1
|
Zheng G, Xia H, Lai Z, Shi H, Zhang J, Wang C, Tian F, Lin H. Dietary Inflammatory Index and Dietary Diversity Score Associated with Sarcopenia and Its Components: Findings from a Nationwide Cross-Sectional Study. Nutrients 2024; 16:1038. [PMID: 38613070 PMCID: PMC11013103 DOI: 10.3390/nu16071038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Little is known about the independent and joint effects of the energy-adjusted dietary inflammatory index (E-DII) and dietary diversity score (DDS) on sarcopenia and its components (low muscle mass, low muscle strength, and low physical performance). A total of 155,669 UK Biobank participants with ≥1 (maximum 5) 24 h dietary assessments were included in this cross-sectional analysis. We used logistic regression models to investigate the associations of E-DII and DDS with sarcopenia and its three components. We further examined the joint effects of E-DII and DDS on sarcopenia and its components using additive and multiplicative interaction analyses. We observed that lower E-DII and higher DDS were associated with lower odds of sarcopenia and its components. There were significant joint associations of E-DII and DDS with sarcopenia and low physical performance (p-interaction < 0.05) on the multiplicative interactive scale. Our study suggests that lower dietary inflammatory potential and higher dietary diversity might be important protective factors against sarcopenia and its components. More cases of sarcopenia and low physical performance might be preventable by adherence to a more anti-inflammatory diet combined with a higher dietary diversity.
Collapse
Affiliation(s)
- Guzhengyue Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou 510080, China; (G.Z.); (Z.L.); (H.S.); (J.Z.); (F.T.)
| | - Hui Xia
- Center for Health Care, Longhua District, Shenzhen 518109, China;
| | - Zhihan Lai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou 510080, China; (G.Z.); (Z.L.); (H.S.); (J.Z.); (F.T.)
| | - Hui Shi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou 510080, China; (G.Z.); (Z.L.); (H.S.); (J.Z.); (F.T.)
| | - Junguo Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou 510080, China; (G.Z.); (Z.L.); (H.S.); (J.Z.); (F.T.)
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China;
| | - Fei Tian
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou 510080, China; (G.Z.); (Z.L.); (H.S.); (J.Z.); (F.T.)
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou 510080, China; (G.Z.); (Z.L.); (H.S.); (J.Z.); (F.T.)
| |
Collapse
|
2
|
Murphy CH, McCarthy SN, McMorrow AM, Egan B, McGowan MJ, Rafferty S, Corish CA, Roche HM. Prevalence and determinants of sarcopenia in community-dwelling older adults in Ireland. Aging Clin Exp Res 2023; 35:1651-1660. [PMID: 37326940 DOI: 10.1007/s40520-023-02453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data on the prevalence of sarcopenia among older adults in Ireland are lacking. AIMS To assess the prevalence and determinants of sarcopenia among community-dwelling older adults in Ireland. METHODS This cross-sectional analysis involved n = 308 community-dwelling adults aged ≥ 65 y living in Ireland. Participants were recruited via recreational clubs and primary healthcare services. Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Skeletal muscle mass was estimated using bioelectrical impedance analysis, strength was measured via handgrip dynamometry, and physical performance was assessed using the Short Physical Performance Battery. Detailed information was collected on demographics, health, and lifestyle. Dietary macronutrient intake was measured via a single 24 h recall. Binary logistic regression was used to examine potential demographic, health, lifestyle, and dietary determinants of sarcopenia (where both probable and confirmed sarcopenia were combined). RESULTS The prevalence of EWGSOP2-defined probable sarcopenia was 20.8% and confirmed sarcopenia was 8.1% (5.8% had severe sarcopenia). Polypharmacy (OR 2.60, 95% confidence interval [CI] 1.3, 5.23), height (OR 0.95, 95% CI 0.91, 0.98), and Instrumental Activities Of Daily Living (IADL) score (OR 0.71, 95% CI 0.59, 0.86) were independently associated with sarcopenia (probable and confirmed combined). There were no independent associations between energy-adjusted macronutrient intakes, as determined by 24 h recall, and sarcopenia. CONCLUSION Sarcopenia prevalence within this sample of community-dwelling older adults in Ireland is broadly similar to other European cohorts. Polypharmacy, lower height, and lower IADL score were independently associated with EWGSOP2-defined sarcopenia.
Collapse
Affiliation(s)
- Caoileann H Murphy
- Rural Economy and Development Programme, Teagasc Food Research Centre, Ashtown, Dublin, D15 KN3K, Ireland
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Sinead N McCarthy
- Rural Economy and Development Programme, Teagasc Food Research Centre, Ashtown, Dublin, D15 KN3K, Ireland.
| | - Aoibheann M McMorrow
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Brendan Egan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Maureen J McGowan
- Health Service Executive Community Health Organisation 6, Wicklow, Ireland
| | - Sheena Rafferty
- Health Service Executive Community Health Organisation 9, Dublin, Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Helen M Roche
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
- Institute for Global Food Security, Queen's University, Belfast, UK
| |
Collapse
|
3
|
Magalhães NV, Waitzberg DL, Lopes NC, Vicedomini ACC, Prudêncio APA, Jacob-Filho W, Busse AL, Ferdinando D, Alves TP, Pereira RMR, Torrinhas RS, Belarmino G. High Prevalence of Energy and Nutrients Inadequacy among Brazilian Older Adults. Nutrients 2023; 15:3246. [PMID: 37513664 PMCID: PMC10384757 DOI: 10.3390/nu15143246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Poor nutrition increases the risk of diseases and adverse health outcomes in older adults. We evaluated the potential inadequacy of nutrient intake among older adults in Brazil and its association with body anthropometry and composition outcomes. Dietary intake was obtained from 295 community-living older adults (>60 years old), of both genders, using a seven-day food record. Nutrient inadequacy was further identified based on the Dietary Reference Intakes and European Guidelines. Skeletal muscle mass (SM), strength and performance, and the diagnosis of sarcopenia were assessed using reference methods. Nutritional inadequacy was high, with energy, dietary fiber, and six micronutrients exhibiting the greatest inadequacy levels (>80%). Energy intake was correlated with SM strength (p = 0.000) and performance (p = 0.001). Inadequate energy, fiber, and protein intakes influenced BMI, while inadequate intake of vitamin B6 directly affected the diagnosis of sarcopenia (p ≤ 0.005). Further research is required to investigate whether these inadequacies can be associated with other clinical health outcomes.
