The Association between Malnutrition and Physical Performance in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Development of a Brief Assessment Tool to Evaluate Early Low Nutrition Risk in Community Elderly. Creation of the tool and examination of its reliability and criterion-related validity

BACKGROUND

To date simple assessment tool to evaluate early low nutrition risk in general older population has not been available. This study aimed to create such tool and examined its reliability and criterion-related validity.

METHODS

1,192 community elderly with a mean age of 74.7(5.8) years responded to a questionnaire consisting of 48 (Hatoyama) or 34 items (Kusatsu), which have been reported to be associated with nutritional state in older people. Item analysis was conducted on the 34 common items, and items were selected based on the following criteria: adequate pass rates and discriminative power, no gender and regional differences, and a certain level of commonality based on factor analysis. Next, the factor structure of the candidate items was examined through exploratory factor analysis, and confirmatory factor analysis was conducted as the final scale structure. Furthermore, Spearman's partial rank correlation coefficients (sex- and age-adjusted) between the created index and important health indicators were examined to determine the criterion-related validity.

RESULTS

Finally, we obtained a semantic coherence of 4 factors (named health beliefs, dietary status, physical activity, and food-related quality of life) totaling 13 items; confirmatory factor analysis of the 4-factor solution yielded good model fit values, χ2 (59) =275.4 (p<0.001), CFI=0.930, and RMSEA=0.056. The factor loadings for each factor ranged from 0.43 to 0.82, indicating adequate loadings. The reliability of the index was shown to be high by Good-Poor analysis and Cronbach's α. The index showed statistically significant correlations with all health indicators.

CONCLUSIONS

We have developed a simple assessment tool to evaluate early low nutrition risk in general older population.

Advancing the Understanding of Malnutrition in the Elderly Population: Current Insights and Future Directions

Malnutrition is a growing public health problem leading to increased morbidity and mortality worldwide. Up to 50% of elderly patients are hospitalized due to this condition. In this review, we focused on analyzing the current diagnostic criteria for malnutrition among the elderly population and proposing promising solutions. Currently used diagnostic methods such as BMI or serum albumin levels are not sufficient to indicate malnutrition, which is affected by many factors, including the number of chronic diseases, multiple medications taken, or physical condition. Moreover, current recommendations are inadequate because they fail to account for various factors such as chronic illnesses, multiple medications, and bodily changes that are crucial in diagnostic evaluations. There is a noticeable gap between these recommendations and actual clinical practice. Nevertheless, developing more precise, non-invasive biomarkers and personalized nutrition strategies has to be explored. One of these strategies we discuss in our review is multidisciplinary approaches that combine nutrition, physical activity, and psychosocial support. Addressing malnutrition among the elderly should rely on standardized protocols and personalized interventions to enhance their nutritional health and overall well-being.

Nutritional Status and Post-Cardiac Surgery Outcomes: An Updated Review with Emphasis on Cognitive Function

Background/Objectives: Nutritional status significantly influences cardiac surgery outcomes, with malnutrition contributing to poorer results and increased complications. This study addresses the critical gap in understanding by exploring the relationship between pre-operative nutritional status and post-operative cognitive dysfunction (POCD) in adult cardiac patients. Methods: A comprehensive search across key databases investigates the prevalence of malnutrition in pre-operative cardiac surgery patients, its effects, and its association with POCD. Factors exacerbating malnutrition, such as chronic illnesses and reduced functionality, are considered. The study also examines the incidence of POCD, its primary association with CABG procedures, and the impact of malnutrition on complications like inflammation, pulmonary and cardiac failure, and renal injury. Discussions: Findings reveal that 46.4% of pre-operative cardiac surgery patients experience malnutrition, linked to chronic illnesses and reduced functionality. Malnutrition significantly contributes to inflammation and complications, including POCD, with an incidence ranging from 15 to 50%. CABG procedures are particularly associated with POCD, and malnutrition prolongs intensive care stays while increasing vulnerability to surgical stress. Conclusions: The review underscores the crucial role of nutrition in recovery and advocates for a universally recognized nutrition assessment tool tailored to diverse cardiac surgery patients. Emphasizing pre-operative enhanced nutrition as a potential strategy to mitigate inflammation and improve cognitive function, the review highlights the need for integrating nutrition screening into clinical practice to optimize outcomes for high-risk cardiac surgery patients. However, to date, most data came from observational studies; hence, there is a need for future interventional studies to test the hypothesis that pre-operative enhanced nutrition can mitigate inflammation and improve cognitive function in this patient population.

