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Yan G, Liu L, Liu M, Jiang X, Chen P, Li M, Ma Q, Li Y, Duan S, You R, Huang Y, Li Z, You D. Bidirectional association between perioperative skeletal muscle and subcutaneous fat in colorectal cancer patients and their prognostic significance. Front Nutr 2024; 11:1381995. [PMID: 39360277 PMCID: PMC11445023 DOI: 10.3389/fnut.2024.1381995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 08/26/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Low skeletal muscle mass and high adipose tissue coexist across the body weight spectrum and independently predict the survival ratio of colorectal cancer (CRC) patients. This combination may lead to a mutually exacerbating vicious cycle. Tumor-associated metabolic conditions primarily affect subcutaneous adipose tissue, but the nature and direction of its relationship with skeletal muscle are unclear. This study aims to examine the bidirectional causal relationship between skeletal muscle index (SMI) and subcutaneous fat index (SFI) during the perioperative period in CRC patients; as well as to validate the association between perioperative SMI, SFI, and CRC prognosis. Methods This population-based retrospective cohort study included patients with stage I-III colorectal cancer who underwent radical resection at the Third Affiliated Hospital of Kunming Medical University between September 2012 and February 2019. Based on inclusion and exclusion criteria, 1,448 patients were analyzed. Preoperative (P1), 2 months postoperative (P2), and 5 months postoperative (P3) CT scans were collected to evaluate the skeletal muscle index (SMI; muscle area at the third lumbar vertebra divided by height squared) and subcutaneous fat index (SFI; subcutaneous fat area at the third lumbar vertebra divided by height squared). A random intercept cross-lagged panel model (RI-CLPM) was used to examine the intra-individual relationship between SMI and SFI, and Cox regression was employed to assess the association between SMI, SFI, recurrence-free survival (RFS), and overall survival (OS). Results The median age at diagnosis was 59.00 years (IQR: 51.00-66.00), and 587 patients (40.54%) were female. RI-CLPM analysis revealed a negative correlation between SFI and subsequent SMI at the individual level: P1-P2 (β = -0.372, p = 0.038) and P2-P3 (β = -0.363, p = 0.001). SMI and SFI showed a negative correlation during P1-P2 (β = -0.363, p = 0.001) but a positive correlation during P2-P3 (β = 0.357, p = 0.006). No significant correlation was found between the random intercepts of SFI and SMI at the between-person level (r = 0.157, p = 0.603). The Cox proportional hazards multivariate regression model identified that patients with elevated SFI had poorer recurrence-free survival (HR, 1.24; 95% CI: 1.00-1.55). Compared to patients with normal preoperative SMI and SFI, those with low SMI or high SFI had poorer recurrence-free survival (HR, 1.26; 95% CI: 1.03-1.55) and overall survival (HR, 1.39; 95% CI: 1.04-1.87). However, no significant association between SMI and SFI and the prognosis of colorectal cancer patients was observed postoperatively. Conclusion In CRC patients, preoperative muscle loss leads to postoperative fat accumulation, exacerbating muscle loss in a feedback loop. Elevated preoperative SFI predicts poorer survival outcomes. Monitoring SMI and SFI is crucial as prognostic indicators, despite non-significant postoperative associations. Further research is needed to improve patient outcomes.
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Affiliation(s)
- Guanghong Yan
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Lizhu Liu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Mengmei Liu
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Xinyue Jiang
- Second Ward of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ping Chen
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Min Li
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Qingyan Ma
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Yani Li
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Sifan Duan
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
| | - Ruimin You
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yanni Huang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Dingyun You
- Yunnan Provincial Key Laboratory of Public Health and Biosafety, School of Public Health, Kunming Medical University, Kunming, China
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Sanchez-Garcia E, Cruz-Jentoft AJ, Ravasco P, Suominen M, Pitkälä PK. Nutritional care in older adults: are we doing everything? An expert opinion review. Curr Med Res Opin 2024; 40:1563-1576. [PMID: 39044672 DOI: 10.1080/03007995.2024.2380007] [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: 05/28/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality-of-life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.
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Affiliation(s)
- Elisabet Sanchez-Garcia
- Consultant in Geriatric Medicine, Mater Private Network, Cork, Ireland
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paula Ravasco
- Universidade Católica Portuguesa, Faculty of Medicine and Centre for Interdisciplinary Research in Health, Centre for Interdisciplinary Research Egas Moniz (CiiEM), Lisbon, Portugal
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Prof Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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Kim E, Seol EM, Lee HJ. The Association of Body Mass Index on Falls Risk and Mortality in Hospitalized Patients of Different Old-Age Categories Requiring Nutritional Support. Clin Nutr Res 2024; 13:96-107. [PMID: 38784849 PMCID: PMC11109932 DOI: 10.7762/cnr.2024.13.2.96] [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: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Malnutrition affect clinical outcomes in hospitalized old age patients, but the data on the related outcomes on the basis of different age categories are still limited. We aimed to investigate the interplay of associations among body mass index (BMI), falls risk, and mortality rate in different older adult patient age categories. This retrospective study included hospitalized patients aged ≥ 65 years who received artificial nutrition. Demographic, biochemical, and survival data were collected. BMI was evaluated using the World Health Organization BMI cutoffs for Asians, and patients were classified into high (≥ 23.0 kg/m2), normal (18.5-22.9 kg/m2), and low (< 18.5 kg/m2) BMI groups. The Morse Fall Scale was used to assess falls risk. By age categories, all patients (n = 4,642) were divided into the 65-74 (n = 2,649) and ≥ 75 (n = 1,993) years age groups. We found that the proportion of low-BMI and high risk of falls increased with age. Further, low-BMI was associated with increased falls risk in both age groups. Overall survival rate tended to be lower in the low-BMI and ≥ 75 years group than that in other patient groups, but did not differ significantly compared with the low-BMI and 65-74 years group. Low-BMI was associated with increased falls risk and mortality; however, the association depended on specific patient age groups.
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Affiliation(s)
- Eunjung Kim
- Department of Nutritional Support Team, Seoul National University Hospital, Seoul 03080, Korea
- Department of Nursing, Seoul National University Hospital, Seoul 03080, Korea
| | - Eun-Mi Seol
- Department of Nutritional Support Team, Seoul National University Hospital, Seoul 03080, Korea
- Department of Nursing, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
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Mirzai S, Sarnaik KS, Persits I, Martens P, Estep JD, Chen P, Tang WHW. Combined Prognostic Impact of Low Muscle Mass and Hypoalbuminemia in Patients Hospitalized for Heart Failure: A Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e030991. [PMID: 38258654 PMCID: PMC11056110 DOI: 10.1161/jaha.123.030991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Sarcopenia and hypoalbuminemia have been identified as independent predictors of increased adverse outcomes, including mortality and readmissions, in hospitalized older adults with acute decompensated heart failure (ADHF). However, the impact of coexisting sarcopenia and hypoalbuminemia on morbidity and death in adults with ADHF has not yet been investigated. We aimed to investigate the combined effects of lower muscle mass (LMM) as a surrogate for sarcopenia and hypoalbuminemia on in-hospital and postdischarge outcomes of patients hospitalized for ADHF. METHODS AND RESULTS A total of 385 patients admitted for ADHF between 2017 and 2020 at a single institution were retrospectively identified. Demographic and clinical data were collected, including serum albumin levels at admission and discharge. Skeletal muscle indices were derived from semi-automated segmentation software analysis on axial chest computed tomography at the twelfth vertebral level. Our analysis revealed that patients who had LMM with admission hypoalbuminemia experienced increased diagnoses of infection and delirium with longer hospital length of stay and more frequent discharge to a facility. Upon discharge, 27.9% of patients had higher muscle mass without discharge hypoalbuminemia (reference group), 9.7% had LMM without discharge hypoalbuminemia, 38.4% had higher muscle mass with discharge hypoalbuminemia, and 24.0% had LMM with discharge hypoalbuminemia; mortality rates were 37.6%, 51.4%, 48.9%, and 63.2%, respectively. 1- and 3-year mortality risks were highest in those with LMM and discharge hypoalbuminemia; this relationship remained significant over a median 23.6 (3.1-33.8) months follow-up time despite multivariable adjustments (hazard ratio, 2.03 [95% CI, 1.31-3.16]; P=0.002). CONCLUSIONS Hospitalization with ADHF, LMM, and hypoalbuminemia portend heightened mortality risk.
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Affiliation(s)
- Saeid Mirzai
- Section on Cardiovascular Medicine, Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNCUSA
- Department of Internal MedicineCleveland ClinicClevelandOHUSA
| | | | - Ian Persits
- Department of Internal MedicineCleveland ClinicClevelandOHUSA
| | - Pieter Martens
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOHUSA
| | - Jerry D. Estep
- Department of CardiologyCleveland Clinic FloridaWestonFLUSA
| | - Po‐Hao Chen
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland ClinicClevelandOHUSA
| | - W. H. Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOHUSA
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Hegazi R, Miller A, Sauer A. Evolution of the diagnosis of malnutrition in adults: a primer for clinicians. Front Nutr 2024; 11:1169538. [PMID: 38379550 PMCID: PMC10876842 DOI: 10.3389/fnut.2024.1169538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
During the last two decades, the definition, diagnosis, and management of malnutrition have significantly evolved. Malnutrition is generally defined as deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. While malnutrition is associated with a significantly increased risk of morbidity, mortality, and healthcare cost, it is often underdiagnosed both in healthcare and community settings. One contributing factor is the lack of a consensus on its definition and appropriate diagnostic indicators. In the current article, we review the evolution of frameworks for the diagnosis of malnutrition. Recently published consensuses by prominent clinical nutrition societies have established a trajectory for the uniform global diagnosis of malnutrition. Limiting the use of body mass index (BMI) as a diagnostic criterion while emphasizing the use of muscle mass enables a more consistent and accurate diagnosis of malnutrition in the clinical setting. Guidance for the unified methodology and terminology for diagnosing malnutrition, such as the one proposed in the current article will enable policy makers to systematically address the two faces of malnutrition, starvation- and disease-related malnutrition applicable to both pediatric and adult populations. Policies and programs that could address issues of food insecurity and scarcity as well as early diagnosis and management of disease-related malnutrition will empower better care of community nutrition.
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Affiliation(s)
- Refaat Hegazi
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| | - Anthony Miller
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Abby Sauer
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
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Netzer R, Elboim-Gabyzon M. Implementation of Nutritional Assessment and Counseling in Physical Therapy Treatment: An Anonymous Cross-Sectional Survey. Nutrients 2023; 15:4204. [PMID: 37836488 PMCID: PMC10574340 DOI: 10.3390/nu15194204] [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: 09/10/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
In the context of the evolving role of Physical Therapists (PTs) in health promotion, this study explored the incorporation of nutritional assessment and counseling into PTs' professional practice in Israel. Using an anonymous cross-sectional survey design, the research gauged PTs' professional background, nutritional knowledge, lifestyle habits, and the extent of nutritional care integration. Our survey gathered data from 409 certified PTs in Israel, revealing inadequate nutritional knowledge, commendable nutritional lifestyles, and limited nutritional care integration. Participants with over 13 years of clinical experience demonstrated significantly higher levels of nutritional assessment and counseling integration within their physical therapy practices. Workplace setting, nutritional lifestyle, and nutritional knowledge emerged as significant predictors for nutritional care integration. Specifically, working in outpatient clinics and possessing better nutritional lifestyles and knowledge were associated with the increased integration of nutritional assessment and counseling within physical therapy practice. These findings underscore the need for targeted interventions and formal nutrition education to bridge the knowledge gaps and optimize patient care. These results advocate for comprehensive nutrition education in physical therapy curricula and the fostering of PTs as role models. Integrating nutrition care could empower PTs to enhance patient outcomes and fulfill their role in preventive healthcare.
