1
|
Kobayashi S, Kamiya K, Miki T, Yamashita M, Noda T, Ueno K, Hotta K, Sakuraya M, Niihara M, Fukuda M, Hiki N. Association Between Changes in Skeletal Muscle Quality and Prognosis in Postoperative Patients with Early Gastric Cancer. Ann Surg Oncol 2024; 31:7722-7729. [PMID: 39154156 DOI: 10.1245/s10434-024-16012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 07/24/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Identifying accurate prognostic factors is crucial for postoperative management of early gastric cancer (EGC) patients. Skeletal muscle quality (SMQ), defined by muscle density on computed tomography (CT) images, has been proposed as a novel prognostic factor. This study compared the prognostic significance of SMQ changes with the well-established factor of body weight (BW) loss in the postoperative EGC setting. METHODS This single-center retrospective study included 297 postoperative EGC patients (median age 69 years, 68.4% male) who had preoperative and 1-year-postoperative gastrectomy CT images. SMQ was defined as the modified intramuscular adipose tissue content (mIMAC = skeletal muscle density-subcutaneous fat density on CT images) and the change as ΔmIMAC. Log-rank test, Kaplan-Meier survival, and Cox proportional hazards regression analyses were used to assess the associations between prognosis and either ΔmIMAC or BW change (ΔBW). Prognosis prediction by ΔmIMAC and ΔBW was compared by using the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS ΔmIMAC was significantly associated with prognosis (log-rank test; P = 0.037), but ΔBW was not (P = 0.243). Prognosis was significantly poorer in the severely decreased mIMAC group than in the preserved group (multivariate Cox proportional hazards regression analysis; P = 0.030) but was unaffected by BW changes (P = 0.697). The AUC indicated a higher prognostic value for ΔmIMAC than ΔBW (ΔmIMAC: AUC = 0.697, ΔBW: AUC = 0.542). CONCLUSIONS One-year post-gastrectomy SMQ changes may be better prognostic EGC predictors than BW changes.
Collapse
Affiliation(s)
- Shiho Kobayashi
- Department of Rehabilitation, Toranomon Hospital, Minato-ku, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
| | - Takashi Miki
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
- Division of Research, ARCE Inc., Sagamihara, Kanagawa, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Kazuki Hotta
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Mikiko Sakuraya
- Department of Upper Gastrointestinal Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Michinari Fukuda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan
| |
Collapse
|
2
|
Garmendia J, Labayru G, Souto Barreto PD, Vergara I, de Munain AL, Sistiaga A. Common Characteristics Between Frailty and Myotonic Dystrophy Type 1: A Narrative Review. Aging Dis 2024:AD.2024.0950. [PMID: 39325937 DOI: 10.14336/ad.2024.0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disorder often considered a model of accelerated aging due to the early appearance of certain age-related clinical manifestations and cellular and molecular aging markers. Frailty, a state of vulnerability related to aging, has been recently studied in neurological conditions but has received considerably less attention in neuromuscular disorders. This narrative review aims to describe 1) the common characteristics between Fried's frailty phenotype criteria (muscular weakness, slow gait speed, weight loss, exhaustion/fatigue, and low physical activity) and DM1, and 2) the psychological and social factors potentially contributing to frailty in DM1. This review gathered evidence suggesting that DM1 patients meet four of the five frailty phenotype criteria. Additionally, longitudinal studies report the deterioration of these criteria over time in DM1. Patients also exhibit psychological/cognitive and social factors that might contribute to frailty. Monitoring frailty criteria in the DM1 population could help to implement timely preventions and interventions to reduce the disease burden and severity of frailty symptoms.
Collapse
Affiliation(s)
- Joana Garmendia
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Garazi Labayru
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
- Neuroscience Area, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Philipe de Souto Barreto
- Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Institut Hospitalo-Universitaire (IHU) HealthAge, Toulouse, France
- CERPOP UMR 1295, Inserm, Université Paul Sabatier, Toulouse, France
| | - Itziar Vergara
- Osakidetza Health Care Directorate, PC-IHO Research Unit of Gipuzkoa, Donostia-San Sebastián, Gipuzkoa, Spain
- Primary Care Group, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Adolfo López de Munain
- Neurology Department, Donostia University Hospital, Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
- Neuroscience Area, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Andone Sistiaga
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
- Neuroscience Area, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| |
Collapse
|
3
|
Panayi AC, Heyland DK, Stoppe C, Jeschke MG, Knoedler S, Tapking C, Didzun O, Haug V, Bigdeli AK, Kneser U, Orgill DP, Hundeshagen G. Frailty as a sequela of burn injury: a post hoc analysis of the "RE-ENERGIZE" multicenter randomized-controlled trial and the National Health Interview Survey. Mil Med Res 2024; 11:63. [PMID: 39267196 PMCID: PMC11391741 DOI: 10.1186/s40779-024-00568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND With advancements in burn treatment and intensive care leading to decreased mortality rates, a growing cohort of burn survivors is emerging. These individuals may be susceptible to frailty, characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging, which significantly complicates their recovery process. To date, no study has investigated burns as a potential risk factor for frailty. This study aimed to determine the short-term prevalence of frailty among burn survivors' months after injury and compare it with that of the general population. METHODS A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury (RE-ENERGIZE) trial, an international randomized-controlled trial involving 1200 burn injury patients with partial- or full-thickness burns. Participants who did not complete the 36-Item Short Form Health Survey (SF-36) questionnaire were excluded. Data for the general population were obtained from the 2022 National Health Interview Survey (NHIS). Frailty was assessed using the FRAIL (Fatigue, Resistance, Ambulation, Illness, Loss of weight) scale. Due to lack of data on loss of weight, for the purposes of this study, malnutrition was used as the fifth variable. Illness and malnutrition were based on admission data, while fatigue, resistance, and ambulation were determined from post-discharge responses to the SF-36. The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status. Within the burn group, patients were divided into different subgroups based on their frailty status, and the differences in their (instrumental) activities of daily living (iADL and ADL) were compared. A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL. RESULTS Out of the 1200 burn patients involved in the study, 600 completed the required questionnaires [follow-up time: (5.5 ± 2.3) months] and were matched to 1200 adults from the general population in the U.S. In comparison to the general population, burn patients exhibited a significantly higher likelihood of being pre-frail (42.3% vs. 19.8%, P < 0.0001), or frail (13.0% vs. 1.0%, P < 0.0001). When focusing on specific components, burn patients were more prone to experiencing fatigue (25.8% vs. 13.5%, P < 0.0001), limited resistance (34.0% vs. 2.7%, P < 0.0001), and restricted ambulation (41.8% vs. 3.8%, P < 0.0001). Conversely, the incidence rate of illness was observed to be higher in the general population (1.2% vs. 2.8%, P = 0.03), while no significant difference was detected regarding malnutrition (2.3% vs. 2.6%, P = 0.75). Furthermore, in comparison with robust burn patients, it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL. The frail cohort reported the most pronounced limitation. CONCLUSIONS Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury. Burn survivors experience compromised fatigue, resistance, and ambulation, while rates of illness and malnutrition were lower or unchanged, respectively. These results underscore the critical need for early identification of frailty after a burn injury, with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists, community physicians, physiotherapists, nutritionists, and social workers. This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
Collapse
Affiliation(s)
- Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080, Würzburg, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, 10117, Berlin, Germany
| | - Marc G Jeschke
- Hamilton Health Sciences Research, Department of Surgery, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Oliver Didzun
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Valentin Haug
- Burns Center and Plastic Surgery, Unfallkrankenhaus Berlin, 12683, Berlin, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany.
| |
Collapse
|
4
|
Guevara E, Simó-Servat A, Perea V, Quirós C, Puig-Jové C, Formiga F, Barahona MJ. Frailty Detection in Older Adults with Diabetes: A Scoping Review of Assessment Tools and Their Link to Key Clinical Outcomes. J Clin Med 2024; 13:5325. [PMID: 39274537 PMCID: PMC11396781 DOI: 10.3390/jcm13175325] [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: 07/29/2024] [Revised: 08/26/2024] [Accepted: 09/07/2024] [Indexed: 09/16/2024] Open
Abstract
Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes.
Collapse
Affiliation(s)
- Ernesto Guevara
- Department of Geriatrics, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Verónica Perea
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Carmen Quirós
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Carlos Puig-Jové
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, University of Barcelona, 08007 Barcelona, Spain
| | - María-José Barahona
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| |
Collapse
|
5
|
Romera C, Riba M, Alsina R, Sartorio M, Vilaplana J, Pelegrí C, Del Valle J. Mouse brain contains age-dependent extraparenchymal granular structures and astrocytes, both reactive to natural IgM antibodies, linked to the fissura magna. Immun Ageing 2024; 21:56. [PMID: 39169358 PMCID: PMC11337560 DOI: 10.1186/s12979-024-00460-1] [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: 06/04/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Mouse brains can contain specific polyglucosan aggregates known as Periodic Acid-Schiff (PAS)-granules. Generated in astrocytes, these granules increase with age and exhibit neo-epitopes of carbohydrate nature that are recognized by natural IgM antibodies (IgMs). The existence of neoepitopes on PAS granules suggests the presence of neoepitopes in other brain structures, and this is investigated here. To this end, brain sections from SAMP8 and ICR-CD1 mice were examined at different ages. RESULTS We have identified two novel structures that, apart from PAS granules, are recognized by natural IgMs. On one side, IgM reactive (IgM+) granular structures which are placed in the longitudinal fissure, the quadrigeminal cistern, and a region that extends from the quadrigeminal cistern to the interpeduncular cistern. This last region, located between the telencephalon and both the mesencephalon and diencephalon, is designated henceforth as the fissura magna, as it is indeed a fissure and the largest in the brain. As all these regions are extraparenchymal (EP), the IgM+ granules found in these zones have been named EP granules. These EP granules are mainly associated with fibroblasts and are not stained with PAS. On the other side, some IgM+ astrocytes have been found in the glia limitans, near the above-mentioned fissures. Remarkably, EP granules are more prevalent at younger ages, while the number of IgM+ astrocytes increases with age, similarly to the already described evolution of PAS granules. CONCLUSIONS The present work reports the presence of two brain-related structures that, apart from PAS granules, contain neo-epitopes of carbohydrate nature, namely EP granules and IgM+ astrocytes. We suggest that EP granules, associated to fibroblasts, may be part of a physiological function in brain clearance or brain-CSF immune surveillance, while both PAS granules and IgM+ astrocytes may be related to the increasing accumulation of harmful materials that occurs with age and linked to brain protective mechanisms. Moreover, the specific localisation of these EP granules and IgM+ astrocytes suggest the importance of the fissura magna in these brain-related cleaning and immune functions. The overall results reinforce the possible link between the fissura magna and the functioning of the glymphatic system.
Collapse
Affiliation(s)
- Clara Romera
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain
- Centros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28031, Spain
| | - Marta Riba
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain
- Centros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28031, Spain
| | - Raquel Alsina
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain
- Centros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28031, Spain
| | - Marina Sartorio
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain
| | - Jordi Vilaplana
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain
- Centros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28031, Spain
| | - Carme Pelegrí
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain.
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain.
- Centros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28031, Spain.
| | - Jaume Del Valle
- Secció de Fisiologia, Departament de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de L'Alimentació, Universitat de Barcelona, Barcelona, 08028, Spain.
- Institut de Neurociències, Universitat de Barcelona, Barcelona, 08035, Spain.
- Centros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28031, Spain.
| |
Collapse
|
6
|
Castrejón-Pérez RC, Borges-Yáñez SA, Ramírez-Aldana R, Nasu I, Saito Y. Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis. Community Dent Oral Epidemiol 2024; 52:572-580. [PMID: 38509032 DOI: 10.1111/cdoe.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people. METHODS The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence. RESULTS The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]). CONCLUSION Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.
