Nutrients with anabolic/anticatabolic, antioxidant, and anti-inflammatory properties: Targeting the biological mechanisms of aging to support musculoskeletal health

Exploring In Vivo Models of Musculoskeletal Frailty: A Comprehensive Systematic Review

Musculoskeletal frailty-a common and debilitating condition linked to aging and chronic diseases-presents a major public health issue. In vivo models have become a key tool for researchers as they investigate the condition's underlying mechanisms and develop effective interventions. This systematic review examines the current body of research on in vivo models of musculoskeletal frailty, without any time constraints. To achieve this aim, we utilized three electronic databases and incorporated a total of 11 studies. Our investigation delves into varied animal models that simulate specific features of musculoskeletal frailty, including muscle loss, bone density reduction, and functional decline. Furthermore, we examine the translational prospects of these models in augmenting our comprehension of musculoskeletal frailty and streamlining the production of groundbreaking therapeutic approaches. This review provides significant insights and guidance for healthcare researchers and practitioners who aim to combat musculoskeletal frailty, ultimately enhancing the quality of life for older adults and individuals affected by this condition.

Quantity and Variety of Fruit and Vegetable Intake with Changes in Measures of Adiposity among Community-Dwelling Chinese Older Adults

BACKGROUND

The association between fruit and vegetable intake, considering both quantity and variety, and weight change among older adults remains controversial. We aimed to investigate the association between fruit and vegetable intake, variety, and changes in adiposity measures among community-dwelling Chinese older adults.

METHODS

A total of 2944 participants aged ≥65 years from Hong Kong communities were included. Fruit and vegetable intake was estimated by a locally validated food frequency questionnaire. Adiposity measures (weight, body mass index (BMI), waist circumference, fat and lean mass) were assessed at baseline and the year four follow-up. Restricted cubic spline and logistic models were performed to estimate the associations between fruit and vegetable intake, variety, and changes in adiposity measures.

RESULTS

A nonlinear association between vegetable intake and weight change was found, following a J-shape curve. Increased vegetable intake was associated with less increases in weight, BMI, and fat mass among those below median intakes. However, these associations became insignificant at higher intakes (all P-nonlinearity < 0.05). The ORs (95% CIs) for weight gain across the quartiles of vegetable intake were as follows: 1.00 (reference), 0.81 (0.56, 1.17), 0.55 (0.36, 0.83), and 0.88 (0.58, 1.33). Similar patterns were observed in overweight and normal weight participants, but not in those with low body weight. No associations with weight change were found for fruit intake or fruit and vegetable variety.

CONCLUSIONS

Moderate vegetable intake was associated with less weight gain among community-dwelling Chinese older adults, but not in those with low body weight. No association was observed between fruit intake or variety with weight change.

Relationship Between Plasma Homocysteine and Bone Density, Lean Mass, Muscle Strength and Physical Function in 1480 Middle-Aged and Older Adults: Data from NHANES

Hyperhomocysteinemia induces oxidative stress and chronic inflammation (both of which are catabolic to bone and muscle); thus, we examined the association between homocysteine and body composition and physical function in middle-aged and older adults. Data from the National Health and Nutrition Examination Survey was used to build regression models. Plasma homocysteine (fluorescence immunoassay) was used as the exposure and bone mineral density (BMD; dual-energy X-ray absorptiometry; DXA), lean mass (DXA), knee extensor strength (isokinetic dynamometer; newtons) and gait speed (m/s) were used as outcomes. Regression models were adjusted for confounders (age, sex, race/Hispanic origin, height, fat mass %, physical activity, smoking status, alcohol intakes, cardiovascular disease, diabetes, cancer and vitamin B12). All models accounted for complex survey design by using sampling weights provided by NHANES. 1480 adults (median age: 64 years [IQR: 56, 73]; 50.3% men) were included. In multivariable models, homocysteine was inversely associated with knee extensor strength (β = 0.98, 95% CI 0.96, 0.99, p = 0.012) and gait speed (β = 0.85, 95% CI 0.78, 0.94, p = 0.003) and borderline inversely associated with femur BMD (β = 0.84, 95% CI 0.69, 1.03, p = 0.086). In the sub-group analysis of older adults (≥ 65 years), homocysteine was inversely associated with gait speed and femur BMD (p < 0.05) and the slope for knee extensor strength and whole-body BMD were in the same direction. No significant associations were observed between homocysteine and total or appendicular lean mass in the full or sub-group analysis. We found inverse associations between plasma homocysteine and muscle strength/physical function, and borderline significant inverse associations for femur BMD.

Associations between leukocyte telomere length and osteosarcopenia in 20,400 adults aged 60 years and over: Data from the UK Biobank

PURPOSE

Two mechanisms implicated in telomere shortening are oxidative stress and inflammation, both of which are linked to bone and muscle loss suggesting a pathological link between telomere attrition and osteosarcopenia. Using older adults aged 60 years and over in the UK Biobank, we examined the association between leukocyte telomere length and osteosarcopenia.

