Nutrition, frailty, and sarcopenia

Prognostic Impact of Sarcopenia and Surgical Timing in Locally Advanced Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoradiotherapy: TIMES Study

BACKGROUND

Optimal timing for surgery after neoadjuvant chemoradiotherapy (NCRT) remains controversial, necessitating reliable preoperative indicators. This study examines how sarcopenia and surgical timing affect prognosis in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC).

PATIENTS AND METHODS

This retrospective study analyzed patients with LA-ESCC who underwent NCRT and surgery at three institutions in China from 2014 to 2023. The skeletal muscle area at the third lumbar vertebra was measured to calculate the skeletal muscle index (SMI). Prognostic analysis was performed using Cox proportional hazards models and propensity score matching (PSM), with survival curves generated using the Kaplan-Meier method and statistical significance set at p<0.05.

RESULTS

A total of 415 patients were analyzed, with a median follow-up of 39.1 months. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 59.3% and 53.1%, respectively. Malnutrition and time to surgery (TTS) were independent prognostic factors for both OS and PFS (p < 0.05). Patients with long TTS showed better OS [hazard ratio (HR) = 0.62, p = 0.01] and PFS (HR = 0.68, p = 0.02) compared with those with short TTS. Among patients with sarcopenia, long TTS significantly improved OS (HR = 0.56; p = 0.01) and PFS (HR = 0.62; p = 0.02), while no survival benefit was observed for TTS in patients who were nonsarcopenic (p > 0.05).

CONCLUSIONS

Sarcopenia does not independently impact OS or PFS. Patients with sarcopenia benefit from a longer surgical time interval after NCRT. In addition, preoperative evaluation of muscle quality may aid in optimizing surgical timing to improve outcomes.

Association between tooth loss and geriatric syndromes in older adults: a cohort study from a rural area in eastern China

BACKGROUND

Tooth loss was linked to health status, with substantial implications for malnutrition and chronic inflammation risks in older adults, especially among vulnerable groups. This study aimed to explore the associations between tooth loss severity, denture status, and geriatric syndromes.

METHODS

In 2019, 1094 participants were recruited and subjected to face-to-face interview to assess tooth loss severity, along with grip strength and body composition. In 2023, a follow-up was conducted with a subsample of the participants. Logistic regression analysis was utilized to explore the association between tooth loss severity at baseline and geriatric syndromes (sarcopenia, malnutrition risk, frailty, fall) at fourth year follow-up, as well as association between denture status and geriatric syndromes.

RESULTS

The multivariate analyses showed that having tooth loss affecting daily life at baseline was associated with a 1.80-fold higher prevalence of sarcopenia and 2.31-fold higher prevalence of malnutrition risk after four years. Participants with fewer than 10 teeth had significantly higher odds of geriatric syndromes compared to those with 21 or more teeth: 1.87-fold for sarcopenia (95% CI: 1.07 to 3.26), 2.99-fold for malnutrition risk (95% CI: 1.93 to 4.62), and 1.68-fold for frailty (95% CI: 1.10 to 2.56). Older adults with tooth loss who did not have dentures exhibited a significantly higher odds of sarcopenia, malnutrition risk, frailty, and falls, more number of geriatric syndromes.

CONCLUSION

Higher severity level of tooth loss at baseline were associated with higher odds of geriatric syndromes at fourth year in older adults. Dentures partially mitigate the association between tooth loss and the higher odds of geriatric syndromes. Screening and intervening oral health is important for the prevention of geriatric syndromes in older adults.

CLINICAL TRIAL NUMBER

Not applicable.

Cardiometabolic multimorbidity and frailty in middle-aged and older adults: a cross-nationally harmonized study

Background

Cardiometabolic diseases are prevalent among ageing populations and have a close association with frailty. However, the cumulative impact multiple cardiometabolic diseases have on frailty remains underexplored.

Methods

This study used data from four international cohorts - HRS, CHARLS, ELSA and SHARE - to examine the correlation between frailty and cardiometabolic diseases (CMD). The frailty index was used for assessing frailty and statistical analyses were performed as a means of analysing the correlation between the number of cardiometabolic conditions and frailty severity. Linear regression models were employed to evaluate the associations between CMD and frailty severity.

Results

The study found that as the number of cardiometabolic diseases increased, the frailty index rose significantly [one disease, β = 7.80 (95% CI: 7.70 to 7.90) p < 0.05; two diseases, β = 17.92 (95% CI: 17.76 to 18.08) p < 0.05; three diseases, β = 28.79 (95% CI: 28.41 to 29.17) p < 0.05]. Stroke was found to have the most pronounced impact on frailty (β = 12.34 [95%CI 12.20 to 12.48] p < 0.05) and the coexistence of multiple conditions served to amplify the symptoms of frailty.

Conclusion

This study highlights the compounded impact multiple cardiometabolic diseases have on frailty and also emphasizes the necessity for early intervention.

The Current Status of Frailty and Influencing Factors in Elderly Patients With Hip Fractures: A Meta-Analysis

Background: Hip fractures have emerged as a significant health risk, posing a substantial threat to the well-being and longevity of the elderly population. The occurrence of postoperative complications and frailty profoundly impacts the quality of life in these individuals. This meta-analysis is aimed at elucidating the present scenario and clarifying the current status and influencing factors of frailty in elderly hip fracture patients. The findings will serve as a solid evidence for formulating effective and scientific strategies to prevent frailty in this vulnerable patient group. Methods: The databases, including PubMed, Cochrane Library, and Embase, were utilized from February 2003 to February 2023, using the keywords frailty, elderly, and hip fractures to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified. Two independent authors assessed the quality of all eligible studies. Statistical analyses were evaluated using Review Manager (RevMan) Version 5.3. Results: Of the 15 studies out of 352 identified studies, 12 cross-sectional research studies, 2 case-control studies, and 1 cohort study were confirmed. There were 3475 hip fracture patients, 1209 of them showed frailty, with a 41% incidence of frailty, and 18 influence factors were determined. A marked between-study heterogeneity (I 2 = 95%, p < 0.00001) was examined. Factors influencing frailty in elderly hip fracture patients were identified including age (odds ratio (OR) = 2.73, 95% confidence interval (CI): 2.12~3.53), comorbidity (OR = 4.20, 95% CI: 2.31~7.62), duration of bed rest (OR = 2.22, 95% CI: 1.54~3.18), nutritional status (OR = 1.62, 95% CI: 1.21~2.17), and self-perceived health status (OR = 3.53, 95% CI: 2.09~5.94). There was no publication bias, and the pooled results were stable basing on sensitivity analysis. Conclusion: Frailty in elderly hip fracture patients is associated with a variety of factors consisting of age, comorbidity conditions, extended periods of bed rest, nutritional status, high comorbid conditions, poor self-perceived health status, advanced age, and poor nutritional status.

Low-volume resistance training: a feasible, cost-effective strategy for musculoskeletal frailty in older adults attending daycare centers

Introduction

Frailty is a prevalent geriatric syndrome, posing significant health risks for older adults attending daycare centers or residing in institutional settings. Addressing frailty with interventions that are feasible and cost effective and also promote high adherence within these environments is crucial.

Objective

This study aimed to evaluate the impact of a low-volume, remotely supervised resistance training protocol on physical frailty among frail older adults attending daycare centers. Secondary outcomes included changes in sarcopenia prevalence and fall risk.

Methods

Thirty-one frail older adults participated in a 12-week usual care period, followed by a 12-weeks intervention featuring low-volume (10-minute sessions) resistance training three times weekly. The program was delivered locally by non-specialized staff under remote supervision. Musculoskeletal, functional, and clinical assessments were conducted at three-time points: baseline, pre-intervention, and post-intervention.

Results

During the usual care period, a decline was observed in handgrip strength (19.2-18.5 kg) and sit-to-stand time (14.5-17.4s) (p < 0.05). However, these measures were preserved during the intervention. Relative muscle power decreased during the usual care but improved with training (4.3-5.2 W/Kg, p < 0.001). While body composition, physical function, gait speed, and Short Performance Physical Battery scores remained stable, reductions were observed in exhaustion and physical inactivity prevalence (p < 0.05). Frailty prevalence showed a decreasing trend (48%-26%, p = 0.099), with significant reductions in sarcopenia prevalence (29%-10%, p = 0.045), and fall frequency (p = 0.022).

Conclusion

The low-volume strength training protocol was a feasible, cost-effective strategy for mitigating musculoskeletal frailty criteria, sarcopenia and fall risk among older adults in daycare centers, potentially delaying the progression of these conditions.

Effects of a multicomponent training and a detraining period on cognitive and functional performance of older adults at risk of frailty

AIMS

This study analyzes the effects of a 6-month multicomponent exercise program (MCT) followed by a 4-month detraining period on functional and cognitive status in pre-frail and frail older adults.

METHODS

A total of 108 pre-frail and frail adults aged 65 and older participated in the study. They were assigned by convenience to either a control group (CG) or an intervention group (IG). The IG underwent a 6-month MCT followed by a 4-month detraining period. Assessments included a DT test, the Timed Up and Go (TUG) test, the Mini-Mental State Examination (MMSE), and evaluations of basic and instrumental activities of daily living. Data were analyzed using repeated-measures ANOVA.

