Nutrition and aging successfully

Toward the recognition and management of sarcopenia in routine clinical care

Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease's adoption into routine care.

Improvement of nutritional status enhances cognitive and physical functions in older adults with orthostatic hypotension

OBJECTIVES

Malnutrition may be an important risk factor for orthostatic hypotension (OH). The aim of this study was to investigate the relationship between malnutrition and OH, and the effect of nutritional improvement on cognitive functions and gait-balance parameters in patients with OH.

METHODS

A total of 692 patients were included in the study. The Head-up Tilt Table Test and Mini Nutritional Assessment (MNA) were implemented for participants. Patients underwent a comprehensive geriatric assessment, including a neurocognitive evaluation and physical performance. After 6 mo, the participants who had OH were reevaluated.

RESULTS

Women comprised 64.8% of the patients and the mean age was 74.98 ± 7.68 y. The frequencies of OH, malnutrition, and risk of malnutrition were 31.9%, 7.4%, and 13.3%, respectively. The rates of dementia, hypertension, sarcopenia, frailty, and a history of falls in the past year were higher in the OH-positive group. OH was associated with malnutrition (odds ratio: 2.48; confidence interval, 1.35‒4.54; P = 0.003) and risk of malnutrition (odds ratio: 1.64; CI, 1.03‒2.62; P = 0.035) in contrast with normal nutritional status. A higher MNA score during the follow-up period resulted in improved cognitive and gait-balance scores when confounding factors were adjusted (P < 0.05). Patients with OH whose MNA score improved during the follow up also had a significant decrease in the number of falls (P = 0.034).

CONCLUSIONS

Optimization of nutritional status may improve global cognition and gait-balance functions, and prevent falls in older people with OH.

Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China

OBJECTIVES

To assess the association between malnutrition and physical frailty among nursing home older adults in China.

DESIGN AND SETTING

A cross-sectional study in 15 nursing homes in Changsha, China.

PARTICIPANTS

A total of 705 nursing home residents who were aged 60 and older.

MEASUREMENTS

Physical frailty was identified based on the following five components: slow gait speed, low physical activity, weight loss, exhaustion, and low grip strength. Nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression models were used to analyze the association between nutritional status and physical frailty.

RESULTS

The mean (SD) age of the participants was 82.5 (8.1) years old (range, 60-106 years), and 226 (32%) was men. Of those participants, 5.1% and 55.6% were malnourished and at risk of malnutrition, respectively; 60.3% and 36.2% were identified as being frail and prefrail, respectively. Compared with participants who were well-nourished, those who were at risk of malnutrition or malnourished were two times more likely to be physically frail (adjusted odds ratio 2.66, 95% confidence interval 1.01 to 7.00), after adjustment for age, education level, cognitive status, depressive symptoms, and disability in activities of daily living. No significant association was observed between malnutrition and physical prefrailty.

CONCLUSION

Our findings suggest that poor nutritional status and physical frailty are highly prevalent in nursing home older adults in China, and that poor nutritional status is associated with increased odds of physical frailty.

Factors associated with muscle mass in community-dwelling older people in Singapore: Findings from the SHIELD study

Objectives

Aging is associated with low muscle mass and has been linked to adverse health outcomes. The objectives of this cross-sectional study were: (1) to describe anthropometry, body composition, appendicular skeletal muscle mass index (ASMI; appendicular skeletal muscle mass/height²), and prevalence of low ASMI in older people with normal nutritional status (Malnutrition Universal Screening Tool score = 0); (2) to determine factors associated with ASMI, and odds ratios of having low ASMI.

Methods

SHIELD is a study of community-dwelling older people aged 65 years and above in Singapore. ASMI was determined using bioelectrical impedance analysis and low ASMI was defined as <7.0 kg/m² for males and <5.7 kg/m² for females (Asian Working Group for Sarcopenia, 2014).

Results

A total of 400 older people (183 males and 217 females) took part in this study. The overall prevalence of low ASMI was 20.6% (15.5% in males and 24.9% in females). Females had significantly lower ASMI than males (P < 0.0001), age was inversely associated with ASMI (P = 0.0024) while BMI and calf circumference were positively associated with ASMI (both P < 0.0001) in the total cohort. In addition, ASMI was positively associated with bone mass in both genders (both P < 0.0001). After adjusting for covariates, the odds ratios of having low ASMI with every 1 year and 10 years increase in age were 1.13 (95% CI: 1.06, 1.20) and 3.36 (95% CI: 1.82, 6.21) respectively.

Conclusions

The high prevalence of low ASMI in community-dwelling older people with normal nutritional status highlights the need for early screening. There was a strong inverse association between age and ASMI while BMI, calf circumference and bone mass were positively associated with ASMI. These findings will give further weight to the importance and development of public health strategies in maintaining and improving muscle health in this population group.

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

OBJECTIVE

The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.

METHODS

These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Malnutrition Screening and Assessment in Hospitalised Older People: a Review

Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.