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Affiliation(s)
| | - Michal Elboim-Gabyzon
- Department of Physical Therapy, School of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
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Sravya SL, Swain J, Sahoo AK, Mangaraj S, Kanwar J, Jadhao P, Das S. Sarcopenia in Type 2 Diabetes Mellitus: Study of the Modifiable Risk Factors Involved. J Clin Med 2023; 12:5499. [PMID: 37685565 PMCID: PMC10488216 DOI: 10.3390/jcm12175499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Sarcopenia has gained much interest in recent years due to an increase in morbidity. Sarcopenia is associated with type 2 diabetes mellitus (T2DM) and vice versa. There is a paucity of information regarding the prevalence and predictors of sarcopenia among T2DM individuals. The aim of the present study was to determine the prevalence and predictors of sarcopenia among T2DM individuals. (2) Methods: This study included 159 diabetics (cases) and 79 non-diabetics (controls) aged >50 years. The subjects were assessed for demographic and anthropometric parameters. Sarcopenia (according to the Asian Working Group for Sarcopenia 2019 criteria) was assessed using Jammer's hydraulic dynamometer for handgrip strength, dual-energy X-ray absorptiometry for muscle mass, and 6m gait speed. The biochemical investigations included glycated hemoglobin; fasting and prandial glucose; fasting insulin; lipid, renal, liver, and thyroid profiles; serum calcium; phosphorous; vitamin D; and parathyroid hormone (PTH). Appropriate statistical methods were used to determine the significance of each parameter, and a multivariate regression analysis was applied to determine the predictors. (3) Results: The prevalence of sarcopenia was significantly higher among the cases than the controls (22.5% vs. 8.86%, p-0.012). Body mass index (BMI) (OR-0.019, CI-0.001-0.248), physical activity (OR-0.45, CI-0.004-0.475), serum calcium levels (OR-0.155, CI-0.035-0.687), hypertension (OR-8.739, CI-1.913-39.922), and neuropathy (OR-5.57, CI-1.258-24.661) were significantly associated with sarcopenia following multivariate regression analysis. (4) Conclusions: T2DM individuals are prone to sarcopenia, especially those with a low BMI, low physical activity, hypertension, neuropathy, and low serum calcium levels. Hence, by modifying these risk factors among the elderly T2DM, sarcopenia can be prevented.
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Affiliation(s)
- Surapaneni Lakshmi Sravya
- Department of Endocrinology, IMS & SUM Hospital, Bhubaneswar 751003, India; (S.L.S.); (A.K.S.); (S.M.); (J.K.); (P.J.)
| | - Jayshree Swain
- Department of Endocrinology, IMS & SUM Hospital, Bhubaneswar 751003, India; (S.L.S.); (A.K.S.); (S.M.); (J.K.); (P.J.)
| | - Abhay Kumar Sahoo
- Department of Endocrinology, IMS & SUM Hospital, Bhubaneswar 751003, India; (S.L.S.); (A.K.S.); (S.M.); (J.K.); (P.J.)
| | - Swayamsidha Mangaraj
- Department of Endocrinology, IMS & SUM Hospital, Bhubaneswar 751003, India; (S.L.S.); (A.K.S.); (S.M.); (J.K.); (P.J.)
| | - Jayabhanu Kanwar
- Department of Endocrinology, IMS & SUM Hospital, Bhubaneswar 751003, India; (S.L.S.); (A.K.S.); (S.M.); (J.K.); (P.J.)
| | - Pooja Jadhao
- Department of Endocrinology, IMS & SUM Hospital, Bhubaneswar 751003, India; (S.L.S.); (A.K.S.); (S.M.); (J.K.); (P.J.)
| | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
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Massimino E, Izzo A, Castaldo C, Ferretti E, Rivellese AA, Della Pepa G. Risk of Sarcopenia and Associated Factors in Older Adults with Type 2 Diabetes: An Exploratory Cross-Sectional Study. Healthcare (Basel) 2023; 11:2081. [PMID: 37510524 PMCID: PMC10380017 DOI: 10.3390/healthcare11142081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Evidence on the risk of sarcopenia and associated factors in older adults with type 2 diabetes (T2D) is lacking. We evaluate (1) the proportion of patients at risk of sarcopenia in older adults with T2D; and (2) the factors associated with the risk of sarcopenia. METHODS We conducted a cross-sectional study on T2D patients over 65 years referred to our outpatient clinic and who carried out the yearly complication assessment visit. Eligible patients were administered questionnaires during phone interviews for the risk evaluation of sarcopenia (SARC-F), the risk evaluation of malnutrition (Mini Nutritional Assessment Short Form (MNA®-SF)), the adherence to the Mediterranean diet (MEDI-quest), and the evaluation of physical activity (the International Physical Activity Questionnaire short form). RESULTS A total of 138 patients were included in the study, and 12 patients (8.7% (95% CI 4.6-14.7)) were at risk of sarcopenia. The mean SARC-F score was significantly higher in women compared with men (2.1 ± 1.8 vs. 0.9 ± 1.4, respectively; p < 0.001). The majority of patients identified at risk of sarcopenia compared with those not at risk were women (75% vs. 30%, respectively; p = 0.003), had a higher proportion of neuropathy (50% vs. 19%, respectively; p = 0.027), a lower mean MNA®-SF score (11.6 ± 1.5 vs. 13.0 ± 1.4, respectively; p = 0.001), a lower mean MEDI-quest score (5.2 ± 1.5 vs. 5.9 ± 1, respectively; p = 0.037), and were more inactive (92% vs. 61%, respectively; p = 0.032). CONCLUSIONS In a sample of older adults with T2D, the risk of sarcopenia was identified in 8.7% (95% CI: 4.6-14.7) of the sample, and the main factors associated were female gender, neuropathy, a lower MNA®-SF score, low adherence to the Mediterranean diet, and low physical activity.
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Affiliation(s)
- Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Anna Izzo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Carmen Castaldo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Erica Ferretti
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
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Cervera-Díaz MDC, López-Gómez JJ, García-Virto V, Aguado-Hernández HJ, De Luis-Román DA. Prevalence of sarcopenia in patients older than 75 years admitted for hip fracture. ENDOCRINOL DIAB NUTR 2023:S2530-0180(23)00102-6. [PMID: 37301697 DOI: 10.1016/j.endien.2023.06.001] [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: 09/28/2021] [Accepted: 03/11/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hip fracture in the population aged 75 years and older is one of the most disabling pathologies. Likewise, disease related malnutrition (DRM) and sarcopenia are two frequent diagnoses in this age group, whose prevalence may be increased in patients with hip fracture. AIMS To determine the prevalence of malnutrition and/or sarcopenia in patients admitted for hip fracture and evaluate the existence of malnutrition related to disease and sarcopenia, and the differences between the sarcopenic and non-sarcopenic group. METHODS 186 patients aged 75 years or over, hospitalised for hip fracture from March 2018 to June 2019 were included. Demographic, nutritional and biochemical variables were collected. Nutritional screening was carried out with the Mini-Nutritional Assessment (MNA), the presence of DRM was established with The Global Leadership Initiative on Malnutrition (GLIM) criteria. For sarcopenia screening, the Strength, Assistance with walking, Rising from a chair, Climbing stairs and Falls (SARC-F) was used and the diagnosis of sarcopenia was made using the criteria from the European Working Group on Sarcopenia in Older People (EWGSOP) reviewed in 2019 (EWGSOP2). Muscle strength was determined by hand-grip strength, body composition by measurement of bioelectrical impedance. RESULTS The mean age was 86.2 years, most of the patients were women (81.7%). 37.1% of patients were at nutritional risk (MNA 17-23.5) and 16.7% were malnourished (MNA < 17). 72.4% of women and 79.4% of men, were diagnosed with DRM. 77.6% of the women and 73.5% of the men had low muscle strength. The appendicular muscle mass index was below the cut-off points for sarcopenia in 72.4% of the women and 79.4% of the men. Patients with sarcopenia had a lower body mass index, older age, poorer previous functional status and higher disease burden. The relationship between weight loss and hand grip strength (HGS) was significant (p = 0.007). CONCLUSIONS 53.8% of patients admitted for hip fracture present malnutrition or are at risk after screening with MNA. Sarcopenia and DRM affects at least three out of four patients older than 75 years admitted for hip fracture. Older age, worse functional status, lower body mass index and high number of comorbidities, are associated with these two entities. There is a relationship between DRM and sarcopenia.
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Affiliation(s)
| | - Juan José López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Virginia García-Virto
- Servicio de Traumatología y Ortopedia, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Nishioka S. Current Understanding of Sarcopenia and Malnutrition in Geriatric Rehabilitation. Nutrients 2023; 15:nu15061426. [PMID: 36986156 PMCID: PMC10056038 DOI: 10.3390/nu15061426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Malnutrition and sarcopenia are different but common conditions in older adults that share some underlying causes, including age-related physiological changes, decreased food intake, acute or chronic inflammation [...]
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan; ; Tel.: +81-88-633-7095
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Tokushima 770-8503, Japan
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Rodríguez-Mañas L, Murray R, Glencorse C, Sulo S. Good nutrition across the lifespan is foundational for healthy aging and sustainable development. Front Nutr 2023; 9:1113060. [PMID: 36761990 PMCID: PMC9902887 DOI: 10.3389/fnut.2022.1113060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
Ensuring healthy lives and promoting wellbeing across the age spectrum are essential to sustainable development. Nutrition is at the heart of the World Health Organization (WHO) Sustainable Development Goals, particularly for Sustainable Development Goal 2/Subgoal 2, which is to End all forms of malnutrition by 2030. This subgoal addresses people of all ages, including targeted groups like young children and older adults. In recent decades, there have been marked advances in the tools and methods used to screen for risk of malnutrition and to conduct nutritional assessments. There have also been innovations in nutritional interventions and outcome measures related to malnutrition. What has been less common is research on how nutritional interventions can impact healthy aging. Our Perspective article thus takes a life-course approach to consider what is needed to address risk of malnutrition and why, and to examine how good nutrition across the lifespan can contribute to healthy aging. We discuss broad-ranging yet interdependent ways to improve nutritional status worldwide-development of nutritional programs and policies, incorporation of the best nutrition-care tools and methods into practice, provision of professional training for quality nutritional care, and monitoring health and economic benefits of such changes. Taken together, our Perspective aims to (i) identify current challenges to meeting these ideals of nutritional care, and to (ii) discover enabling strategies for the improvement of nutrition care across the lifespan. In harmony with the WHO goal of sustainable development, we underscore roles of nutrition to foster healthy human development and healthy aging worldwide.
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Affiliation(s)
- Leocadio Rodríguez-Mañas
- Service of Geriatrics, Getafe University Hospital and CIBER on Frailty and Healthy Aging (CIBERFES), Getafe, Spain,*Correspondence: Leocadio Rodríguez-Mañas,
| | - Robert Murray
- Department of Pediatrics, Emeritus, The Ohio State University College of Medicine, Columbus, OH, United States
| | | | - Suela Sulo
- Abbott Laboratories, Abbott Park, IL, United States
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12
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Chew STH, Tey SL, Yalawar M, Liu Z, Baggs G, How CH, Cheong M, Chow WL, Low YL, Huynh DTT, Tan NC. Prevalence and associated factors of sarcopenia in community-dwelling older adults at risk of malnutrition. BMC Geriatr 2022; 22:997. [PMID: 36564733 PMCID: PMC9789557 DOI: 10.1186/s12877-022-03704-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is an increasingly strong association between sarcopenia and malnutrition in research findings. We aimed to determine the prevalence and factors associated with sarcopenia in community-dwelling older adults (≥ 65 years) at risk of malnutrition based on Malnutrition Universal Screening Tool (MUST). METHODS This was a cross-sectional study of 811 participants. Participants were recruited from the general population, community centers, senior activity centers, polyclinics, and hospital. Community-dwelling older adults at risk of malnutrition participated in the study. Participants' data and measurements were collected at the baseline visit. Data included socio-demographic information, anthropometric measurements, body composition, dietary intakes, and functional assessments. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 consensus. RESULTS Of the 694 participants with complete datasets, overall prevalence of sarcopenia was 76% (n = 530); 57% (n = 393) had severe sarcopenia. In the overall cohort, compared to participants without sarcopenia, those with sarcopenia were older, had lower physical activity scale for the elderly score, leg strength, handgrip endurance, mid-upper arm circumference, calf circumference, and bone mass, and had lower dietary protein intake and poorer nutritional status (all p ≤ 0.015). After adjusting for confounders, sarcopenia was significantly associated with older age, male gender, higher risk of malnutrition, lower calf circumference, and lower bone mass (all p ≤ 0.044). CONCLUSIONS In community-dwelling older adults at risk of malnutrition, there is a high prevalence of sarcopenia and severe sarcopenia. As such, screening positive for either malnutrition risk or sarcopenia in older adults should prompt screening for the other risk factor, to allow early institution of disease modifying interventions to forestall adverse outcomes for both malnutrition and sarcopenia. TRIAL REGISTRATION The study was registered at clinicaltrials.gov as NCT03245047 .
