Longitudinal change in energy expenditure and effects on energy requirements of the elderly

Association between doubly labelled water-calibrated energy intake and objectively measured physical activity with mortality risk in older adults

BACKGROUND

Physical activity or biomarker-calibrated energy intake (EI) alone is associated with mortality in older adults; the interaction relationship between the combined use of both factors and mortality has not been examined. We evaluated the relationship between mortality and calibrated EI and step counts in older adults.

METHODS

This prospective study included 4,159 adults aged ≥65 years who participated in the Kyoto-Kameoka study in Japan and wore a triaxial accelerometer between 1 April and 15 November 2013. The calibrated EI was calculated based on a previously developed equation using EI biomarkers. The step count was obtained from the accelerometer ≥ 4 days. Participants were classified into the following four groups: low EI (LEI)/low step counts (LSC) group (EI: <2,400 kcal/day in men and <1,900 kcal/day in women; steps: <5,000 /day), n = 1,352; high EI (HEI)/LSC group (EI: ≥2,400 kcal/day in men and ≥1,900 kcal/day in women; steps: <5,000 /day), n = 1,586; LEI/high step counts (HSC) group (EI: <2,400 kcal/day in men and < 1,900 kcal/day in women; steps: ≥5,000 /day), n = 471; and HEI/HSC group (EI: ≥2,400 kcal/day in men and ≥1,900 kcal/day in women; steps: ≥5,000 /day), n = 750. Mortality-related data were collected until 30 November 2016. We performed a multivariable Cox proportional hazard analysis.

RESULTS

The median follow-up period was 3.38 years (14,046 person-years), and 111 mortalities were recorded. After adjusting for confounders, the HEI/HSC group had the lowest all-cause mortality rate compared to other groups (LEI/LSC: reference; HEI/LSC: hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.41-1.23; LEI/HSC: HR: 0.59, 95% CI: 0.29-1.19; and HEI/HSC: HR: 0.10, 95% CI: 0.01-0.76). No significant interaction was observed between the calibrated EI and steps with mortality. The spline model showed that 35-42 kcal/100 steps/day of EI/100 steps was associated with the lowest mortality risk.

CONCLUSIONS

HR mortality risk was lowest at 35-42 kcal/100 steps/day, suggesting that very high (≥56 kcal) or low (<28 kcal) EI/100 steps are not inversely associated with mortality. Adherence to optimal EI and adequate physical activity may provide sufficient energy balance to explain the inverse association with mortality among older Japanese adults.

Publication trends in nutrition research for sarcopenic obesity: A 20-year bibliometric analysis

BACKGROUND

We used bibliometric methods to evaluate publications on the role of nutrition in sarcopenic obesity and analyzed the current situation and developmental trends over the past 2 decades.

METHODS

Publications from 2002 to 2022 related to the role of nutrition in sarcopenic obesity were extracted from the Web of Science Core Collection database. CiteSpace, VOSviewer, and the Bibliometrix R package were applied to build relevant network diagrams.

RESULTS

One thousand ninety-four articles from 64 countries were included. The annual number of publications in this field has shown an intense growth trend. The University of Alberta, Yonsei University, and Korea University are the major research institutions. Clinical Nutrition has published the most papers on the role of nutrition in sarcopenic obesity, and the American Journal of Clinical Nutrition is the most co-cited journal. A total of 5834 authors conducted the relevant studies. Yves Boirie has published the most papers in this field, and AJ Cruz-Jentoft is the most co-cited author.

CONCLUSION

This is the first bibliometric study of the role of nutrition in sarcopenic obesity. This study systematically summarizes the research hotspots and development directions in this field, and provides a reference for scholars studying the role of nutrition in sarcopenic obesity.

Resting metabolic rate in relation to incident disability and mobility decline among older adults: the modifying role of frailty

BACKGROUND

Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life.

AIMS

To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations.

METHODS

Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007-2009 and a follow-up measurement 10 years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried's frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted.

RESULTS

Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23-0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18-0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14-0.64, p = 0.002).

CONCLUSIONS

To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline.

Sociodemographic and behavioural risk factors for obesity among community-dwelling older adults in Ghana and Nigeria: A secondary analysis of data from the SIREN study

OBJECTIVES

To explore the prevalence and risk factors of obesity among older adults from low- and middle-income countries (LMICs).

METHODS

This is a secondary analysis of data obtained from the SIREN study through in-person interviews and measurements from healthy stroke-free older adults (≥60 years). Overweight/obesity was defined as body mass index ≥25 kg/m². Abdominal obesity was defined as waist-to-hip ratio (WHR) of >0.90 for males and >0.85/females or waist circumference (WC) of >102 cm for males/>88 cm for females. Adjusted odds ratio (aORs) with 95% confidence interval (CIs) of the relationship between obesity and sociodemographic factors were assessed at P < 0.05.

