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Kinugasa Y, Ida M, Kawaguchi M. Fried Frailty Phenotype Questionnaire scores and postoperative patient-reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis. Geriatr Gerontol Int 2024; 24:464-469. [PMID: 38597119 DOI: 10.1111/ggi.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
AIM This study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient-reported postoperative outcomes. METHODS This secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery-15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability-free survival, defined as a 12-item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis. RESULTS After confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery-15 score on postoperative day 2 (β = -2.67, 95% confidence interval -5.20, -0.15), 4 (β = -3.54, 95% confidence interval -5.77, -1.30) and 7 (β = -3.70, 95% confidence interval -5.75, -1.65). The adjusted odds ratio of the FFPQ score for disability-free survival postoperatively was 0.66 (95% confidence interval 0.49-0.90). CONCLUSIONS Patients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery-15 scores and poor disability-free survival. Geriatr Gerontol Int 2024; 24: 464-469.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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Sato R, Sawaya Y, Ishizaka M, Shiba T, Hirose T, Yin L, Urano T. Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care. Geriatr Gerontol Int 2023; 23:906-911. [PMID: 37861100 DOI: 10.1111/ggi.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
AIM Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care. METHODS The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs. RESULTS Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001). CONCLUSIONS Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumference is suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.
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Affiliation(s)
- Ryo Sato
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Yohei Sawaya
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Takahiro Shiba
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Tamaki Hirose
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Lu Yin
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Tomohiko Urano
- Department of Day Rehabilitation, Nishinasuno General Home Care Center, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Wan SN, Thiam CN, Ang QX, Engkasan J, Ong T. Incident sarcopenia in hospitalized older people: A systematic review. PLoS One 2023; 18:e0289379. [PMID: 37531398 PMCID: PMC10395895 DOI: 10.1371/journal.pone.0289379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
Hospitalization has been associated with the development of sarcopenia. This study aimed to examine the new incidences of hospital sarcopenia, associated risk factors and health outcomes, as defined by internationally recognized diagnostic criteria in hospitalized older people. Pre-defined search terms were run through five databases. Six studies that assessed sarcopenia on two separate time points during hospitalization on older inpatients were included. Prevalence of sarcopenia varied from 14.1% to 55% depending on diagnostic criteria and cut-off points used. New sarcopenia occurred between 12% to 38.7% patients following hospitalization. Risk factors were older age, longer duration of bed rest, lower baseline body mass index, cognitive impairment and activities of daily living disability. None of the studies reported health outcomes associated with newly developed sarcopenia in hospital.
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Affiliation(s)
- Safiyyah Nurnajah Wan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Chiann Ni Thiam
- Department of Medicine, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Qi Xuan Ang
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Julia Engkasan
- Department of Rehabilitation Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
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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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Hama T, Morita N, Ushijima A, Ueno A, Iida T, Ikari Y, Kobayashi Y. Impact of bedrest on cardiovascular events and complications associated with temporary pacemakers in patients waiting for permanent pacemaker implantation. J Arrhythm 2021; 37:669-675. [PMID: 34141020 PMCID: PMC8207420 DOI: 10.1002/joa3.12534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with a temporary pacemaker (TPM) for bradycardias are required to maintain bedrest until permanent pacemakers (PPMs) are implanted because of the development of Adams-Stokes syndrome, worsening heart failure, or complications associated with TPMs is anticipated. However, bedrest may be detrimental in patients because it leads to disuse syndrome. This study examined whether bedrest could decrease the incidence of cardiovascular events or complications associated with TPMs in patients waiting for PPM implantation. METHODS We conducted a retrospective cohort study on 88 patients who had emergency hospitalization for the treatment of bradycardias, and a TPM was inserted during the waiting period before PPM implantation. We divided patients into two groups according to whether they underwent bedrest (Bedrest Group) or not (Ambulation Group) during the period that patients were supported with TPM. We evaluated whether bedrest was a predictor of adverse events using a logistic regression analysis. RESULTS Adverse events occurred in 31 patients (35%). In the univariate analysis, there was no significant difference in the incidence of adverse events between the Bedrest and Ambulation Groups (39% vs. 29%). In the logistic regression analysis, bedrest was not a predictor of adverse events (odds ratio, 1.40; 95% confidence interval, 0.53-3.68, P = .497). CONCLUSIONS In patients with TPMs for bradyarrhythmias during the waiting period for PPM implantations, bedrest might not prevent adverse events, such as cardiovascular events and complications associated with TPMs.
