Resting metabolic rate and anthropometry in older people: a comparison of measured and calculated values

Parenteral nutrition-related complications in older patients with acute intestinal failure: A descriptive cohort study

INTRODUCTION

Reported outcomes for parenteral nutrition (PN)-related complications in older adult patients with acute intestinal failure who are receiving PN in the acute hospital setting are limited. Our study aims to compare PN-related complications between older and younger adult patients.

METHODS

A retrospective descriptive study of inpatients who were administered PN from January 1, 2019, to December 31, 2019, was performed. Patients were categorized into older (≥65 years old) and younger (<65 years old) adult groups.

RESULTS

Two hundred thirty-five patients were included. There were 103 patients in the older adult group (mean age: 73.9 [SD: 6.9] years) and 132 patients in the younger adult group (mean age: 52.4 [SD: 12.5] years). There was a significantly higher Charlson Comorbidity Index score and lower Karnofsky score in the older adult group. The older adult group received significantly lower total energy (20.8 [SD: 7.8] vs 22.8 [SD: 6.3] kcal/kg/day), dextrose (3.1 [SD: 1.4] vs 3.6 [SD: 1.4] g/kg/day), and protein (1.1 [SD: 0.4] vs 1.2 [SD: 0.3] g/kg/day) than the younger group received. The mean length of stay was significantly shorter in the older adult group (35.9 [SD: 21.3] vs 59.8 [SD: 55.3]; P < 0.05). There was no significant difference in PN-related complications and clinical outcomes (catheter-related bloodstream infections, hypoglycemia or hyperglycemia, fluid overload, or inpatient mortality) between the two groups.

CONCLUSION

Despite more comorbidities in the older adult, the usage of PN in older adult patients with acute intestinal failure was associated with neither an increased rate of PN-related complications nor worse clinical outcomes when compared with that of younger patients.

Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area

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.

Body composition affects the accuracy of predictive equations to estimate resting energy expenditure in older adults: An exploratory study

BACKGROUND

To investigate the accuracy of ten different predictive equations to estimate resting energy expenditure (REE) in a sample of Brazilian older adults and develop a predictive equation for estimating REE based on body composition data.

METHODS

A cross-sectional study with thirty-eight Brazilian older adults aged 60-84 years, who had their REE measured by indirect calorimetry (IC) and BC assessed by dual-energy x-ray absorptiometry (DXA). REE was compared to the estimation of ten predictive equations, and the differences between BC and anthropometric-based equations were investigated using Bland-Altman plots and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured REE.

RESULTS

The sample was composed of 57.9% men, with a mean age of 68.1 (5.8) years, and a mean REE by IC of 1528 (451) kcal. The highest accuracy was 47.4% obtained by Luhrmann and Fredrix equations, and the lowest accuracy was 13.2% reached by Weigle equation. In general, the proportion of underestimation was higher than overestimation. All anthropometric-based equations presented a good agreement with REE from IC. For those equations derived from BC, however, three of them reached only a moderate agreement. In terms of accuracy, all equations presented lower than 50% of accurate prediction of REE.

CONCLUSIONS

In this sample of older adults, previous predictive equations to estimate REE did not show good accuracy, and those based on BC presented even worse results, showing that changes in BC related to aging could impact the accuracy of these equations.

Calibration of an Accelerometer Activity Index among Older Women and Its Association with Cardiometabolic Risk Factors

Purpose

Traditional summary metrics provided by accelerometer device manufacturers, known as counts, are proprietary and manufacturer specific, making them difficult to compare studies using different devices. Alternative summary metrics based on raw accelerometry data have been introduced in recent years. However, they were often not calibrated on ground truth measures of activity-related energy expenditure for direct translation into continuous activity intensity levels. Our purpose is to calibrate, derive, and validate thresholds among women 60 years and older based on a recently proposed transparent raw data based accelerometer activity index (AAI), and to demonstrate its application in association with cardiometabolic risk factors.