Collapse
Affiliation(s)
- Natalia Vieira Magalhães
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Dan Linetzky Waitzberg
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Natalia Correia Lopes
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Ana Carolina Costa Vicedomini
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Ana Paula Aguiar Prudêncio
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Wilson Jacob-Filho
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Alexandre Leopold Busse
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Douglas Ferdinando
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Tatiana Pereira Alves
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Rosa Maria Rodrigues Pereira
- Research Laboratory in Rheumatology, LIM-17, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Raquel Susana Torrinhas
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Giliane Belarmino
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| |
Collapse
|
4
|
Ticinesi A, Nouvenne A, Cerundolo N, Parise A, Meschi T. Accounting Gut Microbiota as the Mediator of Beneficial Effects of Dietary (Poly)phenols on Skeletal Muscle in Aging. Nutrients 2023; 15:nu15102367. [PMID: 37242251 DOI: 10.3390/nu15102367] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Sarcopenia, the age-related loss of muscle mass and function increasing the risk of disability and adverse outcomes in older people, is substantially influenced by dietary habits. Several studies from animal models of aging and muscle wasting indicate that the intake of specific polyphenol compounds can be associated with myoprotective effects, and improvements in muscle strength and performance. Such findings have also been confirmed in a smaller number of human studies. However, in the gut lumen, dietary polyphenols undergo extensive biotransformation by gut microbiota into a wide range of bioactive compounds, which substantially contribute to bioactivity on skeletal muscle. Thus, the beneficial effects of polyphenols may consistently vary across individuals, depending on the composition and metabolic functionality of gut bacterial communities. The understanding of such variability has recently been improved. For example, resveratrol and urolithin interaction with the microbiota can produce different biological effects according to the microbiota metabotype. In older individuals, the gut microbiota is frequently characterized by dysbiosis, overrepresentation of opportunistic pathogens, and increased inter-individual variability, which may contribute to increasing the variability of biological actions of phenolic compounds at the skeletal muscle level. These interactions should be taken into great consideration for designing effective nutritional strategies to counteract sarcopenia.
Collapse
Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Microbiome Research Hub, University of Parma, Parco Area delle Scienze 11/1, 43124 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Antonio Nouvenne
- Microbiome Research Hub, University of Parma, Parco Area delle Scienze 11/1, 43124 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Microbiome Research Hub, University of Parma, Parco Area delle Scienze 11/1, 43124 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| |
Collapse
|
5
|
He X, Song Y, Ma L, Ainsworth BE, Liu Y, Chen N. Prevalence and Factors Influencing Sarcopenia Among Community-Dwelling Older Adults Using the Asian Working Group for Sarcopenia Definition. Clin Interv Aging 2022; 17:1707-1727. [PMID: 36471806 PMCID: PMC9719269 DOI: 10.2147/cia.s388319] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/20/2022] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore the prevalence and impact of related factors for sarcopenia among community-dwelling older people in Chongming district, China, according to the diagnostic criteria of the Asia Working Group for Sarcopenia-2019. METHODS We conducted a cross-sectional study from April 2021 to December 2021. Diagnosis of sarcopenia (non-sarcopenia, possible sarcopenia, sarcopenia, and severe sarcopenia) was based on appendicular skeletal muscle mass index, handgrip strength, gait speed, and the 5-time chair stand test. Staff collected all subjects' clinical and sociodemographic characteristics, cardiovascular disease (CVD) risk factors, inflammatory markers, physical activity (PA), and daily lifestyle activities to identify sarcopenia-related factors. RESULTS A total of 1407 older people aged ≥ 65 years were enrolled into the study (58.7% female). The prevalence of confirmed sarcopenia was 19.6% (17.1% in females and 23.1% in males). The prevalence of possible sarcopenia, sarcopenia, and severe sarcopenia were 19.7% (22.2% in females, 16.2% in males), 11.9% (10.1% in females, 14.5% in males), and 7.7% (7% in females, 8.6% in males), respectively. Increasing age, gender, depression status, and high-fat mass were associated with an increased likelihood of sarcopenia in all subjects. In females, living alone, high-fat mass, lower body mass index (BMI), lower body weight, and have no time spent doing housework increased the likelihood of sarcopenia. In males, depression status, high-fat mass, higher neutrophils-to-lymphocytes ratio (NLR), lower BMI, lower body weight increased the likelihood of sarcopenia. CONCLUSION Our study showed a high prevalence of sarcopenia among community-dwelling older people in the Chongming district. Detection, prevention, and treatment efforts are needed to reduce the impact of sarcopenia in older, rural communities in China.
Collapse
Affiliation(s)
- Xiangfeng He
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
| | - Yanping Song
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
| | - Lin Ma
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
| | | | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
- School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of China
| |
Collapse
|
6
|
Sarkopenie – Ein geriatrisches Syndrom mit hoher Relevanz für die Gefäßchirurgie. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00938-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
7
|
Dietary patterns and sarcopenia in elderly adults: the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) study. Br J Nutr 2022; 128:900-908. [PMID: 34565491 DOI: 10.1017/s0007114521003871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sarcopenia is a core contributor to several health consequences, including falls, fractures, physical limitations and disability. The pathophysiological processes of sarcopenia may be counteracted with the proper diet, delaying sarcopenia onset. Dietary pattern analysis is a whole diet approach used to investigate the relationship between diet and sarcopenia. Here, we aimed to investigate this relationship in an elderly Chinese population. A cross-sectional study with 2423 participants aged more than 60 years was performed. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia, composed of low muscle mass plus low grip strength and/or low gait speed. Dietary data were collected using a FFQ that included questions on 100 food items along with their specified serving sizes. Three dietary patterns were derived by factor analysis: sweet pattern, vegetable pattern and animal food pattern. The prevalence of sarcopenia was 16·1 %. The higher vegetable pattern score and animal food pattern score were related to lower prevalence of sarcopenia (Ptrend = 0·006 and < 0·001, respectively); the multivariate-adjusted OR of the prevalence of sarcopenia in the highest v. lowest quartiles were 0·54 (95 % CI 0·34, 0·86) and 0·50 (95 % CI 0·33, 0·74), separately. The sweet pattern score was not significantly related to the prevalence of sarcopenia. The present study showed that vegetable pattern and animal food pattern were related to a lower prevalence of sarcopenia in Chinese older adults. Further studies are required to clarify these findings.
