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López-Plaza B, Gil Á, Menéndez-Rey A, Bensadon-Naeder L, Hummel T, Feliú-Batlle J, Palma-Milla S. Effect of Regular Consumption of a Miraculin-Based Food Supplement on Taste Perception and Nutritional Status in Malnourished Cancer Patients: A Triple-Blind, Randomized, Placebo-Controlled Clinical Trial-CLINMIR Pilot Protocol. Nutrients 2023; 15:4639. [PMID: 37960292 PMCID: PMC10648678 DOI: 10.3390/nu15214639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Taste disorders are common among cancer patients undergoing chemotherapy, with a prevalence ranging from 20% to 86%, persisting throughout treatment. This condition leads to reduced food consumption, increasing the risk of malnutrition. Malnutrition is associated not only with worse treatment efficacy and poor disease prognosis but also with reduced functional status and quality of life. The fruit of Synsepalum dulcificum (Daniell), commonly known as miracle berry or miracle fruit, contains miraculin, a taste-modifying protein with profound effects on taste perception. The CLINMIR Protocol is a triple-blind, randomized, placebo-controlled clinical trial designed to evaluate the regular consumption of a food supplement containing a miraculin-based novel food, dried miracle berry (DMB), on the taste perception (measured through electrogustometry) and nutritional status (evaluated through the GLIM Criteria) of malnourished cancer patients under active antineoplastic treatment. To this end, a pilot study was designed with 30 randomized patients divided into three study arms (150 mg DMB + 150 mg freeze-dried strawberries, 300 mg DMB, or placebo) for three months. Throughout the five main visits, an exhaustive assessment of different parameters susceptible to improvement through regular consumption of the miraculin-based food supplement will be conducted, including electrical and chemical taste perception, smell perception, nutritional and morphofunctional assessment, diet, quality of life, the fatty acid profile of erythrocytes, levels of inflammatory and cancer-associated cytokines, oxidative stress, antioxidant defense system, plasma metabolomics, and saliva and stool microbiota. The primary anticipated result is that malnourished cancer patients with taste distortion who consume the miraculin-based food supplement will report an improvement in food taste perception. This improvement translates into increased food intake, thereby ameliorating their nutritional status and mitigating associated risks. Additionally, the study aims to pinpoint the optimal dosage that provides maximal benefits. The protocol adheres to the SPIRIT 2013 Statement, which provides evidence-based recommendations and is widely endorsed as an international standard for trial protocols. The clinical trial protocol has been registered at the platform for Clinical Trials (NCT05486260).
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Affiliation(s)
- Bricia López-Plaza
- Nutrition Research Group, La Paz University Hospital Institute for Health Research (IdiPAZ), 28046 Madrid, Spain;
- Medicine Department, Faculty of Medicine, Complutense University of Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria IBS.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Jaime Feliú-Batlle
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain;
- CIBERONC (CIBER Cancer), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Samara Palma-Milla
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Nutrition Department, Hospital University La Paz, 28046 Madrid, Spain
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Influence of fat-free mass index on the survival of patients with head and neck cancer. Eur Arch Otorhinolaryngol 2023; 280:1909-1917. [PMID: 36437380 PMCID: PMC9988755 DOI: 10.1007/s00405-022-07732-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/26/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether muscle mass, defined by fat-free mass index (FFMI) measured with bioelectrical impedance analysis (BIA), is predictive of survival of head and neck squamous cell carcinoma (HNSCC) patients. METHODS HNSCC patients treated between 2014 and 2018 at the Department for Nutrition of the Institute of Oncology Ljubljana were reviewed. The FFMI values from the pretreatment BIA measurements and pretreatment body mass index (BMI) were used to categorize patients into groups with low and normal muscle mass and BMI using the Global Leadership Initiative on malnutrition (GLIM) recommended cutoff values. The impact of FFMI on disease-free survival (DFS) and overall survival (OS) was determined. RESULTS Of the 71 included patients, 31 (43.7%) had normal FFMI, and 40 (56.3%) had low FFMI, whereas 44 (62%) and 27 (38%) of the patients had normal and low BMI, respectively. Between FFMI and BMI values, a significant correlation was found (RP = 0.75, p < 0.001). Univariate regression analysis showed that FFMI (as a continuous variable) was of prognostic significance for OS (p = 0.039), which was confirmed by multivariate regression analysis (p = 0.029). The model where BMI replaced FFMI negated the prognostic value of BMI (as a continuous variable). Neither FFMI nor BMI was found to be a predictor of DFS on univariate or multivariate analysis. CONCLUSIONS In the present group of HNSCC patients, low FFMI adversely influenced OS, emphasizing the importance of using body composition measurement over BMI alone for pretreatment nutritional evaluation of these patients.