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Affiliation(s)
- Samuel Teong Huang Chew
- grid.413815.a0000 0004 0469 9373Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Siew Ling Tey
- grid.497499.e0000 0004 0620 5859Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, Singapore
| | - Menaka Yalawar
- Statistical Services, Cognizant Technologies Solution Pvt. Ltd., Bangalore, India
| | - Zhongyuan Liu
- grid.497499.e0000 0004 0620 5859Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, Singapore
| | - Geraldine Baggs
- grid.417574.40000 0004 0366 7505Abbott Nutrition Research and Development, Columbus, OH USA
| | - Choon How How
- grid.413815.a0000 0004 0469 9373Care and Health Integration, Changi General Hospital, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | - Magdalin Cheong
- grid.413815.a0000 0004 0469 9373Department of Dietetic & Food Services, Changi General Hospital, Singapore, Singapore
| | - Wai Leng Chow
- grid.413815.a0000 0004 0469 9373Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Yen Ling Low
- grid.497499.e0000 0004 0620 5859Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, Singapore
| | - Dieu Thi Thu Huynh
- grid.497499.e0000 0004 0620 5859Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, Singapore
| | - Ngiap Chuan Tan
- grid.4280.e0000 0001 2180 6431SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore ,grid.490507.f0000 0004 0620 9761SingHealth Polyclinics, Singapore, Singapore
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13
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Comparison of nutritional risk screening with NRS2002 and the GLIM diagnostic criteria for malnutrition in hospitalized patients. Sci Rep 2022; 12:19743. [PMID: 36396666 PMCID: PMC9672100 DOI: 10.1038/s41598-022-23878-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Nutritional risk screening, to identify patients at risk of malnutrition, is the first step in the prevention and treatment of malnutrition in hospitalized patients, and should be followed by a thorough nutritional assessment resulting in a diagnosis of malnutrition and subsequent treatment. In 2019, a consensus on criteria has been suggested for the diagnosis of malnutrition by the Global Leadership Initiative for Malnutrition (GLIM). This study investigates the diagnosis of malnutrition in hospitalized patients using nutritional risk screening and the diagnostic assessment suggested by GLIM. Hospitalized patients (excluding cancer, intensive care, and transmissible infections) who underwent nutritional risk screening (by NRS2002) were included. Nutritional risk screening was followed by anthropometric measurements including measurement of muscle mass, assessment of dietary intake and measurement of serum C-reactive protein (CRP) for inflammation in all patients. Malnutrition was diagnosed according to the GLIM-criteria. In total, 328 patients (median age 71 years, 47% women, median length of stay 7 days) were included. Nutritional risk screening identified 143 patients as at risk of malnutrition, while GLIM criteria led to a diagnosis of malnutrition in 114 patients. Of these 114 patients, 77 were also identified as at risk of malnutrition by NRS2002, while 37 patients were not identified by NRS2002. Malnutrition was evident in fewer patients than at risk of malnutrition, as expected. However, a number of patients were malnourished who were not identified by the screening procedure. More studies should investigate the importance of inflammation and reduced muscle mass, which is the main difference between nutritional risk screening and GLIM diagnostic assessment.
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Samoilova YG, Matveeva MV, Khoroshunova EA, Kudlay DA, Oleynik OA, Spirina LV. Markers for the Prediction of Probably Sarcopenia in Middle-Aged Individuals. J Pers Med 2022; 12:jpm12111830. [PMID: 36579539 PMCID: PMC9692986 DOI: 10.3390/jpm12111830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Sarcopenia is a condition that is characterized by a progressive loss of muscle mass, strength, and function, resulting in reduced quality of life. The aim of the study was to analyze the significance of pro-inflammatory markers in the prognostic diagnosis of sarcopenia. The participants were divided into two groups: the main group of 146 people and the control-75 people. The complex of examinations included neuropsychological testing (Hospital Anxiety and Depression Scale (HADS), quality-of-life questionnaire for patients with sarcopenia (SarQoL), and short health assessment form (MOS SF-36)), a 6 m walking speed test, manual dynamometry, bioimpedancemetry, and metabolic markers (nitrates, fibroblast growth factor 21, and malondialdehyde). When analyzing metabolic markers in the main group, a twofold increase in nitrates in the main group was recorded in a subsequent analysis adjusted for multiple variables, there was a negative association between the nitrate levels for weak grip strength and appendicular muscle mass. An additional analysis revealed that the complaint of pain in the lower extremities was more frequent in patients of the main group, as well as constipation and the pathology of thyroid gland, and they were more frequently diagnosed with arterial hypertension. At the same time, patients from the main group more frequently took vitamin D. When conducting body composition, the main group recorded a higher weight visceral fat content, as well as a decrease in appendicular and skeletal muscle mass; these changes were accompanied by a decrease in protein and minerals. Among the markers that differed significantly were nitrates, and it was this that was associated with decreased muscle strength and appendicular mass, which may indicate both a possible mechanism and a possible predictive marker. The results of this study can be used to develop a screening method for diagnosing sarcopenia at the outpatient stage.
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Affiliation(s)
- Yulia G. Samoilova
- Federal State Budgetary Educational Institution of Higher Education «Siberian State Medical University» of the Ministry of Health of Russia, Moskovsky Trakt 2, 634050 Tomsk, Russia
| | - Mariia V. Matveeva
- Federal State Budgetary Educational Institution of Higher Education «Siberian State Medical University» of the Ministry of Health of Russia, Moskovsky Trakt 2, 634050 Tomsk, Russia
- Correspondence: ; Tel.: +7-913-815-2552
| | - Ekaterina A. Khoroshunova
- Federal State Budgetary Educational Institution of Higher Education «Siberian State Medical University» of the Ministry of Health of Russia, Moskovsky Trakt 2, 634050 Tomsk, Russia
| | - Dmitry A. Kudlay
- Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University Named after I.I. THEM. Sechenov” of the Ministry of Health of Russia (Sechenov University), St. Trubetskaya 8, Building 2, 119048 Moscow, Russia
- Federal State Budgetary Institution “State Research Center “Institute of Immunology”” FMBA of Russia, Kashirskoe sh., 24, 115478 Moscow, Russia
| | - Oxana A. Oleynik
- Federal State Budgetary Educational Institution of Higher Education «Siberian State Medical University» of the Ministry of Health of Russia, Moskovsky Trakt 2, 634050 Tomsk, Russia
| | - Liudmila V. Spirina
- Federal State Budgetary Educational Institution of Higher Education «Siberian State Medical University» of the Ministry of Health of Russia, Moskovsky Trakt 2, 634050 Tomsk, Russia
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15
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Chen W, Shi S, Tu J, Liao L, Liao Y, Chen K, Chen L, Huang R. Nutrition-related diseases and cardiovascular mortality in American society: national health and nutrition examination study, 1999-2006. BMC Public Health 2022; 22:1849. [PMID: 36192729 PMCID: PMC9531382 DOI: 10.1186/s12889-022-14257-8] [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: 05/06/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Despite many significant advances in treatment and management, cardiovascular disease remains the main cause of the global disease burden. Nutrition-related disease is a modifiable cardiovascular risk factor. However, few studies have examined the relationship between nutrition-related diseases and cardiovascular mortality. Objective We aimed to investigate the association of nutrition-related diseases with cardiovascular mortality based on a large nationally representative community population. Design We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2006 with mortality follow-up through December 31, 2015. Finally, 12,469 participants were analyzed. Each participant was assigned to one of four groups: normal nutrition without sarcopenia, sarcopenia with normal nutrition, malnutrition without sarcopenia, and malnutrition-sarcopenia syndrome. Survival curves and Cox regressions based on the NHANES recommended weights were used to assess the association between nutrition-related diseases and cardiovascular mortality. Results Of the 12,469 patients included in the study and divided into four groups, malnutrition-sarcopenia syndrome had the highest 5- and 10-year cardiovascular mortality rates. After adjustment for related factors, sarcopenia with normal nutrition (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.28–2.06; P < 0.001), malnutrition without sarcopenia (HR: 1.28, 95% CI:1.03–1.58; P = 0.024), and malnutrition-sarcopenia syndrome (HR: 2.66, 95% CI:1.89 − 3.74; P < 0.001) were significantly associated with increased risk of all-cause mortality. Malnutrition-sarcopenia syndrome remained associated with an increased risk of cardiovascular mortality (HR: 3.56, 95% CI: 1.17 − 10.84; P < 0.001). Conclusions Malnutrition-sarcopenia syndrome was highly prevalent among community-dwelling adults in the United States and was a strong prognostic factor for cardiovascular mortality in the community setting. Randomized clinical trials are needed to demonstrate whether prevention or treatment of malnutrition-sarcopenia syndrome in community populations can reduce global cardiovascular mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14257-8.
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Affiliation(s)
- Weihua Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Shanshan Shi
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Jiabin Tu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Lihua Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Ying Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Liling Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Rongchong Huang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
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Sadeghian F, Divsalar DN, Fadil R, Tavakolian K, Blaber AP. Canadian aging and inactivity study: Spaceflight-inspired exercises during head-down tilt bedrest blunted reductions in muscle-pump but not cardiac baroreflex in older persons. Front Physiol 2022; 13:943630. [PMID: 36213230 PMCID: PMC9532525 DOI: 10.3389/fphys.2022.943630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
As part of the first Canadian aging and inactivity study (CAIS) we assessed the efficacy of space-based exercise countermeasures for maintenance of cardiac and muscle-pump baroreflex in older persons during bedrest. An initiative of the Canadian Space Agency, Canadian Institutes of Health Research and the Canadian Frailty Network, CAIS involved 14 days of 6-degree head-down tilt bedrest (HDBR) with (Exercise) or without (Control) combined upper and lower body strength, aerobic, and high-intensity interval training exercise countermeasures. Twenty healthy men and women aged 55 to 65, randomly divided into control and exercise groups (male control (MC, n = 5), male exercise (ME, n = 5), female control (FC, n = 6), female exercise (FE, n = 4)) (age: 58.7 ± 0.5 years, height: 1.67 ± 0.02 m, body mass: 70.2 ± 3.2 kg; mean ± SEM), completed the study. Cardiac and muscle-pump baroreflex activity were assessed with supine-to-stand tests. Wavelet transform coherence was used to characterise cardiac and muscle-pump baroreflex fraction time active (FTA) and gain values, and convergent cross-mapping was used to investigate causal directionality between blood pressure (BP) and heart rate, as well as BP and lower leg muscle electromyography (EMG). Seven of the twenty participants were unable to stand for 6 minutes after HDBR, with six of those being female. Our findings showed that 2 weeks of bedrest impaired skeletal muscle’s ability to return blood to the venous circulation differently across various sexes and intervention groups. Comparing values after bed rest with before bed rest values, there was a significant increase in heart rates (∆ of +25%; +17% in MC to +33% in FC; p < 0.0001), beat-to-beat EMG decreased (∆ of −43%; −25% in ME to −58% in MC; p < 0.02), while BP change was dependent on sex and intervention groups. Unlike their male counterparts, in terms of muscle-pump baroreflex, female participants had considerably decreased FTA after HDBR (p < 0.01). All groups except female control demonstrated parallel decreases in cardiac active gain and causality, while the FC demonstrated an increase in cardiac causality despite a similar decline in cardiac active gain. Results showed that the proposed exercises may alleviate muscle-pump baroreflex declines but could not influence the cardiac baroreflex decline from 14 days of inactivity in older adults.
