Nutritional Strategies Facing an Older Demographic: The Nutrition UP 65 Study Protocol

Arm muscle area is correlated to handgrip strength in postmenopausal women

OBJECTIVE

To analyze the correlation between arm muscle area and handgrip strength among postmenopausal community dwelling low-income women in order to provide an easy anthropometric indicator to assess muscle mass quantity and quality.

METHODS

This was a cross-sectional study involving postmenopausal women (n = 171) from three urban-marginal communities of Guayaquil, Ecuador. Corrected arm muscle area was calculated using the Frisancho formula. Dynapenia was defined as HGS < 16 kg. Spearman's correlation coefficient was calculated at a 5% significance level to test the correlation between corrected arm muscle area and handgrip strength.

RESULTS

Median (interquartile range: IQR) age of the sample was 72.0 years (17.0). The median of corrected arm muscle area was 34.8 cm2 (20.7). The overall prevalence of dynapenia was 57.9% (n = 99). There was a significant decreasing trend with age regarding all anthropometric characteristics and handgrip strength, as well as a higher prevalence of dynapenia with age. For the whole sample, a statistically significant positive correlation was found between corrected arm muscle area and handgrip strength [r = 0.267; p < .001].

There was a significant yet weak positive correlation between corrected arm muscle area and handgrip strength in this postmenopausal sample. There is a need for additional research in this regard.

Associations Between Gait Speed and Fat Mass in Older Adults

Purpose

Although both gait speed and fat mass are crucial for healthy aging, evidence suggests that the associations between these components remain unclear. Therefore, the main purpose of the study was to examine the associations between gait speed and fat mass.

Patients and Methods

In this cross-sectional study, we recruited 643 older men and women aged >60 years. Fat mass was assessed using bioelectrical impedance analysis, while gait speed was determined by calculating the time an individual has taken to walk across a 4.6-m distance. Receiver operating characteristic (ROC) curves and odds ratios (OR) were performed to determine cut-off points and mutual associations.

Results

In older men, the optimal threshold of gait speed to detect high level of fat mass was 1.40 m/s with the area under the curve (AUC) being 0.82 (95% CI 0.76-0.89, p < 0.001). In older women, the optimal cut-off point was 1.37 m/s (AUC = 0.85, 95% CI 0.81-0.90, p < 0.001). Older men and women who walked below the newly developed threshold were approximately 12 times more likely to have high level of fat.

Conclusion

In summary, newly developed cut-off points of gait speed have adequate discriminatory ability to detect older men and women with high level of fat mass. Although gait speed may be considered as a satisfactory screening tool for fat mass, its utility in clinical practice needs to be further investigated.

Laboratory Assessment of the Effects of AGA@4life Multidisciplinary Intervention on the Inflammatory Profile, MMPs, and TIMPs in a Geriatric Population

In recent years, the world's aging population has increased, contributing to the development of age-related pathologies, which have been aggravated by physical inactivity and excessive fat intake. This study aimed to evaluate the effect of implementing a nutritional program (control group-CG) combined with exercise (intervention group-IG) on the inflammatory profile, MMPs, and TIMPs in a group of 34 elderly participants (IG, n = 18; CG, n = 16). Participants underwent a full multidisciplinary diagnostic evaluation (T0), with the gathering of clinical information and biochemical and hematological determinations being re-evaluated eight weeks later (T1). A diet manual was made, which provided a selection of different types of diets resulting from the nutritional needs of the different users at the center. The aerobic exercise consisted of two sessions per week with a total duration of 1 h. The laboratory evaluation was performed by slot blot. Statistical analysis included a paired sample t-test and Spearman's correlation coefficient. We observed that in the IG, there was a significant increase at T1 of TNF-α (p < 0.05) and MMP-2 (p < 0.05), without changes in IL-6 and MMP-9, showing that the intervention did not cause an exacerbated inflammatory response in exercised elderly people. The intervention program implemented showed potential to contribute to better active aging strategies, taking advantage of the known benefits of exercise without inducing a harmful inflammatory response in elderly participants.

Criterion-Referenced Standards of Handgrip Strength for Identifying the Presence of Hypertension in Croatian Older Adults

BACKGROUND

It is well known that muscular fitness has been associated with hypertension. However, it is less known which cut-off values of muscular fitness may predict the presence of hypertension. The main purpose of this study was to establish criterion-referenced standards of muscular fitness to define the presence of hypertension in Croatian older adults.

METHODS

In this cross-sectional study, we recruited men and women over 60 years of age. Muscular fitness was assessed by handgrip strength and normalized by height squared. Hypertension was defined as having systolic blood pressure ≥130 mm/Hg or diastolic blood pressure ≥80 mm/Hg.

RESULTS

In older men, the optimal cut-point of muscular fitness in defining hypertension was 15.4 kg/m2. The area under the curve (AUC) was 0.85 (96% CI 0.77 to 0.92, p < 0.001). In older women, the optimal cut-point was 11.8 kg/m2, with an AUC of 0.84 (95% CI 0.80 to 0.89, p < 0.001). Men and women with cut-points of < 15.4 kg/m2 and < 11.8 kg/m2 were 11.8 (OR = 11.8, 95% CI 4.3 to 32.4, p < 0.001) and 10.6 (OR = 10.6, 95% CI 5.7 to 19.7, p < 0.001) times more likely to be diagnosed with hypertension.