RESULTS

Overall, 47.5% of participants were overweight/obese, 76.6% had a larger than recommended WHR, and 54.4% had a larger than recommended WC. Abdominal obesity (WC; aOR: 9.43, CI: 6.99-12.50), being a Nigerian (aOR: 0.55; CI: 0.42-0.72), living in an urban setting (aOR: 1.92; CI: 1.49-2.46), earning >$100/month (aOR: 1.53; CI: 1.19-1.96), and having formal education (aOR: 1.42; CI: 1.08-1.87) were associated with overweight/obesity.

CONCLUSION

Living in urban settings, earning a higher income, and having a formal education were associated with a higher odds of obesity among older adults from LMICs.

Factors associated with changes in the objectively measured physical activity among Japanese adults: A longitudinal and dynamic panel data analysis

Factors associated with dynamic changes in the objectively measured physical activity have not been well understood. We aimed to 1) evaluate the longitudinal change in the physical activity trajectory according to sex which is associated with age and to 2) determine the factors associated with the dynamic change in physical activity-related variables across a wide age range among Japanese adults. This longitudinal prospective study included 689 Japanese adults (3914 measurements) aged 26-85 years, whose physical activity data in at least two surveys were available. Physical activity-related variables, such as intensity (inactive, light [LPA; 1.5 to 2.9 metabolic equivalents (METs)], moderate-to-vigorous [MVPA; ≥3.0 METs]), total energy expenditure (TEE), physical activity level (PAL), and step count, were evaluated using a validated triaxial accelerometer. Statistical analysis involved the latent growth curve models and random-effect panel data multivariate regression analysis. During a mean follow-up period of 6.8 years, physical activity was assessed an average of 5.1 times in men and 5.9 times in women. The profiles for the inactive time, LPA (only men), MVPA, step count, PAL, and TEE showed clear curvature, indicating an accelerated rate of change around the age of 70. In contrast, other variables exhibited minimal or no curvature over the age span. The MVPA trajectory was positively associated with alcohol consumption, hand grips, leg power, and trunk flexibility and negatively associated with age, local area, body mass index (BMI), comorbidity score, and heart rate over time. Our results indicated that the physical activity trajectory revealed clear curvature, accelerated rate of change around the age of 70, and determined physical health and fitness and BMI as dynamic factors associated with physical activity changes. These findings may be useful to help support populations to achieve and maintain the recommended level of physical activity.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Metabolic Responses to Eight Weeks of Consuming Cottonseed Oil v. Olive Oil in Adults with Dyslipidemia, a Randomized Trial

BACKGROUND

Differences in metabolic responses between diets rich in monounsaturated (MUFA) and polyunsaturated fats (PUFA) could affect energy balance and weight maintenance. The present study was a secondary analysis to investigate 8-week diet interventions rich in either PUFA (cottonseed oil (CSO)) or MUFA (olive oil (OO)) on metabolic responses in adults with dyslipidemia.

METHODS

Forty-one adults with dyslipidemia completed this randomized trial consisting of an 8-week partial-outpatient feeding trial. Provided foods accounted for ~60% of their daily energy needs, with ~30% of energy needs provided by CSO (n=20) or OO (n=21). At pre- and post-diet intervention visits, participants consumed a high saturated fat (SFA) meal (35% daily energy needs, 47.9% from SFA), and fasting and 3.5h postprandial indirect calorimetry was used to measure energy expenditure (EE) and substrate oxidation.

RESULTS

No changes were observed in fasting measures. The OO group had greater increases in postprandial EE (p=0.002); however, there were no differences in substrate oxidation between groups. A lack of metabolic flexibility was found in both groups, which was partially explained by changes in insulin sensitivity (homeostasis model assessment of insulin resistance (HOMA-IR)).

CONCLUSIONS

The results of the present study show OO, but not CSO, diet enrichment improves EE following the occasional high SFA meal, which may improve weight maintenance over time. Registered at clinicaltrials.gov (NCT04397055). This article is protected by copyright. All rights reserved.

A narrative review on the application of doubly labeled water method for estimating energy requirement for Koreans

Research articles were reviewed to validate the estimated energy requirements (EERs) equations developed by the Institute of Medicine of the National Academies (IOM). These equations are based on total energy expenditure (TEE) measured by the doubly labeled water (DLW) method. We subsequently aimed to provide the basis for the suitability to apply the IOM equations as EER equations for Koreans, and develop relevant equations for EER in the Dietary Reference Intake for Koreans (KDRI). Additionally, besides the EER(IOM) equations, other equations were examined for EER estimation. Research papers demonstrating the validation of the EER(IOM) equations based on TEE(DLW) were searched through PubMed (up to September 2019). Of the 637 potentially relevant articles identified, duplicates and unsuitable titles and abstracts were excluded. Furthermore, papers with irrelevant subject and inappropriate study design were also excluded. Finally, 11 papers were included in the review. Among the reviewed papers, 8 papers validated the application of the EER(IOM) equations for EER based on TEE(DLW). These included 3 studies for children (USA 1, Korea 2), 1 for adolescents (Portugal), 2 for adults (Korean), and 2 for the elderly (Korea, USA). EER(IOM) equations were found to be generally acceptable for determining EER by using the DLW method, except for Korean boys at 9–11 yrs (overestimated) and female athletes at 19–24 yrs (underestimated). Additionally, 5 papers include the validation of other EER equations, beside EER(IOM) for EER based on TEE(DLW). In Japanese dietary reference intake and recommended dietary allowance, EER equations are acceptable for determining EER based on TEE(DLW). The EER(IOM) equations is generally acceptable for determining EER using the DLW method in Koreans as well as several populations, although certain defined groups were found to be unfit for the estimation. Additionally, the concept of healthy body mass index of Koreans and physical activity levels need to be considered, thereby providing the basis for developing relevant equations of EER in KDRI.