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Affiliation(s)
- Farshid Sadeghian
- Department of Biomedical Physiology and Kinesiology, Aerospace Physiology Laboratory, Simon Fraser University, Burnaby, Canada
| | - Donya Naz Divsalar
- Department of Biomedical Physiology and Kinesiology, Aerospace Physiology Laboratory, Simon Fraser University, Burnaby, Canada
| | - Rabie Fadil
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
| | - Kouhyar Tavakolian
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
| | - Andrew P. Blaber
- Department of Biomedical Physiology and Kinesiology, Aerospace Physiology Laboratory, Simon Fraser University, Burnaby, Canada
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
- *Correspondence: Andrew P. Blaber,
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Milewska M, Przekop Z, Szostak-Węgierek D, Chrzanowska M, Raciborski F, Traczyk I, Sińska BI, Samoliński B. Prevalence of Risk of Sarcopenia in Polish Elderly Population—A Population Study. Nutrients 2022; 14:nu14173466. [PMID: 36079726 PMCID: PMC9459963 DOI: 10.3390/nu14173466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
Sarcopenia in the elderly population is a public health challenge, and there are few data on its prevalence in Europe. In this study, we investigated the prevalence of sarcopenia in the elderly Polish population and its association with the level of obesity and co-existing diseases. We conducted a population-based cross-sectional study involving 823 men and 1177 women aged 65 years and older, randomly selected from the population living in the territory of the Republic of Poland between 2017 and 2020. We analyzed the results of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Risk of sarcopenia was assessed with the simple questionnaire to rapidly diagnose sarcopenia (SARC-F), and sarcopenic obesity risk was defined as the combination of anthropometry and SARC-F results. In addition, we collected disease data with an author questionnaire. The prevalence of risk of sarcopenia was 18.6% (22.3% in women and 13.2% in men), and its incidence significantly increased with age in both sexes. The risk of sarcopenic obesity was more common in women than in men, and it was higher in the older age group, except for sarcopenic obesity diagnosed by the WHR criteria. The group of elderly with concomitant diseases had a higher risk of developing sarcopenia, which emphasizes the need to monitor sarcopenia when concomitant diseases are diagnosed. In both groups, risk of sarcopenia was associated with motor and respiratory system diseases, type 2 diabetes, and neurological diseases. This study highlights that the risk of sarcopenia in the elderly population affects women to a greater extent than men. It is important to identify the elderly at risk of sarcopenia in routine clinical practice to develop long-term prevention strategies.
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Affiliation(s)
- Magdalena Milewska
- Department of Clinical Dietetics, Faculty of Health and Science, Medical University of Warsaw, 01-445 Warszawa, Poland
| | - Zuzanna Przekop
- Department of Clinical Dietetics, Faculty of Health and Science, Medical University of Warsaw, 01-445 Warszawa, Poland
- Correspondence: ; Tel.: +48-22-57-20-931
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health and Science, Medical University of Warsaw, 01-445 Warszawa, Poland
| | - Mariola Chrzanowska
- Department of Prevention of Environmental Hazards and Allergology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland
- Department of Econometrics and Statistics, Institute of Economics and Finance, Warsaw University of Life Sciences, 02-787 Warszawa, Poland
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Iwona Traczyk
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warszawa, Poland
| | - Beata Irena Sińska
- Department of Econometrics and Statistics, Institute of Economics and Finance, Warsaw University of Life Sciences, 02-787 Warszawa, Poland
| | - Bolesław Samoliński
- Department of Prevention of Environmental Hazards and Allergology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland
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Chen WZ, Zhang XZ, Zhang FM, Yu DY, Chen WH, Lin F, Dong QT, Zhuang CL, Yu Z. Coexistence of GLIM-defined malnutrition and sarcopenia have negative effect on the clinical outcomes in the elderly gastric cancer patients after radical gastrectomy. Front Nutr 2022; 9:960670. [PMID: 36061885 PMCID: PMC9437552 DOI: 10.3389/fnut.2022.960670] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Malnutrition and sarcopenia are common in elderly gastric cancer patients, which are also interrelated and affect each other. We aimed to determine the characteristics of coexistence of malnutrition and sarcopenia in the elderly gastric cancer patients and investigate the predictive roles of malnutrition and sarcopenia on clinical outcomes. Methods Between 2014 and 2019, a total of 742 elderly gastric cancer patients were enrolled. Malnutrition and sarcopenia were diagnosed according to the most recent diagnostic criteria. Patients were divided into four groups according to presence of these two symptoms. Clinical characteristics, short- and long-term outcomes were compared among four groups. The independent risk factors for complications and survival were evaluated using univariate and multivariate analyses. Results Of all patients, 34.8% were diagnosed with malnutrition and 34.0% were diagnosed with sarcopenia. Patients with both malnutrition and sarcopenia had the highest rate of total (P < 0.001), surgical (P = 0.003), and medical complications (P = 0.025), and the highest postoperative hospital stays (P < 0.001) and hospitalization costs (P < 0.001). They also had the worst overall survival (P < 0.0001) and disease-free survival (P < 0.0001). Sarcopenia and Charlson Comorbidity Index (≥2) were independent risk factors for total complications. Hypoalbuminemia and malnutrition were non-tumor-related independent risk factors for overall survival and disease-free survival. Conclusions Malnutrition and sarcopenia had superimposed negative effects on elderly gastric cancer patients. Preoperative geriatric evaluation including screening for malnutrition and sarcopenia are recommended for all elderly gastric cancer patients for accurate treatment strategy.
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Affiliation(s)
- Wei-Zhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian-Zhong Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng-Min Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ding-Ye Yu
- Department of General Surgery, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Hao Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Lin
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian-Tong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Cheng-Le Zhuang
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Zhen Yu
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Tay W, Quek R, Kaur B, Lim J, Henry CJ. Use of Facial Morphology to Determine Nutritional Status in Older Adults: Opportunities and Challenges. JMIR Public Health Surveill 2022; 8:e33478. [PMID: 35849429 PMCID: PMC9345026 DOI: 10.2196/33478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Undiagnosed malnutrition is a significant problem in high-income countries, which can reduce the quality of life of many individuals, particularly of older adults. Moreover, it can also inflate the costs of existing health care systems because of the many metabolic complications that it can cause. The current methods for assessing malnutrition can be cumbersome. A trained practitioner must be present to conduct an assessment, or patients must travel to facilities with specialized equipment to obtain their measurements. Therefore, digital health care is a possible way of closing this gap as it is rapidly gaining traction as a scalable means of improving efficiency in the health care system. It allows for the remote monitoring of nutritional status without requiring the physical presence of practitioners or the use of advanced medical equipment. As such, there is an increasing interest in expanding the range of digital applications to facilitate remote monitoring and management of health issues. In this study, we discuss the feasibility of a novel digital remote method for diagnosing malnutrition using facial morphometrics. Many malnutrition screening assessments include subjective assessments of the head and the face. Facial appearance is often used by clinicians as the first point of qualitative indication of health status. Hence, there may be merit in quantifying these subtle but observable changes using facial morphometrics. Modern advancements in artificial intelligence, data science, sensors, and computing technologies allow facial features to be accurately digitized, which could potentially allow these previously intuitive assessments to be quantified. This study aims to stimulate further discussion and discourse on how this emerging technology can be used to provide real-time access to nutritional status. The use of facial morphometrics extends the use of currently available technology and may provide a scalable, easily deployable solution for nutritional status to be monitored in real time. This will enable clinicians and dietitians to keep track of patients remotely and provide the necessary intervention measures as required, as well as providing health care institutions and policy makers with essential information that can be used to inform and enable targeted public health approaches within affected populations.
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Affiliation(s)
- Wesley Tay
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rina Quek
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Joseph Lim
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Murawiak M, Krzymińska-Siemaszko R, Kaluźniak-Szymanowska A, Lewandowicz M, Tobis S, Wieczorowska-Tobis K, Deskur-Śmielecka E. Sarcopenia, Obesity, Sarcopenic Obesity and Risk of Poor Nutritional Status in Polish Community-Dwelling Older People Aged 60 Years and Over. Nutrients 2022; 14:2889. [PMID: 35889850 PMCID: PMC9317847 DOI: 10.3390/nu14142889] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Poor nutritional status (PNS) is a modifiable factor determining abnormalities in body composition-sarcopenia, obesity, and sarcopenic obesity (SO). We aimed to assess the prevalence of these conditions and their association with PNS in 211 community-dwelling older adults. Sarcopenia was diagnosed based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recommendations. Obesity was diagnosed with the Percent Body Fat (>42% in women and >30% in men). Subjects fulfilling the criteria for obesity and concomitantly with reduced lower and/or upper limbs muscle strength and muscle mass (ALM/BMI < 0.512 in women and <0.789 in men) were classified as SO phenotype. Participants without obesity and sarcopenia were categorized as ‘normal’ phenotype. Nutritional status was estimated with the Mini Nutritional Assessment, and a score of <24 indicated PNS. In total, 49.8% participants had abnormal body composition (60.7% men and 42.5% women; p = 0.001). Sarcopenia, obesity, and SO were diagnosed in 10%, 32.7%, and 7.1% of subjects. PNS was found in 31.3% of the study sample. Its prevalence differed between phenotypes: 81% in sarcopenia, 60% in SO, 14.5% in obesity, and 28.3% in the ‘normal’ phenotype group (p = 0.000). Based on the results, abnormal body composition is prevalent in elderly subjects. Sarcopenia and SO are often associated with PNS.
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Affiliation(s)
- Marika Murawiak
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Roma Krzymińska-Siemaszko
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Aleksandra Kaluźniak-Szymanowska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Marta Lewandowicz
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland;
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Ewa Deskur-Śmielecka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
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Cervera-Díaz MDC, López-Gómez JJ, García-Virto V, Aguado-Hernández HJ, De Luis-Román DA. Prevalencia de sarcopenia en pacientes mayores de 75 años ingresados por fractura de cadera. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Dhar M, Kapoor N, Suastika K, Khamseh ME, Selim S, Kumar V, Raza SA, Azmat U, Pathania M, Rai Mahadeb YP, Singhal S, Naseri MW, Aryana IGPS, Thapa SD, Jacob J, Somasundaram N, Latheef A, Dhakal GP, Kalra S. South Asian Working Action Group on SARCOpenia (SWAG-SARCO) – A consensus document. Osteoporos Sarcopenia 2022; 8:35-57. [PMID: 35832416 PMCID: PMC9263178 DOI: 10.1016/j.afos.2022.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/20/2021] [Accepted: 04/23/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Minakshi Dhar
- Department of Internal Medicine, AIIMS, Rishikesh, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
- Non Communicable Disease Unit, The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ketut Suastika
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University Denpasar, Bali, Indonesia
| | - Mohammad E. Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Vijay Kumar
- Department of Geriatric Medicine AIIMS New Delhi, India
| | - Syed Abbas Raza
- Department of Medicine, Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Umal Azmat
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | | | - Sunny Singhal
- Department of Geriatric Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Mohammad Wali Naseri
- Internal Medicine, Division of Endocrinology Metabolism and Diabetes, Kabul University of Medical Sciences (KUMS), Kabul, Afghanistan
| | - IGP Suka Aryana
- Geriatric Division of Internal Medicine Department, Udayana University, Bali, Indonesia
| | - Subarna Dhoj Thapa
- Department of Endocrinology and Metabolism, Grande International Hospital, Kathmandu, Nepal
| | - Jubbin Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, 10, Sri Lanka
| | - Ali Latheef
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Maldives
| | - Guru Prasad Dhakal
- Department of Gastroenterology, Jigme Dorji Wangchuk National Referral Hospital, Thimpu, Bhutan
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
- Corresponding author.
