Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study

Daily Supplementation with Protein-Enriched Lacto-Vegetarian Soups and Muscle Health in Community-Dwelling Older Adults: A Randomized Controlled Trial

BACKGROUND

Dietary protein adequacy is crucial for muscle health in aging individuals, posing a particular challenge for vegetarian seniors. This randomized controlled trial (RCT) investigates the impacts of protein-enriched lacto-vegetarian soup supplementation on body composition, physical performance and muscle strength functional assessment as well as cardiometabolic and inflammatory biomarkers in older adults.

METHODS

We enrolled 100 participants ≥65 years at risk for malnutrition (MNA-SF ≤ 11) and at risk for sarcopenia (SARC-F ≥4 or SARC-CalF ≥11) in this RCT. Participants were randomized assigned to receive a daily protein-enriched lacto-vegetarian soup (24-30 g protein) or usual diet. Primary outcomes of interest including (1) body composition (anthropometric measurements and body composition measured by bioimpedance analysis (BIA)), (2) physical performance (Short Physical Performance Battery, SPPB) and muscle strength (hand grip strength), and (3) functional assessments (including sarcopenia risk scales and nutritional status) as well as secondary outcomes of interests including cardiometabolic and inflammatory biomarkers were assessed at baseline and the 12th week of follow-up.

RESULTS

Data of 97 participants (intervention: n = 48, control: n = 49) were analyzed. Despite no significant changes in body composition were observed in the intervention group, compared to the usual diet, those who received protein-enriched lacto-vegetarian soup supplementation had an improved physical performance including an increase in SPPB score (β = 0.83 [95% CI 0.15-1.51], p = 0.02), a decrease in time to complete the 5 times chair rise test (β = -2.25 [-4.04 to -0.44], p = 0.01). Some functional assessments, including improved sarcopenia risk scale (e.g., SARC-F score [β = -0.68, p = 0.04]) and nutritional status (e.g., MNA-SF score [β = 0.44, p = 0.03]) were also observed.

CONCLUSIONS

Daily supplementation with protein-enriched lacto-vegetarian soups enhanced physical performance and functional assessments (such as sarcopenia risk scale and nutritional status) among older adults at risk of malnutrition and sarcopenia. Further study is needed to explore the long-term benefits of protein-enriched lacto-vegetarian soup supplementation for healthy aging.

Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan

BACKGROUND

Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.

METHODS

This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.

RESULTS

Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p < 0.001 for women). Notably, women in the "poor sleep quality" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.

CONCLUSION

This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors (such as depressive symptoms) in healthy aging.

The Evolving Landscape of Sarcopenia in Asia: A Systematic review and meta-analysis following the 2019 Asian working group for sarcopenia (AWGS) diagnostic criteria

BACKGROUND

Sarcopenia, characterized by age-related loss of muscle mass and function, poses a significant public health concern, particularly in Asia's rapidly aging population. This systematic review and meta-analysis aimed to evaluate the current epidemiology of sarcopenia in Asia using the 2019 Asian Working Group for Sarcopenia (AWGS) diagnostic criteria.

METHODS

Databases including PubMed, Embase, Web of Science, and Cochrane were systematically searched for studies published until December 7, 2023, involving older adults aged ≥ 60 years diagnosed with sarcopenia using the 2019 AWGS criteria in Asia. Study quality was assessed, and meta-analyses were conducted to estimate the pooled prevalence of sarcopenia, possible sarcopenia, and severe sarcopenia.

RESULTS

A total of 140 studies, collectively involving 156,325 participants (67.1 % community-dwelling older adults with the minimum age for participant inclusion ranging from 60 to 80 years) from various Asian countries, were included. The overall prevalence of sarcopenia among community-dwelling older adults was 16.5 % (95 % CI: 14.7 %-18.4 %). Notably, the prevalence of possible sarcopenia was higher at 28.7 % (95 % CI: 22.0 %-36.5 %), while severe sarcopenia had a lower prevalence of 4.4 % (95 % CI: 3.3 %-5.8 %). Subgroup analyses revealed variations in sarcopenia prevalence based on diagnostic modalities, ranging from 7.5 % (95 % CI: 6.0 %-9.4 %) for assessments using bioelectrical impedance analysis, handgrip strength, gait speed, chair stand and short physical performance battery, to 20.8 % (95 % CI: 18.9 %-23.0 %) when using dual-energy X-ray absorptiometry coupled with muscle strength and physical performance measures.