Collapse
Affiliation(s)
- Roberto C Castrejón-Pérez
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
| | - S Aída Borges-Yáñez
- Division of Postgraduate and Research Studies, School of Dentistry, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja, Logroño, Spain
- Departamento de Matemáticas, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ikuo Nasu
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja, Logroño, Spain
| | - Yasuhiko Saito
- School of Dentistry at Matsudo, Nihon University, Chiba, Japan
- College of Economics, Nihon University, Tokyo, Japan
| |
Collapse
|
7
|
Li TC, Li CI, Liu CS, Lin CH, Yang SY, Lin CC. Comparison of Mini Nutritional Assessment Tool and Geriatric Nutrition Risk Index in Predicting 12-Y Mortality Among Community-Dwelling Older Persons. J Nutr 2024; 154:2215-2225. [PMID: 38763266 PMCID: PMC11282499 DOI: 10.1016/j.tjnut.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Malnutrition is a common and dangerous condition in older adults, which has been associated with increased risk of mortality. OBJECTIVES This study aimed to evaluate and compare the abilities of Mini Nutritional Assessment short form (MNA-SF), MNA full form (MNA-FF), and geriatric nutritional risk index (GNRI) to predict all-cause and expanded cardiovascular disease (CVD)-related mortality in community-dwelling older adults. METHODS This research was an observational cohort study conducted in a community setting, with a 12-y follow-up involving 1001 community-living older adults aged 65 y or older who were enrolled in 2009 and followed up until 2021. Nutritional status assessment was carried out in 2009 using MNA-SF, MNA-FF, and GNRI. Multivariate Cox proportional hazards regression was applied to determine adjusted hazard ratios of mortality with 95% CIs. RESULTS A total of 368 deaths (36.76%) and 122 expanded CVD-related deaths (12.19%) were observed after a median follow-up of 12 y. Compared with normal nutritional status, poor nutritional status assessed by the MNA-SF, MNA-FF, and GNRI was found to be associated with an increased all-cause mortality in older persons. MNA-SF and MNA-FF, but not GNRI, were associated with expanded CVD-related mortality. The MNA-FF showed better discriminatory accuracy for all-cause (C-statistics: 0.77; 95% CI: 0.63, 0.79) and expanded CVD-related mortality (C-statistics: 0.79; 95% CI: 0.70, 0.83) than MNA-SF (C-statistics: 0.76; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.81, respectively) and GNRI (C-statistics: 0.75; 95% CI: 0.73-0.79; and C-statistics: 0.76; 95% CI: 0.72-0.80, respectively). CONCLUSIONS Our findings indicate that MNA-SF, MNA-FF, and GNRI were all independent predictors of all-cause mortality. In particular, the MNA-FF may be the best nutritional assessment tool for predicting all-cause and CVD-related mortality among older persons residing in community, compared with MNA-SF and GNRI.
Collapse
Affiliation(s)
- Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Audiology and Speech-Language Pathology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
8
|
Grabmann C, Hussain I, Zeller A, Kirnaz S, Sullivan V, Sommer F. Early Postoperative Weight-Bearing Ability after Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture. J Clin Med 2024; 13:3128. [PMID: 38892839 PMCID: PMC11172539 DOI: 10.3390/jcm13113128] [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: 09/01/2023] [Revised: 10/29/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the postoperative weight-bearing ability in the early postoperative phase is still not entirely clear. Methods: Patients who underwent either THA or BA were consecutively included in our prospective cohort study. Gait analysis was performed during the early postoperative period. The gait analysis consisted of a walking distance of 40 m coupled with the turning movement in between. During the gait analysis, the duration of the measurement, the maximum peak force and the average peak force were recorded. Results: A total of 39 patients were included, 25 of whom underwent BA and 14 of whom underwent THA. The maximum peak force during the gait analysis was, on average, 80.6% ± 19.5 of the body weight in the BA group and 78.9% ± 21.6 in the THA group. The additionally determined average peak force during the entire gait analysis was 66.8% ± 15.8 of the body weight in the BA group and 60.5% ± 15.6 in the THA group. Conclusions: Patients with femoral neck fractures undergoing THA and BA can achieve sufficient weight bearing on the operated leg in the early postoperative period. In our study, BA did not allow for a significantly higher average and maximum loading capacity compared with THA.
Collapse
Affiliation(s)
- Chiara Grabmann
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Ibrahim Hussain
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anne Zeller
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Sertac Kirnaz
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Vincent Sullivan
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Fabian Sommer
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| |
Collapse
|
9
|
Cullins MJ, Connor NP. Differential impact of unilateral stroke on the bihemispheric motor cortex representation of the jaw and tongue muscles in young and aged rats. Front Neurol 2024; 15:1332916. [PMID: 38572491 PMCID: PMC10987714 DOI: 10.3389/fneur.2024.1332916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Dysphagia commonly occurs after stroke, yet the mechanisms of post-stroke corticobulbar plasticity are not well understood. While cortical activity associated with swallowing actions is bihemispheric, prior research has suggested that plasticity of the intact cortex may drive recovery of swallowing after unilateral stroke. Age may be an important factor as it is an independent predictor of dysphagia after stroke and neuroplasticity may be reduced with age. Based on previous clinical studies, we hypothesized that cranial muscle activating volumes may be expanded in the intact hemisphere and would contribute to swallowing function. We also hypothesized that older age would be associated with limited map expansion and reduced function. As such, our goal was to determine the impact of stroke and age on corticobulbar plasticity by examining the jaw and tongue muscle activating volumes within the bilateral sensorimotor cortices. Methods Using the middle cerebral artery occlusion rat stroke model, intracortical microstimulation (ICMS) was used to map regions of sensorimotor cortex that activate tongue and jaw muscles in both hemispheres. Young adult (7 months) and aged (30 months) male F344 × BN rats underwent a stroke or sham-control surgery, followed by ICMS mapping 8 weeks later. Videofluoroscopy was used to assess oral-motor functions. Results Increased activating volume of the sensorimotor cortex within the intact hemisphere was found only for jaw muscles, whereas significant stroke-related differences in tongue activating cortical volume were limited to the infarcted hemisphere. These stroke-related differences were correlated with infarct size, such that larger infarcts were associated with increased jaw representation in the intact hemisphere and decreased tongue representation in the infarcted hemisphere. We found that both age and stroke were independently associated with swallowing differences, weight loss, and increased corticomotor thresholds. Laterality of tongue and jaw representations in the sham-control group revealed variability between individuals and between muscles within individuals. Conclusion Our findings suggest the role of the intact and infarcted hemispheres in the recovery of oral motor function may differ between the tongue and jaw muscles, which may have important implications for rehabilitation, especially hemisphere-specific neuromodulatory approaches. This study addressed the natural course of recovery after stroke; future work should expand to focus on rehabilitation.
Collapse
Affiliation(s)
- Miranda J. Cullins
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Nadine P. Connor
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
10
|
Sirakawin C, Lin D, Zhou Z, Wang X, Kelleher R, Huang S, Long W, Pires‐daSilva A, Liu Y, Wang J, Vinnikov IA. SKN-1/NRF2 upregulation by vitamin A is conserved from nematodes to mammals and is critical for lifespan extension in Caenorhabditis elegans. Aging Cell 2024; 23:e14064. [PMID: 38100161 PMCID: PMC10928581 DOI: 10.1111/acel.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 03/13/2024] Open
Abstract
Vitamin A (VA) is a micronutrient essential for the physiology of many organisms, but its role in longevity and age-related diseases remains unclear. In this work, we used Caenorhabditis elegans to study the impact of various bioactive compounds on lifespan. We demonstrate that VA extends lifespan and reduces lipofuscin and fat accumulation while increasing resistance to heat and oxidative stress. This resistance can be attributed to high levels of detoxifying enzymes called glutathione S-transferases, induced by the transcription factor skinhead-1 (SKN-1). Notably, VA upregulated the transcript levels of skn-1 or its mammalian ortholog NRF2 in both C. elegans, human cells, and liver tissues of mice. Moreover, the loss-of-function genetic models demonstrated a critical involvement of the SKN-1 pathway in longevity extension by VA. Our study thus provides novel insights into the molecular mechanism of anti-aging and anti-oxidative effects of VA, suggesting that this micronutrient could be used for the prevention and/or treatment of age-related disorders.
Collapse
Affiliation(s)
- Chaweewan Sirakawin
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Dongfa Lin
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
- Key Laboratory for Molecular Enzymology and Engineering, School of Life SciencesJilin UniversityChangchunChina
| | - Ziyue Zhou
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Xiaoxin Wang
- Shanghai Key Laboratory of Pancreatic Diseases, Institute of Translational Medicine, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | | | - Shangyuan Huang
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Weimiao Long
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | | | - Yu Liu
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| | - Jingjing Wang
- Shanghai Key Laboratory of Pancreatic Diseases, Institute of Translational Medicine, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ilya A. Vinnikov
- Laboratory of Molecular Neurobiology, Sheng Yushou Center of Cell Biology and Immunology, Department of Genetics and Developmental Biology, School of Life Sciences and BiotechnologyShanghai Jiao Tong UniversityShanghaiChina
| |
Collapse
|
11
|
Holmes R, Duan H, Bagley O, Wu D, Loika Y, Kulminski A, Yashin A, Arbeev K, Ukraintseva S. How are APOE4, changes in body weight, and longevity related? Insights from a causal mediation analysis. FRONTIERS IN AGING 2024; 5:1359202. [PMID: 38496317 PMCID: PMC10941013 DOI: 10.3389/fragi.2024.1359202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Abstract
The ε4 allele of the APOE gene (APOE4) is known for its negative association with human longevity; however, the mechanism is unclear. APOE4 is also linked to changes in body weight, and the latter changes were associated with survival in some studies. Here, we explore the role of aging changes in weight in the connection between APOE4 and longevity using the causal mediation analysis (CMA) approach to uncover the mechanisms of genetic associations. Using the Health and Retirement Study (HRS) data, we tested a hypothesis of whether the association of APOE4 with reduced survival to age 85+ is mediated by key characteristics of age trajectories of weight, such as the age at reaching peak values and the slope of the decline in weight afterward. Mediation effects were evaluated by the total effect (TE), natural indirect effect, and percentage mediated. The controlled direct effect and natural direct effect are also reported. The CMA results suggest that APOE4 carriers have 19%-22% (TE p = 0.020-0.039) lower chances of surviving to age 85 and beyond, in part, because they reach peak values of weight at younger ages, and their weight declines faster afterward compared to non-carriers. This finding is in line with the idea that the detrimental effect of APOE4 on longevity is, in part, related to the accelerated physical aging of ε4 carriers.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| |
Collapse
|
12
|
Qian S, Zhang S, Lu M, Chen S, Liu L, Liu S, Jiang F, Zhang J. The accuracy of screening tools for sarcopenia in older Chinese adults: a systematic review and meta-analysis. Front Public Health 2024; 12:1310383. [PMID: 38375338 PMCID: PMC10876058 DOI: 10.3389/fpubh.2024.1310383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024] Open
Abstract
Objective This review aimed to analyze and compare the accuracy of eight screening tools for sarcopenia in older Chinese adults according to different diagnostic criteria. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched between the publication of the first expert consensus on sarcopenia in 2010 and April 2023 using relevant MeSH terms. We evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The pooled result of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and plot the summary receiver operating characteristic curve (SROC) were calculated by using a bivariate random-effects model. The accuracies of sensitivity and specificity of the screening tools were compared using the Z-test. Results A total of 30 studies (23,193 participants) were included, except for calf circumference (CC), Ishii, and Finger-ring Test; Screening tools for sarcopenia in older Chinese adults have consistently shown low to moderate sensitivity and moderate to high specificity. Regional and sex differences affect the accuracy of the screening tools. In terms of sensitivity and specificity, the CC, Ishii, and Finger-ring Test were superior to the other screening tools. Conclusion The Asian Working Group on Sarcopenia (AWGS) 2019 criteria are more appropriate for the diagnosis of sarcopenia in older Chinese adults. According to the AWGS 2019, CC and Ishii are recommended for sarcopenia screening in older Chinese adults.
