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Gonzalez A, Soto J, Babiker N, Wroblewski K, Sawicki S, Schoeller D, Luke A, Huisingh-Scheetz M. Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area. BMC Geriatr 2023; 23:815. [PMID: 38062368 PMCID: PMC10704798 DOI: 10.1186/s12877-023-04534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Dysregulated energy metabolism is one hypothesized mechanism underlying frailty. Resting energy expenditure, as reflected by resting metabolic rate (RMR), makes up the largest component of total energy expenditure. Prior work relating RMR to frailty has largely been done in cross section with mixed results. We investigated whether and how RMR related to 1-year frailty change while adjusting for body composition. METHODS N = 116 urban, predominantly African-American older adults were recruited between 2011 and 2019. One-year frailty phenotype (0-5) was regressed on baseline RMR, frailty phenotype, demographics and body composition (DEXA) in an ordinal logistic regression model. Multimorbidity (Charlson comorbidity scale, polypharmacy) and cognitive function (Montreal Cognitive Assessment) were separately added to the model to assess for change to the RMR-frailty relationship. The model was then stratified by baseline frailty status (non-frail, pre-frail) to explore differential RMR effects across frailty. RESULTS Higher baseline RMR was associated with worse 1-year frailty (odds ratio = 1.006 for each kcal/day, p = 0.001) independent of baseline frailty, demographics, and body composition. Lower fat-free mass (odds ratio = 0.88 per kg mass, p = 0.008) was independently associated with worse 1-year frailty scores. Neither multimorbidity nor cognitive function altered these relationships. The associations between worse 1-year frailty and higher baseline RMR (odds ratio = 1.009, p < 0.001) and lower baseline fat-free mass (odds ratio = 0.81, p = 0.006) were strongest among those who were pre-frail at baseline. DISCUSSION We are among the first to relate RMR to 1-year change in frailty scores. Those with higher baseline RMR and lower fat-free mass had worse 1-year frailty scores, but these relationships were strongest among adults who were pre-frail at baseline. These relationships were not explained by chronic disease or impaired cognition. These results provide new evidence suggesting higher resting energy expenditure is associated with accelerate frailty decline.
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Affiliation(s)
| | - J Soto
- Illinois Institute of Technology, Chicago, USA
| | | | - K Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - S Sawicki
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA
| | - D Schoeller
- University of Wisconsin in Madison, Madison, USA
| | - A Luke
- Department of Public Health Sciences, Loyola University, Chicago, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA.
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Resting metabolic rate in relation to incident disability and mobility decline among older adults: the modifying role of frailty. Aging Clin Exp Res 2023; 35:591-598. [PMID: 36626043 DOI: 10.1007/s40520-022-02340-4] [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: 11/23/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life. AIMS To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations. METHODS Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007-2009 and a follow-up measurement 10 years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried's frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted. RESULTS Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23-0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18-0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14-0.64, p = 0.002). CONCLUSIONS To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline.
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Li Q, Legault V, Girard VD, Ferrucci L, Fried LP, Cohen AA. An objective metric of individual health and aging for population surveys. Popul Health Metr 2022; 20:11. [PMID: 35361249 PMCID: PMC8974028 DOI: 10.1186/s12963-022-00289-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/21/2022] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND We have previously developed and validated a biomarker-based metric of overall health status using Mahalanobis distance (DM) to measure how far from the norm of a reference population (RP) an individual's biomarker profile is. DM is not particularly sensitive to the choice of biomarkers; however, this makes comparison across studies difficult. Here we aimed to identify and validate a standard, optimized version of DM that would be highly stable across populations, while using fewer and more commonly measured biomarkers. METHODS Using three datasets (the Baltimore Longitudinal Study of Aging, Invecchiare in Chianti and the National Health and Nutrition Examination Survey), we selected the most stable sets of biomarkers in all three populations, notably when interchanging RPs across populations. We performed regression models, using a fourth dataset (the Women's Health and Aging Study), to compare the new DM sets to other well-known metrics [allostatic load (AL) and self-assessed health (SAH)] in their association with diverse health outcomes: mortality, frailty, cardiovascular disease (CVD), diabetes, and comorbidity number. RESULTS A nine- (DM9) and a seventeen-biomarker set (DM17) were identified as highly stable regardless of the chosen RP (e.g.: mean correlation among versions generated by interchanging RPs across dataset of r = 0.94 for both DM9 and DM17). In general, DM17 and DM9 were both competitive compared with AL and SAH in predicting aging correlates, with some exceptions for DM9. For example, DM9, DM17, AL, and SAH all predicted mortality to a similar extent (ranges of hazard ratios of 1.15-1.30, 1.21-1.36, 1.17-1.38, and 1.17-1.49, respectively). On the other hand, DM9 predicted CVD less well than DM17 (ranges of odds ratios of 0.97-1.08, 1.07-1.85, respectively). CONCLUSIONS The metrics we propose here are easy to measure with data that are already available in a wide array of panel, cohort, and clinical studies. The standardized versions here lose a small amount of predictive power compared to more complete versions, but are nonetheless competitive with existing metrics of overall health. DM17 performs slightly better than DM9 and should be preferred in most cases, but DM9 may still be used when a more limited number of biomarkers is available.