CONCLUSION

This comprehensive systematic review and meta-analysis highlights the substantial burden of sarcopenia among older adults in Asia, underscoring the need for early identification and intervention strategies to mitigate its adverse consequences on public health.

Sarcopenia in the era of precision health: Toward personalized interventions for healthy longevity

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, significantly impacts health outcomes in older adults. This review explores the evolving landscape of sarcopenia research, with a particular focus on its unique characteristics in Asian populations and emerging pharmaceutical interventions. Recent studies have revealed distinct patterns of muscle mass decline in Asian adults, particularly in women, challenging the universal application of global sarcopenia diagnostic criteria. The Asian Working Group for Sarcopenia has proposed region-specific diagnostic criteria, acknowledging these ethnic variations. Prevalence estimates of sarcopenia vary widely, ranging from 10% to 40% in community-dwelling older adults. For specific chronic conditions, the prevalence of sarcopenia is notably higher, reaching 35% for cardiovascular diseases and 24.5% for chronic kidney disease. Sarcopenia is strongly associated with various chronic conditions, increasing the risk of falls by 1.5 to 3 times and significantly increasing mortality risk by 29% to 51%. Current management strategies primarily involve resistance exercise and nutritional interventions, with a recommended daily protein intake of at least 1.2 g/kg to maintain muscle health. Pharmaceutical development has gained significant momentum, with over 20 compounds in various stages of clinical trials. These include myostatin inhibitors, selective androgen receptor modulators, ghrelin receptor agonists, mesenchymal stem cell therapy, and follistatin gene therapy. However, the unique dietary patterns, cultural contexts, and potentially distinct drug responses in Asian populations necessitate tailored interventions and Asia-specific clinical trials. Future directions include refining Asian-specific diagnostic criteria, conducting large-scale epidemiological studies across multiple Asian countries, developing culturally appropriate interventions, integrating sarcopenia management into chronic disease care, and advancing pharmaceutical research with a focus on Asian populations. In conclusion, sarcopenia emerges as a critical nexus in the aging process, intricately linked with multiple organ systems and chronic conditions, underscoring the imperative for its recognition as a cornerstone in person-centered care and the holistic management of age-related health challenges.

Development and validation of a nomogram for predicting anorexia of aging in older people

BACKGROUND

Anorexia of aging (AA) is a common geriatric syndrome that seriously endangers the health of older adults. Early identification of populations at risk of AAand the implementation of appropriate intervention measures hold significant public health importance. This study aimed to develop a nomogram for predicting the risk of AA among older people.

METHODS

We conducted a cross-sectional study involving 2144 community-dwelling older adults to evaluate the AA using the Simplified Nutritional Appetite Questionnaire. We utilized the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression analysis to select variables and develop a nomogram prediction model. The predictive performance of the nomogram was evaluated using the Receiver Operating Characteristic (ROC) curves, calibration curves, Decision Curve Analysis (DCA), and internal validation.

RESULTS

The prevalence of AA among Chinese older adults was 21.7% (95%CI: 20.0%-23.5%). Age, sex, family economic level, smoking status, dysphagia, loneliness, depressive symptoms, living alone, health literacy, life satisfaction, and body mass index have been identified as predictive factors for AA among older people. The nomogram constructed based on these predictive factors showed an area under the curve (AUC) of 0.766 (95%CI: 0.742-0.791), indicating good calibration and discrimination ability. Additionally, the results obtained from the 10-fold cross-validation process confirmed the nomogram's good predictive capabilities. Furthermore, the DCA results showed that the nomogram has clinical utility.

CONCLUSION

The nomogram constructed in this study serves as an effective tool for predicting anorexia of aging among community-dwelling older adults. Its implementation can help community healthcare workers evaluate the risk of AA in this population and identify high-risk groups.

