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Loda I, D’Angelo E, Marzetti E, Kerminen H. Prevention, Assessment, and Management of Malnutrition in Older Adults with Early Stages of Cognitive Disorders. Nutrients 2024; 16:1566. [PMID: 38892503 PMCID: PMC11173938 DOI: 10.3390/nu16111566] [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: 04/29/2024] [Revised: 05/11/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Malnutrition is common in older adults, and its risk is greater in those living with dementia. Relative to cognitively healthy peers, the prevalence of malnutrition is also increased in individuals with early stages of cognitive disorders owing to pathophysiological, cognitive, and psychosocial changes related to cognitive impairment. Malnutrition is associated with adverse health outcomes, including faster cognitive and functional decline. Here, we provide an overview of the prevention, assessment, and management of malnutrition in older adults, with a special focus on the aspects that are important to consider in individuals with early stages of cognitive disorders. Strategies to prevent malnutrition include systematic screening for malnourishment using validated tools to detect those at risk. If the screening reveals an increased risk of malnutrition, a detailed assessment including the individual's nutritional, medical, and functional status as well as dietary intake should be performed. The management of malnutrition in the early stages of cognitive disorders should be based on the findings of a comprehensive assessment and be personalized according to the individual's specific characteristics. In the article, we also provide an overview of the evidence on vitamin supplements and specific dietary patterns to prevent cognitive decline or attenuate its progression.
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Affiliation(s)
- Irene Loda
- Scuola di Specialità in Geriatria, Università degli Studi di Brescia, Viale Europa 11, 25123 Brescia, Italy;
| | - Emanuela D’Angelo
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
| | - Hanna Kerminen
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
- Faculty of Medicine and Health Technology, The Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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Sánchez-Sánchez JL, Guyonnet S, Lucas A, Parini A, Rolland Y, de Souto Barreto P. Plasma Inflammatory Biomarkers and Anorexia of Ageing among Community-Dwelling Older Adults: An Exploratory Analysis of the MAPT Study. J Nutr Health Aging 2023; 27:1127-1131. [PMID: 37997735 DOI: 10.1007/s12603-023-2024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
Anorexia of aging and biological aging might share physiological underpinnings. The aim of this secondary analysis was to investigate the associations between circulating inflammation-related markers and anorexia of aging in community-dwelling older adults. C-reactive protein (CRP), tumor necrosis factor receptor-1 (TNFR-1), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and growth/differentiation factor-15 (GDF-15) were measured in plasma. Anorexia of aging was defined by the response "severe/moderate decrease in food intake" to the first item of the Mini-Nutritional Assessment. We included 463 subjects (median age=74y, IQR=71-78; 63.1% women). 33 subjects (7.1%) presented with anorexia at baseline, whereas 25 out of 363 (6.9%) developed it along 1-year follow-up. We found that TNFR1 (OR=1.74, 95%CI=1.27-2.39) and GDF-15 (OR=1.38, 95%CI=1.01-1.89) were associated with a significant increase in the odds of presenting with anorexia of aging cross-sectionally. No further significant associations were found. Biological aging mechanisms might be involved in the pathogenesis of anorexia of aging.