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Affiliation(s)
- Qing Li
- School of Economics and Management, Xinjiang University, 666 Shengli Road, Urumqi, 830046, China
| | - Véronique Legault
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Vincent-Daniel Girard
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Luigi Ferrucci
- Translational Gerontology Branch, Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, MedStar Harbor Hospital, 3001 S. Hanover Street, Baltimore, MD, 21225, USA
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, R140810032, USA
| | - Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada.
- Research Center on Aging, 1036 Belvédère S, Sherbrooke, QC, J1H 4C4, Canada.
- Research Center of Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada.
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Leal-Martín J, Muñoz-Muñoz M, Keadle SK, Amaro-Gahete F, Alegre LM, Mañas A, Ara I. Resting Oxygen Uptake Value of 1 Metabolic Equivalent of Task in Older Adults: A Systematic Review and Descriptive Analysis. Sports Med 2022; 52:331-348. [PMID: 34417980 DOI: 10.1007/s40279-021-01539-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is important for sport scientists and health professionals to have estimative methods for energy demand during different physical activities. The metabolic equivalent of task (MET) provides a feasible approach for classifying activity intensity as a multiple of the resting metabolic rate (RMR). RMR is generally assumed to be 3.5 mL of oxygen per kilogram of body mass per minute (mL O2 kg-1 min-1), a value that has been criticized and considered to be overestimated in the older adult population. However, there has been no comprehensive effort to review available RMR estimations, equivalent to 1 MET, obtained in the older adult population. OBJECTIVE The aim of this review was to examine the existing evidence reporting measured RMR values in the older adult population and to provide descriptive estimates of 1 MET. METHODS A systematic review was conducted by searching PubMed, Web of Science, Scopus, CINAHL, SPORTDiscus, and Cochrane Library, from database inception to July 2021. To this end, original research studies assessing RMR in adults ≥ 60 years old using indirect calorimetry and reporting results in mL O2 kg-1 min-1 were sought. RESULTS Twenty-three eligible studies were identified, including a total of 1091 participants (426 men). All but two studies reported RMR values lower than the conventional 3.5 mL O2 kg-1 min-1. The overall weighted average 1 MET value obtained from all included studies was 2.7 ± 0.6 mL O2 kg-1 min-1; however, when considering best practice studies, this value was 11% lower (2.4 ± 0.3 mL O2 kg-1 min-1). CONCLUSION Based on the results of this systematic review, we would advise against the application of the standard value of 1 MET (3.5 mL O2 kg-1 min-1) in people ≥ 60 years of age and encourage the direct assessment of RMR using indirect calorimetry while adhering to evidence-based best practice recommendations. When this is not possible, assuming an overall value of 2.7 mL O2 kg-1 min-1 might be reasonable. Systematic review registration: International Prospective Register of Systematic Reviews on 30 September 2020, with registration number CRD42020206440.
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Affiliation(s)
- Javier Leal-Martín
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Miguel Muñoz-Muñoz
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Sarah Kozey Keadle
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA
| | | | - Luis M Alegre
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Asier Mañas
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.