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Affiliation(s)
- Tomoaki Hama
- The Division of CardiologyDepartment of MedicineTokai University Hachioji HospitalHachiojiJapan
| | - Norishige Morita
- The Division of CardiologyDepartment of MedicineTokai University Hachioji HospitalHachiojiJapan
| | - Akiko Ushijima
- The Division of CardiologyDepartment of MedicineTokai University Hachioji HospitalHachiojiJapan
| | - Akira Ueno
- The Division of CardiologyDepartment of MedicineTokai University Hachioji HospitalHachiojiJapan
| | - Takayuki Iida
- The Division of CardiologyDepartment of MedicineTokai University Hachioji HospitalHachiojiJapan
| | - Yuji Ikari
- The Division of CardiologyDepartment of MedicineTokai University HospitalIseharaJapan
| | - Yoshinori Kobayashi
- The Division of CardiologyDepartment of MedicineTokai University Hachioji HospitalHachiojiJapan
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Lim S, D’Souza C. Wheeled Mobility Use on Accessible Fixed-Route Transit: A Field Study in Environmental Docility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2840. [PMID: 33802242 PMCID: PMC8001639 DOI: 10.3390/ijerph18062840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/18/2021] [Accepted: 03/04/2021] [Indexed: 12/02/2022]
Abstract
Multiple field studies provide qualitative accounts of usability barriers experienced by users of wheeled mobility devices on public transit. This study aimed to examine these usability barriers from the theoretical perspective of Environmental Docility by quantifying the relationship between functional capabilities of wheeled mobility device users and ingress-egress performance on accessible fixed-route transit vehicles in an urban setting. Twenty-eight wheeled mobility users each completed three trips on a predetermined route through the local public transit system. Ingress and egress times, user-reported usability ratings and open-ended comments were analyzed. Regression analyses indicated significant interactions between age and minimum parallel-park length on ingress and egress times. Specifically, lower functional capability reflected in older age and less maneuvering ability predicted decreased performance (longer ingress-egress times), indicating less adaptability to environmental demands and agreement with the Environmental Docility Hypothesis. Usability ratings and comments revealed difficulty with negotiating access ramps and turning maneuvers in the vehicle interior and in proximity to other passengers. Despite compliance with accessibility standards, current design of transit vehicles present substantial usability barriers for wheeled mobility users. Environmental Docility provides a theoretical basis to identifying modifiable factors related to person and environment for improving usability of public transit for people aging and/or with mobility impairments.
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Affiliation(s)
- Sol Lim
- Department of Systems and Industrial Engineering, The University of Arizona, Tucson, AZ 85721-0020, USA;
| | - Clive D’Souza
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 48109-2117, USA
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Wahyuni S, Effendy C, Kusumaningrum FM, Dewi FST. Factors Associated with Independence for Elderly People in Their Activities of Daily Living. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i12021.44-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Health in the elderly does not merely refer to a condition free from disease but should also have elements regarding functionality and independence. Purpose: This study aimed to measure Activities of Daily Living (ADLs) and to identify the factors affecting ADLs among the elderly population in Sleman District. Methods: A cross-sectional study was carried out using secondary data from the Multidimensional Elderly Care project, nested on the Health Demographic and Surveillance System in Sleman, involving 549 elderly participants. The independence of these elderly people was measured using an Activities of Daily Living Scale questionnaire. Factors measured were cognitive (using the Mini-Mental State Examination questionnaire), psychological (using the Geriatric Depression Scale or Cornell Scale for Depression in Dementia questionnaires), economic (using the Financial Management Behavior Scale questionnaire), and nutritional status (using the Mini Nutritional Assessment questionnaire). The data were analyzed using the chi-square test, Fisher test, and Poisson test for bivariate analysis, while multivariate analysis using a logistic regression test. Results: The prevalence of elderly dependence was 14.03%. Elderly dependence was significantly related to age, job, residence, financial management, dementia, depression, malnutrition, and stroke disease in the bivariate analysis. However, after multivariate analysis, only age (>86 years) (PR = 4.31; 95% CI = 1.91–9.72), malnutrition (PR = 6.62; 95% CI = 3.79–11.57), and stroke (PR = 3.06; 95% CI = 2.03–4.61) were still shown to be related to elderly dependence. Conclusion: Increasing age, malnutrition, and stroke in elderly people lead to higher dependency in their ADLs.