Determinants of Resting Energy Expenditure in Very Old Nursing Home Residents

OBJECTIVES

This study aimed to measure resting energy expenditure (REE) in institutionalized old persons and to determine factors possibly related to change in REE as a basis for estimating energy requirements.

DESIGN AND SETTINGS

A monocentric cross-sectional study was conducted. Statistical approaches were conducted to determine independent factors associated with REE. Various published predictive equations of REE were compared to our population.

PARTICIPANTS

72 residents of a nursing home, mostly women (80.5%) aged 87.4±6.6 years were included.

MEASUREMENTS

REE (indirect calorimetry), body composition (bio-impedance analysis), biological and anthropometric data were collected.

RESULTS

Mean REE was 1006±181 kcal/d and was higher in men than in (1227±195 vs. 953±131 kcal/d, p<0.05). According to criteria adapted from the Global Leadership Initiative on Malnutrition consensus, 65.3 % of the institutionalized population were malnourished. In multivariate analysis adjusted on gender and age, REE was positively associated with calorie intake, fat-free mass (FFM), functional abilities (French Autonomie Gérontologie Groupe Iso Ressources scale), and elevated CRP level (> 25 mg/l). Significant differences (p<0.05) appeared between measured REE and predicted REE by using various published equations.

CONCLUSION

REE of very old nursing home residents is influenced by FFM, calorie intake, functional abilities, and CRP levels and is poorly predicted by classical equations based on age, gender, height, and weight. This suggests a metabolic adaptation to caloric restriction and inflammation and prompts to consider the level of physical activity and muscle loss when assessing caloric requirements in this population.

Age-Related Decline in Physical Activity Level in the Healthy Older Japanese Population

The Dietary Reference Intakes 2020 divided the older population into those aged 65-74 y and those over 75 y old. However, physical activity level in each age group was not specified. This study examined age-related differences in physical activity level among healthy Japanese older people, and the effect of lifestyles on these differences. In total, 70 people (22 men, 48 women) aged 65-85 y old participated in this study. Total energy expenditure was measured using the doubly labeled water method, and basal metabolic rate using expired gas concentration and volume. The Physical Activity Scale for the Elderly and a triaxial accelerometer were used to assess physical activities. Physical activity level was significantly higher among 65-74 y old (median 1.86) than those over 75 y old (1.76). However, the Physical Activity Scale for the Elderly did not show any significant differences between the age groups. The duration of physical activity with 3.0-5.9 metabolic equivalents was longer for both locomotive and household activities among 65-74 y old than those over 75 y old. Younger participants walked a median of 6,364 steps a day, compared with 4,419 steps for older people. The 65-74 y old participants involved in paid work or who habitually exercised, and those over 75 y old taking more than 40 min a day of moderate to vigorous physical activity, and walking more than the median level for their sex and age group had significantly higher physical activity levels.

Energy compensation and adiposity in humans

Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures.^1-3 This suggestion has profound implications for both the evolution of metabolism and human health. It implies that a long-term increase in activity does not directly translate into an increase in total energy expenditure (TEE) because other components of TEE may decrease in response-energy compensation. We used the largest dataset compiled on adult TEE and basal energy expenditure (BEE) (n = 1,754) of people living normal lives to find that energy compensation by a typical human averages 28% due to reduced BEE; this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day. Moreover, the degree of energy compensation varied considerably between people of different body compositions. This association between compensation and adiposity could be due to among-individual differences in compensation: people who compensate more may be more likely to accumulate body fat. Alternatively, the process might occur within individuals: as we get fatter, our body might compensate more strongly for the calories burned during activity, making losing fat progressively more difficult. Determining the causality of the relationship between energy compensation and adiposity will be key to improving public health strategies regarding obesity.

Indirect Calorimetry as an Instrument of Research to Identify the Effect of Hypermetabolism in Critical Patients' Prognosis

Background: Energy expenditure (EE) evaluation in Intensive Care Unit (ICU) patients can be very challenging. Critical illness is characterized by great variability in EE, which is influenced by the disease itself and the effects of treatment. Indirect calorimetry (IC) is currently the gold standard to measure EE in Intensive Care Unit (ICU) patients. However, calorimeters are not widely available, and predictive formulas (PF) are still commonly used, leading to under or overfeeding and deleterious consequences.Important metabolic changes occur and catabolism becomes prominent in critically ill patients.Both hyper and hypometabolism can be observed, but hypermetabolic patients appear to have higher mortality rates compared to metabolically normal patients. This study aimed to assess hypermetabolism incidence and compare clinical outcomes between hypermetabolic and normometabolic patients in ICU.