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Chung SM, Lee YH, Kim CO, Lee JY, Jin SM, Yoo SH, Moon JS, Kim KJ. Daytime Glycemic Variability and Frailty in Older Patients with Diabetes: a Pilot Study Using Continuous Glucose Monitoring. J Korean Med Sci 2021; 36:e190. [PMID: 34254474 PMCID: PMC8275461 DOI: 10.3346/jkms.2021.36.e190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/13/2021] [Indexed: 12/18/2022] Open
Abstract
We investigated the relationship between glucose variability and frailty. Forty-eight type 2 diabetic patients aged ≥ 65 years were enrolled. The FRAIL scale was used for frailty assessment, and participants were classified into 'healthy & pre-frail' (n = 24) and 'frail' (n = 24) groups. A continuous glucose monitoring (CGM) system was used for a mean of 6.9 days and standardized CGM metrics were analyzed: mean glucose, glucose management indicator (GMI), coefficient of variation, and time in range, time above range (TAR), and time below range. The demographics did not differ between groups. However, among the CGM metrics, mean glucose, GMI, and TAR in the postprandial periods were higher in the frail group (all P < 0.05). After multivariate adjustments, the post-lunch TAR (OR = 1.12, P = 0.019) affected the prevalence of frailty. Higher glucose variability with marked daytime postprandial hyperglycemia is significantly associated with frailty in older patients with diabetes.
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Affiliation(s)
- Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | | | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Man Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyun Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Bendavid I, Lobo DN, Barazzoni R, Cederholm T, Coëffier M, de van der Schueren M, Fontaine E, Hiesmayr M, Laviano A, Pichard C, Singer P. The centenary of the Harris-Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group. Clin Nutr 2021; 40:690-701. [PMID: 33279311 DOI: 10.1016/j.clnu.2020.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure. METHODS Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription. RESULTS In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice. CONCLUSIONS While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding.
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Affiliation(s)
- Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Moïse Coëffier
- Department of Nutrition, CIC1404, Rouen University Hospital and Normandie University, UNIROUEN, Inserm UMR1073, Rouen, France
| | - Marian de van der Schueren
- Department of Nutrition and Dietetics, HAN University of Applied Sciences, School of Allied Health, Nijmegen, the Netherlands
| | - Eric Fontaine
- Université Grenoble Alpes, LBFA, INSERM U1055, Grenoble, France
| | - Michael Hiesmayr
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Claude Pichard
- Clinical Nutrition, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel.
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Fried LP, Cohen AA, Xue QL, Walston J, Bandeen-Roche K, Varadhan R. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. NATURE AGING 2021; 1:36-46. [PMID: 34476409 PMCID: PMC8409463 DOI: 10.1038/s43587-020-00017-z] [Citation(s) in RCA: 197] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
Frailty in aging marks a state of decreased reserves resulting in increased vulnerability to adverse outcomes when exposed to stressors. This Perspective synthesizes the evidence on the aging-related pathophysiology underpinning the clinical presentation of physical frailty as a phenotype of a clinical syndrome that is distinct from the cumulative-deficit-based frailty index. We focus on integrating the converging evidence on the conceptualization of physical frailty as a state, largely independent of chronic diseases, that emerges when the dysregulation of multiple interconnected physiological and biological systems crosses a threshold to critical dysfunction, severely compromising homeostasis. Our exegesis posits that the physiology underlying frailty is a critically dysregulated complex dynamical system. This conceptual framework implies that interventions such as physical activity that have multisystem effects are more promising to remedy frailty than interventions targeted at replenishing single systems. We then consider how this framework can drive future research to further understanding, prevention and treatment of frailty, which will likely preserve health and resilience in aging populations.
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Affiliation(s)
- Linda P. Fried
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alan A. Cohen
- Groupe de recherche PRIMUS, Department of Family Medicine, Université de Sherbrooke, Quebec City, Quebec, Canada
| | - Qian-Li Xue
- Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy Walston
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- These authors jointly supervised this work: Karen Bandeen-Roche, Ravi Varadhan
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- These authors jointly supervised this work: Karen Bandeen-Roche, Ravi Varadhan
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Bastone ADC, Ferriolli E, Pfrimer K, Moreira BDS, Diz JBM, Dias JMD, Dias RC. Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study. J Geriatr Phys Ther 2020; 42:E135-E141. [PMID: 28786908 DOI: 10.1519/jpt.0000000000000138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail. METHODS A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry. RESULTS AND DISCUSSION The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail. CONCLUSION This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.