CONCLUSIONS

Our newly developed cut-points of muscular fitness assessed by the handgrip strength and normalized by height squared have satisfactory predictive validity properties in detecting men and women aged 60-81 years with hypertension.

Educational Needs for Coaching Judo in Older Adults: The EdJCO Focus Groups

Judo coaches are urged to develop specific competencies and skills for addressing the special needs of older practitioners. Thus, the purpose of this study was to investigate the experts' opinions on judo training in late adulthood to develop sound educational programs for coaches of older judo practitioners. Overall, eighty-eight experts from an international consortium of judo and educational partners participated in national focus groups. During the focus groups, experts discussed five themes and generated statements pertinent to educate coaches to support older judo practitioners (e.g., benefits; necessary knowledge; risks; training groups definition; tools; and tests for monitoring training plans). The initial list of 262 statements was synthesized, validated, analyzed, and organized into a final list of 55 statements and six macro-areas: aging process (n = 10); safety and first aid (n = 6); physiology and fitness (n = 12); psychology and mental health (n = 11); organization and environment (n = 5); adapted judo teaching and training (n = 11). The present international eminence-based study, harmonizing diverse intercultural perspectives, highlighted the specific needs of older judo practitioners. The results of this study will contribute to the structure of a sound educational program for coaches of older judo practitioners to enhance the quality of older adults' sports experiences by linking safety, enjoyment, social interactions, and learning principles.

Allometric normalization of handgrip strength in older adults: Which body size parameter is the most appropriate?

BACKGROUND

Although absolute handgrip strength has been associated with health-related outcomes in older adults, little evidence has been provided regarding its adjustment by a variety of body size dimensions. Therefore, the main purpose of the study was to establish the most appropriate normalization of handgrip strength by different body size parameters in a large sample of noninstitutionalized older adults.

METHODS

In this cross-sectional study, we enrolled 643 men and women aged > 60, who were part of the rehabilitation center facility program. Handgrip strength was objectively measured using a Jamar Plus* + Digital Hand Dynamometer. Body size parameters included body weight and height, body mass index, waist circumference, waist-to-height ratio, fat mass and fat-free mass. The most appropriate parameter associated with handgrip strength was identified using allometry.

RESULTS

Findings showed that the most appropriate body size parameter for handgrip strength normalization was height (allometric exponent: 0.85), compared to fat-free mass (0.26) and body mass (0.12). Other body size variables were not significantly associated with handgrip strength and were omitted from further analyses. The correlations between normalized handgrip strength were significant when handgrip strength was normalized by body mass and fat-free mass, while no significant correlations were found, when handgrip strength was normalized by body height.

CONCLUSION

Based on the study results, body height seems to be the best body size parameter for handgrip strength normalization in older adults, omitting the influence of body size on strength performance. If handgrip strength is measured, body height may help normalize strength for large-scale research.

Polymedication and its association with individual factors in Portuguese older adults–a cross-sectional study

Population aging is a reality resulting in polymedication and its harmful consequences. Therefore, determining polymedication state in Portugal and identifying its associated characteristics is vital.

Prevalence of probable sarcopenia in community-dwelling older Greek people

Objectives:

The objective of this study was to assess the prevalence rate of probable sarcopenia and to determine the factors associated with it in older people living in Western Greece.

Methods:

Probable sarcopenia was estimated based on cut-off values for handgrip strength (HGS) as recommended by EWGSOP2. Information about socio-demographic, chronic diseases, fear of falls and lifestyle of the participants were also collected. HGS was assessed using a SAEHAN dynamometer. Calf circumference was assessed with inelastic tape. A logistic regression analysis was performed in order to determine associated risk factors.

Results:

The sample comprised 402 participants (292 women;110 men), with a mean age of 71.51±7.63 years. Overall, 25.4% of the elderly participants were diagnosed with probable sarcopenia (men:36.4%; women:21.2%). The findings of this study demonstrated that probable sarcopenia was positively associated with age (OR=0.14, 95% CI=0.008 to 0.200), gender (OR=-0.6, 95% CI=-0.700 to -0.530), Body mass Index (OR=0.01, 95% CI=-0.030 to -0.005), Skeletal muscle mass index (OR=0.05, 95% CI=0.030 to 0.080), calf circumference (OR=0.02, 95% CI=0.007 to 0.040), and comorbidities (OR=0.04, 95% CI=0.030 to 0.080).

Conclusion:

There was a 25.4% prevalence of probable sarcopenia in Greek elderly. The results highlight the importance of the detection of HGS and probable sarcopenia in older people in order to develop effective strategies of prevention and intervention of sarcopenia.

Urinary Sodium Excretion and Adherence to the Mediterranean Diet in Older Adults

Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03–3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.

Prediction equations for estimating body weight in older adults

BACKGROUND

Assessing body weight in older adults may be challenging. Hence, the present study aimed to develop and cross-validate updated and reproducible equations to estimate body weight in a large sample of older adults, namely among the older-old.

METHODS

In total, 1456 individuals aged ≥ 65 years, from the Nutrition UP 65 study, were included in the present analysis. The participants were randomly assigned to one of two sub-samples: development (n = 991) and validation samples (n = 465). Prediction equations using height, mid-upper arm circumference (MUAC), waist circumference (WC), calf circumference (CC) and triceps skinfold thickness (TST) were generated for the development sample using multiple regression analysis and then validated using the validation sample.