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Lunt E, Ong T, Gordon AL, Greenhaff PL, Gladman JRF. The clinical usefulness of muscle mass and strength measures in older people: a systematic review. Age Ageing 2021; 50:88-95. [PMID: 32706848 PMCID: PMC7793605 DOI: 10.1093/ageing/afaa123] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/23/2020] [Indexed: 01/06/2023] Open
Abstract
Background sarcopenia is the loss of muscle mass and quality and is diagnosed using measures of muscle strength, size and mass. We evaluated the literature on whether sarcopenia measures are predictive of motor outcomes in older people in clinical settings. Methods electronic databases (MEDLINE Ovid, EMBASE, CINAHL and Web of Science) were searched for articles on measures of muscle mass, volume, thickness or strength, in older people in clinical settings, which reported cross-sectional or longitudinal associations with motor outcomes. Clinical cohorts included geriatric medical inpatients and outpatients, patients with hip fracture, geriatric rehabilitation and care home residents. Motor outcomes were mobility, falls, balance and activities of daily living (ADL). Due to high study heterogeneity, standardised mean differences were used to compare strength of associations. Results in total, 83 articles were identified. The most frequently studied measures were grip strength (47 studies), knee extension strength (21 studies) and bioelectrical impedance analysis (18 studies). Handgrip strength (HGS) had evidence for cross-sectional associations with mobility (14 of 16 studies, 2,088 participants), balance (6 of 6 studies, 1,177 participants) and ADL independence (10 of 11 studies, 3,228 participants), and evidence of longitudinal associations with mobility (3 of 3 studies, 883 participants) and ADL independence (7 of 10 studies, 1,511 participants). There was no conclusive evidence for association with falls. Conclusions HS was the most studied measure and was associated with mobility, balance and ADL outcomes. There was a paucity of studies, particularly with longitudinal follow-up, measuring muscle mass, volume or thickness using gold-standard approaches.