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Affiliation(s)
| | - Eduardo Ferriolli
- Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Pfrimer
- Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruno de Souza Moreira
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliano Bergamaschine Mata Diz
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - João Marcos Domingues Dias
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosângela Corrêa Dias
- Postgraduate Program in Rehabilitation Sciences-Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Bonnefoy M, Gilbert T, Normand S, Jauffret M, Roy P, Morio B, Cornu C, Roche S, Laville M. Energy Expenditure in Older People Hospitalized for an Acute Episode. Nutrients 2019; 11:E2946. [PMID: 31817061 PMCID: PMC6949974 DOI: 10.3390/nu11122946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 12/26/2022] Open
Abstract
Weight loss and worsening of nutritional state is a frequent downfall of acute hospitalization in older people. It is usually accepted that acute inflammation is responsible for hypercatabolism. However, several studies suggest, on the contrary, a reduction in resting energy expenditure (REE). This study aimed to obtain a reliable measure of REE and total energy expenditure (TEE) in older patients hospitalized for an acute episode in order to better assess patients' energy requirements and help understand the mechanisms of weight loss in this situation. Nineteen hospitalized older patients (mean age 83 years) with C-reactive protein (CRP) level >20mg/L were recruited. REE and TEE were measured using gold standard methods of indirect calorimetry and doubly labeled water (DLW), respectively. REE was then compared to data from a previous study on aged volunteers from nursing homes who were free of an acute stressor event. Energy requirements measured by DLW were confirmed at 1.3 × REE. Energy intake covered the needs but did not prevent weight loss in these patients. TEE was not increased in hospitalized patients and was not influenced by inflammation, while the relationship between REE and inflammation was uncertain. Our results suggest that lean mass remains the major determinant of REE in hospitalized older people and that weight loss may not be explained solely by a state of hypercatabolism.
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Affiliation(s)
- Marc Bonnefoy
- Department of Geriatric Medicine, Groupement Hospitalier Sud, CHU de Lyon, 69495 Bénite-Pierre CEDEX, France; (T.G.); (M.J.)
- CarMeN, U1060 INSERM, 69921 Oullins CEDEX, France; (B.M.); (M.L.)
- Rhône-Alpes Center for Research in Human Nutrition, European Center for Nutrition and Health, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France;
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Thomas Gilbert
- Department of Geriatric Medicine, Groupement Hospitalier Sud, CHU de Lyon, 69495 Bénite-Pierre CEDEX, France; (T.G.); (M.J.)
- HESPER, EA 7425 Université Claude Bernard lyon 1, 69373 Lyon 8 CEDEX, France
| | - Sylvie Normand
- Rhône-Alpes Center for Research in Human Nutrition, European Center for Nutrition and Health, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France;
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Marc Jauffret
- Department of Geriatric Medicine, Groupement Hospitalier Sud, CHU de Lyon, 69495 Bénite-Pierre CEDEX, France; (T.G.); (M.J.)
| | - Pascal Roy
- Department of Biostatistics, Health sciences department, Hospices Civils de Lyon, 69003 Lyon, France; (P.R.); (S.R.)
- CNRS UMR 5558, Laboratory of Biometry and evolutive Biology, Biostatistics and health, 69100 Villeurbanne, France
| | - Béatrice Morio
- CarMeN, U1060 INSERM, 69921 Oullins CEDEX, France; (B.M.); (M.L.)
| | - Catherine Cornu
- Center of clinical investigations, Hôpital Louis Pradel, 69500 Bron, France;
| | - Sylvain Roche
- Department of Biostatistics, Health sciences department, Hospices Civils de Lyon, 69003 Lyon, France; (P.R.); (S.R.)
- CNRS UMR 5558, Laboratory of Biometry and evolutive Biology, Biostatistics and health, 69100 Villeurbanne, France
| | - Martine Laville
- CarMeN, U1060 INSERM, 69921 Oullins CEDEX, France; (B.M.); (M.L.)