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Affiliation(s)
- J L Sánchez-Sánchez
- Juan Luis Sánchez-Sánchez, CHU Toulouse Gérontopôle: Centre Hospitalier Universitaire de Toulouse Gerontopole, France,
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Picca A, Calvani R, Coelho-Júnior HJ, Landi F, Marzetti E. Anorexia of Aging: Metabolic Changes and Biomarker Discovery. Clin Interv Aging 2022; 17:1761-1767. [PMID: 36483084 PMCID: PMC9726216 DOI: 10.2147/cia.s325008] [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: 08/23/2022] [Accepted: 11/24/2022] [Indexed: 08/04/2023] Open
Abstract
The age-associated decrease in appetite and food intake is referred to as "anorexia of aging". Older adults with anorexia show changes in the quantity/quality of energy supplied to the organism which eventually may cause a mismatch between ingested calories and physiological energy demands. Therefore, a state of malnutrition and impaired metabolism may ensue which renders older people more vulnerable to stressors and more prone to incur negative health outcomes. These latter cover a wide range of conditions including sarcopenia, low engagement in physical activity, and more severe consequences such as disability, loss of independence, hospitalization, nursing home placement, and mortality. Malnutrition has been recognized by the European Society of Clinical Nutrition (ESPEN) among the chief risk factors for the development of frailty. Frailty refers to a state of increased vulnerability to stressors stemming from reduced physiologic reserve, and according to ESPEN, is also nutrition-based. Alike frailty, anorexia is highly prevalent among older adults, and its multifactorial nature includes metabolic changes that develop in older age and possibly underly the condition. Circulating factors, including hormones (eg, cholecystokinin, ghrelin, leptin, and inflammatory and microbial mediators of gut dysbiosis), have been proposed as biomarkers for this condition to support early identification and develop personalized nutritional interventions. Additional studies are needed to untangle the interrelationship between gut microbiota and appetite regulation in older adults operating through brain-gut crosstalk. Furthermore, the contribution of the genetic background to appetite regulation and specific nutritional needs warrants investigation. Here, we provide an overview on anorexia of aging in the context of age-related metabolic changes. A special focus is placed on candidate biomarkers that may be used to assist in the early identification of anorexia of aging and in the development of personalized nutritional counseling.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | | | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
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Αntoniadou M, Varzakas T. Breaking the vicious circle of diet, malnutrition and oral health for the independent elderly. Crit Rev Food Sci Nutr 2020; 61:3233-3255. [PMID: 32686465 DOI: 10.1080/10408398.2020.1793729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aging impairs senses, mastication, oral status and function, causing nutritional needs and diet insufficiencies. The present needs of independent older adults suggest that health research and oral health care should shift from reductionist disease management to integral and personal treatment plans, including lifestyle, psychological, nutritional and oral health coaching approaches. Dentists and other medical professionals that work in the field of gerodontology should be educated on the macro and micronutrient needs of the elderly and incorporate certain nutritional plans early in the life of their patients with their approval and cooperation, in order to postpone tooth loss and masticatory impairment. Old recipes such as the Mediterranean diet should be kept as a base for all the elderly and be enriched in a customized interpersonal way from the dentist as well as the medical professional according to the specific needs of one's oral and general health status. In this nonsystematic review paper, the basic aspects of the vicious cycle of nutrition and oral health status are discussed and suggestions of major nutrients' influence and needs for independent elders are reported. Based on the scientific data collected, suggestions are made for the food industry for better quality and dosage of foods for this category of individuals. Such strategies can be a whole new area of interest for the food industry in order to obtain better quality of food packaging for the independent OA with accepted texture, odor, colors, macronutrients and micronutrients' consistency and in specific portions.
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Affiliation(s)
- Maria Αntoniadou
- Dental School, National and Kapodistrian University of Athens, Greece
| | - Theodoros Varzakas
- Dept. Food Science and Technology, University of the Peloponnese, Kalamata, Greece
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Abstract
Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults.
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Affiliation(s)
- Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy.
| | - Anna Picca
- Department of Geriatrics, Neurosciences and Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Neurosciences and Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy
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Grzelkowska-Kowalczyk K, Tokarska J, Grabiec K, Gajewska M, Milewska M, Błaszczyk M. Tumor necrosis factor-α alters integrins and metalloprotease ADAM12 levels and signaling in differentiating myoblasts. Pol J Vet Sci 2016; 19:253-9. [PMID: 27487498 DOI: 10.1515/pjvs-2016-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The extracellular matrix (ECM) is important in the regulation of myogenesis. We hypothesized that tumor necrosis factor-α (TNF-α) modifies ECM during differentiation of mouse C2C12 myoblasts. Exogenous TNF-α (1 ng/ml) stimulated myoblast fusion on the 3rd day (by 160% vs control) but not on the 5th day of myogenesis. The level of integrin α5 was significantly augmented by TNF-α during 5 day-differentiation; however, integrin β1 was higher than control only on the 3rd day of cytokine treatment. Both the abundance of integrin α5 bound to actin and the level of integrin β1 complexed with integrin α5 increased in the presence of TNF-α, especially on the 3rd day of differentiation. Similarly, the stimulatory effects of TNF-α on integrin α3, metalloprotease ADAM12 and kinases related to integrins, FAK and ILK, were limited to the 3rd day of differentiation. We concluded that TNF-α-induced changes in ECM components in differentiating myogenic cells, i.e. i) increased expression of integrin α5, β1, α3, and metalloprotease ADAM12, ii) enhanced formation of α5β1 integrin receptors and interaction of integrin α5-cytoskeleton, and iii) increased expression of kinases associated with integrin signaling, FAK and ILK, were temporarily associated with the onset of myocyte fusion.