Collapse
|
8
|
Wu YZ, Chan YT, Hsieh JG, Chen JC. Profiles of Physical Activity and Physical Performance in Matched Religious Vegetarian and Nonvegetarian Women: A Preliminary Observational Study in Taiwan. Nutrients 2022; 14:nu14102170. [PMID: 35631312 PMCID: PMC9147246 DOI: 10.3390/nu14102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 02/04/2023] Open
Abstract
Religious vegetarianism has become more popular with women and increases with age. However, concerns have been raised that vegetarians are less productive than nonvegetarians. Thus, we aimed to compare the characteristics of physical activity and physical performance in properly matched religious vegetarian and nonvegetarian women aged ≥ 45 years. Participants (n = 160) were recruited via convenience sampling in the community of Hualien, Taiwan, and matched by demographic and cognitive characteristics. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Physical performance was assessed with handgrip strength, five-times-sit-to-stand, gait speed, timed up-and-go, and functional reach tests (FRT). Overall, 90% of religious vegetarians practiced lacto-ovo-vegetarianism. The proportions of those with low physical activity levels and poor physical performance did not significantly differ between religious vegetarians and nonvegetarians. Additionally, there were no significant between-group differences in IPAQ-SF scores and physical performance, except for FRT performance (mean 24.5 cm vs. 19.7 cm, p < 0.001). Exhaustion after work, busyness, and a lack of interest were three main reasons for low physical activity levels, and none of these had significant between-group differences (p = 0.936). Our results show a similar profile of physical activity and physical performance in religious vegetarian and nonvegetarian women.
Collapse
Affiliation(s)
- Yu-Zu Wu
- Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-T.C.); (J.-C.C.)
- Correspondence: ; Tel.: +886-3-856-5301 (ext. 2501)
| | - Yun-Ting Chan
- Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-T.C.); (J.-C.C.)
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Jyh-Gang Hsieh
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Jia-Ching Chen
- Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-T.C.); (J.-C.C.)
| |
Collapse
|
9
|
Augenmerk auf die Ernährung im Alter. PROCARE 2022; 27:24-29. [PMID: 35669913 PMCID: PMC9145120 DOI: 10.1007/s00735-022-1552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Jenseits des 70. Lebensjahrs ist bei älteren Menschen regelhaft eine Abnahme der Muskelmasse sowie eine Zunahme der Fettmasse zu beobachten. Diese Veränderungen der Körperzusammensetzung stellen eine wesentliche Prädisposition für den im Alter drohenden Verlust an Funktionalität und Selbstständigkeit dar. In diesem Kontext kommt der richtigen Ernährung sowie insbesondere dem Vermeiden einer Mangelernährung große Relevanz zu. Da die ältere Bevölkerung hinsichtlich der Geschwindigkeit und Ausprägung der Alterungsvorgänge sowie ihrer Komorbiditäten als äußerst heterogen zu betrachten ist, müssen Ernährungsempfehlungen individualisiert erfolgen. In Hinblick auf eine potenzielle Gefährdung durch eine Sarkopenie ist selbst eine beabsichtigte Gewichtsabnahme im Alter kritisch zu sehen. Fastenepisoden sollten generell vermieden werden. Dies betrifft insbesondere eine unzureichende Kalorienzufuhr im Kontext von akuten oder chronischen Erkrankungen. Im höheren Lebensalter sollten daher regelmäßige Gewichtskontrollen erfolgen, um das Auftreten einer Mangelernährung frühzeitig zu erkennen und entsprechende Maßnahmen einleiten zu können. Zum Erhalt der Muskelmasse und -funktion sollte eine gegenüber jüngeren Menschen erhöhte Eiweißzufuhr von 1,0 g/kgKG angestrebt werden. Bei älteren Menschen mit Sarkopenie wird dieses Ziel auf 1,2 g/kg KG angehoben. Während sich im Alter restriktive Diäten als nachteilig erweisen können, scheinen gesunde Ernährungsformen wie z. B. die mediterrane Ernährung den Erhalt der muskulären und kognitiven Funktion zu fördern.
Collapse
|
10
|
Van Elswyk ME, Teo L, Lau CS, Shanahan CJ. Dietary Patterns and the Risk of Sarcopenia: A Systematic Review and Meta-Analysis. Curr Dev Nutr 2022; 6:nzac001. [PMID: 35542386 PMCID: PMC9071101 DOI: 10.1093/cdn/nzac001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/07/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this systematic review is to examine the relationship between dietary patterns and sarcopenia using a protocol developed for use by the 2020 Dietary Guidelines Advisory Committee, and to conduct a meta-analysis to summarize the evidence. Multiple electronic databases were searched for studies investigating sarcopenia risk factors or risk of sarcopenia and dietary patterns. Eligible studies were 1) peer-reviewed controlled trials or observational trials, 2) involving adult or older-adult human subjects who were healthy and/or at risk for chronic disease, 3) comparing the effect of consumption or adherence to dietary patterns (measured as an index/score, factor or cluster analysis; reduced rank regression; or a macronutrient distribution), and 4) reported on measures of skeletal muscle mass, muscle strength, muscle performance, and/or risk of sarcopenia. Thirty-eight publications met all inclusion criteria for qualitative synthesis. Thirteen observational studies met inclusion criteria for meta-analysis. Higher adherence to a healthy dietary pattern was associated with a decreased risk of gait speed reduction (OR = 0.58; 95% CI: 0.18, 0.97). The association between healthy dietary pattern adherence and other intermediate markers or risk of sarcopenia was not statistically significant. The majority of individual studies were judged as "serious" risk of bias and analysis of the collective evidence base was suggestive of publication bias. Studies suggest a significant association between healthy dietary patterns and maintenance of gait speed with age, an intermediate marker of sarcopenia risk, but the evidence base is limited by serious risk of bias, within and between studies. Further research is needed to understand the association between healthy dietary patterns and risk of sarcopenia.