RESULTS

Significant group-by-time interactions were observed for the DT test (p < 0.05). The IG showed improved DT performance after the 6-month MCT (4.0, 95% CI: 2.2 to 5.7 s), followed by a decline after the detraining period (-1.1, 95% CI: -2.1 to -0.2 s). However, performance after detraining remained higher than at baseline (2.9, 95% CI: 1.0 to 4.6 s, p < 0.05). No statistically significant changes were observed in the CG. Additionally, no significant effects were found for MMSE scores or daily activity questionnaires.

CONCLUSION

MCT had beneficial effects on functional and cognitive performance in older adults, as assessed by the DT test. However, improvements in DT performance did not translate into better daily life activities. Although the 4-month detraining period negatively impacted DT performance, the results remained superior to baseline levels.

TRIAL REGISTRATION NUMBER

NCT03831841 and date of registration: 5th of November 2018.

Thirty-day survival rate of patients having a treatment withholding or treatment withdrawal decision in the emergency department: A retrospective monocentric study

AIM

Treatment withholding or withdrawal (TWW) is frequent in the emergency department (ED). Most studies on this topic only study patients who die in the ED. The main aim of this study was to determine 30-day mortality after a TWW decision in the ED, for patients discharged alive from ED.

METHODS

This was a retrospective monocentric study conducted from January 1, 2020, to March 31, 2022, in a university hospital in France. Classes of TWW levels were low, medium and high, corresponding to do-not-resuscitate order, treatment withholding and treatment withdrawal, respectively. The secondary aim was to determine if there were predictive factors of survival among patients with medium-level TWW.

RESULTS

Overall, 280 patients were included and 219 (78%) were analyzed, with mean age of 82 (±12) years. Respectively, 12 (5%), 145 (66%) and 62 (28%) had a low, medium, or high level of TWW. A total of 78 (36% [95% CI, 29%-42%]) patients were alive on day 30 following their ED admission: 7 (11%) with a high level, 63 (43%) with a medium level and 8 (67%) with a low level. No difference was found after adjustment between surviving and nonsurviving patients having a medium TWW level.

CONCLUSIONS

Among patients having a TWW decision in the ED, 36% of patients were alive at 30 days. The decision to limit some therapeutics for patients does not mean an imminent death, and those patients need adequate care. The care pathway for these patients must be organized accordingly. Geriatr Gerontol Int 2025; 25: 528-534.

Prevalence of sarcopenia in Asian older adults: A comparison of nine diagnostic criteria across different regions

OBJECTIVE

This study aimed to compare sarcopenia prevalence in older adults using nine diagnostic criteria from different regions to assess how these guidelines influence prevalence rates within the same population. Additionally, we analyzed variations across subgroups to identify factors contributing to prevalence differences.

METHODS

A total of 1760 participants aged 65-99 were enrolled. Bioelectrical impedance analysis was used to assess muscle mass, while muscle strength and physical performance were evaluated using grip strength, gait speed, and the repeated chair stands test. Sarcopenia prevalence was determined based on definitions provided by ESPEN (European Society for Clinical Nutrition and Metabolism), EWGSOP (European Working Group on Sarcopenia in Older People), IWGS (International Working Group on Sarcopenia), SCWD (Society for Sarcopenia, Cachexia, and Wasting Disorders), AWGS (Asian Working Group for Sarcopenia), FNIH (Foundation for the National Institutes of Health), and SDOC (Sarcopenia Definitions and Outcomes Consortium). Additionally, prevalence rates were assessed across subgroups based on age, sex, and BMI categories.

RESULTS

Sarcopenia prevalence varied from 4.8 % (n = 79), based on the FNIH criteria, to 16.1 % (n = 261), according to the EWGSOP criteria. Among females, higher prevalence rates were observed using the ESPEN, AWGS, and EWGSOP2 criteria, while the FNIH criteria indicated a higher prevalence in males. Prevalence increased with age, especially in those aged 85 and older. Lower BMI was associated with higher sarcopenia prevalence according to most criteria, except the FNIH and ESPEN.

CONCLUSION

The notable variability in sarcopenia prevalence across different diagnostic criteria highlights the need for population-specific guidelines. Refining diagnostic criteria to address demographic variations could enhance the accuracy and applicability of sarcopenia assessments. Future studies should aim to further tailor diagnostic approaches and interventions to meet the needs of diverse populations.

Skeletal Muscle Atrophy Induced by Dexamethasone Is Attenuated by Amino Acid Complex Supplementation in Rats

Muscle atrophy, a physiological decline in muscle mass and strength due in ageing, occurs through an imbalance between protein breakdown and synthesis. The purpose of this study was to verify whether amino acid complex supplementation (ACS) can prevent and treat muscle loss in a dexamethasone (Dexa, 800 μg/kg)-induced rat model of sarcopenia. Sprague Dawley rats (6 weeks old) were assigned to seven groups: (i) normal control, (ii) positive control (high-dose ACS, 500 mg), (iii) Dexa only, (iv) Dexa + high-dose ACS (500 mg), (v) Dexa + medium-dose ACS (300 mg), (vi) Dexa + low-dose ACS (100 mg), or (vii) Dexa + liquid amino acid complex formulation (LF, 2 mL), administered orally for 4 weeks. Exercise capacity tests were performed five times using a treadmill test (TT) and forced swimming test (FST). The body weight increase in each group was less than that of the normal group. The blood biochemical indices, AST levels, and AST/ALT ratio significantly increased in the Dexa-treated medium-dose ACS group. The total muscle protein also significantly increased in all ACS groups. In the Dexa-treated LF group, CK decreased below the normal level. Exercise capacity, assessed by TT and FST, increased the most in the positive control and Dexa-treated high-dose ACS groups. In the TT, the Dexa-only group increased by about 18%, but the Dexa-treated high-dose ACS group increased by about 110%. Additionally, in the FST, Dexa-treated rats receiving a high dose of ACS demonstrated significantly increased exercise time and capacity. Electron microscopic (EM) and hematoxylin and eosin (H&E) observations of muscle tissue revealed muscle fiber atrophy in the gastrocnemius muscles of the Dexa-only group. In the EM findings of the Dexa-treated high-dose ACS group, the M-line and Z-line were clearer than in the Dexa-only group, and the mitochondria were partially preserved. In conclusion, the ACS-treated rats showed a clear recovery from muscle damage based on serum indices, total muscle protein mass, and the microscopic findings on muscle tissue. Notably, a high dose of ACS demonstrated the most effective protection and recovery of muscle tissue in the Dexa-induced sarcopenia rat model.

Impact of Frailty in Patients With Continuous-Flow Left Ventricular Assist Device Therapy in End-Stage Heart Failure: A Systematic Review and Meta-Analysis

BACKGROUND

Frailty, marked by increased vulnerability and reduced physiological reserve, is common in end-stage heart failure patients. Continuous flow left ventricular assist devices (LVADs) have improved outcomes, but the impact of frailty on these outcomes is unclear. This systematic review and meta-analysis investigate the effect of frailty on clinical outcomes in patients undergoing LVAD therapy.

METHODS

Following PRISMA guidelines, we searched PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar up to September 2023 for studies comparing frail and non-frail patients undergoing LVAD implantation. Data on mortality, hospital length of stay, intubation duration, bleeding, infection, and readmission rates were extracted and analyzed using the Mantel-Haenszel random-effects model, with heterogeneity assessed by the I2 statistic.

RESULTS

Fifteen studies involving 3458 patients were included. Frailty was significantly associated with higher long-term mortality (OR: 2.12; 95% CI: 1.17-3.83; p = 0.01), but not with short-term mortality (OR: 1.61; 95% CI: 0.71-3.65; p = 0.26), hospital length of stay (MD: 1.93; 95% CI: -9.83 to 13.68; p = 0.75), or intubation duration (MD: 34.28; 95% CI: -1.15-69.71; p = 0.06). No significant differences were found in bleeding (OR: 1.76; 95% CI: 0.76-4.10; p = 0.19), infection (OR: 0.44; 95% CI: 0.11-1.84; p = 0.26), or readmission rates (OR: 1.07; 95% CI: 0.78-1.46; p = 0.68).

CONCLUSION

Frail patients with LVADs have higher long-term mortality but similar short-term outcomes, hospital stays, intubation times, bleeding, infection, and readmission rates compared to non-frail patients. These findings highlight the need for tailored strategies to improve outcomes in frail LVAD patients and suggest further research on frailty interventions.