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

Physical Performance, Body Composition, and Oral Health in Community-Residing Older Adults: A Cross-Sectional Study

Physical activity is essential for healthy aging. This study aimed to identify an association between physical performance, body fat percentage (%BF), and the perception of oral health-related quality of life (OHRQoL) in independent older adults.

METHOD

A group of active older adults was selected from a government-sponsored reunion center in Mexico City. OHRQoL was assessed using the General Oral Health Index (GOHAI), and nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool. A short physical performance battery (SPPB) was applied, and, for body composition, DXA (dual X-ray absorptiometry) was conducted. Data were analyzed using logistic regression models, and marginal probabilities were obtained.

RESULTS

This study involved 366 participants; their mean age was 73.9 (±6.2) years, and 24.9% had type 2 diabetes mellitus (T2DM). OHRQoL information revealed that pain or discomfort in the oral cavity was perceived by 63.9% of the older adults during the previous three months. The SPPB score was low in 159 (43.44%) participants. The logistic regression model revealed that age (OR = 1.13, p < 0.001), T2DM (OR = 2.10, p = 0.009), the risk of malnutrition/malnutrition (OR = 1.76, p = 0.047), high %BF (OR = 1.09, <0.001), and poor OHRQoL (OR = 1.96, p = 0.009) were associated with deteriorated physical performance.

CONCLUSION

OHRQoL self-perception, excess body fat, and nutritional status impacted physical performance. Aging well requires a comprehensive approach.

The Mini Nutritional Assessment combined with body fat for detecting the risk of sarcopenia and sarcopenic obesity in metabolic syndrome

Malnutrition is a key factor in metabolic syndrome (MS) and sarcopenia, assessing the nutritional status of these patients is a pressing issue. The purpose of this study was to clarify sarcopenia and sarcopenic obesity in patients with MS based on nutritional status. This was a case-control study between MS/non-MS. Body composition was measured by dual-energy X-ray absorptiometry. Muscle function was assessed by handgrip strength, five times sit-to-stand test, gait speed test and short physical performance battery (SPPB). The Mini Nutritional Assessment (MNA) was performed to assess the nutritional status in the participants in this study. Overall, a total of 56 % and 13 % of participants suffered from possible sarcopenia and sarcopenia, respectively. There was a higher rate of possible sarcopenic obesity in the MS group than in the non-MS group (48·9 % v. 24·7 %, P < 0·01), and all the sarcopenia participants in the MS group had sarcopenic obesity. MNA score was significantly associated with sarcopenia status (P < 0·01). The MNA combined with body fat score showed better acceptable discrimination for detecting sarcopenic obesity and sarcopenia in MS (AUC = 0·70, 95 % CI 0·53, 0·86). In summary, there was a higher prevalence of possible sarcopenic obesity in MS, and all the MS patients with sarcopenia had sarcopenic obesity in the present study. We suggest that the MNA should be combined with body fat percentage to assess the nutritional status of MS participants, and it also serves as a good indicator for sarcopenia and sarcopenic obesity in MS.

Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries

BACKGROUND

There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations.

RESULTS

Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%).

CONCLUSIONS

Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.

Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients

The Controlling Nutritional Status (CONUT) score has demonstrated its ability to identify patients with poor nutritional status and predict various clinical outcomes. Our objective was to assess the association between the CONUT score, inflammatory status, and body composition, as well as its ability to identify patients at risk of frailty in hospitalized elderly patients.

METHODS

a total of 361 patients were retrospectively recruited and divided into three groups based on the CONUT score.