RESULTS

The model with five predictor variables generated the following equations: females 65-79 years: -114.682 + 0.522 × height (cm) + 0.620 × MUAC (cm) + 0.517 × WC (cm) + 0.893 × CC (cm) + 0.111 × TST (mm) (adjusted r²  = 0.883, standard error of the estimate (SEE) = 4.4); females ≥ 80 years: -110.806 + 0.494 × height (cm) + 0.637 × MUAC (cm) + 0.500 × WC (cm) + 0.986 × CC (cm) + 0.021 × TST (mm) (adjusted r²  = 0.890, SEE = 3.9); males 65-79 years: -114.875 + 0.558 × height (cm) + 0.073 × MUAC (cm) + 0.671 × WC (cm) + 0.717 × CC (cm) + 0.182 × TST(mm) (adjusted r²  = 0.820, SEE=5.0); and males ≥ 80 years: -128.789 + 0.546 × height (cm) + 0.202 × MUAC (cm) + 0.612 × WC (cm) + 1.236 × CC (cm) + 0.093 × TST (mm) (adjusted r²  = 0.906, SEE = 3.5).

CONCLUSIONS

Body weight can be estimated with good accuracy in older adults using these sex- and age-specific equations generated from regression models using three to five anthropometric predictor variables.

Are older adults with excessive sodium intake at increased risk of hypohydration?

BACKGROUND

Sodium intake is expected to affect water needs, although compensation mechanisms may not work efficiently particularly in older adults. The aim of this cross-sectional study was to quantify the association between sodium excretion and hydration status in a representative sample of Portuguese older adults.

METHODS

A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to sex, education level and region. From a sample size of 1500 participants, 1318 were eligible for the present analysis. A 24-h urine sample was collected, and volume, osmolality, creatinine and sodium were quantified. Free water reserve (FWR) was used to assess hydration status. Excessive sodium intake was defined as above 2000 mg day^-1 as recommended by the World Health Organization. A multivariable binary logistic regression model was used to estimate the association between FWR and sodium excretion. Odds ratios (OR) and respective 95% confidence intervals (95% CI) were calculated.

RESULTS

Excessive sodium excretion was observed in 80.0% of women and 91.5% of men, whereas hypohydration affected 10.9% of women and 23.6% of men. After adjusting for confounders, excessive sodium excretion was associated with an increased risk of hypohydration among men (OR = 2.75; 95% CI = 1.06-7.15).

CONCLUSIONS

These results stress the positive association between excessive sodium intake and hypohydration in men and highlight the need for implementing strategies regarding the reduction of salt consumption and the promotion of water intake.

Frailty status is related to general and abdominal obesity in older adults

The association between frailty and obesity may differ according to the heterogeneity of body mass index (BMI) and waist circumference (WC) phenotypes in older adults. We hypothesized that the use of simple indicators of general and abdominal obesity combined, may more accurately represent obesity and allow to further elucidate on how frailty status and its criteria are related to obesity. A sample of 1444 older adults, aged ≥65 years (Nutrition UP 65 study) was included in a cross-sectional analysis. General and abdominal obesity were defined according to World Health Organization BMI and WC cut-offs, and frailty by Fried et al. phenotype. A cluster analysis defined groups according to BMI and WC levels. Overweight (BMI between 25.0 and 29.9 kg/m²; 44.6%), general obesity (BMI ≥30.0 kg/m²; 39.0%), and abdominal obesity (WC >102 cm for men and >88 cm for women) were highly frequent (66.5%). Prefrailty (odds ratio [OR]: 2.33; 95% confidence interval [CI]: 1.52-3.57) and frailty (OR: 2.87; 95% CI: 1.58-5.22) were directly associated with the "general and abdominal obesity" cluster. Regarding frailty criteria, low handgrip strength (OR: 2.29; 95% CI: 1.55-3.38) and weight loss (OR: 0.27; 95% CI: 0.14-0.52) were also associated with this cluster. In this sample of older adults presenting a high frequency of overweight and obesity, prefrailty and frailty are linked to higher levels of adiposity, but only when both general and abdominal obesity are present. Present results emphasize the importance of the evaluation of both BMI and WC in the geriatric clinical practice and suggest that older adults presenting both general and abdominal obesity should be routinely screened for frailty.

Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study

OBJECTIVES

To investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population.

DESIGN

Cross-sectional.

SETTING

Portugal.

PARTICIPANTS

1454 older adults with 65 years or older, from Nutrition UP 65 study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sarcopenia was identified using the European Working Group on Sarcopenia in Older People 2 guidelines and physical frailty using Fried phenotype. Mini-Nutritional Assessment-Short Form was used to ascertain undernutrition, and obesity was evaluated by body mass index.

RESULTS

57.3% presented at least one condition, 38.0% were identified with one and 19.3% were identified with two or more conditions. When all preconditions were considered, 95.7% of the older adults presented at least one of these preconditions or conditions. Multinomial logistic regression multivariate analysis revealed that being male (OR 0.61; 95% CI 0.43 to 0.88), being married or in a common-law marriage (OR 0.58; 95% CI 0.40 to 0.84) and having a higher educational level (OR 0.23; 95% CI 0.07 to 0.73) were inversely associated with having two or more conditions, while age >75 years (OR 1.60; 95% CI 1.14 to 2.24), a poor self-perception of health status (OR 5.61; 95% CI 3.50 to 9.01), ≥5 medications (OR 3.11; 95% CI 1.77 to 5.46) and cognitive impairment (OR 1.84; 95% CI 1.37 to 2.48) were directly associated.