Impact of Preoperative CT-Measured Sarcopenia on Clinical, Pathological, and Oncological Outcomes After Elective Rectal Cancer Surgery

Background: Patients with rectal cancer may be exposed to a loss of muscle strength and quality. This study aimed to assess the role of preoperative CT-based sarcopenia on postoperative clinical, pathological, and oncological outcomes after rectal cancer surgery. Methods: This retrospective monocentric study included patients who underwent elective oncologic resection for rectal adenocarcinoma between 01/2014 and 03/2022. The skeletal muscle index (SMI) was measured using CT at the third lumbar vertebral level, and sarcopenia was defined based on pre-established sex-specific cut-offs. Patients with sarcopenia were compared to those without sarcopenia in terms of outcomes. A Cox proportional hazard regression analysis was used to determine the independent prognostic factors of disease-free survival (DFS) and overall survival (OS). Results: A total of 208 patients were included, and 123 (59%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (66 vs. 61 years, p = 0.003), had lower BMI (24 vs. 28 kg/m2, p < 0.001), and were mainly men (76 vs. 48%, p < 0.001). There was no difference in overall and major complication rates between the sarcopenia and non-sarcopenia group (43 vs. 37%, p = 0.389, and 17 vs. 17%, p = 1.000, respectively). Preoperative and postoperative features related to rectal surgery were comparable. The only predictive factor impacting OS was R1/R2 resection (HR 4.915, 95% CI, 1.141-11.282, p < 0.001), while sarcopenia (HR 2.013, 95% CI 0.972-4.173, p = 0.050) and T3/T4 status (HR 2.108, 95% CI 1.058-4.203, p = 0.034) were independently associated with DFS. Conclusions: A majority of patients undergoing rectal cancer surgery had preoperative CT-based sarcopenia. In this cohort, sarcopenia had no impact on postoperative morbidity and OS but was independently associated with DFS.

Perspectives on Diet and Exercise Interaction for Healthy Aging: Opportunities to Reduce Malnutrition Risk and Optimize Fitness

Nutrition and exercise play a pivotal role in counteracting the effects of aging, promoting health, and improving physical fitness in older adults. This perspective study examines their interplay, highlighting their combined potential to preserve muscle mass, cognitive function, and quality of life. The objective is to address gaps in the current understanding, such as the frequent neglect of dietary intake in exercise interventions and vice versa, which can limit their effectiveness. Through a synthesis of the existing literature, we identify key findings, emphasizing the importance of adequate nutritional intake-particularly protein, essential amino acids, and micronutrients-in supporting exercise benefits and preventing sarcopenia and malnutrition. Additionally, supplementation strategies, such as omega-3 fatty acids, creatine, and essential amino acids, are explored alongside the emerging role of the gut microbiota in mediating the benefits of nutrition and exercise. Despite these advances, challenges remain, including determining optimal dosages and timing and addressing individual variability in responses. Personalized approaches tailored to sex differences, gut microbiota diversity, and baseline health conditions are critical for maximizing intervention outcomes. Our conclusions underscore the necessity of integrated strategies that align dietary and exercise interventions to support healthy and active aging. By addressing these gaps, future research can provide actionable insights to optimize health and quality of life in older populations.

Visual Analysis of Hot Topics and Trends in Nutrition for Decompensated Cirrhosis Between 1994 and 2024

OBJECTIVE

An updated summary of the research profile of nutrition for the last 30 years for decompensated cirrhosis is lacking. This study aimed to explore the literature on nutrition for decompensated cirrhosis, draw a visual network map to investigate the research trends, and provide suggestions for future research. The Web of Science database retrieves the literature on nutrition for decompensated cirrhosis between 1994 and 2024.

METHODS

We used the cooperative, co-occurrence, and co-citation networks in the CiteSpace knowledge graph analysis tool to explore and visualize the relevant countries, institutions, authors, co-cited journals, keywords, and co-cited references.

RESULTS

We identified 741 articles on nutrition for decompensated cirrhosis. The number of publications and research interests has generally increased. The USA contributed the largest number of publications and had the highest centrality. The University of London ranked first in the number of articles issued, followed by the University of Alberta and Mayo Clinic. TANDON P, a "core strength" researcher, is a central hub in the collaborative network. Of the cited journals, HEPATOLOGY had the highest output (540, 15.3%).

CONCLUSIONS

Over the past three decades, the focus of research on nutrition in decompensated cirrhosis has shifted from "hepatic encephalopathy, intestinal failure, metabolic syndrome, and alcoholic hepatitis" to "sarcopenia and nutritional assessment." In the future, nutritional interventions for sarcopenia should be based on a multimodal approach to address various causative factors. Its targeted treatment is an emerging area that warrants further in-depth research.

Association between oral health-related quality of life and physical frailty among community-dwelling older adults: A 2-year longitudinal study

BACKGROUND

Frailty is a major health concern among older adults, and its association with oral health-related quality of life (OHRQoL) remains underexplored in longitudinal studies.

OBJECTIVE

To investigate the association between baseline OHRQoL and physical frailty incidence at a 2-year follow-up in community-dwelling older adults.

DESIGN

Prospective longitudinal study.

SETTING

The study was conducted within the Tosa Longitudinal Aging Study framework in Japan.

PARTICIPANTS

This study included 144 community-dwelling older adults (50 men and 94 women; median age, 81.0 years) with complete data who participated in the Tosa Longitudinal Aging Study in 2016 and 2018 and were not categorized as physical frailty in 2016.

MEASUREMENTS

Baseline assessment included OHRQoL, which was evaluated using the General Oral Health Assessment Index (GOHAI; range 12-60), with higher scores indicating better OHRQoL, oral function, and general health status. The incidence of physical frailty was defined using the revised Japanese version of the Cardiovascular Health Study criteria. The association between the GOHAI score and physical frailty was assessed using logistic regression analysis.

RESULTS

The median baseline GOHAI score was 58. The incidence of frailty after a 2-year follow-up was 13.9 % among the participants (18.0 and 11.7 % for men and women, respectively). Each point of the GOHAI score was associated with an 11 % reduction in frailty risk over 2 years after adjusting by age, sex, number of teeth, Food Diversity Score, Geriatric Depression Scale score, eating alone, smoking, and more than five medications (adjusted odds ratio: 0.893; 95 % confidence interval: 0.810-0.984).

CONCLUSIONS

This longitudinal study showed that a higher baseline OHRQoL, based on the GOHAI score, was linked to a lower incidence of physical frailty among community-dwelling older adults after 2 years.

Ultra-Processed Food Intakes and Health Outcomes in Adults Older Than 60 Years: A Systematic Review

CONTEXT

Relationships between ultraprocessed food (UPF) intakes and health have been well described in adults, but evidence of these relationships in older adults is rather limited. Demographic shifts in aging emphasize the importance of understanding the role of diet in maintaining health during later life.

OBJECTIVE

The aim of this systematic review was to identify health outcomes associated with UPF consumption in those aged ≥60 years.

DATA SOURCES

The Medline, Web of Science, Scopus, and Embase databases were searched from inception until June 2023, using search terms representing UPF and any health outcome. Observational studies restricted to individuals aged ≥60 years using the Nova food classification were included. Articles were screened independently by 2 researchers using PECOS inclusion criteria.

DATA EXTRACTION

Two-thirds of the studies in the present review were prospective cohort studies (n = 4) and the rest were cross-sectional (n = 2). The number of participants ranged from 652 to 2713 across the 6 studies. The mean age of participants ranged between 67 and 73 years.

DATA ANALYSIS

In the prospective cohort studies, the highest consumption of UPF was associated with incident frailty, incident dyslipidemia, renal function decline, and abdominal obesity. For cross-sectional studies, the highest intake of UPF was associated with negative outcomes similar to young and middle-aged cohorts, with the addition of nutritional frailty and worse cognitive performance.

CONCLUSIONS

Currently, the limited understanding of how high UPF intakes could be associated with negative health outcomes for older adults influences the ability to inform policy and practice recommendations. More research is required owing to the very limited number of studies, specifically in older adults.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023442783.

Frailism: a scoping review exploring discrimination against people living with frailty

People living with frailty can experience discrimination, but unlike the characteristics of age and disability, frailty is not protected by law. Frailty is a clinical syndrome associated with ageing in which health deficits increase a person's vulnerability to illness, disability, and death. This scoping review, conducted by a team of methodologists, clinicians, lawyers, and patients, aimed to investigate the extent of discrimination against people living with frailty described in health-care literature. We searched five health-care databases from inception up to June, 2022, and grey literature, to identify 144 texts. The texts were classified by the types of discrimination (direct discrimination, indirect discrimination, harassment, and victimisation) and inductively developed into contextual themes. The median age of the participants was 77 years (IQR 69·9-82·0), and 65·4% were women. The most common types of discrimination were direct (in 90 [63%]), indirect (in 66 [46%]), and harassment (in one [1%]) of the 144 texts, with no instances of victimisation reported. Nine themes of discriminatory actions were developed. Discrimination against people living with frailty overlapped with discrimination based on established protected characteristics, including age, disability, race, and sex. Evidence indicated that frailty discrimination replaces, mediates, masks, and potentiates age discrimination. Discrimination against people with frailty seemed to be both an independent event and one that interacts with established protected characteristics. Future research should focus on preventing frailty-based discrimination and establishing whether frailty should be considered a new protected characteristic by law.

A combined health promotion program of exercise with protein and vitamin D-enriched menu enhances skeletal muscle mass and strength in Japanese elderly men

The study aimed to investigate the effectiveness of combining a protein and vitamin D-enriched menu with an exercise program to reduce frailty risk and enhance muscle performance. However, current evidence lacks accurate dosage and effectiveness information for this combination. This study involved Japanese men in their 60s who were randomly assigned to two groups : the ExN group, which received a 10-day exercise program along with enriched diet, and the Ex group, which underwent the exercise program alone. The effects of these interventions on muscle mass, strength, and serum vitamin D metabolite levels were assessed. The ExN intervention resulted in a significant increase in skeletal muscle mass and serum 25-hydroxyvitamin D3 (25(OH)D3) levels, while the Ex intervention did not yield the same effects. These results indicate that a combined program of exercise with protein and vitamin D-enriched meal improves serum 25(OH)D3 levels and skeletal muscle mass among older Japanese men. J. Med. Invest. 72 : 76-84, February, 2025.