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Affiliation(s)
- Eleanor Lunt
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Health Care of Older People Division, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Terence Ong
- Health Care of Older People Division, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Adam L Gordon
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- East Midlands Collaboration for Leadership in Applied Health Research and Care, Nottingham, UK
| | - Paul L Greenhaff
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- MRC/ARUK Centre for Musculoskeletal Ageing Research, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK
| | - John R F Gladman
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Health Care of Older People Division, Nottingham University Hospital NHS Trust, Nottingham, UK
- East Midlands Collaboration for Leadership in Applied Health Research and Care, Nottingham, UK
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Ligthart-Melis GC, Luiking YC, Kakourou A, Cederholm T, Maier AB, de van der Schueren MA. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 21:1216-1228. [DOI: 10.1016/j.jamda.2020.03.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
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Jones C, Chen KM, Weeks B, Qi M, Moyle W. Healthy Beat Acupunch exercise program: Validation and feasibility study for older adults with reduced physical capacity or probable sarcopenia. Explore (NY) 2020; 17:498-504. [PMID: 32527686 DOI: 10.1016/j.explore.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This research aims to validate the Healthy Beat Acupunch (HBA) exercise program, determine the feasibility of the HBA exercise program protocol and gain an understanding of the effects on well-being for older adults with sarcopenia. Design, Setting & Intervention: Validation of the HBA exercise program was conducted using two rounds of Delphi communication among eight experts. A one-group, pre-post experimental study was conducted with 17 older adults with probable sarcopenia and/or low gait speed at an Australian retirement village. The HBA exercise program lasted 40 min per session, three sessions per week for four weeks. OUTCOME MEASURES Muscle mass, muscle strength, gait speed and health-related quality of life were assessed before and after the intervention. The HBA exercise program was evaluated via a questionnaire and individual interviews. RESULTS Experts validated the HBA exercise program and deemed it to be simple, safe, suitable and helpful for practice by older adults with sarcopenia. Participants enjoyed the HBA exercise program, planned to continue and would recommend to friends. Frequency, duration and size of the exercise class were appropriate, and they appreciated the trainer's support and directions when mastering the exercise motions. Improvement in participants' gait speed was found post-exercise intervention (p<.005). CONCLUSION The HBA exercise program is appropriate for practice by older adults, particularly those with reduced physical capacity and probable sarcopenia with possible benefits of improved gait speed. Future studies need to consider and overcome the limitations (i.e. study design, sample size) and challenge (participant recruitment) encountered in this research.
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Affiliation(s)
- Cindy Jones
- Faculty of Health Sciences & Medicine, Bond University, Australia, Menzies Health Institute Queensland, Australia.
| | - Kuei-Min Chen
- College of Nursing & Centre for Long-Term Care Research, Kaohsiung Medical University, Taiwan.
| | - Benjamin Weeks
- School of Allied Health Sciences, Griffith University, Australia, Menzies Health Institute Queensland, Australia.
| | - Meiling Qi
- School of Nursing, Shandong University, China.
| | - Wendy Moyle
- School of Nursing and Midwifery, Griffith University, Australia, Menzies Health Institute Queensland, Australia.
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Zhang XL, Zhang Z, Zhu YX, Tao J, Zhang Y, Wang YY, Ke YY, Ren CX, Xu J, Zhang XY. Comparison of the efficacy of Nutritional Risk Screening 2002 and Mini Nutritional Assessment Short Form in recognizing sarcopenia and predicting its mortality. Eur J Clin Nutr 2020; 74:1029-1037. [DOI: 10.1038/s41430-020-0621-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
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Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020; 21:300-307.e2. [PMID: 32033882 DOI: 10.1016/j.jamda.2019.12.012] [Citation(s) in RCA: 2907] [Impact Index Per Article: 726.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
Abstract
Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
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Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Prasert Assantachai
- Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tung-Wai Auyeung
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, China
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jenny S W Lee
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ken Sugimoto
- Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Tanaka
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Teimei Zhang
- Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Health, Beijing, China
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
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Maeda K, Mori N. Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study. BMC Geriatr 2020; 20:26. [PMID: 31992227 PMCID: PMC6986081 DOI: 10.1186/s12877-020-1429-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background Poor oral health at hospital admission is a potential higher mortality risk predictor. We aimed to determine in-hospital mortality by assessing poor oral health using a validated tool. Methods A retrospective observational study was conducted in an acute care hospital, and 624 consecutive geriatric patients were included. Patients were divided into three groups according to oral health, stratified by the Oral Health Assessment Tool (OHAT) scores. Nutritional status, daily living activities, cognitive impairment, and comorbidities were collected as covariates. Univariate and multivariate analyses were performed to identify the relationship between oral health and survival. Results The mean age was 83.8 ± 7.9 years, and 41% were males. Groups with an OHAT score equivalent to 0, 1–2, and ≥ 3 comprised 213, 206, and 205 patients, and 11 (5.2%), 13 (6.3%), and 37 (18.0%) of those patients died in the hospital, respectively. Patients in the OHAT score ≥ 3 group had higher mortality than those in the other groups (log-rank test: p = 0.012 for the OHAT = 0 group; p = 0.010 for the OHAT = 1–2 group after Bonferroni corrections). Patients in the OHAT score ≥ 3 group continued to have poor survival even after adjusting for confounders in the Cox’s regression analysis (hazard ratio: 2.514, 95% confidence interval: 1.220–5.183, p = 0.012). Conclusion In geriatric patients, poor oral health at hospital admission was an independent in-hospital mortality predictor. Future studies on oral care intervention stratified by oral health conditions are warranted.