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [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: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Hernandez-Martinez J, Castillo-Cerda M, Vera-Assaoka T, Carter-Truillier B, Herrera-Valenzuela T, Guzmán-Muñoz E, Branco BHM, Jofré-Saldía E, Valdés-Badilla P. Warm-Up and Handgrip Strength in Physically Inactive Chilean Older Females According to Baseline Nutritional Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13335. [PMID: 36293916 PMCID: PMC9602643 DOI: 10.3390/ijerph192013335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
This study aims to analyze the effect of different types of warm-ups on handgrip strength (HGS) in physically inactive older females. Secondarily, it aims to compare HGS according to their baseline nutritional status. A randomized crossover trial study was conducted with 44 physically inactive older females distributed into normal weight (n = 12, BMI = 23.9 ± 3.2 kg/m2), overweight (n =16, BMI = 27 ± 4.7 kg/m2) and obese (n = 16, BMI = 31.6 ± 5.3 kg/m2), who participated in three warm-up conditions (static stretching condition, SSC; elastic band condition, EBC; and therapeutic compression ball condition, TCBC) and one control condition (CC, no warm-up). All participants performed the four randomized conditions with recovery within 72 h. A significant decrease (p < 0.05) in HGS for the dominant and non-dominant hands was observed when comparing SSC vs. CC. In contrast, comparing the warm-up conditions according to the baseline nutritional status, statistically significant differences (p < 0.05) were only reported in the obese group in the dominant and non-dominant hand in favor of CC concerning SSC. In conclusion, warm-up with static flexibility led to a decrease in HGS in physically inactive older females. Only the obese group exhibited this result when analyzed by nutritional status.
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Affiliation(s)
- Jordan Hernandez-Martinez
- Programa de Investigación en Deporte, Sociedad y Buen Vivir, Universidad de los Lagos, Osorno 5290000, Chile
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno 5290000, Chile
| | - María Castillo-Cerda
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno 5290000, Chile
| | - Tiago Vera-Assaoka
- Programa de Investigación en Deporte, Sociedad y Buen Vivir, Universidad de los Lagos, Osorno 5290000, Chile
| | - Bastian Carter-Truillier
- Programa de Investigación en Deporte, Sociedad y Buen Vivir, Universidad de los Lagos, Osorno 5290000, Chile
- Department of Education, Universidad de Los Lagos, Osorno 5290000, Chile
- Faculty of Education, Universidad Católica de Temuco, Temuco 4810302, Chile
| | - Tomás Herrera-Valenzuela
- Department of Physical Activity, Sports and Health Sciences, Faculty of Medical Sciences, Universidad de Santiago de Chile (USACH), Santiago 8370003, Chile
| | - Eduardo Guzmán-Muñoz
- School of Kinesiology, Faculty of Health, Universidad Santo Tomás, Talca 3530000, Chile
| | | | - Emilio Jofré-Saldía
- Facultad de Educación y Ciencias Sociales, Instituto del Deporte y Bienestar, Universidad Andres Bello, Las Condes, Santiago 7550000, Chile
- Instituto de Ciencias de la Salud, Universidad de O’Higgins, Rancagua 2820000, Chile
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca 3530000, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar 2520000, Chile
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Rossi AP, Muollo V, Dalla Valle Z, Urbani S, Pellegrini M, El Ghoch M, Mazzali G. The Role of Obesity, Body Composition, and Nutrition in COVID-19 Pandemia: A Narrative Review. Nutrients 2022; 14:3493. [PMID: 36079751 PMCID: PMC9458228 DOI: 10.3390/nu14173493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, infecting nearly 500 million people, with more than 6 million deaths recorded globally. Obesity leads people to be more vulnerable, developing worse outcomes that can require hospitalization in intensive care units (ICU). This review focused on the available findings that investigated the link between COVID-19, body composition, and nutritional status. Most studies showed that not only body fat quantity but also its distribution seems to play a crucial role in COVID-19 severity. Compared to the body mass index (BMI), visceral adipose tissue and intrathoracic fat are better predictors of COVID-19 severity and indicate the need for hospitalization in ICU and invasive mechanical ventilation. High volumes of epicardial adipose tissue and its thickness can cause an infection located in the myocardial tissue, thereby enhancing severe COVID-related myocardial damage with impairments in coronary flow reserve and thromboembolism. Other important components such as sarcopenia and intermuscular fat augment the vulnerability in contracting COVID-19 and increase mortality, inflammation, and muscle damage. Malnutrition is prevalent in this population, but a lack of knowledge remains regarding the beneficial effects aimed at optimizing nutritional status to limit catabolism and preserve muscle mass. Finally, with the increase in patients recovering from COVID-19, evaluation and treatment in those with Long COVID syndrome may become highly relevant.