METHODS

Baseline leukocyte telomere length was measured using a multiplex qPCR technique and expressed as the amount of the telomere amplification product (T) to that of a single-copy gene (S) (T/S ratio). Osteosarcopenia data was from the first imaging visit and defined by WHO criteria (femoral neck bone density T score ≤ -1) for osteopenia/osteoporosis plus either the EWGSOP2 (low appendicular lean mass/height² and low grip strength) or SDOC (low grip strength and slow walking pace) criteria for sarcopenia. Binary or multinomial logistic regression models were used to associate telomere length and osteosarcopenia or its components, adjusting for the covariates: age, sex, race, education, Townsend deprivation index, alcohol, smoking, BMI/weight, physical activity levels.

RESULTS

Among 20,400 older adults (mean age: 67.79 ± 4.9 years, 53% men), the prevalence of osteosarcopenia by EWGSOP2 (n = 96, 0.47%) or SDOC (n = 205, 1%) criteria was low at the first imaging visit (mean 8.82 years after baseline). Baseline telomere length was not associated with osteosarcopenia by EWGSOP2 (Relative Risk (RR): 1.00, 95% CI: 0.82-1.23 comparing osteosarcopenia to normal (non-osteopenic, non-osteoporotic, and non-sarcopenic) per Standard Deviation (SD) increase in telomere length) or SDOC (RR: 0.95, 95% CI: 0.83-1.09) criteria. Longer telomere length was associated with a lower risk of slow walking pace (Odds Ratio: 0.92, 95% CI: 0.87-0.99 per SD increase in telomere length, p = 0.021). Telomere length, however, was not associated with low grip strength, low bone density or low appendicular lean mass/height² (p > 0.05).

CONCLUSIONS

In this population-based study, telomere length was not associated with osteosarcopenia; however, slow walking pace was. Further studies are needed to reexamine this relationship, including a greater number of the oldest-old (≥75 years) where osteosarcopenia is more prevalent.

Effects of 3 months of multi-nutrient supplementation on the immune system and muscle and respiratory function of older adults in aged care (The Pomerium Study): protocol for a randomised controlled trial

INTRODUCTION

Immunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19), which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intakes associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the impact of inadequate nutrition can be reversed using multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections and improving respiratory and muscle function.

METHODS AND ANALYSIS

The Pomerium Study is a 3-month, single-blind, randomised, controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20 g protein, 1.5 g calcium 3-hydroxy-3-methylbutyrate monohydrate (CaHMB), 449 mg calcium, 500 IU vitamin D₃ and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). The primary outcome is a change in T-cell subsets CD8 + and CD28null counts at months 1 and 3. Secondary outcomes measured at baseline and month 3 are multiple markers of immunosenescence (also at 1 month), body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry) and quality of life (EQ-5D-5L). Incidence and complications of COVID-19 and/or viral infections (ie, hospitalisation, complications or death) will be recorded throughout the trial, including 3 months after supplementation is ceased.

ETHICS AND DISSEMINATION

This study was approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115). Written informed consent will be obtained from participants. Results will be published in peer-reviewed journals and made available to key aged care stakeholders, including providers, residents, and government bodies.

TRIAL REGISTRATION NUMBER

ACTRN12621000420842.

Risk Factors of Frailty in Patients with Distal Radius Fractures

Aim

The aim of this study was to determine risk factors for the incidence of frailty in patients with distal radius fractures (DRFs).

Methods

In total, 116 patients (mean age, 66.3 ± 7.7 years) with DRFs were recruited. The participants were categorized into two groups, “frail” and “non-frail,” according to the presence or absence of frailty, respectively. The areal bone mineral densities (aBMDs) of the total hip, femoral neck, and lumbar spine were measured using dual-energy x-ray absorptiometry. The participants’ levels of resilience, depression, anxiety, nutritional intake, oral health-related quality of life, and social support were evaluated by self-reported questionnaires. The participants’ grip strength, gait speed, number of teeth present in their oral cavities, circumference of their upper arms and calves, and serum levels of vitamin D were also assessed.

Results

The participants in the “frail” group seemed to have lower aBMDs and muscle function and mass than those in the “non-frail” group. There were significant differences in grip strength, calf circumference, gait speed, and aBMD of the total hip, femoral neck, and lumbar spine between the groups. There were also significant differences in the levels of resilience and depression between the groups. A multivariate logistic regression analyses demonstrated that levels of sarcopenia, malnutritional status, and aBMDs of the total hip and femoral neck had significant relationships with the development of frailty in patients with DRFs.

Conclusions

An interdisciplinary approach involving the management of osteoporosis, sarcopenia, oral health, social relationships, and psychological support would be required for the proper management of DRF patients in preventing frailty.