Collapse
Affiliation(s)
| | - Lynn Teo
- Teo Research Consulting, Portland, ME, USA
| | - Clara S Lau
- National Cattlemen's Beef Association, a contractor to the Beef Checkoff, Washington, DC, USA
| | | |
Collapse
|
11
|
Ernährung im Alter – ein wesentlicher Schlüssel zum Erhalt der Funktionalität und Lebensqualität. SCHWEIZER GASTROENTEROLOGIE 2022. [PMCID: PMC8896067 DOI: 10.1007/s43472-022-00064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Jenseits des 70. Lebensjahrs ist bei älteren Menschen regelhaft eine Abnahme der Muskelmasse sowie eine Zunahme der Fettmasse zu beobachten. Diese Veränderungen der Körperzusammensetzung stellen eine wesentliche Prädisposition für den im Alter drohenden Verlust an Funktionalität und Selbständigkeit dar. In diesem Kontext kommt der richtigen Ernährung sowie insbesondere dem Vermeiden einer Mangelernährung große Relevanz zu. Da die ältere Bevölkerung hinsichtlich der Geschwindigkeit und Ausprägung der Alterungsvorgänge sowie ihrer Komorbiditäten als äußerst heterogen zu betrachten ist, müssen Ernährungsempfehlungen individualisiert erfolgen. Mit Hinblick auf eine potenzielle Gefährdung durch eine Sarkopenie ist selbst eine beabsichtigte Gewichtsabnahme im Alter kritisch zu sehen. Fastenepisoden sollten generell vermieden werden. Dies betrifft insbesondere eine unzureichende Kalorienzufuhr im Kontext von akuten oder chronischen Erkrankungen. Im höheren Lebensalter sollten daher regelmäßige Gewichtskontrollen erfolgen, um das Auftreten einer Mangelernährung frühzeitig zu erkennen und entsprechende Maßnahmen einleiten zu können. Zum Erhalt der Muskelmasse und -funktion sollte eine gegenüber jüngeren Menschen erhöhte Eiweißzufuhr von 1,0 g/kgKG angestrebt werden. Bei älteren Menschen mit Sarkopenie wird dieses Ziel auf 1,2 g/kgKG angehoben. Während sich im Alter restriktive Diäten als nachteilig erweisen können, scheinen gesunde Ernährungsformen wie z. B. die mediterrane Ernährung den Erhalt der muskulären und kognitiven Funktion zu fördern.
Collapse
|
12
|
Bauer JM, Grund S, Hauer K. [Sarcopenia-what should the orthopedist know?]. DER ORTHOPADE 2022; 51:116-121. [PMID: 35024888 DOI: 10.1007/s00132-021-04211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Sarcopenia - the age-associated loss of muscle function and muscle mass - is of utmost importance for older patients with degenerative and traumatic diseases of the musculoskeletal system, as it closely linked to the loss of independence and quality of life in higher age. Impairments of mobility that are highly present in this patient group accelerate the age-associated decline of muscle function and muscle mass. The diagnosis of sarcopenia relies primarily on tests of strength and function like handgrip, chair-rise test and gait speed. The measurement of muscle mass is desirable, but not mandatory. In the near future the prevention and treatment of sarcopenia has to become part of the clinical routine for older orthopedic patients. Specific modifications of physical exercise like resistance training and optimal nutrition with regard to protein intake (1.0-1.2 g/kg bodyweight per day) in combination with vitamin D supplementation are key components of sarcopenia prevention and therapy.
Collapse
Affiliation(s)
- Jürgen M Bauer
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, Agaplesion Bethanien Krankenhaus, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland. .,Netzwerk Alternsforschung, Universität Heidelberg, Heidelberg, Deutschland.
| | - Stefan Grund
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, Agaplesion Bethanien Krankenhaus, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland.,Netzwerk Alternsforschung, Universität Heidelberg, Heidelberg, Deutschland
| | - Klaus Hauer
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, Agaplesion Bethanien Krankenhaus, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland.,Netzwerk Alternsforschung, Universität Heidelberg, Heidelberg, Deutschland
| |
Collapse
|
13
|
Exercise and Nutrition Impact on Osteoporosis and Sarcopenia-The Incidence of Osteosarcopenia: A Narrative Review. Nutrients 2021; 13:nu13124499. [PMID: 34960050 PMCID: PMC8705961 DOI: 10.3390/nu13124499] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.
Collapse
|
14
|
Ryan J, McCallion P, McCarron M, Luus R, Burke EA. Overweight/obesity and chronic health conditions in older people with intellectual disability in Ireland. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:1097-1109. [PMID: 34750916 DOI: 10.1111/jir.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study examines overweight/obesity and chronic health conditions (CHCs) in older people with intellectual disability (ID). METHODS Data for this cross-sectional observational study emanated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a longitudinal study assessing the health and well-being of older Irish adults with ID aged ≥40 years across all levels of ID. Participation involves an interview process and collation of objective health measures. In this study, body mass index (BMI) (n = 572), used as a measure of weight status, was examined with clustered doctor's diagnosed CHCs. Descriptive analysis was conducted where counts (n) and proportions (%) were used to summarise the variables univariately, while cross-tabulations were used for bivariate summary into counts and proportions. With overweight/obesity prevalence established and patterns described using logistical regression, Pearson's chi-squared test was used to test for significant associations. RESULTS Overweight/obesity identified in 69% of participants occurred with greater frequency in women (72%). A higher percentage of participants aged <50 years (72.5%) were overweight/obese than those aged 50-64 (70%) and 65+ (61.4%). Level of ID and residence type were significantly associated with weight status (P < 0.001), with overweight/obesity more prevalent in mild (85.7%) than moderate (72%) or severe/profound ID (51.4%). Of those who lived independently/with family, 78.4% were overweight/obese, as were 74% living in a community group home (P < 0.001). Almost all overweight/obese participants' waist measurements were in the substantially increased risk of metabolic disease waist measurement category (92%, P < 0.001). Logistical regression used to model CHCs on BMI showed significant association between BMI and gastrointestinal tract [odds ratio (OR) = 0.57, P < 0.008, 95% confidence interval (CI) = (0.37; 0.86)], respiratory condition [OR = 8.95, P < 0.004, 95% CI = (2.57; 56.72)] and musculoskeletal disorders [OR = 0.40, P < 0.001, 95% CI = (0.25; 0.63)]. CONCLUSIONS The findings illustrate the strong cross-sectional association between overweight/obesity and CHCs. These findings suggest a need to prioritise weight status as a health risk to people with ID as they age.