Collapse
Affiliation(s)
- Siyu Qian
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Siqing Zhang
- School of Physical Education, Huazhong University of Science and Technology, Wuhan, China
| | - Mengchen Lu
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Shuhang Chen
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Liyao Liu
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Siqi Liu
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Fanglin Jiang
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Jisheng Zhang
- School of Physical Education, Hunan Normal University, Changsha, China
| |
Collapse
|
13
|
Ogawa M, Okamura M, Inoue T, Sato Y, Momosaki R, Maeda K. Relationship between nutritional status and clinical outcomes among older individuals using long-term care services: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 59:365-377. [PMID: 38220398 DOI: 10.1016/j.clnesp.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Nutritional status is a significant issue in an aging society; however, the impact of the nutritional status of older individuals using long-term care services on the caregiving burden remains unclear. This systematic review and meta-analysis aimed to investigate the impact of nutritional issues on adverse outcomes in older individuals using long-term care services. METHODS We used data from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science, CINAHL, and Ichu-shi Web databases. Original articles published in English or Japanese between January 2000 and July 2022 were included. The inclusion criteria were interventional and observational studies on individuals using long-term care services with aged ≥65 years and a focus on body weight or weight loss. Data on adverse outcomes related to caregiving burden, including the number of people requiring care, mortality, complications, activities of daily living (ADL), and quality of life, were collected. RESULTS The literature search yielded 7873 studies, of which 35 were ultimately included. Seven observational studies investigated mortality outcomes, and seven examined ADL outcomes. The meta-analysis revealed significantly higher mortality rates in individuals classified as underweight (BMI <18.5 kg/m2) than in those with BMI ≥18.5 kg/m2 (risk ratio [RR] 1.49; 95 % confidence interval [CI] 1.31 to 1.73, 0.22; I2 93 %). Further, on categorising the participants based on a BMI cutoff of 25 kg/m2, those with a BMI of <25 kg/m2 had a significantly increased mortality rate (RR 1.21; 95 % CI 1.04-1.40; I2 = 98 %). BMI and weight loss did not affect ADL. CONCLUSIONS Our findings indicate that underweight and weight loss are significantly associated with increased mortality in older individuals using long-term care services. Therefore, appropriate weight management is recommended for this population. However, further research is necessary owing to the high heterogeneity observed in this study.
Collapse
Affiliation(s)
- Masato Ogawa
- Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
| |
Collapse
|
14
|
Wadhwa A, Balbale SN, Palleti SK, Samra M, Lopez-Soler RI, Stroupe KT, Markossian TW, Huisingh-Scheetz M. Prevalence and feasibility of assessing the frailty phenotype among hemodialysis patients in a dialysis unit. BMC Nephrol 2023; 24:371. [PMID: 38093284 PMCID: PMC10720194 DOI: 10.1186/s12882-023-03413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Frailty increases risk of morbidity and mortality in hemodialysis patients. Frailty assessments could trigger risk reduction interventions if broadly adopted in clinical practice. We aimed to assess the clinical feasibility of frailty assessment among Veteran hemodialysis patients. METHODS Hemodialysis patients' ≥50 years were recruited from a single dialysis unit between 9/1/2021 and 3/31/2022.Patients who consented underwent a frailty phenotype assessment by clinical staff. Five criteria were assessed: unintentional weight loss, low grip strength, self-reported exhaustion, slow gait speed, and low physical activity. Participants were classified as frail (3-5 points), pre-frail (1-2 points) or non-frail (0 points). Feasibility was determined by the number of eligible participants completing the assessment. RESULTS Among 82 unique dialysis patients, 45 (52%) completed the assessment, 13 (16%) refused, 18 (23%) were not offered the assessment due to death, transfers, or switch to transplant or peritoneal dialysis, and 6 patients were excluded because they did not meet mobility criteria. Among assessed patients, 40(88%) patients were identified as pre-frail (46.6%) or frail (42.2%). Low grip strength was most common (90%). Those who refused were more likely to have peripheral vascular disease (p = 0.001), low albumin (p = 0.0187), low sodium (p = 0.0422), and ineligible for kidney transplant (p = 0.005). CONCLUSIONS Just over half of eligible hemodialysis patients completed the frailty assessment suggesting difficulty with broad clinical adoption expectations. Among those assessed, frailty and pre-frailty prevalence was high. Given patients who were not tested were clinically high risk, our reported prevalence likely underestimates true frailty prevalence. Providing frailty reduction interventions to all hemodialysis patients could have high impact for this group.
Collapse
Affiliation(s)
- Anuradha Wadhwa
- Department of Medicine/ Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA.
- Department of Medicine/ Nephrology, Loyola University Chicago, Maywood, IL, USA.
| | - Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Sujith K Palleti
- Department of Medicine/ Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
- Department of Medicine/ Nephrology, Loyola University Chicago, Maywood, IL, USA
| | - Manpreet Samra
- Department of Medicine/ Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
- Department of Medicine/ Nephrology, Loyola University Chicago, Maywood, IL, USA
| | - Reynold I Lopez-Soler
- Department of Surgery and Renal Transplant, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
- Department of Surgery and Renal Transplant, Loyola University Chicago, Maywood, IL, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Public Health Sciences, Parkinson School of Health Science and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Talar W Markossian
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Public Health Sciences, Parkinson School of Health Science and Public Health, Loyola University Chicago, Maywood, IL, USA
| | | |
Collapse
|
15
|
Castrejón-Pérez RC, Wanyonyi KL, García-Vázquez PE, Cruz-Hervert LP, Ramírez-Aldana R, Borges-Yáñez SA. Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis. Gerodontology 2023; 40:372-381. [PMID: 36358062 DOI: 10.1111/ger.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people. BACKGROUND Studies suggest that the association between frailty and oral conditions are mediated by nutrition. MATERIALS AND METHODS This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome. RESULTS Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index. CONCLUSION Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.
Collapse
Affiliation(s)
| | | | - Paola E García-Vázquez
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luis Pablo Cruz-Hervert
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
| | - S Aída Borges-Yáñez
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| |
Collapse
|
16
|
Li G, Pan Y. Can the Frailty of Older Adults in China Change? Evidence from a Random-Intercept Latent Transition Profile Analysis. Behav Sci (Basel) 2023; 13:723. [PMID: 37754001 PMCID: PMC10525735 DOI: 10.3390/bs13090723] [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: 06/27/2023] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A major aspect of caring for older adults in the medical field is addressing their health risks. The term "frailty" is generally used to describe the changes in health risks of older adults. Although there is considerable heterogeneity in the Chinese older adult population who are classified as frail, there remain few relevant studies. Furthermore, there is a lack of research on the frailty status transitions of older Chinese adults at different time points. This research intends to determine the frailty status and category of older adults according to their physical, psychological, social, and cognitive function domains, and on this basis, to investigate changes in their frailty states. METHODS This article studied 2791 respondents who were over 60 years old (n = 2791; 53.2% were women) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) follow-up survey on factors affecting the health of older adults in China. In this article, the frailty variables include self-reported health, social function, mental health, cognitive function, functional limitations, and morbidity status. Random-intercept latent transition profile analysis (RI-LTPA) was used to divide older adults into different subgroups, and then an in-depth analysis of the state transitions was conducted. RESULTS The latent profile analysis revealed that the evaluation results of the frailty state of older adults showed obvious group heterogeneity. Each fitting index supported four latent states, which were named according to the degree of the symptoms (i.e., multi-frailty, severe socially frailty, mild socially frailty, and relatively healthy frailty). Based on the categorical probability and the probability of transition, it can be concluded that most of the samples belonged to the healthy population, and the health status had generally improved across the four time points. The relatively healthy frailty group and the severe socially frailty group have relatively strong stabilities. The multi-frailty group and the mild socially frailty group had the highest probability of joining to the relatively healthy frailty group. Strengthening social interactions among older adults and promoting their participation in social activities can significantly improve their frail state. CONCLUSIONS This study supplements related research on frailty. Firstly, it deepens the meaning of frailty, which is defined based on four aspects: physical, psychological, cognitive, and social functioning. Secondly, it divides frailty into different sub-categories. Frailty is discussed from the perspective of longitudinal research, which can provide practical adjustment suggestions for older adult nursing intervention systems and measures in China.
Collapse
Affiliation(s)
- Guangming Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou 510631, China
- School of Psychology, Center for Studies of Psychological Application and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Yuxi Pan
- School of Psychology, Center for Studies of Psychological Application and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| |
Collapse
|
17
|
Khan J, Chattopadhyay A, Shaw S. Assessment of nutritional status using anthropometric index among older adult and elderly population in India. Sci Rep 2023; 13:13015. [PMID: 37563173 PMCID: PMC10415320 DOI: 10.1038/s41598-023-39167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Malnutrition poses a significant risk to the older population globally, highlighting the critical role of nutrition in healthy aging. In this study, the aim is to estimate the prevalence of malnutrition among older adults aged 45-59 years and the elderly population aged 60 years and above based on their socioeconomic and demographic characteristics. Furthermore, the study examines the risk factors within a multivariate framework. A sample of 59,073 individuals aged 45 years and above from the Longitudinal Aging Study in India (LASI), Wave 1 survey constitutes the study population. This study adopts a cross-sectional design. Bivariate cross-tabulation analysis and multivariate logistic regression analysis are employed to understand the prevalence and determinants of nutritional status. About 25% of males and 37% of females below the age of 60 years are overweight (including obese), while among those aged 60 years and above, 28% of males and 25% of females are underweight. The elderly male population carries a comparatively higher burden of underweight (28%) prevalence than the females (25%) in the same age group. Overall, the urban population is less likely to be underweight [AOR: 0.41, C.I 0.38-0.43] and more likely to be overweight [AOR: 2.41, C.I 2.32-2.52]. Older adults from low economic and social strata are more likely to be underweight. In terms of bio-physical factors, individuals aged 60 years and above with infections to endemic diseases [AOR: 1.24; p-value < 0.01] and those with edentulism [AOR: 1.29; p-value < 0.01] are more likely to be underweight. As evident from the study, nutritional status among older adults is a complicated manifestation of multiple risk factors and requires potential nutritional intervention. Initiating a routine screening program at the grassroots level can effectively identify older adults and the elderly in India, facilitating the provision of nutritional care.
Collapse
Affiliation(s)
- Junaid Khan
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Aparajita Chattopadhyay
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Subhojit Shaw
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
| |
Collapse
|
18
|
Zupo R, Donghia R, Castellana F, Bortone I, De Nucci S, Sila A, Tatoli R, Lampignano L, Sborgia G, Panza F, Lozupone M, Colacicco G, Clodoveo ML, Sardone R. Ultra-processed food consumption and nutritional frailty in older age. GeroScience 2023; 45:2229-2243. [PMID: 36826622 PMCID: PMC10651811 DOI: 10.1007/s11357-023-00753-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Frailty is a multidisciplinary public health issue and nutrition is key concern. Given the scientific consistency about inflammation as shared pathway to poor nutrition and frailty, food processing seems a suitable target to gain evidence in frailty prevention nutrition settings. This study aimed to assess diet in relation to nutritional frailty using the NOVA classification. Browsing the dataset of the Salus in Apulia, 2185 older adults were found to have completed the nutritional assessment, providing eligible data for this study goal. A validated construct, based on the co-presence of physical frailty by CHS criteria plus nutritional imbalance, was applied to characterize nutritional frailty phenotypes. Using the NOVA classification, daily food and beverage intakes from an 85-item self-administered FFQ were assigned to three categories, and effect sizes were tested among groups according to nutritional frailty status (presence/absence). Raw and adjusted logistic regression models were run to assess associations between NOVA food categories by quintiles of daily exposure (very-low, low, mild, moderate, high) and nutritional frailty. Nutritional frailty prevalence was 27%, being more frequent in males. Eating more unprocessed or minimally processed foods was inversely related to nutritional frailty, even after adjustment (OR: 0.10, 95%CI 0.07-0.16), showing a downward ORs behavior toward lower consumption quintiles. Listing in the quintile of moderate consumption of processed foods meant a nearly 50% increase in nutritional frailty probability (OR: 1.46, 95%CI 1.03-2.06), while the probability was double for the highest quintile against the lowest (OR: 3.22, 95%CI 2.27-4.58). A growing probability of nutritional frailty was found for increasing consumption of ultra-processed foods, but significance was lacking. The contribution of food processing to poor nutrition needs to be considered when promoting a better understanding of effective nutritional screening in aging. Therefore, food processing should be accounted for when composing diet guidelines for the older population within the framework of multidisciplinary efforts to ease the frailty healthcare burden.