CONCLUSIONS

Almost three out of five older adults presented at least one of the conditions related to nutritional status, and about one in five had two or more of these occurrences. However, the low coexistence observed between all of these reinforces the need to assess them all individually during the geriatric assessment.

Adherence to a Mediterranean Dietary Pattern and Functional Parameters: A Cross-Sectional Study in an Older Population

OBJECTIVES

In older adults, diet and physical activity are among the most important behaviours that influence health. The Mediterranean Dietary Pattern has been related to longevity and can benefit physical function in older adults. The present study aims to quantify the association of adherence to a Mediterranean Dietary Pattern with physical functioning through by handgrip strength, as well as, with sedentary behaviour based on sitting time, in a sample of older adults.

METHODS

A cross-sectional study was conducted in 1,491 older adults ≥ 65 years old. The adherence or non-adherence to a Mediterranean Dietary Pattern was assessed using the previously validated and translated 14 item questionnaire, the PREDIMED (Prevención com Dieta Mediterránea). Handgrip strength was measured with a Jamar Dynamometer. Sitting time per day was used as an indicator of sedentary behaviour. Multinomial logistic regressions were performed to quantify the association of adherence to a Mediterranean Dietary Pattern with handgrip strength and sitting time.

RESULTS

Compared to participants who adhered to a Mediterranean Dietary Pattern, those who did not adhere to this diet have a significantly higher adjusted odds ratio for low handgrip strength [adjusted odds ratio: 1.50; 95% confidence interval: 1.09-2.05], as well as for longer sitting time [adjusted odds ratio: 1.43; 95% confidence interval: 1.04-1.96].

CONCLUSION

In older adults, the non-adherence to a Mediterranean Dietary Pattern was associated with both lower values of handgrip strength and longer sitting time.

Are hypohydrated older adults at increased risk of exhaustion?

BACKGROUND

Dehydration appears to affect muscle strength and weakness, although its influence on exhaustion remains unclear. The present study aimed to quantify the association between hydration status and exhaustion among older adults.

METHODS

A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to age, sex, education level and region within the Nutrition UP65 cross-sectional study. A 24-h urine sample was collected to estimate free water reserve (FWR), which was categorised into tertiles according to sex. Subjects with incomplete 24-h urine and renal disease were excluded. From a sample size of 1500 subjects, 1143 were eligible. Exhaustion was self-reported according to the Center for Epidemiologic Studies Depression Scale. A logistic regression model was conducted to evaluate the association between FWR and exhaustion. Odds ratios and the respective 95% confidence intervals were calculated by sex and age.

RESULTS

Free water reserve median (interquartile range) was 0.52 (0.68) L in women and 0.36 (0.77) L in men. Hypohydration affected 11.6% of women and 25.1% of men, whereas exhaustion was reported by 39.3% of women and 25.1% of men. After adjusting for confounders, women ≥80 years classified in the highest tertile of FWR showed a decreased risk of exhaustion (third tertile: odds ratio = 0.38; 95% confidence interval = 0.15-0.96) compared to women in the lowest FWR tertile. No such significant association was observed in women with <80 years and in men.

CONCLUSIONS

These results show an association between worse hydration status and exhaustion in older women, highlighting the need to implement further studies clarifying this association.

Sitting time and associated factors among Portuguese older adults: results from Nutrition UP 65

Older adults are particularly susceptible to sedentary behaviours. Sitting time has been increasingly referred to as a potentially modifiable risk factor in the prevention of chronic diseases. Identifying factors associated with sitting time, particularly those that are modifiable, will allow for more effective public health strategies. This study aimed to describe sitting time among Portuguese older adults and to evaluate associated factors. A cross-sectional study including 1423 older adults ≥ 65 years old was conducted. Sitting time was assessed with the International Physical Activity Questionnaire. Socio-demographic, health, anthropometric and functional variables were collected. Bivariate and multivariate linear regression models were conducted to study the association between these variables and sitting time. The median of sitting time was 300 min/day (interquartile range = 240 min/day), which is equal to 5 h/day. The following factors were directly associated with longer sitting time: being male, age ≥ 80 years, living in Central or Southern Portugal, being retired from work, as well as presenting low physical activity, obesity or longer time to walk 4.6 metres. On the other hand, being married, having higher education and higher household income were inversely associated with longer sitting time. It can be concluded that Portuguese older adults spend a considerable amount of time sitting per day. Potentially modifiable risk factors associated with longer sitting time in this population were related to nutritional status and functional ability.

Comparison of Nutritional Status Between Nursing Home Residents and Community Dwelling Older Adults: a Cross-Sectional Study from Bosnia and Herzegovina

Aim:

The aim of the study was to determine the differences in nutritional status and risk for malnutrition between nursing home and community-dwelling residents.

Methods:

Cross-sectional study included 146 nursing home residents and 300 community-dwelling elderly adults from four municipalities in Bosnia and Herzegovina. Anthropometric measurements, biochemical analyses, nutritive, functional and cognitive assessments were carried out. Nutritional status and risk for malnutrition were assessed by Mini Nutritional Assessment (MNA), Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (Screen II) and the food intake analysis for the past 24 hours. Functional status was assessed by the Lawton scale, the Katz Independence Index, Timed Up and Go test, the Functional Reach Test. Mini Cog test and Six-item cognitive impairment test were used for the evaluation of cognitive functioning.