Collapse
Affiliation(s)
- J Ryan
- Trinity Center for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - P McCallion
- Temple School of Social Work, Temple University College of Public Health, Philadelphia, PA, USA
| | - M McCarron
- Trinity Center for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - R Luus
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - E A Burke
- Trinity Center for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| |
Collapse
|
15
|
Karlsson M, Becker W, Cederholm TE, Byberg L. A posteriori dietary patterns in 71-year-old Swedish men and the prevalence of sarcopenia 16 years later. Br J Nutr 2021; 128:1-12. [PMID: 34585650 PMCID: PMC9361200 DOI: 10.1017/s0007114521003901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
The role of diet in sarcopenia is unclear, and results from studies using dietary patterns (DP) are inconsistent. We assessed how adherences to a posteriori DP are associated with the prevalence of sarcopenia and its components 16 years later. Four DP were defined in the Uppsala Longitudinal Study of Adult Men at baseline (n 1133, average age 71 years). Among 257 men with information at follow-up, 19 % (n 50) had sarcopenia according to the European Working Group on sarcopenia in Older People 2 definition. Adherence to DP2 (mainly characterised by high intake of vegetables, green salad, fruit, poultry, rice and pasta) was non-linearly associated with sarcopenia; adjusted OR and 95 % CI for medium and high v. low adherence: 0·41 (0·17, 0·98) and 0·40 (0·17, 0·94). The OR per standard deviation (sd) higher adherence to DP2 was 0·70 (0·48, 1·03). Adjusted OR (95 % CI) for 1 sd higher adherence to DP1 (mainly characterised by high consumption of milk and cereals), DP3 (mainly characterised by high consumption of bread, cheese, marmalade, jam and sugar) and DP4 (mainly characterised by high consumption of potatoes, meat and egg and low consumption of fermented milk) were 1·04 (0·74, 1·46), 1·19 (0·71, 2·00) and 1·08 (0·77, 1·53), respectively. There were no clear associations between adherence to the DP and muscle strength, muscle mass, physical performance or sarcopenia using EWGSOP1 (sarcopenia n 54). Our results indicate that diet may be a potentially modifiable risk factor for sarcopenia in old Swedish men.
Collapse
Affiliation(s)
- Mikael Karlsson
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Wulf Becker
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Tommy E. Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
16
|
Ryu H, Yang YJ, Kang E, Ahn C, Yang SJ, Oh KH. Greater adherence to the dietary approaches to stop hypertension dietary pattern is associated with preserved muscle strength in patients with autosomal dominant polycystic kidney disease: a single-center cross-sectional study. Nutr Res 2021; 93:99-110. [PMID: 34461351 DOI: 10.1016/j.nutres.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
The present study aimed to determine whether certain diets lower the risk of low muscle strength in patients with autosomal dominant polycystic kidney disease (ADPKD). In this cross-sectional study, outpatient ADPKD patients were enrolled from a tertiary care hospital. Muscle strength was assessed on the basis of handgrip strength (HGS), and dietary pattern indices were calculated using dietary intake data. Among the 68 participants included in this study, 19 (27.9%) had low HGS. Cystatin C concentrations were significantly higher in all participants, and in women in the low compared to the normal HGS group in the unadjusted analyses (P = 0.004). Among analyzed dietary pattern indices, the Dietary Approaches to Stop Hypertension (DASH) score was lower, for all participants and men, in the low compared to the normal HGS group (P < 0.05). Especially, the component score for whole grains of the DASH score was significantly lower in men in the low compared to the normal HGS group in unadjusted analyses. The DASH score was positively correlated with HGS in men (r = 0.387, P = 0.046). In addition, logistic regression analysis showed that the DASH score was negatively associated with low HGS, for all participants (odds ratio = 0.851, P = 0.049) and men (odds ratio = 0.716, P = 0.043), after adjusting for age, sex, and body weight. These findings suggest that the DASH dietary pattern may promote the preservation of muscle strength in ADPKD patients. The DASH diet can be considered as a nutritional strategy to maintain muscle strength and prevent sarcopenia in ADPKD patients.
Collapse
Affiliation(s)
- Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Yun Jung Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, National Medical Center, Seoul, 04564, Republic of Korea
| | - Soo Jin Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea.
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| |
Collapse
|
17
|
Jacob L, Kostev K, Smith L, Oh H, López-Sánchez GF, Shin JI, Abduljabbar AS, Haro JM, Koyanagi A. Sarcopenia and Mild Cognitive Impairment in Older Adults from Six Low- and Middle-Income Countries. J Alzheimers Dis 2021; 82:1745-1754. [PMID: 34219725 DOI: 10.3233/jad-210321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the relationship between sarcopenia and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs). OBJECTIVE This study aimed to investigate this association among community-dwelling adults aged≥65 years from six LMICs. METHODS Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. These data were obtained in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010. Participants were considered to have sarcopenia if they had low skeletal muscle mass (i.e., lower skeletal mass index) and a weak handgrip strength. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression analysis was conducted to assess associations. RESULTS The final analytical sample consisted of 12,912 individuals aged≥65 years with preservation in functional abilities without stroke (mean [standard deviation] age 72.2 [10.8] years; 45.2% males). The overall prevalence of sarcopenia and MCI were 11.3% and 18.1%, respectively. After adjusting for potential confounders, there was a positive association between sarcopenia and MCI in all countries (i.e., odds ratio [OR] > 1) with the exception of South Africa, and the overall estimate was OR = 1.60 (95% confidence interval [CI] = 1.32-1.93) with a low level of between-country heterogeneity (I2 = 0.0%). CONCLUSION There was a positive association between sarcopenia and MCI in this sample of older adults living in LMICs. Causality should be assessed in future longitudinal research, while the utility of sarcopenia as a marker of MCI should also be investigated.