- Rhône-Alpes Center for Research in Human Nutrition, European Center for Nutrition and Health, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France;
- Department of endocrinology and Nutrition, Groupement Hospitalier Sud, CHU de Lyon, 69495 Pierre-Bénite CEDEX, France
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10
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McAdams-DeMarco MA, Chu NM, Segev DL. Frailty and Long-Term Post-Kidney Transplant Outcomes. CURRENT TRANSPLANTATION REPORTS 2019; 6:45-51. [PMID: 31768307 PMCID: PMC6876846 DOI: 10.1007/s40472-019-0231-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes. RECENT FINDINGS Frailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies, >50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were consistent with those on short-term post-KT outcomes. Pilot data suggests that prehabilitation may be an intervention that increases physiologic reserve in frail KT recipients. SUMMARY The PFP is a effective tool to measure frailty in ESRD that improves risk stratification for short-term and long-term post-KT outcomes. Interventions to improve physiologic reserve and prevent adverse KT outcomes, particularly among frail KT recipients, are needed.
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Affiliation(s)
- Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD
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11
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Eslamparast T, Vandermeer B, Raman M, Gramlich L, Den Heyer V, Belland D, Ma M, Tandon P. Are Predictive Energy Expenditure Equations Accurate in Cirrhosis? Nutrients 2019; 11:nu11020334. [PMID: 30720726 PMCID: PMC6412603 DOI: 10.3390/nu11020334] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
Malnutrition is associated with significant morbidity and mortality in cirrhosis. An accurate nutrition prescription is an essential component of care, often estimated using time-efficient predictive equations. Our aim was to compare resting energy expenditure (REE) estimated using predictive equations (predicted REE, pREE) versus REE measured using gold-standard, indirect calorimetry (IC) (measured REE, mREE). We included full-text English language studies in adults with cirrhosis comparing pREE versus mREE. The mean differences across studies were pooled with RevMan 5.3 software. A total of 17 studies (1883 patients) were analyzed. The pooled cohort was comprised of 65% men with a mean age of 53 ± 7 years. Only 45% of predictive equations estimated energy requirements to within 90⁻110% of mREE using IC. Eighty-three percent of predictive equations underestimated and 28% overestimated energy needs by ±10%. When pooled, the mean difference between the mREE and pREE was lowest for the Harris⁻Benedict equation, with an underestimation of 54 (95% CI: 30⁻137) kcal/d. The pooled analysis was associated with significant heterogeneity (I2 = 94%). In conclusion, predictive equations calculating REE have limited accuracy in patients with cirrhosis, most commonly underestimating energy requirements and are associated with wide variations in individual comparative data.
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Affiliation(s)
- Tannaz Eslamparast
- Department of Medicine, University of Alberta, 130 University Campus, Zeidler ledcor Centre, Edmonton, AB T6G 2X8, Canada.
| | - Benjamin Vandermeer
- Alberta Research Center for Health Evidence, Pediatrics, 4-496 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, 6D26 TRW Building 3280 Hospital drive NW, Calgary, AB T2N 4N1, Canada.
| | - Leah Gramlich
- Department of Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB T5H 3V9, Canada.
| | - Vanessa Den Heyer
- Alberta Health Services Nutrition Services, University of Alberta Hospital, Edmonton, AB T5H 3V9, Canada.
| | - Dawn Belland
- Alberta Health Services Nutrition Services, University of Alberta Hospital, Edmonton, AB T5H 3V9, Canada.
| | - Mang Ma
- Department of Medicine, University of Alberta, 130 University Campus, Zeidler ledcor Centre, Edmonton, AB T6G 2X8, Canada.
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, 130 University Campus, Zeidler ledcor Centre, Edmonton, AB T6G 2X8, Canada.