Methods

We first built calibration equations for estimating metabolic equivalents (METs) continuously using AAI and personal characteristics using internal calibration data (n=199). We then derived AAI cutpoints to classify epochs into sedentary behavior and intensity categories. The AAI cutpoints were applied to 4,655 data units in the main study. We then utilized linear models to investigate associations of AAI sedentary behavior and physical activity intensity with cardiometabolic risk factors.

Results

We found that AAI demonstrated great predictive accuracy for METs (R2=0.74). AAI-based physical activity measures were associated in the expected directions with body mass index (BMI), blood glucose, and high density lipoprotein (HDL) cholesterol.

Conclusion

The calibration framework for AAI and the cutpoints derived for women older than 60 years can be applied to ongoing epidemiologic studies to more accurately define sedentary behavior and physical activity intensity exposures which could improve accuracy of estimated associations with health outcomes.

Multidomain Intervention for Reversal of Cognitive Frailty, Towards a Personalized Approach (AGELESS Trial): Study Design

Background:

Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF.

Objective:

The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention.

Methods:

A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 165). The control group (n = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use.

Results:

The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF.

Conclusion:

This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.

Prediction of resting energy expenditure in healthy older adults: A systematic review

BACKGROUND & AIMS

Estimates of energy requirements, based on measured or predicted resting energy expenditure (REE), are needed to avoid undernutrition or overnutrition (and their clinical consequences) in elderly subjects. The aims of this systematic review were to evaluate the prediction accuracy of REE in healthy elderly subjects and to ascertain which equation is more reliable at group level and/or individual level.

METHODS

Studies assessing prediction of REE in general elderly population were systematically searched using PubMed, EMBASE, Web of Science and CINAHL until March 2020. Prediction accuracy of REE was assessed at both group (bias) and individual (precision) level for each equation.

RESULTS

Fourteen studies met the inclusion criteria of this systematic review. Bias was reported in 8 papers and calculated in another 5 from absolute values. There was a prevalent tendency towards an overestimation of REE across the studies. The least bias was observed for the Mifflin (-0.3%) and Harris-Benedict (+2.6%) equations, with values above 5% for the FAO/WHO/UNU, Fredrix and Muller equations. Precision widely varied between studies for the same equation. The higher precision was observed using the Harris-Benedict equation (~70%), while the Henry and Mifflin equations provided estimates within 10% of measured values in 65% and 61% of elderly individuals, respectively.

CONCLUSIONS

None of the prediction equations considered provides accurate and precise REE estimates in healthy older adults. However, the best prediction is given by the Mifflin equation at group level and by the Harris-Benedict equation at individual level. Further studies with strong quality design are needed to evaluate the variability and accuracy of REE in the elderly general population.

The use of a portable metabolic monitoring device for measuring RMR in healthy adults

Objective measurement of RMR may be important for optimal nutritional care but is hindered by the price and practicality of the metabolic monitoring device. This study compared two metabolic monitoring devices for measuring RMR and VO2 and compared the measured RMR with the predicted RMR calculated from equations. RMR was measured using QUARK RMR (reference device) and Fitmate GS (COSMED) in a random order for 30 min, each on fasted participants. In total, sixty-eight adults participated (median age 22 years, interquartile range 21-32). Pearson correlation showed that RMR (r 0·86) and VO2 (r 0·86) were highly correlated between the two devices (P < 0·05). Intraclass correlation coefficients (ICC) showed good relative agreements regarding RMR (ICC = 0·84) and VO2 (ICC = 0·84) (P < 0·05). RMR measured by QUARK RMR was significantly higher (649 (sd 753) kJ/d) than Fitmate GS. Equations significantly overpredicted RMR. Accurate RMR (i.e. within ±10 % of the RMR measured by QUARK RMR) was found among 38 % of the participants for Fitmate GS and among 46-68 % depending on the equations. Bland-Altman analysis showed a low absolute agreement with QUARK RMR at an individual level for both Fitmate GS (limits of agreement (LOA): -828 to +2125 kJ/d) and equations (LOA ranged from -1979 to +1879 kJ/d). In conclusion, both Fitmate GS and predictive equations had low absolute agreements with QUARK RMR at an individual level. Therefore, these limitations should be considered when determining RMR using Fitmate GS or equations.