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Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients 2016; 8:69. [PMID: 26828516 PMCID: PMC4772033 DOI: 10.3390/nu8020069] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/20/2016] [Indexed: 11/21/2022] Open
Abstract
Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an “ageist” approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons.
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Morley JE. Psychoimmunology and Aging: A Tribute to George Freeman Solomon. J Am Med Dir Assoc 2015; 16:901-4. [PMID: 26432626 DOI: 10.1016/j.jamda.2015.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO.
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Nonsteroidal anti-inflammatory drug (NSAID) use and sarcopenia in older people: results from the ilSIRENTE study. J Am Med Dir Assoc 2013; 14:626.e9-13. [PMID: 23747142 DOI: 10.1016/j.jamda.2013.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently, a great deal of attention has been paid to the role of inflammatory processes in the pathophysiology of sarcopenia. The aim of the present study was to examine the relationship between NSAID use and sarcopenia in a large sample of community-dwelling elderly people aged 80 years or older. METHODS Data are from the baseline evaluation of 354 individuals enrolled in the ilSIRENTE Study. Following the recommendations of the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia was established on the basis of low muscle mass plus either low muscle strength or low physical performance. The relationship between NSAID use and sarcopenia was estimated by deriving odds ratios (ORs) from multiple logistic regression models considering sarcopenia as the dependent variable. RESULTS Nearly 12% (n = 44) of the study sample used NSAIDs. Using the EWGSOP-suggested algorithm, 103 individuals (29.1%) with sarcopenia were identified. Ninety-nine (31.9%) participants were affected by sarcopenia among non-NSAID users compared with 4 participants (9.1%) among NSAID users (P < .001). Compared with all nonusers, NSAID users had a nearly 80% lower risk of being affected by sarcopenia (OR 0.21, 95% CI 0.07-0.61). After adjusting for potential confounders, NSAID users had a lower risk of sarcopenia compared with nonusers (OR 0.26, 95% CI: 0.08-0.81). CONCLUSIONS The results are consistent with the hypothesis that long-term NSAID use might have a protective effect against the loss of muscle mass and function. Interventions able to reduce inflammation-related adverse outcomes at muscle level may be warranted.
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Anorexia of Aging: Can We Decrease Protein Energy Undernutrition in the Nursing Home? J Am Med Dir Assoc 2013; 14:77-9. [DOI: 10.1016/j.jamda.2012.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 11/19/2012] [Indexed: 12/29/2022]
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Morley JE. Do Frail Older Persons Need More Protein? J Am Med Dir Assoc 2012; 13:667-8. [DOI: 10.1016/j.jamda.2012.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 12/27/2022]
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High Technology Coming to a Nursing Home Near You. J Am Med Dir Assoc 2012; 13:409-12. [DOI: 10.1016/j.jamda.2012.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 12/22/2022]
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LeGrand EK, Alcock J. Turning up the heat: immune brinksmanship in the acute-phase response. QUARTERLY REVIEW OF BIOLOGY 2012; 87:3-18. [PMID: 22518930 DOI: 10.1086/663946] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The acutephase response (APR) is a systemic response to severe trauma, infection, and cancer, although many of the numerous cytokine-mediated components of the APR are incompletely understood. Some of these components, such as fever, reduced availability of iron and zinc, and nutritional restriction due to anorexia, appear to be stressors capable of causing harm to both the pathogen and the host. We review how the host benefits from differences in susceptibility to stress between pathogens and the host. Pathogens, infected host cells, and neoplastic cells are generally more stressed or vulnerable to additional stress than the host because: (a) targeted local inflammation works in synergy with APR stressors; (b) proliferation/growth increases vulnerability to stress; (c) altered pathogen physiology results in pathogen stress or vulnerability; and (d) protective heat shock responses are partially abrogated in pathogens since their responses are utilized by the host to enhance immune responses. Therefore, the host utilizes a coordinated system of endogenous stressors to provide additional levels of defense against pathogens. This model of immune brinksmanship can explain the evolutionary basis for the mutually stressful components of the APR.
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Affiliation(s)
- Edmund Kenwood LeGrand
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee Knoxville, Tennessee 37996, USA.