Collapse
Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Karel Kostev
- Philipps University of Marburg, Marburg, Germany
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | | | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,King Saud University, Riyadh, Saudi Arabia
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,ICREA, Barcelona, Spain
| |
Collapse
|
18
|
Ernährung im Alter – ein wesentlicher Schlüssel zum Erhalt der Funktionalität und Lebensqualität. DER GASTROENTEROLOGE 2021; 16:324-331. [PMID: 34341672 PMCID: PMC8320417 DOI: 10.1007/s11377-021-00546-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Jenseits des 70. Lebensjahrs ist bei älteren Menschen regelhaft eine Abnahme der Muskelmasse sowie eine Zunahme der Fettmasse zu beobachten. Diese Veränderungen der Körperzusammensetzung stellen eine wesentliche Prädisposition für den im Alter drohenden Verlust an Funktionalität und Selbständigkeit dar. In diesem Kontext kommt der richtigen Ernährung sowie insbesondere dem Vermeiden einer Mangelernährung große Relevanz zu. Da die ältere Bevölkerung hinsichtlich der Geschwindigkeit und Ausprägung der Alterungsvorgänge sowie ihrer Komorbiditäten als äußerst heterogen zu betrachten ist, müssen Ernährungsempfehlungen individualisiert erfolgen. Mit Hinblick auf eine potenzielle Gefährdung durch eine Sarkopenie ist selbst eine beabsichtigte Gewichtsabnahme im Alter kritisch zu sehen. Fastenepisoden sollten generell vermieden werden. Dies betrifft insbesondere eine unzureichende Kalorienzufuhr im Kontext von akuten oder chronischen Erkrankungen. Im höheren Lebensalter sollten daher regelmäßige Gewichtskontrollen erfolgen, um das Auftreten einer Mangelernährung frühzeitig zu erkennen und entsprechende Maßnahmen einleiten zu können. Zum Erhalt der Muskelmasse und -funktion sollte eine gegenüber jüngeren Menschen erhöhte Eiweißzufuhr von 1,0 g/kgKG angestrebt werden. Bei älteren Menschen mit Sarkopenie wird dieses Ziel auf 1,2 g/kgKG angehoben. Während sich im Alter restriktive Diäten als nachteilig erweisen können, scheinen gesunde Ernährungsformen wie z. B. die mediterrane Ernährung den Erhalt der muskulären und kognitiven Funktion zu fördern.
Collapse
|
19
|
Bagheri A, Hashemi R, Soltani S, Heshmat R, Dorosty Motlagh A, Larijani B, Esmaillzadeh A. The Relationship Between Food-Based Pro-inflammatory Diet and Sarcopenia: Findings From a Cross-Sectional Study in Iranian Elderly People. Front Med (Lausanne) 2021; 8:649907. [PMID: 34041251 PMCID: PMC8141626 DOI: 10.3389/fmed.2021.649907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sarcopenia has rarely been linked to Food-based Inflammatory Potential of the Diet (FIPD) in earlier studies. This study was performed to examine the association of FIPD and sarcopenia and its components. Method: In the cross-sectional research, dietary intakes of 300 randomly-selected elderly adults aged 55 years or older were collected through a validated food frequency questionnaire. We constructed FIPD score based on average consumptions of 28 food items. According to The European Working Group on Sarcopenia definition, sarcopenia and its components such as muscle strength, muscle mass, and gait speed were defined. Result: No significant difference was found between the prevalence of sarcopenia (P = 0.05), low muscle mass (P = 0.27), low handgrip strength (P = 0.72), and lower gait speed (P = 0.14) across tertiles of FIPD score. Moreover, we did not find significant differences among means of handgrip strength (P = 0.65), muscle mass (P = 0.33), and walking speed (P = 0.89) across FIPD categories. However, binary logistic regression analysis indicated a significant positive relationship between FIPD score and odds of sarcopenia; such that subjects in the top vs. those in the bottom FIPD tertile had 155% greater chance of having sarcopenia (OR: 2.55; 95% CI: 1.17-5.55). After controlling for all confounding factors, this association strengthened (OR: 2.67; 95% CI: 1.18-6.01). Conclusion: We found that greater FIPD score, which means a more pro-inflammatory diet, was positively linked with sarcopenia.
Collapse
Affiliation(s)
- Amir Bagheri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvan Hashemi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Soltani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Dorosty Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
20
|
Tanaka T, Kawahara T, Aono H, Yamada S, Ishizuka S, Takahashi K, Iijima K. A comparison of sarcopenia prevalence between former Tokyo 1964 Olympic athletes and general community-dwelling older adults. J Cachexia Sarcopenia Muscle 2021; 12:339-349. [PMID: 33463012 PMCID: PMC8061394 DOI: 10.1002/jcsm.12663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aimed to determine how increased muscle mass and athletic performance in adolescence contribute to the prevention of sarcopenia in old age, accounting for the type of sport and the continuation of exercise habits. We compared the prevalence of sarcopenia, its components (low appendicular skeletal muscle mass, low muscle strength, and low physical function), and musculoskeletal pain using data from two cohorts: former athletes who competed in the 1964 Tokyo Olympics and general community-dwelling older adults living in Kashiwa City, Chiba Prefecture. METHODS We analysed the data from 101 former Olympic athletes (mean age ± SD: 75.0 ± 4.4 years; 26% female) and 1529 general community-dwelling older adults (74.1 ± 5.5 years; 49% women). We assessed sarcopenia (defined by the Asian Working Group for Sarcopenia revised in 2019) and musculoskeletal pain and considered potential confounding factors such as demographic characteristics, for example, sex and exercise habits. RESULTS The prevalence of sarcopenia was significantly lower in former Olympic athletes than general older adults (odds ratios [OR], 0.49; 95% confidence interval [CI], 0.20-0.94), especially with regard to superior appendicular skeletal muscle mass and muscle strength. This effect was more pronounced in individuals who continued their exercise and in athletes whose sporting discipline was classified as having a high exercise intensity. Conversely, low physical function (OR, 2.60; 95% CI, 1.16-6.07) and musculoskeletal pain (OR, 2.22; 95% CI, 1.24-3.97) were more prevalent in former Olympic athletes and in athletes who competed in sports with physical contact. CONCLUSIONS We observed a lower prevalence of sarcopenia and superior appendicular skeletal muscle mass and strength in the former Olympic athletes, especially among those that continued their exercise habits and those in sports with high exercise intensity. Conversely, low physical function and higher musculoskeletal pain scores were more prevalent in former Olympic athletes, especially among athletes who competed in sports with physical contact. Our results warrant further promotion of exercise in adolescence and beyond as well as providing safety education, which is required to prevent the development of sarcopenia and musculoskeletal pain in old age.