Effects of integrated care with case management and nutritional counselling for frail older adults with nutritional risk in the primary care setting

BACKGROUND

The effects of integrated care with case management and nutritional counselling for frail patients with nutritional risk are unclear.

OBJECTIVES

To assess the impact of the integrated care model for frail patients with nutritional risk in the primary care setting.

METHODS

This was a retrospective observational study. We enrolled 100 prefrail or frail patients according to Clinical Frailty Scale (CFS) aged ≥ 60 years with nutritional risk from the geriatric clinic. We implemented the frailty intervention model, including integrated care with comprehensive geriatric assessments (CGA), case management, and nutritional counselling by the dietitian. We obtained measures of CGA components, physical performance, body mass index (BMI), and daily caloric intake before and after the 2-month care program. We used the Wilcoxon signed-rank test to analyse differences after the care program and applied multiple linear regression to determine the predictive factors for CFS improvement.

RESULTS

Among the 100 patients (mean age, 75.0 ± 7.2 years; females, 71.0%; frail patients, 26%), 93% improved their CFS status, and 91% achieved > 80% of recommended daily caloric intake after the care program. The Mini Nutritional Assessment Short-Form significantly improved after the program. BMI and daily caloric intake increased significantly after nutritional counselling. The post-test short physical performance battery (SPPB) significantly increased with a faster 4 m gait speed. Baseline poor CFS was a significant predictor for CFS improvement.

CONCLUSIONS

Integrated care with case management and nutritional counselling for prefrail and frail patients with nutritional risk in the primary care setting may improve physical performance and nutritional status.

Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis

INTRODUCTION

The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients.

DATA AND METHODS

The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software.

RESULTS

A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention.

CONCLUSIONS

This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.

Energy and nutrient intake by people with and without sarcopenia diagnosed by the European Working Group on Sarcopenia in Older People: a systematic review and meta-analysis

CONTEXT

There is growing evidence that insufficient dietary intake is associated with sarcopenia.

OBJECTIVE

In this systematic review and meta-analysis, the energy and nutrient intakes by people with and without sarcopenia were compared using only the European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) consensus diagnostic criteria.

DATA SOURCES

Only observational studies that compared energy and nutrient intake from food alone by individuals with and without sarcopenia were included. Studies were searched in the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus. The review followed the PRISMA checklist and submitted the protocol to PROSPERO.

DATA EXTRACTION

Data were extracted by 2 authors independently. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale.

DATA ANALYSIS

A total of 8648 articles were identified and 12 were selected. Among individuals with sarcopenia, lower intakes of energy and some nutrients, mainly with antioxidant properties, were observed compared with those without sarcopenia. Meta-analyses showed that individuals with sarcopenia consume fewer calories/day than individuals without sarcopenia (n = 10 studies; standardized mean difference (SMD) -0.15; 95% confidence interval: -0.29, -0.01) diagnosed by EWGSOP1 and EWGSOP2. Individuals with sarcopenia consume less omega-3, folate, magnesium, phosphorus, selenium, zinc, and vitamins C, D, and E when compared with those without sarcopenia.

CONCLUSION

The results of the present study suggest that insufficient intake of energy and nutrients with antioxidant potential may be associated with sarcopenia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD 42020195698.

Sarcopenia, Frailty and Diabetic Foot: A Mini Narrative Review

The aim of this narrative mini review was to investigate the potential association of the diabetic foot (DF) with sarcopenia and frailty. Data is still limited, but it appears that DF patients may be more prone to frailty. In addition, patients with DF and sarcopenia exhibit more frequently foot ulcers and amputations, as well as increased mortality rates post-operatively. Further studies are now needed to see how these realizations may be used in clinical practice, aiming to improve DF outcomes.

Association between dysphagia and activities of daily living in older adults: a systematic review and meta-analysis

PURPOSE

Numerous epidemiological studies have suggested a possible association between dysphagia and the risk of decline in Activities of daily living (ADL) among older adults. This systematic review and meta-analysis aimed to elucidate the relationship between dysphagia and ADL in older adults.

METHODS

PubMed, Web of Science, Cochrane Library, Embase, Ebsco, MEDLINE, Wiley, CINAHL, and Ovid databases were comprehensively examined for relevant studies published up to October 31, 2022. Quantitative studies published in English were included to explore the relationship between dysphagia and ADL in people aged 65 years and older. The NIH Quality Assessment Tool was used to assess the study quality. R software was used to draw forest plots and I2 was employed to indicate study heterogeneity. Sensitivity analysis was performed using the one-by-one exclusion method. Publication bias was measured using funnel plots and Egger's test.

RESULTS

A total of 3,498 studies were retrieved from the database, 22 of which were eventually included in the systematic evaluation, and 14 of which were subjected to meta-analysis. Data from nine studies were categorical variables, and meta-analysis results showed that swallowing disorders in older adults were associated with a lower ability to perform ADL (OR = 3.39, 95% CI: 2.55-4.50, p < 0.001), with moderate heterogeneity (I2 = 62%, p = 0.006). Data from seven studies were continuous variables, resulting in a negative association between the prevalence of dysphagia and ADLs in older adults (SMD = -0.80, 95% CI: -1.08 to -0.51, p < 0.001), with high heterogeneity (I2 = 94%, p < 0.001). Sensitivity analysis showed robust results, funnel plots and Egger's test indicated no publication bias.

CONCLUSION

Dysphagia is significantly associated with the capacity to perform ADL. Prevention and screening of dysphagia in older patients dependent on others for daily care are needed. Further long-term studies are needed in the future to prove causality.

CT parameters of psoas muscle predicts 28-day mortality in older patients with sepsis: a retrospective study

ODJECTIVES

To investigate the predictive value of computed tomography (CT)-based transverse diameter (TD) and longitudinal diameter (LD) of the psoas muscle at the level of third lumbar vertebra for 28-day mortality in older patients with sepsis.

METHODS

This retrospective single-center cohort study included 115 septic patients aged over 65 years old who were admitted to ICU in Beijing-Chaoyang Hospital between July 2017 and July 2022. The TD and LD of psoas muscle were obtained by measurement on abdominal CT images. Logistic regression analysis was conducted to identify the prognostic factors for 28-day mortality in older patients with sepsis, and their predictive performances were evaluated using the receiver operating characteristic (ROC) curve.

RESULTS

Multivariable logistic analysis indicated that TD (OR: 0.405, 95% CI: 0.190-0.864) was a protective factor for 28-day mortality in older patients with sepsis, whereas LD was not. The areas under the curve (AUCs) of TD, APACHE II, and SOFA were 0.666 (95% CI: 0.565-0.767), 0.660 (95% CI: 0.561-0.760), and 0.679 (95% CI: 0.581-0.777), respectively. Furthermore, the AUCs for the combination of TD with APACHE II or SOFA were 0.766 (95% CI: 0.679-0.853, P < 0.001) and 0.765 (95% CI: 0.679-0.852, P < 0.001).

CONCLUSIONS

TD of psoas muscle was a predictor for 28-day mortality in older patients with sepsis. The combination of TD with APACHE II or SOFA scores enhances the early identification of patients at high risk for poor prognosis.

CLINICAL TRIAL NUMBER

not applicable.

Stored Energy and Recovery: A Key Factor in Post-Stroke Sarcopenia Management

INTRODUCTION

This study aimed to determine the effects of Stored Energy on changes in body weight (BW) and skeletal muscle mass (SMM) in patients with post-acute stroke and sarcopenia.

METHODS

This retrospective cohort study included patients with stroke and sarcopenia consecutively admitted to a Japanese rehabilitation hospital between 2015 and 2022. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia in 2019 criteria. Total Stored Energy (kcal) was defined as total energy intake minus total energy requirements during hospitalization, and energy requirements were estimated as actual BW (kg) × 30 (kcal/day). Multiple regression analysis was used to adjust for the effects of confounders and to analyze the association between Total Stored Energy divided by length of hospital stay (= Stored Energy) and changes in BW and SMM during hospitalization.

RESULTS

Of the total 556 patients, 193 patients (mean age, 80 years; 43% male) were analyzed. The median (IQR) Total Stored Energy was -1,544 (-18,524, 16,566) kcal and Stored Energy was -23 (-169, 165) kcal/day; 90 patients had Stored Energy >0. Multiple linear regression analysis showed that Stored Energy was independently and positively associated with BW gain (β = 0.412, p < 0.001) and SMM gain (β = 0.263, p < 0.001).

CONCLUSION

Stored Energy has a positive impact on BW and SMM in patients with post-acute stroke and sarcopenia.

Construction of frailty and risk prediction models in maintenance hemodialysis patients: a cross-sectional study

Objective

As the prevalence of diabetic nephropathy and hypertensive nephropathy increases with age in mainland China, the number of patients with end-stage renal disease is increasing, leading to an increase in the number of patients receiving maintenance hemodialysis. Considering the harmful effects of frailty on the health of maintenance hemodialysis patients, this study aims to identify hemodialysis patients at risk for frailty at an early stage, in order to prevent or delay the progression of frailty in the early stage, so as to prevent the adverse consequences of frailty.