Methods: A single-center, retrospective, and observational study was conducted in the ICU of the Hospital do Divino Espírito Santo in Ponta Delgada, between August 2018 and February 2021. Only invasively mechanically ventilated patients were included. Resting energy expenditure (REE) was predicted by 25 kcal/kg/day formula to obtain predicted resting energy expenditure (PREE), and REE was measured by IC to obtain measured resting energy expenditure (MREE). According to their metabolic state (PREE/MREE), patients were divided into hypermetabolic (≥1.3) and normometabolic (<1.3). To determine the limits of agreement between PREE and MREE, we performed a Bland-Altman (BA) analysis. Baseline characteristics, severity criteria, nutritional status, and main diagnosis on admission were compared. The primary outcome considered was 30-day mortality. Other outcomes such as the ICU length of stay (LOS), in-hospital LOS, and length of invasive ventilation were also evaluated.

Results: Among the 80 ICU patients included in the final analysis, 67 patients were normometabolic (83.4%). Patients admitted due to pneumonia were more hypermetabolic, 8 (61.5%) vs. 10 (14.9%); p<0.001. Hypermetabolism was found also in patients admitted due to sepsis/septic shock, 7 (53.8%) vs. 16 (23.9%); p=0.029. Hypermetabolic patients had lower body mass index (22.5 [interquartile range (IQR): 21.5-24.9] vs. 27.7 [IQR: 25.0-32.4] kg/m²; p=0.001) and higher MREE (2715.0 [2399.0-3090.0] vs. 1690.0 [1410.0-2190.0] kcal/day; p<0.001). Bland-Altman analysis showed a mean difference of -5.6 ± 744.7 Kcal/day between the PREE and MREE by IC. No statistically significant difference was found between the two groups, neither in 30-day mortality nor in the other outcomes considered.

Conclusions: Hypermetabolism was not seen to present a greater risk of death in mechanically ventilated patients in ICU. Lower BMI, sepsis/septic shock, and pneumonia appear to be associated with a hypermetabolic state.

Methionine restriction plus overload improves skeletal muscle and metabolic health in old mice on a high fat diet

Methionine restriction (MR) has been shown to reduce the age-induced inflammation. We examined the effect of MR (0.17% methionine, 10% kCal fat) and MR + high fat diet (HFD) (0.17% methionine, 45% kCal fat) on body mass, food intake, glucose tolerance, resting energy expenditure, hind limb muscle mass, denervation-induced atrophy and overload-induced hypertrophy in young and old mice. In old mice, MR and MR + HFD induced a decrease in body mass. Muscle mass per body mass was lower in old compared to young mice. MR restored some of the HFD-induced reduction in muscle oxidative capacity. The denervation-induced atrophy of the m. gastrocnemius was larger in animals on MR than on a control diet, irrespective of age. Old mice on MR had larger hypertrophy of m. plantaris. Irrespective of age, MR and MR + HFD had better glucose tolerance compared to the other groups. Young and old mice on MR + HFD had a higher resting VO₂ per body mass than HFD group. Mice on MR and MR + HFD had a resting respiratory quotient closer to 0.70, irrespective of age, indicating an increased utilization of lipids. In conclusion, MR in combination with resistance training may improve skeletal muscle and metabolic health in old age even in the face of obesity.

Estimating total daily energy requirements in community-dwelling older adults: validity of previous predictive equations and modeling of a new approach

BACKGROUND/OBJECTIVES

Accurate estimation of energy requirements is crucial for health maintenance and prevention of malnutrition in older adults. This study aimed to assess the accuracy of predictive equations for estimating energy requirements in older adults and to test the validity of new predictive equations for this age group.

SUBJECTS/METHODS

This is a cross-sectional study including 38 Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEE_DLW). The energy expenditure was compared to the Institute of Medicine (Dietary Reference Intake (DRI)) and Vinken et al. previous predictive equations and three predictive models developed in a modeling sample. The agreement was assessed using intra-class correlation coefficient, Bland-Altman plots, and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured energy expenditure.

RESULTS

The mean (standard deviation) TEE_DLW was 2656.7 (405.6) kcal/day for men and 2168.9 (376.9) for women. Vinken et al. and both DRI equations presented moderate to good degree of agreement, while the developed models vary from fair to very good agreement in comparison to DLW. The accuracy rate was the same for both DRI equations and Vinken et al. equation (60.53%). The new equations developed in this study had accuracy in predicting TEE for Brazilian older adults varying from 43.11% to 73.68%.

CONCLUSIONS

The results corroborate the use of previous predictive equations for estimating energy requirements in Brazilian older adults. Further studies have the potential to explore the use of the developed models to assess energy needs in this population.