Results:

The incidence of high nutritive risk by SCREEN II (100%) and being “at risk for malnutrition” by MNA (81.60%) was higher among nursing home residents compared to community-dwellers. Community-dwelling elderly people had higher BMI (27.94 ± 4.73), weight (78.40 ± 13.99), height (167.69 ± 9.74), waist circumference (97.77 ± 12.88), hip circumference (104.61 ± 11.47), mid-arm arm (27.54 ± 3.58), hip (27.54 ± 3.58) and calf circumference (34.02 ± 5.16 ). Statistical differences in regards to place of living were found in functional status (p<0.001), cognitive functioning (p<0.001) and hand grip strength (p<0.001).

Conclusion:

The frequency of malnutrition and high nutritional risk was higher in respondents who were living in the nursing homes compared to community-dwellers. The results of this study showed that health professionals involved in the care for institutionalized elderly people should implement routine screening of malnutrition within the comprehensive geriatric assessment in their daily practice.

Reference values for handgrip strength and their association with intrinsic capacity domains among older adults

OBJECTIVE

The purposes of this study were three-fold: (i) to describe handgrip strength in older individuals aged ≥60 years in Colombia; (ii) to identify sex-specific and age-specific muscle weakness cut-off points in older adults; and (iii) to determine the odds of adverse events for each of the intrinsic capacity domains for individuals with handgrip strength greater than the muscle weakness cut-off points, as compared with their weaker counterparts.

METHODS

A cross-sectional study was conducted in Colombia, among 5237 older adults aged ≥60 years old (58.5% women, 70.5 ± 7.8 years), according to 'SABE Survey 2015'. Handgrip strength data were obtained with a Takei dynamometer. Sociodemographic variables, five domains of intrinsic capacity (i.e. locomotion, vitality, cognition, psychological, and sensory), and medical conditions were assessed and analyzed. Adjustments variables were age, ethnicity, socio-economic status, urbanicity, body mass index, smoking status, alcohol intake, drug use, physical activity, and co-morbid chronic diseases. Sex-stratified analyses were conducted with logistic regression models.

RESULTS

Handgrip strength was greater among men than among women (26.7 ± 8.5 vs. 16.7 ± 5.7 kg, respectively, P < 0.001) at all ages. Weak handgrip strength cut-off points ranged from 17.4 to 8.6 and from 10.1 to 4.9 in men and women, respectively. Overall, participants with optimal handgrip strength had better intrinsic capacity [in men, odds ratio (OR) = 0.62, 95% confidence interval (CI) 0.53 to 0.71; P < 0.001; and in women, OR = 0.79, 95% CI 0.68 to 0.92; P = 0.002] than their weaker counterparts. Also, men with optimal handgrip strength had a lower risk of hospitalization (OR = 0.47, 95% CI 0.29 to 0.78; P = 0.004) than their weaker counterparts.

CONCLUSIONS

This study is the first to describe handgrip strength values and cut-off points for muscle weakness among a nationally representative sample of Colombian older adults by age and sex. After categorizing older adults as weak or not weak based on the handgrip cut-off points, non-weakness was associated with a decreased odds of intrinsic capacity impairments. These cut-off points may be good candidates for clinical assessment of risks to physical and mental health in older Colombian adults.

Adherence to a Mediterranean Dietary Pattern status and associated factors among Portuguese older adults: Results from the Nutrition UP 65 cross-sectional study

OBJECTIVES

The aim of this study was to evaluate adherence to the Mediterranean dietary pattern (MDP) and its associated factors in older Portuguese adults.

METHODS

A cross-sectional observational study was designed. In the context of the Nutrition UP 65 study, a national cluster sample of 1407 Portuguese individuals ≥65 y of age was analyzed. Adherence to the MDP was evaluated with the Portuguese version of the Prevention with Mediterranean Diet tool. The association between an individual's characteristics and adherence to the MDP was analyzed through hierarchical logistic regression analysis.

RESULTS

In this study, 43% of participants adhered to the MDP (n = 609). Higher educational level (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.54-3.69), living in the center (OR, 1.35; 95% CI, 1.01-1.79), being married or living in a common-law marriage (OR, 1.54; 95% CI, 1.20-1.97), and body mass index (OR_preobese, 1.52; 95% CI, 1.02-2.25) were related with increased odds of adherence to the MDP. Otherwise, lower adherence to the MDP was found for participants who were ≥80 y of age (OR, 0.70; 95% CI, 0.52-0.94), who lived in Madeira (OR, 0.35; 95% CI, 0.14-0.89) and Azores (OR, 0.28; 95% CI, 0.08-0.99), who rated their health as moderate (OR, 0.65; 95% CI, 0.50-0.84) or as bad or very bad (OR, 0.63; 95% CI, 0.45-0.90), and those who reported six or more comorbidities (OR, 0.62; 95% CI, 0.39-0.97).

CONCLUSIONS

Of the sample, 57% did not adhere to the Mediterranean diet. Potentially modifiable factors associated with lower adherence to the MDP were lower educational and health status.