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12
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McCullagh R, Dillon C, O'Connell AM, Horgan NF, Timmons S. Step-Count Accuracy of 3 Motion Sensors for Older and Frail Medical Inpatients. Arch Phys Med Rehabil 2017; 98:295-302. [DOI: 10.1016/j.apmr.2016.08.476] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/29/2016] [Accepted: 08/27/2016] [Indexed: 12/21/2022]
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13
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Beckert AK, Huisingh-Scheetz M, Thompson K, Celauro AD, Williams J, Pachwicewicz P, Ferguson MK. Screening for Frailty in Thoracic Surgical Patients. Ann Thorac Surg 2016; 103:956-961. [PMID: 27720368 DOI: 10.1016/j.athoracsur.2016.08.078] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/08/2016] [Accepted: 08/22/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The presence of frailty or prefrailty in older adults is a risk factor for postsurgical complications. The frailty phenotype can be improved through long-term resistance and aerobic training. It is unknown whether short-term preoperative interventions targeting frailty will help to mitigate surgical risk. The purpose of this study was to determine the proportion of frail and prefrail patients presenting to a thoracic surgical clinic who could benefit from a frailty reduction intervention. METHODS A prospective cohort study was performed at a single-site thoracic surgical clinic. Starting October 1, 2014, surgical candidates 60 years of age or older who consented to be screened were included. Patients were screened using an adapted version of Fried's phenotypic frailty criteria: weakness (grip strength), slow gait (15-foot walk), unintentional weight loss, self-reported exhaustion, and low self-reported physical activity (Physical Activity Scale for the Elderly). Prefrailty was identified when participants demonstrated one to two frailty characteristics; frailty was identified when participants demonstrated three to five frailty characteristics. RESULTS Of 180 eligible patients, 126 consented, and 125 completed screening. Thirty-nine participants (31%) were not frail, 71 (57%) were prefrail, and 15 (12%) were frail. Exhaustion was the most common frailty symptom (34%). Frailty prevalence did not significantly differ among men and women (men: 10%, women: 14%; p = 0.75). CONCLUSIONS We found a high proportion of prefrail and frail patients among patients deemed candidates for thoracic surgical procedures. This finding indicates that frailty may be underrecognized. Substantial numbers of patients may be considered for a presurgical frailty reduction intervention.
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Affiliation(s)
- Angela K Beckert
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | - Katherine Thompson
- Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Amy D Celauro
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois
| | - Jordan Williams
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois
| | - Paul Pachwicewicz
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois
| | - Mark K Ferguson
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois; Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois
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Gurven MD, Trumble BC, Stieglitz J, Yetish G, Cummings D, Blackwell AD, Beheim B, Kaplan HS, Pontzer H. High resting metabolic rate among Amazonian forager-horticulturalists experiencing high pathogen burden. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 161:414-425. [PMID: 27375044 DOI: 10.1002/ajpa.23040] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Resting metabolic rate (RMR) reflects energetic costs of homeostasis and accounts for 60 to 75% of total energy expenditure (TEE). Lean mass and physical activity account for much RMR variability, but the impact of prolonged immune activation from infection on human RMR is unclear in naturalistic settings. We evaluate the effects of infection on mass-corrected RMR among Bolivian forager-horticulturalists, and assess whether RMR declines more slowly with age than in hygienic sedentary populations, as might be expected if older adults experience high pathogen burden. MATERIALS AND METHODS RMR was measured by indirect calorimetry (Fitmate MED, Cosmed) in 1,300 adults aged 20 to 90 and TEE was measured using doubly labeled water (n = 40). Immune biomarkers, clinical diagnoses, and anthropometrics were collected by the Tsimane Health and Life History Project. RESULTS Tsimane have higher RMR and TEE than people in sedentary industrialized populations. Tsimane RMR is 18 to 47% (women) and 22 to 40% (men) higher than expected using six standard prediction equations. Tsimane mass-corrected TEE is similarly elevated compared to Westerners. Elevated leukocytes and helminths are associated with excess RMR in multivariate regressions, and jointly result in a predicted excess RMR of 10 to 15%. After age 40, RMR declines by 69 kcal/decade (p < .0001). Controlling for lean mass and height accounts for 71% of age-related RMR decline, and adding indicators of infection minimally affects the age slope. The residual level of age-related decline from age 40 is 1.2% per decade. CONCLUSION High pathogen burden may lead to higher metabolic costs, which may be offset by smaller body mass or other energy-sparing mechanisms.
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Affiliation(s)
- Michael D Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA.
| | - Benjamin C Trumble
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA
| | | | - Gandhi Yetish
- Department of Anthropology, University of New Mexico, Albuquerque, NM
| | - Daniel Cummings
- Department of Anthropology, University of New Mexico, Albuquerque, NM
| | - Aaron D Blackwell
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA
| | - Bret Beheim
- Department of Anthropology, University of New Mexico, Albuquerque, NM
| | - Hillard S Kaplan
- Department of Anthropology, University of New Mexico, Albuquerque, NM
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15
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Fried LP. Interventions for Human Frailty: Physical Activity as a Model. Cold Spring Harb Perspect Med 2016; 6:cshperspect.a025916. [PMID: 27143701 DOI: 10.1101/cshperspect.a025916] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the last 100 years, populations in developed countries have experienced an unprecedented addition of 30 years to life expectancy. Developing countries are now experiencing this same phenomenon, but over a shorter time frame. With this success comes the challenge of maximizing health and vitality across these added years. The compression of morbidity to the latest point in the human life span could unleash a sustained third demographic dividend that benefits all of society. To accomplish this, society needs to invest in the prevention and treatment of frailty, as well as in the prevention of chronic diseases at every age and stage of life. A model intervention, physical activity, may offer a road map.