Collapse
Affiliation(s)
- Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Rossella Donghia
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Ilaria Bortone
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Sara De Nucci
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Annamaria Sila
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Rossella Tatoli
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Luisa Lampignano
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Giancarlo Sborgia
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Panza
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Colacicco
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari Aldo Moro, Bari, Italy
| | - Maria Lisa Clodoveo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
- Local Healthcare Authority of Taranto, Taranto, Italy
| |
Collapse
|
19
|
Yamagishi S, Okamura Y, Kang W, Shindate M, Kochi M, Mitsuka Y, Watabe M, Yoshida N, Ikarashi M, Yamazaki S, Aramaki O, Nakayama H, Moriguchi M, Higaki T, Yamashita H. Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy. Dig Surg 2023; 40:143-152. [PMID: 37527628 DOI: 10.1159/000531797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy. METHODS This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher. RESULTS Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010). CONCLUSION Sarcopenic obesity is an independent risk factor for severe postoperative complications.
Collapse
Affiliation(s)
- Shunsuke Yamagishi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan,
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Woodae Kang
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan
| | - Masataka Shindate
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mitsuka
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Megumu Watabe
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masahito Ikarashi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroharu Yamashita
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Kim N, Kim GS, Won CW, Lee JJ, Park MK, Shin J, Kim M. Two-year longitudinal associations between nutritional status and frailty in community-dwelling older adults: Korean Frailty and Aging Cohort Study. BMC Geriatr 2023; 23:216. [PMID: 37020292 PMCID: PMC10074647 DOI: 10.1186/s12877-023-03903-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Korea is expected to become a super-aged society in 2026, and improving nutritional status, which is directly related to health problems, is therefore important for increasing healthy life expectancy. Frailty is the most complex phenotype of aging, and leads to adverse health outcomes, disability, poor quality of life, hospitalization, and mortality. Malnutrition is a major risk factor for frailty syndrome. This study aimed to investigate the incidence of pre-frailty or frailty in the second wave (T2, 2018-2019) according to general characteristics and nutritional status in the first wave (T1, 2016-2017); and examine the longitudinal association of nutritional status in T1 and the incidence of pre-frailty or frailty in T2 among older adults living in a community. METHODS A secondary data analysis was performed using the Korean Frailty and Aging Cohort Study (KFACS). Participants comprised 1125 community-dwelling older Korean adults aged 70-84 years (mean age: 75.03 ± 3.56 years; 53.8% males). Frailty was assessed using the Fried frailty index, and nutritional status was assessed using the Korean version of the Mini Nutritional Assessment Short-Form and blood nutritional biomarkers. Binary logistic regression was used to identify longitudinal associations between the nutritional status at T1 and pre-frailty or frailty at T2. RESULTS Over the two-year follow-up period, 32.9% and 1.7% of the participants became pre-frail and frail, respectively. After the potential confounders were adjusted (sociodemographic, health behaviors, and health status characteristics), pre-frailty or frailty had a significant longitudinal association with severe anorexia (adjusted odds ratio [AOR], 4.17; 95% confidence interval [CI], 1.05-16.54), moderate anorexia (AOR, 2.31; 95% CI, 1.46-3.64), psychological stress or acute disease (AOR, 2.61; 95% CI, 1.26-5.39), and body mass index (BMI) less than 19 (AOR, 4.11; 95% CI, 1.20-14.04). CONCLUSIONS Anorexia, psychological stress, acute disease, and low BMI are the most significant longitudinal risk factors for pre-frailty or frailty in older adults. As nutritional risk factors may be preventable or modifiable, it is important to develop interventions targeting the same. Community-based health professionals in health-related fields should recognize and manage these indicators appropriately to prevent frailty among older adults living in the community.
Collapse
Affiliation(s)
- Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, 26, Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, Republic of Korea.
| | - Jae Jun Lee
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Jinhee Shin
- College of Nursing, Woosuk University, Jeollabuk-Do, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
21
|
Bart NK, Powell A, Macdonald PS. The role of frailty in advanced HF and cardiac transplantation. Front Cardiovasc Med 2023; 10:1082371. [PMID: 37077743 PMCID: PMC10106718 DOI: 10.3389/fcvm.2023.1082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Frailty is a complex, multi-system condition often associated with multimorbidity. It has become an important prognostic maker across a range of conditions and is particularly relevant in patients with cardiovascular disease. Frailty encompasses a range of domains including, physical, psychological, and social. There are currently a range of validated tools available to measure frailty. It is an especially important measurement in advanced HF, because frailty occurs in up to 50% of HF patients and is potentially reversible with therapies such as mechanical circulatory support and transplantation. Moreover, frailty is dynamic, and therefore serial measurements are important. This review delves into the measurement of frailty, mechanisms, and its role in different cardiovascular cohorts. Understanding frailty will help determine patients that will benefit from therapies, as well as prognosticate outcomes.
Collapse
Affiliation(s)
- Nicole K. Bart
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- Correspondence: Nicole K. Bart
| | - Alice Powell
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Peter S. Macdonald
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| |
Collapse
|
22
|
Dibello V, Lobbezoo F, Lozupone M, Sardone R, Ballini A, Berardino G, Mollica A, Coelho-Júnior HJ, De Pergola G, Stallone R, Dibello A, Daniele A, Petruzzi M, Santarcangelo F, Solfrizzi V, Manfredini D, Panza F. Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review. GeroScience 2023; 45:663-706. [PMID: 36242694 PMCID: PMC9886742 DOI: 10.1007/s11357-022-00663-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023] Open
Abstract
A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.
Collapse
Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Madia Lozupone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario Ernesto Quagliariello, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Berardino
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Anita Mollica
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Hélio José Coelho-Júnior
- School of Physical Education, University of Campinas, Cidade Universitaria Zeferino Vaz, Barao Geraldo, Campinas, Brazil
| | - Giovanni De Pergola
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Roberta Stallone
- Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy
| | - Antonio Dibello
- Accident and Emergency Department (AED), F. Perinei Hospital, Altamura, Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, Section of Dentistry, University of Bari Medical School, Bari, Italy
| | | | - Vincenzo Solfrizzi
- Cesare Frugoni Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy.
| |
Collapse
|
23
|
Ketchem JM, Bowman EJ, Isales CM. Male sex hormones, aging, and inflammation. Biogerontology 2023; 24:1-25. [PMID: 36596999 PMCID: PMC9810526 DOI: 10.1007/s10522-022-10002-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/15/2022] [Indexed: 01/05/2023]
Abstract
Adequate levels of androgens (eugonadism), and specifically testosterone, are vital compounds for male quality of life, longevity, and positive health outcomes. Testosterone exerts its effects by binding to the androgen receptor, which is expressed in numerous tissues throughout the body. Significant research has been conducted on the impact of this steroid hormone on skeletal, muscle and adipose tissues and on the cardiovascular, immune, and nervous systems. Testosterone levels have also been studied in relation to the impact of diseases, aging, nutrition and the environment on its circulating levels. Conversely, the impact of testosterone on health has also been evaluated with respect to its cardiac and vascular protective effects, body composition, autoimmunity and all-cause mortality. The male aging process results in decreasing testosterone levels over time. The exact mechanisms and impact of these changes in testosterone levels with age on health- and life-span are still not completely clear. Further research is needed to determine the optimal testosterone and androgen levels to protect from chronic age-related conditions such as frailty and osteoporosis.
Collapse
Affiliation(s)
- Justin M. Ketchem
- grid.410427.40000 0001 2284 9329Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | | | - Carlos M. Isales
- grid.410427.40000 0001 2284 9329Departments of Medicine, Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA 30912 USA
| |
Collapse
|
24
|
Levitt DE, Simon L, Lin HY, Siggins RW, Ferguson TF, Molina PE, Welsh DA. Alcohol use, physical activity, and muscle strength moderate the relationship between body composition and frailty risk among people living with HIV. Alcohol Clin Exp Res 2022; 46:2041-2053. [PMID: 36124866 PMCID: PMC10801810 DOI: 10.1111/acer.14941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiretroviral therapy has improved life expectancy among people living with HIV (PLWH). Despite increased longevity, PLWH are at increased risk of age-related comorbidities, including frailty. We examined the relationship between body composition and frailty among PLWH, and moderation of this relationship by substance use, physical activity (PA), and physical function. METHODS Participants (n = 341; 71% male, 48 ± 10 years, body mass index (BMI) = 27.3 ± 7.0 kg/m2 ) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study underwent measures of body composition, muscle strength, and gait speed. Whole blood phosphatidylethanol (PEth) was measured, and substance use and PA were self-reported. Frailty risk measures included the 58-Item Deficit Index (DI58) and the Veterans Aging Cohort Study (VACS) Index 1.0, where higher scores indicate greater frailty risk. RESULTS Multivariable linear regression adjusted for age, sex, and race showed that higher fat-free mass index (FFMI), body fat (%), waist-to-hip ratio, and body mass index (BMI) ≥ 25.0 kg/m2 vs. < 25.0 kg/m2 were significantly (p < 0.05) associated with decreased frailty risk measured by the VACS Index, whereas adjusted analyses showed no association between body composition variables and the DI58 score. Recent alcohol use, muscle strength, and PA, but not lifetime alcohol use or gait speed, significantly moderated associations between body composition variables and frailty risk with medium-to-large effect sizes. Subgroup analyses revealed a negative relationship between DI58 and FFMI among people with PEth > 8 ng/ml and negative relationships of VACS Index with FFMI and WHR in people with lower muscle strength. Overweight or obese BMI categories were positively associated with DI58 in people with lower muscle strength or higher PA level but negatively associated in those with higher muscle strength. CONCLUSIONS Our findings indicate that body composition has significant modulatory effects on frailty risk in PLWH, where obesity increases the risk of frailty and greater muscle mass may be protective, even in individuals who use alcohol. These results highlight the importance of considering body composition, physical activity, and physical function in assessing frailty risk in PLWH, particularly among individuals who use alcohol. Moreover, they support the implementation of physical activity interventions to ameliorate the risk of frailty in aging PLWH.
