized formulas. The receiver operator characteristic curves (ROCs) were conducted in detecting the best anthropometric parameters. Adjusted odds ratios (OR) (stratified by sex) calculated for each anthropometric index.

RESULTS

Participants with both BMI < 18.5 (1.1%) and BMI > 25 (80%) defined as the malnourished group and BMI of 18.5-24.99 (18.9%) defined as the normal group. In both sexes, the area under the curve (AUC) was > 0.7 for all anthropometric indices except WHR in females (AUC 0.66). BRI, WHR, WHtR, and AVI indices strongly predict the risk of malnutrition among both sexes. In males, the ORs were for BRI (6.83, 95% CI 5.39-8.66), WHR (6.43, 95% CI 5.9-6.9), AVI (2.02, 95% CI 1.86-2.12). In females, the ORs were for BRI (3.72, 95% CI 3.09-4.48), WtHR (2.63, 95% CI 1.3-3.5), and WHR (2.45, 95% CI 1.9-3.06).

DISCUSSION

The presence of a large AUC in almost all anthropometric indices suggests that they can be used to assess the risk of malnutrition among older persons in both sexes.

Dietary behaviors and patterns of centenarians in Hainan: A cross-sectional study

OBJECTIVES

The aim of this study was to understand the diet-related behaviors of Hainan centenarians and to analyze dietary factors that affect their nutritional status.

METHODS

Data were collected from the China Hainan Centenarian Cohort Study, a full sample survey including questionnaires, physical examinations, and physiologic indices of the centenarian population. The study included 1002 centenarians. The diet-related behaviors were assessed using the food frequency questionnaire; nutritional status was determined according to the Mini Nutritional Assessment - short form scale scores. We used logistic regression models to analyze the main dietary risk factors of malnutrition.

RESULTS

Of all the centenarians, 94.6% maintained regular meals, 80.4% had three meals a day, 53.4% ate each meal until 80% full, 88.7% ate vegetables daily, and 70% drank one to two cups of water daily. Centenarians ate rice-based staple foods; eggs, dairy, legumes, nuts, and poultry were not popular. The main sources of meat were red meat and seafood. None liked fried food, and 19.3% preferred sweet flavors. People with normal nutritional status accounted for 12.3% of the population, whereas those with malnutrition comprised 20.8%. Dietary factors that affected nutritional status included three meals a day (odds ratio [OR], 0.366; 95% confidence interval [CI], 0.173-0.778), tea drinking (OR, 0.236; 95% CI, 0.087-0.641), and the frequency of poultry (OR, 0.261; 95% CI, 0.088-0.771), seafood (OR, 0.247; 95% CI, 0.110-0.554), nuts (OR, 0.381; 95% CI, 0.150-0.965), and pastry (OR, 0.219; 95% CI, 0.080-0.600) consumption.

CONCLUSION

This was the first study on the dietary behaviors and nutritional status of centenarians using survey data. We highlighted the factors affecting nutritional status and provided scientific support for dietary strategies that may improve the nutritional status of the elderly population.

Prevalence and Related Factors of Sarcopenia in Community-dwelling Elderly with Long-term Care Insurance

BACKGROUND AND OBJECTIVE

The purpose of this investigation was to examine the prevalence, related factors, and cut-off value of body mass index for sarcopenia in community-dwelling elderly covered by long-term care insurance.

METHODS

Design was a cross-sectional study, in which113 consecutive community-dwelling elderly with long-term care insurance who underwent rehabilitation at a daycare center in Japan from January 2016 to January 2018, those who were aged ≥65 years old and could walk were included. Those in whom skeletal muscle mass index could not be measured were excluded. The determination of sarcopenia was made according to the criteria of the Asian Working Group for Sarcopenia. We analyzed the data with the unpaired t-test, χ² test, logistic regression analysis, and receiver operating characteristic curves.

RESULTS

The 99 elderly meeting the criteria were included and divided into the sarcopenia group (n=36) and no sarcopenia group (n=63). The prevalence was 36.4%. The sarcopenia group was significantly older and had lower body mass index, skeletal muscle mass index, and grip strength than the group without sarcopenia (p <0.05). Age and body mass index were extracted as significant sarcopenia- related factors (p <0.05). The cut-off value of body mass index for sarcopenia was 22.6 kg/m².