The association between 25(OH)D levels, frailty status and obesity indices in older adults

BACKGROUND

Vitamin D deficiency is common in older adults and has been linked with frailty and obesity, but it remains to be studied whether frail obese older adults are at higher risk of vitamin D deficiency. Therefore, the aim of this study is to explore the association between frailty, obesity indices and serum 25(OH)D concentrations.

METHODS

1447 individuals with 65 years or older, participating in a cross-sectional study (Nutrition UP 65) were included. Frailty, according to Fried et al., body mass index (BMI), waist circumference (WC), body roundness index (BRI) and body shape index (ABSI) were evaluated. A stepwise multinomial logistic regression was carried out to quantify the association between 25(OH)D quartiles and independent variables.

RESULTS

Median 25(OH)D levels were lower in individuals presenting both frailty and obesity (p<0.001). In the multivariate analysis, pre-frailty (OR: 2.65; 95% CI: 1.63-4.33) and frailty (OR: 3.77; 95% CI: 2.08-6.83) were associated with increased odds of lower 25(OH)D serum levels (first quartile). Regarding obesity indices, the highest categories of BMI (OR: 1.74; 95% CI: 1.06-2.86), WC (OR: 3.46; 95% CI: 1.95-6.15), BRI (OR: 4.35; 95% CI: 2.60-7.29) and ABSI (OR: 3.17 95% CI: 1.86-5.38) were directly associated with lower 25(OH)D serum levels (first quartile).

CONCLUSIONS

A positive association between frailty or obesity and lower vitamin D levels was found. Moreover, besides BMI and WC, other indicators of body adiposity, such as BRI and ABSI, were associated with lower 25(OH)D serum concentrations.

Vitamin D status and functional parameters: A cross-sectional study in an older population

The present study aims to clarify the association of vitamin D status with functionality, measured through gait speed and hand grip strength, in a sample of older adults, considering sex-specific characteristics and the potential confounding effect of lifestyle factors, disease, skin phenotype, season of blood collection and vitamin D supplementation. The Nutrition UP 65 cross-sectional study was conducted in a population-based sample of 1,425 older adults ≥ 65 years old. Serum levels of 25-hydroxyvitamin D were quantified through electrochemiluminescence immunoassay. Multinomial logistic regressions were carried out using quartiles of gait speed and of hand grip strength as dependent variables. Participants at risk of vitamin D inadequacy (30.0-49.9 nmol/L) and deficiency (< 30.0 nmol/L) presented higher adjusted odds ratio of the lowest values of gait speed and hand grip strength than those with adequate vitamin D levels (≥ 50.0 nmol/L). These associations were strongest among men at risk of vitamin D deficiency [adjusted odds ratio for the lowest quartile of gait speed = 3.24; 95% CI: 1.56–6.73 and for the lowest quartile of hand grip strength = 3.28; 95% CI: 1.47-7.31] than in women at risk of vitamin D deficiency [adjusted odds ratio for the lowest quartile of gait speed = 2.72; 95% CI: 1.37-5.41 and for the lowest quartile of hand grip strength = 1.56; 95% CI: 0.81–3.00]. In conclusion, in older adults, particularly in men, the risk of vitamin D deficiency was directly associated with the lowest values of gait speed and of hand grip strength. However, randomized controlled trials are needed to overcome the possibility of reverse causation and residual confounding. Present results emphasise the need for strategies to promote the reduction of the high prevalence of low vitamin D status among the Portuguese older adult population.

Association of Anthropometric and Nutrition Status Indicators with Hand Grip Strength and Gait Speed in Older Adults

BACKGROUND

How nutrition status indicators relate to function in older adults is an issue that needs to be explored. This study aimed to quantify the associations of anthropometric parameters and nutrition status indicators with hand grip strength (HGS) and gait speed (GS) in older adults.

METHODS

A cross-sectional observational study was conducted in a population-based sample of 1500 older adults ≥65 years old. Logistic regression models were used to explore the associations between anthropometric, nutrition, and functional measures.

RESULTS

Lower values of height, mid-arm muscle circumference, and calf circumference, as well as higher values of waist circumference, were associated with both low GS and HGS. The adjusted odds ratio (OR) for low GS was around 2-fold higher in participants presenting risk for undernutrition or undernutrition. The adjusted OR (95% confidence interval) for low HGS was 1.54 (1.01-2.36) in women and 1.57 (0.91-2.72) in men at risk for undernutrition/undernutrition.

CONCLUSIONS

In older adults, lower values of height and calf circumference, as well as higher waist circumference, were associated with both low GS and HGS. Lower values of mid-arm muscle circumference were also associated with low values of both functional parameters only in men. The risk for undernutrition/undernutrition was more strongly associated with low GS than with low HGS in both women and men.

Sarcopenia and Undernutrition Among Portuguese Older Adults: Results From Nutrition UP 65 Study

BACKGROUND

Although undernutrition and sarcopenia are common among older adults and both result in worse health outcomes, data concerning the burden of these conditions in Portuguese community-dwelling older adults are scarce.

OBJECTIVE

The aim of this study was to firstly describe the occurrence of sarcopenia and undernutrition among a nationwide community-dwelling sample of older adults.

METHODS

Using a cross-sectional analysis, 1493 Portuguese older adults age ≥65 years from the Nutrition UP 65 study were evaluated. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People, and undernutrition status was evaluated by Mini-Nutritional Assessment-Short Form.