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Radigan KA, Urich D, Misharin AV, Chiarella SE, Soberanes S, Gonzalez A, Perlman H, Wunderink RG, Budinger GRS, Mutlu GM. The effect of rosuvastatin in a murine model of influenza A infection. PLoS One 2012; 7:e35788. [PMID: 22536437 PMCID: PMC3335012 DOI: 10.1371/journal.pone.0035788] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 03/22/2012] [Indexed: 02/03/2023] Open
Abstract
RATIONALE HMG-CoA reductase inhibitors such as rosuvastatin may have immunomodulatory and anti-inflammatory effects that may reduce the severity of influenza A infection. We hypothesized that rosuvastatin would decrease viral replication, attenuate lung injury, and improve mortality following influenza A infection in mice. METHODS C57Bl/6 mice were treated daily with rosuvastatin (10 mg/kg/day) supplemented in chow (or control chow) beginning three days prior to infection with either A//Udorn/72 [H3N2] or A/WSN/33 [H1N1] influenza A virus (1×10(5) pfu/mouse). Plaque assays were used to examine the effect of rosuvastatin on viral replication in vitro and in the lungs of infected mice. We measured cell count with differential, protein and cytokines in the bronchoalveolar lavage (BAL) fluid, histologic evidence of lung injury, and wet-to-dry ratio on Day 1, 2, 4, and 6. We also recorded daily weights and mortality. RESULTS The administration of rosuvastatin had no effect on viral clearance of influenza A after infection. Weight loss, lung inflammation and lung injury severity were similar in the rosuvastatin and control treated mice. In the mice infected with influenza A (A/WSN/33), mortality was unaffected by treatment with rosuvastatin. CONCLUSIONS Statins did not alter the replication of influenza A in vitro or enhance its clearance from the lung in vivo. Statins neither attenuated the severity of influenza A-induced lung injury nor had an effect on influenza A-related mortality. Our data suggest that the association between HMG CoA reductase inhibitors and improved outcomes in patients with sepsis and pneumonia are not attributable to their effects on influenza A infection.
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Affiliation(s)
- Kathryn A Radigan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
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Abstract
Undernutrition in older persons usually presents as weight loss and is predominantly due to protein energy wasting. The presentation of undernutrition is often subtle in older persons and there is a need to utilize screening tools and increasing physician awareness. There are multiple treatable causes of undernutrition in older persons. The major causes are anorexia, cachexia, sarcopenia, dehydration, malabsorption and hypermetabolism. This article also provides an overview of the use of nutritional supplements and an approach to managing protein energy wasting.
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Affiliation(s)
- John E Morley
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, St Louis, MO 63104, USA.
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Increasing Awareness of the Factors Producing Falls: The Mini Falls Assessment. J Am Med Dir Assoc 2012; 13:87-90. [DOI: 10.1016/j.jamda.2011.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 11/21/2022]
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Growth factor and cytokine interactions in myogenesis. Part I. The effect of TNF-alpha and IFN-gamma on IGF-I-dependent differentiation in mouse C2C12 myogenic cells. Pol J Vet Sci 2011; 14:417-24. [PMID: 21957736 DOI: 10.2478/v10181-011-0062-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim of this study was to examine the potential interactions of IGF-I with TNF-alpha and IFN-gamma with regard to regulation of the myogenesis and proliferative potential of mouse C2C12 myoblasts. The stimulation of myogenesis by IGF-I (30 nmol/l) was manifested by an enhanced myoblast fusion and expression of myosin heavy chain (MHC) during the first 3 days of differentiation. IGF-I-dependent fusion and MHC expression was reduced by TNF-alpha and IFN-gamma. Both cytokines prevented the stimulatory effect of IGF-I on MyoD expression with minor modification of the myogenin level. Both TNF-alpha and IFN-gamma activated the expression of cyclin A in myoblasts restimulated to proliferation; however, when used in combination with IGF-I these cytokines prevented the rise in cyclin A induced by growth factor. IN CONCLUSION i) TNF-alpha and IFN-gamma reduce IGF-I-dependent myogenesis which was manifested by the reduction of myoblast fusion and MHC cellular levels, ii) Molecular mechanisms of inhibitory action of TNF-alpha and IFN-gamma on IGF-I-mediated differentiation involve a decrease in MyoD whereas myogenin level plays a minor role, iii) TNF-alpha and IFN-gamma increase the proliferative potential of myoblasts; however, they reduced the mitogenic effect of IGF-I, manifested by a decrease of IGF-I-stimulated cyclin A expression in myoblasts reinduced to proliferation. Interactions among IGF-I and proinflammatory cytokines are therefore important to establish a number of myoblasts and the onset of myogenesis during muscle regeneration.