Collapse
Affiliation(s)
- Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Kyo Takahashi
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
21
|
Santiago ECS, Roriz AKC, Ramos LB, Ferreira AJF, Oliveira CC, Gomes-Neto M. Comparison of calorie and nutrient intake among elderly with and without sarcopenia: A systematic review and meta-analysis. Nutr Rev 2021; 79:1338-1352. [PMID: 33616172 DOI: 10.1093/nutrit/nuaa145] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Sarcopenia, besides having an impact on functional capacity, has been associated with increased hospitalization and mortality, and stands out as an essential cause of disability among older people. OBJECTIVE We conducted a systematic review and meta-analysis of published studies comparing the calories and nutrients ingested by elderly people with and without sarcopenia. DATA SOURCES MEDLINE/PubMed, Scopus, LILACS, Cochrane Library, and Scielo databases were searched. STUDY SELECTION Studies comparing calories and nutrient intake among elderly people diagnosed with sarcopenia and people without sarcopenia were included. DATA ANALYSIS Mean differences and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using I2 test. RESULTS A total of 23 studies fulfilled the inclusion criteria. The average number of calories and nutrients ingested were significantly lower in elderly study participants with sarcopenia compared with those without sarcopenia. The meta-analyses showed that the average number of calories ingested (n = 19 studies; mean difference, -156.7 kcal; 95%CI, -194.8 to -118.7) were significantly lower in those with sarcopenia than in elderly participants without sarcopenia. Compared to those without sarcopenia, elderly people with sarcopenia consumed lower amounts of proteins; carbohydrates; saturated fatty acids; vitamins A, B12, C, and D; and minerals such as calcium, magnesium, sodium, and selenium. CONCLUSIONS The evidence so far available suggests a difference in caloric, macronutrient (ie, proteins, carbohydrates, saturated fatty acids), and micronutrient (ie calcium, magnesium, sodium, selenium, and vitamins A, B12, C, and D) intake among the elderly with and without sarcopenia. Additional studies are needed to define the best interventions to improve the consumption of calories and nutrients by the aging population.
Collapse
Affiliation(s)
- Emanuelle C S Santiago
- E.C.S. Santiago and M. Gomes-Neto are with the Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil. E.C.S. Santiago, A.K.C. Roriz, L.B. Ramos, A.J.F. Ferreira, C.C. Oliveira, and M. Gomes-Neto are with the Aging-Related Research and Intervention Center, Federal University of Bahia, Salvador, Bahia, Brazil. A.K.C. Roriz and L.B. Ramos are with the Graduate Program in Food, Nutrition and Health, Federal University of Bahia, Salvador, Bahia, Brazil. A.J.F. Ferreira is with the Institute of Public Health, Federal University of Bahia, Salvador, Bahia, Brazil. C.C. Oliveira is with the Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil. M. Gomes-Neto is with the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Anna K C Roriz
- E.C.S. Santiago and M. Gomes-Neto are with the Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil. E.C.S. Santiago, A.K.C. Roriz, L.B. Ramos, A.J.F. Ferreira, C.C. Oliveira, and M. Gomes-Neto are with the Aging-Related Research and Intervention Center, Federal University of Bahia, Salvador, Bahia, Brazil. A.K.C. Roriz and L.B. Ramos are with the Graduate Program in Food, Nutrition and Health, Federal University of Bahia, Salvador, Bahia, Brazil. A.J.F. Ferreira is with the Institute of Public Health, Federal University of Bahia, Salvador, Bahia, Brazil. C.C. Oliveira is with the Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil. M. Gomes-Neto is with the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lílian B Ramos
- E.C.S. Santiago and M. Gomes-Neto are with the Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil. E.C.S. Santiago, A.K.C. Roriz, L.B. Ramos, A.J.F. Ferreira, C.C. Oliveira, and M. Gomes-Neto are with the Aging-Related Research and Intervention Center, Federal University of Bahia, Salvador, Bahia, Brazil. A.K.C. Roriz and L.B. Ramos are with the Graduate Program in Food, Nutrition and Health, Federal University of Bahia, Salvador, Bahia, Brazil. A.J.F. Ferreira is with the Institute of Public Health, Federal University of Bahia, Salvador, Bahia, Brazil. C.C. Oliveira is with the Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil. M. Gomes-Neto is with the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andrêa J F Ferreira
- E.C.S. Santiago and M. Gomes-Neto are with the Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil. E.C.S. Santiago, A.K.C. Roriz, L.B. Ramos, A.J.F. Ferreira, C.C. Oliveira, and M. Gomes-Neto are with the Aging-Related Research and Intervention Center, Federal University of Bahia, Salvador, Bahia, Brazil. A.K.C. Roriz and L.B. Ramos are with the Graduate Program in Food, Nutrition and Health, Federal University of Bahia, Salvador, Bahia, Brazil. A.J.F. Ferreira is with the Institute of Public Health, Federal University of Bahia, Salvador, Bahia, Brazil. C.C. Oliveira is with the Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil. M. Gomes-Neto is with the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carolina C Oliveira
- E.C.S. Santiago and M. Gomes-Neto are with the Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil. E.C.S. Santiago, A.K.C. Roriz, L.B. Ramos, A.J.F. Ferreira, C.C. Oliveira, and M. Gomes-Neto are with the Aging-Related Research and Intervention Center, Federal University of Bahia, Salvador, Bahia, Brazil. A.K.C. Roriz and L.B. Ramos are with the Graduate Program in Food, Nutrition and Health, Federal University of Bahia, Salvador, Bahia, Brazil. A.J.F. Ferreira is with the Institute of Public Health, Federal University of Bahia, Salvador, Bahia, Brazil. C.C. Oliveira is with the Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil. M. Gomes-Neto is with the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mansueto Gomes-Neto
- E.C.S. Santiago and M. Gomes-Neto are with the Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil. E.C.S. Santiago, A.K.C. Roriz, L.B. Ramos, A.J.F. Ferreira, C.C. Oliveira, and M. Gomes-Neto are with the Aging-Related Research and Intervention Center, Federal University of Bahia, Salvador, Bahia, Brazil. A.K.C. Roriz and L.B. Ramos are with the Graduate Program in Food, Nutrition and Health, Federal University of Bahia, Salvador, Bahia, Brazil. A.J.F. Ferreira is with the Institute of Public Health, Federal University of Bahia, Salvador, Bahia, Brazil. C.C. Oliveira is with the Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil. M. Gomes-Neto is with the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