RESULTS

Sarcopenia frequency was 11.6%, and of these, 4.4% were classified with severe sarcopenia. Furthermore, 0.8% presented sarcopenic obesity. Undernutrition frequency was 1.3%, and 14.7% of the older adults were classified as being at undernutrition risk.

CONCLUSION

Sarcopenia is present in one-tenth of the sample. This frequency taken together with undernutrition data warrants further study and preventive measures.

Nutritional status and gait speed in a nationwide population-based sample of older adults

The association between nutritional status and gait speed remains unclear. This study described gait speed in older adults and quantified the association between overweight, obesity, undernutrition risk and gait speed. Gait speed as potential indicator of nutritional outcomes was also explored. A cross-sectional analysis was conducted in a population-based sample of 1,500 older adults ≥65 years old. Compared to “normal body mass index” women, odds ratio for a slow gait speed was approximately 2-fold higher in“overweight”, 4-fold higher in “obese” and 6-fold higher in women at “undernutrition risk”. “Undernutrition risk” category resulted from joining “undernutrition risk/undernutrition”. For men, these associations were in the same direction, but the odds ratio estimates halved. In women, identified gait speed cut-offs were 0.87 m/s for “obesity” and 0.79 m/s for “undernutrition risk”. In men, 0.94 m/s is the cut-off in which most older adults were correctly classified relative to “undernutrition risk”. About half of Portuguese older adults presented a gait speed ≤0.8 m/s. Overweight, obesity and undernutrition risk were directly and increasingly associated with slow gait speed, but approximately twice as high in women compared to men. Gait speed revealed potential utility in marking nutritional problems, but further investigation is recommended.

Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study

BACKGROUND

We aimed to describe urinary sodium and potassium excretion and their ratio in a representative sample of Portuguese elderly population, according to sociodemographic characteristics and weight status.

METHODS

A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according to age, sex, education level, and regional area within the Nutrition UP 65 study. This cross-sectional evaluation was conducted in 2015 and 2016. From a sample size of 1,500 participants, 1,318 were eligible for the present analysis, 57.3% were women, and 23.5% were aged ≥80 years. Sodium and potassium consumption was evaluated through one 24 h urinary excretion. Inadequate sodium intake was defined as ≥2,000 mg/day, inadequate potassium intake was considered as <3,510 mg/day, and inadequate sodium-to-potassium ratio was defined as >1, according to the World Health Organization cutoffs.

RESULTS

The proportion of the participants with an inadequate intake was 80.0% in women and 91.5% in men (sodium), 96.2% of women and 79.4% of men (potassium), and 98.4% of women and 99.1% of men (sodium-to-potassium ratio). Higher sodium adequacy was observed among the older elderly, unmarried, with lower household income, and underweight/normal weight. Higher potassium adequacy was observed in the younger elderly, married, and with higher income.

CONCLUSION

The majority of the Portuguese elderly population was classified as having inadequate sodium, potassium, and sodium-to-potassium ratio urinary excretion. Therefore, strategies for reducing sodium and increasing potassium intake are priorities in the Portuguese elderly population.

A Cross-Sectional Study on the Association between 24-h Urine Osmolality and Weight Status in Older Adults

Data on the association between hydration and body weight in the elderly are scarce. The objective of this work was to quantify the association between 24-h urine osmolality and weight status in the elderly. A cross-sectional study was conducted within the Nutrition UP 65 study. A quota sampling was implemented to achieve a nationally representative sample of Portuguese older adults (≥65 years) according to age, sex, education and region. From a sample size of 1500 participants, 1315 were eligible for the present analysis, 57.3% were women and 23.5% were aged ≥80 years. Participants were grouped using tertiles of 24-h urine osmolality by sex. World Health Organization cutoffs were used to classify participants according to weight status. Multinomial multivariable logistic regression models were conducted to evaluate the association of tertiles of osmolality with weight status, adjusting for confounders. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Being in the 3rd urine osmolality tertile (highest) was associated with a higher risk of being obese in men, OR = 1.97, 95% CI = 1.06, 3.66. No such association was found in women. These results highlight the need for implementing studies in order to clarify the association between hydration and weight status in the elderly.

Association between serum 25-hidroxyvitamin D concentrations and ultraviolet index in Portuguese older adults: a cross-sectional study

Background

The older population is a risk group for hypovitaminosis D. The Ultraviolet Index (UVI) can be an indicator of potential for cutaneous synthesis of vitamin D but physiological and other environmental factors also influence vitamin D synthesis and status. Knowledge about vitamin D status in Portuguese older adults is limited. This study aims to explore the association between Ultraviolet Index and serum 25-hidroxyvitamin D3 [25(OH)D] levels accounting for other potential influential factors.

Methods

A cross-sectional study was conducted between December 2015 and June 2016, in 1497 Portuguese older adults (≥ 65 years) within Nutrition UP 65 project. For each participant, serum 25(OH)D was determined and the mean UVI (mUVI) in the respective residence district was calculated for the previous 30 days. Stepwise linear regression analyses were conducted for the following periods of blood collection: between December and June, December and March and April and June. Standardized regression coefficients (Sβ) and 95% confidence intervals were calculated.

Results

The median 25(OH)D concentration was 35.9 nmol/L. The UVI was independently and positively associated with 25(OH)D in the models for December–June (Sβ = 0.244, 95% CI: 0.198; 0.291, P < 0.001) and April–June (Sβ = 0.295, 95% CI: 0.299; 0.362, P < 0.001) and independently and negatively associated in December–March period (Sβ = −0.149, 95% CI: -0.211; −0.087, P < 0.001).