Older adult women with chronic anorexia nervosa: heterogeneous adaptation to undernutrition over time

INTRODUCTION

Anorexia nervosa (AN) in older adult women is primarily described through reviews or case reports focusing on psychiatric traits, with no comprehensive studies evaluating their complete nutritional and hormonal profiles. This study aimed to describe a group of women with anorexia nervosa aged above 35 years old (AN35), and compare them with young women with anorexia nervosa (ANY) and normal-weight control participants.

METHOD

Anthropometric, metabolic, nutritional, and psychiatric parameters were collected and compared among three groups of women: 50 AN35, 37 ANY, and 38 controls.

RESULTS

AN35 exhibited a mean disease duration of 271 ± 19 months, with 94% chronic forms and 58% restrictive types. Despite having similar BMI as ANY, AN35 displayed more altered parameters, including higher liver enzymes (p = 0.007), free T3 (p = 0.0046) and leptin (p < 0.0001); and lower albumin (p = 0.0029), and white cells (p < 0.0001). AN35 showed significant heterogeneity in hormonal adaptation, such as free T3. Half of the patients aged above 51 years revealed high gonadotropin levels despite being undernourished. Additionally, AN35 groups presented with 50% of bones fractures, decreased T-scores under -2.5 (p < 0.0001 for femoral), and altered micro architectural HRPQT parameters compared to ANY.

CONCLUSION

Anorexia nervosa in older adult women is predominantly chronic. Nutritional parameters changes with age suggests a significant heterogeneity and possible adaptation of energy balance and bodyweight set point for others. Complications may be severe, altering the quality of life, and sometimes potentially lethal. These findings highlight the potential adaptation of energy balance with age, and should assist clinicians in clinical practice.

Reliability and validity of Chinese version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in community-dwelling old people

OBJECTIVE

To investigate the reliability and validity of the Chinese version of simplified nutritional appetite questionnaire (SNAQ).

METHODS

The SNAQ was translated and back-translated for the study population. We surveyed 122 community-dwelling residents aged ≥60 years in Beijing's residential communities. Participants underwent face-to-face surveys including the SNAQ, mini-nutritional assessment short-form (MNA-SF), FRAIL scale, Sarcopenia-Five (SCAR-F), 15-item Geriatric Depression Scale (GDS-15), 7-item Generalized Anxiety Disorder (GAD-7), 8-item Oral Frailty Index (OFI-8), 10-item Eating Assessment Tool (EAT-10), and Mini-Mental State Examination (MMSE). Cronbach's alpha was used to measure the internal consistency and the relationship between individual items. The construct validity was verified using the KMO-Bartlett. Concurrent validity was established to validate measures of the same constructs.

RESULTS

Cronbach's alpha measured the internal consistency of the questionnaire at 0.694. The split-half reliability stood at 0.725. The construct validity of the SNAQ was confirmed using a KMO-Bartlett value of 0.648 (P <0.001). The MNA-SF, as validation benchmark, has a correlation coefficient of 0.345 (P =0.001).

CONCLUSION

The Chinese version of the SNAQ has good reliability and validity for older adults in community settings.

The distinct impacts of sarcopenic and dynapenic obesity on mortality in middle-aged and older adults based on different adiposity metrics: Results from I-Lan Longitudinal Aging Study

BACKGROUND & AIMS

Sarcopenic obesity (SO) and dynapenic obesity (DO) represent two manifestations of excessive fat accumulation concurrent with compromised muscle mass and function, thereby necessitating an examination of their implications for health. This study aims to investigate the relationship between SO/DO and mortality, taking into account various adiposity measures and existing sarcopenia criteria, with further stratified analyses based on age and gender.

METHODS

The study sample comprised 1779 older adults residing in the community from the I-Lan Longitudinal Aging Study (ILAS). Body composition was assessed via dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was adhered to the 2019 consensus of the Asian Working Group for Sarcopenia, while adiposity was measured by waist circumference (WC), body mass index (BMI), and fat percentage. SO/DO was defined as the coexistence of sarcopenia/dynapenia and obesity. Multivariate Cox proportional hazard regression models were adopted to examine the association between SO or DO, defined by WC, BMI, fat percentage, and mortality.