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Affiliation(s)
- Linda P Fried
- Columbia University Medical Center, New York, New York 10032
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16
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Abizanda P, Romero L, Sánchez-Jurado PM, Ruano TF, Ríos SS, Sánchez MF. Energetics of Aging and Frailty: The FRADEA Study. J Gerontol A Biol Sci Med Sci 2015; 71:787-96. [PMID: 26463762 DOI: 10.1093/gerona/glv182] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 09/24/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Resting metabolic rate (RMR) and total daily energy expenditure (TDEE) decrease with aging, but it is not known whether frailty modulates this association. We hypothesize that RMR and TDEE values are similar between younger and older nonfrail older adults, whereas they are lower in older prefrail and frail compared with younger adults. METHODS A cross-sectional analysis of the FRADEA study, Albacete (Spain), including 402 participants (213 women) older than 70 years (mean age 76 years; range 70-91), was conducted. Estimated RMR (eRMR), oxygen consumption (VO2), expired volume (Ve), and respiratory frequency (RF) were determined using indirect calorimetry; TDEE was determined with the Calcumed instrument; and fat-free mass was determined by bioimpedanciometry. General linear models were used for analysis. RESULTS Mean TDEE was 1,889 (SD 470) kcal and eRMR was 1,071 (SD 323) kcal. Both TDEE (B = -24 kcal/day; 95% confidence interval: -35.4 to -14.2; p < .001) and eRMR (B= -15.8 kcal/day; 95% confidence interval: -23.1 to -8.5; p < .001) diminished linearly with age, with lower values in frail and prefrail participants. There was a strong trend between frailty and lower eRMR (F = 2.9; p = .058), with a modifying effect between age and frailty (F = 3.6; p = .002). eRMR in prefrail and frail participants were on average 160 and 114 kcal/day less than that in the nonfrail participants, respectively, and taken together, 154 kcal/day less (F = 5.4; p = .020). Frail and prefrail participants also presented lower Ve and VO2 values that were partially compensated by an RF increase. CONCLUSION Frailty status modulates the energy requirements of aging. Frail and prefrail older adults present lower eRMR than nonfrail adults.
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Affiliation(s)
- Pedro Abizanda
- Department of Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain.
| | - Luis Romero
- Department of Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain
| | - Pedro M Sánchez-Jurado
- Department of Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain
| | - Teresa Flores Ruano
- Department of Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain
| | - Sergio Salmerón Ríos
- Department of Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain
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Fabbri E, An Y, Schrack JA, Gonzalez-Freire M, Zoli M, Simonsick EM, Guralnik JM, Boyd CM, Studenski SA, Ferrucci L. Energy Metabolism and the Burden of Multimorbidity in Older Adults: Results From the Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2014; 70:1297-303. [PMID: 25409892 DOI: 10.1093/gerona/glu209] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/08/2014] [Indexed: 12/19/2022] Open
Abstract
Excessively elevated resting metabolic rate (RMR) for persons of a certain age, sex, and body composition is a mortality risk factor. Whether elevated RMR constitutes an early marker of health deterioration in older adult has not been fully investigated. Using data from the Baltimore Longitudinal Study of Aging, we hypothesized that higher RMR (i) was cross-sectionally associated with higher multimorbidity and (ii) predicted higher multimorbidity in subsequent follow-ups. The analysis included 695 Baltimore Longitudinal Study of Aging participants, aged 60 or older at baseline, of whom 248 had follow-up data available 2 years later and 109 four years later. Multimorbidity was assessed as number of chronic diseases. RMR was measured by indirect calorimetry and was tested in regression analyses adjusted for covariates age, sex, and dual-energy x-ray absorptiometry-measured total body fat mass and lean mass. Baseline RMR and multimorbidity were positively associated, independent of covariates (p = .002). Moreover, in a three-wave bivariate autoregressive cross-lagged model adjusted for covariates, higher prior RMR predicted greater future multimorbidity above and beyond the cross-sectional and autoregressive associations (p = .034). RMR higher than expected, given age, sex, and body composition, predicts future higher multimorbidity in older adults and may be used as early biomarker of impending health deterioration. Replication and the development of normative data are required for clinical translation.