RESULTS

patients with a score ≥5 exhibited significantly higher levels of inflammatory markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Neutrophil/Lymphocytes ratio (NLR), main platelet volume (MPV), and ferritin, compared to those with a lower score. Furthermore, these patients showed unfavorable changes in body composition, including a lower percentage of skeletal muscle mass (MM) and fat-free mass (FFM) and a higher percentage of fatty mass (FM). A positive correlation was found between the CONUT score and inflammatory markers, Geriatric Depression Scale Short Form (GDS-SF), and FM. Conversely, the Mini Nutritional Assessment (MNA), Mini-Mental Status Examination, activity daily living (ADL), instrumental activity daily living (IADL), Barthel index, FFM, and MM showed a negative correlation. Frailty was highly prevalent among patients with a higher CONUT score. The receiver operating characteristic (ROC) curve demonstrated high accuracy in identifying frail patients (sensitivity).

CONCLUSIONS

a high CONUT score is associated with a pro-inflammatory status as well as with unfavorable body composition. Additionally, it is a good tool to identify frailty among hospitalized elderly patients.

Incidence of the Risk of Malnutrition and Excess Fat Mass, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults

BACKGROUND AND AIMS

Only one cohort study exists on the incidence of the risk of malnutrition (RM) in older adults, though numerous cross-sectional reports, identified several risk factors associated with the prevalence and incidence of this condition. However, alterations in body composition and impaired physical performance as exposition variables of RM have not been explored. This study assessed the incidence of RM and determined its association with excess fat mass, low total lean tissue, gait speed, and handgrip strength as exposition variables for RM in community-dwelling older adults.

METHODS

This is a secondary analysis of older adults (≥60 years) derived from the study "Frailty, dynapenia, and sarcopenia in Mexican adults (FraDySMex)", a prospective cohort project conducted from 2014 to 2019 in Mexico City. At baseline, volunteers underwent body composition analysis and physical performance tests. Several covariates were identified through comprehensive geriatric assessment. At baseline and follow-up, RM was assessed using the long form of the mini nutritional assessment (MNA-LF) scale. Associations between the exposition variables and RM were assessed by multiple logistic regression.

RESULTS

The cohort included 241 subjects. The average age was 75.6 ± 7.8 years, and 83.4% were women. The mean follow-up period was 4.1 years, during which 28.6% of subjects developed RM. This condition was less likely to occur in those with an excess fat mass, even after adjusting for several covariates. Regarding total lean tissue, the unadjusted model showed that RM was more likely to occur in men and women with a low TLT by the TLTI classification, compared to the normal group. However, after adjusting for several covariates (models 1 and 2), the association lost significance. Results on the association between gait speed and RM showed that this condition was also more likely to occur in subjects with low gait speed, according to both the unadjusted and adjusted models. Similar results were found for RM in relation to low handgrip strength; however, after adjusting for the associated covariates, models 1 and 2 no longer reached the level of significance.

CONCLUSIONS

RM diagnosed by MNA-LF was significantly less likely to occur among subjects with excess fat mass, and a significant association emerged between low gait speed and RM after 4.1 years of follow-up in these community-dwelling older adults. These results confirm the association between some alterations of body composition and impaired physical performance with the risk of malnutrition and highlight that excess fat mass and low gait speed precede the risk of malnutrition, not vice versa.

Two-CyDye-Based 2D-DIGE Analysis of Aged Human Muscle Biopsy Specimens

The gradual loss of skeletal muscle mass during aging and associated decline in contractile strength can result in reduced fitness, frailty, and loss of independence. In order to better understand the molecular and cellular mechanisms that underlie sarcopenia of old age and the frailty syndrome, as well as identify novel therapeutic targets to treat age-related fiber wasting, it is crucial to develop a comprehensive biomarker signature of muscle aging. Fluorescence two-dimensional gel electrophoresis (2D-DIGE) in combination with sensitive mass spectrometry presents an ideal bioanalytical tool for biomarker discovery in biogerontology. This chapter outlines the application of the 2D-DIGE method for the comparative analysis of human biopsy specimens from middle-aged versus senescent individuals using a two-CyDye-based method.