Collapse
Affiliation(s)
- Danielle E. Levitt
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Liz Simon
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Hui-Yi Lin
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Robert W. Siggins
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tekeda F. Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patricia E. Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David A. Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Internal Medicine, Section of Pulmonary/Critical Care, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
25
|
Amitani H, Chiba S, Amitani M, Michihara S, Takemoto R, Han L, Fujita N, Takahashi R, Inui A. Impact of Ninjin’yoeito on frailty and short life in klotho-hypomorphic (kl/kl) mice. Front Pharmacol 2022; 13:973897. [DOI: 10.3389/fphar.2022.973897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
With the recent aging of society, the prevention of frailty has become an important issue because people desire both a long and healthy lifespan. Klotho-hypomorphic (kl/kl) mice are known to show phenotypes of premature aging. Ninjin’yoeito (NYT) is a traditional Japanese Kampo medicine used to treat patients with vulnerable constitution, fatigue or physical exhaustion caused by aging and illness. Recent studies have reported the potential efficacy of NYT against frailty. We therefore evaluated the effect of NYT on the gait function, activity, the histopathological status of organs and survival using kl/kl mice as a model of aging-related frailty. Two sets of 28-day-old male kl/kl mice were assigned to the vehicle (non-treated; NT), 3% or 5% NYT dietary groups. One set of groups (NT, n = 18; 3% NYT, n = 11; 5% NYT, n = 11) was subjected to the analysis of free walking, rotarod, and spontaneous activity tests at approximately 58 days old. Thereafter, we measured triceps surae muscles weight and myofiber cross-sectional area (CSA), and quantified its telomere content. In addition, we evaluated bone strength and performed histopathological examinations of organs. Survival was measured in the second set of groups (NT, 3% NYT and 5% NYT group, n = 8 each). In the walking test, several indicators such as gait velocity were improved in the NYT 3% group. Similar results were obtained for the latency to fall in the rotarod test and spontaneous motor activity. Triceps muscle mass, CSA and its telomere content were significantly improved in the NYT 3% group. Bone density, pulmonary alveolus destruction and testicular atrophy were also significantly improved in the NYT 3% group. Survival rate and body weight were both significantly improved in the NYT3% group compared with those in the NT group. Continuous administration of NYT from the early stage of aging improved not only gait performance, but also the survival in the aging-related frailty model. This effect may be associated with the improvements in aging-related organ changes such as muscle atrophy. Intervention with NYT against the progression of frailty may contribute to a longer, healthier life span among the elderly individuals.
Collapse
|
26
|
Douzi W, Bon D, Suikkanen S, Soukkio P, Boildieu N, Nenonen A, Hupli M, Kukkonen-Harjula K, Dugué B. 1H NMR Urinary Metabolomic Analysis in Older Adults after Hip Fracture Surgery May Provide Valuable Information for Patient Profiling-A Preliminary Investigation. Metabolites 2022; 12:metabo12080744. [PMID: 36005617 PMCID: PMC9415398 DOI: 10.3390/metabo12080744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.
Collapse
Affiliation(s)
- Wafa Douzi
- Laboratoire «Mobilité, Vieillissement, Exercice (MOVE)—UR 20296», Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, 86000 Poitiers, France
| | - Delphine Bon
- INSERM U1313, (IRMETIST), Poitiers, France and Faculty of Medicine and Pharmacy, University of Poitiers, 86000 Poitiers, France
| | - Sara Suikkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, 53130 Lappeenranta, Finland
| | - Paula Soukkio
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Nadège Boildieu
- INSERM U1313, (IRMETIST), Poitiers, France and Faculty of Medicine and Pharmacy, University of Poitiers, 86000 Poitiers, France
| | - Arja Nenonen
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Markku Hupli
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Katriina Kukkonen-Harjula
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Benoit Dugué
- Laboratoire «Mobilité, Vieillissement, Exercice (MOVE)—UR 20296», Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, 86000 Poitiers, France
- Correspondence: ; Tel.: +33-549-454-040; Fax: +33-549-453-396
| |
Collapse
|
27
|
Kamiya A, Hayashi T, Sakon R, Ishizu K, Wada T, Otsuki S, Yamagata Y, Katai H, Yoshikawa T. Long-term postoperative pneumonia in elderly patients with early gastric cancer. BMC Surg 2022; 22:220. [PMID: 35672847 PMCID: PMC9175355 DOI: 10.1186/s12893-022-01670-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pneumonia is a major cause of death in the elderly population. Considering body weight loss, muscle loss, and reflux after gastrectomy, elderly patients are considered to be at very high risk for pneumonia, which could decrease overall survival because early gastric cancer is mostly curable only by surgery. We aimed to clarify the incidence of pneumonia in the long-term period after gastrectomy in elderly patients who were diagnosed with early gastric cancer and its risk factors. Methods We retrospectively examined patients of > 75 years of age who underwent R0 gastrectomy for gastric cancer and who were diagnosed with T1 disease at National Cancer Center Hospital between 2005 and 2012. Long-term postoperative pneumonia was diagnosed by chest computed tomography every year until 2 years after surgery. The presence of preoperative sarcopenia was assessed using preoperative L3 skeletal muscle index. Results 167 patients were included in this study. Long-term postoperative pneumonia was observed in 44 (26%) patients. Of the 44 people diagnosed with long-term postoperative pneumonia, 33 were diagnosed in the 1st year and 11 in the 2nd year. 117 patients (70%) were diagnosed with sarcopenia which was significantly frequently found in the patients who developed long-term postoperative pneumonia (91%) than those without (63%). Preoperative sarcopenia was the only independent risk factor in multivariate analysis. Type of gastrectomy was not a significant risk factor. Conclusions Long-term postoperative pneumonia was frequently observed in the elderly patients. Preoperative sarcopenia was associated with long-term postoperative pneumonia in elderly patients who underwent curative surgery for gastric cancer. After gastrectomy, long-term special care would be required for elderly patients, especially with sarcopenia.
Collapse
Affiliation(s)
- Ayako Kamiya
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tsutomu Hayashi
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ryota Sakon
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kenichi Ishizu
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeyuki Wada
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sho Otsuki
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukinori Yamagata
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hitoshi Katai
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| |
Collapse
|
28
|
Zupo R, Castellana F, De Nucci S, Sila A, Aresta S, Buscemi C, Randazzo C, Buscemi S, Triggiani V, De Pergola G, Cava C, Lozupone M, Panza F, Sardone R. Role of Dietary Carotenoids in Frailty Syndrome: A Systematic Review. Biomedicines 2022; 10:632. [PMID: 35327434 PMCID: PMC8945528 DOI: 10.3390/biomedicines10030632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023] Open
Abstract
Unbalanced diets and altered micronutrient intake are prevalent in the aging adult population. We conducted a systematic review to appraise the evidence regarding the association between single (α-carotene, β-carotene, lutein, lycopene, β-cryptoxanthin) or total carotenoids and frailty syndrome in the adult population. The literature was screened from study inception to December 2021, using six different electronic databases. After establishing inclusion criteria, two independent researchers assessed the eligibility of 180 retrieved articles. Only 11 fit the eligibility requirements, reporting five carotenoid entries. No exclusion criteria were applied to outcomes, assessment tools, i.e., frailty constructs or surrogates, recruitment setting, general health status, country, and study type (cohort or cross-sectional). Carotenoid exposure was taken as either dietary intake or serum concentrations. Cross-sectional design was more common than longitudinal design (n = 8). Higher dietary and plasma levels of carotenoids, taken individually or cumulatively, were found to reduce the odds of physical frailty markedly, and the evidence showed consistency in the direction of association across all selected studies. Overall, the methodological quality was rated from moderate (27%) to high (73%). Prevention of micronutrient deficiencies has some potential to counteract physical decline. Considering carotenoids as biological markers, when monitoring micronutrient status, stressing increased fruit and vegetable intake may be part of potential multilevel interventions to prevent or better manage disability.
Collapse
Affiliation(s)
- Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (F.C.); (S.D.N.); (A.S.); (S.A.); (R.S.)
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (F.C.); (S.D.N.); (A.S.); (S.A.); (R.S.)
| | - Sara De Nucci
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (F.C.); (S.D.N.); (A.S.); (S.A.); (R.S.)
| | - Annamaria Sila
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (F.C.); (S.D.N.); (A.S.); (S.A.); (R.S.)
| | - Simona Aresta
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (F.C.); (S.D.N.); (A.S.); (S.A.); (R.S.)
| | - Carola Buscemi
- Department of Health Promotion, Maternal and Child Health, Internal and Specialty Medicine of Excellence (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.B.); (C.R.); (S.B.)
| | - Cristiana Randazzo
- Department of Health Promotion, Maternal and Child Health, Internal and Specialty Medicine of Excellence (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.B.); (C.R.); (S.B.)
| | - Silvio Buscemi
- Department of Health Promotion, Maternal and Child Health, Internal and Specialty Medicine of Excellence (PROMISE), University of Palermo, 90127 Palermo, Italy; (C.B.); (C.R.); (S.B.)
- Unit of Gastroenterology, Section of Obesity, Metabolic Diseases and Clinical Nutrition, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Vincenzo Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology, and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, 70124 Bari, Italy;
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy;
| | - Claudia Cava
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Via F. Cervi 93, 20131 Milan, Italy;
| | - Madia Lozupone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy; (M.L.); (F.P.)
| | - Francesco Panza
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy; (M.L.); (F.P.)
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (F.C.); (S.D.N.); (A.S.); (S.A.); (R.S.)
| |
Collapse
|
29
|
Ijaz N, Buta B, Xue QL, Mohess DT, Bushan A, Tran H, Batchelor W, deFilippi CR, Walston JD, Bandeen-Roche K, Forman DE, Resar JR, O'Connor CM, Gerstenblith G, Damluji AA. Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:482-503. [PMID: 35115105 PMCID: PMC8852369 DOI: 10.1016/j.jacc.2021.11.029] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
With the aging of the world's population, a large proportion of patients seen in cardiovascular practice are older adults, but many patients also exhibit signs of physical frailty. Cardiovascular disease and frailty are interdependent and have the same physiological underpinning that predisposes to the progression of both disease processes. Frailty can be defined as a phenomenon of increased vulnerability to stressors due to decreased physiological reserves in older patients and thus leads to poor clinical outcomes after cardiovascular insults. There are various pathophysiologic mechanisms for the development of frailty: cognitive decline, physical inactivity, poor nutrition, and lack of social supports; these risk factors provide opportunity for various types of interventions that aim to prevent, improve, or reverse the development of frailty syndrome in the context of cardiovascular disease. There is no compelling study demonstrating a successful intervention to improve a global measure of frailty. Emerging data from patients admitted with heart failure indicate that interventions associated with positive outcomes on frailty and physical function are multidimensional and include tailored cardiac rehabilitation. Contemporary cardiovascular practice should actively identify patients with physical frailty who could benefit from frailty interventions and aim to deliver these therapies in a patient-centered model to optimize quality of life, particularly after cardiovascular interventions.
Collapse
Affiliation(s)
- Naila Ijaz
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Brian Buta
- Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qian-Li Xue
- Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Denise T Mohess
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Division of Geriatric Medicine, Department of Medicine, Inova Heath, Falls Church, Virginia, USA
| | - Archana Bushan
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Division of Geriatric Medicine, Department of Medicine, Inova Heath, Falls Church, Virginia, USA
| | - Henry Tran
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Wayne Batchelor
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Christopher R deFilippi
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Jeremy D Walston
- Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Karen Bandeen-Roche
- Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jon R Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Christopher M O'Connor
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Gary Gerstenblith
- Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Abdulla A Damluji
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
30
|
Fernández-Ballesteros R, Valeriano-Lorenzo E, Sánchez-Izquierdo M, Botella J. Behavioral Lifestyles and Survival: A Meta-Analysis. Front Psychol 2022; 12:786491. [PMID: 35185686 PMCID: PMC8854179 DOI: 10.3389/fpsyg.2021.786491] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the study is to determine the association between Behavioral Lifestyles (regular physical activity, healthy diet, sleeping, and weight control) and longevity in the elderly. A search strategy was conducted in the PsycInfo, Medline, PubMed, Web of Science (WoS), and Scopus databases. The primary outcome was mortality/survival. Four variables (mean of participant's age at the baseline of the study, follow-up years of the study, gender, and year of publication) were analyzed to evaluate the role of potential moderators. Ninety-three articles, totaling more than 2,800,000 people, were included in the meta-analysis. We found that the lifestyles analyzed predict greater survival. Specifically, doing regular physical activity, engaging in leisure activities, sleeping 7-8 h a day, and staying outside the BMI ranges considered as underweight or obesity are habits that each separately has a greater probability associated with survival after a period of several years.