Energy Expenditure in Older People Hospitalized for an Acute Episode

Weight loss and worsening of nutritional state is a frequent downfall of acute hospitalization in older people. It is usually accepted that acute inflammation is responsible for hypercatabolism. However, several studies suggest, on the contrary, a reduction in resting energy expenditure (REE). This study aimed to obtain a reliable measure of REE and total energy expenditure (TEE) in older patients hospitalized for an acute episode in order to better assess patients’ energy requirements and help understand the mechanisms of weight loss in this situation. Nineteen hospitalized older patients (mean age 83 years) with C-reactive protein (CRP) level >20mg/L were recruited. REE and TEE were measured using gold standard methods of indirect calorimetry and doubly labeled water (DLW), respectively. REE was then compared to data from a previous study on aged volunteers from nursing homes who were free of an acute stressor event. Energy requirements measured by DLW were confirmed at 1.3 × REE. Energy intake covered the needs but did not prevent weight loss in these patients. TEE was not increased in hospitalized patients and was not influenced by inflammation, while the relationship between REE and inflammation was uncertain. Our results suggest that lean mass remains the major determinant of REE in hospitalized older people and that weight loss may not be explained solely by a state of hypercatabolism.

Current perspective for tube feeding in the elderly: from identifying malnutrition to providing of enteral nutrition

With the number of individuals older than 65 years expected to rise significantly over the next few decades, dramatic changes to our society and health care system will need to take place to meet their needs. Age-related changes in muscle mass and body composition along with medical comorbidities including stroke, dementia, and depression place elderly adults at high risk for developing malnutrition and frailty. This loss of function and decline in muscle mass (ie, sarcopenia) can be associated with reduced mobility and ability to perform the task of daily living, placing the elderly at an increased risk for falls, fractures, and subsequent institutionalization, leading to a decline in the quality of life and increased mortality. There are a number of modifiable factors that can mitigate some of the muscle loss elderly experience especially when hospitalized. Due to this, it is paramount for providers to understand the pathophysiology behind malnutrition and sarcopenia, be able to assess risk factors for malnutrition, and provide appropriate nutrition support. The present review describes the pathophysiology of malnutrition, identifies contributing factors to this condition, discusses tools to assess nutritional status, and proposes key strategies for optimizing enteral nutrition therapy for the elderly.

Validity of a triaxial accelerometer and simplified physical activity record in older adults aged 64-96 years: a doubly labeled water study

BACKGROUND

The aim was to examine the validity of a triaxial accelerometer (ACCTRI) and a simplified physical activity record (sPAR) in estimating total energy expenditure (TEE) and physical activity level (PAL) in older adults with the doubly labeled water (DLW) method.

METHODS

A total of 44 Japanese elderly individuals (64-96 years), of which 28 were community-dwelling healthy adults with or without sporting habits (S or NS group) and 16 were care home residents with frailty (F group), were included in the study. Basal metabolic rate (BMR) was measured by indirect calorimetry, TEE was obtained by the DLW method, and PAL was calculated as TEE/BMR. Daily step count was monitored by a pedometer (Lifecorder). The 24-h average metabolic equivalent was assessed by ACCTRI and sPAR.

RESULTS

The TEE_DLW in men was 2704 ± 353, 2308 ± 442, and 1795 ± 338 kcal d^-1, and that in women was 2260 ± 208, 1922 ± 285, and 1421 ± 274 kcal d^-1 for the S, NS, and F groups, respectively. ACCTRI and sPAR systematically underestimated actual TEE (- 14.2 ± 11.6 and - 15.3 ± 12.3% for ACCTRI and sPAR, respectively). After diet-induced thermogenesis was taken into account for ACCTRI and sPAR, TEE_DLW was significantly correlated with TEE_ACCTRI (R² = 0.714) and TEE_sPAR (R² = 0.668). PAL_DLW was also significantly correlated with PAL_ACCTRI (R² = 0.438) and PAL_sPAR (R² = 0.402).

CONCLUSIONS

Age, living conditions, frailty, and sporting habits contribute to TEE and PAL in the elderly population. ACCTRI and sPAR underestimated TEE and PAL, and adequate corrections are required. The corrected ACCTRI and sPAR are both useful tools to estimate TEE and PAL.

Exercise and Nutrition Strategies to Counteract Sarcopenic Obesity

As the population is aging rapidly, there is a strong increase in the number of individuals with chronic disease and physical limitations. The decrease in skeletal muscle mass and function (sarcopenia) and the increase in fat mass (obesity) are important contributors to the development of physical limitations, which aggravates the chronic diseases prognosis. The combination of the two conditions, which is referred to as sarcopenic obesity, amplifies the risk for these negative health outcomes, which demonstrates the importance of preventing or counteracting sarcopenic obesity. One of the main challenges is the preservation of the skeletal muscle mass and function, while simultaneously reducing the fat mass in this population. Exercise and nutrition are two key components in the development, as well as the prevention and treatment of sarcopenic obesity. The main aim of this narrative review is to summarize the different, both separate and combined, exercise and nutrition strategies so as to prevent and/or counteract sarcopenic obesity. This review therefore provides a current update of the various exercise and nutritional strategies to improve the contrasting body composition changes and physical functioning in sarcopenic obese individuals.