Nutrition Risk Is Associated with 3-Year Strength and Performance Indicators among Older Adults in the Canadian Longitudinal Study on Aging

OBJECTIVES

Determine if nutrition risk, as measured by SCREEN-8 is predictive of 3-year strength and performance indicators among community-living older adults after adjusting for key demographic and health variables. Sex-stratified analyses were also determined.

DESIGN

Cohort study with baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging (CLSA).

PARTICIPANTS

Participants 55 years and older at baseline were included (n = 22,502); those who reported nasogastric or abdominal tube feeding at either timepoint were excluded (n = 26). The final sample of participants available for analyses slightly varied depending on completion of the three outcome variables. List-wise deletion was used for nutrition risk and covariates to arrive at the sample available for analysis (n = 17,250).

MEASUREMENTS

The valid and reliable SCREEN-8 tool was used to measure nutrition risk. The minimum and maximum score of SCREEN-8 is 0 and 48, respectively, with lower scores indicating greater nutrition risk. Baseline SCREEN-8 score was used in analyses. Grip strength, chair rise test time and gait speed assessed at the 3-year follow-up were the strength and performance outcomes. Criteria outlined by the European Working Group on Sarcopenia in Older People 2 were used to determine low performance for grip strength (<27 kg for males and <16 kg for females), chair rise test time (>15 seconds) and gait speed (≤0.8 m/s).

RESULTS

Half of participants were female (49.4%) and mean age was 66.7 years (SD 7.9). Mean SCREEN-8 score was 39.2 (SD 6.0). Low grip strength, chair rise test performance and gait speed were found in 18.5%, 19.6% and 29.3% of participants, respectively. After adjusting for covariates (e.g., sex, age, education), SCREEN-8 score was significantly associated with grip strength (F = 11.21, p = .001; OR = 0.98, CI [0.97, 0.99]), chair rise time (F = 5.97, p = .015; OR = 0.99, CI [0.97, 0.997]), and gait speed (F = 9.99, p = .002; OR = 0.98, CI [0.97, 0.99]). Similar interpretation was seen in sex-stratified analyses, although chair rise time was not significant. Age, body mass index, Life Space Index Score and self-rated health were consistently associated with all outcome measures.

CONCLUSION

Nutrition risk, as measured by SCREEN-8, significantly predicted 3-year strength and performance measures. Greater nutrition risk is associated with an increased odds of low performance on grip strength, chair rise test, and gait speed. Future research should implement nutrition risk screening in primary care settings with subsequent assessment and treatment for at risk clients to determine if nutrition interventions implemented post screening can delay age-related losses in strength and performance.

Development of a Tool for Determining the Equivalence of Nutritional Supplements to Diabetic Food Exchanges

Malnutrition is a prevalent issue in hospitals, nursing homes and the community setting. Nutritional products can be used by dietitians to supplement people’s diet by adding energy, macronutrients and other constituents. The aim of the present work was (i) to create a database of nutritional products with information on their energy and macronutrient content, (ii) to estimate the food exchanges of each product and assist in diet plan development for malnourished persons and (iii) to provide a tool for calculation of food exchanges of newly developed products not included in the database. We searched the web for nutritional supplements, and an electronic database with 461 products was generated with data regarding the contained energy and macronutrients of each entry. The following companies were included: Abbott Nutrition, Nestle Nutrition, Nutricia North America, Nutricia Global, Nutricia Europe & Middle East, Axcan Pharma Inc., Kate Farms, Global Health, High Protein, NutriMedical BV, Hormel Health Labs, Hormel Health Labs/Diamond Crystal Brands, Lyons Magnus, Mead Johnson, Medical Nutrition USA Inc., Medtrition, Nutritional Designs Inc., Nutrisens, Humana (Germany), and Vitaflo USA. The created database facilitates product comparisons and categorization into several groups according to energy and protein content. In addition, a tool was created to determine food exchanges for each supplement per serving and/or food exchanges for newly developed products by simply inserting their macronutrient content. The developed tool can facilitate dietitians in comparing products and incorporating them into diet plans, if needed. Such tools may thus serve clinical practice, may be used in dietary or other smart applications and can familiarize dietitians with the digital epoch.