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Affiliation(s)
- Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, 2172 Tamana, Tamana, Kumamoto, 865-0005, Japan.
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Shirado K, Wakabayashi H, Maeda K, Nishiyama A, Asada M, Isse H, Saito S, Kakitani C, Momosaki R. Impact of Energy intake at One Week after Hospitalization on Prognosis for Older Adults with Pneumonia. J Nutr Health Aging 2020; 24:119-124. [PMID: 31886818 DOI: 10.1007/s12603-019-1282-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study objectives to investigate the influence of average energy intake at 1 week of hospitalization on prognosis for older adults with pneumonia. DESIGN Retrospective observational cohort study. SETTING The Japan Rehabilitation Nutrition Database comprise those with pneumonia in acute care hospitals. PARTICIPANTS The study included 329 pneumonia patients (aged over 65 years) who entered into the Japan Rehabilitation Nutrition Database (JRND) from November 2015 to March 2018. MEASUREMENTS Logistic regression analysis was performed to confirm the relationship of energy intake with the rate of mortality, discharge home, and pneumonia recurrence during hospitalization. Variables included in the multiple regression analysis model were age, sex, Mini Nutritional Assessment-Short Form score (MNA-SF) at hospitalization, A-DROP, Charlson comorbidity index (CCI), and presence or absence of rehabilitation. RESULTS Of 315 patients with pneumonia (median age 85 years), 63.8% were men. 57.7% were assigned to the lack of energy intake (LEI) at 1 week after admission. Patients in the LEI group were older (p = 0.033), had higher A-DROP score (p < 0.001), and showed higher malnutrition rate in MNA-SF at hospitalization (p < 0.001) than those in the control group. Mortality, pneumonia recurrence (p = 0.001), median body mass index (p = 0.012), and low malnutrition in MNA-SF (p < 0.001) at discharge were significantly higher in the LEI group than in the control group. Logistic regression analysis showed that LEI was an independent risk factor for mortality (Odds ratio: 5.07, p = 0.002), discharge home (Odds ratio: 0.33, p = 0.007), and pneumonia recurrence (Odds ratio: 3.26, p = 0.007). CONCLUSIONS LEI at 1 week after hospitalization in older adults with pneumonia was an independent risk factor for mortality, difficult at-home recovery, and pneumonia recurrence. These findings suggest the importance of adequate energy intake from the early days of hospitalization.
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Affiliation(s)
- K Shirado
- Kengo Shirado, R.P.T. Department of Rehabilitation, Aso Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka 820-8505, Japan; Tel: +81-948-29-8038; Fax: +81-948-25-8018,
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Comprehensive Geriatric Assessment and Nutrition-Related Assessment: A Cross-Sectional Survey for Health Professionals. Geriatrics (Basel) 2019; 4:geriatrics4010023. [PMID: 31023991 PMCID: PMC6473726 DOI: 10.3390/geriatrics4010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 01/06/2023] Open
Abstract
(1) Background: It is important to assess physical and nutritional status using the Comprehensive Geriatric Assessment (CGA). However, the correlation between the CGA usage and nutritional-related assessments remain unclear. This study aims to clarify the correlation between the CGA usage and other nutritional-related assessments. (2) Methods: We conducted a questionnaire survey on clinical use of CGA, assessment of sarcopenia/sarcopenic dysphagia/cachexia, and defining nutritional goals/the Nutrition Care Process/the International Classification of Functioning, Disability, and Health (ICF)/the Kuchi–Kara Taberu Index. (3) Results: The number of respondents was 652 (response rate, 12.0%), including 77 who used the CGA in the general practice. The univariate analyses revealed that participants using the CGA tended to assess sarcopenia (P = 0.029), sarcopenic dysphagia (P = 0.001), and define nutritional goals (P < 0.001). Multivariate logistic regression analyses for the CGA usage revealed that using ICF (P < 0.001), assessing sarcopenia (P = 0.001), sarcopenic dysphagia (P = 0.022), and cachexia (P = 0.039), and defining nutritional goals (P = 0.001) were statistically significant after adjusting for confounders. (4) Conclusions: There are correlations between the use of CGA and evaluation of sarcopenia, sarcopenic dysphagia, and cachexia and nutritional goals.