Collapse
Affiliation(s)
| | | | | | - Juan Botella
- Department of Social Psychology and Methodology, Autonomous University of Madrid, Madrid, Spain
| |
Collapse
|
31
|
Tan YH, Lim JP, Lim WS, Gao F, Teo LL, Ewe SH, Keng BM, Tan RS, Koh WP, Koh AS. Obesity in Older Adults and Associations with Cardiovascular Structure and Function. Obes Facts 2022; 15:336-343. [PMID: 35249039 PMCID: PMC9209947 DOI: 10.1159/000521729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Body mass index (BMI), despite being widely used as a marker of obesity, fails to fully capture cardiovascular risks as it is an insufficient biomarker of abdominal adiposity, unlike waist circumference (WC). We aimed to characterize associations between BMI and WC with cardiovascular structure and function in older adults. METHODS Among an observational cohort study of a community of older adults, transthoracic echocardiography determined cardiovascular structure and function, while aerobic capacity was determined by peak oxygen uptake (VO2) metrics. The cut-offs for obesity were 27.5 kg/m2 for BMI, and >90 cm for males and >80 cm for females for WC. RESULTS Of 970 older adults without cardiovascular disease (mean age 73 ± 4 years, 432 [44%] males), 124 (12.8%) were obese by BMI definition while 347 (35.7%) were obese by WC definition. Inter-definitional agreement was fair (Cohen's κ = 0.345). Unlike the BMI definition, participants defined as obese by WC were more likely to be women (65% vs. 50%, p < 0.001), older (65 ± 11 vs. 63 ± 14 years, p = 0.007), and had lower handgrip strength (24 ± 0.6 vs. 26 ± 0.4 kg, p = 0.022). Across BMI categories, high WC was associated with more impaired myocardial relaxation (E/A), and VO2 measurements (all p < 0.05). Among those with low BMI, high WC was associated with larger left atrial (LA) volumes (p = 0.003). WC, but not BMI, was independently associated with E/A (β = -0.114, SE -0.114 ± 0.024, p < 0.001) in regression analysis. CONCLUSION WC identified a higher prevalence of obesity, possibly related to central adiposity. Across BMI categories, WC identified more adverse measurements in E/A, aerobic capacity, and LA structure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02791139.
Collapse
Affiliation(s)
- Yen How Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - Jun Pei Lim
- Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Fei Gao
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Louis L.Y. Teo
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - See Hooi Ewe
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Ru San Tan
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angela S. Koh
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- *Angela S. Koh,
| |
Collapse
|
32
|
Tang H, Zhu H, Sun Q, Qin H, Wang S. Transitions in the Cognitive Frailty States in Community-Living Older Adults: A 6-Year Prospective Cohort Study. Front Aging Neurosci 2021; 13:774268. [PMID: 34924997 PMCID: PMC8672135 DOI: 10.3389/fnagi.2021.774268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Frailty is a multidimensional concept, including physical, cognitive, social, sensorial, psychological, and nutritional phenotypes. Among these phenotypes, cognitive frailty is the most widely investigated, which is related to many adverse health outcomes in older individuals. Whether cognitive frailty is dynamic or how these frail phenotypes interact remains an open issue. We studied the rate of these changes over time and their associated factors in a 6-year follow-up cohort. Methods: A total of 426 Chinese community-living older adults in Dujiangyan aged 65 years or older were involved and followed up in three visits 6 years apart. Frailty and cognitive function were assessed using the FRAIL scale and the Mini-Mental State Examination scale. Demographic information, geriatric syndrome, and social interaction status were studied. Rates of transitions in cognitive frailty states and associated risk factors were studied. We used the stepwise logistic regression model to analyze risk factors. Results: At baseline, 18.8% of participants were only in the physical frailty (PF) or mild cognitive impairment (MCI) group, and 0.09% of participants were in the cognitive frailty group. By the end of 6 years, 62 (14.5%) participants had died, and the rates of only PF or MCI group and cognitive frailty group increased to 36.2 and 3.3%, respectively. Also, 199 (46.7%) participants had deteriorated compared with the baseline. The multivariate regression analysis showed that older (OR = 1.12, 95% CI = 1.07 − 1.16, P < 0.001), smoker (OR = 2.15, 95% CI = 1.37 − 3.39, P = 0.001), poor self-evaluation health status (OR = 1.93, 95% CI = 1.06 − 3.51, P = 0.033), and malnutrition (OR = 2.07, 95% CI = 1.21 − 3.52, P = 0.008) were risk factors for worsening, whereas willing to make new friends (OR = 0.61, 95% CI = 0.38 − 0.96, P = 0.032) was associated with 39% lower chance of deterioration. Conclusion: Cognitive frailty is a dynamically changing state, where transitions may be influenced by multidimensions. Multidimensional monitoring of a wide range of events occurring in aging may be the best way to act early. We hope our study may serve as a starting point for redefining the definition of cognitive frailty by covering different frailty domains.
Collapse
Affiliation(s)
- Huiyu Tang
- The Center of Gerontology and Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Huan Zhu
- The Center of Gerontology and Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Sun
- The Center of Gerontology and Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Qin
- Internal Medicine Department, Pingyi Community Health Service Center, Dujiangyan, China
| | - Shuang Wang
- The Center of Gerontology and Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
33
|
Hajek A, König HH. Asymmetric effects of obesity on loneliness among older Germans. Longitudinal findings from the Survey of Health, Ageing and Retirement in Europe. Aging Ment Health 2021; 25:2293-2297. [PMID: 32962423 DOI: 10.1080/13607863.2020.1822285] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this longitudinal study was to examine whether the onset and the end of obesity was associated with loneliness. METHOD Nationally representative longitudinal data from Germany were taken from the Survey of Health, Ageing and Retirement in Europe (wave 5 to wave 7; n = 10,446 observations in the analytical sample). Using the three item loneliness scale (UCLA), loneliness was measured. According to the WHO thresholds, obesity was defined as BMI ≥ 30 kg/m2. Asymmetric fixed effects (FE) regressions were used. RESULTS Conventional FE regression analysis revealed that changes in obesity status were associated with changes in loneliness (men: β = -.19, p < .05; women: β = .19, p < .05). Asymmetric FE regressions showed that in men the onset of obesity was associated with a decrease in loneliness (β = -.31, p < .05), whereas the end of obesity was not associated with loneliness. Asymmetric FE regressions showed that in women, the onset of obesity was associated with an increase in loneliness (β = .33, p < .01), whereas the end of obesity was not associated with loneliness. CONCLUSION Findings showed that the onset of obesity has different consequences in terms of loneliness for older women and men in Germany, whereas the end of obesity was not associated with changes in loneliness scores. We recommend that future studies should distinguish between the onset and the end of obesity - which comes along with important practical implications. When older women report transitions to obesity, efforts to prevent loneliness may be of importance.
Collapse
Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
34
|
Gebran A, Gallastegi AD, Fagenholz P, King D, Kaafarani HMA, Paranjape C, Velmahos GC, Hwabejire JO. Factors that Predict Survival From Mesenteric Ischemia in the Geriatric Patient: Not a Death Sentence. Am Surg 2021:31348211050585. [PMID: 34748456 DOI: 10.1177/00031348211050585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mortality rate from mesenteric ischemia is reported to be as high as 80%. The goal of our study was to identify demographic and clinical predictors of post-operative mortality and discharge disposition among elderly patients with mesenteric ischemia. METHODS All patients 65 years and older who underwent emergency surgery (ES) for the management of mesenteric ischemia in the American College of Surgeons-National Surgical Quality Improvement Program database from 2007 to 2017 were included. Univariate analyses and logistic regressions were used to identify independent predictors of mortality and discharge disposition. RESULTS A total of 2438 patients met inclusion criteria, with a median age of 77 years and 60.8% being female. The 30-day mortality of the overall cohort was 31.5% and the 30-day morbidity was 65.3%. The following were the major predictors of 30-day mortality: pre-operative diagnosis of septic shock [OR: 2.46, (95% CI: 1.94-3.13)], dialysis dependence [OR: 2.05, (95% CI: 1.45-2.90)], recent weight loss [OR: 1.80, (95% CI: 1.16-2.79)], age ≥80 years [OR: 1.67, (95% CI: 1.25-2.23)], and ventilator dependence [OR: 1.65, (95% CI: 1.23-2.23)]. In the absence of these predictors, survival rate was 84%. The major predictors of discharge to post-acute care (PAC) included age ≥80 years [OR: 3.70, (95% CI: 2.50-5.47)] and pre-operative septic shock [OR: 2.20, (95% CI: 1.42-3.41)]. CONCLUSION In the geriatric patient, a diagnosis of mesenteric ischemia does not equate to an automatic death sentence. The presence of certain pre-operative risk factors confers a high risk of mortality, whereas their absence is associated with a high chance of survival.
Collapse
Affiliation(s)
- Anthony Gebran
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Charu Paranjape
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
35
|
Zupo R, Castellana F, Guerra V, Donghia R, Bortone I, Griseta C, Lampignano L, Dibello V, Lozupone M, Coelho-Júnior HJ, Solfrizzi V, Giannelli G, De Pergola G, Boeing H, Sardone R, Panza F. Associations between nutritional frailty and 8-year all-cause mortality in older adults: The Salus in Apulia Study. J Intern Med 2021; 290:1071-1082. [PMID: 34437740 DOI: 10.1111/joim.13384] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Preventive nutritional management of frailty, a multidimensional intermediate status in the ageing process, may reduce the risk of adverse health-related outcomes. We investigated the ability of a measure combining physical frailty with nutritional imbalance, defined as nutritional frailty, to predict all-cause mortality over a period of up to 8 years. METHODS We analysed data on 1,943 older adults from the population-based 'Salus in Apulia Study'. Physical frailty was operationalized using Cardiovascular Health Study criteria and cognitive frailty by combining physical frailty with cognitive impairment. A novel five-item construct was built to assess the extent of nutritional imbalance identified with a machine learning algorithm. Cox models and Kaplan-Meier survival probability analyses of physical frailty, nutritional imbalance (two or more of the following: low body mass index, low skeletal muscle index, ≥2.3 g/day sodium intake, <3.35 g/day potassium intake and <9.9 g/day iron intake), cognitive frailty and the novel nutritional frailty phenotype (physical frailty plus nutritional imbalance) were applied to assess all-cause mortality risk, adjusted for age, sex, education and multimorbidity. RESULTS The overall prevalence of nutritional frailty was 4.52% (95% confidence interval, CI:3.55-5.44), being more frequent in males. Subjects with nutritional frailty were at higher risk for all-cause mortality [hazard ratio (HR):2.31; 95%CI:1.41-3.79] than those with physical frailty (HR:1.45,95% CI:1.0-2.02), nutritional imbalance (HR:1.39; 95%CI:1.05-1.83) and cognitive frailty (HR:1.06; 95%CI:0.56-2.01). CONCLUSIONS Efforts to identify, manage and prevent frailty should include the nutritional domain. The nutritional frailty phenotype may highlight major nutritional determinants that could drive survival and health trajectories in older adults.