CONCLUSION

The prevalence of sarcopenia in the elderly in the long-term care insurance region was 36.4%, and age and body mass index were extracted as sarcopenia-related factors. The cut-off value of body mass index for sarcopenia was 22.6 kg/m².

Canonical Correlation Analysis on the Association Between Sleep Quality and Nutritional Status Among Centenarians in Hainan

Objective: To analyze the correlation between nutritional status and sleep quality among centenarians.

Methods: A total of 1,002 centenarians in Hainan were included in the full sample survey. The Mini Nutritional Assessment-Short Form (MNA-SF) was used for nutritional risk assessment and the Pittsburgh Sleep Quality Index Scale (PSQI) was used for evaluating sleep quality. Canonical correlation analysis was conducted to analyze their correlation.

Results: Two statistically significant (p < 0.05) canonical coefficients were found, with the first canonical correlation coefficient having a value of 0.247, eigenvalue of 0.065, and contribution rate of 89.0%. The linear combination of nutrition variable V₁, mainly determined by MNA1 (appetite loss), MNA5 (dementia/depression), and MNA2 (weight loss), indicates an association with sleep quality; the linear combination of sleep quality W₁, mainly determined by PSQI1 (subjective sleep quality), PSQI7 (daytime dysfunction), and PSQI2 (sleep latency), indicates an association with nutritional status. Appetite loss, dementia/depression, and weight loss have negative correlations with subjective sleep quality and daytime dysfunction.

Conclusion: Among centenarians, the relationship between nutritional status and sleep quality is bidirectional. Furthermore, appetite loss, dementia/depression, weight loss, subjective sleep quality, and daytime dysfunction are the main relevant factors.

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems-such as osteoporotic fractures and low bone mineral density-and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.

Denture Wearing and Malnutrition Risk Among Community-Dwelling Older Adults

Most studies have associated denture wearing with a higher risk of malnutrition and lower nutritional intake in the elderly. As the effect of wearing dentures remains debatable, the aim of this study was to determine if older adults wearing dentures have a higher risk of malnutrition. We recruited 294 Japanese community-dwelling adults aged ≥65 years from two elderly welfare centers in Sapporo. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess their nutritional status. Their demographic characteristics, eating habits, and health status were assessed using a questionnaire. Moreover, salt-impregnated taste paper and bioelectrical impedance analysis were used to obtain salt taste sensitivity and body composition (body mass index and protein mass). The mean age of older adults was 75.8 ± 5.8 years and 71.1% were women. We found that 74.1% of the older adults wore dentures. The proportion of the whole population with a risk of malnutrition was 23.5%. Multivariate analysis revealed that partial denture wearing could be protective against the risk of malnutrition. In this study, we found more partial denture wearers with normal nutritional conditions and cooking by themselves than non-denture-wearing older adults. Furthermore, complete denture wearers were eating significantly less meats or fish every day. This study suggests that using partial dentures to replace the lost teeth to meet the dietary needs of the elderly is critical to maintaining a healthy nutritional status. Moreover, it also indicates the importance of providing education to older adults who wear complete dentures.

Relationship among Activities of Daily Living, Nutritional Status, and 90 Day Readmission in Elderly Patients with Heart Failure

Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients. Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t-test, χ² test, Cox proportional hazard model, and Kaplan-Meier method. Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) (p = 0.03), hemoglobin (p = 0.047), GNRI (p = 0.02) and motor-FIM (p = 0.007) were significantly different between the readmission (n = 31) and non-readmission (n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study’s cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower (p = 0.002) in the group with GNRI <92 and motor FIM <75. Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.

Chronic pancreatitis and the heart disease: Still terra incognita?

BACKGROUND

It has been suggested that chronic pancreatitis (CP) may be an independent risk factor for development of cardiovascular disease (CVD). At the same time, it seems that congestive heart failure (CHF) and CP share the responsibility for the development of important clinical conditions such as sarcopenia, cachexia and malnutrition due to development of cardiac cachexia and pancreatic exocrine insufficiency (PEI), respectively.