Evaluation of Factors Associated with Hypermetabolism and Hypometabolism in Critically Ill AKI Patients

Acute kidney injury (AKI) is a frequent and serious condition with high mortality. The presence of hypermetabolism may be a factor related to poorer prognosis. This study evaluated the resting energy expenditure (REE) of intensive care unit (ICU) patients with severe AKI using indirect calorimetry (IC) and identified factors associated with metabolism categories. Patients were evaluated through measurement of REE and estimation of basal energy expenditure (BEE) using the Harris⁻Benedict equation. Metabolism categories were as follows: hypermetabolism (REE/BEE > 1.3) and hypometabolism (REE/BEE < 0.9). The metabolism categories were compared using ANOVA and the chi-square test. Variables were analyzed by multiple logistic regression tests. Also, survivors and non-survivors were compared using Student&rsquo;s t-tests along with Cox regression tests. Kaplan⁻Meier survival curves were also performed. We evaluated 124 patients with a mean age of 61.08 &plusmn; 16.6 years. Sixty-four patients were hypermetabolic (62%) and 18 were hypometabolic (14%). Vasoactive drug (VAD) dose and younger age were independently associated with hypermetabolism. The survival analysis was not associated with metabolism categorization. In conclusion, patients with severe AKI are mostly hypermetabolic and hypermetabolic patients of a lower age receiving treatment with higher VAD doses. The only factors associated with death were protein intake and VAD dose.

Total energy expenditure in adults aged 65 years and over measured using doubly-labelled water: international data availability and opportunities for data sharing

BACKGROUND

Increasing population lifespan necessitates a greater understanding of nutritional needs in older adults (65 year and over). A synthesis of total energy expenditure in the older population has not been undertaken and is needed to inform nutritional requirements. We aimed to establish the extent of the international evidence for total energy expenditure (TEE) using doubly-labelled water (DLW) in older adults (65 years and over), report challenges in obtaining primary data, and make recommendations for future data sharing.

METHODS

Four databases were searched to identify eligible studies; original research of any study design where participant level TEE was measured using DLW in participants aged ≥65 years. Once studies were identified for inclusion, authors were contacted where data were not publicly available.

RESULTS

Screening was undertaken of 1223 records; the review of 317 full text papers excluded 170 records. Corresponding or first authors of 147 eligible studies were contacted electronically. Participant level data were publicly available or provided by authors for 45 publications (890 participants aged ≥65 years, with 248 aged ≥80 years). Sixty-seven percent of the DLW data in this population were unavailable due to authors unable to be contacted or declining to participate, or data being irretrievable.

CONCLUSIONS

The lack of data access limits the value of the original research and its contribution to nutrition science. Openly accessible DLW data available through publications or a new international data repository would facilitate greater integration of current research with previous findings and ensure evidence is available to support the needs of the ageing population.

TRIAL REGISTRATION

The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42016047549 .

Nutrition in the Very Old

The population of older adults aged 85 years and over (the very old) is growing rapidly in many societies because of increases in life expectancy and reduced mortality at older ages. In 2016, 27.3 million very old adults were living in the European Union, and in the UK, 2.4% of the population (1.6 million) were aged 85 and over. Very old age is associated with increased risks of malnutrition, multimorbidity, and disability. Diet (nutrition) is a modifiable risk factor for multiple age-related conditions, including sarcopenia and functional decline. Dietary characteristics and nutrient intakes of the very old have been investigated in several European studies of ageing to better understand their nutritional requirements, which may differ from those in the young-old. However, there is a major gap in regard to evidence for the role of dietary patterns, protein, vitamin D and other nutrients for the maintenance of physical and cognitive functioning in later life. The Newcastle 85+ Study, UK and the Life and Living in Advanced Age, New Zealand are unique studies involving single birth cohorts which aim to assess health trajectories in very old adults and their biological, social and environmental influences, including nutrition. In this review, we have updated the latest findings in nutritional epidemiology with results from these studies, concentrating on the diet-physical functioning relationship.

Surveying predictors of late-life longitudinal change in daily activity energy expenditure

Background

Total daily energy expenditure (TEE) is composed of resting metabolic rate (RMR), post-prandial thermogenesis and activity energy expenditure (AEE). Higher AEE is strongly associated with lower mortality and physical limitations among older adults, but factors that predict changes in AEE in septu and octogenarians are not clearly understood.

Objective

To identify factors associated with late-life longitudinal change in AEE.

Design

Energy expenditure was re-assessed in 83 participants (average age at baseline, 74.4±3.2 years)—an average of 7.5±0.54 years since the baseline measure. RMR was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of TEE. AEE was calculated as: TEE(0.9)-RMR. Participants were categorized into two groups according to the estimated day-to-day precision of the doubly-labeled water technique. Those who were within 10% or increased relative to their initial AEE measurement were categorized as having preserved AEE. Participants who declined greater than 10% of their initial measurement were categorized as having reduced AEE. A variety of socio-demographic, functional and mental factors, body composition, community and personal behaviors, blood measurements and health conditions were evaluated between groups at baseline and changes during follow-up.