Anthropometric and dietary differences among Mexican older adults with and without adequate body image perception

OBJECTIVE

We compared anthropometric and dietary indicators between groups of older Mexican adults with accurate or inaccurate body image perception (BIP).

METHODS

A cross-sectional study was carried out with 201 older adults (age ≥ 60 years) of both sexes who completed the Stunkard scale for BIP, which consists of nine silhouettes with an equivalent of body mass index (BMI) status, then, the accuracy with their real BMI was calculated and reported energy and macronutrient intake through a 24-h dietary recall directed by different geriatric centers in Colima, Mexico. Basic anthropometry and bioelectrical impedance analyses were performed.

RESULTS

We found that 71.1% of the older adults had inaccurate BIP; 66.6% underestimated their body mass and 4.5% overestimated their body mass, the other 28.9% hat accurate BIP. The overall concordance between the real nutritional status and BIP was poor (kappa coefficient = 0.03). The inaccurate BIP group had a significantly higher mean body mass index, body fat percentage, muscle mass, and arm and calf circumference compared to the accurate BIP group (p < .001); only 4.3% of the older adults who were overweight and 6.2% who were obese had an accurate BIP. Regarding dietary consumption, we found significant differences only in energy and carbohydrate intake between the two groups. Finally, excess body fat was associated with an inaccurate BIP (OR: 2.8, 95% CI: 1.5-5.5).

CONCLUSION

In older adults, an inaccurate BIP is generally associated with high anthropometric values and less than adequate dietary intake.

Accuracy of Predictive Resting-Metabolic-Rate Equations in Chinese Mainland Adults

Accurate measurement of the resting metabolic rate (RMR) is necessary when we make energy requirements and nutrition suggestions in clinical. However, indirect calorimetry is not always available. The objectives of this study were to make a comparison between RMR measured by indirect calorimetry and RMR predicted by different kinds of equations, and to develop new predictive equations for Chinese mainland adults. In this study, 315 Chinese mainland adults from different provinces all over China were recruited. Subjects underwent half a day of testing, which consisted of anthropometric assessment and RMR measurement. Measured and predicted RMR were compared; new optimal equations for Chinese mainland adults were developed and tested by splitting the subjects into a development and validation group. The measured RMR was in the range of 831–2776 kcal/day (mean 1651 ± 339 kcal/day). Our findings indicated that, except for the Harris–Benedict and Schofield equations, three Chinese equations and two fat-free mass (FFM) modeling equations all significantly underestimated RMR compared to the measured value (all p < 0.01). There were no significant differences between predicted and measured RMR using the new equations for females and males. Of the pre-existing equations, Schofield’s is the most suitable for Chinese mainland adults. However, the two new equations developed in this study seem to be more effective for predicting the RMR of Chinese mainland adults, and need to be validated by a larger independent sample with different physiological and anthropometric characteristics.

Latent profile analysis of dietary intake in a community-dwelling sample of older Americans

Objective:

To estimate latent dietary profiles in a community-dwelling sample of older Americans and identify associations between dietary profile membership and individual demographic, socio-economic and health characteristics.

Design:

Secondary analysis of the 2012 Health and Retirement Study (HRS) and linked 2013 Health Care and Nutrition Study (HCNS). Latent profile analysis identified mutually exclusive subgroups of dietary intake and bivariate analyses examined associations between dietary profile membership, participant characteristics and nutrient intakes.

Setting:

USA.

Participants:

An analytic sample of 3558 adults aged 65 years or older.

Results:

Four dietary profiles were identified with 15·5 % of the sample having a ‘Healthy’ diet, 42·0 % consuming a ‘Western’ diet, 29·7 % having a diet consisting of high intake of all food groups and 12·7 % reporting relatively low intake of all food groups. Members of the ‘Healthy’ profile reported the greatest socio-economic resources and health, and members of the ‘Low Intake’ profile had the fewest resources and worst health outcomes. Macronutrient and micronutrient intakes varied across profile although inadequate and excessive intakes of selected nutrients were observed for all profiles.