Collapse
Affiliation(s)
- Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Vito Guerra
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Rossella Donghia
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Ilaria Bortone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Chiara Griseta
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Luisa Lampignano
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Madia Lozupone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Vincenzo Solfrizzi
- "C. Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, Research Hospital, National Institute of Gastroenterology "Saverio de Bellis", Castellana Grotte, Bari, Italy
| | - Giovanni De Pergola
- Scientific Direction, Research Hospital, National Institute of Gastroenterology "Saverio de Bellis", Castellana Grotte, Bari, Italy
| | - Heiner Boeing
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.,German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Francesco Panza
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| |
Collapse
|
36
|
Whiting D, Challacombe B, Madaan S, Fowler S, Napier-Hemy R, Sriprasad S. Complications after radical nephrectomy according to age: analysis from the British Association of Urological Surgeons Nephrectomy Audit. J Endourol 2021; 36:188-196. [PMID: 34663080 DOI: 10.1089/end.2021.0165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction To compare complication rates in radical nephrectomy for renal cell carcinoma across different age groups. Methods Retrospective analysis of the British Association of Urological Surgeons Nephrectomy Audit database between 1st January 2012 and 31st December 2017 was performed. Comparisons were made between different age groups (<60, 60-79, ≥80) in patients undergoing radical nephrectomy for renal cell carcinoma. Results 18438 patients with renal cell carcinoma underwent radical nephrectomy: 6128 (33.2%) aged <60, 10785 (58.5%) aged 60-79 and 1525 (8.3%) aged ≥80. There was a significantly lower pre-operative haemoglobin and eGFR with advancing age (p<0.001). Patients ≥80 had a higher Charlson co-morbidity index and WHO performance status (p<0.001). There was also significant variability in the approach to RN (p<0.001): laparoscopy was most commonly performed (68.8% vs. 69.3% vs. 75.0%). Patients ≥80 years were found to have the shortest operating time (p<0.001). There were significant differences in T stage between groups with patients aged ≥80 having a higher T stage (p<0.001). The incidence of intra-operative complications did not significantly differ between age groups (p=0.18). The incidence of post-operative complications was 15.7%, 18.2% and 20.5% and major post-operative complications was 1.4%, 2.1% and 2.8% in patients <60, 60-79 and ≥80, respectively (p<0.001). The most common complication in all age groups was blood transfusion (7.6% <60, 8.6% 60-79, 9.1% ≥80). Stepwise logistic regression analysis adjusting for additional variables found the odds of a post-operative complication increased with age with an odds ratio of 1.25 in patients ≥80 and an odds ratio of 1.09 in patients aged 60-70 compared with <60. Conclusion Overall complications in all age groups are low but advancing age should be considered as an independent risk factor for post-operative complications after radical nephrectomy and should be appropriately considered when counselling elderly patients prior to treatment.
Collapse
Affiliation(s)
- Danielle Whiting
- Darent Valley Hospital, 156489, Darent Valley Hospital, Darenth Wood Road, Dartford, United Kingdom of Great Britain and Northern Ireland, DA2 8DA;
| | - Benjamin Challacombe
- Guy's Hospital, Urology, London, London, United Kingdom of Great Britain and Northern Ireland, SE1 7RT;
| | - Sanjeev Madaan
- Darent Valley Hospital, 156489, Dartford, United Kingdom of Great Britain and Northern Ireland;
| | - Sarah Fowler
- British Association of Urological Surgeons, London, United Kingdom of Great Britain and Northern Ireland;
| | - Richard Napier-Hemy
- Manchester University NHS Foundation Trust, 5293, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland;
| | - Seshadri Sriprasad
- Darent Valley Hospital, 156489, Dartford, United Kingdom of Great Britain and Northern Ireland;
| |
Collapse
|
37
|
Yaegashi A, Kimura T, Hirata T, Tamakoshi A. Association of dietary protein intake with skeletal muscle mass in older adults: A systematic review. Geriatr Gerontol Int 2021; 21:1077-1083. [PMID: 34643981 DOI: 10.1111/ggi.14291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022]
Abstract
Protein supplementation has been shown to be effective in attenuating the loss of lean body mass and muscle mass in older adults; however, its benefits as dietary protein remain unclear. This systematic review of observational studies aimed to investigate the association of dietary protein intake with skeletal muscle mass (SM). Observational studies that investigated the association of dietary protein intake with SM in older adults were retrieved from MEDLINE, Web of Science and Cochrane-CENTRAL databases. Of the 26 analyses in the 17 studies, 18 showed a significant positive association. In cohort studies, 55.6% (five of nine analyses) showed a significant positive association. Of these, four analyses were adjusted for well-known confounding factors, used energy-adjusted protein intake, and used the amount of change of SM between baseline and follow-up as the outcome, with two of them showing a significant positive association. Although 69.2% (18 of 26 analyses) of the 17 studies showed a significant positive association between dietary protein intake and SM in older adults, most studies were cross-sectional and had at least one important methodological limitation. Therefore, we could not draw any conclusions. Thus, well-designed cohort studies are needed in future to identify the association between dietary protein intake and SM in older adults. Geriatr Gerontol Int 2021; 21: 1077-1083.
Collapse
Affiliation(s)
- Akinori Yaegashi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Health and Nutrition, Faculty of Human Science, Hokkaido Bunkyo University, Eniwa, Japan
| | - Takashi Kimura
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takumi Hirata
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akiko Tamakoshi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
38
|
Miura H, Sakaguchi K, Ogawa W, Tamori Y. Clinical features of 65-year-old individuals in Japan diagnosed with possible sarcopenia based on the Asian Working Group for Sarcopenia 2019 criteria. Geriatr Gerontol Int 2021; 21:689-696. [PMID: 34164909 DOI: 10.1111/ggi.14182] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/28/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
AIM The prevalence of sarcopenia and the health status of affected individuals, particularly among the young elderly, are unclear in Japan. We determined the prevalence of possible sarcopenia, a concept proposed by the Asian Working Group for Sarcopenia (AWGS) in 2019, and then investigated its clinical features in community-dwelling young elderly individuals in Kobe, a representative large city in Japan. METHODS This retrospective cross-sectional study examined 1768 residents of Kobe aged 65 years who underwent health and frailty checkups implemented by Kobe City between April 2017 and March 2019. Possible sarcopenia was diagnosed by the AWGS 2019 algorithm. Frailty status was assessed with the use of the Kihon Checklist, which was developed to identify senior citizens requiring nursing care in Japan. RESULTS Fifty-one of the 1768 subjects were diagnosed with possible sarcopenia (overall prevalence of 2.9% [confidence interval: 2.1-3.7%]), with the prevalence being higher in women than in men. Individuals with possible sarcopenia had a lower body mass index, abdominal circumference, diastolic blood pressure and percentage of taking lipid-lowering drugs as well as a higher high-density lipoprotein cholesterol level and estimated glomerular filtration rate. They also showed a higher degree of frailty. A low body mass index and physical inactivity were significantly associated with possible sarcopenia. CONCLUSIONS The prevalence of possible sarcopenia based on the AWGS 2019 criteria was 2.9% among 65-year-olds in Japan, with affected individuals more likely to be frail compared with those without this condition. Geriatr Gerontol Int 2021; 21: 689-696.
Collapse
Affiliation(s)
- Hiroshi Miura
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiko Sakaguchi
- Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshikazu Tamori
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Creative Health Promotion, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
39
|
Leung AYM, Sun Q, Kwan RYC, Lam SC, Deng R. Moderating effect of age on the relationships between pre-frailty and body measures. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:515-525. [PMID: 32746506 DOI: 10.1111/hsc.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.
Collapse
Affiliation(s)
- Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Qian Sun
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Faculty of Social Security, School of Public Administration, Hebei University of Business and Economics, Shijiazhuang, China
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Simon Ching Lam
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Renli Deng
- Nursing Department, The 5th Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| |
Collapse
|
40
|
Clinical Implications of Research on Frailty. J Am Med Dir Assoc 2021; 22:524-526. [PMID: 33485857 DOI: 10.1016/j.jamda.2021.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
|
41
|
Purcell SA, Mackenzie M, Barbosa-Silva TG, Dionne IJ, Ghosh S, Siervo M, Ye M, Prado CM. Prevalence of Sarcopenic Obesity Using Different Definitions and the Relationship With Strength and Physical Performance in the Canadian Longitudinal Study of Aging. Front Physiol 2021; 11:583825. [PMID: 33551830 PMCID: PMC7859259 DOI: 10.3389/fphys.2020.583825] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022] Open
Abstract
Sarcopenic obesity is associated with several negative health outcomes. However, the prevalence of this condition – and the relationship to physical performance parameters – varies across definitions. The aim of this cross-sectional investigation was to describe the prevalence of sarcopenic obesity using different published definitions and their relationship with handgrip strength and walking speed in older Canadian adults. Individuals aged 65+ in the Canadian Longitudinal Study on Aging (n = 11,803; 49.6% male, 50.4% female) were included. Body composition was measured using dual X-ray absorptiometry. Sarcopenic obesity was defined using 29 definitions. Low handgrip strength was identified as < 27 kg in males and < 16 kg in females and poor physical performance was defined as gait speed ≤ 0.8 m/s. The prevalence of sarcopenic obesity ranged from 0.1 to 85.3% in males, and from 0 to 80.4% in females. Sarcopenic obesity was frequently associated with low handgrip strength (p < 0.05) in both males (14/17 definitions, 82.4%) and females (21/29 definitions, 72.4%). In very few definitions, sarcopenic obesity was associated with slow gait speed (males: 1/17 definitions [6.7%]; females: 2/29 [6.9%]). In conclusion, the prevalence of sarcopenic obesity varied greatly according to definitions and sarcopenic obesity was frequently associated with low handgrip strength.
Collapse
Affiliation(s)
- Sarah A Purcell
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB, Canada.,Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado, Aurora, Colorado, CO, United States.,Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, CO, United States
| | - Michelle Mackenzie
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Thiago G Barbosa-Silva
- Department of General Surgery, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil.,Department of Obstetrics and Gynecology, Catholic University of Pelotas, Pelotas, Brazil
| | - Isabelle J Dionne
- Department of Kinanthropology, Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, Sherbrooke, QC, Canada
| | - Sunita Ghosh
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Ming Ye
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
42
|
Panza F, La Montagna M, Lampignano L, Zupo R, Bortone I, Castellana F, Sardone R, Borraccino L, Dibello V, Resta E, Altamura M, Daniele A, Lozupone M. Vitamin D in the development and progression of alzheimer's disease: implications for clinical management. Expert Rev Neurother 2021; 21:287-301. [PMID: 33406925 DOI: 10.1080/14737175.2021.1873768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Although the pathophysiological bases of Alzheimer's disease (AD) remain incompletely understood and disease-modifying therapies are not available, intervention on modifiable risk factors is warranted. Research on nutrition and dietary components is challenging and controversies still persist about the role of micro- and macronutrients and health outcomes in dementia. Importantly, results of preclinical investigations have shown that vitamin D triggers different neural pathways that may be protective against these neurodegenerative mechanisms, including the deposition of amyloid plaques, inflammatory processes, neurofibrillary degeneration, glutamatergic excitotoxicity, excessive intraneuronal calcium influx, and oxidative stress, although its relationship with AD still needs to be fully understood. AREAS COVERED The authors analyzed the recent evidence about the effects of vitamin D insufficiency on AD and the role of supplementation. EXPERT OPINION Both insufficient (25-49.9 ng/ml) and deficient levels (<25 ng/ml) of vitamin D may contribute to an increased susceptibility to AD. However, further well-designed prospective studies are needed for a better understanding of the involvement of low vitamin D concentrations in the AD natural history. Randomized clinical trials will also be necessary to address the issue of causality and determine whether vitamin D supplementation may be effective for the prevention or treatment of AD.
Collapse
Affiliation(s)
- Francesco Panza
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luisa Lampignano
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Roberta Zupo
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Ilaria Bortone
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Fabio Castellana
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Rodolfo Sardone
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Luisa Borraccino
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vittorio Dibello
- Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy.,Department of Orofacial Pain & Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam & Vrije Universiteit Amsterdam, The Netherlands
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy.,Translational Medicine & Management of Health Systems, University of Foggia, Foggia, Italy
| | - Mario Altamura
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy.,Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
43
|
Fostinelli S, De Amicis R, Leone A, Giustizieri V, Binetti G, Bertoli S, Battezzati A, Cappa SF. Eating Behavior in Aging and Dementia: The Need for a Comprehensive Assessment. Front Nutr 2020; 7:604488. [PMID: 33392240 PMCID: PMC7772186 DOI: 10.3389/fnut.2020.604488] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023] Open
Abstract
Eating behavior can change during aging due to physiological, psychological, and social changes. Modifications can occur at different levels: (1) in food choice, (2) in eating habits, and (3) in dietary intake. A good dietary behavior, like the Mediterranean dietary pattern, can be a protective factor for some aging related pathologies, such as dementia, while a worse eating behavior can lead to pathological conditions such as malnutrition. Changes in eating behavior can also be linked to the onset of dementia: for some types of dementia, such as frontotemporal dementia, dietary changes are one of the key clinical diagnostic feature, for others, like Alzheimer's disease, weight loss is a clinical reported feature. For these reasons, it is important to be able to assess eating behavior in a proper way, considering that there are normal age-related changes. An adequate assessment of dietary behavior can help to plan preventive intervention strategies for heathy aging or can help to identify abnormal behaviors that underline aging related-diseases. In this review, we have analyzed normal age-related and dementia-related changes and the tools that can be used to assess eating behavior. Thus, we make recommendations to screening and monitoring eating behavior in aging and dementia, and to adopt these tools in clinical practice.