Results

Daily AEE declined 106.61±293.25 kcal, which equated to a 14.63±40.57 kcal/d decrease per year. Fifty-nine percent (n = 49) preserved their AEE and 41% (n = 34) declined. Those who demonstrated a decline in AEE were older, had lower walking speed at baseline and showed a higher lean mass loss during follow up. Otherwise, groups were similar for socio-demographic characteristics, body composition, mental and physical function, health conditions and community and personal behaviors at baseline and change in these factors during follow-up.

Conclusions

This study demonstrates that AEE declines through the 8^th decade of life and is associated with age, lower walking speed at baseline and lean mass loss. Additionally, there are a significant number of individuals who appear to be resilient to these declines despite having health events that are expected to have a negative impact on their physical activity.

Measurement Methods for Physical Activity and Energy Expenditure: a Review

Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure. The benefits of physical activity for health maintenance have been well documented, especially in the prevention and management of chronic diseases. Therefore, accurate measurement of physical activity and energy expenditure is essential both for epidemiological studies and in the clinical context. Given the large number of available methods, it is important to have an understanding of each, especially when one needs to choose a technique to use. The purpose of this review was to discuss the components of total energy expenditure and present advantage and limitations of different methods of physical activity and energy expenditure assessment.

Gender- and Age-Specific REE and REE/FFM Distributions in Healthy Chinese Adults

Basic data on the resting energy expenditure (REE) of healthy populations are currently rare, especially for developing countries. The aims of the present study were to describe gender- and age-specific REE distributions and to evaluate the relationships among glycolipid metabolism, eating behaviors, and REE in healthy Chinese adults. This cross-sectional survey included 540 subjects (343 women and 197 men, 20–79 years old). REE was measured by indirect calorimetry and expressed as kcal/day/kg total body weight. The data were presented as the means and percentiles for REE and the REE to fat-free mass (FFM) ratio; differences were described by gender and age. Partial correlation analysis was used to analyze the correlations between REE, tertiles of REE/FFM, and glycolipid metabolism and eating behaviors. In this study, we confirmed a decline in REE with age in women (p = 0.000) and men (p = 0.000), and we found that men have a higher REE (p = 0.000) and lower REE/FFM (p = 0.021) than women. Furthermore, we observed no associations among glycolipid metabolism, eating behaviors, and REE in healthy Chinese adults. In conclusion, the results presented here may be useful to clinicians and nutritionists for comparing healthy and ill subjects and identifying changes in REE that are related to aging, malnutrition, and chronic diseases.

Estimation of basal metabolic rate in Chinese: are the current prediction equations applicable?

BACKGROUND

Measurement of basal metabolic rate (BMR) is suggested as a tool to estimate energy requirements. Therefore, BMR prediction equations have been developed in multiple populations because indirect calorimetry is not always feasible. However, there is a paucity of data on BMR measured in overweight and obese adults living in Asia and equations developed for this group of interest. The aim of this study was to develop a new BMR prediction equation for Chinese adults applicable for a large BMI range and compare it with commonly used prediction equations.

METHODS

Subjects were 121 men and 111 women (age: 21-67 years, BMI: 16-41 kg/m(2)). Height, weight, and BMR were measured. Continuous open-circuit indirect calorimetry using a ventilated hood system for 30 min was used to measure BMR. A regression equation was derived using stepwise regression and accuracy was compared to 6 existing equations (Harris-Benedict, Henry, Liu, Yang, Owen and Mifflin). Additionally, the newly derived equation was cross-validated in a separate group of 70 Chinese subjects (26 men and 44 women, age: 21-69 years, BMI: 17-39 kg/m(2)).

RESULTS

The equation developed from our data was: BMR (kJ/d) = 52.6 x weight (kg) + 828 x gender + 1960 (women = 0, men = 1; R(2) = 0.81). The accuracy rate (within 10 % accurate) was 78 % which compared well to Owen (70 %), Henry (67 %), Mifflin (67 %), Liu (58 %), Harris-Benedict (45 %) and Yang (37 %) for the whole range of BMI. For a BMI greater than 23, the Singapore equation reached an accuracy rate of 76 %. Cross-validation proved an accuracy rate of 80 %.

CONCLUSIONS

To date, the newly developed Singapore equation is the most accurate BMR prediction equation in Chinese and is applicable for use in a large BMI range including those overweight and obese.

Macronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ)

As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand. The median BMI was higher for Māori (28·3 kg/m2) than for non-Māori (26·2 kg/m2) P=0·007. For Māori, median energy intake was 7·44 MJ/d for men and 6·06 MJ/d for women with 16·3 % energy derived from protein, 43·3 % from carbohydrate and 38·5 % from fat. Median energy intake was 7·91 and 6·26 MJ/d for non-Māori men and women, respectively, with 15·4 % of energy derived from protein, 45 % from carbohydrate and 36·7 % from fat. For both ethnic groups, bread was the top contributor to energy and carbohydrate intakes. Protein came from beef and veal, fish and seafood, bread, milk and poultry with the order differing by ethnic groups and sex. Fat came mainly from butter and margarine. Energy-adjusted protein was higher for Māori than non-Māori (P=0·049). For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.