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Rodríguez-Rejón AI, Ruiz-López MD, Wanden-Berghe C, Artacho R. Prevalence and Diagnosis of Sarcopenia in Residential Facilities: A Systematic Review. Adv Nutr 2019; 10:51-58. [PMID: 30668619 PMCID: PMC6370256 DOI: 10.1093/advances/nmy058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/05/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023] Open
Abstract
Assessing sarcopenia, the age-related loss of muscle mass and function, in institutionalized older adults is a challenging task. Data on its prevalence in residential facilities are scant and highly variable. Our objective was to report the prevalence of sarcopenia in older adults living in residential facilities (nursing/long term-care homes and assisted-living facilities) and review the criteria and methodologies used to diagnose sarcopenia in this setting. Bibliographic searches were carried out in 6 electronic databases (Medline via PubMed, Web of Science, Scopus, CINAHL, LILACS, and Cochrane) with the use of the Medical Subject Heading terms "Sarcopenia" and "Residential Facilities." We included studies that evaluated the prevalence of sarcopenia among older adults (aged ≥60 y) living in residential facilities. Forty-four studies were identified, of which 21 studies were included after applying eligibility criteria. The reported prevalence of sarcopenia ranged widely between 17.7% and 73.3% in long term-care homes and between 22% and 87% in assisted-living facilities. Most studies (n = 14) followed the consensus on sarcopenia diagnosis published by the European Working Group on Sarcopenia in Older People. In the other 7 studies, sarcopenia was diagnosed according to muscle mass, which was measured via 5 different techniques, most frequently bioelectrical impedance analysis, establishing cutoff scores for low muscle mass with the use of 5 different indexes, most frequently the skeletal muscle index. There are major differences in study design, methodology, and the approach to sarcopenia diagnosis in this setting, which would, in part, explain the enormous variability in the reported prevalence data. The lack of consensus on the correct diagnostic approach hampers the implementation of appropriate nutritional interventions.
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Affiliation(s)
| | - María Dolores Ruiz-López
- Department of Nutrition and Food Sciences, Faculty of Pharmacy, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology, Health Sciences Technology Park, University of Granada, Granada, Spain
| | - Carmina Wanden-Berghe
- General University Hospital of Alicante, Institute of Health and Biomedical Research of Alicante, Alicante, Spain
| | - Reyes Artacho
- Department of Nutrition and Food Sciences, Faculty of Pharmacy, University of Granada, Granada, Spain
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Maeda K, Koga T, Akagi J. Nutritional variables predict chances of returning home and activities of daily living in post-acute geriatric care. Clin Interv Aging 2018; 13:151-157. [PMID: 29416323 PMCID: PMC5790089 DOI: 10.2147/cia.s154129] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about the association between malnutrition and the chances of returning home from post-acute facilities in older adult patients. This study aimed to understand whether malnutrition and malnutrition-related factors would be determinants for returning home and activities of daily living (ADL) at discharge after post-acute care. Methods Patients aged ≥65 years living at home before the onset of an acute disease and admitted to a post-acute ward were enrolled (n=207) in this prospective observational study. Malnutrition was defined based on the criteria of the European Society for Clinical Nutrition and Metabolism. Nutritional parameters included the nutritional intake at the time of admission and oral conditions evaluated by the Oral Health Assessment Tool (OHAT). The Barthel Index was used to assess daily activities. A Cox regression analysis of the length of stay was performed. Multivariable linear regression analyses to determine associations between malnutrition, returning home, and ADL at discharge were performed, after adjusting the variables of acute care setting. Results The mean patient age was 84.7±6.7 years; 38% were men. European Society for Clinical Nutrition and Metabolism-defined malnutrition was observed in 129 (62.3%) patients, and 118 (57.0%) of all patients returned home. Multivariable regression analyses showed that malnutrition was a negative predictor of returning home (hazard ratio: 0.517 [0.351–0.761], p=0.001), and an increase in the nutritional intake (kcal/kg/d) was a positive predictor of the Barthel Index at discharge (coefficient: 0.34±0.15, p=0.021). The OHAT was not associated with returning home and ADL. Conclusion Malnutrition and nutritional intake are associated with returning home and ADL at discharge, respectively, after post-acute care. Further studies investigating the effects of a nutritional intervention for post-acute patients would be necessary.