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Affiliation(s)
- Andrea P. Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, 31100 Treviso, Italy
| | - Valentina Muollo
- Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Zeno Dalla Valle
- Department of Medicine, Geriatrics Division, University of Verona, 37126 Verona, Italy
| | - Silvia Urbani
- Department of Medicine, Geriatrics Division, University of Verona, 37126 Verona, Italy
| | - Massimo Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Marwan El Ghoch
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, 37126 Verona, Italy
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Prognostic Value of Isolated Sarcopenia or Malnutrition-Sarcopenia Syndrome for Clinical Outcomes in Hospitalized Patients. Nutrients 2022; 14:nu14112207. [PMID: 35684006 PMCID: PMC9182528 DOI: 10.3390/nu14112207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
Malnutrition-sarcopenia syndrome (MSS) is frequent in the hospital setting. However, data on the predictive validity of sarcopenia and MSS are scarce. We evaluated the association between sarcopenia and MSS and clinical adverse outcomes (prolonged length of hospital stay-LOS, six-month readmission, and death) using a prospective cohort study involving adult hospitalized patients (n = 550, 55.3 ± 14.9 years, 53.1% males). Sarcopenia was diagnosed according to the EWGSOP2, and malnutrition according to the Subjective Global Assessment (SGA). Around 34% were malnourished, 7% probable sarcopenic, 15% sarcopenic, and 2.5% severe sarcopenic. In-hospital death occurred in 12 patients, and the median LOS was 10.0 days. Within six months from discharge, 7.9% of patients died, and 33.8% were readmitted to the hospital. Probable sarcopenia/sarcopenia had increased 3.95 times (95% CI 1.11-13.91) the risk of in-hospital death and in 3.25 times (95% CI 1.56-6.62) the chance of mortality in six months. MSS had increased the odds of prolonged LOS (OR = 2.73; 95% CI 1.42-5.25), readmission (OR = 7.64; 95% CI 3.06-19.06), and death (OR = 1.15; 95% CI 1.08-1.21) within six months after discharge. Sarcopenia and MSS were predictors of worse clinical outcomes in hospitalized patients.
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7
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Han P, Yu H, Zhang Y, Xie F, Shao B, Liu X, Yuan B, Liu Z, Liu X, Guo Q. Preoperative Short Physical Performance Battery as a predictor of prolonged hospitalization after coronary artery bypass grafting in older patients. J Int Med Res 2021; 49:3000605211044043. [PMID: 34528470 PMCID: PMC8451264 DOI: 10.1177/03000605211044043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The study aimed to evaluate the predictive value of the Short Physical Performance Battery (SPPB) and its three components for identifying the requirement for a prolonged hospitalization for coronary artery bypass grafting (CABG) in older patients. Methods This prospective, observational study included 425 older patients who consecutively underwent selective CABG surgery. All patients were assessed for the SPPB. We analysed the association of the postoperative length of hospital stay with the SPPB and three components. Receiver operating characteristic curve analysis was performed to determine the validity of the SPPB for predicting older patients with a prolonged hospitalization (>8 days). Results The SPPB and its three individual components were independent risk factors for a prolonged postoperative length of hospital stay. Only the SPPB summary score and the 4-m gait speed components showed good discriminative capabilities. An SPPB score cut-off of 9.5 provided the best accuracy for identifying a prolonged hospitalization. A poor physical performance (SPPB <10 score) was related to an increased risk of adverse cardiac and cerebrovascular events within 6 months after discharge. Conclusions This study provides evidence for clinical utility of the SPPB score for identifying older patients undergoing CABG who are at risk of prolonged hospitalization.
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Affiliation(s)
- Peipei Han
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,TEDA International Cardiovascular Hospital, Tianjin, China
| | - Hairui Yu
- Wuhan University Zhongnan Hospital, Wuhan, Hubei, China
| | - Yuanyuan Zhang
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Fandi Xie
- Shanghai Jiangwan Hospital, Shanghai, China
| | - Bohan Shao
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Xiangjing Liu
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Bo Yuan
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Zhigang Liu
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Xiaocheng Liu
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Qi Guo
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,TEDA International Cardiovascular Hospital, Tianjin, China
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Rodrigues FW, Burgel CF, Brito JE, Baumgardt E, de Araújo BE, Silva FM. SARC-CalF tool has no significant prognostic value in hospitalized patients: A prospective cohort study. Nutr Clin Pract 2021; 36:1072-1079. [PMID: 34245469 DOI: 10.1002/ncp.10675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Screening of sarcopenia is proposed to identify patients who require the diagnosis of this condition. One of the proposed screening tools is Strength, Assistance with walking, Rise from a chair, Climb stairs, Fall and Calf Circumference (SARC-CalF). However, evidence for its applicability, especially in a hospital setting, is scarce. Therefore, this study aimed to evaluate the association between "suggestive signs of sarcopenia using SARC-CalF" and clinical outcomes. METHODS Prospective cohort study with hospitalized patients aged ≥60 years was conducted, and they were evaluated within 48 h of admission using the SARC-CalF tool. Calf circumference and handgrip strength were measured, and the "timed get up and go" test was performed in all patients. The outcomes for testing the predictive validity of SARC-CalF were prolonged length of hospital stay, in-hospital death, hospital readmission, and mortality in 6 months. RESULTS Of the 554 patients (55.22 ± 14.91 years old, 52.9% males) evaluated, 17.3% were classified as having "suggestive signs of sarcopenia using SARC-CalF." In univariate analysis, "suggestive signs of sarcopenia using SARC-CalF" was associated with in-hospital death (P = .002) and mortality in 6 months (P = .004). However, in the multivariate analysis, these associations were not significant. CONCLUSION SARC-CalF was not an independent predictor of clinical outcomes during the hospitalization neither in the following 6 months of discharge.