AIM

To explore the evidence regarding the association of CP and heart disease, more specifically CVD and CHF.

METHODS

A systematic search of MEDLINE, Web of Science and Google Scholar was performed by two independent investigators to identify eligible studies where the connection between CP and CVD was investigated. The search was limited to articles in the English language. The last search was run on the 1st of May 2019. The primary outcomes were: (1) Incidence of cardiovascular event [acute coronary syndrome (ACS), chronic coronary disease, peripheral arterial lesions] in patients with established CP; and (2) Incidence of PEI in patients with CHF.

RESULTS

Out of 1166 studies, only 8 were eligible for this review. Studies regarding PEI and CHF showed an important incidence of PEI as well as associated malabsorption of nutritional markers (vitamin D, selenium, phosphorus, zinc, folic acid, and prealbumin) in patients with CHF. However, after substitution of pancreatic enzymes, it seems that, at least, loss of appetite was attenuated. On the other side, studies investigating cardiovascular events in patients with CP showed that, in CP cohort, there was a 2.5-fold higher incidence of ACS. In another study, patients with alcohol–induced CP with concomitant type 3c diabetes had statistically significant higher incidence of carotid atherosclerotic plaques in comparison to patients with diabetes mellitus of other etiologies. Earlier studies demonstrated a marked correlation between the clinical symptoms in CP and chronic coronary insufficiency. Also, statistically significant higher incidence of arterial lesions was found in patients with CP compared to the control group with the same risk factors for atherosclerosis (hypertension, smoking, dyslipidemia). Moreover, one recent study showed that PEI is significantly associated with the risk of cardiovascular events in patients with CP.

CONCLUSION

Current evidence implicates a possible association between PEI and malnutrition in patients with CHF. Chronic pancreatic tissue hypoxic injury driven by prolonged splanchnic hypoperfusion is likely to contribute to malnutrition and cachexia in patients with CHF. On the other hand, CP and PEI seem to be an independent risk factor associated with an increased risk of cardiovascular events.

Adductor pollicis muscle and nutritional status in heart failure patients: Is there an association?

OBJECTIVES

Adductor pollicis muscle thickness (APMT) has been used as a simple index for muscle mass for the assessment of nutritional status among hospitalized patients to identify malnutrition. The aim of this study was to evaluate the association between APMT and nutritional status in clinical patients diagnosed with congestive heart failure (CHF).

METHODS

APMT was measured in 500 patients with CHF on the dominant side. Nutritional status was assessed means of by the Subjective Global Assessment (SGA). Functional classification was performed according to guidelines provided by the New York Heart Association (NYHA), which establishes four categories of CHF severity. Poisson regression was used to verify the association of APMT, malnutrition, and severity of CHF. P ≤ 0.05 was considered statistically significant.

RESULTS

The malnutrition prevalence varied from 1.5% in patients with functional class I CHF to 96.2% in patients classified as functional class IV (P ≤ 0.001). In both sexes, APMT values were significantly lower in patients who were malnourished (P< 0.001). The proportion of patients with CHF and malnutrition was higher among women than men (47.2 versus 37.4%, P = 0.027). Malnutrition was slightly more common among patients ≥60 y of age compared with other age groups (48.3%, P ≤ 0.001). APMT is a significant protective factor for malnutrition even after controlling for sex, age, body mass index, and CHF functional class.

CONCLUSIONS

Malnutrition is highly prevalent among patients with CHF and is associated with functional class. APMT may be used as a simple index for muscle mass for the assessment of nutritional status in these patient populations, and is also associated with malnutrition in these patients, even after controlling for other risk factors.

Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.

DESIGN

A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).

SETTING AND PARTICIPANTS

A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms "malnutrition," "aged," "community-dwelling," and "screening." The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.

MEASURES

Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.

RESULTS

Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75-0.99) and 0.95 (95% CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80-0.89) and 0.87 (95% CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77-0.89) and 0.84 (95% CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.

CONCLUSIONS AND IMPLICATIONS

The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.