Methods

A total of 479 patients admitted to the blood purification centers of two grade tertiary hospitals in Anhui Province, China, using convenient sampling. The Frailty Scale, the SARC-F questionnaire, the Simplified Food Appetite Questionnaire (SNAQ) and the mini nutritional assessment short-form (MNA-SF) were used in the study. Pearson correlation analysis was used to explore the correlation among the frailty influencing factors.

Results

The incidence of frailty was 24.0% among 479 Chinese hemodialysis patients. Gender (p < 0.05), Malnutrition (p < 0.001), sarcopenia (p < 0.001), and feel tired after dialysis (p < 0.001) were highly correlated with frailty in Chinese hemodialysis patients. Serum albumin concentration (p < 0.05) was a protective factor of frailty.

Conclusion

This survey shows that frailty was highly prevalent among Chinese hemodialysis patients. Medical staff and their families should make early judgments and carry out interventions on the risk of frailty.

Frailty in the context of kidney transplantation

Frailty, defined as an inappropriate response to stressful situations due to the loss of physiological reserve, was initially described in the elderly population, but is currently being identified in younger populations with chronic diseases, such as chronic kidney disease. It is estimated that about 20% of patients are frail at the time of kidney transplantation (KT), and there is great interest in its potential predictive value for unfavorable outcomes. A significant body of evidence has been generated; however, several areas still remain to be further explored. The pathogenesis is poorly understood and limited to the extrapolation of findings from other populations. Most studies are observational, involving patients on the waiting list or post-KT, and there is a scarcity of data on long-term evolution and possible interventions. We reviewed studies, including those with Brazilian populations, assessing frailty in the pre- and post-KT phases, exploring pathophysiology, associated factors, diagnostic challenges, and associated outcomes, in an attempt to provide a basis for future interventions.

Low muscle quality on a procedural computed tomography scan assessed with deep learning as a practical useful predictor of mortality in patients with severe aortic valve stenosis

BACKGROUND & AIMS

Accurate diagnosis of sarcopenia requires evaluation of muscle quality, which refers to the amount of fat infiltration in muscle tissue. In this study, we aim to investigate whether we can independently predict mortality risk in transcatheter aortic valve implantation (TAVI) patients, using automatic deep learning algorithms to assess muscle quality on procedural computed tomography (CT) scans.

METHODS

This study included 1199 patients with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) between January 2010 and January 2020. A procedural CT scan was performed as part of the preprocedural-TAVI evaluation, and the scans were analyzed using deep-learning-based software to automatically determine skeletal muscle density (SMD) and intermuscular adipose tissue (IMAT). The association of SMD and IMAT with all-cause mortality was analyzed using a Cox regression model, adjusted for other known mortality predictors, including muscle mass.

RESULTS

The mean age of the participants was 80 ± 7 years, 53% were female. The median observation time was 1084 days, and the overall mortality rate was 39%. We found that the lowest tertile of muscle quality, as determined by SMD, was associated with an increased risk of mortality (HR 1.40 [95%CI: 1.15-1.70], p < 0.01). Similarly, low muscle quality as defined by high IMAT in the lowest tertile was also associated with increased mortality risk (HR 1.24 [95%CI: 1.01-1.52], p = 0.04).

CONCLUSIONS

Our findings suggest that deep learning-assessed low muscle quality, as indicated by fat infiltration in muscle tissue, is a practical, useful and independent predictor of mortality after TAVI.

Nutritional Interventions in Older Persons with Type 2 Diabetes and Frailty: A Scoping Systematic Review

In the elderly, the coexistence of type 2 diabetes mellitus (T2DM) and frailty is frequent. Much has been described about pharmacological management and glycemic control goals. However, there is a knowledge gap in terms of the objectives and characteristics of interventions, especially nutritional ones, for this population. A scoping review was performed to document the objectives, characteristics, and results of nutritional interventions in older people with T2DM and frailty. The five-stage framework of Arksey and O'Malley was used, as was the PRISMA extension for scoping reviews. The results stand out for three trends, as follows: (1) experimental studies with multicomponent intervention physical exercise programs and nutritional programs based on educational processes or behavioral intervention; (2) observational studies with an association of the kind of diet assessed by scales and their relation to stages of frailty; (3) a review that updates recommendations on pharmacological and non-pharmacological, diet, exercise, management, as well as glucose control goals for diabetes in frail older persons. Finally, the evidence shows that management of T2DM in older adults with frailty requires goals and interventions tailored to their functional capacity and health condition. The exercise, diet, and education programs reviewed have demonstrated their effectiveness in improving physical performance, reducing the risk of frailty or progression to more advanced stages, and achieving better glycemic control.

Nutritional care in older adults: are we doing everything? An expert opinion review

Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality-of-life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.

Prevalence of mild cognitive impairment and its association with malnutrition in older Chinese adults in the community

Objective

This study aims to characterize the prevalence and associated factors of cognitive impairment in older adults within Chinese community settings.

Background

Research exploring the interrelation between malnutrition and cognitive impairment in the older adult community-dwelling population is scarce. The impact of nutritional status on cognitive function in aging adults has not been definitively established.

Methods

A cross-sectional survey was conducted in one urban and one rural community in Chengdu, China, from October 2022 to March 2023. The sample included 706 older adults. Logistic regression was utilized to determine independent risk factors for mild cognitive impairment (MCI).

Results

The study found a significant prevalence of MCI at 32.0% among the older adult population. Among those suffering from malnutrition, 55.6% were affected by MCI. The logistic regression analysis indicated that malnutrition risk (OR = 2.192, 95% CI 1.431 to 3.357, p < 0.001), rural residence (OR = 1.475, 95% CI 1.003 to 2.170, p = 0.048), age (70-79 years old; OR = 2.425, 95% CI 1.611 to 3.651, p < 0.001; ≥80 years old: OR = 4.773, 95% CI 2.571 to 8.859, p < 0.001), male (OR = 1.584, 95% CI 1.085 to 2.313, p = 0.017), middle education level (OR = 0.986, 95% CI 1.627 to 5.482, p < 0.001), and ADL dependence (OR = 1.810, 95% CI 1.158 to 2.827, p = 0.009) were significantly associated with the occurrence of MCI.

Conclusion

The findings indicate a widespread occurrence of MCI in community-dwelling older Chinese adults. The association between malnutrition, as measured by the Mini Nutritional Assessment-Short Form (MNA-SF), and cognitive decline is evident. Older adult individuals with nutritional risk, advancing age, rural residence, male gender, moderate education, and ADL dependency are at increased likelihood of developing MCI. Longitudinal research is needed to clarify the temporal relationships between MCI, demographic factors, and whether improvements in nutritional status or ADL can reduce the incidence of MCI in this population.

Measuring calf circumference in frail hospitalized older adults and prediction of in-hospital complications and post-discharge mortality

Background

Sarcopenia, characterized by muscle mass, strength, and performance decline, significantly impacts outcomes in older adults. This study aims to assess the predictive value of calf circumference (CC), in conjunction with SARC-F and hand grip, concerning in-hospital complications and post-discharge mortality among hospitalized frail older adults.

Methods

A cohort of 158 hospitalized patients aged over 65 years underwent Comprehensive Geriatric Assessment and sarcopenia screening, including CC measurement. Multivariable regression analyses, adjusted for confounders, were conducted to assess predictive associations.

Results

The study cohort, comprising 53% males with a median age of 86 years, exhibited significant sarcopenia prevalence based on SARC-F (85% indicating sarcopenia), hand grip strength (probable sarcopenia in 77% of males and 72% of females), and CC (sarcopenia in 83%). Multivariate analysis, adjusting for age, sex, Clinical Frailty Scale (CFS), and Mini Nutritional Assessment-Short Form (MNA-SF), demonstrated associations of CC and SARC-F with in-hospital complications, while CC also showed a significant association with reduced risks of in-hospital mortality (OR 0.441, 95% CI 0.257 to 0.754, p = 0.003) and 90-day mortality (OR 0.714, 95% CI 0.516 to 0.988, p = 0.043).

Conclusion

This study provides insights into the predictive accuracy of sarcopenia screening tools on mortality in real-world hospitalized older adults with frailty. Notably, CC emerges as a robust predictor of mortality outcomes. Further research is warranted to validate and elucidate the respective contributions of CC and frailty to mortality in vulnerable populations.

Nutrition for the older adult - Current concepts. Report from an ESPEN symposium

BACKGROUND & AIMS

In view of the global demographic shift, a scientific symposium was organised by the European Society for Clinical Nutrition and Metabolism (ESPEN) to address nutrition-related challenges of the older population and provide an overview of the current state of knowledge.

METHODS

Eighteen nutrition-related issues of the ageing global society were presented by international experts during the symposium and summarised in this report.