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Affiliation(s)
| | - Camila Ferri Burgel
- Division of Nutrition, Santa Casa de Misericórdia de Porto Alegre Hospital, Porto Alegre, Brazil
| | - Júlia Epping Brito
- Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Baumgardt
- Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
| | | | - Flávia Moraes Silva
- Department of Nutrition, Graduate Program in Nutrition Sciences, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
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Deutz NE, Ziegler TR, Matheson EM, Matarese LE, Tappenden KA, Baggs GE, Nelson JL, Luo M, Hegazi R, Jonnalagadda SS. Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: Sub-group analysis of the NOURISH study. Clin Nutr 2021; 40:1388-1395. [DOI: 10.1016/j.clnu.2020.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 01/22/2023]
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10
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Prevalence, associated factors, and prognostic value of sarcopenia in patients with acute exacerbated chronic obstructive pulmonary disease: A cohort study. Clin Nutr ESPEN 2021; 42:188-194. [PMID: 33745576 DOI: 10.1016/j.clnesp.2021.01.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Besides pulmonary dysfunctions, patients with chronic obstructive pulmonary disease (COPD) also frequently have systemic comorbidities. Among these, sarcopenia is associated with worse pulmonary function and clinical outcomes. Patients with acute exacerbated COPD (AECOPD) have increased systemic inflammation, which can intensify muscle dysfunction. Therefore, the present study aimed to evaluate the prevalence of sarcopenia in AECOPD patients and assess the associated factors and their prognostic value. As a secondary aim, we also assessed the performance of calf circumference (CC) to diagnose this condition. METHODS Prospective cohort study in a Brazilian public hospital with AECOPD patients. Sarcopenia was assessed according to the recommendations from the European Working Group of Sarcopenia in Older People Consensus 2 (EWGSOP2); namely, reduced handgrip strength (HGS) combined with low fat-free mass index (FFMI) or CC. Data on clinical, nutritional, and sociodemographic features were collected. The evaluated clinical outcomes were the length of hospital stay (LOS), admission in intensive care units (ICUs), and in-hospital death. RESULTS Among 208 patients (54.8% females, 67.6 ± 10.1 years) evaluated, 16.3% presented sarcopenia. Malnutrition (odds ratio [OR] = 16.50, 95% confidence interval [CI] 3.58-76.08), and disease stages III-IV (OR = 4.05 95%CI 1.20-13.76) were associated with the presence of sarcopenia. The CC showed satisfactory performance in diagnosing sarcopenia as compared to FFMI as a marker of reduced muscle mass (kappa = 0.703; area under the receiver operating characteristic [AUC ROC] curve = 0.886; 95%CI 0.811-0.961). Sarcopenia was not associated with clinical outcomes. CONCLUSION Almost 20% of patients in this study presented sarcopenia. Malnutrition and advanced Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage were associated with increased chances of this condition in AECOPD patients. Reduced HSG combined with low CC may be an alternative when FFMI not be obtained for sarcopenia diagnosis.