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Morley JE, Abbatecola AM, Argiles JM, Baracos V, Bauer J, Bhasin S, Cederholm T, Coats AJS, Cummings SR, Evans WJ, Fearon K, Ferrucci L, Fielding RA, Guralnik JM, Harris TB, Inui A, Kalantar-Zadeh K, Kirwan BA, Mantovani G, Muscaritoli M, Newman AB, Rossi-Fanelli F, Rosano GMC, Roubenoff R, Schambelan M, Sokol GH, Storer TW, Vellas B, von Haehling S, Yeh SS, Anker SD. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12:403-9. [PMID: 21640657 DOI: 10.1016/j.jamda.2011.04.014] [Citation(s) in RCA: 731] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 04/14/2011] [Indexed: 12/13/2022]
Abstract
A consensus conference convened by the Society of Sarcopenia, Cachexia and Wasting Disorders has concluded that "Sarcopenia, ie, reduced muscle mass, with limited mobility" should be considered an important clinical entity and that most older persons should be screened for this condition. "Sarcopenia with limited mobility" is defined as a person with muscle loss whose walking speed is equal to or less than 1 m/s or who walks less than 400 m during a 6-minute walk, and who has a lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean of healthy persons between 20 and 30 years of age of the same ethnic group. The limitation in mobility should not clearly be a result of otherwise defined specific diseases of muscle, peripheral vascular disease with intermittent claudication, central and peripheral nervous system disorders, or cachexia. Clinically significant interventions are defined as an increase in the 6-minute walk of at least 50 meters or an increase of walking speed of at least 0.1 m/s.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine and GRECC, VA Medical Center, St. Louis, MO 63104, USA.
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical Update on Nursing Home Medicine: 2011. J Am Med Dir Assoc 2011; 12:615-626.e6. [DOI: 10.1016/j.jamda.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022]
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Fudim M, Wagman G, Altschul R, Yucel E, Bloom M, Vittorio TJ. Pathophysiology and treatment options for cardiac anorexia. Curr Heart Fail Rep 2011; 8:147-53. [PMID: 21327573 DOI: 10.1007/s11897-011-0049-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The anorexia-cachexia syndrome (ACS) occurs in many chronic illnesses, such as cancer, AIDS, and chronic obstructive pulmonary disease in addition to chronic congestive heart failure (CHF). Comparable to other chronic states, the ACS complicates CHF and impacts its prognosis; however, the available treatment options for this syndrome remain unsatisfactory. This review article focuses on the complex pathophysiology of cardiac anorexia. We focus on the recent data demonstrating the relationships between central appetite-regulating structures, inflammatory processes, and neurohormonal activation, and their respective roles in the development of anorexia. We then describe the different treatment options and discuss some future prospects for the management for cardiac anorexia.
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Affiliation(s)
- Marat Fudim
- Heinrich-Heine-Universität, Düsseldorf, Germany
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Morley JE. Undernutrition: a major problem in nursing homes. J Am Med Dir Assoc 2011; 12:243-6. [PMID: 21527163 DOI: 10.1016/j.jamda.2011.02.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 11/16/2022]
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Regunath H, Shivakumar BM, Kurien A, Satyamoorthy K, Pai CG. Anthropometric measurements of nutritional status in chronic pancreatitis in India: comparison of tropical and alcoholic pancreatitis. Indian J Gastroenterol 2011; 30:78-83. [PMID: 21509539 DOI: 10.1007/s12664-011-0093-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 03/07/2011] [Indexed: 02/04/2023]
Abstract
AIM Undernutrition is considered to be a cause of tropical pancreatitis (TP) since this disease is commonly seen in the underprivileged populations of the world. This study was done to compare the nutritional status in patients with TP and alcoholic chronic pancreatitis (ACP) using anthropometric measurements. METHODS Anthropometric measurements were done in patients with TP and ACP aged >18 years and matched healthy controls. Presence of pain, recent dietary restriction, diabetes mellitus (DM), calcification, serum prealbumin (PAB), and quantitative fecal elastase (FE) was assessed. Premorbid body mass index (BMI) was determined from weight before the onset of illness as reported by the patients. RESULTS Of 54 patients (47 male), 39 (72.2%) had TP and the rest had ACP. Patients with TP were younger than those with ACP; the frequency of pain, DM, calcification, and exocrine insufficiency was similar in the two groups. Compared to control subjects, patients had lower BMI, triceps skin fold thickness (TSFT) and mid-arm circumference (MAC) (p < 0.01), but waist-to-hip ratio (W/H) was similar. Undernutrition was equally common in TP and ACP (15 [38.5%] vs. 6 [40%]). The BMI, TSFT, MAC, and W/H were similar in TP and ACP. The premorbid BMI was higher than that at presentation (20.2 [3.8] kg/m² vs. 19.1 [3.3] kg/m², p < 0.01). There was no association between BMI and features contributing to undernutrition (DM, pain, recent dietary restriction, FE level, and calcification) on univariate analysis. CONCLUSIONS Energy undernutrition occurs equally commonly in TP and ACP and this appears to develop after the onset of illness.