RESULTS

This 11-year follow-up study of 1779 participants aged 63.9 ± 9.2 years involved 15,068 person-years and 229 deaths. WC-defined SO (HR 1.9, 95% CI 1.1-3.3, p = 0.021) and WC-defined DO (HR 1.4, 95% CI 1.1-1.9, p = 0.022) significantly increased mortality risk, whereas definitions employing alternative adiposity metrics exhibited no statistical significance. WC-defined SO was associated with increased risk of mortality among middle-aged adults, while WC-defined DO was associated with increased risk of mortality among older adults. In sex-specific analysis, WC-defined DO was also associated with increased risk of mortality in men (HR 1.6, 95% CI 1.1-2.4, p = 0.019), while defined by other measurements showed no associations in both sexes.

CONCLUSIONS

The study identified a significant link between SO/DO, defined by WC, and an 11-year mortality risk, advocating for WC-defined adiposity as an obesity measure and personalized interventions considering SO and DO's distinct impacts on mortality in middle-aged and older adults.

Effects of Oral Nutritional Supplement with β-Hydroxy-β-methylbutyrate (HMB) on Biochemical and Hematological Indices in Community-Dwelling Older Adults at Risk of Malnutrition: Findings from the SHIELD Study

Malnutrition may result in abnormal biochemical and hematological indices. This planned prespecified analysis investigated the effects of a specialized oral nutritional supplement (ONS) on biochemical and hematological indices in community-dwelling older adults at risk of malnutrition. In the Strengthening Health in ELDerly through nutrition (SHIELD) study, 811 older adults aged 65 years and above took part in this randomized, double-blind, placebo-controlled, multi-center study. Participants were randomly allocated to either a complete and balanced specialized ONS (each serving provides 262 kcal, 10.5 g protein, 7.75 µg vitamin D3, and 0.74 g calcium β-hydroxy-β-methylbutyrate) and dietary counselling (intervention group) or a placebo and dietary counselling (placebo group). Both groups consumed study products twice a day for 180 days. Data were collected at baseline, day 90, and day 180. Blood analysis results at follow-up visits were analyzed using repeated measures analysis of covariance with adjustments for confounders. Overall, when compared with the placebo group, the intervention group showed significantly greater urea (6.0 mmol/L vs. 5.4 mmol/L, p < 0.001), urea to creatinine ratio (4.39 vs. 4.26, p < 0.001), prealbumin (24.9 mg/dL vs. 24.0 mg/dL, p < 0.001), vitamin B12 (480.0 pmol/L vs. 420.1 pmol/L, p < 0.001), and globulin levels (26.8 g/L vs. 26.5 g/L, p = 0.032). The intervention group also had a significantly higher absolute reticulocyte count (62.0 × 103/µL vs. 58.2 × 103/µL, overall p < 0.001) and mean platelet volume (10.0 fL vs. 9.9 fL, overall p = 0.003). Furthermore, significant improvements were seen in total protein at day 90 (71.7 g/L vs. 71.1 g/L, p = 0.017) and in absolute monocyte count at day 90 (0.50 × 103/µL vs. 0.47 × 103/µL, p = 0.009) in the intervention group. In conclusion, daily consumption of a specialized ONS for six months led to significant improvements in biochemical and hematological indices in community-dwelling older adults at risk of malnutrition.

Joint trajectories of loneliness, social isolation and sarcopenia and associations with adverse outcomes: A prospective cohort study

This study aimed to examine joint trajectories of loneliness, social isolation and sarcopenia and their associations with adverse outcomes. A total of 4701 participants aged ≥60 years who had a baseline and at least one follow-up assessment of loneliness, social isolation and sarcopenia across 2011, 2013 and 2015 waves in China Health and Retirement Longitudinal Study. Adverse outcomes were obtained in 2018 wave. Joint trajectories were fit using the parallel process latent class growth analysis, and their associations with adverse outcomes were evaluated using modified Poisson regression. Joint trajectory patterns for social relationship and sarcopenia did not vary by the assessment for sarcopenia, but did vary by the assessment for social relationship. Older adults exhibit distinct joint trajectories and those with persistent combination of loneliness or social isolation and sarcopenia experience greatest risk of adverse outcomes. These findings implicate integration of health care and social care for community-dwelling older adults.