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11
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Brook MS, Wilkinson DJ. Contemporary stable isotope tracer approaches: Insights into skeletal muscle metabolism in health and disease. Exp Physiol 2020; 105:1081-1089. [PMID: 32362047 DOI: 10.1113/ep087492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review discusses the application of new stable isotope tracer techniques in understanding the control of skeletal muscle mass. What advances does it highlight? This review highlights current advances in stable isotope tracer techniques through their combination with high-throughput proteomics technologies. ABSTRACT Beyond its primary locomotory and key structural functions, skeletal muscle provides additional vital roles for maintenance of metabolic health, acting as a storage point for glucose and intramuscular lipids for energy production, alongside being the largest reservoir for amino acids in the body. Therefore, maintenance of muscle mass is key to the promotion of health and well-being across the lifespan and in several disease states. As such, when skeletal muscle is lost, in either clinical (cancer, organ failure etc.) or non-clinical (ageing, inactivity) situations, there are potentially devastating consequences attached, with robust links existing between muscle mass loss and mortality. Great efforts are being made to reverse or slow muscle mass declines in health and disease, through combinations of lifestyle changes and nutritional and/or pharmaceutical intervention. However, despite this comprehensive research effort, the underlying metabolic and molecular mechanisms have yet to be defined properly. However, with the rapid acceleration of analytical developments over recent years, the application of stable isotope tracers to the study of human muscle metabolism is providing unique insights into the mechanisms controlling skeletal muscle loss and allowing more targeted therapeutic strategies to be developed. The aim of this review is to highlight the technical breakthroughs in our understanding of muscle wasting in health and disease and how future directions and developments incorporating 'omics' with stable isotope tracers will allow for a more personalized and stratified therapeutic approach.
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Affiliation(s)
- Matthew S Brook
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,School of Life Science, Queen's Medical Centre, Nottingham, UK
| | - Daniel J Wilkinson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Division of Health Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital Centre, Derby, UK
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Deutz NEP, Ashurst I, Ballesteros MD, Bear DE, Cruz-Jentoft AJ, Genton L, Landi F, Laviano A, Norman K, Prado CM. The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition. J Am Med Dir Assoc 2020; 20:22-27. [PMID: 30580819 DOI: 10.1016/j.jamda.2018.11.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 01/06/2023]
Abstract
Preserving muscle is not only crucial for maintaining proper physical movement, but also for its many metabolic and homeostatic roles. Low muscle mass has been shown to adversely affect health outcomes in a variety of disease states (eg, chronic obstructive pulmonary disease, cancer, cardiovascular disease) and leads to an increased risk for readmission and mortality in hospitalized patients. Low muscle mass is now included in the most recent diagnostic criteria for malnutrition. Current management strategies for malnutrition may not prioritize the maintenance and restoration of muscle mass. This likely reflects the challenge of identifying and measuring this body composition compartment in clinical practice and the lack of awareness by health care professionals of the importance that muscle plays in patient health outcomes. As such, we provide a review of current approaches and make recommendations for managing low muscle mass and preventing muscle loss in clinical practice. Recommendations to assist the clinician in the optimal management of patients at risk of low muscle mass include the following: (1) place muscle mass at the core of nutritional assessment and management strategies; (2) identify and assess low muscle mass; (3) develop a management pathway for patients at risk of low muscle mass; (4) optimize nutrition to focus on muscle mass gain versus weight gain alone; and (5) promote exercise and/or rehabilitation therapy to help maintain and build muscle mass. The need to raise awareness of the importance of screening and managing 'at risk' patients so it becomes routine is imperative for change to occur. Health systems need to drive clinicians to treat patients with this focused approach, and the economic benefits need to be communicated to payers. Lastly, further focused research in the area of managing patients with low muscle mass is warranted.
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Affiliation(s)
- Nicolaas E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX.
| | - Ione Ashurst
- Department of Nutrition & Dietetics, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Maria D Ballesteros
- Servicio de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, Altos de Nava, León, Spain
| | - Danielle E Bear
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Laurence Genton
- Clinical Nutrition, Hôpitaux Universitaires de Genève Unité de nutrition Geneva, Switzerland
| | - Francesco Landi
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Kristina Norman
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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McNicholl T, Curtis L, Dubin JA, Mourtzakis M, Nasser R, Laporte M, Keller H. Handgrip strength predicts length of stay and quality of life in and out of hospital. Clin Nutr 2019; 39:2501-2509. [PMID: 31757485 DOI: 10.1016/j.clnu.2019.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/30/2019] [Accepted: 11/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Handgrip strength (HGS) is a practical measure of strength and physical function that can be used to identify frailty among hospitalized patients, but its utility in this setting is unclear. To be considered useful, any functional measure needs to provide pertinent information on the patient and predict relevant outcomes such as health-care utilization (e.g., length of stay (LOS)) and patient-reported quality of life (QOL). The purpose of this study was to determine if HGS predicted LOS and QOL. A second aim was to examine the best sensitivity (SE) and specificity (SP) for predicting length of stay (>7 or >13 days) using previously published cut-points for HGS. METHODOLOGY HGS was measured on 1136 medical patients shortly after admission with a Lafayette dynamometer. QOL was assessed with the self-reported SF-12 completed with an interviewer during hospitalization and 30- days after discharge via telephone. Physical (PCS) and mental (MCS) component scores of SF-12 were calculated. A variety of covariates were assessed (e.g., nutritional status). Multivariate analyses stratified by sex were completed. RESULTS The mean LOS was 12.71 days (median = 8.00; SD = 13.20), 12.88 days (SD = 13.82) for males, and 12.58 days (SD = 12.68) for females. Lower admission HGS scores were associated with longer LOS (male X2 = 7.85, p < 0.05; female X2 = 14.9, p < 0.0001). The average quality of life scores were as follows: in hospital PCS: 34.66, MCS: 46.49; post discharge PCS: 36.17; MCS: 51.22. HGS predicted PCS during hospitalization (male X2 = 36.22, p < 0.0001; female X2 = 19.87, p < 0.0001) and post hospitalization (male X2 = 6.98, p < 0.01; female X2 = 10.99, p < 0.01). Various reference cut-points for HGS were tested against LOS, with none being considered appropriate (e.g., SE and SP both < 70) when adjusting for age and sex. CONCLUSION Admission HGS adds predictive value for both LOS and physical components of QOL and is worth pursuing in practice to identify potential frailty and the need for proactive steps to mitigate further functional decline during hospitalization. However, HGS cut-points for LOS specific to acute care patients need to be defined and tested.