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Xiang Q, Li Y, Xia X, Deng C, Wu X, Hou L, Yue J, Dong B. Associations of geriatric nutrition risk index and other nutritional risk-related indexes with sarcopenia presence and their value in sarcopenia diagnosis. BMC Geriatr 2022; 22:327. [PMID: 35428245 PMCID: PMC9012026 DOI: 10.1186/s12877-022-03036-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/07/2022] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objective
Standard modalities recommended for sarcopenia diagnosis may be unavailable in primary care settings. We aimed to comprehensively evaluate and compare associations of some better popularized nutritional risk-related indexes with sarcopenia presence and their value in sarcopenia diagnosis in community-dwelling middle-aged and elderly adults, including geriatric nutrition risk index (GNRI), albumin (ALB), calf circumference (CC), mid-arm circumference (MAC), triceps skinfold thickness (TST) and body mass index (BMI).
Methods
Based on the West China Health and Aging Trend study, the current study included participants aged 50 or older who were recruited in 2018. Sarcopenia-related assessment and diagnosis were in line with Asian Working Group for Sarcopenia 2019. For each single index, we assessed its association with sarcopenia presence by univariate and multivariate logistic regression analysis; we also computed diagnostic measures including the area under the receiver operating characteristic curve (AUC) and sensitivity, specificity, accuracy at the optimal cut-off value determined according to Youden’s index.
Results
A total of 3829 subjects were included, consisting of 516 and 3313 subjects in the sarcopenia and non-sarcopenia groups, respectively. Regarding the risk for sarcopenia presence, the fully adjusted odds ratios of GNRI, ALB, CC, MAC, TST and BMI per standard deviation decrease were 2.95 (95% CI 2.51–3.47, P < 0.001), 1.01 (95% CI 0.90–1.15, P = 0.816), 4.56 (95% CI 3.82–5.44, P < 0.001), 4.24 (95% CI 3.56–5.05, P < 0.001), 1.67 (95% CI 1.92–1.45, P < 0.001) and 4.09 (95% CI 3.41–4.91, P < 0.001), respectively. Regarding the value in sarcopenia diagnosis in the entire study population, their AUCs could be ordered as MAC (0.85, 95% CI 0.83–0.86) > GNRI (0.80, 95% CI 0.78–0.82), CC (0.83, 95% CI 0.81–0.85), BMI (0.81, 95% CI 0.79–0.83) > TST (0.72, 95% CI 0.70–0.74) > ALB (0.62, 95% CI 0.60–0.65). At the relevant optimal cut-off values, the sensitivity was the highest for CC (0.83, 95% CI 0.80–0.87) and MAC (0.80, 95% CI 0.77–0.84), while GNRI showed the highest specificity (0.79, 95% CI 0.78–0.81) and accuracy (0.78, 95% 0.76–0.79).
Conclusion
Overall diagnostic performance was the best for MAC, followed by GNRI, CC, BMI, and the worst for TST, ALB in distinguishing sarcopenia from non-sarcopenia in middle-aged and elderly adults in community-based settings. CC or MAC might do better in reducing missed diagnosis, while GNRI was superior in reducing misdiagnosis.
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Biomarker Changes in Response to a 12-Week Supplementation of an Oral Nutritional Supplement Enriched with Protein, Vitamin D and HMB in Malnourished Community Dwelling Older Adults with Sarcopenia. Nutrients 2022; 14:nu14061196. [PMID: 35334853 PMCID: PMC8953113 DOI: 10.3390/nu14061196] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Malnutrition and sarcopenia commonly overlap and contribute to adverse health outcomes. Previously, chronic supplementation with two oral nutritional supplements (ONS), control (CONS) and experimental ONS enriched with protein, vitamin D and β-hydroxy β-methylbutyrate (HMB) (EONS), improved muscle strength and quality in malnourished sarcopenic older adults, with EONS demonstrating early strength benefits at 12 weeks. To understand the underlying biological mechanisms contributing to the observed early strength benefits of EONS, we examined serum biomarker changes in response to 12-week supplementation. Serum samples (EONS (n = 90) and CONS (n = 103)) collected at baseline and 12 weeks were analyzed. Biomarkers (n = 243) were measured using multiplexed immunoassay, commercial immunoassays and ELISAs. Sixty markers were excluded with levels below assay detection limits. Sixteen biomarkers significantly changed in response to both interventions including nutritional and metabolic markers. Thirteen biomarkers significantly changed in response to EONS but not CONS. Increases in immunoglobulins, myoglobin, total protein, vitamin E and magnesium were observed with EONS. Inflammation-related ferritin and osteopontin decreased, while soluble receptors for cytokines increased, suggesting decreased inflammation. Sex hormone-binding globulin associated with sarcopenia also decreased with EONS. Biomarkers reflective of multiple biological systems were impacted by nutritional intervention in sarcopenic older adults. Incremental biomarker changes were observed in response to EONS containing HMB that possibly link to improvements in skeletal muscle health.
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25
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Nutrients against Glucocorticoid-Induced Muscle Atrophy. Foods 2022; 11:foods11050687. [PMID: 35267320 PMCID: PMC8909279 DOI: 10.3390/foods11050687] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Glucocorticoid excess is a critical factor contributing to muscle atrophy. Both endogenous and exogenous glucocorticoids negatively affect the preservation of muscle mass and function. To date, the most effective intervention to prevent muscle atrophy is to apply a mechanical load in the form of resistance exercise. However, glucocorticoid-induced skeletal muscle atrophy easily causes fatigue in daily physical activities, such as climbing stairs and walking at a brisk pace, and reduces body movements to cause a decreased ability to perform physical activity. Therefore, providing adequate nutrients in these circumstances is a key factor in limiting muscle wasting and improving muscle mass recovery. The present review will provide an up-to-date review of the effects of various nutrients, including amino acids such as branched-chain amino acids (BCAAs) and β–hydroxy β–methylbutyrate (HMB), fatty acids such as omega-3, and vitamins and their derivates on the prevention and improvement of glucocorticoid-induced muscle atrophy.
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26
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Djordjevic A, Deftereos I, Carter VM, Morris S, Shannon R, Kiss N, Yeung JMC. Ability of malnutrition screening and assessment tools to identify computed tomography defined low muscle mass in colorectal cancer surgery. Nutr Clin Pract 2022; 37:666-676. [DOI: 10.1002/ncp.10844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Aleksandra Djordjevic
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of General Internal Medicine Western Health Footscray Australia
| | - Irene Deftereos
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Vanessa M. Carter
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Stephanie Morris
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Roland Shannon
- Department of Radiology and Medical Imaging Western Health Footscray Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition Deakin University Geelong Australia
- Department of Allied Health Peter MacCallum Cancer Centre Melbourne Australia
| | - Justin M. C. Yeung
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of Colorectal Surgery Western Health Footscray Australia
- Western Health Chronic Disease Alliance, Western Health Melbourne Australia
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27
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Singh A, Wall C, Levine A, Midha V, Mahajan R, Sood A. Nutritional screening and assessment in inflammatory bowel disease. Indian J Gastroenterol 2022; 41:5-22. [PMID: 35031977 DOI: 10.1007/s12664-021-01223-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/24/2021] [Indexed: 02/04/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with increased risk of malnutrition and sarcopenia. Both malnutrition and sarcopenia negatively impact the clinical course, quality of life, response to therapy, and surgical outcomes in patients with IBD. This review article highlights the importance of nutritional assessment in patients with IBD and also discusses the different nutritional screening and assessment tools, and measures to detect sarcopenia in relation to IBD. Identification of malnutrition and sarcopenia will allow prioritization of the corrective actions, such as nutritional rehabilitation, to improve clinical outcomes. An approach to the evaluation of nutritional status in patients with IBD is also suggested.
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Affiliation(s)
- Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Catherine Wall
- Department of Medicine and Department of Human Nutrition, University of Otago, Christchurch, New Zealand
| | - Arie Levine
- Pediatric Gastroenterology and Nutrition Unit, Pediatric IBD Center, Wolfson Medical Center Holon, Tel Aviv University, Tel Aviv, Israel
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, 141 001, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India.
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Lester S, Kleijn M, Cornacchia L, Hewson L, Taylor MA, Fisk I. Factors Affecting Adherence, Intake, and Perceived Palatability of Oral Nutritional Supplements: A Literature Review. J Nutr Health Aging 2022; 26:663-674. [PMID: 35842756 DOI: 10.1007/s12603-022-1819-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Oral nutritional supplements (ONS) are a clinically effective and relatively inexpensive way to supplement the diet of patients with, or at risk of, undernutrition. Good adherence is a primary determinant of the effectiveness of ONS. However adherence can be problematic for those with the greatest clinical need, such as undernourished older adults. This review aimed to appraise the available literature for the factors (contextual, personal and product related) affecting patient adherence and perceived palatability of ONS, identify areas requiring improvement and uncover gaps in the evidence to guide the focus of future research. Contextual factors identified were healthcare staff and the timing of administration. Personal factors included sensory changes and motivation which alter experience of and desire to consume ONS. The product's sensory characteristics determined palatability and intake, but undesirable attributes, such as off-flavours, can stem from nutritional ingredients. The contribution made by aroma to older adults' experience of ONS was a comparatively under-researched area. Further research should address this evidence gap to optimise the flavour, aroma profile and palatability for undernourished older consumers, thereby optimising intake. A combined multidisciplinary effort involving strategic expansion of research, industry development and clinical practice should simultaneously address the factors identified, to provide the best approach to improve adherence.
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Affiliation(s)
- S Lester
- Ian Fisk, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom,
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Veraldi S, Pietrobattista A, Soglia G, Monti L, Alterio T, Mosca A, Liccardo D, Basso MS, Della Corte C, Russo L, Candusso M, Chiusolo F, Tortora F, Spada M, Maggiore G. Sarcopenia in children with chronic liver disease: Prevalence and impact on liver transplant outcomes. Front Pediatr 2022; 10:1033570. [PMID: 36741094 PMCID: PMC9891232 DOI: 10.3389/fped.2022.1033570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Sarcopenia is a clinical condition characterized by a reduction in muscle mass, which typically affects adult patients; however, it has recently been recognized in pediatric literature. Few studies in children with chronic liver disease (CLD) undergoing liver transplantation (LT) have investigated the role of sarcopenia, with controversial results. The aim of our study was to assess the prevalence and impact of sarcopenia among children with CLD who are candidates for LT. We conducted a retrospective, single-center study at Bambino Gesù Children's Hospital (Rome, Italy) from July 2016 to July 2021, evaluating all children (0-16 years old) with CLD listed for LT with an abdomen computed tomography imaging available before LT. The total psoas muscle surface area (t-PMSA) was defined as the sum of left and right psoas muscle surface area measured at L4-L5 on axial images. The t-PMSA z-score was calculated according to reference data, and sarcopenia was defined as a t-PMSA z-score of ≤-2 (1-16 years) or a psoas muscle index [PMI; PMI = t-PMSA/(100 × BSA)] of <50th percentile of the population examined (<1 year). Clinical, laboratory, and LT outcome data were collected from all the patients with CLD. 27 out 48 (56%) of the patients aged 1-16 years were sarcopenic. No differences were noted in anthropometrics, nutritional support, liver function tests, model for ESLD (MELD), or pediatric ESLD (PELD) scores between patients with and without sarcopenia. The former showed a higher prevalence of respiratory complications (66.7% vs. 42.1%) and need for inotropes (40.7% vs. 10.8%) after LT. Among patients aged 0-1 years (n: 36), those with reduced muscle mass (50%) had a longer hospitalization time (44 vs. 24 days) and higher incidences of multi-organ failure syndrome (38.9% vs. 0%) and intensive care unit-related infections (61.1% vs. 27.8%) compared to those with greater muscle mass. t-PMSA and PMI were statistically significant predictors of LT outcomes. Sarcopenia is a reliable index of frailty in children with CLD, as its presence is associated with the risk of a more challenging LT. Future studies will have to investigate the functional aspects of sarcopenia and conceive preventive measures of muscle wasting in CLD patients.