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Affiliation(s)
- Keisuke Maeda
- Palliative Care Center, Aichi Medical University, Aichi, Japan.,Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto, Japan
| | - Takayuki Koga
- Department of Swallowing and Nutritional Therapy, Tamana Regional Health Medical Center, Kumamoto, Japan
| | - Junji Akagi
- Department of Surgery, Tamana Regional Health Medical Center, Kumamoto, Japan
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Bernabeu-Wittel M, Barón-Franco B, Nieto-Martín D, Moreno-Gaviño L, Ramírez-Duque N, Ollero-Baturone M. Prognostic stratification and the healthcare approach in patients with multiple pathologies. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bernabeu-Wittel M, Barón-Franco B, Nieto-Martín D, Moreno-Gaviño L, Ramírez-Duque N, Ollero-Baturone M. Estratificación pronóstica y abordaje asistencial de los pacientes pluripatológicos. Rev Clin Esp 2017; 217:410-419. [DOI: 10.1016/j.rce.2017.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
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Maeda K, Koga T, Nasu T, Takaki M, Akagi J. Predictive Accuracy of Calf Circumference Measurements to Detect Decreased Skeletal Muscle Mass and European Society for Clinical Nutrition and Metabolism-Defined Malnutrition in Hospitalized Older Patients. ANNALS OF NUTRITION AND METABOLISM 2017. [DOI: 10.1159/000478707] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background/Aims: The ability to readily diagnose sarcopenia and malnutrition in a clinical setting is essential. This study is aimed at clarifying the calf circumference (CC) cut-off values for decreased skeletal muscle mass (SMM), according to the Asian Work Group for Sarcopenia's criteria definition of sarcopenia, and those for European Society for Clinical Nutrition and Metabolism-defined malnutrition, in hospitalized Japanese patients. Methods: The study involved 1,164 patients aged ≥65 years. Predictive CC cut-off values were determined using receiver operating curve (ROC) analyses. The predictive validity of the cut-off values was confirmed against in-hospital mortality. Results: There were 654 females and 510 males (mean age, 83.5 ± 8.2 years). Decreased SMM and malnutrition were observed in 80.4 and 32.8% of all patients, respectively. ROC analyses identified CCs of ≤29 cm (female, area under the curve [AUC] 0.791) and ≤30 cm (male, AUC 0.832) as cut-off values for decreased SMM, and CCs of ≤26 cm (female, AUC 0.798) and ≤28 cm (male, AUC 0.837) for malnutrition. CC cut-off values for SMM and malnutrition were independently correlated with in-hospital mortality. Conclusions: The study determined appropriate cut-off values for CC to identify decreased SMM and malnutrition according to the relevant guidelines.
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Prevalence of skeletal muscle mass loss and its association with swallowing function after cardiovascular surgery. Nutrition 2017; 38:70-73. [DOI: 10.1016/j.nut.2017.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/11/2017] [Accepted: 01/22/2017] [Indexed: 12/25/2022]
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