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Affiliation(s)
- Tara McNicholl
- University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada.
| | - Lori Curtis
- University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada.
| | - Joel A Dubin
- University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada.
| | - Marina Mourtzakis
- University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada.
| | - Roseann Nasser
- Pasqua Hospital, 101 Dewdney Avenue, Regina, SK, S4T 1A5, Canada.
| | - Manon Laporte
- Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, 189 Lily Lake Road, Campbellton, NB, E3N 3H3, Canada.
| | - Heather Keller
- University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada; Schlegel-Univeristy of Waterloo Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada.
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14
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Shuler K, Sucic JF, Talley SA, Goldberg A. Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism, Lower Extremity Strength, and Physical Performance in Older Adults. Phys Ther 2019; 99:998-1009. [PMID: 31087072 DOI: 10.1093/ptj/pzz073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/24/2018] [Accepted: 02/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence for associations between the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene and physical performance is conflicting. Furthermore, investigations of relationships between lower extremity strength and physical performance have usually not considered the role of the ACE genotype, and it is unclear whether there are variations in relationships between lower extremity strength and physical performance among ACE genotypes in older adults. OBJECTIVE The objectives of this study were to investigate associations between the ACE I/D polymorphism and physical performance and to determine whether relationships between lower extremity strength and physical performance vary among ACE genotypes in older adults. DESIGN This was a cross-sectional observational study. METHODS Community-dwelling adults (N = 88) who were at least 60 years old completed physical performance and lower extremity strength tests. After DNA was extracted from saliva, ACE I/D polymorphism genotyping was done. The Spearman rank order correlation coefficient was used to examine associations between lower extremity strength and physical performance within ACE genotype subgroups. Analysis of covariance and linear regression were used to examine ACE genotype and ACE genotype × lower extremity strength interaction effects in relation to physical performance. RESULTS Genotype-specific correlation coefficients exhibited substantial variation among ACE genotype subgroups; however, differences did not attain statistical significance. Statistically significant genotype × lower extremity strength interaction effects in relation to physical performance were detected. LIMITATIONS The cross-sectional design precludes inferring causal relationships between strength and performance. The small sample size contributed to limited power to detect additional interaction effects and to detect statistically significant differences between correlation coefficients among ACE genotype subgroups. CONCLUSIONS The ACE I/D polymorphism is, interactively with lower extremity strength, associated with physical performance. Genotype-specific correlation coefficients and ACE genotype × lower extremity strength interaction effects on physical performance are consistent with variations in relationships between lower extremity strength and performance among ACE genotype subgroups.