Collapse
Affiliation(s)
- Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ramona De Amicis
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Alessandro Leone
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Valentina Giustizieri
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Giuliano Binetti
- Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Simona Bertoli
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Stefano F Cappa
- University School for Advanced Studies, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
44
|
Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
Collapse
|
45
|
Spadaccini D, Perna S, Peroni G, D’Antona G, Iannello G, Faragli A, Infantino V, Riva A, Petrangolini G, Negro M, Gasparri C, Rondanelli M. DXA-Derived Visceral Adipose Tissue (VAT) in Elderly: Percentiles of Reference for Gender and Association with Metabolic Outcomes. Life (Basel) 2020; 10:E163. [PMID: 32846931 PMCID: PMC7554982 DOI: 10.3390/life10090163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 12/23/2022] Open
Abstract
This study aimed to establish the Dual-Energy X-ray Absorptiometry (DXA)-derived Visceral adipose tissue (VAT) reference values for gender and assess the metabolic outcomes associated to the VAT in a cohort of elderly patients. The sample included 795 elderly patients (226/569: men/women) aged 65-100 years (mean age 80.9 ± 7.5ys). Body composition measures and VAT were assessed by DXA and Core-Scan software. Biochemical analysis and a multidimensional comprehensive geriatric assessment were performed. VAT percentiles at the level of 5, 25, 50, 75, 95 were found in males at the following levels: 246, 832, 1251, 1769, 3048 cm3 and for females at 99, 476, 775, 1178, 2277 cm3. Moreover, this study showed that DXA-VAT was associated to a worsening of lipid, glycemic, hematocrit and kidney profile. Further studies will be needed in order to implement these findings in order to define the (DXA)-derived VAT levels associated to the frailty related risk factors in elderly.
Collapse
Affiliation(s)
- Daniele Spadaccini
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Via Emilia 12, 27100 Pavia, Italy; (G.P.); (C.G.)
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Zallaq 32038, Bahrain;
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Via Emilia 12, 27100 Pavia, Italy; (G.P.); (C.G.)
| | - Giuseppe D’Antona
- CRIAMS-Sport Medicine Centre, University of Pavia, 27058 Voghera, Italy; (G.D.); (M.N.)
| | - Giancarlo Iannello
- General Management, Azienda di Servizi alla Persona di Pavia, 27100 Pavia, Italy;
| | - Alessandro Faragli
- Department of Internal Medicine and Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany;
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), 10785 Berlin, Germany
| | - Vittoria Infantino
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, 27100 Pavia, Italy; (V.I.); (M.R.)
| | - Antonella Riva
- Research and Development Unit, Indena, 20139 Milan, Italy; (A.R.); (G.P.)
| | | | - Massimo Negro
- CRIAMS-Sport Medicine Centre, University of Pavia, 27058 Voghera, Italy; (G.D.); (M.N.)
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Via Emilia 12, 27100 Pavia, Italy; (G.P.); (C.G.)
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, 27100 Pavia, Italy; (V.I.); (M.R.)
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| |
Collapse
|
46
|
Protective effect of smoking cessation on subsequent myocardial infarction and ischemic stroke independent of weight gain: A nationwide cohort study. PLoS One 2020; 15:e0235276. [PMID: 32673331 PMCID: PMC7365437 DOI: 10.1371/journal.pone.0235276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/12/2020] [Indexed: 01/27/2023] Open
Abstract
Smoking cessation reduces the cardiovascular risk but increases body weight. We investigated the risk of subsequent myocardial infarction and ischemic stroke according to weight gain after smoking cessation, using a nationwide population based cohort. We enrolled 3,797,572 Korean adults aged over 40 years who participated in national health screenings between 2009 and 2010. Subjects who quit smoking were classified into three subgroups according to the weight change between baseline and 4 years prior. Myocardial infarctions and ischemic strokes were followed until the end of 2015. We compared the hazard ratios among smoking cessation subgroups, non-smokers, and current smokers. The mean changes in weight (1.5 ± 3.9 kg) of the smoking cessation group were higher than those of the other groups (p < 0.0001). A total of 31,277 and 46,811 subjects were newly diagnosed with myocardial infarction and ischemic stroke, respectively. Regardless of weight change, all subgroups of smoking cessation had significantly less risk than current smokers. The subgroup of smoking cessation with weight gain over 4kg showed the lowest risk for myocardial infarctions (hazard ratio 0.646, 95% confidence interval 0.583-0.714, p < 0.0001) and ischemic strokes (hazard ratio 0.648, 95% confidence interval 0.591-0.71, p < 0.0001) after multivariable adjustment. In conclusion, weight gain after smoking cessation did not adversely affect the cardiovascular protective effect.
Collapse
|
47
|
Yuan M, Pickering RT, Bradlee ML, Mustafa J, Singer MR, Moore LL. Animal protein intake reduces risk of functional impairment and strength loss in older adults. Clin Nutr 2020; 40:919-927. [PMID: 32753351 DOI: 10.1016/j.clnu.2020.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Protein intake has been shown to lower risk of aging-related functional decline. The goal of this study was to assess long-term effects of weight-adjusted animal (AP) and plant protein (PP) intakes on aging-related change in functional status and grip strength. METHODS Framingham Offspring Study participants (n = 1896, 891 men and 1005 women), ≥age 50, were followed for an average of 14.4 years. Protein intake derived from two sets of 3-day diet records (exams 3 and 5) was expressed as both weight-adjusted intake (from residuals) and per kilogram of body weight (g/kg/d). Seven tasks from two standardized assessments (Nagi and the Rosow-Breslau scales) were selected to determine functional status at exams 5-9. Functional impairment was defined as failure to complete (or having a lot of difficulty completing) a given task. Grip strength was assessed by dynamometer at exams 7-9. RESULTS Participants with higher (vs. lower) weight-adjusted intakes of AP and PP maintained higher functional scores (p = 0.001 and p < 0.001, respectively). After accounting for baseline skeletal muscle mass (SMM) and physical activity, only AP was linked with lower risks of functional impairment. Higher AP intake among sedentary individuals led to 29% (95% CI: 0.51-1.00) reduced risks of impairment; among subjects with lower SMM, higher AP was associated with 30% (95% CI: 0.49-0.98) reduced risks. Physical activity and SMM were independently associated with reduced risks of functional impairment, regardless of protein intake. Finally, higher AP intake led to 34% and 48% greater preservation of grip strength in men (p = 0.012) and women (p = 0.034). Results were similar for protein intake expressed as g/kg/d. CONCLUSIONS Higher AP intake and higher levels of physical activity and SMM were independently associated with lower risks of functional impairment and greater preservation of grip strength in adults over the age of 50 years.
Collapse
Affiliation(s)
- Mengjie Yuan
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - R Taylor Pickering
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - M Loring Bradlee
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jabed Mustafa
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Martha R Singer
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Lynn L Moore
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
| |
Collapse
|
48
|
Dietary betaine intake is associated with skeletal muscle mass change over 3 years in middle-aged adults: the Guangzhou Nutrition and Health Study. Br J Nutr 2020; 125:440-447. [PMID: 32616104 DOI: 10.1017/s0007114520002433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A higher dietary intake or serum concentration of betaine has been associated with greater lean body mass in middle-aged and older adults. However, it remains unknown whether betaine intake is associated with age-related loss of skeletal muscle mass (SMM). We assessed the association between dietary betaine intake and relative changes in SMM after 3 years in middle-aged adults. A total of 1242 participants aged 41-60 years from the Guangzhou Nutrition and Health Study 2011-2013 and 2014-2017 with body composition measurements by dual-energy X-ray absorptiometry were included. A face-to-face questionnaire was used to collect general baseline information. After adjustment for potential confounders, multiple linear regression found that energy-adjusted dietary betaine intake was significantly and positively associated with relative changes (i.e. percentage loss or increase) in SMM of legs, limbs and appendicular skeletal mass index (ASMI) over 3 years of follow-up (β 0·322 (se 0·157), 0·309 (se 0·142) and 0·303 (se 0·145), respectively; P < 0·05). The ANCOVA models revealed that participants in the highest betaine tertile had significantly less loss in SMM of limbs and ASMI and more increase in SMM of legs over 3 years of follow-up, compared with those in the bottom betaine tertile (all Ptrend < 0·05). In conclusion, our findings suggest that elevated higher dietary betaine intake may be associated with less loss of SMM of legs, limbs and ASMI in middle-aged adults.
Collapse
|
49
|
Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, Ye X, Jiang L. Risk Factors for Postoperative Infectious Complications in Elderly Patients with Gastric Cancer. Cancer Manag Res 2020; 12:4391-4398. [PMID: 32606934 PMCID: PMC7293399 DOI: 10.2147/cmar.s253649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC. Methods Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications. Results Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70–88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15–4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30–6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14–5.38; p = 0.022) were independently associated with infectious complications. Conclusion Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
Collapse
Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| |
Collapse
|
50
|
Saghir SA, Ansari RA, Dorato MA. Rethinking toxicity testing: Influence of aging on the outcome of long-term toxicity testing and possible remediation. Food Chem Toxicol 2020; 141:111327. [PMID: 32380075 DOI: 10.1016/j.fct.2020.111327] [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: 01/31/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Traditionally, toxicity testing is conducted at fixed dose rates (i.e., mg/kg/day) without considering life-changing events, e.g., stress, sickness, aging- and/or pregnancy-related changes in physical, physiological and biochemical parameters. In humans, life-changing events may cause systemic dose non-proportionality requiring modulation of drug dosage; similar changes occur in animals altering systemic dose during chronic/carcinogenic testing leading to "late-occurring" effects in some studies. For example, propylene monomethyl ether, an industrial chemical, initially induced sedation in rats and mice with recovery upon induction of hepatic CYPs after ~1 week. Sedation reappeared in rats but not in mice after ~12 months of exposure due to decreased CYP activity in rats, elderly mice were able to maintain slightly higher CYP activity avoiding recurrence of sedation. The systemic dose of two pharmaceuticals (doxazosin and brimonidine tartrate) increased up to 6-fold in ≥12-month old rats with no toxicity. In a rat reproductive toxicity study, systemic dose of 2,4-D, an herbicide, rapidly increased due to increased consumption of 2,4-D-fortified diet during pregnancy, lactation and neonatal growth, requiring adjustment to maintain the targeted systemic dose. Ideally, toxicological studies should be based on systemic dose with the option of modulating external dose rates to maintain the targeted systemic dose. Systemic dose can easily be monitored in selected core study animals at desired intervals considering recent developments in sampling and analysis at a fraction of the overall cost of a study.
Collapse
Affiliation(s)
- Shakil Ahmed Saghir
- Scotts Miracle-Gro, 14111 Scottslawn Road, Marysville, OH, 43041, USA; Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan; ToxInternational, Inc., 5057 Stonecroft Ct., Hilliard, OH 43026, USA.
| | - Rais Ahmad Ansari
- Department of Pharmaceutical Sciences, College of Pharmacy, Health Professions Division, Nova Southeastern University, 3200 S University Drive, Fort Lauderdale, FL, 33328, USA.
| | - Michael A Dorato
- Inotiv, 13 Firstfield Road, Suite 110, Gaithersburg, MD, 20878, USA.
| |
Collapse
|