Conclusions

In this sample with high vitamin D deficiency frequency, the UVI was a predictor of 25(OH)D levels but the direction of the association varied according to the blood collection period. Our results suggest that accounting for the time of year in future research regarding vitamin status and related public health recommendations may be relevant.

Electronic supplementary material

The online version of this article (10.1186/s12877-017-0644-8) contains supplementary material, which is available to authorized users.

Weakness: The most frequent criterion among pre-frail and frail older Portuguese

AIM

In Portugal, the burden of pre-frailty and frailty in community-dwelling older adults is still unknown. The purpose of this study is to estimate the frequency of frailty in a Portuguese sample with ≥ 65years and to evaluate its associated factors. We also intend to identify which criterion has more impact on the diagnosis of frailty.

METHODS

1457 older adults with ≥ 65years from the Nutrition UP 65 study were evaluated in a cross-sectional analysis. Frailty was identified according to Fried et al. by the presence of three or more of the following factors: unintentional weight loss, self-reported exhaustion, slowness, weakness and low physical activity. Pre-frailty was defined as the presence of one or two of these criteria. The association between individuals' characteristics and frailty status was analysed through logistic regression analysis.

RESULTS

The frequency of pre-frailty and frailty is 54.3% and 21.5%, respectively. In older adults classified as pre-frail or frail, 76.7% presented weakness and 48.6% exhaustion. In multivariate analyses, frailty was associated with age >75, lower education level, being single, divorced or widower, being professionally inactive, poor self-perception of health status, not drinking alcohol, being obese and undernourished or at undernutrition risk.

CONCLUSION

This condition is very prevalent in Portuguese older adults, one fifth are frail whereas half are pre-frail. Weakness identified by low handgrip strength is the most prevalent criterion in pre-frail and frail Portuguese older adults.

Handgrip strength values of Portuguese older adults: a population based study

Background

Handgrip strength is used to identify sarcopenia and frailty phenotypes, being a potential predictor of mortality in older adults. However, uniformity is lacking in the reference values. This study aimed to describe handgrip strength values of older population aged ≥65 years in Portugal, considering the possible influence of anthropometric parameters.

Methods

A cross-sectional study was conducted in Portugal, among 1500 older adults aged ≥65 years old, according to “The Nutrition UP 65 Study Protocol”. Demographic data were collected and cognitive performance, subjective general health, physical activity, anthropometric parameters and nutritional status were assessed and analysed. Handgrip strength data was obtained with a Jamar dynamometer. A Pubmed/Medline search was carried out to compare handgrip strength data between Portuguese older adults and other older populations.

Results

Handgrip strength was higher among men than among women (30.3 ± 9.2 Kgf vs 18 ± 5.4 Kgf, p < 0.001, respectively). In general, handgrip strength values of Portuguese older adults were lower than other older populations. In our sample, age, cognitive and nutritional status, self-reported sitting time and practice of physical activity were significantly correlated with handgrip strength in both sexes. Concerning anthropometric parameters, height was the most significantly correlated with handgrip strength (r = 0.34, p < 0.001, in women and r = 0.40, p < 0.001, in men).

Conclusion

This study described, for the first time, handgrip strength values of Portuguese population aged ≥65 years, according to age and to sex-specific tertiles of height. The definition of handgrip strength reference values in this age group merits further reflection.

Vitamin D status and associated factors among Portuguese older adults: results from the Nutrition UP 65 cross-sectional study

OBJECTIVES

To evaluate vitamin D status and its associated factors in Portuguese older adults from the Nutrition UP 65 study.

DESIGN

Cross-sectional observational study.

PARTICIPANTS AND METHODS

Nationwide cluster sample of 1500 Portuguese subjects ≥65 years old. Participants were classified, according to US Institute of Medicine cut-offs, as presenting normal 25-hydroxyvitamin D (25(OH)D) levels (≥50.0 nmol/L), at risk of inadequacy (30.0-49.9 nmol/L) or at risk of deficiency (<30 nmol/L). The association between individuals' characteristics and 25(OH)D levels was analysed through multinomial logistic regression analysis.

RESULTS

Median 25(OH)D serum value was 36.1 (interquartile range (IQR): 35.5) nmol/L. According to the used cut-offs, 39.6% of participants were at risk of 25(OH)D deficiency and 29.4% were at risk of 25(OH)D inadequacy. In the adjusted model, having higher skin pigmentation and waist circumference >88 cm for women and >102 cm for men were associated with higher odds of 25(OH)D deficiency. Otherwise, living in Lisbon Metropolitan Area and in Madeira, 1-12 years of schooling, being married or in a common-law marriage, monthly income ≥€1000, alcohol consumption, medication or supplements with vitamin D supplement use, and blood samples collected in spring or summer were associated with lower odds of being at risk of 25(OH)D deficiency. In this model, season of blood sample collection, medication or supplements use, and waist circumference were the factors more strongly associated with 25(OH)D levels.

CONCLUSIONS

Despite using the conservative Institute of Medicine cut-offs, over two-thirds of these study participants presented inadequate 25(OH)D levels, warranting the implementation of corrective measures. Potentially modifiable factors were strongly associated with 25(OH)D levels in this study. These findings may be particularly relevant to the development of public health policies in southern European countries.