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Affiliation(s)
- Hariharan Regunath
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, 576 104, Karnataka, India
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Morley JE. Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment. J Nutr Health Aging 2011; 15:87-90. [PMID: 21365159 DOI: 10.1007/s12603-011-0018-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J E Morley
- GRECC, St. Louis VA Medical Center and Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA.
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Liang SC, Nickerson-Nutter C, Pittman DD, Carrier Y, Goodwin DG, Shields KM, Lambert AJ, Schelling SH, Medley QG, Ma HL, Collins M, Dunussi-Joannopoulos K, Fouser LA. IL-22 induces an acute-phase response. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2010; 185:5531-8. [PMID: 20870942 DOI: 10.4049/jimmunol.0904091] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IL-22 is made by a unique set of innate and adaptive immune cells, including the recently identified noncytolytic NK, lymphoid tissue-inducer, Th17, and Th22 cells. The direct effects of IL-22 are restricted to nonhematopoietic cells, its receptor expressed on the surface of only epithelial cells and some fibroblasts in various organs, including parenchymal tissue of the gut, lung, skin, and liver. Despite this cellular restriction on IL-22 activity, we demonstrate that IL-22 induces effects on systemic biochemical, cellular, and physiological parameters. By utilizing adenoviral-mediated delivery of IL-22 and systemic administration of IL-22 protein, we observed that IL-22 modulates factors involved in coagulation, including fibrinogen levels and platelet numbers, and cellular constituents of blood, such as neutrophil and RBC counts. Furthermore, we observed that IL-22 induces thymic atrophy, body weight loss, and renal proximal tubule metabolic activity. These cellular and physiological parameters are indicative of a systemic inflammatory state. We observed that IL-22 induces biochemical changes in the liver including induction of fibrinogen, CXCL1, and serum amyloid A that likely contribute to the reported cellular and physiological effects of IL-22. Based on these findings, we propose that downstream of its expression and impact in local tissue inflammation, circulating IL-22 can further induce changes in systemic physiology that is indicative of an acute-phase response.
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Affiliation(s)
- Spencer C Liang
- Inflammation and Immunology Research Unit, Pfizer Biotherapeutics Research and Development, Cambridge, MA 02140, USA
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Abstract
Numerous studies have now found that good nutrition coupled with exercise are key factors to aging successfully. In addition, it is now clear that men who drink 2 shots of alcohol (red wine or other) do better. Women are limited to only 1 drink a day. This article examines some key nutritional factors involved in successful aging and highlights different needs between men and women.
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Affiliation(s)
- John E Morley
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, 1 Jefferson Barracks Drive, Saint Louis, MO 63125, USA.