RESULTS

Anorexia of ageing, dysphagia, malnutrition, frailty, sarcopenia, sarcopenic obesity, and the metabolic syndrome were highlighted as major nutrition-related geriatric syndromes. Great progress has been made in recent years through standardised definitions of some but not all syndromes. Regarding malnutrition, the GLIM approach has shown to be suitable also in older adults, justifying its continuous implementation. For anorexia of ageing, a consensus definition is still required. Intervention approaches should be integrated and person-centered with the aim of optimizing intrinsic capacity and maintaining functional capacity. Landmark studies like EFFORT and FINGER have impressively documented the potential of individualised and multifactorial interventions for functional and health benefits. Combining nutritional intervention with physical training seems particularly important whereas restrictive diets and drug treatment should generally be used with caution because of undesirable risks. Obesity management in older adults should take into account the risk of promoting sarcopenia.

CONCLUSIONS

In the future, even more individualised approaches like precision nutrition may enable better nutritional care. Meanwhile all stakeholders should focus on a better implementation of currently available strategies and work closely together to improve nutritional care for older adults.

Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document

OBJECTIVES

To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice.

METHOD

A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm.

RESULTS

The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.

Exploring the complex associations among risks of malnutrition, sarcopenia, and frailty in community-dwelling older adults

BACKGROUND

Malnutrition, sarcopenia, and frailty are age-related conditions that are associated with multiple health-related negative outcomes. However, the complex associations between them remain to be elucidated. The aims of the study were to explore: (1) whether the risk of sarcopenia has a mediator effect on the association between risks of malnutrition and frailty; and (2) whether physical activity (PA) level modulates this mediator effect in community-dwelling older adults.

METHODS

This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed.

RESULTS

The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085).

CONCLUSIONS

The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.

The associations between nutritional status and physical frailty and Alzheimer's disease plasma biomarkers in older cognitively unimpaired adults with positive of amyloid-β PET

BACKGROUND & AIMS

It has been revealed good nutritional status and no physical frailty, which are modifiable lifestyle factors, are linked to less cognitive decline and a lower risk of Alzheimer's disease (AD). We aimed to investigate the associations between nutritional status and physical frailty and plasma AD biomarkers, especially the Tau-associated biomarkers in older cognitively unimpaired (CU) adults with higher β-amyloid (Aβ) burden.

METHODS

The nutritional status and physical frailty were assessed via Mini-Nutritional Assessment Short-Form (MNA-SF) and Fried frailty index. The participants underwent the examination of plasma AD biomarkers and 18F-florbetapir PET scan as well as 18F-MK6240 PET in the validation cohort. Correlation and multiple linear regression analyses were used to investigate the associations between nutritional status and frailty and AD biomarkers.

RESULTS

Two cohorts were included in our study. A total of 129 participants with Aβ-PET positive were enrolled in the development cohort. Multiple linear regression analysis showed MNA-SF scores, normal nutritional status, Fried frailty index scores, frailty and some domains of frailty including weight loss, maximal grip strength and exhaustion were associated with plasma p-Tau-181. Furthermore, weight loss, Fried frailty index scores and frailty were associated with higher Aβ-PET standard uptake value ratio. We further performed subgroup analyses stratified by age, sex and apolipoprotein E ε4 genotype to investigate the beneficial characteristics of nutrition and frailty in the special subgroups. Validation cohort contained 38 Aβ-PET positive participants. MNA-SF scores, normal nutritional status, Fried frailty index scores and frailty were associated with Tau burden evaluated by 18F-MK6240 PET Braak-like stages.

CONCLUSIONS

Our data indicates that normal nutritional status and no physical frailty may be associated with expected trend of plasma AD biomarkers, especially less Tau pathology in older CU adults with Aβ deposition. Adjusting to these characteristics of nutrition and physical frailty may help reduce the risk of AD development.

Association between milk consumption in middle age and frailty in later life: The Aichi Workers' cohort study

AIM

Several studies have shown that dairy consumption in old age is effective in preventing frailty. However, there is a lack of evidence regarding the association between milk consumption during middle age and the development of frailty in old age. Therefore, we carried out an investigation to explore the association between milk consumption during middle age and development of frailty examined after over 15 years of follow up in a long-term cohort study in Japan.

METHODS

We studied 265 participants aged 60-79 years (212 men and 53 women) in 2018, who participated in both the baseline survey in 2002 and the frailty assessment in 2018. The amount of milk consumption (g/day) at baseline was age- and energy-adjusted, and classified into three categories (no, low and high consumption: 0 g/day, ≤135.86 g/day, >135.86 g/day in men and 0 g/day, ≤126.44 g/day, >126.44 g/day in women). Odds ratios (OR) and 95% confidence intervals (CI) for prefrailty/frailty after adjusting for lifestyles at baseline, stratified by sex, were estimated using logistic regression analysis.

RESULTS

The prevalence of prefrailty/frailty in 2018 was 37.7% and 28.3% in men and women, respectively. Milk consumption categories were inversely associated with the prevalence of prefrailty/frailty in men (OR 0.34, 95% CI 0.14-0.84 in low consumption; OR 0.31, 95% CI 0.10-0.95 in high consumption; P < 0.05), but not in women (OR 0.53, 95% CI 0.11-2.65; P = 0.44).

CONCLUSIONS

In this study, milk intake in middle-aged men was inversely associated with the prevalence of prefrailty/frailty later in life. Geriatr Gerontol Int 2024; 24: 700-705.

Research Hotspots and Trends of Interventions for Sarcopenic Obesity: A Bibliometric Analysis

Sarcopenic obesity, characterized by both obesity and sarcopenia, significantly impacts health and independence of affected individuals. There is an urgent need to explore effective strategies for addressing or preventing sarcopenic obesity. An initial critical step is to promptly assess the impact of academic research in this field, considering factors such as geographical regions, authors, journals, and institutions. It is also essential to analyze current trends and identify potential areas that may inspire future researchers to conduct further studies, ultimately improving public health outcomes for individuals with sarcopenic obesity. To achieve this, bibliometric research was conducted using the Web of Science Core Collection database to identify English language articles and reviews focusing on sarcopenic obesity interventions published between January 1, 2004, and June 15, 2024, followed by a literature review. A total of 929 English-language articles were collected, consisting of 645 research articles and 284 reviews. Research output in the field has shown significant growth since 2017, reaching a peak of 139 papers in 2022. The United States leads in publication output with 234 papers and a total of 13,971 citations, highlighting substantial international collaboration. Both the United States and Europe are recognized as key academic hubs for sarcopenic obesity intervention research, characterized by robust academic interactions. Moreover, there has been a notable increase in publication volume from China, South Korea, and Japan. Noteworthy authors in this field include Boirie Y from Université Clermont Auvergne in France, Prado CM from the University of Alberta in Canada, Cruz-Jentoft AJ from Hospital Universitario Ramon y Cajal in Spain, and Prado CM from the University of Alberta, known for their high citation count. The University of Alberta leads in the number of publications, while the University of Verona in Italy leads in citation frequency. Journals with higher publication volumes in sarcopenic obesity intervention include Nutrients, Clinical Nutrition, and Journal of Cachexia Sarcopenia and Muscle. Among the top 20 keywords, the most relevant interventions for sarcopenic obesity are exercise, nutrition, resistance training, physical activity, and muscle strength. The primary evidence currently available suggests that resistance training is the most effective method for enhancing muscle strength in sarcopenic obesity patients. Additionally, combining protein supplementation with resistance exercise has shown encouraging results in reducing fat mass in these individuals. To progress in this field, it is crucial to foster collaboration among countries, regions, and academic institutions, promoting multidisciplinary partnerships.

Improving Lower Limb Function and Frailty in Frail Older Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention: A Randomized Controlled Study of Neuromuscular Electrical Stimulation

Background

A global public health problem, frailty is closely associated with poor prognosis after percutaneous coronary intervention (PCI) in older patients with acute myocardial infarction (AMI). Although exercise intervention is the most commonly used method to reverse and alleviate frailty, its application is restricted in patients with acute myocardial infarction following PCI due to cardiovascular instability and autonomic imbalance. Consequently, there is a need for a new practical intervention to address frailty syndrome in these patients.

Purpose

This study aimed to investigate the effect of neuromuscular electrical stimulation in frail older AMI patients post-PCI.

Patients and Methods

A single-blind, randomized controlled trial was carried out in the Department of Cardiovascular Medicine from March to October 2023. A total of 100 eligible participants were randomly divided into two groups: experimental (n = 50) and control (n = 50) groups, respectively. Both groups received usual care. The experimental group underwent neuromuscular electrical stimulation (NMES) on bilateral quadriceps and gastrocnemius muscles for 30 minutes daily from day 1 to day 7 after surgery. The primary outcomes measured included the frailty score, lower limb muscle strength, and lower limb muscle quality. Secondary outcomes included the activities of daily living score, inflammatory markers, and length of hospital stay. All participants were included in an intention-to-treat analysis after the study ended.

Results

The frailty scores of the two groups exhibited a gradual decrease over time, and the scores of the experimental group were lower than those of the control group at 4 and 7 days after surgery (P<0.001). Concurrently, the lower limb muscle strength showed an increasing trend over the time in the experimental group and a decreasing trend in the control group, and the scores of the experimental group surpassed those of the control group (p<0.001). Moreover, a statistical difference was observed in the lower limb muscle mass across the groups after 7 days postoperatively compared with baseline on both sides (p<0.05).