Differences in nutritional status and activities of daily living and mobility in elderly hospitalized patients with heart failure

Aims

This study aims to examine the effect of differences in nutritional status on activities of daily living (ADL) and mobility recovery of hospitalized elderly patients with heart failure (HF).

Methods and results

From among 377 consecutive HF patients who underwent rehabilitation at one acute‐care hospital from January 2013 to August 2015, those who were aged ≥ 65 years could walk with assistance before hospitalization and who were hospitalized for the first time were included in this retrospective cohort study. Exclusion criteria were pacemaker surgery during hospitalization, change to other departments, death during hospitalization, and unmeasured ADL. We investigated patient characteristics, basic attributes, Geriatric Nutritional Risk Index (GNRI), ADL [motor Functional Independence Measure (motor FIM)], and Rivermead Mobility Index (RMI). Of these 377 patients, 96 met the inclusion criteria and were divided into the low GNRI group (n = 38, 83.5 ± 8.3 years, 44.7% male) and high GNRI group (n = 58, 81.0 ± 6.6 years, 55.2%). Patient characteristics and the difference between motor ADL and motility recovery and nutrition data were analysed with unpaired t‐test, χ² test, and two‐way analysis of covariance. In comparing the two groups, the following parameters were significantly lower in the low GNRI group than in the high GNRI group: body mass index (18.7 ± 2.2 vs. 23.2 ± 2.7 kg/m², P < 0.01), albumin (3.4 ± 0.4 vs. 3.8 ± 0.4 g/dL, P < 0.01), diabetes mellitus ratio (21.1% vs. 50.0%, P < 0.01), RMI at discharge (6.8 ± 2.6 vs. 8.2 ± 2.2, P = 0.01), and motor FIM at discharge (67.2 ± 19.5 vs. 75.6 ± 13.3, P = 0.02). RMI showed a significant group and term main effect and interaction effect (P < 0.05). Motor FIM showed a significant main effect of group and term (P < 0.05), and no significant interaction effect.

Conclusions

Low nutritional status in hospitalized elderly HF patients affected their recovery of mobility but did not appear to affect the recovery of ADL.

Hand grip strength measurement in different epidemiologic studies using various methods for diagnosis of sarcopenia: a systematic review

BACKGROUND

The purpose of this systematic review was to compare various methods for measuring hand grip strength to provide data for the development of a standardized protocol for such a measurement based on epidemiologic studies of sarcopenia in older population.

METHODS

Systematic review and meta-analysis were performed using 34 available epidemiologic studies.

RESULTS

The choice of hand dynamometer and measurement protocols for measuring hand grip strength was not consistent among studies. Mean values of hand grip strength in older population were also different by study area (Europe, America, and Asia) and gender.

CONCLUSION

This systematic review demonstrated that various grip strength measurement methods were used in different epidemiologic studies. A standardized method is needed to enable more consistent measurement of grip strength and better assessment of sarcopenia.

Occurrence of Malnutrition and Associated Factors in Community-Dwelling Older Adults: Those with a Recent Diagnosis of Cancer Are at Higher Risk

OBJECTIVES

In older adults, nutritional health is essential for good quality of life and living independently at home. Especially in cancer patients, malnutrition is common and known to complicate treatment. This study aims to evaluate the nutritional status and its associated factors in community-dwelling older adults with and without cancer.

DESIGN

This is an observational study.

SETTING

This study focuses on older community-dwelling people.

PARTICIPANTS

This study included older people with and without cancer (≥70 years). Cancer patients included patients with a new diagnosis of breast, lung, prostate, or colorectal cancer.

MEASUREMENTS

Data collection included measures of nutritional status, quality of life, depression, fatigue, distress and functional status. We used multivariate logistic regression analysis to assess the association between personal characteristics and malnutrition.

RESULTS

Data were available for 657 people; 383 people without cancer and 274 with a cancer diagnosis. Overall, malnutrition was detected in 245 (37.5%) people; in cancer patients this was 66.1%. Multivariate analysis showed that having cancer (OR 14.4, 95% CI: 8.01 - 23.3), being male (OR 2.38, 95% CI: 1.49 - 3.70), having depression (OR 13.5, 95% CI: 6.02-30.0), distress (OR 2.60, 95% CI: 1.55 - 4.37) and impaired instrumental activities of daily living (IADL) (OR 2.63, 95% CI: 1.63 - 4.24) were associated with a higher risk of malnutrition.