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Affiliation(s)
- Kurt Shuler
- Department of Biology, College of Arts and Sciences, University of Michigan-Flint, Flint, Michigan
| | - Joseph F Sucic
- Department of Biology, College of Arts and Sciences, University of Michigan-Flint
| | - Susan Ann Talley
- Physical Therapy Department, College of Health Sciences, University of Michigan-Flint
| | - Allon Goldberg
- Physical Therapy Department, College of Health Sciences, University of Michigan-Flint, 303 East Kearsley Rd, Flint, MI 48502 (USA)
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15
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Ibrahim K, Howson FFA, Culliford DJ, Sayer AA, Roberts HC. The feasibility of assessing frailty and sarcopenia in hospitalised older people: a comparison of commonly used tools. BMC Geriatr 2019; 19:42. [PMID: 30770722 PMCID: PMC6377779 DOI: 10.1186/s12877-019-1053-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background Frailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes. Widely recognised tools for their identification are the Fried Frailty Phenotype, its self-report version the FRAIL Scale, and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. We studied the feasibility of using these tools in a hospital setting of acute wards for older people. Methods Patients aged 70+ years admitted to acute wards at one English hospital were prospectively recruited. The Fried Frailty Phenotype was assessed through measured grip strength, gait speed and questions on unintentional weight loss, exhaustion and physical activity. The 5-item self-reported FRAIL scale questionnaire covering the same domains was completed. Agreement between the two tools was reported using the Cohen kappa statistic. The EWGSOP criteria (gait speed, grip strength and muscle mass) were assessed by additional bedside measurement of muscle mass with bioelectrical impedance. Results Two hundred thirty three participants (median age 80 years, 60% men) were recruited. Most (221, 95%) had their grip strength measured: 4 (2%) were unable and data were missing for 8 (3%). Only 70 (30%) completed the gait speed assessment: 153 (66%) were unable with missing data on 10 (4%). 113 (49%) participants had the bioelectrical impedance assessment. Muscle mass measurement was not possible for 84 (36%) participants: 25 patients declined, 21 patients were unavailable, 22 results were technically invalid, and 16 had clinical contra-indications. Data on 36 (15%) were missing. Considering inability to complete grip strength or gait speed assessments as low values, data for the Fried Frailty Phenotype was available for 218 (94%) of participants; frailty was identified in 105 (48%). 230 (99%) patients completed the FRAIL scale; frailty was identified among 77 (34%). There was moderate agreement between the two frailty tools (Kappa value of 0.46, 95%CI: 0.34 to 0.58). Complete data for the EWGOSP criteria were only available for 124 (53%) patients of whom 40 (32%) had sarcopenia. Conclusion It was feasible to measure grip strength and complete the FRAIL scale among older inpatients in hospital. Measuring gait speed and muscle mass to identify sarcopenia was challenging in the acute setting. Trial registration ISRCTN registry (ID ISRCTN16391145) on 30.12.14.
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Fiona F A Howson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J Culliford
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Avan A Sayer
- Academic Geriatric Medicine, University of Southampton, Southampton, UK.,AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, University of Southampton, Southampton, UK. .,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK. .,University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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16
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Abstract
PURPOSE/OBJECTIVES The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. PRIMARY PRACTICE SETTING(S) This article focuses on case management of older adults transitioning from hospital to home. FINDINGS/CONCLUSIONS There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.
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17
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Køhler M, Olesen SS, Rasmussen HH. Body composition predicts clinical outcome in patients with intestinal failure on long-term home parenteral nutrition. Clin Nutr ESPEN 2018; 28:193-200. [PMID: 30390880 DOI: 10.1016/j.clnesp.2018.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/06/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Patients with chronic intestinal failure (CIF) are at risk of altered body composition and impaired muscle function, which may negatively affect clinical outcome. The aim of this study was to investigate the predictive value of body composition and muscle strength in relation to clinical outcome in CIF patients on long-term home parenteral nutrition (HPN). METHODS This was an observational cohort study comprising 77 clinically stable patients with CIF on HPN (>12 months). At inclusion, we recorded demographic data and information regarding anthropometry, body composition assessed by bioelectrical impedance and muscle strength by hand grip strength. Number of yearly hospital readmissions and length of hospital stay (LOS) as well as all-cause mortality characterized clinical outcome. Assessment parameters were categorized according to normative reference values. RESULTS The average number of readmissions was 2.0 ± 1.8 per year and the average LOS was 23.2 ± 23.6 days. In univariate analysis phase angle (PA, p = 0.009) and handgrip strength (HGS, p = 0.012) were associated with the number of readmissions. Multivariate analysis confirmed the independence and significance of the association for PA (coefficient -0.5 [95% CI; -0.9 to -0.2]; p = 0.007). In addition, PA was associated with LOS in univariate analysis (p = 0.019), while none of the remaining parameters were significantly associated with LOS. During the follow-up period (median 24.3 months), 16 (20.8%) patients died and the cumulative mortality rate was 14.3% after two years. Fat free mass index (FFMI) below normal (Hazard Ratio 3.9 [95% CI; 1.1-14.1]; p = 0.04) and PA below normal (Hazard Ratio 5.3 [95% CI; 1.6-17.5]; P = 0.007) were identified as independent risk factors for mortality. CONCLUSIONS Phase angle significantly predicted number of readmissions, length of hospital stay and mortality in patients with intestinal failure on long-term parenteral nutrition, while fat free mass index only predicted mortality.