Conclusion

Neuromuscular electrical stimulation has the potential to enhance lower limb function and alleviate frailty in elderly patients with acute myocardial infarction after PCI. These findings introduce a novel intervention approach for frailty management in the elderly population.

Comparison of Mini Nutritional Assessment Tool and Geriatric Nutrition Risk Index in Predicting 12-Y Mortality Among Community-Dwelling Older Persons

BACKGROUND

Malnutrition is a common and dangerous condition in older adults, which has been associated with increased risk of mortality.

OBJECTIVES

This study aimed to evaluate and compare the abilities of Mini Nutritional Assessment short form (MNA-SF), MNA full form (MNA-FF), and geriatric nutritional risk index (GNRI) to predict all-cause and expanded cardiovascular disease (CVD)-related mortality in community-dwelling older adults.

METHODS

This research was an observational cohort study conducted in a community setting, with a 12-y follow-up involving 1001 community-living older adults aged 65 y or older who were enrolled in 2009 and followed up until 2021. Nutritional status assessment was carried out in 2009 using MNA-SF, MNA-FF, and GNRI. Multivariate Cox proportional hazards regression was applied to determine adjusted hazard ratios of mortality with 95% CIs.

RESULTS

A total of 368 deaths (36.76%) and 122 expanded CVD-related deaths (12.19%) were observed after a median follow-up of 12 y. Compared with normal nutritional status, poor nutritional status assessed by the MNA-SF, MNA-FF, and GNRI was found to be associated with an increased all-cause mortality in older persons. MNA-SF and MNA-FF, but not GNRI, were associated with expanded CVD-related mortality. The MNA-FF showed better discriminatory accuracy for all-cause (C-statistics: 0.77; 95% CI: 0.63, 0.79) and expanded CVD-related mortality (C-statistics: 0.79; 95% CI: 0.70, 0.83) than MNA-SF (C-statistics: 0.76; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.81, respectively) and GNRI (C-statistics: 0.75; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.80, respectively).

CONCLUSIONS

Our findings indicate that MNA-SF, MNA-FF, and GNRI were all independent predictors of all-cause mortality. In particular, the MNA-FF may be the best nutritional assessment tool for predicting all-cause and CVD-related mortality among older persons residing in community, compared with MNA-SF and GNRI.

Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials

Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.

Preoperative geriatric assessment of urological patients: a narrative review

PURPOSE OF REVIEW

The proportion of older people is increasing disproportionately. The age between 60 and 65 years is seen as the transition to 'old age'. Frailty is a risk factor for morbidity, mortality, and complications in the context of medical interventions or adverse effects of drug therapies. One of the core components of frailty, the age-related loss of muscle mass, is sarcopenia. Is there an influence of frailty, as well as sarcopenia and some other aspects, i.e. malnutrition, on the outcome in elderly urologic patients?

RECENT FINDINGS

These phenomena of aging correlate with the incidence postoperative complication, infections, readmission rates or mortality. There are numerous studies on the value and informative value of the 5-item frailty index or the G8 questionnaire in older urological patients.

SUMMARY

Geriatric assessment is becoming increasingly important in urological surgery. Simple instruments that are practicable in clinical routine are required in this clinical setting. Which method of preoperative assessment is chosen is secondary. It is important that the risk of geriatric syndromes is assessed prior to surgical interventions in order to determine the most suitable therapeutic approach for each patient.

Targeted metabolomic profiles of serum amino acids are independently correlated with malnutrition in older adults

BACKGROUND

Malnutrition is a common geriatric syndrome that is closely associated with adverse clinical outcomes and poses significant harm to older adults. Early assessment of nutritional status plays a crucial role in preventing and intervening in cases of malnutrition. However, there is currently a lack of measurable methods and biomarkers to evaluate malnutrition in older adults accurately. The aim of this study is to investigate the independent correlation between serum levels of amino acids and malnutrition in older adults, and to identify effective metabolomics biomarkers that can aid in the early detection of geriatric malnutrition.

METHODS

A total of 254 geriatric medical examination participants from Beijing Hospital were included in the study, consisting of 182 individuals with normal nutritional status (Normal group) and 72 patients at risk of malnutrition or already malnourished (MN group). Malnutrition was assessed using the Mini-Nutritional Assessment Short-Form (MNA-SF). Demographic data were collected, and muscle-related and lipid indexes were determined. Serum amino acid concentrations were measured using isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS). The correlation between serum amino acid levels and malnutrition was analyzed using non-parametric tests, partial correlation analysis, linear regression, and logistic regression.

RESULTS

The geriatric MN group exhibited significantly lower serum aromatic amino acid levels (P < 0.05) compared to the normal group. A positive correlation was observed between serum aromatic amino acid levels and the MNA-SF score (P = 0.002), as well as with known biomarkers of malnutrition such as body mass index (BMI) (P < 0.001) and hemoglobin (HGB) (P = 0.005). Multivariable logistic or linear regression analyses showed that aromatic amino acid levels were negatively correlated with MN and positively correlated with the MNA-SF score, after adjusting for some confounding factors, such as age, gender, BMI, smoking status, history of dyslipidemia, diabetes mellitus and frailty. Stratified analyses revealed that these trends were more pronounced in individuals without a history of frailty compared to those with a history of frailty, and there was an interaction between aromatic amino acid levels and frailty history (P = 0.004).

CONCLUSION

Our study suggests that serum aromatic amino acids are independently associated with malnutrition in older adults. These results have important implications for identifying potential biomarkers to predict geriatric malnutrition or monitor its progression and severity, as malnutrition can result in poor clinical outcomes.

Association of Sarcopenia, as Defined Based on the Skeletal Muscle Index, With Mortality and Morbidity After Cardiac Surgery: A Retrospective Cohort Study

OBJECTIVE

To investigate whether "sarcopenia," defined based on the preoperative skeletal muscle index (SMI), can predict major postoperative morbidity and all-cause mortality.

DESIGN

A retrospective observational cohort study.

SETTING

At the authors' Department of Critical Care Medicine.

PARTICIPANTS

A total of 986 adult Chinese patients underwent cardiac surgery (coronary artery bypass graft, valve surgery, combined surgery, or aortic surgery) between January 2019 and August 2022.

MEASUREMENTS AND MAIN RESULTS

The skeletal muscle area at the third lumbar level (L3) was measured via preoperative computed tomography (up to 3 months from the date of imaging to the date of surgery) and normalized to patient height (skeletal muscle index). Sarcopenia was determined based on the skeletal muscle index being in the lowest sex-specific quartile. The primary outcome was all-cause mortality. The secondary outcome was major morbidity. A total of 968 patients were followed for a median of 2.00 years, ranging from 1.06 to 2.90 years. After the follow-up, 76 patients died during the follow-up period. Multivariate Cox proportional analysis showed a relationship between sarcopenia (adjusted hazard ratio 1.80, 95% CI 1.04-3.11; p = 0.034) and all-cause mortality. Kaplan-Meier curves revealed a significantly lower survival rate in the sarcopenia group than in the nonsarcopenia group. Overall, 199 (20.6%) patients had major morbidity. Multivariate analysis showed a significant relationship between sarcopenia (adjusted odds ratio = 2.21, 95% CI 1.52∼3.22, p < 0.001) and major morbidity.

CONCLUSIONS

Sarcopenia, defined by the skeletal muscle index, is associated with all-cause mortality and major morbidity after cardiac surgery, thereby suggesting the need for perioperative sarcopenia risk assessment for patients undergoing cardiac surgery to guide the prevention and management of adverse outcomes.

Association between adherence to the Nordic diet and frailty in older adults: A systematic review of observational studies

BACKGROUND

The Nordic or Baltic Sea diet is a healthy plant-based dietary pattern composed of foods originating from Nordic countries, closely related to the Mediterranean diet. Adherence to the Mediterranean diet has been found to be associated with a reduced risk of frailty. Although adherence to the Nordic diet has been associated with health benefits, little is known about its association with frailty.

OBJECTIVES

To investigate the evidence from observational studies regarding the association between the Nordic/Baltic Sea diet and frailty among older adults.

DESIGN

Systematic review.

METHODS

Three databases (Medline/Ovid, Embase/Ovid, and Scopus) were systematically searched in February 2023 for observational studies examining the association between adherence to the Nordic diet and frailty among adults ≥60 years. The two authors independently assessed the full text of the papers for eligibility of studies and risk of bias.

RESULTS

Three studies (the results of which were reported across 6 papers) met the inclusion criteria, among which one study (2 papers) included only women. Greater adherence to the Nordic diet was associated with a reduced risk of frailty measured by modified Fried criteria in women (one study). Moreover, greater adherence to the Nordic diet was associated with improved muscle (handgrip/leg) strength (one study) and physical performance (two studies), but these differences were seen only in women, with no significant results in men in two studies. Greater adherence to the Nordic diet was also associated with a lower risk of mobility limitations and improved ability to carry out self-care tasks (one study) and a borderline non-significant difference in Activities of Daily Living (one study). A meta-analysis was not performed due to heterogenous outcomes. Although all studies were of good quality, the results should be carefully interpreted due to methodological limitations.

CONCLUSIONS

Adherence to the Nordic diet could be promising in reducing frailty risk, but more robust studies with equal gender representation and frailty-specific outcomes are needed.