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Affiliation(s)
- Elisa Fabbri
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland. Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Yang An
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jennifer A Schrack
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marta Gonzalez-Freire
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Eleanor M Simonsick
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephanie A Studenski
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Schrack JA, Knuth ND, Simonsick EM, Ferrucci L. "IDEAL" aging is associated with lower resting metabolic rate: the Baltimore Longitudinal Study of Aging. J Am Geriatr Soc 2014; 62:667-72. [PMID: 24635835 DOI: 10.1111/jgs.12740] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess the associations among age, health status, and resting metabolic rate (RMR) in a large population of older adults. DESIGN Cross-sectional analysis. SETTING Community-dwelling volunteers from the Baltimore Longitudinal Study of Aging (BLSA). PARTICIPANTS Persons aged 40 to 96 (mean 68.2 ± 11.0) who underwent a comprehensive physical examination, cognitive assessment, RMR testing, body composition assessment, and physical function testing during a 3-day clinic visit (N = 420). MEASUREMENTS Participants were assigned to Insight into the Determination of Exceptional Aging and Longevity (IDEAL) or non-IDEAL categories based on health status. IDEAL participants were defined according to the absence of physical and cognitive impairments, chronic conditions and comorbidities, and blood profile abnormalities. A three-stage linear regression model was used to assess the relationship between RMR and age, using IDEAL classification as a predictor and adjusting for sex and body composition. RESULTS Resting metabolic rate averaged 1,512.4 ± 442.9 kcal/d and was lower with older age (β = -8.55, P < .001). After adjusting for age, sex, and body composition, RMR was 109.6 kcal/d lower in IDEAL than non-IDEAL participants (P < .005). CONCLUSION Individuals who are fully functional and free of major medical conditions have lower RMR than those with disease and functional impairments. These findings suggest that health status plays a role in energy use and regulation independent of age and body composition and that elevated RMR may be a global biomarker of poor health in older persons.
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Affiliation(s)
- Jennifer A Schrack
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Kim S, Welsh DA, Ravussin E, Welsch MA, Cherry KE, Myers L, Jazwinski SM. An elevation of resting metabolic rate with declining health in nonagenarians may be associated with decreased muscle mass and function in women and men, respectively. J Gerontol A Biol Sci Med Sci 2013; 69:650-6. [PMID: 24162336 DOI: 10.1093/gerona/glt150] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Previously, we showed that FI34, a frailty index based on 34 health and function ability variables, is heritable and a reliable phenotypic indicator of healthy aging. We have now examined the relationship between major components of energy expenditure and the FI34 in participants of the Louisiana Healthy Aging Study. Resting metabolic rate was associated with FI34, even after adjustment for fat-free mass, fat mass, age, sex, thyroid hormones, and insulin-like growth factor 1 levels, in multiple regression analyses. In contrast, there was no association between total daily energy expenditure and FI34. Circulating creatine phosphokinase, a clinical marker of muscle damage, was also significantly associated with FI34. However, these associations of resting metabolic rate with FI34 were restricted to the oldest old (≥90 years) and absent in younger age groups. In oldest old men, the association of FI34 with creatine phosphokinase persisted, whereas in the oldest old women, only the association with resting metabolic rate pertained with the appearance of an effect of body size and composition. These results point toward an increasing metabolic burden for the maintenance of homeodynamics as health declines in nonagenarians, and this has implications for contraction of metabolic reserve that may potentially accelerate the path to disability.
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Affiliation(s)
- Sangkyu Kim
- Department of Medicine, Tulane Center for Aging, Tulane University Health Sciences Center, New Orleans, Louisiana.
| | - David A Welsh
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Katie E Cherry
- Department of Psychology, Louisiana State University, Baton Rouge
| | - Leann Myers
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - S Michal Jazwinski
- Department of Medicine, Tulane Center for Aging, Tulane University Health Sciences Center, New Orleans, Louisiana
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21
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Affiliation(s)
- Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Jennifer A. Schrack
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | | | - Eleanor M. Simonsick
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD
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