Gender-Specific Associations in Age-Related Changes in Resting Energy Expenditure (REE) and MRI Measured Body Composition in Healthy Caucasians

BACKGROUND

The effect of gender as well as gender-specific changes of fat free mass (FFM) and its metabolic active components (muscle mass and organ masses [OMs]) and fat mass (FM) on age-related changes in resting energy expenditure (REE) are not well defined. We hypothesized that there are gender differences in (1) the age-specific onset of changes in detailed body composition (2); the onset of changes in body composition-REE associations with age.

METHODS

Using a cross-sectional magnetic resonance imaging database of 448 Caucasian participants (females and males) with comprehensive data on skeletal muscle (SM) mass, adipose tissue (AT), OMs, and REE.

RESULTS

We observed gender-specific differences in the onset of age-related changes in metabolic active components and REE. Declines in body composition and REE started earlier in females than in males for SM (29.4 vs 39.6 years), AT (38.2 vs 49.9 years), OM (34.7 vs 45.7 years), and REE (31.9 vs 36.8 years). The age-related decrease of AT was significantly higher in females than in males (-5.69kg/decade vs -0.59kg/decade). In females adjusted REEmFFM&FM (resting energy expenditure measured adjusted for FFM and FM) and REEmSM/OM/AT (resting energy expenditure measured adjusted for skeletal muscle and organ mass and adipose tissue) decreased by -145 kJ/d/decade and -604.8 kJ/d/ decade after the age of 35.2 respectively 34.3 years. SM was main determinant of REEm in females (R (2) = .67) and males (R (2) = .66) with remaining variance mainly explained by kidney mass (R (2) = .07) in females and liver mass (R (2) = .09) in males.

CONCLUSION

We concluded that gender affects the age-related changes in body composition as well as changes in body composition-REE relationship. This trial was registered at linicaltrials.gov as NCT01737034.

Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review

One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.

Macronutrient Intake and Inadequacies of Community-Dwelling Older Adults, a Systematic Review

BACKGROUND

Anorexia of ageing may predispose older adults to under-nutrition and protein energy malnutrition. Studies, however, report a large variation in nutrient inadequacies among community-dwelling older adults.

SUMMARY

This systematic review provides a comprehensive overview of the energy and macronutrient intakes and possible inadequacies in community-dwelling older adults. PubMed and EMBASE were screened up to December 2013; data from national nutrition surveys were added. Forty-six studies were included, following the PRISMA guideline.

KEY MESSAGES

Mean daily energy intake was 8.9 MJ in men and 7.3 MJ in women. Mean daily carbohydrate and protein intakes were 46 and 15 En% in men and 47 and 16 En% in women, respectively. Mean daily total fat, saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid intakes were respectively 34, 13, 13 and 5-6 En%. The carbohydrates and MUFA intakes are below the acceptable macronutrient distribution ranges (AMDR). Fat intake is relatively high, and SFA intake exceeds the upper-AMDR. Based on the estimated average requirement (EAR) cut-point method, 10-12% of older adults do not meet the EAR for protein. To interpret a possible energy imbalance additional information is needed on physical activity, energy expenditure and body weight changes. This systematic review indicates a suboptimal dietary macronutrient distribution and a large variation in nutrient intakes among community-dwelling older adults.

Age-related changes in resting energy expenditure in normal weight, overweight and obese men and women

OBJECTIVES

Aging is associated with changes in resting energy expenditure (REE) and body composition. We investigated the association between age and changes in REE in men and women stratified by body mass index (BMI) categories (normal weight, overweight and obesity). We also examined whether the age-related decline in REE was explained by concomitant changes in body composition and lifestyle factors.

STUDY DESIGN

Cross-sectional.

MAIN OUTCOME MEASURES

3442 adult participants (age range: 18-81 y; men/women: 977/2465) were included. The BMI range was 18.5-60.2 kg/m(2). REE was measured by indirect calorimetry in fasting conditions and body composition by bioelectrical impedance. Regression models were used to evaluate age-related changes in REE in subjects stratified by sex and BMI. Models were adjusted for body composition (fat mass, fat free mass), smoking, disease count and physical activity.

RESULTS

In unadjusted models, the rate of decline in REE was highest in obese men (slope=-8.7±0.8 kcal/day/year) whereas the lowest rate of decline was observed in normal weight women (-2.9±0.3 kcal/day/year). Gender differences were observed for the age of onset of REE adaptive changes (i.e., not accounted by age related changes in body composition and lifestyle factors). In women, adaptive changes appeared to occur in middle-age (∼47 y) across all BMI groups whereas changes seemed to be delayed in obese men (∼54 y) compared to overweight (∼43 y) and normal weight (∼39 y) men.

CONCLUSIONS

Sex and BMI influenced the rate and degree of the age-related decline in REE. Critical age windows have been identified for the onset of putative mechanisms of energy adaptation. These findings require confirmation in prospective studies.