Malnutrition as a prognostic factor for 2-year mortality in hospitalized patients in Norway: A matched cohort study

BACKGROUND

Risk of malnutrition and malnutrition have been previously associated with increased risk of mortality. It remains unclear, however, whether the severity of malnutrition differentiates in association with all-cause mortality. The aim was to assess the association between being at risk of malnutrition or being diagnosed with malnutrition according to the diagnostic assessment of the Global Leadership Initiative on Malnutrition (GLIM) with all-cause mortality during a 2-year follow-up in hospitalized patients.

METHODS

A matched cohort study was conducted in hospitalized patients (excluding cancer, intensive care, and transmissible infections) at a university hospital in Bergen, Norway. All patients underwent nutrition screening with the Nutritional Risk Screening 2002 and a further nutrition assessment using the GLIM criteria. All-cause mortality was estimated from the Norwegian death registry after 2 years, and risk factors were calculated by Cox regression analysis.

RESULTS

Among 326 patients included, 55 patients died within 2 years (17% mortality rate). Risk of malnutrition was associated with increased all-cause mortality, which disappeared after adjustment for age and sex. Malnutrition was associated with an increased risk of all-cause mortality at 2 years also after adjustment for age and sex and, additionally, for further comorbidities (hazard ratio = 2.50; 95% CI, 1.41-4.42). When analyzed separately only severe malnutrition was associated with mortality (hazard ratio = 2.73; 95% CI, 1.44-5.15).

CONCLUSION

The findings highlight a strong association between inpatients with severe malnutrition, defined by the GLIM criteria, and an increased risk of all-cause mortality within a 2-year follow-up.

Association of vitamins B1 and B2 intake with early-onset sarcopenia in the general adult population of the US: a cross-sectional study of NHANES data from 2011 to 2018

Background

Early-onset sarcopenia refers to the progressive loss of muscle mass and function that occurs at an early age. This condition perpetuates the vicious cycle of muscle loss and is associated with adverse outcomes. It is important to identify the contributing factors for early intervention and prevention. While diet is known to impact muscle mass, the association of B vitamins with early-onset sarcopenia remains unexplored.

Objectives

To investigate the association of B vitamins intake with early-onset sarcopenia risk in a cross-sectional study.

Methods

We conducted data analysis on a total of 8,711 participants aged between 20 and 59 years who took part in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Early-onset sarcopenia was defined as a SMI measured by DXA that was one standard deviation below the sex-specific mean of the reference population. B vitamins intake (B1, B2, B3, B6, B9, and B12) was assessed by 24-h dietary recall. We used weighted multiple logistic regression and RCS models to estimate the OR and 95% CI of sarcopenia by B vitamins intake, adjusting for demographic, physical, lifestyle, comorbidities, and nutritional covariates.

Results

Higher intake of vitamin B1 was associated with a 22% lower sarcopenia risk (OR = 0.78, CI = 0.63-0.97, p = 0.022), and higher intake of vitamin B2 with a 16% lower risk (OR = 0.84, CI = 0.74-0.97, p = 0.012) in both genders. Gender-specific analyses showed a 28% reduction in sarcopenia risk among males with each additional mg of vitamin B1 intake (OR = 0.72, CI = 0.52-0.97, p = 0.038), and a 26% decrease among females with each additional mg of vitamin B2 intake (OR = 0.74, CI = 0.57-0.96, p = 0.021). No significant differences were found between vitamin B2 and males, or between vitamin B1 and females. The RCS model suggested a nonlinear relationship between vitamin B2 intake and sarcopenia risk (POverall = 0.001, PNonlinear = 0.033), with a plateau effect above 3 mg/d.

Conclusion

Higher intake of vitamin B1 and B2 may lower the risk of early-onset sarcopenia, with gender differences. This suggests the potential of nutritional intervention by increasing these vitamins intake through diet and supplements. Further research is warranted to elucidate the mechanisms and design targeted interventions.

Implications of Protein and Sarcopenia in the Prognosis, Treatment, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common cause of chronic liver disease globally, with prevalence rapidly increasing in parallel with rising rates of obesity and metabolic syndrome. MASLD is defined by the presence of excess fat in the liver, which may induce inflammatory changes and subsequent fibrosis in high-risk patients. Though MASLD occurs frequently, there is still no approved pharmacological treatment, and the mainstay of therapy remains lifestyle modification via dietary changes, enhancement of physical activity, and management of metabolic comorbidities. Most nutrition research and clinical guidance in this disease centers on the reduction in fructose and saturated fat in the diet, although the emerging literature suggests that protein supplementation is important and implicates muscle mass and sarcopenia in disease-related outcomes. This review will assess the current data on these topics, with the goal of defining best practices and identifying research gaps in care.

The moderating effect of oral health on the association between exercise and frailty in patients with musculoskeletal disorders: Findings from the Korean Longitudinal Study of Aging

PURPOSE

This study aimed to examine the effects of exercise and oral health on frailty and to investigate the moderating effect of oral health on the relationship between exercise and frailty among patients with musculoskeletal disorders.

METHODS

This descriptive, cross-sectional study used data from the seventh wave of the Korean Longitudinal Study of Aging. Frailty index based on 41 deficits across seven domains was used, and oral health was assessed using the Geriatric Oral Health Assessment Index. Hierarchical regression analysis was performed to confirm the moderating effect of oral health, and PROCESS macro model 1 by Hayes was applied to examine an inference test of the conditional effect of the moderator.

RESULTS

Data on 1,812 participants with musculoskeletal disorders (mean age 75.0 ± 8.6 years) was analyzed. Compared with no exercise, regular exercise (β= -2.39, 95% confidence interval [CI]= -3.42; -1.34) was significantly associated with lower frailty level. Good oral health (β= -0.38, 95% CI= -0.44, -0.32) was significantly associated with lower frailty level. A significant moderating effect of oral health on the relationship between regular exercise and frailty was detected (β= 0.18, 95% CI= 0.05, 0.30).

CONCLUSIONS

The beneficial effects of regular exercise on frailty were greater in participants with poor oral health than in those with good oral health. Healthcare providers should actively encourage older patients with musculoskeletal disorders and poor oral health to exercise regularly. Combined exercise and oral healthcare interventions may be the most effective strategy for managing frailty in older patients with musculoskeletal disorders.

Feasibility of using cross-sectional area of masticatory muscles to predict sarcopenia in healthy aging subjects

Determination of sarcopenia is crucial in identifying patients at high risk of adverse health outcomes. Recent studies reported a significant decline in masticatory muscle (MM) function in patients with sarcopenia. This study aimed to analyze the cross-sectional area (CSA) of MMs on computed tomography (CT) images and to explore their potential to predict sarcopenia. The study included 149 adult subjects retrospectively (59 males, 90 females, mean age 57.4 ± 14.8 years) who underwent head and neck CT examination for diagnostic purposes. Sarcopenia was diagnosed on CT by measuring CSA of neck muscles at the C3 vertebral level and estimating skeletal muscle index. CSA of MMs (temporal, masseter, medial pterygoid, and lateral pterygoid) were measured bilaterally on reference CT slices. Sarcopenia was diagnosed in 67 (45%) patients. Univariate logistic regression analysis demonstrated a significant association between CSA of all MMs and sarcopenia. In the multivariate logistic regression model, only masseter CSA, lateral pterygoid CSA, age, and gender were marked as predictors of sarcopenia. These parameters were combined in a regression equation, which showed excellent sensitivity and specificity in predicting sarcopenia. The masseter and lateral pterygoid CSA can be used to predict sarcopenia in healthy aging subjects with a high accuracy.

Effect of sarcopenia on survival in patients after pancreatic surgery: a systematic review and meta-analysis

Background

Numerous studies have reported sarcopenia to be associated with unfavorable outcomes in patients who have undergone pancreatectomy. Therefore, in this meta-analysis, we examined the relationship between sarcopenia and survival after pancreatic surgery.

Methods

PubMed, Embase, and Cochrane Library were searched for studies that examined the association between sarcopenia and survival after pancreatic surgery from the inception of the database until June 1, 2023. Hazard ratio (HR) for overall survival (OS) and/or progression-free survival (PFS) of sarcopenia and pancreatic surgery were extracted from the selected studies and random or fixed-effect models were used to summarize the data according to the heterogeneity. Publication bias was assessed using Egger's linear regression test and a funnel plot.

Results

Sixteen studies met the inclusion criteria. For 13 aggregated univariate and 16 multivariate estimates, sarcopenia was associated with decreased OS (univariate analysis: HR 1.69, 95% CI 1.48-1.93; multivariate analysis: HR 1.69; 95% CI 1.39-2.05, I2 = 77.4%). Furthermore, sarcopenia was significantly associated with poor PFS of pancreatic resection (Change to univariate analysis: HR 1.74, 95% CI 1.47-2.05; multivariate analysis: HR 1.54; 95% CI 1.23-1.93, I2 = 63%).

Conclusion

Sarcopenia may be a significant prognostic factor for a shortened survival following pancreatectomy since it is linked to an elevated risk of mortality. Further studies are required to understand how sarcopenia affects long-term results after pancreatic resection.Systematic review registrationRegistration ID: CRD42023438208 https://www.crd.york.ac.uk/PROSPERO/#recordDetails.