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Affiliation(s)
- Silvio Veraldi
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Department of Anatomical, Histological, Forensic and Locomotor Apparatus Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Pietrobattista
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giovanna Soglia
- Department of Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lidia Monti
- Department of Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Tommaso Alterio
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Antonella Mosca
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daniela Liccardo
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Sole Basso
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Claudia Della Corte
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luca Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCSS, Rome, Italy
| | - Manila Candusso
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesca Tortora
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giuseppe Maggiore
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Malnutrition–Sarcopenia Syndrome and Self-Management Behaviors in Continuing-Care Retirement Community Residents. Geriatrics (Basel) 2021; 7:geriatrics7010009. [PMID: 35076519 PMCID: PMC8788284 DOI: 10.3390/geriatrics7010009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 12/28/2022] Open
Abstract
Malnutrition–sarcopenia syndrome (MSS) might put older adults at higher risk for disability, frailty, and mortality. This study examined the prevalence and association of the self-management-process factors (i.e., self-efficacy and aging expectations) and behaviors (protein and caloric intake and sedentary and physical-activity behaviors) to MSS among older adults living in continuing care retirement communities (CCRCs). Using a cross-sectional correlational design, data of 96 CCRC residents (82.4 ± 7.4 years) were analyzed. Muscle mass, strength, function, nutritional status, sedentary time, physical activity levels, protein and caloric intake, self-efficacy for physical activity, aging expectations, and physical and mental health-related quality of life were measured. Results show that 36 (37.5%) had sarcopenia, 21 (21.9%) had malnutrition risk, 13 (13.4%) had malnutrition, and 12 (12.5%) had MSS. We also found that high time spent in sedentary behaviors (OR = 1.041; 95% CI: 1.011–1.071) was associated with higher odds of having MSS and high expectations regarding aging (OR = 0.896; 95% CI: 0.806–0.997) were associated with less likelihood of having MSS. Findings suggest that CCRC residents should be screened for MSS. Self-management interventions that consider the self-management-process factors are needed to prevent MSS and mitigate its negative outcomes among CRCC residents.
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Malnutrition, Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD. Nutrients 2021; 14:nu14010044. [PMID: 35010919 PMCID: PMC8746722 DOI: 10.3390/nu14010044] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world population. In addition to airflow obstruction, COPD is associated with multiple systemic manifestations, including impaired nutritional status or malnutrition and changes in body composition (low muscle mass, LMM). Poor nutritional status and sarcopenia in subjects with COPD leads to a worse prognosis and increases health-related costs. Data from previous studies indicate that 30–60% of subjects with COPD are malnourished, 20–40% have low muscle mass, and 15–21.6% have sarcopenia. This study aimed to assess the prevalence of malnutrition, sarcopenia, and malnutrition-sarcopenia syndrome in elderly subjects with COPD and investigate the relationship between COPD severity and these conditions.Patients and methods: A cross-sectional study involving 124 patients with stable COPD, aged ≥60, participating in a stationary pulmonary rehabilitation program. Nutritional status was assessed following the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia with the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. The results of pulmonary function tests and exercise capacity were obtained from the hospital database. Results: 22.6% of participants had malnutrition according to the GLIM criteria. Subjects with malnutrition had lower gait speed (p = 0.0112) and worse results of the Six Minute Walk Test. Sixteen participants (12.9%) had sarcopenia; 12 subjects with sarcopenia had concomitant malnutrition. The prevalence of severe and very severe obstruction (GOLD3/GOLD4) was 91.7%. It was significantly higher in patients with malnutrition-sarcopenia syndrome. Conclusions: Malnutrition was found in nearly one out of four subjects with COPD, while sarcopenia was one out of seven patients. About 10% of our study sample had malnutrition-sarcopenia syndrome. The prevalence of severe and very severe obstruction was significantly higher in patients with malnutrition-sarcopenia syndrome.
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Effect on an Oral Nutritional Supplement with β-Hydroxy-β-methylbutyrate and Vitamin D on Morphofunctional Aspects, Body Composition, and Phase Angle in Malnourished Patients. Nutrients 2021; 13:nu13124355. [PMID: 34959907 PMCID: PMC8706927 DOI: 10.3390/nu13124355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 02/06/2023] Open
Abstract
This is a retrospective study of data from clinical practice to observe the effect of a high-calorie, high-protein oral nutritional supplement (ONS) with β-hydroxy-β-methylbutyrate (HMB) on nutritional status, body weight, and muscle-related parameters in 283 adult patients with or at risk of malnutrition under standard of care, 63% being cancer patients. They were recommended to increase physical activity and energy and protein intake from regular diet plus two servings per day of a specialized ONS enriched with HMB or standard ONS for up to 6 months. Dietary records, adherence and tolerance to ONS, nutritional status, body composition, handgrip strength, and blood analysis at the beginning and the end of the intervention were recorded. This program improved nutritional status from 100% malnourished or at risk of malnutrition at baseline to 80% well-nourished at final visit. It also increased body weight by 3.6–3.8 kg, fat-free mass by 0.9 to 1.3 kg, and handgrip strength by 4.7 to 6.2 kg. In a subgroup of patients (n = 43), phase angle (PhA), and body cell mass (BCM) increased only in the patients receiving the ONS enriched with HMB (0.95 (0.13) vs. −0.36 (0.4), and 2.98 (0.5) vs. −0.6 (1.5) kg, mean difference (SE) from baseline for PhA and BCM, respectively), suggesting the potential efficacy of this supplement on muscle health.
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Chen KC, Jeng Y, Wu WT, Wang TG, Han DS, Özçakar L, Chang KV. Sarcopenic Dysphagia: A Narrative Review from Diagnosis to Intervention. Nutrients 2021; 13:nu13114043. [PMID: 34836299 PMCID: PMC8621579 DOI: 10.3390/nu13114043] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
Sarcopenia, defined as a decline in muscle mass and function related to aging, affects both limb and swallowing-related muscles. Sarcopenic dysphagia is characterized by decreased swallowing function; therefore, early detection of subclinical dysphagia and subsequent intervention appear to be crucial in the elderly. Numerous tools have been employed to measure the function, strength, and mass of swallowing-related muscles in sarcopenic elderly. The swallowing function can be evaluated by questionnaires like Eating Assessment Tool, Functional Oral Intake Scale, and Food Intake Level Scale, and tests such as the modified water swallowing test and videofluoroscopic swallowing study. Surface electromyography and high-resolution manometry can be applied for quantifying swallowing-related muscle strength. Modalities such as ultrasonography and magnetic resonance imaging are capable of estimating the swallowing muscle mass. In patients with sarcopenic dysphagia, a thorough assessment should be given followed by an integrated intervention combining swallowing muscle strengthening, nutrition support, food texture modification, physical, and occupational therapies. This article aimed to comprehensively summarize the diagnostic criteria/tools as well as their associations/performance in sarcopenic dysphagia. The intervention strategy will also be narrated in this review.
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Affiliation(s)
- Kuan-Cheng Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital, New Taipei 22000, Taiwan
| | - Ying Jeng
- Department of Medical Image, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan;
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence: ; Tel.: +886-223717101 (ext. 5309)
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Prevalence and Associated Factors of Coexistence of Malnutrition and Sarcopenia in Geriatric Rehabilitation. Nutrients 2021; 13:nu13113745. [PMID: 34836001 PMCID: PMC8620459 DOI: 10.3390/nu13113745] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022] Open
Abstract
Malnutrition and sarcopenia often coexist in rehabilitation patients, although they are often overlooked and undertreated in clinical practice. This cross-sectional study aimed to clarify the prevalence of the coexistence of malnutrition and sarcopenia (Co-MS) and its associated factors in convalescent rehabilitation wards in Japan. Consecutive patients aged ≥ 65 years in convalescent rehabilitation wards between November 2018 and October 2020 were included. Malnutrition and sarcopenia were determined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Asian Working Group for Sarcopenia (AWGS 2019) criteria, respectively. Patients who presented both with malnutrition and sarcopenia were classified as Co-MS. Potentially associated factors included age, sex, days from onset to admission of rehabilitation wards, reason for admission, pre-morbid functional dependency, comorbidity, activities of daily living, swallowing ability, and oral function and hygiene. The prevalence of malnutrition, sarcopenia, and Co-MS was calculated. Binary logistic regression analyses were performed to compute odds ratios (ORs) and the 95% confidence interval (CI) of possible associated factors for each condition. Overall, 601 patients were eligible for the analysis (median 80 years old, 355 female patients, 70% cerebrovascular disease). Co-MS, malnutrition, and sarcopenia were found in 23.5%, 29.0%, and 62.4% of the enrolled patients, respectively. After adjustment, onset–admission interval (OR = 1.04; 95% CI = 1.02 to 1.06), hospital-associated deconditioning (OR = 4.62; 95% CI = 1.13 to 18.8), and swallowing ability (Food Intake LEVEL Scale) (OR = 0.83; 95% CI = 0.73 to 0.93) were identified as independent explanatory factors of Co-MS. In conclusion, Co-MS was prevalent in geriatric rehabilitation patients; thus, healthcare professionals should be aware of the associated factors to detect the geriatric rehabilitation patients who are at risk of both malnutrition and sarcopenia, and to provide appropriate treatments.
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Mine K, Sugihara M, Fujita T, Kato Y, Gondo K, Arimura T, Takamiya Y, Shiga Y, Kuwano T, Miura SI. Impact of Controlling a Nutritional Status Score on Wound Healing in Patients with Chronic Limb-Threatening Ischemia after Endovascular Treatment. Nutrients 2021; 13:nu13113710. [PMID: 34835966 PMCID: PMC8625291 DOI: 10.3390/nu13113710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic limb-threatening ischemia (CLTI) is the most advanced stage of peripheral artery disease. Therefore, a multidisciplinary approach is necessary to avoid major amputation in CLTI patients. Malnutrition worsens the condition of CLTI patients, and therefore, it may be important to evaluate the nutritional status in patients with CLTI. This study was designed to evaluate the baseline patient characteristics and the influence of the controlling nutritional status (CONUT) score on the clinical results. Method and Results: A retrospective, single-center, non-randomized study was conducted to evaluate the associations of death, major amputation, and wound healing rate at 12 months with the CONUT score on admission. Consecutive CLTI patients (mean age 73.2 ± 10.4 years; 84 males) who underwent endovascular therapy (EVT) for infra-popliteal lesions at Fukuoka University Hospital from January 2014 to May 2019 were enrolled and divided into two groups (higher and lower CONUT score groups). The higher CONUT group showed a higher percentage of dialysis (66.7% vs. 33.9%, p < 0.001) and a higher clinical frailty scale (5.9 ± 1.4 vs. 4.9 ± 1.9, p = 0.005) than the lower CONUT group. Rates of amputation-free survival were 89.5% and 69.8% in the lower and higher CONUT groups, respectively. In addition, rates of wound healing at 12 months were 98.0% and 78.3% in the lower and higher CONUT groups, respectively. Multivariate regression analysis demonstrated that a higher CONUT score was an independent predictor for delayed wound healing (OR: 11.2; 95% CI: 1.29–97.5; p = 0.028). Conclusion: An assessment of the nutritional status using the CONUT score could be useful for predicting wound healing, and earlier nutritional intervention may improve the outcome of CLTI patients. Early examination and treatment, along with raising awareness of the issue, may be important for improving the prognosis.
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Affiliation(s)
- Kaori Mine
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
- Correspondence: (M.S.); (S.-i.M.); Tel.: +92-801-1011 (M.S. & S.-i.M.); Fax: +092-865-2692 (M.S. & S.-i.M.)
| | - Takafumi Fujita
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Koki Gondo
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Yosuke Takamiya
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
- Division of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka 814-8522, Japan
- Correspondence: (M.S.); (S.-i.M.); Tel.: +92-801-1011 (M.S. & S.-i.M.); Fax: +092-865-2692 (M.S. & S.-i.M.)