22
|
Abstract
OBJECTIVE To explore the relationship between dietary patterns and physical fitness among older Chinese (≥60 years) individuals. DESIGN Cross-sectional survey. Dietary data were collected by a simplified semi-quantitative FFQ. The 30-s Chair Stand test (30sCST), 30-s Arm Curl test (30sACT), 8-foot Time Up-and-Go test (8fTUAGT) and 6-min Walking test (6mWT) were used to assess physical fitness. Dietary patterns were obtained by factor analysis. The association between dietary patterns and physical fitness was explored by multiple logistic regression. SETTING Six communities (villages) of three districts in Liaocheng City (Shandong Province, China). PARTICIPANTS A total of 596 residents were recruited from April to May 2017. RESULTS Among 556 residents who were finally enrolled, 196 were men (35 %) and 360 were women (65 %). Three dietary patterns were identified: 'Western', 'Vegetarian' and 'Modern'. The 30sACT revealed that men in the fourth quartile of the Western pattern were less likely to be classified in the 'high-level' group, but men in the fourth quartile of the Vegetarian pattern were classified in the high-level group. The 6mWT revealed that men in the fourth quartile of the Modern pattern were classified in the high-level group. These associations were independent of confounding factors. CONCLUSIONS Adherence to the Vegetarian pattern and Modern pattern may be protective factors for maintaining good physical fitness in older Chinese individuals. The Western pattern may lead to poor physical fitness in this population.
Collapse
|
23
|
Muscle Wasting and Sarcopenia in Heart Failure-The Current State of Science. Int J Mol Sci 2020; 21:ijms21186549. [PMID: 32911600 PMCID: PMC7555939 DOI: 10.3390/ijms21186549] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia is primarily characterized by skeletal muscle disturbances such as loss of muscle mass, quality, strength, and physical performance. It is commonly seen in elderly patients with chronic diseases. The prevalence of sarcopenia in chronic heart failure (HF) patients amounts to up to 20% and may progress into cardiac cachexia. Muscle wasting is a strong predictor of frailty and reduced survival in HF patients. Despite many different techniques and clinical tests, there is still no broadly available gold standard for the diagnosis of sarcopenia. Resistance exercise and nutritional supplementation represent the currently most used strategies against wasting disorders. Ongoing research is investigating skeletal muscle mitochondrial dysfunction as a new possible target for pharmacological compounds. Novel agents such as synthetic ghrelin and selective androgen receptor modulators (SARMs) seem promising in counteracting muscle abnormalities but their effectiveness in HF patients has not been assessed yet. In the last decades, many advances have been accomplished but sarcopenia remains an underdiagnosed pathology and more efforts are needed to find an efficacious therapeutic plan. The purpose of this review is to illustrate the current knowledge in terms of pathogenesis, diagnosis, and treatment of sarcopenia in order to provide a better understanding of wasting disorders occurring in chronic heart failure.
Collapse
|
24
|
Michaëlsson K, Baron JA, Byberg L, Höijer J, Larsson SC, Svennblad B, Melhus H, Wolk A, Warensjö Lemming E. Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study. PLoS Med 2020; 17:e1003331. [PMID: 32941436 PMCID: PMC7497998 DOI: 10.1371/journal.pmed.1003331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is unclear whether the effect on mortality of a higher body mass index (BMI) can be compensated for by adherence to a healthy diet and whether the effect on mortality by a low adherence to a healthy diet can be compensated for by a normal weight. We aimed to evaluate the associations of BMI combined with adherence to a Mediterranean-like diet on all-cause and cardiovascular disease (CVD) mortality. METHODS AND FINDINGS Our longitudinal cohort design included the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM) (1997-2017), with a total of 79,003 women (44%) and men (56%) and a mean baseline age of 61 years. BMI was categorized into normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (30+ kg/m2). Adherence to a Mediterranean-like diet was assessed by means of the modified Mediterranean-like diet (mMED) score, ranging from 0 to 8; mMED was classified into 3 categories (0 to <4, 4 to <6, and 6-8 score points), forming a total of 9 BMI × mMED combinations. We identified mortality by use of national Swedish registers. Cox proportional hazard models with time-updated information on exposure and covariates were used to calculate the adjusted hazard ratios (HRs) of mortality with their 95% confidence intervals (CIs). Our HRs were adjusted for age, baseline educational level, marital status, leisure time physical exercise, walking/cycling, height, energy intake, smoking habits, baseline Charlson's weighted comorbidity index, and baseline diabetes mellitus. During up to 21 years of follow-up, 30,389 (38%) participants died, corresponding to 22 deaths per 1,000 person-years. We found the lowest HR of all-cause mortality among overweight individuals with high mMED (HR 0.94; 95% CI 0.90, 0.98) compared with those with normal weight and high mMED. Using the same reference, obese individuals with high mMED did not experience significantly higher all-cause mortality (HR 1.03; 95% CI 0.96-1.11). In contrast, compared with those with normal weight and high mMED, individuals with a low mMED had a high mortality despite a normal BMI (HR 1.60; 95% CI 1.48-1.74). We found similar estimates among women and men. For CVD mortality (12,064 deaths) the findings were broadly similar, though obese individuals with high mMED retained a modestly increased risk of CVD death (HR 1.29; 95% CI 1.16-1.44) compared with those with normal weight and high mMED. A main limitation of the present study is the observational design with self-reported lifestyle information with risk of residual or unmeasured confounding (e.g., genetic liability), and no causal inferences can be made based on this study alone. CONCLUSIONS These findings suggest that diet quality modifies the association between BMI and all-cause mortality in women and men. A healthy diet may, however, not completely counter higher CVD mortality related to obesity.
Collapse
Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - John A. Baron
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Höijer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Susanna C. Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Svennblad
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|