CONCLUSION

The prevalence of malnutrition in community-dwelling older people is high, particularly in patients with cancer. Benchmarking and routine screening of older patients may be helpful strategies to increase awareness of (risk of) malnutrition among professionals.

Nutritional Status and Frailty in Community-Dwelling Older Korean Adults: The Korean Frailty and Aging Cohort Study

OBJECTIVES

To examine the association between nutritional status and frailty in older adults.

DESIGN

Cross-sectional study.

SETTING

Community-dwelling older adults were recruited from 10 study sites in South Korea.

PARTICIPANTS

1473 volunteers aged 70-84 years without severe cognitive impairment and who participated in the Korean Frailty and Aging Cohort Study (KFACS) conducted in 2016.

MEASUREMENTS

Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Frailty was assessed with the Fried's frailty index. The relationship between nutritional status and frailty was examined using the multinomial regression analysis, adjusting for covariates.

RESULTS

Of the respondents 14.3% had poor nutrition (0.8% with malnutrition, 13.5% at risk of malnutrition). There were 10.7% who were frail, with 48.5% being prefrail, and 40.8% robust. Poor nutrition was related to a significantly increased risk of being prefrail (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.09-2.32) and frail (OR: 3.30, 95% CI: 1.96-5.54).

CONCLUSION

Poor nutritional status is strongly associated with frailty in older adults. More research to understand the interdependency between nutritional status and frailty may lead to better management of the two geriatric conditions.

Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies

BACKGROUND

Sarcopenia, an age-related decline in muscle mass and function, is one of the most important health problems in elderly with a high rate of adverse outcomes. However, several studies have investigated the prevalence of sarcopenia in the world, the results have been inconsistent. The current systematic review and meta- analysis study was conducted to estimate the overall prevalence of sarcopenia in both genders in different regions of the world.

METHODS

Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched between January 2009 and December 2016. The population- based studies that reported the prevalence of sarcopenia in healthy adults aged ≥ 60 years using the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and Asian Working Group for Sarcopenia (AWGS) definitions, were selected. According to these consensual definitions, sarcopenia was defined by presence of low muscle mass (adjusted appendicular muscle mass for height) and muscle strength (handgrip strength) or physical performance (the usual gait speed). The random effect model was used for estimation the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia and 95% confidence interval (CI) were calculated using the Binomial Exact Method. Heterogeneity was assessed by subgroup analysis.

RESULTS

Thirty- five articles met our inclusion criteria, with a total of 58404 individuals. The overall estimates of prevalence was 10% (95% CI: 8-12%) in men and 10% (95% CI: 8-13%) in women, respectively. The prevalence was higher among non- Asian than Asian individuals in both genders especially, when the Bio-electrical Impedance Analysis (BIA) was used to measure muscle mass (19% vs 10% in men; 20% vs 11% in women).

CONCLUSION

Despite the differences encountered between the studies, regarding diagnostic tools used to measure of muscle mass and different regions of the world for estimating parameters of sarcopenia, present systematic review revealed that a substantial proportion of the old people has sarcopenia, even in healthy populations. However, sarcopenia is as a consequence of the aging progress, early diagnosis can prevent some adverse outcomes.

Muscle wasting in heart failure : The role of nutrition

Muscle wasting and malnutrition are common complications in patients with advanced heart failure (HF); however, both remain underdiagnosed and undertreated although they both play relevant roles in the progression of HF. The risk of muscle wasting in patients with HF increases in those patients with malnutrition or at risk of malnutrition. Muscle wasting and malnutrition are thought to be positively influenced by adequate therapeutic interventions such as physical activity and nutritional support. Consequently, early detection of malnutrition in patients with HF is recommended. This review discusses muscle wasting and nutritional status, describing the effects of malnutrition on muscle wasting in patients with HF. We review specific issues related to muscle wasting and nutritional status in patients with HF; however, no established strategies currently exist to focus on patients suffering from muscle wasting with malnutrition.