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Hegendörfer E, VanAcker V, Vaes B, Degryse JM. Malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged 80 years and over. Acta Clin Belg 2021; 76:351-358. [PMID: 32134709 DOI: 10.1080/17843286.2020.1737779] [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] [Indexed: 12/26/2022]
Abstract
Objectives: To investigate the prevalence of malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged ≥80 years, a worldwide growing age-group.Methods: In the BELFRAIL cohort, malnutrition risk was evaluated with the Mini Nutritional Assessment (MNA total score <24) and prealbumin levels (<20 mg/dl). Agreement between them was assessed with Kohen's kappa coefficient. Association with first unplanned hospitalization (3.0 ± 0.25 years follow-up) and mortality (5.1 ± 0.25 years follow-up) was investigated with survival analysis and Cox multivariate regression.Results: Out of 567 BELFRAIL participants, 556 (98.1%) had MNA and 545 (96.1%) prealbumin levels. Sixty-eight (12.2%) were at risk of malnutrition based on MNA and 69 (12.7%) based on prealbumin, with very poor agreement between them (Kappa = 0.024, 95% CI -0.064, 0.112). For both MNA and prealbumin, participants with malnutrition risk had lower physical and cognitive performance tests' scores. They had no higher risk for first hospitalization compared to those without malnutrition risk, but higher risk for all-cause mortality even after adjustment for multimorbidity, inflammation, physical and mental functioning (HR 1.35 95%CI 0.92-1.97 for MNA; HR 1.46; 95%CI 1.01-2.12 for prealbumin).Conclusion: Malnutrition risk based on MNA or prealbumin was low in a Belgian cohort of community-dwelling adults aged ≥80 years. Physical and cognitive performance was lower in those with malnutrition risk, but malnutrition risk was not independently associated with hospitalization and mortality (except for malnutrition risk by prealbumin). Further research needs to investigate the best tool to assess malnutrition risk in this age group.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (Uclouvain), Louvain, Belgium
| | - Veronika VanAcker
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (Uclouvain), Louvain, Belgium
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Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients 2021; 13:nu13082764. [PMID: 34444924 PMCID: PMC8399049 DOI: 10.3390/nu13082764] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.
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Borda MG, Bani Hassan E, Weon J, Wakabayashi H, Tovar-Rios DA, Oppedal K, Aarsland D, Duque G. Muscle volume and intramuscular fat of the tongue evaluated with MRI predict malnutrition in people living with dementia: a five-year follow-up study. J Gerontol A Biol Sci Med Sci 2021; 77:228-234. [PMID: 34338751 DOI: 10.1093/gerona/glab224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
Malnutrition is highly prevalent in older persons with dementia. Therefore, strong predictors of malnutrition in this population are crucial to initiating early interventions. This study evaluates the association between the probability of having malnutrition with the muscle volume and intramuscular fat (iMAT) of the masseter and the tongue in magnetic resonance images (MRI) of community-dwelling older persons diagnosed with mild dementia followed for five years. This is a longitudinal study conducted in the western part of Norway. Muscle volume and iMAT of the tongue and masseter were computed from structural head MRIs obtained from 65 participants of The Dementia Study of Western Norway (DemVest) using Slice-O-Matic software for segmentation. Malnutrition was assessed using the glim index. Linear mix models were conducted. Having malnutrition at baseline was associated with lower muscle volume (OR 0.60 SE 0.20 p=0.010) and higher iMAT (OR 3.31 SE 0.46 p=0.010) in the tongue. At five years follow-up, those with lower muscle volume (OR 0.55, SE 0.20 p=0.002) and higher iMAT (OR 2.52, SE 0.40 p=0.022) in the tongue had a higher probability of presenting malnutrition. The masseter iMAT and volume were not associated with malnutrition in any of the adjusted models.In people diagnosed with mild dementia, tongue muscle volume and iMAT were associated with baseline malnutrition and the probability of developing malnutrition in a 5-year trajectory. In the masseter, there were no significant associations after adjustments.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana.Bogotá, Colombia.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ebrahim Bani Hassan
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Geroscience and Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
| | - JangHo Weon
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Geroscience and Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Universidad del Valle, School of Statistics, Santiago de Cali, Colombia
| | - Ketil Oppedal
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering & Computer Science, University of Stavanger, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gustavo Duque
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Geroscience and Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
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Association of Daily Physical Activity and Sedentary Behaviour with Protein Intake Patterns in Older Adults: A Multi-Study Analysis across Five Countries. Nutrients 2021; 13:nu13082574. [PMID: 34444732 PMCID: PMC8398631 DOI: 10.3390/nu13082574] [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: 06/15/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 01/04/2023] Open
Abstract
Physical activity and protein intake are associated with ageing-related outcomes, including loss of muscle strength and functional decline, so may contribute to strategies to improve healthy ageing. We investigated the cross-sectional associations between physical activity or sedentary behaviour and protein intake patterns in community-dwelling older adults across five countries. Self-reported physical activity and dietary intake data were obtained from two cohort studies (Newcastle 85+ Study, UK; LiLACS, New Zealand Māori and Non-Māori) and three national food consumption surveys (DNFCS, The Netherlands; FINDIET, Finland; INRAN-SCAI, Italy). Associations between physical activity and total protein intake, number of eating occasions providing protein, number of meals with specified protein thresholds, and protein intake distribution over the day (calculated as a coefficient of variance) were assessed by regression and repeated measures ANOVA models adjusting for covariates. Greater physical activity was associated with higher total protein intake and more eating occasions containing protein, although associations were mostly explained by higher energy intake. Comparable associations were observed for sedentary behaviour in older adults in Italy. Evidence for older people with higher physical activity or less sedentary behaviour achieving more meals with specified protein levels was mixed across the five countries. A skewed protein distribution was observed, with most protein consumed at midday and evening meals without significant differences between physical activity or sedentary behaviour levels. Findings from this multi-study analysis indicate there is little evidence that total protein and protein intake patterns, irrespective of energy intake, differ by physical activity or sedentary behaviour levels in older adults.
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Low prealbumin levels are associated with sarcopenia in older men with type 2 diabetes mellitus: A cross-sectional study. Nutrition 2021; 91-92:111415. [PMID: 34399401 DOI: 10.1016/j.nut.2021.111415] [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: 03/15/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between the serum levels of prealbumin and sarcopenia in older adults with type 2 diabetes mellitus. METHODS This cross-sectional study included 582 older adults with type 2 diabetes mellitus. Sarcopenia was defined based on the recently updated Asian Working Group for Sarcopenia 2019 criteria. Appendicular skeletal muscle was measured by dual energy x-ray absorptiometry. Serum levels of prealbumin, hemoglobin, hemoglobin A1c, and 25-hydroxyvitamin D3 were also tested. Multivariate analyses were used to assess the association between prealbumin levels and sarcopenia, adjusted for potential confounders. RESULTS The overall prevalence of sarcopenia was 9%, of which 12% for men and 6% for women. Male participants with sarcopenia had lower prealbumin levels than those without sarcopenia (213 ± 72 versus 260 ± 56 mg/L, P < 0.001). The proportion of men with low prealbumin level (<170 mg/L) was significantly higher in individuals with sarcopenia than in those without (31% versus 6%, respectively). In a logistic regression model, after adjusting for all potential covariates, low prealbumin (odds ratio, 4.15; 95% confidence interval, 1.13-15.25; P = 0.03) was significantly associated with sarcopenia in men, but the relationship between prealbumin and sarcopenia was not found in women. CONCLUSION Low prealbumin levels were associated with an increased risk for sarcopenia in older men with T2DM.
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Sato M, Morishita T, Katayama T, Satomura S, Okuno H, Sumida N, Sakuma M, Arai H, Katoh S, Sairyo K, Kawaura A, Takeda E. Relationship between age-related decreases in serum 25-hydroxyvitamin D levels and skeletal muscle mass in Japanese women. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 67:151-157. [PMID: 32378599 DOI: 10.2152/jmi.67.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A clearer understanding of skeletal muscle mass (SMM) in middle-aged and elderly individuals is important for maintaining functionality. In the present study, age-related changes in SMM, the threshold of SMM with walking difficulty, intestinal nutrient absorption rate, and various serum factors were examined in Japanese populations of different ages. We used 24-h creatinine excretion as a measure of total body SMM. Age-related decreases in SMM, intestinal nutrient absorption rates, and serum 25-hydroxyvitamin D [25(OH)D] concentrations were significantly higher in women than in men. The cut-off values for SMM (kg), its percentage of total body weight (BW), the SMM index [SMMI] (Kg / m2), and creatinine height index (CHI) (%) in elderly individuals with walking difficulty were approximately 8-10 kg, 17-20% of BW, 3.9-4.6 kg / m2, and 44%, respectively. Serum 25(OH)D concentrations were closely associated with SMM (kg, % of BW, kg / m2) and CHI (%) as well as the intestinal absorption rates of nitrogen (%) and phosphorus (%) in women, but not in men. The present results demonstrate that vitamin D is an important metabolic factor in skeletal muscle, and contributes to the optimal management of skeletal muscle and the prevention of sarcopenia. J. Med. Invest. 67 : 151-157, February, 2020.
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Affiliation(s)
- Michiko Sato
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan.,Equally contributed to this study
| | - Teruhiro Morishita
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan.,Equally contributed to this study
| | - Takafumi Katayama
- Department of Statistics and Computer Science, College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Shigeko Satomura
- Division of Child Neurology, Tokushima Prefectural Hinomine Medical Center for the Handicapped, Komatsushima, Japan
| | - Hiroko Okuno
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan
| | - Nami Sumida
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan
| | - Masae Sakuma
- Department of Human Nutrition, School of Life Studies, Sugiyama Jogakuen University, Nagoya, Japan
| | - Hidekazu Arai
- Laboratory of Clinical Nutrition and Management, Graduate School of Nutritional and Environmental Sciences, The University of Shizuoka, Shizuoka, Japan
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Akihiko Kawaura
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan
| | - Eiji Takeda
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan
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Ali AM, Kunugi H. Screening for Sarcopenia (Physical Frailty) in the COVID-19 Era. Int J Endocrinol 2021; 2021:5563960. [PMID: 34113379 PMCID: PMC8152925 DOI: 10.1155/2021/5563960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Although the numbers of aged populations have risen considerably in the last few decades, the current coronavirus disease 2019 (COVID-19) has revealed an extensive vulnerability among these populations. Sarcopenia is an age-related disorder that increases hospitalization, dependencies, and mortality in older adults. It starts to develop in midlife or even earlier as a result of unbalanced diet/poor nutrition and low levels of physical activity, in addition to chronic disorders such as obesity and diabetes mellitus. Given that social isolation is adopted as the most protective measure against COVID-19, the level of physical activity and the intake of adequate diet have considerably declined, especially among older adults-denoting an increased possibility for developing sarcopenia. Research also shows a higher vulnerability of sarcopenic people to COVID-19 as well as the development of wasting disorders such as sarcopenia and cachexia in a considerable proportion of symptomatic and recovering COVID-19 patients. Muscular wasting in COVID-19 is associated with poor prognosis. Accordingly, early detection and proper management of sarcopenia and wasting conditions in older adults and COVID-19 patients may minimize morbidity and mortality during the current COVID-19 crisis. This review explored different aspects of screening for sarcopenia, stressing their relevance to the detection of altered muscular structure and performance in patients with COVID-19. Current guidelines recommend prior evaluation of muscle strength by simple measures such as grip strength to identify individuals with proven weakness who then would be screened for muscle mass loss. The latter is best measured by MRI and CT. However, due to the high cost and radiation risk entailed by these techniques, other simpler and cheaper techniques such as DXA and ultrasound are given preference. Muscle loss in COVID-19 patients was measured during the acute phase by CT scanning of the pectoralis muscle simultaneously during a routine check for lung fibrosis, which seems to be an efficient evaluation of sarcopenia among those patients with no additional cost. In recovering patients, muscle strength and physical performance have been evaluated by electromyography and traditional tests such as the six-minute walk test. Effective preventive and therapeutic interventions are necessary in order to prevent muscle loss and associated physical decline in COVID-19 patients.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Chew STH, Kayambu G, Lew CCH, Ng TP, Ong F, Tan J, Tan NC, Tham SL. Singapore multidisciplinary consensus recommendations on muscle health in older adults: assessment and multimodal targeted intervention across the continuum of care. BMC Geriatr 2021; 21:314. [PMID: 34001023 PMCID: PMC8127264 DOI: 10.1186/s12877-021-02240-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care. METHODS The recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings. RESULTS The panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment. Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described. CONCLUSIONS Reviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.