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Morley JE. Anorexia, weight loss, and frailty. J Am Med Dir Assoc 2010; 11:225-8. [PMID: 20439039 DOI: 10.1016/j.jamda.2010.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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Mupere E, Zalwango S, Chiunda A, Okwera A, Mugerwa R, Whalen C. Body composition among HIV-seropositive and HIV-seronegative adult patients with pulmonary tuberculosis in Uganda. Ann Epidemiol 2010; 20:210-6. [PMID: 20159491 DOI: 10.1016/j.annepidem.2009.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 10/18/2009] [Accepted: 11/21/2009] [Indexed: 01/10/2023]
Abstract
PURPOSE We determined whether human immunodeficiency virus (HIV) infection affects body cell mass and fat mass wasting among adults with pulmonary tuberculosis (PTB). METHODS We screened 967 Ugandan adults for PTB and HIV infection in a cross-sectional study. We compared anthropometric and bioelectric impedance analysis (BIA) body composition parameters among HIV-seropositive and HIV-seronegative men and women with or without PTB by using a non-parametric test. RESULTS We found that poor nutritional status associated with TB differed among men and women. Anthropometric and BIA body composition did not differ between HIV-seropositive and HIV-seronegative patients regardless of gender. Average weight group difference in men consisted of body cell mass and fat mass in equal proportions of 43%. In women, average weight group difference consisted predominantly of fat mass of 73% and body cell mass of 13%. Compared to individuals without TB, patients with TB had lower body mass index, weight, body cell mass, and fat mass regardless of gender and HIV status. CONCLUSIONS Gender, but not HIV status, was associated with body composition changes in TB. TB appears to be the dominant factor driving the wasting process among co-infected patients.
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Affiliation(s)
- Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
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Aging male. Clin Geriatr Med 2010; 26:171-84. [PMID: 20497839 DOI: 10.1016/j.cger.2010.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There are several special issues that confront the physician when dealing with the older male. Physicians need to pay attention to these issues and recognize their importance to their patients. This article briefly reviews these unique challenges.
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Landi F, Laviano A, Cruz-Jentoft AJ. The Anorexia of Aging: Is It a Geriatric Syndrome? J Am Med Dir Assoc 2010; 11:153-6. [DOI: 10.1016/j.jamda.2009.09.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 09/02/2009] [Indexed: 01/04/2023]
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Abstract
PURPOSE OF REVIEW The role of calorie restriction in humans is controversial. Recently, new data in monkeys and humans have provided new insights into the potential role of calorie restriction in longevity. RECENT FINDINGS A study in rhesus monkeys showed a reduction in aging-associated mortality. A number of controlled studies have suggested a variety of beneficial effects during studies of 6-12 months in humans. Major negative effects in humans were loss of muscle mass, muscle strength and loss of bone. SUMMARY Dietary restriction in rodents has not been shown to be effective when started in older rodents. Weight loss in humans over 60 years of age is associated with increased mortality, hip fracture and increased institutionalization. Calorie restriction in older persons should be considered experimental and potentially dangerous. Exercise at present appears to be a preferable treatment for older persons.
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Abstract
PURPOSE OF REVIEW Anorexia and weight loss are associated with increased mortality in cachectic patients. The role of caloric supplementation is controversial. The purpose of this review is to examine the role of calorie supplementation in cachexia. RECENT FINDINGS Caloric supplementation improves outcomes in malnourished hospital patients and malnourished older persons. It may improve the quality of life in cancer patients and for those persons receiving palliative care. Caloric supplementation should include a balanced essential amino acid supplement given at least twice a day. The role of eicosapentanoic acid as a supplement is controversial. All caloric supplements should be given between and not with meals. SUMMARY Caloric supplementation rich in protein and with adequate vitamin D should be given between meals to all patients with cachexia.
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Affiliation(s)
- John E Morley
- GRECC, VA Medical Center and Division of Geriatric Medicine, Saint Louis University, School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA.
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Clinical Update on Nursing Home Medicine: 2009. J Am Med Dir Assoc 2009; 10:530-53. [DOI: 10.1016/j.jamda.2009.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 12/25/2022]
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Diarrhea in long-term care: a messy problem. J Am Med Dir Assoc 2009; 10:213-7. [PMID: 19426933 DOI: 10.1016/j.jamda.2009.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 01/30/2023]
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Abstract
Diabetes mellitus has long been recognized as a cause of accelerated aging. As the understanding of the metabolic syndrome has evolved, it has been recognized that the interaction of a panoply of factors in the presence of insulin resistance results in accelerated aging. This article explores the increasing prevalence of diabetes mellitus with aging and how insulin resistance leads to accelerated frailty, disability, hospitalization, institutionalization, and death.
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Affiliation(s)
- John E Morley
- Geriatric Research Education and Clinical Center, St. Louis VA Medical Center, 1 Jefferson Barracks Drive, 11G, St. Louis, MO 63125, USA.
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Messinger-Rapport BJ, Thomas DR, Gammack JK, Morley JE. Clinical Update on Nursing Home Medicine: 2008. J Am Med Dir Assoc 2008; 9:460-75. [DOI: 10.1016/j.jamda.2008.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 07/07/2008] [Indexed: 12/11/2022]
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