Conclusions:

We identified dietary patterns among older Americans typified by either selective intake of foods or overall quantity of foods consumed, with those described as ‘Low Intake’ reporting the fewest socio-economic resources, greatest risk of food insecurity and the worst health outcomes. Limitations including the presence of measurement error in dietary questionnaires are discussed. The causes and consequences of limited dietary intake among older Americans require further study and can be facilitated by the HRS and HCNS.

Dietary and Physical Activity Outcomes Determine Energy Balance in U.S. Adults Aged 50-74 Years

This study identified which energy expenditure (EE) and dietary intake outcomes determine EE from doubly-labeled water (DLW) in U.S. older adults (n = 681; 45.9% male; mean age 63.2). A secondary data analysis using baseline data from The Interactive Diet and Activity Tracking in AARP (IDATA) study was conducted. Stepwise linear regressions identified predictor outcomes of EE from DLW within sexes. Outcomes included data from ActiGraph accelerometers, Community Healthy Activities Model Program for Seniors (CHAMPS) self-report activity questionnaire, Automated Self-Administered 24-hour dietary recall, Dietary History Questionnaire II (DHQ II), and resting EE. Energy expenditure by ActiGraph in males predicted EE from DLW (R² = 0.33, p < .001). EE from ActiGraph and total dietary fiber from DHQ II predicted EE from DLW in females (R² = 0.44, p < .001). The CHAMPS closely matched EE from DLW when considering resting EE. These findings can be used to assess energy balance in a non-invasive manner in older adults.

Pilot Study to Explore the Accuracy of Current Prediction Equations in Assessing Energy Needs of Patients with Newly Diagnosed Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is rare, yet it is the most common brain malignancy and has a poor prognosis. In regard to GBM, there is a dearth of research on resting energy expenditure (REE) and the accuracy of extant prediction equations. The aim of this cross-sectional study was to compare measured REE (mREE) to commonly used prediction equations in newly diagnosed GBM patients. REE was collected by indirect calorimetry in 20 GBM patients. Calculated REE was derived from Harris-Benedict (again with weight adjusted for obesity), Mifflin-St Jeor, and the 20 kcal/kg body weight ratio method. Paired t-tests and Bland-Altman analyses were used to compare group means, evaluate the bias, and find the limits of agreement. Clinical accuracy was assessed by determining the percentage of patients with predicted REE within ±10% of mREE. Subjects were evenly distributed with regard to gender, primarily Caucasian, and largely overweight or obese and had a mean age of 57 years. All equations overestimated mREE. Mifflin-St Jeor and adjusted Harris-Benedict had the narrowest limits of agreement and accurately predicted 60% and 65% of subjects, respectively. Clinicians should be aware of the discrepancy between commonly used prediction equations and REE. More research is needed to verify these findings and decipher the cause and significance in the GBM population.

Improved interpretation of studies comparing methods of dietary assessment: combining equivalence testing with the limits of agreement

The aim of this study was to demonstrate the use of testing for equivalence in combination with the Bland and Altman method when assessing agreement between two dietary methods. A sample data set, with eighty subjects simulated from previously published studies, was used to compare a FFQ with three 24 h recalls (24HR) for assessing dietary I intake. The mean I intake using the FFQ was 126·51 (sd 54·06) µg and using the three 24HR was 124·23 (sd 48·62) µg. The bias was -2·28 (sd 43·93) µg with a 90% CI 10·46, 5·89 µg. The limits of agreement (LOA) were -88·38, 83·82 µg. Four equivalence regions were compared. Using the conventional 10 % equivalence range, the methods are shown to be equivalent both by using the CI (-12·4, 12·4 µg) and the two one-sided tests approach (lower t=-2·99 (79 df), P=0·002; upper t=2·06 (79 df), P=0·021). However, we make a case that clinical decision making should be used to set the equivalence limits, and for nutrients where there are potential issues with deficiency or toxicity stricter criteria may be needed. If the equivalence region is lowered to ±5 µg, or ± 10 µg, these methods are no longer equivalent, and if a wider limit of ±15 µg is accepted they are again equivalent. Using equivalence testing, acceptable agreement must be assessed a priori and justified; this makes the process of defining agreement more transparent and results easier to interpret than relying on the LOA alone.

Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables

Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population-specific cut-off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.