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Affiliation(s)
- Samuel T H Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
- Society for Geriatric Medicine Singapore, Singapore, Singapore.
| | - Geetha Kayambu
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | | | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fangyi Ong
- Singapore Nutrition and Dietetics Association, Singapore, Singapore
| | - Jonathan Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
| | - Shuen-Loong Tham
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Society of Rehabilitation Medicine, Singapore, Singapore
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Caldo-Silva A, Furtado GE, Chupel MU, Bachi ALL, de Barros MP, Neves R, Marzetti E, Massart A, Teixeira AM. Effect of Training-Detraining Phases of Multicomponent Exercises and BCAA Supplementation on Inflammatory Markers and Albumin Levels in Frail Older Persons. Nutrients 2021; 13:1106. [PMID: 33800577 PMCID: PMC8066027 DOI: 10.3390/nu13041106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
Nowadays, it is accepted that the regular practice of exercise and branched-chain amino acids supplementation (BCAAs) can benefit the immune responses in older persons, prevent the occurrence of physical frailty (PF), cognitive decline, and aging-related comorbidities. However, the impact of their combination (as non-pharmacological interventions) in albumin and the inflammatory markers is not fully understood. Therefore, we investigated the effect of a 40-week multifactorial intervention [MIP, multicomponent exercise (ME) associated or not with BCAAs] on plasma levels of inflammatory markers and albumin in frail older persons (≥75 years old) living at residential care homes (RCH). This study consisted of a prospective, naturalistic, controlled clinical trial with four arms of multifactorial and experimental (interventions-wahshout-interventions) design. The intervention groups were ME + BCAAs (n = 8), ME (n = 7), BCAAs (n = 7), and control group (n = 13). Lower limb muscle-strength, cognitive profile, and PF tests were concomitantly evaluated with plasma levels of albumin, anti- and pro-inflammatory cytokines [Interleukin-10 (IL-10) and Tumor Necrosis Factor-alpha (TNF-α) respectively], TNF-α/IL-10 ratio, and myeloperoxidase (MPO) activity at four different time-points: Baseline (T1), after 16 weeks of multifactorial intervention (T2), then after a subsequent 8 weeks washout period (T3) and finally, after an additional 16 weeks of multifactorial intervention (T4). Improvement of cognitive profile and muscle strength-related albumin levels, as well as reduction in the TNF-α levels were found particularly in ME plus BCAAs group. No significant variations were observed over time for TNF-α/IL-10 ratio or MPO activity. Overall, the study showed that MIP triggered slight alterations in the inflammatory and physical function of the frail older participants, which could provide independence and higher quality of life for this population.
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Affiliation(s)
- Adriana Caldo-Silva
- University of Coimbra, Faculty of Sports Sciences and Physical Education—(FCDEF-UC), 3040-248 Coimbra, Portugal; (R.N.); (A.M.); (A.M.T.)
- Research Centre for Sport and Physical Activity, CIDAF-FCDEF-UC, 3040-248 Coimbra, Portugal;
| | - Guilherme Eustáquio Furtado
- Research Centre for Sport and Physical Activity, CIDAF-FCDEF-UC, 3040-248 Coimbra, Portugal;
- Health Sciences Research Unit: Nursing (UICISAE), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Matheus Uba Chupel
- Research Centre for Sport and Physical Activity, CIDAF-FCDEF-UC, 3040-248 Coimbra, Portugal;
| | - André L. L. Bachi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil;
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | - Marcelo P. de Barros
- Institute of Physical Activity Sciences and Sports (ICAFE), Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, São Paulo 01506-000, Brazil;
| | - Rafael Neves
- University of Coimbra, Faculty of Sports Sciences and Physical Education—(FCDEF-UC), 3040-248 Coimbra, Portugal; (R.N.); (A.M.); (A.M.T.)
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy;
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alain Massart
- University of Coimbra, Faculty of Sports Sciences and Physical Education—(FCDEF-UC), 3040-248 Coimbra, Portugal; (R.N.); (A.M.); (A.M.T.)
- Research Centre for Sport and Physical Activity, CIDAF-FCDEF-UC, 3040-248 Coimbra, Portugal;
| | - Ana Maria Teixeira
- University of Coimbra, Faculty of Sports Sciences and Physical Education—(FCDEF-UC), 3040-248 Coimbra, Portugal; (R.N.); (A.M.); (A.M.T.)
- Research Centre for Sport and Physical Activity, CIDAF-FCDEF-UC, 3040-248 Coimbra, Portugal;
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Krzymińska-Siemaszko R, Deskur-Śmielecka E, Styszyński A, Wieczorowska-Tobis K. Polish Translation and Validation of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire to Assess Nutritional and Non-Nutritional Risk Factors of Sarcopenia in Older Adults. Nutrients 2021; 13:1061. [PMID: 33805185 PMCID: PMC8064359 DOI: 10.3390/nu13041061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study's aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7-47.2%) than the PL-MSRA-7 (33.1-34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9-29.5%; PL-MSRA-7: 14.4-25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8-95.9%; PL-MSRA-5: 92.3-98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0-55% vs. 39.4-45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.
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Affiliation(s)
- Roma Krzymińska-Siemaszko
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (E.D.-Ś.); (A.S.); (K.W.-T.)
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Liu X, Xia X, Hu F, Hou L, Jia S, Liu Y, Deng L, Zhang Y, Zhao W, Zhang G, Yue J, Dong B. Nutrition status mediates the association between cognitive decline and sarcopenia. Aging (Albany NY) 2021; 13:8599-8610. [PMID: 33714959 PMCID: PMC8034889 DOI: 10.18632/aging.202672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/03/2021] [Indexed: 02/05/2023]
Abstract
In this study, we investigated whether nutrition status mediates the relationship between cognitive decline and sarcopenia. Sarcopenia was assessed in 4023 community-dwelling older adults from West China using the AWGS 2014 diagnostic criteria. Cognitive function and nutrition status were assessed using the 10-item Short Portable Mental Status Questionnaire (SPMSQ) and Mini Nutrition Assessment-Short Form (MNA-SF) scale, respectively. Mediation model regression analysis demonstrated that nutrition status was negatively associated with sarcopenia (β = -0.521; 95% CI: -0.583 to -0.459). The indirect effects of cognitive decline on sarcopenia were significant after adjusting for age, sex, and ethnicity (β = 0.015; 95% CI: 0.012 to 0.017), but the direct effects of cognitive decline on sarcopenia were not statistically significant after adding nutrition status as a parameter in the mediation model analysis (β = -0.001; 95% CI: -0.008 to 0.005). Structural equation model (SEM) framework pathway analysis confirmed the association between nutrition status, cognitive decline, and sarcopenia. These findings demonstrate that the negative effects of cognitive decline on sarcopenia were mediated by nutrition status. We therefore postulate that maintaining a good nutrition status delays the negative effects of cognitive decline on sarcopenia in older adults.
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Affiliation(s)
- Xiaolei Liu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Xin Xia
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Fengjuan Hu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Lisha Hou
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Shuli Jia
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Yixin Liu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Linghui Deng
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Zhang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Wanyu Zhao
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Gongchang Zhang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Jirong Yue
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
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Ali AM, Kunugi H. Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2772. [PMID: 33803339 PMCID: PMC7967488 DOI: 10.3390/ijerph18052772] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients-MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19.
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Affiliation(s)
- Amira Mohammed Ali
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Hiroshi Kunugi
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo 173-8605, Japan
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Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/9695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Martin-Cantero A, Reijnierse EM, Gill BMT, Maier AB. Factors influencing the efficacy of nutritional interventions on muscle mass in older adults: a systematic review and meta-analysis. Nutr Rev 2021; 79:315-330. [PMID: 33031516 PMCID: PMC7876433 DOI: 10.1093/nutrit/nuaa064] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Nutritional interventions stimulate muscle protein synthesis in older adults. To optimize muscle mass preservation and gains, several factors, including type, dose, frequency, timing, duration, and adherence have to be considered. OBJECTIVE This systematic review and meta-analysis aimed to summarize these factors influencing the efficacy of nutritional interventions on muscle mass in older adults. DATA SOURCES A systematic search was performed using the electronic databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus from inception date to November 22, 2017, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included randomized controlled trials, mean or median age ≥65 years, and reporting muscle mass at baseline and postintervention. Exclusion criteria included genetically inherited diseases, anabolic drugs or hormone therapies, neuromuscular electrical stimulation, chronic kidney disease, kidney failure, neuromuscular disorders, and cancer. DATA EXTRACTION Extracted data included study characteristics (ie, population, sample size, age, sex), muscle mass measurements (ie, method, measure, unit), effect of the intervention vs the control group, and nutritional intervention factors (ie, type, composition, dose, duration, frequency, timing, and adherence). DATA ANALYSIS Standardized mean differences and 95%CIs were calculated from baseline to postintervention. A meta-analysis was performed using a random-effects model and grouped by the type of intervention. CONCLUSIONS Twenty-nine studies were included, encompassing 2255 participants (mean age, 78.1 years; SD, 2.22). Amino acids, creatine, β-hydroxy-β-methylbutyrate, and protein with amino acids supplementation significantly improved muscle mass. No effect was found for protein supplementation alone, protein and other components, and polyunsaturated fatty acids. High interstudy variability was observed regarding the dose, duration, and frequency, coupled with inconsistency in reporting timing and adherence. Overall, several nutritional interventions could be effective to improve muscle mass measures in older adults. Because of the substantial variability of the intervention factors among studies, the optimum profile is yet to be established. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42018111306.
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Affiliation(s)
- Aitana Martin-Cantero
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin M T Gill
- Department of Clinical Nutrition, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Tan VMH, Pang BWJ, Lau LK, Jabbar KA, Seah WT, Chen KK, Ng TP, Wee SL. Malnutrition and Sarcopenia in Community-Dwelling Adults in Singapore: Yishun Health Study. J Nutr Health Aging 2021; 25:374-381. [PMID: 33575731 DOI: 10.1007/s12603-020-1542-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the overlapping prevalence of malnutrition and sarcopenia and the association between parameters of malnutrition with muscle mass and strength in a community-dwelling Singaporean adult population. DESIGN This was a cross-sectional study. SETTING Large north-eastern residential town of Yishun in Singapore. PARTICIPANTS Random sampling of community-dwelling Singaporeans aged 21-90 years old (n=541). MEASUREMENTS Anthropometry, body composition and handgrip strength (muscle strength) were measured. Sarcopenia was identified using dual-energy x-ray absorptiometry scan (muscle mass). Nutritional status was measured using Mini Nutritional Assessment (MNA-SF). Other questionnaires collected included physical activity and cognition. Associations between nutritional status with sarcopenia as well as with muscle mass and strength were analysed using multinomial logistics and linear regressions. RESULTS The overall population-adjusted prevalence of those at nutritional risk and malnourished were 18.5% and 0.1% respectively. More than a third of participants (35%) who were at nutritional risk were sarcopenic. Malnourished participants were all sarcopenic (100%, N=2) whereas those who were sarcopenic, 27.0% (N=37) were at nutritional risk/malnourished. Being at nutritional risk/malnourished was significantly associated with 2 to 3 times increased odds of sarcopenia in multivariate analyses adjusting for age, gender, physical activity level and cognition, and fat mass index. Favourable MNA parameter scores on food intake and BMI were positively associated with greater muscle mass and handgrip strength (p<0.05). CONCLUSION Given the overlapping clinical presentation of malnutrition and sarcopenia, community screening protocols should include combination screening of nutritional status and sarcopenia with appropriate interventions to mitigate risk of adverse health outcomes.
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Affiliation(s)
- V M H Tan
- Shiou-Liang Wee, Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, 768024, Singapore, Phone: +65 6592 4606,
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