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Affiliation(s)
- Marianne Køhler
- Center for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Søren Schou Olesen
- Center for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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18
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Byrnes A, Mudge A, Young A, Banks M, Bauer J. Use of hand grip strength in nutrition risk screening of older patients admitted to general surgical wards. Nutr Diet 2018; 75:520-526. [PMID: 29663632 DOI: 10.1111/1747-0080.12422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/25/2018] [Accepted: 02/25/2018] [Indexed: 02/06/2023]
Abstract
AIM Hand grip strength (HGS) has been proposed as an indicator of nutritional status that is objective, requires minimal assessor training and is quick to administer, making it attractive for use in the acute setting. This study aimed to determine the discriminatory ability of impaired HGS to screen for malnutrition in an older hospital population and assess the added value of combining this with existing screening tools. METHODS Measures were undertaken during acute admission in patients ≥65 years admitted to general surgical wards. Impaired HGS was defined as a mean value below the lower limit of the 95% CI of population norms and observed HGS standardised as a percentage of this value. Nutritional risk was assessed using the Malnutrition Screening Tool (MST) and malnutrition defined as Patient-Generated Subjective Global Assessment (PG-SGA) rating B or C. Discriminatory ability of impaired HGS to identify malnourished patients was tested using the area under the receiver operating characteristic curve (AUC). RESULTS Seventy-five patients (mean age: 74.0 (SD 6.7) years, 60% male) were recruited. Impaired HGS did not accurately identify malnutrition (AUC (95% CI): 0.41 (0.25-0.58), P < 0.001), nor did it improve discriminatory ability of the MST (AUC (95% CI), MST: 0.83 (0.71-0.95), P = 0.32; MST/HGS combined: 0.68 (0.51-0.86), P = 0.035). CONCLUSIONS HGS was not found to be suitable in screening older inpatients for malnutrition during admission to surgical wards. As such, screening for nutrition risk using an existing validated tool to identify patients for further in-depth nutritional assessment by an appropriately trained clinician remains the preferred method.
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Affiliation(s)
- Angela Byrnes
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alison Mudge
- Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne Young
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Merrilyn Banks
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Judy Bauer
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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19
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Mitchell CJ, D'Souza RF, Schierding W, Zeng N, Ramzan F, O'Sullivan JM, Poppitt SD, Cameron-Smith D. Identification of human skeletal muscle miRNA related to strength by high-throughput sequencing. Physiol Genomics 2018; 50:416-424. [PMID: 29602299 DOI: 10.1152/physiolgenomics.00112.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The loss of muscle size, strength, and quality with aging is a major determinant of morbidity and mortality in the elderly. The regulatory pathways that impact the muscle phenotype include the translational regulation maintained by microRNAs (miRNA). Yet the miRNAs that are expressed in human skeletal muscle and relationship to muscle size, strength, and quality are unknown. Using next-generation sequencing, we selected the 50 most abundantly expressed miRNAs and then analyzed them in vastus lateralis muscle, obtained by biopsy from middle-aged males ( n = 48; 50.0 ± 4.3 yr). Isokinetic strength testing and midthigh computed tomography was undertaken for muscle phenotype analysis. Muscle attenuation was measured by computerized tomography and is inversely proportional to myofiber lipid content. miR-486-5p accounted for 21% of total miR sequence reads, with miR-10b-5p, miR-133a-3p, and miR-22-3p accounting for a further 15, 12, and 10%, respectively. Isokinetic knee extension strength and muscle cross-sectional area were positively correlated with miR-100-5p, miR-99b-5p, and miR-191-5p expression. Muscle attenuation was negatively correlated to let-7f-5p, miR-30d-5p, and miR-125b-5p expression. In silico analysis implicates miRNAs related to strength and muscle size in the regulation of mammalian target of rapamycin, while miRNAs related to muscle attenuation may have potential roles regulating the transforming growth factor-β/SMAD3 pathway.
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Affiliation(s)
| | | | | | - Nina Zeng
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Farha Ramzan
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | | | - Sally D Poppitt
- School of Biological Sciences, University of Auckland , Auckland , New Zealand.,Riddet Institute , Palmerston North , New Zealand
| | - David Cameron-Smith
- Liggins Institute, University of Auckland , Auckland , New Zealand.,Food & Bio-based Products Group, AgResearch, Palmerston North , New Zealand.,Riddet Institute , Palmerston North , New Zealand
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20
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Measurement of function in older adults transitioning from hospital to home: an integrative review. Geriatr Nurs 2017; 39:336-343. [PMID: 29249631 DOI: 10.1016/j.gerinurse.2017.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Abstract
Older adults often experience decline in functional status during the transition from hospital to home. In order to determine the effectiveness of interventions to prevent functional decline, researchers must have instruments that are reliable and valid for use with older adults. The purpose of this integrative review is to: (1) summarize the research uses and methods of administering functional status instruments when investigating older adults transitioning from hospital to home, (2) examine the development and existing psychometric testing of the instruments, and (3) discuss gaps and implications for future research. The authors conducted an integrative review of forty research studies that assessed functional status in older adults transitioning from hospital to home. This review reveals important gaps in the functional status instruments' psychometric testing, including limited testing to support their validity and reliability when administered by self-report and limited evidence supporting their ability to detect change over time.
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